Adherence to psychopharmacological treatment in patients with severe and persistent mental disorders: A systematic review.

INTRODUCTION: It is known that non-adherence to psychiatric medications has harmful consequences for both patients and society. OBJECTIVE: To collect information on the incidence of non-adherence, and the factors and causes affecting adherence to psychopharmacological treatment in patients with severe and persistent mental disorders. METHODS: A systematic review of scientific articles on adult patients (>17 years) published in the last five years (2015-2020) on specialised databases such as PubMed, Scopus, Scielo and BioMed. Original articles from indexed journals with an impact factor >0.5, in English or Spanish, with an analytical, prospective, retrospective, cross-sectional and randomised design were included. Once the articles were identified, they were analysed, extracting the information necessary to answer the research questions. RESULTS: Fifteen articles were included. Of these, 40% (n = 6) were published in 2020, 20% (n = 3) were produced in China and 53.3% (n = 8) had an observational design. A total of 5,837 patients were included, of which 50.6% were men (n = 2,955), with moderate adherence (n = 10; 66.7%) reported in 10 investigations. Non-adherence varies from 7.7% to 60.6%. The factors that affect adherence are specific to the patient (age and sex), their family support network, and related to the disease or the treatment. The main cause of non-adherence is lack of insight. CONCLUSIONS: Adherence to treatment with psychotropic drugs is multifactorial. Access to mental health services should be improved, with an emphasis placed on patient education and providing greater knowledge of mental illness. Interventions to promote education and interaction with the psychiatrist could be beneficial.

Adherencia al Tratamiento Psicofarmacológico de los Pacientes con Trastornos Mentales Graves y Persistentes: Revisión Sistemática / Adherence to Psychopharmacological Treatment in Patients with Severe and Persistent Mental Disorders: a Systematic Review

resumen Introducción: Se sabe que la falta de adherencia a los medicamentos psiquiátricos tiene consecuencias perjudiciales tanto para los pacientes como para la sociedad. Objetivo: Recopilar información sobre la incidencia de falta de adherencia, los factores y las causas que afectan a la adherencia al tratamiento psicofarmacológico de los pacientes con trastornos mentales graves y persistentes. Métodos: Revisión sistemática de artículos científicos en pacientes adultos (edad > 17 arios), publicados en los últimos 5 años (2015-2020) en bases de datos especializadas como Pub-Med, Scopus, Scielo y BioMed. Se incluyeron artículos de revistas indexadas con factor de impacto > 0,5 en inglés o español, originales, con diseño analítico, prospectivo, retrospectivo, transversal y aleatorizados. Una vez identificados los artículos, se procedió a su análisis, extrayendo la información necesaria para responder las preguntas de investigación. Resultados: Se incluyeron 15 artículos, el 40% (n = 6) publicados en 2020, el 20% (n = 3) realizados en China y el 53,3% (n = 8) de diseño observacional. Se incluyó una población total de 5.837 pacientes, varones el 50,6% (n = 2.955). Reportaron adherencia moderada 10 investigaciones (66,7%). La falta de adherencia varía desde el 7,7 al 60,6%. Los factores que afectan a la adherencia son propios del paciente (edad y sexo) o su red de apoyo familiar, relacionados con la enfermedad o el tratamiento. La principal causa de la falta de adherencia es la ausencia de insight. Conclusiones: La adherencia al tratamiento con psicofármacos es multifactorial. Se debería mejorar el acceso a los servicios de salud mental, poner énfasis en la formación del paciente y aportar mayor conocimiento de la enfermedad mental; la formación y la interacción con el psiquiatra podrían ser intervenciones beneficiosas.

abstract Introduction: It is known that non-adherence to psychiatric medications has harmful consequences for both patients and society. Objective: To collect information on the incidence of non-adherence, and the factors and causes affecting adherence to psychopharmacological treatment in patients with severe and persistent mental disorders. Methods: A systematic review of scientific articles on adult patients (>17 years) published in the last five years (2015-2020) on specialized databases such as PubMed, Scopus, Scielo and BioMed. Original articles from indexed journals with an impact factor>0.5, in English or Spanish, with an analytical, prospective, retrospective, cross-sectional and randomized design were included. Once the articles were identified, they were analyzed, extracting the information necessary to answer the research questions. Results: Fifteen articles were included. Of these, 40% (n = 6) were published in 2020, 20% (n = 3) were produced in China and 53.3% (n = 8) had an observational design. A total of 5,837 patients were included, of which 50.6% were men (n = 2,955), with moderate adherence (n = 10; 66.7%) reported in 10 investigations. Non-adherence varies from 7.7% to 60.6%. The factors that affect adherence are specific to the patient (age and sex), their family support network, and related to the disease or the treatment. The main cause of non-adherence is lack of insight. Conclusions: Adherence to treatment with psychotropic drugs is multifactorial. Access to mental health services should be improved, with an emphasis placed on patient education and providing greater knowledge of mental illness. Interventions to promote education and interaction with the psychiatrist could be beneficial.

Recomendaciones clínicas para la solicitud de evaluación de neurocirugía en el trastorno obsesivo compulsivo / Clinical recommendations for requesting neurosurgical evaluation in obsessive-compulsive disorder

Estas recomendaciones clínicas delinean los criterios utilizados por el Equipo de Cirugía de los Trastornos Psiquiátricos del Hospital de Clínicas para la selección de candidatos a neurocirugía en pacientes con trastorno obsesivo compulsivo grave y refractario al tratamiento convencional. Los criterios de inclusión se enfocan en la cronicidad, la gravedad y la resistencia, considerando procedimientos ablativos o de neuromodulación. La gravedad se evalúa mediante la Escala Yale-Brown Obsessive Compulsive, junto con una evaluación integral del desempeño y la discapacidad. La refractariedad se define como la falta de respuesta, según criterios consensuados, a diversos tratamientos farmacológicos y no farmacológicos respaldados por evidencia científica significativa para el trastorno obsesivo compulsivo. Es esencial realizar una evaluación dimensional del desempeño global y estimar el pronóstico sin intervención quirúrgica. Los criterios de exclusión abarcan comorbilidades graves, trastornos de personalidad específicos y discapacidad intelectual. Además, se especifican pruebas paraclínicas necesarias, incluyendo evaluaciones sanguíneas, serológicas, cardíacas y neurológicas. Se detallan las tablas utilizadas para el registro de información necesaria para la evaluación. Todas las evaluaciones de neurocirugía culminan en un ateneo clínico conjunto entre el Equipo de Cirugía de los Trastornos Psiquiátricos del Hospital de Clínicas y la Unidad Académica de Psiquiatría de la Facultad de Medicina en donde se determinan las estrategias terapéuticas posibles.

These clinical recommendations outline the criteria used by the Psychiatric Disorders Surgery Team for selecting neurosurgery candidates among patients with severe Obsessive Compulsive Disorder refractory to conventional treatment. Inclusion criteria focus on chronicity, severity, and resistance. Ablative procedures or neuromodulation are taken into consideration. Severity is assessed by means of Yale-Brown Obsessive Compulsive Scale, and a comprehensive evaluation of performance and disability. Refractoriness is defined as lack of response, according to consensus criteria, to various pharmacological and non-pharmacological treatments for Obsessive Compulsive Disorder supported by significant scientific evidence. It is essential to conduct a dimensional assessment of overall performance and estimate prognosis without surgical intervention. Exclusion criteria encompass serious comorbidities, specific personality disorders, and intellectual disability. Furthermore, necessary paraclinical tests are specified, including blood, serological, cardiac, and neurological evaluations. Tables used for recording essential information for assessment are detailed. All neurosurgical assessments culminate in a joint clinical discussion of possible therapeutic strategies between the Psychiatric Disorders Surgery Team and the Psychiatry Academic Department (Facultad de Medicina) at the Hospital de Clínicas.

Autolesión no suicida en población general: frecuencia y factores asociados en Paraguay

Introducción: La investigación sobre la autolesión no suicida permite aumentar la conciencia sobre este fenómeno, posibilita su detección temprana y la implementación de estrategias más eficaces en prevención y tratamiento. Esto conlleva a una reducción del sufrimiento individual, los costos económicos y el impacto en la sociedad en su totalidad. Objetivo: Determinar la frecuencia y factores asociados a autolesión no suicida en una muestra de población adulta de Paraguay. Metodología: Estudio descriptivo de asociación cruzada, de corte transversal y prospectivo. Una encuesta en línea fue difundida a través de redes sociales y aplicaciones de mensajería. Esta incluía preguntas sobre datos sociodemográficos y clínicos. La presencia de autolesiones se determinó a través de la versión en español de la escala Self-Harm Questionnaire. Se utilizó estadística descriptiva para todas las variables. Para buscar asociaciones se utilizó la prueba chi cuadrado. Resultados: Participaron 241 personas (media de edad=32±12 años, 74,7% mujeres). Se encontró una frecuencia de autolesiones de 24,5% (n=59). De estos, el 91,5% había tenido ideación suicida al menos una vez. Se encontró asociación entre el nivel de ingresos y la frecuencia de autolesiones (χ

Introduction: Research on non-suicidal self-injury raises awareness of this phenomenon, enabling the early detection and implementation of more effective strategies in prevention and treatment. This leads to a reduction in individual suffering, economic costs, and impact on society. Objective: To determine the frequency and associated factors of non-suicidal self-injury in a sample of the adult population of Paraguay. Methodology: This was a descriptive, cross-sectional, and prospective study. An online survey was disseminated through social networks and messaging applications. The survey included questions on sociodemographic and clinical data. The presence of self-injury was determined by using the Spanish version of the Self-Harm Questionnaire. Descriptive statistics were used for all the variables. The chi-square test was used to examine associations. Results: There were 241 participants (mean age=32±12 years, 74.7%female). A non-suicidal self-injury frequency of 24.5% (n=59) was observed. Of these, 91.5% reported suicidal ideation at least once. An association was found between income level and the frequency of non-suicidal self-injury (χ

Guia da gestão autônoma da medicação como ferramenta educativa do enfermeiro na atenção psicossocial / Guide to the autonomous medication management as an educational tool for nurses in psychosocial care / Guía para la gestión autónoma de medicamentos como herramienta educativa para enfermeros en atención psicossocial

Objetivo: analisar as repercussões da intervenção educativa do enfermeiro com o uso do Guia da Gestão Autônoma da Medicação para usuários de um Centro de Atenção Psicossocial. Métodos: estudo qualitativo, com referencial metodológico na Pesquisa Convergente Assistencial, realizado com 27 usuários de um Centro de Atenção Psicossocial que participaram de grupos de intervenção educativa. Empregou-se o princípio da triangulação dos dados, com quatro diferentes fontes de dados, observação participante, entrevista conversação, grupos e diário de campo. A análise dos dados envolveu processos de apreensão, síntese, teorização e transferência. Resultados: a intervenção educativa propiciou aos usuários mais empoderamento frente ao tratamento, organização de estratégias de enfrentamento dos problemas e cooperou para a cogestão do tratamento. Conclusão: o Guia da Gestão Autônoma da Medicação mostrou-se um instrumento importante no âmbito da educação em saúde para a prática assistencial do enfermeiro, e contribuiu para o compartilhamento de cuidado e de autonomia no processo de reabilitação psicossocial. (AU)

Objective: to analyze the repercussions of the educational intervention of nurses using the Guide to the Autonomous Management of Medication for users of a Psychosocial Care Center. Methods: qualitative study, with a methodological framework in the Convergent Care Research, carried out with 27 users of a Psychosocial Care Center who participated in educational intervention groups. The principle of data triangulation was used, with four different data sources, participant observation, conversational interview, groups and field diary. Data analysis involved processes of apprehension, synthesis, theorization and transfer. Results: the educational intervention provided users with more empowerment regarding the treatment, organization of coping strategies for the problems and cooperated for the co-management of the treatment. Conclusion: The Autonomous Medication Management Guide proved to be an important instrument in the context of health education for the nursing care practice, and contributed to the sharing of care and autonomy in the psychosocial rehabilitation process. (AU)

Objetivo: analizar las repercusiones de la intervención educativa de enfermeros utilizando la Guía para el Manejo Autónomo de Medicamentos para usuarios de un Centro de Atención Psicosocial. Métodos: estudio cualitativo, con marco metodológico en la Investigación de Atención Convergente, realizado con 27 usuarios de un Centro de Atención Psicosocial que participaron en grupos de intervención educativa. Se utilizó el principio de triangulación de datos, con cuatro fuentes de datos diferentes, observación participante, entrevista conversacional, grupos y diario de campo. El análisis de datos involucró procesos de aprehensión, síntesis, teorización y transferencia. Resultados: la intervención educativa proporcionó a los usuarios un mayor empoderamiento con respecto al tratamiento, organización de estrategias de afrontamiento de los problemas y cooperó para el co-manejo del tratamiento. Conclusión: La Guía de Manejo Autónomo de Medicamentos demostró ser un instrumento importante en el contexto de la educación en salud para la práctica del cuidado de enfermería, y contribuyó a la compartición del cuidado y la autonomía en el proceso de rehabilitación psicosocial. (AU)

Cuidado de enfermería del paciente con trastorno mental en atención domiciliaria: revisión narrativa / Nursing care of the patient with mental disorder in home care: narrative review

INTRODUCCIÓN: El manejo integral del paciente con trastorno mental desde enfermería, incluye abordajes que son llevados a cabo en la atención domiciliaria permitiendo así desarrollar actividades de valoración, seguimiento y atención al paciente y su familia. MATERIALES Y MÉTODOS: Se realizó una búsqueda estratégica en Medline, Epistemonikos, Base JBI, Biblioteca Virtual en Salud, utilizando los términos "mental disease", "mental illness", "homecare", "nursing". La extracción y análisis de los datos se dio acorde a los planteamientos del JBI, RESULTADOS: Se identificaron 25 artículos que cumplían con los criterios de inclusión y se clasificaron en 4 temas: 1. La experiencia del cuidado en el domicilio del paciente con trastorno mental. 2. Adherencia a la medicación de pacientes con trastorno mental que reciben tratamiento en casa. 3. El adulto mayor con trastorno mental y 4. Estrategias tecnológicas para dar atención domiciliaria al paciente con trastorno mental. CONCLUSIONES: Para abordar integralmente el cuidado del paciente con trastorno mental en el domicilio se deben incluir intervenciones de cuidado soportadas en la evidencia que incluyan la instrucción al cuidador familiar, por lo que es central el rol de enfermería teniendo en cuenta la creciente demanda de intervenciones domiciliarias en psiquiatría basadas en la evidencia, teniendo en cuenta el impacto de la trastorno mental, así como con los desafíos sociales y económicos que conlleva el padecer una trastorno mental para el paciente y su familia.

INTRODUCTION: The comprehensive management of the patient with mental disorder from nursing, includes approaches that are carried out in home care, thus allowing the development of assessment, monitoring and care activities for the patient and his family. MATERIALS AND METHODS: A strategic search was carried out in Medline, Epistemonikos, JBI Database, Virtual Health Library, using the terms "mental disease", "mental illness", "homecare", "nursing". The extraction and analysis of the data occurred according to the approaches of the JBI. RESULTS: 25 articles were identified that met the inclusion criteria and were classified into 4 themes: 1. The experience of care at home for patients with mental disorder. 2. Medication adherence of patients with mental disorder receiving treatment at home. 3. The elderly with mental disorder and 4. Technological strategies to provide home care to patients with mental disorder. CONCLUSIONS: In order to comprehensively address the care of patients with mental disorder at home, care interventions supported by evidence should be included, including instruction for the family caregiver, so the role of nursing is central, taking into account the growing demand for interventions evidence-based psychiatry home care, taking into account the impact of mental disease, as well as the social and economic challenges that mental disease entails for the patient and their family.

Delirio Erotomaníaco, a propósito de un caso en un Hospital General de Lima / Erotomanic delirium, a case report in a General Hospital of Lima

RESUMEN Dentro de los llamados trastornos delirantes, el subtipo erotomaníaco se caracteriza por la creencia delusional de que una persona, por lo general de mayor estatus social e intelectual, está enamorado del paciente. Se presenta el caso de un varón joven cuyo cuadro clínico consiste en su vinculación romántica con una cantante argentina que se enamoró de él a través de la pantalla y con quien se comunica por medios telepáticos. La importancia de este caso radica en que se trata de una patología infrecuente y escasamente documentada, sobre todo en áreas de salud mental de hospitales generales. Es importante estar informado de su existencia a fin de posibilitar diagnóstico y tratamiento oportunos.

SUMMARY Among the so-called delusional disorders, the erotomanic subtype is characterized by, the delusional belief that a person, usually of higher social and intellectual status, is in love with the patient. The case of a young man whose clinical picture consists in his romantic relationship with an Argentinian singer who fell in love with him through the screen and communicates by telepathic connections, is presented. Erotomanic delirium is an uncommon and poorly documented pathology, particularly in mental health areas of general hospitals. It is important to remain awareness of cases like this in order to provide reliable information and make it possible a timely diagnosis and treatment.

Diagnostic stability in substance-induced psychosis.

INTRODUCTION: Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion. MATERIAL AND METHODS: We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression. RESULTS: Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD = 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16 years was 41.6% (95%CI: 32.2-52.2) over a mean 36.43 months. CONCLUSIONS: In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years.

Comparison of disability between common mental disorders and severe mental disorders using WHODAS 2.0.

INTRODUCTION: Mental disorders are among the leading causes of disability worldwide. Despite the fact that severe mental disorders (SMD) are associated with high disability, the impact of common mental disorders (CMD) is not negligible. In this work, we compare the disability measured with the WHODAS 2.0 scale of both diagnostic groups at the Mental Health Nurse facility. MATERIAL AND METHODS: Sociodemographic data, clinical diagnosis and disability scores were collected, using the WHODAS 2.0 scale, of the patients attended by the Mental Health specialist nurse at the Infanta Elena de Valdemoro Hospital (Madrid) and disability was compared in patients with SMD and CMD, using the Student t test. RESULTS: Our study sample consisted of 133 patients. Patients with CMD showed greater disability compared to patients with SMD. It was observed that the disability associated with CMD is higher, compared to SMD, this difference being significant for the domain of work (p < 0.001) and participation in society (p = 0.041). CONCLUSIONS: In this study we showed that the level of disability associated with CMD was higher in certain areas compared to SMD, this difference was of special relevance for the «Work¼ and «Participation¼ domains. This may serve to adapt the interventions aimed at these people and improve their quality of life.

Transtornos Mentais Comuns e rotina acadêmica na graduação em Enfermagem: impactos da pandemia de COVID-19 / Common Mental Disorders and academic routine in Nursing graduation: impacts of the COVID-19 pandemic / Trastornos Mentales Comunes y rutina académica en el pregrado en Enfermería: impactos de la pandemia del COVID-19

Resumo Contexto: Transtornos Mentais Comuns (TMC) causam intenso sofrimento psíquico, perda da qualidade de vida e problemas sociais, sendo frequentes entre estudantes universitários. Objetivo: Investigar a prevalência de TMC entre estudantes de Enfermagem em relação a aspectos sociodemográficos, acadêmicos e da pandemia da COVID-19, e descrever formas de alívio/ manejo em saúde mental na percepção desses estudantes. Métodos: Estudo descritivo, quantitativo, realizado com estudantes da graduação em Enfermagem de uma universidade do sul da Bahia, Brasil. Os dados foram coletados a partir de questionário eletrônico, que incluía o Self Reporting Questionaire-20 (SRQ-20). Nas análises de associações, calculou-se a Razão de Prevalência (RP) com Intervalo de Confiança (IC) de 95%. O nível de significância utilizado foi p<0,05. Resultados: Participaram do estudo 146 estudantes, com média de idade de 23,6 anos. A prevalência de TMC foi de 68,5% e esteve associada a sexo feminino, raça autodeclarada indígena, histórico de trancamento, reprovação em disciplina e situação irregular no curso, e ao sentimento de incapacidade em relação ao futuro devido à pandemia da COVID-19. Observou-se que 67,1% dos estudantes utilizava alguma forma de manejo em saúde mental, e percebiam como terapêuticos, dentre outras estratégias, apoio psicológico, psicofármacos e musicoterapia. Conclusões: O estudo evidenciou alta prevalência de TMC entre os estudantes, no contexto da pandemia, e descreve formas de manejo da saúde mental de (possíveis) uso dos mesmos, podendo servir como subsídio para a elaboração de estratégias de prevenção de sofrimento psíquico e promoção da saúde mental por parte das universidades.

Abstract Context: Common Mental Disorders (CMD) cause intense psychological distress, loss of quality of life and social problems, being frequent among university students. Objective: To investigate the prevalence of CMD among nursing students in relation to sociodemographic, academic and COVID-19 pandemic aspects, and to describe forms of relief/management in mental health in these students' perception. Methods: Descriptive, quantitative study carried out with undergraduate nursing students from a university in southern Bahia, Brazil. Data were collected from an electronic questionnaire, which included the Self Reporting Questionaire-20 (SRQ-20). In the association analyses, the Prevalence Ratio (PR) with a Confidence Interval (CI) of 95% was calculated. The level of significance used was p<0.05. Results: 146 students participated in the study, with a mean age of 23.6 years. The prevalence of CMD was 68.5% and was associated with female gender, self-declared indigenous race, history of confinement, failure in discipline and irregular status in the course, and a feeling of incapacity for the future due to the COVID-19 pandemic . It was observed that 67.1% of the students used some form of mental health management, and they perceived psychological support, psychotropic drugs and music therapy as therapeutic, among other strategies. Conclusions: The study evidenced a high prevalence of CMD among students, in the context of the pandemic, and describes forms of mental health management of (possible) use of them, which can serve as a subsidy for the elaboration of strategies for the prevention of psychological distress and promotion of mental health by universities.

Resumen Contexto: Los Trastornos Mentales Comunes (TMC) provocan angustia psicológica intensa, pérdida de calidad de vida y problemas sociales, siendo frecuentes entre los estudiantes universitarios. Objetivo: Investigar la prevalencia de TMC en estudiantes de enfermería en relación a aspectos sociodemográficos, académicos y pandémicos de COVID-19, y describir formas de alivio / manejo en salud mental en la percepción de estos estudiantes. Métodos: Estudio descriptivo cuantitativo realizado con estudiantes de pregrado en enfermería de una universidad del sur de Bahía, Brasil. Los datos se obtuvieron de un cuestionario electrónico, que incluía el Self Reporting Questionaire-20 (SRQ-20). En los análisis de asociación se calculó la Razón de Prevalencia (PR) con un Intervalo de Confianza (IC) del 95%. El nivel de significancia utilizado fue p <0,05. Resultados: 146 estudiantes participaron en el estudio, con una edad media de 23,6 años. La prevalencia de CMD fue de 68,5% y se asoció con género femenino, raza autóctona autodeclarada, antecedente de encierro, falta de disciplina y situación irregular en el curso, y sentimiento de incapacidad para el futuro por la pandemia de COVID-19. Se observó que el 67,1% de los estudiantes utilizó alguna forma de manejo de la salud mental, y percibieron el apoyo psicológico, los psicofármacos y la musicoterapia como terapéuticas, entre otras estrategias. Conclusiones: El estudio evidenció una alta prevalencia de TMC entre los estudiantes, en el contexto de la pandemia, y describe formas de manejo en salud mental del (posible) uso de los mismos, que pueden servir como subsidio para la elaboración de estrategias para la prevención de angustia psicológica y promoción de la salud mental por parte de las universidades.

Stigma experienced by people with mental illness in South America: an integrative review

Introduction: People with mental illness are highly stigmatized by populations around the world and are perceived to be a burden on society. As a result of stigma, many people with mental illness are discriminated against, which leads to limited life opportunities. Given that beliefs about mental illness can vary based on culture, religion, nationality and ethnicity, it is important to understand the different types of mental illness-related stigma experienced around the world. Materials and Methods: Whittemore and Knafl's (2005) methodology for integrative reviews was used to analyze 18 studies about lived experiences of mental illness-related stigma in South America. Results: Findings suggest that certain types of stigma in South America are based on gender and social norms, such as the social position of men and women in society. This leads to discrimination, isolation and violence from family, intimate partners, friends, society and health professionals. Employment is also limited for South Americans with mental illness. Other consequences, such a self-stigma, also impact the lives of people with mental illness in many South American contexts. Discussion: Family, friendship and social relationships, including health professionals, can involve processes that lead to the stigma experienced by people with mental illness. Conclusion: This integrative review highlights how mental illness related-stigma impacts individuals in South America.

Introducción: Las personas con trastornos mentales están muy estigmatizadas por poblaciones de todo el mundo y son vistas como una carga para la sociedad. Muchas personas con trastornos mentales son discriminadas, lo que genera oportunidades de vida limitadas. Dado que las creencias sobre los trastornos mentales pueden variar según la cultura, la religión, la nacionalidad y la etnia, es importante comprender los diferentes tipos de estigma relacionados con el trastorno mental que se experimentan en todo el mundo. Materiales y métodos: Se utilizó la metodología de Whittemore y Knafl (2005) para revisiones integrativas para analizar 18 estudios sobre experiencias vividas de estigma relacionado con el trastorno mental en América del Sur. Resultados: Los resultados sugieren que ciertos tipos de estigma en América del Sur. se basan en normas sociales y de género, como la posición social de hombres y mujeres en la sociedad. Esto conduce a la discriminación, el aislamiento y la violencia por parte de la familia, la pareja íntima, los amigos, la sociedad y los profesionales de la salud. El empleo también es limitado para los sudamericanos con trastornos mentales. Otras consecuencias, como el autoestigma, también afectan la vida de las personas con trastornos mentales en muchos contextos sudamericanos. Discusión: Las relaciones familiares, de amistad y sociales, incluidos los profesionales de la salud, pueden involucrar procesos que conducen al estigma vivido por las personas con trastornos mentales. Conclusión: Esta revisión integradora destaca cómo el estigma relacionado con el trastorno mental afecta a las personas en América del Sur.

Introdução: Pessoas com transtornos mentais são altamente estigmatizadas por populações em todo o mundo e são vistas como um fardo para a sociedade. Como resultado do estigma, muitas pessoas com transtornos mentais são discriminadas, o que leva a oportunidades de vidas limitadas. Dado que as crenças sobre o transtorno mental podem variar de acordo com a cultura, religião, nacionalidade e etnia, é importante compreender os diferentes tipos de estigma relacionados ao transtorno mental vividos em todo o mundo. Objetivos e métodos: a metodologia de Whittemore e Knafl (2005) para revisões integrativas foi usada para analisar 18 estudos sobre experiências vividas de estigma relacionado ao transtorno mental na América do Sul. Resultados: os resultados sugerem que certos tipos de estigma na América do Sul são baseados em gênero e normas sociais, como a posição social de homens e mulheres na sociedade. Isso leva à discriminação, isolamento e violência por parte da família, de parceiros íntimos, amigos, sociedade e profissionais de saúde. O emprego também é limitado para sul-americanos com transtornos mentais. Outras consequências, como o autoestigma, também afetam a vida de pessoas com transtornos mentais em muitos contextos sul-americanos. Discussão: Relações familiares, de amizade e sociais, incluindo profissionais de saúde, podem envolver processos que levam aos estigma vivenciado por pessoas com transtornos mentais. Conclusão: Esta revisão integrativa destaca como o estigma relacionado ao transtorno mental afeta os indivíduos na América do Sul.

Validez, confiabilidad y utilidad clínica de los trastornos mentales: el caso de la esquizofrenia de la CIE-11 / Validity, Reliability and Clinical Utility of Mental Disorders: The Case of ICD-11 Schizophrenia

RESUMEN Los sistemas de clasificación diagnóstica categorizan la psicopatología en trastornos mentales. Aunque estas entidades son constructos clínicos elaborados por consenso, se ha señalado que en la práctica se suele tratarlas como entidades naturales y sin valorar aspectos relacionados con su construcción nosológica. Los objetivos del estudio son revisar: a) la conceptualización de los trastornos mentales; b) los indicadores de validez, confiabilidad y utilidad clínica, y c) los valores de estos indicadores en la esquizofrenia de la CIE-11. Los resultados muestran que los trastornos mentales están conceptualizados como entidades discretas, al igual que las enfermedades de otras áreas de la medicina; sin embargo, se observan diferencias entre ambas categorías diagnósticas en la práctica clínica. La confiabilidad y la utilidad clínica de los trastornos mentales son adecuadas; no obstante, la validez aún no está esclarecida. De modo similar, la esquizofrenia de la CIE-11 presenta adecuadas confiabilidad y utilidad clínica, pero su validez permanece incierta. La conceptualización de la psicopatología mental en entidades discretas puede resultar inadecuada para su estudio, por lo que se han propuesto modelos dimensionales y mixtos. Los indicadores de validez, confiabilidad y utilidad clínica permiten tener una visión precisa del estado nosológico de los trastornos mentales al valorar distintos aspectos de su construcción nosológica.

ABSTRACT Diagnostic classification systems categorize mental psychopathology in mental disorders. Although these entities are clinical constructs developed by consensus, it has been pointed out that in practice they are usually managed as natural entities and without evaluating aspects related to their nosological construction. The objectives of the study are to review a) the conceptualization of mental disorders, b) the indicators of validity, reliability and clinical utility, and c) the values of these indicators in ICD-11 schizophrenia. The results show that mental disorders are conceptualized as discrete entities, like the diseases of other areas of medicine; however, differences are observed between these diagnostic categories in clinical practice. The reliability and clinical utility of mental disorders are adequate; however, the validity is not yet clarified. Similarly, ICD-11 schizophrenia demonstrates adequate reliability and clinical utility, but its validity remains uncertain. The conceptualization of psychopathology in discrete entities may be inadequate for its study, therefore dimensional and mixed models have been proposed. The indicators of validity, reliability and clinical utility enable us to obtain an accurate view of the nosological state of mental disorders when evaluating different aspects of their nosological construction.

Validity, reliability and clinical utility of mental disorders: The case of ICD-11 schizophrenia.

Diagnostic classification systems categorise mental psychopathology in mental disorders. Although these entities are clinical constructs developed by consensus, it has been pointed out that in practice they are usually managed as natural entities and without evaluating aspects related to their nosological construction. The objectives of the study are to review a) the conceptualisation of mental disorders, b) the indicators of validity, reliability and clinical utility, and c) the values ​​of these indicators in ICD-11 schizophrenia. The results show that mental disorders are conceptualised as discrete entities, like the diseases of other areas of medicine; however, differences are observed between these diagnostic categories in clinical practice. The reliability and clinical utility of mental disorders are adequate; however, the validity is not yet clarified. Similarly, ICD-11 schizophrenia demonstrates adequate reliability and clinical utility, but its validity remains uncertain. The conceptualisation of psychopathology in discrete entities may be inadequate for its study, therefore dimensional and mixed models have been proposed. The indicators of validity, reliability and clinical utility enable us to obtain an accurate view of the nosological state of mental disorders when evaluating different aspects of their nosological construction.

[Hip fractures in patients treated with antipsychotic drugs. Study of retrospective cohorts in Catalonia]. / Fracturas de cadera en pacientes tratados con fármacos antipsicóticos. Estudio de cohortes históricas en Cataluña.

OBJECTIVE: To evaluate the incidence of hip fracture in patients with antipsychotic treatment, comparing it with that of individuals who have not been treated with antipsychotics. DESIGN: Retrospective cohort study of patients treated with antipsychotic drugs (TAP) and patients without known treatment (non-TAP). The observation period was 2006-2014. SITE: All primary care teams in Catalonia of the Catalan Health Institute (ICS). PARTICIPANTS: Patients older than 44 years with TAP lasting at least 3 months. Control cohort: random selection of non-TAP patients matching for baseline comorbidities and other variables. A total of 22,010 are analyzed. Main measurements Incidence rate (1000× person-years: PY) of hip fracture in each group (TAP and non-TAP). Cox regression models to estimate adjusted risks (hazard ratio: HR). RESULTS: The hip fracture incidence rate was higher in TAP patients (5.83 vs 3.58 fractures per 1000 PY), and is higher in all strata according to sex, age and type of diagnosis. The risk of suffering a hip fracture was 60% higher (HR: 1.60 95% CI: 1.34-1.92) in the TAP group than in the non-TAP group. The risk was higher in the group with schizophrenia (HR: 3.57 95% CI: 1.75-7.30), followed by bipolar disorder (HR: 2.61; 95% CI: 1.39-4.92) and depression (HR: 1.51; 95% CI: 1.21-1.88). CONCLUSIONS: Patients with antipsychotic treatment have a higher risk of hip fracture than those who have not been treated with antipsychotics.

Características sociodemográficas, clínicas y familiares de pacientes con trastornos mentales de una unidad médica familiar / Sociodemographic, clinical and family characteristics of patients with mental disorders in a family medical unit

RESUMEN: Objetivo: Determinar las características epidemiológicas, clínicas y familiares de los pacientes con trastornos mentales adscritos a una unidad de medicina familiar (UMF) mexicana. Material y métodos: Estudio prospectivo, transversal, observacional, descriptivo, sobre 164 pacientes adscritos a una UMF mexicana, elegidos por muestreo no probabilístico que cumplieron criterios de selección: mayores de 18 años, con trastorno mental, sin impedimento físico o cognitivo. Resultados: Se presentaron 51 hombres y 113 mujeres con edad promedio de 48,6 años; 57% con más de un trastorno mental; los más frecuentes fueron depresión y ansiedad. En escolaridad sobresale licenciatura; 16% reportaron intento de suicidio, 42% tiene más de 6 años diagnosticado. El 64,6% recibe psicoterapia y farmacología; el 18% fue hospitalizado a causa de sus trastornos, gran parte de ellos entre 1 y 4 semanas y 38% tiene algún familiar con algún trastorno mental, Las comorbilidades más frecuentes fueron Hipertensión, obesidad, diabetes mellitus, dislipidemia y artrosis. Los tipos de familia más frecuentes son: nuclear o nuclear simple, con núcleo integrado y núcleo no integrado; subsisten principalmente de los servicios; viven con niveles 1 y 2 de pobreza familiar; son modernas y urbanas en mayor número. Conclusiones: las características sociodemográficas, clínicas y familiares de los pacientes con trastornos mentales adscritos a una unidad de medicina familiar (UMF) mexicana son en su mayoría mujeres, en adultez media, que cursan con más de un trastorno mental (ansiedad y depresión), tratadas con fármacos y psicoterapia, además cursaban con hipertensión, y pertenecen a familias de tipo nuclear simple, de núcleo integrado y núcleo no; subsisten por servicios; viven con niveles 1 y 2 de pobreza familiar, son modernas y urbanas.

ABSTRACT: Objective: To determine the epidemiological, clinical and family characteristics of patients with mental disorders assigned to a Mexican family medicine unit (FMU). Material and methods: Prospective, cross-sectional, observational, descriptive study of 164 patients assigned to a Mexican FMU, chosen by non-probabilistic evidence that they met the selection criteria: older than 18 years, with mental disorder, without physical or cognitive impairment. Results: 51 men and 113 women with a mean age of 48.6 years were presented; 57% with more than one mental disorder; the most frequent were depression and anxiety. In schooling overselling bachelor's degree; 16% reported attempted suicide, 42% have been diagnosed for more than 6 years. 64.6% receive psychotherapy and pharmacology; 18% were hospitalized due to their disorders, most of them between 1 and 4 weeks and 38% have a family member with a mental disorder. The most frequent comorbidities were hypertension, obesity, diabetes mellitus, dyslipidemia and osteoarthritis. The most frequent types of family are: nuclear or simple nuclear, with integrated nucleus and non-integrated nucleus; they subsist mainly on services; they live with levels 1 and 2 of family poverty; are modern and urban in greater number. Conclusions: the epidemiological, clinical and family characteristics of patients with mental disorders assigned to a Mexican family medicine unit (FMU) are mostly women, in middle adulthood, who attend more than a mental disorder (anxiety and depression), treated with drugs and psychotherapy, also had hypertension, and belong to families of simple nuclear type and non-integrated nucleus; subsist on services; they live with levels 1 and 2 of family poverty, they are modern and urban.

Repeated Suicide Attempts Among Service Users of An Emergency Service in Northern Colombia: Characteristics, Associated Factors, And Management / Intento de Suicidio Repetido en Usuarios de un Servicio de Emergencias En Colombia Del Norte: Características, Factores Asociados y Manejo

Abstract Suicide has increased close to 60% in the last four decades worldwide. In Colombia, during the year 2019, 10,9% of violent deaths were due to suicide. This study aimed to identify risk factors predicting repeated suicide attempts. It also aimed to describe the management of suicidal behaviour within an emergency department of Northern Colombia. Dataset comprised 336 medical records of individuals seeking medical assistance for intentional self-harm between 2008-2019; 136 medical records were associated with previously reported suicide attempts. Results from a multivariate logistic regression showed that suicide ideation and having a history of psychiatric disorders significantly predicted repeated suicide attempts. Furthermore, repeated attempts were more likely in underaged individuals and young adults. Management of patients engaging in suicidal behaviour involved hospitalization and outpatient mental health services. However, a few patients were sent home with recommendations or were non-compliant. Findings from this study highlight the importance to develop evidence-based screening and monitoring protocols that prevent repeated suicide attempts.

Resumen El suicidio ha aumentado en cerca de un 60% en los últimos cuarenta años. En Colombia, para el año 2019, el 10.9% de las muertes violentas se presentaron por suicidio. Este estudio busca identificar los factores de riesgo asociados con los intentos repetidos de suicidio y además realiza un análisis descriptivo del manejo dado a estos pacientes. Esta investigación utiliza la base de datos de la unidad de emergencias en un hospital del norte de Colombia, y se centra en los pacientes que acudieron al hospital por intento de suicidio entre enero de 2008 y junio de 2019. La base de datos presenta 336 casos de los cuales el 81% corresponden a intentos suicidas y 19% a gestos. Resultados de un análisis de regresión logística multivariada mostraron que la ideación suicida y la historia de desorden psiquiátrico predecían significativamente los intentos suicidas repetidos y que los intentos repetidos eran más probables en el grupo de individuos menores de edad y en adultez temprana. El tratamiento administrado a los pacientes fue hospitalización y servicios ambulatorios; un porcentaje fue enviado a casa con recomendaciones. Los hallazgos de este estudio destacan la importancia del desarrollo de protocolos estandarizados basados en evidencia para prevenir los intentos repetidos.

Acompanhamento familiar no CRAS segundo familiares de usuários do benefício de prestação continuada / Family assistance cras in family members of users of the continued payment benefit / Apoyo familiar en cras para familiares del usuarios del beneficio pago continuo

RESUMO O estudo analisou as perspectivas das famílias usuárias do Benefício de Prestação Continuada (BPC) acerca do Acompanhamento Familiar realizado por psicólogos em uma cidade do interior de Minas Gerais. Participaram oito familiares de pessoas com transtornos mentais que recebiam o BPC e que faziam acompanhamento nos oito CRAS da cidade. Empregou-se um roteiro de entrevista semiestruturada e os dados foram submetidos à análise de conteúdo de Bardin. Os resultados demonstraram que os familiares desconheciam tanto o serviço de Acompanhamento Familiar quanto seus Direitos Sociais e, consequentemente, não desenvolviam a Autonomia. Constatou-se que, embora os psicólogos não desenvolvessem atendimentos clínicos, evidenciou-se a necessidade de que psicólogos realizem atendimentos em contextos terapêuticos para acolhimento das demandas emocionais desses familiares.

ABSTRACT This research analyzed the perspective of families benefiting from the Continued Payment Benefit (BPC) about the family care assistance service performed by psychologists in a city in the interior of Minas Gerais. Participants were eight families of individuals diagnosed with mental disorders that received BPC and were inserted into eight CRAS unities. The instrument used was a semistructured interview script. Data were submitted to content analysis in thematic modality from Bardin. Results showed that family members were unaware of both family care assistance service and their Social Rights. Consequently, they had not developed autonomy. Moreover, although the psychologists did not perform clinical care, the need for them to develop therapeutic assistance to embrace the emotional demands of family members was evident.

El Estudio analizó perspectivas de familias que utilizan Beneficio Pago Continuo (BPC) sobre Apoyo Familiar realizado por psicólogos en una ciudad del interior de Minas Gerais. Participaron ocho familiares de personas con trastornos mentales que recibieron el BPC y fueron seguidos de ocho CRAS de la ciudad. Se utilizó un guión de entrevista semiestructurado y los datos se sometieron a análisis de contenido en modalidad temática de Bardin. Los resultados mostraron que los familiares desconocían tanto el servicio de Apoyo Familiar como sus Derechos Sociales, en consecuencia, no desarrollaron autonomía. Se encontró que, si bien los psicólogos no brindaron atención clínica, se evidenció la necesidad de que los psicólogos brinden atención en contextos terapéuticos para cuidar de las demandas emocionales de estos familiares.

Comparison of disability between common mental disorders and severe mental disorders using WHODAS 2.0. / Comparación de la discapacidad entre trastornos mentales graves y comunes usando la escala WHODAS 2.0.

INTRODUCTION: Mental disorders are among the leading causes of disability worldwide. Despite the fact that severe mental disorders (SMD) are associated with high disability, the impact of common mental disorders (CMD) is not negligible. In this work, we compare the disability measured with the WHODAS 2.0 scale of both diagnostic groups at the Mental Health Nurse facility. MATERIAL AND METHODS: Sociodemographic data, clinical diagnosis and disability scores were collected, using the WHODAS 2.0 scale, of the patients attended by the Mental Health specialist nurse at the Infanta Elena de Valdemoro Hospital (Madrid) and disability was compared in patients with SMD and CMD, using the Student t test. RESULTS: Our study sample consisted of 133 patients. Patients with CMD showed greater disability compared to patients with SMD. It was observed that the disability associated with CMD is higher, compared to SMD, this difference being significant for the domain of work (p<0.001) and participation in society (p=0.041). CONCLUSIONS: In this study we showed that the level of disability associated with CMD was higher in certain areas compared to SMD, this difference was of special relevance for the «Work¼ and «Participation¼ domains. This may serve to adapt the interventions aimed at these people and improve their quality of life.

Intentos de suicidio y trastornos mentales / Suicide attempts and mental disorders

Introducción: el suicidio es un grave problema de salud pública mundial, más de 800,000 personas se suicidan cada año y entre 10 y 20 millones lo intentan cada año. Ha sido considerado como una conducta prevenible y el intento es un predictor clínicamente relevante que está presente en un tercio de los suicidios consumados, así como padecer un trastorno mental es otro factor de riesgo para el suicido. Objetivo: determinar la relación entre los intentos de suicidio y los trastornos mentales. Material y Métodos: se realizó una búsqueda en las bases de datos; Dialnet, Redalyc, Scielo, Biblioteca Virtual en Salud (BVS), PubMed, Science Direct y Google Académico, en español e inglés y limitada a las publicaciones entre 01 de enero 2010 y 31 de diciembre de 2020. Desarrollo: la prevalencia de vida del intento de suicidio en pacientes con Trastorno Bipolar es del 33,9 por ciento, en pacientes con Trastorno Depresivo Mayor es del 31 por ciento, y en pacientes con Esquizofrenia es del 26,8 por ciento. Conclusiones: los pacientes con trastorno bipolar y trastorno depresivo mayor, presentan mayor porcentaje de intentos de suicidio. Aunado a una comorbilidad psiquiátrica (consumo de alcohol, consumo de tabaco y trastorno de la personalidad límite), más intentos de suicidio previos, aumenta el riesgo del comportamiento suicida(AU)

Introduction: Suicide is a serious global public health problem. More than 800,000 people commit suicide every year and between 10 and 20 million people attempt suicide annually. Suicide has been considered a preventable behavior and suicide attempt is a clinically relevant predictor which is present in one-third of consummated suicides. Besides, having a mental disorder is another risk factor for suicide. Objective: To determine the relationship between suicide attempts and mental disorders such as depressive and anxiety disorders, bipolar disorder, substance-related disorders, schizophrenia and other psychotic disorders, personality disorders, and eating disorders. Material and Methods: A search was performed in Dialnet, Redalyc, Scielo, Virtual Health Library (VHL), PubMed, Science Direct, and Google Scholar databases in Spanish and English. It was limited to publications between January 1, 2010 and December 31, 2020. Development: The lifetime prevalence of suicide attempt is 31 percent in patients with Bipolar Disorder; 33,9 percent in patients with Major Depressive Disorder and 26.8 percent in patients with Schizophrenia. Conclusions: Patients with bipolar disorder and major depressive disorder have higher rates of suicide attempts. Coupled with psychiatric comorbidity (alcohol consumption, smoking, borderline personality disorder), more previous suicide attempts increase the risk of suicidal behavior(AU)

[Impact on mental healthcare after collaboration between primary healthcare and mental health services]. / Impacto en la asistencia en salud mental tras la colaboración entre atención primaria y salud mental.

INTRODUCTION: The primary care physician is the professional with whom the psychiatric patient has contact first and most frequently. For this reason, a good coordination between the Primary Healthcare (PHC) and Mental Health (MH) services is essential to provide the best care to patients and at the same time optimise the limited resources of this service. The aim of this work is to determine whether the collaboration between PHC and MH results in a more efficient use of the limited resources in MH. METHODOLOGY: An observational, retrospective, mirror study was carried out with a total sample of 135 patients over 16 years old referred for the first time from PHC to Psychiatry. The results during the first 6 months of the collaboration between PHC and MH (POST Group) are compared with those of the 6 months prior to the intervention (PRE Group). RESULTS: After collaboration meetings, the percentage of patients who are discharged by the psychiatrist after the first visit decreases (32.2% vs. 16%) and the percentage of follow-up by psychiatry and psychology increases. Furthermore, the percentage of patients who do not attend the first visit decreases (23.3% vs. 13.7%). CONCLUSIONS: The data suggest that the collaboration between PHC and MH improves the effectiveness and functioning of MH services.