Possibilities for the future of global mental health: a scenario planning approach.

BACKGROUND: Global mental health is a widely used term describing initiatives in policies, research and practice to improve the mental health of people worldwide. It has been gaining momentum over the last 10 years, reflected in increasing funding opportunities, training programmes, and publications. In light of the rising importance of global mental health and the various uncertainties about its future directions, this paper explores what the future may hold for global mental health in 30 years' time. METHOD: A scenario planning method was used, involving a workshop with experts from four continents and a range of backgrounds, including clinical and academic psychiatry, psychology, art and music therapy, service user advisory role, funder of global health research and post-graduate students. RESULTS: Six distinct scenarios that describe potential future situations were developed: universal standards for care; worldwide coordination of research; making use of diversity; focus on social factors; globalised care through technology; mental health as a currency in global politics. CONCLUSIONS: These scenarios consider different social, economic, scientific and technological drivers and focus on distinct aspects. Some reflect a global application of possible trends in mental health, whilst others apply general global developments to mental health care. They are not fixed forecasts, but instead may help to promote discussion and debate about further developments and decisions.

Clinical and Demographic Variables Associated Coping and the Burden of Caregivers of Schizophrenia Patients. / Variables demográficas y clínicas relacionadas con la carga y el afrontamiento de los cuidadores de personas diagnosticadas de esquizofrenia.

OBJECTIVE: To analyse of the relationship between burden of illness and coping strategies and the demographic variables of caregivers, and the demographic and clinical variables of people diagnosed with schizophrenia. METHODS: Multicentre correlational cross-sectional study including 70 people diagnosed with schizophrenia, or a schizoaffective disorder, and 70 primary informal caregivers. They were evaluated using Zarit Caregiver Burden Inventory, Family Coping Strategies Questionnaire, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and the brief Disability Assessment Scale. RESULTS: Burden of illness positively associated with patient impairment in occupational and social functioning, and negatively with education level. Avoidance, coercion and positive communication were positively associated with impairment in occupational and social functioning of patients. Social interest and friendships showed a positive association with the education level of caregivers. Spiritual assistance negatively correlated with impairment in social functioning and patient age, and resignation was negatively associated with length of the disorder and patient education level. CONCLUSIONS: Burden and dysfunctional coping strategies, such as avoidance and coercion, are associated with functional impairment of the patient. These findings suggest the need to provide support to caregivers, adjusted to the functional level of the patient, in order to prevent burden of care.

[Prevention and Treatment of Common Acute Adverse Effects With Antipsychotic Use in Adults With Schizophrenia Diagnosis]. / Prevención y tratamiento de los efectos adversos agudos más frecuentes por el uso de antipsicóticos en pacientes adultos con diagnóstico de esquizofrenia.

OBJECTIVE: To determine the most adequate strategies for the prevention and treatment of the acute adverse effects of the use of antipsychotics. METHODS: A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. A systematic literature search was carried out. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. RESULTS: The non-pharmacological interventions such as nutritional counseling by a nutritionist, exercise and psychotherapy are effective in preventing weight gain with the use of antipsychotics. (Kg Weight reduction in DM of -3.05 (-4.16, -1.94)). The antipsychotic change from olanzapine to aripiprazole showed weight loss and decreased BMI (decreased weight in KG DM -3.21 (-9.03, -2.61). The use of beta blockers was ineffective in reducing akathisia induced by antipsychotic; using as outcome the 50% reduction of symptoms of akathisia comparing beta-blockers with placebo RR was 1.4 (0.59, 1.83). CONCLUSION: It is recommended to make psychotherapeutic accompaniment and nutrition management of overweight for patients with weight gain. If these alternatives are ineffective is suggested to change the antipsychotic or consider starting metformin. For the management of drug-induced akathisia it is recommended to decrease the dose of the drug and the addition of lorazepam. It is recommended using 5mg biperiden IM or trihexyphenidyl 5mg orally in case of secondary acute dystonia and for the treatment of antipsychotic-induced parkinsonism to decrease the dose of antipsychotic or consider using 2 - 4mg/day of biperiden or diphenhydramine 50mg once daily.

[Clinical Practice Guidelines for Management of Schizophrenia: Evaluation Using AGREE II]. / Guías de práctica clínica en esquizofrenia: evaluación mediante AGREE II.

INTRODUCTION: Colombia is developing multiple national practice guidelines from a range of diseases. Clinical practice guidelines represent a very useful tool to be able to take decision over a patient care that is widely available for the clinician. In psychiatry there are a good number of international clinical guidelines for the treatment of schizophrenia nevertheless there is no article that evaluate them scientifically METHODS: In the settings of developing a Colombian schizophrenia practice guideline, a systematic search was performed in multiple databases and the results were then evaluated by two trained persons. We present the results globally and by domains. RESULTS: We found 164 matches for possible guidelines. After screening 7 guidelines were evaluated with the AGREE II instrument. Globally and by the different domains, the National Institute for Health and Care Excellence (NICE) was the guideline that got the best score. From the guidelines that were reviewed, 4 were from Europe and only 2 were from Latin America. None of the guidelines used GRADE methodology for the recommendations. CONCLUSION: The diversity of the schizophrenia treatment guidelines does not allow an easy adoption of the recommendation by a psychiatrist in Colombia.

Prevención y tratamiento de los efectos adversos agudos más frecuentes por el uso de antipsicóticos en pacientes adultos con diagnóstico de esquizofrenia / Prevention and Treatment of Common Acute Adverse Effects With Antipsychotic Use in Adults With Schizophrenia Diagnosis

Objetivo: Determinar las estrategias más adecuadas para la prevención y tratamiento de los efectos adversos agudos más frecuentes con el uso de Antipsicóticos. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de Salud y Protección Social para identificar, sintetizar, evaluar la evidencia y formular recomendaciones respecto al manejo y seguimiento de los pacientes adultos con diagnóstico de esquizofrenia. Se realizó una búsqueda sistemática de la literatura de novo. Se presentó la evidencia y su graduación al grupo desarrollador de la guía (GDG) para la formulación de las recomendaciones siguiendo la metodología propuesta por el abordaje GRADE. Resultados: Resultados: Las intervenciones no farmacológicas tales como los consejos nutricionales por nutricionista, el ejercicio y la psicoterapia son efectivas para prevenir la ganancia de peso con el uso de antipsicóticos (disminución de peso en kg DM -3.05 [-4.16, -1.94]). La estrategia de cambio de antipsicótico fue efectiva para demostrar disminución de peso e IMC con el paso de olanzapina a aripiprazol (disminución del peso en kg DM -3.21 [-9.03; -2.61]). El uso de betabloqueadores comparado con placebo, usando como desenlace la reducción del 50% de los síntomas de acatisia, no mostró ser efectivo en la reducción de la acatisia inducida por antipsicóticos con un RR de 1.4 (0.59, 1.83). Conclusión: En esta evaluación se recomienda realizar acompan˜ amiento psicoterapéutico y por nutrición para el manejo del sobrepeso en pacientes en tratamiento farmacológico. En caso de que estas alternativas no sean efectivas se sugiere cambiar el antipsicótico a uno con menor riesgo de presentar incremento de peso o considerar el inicio de metformina. Para el manejo de acatisia inducida por medicamentos se recomienda la disminución de la dosis del medicamento y la adición de benzodiacepinas tipo lorazepam. No se recomienda el uso de betabloqueadores.

Objective: To determine the most adequate strategies for the prevention and treatment of the acute adverse effects of the use of antipsychotics. Methods: A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. A systematic literature search was carried out. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. Results: The non-pharmacological interventions such as nutritional counseling by a nutritionist, exercise and psychotherapy are effective in preventing weight gain with the use of antipsychotics. (Kg Weight reduction in DM of −3.05 (−4.16, −1.94)). The antipsychotic change from olanzapine to aripiprazole showed weight loss and decreased BMI (decreased weight in KG DM −3.21 (−9.03, −2.61). The use of beta blockers was ineffective in reducing akathisia induced by antipsychotic; using as outcome the 50% reduction of symptoms of akathisia comparing beta-blockers with placebo RR was 1.4 (0.59, 1.83). Conclusion: It is recommended to make psychotherapeutic accompaniment and nutrition management of overweight for patients with weight gain. If these alternatives are ineffective is suggested to change the antipsychotic or consider starting metformin. For the management of drug-induced akathisia it is recommended to decrease the dose of the drug and the addition of lorazepam. It is recommended using 5 mg biperiden IM or trihexyphenidyl 5 mg orally in case of secondary acute dystonia and for the treatment of antipsychotic-induced parkinsonism to decrease the dose of antipsychotic or consider using 2 -4 mg/day of biperiden or diphenhydramine 50 mg once daily.

Guías de práctica clínica en esquizofrenia: evaluación mediante AGREE II / Clinical Practice Guidelines for Management of Schizophrenia: Evaluation Using AGREE II

Introducción: Colombia se encuentra en estos momentos en la realización de guías de práctica clínica para el tratamiento de diversas patologías. Las guías de práctica clínica representan una herramienta al alcance del clínico para la toma de decisiones sobre sus pacientes. En psiquiatría se dispone internacionalmente de práctica clínica para esquizofrenia, no obstante no se dispone de una guía colombiana ni de una apreciación de las guías desarrolladas en el mundo sobre esta patología. Método: En el marco del desarrollo de la Guía de práctica clínica sobre esquizofrenia para Colombia se realiza una búsqueda sistemática sobre GPC en diversas bases y se evalúan empleando la herramienta AGREE II por parte de 2 personas entrenadas para ello. Se presentan los resultados de esta fase de manera global y por dominios. Resultados: Se encontraron 164 resultados de posibles guías, de las cuales se evalúan finalmente 7 mediante AGREE II. Por dominios y calificación global la guía realizada por el National Institute for Health and Care Excellence (NICE) obtuvo el mejor puntaje. De las guías evaluadas, únicamente dos eran de América Latina y la mayoría (cuatro) de Europa. Solamente una de las guías evaluadas utilizó el abordaje GRADE para evaluar la calidad de la evidencia y formular las recomendaciones. Conclusión: La diversidad de guías encontrados sobre esquizofrenia no permite una fácil adopción ni adaptación de alguna guía por el médico psiquiatra de acuerdo con los parámetros que se han planteado para Colombia.

Introduction: Colombia is developing multiple national practice guidelines from a range of diseases. Clinical practice guidelines represent a very useful tool to be able to take decision over a patient care that is widely available for the clinician. In psychiatry there are a good number of international clinical guidelines for the treatment of schizophrenia nevertheless there is no article that evaluate them scientifically. Methods: In the settings of developing a Colombian schizophrenia practice guideline, a sys tematic search was performed in multiple databases and the results were then evaluated by two trained persons. We present the results globally and by domains. Results: We found 164 matches for possible guidelines. After screening 7 guidelines were evaluated with the AGREE IIinstrument. Globally and by the different domains, the National Institute for Health and Care Excellence (NICE) was the guideline that got the best score. From the guidelines that were reviewed, 4 were from Europe and only 2 were from Latin America. None of the guidelines used GRADE methodology for the recommendations. Conclusion: The diversity of the schizophrenia treatment guidelines does not allow an easy adoption of the recommendation by a psychiatrist in Colombia.

Revisión de la historia del trastorno esquizoafectivo y su relación con los rasgos de personalidad / Revision of the Schizo-affective Disorder and its Relation to Personality Traits

Objetivos Revisar los aspectos históricos del trastorno esquizoafectivo, así como la importancia del abordaje, teniendo en cuenta la personalidad. Métodos. Revisión de la literatura. Se presenta una revisión literaria centrada en los aspectos históricos y la polémica que ha existido acerca del trastorno esquizoafectivo como una entidad independiente dentro de la nosografía. Se revisa también la importancia del estudio de la dimensión de la personalidad en el diagnóstico y el manejo de este trastorno. Conclusiones La comprensión del trastorno esquizoafectivo requiere de un abordaje multidimensional, con especial interés en los rasgos de personalidad.