Mental health research in South America: Psychiatrists and psychiatry trainees' perceived resources and barriers.

As mental health issues continue to rise in Latin America, the need for research in this field becomes increasingly pressing. This study aimed to explore the perceived barriers and resources for research and publications among psychiatrists and psychiatry trainees from nine Spanish-speaking countries in South America. Data was collected through an anonymous online survey and analyzed using descriptive methods and the SPSS Statistical package. In total, 214 responses were analyzed. Among the participating psychiatrists, 61.8% reported having led a research project and 74.7% of them reported having led an academic publication. As for the psychiatry trainees, 26% reported having conducted research and 41.5% reported having published or attempted to publish an academic paper. When available, having access to research training, protected research time and mentorship opportunities were significant resources for research. Further support is needed in terms of funding, training, protected research time and mentorship opportunities. However, despite their efforts to participate in the global mental health discussion, Latin American psychiatrists and psychiatry trainees remain largely underrepresented in the literature.

An international research agenda for clozapine-resistant schizophrenia.

Treatment-resistant symptoms occur in about a third of patients with schizophrenia and are associated with a substantial reduction in their quality of life. The development of new treatment options for clozapine-resistant schizophrenia constitutes a crucial, unmet need in psychiatry. Additionally, an overview of past and possible future research avenues to optimise the early detection, diagnosis, and management of clozapine-resistant schizophrenia is unavailable. In this Health Policy, we discuss the ongoing challenges associated with clozapine-resistant schizophrenia faced by patients and health-care providers worldwide to improve the understanding of this condition. We then revisit several clozapine guidelines, the diagnostic tests and treatment options for clozapine-resistant schizophrenia, and currently applied research approaches in clozapine-resistant schizophrenia. We also suggest methodologies and targets for future research, divided into innovative nosology-oriented field trials (eg, examining dimensional symptom staging), translational approaches (eg, genetics), epidemiological research (eg, real-world studies), and interventional studies (eg, non-traditional trial designs incorporating lived experiences and caregivers' perspectives). Finally, we note that low-income and middle-income countries are under-represented in studies on clozapine-resistant schizophrenia and propose an agenda to guide multinational research on the cause and treatment of clozapine-resistant schizophrenia. We hope that this research agenda will empower better global representation of patients living with clozapine-resistant schizophrenia and ultimately improve their functional outcomes and quality of life.

[Depressive Symptoms in Healthcare Workers Two Years After the Start of the COVID-19 Pandemic in Bogotá, Colombia]. / Síntomas depresivos en trabajadores de la salud dos años después del inicio de la pandemia COVID-19 en Bogotá, Colombia.

Introduction: During the COVID-19 pandemic, different events arose worldwide, including the impact on the mental health of health personnel. Our main aim was to determine the association between sociodemographic, clinical, tobacco and alcohol abuse, and fear of COVID-19 variables with the presence of depressive symptoms in a healthcare facility, in Bogotá DC, in 2022. Materials and methods: Analytical cross-sectional study. Sociodemographic and clinical variables, alcohol and tobacco abuse, and fear of COVID-19 were explored. The presence and severity of depressive symptoms were evaluated with the PHQ-9 scale. Descriptive analysis and chi-square tests were performed. Statistically significant variables (P < .05) were entered into a logistic regression model with depressive symptoms as the dependent variable. Results: 597 people were included, 80% female. The median age was 34 years (Interquartile Range [IQR]: 28-41. The prevalence of depressive symptoms was 12.4% (95% CI: 9,74-15,05). The multivariate analysis showed that fear of COVID-19, tobacco use, age under 28, and middle socioeconomic status were the factors that best explained the presence of depressive symptoms. Conclusions: Two years after COVID-19 was declared a pandemic, the prevalence of depressive symptoms is 12.4%. It is necessary to carry out strategies to promote mental health in health professionals.

Functionality During the First Five Years After the Diagnosis of Schizophrenia. A Cohort Study in a Colombian Population.

OBJECTIVE: There is a lack of studies on the natural history of the initial stages of schizophrenia in Colombia. This study aims to assess functionality in the first five years after the diagnosis of schizophrenia. METHODS: Naturalistic longitudinal study of 50 patients with early schizophrenia evaluated between 2011 and 2014. Data about demographic background, symptoms, introspection, treatment and adverse reactions were collected in all patients every 3 months for at least 3-5 years. Functionality was measured with the Global Assessment of Functioning (GAF) and Personal and Social Performance (PSP) scales. RESULTS: Patients were followed up for a mean of 174±62.5 weeks and showed moderate difficulties in overall functioning. This functioning was modified by polypharmacy, degree of introspection, changes in antipsychotic regimens, and the number of episodes, relapses and hospitalisations. CONCLUSIONS: The results suggest that functional outcomes seem to be related to the use of polypharmacy, degree of insight, changes in antipsychotic regimens, and number of episodes, relapses and hospitalisations during the first years of schizophrenia.

Functionality During the First Five Years After the Diagnosis of Schizophrenia. A Cohort Study in a Colombian Population / Funcionalidad en los primeros cinco años después del diagnóstico de esquizofrenia. Estudio de cohorte en población colombiana

ABSTRACT Objective: There is a lack of studies on the natural history of the initial stages of schizophrenia in Colombia. This study aims to assess functionality in the first five years after the diagnosis of schizophrenia. Methods: Naturalistic longitudinal study of 50 patients with early schizophrenia evaluated between 2011 and 2014. Data about demographic background, symptoms, introspection, treatment and adverse reactions were collected in all patients every 3 months for at least 3-5 years. Functionality was measured with the Global Assessment of Functioning (GAF) and Personal and Social Performance (PSP) scales. Results: Patients were followed up for a mean of 174 ± 62.5 weeks and showed moderate difficulties in overall functioning. This functioning was modified by polypharmacy, degree of introspection, changes in antipsychotic regimens, and the number of episodes, relapses and hospitalisations. Conclusions: The results suggest that functional outcomes seem to be related to the use of polypharmacy, degree of insight, changes in antipsychotic regimens, and number of episodes, relapses and hospitalisations during the first years of schizophrenia.

RESUMEN Objetivo: Existe una falta de estudios en la historia natural de los estadios iniciales de la esquizofrenia en Colombia. Este estudio apunta a evaluar la funcionalidad en los primeros cinco años después del diagnóstico de esquizofrenia. Método: Estudio longitudinal naturalístico de 50 pacientes con esquizofrenia temprana evaluados entre los anos 2011 y 2014. Loa datos demográficos, síntomas, introspección, tratamiento, y reacciones adversas fueron recolectados en todos los pacientes cada 3 meses por lo menos3a5anos. La funcionalidad se midió mediante la escala global de funcionamiento (GAF), y la escala de funcionamiento personal y social (PSP). Resultados: Los pacientes fueron seguidos por una media de 174 semanas (SD: 62.5) y mostraron dificultades moderadas en su funcionamiento global. Este funcionamiento fue modificado por la presencia de polifarmacia, grado de introspección, cambios en los esquemas antipsicóticos, y el número de episodios, recaídas, y hospitalizaciones. Conclusiones: Los resultados sugieren que los desenlaces en funcionalidad parecen estar relacionados con uso de polifarmacia, grado de introspección, cambios en esquemas antipsicóticos, y numero de episodios, recaídas, y hospitalizaciones durante los primeros años de esquizofrenia.

Mapping Retinal Abnormalities in Psychosis: Meta-analytical Evidence for Focal Peripapillary and Macular Reductions.

BACKGROUND: Several studies have suggested that the retina structure is affected in schizophrenia spectrum disorders (SSD). We aimed to investigate the location and size of the potential differences between patients and healthy controls (HC) in several thickness and volume measures across the retina. STUDY DESIGN: We included cross-sectional studies comparing peripapillary retinal nerve fiber layer (pRNFL) thickness, macular volume, macular thickness (MT), foveal thickness, ganglion cell and inner plexiform layer thickness (GCL+IPL), cup volume, and cup/disc ratio (C/D) in the right and/or left eyes and/or the pRNFL and MT quadrants between patients with SSD and HC. Search databases were MEDLINE, Web of Science, PsycINFO, Cochrane Central, and medrxiv.org. Risk of bias was assessed with the Newcastle-Ottawa Scale. Standardized mean differences (SMD), subgroup analysis, and meta-regression with several variables were computed using the dmetar package in R. PROSPERO: CRD42021287873. STUDY RESULTS: Data from 22 reports (942 patients, 742 HC) were included. We found a retinal thinning in pRNFL (-0.30; 95% CI: -0.46, -0.14), macula (-0.37; 95% CI: -0.61, -0.13), and GCL+IPL (-0.33; 95% CI: -0.57, -0.10). The retinal thinning was especially pronounced in the superior and inferior quadrants of the inner ring of the macula. We also observed a decrease of macular volume (-0.44; 95% CI: -0.68, -0.20) and an increase in C/D ratio (0.35; 95% CI: 0.03, 0.67). CONCLUSIONS: Current evidence demonstrates retinal thinning in SSD, affecting both axonal and cellular structures, specially focused in the inner ring of the macula.

The grief experience during the COVID-19 pandemic across different cultures.

Grief is the physical or mental suffering experienced after a major loss, usually the death of a loved one. It is a universal experience, but sociocultural factors, such as cultural or ethnic identity and religious beliefs predict and shape the expression of grief. The circumstances under which people are experiencing grief during the coronavirus outbreak have adversely affected the grieving process. Unexpected deaths, social distancing rules and visitor restrictions in healthcare facilities have posed a heavier burden on the loss and have heightened the risk of grievers experiencing complicated or persistent grief. This concern led us, as early career psychiatrists (ECPs) from 14 different countries connected by the Early Career Psychiatrists Section of the World Psychiatric Association (WPA), to share our country-specific experiences on the mourning, grief tradition, and burial rites during the COVID-19 pandemic. In this paper, we discuss our experiences, similarities and differences with relation to the: 'Effect of the pandemic on mourning', 'Restrictions and Guideline on burial rites due to the pandemic', 'Effect of the pandemic on social support' and 'Role of media and telecommunication on mourning practices and burial rites'. We conclude that while telecommunication means have attempted to bridge the gap and provide some form of social connectedness, the total and global effect of the pandemic is yet to be fully seen and understood.

[The Role of Colombian Psychiatrists in the Midst of the COVID 19 Pandemic]. / El rol del psiquiatra colombiano en medio de la pandemia de COVID-19.

INTRODUCTION: The COVID-19 pandemic is having an impact on multiple levels, one being the way of providing mental health care services. A study was proposed in order to identify the standpoints regarding the role we must assume as psychiatrists in the setting of this pandemic in Colombia. METHODS: A study was developed employing a Delphi-type methodology. Three types of psychiatrist were included for the application of the instrument: directors of academic psychiatry programmes, directors of mental health institutions and private practitioners. RESULTS: Responses were collected over the course of a month (between April and May) by 24 participants corresponding to 14 private practitioners (58.3%), 6 heads of academic programmes (25.1%) and 4 directors of mental health services (16.6%). The results, grouped around the psychiatric work, describe the impact generated by the pandemic and the possible role of the specialist. CONCLUSIONS: Consistency was identified around the need to provide a differential approach according to the vulnerabilities of each group of people exposed to the pandemic; as well as the remote provision of health care through technology, often using videoconferencing.

The role of Colombian psychiatrists in the midst of the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic is having an impact on multiple levels, one being the way of providing mental health care services. A study was proposed in order to identify the standpoints regarding the role we must assume as psychiatrists in the setting of this pandemic in Colombia. METHODS: A study was developed employing a Delphi-type methodology. Three types of psychiatrist were included for the application of the instrument: directors of academic psychiatry programmes, directors of mental health institutions and private practitioners. RESULTS: Responses were collected over the course of a month (between April and May) by 24 participants corresponding to 14 private practitioners (58.3%), 6 heads of academic programmes (25.1%) and 4 directors of mental health services (16.6%). The results, grouped around the psychiatric work, describe the impact generated by the pandemic and the possible role of the specialist. CONCLUSIONS: Consistency was identified around the need to provide a differential approach according to the vulnerabilities of each group of people exposed to the pandemic; as well as the remote provision of health care through technology, often using videoconferencing.

El rol del psiquiatra colombiano en medio de la pandemia de COVID-19 / The Role of Colombian Psychiatrists in the Midst of the COVID 19 Pandemic

RESUMEN Introducción: La pandemia de COVID-19 genera impactos en múltiples niveles, uno de ellos es la forma de prestar servicios de atención en salud mental. Este estudio se planteó con el fin de identificar las posturas sobre el rol que debemos asumir como psiquiatras en el marco de la pandemia de COVID-19 en Colombia. Métodos: Se desarrolló un estudio mediante metodología tipo Delphi. Para la aplicación del instrumento, se incluyeron 3 tipos de participantes: psiquiatras directores de programas académicos de psiquiatría, psiquiatras directores de instituciones de salud mental y psiquiatras que ejercieran su labor clínica fuera del contexto académico. Resultados: Recolectaron las respuestas en el transcurso de 1 mes (entre abril y mayo) 24 participantes: 14 psiquiatras clínicos (58,3%), 6 directores de residencia (25,1%) y 4 coordinadores de servicios de salud mental (16,6%). Se describen los resultados agrupados en torno al quehacer psiquiátrico, el impacto generado por la pandemia y el posible rol del especialista. Conclusiones: Se identificó consistencia en torno a la necesidad de brindar un abordaje diferencial acorde con las vulnerabilidades propias de cada grupo de personas expuestas a la pandemia, así como la implementación de estrategias de atención psiquiátrica a distancia. © 2021 Publicado por Elsevier España, S.L.U. en nombre de Asociación Colombiana de Psiquiatría.

ABSTRACT Introduction: The COVID-19 pandemic is having an impact on multiple levels, one being the way of providing mental health care services. A study was proposed in order to identify the standpoints regarding the role we must assume as psychiatrists in the setting of this pandemic in Colombia. Methods: A study was developed employing a Delphi-type methodology. Three types of psychiatrist were included for the application of the instrument: directors of academic psychiatry programmes, directors of mental health institutions and private practitioners. Results: Responses were collected over the course of a month (between April and May) by 24 participants corresponding to 14 private practitioners (58.3%), 6 heads of academic programmes (25.1%) and 4 directors of mental health services (16.6%). The results, grouped around the psychiatric work, describe the impact generated by the pandemic and the possible role of the specialist. Conclusions: Consistency was identified around the need to provide a differential approach according to the vulnerabilities of each group of people exposed to the pandemic; as well as the remote provision of health care through technology, often using videoconferencing.

Emerging Psychiatric Themes in Post-COVID-19 Patients on a Psychiatry Consultation-liaison Service.

The need for consultation-liaison psychiatry on COVID-19 wards has substantially increased since the start of the pandemic. In this cross-sectional study, we aimed to summarize the characteristics of patients admitted to the post-COVID-19 ward of the American University of Beirut Medical Center who received a psychiatric consultation. We collected relevant sociodemographic and medical data, information about past psychiatric history, psychiatry consultation details, hospital course, and disposition outcome. We also conducted chi-square and binary logistic regression analyses to assess the association between the different variables and disposition outcome. A total of 52 patients (mean age 57.33 years; equal gender distribution) were seen by the psychiatry consult-liaison team. Most had medical comorbidities and 21.2% required intubation. The most prevalent psychiatric diagnoses were delirium (30.8%), major depressive episode (15.4%), and other anxiety disorder (15.4%). Pharmacological management was implemented in 90.4% of cases and mainly included second-generation antipsychotics (36.5%). Non-pharmacological interventions consisted of those related to delirium and therapy for anxiety. Only intubation was significantly associated with disposition outcome (p = 0.004). This study highlights the various psychiatric themes emerging during the acute and post-acute periods of hospitalization for COVID-19. Hospitalized individuals recovering from the infection should be diligently screened and referred to the psychiatry consultation-liaison team to ensure the implementation of appropriate interventions.

Functionality During the First Five Years After the Diagnosis of Schizophrenia. A Cohort Study in a Colombian Population.

OBJECTIVE: There is a lack of studies on the natural history of the initial stages of schizophrenia in Colombia. This study aims to assess functionality in the first five years after the diagnosis of schizophrenia. METHODS: Naturalistic longitudinal study of 50 patients with early schizophrenia evaluated between 2011 and 2014. Data about demographic background, symptoms, introspection, treatment and adverse reactions were collected in all patients every 3 months for at least 3-5 years. Functionality was measured with the Global Assessment of Functioning (GAF) and Personal and Social Performance (PSP) scales. RESULTS: Patients were followed up for a mean of 174±62.5 weeks and showed moderate difficulties in overall functioning. This functioning was modified by polypharmacy, degree of introspection, changes in antipsychotic regimens, and the number of episodes, relapses and hospitalisations. CONCLUSIONS: The results suggest that functional outcomes seem to be related to the use of polypharmacy, degree of insight, changes in antipsychotic regimens, and number of episodes, relapses and hospitalisations during the first years of schizophrenia.

COVID-19 related mental health issues: a narrative review of psychometric properties of scales and methodological concerns in scale development.

OBJECTIVES: The global crisis of COVID-19 and its consequential strict public health measures placed around the world have impacted mental health. New scales and tools have been developed to measure these mental health effects. This narrative review assesses the psychometric properties of these scales and tools and methodological aspects of their development. METHODS: PubMed, PubMed Central, and Google Scholar were searched for articles published from 15 May 2020 to 15 August 2020. This search used three groups of terms ("tool" OR "scale" AND "mental" OR "psychological"; AND "COVID-19" OR "coronavirus"). The identified scales were further evaluated for their psychometric properties and methodological aspects of their development. RESULTS: Though the studies developing these scales (n = 12) have demonstrated their robust psychometric properties, some methodological concerns are noteworthy. Most of the scales were validated using internet-based surveys, and detailed descriptions of the mode of administration, sampling process, response rates, and augmentation strategies were missing. CONCLUSIONS: The heterogeneous and inadequate reporting of methods adopted to evaluate the psychometric properties of the identified scales can limit their utility in clinical and research settings. We suggest developing guidelines and checklists to improve the design and testing, and result in reporting of online-administered scales to assess the mental health effects of the COVID-19 pandemic.

Telepsychiatry During the COVID-19 Pandemic: Development of a Protocol for Telemental Health Care.

BACKGROUND: The rapid spread of the Coronavirus disease 2019 (COVID-19) has forced most countries to take drastic public health measures, including the closure of most mental health outpatient services and some inpatient units. This has suddenly created the need to adapt and expand telepsychiatry care across the world. However, not all health care services might be ready to cope with this public health demand. The present study was set to create a practical and clinically useful protocol for telemental health care to be applied in the context of the current COVID-19 pandemic. METHODS: A panel of psychiatrists from 15 different countries [covering all World Health Organization (WHO) regions] was convened. The panel used a combination of reactive Delphi technique and consensus development conference strategies to develop a protocol for the provision of telemental health care during the COVID-19 pandemic. RESULTS: The proposed protocol describes a semi-structured initial assessment and a series of potential interventions matching mild, moderate, or high-intensity needs of target populations. CONCLUSIONS: Telemedicine has become a pivotal tool in the task of ensuring the continuous provision of mental health care for the population, and the outlined protocol can assist with this task. The strength of this protocol lies in its practicality, clinical usefulness, and wide transferability, resulting from the diversity of the consensus group that developed it. Developed by psychiatrists from around the globe, the proposed protocol may prove helpful for many clinical and cultural contexts, assisting mental health care providers worldwide.