[Implementation and operation of protected residences for people with serious mental illness in Iquitos, Peru (2013-2016)Implementação e funcionamento de residências terapêuticas para pessoas com transtornos mentais graves em Iquitos, Peru (2013-2016)]. / Implementación y funcionamiento de hogares protegidos para personas con trastornos mentales graves en Iquitos, Perú (2013-2016).

OBJECTIVE: Evaluate the implementation and operation of protected residences for people with serious mental illness in Iquitos, based on the benefits and perceived improvement in their quality of life. METHODS: Qualitative and cross-cutting study. Thirty-six in-depth interviews of residents, caregivers, neighbors, and health professionals were conducted. A sociodemographic and clinical file was completed for each resident, along with a file on managerial processes for each facility. Focus groups were conducted with managers and caregivers. RESULTS: Residents' previous length of stay in a psychiatric hospital was 7 years and 3 months. Only 28 % had suffered a clinical relapse in the past year. Residents reported an improvement in their quality of life and greater satisfaction with their stay in the facility compared with their stay in the psychiatric hospital. The residences evaluated are located in areas accessible to social and community services, with adequate access to transportation. Periodic supervision of caregivers, infrastructure, and residence maintenance was performed. CONCLUSIONS: Caregivers, managers, residents, and neighbors have a positive view of residence operations.

OBJETIVO: Avaliar o processo de implementação e funcionamento de residências terapêuticas ("pensões protegidas") para pessoas portadoras de transtornos mentais graves segundo a percepção de benefício e melhoria da qualidade de vida. MÉTODOS: Trata-se de um estudo transversal qualitativo realizado em Iquitos, no Peru. Trinta e seis entrevistas em profundidade foram conduzidas com os moradores de residências terapêuticas, cuidadores, vizinhos e profissionais de saúde. Foi feito o preenchimento de uma ficha sociodemográfica e clínica para cada morador e uma ficha do processo de gestão por residência. Foram realizados grupos de discussão com gestores e cuidadores. RESULTADOS: A permanência prolongada anterior em instituição manicomial dos moradores das residências foi de 7 anos e 3 meses. Apenas 28% tiveram recaída clínica no último ano. Os moradores perceberam melhoria da qualidade de vida e informaram um nível maior de satisfação com a permanência nas residências terapêuticas em comparação à permanência anterior em instituição manicomial. As residências estudadas se situavam em locais acessíveis aos funcionários dos serviços sociais e comunitários, com acesso adequado ao transporte público. O trabalho dos cuidadores e a infraestrutura e manutenção das residências receberam supervisão periódica. CONCLUSÕES: O funcionamento das residências terapêuticas é percebido favoravelmente por cuidadores, gestores, moradores e vizinhos.

Perception about psychosocial integration clubs for people with schizophrenia in Lima, Peru. / Percepción sobre los clubes de integración psicosocial para personas con esquizofrenia en Lima, Perú.

OBJECTIVE: To know the perception of users, caregivers and health professionals about the implementation, operation and satisfaction related to their participation in psychosocial integration clubs (PIC) for people with diagnosis of schizophrenia in two districts of northern Lima. MATERIALS AND METHODS: This study had a qualitative methodological approach. In-depth interviews and 3 focus groups were conducted with 21 participants including users, family caregivers, and mental health professionals. The information was collected in December 2018. We analyzed the perceptions of the implementation process and satisfaction of the club's users, their affective relationships and leisure, their link with families and socio-community networks, as well as the perceived limitations. RESULTS: The perception of club's users, caregivers and mental health professionals was favorable regarding the implementation, functioning and satisfaction of the users, as an integrating and socializing role, through their active participation, social reintegration in normalizing activities with their community, the health network and in the strengthening of family ties. PICs are perceived as spaces for socialization that have a relevant meaning in the lives of users. CONCLUSIONS: Participants perceive PICs as a space for well-being and adequate use of free time, which contributes to the rehabilitation of the user's disease.

OBJETIVO: Conocer la percepción de los usuarios, cuidadores y profesionales de la salud sobre la implementación, funcionamiento y satisfacción relacionada con su participación en los clubes de integración psicosocial (CIP) para personas con diagnóstico de esquizofrenia en dos distritos de Lima Norte. MATERIALES Y MÉTODOS: Estudio con enfoque metodológico cualitativo. Se realizaron entrevistas a profundidad y 3 grupos focales con 21 participantes, entre usuarios, familiares cuidadores y profesionales de la salud mental. Se recolectó la información en diciembre de 2018 y se analizaron las percepciones sobre el proceso de implementación y satisfacción de los usuarios del club, sus relaciones afectivas y el ocio, su vinculación con las familias y redes sociocomunitarias, así como las limitaciones percibidas. RESULTADOS: La percepción de los usuarios, cuidadores y profesionales de la salud mental fue favorable acerca de la implementación, funcionamiento y satisfacción de los socios como rol integrador y socializador a través de su participación, la reinserción social en actividades normalizadoras en su comunidad, red sanitaria y en el fortalecimiento de vínculos familiares. Los CIP se perciben como espacios de socialización que tienen un significado relevante en la vida de los usuarios. CONCLUSIONES: Los participantes perciben el CIP como un espacio de bienestar y uso de tiempo libre adecuado que contribuye en la rehabilitación de su enfermedad.

Percepción sobre los clubes de integración psicosocial para personas con esquizofrenia en Lima, Perú / Perception about psychosocial integration clubs for people with schizophrenia in Lima, Peru

RESUMEN Objetivo: Conocer la percepción de los usuarios, cuidadores y profesionales de la salud sobre la implementación, funcionamiento y satisfacción relacionada con su participación en los clubes de integración psicosocial (CIP) para personas con diagnóstico de esquizofrenia en dos distritos de Lima Norte. Materiales y métodos: Estudio con enfoque metodológico cualitativo. Se realizaron entrevistas a profundidad y 3 grupos focales con 21 participantes, entre usuarios, familiares cuidadores y profesionales de la salud mental. Se recolectó la información en diciembre de 2018 y se analizaron las percepciones sobre el proceso de implementación y satisfacción de los usuarios del club, sus relaciones afectivas y el ocio, su vinculación con las familias y redes sociocomunitarias, así como las limitaciones percibidas. Resultados: La percepción de los usuarios, cuidadores y profesionales de la salud mental fue favorable acerca de la implementación, funcionamiento y satisfacción de los socios como rol integrador y socializador a través de su participación, la reinserción social en actividades normalizadoras en su comunidad, red sanitaria y en el fortalecimiento de vínculos familiares. Los CIP se perciben como espacios de socialización que tienen un significado relevante en la vida de los usuarios. Conclusiones: Los participantes perciben el CIP como un espacio de bienestar y uso de tiempo libre adecuado que contribuye en la rehabilitación de su enfermedad.

ABSTRACT Objective: To know the perception of users, caregivers and health professionals about the implementation, operation and satisfaction related to their participation in psychosocial integration clubs (PIC) for people with diagnosis of schizophrenia in two districts of northern Lima. Materials and methods: This study had a qualitative methodological approach. In-depth interviews and 3 focus groups were conducted with 21 participants including users, family caregivers, and mental health professionals. The information was collected in December 2018. We analyzed the perceptions of the implementation process and satisfaction of the club's users, their affective relationships and leisure, their link with families and socio-community networks, as well as the perceived limitations. Results: The perception of club's users, caregivers and mental health professionals was favorable regarding the implementation, functioning and satisfaction of the users, as an integrating and socializing role, through their active participation, social reintegration in normalizing activities with their community, the health network and in the strengthening of family ties. PICs are perceived as spaces for socialization that have a relevant meaning in the lives of users. Conclusions: Participants perceive PICs as a space for well-being and adequate use of free time, which contributes to the rehabilitation of the user's disease.

Implementación y funcionamiento de hogares protegidos para personas con trastornos mentales graves en Iquitos, Perú (2013-2016) / Implementation and operation of protected residences for people with serious mental illness in Iquitos, Peru (2013-2016) / Implementação e funcionamento de residências terapêuticas para pessoas com transtornos mentais graves em Iquitos, Peru (2013-2016)

RESUMEN Objetivo Evaluar el proceso de implementación y funcionamiento de los hogares protegidos para las personas con trastornos mentales graves en Iquitos, con base en el beneficio y la mejora en la calidad de vida percibida. Métodos Estudio con enfoque cualitativo y transversal. Se realizaron 36 entrevistas a profundidad a residentes del hogar, cuidadores, vecinos y profesionales de salud. Se llenó una ficha sociodemográfica y clínica por cada residente y una ficha de procesos de gestión por cada hogar protegido. Se realizaron grupos focales con gestores y cuidadores. Resultados El tiempo de estancia prolongada manicomial previa de los residentes de hogares protegidos fue de 7 años y 3 meses. Solo 28 % habían presentado recaída clínica durante el último año. Los residentes percibieron mejoría en su calidad de vida y mayor satisfacción en la estancia en hogar protegido respecto a la estancia manicomial previa. Los hogares evaluados se encuentran en lugares accesibles a servicios sociales y comunitarios, con adecuado acceso a medios de transporte. Se realizaron supervisiones periódicas a los cuidadores, infraestructura y mantenimiento del hogar. Conclusiones Existe percepción favorable de cuidadores, gestores, residentes y vecinos sobre el funcionamiento de los hogares protegidos.

ABSTRACT Objective Evaluate the implementation and operation of protected residences for people with serious mental illness in Iquitos, based on the benefits and perceived improvement in their quality of life. Methods Qualitative and cross-cutting study. Thirty-six in-depth interviews of residents, caregivers, neighbors, and health professionals were conducted. A sociodemographic and clinical file was completed for each resident, along with a file on managerial processes for each facility. Focus groups were conducted with managers and caregivers. Results Residents' previous length of stay in a psychiatric hospital was 7 years and 3 months. Only 28 % had suffered a clinical relapse in the past year. Residents reported an improvement in their quality of life and greater satisfaction with their stay in the facility compared with their stay in the psychiatric hospital. The residences evaluated are located in areas accessible to social and community services, with adequate access to transportation. Periodic supervision of caregivers, infrastructure, and residence maintenance was performed. Conclusions Caregivers, managers, residents, and neighbors have a positive view of residence operations.

RESUMO Objetivo Avaliar o processo de implementação e funcionamento de residências terapêuticas ("pensões protegidas") para pessoas portadoras de transtornos mentais graves segundo a percepção de benefício e melhoria da qualidade de vida. Métodos Trata-se de um estudo transversal qualitativo realizado em Iquitos, no Peru. Trinta e seis entrevistas em profundidade foram conduzidas com os moradores de residências terapêuticas, cuidadores, vizinhos e profissionais de saúde. Foi feito o preenchimento de uma ficha sociodemográfica e clínica para cada morador e uma ficha do processo de gestão por residência. Foram realizados grupos de discussão com gestores e cuidadores. Resultados A permanência prolongada anterior em instituição manicomial dos moradores das residências foi de 7 anos e 3 meses. Apenas 28% tiveram recaída clínica no último ano. Os moradores perceberam melhoria da qualidade de vida e informaram um nível maior de satisfação com a permanência nas residências terapêuticas em comparação à permanência anterior em instituição manicomial. As residências estudadas se situavam em locais acessíveis aos funcionários dos serviços sociais e comunitários, com acesso adequado ao transporte público. O trabalho dos cuidadores e a infraestrutura e manutenção das residências receberam supervisão periódica. Conclusões O funcionamento das residências terapêuticas é percebido favoravelmente por cuidadores, gestores, moradores e vizinhos.

[Pregnancy Delusions and Pseudocyesis: Brief Approach]. / Delirios de embarazo y pseudociesis: una breve aproximación.

INTRODUCTION: Pregnancy delusions have usually been considered as symptoms of psychotic disorders in opposition to the hysterical and psychosomatic nature of pseudocyesis, though several authors have described some semiologic intersection between the two phenomena. METHOD: Introduction of four cases of patients with pregnancy delusions as well as review and discussion of relevant bibliography. RESULTS: In fact, there are symptoms shared by pregnancy delusions psychosis and pseudocyesis, without detriment of nosological differentiation between the two phenomena. There is certain confusion regarding conceptual and terminological issues that does not contribute to mark precise boundaries. CONCLUSION: A comprehensive and holistic approach for the study of pseudocyesis and pregnancy delusion is proposed. Maybe, these disorders are more frequently observed in Latin America.

Estrés postraumático y comorbilidad asociada en víctimas de la violencia política de una comunidad campesina de Huancavelica, Perú. 2013 / Post-traumatic stress disorder and co-morbidity among victims of political violence in a rural community of Huancavelica, Peru. 2013

Entre los años 1980 y 2000 nuestro país vivió uno de los más cruentos conflictos armados de su historia. El departamento de Huancavelica, zona de extrema pobreza del Perú, fue uno de los principales lugares afectados.Objetivos: Determinar las características sociodemográficas, prevalencia de trastorno de estrés postraumático (TEPT), comorbilidad psiquiátrica y factores asociados en víctimas de la violencia política de la comunidad campesina de Cuñi, en el departamento de Huancavelica. Material y métodos: Se usó un diseño observacional, de corte transversal, se seleccionó a 121 habitantes de la comunidad, mayores de 18 años, que vivieron en el lugar durante el periodo de violencia política. La muestra representativa se seleccionó mediante muestreo por conglomerados multietápico y aleatorio. Se aplicó el Cuestionario Mini International Neuropsychiatric Interview (MINI) adaptado por el Instituto Nacional de Salud Mental de Perú (INSM) para valorar TEPT y comorbilidad asociada. Resultados: La mayoría de encuestados estaban en extrema pobreza. El promedio de eventos traumáticos como consecuencia de la violencia política fue de 2,26. La prevalencia de vida de TEPT fue 25,6%. Todas las personas encuestadas tuvieron al menos un trastorno psiquiátrico comórbido: los más frecuentes fueron el trastorno de ansiedad generalizada y la depresión. Conclusiones: Se evidenció elevada prevalencia de eventos traumáticos y prevalencia de vida de TEPT y comorbilidad asociada en dicha zona rural.

Between 1980 and 2000, our country experienced one of the bloodiest conflicts in its history. The department of Huancavelica, extreme poverty area of Peru, was one of the main sites affected. Objectives: To determine the sociodemographic characteristics, prevalence of Post-traumatic Stress Disorder (PTSD), comorbidity, and associated factors in victims of political violence in the rural community of Cuñi, in the department of Huancavelica. Methods: An observational, cross-section design was used. One hundred and twenty one community residents were selected , aged 18, who lived at the site during the period of political violence. The representative sample was selected by multistage random sampling clusters. The Mini International Neuropsychiatric Interview (MINI) questionnaire adapted by the National Institute of Mental Health of Peru (INSM) was used to assess PTSD and comorbidity. Results: Most respondents were in extreme poverty (average monthly income 24.4 dollars). The average number of traumatic events relating to political violence was 2.26. The lifetime prevalence of PTSD was 25.6 %. All respondents had at least one comorbid disorder. The most prevalent comorbidity was generalized anxiety disorder and depression. Conclusions: High prevalence of PTSD and comorbidity was observed. Furthermore, high prevalence of traumatic events and extreme poverty in this rural area was evident.

Cine peruano actual y psicopatología / Current Peruvian cinema and psychopathology

La conducta humana anormal ha sido fuente inagotable para la industria cinematográfica, difusora muchas veces de prejuicios, mas también creadora de personajes memorables para la psiquiatría. En el presente artículo se presenta un análisis psicopatológico de cinco películas peruanas actuales: “Maruja en el infierno” (1983), “Caídos del cielo” (1990), “Bajo la piel” (1996), “Días de Santiago” (2004) y “La teta asustada” (2009).

Abnormal human behavior has been an inexhaustible source for the film industry, often disseminating prejudice, but also cinema has created memorable characters for psychiatry. A psychopathological analysis of five current Peruvian films are presented in this article: “Maruja en el infierno” (1983), “Caídos del cielo” (1990), “Bajo la piel” (1996), “Días de Santiago” (2004) y “La teta asustada” (2009).

Delirios de embarazo y pseudociesis una breve aproximación / Pregnancy delusions and pseudocyesis: brief approach

Introducción: Los delirios de embarazo como síntomas de distintos cuadros psicóticos hansido presentados usualmente en oposición a la naturaleza histérica y psicosomática de laPseudociesis, aunque diversos autores han advertido cierta intersección semiológica entreAmbos fenómenos. Método: Presentamos cuatro casos de pacientes psicóticas que presen-taron delirios de embarazo y revisamos y discutimos la bibliografía pertinente. Resultados: Constatamos la presencia de algunos síntomas compartidos entre psicosis con delirios de embarazo y pseudociesis, aunque sin desmedro de la respectiva diferenciación no sológicaentre los dos fenómenos; existe cierta confusión en los aspectos conceptuales y terminológicos que no contribuye a deslindarlos de forma precisa. Conclusión: Se plantea una visiónamplia y holística para el estudio de la pseudociesis y los delirios de embarazo, que podríanser más frecuentes en realidades como la latinoamericana…

Introduction: Pregnancy delusions have usually been considered as symptoms of psychotic disorders in opposition to the hysterical and psychosomatic nature of pseudocyesis, though several authors have described some semiologic intersection between the two phenomena. Method: Introduction of four cases of patients with pregnancy delusions as well as review and discussion of relevant bibliography. Results: In fact, there are symptoms shared by pregnancy delusions psychosis and pseu- docyesis, without detriment of nosological differentiation between the two phenomena. There is certain confusion regarding con- ceptual and terminological issues that does not contribute to mark precise boundaries. Conclusion: A comprehensive and holistic approach for the study of pseudocyesis and pregnancy delusion is proposed. Maybe, these disorders are more frequently observed in Latin America…

Insulinoma, convulsiones y psicosis: a propósito de un caso / Insulinoma, seizures and psychosis: a case report

El insulinoma es una causa poco frecuente de hipoglicemia, que puede manifestarse con síntomas neurológicos y psiquiátricos. Se describe el caso de un varón con insulinoma, que presentó convulsiones y síntomas psicóticos durante varios años, hasta que fue diagnosticado e intervenido quirúrgicamente.

Insulinoma is a rare cause of hypoglycemia, which may manifest as neurological and psychiatric symptoms. We report a case of a man with insulinoma, who presented seizures and psychotic symptoms for several years, until he was diagnosed and underwent surgery.

Encuesta virtual sobre uso de internet y medios informáticos entre psiquiatras y residentes de psiquiatría en el Perú / Virtual survey of internet use and computer resources by peruvian psychiatrists and psychiatric residents

Objetivo: Describir las características del uso de Internet y medios informáticos por psiquiatras y residentes de psiquiatría peruanos.Material y métodos: Se elaboró una encuesta virtual que fue distribuida entre psiquiatras y residentes de psiquiatría vía enlace web y por correo a través de la lista de correos (grupo virtual) de la Asociación Psiquiátrica Peruana. El cuestionario estuvo constituido por 17 ítems que incluían datos demográficos, datos de acceso, uso de Internet y recursos informáticos.Resultados: La población fue de 285, contestaron 119 personas y se consideraron 100 encuestas. La edad promedio fue de 48 años (66% del sexo masculino, 34% del sexo femenino). El 83% de los encuestados tenía como principal lugar de actividad laboral un organismo público, residiendo el 87% de los encuestados en Lima. El 77% de los encuestados afirmó acceder al uso de Internet diariamente, siendo el promedio de horas semanales 11,6 horas. Respecto al uso de bases de información a texto completo, el 65%utilizaba Hinari, el 44% SciELO y el 40% Cochrane. Entre las bases referenciales el 55% utilizaba Pubmed y el 37%LILACS. El 92,6% de médicos afirmó estar de acuerdo en que los usuarios de servicios de salud busquen información orientada a la salud mental en Internet. Conclusión: La mayoría de psiquiatras y residentes encuestados utiliza el Internet y correo electrónico como medio para acceder a información académica relevante. El uso de diversas bases de datos es frecuente, a diferente edad. Existe buena aceptación de los encuestados sobre la difusión y acceso a información médica por parte de los usuarios de servicios de salud mental.(Rev Neuropsiquiatr 2011;74:191-199).

Objective: To describe the features of lntemet use and computer resources by Peruvian psychiatrists and psychiatric residents. Material and methods: A virtual survey was developed and distributed among psychiatrists and psychiatric residents by a web link and e-mail (virtual group) of the Peruvian Psychiatric Association. The questionnaire contained 17 items including demographic information, information access, use of Internet and computer resources. Results: The population was 285, 119 persons answered the survey and 100 surveys were analyzed. The average age was 48 years (66 % were male, 34 % female). Eighty three percent of the subjects had a public institution as their main working place, 87 % lived in Lima, 77 % had daily access to the Internet, and the average of weekly hours was 11.6 hours. Regarding the use of database full text information, 65% accessed Hinari, 44 % SciELO and 40 % Cochrane. Fifty five percent used Pubmed and 37% LILACS as reference database and 92.6% of psychiatrists agreed that patients seek information geared towards mental health online. Conclusion: The majority of psychiatrists and psychiatric residents surveyed used Internet and e-mail as a way to access relevant academic information. The use of several databases is frequent at different ages. There is a good acceptance of the diffusion and access to medical information by mental health service users among the surveyed practitioners.