Critical appraisal of the Colombian clinical practice guide for the prevention, diagnosis and treatment of suicidal ideation and/or behaviour (adoption).

INTRODUCTION: Suicide is a complex, global public health problem. The Colombian clinical practice guideline provides relevant input for its prevention, diagnosis and treatment. The objective was to evaluate the methodological quality, credibility and applicability of the Colombian clinical practice guideline for suicidal behaviour. METHODS: An academic group of 12 evaluators was established to assess the guide and its recommendations in a standardised way, using the AGREE-II and AGREE-REX instruments. The evaluations were given in the range of 0.0-1.0 with 0.7 as a cut-off point for appropriate quality. RESULTS: The global assessment of the AGREE-II was greater than 0.7 in the dimensions: "scope and objective" (0.86), "clarity of presentation" (0.89), "applicability" (0.73) and "editorial independence" (0.89). The lowest scores were for "participation of those involved" (0.67) and "rigour in preparation" (0.69). With the AGREE-REX, the results in all dimensions were below 0.70, which indicates lower quality and suitability for use. CONCLUSIONS: The adoption process of the Colombian guideline for suicidal behaviour was a rigorous methodological process, while the practice recommendations were valued as of low applicability due to low support in local evidence. It is necessary to strengthen the generation and synthesis of evidence at the national level to give greater support and applicability to the practice recommendations.

Relación entre antecedente de maltrato en la niñez y comportamiento maltratador hacia los hijos. Itagüí, Colombia, 2012-2013 / Relationship Between the History of Abuse in the Childhood and Abusive Behaviour Towards Children. Itagüí, Colombia, 2012-2013

RESUMEN Introducción: Una de las experiencias que representan mayor riesgo para el desarrollo de cualquier sociedad es el maltrato infantil. A pesar de las graves consecuencias que derivan de esta forma de violencia, tiende a ser un fenómeno oculto y poco comprendido. La razón que los padres maltraten a sus hijos es una de las cuestiones que mayor interés ha suscitado en la investigación de este fenómeno. Objetivo: Determinar cómo se relaciona el antecedente de maltrato en la niñez de los adultos con el comportamiento maltratador dirigido a sus propios hijos. Métodos: Estudio transversal, a partir de fuente de información secundaria. Se incluyeron variables sociodemográficas, relacionadas con comportamientos violentos dirigidos a otras personas, factores prosociales y el uso de sustancias psicoactivas. A partir de esta población, se seleccionaron 2 grupos, padres maltratadores y no maltratadores de sus propios hijos. En ambos grupos se evaluó la frecuencia de diferentes factores que pudieran explicar la probabilidad de comportamiento maltratador de los adultos hacia sus hijos. Se analizó la asociación entre el comportamiento agresivo contra los propios hijos y el hecho de tener el antecedente de haber sufrido maltrato en la niñez. Como medida de asociación, se utilizó la odds ratio (OR) con su respectivo intervalo de confianza del 95% (IC95%) y un umbral de significación p < 0,05. Resultados: Se incluyó a 187 adultos; el 63,1% eran mujeres. La mediana [intervalo intercuartílico] de edad fue 38 [24-52] años. El comportamiento maltratador de los padres hacia sus hijos se asoció con: sexo femenino (OR = 2,23; IC95%, 1,13-4,40), agresión a la pareja (OR = 3,28; IC95%, 1,58-6,80), agresión a otras personas fuera de la familia (OR = 2,66; IC95%, 1,05-6,74), comportamiento prosocial (OR = 0,32; IC95%, 0,14-0,73) y rasgos de conducta disfuncionales (OR = 2,23; IC95%, 1,11-4,52). No se encontró asociación con el antecedente de maltrato infantil en la niñez (OR = 1,54; IC95%, 0,59-4,04). Conclusiones: El antecedente de los padres de maltrato en la niñez no se asoció con el comportamiento maltratador hacia sus hijos. Sí se asociaron otras formas de violencia dirigida a la pareja y agresión a personas no familiares, lo que indica que el maltrato de la niñez en la población estudiada se relaciona con otras expresiones de violencia familiar y social.

ABSTRACT Introduction: One of the experiences that represent the biggest risk for any society is child abuse. Despite the consequences of this form of violence, it tends to be a hidden and little understood phenomenon. The reason why parents mistreat their children has been one of the issues that has raised the most interest in the investigation of this phenomenon. Objective: To determine how the history of child abuse in adults is related to abusive behaviour directed at their own children. Methodology: A cross-sectional study, based on a source of secondary information. The study included sociodemographic variables, variables related to violent behaviours directed to other people, pro-social factors and the use of psychoactive substances. From this population, 2 groups were selected, parents who were abusive and parents who were not abusive towards their own children. In both groups the frequency of different factors that could explain the probability of abusive behaviour of the adults towards their children was evaluated. We analysed the association between aggressive behaviour against one's own children and having a history of child abuse. As a measure of association, the OR was used with its respective 95% confidence interval and P-value<.05. Results: 187 adults were included, 63.1% were women. The median [IQR] age was 38 [2452] years. The abusive behaviour of the parents towards their children was associated with: the female sex (OR = 2.23; 95%CI, 1.13-4.40), partner's aggression (OR = 3.28; 95%CI, 1.58-6.80), aggression towards other people outside the family (OR = 2.66; 95%CI, 1.05-6.74), pro-social behaviour (OR = 0.32; 95%CI, 0.14-0.73), and dysfunctional behavioural traits (OR = 2.23; 95%CI, 1.11-4.52). There was no association with the history of child abuse (OR= 1.54; 95%CI, 0.59-4.04). Conclusions: The history of abuse in the parents' childhood was not associated with abusive behaviour towards their children. Other forms of partner's violence and non-family violence were associated, suggesting that child abuse in the study population was related to other expressions of family and social violence.

Relationship Between the History of Abuse in the Childhood and Abusive Behaviour Towards Children. Itagüí, Colombia, 2012-2013. / Relación entre antecedente de maltrato en la niñez y comportamiento maltratador hacia los hijos. Itagüí, Colombia, 2012-2013.

INTRODUCTION: One of the experiences that represent the biggest risk for any society is child abuse. Despite the consequences of this form of violence, it tends to be a hidden and little understood phenomenon. The reason why parents mistreat their children has been one of the issues that has raised the most interest in the investigation of this phenomenon. OBJECTIVE: To determine how the history of child abuse in adults is related to abusive behaviour directed at their own children. METHODOLOGY: A cross-sectional study, based on a source of secondary information. The study included sociodemographic variables, variables related to violent behaviours directed to other people, pro-social factors and the use of psychoactive substances. From this population, 2 groups were selected, parents who were abusive and parents who were not abusive towards their own children. In both groups the frequency of different factors that could explain the probability of abusive behaviour of the adults towards their children was evaluated. We analysed the association between aggressive behaviour against one's own children and having a history of child abuse. As a measure of association, the OR was used with its respective 95% confidence interval and P-value<.05. RESULTS: 187 adults were included, 63.1% were women. The median [IQR] age was 38 [24-52] years. The abusive behaviour of the parents towards their children was associated with: the female sex (OR=2.23; 95%CI, 1.13-4.40), partner's aggression (OR=3.28; 95%CI, 1.58-6.80), aggression towards other people outside the family (OR=2.66; 95%CI, 1.05-6.74), pro-social behaviour (OR=0.32; 95%CI, 0.14-0.73), and dysfunctional behavioural traits (OR=2.23; 95%CI, 1.11-4.52). There was no association with the history of child abuse (OR=1.54; 95%CI, 0.59-4.04). CONCLUSIONS: The history of abuse in the parents' childhood was not associated with abusive behaviour towards their children. Other forms of partner's violence and non-family violence were associated, suggesting that child abuse in the study population was related to other expressions of family and social violence.

Isotretinoin therapy for acne vulgaris and first episode psychosis in an adolescent patient / Primer episodio psicótico en adolescente con acné vulgar y tratamiento con isotretinoína

ABSTRACT Introduction: Isotretinoin is a member of the retinoid family of drugs, and has been used for the treatment of severe acne. Its use has been associated with various psychiatric and behavioural symptoms. Methodology: A case report and a non-systematic review of the literature are presented. Results: The case concerns a 13 year-old adolescent with insomnia, delusions, and auditory hallucinations, after two months of treatment with isotretinoin. The patient was admitted to hospital, where the use of psychoactive drugs and systemic disease that could explain the psychotic symptoms are ruled out. After two weeks of stopping the isotretinoin and starting with treatment with olanzapine 10 mg per day, there was complete remission of the psychotic symptoms. Discussion: On the onset of psychotic symptoms in an adolescent with no prior personal or family history of mental illness, the diagnosis of a secondary psychosis needs to be considered. Conclusion: Clinicians would benefit from knowing the psychiatric symptoms that could be associated with the use of this drug, as well as its suspension and specific treatment for emerging psychotic illness.

RESUMEN Introducción: La Isotreitonina, un medicamento de la familia de los retinoides ha sido utilizada para el tratamiento del acné severo. Su uso ha sido asociado con diversos síntomas psiquiátricos de tipo afectivo, psicótico y comportamental. Metodología: Reporte de caso y revisión no sistemática de la literatura relevante. Resultados: Hombre adolescente de 13 anos con insomnio, ideas delirantes, alucinaciones auditivas, luego de dos meses de tratamiento con isotretinoina. El paciente es hospital izado, se descartó el consumo de drogas psicoactivas y enfermedad sistémica que explicaran los síntomas psicóticos. Luego de dos semanas de suspender la isotretinoina y recibir tratamiento con olanzapina 10 mg al día remitieron los síntomas psicóticos. Discusión: El inicio de síntomas psicóticos en un adolescente sin antecedentes personales ni familiares de enfermedad mental exige considerar el diagnósitico de psicosis secundaria. Los clínicos se benefician de conocer los síntomas psiquiátricos que se pueden asociar con este medicamento, considerar la suspensión y el tratamiento específico para la psicopatología emergente.

Características asociadas al riesgo de suicidio valorado clínicamente en personas con intento reciente / Clinical Assessment of Suicidal Risk in Subjects with a Recent Suicide Attempt

Objetivos: Describir en un grupo de sujetos que ingresaron por intento de suicidio a los servicios de urgencias de diferentes centros asistenciales de Medellín (Colombia), las características de aquéllos clasifi cados en la evaluación clínica psiquiátrica como de alto y bajo riesgo de reincidencia. Métodos: Estudio de corte transversal. Se hizo entrevista psiquiátrica a 238 individuos con intento de suicidio reciente para clasifi carlos en dos grupos, de alto y bajo riesgo de reincidencia, y se aplicó el instrumento de autorreporte “inventario de razones para vivir” (RFL). Posteriormente, se compararon las características de ambos grupos. Resultados: El 60,5% de los participantes se consideraron de alto riesgo de suicidio y los factores que se encontraron asociados fueron: trastorno depresivo mayor (OR=5,78, IC95%: 3,01-11,2), método violento (OR=5,21, IC95%: 1,89-14,37), intoxicación por sustancias psicoactivas durante el intento (OR=2,46, IC95%: 1,07-5,64) y puntuación en el “inventario de razones para vivir” (OR=0,47, IC95%: 0,34- 0,66). Conclusiones: Aunque los resultados no son generalizables, son similares a los encontrados en otros lugares. Es necesario hacer estudios longitudinales que permitan determinar la utilidad de estas características para predecir conductas suicidas.

Objectives: To describe the characteristics that rendered subjects as having either high risk or low risk of suicide, according to the psychiatric evaluation performed after a suicidal attempt in different emergency services in Medellín, Colombia. Methods: It is a cross-sectional design. 238 individuals were interviewed to classify them in a group of high suicide risk or a group of low suicide risk. The self-report scale “Reasons for Living Inventory” (RFL) was applied. After that, characteristics of the high and low risk groups were compared. Results: The 60.5% of the participants were classifi ed as high risk attempters. The factors associated with high risk were: major depressive disorder (OR=5.78, CI 95%: 3.01-11.2), violent method (OR=5.21, CI 95%: 1.89-14.37), attempt during psychoactive substance intoxication (OR=2.46, CI95%: 1.07-5.64) and score of the “Reasons for Living Inventory” (OR=0.47, IC95%: 0.34-0.66). Conclusions: The results are similar to those reported in studies carried out in other places. Further longitudinal studies are required for determining the utility of these characteristics to predict future suicidal behavior.