Development and content validity of EVAD: A novel tool for evaluating and classifying the severity of adverse events for psychotherapeutic clinical trials.

OBJECTIVE: Develop and obtain content validity of a new tool for Evaluating and Classifying the Severity of Adverse Events for Psychotherapeutic Clinical Trials (EVAD). METHOD: Study of the development process of EVAD in four stages: (1) identify the domain and concept definition through a literature review, (2) instrument design, (3) expert judgment of the EVAD items through Gwent's concordance coefficient, and (4) applicability. RESULTS: In the absence of a consistent conceptual framework of adverse events in psychotherapeutic clinical trials, we have developed a framework and defined it. We have designed EVAD items and their complementary tool for rating adverse events. Content validation by expert judges resulted in CVR = 1.0 for each item and CVI = 0.79 in sufficiency, 0.76 in clarity, 0.91 in coherence and 0.95 in relevance for all items (p < 0.001). Final version of EVAD were applied to three participants for 7 weeks. Overall EVAD seems to be clear and meaningful for participants. CONCLUSIONS: EVAD is a semistructured interview based on a consistent conceptual framework, and proven content validity following the most important guidelines described in the literature. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03878186.

Low quality of life, increased number of anti-seizure drugs, and the lack of caregiver support are associated with internalized stigma in adult Mexican patients with epilepsy.

BACKGROUND: People with epilepsy (PWE) have been subject to stigma throughout history, a factor that could compromise their performance in daily life. In Mexico, little is known about the factors that may be affecting internalized stigma. OBJECTIVE: To evaluate the internalized stigma in adult PWE, its relationship with the quality of life, cognitive and depressive symptomatology, and clinical-demographic characteristics. MATERIAL AND METHODS: We conducted a cross-sectional study with a consecutive sampling approach in patients with epilepsy treated at the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez (NINNMVS). Sociodemographic and clinical data, depressive symptomatology (Beck's depression inventory, DBI), cognition (MoCA test), quality of life (QOLIE-31 scale), and internalized stigma (King's internalized stigma scale, ISS) were evaluated. Correlations were made between the continuous variables and the ISS to select those with statistical significance and include them in a multiple linear regression model, along with the dummy variables, to explain internalized stigma. RESULTS: Of 128 patients, 74 (58%) were women; 38% of the patients had more than 20 years of epilepsy evolution. In addition, 39% presented depressive symptoms, and around 60% manifested a possible cognitive impairment. The variables that showed statistical significance concerning the ISS were selected along with dummy variables for multiple linear regression analysis. The resultant model considers the QOLIE-31 total score (ß = -0.489), the number of anti-seizure drugs (ASD, ß = 0.253), and those patients without caregiver support (ß = -0.166) with an adjusted R2 value of 0.316. CONCLUSIONS: A diminishing quality of life, an increased number of ASD, and patients without caregiver support influence a slight to moderate variation of internalized stigma in Mexican PWE. Therefore, it is necessary to continue studying other possible factors that influence internalized stigma to generate effective strategies to reduce its negative effects on PWE.

Psychiatric beds and prison populations in 17 Latin American countries between 1991 and 2017: rates, trends and an inverse relationship between the two indicators.

BACKGROUND: In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America. METHODS: We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela. RESULTS: The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median -35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship -2.70 (95% CI -4.28 to -1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates -2.37 (95% CI -3.95 to -0.8; p = 0.006). CONCLUSIONS: Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.

Mexican Psychiatric Trainees' Attitudes Towards People with Mental Illness: A Qualitative Study.

Despite their training, psychiatrists have been found to have negative attitudes towards people with mental illness, including the patients they treat. Similarly, studies focused on service users have identified psychiatrists as a source of stigma. Even though negative attitudes in psychiatrists have been identified in different countries and settings, in Mexico the attitudes of these professionals have never been assessed. Because of this, we invited psychiatric trainees from a hospital in Mexico to participate in individual interviews to describe their opinions regarding mental health-related stigma, to evaluate their attitudes towards people with mental illness and to identify factors that could be influencing their attitudes. Interviews were audio recorded, transcribed and analysed using thematic analysis. A total of 29 trainees participated in the study. The results suggested that trainees recognised psychiatrists can have negative attitudes towards people with mental illness, such as poor empathy, judgement and labelling, and mainly towards patients considered difficult and with borderline personality disorder. Participants recognised these attitudes can influence their relationship with patients, and considered it is necessary to develop interventions to improve their own attitudes and reduce mental health stigma. From this study we concluded Mexican psychiatrists are not free from stigma towards people with mental illness. However, Mexican psychiatric trainees are interested in improving their attitudes and reactions towards their patients.

Mental Health Factors Associated With Fatigue in Mexican Patients With Inflammatory Bowel Disease.

GOALS: The aim of this study was to describe mental health factors associated with the development of fatigue in inflammatory bowel disease (IBD) patients. BACKGROUND: IBD includes ulcerative colitis and Crohn's disease. Patients with chronic diseases can present fatigue differently and qualitatively more severely than those typically represented by healthy populations. STUDY: This was a cross-sectional study in which 200 Mexican patients were attending the Inflammatory Bowel Disease Clinic at the National Institute of Medical Sciences and Nutrition. All patients answered 3 instruments: the first IBD-fatigue, HADS (Hospital Anxiety and Depression Scale), and PSQI (Pittsburgh Sleep Quality Index). The statistical analysis was carried out in the statistical program SPSS v 24. RESULTS: The percentage of fatigue in our patients was 55.5% (n=111) for mild-moderate fatigue, 31.5% (n=63) for severe fatigue, and only 13% (n=26) had no fatigue. Sleep disturbance and sleep latency were the most important predictors of fatigue in IBD patients. CONCLUSIONS: Sleep quality and depression have an impact on fatigue in Mexican patients with IBD. It is important for multidisciplinary management to reduce these symptoms and improve the quality of life of patients with IBD.

The ICD-11 classification of gender incongruence of adolescence and adulthood: adequacy among transgender people in Lebanon.

The aim of this study was to evaluate the adequacy of the then proposed International Classification of Diseases version 11 (ICD-11) diagnostic guidelines for Gender Incongruence of Adolescence and Adulthood in a sample of transgender people accessing multi-disciplinary health care services at specialised organisations in Lebanon. The cross-sectional study reported here was part of the ICD-11 field test studies that took place in several countries. Twenty-eight Arab transgender adults residing in Lebanon were recruited after giving consent to participate in a structured interview with a mental health professional. The questions asked of them consisted of the following: socio-demographic data; medical history related to gender identity; experiences of gender incongruence; psychological distress; rejection; violence; and functional impairment. Results showed that Arab transgender individuals living in Lebanon report being the victims of violence, abuse, discrimination and rejection from family, peers and society in general. As a result, they develop psychological distress that is better explained by the social context in which they live, rather than by their transgender identity. Reformulating ICD-10 Transsexualism as Gender Incongruence of Adolescence and Adulthood in ICD-11 and moving this diagnosis out of the chapter on mental disorders chapter would be favourable to the Lebanese sample.

Mental Health Service Users' Perceptions of Stigma, From the General Population and From Mental Health Professionals in Mexico: A Qualitative Study.

Negative attitudes towards people with mental health disorders have been widely studied and identified in the general population, and even within health care professionals. Moreover, studies focused on service users have also identified mental health professionals, including psychiatrists, as a source of stigma. However, in Mexico and Latin America few studies have been conducted addressing this issue. To explore mental health service users' perceptions of stigma by members of the general population and by psychiatrists in Mexico, service users at a psychiatric hospital in Mexico were invited to participate in either focus groups or individual interviews, which were audio recorded, transcribed and analysed using thematic analysis. A total of 47 service users participated in this study. The results suggested that participants were not only aware of the possible consequences of mental health related stigma, but they have also experienced stigmatisation for having a mental illness. Participants also considered psychiatrists can hold negative attitudes towards people with mental illness, something that can represent a barrier for them to have optimal quality of care. Therefore, participants agreed that these attitudes should be addressed to improve the care they received from these professionals. This study suggests that, like members of the general population, psychiatrists are also considered as a source of stigma by people with mental illness in Mexico. These findings not only add to previous work conducted in Mexico and other countries, they also confirm the importance of addressing negative attitudes in this group of health professionals.

Validity and reliability of the Inflammatory Bowel Disease Fatigue Scale in Mexican patients.

INTRODUCTION: Fatigue is an extra-intestinal manifestation of inflammatory bowel disease (IBD). OBJECTIVE: To determine the construct validity, discriminant validity and reliability of an instrument for evaluating the Fatigue Scale for IBD in Mexican patients. METHODS: Two hundred patients with an IBD confirmed diagnosis were included. Current demographic and clinical characteristics of the condition were evaluated. Each patient answered the IBD Fatigue Scale (IBD-F) and the Pittsburgh Sleep Quality Index (PSQI), which was used to determine IBD-F discriminant validity. A factor analysis of each IBD-F section was performed, independent sample Student's t-tests were used to contrast the PSQI, and reliability was evaluated using Cronbach's alpha. RESULTS: The items in both IBD-F sections showed high factor loadings, which explained 68.3 and 38.4% of variance, respectively. Cronbach's alpha was > 0.80 in both, which discriminated patients with greater sleep disturbances. CONCLUSIONS: IBD-F is a valid and reliable scale for Mexican patients with IBD. Fatigue objective evaluation will allow timely interventions in order to reduce its impact on patients with IBD.

INTRODUCCIÓN: La fatiga es una manifestación extraintestinal de la enfermedad inflamatoria intestinal (EII). OBJETIVO: Obtener la validez de constructo, la validez discriminante y la confiabilidad de un instrumento para evaluar una escala de fatiga para EII en pacientes mexicanos. MÉTODOS: Se incluyeron 200 pacientes con diagnóstico confirmado de EII. Se evaluaron las características demográficas y clínicas actuales del padecimiento. Cada paciente contestó la Escala de Fatiga para EII (IBD-F) y el Índice de Calidad de Sueño de Pittsburgh (PSQI), empleado para determinar la validez discriminante de la IBD-F. Se realizó un análisis factorial de cada sección de la IBD-F, se utilizó la t de Student de muestras independientes para el contraste del PSQI y la confiabilidad se evaluó mediante alfa de ZCronbach. RESULTADOS: Los reactivos de ambas secciones de la IBD-F mostraron altas cargas factoriales, que explicaron 68.3 y 38.4 % de la varianza, respectivamente. El alfa de Cronbach fue > 0.80 en ambas, las cuales discriminaron a los pacientes con mayores alteraciones en el sueño. CONCLUSIONES: La IBD-F es una escala válida y confiable para pacientes mexicanos con EII. La evaluación objetiva de la fatiga permitirá realizar intervenciones oportunas para disminuir el impacto de esta manifestación en el paciente con EII.

Combining Adobe Forms and Dropbox to Obtain a Low-Cost Electronic Data Collection System.

BACKGROUND: The method used to collect, store, and analyze data can affect the quality of data obtained. Many studies have shown the advantages of electronic systems over paper. Numerous tools are available for this purpose; however, they tend to be implemented only in high-budget protocols as they tend to be expensive. INTRODUCTION: We report the experience of the Affective Disorders' Clinic of the National Institute of Psychiatry in Mexico City using Adobe Acrobat® Forms combined with Dropbox® as storage and distribution method for clinical protocols. MATERIALS AND METHODS: Adobe Acrobat 9 Pro® was used to create personalized forms to capture data for seven different clinical purposes. Dropbox was used to share the distributed forms with fellow researchers. Completed forms were stored in Dropbox and the main researcher kept the data collection file, from where the forms were gathered for analysis. RESULTS: Sixteen forms created for different clinical purposes had an average of 1.2% missing fields. DISCUSSION: The main drawbacks relate to remote filling and the time spent in fine-tuning complex forms. The main advantages relate to the simplicity of the implementation of the method and the fact that no software other than the one available at the Institute is required. CONCLUSIONS: Compared with other types of electronic data collection systems, the combination of these tools achieves similar goals and is low cost, requiring minimal knowledge of informatics.

Validación de Belief Medicines Questionnaire y Self-efficacy for Appropriate Medication Use Scale para medir adherencia al tratamiento farmacológico en pacientes con enfermedad inflamatoria intestinal.

INTRODUCTION: Treatment adherence is crucial in inflammatory bowel disease (IBD) to prevent relapses and complications. In Mexico, there is not a validated tool to assess adherence in patients with IBD. OBJECTIVE: To translate the beliefs about medicines questionnaire (BMQ) and self-efficacy for appropriate medication use scale (SEAMS) instruments, as well as to determine their validity, reliability and sensitivity in IBD-diagnosed Mexican patients. METHOD: After informed consent was obtained, 149 IBD-diagnosed patients were included. The instruments were translated into Spanish and were subsequently applied during medical consultation. For SEAMS, exploratory factorial analysis and ROC curve analysis were carried out and Cronbach's alpha was determined; for the BMQ, Cohen's kappa coefficient and its predictive capacity were employed. RESULTS: Seventy-five women (50.3%) were included, with an average age of 44 years. The SEAMS scale showed a single factor that was highly reliable (Cronbach's alpha = 0.92) and a cutoff point of 33 to identify adherent patients. The "adherence" and "recall barrier" dimensions of the BMQ were adequate adherence predictors. CONCLUSIONS: The SEAMS and BMQ Spanish versions are valid for measuring self-efficacy and barriers to pharmacological treatment adherence in Mexican patients with IBD.

INTRODUCCIÓN: La adherencia terapéutica es crucial en la enfermedad inflamatoria intestinal (EII) para evitar recaídas y complicaciones. En México no se dispone de una herramienta validada para evaluar adherencia en pacientes con EII. OBJETIVO: Traducir los instrumentos Belief Medicines Questionnaire (BMQ) y Self-Efficacy for Appropriate Medication Use Scale (SEAMS), y determinar su validez, fiabilidad y sensibilidad en pacientes mexicanos con diagnóstico de EII. MÉTODO: Se incluyeron 149 pacientes con diagnóstico de EII, previo consentimiento informado. Se tradujeron los instrumentos al español y posteriormente fueron aplicados durante la consulta médica. Para la SEAMS se realizó análisis factorial exploratorio, análisis de curva ROC y determinación del alpha de Cronbach; para el BMQ se empleó el coeficiente kappa de Cohen y su capacidad predictiva. RESULTADOS: Se incluyeron 75 mujeres (50.3 %) con edad promedio de 44 años. La escala SEAMS mostró un único factor altamente confiable (alfa de Cronbach = 0.92) y un punto de corte de 33 para identificar a los pacientes adherentes. Las dimensiones "adherencia" y "barrera de recuerdo" del BMQ fueron adecuados predictores de adherencia. CONCLUSIONES: Las versiones en español SEAMS y BMQ son válidas para medir autoeficacia y barreras para la adherencia al tratamiento farmacológico en pacientes mexicanos con EII.

Hospital Anxiety and Depression Scale (HADS): Validation in Mexican Patients with Inflammatory Bowel Disease. / Escala de Ansiedad y Depresión Hospitalaria (HADS): Validación en pacientes mexicanos con enfermedad inflamatoria intestinal.

INTRODUCTION: The Hospital Anxiety and Depression Scale (HADS) is a self-administered instrument for outpatients, but its behaviour differs according to the clinical population to which it is applied. In Mexico it is not validated in patients with Inflammatory Bowel Disease (IBD). OBJECTIVES: To validate the HADS scale in the Mexican population with IBD. METHODS: 112 patients with IBD from the "Salvador Zubirán" National Institute of Medical Sciences and Nutrition were included, to whom the HADS was applied and some demographic and clinical characteristics of the disease were evaluated. An exploratory factor analysis was performed and factorial congruence was calculated to determine the construct validity of the HADS, while reliability was evaluated using Cronbach's alpha. RESULTS: The result of the varimax rotation of the 14 items of the HADS explained 50.1% of the variance, having two main factors. Ten items showed high factor loading for the dimensions originally proposed. The internal consistency of the HADS was high (alpha=0.88) with high values for the congruence coefficients. CONCLUSIONS: The HADS scale is a valid instrument to detect possible cases of Anxiety and Depression in Mexican patients with IBD. The validation of this instrument allows its routine use for the integral evaluation of the patient and their timely referral to mental health.

The Effects of Ketamine on Cognitive Function in Elderly Patients Undergoing Ophthalmic Surgery: A Pilot Study.

BACKGROUND: Acute postoperative cognitive dysfunction is characterized by neurocognitive dysfunction and confusion. In this study, we compared the cognitive status of a geriatric population undergoing ophthalmic surgery, as assessed by the Short Portable Mental Status Questionnaire (SPMSQ) before and after ketamine administration. METHODS: Eighty patients were enrolled and randomly assigned in a double-blind study to receive either ketamine (0.3 mg/kg dose) or physiologic solution (control group). Sixty-five (control, n = 32; ketamine, n = 33) patients completed the trial. Cognitive performance was assessed with an abbreviated version of the SPMSQ. Measurements of analgesia, sedation, intraocular pressure, and hemodynamic variables were recorded. RESULTS: With respect to cognitive performance, the baseline evaluation was similar for the control and ketamine groups. Postoperative evaluation showed an improvement only in the ketamine group. No increase in intraocular pressure or a secondary nystagmus was observed. The average dose of midazolam was higher in the control group, but the difference was not clinically significant. After surgery, analgesic behavior was better in the ketamine group than in the control group. There were no differences between groups in the sedation scale or in hemodynamic variables. CONCLUSIONS: The administration of 0.3 mg/kg ketamine during ophthalmic surgery in geriatric patients changed their cognitive status as assessed by the SPMSQ, decreased the required dose of anesthetics, and produced no increase in intraocular pressure or in hemodynamic variables. However, because the evaluation only analyzed the immediate effects of the administered drug, further research will be required to examine the impact of ketamine on the postoperative cognitive performance of geriatric patients before the drug can be formally recommended for this purpose.

Validity and reliability of a novel Color-Risk Psychiatric Triage in a psychiatric emergency department.

BACKGROUND: Classification of Psychiatric Emergency Presentations (PEP) is not sufficiently clear due to their inherent high inter-subjectivity and lack of validated triage instruments. In order to improve current classification of psychiatric emergency presentations (PEP) at Emergency Departments, we implemented and validated the Color-Risk Psychiatric Triage (CRPT), an instrument for classifying PEP risk by sorting one to five color/risk levels and one to thirty-two possible conditions arranged by risk. METHODS: Users who visited the Emergency Department (ED) of a Mexican psychiatric hospital from Dec 1st, 2008 to Dec 1st, 2009 were included. One CRPT was assessed by an ED psychiatrist to each patient upon their arrival to ED. Some patients were randomly assessed simultaneously with an additional CRPT and a Crisis and Triage Rating Scale (CTRS) to test validity and reliability of the CRPT. RESULTS: A total of 7,631 CRPT assessments were included. The majority of PEP were non-urgent (74.28 %). For the validation phase n = 158 patients were included. CRPT score showed higher concurrent validity than CRPT color/risk. CRPT level/risk and score showed highest concurrent validity within dangerousness domain of CTRS (r = 0.703, p < 0.0001). CRPT and CTRS scores showed similar predictive validity (p < 0.0001). High intraclass correlation coefficient (0.982) and Cohen's Kappa (0.89) were observed for CRPT score (r = 0.982, p < 0.0001). CONCLUSIONS: CRPT appeared to be a useful instrument for PEP classification due to its concurrent validity, predictive validity and reliability. CRPT score showed higher correlations than the CRPT color/risk. The five levels of risk provided by the CRPT appear to represent a simple and specific method for classifying PEP. This approach considers actual or potential risk, rather than severity, as the main factor for sorting PEP, which improves upon the current approach to emergency classification that is mainly based on the criterion of severity. Regardless of the triage procedure, emergency assessments should no longer classify PEP as "not real emergencies."

Melatonin attenuates antipsychotic metabolic effects: an eight-week randomized, double-blind, parallel-group, placebo-controlled clinical trial.

OBJECTIVE: Second-generation antipsychotics (SGAs) are among the first-line treatments for bipolar disorder and schizophrenia, but have a tendency to generate metabolic disturbances. These features resemble a metabolic syndrome for which a central autonomic imbalance has been proposed that may originate from the hypothalamic suprachiasmatic nuclei. In a clinical trial, we hypothesized that melatonin, a hormone that regulates the suprachiasmatic nucleus, could attenuate SGA-induced adverse metabolic effects. METHODS: In an eight-week, double-blind, randomized, placebo-controlled, parallel-group clinical trial, we evaluated the metabolic effect of melatonin in SGA-treated patients in terms of weight, blood pressure, lipid, glucose, body composition, and anthropometric measures. A total of 44 patients treated with SGAs, 20 with bipolar disorder and 24 with schizophrenia, randomly received placebo (n = 24) or melatonin 5 mg (n = 20). RESULTS: The melatonin group showed a decrease in diastolic blood pressure (5.1 versus 1.1 mmHg for placebo, p = 0.003) and attenuated weight gain (1.5 versus 2.2 kg for placebo, F = 4.512, p = 0.040) compared to the placebo group. The strong beneficial metabolic effects of melatonin in comparison to placebo on fat mass (0.2 versus 2.7 kg, respectively, p = 0.032) and diastolic blood pressure (5.7 versus 5.5 mmHg, respectively, p = 0.001) were observed in the bipolar disorder and not in the schizophrenia group. No adverse events were reported. CONCLUSIONS: Our results show that melatonin is effective in attenuating SGAs' adverse metabolic effects, particularly in bipolar disorder. The clinical findings allow us to propose that SGAs may disturb a centrally mediated metabolic balance that causes adverse metabolic effects and that nightly administration of melatonin helps to restore. Melatonin could become a safe and cost-effective therapeutic option to attenuate or prevent SGA metabolic effects.

Psychometric Properties of the Spanish Version of the Cognitive Problems and Strategies Assessment in Patients with Bipolar Disorder.

Cognitive deficits play an important role in Bipolar Disorder (BPD). The Cognitive Problems and Strategies Assessment (CPSA) is a measure that evaluates the patient's perception of cognitive difficulties, and the spontaneous use of compensatory strategies and could thus have potential utility for clinical practice in patients with BPD. Our aim was to determine the validity and reliability of the Cognitive Problems and Strategies Assessment (CPSA) in Bipolar Disorder (BPD). Ninety-three BPD outpatients and 90 controls completed the Assessment of Problems with Thinking and Memory (APTM) questionnaire and the Assessment of Memory and Thinking Strategies (AMTS) questionnaire which constitute the CPSA, the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), as a measure of convergent validity, and general sociodemographic data. Cronbach's alpha coefficient, Spearman's correlation coefficient and independent sample t tests were used for Internal consistency, Convergent validity and Discriminant validity. The APTM had a Cronbach's alpha coefficient of 0.93 and the AMTS 0.90. The COBRA score and the APTM were significantly correlated. BPD patients exhibited higher scores on the APTM and lower scores on the AMTS than controls. The present instrument enriches the clinician's repertoire for rapid and inexpensive cognitive evaluation in BPD.

The role of personality traits on self-medicated cannabis in rheumatoid arthritis patients: A multivariable analysis.

BACKGROUND: Rheumatoid arthritis (RA) patients commonly report medicinal cannabis use (MCU). Personality has been independently associated with both RA-related outcomes and MCU, but there is no information available on how they interact in RA patients. This study aimed to investigate a potential association between personality traits and MCU in RA outpatients, as well as to identify additional factors associated with its use. METHODS: This cross-sectional study was performed between June 2020 and August 2021. Consecutive RA outpatients had standardized evaluations using an interview format to collect sociodemographic information, comorbidities, risk of recreational substance use, RA-related disease activity/severity, health-related quality of life, depressive and anxiety symptoms, five personality traits, and MCU in the 12 months before the interview. Multivariable logistic regression estimated adjusted odds ratios (aOR). The study was IRB-approved. RESULTS: 180 patients were included; 160 (88.9%) were women with a mean age of 53.4 ± 13 years. Fifty-three (29.4%) patients reported MCU. Among them, 52 (98.1%) used topical formulations. Neuroticism had the highest overall score ([Formula: see text] = 3.47 ± 0.34). Openness to experience trait was higher in MCU patients in the comparative analysis (p = 0.007). In the multivariable regression, higher openness trait (aOR: 2.81, 95%CI: 1.11-7.10) along with moderate risk in tobacco use (aOR: 3.36, 95%CI: 1.04-10.7) and higher RA disease activity/severity (aOR: 1.10, 95%CI: 1.01-1.19) were independently associated with MCU. CONCLUSIONS: In the current study, personality influenced the seeking of MCU for pain relief, associating dynamically with higher disease activity/severity and tobacco use. Contrary to other available information, it did not relate to psychopathology or the recreational use of cannabis. Proactive interdisciplinary clinical evaluations around MCU in RA outpatients should include personality, besides standard clinical assessments, to understand patients' motivations for its use as they may reveal important clinical information.

Evaluation of an anti-stigma intervention for Mexican psychiatric trainees.

BACKGROUND: There is research evidence regarding the presence of stigmatising attitudes in psychiatrists towards people with mental illness, but a lack of studies and interventions focused on this issue in low and middle-income countries. AIMS: To assess the feasibility of implementing an anti-stigma intervention for Mexican psychiatric trainees, and its potential effects. METHODS: This study comprised a pre-post design with outcome measures compared between baseline and 3-month follow-up. Quantitative outcome measures were used to evaluate the potential effects of the intervention, whilst the process evaluation required the collection and analysis of both quantitative and qualitative data. RESULTS: Twenty-nine trainees (25% of those invited) participated in the intervention, of whom 18 also participated in the follow-up assessment. Outcome measures showed the intervention had moderately large effects on reducing stereotypes and the influence of other co-workers on trainees' own attitudes. The main mechanisms of impact identified were recognition of negative attitudes in oneself and colleagues, self-reflection about the impact of stigma, one's own negative attitudes and recognition of one's ability to make change. Participants accepted and were satisfied with the intervention, which many considered should be part of their routine training. However, trainees' work overload and lack of support from the host organisation were identified as barriers to implement the intervention. CONCLUSIONS: A brief anti-stigma intervention for Mexican psychiatric trainees is feasible, potentially effective, well accepted and was considered necessary by participants. This study also suggests mechanisms of impact and mediators should be considered for developing further interventions, contributing to reducing the damaging effects that mental health-related stigma has on people's lives.

Looking for factors affecting functioning in euthymic patients with bipolar I disorder: the importance of cognitive complaints and BDNF's Val66Met polymorphism.

INTRODUCTION: Functioning in Bipolar Disorder (BD) is affected in a substantial proportion of patients. The impact of demographic, clinical, cognitive, and genetic factors on functioning has been shown individually; however, as a complex phenomenon, a global approach to identify the most relevant as well as possible interactions is needed. METHODS: 102 patients with type I BD in euthymia were invited for evaluation of demographic, clinical, and cognitive characteristics as well as genotype for Val66Met polymorphism of BDNF gene to determine those associated with poor functioning according to the FAST scale cut-off score. Clinical evaluation included assessment of residual affective symptoms and anxiety. Cognitive evaluation included the COBRA scale, verbal memory, and executive functions testing. RESULTS: Residual depressive symptoms, anxiety, cognitive complaints and being a Met carrier were more frequent in the poor functioning group and were entered in a logistic regression model. Being a Met carrier (OR=4.46, CI=1.19-16.67) and cognitive complaints (OR=1.29, CI= 1.13-1.46) were the most important predictors of poor functioning in type I BD. LIMITATIONS: Cross-sectional study, with select population limiting generalizability of findings. CONCLUSIONS: A better understanding of underlying factors affecting cognition, including the possible involvement of BDNF Val66Met polymorphism, its systematic evaluation and a continued search for targeted treatment, along with recognition and attention of residual affective and anxious symptoms might improve psychosocial outcomes such as functioning in this population.

Self-Perceived Mental Health and Perceived Discrimination in Family Physicians and Residents: A Comparative Study Between Men and Women.

INTRODUCTION: The present study aims to examine sex differences in demographic variables, professional activities and adversities, self-reported mental health problems, and perceived discrimination in a sample of family doctors and family medicine residents in Mexico. METHODS: From a larger sample of medical specialists, an analytic, cross-sectional study was conducted with 566 participants, including 317 (56%) family medicine residents and 249 (44%) family doctors in Mexico through an online survey. Demographic features, professional activities and adversities, mental health, and perceived discrimination were examined. Descriptive and comparative analyses were performed. Cramer's V for chi-square tests and Hedge's g for t test were conducted to determine effect sizes. RESULTS: Both sexes displayed similar percentages of professional adversities (such as attending patients with suicidal behavior or who died not by suicide under their care), and a higher number of women reported seeking specialized support to cope with these deaths (Fisher = 0.04). Men perceived greater discrimination (P = .01), worked more hours per day (P < .001) and were more verbally assaulted (P = .04), whereas women reported mental health problems more frequently (P < .001) particularly depression, anxiety, burnout and sleeping problems. Women also reported worse health status (P < .001) when compared with men. CONCLUSION: Family medicine specialists constitute a vulnerable group for mental health problems and perceived discrimination. Particular attention should be paid to how men and women cope with professional adversities to determine whether additional support is required. Interventions should encourage self-care and promote the well-being of health personnel.