Trastornos de síntomas somáticos y trastornos relacionados / No disponible

En esta mesa se comentan las perspectivas epistemológicas, diagnósticas, explicativas y etiopatogénicas, así como una pauta general de actuación ante los trastornos de síntomas somáticos y trastornos relacionados (AU)

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Programa de Atención Integral al Enfermo Mental en las prisiones españolas (paiem ). Valoración tras cuatro años de funcionamiento / Comprehensive Care Program for the Mentally ill in spanish prisons (paiem ). Assessment after four years operation

Objetivo: Evaluar el programa de atención integral a los enfermos mentales (PAIEM) implantado desde hace 3 años en las prisiones españolas, con el fin de mejorar su funcionamiento y resultados. Metodología: Estudio descriptivo de los datos recogidos en un cuestionario anónimo cumplimentado por los miembros del equipo PAIEM de los centros penitenciarios. Se obtuvieron distribuciones de frecuencia de todas las variables acerca de hechos, actitudes, opiniones, experiencias, situaciones y procesos del PAIEM. Resultados: Han respondido el 91,2% de los equipos del PAIEM. Psicólogos, educadores, médicos y trabajadores sociales son los profesionales que colaboran más activamente en el PAIEM (73%-84%) y los que con más frecuencia ejercen como tutores. Los enfermos mentales se ubican habitualmente en módulos ordinarios (80%). Las actividades más utilizadas para su rehabilitación psicosocial son autocuidados (73%) y educación para la salud, preparación para la vida diaria y habilidades sociales con más del 60%. Las intervenciones con las familias son básicamente por contacto telefónico (79%). En el análisis bivariante se demuestra que los PAIEM que mejor funcionan son los que tienen una buena coordinación con el resto de los equipos técnicos, los que preparan la derivación con más de seis meses previos a la libertad y en los que las ONG’s tramitan las derivaciones. Más del 71% de los profesionales observan mejoras en carencias y discapacidades en más de la mitad de los enfermos y están mayoritariamente satisfechos (3,4/5) de su participación, aunque reconocen mayor carga de trabajo. Conclusiones: Las actividades del PAIEM son adecuadas, en especial en las fases de detección precoz, estabilización y rehabilitación y menos en la fase de reincorporación social que mejora cuando interviene el tercer sector en las derivaciones del enfermo a la red sociosanitaria extrapenitenciaria (AU)

Objective: To assess the comprehensive care program for the mentally ill in prison (PAIEM), which has been implemented for 3 years in Spanish prisons with the aim of improving processes and results. Methods: Descriptive study of the data gathered from an anonymous questionnaire completed by members of the PAIEM team in prisons. Frequency distributions were obtained of all the variables relating to facts, attitudes, opinions, experiences, situations and processes of the PAIEM. Results: 91.2% of the PAIEM teams responded. Psychologists, educators, doctors and social workers were the professionals that collaborated most actively in the PAIEM (73%-84%) and were the ones to act most frequently as tutors. The mentally ill are usually located in ordinary modules (80%). The most commonly used activities for their psycho-social rehabilitation are self care (73%), education for health, preparation for daily life and social skills (more than 60%). Interventions with families are basically by telephone (79%). Bivariate analysis showed that the PAIEMs that operate most effectively are those that coordinate well with other technical teams, that prepare referral more than six months prior to release and ones where the NGOs process the referrals. Over 71% of the professionals observed improvements of disabilities and needs in over half the patients more than half of the professionals involved are satisfied (3.4/5) with their participation, although they acknowledge that there is a greater work load. Conclusions: The activities of the PAIEM are adequate, especially in the phases of early detection, stabilisation and rehabilitation and less so in the social incorporation phase, which improves when the third sector intervenes in referrals of patients to the social health care network outside prison (AU)

Adaptation of an evidence-based intervention targeting HIV-infected prisoners transitioning to the community: the process and outcome of formative research for the Positive Living Using Safety (PLUS) intervention.

No evidence-based interventions (EBIs) have been designed for implementation during the critical period when HIV-infected prisoners are being transitioned from prison to the community. We therefore conducted formative research aimed at systematically selecting and adapting an EBI that integrates HIV risk reduction and adherence to antiretroviral therapy to implement among HIV-infected prisoners transitioning back to the community. Our formative research involved a critical examination of established EBIs and associated published reports complemented by data elicited through structured interviews with key stakeholders in community and correctional settings and members of the target population. Between September 2006 and February 2007, structured one-on-one interviews were conducted with key stakeholders in the target organizations (n = 19) and with members of the target population (n = 26) in Hartford and New Haven, Connecticut. Based on the formative research, we abbreviated and adapted the Holistic Health Recovery Program targeting people living with HIV (HHRP+), an EBI, to consist of four 45-minute sessions that cover a range of prespecified topics so that participants may individually apply intervention content as needed to their own HIV risk profile and antiretroviral adherence issues. The EBI was adapted so that it could be provided in an individual or group format and delivered in either consecutive or weekly sessions and so that it could be provided within the prison system and delivered just prior to release, or in a community-based setting where it could be delivered immediately after release. This study provides a comprehensive exemplar of the process of selecting and adapting an EBI taking into account both empirical evidence and input from target organization stakeholders and target population members in real-world settings where high-risk populations are concentrated.

An algorithm for the treatment of schizophrenia in the correctional setting: the Forensic Algorithm Project.

The Forensic Algorithm Project (FAP) was born of the need for a holistic approach in the treatment of the inmate with schizophrenia. Schizophrenia was chosen as the first entity to be addressed by the algorithm because of its refractory nature and high rate of recidivism in the correctional setting. Schizophrenia is regarded as a spectrum disorder, with symptom clusters and behaviors ranging from positive to negative symptoms to neurocognitive dysfunction and affective instability. Furthermore, the clinical picture is clouded by Axis II symptomatology (particularly prominent in the inmate population), comorbid Axis I disorders, and organicity. Four subgroups of schizophrenia were created to coincide with common clinical presentations in the forensic inpatient facility and also to parallel 4 tracks of intervention, consisting of pharmacologic management and programming recommendations. The algorithm begins with any antipsychotic medication and proceeds to atypical neuroleptic usage, augmentation with other psychotropic agents, and, finally, the use of clozapine as the common pathway for refractory schizophrenia. Outcome measurement of pharmacologic intervention is assessed every 6 weeks through the use of a 4-item subscale, specific for each forensic subgroup. A "floating threshold" of 40% symptom severity reduction on Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale items over a 6-week period is considered an indication for neuroleptic continuation. The forensic algorithm differs from other clinical practice guidelines in that specific programming in certain prison environments is stipulated. Finally, a social commentary on the importance of state-of-the-art psychiatric treatment for all members of society is woven into the clinical tapestry of this article.