Retorno al siglo XX: setenta años de psiquiatría, psicoanálisis y medicina psicosomática en Santiago de Chile / Return to the 20th century: seventy years of psychiatry, psychoanalysis and psychosomatic medicine in Santiago de Chile

Este trabajo resume los cambios en la psiquiatría clínica y el psicoanálisis y la medicina psicosomática en el siglo pasado, destacando a dos médicos chilenos, un internista y un psiquiatra que influenciaron profundamente al autor. Los Drs. Hernán Alessandri Rodríguez e Ignacio Matte Blanco fueron formadores de médicos no solo en la Facultad de Medicina de la Universidad de Chile, sino a nivel nacional e internacional, dejando su sello hasta hoy. El artículo recorre la historia de esa Facultad, así como de la Clínica Psiquiátrica Universitaria, cuyo primer director fue el Prof. Matte. Este fue también el promotor de la Asociación Psicoanalítica Chilena, admitida en agosto de 1949 como sociedad componente de la Asociación Psicoanalítica Internacional. Se revisan los antecedentes históricos del psicoanálisis freudiano y de la medicina psicosomática hasta la mitad del siglo XX, para luego analizar los desarrollos posteriores tanto de la psiquiatría clínica, del psicoanálisis post-freudiano y de la salud mental chilenas. Se concluye subrayando cómo las personalidades, sus vinculaciones familiares y el contexto socio-cultural marcan los avances y las dificultades de los progresos en salud.

La espiritualidad y religiosidad como factor protector en mujeres depresivas con riesgo suicida: consenso de expertos / Spirituality and religiosity as a protective factor in depressive women with suicidal risk: expert consensus

Se presenta un consenso de expertos sobre "La Espiritualidad y Religiosidad como Factor Protector en Mujeres Depresivas con Riesgo Suicida", que se obtuvo utilizando una metodología Delphi. Sus resultados se han organizado en cinco áreas enfocadas en aspectos referentes al diseño de una intervención espiritual/religiosa: a) encuadre; b) características yformación del interventor, c) elementos a resguardar, d) contenidos y e) fases. Se concluye que los aspectos espirituales y religiosos deben considerarse en cada caso, y que un acompañamiento en pacientes creyentes puede mejorar su evolución y prevenir nuevos episodios de de riesgo suicida. En algunos casos la religiosidad pudiera aumentar los montos de culpa, aumentando la severidad y complejidad del cuadro clínico.

This document presents the expert consensus produced by a working meeting in Santiago de Chile during 2010 about "The Spirituality and Religiosity as a protective factor in depressive women with Suicidal Risk". The consensus followed the steps suggested by Delphi methodology. Its results are organized in five areas referent to spiritual/religious interventions: a) setting, b) counselor training, c) elements, d) subjects covered, e) stages. The experts consulted concluded that spiritual and religious aspects need to be considerate in each case, and that in believers can improve progress and prevent relapses at suicidal risk. However in some cases religious can increase the amounts offault, amplifying the severity and complicating the evolution.

[Efficacy and associated costs of an outpatient intervention in women with severe depression and early trauma]. / Eficacia y costos asociados a un tratamiento ambulatorio en mujeres con depresión severa y trauma temprano.

BACKGROUND: A high proportion of women consulting for depression have a history of childhood abuse and trauma. AIM: To compare the efficacy and costs associated with a treatment that enquires directly into childhood trauma and understands present interpersonal difficulties as a compulsion to repeat the traumatic past, versus the usual treatment, in women with severe depression and childhood trauma. MATERIAL AND METHODS: Eighty seven women with depression and prior history of early trauma that sought help at the Mental Health Unit of the Hospital de Curicó were studied. Forty four were randomly assigned to the experimental treatment, and 43 to the usual management. Patients were evaluated using the Hamilton Depression Scale, the Outcome Questionnaire (OQ 45.2) and an expenditures sheet at baseline, three and six months. An intention to treat analysis and a simple cost-analysis were performed. RESULTS: Hamilton and OQ 45.2 scores improved in both treatment groups, with significantly better results achieved in the experimental patients. The direct overall costs of experimental and control treatments were CLP 8,628,587 and 9,688,240, respectively. The main contributors to costs in both arms were medications (26.5%), followed by the number of psychiatric consultations (19.2%) in the experimental group and by hospitalizations (25.4%) in the control group. The costs per patient recovered in experimental and control groups were CLP 616,328 and 1,973,649, respectively. CONCLUSIONS: The proposed model resulted more effective for the treatment of this group of women.

Eficacia y costos asociados a un tratamiento ambulatorio en mujeres con depresión severa y trauma temprano / Efficacy and associated costs of an outpatient intervention in women with severe depression and early trauma

Background: A high proportion of women consulting for depression have a history of childhood abuse and trauma. Aim: To compare the effcacy and costs associated with a treatment that inquires directly into childhood trauma and understands present interpersonal diffculties as a compulsion to repeat the traumatic past, versus the usual treatment, in women with severe depression and childhood trauma. Material and Methods: Eighty seven women with depression and prior history of early trauma that sought help at the Mental Health Unit of the Hospital de Curicó were studied. Forty four were randomly assigned to the experimental treatment, and 43 to the usual management. Patients were evaluated using the Hamilton Depression Scale, the Outcome Questionnaire (OQ 45.2) and an expenditures sheet at baseline, three and six months. An intention to treat analysis and a simple cost-analysis were performed. Results: Hamilton and OQ 45.2 scores improved in both treatment groups, with signifcantly better results achieved in the experimental patients. The direct overall costs of experimental and control treatments were CLP 8,628,587 and 9,688,240, respectively. The main contributors to costs in both arms were medications (26.5 percent), followed by the number of psychiatric consultations (19.2 percent) in the experimental group and by hospitalizations (25.4 percent) in the control group. The costs per patient recovered in experimental and control groups were CLP 616,328 and 1,973,649, respectively. Conclusions: The proposed model resulted more effective for the treatment of this group of women.