Assessment of Classical and Non-Classical Quantitative Electroencephalographic Measures in Patients with Substance Use Disorders.

Background: People diagnosed with substance use disorders (SUDs) are at risk for impairment of brain function and structure. However, physicians still do not have any clinical biomarker of brain impairment that helps diagnose or treat these patients when needed. The most common method to study these patients is the classical electroencephalographic (EEG) analyses of absolute and relative powers, but this has limited individual clinical applicability. Other non-classical measures such as frequency band ratios and entropy show promise in these patients. Therefore, there is a need to expand the use of quantitative (q)EEG beyond classical measures in clinical populations. Our aim is to assess a group of classical and non-classical qEEG measures in a population with SUDs. Methods: We selected 56 non-medicated and drug-free adult patients (30 males) diagnosed with SUDs and admitted to Rehabilitation Clinics. According to qualitative EEG findings, patients were divided into four groups. We estimated the absolute and relative powers and calculated the entropy, and the alpha/(delta + theta) ratio. Results: Our findings showed a significant variability of absolute and relative powers among patients with SUDs. We also observed a decrease in the EEG-based entropy index and alpha/(theta + delta) ratio, mainly in posterior regions, in the patients with abnormal qualitative EEG. Conclusions: Our findings support the view that the power spectrum is not a reliable biomarker on an individual level. Thus, we suggest shifting the approach from the power spectrum toward other potential methods and designs that may offer greater clinical possibilities.

Comprehensive rehabilitation and job reintegration of people with severe mental illness in a Latin American country: REINTEGRA study protocol.

BACKGROUND: Despite the increasing use of comprehensive rehabilitation models for people with severe mental illness (SMI), there are still limitations to their implementation and replicability in a consensual way, particularly in Latin American countries. The REINTEGRA program aims to be a standardized model of comprehensive rehabilitation focused on psychosocial and cognitive improvement through a set of interventions on different areas of people's functionality, with the goal of reintegrating people with SMI into the labour market. In this paper we summarize the protocol for its subsequent implementation in a mental health institution in Mexico. METHOD: The protocol is based on a quasi-experimental, prospective longitudinal study, with a pragmatic or naturalistic control group. It will be carried out in three phases. Phase 1 consists of a series of interventions focused on psychosocial improvement; Phase 2 focuses on cognitive and behavioral improvement treatments; and Phase 3 targets psychosocial recovery through rehabilitation and reintegration into the labour market. The overall procedure will be monitored with standarized evaluations at different stages of the program. DISCUSSION: This study presents a model of integral rehabilitation of people with SMI. At the moment, one of the obstacles to overcome is the organization and procedural control of the different actors needed for its implementation (nurses, psychologists, doctors, companies, institutions, etc.). REINTEGRA will be the first comprehensive rehabilitation model that includes systematized procedures for job reinsertion for people with SMI in Mexico, which aims to be a standardized tool of easy adaptation and the replicability for other mental health centers and institutions.

Resilience and risk factors associated to depressive symptoms in Mexican healthcare workers during the Covid-19 pandemic.

OBJECTIVE: Report the prevalence of depression, resilience, and risk factors among healthcare workers (HCW) during Co-vid-19. MATERIALS AND METHODS: This is an observational cross-sectional study derived from the ongoing international, prospective multicentric study "The COVID-19 HEalth caRe wOrk-Ers Study" (HEROES). A convenience sample of 2 127 HCW was obtained from Chiapas and Jalisco between May 19th and July 24th 2020. Depression was assessed using the Patient Health Questionnaire, resilience with the Brief Resilience Scale and a Covid risk scale was developed. Model-adjusted prevalence ratios (PRs) and an additive interaction model were performed. RESULTS: Moderate-severe depression was found in 16.6% of HCW. Those from Jalisco, physicians, in hospitals, with chronic illness and mental health history were more depressed. The interaction between resilience and risk showed that, compared to those with no risk and medium/high resilience, HCW at risk with medium/high resilience had a 2.38 PR for depression while those at risk and low resilience had a PR of 5.83. CONCLUSION: This evidence points the need to develop strategies to enhance resilience and reduce the risk in HCW.

Green Tea Extract Increases Soluble RAGE and Improves Renal Function in Patients with Diabetic Nephropathy.

One of the proposed mechanisms for the development of diabetic nephropathy (DN) is the increase of end products of advanced glycosylation (AGEs), which bind to its receptor (RAGE), favoring nephron cellular damage. An isoform of this receptor is soluble RAGE (sRAGE), which can antagonize AGE-altered intracellular signaling. It has known that green tea extract (GTE) increases the expression of sRAGE, but it is unknown whether this could improve kidney function. The objective of this study was to evaluate the effect of the administration of GTE on the concentrations of sRAGE, renal function, and metabolic profile in patients with type 2 diabetes mellitus (T2DM) and DN. A randomized, double-blinded, placebo-controlled clinical trial was carried out in 39 patients who received GTE (400 mg every 12 h) or placebo for 3 months. sRAGE levels, renal function, and metabolic parameters were determined before and after the intervention. In the GTE group, there were statistically significant increase on sRAGE (320.55 ± 157.63 pg/mL vs. 357.59 ± 144.99 pg/mL; P = .04) and glomerular filtration rate (GFR; 66.44 ± 15.17 mL/min/1.73 m2 vs. 71.70 ± 19.33 mL/min/1.73 m2; P = .04), and a statistically significant decrease in fasting serum glucose (7.62 ± 3.00 mmol/L vs. 5.86 ± 1.36 mmol/L; P ≤ .01) and triacylglycerols (1.91 ± 0.76 mmol/L vs. 1.58 ± 0.69; P = .02). Administration of GTE increases the serum concentration of sRAGE and the GFR and decreases the concentration of fasting serum glucose and triacylglycerols. The study was registered in ClinicalTrials.gov with the identifier NCT03622762.

Atypical Charles Bonnet syndrome secondary to frontal meningioma: a case report.

BACKGROUND: Charles Bonnet Syndrome (CBS) is a rare clinical entity that is classically composed of visual hallucinations in the context of an altered optic pathway with preservation of reality judgment. This case aims to present the association of visual hallucinations with complex alterations of the nervous structures adjacent to the visual pathway and an atypical clinical presentation, thus explaining the possible mechanisms involved in the generation of these symptoms. CASE PRESENTATION: A 43-year-old man presents seeking care due to visual hallucinations with partial preservation of reality judgment and symptoms compatible with a major depressive disorder, including irritability and diminished hygiene habits. He has a history of complete gradual loss of vision and hyposmia. Due to poor treatment response during hospitalization, an MRI was obtained, which showed a frontal tumor lesion with meningioma characteristics adjacent to the olfactory groove and compression of the optic chiasm. He underwent surgical resection of the lesion, which remitted the psychotic symptoms, but preserving the visual limitation and depressive symptoms. CONCLUSIONS: The presence of visual hallucinations, without other psychotic features as delusions, is a focus of attention for basic structural pathologies in the central nervous system. Affection at any level of the visual pathway can cause CBS. When finding atypical symptoms, a more in-depth evaluation should be made to allow optimization of the diagnosis and treatment.

Community mental health care in Mexico: a regional perspective from a mid-income country.

BACKGROUND: Access to mental health care is a worldwide public health challenge. In Mexico, an unacceptably high percentage of the population with mental disorders does not receive the necessary treatment, which is mainly due to the lack of access to mental health care. The community mental health care model was created and has been implemented to improve this situation. In order to properly plan and implement this model a precise situational diagnosis of the mental health care network is required, thus this is a first approach to evaluate the community mental health networks in the state of Jalisco. METHODS: Two components from the EvaRedCom-TMS instrument were used including a general description and accessibility of the community mental health care network. A geographic and economic accessibility evaluation was carried out for the different regions of the state ranging from scattered rural to urban communities using information gathered from health institutions, telephone interviews and computer applications. RESULTS: Jalisco's community mental health network includes a total of 31 centers and 0.64 mental health workers for every 10,000 inhabitants > 15 years of age. The mean transportation cost required to access mental health care was 16.25 USD per visit. The time needed to reach the closest mental health center in 7 of the 13 analyzed regions was more than 30 min and the mean time required to reach a prolonged stay center was 172.7 min with transportation cost (taxi, private and public transport) of 22.3 USD. Some marginalized regions in the state have a mean 114 min required to reach the closest mental health care center and 386 min to reach a prolonged stay center. CONCLUSIONS: This first approach to evaluate the mental health networks in Mexico showed that there are multiple barriers to access its care including an unfavorable number of human resources, long distances, and high costs. The identification of Jalisco's mental health network deficiencies is the first step towards establishing a properly planned community mental health care model within the country.

Physicians specializing in psychiatry of Mexico: An update 2018 / Médicos especialistas en psiquiatría de México: actualización 2018

Abstract Introduction In 2016, there were 4,393 psychiatrists in Mexico, with an estimated rate of 3.68 per 100,000 inhabitants. It is essential to keep this information updated in order to achieve the overall objectives of mental health care. Objective Estimate the total number of psychiatrists and paidopsychiatrists in Mexico in 2018; identify their geographical distribution, and compare the results with those obtained in 2011 and 2016. Method Comparative, longitudinal study. Various sources were consulted to update the number of psychiatrists and paidopsychiatrists in 2018 and to determine their sociodemographic characteristics. These characteristics were compared with those found in 2011 and 2016. Results A total of 4,999 specialists in psychiatry practiced their specialty in Mexico in 2018, 365 of whom are child and adolescent psychiatrists. A rate of 3.71 psychiatrists per 100,000 inhabitants was obtained for a population of 124,737,789. Regarding pedopsychiatric specialists, if we consider a population of 37,714,991 inhabitants under 16, the corresponding rate is .96 child and adolescent psychiatrists per 100,000 minors. These specialists are unevenly distributed throughout the country. Approximately 60% of all psychiatrists and child and adolescent psychiatrists practice in the three largest cities in Mexico. Discussion and conclusion Although the national rate of psychiatrists was increased in comparison with 2016, it is still lower than that recommended by the World Health Organization (WHO). The geographical distribution of psychiatrists is uneven due to centralization and economic factors as happens in many countries in the world.

Resumen Introducción En 2016 se contabilizaron en México 4,393 psiquiatras, con una tasa estimada de 3.68 por cada 100,000 habitantes. Es necesario mantener actualizada esta información para alcanzar los objetivos globales de atención a la salud mental. Objetivo Estimar el número total de psiquiatras y paidopsiquiatras en México en 2018; determinar su distribución geográfica y comparar los resultados con los obtenidos en 2011 y 2016. Método Estudio comparativo y longitudinal. Se consultaron diversas fuentes para actualizar el número de psiquiatras y paidopsiquiatras en 2018 y conocer sus características sociodemográficas. Se compararon estas características con las encontradas en 2011 y 2016. Resultados Un total de 4,999 especialistas en psiquiatría ejercen su especialidad en México en 2018 y de estos 365 son paidopsiquiatras. En una población de 124,737,789 habitantes, se obtuvo una tasa de 3.71 psiquiatras por cada 100,000 habitantes. Respecto a los especialistas en paidopsiquiatría, si consideramos una población de 37,714,991 habitantes menores de 16 años, la tasa correspondiente es de .96 paidopsiquiatras por cada 100,000 menores. Existe una distribución desigual de estos especialistas en el país. Alrededor del 60% de todos los psiquiatras y paidopsiquiatras ejercen en las tres mayores ciudades de México. Discusión y conclusión Aunque la tasa nacional de psiquiatras se incrementó en comparación con la obtenida en 2016, sigue siendo todavía menor a la recomendada por la Organización Mundial de la Salud. La distribución geográfica de los psiquiatras es inequitativa debido a la centralización y a factores económicos como sucede en muchos países del mundo.

Los especialistas en psiquiatría en México: año 2016 / Specialty in psychiatry: Mexico 2016

RESUMEN: Introducción: En el año de 2011 había en México 3 823 psiquiatras, con una tasa estimada de 3.4 por cada 100 mil habitantes. Es necesario mantener actualizada esta información para alcanzar los objetivos globales de atención a la salud mental. Objetivo: Estimar el número total de psiquiatras en México en 2016; determinar su distribución geográfica y comparar los resultados con los obtenidos en el año 2011. Método: Estudio comparativo y longitudinal. Se consultaron diversas fuentes para actualizar el número de psiquiatras en 2016 y conocer sus características sociodemográficas. Se compararon estas características con las encontradas en 2011. Resultados: Un total de 4 393 psiquiatras ejercen su especialidad en México en 2016. Sobre una población de 119 530 753 habitantes, se obtuvo una tasa de 3.68 psiquiatras por cada 100 000 habitantes. Existe una pobre distribución de estos especialistas en el país. Alrededor del 60% de todos los psiquiatras ejercen en las tres mayores ciudades de México. Discusión y conclusión: La tasa nacional de psiquiatras se incrementó en comparación con la obtenida en 2011, sigue siendo inferior a la recomendada por la Organización Mundial de la Salud (OMS). La distribución geográfica de los psiquiatras es inequitativa debido a la centralización y a factores económicos.

ABSTRACT: Introduction: In 2011 we had 3823 psychiatrists in Mexico, with an estimated rate of 3.4 per 100 000 inhabitants. In order to achieve the global targets of mental health attention, it is important to update this information. Objetive: To estimate the total number of psychiatrists in Mexico in 2016; detemine their geographic distribution and compare the results with the ones obtained in 2011. Method: Longitudinal and comparative study. Diverse sources of information were consulted in order to update the number of psychiatrists in 2016 and to know their sociodemographic characteristics, that were compared with the ones obtained in 2011. Results: 4 393 psychiatrists practiced their specialty in Mexico in 2016. With a population of 119 530 753 inhabitants, we obtained a rate of 3.68 psychiatrists per 100 000 inhabitants. There's a poor distribution of theese specialists in the country. Around 60% of all psychiatrists practice in the tree major cities of Mexico. Discussion and conclusion: The national rate of psychiatrists increase in comparisson with the one we found in 2011, it remains lower that the one recommended by the World Health Organization (WHO). Geographic distribution of the psychiatrists is inequitative because of centralization and economic factors.