Psychiatric disorders in pregnant women admitted to the high-risk obstetric service in a Colombian university clinic between 2013 and 2017.

OBJECTIVE: To determine the psychiatric diagnoses and treatments of patients admitted to the high-risk obstetric service who underwent a consultation with a liaison psychiatrist. METHODS: A descriptive observational study that included pregnant women from the high-risk obstetric service of a highly specialised clinic in Medellín, who had a liaison psychiatry consultation between 2013 and 2017. The main variables of interest were psychiatric and obstetric diagnoses and treatments, in addition to biopsychosocial risk factors. RESULTS: A total of 361 medical records were screened, with 248 patients meeting the inclusion criteria. The main prevailing psychiatric diagnosis was major depressive disorder (29%), followed by adaptive disorder (21.8%) and anxiety disorders (12.5%). The pharmacologic treatments most used by the psychiatry service were SSRI antidepressants (24.2%), trazodone (6.8%) and benzodiazepines (5.2%). The most common primary obstetric diagnosis was spontaneous delivery (46.4%), and the predominant secondary obstetric diagnoses were hypertensive disorder associated with pregnancy (10.4%), gestational diabetes (9.2%) and recurrent abortions (6.4%). Overall, 71.8% of the patients had a high biopsychosocial risk. CONCLUSIONS: The studied population's primary psychiatric disorders were major depressive disorder, adjustment disorder and anxiety disorders, which implies the importance of timely recognition of the symptoms of these perinatal mental pathologies, together with obstetric and social risks, in the prenatal consultation. Psychiatric intervention should be encouraged considering the negative implications of high biopsychosocial risk in both mothers and children.

Analysis of the care provided over a six-month period by the liaison psychiatry unit at a general hospital in Lima, Peru.

INTRODUCTION: Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. AIM: To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyse the symptomatic and syndromic nature of the identified conditions. METHODS: Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. RESULTS: In a total of 400 referrals evaluated, the average age was 58 ±â€¯17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. CONCLUSIONS: The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.

Caracterización de las atenciones de la unidad de psiquiatría de enlace durante seis meses en un hospital general de Lima, Perú / Analysis of the Care Provided Over a Six-Month Period by the Liaison Psychiatry Unit at a General Hospital in Lima, Peru

Resumen Introducción: La psiquiatría de interconsulta y enlace es un área de la psiquiatría clínica cuya función es que psiquiatras lleven a cabo una serie de actividades dentro de un hospital general. En el contexto internacional, el número de unidades de psiquiatría de enlace se ha incrementado significativamente, situación que está repercutiendo en Perú. Sin embargo, este desarrollo es heterogéneo y desconocido, por lo que se requieren reportes de estudios recientes que revelen las características y los detalles de los servicios de atención clínica de estas unidades. Objetivo: Examinar y reportar las características sociodemográficas y clínicas de los pacientes evaluados en la Unidad de Psiquiatría de Enlace del Hospital Nacional Guillermo Almenara Irigoyen (HNGAI) de Lima, Perú, y analizar la naturaleza de los cuadros sintomáticos y sindrómicos presentes. Métodos: Estudio descriptivo y transversal de las interconsultas recibidas por la Unidad de Psiquiatría de Enlace del HNGAI entre mayo y octubre de 2019; se aplicó un análisis factorial de los síntomas. Resultados: En el total de 400 pacientes vistos en interconsulta, la media de edad fue 58 ± 17,09 arios. El 61,5% eran mujeres. La tasa de derivación fue del 2,73%. El servicio con el mayor número de referencias fue Medicina Interna (13,9%). Los trastornos más frecuentes fueron de naturaleza ansiosa (44%); los síntomas más frecuentes fueron ánimo depresivo (45,3%), insomnio (44,5%) y afecto ansioso (41,3%). Con respecto al tratamiento, el más prescrito fue con antidepresivos (44,3%). El análisis factorial exploratorio de los síntomas mostró 3 factores o componentes sindrómicos importantes: delirio, depresión y ansiedad. Conclusiones: El paciente típico de esta muestra es una mujer al final de su quinta década de vida, con enfermedad médica no psiquiátrica y con evidencia de trastornos ansiosos como diagnóstico principal resultante de la interconsulta psiquiátrica.

ABSTRACT Introduction Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. Aim To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyze the symptomatic and syndromic nature of the identified conditions. Methods Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. Results In a total of 400 referrals evaluated, the average age was 58 ± 17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. Conclusions: The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.

Analysis of the Care Provided Over a Six-Month Period by the Liaison Psychiatry Unit at a General Hospital in Lima, Peru. / Caracterización de las atenciones de la unidad de psiquiatría de enlace durante seis meses en un hospital general de Lima, Perú.

INTRODUCTION: Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. AIM: To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyse the symptomatic and syndromic nature of the identified conditions. METHODS: Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. RESULTS: In a total of 400 referrals evaluated, the average age was 58±17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. CONCLUSIONS: The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.

Factors Affecting Psychiatry Resident Decision to Pursue Consultation-Liaison Psychiatry or Other Subspecialty Fellowship Training.

BACKGROUND: There is a national shortage of psychiatrists with subspecialty fellowship training, and many fellowship positions are unfilled. OBJECTIVE: We conducted a survey of US psychiatry residents to better understand the motivation to pursue fellowship training and to determine any specific factors that were particularly influential in choosing a fellowship in consultation-liaison (C-L) psychiatry. METHODS: Online surveys were distributed electronically to US general psychiatry residents through the American Association of Directors of Psychiatric Residency Training list server. RESULTS: A total of 219 questionnaires were completed. Interest in fellowship declined during residency training. Most important factors in consideration of fellowship training were lifestyle (89%), finances (69%), and academic opportunities (63%). Specific influential factors were residency experiences, attending staff as a role model, and medical school experiences. Most important discouraging factors were extra training time, financial concerns, and belief that fellowship training was not necessary. Only 30% of residents had outpatient C-L psychiatry experiences. Few residents belonged to any subspecialty organization or attended any subspecialty meeting. Residents interested in C-L psychiatry fellowships had lower expectation of increased salary than other residents. Outpatient practice settings were seen as preferable over inpatient settings by most residents. CONCLUSIONS: Results of this survey suggest that enhancing consultation psychiatry exposure in medical school and residency with strong role models, outpatient C-L psychiatry experiences, facilitating subspecialty organization membership and meeting attendance, emphasizing academic opportunities of fellowship training, and improving remuneration for fellowship-trained psychiatrists might be important factors that could improve recruitment into C-L psychiatry and other psychiatric fellowships.

Caracterización de las interconsultas de psiquiatría realizadas en el Hospital Pediátrico Docente "Juan Manuel Márquez" / Characterization of psychiatric interconsultations carried out at "Juan Manuel Márquez" Pediatric Teaching Hospital

RESUMEN Introducción: La relación entre las diferentes especialidades es necesaria para elevar la calidad de la atención a los pacientes. Objetivo: Describir las características de las interconsultas de psiquiatría realizadas en el Hospital Pediátrico Juan Manuel Márquez entre enero de 2017 y junio de 2018. Material y Métodos: Se realizó un estudio descriptivo, longitudinal prospectivo, entre enero 2017 y junio 2018, a partir de 154 solicitudes de interconsultas de psiquiatría (escritas). Se constituyeron además en unidades de análisis los pacientes interconsultados. Los datos fueron recogidos en una planilla, y se analizaron descriptivamente con el software SPSS 21.0. Las correlaciones consideraron p< 0,05 como valor de significación. Resultados: Se verificó aumento semestral sostenido en la solicitud de interconsultas. Miscelánea fue el servicio que más solicitudes hizo (51,9%). El 81.9% de las solicitudes expresaba los motivos de interconsulta, la valoración por intento suicida fue el más frecuente (40,8%). El diagnóstico más frecuente fue Trastorno de Adaptación (35.7%). El 94.8% de los casos fueron vistos el mismo día de la solicitud. Las interconsultas paralelas (66.9%) fueron las más realizadas. Conclusiones: La imagen de la psiquiatría de interconsulta y enlace está cambiando al interior de la cultura hospitalaria, pero aún persisten claras evidencias de las carencias que tienen los médicos de otras especialidades en relación con la interpretación de las manifestaciones psicopatológicas de sus pacientes y la asociación con las patologías de base.

ABSTRACT Introduction: The relationship between different specialties is necessary to give better care to patients. Objective: To describe the characteristics of psychiatric interconsultations carried out at "Juan Manuel Marquez" Pediatric Teaching Hospital from January, 2017 to June, 2018. Materials and Methods: A descriptive prospective cross-sectional study was conducted between January 2017 and June 2018 on the basis of 154 written requests for psychiatric interconsultations. The patients consulted were also considered as units of analysis. The data were collected on a list and analyzed descriptively using SPSS version 21.0 software. The correlations considered p< 0.005 as significance value. Results: A sustained increase in the semester was determined in the request for interconsultations. The miscellaneous service made more requests (51.9%). The reasons for consultation were expressed in 81.9% of the requests, and the assessment for suicide attempt was the most frequent (40.8%). The most frequent diagnosis was Adjustment Disorder (35.7%). Also, 94.8% of the cases were seen the same day. Parallel consultations (66.9%) were the most performed. Conclusions: The image of consultation-liaison psychiatry is changing in the interior environment of hospital culture, but there is still clear evidence of the deficiencies that doctors from other specialties have in relation to the interpretation of psychopathological manifestations of their patients and their association with the underlying pathologies.

Electroconvulsive therapy for trichotillomania in a bipolar patient.

A recent review on the use of electroconvulsive therapy (ECT) in obsessive-compulsive-related disorders (OCRDs) identified reports of trichotillomania (TTM) in only three patients, but it did not describe the specific effect of ECT on hair-pulling behaviors. The authors present a case report of Mrs. A, a 77-year-old widowed housewife with a lifelong history of episodic TTM and bipolar disorder who was effectively treated with ECT. However, on each attempt to withdraw ECT, her condition deteriorated. Eventually, a decision was made to maintain ECT (one session every week), which resulted in no further relapse over the followup period. ECT shows some potential promise for reducing hair-pulling behaviors in the context of severe depression.

Medición de la concordancia en la elección de antidepresivos entre psiquiatras costarricenses que no aplican y sí aplican el algoritmo de razonamiento psicofarmacológico / Measurement of the concordance in the selection of antidepressants between costarican psychiatrists that do not apply and apply the Psychopharmacological Reasoning Algorithm

Resumen Justificación: existe una alta comorbilidad entre las enfermedades médico-quirúrgicas y la depresión. No hay parámetros sistematizados que guíen la selección individualizada del tratamiento farmacológico en estas circunstancias. Objetivo: analizar la concordancia entre los psiquiatras costarricenses que no aplican y sí aplican el algoritmo de razonamiento psicofarmacológico para la elección de los antidepresivos, en 3 casos clínicos de pacientes deprimidos y con una enfermedad médico-quirúrgica. Metodología: se distribuyó de forma aleatoria en dos grupos a los participantes, y se les presentó tres casos clínicos reales y anónimos de personas deprimidas y con una enfermedad médico-quirúrgica. El grupo A eligió el antidepresivo según sus criterios personales, mientras que el grupo B realizó la elección del tratamiento basándose en la implementación del algoritmo de razonamiento psicofarmacológico. Resultados: no hubo concordancia respecto al fármaco entre los 22 psiquiatras del grupo que solo aplicó el criterio clínico (kappa= -0,0154, p= 0,3851), mientras que la concordancia sí fue estadísticamente significativa en el grupo de los 24 psiquiatras que aplicó el algoritmo de razonamiento psicofarmacológico (kappa=0,016, p<0,01). La concordancia entre ambos grupos fue del 25 % en el caso 1, el 16,67% en el caso 2 y el 20,83% en el caso 3. Los psiquiatras que emplearon el algoritmo de razonamiento psicofarmacológico lo consideran útil (87,50%), aplicable (83,33%) y con posible impacto clínico (91,67%). Conclusiones: el algoritmo de razonamiento psicofarmacológico aumentó la concordancia entre los psiquiatras para la selección de los antidepresivos en tres casos clínicos de pacientes deprimidos con enfermedades médico-quirúrgicas, en comparación con el criterio personal. La concordancia entre los grupos A y B fue muy baja. El algoritmo de razonamiento psicofarmacológico es una herramienta considerada útil, aplicable y de posible impacto en la práctica clínica.

Abstract There is a high comorbidity between medical surgical diseases and depression. There is no current systematic approach to guide how to select an individualized treatment under these circumstances. Objective: to analyze the concordance between psychiatrist that do not use and those who use the Psychopharmacological Reasoning Algorithm to choose the treatment for 3 clinical cases of depression and medical surgical diseases. Methodology: Three case vignettes of anonymous real depressed patients with medical surgical diseases were presents to both groups. Group A made the selection of the antidepressant using their personal criteria; group B made the selection applying the Psychopharmacological Reasoning Algorithm. Results: There was no concordance on the drug among the 22 psychiatrists in the group that only applied the clinical criterion (kappa = -0.0154, p = 0.3851), whereas concordance was statistically significant in the group of 24 psychiatrists who applied the Psychopharmacological Reasoning Algorithm (kappa = 0.016, p <0.01). The concordance between groups A and B was 25% in the case 1, 16.67% in the case 2 and 20.83% in the case 3. The biggest majority of the psychiatrist that used the PPRA considers it useful (87.50%), applicable (83.33%) and with the possibility of impact the clinical practice (91.67%). Conclusion: The Psychopharmacological Reasoning Algorithm increased the concordance in the selection of antidepressants made by Costa Rican psychiatrists in 3 clinical vignettes of depressed patients with a medical surgical disease, when compared to personal criteria. The concordance in the selection of the antidepressants in the 3 cases between both groups is low. The Psychopharmacological Reasoning Algorithm is a tool considered useful, applicable and with a possible impact in clinical practice.

Comités de ética y salud mental / Ethics Committees and Mental Health

RESUMEN Los procesos de investigación, aunque están comprendidos en la objetividad de la ciencia, no dejan de estar permeados por los intereses propios de quienes los ejecutan. Por eso se han destinado comisiones de alto nivel para delimitar el alcance de los estudios y hacer un examen riguroso por los grandes dilemas que acarrean. A partir de esta premisa surgen los comités de ética, en los cuales la psiquiatría de enlace ha ocupado importantes puestos, por sus habilidades en comunicación y conocimiento del comportamiento humano. El presente artículo pretende aportar algunas observaciones que tener en cuenta en la relación existente entre la ética y la salud mental, al abordar el escenario de los comités de ética y la importancia del desempeño de los psiquiatras en ellos, mediante la revisión de artículos clave sobre el tema. Se da una descripción detallada de la ética de la investigación, en cuanto a justificación, propósitos y deberes, haciendo énfasis en cada una de las áreas en que el psiquiatra se ve envuelto con grandes responsabilidades en el ejercicio de la toma de decisiones médicas hasta el aval en el consentimiento informado de aquellos que participan en las investigaciones médicas. Finalmente, se concluye que existen varios interrogantes respecto a la relevancia que se ha dado a estos comités en la evaluación metodológica y ética de proyectos de investigación, lo que supone mayores esfuerzos en busca de una cultura de la calidad que realce el énfasis en el sujeto de investigación.

ABSTRACT Although research processes are covered by the objectivity of science, they are still influenced by the interests of those who conduct them. This is why high level committees have been tasked with defining the scope of the studies and performing a thorough assessment of them, since these imply great dilemmas. This premise leads to the emergence of Ethics Committees, where liaison psychiatry has an important place due to its communication abilities and knowledge of the human behavior. This paper attempts to provide some observations to take into account when discussing the link between ethics and mental health. In this work, the authors approach the question of ethics committees and the importance that psychiatrist performance has within them. This is done through a review of relevant papers on the subject. A detailed description on research ethics is provided in terms of justification, purpose and duties. Likewise, emphasis is placed on each of the areas in which psychiatrists are involved and bear great responsibilities in the medical decision-making process. Similarly, this description also includes the moment in which participants give their informed consent when taking part in medical research. Finally, we conclude that there are several questions regarding the relevance given to these committees in the methodological and ethical assessment of research projects. This in turn implies greater effort in the search for a culture of quality which highlights the emphasis on research subjects.

Psychiatric Aspects of Acute Porphyria: a Comprehensive Review.

PURPOSE OF REVIEW: The aim of this paper is to review psychiatric manifestations, comorbidities, and psychopharmacological management in individuals with acute porphyria (AP). RECENT FINDINGS: Recent literature begins to clarify associations between AP, schizophrenia, bipolar disorder, and other psychopathology. Broad psychiatric symptoms have been associated to acute porphyria (AP) and correspond to a spectrum of heterogeneous manifestations such as anxiety, affective alterations, behavioral changes, personality, and psychotic symptoms. These symptoms may be difficult to identify as being related to porphyria since symptoms may arise at any time during the disease process. In addition, these patients may present psychiatric conditions secondary to the disease, such as adjustment disorder and substance use disorders. Timely diagnosis and appropriate treatment of psychiatric manifestations positively impact the course of the disease.

Repercusión y tratamiento de los aspectos psicosociales de la diabetes mellitus tipo 1 en adolescentes / Impact and treatment of psychosocial aspects of type 1 diabetes mellitus in adolescents

La diabetes mellitus tipo 1 es la endocrinopatía más frecuente en niños y adolescentes, con una tendencia al aumento de la incidencia mundial. De evolución crónica, lleva tratamientos de por vida, con limitaciones y aparición de complicaciones, que se hacen más difíciles de manejar en la etapa de la adolescencia, etapa en la que deben cumplir un grupo de tareas propias del desarrollo para garantizar su normal crecimiento hacia la adultez, además de sortear las dificultades de la enfermedad. Durante el proceso de duelo los mecanismos de afrontamiento en pacientes y familiares pueden ser desadaptativos. Son frecuentes la disfunción familiar y los trastornos emocionales, como la depresión, ambos factores causas, a menudo, de mal control metabólico. La psiquiatría de enlace constituye una herramienta fundamental en el diagnóstico y tratamiento de estas alteraciones. A pesar de la importancia, no se encuentran suficientes publicaciones sobre el tema en nuestro medio, por lo cual el objetivo del trabajo es dar a conocer elementos teóricos sobre los aspectos psicosociales en adolescentes diabéticos.

Type 1 diabetes mellitus is the commonest endocrinopathy in children and adolescents, with a rising tendency of world incidence. It is a chronic disease with lifetime treatment, limitations and complications that are more difficult to manage at adolescence, a phase in which a number of tasks inherent to individual development must be complied in order to assure his/her normal growth into adulthood, in addition to overcoming the difficulties of the disease as such. During the process, the coping mechanisms of patients and relatives may be non adaptive. Family dysfunction and emotional disorders like depression are frequent causes of bad metabolic control. Liaison psychiatry is a fundamental tool for diagnosis and treatment of these alterations. Despite their importance, there are not enough publications on this topic in our setting, so the objective of this paper was to provide theoretical elements on the psychosocial aspects of diabetic adolescents.

Managing severe behavioral symptoms of a patient with anti-NMDAR encephalitis: case report and findings in current literature / Manejo de sintomas comportamentais severos em um paciente com encefalite-anti-NMDAR: relato de caso e literatura atual

Objective: Psychiatric symptoms emerge in the early stages of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, and patients often seek treatment in psychiatric departments before visiting any other general medical services. Numerous articles about anti-NMDAR encephalitis have been published in the scientific community worldwide, but few emphasize the role of psychiatry in symptom management. Case description: We describe the case of a patient with anti- -NMDAR encephalitis seen in our service and discuss the management of behavioral symptoms based on current scientific literature. High doses of atypical antipsychotics and benzodiazepines were used to control agitation, and trazodone was administered to treat insomnia. Comments: Consultation-liaison psychiatry may help the healthcare team adjust the management of neuropsychiatric complications that might affect inpatients with anti-NMDAR encephalitis. .

Objetivo: Sintomas psiquiátricos surgem em estágios precoces da encefalite antirreceptor N-metil-D-aspartato (NMDAR), o que faz muitos pacientes procurarem tratamento em serviços de psiquiatria antes de se dirigirem a unidades de clínica geral. Embora muitos artigos sobre encefalite anti-NMDAR venham sendo publicados na comunidade científica internacional, poucos enfatizam o papel do psiquiatra no seu manejo sintomatológico. Descrição do caso: O presente artigo relata o caso de um paciente que desenvolveu encefalite anti-NMDAR em nosso serviço e discute manejo de alterações comportamentais com base na literatura científica atual. Altas doses de antipsicóticos atípicos e benzodiazepínicos foram usados para controle de agitação, e trazodona foi utilizada para tratar insônia. Comentários: A interconsulta psiquiátrica pode ajudar no ajuste de condutas de toda a equipe assistente para as complicações neuropsiquiátricas que possam surgir na evolução de pacientes internados por encefalite anti-NMDAR. .

Delírium en pacientes mayores de 60 años en un hospital público de tercer nivel en la ciudad de Pereira (Colombia ): subdiagnóstico y subregistro / Delirium in Patients Over 60 Years of Age in a Tertiary Level Public Hospital in the City of Pereira (Colombia ): Under-Diagnosed and Under-Recorded

Introducción: El delírium es un trastorno común entre la población geriátrica hospitalizada y es de gran importancia por sus repercusiones en la evolución clínica de los pacientes, pero a menudo su diagnóstico no se realiza. Objetivo: Clarificar el estado del registro y el diagnóstico del delírium en un hospital público de tercer nivel en la ciudad de Pereira. Métodos: Se realizó un estudio descriptivo de corte transversal, en el cual se consultaron las bases de datos de pacientes hospitalizados entre 2010 y 2011 mayores de 60 años, utilizando como filtro la clasificación CIE-10 y verificando los criterios diagnósticos del DSM-IV en las historias clínicas. Resultados: En los años 2010 y 2011, estuvieron hospitalizados 5.325 pacientes mayores de 60 años (19,3 %); según registros de estadística oficiales, el 0,08 % de ellos con diagnóstico de delírium no especificado (F059 ). En la consulta por historias clínicas, se encontró que 455 pacientes tenían esos mismos criterios (40,2 %); el 90,1 % de ellos sufrían delírium y se clasificó con el código F059 sólo al 29,5 %. Conclusiones: Se produce subregistro y subdiagnóstico de delírium de los pacientes mayores de 60 años, lo que se evidencia por la incongruencia en la información oficialmente reportada y la información real obtenida de las historias clínicas respectivas; este hecho incrementa el riesgo y la vulnerabilidad de los pacientes con delírium no diagnosticado o diagnosticado y no reportado en las fuentes estadísticas hospitalarias. La psiquiatría de enlace es una necesidad en las instituciones de tercer nivel, al igual que la formación continua del personal de salud sobre los criterios de prevención, diagnóstico y manejo del delírium.

Introduction: Delirium is a common disorder in the hospitalized geriatric population and it has a great importance on the clinical outcome of inpatients; however, delirium is not diagnosed properly. Objective: To clarify the state of delirium diagnosis and records in a tertiary level public hospital in the city of Pereira. Methods: A cross-sectional descriptive study was performed by searching the clinical records of hospitalized patients older than 60 years 2010 and 2011, using the ICD-10 classification as a filter, and verifying the diagnostic criteria of DSM-IV in the clinical records. Results: In the years 2010 and 2011, 5325 patients older than 60 years were hospitalized (19.3 %). According to the official statistical records; 0.08 % of them were reported with an unspecified diagnosis of delirium (F059 ). In the clinical records search 455 additional delirium patients were found using the same criteria (40.2 %), of which 90.1 % had delirium, and only 29.5 % were classified with the code F059. Conclusions: The diagnoses and recording of delirium patients over 60 years old patients are underestimated, which is demonstrated by the incongruence of the data obtained from the official records and those obtained from the clinical records. This fact increases the risk and vulnerability of patients with undetected delirium or diagnosed but not reported delirium in hospital statistical sources. Liaison psychiatry is a necessity in third level health institutions, as well as a program of continued education for the health staff about prevention, diagnosis criteria and treatment of delirium.

Del principio de beneficencia al principio de autonomía aproximación a la evaluación de la competencia mental de los pacientes en el hospital general / From the principle of beneficence to the principle of autonomy. assessment of patients’ mental competency in the general hospital

Introducción: Rechazar un acto médico es un ejercicio válido dentro del derecho a la autonomía que tiene todo paciente. Desde el punto de vista legal, la autonomía se fundamenta en el derecho a la intimidad. En los últimos decenios, el derecho legal a la autodeterminación se ha ampliado progresivamente y hoy los pacientes en pleno uso de sus facultades mentales tienen el derecho moral y legal de tomar sus propias decisiones y estas tienen prioridad sobre las decisiones del médico y la familia. Objetivo: Analizar el papel de los psiquiatras de enlace para evaluar la competencia mental de estos pacientes. Discusión y Conclusiones: La evaluación de la capacidad de un paciente para decidir y autodeterminarse es un problema clínico frecuente en los hospitales generales. La evaluación de estos pacientes exige un conocimiento apropiado de los fundamentos filosóficos, éticos y legales que guían el tratamiento apropiado de estos complejos problemas clínicos…

Introduction: Refusing a medical procedure is a valid way of exercising every patient’s right to autonomy. From the legal point of view, autonomy is based on the right to privacy. In recent decades the legal right to self-determination has gradually expanded and today patients in full possession of their mental faculties, have the moral and legal right to make their own decisions and these decisions take precedence over physician and family. Often liaison psychiatrists are called in to assess the mental competence of patients in the general hospital. Objective: To determine the psychiatrist’s role in evaluating these patients. Discussion and Conclusions: The assessment of a patient’s ability to decide and self-determine is a common clinical problem in general hospitals. Evaluation of these patients requires a proper understanding of the philosophical, ethical, and legal issues that guide the appropriate treatment of these complex clinical problems…

[From the Principle of Beneficence to the Principle of Autonomy. Assessment of Patients' Mental Competency in the General Hospital]. / Del principio de beneficencia al principio de autonomía: aproximación a la evaluación de la competencia mental de los pacientes en el hospital general.

INTRODUCTION: Refusing a medical procedure is a valid way of exercising every patient's right to autonomy. From the legal point of view, autonomy is based on the right to privacy. In recent decades the legal right to self-determination has gradually expanded and today patients in full possession of their mental faculties, have the moral and legal right to make their own decisions and these decisions take precedence over physician and family. Often liaison psychiatrists are called in to assess the mental competence of patients in the general hospital. OBJECTIVE: To determine the psychiatrist's role in evaluating these patients. DISCUSSION AND CONCLUSIONS: The assessment of a patient's ability to decide and self-determine is a common clinical problem in general hospitals. Evaluation of these patients requires a proper understanding of the philosophical, ethical, and legal issues that guide the appropriate treatment of these complex clinical problems.

Intervención psiquiátrica en programa de trasplantes / Psychiatric intervention in a transplantation program

En los últimos años la Psiquiatría de Enlace e Interconsulta ha experimentado un salto cualitativo, acercándose al espacio común del resto de las especialidades médicas: el hospital general. La participación de psiquiatras en programas clínicos específicos como las unidades de trasplantes de órganos sólidos tiene fundamentaciones técnicas precisas dada la correlación entre síntomas psíquicos y las características clínicas específicas de las enfermedades médicas que requieren de este procedimiento. Cada vez hay una mayor preocupación en los clínicos y cirujanos en relación a los factores psíquicos que obstaculizan la adherencia a los tratamientos e indicaciones médicas tanto antes como después de efectuado el trasplante. La población de pacientes pre y post-trasplantados exhiben elevadas tasas de cuadros psiquiátricos específicos que ameritan un tratamiento coordinado multidisciplinario. El objetivo de este trabajo es mostrar la experiencia inicial que estamos desarrollando en la Unidad de Trasplantes de Clínica Las Condes.

In recent years consultation-liaison psychiatry has experienced a quantum leap closer to the common space of the other medical specialties: the general hospital. The participation in clinical programs such as the units of solid organ transplants have required technical arguments given the correlation between psychiatric symptoms and the clinical features of specific medical illness that require this procedure. During the last time, there have been and increasingly concern among clinicians and surgeons in regard to the psychological factors that affect the adherence to treatment and medical advice before and after transplant. The population concerning pre and post transplantation issues, exhibits significant rates of specifics psychiatric disorders which require evaluation and drug treatment specialist coordination. The aim of this paper is to show the initial experience we have developed in the transplant unit of Clínica Las Condes, concerning psychiatric and psychosocial issues.

Técnicas de psicoterapia breve en psiquiatría de enlace / Short Psychotherapeutic Techniques in Liaison Psychiatry

Introducción: Los pacientes y las condiciones que trata el psiquiatra de enlace requieren técnicas terapéuticas breves que aporten soluciones a los problemas y que disminuyan la carga que existe sobre las familias y los profesionales de la salud. Objetivo: Hacer una revisión narrativa de algunas técnicas terapéuticas de uso en enlace. Método: Revisión de la literatura. Desarrollo: Se provee una revisión de algunas técnicas de terapia breve, modalidades grupales, técnicas de relajación, hipnosis, terapia de ordalía y otras usadas en los profesionales de la salud, como los grupos Balint, y en los pacientes y sus familias, como la psicoeducación.

Introduction: Liaison psychiatrist treat patients and conditions that require short psychotherapeutic techniques, which will contribute to solve the patient’s problems, and reduce the burden on both family and health professionals. Objective: To do a narrative review of some therapeutic techniques used in liaison psychiatry. Method: Literature review. Development: Some short therapy techniques are reviewed, i.e. group therapy, relaxation techniques, hypnosis, ordalia therapy and others used by health professionals, such as Balint Groups, as well as psychoeducation for the patients and their families.

Um modelo para o parecer psiquiátrico no hospital geral / A model for the written report in consultation-liaison psychiatry

Objetivo: propor um modelo estruturado para elaboração das respostas às solicitações de pareceres psiquiátricos no hospital geral e discutir seus aspectos fundamentais. Métodos: foi realizada uma pesquisa sistemática nas bases de dados PubMed/Medline e PsycINFO à procura de artigos que descrevessem modelos para a resposta aos pareceres psiquiátricos em hospitais gerais. Além disso, todos os artigos sobre psiquiatria de ligação publicados no Jornal Brasileiro de Psiquiatria (indexado no PsycINFO) nos últimos dez anos foram analisados para localizar as contribuições brasileiras o tema. Foram selecionados artigos que descrevessem modelos estruturados para as respostas às solicitações de pareceres psiquiátricos em hospitais gerais. As informações contidas nesses artigos foram usadas na construção de uma proposta de ficha de parecer psiquiátrico. Resultados: apenas dois artigos preenchiam os critérios de seleção. Outros cinco artigos que descreviam problemas no processo de consultoria psiquiátrica forneceram informações sobre questões que deveriam ser abordados nos pareceres. Os modelos de parecer descritos foram analisados, e um novo modelo foi desenvolvido. Conclusão: os pareceres psiquiátricos são documentos que atendem às necessidades médicas e educacionais em um hospital geral. Um modelo estruturado de parecer evita a omissão de informações importantes, melhorando a comunicação entre os psiquiatras pareceristas e os outros médicos no hospital geral.