Comparing Differences between Two Groups of Adolescents Hospitalized for Self-Harming Behaviors with and without Personality Disorders.

Self-harm (non-suicidal self-injury (NSSI) and suicidal behavior (SB)) is frequent display during adolescence. Patients with personality disorders (PDs) frequently self-harm. However, few studies have focused on the role of PDs in self-harming adolescents. In this study, we collected 79 adolescents hospitalized due to self-harm (88.6% female; 78.5% Caucasian) and divided them into two groups, with or without a diagnosis of PD. The socio-demographic and psychological-clinical data were collected through a structured interview by clinicians. Univariate, subgroup, and multiple logistic regression analyses were performed. Univariate analysis showed that adolescents with a PD and self-harm had (1) an older age at hospitalization (p < 0.01); (2) experienced physical and sexual abuse (p = 0.05, and p < 0.01, respectively); (3) ADHD (p = 0.05); (4) a greater number of SA (p < 0.01); and (5) probability of being a major NSSI patient (>20 lifetime NSSI episodes) (p < 0.01). After multivariate stratified analysis, the results indicated that an older age, and particularly major NSSI status were predictors of PD diagnosis. Early identification and a better understanding of the characteristics of adolescent PDs can assist clinicians in intervening earlier and developing more rational treatment strategies to reduce the long-term effects of PDs.

Demand Analysis of a Psychiatric Emergency Room and an Adolescent Acute Inpatient Unit in the Context of the COVID-19 Pandemic in Madrid, Spain.

Introduction: COVID-19 represents a serious threat to mental health worldwide. The aim of this study is to identify changes in adolescent psychiatry treatment demand in a tertiary hospital in Madrid during the first month (March 11 to April 11) after the pandemic declaration by the World Health Organization (WHO). We hypothesized that fear of contagion within COVID-19 may deter people from asking for psychiatric care. Method: The current study is retrospective, observational, and transversal. We reviewed the clinical records of 89 adolescents who went to the Emergency Room (ER) or were hospitalized at the Acute Inpatient Unit (AIU) at the Puerta de Hierro University Hospital-Majadahonda (PHUH-M) between March 11 and April 11. Socio-demographic, clinical, and demand variables were included in the study. Chi-square or Fisher exact tests were performed to compare categorical variables. We used the U Mann-Whitney test to compare quantitative variables. The level of statistical significance was set at p< 0.05. Analyses were conducted using SPSS v11.0. Results: The number of adolescents demanding psychiatric care at the ER dropped from 64 adolescents in 2019 to 25 in 2020. Similarly, psychiatric demand collapsed from 31 to 18 patients when comparing 2019 and 2020. Furthermore, the average hospital stay in 2020 trended toward a decrease when compared to 2019 (8.94 ± 4.87 vs. 14.32 ±10.23, p = 0.08). Self-injurious thoughts and behaviors were the most predominant reasons for consultation at both ER and AIU. Conclusion: The demand for adolescent psychiatric care decreased in the first month after the declaration of the pandemic. Our findings may be explained by (1) the fear of contagion, (2) the strict confinement measures, and (3) the initial shock as an adaptive reaction described in other disasters. Further studies are needed.

Estudio de derivaciones de Atención Primaria a centros de Salud Mental en pacientes adultos en la Comunidad de Madrid / Study of primary care referrals to Mental Health centers in adult patients in Madrid Region

En el presente trabajo se estudian y analizan variables sociodemográficas, clínicas y asistenciales incluidas en los partes de interconsulta (PIC) que traen los pacientes adultos durante un periodo de 15 días recogidos de forma consecutiva en los meses de marzo a junio del 2015 en tres centros de Salud Mental de Madrid (CSM Colmenar Viejo, CSM Vallecas Villa y CSM Villaverde). El estudio estadístico mediante el análisis de variables descriptivas y variables dicotómicas muestra los siguientes resultados: dos tercios de las derivaciones a salud mental son a psiquiatría y un tercio están destinadas a psicología clínica; el tiempo medio de espera para la primera consulta en psicología es de 74 días frente a 38 días en psiquiatría; el 31% de las derivaciones son con carácter preferente con un tiempo medio de demora de 28 días y la mayor parte de las mismas se dirigen a la especialidad de psiquiatría; las principales patologías derivadas son trastornos de ansiedad, cuadros adaptativos y depresivos; el 46.7% de los pacientes derivados a salud mental toman ya algún psicofármaco; las derivaciones a psicología clínica se realizan con pacientes más jóvenes y menos medicados, con menor carácter de urgencia y con menos especificaciones sobre información diagnóstica y farmacológica en los PIC que las derivaciones a psiquiatría. Estos resultados son en su mayoría coherentes con los encontrados en estudios previos, aunque faltan investigaciones que incluyan varios CSM o analicen la información cualitativa de los PIC de derivación

In this paper, we analyze the sociodemographic, clinical, and health care variables included in the interconsultation reports (PIC) that bring adult patients over a period of 15 days, collected consecutively in the months of March through June 2015 from three mental health centers in Madrid (Colmenar Viejo CSM, Villaverde CSM, and Vallecas Villa CSM). The statistical analysis of data, including analysis of descriptive variables and dichotomous variables, shows the following results: two thirds of referrals are transfers to psychiatry and one third are transfers to clinical psychology; mean time in the waiting list is 74 days for clinical psychology consultation and 38 days for psychiatry consultation; preferential referrals are 31%, with 28 days of mean time in waiting list, being mostly intended for psychiatry; main referred pathologies are anxiety and adaptive and depressive disorders; 46.7% of patients transferred to mental health were already taking some psychiatric medication; clinical psychology referrals involve significantly younger and less medicated patients, significantly less preferential, and with fewer diagnostic and pharmacologic specifications in the PIC than psychiatry referrals. These results are consistent with previous studies, although we have not found other studies that include more than one mental health center, or analyze qualitative information contained in the inter-consultation reports

Prevalencia y funciones de los pensamientos y conductas autoagresivas en una muestra de adolescentes evaluados en consultas externas de salud mental / Prevalence and functions of self-injurious thoughts and behaviors in a sample of Spanish adolescents assessed in mental health outpatient departments

Introducción. Las conductas suicidas y autoagresivas de los adolescentes suponen un importante problema de salud pública. Sin embargo, se desconoce en nuestro medio la prevalencia y funciones de la ideación así como de las conductas suicidas y autoagresivas en la población adolescente atendida en salud mental. Métodos. Un total de 267 adolescentes de entre 11 y 18 años fueron reclutados de las consultas ambulatorias del Servicio de Psiquiatría de la Fundación Jiménez Díaz del 1 de noviembre de 2011 al 31 de octubre de 2012. Se administró a todos los pacientes la Escala de Pensamientos y Conductas Autolesivas que evalúa la presencia, frecuencia y características de la ideación suicida, la planificación suicida, los gestos de suicidio, los intentos de suicidio y las autolesiones sin intención suicida. Resultados. Un 20,6% de los adolescentes afirmaron haber tenido ideación suicida; un 2,2% planes suicidas; un 9,4% gestos suicidas; un 4,5% intentos de suicidio y un 21,7% autolesiones al menos una vez a lo largo de su vida. El 47,6% de los adolescentes refirieron haber tenido a lo largo de su vida al menos una de las conductas estudiadas y el 47,2% de ellos señalaron 2 ó más de estas conductas. Con relación a la función atribuida a las conductas examinadas, la mayor parte se realizaron con la intención de regular emociones, a excepción de los gestos suicidas (que mostró una función relacionada con el contexto social). Conclusiones. Dadas las elevadas cifras en población clínica de prevalencia y comorbilidad, unido al conocido riesgo de transición de unas conductas autoagresivas a otras, se recomienda la evaluación sistemática y rutinaria de dichas conductas en los adolescentes atendidos en salud mental (AU)

Introduction. Suicidal and self-injurious behaviors in adolescents are a major public health concern. However, the prevalence of self-injurious thoughts and behaviors in Spanish outpatient adolescents is unknown. Methods. A total of 267 adolescents between 11 and 18 year old were recruited from the Child and Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 1st 2011 to October 31st 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Inventory, which is a structured interview that assesses the presence, frequency, and characteristics of suicidal ideation, suicide plans, suicide gestures, suicide attempts, and non-suicidal self-injury. Results. One-fifth (20.6%) of adolescents reported having had suicidal ideation at least once during their lifetime. Similarly, 2.2% reported suicide plans, 9.4% reported suicide gesture, 4.5% attempted suicide, and 21.7% reported non-suicidal self-injury, at least once during their lifetime. Of the whole sample, 47.6% of adolescents reported at least one of the studied thoughts or behaviors in their lifetime. Among them, 47.2% reported 2 or more of these thoughts or behaviors. Regarding the reported function of each type of thoughts and behaviors examined, most were performed for emotional regulation purposes, except in the case of suicide gestures (performed for the purposes of social reinforcement). Conclusions. he high prevalence and high comorbidity of self-injurious thoughts and behaviors, together with the known risk of transition among them, underline the need of a systematic and routine assessment of these thoughts and behaviors in adolescents assessed in mental health departments (AU)

[Prevalence and functions of self-injurious thoughts and behaviors in a sample of Spanish adolescents assessed in mental health outpatient departments]. / Prevalencia y funciones de los pensamientos y conductas autoagresivas en una muestra de adolescentes evaluados en consultas externas de salud mental.

INTRODUCTION: Suicidal and self-injurious behaviors in adolescents are a major public health concern. However, the prevalence of self-injurious thoughts and behaviors in Spanish outpatient adolescents is unknown. METHODS: A total of 267 adolescents between 11 and 18 year old were recruited from the Child and Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 1st 2011 to October 31st 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Inventory, which is a structured interview that assesses the presence, frequency, and characteristics of suicidal ideation, suicide plans, suicide gestures, suicide attempts, and non-suicidal self-injury. RESULTS: One-fifth (20.6%) of adolescents reported having had suicidal ideation at least once during their lifetime. Similarly, 2.2% reported suicide plans, 9.4% reported suicide gesture, 4.5% attempted suicide, and 21.7% reported non-suicidal self-injury, at least once during their lifetime. Of the whole sample, 47.6% of adolescents reported at least one of the studied thoughts or behaviors in their lifetime. Among them, 47.2% reported 2 or more of these thoughts or behaviors. Regarding the reported function of each type of thoughts and behaviors examined, most were performed for emotional regulation purposes, except in the case of suicide gestures (performed for the purposes of social reinforcement). CONCLUSIONS: The high prevalence and high comorbidity of self-injurious thoughts and behaviors, together with the known risk of transition among them, underline the need of a systematic and routine assessment of these thoughts and behaviors in adolescents assessed in mental health departments.

“Depresión”. Imprecisión diagnóstica y terapéutica. Importantes consecuencias en la práctica clínica / Depression as an imprecise and heterogeneous mental disorder. Consequences for clinical practice

Los trastornos depresivos constituyen un grupo enormemente heterogéneo de cuadros clínicos, cuya severidad se distribuye en un continuum que abarca, desde cuadros de dudosa o inconsistente significación clínica y próximos a las reacciones emocionales no patológicas, hasta cuadros severos con gran afectación funcional y riesgo vital. El episodio depresivo y la depresión mayor son categorías heterogéneas e imprecisas y el término depresión, aunque ampliamente utilizado en medios profesionales y extra profesionales, es todavía más ambiguo. Se subrayan algunas características clínicas que diferencian los trastornos depresivos con significación clínica del resto. Frente a la heterogeneidad clínica de los trastornos depresivos existe una llamativa uniformidad en el abordaje terapéutico, basado en la administración indiscriminada de fármacos antidepresivos para cualquier cuadro del amplio espectro de trastornos depresivos. Sería necesario desarrollar protocolos de actuación, con abordajes específicos, biológicos, psicoterapéuticos y psicosociales en función de los datos de eficacia de cada tipo de abordaje y de cada paciente específico, restringiendo los tratamientos farmacológicos a los cuadros en que han mostrado eficacia (AU)

Depressive disorders constitute a very heterogeneous group of clinical syndromes which includes from depressive syndromes of doubtful clinical significance to very severe and disabled disorders of high risk for life. The depressive episode and major depression categories, according to diagnostic criteria, are also very heterogeneous and vague entities. The “depression” term, widely used in scientific literature, is excessively ambiguous. In spite of this clinical heterogeneity, there is a striking uniformity in therapeutic management of depressive syndromes, based excessively in antidepressant drugs. Development of practice guidelines including not only biological but psychotherapeutic and psychosocial techniques is needed. Pharmacologic treatments should be restricted to more severe depressive episodes (AU)