Áreas de mejora en el manejo clínico de la depresión: perspectiva de pacientes, familiares y profesionales / Areas for improvement in the management of depression: perspectives of patients, families and professionals

Introducción. Actualmente existe consenso en que la atención a la depresión requiere entender las experiencias, expectativas y preferencias de los pacientes e incorporar la visión de los profesionales implicados en su manejo. El objetivo de este estudio fue explorar y comparar las perspectivas de pacientes, familiares y profesionales respecto de las principales áreas de mejora de la práctica clínica de la depresión. Material y métodos. Se realizaron 4 grupos focales (2 con pacientes con depresión mayor, uno con familiares y uno con profesionales). Para la captación de los participantes se contó con la colaboración del Servizo Galego de Saúde y de la Federación de Asociaciones de Familiares y Personas con Enfermedad Mental. El contenido de las transcripciones se analizó temáticamente. Resultados. Se identificaron 5 temas principales y 18 subtemas: los retos diagnósticos, la necesidad de un abordaje integral, las mejoras en la coordinación y seguimiento, el establecimiento de un espacio y relación terapéutica adecuados y, por último, el impacto del estigma. Los pacientes, familiares y profesionales aportaron información parcialmente coincidente y complementaria sobre estos temas principales. Conclusiones. El manejo de la depresión es una labor compleja que requiere la puesta en marcha de medidas de diferente naturaleza. Incorporar las perspectivas de los principales agentes implicados es fundamental y se hace patente la necesidad de seguir trabajando en modelos de atención a la depresión que optimicen las experiencias de los pacientes y que tengan en cuenta sus preferencias y expectativas (AU)

Introduction. There is currently a consensus that depression care requires understanding the experiences, expectations, and preferences of patients, and incorporating the views of the professionals involved in its management. The aim of this study was to explore and compare the perspectives of patients, families, and health professionals on the main areas for improvement in the clinical practice of depression. Material and methods. Four focus groups were performed (2 with patients with major depression, one with family members, and one with professionals). Participants were recruited with the collaboration the Galician Health Service and the Federation of Associations of Relatives and Persons with Mental Disease. The content of the transcripts were analysed thematically. Results. Five themes and 18 sub-themes emerged, including, diagnostic challenges, the need for a comprehensive approach, improvements in the coordination and monitoring, the establishment of an adequate relationship and therapeutic space and, finally, the impact of stigma. Patients, families and professionals provided partially overlapping and complementary information on these main themes. Conclusions. The management of depression is a complex task, which requires the implementation of measures of a different nature. The incorporation of the perspectives of key stakeholders is essential and it is necessary to continue working on models of care for depression that optimise the experiences of patients, and take into account their preferences and expectations (AU)

[Areas for improvement in the management of depression: perspectives of patients, families and professionals]. / Áreas de mejora en el manejo clínico de la depresión: perspectiva de pacientes, familiares y profesionales.

INTRODUCTION: There is currently a consensus that depression care requires understanding the experiences, expectations, and preferences of patients, and incorporating the views of the professionals involved in its management. The aim of this study was to explore and compare the perspectives of patients, families, and health professionals on the main areas for improvement in the clinical practice of depression. MATERIAL AND METHODS: Four focus groups were performed (2 with patients with major depression, one with family members, and one with professionals). Participants were recruited with the collaboration the Galician Health Service and the Federation of Associations of Relatives and Persons with Mental Disease. The content of the transcripts were analysed thematically. RESULTS: Five themes and 18 sub-themes emerged, including, diagnostic challenges, the need for a comprehensive approach, improvements in the coordination and monitoring, the establishment of an adequate relationship and therapeutic space and, finally, the impact of stigma. Patients, families and professionals provided partially overlapping and complementary information on these main themes. CONCLUSIONS: The management of depression is a complex task, which requires the implementation of measures of a different nature. The incorporation of the perspectives of key stakeholders is essential and it is necessary to continue working on models of care for depression that optimise the experiences of patients, and take into account their preferences and expectations.

Satisfacción y utilidad percibidas por pacientes y familiares acerca de la información sobre prevención de suicidio / Perceived satisfaction and usefulness of suicide prevention information for patients and relatives

Objetivo: Evaluar la satisfacción de personas con conducta suicida y de sus familiares con la información incluida en la «Guía de práctica clínica de prevención y tratamiento de la conducta suicida». Método: Los participantes fueron reclutados a través de un programa de prevención de suicidio (Programa de intervención intensiva en conducta suicida [PII]) y de una Asociación (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES]). Se diseñó un cuestionario ad hoc para conocer el grado de satisfacción y utilidad percibidas con la información incluida en la guía. Resultados: La muestra estuvo formada por 57 pacientes con ideación o conducta suicidas y 52 familiares. Los pacientes puntuaron significativamente más bajo que los familiares en las 2 dimensiones: formato y utilidad; sin embargo, no se encontraron diferencias significativas entre ambos grupos en el nivel de satisfacción general. Las variables sociodemográficas no influyeron en los resultados. Tampoco se encontraron diferencias entre pacientes con y sin antecedentes de conducta suicida. Conclusiones: En general, tanto pacientes como familiares mostraron un alto nivel de satisfacción con el documento. Los participantes destacaron la atención primaria como el ámbito más adecuado para la difusión de este tipo de información. Suministrar información de estas características a pacientes con ideación y/o conducta suicida podría actuar como herramienta preventivo-educativa (AU)

Objective: To assess the satisfaction of persons with suicidal behaviour and their relatives using patient information material included in the Clinical Practice Guidelines on Prevention and Treatment of Suicidal Behaviour. Method: The sample was made up of 57 patients with suicidal ideation or behaviour, and 52 relatives. The participants were recruited through a suicide prevention programme (Programa de intervención intensiva en conducta suicida [PII] - Suicidal Behaviour IntensiveIntervention Programme) and a family association (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES] - Galician Federation of Associations of Relatives and Persons with mental diseases). An ad-hoc questionnaire was designed to ascertain the degree of perceived satisfaction and usefulness of using the information included in the guidelines. Results: The descriptive data of the sample is presented, along with an exploratory factorial analysis of the questionnaire that yielded two dimensions, i.e., format and usefulness. Patients scored significantly lower than the relatives in two dimensions; nevertheless, no significant differences were found between the two groups in the level of general satisfaction. The sociodemographic variables did not influence the results. Similarly, no differences were observed between patients with and without history of suicidal behaviour. Participants stressed that Primary Care was the setting best suited for dissemination of this type of information. Conclusions: In general, both patients and relatives displayed a high level of satisfaction with the patient information material assessed. Furnishing information of this type to patients with suicidal ideation and/or behaviour could act as a preventive-educational tool (AU)

[Perceived satisfaction and usefulness of suicide prevention information for patients and relatives]. / Satisfacción y utilidad percibidas por pacientes y familiares acerca de la información sobre prevención de suicidio.

OBJECTIVE: To assess the satisfaction of persons with suicidal behaviour and their relatives using patient information material included in the Clinical Practice Guidelines on Prevention and Treatment of Suicidal Behaviour. METHOD: The sample was made up of 57 patients with suicidal ideation or behaviour, and 52 relatives. The participants were recruited through a suicide prevention programme (Programa de intervención intensiva en conducta suicida [PII] - Suicidal Behaviour Intensive Intervention Programme) and a family association (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES] - Galician Federation of Associations of Relatives and Persons with mental diseases). An ad-hoc questionnaire was designed to ascertain the degree of perceived satisfaction and usefulness of using the information included in the guidelines. RESULTS: The descriptive data of the sample is presented, along with an exploratory factorial analysis of the questionnaire that yielded two dimensions, i.e., format and usefulness. Patients scored significantly lower than the relatives in two dimensions; nevertheless, no significant differences were found between the two groups in the level of general satisfaction. The socio-demographic variables did not influence the results. Similarly, no differences were observed between patients with and without history of suicidal behaviour. Participants stressed that Primary Care was the setting best suited for dissemination of this type of information. CONCLUSIONS: In general, both patients and relatives displayed a high level of satisfaction with the patient information material assessed. Furnishing information of this type to patients with suicidal ideation and/or behaviour could act as a preventive-educational tool.

A review of the natural course of bipolar disorders (manic-depressive psychosis) in the pre-drug era: review of studies prior to 1950.

A review of the most important original studies describing the natural course of bipolar disorder (manic-depressive psychosis) published in the pre-drug era - before 1950 - is conducted. Discrepancies among studies are detected, most of which are likely explained by methodological differences. However, some conclusions from these old studies remain perfectly valid nowadays: mania is a chronic brain disorder, inherited in most cases, decompensation being more frequent between March and August. It is more common in males, and in some cases, is secondary to other somatic problems. Mixed states are more frequent in the elderly. The review of this type of historical studies is aimed at underscoring the importance that should be attached to the careful study of psychopathology and its recording, both in clinical practice and in psychiatry research.