Hoarding behaviour: special features and complications in real-world clinical practice.

OBJECTIVE: Hoarding behaviour is a common but poorly characterised problem in real-world clinical practice. Although hoarding behaviour is the key component of Hoarding Disorder (HD), there are people who exhibit hoarding behaviour but do not suffer from HD. The aim of the present study was to characterise a clinical sample of patients with clinically relevant hoarding behaviour and evaluate the differential characteristics between patients with and without HD. METHODS: This study included patients who received treatment at the home visitation program in Barcelona (Spain) from January 2013 through December 2020, and scored ≥ 4 on the Clutter Image Rating scale. Sociodemographic, DSM-5 diagnosis, clinical data and differences between patients with and without an HD diagnosis were assessed. RESULTS: A total of 243 subjects were included. Hoarding behaviour had been unnoticed in its early stages and the median length in the sample was 10 years (IQR 15). 100% of the cases had hoarding-related complications. HD was the most common diagnosis in 117 patients (48.1%). CONCLUSIONS: The study found several differential characteristics between patients with and without HD diagnosis. Alcohol use disorder could play an important role among those without HD diagnosis. Home visitation programs could improve earlier detection, preventing hoarding-related complications.

Burden and satisfaction experienced in relatives and patients during home hospitalisation in psychiatry.

The role of caregivers is essential during home hospitalization since they act as co-therapists, being the level of responsibility experienced by them higher than usual.

Sobrecarga experimentada y satisfacción en familiares y pacientes durante una hospitalización domiciliaria en psiquiatría / Burden and satisfaction experienced in relatives and patients during home hospitalisation in psychiatry

Introducción: El rol de los cuidadores es esencial durantela hospitalización domiciliaria ya que ejercen de coterapeutas,siendo el nivel de responsabilidad que experimentan mayora la habitual. El objetivo de este estudio es evaluar lasobrecarga experimentada en los cuidadores principalesy también determinar el nivel de satisfacción percibida enlos cuidadores principales y en los pacientes atendidos ennuestra unidad de hospitalización domiciliaria (HADMar).Metodología. Estudio prospectivo observacional. Se hanincluido todos los pacientes que han ingresado en HADMarentre mayo de 2020 y abril de 2021. Se han recogido datossocio-demográficos y clínicos de la muestra. Para evaluar elgrado de sobrecarga se ha utilizado la escala de Zarit al finaldel ingreso en los cuidadores principales. Para determinar lasatisfacción percibida se ha administrado la escala CRES-4 alfinal del ingreso tanto a los cuidadores como a los pacientesatendidos.Resultados. 182 pacientes han sido atendidos. Del total,144 cuidadores principales han respondido la escala de Zarit,siendo la puntuación media de 49,59 (correspondiente asobrecarga ligera). 152 cuidadores han respondido la escalaCRES-4, obteniendo una puntuación media de 241,75 (sobreun máximo posible de 300). 158 pacientes han respondido laescala CRES-4 y la puntuación media ha sido 242,57. (AU)

Introduction: The role of caregivers is essential duringhome hospitalization since they act as co-therapists, beingthe level of responsibility experienced by them higher thanusual. The objective of this study is to evaluate the burdenexperienced in the main caregivers and also to determine thelevel of satisfaction perceived in the main caregivers and in thepatients attended in our home hospitalization unit (HADMar).Methodology. Prospective observational study. Allpatients admitted to HADMar between May 2020 and April2021 have been included. Socio-demographic and clinicaldata have been collected from the sample. To assess thedegree of burden, the Zarit scale was used at the end ofadmission in the main caregivers. To determine the perceivedsatisfaction, the CRES-4 scale was administered at the end ofadmission to both the caregivers and the patients attended.Results. 182 patients have been attended. Of them, 144main caregivers answered the Zarit scale, being the meanscore 49.59 (corresponding to mild burden). 152 caregivers answered the CRES-4 scale, obtaining a mean score of241.75 (out of a possible maximum of 300). 158 patientsanswered the CRES-4 scale and the mean score was 242.57. (AU)

[Suicidal attempt and suicidal ideation during the COVID-19 pandemic compared to previous years]. / Intentos e ideas de suicidio durante la pandemia por COVID-19 en comparación con los años previos.

INTRODUCTION: Since the COVID-19 pandemic began, warnings have been made about the impact on the mental health of the population and as occurred in previous pandemics, an increase in suicide rates had been anticipated. To date, studies differ with regard to whether suicide rates are being affected during the COVID pandemic. MATERIAL AND METHODS: All individuals registered for suicidal ideation or suicidal attempt in the Suicide Risk Code (CRS) from the city of Barcelona from January 1, 2018 to June 30, 2021 have been included. A bivariate analysis has been carried out between the 2018-2019 period and the pandemic period. The percentage increase in the monthly incidence of CRS cases has been calculated, using the average monthly incidence for the 2018-2019 period as a reference. RESULTS: A total of 3388 consultations for suicide ideation or suicidal attempt were registered. There has been an increase of 43.20% in the monthly incidence of suicidal ideation and suicidal attempts during the pandemic compared to the 2018-2019 period, reaching a maximum increase of 573.8% in young people under 18 years in the month of May 2021. CONCLUSIONS: During the COVID-19 pandemic period, consultations for suicidal ideation and suicidal attempts have increased compared to the previous 2 years in the city of Barcelona. It should be noted this growth especially in young people under 18 years.

Unidad de hospitalización domiciliaria en Barcelona: resultados clínicos y funcionales después de tres años de experiencia / No disponible

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Family Features of Social Withdrawal Syndrome (Hikikomori).

Background: Family may play an important role in the origin, maintenance, and treatment of people with social withdrawal. The aim of this study is to analyze family factors related to social withdrawal syndrome. Methods: Socio-demographic, clinical, and family data, including family psychiatric history, dysfunctional family dynamics, and history of family abuse were analyzed in 190 cases of social withdrawal with a minimum duration of 6 months that started an at-home treatment program. Data were analyzed at baseline and at 12 months. Results: In 36 cases (18%) neither the patient nor the family allowed at home evaluation and treatment by the Crisis Resolution Home Treatment (CRHT) team. Patients had high rates of dysfunctional family dynamics (n = 115, 61.5%), and family psychiatric history (n = 113, 59.3%), especially maternal affective (n = 22, 42.9%), and anxiety disorders (n = 11 20.4%). There was a non-negligible percentage of family maltreatment in childhood (n = 35, 20.7%) and single-parent families (n = 66, 37.8%). Most of the cases lived with their families (n = 135, 86%), had higher family collaboration in the therapeutic plan (n = 97, 51.9%) and families were the ones to detect patient isolation and call for help (n = 140, 73.7%). Higher social withdrawal severity (as defined by at least one of: early age of onset, no family collaboration, lack of insight, higher CGSI score, and higher Zarit score), was associated with family psychiatric history, dysfunctional family dynamics, and family abuse history. All of these predictive variables were highly correlated one to each other. Conclusions: There is a high frequency of family psychiatric history, dysfunctional family dynamics, and traumatic events in childhood (family maltreatment), and these factors are closely interrelated, highlighting the potential role of family in the development and maintenance of social withdrawal.

Síntomas neuropsiquiátricos como factor de confusión en la detección de la demencia / No disponible

OBJETIVO: Valorar si los síntomas neuropsiquiátricos interfieren en la detección de deterioro cognitivo por los médicos de familia en atención primaria, así como describir cuáles generan más confusión. DISEÑO: Estudio observacional y descriptivo. Emplazamiento: Equipo de psiquiatría de intervención en domicilio en colaboración con la red de atención primaria de Barcelona. PARTICIPANTES: Un total de 104 pacientes mayores de 65 años derivados desde atención primaria por sus médicos de familia solicitando valoración psiquiátrica en el domicilio por sospecha de enfermedad mental. Mediciones principales: Todos los casos recibieron un diagnóstico según criterios DSM-IV-TR. Se incluyeron en el estudio el Mini Mental State Examination (MMSE), el Inventario Neuropsiquiátrico de Cummings, la escala de Gravedad de Enfermedad Psiquiátrica, la escala de Evaluación de la Actividad Global, la escala de Impresión Clínica Global y el Cuestionario de Evaluación de la Discapacidad de la Organización Mundial de la Salud. RESULTADOS: El 55,8% de los pacientes derivados desde atención primaria tenían el MMSE alterado. Los síntomas neuropsiquiátricos más frecuentemente asociados a la sospecha de deterioro cognitivo fueron los delirios, las alucinaciones, la agitación, la desinhibición, la irritabilidad y la conducta motora sin finalidad. CONCLUSIONES: Cuando se detecten síntomas psiquiátricos propios de trastorno mental severo (TMS) en individuos de edad avanzada sin antecedentes de TMS hay que sospechar un deterioro cognitivo y se debería administrar una prueba de cribado

OBJECTIVE: The aim of the study was to evaluate whether the neuropsychiatric symptoms interfere with cognitive impairment detection in primary care and to describe which of them generate more confusion. DESIGN: Descriptive and observational study. LOCATION: Mobile psychiatric unit in collaboration with primary healthcare centers in Barcelona. PARTICIPANTS: A total of 104 patients over 65 years referred to mobile psychiatric unit from primary healthcare clinicians suspecting mental disease. MAIN MEASUREMENTS: All patients received a DSM-IV-TR diagnosis. We included in the study the Mini Mental State Examination (MMSE), Neuropsichiatric Inventory, Severe Psychiatric Illness scale, Global Assessment of Functioning, Clinical Global Impression and Word Health Organisation Dissability Assessment Schedule. RESULTS: 55.8% of patients referred from primary care had altered MMSE score. Neuropsychiatric symptoms more frequently associated with suspected cognitive impairment were delusions, hallucinations, agitation, disinhibition, irritability and purposeless motor behavior. CONCLUSIONS: When psychiatric symptoms of Severe Mental Disorder (SMD) are detected in elderly individuals with no history of SMD, cognitive impairment should be suspected and a screening test be done

A 12-month study of the hikikomori syndrome of social withdrawal: Clinical characterization and different subtypes proposal.

Social withdrawal is a new mental health problem increasingly common, present in different cultures, whose psychopathology and treatment is not yet established. This study aims to determine the socio-demographic and clinical features and possible clinical subtypes that predict the 12-month outcomes of cases with hikikomori syndrome, a severe form of social withdrawal. Socio-demographic and clinical data at baseline were analysed as well as data obtained for 12 months after at-home treatment in 190 cases. The inclusion criteria were: spending all time at home, avoiding social situations and relationships, significant deterioration due to social isolation, with a minimum duration of 6 months. Six major diagnostic groups were identified: affective, anxiety, psychotic, drug use, personality and other Axis I disorders. The anxiety-affective subgroup demonstrated lower clinical severity, but worse evolution. Less than half of the cases were available for medical follow-up at 12-months. Subjects undergoing intensive treatment had a higher medical follow-up rate and better social networks at 12-months. Therefore, our findings provide data to reach consensus on the specific characteristics of social isolation hikikomori syndrome. The analysis demonstrated the fragility and tendency to relapse and have disengagement, particularly relevant in the anxiety-affective subgroup, suggesting that intensive treatments are more effective.

Síntomas neuropsiquiátricos como factor de confusión en la detección de la demencia.

OBJECTIVE: The aim of the study was to evaluate whether the neuropsychiatric symptoms interfere with cognitive impairment detection in primary care and to describe which of them generate more confusion. DESIGN: Descriptive and observational study. LOCATION: Mobile psychiatric unit in collaboration with primary healthcare centers in Barcelona. PARTICIPANTS: A total of 104 patients over 65years referred to mobile psychiatric unit from primary healthcare clinicians suspecting mental disease. MAIN MEASUREMENTS: All patients received a DSM-IV-TR diagnosis. We included in the study the Mini Mental State Examination (MMSE), Neuropsichiatric Inventory, Severe Psychiatric Illness scale, Global Assessment of Functioning, Clinical Global Impression and Word Health Organisation Dissability Assessment Schedule. RESULTS: 55.8% of patients referred from primary care had altered MMSE score. Neuropsychiatric symptoms more frequently associated with suspected cognitive impairment were delusions, hallucinations, agitation, disinhibition, irritability and purposeless motor behavior. CONCLUSIONS: When psychiatric symptoms of Severe Mental Disorder (SMD) are detected in elderly individuals with no history of SMD, cognitive impairment should be suspected and a screening test be done.

Home treatment in preventing hospital admission for moderate and severe mentally ill people.

A Home Treatment team was compared with a Psychiatric Emergency Department (PED) on preventing hospitalization among two cohorts of 448 patients matched by diagnosis, sex, and age. The logistic regression showed that HT people were 4.6 times less likely to be admitted than those from PED.

Clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder in a psychiatric emergency service.

INTRODUCTION: To analyze factors associated with clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder (AD) seeking care at a psychiatric emergency unit. METHOD: A total of 5003 consecutive visits were reviewed over a three-year period at a psychiatric emergency service in a tertiary university hospital. Data collected included sociodemographic and clinical information as well as the Global Assessment of Functioning (GAF) and the Severity Psychiatric Illness (SPI) scale scores. RESULTS: Of all the visits, 992 (19.8%) were diagnosed of AD. Of these, 19.6% required clinical observation and 72.2% were referred to a psychiatrist at discharge. Regression analysis showed that referral to psychiatry was associated with being male, native, psychiatric background, greater severity, lower global functioning, and behavioral disorders. Clinical observation (in a box) was associated with being female, greater severity, and psychotic or behavioral symptoms. Prescription of benzodiazepines was associated with anxiety, no history of addiction, and lower global functioning. Antidepressants were associated with being a native, anxiety with no history of addiction, and lower functioning. Antipsychotics were associated with being native, psychiatric background (not addiction), anxiety, and lower functioning. CONCLUSION: Behavior, psychiatric background and illness severity were determinants of referral to a specialist. Besides these, psychotic symptoms and non-specific clinical symptoms were determinants of observation. Drug prescription in AD is less frequent if the main complaint is not anxiety and depends more on the level of functioning than on that of severity.

Observación, farmacoterapia y derivación al alta de los pacientes con trastorno de ansiedad en urgencias de psiquiatría / Clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder in a psychiatric emergency service

Introducción. Analizar los determinantes asociados a indicar observación, prescribir psicofármacos y derivar al especialista en los pacientes con trastorno de ansiedad (TA) visitados en urgencias de psiquiatría. Método. Se analizaron 5003 visitas consecutivas realizadas en un hospital general universitario durante tres años. Se incluyó información sociodemográfica, clínica y puntuación en las escalas de Evaluación de la Actividad Global (EEAG) y de Gravedad de la Enfermedad Psiquiátrica (GEP). Resultados. Del total de visitas, 992 (19,8%) fueron diagnosticadas de TA. De estas visitas, 19,6% utilizaron box y 72,2% fueron derivadas al especialista. El análisis de regresión mostró que la derivación a psiquiatría se asociaba con ser hombre, autóctono, tener antecedentes, mayor gravedad, menor actividad global y alteraciones conductuales. La observación (uso del box) se relacionó con ser mujer, mayor gravedad y síntomas psicóticos o de conducta. La prescripción de benzodiacepinas se asoció a ansiedad sin problemas de toxicomanías y a una menor actividad global. Los antidepresivos se relacionaron con ser autóctono, ansiedad sin toxicomanías y con menor actividad. Los antipsicóticos con ser autóctono, tener antecedentes sin toxicomanías, ansiedad y menor actividad. Conclusión. La conducta, los antecedentes y la gravedad resultaron determinantes de derivación al especialista. Además de estos, los síntomas psicóticos y la inespecificidad clínica lo fueron para indicar observación. La prescripción farmacológica en los TA es menos frecuente si el motivo de consulta no es por ansiedad y depende más del nivel de actividad que de la gravedad

Introduction. To analyze factors associated with clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder (AD) seeking care at a psychiatric emergency unit. Method. A total of 5003 consecutive visits were reviewed over a three-year period at a psychiatric emergency service in a tertiary university hospital. Data collected included sociodemographic and clinical information as well as the Global Assessment of Functioning (GAF) and the Severity Psychiatric Illness (SPI) scale scores. Results. Of all the visits, 992 (19.8%) were diagnosed of AD. Of these, 19.6% required clinical observation and 72.2% were referred to a psychiatrist at discharge. Regression analysis showed that referral to psychiatry was associated with being male, native, psychiatric background, greater severity, lower global functioning, and behavioral disorders. Clinical observation (in a box) was associated with being female, greater severity, and psychotic or behavioral symptoms. Prescription of benzodiazepines was associated with anxiety, no history of addiction, and lower global functioning. Antidepressants were associated with being a native, anxiety with no history of addiction, and lower functioning. Antipsychotics were associated with being native, psychiatric background (not addiction), anxiety, and lower functioning. Conclusion. Behavior, psychiatric background and illness severity were determinants of referral to a specialist. Besides these, psychotic symptoms and non-specific clinical symptoms were determinants of observation. Drug prescription in AD is less frequent if the main complaint is not anxiety and depends more on the level of functioning than on that of severity

Síndrome de Dhat: descripción de 6 casos / Dhat syndrome: report of six cases

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Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service.

OBJECTIVE: This study aimed to determine factors associated with hospitalization and decisions to prescribe psychotropic medication for patients with borderline personality disorder seeking care at psychiatric emergency units. METHODS: A total of 11,578 consecutive visits were reviewed over a four-year period at a psychiatric emergency service in a tertiary hospital in Spain. Some patients were repeat visitors. Data collected included sociodemographic, clinical, social, and therapeutic information and the Severity of Psychiatric Illness (SPI) score. RESULTS: Borderline personality disorder was the diagnosis in 1,032 of the visits (9%) to the emergency department, which corresponded to 540 individuals. Of these visits, 11% required hospitalization. Multivariate statistical logistic regression analysis showed that the decision to hospitalize was associated with risk of suicide, danger to others, severity of symptoms, difficulty with self-care, and noncompliance with treatment. The decision to prescribe benzodiazepines was related to male sex, anxiety as the reason for seeking care, little difficulty with self-care, few medical or drug problems, and housing instability. Factors related to the prescription of antipsychotics were male sex, risk of endangering others, and psychosis as the reason for the visit. Factors associated with the prescription of antidepressants were depression as the reason for seeking help and little premorbid dysfunction. CONCLUSIONS: Patients with borderline personality disorder had greater clinical severity, but the percentage of hospitalizations was lower than for patients without the disorder. Although a psychiatric emergency service is not the ideal setting to initiate pharmacotherapy, in practice, psychiatrists often prescribe medications in this setting. The SPI was a good tool to assess the severity of illness of these patients.