Delay in the Diagnosis of Breast and Colorectal Cancer in People With Severe Mental Disorders.

BACKGROUND: People with severe mental disorders have a worse cancer prognosis, with higher mortality rates than the general population, and this could be partially attributed to a later detection. Breast cancer and colorectal cancer have mass population screenings in Spain, but the influence in early diagnosis is unknown in persons with severe mental disorders. OBJECTIVE: To compare the severity of breast and colorectal cancers at diagnosis in people with and without mental disorders. METHODS: This was an observational, retrospective, case-control study with 1:2 matching performed in Eastern Spain. Data were retrieved for analysis from electronic medical records. RESULTS: The study included 111 oncology patients (75 with breast cancer and 36 with colorectal cancer). Individuals with mental disorders had a significantly higher (P = .002) relative risk (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.60-9.65) to be diagnosed with an advanced tumor stage (clinical stages IIIA, IIIB, IIIC, and IV), for both breast and colorectal cancers when analyzed separately. The variables associated with advanced cancer at the time of diagnosis were the presence of a previous mental disorder (OR, 4.67; 95% CI, 1.73-12.61) and older age (OR, 1.08; 95% CI, 1.02-1.14). CONCLUSIONS: Individuals with severe mental disorders showed a higher risk of being diagnosed with breast and colorectal cancers at advanced stages. IMPLICATIONS FOR PRACTICE: Cancer screening for earlier detection and intervention in people with severe mental disorders needs improvement. Mental health nurses, screening nurses, and oncology nurses could serve an essential role in increasing the screening adherence of this group of individuals.

Diagnóstico y prevalencia de trastornos de la personalidad en atención ambulatoria. Estudio descriptive / The diagnosis and prevalence of personality disorders in outpatient services. A descriptive study

Introducción: los trastornos de personalidad (TP) son difíciles de diagnosticar. La literatura científica informa de su elevada prevalencia en muestras clínicas, pero en la práctica clínica diaria su diagnóstico es muy poco frecuente. Objetivos: Este estudio pretende estimar la prevalencia de TP en una Unidad ambulatoria de Salud Mental (USM), en situación real, para primeras citas. Método: Se aplicó el Cuestionario Salamanca (CS) como instrumento de cribado y, con los puntos de corte mínimo (2/3) y máximo (5/6), se comparó con el diagnóstico clínico realizado por un psicólogo clínico o psiquiatra, sin conocer el resultado del cribado con CS. Resultados: El diagnóstico de TP realizado por un profesional fue de un 7%, frente al 100% de positivos obtenido por el CS en el punto de corte mínimo y el 53% con el máximo: 11,8% para Cluster A, 19,8% Cluster B y 21,4% en el C. Conclusiones: La elevada prevalencia de TPs en los centros de salud mental, junto con el infradiagnóstico clínico, son otros factores que ensombrecen el pronóstico de estos pacientes (AU)

Introduction: Personality disorders (PD) are difficult to diagnose. Scientific literature shows a high prevalence in outpatient mental health services, but in daily practice the diagnosis of a PD is infrequent. Objectives: This study aims to calculate the prevalence of PD in outpatient mental health services in real clinic situation among patients who come for the first time. Method: Salamanca Questionnaire (SQ) was used as a screening method with the minimum score cut (2/3) and the maximum score cut (5/6). The results were compared with the clinical diagnose proposed by the psychiatrist or psychologyst, who did not know the result of SQ. Results: Only 7% of patients received PD diagnose although 100% of patients had pathological results with SQ using the lowest score proposed and 53% using the highest score proposed: 11,8% Clúster A, 19,8%, Clúster B and 21,4% Cluster C. Conclusions: The high prevalence of PD in outpatient mental health services and the low diagnosis rate are elements that worsen the prognosis of these patients (AU)

Impact of involuntary out-patient commitment on reducing hospital services: 2-year follow-up.

Aims and method To evaluate whether involuntary out-patient commitment (OPC) in patients with severe mental disorder reduces their use of hospital services. This is a retrospective case-control study comparing a group of patients on OPC (n = 75) and a control group (n = 75) which was composed of patients whose sociodemographic variables and clinical characteristics were similar to those of the OPC group. Each control case is paired with an OPC case, so the control case must have an involuntary admission in the month that the index OPC case admission occurred. Emergency room visits, admissions and average length of hospital stay over a 2-year follow-up after the initiation of OPC were compared. Results No statistically significant evidence was found in the use of mental healthcare services between the two groups. Different reasons for admission found between the groups limit similarity when comparing the two. Clinical implications The findings cast doubt over the effectiveness of this legal measure to reduce emergency visits, the number of admissions and the length of stay in the hospital.

Experiencia de colaboración entre atención primaria y salud mental en el Departamento de Salud La Ribera, 7 años después / An experience of collaboration between primary health care and mental health care in La Ribera Department of Health (Valencia, Spain)

Pese a la gran frecuencia de problemas de salud mental entre los consultantes de atención primaria, persiste el problema de unos inadecuados diagnóstico y tratamiento. Se necesita una buena capacitación de los médicos de familia para el manejo de estos trastornos, a fin de minimizar su impacto sanitario, económico y social. Entre otros elementos, se considera relevante la cooperación con los servicios de salud mental, para la cual existen diferentes modelos. Nuestro departamento de salud inició en 2006 una colaboración estable según el modelo de enlace. Se han obtenido resultados positivos en términos de reducción de demora para las primeras visitas al especialista y de aumento de la satisfacción de los profesionales, aunque deben interpretarse con cautela. Recientemente se han acumulado evidencias sobre la utilidad del modelo colaborativo, aunque su evaluación y extrapolación son complejas. Nos proponemos ahondar en la evaluación de nuestro modelo, de manera análoga a otras iniciativas de nuestro entorno (AU)

Despite the high prevalence of mental health problems among patients attending primary care, diagnosis and treatment of these disorders remain inadequate. Sound training of primary care physicians in how to manage mental health problems is needed to reduce the health, economic and social impact associated with these disorders. Among other elements, there is a need for cooperation between primary care physicians and mental health services. Distinct models are available for such collaboration. In 2006, our health department started a collaboration between these two levels of heath care, using a liaison model. Delays until the first specialist visit were reduced and satisfaction among health professionals increased, although these results should be interpreted with caution. Evidence has recently accumulated on the usefulness of the collaborative model, but evaluation of this model and extrapolation of its results are complex. We intend to evaluate our model more thoroughly, similar to other projects in our environment (AU)

[An experience of collaboration between primary health care and mental health care in La Ribera Department of Health (Valencia, Spain)]. / Experiencia de colaboración entre atención primaria y salud mental en el Departamento de Salud La Ribera, 7 años después.

Despite the high prevalence of mental health problems among patients attending primary care, diagnosis and treatment of these disorders remain inadequate. Sound training of primary care physicians in how to manage mental health problems is needed to reduce the health, economic and social impact associated with these disorders. Among other elements, there is a need for cooperation between primary care physicians and mental health services. Distinct models are available for such collaboration. In 2006, our health department started a collaboration between these two levels of heath care, using a liaison model. Delays until the first specialist visit were reduced and satisfaction among health professionals increased, although these results should be interpreted with caution. Evidence has recently accumulated on the usefulness of the collaborative model, but evaluation of this model and extrapolation of its results are complex. We intend to evaluate our model more thoroughly, similar to other projects in our environment.

[Relationship between insight, violence and diagnoses in psychotic patients]. / Relación entre insight, violencia y diagnóstico en pacientes con psicosis.

INTRODUCTION: Lack of insight is a common clinical problem in psichiatric patients, but few times has been properly studied until recently. Patients with good insight tend to show a better treatment adherence with a better prognosis and swow less hostility. This study aims to investigate whether there is a relationship between the hostility degree and insight or not and to anlalyze if there are insight quantitative differences between the patients regarding their diagnoses. METHOD: 168 psychotic patients were studied (including 86 patients with schizophrenia and 43 with bipolar disorder). PANNS P7 (hostility) item and G14 (poor impulse control) were analized in order to assess patients' violence and G12 in order to assess insight. All these data was correlated. It was also analyzed the PANSS results of schizophrenic vs bipolar patients regarding insight and hostility separately looking for a more homogenic pull of patients. RESULTS: Patients with greater hostility showed a worse impulse control and poorer insight than the rest. Schizophrenic patients showed a greater hostility and lower insight than bipolar patients. DISCUSSION: Lack of insight may lead to a greater hostility and worse impulse control. Therapeutic interventions adressed to improve insight could indirectly lower hostility and gain a better impulse control for psychotic patients.

Relación entre insight, violencia y diagnóstico en pacientes con psicosis / Relationship between insight, violence and diagnoses in psychotic patients

Introducción. En pacientes con trastornos psiquiátricos el déficit en la capacidad de introspección o insight es frecuentemente un problema clínico importante, pero ha sido pocas veces objeto de estudio formal. Los pacientes psicóticos con buen insight suelen cumplir mejor las pautas de medicación siendo un factor de buen pronóstico y muestran menor hostilidad. Con este estudio se pretende valorar si existe una relación entre el grado de hostilidad del paciente y la conciencia de enfermedad además de analizar si el grado de conciencia de enfermedad varía según el diagnóstico del paciente (esquizofrenia vs. trastorno bipolar). Metodología. Se estudiaron en 168 pacientes psicóticos (entre ellos 86 con esquizofrenia y 43 con trastorno bipolar) los ítems de la PANSS P7 (hostilidad) y G14 (control deficiente de impulsos) para valorar el grado de violencia y el ítem G12 (ausencia de juicio e introspección) correlacionándolos entre ellos. Para observar si había diferencias en cuanto a insight y hostilidad según el diagnóstico, se estudiaron los datos utilizando una muestra más reducida y homogénea comparando los pacientes diagnosticados de esquizofrenia con los diagnosticados de trastorno bipolar. Resultados. Los pacientes con mayor hostilidad presentaban un peor control de impulsos y una pobre conciencia de enfermedad. Los pacientes diagnosticados de esquizofrenia presentan una mayor hostilidad y un peor insight comparados con los diagnosticados de trastorno bipolar. Discusión. La ausencia de introspección supondría un mayor nivel de hostilidad y mayor déficit de control de impulsos. Las estrategias terapéuticas encaminadas a aumentar el grado de insight del paciente podrían disminuir indirectamente el grado de hostilidad y proporcionar un mejor control de los impulsos(AU)

Introduction. Lack of insight is a common clinical problem in psychiatric patients, but few times has been properly studied until recently. Patients with good insight tend to show a better treatment adherence with a better prognosis and show less hostility. This study aims to investigate whether there is a relationship between the hostility degree and insight or not and to analyse if there are insight quantitative differences between the patients regarding their diagnoses. Method. One hundred and sixty-eight psychotic patients were studied (including 86 patients with schizophrenia and 43 with bipolar disorder). PANNS P7 (hostility) item and G14 (poor impulse control) were analysed in order to assess patients’ violence and G12 in order to assess insight. All these data were correlated. It was also analysed the PANSS results of schizophrenic vs bipolar patients regarding insight and hostility separately looking for a more homogenic pull of patients. Results. Patients with greater hostility showed a worse impulse control and poorer insight than the rest. Schizophrenic patients showed a greater hostility and lower insight than bipolar patients. Discussion. Lack of insight may lead to a greater hostility and worse impulse control. Therapeutic interventions addressed to improve insight could indirectly lower hostility and gain a better impulse control for psychotic patients(AU)

Involuntary outpatient treatment (iot) for severe mental patients: current situation in Spain.

Involuntary Outpatient Treatment (IOT) expects to improve treatment compliance and, therefore, prevent the impairment of patients with severe mental illness, as well as the risk for them and others. Besides IOT introduction defenders and opponent's states, scientific literature offers contradictory results. Legislative changes have been taken in the vast majority of our neighbouring countries in order to regulate IOT application. There is no legal regulation in Spain; however, OIT application is possible in certain Spanish cities. This article reviews IOT in Spain and surrounding countries.

[Evaluation of the efficacy of involuntary outpatient treatment in reducing the use of mental health services in hospital]. / Evaluación de la eficacia del tratamiento ambulatorio involuntario para reducir la atención hospitalaria.

OBJECTIVE: To determine whether psychiatric patients in involuntary outpatient treatment (IOT) show reduced use of mental health services in hospital compared with a control group not subject to a judicial order. METHOD: We compared a group of patients in IOT (n=38) with a control group (n=38), selected from involuntarily hospitalized patients during the same period. Patients in the control group had similar sociodemographic, clinical and psychiatric characteristics to the group with IOT. We analyzed the number of emergencies, inpatient admissions and length of hospital stay during a follow-up period of 6 months after the beginning of the judicial order in the IOT group or after hospital discharge in the control group. RESULTS: No significant differences were found between the IOT and the control group in hospital use (number of emergencies, inpatient admissions and mean length of hospital stay). CONCLUSIONS: These results question the efficacy of IOT to reduce the use of hospital services.

Sindrome de Diogenes: a proposito de un caso / Diogenes syndrome: apropos of a case

Introducción: El síndrome de Diógenes no está reconocido en los manuales diagnósticos internacionales como entidad diagnóstica y además puede aparecer en distintas enfermedades. Sin embargo el término ha tenido éxito y es utilizado con frecuencia, sobre todo, por los medios de comunicación. La prevalencia sería de 1,7/1.000 ingresos hospitalarios en mayores de 65 años. Clínica: Las personas afectadas por este síndrome presentan un descuido severo del autocuidado (higiene, alimentación y salud), se aíslan y abandonan el contacto con la sociedad. Viven entre gran suciedad doméstica y acumulan objetos y basura en la casa. Diagnóstico diferencial: La conducta de acumulación puede aparecer en el trastorno de personalidad obsesivo-compulsivo, en el coleccionismo o como otras causas. Tratamiento: En lo posible hay que evitar la hospitalización y se debe favorecer las medidas y el seguimiento ambulatorios. Los pacientes con este síndrome tienen un 46% de mortalidad en los 5 años siguientes. Caso clínico: Mujer de 67 años, que vive con su esposo y un hijo. Diagnosticada de esquizofrenia paranoide de más de 30 años de evolución y varios ingresos psiquiátricos, con seguimiento terapéutico irregular y que recibe el diagnóstico de síndrome de Diógenes. Discusión: El diagnóstico de síndrome de Diógenes podría informar de la situación psicosocial de la paciente, alertando del problema para que intervengan los servicios sociosanitarios y a la espera de hacer una evaluación diagnóstica

Introduction: Diogenes syndrome is not recognized in international diagnostic manuals as a diagnostic entity and can be present in several disorders. Nevertheless, the term Diogenes syndrome is frequently used in the media and other settings because of the social alarm it generates. The prevalence of this syndrome is 1.7/1000 hospital admissions in persons aged more than 65 years old. Clinical features: People with Diogenes syndrome show severe self-care deficit (hygiene, eating and health) and social isolation and usually live in domestic squalor surrounded by a clutter of objects and garbage. Differential diagnosis: Hoarding can be observed in obsessive-compulsive personality disorder, in collectionism, and in other disorders. Treatment: Hospitalization should be avoided when possible and outpatient treatment should be provided. Outcome: mortality among patients diagnosed with this syndrome is 46% within 5 years. Case report: A 67-year-old woman who lived with her husband and son and who had received a diagnosis of paranoid schizophrenia more than 30 years previously with various hospital admissions and irregular follow-up was diagnosed with Diogenes syndrome. Discussion: A diagnosis of Diogenes syndrome could provide information about the patient's psychosocial situation, alerting medical and social services to the need for intervention and evaluation

Tratamiento ambulatorio involuntario: opinión de las personas implicadas / Involuntary outpatient treatment: the views of those involved

El tratamiento ambulatorio involuntario (TAI) pretende mejorar la adhesión al tratamiento y, por tanto, prevenir el deterioro de las personas con enfermedad mental grave y el peligro para sí mismas y los demás. La aplicación del TAI no está exenta de polémica, con defensores que consideran que es una forma de conseguir la cumplimentación terapéutica, y opositores que encuentrar en este tipo de medidas una vulneración de los derechos fundamentales de la persona y que conllevan un aumento de la coerción y el estigma del paciente psiquiátrico. En este trabajo se ha realizado un estudio de carácter descriptivo que trata de recoger la opinión que tienen la personas implicadas en el TAI. La población de estudio está compuesta por todos los pacientes que estaban en tratamiento obligatorio ambulatorio en la ciudad de Valencia al inicio del estudio – octubre-, sus familiares y psiquiatras encargados de su seguimiento ambulatorio. En los resultados destaca que la gran mayoría de los psiquiatras y familiares (93-83%) opinan que el TAI ha sido beneficioso para el tratamiento del paciente, incluso se ha apreciado una mejoría global de la clínica tras su instauración. Respecto a la opinión de los pacientes, más de la mitad (54%) también consideran que el TAI es una medida beneficiosa para su tratamiento

Involuntary outpatient treatment (IOT) aims to improve compliance with treatment and so prevent the deterioration of patients with severe mental illness and reduce the risk to themselves and other people. IOT is not free of controversy. Those who defend it regard it as a way of ensuring that treatment is carried out, while opponents consider it a violation of the basic rights of the individual, leading to an increase in the coercion and stigmatisation of psychiatric patients. This article is a descriptive study, for which we have attempted to collect the opinions of people involved in IOT. The group studied was made up of all the patients in Involuntary Outpatient Treatment in the city of Valencia at the beginning of the project –October 2005-. Their reltives and their outpatient unit psychiatrists. The results show that the great majority of psychiatrists and relatives (93-83%) think that IOT has been beneficial for patient´s treatment. There has even been an overall clinical improvement since it was introduced. As for the opinion of the patients, over half of them (54%) also consider that IOT has been a beneficial measure for their treatment

Tratamiento ambulatorio involuntario para personas con trastorno mental severo. Resultados de un estudio en la ciudad de Valencia / Involuntary outpatient treatment for persons with severe mental illness. Results of a study in the city of Valencia, Spain

El tratamiento ambulatorio involuntario (TAI) es una forma de tratamiento no voluntario aplicado en la comunidad, que pretende asegurar el cumplimiento terapéutico en pacientes que sufren una enfermedad mental grave, sin conciencia de enfermedad y en los que el abandono del tratamiento supone un riesgo alto de recaída, con aparición de conductas disruptivas y violentas, así como hospitalizaciones repetidas y urgencias frecuentes. En este artículo se presentan los resultados de un estudio observacional-retrospectivo, realizado en la ciudad de Valencia sobre una población de 38 pacientes sometidos a esta medida de tratamiento judicializado. Describimos el diagnóstico psiquiátrico, quién solicita la medida y por qué motivo. Comparamos el número de urgencias e ingresos y la estancia media de los ingresos realizados en los 6 meses antes y después de la introducción de la autorización judicial. Finalmente, analizamos las incidencias acontecidas en este período

Involuntary outpatient treatment is non-voluntary treatment applied in the community to ensure therapeutic compliance in patients with severe mental illness and little insight, in whom noncompliance involves a high risk of relapse, with disruptive and violent behaviors, or frequent hospitalizations and emergency care. In this article we present the results of an observational, retrospective study in 38 patients undergoing involuntary outpatient treatment in the city of Valencia. We describe the psychiatric diagnosis, the persons seeking this treatment and the reasons for seeking it. We compare the number of emergencies and admissions and the average length of stay of admissions in the 6 months before and after the introduction of court authorization. Finally we analyze the events occurring during this period of time

Tratamiento ambulatorio involuntario (TAI) para personas con enfermedad mental grave / Involuntary outpatient treatment for people with severe mental disorders

El tratamiento ambulatorio involuntario (TAI) pretende mejorar la adhesión al tratamiento y, por tanto, prevenir el deterioro de las personas con enfermedad mental grave y el peligro para sí mismas y los demás. Además de las posiciones manifestadas a favor y en contra con la introducción del TAI, los estudios publicados en la literatura médica obtienen también resultados contradictorios. La mayoría de los estudios observacionales encuentran una mejoría de los pacientes; sin embargo, las limitaciones metodológicas disminuyen la confianza en los resultados. Se han publicado 2 estudios aleatorizados en los que sólo se encuentra mejoría cuando la medida involuntaria se acompaña de servicios comunitarios de seguimiento intensivo. En este artículo se hace una revisión sobre el tema del TAI, incluida la situación actual en España

Involuntary outpatient treatment is believed to increase adherence, thereby preventing deterioration and harm to people with severe mental illness or to others. Involuntary treatment remains controversial. In addition to arguments for and against the introduction of involuntary outpatient treatment, the results of published studies are contradictory. Most observational studies report patient improvement, although methodological limitations cast doubt on these results. Two randomized studies suggest that outpatient commitment is only effective when linked to the provision of intensive community services. In this article we review this topic, including the current situation in Spain