Trabajo social y enfermero en un equipo de atención precoz a la psicosis / Social work and nursing work in an early care team for at-risk of psychosis patients

Partiendo de las esferas de intervención propias del trabajo social: micro, meso y macro, y de los niveles para la intervención en salud mental: promoción, prevención, detección, tratamiento y recuperación, se describe el trabajo social en un equipo de atención temprana a personas en riesgo de psicosis, desde una perspectiva histórica de lo que ha sido y como se ha constituido la disciplina del trabajo social en relación a los cuidados de la salud mental. Así mismo se describe el trabajo enfermero en los diversos niveles de prevención, en este recurso específico de salud mental (AU)

On the basis of areas of intervention in social work: micro, meso and macro, and levels for intervention in mental health: promotion, prevention, detection, treatment and recovery, the authors describe the social work in an early care team for at-risk of psychosis patients. A historical perspective of the discipline of social work in relation to mental health care is considered. Nursing work at various levels of prevention in this specific mental health resource for at-risk of psychosis patients is also described (AU)

At-risk mental state (ARMS) detection in a community service center for early attention to psychosis in Barcelona.

AIM: To describe the strategy and some results in at-risk mental state (ARMS) patient detection as well as some of the ARMS clinical and socio-demographical characteristics. The subjects were selected among the patients visited by an Early Care Equipment for patients at high risk of psychoses, in Barcelona (Spain) during its first year in operation. METHODS: Descriptive study of the community-team relations, selection criteria and intervention procedure. Description of patient's socio-demographic and symptomatic characteristics according to the different instruments used in detection and diagnoses, taking account of four principal origins of referrals: mental health services, primary care services, education services and social services. RESULTS: Twenty of 55 referred people fulfilled the at-risk mental state criteria, showing an incidence of 2.4 cases per 10,000 inhabitants. They were mainly adolescent males referred from health, education and social services. Overall, negative symptoms were predominant symptoms and the more frequent specific symptoms were decrease of motivation and poor work and school performance, decreased ability to maintain or initiate social relationships, depressed mood and withdrawal. CONCLUSIONS: It is possible to detect and to provide early treatment to patients with prodromal symptoms if the whole matrix of the community--including the social services--contributes to the process. The utilization of a screening instrument and a two-phase strategy--the second carried out by the specialized team--seems to be an appropriate approach for early psychosis and ARMS detection.

Psicosis y diferencias sociales: comparando la prevalencia de las psicosis en dos medios urbanos diferenciados / Psychosis and social differences: comparing psychosis prevalence between two socially differentiated urban settings

Objetivos: Contribuir a la reflexión sobre la etiología y/o los factores de riesgo para las psicosis comparando la prevalencia en población general y población de riesgo de la esquizofrenia y otras psicosis en dos barrios de Barcelona (España). Método: Nuestras aportaciones en este trabajo se apoyan sobre todo en un estudio descriptivo transversal de todos los pacientes con psicopatología detectados en la USM de Sant Martí-La Mina: un territorio geodemográfica y asistencialmente delimitado formado por 5 Áreas Básicas de Salud (103.615 habitantes. Resultados: Sobre un total de 21.536 pacientes con registro de casos abierto desde el año 1982 hasta el año 2000, se halló que 838 cumplían los criterios restrictivos para ser diagnosticados como «esquizofrénicos» (N=476) o «afectados por otras psicosis» (N=362). Sin embargo, las prevalencias de esquizofrenia y otras psicosis en el barrio sujeto a más factores de riesgo psicosociales eran alrededor de 2 veces mayores que las encontradas en el barrio colindante por el mismo equipo y en el mismo período temporal. Conclusión: Es necesario tener en cuenta el gran peso de los factores de sociales y psicosociales para poderse explicar las diferencias de prevalencia de la esquizofrenia y otras psicosis entre diferentes poblaciones (AU)

Objectives: To contribute to the discussion about aetiology and risk factors of psychosis comparing the prevalence in general population and in «age of risk population» for schizophrenias and other psychoses on two neighbourhoods of Barcelona (Spain). Method: We base our reflections in a transversal study about the results of an informatized case register of all the patients' with detected psychopathology in this geodemographic and assistencially differentiated area: 5 Basic Areas of Health (103.615 inhabitants). Results: The total «psychopathological patients» detected were 21.536. From them, 838 completed the restrictive criteria to be diagnosed as «schizophrenics» (476) or «affected by other psychoses» (362). Among the neighborhood charged with psychosocial risk factors and the other 4 adjacent basic areas of health, assisted for the same team, so much clinical as investigator, the incidence and the prevalence of the schizophrenia and other psychoses is twice as much, almost in each group diagnosis. Conclusion: It seems necessary to keep in mind the great weight of the social and psychosocial factors to explain those differences of incidence and prevalence of the schizophrenia and the psychoses in different populations (AU)

Neighborhood differences in psychoses: prevalence of psychotic disorders in two socially-differentiated metropolitan areas of Barcelona.

INTRODUCTION: The prevalence of schizophrenia and other psychoses can vary between close geographic locations and can be biased by the use of epidemiological designs. With data derived from a public mental health centre with close relations to primary care teams we have compared the distribution of psychotic disorders in two neighborhoods in Barcelona with marked psycho-social differences. METHODS: Using a computerized database from Barcelona's National Health Service covering 5 basic health-care areas with a total population of 103,615 inhabitants, we have accessed case records showing any psycho-pathology between the years of 1982 and 2000. RESULTS: From the case records of 21,536 registered patients showing any psycho-pathology, and using strict diagnostic, clinical and assistance criteria, we found that there were 476 patients diagnosed as "schizophrenic" and 362 that were "affected by other psychoses." Despite being evaluated by the same mental health personal, the same research team using identical criteria and over the same period of time (thus precluding operator and selection bias) the prevalence of these disorders was twice as high in La Mina (a district with a marked accumulation of psycho-social risk-factors) as compared to the neighboring district of La Verneda. CONCLUSIONS: When assessing prevalence of psychoses, it is necessary to consider the impact of social and psycho-social factors, even in neighboring communities.

Factores de riesgo para padecer trastornos psicóticos: ¿es posible realizar una detección preventiva? / Psychosis risk factors: is there a chance for preventive identification?

Introducción: Revisión de los factores de riesgo para las psicosis desde la perspectiva de la literatura internacional y desde la perspectiva de la experiencia clínica e investigadora del equipo. Objetivo principal: Se presenta el diseño y las primeras pruebas de un instrumento de exploración y cribaje de señales de alarma y factores de riesgo de trastornos mentales severos, y en especial trastornos psicóticos, aplicable en los primeros años de vida por parte de los servicios de atención primaria de salud y los equipamientos de salud mental vinculados con ellos. Se trata del LISMEN(Listado de ítems de Salud Mental en edades preescolares y escolares). Metodología: 5 muestras diferentes, tanto de edad infantil como de adultos. El trabajo se centra en la muestra A del Proyecto LISMEN: Se trata de un estudio descriptivo retrospectivo de los dossieres de los pacientes que han desarrollado una psicosis (N=838) y se habían visitado previamente, ya durante la infancia, en la misma Unidad de Salud Mental (N=120). Resultados: Se utilizan los resultados de las muestras anteriormente estudiadas para encuadrar el tema y presentar los primeros resultados de la muestra A: Estos señalan una constelación de factores de riesgo que aparecen ya en las historias o dossiers clínicos de la infancia de los pacientes que van a desarrollar una psicosis postpuberal. Conclusiones: Aunque hoy poseemos un amplio acervo de conocimientos sobre factores de riesgo de la esquizofrenia y otras psicosis, eso no implicaque podamos predecir el trastorno en base a los mismos. El LISMEN es un intento en ese sentido (AU)

This paper reviews risk factors associated with psychosis from both a literatureperspective and the clinical and research practice. The development of atool for the diagnosis and screening of alarm signs and risk factors of severemental disorders is described along with preliminary tests. The tool is aimedto be administered by primary health care systems and associated mentalhealth teams during a person’s early years. The tool is called LISMEN–standing for “list of mental health items at pre-school and school ages”.The list was administered to 5 different samples including children andadults. This paper focuses on Project LISMEN sample A. It is an investigationof medical records of patients who had developed a psychosis (N = 838). Anumber of them (N = 120) had already been assisted by the same MentalHealth Unit during their childhood. Samples already assisted were used as abenchmark for sample A preliminary results. A constellation of risk factors hadalready been identified in medical records during the childhood of people whowould develop a psychosis after their adolescence.Even though there is a broad pool of knowledge on risk factors associatedwith schizophrenia and other psychoses, this does not mean that prediction ofthe disorder can be made on this base. Nevertheless, LISMEN is a contributionin this direction (AU)

Trastornos esquizofrénicos en la atención primaria a la salud mental / Schizophrenic disorders in primary care mental health

Objetivos. Determinar la prevalencia y la incidencia de la esquizofrenia y otras psicosis en una unidad de salud mental (USM) estrechamente vinculada con la atención primaria de salud. Diseño. Estudio longitudinal, retrospectivo, del registro de todos los pacientes con psicopatología detectados en un área geodemográfica y asistencialmente delimitada. Emplazamiento. Cinco áreas básicas de salud de Barcelona (103.615 habitantes). Participantes. Pacientes de la USM que habían consultado por trastornos de salud mental durante el período 1982-2000 (n = 21.236). Se aplicaron criterios asistenciales y diagnósticos estrictos basados en la clasificación DSM-4. Todos los casos fueron validados mediante consulta de la historia clínica y el censo. Mediciones. Incidencia (en los últimos 3 años) y prevalencia de esquizofrenia y otras psicosis, en todo el período del estudio, tanto en población general como en la población en edad de riesgo (15-54 años). Resultados. En total, 838 pacientes cumplían los criterios para ser diagnosticados como esquizofrénicos (n = 476) o afectados por otras psicosis (n = 362). La incidencia de esquizofrenia es de 3,47/10.000 (intervalo de confianza [IC] del 95%, 2,3-4,6) en la población general y de 5,09/10.000/IC del 95%, 3,2-6,9) en la población en riesgo, y la prevalencia de esquizofrenia es de 54,9/10.000 (IC del 95%, 41,8-50,1) en la población general y de 80,7/10.000 (IC del 95%, 73,5-88) en la población en riesgo. Conclusiones. La interfase USM comunitaria-atención primaria de salud puede ser un buen lugar para la detección y el estudio de los síndromes esquizofrénicos y otras psicosis, siempre que se cumplan determinados criterios asistenciales y de investigación

Objectives. To determine the prevalence and incidence of schizophrenia and other psychoses in a mental health unit (MHU) closely connected to primary health care. Design. Retrospective longitudinal study of the register of all patients with psychiatric illnesses detected in a specific geo-demographic and health care area. Setting. Five basic health care areas of Barcelona (103 615 inhabitants). Participants. MHU patients who had attended clinics due to mental health disorders during the period from 1982-2000 (N=21 236). Strict health and diagnostic criteria based on the DSM-4 classification were applied. All cases were validated using clinical history review and concensus. Measurements. Incidence (in the last 3 years) and prevalence of schizophrenia and other psychoses in the whole period of study, both in the general population and in the risk population age group (15-54 years). Results. In total, 838 patients complied with the diagnosis of suffering from schizophrenia (N=476) or other psychoses (N=362). The incidence of schizophrenia was 3.47/10 000 (95% confidence interval [CI], 2.3-4.6) in the general population and 5.09/10 000, 95% CI, 3.2-6.9) in the population at risk, and the prevalence of schizophrenia was 54.9/10 000 (95% CI, 41.8-50.1) in the general population and 80.7/10 000 (95% CI, 73.5-88) in the population at risk. Conclusions. The MHU-primary health care interface can be a good place to detect and study schizophrenic syndromes and other psychoses, as long as they comply with the agreed health and research criteria

[Schizophrenic disorders in primary care mental health]. / Trastornos esquizofrénicos en la atención primaria a la salud mental.

OBJECTIVES: To determine the prevalence and incidence of schizophrenia and other psychoses in a mental health unit (MHU) closely connected to primary health care. DESIGN: Retrospective longitudinal study of the register of all patients with psychiatric illnesses detected in a specific geo-demographic and health care area. SETTING: Five basic health care areas of Barcelona (103 615 inhabitants). PARTICIPANTS: MHU patients who had attended clinics due to mental health disorders during the period from 1982-2000 (N=21 236). Strict health and diagnostic criteria based on the DSM-4 classification were applied. All cases were validated using clinical history review and concensus. MEASUREMENTS: Incidence (in the last 3 years) and prevalence of schizophrenia and other psychoses in the whole period of study, both in the general population and in the risk population age group (15-54 years). RESULTS: In total, 838 patients complied with the diagnosis of suffering from schizophrenia (N=476) or other psychoses (N=362). The incidence of schizophrenia was 3.47/10,000 (95% confidence interval [CI], 2.3-4.6) in the general population and 5.09/10,000, 95% CI, 3.2-6.9) in the population at risk, and the prevalence of schizophrenia was 54.9/10,000 (95% CI, 41.8-50.1) in the general population and 80.7/10,000 (95% CI, 73.5-88) in the population at risk. CONCLUSIONS: The MHU-primary health care interface can be a good place to detect and study schizophrenic syndromes and other psychoses, as long as they comply with the agreed health and research criteria.

Hijos de pacientes psicóticos en el proyecto SASPE: investigar para cuidar un futuro comprometido / Children of psychotic patients in the SASPE projects: research for a future of commitment

Objetivos: Contribuir al conocimientod e la fertilidad y la fecundidad de una muestra urbana de pacientes diagnosticados bajo los rótulos de «trastorno esquizofrénico» y «otras psicosis» (estudio SASPE), así como de la psicopatología de su descendencia. Diseño:Estudio retrospectivo fundamentado en el procesamiento informático de los datos del Proyecto SASPE, en el vaciado de historias clínicas de cinco Equipos deSalud Mental Comunitaria estrechamente vinculada con la Atención Primaria a la Salud (APS) y en entrevistas con pacientes, hijos de pacientes y profesionales de losEquipos de Atención Primaria (EAP) y de Pediatría de AP. Emplazamiento del Proyecto: Unitat de Salut Mental (USM) de Sant Martí-La Mina, cinco Áreas Básicas de Salud (ABS) de Barcelona y Sant Adria (provincia de Barcelona),además de la Unidad Funcional de Atención a la Primera Infancia de Sant Martí(Institut Catalá de la Salut).Sujetos: 838 pacientes esquizofrénicos y con «otras psicosis» detectados por la USM. 917 descendientedse los mismos. Personal asistencial de la USM,5 ABS y de la Unidad Funcional de Atención a la Primera Infancia ( UFAP1).N iños con señalesd e alerta detectadase n los diversosC entrosd e la USM,y niños con señalesd e alerta o factoresd e riesgo detectadose n los EAP y en los Equiposd e Pediatríad e APS. Metodologíae instrumentos:D iagnósticosD SM-1V.E ntrevistase structuradasE RIElRAOS. E scalaso sistemasd e cribado en la infancia: cribadosA RBB-ADBB,C BCL y USMEP. Based e datos informatizadosd e la USM-SASPE

Objectives: To contribute to the knowledge of the fertility and fecundity of an urban sample of patients diagnosed with schizophrenic disorder or «other psychoses» (SASPE study), as well as of the offspring's psychopathology. Design: A retrospective study based in the computer treatment of the data of Project SASPE, in the casting of clinical histories of five Units of Community Mental Health closely linked with the Primary Health CaTe (PHC) and in interviews with patients, patient's offspring and professionals of the PHC and of Pediatrics of PHC. Location of the Project: Mental Health Unir (USM) of Sant Martí -The Mine, five Basic Health Areas of Barcelona and Sant Adria (Barcelona), besides the Functional Unir of Attention to the Early Childhood of Sant Martí (Catalan lnstitute of Health). Participants: 838 schizophrenic patients and with «delirant psychoses» detected by the USM. 917 descendants of the same ones. Staff of the USM, 5 Basic Health Areas and of the Functional Unir of Attention to the Early Childhood (UFAPI). Children with alert signs detected in the diverse Centers of the USM, and children with signs of alert or factors of risk detected in the PHC Teams and Pediatrics PHC teams. Methodology and instruments: Diagnoses DSM-IV. Structured'interview ERIE-lRAOS. Screening for childhood mental health ARBB-ADBB, CBCL and LISMEP. Informatized Data Base USM-SASPE