Factors associated with visits to general practitioners in patients with schizophrenia in Malaga.

BACKGROUND: Patients with psychiatric disorders have more physical problems than other patients, so their follow-up by the general practitioner is particularly important for them. METHODS: We aimed to elaborate a multilevel explanatory model of general practitioner (GP) visits made by patients with schizophrenia and related disorders (SRD). An observational, cross-sectional study was conducted from January 1, 2008 to July 1, 2011, in the area of the Clinical Management Unit of Mental Health (CMU-MH) of the Regional Hospital of Malaga (Spain). The eligible population consisted of all patients with SRD in contact with a GP residing in the study area. Our dependent variable was total number GP visits. The independent variables were: 1) patient variables (sociodemographic and clinical variables); 2) primary care centre (PCC) variables. We performed descriptive analysis, bivariate analysis and multilevel regression. RESULTS: Four hundred ninety four patients were included. Mean annual number of GP visits was 4.1. Female sex, living in a socioeconomically deprived area, a diagnosis of schizoaffective disorder and contact with a GP who had a more active approach to mental health issues were associated with a higher number of visits whilst being single and good communication between the PCC and mental health teams were associated with a lower number of GP visits. CONCLUSIONS: Number of GP visits was not just associated with patient factors, but also with organisational and the involvement of health professionals, for example GPs with an active approach to mental health issues.

A systematic review and meta-analysis of the incidence of psychotic disorders: the distribution of rates and the influence of gender, urbanicity, immigration and socio-economic level.

BACKGROUND: Considering existing knowledge on the relationship between certain environmental factors and incidence rates of psychosis, we carried out a systematic review to provide a broad and updated picture of the incidences of different psychotic disorder subgroups worldwide and how some environmental factors influence these rates. METHODS: Studies with original data related to the incidence of psychosis (published between 2000 and 2015) were identified via searching electronic databases (CINAHL, MEDLINE, PSYCINFO, PUBMED, and SCOPUS). Data on the following risk factors were extracted: gender, urbanicity, immigration and socio-economic level. Descriptive appraisals of variation in incidence rates (IR) and incidence rate ratios (IRR), with a 95% confidence interval were calculated. In addition, a meta-analysis was performed to calculate IR pooled by diagnosis group and IRR pooled by diagnosis and gender, urbanity, immigration and socio-economic level, using a random effects model. RESULTS: We identified 33 reports to analyse. Overall IR per 100 000 persons for non-affective psychoses (IR pooled = 22.53 (16.51-28.54)) were higher than affective psychoses (IR pooled = 7.12 (5.03-9.22)). There was an increase in rates of psychosis in men v. women (IRR pooled = 1.54 (1.37-1.72)), in urban v. rural areas (IRR pooled = 1.64 (1.38-1.95)), in immigrants v. natives (IRR pooled = 3.09 (2.74-3.49)), and in lower socio-economic level areas (IRR pooled = 1.78 (1.43-2.22)). CONCLUSIONS: IR among different psychotic disorders was found to vary depending on gender, urbanicity, and immigration (as most of the previous literature focuses on non-affective psychosis or schizophrenia).

Las demandas por conducta suicida a los servicios de urgencias prehospitalarios de Málaga: características y factores asociados / Calls due to suicidal behaviour made to the prehospital, emergency department in Málaga: characteristics and associated factors

Fundamento: El comportamiento suicida, mortal y no mortal, se ha convertido en un problema grave de salud pública en muchos países. El objetivo de este estudio es describir las características diferenciales de las llamadas al Centro Coordinador de Urgencias y Emergencias de la provincia de Málaga por conducta suicida, frente a las llamadas por problemas físicos o psiquiátricos. Material y métodos: Esta investigación consiste en un estudio observacional retrospectivo de las demandas registradas en la base de datos de la Empresa Pública de Emergencias Sanitarias durante un año. Las comparaciones y análisis de regresión logística multivariante se realizaron respecto a la edad y sexo de los demandantes y respecto a las siguientes características de las demandas: horas del día, días laborables o festivos, meses del año y trimestres, número de recursos movilizados y tipos de resolución. Resultados: Los análisis se realizaron sobre un total de 163.331 llamadas. 1.380 fueron por conducta suicida (0,8%), 9.951 por motivos psiquiátricos (6,1%) y 152.000 por motivos físicos (93%). Las llamadas por conducta suicida fueron realizadas preferentemente por mujeres jóvenes, que solicitan atención durante la tarde y la noche, requiriendo traslado al hospital y la movilización de más de un recurso sanitario. Las demandas por suicidio consumado las realizaron más frecuentemente varones en edades más avanzadas. En el primer trimestre del año se dan más demandas por ideación que por amenaza/intento, mientras que en el tercer trimestre ocurre lo contrario. Conclusión: Los resultados indicaron características diferenciales de las llamadas por conducta suicida potencialmente relevantes para la prevención del suicidio (AU)

Background: Suicidal behaviour (fatal and non-fatal) has become a serious public health problem in many countries. The aim of the study was to describe the differential characteristics of emergency calls due to suicidal behaviour made to the Emergency Coordinating Centre (CCUE) in the province of Málaga, in comparison with calls due to physical or psychiatric problems. Methods: Retrospective observational study of the calls recorded in the database of the Public Company for Emergency Health during one year. Multivariate logistic regression analyses were carried out including age, gender and the following variables related with the demand: hours of the day, type of day (working days or bank holidays), months of the year and trimesters, number of resources mobilized and types of resolution. Results: The analyses were carried out on 163,331 calls, of which 1,380 calls were due to suicidal behaviour (0.8%), 9,951 for psychiatric reasons (6.1%) and 152,000 for physical reasons (93%). The emergency calls for suicidal behaviour were mainly made by females, between 31-60 years, in the evening and at night, and required transfer to hospital and more than one mobilized resource. Calls due to completed suicide were more frequently made by older men. Calls due to suicidal tendencies predominated over those due to attempted or threatened suicide during the first trimester of the year, while the opposite was the case during the third trimester. Conclusions: The results indicated differential characteristics of suicide calls that are potentially relevant for prevention in spite of the limitations of the present study (AU)

[Calls due to suicidal behaviour made to the prehospital, emergency department in Málaga: characteristics and associated factors]. / Las demandas por conducta suicida a los servicios de urgencias prehospitalarios de Málaga: características y factores asociados.

BACKGROUND: Suicidal behaviour (fatal and non-fatal) has become a serious public health problem in many countries. The aim of the study was to describe the differential characteristics of emergency calls due to suicidal behaviour made to the Emergency Coordinating Centre (CCUE) in the province of Málaga, in comparison with calls due to physical or psychiatric problems. METHODS: Retrospective observational study of the calls recorded in the database of the Public Company for Emergency Health during one year. Multivariate logistic regression analyses were carried out including age, gender and the following variables related with the demand: hours of the day, type of day (working days or bank holidays), months of the year and trimesters, number of resources mobilized and types of resolution. RESULTS: The analyses were carried out on 163,331 calls, of which 1,380 calls were due to suicidal behaviour (0.8%), 9,951 for psychiatric reasons (6.1%) and 152,000 for physical reasons (93%). The emergency calls for suicidal behaviour were mainly made by females, between 31-60 years, in the evening and at night, and required transfer to hospital and more than one mobilized resource. Calls due to completed suicide were more frequently made by older men. Calls due to suicidal tendencies predominated over those due to attempted or threatened suicide during the first trimester of the year, while the opposite was the case during the third trimester. CONCLUSIONS: The results indicated differential characteristics of suicide calls that are potentially relevant for prevention in spite of the limitations of the present study.

Prevalence of schizophrenia and related disorders in Malaga (Spain): results using multiple clinical databases.

BACKGROUND: To calculate the 1-year prevalence of schizophrenia and related disorders in a catchment area of Malaga (Spain) and determine the prevalence by gender, dwelling (rural or urban) and socioeconomic area (deprived or non-deprived area). METHOD: This cross-sectional study comprised the mental health area covered by Carlos Haya Hospital. We used multiple large clinical databases and key informants to identify cases. RESULTS: The mean 1-year prevalence of schizophrenia and related disorders was 6.27 per 1000. It was nearly double in men (8.45 per 1000) than in women (4.26 per 1000) (p < 0.001), with a male-to-female ratio of 1.98. The rate was higher in urban (6.64 per 1000) than rural areas (3.95 per 1000) (p < 0.0001) and in socioeconomic deprived areas (7.56 per 1000) than non-deprived areas (6.12 per 1000) (p = 0.005). For the subgroup of schizophrenia, the rates were: men, 5.88 per 1000 and women, 2.2 per 1000 (p < 0.0001), with a male-to-female ratio of 2.67. The rate was also higher in urban (4.2 per 1000) than rural areas (2.49 per 1000) (p < 0.0001) and in socioeconomic deprived areas (4.49 per 1000) than non-deprived areas (3.9 per 1000) (p = 0.149). CONCLUSIONS: The use of multiple clinical sources of information not only from mental health services, but also from emergency departments, primary care and private settings revealed high prevalence rates of schizophrenia and related disorders. This diagnosis is more common in men and in cities. Such precise estimates of the prevalence of schizophrenia have important repercussions for resource allocation and policy planning.

[Opinions of healthcare professionals on the definition of severe mental illness: a qualitative study]. / Opiniones de los profesionales del ámbito sanitario acerca de la definición de trastorno mental grave. Un estudio cualitativo.

BACKGROUND: Over the years, a number of definitions of severe mental illness (SMI) have been proposed and substantial controversy about the definition still remains. The aim of this study was to evaluate the views of a group of mental health professionals on the appropriate criteria for defining SMI. METHODOLOGY: This was a qualitative study, based on five focus groups with mental health professionals (psychiatrists, psychologists, nurses, general practitioners, monitors and social workers) from Carlos Haya Hospital in Malaga, Spain. A content analysis was performed on the transcriptions by three independent researchers. RESULTS: The professionals agreed that a certain degree of dysfunctionality must be present for a definition of SMI. There was some disagreement between the different categories of professionals regarding the inclusion of dimensions such as diagnosis, family and social support, use of healthcare resources and duration of the illness as necessary and sufficient criteria for the definition of SMI. From the professionals' discourse, some personal patient variables such as age of onset of illness, lack of insight and level of education emerged as relevant for the definition of SMI. CONCLUSIONS: Apart from the dimensions considered in the literature, the interviewed mental health professionals discussed other criteria that could be taken into account in the definition of SMI. Perceptions differ between categories of professional and work settings in which they operate.

Opiniones de los profesionales del ámbito sanitario acerca de la definición de trastorno mental grave. Un estudio cualitativo / Opinions of healthcare professionals on the definition of severe mental illness. A qualitative study

Fundamento: Aunque a lo largo de los años se han propuesto diferentes definiciones de trastorno mental grave (TMG), aún existe una gran controversia a la hora de obtener una definición consensuada. El objetivo de este trabajo fue analizar la opinión de un grupo de profesionales de la red pública de servicios sanitarios sobre cuáles son los criterios que se deben tener en cuenta en la definición de TMG. Método: Estudio cualitativo en el cual se llevaron a cabo 5 grupos focales con profesionales (psiquiatras, psicólogos, enfermeras, médicos de familia, monitores y trabajadores sociales) relacionados con la atención a la salud mental del área de la Unidad de Gestión Clínica Salud Mental del Hospital Regional Universitario Carlos Haya de Málaga (España). Se codificaron las transcripciones mediante un análisis de contenido llevado a cabo por tres investigadoras de forma independiente. Resultados: Los profesionales entrevistados estuvieron de acuerdo en que debe tenerse en cuenta un cierto grado de disfuncionalidad para la definición de un TMG. Sin embargo, existía cierta discrepancia en función de la profesión en la inclusión de dimensiones como el diagnóstico, el soporte familiar y social, el uso de recursos sanitarios y la duración de la enfermedad como criterios necesarios y suficientes para la definición de TMG. En el discurso de los profesionales emergieron variables personales de los pacientes como la edad de comienzo de la enfermedad, la falta de insight y el nivel de formación, como relevantes para la definición del TMG. Conclusión: Además de las dimensiones propuestas por la literatura, los profesionales de salud mental entrevistados consideran otros criterios a tener en cuenta en la definición del TMG. Los discursos difieren en función de la profesión y ámbito laboral al que pertenecen (AU)

Background: Over the years, a number of definitions of severe mental illness (SMI) have been proposed and substantial controversy about the definition still remains. The aim of this study was to evaluate the views of a group of mental health professionals on the appropriate criteria for defining SMI. Methodology: This was a qualitative study, based on five focus groups with mental health professionals (psychiatrists, psychologists, nurses, general practitioners, monitors and social workers) from Carlos Haya Hospital in Malaga, Spain. A content analysis was performed on the transcriptions by three independent researchers. Results: The professionals agreed that a certain degree of dysfunctionality must be present for a definition of SMI. There was some disagreement between the different categories of professionals regarding the inclusion of dimensions such as diagnosis, family and social support, use of healthcare resources and duration of the illness as necessary and sufficient criteria for the definition of SMI. From the professionals’ discourse, some personal patient variables such as age of onset of illness, lack of insight and level of education emerged as relevant for the definition of SMI. Conclusions: Apart from the dimensions considered in the literature, the interviewed mental health professionals discussed other criteria that could be taken into account in the definition of SMI. Perceptions differ between categories of professional and work settings in which they operate (AU)

Predicting the onset of major depression in primary care: international validation of a risk prediction algorithm from Spain.

BACKGROUND: The different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care. METHOD: A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI). RESULTS: Six variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79-0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain. CONCLUSIONS: The PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries.

[Assessment of needs for care of a schizophrenic patient sample from the Granada Sur Mental Health Care Area]. / Evaluación de las necesidades asistenciales de una muestra de pacientes esquizofrénicos del Area de Salud Mental Granada Sur.

INTRODUCTION: The assessment of the needs for care for long term severe ill patients has been one of the areas of greatest interest since the community mental health system was established. OBJECTIVE: This study has aimed to describe the needs for care of a group of schizophrenic patients and to know if these needs are met by the public mental health network. METHODS: A cohort of 83 schizophrenic patients was selected. The diagnosis was confirmed by the SCAN method. The Needs for Care Assessment instrument was used to assess the needs for care of the patients. RESULTS: The positive psychotic symptoms (98%) followed by slowness and underactivity (71%) are the most common clinical problems between the patients of the cohort. In regards to skills and abilities, the most common are those related with work (49%) and house keeping (domestic work, getting meal and domestic shopping, with 42, 41 and 41%, respectively). In regards to the state of the need, 81% of the clinical problems are covered while this is only 40% in the social area. CONCLUSIONS: The clinical needs of the schizophrenic patients can be met by the mental health services established, oriented to the community care. However, attending social needs requires more rehabilitation, occupational and residential resources to be developed.

Evaluación de las necesidades asistenciales de una muestra de pacientes esquizofrénicos del Área de Salud Mental Granada Sur / Assessment of needs for care of a schizophrenic patient sample from the Granada Sur Mental Health Care Area

Introducción. La evaluación de las necesidades asistenciales de las personas con una enfermedad mental de larga evolución es una de las áreas de mayor interés desde que se instauró el modelo comunitario de atención a la salud mental. Objetivo. El objetivo de este estudio es describir las necesidades asistenciales que presentan un grupo de pacientes esquizofrénicos y determinar si dichas necesidades están cubiertas por la red pública de servicios de salud mental. Métodos. Se ha seleccionado una muestra de 83 pacientes con diagnóstico de esquizofrenia confirmado según el método SCAN. Para la evaluación de las necesidades asistenciales se ha utilizado el instrumento Needs for Care Assessment (NCA).Resultados. Los problemas clínicos que se presentan más frecuentemente entre los pacientes de la cohorte son los síntomas psicóticos positivos (98 por ciento), seguidos de lentitud y baja actividad (71 por ciento). Respecto a los problemas presentes en la sección de destrezas y habilidades, los más frecuentes son los relacionados con la ocupación (49 por ciento) y el mantenimiento del hogar (tareas domésticas, conseguir alimentos y compras domésticas, con 42, 41 y 41 por ciento, respectivamente). Respecto al estado de la necesidad, el 81 por ciento de los problemas clínicos están cubiertos, mientras que en el área social este porcentaje desciende hasta el 40 por ciento. Conclusiones. Las necesidades clínicas de los pacientes esquizofrénicos pueden ser atendidas con los servicios de atención ya establecidos, orientados a la intervención en la comunidad. Sin embargo, la atención a las necesidades sociales requiere de forma específica del desarrollo de más recursos rehabilitadores, ocupacionales y residenciales (AU)

Características sociodemográficas de una cohortede pacientes esquizofrénicos del Área SaludMental Granada Sur / Sociodemographics characteristics of patients with schizophrenia in Granada South Area

Las variables sociodemográficas juegan un papel importante en el pronóstico de la esquizofrenia. Si se conocen dichas características se pueden planificar servicios más adaptados a las necesidades de los pacientes. El objetivo de este trabajo es presentar el perfil sociodemográfico de una cohorte de 83 pacientes esquizofrénicos que está recibiendo atención de los servicios de salud mental del área Granada Sur. Los resultados muestran que se trata de un varón (75 por ciento), de 35 años de edad, soltero (82 por ciento), que vive con su familia de origen (79 por ciento), con un nivel de estudios primarios (65 por ciento), sin trabajo (73 por ciento), y que recibe una pensión de jubilación (66 por ciento). Llama la atención el alto porcentaje de varones que acude a demandar atención (AU)

[Predictors for hospitalization rates of patients with schizophrenia]. / Variables predictoras de los ingresos hospitalarios en pacientes con esquizofrenia.

INTRODUCTION: For clinicians and care providers, the use of hospital facilities by patients with schizophrenia is one of the areas of most concern in the field of mental health studies. The objective of this study is to determine those characteristics which relate to hospital admissions for this group of patients. METHOD: A one year follow up study for a group of 83 patients with schizophrenia in contact with mental health services was carried out to identify the socio-demographic, clinical and care needs' variables related to hospital admissions. RESULTS: As a result of the multivariate models applied, male patients presenting hyperactivity, thought disturbance, deliria and exaggerated interpretation, socially embarrassing behaviour and use of drugs were shown to be those with a greater probability of hospital admission.

[Mental health services evaluation]. / Evaluación de Servicios de Salud Mental en el ámbito de la atención comunitaria.

The evaluation of the community mental health services to the chronic mental health patients is one of the areas of more interest since the psychiatric reform began. To carry out an evaluation of the attention in depth it is necessary to keep in mind many different aspects. The new conception of the mental health services has implied a change in the whole system. The evaluation process can be divide in three levels: structures, processes and results which are interrelated to each other. For each one of these levels specific indicators exist and all should complete a minimum requirements as being valid, objectives, sensitive and specific. For a good evaluation and planning of mental health services is necessary to know what type of services are implied in the attention, which are the patients that go to the services and which are the changes that have taken place in this patients.

Variables predictoras de los ingresos hospitalarios en pacientes con esquizofrenia / Predictors for hospitalization rates of patients with schizophrenia

Introduccion. El uso de servicios hospitalarios que realizan los pacientes con esquizofrenia es uno de los temas de preocupación más frecuente en el campo de la salud mental por parte de los clínicos y los gestores de los recursos asistenciales. El objetivo de este trabajo es determinar aquellas variables que están relacionadas con los ingresos hospitalarios en este grupo de pacientes. Método. Para ello se ha realizado un seguimiento, durante un año, a un grupo de 83 pacientes con esquizofrenia, en contacto con los servicios de salud mental, para identificar las variables sociodemográficas, psicopatológicas y de necesidades asistenciales relacionadas con los ingresos hospitalarios. Resultados. Como resultado de los modelos multivariantes aplicados, los pacientes que son varones, que presentan hiperactividad, experiencias de distorsión de la forma del pensamiento, delirios e interpretaciones extravagantes, comportamiento socialmente embarazoso y uso de drogas son los que tienen una probabilidad mayor de ser ingresados (AU)

Evaluación de Servicios de Salud Mental en el ámbito de la atención comunitaria / Mental Health Services Evaluation

La evaluación de la atención comunitaria en salud mental a los pacientes mentales crónicos es una de las áreas de mayor interés desde que comenzó la reforma psiquiátrica. Para realizar una evaluación de la atención en profundidad es necesario tener en cuenta tanto aspectos organizativos como del propio individuo, ya que la nueva concepción de la atención a la salud mental ha implicado un cambio en todo el sistema de servicios de salud mental. El proceso de evaluación se puede dividir en tres niveles: estructura, procesos y resultados, los cuales se encuentran interrelacionados entre sí. Para cada uno de estos niveles existen indicadores específicos que ayudan en el proceso de evaluación de los mismos, y todos ellos deben cumplir unos requisitos mínimos tales como ser válidos, objetivos, sensibles y específicos. La principal aportación que se deriva a partir de este trabajo de revisión es que para una buena evaluación y planificación de servicios es necesario conocer qué tipo de servicios están implicados en la atención, cuáles son los pacientes que acuden a los servicios y qué cambios se han producido en dichos pacientes (AU)

Analysis of patterns of mental health care with three different approaches (cross-sectional, longitudinal and dynamic).

OBJECTIVE: This article attempts to provide an overview of different methods of analysis of information on service utilization from different approaches. METHODS: A systematic review of the studies of pattern of care is done. The analysis of pattern of care has been divided into three different approaches: cross-sectional, longitudinal and dynamic. RESULTS: In cross-sectional studies, information on utilization is based on the total number of contacts with mental health services during a given period. In the second approach, called longitudinal, survival analysis is applied considering the interval of time between each contact. The third type of analysis, called here the "dynamic" approach, involves the application of mathematical models based on the Markov chain to analyse the probability of change from one type of contact to another. CONCLUSIONS: We emphasise the need for further studies designed to analyse data from psychiatric case registers with standardised models for mental health services utilization analysis.

Estudio de las alternativas residenciales para pacientes desinstitucionalizados en Granada y Sevilla / Study of the residential facilities for a group of deinstitutionalised patiens in Granada and Sevilla

Este trabajo tiene como objetivo estudiar los alojamientos protegidos desarrollados recientemente en Granada y Sevilla por el Programa Andaluz de Salud Mental y la Fundación Andaluza para la Integración Social del Enfermo Mental (FAISEM). La muestra está formada por 77 pacientes con largas hospitalizaciones previas que viven en 18 pisos y hogares protegidos situados en las ciudades de Sevilla y Granada. Los alojamientos poseen dimensiones reducidas, entre 4 y 26 plazas, y grados variables de supervisión y restricción. Sólo dos pacientes han reingresado en unidades de salud mental en el último año. Ninguno de los residentes ha cometido delitos. El 41 por ciento de los sujetos realiza actividades domésticas, el 26 por ciento acude a terapia ocupacional y el 4 por ciento tiene un empleo protegido. El 60 por ciento de los pacientes recibe visitas regulares de familiares o amigos. El 78 por ciento de los residentes prefiere vivir en la comunidad frente al 13 por ciento que desea volver al hospital. Las alternativas residenciales estudiadas proporcionan a los pacientes alojamientos más satisfactorios que los hospitales psiquiátricos, sin que el nuevo régimen de vida suponga un riesgo para la estabilidad clínica de los residentes o la seguridad del entorno social. (AU)