El profesional en urgencias y emergencias: agresividad y burnout / The professional in emergency care: aggressiveness and burnout

La violencia contra profesionales y el síndrome deburnout, o desgaste profesional del personal sanitario,ha adquirido una enorme importancia en los últimosaños, especialmente en los servicios de urgencias. Sólouna pequeña proporción de las agresiones al personalsanitario sale a la luz, pero hay un gran volumende incidentes violentos sumergidos que no constan enninguna parte. Se han creado protocolos y registros deagresiones en diversas comunidades para contar condatos precisos y poder tomar las decisiones más adecuadasy oportunas.Las agresiones sufridas por los trabajadores seencuentran dentro del amplio abanico de riesgos queafectan a la seguridad y salud de los trabajadores sanitarios,ya de por sí sometidos a factores de estrés laboralelevados que conducen a altos niveles de desgasteprofesional (burnout).Por otra parte, los «profesionales quemados» incrementan,con sus actitudes en el trabajo, el riesgo deagresiones contra sí mismos y contra sus compañeros.Las autoridades sanitarias tienen entre sus prioridadesno sólo ofrecer un servicio de calidad a todas las personasusuarias del sistema sanitario, sino también quetodo profesional sanitario pueda trabajar en las mejorescondiciones laborales y con unos niveles de satisfacción,motivación y seguridad adecuados(AU)

Violence against professionals and the syndrome ofburnout, or the professional exhaustion of health personnel,has acquired enormous significance in recentyears, especially in emergency care. Only a small proportionof the aggressions against the health personnelcome to light, but there is a great volume of submergedviolent incidents that are not recorded anywhere. Protocolsand registers of aggressions have been createdin different autonomous communities to make precisedata available so that more suitable and opportune decisionscan be taken. The aggressions suffered by theworkers fall within a wide range of risks that affect thesafety and health of health workers, who are alreadysubjected to high stress that lead to high levels of professionalexhaustion (burnout). On the other hand,“burnt-out professionals”, with their attitudes at work,increase the risk of aggressions against themselves andagainst their colleagues. The priorities of the health authoritiesinclude not only offering a quality service toall the users of the health system, but also ensuring thatevery health professional can work in optimum workingconditions, with suitable levels of satisfaction, motivationand safety(AU)

[Migration and psychiatric diseases]. / Patología psiquiátrica en el inmigrante.

Immigration is an emergent social phenomenon with a great impact on health systems. Psychiatric disorders are said to be universal phenomenon, but their clinical expression may be determined by cultural factors. Indeed, immigration acts as a risk factor for the development of mental diseases, as it works as a stress generating factor. The adaptability process for both the immigrants and the receptor environment, involves a social and cultural effort that modifies interindividual relationships, mainly at the therapeutic level. Psychiatry faces up to a new therapeutic and diagnostic challenge, where ethnocultural barriers (either individual or collective) and social and biological barriers need to be got over. Barriers to access to Mental Health Services or social resources and language differences mean an important obstacle which has to be got over by health systems providing special mental health programs, either segregationist or integrative. This review tries to summarize the different issues that limit or interfere with daily clinical practice when treating the immigrant population, meaningful both in quantitative and qualitative psychiatric terms.

Patología psiquiátrica en el inmigrante / Migration and psychiatric diseases

La inmigración es un fenómeno social emergente con notable impacto en el ámbito sanitario.Los síndromes psiquiátricos son fenomenológicamente universales, pero su expresión clínica está primariamente determinada por factores culturales. Del mismo modo, la inmigración, como fenómeno generador de estrés, supone un factor de riesgo para el desarrollo de patología mental. La adaptación del inmigrante así como la del medio receptor, supone un esfuerzo cultural y social que condiciona las interacciones entre los individuos y de modo sustancial la relación paciente-terapeuta.La clínica psiquiátrica se enfrenta a un nuevo reto diagnóstico y terapéutico en el que han de superarse barreras etnoculturales individuales y colectivas, sociales y biológicas.Las diferencias idiomáticas y la restricción en el acceso a recursos y servicios sanitarios, suponen un obstáculo de primer orden que debe ser superado mediante políticas sanitarias que aboguen, bien por la discriminación positiva (segregación), bien por la integración.Este artículo trata de revisar los diferentes aspectos que limitan e interfieren la práctica clínica diaria para un sector importante de la población, tanto por su presencia numérica como por su prevalencia en cuanto a patología psiquiátrica

Immigration is an emergent social phenomenon with a great impact on health systems. ;;Psychiatric disorders are said to be universal phenomenon, but their clinical expression may be determined by cultural factors. Indeed, immigration acts as a risk factor for the development of mental diseases, as it works as a stress generating factor. The adaptability process for both the immigrants and the receptor environment, involves a social and cultural effort that modifies interindividual relationships, mainly at the therapeutic level. ;;Psychiatry faces up to a new therapeutic and diagnostic challenge, where ethnocultural barriers (either individual or collective) and social and biological barriers need to be got over. ;;Barriers to access to Mental Health Services or social resources and language differences mean an important obstacle which has to be got over by health systems providing special mental health programs, either segregationist or integrative. ;;This review tries to summarize the different issues that limit or interfere with daily clinical practice when treating the immigrant population, meaningful both in quantitative and qualitative psychiatric terms

Patterns of symptoms in neuroleptic-naive patients with schizophrenia and related psychotic disorders before and after treatment.

A three-factor structure of schizophrenic symptoms has received considerable support, but there are no data on the factor structure of symptoms in neuroleptic-naive patients and how symptoms evolve after the inception of antipsychotic treatment. Seventy neuroleptic-naive patients with schizophrenia or related psychotic disorders were assessed with the Scales for the Assessment of Positive and Negative Symptoms before and after neuroleptic treatment. Ten global ratings of symptoms were subjected to factor analysis at the two time points and the factor solutions compared. A three-factor structure composed of psychotic, disorganization, and negative dimensions was found at the two assessment points. The negative and disorganization factors were highly correlated at each assessment and across assessments. While the symptom composition of the factors at the neuroleptic-naive assessment fitted that described in most previous studies, the composition of the negative and disorganization factors after neuroleptic treatment was somewhat different in that attention and inappropriate affect loaded on the negative factor instead of the disorganization factor. It is concluded that caution is warranted when using the three-factor model of schizophrenic symptoms as it may not be stable at different phases of the illness.

Differentiating primary from secondary negative symptoms in schizophrenia: a study of neuroleptic-naive patients before and after treatment.

OBJECTIVE: The study examined the primary versus secondary character of negative symptoms in a group of first-episode, neuroleptic-naive psychotic patients before and after they started neuroleptic treatment. METHOD: Forty-seven inpatients with a first episode of schizophrenia or related psychotic disorders were examined for the presence of negative symptoms, psychosis, depression, and parkinsonism at admission to an inpatient psychiatric unit, before receiving neuroleptics, and at discharge an average 3.3 weeks later, after starting neuroleptic treatment. RESULTS: Although patients' mean scores on measures of positive, negative, and depressive symptoms decreased significantly over the treatment period, the mean rating of nonakinetic parkinsonism worsened. The mean rating of akinetic parkinsonism did not change significantly over the treatment period. Negative symptoms at admission were not predicted by positive or depressive symptoms at admission. Residual negative symptoms at discharge were mainly predicted by negative symptoms at admission (i.e., primary symptoms) and to a negligible degree by residual positive and depressive symptoms. Change in negative symptoms over the observation period was predicted to a marginal degree by change in depressive symptoms. CONCLUSIONS: Negative symptoms rated during a first psychotic episode before and after starting antipsychotic treatment are mainly primary in character and should be considered as a direct manifestation of the basic dysfunctions of schizophrenia.

Neuroleptic dose and schizophrenic symptoms. A survey of prescribing practices.

A study was conducted to survey the prescribing practices of neuroleptic doses in 100 consecutively hospitalized DSM-III-R schizophrenic patients. The relationship between doses and clinical and symptomatological variables was subsequently analyzed. Patients were evaluated through the Positive and Negative Syndrome Scale (PANSS). The peak mean dose in chlorpromazine equivalents was 1290 (range 250-7200). Haloperidol was the most commonly employed neuroleptic (67 patients). Neuroleptic doses were correlated with excitement, suspiciousness, hostility, uncooperativeness and poor impulse control. The neuroleptic doses administered in our hospital were similar to those found in other survey reports but higher than those recommended by the controlled dose-response studies. The correlation found between neuroleptic doses and symptoms of disruptive behavior suggests that we employed high-dose practices to treat the disruptive symptoms of schizophrenia. We concluded that it is useful to distinguish between the neuroleptic doses required to control the psychotic episode and those to treat the disruptive behavior.