Involuntary outpatient treatment (IOT) in Spain.

In recent decades there have been significant legislative changes in Spain. Society develops faster than laws, however, and new challenges have emerged. In 2004, the Spanish Association of Relatives of the Mentally Ill (FEAFES) proposed amending the existing legislation to allow for the implementation of involuntary outpatient treatment (IOT) for patients with severe mental illness. Currently, and after having made several attempts at change, there is no specific legislation governing the application of this measure. Although IOT may be implemented in local programmes, we consider legal regulation to be needed in this matter.

Involuntary outpatient treatment in patients with severe mental illness: a one-year follow-up study.

INTRODUCTION: Involuntary outpatient treatment (IOT) aims to ensure adherence to therapy in patients with serious mental disease who are unaware of their illness and for whom treatment discontinuation carries a high risk of relapse. OBJECTIVES: To evaluate the effectiveness of IOT in preventing relapse among patients with serious mental disease. METHOD: A retrospective observational study was carried out on all of the patients (n=140) receiving IOT in the city of Valencia, Spain. Hospital service uses (emergency care, admissions and mean stay times) during the 12 months before and after the introduction of IOT were compared. RESULTS: Patients with schizophrenia, delusional disorder or schizoaffective disorder showed a significant reduction in the number of admissions and days spent in the psychiatry ward during the year of IOT. The reduction in the number of visits to the emergency department was only significant for the patients with schizophrenia. DISCUSSION: We conclude that involuntary outpatient treatment may be effective for patients with serious mental disease who are unaware of their illness and for whom treatment discontinuation carries a high risk of relapse.

[Familiar Munchausen syndrome: an unusual presentation]. / Síndrome de Munchausen familiar: una presentación inusual.

Munchausen syndrome is a subtype included in factitious disorders in which somatic signs and symptoms predominate. The patient self-inflicts damage with the only objective of assuming a <

Síndrome de Munchausen familiar:una presentación inusual / Familiar Munchausen syndrome: an unusual presentation

El síndrome de Munchausen es un subtipo dentro de los trastornos facticios en el que predominan los signos y síntomas somáticos. El paciente se autoinflinge un daño físico, con el único objetivo de asumir el rol de enfermo. Es una patología infradiagnosticada, caracterizada por numerosos ingresos hospitalarios y una historia de peregrinaje por diferentes especialistas. Un diagnóstico precoz evitaría el elevado gasto sanitario ocasionado por las exploraciones innecesarias y el deterioro sociolaboral y familiar del paciente. Se describe un caso que afecta a dos hermanos, infrecuente en la literatura revisada, y se exponen los criterios de sospecha en la práctica clínica diaria. (AU)