[Impact on mental healthcare after collaboration between primary healthcare and mental health services]. / Impacto en la asistencia en salud mental tras la colaboración entre atención primaria y salud mental.

INTRODUCTION: The primary care physician is the professional with whom the psychiatric patient has contact first and most frequently. For this reason, a good coordination between the Primary Healthcare (PHC) and Mental Health (MH) services is essential to provide the best care to patients and at the same time optimise the limited resources of this service. The aim of this work is to determine whether the collaboration between PHC and MH results in a more efficient use of the limited resources in MH. METHODOLOGY: An observational, retrospective, mirror study was carried out with a total sample of 135 patients over 16 years old referred for the first time from PHC to Psychiatry. The results during the first 6 months of the collaboration between PHC and MH (POST Group) are compared with those of the 6 months prior to the intervention (PRE Group). RESULTS: After collaboration meetings, the percentage of patients who are discharged by the psychiatrist after the first visit decreases (32.2% vs. 16%) and the percentage of follow-up by psychiatry and psychology increases. Furthermore, the percentage of patients who do not attend the first visit decreases (23.3% vs. 13.7%). CONCLUSIONS: The data suggest that the collaboration between PHC and MH improves the effectiveness and functioning of MH services.

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.

Melatonin levels in Parkinson's disease: drug therapy versus electrical stimulation of the internal globus pallidus.

The objective of our work was to measure plasma melatonin levels in patients with Parkinson's Disease (PD) following electrical stimulation of the internal globus pallidus (GPi), and to compare these levels with groups of PD patients under drug therapy and healthy controls. The levels of melatonin were measured twice daily at 1000 and 1200. The GPi stimulation at 130 Hz lowered melatonin levels, while no changes were observed in the absence of stimulation. The melatonin levels from healthy subjects were lower than those observed in PD patients. The melatonin levels from PD patients under drug therapy were also measured during the night (2000-2400-0400) and at 0800 in order to observe their circadian changes. The Internal Globus Pallidus (GPi) stimulation was effective in lowering the melatonin levels during the day and, therefore returned these levels to those observed in normal subjects.