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.

Diagnóstico y manejo de la esquizofrenia en España: el proyecto ACEE / Diagnostic process and management of schizophrenia in Spain: the ACEE project

Introducción. A pesar de tratarse de una enfermedad con una gran repercusión sanitaria, social y familiar, en España se dispone de escasa información epidemiológica sobre los pacientes con esquizofrenia, su diagnóstico y tratamiento. El estudio ACEE (Abordaje Clínico de la Esquizofrenia en España) se ha diseñado con el objetivo principal de conocer en la práctica clínica habitual el manejo de la esquizofrenia en España.Método. El ACEE es un estudio observacional, descriptivo, transversal, multicéntrico, con datos recogidos en el curso de la práctica clínica habitual mediante un cuestionario diseñado específicamente.Resultados. Se han analizado un total de 1.937 pacientes (83% del sector público y 17% del privado). La mayoría presenta una esquizofrenia paranoide en fase de estabilización y no trabaja debido a su enfermedad. El 96% está sometido a tratamiento con antipsicóticos y un 55 % recibe además algún tipo de terapia no farmacológica. Se presentan con mayor frecuencia síntomas negativos que positivos (88 frente a 63%). Existen diferencias significativas entre el tipo de pacientes y el procedimiento de diagnóstico entre el sector público y el privado.Conclusiones. El ACEE muestra que el perfil del paciente atendido por esquizofrenia en las consultas psiquiátricas españolas es mayoritariamente varón, soltero, viviendo sin trabajo en un entorno familiar, tratado básicamente con fármacos antipsicóticos combinados con otras medicaciones y al que se practica un reducido número de exploraciones complementarias

Introduction. Although schizophrenia has a great impact on the health care, social and family levels, there is little epidemiological information on patients with schizophrenia, its diagnosis and treatment in Spain. The ACEE (Abordaje Clínico de la Esquizofrenia en España; Clinical Approach to Schizophrenia in Spain) study was designed with the primary objective of defining the management of schizophrenia in Spain from the perspective of current clinical practice. Method. ACEE is a descriptive cross-sectional multicenter observational study with data collected in the setting of current clinical practice by means of a specifically designed questionnaire. Results. A total of 1,937 patients have been studied (83% pertaining to the public sector and 17% to private one). Most subjects had paranoid schizophrenia in the stabilization phase, and did not work because of their illness. Most (96%) were receiving antipsychotic treatment and 55% also received some non-drug treatment. Negative symptoms were more frequent than positive symptoms (88% versus 63%). Significant differences were observed for type of patients and diagnostic procedures involved between the public and private health care sectors. Conclusions. The ACEE study shows that schizophrenic patients attending Spanish psychiatric centers are mainly single, non-working males who are living in their family setting. Treatment basically consists of antipsychotics combined with other drugs, and few complementary examinations are performed

[Diagnostic process and management of schizophrenia in Spain: the ACEE project]. / Diagnóstico y manejo de la esquizofrenia en España: el proyecto ACEE.

INTRODUCTION: Although schizophrenia has a great impact on the health care, social and family levels, there is little epidemiological information on patients with schizophrenia, its diagnosis and treatment in Spain. The ACEE (Abordaje Clínico de la Esquizofrenia en España; Clinical Approach to Schizophrenia in Spain) study was designed with the primary objective of defining the management of schizophrenia in Spain from the perspective of current clinical practice. METHOD: ACEE is a descriptive cross-sectional multicenter observational study with data collected in the setting of current clinical practice by means of a specifically designed questionnaire. RESULTS: A total of 1,937 patients have been studied (83% pertaining to the public sector and 17% to private one). Most subjects had paranoid schizophrenia in the stabilization phase, and did not work because of their illness. Most (96%) were receiving antipsychotic treatment and 55% also received some non-drug treatment. Negative symptoms were more frequent than positive symptoms (88% versus 63%). Significant differences were observed for type of patients and diagnostic procedures involved between the public and private health care sectors. CONCLUSIONS: The ACEE study shows that schizophrenic patients attending Spanish psychiatric centers are mainly single, non-working males who are living in their family setting. Treatment basically consists of antipsychotics combined with other drugs, and few complementary examinations are performed.

Validez del trastorno autodestructivo de la personalidad DSM-III-R / Validity of DSM-III-R self-defeating personality disorder

Introducción: El trastorno autodestructivo de personalidad se introdujo en el DSM-III-R como una categoría propuesta para estudio adicional, siendo retirada de la cuarta edición del DSM debido a las dudas en torno a su validez. Objetivos: El objetivo de esta revisión es examinar la justificación de dicha decisión. Se presenta y discute la historia del trastorno, así como las bases para su inclusión como una categoría provisional del DSM-III-R. También se exponen los resultados de un estudio llevado a cabo por nuestro equipo con el objetivo de verificar la existencia del trastorno. Sujetos y métodos: Tras la evaluación de una muestra aleatoria de 200 pacientes psiquiátricos atendidos en un centro de salud mental, se seleccionaron 15 casos con sospecha clínica de rasgos autodestructivos para ser evaluados por un panel de expertos, mediante la historia clínica y la información aportada por el Personality Assessment Schedule(PAS). Resultados: Se identificaron dos casos, ambos comórbidos con el trastorno de personalidad dependiente. Seis sujetos más fueron diagnosticados como casos subumbral de acuerdo con los criterios DSM, presentando todos ellos comorbilidad en el eje 11. Conclusión: El trastorno "autodestructivo de personalidad parece existir; probablemente con una baja prevalencia y una alta comorbilidad, pero es necesario llevar acabo una mayor investigación para clarificar estos aspectos

lntroduction: Self-defeating Personality Disorder was introduced in DSM-III-R classificationas a category in need offurther study and then removedfrom DSM-IV edition because of its doubt ul validity. Objectives: The aim of this review is to examine the justification of such a decision. The history of the disorder as well as the bases for its inclusion as a provisional categoryin DSM-III-R are presented and discussed. Then, the results of a study carried outby our team with the aim of verifying the existence of the disorder are presented. Subjects and method: 15 patients with clinical suspicion of self-defeating traits were selected from a random sample of two hundred psychiatric outpatients and the information obtained from Personality Assessment Schedule (PAS) and clinical interview was assessed by a panel of experts. Results: Two cases were identified, both comorbid with Dependent Personality Disordel: Six more subjects were diagnosed as subthreshold cases according to DSM criteria. All of them presented other comorbidities. Conclusion: Self-defeating Personality Disorder seems to exist, though probably with a low prevalence and a high comorbidity, but further research is necessary to clarify these aspects

Homicidio-suicidio en el anciano: ¿por qué el cuidador mata a su pareja con enfermedad de Alzheimer y después se suicida? / Homicide-suicide in the elderly: why do caragivers kill partners with Alzheimer's disease and then kill themselves?

Las consecuencias negativas para los cuidadores de los familiares con demencia son bien conocidas. Sin embargo, existe poca información sobre la violencia familiar que implica a los cuidadores, habitualmente esposos, que matan al paciente y, en ocasiones, después se suicidan o lo intentan. En este artículo se hace una revisión sobre este tema. Y se encuentra que la depresión es una característica nuclear del anciano agresor y que generalmente es el varón

The negative consequences of caring for relatives with dementia have been well documented. However, data are lacking about violence involving caregivers, usually spouses, who kill the patient and sometimes attempt or commit suicide. In the present article we review this topic, in which depression in the perpetrator, usually a man, plays an important role

Recall and recognition confabulation in psychotic and bipolar disorders: evidence for two different types without unitary mechanisms.

Several forms of confabulation have been identified recently in schizophrenic patients, but it has not yet been investigated whether these forms are specific to schizophrenia. Furthermore, the origin of confabulation is unclear. The present study investigated recall and recognition confabulation and their relations with symptomatology, cognitive domains (abstraction and flexibility, verbal fluency, verbal memory, motor activity, and visual-motor processing/attention), computed tomographic (CT) measures (ventricular, cerebral, and Sylvian fissure size), and auditory event-related potentials (amplitudes and latencies of peak components in oddball paradigms) in 33 schizophrenic patients, 35 bipolar I patients, eight schizoaffective patients, and seven patients with other psychotic disorders. We found that neither type of confabulation was specific of any diagnostic group. Recall confabulation was mainly predicted by the predominance of positive symptoms, while recognition confabulation was predicted by a delay in P300 latency and the doses of antipsychotics used. Our results suggest two different mechanisms for both types of confabulation based on interference with the adequate retrieval of information and slowness in early stimulus detection.

Trastorno depresivo de la personalidad y alteraciones del estado de ánimo / Depressive personality disorder and mood disorders

INTRODUCCIÓN: El trastorno depresivo de la personalidad (TDP) está incluido en el apéndice B del DSM-IV a la espera de que estudios futuros puedan aclarar si se trata de una categoría diagnóstica independiente de otros trastornos de los ejes I y II. En este artículo se presentan nuevos datos sobre su relación con el trastorno depresivo mayor y la distimia. PACIENTES Y MÉTODO: En una muestra aleatoria de atención primaria, se evalúa si los pacientes presentan un trastorno depresivo de la personalidad según los criterios del DSM-IV, un trastorno depresivo mayor o un trastorno distímico, así como los antecedentes personales y familiares de los pacientes con trastornos afectivos. RESULTADOS: Se obtiene una muestra de 657 pacientes, de los cuales el 3,6 por ciento (n = 24) cumple criterios diagnósticos de trastorno depresivo de la personalidad. En el momento de la exploración, el 37,5 por ciento de los pacientes con trastorno depresivo de la personalidad son diagnosticados también de distimia y el 20,8 por ciento de trastorno depresivo mayor. Una tercera parte de los casos diagnosticados de trastorno depresivo de la personalidad nunca han presentado un trastorno del estado de ánimo. Los antecedentes familiares afectivos son más frecuentes en los pacientes diagnosticados de trastorno depresivo de la personalidad. CONCLUSIONES: El trastorno depresivo de la personalidad, a pesar del solapamiento conceptual y empírico existente, puede ser distinguido clínicamente de otros trastornos afectivos del eje I. Estudios futuros deberán informar acerca del curso y pronóstico de este trastorno y de su relación con otros trastornos del eje II (AU)

Preferencia motora y esquizofrenia (II) / Motor preferency and schizophrenia (II)

Este artículo corresponde a la segunda parte de una revisión de la literatura sobre preferencia manual y esquizofrenia. A pesar de la falta de datos definitivos, el mayor número de trabajos apuntan a que en la esquizofrenia existe una alteración del patrón normal de preferencia manual, con un incremento de los zurdos o nodiestros. Se describen las asociaciones entre preferencia manual y las distintas variables clínicas de la esquizofrenia. Al final, se discuten las implicaciones de estos estudios en la etiología biológica de la esquizofrenia. En cualquier caso, parece evidente la importancia de conocer esta variable en los pacientes esquizofrénicos, dentro del contexto de la práctica clínica y de la investigación básica (AU)

Preferencia motora y esquizofrenia (I) / Motor preferency and schizophrenia (I)

Este trabajo es la primera parte de una revisión crítica acerca de los diferentes estudios sobre la preferencia motora en la esquizofrenia. Se analizan y discuten los métodos de medición de la preferencia manual y las características muestrales de los trabajos (AU)

[Influence of behaviour, attitudes and childrearing on the development of the child in mothers with postpartum depression]. / Influencia de la conducta, las actitudes y el estilo de crianza sobre el desarrollo del niño en madres con depresión postparto.

INTRODUCTION: Various studies find an association between the postpartum depression and child development; nevertheless, it exists few uniformity in the method in which are accomplished these. The objective of this study is to analyze the influence of the postpartum depression on the development of the children during the first 28 months. Also, it is studied the childrearing of the mother, as possible mechanism for which exercises this influence. METHOD: Longitudinal and prospective study of 205 primiparous women and their children. The definitive sample understands 23 depressed women and 37 belonging to the group control that they are followed during the first 28 months postpartum. RESULTS: It is obtained a 13.5% from women with postpartum depression. The duration of the depression is related to a childrearing characterized by a under affection and care. The childrearing low in affection is associated negatively with the cognitive and social development of the son during the first year of life. The association of a greater duration of the depression with a childrearing low in affected during the first year has a negative affection on the cognitive development of the son to the 28 months. CONCLUSIONS: The mothers with postpartum depression accomplish a childrearing on their children characterized by a lower affection and care. The variable that more weigh develops on the development of the child during the period of study is the childrearing low in affection.

Trastorno depresivo de la personalidad / Depressive personality disorder

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Influencia de la conducta, las actitudes y el estilo de crianza sobre el desarrollo del niño en madres con depresión postparto / Influence of behaviour, attitudes and childrearing on the development of the child in mothers with postpartum depression

Introducción. Diversos estudios encuentran una asociación entre la depresión postparto y el desarrollo del niño; no obstante, existe poca uniformidad en el método en que se realizan éstos. El objetivo de este estudio es analizar la influencia de la depresión postparto sobre el desarrollo de los hijos durante los primeros 28 meses. Asimismo, se estudia el estilo de crianza de la madre como posible mecanismo por el que ejerce esta influencia. Método. Estudio longitudinal y prospectivo de 205 mujeres primíparas y sus hijos. La muestra definitiva comprende 23 mujeres deprimidas y 37 pertenecientes al grupo control que son seguidas durante los primeros 28 meses postparto. Resultados. Se obtiene un 13,5 por ciento de mujeres con depresión postparto. La duración de la depresión se relaciona con un estilo de crianza caracterizado por un bajo afecto y cuidado. El estilo de crianza bajo en afecto (EBA) se asocia negativamente con el desarrollo cognitivo y social del hijo durante el primer año de vida. La asociación de una mayor duración de la depresión junto a un EBA durante el primer año tiene un efecto negativo sobre el desarrollo cognitivo del hijo a los 28 meses. Conclusiones. Las madres con depresión postparto realizan una crianza sobre sus hijos caracterizada por un menor afecto y cuidado. La variable que más peso tiene sobre el desarrollo del niño durante el período de estudio es el EBA (AU)

[Neurophysiology and neuropsychology of recognition confabulation in hospitalized schizophrenic patients]. / Neuropsicología y neurofisiología de la confabulación de reconocimiento en pacientes esquizofrénicos hospitalizados.

Recognition confabulation was studied in 16 schizoprhenic patients and 16 normal controls. Half of the schizophrenics presented recognition confabulation, while the remaining 8 and 16 controls did not. This type of confabulation was associated to attentional deficiency, difficulties in perceptual follow-up and perceptive changes. These test satisfactorily discriminated confabulating schizoprhenics and both ill and healthy non-confabulating subjects. The possible mechanisms underlying this type of confabulation are discussed, in relation to the deficiences observed.

[Child rearing patterns in mothers with postpartum depression]. / Estilo de crianza en madres con depresión postparto.

INTRODUCTION: Postpartum Depression is a psychiatric syndrome with a prevalence of 10-15%. The studies show that depressive mothers have a "negative" relation with their children. METHOD: 205 primiparous women are analyzed, of them, we take a group of "cases" (23 depressive mothers) and a "control" group (37 women without psychiatric symptoms). Childrearing in the first postpartum year is analyzed. RESULTS: 13.5% of the studied women have a Postpartum Depression within the first six postpartum months. There aren't sociodemographics differences between both groups. Childrearing of depressive mothers is lower in affect and care than control mothers. CONCLUSIONS: Childrearing of depressive mothers in postpartum period is lower in Affect and Care than non depressive mothers in the same period.

[Preparation of a SCID-II-based diagnostic tool for personality disorders. Spanish version. Translation and adaptation]. / Elaboración de un instrumento para el diagnóstico de los trastornos de personalidad basado en el SCID-II: Versión española. Traducción y adaptación.

We carried out the translation and adaptation into Spanish of the original version of the SCID-II (Semistructured Clinical Interview for Diagnosis in Axis II according to DSM-III-R). In the questionnaire we modified the formulation of some items: the questions were changed into assertions and the answer scale was broadened into seven options. In the interview, questions and operative formulations which did not appear in the English version were created. Four trained psychiatrist interviewed in pairs a sample of 60 patients who has previously filled in the questionnaire. The reliability between interviewers oscilates between K = 0.37 for the Schizotypical Personality Disorder and K = 1 for the Avoidant Personality Disorder. The overall agreement (presence or absence of diagnosis) is K = 0.85. With the questionnaire we established 257 diagnoses whereas with the interview we diagnosed 35 cases.