Development of mental health first-aid guidelines for a person after a potentially traumatic event: A Delphi expert consensus study in Argentina and Chile.

BACKGROUND: Exposure to potentially traumatic events increases the risk of a person developing a mental disorder. Training community members to offer support to a person during and after a traumatic situation may help lower this risk. This study reports on the cultural adaptation of Australian mental health first aid guidelines for individuals exposed to a potentially traumatic event to the Chilean and Argentinian context. METHODS: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of trauma (either their own or as a carer; n = 26) and another one of health professionals (n = 41). A total of 158 items, drawn from guidelines developed by Australian experts in 2019, were translated to Spanish and evaluated in a two-round survey process. The panellists were asked to rate each item on a five-point Likert scale; statements were included in the final guidelines if 80% of both panels endorsed the item as "essential" or "important". RESULTS: Consensus was achieved on 142 statements over two survey rounds. A total of 102 statements were included from the English-language guidelines, and 40 locally generated statements were accepted in the second round. Local experts endorsed a larger number of items compared to their counterparts in Australia and emphasised the importance of acknowledging the first aider's limitations, both personally and as part of their helping role. Additional items about working as a team with other first responders and considering helping the person's significant others were endorsed by the local panellists. CONCLUSIONS: The study showed a high level of acceptance of the original actions suggested for inclusion in the guidelines for Australia, but also a significant number of new statements that highlight the importance of the adaptation process. Further research on the dissemination of these guidelines into a Mental Health First Aid training course for Chile and Argentina is still required.

Development of mental health first-aid guidelines for psychosis: a Delphi expert consensus study in Argentina and Chile.

BACKGROUND: Psychotic symptoms may be less common than anxiety or affective symptoms, but they are still frequent and typically highly debilitating. Community members can have a role in helping to identify, offer initial help and facilitate access to mental health services of individuals experiencing psychosis. Mental health first aid guidelines for helping a person experiencing psychosis have been developed for the global north. This study aimed to adapt the English- language guidelines for Chile and Argentina. METHODS: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of psychosis (either their own or as a carer; n = 29) and another one of health professionals (n = 29). Overall, 249 survey items from the original English guidelines and 26 items suggested by the local team formed a total of 275 that were evaluated in the first round. Participants were invited to rate how essential or important those statements were for Chile and Argentina, and encouraged to suggest new statements if necessary. These were presented in a second round. Items with 80% of endorsement by both panels were included in the guidelines for Chile and Argentina. RESULTS: Data were obtained over two survey rounds. Consensus was achieved on 244 statements, including 26 statements locally generated for the second round. Almost 20% of the English statements were not endorsed (n = 50), showing the applicability of the original guidelines but also the importance of culturally adapting them. Attributions and tasks expected to be delivered by first aiders were shrunk in favour of a greater involvement of mental health professionals. Self-help strategies were mostly not endorsed and as were items relating to respecting the person's autonomy. CONCLUSIONS: While panellists agreed that first aiders should be aware of human rights principles, items based on recovery principles were only partially endorsed. Further research on the dissemination of these guidelines and development of a Mental Health First Aid training course for Chile and Argentina is still required.

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile.

BACKGROUND: Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context. METHODS: A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as "essential" or "important" from both panels. RESULTS: Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts' reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs. CONCLUSIONS: A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.

Development of mental health first-aid guidelines for depression: a Delphi expert consensus study in Argentina and Chile.

BACKGROUND: Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. METHODS: A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. RESULTS: Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. CONCLUSIONS: The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.

Discrimination and social stigma against people with mental illnesses in Argentina.

BACKGROUND: Individuals with mental and neurological illnesses face stigma and discrimination every day. There are only a few studies regarding the degree of discrimination in the comparison between the illnesses, and no recent research has been found in Argentina about this topic. AIMS: The aim of this research is to study and compare stigma and discrimination toward people with mental illnesses (schizophrenia, substance use disorder, and bipolar disorder) and with neurological disorders (epilepsy) in Argentina, while analyzing the social distance toward them. The level of responsibility attributed to individuals with these disorders were also assessed and compared. METHOD: Individuals from Buenos Aires, Argentina, were surveyed in order to measure the social distance given to people with mental illnesses and a neurological disease. For that purpose a modified version of the Bogardus scale was used, with a sample of 500 individuals contacted online in January 2021. RESULTS: Social distance toward people with mental illnesses was higher than those with a neurological disorder (epilepsy). A significant difference was found in the level of responsibility attributed to people with substance use disorder in comparison to the other illnesses. On the contrary, there were no significant differences of discrimination according to age or sex. Finally, the research outcomes showed that people with substance use disorder are the most discriminated against and stigmatized. CONCLUSION: A significant level of discrimination was found against individuals with mental disorders and, specially, toward people with substance use disorder. Moreover, they are perceived as responsible for their disorder. For this reason, anti-stigma campaigns should be directed to end the misconceptions toward the most discriminated groups. More support is needed to counteract the stigmatization and exclusion of individuals with mental and neurological disorders in our society.

Development of mental health first aid guidelines for problem drinking: a Delphi expert consensus study in Argentina and Chile.

BACKGROUND: Among all psychoactive substances, alcohol consumption presents the most significant public health problem and is a leading risk factor for overall disease burden in Latin America. However, most people who meet criteria for a substance use disorder do not receive treatment in primary or secondary care sources. Community members can play a role in helping people to seek help as they are likely to encounter people experiencing problem drinking and recognize the signs. However, many do not have adequate mental health first aid knowledge or skills to provide help. We aimed to culturally adapt the existing English-language mental health first aid guidelines for helping someone with problem drinking for Argentina and Chile. METHODS: The Delphi consensus method was used to determine the importance of helping actions translated from the English-language guidelines and to add new actions suggested by expert panellists. The importance of each statement was rated by two expert panels. Panel one included people with lived experience (either their own or as a support person, n = 23) recruited in Argentina and panel two included health professionals (n = 31) recruited in Argentina and Chile. RESULTS: Overall, 165 helping actions were endorsed by panellists across two consecutive survey rounds. Endorsed items included 132 of the 182 items translated into Spanish from the English-language guidelines and 33 of the 61 new items generated from panellists' comments in the first survey round. CONCLUSIONS: While there were some similarities in recommended helping actions between English-speaking countries, and Argentina and Chile, key differences were seen in attitudes to low-risk drinking. While there was a relatively high level of agreement between health professionals and people with lived experience, some divergence of opinion was seen, particularly in the area of commitment to recovery as a condition for help. Future research should explore the implementation of the guidelines.

Differences in opinions and positions about psychiatric practice topics between undergraduate medical and psychology students / Diferencias de opiniones y posturas sobre temas de práctica psiquiátrica entre alumnos superiores de Medicina y de Psicología.

Introduction: Due to the prevalence of the model of interdisciplinary attention in mental health it is necessary to establish common views about therapeutic practices of the different disciplines that intervene in mental attention. Our objective was to determine if there are differences in opinions and positions with respect to psychiatric practice topics between undergraduate students of the last years of medicine and psychology. Methods: An ad hoc survey with different statements about psychiatric hospitalization, electroconvulsive therapy and psychotropics was done. One hundred eighteen medical students and 122 psychology students answered the online survey on February 2022. Results: One third of the opinions were statistically different between the students. Medical students had positions a little more positive towards electroconvulsive therapy and psychiatric hospitalization than psychology students. The prejudice towards psychiatric practices is important in both groups. Discussion and conclusionss: There are no important differences on the opinions of medical and psychology students. The prejudice and stigma towards mental health should be addressed since the first years of both carreers.

Introducción: Dada la prevalencia del modelo de atención interdisciplinaria en salud mental es necesario establecer miradas comunes en relación a prácticas terapéuticas de las distintas disciplinas que intervienen en la atención mental. Nuestro objetivo fue determinar si hay diferencias de opiniones y posturas en cuanto a temas de práctica psiquiátrica entre alumnos de Medicina y Psicología de años superiores. Métodos: Se realizó una encuesta ad hoc con distintas afirmaciones sobre la internación psiquiátrica, la terapia electroconvulsiva y los psicofármacos. Ciento dieciocho estudiantes de Medicina y 122 estudiantes de Psicología contestaron esta encuesta en forma online en febrero del año 2022. Resultados: Un tercio de las opiniones fueron significativamente distintas entre los alumnos. Los alumnos de Medicina tuvieron posturas un poco más positivas en relación a la terapia electroconvulsiva y a la internación psiquiátrica que los alumnos de Psicología. El prejuicio en relación a prácticas psiquiátricas es importante en ambos grupos. Discusión y conclusiones: No existen diferencias importantes entre las opiniones de los alumnos de Medicina y Psicología. El estigma y prejuicio sobre la salud mental debe ser abordado desde los primeros años de ambas carreras.

[Argentine consensus on the diagnosis and therapeutics of treatment resistant schizophrenia]. / Consenso argentino sobre diagnóstico y tratamiento de la esquizofrenia resistente al tratamiento.

Approximately 30% of people with schizophrenia fail to respond to first-line antipsychotic treatment which impacts the burden of the disease. Treatment-resistant schizophrenia (TRS) denotes patients with failure to respond to at least two adequate trials of different antipsychotics. Clozapine is a unique drug approved for treating treatment-resistant schizophrenia, however 1/3 of patients fail to respond to clozapine. Even though different strategies have been proposed for treating clozapine-resistant schizophrenia, the evidence is very limited, unclear, and of poor quality. A formal literature search was conducted and then, panel members were asked to complete 35 questions addressing different aspects of TRS. A modified Delphi method was used to unify expert opinion and achieve consensus. The expert consensus in diagnostic and treatment of TRS is the result of experts from the main national scientific societies under the organization of the Argentine Association of Biological Psychiatric (AAPB). The consensus statement aims to guide on diagnosis and treatment.

Psychotic experiences and psychiatric treatment utilization in Buenos Aires.

OBJECTIVE: Psychotic experiences are associated with psychiatric treatment utilization, though findings have not been entirely consistent. Furthermore, it is unclear how psychotic experiences relate to specific types of psychiatric treatment, and whether mental illness moderates these associations. METHODS: In total, 1,036 adult residents of Buenos Aires were recruited through convenience sampling in public places. Multivariable logistic regression models examined the associations between psychotic experiences and psychiatric treatment, adjusted for age, sex and education. Analyses were then stratified by diagnosis of mental illness. RESULTS: Approximately 17.95% (N = 186) of the sample reported at least one psychotic experience over the past week, about 22.39% (N = 232) of the sample was receiving some psychiatric or psychological treatment and 8.59% (N = 89) was receiving psychopharmacological treatment. In the total sample, psychotic experiences were associated with greater odds of being in psychiatric/psychological treatment (adjusted odds ratio (AOR): 1.52; 95% confidence interval (CI): 1.05-2.21) and psychopharmacological treatment (AOR: 2.49; 95% CI: 1.52-4.09), adjusted for age, sex and education. Mental illness did not moderate the association between psychotic experiences and psychiatric/psychological treatment, but did moderate the association between psychotic experiences and psychopharmacological treatment. Among people with mental disorders, psychotic experiences were associated with greater odds of receiving psychopharmacological treatment (AOR: 14.63; 95% CI: 1.73-123.45) versus people without mental disorders (AOR: 1.75; 95% CI: 0.98-3.15). CONCLUSION: Psychotic experiences are associated with psychiatric treatment utilization, particularly psychopharmacological treatment among people with a co-occurring mental illnesses. Translational research should explore the utility of psychosis screens in assessing need for medication or clinical responsiveness to medications.

[Psychotherapeutic treatment in the city of Buenos Aires. Prevalence and characteristics. comparison with the study of the year 2007]. / Tratamiento psicoterapéutico en la ciudad de Buenos Aires. Prevalencia y características. Comparación con el estudio del año 2007.

INTRODUCTION: In the last few years, use of psychotherapy has been studied in both our country and other parts of the world. The aim of our study was to determine the current prevalence of psychotherapy use, its characteristics and to compare it with the study done in 2007. METHOD: A survey was conducted among 1348 inhabitants over 18 years of age in the city of Buenos Aires between April and May 2019 and it was compared with the study done in the year 2007. RESULTS: During the month prior to the survey, 19.9% of the sample received psychotherapy treatment. Psychotherapy treatment is more prevalent among women, middle-aged people and individuals with a higher educational level. Half of the treatments were psychoanalytic and the majority of them were individual and with a private funding source. Only one out of 5 had signed an informed consent before starting the treatment, and only one in 4 had been informed about other treatment options. In comparison with the previous survey, in which the prevalence of psychotherapeutic treatment in the last month was of 15,6%, in this survey a greater percentage of individuals had psychotherapy, although with a lower frequency and mainly with private funding. CONCLUSIONS: The prevalence of psychotherapy in the city of Buenos Aires is high and has increased in the last decade.

[Psychotropic medication consumption in the general population of Buenos Aires City, Argentina. Comparison 2005-2017]. / Consumo de psicofármacos en la población general de la ciudad de Buenos Aires, Argentina. Comparación 2005-2017.

OBJECTIVE: The purpose of this study was to estimate the prevalence of psychotropic use among inhabitants of Buenos Aires city and to compare it with the study done in 2005. METHODS: A survey was conducted among 899 inhabitants of different districts of Buenos Aires city between September and October 2017 with a modified survey used in 2005. RESULTS: At the time of the survey, 22,4% of the general population of Buenos Aires city used some kind of psychotropic medication. There were significant consumption differences by age and level of income but not by educational level. There were no sex differences in present consumption but there were in life time use of psychotropics. Almost the third part of the consumers use them without medical advice. There is a significative increase in present consumption compared with the one 12 years ago (p <0.001). DISCUSSION: The use of psychotropics is highly widespread among the population of Buenos Aires city and has continued increasing. The understanding of the causes of this increase will allow to implement measures for an adequate medical control and to prevent the irrational use of these medications.

[Schizophrenia: Recent data, future perspectives]. / Esquizofrenia: datos recientes, perspectivas futuras.

Schizophrenia is one of the most incapacitating mental disorders. During the last years, new findings have been done in the physiopathology of the disorder such as the influence of inflammation, glial changes, neural oscillations and alterations in the gabaergic interneurons. Furthermore, new conceptualizations have led to research of new therapeutics both biological and psychotherapeutic. The perspectives of the diagnostic refinement and the new therapeutics allow us to be optimistic and imagine the possibility in the future when individuals with schizophrenia could fully integrate to the society.

[Prescription patterns in the treatment of schizophrenia]. / Hábitos prescriptivos en el tratamiento de la esquizofrenia.

OBJECTIVE: The aim of this study was to determine prescribing patterns for the pharmacological treatment of schizophrenia in a sample of Argentinean psychiatrists and to compare some results with those obtained in a previous survey done on a similar population. METHODS: A self-administered survey was conducted among psychiatrists who attended a conference of psychopharmacology held in August 2012 in Buenos Aires city. Answers were analyzed descriptively and some of them were compared with results of another survey done in 2006 in a psychiatry conference. RESULTS: Ninety six percent of the surveyed psychiatrists considered that every schizophrenic patient with an acute episode must be pharmacologically treated. For the acute and chronic treatment of positive symptoms most psychiatrists chose risperidone, haloperidol, olanzapine and quetiapine. In contrast, for the chronic treatment of negative symptomatology, physicians preferred risperidone, aripiprazole, olanzapine, quetiapine and clozapine. An increased choice of quetiapine and aripiprazole was observed between this survey and the previous one. Sixty four percent of respondents reported using antipsychotic combination, similar as assessed in the previous survey. Most preferred to maintain pharmacological treatment during the pregnancy, although changing the antipsychotic to haloperidol. Ninety eight percent stated that they use some kind of psychotherapy in the treatment. CONCLUSION: In the pharmacological treatment of schizophrenia, similarities between reported clinical practice and current treatment guidelines were observed. There were no significant differences in the prescription patterns referred by psychiatrists between 2006 and 2012.

[PRESCRIPTION PATTERNS IN THE TREATMENT OF SCHIZOPHRENIA]. / Hábitos prescriptivos en el tratamiento de la esquizofrenia.

OBJECTIVE: The aim of this study was to determine prescribing patterns for the pharmacological treatment of schizophrenia in a sample of Argentinean psychiatrists and to compare some results with those obtained in a previous survey done on a similar population. METHODS: A self-administered survey was conducted among psychiatrists who attended a conference of psychopharmacology held in August 2012 in Buenos Aires city. Answers were analyzed descriptively and some of them were compared with results of another survey done in 2006 in a psychiatry conference. RESULTS: Ninety six percent of the surveyed psychiatrists considered that every schizophrenic patient with an acute episode must be pharmacologically treated. For the acute and chronic treatment of positive symptoms most psychiatrists chose risperidone, haloperidol, olanzapine and quetiapine. In contrast, for the chronic treatment of negative symptomatology, physicians preferred risperidone, aripiprazole, olanzapine, quetiapine and clozapine. An increased choice of quetiapine and aripiprazole was observed between this survey and the previous one. Sixty four percent of respondents reported using antipsychotic combination, similar as assessed in the previous survey. Most preferred to maintain pharmacological treatment during the pregnancy, although changing the antipsychotic to haloperidol. Ninety eight percent stated that they use some kind of psychotherapy in the treatment. CONCLUSION: In the pharmacological treatment of schizophrenia, similarities between reported clinical practice and current treatment guidelines were observed. There were no significant differences in the prescription patterns referred by psychiatrists between 2006 and 2012.

[Attitudes of mental health workers toward people with schizophrenia]. / Actitudes de los profesionales de la Salud Mental hacia las personas con esquizofrenia.

OBJECTIVE: Stigma is a social and universal phenomenon which constitutes the core of various social barriers. Stigmatizing attitudes of mental health workers influence the outcome of patients and affect their recovery. Our purpose was to determine some attitudes and social distance of mental health workers toward people with schizophrenia. METHODS: 517 mental health workers were surveyed at two national conferences in Argentina. RESULTS: More than 90% believed that patients have the right to know their diagnosis, but only 64% informed it. Psychiatrists and men professionals were more likely to inform the diagnosis. Eighteen per cent thought that the voting right of people with schizophrenia should be revoked, 13% believed that this group should not have children and 63.7% thought that they should not be mental health professionals. Only 10% believed that people with schizophrenia can recover completely. There was a statistical difference in the social distance according to health workers' gender, years of experience and the percentage of patients assisted. CONCLUSIONS: There exist social distance and stigmatizing attitudes toward people with schizophrenia among mental health workers. The contact could help to reduce social distance. Anti-stigmatizing education programs should be directed toward mental health workers since their initial training.

Actitudes de los profesionales de la Salud Mental hacia las personas con esquizofrenia. / [Attitudes of mental health workers toward people with schizophrenia].

OBJECTIVE: Stigma is a social and universal phenomenon which constitutes the core of various social barriers. Stigmatizing attitudes of mental health workers influence the outcome of patients and affect their recovery. Our purpose was to determine some attitudes and social distance of mental health workers toward people with schizophrenia. METHODS: 517 mental health workers were surveyed at two national conferences in Argentina. RESULTS: More than 90

believed that patients have the right to know their diagnosis, but only 64

informed it. Psychiatrists and men professionals were more likely to inform the diagnosis. Eighteen per cent thought that the voting right of people with schizophrenia should be revoked, 13

believed that this group should not have children and 63.7

thought that they should not be mental health professionals. Only 10

believed that people with schizophrenia can recover completely. There was a statistical difference in the social distance according to health workers gender, years of experience and the percentage of patients assisted. CONCLUSIONS: There exist social distance and stigmatizing attitudes toward people with schizophrenia among mental health workers. The contact could help to reduce social distance. Anti-stigmatizing education programs should be directed toward mental health workers since their initial training.

Actitudes de los profesionales de la Salud Mental hacia las personas con esquizofrenia / [Attitudes of mental health workers toward people with schizophrenia].

OBJECTIVE: Stigma is a social and universal phenomenon which constitutes the core of various social barriers. Stigmatizing attitudes of mental health workers influence the outcome of patients and affect their recovery. Our purpose was to determine some attitudes and social distance of mental health workers toward people with schizophrenia. METHODS: 517 mental health workers were surveyed at two national conferences in Argentina. RESULTS: More than 90

believed that patients have the right to know their diagnosis, but only 64

informed it. Psychiatrists and men professionals were more likely to inform the diagnosis. Eighteen per cent thought that the voting right of people with schizophrenia should be revoked, 13

believed that this group should not have children and 63.7

believed that people with schizophrenia can recover completely. There was a statistical difference in the social distance according to health workers’ gender, years of experience and the percentage of patients assisted. CONCLUSIONS: There exist social distance and stigmatizing attitudes toward people with schizophrenia among mental health workers. The contact could help to reduce social distance. Anti-stigmatizing education programs should be directed toward mental health workers since their initial training.

Depression: point-prevalence and sociodemographic correlates in a Buenos Aires community sample.

BACKGROUND: Since the current epidemiology of depression is not well documented in Latin America, we conducted a community-based survey study in Argentina. METHODS: The Beck Depression Inventory (BDI) and a general health questionnaire were completed by 1335 adult participants, representing most of the neighborhoods of Buenos Aires. RESULTS: Prevalence of high total BDI scores (≥13) indicating probable current clinically significant depression was 20.0% (women: 20.6%; men: 19.6%). Probable depression was associated with being unmarried and older, less educated, reporting recent stressors and significant medical illness. LIMITATIONS: Sampling was cross-sectional and by convenience; probable depression was not verified by clinical assessment. CONCLUSIONS: Within methodological limits, probable current clinically significant depression was highly prevalent in an urban community sample in Argentina, at rates and with risk factors similar to those found in other world regions.

[Recent advances in the comprehension and understanding of schizophrenia]. / Ultimos avances en la comprensión y entendimiento de la esquizofrenia.

In this article we explore the changes that the concept of schizophrenia has undergone in the last century, its difficulties, discoveries of the last 20 years and the future way for the study of this illness. Nowadays it is known that schizophrenia is not one morbid entity and is heterogeneous in its clinic and outcome. It has been demonstrated that cognitive deficits make up the core of this illness and determine the functionality of the patient. Some of the neurobiological disturbances and models are revised as well as the psychopharmacological and psychosocial treatments that have been proved to be more effective for this illness. A paradigmatic shift in psychiatric nosography will grant more possibilities for a true comprehension of this disease.