Autores clásicos en psiquiatría: evaluación de un modelo de enseñanza de la psicopatología para residentes de psiquiatría / Classical authors in psychiatry: evaluation of a teaching model of psychopathology for psychiatry residents

Introducción: El aprendizaje de la psicopatología ha sido considerado una piedra angular en la formación de los residentes de psiquiatría. Objetivo: Evaluar el impacto de la enseñanza de un curso sobre autores clásicos de la psiquiatría y psicopatología en los residentes del programa de psiquiatría para determinar cambios en el nivel de conocimientos y valoración de la historia y fundamentos de la psicopatología. Método: Estudio de corte transversal pre post, con una encuesta anónima y voluntaria que se aplicó a todos los residentes con evaluación de las características socio demográficas, interés, utilidad y pertinencia de los contenidos, entre otros. Al inicio de cada seminario, evaluación de los conocimientos con una prueba escrita de desarrollo. Resultados: Participaron 24 residentes en total, 14 del programa adultos y 10 de infantojuvenil. La tasa de participación promedio fue de 87,5 por ciento. El 87,5 por ciento declaró tener conocimientos insuficientes o muy insuficientes. Entre las características de los residentes destacaron el interés por el deporte, la música y la literatura. Un 95,8 por ciento se proyecta como clínico y solo un 12,5 por ciento como docente. Al inicio del seminario solo hubo 29,16 por ciento de respuestas correctas en relación al origen y autor de los conceptos psicopatológicos revisados lo que aumentó a 65,4 por ciento al finalizar la serie de seminarios. Un 83 por ciento consideró los seminarios muy interesantes y el 75 por ciento muy útil para conocer la historia de la psiquiatría y mejorar su práctica clínica. Conclusión: La enseñanza de la psicopatología a partir de las descripciones clínicas de autores clásicos de la psiquiatría es altamente valorada por los residentes de psiquiatría en múltiples aspectos incluyendo el enriquecimiento de su práctica clínica.(AU)

Objective: To evaluate the impact of learning psychopathology in seminars, focusing on clinical cases described by classic psychiatry authors. Methods: A specially designed questionnaire was administered to 24 residents of the psychiatry program at the beginning and end of a series of 12 seminars analyzing the life, work and selected clinical cases of classic psychiatry authors including S. Freud, K. Kraepelin, E. Bleuler and K. Schneider. Data were collected included respondents characteristics, how interesting and useful the seminars were perceived to be and respondents' knowledge of classic psychiatry authors. Results: Respondents were interested in sports, music and literature; 95.8 percent regarded themselves as clinicians and 12.5 percent regarded themselves as teachers. The seminars were rated very interesting by 83.0 percent and very useful by 58.3 percent; they were considered to contribute to knowledge of the history of psychiatry, professional development and clinical practice. Most respondents (87.5 percent ) stated that their knowledge of classic authors was inadequate or very inadequate. At the beginning of the seminar series only 29.2 percent of responses about the origin and author of the psychopathological concepts covered in the seminars were correct; increasing to 65.4 percent by the end of the course. Conclusion: Teaching psychopathology through the study of classical cases is valued by residents for various reasons, including its potential to enrich clinical practice.(AU)

[High prevalence of thyroid dysfunction among psychiatric inpatients]. / Alta prevalencia de disfunción tiroidea en pacientes psiquiátricos hospitalizados.

BACKGROUND: Thyroid dysfunction is frecuent in psychiatric outpatients and in the general Chilean population but there is no information about the prevalence of thyroid diseases in Chilean psychiatric inpatients. AIM: To retrospectively assess the frequency of thyroidal diseases in psychiatric inpatients. MATERIAL AND METHODS: Clinical charts and thyroid assessment of 241 psychiatric inpatients (147 women, mean age 33+/-16 years) attended in a University Psychiatric Clinic, were reviewed. Psychiatric diagnosis at discharge was made according to DSM IV criteria and endocrine diagnosis was made based on international criteria. RESULTS: Forty nine patients (20.7%) had thyroid abnormalities. Forty four patients had hypothyroidism (18.3%) and five had hyperthyroidism (2.35%). No specific associations were found between gender or psychiatric diagnosis and endocrine abnormalities. CONCLUSIONS: In this sample, the prevalence of thyroid abnormalities was similar to other reports in psychiatric inpatiens and higher than in the general population in Chile.

Alta prevalencia de disfunción tiroidea en pacientes psiquiátricos hospitalizados / High prevalence of thyroid dysfunction among psychiatric inpatients

Background: Thyroid dysfunction is frecuent in psychiatric outpatients and in the general Chilean population but there is no information about the prevalence of thyroid diseases in Chilean psychiatric inpatients. Aim: To retrospectively assess the frequency of thyroidal diseases in psychiatric inpatients. Material and Methods: Clinical charts and thyroid assessment of 241 psychiatric inpatients (147 women, mean age 33±16 years) attended in a University Psychiatric Clinic, were reviewed. Psychiatric diagnosis at discharge was made according to DSM IV criteria and endocrine diagnosis was made based on international criteria. Results: Forty nine patients (20.7%) had thyroid abnormalities. Forty four patients had hypothyroidism (18.3%) and five had hyperthyroidism (2.35%). No specific associations were found between gender or psychiatric diagnosis and endocrine abnormalities. Conclusions: In this sample, the prevalence of thyroid abnormalities was similar to other reports in psychiatric inpatiens and higher than in the general population in Chile.

Trastornos del ánimo, psicofármacos y tiroides / Mood disorders, psychopharmacology and thyroid hormones

For more than 40 years thyroid hormones and mood disorders have been associated. Some psychiatric symptoms are produced by thyroid illnesses and there is a frequent association of thyroid dysfunction with mood disorders. Therefore, routine thyroid function assessment in patients with mood disorders and the treatment of sub-clinical thyroid dysfunctions is recommended. The usefulness of adding thyroid hormones to antidepressive treatment in euthyroid patients to obtain a potentiation effect has been probed repeatedly. The most common strategy is potentiation with T3, but high doses of T4 have been also used in patients with resistant depression. Thyroid hormones exert their action in the central nervous system through a variety of mechanisms: modulation of gene expression of several groups of proteins, some of them with known physiopathological implications in mood disorders and the influence over serotonin and noradrenergic neurotransmission, known to be one of the modes of action of antidepressants. Finally, it is also important to stress the complex relationship between psychiatric drugs, deiodinases and thyroid hormones, that can potentially help to understand the mechanisms of action of these drugs.

Estudio descriptivo de los episodios de fuga en el Hospital Psiquiátrico de Santiago / Descriptive study of the patients elopements in the Psychiatric Hospital in Santiago de Chile

Las fugas de pacientes desde Hospitales psiquiátricos son un hecho frecuente, y en la literatura se las ha vinculado a factores de la patología del paciente, conflictos con la familia, conflictos en las unidades de hospitalizción y dificultades en la relación terapeuta-paciente. Se presentan datos de 44 pacientes que realizan 61 fugas en un período de dos meses, y los resultados muestran que se trata de enfermos esquizofrénicos, jóvenes, con múltiples intentos previos de fuga. Se analizan factores desencadenantes, características de las fugas y las consecuencias de éstas, comparándolas con lo publicado en otros estudios. Se concluye que es un problema cuya alta incidencia obliga a incorporarlo activamente en el trabajo de los equipos de Sectores de Agudos del Hospital