Non-binary gender, vulnerable populations and mental health during the COVID-19 pandemic: Data from the COVID-19 MEntal health inTernational for the general population (COMET-G) study.

BACKGROUND: The COVID-19 pandemic has brought significant mental health challenges, particularly for vulnerable populations, including non-binary gender individuals. The COMET international study aimed to investigate specific risk factors for clinical depression or distress during the pandemic, also in these special populations. METHODS: Chi-square tests were used for initial screening to select only those variables which would show an initial significance. Risk Ratios (RR) were calculated, and a Multiple Backward Stepwise Linear Regression Analysis (MBSLRA) was followed with those variables given significant results at screening and with the presence of distress or depression or the lack of both of them. RESULTS: The most important risk factors for depression were female (RR = 1.59-5.49) and non-binary gender (RR = 1.56-7.41), unemployment (RR = 1.41-6.57), not working during lockdowns (RR = 1.43-5.79), bad general health (RR = 2.74-9.98), chronic somatic disorder (RR = 1.22-5.57), history of mental disorders (depression RR = 2.31-9.47; suicide attempt RR = 2.33-9.75; psychosis RR = 2.14-10.08; Bipolar disorder RR = 2.75-12.86), smoking status (RR = 1.15-5.31) and substance use (RR = 1.77-8.01). The risk factors for distress or depression that survived MBSLRA were younger age, being widowed, living alone, bad general health, being a carer, chronic somatic disorder, not working during lockdowns, being single, self-reported history of depression, bipolar disorder, self-harm, suicide attempts and of other mental disorders, smoking, alcohol, and substance use. CONCLUSIONS: Targeted preventive interventions are crucial to safeguard the mental health of vulnerable groups, emphasizing the importance of diverse samples in future research. LIMITATIONS: Online data collection may have resulted in the underrepresentation of certain population groups.

Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study).

BACKGROUND: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Assessing essential service provision for prevention and management of violence against women in a remote indigenous community in Amantaní, Peru.

BACKGROUND: Women living in indigenous communities in Peru currently experience extremely high rates of intimate partner violence (IPV). Over the past 10 years, there has been a large multi-sectoral initiative to establish a national network of Centros de Emergencia de la Mujer (Women's Emergency Centres) that integrate health and police services, and substantial increase in efforts from non-governmental organisations in supporting survivors of violence. However, there is currently little evidence on how existing services meet the needs of indigenous women experiencing violence in Peru. METHODS: As part of a broader mixed-methods participatory VAWG prevention study, we assessed existing service provision for women experiencing violence in an indigenous Quechua community from Amantaní, Peru. This involved 17 key informant interviews with legal, government, police, and civil society representatives. We used the UN Women Essential Services Package for Women and Girls Subject to Violence framework to guide our analysis. RESULTS: Participants identified major gaps in existing services for indigenous women survivors of violence in Peru. They discussed survivors and perpetrators not being identified by the health system, a lack of IPV response training for health professionals, IPV not being prioritised as a health concern, and a lack of health services that are culturally appropriate for indigenous populations. Survivors who report to police are often treated poorly and discriminated against. Legal systems were perceived as insufficient and ineffective, with inadequate legal measures for perpetrators. While legal and policy frameworks exist, they are often not applied in practice. Service provision in this region needs to adopt an intercultural, rights based, gendered approach to IPV response and prevention, considering cultural and linguistic relevance for indigenous populations. CONCLUSION: The role of structural violence in perpetuating indigenous women's experiences of violence and undermining their access to services must be central to designing and implementing appropriate policies and services if they are to meet the needs of indigenous women in Peru.

Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism.

INTRODUCTION: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak. MATERIALS AND METHODS: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23). CONCLUSIONS: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic: Data from the international COMET-G study.

INTRODUCTION: During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question. MATERIAL AND METHODS: During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis RESULTS: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small. CONCLUSIONS: The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health. Our findings, support previous suggestions concerning the need for a proactive targeted intervention to protect mental health more specifically in vulnerable groups.

Results of the COVID-19 mental health international for the general population (COMET-G) study.

INTRODUCTION: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. MATERIAL AND METHODS: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. CONCLUSIONS: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

Trastorno por déficit de atención con hiperactividad (TDAH) en niños y adolescentes. Una revisión clínica / Attention Deficit and Hyperactivity Disorder in children and adolescents. A clinical review

Resumen El trastorno por déficit de atención con hiperactividad (TDAH) es una alteración del neurodesarrollo, cuyos síntomas principales son inatención, hiperactividad e impulsividad. El TDAH se ha asociado a un modelo de heterogeneidad fisiopatológica, en el que se encuentran afectadas, entre otras, las funciones ejecutivas, implicando significativas dificultades para responder a determinados estímulos, planificar y organizar acciones, reflexionar sobre posibles consecuencias e inhibir una respuesta automática inicial a fin de sustituirla por una más apropiada. El TDAH abarca hasta un 50% de las consultas en psiquiatría infantil y su prevalencia se ha estimado entre un 2 a 12% de la población pediátrica; es de origen multifactorial y en el 70% de casos, puede coexistir con otros trastornos psiquiátricos y neurológicos. El diagnóstico es básicamente clínico y requiere, idealmente, de un examen cuidadoso, así como de entrevistas exhaustivas a los padres o cuidadores y profesores además de la entrevista al niño(a) o adolescente en la medida de lo posible. Todo niño(a) o adolescente con TDAH debe tener un plan integral de tratamiento individualizado, que considere la potencial cronicidad y el impacto del cuadro, involucrando manejo psicofarmacológico y/o enfoques terapéuticos conductuales para mejorar las manifestaciones centrales de esta condición y un posible deterioro funcional asociado.

Summary Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition whose main symptoms are inattention, hyperactivity, and impulsivity. ADHD has been associated with a model of pathophysiological heterogeneity, in which, among others, executive functions are mostly affected, generating significant difficulties in responding to certain stimuli, planning and organizing a variety of actions, reflecting on possible consequences, and inhibiting the first, initial automatic response to substitute it with a more appropriate one. ADHD accounts for up to 50% of consultations in child psychiatry, and its prevalence has been estimated between 2% and 12% of the pediatric population. It is multifactorial in origin and, in 70% of the cases, it can coexist with other psychiatric and neurological disorders. The diagnosis is basically clinical and requires, ideally, a careful medical examination as well as exhaustive interviews with parents or caregivers and teachers, as well as, the interview of the child or adolescent whenever possible. Every child or adolescent with ADHD should have a comprehensive, individualized treatment plan that considers the chronicity and impact of the condition, and involves psychopharmacological and/or therapeutic behavioral measures to improve the central manifestations of ADHD and a possible associated functional decline.

La cura de sueño en la historia / Sleep therapy in history

Resumen A finales del siglo XIX comenzaron a utilizarse sustancias tales como los bromuros para inducir sueño profundo en personas con trastornos mentales. El uso de barbitúricos con el mismo fin fue reportado por Epifanio en 1913, pero fue Kläsi quien difundió con más éxito la administración de aquellos medicamentos, particularmente el Somnifen, y la denominó "cura de sueño prolongado" o "narcosis prolongada" (dauernarkose), a partir de la década de 1920. En 1934 se introdujo el Cloettal, una mezcla de barbitúricos y otros compuestos, en reemplazo del Somnifen. El uso de este procedimiento declinó con la aparición de otros métodos terapéuticos, pero continuó por varias décadas. En la Unión Soviética, la cura de sueño estuvo influida por la doctrina pavloviana, y se usó tanto para trastornos mentales como para padecimientos considerados psicosomáticos. El mayor desprestigio del método se dio en el Hospital de Chelmsford, en Australia, donde se reportaron 25 muertes asociadas a su uso durante el periodo 1963-1979. En el 2009, el Colegio Real de Psiquiatras de Australia y Nueva Zelanda concluyó que "la terapia de sueño profundo y la administración de barbitúricos endovenosos no tiene lugar en el tratamiento de trastornos psiquiátricos". Aun cuando en la actualidad no forma parte de ningún tratamiento convencional, la cura de sueño sigue siendo ofrecida y solicitada.

Summary At the end of the 19th century, substances such as bromides began to be used to induce deep sleep in people with mental disorders. The use of barbiturates for the same purpose was reported by Epifanio in 1913, but it was Kläsi, in the early 1920s, who most successfully fostered the administration of such agents, particularly Somnifen, for what he called "sleep cure" or "prolonged narcosis" (dauernarkose). In 1934 Cloettal, a mixture of barbiturates and other compounds, was introduced to replace Somnifen. The use of this procedure declined with the appearance of other therapeutic methods, but continued for several decades. In the Soviet Union, sleep cure was influenced by the Pavlovian doctrine, and used for both mental disorders and conditions considered as psychosomatic. The method's greatest discredit occurred at Chelmsford Hospital in Australia, where 25 deaths associated with its use were reported during the period 1963-1979. In 2009, the Royal College of Psychiatrists of Australia and New Zealand concluded that "deep sleep therapy and the administration of intravenous barbiturates has no place in the treatment of psychiatric disorders". Even though, currently it is not part of any conventional treatment, sleep cure is still offered and requested.

Health need assessment in an indigenous high-altitude population living on an island in Lake Titicaca, Perú.

BACKGROUND: Health needs and access to health care is a huge challenge in developing countries, especially in some isolated indigenous communities. Amantani is an island located at 3854 m above sea level in Lake Titicaca, Peru. There is no official date on key local health needs and determinants, which precludes the prioritization and efficient implementation of health interventions. The objective of this study is to validate a health need assessment tool and ascertain the main health needs of the indigenous high-altitude population living on Amantani. METHODS: We conducted a cross-sectional study to describe the health needs of the indigenous population of Amantani using a questionnaire based on the "Peruvian Demographic and Health Survey". The questionnaire underwent expert and field-work validation. We selected a random sample of the island residents using two-stage cluster sampling. We estimated the prevalence of key health needs and determinants, and evaluated their distribution by age, sex and education through prevalence ratio. All analyses accounted for the complex sampling design. RESULTS: We surveyed 337 individuals (223 adults and 144 children) in 151 houses. The most frequent health needs were: (i) lack of access to medical screening for a)non-communicable diseases (> 63.0%) and b)eye problems (76.5%); and (ii) poor knowledge about communicable diseases (> 54.3%), cancer (71.4%) and contraception (> 32.9%). Smoking and alcohol use was more frequent in males (PR = 4.70 IC95%:1.41-15.63 and PR = 1.69 95% CI:1.27-2.25, respectively). People with higher education had more knowledge about TB/HIV and cancer prevention (p < 0.05). Regarding children's health, > 38% have never undergone eye or dental examination. Corporal punishment and physical bullying at school in the last month were relatively common (23 and 33%, respectively). CONCLUSION: The main health needs in Amantani are related to poor healthcare access and lack of awareness of disease prevention. Our findings can be used to develop and implement efficient health interventions to improve the health and quality of life of indigenous populations living in the islands in Southern Peru/Northern Bolivia.

[Clinical characteristics of patients treated with electroconvulsive therapy in a public hospital in Peru]. / Características clínicas de pacientes tratados con terapia electroconvulsiva en un hospital público de Perú.

With the purpose of describe the profile of use of electroconvulsive therapy (ECT) on hospitalized patients at "Honorio Delgado - Hideyo Noguchi" National Institute of Mental Health in Lima, Peru, the medical records of patients receiving ECT between 2001 and 2011 were reviewed. The main findings were: four hundred and nineteen ECT courses were applied to 372 patients, with a total of 5439 applications the most common diagnosis was paranoid schizophrenia (70.7%), the most common indication was resistance to treatment (80.7%), also the clinical response to ECT was good in 70.1% of cases while side effects were generally transient and mild. The use of ECT decreased over the period of the study but it was tolerable and safe, especially in the modified version, and it had a high response rate so remains as a first-line psychiatric treatment.

Características clínicas de pacientes tratados con terapia electroconvulsiva en un hospital público de Perú / Clinical characteristics of patients treated with electroconvulsive therapy in a public hospital in Peru

Con el objetivo de describir el perfil de uso de la terapia electroconvulsiva (TEC) en pacientes hospitalizados en el Instituto Nacional de Salud Mental "Honorio Delgado - Hideyo Noguchiõ de Lima, Perú, se revisaron las historias clínicas de pacientes que recibieron TEC entre los años 2001 y 2011. Se aplicaron 419 cursos de TEC a 372 pacientes, con un total de 5439 aplicaciones; la esquizofrenia paranoide fue el diagnóstico más frecuente (70,7%), y la indicación más usual fue la resistencia al tratamiento (80,7%); asimismo, la respuesta clínica a la TEC fue buena en 70,1% de casos, mientras que los efectos secundarios, en general, fueron pasajeros y leves. El uso de TEC disminuyó a lo largo del periodo estudiado, pero fue muy tolerable y segura, especialmente en su versión modificada, y mostró una alta respuesta que la mantiene como un tratamiento psiquiátrico de primera línea...

With the purpose of describe the profile of use of electroconvulsive therapy (ECT) on hospitalized patients at ôHonorio Delgado - Hideyo Noguchiõ National Institute of Mental Health in Lima, Peru, the medical records of patients receiving ECT between 2001 and 2011 were reviewed. The main findings were: four hundred and nineteen ECT courses were applied to 372 patients, with a total of 5439 applications the most common diagnosis was paranoid schizophrenia (70.7%), the most common indication was resistance to treatment (80.7%), also the clinical response to ECT was good in 70.1% of cases while side effects were generally transient and mild. The use of ECT decreased over the period of the study but it was tolerable and safe, especially in the modified version, and it had a high response rate so remains as a first-line psychiatric treatment...

Severe Burns and Amputation of Both Arms in the First Psychotic Episode of a Schizophrenic Patient.

An alleged reduction of sensitivity to pain in people with schizophrenia has been reported, but the nature of this complex phenomenon has not been elucidated yet. Reports of insensitivity to burns from people with schizophrenia are extremely rare. We report the case of a 24-year-old man who set both of his arms on fire during the first break of paranoid schizophrenia. As a result of severe tissue damage, both of his limbs had to be amputated. Today, at the age of 59, the patient is physically and mentally rehabilitated and is adherent to treatment. Additionally, given the uncertainty about the true nature of the alleged hypoalgesia in schizophrenia, we postulate the need for a comprehensive phenomenological approach in the study of embodiment in people with this condition.

Manía inducida por bebidas energéticas con alto contenido de cafeína / Mania induced by high content caffeinated energy drinks

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Trastorno depresivo y otros problemas de salud mental en hijos adolescentes de madres con depresión en la costa peruana en el año 2006 / Depressive disorder and other mental health problems in adolescent children of mothers with depression in the Peruvian coast in 2006

La depresión materna es un factor de riesgo para el desarrollo de problemas emocionales y/o conductuales en los hijos que dificultan su adaptación a situaciones cambiantes del entorno. Se ha descrito una asociación entre depresión materna y trastornos psiquiátricos durante la adolescencia y posiblemente, con una mayor severidad de los cuadros depresivos en adolescentes. Objetivo: Estimar la relación entre la presencia de trastornos depresivos en madres y problemas de salud mental en sus hijos adolescentes (trastornos depresivos y de ansiedad y consumo de sustancias psicoactivas) en cinco ciudades de la costa peruana en el 2006. Metodología: El estudio fue descriptivo y de corte transversal. Se utilizaron los datos obtenidos a partir de la Entrevista Neuropsiquiátrica Internacional (MINI) y del Cuestionario de Salud Mental (CSM) aplicados a una muestra comprendida por díadas de adolescentes y madres que participaron del Estudio Epidemiológico de Salud Mental en la Costa Peruana (EESMCP)-2006, ejecutado por el Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi" (INSM "HD-HN"). Procedimientos y análisis de datos: Se realizó un emparejamiento madre-hijo. Los datos obtenidos fueron procesados y analizados mediante análisis estadístico descriptivo; se estimaron prevalencias, se relacionaron las variables clínicas y se realizó un análisis de regresión logística para controlar el efecto de variables intervinientes. Resultados: Se encontró una asociación significativa entre la presencia de trastorno depresivo en la madre y trastorno depresivo (OR 1.92 IC 1.1-3.5) e intento de suicidio en el adolescente (OR 2.93, IC 1.11-7.78). No se observó asociación significativa entre el trastorno depresivo en la madre y los trastornos de ansiedad y de consumo de sustancias psicoactivas en el adolescente, tampoco a un inicio más temprano del consumo de alcohol. Al controlar edad, sexo y nivel de pobreza si se encontró asociación significativa con consumo de tabaco...

Maternal depression is a risk factor for the development of emotional, behavioral problems or both in children and inhibits adaptation to changing environmental situations. An association between maternal depression and psychiatric disorders during adolescence, and possibly with greater severity of depressive symptoms in adolescents has been described. Objective: To estimate the relationship between the presence of depressive disorders in mothers and mental health problems in their teenage children (anxiety disorders, depressive disorders and substance use) in five cities of the Peruvian coast during 2006. Methods: The study was descriptive and cross-sectional. Data obtained from the International Neuropsychiatric Interview (MINI) and the Mental Health Questionnaire (CSM) that were applied to a sample of dyads of adolescents and their mothers, was used. Both groups participated in the Epidemiologic Study of Mental Health in the Peruvian Coast (EESMCP), 2006 executed by the National Institute of Mental Health from Peru "Honorio Delgado-Hideyo Noguchi" (NIMH-"HD-HN"). Data analysis: A mother-son pairing was performed. The data obtained was processed and analyzed using descriptive statistical analysis; prevalence estimates and clinical variables were related. Logistic regression analysis was also performed to control the effect of intervening variables. Results: A significant association between the presence of depressive disorder in the mother and depressive disorder (OR 1.92 IC 1.1-3.5) and attempted suicide in adolescents was found (OR 2.93, IC 1.11-7.78). No significant association between maternal depressive disorder and anxiety disorders and substance use in adolescents, was observed, neither an earlier onset of alcohol use in adolescents. By controlling age, gender and poverty level a significant association with consumption of tobacco was found. Conclusions: It is necessary to establish appropriate strategies for early diagnosis and treatment of...

Forma de crianza recibida por el agresor y su asociación con violencia hacia la pareja en tres ciudades de la selva peruana en el año 2004 / Parental rearing styles received by the aggressor and its association to intimate partner violence in three cities from Peruvian jungle in 2004

Objetivos: Identificar las formas de crianza recibidas por el varón agresor asociadas con la violencia contra la pareja (VCP) en tres ciudades de la selva peruana. Métodos: Estudio descriptivo de corte transversal usando la información del estudio epidemiológico de salud mental en la Selva Peruana del 2004 realizado en las ciudades de Iquitos, Pucallpa y Tarapoto. La información de las mujeres, de las parejas participantes (N=940), permitió identificar a los agresores y los tipos de VCP; en los hombres se analizaron algunas formas de crianza recibidas. Se realizó el análisis bivariado y multivariado utilizando regresión logística. Resultados: La crianza en que se favoreció excesivamente al varón cuando era niño como cuando se le engrió más que a sus hermanos se asoció con la violencia sexual (OR: 1,88; I.C 1,02 û 3,46) y el permitirles hacer cosas que a sus hermanos no, se asoció con la violencia física (OR: 1,93; I.C 1,11 û 3,37) y psicológica (OR: 1,9; I.C 1,12 û 3,2). Castigar severamente por cosas pequeñas se asoció con la violencia por abandono (OR: 1.71; I.C 1,02û 2,88). Conclusiones: Las formas de crianza en las que se favoreció excesivamente al agresor cuando niño, se asociaron con varios tipos de violencia. Se necesitan más estudios para identificar el rol del castigo en la VCP.

Objectives: To identify ways of parenting received by the male aggressor associated with intimate partner violence(IPV) in three cities of the Peruvian jungle. Methods: A cross sectional study using information from theEpidemiological Study of Mental Health in the Peruvian jungle in 2004 held in the cities of Iquitos, Pucallpa andTarapoto. WomenÆs information, from participating couples (N = 940) allowed the identification of the aggressorand types of IPV. We also discussed some forms of parenting received by men. We performed bivariate andmultivariate analysis using logistic regression to look for associations. Results: Parental rearing in which thesubject was treated more leniently than his siblings was associated with sexual violence (OR: 1.88, CI 1.02 - 3.46); when the subject was allowed to do things that his siblings were not allowed, was associated with physical (OR:1.93, CI 1.11 - 3.37) and psychological violence (OR: 1.9, CI 1.12 - 3.2). Being severely punished for insignificantthings was associated with neglect (OR: 1.71, CI: 1.02 - 2.88). Conclusions: Forms of parenting characterized byexcessive favoritism were associated with various types of violence against the intimate partner. Further studies areneeded to identify the role of punishment as child within violence against the intimate partner.

Delusiones de cambio de sexo, transexualismo y esquizofrenia: a propósito de un caso / Delusions of sexual change, transsexualism and schizophrenia: apropos of a case

Una importante proporción de personas con esquizofrenia experimenta delusiones de contenido sexual en algún momento del curso de su enfermedad; incluso, algunos pacientes pueden llegar a la convicción de que pertenecen a un sexo distinto del que poseen. Esto puede llevar a un diagnóstico inapropiado de transexualismo y eventualmente a procedimientos hormonales o quirúrgicos innecesarios. A partir del caso de una paciente con esquizofrenia y delusión de cambio de sexo revisamos la literatura pertinente en donde se evidencia la rareza de una real comorbilidad entre transexualismo y esquizofrenia aunque permanece pendiente profundizar en la compleja situación de la sexualidad de nuestros pacientes con esquizofrenia.

A significant number of people with schizophrenia experiences delusions of sexual content at some point in the course of their disease; moreover, some patients may be convinced that they belong to a different sex from their own. This can lead to inappropriate diagnosis of transsexualism and eventually unnecessary hormonal or surgical procedures. Taking the case of a patient with schizophrenia and delusion sex change as a starting point, we review and discuss relevant literature, where we find a real rarity of comorbidity between transsexualism and schizophrenia. However, the complex situation of the sexuality of our patients with schizophrenia remains pending of further study.

Encuesta a médicos residentes de psiquiatría sobre la calidad de su formación como especialistas / A survey of Psychiatry residents about the quality of their training as specialists

El psiquiatra en formación debe cumplir estándares que le permitan desarrollar con éxito su labor profesional. Los programas de posgrado de psiquiatría deberían evaluar constantemente la formación de los residentes para asegurar que alcancen su máximo potencial y atiendan con mayor eficiencia la demanda de Salud Mental. Objetivo: Recoger información sobre las actividades formativas y la opinión de los residentes sobre la calidad de dichaformación. Método: Se aplicó una encuesta auto-administrada para valorar la satisfacción acerca del programa formativo de la universidad. Se evaluaron las áreas de aspectos formativos, opiniones y satisfacción. El instrumento fue evaluado por juicio de expertos y afinado durante el proceso. Se encuestaron 54 residentes de distintas sedes luego de haber dado su consentimiento. Resultados:El 59,3% de los residentes fueron mujeres. El 77,8% llevan un curso de psicofarmacología, el 59,3% de psicopatología, el 63% de psicoterapia y el 26,4% de salud mental comunitaria. Solo el 11 % ha realizado trabajos de investigación diferentes a su tesis y sólo 2 han publicado estos trabajos en una revista indizada. El 92,6% cuentan con un tutor y de éstos, el 35% se reúne con él una vez semestral o anual. Las actividades académicas más frecuentes fueron los casos clínicos y exposiciones. Las atenciones en consulta externa tendieron a incrementarse a lo largo de los tres años. El 16,7% de residentes del primer año no hicieron entrenamiento en terapia electroconvulsiva. Sólo el 37,8% consideró estar satisfecho o muy satisfecho con la formación impartida por la universidad y sólo el 40,8% con la función de su tutor. La mayor satisfacción se observó en relación a a sede, el nivel académico de los docentes y la formación en emergencia y hospitalización y la menor en relación a la formación en psicoterapia e investigación. ...

The psychiatrist in training must meet standards javascript:void(Set_Locked(0,'CANCELA%20EDICAO%20DE%20REGISTRO.x'))that enable a successful development of his professional work. Postgraduate programs should constantly evaluate psychiatry residents in training to ensure that they reach their full potential and efficiently meet the demand for Mental Health Services. Objective: To collect information about the educational activities and the opinion from residents about the quality of their training. Methods: A survey was administered to medical residents in order to assess their self- satisfaction about the training program of the university. The evaluated areas were medical training aspects, opinions and global satisfaction with the curriculum. The instrument was evaluated by expert judgment and refined and adjusted during the process. A number of 54 residents were surveyed at different locations after giving consent. Results: 59.3 % of the residents were women. 77.8 % of the residents had a course of psychopharmacology, 59.3 % of psychopathology, 63% of psychotherapy and 26.4 % of community mental health. Only 11 % of the residents did research work different from the thesis and only 2 have published these papers in an indexed journal. A 92.6 % had a tutor and of these, 35% met with him only once in a semester or year. The most frequent academic activities of the medical residents were clinical cases and presentation of scientific literature reviews. The outpatient consultation activities tended to increase throughout the three years. Only 37.8 % said they were satisfied or very satisfied with the training provided by the university and only 40.8 % with the role of the tutor. The greatest satisfaction was observed in relation to the institution, the academic level of the teachers and training in emergency and hospitalization whereas the lower was observed in relation to training in psychotherapy and research...

Abuso de anticolinérgicos en pacientes con esquizofrenia: reportes de caso y breve revisión de la literatura / Abuse of anticholinergic drugsin schizophrenic patients: case reports and brief literature review

Introducción: El abuso de fármacos anticolinérgicos es un problema que ocasionalmente se ha reportado en la literatura médica aunque al parecer su frecuencia puede ser mayor a lo considerado usualmente; sobre todo en pacientes con esquizofrenia, donde se indica anticolinérgicos para contrarrestar los síntomas extrapiramidales secundarios al uso de antipsicóticos, es donde se detectan la mayoría de casos. Método: reportamos cuatro casos de pacientes con esquizofrenia que abusaban de anticolinérgicos y revisamos la literatura pertinente. Resultados: El uso excesivo de anticolinérgicos por pacientes con esquizofrenia ha sido atribuido a su intento de controlar síntomas depresivos o negativos o la disforia inducida por antipsicóticos sin embargo no hay usualmente correlación entre el uso de antipsicóticos y el abuso de anticolinérgicos; por tanto, es menester considerar el potencial de abuso de los anticolinérgicos. Conclusión: Se impone revisar la indiscriminada prescripción de fármacos anticolinérgicos a los usuarios de antipsicóticos de modo tal que el riesgo de abuso se detecte tempranamente.

Introduction: The abuse of anticholinergic drugs is a problem occasionally reported in the medical literature although it has been suggested that its frequency is higher than usually considered. Since the main indication of anticholinergics today is to alleviate extrapyramidal symptoms in patients using antipsychotics, several cases of excessive use of anticholinergic drugs in schizophrenic patients are detected in psychiatric practice. Method: We report four schizophrenic patients who used anticholinergic drugs in excessive doses and we review the respective bibliography. Results: The excessive use of anticholinergic drugs by schizophrenic patients has been attributed to their attempt to counteract their negative symptoms, depressive symptoms or the dysphoria induced by antipsychotics, however, there is not usually correlation between the use of neuroleptics and anticholinergics abuse; therefore it is necessary to take into account the addictive potential of antiparkinson drugs. Conclusion: We advise to review the extensive prescription of anticholinergic drugs to antipsychotic users so the risk of anticholinergic drug abuse can be detected early.