Tratamiento de la Psicosis Cicloide en fase aguda: Estudio sobre una muestra de pacientes libres de medicación hospitalizados por un Primer Episodio Psicótico (PEP) / Acute treatment of Cycloid Psychosis: Study on a sample of naive hospitalized patients with FirstEpisode Psychosis (FEP)

Introducción. A pesar de la relevancia histórica, clínica y terapéutica de las psicosis cicloides, hasta el momento actual no se han realizado estudios controlados sobre su tratamiento. La terapia electroconvulsiva ha sido clásicamente de elección y los antipsicóticos de primera generación no han estado indicados. El presente estudio tiene como objetivo analizar el tratamiento agudo (y la respuesta al mismo) de las psicosis cicloides. Metodología. En una muestra de 75 pacientes libres de medicación hospitalizados y tratados por presentar un Primer Episodio Psicótico (PEP), se detectaron los posibles casos de psicosis cicloides utilizando los criterios diagnósticos operativos de Perris y Brockington. Se dividió la muestra en 'cicloides' y 'no cicloides' y se compararon ambos grupos en función de variables clínicas y terapéuticas. Resultados. Todos los pacientes fueron tratados con antipsicóticos de segunda generación. No se encontraron diferencias significativas (p=0,17; t-1,39) en la dosis de antipsicótico pautado (equivalentes de clorpromacina), pero si se observaron diferencias significativas en la mejoría al alta hospitalaria (CGI-S), con una mejor respuesta en el grupo de los ‘cicloides’ (p=0,002; u=162). También se observaron diferencias significativas en la dosis de benzodiacepinas, siendo notablemente mayor para el grupo de ‘cicloides’ (p>0,001; u=28). Conclusiones. Sin contradecir la idea clásica del tratamiento de las psicosis cicloides, el presente estudio contribuye a abrir una nueva expectativa terapéutica. De manera que en el tratamiento agudo de las psicosis cicloides, el uso de antipsicóticos de segunda generación podría tener un efecto particularmente beneficioso, especialmente si se combina con benzodiacepinas a dosis altas. Si bien es preciso la realización de estudios controlados que confirmen este dato

Introduction. In spite of the historic, clinical and therapeutic importance of cycloid psychosis, no controlled studies have been performed as yet on its treatment. Electroconvulsive therapy has classically been the treatment of choice and the first generation antipsychotics have not been indicated. This study has aimed to analyze the acute treatment (and response to it) of cycloid psychoses. Methodology. In a sample of 75 hospitalized medication-naive patients treated for a First Psychotic Episode (FPE), possible cases of cycloid psychoses were detected using the Perris and Brockington operative diagnostic criteria. The sample was divided into 'cycloids' and 'non-cycloids' and both groups were compared based on clinical and therapeutic variables. Results. All the patients were treated with second generation antipsychotics. No significant differences (p=0.17; t-1.39) were found in the antipsychotic dose prescribed (equivalents of chlorpromazine). However, significant differences were observed in the improvement on hospital discharge (clinical global impression severity: CGI-S), with better response in the "cycloid" group(p=0.002; u=162). Significant differences were also observed in the dose of benzodiazepines, there being significantly greater improvement for the ‘cycloid’ group (p>0.001; u=28). Conclusions. Without contradicting the classical idea of the treatment of cycloid psychoses, the present study contributes to the opening of a new therapeutic prospect. Thus, the use of second generation antipsychotics could have a particularly beneficial effect, especially if combined with high doses of benzodiazepines in the acute treatment of cycloid psychoses. However, controlled studies need to be carried out to confirm this

Acute treatment of cycloid psychosis: study on a sample of naive hospitalized patients with first-episode psychosis (FEP).

INTRODUCTION: In spite of the historic, clinical and therapeutic importance of cycloid psychosis, no controlled studies have been performed as yet on its treatment. Electroconvulsive therapy has classically been the treatment of choice and the first generation antipsychotics have not been indicated. This study has aimed to analyze the acute treatment (and response to it) of cycloid psychoses. METHODOLOGY: In a sample of 75 hospitalized medication- naive patients treated for a First Psychotic Episode (FPE), possible cases of cycloid psychoses were detected using the Perris and Brockington operative diagnostic criteria. The sample was divided into “cycloids” and “non-cycloids” and both groups were compared based on clinical and therapeutic variables. RESULTS: All the patients were treated with second generation antipsychotics. No significant differences (p=0.17; t-1.39) were found in the antipsychotic dose prescribed (equivalents of chlorpromazine). However, significant differences were observed in the improvement on hospital discharge (clinical global impression severity: CGI-S), with better response in the “cycloid” group” (p=0.002; u=162). Significant differences were also observed in the dose of benzodiazepines, there being significantly greater improvement for the “cycloid” group (p>0.001; u=28). CONCLUSIONS: Without contradicting the classical idea of the treatment of cycloid psychoses, the present study contributes to the opening of a new therapeutic prospect. Thus, the use of second generation antipsychotics could have a particularly beneficial effect, especially if combined with high doses of benzodiazepines in the acute treatment of cycloid psychoses. However, controlled studies need to be carried out to confirm this.

Romanticismo y Esquizofrenia. Segunda Parte: La hipótesis de la Intimidad / Romanticism and Schizophrenia. Second part: The Intimacy hypothesis

En la primera parte de este artículo hemos analizado la evidencia en que se basa la hipótesis de la recencia de la esquizofrenia y también lo que podemos llamar la naturaleza íntima de la enfermedad. En esta parte subrayamos el papel de ciertos aspectos culturales que han sido ignorados hasta ahora, aspectos que se asocian con los profundos cambios en la Weltanschauung y en los sistemas de creencias sobre la naturaleza humana que trajo consigo la modernidad tardía y concretamente el romanticismo. La descripción de las características principales del romanticismo, empezando por "el descubrimiento de la intimidad", nos lleva a la conclusión de que la alteración de la ipseidad y de la subjetividad característica de la enfermedad parece ser un factor de vulnerabilidad cuando la persona ha de afrontar los nuevos retos que plantea el romanticismo. La consideración de los logros literarios de Hölderlin y del drama psicológico profundo presente en su obra, pone de manifiesto como, en el contexto del final de la edad moderna tardía, el ser humano encuentra en el romanticismo no sólo una fuente de creatividad y desarrollo personal, sino también la amenaza de su propia destrucción. Por último, ponemos nuestra hipótesis en relación con hipótesis genéticas recientes que identifican conjuntos de enfermedades asociadas con el mismo gen o genes (diseasoma). En todo caso, el proceso de asociación de los rasgos del romanticismo con las principales características de la esquizofrenia nos permite considerar la posibilidad de una especie de amalgama entre locura y civilización, tanto a nivel general como en los pacientes individuales, que allana el camino para nuevos enfoques terapéuticos

In the first part of this article we have analyzed the evidence supporting the recency hypothesis of schizophrenia and also what we can call the intimate nature of the disease. In this part we highlight the role of certain cultural aspects that have been ignored up to now, aspects that are associated with deep changes in the Weltanschauung and systems of beliefs on human nature brought up by the late Modernism, specifically by Romanticism. The description of the main characteristics of Romanticism, starting with the "discovery of intimacy", leads to the conclusion that the characteristic alteration of subjectivity and ipseity of the disease appears to be a vulnerability factor when somebody has to face the new challenges raise Romanticism. The consideration of Hölderlin’s literary achievements and the deep psychological drama prevailing in them, makes explicit how the late modern human being finds in Romanticism the source of creativity and personal development but also the threat of his or her own destruction. Finally we link our hypothesis with recent genetic perspectives that consider sets of diseases associated to the same gene or genes (diseasome). In any case the process of associating the traits of Late Modernism and Romanticism with the core features of schizophrenia allows to consider the amalgamation of insanity with society, both at a general level an in what concerns individual patients, paving the way for novel therapeutic strategies

Romanticism and schizophrenia. Second part: The intimacy hypothesis.

In the first part of this article we have analyzed the evidence supporting the recency hypothesis of schizophrenia and also what we can call the intimate nature of the disease. In this part we highlight the role of certain cultural aspects that have been ignored up to now, aspects that are associated with deep changes in the Weltanschauung and systems of beliefs on human nature brought up by the late Modernism, specifically by Romanticism. The description of the main characteristics of Romanticism, starting with the “discovery of intimacy”, leads to the conclusion that the characteristic alteration of subjectivity and ipseity of the disease appears to be a vulnerability factor when somebody has to face the new challenges raise Romanticism. The consideration of Hölderlin’s literary achievements and the deep psychological drama prevailing in them, makes explicit how the late modern human being finds in Romanticism the source of creativity and personal development but also the threat of his or her own destruction. Finally we link our hypothesis with recent genetic perspectives that consider sets of diseases associated to the same gene or genes (diseasome). In any case the process of associating the traits of Late Modernism and Romanticism with the core features of schizophrenia allows to consider the amalgamation of insanity with society, both at a general level an in what concerns individual patients, paving the way for novel therapeutic strategies.

Romanticismo y Esquizofrenia. Primera parte: La Hipótesis de la recencia y el núcleo fundamental de la enfermedad / Romanticism and schizophrenia. First part: The recency hypothesis and the core Gestalt of the disease

Podemos encontrar en la Biblia, en tablillas de Mesopotamia, en la literatura clásica griega y romana y en los escritos de muchas culturas no occidentales, descripciones de comportamientos irracionales, incomprensibles o fuera de control, tal y como es frecuente en nuestros días en pacientes con trastornos mentales graves. Sin embargo, la presencia en tiempos antiguos del cuadro completo de la esquizofrenia que vemos hoy en día en nuestros servicios psiquiátricos es cuestionable. De hecho, los síntomas típicos, su inicio, sus características, su duración y su estado final no aparecen con nitidez. El impacto de la enfermedad sobre el funcionamiento psíquico y la discapacidad asociada a la enfermedad están en su mayoría ausentes en esos textos. Torrey (1980) y Hare (1988) afirman que la enfermedad no existía antes del año1800 (esto se conoce como hipótesis de recencia). En su opinión, esto sería consecuencia de factores biológicos, como virus, predisposición genética, factores dietéticos o contaminantes ambientales asociados a otras consecuencias de la civilización. Otros han puesto más énfasis en la industrialización y sus consecuencias sobre determinadas condiciones sociales, tales como la estructura familiar y la migración. Después de analizar las múltiples facetas de la locura en personajes literarios, en textos de medicina y en diversas figuras históricas, los argumentos que presentamos tienden a apoyar de la hipótesis de recencia. Una revisión de las características nucleares de la esquizofrenia, de su impacto en la vivencia del yo individual, en la intersubjetividad y en la ipseidad, temas que están relativamente descuidados en la literatura psiquiátrica reciente, nos abren las puertas para considerar en una segunda parte la relación entre las características del romanticismo, empezando por "el descubrimiento de la intimidad", y su articulación con la alteración de la ipseidad y de la subjetividad característica de la enfermedad

Descriptions of irrational, incomprehensible, or unconstrained behavior such as is common nowadays in patients suffering from severe mental disorders can be found in the Bible, in Mesopotamian scripts, in classical Greek and Roman literature, and in the writings of many non-Western cultures. However, the presence of full-blown features of schizophrenia as seen today in psychiatric settings is controversial. Typical symptoms, the expected onset, duration and outcome, the impact of the disease on psychic functioning and the associated disability of the disease are mostly absent in those texts. Torrey (1980) and Hare (1988) have claimed that the disease did not exist before the year1800 (this is known as the recency hypothesis). This would be the consequence of biological factors such as viruses, genetic or dietary factors or environmental contaminants associated to civilization. Others have put the emphasis on industrialization and its repercussions on social conditions such as family structure and migration. After analyzing the many manifestations of insanity in literary characters, in medical texts and in key historical figures, the arguments presented in this paper tend to support the recency hypothesis. A review of the core characteristics of schizophrenia and its impact on selfhood, intersubjetivity and ipseity, topics relatively neglected in recent psychiatric literature, opens the doors to consider in a second part the relationship between the features of Romanticism, starting by the "discovery of intimacy", and its articulation with the disturbance of ipseity and selfhood characteristic of the disease

Romanticism and schizophrenia. First part: The recency hypothesis and the core Gestalt of the disease.

Descriptions of irrational, incomprehensible, or unconstrained behavior such as is common nowadays in patients suffering from severe mental disorders can be found in the Bible, in Mesopotamian scripts, in classical Greek and Roman literature, and in the writings of many non-Western cultures. However, the presence of full-blown features of schizophrenia as seen today in psychiatric settings is controversial. Typical symptoms, the expected onset, duration and outcome, the impact of the disease on psychic functioning and the associated disability of the disease are mostly absent in those texts. Torrey (1980) and Hare (1988) have claimed that the disease did not exist before the year 1800 (this is known as the recency hypothesis). This would be the consequence of biological factors such as viruses, genetic or dietary factors or environmental contaminants associated to civilization. Others have put the emphasis on industrialization and its repercussions on social conditions such as family structure and migration. After analyzing the many manifestations of insanity in literary characters, in medical texts and in key historical figures, the arguments presented in this paper tend to support the recency hypothesis. A review of the core characteristics of schizophrenia and its impact on selfhood, intersubjetivity and ipseity, topics relatively neglected in recent psychiatric literature, opens the doors to consider in a second part the relationship between the features of Romanticism, starting by the "discovery of intimacy", and its articulation with the disturbance of ipseity and selfhood characteristic of the disease.

A new time limited psychotherapy for BPD: preliminary results of a randomized and controlled trial.

INTRODUCTION: Psychic Representation focused Psychotherapy (PRFP) is a new time limited dynamic psychotherapy for the treatment of Borderline Personality Disorder. It is a psychodynamic technique based on brief psychoanalytic psychotherapy principles. It is manualized and designed to be applied in the framework of public health care services. A randomized and controlled study with a sample of 53 patients was conducted to assess PRFP efficacy. This work presents the results for the first 44 trial completers at termination of treatment. METHODS: Both groups, the experimental (n= 18) and control group (n= 26), received treatment as usual. The experimental group received an additional 20 (PRFP) sessions, conducted by four therapists with homogenous characteristics specifically trained in this technique. The main outcome variables measures were: Severity global index of SCL-90-R, Barrat Impulsivity Scale scores and Social Adaptation (SASS score). Baseline and final condition at termination was compared. CONCLUSIONS: Preliminary results showed significantly better outcomes for the experimental group in all the main variables measured and in most of the secondary ones. PRFP may represent an important contribution for the treatment of BPD patients. Follow-up assessment at 6 and 12 months is planned.

Una nueva Psicoterapia Breve para Trastornos límite de la personalidad. Resultados preliminares de un Ensayo controlado y aleatorizado / A new Time Limited Psychotherapy for BPD: Preliminary Results of a Randomized and Controlled Trial

Introducción: La Psicoterapia centrada en la Representación Psíquica (PCRP) es una nueva psicoterapia breve manualizada para los Trastornos Límite de la personalidad (TLP). Es una técnica psicodinámica basada en los principios de las psicoterapias psicoanalíticas breves, está manualizada y diseñada para su utilización en los servicios públicos. Con el objetivo de evaluar su eficacia en pacientes ambulatorios se realizó un estudio randomizado y controlado con una muestra total de 53 pacientes. En este trabajo se presenta la metodología del estudio y los resultados preliminares de los primeros 44 pacientes al final del periodo de intervención. Metodología: Ambos grupos, experimental (n= 18) y control (n= 26), recibieron tratamiento convencional, el grupo experimental recibió además 20 sesiones de PCRP realizada por cuatro terapeutas con características homogéneas y especialmente entrenados. Las variables principales de resultados fueron: Índice global de gravedad del SCL-90-R y puntuaciones de la escala de Impulsividad de Barrat y Adaptación Social SASS, comparándose entre la situación basal y al final de la intervención en cada grupo y en ambos. Los resultados preliminares resultaron significativamente superiores en el grupo experimental en las variables principales yen la mayoría de las secundarias. Conclusiones: La PCRP puede suponer un avance importante para el tratamiento de los TLP si se confirman los resultados preliminares con los datos finales del estudio. Éstos se presentarán una vez finalizado el mismo incluyendo la evaluación en el seguimiento a los seis y doce meses (AU)

Introduction: Psychic Representation focused Psychotherapy (PRFP) is a new time limited dynamic psychotherapy for the treatment of Borderline Personality Disorder. It is a psychodynamic technique based on brief psychoanalytic psychotherapy principles. It is manualized and designed to be applied in the framework of public health care services. A randomized and controlled study with a sample of 53 patients was conducted to assess PRFP efficacy. This work presents the results for the first 44 trial completers at termination of treatment. Methods: Both groups, the experimental (n= 18) and control group (n= 26), received treatment as usual. The experimental group received an additional 20 (PRFP) sessions, conducted by four therapists with homogenous characteristics specifically trained in this technique. The main outcome variables measures were: Severity global index of SCL-90-R, Barrat Impulsivity Scale scores and Social Adaptation (SASS score). Baseline and final condition at termination was compared. Conclusions: Preliminary results showed significantly better outcomes for the experimental group in all the main variables measured and in most of the secondary ones. PRFP may represent an important contribution for the treatment of BPD patients. Follow-up assessment at 6 and 12 months is planned (AU)

Paving the way for new research strategies in mental disorders. Second part: the light at the end of the tunnel.

Following we consider strategies to overcome the situation described in a previous article (López-Ibor JJ, López-Ibor MI. Paving the Way for New Research Strategies in Mental Disorders. First part: the recurring crisis of psychiatry. Actas Esp Psiquiat. 2013;41(1):33-43), by putting emphasis on psychopathology instead than in classification, in functions rather than in diagnostic criteria, to be aware in the progress in neuroscientific monistic perspectives and by importing the methods of the emerging connectomics. Medicine is undergoing deep changes. Networking is becoming the new paradigm and we consider that it should be the turning point of the future psychiatry, both in research and in practice.

Hacia nuevas estrategias de investigación en los trastornos mentales. Segunda parte: La luz al final del túnel / Paving the way for new research strategies in mental disorders. Second part: The light at the end of the tunnel

A continuación consideraremos las estrategias a seguir para superar la situación descrita en un artículo previo (López-Ibor JJ, López-Ibor MI. Hacia nuevas estrategias de investigación en los trastornos mentales. Primera parte: La crisis recurrente de la psiquiatría. Actas Esp Psiquiat. 2013; 41(1); 33-43.) centrándonos en la psicopatología en lugar de en la clasificación, en las funciones más que en los criterios diagnósticos, teniéndolos en cuenta en el progreso de las perspectivas monistas neurocientíficas e importando los métodos de la conectómica emergente. La medicina está sufriendo profundos cambios. La creación de redes se está convirtiendo en el nuevo paradigma y consideramos que este debería ser el punto de inflexión de la futura psiquiatría, tanto en investigación como en la práctica (AU)

Following we consider strategies to overcome the situation described in a previous article (López-Ibor JJ, López-Ibor MI. Paving the Way for New Research Strategies in Mental Disorders. First part: the recurring crisis of psychiatry. Actas Esp Psiquiat. 2013;41(1):33-43), by putting emphasis on psychopathology instead than in classification, in functions rather than in diagnostic criteria, to be aware in the progress in neuroscientific monistic perspectives and by importing the methods of the emerging connectomics. Medicine is undergoing deep changes. Networking is becoming the new paradigm and we consider that it should be the turning point of the future psychiatry, both in research and in practice (AU)

Paving the way for new research strategies in mental disorders. First part: the recurring crisis of psychiatry.

Psychiatry is going through a deep crisis, both as a scientific discipline as a medical speciality. In the present paper we consider in length what we consider to be the three aspects that could explain the situation: the recurring disappointment in classification; the persistence of dualistic perspectives in research; and third, the continuing of a localizacionism inadequate to explain normal and pathological behaviour. Psychiatry lacks a definition of mental disorder that covers all situations, there are difficulties in drawing a precise distinction between normality and psychopathology, and the majority of these “diagnostic” categories are not validated by biological criteria. Furthermore, there is still a debate on the nature of the symptoms of mental disorders, a confusion classification and diagnosis and a preoccupation with the growing inflation of diagnostic categories. Dualism is at the core of psychopathology, simply because Cartesian dualism led to the development of modern science, but the price paid includes the split-up of mental and physical phenomena and illnesses and of psychiatry and the rest of medicine. Localizationism, that is, the approach to brain function considering that particular pychological functions are carried out by particular brain areas or centers, helps to understand many clinical and psychological phenomena, but have largely fild in explaining the nature of most mental disorders. In a second part of this article we provide some strategies that could help to go beyond the present impasse.

Investigación en psiquiatría: Entre Sísifo y Pedro / Research in psychiatry: between Sisyphus and Peter

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Hacia nuevas estrategias de investigación en los trastornos mentales. Primera Parte: La crisis recurrente de la psiquiatría / Paving the Way for New Research Strategies in Mental Disorders. First part: The recurring crisis of psychiatry

La psiquiatría está atravesando una profunda crisis como disciplina científica y como especialidad médica. En este artículo analizamos en profundidad los tres aspectos que consideramos que podrían explicar la situación: el recurrente fiasco de la nosología; la persistencia de las perspectivas dualistas en investigación y en tercer lugar, la continuidad de un localizacionismo inadecuado para explicar el comportamiento normal y el patológico. La psiquiatría carece de una definición de trastorno mental que cubra todas las situaciones, existen dificultades en delinear una distinción precisa entre la normalidad y la psicopatología, y la mayoría de estas categorías “diagnósticas” no están validadas por criterios biológicos. A continuación consideramos estrategias para superar esta situación poniendo énfasis en la psicopatología en lugar de en la clasificación, en las funciones más que en los criterios diagnósticos, estando atentos en el progreso en las perspectivas neurocientíficas monistas e importando los métodos de la conectómica emergente. La medicina está cambiando profundamente. La creación de redes se está convirtiendo en el nuevo paradigma y consideramos que podría ser el punto de inflexión de la psiquiatría futura, tanto en la investigación como en la práctica(AU)

Psychiatry is going through a deep crisis, both as as cientific discipline as a medical speciality. In the present paper we consider in length what we consider to be the three aspects that could explain the situation: the recurring disappointment in classification; the persistence of dualistic perspectives in research; and third, the continuing of a localizacionism inadequate to explain normal and pathological behaviour. Psychiatry lacks a definition of mental disorder that covers all situations, there are difficulties in drawing a precise distinction between normality and psychopathology, and the majority of these “diagnostic” categories are not validated by biological criteria. Furthermore, there is still a debate on the nature of the symptoms of mental disorders, a confusion classification and diagnosis and a preoccupation with the growing inflation of diagnostic categories. Dualism is at the core of psychopathology, simply because Cartesian dualism led to the development of modern science, but the price paid includes the split-up of mental and physical phenomena and illnesses and of psychiatry and the rest of medicine. Localizationism, that is, the approach to brain function considering that particular pychological functions are carried out by particular brain areas or centers, helps to understand many clinical and psychological phenomena, but have largely fild in explaining the nature of most mental disorders. In a second part of this article we provide some strategies that could help to go beyond the present impasse(AU)

Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey.

BACKGROUND: Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. METHODS: In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. FINDINGS: 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coefficient 0·20 [95% CI 0·09-0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032; unpaid employed 0·34 [0·09-0·60], p=0·007; looking for a job 0·26 [0·09-0·43], p=0·002; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p<0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in finding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination. INTERPRETATION: Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving effective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the effects of stigma when it is already established. FUNDING: European Commission, Directorate General for Health and Consumers, Public Health Executive Agency.

¿Qué necesitan aprender los psiquiatras? Conocimientos, habilidades y actitudes / What do psychiatrists need to learn? knowledge, skills and attitudes

En todas las culturas y a lo largo de la historia la religión ha desempeñado un papel destacado, de lo que se deduce que realiza una función adaptativa, invocada en todas las sociedades para satisfacer una o varias necesidades universales humanas. Por tanto, y desde el punto de vista psicológico el rasgo más destacado de la religión es su universalidad. La religión y la espiritualidad son importantes para la vida de muchas personas, le dan un sentido a sus vidas, en este sentido y no en otro, se puede considerar que la religión y la espiritualidad son parte de la calidad de vida. La organización mundial de la salud (OMS) reconoce que los valores espirituales o la espiritualidad es un componente de la calidad de vida. Muy a menudo el fenómeno religioso ha sido considerado muy superficialmente por los psiquiatras. Por eso no es de extrañar que pocas publicaciones existen que ayuden a los psiquiatras a explorar la religiosidad de los pacientes. Muchos estudios científicos que demuestran que la religión en particular o la espiritualidad en general (definida como experiencia individual y personal y que no incluye los ritos y rituales de una determinada religión) se asocia con un mayor bienestar y disminuye los síntomas depresivos pudiendo relacionarse con estilos de vida (mejorar las estrategias de afrontamiento ante situaciones adversas) y proporcionan una de las mayores y más poderosas redes sociales. A lo largo de su formación como especialistas los psiquiatras son entrenados en la entrevista clínica y en la exploración del estado mental, son conscientes de los aspectos que deben abordar durante la entrevista: el motivo de consulta, los criterios diagnósticos, la historia familiar y social..., pero incluso aunque sabemos que la espiritualidad es a veces muy importante para el paciente, psiquiatras consideramos que es más difícil preguntar a los pacientes sobre sus creencias religiosas que sobre aspectos relacionados con la sexualidad. En este trabajo se revisan una serie de cuestionarios que pueden ser utilizados y ayudar a los psiquiatras a explorar la religiosidad, la espiritualidad y si la religión o no juega un papel en las estrategias de afrontamiento del paciente. Los aspectos religiosos y espirituales de nuestros pacientes deben ser explorados, es necesario que tengamos en cuenta que son valores en ocasiones importantes y que junto con otros deben pasar a formar parte de lo que hoy se denomina medicina basada en el paciente. Por lo tanto los psiquiatras deben de aprender el papel que la religiosidad y la espiritualidad juegan en la aparición y manifestaciones de la enfermedad y en el proceso de afrontar la enfermedad, el sufrimiento y la discapacidad y en la resiliencia en general (AU)

In every culture and through history, religion has always being important, it is considered to play an adaptative role, that may help different societies to satisfied one or some human universal necessities. Therefore, according to psychological point of view, the more common aspect of religion in universality. Religion and spirituality are very important for some people, it helps them to find life sense, in this aspect and not in other, we can clonclude that religion and spirituality are part of the quality of life. The World Health Organization (WHO) support that spiritual values or spirituality are an important component in quality of life. Very often religious experience has not been taken into consideration by psychiatrist. It is not surprising that there are very few research studies and publications that help psychiatrist to explore religiosity in their patients. Many data suggest that religion in particular, or sipirituality in general (considered as an intimate and personal experience that not include rituals of any religion) is associated with increased sense of well-being, decreased depressive symptoms and is related with lifestyle behaviors’ (enhance positive coping strategies against stressful life events) and provide larger and stronger social networks. Psychiatrists are trained in interviewing and they are aware of the domains that should be assessed: history of the present illness, diagnostic criteria, family history , formal mental status, social history, ... but even though we know spirituality is sometimes essential for patients, psychiatrist in general find more difficult and intimate to talk about one's religions or spiritual life than one's sexual experience. In this paper we review questionaires that measure religiosity, spiritual well-being, religious coping strategies and beliefs and could help psychiatrist in taking spiritual history. Spiritual matters and religion should become part of clinical psychiatric assessment, we have to take into consideration cultural beliefs, values that are important for patients and therefore spiritual concerns should be considered as a part of the patient-center medicine. Therefore psychiatrists need to take into consideration the role of religion and spirituality in the diagnosis, symptoms, dyshabilities and resilience (AU)

La gestión clínica y la gestión de procesos en el ámbito de los trastornos mentales / Clinical management and management of processes in the mental health setting

No disponible

Pasos para desarrollar un proceso de Ansiedad y Depresión desde Atención Primaria hasta los Servicios Psiquiátricos / Steps for the development of a management process of Anxiety and Depression from Primary Care up to the Psychiatry Departments

No disponible

Protocolos integrados con Psiquiatría y Atención Primaria para Trastornos Depresivos y de Ansiedad / Comprehensive Protocols with Psychiatry and Primary Care for Depressive and Anxiety Disorders

No disponible