Experiencias, actitudes y expectativas laborales de personas con trastornos mentales severos en un hospital de día del sector privado / Experiences, attitudes and expectations towards work among individuals with severe mental disorders in a private day hospital

INTRODUCCIÓN: El empleo es uno de los componentes centrales de la recuperación en personas con trastornos mentales severos y un aspecto clave en la validación social. El objetivo del estudio fue conocer la experiencia laboral, el interés por trabajar, las conductas específicas de búsqueda laboral, el estatus ocupacional y las actitudes frente al trabajo en esta población. MÉTODOS: Un total de 103 personas en tratamiento en una institución de salud mental de la ciudad de Buenos Aires completaron un cuestionario censal en 2018 con preguntas abiertas y cerradas. El análisis fue mixto, con cálculo y comparación de frecuencias según grupos y análisis temático. RESULTADOS: La mayoría de los participantes tenía experiencia laboral, aunque solo el 29% estaba trabajando. El 93% de quienes no trabajaban dijo tener interés en hacerlo. Solo un 33% de quienes no tenían trabajo realizaban actividades para conseguirlo. Un 85% consideró que podría tener problemas en caso de trabajar y el 15% señaló que podría hacerle mal. No se observaron diferencias significativas según diagnóstico o género. DISCUSIÓN: El elevado interés por trabajar de las personas con trastornos mentales severos contrasta con un porcentaje considerable que, pese a ello, no busca trabajo y anticipa dificultades laborales. El estigma podría ser uno de los mayores obstáculos para la búsqueda y la inclusión laboral. Los programas de apoyo al empleo deben considerar algunos de los problemas hallados en este estudio.

'Love comes first, and it is ahead of any different political partisanism': How political polarizations compare to other forms of discrimination in Buenos Aires (Argentina).

BACKGROUND: Affective polarization and stigma toward individuals with schizophrenia and toward immigrants in Argentina are not new despite its importance and dissemination. However, no research has been conducted taking into consideration political partisanship and attitudes toward these groups. AIMS: Political polarization and attitudes toward socialization across party lines are studied in conjunction with attitudes toward immigrants and toward individuals with schizophrenia. METHOD: Individuals from Buenos Aires (n = 712) were surveyed for their political partisanship and their attitudes toward Peruvian and Bolivian immigrants, people with schizophrenia and partisans from the opposing political party. A modified version of the Bogardus scale was used. RESULTS: Social distance was from highest to lowest toward people with schizophrenia, political opponents, and immigrants. Individuals with schizophrenia were strongly discriminated against by most participants: 86% would definitely or probably not want them to take care of their children, 83% would not want them to be their healthcare provider, and 81% would not want to marry them. Immigrants were comparatively not discriminated against: 10% would not want them to take care of their children, 8% would not want to receive health care from them, and 28% would not want to marry them. Cristina Fernández de Kirchner partisans showed the lowest level of discrimination toward these two groups, compared to Mauricio Macri partisans and to independent voters. However, the former group had greater discriminatory attitudes toward Mauricio Macri partisans than the latter. CONCLUSIONS: As compared to other discriminatory attitudes, discrimination toward persons with schizophrenia is widespread and pervasive. Lower levels of discrimination toward people with schizophrenia and toward immigrants would not predict attitudes toward the opposing political partisans.

[Notes on telework, psychiatric care and changes in communication during pandemic]. / Notas sobre el teletrabajo, la atención psiquiátrica y los cambios comunicacionales en pandemia.

COVID-19 has accelerated the transformations of teleworking, generating conditions of great opportunities and terrible threats. The digital divide deepens inequities and exploitation, where the most unprotected countries and the most vulnerable populations are closer to the abyss Digital changes have formatted new modes of care, which are constantly changing and present new challenges to find their scope and limits.

Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina

Objective: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). Methods: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. Results: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. Conclusions: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.

Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina.

OBJECTIVE: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). METHODS: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. RESULTS: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. CONCLUSIONS: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.

[Epidemiological study of mental health in the general population of Argentina]. / Estudio epidemiológico de salud mental en población general de la República Argentina.

In this paper we report the findings of the first "Epidemiological study of mental health in the general population of Argentina" in the framework of the World Mental Health Survey Initiative WHO / Harvard, in collaboration with the Faculty of Medicine of the University of Buenos Aires and the Asociación de Psiquiatras Argentinos (APSA) with funding from the Ministry of Health. Methodology: A multistage probabilistic household survey was conducted using the Composite International Diagnostic Interview (CIDI). The survey was conducted on 3,927 people aged 18 and over (no age limit), with fixed residence in one of the eight largest urban areas in the country (Buenos Aires, Córdoba, Corrientes-Resistencia, Mendoza, Neuquén, Rosario, Salta and Tucumán), representing approximately 50.1% of the adults living in the country. The response rate was 77%. Results: The lifetime prevalence of any mental disorder in the general population of Argentina over 18 years of age was 29.1% and the projected life risk up to 75 years of age was 37.1%. The disorders with the highest life prevalence were Major Depressive Disorder (8.7%), Alcohol Abuse Disorder (8.1%) and Specific Phobia (6.8%). Anxiety Disorders were the most prevalent group (16.4%), followed by Mood Disorders (12.3%), Substance Disorders (10.4%), and Impulse Control Disorders (2.5%). The prevalence in the last 12 months of any mental disorder was 14.8%, a quarter of wich were classified as severe. 11.6% received treatment in the previous 12 months and only 30.2% of those who suffered a severe disorder received it. The results provide essential data for health planning and implementation and the training of the mental health workforce.

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries.

PURPOSE: There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes. METHODS: This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models. RESULTS: A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio. CONCLUSION: Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.

[How do Argentinean psychiatrists treat bipolar depression?]. / ¿Cómo tratan los psiquiatras argentinos la depresión bipolar?

We show the results of a survey on bipolar depression treatment using a sample of 359 argentine psychiatrists in the context of The National Psychiatry Congress that took place in the City of Buenos Aires, between September 26th and 29th, 2007. The objective was to study the attendant psychiatrists' prescribing habits in the treatment of bipolar depression. The discussion is based on the comparison between the answers and the recommendations taken from the main consensus, guidelines and from articles published by experts. The differences found point to the distance often present between guidelines and expert consensus series (based on patients meeting the strict criteria used in randomized controlled studies) on one hand, and a clinician's everyday real world practice, on the other hand.

[Category and dimension in psychiatry]. / Categoría y dimensión en psiquiatría.

The present paper discusses the concepts of category and dimension in the field of Psychiatry. As the need for a taxonomy is widely accepted, a broad review is offered of the present debate in its historical background, revolving around what mostly appears as a dichotomy between category and dimension. The classical descriptions of psychiatric entities, of categorial linneage, have had and still have unquestionable weight in clinical practice and even in the construction of Psychiatry as a medical speciality. Its limitations, especially since the most recent versions of the DSM appeared, have given lieu both to objections and to new proposals, themselves not extent of conflict and limitations of their own. Lastly, the authors suggest that the problem is wrongly posed when presented in terms of an "either/or" disjunctive.

[How do Argentinean psychiatrists treat depression?]. / ¿Cómo tratan los psiquiatras argentinos la depresión? Encuesta a una muestra de 402 psiquiatras acerca de sus hábitos prescriptivos para el tratamiento farmacológico.

OBJECTIVE: The objective of this study was to examine the prescribing practices of Argentinean psychiatrists in the treatment of major depression and to observe similarities and/or differences with some consensus or treatment guidelines. METHODOLOGY: Four hundred two psychiatrists were surveyed during a specialty meeting in October 2005. RESULTS: A total of 88.2 % of psychiatrists surveyed considered that every depressed patient must be treated with medication. The most prescribed antidepressants for outpatients were paroxetine, sertraline and fluoxetine. Venlafaxine was included for inpatients. The majority of psychiatrists indicated antidepressant therapy lasting from 12 to 24 months after remission of the first depressive episode. Antidepressant dosages remained unchanged during that period. A low percentage had used lithium or thyroid hormones as augmentation medications, the addition of other antidepressant being the most used augmentation strategy. The most prescribed antidepressant combination was dual antidepressants and SSRIs. Prescribing practices differed according to personal factors of the physicians. CONCLUSIONS: Discrepancies between clinical practice and treatment guidelines were observed. Further research over the underlying causes of these discrepancies and mechanisms to reduce them are necessary.

[Assessment of sexual function from a psychopharmacological viewpoint]. / La evolución de la función sexual desde la óptica psicofarmacológica.

The aim of this paper is to discuss aspects linked to the assessment of sexual activity in mental health patients. Traditionally, and to this day, this assessment has received insufficient consideration by intervening professionals. Emphasis is made on determining the onset of sexual dysfunction with respect to the disorder prompting the visit. Schizophrenia is taken as the paradigm of the pathology least considered as regards assessment of the sexual activity of those suffering from this disorder.

[Diagnosis and treatment of borderline personality disorder: a professionals' survey]. / Diagnóstico y tratamiento del trastorno borderline de la personalidad: una encuesta a profesionales.

UNLABELLED: Borderline personality disorder (BPD) is a frequent mental disorder whose affected present high levels of stress and suffering. Diverse diagnostic criteria exist for this disorder. OBJECTIVE: The objective of our study was to establish which are the most sensitive symptoms to diagnose BPD at the present time together with the expectations and treatments of choice of mental health professionals of Buenos Aires city. METHODS: A voluntary auto survey was completed by 116 mental health professionals from private and public institutes of Buenos Aires city . RESULTS: Impulsivity, affective instability and boredom or emptiness were the symptoms referred as the most important to make the diagnosis of BPD. More than half of the people polled reported that the DSM IV was useless to establish the diagnosis of this disorder. Individual psychoanalytic psychotherapy was chosen by the majority of the surveyed as the most important treatment for these patients. Mood stabilizers are the drugs of choice for the pharmacological treatment of impulsivity. CONCLUSIONS: It is important to elaborate in our country diagnostic criteria and treatment guidelines that consider the knowledge and local experience with these patients.