CLINICAL VIEW ON SUBSTANCE-INDUCED PSYCHOTIC SYMPTOMS IN A MEDICALLY SUPERVISED INJECTING ROOM: A DECADE OF EXPERIENCE.

Medically supervised injecting rooms (MSIRs) are extremely important facilities for people who inject drugs (PWID) as MSIRs provide a safe place for the consumption of street-sourced drugs, impacting overdose rates and viral transmitted infections.

Una visión clínica de los síntomas psicóticos inducidos por sustancias en una sala de venopunción supervisada: Una década de experiencia / A clinical view of substance-induced psychotic symptoms in a supervised venipuncture room: A decade of experience

Introducción. Las salas de venopunción supervisadas (MSIR) son centros extremadamente importantes para las personas que usan drogas intravenosas (PWID), ya que las MSIR brindan un lugar sanitariamente seguro para el consumo de sustancias psicoativas ilícitas, teniendo un impacto importante en las tasas de sobredosis y las infecciones virales transmitidas por vía sanguínea. Métodos. Descripción de los síntomas psicóticos inducidos observados en una MSIR y su relación con la sustancia utilizada. El análisis se realizó con datos recopilados entre el 01/01/2009 y el 31/08/2021. Resultados. Se registraron 3731 autoinyecciones (68,7% heroína, 29,1% cocaína, 2,1% speedball y 0,2% otra sustancia) durante el período estudiado. Los síntomas psicóticos solo se observaron en el 7,1% del total de autoinyecciones. Sin embargo, se detectaron grandes diferencias entre las sustancias: el 23,2% de los consumos de cocaína estuvieron relacionados con síntomas psicóticos, el 20,8% de las inyecciones de speedball presentaron síntomas psicóticos y solo el 0,3% de las venopunciones de heroína se relacionaron con síntomas psicóticos (X2 =604.99; p<0.001). Además, algunas variables señalan que los síntomas psicóticos inducidos por sustancias pueden estar asociados con una mayor gravedad clínica. Conclusiones. Los sujetos con consumo de cocaína o speedball que acuden a MSIR pueden presentar síntomas psicóticos inducidos por sustancias, siendo esto un criterio de mayor gravedad clínica. Por lo tanto, los protocolos de las MSIR deben analizarse y adaptarse en función de la sustancia utilizada y la inducción de síntomas psicóticos. Además, se necesita más investigación en esta área. (AU)

Introduction. Medically supervised injecting rooms (MSIRs) are extremely important facilities for people who inject drugs (PWID) as MSIRs provide a safe place for the consumption of street-sourced drugs, impacting overdose rates and viral transmitted infections. Methods. The current paper describes more than 10 years of our MSIR experience regarding psychotic symptoms and their relationship with the substance used. The analysis was performed using data collected between 01/01/2009 and 08/31/2021. Results. 3731 self-injections (68.7% heroin, 29.1% cocaine, 2.1% speedball, and 0.2% other substance) were recorded during the studied period. Psychotic symptoms were only observed in 7.1% of the total self-injections. However, large differences were detected among substances: 23.2% of cocaine consumptions were related to psychotic symptoms, 20.8% of speedball injections presented psychotic symptoms, and only 0.3% of heroin consumptions had psychotic symptoms (X2=604.99; p<0.001). Also, some other variables highlight that psychotic symptoms induced by substances may be associated with higher clinical severity. Conclusions. subjects with cocaine or speedballuse who attend MSIRs may present substance-induced psychotic symptoms, having higher clinical severity. Thus, MSIRs’ protocols should be analyzed and adapted in terms of the substance used and the induction of psychotic symptoms. Moreover, further research is necessary on this critical issue. (AU)

Relationships between neuropsychiatric symptoms and cognitive profiles in Alzheimer's disease and related syndromes.

OBJECTIVES: To investigate the rate of occurrence of neuropsychiatric symptoms (NPS) and their relationship with age, sex and cognitive performance in subjects with Alzheimer's disease and related dementias (Alzheimer's disease and related dementias [ADRD]). METHODS: This is a retrospective matched case-control study. Data from memory clinic patients included demographic information presence of NPS, and cognitive testing of Orientation, Immediate and Delayed Memory, Visuospatial Function, Working Memory, Attention, Executive Control and Language. Participants were Individuals with subjective cognitive impairment (n = 352), mild cognitive impairment (MCI) (n = 369), vascular MCI (n = 80), Alzheimer's disease (n = 147), vascular dementia (n = 41), mixed dementia (n = 33), and healthy controls (n = 305). Logistic regression was used to investigate the relationship between the presence of NPS, age and sex. A generalised additive model was used to investigate the relationship between presence of NPS, age and cognitive impairment. Analysis of variance was used to investigate differences in cognition between younger and older groups with and without NPS. RESULTS: We found an increased likelihood of occurrence of NPS in younger individuals and females across cohorts. Anxiety, depression, agitation, and apathy were associated with higher overall rate of NPS. We also found that individuals under 65 years of age with NPS had worse cognitive scores than their counterpart without NPS. CONCLUSION: The younger group with ADRD and NPS had lower cognitive scores, probably reflecting more aggressive neurodegenerative disease. Further work will be needed to elicit the degree to which imaging or mechanistic abnormalities distinguish this group.

Patients with severe mental illness and hepatitis C virus infection benefit from new pangenotypic direct-acting antivirals: Results of a literature review / Los beneficios de los nuevos antivirales pangenotípicos de acción directa en pacientes con enfermedad mental grave e infección por el virus de la hepatitis C: resultados de una revisión bibliográfica

Introduction: Hepatitis C virus (HCV) infection is a global health problem that can results in cirrhosis, hepatocellular carcinoma and even death. HCV infection is 3–20-fold more prevalent among patients with versus without severe mental illness (SMI), such as major depressive disorder, personality disorder, bipolar disorder and schizophrenia. Treatment options for HCV were formerly based on pegylated interferon alpha, which is associated with neuropsychiatric adverse events, and this contributed to the exclusion of patients with SMI from HCV treatment, elimination programmes, and clinical trials. Moreover, the assumption of poor adherence, scant access to healthcare and the stigma and vulnerability of this population emerged as barriers and contributed to the low rates of treatment and efficacy. Methods: This paper reviews the literature published between December 2010 and December 2020 exploring the epidemiology of HCV in patients with SMI, and vice versa, the effect of HCV infection, barriers to the management of illness in these patients, and benefits of new therapeutic options with pangenotypic direct antiviral agents (DAAs). Results: The approval of DAAs has changed the paradigm of HCV infection treatment. DAAs have proven to be an equally efficacious and safe option that improves quality of life (QoL) in patients SMI. Conclusions: Knowledge of the consequences of the HCV infection and the benefits of treatment with new pangenotypic DAAs among psychiatrists can increase screening, referral and treatment of HCV infection in patients with SMI.(AU)

Introducción: La infección por el virus de la hepatitis C (VHC) es un problema de salud mundial que puede provocar cirrosis, carcinoma hepatocelular e incluso la muerte. La infección por el VHC es de 3 a 20 veces más prevalente entre los pacientes con enfermedades mentales graves (EMG), como el trastorno depresivo mayor, el trastorno de personalidad, el trastorno bipolar y la esquizofrenia. Las opciones de tratamiento para el VHC se basaban anteriormente en el interferón pegilado alfa, que se asocia con efectos adversos neuropsiquiátricos, y esto contribuyó a la exclusión de los pacientes con EMG del tratamiento del VHC, tanto de los programas de eliminación como de los ensayos clínicos. Además, la mala adherencia terapéutica, el escaso acceso de los pacientes a la asistencia sanitaria y el estigma y la vulnerabilidad de esta población surgieron como barreras y contribuyeron a las bajas tasas de tratamiento y eficacia. Métodos: En este trabajo se revisa la literatura publicada entre diciembre de 2010 y diciembre de 2020 en la que se explora la epidemiología del VHC en pacientes con EMG, y vice versa, el efecto de la infección por VHC, las barreras para el manejo de la enfermedad en estos pacientes y los beneficios de las nuevas opciones terapéuticas con agentes antivirales directos pangenotípicos (AAD). Resultados: La aprobación de los AAD ha cambiado el paradigma del tratamiento de la infección por VHC. Los AAD han demostrado ser una opción igualmente eficaz y segura que mejora la calidad de vida (QoL) en los pacientes SMI. Conclusiones: El conocimiento de las consecuencias de la infección por el VHC y los beneficios del tratamiento con los nuevos AAD pangenotípicos entre los psiquiatras puede aumentar el cribado, la derivación y el tratamiento de la infección por el VHC en pacientes con EMG.(AU)

Clinical features and factors related to lifetime suicidal ideation and suicide attempts in patients who have had substance-induced psychosis across their lifetime.

Suicidal behaviors are common among patients with substance use disorders (SUD). However, the prevalence and clinical factors related to suicide behaviors among patients who have had substance-induced psychosis (SIP) is unknown. This study aims to explore the prevalence, clinical features, and factors related to lifetime suicidal ideation (SI) and suicide attempts (SA) in patients who have had SIP across their lifetime. A cross-sectional study was conducted in an outpatient center for addiction treatment between 01/01/2010 and 12/31/2021. 601 patients were evaluated with validated scales and questionnaires (79.03% males; M age 38.11±10.11 years). The prevalence of SI and SA was 55.4% and 33.6%, respectively. SI was independently related to any type of lifetime abuse, depressive spectrum disorders, benzodiazepine use disorder, borderline personality disorder, and the level of depressive symptoms. SA was independently associated with lifetime physical abuse, benzodiazepine use disorder, the number of psychotic symptoms, borderline personality disorder, and the level of depressive symptoms. The main factors related to SI and SA in those patients should be evaluated in daily clinical practice and considered in any approach to clinical practice as well as in health policies targeting suicide prevention.

Prevalence of hepatitis C virus infection in patients with chronic mental disorders: The relevance of dual disorders / Prevalencia de la infección por el virus de la hepatitis C en pacientes con trastornos mentales crónicos: la relevancia de la patología dual

Objective: The prevalence of hepatitis C virus (HCV) infection is higher in people with psychiatric disorders compared to the general population. In addition, patients with severe mental illness are frequently affected by substance abuse, which increases the risk of blood-borne viral infections. Epidemiological studies in samples of hospitalised individuals with chronic mental disorders and dual diagnosis (DD) are lacking. The objective of this study was to investigate the prevalence of HCV infection in a sample of in-patients with severe mental illness. Patients and methods: This was a retrospective observational study. All patients meeting selection criteria admitted to the Medium-Term Psychiatric Unit of the University of Salamanca Health Care Complex between 2007 and 2018 were included. The primary endpoint was the prevalence of HCV infection. The secondary endpoint comprised the characteristics influencing the occurrence of HCV infection in these patients. Results: A total of 497 admissions were included and patients’ last admission data were considered for analyses (n=345). The overall prevalence of HCV infection was 3.8% and reached 14.3% among DD patients, who showed a higher prevalence than those without this condition (14.3% versus 3.1%, p=0.009). HCV RNA was detected in 6 individuals at diagnosis who received DAA treatment reaching sustained virological response. Conclusions:The prevalence of HCV infection in our sample was higher than in the general population, especially among DD patients. Despite the multiple barriers to access healthcare by patients with chronic mental illness, efforts to include this population in screening and treatment are mandatory.(AU)

Objetivo: La prevalencia de la infección por el virus de la hepatitis C (VHC) es mayor en las personas con trastornos psiquiátricos que en la población general. Además, los pacientes con enfermedades mentales graves padecen con frecuencia abuso de sustancias, que aumenta el riesgo de infecciones virales transmitidas por la sangre. El objetivo de este estudio fue investigar la prevalencia de la infección por el VHC en una muestra de pacientes hospitalizados con trastornos psiquiátricos graves. Pacientes y métodos: Se trata de un estudio observacional retrospectivo. Se incluyeron todos los pacientes que cumplían los criterios de selección ingresados en la Unidad de Convalecencia del Servicio de Psiquiatría del Complejo Asistencial Universitario de Salamanca entre 2007 y 2018. El criterio de evaluación principal fue la prevalencia de la infección por VHC. El criterio de evaluación secundario abarcó las características que contribuyen a dicha infección en estos pacientes. Resultados: Se consideraron los datos del último ingreso de los pacientes incluidos (n=345). La prevalencia global de la infección por VHC fue del 3,8% y alcanzó el 14,3% entre los pacientes con patología dual, que mostraron una prevalencia mayor que aquellos sin esta condición (14,3 versus 3,1%, p=0,009). Se detectó ARN de VHC en 6 individuos en el momento del diagnóstico, que recibieron tratamiento DAA y alcanzaron una respuesta virológica sostenida. Conclusiones: La prevalencia de infección por VHC en nuestra muestra fue mayor que en la población general, especialmente entre los pacientes con patología dual. A pesar de las barreras que dificultan el acceso a la atención sanitaria de los pacientes con enfermedades mentales crónicas, es imprescindible incluirlos en el cribado y el tratamiento.(AU)

Patients with severe mental illness and hepatitis C virus infection benefit from new pangenotypic direct-acting antivirals: Results of a literature review.

INTRODUCTION: Hepatitis C virus (HCV) infection is a global health problem that can results in cirrhosis, hepatocellular carcinoma and even death. HCV infection is 3-20-fold more prevalent among patients with versus without severe mental illness (SMI), such as major depressive disorder, personality disorder, bipolar disorder and schizophrenia. Treatment options for HCV were formerly based on pegylated interferon alpha, which is associated with neuropsychiatric adverse events, and this contributed to the exclusion of patients with SMI from HCV treatment, elimination programmes, and clinical trials. Moreover, the assumption of poor adherence, scant access to healthcare and the stigma and vulnerability of this population emerged as barriers and contributed to the low rates of treatment and efficacy. METHODS: This paper reviews the literature published between December 2010 and December 2020 exploring the epidemiology of HCV in patients with SMI, and vice versa, the effect of HCV infection, barriers to the management of illness in these patients, and benefits of new therapeutic options with pangenotypic direct antiviral agents (DAAs). RESULTS: The approval of DAAs has changed the paradigm of HCV infection treatment. DAAs have proven to be an equally efficacious and safe option that improves quality of life (QoL) in patients SMI. CONCLUSIONS: Knowledge of the consequences of the HCV infection and the benefits of treatment with new pangenotypic DAAs among psychiatrists can increase screening, referral and treatment of HCV infection in patients with SMI.

Prevalence of hepatitis C virus infection in patients with chronic mental disorders: The relevance of dual disorders.

OBJECTIVE: The prevalence of hepatitis C virus (HCV) infection is higher in people with psychiatric disorders compared to the general population. In addition, patients with severe mental illness are frequently affected by substance abuse, which increases the risk of blood-borne viral infections. Epidemiological studies in samples of hospitalised individuals with chronic mental disorders and dual diagnosis (DD) are lacking. The objective of this study was to investigate the prevalence of HCV infection in a sample of in-patients with severe mental illness. PATIENTS AND METHODS: This was a retrospective observational study. All patients meeting selection criteria admitted to the Medium-Term Psychiatric Unit of the University of Salamanca Health Care Complex between 2007 and 2018 were included. The primary endpoint was the prevalence of HCV infection. The secondary endpoint comprised the characteristics influencing the occurrence of HCV infection in these patients. RESULTS: A total of 497 admissions were included and patients' last admission data were considered for analyses (n=345). The overall prevalence of HCV infection was 3.8% and reached 14.3% among DD patients, who showed a higher prevalence than those without this condition (14.3% versus 3.1%, p=0.009). HCV RNA was detected in 6 individuals at diagnosis who received DAA treatment reaching sustained virological response. CONCLUSIONS: The prevalence of HCV infection in our sample was higher than in the general population, especially among DD patients. Despite the multiple barriers to access healthcare by patients with chronic mental illness, efforts to include this population in screening and treatment are mandatory.

The challenge of community mental health interventions with patients, relatives, and health professionals during the COVID-19 pandemic: a real-world 9-month follow-up study.

Since the beginning of the COVID-19 pandemic, the need to implement protocols that respond to the mental health demands of the population has been demonstrated. The PASMICOR programme started in March 2020, involving a total of 210 requests for treatment. Out of those subjects, the intervention was performed in 53 patients with COVID-19 without history of past psychiatric illness, 57 relatives and 60 health professionals, all of them within the area of Salamanca (Spain). Interventions were carried out by professionals of the public mental health service mostly by telephone. Depending on clinical severity, patients received basic (level I) or complex psychotherapeutic care combined with psychiatric care (level II). The majority of attended subjects were women (76.5%). Anxious-depressive symptoms were predominant, although sadness was more frequent in patients, insomnia in relatives and anxiety and fear in health professionals. 80% of the sample, particularly most of the health professionals, required a high-intensity intervention (level II). Nearly 50% of the people treated were discharged after an average of 5 interventions. Providing early care to COVID-19 patients, relatives and professionals by using community mental health resources can help to reduce the negative impact of crises, such as the pandemic, on the most affected population groups.

Healthcare professionals' perception and satisfaction with mental health tele-medicine during the COVID-19 outbreak: A real-world experience in telepsychiatry.

Background: The use of telemedicine is increasingly being implemented, showing numerous benefits over other methods. A good example of this is the use of telemedicine following the breakdown caused by the COVID-19 pandemic. Previous experiences with telemedicine (TM) have not been significantly explored in relation to the professionals' own perspectives. Objective: Identify and explore the perceptions and interests of mental health professionals who have performed TM during the period of pandemia. Methods: A questionnaire on mental health professionals' perceptions of and satisfaction of TM, the Font Roja Work Satisfaction Questionnaire, was adapted and used. Data collected included 112 Psychiatric Service professionals who conducted TM in March 2020, after the country had been under lockdown for 10 weeks. Over 12.000 medical consultations were carried out by the phone, showing an overwhelming response to this method. Results: High levels of satisfaction were recorded amongst professionals. TM would function as a complement to the traditional system of face-to-face visits (n-112, f-109, 96.5%). Only 9.7% (f-11) believed that digital or virtual interventions would completely replace face-to-face visits. 60.8% did not consider this monotonous work. The older the health workers were, the more satisfied they felt during their follow-up telephone consultation. The greater the previous experience, the more satisfaction was shown. There were gender differences: female mental health workers reported a greater level of comfort. Conclusion: TM can be implemented with less effort, but it requires time, methods, and resources to be managed. Satisfaction among professionals is high, especially among those with more clinical experience. Patient satisfaction must be contrasted against this.

Confirmatory factor analysis of 20-item toronto alexithymia scale in spanish patients with substance use disorder.

Alexithymia is highly prevalent in patients with substance use disorders (SUDs) and has been implied in SUD pathogenesis and treatment outcomes. However, the psychometric properties of the most-used instrument for evaluating alexithymia (the 20-item Toronto Alexithymia Scale, TAS-20) have been scarcely studied in relation to SUD patients.

Análisis factorial confirmatorio dela escala de alexitimia de toronto de20 ítems en pacientes españoles contrastorno por uso de sustancias / Confirmatory factor analysis of 20-item toronto alexithymia scale in spanish patients with substance use disorder

La alexitimia es altamente prevalente en pacientes con trastorno por uso de sustancias (TUS) y ha sido relacionado conla patogénesis y la evolución del TUS. Sin embargo, el instrumento más frecuentemente usado para la medición de laalexitimia (la Escala de Alexitimia de Toronto de 20 ítems- TAS-20) ha sido poco estudiado en cuanto a sus propiedades psicométricas en pacientes con TUS. Solamente cincoestudios han evaluado las características psicométricas de laTAS-20 en pacientes con TUS y ninguno en población española con TUS. Por lo anterior, se realizó un análisis factorialconfirmatorio y de fiabilidad en una muestra de pacientesespañoles con TUS (n=126; 75,4% hombres; edad media de43,7±14,6 años). El análisis factorial confirmatorio se realizóconsiderando que la TAS-20 tiene una estructura de tres factores (Dificultad para Identificar Sentimientos [DIF]; Dificultad para Describir Sentimientos [DDF]; Pensamiento Orientado hacia lo Externo [EOT]). En general, la TAS-20 tiene unaspropiedades psicométricas adecuadas en pacientes españolescon TUS. Sin embargo, el modelo clásico de tres factores dela TAS-20 se ajusta solo moderadamente bien en pacientesespañoles con TUS, siendo los factores DIF y DDF los constructos fiables y válidos, mientras que el factor EOT necesitamás investigación y debe analizarse con cautela en pacientescon adicciones. (AU)

Alexithymia is highly prevalent in patients withsubstance use disorders (SUDs) and has been implied inSUD pathogenesis and treatment outcomes. However, thepsychometric properties of the most-used instrument forevaluating alexithymia (the 20-item Toronto AlexithymiaScale, TAS-20) have been scarcely studied in relation toSUD patients. Specifically, only five psychometric studieshave been performed with samples of SUD patients, andno studies have focused exclusively on Spanish patientswith SUDs. Therefore, the aim of the present study was toexamine the internal accuracy and reliability of the TAS20 with a sample of Spanish SUD patients (n = 126; 75.4%male; mean age 43.7 ± 14.6 years). A reliability analysis and aconfirmatory factor analysis were executed, considering thatTAS-20 has a three-factor structure (difficulty identifyingfeelings [DIF]; difficulty describing feelings [DDF]; externallyoriented thinking [EOT]). The results indicated that TAS20’s psychometric properties are acceptable for assessingalexithymia in Spanish patients with SUDs. However,the three-factor model of TAS-20 was found to fit onlymoderately well with the patient sample, with DIF and DDFbeing the most reliable and valid constructs. In contrast, theEOT factor needs further research and should be cautiouslyanalyzed in the context of patients with addictions. (AU)

[Approaches used in secondary prevention of eating disorders: review of the evidence and effectiveness]. / Enfoques utilizados en la prevención secundaria de los trastornos de la conducta alimentaria: revisión de la evidencia y la efectividad.

Introduction: The most up-to-date information on the secondary prevention of eating disorders (EDs) is systematically and thoughtfully reviewed. Recommendations are given on screening and detection methods in the school population and at-risk populations; successful programs, training of professionals; referral to care and therapeutic resources; and early intervention. Also future lines are pointed out.

Introducción: Se revisa de forma sistemática y reflexiva la información más actualizada acerca de la prevención secundaria de los trastornos de la conducta alimentaria (TCA). Se dan recomendaciones sobre métodos de criba y detección en la población escolar y las poblaciones de riesgo; programas exitosos y formación de profesionales; derivación a recursos de atención y terapéutica, e intervención temprana. Y se apuntan líneas futuras.

[Self-esteem, self-image, and school bullying in eating disorders]. / Autoestima, imagen personal y acoso escolar en los trastornos de la conducta alimentaria.

Introduction: Body dissatisfaction (BD) is considered one of the most important risk factors for the development of an eating disorder (ED), and low self-esteem a confirmed psychological trait of vulnerability. People with ED or related characteristics suffer more often (two to three times more) from bullying or teasing related to appearance. Special mention should be made of participants in intimidation and harassment behaviors, both as victims or perpetrators, who are at greater risk of developing food symptoms. The results are homogeneous when the control group is made up of the general population and more contradictory with psychiatric control groups. It is also necessary to study cyberbullying because of its relevance. Teasing interventions do not appear to be a priority in ED prevention programs, although EAT-IV results support the importance of targeting weight-related ridicule in education and health initiatives, and of including the family environment as a target in anti-bullying interventions, especially in girls. It will be necessary to consider different models of preventive intervention depending on their gender. In both sexes, personal and socio-family education interventions would be appropriate to expand a more flexible body aesthetic model. Interventions based on health promotion and education to improve self-esteem, where positive body image is promoted with face-to-face interventions, have been successful in reducing BD and ED. Body Project, ZARIMA, DITCA and AMEMC are effective programs.

Introducción: La insatisfacción corporal (IC) se considera uno de los factores de riesgo más importantes para el desarrollo de un trastorno de conducta alimentaria (TCA). Y la baja autoestima como un rasgo psicológico de vulnerabilidad confirmado. Las personas que tienen TCA o características afines sufren con más frecuencia (dos a tres veces más) acoso escolar o burlas relacionadas con la apariencia. Mención especial merecen los participantes en conductas de intimidación y acoso, tanto cómo víctimas o verdugos, que tienen más riesgo de desarrollar sintomatología alimentaria. Los resultados son homogéneos cuando el grupo de control lo constituye la población general y más contradictorios con grupos de control psiquiátricos. Se hace necesario también estudiar el ciberacoso o cyberbullying, por su actualidad. Las intervenciones en las burlas no parecen ser una prioridad en los programas de prevención de los TCA, aunque los resultados del EAT-IV apoyan la importancia de abordar las burlas relacionadas con el peso en las iniciativas de educación y salud e incluir el ambiente familiar como diana en las intervenciones anti-bullying, especialmente en las chicas. Habrá que plantearse diferentes modelos de intervención preventiva en función del género. En los dos sexos serían apropiadas las intervenciones personales y de educación sociofamiliar para expandir un modelo estético corporal más flexible. Las intervenciones basadas en la promoción y educación de la salud para mejorar la autoestima, donde se promociona la imagen corporal positiva con intervenciones presenciales, han tenido éxito en reducir IC y patología alimentaria. Body Project, ZARIMA, DITCA y AMEMC son programas efectivos.

[Reducing stigma-discrimination. Help seeking-empowerment. Emotional education-mental health literacy]. / Disminuir la estigmatización-discriminación. Búsqueda de la ayuda-empoderamiento. Educación emocional-alfabetización en salud mental.

Introduction: The existing literature is reviewed to determine the current state of knowledge about eating disorders (ED), prevention programs in relation to stigma-discrimination, help search, empowerment, emotional education, mental health literacy, and recommending future directions. Preventive interventions, necessary during adolescence and young adulthood, must be designed with the focus on reducing discrimination based on weight and the stigmatization of ED. With some gender specificities, with attention to stress and social isolation, social consensus, EDs in men; with work to reduce compliance with some norms of the male gender, as one of the targets in the development of prevention programs. And reduce teasing by peers and family, experiences of stigmatization with the family and at work, which predict greater internalization of prejudice due to weight (IPP). And carry out mental health literacy activities such as the Media Smart program, promote help seeking, empowerment as in the REBel program and improve emotional education, the management of negative emotions with activities for the improvement of emotions, in addition to the Body Project (cognitive dissonance).

Introducción: Se revisa la bibliografía existente para determinar el estado actual del conocimiento acerca de los programas de prevención de TCA en relación con la estigmatización-discriminación, la búsqueda de ayuda, el empoderamiento, la educación emocional, la alfabetización en salud mental y recomendar futuras direcciones. Hay que diseñar intervenciones preventivas, necesarias durante la adolescencia y la edad adulta joven, con el foco en reducir la discriminación basada en el peso y la estigmatización de los TCA. Con algunas especificidades por género, con atención al estrés y el aislamiento social, el consenso social, los TCA en varones; con trabajo en disminuir la conformidad con algunas normas del género masculino, como una de las dianas en el desarrollo de los programas de prevención. Y disminuir las burlas por compañeros y familia, las experiencias de estigmatización con la familia y en el trabajo, que predicen mayor internalización de prejuicio por el peso (IPP). Y realizar actividades de alfabetización de salud mental como el programa Media Smart, fomentar la búsqueda de ayuda y el empoderamiento como en el programa REBel, y mejorar la educación emocional y el manejo de las emociones negativas con actividades para la mejora de las emociones, adicionales al Body Project (disonancia cognitiva).

A Feasibility Study of Patients with Major Depression and Substance Use Disorders: Vortioxetine as Maintenance Treatment.

Background: Limited studies have evaluated the effectiveness of vortioxetine in real-world settings, and none of them has involved patients with dual depression (major depressive disorder [MDD] and substance use disorder [SUD]). The objective of the study was to describe the effectiveness of vortioxetine in clinical practice and determine its effect on affective symptoms, cognitive function, quality of life, and substance use in patients with MDD and SUD. Methods: Post-authorization, retrospective, multicenter, descriptive, and observational study in 80 patients with MDD and SUD receiving a maintenance treatment with vortioxetine for six months between January 2017 and April 2021. Results: Compared with baseline, scores significantly decreased after 3 and 6 months of treatment in the Montgomery-Åsberg Depression Rating Scale total (from 28.9 to 17.7 and 12.0), and global functional impairment of the Sheehan Disability Inventory (from 26.3 to 19.1 and 16.7). The number of correct answers in the symbol digit modalities test significantly improved during vortioxetine treatment (from 40.4 to 43.8 and 48.4). Regarding the clinical global impression scale, the score for disease severity significantly decreased from 3.8 to 3.0 and 2.4. Compared with baseline, there was a significant reduction in consumption of practically all substances, especially of alcohol, cannabis, and cocaine. Conclusion: Vortioxetine was effective in clinical practice for alleviating depressive symptoms and functional impairment, and in improving cognitive and executive functions and disease severity in patients with MDD and SUD. Moreover, the treatment with vortioxetine favored a reduction in substance use and the severity of the SUDs.

Increased incidence of high-lethality suicide attempts after the declaration of the state of alarm due to the COVID-19 pandemic in Salamanca: A real-world observational study.

The coronavirus pandemic has led to people getting involved in harmful behaviors. In our observational study, we assessed 241 patients with suicidal thoughts or behaviors in the emergency room before, during, and after the lockdown, from January to July 2020. After the lockdown, retired patients made higher-lethality attempts, and consultations related to suicide were less frequent, but active suicidal behaviors were more frequent. Men tended to use more lethal methods, and women made more suicidal gestures and had more suicide-related consultations. We observed an increase in the lethality of the attempts after the declaration of the state of alarm.

Frequency and Associated Factors of Suicidal Ideation in Patients with Chronic Obstructive Pulmonary Disease.

We aimed to examine the prevalence of suicidal ideation in patients with chronic obstructive pulmonary disease (COPD) and the association between demographic and clinical variables and the occurrence of suicidal thoughts. This was a cross-sectional study. Sociodemographic and clinical data were recorded, and questionnaires were used to assess depressive symptoms (Beck Depression Inventory), comorbidities (Charlson Index), cognitive performance (Mini Mental State Examination), and quality of life (EuroQoL-5 dimensions and CAT). Specific questions about suicide-related behavior were included. Multivariate logistic regression analysis identified the significant factors associated with previous suicidal ideation and suicide attempts. The analysis included 1190 subjects. The prevalence of suicidal ideation and suicide attempts were 12.1% and 2.5%, respectively. Severely depressed patients had the highest prevalence of suicide-related behavior. The adjusted logistic model identified factors significantly associated with suicidal ideation: sex (odds ratio (OR) for women vs. men = 2.722 (95% confidence interval (CI) = 1.771-4.183)), depression score (OR = 1.163 (95% IC = 1.127-1.200)), and Charlson Index (OR 1.228 (95% IC 1.082-1.394)). Suicidal ideation is common in COPD patients, especially in women. While addressing suicidal ideation and suicide prevention, clinicians should first consider the management of depressive symptomatology and the improvement of coping strategies.

Impact on Sleep Quality, Mood, Anxiety, and Personal Satisfaction of Doctors Assigned to COVID-19 Units.

The SARS-CoV-2 health emergency has led to a restructuring of health care systems and the reassignment of medical specialists from their usual duties to attend COVID-19 patients. The aim of this paper is to describe the levels of insomnia, anxiety, depression, and the impact on quality of life of doctors who were on the frontline of COVID-19 during the first two waves of the pandemic. Self-report surveys were conducted on said physicians during both waves, with 83 and 61 responses in the first and second waves, respectively. The reported presence of insomnia was frequent (71.8%), although it decreased in the second survey. Anxiety was moderate, decreasing from 57.1% to 43.1% between measurements. Overall, depression rates decreased between the two surveys. Substance use was found to have an indirect correlation with personal and professional satisfaction. In the light of the unforeseeable evolution of the pandemic and the medium- to long-term repercussions on professionals, we believe the adaptation of health resources is crucial to meet the new unpredictable mental health needs of this group.

Effectiveness and types of interventions to reduce mental illness-related stigma among Medical university students: A literature review (1997-2020).

There is a high prevalence of stigma among medical students towards mental illness, which can have far reaching negative consequences. It is essential to intervene and modify their preconceptions in order to fight against stigma.