Evaluación del modelo comunitario de atención a los trastornos mentales en España / Evaluation of the community mental health care model in Spain

Introducción: El objetivo de este trabajo consiste en evaluar la implementación del modelo comunitario de atención en salud mental en el Estado español en 2014. Secundariamente, se analizan los cambios que el modelo experimentó en 2008, en relación con la recesión económica. Material y Método: Se adoptó la definición de modelo comunitario que se propone en la Estrategia en Salud Mental del SNS, según la cual el modelo se rige por 8 principios y se implementa mediante 39 prácticas asistenciales. Se elaboró una encuesta dirigida a las Juntas Autonómicas de Gobierno de la Asociación Española de Neuropsiquiatría sobre el grado de cumplimiento del modelo comunitario en cada comunidad. Resultados: Se obtuvieron respuestas de 13 Juntas Autonómicas que incluyeron información sobre el 93% de la población española. Conclusión: Las carencias más importantes en la implementación del modelo comunitario en 2014 se relacionaron con la ausencia de una perspectiva de salud pública, con la mala gestión y rendición de cuentas, y la ralentización del desarrollo de equipos, servicios y redes de servicios de orientación comunitaria. El modelo se modificó poco globalmente entre 2008 y 2014, pero algunas prácticas clave, como la universalidad y gratuidad del sistema, la atención sectorizada, el acortamiento de los tiempos de espera, las subvenciones a las asociaciones de usuarios y familiares, y la aplicación de la "ley de dependencia" se contrajeron de forma sustancial en muchas comunidades. Otras prácticas, como la historia clínica informatizada, los planes Individualizados de atención y el tratamiento asertivo comunitario, incrementaron su cobertura en algunas comunidades a pesar de la recesión

Introduction: The objective of this study is to evaluate the implementation of the community mental health care model in the Spanish state in 2014. Secondly, we aim to analyze the changes experienced by the model in 2008, in relation to the economic recession. Materials and methods: We adopted the definition of community model proposed in the Strategy in Mental Health of the National Health System; according to which the model is based on 8 principles and is implemented by means of 39 care practices. The Autonomous Boards of the Spanish Association of Neuropsychiatry conducted a survey on the degree of compliance with the community model in each autonomous community. Results:Responses were obtained from 13 Autonomous Boards, which provided information on the 93% of the Spanish population. Conclusion: The most important shortcomings in the implementation of the community model in 2014 were related to the absence of a public health perspective, to poor management and accountability, and a slowdown in the diversification of community-based teams, services and networks. Globally, the model changed little between 2008 and 2014, but some key practices, such as the free and universal health coverage, the sectorization, the shortening of waiting times, the financial support to users and associations of relatives, and the implementation of the "Dependency Act", deteriorated substantially in many autonomous communities. However, other practices, such as the computerization of medical files, individualized care plans (Care Programme Approach), and the assertive community treatment, increased their coverage in some communities despite the recession

Relationship between personality traits and panic disorder.

Panic disorder is a chronic course disorder that causes important distress and impaired social function. The relationship between personality disorders and panic disorder has been studied, and determines its severity, course and treatment, but it has not been studied the relationship between personality traits and outcome of panic disorder. 82 patients with a first episode of panic disorder are selected and followed during 1 year, to analyze the existence and kind of relationship between their personality traits and the outcome of their disorder.

Relación entre rasgos de personalidad y evolución del trastorno de angustia / Relationship between personality traits and panic disorder

El trastorno de angustia es un trastorno de curso crónico que causa importante malestar y un deterioro de la función social. La relación entre trastornos de la personalidad y trastorno de angustia ha sido estudiada, y determina la severidad, curso y tratamiento del mismo, pero no se ha estudiado tanto la relación entre rasgos de personalidad y ansiedad. Ochenta y dos pacientes con un primer episodio de trastorno de angustia son seleccionados y seguidos durante un año, para estudiar la existencia y tipo de relación entre sus rasgos de personalidad y el curso evolutivo de su trastorno(AU)

Panic disorder is a chronic course disorder that causes important distress and impaired social function. The relationship between personality disorders and panic disorder has been studied, and determines its severity, course and treatment, but it has not been studied the relationship between personality traits and outcome of panic disorder.82 patients with a first episode of panic disorder are selected and followed during 1 year, to analyze the existence and kind of relationship between their personality traits and the outcome of their disorder(AU)

Can personality traits help us explain disability in chronic schizophrenia?

Psychotic features have been considered the main determinant of psychosocial function in schizophrenia. However, other variables are likely to affect dysfunction in these patients. The authors' hypothesis is that personality traits in outpatients with chronic schizophrenia differ from traits found in the healthy population and may be associated with disability in this disorder. A total of 62 patients with schizophrenia were evaluated with the Eysenck Personality Questionnaire (EPQ) and the Tridimensional Personality Questionnaire (TPQ). Psychotic features were measured with the help of the Positive and Negative Syndrome Scale (PANSS). Disability was assessed with the Disability Assessment Schedule (DAS). A total of 43 healthy subjects were used as controls for personality measurements. Normative data for the study population was also used to evaluate results in patients. Patients with schizophrenia had higher levels of neuroticism (median in percentile 65) and lower levels of extraversion (median in percentile 25) than the healthy population. Results of the TPQ showed higher harm avoidance and lower reward dependence levels compared to the healthy population. After multiple regression tests, negative symptoms were the strongest predictor of disability in patients with schizophrenia. Neuroticism contributed independently to the DAS overall behavior and global judgement subscales scores (more negative symptoms and higher neuroticism resulted in worse functioning), but not to the social role subscale. Outpatients with chronic schizophrenia showed high levels of neuroticism, harm avoidance, and introversion. Neuroticism significantly contributes to the long-term deficits found in patients with schizophrenia.

Quality of life in early phases of panic disorder: predictive factors.

OBJECTIVE: To analyse the quality of life (QoL) of patients with panic disorder of recent onset and to find related clinical variables. METHOD: Panic disorder patients with and without agoraphobia (N=125) in the first stages of the disorder (median of 8 months since the first panic attack) were compared with a community control group. Quality of life was evaluated by 36-item Short-Form Health Survey (SF-36) and by a single-item scale evaluating subjective well-being. RESULTS: Panic disorder patients had worse scores than the general population in all of the dimensions of the SF-36. Anxiety and depressive symptoms, age, frequency of panic attacks and agoraphobic avoidance accounted for 18-42% of the variance in QoL scores. Frequency of panic attacks and agoraphobic avoidance were variables accounting for poor QoL in physical functioning and mental health respectively. However, unspecific factors in addition to panic symptomatology, particularly depressive and anxiety symptoms, significantly contribute to the worse QoL of these patients. CONCLUSION: Panic disorder of recent onset is a deteriorating condition. Clinical variables do not equally affect mental health and physical functioning, and unspecific factors in addition to panic contribute to the poor QoL.

The acute phase response in panic disorder.

An acute-phase response (APR), manifested as an increase of acute-phase proteins has been shown in major depression. Panic disorder (PD) may share some aetiopathogenic mechanisms with depression, but APR has not been studied in this disorder. Forty-one panic patients in the first stages of their illness were compared with 32 healthy subjects of comparable sex, age, and body mass index. Clinical diagnosis was established with the mini international neuropsychiatric interview, and severity with the panic disorder severity scale and the CGI scale. Laboratory determinations included four acute phase proteins (APPs) [albumin, gammaglobulins, fibrinogen, C-reactive-protein (CRP)] and basal cortisol level. Patients were studied after 8-wk follow-up taking selective serotonin reuptake inhibitors (SSRIs) to assess the evolution of the APPs. Gammaglobulin levels were lower, and both cortisol and CRP levels were higher in PD patients than in controls. APP did not differ between patients with or without agoraphobia. At follow-up, patients who responded to SSRIs presented a decrease in albumin levels, and a trend towards a decrease in cortisol and CRP compared with levels at intake. The conclusions of this study are that there is an APR in patients suffering from PD, and this APR tends to diminish after a successful treatment with SSRIs.

Alterations of liver function test in patients treated with antipsychotics.

The prevalence of alterations of liver function tests in patients treated with a wide range of antypsychotics is unknown. The aim of this study was to analyze the effects of antipsychotics on liver function tests in a population of schizophrenic outpatients. Concentrations of AST, ALT, GGT, alkaline phosphatase, albumin, and bilirubin were determined in 54 patients fitting DSM-IV criteria of schizophrenia, and the same number of sex- and age-matched healthy subjects. Assessments included the Clinical Global Impression (CGI) and the Positive and Negative Syndrome Scale (PANSS) in addition to treatment related variables. Transaminases concentrations were slightly elevated in study patients compared to healthy controls, but without statistical significance. Alkaline phosphatase showed higher values in schizophrenic patients. Albumin and bilirubin were lower in study patients. Liver function tests abnormalities were found in about 10% of schizophrenic patients treated with antipsychotics. Treatment with depot phenotiazines induces alteration in these tests more frequently than treatment with other antipsychotics. PANSS negative subscale scores directly correlated with alkaline phosphatase and inversely correlated with albumin. A substantial number of patients in treatment with antipsychotic drugs present alterations of liver function tests. Both pharmacological and clinical factors could be related with these alterations.