Decision Making in Psychiatric Patients: A Qualitative Study with Focus Groups. / Toma de decisiones en pacientes psiquiátricos: un estudio cualitativo con grupos focales.

INTRODUCTION: It has been said that mental illnesses are characterised by poor decision making; there is some neuroscientific evidence of specific alterations in performance in decision making tests, but little is known about how patients make choices about their own treatments. METHODS: Focus groups with patients from two psychiatric clinics, with discourse analysis. RESULTS: Five deductive categories (tools, capacity, therapeutic relationship, method and family and network), plus one additional category from the analysis (stigma), and 35 inductive (posterior) categories were considered. The categories are analysed and the findings presented. CONCLUSIONS: Patients express a need for greater participation in decisions about their treatment, and a more symmetrical psychiatrist-patient relationship, involving families. Decisions may be changed due to stigma, barriers to treatment access, and previous experiences.

Toma de decisiones en pacientes psiquiátricos: un estudio cualitativo con grupos focales

Introducción: Se ha dicho que las enfermedades mentales se caracterizan por la mala toma de decisiones; existe evidencia de neurociencias de alteraciones específicas en el desempeño en pruebas relacionadas con decisiones, pero poco se conoce sobre cómo los pacientes eligen acerca de su tratamiento. Métodos: Grupos focales con pacientes en 2 clínicas psiquiátricas, con análisis de discurso. Resultados: Se consideraron categorías previas (ayudas, capacidad, relación terapéutica, método, familia y red), con una categoría adicional (estigma) producto del análisis y 35 categorías inductivas. Se analizan las categorías, se presentan los hallazgos. Conclusiones: Los pacientes expresan necesidad de mayor participación en elecciones sobre su tratamiento y una relación más simétrica con el psiquiatra, con participación de las fami lias. Las decisiones pueden alterarse por el estigma, las barreras de acceso al tratamiento y las experiencias previas.

Introduction: It has been said that mental illnesses are characterised by poor decision making; there is some neuroscientific evidence of specific alterations in performance in decision making tests, but little is known about how patients make choices about their own treat ments. Methods: Focus groups with patients from two psychiatric clinics, with discourse analysis. Results: Five deductive categories (tools, capacity, therapeutic relationship, method and family and network), plus one additional category from the analysis (stigma), and 35 induc tive (posterior) categories were considered. The categories are analysed and the findings presented. Conclusions: Patients express a need for greater participation in decisions about their treatment, and a more symmetrical psychiatrist-patient relationship, involving families. Decisions may be changed due to stigma, barriers to treatment access, and previous expe riences.

Grounded theory. / Teoría fundamentada.

Grounded theory is a qualitative method that emphasises the induction or emergence of information from data, in order to establish a theory or model. From the classic description by Strauss and Glaser, different developments or schools are recognised, and some of the peculiarities and differences among them are discussed. Grounded theory is a versatile, organised and rigorous method, the application of which in health includes diverse fields such as public health, clinics and education.

Differences in BMI between Mexican and Colombian patients receiving antipsychotics: results from the International Study of Latinos on Antipsychotics (ISLA).

Objective: The objective of this study is to examine the association of country of residence with body mass index (BMI) between Mexican and Colombian patients exposed to antipsychotics. We hypothesize that there will be a significant association between country of residence and BMI and that Mexican patients will have higher BMI than their Colombian counterparts.Design: The International Study of Latinos on Antipsychotics (ISLA) is a multisite, international, cross sectional study of adult Latino patients exposed to antipsychotics in two Latin American Countries (i.e. Mexico and Colombia). Data were collected from a total of 205 patients (149 from Mexico and 56 from Colombia). The sites in Mexico included outpatient clinics in Mexicali, Monterrey and Tijuana. In Colombia, data were collected from outpatient clinics in Bogotá. For this study we included patients attending outpatient psychiatric community clinics that received at least one antipsychotic (new and old generation) for the last 3 months. A linear regression model was used to determine the association of country of residence with BMI for participants exposed to an antipsychotic.Results: After controlling for demographics, behaviors, biological and comorbid psychiatric variables, there was a significant difference between Colombia vs. Mexico in the BMI of patients exposed to antipsychotics (ß = 4.9; p < 0.05).Conclusion: Our hypotheses were supported. These results suggest that differences in BMI in patients exposed to antipsychotics in Mexico and Colombia may reflect differences in prevalence of overweight/obesity at the population level in the respective countries, and highlights the involvement of other risk factors, which may include genetics.

Clinical and Demographic Variables Associated Coping and the Burden of Caregivers of Schizophrenia Patients. / Variables demográficas y clínicas relacionadas con la carga y el afrontamiento de los cuidadores de personas diagnosticadas de esquizofrenia.

OBJECTIVE: To analyse of the relationship between burden of illness and coping strategies and the demographic variables of caregivers, and the demographic and clinical variables of people diagnosed with schizophrenia. METHODS: Multicentre correlational cross-sectional study including 70 people diagnosed with schizophrenia, or a schizoaffective disorder, and 70 primary informal caregivers. They were evaluated using Zarit Caregiver Burden Inventory, Family Coping Strategies Questionnaire, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and the brief Disability Assessment Scale. RESULTS: Burden of illness positively associated with patient impairment in occupational and social functioning, and negatively with education level. Avoidance, coercion and positive communication were positively associated with impairment in occupational and social functioning of patients. Social interest and friendships showed a positive association with the education level of caregivers. Spiritual assistance negatively correlated with impairment in social functioning and patient age, and resignation was negatively associated with length of the disorder and patient education level. CONCLUSIONS: Burden and dysfunctional coping strategies, such as avoidance and coercion, are associated with functional impairment of the patient. These findings suggest the need to provide support to caregivers, adjusted to the functional level of the patient, in order to prevent burden of care.

[Metachromatic Leukodystrophy. Case Presentation]. / Leucodistrofia metacromática. Presentación de caso.

Metachromatic leukodystrophy (MLD) is a rare demyelinating disease (prevalence 1:40 000), also called arylsulfatase A deficiency (ARS-A), which may present with neurological and psychiatric symptoms. Clinical assessment may be difficult, due to unspecific signs and symptoms. A case is presented of a 16 year-old female patient seen in psychiatry due to behavioural changes, psychosis, and with impaired overall performance. She was initially diagnosed with schizophrenia, but the Nuclear Magnetic Resonance (NMR) scan and laboratory tests lead to the diagnosis of MLD.

Cutis verticis gyrata en población masculina institucionalizada con enfermedad mental crónica en colombia. Serie de casos / Cutis verticis gyrata in adult male institutionalized population in colombia. Case series

El artículo describe casos de cutis verticis gyrata (CVG) encontrados institución de protección en Sibaté, Colombia. Se trata de una serie de casos de 65 hombres adultos; se describen las variables sociodemográficas y clínicas. Se encuentra en la institución una prevalencia de 5,9%, mucho más alta que lo esperada en la población general (1:100.000 hombres). El promedio de edad fue de 38,5 años, la mayoría analfabetas (98,46%). El diagnostic más frecuente fue de retard mental profundo en 59 casos (90,77%), con alta comorbiidad multiaxial. La presencia de surcos en cuero cabelludo tuvo un rango de 1 a 16. La edad de inicio y el tipo de CVG no pudieron ser establecidos. Se trata de la mayor serie de casos reportada en una sola institución. Existe necesidad de estudios posteriores para determinar el tipo, origen y evolución del hallazgo.

To describe Cutis Verticis gyrate (CVG) in cases found in an institutionalized people facility in Colombia. Case series with 65 male adult in-patients, describing socio-demographic and clinical variables. Prevalence of 5.9 % was higher than expected in the general population (1:100.000 in males). Mean age: 38.5 years, most illiterate (98.46%). The most frequent diagnosis was profound mental retardation in 59 (90.77 %) cases, with high multi-axis comorbidity. Folds range from 1 to 16. Age of onset and type of CVG couldn't be established. This is the largest case series reported from a single institution. There is need of further study to determine type, origin, and evolution of the sign.

Signos de liberación cortical en pacientes con esquizofrenia, trastornos depresivos, trastorno afectivo bipolar, demencia y enfermedad cerebrovascular / Cortical Release Signs in Patients with Schizophrenia, Depressive Disorders, and Bipolar Affective Disorder

Resumen Introducción y objetivos: Determinar la presencia de signos de liberación cortical, asociada a daño de sustancia blanca, es un método clínico de fácil realización. El objetivo es deter minar la presencia de signos de liberación cortical en pacientes con enfermedades mentales y enfermedad cerebrovascular y determinar su utilidad clínica, dado que indica daño cortical. Material y métodos: Se realiza búsqueda de signos de liberación cortical en pacientes hospitalizados en clínica psiquiátrica y hospital general con diagnósticos de trastorno afectivo bipolar (40), depresión (37), esquizofrenia (33), enfermedad cardiovascular (33) y demencia (37). Resultados: Los signos de liberación cortical no tienen igual importancia en la determinación de daño cortical; por ejemplo, se encontró reflejo glabelar en todos los grupos; el de paratonía, especialmente en el grupo con esquizofrenia, y más signos, en el grupo de pacientes con demencia. Conclusiones: Se formula que estos signos implican daño de sustancia blanca subcortical; la aparición de estos signos supone la necesidad de seguimiento de pacientes con diagnósticos de trastorno afectivo bipolar, depresión y esquizofrenia.

Abstract Background and objectives: Determining the presence of cortical release signs associated with white matter damage, is a clinically easy method to perform. The objective of this study is to determine the presence of cortical release signs in patients with mental illnesses and cerebrovascular disease, as well as its clinical usefulness, given that it indicates cortical damage. Material and methods: A review was made of cortical release signs in patients hospitalized in clinical psychiatry and general hospitals with bipolar affective disorder (40), depression (37), schizophrenia (33), cardiovascular disease (33) and dementia (37). Results: The signs of cortical release do not have the same importance as cortical damage. For example, the glabellar reflex was found in all the groups, that of paratonia, particularly in the group with schizophrenia, and others signs in the group of patients with dementia. Conclusions: It is suggested that these signs imply subcortical white matter damage. The appearance of these signs shows the need for a follow up of patients diagnosed with bipolar affective disorder, depression and schizophrenia.

Construcción de una carta institucional de deberes y derechos de pacientes con enfermedad mental / Construction of an Institutional Declaration of Duties and Rights of Mentally Ill Patients

Resumen Introducción: Se presenta el proceso de construcción de una carta institucional de deberes y derechos de pacientes con enfermedad mental, dado que a estas personas se las considera particularmente susceptibles a la vulneración de sus derechos. Se parte de los aspectos históricos, de calidad y legislación en Colombia. Se realizó una recopilación de cartas existentes, viendo la necesidad de actualización y aplicación de condiciones específicas de la prestación de salud en instituciones hospitalarias. Material y métodos: Estudio cualitativo, búsqueda de literatura, grupos focales y reuniones de concertación de los deberes y derechos con representantes de pacientes, familiares, residentes de psiquiatría, estudiantes de profesiones de ciencias de la salud y trabajadores en salud mental. Se enuncian principios generales y definiciones, buscando la comprensibilidad de la carta por los diferentes estamentos que participaron. Resultados: Se realizó un documento concertado con usuarios, compatible con la normativa en Colombia y los principios bioéticos, de calidad y de participación ciudadana, el cual se aprobó y se divulgó para integrarlo a la información institucional.

Abstract Introduction: A process of construction of institutional declaration of mental health patient's duties and rights is shown, highlighting that mentally ill people are considered particularly susceptible to the violation of their rights. Some aspects from historical, quality issues and law in Colombia are presented. Some declarations of rights were available, but they needed to be updated and adapted to the specific conditions of mental hospital health care. Material and methods: Qualitative research, literature search, focus groups and consultation meetings of duties and rights with representatives of patients, families, residents of psychiatry, medicine students, and mental health workers. It sets out general principles and definitions, looking understandability of the Declaration by the different groups involved. Results:The final document had users participation, this methodology is compatible with the regulations in Colombia, bioethical principles, quality issues and community participation. The final declaration was approved and integrated with corporate information.

[Construction of an Institutional Declaration of Duties and Rights of Mentally Ill Patients]. / Construcción de una carta institucional de deberes y derechos de pacientes con enfermedad mental.

INTRODUCTION: A process of construction of institutional declaration of mental health patient's duties and rights is shown, highlighting that mentally ill people are considered particularly susceptible to the violation of their rights. Some aspects from historical, quality issues and law in Colombia are presented. Some declarations of rights were available, but they needed to be updated and adapted to the specific conditions of mental hospital health care. MATERIAL AND METHODS: Qualitative research, literature search, focus groups and consultation meetings of duties and rights with representatives of patients, families, residents of psychiatry, medicine students, and mental health workers. It sets out general principles and definitions, looking understandability of the Declaration by the different groups involved. RESULTS: The final document had users participation, this methodology is compatible with the regulations in Colombia, bioethical principles, quality issues and community participation. The final declaration was approved and integrated with corporate information.

[Cortical Release Signs in Patients with Schizophrenia, Depressive Disorders, and Bipolar Affective Disorder]. / Signos de liberación cortical en pacientes con esquizofrenia, trastornos depresivos, trastorno afectivo bipolar, demencia y enfermedad cerebrovascular.

BACKGROUND AND OBJECTIVES: Determining the presence of cortical release signs associated with white matter damage, is a clinically easy method to perform. The objective of this study is to determine the presence of cortical release signs in patients with mental illnesses and cerebrovascular disease, as well as its clinical usefulness, given that it indicates cortical damage. MATERIAL AND METHODS: A review was made of cortical release signs in patients hospitalized in clinical psychiatry and general hospitals with bipolar affective disorder (40), depression (37), schizophrenia (33), cardiovascular disease (33) and dementia (37). RESULTS: The signs of cortical release do not have the same importance as cortical damage. For example, the glabellar reflex was found in all the groups, that of paratonia, particularly in the group with schizophrenia, and others signs in the group of patients with dementia. CONCLUSIONS: It is suggested that these signs imply subcortical white matter damage. The appearance of these signs shows the need for a follow up of patients diagnosed with bipolar affective disorder, depression and schizophrenia.

Historias de mujeres filicidas inimputables por enfermedad mental / Histories of unimputable filicidal women due to mental illness

Objetivo: el objetivo general del presente trabajo es analizar historias de mujeres filicidas inimputables por enfermedad mental y determinar si existe una caracterización de este grupo, si el hecho tiene sentido y si se inscribe en las historias personales y familiares. Métodos: investigación de tipo cualitativo mediante entrevistas semiestructuradas a mujeres filicidas del programa de inimputables del Ministerio de la Protección Social de Colombia. Desde 1997 al primer semestre de 2003, ocho casos son analizados. Se realizó entrevista, grabación de audio y posterior categorización según método deductivo e inductivo. Se presentan viñetas clínicas, datos generales y análisis de casos de tipo cualitativo. Se excluyeron mujeres imputables o en fase probatoria del proceso judicial. Las mujeres firmaron consentimiento informado, los datos obtenidos son confidenciales y no se utilizarán en los procesos, los cuales ya han sido fallados. Resultados: las pacientes de la muestra presentan las siguientes características: edad adulta (promedio 26,5 años), baja escolaridad, dependencia a figura masculina, devaluación de rol femenino, historia de maltrato y ausencia o muerte de alguno de los padres. Se presentan dos casos de filicidio múltiple y uno de neonaticidio. Las características de los menores son variables, desde hijos deseados, hijo único (1 caso), multiparidad (7 casos) hasta hijos no deseados. Las víctimas son de ambos géneros por igual. Conclusión: no existe un perfil único de la madre, del hijo o del tipo de delito.

Objective: The main objective of this work is to analyse the histories of filicidal women who are unimputable due to mental illness, and also to determine if there is a characterization in this group of women, if there is a meaning to the act, and if it fits in personal and family histories. Methods: This is a qualitative investigation by means of semi-structured interviews of filicidal women in the unimputables’ program of the Ministry of Social Protection in Colombia. Eight cases are analysed from 1997 to 2003. Personal interviews, audio taping and further categorisation by deductive and inductive methods was performed. Cases are shown with clinical vignettes, general data and qualitative analysis. Imputable women or cases not yet judged were excluded. The women signed an informed consent form, and data was kept confidential and will not be used in the legal process. Results: This sample was characterized by adult age (mean 26.5 years), low education level, dependence on a masculine figure, devaluation of the feminine role, history of childhood abuse, and death or absence of one or both parents. Two multiple filicide cases are shown and one case of neonaticide; child characteristics vary from wanted to unwanted pregnancies, and from only child to children with siblings. Victims are of both genders equally. Conclusion: There is not an only profile of mother, child, or type of crime.

Filicidio: una revisión / Filicide: A Review

El filicidio es un hecho impactante que ocurre en todas las culturas, como acto aislado o sistemático. Su interpretación es específica para cada cultura. Sólo en años recientes el filicidio ha sido retomado por la literatura psiquiátrica. El objetivo general de la presente revisión es evaluar factores históricos y culturales asociados al filicidio, con énfasis en elfilicidio materno y la enfermedad mental. Mediante la revisión de la literatura se establece el conocimiento actual sobre el tema y los diferentes abordajes teóricos.