Dolor crónico y tentativa de suicidio en la vejez a través de una narración de caso / [Chronic pain and suicide attempt in the elderly through a case narration].

We sought to reconstruct the case of an elderly patient who made a suicide attempt. We have isolated and identified certain risk factors which could have determined the patient’s final decision, such as chronic pain, social isolation, narcissistic personality traits, depression and family suicidality. We analyze the difficulties and limitations found in the current treatment of these patients, with an aim to raise greater interest in the research and treatment of them.

Suicidio, palabra maldita (muerte, palabra prohibida) / [Suicide, damned word (death, forbidden word)].

This paper addresses four main questions regarding suicide: Death, as a substitute to Sex as a Tabu, the lack of a theory capable of rendering a comprehensive concept, the dichotomy severing epidemiology from clinics; and lastly the notion of the good treatment as the best preventive approach to the individual patient.

Riesgo y suicidio en sistemas de puertas abiertas. Responsabilidad civil y aspectos médico legales / [Risk and suicide in open door institutions. Liability and phorensic issues].

Suicide is a complex issue and a source of discussion between different disciplines. Suicide assessment and management research had received a huge attention in the field. Argentina has a legal framework focused on protecting human rights. Malpractice and liability discussion is offered in cases of suicide in psychiatric patients recently admitted to an inpatient setting. Imminent and certain risk of damage is the legal requirement for involuntary psychiatric admission in terms of Mental Health Law in Argentina.

Autolesiones deliberadas. Entre la restricción y el alivio / [Deliberate self-harm (DSH). Between constraint and relief].

This article is the product of the research work done on "Deliberate self-harm -DSH-: a constraint way to open to the world?" in which this Deliberate Self Harm was explored as from the phenomenological psychopathology and the suicidology theoretical approach, such research being done on the subjective and reflective narrations of people undergoing such problems, coming from different sources. Some discourse patterns are exposed that may be considered of great usefulness for the identification, the treatment -or postvention-, as well as for the prevention of the problem at issue. As an annex, a Survey of Self-harm is presented made for data collection and the planning of actions in communitarian interventions with adolescents form different places in Argentina, in conjunction with the Argentinean Professional Team of the Argentinean Association for Suicide Prevention.

Pacientes hospitalizadas por ideación e intento de suicidio en un Hospital de Salud Mental: características clínico-demográficas y seguimiento a seis meses / [Patients hospitalized for suicidal ideation and suicide attempt in a Mental Health Hospital: Clinicodemographical features and 6-month follow-up].

BACKGROUND: Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. OBJECTIVE: To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. METHODS: In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. RESULTS: Baseline data show that of all patients who entered the Emergency Department, 27

did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41

) and schizophrenia (16

). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22

of patients had a new attempted suicide and 34

had a readmission in a 6-month period. CONCLUSIONS: Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.

Centro Público Provincial de Intervención en Crisis y Rehabilitación Psicosocial. Una senda hacia la Suicidología Comunitaria / [Provincial public center for crisis intervention and psycho-social rehabilitation. A path towards communitary suicidology].

This work on the systematic comprehensive approach towards the Prevention and Postvencion of Suicide started to develop back in mid 2011 in Río Gallegos, capital of Santa Cruz Province. The first step on this development was a Pilot Plan for the Training of Professionals and also field intervention. The Center for Crisis Intervention and Psycho-social Rehabilitation was founded eight months later. The case-client in crisis plus family group- undergoes quantitative and qualitative evaluation by means of a triage system, all of which allows starting intensive face-to-face and also phone follow up according to the Crisis Intervention Model. Such intervention is developed by means of the participation in the "Grupo Sostén", the Adolescents Group if the client fits into that age, and also family relationship interviews as well as Multi-family meetings open to the Community. There is also a Community Team in the Center which performs collective assessment in schools, in conjunction with the "Equidad en Redes" Educational Specialty Team, belonging to the Provincial Education Council. The approach takes place on the field, and works as a screening step for the early detection of risk. Such risk is dealt with by means of short term intervention group programs involving the whole of the educational community. When facing situations of committed suicide there are interventions in communities to the interior of the province, fundamentally through the Hospital Team which works as the cluster convener for the social intersectoral frame-work.

El suicidio de un paciente. Impacto en el psiquiatra / [A patient’s suicide. The psychiatrist’s impact].

The clinical work of the psychiatrist often faces him to people who openly talk about their wish to die. However, although such thoughts did not culminate in most cases, unfortunately statistics show that suicide is a concrete possibility, more frequent than suspected. Globally, a million people die by suicide each year. The will to kill themselves is a complex phenomenon that is neither new nor modern. Suicide has crossed different times adopting different forms and meanings according to culture and history. As doctors, we tend to describe behaviors, in this case highly such a variable one, which involves various reasons and determinants. Thus, much has been written in the scientific literature about suicide in the causes, risk and protective factors, most vulnerable groups, etc. It has also been remarked the pain that the suicide causes in the family and close friends. Lots of articles propose psychotherapeutic and supporting measures for the suicide survivors to avoid the traumatic consequences of the experience. But, what about the psychiatrist? Isn’t him a person who has been in close contact with the subject who has killed himself? The survivor risk of having traumatic symptoms, does it not apply to the doctor who was in charge? In this article, it will be taken into account the point of view of the psychiatrist in the grief after a patient’s suicide.

Quemaduras intencionales con ácido. Nuevas expresiones de violencia contra la mujer en Medellín, Colombia. Serie de casos / [Deliberate burning with acid. New expressions of violence against women in Medellín, Colombia. Series of cases].

INTRODUCTION: The deliberate burns with acid are recognized as violence against women described in the 17th century. However, in the second half of the 20th Century this practice becomes frequent in South East Asia, Africa and Middle East. In Latin America is a recent phenomena over which little has been published in the scientific literature. OBJECTIVE: To describe the clinical and psychic-pathological characteristics of 8 Colombian women burned with acid in the context of violence based on gender. METHOD: retrospective series of cases, patients admitted at a university hospital in a period of 7 years after being burned with acid within the context of hetero-aggression. The patients were attended by a group of interdisciplinary health professionals, including the psychiatrists. The psychiatric analyses were carried out parting from the non structured psychiatric interview complying with diagnostic criteria of the Statistic and Diagnostic Manual. RESULTS: Eight women with an average age of 29.5 years were attacked with acid in a period of 8 years. The context for the aggression was violence based on gender. All the attackers were males. The body surface burned was 24

in average. The ocular involvement was present in 80

of the cases, two of them with bilateral blindness. The direct aggressor was the partner in three cases. The reason for the attack was jealousy and revenge due to rejection to sexual or love advancements or pretensions. CONCLUSIONS: The burns with acid constitute a new expression of the violence based on gender in Colombia. This type of aggressions generates suffering, rejection and social isolation and although, it does not have the intent to cause death to the victim, it does leave permanent scars of the aggression.

Las crisis de angustia en la urgencia y su relación con los factores desencadenantes desde una perspectiva de género / [Acute stress disorder in the emergency, its relationship with trigger factors from a gender perspective].

BACKGROUND: Anxiety disorders and, in particular, acute stress disorder are one of the principal reasons for medical assistance, being the women the ones who frequently consult. AIMS: To describe and analyze, from a perspective of gender, the factors that unleash the consultation of an episode of acute stress disorder in the emergency. MATERIALS AND METHOD: An exploratory descriptive study was performed. A semi-directed interview and a socio-demographic questionnaire were assessed and scales to evaluate anxiety and depression were administered to females that consulted for an acute stress disorder. RESULTS: Sixty nine percent of the patients described the physical discomfort as trigger factor, presenting in the 85

of the cases a degree of major anxiety; associating the family conflicts as the principal cause of distress, followed by violence against women. The situation of distress, in 75

of the cases, did not correspond with an isolated episode. CONCLUSION: The physical symptomatology was the principal cause for consultation of an episode of acute stress disorder in the emergency, being the family conflicts and the violence against women the principal reasons of distress. Therefore, interdisciplinary approach for the assistance of mental disorders in emergency should be taken in consideration.

Satisfacción con los servicios de salud mental para niños y adolescentes según el sexo de los usuarios y profesionales / [Satisfaction with child and adolescent mental health services by user and clinician sex].

Client Satisfaction with mental health services is an important aspect in the evaluation of quality of those services. In youth mental health field, a few studies had being made about this characteristic. The aim of this study is to evaluate the relationship between satisfaction of parents, children and adolescents according to sex of patients and therapists. The sample included 382 subjects who attended to Buenos Aires private services who completed the questionnaire of experiences with the service. The results in teenagers’ group showed differences in the satisfaction with the service matching the sex of teenagers with the sex of therapist, however in children and parent groups we haven’t found significant differences. We discuss the implications of the results in order to improve the services given in youth area.

Abordajes reduccionistas de problemáticas complejas: una reflexión epistemológica y ética / [Reductionist approaches of complex problems: an epistemological and ethical reflection].

Reductionism is a constitutive feature of the "standard view" or inherited conception in philosophy of science, such as Enrique Marí says in his book "Elements of comparative epistemology". Whereas the "standard view" is one of the articulators of scientism - epistemological hegemonic position in the contexts of education, innovation, evaluation and application of techno-scientific knowledge - imposed an analysis of this concept as a necessary condition for its overcoming. This article intends to define the meaning and scope of the epistemological reductionism within the framework of the biomedical sciences, on the basis of their genealogy, and then moving in the explicitation of the multiple ways that invest for, finally, realize the consequences of his naive acceptance - or perhaps downright accomplice, of a great part of the scientific community. The consequences are presented in the field of theory, but very particularly in the field of praxis. Establishing the ethical implications of the epistemological reductionism in the theory and practice of Biomedical Sciences is the objective of this work.

¿Estamos (los psiquiatras infantiles) patologizando la infancia? / [Are we (child psychiatrists) pathologizing childhood?].

Child psychiatry is a young discipline with great potential. Comparing the current resources that we had a few decades ago the contrast is marked. Our discipline has had a great development. The current psychiatric thinking cannot be defined based on one main theory to which all psychiatrists adhere. There is a theoretical pluralism where different models coexist in tension. The child psychiatrist requires conducting diagnostic regardless of their frame of reference without polarizing the field because not only is required to make a psychiatric diagnosis but also requires an understanding of the unique problems of the patient. Currently we have two methods of assessment and diagnosis of children with psychiatric disorders: 1) the phenomenological method (derived from DSM), and 2) the traditional method (dynamic). The best is to make use of all available resources and clinical tools. The use of psychotropic drugs in clinical practice in children and adolescents has been installed as a controversial issue in our society. These debates have great difficulty crossing ideological and clinical arguments. It is appropriate to put in discussion the use of drugs. It is remarkable the therapeutic potential of psychotropics but we must also keep in mind the great business environment underlying our practice.

La importancia de la detección precoz y de la intervención temprana en niños con condiciones del espectro autista / [The importance of early detection and early intervention for children with autism spectrum conditions].

Autism spectrum disorders are a group of neurodevelopmental disorders characterized by social communication difficulties and restrictive and repetitive patterns of behavior, interests and activities. In Argentina in 2013, legislation introduced both at national and provincial levels generated vigorous debate in relation to early detection of autism spectrum disorders, diagnosis or "pathologization" of children, and early intervention for these children. This paper provides evidence supporting the importance of systematic screening for autism spectrum disorders in toddlers, the usefulness of the new autism spectrum disorder classification provided by DSM-5, the desirability of timely and comprehensive diagnostic assessments by interdisciplinary teams specialized in development, and the critical importance of early intervention. Early intervention takes advantage of the neuroplasticity present in early life and positively impacts prognosis of children and family quality of life. Finally, the role of parent-mediated interventions in the treatment of children with autism spectrum disorders is mentioned.

Entre la clínica exagerada y la clínica exasperada. Puentes, diferencias y rupturas en Salud Mental Infantojuvenil / [Between the exaggerated and the exasperated clinic. Bridges, differences and rupture in child and youth mental care].

This article intends to approach a series of contrasting concepts regarding different relevant issues for the Child and Youth Mental Health. Diagnosis as a temporary and unstable assessment method. Early detection and treatment as opposed to the possibility of premature diagnoses. The possible or impossible dialogues between psychoanalysis, neuroscience and cognitive sciences. The problems associated with autism and its different theoretical approach models. The development of each of these complex aspects of the practice considers the risk of treating the child as a mere "pathological entity" and dehumanizing him and his condition from the different perspectives, disciplines and discourses, which intend to address the child and his condition. Finally this proposal aims at building bridges of dialogue, overcoming differences in order to avoid rupture.

Crisis no epilépticas de origen psicógeno. Diagnóstico diferencial con la epilepsia, presentación clínica y abordaje terapéutico / [Psychogenic non-epileptic seizures. Differential diagnosis with epilepsy, clinical presentation and therapeutic approach].

The current term psychogenic non-epileptic seizures were coined by contemporary neurologists and epileptologists, since the implementation of Video electroencephalogram, considered today the gold standard diagnostic tool. Patients with psychogenic non-epileptic seizures comprise a heterogeneous group from the psychiatric point of view. The diagnosis that describes the psychogenic non-epileptic seizures is "conversion disorder", often associated with dissociative disorder. These disorders are frequently co-morbid with depression, anxiety and posttraumatic stress disorder. Furthermore, usually coexist with personality disorders, especially borderline personality disorder, although dependence personality disorder has also been described. A history of trauma is very important in the pathogenesis and development of psychogenic non-epileptic seizures. The symptoms "core" of the psychogenic non-epileptic seizures (conversion and dissociation), some co-morbidities and personality disorders are treated with psychotherapy, while psychotropic drugs are used for co-morbidities such as depression and posttraumatic stress disorder.

El concepto de "comprensión" (Verstehen) en Karl Jaspers / [The concept of \"understanding\" (Verstehen) in Karl Jaspers].

This article explores the relationship between empathy and psychopathology. It deals with the concept of "understanding" in Jaspers’ General Psychopathology, 100 years after the publication of its first edition. The Jaspersian proposal has the person and his/her experience as its primary object of study, just as in Ortegas’ vital reason. Jaspers’ understanding is not rational but empathetic, based on the co-presence of emotional content and detailed descriptions. Jaspers’ methodology is essentially pluralistic, considering both explanation and understanding, necessary for psychopathology. Despite certain limits, the concept of understanding is the backbone of the psychopathological reasoning, and has proven useful over a century of clinical practice. However, it needs a review covering the recent epistemological and clinical findings. "To be understandable" is a relational property that emerges from a semiotic process. Therefore, an effective psychology should encompass an inter-subjective process, and get away from strict rationalism.

Teoría de la mente en los trastornos alimentarios: ¿endofenotipo de la enfermedad? / [Theory of Mind in eating disorders: endophenotype of the disease?].

UNLABELLED: Considering the clinical and empirical evidence of socio-cognitive difficulties in patients with eating disorders, this paper aims to critically review the current state of research on theory of mind in anorexia and bulimia, to evaluate if there is any alteration of it in these pathologies and to determine whether there are indicators that can be considered endophenotype. METHOD: We conducted a literature search of PubMed database, using keywords related to the topic. The papers were analyzed according to inclusion/ exclusion criteria. RESULTS: We identified seven studies of patients with anorexia, one on bulimia and four on both pathologies. Most studies reported that patients with anorexia have alterations in the theory of mind. Studies on bulimia are scarce, and their results contradictory. CONCLUSION: Research on theory of mind in eating disorders at initial level, being the most of works on anorexia. There are indicators of deficits for this pathology on ToM tasks, and they might be considered endophenotypes, although studies that evaluate unaffected first-degree relatives are still lacking.

Confiabilidad de la versión chilena de la Hare PCL-R y validez convergente con otros instrumentos de evaluación de psicopatía / [Reliability of the chilean version of the Hare PCL-R and convergent validity with other assessment tools for psychopathy].

INTRODUCTION: Evaluation of mental health in forensic field is relevant in order to plan interventions and diminish institutional risks. The procedure includes the evaluation of psychopathic traits, which should be assessed by reliable and valid instruments. OBJECTIVES: To evaluate the internal congruence of the Chilean version of the PCL-R, and the convergent validity with the PCL: SV, the SRP-III-SF and the IM-P. To explore the utility of the PCL: SV as screening tool. MATERIAL AND METHOD: The population of sentenced inmates of the Jail of Los Andes, Chile, was evaluated in a cross sectional study (N=209 inmates of a universe of 235 eligible subjects). Data was obtained from different sources and the interviews were video-recorded. The PCL-R, PCL: SV, IM-P and SRP-III-SF were used. RESULTS: Cronbach Alpha for the PCL-R total score was 0.97. The correlation of the total PCL-R score with the PCL: SV was 0.87; 0.37 with the SRP-III-SF and 0.75 with the IM-P. Sensibility of the PCL: SV was 1 and specificity 0.90 thus concluding that it is an excellent screening test.