Comparison of immigrant and native-born population adherence to antipsychotic treatment in a Spanish health region.

Previous studies report that immigrants underuse psychiatric hospitalization services and are less exposed to antipsychotic medication. The objective of this study is to determine whether immigrant and Spanish native groups with psychotic disorder adhere differently to antipsychotic drugs. Retrospective study including two matched samples of 47 immigrants and 47 native-born patients with psychotic disorder admitted to a psychiatric Unit (2006-2007). Adherence was measured after one-year follow-up. Only 30 % of patients adhered to treatment (40.4 % of native-born, and 19.1 % of immigrants). The lowest rate of adherence was found in sub-Saharans. Fifty per cent of non-adherents were readmitted after 12 months, compared with 21.4 % of adherents, the effect was observed in both native and immigrants. This alarmingly poor adherence in immigrant patients with psychosis underlines the need for preventive strategies to minimize the negative clinical, social and economic outcomes.

Functional Connectivity Bias in the Prefrontal Cortex of Psychopaths.

BACKGROUND: Psychopathy is characterized by a distinctive interpersonal style that combines callous-unemotional traits with inflexible and antisocial behavior. Traditional emotion-based perspectives link emotional impairment mostly to alterations in amygdala-ventromedial frontal circuits. However, these models alone cannot explain why individuals with psychopathy can regularly benefit from emotional information when placed on their focus of attention and why they are more resistant to interference from nonaffective contextual cues. The present study aimed to identify abnormal or distinctive functional links between and within emotional and cognitive brain systems in the psychopathic brain to characterize further the neural bases of psychopathy. METHODS: High-resolution anatomic magnetic resonance imaging with a functional sequence acquired in the resting state was used to assess 22 subjects with psychopathy and 22 control subjects. Anatomic and functional connectivity alterations were investigated first using a whole-brain analysis. Brain regions showing overlapping anatomic and functional changes were examined further using seed-based functional connectivity mapping. RESULTS: Subjects with psychopathy showed gray matter reduction involving prefrontal cortex, paralimbic, and limbic structures. Anatomic changes overlapped with areas showing increased degree of functional connectivity at the medial-dorsal frontal cortex. Subsequent functional seed-based connectivity mapping revealed a pattern of reduced functional connectivity of prefrontal areas with limbic-paralimbic structures and enhanced connectivity within the dorsal frontal lobe in subjects with psychopathy. CONCLUSIONS: Our results suggest that a weakened link between emotional and cognitive domains in the psychopathic brain may combine with enhanced functional connections within frontal executive areas. The identified functional alterations are discussed in the context of potential contributors to the inflexible behavior displayed by individuals with psychopathy.

Pediatria i salut mental infantojuvenil: claus per millorar en l'abordatge dels pacients / Pediatría y salud mental infantojuvenil / Pediatrics and child and adolescent mental health: Keys to Keys to improving care

Fonament: En les darreres dècades s'ha produït un notable increment en la demanda d'atenció en l'àmbit de salut mental infantojuvenil. Es detecta, a la vegada, una formació escassa o irregular. Objectiu: Descriure les competències del pediatre en salut mental infantil i identificar-ne les àrees d'intervenció. Mètode: Revisió bibliogràfica. Resultats: L'Associació Americana de Pediatria descriu sis àrees competencials que cal assolir en pediatria: pràctica basada en sistemes per millorar la base organitzativa i econòmica de l'assistència i la pràctica clínica; assistència dels pacients; coneixements mèdics; aprenentatge i millora basats en la pràctica clínica; habilitats interpersonals i de comunicació, i professionalitat. Les limitacions més importants per desenvolupar-les serien la manca de formació i de temps. Les àrees identificades son: promoció d'una bona salut mental, prevenció de trastorns, detecció precoç i abordatge de trastorns concrets. Conclusió: És necessari concretar l'àrea de coneixement de pediatre en salut mental infantil, definint bé les competències necessàries i les funcions que cal desenvolupar

Fundamento: En las últimas décadas se ha producido un notable incremento en la demanda de atención en el ámbito de salud mental infantojuvenil. Se detecta, a la vez, una escasa o irregular formación. Objetivo: Describir las competencias del pediatra en salud mental infantil e identificar sus áreas de intervención. Método: Revisión bibliográfica. Resultados: La Asociación Americana de Pediatría describe seis áreas competenciales en pediatría: práctica basada en sistemas para mejorar la base organizativa y económica de la asistencia y la práctica clínica; asistencia de los pacientes; conocimientos médicos; aprendizaje y mejora basados en la práctica clínica; habilidades interpersonales y de comunicación, y profesionalidad. Las limitaciones más importantes para desarrollarlas serían la falta de formación y de tiempo. Las áreas identificadas son: promoción de una buena salud mental, prevención de trastornos, detección precoz y abordaje de trastornos concretos. Conclusión: Es necesario concretar el área de conocimiento del pediatra en salud mental infantil, definiendo bien las competencias necesarias y las funciones a desarrollar

Background: Over the last decades there has been a marked increase in the demand for care in the field of child and adolescent mental health. However, training and education in this field is limited and irregular. Objective: To describe the competencies of the pediatrician in childhood mental health and identify the areas of intervention. Method: Bibliographic review. Results: The American Pediatric Association describes six competency areas to be achieved in pediatrics: system-based practice to improve the organizational and economic basis of clinical assistance and practice, patient care, medical knowledge, practicebased learning and improvement, interpersonal skills, and communication and professionalism. The most important limitations for developing those competencies are the lack of training and time. The identified areas for intervention are: promotion of good mental health, prevention, early detection, and treatment of specific disorders. Conclusion: It is necessary to specify the pediatrician's knowledge in child and adolescent mental health, defining well the required competencies to be developed

Breakdown in the brain network subserving moral judgment in criminal psychopathy.

Neuroimaging research has demonstrated the involvement of a well-defined brain network in the mediation of moral judgment in normal population, and has suggested the inappropriate network use in criminal psychopathy. We used functional magnetic resonance imaging (fMRI) to prove that alterations in the brain network subserving moral judgment in criminal psychopaths are not limited to the inadequate network use during moral judgment, but that a primary network breakdown would exist with dysfunctional alterations outside moral dilemma situations. A total of 22 criminal psychopathic men and 22 control subjects were assessed and fMRI maps were generated to identify (i) brain response to moral dilemmas, (ii) task-induced deactivation of the network during a conventional cognitive task and (iii) the strength of functional connectivity within the network during resting-state. The obtained functional brain maps indeed confirmed that the network subserving moral judgment is underactive in psychopathic individuals during moral dilemma situations, but the data also provided evidence of a baseline network alteration outside moral contexts with a functional disconnection between emotional and cognitive elements that jointly construct moral judgment. The finding may have significant social implications if considering psychopathic behavior to be a result of a primary breakdown in basic brain systems.