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In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America.
We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela.
The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median −35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship −2.70 (95% CI −4.28 to −1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates −2.37 (95% CI −3.95 to −0.8; p = 0.006).
Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.
Rewetting is the establishment of water–surface contact that occurs during quenching of high temperature surfaces by water jet impingement. Rewetting is an unexpectedly complex phenomenon that has been reported to occur at surface temperatures significantly higher than the superheating limit of water. The presence of intermittently wet and dry episodes, and in particular the occurrence of so-called explosive boiling, is one of the theories to explain the contact of water with high temperature surfaces. However, there is a lack of experimental data in the literature to prove the presence of explosive boiling and intermittent wetting due to the small duration and scale of the rewetting phenomenon. In this study, recordings of the jet stagnation zone during rewetting are provided at a frame rate of 81 kfps. The high-speed recordings show a flashing regime consisting of intermittent (dry) bubble-rich and (wet) bubble-free periods at frequencies up to 40 kHz when the rewetted surface temperature exceeds the water superheat limit. As far as the authors know, these are the first direct observations of intermittent dry–wet periods occurring in the jet stagnation zone during quenching by water jet impingement. The dependency of the flashing frequency on initial surface temperature is quantified. A correlation between the size of the rewetting patch and the flashing frequency is found. Finally, a hypothesis to explain the role of water subcooling in maintaining the water–surface contact at surface temperatures well above the superheating limit of water is presented.
Nowadays several authors defend the existence of an obsessive-compulsive (OC) spectrum in which eating disorders (ED), especially anorexia nervosa, would be include. We investigated the presence of OC symptoms in bulimic and anorexic patients and its relationships with personality traits.
The Maudsley Obsessive Compulsive Questionnaire (MOCQ) and the revised version of the Temperament and Character Inventory (TCI-R) were administered to patients and healthy controls.
Patients show higher scores than controls in the global punctuation of de MOCQ, and in the checking and doubt subscales. Cases also score higher in harm avoidance (dimension associated with personality disorders of cluster C) and in its subscale anticipatory worry. No differences were found between patients subgroups.
Restricting Anorexia Nervosa (RAN, n = 21)
Binging-Purging Anorexia Nervosa (BPAN, n = 29)
Bulimia Nervosa (BN, n = 34)
Control (C, n = 52)
RAN, BPAN, BN > C
Checking subscale (MOCQ)
BPAN, BN > C
RAN, BPAN, BN > C
Harm avoidance (TCI-R)
BPAN, BN > C
Anticipatory worry vs optimism (TCI-R)
RAN, BPAN, BN > C
Patients present more OC behaviours in comparison with healthy population but measures of obsessivity do not differ between the types of ED. Traits of personality characteristically associated to cluster C and to anxiety disorders seem to be also common features. These results do not support a separated classification of RAN into the OC spectrum.
The aim of this study is to assess the personality traits in a sample of Spanish anorexic and bulimic outpatients.
The revised version of the Temperament and Character Inventory was administered to 76 women attended in an Eating Disorders Unit and to 46 healthy controls. Both groups were matched by gender, age and instruction.
Diagnoses in the sample were distributed as follows: bulimia nervosa (BN) 33, binging-purging type anorexia nervosa (BPAN) 23 and restricting anorexia nervosa (RAN) 18. RAN patients were significantly younger (21.6 vs. 26.3 p < 0.01). Differences in the harm avoidance, persistence and selfdirectedness subscales of the TCI were found (see table).
BPAN, BN > C
RAN > C
C > RAN, BPAN, BN
In concordance with previous reports, compared with healthy controls, patients show lower scores in self-directedness. Persistence seems to be associated with restricting behaviours, whereas harm avoidance with binging and purging. RAN trends to have low scores in novelty seeking items and BN shows lower reward dependence, but this differences are not statistically significant, perhaps because of sample size.
Describe Attention Deficit Hyperactive Disorder's (ADHD) prevalence in Bipolar Disorders (BD) and relatives.
78 admissions for Bipolar Disorder (DSM-IV) in Impatient Psychiatric Unit, in Hospital Clínico Universitario of Valladolid (Spain). Only 36/78 patients participate in study. Demographic, social and clinical information were registered. ADHD symptomatology was evaluated from patient and descendant (Conners short version).
ADHD symptomatology suggestive in childhood/adolescence were detected in 13,9% (5/36). Conners score were negative (below 15) in all case.
ADHD symptomatology suggestive in their children were detected in 6,25% (n=3). Conner score were positive in 2,1%. Family psychiatry history in 72,2% (n=26), affective disorder in 60,52% (n=23). No family history with ADHD diagnosis. Only one case (2,8%) with symptomatology suggestive of ADHD in relatives.
The ADHD prevalence in our sample of BD and relatives weren’t higher than general population.
- Frontiers Between Attention Deficit Hyperactivity Disorder and Bipolar Disorder. Cathryn A. Galanter, MDa, Ellen Leibenluft, MD. Child Adolesc Psychiatric Clin N Am 17 (2008) 325-346.
- Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children.
One of the most important prognostic factors in patients diagnosed with schizophrenia is the number of hospitalizations they need during their life. In this work we describe risk factors which determinate psychotic relapse.
Retrospective review of the clinical histories of patients diagnosed with schizophrenia who needed hospitalization during the year 2008 using Hospital Ramon Cajal's history software. Data were analyzed using the SPSS software 15.0 version.
- Socio-demographic: We collected a total of 57 patients, 60% were men and 77,2% were single who lived with their families. 52,8% only had Primary education and 14% had been to University. 38,6% were pensioner and 12,3% workers.
- Risk factors: 54,4% had abandoned their medication, 7% had had recent modifications in their medication, and 35,1% received long acting antipsychotic. 42,1% were identified as substance users.
- 40,4% had been diagnosed with schizophrenia more than three years ago; 57,9% had had less than 3 previous hospitalizations, and 54,4% need hospitalization the previous year.
Male under 30 years old have more risk of needing more hospitalizations. The main risk factor for suffering new psychotic episodes is the medication nonadherence, modifying medication only causes new episodes in few patients. Patients receiving long-acting antipsychotic agents suffer less psychotic relapse. Substance abuse among schizophrenia patients is a major complicating factor since almost half of the hospitalizations are related to it.
UPD is a regional referral hospital psychiatric care unit, endowed with multidisciplinary equipment. It provides care to people with light/moderate/severe intellectual incapacity coexisting with mental disease and/or severe behavioral disorders. It offers attention to patients who need a protected therapeutical environment for correcting behavior disorders. It was opened in September 2008.
Description of:therapeutic goals, inclusion/exclusion criteria, admission protocol and psychotherapeutic/pharmacological interventions.
Analysis of inpatients's sociodemographic/clinical characteristics and preliminary assessment of therapy goals.
Retrospective study(13-month) of patients admitted to UPD of Leon Hospital from its inception to date. Data are collected from medical histories.
47 referrals have been received,5 of them have been rejected not to fulfill criteria. We’ve 16 patients on waiting list.32 incomes have been realized and 22 discharges have occurred.
19 of the incomes correspond to Mild,6 to Moderate,6 to Severe and 1 to Profound mental Retardation.
Regarding co-morbidity:22 patients presented serious behavioral disorder. From this group, 2 met criteria for autistic disorder, 5 had schizophrenia or unspecific psychotic disorders, 5 presented Personality Disorder and one ADHD.
10 patients did’nt present any important behavioral disturbance. From this group 2 were diagnosed with OCD,3 presented problems due to Alcohol and Substance-related Disorders,3 had Psychotic Disorders, one met criteria for Impulse Control Disorder and one presented Mood Disorder.
Before admission, 12 patients resided in specific handicappeds center, 5 intermittently at selected centers and in family, and 15 lived with family.
Psychotherapeutic intervention and treatment were useful in most cases. It was particularly helpful in treatment of behavioral disturbances. Now we must determine effectiveness in maintenance of improvement when they return to their community.
Alexithymia is a term to describe a state of deficiency in understanding, processing, or describing emotions. It expresses the cognitive-emotional state of vulnerable subjects who prone to suffer from psychosomatic illnesses. It’s characterized by difficulties in relationship and emptiness of feelings. It has been incriminated in genesis and maintenance of various psychosomatic pathologies, included psoriasis. Psychological stress is important in onset and exacerbation of psoriasis. We assume hypothesis that emotions that cannot be expressed through the appropriate symbolic language will be expressed through a symbolic somatic symptom.
A case study of psoriasis in a woman of 27 years without a previous psychiatric history. She was treated jointly by the service of psychiatry and dermatology. Methodology: We performed a detailed history in the course of the disease, summarizing vital changes and outstanding events of her lifetime in the different vital areas (family, work, school and sex life).
From the comprehensive revision of the ailments and pathobiography we can establish a clear relationship between physical-psychological symptoms.
Skin is an envelope that represents the boundary line between body-psyche. Skin and psyche interact in many ways. The skin reacts to feelings and perceptions. Psychosomatic patients feel extreme anxiety when they have to cope with separation and merger situations. They experience these situations as if they were to lose their physical limit. Broadly speaking, because of their alexithymia, they cannot process a painful emotion properly, and though they will express it through somatisation disorders and the development of diseases. In the case of our patient, the skin verbalizes her emotional silence.
Psychotic diseases in the elderly are underdiagnosed due to the limited use of medical resources. Advanced age makes psychoses of any cause less pure and differentiated, since old age adds a cognitive-impairment component to the basal psychotic defect.
We intend to estimate the prevalence of paranoid symptoms in older patients, and to study the many medical conditions associated with psychosis.
We conducted a literature review and we have performed a review of several clinical trials.
We found 12.1% of paranoid symptoms in the elderly with cognitive impairment. In absence of this factor, we found a prevalence of 14.1% for suspicion tendencies, 6.9% for paranoid thoughts and 5.5% for evident delusions. These figures were significantly higher in old black people.
We present a table of the main medical conditions that can produce psychotic symptoms. Some cases of apparently typical delusional disorder can appear as a long-term complication of some of these diseases. If organic factors are subtle and long lasting, the clinical may reproduce a fairly typical delusional disorder and may respond to treatment with neuroleptic drugs.
It seems possible that organic brain factors are more common that we believe, becoming essential a comprehensive study of the old psychotic patient. We should pay more attention to psychotic symptoms in elderly patients and avoid conclusions based on cross-evaluations. Diagnosis will be defined by evolution in most of the cases.
High levels of alexithymia as well as low scores on assertiveness have been described in patients with chronic pain and headache.
To determine alexithymia and assertiveness scores and to explore their association with headache impact, in primary chronic headache patients.
This study aims to advance knowledge of the emotional expressiveness in headache impact.
In a sample of 62 outpatients, we used the Toronto Alexithymia Scale (TAS-20), the Rathus Assertiveness Scale and the Headache Impact Test (HIT-6) and applied the Pearson correlation index.
77.4% of women, 36.3 years mean age. The most prevalent diagnoses are migraine combined with tension type headache (33.9%), migraine alone (32.3%) and tension-type headache alone (22.6%). Most of the patients have not any psychiatric comorbidity (77.8%). We observe a direct linear relationship and statistically significant difference, between the total impact of headache and the total score of alexithymia (r = 0.27 p = 0.03) and there is an inverse correlation between the impact of headache and the total score of the scale of assertiveness, not statistically significant (r = −0.004 p = 0.97).
Discriminated by diagnostic groups, we found that the association between assertiveness and headache impact remains only in patients with migraine alone, while that between alexithymia and headache impact is preserved in all subgroups.
Two indirect measures of the difficulties in emotional expressiveness such as alexithymia and assertiveness, show the expected association with headache impact. The sample size can influence some of the correlations not statistically significant.
Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.
In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.
No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).
Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.
Suicide is a major and preventable public health problem. Risk factors may vary with age, gender, or ethnic group, being substance abuse one of the most frequent.
To investigate the relation of substance related disorder and suicide attempt.
Review of the suicidal attempts of patients with personal history of substance related disorder attended during the year 2010.
We identified 85 cases.
Alcohol (64″3%) and cocaine (47″7%) were the two most identified substances. Cannabis (17″2%) and heroin (23″06%) were less consumed. Benzodiacepines abuse was very frequent among the patients attended (38″2%).
Previous attempts were found in 43″8% of the patients.
Drug overdose was the most commonly method used (98″4%), especially with benzodiacepines and antidepressants, but non psychiatric drugs were also frequent. Substance overdosage or intoxication was the second most frequent method used (23%), and poisoning the third (9%). Most of times these methods were presented with concomitant drug overdose.
Defenestration threats were very rare (2″34%), and always associated with hospitalization request by the patient.
We did find significant differences when studying triggers (family, partnership, economical or others) compared with non substance abusers suicidal attempts.
- Chronic substance misuse and acute substance abuse is associated with a higher risk of suicide, what may be explained by the disinhibiting effects of psychoactive substances.
- As benzodiazepine misuse is associated with suicide, special care must be taken when prescribing to at risk patients such as substance abusers
Voluntary drug overdoses are an important part of psychiatric demand in the emergency service. Nevertheless, a protocolized attention for these cases does not exist. Therefore, its management only depends on doctors’ personal criteria. Many of these cases have been previously diagnosed as Personality Disorder.
Studying the differences in management of drug overdosing depending on previous diagnosis of personality disorder. Also, we look for associated factors that can influence the final decision.
We conducted a retrospective analysis of 112 drug overdoses attended from July to December 2009. Data were analyzed using SPSS software.
34 attended patients (30,4%) have previous diagnosis of personality disorder. In these, the most frequent diagnosis was parasuicide attempt in the Emergency Service. In contrast, the rest of the patients were diagnosed as suicidal attempt.
We found statistically significant differences (p < 0,05) in the destination after Emergency evaluation (ambulatory or hospitalization) depending on a previous personality disorder diagnosis.
The media of previous overdoses in personality disorder group was significantly higher (3,29 Vs 0,64; P < 0,01).
We found that humor and anxiety disease comorbility, associated toxicomany, alcohol or cocaine use during the overdose, were more frequent in the group with personality disorder.
Although drug overdoses in patients with personality disorder have less letal intention, these patients were hospitalized more frequently than the others. This finding could be explained because of the presence of other associated factors that contribute to the global risk of overdosing. Previous overdoses seem to have significant influence in final decision.
Late psychoses are a heterogeneous group of disorders whose nosology has been controversial throughout history. The concept of dementia praecox introduced by Kraepelin, and based on the progressive deterioration and early onset, has been so dominant in the last decades that few issues have created as much controversy as that schizophrenia can begin in late age. Our purpose is to identify the different obstacles in the research in late psychoses to be able to overcome these limitations and improve the study in this area.
A literature review was achieved using the National Library of Medicine and PubMed search system.
We found historical limitations, because over the last century, different schools of psychiatry have used different nomenclatures and age limits to define late-onset psychotic disorders. Prevailing beliefs in the low frequency of these diseases or in the association of the onset of psychotic symptoms in the elderly with cognitive impairment have interfered with epidemiological research in this area. Moreover, older psychotic patients are often excluded from epidemiological and pharmacological research. Lack of insight and social isolation determine sampling bias and reliability problems.
Seemengly strong knowledge on late-onset schizophrenia is based, in fact, in samples from patients with late paraphrenia or mixed samples. It becomes mandatory to define concepts and establish diagnostic criteria, and to conduct multicenter studies to increase the size of our samples.
Bioethics in psychiatry is a research area that is gaining more relevance each year. To understand what bioethics is we need to clarify some concepts.
Morals are the rules that govern the behaviour of humans being in relation to society and themselves but that does not imply alone the concept of good or bad.
Ethics consider what is moral, how to rationally justify a moral system and how it is applied then to different areas of our social life. We therefore conclude that bioethics is responsible for studying what is moral in the field of human behavior.
We provide a historical review of bioethics in psychiatry from the Middle Ages to the present day.
Having reviewed documents we will cover the key historical events which changed the course of bioethics in psychiatry as well as in other areas of medicine.
In our field, Psychiatry, Bioethics is a relatively new discipline which has changed over the centuries to find a model based on patient autonomy and beneficence. These two basic ethical principles were specially established since the Belmont Report was published in the 70s.
Despite the changes and evolution through the history, bioethics is a subject that still requires more research and analysis. There are still few professionals who have an adequate training in bioethics.
It is interesting to note somatic comorbidity of psychiatric patients that attend an outpatient Mental Health Unit (MHU). In medical literature there are few studies that reflect which diseases make these patients go to an Emergency Room (ER).
To determine the percentage of patients presenting to an ER in the year prior to psychiatric consultation in a MHU, noting which is the most common assitance and the differences regarding sex, age and marital status.
Retrospective and descriptive study of ER assistances at the Hospital Clínico de Santiago in the previous year of patients attending our MHU. Time period: from February 1st 2010 to August 31th 2010. Once collected the data, these are analyzed using the Excel 2008 Statistical Package for Mac.
From 577 patients studied (68.3% women), 224 had gone at least once to the ER in the last year (72.3% women): 19.6% consulted for psychiatric conditions and 80.4% for somatic causes. Among the predominant somatic complaints we found musculoskeletal causes (24.4%), cardiovascular (8.8%), respiratory (9.4%) and gynecological (2.7%). 3% of them were hospitalized in medical or surgical services and 3% in psychiatric units. There was not statistically significant differences regarding their age. Married and divorced patients went to the ER more than bachelors or widowers.
Profile of the studied patient: “Woman, 53 years old, married, user of an outpatient MHU and that has consulted at least once in the last year to an ER due to musculoeskeletal cause.”
Suicidal behaviours are commonly found at increased rates among individuals with psychiatric disorders.
To identify risk factors of suicide among the population attended in our area, describe the characteristics of the attempt and the management.
Review of the drug overdosings attended in our Hospital from July to December of 2009.
We identified 112 drug overdosings. 80′4% of the patients had psychiatric history: Mood-Anxiety disorders 60′7%, Substance-Related Disorders 41′1%, Personality disorder 30′4% and Psychotic disorder 10′7. Previous attempts were found in 43′8% of the patients. The most common drug used were benzodiacepines (73% of the cases), followed by antypsychotics (17′9%). Up to 32′1% of the patients used non psychiatric drugs. 64′3% of the patients consumed alcohol and 13′4% cocaine. Moreover, 15′2% of the patients took other toxic substances such us bleach, soap and other chemical products.
We did not find significant differences when studying triggers (family, partnership, economical or others)
The most common diagnosis was suicide attempt (41′1%), followed by parasuicide attempt. 41′4% of the drug overdosings were not considered as self injurious behavior. 64% were referred to ambulatory services, 22′5% needed hospitalization in psychiatric units, and 5′4 were hospitalized in medical services. Although those diagnosed of personality disorder were more often diagnosed of parasuicide (50% Vs 32′1%), they needed more hospitalizations (41% Vs 21%)
- Self-injurious behavior is one of the most common causes of consulting in the emergency services.
- Patients diagnosed of personality disorder are more commonly hospitalized after making a suicide attempt.
The hepatitis C virus infection (HVC) represents a public health problem that affects the 3% of world population. The currently recommended treatment is Pegylated Interferon (PegIFN) alpha and Ribavirin (RBV) during 24 or 48 weeks. This treatment has been associated with high rates of neuropsychiatric side effects, mainly depression. Recent studies have documented impairment in health related quality of life (SF-36) in these patients.
To study the induced depression and quality of life of chronic HVC patients under antiviral treatment.
Three hundred seventeen consecutive HCV patients, who received PegIFN alpha and RBV, were assessed using the SCID interview for DSM-IV. Moreover, the PHQ, the HADS and the SF-36 were administered at baseline, 4, 12, 24, and/or 48 weeks of treatment.
Two hundred twenty-four (64.7%) of patients were men, the mean (SD) age was 43.6 (10.6), and 130 (40.1%) had history of mood disorder. One-hundred eleven (41%) of the sample had a depressive disorder during the treatment. There was a significant difference in the total SF-36 score and in all subscales (p < 0.001). HADS subscale of depression was highly correlated with SF-36 total score (p < 0.001).
During the antiviral treatment, HVC patients had a higher incidence of induced depression. Both physical and mental component scores of SF-36 in induced depressed patients were significantly worse.
This study has been supported in part by Spanish grants: FIS E08/00268, Dra. Martín-Santos, and Dr. Solà.
Schizophreniais a psychiatric disorder with multiple causes, including genetic, immune, environmental causes of various kinds, which all increase the vulnerability andpredisposition to the disorder. Among them stand out prenatal infections, thusbeing a preventable risk potential factor in our daily clinical practice.
To analyze the relation between prenatal infecions andschizophrenia.
Review of the subject and recent articles on schizophreniain Psychiatric guides and magazines.
After analyzing several studies, it have shown that prenatal infections, where the nervous system is not yet fully developed, may be a risk factorfor the development of schizophreniain adults, in relation with genetically predisposed individuals. Infections such as influenza, especiallyduring the first quarter of gestation;rubella, toxoplasma and herpes simplex virus-type 2 are related topotencially increase risk of suffer schizophrenia.
Prenatal infections, especially in the firstquarter and the periconceptional period, constitute a risk factor inindividuals with vulnerability to develop schizophrenia. Awareness andprevention is important in the pregnant population of the influence of theseinfections on the possible origin of psychotic episodes.