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The prevalence of mental disorders (MD) is greater in children; however, they are the population with less help-seeking and access to mental health-care services (MHS).
To explore the characteristics of help-seeking and access to specialized MHS in children with MD.
A cross-sectional study was carried out from 2018 to 2019, in the Children’s Psychiatric Hospital and National Institute of Psychiatry in Mexico City. Sample 397 children and 397 caregivers. The project was approved by the Ethics Committee of both institutions. The patient’s family member was questioned on sociodemographic data and help-seeking to MHS. Sample’s descriptive statistics applying measures of central tendency, Inferential statistics with t-test for differences in means between groups (diagnosis), and one-way ANOVA to variables associated with the help-seeking to MHS.
Children´s sample: 37% female, average age 12 years (SD± 3.6), 51% had diagnosis of hyperkinetic disorder (HD), 34% depressive disorder (DD). The children´s age at the time of seeking healthcare was different according to the diagnosis: DD 10.1 (SD ± 4.5) and HD 6.95 (SD ± 3.4), (T = -3.18, p = 0.000); and by sex: girls 10.9 (SD ± 4.5), boys 7.85 (SD ± 4.0); (T = -3.07, p = 0.000). The mother was the first person to notice the symptoms.
The search for MHS differs by sex, diagnosis and family history; it is necessary to design mental health interventions considering gender-based differences, namely, to integrate a gender perspective.
The giant gypsum crystals of Naica cave have fascinated scientists since their discovery in 2000. Human activity has changed the microclimate inside the cave, making scientists wonder about the potential environmental impact on the crystals. Over the last 9 years, we have studied approximately 70 samples. This paper reports on the detailed chemical–structural characterization of the impurities present at the surface of these crystals and the experimental simulations of their potential deterioration patterns. Selected samples were studied by petrography, optical and electronic microscopy, and laboratory X-ray diffraction. 2D grazing incidence X-ray diffraction, X-ray μ-fluorescence, and X-ray μ-absorption near-edge structure were used to identify the impurities and their associated phases. These impurities were deposited during the latest stage of the gypsum crystal formation and have afterward evolved with the natural high humidity. The simulations of the behavior of the crystals in microclimatic chambers produced crystal dissolution by 1–4% weight fraction under high CO2 concentration and permanent fog, and gypsum phase dehydration under air and CO2 gaseous environment. Our work suggests that most surface impurities are of natural origin; the most significant anthropogenic damage on the crystals is the extraction of water from the caves.
Previously, we showed the usefulness of the REF scale to assess referential thinking (Rodríguez-Testal et al., 2001; 2009) although it isn’t specific for patients with psychotic disorders (Rodríguez-Testal et al., 2008).
This instrumental work aims to replicate the exploratory factor analysis about the Referential Thinking Scale (REF scale) already developed by Lenzenweger et al. (1997) to examine its multidimensionality.
Participants: The analyzed sample consisted of 193 participants (67.36% women, mean 28.36 years old, SD = 10.35), of whom 131 were patients.
Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language. This questionnaire consists of 34 items that assess the frequency of referential thinking on a dichotomic scale (true/false). We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation.
The principal-components factor analysis method led to 5 factors that explain 37.35% of variance for the rotated solution. Because of inter-factors correlations are small, we considered these factors as being independent. The five factors were labeled as: Laughter, Commentaries (it accounted for 8.92% of variance); Guilt (it accounted for 8.77% of variance); Causal Explanations (it accounted for 7.17% of variance); Songs, Newspapers, Books (it accounted for 6.44% of variance); and Attention, Appearance (it accounted for 6.04% of variance).
It's obtained the five factors isolated in previous studies (Lenzenweger et al., 1997; Rodríguez-Testal et al., 2001). However, the multidimensionality of the REF scale must be viewed with caution because of a small percentage of explained variance.
Kernberg's classification of personality disorders (1987) differentiates psychic organization according to the severity: neurotic, borderline and psychotic. Lenzenweger et al. (2001) used a reduced version of IPO with 57 items developed by Kernberg and Clarkin (1995).
Objectives and hypothesis
IPO was applied in a sample of patients and a control group. We expected to find an adequate reliability and validity of the inventory. Scales adequately distinguish content borderline, neurotic and psychotic.
Participants: 288 subjects (64.9% women), 116 patients attended to private clinical practice from February 2007 to September 2009. 172 control subjects matched by sex, social class and sincerity (EPI).
Transversal design, a measure collective in the comparison group and individual in patients ones. A group of patients was selected for the retest (n = 88).
Instruments. We applied IPO, the BPRS, MCMI-II and MIPS. Diagnoses according to DSM-IV-TR.
Internal consistency (Cronbach) was adequate for the three scales: .83; .90 and .89. The testretest reliability was correct for a mean interval of 44 days (.78; .81; .78). The validity analyses differed between diagnostic groups in Axis I (p< .05), but not in the clusters of personality (p>.05). No differences in BPRS with scale of borderline, but yes with neurotic and psychotic ones. The MCMI-II was properly differentiated by the three scales of the IPO.
The IPO is an useful scale with reliability and validity. The main drawback concerns certain aspects of the borderline scale.
Previously (Rodríguez-Testal et al., 2001) we analysed the multidimensionality of Referential Thinking Scale, obtaining similar results to original research of Lenzenweger et al. (1997) but warning about the construction of subscales.
In this study we intended to analyse if the REF Scale is a good indicator to differentiate the two subtypes of paranoia “Bad Me” and “Poor Me” (Trower & Chadwick, 1995).
Participants: We analyzed data from a different sample of previous studies with 326 participants (64.11% women, mean age 30.8, SD = 10.84), of whom 212 were patients.
Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, of which we deleted two items because of psychometric criteria, resulting 32 dichotomic items. We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation, retaining two factors.
Two factors explained 31.32% of the variance (rotated solution). We interpreted factor through factor loadings higher than .42. Factor 1 accounted for 18.28% of the variance and it's associated with referential laughter, commentaries and guilt. Factor 2 accounted for 13.05% of the variance and it's associated with referential concerns related to the media.
Since the inter-factor correlation is moderate (.44) and there are no relevant clinical differences about the content between the two factors, the REF scale is a one-dimensional measure. Therefore, two big factors don’t emerge from the REF scale related to referential concerns about laughter-commentaries and guilt that correspond to “Poor Me” and “Bad Me”, respectively.
In previous works we demonstrated the utility of the REF scale for the assessment referential thinking (Rodríguez-Testal et al., 2001) although it wasn't specific for patients with psychotic disorder (Rodríguez-Testal et al., 2008).
Objectives and hypotheses
We analyzed the psychometric properties of reliability and validity of the REF scale. We compared the differences in referential thinking between subjects with and without psychopathology. In the patient group we will not obtain differences in referential-thinking between diagnosis types of Axis I, Axis II, or patients with diagnoses on both axes.
Participants: 120 subjects, 70 patients attending a private center of clinic psychology, 64.3 % women, mean age = 35.21 (SD = 10.5) and 50 controls selected from the normal population, 54 % women, mean age = 33.48 (SD = 10.83).
It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.
We reached adequate internal consistency (Cronbach's alpha= .90, split-half reliability= .83 and .82). The test-restest reliability was significant (mean interval of 44 days). There are significant differences in referential thinking between subjects with and without psychopathology (t=3.8; p=.001). There are significant differences in referential thinking between types of diagnoses (F=3.99; p=.001).
The REF scale has adequate psychometric properties (reliability and validity). It discriminated between patients and no-patients, and between the different types of diagnoses, especially for those who suffer psychotic disorders.
In previous works we used the REF scale of referential thinking as criterion of therapeutic evolution (Benítez-Hernández et al., 2006; Rodríguez-Testal et al., 2009).
Objectives and hypotheses
We designed a group therapy of social skills for monitoring and modification of the referential thinking. We predict a decrease of referential thinking (frequency and intensity) both in pretest and posttest measures for each session, as in the progress of the all sessions as a whole.
Participants: 5 women from 24 to 38 years old with the diagnoses: Panic Disorder with Agoraphobia and history of Sexual Abuse; generalized Social Phobia; Avoidance Personality Disorder; Bipolar I Disorder; Obsessive-Compulsive Disorder and Avoidance Personality Disorder. It's employed a longitudinal design (brief time-series) of REF measurement (frequency and intensity) at a weekly interval. C Young (p < 0.01) was used for the statistical analysis of the data, t (paired samples) and the method of least squares to obtain the trend line.
#1: frequency-posttest (p=.01).
#2: intensity-pretest (p =.01); intensity-posttest, C =.663 (p< .01).
#3: intensity-pretest, C =.772 (p< .01), intensity-posttest, C =.681 (p< .01).
#4: frequency-pretest, C =.695 (p< .01), frequency- posttest, C =.74 (p< .01).
#5: frequency-pretest and frequency-posttest (p>.01).
Preliminary analysis indicates an improvement of referential thinking in the frequency and intensity both intra and inter-sessions. More therapy sessions are needed to reflect a change statistically significant.
In previous works we found that REF scale (Lenzenweger et al., 1997) is a stable and reliable measure (Rodríguez-Testal et al., 2009).
In this study we assess the sensitivity of REF scale to detect the disorganization of patient's mental state longitudinally.
Participants: It's a 35-year-old man diagnosed with Schizotypal Personality Disorder. He had a psychotic breakdown and he is being treated with haloperidol. The psychological intervention is cognitive type.
Design, materials and procedure: We used an experimental adaptation of the REF-scale. This self-applied scale consists of 34 items that evaluate the referential thinking in Likert format. We employed a longitudinal design (brief time-series). C Young (p < 0.01) was used for the statistical analysis of the data and the method of least squares to obtain the trend line. We included 103 measures registered at an interval of 3 days.
It's observed a significant declining trend in the whole of the measures both intensity and frequency from the beginning of therapy. However, we observed a significant declining trend in intensity but not in frequency when we analyzed the data from the 50th measurement, which was the period during which the patient got worse.
It's confirmed again that the REF-scale is a stable and reliable measure. It's able to detect changes in the patient's evolution of the referential thinking from the beginning of therapy. In addition, the REF-scale is sensitive detecting decompensations in patients. Therefore, we conclude REF scale is a useful measure for the subsequent decision-making therapeutic.
We created an experimental adaptation of the REF scale (Lenzenweger et al., 1997), in a Likert format for discriminate between frequency and intensity of referential thinking (Rodríguez-Testal et al., 2008).
Objectives and hypotheses
We try to verify if the Likert format of the REF discriminates between controls and patients, and also in patients with different diagnoses. We predict that there will be differences in frequency and intensity between patients and controls.
Participants: 108 subjects, 40 patients from a private center of clinical psychology, 55% women, mean age = 35.70 (SD = 12.42) and 68 controls selected from the normal population, 50% women, mean age = 36.35 (SD = 12.99).
It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.
No differences in referential thinking between patients and controls with Likert format in frequency (t = 1.496, P = 1.14), although there were differences in intensity (t = 2.30, p =.023). No significant differences in referential thinking between types of diagnoses with the Likert format (X2 = 6.63, p =. 249).
The Likert format of the REF scale adequately discriminates between patients and controls in intensity but not in frequency. This format doesn't discriminate between different diagnoses. The Likert format induces and overestimates the response.
In previous works, referential thinking was predicted by clinical and dispositional variables such as social anxiety or vulnerability to depression (Rodríguez-Testal, Senín-Calderón & Fernández-Jiménez, submitted to revision).
Objectives and hypotheses
We propose to find personality variables to characterize the emergence of referential thinking. We predict a greater referential thinking in subjects with a high sensitivity to punishment and higher scores on social anxiety.
Participants: 366 subjects selected from the general population, 66.6% women, mean age = 33.18 (SD = 12.79).
We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, GHQ-28 (Goldberg, 1996), SPSRQ (Torrubia et al., 2001) and The Revised Self-Consciousness Scale (Scheier & Carver, 1985).
It was applied a cross-sectional design and a correlation method. All the analysis were accepted at p < .05.
The multiple linear regression analysis showed the importance of the clinical variable of depression, public self-consciousness, and sensitivity to reward and punishment as predictors of referential thinking (34% of the variance explained). The discriminant analysis according to scores in referential thinking was significant (Lambda = .87, p = .001). The combination of the above variables correctly classified 85.1% of cases.
Subjects more concerned about how they are perceived by others tend to a greater presence of self-references, although they don’t show a high score in social anxiety. Susceptibility to reward and high vulnerable to punishment are the personality variables that best predicted referential thinking.
This study examined gender differences in the short-term (2 years) course of schizophrenia in a sample of 200 schizophrenic (DSM-IV criteria) outpatients (74 women and 126 men). Number and length of hospitalizations during the prospective follow-up were recorded. After 2 years, men were found to have more hospitalizations and longer stays than women. Among subjects who had at least one hospitalization (12 women and 38 men), men had greater length of hospitalization. In conclusion, schizophrenic women had a significantly better short-term outcome.
In a previous study (Senín-Calderón et al., 2010) we observed that the REF scale of referential thinking (Lenzenweger et al., 1997) didn’t discriminate among different mental disorders.
Objectives and hypotheses
We try to verify if self-references in various disorders are related to the severity of psychopathology (patients from public hospital and a private clinical). We predict that there will be differences between patients and controls, but not between the clinical samples. Psychotic disorders will be characterized by a significantly greater presence of self-references.
Participants: 287 subjects, 47 patients from a private clinical center, 57.4% women (mean age = 35.02, SD = 12.69), 30 patients from a public hospital, 53.3% women (38.36 years, SD = 9.53), and 210 controls selected from the general population, 50.5% women (33.80 years, SD = 11.79). Cross-sectional design, correlation method. All analysis were accepted at p < .05.
There are significant differences in self-references between patients and controls in frequency (t (285) = 2.33, p = . 021) and intensity (t (83.98) = 3.59, p = . 001). No significant differences between patients groups (p>.05) (REF-intensity without homogeneity, p < .05). No significant differences in self-references between types of diagnoses except psychotic patients versus adjustment disorder (frequency and intensity).
Self-references are highlighted in psychosis but, with the exception of adjustment disorders, doesn’t discriminate between personality, mood or anxiety disorders. Differences are more related to the clinical severity (BPRS) than with referential thinking.
Despite the high prevalence of obsessive-compulsive symptoms located around 2-3% of the population, there continue to be cases where the characteristics of the patient or the circumstances of their environment, they fall short queries mental health or when they do not for the disorder itself, but for another reason obsessional symptoms worsen.
Expose using clinical case, the existence of patients with obsessive pathology whose characteristics do not seek mental health consultation, until this is associated with a new disease that interferes significantly in vital organization.
We report the case of a man of 88 years old, married at 60, was admitted to the psychiatric consultation at the request of his wife 29 years his junior, for behavioral disorders several years of evolution and history of obsessive symptoms compulsive, which did not interfere with their daily lives by the lack of insight and poor social environment
OCD is included in anxiety disorders.
It is characterized by the presence of obsessions and compulsions that interfere with personal, work and / or patient's social.
There are cases that own personality traits of the patient, this disorder is not diagnosed early and choose to go only when associated with worsening cognitive impairment rituals and interfere with family life.
In this exhibition we aim to describe a clinical case and the different consequences that may present additional problems with eating disorders, focusing with emphasis on development and clinical picture. This disorder usually occurs in non-obese adolescents accused, showing symptoms significantly related to interpersonal functioning of these adolescents, who tend to be isolated or seek company of younger guys. They are characteristic of obsessive-compulsive disorders related or unrelated to the food. Dietary restriction involves biological and physical changes, highlighting the alteration of hypothalamic and endocrine system, leading to signs and symptoms such as amenorrhea, cold intolerance, hypotension … Neurochemical changes have also been attributed to malnutrition.
The present case is a 31 year old woman. Initiates contact with Mental Health at age 15 by anorexia nervosa. Patient requests for worsening nutritional status, family relationships, and alcohol consumption, being the turning point and main motivation, the birth of his daughter. 8 months ago gave birth, being an unexpected delivery at home. Unaware that pregnancy, justifying as secondary amenorrhea eating disorder and abdominal inflammation malnutrition. Daughter born seven months income requires low weight and withdrawal symptoms during pregnancy as continuous with anxiolytic and antidepressant treatment.
It has a favorable, always maintaining therapeutic commitment announced at the beginning of tratamiento. Currently still in out patient reviews with Psychiatry, Clinical Psychology, Nursing and Nutrition.
Immigration in Spain is from the early ‘90s phenomenon of demographic and economic importance, according to INE, in January 2011 first residing in the country nearly 6.7 million people born outside our borders. In recent years, many immigrants are living in especially difficult circumstances.
Show that these people undergo a series of very specific stressors and duels: precarious and harsh working conditions, poor diet, loneliness and lack of social support… This would enhance the appearance of psychiatric symptoms in various areas, closely related to lifestyles that maintain and in some cases precipitate substance use in this group, primarily those that have a sedative profile.
We will present the clinical case of a 34 year old Nigerian male. No somatic or psychiatric history of interest. Cannabis smoker since adolescence. A year after his arrival in Spain admitted to our inpatient unit due to clinical psychotic. Was a challenge from the point of view of psychopharmacological have many side effects with low doses of typical antipsychotics
Disappearance of psychotic and affective symptoms to approach the case from a pharmacological perspective, social and cultural.
Addressing the relationship between life stressors and cannabis as a trigger or catalyst for psychotic episodes in individuals predisposed. Pathological elaborations of cultural integration of an immigrant (whether by denial of the original culture or over-identification with the host culture) facilitates the use of toxic either for blending with Western consumer culture or cultural consumption radicalization toxic in some East African countries.
Given the high prevalence, severity and difficulty recognizing psychiatric disorders in patients with TBI, it is necessary to conduct a detailed history, gathering information on the location of the lesion and its relationship with the table in the psychopathological examination.
Illustrated by a clinical case, the close relationship between the injury of specific brain areas and the emergence of psychopathology that allows us to deepen the understanding of the biological substrate of mental disorders.
Exposure of a clinical picture and brief literature review of the existing literature.
We report the case of a man of 49 years old, no personal or family history was admitted to the hospital after a traffic accident with severe TBI. Computed tomography (CT) scan shows intraparenquematoso right temporal hematoma, subarachnoid hemorrhage, subdural hematoma right, pneumocephalus front right, front left fracture of both orbits and right maxillary sinus.
The interest in the study and the relationship of psychiatric symptoms with the location of the lesions, we can provide improved understanding of the biological basis of mental disorders.
Suicide is a public health problem of the first magnitude for both its costs and its implications for the population. The attention to suicide attempts is itself one of the first reasons for psychiatric consultation, if not the first, in hospitals. Among the risk factors for suicide is the presence of mental disorders on Axis I and II, and the existence of previous attempts.
Studying the behavior of some of the risk factors for suicide known (psychiatric history and previous attempts) in a sample from service Emergency Hospital Juan Ramón Jiménez
Performed a retrospective analysis (for a period of 6 months of 2013) of the risk factors associated with suicidal behavior of patients seen in the emergency department of our hospital for attempted suicide.
In an interim analysis found that up to 50% of patients treated for attempted suicide had made ??previous attempts. Most of them had any axis I disorder (> 75%) and were or had been in outpatient psychiatric follow. Extensive treatment with psychotropic drugs performed most (> 80%)
The high number of cases with previous attempts provides a clear example of the problem of suicidal behavior relapse. The importance of this is increased when you consider that most were receiving or had received psychiatric treatment, reflecting the limitations in our daily clinical practice we have to control this pubic health problem.
The potential suicide is a person with intense suffering and is always a serious patient, for whom by their despair, future expectations do not exceed a painful present.
Expose more carefully try this idea by describing a case of a patient with highly lethal suicide attempts, severe, recurrent (repeated blows with a hammer to the skull, incised wound in the abdomen after a knife stab, multiple cuts with a knife upper and lower limbs …). Besides these aspects, point out the risk factors found in this patient and further foster suicide problem. Borderline personality disorder and depressive disorder, in which we highlight a high difficulty in solving problems and hopelessness, the harmful use of cocaine and alcohol, and demographic factors such as age, gender and part of socially minority group. The profile of temperament and personality point out a tendency to novelty seeking and harm avoidance, coupled with aggressive and impulsive behavior, without a clear definition of objectives and targets, and low capacity for cooperation which is observed by manipulative attitude posing in repeated hospital admissions.
Therefore, we emphasize that suicide is a complex entity and their pricing strategies, risk detection and prevention, are hampered by the lack of a definition and classification operative. That said, and considering that you have to work in a comprehensive manner, we considered what we should prioritize in the treatment of this patient to prevent another attempted suicide, is the psychiatric disorder, substance use, social status risk that found, or suicidal symptoms itself?