Actitudes de los profesionales de la Salud Mental hacia las personas con esquizofrenia / [Attitudes of mental health workers toward people with schizophrenia].

OBJECTIVE: Stigma is a social and universal phenomenon which constitutes the core of various social barriers. Stigmatizing attitudes of mental health workers influence the outcome of patients and affect their recovery. Our purpose was to determine some attitudes and social distance of mental health workers toward people with schizophrenia. METHODS: 517 mental health workers were surveyed at two national conferences in Argentina. RESULTS: More than 90

believed that patients have the right to know their diagnosis, but only 64

informed it. Psychiatrists and men professionals were more likely to inform the diagnosis. Eighteen per cent thought that the voting right of people with schizophrenia should be revoked, 13

believed that this group should not have children and 63.7

believed that people with schizophrenia can recover completely. There was a statistical difference in the social distance according to health workers’ gender, years of experience and the percentage of patients assisted. CONCLUSIONS: There exist social distance and stigmatizing attitudes toward people with schizophrenia among mental health workers. The contact could help to reduce social distance. Anti-stigmatizing education programs should be directed toward mental health workers since their initial training.

Psicoterapia ambulatoria en el Conurbano Bonaerense: tasa de su utilización, costo y características de las psicoterapias y sus usuarios / Outpatient psychotherapy in suburban Buenos Aires: rate of use, costs, practices and patient charac-teristics

Objetivo: El objetivo de este estudio fue conocer la frecuencia de tratamiento psicoterapéutico en la población adulta del Conurbano Bonaerense, su costo, particularidades de las terapias y características demográficas de los usuarios. Metodología: Se realizaran encuestas a 899 habitantes de 11 partidos del Gran Buenos Aires entre septiembre y noviembre del año 2007. Resultados: El 14,2 por ciento de los entrevistados había realizado psicoterapia en el último mes. El 42,8 por ciento de los encuestados había asistido alguna vez o asistía a tratamiento psicoterapéutico. La concurrencia es mayor entre las mujeres, viudos y personas de edad media y nivel educativo y socioeconómico elevado. Casi el 40 por ciento de los que están actualmente en psicoterapia realiza tratamiento psicoanalítico, 10 por ciento tratamiento cognitivo-conductual y 41 por ciento desconoce el tipo de psicoterapia que realiza. Los tratamientos son conducidos principalmente por psicólogos (85 por ciento), en su mayoría son de tipo individual y se realizan en forma privada. La duración promedio de la entrevista psicoterapéutica es de 52 minutos. Existe una relación positiva entre duración de la entrevista y su costo. No existen diferencias significativas en la frecuencia de uso de tratamiento psicoterapéutico entre las distintas zonas del Conurbano, como así tampoco con la frecuencia de la ciudad de Buenos Aires. Conclusiones: La asistencia a tratamiento psicoterapéutico en el Gran Buenos Aires es mayor que en otros países, sin embargo es menor en ciertos grupos sociales y etarios. Se necesitan estudios más detallados para dilucidar la adecuación de los tratamientos a los problemas mentales de la población.

Objective: The purpose of this study was to estimate the rate of use, costs and details of psychotherapeutic treatment in general population of suburban Buenos Aires along with patient demographic characteristics. Methods: A survey was conducted between September and November 2007 among 899 inhabitants of 11 districts in greater Buenos Aires. Results: During the previous month 14, 2 percent of the population received psychotherapy treatment. Lifetime prevalence of psychotherapy was 42, 8 percent. Use of psychotherapy was higher among women, the widowed, middle aged individuals and persons with higher socioeconomic status and levels of education. Almost 40 percent of the individuals in psychotherapy at the time of the survey reported receiving psychoanalytic treatment, 10 percent reported receiving cognitive-behavioral therapy while 41 percent was not aware of the type of psychotherapy received. Treatments were conducted mainly by psychologists (85 percent) and the majority consisted of individual psychotherapy in a private practice setting. Mean duration of a psychotherapy session was 52 minutes. A positive correlation was found between the duration of a session and its cost. There were no overall differences in the rate of use of psychotherapy between different areas of greater Buenos Aires, nor between these areas and previous estimates of prevalence in the city of Buenos Aires. Conclusions: Psychotherapy use in greater Buenos Aires is higher than in other countries. However, the rate of use is lower for certain socioeconomic and age groups. Further research is needed to determine whether the treatments observed are appropriate for the mental health needs of this population.

Estudio de efectividad en pacientes con esquizofrenia crónica: CATIE: ¿qué podemos aprender? / Effectiveness trials in chronic schizophrenic patients: CATIE. What can we learn?

La necesidad de contar con estudios clínicos prácticos en los pacientes esquizofrénicos llevó al desarrollo del estudio CATIE para estudiar la efectividad de los antipsicóticos en el "mundo real". Este estudio consta de distintas fases que se describen en este artículo, detallando su metodología, resultados y limitaciones. No hubo diferencias significativas en eficacia entre los antipsicóticos de primera y segunda generación. La olanzapina aparece como una droga de efectividad superior aunque con un perfil de efectos adversos metabólicos importantes. La clozapina tuvo eficacia superior en pacientes que no habían respondido al antipsicótico administrado en la fase anterior de este estudio. La risperidona parece ser más conveniente en pacientes que abandonan el tratamiento antipsicótico por intolerancia. Los antipsicóticos aún dejan muchas expectativas terapéuticas sin cumplirse. Se deben implementar otras medidas terapéuticas para lograr un tratamiento más integral. El tratamiento para cada paciente debe ser diseñado específica mente, siendo de enorme importancia lograr una mayor adherencia.

The need for practical clinical trials on schizophrenic patients led to the development of the CATIE to study the effectiveness of antipsychotics in the "real world". This study has different phases that are described in this article, detailing their methodology, results and limitations. There were no significant differences between the antipsychotics of first and second generation. Olanzapine appeared as a drug of higher effectiveness but with important metabolic side effects. Clozapine had higher efficacy in patients that had not responded to an antipsychotic administered in a previous phase of this study. Risperidone appeared to be more convenient for patients that abandoned their antipsychotic treatment because of intolerability. Antipsychotics still leave a lot of therapeutic expectations without fulfillment. Other therapeutic measures should be carried out to accomplish a more comprehensive treatment. The treatment for each patient must be specifically designed and the achievement of compliance must be considered of great importance.