Autopsias psicológicas de treinta suicidios en la IV región de Chile / Psychological autopsies of thirty suicides of the IV region of Chile

Background: Suicide is a relevant public health problem in Chile. This is the first Chilean study with the psychological autopsy method (PA). Aims: a) to identify risk factors for suicide in Chilean victims; b) to identify risk indicators for early intervention; c) to assess acceptability of the PA method by informants. Method: Sample consisted of 30 subjects (24 males, six females) who commited suicide in the IV Region of Chile (December 2008-September 2010). Data was collected from informant interviews. Main instrument was the Psychological Autopsy Interview Protocol. Results: Mean age at suicide was 35.8 years. Most victims communicated suicidal intent before consummation. Almost all experienced negative life events, in many cases shortly before suicide. One half had attempted suicide previously, some during the preceding month. Thirty-six percent were in mental health treatments at time of death. A quarter had recently visited mental health professionals. Psychiatric disorders (ICD-10) were identified in 90 percent, mainly depressive and substance use disorders. Personality disorders were evident in eight victims (33 percent): dissocial (4), emotionally unstable (2), paranoid (1), and anxious (avoidant) (1). Conclusions: A high rate of psychiatric disorders was confirmed. Previous suicide attempts are sensitive predictors of completed suicide. Communication of suicide intent is frequent, and may be an opportunity for intervention. Suicide is often preceded by negative life events. Prevention of suicide may be improved by effective treatment of psychiatric disorders, and focused psychosocial interventions. Intensive follow-up of attempters seems highly relevant. PA is an acceptable method for informants.

Introducción: El suicidio es un problema de salud pública relevante en Chile. Este es el primer estudio chileno con el método de la autopsia psicológica (AP). Objetivos: a) identificar factores de riesgo de suicidio en víctimas chilenas; b) identificar indicadores de riesgo para la intervención temprana; c) evaluar la aceptabilidad del método de la AP por los informantes. Método: La muestra consistió en 30 sujetos (24 hombres y 6 mujeres) que cometieron suicidio en la IV Región de Chile (diciembre de 2008-septiembre de 2010). La información fue recogida de entrevistas a informantes. El instrumento principal fue el Protocolo de Entrevista para Autopsia Psicológica. Resultados: La edad promedio fue 35,8 años. La mayoría comunicó intención suicida antes de consumarlo. Casi todos experimentaron eventos negativos, frecuentemente poco antes del suicidio. La mitad había intentado suicidarse previamente, algunos durante el mes precedente. El 36 por ciento estaba en tratamientos de salud mental al fallecer y un cuarto había visitado recientemente a profesionales de salud mental. Se identificó trastornos psiquiátricos (CIE-10) en el 90 por ciento, principalmente trastorno depresivo y por uso de sustancias. Los trastornos de personalidad fueron evidentes en ocho víctimas (33 por ciento): disocial (4), emocionalmente inestable (2), paranoide (1) y ansioso (evitativo) (1). Conclusiones: Se confirmó una elevada tasa de trastornos psiquiátricos. El antecedente de intentos previos es un predictor sensible de suicidio. La comunicación de intención suicida es frecuente y puede ser una oportunidad de intervención. El suicidio es frecuentemente precedido por eventos vitales negativos. La prevención del suicidio puede mejorar mediante el tratamiento efectivo de trastornos psiquiátricos e intervenciones psicosociales focalizadas. El seguimiento intensivo de intentadores parece altamente relevante. La AP es aceptable para los informantes.

Trastornos de ansiedad en pacientes hospitalizados en Medicina Interna / Anxiety disorders among patients hospitalized in a medical ward

Background: Anxiety symptoms and anxiety disorders are common among medical patients, however few studies differentiate both and consider the psychiatric comorbidity of anxiety disorders among such patients. Aim: To evaluate the presence of anxiety disorders among patients admitted to a medical ward. Patients and methods: Random selection of 406 patients (mean age 56 years, 203 female), hospitalized in a medical ward of a public hospital, mainly for cardiovascular, genitourinary and digestive diseases. All were assessed using an structured interview for DSM-III-R. Results: Twenty six percent of women and 13% of men had anxiety disorders. Fifteen percent of women and 6% of men had specific phobias, 7% of women and 4% of men had generalized anxiety, 5% of women and 0.5% of men had agoraphobia, 3% of women and 0.5% of men had social phobia, 1% of men and 0.5% of women had panic disorders and 0.5% of women had a post traumatic stress. Specific phobias and social phobias started during childhood. Anxiety and agoraphobia started during adulthood. Among patients with anxiety disorders, 43% of women and 34% of men did not have other psychiatric ailment, 34% of women and 19% of men had an associated depression and 34% of men had disorders due to use of alcohol. Conclusions: A high proportion of patients hospitalized in medical wards have anxiety disorders, that once identified it may help to treat the medical ailments.

Prevalencia de trastornos psiquiátricos por uso de alcohol y otras sustancias en hombres y mujeres hospitalizados en medicina interna de un hospital de Santiago de Chile / Prevalence of substance abuse among patients hospitalized in an internal medicine service from Santiago de Chile

Background: Studies done in Chile and abroad report a high frequency of substance abuse among patients hospitalized in general medical services. Aim: To report the frequency of substance abuse in a sample of patients hospitalized in a public hospital of Santiago. Material and methods: A structured psychiatric interview for the Third Revised Version of The Diagnostic and Statistical Manual (DSM-III-R) was applied to 203 males, aged 58.5 years and 203 females, aged 52,9 years, hospitalized in an internal medicine Service of a public hospital. All subjects had a low educational and income level. Results: The discharge diagnoses of studied patients were digestive diseases in 32 percent, circulatory diseases in 19 percent, cancer, diabetes mellitus and genitourinary diseases in 11 percent respectively and mental or behavioral diseases in 5 percent. Thirty eight percent of males and 6 percent of females qualified for alcohol dependency or abuse in some moment of their lives. The figures for benzodiazepine dependency were 1 percent among males and 6 percent among females. The figures for cannabis, cocaine or stimulant abuse were 1.5 percent for males and 1 percent for females. Other conditions of the axis 1 of DSM-IIIR were diagnosed in 47 percent of males and 65 percent of females with substance abuse. Conclusions: Substance abuse underlies medical conditions in a high proportion of patients admitted to medical services in general hospitals

Prevalencia de trastornos psiquiátricos en hombres y mujeres hospitalizados en un servicio de medicina interna de un hospital de Santiago de Chile / Prevalence of psychiatric disorders among subjects hospitalized in a medicine ward of a general hospital

Background: Mental disorders may interfere, aggravate or mimic medical conditions. Aim: To study the prevalence of psychiatric disorders among patients hospitalized in a medical ward of a general hospital. Patients and methods: A structured interview for DSM-III, devised for "non patients", was applied to 203 men and 203 women, aged 11 to 90 years old, hospitalized in an internal medicine service of a public hospital. Thirty four psychiatric conditions that can be discriminated with the instrument and others that complied with DSM-III criteria, were investigated. Results: There was a 60 percent prevalence of mental disorders among men (alcohol dependency in 26 percent, delirium or dementia in 10.8 percent, anxiety disorders in 10.4 percent, major depression in 7.8 percent and adaptation disorders in 3 percent). Among women, the prevalence of mental disorders was 65 percent (major depression in 23.2 percent, anxiety disorders in 14.3 percent, adaptation disorders in 8.4 percent, dementia in 5.6 percent, delirium in 3 percent and alcohol dependency in 2.5 percent). Most conditions were of moderate or mild intensity. Two or more conditions coexisted in 40 percent of cases. Only in 8 percent of these subjects, a psychiatric consultation was requested. Conclusions: There is a high frequency of psychiatric disorders among medical patients. These must be adequately diagnosed and treated

La conducta suicida en mujeres: un estudio prospectivo / Study of female suicide attempters: a 5 years follow up

Background: A previous suicide attempt is one of the strongest predictors of future suicidal behavior. Aim: To explore the evolution of suicidal tendencies in women who attempted suicide 5 to 7 years earlier. Patients and methods: Ninety two women aged 37 ñ 9 years old, that attempted suicide between 1989 and 1991 were followed and reassessed in 1997. Results: In the study period two women committed suicide and 30 attempted suicide. Forty three percent of new self harm behaviors occurred during the first year after the first suicide attempt and the harming method was similar. Conclusions: In this study, 34percent of women with previous suicide attempts, repeated this behavior, using similar methods

Demanda de consultas al servicio de urgencia del Instituto Psiquiátrico Dr. José Horwitz B. de Santiago: comparación entre 1988 y 1994 / Consultation demand at emergency service of Instituto Psiquiátrico Dr. José Horwitz B. at Santiago: comparison between 1988-1994

Materials and methods: A random sample of 439 patients charts, corresponding to 3 percent of all consultations during 1994, were analyzed. The results were compared with consultations during 1998, analyzed in a previous study. Results: During 1994, patients were older, came alone to the emergency wards and consulted during the night with greater frequency than during 1988. In both years psychosis were the main cause of consultation. Compared to 1988, during 1994 there was an increase in the frequency of affective disorders (16 and 12 percent of all consultations respectively) and substance abuse (15 and 3 percent respectively). Conclusions: The increase in consultations due to affective disorders and substance abuse in 1994 is in accordance with changes in the epidemiological profile of psychiatric disorders in Santiago

Desarrollo y validación de una encuesta para evaluar la satisfacción de los pacientes con la consulta médica en consultorios de atención primaria / Development and validation of a survey to assess patients satisfaction with medical consultation in primary health care

Te aim of this work was to devise and assess the reliability of an instrument to measure satisfaction with medical consultation of primary care urban patients at public outpatients clinics. A model was elaborated, based on data collected from the literature and from focal groups of patients and physicians and an enquiry was developed and applied at four outpatient clinics. Fifty enquires were obtained and analyzed to discard questions of difficult understanding. Next, a second self administered questionnaire and with fewer questions was devised. Its reliability was assessed in 53 enquires, obtaining a Cronbach's of 0.904. Questions that decreased consistency were discared, finally obtaining a self administered instrument with analysis with varimax rotation, which separated three factors that explain 64 percent of the variance. It is concluded that a valid and reliable instrument was obtained

Construcción y evaluación de pauta de medición de riesgo relacional madre-recién nacido / Construction and assessment of a scale to measure mother-newborn relationship risk

The purpose of this work was to construct and assess a scale aimed to detect risky relationship between mothers and newborns that could predict future child abuse and neglect. The instrument was applied in 2 opportunities, by a trained midwife and by expert in mental health, to a sample of 106 mother-newborn dyads. When both assessments were compared, the concordance to assess relationship risk was 99.3 percent. The reliability of the scale, measured with the Crombach, a internal consistence index, was 0.88. Those items with a low discriminative capacity were eliminated. The massive use of the resultant scale, that is easy to apply and highly reliable, could help to prevent child abuse and neglect