Factores psicosociales asociados a la reincidencia de intentos de suicidio en pacientes con enfermedad mental atendidos en el Hospital Mental de Antioquia, Colombia, 2014-2016

Objetivo: Este estudio buscó analizar el comportamiento de factores psicosociales (características sociodemográficas, diagnóstico principal, método de intento, cognición y comportamiento) en relación con el número de intentos de suicidio en pacientes con diagnóstico de enfermedad mental, atendidos en el Hospital Mental de Antioquia, entre los años 2014 y 2016, además de evaluar la relación asociativa de dichos factores en la reincidencia por intento. Metodología: Estudio de corte transversal, que analiza, en 248 personas con diagnóstico de afecciones mentales, la asociación mencionada. Para ello, se describe, primero, el perfil sociodemográfico y clínico; luego, se construye un modelo de regresión logística multivariada, para evaluar la asociación de factores psicosociales con el riesgo de reincidencia por intento. Resultados: La población se caracterizó, principalmente, por ser joven (12-20 años) y de género femenino (62,9 %), siendo la reincidencia del 40 %. Entre los hallazgos de mayor relevancia se informa que se presenta una mayor proporción de consumo de sustancias psicoactivas y bajo apoyo familiar/social en pacientes con cuatro episodios respecto a quienes tuvieron un intento. Los predictores explicativos del riesgo de reincidencia por intento de suicidio fueron el trastorno depresivo recurrente, escaso seguimiento psiquiátrico y el uso de métodos de menor letalidad (corte de muñecas). Conclusión: Los resultados son claves en el marco de la prevención del suicidio, en tanto identifican factores que contribuyen al aumento del número de intentos y su reincidencia, y coincide con la ventana temporal de inicio de vigilancia del evento en el sistema colombiano.

Objective: This study sought to analyze psychosocial factors (sociodemographic characteristics, primary diagnosis, method of the attempt, cognition, and behavior) in relation to the number of suicide attempts in patients with a diagnosed mental illness who received care at Hospital Mental de Antioquia, from 2014 to 2016. We also had the objective of evaluating the associative relationship of such factors in recurrence per attempt. Methodology: Cross-sectional study that analyzes the abovementioned association in 248 people with diagnosed mental disorders. To this end, we first describe the sociodemographic and clinical profile; then, a multivariate logistic regression model is constructed to assess the association of psychosocial factors with the risk of recurrence per attempt. Results: The population was mainly young (12-20 years old) and female (62.9%), with a recurrence rate of 40%. Among the most relevant findings, there is a higher proportion of psychoactive substance use and low family/social support in patients with four episodes compared to those with one attempt. Predictors explaining the risk of suicide attempt recurrence were recurrent depression, little psychiatric follow-up, and the use of less lethal methods (wrist cutting). Conclusion: These results are key in the context of suicide prevention, as they identify factors that contribute to an increased number of suicide attempts and their recurrence, and they coincide with the time window for beginning surveillance of events in the Colombian system.

Objetivo: Este estudo procurou analisar o comportamento de fatores psicossociais (características sociodemográficas, diagnóstico principal, método de tentativa, cognição e comportamento) em relação com o número de tentativas de suicídio em pacientes com diagnóstico de doença mental, atendidos no Hospital Mental de Antioquia, entre os anos 2014 e 2016, além de avaliar a relação associativa de tais fatores na reincidência por tentativa. Metodologia: Estudo de corte transversal que analisa em 248 pessoas com diagnóstico de doenças mentais, a referida associação. Para tanto, descreve-se, primeiro, o perfil sociodemográfico e clínico; depois, constrói-se um modelo de regressão logística multivariada, para avaliar a associação de fatores psicossociais com o risco de reincidência por tentativa. Resultados: A população caracterizou-se, principalmente, por ser jovem (12-20 anos) e de gênero feminino (62,9%), sendo a reincidência do 40%. Entre os resultados de maior relevância encontra-se uma maior proporção de consumo de substâncias psicoativas e pouco apoio familiar/social em pacientes com quatro episódios em relação com aqueles que tiveram uma tentativa. Os preditores explicativos do risco de reincidência por tentativa de suicídio foram o transtorno depressivo recorrente, escasso acompanhamento psiquiátrico e o uso de métodos de menor letalidade (corte dos pulsos). Conclusão: Os resultados são chaves no marco da prevenção do suicídio, pois identificam fatores que contribuem para o aumento do número de tentativas e sua reincidência, e coincide com uma janela temporal de início de vigilância do evento no sistema colombiano.

Pattern Of Infections In Custodial Deaths � A Forensic Autopsy Study

Background: In a country like India, the prisoner cells are not well structured. For instance prisons are known to be a high risk environment for infections like tuberculosis (TB), HIV, HCV, HBV etc. due to overcrowding, low levels of nutrition, poor infection control and lack of accessible healthcare services. This study is an effort to know about the pattern of infections in custodial death cases detected during post mortem examination. Aims and Objectives: To determine the common infections and to know the mortality caused by infections among prisoners in custody, people in police custody and mentally ill patients in mental health institute in Punjab.Methods:This cross sectional study of 100 cases of custodial deaths from 1st Jan 2019 to 4thMay 2021, was carried out in the Forensic Medicine department in collaboration with department of Microbiology, Govt. Medical College, Amritsar.Results:Klebsiella Pneumoniae (37.5%) is more common in age group of 10-30 years while Staphylococcus Aureus (35.9%) infection was more common in the age group of 31 to 50 years. Incidence of positive growth of infections was slightly more in female inmates (76.9%) as compared to the males (75.9%). Inmates from urban area background showed more growth of Staphylococcus Aureus (35.7%) than from rural area background(25%).Conclusions:Timely medical diagnosis and treatment of each prisoner with availability of good doctors are the important issues relating to the healthcare of the individuals in custody.

Toma de decisiones en pacientes psiquiátricos: un estudio cualitativo con grupos focales

Introducción: Se ha dicho que las enfermedades mentales se caracterizan por la mala toma de decisiones; existe evidencia de neurociencias de alteraciones específicas en el desempeño en pruebas relacionadas con decisiones, pero poco se conoce sobre cómo los pacientes eligen acerca de su tratamiento. Métodos: Grupos focales con pacientes en 2 clínicas psiquiátricas, con análisis de discurso. Resultados: Se consideraron categorías previas (ayudas, capacidad, relación terapéutica, método, familia y red), con una categoría adicional (estigma) producto del análisis y 35 categorías inductivas. Se analizan las categorías, se presentan los hallazgos. Conclusiones: Los pacientes expresan necesidad de mayor participación en elecciones sobre su tratamiento y una relación más simétrica con el psiquiatra, con participación de las fami lias. Las decisiones pueden alterarse por el estigma, las barreras de acceso al tratamiento y las experiencias previas.

Introduction: It has been said that mental illnesses are characterised by poor decision making; there is some neuroscientific evidence of specific alterations in performance in decision making tests, but little is known about how patients make choices about their own treat ments. Methods: Focus groups with patients from two psychiatric clinics, with discourse analysis. Results: Five deductive categories (tools, capacity, therapeutic relationship, method and family and network), plus one additional category from the analysis (stigma), and 35 induc tive (posterior) categories were considered. The categories are analysed and the findings presented. Conclusions: Patients express a need for greater participation in decisions about their treatment, and a more symmetrical psychiatrist-patient relationship, involving families. Decisions may be changed due to stigma, barriers to treatment access, and previous expe riences.

Depois do holocausto: efeitos colaterais do hospital colônia em Barbacena / After the holocaust: side effects of colony hospital in Barbacena / Después del holocausto: los efectos secundarios de lo hospital colonia en Barbacena

Este trabalho objetiva abordar os resquícios das práticas manicomiais executadas num grande hospital psiquiátrico e sua repetição nos serviços de saúde mental de Barbacena. Nessa instituição hospitalar, pessoas internadas involuntariamente, sem diagnóstico de doença mental foram violentadas e mortas com a conivência do Estado. Procedeu-se a um breve percurso histórico e crítico sobre a criação desse hospital e entrevistas com profissionais que nele trabalham e que participam da implantação das políticas públicas de atenção a saúde mental no município. A psicanálise será utilizada nesta investigação, como forma de abordar a violência política e social em seus efeitos traumáticos e continuados até a atualidade. O conceito de compulsão à repetição auxiliará na compreensão da manifestação de práticas e discursos ligados à cultura manicomial. Tais práticas se automatizam nesses profissionais que sofrem os efeitos das passagens inconscientes da história relegadas ao esquecimento por jogos de conveniência não explicitados.

This research intends to address the remnants of insane asylum practices performed in a large psychiatric hospital and its repetition in the mental health services of Barbacena. In this hospital institution people were involuntarily admitted, without a diagnosis of mental illness, violated and murdered with the complicity of the state. Proceeded to a brief criticalhistorical analysis about it creation, interviews with professionals who work on it and, also, participate on the implementation of public policies on mental health care in the city. Psychoanalysis will be used on this research as a way to tackle the political and social violence in their traumatic effects that continues on these days. The concept of repetition compulsion will assist us in understanding the manifestation of practices and discourses related to asylum culture. Such practices are automated in those professionals who suffer the effects of unconscious passages of history, relegated to forgetfulness, by convenience games not specified.

Este trabajo tiene como objetivo hacer frente a los restos de las prácticas psiquiátricas realizadas en un gran hospital psiquiátrico y su repetición en los servicios de salud mental de Barbacena. En este hospital, las personas admitidas involuntariamente, sin un diagnóstico de enfermedad mental fueron violadas y asesinadas con la connivencia del Estado. Se ha producido un breve recorrido histórico y crítico en la creación de este hospital y entrevistas a profesionales que trabajan en ella y participar en la implementación de políticas públicas que aborden la salud mental en el municipio. El psicoanálisis se utilizará en esta investigación como una manera de hacer frente a la violencia política y social y sus efectos traumáticos continúa hasta hoy. El concepto de compulsión a la repetición ayudar en la comprensión de la manifestación de prácticas y discursos relacionados con la cultura de asilo. Tales prácticas si automatizan estos profesionales que sufren los efectos de los pasajes inconscientes de la historia relegados al olvido por los juegos de conveniencia no especificados.

A Study to Investigate the Medium- and Long-Term Developmental Directions of Mental Hospitals / 신경정신의학

OBJECTIVES: The aim of this study was to investigate medium- and long-term developmental directions of mental hospitals. METHODS: The preliminary investigation is composed of unstructured interviews with 10 psychiatrists, literature and case investigations, and development of models for medium- and long-term developmental model. The qualitative investigation consisted of constructed interviews with seven professionals. The quantitative investigation was conducted using questionnaires, which were sent to members of the Korean Neuropsychiatric Association, etc. Data were analyzed using frequency analysis. RESULTS: Through the preliminary investigation we were able to make three models : community model emphasizing linkage between mental hospitals and community, specialization model stressing specializations of mental hospitals, and extension model highlighting extensions of the roles of the mental hospital. In the qualitative investigation, two of the seven professionals gave a special preference for the community model, one for the specialization model, and two for the extension model. In the quantitative investigation, the community model and the specialization model were the most favorite models, and the extension model was the least favorite model. CONCLUSION: Three developmental models could be used in planning of the medium- and long-term developmental directions of mental hospitals, although each model needs to be embodied in order to work in practice.

Epidemiological variants in mentally ill patients : a cross-sectional study in mental hospital patients of Ahmedabad city.

Background: Now a day’s mental and behavioural disorders are common in the community. Globally, some 450 million persons suffer from a mental or behavioural disorder contributing to 13% of global burden of disease.1TheServices are provided by psychiatric hospitals where assessments are carried out by psychiatrists, clinical psychologists and sometimes psychiatric social workers, using various methods but often relying on observation and questioning. Even this is done in the community. Thus on the basis of these observations we have drawn the conclusion of epidemiological variants among the patients. Aims & Objective: To assess the frequency of various epidemiological trends in patients in mental hospital and to study associated risk factors in them. Material and Methods: 118 patients out of 237 in mental hospital were selected on random basis. On predesigned Performa, various details were noted and the data was analyzed in epi info 7. Results: There were 48.3% females and 51.7% males. There were 87 cases of schizophrenia and 19 case of bipolar disorder in manic phase. The 57.98% of patients present with behaviour abnormality and 43.45% of patients have the abnormal BMI and 24.25% of patients of patients have primary education level. The 81.21% of people were not working. Conclusion: Resources and service for the mental disorder are comparatively low as compared to the burden of the disease. Thus by studying the various epidemiological correlations we can plan certain preventive measures so that mental disease burden could be decrease. Looking to the etiopathology, found in our study it is recommended that counselling should also be a part of management and importance should be given to environmental or social factors like education living standards etc. for prevention of mental disorders.

Pattern of Child and Adolescent Patients Attending Psychiatric Outpatient Department of the Mental Hospital in Bangladesh.

Bangladesh has only one mental hospital which is situated in Pabna district of the country. People from the nearby locality as well as from distant regions of the country come here for psychiatric service. Clinical records of all the children who attended the outpatient department of 'Mental Hospital, Pabna' (MHP) during January, 2009 to June, 2009 were analyzed. Of the 143 children, 125 (88%) were of school going age (i.e., >_6 years of age). The majority (63%) of the patients were male. International Classification of Diseases (ICD) classification revealed that the patients came with mental retardation (F70-F79) (38%), Episodic and paroxysmal disorder (G43-G44) (26%) and Schizophrenia, schizotypal & delusional disorders (F20-F29) (22%). The main comorbid condition was behavioural problem with mental retardation (43% of mentally retarded). Of the 103 patient we had information about the pathway to care, 20 patients (19%) came directly to MHP and the rest 83 (81%) consulted other service provider before reaching here. Among the previous service providers, there were medical graduates (60%), Kobiraj (36%) and indigenous & religious healer (34%). Considering the variety of presentation of child and adolescent patients, we propose to establish a multidisciplinary approach in MHP.

Presente y futuro de los servicios de salud mental en Paraguay / Present and future of the mental health services in Paraguay

El servicio de salud pública en Paraguay está limitado por la carencia de recursos técnicos, económicos y humanos, además de falta de gratuidad en la atención, a pesar de las políticas legales vigentes. Para la atención en salud mental se destina únicamente el 1% del presupuesto anual de la nación para salud. Afortunadamente, la nueva política nacional de salud mental, aprobada en enero del 2011, se orienta a la erradicación de las violaciones de los derechos humanos sufridas por los usuarios, por medio de la desmanicomialización gradual y la reinserción comunitaria. Con el objetivo de ejemplificar los servicios de salud mental en Paraguay, en este artículo se presentan antecedentes, informes y políticas que resumen la situación actual en la que se encuentran las personas con discapacidad y trastornos mentales, además de los nuevos proyectos planificados para la próxima década.

The public health service in Paraguay is limited due to the lack of technical, economical and human recourses, and also for the scarcity of free medical assistance, in spite of the current legal policies. For the mental health attention, only 1% of the national health budget is provided. Luckily, the new mental health policies, approved in January 2011, are oriented to the eradication of the human rights violations suffered by the users, considering the gradual deinstitutionalization and community reinsertion. With the goal of sampling the mental health services in Paraguay; background, reports and policies are presented in this article. They summarize the current situation of the handicapped and mentally disabled, as well as the new projects planned for the next decade.

O acompanhar na desinstitucionalização / Taking care of deinstitutionalization

São descritos os propósitos e a organização da Conferência Nacional de Voluntariado da Justiça Italiana. Em particular são destacados os fundamentos do trabalho do voluntariado: a salvaguarda dos direitos, a responsabilidade, a gratuidade, o valor da relação. Perante a despersonalização da instituição, a relação entre os voluntários e os detentos, nos manicômios judiciários e nos cárceres, oferece possibilidade de um reconhecimento importante da subjetividade da pessoa. Além disso, o voluntariado oferece respostas concretas para integração na sociedade e contribui para reconstruir uma rede social à volta do sujeito. Algumas possibilidades concretas para ultrapassar o hospital psiquiátrico judiciário na Itália começam a surgir, nos últimos tempos, através do projeto legislativo de Reforma do Código Penal e através da passagem da um sistema privado de saúde carcerária a um sistema único gerenciado pelo Ministério da Saúde. Ponto estratégico tornou-se o envolvimento direto das regiões (os estados) na gestão sanitária dos cárceres e dos manicômios judiciários.

The Experiences of Mental Health Hospital Workers / 간호학회지

PURPOSE: The purpose of this study was to understand the experiences of mental health hospital workers. METHODS: Participants in the study were a total of 8 mental health hospital workers who consisted of nurses, social welfare workers and health managers. To prevent them from being omitted, the interviews were all recorded under the participants prior agreement. The method was analysis using the phenomenological method proposed by Colaizzi(1978). RESULTS: The experiences of the participants of this study were classified into 15 significant areas, from which 10 subjects hard work, conflicts, heavy feeling, irritability, getting familiar, changes of recognition, aptitude determination, feeling of achievement and sense of pride were drawn out. These subjects were then grouped into 5 themes. These five themes were finally grouped into 5 categories, negative emotion, depressive emotion, changes of thinking, delight and value discovery. CONCLUSIONS: The study tried to analyze the experiences of key informants like nurses, social welfare workers and health managers all of whom were serving at mental health hospitals, contribute to social recognition about the special medical establishment, promote qualitative mental health nursing and further provide educational information necessary for understanding mental health hospital workers.

An Estimation of Optimal Medical Manpower in Mental Hospital / 신경정신의학

OBJECTIVES: The purpose of this study is to surmise appropriate level of medical manpower of mental hospital from the perspectives of clinical experts, psychiatrist and psychiatric nurse. METHODS: First, we wlleded data on medical manpower of domestic mental hospitals and foreign mental hospitals. Next, psychiatrists and psychiatric nurses were asked to complete a survey. We estimated the optimal level of medical manpower examining appropriate volume of medical services that should be provided for psychiatric patients, and analizying the survey carried out by direct questions. RESULTS: The number of psychiatrists of group A of private mental hospitals was 1.7 times more than that of public mental hospitals; when the number of psychiatrists in public mental hospitals was regarded as 1.0, and group B of private mental hospitals was 0.5 times, and the university hospitals 8.2 times. The number of psychiatric of group A of private hospitals was 1.5 times more than that of public mental hospitals; when the number of psychiatric nurses in public mental hospitals was regarded as 1.0, the group B of private mental hospitals was 0.6 times and university hospitals was 2.6 times. The foreign mental hospitals had more medical manpowers in all occupations than domestic mental hospitals. The number of psychiatrists estimated according to the first method was 11.1 persons and the number of psychiatric nurses was 26.3 persons per 100 beds, and the number of psychiatrists estimated according to the second method was 4.3 persons per and the number of psychiatric nurses was 20.8 persons per 100 beds. CONCLUSION: The estimated optimal number of psychiatrists for mental hospital is 4.3 persons and of psychiatric nurses was 20.8 persons per 100 beds. However, these numbers can be flexible depending on the ratio of short-term acute patients and long term chronic patients.

An Estimation of Optimal Medical Manpower in Mental Hospital / 신경정신의학

OBJECTIVES: The purpose of this study is to surmise appropriate level of medical manpower of mental hospital from the perspectives of clinical experts, psychiatrist and psychiatric nurse. METHODS: First, we wlleded data on medical manpower of domestic mental hospitals and foreign mental hospitals. Next, psychiatrists and psychiatric nurses were asked to complete a survey. We estimated the optimal level of medical manpower examining appropriate volume of medical services that should be provided for psychiatric patients, and analizying the survey carried out by direct questions. RESULTS: The number of psychiatrists of group A of private mental hospitals was 1.7 times more than that of public mental hospitals; when the number of psychiatrists in public mental hospitals was regarded as 1.0, and group B of private mental hospitals was 0.5 times, and the university hospitals 8.2 times. The number of psychiatric of group A of private hospitals was 1.5 times more than that of public mental hospitals; when the number of psychiatric nurses in public mental hospitals was regarded as 1.0, the group B of private mental hospitals was 0.6 times and university hospitals was 2.6 times. The foreign mental hospitals had more medical manpowers in all occupations than domestic mental hospitals. The number of psychiatrists estimated according to the first method was 11.1 persons and the number of psychiatric nurses was 26.3 persons per 100 beds, and the number of psychiatrists estimated according to the second method was 4.3 persons per and the number of psychiatric nurses was 20.8 persons per 100 beds. CONCLUSION: The estimated optimal number of psychiatrists for mental hospital is 4.3 persons and of psychiatric nurses was 20.8 persons per 100 beds. However, these numbers can be flexible depending on the ratio of short-term acute patients and long term chronic patients.