Use of prescribed psychotropic drugs among medical students and associated factors: a cross-sectional study

Abstract BACKGROUND: The worldwide prevalences of anxiety and depressive disorders are 3.6% and 4.4%, respectively. Among medical students, many studies have indicated that the prevalences of these mental disorders vary between 19.7% and 47.1%, but there is a lack of information on psychotropic drug usage in this group of students. OBJECTIVE: To evaluate the prevalence of psychotropic drug use, adherence to therapy and main clinical and diagnostic indications relating to psychotropic drug use among medical students. DESIGN AND SETTING: Cross-sectional study at a Brazilian private university in the city of Sorocaba, state of São Paulo. METHODS: Observational analytical cross-sectional study, conducted during the second semester of 2019, through a semi-structured online questionnaire, answered by first to sixth-year medical students. RESULTS: Among the 263 participants (41.7% of the 630 enrolled students), the current prevalence of psychotropic drug usage was 30.4%. This prevalence increased over the course and 90.7% of the drugs were prescribed at regular medical consultations (85.5% by psychiatrists). The main indications for psychotropic drug usage were anxiety (30.0%), depression (22.8%), insomnia (7.2%), panic (5.3%) and attention deficit hyperactivity disorder (3.8%). Women were more likely to present diagnoses of depression and panic. Most of the participants used antidepressants and had good adherence to medications. Adequate sleep and regular physical activity were identified as protective factors against mental disorders. CONCLUSION: The prevalence of mental disorders among medical students is high, which justifies the use of psychotropic drugs. This study provides valuable information and recommendations for institutional educational actions to improve students' mental health.

Grupos de acogimiento: Sistematización de un modelo participativo para la formulación diagnóstica y terapéutica en un centro de salud mental comunitaria. Chorrillos-Perú, 2018 / Foster groups: Systematization of a participatory model for the diagnostic and therapeutic formulation in a community mental health center. Chorrillos-Peru, 2018

RESUMEN Objetivo: Sistematizar el proceso de formulación de diagnósticos y planes de tratamiento en grupos participativos de profesionales y usuarios, denominados Grupos de Acogimiento, como alternativa al modelo convencional de consultas psiquiátricas individuales y secuenciales, en el ámbito de la salud mental comunitaria. Material Métodos : El estudio se realizó en un centro de salud mental comunitaria (CSMC) de Lima durante el periodo enero-diciembre de 2018. Se siguió una metodología de investigación-acción en la que propuestas surgidas de la experiencia se implementaban para, luego, analizar críticamente sus resultados y ajustarlos sucesivamente hasta lograr un punto de estandarización o de consenso entre los participantes. Resultados: El modelo participativo se aplicó en 97% de los usuarios durante el periodo de observación y se llegó a la formulación de diagnósticos y planes de tratamiento durante la sesión del Grupo de Acogimiento, en el 85% de los pacientes. Las sesiones se estandarizaron en cuatro momentos concatenados y semi-estructurados: Presentación horizontal de participantes, comprensión empática mutua, exploración colectiva de causas, y decisiones terapéuticas compartidas. Conclusiones: El modelo participativo de Grupos de Acogimiento fue una alternativa viable y eficaz para la formulación inicial de diagnósticos y planes terapéuticos en el CSMC, con fases semiestructuradas convenientemente estandarizadas y replicables.

SUMMARY Objective: To systematize the process of diagnosis and treatment plan formulations in participatory groups of users and professionals, called Fostering Groups, as an alternative to the conventional model of individual and sequential psychiatric consults, in the field of community mental health. Material and Methods : The study was carried out in a community mental health center (CMHC) in Lima throughout the period January-December 2018. An action-research methodology was followed, in which proposals arising from the experiences were put into action to, then, critically analyze the and adjust them successively until reaching a point of standardization or consensus among the participants. Results : The participatory model was applied in 97% of the users during the observation period and the formulation of diagnoses and treatment plans during the Foster Group session was successfully reached in 85% of the patients. The sessions were standardized in four concatenated and semi-structured moments: Horizontal presentation of participants, mutual empathetic understanding, collective exploration of causes, and shared therapeutic decisions. Conclusions : The Fostering group model was a viable and effective alternative for the initial formulation of diagnoses and therapeutic plans in the CMHC, with semi-structured phases conveniently standardized and replicable.

Modos de subjetivação e discurso psiquiátrico: implicação e repercussão do diagnóstico psiquiátrico na construção de identidade dol sujeito / Subjectivity modes in psychiatric speech: implications and impact of psychiatric diagnosis on the subject of identity construction

Resumo O objetivo do artigo é apresentar os resultados da pesquisa que versou sobre o impacto do diagnóstico psiquiátrico nos modos de subjetivação do sujeito. Também se propõe a demonstrar a relação do diagnóstico com o processo de medicalização e a repercussão sobre as relações sociais dos indivíduos. Desse modo, foi realizada uma pesquisa qualitativa exploratória que se baseou nos dados dos prontuários, bem como em entrevistas semidirigidas realizadas com dez usuários de uma unidade básica de saúde com Estratégia Saúde da Família de uma cidade do interior do Rio Grande do Sul. Os principais achados se expressaram em três eixos: subjetivação pela doença, que traz a ideia de que os sujeitos se reconhecem e reproduzem um comportamento coerente ao diagnóstico imposto; medicalização como controle de si mesmo, que discute a dependência dos sujeitos à medicação; e relações interpessoais após o diagnóstico, que alude à mudança de comportamento que as pessoas mais próximas têm com o indivíduo "doente".

Abstract This article aims at presenting the results of a study that approached the impact of the psychiatric diagnosis on the modes of subjectivity. It also proposed to demonstrate the relation of the diagnosis and the medicalization process with the repercussion on the individuals' social relationships. Thus, an exploratory qualitative research was conducted, using data from medical records and semi-directed interviews with ten users of a Basic Health Unit with Family Health Strategy in a city of the state of Rio Grande do Sul, Brazil. The main findings were expressed in three axes: subjectivity by the disease, in which the subjects recognize themselves and reproduce a behavior consistent with the imposed diagnosis; medicalization as self-control, which discusses their dependence on medication; and interpersonal relationships after diagnosis, alluding to the change in behavior that the closest people have towards the subject under treatment.

Modos de subjetivação e discurso psiquiátrico: implicação e repercussão do diagnóstico psiquiátrico na construção de identidade dolsujeito / Subjectivity modes in psychiatric speech: implications and impact of psychiatric diagnosis on the subject of identity construction

Resumo O objetivo do artigo é apresentar os resultados da pesquisa que versou sobre o impacto do diagnóstico psiquiátrico nos modos de subjetivação do sujeito. Também se propõe a demonstrar a relação do diagnóstico com o processo de medicalização e a repercussão sobre as relações sociais dos indivíduos. Desse modo, foi realizada uma pesquisa qualitativa exploratória que se baseou nos dados dos prontuários, bem como em entrevistas semidirigidas realizadas com dez usuários de uma unidade básica de saúde com Estratégia Saúde da Família de uma cidade do interior do Rio Grande do Sul. Os principais achados se expressaram em três eixos: subjetivação pela doença, que traz a ideia de que os sujeitos se reconhecem e reproduzem um comportamento coerente ao diagnóstico imposto; medicalização como controle de si mesmo, que discute a dependência dos sujeitos à medicação; e relações interpessoais após o diagnóstico, que alude à mudança de comportamento que as pessoas mais próximas têm com o indivíduo "doente".

Abstract This article aims at presenting the results of a study that approached the impact of the psychiatric diagnosis on the modes of subjectivity. It also proposed to demonstrate the relation of the diagnosis and the medicalization process with the repercussion on the individuals' social relationships. Thus, an exploratory qualitative research was conducted, using data from medical records and semi-directed interviews with ten users of a Basic Health Unit with Family Health Strategy in a city of the state of Rio Grande do Sul, Brazil. The main findings were expressed in three axes: subjectivity by the disease, in which the subjects recognize themselves and reproduce a behavior consistent with the imposed diagnosis; medicalization as self-control, which discusses their dependence on medication; and interpersonal relationships after diagnosis, alluding to the change in behavior that the closest people have towards the subject under treatment.

Assessment of the Therapeutic Evolution of Psychiatric Patients through Rorschach Psychodiagnosis / Avaliação da Evolução Terapêutica de Doentes Psiquiátricos através do Psicodiagnóstico de Rorschach

Abstract The present work aims to constitute an important contribution to the scientific proof of the effectiveness of psychiatric and psychotherapeutic interventions, through the Rorschach test. A clinical sample of 10 psychiatric patients, admitted and followed at the Day Hospital of a psychiatric hospital in the North of Portugal, where the psychoanalytic orientation intervention model is followed. The data were collected in two moments: upon admission, a sociodemographic and clinical questionnaire and Rorschach's projective proof were applied; after three months of treatment, Rorschach was re-applied, followed by a survey of exclusion criteria and patient evaluation on the therapeutic program.The comparative analysis of the data showed a slight therapeutic evolution and personality functioning.

Resumo O presente trabalho objetiva constituir um contributo de relevo para a comprovação científica da eficácia das intervenções psiquiátricas e psicoterapêuticas, através do teste de Rorschach. Participou no estudo uma amostra clínica de 10 doentes psiquiátricos, admitidos e seguidos no Hospital de Dia de um hospital psiquiátrico da zona norte de Portugal, onde é seguido o modelo de intervenção de orientação psicanalítica. Os dados foram recolhidos em dois momentos: quando da admissão, tendo sido aplicados um questionário sociodemográfico e clínico e a prova projetiva de Rorschach; após três meses de tratamento, procedeu-se à nova aplicação do Rorschach, seguida de um questionário de despiste de critérios de exclusão e avaliação do doente sobre o programa terapêutico. A análise comparativa dos dados permitiu constatar uma ligeira evolução terapêutica e do funcionamento da personalidade.

Tecnologias digitais, subjetividade e psicopatologia: possíveis impactos da pandemia / Digital technologies, subjectivity and psychopathology: possible impacts of the pandemic / Technologies numériques, subjectivité et psychopathologie: impacts possible de la pandémie / Tecnologías digitales, subjetividad y psicopatología: posibles impactos de la pandemia

O artigo aborda o uso de tecnologias digitais na psiquiatria atual, discutindo o impacto dos dispositivos técnicos no horizonte social para além dos limites da clínica, focando a análise no projeto de fenotipagem digital, seu alcance, e nos desafios que ele suscita para o campo psiquiátrico.

The present article addresses the use of digital technologies in current psychiatry, discussing the impact of technical devices on the social horizon, beyond the limits of the clinical field. Our analysis focuses of the digital phenotyping project, its scope and the challenges it poses for the psychiatric field.

Cet article discute l'utilisation des technologies numériques en psychiatrie contemporaine, soit l'impact des dispositifs techniques sur l'horizon social au-delà des limites de la clinique. Il se concentre sur l'analyse du projet de phénotypage numérique, sa portée et les défis qu'il pose au domaine psychiatrique.

El artículo aborda el uso de las tecnologías digitales en la psiquiatría actual, discutiendo el impacto de los dispositivos técnicos en el horizonte social más allá de los límites de la clínica, enfocándose en el análisis del proyecto de fenotipado digital, su alcance y los desafíos que plantea para el campo psiquiátrico.

Description of clinical factors for suicide attempts in a tertiary care hospital of northern part of India

Background: Suicide is the result of an act deliberately initiated and performed by a person in the full knowledge or expectation of its fatal outcome. Suicide attempts are a significant public health problem. The present study aimed to explore the variousclinical characteristics of suicideattempters in a tertiary care hospital of Shimla, Himachal Pradesh, a northern state of India.Methods: We conducted a descriptive study among patients with attempted suicide to the department of Psychiatry, Indira Gandhi Medical College (IGMC) Shimla. A structured, self-designed interview schedule and short-form revised Eyseneck personality questionnaire-Hindi (EPQRS-H) was used for data collection. Data was analyzed using Epi info software v 7.2.0.Results: There were total 77 participants in the study out of which 44 (57.1%) were females. Mean age (Standard deviation) of participants was 30.8 years (9.9 years). Relationship problems were the most common (48.1%) recent life event followed by health events (28.6%). Depression was found to be the most common diagnosis (62.3%). Pesticide consumption was the method of attempting suicide in 72.7% of females compared to 66.7% of males.Conclusions: Recent major life events especially relationship problems may lead to majority of suicide attempts. There is urgent need to focus on patients suffering from depression by health personnel as well as family members. The sale of the pesticides should be regulated to keep in check the misuse of the same.

Between Don Quixote and Hamlet: vicissitudes of contemporary Cultural Psychiatry / Entre Don Quijote y Hamlet: vicisitudes de la Psiquiatría Cultural contemporánea

Abstract: Background: Although Cultural Psychiatry (CP) has emerged as a significant discipline and body of knowledge in recent decades, it finds itself in a current intense debate about its identity, its contributions, and its future. Objective: To examine conflictive areas of historical, epistemological, clinical, educational, and research interest in the present and future development of CP. Method: A narrative review of outstanding sources, articles, and textbooks on CP that reflect its current vicissitudes; for each area, adequate quotations of Cervantes' Don Quixote and Shakespeare's Hamlet are used. Results: In addition to updating definitions and content, discussions about whether CP is a psychiatric subspecialty, the scope of its diagnostic, clinical and therapeutic applications, evaluation of criticisms and strengths, interactions with other disciplines, as well as reflective speculations about its future, are outlined. Discussion and conclusion: CP is considered the receptacle of many disciplines, the last bastion of humanistic medicine in a globalized world, although its development will always be marked by scholarly debates about contexts, meanings, identities, and competencies regarding its ontological and epistemological components.

Resumen: Antecedentes: La Psiquiatría Cultural (PC) es una disciplina y cuerpo de conocimiento de creciente significación en décadas recientes que, sin embargo, es actualmente materia de un debate intenso acerca de su identidad, sus contribuciones y su futuro. Objetivo: Se examinan áreas de conflicto en aspectos históricos, epistemológicos, clínicos, educacionales y de investigación. Método: Revisión narrativa de fuentes relevantes, artículos y textos que reflejan las actuales vicisitudes de la PC; se utilizan citas referenciales apropiadas de Don Quijote, de Cervantes, y Hamlet, de Shakespeare, en tanto que perspectivas opuestas y/o complementarias. Resultados: Además de actualizaciones de definición y contenidos, se discute si la PC es una subespecialidad psiquiátrica, y se revisan sus aplicaciones diagnósticas, clínicas y terapéuticas; sus críticas y méritos; su interacción con otras disciplinas y reflexiones en torno a su futuro. Discusión y conclusión: La PC es el receptáculo de muchas disciplinas, el último bastión de una medicina humanística en un mundo globalizado, pero su futuro estará marcado siempre por debates académicos acerca del contexto, los significados, las identidades y las competencias respecto a sus componentes ontológicos y epistemológicos.

Effects of Psychiatric Factors on Patient-Reported Outcomes after Surgical Correction of Lumbar Degenerative Kyphosis

STUDY DESIGN: A prospective study. PURPOSE: To identify associations between psychiatric factors and patient-reported outcomes after corrective surgery in patients with lumbar degenerative kyphosis (LDK). OVERVIEW OF LITERATURE: Thus far, to the best of our knowledge, patient factors that may help predict patient-reported outcomes after corrective surgery for LDK have not been studied. METHODS: We prospectively investigated 46 patients with LDK who underwent surgical correction with a minimum follow-up of 2 years. Demographic data were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Scoliosis Research Society-22 (SRS-22) scores, and Roland-Morris Disability Questionnaire (RMDQ) scores were determined before the surgery and after 2 years of follow-up. Psychiatric conditions were preoperatively evaluated using the Zung depression scale (ZDS) and Zung anxiety scale (ZAS). Patients were divided into two groups (with or without psychiatric issues), according to baseline ZDS and ZAS scores. RESULTS: Patients included 43 women and 3 men. Twelve patients were deemed to have psychiatric problems (P group) and 34 patients had no psychiatric problems (NP group). No significant intergroup differences were found in MCS, PCS, SRS-22, and RMDQ scores preoperatively. However, at the 2-year follow-up, a significant intergroup difference was observed between PCS and RMDQ scores. Multiple regression analysis revealed that only the presence of a preoperative psychiatric problem can predict PCS and RMDQ scores. Other factors, such as, gender, age, body mass index, bone mineral density, osteotomy site, number of fusion segments, and instrumented levels did not affect PCS or RMDQ scores. CONCLUSIONS: The presence of a psychiatric factor may be an important risk factor underlying poor physical and pain scores after corrective surgery in patients with LDK. The findings presented here suggest that psychiatric factors should be evaluated prior to surgery for determining the risk of a poor outcome.

Modelos psicopatológicos integrativos para la formulación diagnóstica en psiquiatría de niños y adolescentes / Integrative psychopathological models for diagnostic formulation in child and adolescent psychiatry

Resumen: la psiquiatría de niños y adolescentes si quiere tener una línea de acción clínica más efectiva necesita de paradigmas o modelos de comprensión de los fenómenos psicopatológicos. La elección de un modelo o de una perspectiva de análisis ante un determinado caso en muchas ocasiones es un desafío. Aunque el psiquiatra haya sido formado en una teoría o un modelo determinado, la práctica psiquiátrica muchas veces lo insta a buscar modelos más pluralistas e integrativos que den cuenta de un modo más global de la realidad que vive el niño o adolescente psíquicamente afectado. El propósito de este artículo es realizar una reflexión teórica - clínica de distintos modelos de comprensión psicopatológica que pueden ser útiles de considerar cuando se procede a realizar una formulación diagnóstica en psiquiatría infanto juvenil. Se revisan los modelos psicopatológicos tradicionales básicos y se describen algunos modelos complementarios que pueden servir de apoyo a la evaluación psiquiátrica. Se espera que el artículo sea un aporte fundamentalmente para los nuevos profesionales que se están formando en la especialidad y que necesitan de orientaciones clínicas para la realización de un diagnóstico psiquiátrico. (AU)

Abstract: child and adolescent psychiatry needs frameworks or explanatory models for psychopathologic phenomena in order to achieve a more effective clinical course. Oftentimes, choosing a model or an analysis perspective when facing a case can be challenging. Although the psychiatrist may adscribe to a particular model or theory, the psychiatric practice will lead him or her to look for more comprehensive models that account in a global manner for the experience of the affected child or adolescent. The purpose of this article is to pursue both a theoretical and clinical reflection on the different explanatory models of psychopathological comprehension that may be useful to consider when preparing a case formulation in child and adolescent psychiatry. We emphasize the description of some complementary models to the more traditional, foundational psychopathological ones, which may provide support in a clinical psychiatric evaluation. We hope this article will be useful especially to the new professionals that are being trained in the specialty and that need clinical guidance in the formulation of a psychiatric diagnosis.(AU)

Modelo de atención odontológica en niños hospitalizados con enfermedades respiratorias crónicas / Dental care model in hospitalized children with diseases chronic respiratory

La psiquiatría de niños y adolescentes si quiere tener una línea de acción clínica más efectiva necesita de paradigmas o modelos de comprensión de los fenómenos psicopatológicos. La elección de un modelo o de una perspectiva de análisis ante un determinado caso en muchas ocasiones es un desafío. Aunque el psiquiatra haya sido formado en una teoría o un modelo determinado, la práctica psiquiátrica muchas veces lo insta a buscar modelos más pluralistas e integrativos que den cuenta de un modo más global de la realidad que vive el niño o adolescente psíquicamente afectado. El propósito de este artículo es realizar una reflexión teórica - clínica de distintos modelos de comprensión psicopatológica que pueden ser útiles de considerar cuando se procede a realizar una formulación diagnóstica en psiquiatría infanto juvenil. Se revisan los modelos psicopatológicos tradicionales básicos y se describen algunos modelos complementarios que pueden servir de apoyo a la evaluación psiquiátrica. Se espera que el artículo sea un aporte fundamentalmente para los nuevos profesionales que se están formando en la especialidad y que necesitan de orientaciones clínicas para la realización de un diagnóstico psiquiátrico.(AU)

Child and adolescent psychiatry needs frameworks or explanatory models for psychopathologic phenomena in order to achieve a more effective clinical course. Oftentimes, choosing a model or an analysis perspective when facing a case can be challenging. Although the psychiatrist may adscribe to a particular model or theory, the psychiatric practice will lead him or her to look for more comprehensive models that account in a global manner for the experience of the affected child or adolescent. The purpose of this article is to pursue both a theoretical and clinical reflection on the different explanatory models of psychopathological comprehension that may be useful to consider when preparing a case formulation in child and adolescent psychiatry. We emphasize the description of some complementary models to the more traditional, foundational psychopathological ones, which may provide support in a clinical psychiatric evaluation. We hope this article will be useful especially to the new professionals that are being trained in the specialty and that need clinical guidance in the formulation of a psychiatric diagnosis.(AU)

Contemplation of Legal Criteria of Psychiatric Compulsory Admission: Including an Introduction of US Case Which Can be Referred to the Assessment of the Appropriateness of Hospitalization in Korea / 신경정신의학

The Korean Mental Health Act has been radically reformed recently in order to improve psychiatric patients' human rights by regulating the compulsory admission process. However, the expert group brought up questions about difficulties in practice and incoherence in its philosophy before the Act was implemented. There are already discussions concerning the next revision of the Act. In such a situation, lessons can be learned from the experiences of other countries. Articles on psychiatric compulsory admission were comprehensively reviewed with the focus on legal criteria, and found that current trends worldwide include a move towards broad diagnostic criteria, use of capacity and treatability test, and treatment in the interest of health rather than safety. In addition, we introduce the Whittington scale, an assessment tool for the appropriateness of hospitalization used in the Connecticut Mental Health Center, US, as a reference for the similar procedure being implemented soon in Korea.

O diagnóstico da linguagem e a linguagem do diagnóstico: uma perspectiva pragmática / The diagnosis of language and the language of diagnosis: a pragmatic perspective / El diagnóstico del lenguaje y el lenguaje del diagnóstico: una perspectiva pragmática

A teoria dos atos de fala de John Austin apresenta a linguagem a partir de uma perspectiva pragmática: quando os signos têm um compromisso com a produção de realidades. Seguindo esta direção analítica, neste artigo, articulamos a linguagem-ato e as classificações. Argumenta-se que uma classificação não é mera descrição dos fatos; é produto e produtora de realidades. Dentre as possíveis formas de classificação, abordamos o diagnóstico psiquiátrico como um caso particular na teoria dos atos de fala. Elaboramos um conceito denominado de ato diagnóstico, no qual conjugamos a força da linguagem-ato e do diagnóstico médico a partir de suas implicações políticas no campo social, na produção de sujeitos. Conclui-se que o diagnóstico psiquiátrico produz realidades a partir das mesmas propriedades dos atos de fala. Ao produzir sujeitos, os diagnósticos possuem efeitos existenciais, políticos e sociais que só podem ser analisados no encontro singular entre diagnósticos e sujeitos diagnosticados.

Speech Acts, as theorized by John Austin, presents language from a pragmatic perspective. This means that signs/language take on creative forces and produce realities. Through analytical effort, the purpose of this article is to provide the idea that the language-act and classification are related. For further comprehension, we argue that a classification may not be a neutral description about facts. It is substantially the product and the producer of reality. Among many different ways of classification, the psychiatric diagnosis, as a particular case in the theory of Speech Acts, is on which we will focus. We elaborated a concept – diagnosis act – that combines aspects of the efficacy of the language-act with those of medical diagnosis from its political implications in the social field, when it both come to the production of subjects. In conclusion, a psychiatric diagnosis produces realities from the same properties that speech acts do. Diagnoses produce subjects and so, have existential, political and social effects that can only be analyzed at the particular encounter between diagnoses and diagnosed individuals.

La teoria de los actos del habla, de John Austin, presenta el lenguaje a partir de una perspectiva pragmática, es decir, cuando los signos tienen un comprometimiento con la producción de realidades. Seguindo esta orientación analítica, en este artículo buscamos crear un eslabón entre el lenguaje - acto y la potencia de las clasificaciones. Arguméntase que uma clasificación no es una descripción sencilla de hechos, es producto y productora de realidades. Dentre las posibles maneras de clasificaciones, planteamos el diagnóstico psiquiátrico mientras un cuadro particular en la teoria de los actos del habla. Elaboramos un concepto llamado de “acto diagnóstico”, en lo cual unimos la fuerza del lenguaje-acto y del diagnóstico médico a partir de sus implicaciones políticas en el campo social y en la producción de sujectos. Se puede concluir, por lo tanto, que el diagnóstico psiquiátrico produce realidades a partir de las mismas propiedades de los actos del habla. Cuando se producen sujectos, los diagnósticos poseen efectos existenciales, políticos y sociales que sólo pueden ser analisados en el encuentro singular entre diagnósticos y sujectos diagnosticados .

El diagnóstico en psiquiatría: una discusión teórica y práctica para el abordaje clínico / (Diagnosis in psychiatry: a theoretical and practical discussion for clinical assessment)

ResumenEl artículo aborda las dificultades en el diagnóstico psiquiátrico por las características propias de estos trastornos que, junto con la definición de lo patológico desde la prescripción de lo moralmente aceptado y los conflictos de interés entre la psiquiatría y las compañías farmacéuticas, han llevado a cuestionar las categorías diagnósticas en este campo del saber. Se argumenta la necesidad de contar con categorías, aunque imperfectas, para el abordaje clínico inicial, para el disfrute de los derechos laborales y en atención médica, para la investigación en este campo y para la definición y asignación de recursos en políticas públicas basadas en evidencia. Se explica cómo el personal de salud debe evaluar la percepción subjetiva del padeciente acerca de su sintomatología, malestar y disfunción, aunado a una cuidadosa observación del comportamiento no verbal y paraverbal, para proponer un diagnóstico sindrómico presuntivo y el abordaje inicial. Los criterios diagnósticos del DSM o la CIE no se deben aplicar como un "checklist" que resulta en un diagnóstico final incuestionable.Por último, se hace un llamado a desestigmatizar las categorías psiquiátricas. Se ha demostrado que el temor a la estigmatización resultante del etiquetado en psiquiatría, contribuye a que las personas no busquen ayuda profesional para trastornos en los que el tratamiento psicoterapéutico y farmacológico mejoran el malestar, calidad de vida y funcionalidad.

AbstractThis article addresses the difficulties in psychiatric diagnoses together with the practical need for these labels. The characteristics of these disorders, the definition of what is considered pathological by morally prescribed standards and the conflicts of interest between psychiatry and pharmaceutical companies, have led to question the diagnostic categories in this field of knowledge. We argue that diagnostic categories are necessary, for the initial clinical approach; for access to medical care, disability and other legal rights; for research in this field; and for the definition and allocation of resources in evidence-based public policies. We discuss how clinical practitioners should assess the subjective perception of the sufferer of their symptoms, discomfort and dysfunction, together with a careful observation of non-verbal and para-verbal behavior, to propose a presumptive syndromic diagnosis and the initial approach. The diagnostic criteria of the DSM or ICD should not be applied as a "checklist" resulting in an unquestionable final diagnosis. Finally, we make a call to de-stigmatize the psychiatric categories. Fear of stigmatization resulting from psychiatric labels has been shown to contribute to sufferers not seeking professional help, for disorders in which psychotherapeutic and pharmacological treatment, improves symptomatology, quality of life and functionality.

Sobrediagnóstico de trastornos mentales y criterios diagnósticos del DSM: la perspectiva de Jerome Wakefieldx / Mental Disorders Over-Diagnosis and DSM diagnosis criteria: Jerome Wakefield's perspective

Resumen El sobrediagnóstico de trastornos mentales es una preocupación creciente, que se acentuó tras la publicación del DSM-V. Jerome Wakefield es un destacado crítico de la psicopatologización que, sin embargo, ha desarrollado un intenso trabajo para intentar delimitar mejor qué es un trastorno mental sin rechazar este concepto. Se realizó una revisión estructurada de la obra de este autor. Se resumen sus principales planteamientos y se realiza una valoración de su aporte al debate relativo a este tema.

Overdiagnosis of mental disorders is an increasing concern, which was accentuated after the publication of the DSM-V. Jerome Wakefield is a renowned critic of the psycopathologization that, however, has developed an intense work to try to better delimit what a mental disorder is without rejecting this concept. A structured review of the work of this author was carried out. His main approaches are summarized and an assessment of his contribution to the discussion in regards of this issue is performed.

Psychopathology, quality of life, and related factors in children with celiac disease / Psicopatologia, qualidade de vida e fatores relacionados em crianças com doença celíaca

Abstract Objective: This study aimed to survey children with celiac disease (CD) for psychiatric disorders, determine the possible factors that predict psychopathology, and analyze health-related quality of life and possible factors that could affect the quality of life. Methods: In this study, all children completed the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version - Turkish Version (K-SADS-PL-T), as well as the Pediatric Quality of Life Inventory (PedsQL) for the 8-12 age group, and a sentence completion test. A face-to-face interview was performed with the parents of the participants to inform them about the study. Results: This study included 52 children with celiac disease in the age range of 8-12 years, and 40 healthy children. The mean age of the study group was 10.36 ± 0.36 years, and 31 (59%) of them were females. The mean age of the control group was 10.35 ± 0.46 years and 24 (60%) of them were females. The mean subscale scores of the Pediatric Quality of Life Inventory were significantly lower in children with celiac disease when compared to the control group (p < 0.05). There was at least one psychiatric disorder in the 26 (50%) children with celiac disease. Conclusions: This study has shown once more that celiac disease is associated with some psychiatric signs/diagnoses, and that it decreased quality of life. Further studies are needed to determine the factors that could reduce the psychiatric signs. It is apparent that those studies would contribute new approaches to improve diagnosis, treatment, and quality of life.

Resumo Objetivo: Neste estudo, foram avaliadas crianças com doença celíaca (DC) para verificar a existência de transtornos psiquiátricos, determinar os possíveis fatores que predizem psicopatologia e analisar a qualidade de vida relacionada à saúde e possíveis fatores que podem afetá-la. Métodos: Neste estudo, todas as crianças responderam à Entrevista para Transtornos Afetivos e Esquizofrenia em Crianças em Idade Escolar - Versão Presente e ao Longo da Vida - Versão Turca (K-SADS-PL-T), bem como ao Inventário Pediátrico de Qualidade de Vida (PedsQL) da faixa de 8-12 anos e ao teste de completar sentenças. Uma entrevista presencial foi feita com os pais dos participantes para informá-los sobre o estudo. Resultados: Este estudo incluiu 52 crianças com DC entre 8 e 12 anos e 40 crianças saudáveis. A idade média do grupo de estudo era de 10,36 ± 0,36 anos e 31 deles (59%) eram do sexo feminino. A idade média do grupo de controle era de 10,35 ± 0,46 anos e 24 deles (60%) eram do sexo feminino. Os escores médios das subescalas do PedsQL foram significativamente menores em crianças com DC quando comparados com o grupo de controle (p < 0,05). Havia pelo menos um transtorno psiquiátrico em 26 (50%) crianças com DC. Conclusões: Este estudo mostrou mais uma vez que a DC está associada a alguns sintomas/diagnósticos psiquiátricos e reduziu a qualidade de vida. São necessários estudos adicionais para determinar os fatores que podem reduzir os sintomas psiquiátricos. Está claro que esses estudos contribuiriam com novas abordagens para melhorar o diagnóstico, o tratamento e a qualidade de vida.

How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms

Electroconvulsive therapy (ECT) is a time tested treatment modality for the management of various psychiatric disorders. There have been a lot of modifications in the techniques of delivering ECT over decades. Despite lots of criticisms encountered, ECT has still been used commonly in clinical practice due to its safety and efficacy. Research evidences found multiple neuro-biological mechanisms for the therapeutic effect of ECT. ECT brings about various neuro-physiological as well as neuro-chemical changes in the macro- and micro-environment of the brain. Diverse changes involving expression of genes, functional connectivity, neurochemicals, permeability of blood-brain-barrier, alteration in immune system has been suggested to be responsible for the therapeutic effects of ECT. This article reviews different neurobiological mechanisms responsible for the therapeutic efficacy of ECT.

Global Mental Health and systems of diagnostic classification: clinical and cultural perspectives / Salud Mental Global y sistemas de clasificación diagnóstica: perspectivas clínicas y culturales / Saúde Mental Global e sistemas de classificação diagnóstica: perspectivas clínicas e culturais

Historical and conceptual aspects of Global Health and Global Mental Health are examined and topics such as resources, professional and social attitudes toward mental disorders, the multidimensional experience of getting ill and the presence of world systems of psychiatric diagnosis and classification, are reviewed. The application of these areas of knowledge in medical practice require the integrated use of clinical and socio-cultural perspectives whose precise alignment is an essential component of accurate diagnoses, successful treatments and a consistent improvement of mental health as a component of public health. The latter includes preventive measures applicable to general populations, communities and health care proper. Management of socio-cultural aspects of diagnosis and treatment is imperative as is that of the growing relationship between mental health and neurosciences. The operationalization of this series of interactive processes must be part of legislations which, in turn, can make training, research and dissemination of the resulting data, possible.

Se examinan aspectos históricos y conceptuales de Salud Global y Salud Mental Global, formulándose temas de revision sobre recursos, actitudes profesionales y sociales o colectivas en torno a la enfermedad mental, las varias dimensiones de la experiencia de enfermar y la vigencia de sistemas diagnósticos y de clasificación psiquiátrica a nivel mundial. Las aplicaciones de estas áreas de conocimiento en la práctica médica requieren el uso integrado de perspectivas clínicas y socio-culturales cuyo alineamiento preciso es componente esencial de un diagnóstico acertado, un tratamiento exitoso y una mejoría consistente de la salud mental como componente de la salud pública. Esta última incluye medidas preventivas aplicables en niveles de población general, comunitario y de atención en salud propiamente tal. El manejo de aspectos socio-culturales de diagnóstico y tratamiento es imperativo, al igual que el de la creciente relación entre salud mental y neurociencias. La operacionalización de estos procesos interactivos debe ser materia de legislaciones que posibiliten, a su vez, programas de adiestramiento profesional, investigación y difusión adecuada de la información resultante.

São examinados aspectos históricos e conceituais de Saúde Global e Saúde Mental Global, formulando-se temas de revisão sobre recursos, atitudes profissionais e sociais ou coletivas em torno da enfermidade mental, as várias dimensões da experiência de enfermar e a vigência de sistemas diagnósticos e de classificação psiquiátrica em nível mundial. As aplicações destas áreas de conhecimento na prática médica requerem o uso integrado de perspectivas clínicas e socioculturais cujo alinhamento preciso é componente essencial de um diagnóstico acertado, um tratamento exitoso e uma melhoria consistente da saúde mental como componente da saúde pública. Esta última inclui medidas preventivas aplicáveis em níveis de população geral, comunitário e de atenção em saúde propriamente dita. O manejo de aspectos socioculturais de diagnóstico e tratamento é imperativo, igual ao da crescente relação entre saúde mental e neurociências. A operacionalização destes processos interativos deve ser matéria de legislações que possibilitem, por sua vez, programas de adestramento profissional, pesquisa e difusão adequada da informação resultante.

The Diagnostic Distribution of Psychiatric Disorders among the Population Under 19 Years Old: Based on the National Insurance Data

OBJECTIVES: As a preliminary study on the prevalence of mental disorders in Korean children and adolescents, we investigated the diagnosis distribution of mental disorders in people under 19 years of age using the health insurance data. METHODS: From the 2011 health insurance data of 1,375,842 people, the data of 286,465 people under 19 years old were extracted. Among them, we selected 10,778 with psychiatric diagnoses; male 6,453 (59.9%) and female 4,325 (40.1%). The frequency of psychiatric diagnoses in the males was 10,140 (62.7%) cases, which was significantly higher than that (6,031; 37.3%) in the females. We categorized the groups into 3 year intervals. RESULTS: In the males under 3 years old, F80 was the most prevalent diagnosis, followed by F98. F90 and F41 were the most prevalent in the 4-15 and above 16 years old groups, respectively. In the females, F98 was the most prevalent in the children up to 3 years old, while F80 was the second most prevalent. In the 4-6 years of age group, F98 was the most prevalent, followed by F93. F90 and F41 were predominant in the 7-12 and above 12 years old groups, respectively. CONCLUSION: In the analysis of the frequency of diagnosis of mental disorders in the population under 19 years old, there were significant differences in the distribution based on age and gender.

The Stabilization of Psychiatric Diagnosis: Psychotropic Drugs as Boundary Objects / La estabilización del diagnóstico psiquiátrico: los psicofármacos como objetos frontera

This paper examines psychiatric diagnosis-making within biomedicine, as studies in this field, especially empirical ones, have attracted little attention throughout the scientific world. The widely accepted assertion, that diagnosis is the result of clinical judgement, will be discussed. Through analysis of a case study conducted in a Barcelona hospital, it will be suggested that psychiatric diagnosis is not only the result of clinical assessment, but also of psychotropic drugs translation. Drawing on actor-network theory and the notion of boundary objects established by Star and Griesemer (1989), it is therefore proposed that psychotropic drugs are boundary objects which act as central mediators in knowledge management, setting up the semiotic-material assemblage of diagnosis.

El presente artículo examina la producción del diagnóstico psiquiátrico en biomedicina, debido a que los estudios, especialmente los empíricos en este campo, han atraído poco la atención de los investigadores. La afirmación ampliamente aceptada de que el diagnóstico es el resultado de un juicio clínico, será discutida. A través de un estudio de caso llevado a cabo en un hospital de Barcelona, propondremos que el diagnóstico psiquiátrico no es unicamente el resultado de un juicio clínico, sino también de una traducción psicofarmacológica. Haciendo uso de la teoría del actor-red y de la noción de objetos frontera desarrollada por Star y Griesemer (1989), sostenemos que los psicofármacos como objetos frontera actúan como los mediadores centrales en la gestión del conocimiento, estableciendo el ensamblaje semiótico-material del diagnóstico.