Investigation of the clinical functioning of the Dimensional Clinical Personality Inventory 2 criticism avoidance dimension / Investigação do funcionamento clínico da dimensão evitação a críticas do Inventário Dimensional Clínico da Personalidade 2

Abstract Objective: To investigate the clinical functioning of the criticism avoidance dimension from the Dimensional Clinical Personality Inventory 2 (Inventário Dimensional Clínico da Personalidade 2 [IDCP-2]), establishing a clinically relevant cut-off for the typical traits of avoidant personality disorder (AvPD) for screening purposes. Methods: We administered the IDCP-2 to a sample of 2,276 subjects aged 18 to 90 years (mean = 26.95, standard deviation = 9.71). Of the total sample, 1,650 were women (67%) and most were college students (72.7%). The sample was divided into psychiatric patients diagnosed with other personality disorders (PDs) (n = 53), patients diagnosed with AvPD without comorbidities (n = 10), patients with AvPD with comorbidities (n=42) and those without a known diagnosis of PD (nonpsychiatric patients; n=2,171). Results: We checked for psychometric properties, assessed the adequacy of psychometric assumptions, and proceeded to focus analyses. The Wright item-person map showed the predominance of patients with AvPD in high levels of the scale. Analysis of variance (ANOVA) post hoc comparisons pointed to significant and expressive differences for almost all the comparisons; in the receiver operating characteristic (ROC) curve, we observed a sensitivity of 79% and a specificity of 87%. Conclusion: We found a suitable cut-off for the dimension, and results suggest that the dimension may help clinicians discriminate between patients with and without high levels in the symptoms of AvPD.

Resumo Objetivo: Investigar o funcionamento clínico da dimensão evitação a críticas do Inventário Dimensional Clínico da Personalidade 2 (IDCP-2), estabelecendo um ponto de corte relevante para traços típicos do transtorno da personalidade evitativa (avoidant personality disorder - AvPD), para finalidade de triagem. Métodos: Nós aplicamos o IDCP-2 em uma amostra de 2.276 pessoas com idade entre 18 e 90 anos (média=26,95; desvio padrão=9,71). Dessa amostra, 1.650 eram mulheres (67%) e a maioria era de universitários (72,7%). A amostra foi dividida em pacientes psiquiátricos com outros transtornos de personalidade (PD; n = 53), pacientes com AvPD sem comorbidades (n = 10), pacientes com AvPD com comorbidades (n=42) e aqueles sem diagnóstico conhecido de PD (pacientes não psiquiátricos; n=2.171). Resultados: Foram verificadas as propriedades psicométricas, investigando a adequação dos pressupostos psicométricos, e então procedemos às análises principais. O mapa Wright de itens-pessoas mostrou a predominância de pacientes com AvPD nos níveis mais altos da escala. Análises post hoc, pela análise de variância (ANOVA), apontou para diferenças significativas e expressivas para quase todas as comparações; na curva ROC, nós observamos sensibilidade de 79% e especificidade de 87%. Conclusão: Foi encontrado um ponto de corte adequado para a dimensão, e os resultados sugerem que a dimensão pode auxiliar clínicos a discriminar pacientes com elevação nos traços do AvPD de pacientes sem elevação nesses traços.

Administration of paracetamol versus dipyrone by intravenous patient-controlled analgesia for postoperative pain relief in children after tonsillectomy / Administração de paracetamol versus dipirona em analgesia controlada pelo paciente por via intravenosa para alívio da dor no pós-operatório de crianças após tonsilectomia

BACKGROUND AND OBJECTIVE: We compared the efficacy of intravenous (IV) paracetamol versus dipyrone via patient-controlled analgesia (PCA) for postoperative pain relief in children. METHODS: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0- to 100-mm visual analog scale and 1- to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24 h postoperatively. Pethidine (0.25 mg kg-1) was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment related adverse effects were noted. RESULTS: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6 h (p < 0.05), dipyrone group compared with placebo group at 30 min and 6 h (p < 0.05). No significant differences regarding visual analog scale values at 1, 2, 4, 12, and 24 h were found. No significant differences were found between groups with respect to pain relief score (p > 0.05). Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p < 0.05). No significant differences were found between groups with respect to nausea, vomiting and the any other adverse effects of the drugs (p > 0.05). CONCLUSIONS: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered IV-PCA for postoperative analgesia in children after tonsillectomy.

JUSTIFICATIVA E OBJETIVO: Comparamos a eficácia da administração de paracetamol versus dipirona em analgesia controlada pelo paciente (PCA) por via intravenosa (IV) para alívio da dor no período pós-operatório em crianças. MÉTODOS: O estudo foi composto por 120 crianças submetidas à tonsilectomia sob anestesia geral. Os pacientes foram divididos em três grupos de acordo com a dose IV de analgesia controlada pelo paciente no pós-operatório: paracetamol, dipirona ou placebo. A dor foi avaliada com uma escala visual analógica de 0-100 mm e escore de 1-4 para alívio da dor nos tempos de 30 minutos, uma, duas, quatro, seis, 12 e 24 horas de pós-operatório. Petidina (0,25 mg kg-1) foi administrada IV aos pacientes que precisaram de analgesia de resgate. A necessidade de petidina foi registrada durante as primeiras 24 horas de pós-operatório e os efeitos adversos relacionados ao tratamento foram registrados. RESULTADOS: Os escores da escala visual analógica no pós-operatório foram significativamente menores no grupo paracetamol em comparação com o grupo placebo em seis horas (p < 0,05) e no grupo dipirona em comparação com o grupo placebo em 30 minutos e seis horas (p < 0,05). Não houve diferença significativa em relação aos valores da escala visual analógica nos tempos avaliados de uma, duas, quatro, 12 e 24 horas. Não houve diferença significativa entre os grupos quanto ao escore de alívio da dor (p > 0,05). A necessidade de petidina foi significativamente menor nos grupos paracetamol e dipirona em comparação com o grupo placebo (62,5%, 68,4% vs. 90%, p < 0,05). Não houve diferença significativa entre os grupos em relação à incidência de náusea, vômito e outros efeitos adversos dos medicamentos (p > 0,05). CONCLUSÕES: Paracetamol e dipirona têm um perfil de boa tolerabilidade e propriedades analgésicas eficazes quando administrados IV para ACP no pós-operatório de crianças após tonsilectomia.

Descripción de la población asistida en la sala de salud mental del Hospital Maciel en un año / Description of assisted population in the mental health ward Maciel Hospital in a year

Los trastornos psiquiátricos son una de las principales causas de morbilidad mundial, y la respuesta insuficiente de los servicios de salud mental viene siendo objeto de estudios científicos.Surge así la necesidad de actualizar la información epidemiológica de nuestros servicios y compararla con estudios previos.La impresión clínica lleva a plantearnos la hipótesis de un aumento en la frecuencia delos trastornos por consumo de sustancias psicoactivas y violencia, lo cual requiere objetivar estos datos.Es un estudio descriptivo observacional transversal de la población asistida en la sala de salud mental del Hospital Maciel durante un año. La internación en sala cumple actualmente con una asistencia de corta estadía, multidisciplinaria,con criterios geográficos y clínicos, de amplio espectro nosológico, predominando los trastornos por consumo de sustancias.Algunos puntos objetivados son: patología dual 40,82 %, no compensación 15 % (egresos sin alta médica y derivaciones) y el 12,24 % de reinternaciones en el período analizado.

Personality disorders in euthymic bipolar patients: a systematic review

Objective: To identify, by means of a systematic review, the frequency with which comorbid personality disorders (PDs) have been assessed in studies of euthymic bipolar patients. Methods: PubMed, ciELO and PsychINFO databases were searched for eligible articles published between 1997 and 2013. After screening 1,249 empirical papers, two independent reviewers identified three articles evaluating the frequency of PDs in patients with bipolar disorders assessed in a state of euthymia. Results: The total sample comprised 376 euthymic bipolar patients, of whom 155 (41.2%) had at least one comorbid PD. Among them, we found 87 (23.1%) in cluster B, 55 (14.6%) in cluster C, and 25 (6.6%) in cluster A. The frequencies of PD subtypes were: borderline, 38 (10.1%); histrionic, 29 (7.7%); obsessive-compulsive, 28 (7.4%); dependent, 19 (5%); narcissistic, 17 (4.5%); schizoid, schizotypal, and avoidant, 11 patients each (2.95%); paranoid, five (1.3%); and antisocial, three (0.79%). Conclusion: The frequency of comorbid PD was high across the spectrum of euthymic bipolar patients. In this population, the most common PDs were those in cluster B, and the most frequent PD subtype was borderline, followed by histrionic and obsessive-compulsive. .

Tourette's syndrome and associated disorders: a systematic review / Cruzamento de patologias na síndrome de Tourette: uma revisão sistemática

Objective: To compile data on Tourette's syndrome (TS), tics and associated disorders. Methods: A systematic review of the literature was conducted using the 5S levels of organization of healthcare research evidence (systems, summaries, synopses, syntheses, studies), based on the model described by Haynes. The search keywords were Tourette, tics and comorbidity, which were cross-referenced. Studies provided by publishers and articles being processed on July 31, 2013, were also included. Results: Of all studies retrieved during the search, 64 were selected because they analyzed the epidemiology, clinical features and etiopathogenesis of TS and its comorbidities. TS is classified as a hyperkinetic movement disorder, and at least 90% of the patients have neuropsychiatric comorbidities, of which attention deficit hyperactivity and obsessive-compulsive disorders are the most common. The syndrome is clinically heterogeneous and has been associated with a dysfunction of cortico-striatal-thalamic-cortical circuits involving various neurotransmitters. Although its genetic etiology has been widely studied, other factors may be important to understand this syndrome and its associated disorders. Conclusions: TS is a neurodevelopmental disorder that results from the impact of stress factors on a vulnerable biological substrate during the critical periods of neurodevelopment. The study of TS and its comorbidities may contribute, at different levels, to the understanding of several neuropsychiatric disorders of clinical and therapeutic relevance (AU)

Objetivo: Compilar o conhecimento existente sobre a síndrome de Tourette (ST), tiques e patologias associadas. Metodologia: Foi realizada uma revisão sistemática da literatura usando os níveis 5S (sistemas, sumários, sinopses, sínteses e estudos) de organização de evidência de pesquisa em saúde, com base no modelo proposto por Haynes. Os termos de busca foram Tourette, tiques e comorbidades, completados por pesquisa por referência cruzada. Os artigos fornecidos pelos editores e aqueles a serem processados para publicação em 31 de julho de 2013 também foram incluídos. Resultados: De todos os artigos encontrados durante a pesquisa, 64 foram selecionados porque analisavam a epidemiologia, as características clínicas e a etiopatogenia da ST. A ST define-se como um distúrbio hipercinético do movimento, e pelo menos 90% dos pacientes apresentam comorbidades neuropsiquiátricas, das quais as mais comuns são a perturbação de déficit de atenção com hiperatividade e a perturbação obsessivo- -compulsiva. Esta síndrome é clinicamente heterogênea e tem sido relacionada com a disfunção dos circuitos córtico-estriado- -tálamo-corticais envolvendo vários neurotransmissores. Apesar de sua etiologia genética ter sido amplamente estudada, outros fatores podem ser importantes para entender esta síndrome e as perturbações relacionadas. Conclusões: A ST resulta de uma perturbação do desenvolvimento neurológico causado pelo impacto de fatores de estresse num substrato biológico vulnerável durante os períodos críticos do desenvolvimento neurológico. O estudo da ST e das suas comorbidades poderá contribuir, em diferentes níveis, para o entendimento de várias perturbações neuropsiquiátricas com relevância clínica e terapêutica (AU)

Psychological and health comorbidities before and after bariatric surgery: a longitudinal study / Comorbidades físicas e psicológicas antes e depois da cirurgia bariátrica: um estudo longitudinal

Introduction: Morbid obesity has multiple implications for psychological and physical health. Bariatric surgery has been selected as the treatment of choice for this chronic disease, despite the controversial impact of the surgery on psychosocial health. The objective of this study was to describe candidates for bariatric surgery and analyze changes in weight, psychopathology, personality, and health problems and complaints at 6- and 12- month follow-up assessments. Methods: Thirty obese patients (20 women and 10 men) with a mean age of 39.17±8.81 years were evaluated in different dimensions before surgery and 6 and 12 months after the procedure. Results: Six and 12 months after bariatric surgery, patients reported significant weight loss and a significant reduction in the number of health problems and complaints. The rates of self-reported psychopathology were low before surgery, and there were no statistically significant changes over time. The conscientiousness, extraversion, and agreeableness dimensions increased, but neuroticism and openness remained unchanged. All changes had a medium effect size. Conclusions: Our results suggest that patients experience significant health improvements and some positive personality changes after bariatric surgery. Even though these findings underscore the role of bariatric surgery as a relevant treatment for morbid obesity, more in-depth longitudinal studies are needed to elucidate the evolution of patients after the procedure (AU)

Introdução: A obesidade mórbida tem várias implicações para a saúde psicológica e física. A cirurgia bariátrica tem sido o tratamento de escolha para essa doença crônica, apesar da controvérsia sobre o impacto da cirurgia na saúde psicossocial. O objetivo deste estudo foi descrever candidatos a cirurgia bariá- trica e analisar mudanças no peso, psicopatologia personalidade, problemas e queixas de saúde desses pacientes em avaliações realizadas 6 e 12 meses após a cirurgia. Métodos: Trinta pacientes obesos (20 mulheres e 10 homens) com idade média de 39,17±8,81 anos foram avaliados em diferentes dimensões antes da cirurgia e 6 e 12 meses após. Resultados: Aos 6 e 12 meses após a cirurgia bariátrica, os pacientes relataram significativa perda de peso e significativa redução no número de problemas e queixas de saúde. As taxas de psicopatologia autorrelatada foram baixas antes da cirurgia e não sofreram mudanças significativas com o tempo. As dimensões conscienciosidade, extroversão e agradabilidade aumentaram, mas o neuroticismo e a abertura permaneceram inalteradas. Todas as mudanças apresentaram um tamanho de efeito médio. Conclusões: Os nossos resultados sugerem que os pacientes experimentam melhoras significativas em saúde e algumas mudanças positivas de personalidade após a cirurgia bariátrica. Embora esses achados reforcem o papel da cirurgia bariátrica como um tratamento relevante para a obesidade mórbida, mais estudos longitudinais e aprofundados são necessários para elucidar a evolução dos pacientes após a realização do procedimento (AU)

Correlates of conflict, power and authority management, aggression and impulse control in the Jamaican population / Correlatos de conflicto, poder y manejo de la autoridad, agresividad y control de los impulsos en la población Jamaicana

OBJECTIVE: The object of this study is to establish the correlates of the phenomenology of conflict and power management in the Jamaican population. METHODS: A total of 1506 adult individuals were sampled from 2150 households using a stratified sampling method and assessed using the 12 questions of the Jamaica Personality Disorder Inventory (JPDI) on the phenomenology of conflict and power management that are grouped into the psychological features of aggressive social behaviour, unlawful behaviour, socially unacceptable behaviour and financial transgressive behaviour. The database of responses to the demographic and JPDI questionnaires was created and analysed using the Statistical Package for the Social Sciences (SPSS) version 17. RESULTS: Of the national population sampled, 69.1% denied having any phenomenological symptoms of abnormal power management relations while 30.9% of the population admitted to having some degree of conflict and power management, ranging from mild (10.3%), to moderate (17.1), or severe (3.5%). There were 46.55% of the population which had problems with aggressive social behaviour, 9.33% had problems with unlawful behaviour, 9.58% had problems with unacceptable social behaviour and 37.74% had problems with financial transgressive behaviour. Significant gender and socio-economic class patterns for conflict and power management were revealed. This pattern of conflict and power management behaviour is critical in understanding the distinction between normal and abnormal expression of these emotions and actions. CONCLUSION: Nearly one-third of the sample population studied reported problems with conflict, abnormal power and authority management, impulse control and serious aggressive and transgressive behaviour.

OBJETIVO: El objeto de este estudio es establecer los correlatos de la fenomenología del manejo de conflicto y poder en la población jamaicana. MÉTODOS: Se tomaron muestras de un total de 1506 individuos adultos de 2150 hogares, usando un método de muestreo estratificado, y se evaluaron usando las 12 preguntas del Inventario de Trastornos de la Personalidad en Jamaica (JPDI) sobre la fenomenología del manejo del conflicto y el poder, clasificadas como características psicológicas del comportamiento social agresivo, comportamiento ilícito, comportamiento socialmente inaceptable, y conducta financiera transgresora. La base de datos de respuestas a los cuestionarios de demografía y JPDI, fue creada y analizada utilizando el Paquete Estadístico para Ciencias Sociales (SPSS) versión 17. RESULTADOS: El 69.1% de la población nacional muestreada negó tener síntoma fenomenológico alguno de relaciones de poder anormal, mientras que el 30.9% de la población admitía haber tenido algún grado de manejo de conflicto y poder, fluctuando de leve (10.3%) a moderado (17.1), o severo (3.5%). Hubo 46.55% de la población con problemas de comportamiento social agresivo, 9.33% tuvo problemas de comportamiento ilegal, 9.58% tenían problemas de comportamiento social inaceptable, y 37.74% tuvo problemas de comportamiento financiero transgresor. Se pusieron de manifiesto de forma significativa patrones de género y clase socioeconómica con respecto al manejo de conflicto y poder. Este patrón de comportamiento de manejo de conflicto y poder es un factor crítico para entender la distinción entre la expresión normal y anormal de estas emociones y acciones. CONCLUSIÓN: Casi un tercio de la población de la muestra estudiada reportó problemas con el manejo de conflicto, poder anormal y autoridad, control de impulsos, y serio comportamiento agresivo y transgresor.

Prevalence and correlates of personality disorder in the Jamaican population / Prevalencia y correlatos de los trastornos de personalidad en la población Jamaicana

OBJECTIVE: To identify the prevalence and correlates of personality disorder in a representative sample of the Jamaican population using the Jamaica Personality Disorder Inventory (JPDI). METHOD: A four-stage stratified random sampling method was used to obtain a representative population sample consisting of 1506 Jamaicans, M:F = 727 (48.3%):779 (51.7%), ages 18−64 years. A demographic questionnaire and the JPDI were administered to all participants. RESULTS: Two-fifths of the population (41.4%) scored above the scale's cut-point indicating a diagnosis of personality disorder with the level of severity ranging from mild to severe. Persons with personality disorder were significantly more likely to be single (63%), male (60%), between the ages 18 and 44 years (77%) and of a lower socio-economic status (65%) (p < 0.50 to p < 0.001). CONCLUSION: This is the only population study of personality disorder recorded in the English-speaking Caribbean. This suggests a high risk of behavioural dysfunction in the Jamaican population, having significant implications in light of the country's high rate of crime and violence. The findings highlight the need to develop effective and targeted prevention and intervention measures.

OBJETIVO: Identificar la prevalencia y los correlatos del trastorno de la personalidad en una muestra representativa de la población Jamaica, usando el Inventario de los Trastornos de la Personalidad en Jamaica (JPDI). MÉTODO: Se usó un método de muestreo aleatorio estratificado en cuatro etapas, con el propósito de obtener una muestra poblacional representativa, formada por 1506 Jamaicanos, V:H = 727 (48.3%):779 (51.7%), edades 18−64 años. Se aplicó un cuestionario demográfico y el inventario JPDI a todos los participantes. RESULTADOS: Dos quintas partes de la población (41.4%) alcanzaron puntuaciones por encima del valor límite de la escala, lo cual indica un diagnóstico de trastorno de la personalidad con un nivel de severidad que varía de leve a grave. Las personas con trastorno de personalidad presentaron una probabilidad significativamente más alta de ser solteros (63%), hombres (60%), tener edades entre los 18 y 44 años (77%), y ser de una condición socio-económica más baja (65%) (p < 0,50 hasta p < 0.001). CONCLUSIÓN: Este es el único estudio poblacional de trastornos de personalidad registrado en el Caribe anglófono. Esto sugiere un alto riesgo de disfunción conductual en la población jamaicana, lo cual tiene importantes implicaciones a la luz de la alta tasa de crimen y violencia en el país. Los hallazgos destacan la necesidad de desarrollar medidas de prevención e intervención y encaminada a objetos específicos.

Media representation of personality disorder in Jamaica: public scholarship as a catalyst of health promotion / Representación de los trastornos de personalidad en Jamaica por los medios de difusión: la erudición pública como catalizador en la promoción de la salud

OBJECTIVE: To ascertain whether the public scholarship of the epidemiology of personality disorder (PD) in Jamaica prompted a health promotion outcome. METHODS: A January 2011 to December 2012 trawl of news media articles linking 'PD' to published public scholarship articles on the epidemiology of PD recorded titles and contents of the reports that were culled to capture the emotional responses and psychological defence mechanisms expressed. These were analysed with concomitant social, psychological or behavioural activities occurring in Jamaica, using SPSS version 17 software. RESULTS: Two public scholarship interventions to two major broadsheet newspapers triggered 25 contributed articles, which in turn prompted 160 responses from the public, five commentaries on leading radio stations and four Internet blogs. One hundred and sixty-six (84.2%) of the titles targeted PD in the Jamaican nation; 31 (13.7) articles targeted PD in leaders, athletes, inmates, individuals, families and productivity in Jamaica. One hundred and fifty-five (79.1%) expressed agreement with the scientific epidemiological observations, while 20.9% (n = 41) expressed disagreement. Eighty-two (41.8%) of the responses expressed rationalizations, 47 (24%) were expressions of reaction formation, 27 (13.8%) were in frank denial, while 25 (12.8%) were expressing open acting out responses or blunt projection (15, 7.7%) to the published epidemiology. The difference between 139 (70.9%) popular media responses to contemporary social problems and 57 (29.1%) reports that made no reference to social problems was statistically significant (p < 0.03). CONCLUSIONS: The hypothesis that public scholarship reports prompted a popular media response, generating a health promotion outcome linking contemporary social events to this medical research is confirmed.

OBJETIVO: Determinar si la erudición pública sobre la epidemiología de los trastornos de personalidad (TP) en Jamaica trajo como resultado un impulso a la promoción de la salud. MÉTODOS: Una serie de artículos de los medios noticiosos, publicados de enero 2011 a diciembre de 2012, vinculaban los "TP" con artículos de erudición pública sobre la epidemiología de los TP. Dichos artículos recogían títulos así como contenidos de reportes seleccionados para captar las respuestas emocionales y los mecanismos de defensa psicológica expresados. Estos fueron analizados a partir de actividades sociales, psicológicas o conductuales concomitantes en Jamaica, utilizando SPSS, la versión de software 17. RESULTADOS: Dos intervenciones de erudición pública de dos periódicos principales de gran formato desataron una contribución de 25 artículos, los que a su vez provocaron 160 respuestas del público, cinco comentarios sobre importantes estaciones de radio, y cuatro blogs de Internet. Ciento sesenta y seis (84.2%) títulos giraron en torno a los TP en la nación jamaicana; 31 artículos (13.7%) tuvieron como centro los TP en dirigentes, deportistas, individuos y familias, así como los vínculos con la productividad en Jamaica. Ciento cincuenta y cinco (79.1%) expresaron su acuerdo con las observaciones epidemiológicas científicas, mientras que el 20.9% (n = 41) expresó su desacuerdo. Ochenta y dos (41,8%) de las respuestas expresaron racionalizaciones; 47 (24%) fueron expresiones de formación reactiva; 27 (13,8%) estaban en franca negación, mientras 25 (12.8%) dieron respuestas abiertamente de pasaje al acto o proyección directa (15, 7.7%) a la epidemiología tratada en las publicaciones. La diferencia entre las 139 (70.9%) respuestas de los medios populares a los problemas sociales contemporáneos y los 57 (29.1%) reportes que no hacían referencia a los problemas sociales, fue estadísticamente significativa (p < 0.03). CONCLUSIONES: Se confirma la hipótesis de que los reportes de erudición pública provocaron una respuesta de los medios populares, trayendo como resultado una promoción de la salud que vincula los acontecimientos sociales contemporáneos con esta investigación médica.

The prevalence of personality disorder in a psychiatric and substance abuse population in Jamaica / Prevalencia de los trastornos de la personalidad en una población psiquiátrica y adicta al abuso de sustancias en Jamaica

OBJECTIVE: To determine the prevalence of personality disorders in patients admitted to the psychiatric wards of the University Hospital of the West Indies (UHWI). METHOD: Patients (n = 100) sequentially admitted to the psychiatric wards of the UHWI were assessed for personality disorder using the gold standard of a consultant assessment using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S), and the Jamaica Personality Disorder Inventory (JPDI). RESULTS: The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 51% consultant DSM-IV-TR assessment, 57% JPDI and 86% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher that the local instruments used (p < 0.000). CONCLUSIONS: The prevalence of personality disorder assessed by the JPDI and the consultant DSM IVTR instruments in Jamaica is comparable to the prevalence rate of studies in other countries in a similar population.

OBJETIVO: Determinar la prevalencia de los trastornos de la personalidad en pacientes ingresados en las salas de psiquiatría del Hospital Universitario de West Indies (HUWI). MÉTODO: Los pacientes (n = 100) secuencialmente ingresados a las salas de psiquiatría del UHWI, fueron evaluados en relación con trastornos de personalidad, utilizando los criterios de diagnóstico del estándar de oro de la evaluación consultante con el Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta edición revisada (DSM-IV-TR), el cuestionario de tamizaje del Examen Internacional de Trastornos de la Personalidad (IPDE-S), y el Inventario de Trastornos de la Personalidad en Jamaica (JPDI). RESULTADOS: Los tres instrumentos de evaluación identificaron una prevalencia de trastornos de personalidad en la cohorte de pacientes como sigue: 51% en la evaluación del consultante del DSMIV- TR, 57% en el JPDI, y 86% en el IPDE-S. La tasa de prevalencia identificada por el IPDE-S fue significativamente mayor que la de los instrumentos locales (p < 0.000). CONCLUSIONES: La prevalencia del trastorno de personalidad evaluado por el JPDI y los instrumentos de consultante de DSM IV-TR en Jamaica, es comparable a la tasa de prevalencia de estudios en otros países en una población similar.

Personality disorder in convicted Jamaican murderers / Trastornos de personalidad en asesinos Jamaicanos convictos

OBJECTIVE: To establish the aetiology and historical prevalance of personality disorder in violent homicidal men in Jamaica. METHODS: Examination and analysis of primary data from the psychosocial case study interviews of 36 convicted murderers from the Jamaican Government Barnett Commission of Enquiry in 1976. The disaggregated social and clinical data were analysed using a Chi-square statistical analysis RESULTS: The mean age at time of arrest for the male convicted murderers was 24.26 ± 8.48 years. Twenty-three (66%) of the subjects had loving relationships with mothers, particularly in those men reared in the rural areas. Twenty-one (59%) cases showed marked paternal rejection and absence of integrated family life. Twenty-four (69%) of the cases experienced severe parental disciplinary methods, and two-thirds were illiterate or barely literate. Twenty-nine (83%) were from very poor socio-economic conditions. Thirty (86%) of all the murder victims were adult males. There were significant differences between the urban reared murderers (URM) and rural reared murderers (RRM). Sixteen (94%) of the victims of the URM ensued from robbery and police confrontation, while 13 (72%) of the victims of the RRM resulted from domestic disputes (p < 0.00). Seventeen (49%) of the men had normal personalities; 18 (51%) were diagnosed as having antisocial and inadequate personalities. Diagnosis of primary data using Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision (DSM-IV-TR) criteria revealed 23 (66%) men with Antisocial Personality Disorder (APD). There were significantly more APD in the URM than the RRM (p < 0.01). CONCLUSIONS: Antisocial personality disorder as an aetiological precursor of homicidal violence represents a major public health problem in contemporary Jamaica.

OBJETIVO: Establecer la etiología y la prevalencia histórica de los trastornos de personalidad en hombres violentos homicidas en Jamaica. MÉTODOS: Examen y análisis de los datos principales de las entrevistas de casos de estudio psicosociales de 36 asesinos convictos, tomadas de la Comisión de Investigación Barnett del Gobierno de Jamaica en 1976. Los datos clínicos y sociales desagregados se analizaron mediante un análisis estadístico chicuadrado. RESULTADOS: La edad promedio al momento del arresto de los asesinos convictos fue 24.26 ± 8.48 años. Veintitrés (66%) de los sujetos tenían relaciones afectuosas con las madres, especialmente aquellos hombres criados en las zonas rurales. Veintiún casos (59%) mostraron un marcado rechazo paternal y ausencia de vida familiar integrada. Veinticuatro (69%) de los casos experimentaron severos métodos disciplinarios por parte de los padres, y dos tercios eran analfabetos o apenas sabían leer y escribir. Veintinueve (83%) tenían muy malas condiciones socio-económicas. Treinta (86%) de todas las víctimas de los asesinatos eran varones adultos. Hubo diferencias significativas entre los asesinos criados en áreas urbanas (abreviado en inglés, URM) y los asesinos criados en áreas rurales (en inglés, RRM). Dieciséis (94%) de las víctimas de los asesinos provenientes de zonas urbanas (URM) fueron consecuencia de robos y confrontación con la policía, mientras que 13 (72%) de las víctimas de los asesinos de zonas rurales (RRM) fueron resultado de disputas domésticas (p < 0.00). Diecisiete (49%) de los hombres tenían personalidades normales; 18 (51%) fueron diagnosticados con personalidad antisocial e inadecuada. El diagnóstico a partir de datos primarios mediante criterios de DSM-IV-TR reveló 23 hombres (66%) con Trastorno de Personalidad Antisocial (TPA). Hubo significativamente más TPA entre los URM que entre los RRM (p < 0.01). CONCLUSIONES: El trastorno de personalidad antisocial como precursor etiológico de la violencia homicida representa un problema importante de salud pública en la Jamaica actual.

The prevalence of personality disorder in a general medical hospital population in Jamaica / Prevalencia de los trastornos de personalidad en una población del hospital de medicina general de Jamaica

OBJECTIVE: To determine the prevalence of personality disorders in patients admitted to the general medical wards of the University Hospital of the West Indies (UHWI). METHOD: Patients (n = 100) sequentially admitted to the general medical wards of the UHWI were assessed for the diagnosis of personality disorder using the gold standard of a consultant assessment based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S) and the Jamaica Personality Disorder Inventory (JPDI). RESULTS: The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 21% consultant DSM IV-TR assessment, 28% JPDI and 70% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher that the local instruments used (p < 0.000). CONCLUSIONS: The prevalence of personality disorder assessed by the JPDI and the IPDE-S and the consultant DSM IV-TR instruments in Jamaica is significantly higher than the prevalence rate of studies in other countries.

OBJETIVO: Determinar la prevalencia de los trastornos de personalidad en los pacientes ingresados en las salas de medicina general del Hospital Universitario de West Indies (HUWI). MÉTODO: Pacientes (n = 100) secuencialmente ingresados en las salas de medicina general del UHWI fueron sometidos a una evaluación encaminada a diagnosticar trastornos de personalidad. Para la misma se utilizó el método estándar de referencia usado en las evaluaciones realizadas por los consultores. Dicho método se basa en los criterios diagnósticos para los trastornos de personalidad, tomados de la cuarta edición revisada del Manual diagnóstico y estadístico de los trastornos mentales (DSM IV-TR), el cuestionario de tamizaje del Examen Internacional de los trastornos de la personalidad (IPDE-S), y el Inventario de los trastornos de la personalidad en Jamaica (JPDI). RESULTADOS: Los tres instrumentos de evaluación identificaron una prevalencia de los trastornos de la personalidad en la cohorte de pacientes, de 21% con la evaluación DSM IV-TR de los consultores, 28% con el JPDI, y 70% con el tamizaje del IPDE-S. La tasa de prevalencia identificada por el IPDE-S, fue significativamente mayor que la de los instrumentos locales usados (p < 0.000). CONCLUSIONES: La prevalencia de los trastornos de la personalidad, evaluada por el inventario JPDI y el tamizaje del IPDE-S, así como por los instrumentos DSM IV-TR de los consultores en Jamaica, es significativamente mayor que la tasa de prevalencia en los estudios de otros países.

A view of personality disorder from the colonial periphery / Una perspectiva de los trastornos de personalidad desde la periferia colonial

OBJECTIVE: To examine the history of personality disorder in the context of contemporary post-colonial Jamaican society. METHODS: The literature outlining the development and classification of personality disorder is reviewed. The social, psychiatric and epidemiological studies of personality disorder in Jamaica are presented. RESULTS: A categorical classification system of personality disorder has been in use by the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the mid 20th century. Challenging that approach is the Minnesota Multiphasic Personality Inventory (MMPI), which represents the dimensional method, which views pathology as a continuum from normal personality traits. Both systems suffer from an absence of cultural flexibility, an absence of a system of severity, and a lack of treatment specificity, which foster misdiagnosis while making treatment planning difficult and unreliable. The proposed DSM-5 attempts to integrate a prototypematching system and identification of personality traits promises disappointing outcomes. The University of the West Indies, Section of Psychiatry, proposes a phenomenological nosological approach, advocating an alternate DSM Axis I category called Shakatani derived from Swahili shaka (problem), tani (power), and developing a 38-item Jamaica Personality Disorder Inventory (JPDI) screening questionnaire for diagnosing this condition. The epidemiological results using this instrument are reviewed, and the Jamaican print, broadcast and social media responses to this research in Jamaica are described. CONCLUSIONS: The heritage of slavery and colonial oppression in Jamaica has resulted in maladaptive personality disorders that have led to extremely high rates of homicide, violence and transgressive behaviour.

OBJETIVO: Examinar la historia de los trastornos de la personalidad en el contexto de la sociedad jamaicana postcolonial contemporánea. MÉTODOS: Se examina la literatura que bosqueja el desarrollo y la clasificación de los trastornos de la personalidad. Se presentan estudios sociales, psiquiátricos y epidemiológicos de los trastornos de personalidad en Jamaica. RESULTADOS: Un sistema de clasificación por categorías de los trastornos de la personalidad ha formado parte de la Clasificación Internacional de Enfermedades (CIE) y el Diagnóstico y Manual Estadístico de los Trastornos Mentales (DSM) desde mediados del siglo 20. Un reto a tal enfoque, lo hallamos en el Inventario Multifásico de Personalidad de Minnesota (MMPI, por sus siglas en inglés: Minnesota Multiphasic Personality Inventory). El MMPI representa un método dimensional, que considera la patología como un continuo que parte de rasgos de la personalidad normal. Ambos sistemas sufren de falta de flexibilidad cultural, ausencia de un sistema de severidad, y falta de especificidad con respecto al tratamiento. Tales faltas promueven un diagnóstico erróneo, a la par que hacen que la planificación del tratamiento sea difícil y poco confiable. El DSM-5 que se propone, constituye un intento por integrar un sistema de pareamiento de prototipos, y la identificación de rasgos de personalidad augura resultados decepcionantes. El Departamento de Psiquiatría de la Universidad de West Indies propone un enfoque fenomenológico nosológico, que aboga por una categoría alternativa del Eje I del DSM, denominada Shakatani, derivada del Swahili shaka (problema), tani (poder), y el desarrollo de un Inventario de Trastornos de la Personalidad en Jamaica (JPDI), consistente en un cuestionario de tamizaje de 38 ítems destinados a diagnosticar esta condición. Se revisan los resultados epidemiológicos que utilizan este instrumento, y se describen las respuestas dadas a esta investigación por los medios sociales, la televisión, la radio y la prensa escrita de Jamaica, CONCLUSIONES: La herencia de la esclavitud y la opresión colonial en Jamaica ha traído como resultado trastornos de personalidad por inadaptación, los cuales a su vez han llevado a tasas extremadamente altas de homicidios, violencia y conducta transgresora.

The creation and validation of the Jamaica personality disorder inventory / Creación y validación del inventario de trastornos de la personalidad en Jamaica

OBJECTIVE: To describe the creation and validation of the Jamaica Personality Disorder Inventory (JPDI) screening questionnaire. METHOD: Using the phenomenological triad of power management, dependency and psychosexual issues, drafts of the JPDI were piloted on patients from psychiatric and medical wards. The JPDI consisted of 38 close-ended, yes/no questions. Validation was conducted in a sample of 200 patients, using the International Personality Disorder Examination-Screening Instrument (IPDE-S), the Brief Screen for Depression and consultant psychiatrists' Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) personality disorder interview. Construct validity was assessed through principal component factor analysis; Spearman correlation was used to assess criterionrelated and discriminant validity; Cronbach's alpha was used to assess reliability of the entire scale as well as the resulting factors. The Multitrait Multimethod Matrix (MTMM) was used to assess discriminant and construct validity. RESULTS: Factor analysis revealed eight clusters consisting of 30 of the 38 questions, which had close congruence with the clinical triad. Cronbach's alpha for the entire scale was α = 0.79, ranging from a high 0.70 to 0.82 to low 0.63 to 0.45. The JPDI exhibited a sensitivity of 95.06% and a specificity of 67.71%. Significant correlation of scores for the JPDI and IPDE-S (r = 0.432, p = 0.000) and the JPDI and the DSM IV-TR diagnosis (r = 0.598, p = 0.000) established concurrent validity for the JPDI. Correlations (r = 0.293, p = 0.000) suggested that the JPDI possessed predictive validity. The complete sample matrix of the MTMM provided evidence of both convergent and discriminant validity, and thereby, construct validity. CONCLUSION: The JPDI demonstrated reliability, and criterion-related and discriminant validity.

OBJETIVO: Describir la creación y validación del cuestionario de tamizaje del Inventario de Trastornos de la Personalidad en Jamaica (JPDI). MÉTODO: Usando la tríada fenomenológica de manejo del poder, dependencia y problemas psicosexuales, se realizaron pruebas pilotos usando versiones p rovisionales del JPDI con pacientes de salas médicas y psiquiátricas. El JPDI constaba de 38 preguntas cerradas, del tipo que requieren sí o no. La validación se realizó con una muestra de 200 pacientes, usando el Instrumento de Tamizaje del Examen Internacional de los Trastornos de Personalidad (IPDE-S), la Prueba Breve para la Depresión, y el Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta edición (DSM-IV) de los psiquiatras consultantes, para entrevistas de trastornos de personalidad. La validez de constructo se evaluó a través de análisis factorial de componentes principales. El coeficiente de correlación de Spearman se utilizó para evaluar la validez de criterio y la validez discriminante. El coeficiente Alfa de Cronbach fue utilizado para evaluar la fiabilidad de toda la escala, así como los factores resultantes. La matriz multirasgo-multimétodo (MTMM) fue utilizada para evaluar la validez de constructo y la validez discriminante. RESULTADOS: El análisis factorial reveló ocho clústeres que constaban de 30 de las 38 preguntas, las cuales presentaban una estrecha congruencia con la tríada clínica. El Alfa de Cronbach para toda la escala fue α = 0.79, fluctuando desde valores altos de 0.70 a 0.82 hasta valores bajos de 0.63 a 0.45. El inventario JPDI mostró una sensibilidad de 95.06% y una especificidad de 67.71%. La correlación significativa de las puntuaciones para el JPDI y el IPDE-S (r = 0.432, p = 0.000) y el JPDI y el diagnóstico de DSM IV-TR (r = 0.598, p = 0.000) estableció una validez concurrente para el JPDI. Las correlaciones (r = 0.293, p = 0.000) sugirieron que el JPDI poseía validez predictiva. La matriz completa de la muestra de la MTMM proporcionó evidencia tanto de la validez discriminante como de la validez convergente, y por ende, de la validez de constructo. CONCLUSIÓN: El inventario JPDI demostró fiabilidad, así como validez de criterio y validez discriminante.

Shakatani: the phenomenology of personality disorder in Jamaican patients / Shakatani: la fenomenología del trastorno de personalidad en pacientes Jamaicanos

OBJECTIVE: To examine the distribution and clinically significant patterns of the phenomenology of a cohort of Jamaican patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis II diagnosis of personality disorder and to clarify the conventional diagnostic deficiencies of DSMbased personality disorder categories. METHODS: In a case-control study from the naturalistic clinical setting of a private psychiatric practice in Kingston, Jamaica, between 1974 and 2007, the phenomenology of a cohort of 351 patients with an Axis II DSM diagnosis of personality disorder is qualitatively described and quantitatively compared with that of a control group of patients with an Axis I DSM clinical diagnosis, matched for age, gender and socio-economic class. RESULTS: There were 166 males (47.3%); 238 (67.8%) of the patients were between age 18 and 39 years. Ethnically, 325 (92.6%) were Black, 10 (2.8%) White and 16 (4.6%) Other. The majority of patients (20.7%) had a DSM-IV diagnosis of dependent personality disorder. Patients with an Axis II diagnosis were significantly more likely to display symptoms of a 'clinical triad' of power management, dependency and psychosexual issues. Qualitative analysis of the phenomenological symptoms of personality disorder diagnosed patients suggests aetiological interconnections based on early childhood experiences as explained by object relations and attachment theories. CONCLUSIONS: The phenomenological approach to personality disorder may be a viable replacement for the four-cluster classification of DSM-IV in a Jamaican population with the clinical triad called Shakatani, derived from the Swahili words shaka (problem) and tani (power). This phenomenological approach may provide more clinical utility to practitioners.

OBJETIVO: Examinar la distribución y los patrones clínicamente significativos de la fenomenología de una cohorte de pacientes jamaicanos con diagnóstico de trastornos de personalidad de eje II según el Manual Estadístico Diagnóstico (DSM), y aclarar las deficiencias diagnósticas convencionales de categorías de trastorno de la personalidad basadas en DSM. MÉTODOS: Se describe cualitativamente la fenomenología de una cohorte de 351 pacientes con diagnóstico de trastorno de la personalidad de eje II DSM, en un estudio de caso control a partir de un contexto clínico naturalista en una práctica psiquiátrica privada de Kingston, Jamaica, entre 1974 y 2007. Dicha fenomenología fue comparada cuantitativamente con la de un grupo control de pacientes con un diagnóstico clínico de eje I DSM, pareados por edad, género y clase socio-económica. RESULTADOS: Hubo 166 varones (47.3%); 238 (67.8%) de los pacientes tenían entre edades entre 18 y 39 años. Étnicamente, 325 (92.6%) eran negros, 10 (2.8%) blancos, y 16 (4.6%) étnicamente diversos. La mayoría de los pacientes (20,7%) tenía un diagnóstico DSM-IV de trastorno de personalidad dependiente. Los pacientes con un diagnóstico de eje II tuvieron significativamente más probabilidades de mostrar síntomas de una 'tríada clínica' de manejo del poder, dependencia y problemas psicosexuales. El análisis cualitativo de los síntomas fenomenológicos de los pacientes diagnosticados con trastorno de personalidad, sugiere interconexiones etiológicas basadas en experiencias de la niñez temprana, tal cual lo explican la teoría de la relación de objetos y la teoría del apego. CONCLUSIONES: El enfoque fenomenológico de los trastornos de personalidad puede ser un substituto viable para la clasificación de cuatro clústeres de DSM-IV en una población jamaicana con la tríada clínica denominada Shakatani, término derivado de las palabras Swahili shaka (problema) y tani ("poder"). Este enfoque fenomenológico puede ofrecer mayor utilidad clínica a los profesionales.

Personality Profile and Coping Skills among Coronary Heart Disease Patients and Non-Patient Groups.

Background: Coronary heart disease is a leading cause of death and a major cause of disability worldwide. Aims: This study was conducted to see whether there are certain specific personality pattern of coronary heart disease patients and the coping strategies they use to deal with these stressful situations. Methodology: A sample of 30 male patients diagnosed as having coronary heart disease were selected from the outdoor and indoor patient cardiology departments of Ramkrishna Care Hospital and Modern Medical Hospital, Raipur, Chhattisgarh. Results and Conclusions: It was found that CHD patients have certain specific personality traits which reflect that these persons have low frustration tolerance for unsatisfactory conditions, are neurotically fatigued, easily annoyed and emotional (Factor C). They are suspicious and are often involved in their own ego and are self-opinionated and interested in internal mental life.

Migraine life-time prevalence in mental disorders: concurrent comparisons with first-degree relatives and the general population / Prevalencia de migraña en trastornos mentales: comparación concurrente con familiares de primer grado y con la población general

The authors quantified the prevalence of migraine in subjects with mental disorders, first-degree relatives and the adult general population (GP) in Mérida, Venezuela. After validation, a modified, short version of the Lipton’s diagnostic scale was administered to consecutively admitted in- and out-patients (n = 1059), their first-degree relatives (n = 445) and a probabilistic sample of the GP (n = 516). In the GP, the frequency of migraine (percentage and 95% confidence interval) was 14.9 (11.8-17.9). The migraine frequencies were (percentage and odd ratio probability against the GP: bipolar disorder (15.7%, p = 0.5), schizophrenia (8.3%, p = 0.08), depression and dysthimia (24.4%, p = 0.2), anxiety disorders (10.0%, p = 0.02), personality disorders (11.4%, p = 0.15), all other disorders (15.5%, p = 0.4), relatives of bipolar patients (4.4%, p < 0.001), relatives of schizophrenia patients (3.5%, p = 0.003), and relatives of patients with all other mental disorders (12.8%, p = 0.4). Migraine was more common in women (p < 0.001), and the bipolar patients presented the highest female to male ratio (8:1). A high variability was observed in migraine prevalence among the diagnostic categories, but it was particularly high in subjects with affective disorders, mainly in women, who thus deserve special attention from clinicians.

Los autores cuantificaron la prevalencia de migraña en sujetos con trastornos mentales, sus familiares de primer grado y la población general (PG) en Mérida, Venezuela. Se utilizó una versión abreviada de la escala diagnostica de Lipton. Luego de un estudio de validez, tal escala se administró a pacientes ambulatorios u hospitalizados atendidos en forma consecutiva (n = 1.059), a sus familiares de primer grado (n = 445) y a una muestra probabilística de la PG (n = 516). La frecuencia de migraña en la PG (porcentaje e intervalo de confianza de 95%) fue de 14,9 (11,8-17,9). La frecuencia para los diversos trastornos (porcentaje y probabilidad asociada a la razón de momios (odds ratio) con respecto a la PG) fue: trastorno bipolar (15,7%, p = 0,5), esquizofrenia (8,3%, p = 0,08), depresión y distimia (24,4%, p = 0,2), trastornos de ansiedad (10,0%, p = 0,02), trastornos de personalidad (11,4%, p = 0,15), todos los otros trastornos (15,5%, p = 0,4). En los familiares, la frecuencia fue: trastorno bipolar (4,4%, p < 0,001), esquizofrenia (3,5%, p = 0,003), otros trastornos (12,8%, p = 0,4). El diagnóstico de migraña fue más frecuente en mujeres (p < 0,001), y los sujetos con trastorno bipolar presentaron el mayor índice mujer:hombre (8:1). Se observó una alta variabilidad en la prevalencia de migraña en las diversas categorías diagnósticas. Tal frecuencia fue particularmente elevada en sujetos con trastornos afectivos, principalmente en mujeres, las cuales ameritan una atención especial por parte de los médicos tratantes.

[ comparative study on the personality traits of opioid- dependents with and without somatic chronic pain complaints]

Some people use opioid substances to relief their chronic somatic pains. There are differences in the personality traits of this individuals and others who abuse opioid substances. The purpose of the present study was to compare these two groups in regard to their personality traits and disorders. In a cross-sectional study between 2007 to 2011, all patients referred for drug quit to the outpatient addiction clinic of Imam Hospital affiliated to Jundishapur University were investigated demographically. In addition, all of them underwent physical examination, MMPI test and psychiatric interview. Then they were divided into two groups of "with pain complaint" and "without pain complaint". Their personality traits were compared using t-test and chi[2]. The total number of patients was 488, including 478 males and 10 females. Mean scores of Psychatenia [pt] and paranoia [Pa] indexes in the patients who suffered from chronic non- cancer pain was lower in comparison to the patients without pain complaint. Based on the results of psychological interview, the prevalence of personality disorder was higher in the "without pain" group. Patients with chronic pain had higher educational degrees and they were more likely under the influence of their friends at the onset of opioid abuse. In the present study those who used opioid for pain relief, had healthier psychiatric profiles and personalities. Their psychiatric interviews were more valid and reliable and their psychological problems were less than the other group and their addiction was a maladaptive behavior

Evaluación de psicopatología en adultos víctimas de prisión política y tortura durante su infancia y adolescencia / Evaluation of psychopathology in adult victims of political imprisonment and torture during their adolescence and childhood

Objetivo: Evaluar la presencia de indicadores de psicopatología en adultos que fueron prisioneros políticos en infancia y/o adolescencia durante la dictadura militar chilena. Material y método: Estudio de casos y controles en que se compararon indicadores de trastornos mentales en tres grupos: A) adultos con antecedente de tortura en infancia y/o adolescencia sin reparación psicosocial, B) adultos con antecedentes de tortura con reparación psicosocial y C) adultos que han vivido su infancia y/o adolescencia durante la dictadura, sin antecedentes de tortura. Se utilizo una muestra no aleatoria de 60 personas. Se midieron indicadores de depresión, ansiedad (estado/rasgo), trastorno de estrés postraumático (TEPT) y trastorno de personalidad con escala especificas. Resultados: Existen diferencias significativas en los indicadores de trastornos mentales estudiados entre aquellos adultos que tienen antecedentes de tortura y los que no. Sin embargo, no existen diferencias significativas entre aquellos que no han recibido reparación psicosocial de los que sí la han recibido. Conclusiones: Existe asociación entre trauma extremo en infancia y/o adolescencia y psicopatología adulta y la posibilidad de cronificarse depende de las variables sociales interactuantes.

Objective: Evaluate the presence of psychopathology indicators in adults who were political prisoners during childhood and/or adolescence, during the Chilean military dictatorship. Materials and methods: Case studies and controls, in which indicators of mental disorders were compared in three groups: A) adults who suffered torture and have not received psychosocial treatment, B) adults who suffered torture who did receive psychosocial treatment, and C) adults whose adolescence and/or childhood took place during the dictatorship, who did not suffer torture. A nonrandom sample of 60 people was used. Indicators of depression, anxiety (state/trait), post traumatic stress syndrome (PTSD) and personality disorder were measured with specific scales. Results: There are significant differences in the indicators of mental disorder studied, between those adults who suffered torture and those that did not. Nevertheless, there are not significant differences between those that received psychosocial treatment and those that did not. Conclusions: There is an association between external trauma in childhood and/or adolescence, and psychopathology in adults, and that the possibility of disorders becoming chronic or not depends on interacting social variables.

Caracterización de las hospitalizaciones realizadas en la Unidad de Trastornos de Personalidad de la Clínica Psiquiátrica de la Universidad de Chile entre los años 2006 y 2008 / Characterization of admissions (hospitalizations) made in the Personality Disorders Unit of the Psychiatric Clinic of the University of Chile between 2006 and 2008

Introducción: Los Trastornos de Personalidad (TP) tienen una alta complejidad, impacto existencial, difícil vínculo terapéutico y cifras de prevalencia muy variables. La Clínica Psiquiátrica Universitaria de la Universidad de Chile (CPU) tiene desde 1997 la unidad multidisciplinaria para pacientes con TP Unidad de Trastornos de Personalidad (UTP). El objetivo de este trabajo es describir demográfica y psicopatológicamente a los pacientes con TP atendidos en la UTP. Método: Revisión de 174 fichas de pacientes atendidos en la UTP entre los años 2006 y 2008, con base de datos prediseñada y análisis estadístico de ella. Resultados: Existió una mayor proporción de pacientes de sexo femenino (3:1), solteros (48 por ciento), con hijos (56 por ciento), con estudios superiores (56 por ciento), trabajo estable (32 por ciento), con múltiples episodios previos (35 por ciento) y para la mayoría fue su primera hospitalización psiquiátrica (51,7 por ciento). El 71 por ciento de los pacientes tiene algún nivel de riesgo suicida. El diagnóstico de TP más frecuente fue el de Trastorno Límite de la Personalidad (48 por ciento). En Trastornos del Eje I un 30 por ciento presentó depresión, pero un 44 por ciento tenía varios trastornos. Conclusión: Los datos analizados son necesarios para la futura implementación y evaluación de intervenciones orientadas al mejor cuidado de los pacientes con TP de ésta y otras unidades especializadas en el tratamiento de este tipo de pacientes.

Introduction: Personality Disorders (PD) have a high complexity, existential impact, difficult therapeutic bond and prevalence values vary widely. University Psychiatric Clinic of the University of Chile (UPC) has since 1997 a multidisciplinary unit for patients with DP Personality Disorders Unit (PDU). The objective of this paper is to describe demographic and psychopathological patients treated with DP in the PDU. Methods: Review of 174 records of patients treated in the PDU between years 2006 and 2008, with predesigned database and statistical analysis of it. Results: There was a higher proportion of female patients (3:1), single (48 percent) with children (56 percent), highly educated (56 percent), stable job (32 percent) with multiple prior episodes (35 percent) and for most it was their first psychiatric hospitalization (51.7 percent). 71 percent of patients have any level of suicidal risk. The most frequent of PD diagnosis was Borderline Personality Disorder (48 percent). In Axis I disorders 30 percent had depression, but 44 percent had multiple disorders. Conclusion: The analyzed data are needed for future implementation and evaluation of interventions to better care for patients with PD from this and other specialized units created to treat such patients.