Implementación de docencia de postgrado y pregrado presencial y remota con pacientes simulados en psiquiatría / Implementation of postgraduate and undergraduate teaching with simulated patients in Psychiatry

BACKGROUND: Clinical simulation is a strategy with broad support especially when face-to-face medical attention is difficult. In Psychiatry, the use and availability of simulation is lower than in other medical specialties, even for remote teaching. AIM: To report a pedagogical experience whose objective was to develop and implement the simulated patient technique as a teaching strategy for psychopathology and face-to-face Psychiatry for Psychiatry residents and remote for undergraduate medical students. MATERIAL AND METHODS: Six residents and 115 medical students participated in the activity. A descriptive qualitative-quantitative study was designed. Surveys were used to measure the quality and satisfaction of clinical simulation and simulation in psychopathology and psychiatry. In addition, an opinion was requested about the activity. All residents and 104 students participated in the assessment. RESULTS: The simulations were satisfactorily evaluated. The participants perceived that the pedagogical activity favored the development of generic competencies and specific skills for general Psychiatry. CONCLUSIONS: Simulation in Psychiatry does not replace face-to-face practical teaching, but it is a transitional and complementary method for clinical activities.

Evaluación y manejo inicial de las ideas e intentos de suicidio en atención primaria / Initial assessment and management of the suicidal ideation and suicide attempts in primary care

Suicide and suicidal behaviors are a significant public health problem, for which several prevention modalities have been implemented. The identification and treatment of suicidal risk is a critical step in prevention, especially in primary health care, a level where most of the population consults. This article focuses fundamentally on the research on suicide risk in primary care by proposing an action guide for the assessment and management initial of suicide ideas and attempts.

Tendencia de las hospitalizaciones en la Unidad de Corta Estadía de Psiquiatría del Hospital Clínico Herminda Martin durante 14 años / Trend of hospitalizations in the Short Stay of Psychiatry Unit of Herminda Martin Clinical Hospital for 14 years

INTRODUCCIÓN: La hospitalización psiquiátrica de corta estadía es un recurso necesario para tratar trastornos mentales con descompensación severa que no pueden resolverse ambulatoriamente. El conocimiento de sus resultados ayuda en la gestión clínica y administrativa. Este estudio tiene por objeto evaluar la evolución de indicadores hospitalarios, características sociodemográficas y clínicas de pacientes hospitalizados en unidad de corta estadía de psiquiatría. MATERIAL Y MÉTODO: Estudio longitudinal, retrospectivo, de tendencia, realizado sobre el universo constituido por 4.563 egresos de UCEP de Hospital de Chillán, Chile, durante 14 años, desde el 01/07/2005 al 30/06/2019. Se evaluaron variables hospitalarias, sociodemográficas y clínicas. RESULTADOS: en el período en estudio: Disminuyeron los egresos, se prolongó el promedio días estada, aumentó el índice ocupacional y disminuyó el índice de rotación. Un bajo número de pacientes, con predominio de adversidades socioeconómicas y psicosociales, se re-hospitalizó frecuentemente. A mayor número de internaciones mayor estadía. Se incrementaron las hospitalizaciones administrativas y judiciales; éstas últimas con mayor promedio de estada. Aumentó la hospitalización de varones, adolescentes, jóvenes y adultos mayores. Predominaron comunas y consultorios con mayor población, cercanía y acceso. Se mantuvo frecuencia de esquizofrenia y otros trastornos psicóticos y trastorno de personalidad, se duplicaron los trastornos afectivos, triplicaron los trastornos por sustancias, duplicó la patología dual, y el trastorno de personalidad fue frecuente en comorbilidad con trastorno por sustancias y trastornos afectivos. CONCLUSIONES: se requerirían estrategias con Sistema Judicial y Servicio de Salud, implementar unidad de adolescentes y unidad de adicción, y fortalecer atenciones multidisciplinarias para adultos mayores.

BACKGROUND: Short-stay psychiatric hospitalization is a necessary resource to treat mental disorders with severe decompensation that cannot be resolved outpatiently. Knowledge of your results helps in clinical and administrative management. This study aims to evaluate the evolution of hospital indicators, sociodemographic and clinics characteristics of inpatients in a short-stay unit of psychiatry. MATERIAL AND METHODS: Longitudinal, retrospective, trend study was conducted in a universe of 4,563 egress of short-stay psychiatric unit of Chile, for 14 years, from 01/07/2005 to 30/06/2019. Hospital indicators, sociodemographic and clinical variables were evaluated. RESULTS: during the period under study: The egress decreased, the average days were prolonged, the occupational index increased and the turnover rate decreased. A low number of patients, predominantly socioeconomic and psychosocial adversities, were frequently re-hospitalized. The greater the number of hospitalizations longest stay. Administrative and judicial hospitalizations were increased; the latter with the highest average stay. Hospitalization of males, adolescents, young people and older adults increased. Communes and primary care center with a greater population, proximity and access predominated. It remained frequency of schizophrenia and other psychotic disorders and personality disorders, doubled affective disorders, tripled substance disorders, doubled dual pathology, and personality disorder was common in comorbidity with substance disorder and affective disorders CONCLUSIONS: strategies would be required with the Judicial System and Health Service, implement adolescent unity and addiction unit, and strengthen multidisciplinary care for older adults.

Magnitud, impacto y estrategias de enfrentamiento de la depresión, con referencia a Chile / Magnitude, impact and recommended management strategies for depression, with reference to Chile

Depression is a global public health priority. Intervention strategies at different levels of care must be implemented. Research is needed in the areas of depression prevention, treatment and rehabilitation. This paper reports a literature review, focused in Chile, on the magnitude, impact, recommended management strategies and new research on depression.

Confiabilidad y validez de la escala de impulsividad de Barratt (BIS-11) en adolescentes / Reliability and validity of Barratt impulsiveness scale (BIS-11) in adolescents

Introducción: La Escala de Impulsividad de Barratt (BIS) es uno de los instrumentos más frecuentemente usados para evaluar la impulsividad. Este artículo describe la confiabilidad y validez de la BIS-11 en adolescentes chilenos. Sujetos y Métodos: El estudio se efectuó en estudiantes de enseñanza media (n = 763). La confiabilidad se evaluó con análisis de consistencia interna y homogeneidad de los ítems. Para la validez se empleó coeficiente de correlación de Pearson y prueba t de student para muestras independientes. Resultados: La escala obtuvo un coeficiente alfa de Cronbach de 0,77 y su puntaje total correlacionó significativamente con impulsividad según DSM IV, impulsividad según reporte del profesor, intento de suicidio y consumo de alcohol. Conclusiones: La BIS-11 es una medida de impulsividad con adecuada confiabilidad y validez en esta población.

Background: The Barratt Impulsivity Scale (BIS) is one of the most commonly used scales for the assessment of impulsiveness. This report describes the reliability and validity of the BIS-11. Subjects and Methods: The study was conducted in high school students (n = 763). The reliability was evaluated with analysis of internal consistency and homogeneity of the items. For the validity Pearson coefficient of correlation and the student t-test for independent sample were used. Results: The scale obtained a Cronbach alpha coefficient of 0,77, and the total scores of the scale correlated significantly with impulsivity according to DSMIV, impulsivity according to the teacher, suicide attempt and alcohol consumption. Conclusions: The BIS-11 is a valid and reliable measure of impulsivity in this population.

Soledad, impulsividad, consumo de alcohol y su relación con suicidalidad en adolescentes / Association of loneliness, impulsivity and alcohol use with suicidal behavior in adolescents

Background: Suicide and suicide attempts are public health problems. Their prevention requives the detection ofpredictorfactors. Aim: To determine the predictive valué of loneliness, impulsivity and alcohol use on suicidal behavior in adolescents. Subjects and Methods: Suicidal behavior, Loneliness (UCLA), Impulsivity (Barratt) scales and the Alcohol Use Disorders Identification Test (AUDIT), were applied to 763 high school students aged 14 to 19years (49% males), livingin Chillan, Chile. Results: Nineteen percent of participants had attempted suicide and 34.3% had suicidal ideation. Loneliness, impulsivity and alcohol use were directly related to suicidal behavior. These predictors explained 31 % ofthe suicidal behavior. The most important risk factor was loneliness, followed by femóle gender, impulsivity and alcohol use. Conclusions: Loneliness, impulsivity and alcohol use are risk factors for suicide among adolescents. Women are at higher risk than men.

Confiabilidad, validez y punto de corte para escala de screening de suicidalidad en adolescentes / Reliability, validity and cutoff point for scale screening of suicidality in adolescents

Background: With the object to obtain a screening scale of suicidality, assesses the reliability and validity of the suicidality scale of Okasha et al and determine the cutoff point to identify a suicide attempt. Subjects and Methods: The study was conducted in high school students (n = 763, N = 13.825). The reliability was evaluated with analysis of internal consistency and homogeneity of the items. For the validity logistic regression and Pearson coefficient of correlation were used. The cutoff point was determined with Characteristic of Operation of the Receiver (ROC) curve and the area under the curve for the level of discriminatory exactitude. Results: The scale obtained a Cronbach alpha coefficient of 0,89 and adequate homogeneity (item-total correlations corrected: r = 0.76 items 1 and 3; r = 0.82 item 2); discriminate between adolescents who have attempted suicide and those who did not (Wald de X2 (1)= 1.53, p < 0.001; coefficient b = 0.66; odds ratio = 1.94 (IC 95 percent: 1.75-2.16)). The area under ROC curve was of0.89. The cutoff point corresponded to 5 point, sensitivity = 90 percent and specificity = 79 percent. The scores of the scale correlated significantly with low self-esteem (r (761)= -0,52, p < 0.001), lower perceived social support (r (761) = -0,37, p < 0.001) and higher impulsivity (r (761) = 0,29, p < 0.001). Conclusions: The evaluated scale presents high internal consistency and homogeneity, with statistical of validity strongly significant and cutoff point adequate sensitivity and specificity.

Introducción: Con el objeto de obtener una escala de screening de suicidalidad, se evalúa confiabilidad, validez de la escala de suicidalidad de Okasha et al y se determina el puntaje de corte para identificar intento de suicidio. Sujetos y Métodos: El estudio se efectuó en estudiantes de enseñanza media (n = 763, N= 13.825). La confiabilidad se evaluó con análisis de consistencia interna y homogeneidad de los ítems. Para la validez se empleó regresión logística y coeficiente de correlación de Pearson. El punto de córtese determinó con curva Característica de Operación del Receptor (ROC) y se calculó el área bajo la curva para el nivel de exactitud discriminativa. Resultados: La escala obtuvo un coeficiente alfa de Cronbach de 0,89 y adecuada homogeneidad (correlaciones ítem-total corregido: r = 0,76 ítems 1 y 3; r = 0,82 ítem 2); discrimina entre adolescentes que han intentado suicidarse y aquellos que no (Wald de X2 (1) = 1,53, p < 0,001; coeficiente b = 0,66; odds ratio = 1,94 (IC 95 por ciento: 1,75-2,16)). El área bajo la curva ROC fue 0,89. El puntaje de corte correspondió a 5 puntos, con sensibilidad = 90 por ciento y especificidad = 79 por ciento. El puntaje de la escala correlacionó significativamente con baja autoestima (r (761)= -0,52, p < 0,001), menor apoyo social percibido (r (761)= -0,37, p < 0,001) y mayor nivel de impulsividad (r (761) = 0,29, p < 0,001). Conclusiones: La escala evaluada presenta alta consistencia interna y homogeneidad, con estadísticos de validez fuertemente significativos y punto de corte con adecuada sensibilidad y especificidad.

Predictores de suicidalidad en adolescentes / Predictors of suicidality in adolescents

Background: The suicidality has increased in adolescents. Its prevention requives to detect suicide ideation, suicide attempts and associated factors. Objectives: To determine the contribution of the self-esteem, impulsivity, family cohesion, family adaptability, social support in the prediction of suicidality in adolescents. Subjects and Methods: The Suicidality Scale, Rosenberg Self-Esteem Scale, Impulsivity Scale, Olson Family Cohesion and Adaptability Scale and the Multidimensional scale of perceived social support of Zimet were administered to 763 high school students. For statistical analysis, t student, Pearson coefficient of correlation and multiple linear regression analyses, was used. Results: 19.1 percent committed suicidal attempts and 7.9 percent had thought many times to finish with their Ufe. Difference in the relation between gender and suicidality was founded t (751): -6.69; p < 0,001, being greater in women. Age (r: 0.12; p < 0.01) and impulsivity (r: 0,28; p < 0.001) is related directly to suicidality; self-esteem (r: -0.49;p < 0.001), family cohesion (r: -0.36; p < 0.001) and social support (r: -0.34; p < 0.001) inversely. The predictors explains 33.8 percent) of the suicidality (R²:0.338); they contribute in sequence of importance: self-esteem (beta: -0.33; sr.²:0.08; p < 0.001), gender (beta: -0.19; sr.²:0.033; p < 0.001), impulsivity (beta: 0,17; sr.²: 0.025; p < 0.001), family cohesion (fc -0.14; sr.²: 0.011; p < 0.001), social support (ß: -0.11; sr.²: 0.008; p < 0.01) and age (ß: -0.07; sr.²: 0.005; p < 0.05). Conclusions: The adolescents with less self-esteem, greater impulsivity, with problems of family cohesion and less social support present greater suicidality.

Introducción: La suicidalidad ha aumentado en adolescentes. Su prevención requiere detectar ideas suicidas, intentos de suicidio y factores asociados. Objetivos: Determinar la contribución de autoestima, impulsividad, cohesión familiar, adaptabilidad familiar, apoyo social en la predicción de suicidalidad en adolescentes. Sujetos y Métodos: Se administró la escala de Suicidalidad, Escala de Autoestima de Rosenberg, Escala de Impulsividad, Escala de Cohesión y Adaptabilidad familiar de Olson y Escala de Apoyo Social de Zimet a 763 estudiantes de enseñanza media. En el análisis se empleó prueba t de student, coeficiente de correlación de Pearson y análisis de regresión lineal múltiple. Resultados: 19,1 por ciento cometió intentos suicidas y 17,9 por ciento había pensado muchas veces en terminar con su vida. Existe diferencia en la relación entre género y suicidalidad t (751): -6,69; p < 0,001, siendo mayor en mujeres. Edad (r: 0,12; p < 0,01) e impulsividad (r: 0,28; p < 0,001) se relacionan directamente con suicidalidad; autoestima (r: -0,49; p < 0,001), cohesión familiar (r: -0,36; p < 0,001) y apoyo social (r: -0,34; p < 0,001) inversamente. Los predictores explican 33,8 por ciento de la suicidalidad (R² ajustado: 0,338); contribuyendo en el siguiente orden de importancia: autoestima (ß: -0,33; sr²:0,08; p < 0,001), género (ß: -0,19; sr²: 0,033; p < 0,001), impulsividad (ß: 0,17; sr²: 0,025; p < 0,001), cohesión familiar (ß: -0,14; sr²: 0,011; p < 0,001), apoyo social (ß: -0,11; sr²: 0,008; p < 0,01) y edad (ß: -0,07; sr²: 0,005; p < 0,05). Conclusiones: Los adolescentes con menor autoestima, mayor impulsividad, con problemas de cohesión familiar y menor apoyo social presentan mayor suicidalidad.