Systematic review of risk factors for suicide and suicide attempt among psychiatric patients in Latin America and Caribbean / Revisión sistemática de los factores de riesgo de suicidio e intento de suicidio entre los pacientes psiquiátricos de América Latina y el Caribe

OBJECTIVE: To analyze published evidence from the Latin America and Caribbean (LAC) region pertaining to risk factors for completed suicide and suicide attempts among psychiatric populations. METHODS: Potential studies were identified through systematic electronic searches in MEDLINE and LILACS. Included studies were cohort, case-control, and cross-sectional designed investigations of psychiatric samples in which suicide or a suicide attempt was reported as an outcome and evaluated with some measure of impact (odds ratio, risk ratio, or hazard ratio). Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. RESULTS: Of the 2 987 identified studies, a total of 17 studies were reviewed to determine potential suicidal risk factors. Eleven studies used a case-control design, five used a cross-sectional design, and only one study used a prospective-cohort design. The main risk factors for suicide attempts in LAC included major depressive disorder (MDD), family dysfunction, and prior suicide attempt, while the main risk factors for completed suicide were male gender and MDD. The methodological quality of most of the studies was low. CONCLUSIONS: This review provides evidence that the majority of relevant risk factors for suicide and suicide attempts in the LAC region are similar to those observed in Western societies but different from those reported in Eastern societies. Studies of higher methodological quality from the region are needed to support these results.

OBJETIVO: Analizar los datos probatorios publicados de la región de América Latina y el Caribe (ALC) que fueran pertinentes a los factores de riesgo de suicidio consumado e intentos de suicidio entre las poblaciones psiquiátricas. MÉTODOS: Se seleccionaron los posibles estudios mediante búsquedas electrónicas sistemáticas en MEDLINE y LILACS. Se incluyeron estudios cuyos diseños de investigación fueran de cohortes, de casos y controles, o transversales de muestras psiquiátricas, y en los que el suicidio o un intento de suicidio se notificaran como un resultado, y se evaluaran mediante alguna medida de la repercusión (razón de posibilidades, razón de riesgos o razón de riesgos instantáneos). Se evaluó la calidad metodológica mediante el uso de las recomendaciones de la iniciativa de Fortalecimiento de la Notificación de los Estudios Observacionales en Epidemiología (STROBE, por sus siglas en inglés). RESULTADOS: Se analizaron 17 de los 2 987 estudios seleccionados con objeto de determinar los posibles factores de riesgo de suicidio. Once estudios usaron un diseño de casos y controles, cinco usaron un diseño transversal, y un único estudio usó un diseño de cohortes prospectivo. Los principales factores de riesgo de intento de suicidio en ALC fueron el trastorno depresivo mayor (TDM), la disfunción familiar y el intento de suicidio previo, mientras que los principales factores de riesgo de suicidio consumado fueron el sexo masculino y el TDM. La mayor parte de los estudios mostraron una mala calidad metodológica. CONCLUSIONES: Esta revisión aporta datos probatorios de que la mayor parte de los factores de riesgo pertinentes al suicidio y los intentos de suicidio en la región de ALC son similares a los observados en las sociedades occidentales pero diferentes a los notificados en las sociedades orientales. Se necesitan estudios regionales de mayor calidad metodológica para apoyar estos resultados.

Pacientes hospitalizadas por ideación e intento de suicidio en un Hospital de Salud Mental: características clínico-demográficas y seguimiento a seis meses / [Patients hospitalized for suicidal ideation and suicide attempt in a Mental Health Hospital: Clinicodemographical features and 6-month follow-up].

BACKGROUND: Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. OBJECTIVE: To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. METHODS: In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. RESULTS: Baseline data show that of all patients who entered the Emergency Department, 27

did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41

) and schizophrenia (16

). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22

of patients had a new attempted suicide and 34

had a readmission in a 6-month period. CONCLUSIONS: Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.

Evolución histórica y conceptual de los trastornos psicóticos no esquizofrénicos en los DSM / [Historical and conceptual evolution of non-schizophrenic psychotic disorders in DSM].

After firmly established the "kraepelinean dichotomy" (dementia praecox - manic-depressive insanity), classical psychiatry began to describe a group of psychotic disorders which did not fit in any of these main diagnoses. Many of these clinical pictures where incorporated to the DSM and underwent several changes throughout the successive editions of the American manual. This article aims to make a historical and conceptual overview of this group of non-schizophrenic psychotic disorders accompanying schizophrenia in the "Schizophrenia spectrum and other psychotic disorders" chapter of DSM-5.

Acerca del delirio hipocondríaco en las Parafrenias: una revisión historiográfica y clínica / Hypochondriacal delusions in paraphrenias: a historiographical and clinical review

Las ideas delirantes hipocondríacas constituyen un síntoma de eventual aparición en las psicosis crónicas. Algunos autores han planteado la existencia de un cuadro delirante crónico, la Parafrenia Hipocondríaca, en el que este tipo de ideación delirante constituye el síntoma cardinal. En el presente trabajo se evalúa la validez nosológica de la Parafrenia Hipocondríaca y su independencia de las demás formas de Parafrenias. Para esto, se realizó una revisión histórica de la posición de la sintomatología delirante hipocondríaca desde las definiciones originales de Laségue y Griesinger hasta la descripción de la Parafrenia Hipocondríaca por Karl Leonhard. Se presentan tres casos de pacientes con el diagnóstico de Parafrenia Hipocondríaca. Concluimos que la Parafrenia Hipocondríaca representa un constructo teórico válido y útil en la discriminación de los diferentes estados delirantes crónicos.

Hypochondriacal delusions may eventually appear in chronic psychosis. Some authors have proposed the existence of a chronic delusional disease named Hypochondriacal Paraphrenia in which these delusions constitute its main feature. In the present article we discuss the nosological validity of the Hypochondriacal Paraphrenia and its independence from other subtypes of Paraphrenias. With this aim, an historical review of the position of the hypochondriacal symptomatology was performed form the original definitions of Lasegue and Griesinger to the description of the Hypochondriacal Paraphrenia by Karl Leonhard. Then, three cases of patients with the diagnosis of Hypochondriacal Paraphrenia are presented. We conclude that the Hypochondriacal Paraphrenia is a valid and useful nosological construct.