Bienestar y burnout en psiquiatras de Uruguay: estudio transversal descriptivo, año 2019 / Wellbeing and burnout in psychiatrists from Uruguay: transversal descriptive study, year 2019

El proceso de desarrollo profesional del psiquiatra lo hace especialmente vulnerable al agotamiento físico y emocional, puesto que el sujeto es la herramienta misma de atención en la relación médica. Se realizó un estudio descriptivo transversal mediante una encuesta electrónica anónima para psiquiatras y estudiantes de posgrado de Psiquiatría de Uruguay, pertenecientes a la Sociedad Uruguaya de Psiquiatría y a la Asociación de Psiquiatras del Interior, con el objetivo de identificar y describir las características sociodemográficas y de trabajo del médico con especialización en Psiquiatría, así como elementos de burnout y la percepción del bienestar en Uruguay en el año 2019. Se identificó la influencia del multiempleo y la presencia de burnout en el entorno del 10 % de los profesionales. La mitad de los encuestados trabaja en la capital y área metropolitana del país, contribuyendo a la inhomogeneidad de la asistencia. Aún estando inmersos en el modelo de recuperación en el contexto de la nueva ley de salud mental es escaso el porcentaje de profesionales que se desempeña en el área de rehabilitación de personas con trastornos mentales graves.

Psychiatrists' professional development process renders them specially vulnerable to physical and emotional exhaustion due to the fact that psychiatrists themselves become a treatment tool in the clinical relationship. With the aim of identifying and describing socio-demographic and work features as well as burnout elements and well-being perception, a descriptive crosssectional study was carried out by means of an anonymous electronic survey for psychiatrists and medical doctors specializing in psychiatry in postgraduate courses belonging to the Sociedad Uruguaya de Psiquiatría and the Asociación de Psiquiatras del Interior in 2019. Influence of multi-employment and burnout was identified in 10% of the cases. Half of the assessed psychiatrists work in the capital city and metropolitan area, contributing to non homogeneous care. Only a small percentage work in rehabilitation, even if the new mental health law emphasizes this model of care for severe mental disorders.

Analysis of psychiatrists' prescription of opioid, benzodiazepine, and buprenorphine in Medicare Part D in the United States

Abstract Introduction The opioid epidemic is a severe problem in the world, especially in the United States, where prescription opioid overdose accounts for a quarter of drug overdose deaths. Objective To describe psychiatrists' prescription of opioid, benzodiazepine, and buprenorphine in the United States. Methods We conducted a retrospective cross-sectional study of the 2016 Medicare Part D claims data and analyzed psychiatrists' prescriptions of: 1) opioids; 2) benzodiazepines, whose concurrent prescription with opioids can cause overdose death; 3) buprenorphine, a partial opioid agonist for treating opioid addiction; 4) and naltrexone microsphere, a once-monthly injectable opioid antagonist to prevent relapse to opioid dependence. Prescribers with 11 or more claims were included in the analysis. Results In Medicare Part D in 2016, there were a total of 1,131,550 prescribers accounting for 1,480,972,766 total prescriptions and 78,145,305 opioid prescriptions, including 25,528 psychiatrists (2.6% of all prescribers) accounting for 44,684,504 total prescriptions (3.0% of all prescriptions) and 131,115 opioid prescriptions (0.2% of all opioid prescriptions). Psychiatrists accounted for 17.3% of benzodiazepine, 16.3% of buprenorphine, and 33.4% of naltrexone microsphere prescriptions. The opioid prescription rate of psychiatrists was much lower than that of all prescribers (0.3 vs 5.3%). The buprenorphine prescription rate of psychiatrists was much higher than that of all prescribers (2.3 vs. 0.1%). There was a substantial geographical variation across the United States. Conclusions The results show that, proportionally, psychiatrists have lower rates of opioid prescription and higher rates of benzodiazepine and buprenorphine prescription.

Efficacy, patient-doctor relationship, costs and benefits of utilizing telepsychiatry for the management of post-traumatic stress disorder (PTSD): a systematic review

Abstract Introduction Post-traumatic stress disorder (PTSD) is one of the most common psychiatric disorders found among victims of disaster, kidnapping, accidents, sexual assaults and war in Indonesia. However, lacking and unequal distribution of psychiatric medical personnel remains a barrier to its management. This review aims to introduce and evaluate the potential contribution of telepsychiatry to the management of PTSD based on published literature. Methods Original studies were obtained from PubMed, Science Direct, ProQuest, High Wire, and Elsevier Clinical Key databases. Results A total of 125 articles were found, of which 15 articles (12 randomized controlled trials, 2 open trials and 1 pilot study) fulfilled the inclusion criteria. A total of 991 subjects were found with a follow-up period ranging between 5 weeks and 18 months. Telepsychiatry is an innovative use of technology to aid the delivery of PTSD treatments in areas difficult to reach. The quality of care given by telepsychiatry both through video conferencing as well as web- and application-based is comparable to that of face-to-face therapy. Patient satisfaction, quality of doctor-patient relationship also remains high, with lower costs and shorter therapeutic time when compared to face-to-face therapy. Conclusion Various studies have shown that telepsychiatry is an effective solution for the management of PTSD. Studies have also reported that the quality of treatment through telepsychiatry is as effective as face-to-face therapy, with greater efficiency. Countries, especially those with a low patient-to-mental health professional ratio, should be encouraged to develop telepsychiatry systems to manage PTSD.

Complexity of pediatric chronic disease: cross-sectional study with 16,237 patients followed by multiple medical specialties / Complexidade da doença crônica pediátrica: estudo tranversal com 16.237 pacientes seguidos por múltiplas especialidades médicas

ABSTRACT Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

RESUMO Objetivo: Avaliar dados demográficos e características de crianças e adolescentes com doenças crônicas pediátricas, de acordo com o número de especialidades/paciente. Métodos: Realizou-se um estudo transversal com 16.237 pacientes com doenças crônicas pediátricas durante um ano. A análise foi feita em um sistema eletrônico, de acordo com número de consultas médicas para doenças crônicas pediátricas. Este estudo avaliou dados demográficos, características do seguimento, tipos de especialidades médicas, diagnóstico (10ª Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde - CID-10), número de visitas e complicações agudas. Resultados: Os pacientes acompanhados por três ou mais especialidades simultaneamente tiveram seguimento de maior duração comparados com aqueles seguidos por ≤2 especialidades [2,1 (0,4-16,4) vs. 1,4 (0,1-16,2) anos; p<0,001], bem como maior número de consultas em todas as especialidades. As áreas médicas mais comuns em pacientes acompanhados por ≥3 especialidades foram: psiquiatria (Odds Ratio - OR=8,0; intervalo de confiança de 95% - IC95% 6-10,7; p<0,001); dor/cuidados paliativos (OR=7,4; IC95% 5,7-9,7; p<0,001); doenças infecciosas (OR=7,0; IC95% 6,4-7,8; p<0,001); nutrologia (OR=6,9; IC95% 5,6-8,4; p<0,001). As regressões logísticas mostraram que os pacientes com doenças crônicas pediátricas seguidos por ≥3 especialidades tinham alto risco para: maior número de consultas/paciente (OR=9,2; IC95% 8,0-10,5; p<0,001); atendimentos em hospital-dia (OR=4,8; 95%IC3,8-5,9; p<0,001); atendimentos em pronto-socorro (OR=3,2; IC95% 2,9-3,5; p<0,001); hospitalizações (OR=3,0; IC95%2,7-3,3; p<0,001); internação em terapia intensiva (OR=2,5; IC95% 2,1-3,0; p<0,001); óbitos (OR=2,8; IC95%1,9-4,0; p<0,001). Os diagnósticos de asma, obesidade, dor crônica, transplante e infecção do trato urinário foram mais frequentes nos pacientes seguidos por três ou mais especialidades. Conclusões: O presente estudo mostrou que pacientes com doenças crônicas pediátricas que necessitaram de múltiplas especialidades médicas simultaneamente apresentavam doenças complexas e graves, com diagnósticos específicos.

How psychiatrists think about religious and spiritual beliefs in clinical practice: findings from a university hospital in São Paulo, Brazil

Objective: To examine the relationship between psychiatrists' religious/spiritual beliefs and their attitudes regarding religion and spirituality in clinical practice. Methods: A cross-sectional survey of religion/spirituality (R/S) in clinical practice was conducted with 121 psychiatrists from the largest academic hospital complex in Brazil. Results: When asked about their R/S beliefs, participants were more likely to consider themselves as spiritual rather than religious. A total of 64.2% considered their religious beliefs to influence their clinical practice and 50% reported that they frequently enquired about their patients' R/S. The most common barriers to approaching patients' religiosity were: lack of time (27.4%), fear of exceeding the role of the doctor (25%), and lack of training (19.1%). Those who were less religious or spiritual were also less likely to find difficulties in addressing a patient's R/S. Conclusion: Differences in psychiatrists' religious and spiritual beliefs are associated with different attitudes concerning their approach to R/S. The results suggest that medical practice may lead to a religious conflict among devout psychiatrists, making them question their faith. Training might be of importance for handling R/S in clinical practice and for raising awareness about potential evaluative biases in the assessment of patients' religiosity.

The presentation of the mind-brain problem in leading psychiatry journals

Objective: The mind-brain problem (MBP) has marked implications for psychiatry, but has been poorly discussed in the psychiatric literature. This paper evaluates the presentation of the MBP in the three leading general psychiatry journals during the last 20 years. Methods: Systematic review of articles on the MBP published in the three general psychiatry journals with the highest impact factor from 1995 to 2015. The content of these articles was analyzed and discussed in the light of contemporary debates on the MBP. Results: Twenty-three papers, usually written by prestigious authors, explicitly discussed the MBP and received many citations (mean = 130). The two main categories were critiques of dualism and defenses of physicalism (mind as a brain product). These papers revealed several misrepresentations of theoretical positions and lacked relevant contemporary literature. Without further discussion or evidence, they presented the MBP as solved, dualism as an old-fashioned or superstitious idea, and physicalism as the only rational and empirically confirmed option. Conclusion: The MBP has not been properly presented and discussed in the three leading psychiatric journals in the last 20 years. The few articles on the topic have been highly cited, but reveal misrepresentations and lack of careful philosophical discussion, as well as a strong bias against dualism and toward a materialist/physicalist approach to psychiatry.

Genetics in psychiatry.

Today, psychiatrists are focusing on genetics aspects of various psychiatric disorders not only for a future classification of psychiatric disorders but also a notion that genetics would aid in the development of new medications to treat these disabling illnesses. This review therefore emphasizes on the basics of genetics in psychiatry as well as focuses on the emerging picture of genetics in psychiatry and their future implications.

Descripción del uso de la licencia médica psiquiátrica en un servicio especializado de atención ambulatoria / Psychiatric sick-leaves description in a specialized outpatient service

Objetivo: Describir las características de la prescripción del reposo médico de causa psiquiátrica en un servicio de atención especializado. Métodos: Se registraron las atenciones psiquiátricas y las licencias médicas emitidas en un período de 3 meses (julio a septiembre 2009). Resultados: En el período se realizaron 3.105 consultas psiquiátricas, indicándose licencia médica en 399 atenciones (12,7 por ciento). Se eliminaron 16 y se trabajó con 383 licencias. De estas, 184 (48 por ciento) fueron 1° licencia en el período, 190 (49,6 por ciento) fueron prórroga de anterior y 9 (2,3 por ciento) fueron repetición de reposo. El número de pacientes beneficiados con la indicación de reposo fue de 228 (12 por ciento). Los trastornos del ánimo dieron cuenta de un 78,1 por ciento de las licencias y se prescribieron más frecuentemente en mujeres (68,9 por ciento). La duración total del reposo fue 25,5 +/- 20 días y la mediana fue 15. Discusión: En un servicio especializado de Psiquiatría las atenciones generaron 12,7 por ciento de prescripción de licencias médicas. La gravedad de los casos puede explicar la alta frecuencia de prórrogas y repetición de licencias. Los trastornos del ánimo son los diagnósticos más frecuentemente consignados como causa de la licencia médica. Este trabajo aporta datos técnicos sobre el uso y características de la licencia médica psiquiátrica en Chile.

Objectives: To characterize sick leaves prescription in a specialized psychiatric service. Methods: We recorded all of psychiatric attentions as well as all of sick-leaves prescribed during a three months period (July to September, 2009). Results: 3,105 attentions were done, whit a 12,7 percent (399 attentions) of them resulting in a sick-leave prescription, corresponding to 228 out-patients. We discarded 16 sick-leaves because incomplete information. 184 (48 percent) sick-leaves were prescribed in a first visit, 190 (49,6 percent) were a prolongation of a previous sick-leave prescription, and 9 (2,3 percent) were prescribed after a working period posterior to a previous rest. Affective disorder were the most frequent diagnosis observed in sick-leave prescription (78,1 percent), being more frequent in women (68,9). The mean of rest was 25,5 +/- 20 days with a median of 15 days. Discussion: A 12,7 percent of psychiatric attention generated a sick-leave prescription. Severity of disorders seen in a specialized psychiatric service could explain this finding. Our results confirm Affective Disorders are the principal cause of sick-leave prescription. This study add technical knowledge about feature and uses of psychiatric sick-leaves in Chile.

Ten-year growth in the scientific production of Brazilian Psychiatry: the impact of the new evaluation policies / Dez anos de crescimento da produção científica da Psiquiatria brasileira: o impacto das novas políticas de avaliação

OBJECTIVE: Developed by the Ministry of Education, the Qualis evaluation criteria have strongly impacted the scientific production of Post-Graduation Programs. A new set of more stringent criteria has been proposed for Qualis. Our aim was to evaluate the impact of the new Qualis criteria on the scientific production of Post-Graduation Programs in psychiatry over the last 10 years. METHOD:We extracted data from annual reports published between 1998 and 2008, and compared performance measured in terms of the old Qualis rating criteria and the new set of criteria. RESULTS: There was a 25 percent increase in the number of Information Science Institute-indexed articles in the second five-year period, which rose from 1,213 to 1,518. While, according to the old Qualis criteria, 84 percent of the Information Science Institute production would have been classified as highly-rated (IF > 1), only 17 percent of the papers were classified as highly-rated (A1) according to the new Qualis rating criteria. Most papers (65 percent) were assigned to intermediate categories (B1 and B2) with an IF < 2.29. DISCUSSION:All psychiatric Post-Graduation Programs have increased their production, but by favoring quality over quantity, the new rules have proved to be more useful for discriminating among the scientific production.

OBJETIVO: Nosso objetivo foi analisar o impacto dos novos critérios de avaliação de publicações científicas (Qualis) sobre a produção científica de Psiquiatria ao longo dos últimos 10 anos. Os critérios de avaliação do Ministério da Educação têm refletido em forte impacto na produção científica dos Programas de Pós-Graduação. MÉTODO: Extraímos dados dos relatórios anuais publicados entre 1998 e 2008 e comparamos os desempenhos medidos em termos dos antigos critérios de avaliação Qualis e dos novos conjuntos de critérios. RESULTADOS: Houve um aumento de 25 por cento no número de artigos indexados no Information Science Institute no segundo período de cinco anos, que passou de 1.213 para 1.518. Embora, de acordo com os critérios de anteriores do Qualis, 84 por cento da produção Information Science Institute tenha sido classificada como de alta qualificação (IF > 1), apenas 17 por cento dos trabalhos foram classificados como de alta qualificação (A1), de acordo com os novos critérios de avaliação Qualis. A maioria dos trabalhos (65 por cento) foi atribuída a categorias intermediárias (B1 e B2), com IF < 2,29. DISCUSSÃO:Todos os Programas de Pós-Graduação de psiquiatria aumentaram sua produção, porém, favorecendo a qualidade ao invés da quantidade, as novas regras provaram ser de mais utilidade para discriminar a produção científica.

Usefulness of two instruments in assessing depression among elderly Mexicans in population studies and for primary care / Utilidad de dos instrumentos para valorar depresión entre adultos mayores de México en estudios poblacionales y para la atención en el primer nivel de salud

OBJECTIVE: To determine the psychometric qualities of the CES-DR and GDS scales in the elderly and compare them to clinical psychiatric diagnoses. MATERIAL AND METHODS: The first phase consisted of home interviews for determining the psychometric qualities of the GDS and CES-DR scales. In the second phase, psychiatrists conducted diagnostic interviews. The sample consisted of 534 participants older than 60 years of age insured by the Mexican Institute of Social Security. RESULTS: First phase: Cronbach's alpha for the GDS was 0.87 and 0.86 for CES-DR. The GDS factorial analysis found eight factors that could explain 53.5 percent of the total variance and nine factors that explained 57.9 percent in the CES-DR. Second phase: Compared to the psychiatric diagnoses, CES-DR reported a sensitivity of 82 percent and a specificity of 49.2 percent; GDS reported 53.8 percent sensitivity and 78.9 percent specificity. CONCLUSIONS: CES-DR and GDS scales have high reliability and adequate validity but the CES-DR reports higher sensitivity.

RESUMEN OBJETIVO: Determinar las propiedades psicométricas de las escalas CES-DR y GDS para depresión en población anciana y compararlas con el diagnóstico clínico psiquiátrico. MATERIAL Y MÉTODOS: La primera fase consistió en entrevistas en casa para determinar las propiedades psicométricas. En la segunda fase, los psiquiatras condujeron entrevistas diagnósticas. La muestra consistió en 534 participantes de 60 años y más asegurados por el Instituto Mexicano del Seguro Social. RESULTADOS: Primera fase: Alfa de Cronbach para el GDS y CES-DR fue de 0.87 y 0.86, respectivamente. El análisis factorial del GDS reportó ocho factores que explicaron 53.5 por ciento de la varianza, comparado con nueve del CESDR que explicaron 57.9 por ciento. Segunda fase: Comparado con el diagnóstico psiquiátrico, el CES-DR reportó una sensibilidad de 82 por ciento y una especificidad de 49.2 por ciento comparado con 53.8 por ciento y 78.9 por ciento, respectivamente del GDS. CONCLUSIONES: Las escalas CES-DR y GDS tienen consistencia y adecuada validez pero el CES-DR reporta más alta sensibilidad.

The modest but growing Brazilian presence in psychiatric, psychobiological and mental health research: assessment of the 1998-2002 period

The objective of the present survey was to assess the Brazilian scientific production in psychiatry, psychobiology, and mental health during the 1998-2002 period. The universities' graduate programs concentrate the vast majority of the scientific production in Brazil. We assessed the annual reports from the graduate programs to the Brazilian Ministry of Education concerning master's and doctoral theses and the articles published in journals indexed by the Institute of Scientific Information (ISI). There are nine Master's and Doctoral graduate programs dedicated to research in psychiatry, neuropsychiatry, psychobiology, and mental health in the country, seven being located in southern states. During the 5-year period, from 1998 to 2002, 186 students received their doctorate degree (37/year). The programs published 637 articles in journals indexed by ISI, the majority of them in journals with an impact factor higher than 2. The research advisors' productivity varied among graduate programs, ranging from 0.6 to 2.0 articles per year in ISI-indexed journals. Despite the substantial barriers faced by the Brazilian scientific community (mainly financial and writing difficulties), Brazil's scientific mental health production is on the rise. The number of articles published in ISI-indexed journals has doubled without a significant increase in the number of graduate theses, suggesting that there was an improvement in both the quality of the scientific production and the productivity of the graduate programs. Based on these data, it is reasonable to predict a tendency to an increase in production over the next few years.

Perfil dos pacientes internados na enfermaria psiquiátrica do Hospital Municipal Campo Limpo

Conhecer as características da população que é internada na enfermaria de psiquiatria do Hospital Municipal do Campo Limpo (HMCL), e sua evolução ao final de 6 meses. (...) (obs.: texto retirado do sumário/objetivo).

Perfil dos pacientes internados na enfermaria psiquiátrica do Hospital Municipal Campo Limpo / Profile of patients admitted to the psychiatric ward of the Hospital Municipal Campo Limpo

Conhecer as características da população que é internada na enfermaria de psiquiatria do Hospital Municipal do Campo Limpo (HMCL), e sua evolução ao final de 6 meses. (...) (obs.: texto retirado do sumário/objetivo).