The mediating role of reflective functioning in the association between childhood trauma and suicide attempt.

BACKGROUND: Childhood trauma is intimately related with suicidal behaviour. Patients who have suffered childhood trauma develop impaired Reflective Functioning (RF), which refers to the capacity to understand ourselves and others in terms of intentional mental states. An improvement in RF has been associated with a reduction in suicidal attempts, but the mediating role of RF between childhood trauma and suicidal behaviour has not been addressed so far. OBJECTIVE: We aim to examine the potential mediating effect of RF among childhood trauma and suicide attempts. METHOD: We included 748 patients who had attempted suicide at least once. They were asked to complete the Reflective Functioning Questionnaire (RFQ-8), the Columbia-Suicide Severity Rating scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). We conducted linear regressions by simple mediating model to examine the role of RF in the indirect association between childhood trauma and the number of suicide attempts. RESULTS: Our results show significant indirect effects through hypo and hypermentalizing between Emotional Abuse (EA) and Sexual Abuse (SA) in childhood and the number of suicide attempts in lifetime. These results indicate that ineffective RF significantly mediates the association between childhood trauma and suicidality. CONCLUSION: This is the first study supporting the mediational role of RF in the relationship between EA and SA, and the number of suicide attempt in lifetime. These findings have important implications for reducing suicide rates and preventing future re-attempts. Further studies analysing this mediating role and focusing efforts on increasing RF-based interventions are required.

Implementation of a suicide risk prevention program in the Autonomous Community of Madrid. The ARSUIC experience.

INTRODUCTION: This study evaluates the degree of compliance and effectiveness of the ARSUIC Suicide Risk Care Program. ARSUIC seeks to reduce the relapse risk that follows a suicide attempt by scheduling a high priority outpatient visit following hospital discharge. METHOD: Hospital-based retrospective study conducted between years 2012 and 2015. We included every suicide attempt treated at the La Paz University Hospital's mental healthcare resources network. We estimated the time between hospital discharge and the first outpatient visit; the proportion of visits that fulfill the program's objective - a follow-up within a maximum of 7 days; the suicide attempt rate; and the percentage of attempts corresponding to relapses, by study year. RESULTS: After program deployment, median time between discharge and the first visit decreased from 8.5 to 6 days, and the percentage of visits that fulfill the program's objective increased from 32 to 48.5%. Between years 2012 and 2015, the suicide attempt rate per person and year decreased from 1.20 to 1.08 and the proportion of attempts corresponding to relapses from 26.6% to 12.8%. CONCLUSION: Implementing the ARSUIC Program lowered the time between discharge and the first outpatient visit following a suicide attempt. The proportion of suicide attempts due to relapses and the suicide attempt rate per person decreased progressively. The program fulfilment proportion was under 50%, suggesting between-user differences regarding their effective access to the program.

Implementación de un programa de prevención del riesgo de suicidio en la Comunidad Autónoma de Madrid. La experiencia ARSUIC / Implementation of a suicide risk prevention program in the Autonomous Community of Madrid. The ARSUIC experience

INTRODUCCIÓN: Este estudio evalúa el grado de cumplimiento y efectividad del programa ARSUIC de Atención al Riesgo Suicida, cuyo objetivo es reducir el riesgo posterior al intento de suicidio facilitando una cita ambulatoria de alta prioridad después del alta hospitalaria. METODOLOGÍA: Estudio retrospectivo de base hospitalaria conducido, entre 2012 y 2015, en todos los casos de intento de suicidio atendidos en la red de recursos de psiquiatría del Hospital Universitario La Paz. Se obtienen estimadores del tiempo hasta la primera consulta después del alta, de la proporción de citas que cumple el objetivo del programa de ser atendidos en un máximo de 7 días, de la tasa de intento de suicidio y del porcentaje de intentos que corresponde con un reintento, en cada año de estudio. RESULTADOS: Después de la implementación del programa, la mediana de tiempo entre el alta y la primera consulta baja de 8,5 a 6 días y el porcentaje de citas que cumplen el objetivo aumenta de 32 a 48,5%. Entre 2012 y 2015, la tasa de intentos de suicidio por paciente y año se reduce de 1,20 a 1,08, y el porcentaje de intentos que corresponde con reintentos de 26,6 a 12,8%. CONCLUSIÓN: La implementación del Programa ARSUIC ha reducido el tiempo entre el alta después de un intento de suicidio y la primera cita ambulatoria. Han disminuido los intentos de suicidio debidos a reintentos y la tasa de intentos por paciente y año. El porcentaje de cumplimiento menor al 50% sugiere diferencias interindividuales en el acceso efectivo al programa

INTRODUCTION: This study evaluates the degree of com-pliance and effectiveness of the ARSUIC Suicide Risk Care Program. ARSUIC seeks to reduce the relapse risk that follows a suicide attempt by scheduling a high priority outpatient visit following hospital discharge. METHOD: Hospital-based retrospective study conducted between years 2012 and 2015. We included every suicide attempt treated at the La Paz University Hospital's mental healthcare resources network. We estimated the time between hospital discharge and the first outpatient visit; the proportion of visits that fulfill the program's objective-a follow-up within a maximum of 7 days; the suicide attempt rate; and the percentage of attempts corresponding to re-lapses, by study year. RESULTS: After program deployment, median time be-tween discharge and the first visit decreased from 8.5 to 6 days, and the percentage of visits that fulfill the program's objective increased from 32 to 48.5%. Between years 2012 and 2015, the suicide attempt rate per person and year de-creased from 1.20 to 1.08 and the proportion of attempts corresponding to relapses from 26.6% to 12.8%. CONCLUSION: Implementing the ARSUIC Program lowered the time between discharge and the first outpatient visit following a suicide attempt. The proportion of suicide attempts due to relapses and the suicide attempt rate per person decreased progressively. The program fulfilment proportion was under 50%, suggesting between-user differences regarding their effective access to the program

Effectiveness of continuity-of-care programs to reduce time in hospital in persons with schizophrenia.

AIMS: To assess the impact of the Continuity-of-Care Program (CCP; a clinical case management model) on hospital use of persons with schizophrenia in three Community Mental Health Services in Madrid (Spain). METHODS: Using data provided by the Psychiatric Case Register, we analyzed the use of hospitalization in 250 individuals before and after the date of inclusion in this program. RESULTS: During the first year after launching the program, there was a 40-69% reduction in the number of admissions, length of each hospital stay, proportion of admitted patients, total number of days in-hospital, proportion of patients visiting the emergency room, and emergency room visits. This drop was maintained over the subsequent 3 years of program functioning. CONCLUSIONS: These results encourage the development and implementation of such programs, even though more studies evaluating the effectiveness of these programs for other endpoints are needed.

Origen y desarrollo de los programas de seguimiento y cuidados para pacientes mentales graves y crónicos en la comunidad / Origin and development of conmunity-based follop-up, and care programmes for chronic and severe mental patients

En el presente trabajo se revisan los distintos modelos de Programas de Seguimiento y Cuidado de enfermos mentales graves y crónicos en la comunidad (Modelo de agencia, «case management» clínico, «case management» intensivo, tratamiento asertivo comunitario, modelo de competencias y modelo rehabilitador) y se analizan sus características diferenciales. Así mismo se describen los programas de estas características que se han desarrollado en el estado español en las últimas décadas y se presentan los resultados preliminares del estudio IPSE («Impacto de los Programas de Seguimiento y Cuidados en personas con trastornos Esquizofrénicos en la Comunidad») en cuanto a: la valoración cualitativa de los programas por parte de los usuarios y familiares, las características que contribuyen al adecuado funcionamiento del programa y a la consecución de los objetivos, y los obstáculos comunes a su adecuada implementación

Different models of community care for chronic mental health patients (broker case management, clinical case management, intensive case management, assertive communtity treatment, rehabilitation model and strengths model) and their caractheristics are reviewed. Spanish programs developed in the last decades in this field are described and the preliminary results from IPSE study (Impact of Commnunity Care Programs in Persons with Schizophrenia) are presented in relation to: subjetive valoration of the programs made by patients and family, components of the programs which contribute to their adecuate functioning and consecution of results, and common obstacles found for their adecuate implementation (AU)

[Drop-out from out-patient treatment for alcohol dependence: a two-year prospective study]. / Abandono del tratamiento para dependencia alcohólica en medio ambulatorio: estudio prospectivo de dos años.

INTRODUCTION: Treatment compliance in alcohol-dependent patients seems closely related to abstinence rates, so it could be an outcome measure. The aim of our study was to identify which sociodemographic and clinical characteristics of alcohol-dependent patients are associated to high drop-out rates. METHOD: 165 alcohol-dependent out-patients were assessed by means of a structured questionnaire and followed for two years. RESULTS: It was shown a predictive value for personal history of suicidal intents or affective and anxiety disorders, comorbidity with affective and personality disorders, family history of affective disorders and psychiatric and somatic complications of dependence, and past or present abstinence. DISCUSSION: Implications of these findings and inconsistencies between previous studies and these results are discussed.

Abandono del tratamiento para dependencia alcohólica en medio ambulatorio: estudio prospectivo de dos años / Drop-out from out-patient treatment for alcohol dependence: a two-year prospective study

La adherencia al tratamiento en los sujetos con dependencia alcohólica parece guardar relación estrecha con las tasas de abstinencia, por lo que podría tener valor pronóstico. El objetivo del trabajo fue averiguar las características sociodemográficas y clínicas de los pacientes con dependencia alcohólica que se asocien a tasas mayores de abandono del tratamiento. Material y métodos. Se valoró a 165 dependientes de alcohol que iniciaron tratamiento ambulatorio mediante una entrevista estructurada y fueron seguidos durante dos años. Resultados. Surgieron como variables predictivas los antecedentes personales de intentos de suicidio y de trastornos afectivos y ansiosos, la comorbilidad con trastornos afectivos y de personalidad, los antecedentes familiares de trastornos afectivos, así como las complicaciones somáticas y psiquiátricas del consumo y la abstinencia pasada o presente. Discusión/conclusiones. Se discuten las implicaciones de estos hallazgos y las diferencias entre ellos y estudios previos (AU)

Factores pronósticos de sujetos con dependencia alcohólica en tratamiento ambulatorio: estudio prospectivo de dos años / Predictive factors of alcohol dependence in an out-patient clinic: a two-year prospective study

La mayoría de estudios sugieren que ciertas características sociodemográficas de los alcohólicos, pueden tener mayor correlación con el pronóstico que las variables del programa de tratamiento en sí. Este estudio siguió a 165 pacientes dependientes de alcohol que iniciaron tratamiento ambulatorio en un centro de salud mental durante dos años, para establecer las variables sociodemográficas y clínicas que pudieran predecir un mal pronóstico, en cuanto a recaídas. Los resultados mostraron que la edad, el consumo de cannabis, la patología paranoide, los antecedentes psiquiátricos familiares y la evolución a los 3, 6 y 12 meses pueden predecir el pronóstico a los 2 años. Se discuten las implicaciones de estos hallazgos y las diferencias entre ellos y estudios previos (AU)

[Variation of the demand in the emergency of the Psychiatric Hospital of Madrid]. / Variación de la demanda en la urgencia del Hospital Psiquiátrico de Madrid.

The present study investigate several socio-demographics, clinical and therapeutics factors that converge in the emergencies of the Psychiatric Hospital of Madrid on June, 1989 and 1990. Also, the study approach the changes about the demand of attendance, experienced by these emergencies during the period 1979-1990, related to the introduction of a sectorized care organization through the comparison with similar studies realize in the same Hospital. Is studied the function of these changes in the progressive reordering of the population demand.

[Indicators of social support in psychiatric patients admitted to a brief hospitalization unit]. / Indicadores de soporte social en pacientes psiquiátricos ingresados en una unidad de hospitalización breve.

This study constitutes an attempt to analyze the relationship between different characteristics of social support and mental illness. The subjects of the retrospective study were 164 consecutive admissions to the Short Hospitalization Unit of Area 3 during 1989, aged 15-65, who met ICD-9 diagnosis criteria for: Affective Disorders, Schizophrenic Psychosis, Psychogenic psychosis, and Alcoholic Dependence. Social Support was assessed using different characteristics of family system (marriage, familiar network size, level of expressed emotion), social network, and instrumental functioning.