Simultaneous use of contraceptives and hormone replacement therapy in women receiving psychoactive drugs. From theory to integral health practice / Uso simultáneo de anticonceptivos y terapia hormonal de reemplazo en mujeres que reciben psicofármacos. De la teoría a la práctica de la salud integral.

Sexuality in people with mental disorders is a topic usually tinged with prejudice and stigma. Women with severe mental disorders are more exposed to suffer sexually transmitted diseases, becoming victims of gender violence and being involved with unintended pregnancies. In adults and adolescents, sexual intercourse under the influence of alcohol or other drugs, or during worsening or exacerbation of baseline symptoms or condition, are often unplanned, unprotected, with casual partners from high risk groups, without contraceptive methods and with less capacity to agree or deny safe sexual practices. Sexual and reproductive rights as well as gender perspective need to be considered an integral part of women with mental disorders health being and treatment. For this reason, discussing with patients about their desire or not to have children, their sexual life and provide them the most adequate options of contraceptive methods taking into consideration their needs so that and informed decision should be part of the psychiatric consultation. Hormonal contraceptives are widely used globally, being one of the most prescribed groups of drugs. It is estimated that more than 100 million women take oral contraceptives to prevent pregnancy, to treat menstrual pain and/or menstrual heavy bleeding or to control acne. Oral contraceptives result from the combination of estrogen and progestin derivatives, or progestins alone. This review will focus on the description of each hormonal contraceptive methods and hormone replacement therapy and the special features of their concomitant use with psychotropic drugs during treatment of women with psychiatric disorders.

La sexualidad de las personas con trastornos mentales es una temática habitualmente teñida de prejuicios y estigma. Las mujeres con trastornos mentales severos presentan mayor vulnerabilidad a padecer enfermedades de transmisión sexual, ser víctimas de violencia de género y tener embarazos no intencionales. En adultas y adolescentes, las relaciones sexuales bajo la influencia del alcohol o de otras drogas, o en momentos de descompensación de su cuadro de base son a menudo no planificadas, con parejas de riesgo, sin métodos anticonceptivos y con menor capacidad para negociar prácticas sexuales seguras. Desde una perspectiva de género y de derechos humanos, en la atención de mujeres con trastornos mentales, es necesario incluir los derechos sexuales y reproductivos como parte del tratamiento. Por tal motivo, hablar con nuestras pacientes sobre sus deseos de tener hijos, o no, sobre su vida sexual y la provisión de un método anticonceptivo acorde a su elección y necesidades, forma parte de la consulta psiquiátrica. Los anticonceptivos hormonales están ampliamente utilizados a nivel global, constituyendo uno de los grupos de fármacos más prescriptos. Se estima que más de 100 millones de mujeres los consumen para evitar el embarazo, como tratamiento de los sangrados abundantes, las menstruaciones dolorosas o el acné. Resultan de la combinación de derivados estrogénicos y progestágenos, o progestágenos solos. En esta revisión se focalizará en la descripción de los diversos métodos anticonceptivos hormonales, en la terapia hormonal de reemplazo y en las particularidades del uso simultáneo con psicofármacos en mujeres tratadas por trastornos psiquiátricos.

[Length of psychiatric hospitalizations: a clinical and socio-demographic characterization]. / Duración de las internaciones psiquiátricas: una caracterización clínica y socio-demográfica.

AIM: The aim of this study was to determine the clinical, socio-demographic, and therapeutic variables associated with the length of hospitalization in a psychiatric emergency hospital in Buenos Aires City. METHOD: The present retrospective analytical study included 350 consecutively admitted patients aged 18-65, from June 2013 until December 2017 in a public psychiatric hospital in Buenos Aires City. Data collected included socio-demographic, clinical and discharge conditions. RESULTS: Variables that predicted the length of hospitalization were: diagnosis of psychosis, the use of lithium and anticonvulsants, unemployment, no economic autonomy, not have formed a family and have modified the living support group during the hospitalization. CONCLUSION: The representative of social and economic vulnerability variables were associated with the utilization of psychiatric inpatient beds. Public policies are requested to interrupt the relationship between poverty and mental pathology.

[Postpartum psychiatric disorders]. / Trastornos psiquiátricos del puerperio.

The postpartum period represents a very particular time in women's life, the beginning of a new bond, the maternity. As many times, beginnings are such turbulent, intense. In this period the women suffers deep changes in their hormonal status, with its body and changes and affective oscillations. Women are often so labile at this time, ranging from happiness to deep sadness. The vast majority suffers the blues, a benign form of mild depressive state. On the other hand, 20% may have a major depressive episode, and a much less percentage will suffer the most disruptive postpartum syndrome, the postpartum psychosis. In this paper it will be described the symptomatology of such cases, the most important treatment approaches and will focus on the clinical dilemma of using psychotropic medications during breastfeeding.

[A patient's suicide. The psychiatrist's impact]. / El suicidio de un paciente. Impacto en el psiquiatra.

The clinical work of the psychiatrist often faces him to people who openly talk about their wish to die. However, although such thoughts did not culminate in most cases, unfortunately statistics show that suicide is a concrete possibility, more frequent than suspected. Globally, a million people die by suicide each year. The will to kill themselves is a complex phenomenon that is neither new nor modern. Suicide has crossed different times adopting different forms and meanings according to culture and history. As doctors, we tend to describe behaviors, in this case highly such a variable one, which involves various reasons and determinants. Thus, much has been written in the scientific literature about suicide in the causes, risk and protective factors, most vulnerable groups, etc. It has also been remarked the pain that the suicide causes in the family and close friends. Lots of articles propose psychotherapeutic and supporting measures for the suicide survivors to avoid the traumatic consequences of the experience. But, what about the psychiatrist? Isn't him a person who has been in close contact with the subject who has killed himself? The survivor risk of having traumatic symptoms, does it not apply to the doctor who was in charge? In this article, it will be taken into account the point of view of the psychiatrist in the grief after a patient's suicide.

El suicidio de un paciente. Impacto en el psiquiatra / [A patient’s suicide. The psychiatrist’s impact].

The clinical work of the psychiatrist often faces him to people who openly talk about their wish to die. However, although such thoughts did not culminate in most cases, unfortunately statistics show that suicide is a concrete possibility, more frequent than suspected. Globally, a million people die by suicide each year. The will to kill themselves is a complex phenomenon that is neither new nor modern. Suicide has crossed different times adopting different forms and meanings according to culture and history. As doctors, we tend to describe behaviors, in this case highly such a variable one, which involves various reasons and determinants. Thus, much has been written in the scientific literature about suicide in the causes, risk and protective factors, most vulnerable groups, etc. It has also been remarked the pain that the suicide causes in the family and close friends. Lots of articles propose psychotherapeutic and supporting measures for the suicide survivors to avoid the traumatic consequences of the experience. But, what about the psychiatrist? Isn’t him a person who has been in close contact with the subject who has killed himself? The survivor risk of having traumatic symptoms, does it not apply to the doctor who was in charge? In this article, it will be taken into account the point of view of the psychiatrist in the grief after a patient’s suicide.

Trastornos psiquiátricos del puerperio / [Postpartum psychiatric disorders].

The postpartum period represents a very particular time in women’s life, the beginning of a new bond, the maternity. As many times, beginnings are such turbulent, intense. In this period the women suffers deep changes in their hormonal status, with its body and changes and affective oscillations. Women are often so labile at this time, ranging from happiness to deep sadness. The vast majority suffers the blues, a benign form of mild depressive state. On the other hand, 20

may have a major depressive episode, and a much less percentage will suffer the most disruptive postpartum syndrome, the postpartum psychosis. In this paper it will be described the symptomatology of such cases, the most important treatment approaches and will focus on the clinical dilemma of using psychotropic medications during breastfeeding.

El suicidio de un paciente. Impacto en el psiquiatra. / [A patients suicide. The psychiatrists impact].

The clinical work of the psychiatrist often faces him to people who openly talk about their wish to die. However, although such thoughts did not culminate in most cases, unfortunately statistics show that suicide is a concrete possibility, more frequent than suspected. Globally, a million people die by suicide each year. The will to kill themselves is a complex phenomenon that is neither new nor modern. Suicide has crossed different times adopting different forms and meanings according to culture and history. As doctors, we tend to describe behaviors, in this case highly such a variable one, which involves various reasons and determinants. Thus, much has been written in the scientific literature about suicide in the causes, risk and protective factors, most vulnerable groups, etc. It has also been remarked the pain that the suicide causes in the family and close friends. Lots of articles propose psychotherapeutic and supporting measures for the suicide survivors to avoid the traumatic consequences of the experience. But, what about the psychiatrist? Isnt him a person who has been in close contact with the subject who has killed himself? The survivor risk of having traumatic symptoms, does it not apply to the doctor who was in charge? In this article, it will be taken into account the point of view of the psychiatrist in the grief after a patients suicide.

Trastornos psiquiátricos del puerperio. / [Postpartum psychiatric disorders].

The postpartum period represents a very particular time in womens life, the beginning of a new bond, the maternity. As many times, beginnings are such turbulent, intense. In this period the women suffers deep changes in their hormonal status, with its body and changes and affective oscillations. Women are often so labile at this time, ranging from happiness to deep sadness. The vast majority suffers the blues, a benign form of mild depressive state. On the other hand, 20

may have a major depressive episode, and a much less percentage will suffer the most disruptive postpartum syndrome, the postpartum psychosis. In this paper it will be described the symptomatology of such cases, the most important treatment approaches and will focus on the clinical dilemma of using psychotropic medications during breastfeeding.

Embarazo y depresión / Pregnancy and depression

La situación clínica que representa la coexistencia de un episodio depresivo en el transcurso de un embarazo en la vida de una mujer, reviste una gran complejidad y obliga al psiquiatra a evaluar múltiples variables. La alta prevalencia de depresión en las mujeres y la coincidencia temporal con la edad fértil, hace que dicha eventualidad no sea una rareza, sino más bien un escenario posible y frecuente. En este capítulo se describen las características clínicas de la depresión antenatal, se dan pautas de tratamiento teniendo en consideración los cambios farmacocinéticos del embarazo, se discute el dilema clínico sobre el uso de la medicación psicofarmacológica en la gestación y su posible impacto en el desarrollo obstétrico y en el neonato, y se dimensionan las consecuencias de la patología psiquiátrica no tratada. Se propone un abordaje racional sobre la correcta evaluación de los riesgos de la conducta a adoptar; es decir, la valoración del riesgo de la medicación en el embarazo, el riesgo de no medicar a una embarazada cuando la depresión lo amerita y el impacto de la patología psiquiátrica sobre la mujer, el embarazo en sí y el recién nacido.

The clinical situation representing the co-existence of a depressive episode during the course of a pregnancy in a woman's life is very complex and obliges the Psychiatrist to evaluate multiple variables. The high prevalence of depression among women, and the temporal coincidence with childbearing age makes this eventuality not strange, but rather a possible and frequent scenario. In this chapter, the author describes the clinical characteristics of antenatal depression, provides the treatment guidelines taking into consideration the pharmacokinetic changes of pregnancy, discusses the clinical dilemma on the use of psychopharmacological medication during conception and its possible impact on the obstetric development and the newly born, and measures the consequences of untreated psychiatric pathoogy. The author proposes a rational approach to the correct evaluation of the risks of the behavior to be adopted; that is to say, the assessment of the risk of the medication in pregnancy, the risk of not medicating a pregnant woman when depression calls for it, and the impact of the psychiatric pathology on the woman, the pregnancy itself and the newly born.

Embarazo y depresión / Pregnancy and depression

La situación clínica que representa la coexistencia de un episodio depresivo en el transcurso de un embarazo en la vida de una mujer, reviste una gran complejidad y obliga al psiquiatra a evaluar múltiples variables. La alta prevalencia de depresión en las mujeres y la coincidencia temporal con la edad fértil, hace que dicha eventualidad no sea una rareza, sino más bien un escenario posible y frecuente. En este capítulo se describen las características clínicas de la depresión antenatal, se dan pautas de tratamiento teniendo en consideración los cambios farmacocinéticos del embarazo, se discute el dilema clínico sobre el uso de la medicación psicofarmacológica en la gestación y su posible impacto en el desarrollo obstétrico y en el neonato, y se dimensionan las consecuencias de la patología psiquiátrica no tratada. Se propone un abordaje racional sobre la correcta evaluación de los riesgos de la conducta a adoptar; es decir, la valoración del riesgo de la medicación en el embarazo, el riesgo de no medicar a una embarazada cuando la depresión lo amerita y el impacto de la patología psiquiátrica sobre la mujer, el embarazo en sí y el recién nacido.(AU)

The clinical situation representing the co-existence of a depressive episode during the course of a pregnancy in a womans life is very complex and obliges the Psychiatrist to evaluate multiple variables. The high prevalence of depression among women, and the temporal coincidence with childbearing age makes this eventuality not strange, but rather a possible and frequent scenario. In this chapter, the author describes the clinical characteristics of antenatal depression, provides the treatment guidelines taking into consideration the pharmacokinetic changes of pregnancy, discusses the clinical dilemma on the use of psychopharmacological medication during conception and its possible impact on the obstetric development and the newly born, and measures the consequences of untreated psychiatric pathoogy. The author proposes a rational approach to the correct evaluation of the risks of the behavior to be adopted; that is to say, the assessment of the risk of the medication in pregnancy, the risk of not medicating a pregnant woman when depression calls for it, and the impact of the psychiatric pathology on the woman, the pregnancy itself and the newly born.(AU)

[How do Argentinean psychiatrists treat bipolar depression?]. / ¿Cómo tratan los psiquiatras argentinos la depresión bipolar?

We show the results of a survey on bipolar depression treatment using a sample of 359 argentine psychiatrists in the context of The National Psychiatry Congress that took place in the City of Buenos Aires, between September 26th and 29th, 2007. The objective was to study the attendant psychiatrists' prescribing habits in the treatment of bipolar depression. The discussion is based on the comparison between the answers and the recommendations taken from the main consensus, guidelines and from articles published by experts. The differences found point to the distance often present between guidelines and expert consensus series (based on patients meeting the strict criteria used in randomized controlled studies) on one hand, and a clinician's everyday real world practice, on the other hand.

[Haematological adverse effects caused by psychiatric drugs]. / Efectos adversos hematológicos de los psicofármacos.

Almost all clases of psychiatric drugs (typical and atypical antipsychotics, antidepressants, mood stabilizers, benzodiazepines) have been reported as possible causes of haematological toxicity. This is a review of the literature in which different clinical situations involving red blood cells, white blood cells, platelets and impaired coagulation are detailed and the drugs more frequently involved are listed. The haematological adverse reactions detailed here include: aplastic anemia, haemolitic anemia, leukopenia, agranulocytosis, leukocytosis, eosinophilia, thrombocytosis, thrombocytopenia, disordered platelet function and impaired coagulation. The haematologic toxicity profile of the drugs more frequently involved: lithium, clozapine, carbamazepine, valproic acid and SSRI antidepressants is mentioned.

[How do Argentinean psychiatrists treat depression?]. / ¿Cómo tratan los psiquiatras argentinos la depresión? Encuesta a una muestra de 402 psiquiatras acerca de sus hábitos prescriptivos para el tratamiento farmacológico.

OBJECTIVE: The objective of this study was to examine the prescribing practices of Argentinean psychiatrists in the treatment of major depression and to observe similarities and/or differences with some consensus or treatment guidelines. METHODOLOGY: Four hundred two psychiatrists were surveyed during a specialty meeting in October 2005. RESULTS: A total of 88.2 % of psychiatrists surveyed considered that every depressed patient must be treated with medication. The most prescribed antidepressants for outpatients were paroxetine, sertraline and fluoxetine. Venlafaxine was included for inpatients. The majority of psychiatrists indicated antidepressant therapy lasting from 12 to 24 months after remission of the first depressive episode. Antidepressant dosages remained unchanged during that period. A low percentage had used lithium or thyroid hormones as augmentation medications, the addition of other antidepressant being the most used augmentation strategy. The most prescribed antidepressant combination was dual antidepressants and SSRIs. Prescribing practices differed according to personal factors of the physicians. CONCLUSIONS: Discrepancies between clinical practice and treatment guidelines were observed. Further research over the underlying causes of these discrepancies and mechanisms to reduce them are necessary.

[Effects of psychiatric drugs on the fetus and newborn children. Consequences of the treatment of psychiatric disorders during pregnancy and lactation]. / Efectos de los psicofármacos en el feto y el recién nacido. Consecuencias del tratamiento de los trastornos psiquiátricos durante el embarazo y la lactancia.

The management of mental disorders during pregnancy and the postpartum period confronts the psychiatrist to a complex clinical situation. The cero risk utopia should be changed for a more realistic approach which considers the risks of having a conservative conduct (assuming the consequences of the untreated mental disorders) or making a psychopharmacological intervention knowing the expectable effects on the fetus and the offspring. The antidepressants and the conventional antipsychotics seem to be safe drugs in the first trimester of pregnancy. The benzodiazepines and the mood stabilizers are linked with the appearance of teratogenic malformations after the first trimester exposure. In the present article, the pharmacokinetic peculiarities of the pregnancy and the newborn and the general considerations of the psychopharmacological management of this kind of patients are described. At last, there is a review of the literature about the effects of the different groups of psychiatric drugs on the fetal growth, their passage to maternal milk and their impact on the newborn.

Efectos de los psicofármacos en el feto y el recién nacido. Consecuencias del tratamiento de los trastornos psiquiátricos durante el embarazo y la lactancia / [Effects of psychiatric drugs on the fetus and newborn children. Consequences of the treatment of psychiatric disorders during pregnancy and lactation]

The management of mental disorders during pregnancy and the postpartum period confronts the psychiatrist to a complex clinical situation. The cero risk utopia should be changed for a more realistic approach which considers the risks of having a conservative conduct (assuming the consequences of the untreated mental disorders) or making a psychopharmacological intervention knowing the expectable effects on the fetus and the offspring. The antidepressants and the conventional antipsychotics seem to be safe drugs in the first trimester of pregnancy. The benzodiazepines and the mood stabilizers are linked with the appearance of teratogenic malformations after the first trimester exposure. In the present article, the pharmacokinetic peculiarities of the pregnancy and the newborn and the general considerations of the psychopharmacological management of this kind of patients are described. At last, there is a review of the literature about the effects of the different groups of psychiatric drugs on the fetal growth, their passage to maternal milk and their impact on the newborn.

Efectos de los psicofármacos en el feto y el recién nacido. Consecuencias del tratamiento de los trastornos psiquiátricos durante el embarazo y la lactancia. / [Effects of psychiatric drugs on the fetus and newborn children. Consequences of the treatment of psychiatric disorders during pregnancy and lactation]

The management of mental disorders during pregnancy and the postpartum period confronts the psychiatrist to a complex clinical situation. The cero risk utopia should be changed for a more realistic approach which considers the risks of having a conservative conduct (assuming the consequences of the untreated mental disorders) or making a psychopharmacological intervention knowing the expectable effects on the fetus and the offspring. The antidepressants and the conventional antipsychotics seem to be safe drugs in the first trimester of pregnancy. The benzodiazepines and the mood stabilizers are linked with the appearance of teratogenic malformations after the first trimester exposure. In the present article, the pharmacokinetic peculiarities of the pregnancy and the newborn and the general considerations of the psychopharmacological management of this kind of patients are described. At last, there is a review of the literature about the effects of the different groups of psychiatric drugs on the fetal growth, their passage to maternal milk and their impact on the newborn.

[Pharmacological treatment of borderline personality disorder]. / Tratamiento farmacológico del trastorno límite de la personalidad.

Borderline personality disorder is characterised by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships and self image. Clinical signs of the disorder include emotional dysregulation, impulsive aggression, repeated self-injury, and chronic suicidal tendencies, which make these patients frequent users of mental health resources. The treatment of this kind of patients (very dependent, with a great tendency to overestimating the power of the drugs prescribed) must be organized over a psychotherapeutic strategy, which will help them to deal with their troublesome relationships. The psychopharmacological approach is useful but is limited, giving the borderline patients a symptomatic relief. When the affective symptoms are the target, drugs like the SSRI antidepressants are the best choice. If the patient presents a behavioural discontrol pattern, then the psychiatrist will prescribe an SSRI alone or with a mood stabilizer or an antipsychotic. Finally, if the patient has transient psychotic symptoms, then the temporary use of typical or atypical antipsychotics is the rule.