Development and content validity of EVAD: A novel tool for evaluating and classifying the severity of adverse events for psychotherapeutic clinical trials.

OBJECTIVE: Develop and obtain content validity of a new tool for Evaluating and Classifying the Severity of Adverse Events for Psychotherapeutic Clinical Trials (EVAD). METHOD: Study of the development process of EVAD in four stages: (1) identify the domain and concept definition through a literature review, (2) instrument design, (3) expert judgment of the EVAD items through Gwent's concordance coefficient, and (4) applicability. RESULTS: In the absence of a consistent conceptual framework of adverse events in psychotherapeutic clinical trials, we have developed a framework and defined it. We have designed EVAD items and their complementary tool for rating adverse events. Content validation by expert judges resulted in CVR = 1.0 for each item and CVI = 0.79 in sufficiency, 0.76 in clarity, 0.91 in coherence and 0.95 in relevance for all items (p < 0.001). Final version of EVAD were applied to three participants for 7 weeks. Overall EVAD seems to be clear and meaningful for participants. CONCLUSIONS: EVAD is a semistructured interview based on a consistent conceptual framework, and proven content validity following the most important guidelines described in the literature. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03878186.

Changes in Attitudes toward People with Substance Use Disorder: A Comparative Study of the General Population in Mexico.

BACKGROUND: Substance use disorders are among the most stigmatized conditions worldwide. People with substance use disorder (PWSUD) are often considered responsible for their use of drugs. The objectives are to analyze changes in Mexican attitudes toward PWSUD in the general population over the period 2011 to 2016 and to use the latest Mexican household survey to determine which segments of the population are most likely to have negative attitudes. METHODS: Two representative national household surveys employing similar methodologies were conducted in Mexico in 2011 and 2016 with persons aged 12-65 years. Participants were asked about their attitudes toward PWSUD, and changes were compared across GLM. RESULTS: The surveys found a decrease from 2011 to 2016 in the number of respondents who considered PWSUD "sick" or in "need of help" and an increase in the number who believed they were "selfish" or "criminal". The 2016 survey found that men, people 18 years of age or older, people who do not use drugs and people with lower educational levels were the groups with the most negative attitudes toward PWSUD. CONCLUSIONS: These results suggest that it may not be recognized that PWSUD may have a health problem and that this helps to increase stigmatization towards this population.

Changes After Emergency Assessment of Suicidal Patients: An Unexpected Outcome.

INTRODUCTION: Acute Suicide Risk (ASR) is widely evaluated at Emergency Departments (ED). Little is known about follow-up of ASR after psychiatric ED evaluation, and if there are differences within No ASR (NASR) counterparts at baseline and afterwards. METHOD: We developed a naturalistic, 3-month follow-up study of adult patients from a psychiatric ED in Mexico City. Depressive patients who asked voluntarily for an emergency consultation from July 1 to December 1, 2014, were included. We compared depression severity, suicidal ideation, adherence to treatment, and perceived social support scales both in ASR and NASR participants at baseline and follow-up interviews. RESULTS: Participants (n = 120) were divided into ASR or NASR groups (n = 60 each). The ASR group obtained more negative scores in all scales at baseline evaluation. After three months, 85% (n = 51) of ASR and 75% (n = 45) of NASR completed the second interview. 5.21% (n = 3) of participants showed new suicidal behavior. At follow-up, the ASR group showed a higher relative response in depression scales and treatment adherence (p = 0.036), and lower scores in suicidal ideation scales than NASR group (p = 0.012). Perceived support from family was significantly higher in the NASR group (p = 0.016). DISCUSSION: These relative higher responses in clinical scales suggest a paradoxical advantage of ASR over NASR patients, suggesting a hypothetical phenomenon similar to "The Tortoise and the Hare" effect. However, it is not applicable for all ASR patients. Results suggest suicidal patients experience stigma from their families. Further research and public health programs for ASR at ED should be implemented.

Reaction to Severe Stress and Adjustment Disorders After the September 2017 Earthquakes in a Psychiatric Emergency Department in Mexico City.

OBJECTIVE: Earthquakes may lead to a reaction to severe stress and adjustment disorders (RSSAD). On September 7, 19, and 23, 2017, Mexico was struck by many severe earthquakes. The aim of this study was to examine whether there was an increase in the number of consultations and RSSAD in a psychiatric emergency department in Mexico City after these earthquakes. METHODS: We studied retrospectively the diagnosis and triage assessment from a Mexican psychiatric emergency department database from September 1 to November 30, 2017, and analyzed RSSAD and the number of consultations after the earthquakes. RESULTS: A total of 1,811 psychiatric emergency consultations were registered from the period of study. A total of 141 consultations represented RSSAD. There was a significant increase of RSSAD after the September 23, 2017, earthquake. The triage assessment revealed that the urgency of the consultations was higher immediately after the earthquakes. CONCLUSION: Natural disasters, such as earthquakes, may trigger diverse RSSAD leading to increased emergency consultations, especially when those disasters are repetitive. Mental health professionals should be adequately trained and sensitized for possible acute disaster victims. (Disaster Med Public Health Preparedness. 2019;13:686-690).

Validity and reliability of a novel Color-Risk Psychiatric Triage in a psychiatric emergency department.

BACKGROUND: Classification of Psychiatric Emergency Presentations (PEP) is not sufficiently clear due to their inherent high inter-subjectivity and lack of validated triage instruments. In order to improve current classification of psychiatric emergency presentations (PEP) at Emergency Departments, we implemented and validated the Color-Risk Psychiatric Triage (CRPT), an instrument for classifying PEP risk by sorting one to five color/risk levels and one to thirty-two possible conditions arranged by risk. METHODS: Users who visited the Emergency Department (ED) of a Mexican psychiatric hospital from Dec 1st, 2008 to Dec 1st, 2009 were included. One CRPT was assessed by an ED psychiatrist to each patient upon their arrival to ED. Some patients were randomly assessed simultaneously with an additional CRPT and a Crisis and Triage Rating Scale (CTRS) to test validity and reliability of the CRPT. RESULTS: A total of 7,631 CRPT assessments were included. The majority of PEP were non-urgent (74.28 %). For the validation phase n = 158 patients were included. CRPT score showed higher concurrent validity than CRPT color/risk. CRPT level/risk and score showed highest concurrent validity within dangerousness domain of CTRS (r = 0.703, p < 0.0001). CRPT and CTRS scores showed similar predictive validity (p < 0.0001). High intraclass correlation coefficient (0.982) and Cohen's Kappa (0.89) were observed for CRPT score (r = 0.982, p < 0.0001). CONCLUSIONS: CRPT appeared to be a useful instrument for PEP classification due to its concurrent validity, predictive validity and reliability. CRPT score showed higher correlations than the CRPT color/risk. The five levels of risk provided by the CRPT appear to represent a simple and specific method for classifying PEP. This approach considers actual or potential risk, rather than severity, as the main factor for sorting PEP, which improves upon the current approach to emergency classification that is mainly based on the criterion of severity. Regardless of the triage procedure, emergency assessments should no longer classify PEP as "not real emergencies."

Medidas generales de evacuación de enfermos mentales hospitalizados en situaciones de desastres. Revisión de la bibliografía y sugerencias / General evacuation measures in disaster situations for hospitalized mental patients. Literature review and suggestions

Alrededor del mundo, los desastres naturales y los provocados por el hombre causan la migración de grandes grupos humanos, trastornos mentales como el estrés postraumático y pérdidas económicas. Así, se ha calculado que cada año ocurren 1 30 desastres de diferente naturaleza en las Américas y que el 67% de los hospitales o clínicas están en zonas de alto riesgo. Por tal motivo, la Organización Mundial de la Salud considera que la prevención de los desastres, la reducción del riesgo, los preparativos y la recuperación son actividades que forman parte de un ciclo continuo por lo que ha desarrollado el programa de "Hospital Seguro" y el "Índice de Seguridad Hospitalaria" que son herramientas para evaluar la funcionalidad hospitalaria y la probabilidad de continuar en funcionamiento en casos de desastre. El presente artículo hace una revisión breve y práctica de la bibliografía sobre las medidas generales para la evacuación de los enfermos mentales de un hospital psiquiátrico ya que es una población altamente vulnerable por causas intrínsecas y extrínsecas a la enfermedad mental. Estas medidas incluyen: el momento adecuado para tomar la decisión de evacuarlo, la forma de hacerlo, seleccionar a los pacientes que requieren una evacuación inmediata, evaluar el tratamiento antes y durante el siniestro así como el abastecimiento de los medicamentos, quiénes serán los responsables de la evacuación y el lugar donde serán trasladados tomando en cuenta el tiempo que durará la catástrofe; la identificación de los pacientes y la información que se deberá dar a sus familiares, así como la supervisión de la vida en los albergues y su retorno cuando culmine el evento catastrófico. Finalmente sugiere algunos elementos a tomar en cuenta para la prevención y acciones para evacuar un hospital psiquiátrico ante dichas situaciones las cuales no son exclusivas para esta población sino que también pueden aplicarse a otras poblaciones vulnerables como niños y ancianos.

Around the world, natural and man-provoked disasters cause the migration of big human groups, mental disorders -such as post-traumatic stress disorder-, and economic losses. It has been estimated that each year 130 disasters of different nature occur in the Americas and that 67% of the hospitals and clinics are located in high risk areas. For this reason, the World Health Organization considers that disaster prevention, risk reduction, preparations, and recovery are activities which form a continuous cycle. In the light of this, it has developed the "Safe Hospital" program and the "Hospital Safety Index", two tools to evaluate the functionality of hospitals and the probability that they continue working in the case of disaster. This paper makes a brief practical review of the general evacuation measures for the mental patients of a psychiatric hospital as this is a highly vulnerable population given to causes which are intrinsic and extrinsic to mental illness. These measures include: the right moment to make the decision to evacuate a psychiatric hospital, the way to carry this out, evaluating patients requiring an immediate evacuation, evaluating pre- and post-sinister treatment, medical drugs supply, who will be responsible for the evacuation, the place where patients will be transferred taking into account the duration of the catastrophe, patients identification, the information which will be provided to relatives, the supervision of life in the shelters, and patients return at the end of the catastrophe. Finally, the paper suggests some elements to be considered for prevention, as well as some actions to evacuate a psychiatric hospital in the face of disaster situations. These are not exclusive for this population for they can be applied to other vulnerable groups, such as children and the elderly.