Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries.

BACKGROUND: Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. METHODS: The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. RESULTS: We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. CONCLUSIONS: We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

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.

[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)

Retention of Leishmania (Leishmania) mexicana in naturally infected rodents from the State of Campeche, Mexico.

In the State of Campeche, Mexico, zoonotic cutaneous leishmaniasis is mainly due to Leishmania (L.) mexicana. The parasite population is maintained in a mammalian species, a reservoir in which the ideal course of infection should be long and relatively nonpathogenic. The objective of the present study was to document the retention of L. (L.) mexicana in 29 naturally infected rodents. These cricetids lived in captivity for up to two years and were tested monthly for the presence of the parasite, by cultures of needle aspirates from the base of the tail. Peromyscus yucatanicus and Ototylomys phyllotis were incriminated as the primary reservoir hosts. The finding that the multiplication of parasites in P. yucatanicus might be triggered by temperature, suggests that this animal would be a good choice for further research on L. (L.) mexicana.

Adherence-dependent calcium signaling in monocytes: induction of a CD14-high phenotype, stimulus-responsive subpopulation.

Isolation of monocytes by plastic adherence alters cell morphology and function. In order to study the effects of cell isolation procedures and subsequent culture on monocyte function, we examined cytoplasmic calcium concentration changes (delta[Ca2+]in) in human monocytes isolated by either negative (magnetic bead) or positive (plastic adherence) selection then stimulated with formyl-Met-Leu-Phe (fMLP), either immediately after isolation, or after 48 h in culture. We have previously shown that fresh adherence-isolated monocytes respond to fMLP with small delta[Ca2+]in and oxidative burst responses, exhibiting larger responses following 48 h of incubation. We now demonstrate that fresh monocytes, prevented from adhering by negative selection, exhibit an even smaller fMLP-induced delta[Ca2+]in, which does not increase during 48 h in culture if cells are kept nonadherent, in Teflon. Calcium responses of adherent, fresh monocytes do not increase if cells are subsequently placed into suspension and maintained nonadherent, but increase if nonadherent cells are permitted to adhere to plastic. Furthermore, augmented fMLP-[Ca2+]in and oxidative burst responses in plastic-adherent cells are restricted to a CD14-high phenotype subpopulation. The CD14-high phenotype also describes a subpopulation of cells that responds to CD4 crosslinking with a rapid delta[Ca2+]in. Induction of a subpopulation of CD14-high expressing cells by adherence may explain in part maturation-induced response changes observed in macrophage but not in monocyte in vitro systems.

[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.

Chemotactic peptide-induced cytoplasmic pH changes in incubated human monocytes.

Stimulation of phagocytic leukocytes with chemotactic factors results in transient acidification, followed by alkalinization of the cytosol. Human monocytes are known to alter their functional responses to the chemotactic peptide N-formylmethionyl-leucyl-phenylalanine (fMLP) in a complex fashion as they mature in vitro to macrophages. To examine the evolution of the cytoplasmic pH (pHi) response of monocytes to fMLP as they mature into macrophages, we incubated cells for 0, 24, 48, and 96 h (Medium-199 + 10% fetal bovine serum; 37 degrees C) and examined pHi using the fluorescent probe 2',7'-bis(carboxyethyl)-5(6)-carboxyfluorescein (BCECF; 1 microM) and a Perkin-Elmer 650/10 spectrofluorimeter (lambda em = 530 nm, lambda ex = 500, 450 nm) as previously described. The resting pHi of fresh (0 h) monocytes was 7.07 +/- 0.16 (SD) and was unchanged after incubation for 24, 48, or 96 h (7.09, 7.11, 7.05, respectively). Cells exhibited an fMLP dose-dependent cytoplasmic acidification, with maximal delta pHi occurring 30-60 s after exposure to 10(-7) M fMLP. The response to fMLP did not change with the duration of incubation and, as with neutrophils, cytoplasmic realkalinization was blocked by dimethylamiloride (20 microM). Incubation with 2-deoxyglucose (10 min, 5 mM), sufficient to inhibit by more than 90% the formyl peptide-stimulated superoxide generation by monocytes, slowed fMLP-induced acidification and abrogated the alkalinization. In addition, monocytes isolated from the blood of a patient with X-linked chronic granulomatous disease (CGD) underwent fMLP-induced acidification that was unmasked further by coincubation with dimethylamiloride, in a manner quantitatively similar to that of normal monocytes, despite the inability of the CGD cells to produce superoxide. The chemotactic factor-induced cytoplasmic pH responses of monocytes/macrophages remained constant as the cells matured in vitro and exhibited a dimethylamiloride-independent acidification and dependent alkalinization, as did the response in neutrophils. The cytoplasmic acidification of these cells thus did not correlate with the cells' production of superoxide and with the concomitant hexose monophosphate shunt activation, as has been suggested for other leukocyte types.

[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.