Neurologic comorbidity in psychiatric inpatients: evidence from neurologic consultations in a Spanish center. / Comorbilidad neurológica en pacientes psiquiátricos ingresados: evidencia sobre interconsultas de neurología en un centro español.

INTRODUCTION: The presence of psychiatric comorbidity in some neurological disorders is common. A bi-directional influence between some psychiatric and neurological disorders has been discussed, but not widely studied. There is an absence of literature on the typology and rates of neurology consultations in different types of psychiatric inpatients. MATERIALS AND METHODS: Cross-sectional study based on real world data on patients who had a neurological consultation during hospitalization on a psychiatric ward. RESULTS: The most frequent reasons for visits to neurologists in our study were cluster 'Epilepsy/other types of non-epileptic seizures' (n = 177, 36.44%), followed by cluster 'Movement disorders' (n = 77, 20.48%), 'Cognitive disorder' (n = 69, 18.35%), and finally cluster 'Neuropathy' (n = 21, 5.59%). The most frequent type of psychiatric patient who required neurologic consultation presented a psychotic disorder (n = 100, 26.60%), follow by problem behavior (n = 82, 21.81%), bipolar disorder (n = 78, 20.78%), depressive disorder (n = 42, 11.17%) and autism spectrum disorder (n = 20, 5.32%). We found a statistically significant relationship between (problem behavior and intellectual disability) and neurologic consultation for epilepsy/other types of non-epileptic seizures, and between (depressive disorder, bipolar disorder, autism spectrum disorder and intellectual disability) and neurologic consultation for movement disorders. CONCLUSIONS: This is the first study in the literature which analyzes the rates and typology of neurologic consultations in people hospitalized with psychiatric disorders. A deep knowledge of epilepsy, movement disorders and cognitive disorders should be required for health professionals to treat psychiatric inpatients appropriately. Patients with particular psychiatric disorders seem to require a higher number of neurologic consultations than others during their hospitalization.

TITLE: Comorbilidad neurológica en pacientes psiquiátricos ingresados: evidencia sobre interconsultas de neurología en un centro español.Introducción. La presencia de comorbilidad psiquiátrica en algunos trastornos neurológicos es frecuente. Se ha discutido sobre una influencia bidireccional entre algunos trastornos psiquiátricos y neurológicos, pero este hecho no se ha estudiado ampliamente. Existe escasa información en la bibliografía sobre la tipología y la prevalencia de las interconsultas de neurología en los diferentes tipos de pacientes psiquiátricos hospitalizados. Materiales y métodos. Estudio transversal basado en datos reales sobre pacientes que necesitaron una interconsulta de neurología durante su hospitalización en salud mental. Resultados. Los motivos más frecuentes que requirieron una interconsulta de neurología en nuestro estudio fueron el clúster 'Epilepsia/otros tipos de crisis no epilépticas' (n = 177; 36,44%), seguido del clúster 'Trastornos del movimiento' (n = 77; 20,48%), el clúster 'Trastorno cognitivo' (n = 69; 18,35%) y, por último, el clúster 'Neuropatía' (n = 21; 5,9%). El tipo más frecuente de paciente psiquiátrico que requirió consulta neurológica presentó un trastorno psicótico (n = 100; 26,6%), seguido de problemas de conducta (n = 82; 21,81%), trastorno bipolar (n = 78; 20,78%), trastorno depresivo (n = 42; 11,17%) y trastorno del espectro autista (n = 20; 5,32%). Se encontró una relación estadísticamente significativa entre problemas de conducta y discapacidad intelectual e interconsulta de neurología por epilepsia/otros tipos de crisis no epilépticas, y entre trastorno depresivo, trastorno bipolar, trastorno del espectro autista y discapacidad intelectual e interconsulta de neurología por trastornos del movimiento. Conclusiones. Éste es el primer estudio en la bibliografía que analiza la frecuencia y la tipología de las interconsultas de neurología en personas hospitalizadas con trastornos psiquiátricos. Debe requerirse a los profesionales que traten a pacientes de salud mental hospitalizados un conocimiento profundo en epilepsia, trastornos del movimiento y trastornos cognitivos. Algunos pacientes con determinados trastornos psiquiátricos parecen necesitar un mayor número de interconsultas de neurología que otros durante su hospitalización.

Antecedente de trastorno mental en la UCI e interconsulta a psiquiatría / History of mental disorder in an ICU and referrals to psychiatry

Objetivo Determinar la prevalencia de pacientes con trastorno mental (TM) ingresados en la UCI. Comparar las características clínicas según la presencia de antecedentes psiquiátricos. Revisar la pertinencia de las interconsultas realizadas a psiquiatría. Diseño Estudio descriptivo retrospectivo. Ámbito UCI del Hospital General del Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España. Pacientes Pacientes ingresados entre enero de 2016 y junio de 2018. Intervenciones Ninguna. Variables de interés principales Nivel de gravedad (APACHEII), motivo de ingreso, días de ingreso, días de ventilación mecánica, antecedentes psiquiátricos y motivo de interconsulta a psiquiatría. Resultados Se incluyeron 1.247 pacientes; 194 (15,5%) cumplían criterios de TM, siendo su media de edad más joven (59 vs 68, p<0,001) y con menor puntuación media en la escala APACHEII (12 vs 14, p≤0,003). Se realizaron 64 interconsultas a psiquiatría (5,1% de los ingresos), 59 de las cuales fueron en pacientes con TM (92,1%). En cuanto a los motivos de la interconsulta, el 22,6% fueron por intento autolítico, el 61,3% para ajuste farmacológico, el 11,3% para descartar TM y el 4,8% para valoración de competencia. La posibilidad de que se realizara una interconsulta estando indicada fue del 89,1%, mientras que la posibilidad de no realizarla no estando indicada fue del 99,4%. Conclusiones Este estudio respalda la necesidad de ampliar las recomendaciones específicas para realizar interconsulta a psiquiatría, más allá de la valoración tras intento autolítico, puesto que un gran porcentaje (77,5%) de las interconsultas pertinentes fueron por otros motivos (AU)

Objective To describe the prevalence of patients with mental disorders (MD) admitted to the ICU. To compare the clinical characteristics according to the presence of psychiatric history. To review the relevance of the consultations made to Psychiatry. Design Retrospective descriptive study. Setting ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. Patients Patients admitted between January 2016 and June 2018. Interventions None. Main variables of interest Severity level (APACHEII), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. Results A total of 1,247 patients were included; 194 (15.5%) met MD criteria, their mean age being younger (59 vs 68, P<.001) and with a lower mean score on the APACHEII scale (12 vs 14, P≤.003). There were 64 consultations to Psychiatry (5.1% of admissions), 59 of which were in patients with TM (92.1%). Regarding the reasons for the consultation, 22.6% were for attempted suicide, 61.3% for pharmacological adjustment, 11.3% to rule out mental disorder, and 4.8% for competence assessment. The probability of a consultation being carried out while it was indicated was 89.1%, while the probability of not carrying it out when it was not indicated was 99.4%. Conclusions This study supports the need to expand the specific recommendations for consultation to Psychiatry, beyond the assessment after a suicide attempt, since a large percentage (77.5%) of the pertinent consultations were for other reasons (AU)

History of mental disorder in an ICU and referrals to psychiatry.

OBJECTIVE: To describe the prevalence of patients with mental disorders (MD) admitted to the ICU. To compare the clinical characteristics according to the presence of psychiatric history. To review the relevance of the consultations made to Psychiatry. DESIGN: Retrospective descriptive study. SETTING: ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. PATIENTS: Patients admitted between January 2016 and June 2018. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Severity level (APACHE II), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. RESULTS: A total of 1,247 patients were included; 194 (15.5%) met MD criteria, their mean age being younger (59 vs 68, P < .001) and with a lower mean score on the APACHE II scale (12 vs 14, P ≤ .003). There were 64 consultations to Psychiatry (5.1% of admissions), 59 of which were in patients with TM (92.1%). Regarding the reasons for the consultation, 22.6% were for attempted suicide, 61.3% for pharmacological adjustment, 11.3% to rule out mental disorder, and 4.8% for competence assessment. The probability of a consultation being carried out while it was indicated was 89.1%, while the probability of not carrying it out when it was not indicated was 99.4%. CONCLUSIONS: This study supports the need to expand the specific recommendations for consultation to Psychiatry, beyond the assessment after a suicide attempt, since a large percentage (77.5%) of the pertinent consultations were for other reasons.

History of mental disorder in an ICU and referrals to psychiatry. / Antecedente de trastorno mental en la UCI e interconsulta a psiquiatría.

OBJECTIVE: To describe the prevalence of patients with mental disorders (MD) admitted to the ICU. To compare the clinical characteristics according to the presence of psychiatric history. To review the relevance of the consultations made to Psychiatry. DESIGN: Retrospective descriptive study. SETTING: ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. PATIENTS: Patients admitted between January 2016 and June 2018. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Severity level (APACHEII), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. RESULTS: A total of 1,247 patients were included; 194 (15.5%) met MD criteria, their mean age being younger (59 vs 68, P<.001) and with a lower mean score on the APACHEII scale (12 vs 14, P≤.003). There were 64 consultations to Psychiatry (5.1% of admissions), 59 of which were in patients with TM (92.1%). Regarding the reasons for the consultation, 22.6% were for attempted suicide, 61.3% for pharmacological adjustment, 11.3% to rule out mental disorder, and 4.8% for competence assessment. The probability of a consultation being carried out while it was indicated was 89.1%, while the probability of not carrying it out when it was not indicated was 99.4%. CONCLUSIONS: This study supports the need to expand the specific recommendations for consultation to Psychiatry, beyond the assessment after a suicide attempt, since a large percentage (77.5%) of the pertinent consultations were for other reasons.

Barriers and opportunities for the treatment of mild-to-moderate depression with a watchful waiting approach.

OBJECTIVE: The aim of this study is to explore barriers and opportunities in non-pharmacological treatment of depression in primary care (PC) from the perspective of family physicians (FPs). METHODS: Qualitative analysis was used to explore a sample of 36 FPs treating patients with depressive symptoms. Criteria to maximize variability were followed. Participants were identified by key informants. Six group interviews were developed following a semi-structured thematic script. All interviews were transcribed, analyzed and triangulated. Information was saturated. Principals of reflexivity and circularity were implemented. RESULTS: The results obtained followed 3 main theoretical axes: the FP, the patient, the healthcare system, and the interaction between them. Barriers included poor alignment with clinical practice guidelines, inadequate FP training, patients' preferences and structural challenges in PC. Among opportunities were good FP clinical interview skills, the beneficial bond of trust between patients and FPs and improved communication with mental healthcare services. CONCLUSION: Based on FPs' perceptions, non-pharmacological treatment of depression in PC is particularly limited by lack of structured training; patients' preferences and treatment expectations; structural challenges in PC; and insufficient support from specialized mental health professionals. PRACTICE IMPLICATIONS: Resources for education, structural support in PC and modified back up from mental healthcare services are needed.

Effectiveness of watchful waiting versus antidepressants for patients diagnosed of mild to moderate depression in primary care: A 12-month pragmatic clinical trial (INFAP study).

BACKGROUND: Although mild to moderate major depressive disorder (MDD) is one of the main reasons for consulting a general practitioner (GP), there is still no international consensus on the most appropriate therapeutic approach. METHODS: The aim of this study is to evaluate the clinical effectiveness of watchful waiting (WW) compared with the use of antidepressants (ADs) for the treatment of mild to moderate depressive symptoms in 263 primary care (PC) usual-practice patients in a 12-month pragmatic non-randomised controlled trial. Both longitudinal and per-protocol analyses were performed, through a multilevel longitudinal analysis and a sensitivity analysis. RESULTS: We observed a statistically significant time x treatment interaction in the severity of depression (Patient Health Questionnaire, PHQ-9) and disability (World Health Organization Disability Assessment Schedule, WHODAS) in favour of the AD group at 6 months but not at 12 months. The effect size of this difference was small. No statistically significant differences were observed between groups in severity of anxiety (Beck Anxiety Inventory, BAI) or health-related quality-of-life (EuroQol-5D, EQ-5D). Sensitivity analysis and per-protocol analysis showed no differences between the two groups in any of the evaluated scales. CONCLUSIONS: Superiority of either treatment (WW and AD) was not demonstrated in patients treated for depression in PC after one year of follow-up.

Once-monthly paliperidone palmitate in recently diagnosed and chronic non-acute patients with schizophrenia.

OBJECTIVE: To explore the treatment response, tolerability and safety of once-monthly paliperidone palmitate (PP1M) in non-acute patients switched from oral antipsychotics, stratified by time since diagnosis as recently diagnosed (≤3 years) or chronic patients (>3 years). RESEARCH DESIGN AND METHODS: Post hoc analysis of a prospective, interventional, single-arm, multicentre, open-label, 6-month study performed in 233 recently diagnosed and 360 chronic patients. MAIN OUTCOME MEASURES: The proportion achieving treatment response (defined as ≥20% improvement in Positive and Negative Syndrome Scale [PANSS] total score from baseline to endpoint) and maintained efficacy (defined as non-inferiority in the change in PANSS total score at endpoint [Schuirmann's test]). RESULTS: 71.4% of recently diagnosed and 59.2% of chronic patients showed a ≥20% decrease in PANSS total score (p = 0.0028 between groups). Changes in PANSS Marder factors, PANSS subscales, and the proportion of patients with a Personal and Social Performance scale (PSP) total score of 71-100 were significantly greater in recently diagnosed compared with chronic patients. PP1M was well tolerated, presenting no unexpected safety findings. CONCLUSION: These data show that recently diagnosed patients treated with PP1M had a significantly higher treatment response and improved functioning, as assessed by the PSP total score, than chronic patients.

Impact of the mass media OBERTAMENT campaign on the levels of stigma among the population of Catalonia, Spain.

Reducing public stigma could improve patients' access to care, recovery and social integration. The aim of the study was to evaluate a mass media intervention, which aimed to reduce the mental health, related stigma among the general population in Catalonia (Spain). We conducted a cross-sectional population-based survey of a representative sample of the Catalan non-institutionalized adult population (n=1019). We assessed campaign awareness, attitudes to people with mental illness (CAMI) and intended behaviour (RIBS). To evaluate the association between campaign awareness and stigma, multivariable regression models were used. Over 20% of respondents recognized the campaign when prompted, and 11% when unprompted. Campaign aware individuals had better attitudes on the benevolence subscale of the CAMI than unaware individuals (P=0.009). No significant differences in authoritarianism and support for community mental health care attitudes subscales were observed. The campaign aware group had better intended behaviour than the unaware group (P<0.01). The OBERTAMENT anti-stigma campaign had a positive impact to improve the attitudes and intended behaviour towards people with mental illness of the Catalan population. The impact on stigma was limited to attitudes related to benevolence. A wider range of anti-stigma messages could produce a stronger impact on attitudes and intended behaviour.

Use of an integrated Atlas of Mental Health Care for evidence informed policy in Catalonia (Spain).

BACKGROUND: This paper aims to present the Integrated Atlas of Mental Health of Catalonia (2010) focusing on: (a) the importance of using a taxonomy-based coding and standard system of data collection when assessing health services; and (b) its relevance as a tool for evidence-informed policy. METHOD: This study maps all the care-related services for people with mental disorders available in Catalonia in 2010, using the 'Description and Evaluation of Services and Directories in Europe for long-term care' (DESDE-LTC). The unit of analysis is the Basic Stable Input of Care (BSIC), which is the minimal organisation unit composed by a set of inputs with temporal stability. We presented data on: (a) availability of BSICs and their capacity; (b) the adequacy of the provision of care, taking into account availability and accessibility; (c) the evolution of BSCIs from 2002 to 2010; and (d) the perceived relevance of Atlas of Mental Health as a tool for evidence-informed policy. RESULTS: We identified a total of 639 BSICs. A lack of Health services was detected in highly rural areas, although there was moderate availability of Social Services. Overall, more than 80% of the small mental health areas in Catalonia had an adequate core mental health service. Since 2002 the availability of mental health services has increased. Decision makers found the Atlas a useful and relevant tool for evidence informed policy. CONCLUSIONS: Policy makers can use Atlases to detect gaps and inequities in the provision of care for people with mental health needs.

Brain dysfunction in fibromyalgia and somatization disorder using proton magnetic resonance spectroscopy: a controlled study.

OBJECTIVE: To evaluate the brain metabolite patterns in patients with fibromyalgia (FM) and somatization disorder (STD) compared with healthy controls through spectroscopy techniques and correlate these patterns with psychological variables. METHOD: Design. Controlled, cross-sectional study. Sample. Patients were recruited from primary care in Zaragoza, Spain. The control group was recruited from hospital staff. Patients were administered questionnaires on pain catastrophizing, anxiety, depression, pain, quality of life, and cognitive impairment. All patients underwent Magnetic Resonance Imaging and magnetic resonance spectroscopy (MRS). RESULTS: A significant increase was found in the glutamate + glutamine (Glx) levels in the posterior cingulate cortex (PCC): 10.73 (SD: 0.49) for FM and 9.67 (SD: 1.10) for STD 9.54 (SD: 1.46) compared with controls (P = 0.043). In the FM + STD group, a correlation between Glx and pain catastrophizing in PCC (r = 0.397; P = 0.033) and between quality of life and the myo-inositol/creatine ratio in the left hippocampus (r = -0.500; P = 0.025) was found. To conclude Glutamate seems to be relevant in the molecular processes involved in FM and STD. It also opens the door for Proton MRS ((1) H-MRS) in STD and suggests that reducing glutamatergic activity through pharmacological treatment could improve the outcome of patients with FM and STD. CONCLUSION: Glutamate seems to be relevant in the molecular processes involved in FM and STD. It also opens the door for Proton MRS ((1) H-MRS) in STD and suggests that reducing glutamatergic activity through pharmacological treatment could improve the outcome of patients with FM and STD.

[Psychotropic medications use in Spain. Results of the ESEMeD-Spain study]. / Uso de fármacos psicotrópicos en España. Resultados del estudio ESEMeD-España.

INTRODUCTION: Psychotropic drugs are frequently used in the population and account for a big share of the Spanish health budget. This study aims to describe the patterns of use of psychotropic drugs in the Spanish general population and its relationship with mental health. METHODS: A stratified, multistage, clustered area, probability sample design was used and 5,473 non-institutionalized individuals older than 18 were randomly selected among the Spanish population. They were administered the Spanish version of the World Health Organization- Composite International Diagnostic Interview (CIDI 3.0). Information on previous 12-months psychiatric symptoms and psychotropic drugs use was obtained. The proportion of individuals using psychotropic drugs was estimated and stratified according mental health diagnosis. Multivariate analyses were carried out in order to assess the influence of sociodemographic factors on use. RESULTS: 16% of the sample had used some psychotropic drug. Benzodiacepines (11.4 %) and antidepressants (4.7%) were the most commonly used and the most common combination (1.8%). Women showed the highest use of any drug (odds ratio [OR]: 2.1; 95 confidence interval [CI]: 1.7-2.5), benzodiacepines (OR: 2.3; 95 CI: 1.9-2.8), antidepressants (OR: 2.2; 95 CI: 1.6-3.1) and antipsychotics (OR: 1.9; 95 CI: 1.2-3.0). The odds of use did increase with age, and was related with the presence and number of mental disorders. CONCLUSIONS: Use of psychotropic drugs in the Spanish general population is high, although many individuals with mental disorders remain untreated. Gender and age showed an association with psychotropic drug use independent of mental health.

Cost-utility of selective serotonin reuptake inhibitors for depression in primary care in Catalonia.

OBJECTIVE: To determine the cost-utility of selective serotonin reuptake inhibitors (SSRIs) for treating depressive disorders prescribed in primary care (PC). METHOD: A total of 301 participants beginning antidepressant treatment with an SSRI were enrolled in a prospective 6-month follow-up naturalistic study. Incremental cost-utility ratios (ICUR) were obtained for several comparisons among different SSRIs. To address uncertainty in the ICUR's sampling distribution, non-parametric bootstrapping was carried out. RESULTS: Taking into account adjusted total costs and incremental quality of life gained, fluoxetine dominated paroxetine and citalopram with 63.4% and 79.3% of the bootstrap replications in the dominance quadrant, respectively. Additionally, fluoxetine was cost-effective over sertraline with 83.4% of the bootstrap replications below the threshold of 33,936 US$/quality-adjusted life year (30,000 euro/QALY). CONCLUSION: Fluoxetine seems to be a better cost-utility SSRI option for treating depressive disorders in PC.

Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: a six-month randomised study comparing fluoxetine to imipramine.

BACKGROUND: Over the past decade, studies of the effectiveness of pharmacological treatment for depression have often been based on research designs intended to measure efficacy, and for this reason the results are of limited generalizability. Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice. METHODS: A six-month randomised prospective naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres. Outcome measures were the Montgomery Asberg Depression Rating Scale (MADRS), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and at one, three and six months thereafter. RESULTS: Of the 103 patients, 38.8% (n = 40) were diagnosed with major depressive disorder, 14.6% (n = 15) with dysthymic disorder, and 46.6% (n = 48) with depressive disorder not otherwise specified. Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups (mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine). For patients with major depressive disorder and dysthymic disorder, the imipramine group had fewer treatment-associated costs (imipramine 469.66 Euro versus fluoxetine 1,585.93 Euro in major depressive disorder, p < 0.05; imipramine 175.39 Euro versus fluoxetine 2,929.36 Euro in dysthymic disorder, p < 0.05). The group with depressive disorder not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups. LIMITATIONS: Exclusion criteria, participating physicians may not represent GPs. CONCLUSIONS: In a primary care context, imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder. There were no differences in cost-effectiveness in the treatment of depressive disorder not otherwise specified.

[How do we refer to mental health from primary care?]. / ¿Cómo derivamos a salud mental desde atención primaria?

OBJECTIVES: To describe referrals from primary care (PC) to mental health (MH) and to study the diagnostic and therapeutic concordance between the two. DESIGN: Retrospective, descriptive study. SETTING: Gavà II Primary Care Centre, Barcelona.Participants. All patients referred to MH in 1998, 1999 and 2000 (n=380). MAIN MEASUREMENTS: The following from the referral form and PC medical records were analysed: general diagnosis, drugs treatment, number of words in the report, and purpose of referral; and on the first visit to MH: general diagnosis and drugs treatment. The kappa index was used to analyse the concordance between the diagnostic and therapeutic groups. RESULTS: There were 380 referrals, 63.4% of which were women. Information was obtained from the referral form in 81.6% of cases. In 50.7% the reason for referral was for the case to be supervised; and in 12.4% the reason was not recorded. 18.7% (71 cases) did not attend their first MH appointment and waited an average of 78 days (SD=70.9) until the appointment. As 92 cases were lost (71 who did not attend and 21 for whom insufficient information was obtained), only 288 cases were analysed.The greatest diagnostic concordance between PC and MH was in mental deficiency (kappa=0.85) and psychotic disorder (kappa=0.77); and the minimum was in anxiety-depressive disorder (kappa=0.24). The maximum degree of therapeutic concordance was for neuroleptic drugs (kappa=0.66). CONCLUSIONS: The diagnostic and therapeutic concordance between PC and MH is weak. The referral sheet is not present in a great many cases. The waiting-time until the first consultation may explain patient absenteeism.

¿Cómo derivamos a salud mental desde atención primaria? / How do we refer to mental health from primary care?

Objetivo. Describir las derivaciones desde atención primaria (AP) a salud mental (SM) y estudiar la concordancia diagnóstica y terapéutica entre los dos niveles. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Centro de Asistencia Primaria Gavà II (Barcelona).Participantes. Todos los pacientes derivados a SM en 1998, 1999 y 2000 (n = 380).Mediciones principales. En la hoja de derivación y en la historia clínica de AP se analizó: orientación diagnóstica, tratamiento farmacológico, número de palabras del informe, objetivo de la derivación; en primera visita a SM: orientación diagnóstica y tratamiento farmacológico. Para el análisis de concordancia de los grupos diagnósticos y terapéuticos se utilizó el índice de kappa. Resultados. Se realizaron 380 derivaciones; en el 63,4 por ciento de los casos se trataba de mujeres. En el 81,6 por ciento la información se obtuvo del informe de derivación. En el 50,7 por ciento el motivo de la derivación era supervisión del caso y en un 12,4 por ciento no constaba el motivo. El 18,7 por ciento (71 casos) no acude a la primera visita de SM y espera una media de ñ DE 78 ñ 70,9 días para esta visita. Se perdieron 92 casos (71 que no acudieron y 21 de los que no se obtuvo suficiente información), por lo que únicamente se analizaron 288 casos.La concordancia diagnóstica máxima entre AP y SM es en retraso mental (kappa = 0,85) y trastorno psicótico (kappa = 0,77), y la mínima en trastorno ansiosodepresivo (kappa = 0,24). El grado máximo de concordancia terapéutica es para fármacos neurolépticos (kappa = 0,66). Conclusiones. La concordancia diagnóstica y terapéutica entre AP y SM es débil. La hoja de derivación no está presente en un elevado número de casos. El tiempo de espera para la primera visita podría explicar el absentismo de los pacientes (AU)