How is evaluated mental health recovery?: A systematic review.

There is an increasingly recognition of the concept of personal recovery in the treatment of mental illness. Recovery defined as living a fulfilling, rewarding life, even in the ongoing presence of a mental illness. Consequently, a number of different instruments have been designed to assess recovery-oriented outcomes. The objective of the study was to conduct a systematic revision of the domains and the instruments used to assess personal recovery and mental health services orientation to recovery. After the systematic review, it has been carried out a selection process of the most adequate instruments taking into account different criteria of adequacy, psychometric properties and the validation to the Spanish population. In the results have been obtained 35 instruments for measuring personal recovery and 18 for assessing the orientation of recovery in mental health services. However, many of them have been dismissed for not reaching the adequacy criteria. This review makes clear the lack of consensus on the concept of recovery, as a consequence of the high number of instruments that evaluate the same concept through different domains. In addition, few instruments offer data related to the psychometric properties and only one instrument to assess personal recovery is validated to the Spanish population.

A decision support system for assessing management interventions in a mental health ecosystem: The case of Bizkaia (Basque Country, Spain).

Evidence-informed strategic planning is a top priority in Mental Health (MH) due to the burden associated with this group of disorders and its societal costs. However, MH systems are highly complex, and decision support tools should follow a systems thinking approach that incorporates expert knowledge. The aim of this paper is to introduce a new Decision Support System (DSS) to improve knowledge on the health ecosystem, resource allocation and management in regional MH planning. The Efficient Decision Support-Mental Health (EDeS-MH) is a DSS that integrates an operational model to assess the Relative Technical Efficiency (RTE) of small health areas, a Monte-Carlo simulation engine (that carries out the Monte-Carlo simulation technique), a fuzzy inference engine prototype and basic statistics as well as system stability and entropy indicators. The stability indicator assesses the sensitivity of the model results due to data variations (derived from structural changes). The entropy indicator assesses the inner uncertainty of the results. RTE is multidimensional, that is, it was evaluated by using 15 variable combinations called scenarios. Each scenario, designed by experts in MH planning, has its own meaning based on different types of care. Three management interventions on the MH system in Bizkaia were analysed using key performance indicators of the service availability, placement capacity in day care, health care workforce capacity, and resource utilisation data of hospital and community care. The potential impact of these interventions has been assessed at both local and system levels. The system reacts positively to the proposals by a slight increase in its efficiency and stability (and its corresponding decrease in the entropy). However, depending on the analysed scenario, RTE, stability and entropy statistics can have a positive, neutral or negative behaviour. Using this information, decision makers can design new specific interventions/policies. EDeS-MH has been tested and face-validated in a real management situation in the Bizkaia MH system.

¿Cómo evaluar la recuperación en salud mental?: Una revisión sistemática / How is evaluated mental health recovery?: A systematic review

En los últimos años se ha producido un incremento en el reconocimiento del concepto de recuperación personal en la atención a las personas que padecen enfermedades mentales: la recuperación personal definida como la búsqueda de una vida satisfactoria y plena a pesar de las limitaciones causadas por la enfermedad. Consecuentemente, se han creado diferentes instrumentos para evaluar los resultados orientados a la recuperación. El principal objetivo de este estudio ha sido llevar a cabo una revisión sistemática de los dominios e instrumentos que evalúan tanto la recuperación a nivel personal como la orientación de los servicios hacia la recuperación. Tras la revisión sistemática se ha realizado un proceso de selección de los instrumentos más apropiados teniendo en cuenta distintos criterios de adecuación, propiedades psicométricas y su validación al castellano. Como resultado se han obtenido 35 instrumentos que evalúan la recuperación personal y 18 la orientación de los servicios de salud mental, aunque muchos de ellos han sido desestimados por no cumplir los criterios de adecuación. Esta revisión deja clara la falta de consenso en el concepto de recuperación, debido al alto número de instrumentos que evalúan el mismo concepto a través de diferentes dominios. Además, solo unos pocos ofrecen datos de evidencia de las propiedades psicométricas y únicamente un instrumento desarrollado para evaluar la recuperación personal está adaptado al español

There is an increasingly recognition of the concept of personal recovery in the treatment of mental illness. Recovery defined as living a fulfilling, rewarding life, even in the ongoing presence of a mental illness. Consequently, a number of different instruments have been designed to assess recovery-oriented outcomes. The objective of the study was to conduct a systematic revision of the domains and the instruments used to assess personal recovery and mental health services orientation to recovery. After the systematic review, it has been carried out a selection process of the most adequate instruments taking into account different criteria of adequacy, psychometric properties and the validation to the Spanish population. In the results have been obtained 35 instruments for measuring personal recovery and 18 for assessing the orientation of recovery in mental health services. However, many of them have been dismissed for not reaching the adequacy criteria. This review makes clear the lack of consensus on the concept of recovery, as a consequence of the high number of instruments that evaluate the same concept through different domains. In addition, few instruments offer data related to the psychometric properties and only one instrument to assess personal recovery is validated to the Spanish population

Use of the self-organising map network (SOMNet) as a decision support system for regional mental health planning.

BACKGROUND: Decision-making in mental health systems should be supported by the evidence-informed knowledge transfer of data. Since mental health systems are inherently complex, involving interactions between its structures, processes and outcomes, decision support systems (DSS) need to be developed using advanced computational methods and visual tools to allow full system analysis, whilst incorporating domain experts in the analysis process. In this study, we use a DSS model developed for interactive data mining and domain expert collaboration in the analysis of complex mental health systems to improve system knowledge and evidence-informed policy planning. METHODS: We combine an interactive visual data mining approach, the self-organising map network (SOMNet), with an operational expert knowledge approach, expert-based collaborative analysis (EbCA), to develop a DSS model. The SOMNet was applied to the analysis of healthcare patterns and indicators of three different regional mental health systems in Spain, comprising 106 small catchment areas and providing healthcare for over 9 million inhabitants. Based on the EbCA, the domain experts in the development team guided and evaluated the analytical processes and results. Another group of 13 domain experts in mental health systems planning and research evaluated the model based on the analytical information of the SOMNet approach for processing information and discovering knowledge in a real-world context. Through the evaluation, the domain experts assessed the feasibility and technology readiness level (TRL) of the DSS model. RESULTS: The SOMNet, combined with the EbCA, effectively processed evidence-based information when analysing system outliers, explaining global and local patterns, and refining key performance indicators with their analytical interpretations. The evaluation results showed that the DSS model was feasible by the domain experts and reached level 7 of the TRL (system prototype demonstration in operational environment). CONCLUSIONS: This study supports the benefits of combining health systems engineering (SOMNet) and expert knowledge (EbCA) to analyse the complexity of health systems research. The use of the SOMNet approach contributes to the demonstration of DSS for mental health planning in practice.

Uso de ansiolíticos e hipnóticos durante el embarazo y la lactancia / Management of anxiolytics and hypnotics during pregnancy and breastfeeding

Se revisa el uso de ansiolíticos e hipnóticos durante el embarazo y la lactancia, analizando su efecto teratógenico, así como los síndromes perinatales descritos y los posibles efectos en el desarrollo del neonato, concluyéndose que la evidencia de los estudios es insuficiente para garantizar que no existirán problemas relevantes, pero estos parecen ser infrecuentes, en términos absolutos. En líneas generales, sería deseable evitar el uso de benzodiazepinas durante el primer trimestre, especialmente las semanas 3.a a 11.a, por el mayor riesgo de teratogenicidad, pero siempre que se disponga de otra opción alternativa que vaya a cumplirse y que la misma resulte eficaz. Sin embargo, pueden usarse si, estando indicadas, no existe la posibilidad de utilizar otras alternativas mejores, sean estas farmacológicas o no farmacológicas (AU)

A review is presented on the use of anxiolytics and hypnotics during pregnancy and lactation. An analysis is made on their teratogenic effect, as well as the associated perinatal syndromes and the possible effects on the development of the newborn child. It is concluded that the evidence from the studies is insufficient to ensure that their use is safe, although it seems that there are few complications. In general, efforts should be made to avoid the use of benzodiazepines during the first trimester, especially in weeks 3 to 11, due to the increased risk of teratogenicity, and provided that another alternative is available and considered effective. They can be used if there is no feasible and better pharmacological or non-pharmacological alternative, and there is a clinical indication (AU)

Uso de eutimizantes durante el embarazo y la lactancia / The use of mood regulators in pregnancy and breastfeeding

Se revisa el uso de eutimizantes durante el embarazo y la lactancia, analizando su efecto teratógenico, así como los síndromes perinatales descritos y los posibles efectos en el desarrollo del neonato. Los hallazgos de los últimos años sugieren que la lamotrigina es la opción más segura, aunque solo ha demostrado efectividad en la prevención de la depresión bipolar, y que el litio es más seguro que lo clásicamente considerado, mientras que el ácido valproico debe evitarse y no existe suficiente experiencia con carbamazepina. La decisión de tratar o no con un eutimizante dependerá de una cuidadosa valoración de cada caso, con sus antecedentes personales, teniendo en cuenta que el trastorno bipolar por sí mismo se asocia a complicaciones obstétricas y para el feto y que el embarazo y en particular el puerperio son momentos de máximo riesgo de descompensación. En la lactancia el litio parece menos tóxico que lo previamente supuesto y al igual que la lamotrigina puede usarse en casos concretos, mientras que no hay motivos para suspender la carbamazepina o el ácido valproico en niños expuestos a ellos intraútero

A review is presented on the use of mood stabilisers and hypnotics during pregnancy and lactation, analysing their teratogenic effect, as well as the associated perinatal syndromes and the possible effects on the development of the newborn child. Recent evidence suggests that lamotrigine is the safest drug, despite it has only shown to be effective in the prevention of bipolar depression. It is demonstrated that lithium is clearly safer than that classically reported, whereas valproic acid must be avoided, and there is not sufficient experience with carbamazepine. The decision to treat or not to treat with a mood stabiliser will depend on a careful assessment of each patient. This should take into account her psychiatric history, as well as the association of bipolar disorder itself with obstetric complications. Unfavourable outcomes for the foetus, and the maximum risk of acute episodes linked to pregnancy, and especially the puerperium, must also be considered. Lithium seems to be less toxic than previously supposed for breastfeeding infants and lamotrigine can be also be used in selected cases. There appears to be no reasons to withdraw carbamazepine or valproic acid if the infant was exposed in pregnancy

Uso de antidepresivos durante el embarazo y la lactancia / Antidepressant use during pregnancy and breastfeeding

En los últimos 20 años se ha estudiado extensamente la seguridad de los antidepresivos con respecto al riesgo de teratogénesis, síndromes perinatales, complicaciones posnatales del neurodesarrollo y lactancia. La metodología de los estudios tiene limitaciones y la conclusión provisional es que el riesgo de efectos secundarios de los antidepresivos es bajo y su uso está justificado en el embarazo, siempre que exista una indicación clínica

The last 20 years have seen an extensive examination of relevant research questions regarding the reproductive safety of antidepressants: risk of developing teratogenesis, neonatal adaptation syndromes and speech and neurodevelopmental disorders. The provisional conclusion is that the risk is small in absolute terms, therefore their use can be justified if there exists a clinical indication

Manejo de psicofármacos en los trastornos por uso de sustancias durante el embarazo y la lactancia / Management of psychotropic drugs for substance abuse disorders during pregnancy and breastfeeding

Se revisan las consecuencias del uso de sustancias y la seguridad de los fármacos indicados para el tratamiento del trastorno por uso de alcohol, nicotina y opioides durante el embarazo y la lactancia. El uso de sustancias tiene consecuencias nocivas para el feto y el lactante. A pesar de ello, un importante número de mujeres las consume. Los tratamientos pueden no ser fácilmente accesibles y las mujeres pueden ocultar su adicción por temor al estigma y las consecuencias legales. El conocimiento y adecuado uso de los psicofármacos indicados durante el embarazo y la lactancia puede ayudar a reducir los daños. Se recomienda interrumpir el uso de alcohol en cualquier momento del embarazo y prevenir las deprivaciones con benzodiacepinas. Aunque son deseables estudios de mayor calidad existen evidencias para considerar la terapia sustitutiva con nicotina y los agonistas opioides como medicaciones eficaces y seguras. En la mayoría de los casos se recomienda mantener la lactancia materna (AU)

A review is presented on the consequences of substance abuse and the safety of the drugs indicated for the treatment of alcohol, nicotine, and opioid use disorders during pregnancy and lactation. Drugs of abuse cause damage to the foetus and the infant. Despite this, a significant number of women still use them. Treatments may not be easily accessible, and women may hide their addiction, as they fear stigma or legal consequences. Knowledge and proper use of indicated psychoactive drugs during pregnancy and breastfeeding can help reduce damage. It is recommended to discontinue the use of alcohol at any time during pregnancy, and to prevent withdrawal symptoms with benzodiazepines. Although higher quality studies are desirable, there is evidence to consider Nicotine Replacement Therapy and opioid agonists as effective and safe medications. Breastfeeding is recommended in most cases (AU)

Medicamentos en el embarazo. Clasificaciones teratogénicas y otras fuentes de información / Medications in pregnancy. Teratogenic classifications and other sources of information

Las clasificaciones de riesgo teratogénico disponibles han resultado ambiguas y a menudo difíciles de interpretar. No se dispone de guías clínicas basadas en la evidencia para la valoración del riesgo/beneficio en la toma de decisiones en el tratamiento con fármacos en el embarazo. Los estudios disponibles en humanos son limitados y como mucho muestran una asociación entre el fármaco y el efecto indeseable. Se han hecho precisos cambios en las fichas técnicas para mejorar la información sobre el uso de medicamentos en el embarazo, pero no es suficiente. Se ha mejorado la calidad de los estudios en mujeres embarazadas, pero se requiere cierta formación en epidemiología y estadística para interpretarlos. La selección del fármaco más seguro ha de ser personalizada a la situación clínica de la paciente, valorando el riesgo/beneficio del medicamento y de la enfermedad no tratada (AU)

The available teratogenic risk classifications are ambiguous and are often difficult to interpret. There are no evidence-based clinical guidelines on risk/benefit assessment to help with decision-making when drug treatment is considered in pregnancy. Studies available in humans are limited, and at best may show an association between the drug and the undesirable effect. Specific changes have been made in the data sheets to improve information on the use of medicines in pregnancy, but it is not enough. The quality of studies in pregnant women has improved, but some training in epidemiology and statistics is required to interpret them. A personalised selection of the safest drug must take into account the risk/benefit ratio of the drug as well as and the expected outcome of an untreated disease (AU)

Impacto de la "Ley de promoción de la autonomía personal y atención a las personas en situación de dependencia" en las personas con trastorno mental grave / Impact of the "Law on promotion of personal autonomy and care for people dependent" in population with severe mental disorder

La Ley 39/2006, conocida como Ley de Dependencia, ha generado, desde su aprobación, desconfianza por estar enfocada a la atención a la dependencia, siendo la promoción de la autonomía personal un elemento apenas desarrollado y secundario (AU)

Law 39/2006, known as Dependence Law, has generated skepticism since its approval, for being focused on dependancy and barely promoting personal autonomy, treating it as a secondary issue (AU)

Oral health and the symptoms of schizophrenia.

The objectives of this study were to evaluate the oral health of a group of schizophrenic outpatients and a control group without psychiatric illness. The study also aimed to assess the influence of positive and negative symptomatology on oral health among outpatients with schizophrenia. The DMF-T Index (sum of decayed, missing and filled teeth) and the Community Periodontal Index of Treatment Needs (CPITN) were assessed in both groups. We evaluated the psychopathological state of the patient group using the Positive and Negative Syndrome Scale (PANSS). The schizophrenic patients had higher scores than the control group with respect to decayed teeth (4.39 vs. 0.72), missing teeth (5.66 vs. 1.50), the DMF-T index (13.51 vs. 7.8) and CPITN (2.32 vs. 1.04); and lower scores for filled teeth (3.53 vs. 5.54). The PANSS negative subscale score correlated positively with the oral health variables studied, whereas the PANSS positive subscale score correlated negatively and exclusively with the number of missing teeth. Age and smoking status affected oral health in both groups, but even when the influence of these factors was considered, the oral health of the patients was poorer than that of the control group.