Frecuencia de trastornos mentales y sus características sociodemográficas en pacientes con COVID-19 ingresados en un hospital psiquiátrico de Lima Metropolitana

Introducción. La descripción de las características y los diagnósticos de pacientes psiquiátricos con COVID-19 durante la pandemia ha sido poco descrito en el Perú. Objetivo. Describir la frecuencia de diagnósticos psiquiátricos y sus características sociodemográficas en pacientes con prueba antigénica positiva a COVID-19 en un hospital psiquiátrico peruano durante julio 2020 a julio 2021. Métodos. Se realizó un estudio descriptivo basado en la revisión de 100 historias clínicas de pacientes entre 18 y 70 años. Las variables estudiadas fueron el diagnóstico de ingreso y variables sociodemográficas como edad, sexo, nivel académico, ocupación, días de estancia. Resultados. Los diagnósticos más frecuentes fueron esquizofrenia, trastornos esquizotípicos y trastornos de ideas delirantes (49%) y los trastornos del humor (37%). El 66% pertenecía a los niveles socioeconómicos más bajos y el 60% eran pacientes continuadores. El mes de abril de 2021 presentó la mayor cantidad de ingresos (n=15). Conclusión. Durante un año de observación en tiempos de emergencia sanitaria por la COVID-19, ingresaron a un hospital psiquiátrico de referencia 100 pacientes con diagnóstico psiquiátrico que además tuvieron infección por SARS-CoV-2, la mayoría de estos pacientes tuvieron trastornos psicóticos.

Introduction. The description of the characteristics and diagnoses of psychiatric patients with COVID-19 during the pandemic has been poorly described in Peru. Objective. To describe the frequency of mental disorders and the associated sociodemographic characteristics of patients with a positive antigen test for COVID-19 in a peruvian psychiatric hospital from July 2020 to July 2021. Methods. For this descriptive study we analyzed 100 medical records of patients between 18 and 70 years old. The variables studied were the diagnosis according to ICD-10 and sociodemographic features such as age, gender, educational status, employment, days of admission. Results. The most common diagnoses were "Schizophrenia, schizotypal disorders and delusional disorders" (49%) and "mood disorders" (37%), 66% belonged to the lowest socioeconomic levels and 60% were recurrent patients. The month of April 2021 presented the highest number of admissions (n=15). Conclusion. In a year of observation during the COVID-19 outbreak, 100 patients with psychiatric diagnosis who also had SARS-CoV-2 infection were admitted to a reference psychiatric hospital, most of these patients had psychotic disorders.

Schizophrenia in ICD-11: Comparison of ICD-10 and DSM-5. / La esquizofrenia en la CIE-11: comparación con la CIE-10 y el DSM-5.

The conceptualization of schizophrenia has changed from its initial conception in the 19th century to the recent publication of the ICD-11. The changes incorporated in this latest version were made based on the evaluation of the current ICD, the available scientific evidence, and the consensus reached by its developers. In this paper we describe the conceptualization changes (diagnostic criteria and specifiers) of ICD-11 schizophrenia with respect to those of ICD-10 and DSM-5. The changes found are discussed based on the scientific literature published in Medline, Scopus and Scielo until July 2019 and the information on the Wordl Health Organization and American Psychiatric Association websites. Given that the diagnosis of schizophrenia is based on the diagnostic criteria of the diagnostic classification systems, it is important to know the changes made in its conceptualization and the evidence supporting such modifications.

Alteraciones del Yo en las fases iniciales del espectro esquizofrénico / Self-disorders in Early Stages of the Schizophrenia Spectrum

RESUMEN El núcleo patogénico de la esquizofrenia ha variado de acuerdo con la época y la influencia de insignes investigadores. También se ha reconocido a las alteraciones del Yo como el eje de este trastorno, aunque están poco estudiadas debido a su naturaleza subjetiva. En los últimos arios, dado el creciente interés por las fases iniciales de la esquizofrenia, se ha retomado el estudio de las alteraciones del Yo. El modelo de las alteraciones del Yo en la esquizofrenia, desarrollado por Sass y Parnas, propone que en este trastorno la persona sufre pérdida de la perspectiva en primera persona y experimenta fenómenos de hiperreflexibilidad, el sentido disminuido del Yo y trastornos del campo de la conciencia. Por ello, experimenta sentimientos de extrañeza de sí mismo, dificultad para entender el sentido común de las cosas y problemas de interacción con el entorno. Con base en este modelo, se han elaborado instrumentos de evaluación de las alteraciones del Yo y se han conducido estudios empíricos para la evaluación de pacientes en riesgo de sufrir un trastorno del espectro esquizofrénico. Estos estudios muestran que las alteraciones del Yo se encuentran en estadios prepsicóticos y que su presencia puede predecir la transición a trastornos del espectro esquizofrénico. Estos resultados tienen importantes implicaciones clínicas, pues permiten identificar a personas en fases iniciales del trastorno y crean la oportunidad de aplicar intervenciones terapéuticas tempranas.

ABSTRACT The pathogenic nucleus of schizophrenia has varied according to the different eras and influences of distinguished clinical researchers. Self-disorders have also been recognised to be at the heart of this disorder, although they have seldom been studied due to their subjective nature. Recently, due to the growing interest in the study of the early stages of schizophrenia, the study of self-disorders has been resumed. The self-disorders in schizophrenia model, developed by Sass and Parnas, proposes that in this disorder the person suffers loss of the first-person perspective and experiences hyperreflexibility, diminished self-affection and disturbance of the field of awareness. Therefore, the person experiences feelings of strangeness about him/herself, difficulty in understanding the common sense of things and difficulty interacting with his/her environment. Based on this model, self-disorder evaluation instruments have been developed and empirical studies have been conducted to evaluate people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in prepsychotic stages and that their manifestation may predict the transition to schizophrenia spectrum disorders. These results have important clinical implications as they enable people in the early stages of the disorder to be identified and create the opportunity to apply early therapeutic interventions.

Self-disorders in Early Stages of the Schizophrenia Spectrum. / Alteraciones del Yo en las fases iniciales del espectro esquizofrénico.

The pathogenic nucleus of schizophrenia has varied according to the different eras and influences of distinguished clinical researchers. Self-disorders have also been recognised to be at the heart of this disorder, although they have seldom been studied due to their subjective nature. Recently, due to the growing interest in the study of the early stages of schizophrenia, the study of self-disorders has been resumed. The self-disorders in schizophrenia model, developed by Sass and Parnas, proposes that in this disorder the person suffers loss of the first-person perspective and experiences hyperreflexibility, diminished self-affection and disturbance of the field of awareness. Therefore, the person experiences feelings of strangeness about him/herself, difficulty in understanding the common sense of things and difficulty interacting with his/her environment. Based on this model, self-disorder evaluation instruments have been developed and empirical studies have been conducted to evaluate people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in prepsychotic stages and that their manifestation may predict the transition to schizophrenia spectrum disorders. These results have important clinical implications as they enable people in the early stages of the disorder to be identified and create the opportunity to apply early therapeutic interventions.

Herramientas de participación en rehabilitación de base comunitariapara población con esquizofrenia / Tools for participation in Community based rehabilitation for schizophrenia

Objetivo: describir la experiencia de la implementación de estrategias participativas basadas en lahistoria de vida y el audiovisual, como herramientas terapéuticas aplicadas a una persona adulta condiagnóstico de esquizofrenia. Métodos: estudio de Investigación – Acción – Participación,desarrollado en el contexto de la Rehabilitación Basada en Comunidad aplicada en Bogotá - Colombia.Resultados: las acciones participativas y dialogantes, lúdicas, creativas, fortalecen la funcionalidadde la comunidad terapéutica, así como su impacto sobre la rehabilitación individual. El desarrollode la estrategia audiovisual y de socialización permiten reconstruir significados e identidades deutilidad terapéutica, las cuales propician recursos personales que generan nuevos pensamientos yemociones. Conclusiones: es pertinente dar lugar a las posibilidades terapéuticas de laRehabilitación, mediante los aportes de distintos actores sociales, dinamizan y transforman laexperiencia de enfermedad a nivel individual, medio-ambiental, relacional, y comunitario;destacando en ello el poder significador asociado para el sujeto y su entorno social.

Objetivo: descrever a experiência da implementação de estratégias participativas baseadas nahistória de vida e no audiovisual, como ferramentas terapêuticas aplicadas a uma pessoa adultadiagnosticada com esquizofrenia. Métodos: estudo de Pesquisa - Ação - Participação, desenvolvido nocontexto da Reabilitação Baseada na Comunidade aplicada em um Centro de Reabilitação da cidadede Bogotá, Colômbia. Resultados: ações participativas e dialógicas, lúdicas e criativas fortalecem afuncionalidade da comunidade terapêutica, bem como seu impacto na reabilitação individual. Odesenvolvimento da estratégia: audiovisual e socialização baseada na participação permitereconstruir significados e identidades de utilidade terapêutica, que propiciam recursos pessoais que geram novos pensamentos e emoções. Conclusões: há possibilidades terapêuticas desse tipo dereabilitação, através das contribuições de diferentes atores sociais, que dinamizam e transformam aexperiência da doença no nível individual, ambiental, relacional e comunitário; enfatizando nele opoder significante associado ao próprio sujeito e ao seu ambiente social.

Objective: to describe the experience of the implementation of participatory strategies based onthe history of life and audiovisual, as therapeutic tools applied to an adult person diagnosed withschizophrenia. Methods: Research - Action - Participation study, developed in the context ofCommunity Based Rehabilitation applied in Bogotá, Colombia. Results: participative and dialogic,playful and creative actions strengthen the functionality of the therapeutic community, as well asits impact on individual rehabilitation. The development of the strategy: audiovisual andsocialization based on participation allows reconstructing meanings and identities of therapeuticutility, which propitiate personal resources that generate new thoughts and emotions. Conclusions:there are therapeutic possibilities of these rehabilitation, through the contributions of differentsocial actors, which energize and transform the disease experience at the individual, environmental,relational and community level; emphasizing in it the associated signifying power for the subjecthimself and for his social environment.