Mental illness and social exclusion: assessment of the risk of violence after release.

OBJECTIVES: To examine the predictive validity of the HCR-20 (The Historical Clinical Risk Management-20) to predict future violent incidents in a representative sample of patients with severe mental disorders and with a history of previous admission to prison, who after release are in a situation of extreme social exclusion. MATERIAL AND METHOD: The study sample was selected from the 235 patients treated by the Mental Health Street Team of Madrid (ECASAM) from June 2014 to June 2017, including those with a previous history of a previous internment in a penitentiary (about which, the HCR-20 was completed). RESULTS: Of the 44 patients included, 29.6% (n=13) ended up participating in a violent incident after the release. The ROC curves (Receiver Operating Characteristic) analysis indicated that the total score of HCR-20 (AUC 0.98, p=0.01) has a high predictive validity. CONCLUSIONS: The social and medical changes that take place after the release of patients with severe mental illness justify the need to reassess the risk of violence. In this evaluation, the HCR-20 guide is a useful tool for predicting the risk of involvement in future violent incidents, and the inclusion of factors such as social exclusion and its consequences, as well as problems with substance use is especially important.

Enfermedad mental y exclusión social: valoración del riesgo de violencia tras la excarcelación / Mental illness and social exclusion: assessment of the risk of violence after release

OBJETIVOS: Examinar la validez predictiva de la guía HCR-20 (The Historical Clinical Risk Management-20) para predecir futuros incidentes violentos en una muestra representativa de pacientes con trastorno mental grave y con antecedentes de ingreso previo en prisión, que tras la excarcelación presentan una situación de exclusión social extrema. MATERIAL Y MÉTODO: La muestra del estudio se seleccionó de los 235 pacientes atendidos por el Equipo de Calle de Salud Mental (ECASAM) de Madrid, desde junio de 2014 hasta junio de 2017, incluyendo finalmente a aquellos con antecedentes de un internamiento previo en un establecimiento penitenciario, sobre los que posteriormente se cumplimentó la HCR-20. RESULTADOS: De los 44 pacientes incluidos, un 29,6% (n=13) terminaron protagonizando un incidente violento tras la excarcelación. El análisis de curvas ROC (Receiver Operating Characteristic) indicó que la puntuación total de la HCR-20 (área bajo la curva o AUC: 0,98, p = 0,01) tiene una alta validez predictiva. CONCLUSIONES: Los cambios sociosanitarios que se van a producir tras la excarcelación de los pacientes con trastorno mental grave justifican la necesidad de revaluar el riesgo de violencia. En esta evaluación, la aplicación de la guía HCR-20 resulta una útil herramienta para predecir el riesgo de protagonizar futuros incidentes violentos, siendo especialmente relevante la consideración de factores como la exclusión social y sus consecuencias, así como los problemas con el consumo de sustancias

OBJECTIVES: To examine the predictive validity of the HCR-20 (The Historical Clinical Risk Management-20) to predict future violent incidents in a representative sample of patients with severe mental disorders and with a history of previous admission to prison, who after release are in a situation of extreme social exclusion. MATERIAL AND METHOD: The study sample was selected from the 235 patients treated by the Mental Health Street Team of Madrid (ECASAM) from June 2014 to June 2017, including those with a previous history of a previous internment in a penitentiary (about which, the HCR-20 was completed). RESULTS: Of the 44 patients included, 29.6% (n=13) ended up participating in a violent incident after the release. The ROC curves (Receiver Operating Characteristic) analysis indicated that the total score of HCR-20 (AUC 0.98, p = 0.01) has a high predictive validity. CONCLUSIONS: The social and medical changes that take place after the release of patients with severe mental illness justify the need to reassess the risk of violence. In this evaluation, the HCR-20 guide is a useful tool for predicting the risk of involvement in future violent incidents, and the inclusion of factors such as social exclusion and its consequences, as well as problems with substance use is especially important

[Neuroimaging studies in borderline personality disorder]. / Estudios de neuroimagen en el trastorno límite de la personalidad.

DSM-IV defines Borderline personality disorder (BPD) as a personality disorder that can be primarily characterized by emotional instability, extremely polarized thought and chaotic interpersonal relations. It is the most common personality disorder. Its prevalence is estimated to be from 0.2% to 1.8% of the general population, and the 76% of them are women. However, despite these data and the different biologic findings, there are few publications on neuroimage about this nosologic entity. Recent studies suggest that a dual cerebral disorder, including frontal and limbic circuits, could be present in characterize BPD. These cerebral areas would also be involved in the serotonergic dysfunction that seems to be related to the impulse dyscontrol and self-aggressive behaviour, characteristic of these patients. Most authors point out the importance of traumatic precedents in the BPD genesis, with a direct relation between stress and the neurobiological findings observed, including the neuroimage changes. The aim of this article is to make a revision of the main neuroimage data found in BPD, including the new techniques such as functional MRI, diffusion tensor MRI and spectroscopy.

Estudios de neuroimagen en el trastorno límite de la personalidad / Neuroimaging studies in the borderline personality disorder

El trastorno límite de la personalidad (TLP) o borderline, es actualmente definido por el DSM-IV como un trastorno de la personalidad que se caracteriza primariamente por disregulación emocional, pensamiento extremadamente polarizado y relaciones interpersonales caóticas. Es, con mucho, el más común de los trastornos de la personalidad. Se estima que su prevalencia oscila entre un 0,2% y un 1,8% de la población general. De ello el 76 % son mujeres. Sin embargo, a pesar de estas cifras nada desdeñables y de los diferentes hallazgos biológicos, existen pocas publicaciones sobre neuroimagen en esta entidad nosológica. La gran mayoría de los estudios recientes sostienen la hipótesis de que en el TLP existiría una patología cerebral dual que incluiría circuitos frontales y límbicos. Estas áreas cerebrales también estarían implicadas en la disfunción serotoninérgica que parece relacionarse con el descontrol de impulsos y la autoagresividad propios de este tipo de pacientes. Muchos autores apuntan a la importancia de los antecedentes traumáticos en la génesis del TLP, existiendo una relación directa entre el estrés y los hallazgos biológicos observados, incluyendo las alteraciones en la neuroimagen. El propósito de este artículo es realizar una revisión de los principales hallazgos obtenidos en los estudios de neuroimagen realizados en TLP, incluyendo las nuevas técnicas como la resonancia magnética (RM) con tensor de difusión, las pruebas funcionales como la RM funcional y la RM con espectroscopia (AU)

DSM-IV defines Borderline personality disorder (BPD) as a personality disorder that can be primarily characterized by emotional instability, extremely polarized thought and chaotic interpersonal relations. It is the most common personality disorder. Its prevalence is estimated to be from 0,2% to 1,8% of the general population, and the 76% of them are women. However, despite these data and the different biologic findings, there are few publications on neuroimage about this nosologic entity. Recent studies suggest that a dual cerebral disorder, including frontal and limbic circuits, could be present in characterize BPD. These cerebral areas would also be involved in the serotonergic dysfunction that seems to be related to the impulse dyscontrol and self-aggressive behaviour, characteristic of these patients. Most authors point out the importance of traumatic precedents in the BPD genesis, with a direct relation between stress and the neurobiological findings observed, including the neuroimage changes. The aim of this article is to make a revision of the main neuroimage data found in BPD, including the new techniques such as functional MRI, diffusion tensor MRI and spectroscopy (AU)