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

Síndrome de Sotos e hiperactividad / Sotos syndrome and hyperactivity

El síndrome de Sotos se caracteriza por edad ósea avanzada con un crecimiento excesivo, macrocefalia, facies característica y dificultades en aprendizaje. Además, puede asociarse a inquietud, déficit de atención, hiperactividad y agresividad. Presentamos el caso de un niño de 6 años con síndrome de Sotos y un trastorno por déficit de atención con hiperactividad asociado

Sotos syndrome is characterized by advanced bone age with overgrowth, macrocephaly, characteristic facies, and learning difficulties. Also, it can present restlessness, attention deficit, hyperactivity and aggressivity. We report the case of a 6-year old boy with Sotos syndrome and an attention deficit and hyperactivity disorder associated