Basic quality indicators for clinical care of patients with major depression, schizophrenia, and bipolar disorder.

OBJECTIVE: To identify a set of indicators to monitor the quality of care for patients with major depression, schizophrenia, or bipolar disorder. METHODS: A group of 10 experts selected the most automatically applicable indicators from a total of 98 identified in a previous study. Five online sessions and 5 discussion meetings were performed to select the indicators that met theoretical feasibility criteria automatically. Subsequently, feasibility was tested in a pilot study conducted in two hospitals of the Spanish Health Service. RESULTS: After evaluating its measurement possibilities in the Spanish Health Service, and the fulfillment of all the quality premises defined, 16 indicators were selected. Three were indicators of major depression, 5 of schizophrenia, 3 of bipolar disorder, and 5 indicators common to all three pathologies. They included measures related to patient safety, maintenance and follow-up of treatment, therapeutic adherence, and adequacy of hospital admissions. After the pilot study, 5 indicators demonstrated potential in the automatic generation of results, with 3 of them related to treatments (clozapine in schizophrenia, lithium for bipolar disorder, and valproate in women of childbearing age). CONCLUSIONS: Indicators support the monitoring of the quality of treatment of patients with major depression, schizophrenia, or bipolar disorder. Based on this proposal, each care setting can draw up a balanced scorecard adjusted to its priorities and care objectives, which will allow for comparison between centers.

Social cognition in first-episode schizophrenia/schizoaffective disorder patients.

INTRODUCTION: People with schizophrenia have neurocognitive as well as social cognition deficits. Numerous studies have shown impairment in these domains in patients with chronic schizophrenia. However, these disturbances during the early phase of the disease have been less studied. OBJECTIVE: The aim of the study is to explore the theory of mind (ToM) and emotional processing in first-episode patients, compared to healthy subjects. METHOD: Forty patients with a first psychotic episode of less than 5 years' duration, and 40 healthy control subjects matched by age and years of schooling were assessed. The measures of social cognition included four stories of false belief, the Reading the Mind in the Eyes Test (RMET) and the Pictures Of Facial Affect (POFA) series. RESULTS: The patients with a first psychotic episode performed significantly worse in all tasks of social cognition, compared to the healthy controls. The second-order ToM was impaired whereas the first-order ToM was preserved in the patients. Happiness was the emotion most easily identified by both patients and controls. Fear was most difficult for the patients, while for the controls it was disgust. CONCLUSIONS: Deficits in ToM and emotional processing are present in patients with a first psychotic episode.

Family Factors Related to Suicidal Behavior in Adolescents.

Objective: This research aims to investigate what type of family patterns (specifically attachment, bonding and family functioning) and stressful life events can trigger or protect adolescents from developing suicidal behavior. Methods: For these purposes, a case-control study (adolescents with suicidal behavior vs. paired adolescents with no suicidal behavior) was conducted with one hundred 12 to 17-year-old adolescents (50 controls, 50 cases, 74% females), assessed between 2018 and 2020. Results: Negligent (p < 0.001) or affection-less control bonding (p < 0.001), insecure attachment (p = 0.001) and stressful life events (p < 0.001) revealed to be significant risk factors for suicidal behavior. On the contrary, parents' care (p < 0.001) and security (p < 0.001) were revealed as protective factors for suicidal behavior. Conclusions: Considering these results, family interventions and improving coping skills seem to be two essential targets for any suicide prevention intervention in adolescents.

Predictors of Suicide Re-Attempt in a Spanish Adolescent Population after 12 Months' Follow-Up.

Background: This study aims to identify the main predictive factors that allow for the recognition of adolescents with a higher risk of re-attempting suicide. Method: A longitudinal 12-month follow-up design was carried out in a sample of 533 Spanish adolescents between 12 and 17 years old. The data collection period comprised September 2013 to November 2016, including a one-year follow-up after hospital discharge. Results: A statistically significant regression model was obtained to predict suicide re-attempt at 12-months' follow-up (χ2 = 34.843; p < 0.001; Nagelkerke R2 = 0.105), including personal history of self-injury (OR = 2.721, p < 0.001, 95% CI [1.706, 4.340]) and age (OR = 0.541, p = 0.009, 95% CI [0.340, 0.860]), correctly classifying 82.6% of the sample. Our results show that having a personal history of self-injury and being younger than 14 years old were predictors of suicide re-attempt during the first year after an adolescent's first admission to emergency services. Conclusions: Considering these factors could contribute to the design of more tailored and effective interventions to prevent suicidal behavior in adolescents at high risk of re-attempting suicide.

Efficacy and safety of intranasal haloperidol in an acute Psychiatry Unit: a pilot study on schizophrenic patients with mild-modedate agitation.

To study the efficacy and safety of intranasal administration of 5 mg haloperidol on mild-moderate agitated patients with schizophrenia or schizoaffective disorder in an acute psychiatry unit setting.

Eficacia y seguridad del haloperidol intranasal en una Unidad de Agudos: estudio piloto en pacientes esquizofrénicos con leve-moderada agitación / Efficacy and safety of intranasal haloperidol in an acute Psychiatry Unit: a pilot study on schizophrenic patients with mild-modedate agitation

Objetivo: Estudiar la eficacia y seguridad de la administración de 5 mg de haloperidol intranasal en pacientes conesquizofrenia y trastorno esquizoafectivo, con leve o moderada agitación, ingresados en una unidad de agudos depsiquiatría.Método. Diseño: Estudio piloto de ensayo clínico, fase IV,con evaluador ciego, unicéntrico, aleatorizado y controladode grupos paralelos, comparando la administración intranasalcon la intramuscular. Sujetos: 16 pacientes; 7 administraciónintranasal y 9 administración intramuscular. Medidas de eficacia: Escala de Síntomas Positivas y Negativos-ComponenteExcitación (PANSS-EC); Escala de Impresión Clínica Global(CGI). Medidas de seguridad: Cambios en el ECG registrados5 minutos pretratamiento y 5 minutos postratamiento.Resultados. La administración intranasal mostró mayorrapidez de acción en comparación con la intramuscular enla PANSS-EC (p = 0,042) y la CGI (p = 0,041) a los 10 minutos de la administración, con similar eficacia a los 20, 30 y60 minutos. Sin diferencias significativas en el QTc basal ypostratamiento.Conclusión. El haloperidol intranasal fue una alternativarápida, efectiva y bien tolerada para reducir la agitación leve-moderada en estos pacientes. (AU)

Aim: To study the efficacy and safety of intranasal administration of 5mg haloperidol on mild-moderate agitatedpatients with schizophrenia or schizoaffective disorder in anacute psychiatry unit setting.Method. Design: Pilot study of clinical trial, phase IV,open-label, observer-blind, single-center, randomized a haloperidol-controlled trial comparing intranasal with intramuscular administration. Subjects: 16 patients; 7 intranasaladministration, and 9 intramuscular administration. Efficacymeasurement: Positive and Negative Syndrome Scale-Excited Component (PANSS-EC); Clinical Global Impressions-Improvement Scale (CGI). Safety measurement: Changes inthe ECG registered 5 minutes pre-treatment and 5 minutespost-treatment.Results. Intranasal administration showed more quickaction compared with intramuscular on the PANSS-EC(p=0.042) and CGI (p=0.041) 10 minutes after administration, with similar efficacy up to 20, 30, and 60 minutes. There were no significant differences between QTc baseline andpost-treatment.Conclusion. Intranasal haloperidol was a rapid, effective,and well-tolerated alternative for reducing acute mild-moderate agitation. (AU)

Predictors of Adherence to Treatment in Behavioral Health Therapy for Latino Immigrants: The Importance of Trust.

A complex array of barriers to care influence patients' adherence to behavioral healthcare services. Understanding barriers to care is critical to ensure sufficient dosage of treatment. This study assessed the influence of perceived barriers on Latino migrants' prospective adherence to treatment for co-occurring mental health and substance use disorders as part of a clinical trial. Eligible participants (18-70 years-old) were recruited from community-based settings and classified according to their intervention session attendance. Baseline assessments included socio-demographic factors, clinical characteristics (i.e., depression, anxiety, post-traumatic stress disorder, substance use), psychosocial and cultural factors (i.e., ethnic identity, health literacy, discrimination), and perceived attitudinal and structural barriers to care. Treatment involved 10-sessions of cognitive-behavioral therapy, psychoeducation, and mindfulness (Integrated Intervention for Dual problems and Early Action) and emphasized participant's engagement in treatment. We used multinomial logistic regression models to examine the association between barriers to care reported at baseline, sociodemographic characteristics, psychosocial and cultural factors, clinical factors, and treatment adherence. Mistrust in previous behavioral health treatment(s) was the reported barrier significantly associated with completion of the program after adjusting for clinical, psychosocial, and cultural factors, with those expressing mistrust in previous treatment(s) showing higher rates of completion compared to those who did not report this barrier. Evidence-based and culturally-tailored interventions provided by ethnically matched providers may overcome cultural mistrust and increase adherence to behavioral health care among Latino immigrants.

Effects of manual cranial therapy on heart rate variability in children without associated disorders: Translation to clinical practice.

BACKGROUND: and purpose: Heart rate variability (HRV) represents a marker of autonomic activity, self-regulation and psychiatric illness. Few studies of manual therapy have investigated the neurophysiological effects of manual cranial therapy (MC-t). This study assessed the neurophysiological short/medium-term effects of two manual therapy interventions: massage therapy (Mss-t) and MC-t. MATERIALS AND METHODS: A double-blind clinical trial was conducted with 50 healthy children, randomized into two groups who received a Mss-t intervention or MC-t. The variables analysed included vital signs (temperature, respiratory rate, heart rate, blood pressure) and HRV components, including the root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF) and LF/HF ratio. RESULTS: Both interventions produced short-term parasympathetic effects, although the effects of MC-t were more persistent. CONCLUSION: The persistence of the MC-t intervention suggested a prominent vagal control and better self-regulation. Autonomic imbalances in mental pathologies may benefit from the neurophysiological effects of MC-t.

Risk of re-attempts and suicide death after a suicide attempt: A survival analysis.

BACKGROUND: Suicide is the primary cause of unnatural death in Spain, and suicide re-attempts a major economic burden worldwide. The risk factors for re-attempt and suicide after an index suicide attempt are different. This study aims to investigate risk factors for re-attempt and suicide after an index suicide attempt. METHODS: This observational study is part of a one-year telephone management program. We included all first-time suicide attempters evaluated in the emergency department at Parc Taulí-University Hospital (n = 1241) recruited over a five-year period (January 2008 to December 2012). Suicide attempters were evaluated at baseline using standardized instruments. Bivariate logistic regression models were used to identify risk factors. Kaplan-Meier curves were used to compare the time to re-attempt between categorical variables. Comparisons were performed using Log-Rank and Wilcoxon tests. Variables with a p-value lower than 0.2 were included in a multivariate Cox regression model. Bivariate logistic regression models were considered to identify risk factors for suicide. The significance level was set to 0.05. RESULTS: Suicide re-attempters were more likely diagnosed with cluster B personality disorders (36.8% vs. 16.6%; p < 0.001), and alcohol use disorders (19.8 vs. 13.9; p = 0.02). Several [1.2% (15/1241)] of them died by suicide. Attempters who suicide were more likely alcohol users (33.3% vs. 17.2%; p = 0.047), and older (50.9 ± 11.9 vs. 40.7 ± 16.0; p = 0.004). CONCLUSIONS: Alcohol use, personality disorders and younger age are risk factors for re-attempting. Older age is a risk factor for suicide among suicide attempters. Current prevention programs of suicidal behaviour should be tailored to the specific profile of each group.

Comorbilidad entre el trastorno del espectro autista y el trastorno bipolar / No disponible

No disponible

El coste social de la depresión en la ciudad de Sabadell (2007-2008) / The social cost of depression in the city of Sabadell (Barcelona, Spain) (2007-2008)

Objetivo: Determinar el coste y la carga social de la depresión en la ciudad de Sabadell en los años 2007 y 2008. Método: El coste social asociado a la depresión se calculó a partir del enfoque de la prevalencia, según la información obtenida en el desarrollo del proyecto European Project Against Depression (EAAD). Los resultados se refirieron al coste de los recursos públicos utilizados, y las fuentes provinieron de los registros oficiales correspondientes. Resultados: El coste directo público de la depresión en la ciudad de Sabadell fue de 9.155.620 € en 2007 y de 9.304.706 € en 2008. El peso relativo de las visitas de atención primaria y el consumo de fármacos representaron más del 85% del coste directo. En el apartado de los costes indirectos no se ha podido obtener el correspondiente a la incapacidad laboral permanente. En 2007 los costes indirectos alcanzaron los 9.720.225 € y en 2008 fueron 9.763.541 €. En ambos casos, el peso correspondiente a la incapacidad laboral transitoria fue el más importante, llegando a 8.561.962 € y 7.333.181 €, respectivamente. Conclusiones: La depresión ocasiona un sustancial impacto económico sobre el sistema sanitario, ya que se asocia a unos altos costes directos públicos. Sin embargo, en el apartado de los costes indirectos, el desconocimiento del coste relacionado con la incapacidad laboral permanente provoca un vacío importante, pues para esta afección esta categoría de coste es la que representa un porcentaje más grande (AU)

Objective: To determine the social cost and burden of depression in the city of Sabadell (Barcelona, Spain) in 2007 and 2008. Method: The social cost of depression was calculated using the prevalence approach, based on information obtained in the development of the European Project Against Depression (EAAD). The results referred to the cost of public resources used, and the sources came from the appropriate official registers. Results: The direct public cost of depression in the city of Sabadell was € 9,155,620 in 2007 and € 9,304,706 in 2008. The relative weight of primary care visits and the use of drugs accounted for more than 85% of direct costs. In the section of indirect costs, the cost of permanent work disability could not be obtained. Indirect costs amounted to € 9,720,225 in 2007 and € 9,763,541 in 2008. In both years, the highest weight corresponded to temporary work disability reaching € 8,561,962 and € 7,333,181, respectively. Conclusions: Depression has a substantial economic impact on the health system because it is associated with high direct public costs. However, the lack of knowledge of the cost associated with permanent work disability is a major limitation, as this cost category represents the highest percentage for this disorder (AU)

[The social cost of depression in the city of Sabadell (Barcelona, Spain) (2007-2008)]. / El coste social de la depresión en la ciudad de Sabadell (2007-2008).

OBJECTIVE: To determine the social cost and burden of depression in the city of Sabadell (Barcelona, Spain) in 2007 and 2008. METHOD: The social cost of depression was calculated using the prevalence approach, based on information obtained in the development of the European Project Against Depression (EAAD). The results referred to the cost of public resources used, and the sources came from the appropriate official registers. RESULTS: The direct public cost of depression in the city of Sabadell was € 9,155,620 in 2007 and € 9,304,706 in 2008. The relative weight of primary care visits and the use of drugs accounted for more than 85% of direct costs. In the section of indirect costs, the cost of permanent work disability could not be obtained. Indirect costs amounted to € 9,720,225 in 2007 and € 9,763,541 in 2008. In both years, the highest weight corresponded to temporary work disability reaching € 8,561,962 and € 7,333,181, respectively. CONCLUSIONS: Depression has a substantial economic impact on the health system because it is associated with high direct public costs. However, the lack of knowledge of the cost associated with permanent work disability is a major limitation, as this cost category represents the highest percentage for this disorder.

[Cooperation between primary care and mental health services]. / Cooperación entre atención primaria y servicios de salud mental.

PURPOSE: To find out the current coordination/cooperation level of primary care (PC) with the adult mental health centres (AMHC), the addiction treatment centres (ATC) and children and adolescent mental health centres (CAMHC) of Catalonia (Spain). Differences in coordination between urban and non-urban areas were also evaluated. DESIGN: Cross-sectional descriptive study. SETTING: Eighty PC centres representing the seven health regions of Catalonia. PARTICIPANTS: Selection was by means of a multi-staged and stratified sampling method. A total of 356 of the 618 PC physicians who agreed to participate completed a survey evaluating different aspects of coordination with the specialised mental health services. RESULTS: The PC physicians indicated that the availability of AMHC was worse than that provided by ACT and CAMHC. However, the reports on the state of the referred patients and the training courses in mental health offered by the AMHC were more frequent. There were no significant differences in availability or training in mental health between urban and non-urban areas. CONCLUSIONS: The cooperation between the PC and the specialised mental health services of Catalonia is optimal in some aspects, but patient waiting time needs to be reduced for first visits to the AMHC and training activities offered by the CAMHC and the ACT need to be increased.

Cooperación entre atención primaria y servicios de salud mental / Cooperation between primary care and mental health services

ObjetivoConocer el grado de coordinación/cooperación entre la atención primaria (AP) de Cataluña y los centros de salud mental de adultos (CSMA), los centros de atención y seguimiento a las drogodependencias (CASD) y los centros de salud mental infanto-juvenil (CSMIJ). Evaluar si hay diferencias en coordinación en función del carácter urbano o rural de los municipios.DiseñoEstudio descriptivo transversal.Emplazamiento80 centros de AP representativos de las 7 regiones sanitarias de Cataluña.ParticipantesSelección mediante muestreo aleatorio estratificado; 356 de los 618 médicos de familia a los que se ofreció participar completaron una encuesta que evaluaba diferentes aspectos de coordinación con los servicios especializados.ResultadosLos participantes indicaron un peor acceso a los CSMA que a los CASD y a los CSMIJ. Sin embargo, la formación proporcionada por los CSMA era mejor que la de los otros dos dispositivos en todos los indicadores empleados. No se hallaron diferencias significativas en las variables de acceso y formación entre zonas urbanas y rurales.ConclusionesLa cooperación entre la AP y los servicios especializados en salud mental de Cataluña es óptima en algunos aspectos. No obstante, sería conveniente que se redujera el tiempo de espera para las primeras visitas en los CSMA y que los CASD y los CSMIJ incrementaran las actividades de formación(AU)

PurposeTo find out the current coordination/cooperation level of primary care (PC) with the adult mental health centres (AMHC), the addiction treatment centres (ATC) and children and adolescent mental health centres (CAMHC) of Catalonia (Spain). Differences in coordination between urban and non-urban areas were also evaluated.DesignCross-sectional descriptive study.SettingEighty PC centres representing the seven health regions of Catalonia.ParticipantsSelection was by means of a multi-staged and stratified sampling method. A total of 356 of the 618 PC physicians who agreed to participate completed a survey evaluating different aspects of coordination with the specialised mental health services.ResultsThe PC physicians indicated that the availability of AMHC was worse than that provided by ACT and CAMHC. However, the reports on the state of the referred patients and the training courses in mental health offered by the AMHC were more frequent. There were no significant differences in availability or training in mental health between urban and non-urban areas.ConclusionsThe cooperation between the PC and the specialised mental health services of Catalonia is optimal in some aspects, but patient waiting time needs to be reduced for first visits to the AMHC and training activities offered by the CAMHC and the ACT need to be increased(AU)