Health care professionals under programmes for addictions. Personality characteristics of the patients, barriers to treatment and challenges / Programas de atención a los profesionales de la salud con trastornos por uso de sustancias. Idiosincrasias de los usuarios, barreras de accesibilidad y desafíos.

Physicians have privileged information regarding the importance of leading a healthy and drug-free lifestyle, but in everyday reality, they are subject to extreme stressors (work stress, compassion fatigue, burnout syndrome) that have a profound emotional impact. As a result, it is not uncommon for physicians to present substance use disorders and dependencies. Recently, greater attention has been paid to specific factors that may lead to substance use disorder. Despite these efforts, there is a lack of prevention policies and substance use disorders are excluded in the list of occupational diseases. The idiosyncrasies of the tasks and particularities of the behavior of health care workers create a major challenge for the design of effective and safe programs for the health care professional with addictions and their patients. The objective of this work is to carry out an analytical review of the existing literature related to the implementation of specific treatments for health professionals to address SUD. After a tour of the mental health programs in place for health workers in different regions of the world and local resources, a discussion of current information on mental health disorders, as well as prevention and occupational health policies, is presented. In this population, the challenges that must be faced in our reality to create a specific treatment for this population are summarized.

Los médicos cuentan con información privilegiada respecto a la importancia de llevar una vida saludable y libre de drogas, pero la realidad cotidiana señala que están sujetos a estresores extremos (estrés laboral, desgaste por empatía, síndrome de burnout) que producen un impacto emocional profundo. Por ello, no es infrecuente que los médicos presenten trastornos por uso de sustancias y dependencias. Recientemente se ha prestado mayor atención a factores profesionales de las distintas especialidades médicas que puedan propiciar el trastorno por uso de sustancias, aunque faltan políticas de prevención en grupos de mayor riesgo y la incorporación de estos trastornos al listado de enfermedades profesionales por la medicina laboral. La idiosincrasia de las tareas y particularidades de la conducta de trabajadores de la salud generan un desafío mayor para el diseño de programas efectivos y seguros para el profesional con adicciones y sus propios pacientes. El presente trabajo tiene por objetivo realizar una revisión analítica de la bibliografía existente relacionada a la implementación de tratamientos específicos para profesionales de la salud para el abordaje de los trastornos por uso de sustancias. Luego de un recorrido por los programas de salud mental en marcha para trabajadores de la salud en distintas regiones del mundo y los recursos locales, se presenta una discusión de la información actual sobre trastornos de salud mental, así como las políticas de prevención y salud laboral en esta población, se resumen los desafíos con los cuales se deben afrontar en nuestra realidad para el armado de un tratamiento específico para esta población.

Intervenciones facilitadoras para las mujeres en el tratamiento por consumos problemáticos desde un enfoque de género / Facilitating interventions for women in treatment for problematic drug use from a gender perspective

RESUMEN INTRODUCCIÓN: Existen barreras para la atención y permanencia de las mujeres en los tratamientos por consumos problemáticos. Se relacionan con los espacios y el diseño de programas donde no se tienen en cuenta las necesidades específicas para un trabajo con enfoque de género. El objetivo fue explorar las intervenciones que funcionan como facilitadoras para alojar y escuchar a las mujeres a partir de la experiencia de un grupo de ellas en el marco de un tratamiento por consumo problemático de sustancias. MÉTODOS: Se utilizó un diseño mixto, tomando como referencia empírica la implementación de un grupo de mujeres. Se trabajó con una muestra de 33 mujeres de la población de 79 pacientes atendidas en un dispositivo ambulatorio para el tratamiento de consumos problemáticos en la ciudad de Buenos Aires entre julio de 2020 y julio de 2022. RESULTADOS: Los datos relevados describen un aumento en la población de mujeres desde la creación del grupo, mientras que el análisis de las experiencias permite distinguir cuatro categorías de intervenciones: las que vinculan los consumos con el rol social de las mujeres; las destinadas a mejorar el apoyo mutuo entre las compañeras; las que permiten construir un espacio de apertura para el trabajo de situaciones de violencia; y las que nacen de la creación del grupo de mujeres para trabajar la accesibilidad. DISCUSIÓN: El presente trabajo refleja la importancia de abordar la perspectiva de género al interior de los tratamientos de un modo transversal.

ABSTRACT INTRODUCTION: There are barriers for women's care and staying in treatment for problematic drug use. They are related to spaces and design of programs that do not consider the specific needs for gender perspective work. The objective was to explore the interventions that work as facilitators to support and listen to women, based on the experience of a group of women in the context of a treatment for problematic substance use. METHODS: A mixed design was used, taking as empirical reference the implementation of a women's group. The study worked with a sample of 33 women from a population of 79 patients in an outpatient facility for the treatment of problematic substance use in the city of Buenos Aires from July 2020 to July 2022. RESULTS: The collected data show an increase in the population of women since the creation of the group, while the analysis of the experiences allows to distinguish four categories of interventions: the ones that link drug use with women's social role; the ones aimed at improving mutual support among partners; the ones that allow building a space of openness to tackle situations of violence; and the ones arising from the creation of a women's group to work on accessibility. DISCUSSION: This work reflects the importance of addressing gender perspective in the treatment in a cross-sectional way.

Cannabidiol pharmacotherapy for delta-9-tetrahidrocannabinol dependence / Cannabis de grado médico para el tratamiento de la dependencia a Δ-9-Tetrahidrocannabinol.

Addictions are one of the most important health problems worldwide. Within these disorders, cannabis is one of the psychoactive substances with more burden of morbidity and mortality worldwide. The actual knowledge about the effectiveness of treatments for cannabis use disorders is unsatisfactory. This review aims to explore the evidence on cannabidiol for the treatment of cannabis use disorder. There are several clinical pharmacotherapy trials researching cannabis use disorders with limited evidence. A smaller number of trials in animal models and humans on the use of cannabinoids, especially Cannabidiol and Tetrahydrocannabinol to treat cannabis dependence show evidence of reduction in days of use, withdrawal symptoms and craving. New trials are under development, and there is an urgent need for trials with larger numbers of patients and longer treatment periods to support possible indications in the near future.

Las adicciones son uno de los problemas de salud más importantes a nivel mundial. Dentro de estos trastornos, el cannabis es una de las sustancias psicoactivas que provoca mayor morbimortalidad a nivel mundial. La efectividad documentada de los tratamientos para los trastornos por uso de cannabis no es satisfactoria. Esta revisión tiene por objetivo explorar las evidencias sobre la implementación de tratamientos con cannabinoides para el abordaje de estos trastornos. La bibliografía actual cuenta con muchos ensayos sobre el uso de neuropsicofármacos en los trastornos por uso de cannabis con limitada evidencia a favor; mientras que un número más reducido de ensayos en modelos animales y en pacientes sobre el uso de cannabinoides, en especial Cannabidiol y Tetrahidrocannabinol para tratar dicha dependencia muestran evidencias de reducción en días de consumo, síntomas de abstinencia y craving. Se encuentran en desarrollo nuevos ensayos clínicos, estos son una necesidad imperiosa para proveer mayor número de pacientes y con períodos de tratamiento más prolongados y así poder explorar más a fondo su posible indicación en un futuro cercano.

[Improved cognitive performance and post-injury plasticity during intensive outpatient treatment for substance use disorder. A case report]. / Mejoramiento del rendimiento cognitivo y plasticidad post lesional durante el tratamiento ambulatorio intensivo por trastorno por uso de sustancias. Reporte de caso.

There are different degrees of cognitive functional decline and modifiable risk factors related to their evolution. Mild cognitive impairment is a state of cognitive function between that seen in normal aging and dementia and is related to an increased risk of developing dementia. Among its potentially modifiable risk factors, substance use disorders have been described. In particular, techniques with predictive value have been developed to identify this impairment during neuropsychological assessment. We present a clinical case of a young patient with mild cognitive deficit and multiple drug abuse who after 24 months of an intensive outpatient treatment showed improvement in cognitive screening scores and neuroimaging. Together with other modifiable lifestyle factors, early cognitive screening in patients with substance use disorder could be a tool to detect other dimensions affected and contribute with specific therapies that promote post-injury plasticity and overall patient improvement.

Multidimensional evaluation of a 12-month intensive outpatient program for the treatment of substance use disorder. Experience in Argentina / Evaluación multidimensional de un programa de tratamiento ambulatorio intensivo de 12 meses para el trastorno por uso de sustancias. Experiencia en Argentina.

OBJECTIVE: The purpose of this study was to asess the efficacy of an intensive outpatient treatment (IOT) for substance use disorder (SUD) using a multidimensional approach. METHODS: All the patients consecutively admitted to a private institution between May 2019 and May 2020 were invited to participate in the study. The program consisted in a 12-month set of psychosocial, medical and recreative interventions requiring an attendance of at least 9 hours per week. Efficacy was evaluated at admission and every three months by the Addiction Severity Index (ASI). Quality of life was evaluated at admission and at the end of the treatment by the WHOQOL-Bref questionnaire. A comparison of parameters obtained at admission between the group that completed and the one that abandonned the treatment was also performed to detect potential predictors of early dropout. Six months after the end of the treatment, the participants were contacted in order to repeat an evaluation through the ASI and the WHOQOL-Bref scales. RESULTS: 41 participants (73% male, age 42.8 ± 16 years) were included. 14 participants dropped out at a median time of 88 days. Among those who completed the treatment improvements were observed in different clinical dimensions: in alcohol and drug consumption (3 months), in medical problems (6 months), in family/social relationships (9 months), in psychological scores (12 months) and in the four dimensions of WHOQOL-Bref. No changes were observed in legal problems and in the employment status. Only legal problems and family/social relationships at admission were significantly different among patients who completed versus those who dropped-out. Six months after discharge, no differences in WHOQOL-Bref scores were observed in the 15 participants who could be located and accepted the assessment. A little but statistically significant worsening was observed in the psychological problems dimension of the ASI in post-discharge follow-up. The rest of the ASI dimensions remained unchanged 6 months after concluding the treatment. CONCLUSION: This is one of the few studies performed in a latinamerican setting assessing the efficacy of a long-term IOT for SUD. It confirms previous works from developed countries, showing the potential benefits of IOTs implementation in our region.

OBJETIVO: Evaluar la eficacia de un tratamiento ambulatorio intensivo (TAI) para el trastorno por uso de sustancias (TUS) utilizando un enfoque multidimensional. Métodos: Se incluyeron todos los pacientes admitidos consecutivamente en una institución privada entre mayo de 2019 y mayo de 2020. El programa duró 12 meses y consistió en un conjunto de intervenciones médicas, psicosociales y recreativas, con una intensidad ≥ 9 horas/semana. La eficacia fue evaluada comparando los puntajes en el Índice de Severidad de Adicción (ASI) a lo largo del programa y en el cuestionario WHOQOL-Bref al inicio y al finalizar. En 15 pacientes se realizó una nueva medición seis meses después de concluido el tratamiento. MÉTODOS: Se incluyeron todos los pacientes admitidos consecutivamente en una institución privada entre mayo de 2019 y mayo de 2020. El programa duró 12 meses y consistió en un conjunto de intervenciones médicas, psicosociales y recreativas, con una intensidad ≥ 9 horas/semana. La eficacia fue evaluada comparando los puntajes en el Índice de Severidad de Adicción (ASI) a lo largo del programa y en el cuestionario WHOQOL-Bref al inicio y al finalizar. En 15 pacientes se realizó una nueva medición seis meses después de concluido el tratamiento. RESULTADOS: Se incluyeron 41 participantes (73% hombres, edad 42,8 ± 16 años). 14 participantes abandonaron (media 88 días). En los participantes que completaron el tratamiento, se observaron mejoras en los índices de alcohol y drogas (a los 3 meses), en problemas médicos (a los 6 meses), en las relaciones sociales y familiares (a los 9 meses) y en problemas psicológicos (a los 12 meses) así como  en las cuatro dimensiones del WHOQOL-Bref. Estas mejoras persistieron en la evaluación 6 meses post-alta cuando sólo un empeoramiento leve en la dimensión de problemas psicológicos del ASI fue objetivado. Conclusión: Este es uno de los pocos estudios realizados en un ámbito latinoamericano que evalúa la eficacia de un TAI para el TUS. Confirma trabajos previos de países desarrollados, mostrando los beneficios potenciales de la implementación de TAIs en nuestra región. CONCLUSIÓN: Este es uno de los pocos estudios realizados en un ámbito latinoamericano que evalúa la eficacia de un TAI para el TUS. Confirma trabajos previos de países desarrollados, mostrando los beneficios potenciales de la implementación de TAIs en nuestra región.

[Disulfiram: history, controversies and its use today]. / Disulfiram, historia, controversias y su utilización en la actualidad.

Alcoholism represents one of the great public health problems today, which is why it is essential to develop effective therapeutic strategies for the treatment of this pathology. A drug that has been on the market for more than six decades, disulfiram, has been indicated with uneven efficacy over the years, and often used incorrectly (high doses, lack of consent). Not free of potentially serious adverse effects, it finds a subpopulation where it can be highly effective and is also a useful tool because of its low cost in many countries where the other drugs (naltrexone and acamproxate) have non-viable values for many.

[The treatment of cannabis dependence: Clinical work, psychotherapy and evidence]. / Tratamiento de la dependencia cannábica: clínica, psicoterapia y evidencia.

Identifying compulsive consumption of marijuana in association with another mental disorder (attentional defcit disorder, bipolar disorder, depression or psychosis) presents the challenge of clarifying validated therapeutic strategies, especially within the teen population, in which it shows the highest prevalence. The ever-increasing prevalence and the need for regional treatments, demand that we approach this health matter as a public health issue. The ideological con?icts related to the necessary decriminalization of consumption and the current debate on the medical use of marijuana often confuse the urgent need to establish effective therapeutic strategies for the population affected by this mental disorder. Family therapy and community reinforcement are one of the most effcient interventions, other than the traditional individual and group therapies. Contingent, motivational and cognitive-behavioral tailored interventions appear to be most effcient and recommendable. Aerobic exercise and the use of mobile technology also show effectiveness. The administration of medications such as gabepentin, the aminoacid n-acetyl cysteine (NAC) and the cannabinoid cannabidiol (CBD) appear to be very promising. Usual medications, such as valproic acid, quetiapine and bupropion, increase craving, therefore intensifying the need for consumption and thus yielding overall negative results.

[Training psychiatrists: considerations about the beginning, the transit through basic formation, the strong and the weak points of the formation system]. / El psiquiatra en formación. Reflexiones acerca del comienzo, el tránsito por la formación básica, los puntos sólidos y débiles del sistema formativo.

In the present article we will show the results of the workshop known as The First Training Psychiatrists Latin-American Meeting (2012). We will explore as well, the impact of the psychiatric practice on young physicians who look to the specialty. In this article we intend to update existing bibliography on the subject, and share the results of two research studies done by this team: a questionnaire conducted to first year medical residents working in Metropolitan Buenos Aires (2008/9) and a workshop carried out with the participants of the Latin- American meeting mentioned above.

El psiquiatra en formación. Reflexiones acerca del comienzo, el tránsito por la formación básica, los puntos sólidos y débiles del sistema formativo. / [Training psychiatrists: considerations about the beginning, the transit through basic formation, the strong and the weak points of the formation system].

In the present article we will show the results of the workshop known as The First Training Psychiatrists Latin-American Meeting (2012). We will explore as well, the impact of the psychiatric practice on young physicians who look to the specialty. In this article we intend to update existing bibliography on the subject, and share the results of two research studies done by this team: a questionnaire conducted to first year medical residents working in Metropolitan Buenos Aires (2008/9) and a workshop carried out with the participants of the Latin- American meeting mentioned above.

El psiquiatra en formación. Reflexiones acerca del comienzo, el tránsito por la formación básica, los puntos sólidos y débiles del sistema formativo / [Training psychiatrists: considerations about the beginning, the transit through basic formation, the strong and the weak points of the formation system].

In the present article we will show the results of the workshop known as The First Training Psychiatrists Latin-American Meeting (2012). We will explore as well, the impact of the psychiatric practice on young physicians who look to the specialty. In this article we intend to update existing bibliography on the subject, and share the results of two research studies done by this team: a questionnaire conducted to first year medical residents working in Metropolitan Buenos Aires (2008/9) and a workshop carried out with the participants of the Latin- American meeting mentioned above.

Te tengo bajo mi piel: psiquiatría y salud mental / I catch you under my skin: psychiatry and mental health

Contenido: Homenaje a la búsqueda. La locura de Nabucodonosor. El año más difícil: síndrome del residente de psiquiatría de primer año. Dime lo que ves te diré quién eres. Es-Cristo-Frenia: un taller de teatro en una sala de internación psiquiátrica. Te tengo bajo mi piel. La vida en el consultorio. Cómo armar un grupo terapéutico. Radiografía de un endemoniado. La vergüenza. La tentación. El horror está enterrado en San Vicente.

[Delusion of parasitosis: report of twelve cases]. / Delirio de parasitosis: a propósito de doce casos.

In this paper, the history of the chronic delusional syndrome known as delusional parasitosis or Ekbom syndrome is reviewed as well as its main clinical characteristics, evolution, nosographic position and therapeutic approaches. The findings in the published literature are compared with the clinical experience of the authors who have studied twelve cases. The possible connection with other mental diseases, specifically Obsessive Compulsive Spectrum, is evaluated.

Secuencia de un trance: alteraciones psicopatológicas secundarias a experiencias religiosas / Sequence of a trance: psychopathological disorders following religious experiences

Las alteraciones psicopatológicas secundarias a experiencias religiosas más frecuentes son los trastornos disociativos y los fenómenos de trance. Esta clínica no es frecuente observarla en los consultorios de práctica privada ni hospitalaria. Para realizar esta revisión se concurrió a sitios de culto donde los fenómenos de trance y posesión son frecuentes para observar su clínica y los métodos de inducción. Además se revisó la literatura publicada sobre el tema. Conclusiones: en la Ciudad de Buenos Aires los fenómenos de trance y los trastornos disociativos tienen una tasa de diagnóstico menor que en otros sitios. Los trances que evidenciamos fueron en su totalidad producto de inducciones.

The more frequent psychopathological alteration after religious experiences are the dissociative disorders and trance. It's not frequent to see this clinic in private practice or hospitals in Buenos Aires. To do this revision we went to religious sites where the trance and possession status are frequent, in order to observe their clinic and the methods to induce them. We made a bibliographic revision about trance. Conclusion: In Buenos Aires city the dissociative disorders and the trance are less diagnosed than in other sites. The trances that we saw were totally induced.

Delirio de parasitosis: a propósito de doce casos / Delusion of parasitosis: report of twelve cases

En el presente trabajo se da cuenta de la historia del síndrome delirante crónico conocido como "delirio de parasitosis o síndrome de Ekbom", sus principales características clínicas, evolutivas, la ubicación nosográfica y las estrategias terapéuticas utilizadas. Los hallazgos de la principal literatura publicada se comparan con la experiencia de los autores al haber estudiado doce pacientes portadores de esta sintomatología. Asimismo, se indaga acerca de la posible conexión con otros cuadros psicopatológicos, más específicamente con el espectro obsesivo-compulsivo.

In this paper, the history of the chronic delusional syndrome known as delusional parasitosis or Ekbom syndrome is reviewed as well as its main clinical characteristics, evolution, nosographic position and therapeutic approaches. The findings in the published literature are compared with the clinical experience of the authors who have studied twelve cases. The possible connection with other mental diseases, specifically Obsessive Compulsive Spectrum, is evaluated.

[Pharmacological review of alcoholic dependence treatment]. / Actualización del tratamiento farmacológico de la dependencia alcohólica.

The aim of the present pharmacological update is to revise the problem of alcohol dependence. Starting from the biological bases and the impact of alcohol on the neurobiological and neurotransmission systems, a revision of the main pharmacological tools for alcohol dependence treatment will be done. Disulfiram, naltrexone, acamprosate, all of them approved by the FDA (Food and Drug Administration), have shown mechanisms of action, efficacy, tolerance and adherence dissimilar. We will also refer to topiramate, which is being studied for this indication.

Actualización del tratamiento farmacológico de la dependencia alcohólica / Pharmacological review of alcoholic dependence treatment

El objetivo de la presente actualización farmacológica es abordar la problemática de la dependencia alcohólica. Partiendo de las bases biológicas y del impacto del etanol sobre los sistemas neurobiológicos y de neurotransmisión, se hará una revisión de las principales herramientas farmacológicas para el tratamiento de la dependencia alcohólica. El disulfiram, la naltrexona y el acamprosato, todas ellas con aprobación por la FDA (Food and Drug Administration) han mostrado mecanismos de acción, perfiles de eficacia, tolerabilidad y adherencia dispares. También nos referiremos al topiramato, el que está siendo estudiado actualmente con relación a esta indicación.

The aim of the present pharmacological update is to revise the problem of alcohol dependence. Starting from the biological bases and the impact of alcohol on the neurobiological and neurotransmission systems, a revision of the main pharmacological tools for alcohol dependence treatment will be done. Disulfiram, naltrexone, acamprosate, all of them approved by the FDA (Food and Drug Administration), have shown mechanisms of action, efficacy, tolerance and adherence dissimilar. We will also refer to topiramate, which is being studied for this indication.

[Sequence of a trance: psychopathological disorders following religious experiences]. / Secuencia de un trance: alteraciones psicopatológicas secundarias a experiencias religiosas.

UNLABELLED: The more frequent psychopathological alteration after religious experiences are the dissociative disorders and trance. It's not frequent to see this clinic in private practice or hospitals in Buenos Aires. To do this revision we went to religious sites where the trance and possession status are frequent, in order to observe their clinic and the methods to induce them. We made a bibliographic revision about trance. CONCLUSION: In Buenos Aires city the dissociative disorders and the trance are less diagnosed than in other sites. The trances that we saw were totally induced.

[Operative data of a psychiatric inpatient unit of general hospital during one year]. / Datos operacionales de la Sala de Internación de Psicopatología de un hospital general a lo largo de un año.

OBJECTIVE: Due to the scarcity of data and psychiatric inpatient beds in general hospitals it is a priority to generate information about the service provided in an inpatient unit of a general hospital. METHOD: Between June 1st 2004 and may 31 2005 a naturalistic, prospective and descriptive study took place in the psychiatric inpatient unit of Hospital "T. Alvarez". RESULTS: The average age of intern patients was 36.7 years, the reason for admission was mostly due to psychotic states and self injury risk. 82 admissions took place during a one year follow up (for 71 patients admitted during that time) and 68 were discharged. 48.8% had previously been admitted and 25.6% of them had been admitted 4 o more times. 29.3% were admitted through judicial intervention. 19.1% were discharged without their corresponding medical advice. The most frequent diagnosis were: schizophrenia (29.4%), Substance abuse (22.1%); Borderline Personality (10.3%), Bipolar disorder (8.8%), and Depressive Disorder (7.4%). The average length of stay was 45.4 days (bed turn: 4.1) with 90% of them lasting less than 90 days. CONCLUSIONS: These data may be compared to other data produced in other psychiatric units of our city and shed light on the problems to follow the classical WHO advice to use general hospital facilities for psychiatric inpatients.

[A review of thirty years of activity of the Research Program in Psychiatric Epidemiology (PEPSI) of the CONICET]. / Reseña de treinta años de funcionamiento del Programa de Investigaciones en Epidemiología Psiquiátrica (PEPSI) del CONICET.

This article summarizes the activity of the Programa de Investigaciones en Epidemiología Psiquiátrica (PEPSI) (Research Program in Psychiatric Epidemiology) of the CONICET, directed for more than thirty years by Fernando Pages Larraya. After an anthropologic psychiatric experience done in the Gran Chaco Gualamba, by the end of the 60s, Pages Larraya and his team developed the theory of Cultural Isoidias, zones into which the country could be divided for epidemiologic studies. This article summarizes some of the principal lines of investigation of this program which departures from an initial study of the prevalence of mental diseases in Argentina. Other lines of research (such as a study about marginality, about Alzheimer's disease, about alcoholism and about AIDS) are summarized very briefly so as to give the reader an idea about the enormous field of study embraced by the PEPSI.