Phytotherapy in psychiatry: why psychiatrists should know about it.

There is a substantial use of Complementary and Alternative Medicine (CAM) among both the general population and psychiatric patients, with only a minority of these users disclosing this information to their healthcare providers, including physicians and psychiatrists. This widespread use of CAM can impact positively or negatively on the clinical outcomes of psychiatric patients, and it is often done along with conventional medicines. Among CAM, phytotherapy has a major clinical relevance due to the introduction of potential adverse effects and drug interactions. Thus, the psychiatrist must learn about phytotherapy and stay up-to-date with solid scientific knowledge about phytotherapeutics/herbal medicines to ensure optimal outcomes for their patients. Furthermore, questions about herbal medicines should be routinely asked to psychiatric patients. Finally, scientifically sound research must be conducted on this subject.

Exceptional racism at the dawn of scientific psychiatry in Brazil: the curious case of Juliano Moreira.

Twenty years ago, the British Journal of Psychiatry published an editorial regarding racism and psychiatry. Three decades ago, the journal published a lecture by Professor Michael Sheperd about Kraepelin's contributions to racist degeneration theories. A century ago, Albert Einstein visited the Brazilian Academy of Sciences, where he was hosted by Juliano Moreira [1872-1933], one of the most distinguished Brazilian scientists of that time. The only son of a former enslaved woman, he is regarded as one of the founding fathers of scientific psychiatry in Brazil. Moreira may have been a case of 'exceptional racism', the strategy of praising outstanding people from oppressed groups as a way of denying or covering up processes of structural racism.

Identifying suicidal risk factors in the French Overseas Territories with multimethod psychological autopsy (AUTOPSOM): a mixed-methods study protocol.

INTRODUCTION: Understanding suicide in more isolated territories is a challenge because of the entanglement of cultural identity with historical, geographical and sociocultural specificities. This knowledge is a necessary precondition for the implementation of targeted prevention strategies in regions such as the French overseas territories (FOT), where data concerning suicidal risk factors is still incomplete. We aim to untangle sociocultural and clinical suicide risk factors by integrating a novel anthropological and psycholinguistic approach into the psychological autopsy method. This article describes the protocol of the clinical study 'Contribution of Psychological Autopsy to the Understanding of Suicidal Behaviours in Overseas France' (AUTOPSOM study), designed to identify common or new specific suicide risk factors in four FOT. METHODS AND ANALYSIS: A multicentre epidemiological study will be carried out in four FOTs (French Polynesia, Martinique, La Reunion and French Guiana) and at a comparison site in mainland France (La Somme). The methodology will be based on a mixed-methods (quantitative and qualitative) approach using a psychological autopsy to collect clinical data and life events in the deceased's life. We implemented an exploratory multimethod strategy that combines a succession of epidemiological, anthropological, psycholinguistic and psychological methods with a semiautomated analysis of the discourse of relatives bereaved by suicide. ETHICS AND DISSEMINATION: The study protocol (first version) was approved by the French Ethics Committee (CPP OUEST II, approval #22.04267.000122) and the Ethics Committee of French Polynesia (JOPF of 5 April 2022; CEPF opinion n°91 of 29 March 2022). The overall results and the perspectives established at the end of the study will be communicated to the bereaved relatives according to their will and serve for local suicide prevention purposes. TRIAL REGISTRATION NUMBER: NCT05773898.

Is digital psychiatry really for all? A cross-sectional analysis from two randomized clinical trials.

INTRODUCTION: Digital psychiatry holds promise for expanding accessibility to mental health treatment, but concerns exist regarding its inclusivity and the potential for exacerbation of digital exclusion among vulnerable populations. This study aims to evaluate the inclusivity of digital psychiatry research and interventions, and to explore their potential to worsen digital exclusion. METHODS: We conducted a cross-sectional analysis of sociodemographic data from two clinical trials that utilize psychiatric online treatment modalities in Brazil. Participants were recruited nationwide through digital media platforms. RESULTS: The sample comprised 224 individuals, predominantly female (95.1%) and Caucasian (71.87%) participants, with an average of 15.12 years of schooling. It was observed that White individuals were overrepresented compared to national averages (42.8%). Additionally, participants had a higher average number of years of schooling compared to the national average (10.1 years). Our analysis revealed a clear profile among psychiatric patients with access to and interest in digital interventions, predominantly younger, White, educated, and female individuals. DISCUSSION: As digital therapeutic solutions advance, ensuring their inclusivity and accessibility for vulnerable individuals is crucial. Initiatives to promote digital inclusion and reassess participant recruitment strategies are needed to effectively address digital exclusion. By adopting multifaceted approaches, digital mental health care can be made more effective and accessible to all.

Evaluando habilidades en psiquiatría. Implementación y experiencia del ECOE para pregrado de Medicina / Assessing Skills in Psychiatry. Experience and Implementation of OSCE for Medical Students

resumen Introducción: La formación médica ha venido transformándose, así como las estrategias de evaluación, lo que permite abordar, además de los conocimientos, las habilidades clínicas. En salud mental estas habilidades desempeñan un rol central. El Examen Clínico Objetivo Estructurado (ECOE) es una de las evaluaciones que tiene este potencial. El objetivo del presente artículo es describir la implementación y el desempeño que han tenido los estudiantes de pregrado desde la introducción de este en el año 2015. Métodos: Se recuenta la implementación y se describen los ECOE realizados a estudiantes de pregrado de Medicina que cursan el segundo semestre de Salud Mental tomando las bases de datos de los exámenes prácticos finales. Además se describe la percepción de los docentes del área. Resultados: El ECOE de salud mental se implementó en 2015-2, se desarrolla en el Hospital Simulado de la Universidad y cuenta con 5 estaciones (entrevista, examen mental, diagnóstico, tratamiento e información a la familia y ética). Entre 2016-2 y 2019-2, 486 estudiantes pasaron el ECOE con una nota promedio de 3,85 (baremo de 0 a 5). Se observó que la nota obtenida al evaluarse trastornos de ansiedad estuvo por debajo del promedio; la de trastornos afectivos, por encima del promedio y la de trastornos psicóticos, dentro del promedio. Los docentes resaltan la versatilidad, la mirada objetiva integral de los aspectos prácticos y teóricos y la posibilidad de comparación entre los diferentes grupos. Conclusiones: El ECOE brinda la posibilidad de evaluar las competencias en acción de los estudiantes de Medicina y permite la identificación de qué aspectos mejorar en el proceso de enseñanza-aprendizaje.

abstract Introduction: Medical education has been changing, and the evaluation strategies that make it possible to address not only theoretical knowledge but also clinical skills. In Mental Health, these skills play a central role. The Objective Structured Clinical Examination (OSCE) is one of the evaluations that could assess clinical skills. This article describes the implementation and performance for the evaluation of undergraduate students since the OSCE's introduction in 2015. Methods: An explanation of the implementation is made, and a description of the OSCEs carried out to undergraduate medical students in the second semester of mental health, using the databases of the final practical examinations during those years. The perception of mental health teachers is also described. Results: The mental health OSCE implemented in 2015-2, is developed in the Simulated Hospital of the University and has five stations (interview, mental examination, diagnosis, treatment and information to the family and ethics). Between 2016-2 and 2019-2, 486 students performed OSCE with an average score of 3.85 (scale 0-5). It was observed that the grade obtained when evaluating anxiety disorders was below average, that of affective disorders above average, while that of psychotic disorders was within the average. The professors highlight the versatility, the comprehensive objective evaluation of the practical and theoretical aspects, and the possibility of comparison between the different groups. Conclusions: The OSCE is an examination that provides the possibility to evaluate the competences in psychiatry of medical students and allows the identification of the aspects to be improved in the teaching learning process.

The S20 Brazilian Mental Health Report for Building a Just World and a Sustainable Planet: Part II.

This is the second part of the Brazilian S20 mental health report. The mental health working group is dedicated to leveraging scientific insights to foster innovation and propose actionable recommendations for implementation in Brazil and participating countries. In addressing the heightened mental health challenges in a post-pandemic world, strategies should encompass several key elements. This second part of the S20 Brazilian Mental Health Report will delve into some of these elements, including: the impact of climate change on mental health, the influence of environmental factors on neurodevelopmental disorders, the intersection of serious mental illness and precision psychiatry, the co-occurrence of physical and mental disorders, advancements in biomarkers for mental disorders, the utilization of digital health in mental healthcare, the implementation of interventional psychiatry, and the design of innovative mental health systems integrating principles of innovation and human rights. Reassessing the treatment settings for psychiatric patients within general hospitals, where their mental health and physical needs are addressed should be prioritized in mental health policy. As the S20 countries prepare for the future, we need principles that stand to advance innovation, uphold human rights, and strive for the highest standards in mental health care.

How to treat subsyndromal anxiety disorder - practical recommendations for implementation in primary care.

BACKGROUND: Anxiety is a common and disabling condition that significantly impacts quality of life. Subsyndromal anxiety (SSA) refers to anxiety symptoms that do not meet the full diagnostic criteria for an anxiety disorder but pose a risk for developing such disorders. We aimed to provide practical recommendations for the treatment of SSA in primary care settings. METHODS: A narrative review was conducted to identify strategies for recognizing and treating patients with SSA. RESULTS: The recommendations for treating SSA include lifestyle modifications such as exercise and stress reduction techniques, psychotherapy, and pharmacological treatments, including natural compounds like the lavender oil extract Silexan. Regular follow-up care is essential to monitor treatment response and address ongoing symptoms. Additionally, the use of the GAD-7 tool is recommended for accurately identifying patients with SSA. CONCLUSION: Implementing these recommendations in primary care can lead to effective treatment of SSA, preventing the development of more severe anxiety disorders. An integrative approach, combining lifestyle modifications, psychotherapy, and pharmacotherapy, including natural compounds, offers significant benefits for managing anxiety.

Anxiety is prevalent and disablingSubsyndromal anxiety is a risk factor for anxiety disordersSubsyndromal anxiety can be assessed with the GAD-7 (Generalised Anxiety Disorder-7 scale)Subsyndromal anxiety can be treated with life-style modification, psychotherapy and pharmacological treatment, including silexan, a natural compound.

Integrating neuroscience and humanities in healthcare evolution: a multidisciplinary perspective / Integração das neurociências e das ciências humanas na evolução dos cuidados de saúde: uma perspetiva multidisciplinar

The trajectory of healthcare has evolved from ancient holistic practices to the present biomedical model, reflecting the dynamic interplay between scientific progress, technological advancements, and the integration of humanistic values. While biomedical advancements have revolutionized medical treatments, there is an emerging recognition of the importance of integrating neuroscience and humanities to foster holistic patient care and understanding. This paper aims to explore the historical development of medicine, emphasizing the convergence of neuroscience, psychiatry, and neurology within the biomedical framework. Additionally, it investigates the resurgence of humanities in healthcare and its role in promoting patientcentered care. Through a comprehensive review of literature, this study traces the historical roots of medicine and examines the interdisciplinary intersections of neuroscience, psychiatry, neurology, and medical humanities. The exploration reveals the significant contributions of interdisciplinary approaches in enhancing patient-centered care, fostering a comprehensive understanding of health and well-being, and shaping modern healthcare practices. The integration of neuroscience and humanities offers valuable insights into the complexities of human health, bridging legacy practices with innovative approaches. Embracing this interdisciplinary perspective is crucial for promoting holistic healthcare, emphasizing patient-centered care, and enriching the understanding of health and well-being in contemporary healthcare settings.

A trajetória dos cuidados de saúde evoluiu das antigas práticas holísticas para o atual modelo biomédico, reflectindo a interação dinâmica entre o progresso científico, os avanços tecnológicos e a integração de valores humanísticos. Embora os avanços biomédicos tenham revolucionado os tratamentos médicos, há um reconhecimento emergente da importância de integrar as neurociências e as humanidades para promover a compreensão e os cuidados holísticos dos doentes. Este artigo tem como objetivo explorar o desenvolvimento histórico da medicina, salientando a convergência da neurociência, da psiquiatria e da neurologia no quadro biomédico. Além disso, investiga o ressurgimento das humanidades nos cuidados de saúde e o seu papel na promoção de cuidados centrados no doente. Através de uma revisão exaustiva da literatura, este estudo traça as raízes históricas da medicina e examina as intersecções interdisciplinares da neurociência, psiquiatria, neurologia e humanidades médicas. A exploração revela os contributos significativos das abordagens interdisciplinares para melhorar os cuidados centrados no doente, promover uma compreensão abrangente da saúde e do bem-estar e moldar as práticas modernas de cuidados de saúde. A integração das neurociências e das humanidades oferece conhecimentos valiosos sobre as complexidades da saúde humana, fazendo a ponte entre práticas antigas e abordagens inovadoras. A adoção desta perspetiva interdisciplinar é crucial para promover cuidados de saúde holísticos, enfatizando os cuidados centrados no doente e enriquecendo a compreensão da saúde e do bem-estar nos contextos de cuidados de saúde contemporâneos.

Knowledge and perceived confidence of Brazilian psychiatrists about eating disorders´ diagnosis and treatment recommendations.

OBJECTIVE: To investigate Brazilian psychiatrists ́ knowledge and perceived confidence, both in diagnosis and in evidence-based treatments for eating disorders (ED). METHODS: In this cross-sectional study, 259 psychiatrists filled out an online form including: sociodemographic data, questions about ED diagnosis and management based on standard guidelines. Descriptive statistics described sample characteristics and levels of ED knowledge and perceived confidence. RESULTS: Sample was composed mainly by women (65,64%), with mean age of 42.86, from the Southeast of Brazil (56,37%), working predominantly in private practice (59,85%), with less than ten years of experience in Psychiatry (51,74%). We found that 33.21% of participants correctly chose diagnostic criteria for anorexia nervosa (AN); 29.73% for bulimia nervosa (BN), and 38.22% for binge eating disorder (BED). Correct answers for therapeutic options were similar in BN and BED (20.8%), being considerably lower for AN (2.7%). Additionally, reported ED training were: 15.1% during medical school; 59.8% during medical residency/postgraduate studies; 58.7% as complementary training. Only 8.89% felt satisfied with their ED training; 50.97% felt confident diagnosing ED and 37.07% in managing ED patients. CONCLUSION: These results demonstrated an important gap in ED knowledge of Brazilian psychiatrists, and its consequences on their confidence and competence in managing ED patients.

The Role of Parental Emotional Health and Parenting Practices in Offspring Mental Health.

In the family social environment, children can experience and observe stressful situations, involving mental health and parental practices. The review by Mendes-Sousa et al. examines the relation between family stress, child development, and offspring mental health. Of the main results, we highlight the relationship between maternal depression with developmental delays and child internalizing and externalizing symptoms. Furthermore, negative parenting practices were also related to children's emotional and behavioral problems, while positive practices were beneficial to the socio-emotional development of offspring. The review warns about preventing socio-emotional problems in offspring, through promoting parental mental health, positive parenting practices, and cohesive family environments. Finally, we envision a significant path for subsequent research on maternal emotional overload and the central role of mothers in caring for their offspring, exploring shared care for children and potential public policies aimed at mothers' mental health and social inclusion.

Análisis sociodemográfico, metodológico y diagnóstico de los informes periciales en psiquiatría y psicología para la toma de decisiones legales en el Centro de Estudios en Derecho y Salud (Medellín, Colombia) / Socio-demographic, methodological and diagnostic analysis of expert reports in psychiatry and psychology for legal decision-making Centro de Estudios en Derecho y Salud (Medellín, Colombia) / Análise sociodemográfica, metodológica e diagnóstica de relatórios de especialistas em psiquiatria e psicologia para tomada de decisões legais no Centro de Estudios en Derecho y Salud (Medellín, Colombia)

El objetivo del presente estudio fue analizar las características sociodemográficas, metodológicas y diagnósticas de los informes periciales en psiquiatría y psicología realizados en el Centro de Estudios en Derecho y Salud entre 2011 y 2020. Se optó por un enfoque cuantitativo, descriptivo con intención analítica, transversal, con diseño retrospectivo. Se analizó la información obtenida en 145 peritajes. Se adelantó un análisis univariado para todas las variables sociodemográficas, metodológicas y diagnósticas de los informes periciales, según su naturaleza cualitativa o cuantitativa, y un análisis bivariado a través de tablas de contingencia para las variables mencionadas, con intervalos de confianza del 95 % para cada una de las medidas de prevalencia. Se encontró que la mayoría de peritajes fueron solicitados por el área del derecho contencioso-administrativo. Los diagnósticos más prevalentes fueron el trastorno adaptativo, el trastorno por estrés postraumático y el trastorno depresivo. Si bien los informes revisados cumplen con los lineamientos mínimos de ley, se encontraron algunas falencias relacionadas con la ausencia de información. Se espera que estos hallazgos permitan la reflexión por parte de los auxiliares de la justicia sobre los requerimientos de los informes periciales con miras a la humanización de la justicia y el apoyo a la toma de decisiones legales.

The aim of this study was to analyse the socio-demographic, methodological and diagnostic characteristics of the expert reports in psychiatry and psychology carried out at the Centre for Law and Health Studies between 2011 and 2020. We opted for a quantitative, descriptive approach with analytical, cross-sectional, retrospective design. The information obtained from 145 expert opinions was analysed. A univariate analysis was carried out for all sociodemographic, methodological and diagnostic variables in the expert reports, according to their qualitative or quantitative nature, and a bivariate analysis through contingency tables for the aforementioned variables, with confidence intervals of 95 % for each of the prevalence measures. It was found that the majority of expert opinions were requested by the area of contentious-administrative law. The most prevalent diagnoses were adjustment disorder, post-traumatic stress disorder and depressive disorder. Although the reports reviewed comply with the minimum legal guidelines, there were some shortcomings related to the absence of information. It is hoped that these findings will allow for reflection on the part of justice officials on the requirements of expert reports with a view to the humanisation of justice and support for legal decision-making.

O objetivo deste estudo foi analisar as características sociodemográficas, metodológicas e diagnósticas dos laudos periciais em psiquiatria e psicologia realizados no Centro de Estudos em Direito e Saúde entre 2011 e 2020. Optou-se por uma abordagem quantitativa e descritiva com desenho analítico, transversal e retrospectivo. Foram analisadas as informações obtidas de 145 pareceres de especialistas. Foi realizada uma análise univariada para todas as variáveis sociodemográficas, metodológicas e diagnósticas dos laudos periciais, de acordo com sua natureza qualitativa ou quantitativa, e uma análise bivariada por meio de tabelas de contingência para as variáveis mencionadas, com intervalos de confiança de 95 % para cada uma das medidas de prevalência. Verificou-se que a maioria dos pareceres foi solicitada pela área de direito contencioso-administrativo. Os diagnósticos mais prevalentes foram transtorno de ajustamento, transtorno de estresse pós-traumático e transtorno depressivo. Embora os relatórios analisados estejam em conformidade com as diretrizes legais mínimas, houve algumas deficiências relacionadas à ausência de informações. Espera-se que esses resultados permitam uma reflexão por parte dos envolvidos no sistema judiciário sobre os requisitos dos laudos periciais, com vistas à humanização da justiça e ao apoio à tomada de decisões legais.

Síndrome de Rapunzel: atadura sicológica y simulación orgánica / Rapunzel syndrome: psychological bondage and organic simulation

Introducción. El síndrome de Rapunzel es una entidad infrecuente, que se presenta como un tricobezoar a causa de una aglomeración de cabello acumulado dentro del tracto gastrointestinal, por lo que simula otras patologías quirúrgicas. Caso clínico. Paciente femenina de 10 años de edad, con tricotilomanía y tricofagia, dolor abdominal y síntomas inespecíficos de obstrucción intestinal de ocho meses de evolución. Al examen físico se encontró abdomen con distensión y masa palpable en epigastrio y mesogastrio. La ecografía permitió hacer el diagnóstico de tricobezoar gástrico extendido hasta el intestino delgado, por lo que se llevó a cirugía para gastrotomía y se extrajo el tricobezoar, con evolución satisfactoria de la paciente. El abordaje integral permitió conocer la atadura sicológica por posible maltrato infantil. Resultado. La paciente tuvo una evolución satisfactoria y se dio egreso al quinto día de hospitalización. Actualmente se encuentra en seguimiento por sicología, siquiatría infantil y pediatría. Discusión. El caso clínico denota la importancia en reconocer situaciones de presentación infrecuente en pediatría, que puedan estar asociadas a alteraciones sicológicas o presunción de maltrato infantil y que se presenten como una condición orgánica recurrente que simule otras patologías abdominales frecuentes en la infancia. El retraso diagnóstico puede conducir a un desenlace no deseado con complicaciones. Conclusión. Se hace mandatorio el manejo integral del paciente pediátrico y aumentar la sensibilidad para reconocer situaciones de presunción de maltrato infantil, sobre todo en pacientes con una condición orgánica quirúrgica recurrente.

Introduction. Rapunzel syndrome is an uncommon condition that manifests as trichobezoars, which are hair bundles in the stomach or small intestine that can mimics other surgical illnesses. Multiple complications can arise from delayed diagnosis and treatment. Clinical case. A 10-year-old female patient with trichotillomania and trichophagia, with abdominal pain and nonspecific symptoms of intestinal obstruction of eight months of evolution. Physical examination revealed epigastric tenderness and a solid mass was palpable in the mesogastric and epigastric region. An abdominal ultrasound showed gastric trichobezoar that extended into the small intestine. A gastrotomy was performed and the trichobezoar was extracted with satisfactory evolution of the patient. The comprehensive approach allowed knowing the psychological bond due to possible child abuse. Results. The patient had a satisfactory evolution and was discharged on the fifth day of hospitalization. He is currently being monitored by psychology, child psychiatry and pediatrics. Discussion. This clinical case highlights the importance of recognizing situations that seldom present in pediatrics, which may have a psychological aspect due to the presumption of child abuse, and which present as a recurrent organic condition simulating other frequent abdominal pathologies in childhood; all of which may lead to an unwanted outcome due to diagnostic delay. Conclusion. The comprehensive management of the pediatric patient is mandatory to recognize situations of presumed child abuse, in the face of a recurrent surgical conditions.

Psychiatric disorders in pregnant women admitted to the high-risk obstetric service in a Colombian university clinic between 2013 and 2017.

OBJECTIVE: To determine the psychiatric diagnoses and treatments of patients admitted to the high-risk obstetric service who underwent a consultation with a liaison psychiatrist. METHODS: A descriptive observational study that included pregnant women from the high-risk obstetric service of a highly specialised clinic in Medellín, who had a liaison psychiatry consultation between 2013 and 2017. The main variables of interest were psychiatric and obstetric diagnoses and treatments, in addition to biopsychosocial risk factors. RESULTS: A total of 361 medical records were screened, with 248 patients meeting the inclusion criteria. The main prevailing psychiatric diagnosis was major depressive disorder (29%), followed by adaptive disorder (21.8%) and anxiety disorders (12.5%). The pharmacologic treatments most used by the psychiatry service were SSRI antidepressants (24.2%), trazodone (6.8%) and benzodiazepines (5.2%). The most common primary obstetric diagnosis was spontaneous delivery (46.4%), and the predominant secondary obstetric diagnoses were hypertensive disorder associated with pregnancy (10.4%), gestational diabetes (9.2%) and recurrent abortions (6.4%). Overall, 71.8% of the patients had a high biopsychosocial risk. CONCLUSIONS: The studied population's primary psychiatric disorders were major depressive disorder, adjustment disorder and anxiety disorders, which implies the importance of timely recognition of the symptoms of these perinatal mental pathologies, together with obstetric and social risks, in the prenatal consultation. Psychiatric intervention should be encouraged considering the negative implications of high biopsychosocial risk in both mothers and children.

Adherence to the ultra-processed dietary pattern and risk of depressive outcomes: Findings from the NutriNet Brasil cohort study and an updated systematic review and meta-analysis.

BACKGROUND & AIMS: We aimed to analyze the prospective association between adherence to the ultra-processed dietary pattern and risk of depressive outcomes using original data from the NutriNet Brasil cohort and via a systematic review and meta-analysis of observational studies that have investigated the same association. METHODS: In our original research analysis, we used data from 15,960 adults (≥18 y) participating in the NutriNet Brasil cohort study, free of depression or depressive symptoms during the baseline (77.5% women, 45.8 ± 13.0 y). The mean dietary share of ultra-processed foods (%Kcal/d), calculated from two baseline 24-h dietary recalls, was used to measure the adherence to the ultra-processed dietary pattern. New cases of depressive symptoms were assessed using the Patient Health Questionnaire-9 over the follow-up period (mean: 18.3 months). Cox proportional hazards models were used for the main analyses. In our systematic review and meta-analysis, we incorporated effect estimates from six prospective cohort studies that have examined the same association, including ours. RESULTS: In the adjusted model, each 10% increase in the dietary share of ultra-processed foods was associated with a 10% increase in the hazard of incident cases of depressive symptoms (HR:1.10; 95%CI: 1.07-1.14). This association was slightly attenuated in the models including potential mediators. In our meta-analysis of six prospective studies, high versus low exposure to ultra-processed foods was associated with a summary hazard ratio of depressive outcomes of 1.32; 95%CI: 1.19-1.46; I2: 71%. CONCLUSION: A higher adherence to the ultra-processed dietary pattern was associated with a higher risk of developing depressive outcomes in the NutriNet Brasil cohort and in the meta-analysis.

History of writing as a tool for the practice of psychiatry and mental health / Historia de la escritura como herramienta para la práctica de la psiquiatría y la salud mental.

Writing as we know it today is a relatively new development in the cultural history of humanity. More current still is the massiveness of the literacy of the population. Since the origins of psychiatry, writing has been an inherent part of it in the medical literature, but it has also been a tool applied in practice in various formats, both for diagnostic and therapeutic purposes. However, compared to the classic communication tools, such as speech, and in child psychiatry, also play and drawing, writing seems to have been relegated. In this bibliographical research, that would not have precedents of its kind, a historical overview of the subject was carried out from the emergence of psychiatry as a specialty to the present day; where events such as the World Wars, the evolution of the concept of disability or the COVID-19 pandemic seem to have played a key role in delimiting variables that characterize at least three historical periods and presuming a fourth in full gestation. The technological support with which it is written and the use and format given to writing were the main variables of the different periods. Being a time of very high demand in Mental Health, challenging in its accessibility and the massive use of writing from information technologies, this research would represent a significant contribution to the development of writing as a tool for the practice of psychiatry and mental health.

La escritura como la conocemos hoy en día es un desarrollo relativamente nuevo en la historia cultural de la humanidad. Más actual aún es la masividad de la alfabetización de la población. Desde los orígenes de la psiquiatría, la escritura forma parte inherente de ésta en la bibliografía médica pero también como una herramienta aplicada en la práctica en diversos formatos, tanto con fines diagnósticos como terapéuticos. No obstante, frente a las herramientas clásicas de comunicación, como el habla, y en la psiquiatría infantil, también el juego y el dibujo, la escritura parece haber sido relegada. En esta investigación bibliográfica, que no tendría antecedentes en su tipo, se realizó un recorrido histórico de la temática desde el surgimiento de la psiquiatría como especialidad hasta nuestros días; donde hechos como las Guerras Mundiales, la evolución del concepto de discapacidad o la pandemia por COVID-19 parecen haber jugado un papel clave para delimitar variables que caracterizan, al menos, tres períodos históricos y presumir un cuarto en plena gestación. El soporte tecnológico con el que se escribe y el uso y formato dado a la escritura resultaron las principales variables de los distintos períodos. Siendo ésta una época de muy alta demanda en Salud Mental, desafiante en su accesibilidad y la masividad en el uso de la escritura a partir de tecnologías de la información, esta investigación representaría un aporte significativo al desarrollo de la escritura como herramienta para la práctica de la psiquiatría y la salud mental.

Alteraciones psiquiátricas en pacientes con antecedentes de infección por SARS-CoV-2 / Psychiatric alterations in patients with a history of SARS-CoV-2 infection

Objetivo: Caracterizar los trastornos mentales de los pacientes consultantes del Servicio de Psiquiatría del Hospital Universitario de Caracas enero 2020 ­enero 2021, que acudieron por primera vez y habían presentado infección por COVID-19 3 a 6 meses antes de consultar. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo, de corte transversal en pacientes que acudieron al Servicio de Psiquiatría del Hospital Universitario de Caracas para emergencia (por primera vez y sucesivas) por presentar patologías mentales durante y posterior a infección por COVID-19 durante el periodo enero 2020-enero 2021. Resultados: De 718 pacientes, 53 que acudieron con patologías mentales habían presentado infección previa por COVID-19 representando el 7,38%. Edad promedio 27-29 años (66,03 %). La mayoría del sexo femenino (71,69 %). El 77,35 % provenían del Distrito Capital; el 18,86 % del estado Miranda, siendo el estado civil predominante la soltería con 73,58 %; el 56,60 % estaban desempleados y el 79,24 % no poseían nivel de instrucción. En relación a los diagnósticos: trastorno depresivo mayor con síntomas ansiosos (30,18 %), trastorno depresivo (18,86 %), episodio maniforme (1,88 %) episodio psicótico agudo (18,86 %), trastorno de ansiedad generalizada (7,54 %), entre otros. Conclusión: Los síntomas psiquiátricos originados por infección por COVID-19 aparecen de forma más tardía y persisten después de la infección. Las mujeres manifestaron mayor riesgo de presentar síntomas relacionados con la salud mental; se asocia a alto nivel de vulnerabilidad a causa de la influencia de los roles sociales, ciclo reproductivo y mayor morbilidad psiquiátrica(AU)

Objective: To characterize the mental disorders of the consulting patients of the Psychiatry Service of the University Hospital of Caracas January 2020 -January 2021, who came for the first time and hapresented COVID-19 infection 3 to 6 monthsbefore consulting. Methods: An observational, descriptive, retrospective, cross-sectional study was carried out in patients who attended the Psychiatry Service of the University Hospital of Caracas for emergencies (for the first time and successive ones) due to presenting mental pathologies during and after COVID-19 during the period January 2020-January 2021. Results: Of 718 patients, 53 who came with mental pathologies had previous COVID-19 infection, representing 7.38%. Average age 27-29 years(66.03%). The majority were female (71.69%). 77.35% came from the Capital District; 18.86% from the state of Miranda, with the predominant marital status being single with 73.58%; 56.60% were unemployed and 79.24% had no educational level. In relation to the diagnoses: major depressive disorder with anxious symptoms (30.18%), depressive disorder (18.86%), maniform episode (1.88%), acute psychotic episode (18.86%), generalized anxiety disorder (7.54%), among others. Conclusion: Psychiatric symptoms caused by COVID-19 infection appear later and persist after infection. Women expressed a greater risk of presenting symptoms related to mental health; It is associated with a high level of vulnerability due to the influence of social roles, reproductive cycle and greater psychiatric morbidit(AU)

Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study. / Telesalud mental en una unidad pública de psiquiatría infanto-juvenil en pandemia: estudio cualitativo de implementación.

Background: The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. Methods: This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. Results: In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. Conclusions: There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.

Antecedentes: La pandemia por COVID-19 generó una implementación súbita de las atenciones a distancia, especialmente en atenciones de salud mental. La evidencia que sustenta esta modalidad de atención es aún emergente, con escasos estudios cualitativos que representen su implementación en países latinoamericanos. El objetivo de este trabajo es conocer la perspectiva de terapeutas y de usuarios, respecto del uso de la telesalud en una unidad de salud mental infantil y de la adolescencia de un servicio público chileno. Métodos: Estudio cualitativo. Se establecieron dos grupos focales con 14 profesionales en total, y 16 entrevistas en profundidad con usuarios de una unidad ambulatoria de psiquiatría infanto juvenil.. Los datos se analizaron utilizando el modelo de teoría fundamentada. Resultados: En el grupo de terapeutas surgen cuatro categorías fundamentales; antecedentes de la telesalud mental, implementación, telesalud mental desde la posición del terapeuta y proyecciones. En el grupo de usuarios surgieron tres categorías principales: implementación, evaluación de los usuarios de la telesalud mental y proyecciones. Conclusiones: Existen elementos en común entre la opinión de los usuarios y terapeutas. Un elemento importante dentro del grupo de los usuarios es que, a pesar de aceptar la atención remota y reconocer aspectos positivos en esta, fuera del contexto de pandemia prefieren atenciones presenciales o mixtas.

Telesalud mental en una unidad pública de psiquiatría infanto-juvenil en pandemia: estudio cualitativo de implementación / Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study

ANTECEDENTES: La pandemia por COVID-19 generó una implementación súbita de las atenciones a distancia, especialmente en atenciones de salud mental. La evidencia que sustenta esta modalidad de atención es aún emergente, con escasos estudios cualitativos que representen su implementación en países latinoamericanos. El objetivo de este trabajo es conocer la perspectiva de terapeutas y de usuarios, respecto del uso de la telesalud en una unidad de salud mental infantil y de la adolescencia de un servicio público chileno. MÉTODOS: Estudio cualitativo. Se establecieron dos grupos focales con 14 profesionales en total, y 16 entrevistas en profundidad con usuarios de una unidad ambulatoria de psiquiatría infanto juvenil.. Los datos se analizaron utilizando el modelo de teoría fundamentada. RESULTADOS: En el grupo de terapeutas surgen cuatro categorías fundamentales; antecedentes de la telesalud mental, implementación, telesalud mental desde la posición del terapeuta y proyecciones. En el grupo de usuarios surgieron tres categorías principales: implementación, evaluación de los usuarios de la telesalud mental y proyecciones. CONCLUSIONES: Existen elementos en común entre la opinión de los usuarios y terapeutas. Un elemento importante dentro del grupo de los usuarios es que, a pesar de aceptar la atención remota y reconocer aspectos positivos en esta, fuera del contexto de pandemia prefieren atenciones presenciales o mixtas.

BACKGROUND: The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. METHODS: This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. RESULTS: In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. CONCLUSIONS: There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.

Trastornos Psiquiátricos en Gestantes Hospitalizadas en el Servicio de Alto Riesgo Obstétrico de la Clínica Universitaria Bolivariana de Medellín (Colombia) Durante los Años 2013 a 2017 / Psychiatric Disorders in Pregnant Women Admitted to the High-Risk Obstetric Service in a Colombian University Clinic Between 2013 and 2017

RESUMEN Objetivos: Determinar los diagnósticos psiquiátricos y describir características clínicas, el riesgo biopsicosocial y los tratamientos de las pacientes hospitalizadas en el servicio de alto riesgo obstétrico para las que se realizó una interconsulta con psiquiatría. Métodos: Estudio observacional descriptivo en el que se incluyó a las pacientes del servicio de alto riesgo obstétrico de una institución de alta complejidad de Medellín para las que se interconsultó por psiquiatría de enlace entre 2013 y 2017. Las principales variables de interés fueron los diagnósticos y tratamientos tanto psiquiátricos como gineco obstétricos, además de los factores de riesgo obstétricos y psicosociales. Resultados: Se cribaron en total 361 historias clínicas, y 248 pacientes cumplían los criterios de inclusión. El diagnóstico psiquiátrico principal más prevalente fue trastorno depresivo mayor (29%), seguido por el trastorno de adaptación (21,8%) y los trastornos de ansiedad (12,5%); los fármacos más prescritos por psiquiatría fueron antidepresivos ISRS (24,2%), trazodona (6,8%) y benzodiacepinas (5,2%). El diagnóstico obstétrico principal más común fue el parto espontáneo (46,4%) y los diagnósticos obstétricos secundarios que predominaron fueron trastorno hipertensivo asociado con el embarazo (10,4%), diabetes gestacional (9,2%) y abortos recurrentes (6,4%). El 71,8% de las pacientes tenían un riesgo biopsicosocial alto. Conclusiones: Los principales diagnósticos psiquiátricos fueron trastorno depresivo mayor, trastorno de adaptación y trastornos de ansiedad, lo que implica la importancia del oportuno reconocimiento en la evaluación prenatal de los síntomas de estas entidades, conjuntamente con los factores de riesgo obstétrico y social. La intervención psiquiátrica es necesaria considerando las implicaciones negativas que tiene el alto riesgo tanto para la madre como paraelniño.

ABSTRACT Objective To determine the psychiatric diagnoses and treatments of patients admitted to the high-risk obstetric service who underwent a consultation with a liaison psychiatrist. Methods: A descriptive observational study that included pregnant women from the high-risk obstetric service of a highly specialised clinic in Medellín, who had a liaison psychiatry consultation between 2013 and 2017. The main variables of interest were psychiatric and obstetric diagnoses and treatments, in addition to biopsychosocial risk factors. Results: A total of 361 medical records were screened, with 248 patients meeting the inclusion criteria. The main prevailing psychiatric diagnosis was major depressive disorder (29%), followed by adaptive disorder (21.8%) and anxiety disorders (12.5%). The pharmacologic treatments most used by the psychiatry service were SSRI antidepressants (24.2%), trazodone (6.8%) and benzodiazepines (5.2%). The most common primary obstetric diagnosis was spontaneous delivery (46.4%), and the predominant secondary obstetric diagnoses were hypertensive disorder associated with pregnancy (10.4%), gestational diabetes (9.2%) and recurrent abortions (6.4%). Overall, 71.8% of the patients had a high biopsychosocial risk. Conclusions: The studied population's primary psychiatric disorders were major depressive disorder, adjustment disorder and anxiety disorders, which implies the importance of timely recognition of the symptoms of these perinatal mental pathologies, together with obstetric and social risks, in the prenatal consultation. Psychiatric intervention should be encouraged considering the negative implications of high biopsychosocial risk in both mothers and children.

Negación psicótica del embarazo. Reporte de caso / Psychotic denial of pregnancy. Case report

La negación psicótica del embarazo es un trastorno poco frecuente y potencialmente peligroso que puede dividirse en dos variantes: psicótica y no psicótica. La negación psicótica del embarazo suele ir acompañada de antecedentes de enfermedad mental. Entre sus efectos negativos se encuentran la angustia psicológica, los partos no asistidos fuera de los hospitales y un aumento potencial de la morbilidad y mortalidad materna y neonatal. Es crucial incluir antecedentes personales y/o familiares de psicopatologías como parte de la anamnesis, ya que esta condición debe ser tratada por un psiquiatra. En cuanto al manejo de este trastorno durante el embarazo o puerperio, no existen recomendaciones específicas. Para proporcionar una atención integral, suele ser necesario un enfoque multidisciplinario. Se presenta un caso de negación psicótica del embarazo(AU)

Denial of pregnancy is a rare, potentially dangerous disorder that can be divided into two variants: psychotic and nonpsychotic. Psychotic denial of pregnancy is typically accompanied by a history of mental illness. Negative effects include psychological distress, unsupported births outside of hospital, and a potential rise in mother and newborn morbi-mortality. It is crucial to include a personal and/or family history of psychopathology as part of the anamnesis because this condition should be treated by a psychiatrist. Regarding the management of this disorder during pregnancy or puerperium, there are no specific recommendations. To provide comprehensive care, a multidisciplinary approach is typically required. A case of psychotic denial of pregnancy is presented(AU)