Prevalencia y factores de riesgo del uso problemático de psicofármacos de prescripción en población con trastorno mental grave: Una revisión sistemática / Prevalence and risk factors for misuse of prescription psychotropic drug in patients with severe mental illness: a systematic review

Objetivo. El uso problemático de psicofármacos de prescripción es un creciente problema de salud. Uno de los grupos más expuestos al consumo de estas sustancias son las personas con un trastorno mental grave. El objetivo de esta revisión es analizar cuál es la prevalencia y los factores de riesgo, del uso problemático de fármacos psicoactivos, con prescripción médica, en pacientes con trastorno mental grave. Método. Se llevó a cabo una revisión sistemática siguiendo el protocolo PRISMA consultando las bases de datos científicas Medline, Web Of Science, SCOPUS, Proquest y PsycINFO. La revisión se realizó desde enero de 2011 hasta diciembre de 2021. De cada documento se extrajo la información relativa al uso problemático de los psicofármacos prescritos y sus niveles de gravedad. Resultados. De un total de 477 trabajos, 5 cumplían con los criterios de inclusión. Entre un 26% y un 48,7% de pacientes con trastorno mental grave hace un uso problemático de los psicofármacos prescritos y desarrollan dependencia. Los problemas de consumo de otras drogas, tener una historia de prescripción de benzodiacepinas, considerar esencial el uso del fármaco, un uso prolongado, la impulsividad y los comportamientos autolesivos se mostraron como factores de riesgo a la hora de desarrollar un uso problemático de los psicofármacos recetados. Conclusiones. La población con trastorno mental grave convive con factores que la hacen vulnerable al riesgo de desarrollar un uso problemático de las sustancias psicoactivas prescritas. Son necesarios futuros estudios, que profundicen en los efectos y el tratamiento del uso problemático, de los psicofármacos prescritos, en estos pacientes. (AU)

Objective. The misuse of prescription psychotropic drugs is a major health problem. One of the most exposed groups to the use of these substances is people with a severe mental illness. The aim of this review is to assess the prevalence and risk factors of problematic use of psychoactive prescription drugs in patients with SMI. Method. A systematic review was conducted following a PRISMA protocol through the scientific databases PubMed, Web Of Science, SCOPUS, ProquestPsycho and PsycInfo. The review was conducted from January 2011 to December 2021. Information on the misuse of prescribed psychotropic drugs and the levels of dependence generated in the severe mental illness population was examined. Results. A total of 477 studies were identified, and 5 were selected according to the established criteria. Between 26% and 48.7% of patients with severe mental illness misuse prescribed psychotropic drugs and develop dependence. Other drug use problems, having a history of benzodiazepine prescription, perceive drug use as essential, prolonged use, impulsivity and self-harm behaviors were shown as risk factors for developing misuse of prescribed psychotropic drugs. Conclusions. The severe mental illness population lives with several factors that make them vulnerable to the risk of developing misuse of prescribed psychoactive substances. Future studies are needed, since the current evidence is limited, and does not delve into the effects and treatment of misuse of prescribed psychotropic drugs in these patients. (AU)

Hospital de día psiquiátrico en tiempos de COVID: grupos y telemedicina / Psychiatric day hospital in times of covid: Groups and telemedicine

Tras decretarse el estado de alarma y el confinamiento por la amenaza del COVID-19, el acceso a los servicios de salud mental y recursos psicosociales se vio obstaculizado, incluso interrumpido.Un colectivo especialmente en riesgo es el de pacientes diag-nosticados de Trastorno Mental Grave. Estos presentan una serie de características que los hace más vulnerables a padecer un em-peoramiento en su salud mental.Desde el Hospital de Día para primeros brotes psicóticos de Pontones se intentó mantener la atención y el seguimiento estre-cho de los pacientes mediante la reestructuración del programa de tratamiento, optando por una intervención terapéutica alternativa mixto (con atención individual presencial y telefónica y terapias grupales por videoconferencia).El objetivo de este trabajo es dar a conocer la experiencia de la implementación de la telemedicina en nuestro HD como res-puesta a la emergencia sanitaria que ocasionó la pandemia, así como recoger el programa de actividades que se desarrollaron y el nivel de satisfacción con el tratamiento recibido de los pacientes que participaron.(AU)

Following the state of alarm and containment due to the CO-VID-19 threat, access to mental health services and psychosocial resources was hampered, even interrupted.A particularly at-risk group is that of patients diagnosed with Severe Mental Disorder. They present a series of characteristics that make them more vulnerable to a worsening of their mental health.From the Day Hospital for first psychotic outbreaks in Pontones we tried to maintain the attention and close monitoring of patients by restructuring the treatment programme, opting for a mixed al-ternative therapeutic intervention (with individual face-to-face and telephone attention and group therapies by videoconference).The aim of this paper is to report on the experience of implemen-ting telemedicine in our HD as a response to the health emergency caused by the pandemic, as well as to record the programme of activities that were developed and the level of satisfaction with the treatment received by the patients who participated.(AU)

Perfiles clínicos en hospitalización psiquiátrica prolongada: reflexiones para un nuevo enfoque en el abordaje del trastorno mental grave / Clinical profiles in prolonged psychiatric hospitalization: reflections for a new approach in the treatment of serious mental illness

El acceso de los usuarios con trastorno mental grave (TMG) a los dispositivos sociosanitarios viene determinado por unos criterios preestablecidos que pueden estar opacando la existencia de perfiles clínicos con diferentes necesidades terapéuticas. En esta línea, desde el Centro San Juan de Dios de Ciempozuelos (CSJD), se ha realizado un estudio descriptivo de tipo transversal en el que se han encontrado cinco tipologías clínicas mediante la aplicación de un análisis de conglomerados en dos fases. En el estudio participaron 413 personas con TMG ingresadas en diferentes dispositivos de la Unidad de Cuidados Psiquiátricos Prolongados -UCPP- del CSJD (en función de su autonomía y necesidades) y que presentaban una media de edad de 53.78 años (95.4% varones y 4.4% mujeres) y altos niveles de institucionalización (media de 13.06 años). El diagnóstico principal encontrado fue el de esquizofrenia residual (38.3%; n= 158), seguido de esquizofrenia paranoide (26.6%; n= 110). También había un número significativo de trastornos de la personalidad (35 casos). Las cinco tipologías de usuarios se denominaron en función de sus características más destacadas: Rehab (R), Rehab Behav (RB), Young Care (YC), Old Care (OC) y Young Behav (YB). En función de estos resultados se debate la idoneidad de los recursos existentes a la par que se proponen alternativas que maximicen la efectividad de los mismos en relación a casos de TMG complejos, como los de trastorno límite de la personalidad. (AU)

Institutions dedicated to the care of serious mental illness (SMI) have admission criteria that determine the users who are admitted. A thorough analysis of the patients may reveal the existence of different clinical profiles with diverse therapeutic needs. In order to determine the existence of different clinical profiles in the UCPP of the Centro San Juan de Dios de Ciempozuelos (CSJD), a cross-sectional descriptive study was carried out, finding five clinical typologies by applying a two-stage cluster analysis. 413 people with SMI, admitted in different devices of the Prolonged Psychiatric Care Unit (according to their autonomy and needs), with a mean age of 53.78 years (95.4% males and 4.4% females) and high levels of institutionalization (mean 13.06 years), took part in the study. The main diagnosis found was residual schizophrenia (38.3%; n= 158), followed by paranoid schizophrenia (26.6%; n= 110). There was also a significant number of personality disorders (35 cases). The five typologies of users were named according to their most salient characteristics: Rehab (R), Rehab Behav (RB), Young Care (YC), Old Care (OC) and Young Behav (YB). A discussion on the implications of the determination of these profiles for a better use of existing resources is held. In addition, different alternatives for particularly difficult cases of SMI, such as borderline personality disorder, are proposed. (AU)

Internamiento involuntario vs. Retención ilegal en pacientes contrastorno mental grave / Involuntary internment vs. Illegal retention in patients with serious mental disorder

Aunque una buena actitud hacia la terapia y el cumplimiento de la misma son claves para el éxito del tratamiento, en ciertas situaciones el uso de medidas coercitivas en personas con trastornos mentales es la única forma de prevenir daños graves al paciente y a otras personas. La decisión de utilizar estas medidas, como el internamiento involuntario, es un desafío para los médicos, ya que tienen que lidiar no solo con la voluntad del paciente y de sus familiares, que se encuentran en una situación emocional desbordada, sino también con el conocimiento de la normativa vigente, especialmente complejas. Para proteger los derechos del paciente en estas situaciones difíciles y del personal clínico, es esencial que el mismo conozca los límites de su actuación en el marco del procedimiento legal. Por ello, se necesitan más estudios en la materia, que ofrezcan conclusiones contrastadas con respecto a las diferencias entre el internamiento involuntario y la retención ilegal.(AU)

Even though a good attitude towards therapy and adherence are key to an effective treatment, in certain circumstances the use of coercive actions in people with mental disorders is the only way to prevent serious harm to the patient and to others. The choice to use coercive measures, such as involuntary internment, is a challenge for doctors, since not only do they have to deal with the patient and their relatives who are in a highly emotional situation, but there are also complex legal regulations. To defend the rights of patients in these difficult situations, and to avoid legal consequences for clinical staff due to illegal acts, it is essential that staff are familiar with all of the relevant legal rules and procedures. Further studies are warranted to obtain clear conclusions regarding differences between involuntary internment and illegal retention.(AU)

Analisis del impacto de la pandemia por covid-19 en recursos de rehabilitacion psicosocial / Analysis of the impact of the covid-19 pandemic on psychosocial rehabilitation resources

Como se ha podido comprobar, la irrupción de una pandemia como la generada por el COVID-19, así como, las consiguientes restricciones, afectan en mayor medida a los grupos más vulnerables como, entre otros, son las personas con Trastorno Mental Grave (TMG). Los objetivos fundamentales de este estudio pasan por analizar y comparar con la población general a la que pertenecen, el porcentaje de infecciones, hospitalizaciones y fallecimientos relacionados con el COVID-19 en el caso de recursos destinados a la atención a personas con TMG, como son los gestionados por la Línea de Rehabilitación Psicosocial (LRHP) de la organización Hermanas Hospitalarias. A su vez, también se analizan y comparan con periodos previos otras variables que han podido verse afectadas en esta crisis sanitaria tales como ingresos psiquiátricos, abandono de los recursos, intentos autolíticos o suicidios consumados. A diferencia de lo encontrado en la literatura previa, los resultados indican que no existen diferencias estadísticamente significativas entre los porcentajes de infecciones, hospitalizaciones o fallecimientos por COVID-19 entre la LRHP y los registrados en la población general. En cuanto a variables relacionadas con la Salud Mental, se encuentran diferencias estadísticamente significativas entre el año 2020 y el anterior, en el porcentaje de ingresos psiquiátricos y abandono en los recursos ambulatorios, siendo estos menores en 2020. Sin embargo, en el caso de los recursos residenciales, se registra un porcentaje significativamente mayor en el porcentaje de abandonos en 2020. Dichos resultados han de ser tomados con cautela, puesto que existen múltiples limitaciones que pudieran estar afectando a los mismos y pueden ser interpretados teniendo en cuenta los cambios contextuales relacionados con la pandemia respecto al funcionamiento de los recursos hospitalarios o a las restricciones a nivel de movilidad (AU)

As has been seen, the outbreak of a pandemic such as that generated by COVID-19, as well as the consequent restrictions, affect to a greater extent the most vulnerable groups such as, among others, people with Severe Mental Disorder (SMD). The fundamental objectives of this study are to analyze and compare with the general population to which they belong, the percentage of infections, hospitalizations and deaths related to COVID-19 in the case of resources destined to the care of people with TMG, such as those managed by the Linea de Rehabilitacion Psicosocial (LRHP) of the Sisters Hospitallers organization. At the same time, other variables that have been affected in this health crisis such as psychiatric admissions, abandonment of resources, autolytic attempts or completed suicides are also analyzed and compared with previous periods. Unlike what was found in the previous literature, the results indicate that there are no statistically significant differences between the percentages of infections, hospitalizations or deaths from COVID-19 between the LRHP and those registered in the general population. As for variables related to Mental Health, there are statistically significant differences between 2020 and the previous year, in the percentage of psychiatric admissions and abandonment in outpatient resources, these being lower in 2020. However, in the case of residential resources, there is a significantly higher percentage of abandonments in 2020. These results must be taken with caution, since there are multiple limitations that could be affecting them and can be interpreted taking into account the contextual changes related to the pandemic regarding the functioning of hospital resources or restrictions at the level of mobility (AU)

Diagnostic stability in substance-induced psychosis.

INTRODUCTION: Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion. MATERIAL AND METHODS: We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression. RESULTS: Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD = 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16 years was 41.6% (95%CI: 32.2-52.2) over a mean 36.43 months. CONCLUSIONS: In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years.

Estabilidad diagnóstica en la psicosis inducida por sustancias / Diagnostic stability in substance-induced psychosis

Introducción: Se denomina psicosis inducida por sustancias (PIS) a la psicosis que empieza en el contexto del uso de una sustancia pero persiste días y semanas en ausencia del uso continuado de la misma. Los conocimientos sobre el curso longitudinal de las PIS son aún escasos y sugieren que un porcentaje importante son más adelante diagnosticadas de trastorno mental grave (TMG). El objetivo de este estudio es analizar la evolución de las PIS a TMG en nuestro medio y los posibles factores que puedan estar implicados en esa conversión. Material y métodos: Utilizamos un diseño retrospectivo de seguimiento de una cohorte. Se revisaron todos los diagnósticos de los pacientes dados de alta en la unidad de hospitalización de psiquiatría del Hospital Universitario de Basurto desde enero de 2002 hasta diciembre de 2015. Además de datos sociodemográficos y clínicos se recogió información sobre el consumo de cannabinoides, opiáceos, anfetaminas, cocaína y alcohol. Los datos se analizaron mediante estadística descriptiva, curvas de supervivencia Kaplan-Meier y regresión de Cox. Resultados: De los 116 pacientes incluidos el 78,4% fueron hombres, tenían una edad media de 33,0 (DE: 8,9) años y el 44,0% estaban solteros; el 31,0% tenían antecedentes familiares psiquiátricos; la sustancia más consumida fue cannabis (60,3%), seguido por cocaína (40,5%). El riesgo acumulado de conversión diagnóstica a TMG en 16años fue del 41,6% (IC95%: 32,2-52,2) en un tiempo medio de 36,43meses. Conclusiones: En las intervenciones en episodios de PIS debemos tener presente que una proporción importante evolucionará a TMG en los tres primeros años. (AU)

Introduction: Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion. Material and methods: We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression. Results: Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD: 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16years was 41.6% (95%CI: 32.2-52.2) over a mean 36.43months. Conclusions: In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years. (AU)

Estudio relacional de las necesidades de soporte según los servicios de lugar de vida utilizados / Relational study of support needs according to life services used

El objetivo del presente estudio es valorar la relación existente entre el grado de atención requerida por los diferentes usuarios y el servicio de lugar de vida que están utilizando. Para ello se ha realizado un estudio con 388 personas. Las variables estudiadas incluyen el diagnóstico, la edad, el sexo, la situación económica y la Escala ENAR-CPB. El porcentaje de hombres es superior al de mujeres. Los jóvenes son tratados principalmente en los pisos supervisados. Mayoritariamente se atienden esquizofrenias paranoides, sobre todo en las residencias. Las depresiones mayores están sobre todo en el propio domicilio y los trastornos límites de la personalidad son atendidos principalmente en pisos supervisados. Las personas que viven en una residencia son por lo general más dependientes que las que viven en pisos supervisados o en su propio domicilio. Es importante ajustar lo más posible el recurso de lugar de vida a las capacidades y necesidades reales de la persona, pero la situación económica personal marca la diferencia entre el hecho de ir a vivir a un piso supervisado o mantenerse en el propio domicilio. (AU)

This study was conducted with the aim of evaluating the relationship existing between the degree of care required by users of different mental health services and the services provided in the place they are using. The study was performed on a 388-person sample. The variables studied included diagnosis, age, sex, economic circumstances, and the ENAR-CPB scale. In all resources, the percentage of men with support outnumbered that of women. On the other hand, young people were found to mostly be living in supportive housing. The majority in all resources suffered from paranoid schizophrenia, especially in long-term care facilities. Clients with severe depression generally lived in their own homes, while those with borderline personality disorder were mainly attended in supportive housing. The residences clients were more dependent than those living whether in supportive housing or in their own home. It is important to relate the housing resource to a person's real capabilities and needs as much as possible; however, it is economic capacity what determines whether a person lives in a supportive housing unit or in their own home. (AU)

Fracturas de cadera en pacientes tratados con fármacos antipsicóticos. Estudio de cohortes históricas en Cataluña / Hip fractures in patients treated with antipsychotic drugs. Study of retrospective cohorts in Catalonia

Objetivo: Evaluar la incidencia de fractura de cadera en pacientes con tratamiento antipsicótico, comparándola con la de individuos que no han sido tratados con antipsicóticos.Diseño: Estudio de cohortes históricas de pacientes tratados con fármacos antipsicóticos (TAP) y pacientes sin tratamiento conocido (no TAP). El periodo de observación fue 2006-2014.Emplazamiento: Todos los equipos de atención primaria de Cataluña del Instituto Catalán de la Salud (ICS).Participantes: Pacientes mayores de 44 años con TAP de al menos 3 meses de duración. Cohorte control: selección aleatoria de pacientes no TAP emparejando por comorbilidades basales, sexo, edad y prescripción de fármacos (excluyendo psicofármacos). Se analiza un total de 22.010 pacientes.Mediciones principales Tasa de incidencia (×1.000 personas-año [PY]) de fractura de cadera en cada grupo (TAP y no TAP). Modelos de regresión de Cox para estimar riesgos ajustados (hazard ratio [HR]) añadiendo los psicofármacos como covariables. Resultados: La tasa de incidencia de fractura de cadera fue mayor en los pacientes TAP (5,83 frente a 3,58 fracturas por 1.000 PY), y es mayor en todos los estratos según sexo, edad y tipo de diagnóstico. El riesgo de sufrir una fractura de cadera fue un 60% mayor (HR: 1,60; IC95%: 1,34-1,92) en el grupo TAP que en el grupo no TAP. El riesgo fue mayor en el grupo con esquizofrenia (HR: 3,57; IC95%: 1,75-7,30), seguido del trastorno bipolar (HR: 2,61; IC95%: 1,39-4,92) y depresión (HR: 1,51; IC95%: 1,21-1,88). Conclusiones: Los pacientes con tratamiento antipsicótico presentan más riesgo de fractura de cadera que los que no han sido tratados con antipsicóticos.

ObjectiveTo evaluate the incidence of hip fracture in patients with antipsychotic treatment, comparing it with that of individuals who have not been treated with antipsychotics.DesignRetrospective cohort study of patients treated with antipsychotic drugs (TAP) and patients without known treatment (non-TAP). The observation period was 2006–2014.SiteAll primary care teams in Catalonia of the Catalan Health Institute (ICS).ParticipantsPatients older than 44 years with TAP lasting at least 3 months. Control cohort: random selection of non-TAP patients matching for baseline comorbidities and other variables. A total of 22,010 are analyzed.Main measurements Incidence rate (1000× person-years: PY) of hip fracture in each group (TAP and non-TAP). Cox regression models to estimate adjusted risks (hazard ratio: HR).ResultsThe hip fracture incidence rate was higher in TAP patients (5.83 vs 3.58 fractures per 1000 PY), and is higher in all strata according to sex, age and type of diagnosis. The risk of suffering a hip fracture was 60% higher (HR: 1.60 95% CI: 1.34–1.92) in the TAP group than in the non-TAP group. The risk was higher in the group with schizophrenia (HR: 3.57 95% CI: 1.75–7.30), followed by bipolar disorder (HR: 2.61; 95% CI: 1.39–4.92) and depression (HR: 1.51; 95% CI: 1.21–1.88).ConclusionsPatients with antipsychotic treatment have a higher risk of hip fracture than those who have not been treated with antipsychotics.

Alternativas al encarcelamiento de las personas con problemas de salud mental: experiencias internacionales / Alternatives to incarceration for people with mental health problems: international experiences

Partiendo de la realidad de la plétora de personas con trastorno mental que pueblan las cárceles de países occidentales, la precaria atención clínica que reciben y el consiguiente efecto negativo que la estancia en prisión tiene para su porvenir, abordamos en este artículo los datos más relevantes de la relación entre delito y trastorno mental, y revisamos las experiencias más actuales en lo que se refiere a medidas alternativas a la prisión para personas con trastorno mental. Entre todas ellas nos ocupamos de revisar la experiencia de los tribunales especializados en EE. UU. que, desde la perspectiva de la Justicia Terapéutica, ofrecen programas alternativos a la prisión, con el objetivo de buscar una oportunidad para la recuperación de los pacientes. (AU)

Starting from the reality of the plethora of people with mental disorders that populate the prisons of Western countries, the precarious clinical care they receive, and the consequent negative effects that the stay in prison have on their future, in this article we review the most relevant aspects of the relationship between crime and mental disorder, and the newest experiences regarding alternative measures to prison for people with mental disorders. Among all of them, we examine the experience of specialized courts in the US, which, from the perspective of Therapeutic Justice, offer alternative programs to prison, aiming at offering an opportunity for the recovery of patients. (AU)

[Hip fractures in patients treated with antipsychotic drugs. Study of retrospective cohorts in Catalonia]. / Fracturas de cadera en pacientes tratados con fármacos antipsicóticos. Estudio de cohortes históricas en Cataluña.

OBJECTIVE: To evaluate the incidence of hip fracture in patients with antipsychotic treatment, comparing it with that of individuals who have not been treated with antipsychotics. DESIGN: Retrospective cohort study of patients treated with antipsychotic drugs (TAP) and patients without known treatment (non-TAP). The observation period was 2006-2014. SITE: All primary care teams in Catalonia of the Catalan Health Institute (ICS). PARTICIPANTS: Patients older than 44 years with TAP lasting at least 3 months. Control cohort: random selection of non-TAP patients matching for baseline comorbidities and other variables. A total of 22,010 are analyzed. Main measurements Incidence rate (1000× person-years: PY) of hip fracture in each group (TAP and non-TAP). Cox regression models to estimate adjusted risks (hazard ratio: HR). RESULTS: The hip fracture incidence rate was higher in TAP patients (5.83 vs 3.58 fractures per 1000 PY), and is higher in all strata according to sex, age and type of diagnosis. The risk of suffering a hip fracture was 60% higher (HR: 1.60 95% CI: 1.34-1.92) in the TAP group than in the non-TAP group. The risk was higher in the group with schizophrenia (HR: 3.57 95% CI: 1.75-7.30), followed by bipolar disorder (HR: 2.61; 95% CI: 1.39-4.92) and depression (HR: 1.51; 95% CI: 1.21-1.88). CONCLUSIONS: Patients with antipsychotic treatment have a higher risk of hip fracture than those who have not been treated with antipsychotics.

Evaluación de necesidades provocadas por la COVID-19 en personas con trastorno mental grave / Assessment of needs caused by Covid-19 in people with severe mental disorders

La pandemia provocada por la COVID-19 ha mostrado algunas carencias y riesgos asociados en la atención comunitaria de la salud mental a los pacientes más graves. El objetivo de este estudio es analizar las necesidades asistenciales en una muestra de personas con trastorno mental grave durante el pico de la pandemia por COVID-19 en España en la Comunidad de Madrid, la Comunidad Valenciana, Extremadura y el País Vasco. Se utilizó el instrumento Needs of Assesment (NCA) y la Escala de Restricción de Vida (ERVI). La muestra fue de 669 personas y 144 cuidadores familiares convivientes. Los problemas clínicos más frecuentemente encontrados fueron los de ansiedad, seguidos de lentitud, baja actividad y depresión. En el área de destrezas y habilidades, los problemas más frecuentes fueron la estructuración del sueño, la integración comunitaria, la ocupación del tiempo y la capacidad cognitiva. En el área de soportes de apoyo, el principal problema fue la falta de red de apoyo social. Respecto al grado de cobertura, el 71% de los problemas clínicos estuvieron cubiertos. En el área de habilidades, el porcentaje desciende hasta un 68% y en los soportes sociales hasta el 66%. Se concluye que es necesario reforzar los Programas de Rehabilitación Psicosocial para atender las necesidades de pacientes graves de salud mental. Además, los modelos de atención deberían ser adaptados para asegurar su continuidad y permanencia en periodos de distanciamiento de la comunidad. (AU)

The pandemic caused by COVID-19 has revealed some deficiencies and associated risks in Community Mental Health Care for the most severe patients. The objective of this study is to analyze the needs in a sample of people with Severe Mental Illness during the peak of the COVID-19 pandemic in the Communities of Madrid, Valencia, Extremadura, and the Basque Country (in Spain). The Needs of Assessment (NCA) instrument and the Life Restriction Scale (ERVI) were used. The sample consisted of 669 people and 144 cohabiting family caregivers. The clinical problems most frequently encountered were anxiety, followed by slowness, low activity, and depression. In the area of skills and abilities, the most frequent problems were sleep structuring, community integration, time occupation, and cognitive ability. In the area of support, the main problem was the lack of a social support network. Regarding the degree of coverage, 71% of the clinical problems were covered. In the skills area, the percentage drops to 68% and in social media to 66%. It is concluded that it is necessary to reinforce Psychosocial Rehabilitation Programs to meet the needs of serious mental health patients. In addition, the care models should be adapted to ensure their continuity and permanence in periods of distance from the community. (AU)

Problemas de salud mental en población penitenciaria. Un enfoque de salud pública / Mental health problems in prison population. A public health approach

Se revisa la literatura internacional sobre la prevalencia de personas con problemas de salud mental en instituciones penitenciarias, con especial interés por quienes presentan trastornos mentales graves. Se valoran así la magnitud del problema, sus probables factores causales y las soluciones posibles, en general y en su aplicación a nuestro país, tratando de situarse en una perspectiva intersectorial de salud pública, más allá de la habitualmente limitada de la psiquiatría. (AU)

International literature on the prevalence of people with mental health problems in prisons population is reviewed, with special interest for those with severe mental disorders. The magnitude of the problem, its likely causal factors and possible solutions, in general and in its application to our country, are valued, trying to offer a cross-sectoral perspective of public health, beyond the usually limited from psychiatry. (AU)

Relación entre empleo y bienestar emocional en personas con trastorno mental grave / Relationship between employment and emotional state in people with severe mental disorder

Las personas con un diagnóstico de trastorno mental grave (TMG) tienen tasas de desempleo notablemente superiores a las de la población general. Esto se asocia con mayor riesgo de exclusión social y de marginalidad, y favorece la cronicidad de las dificultades personales y sociales. Este estudio observacional pretende evaluar la relación entre el empleo y el estado emocional subjetivo en personas con TMG. El estudio incluyó 744 participantes (304 con TMG usuarias de recursos de rehabilitación psicosocial, 168 personas con TMG con empleo protegido y 272 personas sin TMG con empleo ordinario), con una edad media de 41.9 años y 50.1% mujeres. De los 744 participantes, 577 (77.6%) tuvieron empleo remunerado (409 (60.9%) empleo ordinario y 168 (29.1%) empleo protegido); 244 (32.8%) comunicaron que tenían un diagnóstico de psicosis y 400 (53.8%) que tenían reconocida la discapacidad. Las personas con empleo tuvieron mejores valores de bienestar psicológico subjetivo (p=0.013) que las personas sin empleo, independientemente del diagnóstico o de la discapacidad. Sin embargo, no hubo diferencias significativas en bienestar psicológico subjetivo entre las personas con empleo ordinario y con empleo protegido (p=0.687). Como conclusión, las personas con empleo remunerado tuvieron mayor bienestar psicológico subjetivo que las personas sin empleo, independientemente del diagnóstico, de la discapacidad o de que el empleo fuera ordinario o protegido. (AU)

People with a diagnosis of severe mental disorder (SMD) have significantly higher unemployment rates than the general population. This is associated with a greater risk of social exclusion and marginalization, and favors the chronicity of personal and social difficulties. This observational study aims to assess the relationship between employment and subjective emotional state in people with a SMD diagnosis. The study included 744 participants (304 with a SMD diagnosis who were users of psychosocial rehabilitation resources, 168 with a SMD diagnosis with supported employment, and 272 people without diagnosis of SMD with ordinary (non-supported) employment), with a mean age of 41.9 years and 50.1% women. Out of the 744 participants, 577 (77.6%) had an employment (409 (60.9%) ordinary employment and 168 (29.1%) supported employment), 244 (32.8%) reported that they have a diagnosis of psychosis and 400 (53.8%) that they have a recognized disability. People with an employment had better subjective psychological well-being values than people without an employment (p=0.013), regardless of diagnosis or disability. There were no significant differences in subjective psychological well-being between people with ordinary employment and people with supported employment (p=0.687). In conclusion, people with a paid employment had higher subjective psychological well-being than people without an employment, regardless of diagnosis, disability or whether the employment was ordinary or supported. (AU)

Validación de la entrevista semiestructurada FACE Risk Profile enpersonas con Trastorno Mental Grave / Validation of the semi-structured interview, the FACE Risk Profile, in people with Serious Mental Illness

Introducción: Las personas con Trastorno Mental Grave(TMG) pueden presentar conductas de riesgo que pueden darlugar a recaídas. Hay pocos instrumentos validados en nuestro contexto para valorar factores de riesgo y ninguno quetenga en cuenta diversos factores al mismo tiempo y sea específico para valorar el riesgo de recaída. El objetivo de estetrabajo es la validación en español de la Functional Analysisof Care Environments o FACE Risk Profile en personas conTMG.Metodología. La muestra se compone de 69 participantes con TMG. En la primera evaluación se administró uncuestionario sociodemográfico, la FACE Risk Profile e instrumentos psicométricos de valoración clínica y psicosocial.En una segunda evaluación, se volvió a administrar la FACERisk Profile.Resultados. La FACE Risk Profile presenta una consistencia interna adecuada, buena fiabilidad test-retest y adecuada validez concurrente y discriminante. El acuerdo interevaluadores es muy bueno.Conclusiones. La FACE Risk Profile en un instrumento útily válido para la valoración del riesgo en personas con TMG. (AU)

Introduction: People with Serious Mental Illness (SMI)can present risk behaviour that can lead to relapses. Thereare few instruments validated in our context to assess riskfactors, but none takes into account several factors at thesame time, and is specific for the risk of relapse. The objective of this work is to validate the Functional Analysis ofCare Environments (FACE) Risk Profile into Spanish for people with SMI.Methods. The sample consisted of 69 participants withSMI. The first evaluation was administered using a sociodemographic questionnaire, the FACE Risk Profile and psychometric instruments for clinical and psychosocial assessment.For the second evaluation, the FACE Risk Profile was re-administered.Results. The FACE Risk Profile shows adequate internalconsistency, good test-retest reliability and adequate concurrent and discriminant validity. The inter-rater agreementis very good.Conclusions. The FACE Risk Profile is a useful and validinstrument for risk assessment in people with SMI. (AU)

Rehabilitación psicosocial e intervención familiar en personas con trastorno dual / Psychosocial rehabilitation and family intervention for people with dual disorders

En el trastorno dual confluyen dos trastornos graves y crónicos que aún hoy son un desafío a las redes de atención sanitaria y social. En ese contexto las familias desempeñan un papel importante en el mantenimiento de estas personas en la comunidad. El trastorno dual se asocia con una serie de efectos negativos sobre el entorno familiar, con mayor carga de cuidados y conflictos. Para este artículo, se han revisado cuatro modelos de intervención familiar en el trastorno dual. Conclusiones. La intervención familiar ha demostrado ser un importante elemento del tratamiento del trastorno dual. Los cuatro programas de intervención presentados coinciden en unos componentes comunes: intervención uni/multi familiar, bases teóricas de los modelos de probada eficacia, psicoeducación, entrenamiento en comunicación, resolución de problemas y la entrevista motivacional transversal a todo el programa. Aun así persisten áreas que no mejoran y los resultados no son concluyentes, por lo que es necesario seguir buscando fórmulas que apunten hacia recursos terapéuticos más flexibles según las necesidades y circunstancias de cada una de estas personas. (AU)

In dual disorder, two serious and chronic disorders converge that are still a challenge to health and social care networks. In this context, families play an important role in keeping these people included in the community. Dual disorder is associated with a series of negative effects on the family environment, with a greater burden of care and conflict. For this article, four models of family intervention in dual disorder have been reviewed. Conclusions. Family intervention has proven to be an important element of dual disorder treatment. The four intervention programs presented coincide in share some common components: single / multi-family intervention, theoretical bases of the models of with proven efficacy, psychoeducation, communication training, problem solving, and the motivational interview across the entire program. Even so, some areas still persist without improvements and areas that do not improve persist and the results are not conclusive, so it is necessary to continue looking for formulas that point towards more flexible therapeutic resources according to the needs and circumstances of each of these people. (AU)

Psychosocial rehabilitation and family intervention for people with dual disorders / Rehabilitación psicosocial e intervención familiar en personas con trastorno dual

In dual disorder, two serious and chronic disorders converge that are still a challenge to health and social care networks. In this context, families play an important role in keeping these people included in the community. Dual disorder is associated with a series of negative effects on the family environment, with a greater burden of care and conflict. For this article, four models of family intervention in dual disorder have been reviewed. Conclusions. Family intervention has proven to be an important element of dual disorder treatment. The four intervention programs presented coincide in share some common components: single / multi-family intervention, theoretical bases of the models of with proven efficacy, psychoeducation, communication training, problem solving, and the motivational interview across the entire program. Even so, some areas still persist without improvements and areas that do not improve persist and the results are not conclusive, so it is necessary to continue looking for formulas that point towards more flexible therapeutic resources according to the needs and circumstances of each of these people. (AU)

En el trastorno dual confluyen dos trastornos graves y crónicos que aún hoy son un desafío a las redes de atención sanitaria y social. En ese contexto las familias desempeñan un papel importante en el mantenimiento de estas personas en la comunidad. El trastorno dual se asocia con una serie de efectos negativos sobre el entorno familiar, con mayor carga de cuidados y conflictos. Para este artículo, se han revisado cuatro modelos de intervención familiar en el trastorno dual. Conclusiones. La intervención familiar ha demostrado ser un importante elemento del tratamiento del trastorno dual. Los cuatro programas de intervención presentados coinciden en unos componentes comunes: intervención uni/multi familiar, bases teóricas de los modelos de probada eficacia, psicoeducación, entrenamiento en comunicación, resolución de problemas y la entrevista motivacional transversal a todo el programa. Aun así persisten áreas que no mejoran y los resultados no son concluyentes, por lo que es necesario seguir buscando fórmulas que apunten hacia recursos terapéuticos más flexibles según las necesidades y circunstancias de cada una de estas personas. (AU)

Diagnostic stability in substance-induced psychosis. / Estabilidad diagnóstica en la psicosis inducida por sustancias.

INTRODUCTION: Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion. MATERIAL AND METHODS: We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression. RESULTS: Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD: 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16years was 41.6% (95%CI: 32.2-52.2) over a mean 36.43months. CONCLUSIONS: In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years.

Psychometric study of the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG). / Estudio psicométrico de la Escala de valoración de los Niveles de Atención Requerida para personas con Trastorno Mental Grave (ENAR-TMG).

INTRODUCTION: People with severe mental disorder have significant difficulties in everyday life that involve the need for continued support. These needs are not easily measurable with the currently available tools. Therefore, a multidimensional scale that assesses the different levels of need for care is proposed, including a study of its psychometric properties. METHOD: One-hundred and thirty-nine patients (58% men) with a severe mental disorder were assessed using the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG), the Camberwell Assessment of Need scale, and the Health of the Nation Outcome Scales. ENAR-TMG's psychometric features were examined by: a) evaluating 2 sources of validity evidence (evidence based on internal structure and evidence based on relations to other variables), and b) estimating the internal consistency, temporal stability, inter-rater reliability, and sensitivity to change of scores of the ENAR-TMG's subscales. RESULTS: Exploratory factor analyses revealed a one-factor structure for each of the theoretical dimensions of the scale, in which all but one showed a significant and positive correlation with the Camberwell Assessment of Need (range of r: 0.143-0.557) and Health of the Nation Outcome Scales (range of r: 0.241-0.474) scales. ENAR-TMG subscale scores showed acceptable internal consistency (range of ordinal α coefficients: 0.682-0.804), excellent test-retest (range of intraclass correlation coefficients: 0.889-0.999) and inter-rater reliabilities (range of intraclass correlation coefficients: 0.926-0.972), and satisfactory sensitivity to treatment-related changes (range of η2: 0.003-0.103). CONCLUSIONS: The satisfactory psychometric behaviour of the ENAR-TMG makes the scale a promising tool to assess global functioning in people with a severe mental disorder.

Adaptation into Spanish of the Internalised Stigma of Mental Illness scale to assess personal stigma. / Adaptación al español de la escala Internalized Stigma of Mental Illness para valorar el estigma personal.

INTRODUCTION: Patients with schizophrenia sometimes internalise social stigma associated to mental illness, and they develop personal stigma. Personal stigma includes self-stigma (internalisation of negative stereotypes), perceived stigma (perception of rejection), and experienced stigma (experiences of discrimination). Personal stigma is linked with a poorer treatment adherence, and worst social functioning. For this reason, it is important to have good measurements of personal stigma. One of the most frequently used measurements is the Internalised Stigma of Mental Illness (ISMI) scale. There is a Spanish version of the scale available, although its psychometric properties have not been studied. The main aim of this study is to analyse the psychometric properties of a new Spanish version of the ISMI scale. MATERIAL AND METHODS: The new version was translated as Estigma Interiorizado de Enfermedad Mental (EIEM). Internal consistency and test-retest reliability were calculated in a sample of 69 patients with a diagnosis of schizophrenia or schizoaffective disorder. The rate of patients showing personal stigma was also studied, as well as the relationship between personal stigma and sociodemographic and clinical variables. RESULTS: The adapted version obtained good values of internal consistency and test-retest reliability, for the total score of the scale (0.91 and 0.95 respectively), as well as for the five subscales of the EIEM, except for the Stigma Resistance subscale (Cronbach's alpha 0.42). CONCLUSIONS: EIEM is an appropriate measurement tool to assess personal stigma in a Spanish population with severe mental disorder, at least in those with a diagnosis of schizophrenia or schizoaffective disorder.