Vertex (Buenos Aires, Argentina)最新文献

Incluye un fragmento de la edición en castellano de la obra: Cabanis, P. J. J., Relaciones de lo físico y moral del hombre (1826), París, Imprenta Smith.

Introduction: Health records play multiple roles within mental health care services and systems, from supporting individual clinical work to informing public policy development. Despite this, record-keeping as part of routine practicefaces numerous barriers and challenges. As part of a larger study on consultations for self-inflicted injuries in general neuropsychiatric hospitals in Argentina, this paper presents an analysis of the corresponding records.

Methods: Records from February 2023 were reviewed using a structured form encompassing five domains: readability, comparability, documentary standardization, accessibility, and content. In addition, interviews were conducted with key informants from the management, statistics, and clinical departments of the participating institutions.

Results: The findings highlight the need to strengthen documentary standardization —particularly through the implementation of predefined data-entry fields— and to streamline and clearly define the minimum data required for reporting suicide attempts. The study offers a concrete proposal in this regard.

Conclusions: The results emphasize the importance of enhancing staff training, promoting a stronger sense of ownership of record-keeping as a core (rather than supplementary) professional responsibility, and ensuring the quality of care provided.

Reseña de la obra: Diez historias de vida, sufrimiento y amor de Juan David Nasio. Paidos, 2025.

Involuntary commitment in mental health represent a challenge for professionals working in outpatient services, due to tensions between therapeutic necessity and criticisms from a human rights perspective. Effective management of involuntary commitment requires a dual-level approach: comprehensive risk assessment followed by appropriate risk management. This paper outlines practical guidelines for managing involuntary detention across diverse outpatient settings. We analyze six distinct healthcare scenarios: 1) outpatient services within specialized or general hospitals; 2)public outpatient care services; 3) private outpatient care services within healthcare centers; 4) private outpatient care services outside healthcare centers; 5) private practice offices; and 6) telepsychiatry. For each scenario, we provide detailed recommendations addressing referral protocols, patient safety measures, and inter-professional-institutional coordination. Our findings suggest that implementing clear protocols and standardized guidelines significantly reduces professional uncertainty, minimizes improvisation in critical situations, and ensures consistent, high-quality patient care.

Introduction: The Autism Mental State Exam (AMSE) is a brief clinician-completed instrument that structures theobservation and documentation of the social, communicative, and behavioral signs and characteristics of autism. In its original English version, it demonstrated high accuracy in identifying autism spectrum disorder (ASD). This study explores the sensitivity and specificity of a Spanish version of AMSE in an Argentine sample of 313 subjects, against DSM-5 clinical consensus diagnosis as the primary outcome.

Materials and methods: The cutoff values were calculated using the receiver operating characteristic (ROC) curve, identifying the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The internal homogeneity of the items was determined using Cronbach's alpha, and the Cohen Kappa coefficient was calculated for inter-rater reliability.

Results: Findings indicate an optimized sensitivity of 90.71% and a specificity of 92.17% for this sample of 313 patients. AMSE exhibited fair internal consistency (alpha coefficient of .75) and high inter-rater reliability (.97) in this sample of subjects evaluated for ASD in Argentina.

Discussion & conclusions: AMSE is emerging as a promising tool for diagnostic assessment of ASD in children,adolescents and adults at risk, standing out for its high clinical utility. Its application is particularly relevant in regions like Latin America, where access to the Autism Diagnostic Observation Schedule training, materials and use is limited. These results support the use of AMSE as a brief, reliable, and culturally adapted diagnostic tool to support the clinical diagnosis of autism in Spanish-speaking contexts with limited resources.

Introduction: This research project was initiated in response to a critical issue identified by the team at Esteves Hospital.This issue pertains to the necessity for hospitalised women to narrate their experiences during the pandemic andto examine the potential impact of confinement on outpatient work. The objective of this study is to produce knowledge about the approach to mental health in the context of the Coronavirus Disease 2019 (Covid-19) pandemic from the perspective of hospitalised users. Furthermore, this study aims to make the situation of these women visible in order to contribute to the reduction of stigma.

Methodology: The research employed focus groups comprising eight users, selected intentionally. An informed consent process approved by the ethics committee was conducted. The analysis yielded some convergent meanings. The users highlighted the feeling of confinement during the most restrictive period of the health measures. They were notably distressed by the separation from their roommates and the disruption of their routines. They emphasised the importance of living together in the hospital and how getting to know each other was beneficial for thinking about a possible discharge. We emphasise the importance of situational awareness during the pandemic, particularly in terms of identifying the necessary care.

Discussion and conclusions: We conclude on the significance of the bonds established in the hospital and their relevance in the outpatient project. As a key finding, we highlight the importance of working in small groups for the resolution of coexistence conflicts.

The paper provides a narrative review of the models and theories of suicidal behaviour. It highlights their relevance to empirical research on the phenomenon. It ranges from the classical approaches of Durkheim or Stengel to more recent models such as Joiner's interpersonal psychological theory or O'Connor's motivational-volitional model. It examines philosophical, psychological, sociological, neurobiological and integrative perspectives, analyzing the conceptual contributions, dimensions evaluated and limitations of each model. Following a systematic search of databases (PubMed,PsyINFO, Scopus, Web of Science and Google Scholar), 27 publications that met the inclusion criteria were analyzed. The integrative analysis revealed that classical theories have provided a conceptual basis, while more recent models have integrated individual, contextual and biological factors, providing a broader and more dynamic understanding of suicide. Common limitations of the analyzed models over time are identified, such as the lack of empirical validation or the complexity of practical operationalization of theoretical concepts. The review also highlights the need to develop an integrated theoretical framework that allows for the convergence of individual, interpersonal and societal factors to improve the prevention and intervention of suicidal behaviour in cross-cultural contexts.

Mixed symptoms, combining manic or hypomanic elements with depressive features, are a core and frequent dimension of mood disorders. From Kraepelin and Weygandt’s early descriptions to contemporary formulations, diagnostic definitions have shifted between highly restrictive and broader dimensional approaches. The DSM-5 “with mixed features” specifier represented progress, yet limitations remain, notably the exclusion of overlapping symptoms (irritability, distractibility, psychomotor agitation). Recent systematic reviews estimate prevalence at 18% of major depressive episodes,33% of bipolar depressive episodes, and 35% of manic or hypomanic episodes. Mixed presentations are linked to higher suicide risk, greater illness burden, and poorer treatment response. In recent years, the most robust pharmacological evidence comes from trials with second-generation antipsychotics, particularly lumateperone (with prespecified data across MDD and BD-I/II), lurasidone, ziprasidone, cariprazine, and olanzapine/fluoxetine. In contrast, lithium, valproate, and lamotrigine lack specific studies in depressive episodes with mixed features, and antidepressant monotherapy remains insufficiently supported. This review integrates historical foundations, epidemiological data, and updated therapeutic evidence, highlighting the need for more sensitive diagnostic consensus and longer-term controlled trials to guide clinical practice.

Dementia is characterized by a progressive deterioration of cognitive and functional abilities. While the most prevalent dementia is Alzheimer's disease, the wide spectrum of other forms of presentation such as vascular dementia, frontotemporal dementia or dementia with Lewy bodies, among others, implies a great diagnostic challenge. This instance is highly complicated since dementia generally presents initially with a varied overlap of clinical and cognitive manifestations, as well as with a great heterogeneity in the findings in magnetic resonance imaging scans, which makes their precision difficult.The cognitive profiles of Alzheimer's disease, vascular dementia, behavioral variant of frontotemporal dementia, focal dementias such as primary progressive aphasias, Parkinson's disease dementia, and LATE, a late-onset dementia highly similar to AD, are described. Considering that complex studies such as biomarkers or neuroimaging are not always available, the objective of this paper is to provide a current overview of cognitive profiles of onset and progression that may be clinically useful and guide a possible differential diagnosis.

This document constitutes the second part of the First Argentine Consensus on the Management of Schizophrenia and provides an updated summary of the available evidence on the clinical and diagnostic aspects of the disorder in adults. Following the methodology established in the first part of the Consensus, the panel of experts conducted an exhaustive literature review and systematically discussed and critically evaluated the information identified. This collaborative process resulted in the development of this second section, aimed at guiding clinical practice through a rigorous analysis of the scientific literature.During the deliberative stages, it was also decided to incorporate additional content considered particularly relevant for interdisciplinary teams responsible for providing comprehensive care to individuals with schizophrenia. Accordingly, the document addresses advances in key clinical aspects, diagnostic criteria and conceptual tools that enhance the evaluation of this condition. In this regard, the second part of the document outlines staging models for schizophrenia and its symptomatic variants (negative, cognitive, positive and affective symptoms), as well as the early stages of schizophrenia, ultra-high-risk states, the first psychotic episode, and the duration of untreated psychosis, together with auxiliary diagnostic methods.