Vertex (Buenos Aires, Argentina)最新文献

Introduction: The number of mental health hospitalizations in general hospitals has been rising in Argentina, in thecontext of the implementation of the National Mental Health Law. Expanding the body of evidence on these hospitalizations is essential for monitoring this ongoing transformation. This study aimed to characterize mental health hospitalizations in a public general hospital in the Autonomous City of Buenos Aires, where psychiatric admissions occur in wards designated for other medical specialties. To this end, hospital discharge data from 2018 to 2023 were analyzed, focusing on sociodemographic, clinical, and care process variables.

Methods: A quantitative approach was employed, using descriptive statistics and chi-square tests to explore associations between variables. A total of 412 cases were included in the analysis.

Results: The findings show that the highest number of discharges occurred in 2023. The most frequent reasons for admission were psychotic decompensations, followed by suicide attempts. Among patients of non-Argentinian nationality, this order was reversed. Seventy-four percent of hospitalizations lasted fewer than 30 days, while 9% extended to 90 days or more. Longer hospital stays (≥90 days) were associated with being 60 years of age or older, being admitted due to a psychotic episode, having a discharge diagnosis within the F20–F29 category of the ICD-10, and the type of health coverage.

Treatment-resistant major depression (TRD) poses a significant challenge in psychiatry due to the limited response to conventional therapies. Subanesthetic dose intravenous (IV) ketamine has emerged as an effective therapeutic option, providing rapid effects on depressive and suicidal symptoms. This article outlines the ketamine infusion protocol implemented in a general hospital, following international guidelines. Inclusion and exclusion criteria, dosage, administration procedure, and patient monitoring. Additionally, adverse effects and safety considerations. The implementation of this protocol optimizes the use of ketamine in TRD, ensuring both efficacy and safety.

Reseña del libro: La tragedia de las instituciones de Salud Mental : memorias del manicomio, de Juan A. Garralda. Letra Viva, 2024.

Incluye: Consideraciones sobre legislación de alienados. Fragmento de la Tesis para Doctorado de José Caroni. UBA, Facultad de Ciencias Médicas, 1898,.

Introduction: Cyberchondria is defined as increased anxiety or distress after excessive or repeated searching for health-related information on the Internet. No studies have been found that explore the factors associated with cyberchondria in Hispanic medical students. The objective was to determine the factors associated with cyberchondria in medical students from a Peruvian university in 2018.

Materials and methods: An analytical cross-sectional study was conducted with 657 medical students from a private Peruvian university. The students responded to a survey in which information about cyberchondria levels was collected using the Cyberchondria Severity Scale - 12. Linear Regression was used to calculate the betas with 95 % confidence intervals.

Results: The mean cyberchondria score was 25,1±9,1. An association between cyberchondria and the year of study was evidenced (p<0,001), with the second year reporting the highest scores and the sixth year reporting the lowest. Likewise, students with a first-degree medical relative reported lower levels (p=0,01). A weak inverse correlation with age was evidenced (p<0,001). No association was found with sex, place of birth, smoking or having a first-degree relative that is a health worker.

Conclusions: It was found that age, year of studies, and having a first-degree medical relative were associated with cyberchondria. Further studies are needed, especially of a longitudinal nature.

Introduction: Obsessive-compulsive disorder (OCD) is characterized by obsessions and related compulsions, with aprevalence of 2.5% in the general population and a predominance in men (3:1). Despite numerous hypotheses, its aetiology remains unknown. This study explored the frequency of obsessive-compulsive symptoms (OCS) among second-year medical students at the University of Buenos Aires, and investigated its possible association with a history of repeated pharyngitis.

Materials and methods: This study involved a sample of 494 Physiology and Biophysics students from 2023. The participants completed self-administered questionnaires assessing demographic data, medical history, and the DOCS questionnaire for the assessment of OCD. Inclusion and exclusion criteria were applied, and statistical analyses including chi-square, odds ratio, and multivariate logistic regression were performed using IBM SPSS®.

Results: Among the 494 participants analyzed, the frequency of OCS was 26.92%. Bivariate analysis revealed associations between SOC and gender, recurrent sore throat in childhood, and recurrent sore throat in adulthood. Multivariate analysis confirmed the association between SOC and recurrent sore throat in adulthood, challenging the notion that PANDAS manifests primarily during childhood.

Conclusion: This study suggests a possible link between immune-mediated OCD and repeated streptococcal infections in adulthood, emphasizing the need for further research on specific antibodies and therapeutic interventions. These findings open avenues for larger, more focused studies to validate these results and explore new therapeutic strategies.

Introduction: After the first crisis, family caregivers of persons with severe mental health conditions face situations that impact not only them but also affecting the recovery of these persons.

Objective: To describe and analyze the experiences of family caregivers of people with severe mental health conditions after the first crisis.

Methods: Qualitative research was conducted. The sample was selected intentionally. Semi-structured interviews (n=15) were carried out. The analysis was qualitative.

Results: Participants explained that the experiences after the first crisis generated severe suffering in the family as a group, and the primary caregiver being the most affected. When referring to mental health workers, participants agreed that their support favors changes to the lives both of people with severe mental health conditions and the family group (and the primary caregiver included). Mental health worker´s interventions are considered an opportunity to improve their quality of life.

Conclusions: It has been suggested that family caregivers are the blind spot of the mental health field. They organize and provide care, provide support during and after the first crisis, suffer with the person with severe mental health conditions, but they are invisible to mental health services.

Transforming the mental health care model requires robust information systems that support well-informed discussions about the progress, achievements, and challenges of implemented reforms. Globally, the World Health Organization has developed indicators for this purpose, particularly regarding mental health care in general hospitals and hospitalizations in such settings. However, data from Argentina is often missing from these global analyses. To examine the available information on mental health services in general hospitals in Argentina, a qualitative study was conducted. Six sources of both point-in-time and periodic data, spanning from 2011 to 2023 and with national coverage, were analyzed. The results reveal significant issues in the country’s mental health information systems, including low data coverage when passive data collection methods are used, and limited public access to reports and databases. The study also discusses the global indicators used for tracking mental health hospitalizations in general hospitals, and proposes alternative approaches, given their limited relevance at the local level.

Introduction: The psychotherapeutic work of the psychiatrist in the child and adolescent population requires intervention with responsible adults and often, professionals from the judicial area. The importance of the psychotherapeutic role and its characteristics in some extremely serious situations are discussed. Different contributions are describedand the importance of the holistic comprehensive approach, as well as the long period of neoteny, characteristics of the evolutionary period and particular vulnerability to traumatic experiences such as pregnancy due to violation in an 11-year-old girl. The concept of Double Bind described in family interaction is analyzed, and the possibility of applying it in the therapist's relationship, subject to demands of the judicial field that complicate and aggravate conflicts, versus the psychic reality of the patient.

Conclusion: It concludes that there is a risk of implementing protocols that do not contemplate, perhaps because it is not tangible, the extremely delicate fragility of the psychological structure and the irreparability of its damage.