Research Outputs
Factores de riesgo para intento de suicidio en personas con trastorno depresivo en atención secundaria
Background: Depression is the most common psychiatric disorder in people with suicidal behavior. The knowledge of its risk factors should help to design preventive strategies. Aim: To describe suicidal behavior and risk factors for attempted suicide in people with major depressive disorders (MDD). Material and Methods: A 12-month follow-up study was conducted in 112 outpatients at three psychiatric care centers of Ñuble, Chile, with baseline and quarterly assessments. Demographic, psychosocial and clinical factors as potential risk factors of suicide attempts, were assessed. A clinical interview with DSM-IV diagnostic criteria checklist, Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results: Sixty seven percent of participants had suicidal ideation and 43.8% had attempted suicide. Suicide risk was significantly higher in participants with a single major depressive episode (odds ratio [OR] = 3.98; 95% confidence intervals [CI] = 1,29-12,32 p = 0.02) and those with previous suicide attempts (OR = 13.15; 95% CI = 3,87-44.7 p < 0.01). Young age, not having a partner, being unemployed, having a severe major depressive episode, having psychotic symptoms, having a personality disorder and being devoid of medical illness increased the risk of suicide attempts, but they did not reach statistical significance. Conclusions: Significant risk factors should be specially considered when designing suicide preventive strategies in patients with MDD.
Predictores de remisión del trastorno depresivo mayor en tratamiento en el nivel secundario de atención
Background: The knowledge of predictive factors in depression should help to deal with the disease. Aim: To assess potential predictors of remission of major depressive disorders (MDD) in secondary care and to propose a predictive model. Material and Methods: A 12 month follow-up study was conducted in a sample of 112 outpatients at three psychiatric care centers of Chile, with baseline and quarterly assessments. Demographic, psychosocial, clinical and treatment factors as potential predictors, were assessed. A clinical interview with the checklist of DSM-IV diagnostic criteria, the Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results: The number of stressful events, perceived social support, baseline depression scores, melancholic features, time prior to beginning treatment at the secondary level and psychotherapeutic sessions were included in the model as predictors of remission. Sex, age, number of previous depressive episodes, psychiatric comorbidity and medical comorbidity were not significantly related with remission. Conclusions: This model allows to predict depression score at six months with 70% of accuracy and the score at 12 months with 72% of accuracy.
Implementación de docencia de postgrado y pregrado presencial y remota con pacientes simulados en psiquiatrÃa
Background: Clinical simulation is a strategy with broad support especially when face-to-face medical attention is difficult. In Psychiatry, the use and availability of simulation is lower than in other medical specialties, even for remote teaching. Aim: To report a pedagogical experience whose objective was to develop and implement the simulated patient technique as a teaching strategy for psychopathology and face-to-face Psychiatry for Psychiatry residents and remote for undergraduate medical students. Material and Methods: Six residents and 115 medical students participated in the activity. A descriptive qualitative-quantitative study was designed. Surveys were used to measure the quality and satisfaction of clinical simulation and simulation in psychopatho- logy and psychiatry. In addition, an opinion was requested about the activity. All residents and 104 students participated in the assessment. Results: The simulations were satisfactorily evaluated. The participants perceived that the pedagogical activity favored the development of generic competencies and specific skills for general Psychiatry. Conclusions: Simulation in Psychiatry does not replace face-to-face practical teaching, but it is a transitional and complementary method for clinical activities.
Tendencia de las hospitalizaciones en la Unidad de Corta EstadÃa de PsiquiatrÃa del Hospital ClÃnico Herminda Martin durante 14 años.
Background: Short-stay psychiatric hospitalization is a necessary resource to treat mental disorders with severe decompensation that cannot be resolved outpatiently. Knowledge of your results helps in clinical and administrative management. This study aims to evaluate the evolution of hospital indicators, sociodemographic and clinics characteristics of inpatients in a short-stay unit of psychiatry. Material and Methods: Longitudinal, retrospective, trend study was conducted in a universe of 4,563 egress of short-stay psychiatric unit of Chile, for 14 years, from 01/07/2005 to 30/06/2019. Hospital indicators, sociodemographic and clinical variables were evaluated. Results: during the period under study: The egress decreased, the average days were prolonged, the occupational index increased and the turnover rate decreased. A low number of patients, predominantly socioeconomic and psychosocial adversities, were frequently re-hospitalized. The greater the number of hospitalizations longest stay. Administrative and judicial hospitalizations were increased; the latter with the highest average stay. Hospitalization of males, adolescents, young people and older adults increased. Communes and primary care center with a greater population, proximity and access predominated. It remained frequency of schizophrenia and other psychotic disorders and personality disorders, doubled affective disorders, tripled substance disorders, doubled dual pathology, and personality disorder was common in comorbidity with substance disorder and affective disorders Conclusions: strategies would be required with the Judicial System and Health Service, implement adolescent unity and addiction unit, and strengthen multidisciplinary care for older adults.
Evaluación y manejo inicial de las ideas e intentos de suicidio en atención primaria
Suicide and suicidal behaviors are a significant public health problem, for which several prevention modalities have been implemented. The identification and treatment of suicidal risk is a critical step in prevention, especially in primary health care, a level where most of the population consults. This article focuses fundamentally on the research on suicide risk in primary care by proposing an action guide for the assessment and management initial of suicide ideas and attempts.
CaracterÃsticas clÃnicas del trastorno depresivo mayor en tratamiento en el nivel secundario de atención
Background: Depression is considered the second leading cause of disability worldwide. Aim: To describe the clinical characteristics and the evolution of major depressive disorder (MDD) in secondary care. To evaluate the association between socio-demographic and clinic variables with the first or recurrent major depressive events (MDE). Material and Methods: Clinical features, treatment, remission and duration of MDE were evaluated during a follow up lasting 12 months in 112 participants aged 44 ± 15 years (79% women). Patients were assessed as outpatients every three months at three psychiatric care centers of Chile. Clinical interviews were carried out using DSM-IV diagnostic criteria checklists and the Hamilton Depression Scale was applied. Results: Most patients were referred from primary care. The mean time lapse for referral to the secondary level was 10.8 months. Most patients had episodes that were recurrent, severe, with a high rate of psychosis, with suicide attempts and melancholic features and with psychiatric and medical comorbidities. Remission rate was 27.5%. In only 16 % of patients, the episode lasted six months or less. The group with recurrent episodes had different age, sex and clinical features. Conclusions: MDD treated at the secondary care level is severe and its symptoms are intense. The time lapse prior to referral was prolonged. Primary care management and referral of these patients should be studied more closely.