Actas Espanolas de Psiquiatria

Over the last 40 years, suicide attempts have become a health problem of epidemic proportions. In order to update preventive measures, we describe the variations observed in the epidemiologic pattern of patients who attempted suicide between 1969-96. A total of 1,150 suicide attempts seen in the Emergency Service of a General Hospital during this period was analyzed. The study protocol included: sociodemographic data, psychiatric antecedents and diagnosis, suicide behaviour and triggering life-events. Throughout the 27 years of the study the most relevant changes in the suicide-attempt population were: progressive levelling between males and females and an increase in antecedents and previous psychiatric treatments (11% vs 74%). The distribution of the psychiatric diagnoses changed in its relative frequency. A dramatic increase was observed in the number of patients who repeated the suicide attempt (22% vs 50%). Triggering life-events tended to vary in relation to sociological changes. Throughout the study period we observed a progressive increase of psychiatric diagnoses in suicidal patients. Therapeutic programs are needed to prevent repetition of suicide attempts, both during periods of psychopathologic exacerbation and during psychosocial adaptation crises triggered by life-events.

Obsessive compulsive disorder is a common disorder, but research on its clinical features is scarce. The goal of this study is to describe the clinical characteristics and demographic features of a large sample of patients with Obsessive compulsive disorder. The characteristics of 104 patients who sought psychiatric treatment and who were diagnosed as having Obsessive compulsive disorder were assessed by means of a structured questionnaire. The mean age of onset was 20 years and the mean time before soliciting treatment was 4 years. Most of the patients reported an insidious onset and related the onset to an stressful event. The most frequent obsessions were doubt, aggressiveness and contamination. Checking, need to ask and mental rituals were the most frequent compulsions. Cleaning and repetition compulsions were most frequent in women. Our results regarding age at onset of illness, way of onset or prevalence of certain obsessions and compulsions are similar to previous research. No agreement was obtained with previous research regarding the link between stress and illness onset, the course of the disorder or the time before treatment was sought. The differences with respect to previous studies could be accounted for the use of different instruments or criteria. The need for the development of instruments allowing to shed light on these discrepancies is stressed.

The short version of the Temperament and Character Inventory-Revised (TCI-R), the TCI-140, is presented. This study aimed: a) to obtain the psychometric properties of TCI-140; b) to analyze the relationship with the normal version of the TCI-R, and c) to study its convergent validity with the MMPI-2 PSY-5. The TCI-R and MMPI-2 PSY-5 scales were administered to a sample of consecutive psychiatric inpatients with differential Axis I and II diagnoses. It was found that the TCI-140 dimensions showed reliability coefficients ranging from 0.67 (Reward dependence [RD]) to 0.86 (Self-Transcendence [ST]) and the reliability coefficients of PSY-5 ranging from 0.68 (CON) to 0.86 (NE/NEU). Correlations for the dimensions with the TCI-R original 240-item version and TCI-R 140 item version ranged from 0.91 (Self-Directedness [SD]) to 0.97 (ST). The dimensions had a normal distribution. Correlations of TCI-140 scales with PSY-5 scales provided preliminary evidence supporting the convergent validity of the constructs. Then, Novelty Seeking (NS) was associated with low Constraint, Harm Avoidance (HA) was associated with low Aggressiveness and Positive Emotionality/ Extraversion, and also with high Negative Emotionality/Neuroticism, Reward Dependence (RD) was associated with high Positive Emotionality/Extraversion. Persistence (PS) was related to high aggressiveness, and Positive Emotionality/ Extraversion. On the other hand, SD was correlated with low Psychoticism, and Negative Emotionality/Neuroticism, and also with high Positive Emotionality/Extraversion. Cooperativeness (C) had a relationship to high constraint and low psychoticism. Finally ST was associated with high psychoticism and Positive Emotionality/Extraversion. The short Spanish version of TCI-R is a useful inventory for the evaluation of the principals dimensions of temperament and character.

The Child Behavior Checklist (CBCL/6-18) is the most commonly used parent-completed instrument that assesses child and adolescent psychopathology. It has been used in epidemiology and clinical studies. The last version contains DSM-oriented subscales. Investigate the psychometric properties of the CBCL/6-18 and develops a valid and reliable Mexican version. Psychologists and child psychiatrists adapted the Spanish version of CBCL/6-18, and a back translation was done by a native English speaker. Discrepancies in the adaptation were solved by consensus. The checklist was applied to children in the community and to outpatients from a psychiatric children hospital. Reliability was evaluated by estimating internal consistency (Cronbach's alpha) on all scales: retest at one week was evaluated with intraclass correlation coefficients (ICC). A ROC curve was performed to estimate a cut-off which correctly identified children from the clinically referred patients and children recruited in the community (non-referred). Mean differences for the groups were calculated with the Student's t test. The Mexican version of the CBCL/6-18 showed that the Cronbach's alpha coefficient was 0.90 for internalizing problems, 0.94 for externalizing problems and 0.97 for the total problem scale. The ICC was 0.97 for the total problem scale. Significant differences were found between the mean score in broad band, narrow and the new DSM/oriented scales. Conclusions: The Mexican version of CBCL/6-18 is a reliable and valid screening instrument for clinical and epidemiologic use.

This paper studies the introduction of the new physical therapies in the years prior to the Second Spanish Republic. It concludes that the physical treatments in force in the international literature were introduced early in Spain and were put into practice by the most important psychiatrists, although in few cases. Given the generalized criticism on the efficacy of psychiatry as a specialty, there was a general bias towards a positive evaluation of the efficacy of the physical therapies by the new generation of Spanish psychiatrists that did not occur in other countries of our setting. The psychiatrists who disagreed professionally with the above-psychiatrists opposed this tendency, there not being sufficient empirical support for the opinion of any group.

Suicide in Spain has increased in both genders and in different age groups. It is important to evaluate the tendencies of this phenomenon. This study describes suicide mortality in a limited and homogeneous population, which offers the possibility of collecting detailed data over a long time period (1936- 2000). Suicide cases were extracted from data in regional archives and from autopsy reports in the Olot court registry office. The suicide rate per 100,000 inhabitants was calculated by analyzing the number of suicides and inhabitants in 5-year groups. Suicide occurred more frequently in males and in the over 65-year old population. The suicide rate fluctuated during the period studied. Among males, the peak was 14.92 during 1961-1965 and lowered to 8.68 in 1996-2000. The suicide rate in females was always lower than for men, except during 1946-1950 (7.71 vs. 3.09) and 1976-80 (5.7 vs. 4.9). The most common methods used were hanging (52%) and shooting (18%). There was no difference in the methods among females. The demographic and methodological data reflect those obtained in similar studies. In the last 10 years of the study, Olot citizens did not have a higher risk of suicide than the population of the rest of Spain. This result should be interpreted considering the limits related to the methodology used in the data collection.

Comparative analysis by Spanish Regional Communities (RC) of indicators related to morbidity and staffing in psychiatric care hospital over a period of time (1980-2004) marked by the initiation and development of deinstitutionalization policies and handover of powers to RC. Longitudinal study. Descriptive analysis of variables, broken down by RC, related to psychiatric morbidity (ICD-9, codes 290-319) and indicators of hospital staffing over a 25-year period. DATABASE SOURCE: Hospital Morbidity Survey, 1980-2004 and Statistics for care facilities providing in-patient care regime, 1980-2004. Differences between Regional Communities are substantial in all the analyzed variables: discharges, total and average stay, total and initial consultations, rate of psychiatrists in hospital care, number of beds and psychiatric hospitals. For all the Regional Communities as a whole, an increase is observed in hospital discharges, decrease of total and mean stays, notable increase of consultations, little increase in psychiatric staff in hospital care and stagnation in the decline of psychiatric hospitals and beds in operation in psychiatric hospital during the last period of time series and low increase in beds for the hospitals that are not classified as a psychiatric hospital. We found evidence of qualitatively different care models between Regional Communities and substantial changes in major indicators over time series.

Sentences against psychiatrists dictated in appellate or higher courts of Spain in the period from 1992 to 2007 were analyzed. Decisions were gathered for 13 of the 17 autonomous communities and statistical analysis yielded the following results: in more than 50% of cases, the decision was unfavorable for the psychiatrist, but the damages never exceeded € 600,000. The most frequent condition in the series was personality disorders (48.9%). The most frequent reasons for seeking legal redress were monitoring errors and negligence; no cases were brought to trial for therapeutic errors. The patient died in 58.3% of cases. It is noteworthy that 10% of the sentences cited defects in patient information or informed consent. The psychiatric health care teams in both the public and private sector should maximize monitoring of institutionalized patients and optimize installations to provide special security measures for the patients.

The governments and organizations responsible for scientific policies try to encourage equality of gender, among their priorities that of obtaining equal participation and full integration of women in all aspects of the scientific profession. The study analyzes the scientific production of women in the areas of Psychiatry by means of the bibliometric study of the papers published in ACTAS ESPANOLAS DE PSIQUIATRIA. A total of 458 papers published from 1999- 2006 period were downloaded from the Science Citation Index-Expanded database, these including original research papers, review articles and clinical cases. A bibliometric study broken down by gender was carried out to determine the existence or inequalities between men and women regarding scientific productivity, type of document, order of author signatures, on the institutional and geographical level. The papers were published by 1,194 different authors. The gender of 977 authors was identified, 587 (60.08%) men and 390 (39.92%) women. The percentage of women authorship has risen from 29.92% in 1999 to 38.86% in 2006. A total of 42.92% of authors having one published article were women, while (those with more than nine articles) only accounted for 33%. Bibliometric studies on scientific activity provide essential information to promote gender equality. An annual increase over 1% in the number of female authors in the journal has been observed, which if it continues will lead to a parity in coming years.

Heat waves have been related with lethal effects, especially in Europe during the intensely hot summer of 2003. However, besides increased deaths and ailments, there are no specific data on the psychiatric effects of heat waves. We have compared psychiatric emergencies in Barcelona during a 15-day heat waves period with the rest of the 2003 summer days. The main variables of the study were total emergencies, admissions, diagnoses, Severity of Psychiatric Illness scale (SPI), psychosocial variables, treatment rendered (including use of restraints), and referrals. No differences were found in the number of emergencies and admissions. During the heat wave, there were more patients with psychiatric backgrounds, more diagnoses of alcohol and drug abuse, but fewer anxiety disorders. The proportion of patients with mechanical restraint increased, but this only occurred in half of the cases in patients with drug or alcohol abuse. The item "dangerousness toward others" (part of the SPI scale) scored significantly higher during the heat waves. There were no significant increases or decreases in psychiatric emergencies or admissions. However, the heat wave was related to more violent behavior and higher drug and alcohol abuse. It should be noted that anxiety conditions and benzodiazepine prescriptions were lower during this period. These findings may be useful to implement medical-psychiatric preventive measures against the heat wave phenomenon.

Psychiatric research in Spain went through a notorious increase in quality and quantity of peer-reviewed papers during the last decade of the previous century, in parallel with other medical disciplines. Although there have been systematic studies of scientific production, they are inadequate from the perspective of the research groups and particularly from university departments. We considered this bibliometric study, in order to analyze the scientific production of the Department of Psychiatry and Forensic Medicine, at the Autonomous University of Barcelona, UAB [DPsML]. METHODOLOGY. In a cross-sectional survey of independent groups (n = 57, 54% men), indicators were applied to production, quality, visibility/distribution and sustained popularity. RESULTS. DPsML research groups, published 314 articles and/or reviews (216 international) between 2004 – 2009, reaching a total of 974 quotations in the period (16 quots./ basic researcher and 11.3 quots./clinical researcher). Contributions at the Thomson Scientific Index [TSI], come from clinical groups (56.48%), and basic groups: 43.52%. The basic groups showed on average impact factor of 5.12 and clinical groups of 2. CONCLUSIONS. DPsML published 11.84% of most cited papers in Spanish psychiatry, 20% in the field of drug addiction and 20.84% in the field of behavioral science,1 the inconsistent results with other bibliometric studies2 on the same researchers, shows the need for more tight and demanding indicators and mapping of production encompassing, both research groups as molar units (university departments). Key words: Bibliometrics, Scientific output, Impact index, Citation analysis, Psychiatry.

Introduction: The Strengths and Difficulties Questionnaire (SDQ) is one of the most frequently used screening test for children and adolescents mental health (MH). In 2006, the Spanish National Health Survey included the child’s MH section through the SDQ version for parents. Objective: To obtain reference values of the SDQparents Spanish version for the 4-15 year-old population living in Spain during 2006-2007. Methodology: From the Spanish National Health Survey-2006, measurements of central tendency, dispersion and percentiles scores were calculated for the “Total Difficulties Score” (TDS-SDQ) Index and for the five dimensions of the questionnaire. Results: A sample made up of 6266 children, ages 4 to 15 years, having national representativeness was obtained. Regarding the TDS-SDQ Index, scores were higher (worse MH) in boys than in girls (9.66 vs 9.04) and were higher in the younger age group in the total sample (9.90, 9.49 and 8.73) and also in boys. Girls scored higher than boys on the emotional symptoms and prosocial dimensions, and the scores were higher in older age group for the total sample. Regarding behavior problems, the younger age group scored higher in the total sample (2.19, 1.87 and 1.76) and by sex. Boys scored higher than girls on hyperactivity (4.51 vs. 3.92) and scores were lower in older ages in total sample (4.71, 4.19 and 3.82) and by sex. Peer problems dimension has no statistically significant differences by sex or age. Conclusions: The population values shown are informative and extend the knowledge and interpretation of the SDQ results.

A total of 215 schyzophrenic patients according to DSM-IV criteria in treatment on risperidone were included in an open label postmarketing surveillance 18 months study to evaluate safety and effectivity of the drug in preventing relapses. The Brief Psychiatric Rating Scale, Global Functional Assessment Scale and the Clinical Global Impression were used to assess. Safety was evaluated by the UKU subscale for neurological side effects. A 82.1% of the patients continued risperidone medication without relapse during the 18 month period. Risperidone was used at a mean dosage of 5.69 2.41 mg/d. Patients improved psychotic symptoms and global activity, and significant reductions were observed in mean total UKU subscale for neurological side effect score. 91.7% of the patients did not report any adverse event; only 2 (1.2%) patients dropt out because of intolerance.

Cognitive impairment is a syndrome with multiple causes, presenting frequently neuropsychiatric symptoms. In these cases, the psychiatrist role is essential, including both diagnosis and therapy.HIV-associated dementia usually includes psychiatric symptoms, even in the absence of neurological symptoms in initial stages. Moreover, the prolonged life span of patients with HIV leaves the possibility that prevalence or HIV-associated neurologic disease increases in coming years. We report a case of a HIV male with insidious cognitive impairment, making diagnosis difficult due to ambiguous symptoms. The patient begins with depressive symptoms and slightly develops cognitive impairment. The presence of cognitive impairment in a young person must alert us think about HIV pathology, because it is one of the leading causes of dementia in the young.

The therapeutic uses of melatonin in psychiatry are reviewed. Data source and search strategy: a 39 year period search covering a 39 year period (1966-2004) was carried out using Medline data base. The search strategy consisted in the combination of the key words ((mental disorders or psychiatry)) and ((melatonin and therapeutic use)). Two restrictive criteria were applied: a) selection of studies carried out in humans, and b) only randomized controlled trials were admitted 56 articles were found. Twelve were excluded because they were not directly related to the study aim. Melatonin was used in 44 articles related to different clinical conditions. It was used because of its hypnotic and/or resynchronizing actions in 93.2 % of the articles, while in 4.5 % of the articles melatonin was used due to its antioxidant properties. The main use of melatonin as a therapeutic agent in psychiatry is in sleep disorders and its use in other psychiatric is minor.

Psychotic-like experiences can be considered as a vulnerability marker for psychotic disorders. The psychometric assessment of the extended psychosis phenotype has advanced considerably in recent years, although it must continue to deepen the quality of self-reports available for its assessment in Spanish population. The main goal was to analyze the psychometric quality of the Community Assessment Psychic Experiences-42 (CAPE-42) in Spanish college students and patients with psychosis. The final sample was comprised of a total of 660 students (M = 20.3 years, SD = 2.6) and 97 patients with psychosis (M = 35.4 years, SD = 10.2). The goodness of fit indices resulting from the confirmatory factor analysis that tested the hypothesized three-dimensional model (Positive, Negative and Depressive) were not adequate. In contrast, the exploratory factor analysis yielded a three-dimensional solution. Internal consistency values for the three dimensions of the CAPE-42 ranged between 0.78 and 0.89 in the sample of students and between 0.84 and 0.93 in the patients with psychosis. The CAPE-42 scores correlated statistically significant with delusions and trait anxiety and state. These results show further evidence of validity of the CAPE-42 scores in samples of the Spanish population and support its use as a tool for the assessment of the extended psychosis phenotype.

Hidden psychiatric morbidity represents an important problem, one to two-thirds of serious cases receiving no treatment each year, often due to lack of awareness of illness. We present a case report of a patient diagnosed of schizophrenia whose first contact with the health system occurred at the age of 63 in extreme social circumstances.

There are many studies on delirium in clinical populations and nursing home patients but not in community populations. This study has aimed to know the prevalence of delirium in a community population and to know the survival rate during a five-year period. Case-control and survival study based on data from an epidemiological study to measure the prevalence and incidence of dementia in eight rural villages in Girona. According to the Diagnostic and Statistical Manual of Mental Disorders, delirium was identified for the prevalence study using the information obtained from the Cambridge Mental Disorders of the Elderly Examination. A hypothesis contrast method was used in order to compare all clinical features of the subjects according the presence or the absence of delirium. The Kaplan-Meier technique was used to estimate survival of the subjects, and a multivariate Cox regression analysis was done to know the effect of delirium on mortality over the five-year period. 1,460 subjects older than 69 participated in the study. A prevalence of 0.96% (95% confidence interval [CI]: 0.43-1.49) was detected (14 cases of delirium). Mean survival for subjects with delirium was 3 years (CI 95%: 1.9-4.1) and it was slightly lower than for heal - thy controls. The presence of delirium increased the risk of death in five years by 2.65. The prevalence of delirium in community populations is low and most of the times it is superimposed on dementia. Patients with delirium have a higher risk of mortality at the end of a five-year period.

Background: Mental disorders in old age are a major public health problem. However, few epidemiological studies provide data on prevalence and risk factors of mental illness in older old population. The aim of this study is to assess the prevalence of common mental disorders and their associated factors in primary care patients over 75 years. Method: Cross-sectional epidemiologic study carried out in a sample of 426 older old patients who were attended at Primary Health Care settings, proportionally distributed for provinces and health centers. The Spanish version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) was used in order to diagnose the most common psychiatric disorders in this field. Results: Prevalence and comorbidity rates of affective, anxiety and somatoform disorders are high. 47.4% of the sample presented one or more psychiatric disorder. The most prevalent were affective (33.8%), somatoform (24.4%) and anxiety (14.3%) disorders. 6.3% had comorbidity between affective, anxiety and somatoform disorders. Perceived health status and physical illnesses were significantly associated with these mental disorders. Conclusions: Affective, anxiety and somatoform disorders are highly prevalent in older old population with high rates of comorbidity. Their detection and treatment should be considered a relevant issue in primary care.

To test the consistency of the proposed structure for the SCL-90R. 598 first appointments of a Mental Health Centre were evaluated. 352 of these patients completed the SCL-90-R during their first appointment and also 6 and 12 months later. The structure of this questionnaire from the first appointment as well as from follow-up observations is analysed separately in men and women by exploratory factor analysis. Moreover, confirmatory factor analysis have been applied in order to compare the relative adjustment with the data observed during the first appointment in the original model of Derogatis et al., as well as in 3 other factor models. Exploratory factor analysis rendered a different factor structure with all other contrasted models, that were rejected by confirmatory factor analysis as well, in men and women. Only a relative temporal stability in factor structure, different for men and women, was found. It seems that this tool may be rather more useful as a unitary measure for global distress. In addition, our results suggest that the factor structure of the SCL-90-R may vary in the same sample depending on the gender and also possibly varying throughout the time of observation. According to this, the benefit of the SCL-90-R for descriptive and monitoring studies throughout the time is questionable for this type of samples.

Medico-legal assessment of people who have suffered injuries in road traffic accidents must use Law 30/95 as a reference frame. Psychiatric and neuropsychological syndromes secondary to traumatic brain injury (TBI) are no exception and pose demanding challenges to physicians and psychologists. This paper analyzes descriptive and nosological difficulties face by psychiatrists and psychologists; their expert contribution includes translation of official diagnostic entities into categories published in the annex of Law 30/95. Our psychopathological repertoire was created in the 19th century and has hardly been revised since. The wide and varied types of neuropsychological impairments encountered in TBI have to be diagnosed within a very narrow range of DSM-IV and ICD-10 categories. The most common conflicts encountered in the medicolegal arena are revised: the differential diagnosis between dementia and combinations of organic personality disorder with cognitive impairment; differential diagnosis between spontaneous psychiatric illness (bipolar disorder, schizophrenia) and psychiatric syndromes secondary to brain injury (posttraumatic psychosis, organic bipolar disorder); differential diagnosis between concussional syndrome and organic personality disorder, cognitive impairment or organic affective disorder. Specific diagnostic guidelines are suggested for each of these clinical situations. Actas Esp Psiquiatr 2003;31(6):353-360

Delirium is associated with high morbidity and mortality. There are no available instruments validated for evaluation and follow-up of this syndrome in Columbia. An expert's panel adapted the Spanish DRSR- 98. In 110, randomly selected, medical-surgical hospitalized patients, 17 (15.5 %) of them with delirium diagnosed with DSM-IV-TR criteria, the inter-rater reliability, validity and sensitivity to clinical change of the new adaptation of the scale were measured. Internal consistency (Cronbach's alpha: 0.956), inter- rater reliability (ICC: 0.95) and validity (94.8 % under the ROC curve area) were very good. For the Cut-off score of 14 for the total scale score, sensitivity was 82.4% and specificity 97.8 %. The scale was sensitive to clinical change, with a mean difference of 12.9 (t: 4.071; p=0.007). The Colombian adaptation of the Spanish DRS-R-98 is sensitive, specific and reliable for assessment of delirium in hospitalized adults in medical surgical settings.

Objective: We have analyzed social and leadership abilities in children with ADHD and their relationship with execution of tasks involving sustained attention and inhibitory control. Patients and methods: A retrospective analysis of 170 patients with ADHD was performed. We evaluated leadership and social abilities, measured through the Behavior Assessment System for Children (BASC) and their relations with the results of different neuropsychological tests, including Wechsler scale for children (WISC-IV) and Conners' continuous performance (CPT II). Results: In the differential analysis between the IQ, results of the tests and their relation to BASC scores, a statistically significant relation was observed between attentional capacity expected according to the patient's intelligence and social skills scores (according to BASC filled out by mothers and teachers) and leadership (according to all informants) sections. Conclusions: Attentional difficulties are closely related to social competence in patients with ADHD, either by a direct cause-effect relationship or a shared dysexecutive substrate of this disorder.

Some psychopathological characteristics are frequently observed in women who have voluntarily aborted. However, some resistance currently remains to their recognition as a differentiated nosological category, known as Post-Abortion Syndrome (PAS). We tried to assign a diagnostic category to women with PAS by determining the extent by which they fulfilled the diagnostic criteria of international classifications. Criteria for Post-Traumatic Stress Disorder (PTSD) were met in the ten PAS cases studied. In addition, patients also showed other non-specific symptoms such as repeated and persistent dreams and nightmares related with the abortion, intense feelings of guilt and the "need to repair". PAS should be considered as an additional type of PTSD. It also has some specific characteristics that could help to understand the patient's life experience and to establish a psychotherapeutic intervention.