Scielo RSS <![CDATA[The European Journal of Psychiatry]]> vol. 20 num. 4 lang. <![CDATA[SciELO Logo]]> <![CDATA[The Epidemiology of parasuicide in Canary Islands]]> Objective: To analyze the epidemiology of parasuicide in Canary Islands. Methods: Emergency Department reports at every Hospitals and clinical data of all Mental Health Units were revised in Tenerife (1992-1996) and in Gran Canaria (1994-1996). Data about age, sex, address, educational level, marital status, job situation, time and methods used for committing parasuicide and previous parasuicide events were collected. Results: In Tenerife Island the annual average was 355 parasuicides among which 24.9% of the episodes were repeaters. The average crude rate was 70.99 cases per 100.000 inhabitants and the standardized rate was 61.81. In Gran Canaria Island the annual average was 634 and 21.3% were repeaters. The average crude rate was 120.23 per 100.000 and the standardized rate was 103.7 per 100.000. The age group 15-34 years, showed the higher rate values. Women presented higher rates as compared to men in all age categories. Conclusion: These findings are in agreement with those of the WHO-EURO Multicentre Project on Parasuicide. We found in Tenerife the lowest parasuicide rate values published in Europe. <![CDATA[Current situation of depression healthcare in Spain: results of a psychiatrists' survey]]> Objective: To analyze the current situation of healthcare for depression in Spain, according to psychiatrists opinion, and how it has evolved over the last 20 years, comparativily with the results reported in previous studies of our group. Methods: Throughout 2002, we recorded the opinions of 101 specialists in psychiatry after asking them to fill out structured questionnaires in which they rated care, clinical, therapeutic and care quality. Results: The presence of depressive disorders in healthcare is substantial, despite the high figures for "concealed epidemiology", with an increase in these last 20 years of disorders comorbid with anxiety. Currently, most patients arrive at the psychiatrist having been referred by their general practitioners (GP), as there is now less reluctance in depressive patients to such referral. In the last years there has been an increase in pharmacological treatment, with adverse effects of the drugs representing the major obstacle to non-adherence to such treatment. Selective serotonin reuptake inhibitors (SSRIs) constitute the pharmacological group of choice, and are the drugs most commonly used in the treatment of depression, together with venlafaxine. Areas where there is a need for improvement are time devoted to consultation, coordination between GPs and psychiatrists, waiting lists, and resources available to Mental Health Units. Conclusions: Current situation of depression healthcare in Spain has substantially changed in recent years, improving in some aspects, thanks, in part, to the attitudes of GPs with this disorder and to evolution of pharmacological treatment. <![CDATA[In the general hospital: A doctors'perception survey]]> Psychosocial factors play an important role in the clinical practice in the general hospital. The main objective of this study is to evaluate the relevance assigned by non psychiatry physicians who work in a teaching general hospital, to psychosocial factors in the context of their day-to-day clinical practice, and the coping strategies they adopt to deal with them. A second objective is to assess the evaluation of the Consultation-Liaison (C-L) service in a teaching hospital. Method: A previous questionnaire about perception of psychosocial factors in the general hospital (1) was adapted. Our questionnaire consists of 3 sections. A first section gathers socio-demographic information of surveyed physicians; a second section evaluates the relevance assigned by non psychiatry physicians to psychosocial factors, and their coping strategies, and finally, a third new section designed to provide an evaluation of our C-L unit service provision by non psychiatry physicians. Results: Of a total of 219 non specialty physicians responding to the survey, 35.5% stated they had adequate knowledge of psychiatric disorders, 87.3% considered that psychosocial factors influence the origin and prognosis of physical illnesses and 99.5% considered that social and emotional aspects play an important role in their clinical practice. 79.6% considered psychiatrists to be essential for the care of hospitalized patients. Statistical significance was set at 5%. Conclusion(s): This paper highlights the relevance attributed to psychosocial factors in clinical practice and the importance assigned to the C-L services by non specialty physicians of a teaching general hospital. <![CDATA[Psychiatric treatments for children and adolescents preferred by spanish psychiatrists]]> Objectives: To study the prescription criteria of Spanish psychiatrists treating children and adolescents. Methods: a survey was designed to record their first choice and complementary preferences for pharmacological, psychotherapeutic and psychoeducational interventions in five disorders: autism, depression, separation anxiety, obsessive compulsive and attention-deficit/hyperactivity disorders. Results: One hundred and nine psychiatrists responded. No distinction was made between children and adolescents. Around 90% recommended all three types of intervention in the five disorders. Only 2-10% would use only one treatment. Antidepressants were the most frequently prescribed drugs (recommended by 58%), followed by anxiolytics (33%), antipsychotics (24%), stimulants (20%), beta-blockers (19%), mood stabilizers (10%) and alpha-adrenergics (4%). Cognitive-behavioral therapy was the most popular approach, recommended by 66%; a third of the interviewees recommended family, support, interpersonal and dynamic psychotherapy. Interestingly, respondents quite frequently prescribe drugs, drug combinations and psychotherapies whose efficacy has not been demonstrated in the disorders in question. Conclusions: The majority of Spanish psychiatrists preferred the combined treatments in all disorders. There seems to be a tendency towards excessive generalization of therapeutic results obtained in adults. <![CDATA[Long term studies of depression: what is relevant for the physician?]]> Following a meticulous review of long term studies of depression, we conclude that prolonging antidepressant medication after full recovery is clearly beneficial. In this article, we examine recent long term studies that reveal substantial evidence in this sense. However, we advise physicians to keep in mind that this prophylactic effect has been proven for a restricted population, i.e., patients showing recurrent depressive disorders with low comorbidity on axis 1, and having revealed a satisfying response to antidepressant agents during the acute phase of the index episode. This does not mean that antidepressant agents are not useful for patients showing other characteristics, but more studies are needed to assert this possible advantage. We also examine the limited data on chronic forms of depressive disorders. The effect of long term prescription is believed to be advantageous as long as the medication is taken; it has been demonstrated for up to 5 years. Full dosage is indicated even if the effect of active drug over placebo persists at lower doses. The differences between antidepressant agents appear minor and physicians should be more concerned about the long term tolerance of these drugs than their efficacy when choosing the appropriate medication for maintenance treatment. Physicians should also be aware of the greater risk of recurrence during the 6 months following the discontinuation of medication. This risk occurs regardless of the total length of prescription. The possibility that recurrence may be mistaken for withdrawal symptoms cannot be ruled out. Finally, the side-effects of antidepressant drugs are a major concern, particularly when extending the length of prescription. Even though the newer generation medications display a more favorable short-term side-effect profile, the effects of chronic use of these agents are still unclear. Therefore, the decision to extend treatment over several years requires comprehensive discussion with patients and cautious clinical monitoring to identify potential late-onset side effects. <![CDATA[Internal and external validity of the experiences in close relationships questionnaire in an american and two dutch samples]]> Background and objectives: The Experiences in Close Relationships scale (ECR) is much used in adult attachment research. In this study we examined: the psychometric properties of the Dutch ECR in comparison with the original American ECR; the claim of orthogonality of its scales Avoidance and Anxiety; and a broader applicability of the ECR, because much research is restricted to psychology student samples. Methods: In Study 1 we investigated the ECR's internal structure by means of confirmative factor analysis in the American psychology student sample in which the ECR was originally validated. We compared these findings with the results of factor analyses in: a Dutch psychology student sample to test whether the Dutch translation yields comparable results; and a Dutch general population sample to evaluate the supposed orthogonality and to determine a broader applicability of the ECR. In Study 2 we evaluated aspects of the external validity of the ECR. Results: Confirmative factor analysis supports the original two factor structure in both Dutch samples, although less clear in the population sample. As opposed to both student samples the scales correlate moderately in the population sample. Results support external validity of the ECR in both Dutch samples. Conclusions: Since the supposed orthogonality of the scales varies by sample, the internal validity of the (Dutch) ECR varies by sample as well, namely from satisfactorily (population) to adequate (students). The external validity of the Dutch ECR is compared to the American version adequate, suggesting a broader applicability.