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Resumen Introduccion Los trastornos mentales se encuentran entre las principales causas de discapacidad a nivel mundial. Es conocido que los trastornos mentales graves (TMG) se asocian a una alta discapacidad, pero el impacto de los trastornos mentales comunes (TMC) no es desdenable. En este trabajo comparamos la discapacidad medida con la escala WHODAS 2.0 en ambos grupos diagnosticos desde la consulta de enfermeria de un Centro de Salud Mental. Material y metodos Se recogieron los datos sociodemograficos, el diagnostico clinico y las puntuaciones de discapacidad de los pacientes atendidos por la enfermera especialista de Salud Mental en el Hospital Infanta Elena de Valdemoro (Madrid) y se comparo la discapacidad en pacientes con TMG y TMC, mediante el test t de Student. Resultados Se reclutaron un total de 133 pacientes. Los pacientes con TMC mostraron una mayor discapacidad respecto a los pacientes con TMG, siendo esta diferencia significativa para el dominio del trabajo (p Conclusiones En este estudio mostramos que el nivel de discapacidad asociado con el TMC fue mas alto en ciertas areas en comparacion con el TMG, siendo esta diferencia especialmente relevante para los dominios «trabajo» y «participacion». Esto puede servir para adecuar las intervenciones dirigidas a estas personas y podria mejorar su calidad de vida.

Resumen Introduccion La ideacion suicida, la conducta suicida y las conductas autolesivas sin intencion suicida (autolesiones) son un grave problema de salud publica en la adolescencia. Una proporcion significativa de de adolescentes evaluados en contexto clinico muestran un perfil de disregulacion (DP). El DP se caracteriza por inquietud, irritabilidad, «tormentas afectivas», inestabilidad emocional y agresiones que aparecen de forma desproporcionada ante determinadas situaciones, y parece estar relacionado con un mayor riesgo de pensamientos y conductas suicidas y autolesivas. Metodos Doscientos treinta y nueve adolescentes del Centro de Salud Mental Infantojuvenil del Servicio de Psiquiatria de la Fundacion Jimenez Diaz fueron evaluados con la Escala de Fortalezas y Dificultades para obtener el DP y con la entrevista estructurada sobre suicidio y autolesiones; se recogio tambien informacion sociodemografica. Resultados Estudios de regresion logistica mostraron que los adolescentes con elevacion del DP tenian mas riesgo de presentar planes de suicidio, gestos suicidas e intentos suicidas. Igualmente, mostraron mas riesgo de autolesiones. Conclusiones Los resultados apuntan a dificultades de autorregulacion tras la presencia de planes de suicidio, gestos suicidas, intentos de suicidio y autolesiones. De cara al futuro, estudios longitudinales permitirian esclarecer la direccion de dicha relacion.

Introduction Electronic ecological momentary assessment (EMA) can provide precise information regarding day-to-day functioning of patients overcoming some of the limitations of usual clinical evaluation; however adherence to this methodology might be a major threat. Research and application of EMA concerning clinical settings remains scant. Our goal was to study the user profiles of EMA in a clinical sample of adolescents. Material and methods 209 adolescents following an outpatient mental health treatment accepted to use EMA. They were evaluated in different sociodemographic and clinical variables as well as the use that they made of EMA. Results 39.7% of patients were considered users and 60.3% non-active users. Certain self-harm behaviours were more common in the group of active users, while hyperkinetic disorders were more common in the group of non-active users. A regression analysis revealed that non-suicidal self-injury (OR = 2.99) and hyperkinetic disorders (OR = 0.51) were related to the use of EMA. Conclusion This preliminary study adds novel and promising information about EMA use in clinical practice. Adolescents with self-harm behaviours EMA seem more prone to use this tool. Our study provides support for actively monitoring self-harm behaviours with EMA. Future studies might consider a comprehensive analysis of adherence and EMA data collection.

Resumen Introduccion El auge de la telemedicina en el campo de la salud mental esta haciendo que el uso de instrumentos psicometricos, tradicionalmente basados en un soporte de «lapiz-y-papel», se adapte al formato electronico. El objetivo de este trabajo es verificar si los 2 formatos de conocidos instrumentos como las escalas GHQ-12, WHO-5 y PHQ-9 son intercambiables. Material y metodos Cuarenta y siete voluntarios completaron los cuestionarios GHQ-12, WHO-5 y PHQ-9 en papel y en las siguientes 24 h en su version electronica a traves de la web www.memind.net (24 en formato electronico-Likert y 23 en formato electronico-slider). Se midio la consistencia interna mediante el indice α-Cronbach y el coeficiente omega, la fiabilidad test-retest mediante el coeficiente de correlacion intraclase (CCI), el grado de acuerdo de los items mediante el coeficiente kappa ponderado y comparamos la estructura dimensional de los 2 formatos con el indice de ajuste comparativo (IAC). Resultados La consistencia interna de los instrumentos fue mayor de 0,8 para todos los instrumentos a excepcion del PHQ-9. Los CCI oscilaron entre 0,655 para PHQ-9 lapiz-y-papel/electronico-slider y 0,901 para GHQ-12 lapiz-y-papel/electronico-slider. El acuerdo entre los items en las versiones en lapiz-y-papel y electronica-Likert fue variable, desde acuerdos muy bajos en el del item PHQ-1 (κ ponderada = 0,143; p = 0,384) hasta acuerdos altos en el item PHQ-5 (κ ponderada = 0,769; p = 0,000). La equivalencia arrojada con el IAC fue adecuada. Conclusiones Con la excepcion del PHQ-9 electronico-Likert, los cuestionarios mantienen su estructura en la version electronica. Encontramos discrepancias en el acuerdo entre los items, lo que apoya la idea de que el paso de un instrumento disenado en papel al medio digital no es un proceso automatico, sino que requiere un proceso de adaptacion y de verificacion sobre el tipo de diseno en formato electronico.

Background Suicidal and self-injurious behaviours in adolescents are a major public health concern. However, the prevalence of self-injurious thoughts and behaviours in Spanish outpatient adolescents is unknown. Methods A total of 267 adolescents between 11 and 18 years old were recruited from the Child and Adolescent Outpatient Psychiatric Services, Jimenez Diaz Foundation (Madrid, Spain) from November 1, 2011 to October 31, 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviours Inventory, which is a structured interview that assesses the presence, frequency, and characteristics of suicidal ideation, suicide plans, suicide gestures, suicide attempts, and non-suicidal self-injury. Results One-fifth (20.6%) of adolescents reported having had suicidal ideation at least once during their lifetime. Similarly, 2.2% reported suicide plans, 9.4% reported suicide gesture, 4.5% attempted suicide, and 21.7% reported non-suicidal self-injury, at least once during their lifetime. Of the whole sample, 47.6% of adolescents reported at least one of the studied thoughts or behaviours in their lifetime. Among them, 47.2% reported two or more of these thoughts or behaviours. Regarding the reported function of each type of thoughts and behaviours examined, most were performed for emotional regulation purposes, except in the case of suicide gestures (performed for the purposes of social reinforcement). Conclusions The high prevalence and high comorbidity of self-injurious thoughts and behaviours, together with the known risk of transition among them, underline the need of a systematic and routine assessment of these thoughts and behaviours in adolescents assessed in mental health departments.

Introduction Suicidal ideation, suicidal behavior, and non-suicidal self-injury behavior are serious public health problems among adolescents. A significant proportion of adolescents evaluated in clinical settings meet criteria for the dysregulation profile (DP). DP is characterized by restlessness, irritability, “affective storms‿, mood instability, and aggression in a disproportionate grade to the situation. This DP might be related to increased risk of self-injurious thoughts and behaviors. Methods Two hundred and thirty-nine adolescents from the Child and Adolescent Outpatient Psychiatric Services of the Jimenez Diaz Foundation, Madrid, were assessed with the Strengths and Difficulties Questionnaire-Dysregulation Profile, the Self-Injurious Thoughts and Behaviors Interview and socio-demographic questionnaires. Results Logistic regression showed that DP adolescents were at increased risk for suicide plans, gestures, and suicide attempts. They also tended to present more self-injurious behaviors than adolescents without DP. Conclusions Our results point to the role of self-regulatory problems in the presence of suicide plans, suicide gestures, suicide attempts, and in non-suicidal self-injury behavior. Longitudinal studies are needed to confirm the relationship between the Strengths and Difficulties Questionnaire-Dysregulation Profile and self-injurious thoughts and behaviors.

Resumen Introduccion La mayor parte de instrumentos de evaluacion que se utilizan en nuestro pais examinan un rango limitado de conductas suicidas. En cambio, la escala Self-Injurious Thoughts and Behaviors Interview (SITBI), desarrollada en EE. UU., valora un rango mas amplio de dichas conductas: intento de suicidio, ideacion suicida, gestos suicidas y conductas autolesivas. Dada la carencia senalada, nos parece necesario validar la escala de pensamientos y conductas autolesivas (EPCA), traduccion de la escala SITBI, en la poblacion espanola. Material y metodos Con objeto de examinar las propiedades psicometricas de la EPCA en una muestra espanola, la escala se administro a 150 adultos hospitalizados en el Servicio de Psiquiatria de la Fundacion Jimenez Diaz. Para evaluar la fiabilidad test-retest de la escala, el protocolo de evaluacion se volvio a administrar a todos aquellos pacientes que volvieron a ingresar en nuestra unidad al menos 6 meses despues de la primera evaluacion (n = 50). Para valorar la validez de constructo de nuestra escala, se administraron algunas de las escalas de evaluacion de suicidio mas utilizadas en nuestro pais. Resultados El acuerdo entre examinadores oscilo entre k = 0,90 y 1. La fiabilidad test-retest fue muy buena en el caso de la ideacion suicida, los planes suicidas y los intentos de suicidio; no obstante, fue inferior en el caso de las autolesiones y los gestos suicidas. Nuestros resultados apoyan tambien la validez de constructo de nuestra escala. Conclusiones Nuestros resultados apoyan la fiabilidad (tanto entre-examinadores como test-retest) y validez de constructo de la EPCA en poblacion espanola.

Resumen Introduccion El acuerdo entre-examinadores es un aspecto fundamental en la planificacion de cualquier trabajo de investigacion donde la principal herramienta diagnostica es la entrevista clinica. El objetivo de este estudio es valorar el acuerdo entre-examinadores de un instrumento de evaluacion de la conducta suicida (Protocolo breve de evaluacion del suicidio) utilizando las valoraciones de multiples observadores en una sola sesion. Metodo Durante la fase piloto de un estudio clinico multicentrico centrado en la monitorizacion de intentos de suicidio, 32 examinadores evaluaron el video de la entrevista clinica a un paciente simulado con conducta suicida. Para identificar los items en los que existia una mayor discordancia y a los examinadores cuyo criterio se alejaba mas del acuerdo general, se utilizo el metodo Detection Of Multiple Examiners Not In Consensus (DOMENIC). Resultado El acuerdo interexaminadores oscilo entre pobre ( Conclusiones El diseno propuesto permite evaluar el acuerdo entre-examinadores de una forma eficiente (en una unica sesion). Ademas, con respecto al Protocolo breve de evaluacion del suicidio, el acuerdo entre-examinadores fue apropiado.

Resumen Introduccion El suicidio es un problema importante de salud publica que constituye una de las principales causas de anos de vida perdidos por enfermedad y la tercera causa de mortalidad en adultos jovenes. El objetivo de este proyecto iniciado por la Sociedad Espanola de Psiquiatria y la Sociedad Espanola de Psiquiatria Biologica fue preparar un documento que, a partir de la evidencia disponible y la opinion de los expertos, realizara unas recomendaciones sobre la prevencion y el manejo del comportamiento suicida. Material y metodos En este trabajo se resume la revision de la evidencia disponible sobre la magnitud e impacto epidemiologico de la conducta suicida, los factores de riesgo y factores protectores, los instrumentos de evaluacion del riesgo de conducta suicida, los protocolos preventivos existentes a nivel internacional y local, las intervenciones preventivo-educativas a nivel de los profesionales de la salud, y las posibles intervenciones sobre poblaciones de riesgo. Resultados De esta revision un amplio grupo de psiquiatras expertos sintetizo y consensuo un conjunto de recomendaciones sobre el impacto, la prevencion y el manejo de la conducta suicida. Conclusion Las recomendaciones sobre la prevencion y el manejo del comportamiento suicida fueron resumidas en las diez conclusiones que se presentan en este trabajo.

Resumen El trastorno bipolar conlleva un riesgo elevado de conductas suicidas. La falta de cumplimiento terapeutico es uno de los factores que, en parte, puede ser la causa de esta complicacion frecuente. Realizamos una busqueda en MEDLINE con la combinacion de las palabras clave “compliance” o “adherence” con “suicide” y “bipolar”, y limitada a los articulos publicados en ingles entre 1990 y julio de 2008. Hemos evaluado la literature medica existente en la que se ha estudiado la influencia del cumplimiento terapeutico en las tendencias suicidas en estos pacientes. Nuestros resultados muestran un numero limitado de estudios en los que se ha abordado esta cuestion, la mayoria de ellos llevados a cabo en pacientes registrados en clinicas en que se usa el litio. Los datos obtenidos indican una relacion entre la falta de adherencia y el aumento de riesgo de conducta suicida en los pacientes bipolares. Continua estando sin resolver la cuestion de si la falta de adherencia conduce a un aumento del riesgo de tendencias suicidas a causa de las propiedades especificas de intervenciones como el tratamiento con litio o ello es simplemente secundario a la estabilizacion del estado de animo.

Suicidal and self-injurious behaviors in adolescents are a major public health concern. However, the prevalence of self-injurious thoughts and behaviors in Spanish outpatient adolescents is unknown.A total of 267 adolescents between 11 and 18 year old were recruited from the Child and Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 1st 2011 to October 31st 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Inventory, which is a structured interview that assesses the presence, frequency, and characteristics of suicidal ideation, suicide plans, suicide gestures, suicide attempts, and non-suicidal self-injury.One-fifth (20.6%) of adolescents reported having had suicidal ideation at least once during their lifetime. Similarly, 2.2% reported suicide plans, 9.4% reported suicide gesture, 4.5% attempted suicide, and 21.7% reported non-suicidal self-injury, at least once during their lifetime. Of the whole sample, 47.6% of adolescents reported at least one of the studied thoughts or behaviors in their lifetime. Among them, 47.2% reported 2 or more of these thoughts or behaviors. Regarding the reported function of each type of thoughts and behaviors examined, most were performed for emotional regulation purposes, except in the case of suicide gestures (performed for the purposes of social reinforcement).The high prevalence and high comorbidity of self-injurious thoughts and behaviors, together with the known risk of transition among them, underline the need of a systematic and routine assessment of these thoughts and behaviors in adolescents assessed in mental health departments.

Suicidal behaviour is a major public health issue. Suicidal behaviour is one of the main causes of years of life lost and it is the third leading cause of death among young adults. This project was initiated by the Spanish Society of Psychiatry and the Spanish Society of Biological Psychiatry with the aim of providing a document containing the main recommendations on the prevention and management of suicidal behaviour; these recommendations should be based on the best available evidence and the experts' opinion.In this article we summarize the review of the available evidence on the epidemiology and impact of suicidal behaviour, risk and protective factors, evaluation tools for the assessment of suicide risk, international and local preventive protocols, educational interventions for health professionals, and potential interventions for at risk populations.Based on this review, a panel of psychiatrists summarized and agreed a set of recommendations about the impact, prevention and management of suicidal behaviour.The recommendations on the prevention and management of suicidal behaviour were summarized in the ten conclusions reported in this article.

Inter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behavior (Brief Suicide Questionnaire) and to examine whether the inter-examiner agreement when multiple ratings are made on a single subject is an efficient method to assess the reliability of an instrument.In the context of designing a multicenter clinical trial, 32 psychiatrists assessed a videotaped clinical interview of a patient with suicidal behavior. In order to identify those items in which a greater level of discordance existed and detect the examiners whose ratings differed significantly from the average ratings, we used the DOMENIC method (Detecion of Multiple Examiners Not in Consensus).Inter-rater agreement was between poor (70%) to excelent (90-100%. Inter-rater agreement in Brugha's list of threatening experiences ranged from 75.5 and 100%; in the Global Assessment of Functioning (GAF) Scale was 82.58%; in the Beck's Suicidal Intent Scale, ranged from 67.5 and 97%; in the Beck's Scale for Suicide Ideation, ranged from 63.5 and 100%; and in the Lethality Rating Scale was 88.39%. On the whole, the level of agreement among raters, both in general scores and in particular items, was appropriate.The proposed design allows the assessment of the inter-rater agreement in an efficient way (only in one session). In addition, regarding the Brief Suicide Questionnaire, inter-raters agreement was appropriate.

The aim of the study was to assess the quality of the clinical records of the patients who are seen in public hospitals in Madrid after a suicide attempt in a blind observation.Observational, descriptive cross-sectional study conducted at four general public hospitals in Madrid (Spain). Analyses of the presence of seven indicators of information quality (previous psychiatric treatment, recent suicidal ideation, recent suicide planning behaviour, medical lethality of suicide attempt, previous suicide attempts, attitude towards the attempt, and social or family support) in 993 clinical records of 907 patients (64.5% women), ages ranging from 6 to 92 years (mean 37.1±15), admitted to hospital after a suicide attempt or who committed an attempt whilst in hospital.Of patients who attempted suicide, 94.9% received a psychosocial assessment. All seven indicators were documented in 22.5% of the records, whilst 23.6% recorded four or less than four indicators. Previous suicide attempts and medical lethality of current attempt were the indicators most often missed in the records. The study found no difference between the records of men and women (z=0.296; p=0.767, two tailed Mann-Whitney U test), although clinical records of patients discharged after an emergency unit intervention were more incomplete than the ones from hospitalised patients (z=2.731; p=0.006), and clinical records of repeaters were also more incomplete than the ones from non-repeaters (z=3.511; p0.001).Clinical records of patients who have attempted suicide are not complete. The use of semi-structured screening instruments may improve the evaluation of patients who have self- harmed.

Bipolar disorder is associated with high risk for suicidal behavior. Lack of adherence to treatment is one factor that may be partly responsible for this common complication. We searched MEDLINE with the combination of the key words "compliance" or "adherence" with "suicide" and "bipolar", limited to English language papers published between 1990 and July 2008.We evaluate the existent literature studying the influence of treatment adherence on suicidality among these patients. Our findings show a limited number of studies addressing this issue, mostly conducted with patients enrolled in lithium clinics. Results suggest an association between non-adherence and an increased risk of suicidal behavior among bipolar patients. Whether non-adherence leads to increase risk of suicidality due to specific properties of interventions such as lithium treatment or simply is secondary to mood stabilization is still an open question.