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Brief Strategic Therapy (BST) is a psychosocial treatment for mental disorders based on a unique theory of psychological dysfunction that differs from major psychotherapy approaches in that psychological dysfunction follows non-ordinary logics rather than classic logical principles. BST contends that there are three different kinds of non-ordinary logics that underpin psychological dysfunction: the logic of contradiction, the logic of paradox, and the logic of belief. BST therapeutic strategies are based on these non-ordinary logics processes. Unfortunately, descriptions and case examples of these non-ordinary logics are scattered among a myriad of books so that it is difficult for the clinician to get acquainted with them. Additionally, BST literature has described these non-ordinary logics with a somewhat obscure and metaphorical language that might be difficult for the clinician to grasp. Herein, we condensate descriptions and case examples of the three non-ordinary logics, clarify the phenomenological processes of each of the classes of non-ordinary logics, and highlight research findings from different theoretical orientations that are coherent and consistent with our phenomenological accounts of non-ordinary logics. Based on our clinical observations, non-ordinary logics can be distinguished by three variables: (a) the immediate effect of the dysfunctional attempted solution (DAS), (b) the long-term effect of the DAS, and (c) the most salient mental phenomenon associated with the DAS that maintains a psychological problem. This advancement could foster clinicians' ability to identify non-ordinary logics and their ability to devise appropriate strategies to solve psychological problems.

La esquizofrenia es una enfermedad compleja que actualmente no tiene cura. Existen, sin embargo, numerosas terapias que, solas o en combinacion, son eficaces para tratar los sintomas de la enfermedad y mantenerla bajo control. La eleccion del tratamiento debe ser siempre individualizada, y basarse en la presentacion clinica de la enfermedad, el estado general del paciente y la eficacia del farmaco, si bien hay que considerar tambien el costo y el acceso a servicios y al farmaco, que en Mexico tiene algunas limitaciones. Un panel de 12 expertos mexicanos se reunio de forma virtual para revisar los ultimos datos publicados y establecer unas recomendaciones de tratamiento en Mexico, basadas en la evidencia, que garanticen una atencion medica integral, homogenea, eficiente y con calidad. Schizophrenia is a complex illness that currently has no cure. There are, however, numerous therapies that, alone or in combination, are effective in treating the symptoms of the disease and keeping it under control. The choice of treatment must always be individualized, and based on the clinical presentation of the disease, the general condition of the patient and the efficacy of the drug, although the cost and access to services and to the drug must also be considered, as in Mexico it has some limitations. A panel of 12 Mexican experts met virtually to review the latest published data and establish evidence-based treatment recommendations in Mexico that guarantee comprehensive, homogeneous, efficient, and quality medical care.

Approximately one-third of patients with major depressive disorder (MDD) have treatment-resistant depression (TRD). The TRAL study will evaluate the prevalence and impact of TRD among patients with MDD in four Latin American countries. In this multicenter, prospective, observational study, patients with MDD were recruited from 33 reference sites in Mexico, Colombia, Brazil, and Argentina. Patients were assessed for TRD, defined as failure to respond to ≥ 2 antidepressant medications of adequate dose and duration. Demographics, previous/current treatments, depressive symptoms, functioning, healthcare resource utilization, and work impairment were also collected and evaluated using descriptive statistics, chi-square test, Fisher exact test, t-test for independent samples, or the Mann–Whitney nonparametric test, as appropriate. 1475 patients with MDD were included in the analysis (mean age, 45.6 years; 78% women); 89% were receiving relevant psychiatric treatment. 429 patients met criteria for TRD, and a numerically higher proportion of patients with TRD was present in public versus private sites of care (31% vs 27%). The mean Montgomery-Asberg Depression Rating Scale score was 25.0 among all MDD patients and was significantly higher for patients with TRD versus non-TRD (29.4 vs 23.3; P https://www.ClinicalTrials.gov identifier NCT03207282, 07/02/2017.

Suicidal behavior is result of the interaction of several contributors, including genetic and environmental factors. The integration of approaches considering the polygenic component of suicidal behavior, such as polygenic risk scores (PRS) and DNA methylation is promising for improving our understanding of the complex interplay between genetic and environmental factors in this behavior. The aim of this study was the evaluation of DNA methylation differences between individuals with high and low genetic burden for suicidality. The present study was divided into two phases. In the first phase, genotyping with the Psycharray chip was performed in a discovery sample of 568 Mexican individuals, of which 149 had suicidal behavior (64 individuals with suicidal ideation, 50 with suicide attempt and 35 with completed suicide). Then, a PRS analysis based on summary statistics from the Psychiatric Genomic Consortium was performed in the discovery sample. In a second phase, we evaluated DNA methylation differences between individuals with high and low genetic burden for suicidality in a sub-sample of the discovery sample (target sample) of 94 subjects. We identified 153 differentially methylated sites between individuals with low and high-PRS. Among genes mapped to differentially methylated sites, we found genes involved in neurodevelopment (CHD7, RFX4, KCNA1, PLCB1, PITX1, NUMBL) and ATP binding (KIF7, NUBP2, KIF6, ATP8B1, ATP11A, CLCN7, MYLK, MAP2K5). Our results suggest that genetic variants might increase the predisposition to epigenetic variations in genes involved in neurodevelopment. This study highlights the possible implication of polygenic burden in the alteration of epigenetic changes in suicidal behavior.

Perceived fear during a pandemic along with measures used to contain it can develop or intensify anxiety symptoms. In Mexico, information on the psychological impact of the COVID-19 pandemic in the general population is scarce.We examined the prevalence and factors associated with anxiety during the COVID-19 outbreak in a Mexican sample.We conducted a cross sectional study from June 15, 2020, to January 31, 2021, in a state in north-eastern Mexico, using an online survey. Beck Anxiety Inventory was used to determine the prevalence and severity of anxiety.The overall prevalence of anxiety was 43.5 %. Categories with the highest anxiety prevalence within their groups were women (46.2 %), age group of 18-30 years (47.3 %), higher level of education (43 %), students (48.8 %) and people who weren't currently with a couple (47.3 %). Additionally, we found that people who reported clinically significant anxiety were more likely to be women, ages 18-30 years, not currently partnered and currently living with a psychiatric disorder. Moreover, patients with clinically significant anxiety were more likely to be diagnosed with a mood, anxiety, trauma and stress, or an eating disorder. We also observed that being a woman and having at least one psychiatric disorder were independent factors related to a positive anxiety screening.COVID-19 outbreak results in considerable increase in anxiety symptoms among the Mexican population. It is important to acknowledge the psychological impact of contingency situations to provide information that can allow establishing preventive and therapeutic strategies.

Background Length of stay (LOS) for inpatient psychiatric services is an important factor with serious drawbacks when it is extended more than needed. Impacts on economy, social functioning, and stigma can hamper improvement and affect the patients’ experiences on future mental healthcare. Predictions of which patients have a higher chance for prolonged LOS have been extensively researched. Previous systematic reviews found consistent predictors of both longer and shorter LOS. However, they do not provide an estimate from the pooled effect sizes. Furthermore, to our knowledge, there is no meta-analysis on the influence of these factors. The primary objective of this study will be to provide point estimates on the effect sizes of all studied predictors of the LOS of psychiatric inpatients. Methods We will conduct a systematic search in PubMed, MEDLINE, EMBASE, and PsycINFO for observational studies evaluating the effect size of independent factors on the length of stay of psychiatric inpatients. Prospective and retrospective cohorts that assess the influence of predictors through the reporting of standardized regression coefficients will be included. We will provide a qualitative synthesis of the findings from each study and perform a meta-analysis from pooled regression coefficients that were adjusted for other variables or confounders in order to obtain a point estimate and confidence interval for all factors extracted from the included studies. Discussion The results from this study may provide more accurate predictions for mental health institutions, psychiatrists, mental health service providers, patients, and families on the prognosis regarding the length of stay for needed inpatient care. This information may be used to anticipate individuals with a higher chance for prolonged hospitalization to plan the necessary interventions for these specific situations. Considering both the benefits and disadvantages of longer and shorter stays, the pooled estimates for independent factors may be used by mental healthcare providers and patients for informed decision-making. The results from this study will also update results presented in previous studies and identify the strengths and limitations from the current available evidence. Systematic review registration PROSPERO ID CRD42020172840

This systematic review and meta-analysis examined the prevalence of depression, anxiety, sleep disorders, and posttraumatic stress symptoms among children and adolescents during global COVID-19 pandemic in 2019 to 2020, and the potential modifying effects of age and gender.A literature search was conducted in PubMed, Web of Science, PsycINFO, and two Chinese academic databases (China National Knowledge Infrastructure and Wanfang) for studies published from December 2019 to September 2020 that reported the prevalence of above mental health problems among children and adolescents. Random-effects meta-analyses were used to estimate the pooled prevalence.Twenty-three studies (21 cross-sectional studies and 2 longitudinal studies) from two countries (i.e., China and Turkey) with 57,927 children and adolescents were identified. Depression, anxiety, sleep disorders, and posttraumatic stress symptoms were assessed in 12, 13, 2, and 2 studies, respectively. Meta-analysis of results from these studies showed that the pooled prevalence of depression, anxiety, sleep disorders, and posttraumatic stress symptoms were 29% (95%CI: 17%, 40%), 26% (95%CI: 16%, 35%), 44% (95%CI: 21%, 68%), and 48% (95%CI: -0.25, 1.21), respectively. The subgroup meta-analysis revealed that adolescents and females exhibited higher prevalence of depression and anxiety compared to children and males, respectively.All studies in meta-analysis were from China limited the generalizability of our findings.Early evidence highlights the high prevalence of mental health problems among children and adolescents during the COVID-19 pandemic, especially among female and adolescents. Studies investigating the mental health of children and adolescents from countries other than China are urgently needed.

Purpose: To assess prevalence of suicidality, depression, post-traumatic stress disorder (PTSD) and anxiety among female sex workers (FSW).Methods: A systematic review and meta-analysis was performed. Search strategy was performed in MEDLINE, Scopus, Web of Science, EMBASE, Ovid and Cochrane Central Database from inception until March 2020. Considered for inclusion were cross-sectional studies performed on FSW that assessed prevalence of any of the following: suicide attempt or suicidal ideation, depression, PTSD, or anxiety. Five reviewers independently and in duplicate to select all eligible articles in an abstract and full-text screening phase and to moreover extract information from each study. A binomial-normal generalized linear mixed model was employed to estimate prevalence of the conditions.Results: From 8,035 studies yielded in the search strategy, 55 were included for analysis. The overall prevalence of suicidal ideation and attempt was 27% (95% C.I. 18-39%) and 20% (95% C.I. 13-28%), respectively. Furthermore, overall prevalence of depression and PTSD was 44% (95% C.I. 35-54%) and 29% (95% C.I. 18-44%), respectively. Eleven studies were classified as high quality.Conclusion: Findings indicate there is an overall high prevalence of suicidality, depression, and PTSD among FSW. Development of accessible large-scale interventions that assess mental health among this population remains critical.PROSPERO Registration CRD42020196164

We performed a systematic review and meta-analysis of the efficacy and safety of second generation (SG) long-acting antipsychotics (LAIAs) versus first generation (FG) LAIAs in schizophrenia. We conducted a comprehensive search in PubMed, MEDLINE, EMBASE and PsycINFO until May 2019. Inclusion criteria for randomized trials included: (1) patients ≥18 years with schizophrenia, (2) efficacy evaluated through the Positive and Negative Syndrome Scale (PANSS), (3) safety assessment through clinimetry, laboratory analysis, somatometry or adverse events, and (4) treatment duration ≥12 weeks. Data was synthesized using mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes using a random-effect model. Of 1872 citations, 17 trials were included, and direct comparisons of SG vs FG-LAIAs were observed in 3 (n = 459). SG and FG-LAIAs had similar effects on PANSS scores (MD -1.35; 95% CI -8.33-5.64), tardive dyskinesia (RR 0.99; 95% CI, 0.47–2.07), all-cause discontinuation (RR 1.01; 95% CI 0.75–1.36), discontinuation due to inadequate efficacy (RR 1.13; 95% CI 0.81–1.59) or adverse events (RR 1.08; 95% CI 0.55–2.11). SG-LAIAs reduced the risk of using antiparkinsonian drugs (RR 0.54; 95% CI 0.54–0.76) but significantly increased serum prolactin, weight and BMI. For long-term management, depot preparations of paliperidone, haloperidol, risperidone and fluphenazine were equally effective at symptom control and adherence, with significant differences in their safety profiles. These results however are considerably limited due to the small number of included studies and are therefore preliminary, not generalizable. More clinical trials are required to obtain a broader perspective of SG-LAIAs compared to FG-LAIAs.

Background Suicidal behavior may be divided into completed suicide, suicide attempts, and suicidal ideation. It has been suggested that these behaviors represent a continuum and result from the interaction of several contributors, including genetic and environmental factors. The integration of approaches considering the polygenic component of suicidal behavior, such as polygenic risk scores (PRS) and DNA methylation is promising for improving our understanding of the complex interplay between genetic and environmental factors in this behavior. The aim of this study was the evaluation of DNA methylation differences between individuals with high and low genetic burden for suicidality. Methods The present study was divided into two phases. In the first phase, genotyping with the Psycharray chip was performed in a discovery sample of 568 Mexican individuals, of which 149 had suicidal behavior (64 individuals with suicidal ideation, 50 with suicide attempt and 35 with completed suicide) and 419 non-suicide controls. Then, a PRS analysis based on summary statistics from the Psychiatric Genomic Consortium was performed in the discovery sample. In a second phase, we evaluated DNA methylation differences between individuals with high and low genetic burden for suicidality in a sub-sample of the discovery sample (target sample) of 94 subjects. Methylation profile from individuals in the target sample was assessed with the Illumina Infinium Human Methylation EPIC BeadChip. Results We identified 153 differentially methylated sites between individuals with low and high-PRS. From these, 91 sites were hypermethylated and 62 hypomethylated in the high PRS group relative to low PRS group. Among genes mapped to differentially methylated sites, we found genes involved in neurodevelopment and ATP binding. Discussion To our knowledge, this is the first study integrating polygenic risk scores and DNA methylation in suicidality. Our results suggest that genetic variants might increase the predisposition to epigenetic variations in genes involved in neurodevelopment. This study highlights the possible implication of polygenic burden in the alteration of epigenetic changes in suicidal behavior.

espanolAntecedentes: la concurrencia de trastornos por uso de sustancias (TUS) es alta en personas con enfermedades psiquiatricas; Mas importante aun, las personas con ambos trastornos (diagnostico dual) tienen sintomas mas graves. Se han propuesto trastornos psiquiatricos para compartir una susceptibilidad genetica con los TUS. Para explorar esta susceptibilidad genetica compartida, analizamos si alguna de las puntuaciones de riesgo poligenico (PRS) para los trastornos psiquiatricos podria estar asociada al diagnostico dual en pacientes con esquizofrenia (SCZ) o trastorno bipolar (BD). Metodos: Se incluyeron 192 individuos de ascendencia mexicana: 72 con SCZ, 53 con BD y 67 controles no relacionados sin trastornos psiquiatricos. Derivamos calculos de PRS para trastornos del espectro autista, trastorno de deficit de atencion / hiperactivo, BD, depresion mayor y SCZ utilizando estadisticas resumidas de asociacion de genoma previamente publicadas. Resultados: Encontramos que el diagnostico dual tenia una susceptibilidad genetica compartida con el trastorno depresivo mayor (MDD) y SCZ; Ademas, en individuos con BD, PRS podria predecir el diagnostico dual para MDD. Conclusiones: Nuestros resultados refuerzan la nocion de que las personas con diagnostico dual tienen una mayor susceptibilidad genetica a desarrollar ambos trastornos. Sin embargo, se requieren analisis de muestras de mayor tamano para aclarar aun mas como predecir riesgos a traves de PRS dentro de diferentes poblaciones. EnglishBackground: Concurrence of substance use disorders (SUDs) is high in individuals with psychiatric illnesses; more importantly, individuals with both disorders (dual diagnosis) have more severe symptoms. Psychiatric disorders have been proposed to share a genetic susceptibility with SUDs. To explore this shared genetic susceptibility, we analyzed whether any of the polygenic risk scores (PRSs) for psychiatric disorders could be associated to dual diagnosis in patients with schizophrenia (SCZ) or bipolar disorder (BD). Methods: We included 192 individuals of Mexican ancestry: 72 with SCZ, 53 with BD, and 67 unrelated controls without psychiatric disorders. We derived calculations of PRS for autism spectrum disorders, attention-deficit/hyperactive disorder, BD, major depression, and SCZ using summary genome-wide association statistics previously published. Results: We found that dual diagnosis had a shared genetic susceptibility with major depressive disorder (MDD) and SCZ; furthermore, in individuals with BD, dual diagnosis could be predicted by PRS for MDD. Conclusions: Our results reinforce the notion that individuals with dual diagnosis have a higher genetic susceptibility to develop both disorders. However, analyses of larger sample sizes are required to further clarify how to predict risks through PRS within different populations. (REV INVEST CLIN. 2019;71:321-9)

In order to summarized the polygenic background of psychiatric diseases, polygenic risk scores (PRS) have been developed. Recently, PRS have been use to predict patients with higher comorbidities in psychiatric diseases, like dual diagnosis. PRS are principally derived in analysis of Caucasian and Asian populations, we are not aware of how this PRS could be applied in populations with high admixture. In order to explored this, the present work has the aim to analyzed if previous calculated PRS for psychiatric diseases could predict dual diagnosis in Mexican population, and also, if PRS calculation could be influenced by Mexican Amerindian (MA) global ancestry. We performed PRS calculation, using PRSice, with summary genome-wide association statistics previously published for psychiatric diseases, and also, performed Nagelkerke correlation test in order to established if PRS are correlated with dual diagnosis. We found that dual diagnosis could be predicted by major depressive disorder polygenic risk score. Nevertheless, schizophrenia polygenic risk score is highly correlated with global MA ancestry, independently of the schizophrenia diagnosis. Our results reinforced the notion that PRS calculation could be deviated by the MA global ancestry, nevertheless analysis on larger sample sizes are required in order to clarified this issue.

Objective: Anxiety disorders represent risk factors for other psychiatric and somatic illnesses and represent the second most prevalent psychiatric disorders and the most frequent during an individual’s lifetime. This study was performed to determine if the diagnostic category of anxiety disorders has a seasonal pattern. Methods: This was a retrospective (a data-base was studied), cross-sectional (analyzing prevalence), observational (with no interven-tion), descriptive (did not asses causality) study to determine the prevalence and seasonality of anxiety disorders in a university hospital psychiatric outpatient clinic. Patients were identified between 2005 and 2014 using the diag-nostic criteria of DSM IV-TR; the year was divided into four seasons to assign the consultation date to one of these seasons. Anxiety disorder consultations with incomplete registry data or date were eliminated. Results: From the universe of consultations given (495,062), 13.7% were anxiety disorders, with these being the second most frequent category. These were distributed 24.91% in spring, 25.29% in summer; 26.56% in autumn; and 23.24% in winter. We also found no statistically significant association between summer and anxiety disorders. Discussion: There was no significant difference in the seasonal prevalence of anxiety consultations during the year; therefore, a seasonal pattern was ruled out.