Abstracts of XVII Peruvian Congress of Psychiatry “Federico Sal y Rosas” Bolivarian II Regional Meeting of the Latin American Psychiatric Association and I Regional Meeting of the World Psychiatric Association

Chosen by Drs. Juan Mezzich, Gabriela and Maria Isabel Zapata Kuroiwa

 

Subjectivity in psychiatry and psychopathological phenomena
Dr. Gastelumendi Eduardo D.
The work aims to show how subjective in psychiatry can be understood and experienced in various ways and at various levels.

The initial and more common understanding Psychiatric symptoms and syndromes in approach is through descriptive psychopathology. For this, the diligent and intelligent observation of the patient, held in the framework of a
proper doctor-patient relationship is essential. This approach allows, generally, an approximate diagnosis, appropriate treatment, and, at the other end, the tranquility of the doctor, who has a sense of knowing what you are doing and have done well.
The realm of the subjective, that is, the way the subject lives his illness and his life in general, is no stranger to descriptive psychopathology, as shown by many classical texts. Psychoanalysis and the studio that makes the dynamics of the internal world of the patient, as well as the interaction that occurs between patient and analyst during the session, provide even finer conceptual and technical tools for understanding the subjective, although this time only the patient but also the analyst. This, unlike the classic clinical, often has no peace of mind, for sure, what you are doing. Both have entered a dark, uncertain field. It is precisely this uncertainty that should be tolerated by the doctor.
The work includes some clinical vignettes and reflections of the author on the subject.

Abuse and dependence of psychoactive substances
on women
Dra. Yolanda Briceño Sanez
Addiction is a public, chronic and recurrent for men and women of all ages and health conditions. In the case of women abuse / dependence on drugs you can have different problems and require different forms of therapeutic approach. Women of all races, education levels and types of communities need treatment for addiction, as needing treatment for any other problem affecting their health.
Many women who abuse and / or dependent on drugs have faced serious during his life challenges to their welfare. So studies report that 70% of women who say they have abused drugs, claim history of physical and sexual abuse. Also, there is much more likelihood that women report a history of alcoholism in parents than the male.
From our clinical experience we appreciate that in terms of demand, outpatient and inpatient care to addicted women has been increasing, with providing priority care services consistent with the needs of this special group. Reports of medical records also reveal that her partner was generally consumed and who started on the drug.
In our country, statistical reports of institutions specializing in Mental Health and the National Institute of Mental Health “Honorio Delgado-Hideyo Noguchi “Addiction in the Department reveal that in 2001 67 women were treated; age group as the most concentrated between the ages of 19-44 years. By type of addiction monoadicción 47 cases, 15 cases of poliadicción and 5 cases of reported harmful drinking. In monoadicción the largest caseload it was for alcohol: 21, and THC + poliadicción PBC: 6 cases.
Regarding the psychological characteristics of women
addicted, the findings reveal a poor self-concept, emotional deprivation, discomfort identity, loneliness, feelings guilt and existential emptiness.
Finally, we consider the approach of the phenomenon of drug use by women must be taken from a gender perspective both for explanatory level for prevention and rehabilitation.

Violence and Drugs
Dr. Alfredo Saavedra Castillo

The author makes a review of the relationship between violence and substance use. It starts from the conceptualization of violence from the perspective of Bronnferbrener, framing the analysis from the context of Community and domestic violence. As for drug use, the extent of drug use occurs nationwide, noting that in Peru, there are, according to the latest official national survey (CONTRADROGAS, 1999) – about 1 million of them alcoholics and 750,000 Peruvians They are men and 250,000 are women, the first data showing domestic violence face. Then the relationship between the various addictions and antisocial behavior, the same as between 50% and 100% of cases, data endorsed both clinical samples and epidemiological, whereby the high correlation between evidence cited both phenomena. Then violent conditions data received from the judicial forums where the various criminal acts ranging from domestic violence to homicide are strongly related to both consumption and with substance dependence are cited, particularly alcohol and illegal drugs . On the other hand, the gangs in our country has grown at an alarming rate to the point that today, there are about 1,200 gangs in Peru, of which 700 are in Lima and the rest in the provinces of Peru. On the other hand, it is known by police sources that more than
2/3 of the gang members use both alcohol and illegal drugs, which the influence of various substances in this social phenomenon is quite clear. Another dimension to highlight relates to domestic violence, which in our official epidemiological studies such as the INEI (2000) have reported that 41% of Peruvian women have been abused by their partners and nearly 30% of the assaults the aggressor has been in a state of intoxication of substances. These figures bring us closer to US figures where the database of the US National Domestic Violence revealed that between 25% and 50% of cases of violence in such scenarios are related to alcohol and substances. Additionally, the Committee on Child Abuse North American reveals that 80% of acts of child abuse have been associated with problems of alcohol and drug abuse by parents. On the other hand, around common crime are as robberies, assaults, violent crimes and scams, only available studies of both American and European judicial system, where the first show that in the last decade, about 70% of the They imprisoned for robbery / assault they did intoxicated from alcohol and substance. From the European charter, it was observed that in population studies violent crime, theft and fraud were between 7 and 9 times more frequent among those with diagnoses related to alcohol and substance than those who had no diagnosis. On the other hand, traffic-related offenses were 24 times more frequent among those with diagnoses related to alcohol and substance than among those who did not have any mental health diagnosis. Important to note is that violent behavior epidemiol studies evaluated in
both American and European ógicos evidence, apart from those related to substance use disorders, other diagnoses were strongly related to antisocial behaviors such as severe personality disorders, especially antisocial personality, borderline and obsessive compulsive, like chronic psychosis, organic brain pictures and finally mental retardation.
As follows from the analysis outlined above, both Community and domestic violence is closely related to the use and abuse of substances particularly alcohol and illegal drugs and also other mental health problems
are associated with violent behavior disorders such as
severe personality and some organic brain pictures and psychosis.

Health outcomes in patients with schizophrenia and institutional costs
Drs. Pedro R. Gargoloff *, Carlos Sanchez,
Pedro Munoz and Daniel D. Gargoloff
* Section of Psychiatry and Health Economics SALW

Atypical antipsychotics (APA) or second generation have emerged as new therapeutic options in the pharmacological treatment of schizophrenia, represented in Argentina by risperidone, olanzapine, quetiapine and ziprasidone plus clozapine, a drug that appeared on our market more than a quarter century. The distinctive features of the APA are focused on expanding its therapeutic effects and the best side effect profile compared to conventional antipsychotics, first-generation or typical (APC) in our chlorpromazine medium clotiapine, trifluperazine, haloperidol, pimozide , pipotiazine and thioridazine. The existing scientific data support the notion that this beneficial safety profile and tolerability should be reduced or no extrapyramidal effects, anticholinergics, neuroendocrine sexual dysfunction, as well as lower cardiovascular risk or almost absent.
Moreover, there are reasonable evidence as to claim that atypical antipsychotics are at least as effective as APC in treating the positive symptoms of schizophrenia (delusions, hallucinations, disintegration of thought, excitement, hostility). Numerous studies support the hypothesis that the APA are also superior to the APC in the effective control of other manifestations of schizophrenia, often ignored or undervalued, as are the negative symptoms (affective indifference, apathy, isolation, difficulties in thinking abstract), affective (depression, dysphoria) and cognitive (memory lapses, care and other essential functions for more complex social performance and working capacity).
That is why appear after use benefits such as improvement in overall psychopathology short and long-term recovery of previous psychosocial functioning, particularly in the field of work and study, favorable changes in the quality of life of patients and their families, stronger adherence to prescribed treatment regimens and therefore a greater chance of avoidance of relapses and its feared consequences (individual, family, social and economic). Is this the reason why the APA are currently psychopharmacological therapeutic resource considered as first choice for the treatment of people with schizophrenia, especially in the first psychotic episode.
Despite this evidence, the reality shows that the APA employment in routine clinical practice is difficult due to the high cost of acquisition compared with APC, main and sometimes only variable that most funders of health often look to decide whether or not access to these drugs. However, given the aforementioned characteristics of expanded profile benefits and greater grip and long-term compliance of medical indications, it is appropriate to expect a greater chance of effectiveness in avoiding readmissions and, therefore, reducing or at least compensation costs
and global institutional health care in this population
of patients.
The current consensus derived from studies evaluating economic performance in schizophrenia, conclude that the overall cost of treating schizophrenia with the APA is similar to or even lower than which occurs when APC are used, as are included in this analysis all variables of direct costs (resources the individual and society consumed in accessing health care: medication, hospitalization, professional fees for assistance and rehabilitation) indirect costs (resources that the individual and society do not gain or lose due essentially to the reduction or loss of working ability and learning, coupled with the negative impact on families, legal costs, etc.). It is this compensation costs which should not be overlooked when global and final evaluation of health outcomes arising from the application of these psychotropic drugs for addressing schizophrenia, since only thus can provide a complete, decent health care and financially responsible.
In this line of thinking, the Neuropsychiatric Hospital Alejandro Korn Melchor Romero, La Plata, Argentina has incorporated some new psychotropic drugs, with a program of monitoring their use by the Internal Committee and the Drug Monitoring Hospital pharmacy. Other APA are supervised in their prescriptions through systematic evaluations of their use by naturalistic protocols. The rational use for the institution of the drugs in this disease is defined in the Rules for Treatment of Schizophrenia and Depression Hospital, the Committee of Education and Research has developed and the Medical Directorate has implemented for the pharmacological treatment of patients outpatient and hospitalized.
They have conducted two studies in this hospital costs, evaluating the use of health resources (medication and hospitalization) and its economic impact. These are:
1) first, chronic, schizophrenic patients were evaluated resistant to treatment with conventional antipsychotics and in the hospital for more than two years. The days of hospitalization were compared and the medication used in the previous year (A1) and the subsequent year (A2) to the administration of clozapine and other differentiating variables when compared to APC. The results were: 50% of patients on clozapine graduated with a medical discharge after the first year into the study (10% in APC), three received partial employment and a return to the study. Within the group of patients treated with clozapine, the average days of hospitalization in A2 decreased 28.55% from A1, while inpatient costs decreased by 32.85% in A2; expenditures for psychotropic suffered an increase of 95.45% in A2 due to the higher purchase price of clozapine regarding the APC. The final economic results in the group of patients treated with clozapine showed a savings of 26.62%. Another way of presenting this favorable compensation costs with the APA is the following: It is estimated that the average cost of a relapse in the hospital with his consistent and very common readmission is equivalent to about 2 and a half years of outpatient treatment with clozapine (lapse that institutional statistical records is above average time for readmission to the population of patients leaving treatment); this
allows to interpret that, beyond the clinical response and ethical aspects, from an economic perspective is advantageous to ensure the accessibility of this drug during hospitalization and after it.
2) On the other naturalistic evaluation included 100 inpatients and outpatients who started treatment with risperidone, olanzapine and quetiapine. The group of patients treated with APA and interned at the beginning of the evaluation showed, during the year of assessment, a reduction of 24% in average annual hospitalization time (about 3 years before the start APA) and a significant reduction in readmission rates in the post-discharge year (40% in the previous period to 22% in treated APA), with a lower rate of treatment dropout started the same year. These data, expressed in monetary values, allow broadly similar statements to those highlighted in the previous study: a) compensation for the higher costs of the APA by the significant reduction of psychiatric hospitalization and b) a commitment to keep the line institutional acquisition of these new pharmacological resources, always rational use programs.

Protocolized multicenter study to detect dementia
Dr. Daisy Acosta *
* Dominican Republic.

The rapidly aging population requires urgent research in dementia in developing countries. Describe the existing arrangements for people with dementia, quantify the impact on caregivers and evaluate the effectiveness of new services, they are increasingly necessary. Regional variations in prevalence and incidence in international collaboration using harmonized procedures may increase our understanding of the cause. However, methodological problems need to be confronted, particularly the development of free diagnostic procedures of educational and cultural prejudices. This was the largest study to date to handle this problem.
We interviewed 2885 people over 65 years in India, China, South East Asia, Latin America, the Caribbean and Africa. Among these, 729 patients with mild to moderate dementia, and dementias three free groups; 702 depression, 694 highly educated and low education 760. Blindly administered Geriatric Mental State (GMS), the Instrument for Detecting Dementia in the Community (CSID), and the task of learning 10 words and showed promise CERAD modified as a free evaluation of educational and cultural prejudices. A predictor algorithm of the three measures was developed, showing superiority to the individuality of each.
We identified correctly 94% of dementia cases with false positive 15%, 3% and 6%, depression, high education and low education, respectively.

Prevalence and factors associated with depression in cancer patients hospitalized
Juan Marcos Chavez-Peace *, ***, Johann M. Vega-Dienstmaier *, Guido Mazzotti *, **, * Matsouka Gustavo Hernan J. Sal y Rosas *
* Universidad Peruana Cayetano Heredia; ** National Institute of Mental Health “Honorio Delgado – Hideyo Noguchi”; ***Exhibitor.

Introduction
The aim of this work is to study the prevalence and factors associated with depression in hospitalized cancer patients.

Method
was randomly selected 193 adult patients hospitalized at the Institute of Neoplastic Diseases
“Dr. Eduardo Cáceres Graziani “(Lima, Peru) was applied to an instrument that had 3 sections: personal interview (disease and demographic variables), Mini-Mental Status Examination and depressive symptoms (Structured Clinical Interview for DSM-IV assess depression) .

Results
depression occurred in 30.1% of patients (21.3% major depression and minor depression in 8.7%) and cognitive failure 5.18%. We found the following variables associated with major depression: less educated, younger, radiotherapy (brachytherapy), and symptoms such as pain, insomnia, fatigue, dry mouth and nausea, with some differences according to gender. Self-injurious trends were higher among depressed patients. They were associated with cognitive failure: age, weight loss and chemotherapy in the hospital prior to the current year.

Conclusions
We found a high prevalence of depression in
patients hospitalized with cancer in agreement with previous studies.

Study of antidepressant treatment compliance
Horacio Vargas-Murga *, ** Johann Vega-Dienstmaier, Jose L. Tapia-Carpio *** **** Walter Leyva, Carlos Mendoza ** ***** Monica Luque, Giuliana Malásquez *****
* Psychiatrist – Child and Adolescent Psychiatrist, Instittuto National Mental Health “Honorio Delgado – Hideyo Noguchi” Exhibitor; ** Psychiatrist, Universidad Peruana “Cayetano Heredia” (UPCH); *** Psychiatrist, HHU, UPCH; **** Psychiatrist, Major National University of San Marcos (San Marcos); ***** Doctor-Surgeon, UPCH.

Objective
To study the variables associated to compliance with antidepressant treatment in a sector of the Peruvian population and compare it found with those reported in the literature.

Method
National Institute of Mental Health “Honorio Delgado-Hideyo Noguchi,” Hipolito Unanue Hospital, Maria Auxiliadora Hospital and Clinic Ricardo Palma: 133 outpatients, seen between March and June 1999 for the following health facilities were included.

Results
The variables that were significantly associated with treatment compliance were: Complementary therapy (p <0.001), number of consultations (p <0.001), clear explanation from the doctor how I should take medication (p <0.001), belief the medication helps or beneficial (p <0.001), response to treatment (p = 0.002), considering that the medication is needed for treatment (p = 0.003), good treatment from the doctor (p = 0.007), confidence the treating physician (p = 0.01), headache (p = 0.026) and insomnia (p = 0.041); on the other hand, the factors that were significantly associated with failure were: problems to cover the cost of medication (p <0.001), fear of becoming dependent on medication (p = 0.003), considering that it is sufficient only to take medication feel good (p = 0.044) and abdominal pain (p ​​= 0.03). The noncompliant patients felt that the cost of medication was the main reason why they had stopped taking the treatment.

Conclusions
The variables associated with treatment compliance are similar to those found in other studies, emphasizing those related to the information that the patient receives, the doctor-patient relationship and the cost of the drug.

Personality profile of parents of children
attending the service abused vc
the Cayetano Heredia National Hospital
Drs. Araceli Bautista Bridge, Hever Krüger Malpartida, Claudia Taboada Ugarte, Fernando Llanos Zavalaga

Objective
To determine the profile of the personality of the parents or guardians (PMTs) of the abused child who comes to the Service Module Service Child Abuse in Health (MAMIS) the Cayetano Heredia National Hospital (HNCH) and partnerships with other variables.

Method
A descriptive study of 74 parents, guardians or over 18 years parental figures, who arrived at the service of HNCH MAMIS with a history of abuse or not caused by the PMTs was performed. In the present study assessing the profile d was obtained
and the personality of the father figure; for that we valimos a personal interview and Personality Inventory Revised (NEO Personality Inventory [NEO-R]).

Results
Evaluating every facet of personality, gender difference in relation to the PMTs vulnerability (N6), thrill seeking (E5), openness (A2) and sense of duty (C3) was found. Assessing the relative pleasantness gender factor of PMTs are figures approached statistical difference.

Conclusions
In the PMTs of children who attended the service HNCH MAMIS the high levels of neuroticism were found average levels of extroversion and low openness to experience and consciousness. In addition, more than half of this population was preceded in children have suffered some form of abuse. There was an association between male gender and higher alcohol use and number of sexual partners which could be contributing to family dysfunction.

Levels of postpartum depression scale measured in patients Edinburgh Archbishop Loayza Hospital
Drs. Tania E. Salinas-Piélago *, Johann M. Vega-Dienstmaier **, Joel E. Salinas-Piélago **, ***
* San Martin de Porres University; ** Universidad Peruana Cayetano Heredia; ***Exhibitor.

Introduction
The purpose of this work is to study the levels of postpartum depression in women and associated factors.

Methodology
The study included 211 women whose last birth occurred within the previous 12 months, which were in the Department of Obstetrics and had come bringing their children to the Office of Control of Healthy Child Archbishop Loayza Hospital. A survey to obtain information on potential risk factors and the Scale Edinburgh Postnatal Depression (EPDS) was applied.

Results
28.9% of the women studied had values ​​greater than 13.5 EPDS. Significantly higher levels of depression were found in patients with the following variables: unwanted pregnancy by a relative (p <0.001), unwanted pregnancy by the father (p <0.001), family history of psychiatric illness (p = 0.015) family detached (p = 0.018) and urinary tract infection during pregnancy (p = 0.045). Significant correlation was found between the EPDS scores and the following variables: educational level (Spearman coefficient (rho)
= -0366, p <0.001), median household income (rho = -0223, p = 0.001), income inadequate (rho = 0.259, p <0.001), parity (rho = 0.199, p = 0.004), living children (rho = 0.191, p = 0.005), pregnancies (rho = 0.162, p = 0.018) and antenatal care (rho = -0161, p = 0.02). After a stepwise multiple regression were the following variables as predictors of increased risk of depression: parity, lower level of education, family history of mental illness and younger.

Conclusions
The levels of postpartum depression were associated with obstetric, socioeconomic and family (intra-family and family history of mental disorders relations) factors.

Observational study results intercontinental
health outpatients treated for schizophrenia (IC-SOHO): basal analysis
shows Peruvian
Drs. Martin Dossenbach * * Simone Becker, Cecilia Adrianzén * Paul Adam **, *** Aspilcueta Isabel, Jose Cabrejos **** ***** Gastiaburu Roberto Hernan Zavalaga *****
* Personal Lilly; ** Hospital “Edgardo Rebagliati,” Lima; *** Regional Hospital South, Arequipa; **** Hospital “Guillermo Almenara”, Lima; ***** Police Hospital, Lima.
Background
The Intercontinental Schizophrenia Observational Health Outcomes (IC-SOHO) provide information on clinical, humanistic and economic outcomes of therapy with antipsychotic medication in schizophrenia. In this paper the results of the baseline analysis of Peruvian patients enrolled to the study are presented.

Objective
To understand the comparative costs and health outcomes of a cohort of schizophrenic patients treated with olanzapine versus a cohort of treatment with other antipsychotics under actual clinical practice outpatient or community.

Design
nonintervention, prospective, observational, open, 3-year study. The information is recorded according to the following schedule: baseline, 3 months, 6 months and then every 6 months to 3 years to complete.

Measurements
demographic and clinical data; use of antipsychotic medication and other medications; tolerability; working conditions, housing, social functioning and use of health resources. Standardized units of local costs to each unit of resource used shall apply.

Results of baseline analysis of Peruvian patients
were included 7,648 patients intercontinental level; 852 in the Andean Region and Central America and 100 in Peru. The demographic and clinical characteristics of the two cohorts are comparative. More than 80% live in conditions of dependency and 52% are unable to work. More than 80% have moderate to severe severity. 44% of the total sample is overweight and 13% obese. 13% attempt suicide at least once during their lives and 10% the attempt within 6 months prior to enrollment. The most common adverse events are SEP and sexual dysfunction.

Conclusions
The analysis shows basal poor conditions of life in our patients with schizophrenia and the severity of the disease live. High prevalence of overweight in the total sample was found. The most common adverse events are SEP and sexual dysfunction. The enrollment of patients in Peru began in February 2001 and enrolled 100 patients are ongoing. We are confident that this study will contribute to a better understanding of what happens in the field of real clinical practice daily and to our patients.

Political, ethical and contemporary psychoanalysis in Peru
Dr. Saul Pena K.

As sources of this work the translation of the book by Professor Leo Rangell “The commitment to integrity and the mind of Watergate” important contribution to the study of the dishonest, corrupt and irrational in human behavior and in relation to pathology are. In it I could corroborate that psychoanalysis and psychoanalytic experience could contribute beyond the usual research and study of the social, ethical and political, which Freud had highlighted apart from being a theory of mind, the psyche and deep psychotherapy is also a research method to get into the complexity of human beings, their relationships and gauge their universal value.
The political subject interests me not only an intellectual but an integral level. It is unfortunate that effect have yet neo fascist movements and against which we must be very alert to prevent fatal outcomes against humanity. This danger is on the rise given the technological and scientific power that disrupted minds can become destructiveness against the human being, our identity, otherness and life itself developments. The policy is much more severe psychopathology, harmful and transcendent that individual.
The perverse political violence of dictatorial systems (crimes, torture, corruption, autocracy, crime, unemployment, etc.) hurts not only the body but the soul and the feeling . of belonging to the human species
come in mind the words of Freud which has successfully learning
the truth to itself is heavily protected against the danger of immorality. Psychoanalysis has discovered that man is not only far more immoral than you think, but more moral than he knows.
One intent of this communication is to think about what has happened to the Peruvians in these years of dictatorship disguised and widespread corruption.
Ethics is central to the political performance and the exercise of power by assessing the personal qualities of individual and collective man. The loss of values ​​generated mistrust; confusion could lead to cracks, discouragement and chaos.
It is essential to a revolutionary education of ethical values ​​that the word “common good” does not feel like nonexistent. It would be a contribution to the study of political thought understand human fully nature, their motivations and emotional state of unconscious mental processes that occur in everyday life.
We have to discuss, develop each person his own conclusion and doubt, as being that transcends his existence. The problem of communication or lack thereof, is not only verbal language, but in the background is the interpretation of the soul. Not only visible but invisible unconscious intuitive human potential.
Peru is a country predominantly mestizo. We tend to peruanidad overcoming prejudices we integrate a universality strengthening our identity.
Psychoanalysis is a humanist and anti-dogmatic science that can not exist in a vacuum axiológico with a fundamental importance in the unconscious and conscious of health and pathology, personality and social function, nor ignore social upheavals of corruption and violence. Human rights mean value, respect and concern for others (otherness). The analyst must assume an attitude consistent with his philosophy, ideology, ethics and praxis. The directions of the hidden to the manifest is psychoanalysis.
Psychoanalysis emphasizes the human bond and has to rescue the unconscious, of mutuality and madness of both the freedom, creativity and health.