Alfonso Urzúa

Factores Psicosociales Relacionados con la Calidad de Vida en Salud en Pacientes Hemodializados

Resumen es: Objetivo: analizar la relacion existente entre las variables edad, tiempo en tratamiento, sexo, apoyo familiar percibido, salud mental, estado de salud p...

The role of family therapy in the management of schizophrenia: challenges and solutions

Family interventions for schizophrenia have been amply demonstrated to be effective and are recommended by most of the international clinical guidelines. However, their implementation in the clinical setting as well as in treatment protocols of patients with psychosis has not been fully achieved yet. With the increasing deinstitutionalization of patients, family has begun to assume the role of care performed by psychiatric hospitals, with a high emotional cost for caregivers as well as the recognition of burden experiences. Families have been the substitute in the face of the scarcity of therapeutic, occupational, and residential resources. For this reason, the viability of patients’ care by their families has become a challenge. This article aims to discuss the most important aspects of family interventions, their impact on families, and the most important challenges that need to be overcome in order to achieve well-being and recovery in both patients and caregivers.

Mental health of indigenous school children in Northern Chile

BackgroundAnxiety and depressive disorders occur in all stages of life and are the most common childhood disorders. However, only recently has attention been paid to mental health problems in indigenous children and studies of anxiety and depressive disorders in these children are still scarce. This study compares the prevalence of anxiety and depressive symptoms in Aymara and non-Aymara children. Among the Aymara children, the study examines the relations between these symptoms and the degree of involvement with Aymara culture.MethodsWe recruited 748 children aged 9 to 15 years from nine schools serving low socioeconomic classes in the city of Arica, in northern Chile. The children were equally divided between boys and girls and 37% of the children were Aymara. To evaluate anxiety and depressive symptoms we used the Stress in Children (SiC) instrument and the Children Depression Inventory-Short version (CDI-S), and used an instrument we developed to assess level of involvement in the Aymara culture.ResultsThere was no significant difference between Aymara and non-Aymara children on any of the instrument scales. Dividing the Aymara children into high-involvement (n = 89) and low-involvement (n = 186) groups, the low-involvement group had significantly higher scores on the Hopelessness subscale of the CDI-S (p = 0.02) and scores of marginally higher significance in overall Anxiety on the SiC (p = 0.06).ConclusionsAlthough Aymara children have migrated from the high Andean plateau to the city, this migration has not resulted in a greater presence of anxiety and depressive symptoms. Greater involvement with the Aymara culture may be a protective factor against anxiety and depressive symptoms in Aymara children. This point to an additional benefit of maintaining cultural traditions within this population.

Factores vinculados a la calidad de vida en la adultez mayor

: The Quality of Life Survey for older people developed by the World Health Organization (WHOQOL-Old), the reduced scale of Ryff Psychological Well Being, the Functional Social Support Questionnaire, the SF-12 and GHQ12 general health surveys were applied to 406 older adults aged 71 ± 7 years (83% women), that were members of older people organizations and lived in Antofagasta, Chile.

Violent behavior and aggression in schizophrenia: Prevalence and risk factors. A multicentric study from three Latin-America countries

OBJECTIVE The aim of the present study was (i) to assess the prevalence of Violent Behavior in Schizophrenia (VBS) in a sample of community-dwelling outpatients in three middle-income countries of Latin America and (ii) to determine the clinical and socio-demographical risk factors associated with VBS and aggression level. METHODS The study included 253 stabilized outpatients with schizophrenia and their principal caregivers from 3 public ambulatory psychiatric care centers in Bolivia (N=83), Chile (N=85), and Peru (N=85). VBS was defined according to the Overt Aggression Scale (OAS) score and the aggression level was measured by the aggression subscore of the Agitated Behavior Scale of Corrigan. We collected socio-demographic information and clinical data. Multiple linear and logistic regressions were performed to determine which variables were associated with VBS and aggression level. RESULTS The prevalence of VBS differed statistically between the three countries (p<0.001) with 3.5% in Chile, 14.6% in Peru and 55.4% in Bolivia. After adjustment for confounding factors, VBS was associated with a younger age, a more severe psychotic symptomatology, a lower family income and unemployment. After adjustment for confounding factors, aggression level was associated with a more severe psychotic symptomatology, a lower family income, a younger age at illness onset and higher number of hospitalizations in the last 3years. CONCLUSION These results may guide future health policies to specifically provide social support and rehabilitation care to VBS patients in middle-income countries, including psychoeducation and a more integrated work between the treating medical team and the social workers.

Schizophrenia: Impact on Family Dynamics

In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.

The influence of acculturation strategies in quality of life by immigrants in Northern Chile

PurposeTo establish the influence of acculturation strategies on quality of life, henceforth QoL.MethodsUsing a cross-sectional design, two questionnaires were applied, the WHOQoL-BREF from the World Health Organization and Basabe’s acculturation strategies. The questionnaires were applied to 853 Colombian and Peruvian immigrants living in Northern Chilean cities of Arica, Antofagasta and Santiago de Chile.ResultsIn the psychological and social domains, as well as in the overall assessment of QoL, the most beneficial strategies are those where customs are maintained from the homeland, where “integration” then “separation” are the most beneficial. On the contrary, when the strategy for maintaining homeland customs is low, the QoL tends to be lower. The strategy of “marginalized” is associated with a lower QoL.ConclusionsAcculturation strategies mildly or moderately affect the psychological and social domains of quality of life as well as the overall assessment of QoL.

Caregiver’s quality of life and its positive impact on symptomatology and quality of life of patients with schizophrenia

BackgroundAlthough the quality of life (QoL) experienced by patients with schizophrenia has been recognized, few studies have assessed the relationship between the caregivers’ QoL and patients’ QoL.MethodsThe study included 253 stabilized outpatients with schizophrenia and their caregivers from 3 Mental Health Services in Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Caregivers’ and patients’ QoL were respectively assessed using two specific QoL questionnaires (S-CGQoL and S-QoL 18). We collected socio-demographic information and clinical data. Multiple linear regressions were performed to determine which variables were associated with patient’s QoL. We tested the following hypothesis using structural equation modeling (SEM): caregivers’ QoL may have an indirect effect on patients’ QoL mediated by their influence of the severity of psychotic symptoms.ResultsIn the multivariate analysis, the caregivers’ QoL was not significantly associated with the patients’ QoL, except for one QoL dimension about relationship with family (Beta = 0.23). Among patients’ characteristics, being a woman and Aymara, having lower educational level, unemployment and severity of symptoms was significantly associated to a lower QoL. The SEM revealed a moderate significant association between caregivers’ QoL and psychotic symptoms severity (path coefficient = −0.32) and a significant association between psychotic symptoms severity and patients QoL (path coefficient = −0.40). The indirect effect of caregivers’ QoL on patients’ QoL was significant (mediated effect coefficient = 0.13).ConclusionImprovement of caregiver’s QoL may have a direct impact on the psychotic symptoms of patients and indirectly on patient’s QoL, confirming the need for ongoing family interventions in these regions.

Objective and subjective burden in relatives of patients with schizophrenia and its influence on care relationships in Chile

This study examined the burden on family members of patients with schizophrenia in a Chilean community. Sixty-five caregivers underwent the Subjective and Objective Family Burden Interview. The results showed moderate to high levels of subjective burden and low levels of support from others in providing care. Burden and containment of disturbed behaviour were correlated with worse relationships between patients and caregivers, with the latter spending less time working outside the home. The assessed sample showed a similar pattern of burden to that of caregivers from developed countries; however, the extent of the burden tended to be higher in Chilean caregivers.

Neuropsychological rehabilitation and quality of life in patients with cognitive impairments: A meta-analysis study in Spanish-speaking populations

OBJECTIVE The purpose of this study is to conduct a meta-analysis on the effects of neuropsychological rehabilitation procedures on the quality of life in Spanish-speaking individuals with cognitive deficits. METHOD Twenty four studies published during the last ten years were analyzed, and relevant information was extracted from each, including sample size, data analyses, measures, and publication year, among others. These data were then analyzed following the usual procedures for estimation of effect size. RESULTS The data show a statistical significant value in all variables associated with the characteristics of the intervention (Duration, type of intervention, gender, year of publication and, more important, quality of life and neuropsychological outcomes). CONCLUSION QOL can improve in certain conditions with neuropsychological rehabilitation, but this change is not permanent.