Andrés Arce

Subjective psychological wellbeing in medical students: a pilot study from Paraguay

ABSTRACT Psychological wellbeing is associated with variables of living among all human beings and has important implications for college students. Their coping strategies will vary as will their responses, depending upon their self-esteem and self-efficacy, personality patterns, mental health, financial development and lifestyle. There is little research on subjective psychological wellbeing among college students. This study describes 560 self-report completed questionnaires from 10 medical students. Subjective psychological wellbeing was analyzed employing the questionnaire Versión Adaptada del Método de Muestreo de Experiencia (Adapted Version of the Experience Sampling Method). The assessed conditions were ‘flow’ (perceived skills and challenges are higher and balanced), ‘boredom’ (perceived skills higher than challenges), ‘anxiety’ (perceived challenges higher than skills) and ‘apathy’ (perceived skills and challenges both lower and balanced). We found that the mean score of the perceived challenges was 4.23±2.42, whereas the mean score of perceived skills was higher, at 5.73±2.08. The fact that the ‘perceived skills’ score was higher than ‘perceived challenges’ score meets criteria for a ‘boredom’ condition. It is known that boredom may be associated to drug abuse, delinquency and academic failure among young subjects. Further studies are needed in order to establish strategies to improve motivation and spirit of challenge.

Demographic and clinical characteristics of patients referred to the psychiatry unit of the emergency department at the National University of Asunción’s General Hospital, Paraguay

ABSTRACT All psychiatric consultations carried out over one year at the Psychiatry Unit of the Emergency Department at the National University of Asunción’s Clinical Hospital, Paraguay were analysed with the aim of quantifying the clinical and demographic characteristics of patients presenting to our facilities in order to learn the most common diagnosis, patient characteristics and treatment approaches. We recruited patients admitted to the emergency department between 1 May 2015 and 1 May 2016 for whom a psychiatric consultation was required. Only the first consultation of each patient was taken into consideration. Our study sample included 800 patients. Categorical variables were presented as frequencies and percentages. For comparing the means, we used the Students t-test or ANOVA, as appropriate. For analyzing the association between categorical variables, we performed Pearson’s chi-squared test. We considered test results with p < 0.05 as significant. Statistical analyses were performed using the Epi Info software. The sample’s mean age was of 37±20 years. The patients came mostly from the city of San Lorenzo and nearby towns. The most frequent DSM 5 psychiatric diagnoses were disorders of the ‘Schizophrenia Spectrum and Other Psychotic Disorders’ group in 20.13% of patients, and disorders of the ‘Depressive Disorders’ group in 16.75% of patients. We found statistical association between the diagnoses and age (F = 2.804; p < 0.001) and also between diagnoses and gender (2 = 1742.1 [39]; p < 0.001). Of the sample, 85% had received at least one type of psychotropic drug. Psychotherapy and/or counselling techniques were prescribed in only 10% of cases. The emergency department may represent the place where the first psychiatric visit occurs and a point of reference for chronic patients. The social relevance and clinical challenges of mental disorders are the main contributors to the need for more studies on the quality of medical care for this population, especially in emergency settings.

Olanzapine in the treatment of Capgras Syndrome: a case report

Capgras Syndrome is a delusion characterized by the patients belief that his or her relatives (or close friends) have been replaced by impostors who have a close resemblance to the originals. Here we describe the clinical picture and the therapeutic approach to a 41-year-old, divorced, Caucasian female with acute delusions and problematic behavior. Treatment with olanzapine was initiated, based on its reported efficacy in the treatment of monosymptomatic hypochondriacal psychosis. Our case shows that treatment with olanzapine can lead to a good clinical outcome with a remission of the psychotic symptoms. In our experience, the starting dose should be as low as possible in order to avoid the occurrence of adverse effects (which are often responsible for the dropout). According to the severity of symptoms and the risk to the patient and family, the patients admission to an inpatient unit should be considered.