Camila Valdés

Financiamiento de la salud mental en Chile: una deuda pendiente

In spite of the high prevalence of mental health disorders in Chile, there is a significant financing deficit in this area when compared to the worlds average. The financing for mental health has not increased in accordance with the objectives proposed in the 2000 Chilean National Mental Health and Psychiatry Plan, and only three of the six mental health priorities proposed by this plan have secure financial coverage. The National Health Strategy for the Fulfilment of Health Objectives for the decade 2011-2020 acknowledges that mental disorders worsen the quality of life, increase the risk of physical illness, and have a substantial economic cost for the country. Thus, this article focuses on the importance of investing in mental health, the cost of not doing so, and the need for local mental health research. The article discusses how the United States is trying to eliminate the financial discrimination suffered by patients with mental health disorders, and concludes with public policy recommendations for Chile.

Neurodynamics inside therapeutic interaction: a case study with simultaneous EEG recording / La neurodinámica en el contexto de la interacción terapéutica: un estudio de caso con una grabación simultánea de EEG

Abstract Recent research on processes of psychotherapy has focused on the study of patient-therapist regulation. Evidence concerning verbal and nonverbal coordination as predictors of therapeutic alliance and outcome in psychotherapy has been cumulating. These, along with others results in the field of social neuroscience, suggest that behavioural coordination may have neurophysiological correlates, which play a role in the regulatory process in psychotherapy. Here we introduce an observational paradigm and analytic method to assess the joint neurodynamic activity of patient and therapist. Additionally we report results from ongoing psychotherapy sessions. Our work highlights the involvement of brain activity in the psychotherapeutic process and provides novel insights on how psychotherapy works, in order to further the understanding of the embodied characteristic of the therapeutic interaction.

Propiedades Psicométricas del Inventario de Depresión de Beck IA para la Población Chilena

BACKGROUND According to the Chilean National Health Survey (2009-2010), 17% of people aged 15 years or more have depressive symptoms. Thus, freely-available, easily-administered, and highly sensitive screening tests for depression are needed in clinical and research settings. AIM To evaluate the psychometric properties of a Spanish version of the Beck Depression Inventory (BDI-IA) in adult Chilean population. MATERIAL AND METHODS The inventory was applied to a sample of 1.105 adults aged between 18 to 73 years (94% women). Ninety nine participants were outpatients receiving treatment for affective disorders, 932 were parents and/or guardians of students enrolled in schools and 73 were university students (sample with no known depressive disorder). To perform data analysis, two groups from the random combination of both samples were generated. RESULTS The inventory showed an appropriate degree of internal consistency (Cronbach alpha = .92). An exploratory factor analysis suggested a one-factor solution. This solution was reinforced with a confirmatory factor analysis, which displayed an adequate goodness of fit. The cutoff score, based on the Youden Index, was 13/14 points. It was able to discriminate between depressed and non-depressed participants. CONCLUSIONS These results indicate that the BDI-IA is an appropriate instrument to assess depressive symptoms in Chilean adults.

Del "diván" al policlínico: un modelo de psicoterapia para instituciones. Aprendiendo de la experiencia (empírica)

espanolLa Unidad de Psicoterapia de Adultos (UPA) se formo hace 15 anos en el contexto de la Unidad de Salud Mental, un centro universitario que ofrece servicios psiquiatricos y psicoterapeuticos. El presente articulo tiene dos objetivos: (1) dar cuenta de la implementacion de un modelo de atencion que se sustenta en el modelo de factores comunes, indicacion adaptativa (responsiveness) y practica basada en la evidencia; (2) presentar resultados respecto al efecto de la implementacion de este modelo en la practica rutinaria. Se discuten los resultados en cuanto a sus consecuencias clinicas, de formacion e investigacion. EnglishThe Adult Psychotherapy Unit (UPA) was formed 15 years ago in the context of the Mental Health Unit, an university center that offers psychiatric and psychotherapeutic services. The present article has two objectives: (1) to account for the implementation of a care model that is based on the model of common factors, adaptive indication (responsiveness) and evidence based practice; (2) to present results regarding the effect of the implementation of this model in the routine practice. The results are discussed in terms of their clinical, training and research consequences.

Depressive Experience Dimensions and Structural Performance: What’s at the Basis of Depression Heterogeneity?

Depression has a high prevalence worldwide and has a difficult approach because it is a heterogeneous syndrome. This study explored the associations between self-criticism and dependency dimensions of depressive experience and structural functions in 43 Chilean patients with depressive symptomatology. Patients showed either self-criticism or dependency style. Results showed that the highest the symptomatology, the worst structural functioning. Self-criticism showed to relate more with low structural functioning and self-regulation vulnerability predicted the presence of depressive symptomatology, showing a greater effect on high levels of self-criticism. The results support the perspective of considering heterogeneity at the base of depression and the importance of designing different therapeutic strategies.

Beyond self-criticism and dependency: structural functioning of depressive patients and its treatment

Van Praag states that the underlying psychic dysfunctions in psychopathology must be evaluated (and treated) in patient-centered treatments. In line with this idea, Blatt and colleagues propose the concept of self-critical (introjective) and dependent (anaclitic) functioning. The research program Millennium Initiative has studied self-critical and dependent functioning from different perspectives. The general aim of this paper is to share the results of the program that have contributed to clinical psychotherapeutic thinking. Its first specific aim is to summarize results reported elsewhere that support the predictive value of introjective and anaclitic functioning (Part I), while its second specific aim is to report original data that account for the structural functioning of personality underlying these two constructs (Part II). The results (Part I) show that self-critical functioning is associated with greater reactivity to stress (according to cortisol level in stress tasks) and less subjective awareness of stress, reduced performance in general tasks, and lower mentalization (errors in reading faces); also, patients with introjective (self-critical) depression receiving psychotherapy have more symptoms at onset, higher dropout rates, and poorer response to interventions than anaclitic (dependent) patients. Higher self-criticism was associated with higher depression scores; also, when comparing clinical and nonclinical samples, the latter showed less self-criticism. Therefore, self-critical functioning represents a challenge for researchers and clinicians. The evaluation of the structural functioning of personality showed (Part II) that self-critical functioning is associated with less integrated levels of structure and more depressive symptoms. This functioning is underlain by vulnerabilities in the abilities regulating object relationships and attachments to internal objects. Dependent functioning is associated with vulnerabilities in self-perception, self-regulation, and attachments to external objects. The psychotherapeutic implications of these results are discussed, paying special attention to aspects connected with structure-oriented psychotherapy.

Role of Personality Functioning in the Quality of Life of Patients with Depression

Abstract Depression is associated with reduced quality of life (QoL), and personality pathology is associated with higher impairment and poorer treatment outcomes in patients with depression. This study aims to analyze the effects of personality functioning on the QoL of patients with depression. Severity of depressive symptoms (Beck Depression Inventory), level of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire), and QoL (Medical Outcome Study 36-item Short-Form) were assessed in a sample of 84 depressive outpatients. Personality functioning showed main effects on both the mental and physical components of QoL. A moderating effect of personality functioning on the relationship between depressive symptoms and QoL was tested but not confirmed. Severity of depressive symptoms was found to mediate the effect of personality functioning on the mental component of QoL. These results suggest that the effect of personality functioning on the QoL of patients with depression may be related to the higher severity of depressive symptoms found in patients with lower levels of personality functioning.