Carlos A. León

Sequelae of Venezuelan Equine Encephalitis in Humans: A Four Year Follow-up

The purpose of this study was the identification of possible sequelae of the infection of human individuals with Virus of Venezuelan Equine Encephalitis (VEE). Special emphasis was laid on exploring neurological, psychological and behavioural aspects and particularly on the search for a possible association of the disease with epileptic phenomena, brain damage and/or mental deficiency. A four-year period of observation was conducted on a sample of children from El Carmelo (Colombia) where an epidemic of VEE took place in 1967. A group of seven children who presented the encephalitic type of the illness and were hospitalized with symptoms of CNS involvement and a confirmed diagnosis of VEE constituted the index group. This group was compared with four control groups of children with matched demographic characteristics but separated according to whether they were ill at the time of the epidemic and whether they presented serological evidence of having been infected with VEE Virus. Evaluations were conducted at three points in time during the follow-up period and they included the following procedures: (1) Survey on personal background and behaviour (through a standard questionnaire dealing with all areas of functioning); (2) Complete paediatric examination, including a careful neurological check-up; (3) Psychological examination using intelligence tests; (4) Electro-encephalographic examination according to standard techniques, with the patient awake, asleep and under photic stimulation; (5) Bi-weekly home visits to keep a record on intercurrent illness throughout the observation period. Statistical analysis of results shows significant differences between the groups in regard to the distribution of abnormalities.

Development of an alternative, efficient, low cost mental health delivery system in Cali, Colombia

SummaryA new program was developed for the delivery of mental health services in Cali, Colombia utilizing auxiliary nurses who were given special training and supervision. In order to evaluate this program, equivalent groups of 30 patients each, who came to the psychiatric emergency room, were treated over a three-month period by the auxiliary nurses or by the “traditional” service which relies mostly on interns and residents. It was found that the experimental program produced a greater decrease in symptoms as measured by psychiatric ratings and by a self-report scale. A questionnaire completed by family members also revealed a similar difference. No differences were found between the two systems on patients attitudes toward services, on a self-esteem scale, or on a social adjustment scale. The cost of the new program was somewhat less than the traditional one. The results suggest that the new system should continue to be used and evaluated.

Life change and psychiatric disturbance in a South American city: the effects of geographic and social mobilty.

Geographic and social mobility are important sources of life change for the majority of people in the modern world. On the assumption that such social transitions are potentially stressful, researchers have investigated the relationship between mobility and psychiatric disturbance. Results from these studies are inconsistent and sometimes contradictory, often due to conceptual and methodological differences. This study offers new evidence on this issue. Interviews were conducted with 681 adults residing in a large Colombian city. Analysis focuses on relationships between geographic and social mobility and manifestations of psychiatric symptoms, but also includes consideration of the effects of age, sex, and education. Results indicate significantly higher symptom scores for females and persons with lower educational attainment as well as certain types of social mobility experience. Variations by age and migration experience are minimal. This study casts some doubt about the stressful effects of migration, tends to support the notion that social mobility is related to psychiatric disturbance and, above all, shows that sex and education are factors that override the influence of either type of mobility experience. The paper concludes with the suggestion that these findings can be utilized for purposes of primary prevention and an indication of lines along which future research should be organized.

Colombian views on causes and treatments for mental disorder: A comparative analysis of health workers and the public

SummaryPerception of illness constitutes an important, though relatively neglected, topic for sociomedical research. In this study beliefs about causes and treatments for mental illness are examined. Data are drawn from parallel surveys of health workers and community residents in a Colombian city. Results indicate that both groups emphasize physical causes and treatments, with social and psychological factors given less importance. Nevertheless, sizeable variations are evident between as well as within the two samples. It is also demonstrated that views on causes and treatments are relatively discrepant with one another, and implications for programs of psychiatric care are discussed.

Training in Mental Health for Primary Health Workers

The number of doctors and nurses in developing countries is acutely insufficient and the number of psychiatrists and psychiatric nurses grossly inadequate. About 4/5 of the world population live in areas where there are not psychiatrists. The average proportion of psychiatrists in Latin America is less than 2 per 100.000 inhabitants1, but the rate of prevalence of mental disorders in metropolitan areas has been estimated at 18% of the general population at risk2. Furthermore, several epidemiological studies demonstrate that the rates of prevalence of mental disorders in certain urban marginal and rural areas in Latin America may be higher than those-observed in developed countries3,4,5. The problem becomes even more complex because of the coexistence of high rates of mental disorders with a plethora of communicable diseases, parasitic infestations and malnutrition. Under these circumstances the task of trying to take care of the mental health problems of such communities through the exclusive use of psychiatrists or trained professionals becomes impossible and there is an obvious need for alternative solutions.

Notes on the Relevance of Sociology for Psychiatry in Latin America: The Case of Cali, Colombia

It is only in the last decades that Latin American countries have begun to design community mental health programs which represent an alternative to the traditional custodial model of psychiatric institutions. At present, several countries share a preoccupation to incorporate mental health plans into the general public health programs and it is precisely in this endeavor where social sciences may be particularly useful for better exploring the characteristics of populations, their attitudes, opinions and practices; their notions about mental disorders and their treatment; their demands to the services and the reciprocal expectations of the service providers.

Anxiety Disorders: Considerations from the Perspectives of Primary Mental Health Care

Even though there is a paucity of epidemiological studies dealing with prevalence of mental disorders in Latin America, a few well designed surveys conducted in different places point to the presence of rates of mental disorder quite similar to those found in developed industrial countries. What follows is a brief review of some studies which include data dealing with anxiety disorders and other related problems as observed in populations covered by primary health care services.

Cultural Bases of Images of Causation in Psychological Disorder: a Colombian Survey

This study examines the influence of participation in differing socio-cultural contexts on beliefs about the causes of psychological disorder. Data were obtained through interviews with 794 laymen and 333 health workers, all residing in a single Colombian city. Results indicate an emphasis on organic causes among lay respon dents and nearly equal emphasis on organic and social causes among medical- paramedical personnel. Further variations are evident, between as well as within the two samples, when background characteristics are considered. Differences in these images of causation are explained in terms of the socio-cultural organization of Colombian society as well as that of the medical occupational subculture.