Alarcón, Renato D.

This is a concise literature-based delineation of dignity and its connections with important mental health issues in the Latin American continent. This review examines the relationship between dignity and mental health in Latin America, focusing mostly on Peruvian socio-cultural studies and clinical perspectives. Drawing on published literature, an introductory geographic description and a historical narrative supported by socio-demographic data and cultural realities of the region, the review explores how dignity is shaped by cultural identity and by the mestizaje process as a decisive ontological feature. A series of seven cases covering different aspects of the impact of clinical events on the dignity of the protagonists is presented. Dignity is explored from the perspective of native healers, mothers and human rights principles, as well as its fragility in the face of socio-political, racism-induced conflicts, and sectarian/religious deformations. The difficulties faced in overcoming reductionistic and alienating influences, as well as social inequalities affecting dignity, are discussed. The review emphasizes, in turn, its consideration as one of the central issues of psychotherapeutic approaches and much-needed investigation projects.

Introduction. Mental health and psychiatry have been terms of intense and complex use for almost a century, and they may have reached a critical level of ambiguous and imprecise synonymy that makes their definition and validation difficult. Objective. To examine these concepts in depth, establishing precise distinctions, ontological connections, and instrumental scope reinforced by well-defined ideas in ethics and bioethics. Method. Narrative review of pertinent literature, consultation with diverse scientific, medical, historical, philosophical, and literary sources, with appropriate analysis of ethical and bioethical practices. Results. A broad, comprehensive definition is elaborated of mental health as a field with sociocultural, political, and demographic implications, and of psychiatry as a medical specialty. In addition to making clear distinctions and describing the specific impact of both fields on diverse populations, various levels of conceptual linkages, sociopolitical action, and ethical content are highlighted, as well as in processes of administration, education, and research. Discussion and conclusion. There are factors that reinforce or weaken the scope of mental health and psychiatry, including their ethical and bioethical dimensions. Their effectiveness requires a reaffirmation of objectives and the reinforcement of individual and institutional initiatives, as well as the search for authentic connections and a social projection that is objective, comprehensive, and just.

AbstractBackgroundBipolar disorder (BD) and borderline personality disorder (BPD) share overlapping phenomenology and are frequently misdiagnosed. This study investigated the diagnostic accuracy of the Mood Disorder Questionnaire (MDQ) and McLean Screening Instrument for Borderline Personality Disorder (MSI) in a clinical inpatient setting and whether individual screening items could differentiate BD from BPD.Methods757 sequential inpatients admitted to a Mood Disorder Unit completed both the MDQ and MSI. Screen positive for the MDQ was defined as ≥7/13 symptoms endorsed with concurrence and at least moderate impact. Screen positive for the MSI was defined as a score of ≥7. The clinical discharge summary diagnosis completed by a board‐certified psychiatrist was used as the reference standard to identify concordance rates of a positive screen with clinical diagnosis. Individual items predicting one disorder and simultaneously predicting absence of other disorder by odds ratio (OR>and <1) were identified.ResultsBoth screening instruments were more specific than sensitive (MDQ 83.7%/ 67.8%, MSI 73.2% / 63.3%). MDQ individual items (elevated mood, grandiosity, increased energy, pressured speech, decreased need for sleep, hyperactivity) were significant predictors of BD diagnosis and non‐predictors of BPD diagnosis. Whereas MSI subitem, self‐harm behaviors/suicidal attempts predicted BPD in the absence of BD; distrust and irritability were additional predictors of BPD.ConclusionWhile this study is limited by the lack of structured diagnostic interview, these data provide differential symptoms to discriminate BD and BPD. Further work with larger datasets and more rigorous bioinformatics machine learning methodology is encouraged to continue to identify distinguishing features of these two disorders to guide diagnostic precision and subsequent treatment recommendations.

Background: Historical and conceptual issues related to community psychiatry as an innovative approach to clinical assistance across the world, precede a more or less detailed examination of its presence, role and current accomplishments in Latin America, particularly related to child and adolescent subpopulations. Information about transition processes from the traditional hospital-centered model to the community-based approach, applicable mental health policies, levels of implementation and quality of the available reports in different countries, are duly evaluated. Objective: Within an understanding of the broader Latin American context, the paper describes the situation in Perú, a country considered representative of the Low and Middle Income (LMIC) group in the subcontinent. Methods: The situation in Perú is presented with particular emphasis on a recently established community-based mental health centers program across its territory. Results: This description includes consideration of variables such as personal, family and identity empowerment, a focus on integrated care, and clinical outcomes and community relations. The development of community mental health centers across Perú is described. Conclusion: Adolescents represent the unique future of socio-culturally diverse Latin American countries, and must be the target population of well-conceived, cohesive community mental health policies and programs. The importance of political will to promote community health centers that provide adolescents access to services is critical.