ABSTRACT Background: A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia]. Objectives: To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021. Methods: Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics. Results: In March 2020 and August 2021,10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person. Conclusions: The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.

RESUMEN Introducción: En el LivingLab de la Facultad de Medicina de la Universidad de Antioquia se diseñó un programa de telesalud mental. Objetivo: Describir el desarrollo y el funcionamiento del programa y evaluar la satisfacción de los pacientes atendidos en 2020 y 2021 durante la pandemia de COVID-19. Métodos: Estudio descriptivo que detalla el desarrollo del programa. Se extrajeron los datos de las historias clínicas para describir a los pacientes atendidos. Se aplicó una escala de satisfacción a una muestra aleatoria y se resumieron los datos con estadística descriptiva. Resultados: Durante marzo de 2020 y agosto de 2021, se atendió a 10.229 pacientes con 20.276 atenciones por telepsicología y 4.164 por psiquiatría, 1.808 en la modalidad de telepsiquiatría y 2.356 en la de teleexperticia, con un total de 6.312 atenciones. Los diagnósticos más frecuentes fueron trastornos depresivos (36,8%), ansiosos (12,0%) y psicóticos (10,8%). Los encuestados se mostraron satisfechos, al punto de que más del 93% recomendaría el programa a otra persona. Conclusiones: El programa de telesalud mental del LivingLab permitió la atención de pacientes de Antioquia con problemas y trastornos mentales durante los primeros 2 años de la pandemia de COVID-19 y los beneficiarios mostraron un alto grado de satisfacción, por lo que podría adoptarse para la atención en salud mental.

abstract Introduction: Medical education has been changing, and the evaluation strategies that make it possible to address not only theoretical knowledge but also clinical skills. In Mental Health, these skills play a central role. The Objective Structured Clinical Examination (OSCE) is one of the evaluations that could assess clinical skills. This article describes the implementation and performance for the evaluation of undergraduate students since the OSCE's introduction in 2015. Methods: An explanation of the implementation is made, and a description of the OSCEs carried out to undergraduate medical students in the second semester of mental health, using the databases of the final practical examinations during those years. The perception of mental health teachers is also described. Results: The mental health OSCE implemented in 2015-2, is developed in the Simulated Hospital of the University and has five stations (interview, mental examination, diagnosis, treatment and information to the family and ethics). Between 2016-2 and 2019-2, 486 students performed OSCE with an average score of 3.85 (scale 0-5). It was observed that the grade obtained when evaluating anxiety disorders was below average, that of affective disorders above average, while that of psychotic disorders was within the average. The professors highlight the versatility, the comprehensive objective evaluation of the practical and theoretical aspects, and the possibility of comparison between the different groups. Conclusions: The OSCE is an examination that provides the possibility to evaluate the competences in psychiatry of medical students and allows the identification of the aspects to be improved in the teaching learning process.

resumen Introducción: La formación médica ha venido transformándose, así como las estrategias de evaluación, lo que permite abordar, además de los conocimientos, las habilidades clínicas. En salud mental estas habilidades desempeñan un rol central. El Examen Clínico Objetivo Estructurado (ECOE) es una de las evaluaciones que tiene este potencial. El objetivo del presente artículo es describir la implementación y el desempeño que han tenido los estudiantes de pregrado desde la introducción de este en el año 2015. Métodos: Se recuenta la implementación y se describen los ECOE realizados a estudiantes de pregrado de Medicina que cursan el segundo semestre de Salud Mental tomando las bases de datos de los exámenes prácticos finales. Además se describe la percepción de los docentes del área. Resultados: El ECOE de salud mental se implementó en 2015-2, se desarrolla en el Hospital Simulado de la Universidad y cuenta con 5 estaciones (entrevista, examen mental, diagnóstico, tratamiento e información a la familia y ética). Entre 2016-2 y 2019-2, 486 estudiantes pasaron el ECOE con una nota promedio de 3,85 (baremo de 0 a 5). Se observó que la nota obtenida al evaluarse trastornos de ansiedad estuvo por debajo del promedio; la de trastornos afectivos, por encima del promedio y la de trastornos psicóticos, dentro del promedio. Los docentes resaltan la versatilidad, la mirada objetiva integral de los aspectos prácticos y teóricos y la posibilidad de comparación entre los diferentes grupos. Conclusiones: El ECOE brinda la posibilidad de evaluar las competencias en acción de los estudiantes de Medicina y permite la identificación de qué aspectos mejorar en el proceso de enseñanza-aprendizaje.

Resumen El uso clínico del mindfulness adaptado a la psicosis ha sido rechazado por algunos profesionales de la Salud Mental debido a prejuicios y falta de información. Sin embargo, la evidencia actual ha demostrado que las Intervenciones Basadas en Mindfulness (MBI) son seguras y tienen numerosos beneficios en los trastornos del espectro psicótico. Las MBI son adaptables a diferentes contextos y situaciones clínicas, incluido el deterioro cognitivo, y aunque no constituye su objetivo principal, pueden facilitar la reducción de la sintomatología negativa en la psicosis. Las MBI permiten a las personas con psicosis enfrentar las experiencias alucinatorias desde una perspectiva diferente, fomentando la flexibilidad, la regulación emocional y la aceptación. Es importante adaptar las intervenciones a las características de la psicosis, así como distinguir entre los diferentes tipos de prácticas, para aplicarlas de manera diferencial según la sintomatología específica y las características de la persona.

Abstract The clinical use of psychosis-adapted mindfulness has been rejected by some mental health professionals due to biases and lack of information. However, current evidence has demonstrated the safety and numerous benefits of mindfulness-based interventions (MBIs) in psychotic spectrum disorders. MBIs are adaptable to diverse clinical contexts and situations, including cognitive impairment, and although it is not their primary objective, they can facilitate the reduction of negative symptomatology in psychosis. MBIs enable individuals with psychosis to approach hallucinatory experiences from an alternative perspective, fostering flexibility, emotional regulation, and acceptance. It is crucial to tailor interventions to the characteristics of the psychosis, as well as to differentiate between the different types of practices, in order to apply them differentially depending on the specific symptoms and characteristics of the individual.

Presentamos el caso de una paciente mayor que sufre un cuadro de compromiso de conciencia cualicuantitativo subagudo secundario a un episodio catatónico en contexto de una depresión psicótica. Discutimos y revisamos la forma de presentación, diagnóstico, etiología y tratamiento de la catatonía, enfocado en la persona mayor y desde el punto de vista del médico internista.

We report the case of an older female patient suffering from a subacute qualitative and quantitative alteration in the state of consciousness secondary to a major depressive disorder with catatonic features. We discuss and review the clinical presentation, diagnosis, etiology, and treatment of catatonia in older adults from the internist's point of view.

RESUMO Alucinações musicais e obsessões musicais são fenômenos distintos. O primeiro é compreendido como uma manifestação da Síndrome do Ouvido Musical, a qual produz alucinações auditivas por desaferentação, enquanto o último é um sintoma obsessivo dos transtornos obsessivo-compulsivos. Ambos os sintomas são frequentemente pouco compreendidos e confundidos entre si ou com sinais de transtornos psicóticos. Nós relatamos dois casos, um caracterizado por alucinações musicais e o outro por obsessões musicais, ambos com deficiência auditiva comórbida, a qual é o principal fator confundidor no diagnóstico diferencial. Nós comparamos criticamente os dois casos e suas características-chave, permitindo um diagnóstico diferencial e um tratamento direcionado. distintos Musical desaferentação obsessivocompulsivos. obsessivocompulsivos compulsivos. compulsivos obsessivo-compulsivos psicóticos comórbida característicaschave, característicaschave características chave, chave características-chave direcionado

ABSTRACT Musical hallucinations and musical obsessions are distinct phenomena. The first can be understood as a manifestation of the musical ear syndrome, which produces deafferentation auditory hallucinations, while the latter is an obsessive symptom of obsessive-compulsive disorders. Both symptoms are often poorly understood and mistaken for one another or for signs of psychotic disorders. We report two cases, one characterized by musical hallucinations and the other by musical obsessions, both with comorbid hearing impairment, which is the main confounding factor in their differential diagnosis. We critically compare the two cases and their key features, allowing diagnostic differentiation and a targeted therapeutic approach. phenomena syndrome obsessivecompulsive compulsive disorders impairment diagnosis features approach

RESUMEN Fundamento: Dos de las tres formas en que se presentan los quistes intracraneales de la línea media anterior son: cavum septum pellucidum y cavum vergae; estos normalmente desaparecen después del nacimiento, de persistir suelen ser asintomáticos, pero también pueden estar asociados a manifestaciones obstructivas, trastornos psicóticos o alteraciones del neurodesarrollo que demandan de un seguimiento clínico. Objetivo: Reportar el caso de un paciente de 6 meses con persistencia de estructuras del periodo embrionario en posible asociación con retraso del desarrollo psicomotor. Presentación de caso: Por lo infrecuente que resulta en la práctica, se informa el caso de un paciente de 6 meses con una persistencia del cavum septum pellucidum y cavum vergae en el que se destaca la posible asociación del retraso del neurodesarrollo a la persistencia de estas estructuras. El diagnóstico se realizó de forma precoz y se intervino oportunamente. Conclusiones: La presentación del caso aportó evidencias epidemiológicas que favorecen la posible asociación entre la persistencia de estas estructuras embrionarias y el retraso del desarrollo psicomotor.

ABSTRACT Background: Two out of the three forms in which intracranial anterior midline cysts present are: These usually disappear after birth; if they persist, they are often asymptomatic, but may also be associated with obstructive manifestations, psychotic disorders or neurodevelopmental disorders that require clinical follow up. Objective: To report a case of a 6-month-old patient with persistence of embryonic period structures in possible association with psychomotor developmental retardation. Case presentation: Because of how infrequent it is in practice, a case of a 6-month-old patient with a persistent cavum septum pellucidum and cavum vergae is reported in which the possible association of neurodevelopmental delay with the persistence of these structures is pointed out. The diagnosis was made in an early manner and it was timely intervened. Conclusions: The case presentation provided epidemiological evidences that encourage the possible association among the persistence of these embryonic structures and psychomotor developmental retardation.

ABSTRACT Serotonin syndrome is a set of signs and symptoms caused by serotonergic hyperactivity, primarily characterized by alterations in the central nervous system. Historically, traditional medicine has used herbal remedies for healing and religious purposes, which could affect the serotonergic system, dopamine, glutamate, and noradrenaline receptors. In this context, ayahuasca or «yagé» is mentioned as a brew with psychoactive potential that is generally associated with psychotic symptoms. Here, we present a clinical case of a patient with serotonin syndrome following her first-time consumption of ayahuasca in an indigenous ritual. The patient is a 31-year-old female who ingested an unknown quantity of yagé over two consecutive days in Cachipay, Cundinamarca. Given her clinical symptoms, she was considered to have serotonin syndrome and received treatment with adequate control of her condition. Multiple reports in the literature discuss psychotic disorders especially from DMT use in ayahuasca preparation; however, the occurrence of prolonged psychotic symptoms beyond 48 hours is considered exceptional and has been described in patients with personal and family histories of psychosis, mania, hypomania, or abuse of psychoactive substances.

RESUMEN El síndrome serotoninérgico es un conjunto de signos y síntomas generados por hiperactividad serotoninérgica, caracterizado principalmente por alteración del sistema nervioso central. La medicina tradicional, históricamente utiliza herbales con fines curativos y religiosos que podrían tener efectos sobre el sistema serotoninérgico, receptores de dopamina, glutamato y noradrenalina, en este contexto se menciona la ayahuasca o "yagé" como un brebaje con potencial psicoactivo que por lo general se relaciona con síntomas psicóticos. En esta ocasión presentamos un caso clínico de una paciente con síndrome serotoninérgico posterior al consumo por primera vez de ayahuasca en un ritual indígena. Se trata de una paciente femenina de 31 años quien por primera vez ingirió yagé y en cantidad desconocida durante dos días consecutivos en el municipio de Cachipay, Cundinamarca, por sus síntomas clínicos se consideró que cursaba con un síndrome serotoninérgico, recibió tratamiento con adecuado control de su cuadro. Existen múltiples reportes bibliográficos sobre trastornos psicóticos derivados especialmente del uso de DMT en preparación de ayahuasca, sin embargo, la ocurrencia de síntomas psicóticos prolongados, más allá de 48 horas, se considera excepcional; se han descrito en pacientes con antecedentes personales y familiares de psicosis, manía, hipomanía o abuso de sustancias psicoactivas.

BACKGROUND: Trauma experiences, particularly in childhood, have been associated with criminality and mental illness. There is a paucity of research into the crime of murder, trauma and mental illness. AIM: This research study focused on state patients charged with murder and sought to determine associations with prior trauma experiences, and specific types of traumas (sexual, physical and emotional) SETTING: The study was conducted at a forensic psychiatric hospital in Johannesburg, South Africa. METHODS: The records of state patients admitted over a 21-year period on a charge of murder were reviewed and analysed with respect to sociodemographic variables, clinical profiles, trauma experience and victim characteristics RESULTS: Experience of trauma in this population, with a much higher number of males compared with females, was lower than previous studies. Neurocognitive disorder was significantly associated with physical trauma. Physical trauma was found to have a significantly negative association with psychotic disorders, compared with other mental disorders. CONCLUSION: Although trauma is common in psychiatric patients, the study's findings are lower than previous studies. Noting the male bias in state patients that commit murder, greater sample sizes are needed to adequately address issues of specific types of traumas, the development of mental illness and murder. CONTRIBUTION: Exploring and managing prior trauma in state patients who commit murder is important while considering rehabilitation efforts, such that reintegration into the community and non-recidivism are encouraged.

BACKGROUND: Women charged with violent offences may be referred by courts for forensic psychiatric assessment to determine whether mental disorder or intellectual disability impacts their fitness to stand trial and/or criminal responsibility. The profile of these women is a poorly researched area in South Africa. AIM: This study examined the socio-demographic, offence-related, and clinical profile of South African women charged with violent offences referred for forensic assessment. SETTING: Fort England Hospital (FEH), a forensic psychiatric institution in the Eastern Cape. METHODS: The clinical records of 173 women referred by courts for forensic psychiatric evaluation over a 24-year period (1993-2017) to FEH were systematically reviewed. RESULTS: Most women were single, black mothers with dependent children, who were unemployed and socio-economically impoverished. Many had backgrounds of pre-offence mental illness, alcohol use and alleged abuse. The majority were first-time offenders whose victims were known to them. Most child victims were biological children killed by their mothers. Likely primary motives for violence were related to psychopathology in half of cases, and interpersonal conflict in a third. Forensic assessment most frequently confirmed psychotic disorders and dual diagnoses. Half the cases were fit to stand trial and under half were criminally responsible. CONCLUSION: Violent female offending occurs within a gendered context, with high rates of prior trauma, alcohol use and psychosocial distress in perpetrators. An emphasis on gender-sensitive psychosocial interventions is required. CONTRIBUTION: This study highlights the nature and context of violent offending by women referred for forensic psychiatric assessment in South Africa.

BACKGROUND: Globally, crime is highly masculinised and research into female criminality is scarce. In South Africa, no research specifically investigating the characteristics of female observandi referred for non-violent crimes has been published. AIMS: The study aimed to describe the socio-demographic, clinical, and forensic correlates in women referred to Sterkfontein Hospital for forensic psychiatric observation following a non-violent criminal charge between 2010 and 2019. It also sought to establish the relationship between the correlates and fitness to stand trial and criminal responsibility, as well as the relationship between the socio-demographic characteristics and the different non-violent criminal charges. SETTING: Sterkfontein Hospital. METHODS: A retrospective record review of all cases referred to Sterkfontein Hospital for a single observation over 10 years was conducted. RESULTS: Sixty-five cases were included in the study. Most observandi referred for non-violent crimes were found to be single (84.6%), unemployed (67.7%), reported abuse (55.4%), and had a high prevalence of mental illness (90.8%). Non-adherence to treatment was identified in 59.1% and substance use was identified in 72.2% of the study sample. The most common charge was theft (64.6%). The majority of the sample was found fit and responsible (57%). Bipolar (21%) and Primary Psychotic Disorders (35.7%) were associated with statistically significant outcomes of trial incompetence (p = 0.005) and lack of responsibility (p = 0.028 CONCLUSION: It is recommended that prospective studies are conducted which include comparisons with male counterparts and females referred for violent crimes. CONTRIBUTION: The study identified correlates that should be included in the standard of care in forensic assessments of female observandi.

BACKGROUND: Anecdotal evidence indicates that the prevalence of long-term benzodiazepine prescription is high and not in accordance with accepted prescribing guidelines AIM: To determine the prevalence of long-term prescriptions of benzodiazepines and associations thereof in community psychiatry clinics SETTING: Of the 27 community psychiatry clinics, 5 were randomly selected METHODS: A descriptive, retrospective, and cross-sectional record review of files of 126 adult patients was conducted, to obtain sociodemographic and clinical characteristics. Descriptive statistics were presented as proportions and percentages. Fisher's exact test was used to determine any associations between long-term benzodiazepines use and demographic and clinical variables. Regression analyses were performed to determine the significance of any such associations RESULTS: Approximately one out of every four patients were prescribed benzodiazepines. Most of the patients were males aged between 18 and 50 years, single and unemployed. The most common psychiatric diagnoses were bipolar disorders and psychotic disorders, and the majority had no comorbid medical illnesses or substance use. Ninety-three per cent of the patients were prescribed long-term (more than 180 days) benzodiazepines. There were no statistically significant associations between prescribing patterns and any sociodemographic and clinical characteristics (p > 0.05 CONCLUSION: This study found that nearly all the benzodiazepine prescriptions were long-term (over 180 days) and no statistically significant associations between this practice and any sociodemographic and clinical characteristics could be established CONTRIBUTION: There is high prevalence rate of long-term benzodiazepine prescription in community psychiatry clinics, and as such clinical monitoring systems need to be established and enforced

BACKGROUND: The average length of stay is often used to indicate health system efficiency; shorter stays are associated with reduced costs. In South Africa, mental healthcare expenditure is spent on inpatient care AIM: To identify factors associated with a long stay in an acute psychiatric unit SETTING: A tertiary hospital METHODS: A case-control study review of inpatients diagnosed with psychotic symptoms was used. Sample was divided into two groups, length of stay (LOS) (LOS greater than 21 days, LOS less than 14 days). Total of 82 patients were divided into short stay group (SSG, n = 23) and long stay group (LSG) (n = 59). A comparison of demographic, clinical and system variables was conducted RESULTS: In demographics, LSG had fewer men compared to SSG (78.3%) and differed statistically from LSG with p = 0.05. Long stay groups were older in comparison to SSG with a p = 0.02. Illicit substance use in LSG was 44.1% and statistically less than SSG (73.91%; p = 0.02). A high proportion of LSG had medical or surgical and psychiatric comorbidities (67.8%) compared to SSG (43.5%) (p = 0.04). A total of 95% patients in SSG had family support CONCLUSION: Longer stay was found to be associated with older females with primary psychotic disorders. Comorbidities with less availability of family support were associated with younger males presenting with psychotic symptoms that may be related to illicit substances that respond to rapid stabilisation CONTRIBUTION: Active surveillance of medical comorbidities amongst older female patients is necessary for early liaison services to reduce their length of stay

BACKGROUND: Non-psychotic mental disorders are common during the perinatal period. In South Africa, there are few studies on antenatal anxiety and these results vary. Antenatal anxiety does not only add to the burden of perinatal co-morbidity but has subsequent immediate and long-term effects on the mother, birth outcomes and her offspring. AIM: The aim of this study was to determine the prevalence of anxiety symptoms in pregnant women during the antenatal period and to determine associated factors. SETTING: The study was conducted at an antenatal clinic located in Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, Johannesburg. Data were collected from March to December 2022. METHODS: This was a prospective, cross-sectional study in which 200 pregnant women were interviewed. A biographical questionnaire and the generalised anxiety disorder questionnaire (GAD-7) were administered. RESULTS: The prevalence of anxiety symptoms in pregnant women attending the antenatal clinic was 33%. Participants with anxiety were younger, employed and had lower perceived social support. Women with planned and wanted pregnancies had a lower prevalence of anxiety. CONCLUSION: One-third of the pregnant women screened positive for anxiety symptoms on the GAD-7. This is significantly higher compared to other studies carried out in the same facility previously. High-risk groups should be screened for anxiety. CONTRIBUTION: This study prompts further studies and guiding policies on routine screening of pregnant women for anxiety and other mental illnesses during pregnancy.