Resumen: Hay poca evidencia sobre la eficacia de las psicoterapias para reducir los nuevos intentos de suicidio. Este artículo tiene como objetivo evaluar la efectividad de las intervenciones psicoterapéuticas en la reducción de los intentos de suicidio entre pacientes con intentos previos. Se seleccionaron 17 artículos de cuatro bases de datos: PubMed, Cochrane, APA PsycInfo y LILACS. Seis estudios mostraron diferencias estadísticas que favorecieron la intervención psicoterapéutica en algún momento durante el período de seguimiento. Estas psicoterapias abordaron: resolución de problemas, inducción de esperanza y entrenamiento de habilidades. Al comparar la psicoterapia con el tratamiento habitual, el metanálisis reveló un odds ratio de 0.41 (IC del 95 %, 0.17 a 0.99, p = .05) en el análisis hasta los 12 meses de seguimiento, y un odds ratio de 0.48 (IC del 95 %, 0.30 a 0.78, p < .001) después de 12 meses de seguimiento. Los resultados apuntan a la eficacia de estas intervenciones para reducir los intentos de suicidio adicionales, pero deben analizarse con cautela, dada la heterogeneidad de la muestra, los tratamientos y los comparadores. Esta revisión apoya el desarrollo de estrategias de prevención indicadas para pacientes que han intentado suicidarse.

Abstract: There is little evidence on the effectiveness of psychotherapeutic interventions in reducing new suicide attempts. This article aims to evaluate the effectiveness of psychotherapeutic interventions in reducing suicide attempts among patients with a history of previous attempts. We selected 17 articles from four databases: PubMed, Cochrane, APA PsycInfo and LILACS, in 2023. Six studies showed statistical differences that favored psychotherapeutic intervention at some point during the follow-up period. These psychotherapies addressed: problem-solving, hope induction, skills training. When comparing psychotherapy with usual care, a meta-analysis revealed an odds ratio of 0.41 (95 % CI, 0.17-0.99, p = .05) in the analysis up to 12 months of follow-up, and an odds ratio of 0.48 (95 % CI, 0.30-0.78, p < .001) after 12 months of follow-up. The results indicate the efficacy of these interventions in reducing additional suicide attempts, but they should be analyzed with caution, given the heterogeneity of the sample, treatments, and comparators. This review supports the development of prevention strategies indicated for patients who have attempted suicide.

Abstract Euthanasia and assisted suicide are prohibited by French law. The Citizens’ Convention on the End of Life, created in December 2022, was tasked with evaluating the framework for end-of-life care. Its final report shows that most of the members of the Convention are in favor of evolving of the law towards “active aid in dying”. This conclusion forms the basis of a draft law to be considered before the summer of 2024. This article analyzes the main bioethical dilemmas at stake if the law is adopted.

Resumen La eutanasia y el suicidio asistido están prohibidos por la legislación francesa. La Convención Ciudadana sobre el Final de la Vida, creada en diciembre de 2022, se encargó de evaluar el marco de la asistencia al final de la vida. Su informe final muestra que la mayoría de los miembros de la Convención están a favor de una evolución de la ley hacia la “ayuda activa a morir”. Esta conclusión constituye la base de un proyecto de ley que se estudiará antes del verano de 2024. Este artículo analiza los principales dilemas bioéticos en juego si se aprueba la ley.

ABSTRACT This study investigated 27 male adolescents in socio-educational care at the Belford Roxo Intensive Care Center. It is a descriptive exploratory study with a qualitative approach and a case study methodological proposal. To obtain data, questionnaires were applied that consisted of obtaining answers about i) sociodemographic data, ii) screening for involvement with smoking, alcohol and other drugs, iii) Beck Depression Inventory and iv) Beck suicidal ideation. The group studied was composed of 16.48 years old as a mean; 92.6% were brown or black; 70.37% had attended between the 5th grade of Elementary School I and the 9th grade of Elementary School II; 44.44% consumed alcoholic beverages daily; 40.74% presented depressive symptoms; 25.92% had a history of suicidal ideation, and 11.11% had already attempted suicide. Those surveyed with substance use problems face a high simultaneous risk of mental health problems, an aggravating factor that can result in a more difficult life situation with diffuse social problems, a precarious health status, and a prediction of general adversity. Thus, the situation of these adolescents, who are a sample of the peripheral underworld of cities, is alarming, indicating the urgency of public health and state actions.

RESUMO Este estudo pesquisou 27 adolescentes do sexo masculino em regime socioeducativo no Centro de Atendimento Intensivo Belford Roxo. É um estudo descritivo exploratório de abordagem qualitativa com proposta metodológica de estudo de caso. Na obtenção de dados, foram aplicados questionários que consistiram em obter respostas sobre i) dados sociodemográficos, ii) triagem do envolvimento com fumo, álcool e outras drogas, iii) Inventário Beck de depressão e iv) ideação suicida de Beck. O grupo pesquisado era composto de 16,48 anos como média de idade; percentual de 92,6% de cor parda ou preta; 70,37% tinham frequentado entre a 5ª série do Ensino Fundamental I e a 9ª série do Ensino Fundamental II; 44,44% faziam uso de bebidas alcoólicas diuturnamente; 40,74% apresentaram sintomas depressivos; 25,92% apresentaram histórico de ideação suicida, e 11,11% já tinham tentado suicídio. Os pesquisados com problemas de uso de substâncias psicoativas enfrentam um alto risco simultâneo de saúde mental, agravante que pode incorrer em situação de vida mais difícil com problemas sociais difusos, um quadro de saúde precário, prognosticando adversidades gerais. Dessa forma, é alarmante a situação desses adolescentes, que é uma amostra do submundo periférico das cidades, denotando a urgência de ações de saúde pública e do Estado.

Resumen El paracetamol es una droga analgésica y antipiré tica comúnmente utilizada, que ha experimentado un aumento en su consumo en los últimos años en nuestro medio. También se ha observado un incremento en el número de sobredosis accidentales e intencionales que fueron atendidas por el sistema de salud. Su toxicidad es dosis dependiente y puede causar falla hepática fulminante, convirtiéndose en una de las principales razones de trasplante hepático en países angloparlan tes. Se presenta el caso de una mujer de 28 años con antecedentes de depresión mayor y cinco intentos de suicidio previos, quien ingirió deliberadamente una cantidad significativa de comprimidos de paracetamol. Desarrolló una falla hepática fulminante y acidosis metabólica, por lo que fue sometida a un trasplante hepático de emergencia debido a la gravedad de su condición evolucionando favorablemente. La decisión de realizar un trasplante hepático en casos graves como este y bajo una condición de vulnerabilidad psiquiátrica grave, es un desafío y debe considerarse cuidadosamente. Este caso en particular ilustra la im portancia de la atención multidisciplinaria incluyendo la evaluación psiquiátrica en pacientes con intoxicación por paracetamol.

Abstract Acetaminophen is a commonly used analgesic and antipyretic drug, which has experienced an increase in its consumption in recent years in our environment. There has also been an increase in the number of accidental and intentional overdoses that were treated by the health system. Its toxicity is dose-dependent and can cause ful minant liver failure, becoming one of the main reasons for liver transplantation in English-speaking countries. The case of a 28-year-old woman with a history of major depression and five previous suicide attempts, who de liberately ingested a significant amount of paracetamol tablets, is here presented. She developed fulminant liver failure and metabolic acidosis, for which she underwent an emergency liver transplant due to the severity of her condition, from which she evolved favorably. The decision to perform a liver transplant in serious cases like this and under a condition of severe psychiatric vulnerability is challenging and must be carefully considered. This particular case illustrates the importance of multidisci plinary care including psychiatric evaluation in patients with acetaminophen poisoning.

Abstract Mexico has alarming suicide rates among adolescents and young people. Therefore the objective of the research was to explain how depression influences the manifestation of suicidal thoughts and attempts in young people and, in addition, to know if suicides in the country vary significantly according to their sex. The CHAID classification method, simple indexes, and mean difference were used to test these assumptions. The results for Sonora, Mexico show that there is a connection between depression and the manifestation of suicidal thoughts and attempts in adolescents (X2 Suicidal ideation >200, P-value < 0.01; X2 Suicidal attempt >77, P-value < 0.01). In addition, the number of youth suicides in the country from 1998 to 2021 on average is different between females and males (T-Student = 15.32, P-Value < 0.05; Mean number of suicides in males = 1150, Mean number of suicides in females = 357). We conclude a marked prevalence of depression in young people, is linked to the increase in suicides in Mexico, especially in women. This highlights the urgency of implementing gender-specific preventive strategies and promoting early awareness.

Resumen México tiene alarmantes tasas de suicidios de adolescentes y jóvenes. Por ello el objetivo de la investigación fue explicar cómo la depresión influye en la manifestación de pensamientos e intentos suicidas en jóvenes y, además, conocer si los suicidios en el país varían de manera significativa según el sexo de estos. Los métodos utilizados para probar dichos supuestos fueron el método de clasificación denominado CHAID, índices simples y diferencia de medias. Los resultados para Sonora, México demuestran que existe conexión entre depresión y la manifestación de pensamientos e intentos suicidas en adolescentes (X2 Ideación suicida >200, P-Valor < 0.01; X2 Intento suicida >77, P-Valor < 0.01). Además, el número de suicidios de jóvenes en el país, de 1998 a 2021, en promedio son diferentes entre la mujer y el hombre (T-Student = 15.32, P-Valor < 0.05; Media de suicidios en hombres = 1150, Media de suicidios en mujeres = 357). Se concluye una marcada prevalencia de depresión en jóvenes, vinculada al aumento de suicidios en México, especialmente en mujeres. Esto resalta la urgencia de implementar estrategias preventivas específicas por sexo y promover la concienciación temprana.

Resumo A correspondência do Carlo Cóccioli (1920-2003) traça a relação entre religiosidade, homossexualidade masculina e sociabilidade urbana no México entre 1954 e 1964. Não há publicações sobre o impacto que a obra de Cóccioli teve sobre os homossexuais mexicanos, apesar o fato de que uma densa rede de circulação de ideias se formou em torno de sua denúncia da hipocrisia eclesiástica e da afirmação do amor homossexual como um dom divino. A metodologia deste artigo consiste em uma leitura interpretativa que incorpora a análise de marcos históricos e culturais significativos para desvendar os significados oblíquos dessas cartas. Assim, fica demonstrado que houve uma corrente cultural de ressignificação da simbologia católica para celebrar a experiência homosexual, e que a tensão entre prazer e vergonha foi um dos eixos que articulou as experiências dos homossexuais crentes. Os “entendidos” da classe abastada não manejavam um conceito de orgulho centrado na visibilidade de sua sexualidade, senão que insultavam a efeminação e a promiscuidade dos “jotos” e “vestidas” da classe trabalhadora, mas recorreu aos repertórios camp compartilhados com esses grupos.

Resumen La correspondencia de Carlo Cóccioli (1920-2003) traza la relación entre religiosidad, homosexualidad masculina y sociabilidad urbana en México entre 1954 y 1964. No existen publicaciones sobre el impacto que tuvo la obra de Cóccioli en los homosexuales mexicanos, a pesar de que se formó una densa red de circulación de ideas en torno a su denuncia de la hipocresía eclesiástica y la reclamación del amor homosexual como regalo divino. La metodología de este artículo consiste en una lectura interpretativa que incorpora el análisis de los marcos históricos y culturales para desentrañar los mensajes oblicuos de estas cartas. Se demuestra así que existió una corriente cultural de resignificación de la simbología católica para celebrar la experiencia homosexual, y que la tensión entre el placer y la vergüenza era uno de los ejes que articulaba las experiencias de los varones homosexuales creyentes. Por otro lado, los “entendidos” de clase acomodada no manejaban un concepto de orgullo centrado en la visibilidad de su sexualidad, sino que denostaban el afeminamiento y la promiscuidad de “jotos” y “vestidas” de clases populares, a pesar de recurrir a repertorios camp compartidos con estos grupos.

Abstract The correspondence of Carlo Cóccioli (1920-2003) traces the relationship among religiosity, male homosexuality, and urban sociability in the Mexican context, between 1954 and 1964. There are no publications on the impact that Cóccioli’s work had on Mexican homosexual people, yet there was a dense network of circulation of ideas related to Cóccioli’s denunciation of ecclesiastical hypocrisy and representation of homosexual love as a divine gift. The methodology consists of an interpretive reading that incorporates an analysis of significant historical and cultural frameworks to decipher the oblique meanings of these letters. Hence, the article demonstrated that there was a cultural current of resignification of Catholic symbology to celebrate homosexual experiences, and that the tension between pleasure and shame was one of the central axes in the experiences of homosexual men who were also believers. Well-off entendidos did not use a concept of pride centered on the visibility of their sexuality, rather they disdained the effeminacy and promiscuity of working-class jotos and vestidas but resorted to camp repertoires shared with these groups.

Abstract Objective: Suicide attempt (SA) is the strongest predictive variable for completed suicide. The Department of Cauca in Colombia has an SA rate higher than the national average, but the factors are unknown. The objective was to identify the profiles of SA in children and adolescents of Cauca. Methods: Cross-sectional study, which included all SA (Event-356) records from the SIVIGILA platform in children under 18 years of age between 2016 and 2019. The authors described the variables and multiple correspondence analysis (MCA) with the Burt method, according to the completeness of the data to establish the possible SA profiles using STATA 15.1, and R. The Ethics Committee at Universidad del Cauca approved it. Results: The study found 977 SA during this period, 72.4% female, 97.1% adolescent, 74.4% mestizo, 19.3% indigenous, 45.3% resided in municipalities exposed to the armed conflict, 32.3% expressed ideation and previous attempts, and 15.5% prior attempts. The MCA included 810 SA and identified three profiles: “Classic”, which had mestizo adolescents with a history of prior SA, mental illness, or psychoactive substance use problems; “Related to the armed conflict”, which included female adolescents with a first SA and residents in municipalities exposed to the armed conflict; “Ethnic” represented by male indigenous, with housing in a rural area. Conclusion: The SA profiles found in Cauca were “Classic”, “Related to the armed conflict”, and “Ethnic”; these can be considered to implement prevention strategies from a cross-cultural, mental health, and gender perspective, with the presence of the state in the territories. Objective (SA suicide average unknown Methods Crosssectional Cross sectional Event356 Event 356 (Event-356 1 201 2019 (MCA method 151 15 15.1 R it Results 97 period 724 72 4 72.4 971 97.1 adolescent 744 74 74.4 193 19 3 19.3 indigenous 453 45 45.3 conflict 323 32 32.3 attempts 155 5 15.5 81 Classic, Classic , “Classic” illness problems Related conflict” Ethnic “Ethnic area Conclusion crosscultural, crosscultural cross cultural, cultural cross-cultural health perspective territories Event35 35 (Event-35 20 15. 9 7 72. 97. 74. 19. 45. 32. 8 “Classic Event3 (Event-3 2 (Event- (Event

Abstract This article aims to highlight the need for the structuring and recognition of the field of Racial Rights, which reflects for reflection and elucidation of the complexity of ethnic-racial relations in Brazil, with a view to overcoming the inequalities and structural discriminations of society and the law, conformed by modernity/coloniality. Through the analysis of narratives that refer to suicide cases, it is argued that the denial and silencing of the ethnic, cultural and epistemic diversity of subordinate identities condemns them to physical and psychological suffering as an existential condition and that, when ignored by the dominant legal episteme, enunciate the Law as an instrument for the creation and maintenance of privileges and exclusions. The conclusion is that there is a need to break the univocity of law that performs at the same time legal racism and epistemic racism, through the field of Racial Rights, aimed at investigations related to the conditions of re-culture of soricondais-historical humanity, to related investigations to the dimensions of humanity that are structurally denied to them, and to the revision and normative proposition of decolonialism. Rights ethnicracial ethnic racial Brazil modernitycoloniality modernity coloniality modernity/coloniality cases episteme exclusions reculture re culture soricondaishistorical soricondais historical decolonialism

Resumo Este artigo tem por objetivo evidenciar a necessidade do reconhecimento do campo dos Direitos Raciais, para reflexão e elucidação da complexidade das relações étnico-raciais no Brasil, com fito na superação das desigualdades e discriminações estruturais da sociedade e do direito, conformadas pela modernidade/colonialidade. Através da análise do discurso presente em narrativas que remetem a casos de suicídio, argumenta-se que a negação e silenciamento da diversidade étnica, cultural e epistêmica das identidades contracolonizadoras implicam em sua condenação ao sofrimento físico e psíquico como condição existencial e que, ao serem ignoradas pela episteme jurídica dominante, ratificam o Direito como instrumento de criação e manutenção de privilégios e exclusões. Conclui-se quanto à necessidade de ruptura da univocidade do direito, que performa ao mesmo tempo o racismo epistêmico e o racismo jurídico, por meio do campo dos Direitos Raciais, voltado às investigações atinentes às condições sócio-histórico-culturais que relegam individualidades fecundas à sub-humanidade jurídica, às investigações relativas às dimensões de humanidade que lhes são estruturalmente negadas, e à revisão e proposição normativa decolonial. Raciais étnicoraciais étnico raciais Brasil direito modernidadecolonialidade modernidade colonialidade modernidade/colonialidade suicídio argumentase argumenta se étnica dominante exclusões Concluise Conclui jurídico sóciohistóricoculturais sócio histórico culturais subhumanidade sub negadas decolonial

Resumen El número de fallecimientos por suicidio en España en 2020, año de la irrupción de la covid-19, ha sido el más alto registrado hasta la fecha, muy por encima del número de víctimas mortales por accidentes de tráfico, que han supuesto menos de la mitad que las de suicidios. Con estos datos, parecería razonable que la sociedad estuviera informada sobre este grave problema de salud pública o, cuando menos, que se informara más de los casos de suicidio que de los accidentes de tráfico. Pero esto no es así. El objetivo del artículo es obtener evidencias sobre cómo perciben los ciudadanos la información existente en los medios de comunicación y las redes sociales sobre el suicidio. Para llevar a cabo la investigación se realizó una encuesta a través de la plataforma Google y se preparó un grupo de discusión utilizando la metodología habitual para los grupos focales. Los resultados revelan que, a juicio de las personas encuestadas o entrevistadas, los medios no suelen informar sobre el suicidio y, cuando lo hacen, se abusa habitualmente del morbo y del sensacionalismo, por lo que se debería contar con la ayuda de expertos, formar a los periodistas y considerar la utilización de un enfoque preventivo. También se han detectado diferentes visiones sobre el suicidio en los medios de comunicación por parte de los menores y los mayores de 40 años, siendo los más jóvenes los que más han insistido en la necesidad de una educación para el consumo mediático y para afrontar el tratamiento que se da al suicidio en redes sociales.

Abstract In Spain, the number of deaths by suicide in 2020-the year of the outbreak of COVID-19-has been the highest figure recorded to date, well above the number of fatalities due to traffic accidents, which have accounted for less than half of deaths by suicide. With these data, it would seem reasonable that society was informed about this serious public health problem or, at least, that cases of suicide received more coverage than traffic accidents. But this is not so. The objective of the article is to obtain evidence on how citizens perceive the existing information in the media and social media platforms about suicide. A survey was administered through the Google platform, and a discussion group was prepared using the usual methodology for focus groups. The results have revealed that, in the opinion of the people surveyed or interviewed, the perception about the information on suicide is that the media does not report on it, that when reported, morbidity and sensationalism are habitually abused, and that the media should resort to experts, train journalists, and consider using a precautionary approach in giving this news. Different views on suicide have also been detected in the media by those under 40 years of age and those over this age, with the youngest members of the discussion group being the ones who have most insisted on the need for education for media consumption and to tackle the treatment given to suicide in social media.

Resumo O número de mortes por suicídio na Espanha em 2020, ano marcado pela covid-19, foi o maior registrado até hoje, muito superior ao número de mortes no trânsito, que foi menos da metade do número de suicídios. Com esses dados, pareceria razoável que a sociedade fosse informada sobre esse grave problema de saúde pública ou, pelo menos, que mais pessoas fossem informadas sobre casos de suicídio do que sobre acidentes de trânsito. Mas esse não é o caso. O objetivo deste artigo é obter evidências sobre como os cidadãos percebem as informações sobre suicídio nos meios de comunicação e nas redes sociais. Para realizar a pesquisa, foi feito um questionário por meio da plataforma do Google e um grupo de foco foi preparado usando a metodologia usual para grupos focais. Os resultados revelam que, na opinião das pessoas pesquisadas ou entrevistadas, os meios de comunicação não costumam informar sobre o suicídio e, quando o fazem, geralmente abusam da morbidez e do sensacionalismo, razão pela qual se deve buscar ajuda especializada, formar jornalistas e considerar uma abordagem preventiva. Também foram detectadas diferentes visões sobre o suicídio nos meios de comunicação por parte de crianças e pessoas com mais de 40 anos de idade, sendo que os mais jovens foram os que mais insistiram na necessidade de educação para o consumo midiático e para o enfrentamen-to do tratamento dado ao suicídio nas redes sociais.

ABSTRACT Introduction and objectives: Selective serotonin reuptake inhibitors (SSRIs) are medications used in child and adolescent psychiatry mainly for the treatment of depression, anxiety and obsessive-compulsive disorder. In general, these medications are safe and well tolerated. However, they can cause adverse effects such as activation syndrome, which if not identified can negatively affect adherence and response to treatment. Activation syndrome has received little attention and can be difficult to recognize due to the lack of a clear definition and objective diagnostic measures, and also because it can be confused with a worsening of the psychiatric disorder or mania triggered by the antidepressants. For all the above, it is important that professionals who prescribe antidepressants in the pediatric population are able to identify and manage activation syndrome when it occurs. Our aim was to carry out a narrative review of activation syndrome in children and adolescents treated with SSRIs in terms of definition, prevalence, pathophysiology, associated factors, relationship with suicide risk, management strategies and recommendations for reducing the risk of suicidal behaviors when using antidepressants in this population. Methods: We performed a non-systematic narrative review of activation syndrome in children and adolescents which involved finding information in PubMed, Ovid, EBSCO, Pro-Quest and Embase. Review articles, prospective and retrospective investigations, systematic reviews, meta-analyses and other articles related to activation syndrome in children and adolescents were selected. The search was limited to studies published in English and Spanish that involved children and adolescents and no limits were applied to the publication date or study design. Results: A total of 62 articles were included, 61 of them in English. The results were grouped into the following topics: definition; prevalence; pathophysiology; associated factors; relationship with suicide risk; management strategies; and recommendations for reducing the risk of suicidal behaviors when using antidepressants in this population. Activation syndrome refers to a set of symptoms consisting of impulsiveness, restlessness, increased activity, insomnia, irritability, disinhibition and agitation. This syndrome is poorly characterized in terms of its definition, prevalence, risk factors and pathophysiology, a situation that limits its recognition and evaluation. There are many factors that predispose the development of the syndrome such as age, differences in brain development in the pediatric population, the characteristics of the patient or the antidepressant, disorders of neurological development, and the doses and plasma levels of the medications. It has been thought that activation syndrome may be related to suicidal tendencies. However, the evidence in support of this link is inconsistent and further studies are therefore necessary. Conclusions: Activation syndrome with SSRI is a particularly important adverse effect in children and adolescents and, when it occurs, can cause lack of adherence to or discontinuation of treatment. Strict vigilance is therefore recommended during the use of these medications.

RESUMEN Introducción y objetivos: Los inhibidores selectivos de la recaptación de serotonina (ISRS) son medicamentos que se usan en psiquiatría de niños y adolescentes principalmente para el tratamiento de depresión, ansiedad y trastorno obsesivo compulsivo. En general, estos medicamentos son seguros y se toleran bien, pero pueden producir efectos adversos como el síndrome de activación, que si no se identifica puede afectar negativamente a la adherencia y la respuesta al tratamiento. El síndrome de activación ha recibido poca atención y existen dificultades en su reconocimiento por la falta de una definición clara y de medidas de diagnóstico objetivas y porque, además, puede confundirse con un empeoramiento del trastorno psiquiátrico de base o un viraje a manía con antidepresivos. Por todo lo anterior, es importante que los profesionales que prescriben antidepresivos a población pediátrica puedan identificar y tratar el síndrome de activación cuando se presente. El objetivo de este artículo es desarrollar una revisión narrativa del síndrome de activación en niños y adolescentes tratados con ISRS en cuanto a su definición, prevalencia, fisiopatología, factores asociados, relación con el riesgo de suicidio, las estrategias de tratamiento y las recomendaciones para la reducción del riesgo de conductas suicidas al usar antidepresivos en esta población. Métodos: Se realizó una revisión narrativa no sistemática del síndrome de activación en niños y adolescentes, la cual involucró la búsqueda de información en PubMed, Ovid, EBSCO, ProQuest y EMBASE. Se seleccionaron artículos de revisión, investigaciones prospectivas, retrospectivas, revisiones sistemáticas, metanálisis y demás artículos sobre el síndrome de activación en niños y adolescentes. La búsqueda se limitó a los estudios publicados en inglés y español que involucraran a niños y adolescentes y no se aplicaron límites en cuanto a la fecha de publicación o diseño del estudio. Resultados: Se incluyeron un total de 62 artículos, 61 de ellos en inglés. Los resultados se agruparon en los siguientes temas: definición, prevalencia, fisiopatología, factores asociados, su relación con el riesgo de suicidio, estrategias de tratamiento y recomendaciones para la reducción del riesgo de conductas suicidas al usar antidepresivos en esta población. Se encontró que el síndrome de activación hace referencia a un conjunto de síntomas consistentes en impulsividad, inquietud, aumento de la actividad, insomnio, irritabilidad, desinhibición y agitación. Hasta el momento, este síndrome está mal caracterizado en cuanto a definición, prevalencia, factores de riesgo y fisiopatología, situación que limita su reconocimiento y evaluación. Existen factores que pueden predisponer a la aparición del síndrome, como la edad, las diferencias de desarrollo cerebral en la población pediátrica, las características del paciente o del antidepresivo, los trastornos del desarrollo neurológico y las dosis y concentraciones plasmáticas de los medicamentos. Se ha considerado que el síndrome de activación puede estar relacionado con tendencias suicidas; no obstante, la evidencia que respalda dicho vínculo es contradictoria, por lo cual son necesarios más estudios. Conclusiones: El síndrome de activación con ISRS representa un efecto adverso particularmente importante en niños y adolescentes, y cuando se presenta puede causar la falta de adherencia o la suspensión del tratamiento, por lo cual se recomienda una vigilancia estricta durante el uso de estos medicamentos.

ABSTRACT Introduction: Different parameters of suicide attempts treated since the implementation of the Attention to Suicide Risk Program (ARSUIC) in 2012 at the Hospital Ramón y Cajal in Madrid Region are described in this paper. Method: The sample was composed of 107 patients and the information was collected through a questionnaire created ad hoc with the following variables: type of suicidal ideation; drug use immediately prior to the attempt; method (in case of drug overdosing: drug/s used); location; accessibility to rescue; planning; intentionality; criticism; and brakes. Results: Descriptive statistics were obtained and a comparison by gender was made through the x2 and contingency coefficients tests. The data from the retrospective longitudinal study showed that the most common profile was of patients with unstructured ideas of death and no previous drug use who took an unplanned drug overdose in the family home, with the intention of self-harm or avoidance of discomfort, especially with benzodiazepines. Patients tend to ask for help afterwards and criticise the attempt, but potential restraints are often not recorded in the clinical report. Regarding the dissimilarities based on gender, statistically significant differences were found in prior alcohol consumption, in favour of men and in the overdose method, specifically with benzodiazepines, in favour of women. Conclusions: Knowing the types of attempts at self-harm is essential for improving prevention, understanding and patient management.

RESUMEN Introducción: En el presente trabajo se describen distintos parámetros de las tentativas de suicidio atendidas desde la implementación del programa de Atención al Riesgo Suicida (ARSUIC) en 2012 en el Hospital Ramón y Cajal de la Comunidad de Madrid, España. Métodos: La muestra estuvo compuesta por 107 pacientes y la información se recogió a través de un cuestionario creado ad hoc con las siguientes variables: tipo de ideación suicida, consumo de tóxicos inmediatamente antes, método (en caso de sobreingesta medicamentosa: fármaco/s utilizado/s), ubicación, accesibilidad al rescate, planificación, intencionalidad, crítica y frenadores. Resultados: Se obtuvieron estadísticos descriptivos y se realizó una comparación por sexo a través de las pruebas de x2 y coeficientes de contingencia. Los datos del estudio longitudinal retrospectivo mostraron como perfil más frecuente el de pacientes con ideas de muerte no estructuradas, sin consumo previo de tóxicos, que se realizan en el domicilio familiar de manera no planificada y con intención autolítica o evitativa del malestar de una sobreingesta medicamentosa, especialmente con benzodiacepinas. Los pacientes tienden a solicitar auxilio posterior y realizar crítica del intento, y los potenciales frenadores con frecuencia no se recogen en el informe clínico. Respecto a las disimilitudes en función del sexo, se encontraron diferencias estadísticamente significativas en el consumo previo de alcohol, a favor de los hombres, y en el método sobreingesta, concretamente con benzodiacepinas, a favor de las mujeres. Conclusiones: Profundizar en las tipologías de los intentos autolíticos resulta fundamental para mejorar la prevención, la comprensión y el abordaje sanitario.

ABSTRACT Introduction: Major depressive disorder is related to unfavorable outcomes in patients with severe comorbidities. In transplant patients, major depression is associated with worse clinical outcomes. Case report: We present the case of a 55-year-old man with a heart transplant due to heart failure of ischemic origin. Six months after the transplant he developed depressed mood, anhedonia and suicidal ideation with a score of 20/27 on the PHQ-9 depression screening scale. After receiving mirtazapine 30 mg/night for a week and persisting with a high suicide risk, it was decided to administer ketamine infusion for 24hours, with which a significant improvement in mood was observed, and the disappearance of suicidal ideation 24 hours after the infusion. Discussion: Depression in transplant patients is a factor associated with graft loss and post-transplant mortality, in addition to favoring other negative outcomes such as deep vein thrombosis. Conclusions: Ketamine infusion was shown to be an effective and safe option to treat major depression with suicidal risk in a heart transplant patient.

RESUMEN Introducción: El trastorno depresivo mayor se relaciona con desenlaces desfavorables en pacientes con comorbilidades graves. En pacientes trasplantados, la depresión mayor se asocia con peores desenlaces clínicos. Reporte de caso: Se presenta el caso de un varón de 55 arios, con trasplante de corazón por insuficiencia cardiaca de origen isquémico, que 6 meses después del trasplante presentó ánimo deprimido, anhedonia e ideación suicida, con un puntaje de 20 sobre 27 en la escala para tamizar depresión PHQ-9. Luego de recibir mirtazapina 30 mg/noche durante 1 semana y persistir con alto riesgo suicida, se decidió administrar infusión de ketamina durante 24 h, con lo cual se observó mejoría significativa en el ánimo y desaparición de la ideación suicida 24 h tras la infusión. Discusión: La depresión en pacientes trasplantados es un factor asociado con la pérdida del injerto y la mortalidad postrasplante, además de favorecer otros desenlaces negativos como trombosis venosa profunda. Conclusiones: La infusión de ketamina se ha demostrado como una opción efectiva y segura para tratar la depresión mayor con riesgo suicida en un paciente trasplantado de corazón.