Vía hacia la atención de personas con primer episodio de esquizofrenia, en Chile
DOI:
https://doi.org/10.31053/1853.0605.v72.n4.13797Palavras-chave:
salud mental, psicosis, esquizofrenia,Resumo
Antecedentes. Se ha considerado que la duración del primer episodio de psicosis es un período crítico para la evolución clínica y psicosocial de personas con diagnóstico de esquizofrenia. Sin embargo, se conoce poco de esta situación en países de bajos y medianos ingresos. Objetivo. Describir las características clínicas y de los contactos con servicios en personas con primer episodio de esquizofrenia antes del diagnóstico e inicio de tratamiento.Material y método. La muestra correspondió a la totalidad de las personas con diagnostico de primer episodio de esquizofrenia, en cinco centros de atención psiquiátrica del norte, centro y sur de Chile. El diagnóstico se confirmó con criterios CIE-10 y los síntomas psicopatológicos se exploraron utilizando la PANSS. Resultados. La muestra fue de 48 pacientes (79,2% varones, edad promedio de 23,4 años). El síntoma de depresión fue el primero en aparecer (mediana de 15 meses, previo al diagnóstico). Los síntomas positivos aparecen en el año previo al diagnóstico (ideas delirantes, con mediana en 6 meses). Los síntomas positivos motivan la consulta en el 77,1% de los casos. 91,7% de los casos tuvieron atenciones médicas en esta etapa (en centros de APS y centros comunitarios de salud mental). La mediana de consultas previas fue de 3,5, pero en ellas no se hizo el diagnóstico correcto. Conclusión. La mayoría de los pacientes tienen consultas médicas por síntomas psicóticos, pero el diagnóstico no se realiza oportunamente, retardando el inicio del tratamiento. Es necesario desarrollar estrategias para mejorar la capacidad de diagnóstico.
Abstract
Background. It has been considered that the duration of first episode of psychosis is a critical period influencing the clinical and psychosocial evolution in people with diagnosis of schizophrenia. However, there is little knowledge about this issue in Low and Middle Income Countries. Objective. To describe the clinical characteristics and contacts with health services of people with first episode of schizophrenia, prior to their diagnoses and initiation of treatment. Sources and methods. The sample included all persons with diagnosis of first episode of schizophrenia, in five psychiatric care centers, located in the North, Center and South of Chile. Diagnosis was confirmed with ICD-10 criteria and psychopathology symptoms were explored using PANSS. Results. The sample was constituted by 48 patients (79.2% men, average age in 23.4 years). The symptom of depression was the first to appear (median of 15 months, before diagnosis). Positive symptoms started in the previous year before diagnosis (delusions, median of 6 months). Positive symptoms triggered the first contact in 77.1% of the patients. Of these cases, 91.7% had medical care in this period (in Primary Health Care Centers and Mental Health Centers). The median for previous contacts was 3.5, but the correct diagnosis was not done at that time. Conclusion. Most of the patients had medical contacts for their psychotic symptoms, but their diagnosis were not made within that period, delaying the start of treatment. There is a need to develop strategies to improve diagnosis capabilities in these centers.
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