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Introduction. Mental health has historically been overlooked in public policies in Mexico, with up to 80% of people with mental health and substance-related disorders in Mexico lacking adequate care. Objective. To characterize the mental health provider (psychiatrists and psychologists) shortage in the Mexican public sector. Method. Descriptive study. Data from SINERHIAS (Ministry of Health of Mexico) up to the first half of 2023 were analyzed. Results. A total of 1,504 psychiatrists worked in the public sector (1.1 per 100,000 population). The Health Ministry (Secretaría de Salud; Spanish acronym SS) employed 55.9%, IMSS 25.9%, ISSSTE 7.2%, while 1.0% were affiliated to other public institutions. There were 8,668 psychologists in the public sector (6.9 per 100,000 population), of which the SS employed 78.9%, IMSS 6.3%, ISSSTE 2.4%, while 12.3% worked at other public institutions. Thirty-four per cent of psychiatrists were in Mexico City, while 21 states, accounting for 70% of the population, had one psychiatrist or fewer per 100,000 population. Hospital units employed 83.3% of psychiatrists. Discussion. Mexico has an insufficient number of mental health providers at public institutions, with disparities between states and most providers affiliated to hospital units. Conclusion. There is an acute mental health provider shortage in the Mexican public sector, together with limited resources for community mental health care, affecting the treatment of mental health and substance use disorders. [ABSTRACT FROM AUTHOR]

Introduction. Mental health services have been a focus of human rights advocates and recent legal reforms in some Latin American countries, which have called for a change from the paradigm of hospitalization to one of accompanying and supporting the person with mental health issues, which make it possible to apply the Advance Directives in Psychiatry (PADs). This change will require time, as well as economic, material, and human resources, and transformations in attitudes, culture, and society, but the implementation of PADs cannot be postponed: they must be used to protect the autonomy of the persons affected, within a bioethical framework. Objective. Identify possible bioethical conditions in the prevailing conventional hospital context in Latin America that allow for an implementation of PADs. Method. A participant-observer study was carried out in two psychiatric hospital services from June to September 2022. Results. A thematic analysis found three themes: 1) clinical care, 2) patient predisposition, and 3) medical-legal questions. This study considered part of theme 2, including the following sub-themes: a) patient self-perception, b) biography/narrative versus diagnostic classification, and c) negotiation. Discussion and conclusion. Prominent among the sub-themes discussed are recognition of the values of autonomy and its elements in all of the expressions of the person with mental illness, as well as actions of the physician or health care team in synergy with supported decision- making, a distinctive feature of the anticipatory process of the PAD. [ABSTRACT FROM AUTHOR]

Objective. To reflect on ethical and social issues related to research on the genetics of mental health. Method. A narrative review was undertaken of 87 articles found in three databases: Medline, Scopus, and Scielo. Keywords were defined broadly to capture as many relevant publications as possible. Data were summarized by topic. Results. The following topics were identified regarding the application of genetic and genomic tools to mental health disorders: problems with diagnosis, proper informed consent procedures, protecting confidential data, providing participants with research results, risk-benefit balance, equity and access, commercialization of genotyping, and prenatal testing. Discussion and Conclusion. Although a promising field, there is still much research needed on genetic approaches to mental health to achieve clinical relevance and predictive value, and more so in developing countries where there is little available data. Cost-benefit studies thus do not recommend genetic diagnoses in underdeveloped settings. Instead, local approaches should be enhanced. One limitation of research on the genetics of mental health is that it seeks biological causes for mental illnesses. However, the etiology of most mental health disorders is multifactorial, limiting the predictive value of genetic tests. Still, understanding the genetic origins of the biological pathways that lead to mental illness is important to diagnosis and therapy. Other problems discussed are enhancement of the informed consent process and counseling, protection of the right to know and not to know, and how the geneticization of disease is related to stigma. [ABSTRACT FROM AUTHOR]

Introduction. Factors affecting the quality of physician care include a shortage of trained staff, stigma, and discrimination. Objective. The objective was to compare the intensity of stigmatization before and after a Psychiatry course, as measured by the scale of clinicians' attitudes towards mental illness, a version for medical students (MICA-2) designed to identify stigmatic attitudes towards mental disorders. Method. The fifth-year Medicine students enrolled in the Psychiatry course answered anonymously using the MICA-2 test at the start and the end of their course. Additionally, we asked the students to answer a question about their interest in learning more about mental illness. Results. Three hundred and thirty students were invited; 300 agreed to participate in the first application of the scales, and 291 in the follow-up. The average age was 22 ± 2 years, with a range of 20-30 years, and there was a similar gender distribution in both applications. In the initial application, the average score of the MICA-2 was 41.34 (SD = 7.86, 95% CI = [40.43, 42.25]). The follow-up application's mean was 37.10 (SD = 8.15, 95% CI = [36.30, 38.15]). Also, there was a decrease in interest in learning more about mental illness. Discussion and conclusion. A reduction in the average scores of the MICA-2 was observed after a Psychiatry course, suggesting that attitudes toward mental disorders improved. A Psychiatry clerkship with close supervision modified the attitudes of medical students toward mental disorders. However, it did not increase their interest in learning more about mental illness. [ABSTRACT FROM AUTHOR]

Introduction. Self-perceived health (SPH) is related to disease and well-being. Psychiatrists report burnout and mental disorders more frequently than other physicians, while personality traits related to perfectionism may influence the perception of well-being and health in these professionals. Objective. To compare and determine the association between demographic variables, health conditions, perceived distress, perfectionism, and SPH. Method. A cross-sectional, retrospective, comparative study was performed through an online survey. Psychiatrists and psychiatry trainees who were willing and able to participate were included. Demographic variables and self-reports of mental and physical conditions were examined. SPH was rated on a 10-point visual analogue scale and perfectionism through the Multidimensional Perfectionism Scale. Comparative analyses and multiple linear regression models were performed. Results. Three hundred and thirty psychiatry trainees and 355 psychiatrists were recruited. Psychiatrists reported more physical conditions (32.4% vs. 15%, p < .001), distress (p < .001), and perfectionism (p < .001). Major depression and anxiety were present over 50% of all participants. A higher SPH was associated with being partnered and having higher distress levels in psychiatry trainees and with the absence of a physical health condition, less concern over errors, and higher personal standards in psychiatrists. Discussion and conclusion. Self-oriented perfectionism may have a significant motivational component, accentuated by competitiveness and individualism. Being married and having higher levels of distress in psychiatry trainees appears to create a sense of satisfaction with achievements. The implementation of strategies to prioritize and meet goals is necessary to have an adequate work-life balance without affecting personal satisfaction or the sense of achievement. [ABSTRACT FROM AUTHOR]

Introduction. We assessed the impact of polythetic conceptualizations of mental disorders on the validity and reliability of psychiatric diagnosis, with a specific focus on two levels of heterogeneity: phenomenological and pathophysiological. Objective. We investigated this issue using attention deficit hyperactivity disorder (ADHD) as an example. Method. We examined individuals from two samples enriched for psychopathology (n = 1 255 children in Porto Alegre and 1 257 children in São Paulo, Brazil). We conducted a series of data analyses to investigate phenomenological heterogeneity, including confirmatory factor analysis. We also investigated pathophysiological heterogeneity using symptom-level regressions between ADHD symptoms and four neurocognitive processes consistently linked to ADHD (working memory, inhibitory control, intra-subject variability in reaction times, and temporal processing). Lastly, we assessed the performance of polythetic systems for reliability testing inter-rater and test-rest reliability of two well-known symptomatic scales. Results. Among the 116 200 possible combinations of symptoms to achieve DSM symptomatic threshold for categorical ADHD diagnosis, we found 173 combinations in the two independent samples, and only four were replicated in both samples (2.3%). We also found that the number of ADHD symptoms is a poor indicator of variation in the general ADHD latent trait. Overall, symptoms did not have specific profiles of associations with any of the neurocognitive processes. Reliability analyses revealed that increasing the number of items augments overall reliability of measurements. Discussion and conclusion. Our findings illustrate both potential benefits and problems inherent to the polythetic system for ADHD. Implications for the search of mechanisms underlying psychiatric disorders are discussed. [ABSTRACT FROM AUTHOR]

The Mexican Council of Psychiatry is celebrating this year its 45th anniversary. It is one of the first specialized medical councils in the country, and to date has certified 2 532 psychiatric specialists. This article recounts how the Council was founded, the contributions that more than 40 Mexican psychiatrists have made to its consolidation over the years, and the outlook of its work for the future. [ABSTRACT FROM AUTHOR]

Our country was the pioneer in the care of people with mental illnesses in America. San Hipólito´s Hospital and the general asylum La Castañeda attest to this. Although the knowledge and therapeutic resources were initially limited, advances in psychiatric nosology gradually emerged. A number of prominent Mexican physicians found their way into the field of mental health in the early 1940s. Psychoanalysis left a deep mark on Western culture. However, the discovery of psychotropic drugs and the establishment of a modern psychiatric vision changed the teaching of psychiatry, emphasizing its importance in the medical career and the specialty. On the other hand, in recent decades the development of neuroscience and the social sciences has brought about progress in the classification of mental illnesses and their treatment. Today, resources for mental health care in our country are low and are particularly concentrated in the third level of medical care. Associated with this, we have about four thousand psychiatrists and child and adolescent psychiatrists, who turn out to be insufficient for they are concentrated in large cities and the demand is growing. There exists a great interest in integrating mental health into the primary care network health. In our country, we have twenty offices with structured psychiatric specialization programs in sixteen universities. The future of psychiatry looks promising. The ability to relate more closely mental disorders with biology by imaging techniques, genomics and proteomics opens new horizons for therapeutic, keeping current psychological and social dimensions for clinical attention. [ABSTRACT FROM AUTHOR]

Introduction In several countries, the number of candidates to enter Psychiatry is diminishing. In Mexico, the kind of factors that influence the preference for a medical specialty and the way the selection tendencies change across the years of the medical career is not well known. In this study we analyzed the specialty preferences in a representative sample of students from different years of Medicine School at the National Autonomous University of Mexico (UNAM). Material and methods Descriptive cross-sectional study. Specialty preferences were assessed in students enrolled in the 2009-2010 school year of the Medicine School through a questionnaire designed expressly for this research. Data were analyzed quantitatively and qualitatively. Results A total of 2737 students participated. Most of the students (n = 2634) had already considered a specialty. Preferred specialties were General surgery (n=403, 14.72%), followed by Internal medicine (n=382, 13.96%) and Pediatrics (n=261, 9.54%). On the other hand, Radiology (n=314, 11.47%), Pediatrics (n=280, 10.23%) and Family medicine (n=263, 9.61%) were all specialties that students would not choose. For Psychiatry, there was a greater tendency only among first year students to see it as a choice of specialty. Compared with men (n=114, 11.53%), the percentage of women (n=259, 14.81%) who considered Psychiatry as an option of medical residency was higher. Discussion We could see that Psychiatry is neither the most preferred nor the most rejected specialty among medical students. Unfortunately, misconceptions still prevail around it and they do not favor its selection as a potential option of residency. It would be necessary to strengthen the knowledge about mental health and psychiatry, and to have the teachers promoting it in order to change the trends of selection. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to review the definitions of psychiatry and the epistemological structure of the discipline as a branch of medical science. Reflection makes sense, because in order to navigate the flood of information provided in the journals and scientific conferences today, the psychiatrist requires a body of doctrine to guide, regulate and structure its practice. Critical study and hermeneutic rigour allow us to specify the three largest circulation definitions on the Spanish-speaking world, and also add some new challenges that social organization is asking the mental health professionals, which must be incorporated into their responsibilities and functions. It also discusses the relationship of psychiatry and the so-called human sciences, neurology and neuroscience, as well as their adherence to the general field of medical sciences. Given the diversity of interests, sources of knowledge and research methods that incorporates within it, psychiatry has been considered as an heterogeneous and heterological science. It is closer to the approach of trans-disciplinarity complexity than the structure of the formal disciplines. This places it in an awkward position within the set of medical sciences. Hence, the transit route passes along the edge of epistemological suspicion. [ABSTRACT FROM AUTHOR]

This article discusses ten basic points of epilepsy in children that the psychiatrist should know in his medical practice. We mention the importance of the issue especially in children, since over 75% of patients start their epilepsy before 18 years, with a subsequent increase in the elderly. Epidemiological studies of the Epilepsy Priority Program have shown a prevalence of 15x1000, this is more than a million and half of patients with epilepsy in the country. The article describes the current definition and discusses a new definition proposal which mentioned that epilepsy is a brain disease characterized by a predisposition to present lasting and permanent seizures with their biological, cognitive and psychosocial consequences. It emphasizes the different types of seizures according to the international classification and lists some types of seizures that can be difficult to recognize. Record a brief description of non-epileptic paroxysmal events than can be confused with epilepsy. Describes the usefulness of the electroencephalogram and neuroimaging studies in epilepsy. It emphazises the importance of type of epilepsy, since different anticonvulsants are useful for specific seizures. It also mentions the most common behavioral and learning problems that children with epilepsy may present. The article clarifies some myths and provides recommendations for the long term follow up of these patients [ABSTRACT FROM AUTHOR]

On September 1, 1910, more than two thousand people celebrated the one hundredth anniversary of Mexico's Proclamation of Independence with the inauguration of a psychiatric hospital. According to the event's official chronicler, the 25 buildings constructed by order of president Porfirio Díaz on the site of the former Castañeda Hacienda would place Mexico among the leading countries in the world in treating mental health pathologies. But, what had been Mexico's development in this field during the XIX century? Could we consider La Castañeda «the birthplace of public psychiatry» in Mexico? This work analyzes La Castañeda's contribution to the profes-sionalization of psychiatry in Mexico, not only by looking at the place that research and teaching traditionally had in hospitals, but also by looking at other mechanisms that help to form a discipline, such as the capacity to bring light to scientific societies and to bring credibility to a new medical field such as psychiatry, so much in need of therapeutic successes in those years. In the XIX century around 400 articles, theses and books by Mexican, Hispanic and foreign authors were published that dealt with topics associated with psychiatry. The old hospitals of the colonial system such as San Hipólito and La Canoa established a form of treatment called «moral treatment», precursor to psychiatry, and were directed by a doctor substituting a director-administrator. Between 1865-1910, five projects for a modern mental hospital were made, one of which saw fruition in the form of La Castañeda. In 1887 the first course dealing with mental illness was taught and in 1906 the first specialization in psychiatry was brought about. Nonetheless, this movement was cut short by the Revolution of 1910 which assailed the country for almost a decade and provoked that La Castañeda be left without state support. The professionalization of Mexican psychiatry can be divided in three stages: 1910-1925, a period marked by the decomposition brought on by the war; 1925-1945, characterized by the major medical and administrative reform of the hospital, and 1945-1968, a stage which included the slow dismantling of La Castañeda. In the first stage, La Castañeda saw a certain level of deterioration in its assistance practices, as 25% of patients who entered between 1914-1916 were not diagnosed, and 45% of patients of those entering between 1917-1920 were not diagnosed either. This fact is explained by the institution's instability in those years. Between 1910-1923, La Castañeda had twelve directors. Academic courses in mental illness continued to be offered and a medical society was formed, but with few results. In 1925 Public Welfare asked doctor Enrique Aragón to inspect the Asylum and present a detailed report of any reforms needed. The three most serious problems he discovered were: the deficient way in which doctors handled patient's clinical records, shortages and poor training of personnel and the fact that there was almost no research being done. From 1925-1945, La Castañeda experienced great reforms thanks to three doctors who wanted to professionalize psychiatry in Mexico and place it at a competitive level with hospitals around the world, which they had seen in visits to Europe and the U.S. These doctors were Samuel Ramírez Moreno, Alfonso Millán Maldonado and Manuel Guevara Oropeza, who received support from the federal government. In 1929 a system of occupational therapy was established as a means of rehabilitation, and outpatient services were offered to those not needing hospitalization. In 1932 a Children's Ward was inaugurated and the following year the School for Abnormal Children, both directed by Mathilde Rodríguez Cabo, the first woman psychiatrist in Mexico. Alongside Ramírez Moreno, she began a project offering courses in psychiatric nursing and caregiving. In 1935 the Drug Addicts Unit was inaugurated, and in the years following shock therapies were introduced. A laboratory was established to perform traditional clinical analyses, as well as bacteriological and pathological analyses, and microphotography, both to improve diagnoses and to move research forward. All was influenced to a great extent by Spanish neurobiology which came about after the Spanish Civil War, when exiles such as Dionisio Nieto were received in Mexico. In order to strengthen the guild, at this stage there were important initiatives. In 1934, the Revista Mexicana de Psiquiatría, Neurología y Medicina Legal, the first Journal in its field in Mexico, was published. In 1937 the Sociedad Mexicana de Neurología y Psiquiatría was founded, as well as its official organ, Archivos de Neurología y Psiquiatría de México. Around 1943, a project which would become Mexico's policy of mental health for the years 1945-1968 began to be conceived. This policy would lead to the demolition of La Castañeda, and replace it with farms or field homes for the mentally ill. This therapeutic model, with chronic patients in mind, was based on recreational and occupational therapies, and its intention was to place patients in contact with nature, under a regimen of liberty and dedicated to productive and dignified activities. Yet these farms were located far from urban centers, isolating patients even further from family. In fact, psychiatry itself was also isolated from the rest of the medical world. La Castañeda closed on June 29, 1968, and with it more than 68 000 lives, could they talk today, might well tell this story differently. [ABSTRACT FROM AUTHOR]

A few months ago the paper entitled «Analysis of genomic diversity in Mexican Mestizo populations to develop genomic medicine in Mexico» by Solezzi et al. was published in the Proceedings of the National Academy of Medicine USA. Beyond its genuine scientific merits, we consider important to comment and discuss it, as some of their scopes and implications have caused not only a wide interest but also some concern in the scientific community and in society as a whole. We focused particularly in the possible impact that it could have in the development of psychiatric genetics in Mexico and Latin America. Firstly, a brief recapitulation of the published work is showed, and its principal data are discussed on the ground of the specialized literature. What is the background of this study and why it is important to develop a HapMap of the Mexican population? It is well known that most of the complex diseases, as is the case for psychiatric conditions, have an important genetic associated component. It is expected that the identification of these genetic factors will be of the most importance in the understanding of etiology, diagnosis, prognosis and therapeutic improvement for psychiatric medicine. The information provided by the collection of millions of single nucleotide polymorphisms (SNPs) has been used to develop the socalled international haplotype map (HapMap) Project. The human haplotype blocks catalog allows an important reduction in the number of SNPs that are necessary to perform linkage and genetic association studies, mainly those of the Genome Wide Association Studies (GWAS) category. However, it is recognized that the frequency of these polymorphisms differs significantly among ethnic groups; so the data published by Solezzi et al. are aimed to develop a HapMap particularly oriented to the Mexican mestizo population. This information will be of outstanding importance in studies including Mexican subjects in order to select the most informative group of SNPs and also to control for possible population stratification flaws. However, achievement of these objectives will need much more work to be done, as for example should it be mandatory to analyze a greater number of polymorphisms, develop genome re-sequenciation projects and include other Mexican subpopulations in the analysis. How this results will help psychiatric genetics in Mexico? As noted above, there is substantial evidence that genetics plays an important influence in the phenotypic expression of mental disorders; however, the effort to identify the specific genetic variants associated with psychiatric conditions has not been very successful. Although multiple reasons could be invoked related to this limited success, here we focus in two specific topics. The first one is related to the candidate gene approach in genetic association studies, in which researchers based on a logic scientific hypothesis evaluate specific genetic variants putatively related to the disorder of interest (i.e. the candidate genes hypothesis). … [ABSTRACT FROM AUTHOR]

Mathilde Rodríguez Cabo was the first female psychiatrist in Mexico. She was a prominent feminist leader who participated in the movement for childhood protection. She was also part of the struggle for political, social, and human rights of women. However, her outstanding career has remained forgotten and unknown to the public for a long time. This article seeks to bring to light her biography by rebuilding two important aspects of her life: her performance in the field of child psychiatry in post-revolutionary Mexico, and her fierce struggle as an activist defending Mexican women's rights. Mathilde Rodríguez was born in Las Palmas, San Luis Potosí, in 1902. While the country was convulsed by the revolutionary war, she joined the Colegio Alemán in Mexico City at the age of fourteen. An outstanding student, she finished her high school studies and learned German, which became useful for traveling and studying in Germany. Later she also translated in to Spanish important works from German psychiatry, such as Carl Gustav Jung's Symbolik des Geiste, and the Correspondence, between Sigmund Freud and Oskar Pfister. In 1922, Rodríguez began studing medicine at the Universidad Nacional de México. In 1929, she received a scholarship from the Alexander von Humboldt Society, given to young doctors to study a specialty in psychiatry and neurology at Cursos Internacionales de Perfeccionamiento Médico, offered annually by the University of Berlin. Thus, doctor Rodríguez became part of the small and selected group of Mexicans who got a university degree and a specialty. While still in Germany after finishing her curses, the Mexican government commissioned Rodríguez to travel to the Soviet Union to do research and learn the methods to protect children in that country. The permanence of Mathilde in Stalinist SSRU allowed her to observe directly the Russian social organization, and to get involved in socialist and progressive ideas. In 1932, the Children's Pavilion was created at the General Mental Hospital of La Castañeda, which responded to the general concern on childhood that characterized the Mexican twentieth century. Also, this was considered as a way to revalue and reconstruct the credibility of the institution. In October of the same year, the director of the Mental Hospital named Rodríguez Cabo director of the Children Psychiatric Pavilion. The early work of doctor Mathilde was to plan the organization of the place in order to enhance services and to obtain economical funds for its management. She removed unnecessary personnel and regulated the operation of the annexed school by including life conditions of students and general rules that should be followed in the institution. In addition, she developed a curriculum to include courses on special teaching and general culture, she proposed a class schedule with teaching procedures and evaluation systems, and elaborated a spending budget, which included food and attention of children, as well as the implementation of workshops. During her term as director of the Children's Pavilion, Mathilde Rodríguez intensified the work with mentally ill patients at the mental hospital, seeking a social rehabilitation and considering specific clinical circumstances in each particular case.… [ABSTRACT FROM AUTHOR]

The immediate expression of the scientific activity is very well reflected through the periodic journals, due to the fact that they are the main means of information that scientists have chosen to communicate to their peers and society as a whole the advances and recent contributions of research that is being done. Thus explaining in this manner the reason why bibliometric studies are of great utility to highlight the evolution of the scientific research, also, this allows scientists, institutions and, editors of scientific journals to be aware of a series of indicators to analyze science productivity from different angles. In this study, the editorial productivity of the National Institute of Psychiatry Ramon de la Fuente (NIPRF), and its journal "Salud Mental" included in two indexes of the ISI Web of Science: 1) The Social Science Citation Index (SSCI), 2) The Science Citation Index (SCI) and The Journal Citation Reports (JCR), by Thompson Scientific, between the years 1995 - 2006. The objective of the study is to make public the editorial productivity of the institution, research staff and their journal Salud Mental, according to the mentioned information sources. These databases were selected for this study because of the prestige that Thompson Scientific has not only in the scientific community, but also, in the information media, due to its rigorous methods to select the journals in order to maintain updated journal titles that are included in their indexes. This study shows the productivity of different countries of the world in the SSCI in the period analyzed to place Mexico in the international context. Then, it is shown all the productivity of Mexico in the SSCI by author, subject, institution, publication, type of document and language, with the purpose of knowing the position of productivity of the NIPRF in the national context. After this, all the productivity of the NIPRF contained in the SCI is presented with the total productivity of the institute in both indexes. Afterwards, a chart is shown of the productivity of the authors belonging to the institute that appear in both indexes, showing the number of articles as single authors and as first authors, as well as identifying the type of documents published. The study follows with a series of data of the productivity of three Mexican journals indexed in the SSCI related to subjects such as psychology and psychiatry, they are: Salud Pública de Mexico, Salud Mental and, Revista Mexicana de Psicologia, with the purpose of identifying the institutions journal Salud Mental in the national and international context. The impact factor of the three Mexican journals was obtained from the Journal Citation Reports Edition. All the productivity of the three journals was analyzed by author, institution, type of document and language. The Mexican scientific productivity in social sciences, according to the SSCI, is very low compared with the other countries that were analyzed; in the case of Latin America, only Brazil exceeds Mexico in editorial production in this subject. According to the SSCI, the recurrent subjects in the editorial production in the social sciences are related with subjects such as psychology and psychiatry and the authors that stand out in this study are from the NIPRF. It is worth pointing out the fact that most of the editorial production of Mexico in this field according to the SSCI is generated in public institutions, first of all, the National Autonomous University of Mexico followed by the National Institute of Psychiatry Ramon de la Fuente. [ABSTRACT FROM AUTHOR]