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The multi-faceted phenomenon known as globalization has a particular impact on the conceptual and practical development of mental health disciplines in general, and psychiatry in particular, across different world regions. To be theoretically and functionally effective, global psychiatry requires an integration of its different components. To such objective, and after a brief review of continental European and Anglo-Saxon contributions, this article examines the history, characteristics, and contributions of Latin/Iberian American and Spanish-speaking psychiatry, in order to substantiate its role in world psychiatry. The Latin American proper (including Portuguese-speaking Brazil), Spain, and U.S.-based Hispanic components are described, revealing an identity that is based on a humanistic tradition, a value-based, culturally-determined clinical approach to patient care, and a pragmatic adaptation of different treatment resources and techniques. These may constitute supportive elements of an instrumental inter-regional bond in the present and future of our discipline.

Background: The World Association of Social Psychiatry (SP) and the International College of Person-Centered Medicine (PCM), while having their own background and goals, share some significant interests and concerns, raising hope for collaboration and synergism. Consideration of the COVID-19 pandemic that is severely challenging the world may also offer opportunities for organizations and programmatic perspectives to reflect on and optimize their paths. Objectives: This article is aimed at delineating a pattern of points of conceptual and strategic articulation between SP and PCM as perceived by scholars familiar with these perspectives, and to examine their implications for general health care and for responding to the evolving COVID-19 pandemic. Methods: This is primarily a consultation study involving clinical scholars familiar with the two perspectives at hand around a list of prospective articulation points between SP and PCM based on a selective literature review. The specific methods engaged involved elucidation of prominent SP/PCM articulation patterns through tabular displays of panelist ratings and contrast between such articulation points and recommendations from the UN and WHO for advancing general health care and responding to the COVID-19 pandemic. Results: The initial explorative elucidation of potential articulation points between SP and PCM, including a) Contextualized approach, b) Ethical commitment, c) Humanization of medicine, d) Concern for broad determinants of health, e) Commitment to health care and public health, and f) Contributing to UN SDGs, was supported by the ratings of panelists familiar with both perspectives and the recommendations of authoritative international health declarations (including those focused on COVID-19 response). This was particularly the case for complementary concern for health care and public health, a contextualized person/whole society approach, and ethical commitment to persons' values. Conclusions: The thrust of the results of the present study and their contrast with the emerging professional and scientific literature stimulated by the COVID-19 pandemic affords clarification and validity on the concepts and strategies of SP and PCM and opens new avenues for useful collaboration.

Considerations on the ethical challenges facing social psychiatry are based on the fact that it is an academic and applied endeavor harmonizing different forms of knowledge stemming from diverse sources, with different epistemic traditions. The field requires careful analysis of linguistic uses, distinguishing between public, international, and global health research and practice. Ethical imperatives extend from sound research practices to reasoned application of knowledge, advocacy, and counseling.

This paper addresses the context in which ethical and human right issues as they pertain to psychiatry are discussed in Latin America. Dependency and institutional instability are singled out as pervading characteristics influencing the analysis of issues and the design of mental health policies. According to the landmark 1990 Declaration of Caracas all countries in the region have progressed towards implementing measures designed to improve the condition of the populations regarding mental health care and research. Several principles are now universally accepted and, while there is still room for improvement, provision of services and better contexts for scientific development make it possible to expect advances in the future.

Objetivo: Realizar uma análise da inserção da ética e humanidades no currículo do Curso de Medicina da Escola Superior em Ciências da Saúde - ESCS, escola pública do Distrito Federal, Brasil, de forma a contribuir com o processo de gestão curricular. Metodologia: O Estudo é de coorte e documental. Foram pesquisados 37 termos relacionados à ética e 36 referentes à humanização nos objetivos educacionais e conteúdo dos módulos temáticos, habilidades e atitudes e interação ensino-serviço-comunidade, de 1ª a 4ª série e no programa do internato no currículo (ano 2006) e no projeto pedagógico do Curso de Medicina (2001). Resultados: Maior inserção da humanização, ética e bioética na 1ª e 2ª série, quando comparado à inserção na 3ª e 4ª série e no internato, (IC95%-a=0,034, pvalue=0,007). Unidade de habilidades e atitudes: freqüência das 3 temáticas no currículo da 1ª a 4ª séries (IC95%-a=0,026, pvalue=0,013). Quando comparada a inserção entre o internato e as quatro primeiras séries, observa-se que nestas a inserção da temática humanização é superior (IC95%-a=0,042, pvalue=0,029). Conclusão: O currículo desenvolvido no ano de 2006 na ESCS apresentou correlação com o projeto pedagógico do curso e contemplou a temática de forma abrangente, em todas as séries e internato.Objetivo: Realizar un análisis de la inserción de la ética y de las humanidades en el currículo del Curso de Medicina de la Escuela Superior en Ciencias de la Salud-ESCS, escuela pública del Distrito Federal, Brasil, para contribuir con el proceso de gestión curricular. Metodología: El estudio es de cohorte y documental. Se investigaron 37 términos relacionados con la ética y 36 referidos a la humanización en los objetivos educacionales y en el contenido de los módulos temáticos, habilidades, actitudes e interacción enseñanza-servicio-comunidad, de 1ª a 4ª serie, en el programa del internado del currículo (año 2006) y en el proyecto pedagógico del Curso de Medicina (2001). Resultados: Mayor inserción de la humanización, ética y bioética en la 1ª y 2ª serie, comparada con la inserción en la 3ª y 4ª serie y con el internado, (IC95%-#945; =0,034, pvalue=0,007). Unidad de habilidades y actitudes: frecuencia de las 3 temáticas en el currículo de 1ª a 4ª series (IC95%-#945; =0,026, pvalue=0,013). Cuando se compara la inserción entre el internado y las cuatro primeras series, se observa que en éstas la inserción de la temática humanización es superior (IC95%-#945; =0,042, pvalue=0,029). Conclusión: El currículo desarrollado en 2006 en ESCS presentó correlación con el proyecto pedagógico del curso y contempló la temática de forma abarcadora, en todas las series e internado.Objective: To establish a diagnosis of the insertion of bioethics, ethics and humanistic values and attitudes to the program of the Medical School of ESCS - Escola Superior em Ciências da Saúde, public school of medicine, Distrito Federal, Brazil, in order to contribute to the process of curricular management. Methodology: The study is cohorte and documental. Thirty-two indicators to the thematic on ethics and twenty-four related to humanization were utilized. The educational purpose and contents of activities in modules such as thematic, abilities, interaction and attitude towards the community for teaching and services, from first to senior years as well as in boarding schools programs were all analyzed in the Medical School curriculum of ESCS (2006) and about the pedagogic project of the Course (2001). Results: It was observed a greater insertion of thematic related to ethics and bioethics in the initial levels of the course, Freshman and Sophomore including boarded students, when compared to the insertion in Junior and Senior clerkship years (IC95%-a=0,034, pvalue=0,007). The unit on abilities and attitudes was the axle which presented greater recurrence of the thematic on humanization in programs of 1ª and 4ª years (IC95%-a=0,026, pvalue=0,013). It was observed an increase in the recurrence of the thematic on humanization developed in thematic modules and interaction community-teaching/service in the 2ª year and decline in the subsequent ones. The results were very low in the 3ª and 4ª years. When compared with the clerkship it was observed that the first four series had greater insertion of such thematic (IC95%-a=0,042, pvalue=0,029). Conclusion: The academic program developed in the year of 2006 at ESCS presented improvements when compared to the pedagogical project of the course.

A meeting to evaluate the program of biomedical and psychosocial research ethics, conducted at Interdisciplinary Center for Studies on Bioethics, was held September 8th and 9th, 2011, at the National Health Institute in Lima, Peru, with the following aims: • To evaluate jointly with former trainees the Program on Research Ethics of the Interdisciplinary Center for Studies on Bioethics. • To establish the effects of the program in different Latin America and Caribbean countries. • To update and evaluate research ethics activities in different countries. • To share experiences among trainees in order to establish a collaboration network. • To learn from the experience of groups working in research ethics in Peru. • To propose strategies for strengthening future program.

This paper presents the field of psycholexicology as an area of study concerned with etimology, meaning, and social legitimacy of the terms employed in psychiatric discourse, conceived of as the disciplinary foundation of clinical and research psychiatry. The influence of semantic constraints on structure and usage of psychopathological diagnosis is emphasized. Work in progress related to translation and cultural biases in terminology is briefly described.

Nonclinical populations of male and female subjects of middle socioeconomic level and different age ranges were assessed by means of the content analysis method developed by Gottschalk and associates. Verbal samples consisted of written productions in response to a standard ambiguous instruction to narrate a dramatic or interesting life experience and were scored for anxiety and hostility. Results show that the method shows no influence of gender under the conditions of this study and can be employed for diagnostic purposes, assuming that personality factors and psychopathological influences might have a more pronounced impact on affect scores.

This paper addresses the need to consider the valoric constitution of patients and therapists in the context of psychiatric encounters and proposes the notion of axiogram, a depiction of values and moral beliefs to incorporate into the clinical history as a proxy to a nosological dimension complementing the traditional multiaxial approach.

This paper reports on associations between Neuroticism (N), Psychoticism (P), Extraversion (E) and Lie (L) scores of the EPQ-R and anxiety and hostility measured through verbal content analysis of 10-min written samples collected under standardized procedures in a group of 338 men and 151 women between 15 and 64 years in age. P correlated negatively with number of words and positively with anxiety and hostility in men but not in women. E correlated positively with number of words and negatively with shame and guilt anxiety. N showed positive correlation with these two types of anxiety only in the whole sample. L scores did not correlate with anxiety or hostility. In the sample studied, a negative correlation between P and L was evinced. Results are discussed in terms of mood prediction through personality measures, gender influences and the differential hypothesis of state-trait relationships.

In a sample of 63 female suicide attempters, EPQ-R Psychoticism appeared as the most relevant dimension related to hopelessness, suicidal ideation and number of previous attempts. Extraversion correlated negatively with most measures associated with the attempt (depression, hopelessness, suicide ideation, suicide intention and number of previous attempts). Neuroticism showed a tendency to correlate with two measures of suicide ideation. Data are discussed in terms of the usefulness of the EPQ-R for suicide evaluation and prevention.

O objetivo deste artigo é relatar a experiência do Comitê de Ética em Pesquisa da Secretaria de Estado de Saúde do Distrito Federal (CEP/SES/DF) Brasil, durante o período de 10 anos a partir de sua fundação. Trata-se de uma avaliação descritiva e documental, na modalidade estudo de caso, utilizando-se a totalidade de projetos protocolados no CEP/SES/DF (Nº 052/08) nesse período. As pendências mais freqüentes dos projetos foram: termo de consentimento livre e esclarecido (30%), folha de rosto (25%), metodologia (20%), curriculum vitae (12%), planilha de orçamento (9%), outros (4%). O relato das atividades do CEP/SES/DF no período de 10 anos revelou, através de sua produtividade, a legitimidade do processo de análise ética dos protocolos visando à proteção dos participantes da pesquisa.

The paper deals with a comparison between verbal affective interventions by the same psychoanalyst in different therapeutic settings, individual and group therapy. Since the same therapist is involved, an exploration of interactional aspects of his therapeutic style becomes possible, taking into consideration his theoretical allegiance and his hypotheses about the structure and development of the psychotherapeutic milieu. The conformation of therapist-group and therapist-individual dyads shows a high thematic concordance across both settings, particularly with regard to separation anxiety, but also to a significant degree in relation to other verbally expressed affects. However similar the correlations do appear, there remain certain differences in the affective interactions between group or individual patient and the therapist that are due to developmental aspects of the therapeutic relationship in either setting.

Introducción. El desarrollo de un saber que fundamente la Terapia Ocupacional, nos hallevado a formular una ciencia de la ocupación. Sin embargo, el desafío nos imponetareas especulativas con respecto a: (1) los campos del conocimiento que esta ciencia conectaría, (2) los temas que estudia, (3) la metodología de tratamiento de aquellos temas de estudio, abordando la perspectiva de la atención en el área de la psiquiatría y (4) la spredicciones que, como ciencia, puede aportar al desarrollo de la Terapia Ocupacional. En el presente trabajo se expone, por un lado, los niveles de abstracción que se generanen el ‘desocultar’ los componentes de la ocupación. Con ello, se establecen los límites teóricos del saber científico y tecnológico. Por otra parte, se fundamenta un proceso cognitivo que vincula las bases teóricas y la aplicación práctica de estos conocimientos como terapia de apoyo para la intervención en psiquiatría

This paper intends. to evaluate degrees as a necessary tool in order to assure good quality while teaching a postgraduate course. It sets forth the evaluative experience offered together with the class on Fundamental Bioethics, one of the two courses that conform the Master's degree on Bioethics offered by Cuyo's National University, in Mendoza, Argentina. It also suggests a number of challenges necessary for compatibility, comparability and competitivity of the different educational opportunities offered throughout Latin America and the Caribbean

Most codes and declarations pertaining to the ethics of research involving human subjects have been formulated in response to specific events mostly of a painful or embarrasing nature. Several concepts appearing repeatedly in their texts are highlighted in this paper: principles of respect for persons, beneficence and justice, vulnerability and research propriety. Along with some comments on current revisions of many international guidelines and the role of bioethics committees, a plea is made to have a proactive rather than a reactive stance in ethical regulation of biomedical research (Rev Méd Chile 2001; 129: 680-4

La mención explícita de requisitos bioéticos en publicaciones biomédicas que involucran seres humanos y la incorporación de criterios éticos en la evaluación de trabajos científicos fueron investigadas en una muestra de revistas de la Región de América Latina y el Caribe. Mediante un criterio de selección basado en indexación en bases MEDLINE y LILACS, obtención de texto completo y de instrucciones a los autores, entre otros, se identificó 41 revistas científicas, siendo revisados 625 artículos. Los resultados varían según se trate de ensayos con medicamentos (177 artículos) o estudios clínicos de diagnóstico o tratamiento no farmacológico (448), existiendo mayor preocupación de los investigadores en el primer caso (49% señala consentimiento informado y 46% revisión por comité de ética) que en el segundo (32% indica obtener consentimiento y 27% revisión por comité). Además, se aprecia mayor cumplimiento de disposiciones éticas en los ensayos clínicos fase II y III que en los fase IV. El análisis de las instrucciones a los autores, demuestra que en las revistas revisadas la mayor preocupación de los editores se refiere al consentimiento informado en las revistas indexadas en MEDLINE (50% pide ese requisito) y la aprobación por comité de ética en las indexadas en LILACS (en 43% se solicita). En general, el cumplimiento explícito de requisitos éticos llega como máximo al 50% y no hay referencias éticas en cerca del 45% de las publicaciones

The paper by Heinz Katschnig is a thoughtful description of the challenges faced by psychiatrists worldwide, providing an interesting opportunity to reflect upon what the profession really means. The dilemma may be put through the following question: if psychiatry (and psychiatrists) are the solution, which is in fact the problem? The “eliminative procedure” should lead us to question what would happen if the psychiatric profession disappears. Would health of the populations deteriorate? Would people suffer more? Would anyone notice that we do not have psychiatrists anymore? All these are hard questions. They are hard to pose and hard to answer. A profession is an institutionalized response to a social demand. A demand is not simply a need or a wish. It is a need or a wish consciously perceived by people and for whose satisfaction they are willing to pay, i.e., to provide practitioners with honor (honoraria), money, prestige, power or love. It is important to stress that the perceived need or desire lies in the people and not in the providers of the services 1. One of the most unfortunate developments of postmodernist societies consists in the development of expertocracies, that is, groups of experts who believe that progress and advancement rely exclusively on their own needs and interests. Sometimes, this development leads to ignore the original demand which created the expertise. Experts are concerned with the improvement of their knowledge base, refer to their peers for approval and acceptance and contend to know the real needs of people without confronting changing realities. The typical paternalism of the medical profession, characterized by beneficence without autonomy, is a rough form of expertocratic thinking based on the idea that “doctors know best”. The fact that psychiatrists are criticized is a warning that the profession should review the fundaments of its alleged power and influence on human affairs. As many other knowledge-based professions, the cognitive side of this knowledge has been considered the basis of professional power for psychiatrists. However, in terms of specialized information, current psychiatry could be subsumed under neurology, psychology, social work, or policy making. Searching for power in the knowledge base is not appropriate, or it has not been appropriate considering the results. The fashionable “evidence-based” practice does not apply to many psychiatric practices in diagnosis, treatment, or prevention. The many aspects of a seemingly heterogeneous profession, ranging from Bohemian speculation to hardcore empirical research, do not find a reasonable harmonization within individual practice of psychiatrists. In order to honor all the heterogeneous discourses constituting the historical knowledge base, they should resemble “Renaissance men” and this is seldom the case, particularly in an era of state-controlled or market-driven practice 2. If anything, what needs to be done is to reformulate the actual demand for a profession comprising so many disparate discourses and so different practices. This reformulation can only be done on the basis of a dispassionate analysis of what people really demand and what current health care systems permit. However, the defense of the psychiatric profession nowadays cannot be based exclusively on the knowledge base, contested by other professions and limited by laws, regulations, and pressure groups within society. As a proposal, I strongly believe that what people may really appreciate, and thus may justify an expert role of the kind psychiatrists might be able to provide, is not so much “evidence-based” practice as “value-based” integration of discourses and knowledge 3. The psychiatrist could represent that kind of general harmonizer of information that uses it in a prudent form and can be a counselor, a therapist and a health promoter without colliding with physicians, psychologists, lawyers, or social workers. From competition to integration, going through the intermediate stage of cooperation, psychiatrists could be the systemic organizers of health care and research and not insist to remain one among many medical specialties which, by necessity, could render its claims irrelevant. Psychiatry should become a specialized profession, solving the problems of integrality of approach and human relevance that no other prudent expert could provide. This, of course, might mean reorienting teaching, training, and practice, but is based on a perception of real demand and a response to the challenges now being uncovered and discussed 4.

This editorial emphasizes the descriptive character of two of the most widely employed psychiatric diagnostic systems currently in use: DSM-IV and ICD-10. While they cannot be deemed atheoretical, they strive for neutrality and propose a nomenclature devoid of derogatory connotations. It is contended that the lowered "labeling threshold" of these systems tends to identify conditions that, while abnormal in the sense of producing personal discomfort or dysfunction, could not always be considered diseases requiring intervention from healthcare systems. This distinction is useful when evaluating studies which acritically apply screening instruments with a diagnostic purpose. These studies, while producing data, may not always be relevant for empirical studies of comorbidity or prevalence. (Rev Méd Chile 2000; 128: 705-7).

The administration of the Three-Factor Eating Questionnaire (TFEQ) of Stunkard & Messick to a sample of university students indicates that, whereas in women self-reported body mass index (BMI, weight/height2) is positively correlated with Restraint, in men it is positively correlated with Disinhibition and Hunger. Male and female subsamples did not differ in personality characteristics, age, or actual scores of eating behaviour dimensions. A significant positive correlation between Disinhibition and Hunger was confirmed. These results are discussed in terms of differential awareness of eating habits in the two sexes.

La teoría de la personalidad de Eysenck postula 3 dimensiones ortogonales de personalidad: extraversión (E), neuroticismo (N), psicoticismo (P). Formula predicciones conductuales y fisiológicas relacionándolas a la predisposición a ciertos trastornos. La base biológica de las dimensiones E y N se ha evidenciado en diferencias electrofisiológicas. La dimensión P, agregada posteriormente, ha sido más controvertida, postulándose que no es independiente de las dimensiones antes descritas. Con objeto de estudiar las dimensiones de Eysenck, en particular P, en relación a la reactividad sensorial y a procesos de codificación se registró potencial evocado visual (PEV) por flash a 3 diferentes intensidades y P300 auditiva en 20 voluntarios sanos (x 28,5; ds 9,4 años). Se midió amplitud peak to peak y latencia de los componentes III, IV-V-VI y VII de PEV y de P300 mediante programa cursor. Hubo correlación positiva entre dimensiones N y P (spearman, r=0,52), entre P y amplitud del PEV (r=0,58) a intensidad alta y negativa entre E y latencia de P300 (r=-0,58). Según nuestros hallazgos, la dimensión P no es independiente y demostró relación con la reactividad sensorial. La dimensión E se relacionó a la velocidad de codificación, apoyando las aseveraciones de Eysenck sobre memoria y aprendizaje. Eysenck's personality theory postulates 3 orthogonal dimensions of personality: extraversión (E), neuroticism (N) and psychoticism (P), predicting conductual and physiological predispositions to suffer mental illness. Biological bases of Eysenck's personality traits have been documented electrophysiologically. Psychoticism, the latest described dimension, is controverted, since there is some evidence of common factors with the other two. In order to assess the relation between Eysenck's dimensions and sensorial reactivity and information encoding processes we studied 20 healthy young subjects (x age 28.5 years) with flash visual cortical evoked potentials (VEP, 3 intensities, peak to peak amplitude of III, IV-V-VI, VII components), and auditory cognitive evoked potentials (odd ball paradigm, P300 latency). There was a positive correlation between N and P dimensions (Spearman, r=0.52), between N and VEP amplitude at high intensity (r=0.58) and a negative correlation between E and P300 latency (r=-0.58). In short we found that P is not an independent dimension, but is related to sensorial reactivity. E dimension was related to encoding processes supporting Eysenck's aseverations about memory and learning differences.

This paper provides a discussion of a psychophysiological approach to somatization based on the notions of attention and meaning. It is suggested that several clinical features may be described, explained, and modified with the aid of these concepts.

Augmenting/reducing (A/R) of visual evoked potentials (VEP) has been repeatedly observed in central derivations, with some subjects increasing, and others decreasing, VEP amplitude with increasing intensity of stimulation. Central derivations also exhibit hemispheric lateralization regarding A/R. This paper explores central and occipital VEP in the same population of 16 healthy, right-handed male subjects, stimulated with binocular light flashes 10 usec in duration delivered by a Grass PS2 stimulator at a rate of 1/sec and at the intensities of 0.36, 0.72 and 1.44 joules at source. Amplitudes and latencies of components P1, N1 and P2 agreed with those reported in the literature. On the basis of amplitude/intensity slope functions of «peak to peak» amplitudes (P1N1 and NIP2) at Cz, 10 augmenters (slope greater than 0) and 6 reducers (slope smaller than 0) were found. Compared to central leads (C3 and C4) occipital ones (O1 and 02) did not exhibit significant interhemispheric differences. Vertex augmenters for N1P2 were occipital reducers and vice-versa. The different characteristics of A/R at occipital and central leads are interpreted in terms of stages of visual information processing in primary and association areas and functional significance of VEP components.

In this paper, a plea is made for establishing the dimension communication of emotional meaning as a descriptive axis in biopsychosocial diagnosis. Studies on alexithymia and somatic illness suggest that this dimension possesses not only diagnostic implications but also prognostic and therapeutic ones. A transactional viewpoint considering the definitions and expectations of patients, professionals and society would convert multiaxial into multidimensional diagnosis adapted to a given culture. Somatoform disorders are taken as illustration of the usefulness of the proposed dimension for further research and theorizing.