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This study explored the clinical features of physicians and nurses with dual diagnosis. We conducted a retrospective review of 150 medical records of physicians (n = 120) and nurses (n = 30) admitted from February 2008 to February 2011 to the Barcelona Psychiatric Inpatient Unit for Health Professionals. Routine intake included the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and a clinical interview. The mean age of participants was 48.59 (SD = 8.9) years and 57.3% were male. Patients experienced substance dependence with alcohol (n = 112, 74.7%), sedatives (n = 59, 39.3%), cocaine (n = 24, 16%), other stimulants (n = 15, 10%), and opiates other than heroin (n = 16, 10.7%). About 41% (n = 61) also met criteria for a mental health disorder, mainly major depressive disorder (n = 42, 28%), while 8% (n = 12) had attention deficit hyperactivity disorder. A high proportion of physicians (n = 95, 79.2%) and nurses (n = 25, 83.3%) had nicotine dependence. The most common comorbidity was alcohol dependence and major depressive disorder. No differences were found between groups in the prevalence of substance use disorders, mental health disorders, and dual diagnosis. Dual diagnosis is a common condition among inpatient physicians and nurses with substance use disorders and its clinical presentation may be similar in both groups.

Resumen La prevalencia de los problemas de salud mental en los medicos es similar y en algunos casos superior (p. ej. suicidio) a la de la poblacion general. Dichos problemas pueden comportar serias implicaciones no solo para el bienestar psicofisico del medico y su entorno sino tambien para la seguridad de su practica clinica. En Espana, los Programas para la Atencion Integral del Medico Enfermo (PAIME) se han desarrollado con la finalidad de promocionar la peticion voluntaria de ayuda y para promover la prevencion, diagnostico y tratamiento de estos problemas en entornos especializados que garanticen la confidencialidad. En este estudio describimos como funciona el PAIME de Barcelona desde su creacion en 1998. Tambien presentamos los principios generales de su filosofia, requisitos de entrada, vias de acceso y distintas areas de intervencion. Por ultimo, presentamos como un contrato terapeutico especifico permite el manejo de los casos que suponen un riesgo para la praxis.

BACKGROUND Psychiatrists are at a high risk of becoming mentally ill at some point during their careers. AIMS To compare the profile of psychiatrists admitted to the Barcelona Physicians' Health Programme (PHP) with other sick doctors in the programme. METHODS A retrospective case review of electronic medical records was conducted for physicians registered at the 'Colegio de Medicos' in Barcelona and consecutively admitted to the Barcelona PHP from January 1998 until December 2013. RESULTS One thousand two hundred eighteen records were reviewed. The 72 psychiatrists admitted to the programme were not statistically different from the other physicians in gender (54% versus 51% women), primary diagnosis (34% non-substance use mental disorders versus 29% substance use disorders), prevalence of adjustment disorders and median length of their first treatment episode (9.0 versus 8.4 months). Psychiatrists were significantly older (mean age 53 versus 50 years; t = 2.12; P < 0.05), more frequently had inpatient treatment during their first treatment episode (17% versus 10%; χ (2) = 4.57, P < 0.05) and had more referred (rather than self-referred) admissions (22% versus 13%; χ (2) = 4.57, P < 0.05) than other physicians. However, only the type of referral played a significant role when considering the simultaneous effect of all relevant variables (Wald = 4.43; P < 0.05). CONCLUSIONS Psychiatrists with mental disorders may be more reluctant to ask for help from a PHP voluntarily than other physicians. Members of this professional group should be encouraged to seek help when affected by mental distress or addiction problems.

To the Editor: Substance use disorders (SUDs) in physicians and nurses have major professional, legal, and health consequences,1–3 and over and above the overall risk of developing SUDs, health car...

Co-occurrence of mental disorders and substance use disorders (dual diagnosis) among doctors is a cause of serious concern due to its negative personal, professional, and social consequences. This work provides an overview of the prevalence of dual diagnosis among physicians, suggests a clinical etiological model to explain the development of dual diagnosis in doctors, and recommends some treatment strategies specifically for doctors. The most common presentation of dual diagnosis among doctors is the combination of alcohol use disorders and affective disorders. There are also high rates of self-medication with benzodiazepines, legal opiates, and amphetamines compared to the general population, and cannabis use disorders are increasing, mainly in young doctors. The prevalence of nicotine dependence varies from one country to another depending on the nature of public health policies. Emergency medicine physicians, psychiatrists, and anaesthesiologists are at higher risk for developing a substance use disorder compared with other doctors, perhaps because of their knowledge of and access to certain legal drugs. Two main pathways may lead doctors toward dual diagnosis: (a) the use of substances (often alcohol or self-prescribed drugs) as an unhealthy strategy to cope with their emotional or mental distress and (b) the use of substances for recreational or other purposes. In both cases, doctors tend to delay seeking help once a problem has been established, often for many years. Denial, minimization, and rationalization are common defense mechanisms, maybe because of the social stigma associated with mental or substance use disorders, the risk of losing employment/medical license, and a professional culture of perfectionism and denial of emotional needs or failures. Personal vulnerability interacts with these factors to increase the risk of a dual diagnosis developing in some individuals. When doctors with substance use disorders accept treatment in programs specifically designed for them (Physicians' Health Programs), they show better outcomes than the general population. However, physicians with dual diagnosis have more psychological distress and worse clinical prognosis than those with substance use disorders only. Future studies should contribute to a better comprehension of the risk and protective factors and the evidence-based treatment strategies for doctors with dual diagnosis.

To explore if the Barcelona Integral Care Program for Doctors with mental disorders (PAIMM, in Catalan) has achieved its goal of enhancing earlier and voluntary help-seeking amongst sick doctors. We conducted a retrospective chart review of 1363 medical records of physicians admitted to the inpatient and outpatient units of the PAIMM from February 1st, 1998 until December 31st, 2011. The sample was divided into 3 time periods: 1998–2004, 2005–2007 and 2008–2011 (477, 497, and 389 cases, respectively). The mean age at admission decreased (F = 77.57, p < 0.001) from the first period ( $$\bar x = 54.18$$ ; SD = 10.28 years) to the last period ( $$\bar x = 44.81$$ ; SD = 10.65 years), while voluntary referrals increased from 81.3% to 91.5% (Chi2 = 17.85, p < 0.001). Mental disorders other than substance use disorders grew from 71% during the 1998–2003 period, to 87.4% (2004–2007), and 83.9% in the last period (Chi2 = 29.01, p < 0.001). Adjustment disorders increased their prevalence, while inpatient treatment progressively represented less of the overall clinical activity. Sick doctors may feel encouraged to seek help in non-punitive programs specially designed for them and where treatment becomes mandatory only when there is risk or evidence of malpractice.

IntroductionAlexithymia is said to be an important feature of functional gastrointestinal disorders (FGD). Most studies focus on the presence of alexithymia in patients suffering non-motor FGD (NMFGD) but few studies have analyzed its occurrence in motor FGD (MFGD) patients.Objectives- To describe the presence of alexithymia, measured with the Toronto Alexithymia Scale (TAS-20), in a sample of FGD inpatients.- To analyze the differences in alexithymia, measured with the TAS-20, between MFGD and NMFGD inpatients.Material and method46 inpatients admitted to the Vall d’Hebron Digestive System Research Unit to study the existence of FGD were evaluated from January 2008 to July 2010. All patients completed the Toronto Alexithymia Scale (TAS-20).ResultsThe mean age of the sample was 41.02 ± 16.86 years, 89.1% were women and 10.9% were men. With regard to their diagnostic condition, 31 met criteria of NMFGD, 13 of MFGD, and 2 did not met criteria of both disorders. The mean TAS-20 total score was: 46.24 ± 13.60. MFGD patients obtained a mean score of 45.45 ± 12.53, and patients with NMFGD had a mean score of 45.75 ± 12.53. No statistically significant differences were found between both subtypes with regard to alexithymia.ConclusionsAlexithymia, measured with the TAS-20, may not be present in FGD. Discordances of our results with previous findings in FGD may be due to complex psychosocial factors and to psychometric difficulties in assessing alexithymia in this group of patients.

IntroductionPatients suffering from Functional Gastrointestinal Disorders (FGD) experience a high degree of psychological discomfort difficult to measure with current psychometric tools.Objectives- To describe the presence of affective symptoms measured with the Hospital Anxiety Depression (HAD) Scale in FGD inpatients.- To analyze the differences in HAD subscales scores between motor functional gastrointestinal disorders (MFGD) and non-motor functional gastrointestinal disorders (NMFGD).Material and method46 inpatients admitted to the Vall d’Hebron Digestive System Research Unit to study the existence of FGD were evaluated from January 2008 to July 2010. All patients completed the HAD scale and results from the two HAD subscales - Anxiety subscale (HAD-A) and Depression subscale (HAD-D)- were analyzed.ResultsThe mean age of the sample was 41.02 ± 16.86 years, 89.1% were women and 10.9% were men. Thirty-one patients met criteria of NMFGD, 13 of MFGD, and 2 did not met criteria of both diagnoses. The mean scores of the HAD were: HAD-A = 8.12 ± 5.23) and HAD-D = 5.20 ± 4.20. MFGD patients’ HAD results were: HAD-A = 7.00 ± 5.74 and HAD-D = 4.55 ± 4.52 while NMGFD HAD results were: HAD-A = 8.21 ± 4.98 and HAD-D = 4.96 ± 3.77. No statistically significant differences were found between both groups.ConclusionsAccording to our findings, MFGD patients do not meet HAD criteria of anxiety or depression while NMFGD patients only fulfill criteria for probable anxiety or depression. New psychometric tools should be developed in the future to study the psychological discomfort these patients usually complain of.