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Resumen
Propósito: El objetivo de este estudio fue describir las vías de atención para pacientes con un inicio reciente de psicosis y determinar si éstas se ven afectadas significativamente por el origen étnico y las creencias causales del trastorno.
Métodos: Muestra de 252 pacientes con esquizofrenia y sus cuidadores principales. Se entrevistó a los participantes sobre sus contactos de búsqueda de ayuda utilizando un cuestionario semiestructurado.
Resultados: En general, el 64,7% de los pacientes contactó inicialmente a un médico general para solicitar ayuda, mientras que sólo el 14% consultó a un psicólogo y el 12% se refirió a yatiri (curanderos de la comunidad). Los principales factores asociados con la evitación de una vía distinta fueron la presencia de un familiar o amigo de apoyo y la presencia de un médico general.
Conclusiones: La principal vía de acceso a los servicios psiquiátricos para pacientes con una reciente aparición de psicosis entre las minorías étnicas andinas es a través de un médico general, mientras que una pequeña parte de esta población depende de los curanderos de la comunidad.
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Anderson, K., Flora, N., Archie, S., Morgan, C., & McKenzie, K. (2014). A meta‐analysis of ethnic differences in pathways to care at the first episode of psychosis. Acta Psychiatrica Scandinavica, 130(4), 257-268. https://doi.org/10.1111/acps.12254
Anderson, K., Flora, N., Ferrari, M., Tuck, A., Archie, S., Kidd, S., Tang, T., Kirmaye, L., & McKenzie, K. (2015). Pathways to first-episode care for psychosis in African-, Caribbean-, and European-origin groups in Ontario. The Canadian Journal of Psychiatry, 60(5), 223-231. https://doi.org/10.1177/070674371506000504
Archie, S., Akhtar-Danesh, N., Norman, R., Malla, A., Roy, P., & Zipursky, R. (2008). Ethnic diversity and pathways to care for a first episode of psychosis in Ontario. Schizophrenia Bulletin, 36(4), 688-701. https://doi.org/10.1093/schbul/sbn137
Boydell, K., Pong, R., Volpe, T., Tilleczek, K., Wilson, E., & Lemieux, S. (2006). The rural perspective on continuity of care: pathways to care for children and youth with emotional and behavioral disorders. Journal of Rural Health, 21(2), 182-188.
Burns, J., & Tomita, A. (2015). Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50(6), 867-877. https://doi.org/10.1007/s00127-014-0989-7
Caqueo-Urízar, A., Breslau, J., & Gilman, S. (2015). Beliefs about the causes of schizophrenia among Aymara and non-Aymara patients and their primary caregivers in the Central–Southern Andes. International Journal of Social Psychiatry, 61(1), 82-91. https://doi.org/10.1177/0020764014544768
Cauce, A., Domenech-Rodríguez, M., Paradise, M., Cochran, B., Shea, J., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth. Journal of consulting and clinical psychology, 70(1), 44. http://dx.doi.org/10.1037/0022-006X.70.1.44
Chong, S., Mythily, L., Chan, Y., & McGorry, P. (2005). Determinants of duration of untreated psychosis and the pathway to care in Singapore. International Journal of Social Psychiatry, 51(1), 55-62. https://doi.org/10.1177/0020764005053278
Davy, C., Sicuri, E., Ome, M., Lawrence-Wood, E., Siba, P., Warvi, G., Mueller, I. & Conteh, L. (2010). Seeking treatment for symptomatic malaria in Papua New Guinea. Malaria journal, 9(1), 268. https://doi.org/10.1186/1475-2875-9-268
Duran, B., Oetzel, J., Lucero, J., Jiang, Y., Novins, D., Manson, S., & Beals, J. (2005). Obstacles for rural American Indians seeking alcohol, drug, or mental health treatment. Journal of Consulting and Clinical Psychology, 73(5), 819. http://dx.doi.org/10.1037/0022-006X.73.5.819
Fresán, A., De la Fuente-Sandoval, C., Loyzaga, C., Garcıa-Anaya, M., Meyenberg, N., Nicolini, H., & Apiquián, R. (2005). A forced five-dimensional factor analysis and concurrent validity of the Positive and Negative Syndrome Scale in Mexican schizophrenic patients. Schizophrenia Research, 72(2-3), 123-129. https://doi.org/10.1016/j.schres.2004.03.021
Garety, P., & Rigg, A. (2001). Early psychosis in the inner city: a survey to inform service planning. Social psychiatry and psychiatric epidemiology, 36(11), 537-544. https://doi.org/10.1007/s001270170004
Gater, R., & Goldberg, D. (1991). Pathways to psychiatric care in South Manchester. The British Journal of Psychiatry, 159(1), 90-96. https://doi.org/10.1192/bjp.159.1.90
González-Valderrama, A., Mena, C., Undurraga, J., Gallardo, C., & Mondaca, P. (2015). Implementing psychosocial evidence-based practices in mental health: are we moving in the right direction?. Frontiers in Psychiatry, 6(51), 1-3. https://doi.org/10.3389/fpsyt.2015.00051
Gundermann H. (2000). Las organizaciones étnicas y el discurso de la identidad en el norte de Chile, 1980–2000. Estudios Atacameños (En Línea), (19), 75-92. https://doi.org/10.22199/S07181043.2000.0019.00004
Gundermann, H., González, H., & Vergara, J. (2007). Vigencia y desplazamiento de la lengua Aymara en Chile. Estudios filológicos, (42), 123-140. http://dx.doi.org/10.4067/S0071-17132007000100008
Halvorsrud, K., Nazroo, J., Otis, M., Hajdukova, E., & Bhui, K. (2018). Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis. BMC medicine, 16(1), 223. https://doi.org/10.1186/s12916-018-1201-9
Harff B, & Gurr, T. (2004) Ethnic conflict in world politics. (2nd ed). Boulder, Colorado: Westview Press.
Harrison, G., Holton, A., Neilson, D., Owens, D., Boot, D., & Cooper, J. (1989). Severe mental disorder in Afro-Caribbean patients: some social, demographic and service factors. Psychological medicine, 19(3), 683-696. https://doi.org/10.1017/S0033291700024284
Jeyagurunathan, A., Abdin, E., Shafie, S., Wang, P., Chang, S., Ong, H., Rahman, R., Sagayadevan, V., Samari, E., Chua, Y., Vaingankar, J., Verma, S., Wei, K., Chong, S., & Subramaniam, M. (2018). Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore. International Journal of Social Psychiatry, 64(6), 554-562. https://doi.org/10.1177/0020764018784632
Kay, S., Fiszbein, A., & Opler, L. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia bulletin, 13(2), 261-276. https://doi.org/10.1093/schbul/13.2.261
Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World health Organization, 82(11), 858-866. Recovery from https://europepmc.org/articles/pmc2623050
Kurihara, T., Kato, M., Reverger, R., & Tirta, I. (2006). Beliefs about causes of schizophrenia among family members: a community-based survey in Bali. Psychiatric Services, 57(12), 1795-1799. Recovery from https://ps.psychiatryonline.org/doi/full/10.1176/ps.2006.57.12.1795
Lahariya, C., Singhal, S., Gupta, S., & Mishra, A. (2010). Pathway of care among psychiatric patients attending a mental health institution in central India. Indian journal of psychiatry, 52(4), 333. https://doi.org/10.4103/0019-5545.74308
Larsen, T. K., Moe, L. C., Vibe-Hansen, L., & Johannessen, J. O. (2000). Premorbid functioning versus duration of untreated psychosis in 1-year outcome in first-episode psychosis. Schizophrenia Research, 45(1-2), 1-9. https://doi.org/10.1016/S0920-9964(99)00169-3
Lincoln, C., Harrigan, S., & McGorry, P. (1998). Understanding the topography of the early psychosis pathways: An opportunity to reduce delays in treatment. The British Journal of Psychiatry, 172(S33), 21-25. https://doi.org/10.1192/S0007125000297614
MacBeth, A., & Gumley, A. (2008). Premorbid adjustment, symptom development and quality of life in first episode psychosis: a systematic review and critical reappraisal. Acta Psychiatrica Scandinavica, 117(2), 85-99. https://doi.org/10.1111/j.1600-0447.2007.01134.x
Mann, F., Fisher, H., & Johnson, S. (2014). A systematic review of ethnic variations in hospital admission and compulsory detention in first-episode psychosis. Journal of Mental Health, 23(4), 205-211. https://doi.org/10.3109/09638237.2014.910641
Marco, C., & Vaughan, J. (2005). Emergency management of agitation in schizophrenia. The American journal of emergency medicine, 23(6), 767-776. https://doi.org/10.1016/j.ajem.2005.02.050
Marshall, M., & Rathbone, J. (2006) Early intervention for psychosis. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD004718.pub2
Marshall, M., & Rathbone, J. (2011) Early intervention for psychosis. Cochrane Database of Systematic Reviews, (6). https://doi.org/10.1002/14651858.CD004718.pub3
Marshall, M., Lewis, S., Lockwood, A., Drake, R., Jones, P., & Croudace, T. (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of general psychiatry, 62(9), 975-983. https://doi.org/10.1001/archpsyc.62.9.975
McCabe, R., & Priebe, S. (2004). Explanatory models of illness in schizophrenia: comparison of four ethnic groups. The British Journal of Psychiatry, 185(1), 25-30. https://doi.org/10.1192/bjp.185.1.2
Melle, I., Larsen, T., Haahr, U., Friis, S., Johannessen, S., Opjordsmoen, S., Simonsen, E., Rund, B., Vaglum, P., & McGlashan, T. (2004). Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Archives of general psychiatry, 61(2), 143-150. https://doi.org/10.1001/archpsyc.61.2.143
Mesfin, M., Newell, J., Walley, J., Gessessew, A., & Madeley, R. (2009). Delayed consultation among pulmonary tuberculosis patients: a cross sectional study of 10 DOTS districts of Ethiopia. BMC Public Health, 9(1), 53. https://doi.org/10.1186/1471-2458-9-53
Ministerio de Salud de Chile [MINSAL]. (2006). Política de salud y pueblos indígenas. Santiago – Chile 1-58. Recovery from http://bvs.per.paho.org/bvsapi/e/paises/chile/politica.pdf
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National Coordinating Centre NHS Service Delivery Organ R&D. [NCCSDO] (2005). Vulnerable groups and access to health care: a critical interpretive review (27). Recovery from http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1210-025_V01.pdf
Nazroo, J. (2003). The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism. American journal of public health, 93(2), 277-284. https://doi.org/10.2105/AJPH.93.2.277
Norman, R. (2014). Are the effects of duration of untreated psychosis socially mediated?. The Canadian Journal of Psychiatry, 59(10), 518-522. https://doi.org/10.1177/070674371405901004
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Anderson, K., Flora, N., Ferrari, M., Tuck, A., Archie, S., Kidd, S., Tang, T., Kirmaye, L., & McKenzie, K. (2015). Pathways to first-episode care for psychosis in African-, Caribbean-, and European-origin groups in Ontario. The Canadian Journal of Psychiatry, 60(5), 223-231. https://doi.org/10.1177/070674371506000504
Archie, S., Akhtar-Danesh, N., Norman, R., Malla, A., Roy, P., & Zipursky, R. (2008). Ethnic diversity and pathways to care for a first episode of psychosis in Ontario. Schizophrenia Bulletin, 36(4), 688-701. https://doi.org/10.1093/schbul/sbn137
Boydell, K., Pong, R., Volpe, T., Tilleczek, K., Wilson, E., & Lemieux, S. (2006). The rural perspective on continuity of care: pathways to care for children and youth with emotional and behavioral disorders. Journal of Rural Health, 21(2), 182-188.
Burns, J., & Tomita, A. (2015). Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50(6), 867-877. https://doi.org/10.1007/s00127-014-0989-7
Caqueo-Urízar, A., Breslau, J., & Gilman, S. (2015). Beliefs about the causes of schizophrenia among Aymara and non-Aymara patients and their primary caregivers in the Central–Southern Andes. International Journal of Social Psychiatry, 61(1), 82-91. https://doi.org/10.1177/0020764014544768
Cauce, A., Domenech-Rodríguez, M., Paradise, M., Cochran, B., Shea, J., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth. Journal of consulting and clinical psychology, 70(1), 44. http://dx.doi.org/10.1037/0022-006X.70.1.44
Chong, S., Mythily, L., Chan, Y., & McGorry, P. (2005). Determinants of duration of untreated psychosis and the pathway to care in Singapore. International Journal of Social Psychiatry, 51(1), 55-62. https://doi.org/10.1177/0020764005053278
Davy, C., Sicuri, E., Ome, M., Lawrence-Wood, E., Siba, P., Warvi, G., Mueller, I. & Conteh, L. (2010). Seeking treatment for symptomatic malaria in Papua New Guinea. Malaria journal, 9(1), 268. https://doi.org/10.1186/1475-2875-9-268
Duran, B., Oetzel, J., Lucero, J., Jiang, Y., Novins, D., Manson, S., & Beals, J. (2005). Obstacles for rural American Indians seeking alcohol, drug, or mental health treatment. Journal of Consulting and Clinical Psychology, 73(5), 819. http://dx.doi.org/10.1037/0022-006X.73.5.819
Fresán, A., De la Fuente-Sandoval, C., Loyzaga, C., Garcıa-Anaya, M., Meyenberg, N., Nicolini, H., & Apiquián, R. (2005). A forced five-dimensional factor analysis and concurrent validity of the Positive and Negative Syndrome Scale in Mexican schizophrenic patients. Schizophrenia Research, 72(2-3), 123-129. https://doi.org/10.1016/j.schres.2004.03.021
Garety, P., & Rigg, A. (2001). Early psychosis in the inner city: a survey to inform service planning. Social psychiatry and psychiatric epidemiology, 36(11), 537-544. https://doi.org/10.1007/s001270170004
Gater, R., & Goldberg, D. (1991). Pathways to psychiatric care in South Manchester. The British Journal of Psychiatry, 159(1), 90-96. https://doi.org/10.1192/bjp.159.1.90
González-Valderrama, A., Mena, C., Undurraga, J., Gallardo, C., & Mondaca, P. (2015). Implementing psychosocial evidence-based practices in mental health: are we moving in the right direction?. Frontiers in Psychiatry, 6(51), 1-3. https://doi.org/10.3389/fpsyt.2015.00051
Gundermann H. (2000). Las organizaciones étnicas y el discurso de la identidad en el norte de Chile, 1980–2000. Estudios Atacameños (En Línea), (19), 75-92. https://doi.org/10.22199/S07181043.2000.0019.00004
Gundermann, H., González, H., & Vergara, J. (2007). Vigencia y desplazamiento de la lengua Aymara en Chile. Estudios filológicos, (42), 123-140. http://dx.doi.org/10.4067/S0071-17132007000100008
Halvorsrud, K., Nazroo, J., Otis, M., Hajdukova, E., & Bhui, K. (2018). Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis. BMC medicine, 16(1), 223. https://doi.org/10.1186/s12916-018-1201-9
Harff B, & Gurr, T. (2004) Ethnic conflict in world politics. (2nd ed). Boulder, Colorado: Westview Press.
Harrison, G., Holton, A., Neilson, D., Owens, D., Boot, D., & Cooper, J. (1989). Severe mental disorder in Afro-Caribbean patients: some social, demographic and service factors. Psychological medicine, 19(3), 683-696. https://doi.org/10.1017/S0033291700024284
Jeyagurunathan, A., Abdin, E., Shafie, S., Wang, P., Chang, S., Ong, H., Rahman, R., Sagayadevan, V., Samari, E., Chua, Y., Vaingankar, J., Verma, S., Wei, K., Chong, S., & Subramaniam, M. (2018). Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore. International Journal of Social Psychiatry, 64(6), 554-562. https://doi.org/10.1177/0020764018784632
Kay, S., Fiszbein, A., & Opler, L. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia bulletin, 13(2), 261-276. https://doi.org/10.1093/schbul/13.2.261
Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World health Organization, 82(11), 858-866. Recovery from https://europepmc.org/articles/pmc2623050
Kurihara, T., Kato, M., Reverger, R., & Tirta, I. (2006). Beliefs about causes of schizophrenia among family members: a community-based survey in Bali. Psychiatric Services, 57(12), 1795-1799. Recovery from https://ps.psychiatryonline.org/doi/full/10.1176/ps.2006.57.12.1795
Lahariya, C., Singhal, S., Gupta, S., & Mishra, A. (2010). Pathway of care among psychiatric patients attending a mental health institution in central India. Indian journal of psychiatry, 52(4), 333. https://doi.org/10.4103/0019-5545.74308
Larsen, T. K., Moe, L. C., Vibe-Hansen, L., & Johannessen, J. O. (2000). Premorbid functioning versus duration of untreated psychosis in 1-year outcome in first-episode psychosis. Schizophrenia Research, 45(1-2), 1-9. https://doi.org/10.1016/S0920-9964(99)00169-3
Lincoln, C., Harrigan, S., & McGorry, P. (1998). Understanding the topography of the early psychosis pathways: An opportunity to reduce delays in treatment. The British Journal of Psychiatry, 172(S33), 21-25. https://doi.org/10.1192/S0007125000297614
MacBeth, A., & Gumley, A. (2008). Premorbid adjustment, symptom development and quality of life in first episode psychosis: a systematic review and critical reappraisal. Acta Psychiatrica Scandinavica, 117(2), 85-99. https://doi.org/10.1111/j.1600-0447.2007.01134.x
Mann, F., Fisher, H., & Johnson, S. (2014). A systematic review of ethnic variations in hospital admission and compulsory detention in first-episode psychosis. Journal of Mental Health, 23(4), 205-211. https://doi.org/10.3109/09638237.2014.910641
Marco, C., & Vaughan, J. (2005). Emergency management of agitation in schizophrenia. The American journal of emergency medicine, 23(6), 767-776. https://doi.org/10.1016/j.ajem.2005.02.050
Marshall, M., & Rathbone, J. (2006) Early intervention for psychosis. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD004718.pub2
Marshall, M., & Rathbone, J. (2011) Early intervention for psychosis. Cochrane Database of Systematic Reviews, (6). https://doi.org/10.1002/14651858.CD004718.pub3
Marshall, M., Lewis, S., Lockwood, A., Drake, R., Jones, P., & Croudace, T. (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of general psychiatry, 62(9), 975-983. https://doi.org/10.1001/archpsyc.62.9.975
McCabe, R., & Priebe, S. (2004). Explanatory models of illness in schizophrenia: comparison of four ethnic groups. The British Journal of Psychiatry, 185(1), 25-30. https://doi.org/10.1192/bjp.185.1.2
Melle, I., Larsen, T., Haahr, U., Friis, S., Johannessen, S., Opjordsmoen, S., Simonsen, E., Rund, B., Vaglum, P., & McGlashan, T. (2004). Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Archives of general psychiatry, 61(2), 143-150. https://doi.org/10.1001/archpsyc.61.2.143
Mesfin, M., Newell, J., Walley, J., Gessessew, A., & Madeley, R. (2009). Delayed consultation among pulmonary tuberculosis patients: a cross sectional study of 10 DOTS districts of Ethiopia. BMC Public Health, 9(1), 53. https://doi.org/10.1186/1471-2458-9-53
Ministerio de Salud de Chile [MINSAL]. (2006). Política de salud y pueblos indígenas. Santiago – Chile 1-58. Recovery from http://bvs.per.paho.org/bvsapi/e/paises/chile/politica.pdf
Ministerio de Salud de Perú [MINSA]. (2004). Lineamientos para la acción en salud mental. Lima-Perú 1-79.
National Coordinating Centre NHS Service Delivery Organ R&D. [NCCSDO] (2005). Vulnerable groups and access to health care: a critical interpretive review (27). Recovery from http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1210-025_V01.pdf
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Derechos de autor 2024 Alejandra Caqueo-Urízar, Matías Irarrázaval, Alejandro Cuadra-Peralta, Alfonso Urzúa