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      Mirando atrás para seguir avanzando. Una reflexión crítica sobre el pasado y el presente de la atención en salud mental (I) Translated title: Looking back to keep moving forward. A critical reflection on the past and present of mental health care (I)

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          Abstract

          Resumen: Este es el primero de una serie de dos artículos que tratan de hacer una valoración crítica de los principales aspectos teóricos y técnicos relacionados con la atención en salud mental que se han desarrollado en las 6 o 7 últimas décadas. Se intenta con ello situar los problemas de la atención en salud mental, y, dentro de ellos, los de la psiquiatría, por contraposición a dos tipos de posiciones consideradas inadecuadas: las del reduccionismo biomédico dominante y las de algunas tendencias “antipsiquiátricas”, formalmente opuestas pero que, a mi entender, simplifican excesivamente la visión alternativa, con el riesgo de dejar de lado aspectos básicos de nuestras disciplinas y prácticas profesionales. En este primer artículo se hace una presentación general del conjunto, se exponen algunas posiciones filosóficas previas y se analizan críticamente distintos aspectos de la integración de la salud mental en el campo sanitario.

          Translated abstract

          Abstract: This is the first of two papers that seek to make a critical assessment of the main theoretical and technical aspects related to mental health care developed in the last six or seven decades. It attempts to situate the problems of mental health care, and, within them, those of psychiatry, as opposed to two types of positions considered inadequate: the dominant biomedical reductionism and those of some new “antipsychiatric” tendencies, both of which, although formally opposite, oversimplify, in my opinion, the alternative vision, with the risk of leaving aside basic aspects of our disciplines and professional practices. In this first paper, a general overview is provided, some previous philosophical positions are reviewed, and some of the main implications of integrating mental health in the health field are critically analyzed.

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          Most cited references44

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          The Lancet Commission on global mental health and sustainable development

          The Lancet, 392(10157), 1553-1598
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            Community mental health care worldwide: current status and further developments.

            This paper aims to give an overview of the key issues facing those who are in a position to influence the planning and provision of mental health systems, and who need to address questions of which staff, services and sectors to invest in, and for which patients. The paper considers in turn: a) definitions of community mental health care; b) a conceptual framework to use when evaluating the need for hospital and community mental health care; c) the potential for wider platforms, outside the health service, for mental health improvement, including schools and the workplace; d) data on how far community mental health services have been developed across different regions of the world; e) the need to develop in more detail models of community mental health services for low- and middle-income countries which are directly based upon evidence for those countries; f) how to incorporate mental health practice within integrated models to identify and treat people with comorbid long-term conditions; g) possible adverse effects of deinstitutionalization. We then present a series of ten recommendations for the future strengthening of health systems to support and treat people with mental illness.
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              Auditory Verbal Hallucinations in Persons With and Without a Need for Care

              Auditory verbal hallucinations (AVH) are complex experiences that occur in the context of various clinical disorders. AVH also occur in individuals from the general population who have no identifiable psychiatric or neurological diagnoses. This article reviews research on AVH in nonclinical individuals and provides a cross-disciplinary view of the clinical relevance of these experiences in defining the risk of mental illness and need for care. Prevalence rates of AVH vary according to measurement tool and indicate a continuum of experience in the general population. Cross-sectional comparisons of individuals with AVH with and without need for care reveal similarities in phenomenology and some underlying mechanisms but also highlight key differences in emotional valence of AVH, appraisals, and behavioral response. Longitudinal studies suggest that AVH are an antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficulties and poor coping, plus family history of psychosis, and environmental exposures such as childhood adversity. However, their predictive value for specific psychiatric disorders is not entirely clear. The theoretical and clinical implications of the reviewed findings are discussed, together with directions for future research.
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                Author and article information

                Journal
                neuropsiq
                Revista de la Asociación Española de Neuropsiquiatría
                Rev. Asoc. Esp. Neuropsiq.
                Asociación Española de Neuropsiquiatría (Madrid, Madrid, Spain )
                0211-5735
                2340-2733
                December 2019
                : 39
                : 136
                : 89-116
                Affiliations
                [1] orgnameComité de Expertos de FAISEM España
                Article
                S0211-57352019000200005 S0211-5735(19)03913600005
                10.4321/s0211-57352019000200005
                b9d5fcdc-fbf6-4f74-8839-13f21b9a532c

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 18 November 2019
                : 16 January 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 116, Pages: 28
                Product

                SciELO Spain

                Categories
                Artículos

                community mental health care,atención comunitaria en salud mental,evidence-based care,epidemiology,psychopathology,critical psychiatry,biomedical reductionism,reduccionismo biomédico,psiquiatría crítica,psicopatología,epidemiología,atención basada en la evidencia

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