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Abstract Introduction Mental health and psychiatry have been terms of intense and complex use for almost a century, and they may have reached a critical level of ambiguous and imprecise synonymy that makes their definition and validation difficult. Objective To examine these concepts in depth, establishing precise distinctions, ontological connections, and instrumental scope reinforced by well-defined ideas in ethics and bioethics. Method Narrative review of pertinent literature, consultation with diverse scientific, medical, historical, philosophical, and literary sources, with appropriate analysis of ethical and bioethical practices. Results A broad, comprehensive definition is elaborated of mental health as a field with sociocultural, political, and demographic implications, and of psychiatry as a medical specialty. In addition to making clear distinctions and describing the specific impact of both fields on diverse populations, various levels of conceptual linkages, sociopolitical action, and ethical content are highlighted, as well as in processes of administration, education, and research. Discussion and conclusion There are factors that reinforce or weaken the scope of mental health and psychiatry, including their ethical and bioethical dimensions. Their effectiveness requires a reaffirmation of objectives and the reinforcement of individual and institutional initiatives, as well as the search for authentic connections and a social projection that is objective, comprehensive, and just.

Resumen Introducción Salud Mental y Psiquiatría han sido términos de uso intenso y complejo por casi una centuria y, en el momento actual pueden haber llegado a un nivel crítico de sinonimia ambigua e imprecisa que dificulta su delineación y vigencia. Objetivo Estudiar en profundidad los conceptos mencionados, estableciendo distinciones precisas, vínculos ontológicos y alcances instrumentales reforzados por nociones éticas y bioéticas definidas. Método Revisión narrativa de la literatura, consulta pertinente con fuentes de diversa índole médico-científica, histórica, filosófica y literaria y análisis de contenidos éticos y bioéticos pertinentes. Resultados Se plantean concepciones amplias y comprensivas de Salud Mental como campo de implicaciones socioculturales, políticas y demográficas, y de Psiquiatría como especialidad médica. Aparte de claras distinciones y de su impacto específico en diversos sectores, se precisan varios niveles de vinculación conceptual, acción socio-política y contenido ético-bioético en ambos campos y en procesos de manejo administrativo, pedagógico y de investigación. Discusión y Conclusión Existen factores que apuntalan o debilitan los alcances de Salud Mental y Psiquiatría, así como sus características ético-bioéticas. Su vigencia requiere una reafirmación de objetivos y un reforzamiento de voluntades individuales e institucionales, así como la búsqueda de vinculaciones auténticas y una proyección social objetiva, íntegra y justiciera.

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SUMMARY The migration of millions of Venezuelans to South American countries in the last two or three decades is one of the most significant social phenomena in the continent's history. This article presents a brief historical account of the process and describes a variety of dramatic aspects of the migrants' experiences throughout the long road towards Colombia, Ecuador, Perú and other countries. The main socio-demographic characteristics of the migrant population (numbers, population types, geographic location in the host country, age, gender and civil status, work and employment) in the above three countries, are described as a relevant basis of further inquiries on the repercussions of migration on the mental health of its protagonists. The information covers important aspects of the journey and the arrival as the initiation of a painful and uncertain process of acculturation and adaptation.

RESUMEN La migración de millones de venezolanos a países sudamericanos en las últimas dos o tres décadas constituye uno de los fenómenos sociales más significativos en la historia del continente. El presente artículo formula un breve recuento histórico del proceso y describe odiseas de diversa naturaleza, experimentadas por los migrantes en el extenso recorrido hacia Colombia, Ecuador, Perú y otros países. Como base relevante de futuras investigaciones en torno a repercusiones de la migración en la salud mental de sus protagonistas, se examinan las principales características socio-demográficas (cifras, tipos de población, ubicación geográfica en el país receptor, edad, género y estado civil, trabajos y empleos) de los migrantes en Colombia, Ecuador y Perú. La información cubre aspectos importantes de la travesía y el arribo que generan un doloroso e incierto proceso de aculturación y adaptación.

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Throughout history, Latin American psychiatry has followed a variety of routes as its mythic-religious origins experienced the various influences of European and North American ideas of the last three centuries. In its modern trajectory, a post-colonial subordination was followed by a more selective import of ideas and a critical approach to their application in the New Continent. At one point, the identity of Latin American psychiatry was essentially considered mestiza, social and critical, reflecting a search for autonomy and originality. In this journey, Peruvian psychiatry has been considered one of the most representative versions of the history and position of the discipline. This article attempts to detail the identity-seeking process of Peruvian and Latin American Psychiatry through the life and work of three notable Peruvian figures: Honorio Delgado, Carlos Alberto Seguín and Humberto Rotondo. Delgado fostered the need for scientific evidence in support of any piece of knowledge, as well as humanism as essential component of best service and optimal patient care. Seguín led studies on folkloric and ethnic psychiatry, stimulated integrated approaches to care, and advocated in favour of a regional identity for psychiatry.

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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.

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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.

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Abstract: Background: Although Cultural Psychiatry (CP) has emerged as a significant discipline and body of knowledge in recent decades, it finds itself in a current intense debate about its identity, its contributions, and its future. Objective: To examine conflictive areas of historical, epistemological, clinical, educational, and research interest in the present and future development of CP. Method: A narrative review of outstanding sources, articles, and textbooks on CP that reflect its current vicissitudes; for each area, adequate quotations of Cervantes' Don Quixote and Shakespeare's Hamlet are used. Results: In addition to updating definitions and content, discussions about whether CP is a psychiatric subspecialty, the scope of its diagnostic, clinical and therapeutic applications, evaluation of criticisms and strengths, interactions with other disciplines, as well as reflective speculations about its future, are outlined. Discussion and conclusion: CP is considered the receptacle of many disciplines, the last bastion of humanistic medicine in a globalized world, although its development will always be marked by scholarly debates about contexts, meanings, identities, and competencies regarding its ontological and epistemological components.

Resumen: Antecedentes: La Psiquiatría Cultural (PC) es una disciplina y cuerpo de conocimiento de creciente significación en décadas recientes que, sin embargo, es actualmente materia de un debate intenso acerca de su identidad, sus contribuciones y su futuro. Objetivo: Se examinan áreas de conflicto en aspectos históricos, epistemológicos, clínicos, educacionales y de investigación. Método: Revisión narrativa de fuentes relevantes, artículos y textos que reflejan las actuales vicisitudes de la PC; se utilizan citas referenciales apropiadas de Don Quijote, de Cervantes, y Hamlet, de Shakespeare, en tanto que perspectivas opuestas y/o complementarias. Resultados: Además de actualizaciones de definición y contenidos, se discute si la PC es una subespecialidad psiquiátrica, y se revisan sus aplicaciones diagnósticas, clínicas y terapéuticas; sus críticas y méritos; su interacción con otras disciplinas y reflexiones en torno a su futuro. Discusión y conclusión: La PC es el receptáculo de muchas disciplinas, el último bastión de una medicina humanística en un mundo globalizado, pero su futuro estará marcado siempre por debates académicos acerca del contexto, los significados, las identidades y las competencias respecto a sus componentes ontológicos y epistemológicos.

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Numerous biological, psychological, and social factors influence the mental health of elderly individuals to varying degrees. Apart from components related to the normal aging process and the co-occurrence of various medical conditions, events such as the death of a loved one, retirement, or disability significantly contribute to a variety of mental and emotional problems in this stage of the life cycle. The most frequent problems affect the neurocognitive, emotional, and oneiric spheres. Major neurocognitive disorders reduce one's overall performance and, thus, increase their need for close care. Affective disorders may be exacerbated by the lack of family support and decreased social interactions, which may lead to significant isolation result in suicidal behavior. The increased frequency of sleep disorders such as insomnia and daytime sleepiness and specific disorders such as obstructive apnea significantly alter the quality of life of this population.

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Hispanic immigration in the USA and its effect on many areas of US society are of great relevance to health care, public health, mental health, and medical and social sciences. In this report, we review and discuss pertinent literature on causes, procedures, and eventual outcomes of Hispanic migration waves throughout the last four decades. Hispanic immigrants do not constitute a monolithic group, despite the clear predominance of Mexican and Mexican-American segments. Common features of Hispanic immigrants include a younger average age, higher presence of married households, and lower educational levels than the overall US population. Differences within the Hispanic immigrant population are present in naturalisation figures, English language fluency, occupational and income status, health insurance coverage, and sense of accomplishment in the host society. We examine most of these aspects in the context of the so-called Hispanic paradox, presented as both a cause and a result of a heavily discussed acculturative process. We investigate prevalence and other data on depression, anxiety, substance abuse, and psychotic syndromes, with emphasis on the need to do further neurobiological, epigenetic, and sociocultural research in the Hispanic population.

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Historical and conceptual aspects of Global Health and Global Mental Health are examined and topics such as resources, professional and social attitudes toward mental disorders, the multidimensional experience of getting ill and the presence of world systems of psychiatric diagnosis and classification, are reviewed. The application of these areas of knowledge in medical practice require the integrated use of clinical and socio-cultural perspectives whose precise alignment is an essential component of accurate diagnoses, successful treatments and a consistent improvement of mental health as a component of public health. The latter includes preventive measures applicable to general populations, communities and health care proper. Management of socio-cultural aspects of diagnosis and treatment is imperative as is that of the growing relationship between mental health and neurosciences. The operationalization of this series of interactive processes must be part of legislations which, in turn, can make training, research and dissemination of the resulting data, possible.

Se examinan aspectos históricos y conceptuales de Salud Global y Salud Mental Global, formulándose temas de revision sobre recursos, actitudes profesionales y sociales o colectivas en torno a la enfermedad mental, las varias dimensiones de la experiencia de enfermar y la vigencia de sistemas diagnósticos y de clasificación psiquiátrica a nivel mundial. Las aplicaciones de estas áreas de conocimiento en la práctica médica requieren el uso integrado de perspectivas clínicas y socio-culturales cuyo alineamiento preciso es componente esencial de un diagnóstico acertado, un tratamiento exitoso y una mejoría consistente de la salud mental como componente de la salud pública. Esta última incluye medidas preventivas aplicables en niveles de población general, comunitario y de atención en salud propiamente tal. El manejo de aspectos socio-culturales de diagnóstico y tratamiento es imperativo, al igual que el de la creciente relación entre salud mental y neurociencias. La operacionalización de estos procesos interactivos debe ser materia de legislaciones que posibiliten, a su vez, programas de adiestramiento profesional, investigación y difusión adecuada de la información resultante.

São examinados aspectos históricos e conceituais de Saúde Global e Saúde Mental Global, formulando-se temas de revisão sobre recursos, atitudes profissionais e sociais ou coletivas em torno da enfermidade mental, as várias dimensões da experiência de enfermar e a vigência de sistemas diagnósticos e de classificação psiquiátrica em nível mundial. As aplicações destas áreas de conhecimento na prática médica requerem o uso integrado de perspectivas clínicas e socioculturais cujo alinhamento preciso é componente essencial de um diagnóstico acertado, um tratamento exitoso e uma melhoria consistente da saúde mental como componente da saúde pública. Esta última inclui medidas preventivas aplicáveis em níveis de população geral, comunitário e de atenção em saúde propriamente dita. O manejo de aspectos socioculturais de diagnóstico e tratamento é imperativo, igual ao da crescente relação entre saúde mental e neurociências. A operacionalização destes processos interativos deve ser matéria de legislações que possibilitem, por sua vez, programas de adestramento profissional, pesquisa e difusão adequada da informação resultante.

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RESUMEN Existen numerosos factores biológicos, psicológicos y sociales con impacto más o menos prominente en la salud mental de las personas adultas mayores. Aparte de componentes derivados de los procesos normales de envejecimiento o de la coocurrencia de enfermedades médicas diversas, eventos como la muerte de un ser querido, la jubilación o la discapacidad, contribuyen significativamente a una variedad de problemas mentales o emocionales en esta fase del ciclo vital. Los problemas más frecuentes afectan las esferas neurocognitiva, afectiva y onírica. Los trastornos neurocognitivos mayores reducen el rendimiento general del paciente y generan con ello exigentes necesidades de dependencia y cuidado cercano. Los trastornos afectivos pueden acentuarse por falta de apoyo familiar y disminución marcada de interacciones sociales que pueden dar lugar a un significativo aislamiento con conducta suicida resultante. La mayor frecuencia de trastornos del sueño como insomnio, somnolencia diurna y trastornos específicos como apnea obstructiva alteran significativamente la calidad de vida de esta población.

ABSTRACT Numerous biological, psychological, and social factors influence the mental health of elderly individuals to varying degrees. Apart from components related to the normal aging process and the co-occurrence of various medical conditions, events such as the death of a loved one, retirement, or disability significantly contribute to a variety of mental and emotional problems in this stage of the life cycle. The most frequent problems affect the neurocognitive, emotional, and oneiric spheres. Major neurocognitive disorders reduce one's overall performance and, thus, increase their need for close care. Affective disorders may be exacerbated by the lack of family support and decreased social interactions, which may lead to significant isolation result in suicidal behavior. The increased frequency of sleep disorders such as insomnia and daytime sleepiness and specific disorders such as obstructive apnea significantly alter the quality of life of this population.

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Colombia, South America is currently transitioning to post-conflict status following 6 decades of armed conflict. The population has experienced extensive exposures to potentially traumatic events throughout the lifespan. Sources of trauma exposure include the prolonged armed insurgency, narco-trafficking violence, urban gang violence, violent actions of criminal bands, intra-familial violence, gender-based violence, and sex trafficking. Exposure to potentially traumatic events is related to a variety of psychiatric outcomes, in particular, posttraumatic stress disorder. Given this context of lifetime trauma exposure, socio-demographic patterns of posttraumatic stress disorder were explored in a sample of residents of Medellin, Colombia, the nation's second largest city and a nexus for multiple types of trauma exposure.

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El fenómeno de la globalización, impulsado por migraciones masivas y avances tecnológicos cada vez más complejos, plantea desafíos a la identidad individual y colectiva, a la fisonomía cultural de regiones y continentes y a sus expresiones científicas, entre ellas la medicina y la psiquiatría. Tras describir brevemente las rutas históricas de la psiquiatría latinoamericana, el artículo examina el trabajo de algunas de sus más destacadas figuras y sus contribuciones en campos como psiquiatría social, psicoanálisis, neurobiología, psicopatología y otros. El enfoque central en torno a la visibilidad y aceptación de contribuciones latinoamericanas en el escenario mundial se basa en cifras de Factor de Impacto de publicaciones especializadas, reconocimiento y participación de psiquiatras latinoamericanos en eventos e instituciones internacionales, colaboración en proyectos de investigación, etc. Se concluye que tal visibilidad es modesta y se examinan las razones de la misma y las reacciones de la comunidad psiquiátrica latinoamericana ante tal realidad. Finalmente, se formulan sugerencias y planteamientos de manejo de esta situación para una reafirmación del valor y calidad de aquellas contribuciones en los campos académico, clínico y heurístico.

Globalization, a phenomenon nourished by massive migrations and increasingly complex technological advances, creates challenges to individual and collective identities, to the cultural texture of world regions and continents, and to their scientific expressions, among them medicine and psychiatry. After briefly describing the historical routes of Latin-American psychiatry, this article examines the work of some of its most distinguished figures and their contributions in areas such as social psychiatry, psychoanalysis, neurobiology and others. A focus on the visibility and acceptance of Latin-American contributions to the world psychiatry scene is based on the study of Impact Factor figures of publications, recognition and participation of Latin-American psychiatrists in international organizations and events, collaborative participation in research projects, etc. It is concluded that such visibility is modest, reasons for this and the reactions of the Latin-American psychiatric community in the face of it are examined. Finally, suggestions and management strategies aimed at reaffirming the value and quality of such contributions in the academic, heuristic and clinical fields, are formulated.

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Medical education has incorporated psychiatric or mental health components more consistently during the last decades thanks to various factors such as: advances in neurobiological research; the increasing prevalence of mental disorders in global health; the increasingly close relationship between mental health and public health; comorbidities with medical conditions and the impact of sociocultural phenomena in clinical manifestations, diagnosis, treatment, prognosis and prevention. Based on acquisition of core competencies and ethical principles of universal acceptance, the teaching process examined in this article proposes an education based on the provision of clinical experiences integrated throughout the collection of adequate information, the development of diagnostic capabilities, and exposure to a wide variety of forms of academic assessment of students and residents in training. The cultural components of psychiatric education receive special mention; we provide examples of their systematic integration with the acquisition of general skills. The teaching tools include theoretical and applied activities and supervision. Particular attention is paid to how the principles of modern psychiatric medical education, including cultural aspects and practice of holistic health care objectives, can and should be in effect in Latin American countries.

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La educación médica ha incorporado un componente psiquiátrico, o de salud mental, de manera más consistente en el curso de las últimas décadas, merced a factores tan variados como los avances de la investigación neurobiológica, la creciente prevalencia de trastornos mentales en el escenario de la salud global, la cada vez más estrecha relación entre salud mental y salud pública, comorbilidades con cuadros médicos e impacto de fenómenos socioculturales en expresiones clínicas, diagnóstico, tratamiento, pronóstico y prevención. Basado en la adquisición de competencias nucleares y principios éticos de aceptación universal, el proceso docente examinado en este artículo postula una enseñanza sustentada en la provisión de experiencias clínicas integradas a través del acopio de información adecuada, el desarrollo de capacidades diagnósticas y sujeción a una amplia variedad de modalidades de evaluación académica de estudiantes y residentes en entrenamiento. Los componentes culturales de la educación psiquiátrica reciben mención especial, proveyéndose ejemplos de su sistemática integración con la adquisición de competencias generales. Las herramientas didácticas incluyen actividades teóricas, prácticas y de supervisión. Se presta particular atención a cómo los postulados de la moderna educación médico psiquiátrica, incluidos sus aspectos culturales y la práctica de una atención médica integral como objetivos, pueden y deben tener vigencia en los países latinoamericanos...

Medical education has incorporated psychiatric or mental health components more consistently during the last decades thanks to various factors such as: advances in neurobiological research; the increasing prevalence of mental disorders in global health; the increasingly close relationship between mental health and public health; comorbidities with medical conditions and the impact of sociocultural phenomena in clinical manifestations, diagnosis, treatment, prognosis and prevention. Based on acquisition of core competencies and ethical principles of universal acceptance, the teaching process examined in this article proposes an education based on the provision of clinical experiences integrated throughout the collection of adequate information, the development of diagnostic capabilities, and exposure to a wide variety of forms of academic assessment of students and residents in training. The cultural components of psychiatric education receive special mention; we provide examples of their systematic integration with the acquisition of general skills. The teaching tools include theoretical and applied activities and supervision. Particular attention is paid to how the principles of modern psychiatric medical education, including cultural aspects and practice of holistic health care objectives, can and should be in effect in Latin American countries...

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Cultural Psychiatry deals with the description, definition, evaluation and management of psychiatric conditions as a clinical reflection of cultural factors within an integral context, and as an explanatory, interpretative, nosological, therapeutic and preventive attribute in professional practice. This article attempts to analyze that link in the context of the dominant classification in our era, the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA), with emphasis on the development of its latest version, DSM-5. The cultural content of the International Classification of Diseases (ICD) of the World Health Organization (WHO) can be the subject of further analysis, even when it can be said that, in general, it seemingly has less reach than the American classification. The author's participation, work and reflections about the DSM-5 Committee, created by the APA at the beginning of this century, constitute the basis of the presentation and discussion of concrete achievements, more or less idealized hopes, and more or less realistic expectations with a view to the future. Conclusions will also try to cover implications of DSM-5 cultural components in the field of Latin American and spanish-speaking psychiatry.

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