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La presente publicación describe la metodología del cálculo del Índice de Calidad de Vida (ICV) versión española de Mezzich y colaboradores, estimar su confiabilidad y validez, obtención de normas para la población de Lima y análisis de variación de las puntuaciones según las variables demográficas(AU)

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La publicación describe la metodología del cálculo del Índice de Calidad de Vida (ICV) versión española de Mezzich y colaboradores, estimar su confiabilidad y validez, obtención de normas para la población de Lima y análisis de variación de las puntuaciones según las variables demográficas

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Cultural identity is central to health. Acculturation may be formulated with a bicultural model, assessing in parallel the degree of identification with both the original and the host culture. The Cortes, Rogler and Malgady Bicultural Scale (CRM-BS) is composed of two subscales: "original" culture and "mainstream-United States" (US) culture. It was modified into three ethnic versions: Latino, Korean and Chinese. Validation of the CRM-BS was conducted using health professionals and psychiatric patients from the above three ethnic groups and a control sample of mainstream-US (main-US) health professionals in New York City (n = 394). Mean time of completion was 3.7 min and 73% judged it to be easy to use. Strong test-retest reliability correlation coefficients were found (original culture, 0.78; mainstream-US, 0.82). The internal consistency was documented by high Cronbach's alpha values (original culture, 0.88; mainstream-US, 0.80). Factorial analysis revealed two factors, the first one involving all the items of the original culture and the second all of the mainstream-US items. Concerning its discriminant validity, non-main-US subjects scored significantly higher than main-US subjects on the original culture subscale, and vice versa. Construct validity was assessed comparing intergenerational mean scores on both subscales; as generations become older, mean scores for the original culture decreased, while those for the "host" culture increased. Results for each specific ethnic version are also presented. Cutoff scores were calculated to categorize the involvement with the original culture or the host culture, both of them, or neither.

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OBJECTIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global perception of quality of life). Each item is rated on a 10-point scale. The objective was to evaluate the reliability (test-retest), internal structure, discriminant validity, and feasibility of the Multicultural Quality of Life Index in Lima, Peru. METHOD: The reliability was studied in general medical patients (n = 30) hospitalized in a general medical ward. The Multicultural Quality of Life Index was administered in two occasions and the correlation coefficients ("r") between both interviews were calculated. Its discriminant validity was studied statistically comparing the average score in a group of patients with AIDS (with presumed lower quality of life, n = 50) and the average score in a group of dentistry students and professionals (with presumed higher quality of life, n = 50). Data on its applicability and internal structure were compiled from the 130 subjects. RESULTS: A high reliability correlation coefficient (r = 0.94) was found for the total score. The discriminant validity study found a significant difference between mean total score in the samples of presumed higher (7.66) and lower (5.32) quality of life. The average time to complete the Multicultural Quality of Life Index was less than 4 minutes and was reported by the majority of subjects as easily applicable. A high Cronbach's a (0.88) was also documented. CONCLUSIONS: The results reported that the Multicultural Quality of Life Index is reliable, has a high internal consistency, is capable of discriminating groups of presumed different quality of life levels, is quite efficient, and easy to use.

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OBJETIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global perception of quality of life). Each item is rated on a 10-point scale. The objective was to evaluate the reliability (test-retest), internal structure, discriminant validity, and feasibility of the Multicultural Quality of Life Index in Lima, Peru. METHOD: The reliability was studied in general medical patients (n = 30) hospitalized in a general medical ward. The Multicultural Quality of Life Index was administered in two occasions and the correlation coefficients ("r") between both interviews were calculated. Its discriminant validity was studied statistically comparing the average score in a group of patients with AIDS (with presumed lower quality of life, n = 50) and the average score in a group of dentistry students and professionals (with presumed higher quality of life, n = 50). Data on its applicability and internal structure were compiled from the 130 subjects. RESULTS: A high reliability correlation coefficient (r = 0.94) was found for the total score. The discriminant validity study found a significant difference between mean total score in the samples of presumed higher (7.66) and lower (5.32) quality of life. The average time to complete the Multicultural Quality of Life Index was less than 4 minutes and was reported by the majority of subjects as easily applicable. A high Cronbach's a (0.88) was also documented. CONCLUSIONS: The results reported that the Multicultural Quality of Life Index is reliable, has a high internal consistency, is capable of discriminating groups of presumed different quality of life levels, is quite efficient, and easy to use.

OBJETIVO: O índice Multicultural de Qualidade de Vida é um instrumento conciso para a avaliação ampla, culturalmente informada e auto-aplicável da qualidade de vida relativa à saúde. É composto de 10 itens (do bem-estar físico à percepção global da qualidade de vida). Cada item é classificado de acordo com uma escala de 10 pontos. O objetivo foi o de avaliar a confiabilidade (teste-reteste), estrutura interna, validade discriminante e a viabilidade do índice Multicultural de Qualidade de Vida em Lima, Peru. MÉTODO: A confiabilidade foi estudada em pacientes da clínica geral (n = 30) hospitalizados em uma enfermaria clínica geral. O índice Multicultural de Qualidade de Vida foi ministrado em duas ocasiões e os coeficientes de correlação ("r") entre ambas as entrevistas foram calculados. Sua validade discriminante foi estudada comparando estatisticamente o escore médio em um grupo de pacientes com AIDS (com presumida menor qualidade de vida, n = 50) e o escore médio em um grupo de estudantes e profissionais de odontologia (com presumida maior qualidade de vida, n = 50). Os dados sobre sua aplicabilidade e estrutura interna foram compilados a partir de 130 indivíduos. RESULTADOS: Achou-se um alto coeficiente de correlação de confiabilidade no escore total (r = 0,94). O estudo de validade discriminante encontrou diferença significativa entre o escore médio total nas amostras de qualidade de vida presumida mais alta (7,66) e mais baixa (5,32). O tempo médio para completar o índice Multicultural de Qualidade de Vida foi de menos de 4 minutos e foi relatado pela maioria dos indivíduos como facilmente aplicável. Foi também documentado um alto alfa de Cronbach (0,88). CONCLUSÕES: Os resultados relatam que o índice Multicultural de Qualidade de Vida é confiável, possui uma alta consistência interna, é capaz de discriminar grupos de diferentes níveis de qualidade de vida presumidos, é muito eficiente e é de fácil utilização.

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To deal effectively with the understanding, description and classification of mental morbid conditions, we must address the intricate concept of disease, illness or disorder in mental health. To do so, one needs to consider biological, psychological and social frameworks. These levels of analysis can offer avenues for greater understanding of the bases of illness as well as better ways of formulating its description and classification. Conceptual, epistemological and empirical data analyses are relevant and necessary. All these efforts should be aimed at serving and advancing the main purposes of classification and diagnosis, the chief encompassing one being enhancement of clinical care and public health. Although no definition of mental disorder may strictly embrace every condition of concern, some flexible definitional guidelines within a biopsychosocial framework may be helpful for advancing psychiatric nosology.

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Culturally competent diagnostic systems are necessary for an effective and ethical clinical practice, as cultural diversity of patients increase around the world. Latin American psychiatrists hold a long-standing commitment to this enterprise. Recently, two main Latin American adaptations to the international psychiatric classification have emerged: the Cuban Glossary of Psychiatry, and the project of the Latin American Guide for Psychiatric Diagnosis (GLADP). Keeping ICD-10 as the basis for nosological organization, GLADP is being developed with contributions by mental health professionals from Latin American countries. GLADP comprises 4 parts: (1) historical and cultural framework, (2) comprehensive diagnosis and formulation, (3) psychiatric nosology and (4) appendixes.

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La calidad de la atención en salud mental para los niños depende, no sólo de los servicios especializados de salud mental. Un factor adicional importante es la efectividad con que los proveedores de atención primaria de salud, por ejemplo, pediatras y maestros, identifican, tratan y refieren a niños con problemas emocionales y conductuales. Existe evidencia de que la utilización de instrumentos de tamizajede diversos problemas y/o niveles de difusión psicosocial incrementa la detección de tales problemas por parte del personal de atención primaria de salud. El presente estudio constituye la validación de la Escala de Salud del Niño, una escala para uso en atención primaria infantil, destinada a detectar casos psicosociales. Dicha escala ha sido desarrollada en Guatemala y esta basada en los criterios de diagnóstico y clasificación psiquiatricos interna-cionales. Empleando una muestra de 1820 sujetos pertenecientes a tres grupos poblacionales (psiquiátrico, pediátrico y escolar), la Escala de Salud del Niño permitió discriminar entre caso psicosocial y no caso. Los resultados de la validez de criterio, confiabilidad, sensibilidad y especificidad, sugieren que esta escala es un instrumento adecuado para la detección de casos psicosociales en atención primaria.

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La evaluación psiquiátrica inicial es de suma importancia para establecer programas de operación en los distintos niveles; asistenciales, docentes y de investigación. El presente artículo describe y propone los fundamentos, características y ventajas de una unidad de evaluación psiquiátrica inicial sobre la base de un afronte interdisciplinario en el Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi. Intenta, así, presentar alternativas de atención en países como el Perú, donde existen serias limitaciones en recursos humanos y materiales.

The psychiatric initial assessment is of great importance to design programs at different levels: mental health care, teaching and research. This paper describes and proposes the bases and advantages of a psychiatric interdisciplinary initial assessment unit in the National Institute of Mental health Honorio-Hideyo Noguchi. Such approach is in accordance with the scattered resources of a country like Peru.

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Los autores proponen el uso de un modelo sencillo y de utilidad práctica para el trabajo clínico del equipo de salud mental. Tal modelo permite: 1. Conceptualizar la normalidad y la anormalidad como el resultado del balance dinámico (no psicodinámico), entre las áreas sanas y enfermas de la personalidad en las que la normalidad y anormalidad absolutas serían utopías clínicas; 2. Facilitar el diagnóstico de tal balance tanto por medio de la evaluación de la psicopatología como de las potencialidad sanas del individuo; 3. Relevar que en psiquiatría, a diferencia de otras ramas de la medicina, el balance dinámico de la salud se puede lograr no sólo por la reducción de lo que constituye la enfermedad, sino, por el desarrollo y maduración de su contraparte, la salud; 4. Posibilitar el diseño de estrategias terapéuticas que faciliten no sólo la interacción sistematizada de diversas técnicas sino la participación de diferentes profesionales y aún de la familia, cumpliendo roles complementarios en el manejo del paciente en una verdadera tarea de equipo y favoreciendo la delegación de funciones: 5. Estimar integralmente el pronóstico. Sobre dicha base se proponen la evaluación sistemática de las áreas o potencialidades biopsicosociales sanas, terapéuticamente explotables, en los ejes del sistema diagnóstico multiaxial del DSM-III, lo que plantea la urgente necesidad de crear instrumentos y técnicas para tal finalidad.

The authors propose a simple theoretical model of normality useful for the mental health team's work. Such model allows: 1. To conceptualize normality and abnormality as the final result of the dynamic balance between health and unhealthy areas of the human being. In this sense, absolute normality or abnormality would be clinical utopias; 2. To make the diagnosis of such balance by systematic evaluation of as much of the subjectÆs psychopathology as of his healthy resources; 3. To emphasize that in mental health a healthy dynamic balance can be obtained either by reduction of what constitutes the unhealthy area or by the growing and maturation of his counterpart the healthy one; 4. To design the therapeutic strategy faciliting not only the integration of different therapeutic techniques but also the coordinated participation of the mental health tam members and even of the patientÆs family members allowing the correct delegation of therapeutic tasks; 5. To estimate a comprehensive prognosis of the case. Finally, the authors propose to systematically include the evaluation of the patientÆs biopsicosocial potentials in the multiaxial diagnosis claiming for the urgent need to develop better tools and techniques for that purpose.

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El artículo presenta un afronte semi-estructurado de evaluación psiquiátrica y el registro de la información clínica obtenida en un Formato de Evaluación Inicial. El objetivo de la traducción y adaptación del formato y el manual para su uso fue el ofrecer a los clínicos un instrumento que permita una evaluación comprehensiva del paciente y la correspondiente formulación diagnóstica multiaxial propuesta en el DSM-III. El procedimiento de la participación de consultores biling³es permitió una versión consensual final de la traducción así como el uso de la terminología más comprensible y familiar para los psiquiatras hispanos, con el significado semántico preciso de los síntomas psicopatológicos. El formato, además de su aplicabilidad, tiene ventajas para la investigación y docencia en psiquiatría (AU)

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El artículo presenta un afronte semi-estructurado de evaluación psiquiátrica y el registro de la información clínica obtenida en un Formato de Evaluación Inicial. El objetivo de la traducción y adaptación del formato y el manual para su uso fue el ofrecer a los clínicos un instrumento que permita una evaluación comprehensiva del paciente y la correspondiente formulación diagnóstica multiaxial propuesta en el DSM-III. El procedimiento de la participación de consultores bilingües permitió una versión consensual final de la traducción así como el uso de la terminología más comprensible y familiar para los psiquiatras hispanos, con el significado semántico preciso de los síntomas psicopatológicos. El formato, además de su aplicabilidad, tiene ventajas para la investigación y docencia en psiquiatría

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Luego de una introducción explicatoria acerca de la Naturaleza y los fundamentos del Formato de Evaluación Inicial (FEI), se procede a evaluar la aplicación del mismo en el primer bienio asistencial del INSM (1982-1984). De las variables estudiadas se desprende que el FEI es un instrumento útil y práctico para la descripción de la psicopatología y para la nosografía psiquiátrica y que la sección estructurada es un apoyo objetivo de importancia para complementar la parte narrativa. El tiempo promedio para el llenado del FEI es algo más de una hora (77.1 minutos), y los profesionales encuestados opinan mayoritariamente que la organización y claridad del instrumento son altas

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