The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in Sao Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special programfor victimized children in Sao Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth

Computational Tracking of Mental Health in Youth: Latin American Contributions to a Low-Cost and Effective Solution for Early Psychiatric Diagnosis

The early onset of mental disorders can lead to serious cognitive damage, and timely interventions are needed in order to prevent them. In patients of low socioeconomic status, as is common in Latin America, it can be hard to identify children at risk. Here, we briefly introduce the problem by reviewing the scarce epidemiological data from Latin America regarding the onset of mental disorders, and discussing the difficulties associated with early diagnosis. Then we present computational psychiatry, a new field to which we and other Latin American researchers have contributed methods particularly relevant for the quantitative investigation of psychopathologies manifested during childhood. We focus on new technologies that help to identify mental disease and provide prodromal evaluation, so as to promote early differential diagnosis and intervention. To conclude, we discuss the application of these methods to clinical and educational practice. A comprehensive and quantitative characterization of verbal behavior in children, from hospitals and laboratories to homes and schools, may lead to more effective pedagogical and medical intervention

MENTAL HEALTH AND CRIMINALITY AMONG PSYCHIATRIC OFFENDERS IN SOUTHEASTERN ONTARIO

OBJECTIVES: (1) Describe the population of mentally ill offenders over whom Ontario Review Board (ORB) held jurisdiction. (2) Assess the influences of psychopathology and criminal factors on criminal career. METHOD: This study was a retrospective case series design that reviewed all offenders who were court ordered for psychiatric evaluation at Mental Health Services Site of Providence Care in Kingston, Ontario from 1993 to 2007 (N=347). Eighty five subjects were found not criminally responsible on the account of mental disorder and were included in statistical analysis (n=85). Bivariate associations between five key variables and two outcome variables, seriousness of crime and recidivism, were examined. Logistic regressions were conducted to test the role of the predictor variables on the outcome variables. RESULTS: Age and change in principal psychiatric diagnosis over time were shown to be associated with seriousness of crime. Timing of psychiatric onset, early signs of deviance and change in diagnosis were shown to be associated with recidivism. On the whole, study population did not markedly vary in their distribution of variables by the outcome variables. Regression model included timing of psychiatric onset; psychiatric history; existence of criminal associate; child abuse history; and early signs of deviance. Recidivism was shown to be predicted by early signs of deviance (OR=8.154, p<0.05). Existence of criminal associates was shown to have substantial values of odds ratio at marginal significance (OR=7.577, p=0.13). CONCLUSION: Seriousness of crime is a complex factor that could not be sufficiently predicted by any one or combinations of study variables. Recidivism is better predicted by criminality factors than psychopathology. In the future, an exploratory analysis that more broadly examines the psychopathology and criminal factors in Canadian forensic population is needed. Findings from this study have important clinical and legal implications.

Psychiatric disorders and psychiatric consultation in a general hospital: A case- control study

Introduction: Psychiatric consultation (PC) has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH) inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence). Methods: A case-control patient study was conducted (47 cases and 94 controls) to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures), and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD- 10 criteria. The Self Report Questionnaire (SRQ), the CAGE and Brief Psychiatric Rating Scale (BPRS) were used as well as a specifically designed questionnaire to collect clinical and demographic data. Results: Behavioral alterations, either of elation or of depression, were the main for requesting a PC; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases), while anxiety, depressive and alcohol-related disorders were predominant in group II (controls). Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGE-positive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals). Discussion: The SRQ and CAGE were quite useful in the screening of possible patients and might be important for medical students to learn and use as generalists. Further research is needed to verify if and how the newly-established service will improve the diagnostic and treatment skills of our students.

Attacks on German public figures, 1968-2004: warning behaviors, potentially lethal and non-lethal acts, psychiatric status, and motivations

Fourteen non-terrorist attackers of public figures in Germany between 1968 and 2004 were intensively studied, with a particular focus on warning behaviors, attack behaviors, and the relationship between psychiatric diagnosis, symptoms, and motivations for the assault. A large proportion of the attackers were severely mentally ill, and most likely to be in the potentially lethal rather than the non-lethal group. A new typology of seven warning behaviors was applied to the data, and all were present, most frequently fixation and pathway warning behavior, and least frequently a direct threat. Psychiatric diagnosis could be closely linked to motivation when analyzed at the level of symptom and content of thought, often delusional. Most of the attacks were directed at political figures, and the majority occurred after 1995.

History of Maltreatment and Psychiatric Impairment in Children in Outpatient Psychiatric Treatment

There is increasing evidence that childhood victimization and attachment disruptions impact a child’s development. In this study, children and adolescents from an outpatient psychiatric clinic were assessed, measuring history of trauma, history of out-of-home placement, initial diagnoses, and CBCL internalizing and externalizing problem scores. Multiple regression analyses showed that both violent abuse trauma (physical/sexual abuse) and victim trauma (physical abuse/sexual abuse/witnessing domestic violence/witnessing community violence) are prevalent among patients with externalizing severity problems; concluding that diagnosis alone may not account for a history of victimization, but externalizing problem severity does. Overall, the study is consistent with past literature that it is important to acknowledge a child’s history of maltreatment and out-of-home placement when understanding their psychiatric development and diagnosis.

A known-groups evaluation of the Response Bias Scale in a neuropsychological setting

We evaluated the Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2) Response Bias Scale (RBS). Archival data from 83 individuals who were referred for neuropsychological assessment with no formal diagnosis (n = 10), following a known or suspected traumatic brain injury (n = 36), with a psychiatric diagnosis (n = 20), or with a history of both trauma and a psychiatric condition (n = 17) were retrieved. The criteria for malingered neurocognitive dysfunction (MNCD) were applied, and two groups of participants were formed: poor effort (n = 15) and genuine responders (n = 68). Consistent with previous studies, the difference in scores between groups was greatest for the RBS (d = 2.44), followed by two established MMPI-2 validity scales, F (d = 0.25) and K (d = 0.23), and strong significant correlations were found between RBS and F (rs = .48) and RBS and K (r = −.41). When MNCD group membership was predicted using logistic regression, the RBS failed to add incrementally to F. In a separate regression to predict group membership, K added significantly to the RBS. Receiver-operating curve analysis revealed a nonsignificant area under the curve statistic, and at the ideal cutoff in this sample of >12, specificity was moderate (.79), sensitivity was low (.47), and positive and negative predictive power values at a 13% base rate were .25 and .91, respectively. Although the results of this study require replication because of a number of limitations, this study has made an important first attempt to report RBS classification accuracy statistics for predicting poor effort at a range of base rates.

Os desafios da despatologização da transexualidade: reflexões sobre a assistência a transexuais no Brasil

Em 2008, a partir da Portaria 1707 do Ministério da Saúde, foi instituído no âmbito do Sistema Único de Saúde o Processo Transexualizador que estabeleceu as bases para a regulação do acesso de transexuais aos programas para realizar os procedimentos de transgenitalização. Esta Portaria, que tem como base o reconhecimento de que a orientação sexual e a identidade de gênero são determinantes da situação de saúde e que o mal-estar e sentimento de inadaptação por referência ao sexo anatômico do transexual devem ser abordados dentro da integralidade da atenção preconizada pelo SUS, significou avanços expressivos na legitimação da demanda de transexuais por redesignação sexual e facilitou o acesso dessa população à assistência de saúde. Embora a proposta da atenção a transexuais instituída no Brasil seja a de uma política de saúde integral que ultrapassa a questão cirúrgica e considera fatores psicossociais desta experiência, é possível observar que a mesma está baseada em um modelo biomédico que considera a transexualidade um transtorno mental cujo diagnóstico é condição de acesso ao cuidado e o tratamento está orientado para a realização da cirurgia de redesignação sexual. Nesse sentido, apenas os sujeitos que se enquadram na categoria nosológica de Transtorno de Identidade de Gênero e, consequentemente, expressam o desejo de adequar seu corpo ao gênero com o qual se identificam por meio de modificações corporais têm seu direito à assistência médica garantido. Diante disso, considerando que no Brasil a atenção a transexuais está absolutamente condicionada a um diagnóstico psiquiátrico que, ao mesmo tempo em que legitima a demanda por redesignação sexual e viabiliza o acesso a cuidados de saúde é um vetor de patologização e de estigma que restringe o direito à atenção médica e limita a autonomia, o presente estudo pretende discutir os desafios da despatologização da transexualidade para a gestão de políticas públicas para a população transexual no país. A partir de uma pesquisa sobre as questões históricas, políticas e sociais que definiram a transexualidade como um transtorno mental e dos processos que associaram a regulamentação do acesso aos serviços de saúde ao diagnóstico de transexualismo, espera-se problematizar o atual modelo de assistência a pessoas trans e construir novas perspectivas para a construção de políticas inclusivas e abrangentes que garantam o direito a saúde e o exercício da autonomia para pessoas trans.

DSMs e depressão: dos sujeitos singulares aos transtornos universais

Este estudo tenciona discutir o problema da conceituação das doenças mentais, a partir dos DSMs e dos diferentes paradigmas que os embasaram. O DSM (manual estatístico e diagnóstico de transtornos mentais) é um manual, de influência internacional, para profissionais da saúde mental, que lista diferentes categorias de transtornos mentais, de acordo com a Associação Psiquiátrica Norte-Americana. Desde a sua primeira publicação, em 1952, já foi submetido a cinco revisões (DSM II, DSM III, DSM III-R, DSM IV e DSM IVTR). Escolhemos a categoria diagnóstica da depressão, objetivando realizar um rastreamento conceitual, desde o DSM II - modelo até então marcado pela psicanálise, depois ressaltando o DSM III, que, em 1980, promove uma mudança de paradigma no conhecimento psiquiátrico, ao apresentar um modelo que se propõe descritivo e ateórico até o DSM IV-TR. Dessa perspectiva, são assinaladas algumas considerações e pontos de discussão entre a chamada psiquiatria biológica e a psicanálise, no que diz respeito às suas respectivas influências na forma de entender o diagnóstico psiquiátrico, enfatizando a categoria diagnóstica da depressão.

A emergência da categoria da transexualidade na interseção com as técnicas biomédicas.

Refletindo sobre a emergência da categoria da transexualidade como a conhecemos na atualidade e seus desdobramentos sociais, políticos e subjetivos, especialmente a partir da segunda metade do século XX, procuramos nessa dissertação discutir o contexto que possibilitou o fenômeno da medicalização tecnológica dessa categoria. Ao desenvolvê-lo, essa pesquisa aponta atores da categoria médica e da militância que compuseram uma relação de negociação entre a demanda do indivíduo transexual e as possibilidades técnicas, legais e discursivas da biomedicina. Inicialmente, buscamos compreender como os profissionais médicos, psiquiatras e psicanalistas, pertencentes à ciência da sexologia a partir do fim do século XIX, incluíram em seus discursos e práticas os comportamentos sexuais considerados desviantes na época. O homossexualismo e o travestismo, representantes dessas perversões, constituíram categorias diagnósticas e identitárias de fundamental importância para a inauguração da transexualidade enquanto categoria nosológica médico-psiquiátrica e enquanto tipo humano, ou seja, uma forma subjetiva de experiência e identidade de gênero. Diante disso, e considerando o contexto sociocultural e o desenvolvimento biotecnológico hormonal e cirúrgico na época, temos a hipótese que a criação dessa categoria só foi possível devido à incorporação em indivíduos transexuais de procedimentos tecnocientíficos que possibilitaram que suas transformações anatomobiológicas construíssem o gênero desejado. A medicalização da transexualidade e sua regulação médico-jurídica, ao mesmo tempo em que são vetores de patologização e de estigma, possibilitaram o acesso à essas transformações corporais. Essa pesquisa problematiza o acesso à essas tecnologias, condicionado à obtenção do diagnóstico psiquiátrico, e aborda a relação interativa entre os aspectos discursivos e práticos da categoria médica e dos indivíduos transexuais e militância, assim como seus efeitos que iluminam essa questão. Finalmente, com o objetivo de ilustrar e compreender a interação entre a tecnologia e o corpo transexual, descrevemos e discutimos brevemente os principais procedimentos aplicados em homens transexuais e mulheres transexuais na transição de gênero.

Issues in the prescribing of psychotropic and psychoactive medication for persons with learning disability: quantitative and qualitative perspectives

The administration of psychotropic and psychoactive medication for persons with learning disability and accompanying mental illness and/or challenging behaviour has undergone much critical review over the past two decades. Assessment and diagnosis of mental illness in this population continues to be psychopharmacological treatment include polypharmacy, irrational prescription procedures and frequent over-prescription. It is clear that all forms of treatment including non-pharmacological interventions need to be driven by accurate and appropriate diagnoses. Where a psychiatric diagnosis has been identified, it greatly aides the selection of appropriate medication, although a specific medication for each diagnosis, as was once hoped, is simply no longer a reality in practice. Part one of the present thesis seeks to address many of the current issues in mental health problems and pharmacological treatment to date. The author undertook a drug prevalence study within both residential and community facilities for persons with learning disability within the Mid-West region of Ireland in order to ascertain the current level of prescribing of psychotropic and psychoactive medications for this population. While many attempts have been made to account for the variation in prescribing, little systematic and empirical research has been undertaken to investigate the factors thought to influence such prescribing. While studies investigating the prescribing behaviours of General Practitioners (GP's) have illustrated the complex nature of the decision making process in the context of general practice, no similar efforts have yet been directed at examining the prescribing behaviours of Consultant Psychiatrists. Using The Critical Incident Technique, the author interviewed Consultant Psychiatrists in the Republic of Ireland to gather information relating not only to their patterns of prescribing for learning disabled populations, but also to examine reasons influencing their prescribing in addition to several related factors. Part two of this thesis presents the findings from this study and a number of issues are raised, not only in relation to attempting to account for the findings from part one of the thesis, but also with respect to implications for improved management and clinical practice.

Mental Health and Substance Use Among Patients in a North Carolina HIV Clinic.

BACKGROUND: The HIV/AIDS epidemic is a significant public health concern in North Carolina, and previous research has pointed to elevated mental health distress and substance use among HIV-infected populations, which may impact patients' adherence to medications. The aims of this study were to describe the prevalence of mental health and substance use issues among patients of a North Carolina HIV clinic, to examine differences by demographic characteristics, and to examine factors associated with suboptimal adherence to HIV medications. METHODS: This study was a secondary analysis of clinical data routinely collected through a health behavior questionnaire at a large HIV clinic in North Carolina. We analyzed data collected from February 2011 to August 2012. RESULTS: The sample included 1,398 patients. Overall, 12.2% of patients endorsed current symptomology indicative of moderate or severe levels of depression, and 38.6% reported receiving a psychiatric diagnosis at some point in their life. Additionally, 19.1% had indications of current problematic drinking, and 8.2% reported problematic drug use. Nearly one-quarter (22.1%) reported suboptimal adherence to HIV medications. Factors associated with poor adherence included racial/ethnic minority, age less than 35 years, and indications of moderate or severe depression. LIMITATIONS: The questionnaire was not completed systematically in the clinic, which may limit generalizability, and self-reported measures may have introduced social desirability bias. CONCLUSION: Patients were willing to disclose mental health distress, substance use, and suboptimal medication adherence to providers, which highlights the importance of routinely assessing these behaviors during clinic visits. Our findings suggest that treating depression may be an effective strategy to improve adherence to HIV medications.

Estigma e percepções dos médicos de Clínica Geral sobre a doença mental e o suicídio

RESUMO: INTRODUÇÃO: A OMS (2001) revela que cerca de 450 milhões de pessoas sofrem de perturbações mentais ou comportamentais em todo o mundo, mas apenas uma pequena minoria tem tratamento, ainda que elementar. Transformam-se em vítimas por causa da sua doença e convertem-se em alvos de estigma e discriminação. O suicídio é considerado como um grande problema de saúde pública em todo o mundo, é uma das principais causas de morte de jovens adultos e situa-se entre as três maiores causas de morte na população entre 15-34 anos (OMS, 2001). As perturbações mentais aumentam o risco de suicídio. A depressão, esquizofrenia, e a utilização de substâncias incrementam o risco de suicídio. Estudos (Sartorius, 2002; Magliano et al., 2012) mostram que os profissionais de saúde, tal como o público em geral, podem ter atitudes negativas e estigma em relação às pessoas com perturbações mentais, podendo agir em conformidade, uma vez feito e conhecido o diagnóstico psiquiátrico. Os clínicos gerais são os receptores das perturbações mentais e tentativas de suicídio nas principais portas de entrada no acesso a cuidados de saúde. As crenças, conhecimentos e contacto com a doença mental e o suicídio, podem influenciar a atenção clínica. OBJECTIVOS: Avaliar o estigma e as percepções dos médicos de clínica geral em relação às tentativas de suicídio, o suicídio e perturbações mentais bem como os possíveis factores associados a estes fenómenos. MATERIAIS E MÉTODOS: Estudo do tipo transversal, combinando métodos quantitativos e qualitativos. A amostra é constituída por 125 sujeitos, médicos de clínica geral. Utilizaram-se as versões adaptadas dos seguintes instrumentos: Questionário sobre Percepções e Estigma em Relação à Saúde Mental e ao Suicídio (Liz Macmin e SOQ, Domino, 2005) e a Escala de Atitudes sobre a Doença Mental (Amanha Hahn, 2002). Para o tratamento estatístico dos dados usou-se a estatística 1) descritiva e 2) Análise estatística das hipóteses formuladas (Qui Quadrado - 2) a correlação entre variáveis (Spearman: ρ, rho). Os dados conectados foram limpos de inconsistências com base no pacote informático e estatístico SPSS versão 20. Para a aferição da consistência interna foi usado o teste de Alfa de Cronbach. RESULTADOS: Uma boa parte da amostra (46.4%) refere que não teve formação formal ou informal em saúde mental e (69.35%) rejeitam a ideia de que “grupos profissionais como médicos, dentistas e psicólogos são mais susceptíveis a cometer o suicídio”. Já (28.0%) têm uma perspectiva pessimista quanto a possibilidade de recuperação total dos sujeitos com perturbação mental. Sessenta e oito(54.4%) associa sujeitos com perturbação mental, a comportamentos estranhos e imprevisíveis, 115 (92.0%) a um baixo QI e 35 (26.7%) a poderem ser violentas e e perigosas. Os dados mostram uma associação estatisticamente significativa (p0.001) entre as variáveis: tempo de serviço no SNS, recear estar perto de sujeitos com doença mental e achar que os sujeitos com doença mental são mais perigosos que outros. Em termos estatísticos, existe uma associação estatitisticamente significativa entre as duas variáveis(X2=9,522; p0.05): percepção de que “é vergonhoso ter uma doença mental” e os conhecimentos em relação à doença mental. Existe uma correlação positiva, fraca e estatisticamente significativa entre os conhecimentos dos clínicos gerais(beneficiar-se de formação em saúde mental) e a percepção sobre os factores de risco (0,187; P0,039). DISCUSSÃO E CONCLUSÕES: A falta de conhecimento sobre as causas e factores de risco para os comportamentos suicidários, opções de intervenção e tratamento, particularmente no âmbito da doença mental, podem limitar a procura de ajuda individual ou dos próximos. Percepções negativas como o facto de não merecerem prioridade nos serviços, mitos (frágeis e cobarde, sempre impulsivo, chamadas de atenção, problemas espirituais) podem constituir-se como um indicador de que os clínicos gerais podem sofrer do mesmo sistema de estigma e crenças, de que sofre o público em geral, podendo agir em conformidade (atitudes de afastamento ereceio). As atitudes são influenciadas por factores como a formação, cultura e sistema de crenças. Sujeitos com boa formação na área da saúde mental têm uma percepção positiva e optimista sobre os factores de risco e uma atitude positiva em relação aos sujeitos com doença mental e comportamentos suicidários.-------------ABSTRACT: INTRODUCTION: The WHO (2001) reveals that about 450 million people suffer from mental or behavioral disorders worldwide, but only a small minority have access to treatment, though elementary. They become victims because of their disease and they become the targets of stigma and discrimination. Suicide is seen as a major public health problem worldwide, is a leading cause of death for young adults and is included among the three major causes of death in the population aged 15-34 years (WHO, 2001). Mental disorders increase the risk of suicide. Depression, schizophrenia, and the substances misuse increase the risk of suicide. Studies (Sartorius, 2002; Magliano et al, 2012) show that health professionals, such as the general public, may have negative attitudes and stigma towards people with mental disorders, and can act accordingly after psychiatric diagnosis is known. General practitioners are the main entry points of mental disorders and suicide attempts in the health sistem. Beliefs, knowledge and contact with mental illness and suicide, may influence clinical care. OBJECTIVES: To assess stigma and perceptions of general practitioners in relation to suicide attempts, suicide and mental disorders as well as possible factors associated with these phenomena. MATERIAL AND METHODS: This was a descriptive cross-sectional study, combining quantitative and qualitative methods. The sample consisted of 125 subjects, general practitioners. We used adapted versions of the following instruments: Questionnaire of Perceptions and Stigma in Relation to Mental Health and Suicide (Liz Macmin and SOQ, Domino, 2005) and the Scale of Attitudes on Mental Illness (Tomorrow Hahn, 2002). For the statistical treatment of the data we used: 1) descriptive (Data distribution by absolute and relative frequencies for each of the variables under study (including mean and standard deviation measures of central tendency and deviation), 2) statistical analysis of hypotheses using (Chi Square - 2, a hypothesis test that is intended to find a value of dispersion for two nominal variables, evaluating the association between qualitative variables) and the correlation between variables (Spearman ρ, rho), a measure of non-parametric correlation, which evaluates an arbitrary monotonic function can be the description of the relationship between two variables, without making any assumptions about the frequency distribution of the variables). For statistical analysis of the correlations were eliminated subjects who did not respond to questions. The collected data were cleaned for inconsistencies based on computer and statistical package SPSS version 20. To measure the internal consistency was used the Cronbach's alpha test. RESULTS: A significant part of the sample 64 (46.4%) reported no formal or informal training in mental health and 86 (69.35%) reject the idea that "professional groups such as doctors, dentists and psychologists are more likely to commit suicide." On the other hand, 42 (28.0%) have a pessimistic view of the possibility of full recovery of individuals with mental disorder. Sixty-eight ( 54.4 % ) of them associates subjects with mental disorder to strange and unpredictable behavior, 115 ( 92.0 % ), to low IQ, 35 ( 26.7 % ) and even to violent and dangerous behavior, 78 ( 62.4 % ) The data show a statistically significant (p = 0.001) relationship between the following variables: length of service in the NHS, fear of being close to individuals with mental illness and considering individuals with mental illness more dangerous than others. In statistical terms, there is a dependency between the two variables (X2 = 9.522, p> 0.05): the perception that "it is shameful to have a mental illness" and knowledge regarding mental illness. There is a positive and statistically significant weak correlation between knowledge of general practitioners (benefit from mental health training) and the perception of the risk factors (0,187; P0,039). DISCUSSION AND CONCLUSIONS: The lack of knowledge about the causes and risk factors for suicidal behavior, intervention and treatment, particularly in the context of mental illness options, may decreaseseeking for help by individual and their relatives. Negative perceptions such as considering that they dont deserve priority in services, myths (weak and cowards, always impulsive, seeking for attentions, spirituals problems) may indicate that general practitioners, may suffer the same stigma and beliefs systems as the general public, and can act accordingly (withdrawal and fear attitudes). Attitudes are influenced by factors such as education, culture and belief system. Subjects with good training in mental health have a positive and optimistic perception of the risk factors and a positiveattitude towards individuals with mental illness and suicidal behaviour.