Vertex Revista Argentina de Psiquiatría

Unshrunk. How the mental health industry took over my life - and my fight to get it back

Comité de Redacción — 2025-10-10

Book review: Unshrunk. How the mental health industry took over my life - and my fight to get it back, by Laura Delano. Penguin Random House, 2025.

Editorial

Juan Carlos Stagnaro — 2025-10-10

Indice

Comité de Redacción — 2025-10-10

Aburrimiento, un constructo multifacético

Pamela S. Sacco — 2025-10-10

Carta de la lectora: Pamela S. Sacco, Medica Neuróloga.

Correspondencia: pame_sacco@hotmail.com

Some epistemology issues related to phrenology

Oscar A. Porta — 2025-10-10

Contemporary neuroscience is nourished by the contribution of the localizationist hypothesis of phrenology (circa 1800). However, the consideration of the brain as an organ of the mind in the West has its roots in times as old as the times of Hippocrates and Herophilus. This idea resurfaces in the modern medical tradition in the figures of Thomas Sydenham, Thomas Willis, Herman Boerhaave and William Cullen, just to name the most notable, who considered the cerebral origin of behavior and madness. The specific hypothesis of phrenology is based on the premise that the brain is made up of a series of suborgans responsible for different psychological faculties or innate human qualities (such as amativity and benevolence) that as they were more present in that individual produced a protrusion in the skull that allowed a scientific analysis of these characteristics through palpation. Spurzheim was publicly ridiculed at a meeting when he was asked to analyse the skull of the famous physicist Pierre Laplace and having given him instead that of a mentally deficient man was denied. The aim of this paper is to analyze the epistemological edges of phrenology, and more specifically its characterization as a science or pseudoscience, according to the important traditions of the twen-tieth century: falsificationism (in its classical and sophisticated versions) and consensualism.Keywords: phrenology, espistemology, falsificationism, consensualism

Anxiety and depressive symptoms in adults with subjective cognitive complaints: impact of the COVID-19 Pandemic

Waleska Berrios — 2025-10-10

Introduction: Subjective cognitive complaints (SCC) refer to the perception of cognitive alterations in individuals with normal performance on neuropsychological tests. SCC are associated with an increased risk of cognitive decline, dementia, and neuropsychiatric symptoms, such as anxiety and depression. The COVID-19 pandemic has worsened global mental health, elevating rates of anxiety and depression. This study aims to report the prevalence of neuropsychiatric symptoms in individuals with SCC, particularly anxiety and depression, and to compare these symptoms between the pre-pandemic and pandemic periods. Methods: A cross-sectional study was conducted on 136 neuropsychological reports of adults with SCC evaluated between June 2018 and December 2022. Depressive symptoms were assessed using the Beck Depression Inventory-II or the Geriatric Depression Scale-15, while anxious symptoms were assessed with the Beck Anxiety Inventory. For cases with an informant, the Neuropsychiatric Inventory was employed. Results: Among participants, 52.2 % presented with anxiety symptoms and 30.9 % with depressive symptoms, based on self- administered questionnaires. Anxiety symptoms were significantly more prevalent and severe during the pandemic compared to the pre-pandemic period. In the 59 cases evaluated with the Neuropsychiatric Inventory, depressive symptoms were the most frequent, followed by irritability and anxiety. Conclusions: Anxiety and depressive symptoms are common in individuals with SCC, with a marked increase in anxiety during the pandemic. These findings underscore the importance of comprehensively evaluating neuropsychiatric symptoms in this population to mitigate their present and future impact.

Presby-sleep: analysis of some sleep parameters in elderly patients

Stella Maris Valiensi — 2025-10-10

Introduction: Subjective cognitive complaints (SCC) refer to the perception of cognitive alterations in individuals with normal performance on neuropsychological tests. SCC are associated with an increased risk of cognitive decline, dementia, and neuropsychiatric symptoms, such as anxiety and depression. The COVID-19 pandemic has worsened global mental health, elevating rates of anxiety and depression. This study aims to report the prevalence of neuropsychiatric symptoms in individuals with SCC, particularly anxiety and depression, and to compare these symptoms between the pre-pandemic and pandemic periods. Methods: A cross-sectional study was conducted on 136 neuropsychological reports of adults with SCC evaluated between June 2018 and December 2022. Depressive symptoms were assessed using the Beck Depression Inventory-II or the Geriatric Depression Scale- 5, while anxious symptoms were assessed with the Beck Anxiety Inventory. For cases with an informant, the Neuropsychiatric Inventory was employed. Results: Among participants, 52.2 % presented with anxiety symptoms and 30.9 % with depressive symptoms, based on self- administered questionnaires. Anxiety symptoms were significantly more prevalent and severe during the pandemic compared to the pre-pandemic period. In the 59 cases evaluated with the Neuropsychiatric Inventory, depressive symptoms were the most frequent, followed by irritability and anxiety. Conclusions: Anxiety and depressive symptoms are common in individuals with SCC, with a marked increase in anxiety during the pandemic. These findings underscore the importance of comprehensively evaluating neuropsychiatric symptoms in this population to mitigate their present and future impact.

Association between residence at high altitude and the incidence of depressive episodes in Ecuador

Kevin R. Espinosa-Yépez — 2025-10-10

Introduction: Depression is the main mental disorder in Latin America. Its etiology is multifactorial, encompassing genetic, sociodemographic, cultural and even environmental factors. Some studies have shown that living in high altitude regions may be related to depression. Therefore, this study aims to determine the correlation between altitude and the incidence of depressive episodes in Ecuador. Materials and methods: Cross-sectional analytical study of hospital discharge databases in Ecuador from 2018 to 2022. Relative risk and Pearson correlation were estimated and linear regression was performed to evaluate association. Results: 6460 depressive episodes were observed in the 5 years of the study. The provinces located at high altitude (≥1500 m.a.s.l.) had the highest cumulative incidences per 100,000 inhabitants. These provinces are Tungurahua (81.4), Pichincha (68.8), Chimborazo (63.8), Imbabura (55.8) and Bolívar (51.1), respectively. The relative risk of residence at high altitude was RR=2.67 (95 % CI=2.54 - 2.81, p < 0.001), while the results of the linear regression between cumulative incidence per 100,000 and altitude were r=0.78, r2=0.61 and in the independent variable (altitude) t=5.84, p < 0.001. Conclusion: A positive correlation was found between high-altitude residence and the incidence of depressive episodes, but due to the limitations of this research, further studies are required to corroborate this association, since the results may be influenced by other factors that were not considered.

Cancer-related neuropsychiatric disorders

Juan Manuel Duarte — 2025-10-10

Essential cognitive function may be impaired in cancer patients before the initiation of chemotherapy. Cancer decreases cognitive and biological reserves, resulting in accelerated aging. Prefrontal lobe dysfunction is most commonly encountered owing to various mechanisms. Systemic inflammation causes the release of pro-inflammatory cytokines in the brain, with consequent neurotoxic effects on the Kynurenine pathway, local chronic inflammation, and hypothalamus-pituitary-adrenal dysregulation. Exosomes also play a significant role, as genetic and epigenetic changes exert different effects on oxidative stress proteins. Melatonin dysregulation may contribute in cognitive dysfunctions. Neuropsychological impairment has been demonstrated through various neurophysiological (event-related potentials) and neuroimaging (structural and functional MRI) studies. Paraneoplastic syndromes of the central nervous system have been considered, and specific onconeural antibodies may characterize distinctive central nervous system dysfunction patterns. Treatment of tumor-brain is based mainly on non-pharmacological approaches, such as physical activity, cognitive-behavioral therapy, and the mindfulness approach. Some researchers have recommended the prophylactic use of escitalopram in
patients with head and neck cancer without depression.

Developing an Operational Definition for Delayed Discharges in Mental Health Hospitalizations at General Hospitals

Natalia Delmonte — 2025-10-10

Introduction: Prolonged hospitalizations are a challenge for health systems. This paper discusses prolonged hospitalizations in general hospitals, considering the significance of hospitalization in these services within the framework of psychiatric reform processes. The first aspect of the discussion is to clarify the operational definition of prolonged hospitalizations. Methods: A document review was conducted, including scientific articles and technical documents. The analysis examined the terms used to refer to prolonged hospitalizations and sought to identify whether a specific time frame was specified in such definitions. Results: The results were organized into two categories of definitions: one focused on the temporal dimension and the other on the dimension of care organization. Conclusion: The paper proposes using the term "delayed discharge" and establishing a duration of 30 days to account for excess hospitalization days

Did the DSM ever include Asperger’s autism? Towards a rereading "Asperger syndrome"

Kevin Rebecchi — 2025-10-10

This article critically examines Hans Asperger’s legacy in relation to contemporary autism diagnostics. While “Asperger’s syndrome” is widely discussed, few have engaged with Asperger’s original work or the broader historical literature, including Grunia Sukhareva, Leo Kanner, George Frankl, and Lorna Wing. The paper reviews Asperger’s contributions (1938–1980) to clarify his view of autism as a distinct neurotype with specific strengths and challenges. It then contrasts this with Wing’s reinterpretation, particularly her 1979 study and 1981 introduction of “Asperger’s syndrome,” which emphasized social and communication deficits and blurred lines between
autism and intellectual disability. The article concludes with an analysis of the removal of Asperger’s syndrome from the DSM-V, arguing that the DSM-IV construct reflected Wing’s adaptation, not Asperger’s writings. This change is situated within a broader shift toward cognitive diversity and depathologization, suggesting that debates over the syndrome’s existence are more complex than often assumed.

Religion and Mental Health in the LGBTQ+ community: a review

Valentina Belalcazar Vivas — 2025-10-10

Throughout history, members of the LGBTQ+ community have been victims of stigma and discrimination due to their sexual orientation, gender identity, and expression differing from societal norms. Much of this exclusion has been driven by religion, which often uses biblical references to condemn diversity. This systematic rejection has led to mistreatment of these individuals by healthcare systems and has posed significant barriers to access. Despite this, a substantial percentage of this population is, either voluntarily or involuntarily, affiliated with religious groups. This review article aims to understand and synthesize existing literature on the complex relationship between religion and the mental health of the LGBTQ+ community. A narrative synthesis was performed. Although some religions have made progress towards acceptance, which can positively impact the mental health of this minority, the majority still maintain a stance of rejection and disapproval. This discrimination has been associated with higher rates of internalized stigma, poorer quality of life, increased depression, anxiety, suicide, substance abuse, and participation in risky sexual activities with multiple partners, which puts this population at risk for other adverse health events, such as contracting HIV. It’s essential for medical schools to train their students and residents in holistic approaches that encompass religiosity and spirituality. Further research is needed within this minority in diverse contexts to understand how to address these issues and improve health care outcomes.

First Argentine Consensus Statement on the Management of Schizophrenia. Section I: Introduction and General Concepts

Alejo Corrales — 2025-10-10

The accumulated body of knowledge in the field of schizophrenia is vast yet often complex, fragmented, and, in some cases, inconsistent with certain practices that have been inadvertently perpetuated in psychiatric training over recent decades. In response to this gap, the Argentine Association of Biological Psychiatry (AAPB) initiated the development of the First Argentine Consensus on the Management of Schizophrenia, prepared by a multidisciplinary panel of national experts in the field. This article presents the first section of the consensus, which outlines the working methodology employed and reviews the current definition of schizophrenia, incorporating diagnostic criteria from both the DSM-5 and ICD-11. It also addresses the major unmet clinical needs in schizophrenia, summarizes recent neurobiological findings, and examines the environmental and psychosocial factors implicated in the onset and course of the disorder. Finally, the section emphasizes the importance of prevention and early intervention, highlighting the need for updated, evidence-based, and contextually adapted practices within the Argentine mental health system.

Is it time to abandon the utopia of a world without suicides?

Pablo Richly — 2025-10-10

This analysis critically examines the Zero Suicide initiative, exploring its foundations, limitations, and challenges in suicide prediction and prevention. It discusses the complexities of suicidal behavior, including the prevalence of fatal first attempts and the impulsive nature of many suicidal acts. The study evaluates the limitations of current risk assessment tools and presents the recommendations of the NICE guidelines, which advocate for an approach focused on individual needs rather than risk stratification. It concludes by proposing a paradigm shift towards a more realistic and holistic risk management in suicide prevention.