Determinants of mental and physical health-related quality of life among patients hospitalized for suicidal behavior

The current study was interested in exploring the clinical factors related to mental and physical health-related quality of life among patients hospitalized for suicidal behavior. A multicenter cross-sectional study was designed to compare data obtained form 246 patients hospitalized for suicide behavior. Results suggest that mental health-related quality of life was negatively associated with hopelessness while physical health-related quality of life was negatively associated with age, medical disease and the number of previous suicide attempts and positively associated with employment. Findings are discussed in the context of theoretical evidence and clinical implications.Fil: Grendas, Leandro Nicolás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital Dr. Braulio A. Moyano; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital Dr. Braulio A. Moyano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rojas, Sasha. University of Arkansas for Medical Sciences; Estados UnidosFil: Puppo, Soledad. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Vidjen, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal ; ArgentinaFil: Lado, Gisela. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal ; ArgentinaFil: Portela, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal ; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Patients hospitalized for suicidal ideation and suicide attempt in a mental health hospital: clinico-demographical features and 6-month follow-up

Introducción: El suicidio es un problema de alto impacto para la salud pública. En la Argentina son pocos los estudios publicados sobre suicidio e intento de suicidio. Objetivo: Determinar el porcentaje de internaciones motivadas por intento o ideación suicida en un Hospital de Salud Mental de la Ciudad de Buenos Aires, describir las características clínico-demográficas de estas pacientes y analizar la frecuencia de eventos desfavorables en el seguimiento a 6 meses. Métodos: En el presente estudio se emplean los datos basales y de seguimiento de un estudio analítico, observacional, de cohorte prospectivo. Resultados: Los datos basales muestran que de la totalidad de pacientes que ingresaron al Servicio de Guardia, el 27% lo hizo por ideación o intento de suicidio. Los diagnósticos más frecuentes fueron: trastorno límite de la personalidad (41%), trastorno depresivo mayor (38%), trastorno bipolar (20%) y esquizofrenia (16%). El método utilizado con más frecuencia en el intento de suicidio fue la sobreingesta medicamentosa. En la mitad de las pacientes, el proceso suicida se desarrolló en menos de 10 minutos. Los datos del seguimiento muestran que el 22% de las pacientes presentó un nuevo intento de suicidio y el 34% tuvo una reinternación a 6 meses. Conclusiones: En conjunto, estos resultados describen las características de las pacientes suicidas asistidas en un Hospital de Salud Mental, muestran la baja eficacia de las intervenciones y plantean la necesidad de diseñar nuevas estrategias para el manejo de las mismas.Background: Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. Objective: To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. Methods: In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. Results: Baseline data show that of all patients who entered the Emergency Department, 27% did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41%), major depressive disorder (38%), bipolar disorder (20%) and schizophrenia (16%). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22% of patients had a new attempted suicide and 34% had a readmission in a 6-month period. Conclusions: Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.Fil: Teti, Germán Leandro. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Rebok, Federico. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Grendas, Leandro Nicolás. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Fógola, Agustina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; Argentin

A randomized 3-month, parallel-group, controlled trial of CALMA m-health app as an adjunct to therapy to reduce suicidal and non-suicidal self-injurious behaviors in adolescents: study protocol

BackgroundSuicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth.MethodsTo test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period.DiscussionThis study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America.Clinical trial registrationhttps://clinicaltrials.gov/, NCT05453370

A randomized 3-month, parallel-group, controlled trial of CALMA m-health app as an adjunct to therapy to reduce suicidal and non-suicidal self-injurious behaviors in adolescents: study protocol

Background: Suicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth. Methods: To test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period. Discussion: This study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America.Fil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Chiapella, Luciana Carla. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; ArgentinaFil: Olivera Fedi, Ramiro. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Papavero, Eliana Belen. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Lavoie, Kim L.. Université du Québec a Montreal; CanadáFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Differential Impact of Child Sexual Abuse and Family History of Suicidal Behavior in High-Risk Suicidal Patients

The current study aimed to compare suicide-related variables as a function of 1) family history of suicidal behavior and 2) child sexual abuse among patients hospitalized for a suicide attempt or active suicidal ideation. Family history of suicidal behavior and child sexual abuse were examined independently and in combination as a diathesis for a high-risk suicidal phenotype. A multicenter cross-sectional study was designed to compare data obtained from 292 patients hospitalized for suicidal behavior. Demographic and clinical variables were compared among Group 1 (patients who reported both family history of suicidal behavior and child sexual abuse), Group 2 (patients who reported only family history of suicidal behavior), Group 3 (patients who reported only child sexual abuse), and Group 4 (patients who did not report family history of suicidal behavior or childhood sexual abuse). A multinomial logistic regression was used to examine suicide-related variables associated with each group and to compare differences between groups. Group 1 and 3 endorsed a higher number of previous suicide attempts and were more likely to be younger at the first suicide attempt compared to Group 4. Group differences remained after adjustment in a multinomial regression model. The current findings suggest that child sexual abuse may be more strongly related to suicide risk among high risk patients than family history of suicidal behavior.Fil: Grendas, Leandro. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Rojas, Sasha M.. University of Arkansas for Medical Sciences; Estados UnidosFil: Rodante, Demián E.. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital Neuropsiquiatrico Braulio Aurelio Moyano.; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Puppo, Soledad. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Vidjen, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Portela, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital Neuropsiquiatrico Braulio Aurelio Moyano.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

Differences between female suicidal patients with family history of suicide attempt and family history of completed suicide

Background: Family history of suicidal behavior and suicide are both risk factors for suicide. However, the effects of family history of suicide versus suicide attempts on patient suicidal behavior remain unclear. The aim of the present study was to understand if family history of suicide as compared to family history of suicide attempts or no family history of suicidal behavior evidences different associations with suicidal behavior among psychiatric patients. Method: Participants included 157 female patients between the ages of 18 and 65 years admitted at the Dr. Braulio A. Moyano Neuropsychiatric Women's Hospital. Results: Seventy-nine patients (50.3%) reported no family history of suicidal behavior (NFHSB), while 78 patients (49.7%) reported a family history of suicidal behavior. Specifically, 41 patients (26.1%) reported a family history of suicide attempt (FHSA) and 37 patients (23.6%) reported a family history of suicide (FHS). These groups showed significant differences between family history of psychopathology and number of previous suicide attempts. Patients with an FHSA were more likely to present with a greater number of previous suicide attempts as compared to patients with NFHSB and FHS. Conclusion: There is an association between the number of suicide attempts and family history of suicide attempts in female patients hospitalized for suicidal behavior.Fil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Rojas, S. M.. University of Arkansas; Estados UnidosFil: Feldner, M. T.. University of Arkansas; Estados Unidos. Laureate Institute for Brain Research; Estados UnidosFil: Dutton, C.. University of Arkansas; Estados UnidosFil: Rebok, Federico. Ciudad Autónoma de Buenos Aires. Hospital Neuropsiquiátrico “Dr. Braulio A. Moyano”; ArgentinaFil: Teti, Germán Leandro. Ciudad Autónoma de Buenos Aires. Hospital Neuropsiquiátrico “Dr. Braulio A. Moyano”; ArgentinaFil: Grendas, Leandro Nicolás. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Fógola, Agustina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile

Background: Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context. Methods: A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as “essential” or “important” from both panels. Results: Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts’ reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs. Conclusions: A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.Fil: Encina Zúñiga, Esteban. Universidad de Chile; ChileFil: Rodante, Demián. Universidad de Buenos Aires; ArgentinaFil: Agrest, Martín. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Tapia Muñoz, Thamara. University College London; Estados UnidosFil: Vidal Zamora, Isidora. Universidad de Chile.; ChileFil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; ArgentinaFil: Alvarado, Rubén. Universidad de Chile.; ChileFil: Leiderman, Eduardo A.. Universidad de Palermo. Facultad de Ciencias Sociales; ArgentinaFil: Reavley, Nicola. University of Melbourne; Australi

Pro-inflammatory monocyte profile in patients with major depressive disorder and suicide behaviour and how ketamine induces antiinflammatory M2 macrophages by NMDAR and mTOR

Background: Depression is a highly prevalent disorder that is one of the leading causes of disability worldwide. Despite an unknown aetiology, evidence suggests that the innate and adaptive immune systems play a significant role in the development and maintenance of major depressive disorder (MDD). The non-competitive glutamatergic N-methyl-D-aspartate receptor (NMDAR) antagonist, (R,S)-ketamine (ketamine), has demonstrated rapid and robust efficacy as an antidepressant when administered at sub-anaesthetic doses. Methods: Our goal was to characterize the pro-inflammatory profile of patients with MDD by measuring proinflammatory cytokines in plasma and circulating monocyte subsets and to understand how ketamine induces an anti-inflammatory program in monocyte and macrophages in vitro and vivo. Finding: Our results show that patients with MDD without other comorbidities (N= 33) exhibited significantly higher levels of pro-inflammatory IL-12 and IL-6 in plasma and that these cytokines were associated with increased numbers of non-classical (CD11b+ CD16brightCD14neg) monocytes and increased activation state (CD40+ CD86+ ) of classical monocytes in circulation. Remarkably, we have demonstrated that sub-anaesthetic doses of ketamine programs human monocytes into M2c-like macrophages by inducing high levels of CD163 and MERTK with intermediate levels of CD64 and stimulating mTOR-associated gene expression in vitro. The NMDAR antagonist MK-801, but not the a-amino-3‑hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) antagonist, NBQX, also polarizes macrophages to an M2c-like phenotype, but this phenotype disappears upon mTOR pathway inhibition. Subanaesthetic doses (10 mg/kg) of ketamine administration in mice both promote reduction of circulating classical pro-inflammatory monocytes and increase of alternative M2 macrophage subtypes in the spleen and CNS. Interpretation: Our results suggest an anti-inflammatory property of ketamine that can skew macrophages to an M2-like phenotype, highlighting potential therapeutic implications not only for patients with MDD but also other inflammatory-based diseases.Fil: Nowak, Wanda. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia.; ArgentinaFil: Grendas, Leandro Nicolás. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia.; ArgentinaFil: Sanmarco, Liliana María. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Estecho, Ivana Gisele. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia.; ArgentinaFil: Arena, Ángeles Romina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia.; ArgentinaFil: Eberhardt, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Rodante, Demián Emanuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia.; ArgentinaFil: Aoki, María Pilar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Daray, Federico Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia.; ArgentinaFil: Carrera Silva, Eugenio Antonio. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Errasti, Andrea Emilse. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia.; Argentin

A Cross-National Investigation of Hallucination-Like Experiences in 10 Countries: The E-CLECTIC Study

Hallucination-like experiences (HLEs) are typically defined as sensory perceptions in the absence of external stimuli. Multidimensional tools, able to assess different facets of HLEs, are helpful for a better characterization of hallucination proneness and to investigate the cross-national variation in the frequencies of HLEs. The current study set out to establish the validity, factor structure, and measurement invariance of the Launay-Slade Hallucinations Scale-Extended (LSHS-E), a tool to assess HLEs. A total of 4419 respondents from 10 countries were enrolled. Network analyses between the LSHS-E and the 3 dimensions of the Community Assessment of Psychic Experiences (CAPE) were performed to assess convergent and divergent validity of the LSHS-E. Confirmatory factor analysis was used to test its measurement invariance. The best fit was a 4-factor model, which proved invariant by country and clinical status, indicating cross-national stability of the hallucination-proneness construct. Among the different components of hallucination-proneness, auditory-visual HLEs had the strongest association with the positive dimension of the CAPE, compared with the depression and negative dimensions. Participants who reported a diagnosis of a mental disorder scored higher on the 4 LSHS-E factors. Small effect size differences by country were found in the scores of the 4 LSHS-E factors even after taking into account the role of socio-demographic and clinical variables. Due to its good psychometric properties, the LSHS-E is a strong candidate tool for large investigations of HLEs

Serotonin transporter gene polymorphism as a predictor of short-term risk of suicide reattempts

Objective: The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship. Methods: A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months. Results: At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p = 0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0–7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity. Conclusion: The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.Fil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Hospital Neuropsiquiátrico Braulio A. Moyano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Arena, Ángeles R.. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Armesto, Arnaldo Raúl. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rodante, Demián E.. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Hospital Neuropsiquiátrico Braulio A. Moyano; ArgentinaFil: Puppo, Soledad. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Vidjen, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Portela, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Grendas, Leandro. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Errasti, Andrea Emilse. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin