BackgroundMedically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services.Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month.Methods/designThis study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain). The number of patients required is 242 (121 in each arm), all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions) and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.DiscussionThis study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity of the symptoms, improve quality of life, and reduce frequency of medical consultations.Trial registrationThe trial was registered with ClinicalTrials.gov, number NCT01484223 [ http://ClinicalTrials.gov].

Background“Rite of passage” is an etnographic concept developed by VanGennep that defines the vital transition of an individual between two different status. It is divided in three stages: separation, liminal/threshold and aggregation. Turner described the liminal phase, and the terms of “communitas” and “liminoid” (structure of a rite without religious/spiritual elements). One widely-known Rite of Passage is the initiation of the shamans.ObjetivesStudy the elements of a rite of passage present in Psychiatric Trainning.MethodField study (observational, descriptive, non-experimental).Preliminary Sample=10trainees (5man+5women); last year of Psychiatric Trainning.“ad hoc” semi-structured interview (21items subdivided in open questions). 10interviews (average duration=75mins). Permanent register:digital recorder.Summary and analysis of the answers. Review of the literature.ResultsPsychiatric Trainning shared the elements and tri-phasic structure of VanGennep's “rite of passage” conceptTrainees saw themselves as more empathic(7/10) and humanistic(8/10) than other specialties colleagues. Stigma towards mental illness(8/10) and fear of suicide(9/10) were also considered as their distinctives.The collective behaved as a communitas(10/10)No spiritual elements(0/10): liminoid processResemblances of the ancestral shamans' Initiation: Despite bloody practices were over, suffering was also present(7/10), but was seen as necessary(6/10) and well tolerated(7/10).Trainees felt that they grew spiritual and mentally(7/10) during the trainning yearsConclusionsResults suggest that Psychiatric Trainning has stable phenomena that:are compatible with the Rite of Passage schemaAre considered exclusive of Psychiatry by traineesHave not been systematically studied as a whole, which could help to improve the training.

BackgroundMost of the studies about Eating Disorders in adolescents have been typically focused on females, only to conclude that the approach should be similar in males. It has been stimated that 5-10% of patients with Anorexia Nervosa are males. Later age of onset and higher prevalence of premorbid overweight are considered among the main differences with female patients.ObjectivesAnalysis of the anthropometric variables of a sample of males with diagnosis of Restrictive Eating Disorder.MethodsNaturalistic, Descriptive and Retrospective studySample: 22 male adolescentsInclusion criteria: males with Restrictive Eating Disorder diagnosis (according to DSM-IV criteria) admitted to an Eating Disorder ward during 2007 and 2008“ad hoc” questionnaire (15 items)Analysis: PASW statistics 18ResultsAge range: 7-14years (medium age=14,79±2,50years).11 patients (50%) were older than 16 years-oldMedium BMI (Body Mass Index) at the beginning of the admission was 17,79kg/m2.medium weight loss: 13,5±7,02kg/m2 (corresponding to a reduction of 22,24±7,52% of the previous weight)Medium speed of weight loss: 0,92±1,1kg/54BMI at discharge: 18,69 ±3,43 kg/m219/22 patients (86%) had a premorbid history of overweightBinge eating: 8 patients (36,4%)Purgative behaviour: 10 patients (45%)Laxatives use: 4 patients (18%)Intense physical exercise: 21 patients (95,5%)Average duration of current restrictive episode: 13,7 monthsConclusionsIn the studied sample we observed:High prevalence of premobid overweightVery high frequency of compulsive exerciseDrastic weight loss and loss of a very high percentage of the previous weight, in short periods of time, reaching very low BMI.