trastornos de disociación en la comunidad mexicana

medigraphic

EVALUACIÓN

Artemisa
en línea

DE TRASTORNOS DISOCIATIVOS EN POBLACIÓN

PSIQUIÁTRICA MEXICANA: PREVALENCIA, COMORBILIDAD Y
CARACTERÍSTICAS PSICOMÉTRICAS DE LA

ESCALA DE

EXPERIENCIAS DISOCIATIVAS

Rebeca Robles García*, Susana Elizabeth Garibay Rico*, Francisco Páez Agráz*

SUMMARY
Introduction
Dissociative disorders are characterized by impaired conscious
integration functions,personal identity, memory and environment
perception. Their frequent psychopathological manifestations are
amnesia, depersonalization, fugue states, extra sensorial
experiences, trance states and total personality changes.
They usually appear under different life stressors, and their
clinical course is highly variable. Prevalence estimates give figures
ranging from 5 to 10% among general population,and reach 10.2
to 41.4% among psychiatric populations. This wide variation is
one of the indicators of the complexity of this diagnostic entities
and of its difficulty to be studied. Culture is a key factor in
functionality of subjects with a dissociative disorder, because the
acceptance of many of its clinical features varies.
It is accepted that these diagnostic categories are barelyrecognized,not only by general physicians, but by experienced
mental health specialists.
The original Structured Diagnostic Interviews (SCID, CIDI,
SADS, SCAN), did not include them in their widely distributed
packages, and many of them decided to create a separate appendix
to address them. Unfortunately, structured interviews face an
important limitation as there is a lack of trained, and some times,experienced psychopathologist, a fact that difficults to use them
in large samples.
Self-report instruments, when they show good reliability and
validity, are of great value in terms of time, costs and feasibility.
Their major limitation is the low reliability that they show in
psychiatric conditions in which lack of insight is present (psychotic
disorders).
To evaluate the psychometric properties oftranslated versions
of instruments is highly desirable. This is specially important
when elusive disorders are being evaluated.
Given that the cultural environment of Mexico is surrounded
by several factors that influence this kind of disorders, the
availability of reproducible research instruments is of outmost
relevance.

Therefore, the Dissociative Experiences Scale (DES) -the most
widely usedmeasure in this field- in contrast with the Dissociative
Disorders Interview Schedule (DDIS), was evaluated, with the
purpose to give a first approach to a 12 month prevalence of
some Dissociative disorders in Mexican psychiatric patients.
Methods
Subjects: A non-random, consecutive sample of male and female
patients, between 18 and 63 years old were included. They were
receiving treatment,regardless of the diagnosis, at the Institute
of Mental Health of Jalisco, from the State’s Ministry of the
Health in Mexico. The ethics committee authorized the study,
and they all gave informed consent.
Translation: The Spanish version of the DES, has a Spanish
translation, and a Mexican Spanish idiomatic adaptation was
performed by consensus. The DDIS was translated by one bilingual
psychiatrist, andindependently reviewed by another. Consensus
was reached in controverted items. Once a final translated version
was obtained, it was given to 10 subjects (mainly with primary
school level), to assess item understanding. A second review was
performed to reach a culturally compatible version, concentrating
in respecting item content validity. Back translation was not
considered, because this methoddoes not capture common
language of low school population, which is the case of most
Mexicans.
Measures
Dissociative Experiences Scale (DES): This is a 28 items,
self-report scale, designed to evaluate different kinds and severity
of Dissociative conditions, in a 0 to 100 range. Most populations
without a psychiatric condition or with a non-Dissociative
disorder, scored under 20. A cut-off point...