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Suicide is a common cause of death. Around one million people die by suicide every year worldwide. In our country, suicide has remained the leading cause of external death (INE, 2017). It is estimated that suicide attempts (SA) occur 10–20 times more frequently than suicide. Within the broad spectrum of suicidal behavior, there are high‑lethality suicide attempts (HL‑SA), which are the closest to completed suicide.
Medically serious suicide attempts (MSSA) or high‑lethality suicide attempts (HLSA) are defined as those involving severe organic compromise, regardless of their psychiatric severity.
Within the wide spectrum of suicidal behavior, MSSA are the closest to completed suicide, and the two groups overlap substantially, sharing common characteristics. In addition, MSSA carry a higher risk of subsequent death by suicide compared with low‑lethality suicide attempts.
An important aspect to consider is that evaluating survivors of a severe suicidal act allows direct information to be obtained from the survivor, unlike completed suicides, in which assessment is carried out indirectly through third parties (psychological autopsy). Being able to assess individuals who have come so close to suicide is of great value for understanding the psychological mechanisms behind severe suicidal behavior and for identifying warning signs to prevent suicide.
A considerable percentage of these cases show underlying psychiatric disorders, mainly affective disorders (Depression), followed by Personality Disorders and other Substance‑related Disorders. Other non‑psychiatric and socio‑environmental risk factors must also be assessed: the presence of severe or chronic medical conditions, functional limitations and their impact (such as in people with physical disabilities or older adults), and social support.
Most patients present depressive symptoms that do not always coincide with a recent stressful event. They often have a history of previous suicide attempts. Prior to the MSSA, they typically experience thoughts of wanting to die or a more structured suicidal ideation.
People with an unstable or untreated psychiatric disorder—particularly unipolar affective disorders (Depression)—may be more predisposed to suicidal behavior.
In the event of an MSSA, it is essential to assess and treat any underlying psychiatric disorder.
Once the patient has recovered from the life‑threatening situation, a comprehensive approach is required, addressing both clinical and socio‑environmental aspects. Clinically, it is crucial to evaluate and treat any psychiatric condition. After medical discharge, referral to the mental health network is important, as well as activation of the Suicide Risk Code, which ensures follow‑up after hospital discharge.
Medical‑psychiatric history and psychological evaluation.
Combat myths that perpetuate the social stigma surrounding suicide and assess suicidal ideation in individuals with clinical and sociodemographic risk factors.
Legionellosis is a lung infection caused by Legionella pneumophila, found in contaminated water. It spreads through inhaling contaminated water or vapor, causing fever, pneumonia, muscle pain, and general malaise. It mainly affects older or immunocompromised people. Diagnosis involves cultures, antibody detection, or chest X-ray. Treatment is early antibiotics, and prevention relies on monitoring and disinfecting water systems.
Legionellosis is a disease caused by the bacterium Legionella pneumophila, which typically lives in contaminated water systems, such as water pipes, ponds, cooling towers, swimming pools, or hot tubs.
It is acquired through inhalation after contact with contaminated water, either by bathing in it or being in nearby areas, as the bacteria can spread from the water into the surrounding air.
It generally causes a lung infection in the form of pneumonia, which, if not diagnosed and treated promptly, can become severe and life-threatening.
Legionellosis produces the typical symptoms of pneumonia—fever, chest pain, and difficulty breathing—along with severe muscle pain and a significant overall decline in health, with pronounced malaise.
Legionellosis can affect anyone who comes into contact with the causative bacterium, but it is more common in elderly or immunocompromised individuals who have been exposed to contaminated water or inhaled vapor from such water.
Diagnosis is made by detecting the bacterium or antibodies against it in the blood, once suspected based on clinical characteristics (age of onset, fever, severe general malaise, muscle pain) or radiographic findings (pneumonia affecting large areas of the lungs). Isolation of the bacterium is relatively recent, as it requires special culture media.
In fact, Legionella was not identified as a cause of pulmonary disease until 1976, during a pneumonia outbreak at an American Legion convention in Philadelphia, from which it gets its name.
Legionellosis responds well to specific antibiotic treatment. Early initiation of treatment is very important.
Chest X-ray, blood tests for antibodies against Legionella, and specific cultures to identify the bacterium.
Epidemiological surveillance of detected cases (water pipes, air-conditioning towers, pools, or hot tubs involved) is crucial to disinfect them.
When a case of legionellosis is detected, public health authorities conduct an investigation to locate and eliminate the source.
Legionella does not tolerate high temperatures well and is usually eliminated by temporarily raising the temperature of the water systems. To ensure the bacterium is fully eradicated, these measures should be carried out by specialized professionals.
Coronary artery disease includes the pathology of the coronary arteries. These arteries supply blood to the heart. Coronary artery disease affects approximately 6% of the adult population, although this prevalence has shown an increasing trend in recent years.
Coronary artery disease can present with various symptoms, but the most characteristic is angina, or chest pain. It may also be accompanied by sweating, shortness of breath, arm pain, or palpitations.
The disease most commonly affects men over 50 years of age.
To diagnose this disease, a thorough medical history and physical examination are required; however, the key diagnostic tool is cardiac catheterization.
There are essentially three pillars in the treatment of coronary artery disease. First, medical treatment, which is reserved for mild cases; second, coronary intervention; and third, coronary surgery. Different severity scales are used to decide when a patient requires percutaneous treatment or is a candidate for coronary revascularization surgery.
The first test performed on patients presenting with chest pain is an electrocardiogram. From there, depending on the severity of the case, a stress test may be done in stable cases, or cardiac catheterization may be performed directly in clear-cut cases. Catheterization provides the definitive diagnosis.
Prevention plays a very important role in this disease. Although there are isolated cases with few risk factors, the vast majority of patients have cardiovascular risk factors.
The most important measures to adopt for both primary and secondary prevention are:
People who suffer from Obsessive-Compulsive Disorder are characterized by having recurrent and persistent thoughts that are generally unpleasant, which are called obsessions.
In addition, these thoughts trigger repeated actions or rituals that serve to “cope with” the aforementioned obsessions, called compulsions. Some examples of compulsions include: washing hands, religious behaviors (such as praying a written prayer exactly 15 times to prevent something bad from happening), and counting or checking things (e.g., making sure the door is locked, the gas is off, etc.).
Very often, they feel that “something bad” will happen if they do not carry out the compulsions, so they feel “forced” to perform them. This generates a lot of anxiety and distress, as they feel responsible for a possible misfortune.
They may become detached from daily life activities or avoid them completely due to fear of the obsessions or compulsive behaviors.
They may also experience difficulties with everyday tasks (cooking, cleaning, bathing, etc.) and suffer higher levels of anxiety.
Following some recommendations can help you “live with” or overcome Obsessive-Compulsive Disorder.
However, if recommendations are not enough and the disorder becomes more severe, you should see a psychologist or psychiatrist to complement these tips with other types of treatment (cognitive-behavioral therapy, pharmacological treatment).
Asthma is a disorder of airflow through the airways, especially the small bronchi. It causes difficulty breathing, so the patient feels short of breath and has to exert more effort to try to breathe better.
Asthma is a chronic inflammatory disorder of the airways that causes a variable obstruction of airflow. It usually changes throughout the day (it may worsen at night) and improves with the established treatment, although it can reappear later.
It is a disease primarily caused by an inflammatory mechanism.
In the airways of patients with asthma, three phenomena occur:
There is a set of cells circulating in the blood involved in the local inflammation observed in asthma: T lymphocytes, mast cells, and eosinophils. These cells are responsible for the normal defense of the body and show increased activity in asthma, which is regulated with the administered medication.
Depending on the degree of obstruction, the affected person may experience difficulty breathing and a feeling of shortness of breath. Wheezing is also characteristic of asthma; it is a high-pitched sound produced by air passing through smaller airways and also by increased bronchial secretions.
Asthma can affect all age groups and sometimes coincides with bronchitis. In some cases, it may have an allergic origin or result from exposure to environmental or chemical agents.
Spirometry, chest X-ray, allergy tests.
Some basic questions to help diagnose asthma include:
Treatment is based on the use of bronchodilators, in inhaler or tablet form. Anti-inflammatory medications also play an important role.
The most common diagnostic tests for asthma include:
To prevent asthma, it is essential not to smoke and to avoid exposure to allergens that trigger it, which can be identified through allergy testing as part of the asthma evaluation.
When we talk about venous thromboembolic disease, we refer to a process characterized by the formation of a thrombus (blood clot) within the deep venous system, which can grow or break apart, disrupting normal blood flow and causing various complications.
The main manifestations of venous thromboembolic disease are deep vein thrombosis (DVT) and pulmonary embolism, among others. DVT occurs when a thrombus or clot forms inside a deep vein, usually in the legs (although it can also occur in the arms, portal vein, iliac veins, or even the vena cava), obstructing normal blood circulation in the affected veins.
A thrombus that forms in a deep vein can fragment or break off and become detached. The resulting embolus then travels through the veins toward the heart and reaches the lungs via the pulmonary arteries. In the lungs, the embolus lodges and obstructs one or more pulmonary arteries, preventing normal blood flow. This process is called a pulmonary embolism or thromboembolism (PE).
Deep vein thrombosis (DVT):
- Swelling or inflammation of the affected leg
- Pain or tenderness in the leg, often starting in the calf
- Increased warmth in the leg
- Changes in skin color (redness or bluish and shiny appearance)
Pulmonary embolism (PE):
- Sudden shortness of breath or difficulty breathing (dyspnea)
- Increased respiratory rate
- Increased heart rate
- Sharp chest pain
- Dry cough, sometimes with blood
- Fainting (syncope)
The incidence of venous thromboembolic disease in the general population, including any of its manifestations, is estimated at 1–2 cases per 1,000 inhabitants per year. In Spain, this translates to more than 80,000 cases annually. About 70 % of cases are deep vein thromboses, with the remainder being pulmonary embolisms.
DVT:Diagnosis involves assessing patient symptoms, blood tests, and imaging. The preferred imaging method is Doppler ultrasound (eco-Doppler), which allows visualization of the deep veins and confirms or rules out the diagnosis.
PE:If a pulmonary embolism is suspected, diagnosis is confirmed using tests such as a chest CT scan or a lung scan (ventilation-perfusion scintigraphy).
The main goal in any type of thrombosis is to dissolve the thrombus and restore blood flow to prevent further complications.
Anticoagulation is the treatment of choice for venous thromboembolic disease. Anticoagulants are medications that alter blood clotting to prevent new thrombi from forming and help dissolve existing clots.
Laboratory tests, such as D-dimer Imaging tests, including Doppler ultrasound, CT scans, and lung scintigraphy.
THROMBOPHILIA STUDY: In some cases, a blood test is performed to determine if the patient has abnormalities in clotting proteins that predispose them to thrombosis.
Knowing the risk factors for venous thromboembolic disease is key to managing and reducing risk. One of the simplest and most effective preventive measures is walking, as movement helps prevent thrombus formation.
Fibromyalgia is a chronic condition related to an altered pain perception in the central nervous system. It is mainly characterized by widespread pain, often accompanied by fatigue and sleep disturbances. It can affect people of all ages, especially women. Treatment combines patient education, physical exercise, psychological support, and sometimes medication.
Fibromyalgia is a common condition, affecting 2.4 % of the general population, and is part of the so-called central sensitization syndromes. It is mainly characterized by widespread pain. There is hyperexcitation of the central nervous system with a lowered pain threshold, causing pain to appear earlier and be more intense, longer-lasting, and more diffuse. There is an exaggerated response to painful stimuli (hyperalgesia) and pain in response to normally non-painful stimuli (allodynia). Its cause is unknown, but sometimes there are clear triggers such as physical or emotional trauma or infections.
It is a chronic condition with a fluctuating course, with periods of improvement and others of clinical worsening.
The main symptom is widespread pain, but it is often accompanied by other symptoms such as fatigue, insomnia, tingling in the limbs, headache, dizziness, memory and concentration problems, anxiety, or depression.
It usually affects middle-aged women, with a peak between 40 and 49 years, but it can affect people of all sexes and ages.
Diagnosis is based on criteria that rely on the patient’s clinical presentation, according to the presence of characteristic symptoms and signs.
There is no specific medical test.
Laboratory tests and sometimes imaging studies help rule out other conditions that are often concomitant (present at the same time).
Treatment of fibromyalgia should be based on four pillars: patient education (general information about the disease and attitude toward it), physical exercise according to tolerance, cognitive-behavioral therapy if appropriate, and pharmacological treatment.
1. Patient education and attitude toward the disease
The disease should be explained, providing general advice to improve well-being.
2. Physical exercise according to tolerance
There is evidence of its effectiveness on pain, well-being, and physical function.
It is recommended to start with low-impact aerobic exercise: walking, swimming, stationary cycling, aquagym, tai chi, or pilates.
Exercise should be performed regularly and progressively.
It is recommended to do 20–50 minutes per session, at least three days per week.
In cases of lower tolerance, start with ten minutes per session, four to six days per week, and gradually increase duration, frequency, and intensity, if possible, each month.
3. Cognitive-behavioral therapy
Provided by clinical psychologists in cases of accompanying anxiety or depression.
Although fibromyalgia is not a psychological condition, anxiety and depression can trigger and perpetuate symptoms.
4. Pharmacological treatment
Can help manage some symptoms such as pain, fatigue, or sleep disturbances, although its effectiveness is limited in a large percentage of patients.
Currently, analgesics, muscle relaxants, anticonvulsants, and some groups of antidepressants are used.
The risk/benefit and potential side effects of any medications should be carefully evaluated.
A healthy lifestyle is recommended, maintaining weight with aerobic exercise according to tolerance and a balanced diet, organizing and prioritizing daily tasks with short breaks, and avoiding physically and emotionally stressful activities.
Health advice for people with fibromyalgia is provided.
Myasthenia Gravis (MG) is a neuromuscular disease characterized by fatigue and weakness that worsens with exercise and improves with rest. Etymologically, the word myasthenia comes from the Greek “mys” (muscle) and “astheneia” (weakness), while “gravis” (severe) derives from Latin.
MG is classified as a rare disease, meaning it is uncommon. Its estimated prevalence is 50 to 200 cases per million people. It has a bimodal presentation: in women, it typically begins before the age of 40, while in men it usually appears around 50 years of age. It is rare in children. Recent epidemiological studies have described an increase in the incidence of late-onset cases (after age 60) without a clear sex predominance.
The main initial symptom of myasthenia gravis (MG) is muscle weakness and fatigue, which vary throughout the day. Muscle weakness worsens progressively during periods of physical activity and improves after rest. Many patients also report fluctuations related to seasons, work or psychological stress, menstruation, or intercurrent infections. In general, weakness and fatigue worsen toward the end of the day. These fluctuations and the worsening with physical activity are key signs to differentiate MG from other conditions, such as mental fatigue or chronic fatigue syndrome, where tiredness appears in the morning or at rest.
MG usually begins with ocular symptoms, such as double vision (diplopia) and/or drooping eyelids (ptosis), which can be unilateral or bilateral. Ocular symptoms often worsen when watching TV, reading, driving, or in bright light. Symptoms from bulbar muscle involvement are also common, including difficulty swallowing, chewing, or speaking. Approximately 16% of patients present initially with one of these bulbar symptoms. Other possible manifestations include difficulty holding the head upright, inability to keep the mouth closed, shortness of breath, early fatigue when walking, turning in bed, raising arms, or opening bottles or jars.
Approximately 20% of patients may experience a myasthenic crisis during their lifetime, causing serious respiratory or swallowing problems that may require hospitalization. Crises can be triggered by stress, infections, medications, surgery, or even emotional stress.
Diagnosis of MG is based on symptoms, physical examination, and paraclinical tests. The most important tests include electromyography (EMG and SF-EMG) and the edrophonium test (Tensilon®). In most patients, antibodies (AChR and MuSK) can be detected in serum. A small percentage of patients are seronegative. A CT scan is recommended to rule out the presence of a thymoma.
Treatment usually involves acetylcholinesterase inhibitors combined with immunosuppressive medications. Most of these drugs have dose-dependent side effects that must be considered. Treatment decisions should be made jointly with the patient, taking into account disease guidelines, physician experience, and the clinical form of MG. Care of an MG patient typically involves lifelong follow-up with a neurologist.
Thymectomy (surgical removal of the thymus) can improve symptoms, prevent certain complications, and reduce the dose of immunosuppressive drugs. It is recommended for generalized MG in patients under 55 years of age and in all patients with thymoma, regardless of age.
Plasmapheresis and intravenous immunoglobulins (IVIG) can be used during exacerbations. In myasthenic crises, mechanical ventilation may be required.
With proper treatment, most patients lead relatively normal lives and have a normal life expectancy.
Pregnancy: Physiological changes during pregnancy (nausea, vomiting, weight gain, increased blood volume, changes in kidney function, and altered gastrointestinal absorption) can affect MG and may require medication dose adjustments. Pregnant women with MG are at higher risk of complications and adverse effects. About one-third of pregnancies experience clinical worsening of MG, mainly in the first and third trimesters and postpartum. Some medications used in MG can cause fetal malformations or increase the risk of miscarriage or low birth weight.
Newborns of MG mothers may present transient neonatal myasthenia due to maternal antibody transfer.
Because complications during pregnancy and delivery are unpredictable, specialized multidisciplinary care is recommended, involving at least a neurologist, obstetrician, anesthesiologist, and neonatologist.
Surgery, particularly thymectomy, can precipitate a myasthenic crisis. High disease functional scores, low spirometric values, and severe comorbidities are major risk factors. Risk assessment should involve pulmonologists, surgeons, and anesthesiologists.
Procedures under local, regional, or epidural anesthesia generally do not carry a risk of myasthenic crisis.
Some medications may worsen myasthenic symptoms, so it is important to inform healthcare providers about MG before prescribing new drugs. Certain vaccines, foods, and beverages may also be contraindicated. A list of safe medications is available at: https://www.neuromuscularbarcelona.org/miastenia/
Many MG patients also have other autoimmune disorders. The most common is hypothyroidism.
Daily gentle exercise with rest periods is recommended, considering the fluctuating nature of symptoms. Respiratory exercises at home can complement training. Maintaining a healthy weight is very important.
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