IS TREATMENT IN GROUPS A USEFUL ALTERNATIVE FOR PSYCHIATRY IN LOW-INCOME COUNTRIES - AN EVALUATION OF A PSYCHIATRIC OUTPATIENT UNIT IN NICARAGUA

Centro de Atencion Psicosocial in Leon, Nicaragua is a psychiatric out patient unit that has developed a group-oriented model of working, in which 80% of all visits are in groups: first-admission groups, insight -oriented group psychotherapy, psyche-educative, family groups and rel atives groups. The aim of the present study was to analyze patient cha racteristics and make a preliminary study of improvement, compliance a nd patient satisfaction in a 1-year perspective. One hundred consecuti ve visits were assessed, 44 of them first admissions. They were assess ed according to all axes of DSM-III-R plus the Structural Clinical Int erview for DSM-III Disorders. A 1-year follow up was conducted on 39 o f 41 selected patients within the major diagnostic groups. One of 4 pa tients had a psychotic disorder where schizophrenia dominated. Among n onpsychotics major depression, anxiety and adjustment disorders were m ost frequent. Personality disorders were common (80%) among nonpsychot ic patients, paranoid, obsessive-compulsive, passive-aggressive and ma sochistic personality disorders dominating. The illiteracy rate was 10 %, but 50% had high school or university background. Severity of menta l disorders and functional level did not differ between educational le vels. There was a strong male dominance in all diagnostic, socioeconom ic and educational level strata and few old patients. Improvement in f unctional level was clinically and statistically significant in all gr oups, and more than two thirds were very satisfied with the group trea tment offered.