ABSTRACT
Abstract Introduction Empathy is defined as the ability or process to identify and understand other person's situation, feelings, and motives. These responses are essential for relationships and social behavior. Baron-Cohen et al. created the Empathy Quotient (EQ), a scale explicitly designed to have a clinical application. The instrument evaluates three constructs of empathy and several studies around worldwide, but not in Mexico. Objective To examine the psychometric properties and the factor congruence of the EQ in a community sample from Mexico City. Method Cronbach´s alpha coefficient and a correspondence factorial analysis was performed to test the relation between response options and factors from the Exploratory Factor Analysis 200 adults without Axis I disorders through the MINI, filled out the Spanish version of the short version (28-items) of the EQ. An exploratory factor analysis was performed while reliability was tested with Cronbach's alpha. In addition, correspondence factorial analysis and the factor congruence coefficient were determined. Results Five items were eliminated from the original 28-item EQ. From the 23 remaining items, only 16 were grouped in the three original proposed dimensions (cognitive empathy: 8 items, emotional reactivity: 4 items and social skills: 3 items), while one item showed communality with a different domain from the one originally proposed. Reliability was adequate (.82) as well as the congruence coefficients (.76 to .99). Discussion and conclusion The EQ Mexican 16-item version is a good tool to assess empathy in a Mexican population.
Resumen Introducción La empatía es definida como la capacidad para identificar y comprender las situaciones, sentimientos y motivaciones de otra persona. Estas respuestas son esenciales para relaciones y comportamientos sociales. Baron-Cohen et al. crearon el cociente de empatía (EQ), una escala diseñada para tener aplicación clínica. El instrumento evalúa tres constructos de empatía y ha probado sus propiedades psicométricas con resultados adecuados en varios estudios mundiales, pero no en México. Objetivo El propósito de este estudio fue examinar las propiedades psicométricas y la congruencia factorial del EQ en una muestra mexicana. Método El alpha de Cronbach y el análisis factorial fueron aplicados para probar la relación entre las opciones de respuesta y los factores en 200 adultos sin diagnóstico, a través de la entrevista MINI. Se utilizó la versión corta en español del EQ y se realizó un análisis factorial exploratorio dónde se probó la confiabilidad con el alfa de Cronbach y se determinó adecuada correspondencia y congruencia factorial. Resultados Se eliminaron cinco reactivos de la escala original de 28 reactivos. De los 23 reactivos restantes, solo 16 se agruparon en las tres dimensiones originales (empatía cognitiva: 8 reactivos, reactividad emocional: 4 reactivos y habilidades sociales: 3 reactivos) mientras que un reactivo mostró una comunalidad con un dominio diferente del original. La confiabilidad fue (.82), así como los coeficientes de congruencia (.76 a .99). Discusión y conclusión La versión del EQ es una buena herramienta para evaluar la empatía en población mexicana.
ABSTRACT
Withdrawal signs and symptoms are frequently minor but can develop into a severe, even fatal, condition. Clinical manifestations of the AWS begin as soon as the alcohol consumption is interrupted or diminished after a long period of ingestion of great quantities of alcohol. The clinical manifestations include symptoms of autonomic hyperactivity, like sweating, tachycardia over 100 bpm, tremor, insomnia, nausea or vomiting, transitive visual, tactile, or hearing hallucinations, or even illusions, psychomotor agitation, anxiety and epileptic crisis. Objective Our aim is to assess the usefulness of several biochemical markers and the risk of seizures associated with alcohol withdrawal. Methods This study included 52 inpatients which were assessed with the Ciwa-Ar scale in order to determine the severity of the withdrawal. They were assessed too with the AUDIT scale to determine the risk and abuse of the intake of alcohol. We also obtained a blood sample to determine the levels of several biomarkers (AST, ALT, GGT, FA, HOM-OCISTEINE, and MCV). We compared the two groups (patients with seizures vs. patients without seizures). Student T and Mann Whitney's U tests, and ROC curves were applied. Results We observed a statistical difference between the groups in the levels of alkaline phosphatase. The levels were higher in patients without seizures (148.8±69.58UI) compared with the patients with seizures (113±55.1UI). No differences were observed in other groups. Conclusion The patients with higher levels of alkaline phosphatase had major risk of seizures. There were no elevations in the serum level of homocisteine in both groups.
El síndrome de supresión etílica (SSE) incluye tanto una variedad de signos y síntomas orgánicos y cambios conductuales como modificaciones en la actividad electrofisiológica del Sistema Nervioso Central. No existen estudios clínicos que evalúen el uso de biomarcadores en pacientes con comorbilidades agudas, convulsiones ni delirium tremens, así que su utilidad en estos casos no ha sido valorada. Objetivo Nuestro objetivo es el de valorar el uso de diversos marcadores bioquímicos para determinar el riesgo de convulsiones en el síndrome de supresión etílica. Material y métodos Este estudio incluyó a 52 pacientes, evaluados a su ingreso con la escala Ciwa-Ar para determinar la gravedad de la supresión y la escala AUDIT para detectar riesgo y abuso en el consumo de alcohol. También se tomó una muestra sanguínea para determinar los niveles séricos de los biomarcadores (AST, ALT, GGT, FA, HOMOCISTEINA, VCM). La muestra se dividió en dos grupos (pacientes que convulsionaron vs. pacientes que no convulsionaron). Se utilizó la t de Student y U de Mann Whitney, así como curvas COR para determinar la sensibilidad y especificidad de los biomarcadores, así como la correlación de Pearson. Resultados La única diferencia significativa entre ambos grupos estuvo dada por la fosfatasa alcalina, cuyos niveles fueron más altos en los pacientes que no presentaron crisis convulsiva (148.8±69.58UI) que en aquellos que las presentaron (113±55.1UI). No se encontraron diferencias estadísticamente significativas para el resto de los biomarcadores. Conclusiones Los niveles bajos de fosfatasa alcalina traducen un riesgo mayor de presentar crisis convulsivas. No hubo elevación de los niveles de homocisteína en ninguno de los grupos.
ABSTRACT
In recent years, consumption of alcoholic beverages has become a common practice among young adults attending higher education institutions in Mexico. Over the past two decades, prevalence of alcohol consumption in this population has doubled. In campuses located in Mexico City, 70-90% of undergraduate students have consumed alcoholic beverages during the past year and approximately 25% have engaged in binge drinking. Past year prevalence of Alcohol Dependence (AD) has been estimated in 4.6% and 18.4%. Higher education institutions around the world have implemented programs aimed at reducing students' drinking that have included educational interventions and/or psychosocial treatments delivered individually or in group format. In this regard, the available evidence suggests that programs that have included elements of the Motivational Enhancement Therapy (MET) or components of the Cognitive Behavioral Therapy (CBT) have shown the greatest efficacy in reducing drinking problems in this population. Despite this, there are no studies examining the efficacy of these interventions in Mexico's college student population. In the report presented here, we aim at examining the efficacy of Individual or Group MET and CBT in reducing drinking among undergraduate students diagnosed with AD. We hypothesized that in comparison to CBT, MET would show evidence of a greater reduction in alcohol consumption. To evaluate this hypothesis we examined the treatment effects on the number of consumed drinks, on the number of drinking days, and on the number of drinks per drinking day during the preceding 30 days. Methods We prospectively evaluated during an 8-week treatment phase and during a 12-month follow-up period, 158 undergraduate students who received a diagnosis of AD (ICD-10) at the students' Mental Health and Counseling Center of the National Autonomous University of Mexico (UNAM) in Mexico City. Instruments. In order to screen and to establish the diagnosis of AD we respectively used the Alcohol Use Disorders Identification Test (AUDIT) Mexican version and the Composite International Diagnostic Interview (CIDI). We also used The Alcohol Time line Followback (TLFB) method to retrospectively record the amount and frequency of alcohol consumption. Procedures. Students seeking services at the UNAM Mental Health and Counseling Center, and who had a diagnosis of AD, were invited to participate in the study. After informed consent was obtained, they were randomly assigned to one of four manualized treatment interventions: Individual or Group MET, or Individual or Group CBT. These were delivered in eight weekly sessions lasting one hour. The alcohol TLFB was administered at the beginning and at the end of the 8-week treatment phase, and subsequently monthly for the following 12 months. Statistical analysis. An analysis of variance (ANOVA) for repeated measures was used to examine the treatment effect on drinking during the treatment phase and separately during the 12-month follow-up period. A one-way ANOVA was used to examine differences between treatment groups at specific assessment points. Results Demographic characteristics. In the entire sample the majority of students were men (73.2%), while the mean age was 18.8 [± 2.9] years. There were no differences between intervention groups in their demographic characteristics. Baseline characteristics of alcohol consumption. In the entire sample and separately in each of the intervention groups there was a predominant pattern of weekly heavy drinking. There were no baseline differences between treatment groups in the monthly amount or frequency of drinking, or in the number of drinks consumed during drinking days (all comparisons P>0.50). The average number of Alcohol Dependence symptoms was 6.0 [± 2.6]. There were no differences among groups in the number of these symptoms (P=0.10). Patient Retention during the Treatment Phase and the Follow-up Period. At the end of the 8-week treatment phase, 92% of the students remained in treatment. During this phase, the Individual CBT group had the greatest number of dropouts with 18% of them leaving prematurely (Pearson X² = 15.7, df=3, P = 0.001). During the follow-up period, specifically at the 3, 6 and 12-month follow-up, the retention rates in the study were respectively 91%, 89% and 86%. There were no differences among groups in this variable at any of these follow up points. Alcohol consumption during the treatment phase. In the ANOVA for repeated measures we found that during the treatment phase there was a main effect of time over the three indicators of alcohol consumption (range of F: 7.59-11.81, df=1.142, range of P:0.001-0.007). This reflected the fact that at the end of the four interventions there was a reduction in the amount and frequency of monthly drinking and a reduction in the number of drinks during drinking days. There were no main effects of treatment (range of P:0.07- 0.56) or interactive time X treatment effects (range of P:0.55 to 0.79) on any of the drinking variables. However, at the level of a non-significant trend (F = 2.37, df=3.143, P = 0.07), there was a treatment effect reflecting that in comparison to Individual CBT, there was a trend toward a greater reduction in the frequency of monthly drinking in Group MET (one-way ANOVA: F=2.60, df=3.146, P=0.05, Tukey HSD P=0.07). Alcohol consumption during the follow-up period. In the ANOVA for repeated measures, there was a main effect of time on the amount and frequency of monthly alcohol consumption (range of F: 8.54-9.53, df=3.393, P range: 0.001-0.004), reflecting that during this period there was a reduction in these two drinking variables in the entire sample. This effect was observed mainly during the first six months of follow-up. During the following six months, there was a gradual increase in the amount and frequency of drinking (range of F for the quadratic component of Time: 5.36-10.36, df=1.131, range of P: 0.02-0.002) that approached the levels seen at the end of treatment. There were no main effects of time on the number of drinks consumed during drinking days (P=0.27). There was a treatment X time interaction (F=2.65, df=3.131, P=0.05) on monthly frequency of drinking, indicating that, in comparison to Individual CBT, there was a greater reduction in this drinking variable in Group MET. This effect was specifically observed during the first three months of follow-up (one-way ANOVA: F=3.63, df=3.142, P=0.02, Tukey HSD P=0.007). Subsequently, there were no differences among the intervention groups in this variable for the remaining nine months of follow-up. Finally, there were no main effects attributable to treatment or interactive effects of time X treatment on the number of monthly drinks (P range: 0.49 to 0.65) or on the number of drinks consumed per drinking day (P range: 0.55 to 0.79). Discussion In this sample of alcohol dependent college students, we found that at the end of the 8-week treatment phase there was a comparable reduction in the amount and frequency of alcohol consumption and in the number of drinks consumed during drinking days across the four intervention groups. However, we observed that at the level of a non significant trend (P=0.07), Group MET appeared to be more effective than Individual CBT in reducing the frequency of alcohol drinking.
Introducción Se ha descrito que entre los estudiantes de educación superior de nuestro país la prevalencia del consumo de alcohol se ha duplicado durante las últimas dos décadas. Se han estimado prevalencias durante los últimos 12 meses del diagnóstico de Dependencia al Alcohol (DA) de 4.6%. Aunque se desconoce la magnitud de las consecuencias de estos problemas entre los estudiantes universitarios mexicanos, en Estados Unidos han sido identificados como un problema de salud pública mayor y como el principal problema de salud en las universidades. Para reducir estos problemas, se ha evidenciado que las intervenciones como la Terapia de Incremento de la Motivación (TM) o la Terapia Cognitivo Conductual (TCC) podrían ser igualmente efectivas a largo plazo. Se ha observado una ligera ventaja del formato individual sobre el grupal. Pero al analizar el costo-beneficio, el formato grupal suele ser el más utilizado en las universidades. A pesar de la importancia de los problemas por consumo de alcohol en las universidades y no obstante la efectividad demostrada de estas intervenciones, no hay, hasta lo que sabemos, investigaciones publicadas que comparen la eficacia de la TM y la TCC en el tratamiento de los universitarios con problemas por consumo de alcohol en México o en otros países de habla hispana. Objetivo Examinar los efectos de las intervenciones TM y TCC tanto en su modalidad individual como grupal, en el tratamiento de estudiantes universitarios con diagnóstico de dependencia al alcohol. Material y métodos Se evaluó prospectiva y comparativamente a 158 estudiantes universitarios con diagnóstico de Dependencia al Alcohol. Instrumentos: 1. Alcohol Use Disorders Identification Test (AUDIT); 2. Composite International Diagnostic Interview (CIDI); 3. Línea Base Retrospectiva (LIBARE); 4. Cuestionario de Datos Demográficos. Procedimientos. A los estudiantes con problemas con su manera de beber, se les aplicó el AUDIT; a los que tuvieran respuestas positivas para Dependencia al Alcohol, se les aplicó la sección de <
ABSTRACT
Alcohol dependence is a major global problem, associated with lower quality of physical and mental health, higher mortality and an enormous familial and social cost. Prevention strategies and treatment of this condition are therefore crucial. Success of psychosocial programs and pharmacological treatments has been frequently reported, but a better understanding of the etiology of this chronic disease is needed. For this purpose, the identification of associated factors in different populations is of great significance. It has been clearly demonstrated by twin and adoption studies and supported by animal models that both genetic and environmental components play a substancial role in alcohol dependence. Heritabil ity estimates range from 40 to 60%, depending on the specific analyzed sample. Several coexisting genetic variants in each affected individual, rather than a single gene transmitted in a Mendelian manner, may be the rule in alcohol dependence. Similarly, many environmental factors can increase susceptibility, and because of their diversity, they do not have to be the same in every affected person. Environmental contribution may be linked to epigenetics, which refers to chemical processes that can modify gene activity without changing the sequence of DNA. In humans, the most stable epigenetic process is the union of a methyl group (one carbon atom surrounded by three hydrogen atoms) to cytosines in DNA. Other epigenetic mechanisms are modifications to nuclear proteins called histones, which alter the way DNA is packed. Moreover, non-protein coding RNAs such as microRNAs have been associated with the development of alcohol dependence. MicroRNAs could work as epigenetic intermediaries that allow ethanol to affect complex and divergent developmental mechanisms, which is added to the effect of DNA methylation, histone acetylation, and other epigenetic modifications. Most reasearch points to an association between alcohol dependence and genes related with alcohol metabolism, with neurotransmission of dopamine, GABA, serotonin, glutamate, endogenous opioids, and cannabinoids, signal transduction within the mesolimbic dopamine reward system, and stress response system, among others. During pregnancy, there are several non-genetic factors that may have an important impact on vulnerability to alcohol dependence. Given that the Central Nervous System is developing throughout the entire pregnancy and that alcohol consumed by the mother can reach the fetus through the placental barrier, the brain of a baby is always vulnerable to harm caused by alcohol exposure. Children born to alcoholic mothers may inherit genetic susceptibility variants but at the same time they may be exposed to early effects of ethanol. Heavy alcohol exposure during pregnancy has been associated with mental retardation, epilepsy, attention deficit/ hyperactivity disorder, learning disabilities, and later on with substance abuse, anxiety, personality, affective and psychotic disorders, as well as with engagement in antisocial behaviors and school or work problems. Furthermore, it has been shown that animals exposed to prenatal stress exhibit persisting modifications related to dopamine and glutamate transmission in limbic structures associated with dependence to alcohol and other substances. These alterations may later contribute to increase motivation to drink, to use large amounts of drugs of abuse or to relapse after periods of drug withdrawal. It was shown that after exposure to prenatal stress, male mice consumed more ethanol during alcohol reinforcement in adulthood. In addition, it has been well documented that affective disorders are associated with alcohol dependence. A recent meta-analysis including 54 studies that together involved more than 40749 individuals, confirmed that the 5-HTTLPR polymorphism at the promoter of the serotonin transporter gene moderates the association between stress and depression, where the short allele is related with an increased risk for depression under stress (p = 0.00002). A strong association was detected when the stressful factor was childhood maltreatment (p = 0.00007). Childhood maltreatment, including neglect as well as physical and sexual abuse, is associated with developmental difficulties, low social competence and self-esteem, and it is an important risk factor for binge drinking in adolescence and alcohol dependence in adulthood. Childhood maltreatment may interact with factors such as variants of the monoamine oxidase-A and catechol-o-methyltransferase gene. Adolescence is a critical period for initiation of alcohol intake, experimentation, and establishment of regular drinking patterns. Substance use at this age is considered a risk factor for the development of later alcohol and other drug-related problems, as well as for externalizing disorders such as antisocial personality disorder. Alcohol use initiation is affected by environmental factors such as ethanol availability, parental attitudes, and peer pressure. It has been reported that heavy drinking during adolescence can have a negative impact on brain development. Moreover, dopaminergic and GABAergic systems undergo important changes during adolescence, and they can be affected by alcohol intake. Dopamine is implicated in the rewarding effects of ethanol, and GABA in its sedating effects and development of tolerance. The way an adult copes with environmental challenges is notably influenced by early life experiences and by the familial environment he or she had as an infant, which affects neurodevelopmental behavior. While environmental factors tend to have a crucial role in drinking habits in adolescence, adultood may be characterized by a weaker effect of environment and a higher effect of genetic components. It is probable that a complex set of gene-environment interactions determine the risk to alcohol dependence. Environmental factors that may affect this vulnerability appear at different stages from pregnancy to adulthood. These interactions are mediated by DNA methylation, histone modifications, protein complexes and non-protein-coding RNAs such as microRNAs.
La dependencia al alcohol es un problema mundial grave, que se asocia con mucho sufrimiento, problemas de salud mental y física, una elevada tasa de mortalidad y un costo social y familiar muy alto. Es por esto que las estrategias de prevención y el tratamiento de la enfermedad resultan cruciales. Se ha reportado que programas psicosociales y tratamientos farmacológicos son hasta cierto punto exitosos actualmente. Sin embargo, se requiere conocer más profundamente la etiología de la enfermedad. Por esta razón, es muy importante identificar los factores que se asocien con el incremento a la susceptibilidad en distintas poblaciones. Se ha demostrado claramente a través de estudios en gemelos y de adopción, así como por investigaciones en animales, que tanto factores genéticos como ambientales son relevantes en la dependencia al alcohol. Se ha estimado que la heredabilidad de esta enfermedad se encuentra entre 40 y 60%, dependiendo de la muestra estudiada, lo cual indica que el ambiente y la genética tienen un peso similar en la susceptibilidad. Muchas variantes genéticas que aumentan la susceptibilidad, en lugar de una sola, podrían coexistir en las personas más vulnerables a la dependencia. De manera similar, muchos factores ambientales parecen estar relacionados, los cuales, debido a su diversidad, intensidad y etapas de la vida en la que se presentan, no son exactamente iguales en diferentes personas con dependencia al etanol. La contribución ambiental podría relacionarse con cambios en la expresión de genes, lo cual involucra a la epigenética. Ésta se encarga del estudio de los procesos químicos, afectados por el ambiente, que pueden modificar la actividad de los genes sin cambiar la secuencia del ADN. En humanos, el proceso epigenético más estable es la unión de un grupo metilo (un átomo de carbón unido a tres átomos de hidrógeno) a las citosinas en el ADN. Otros mecanismos epigenéticos son modificaciones a proteínas nucleares llamadas histonas, proceso que modifica la manera en que se encuentra empaquetado el ADN. Por otra parte, ARNs que no codifican para proteína, como los microARNs, se han asociado al desarrollo de la dependencia al alcohol. Ciertos microARNs podrían funcionar como intermediarios epigenéticos, lo cual propiciaría que el etanol afectara procesos complejos y divergentes del neurodesarrollo, sumándose al efecto de la mutilación en el ADN y de la acetilación de histonas, entre otros procesos epigenéticos. La mayoría de las investigaciones señalan que los genes importantes en la vulnerabilidad a la dependencia al alcohol incluyen algunos que codifican para proteínas del metabolismo del alcohol; de neurotransmisión de dopamina, GABA, serotonina, glutamato, opiodes endógenos y canabinoides; de transducción de señal en el sistema de recompensa mosolímbico; y de respuesta al estrés, entre otros. Durante el embarazo, diversos factores no genéticos tienen un impacto importante en la vulnerabilidad a la dependencia al alcohol. Por ejemplo, debido a que el Sistema Nervioso se desarrolla a lo largo de toda la gestación y que el alcohol consumido por la madre puede llegar al feto a través de la barrera placentaria, el cerebro de un feto siempre es vulnerable al daño provocado por la exposición al etanol. Se ha demostrado que los hijos de mujeres alcohólicas no sólo pueden heredar variantes genéticas de riesgo sino que también pueden estar expuestos tempranamente a los efectos del alcohol consumido por sus madres. El consumo excesivo en el embarazo se ha asociado con retraso mental, epilepsia, déficit de atención/ hiperactividad, problemas de aprendizaje, y más adelante con abuso de sutancias, ansiedad y trastornos afectivos, de personalidad y psicóticos, así como con conductas antisociales y problemas en la escuela o el trabajo. Además, se ha demostrado que animales expuestos a estrés prenatal mostraban modificaciones persistentes relacionadas con la transmisión dopaminérgica y GABAérgica en estructuras límbicas que se relacionan con dependencia al alcohol y a otras drogas. Más adelante, estas alteraciones podrían contribuir a la motivación para beber, a utilizar mayores cantidades de alcohol u otras susancias de abuso o a la recaída después de periodos de abstinencia. Se encontró que ratones macho expuestos a estrés prenatal consumían más alcohol en la edad adulta. La depresión y el estrés se han asociado fuertemente con la dependencia al alcohol. Con un metaanálisis reciente en el que se incluyeron datos de 54 estudios en los que en conjunto se habían reclutado 40 749 personas, se confirmó que el polimorfismo 5-HTTLPR del promotor del gen que codifica para el transportador de serotonina modera la asociación entre el estrés y la depresión y el alelo corto (<
ABSTRACT
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Summary In this manuscript we describe results obtained for Group III of the Integral Rehabilitation Program for Outpatient Schizophrenic Patients (IRPS III) at the National Institute of Psychiatry Ramón de la Fuente. This program was created for Mexican schizo-phrenic patients as a refined alternative for the treatment, rehabilitation and integration to a productive life within society. It is interdisciplinary and integral in nature; both patients and their relatives are involved in the treatment and rehabilitation. It includes admission, stabilization of clinical symptoms, and application of strategies for rehabilitation for one year (pharmacological treatment, group psychotherapy, labor -vocation induction therapy, music therapy, psychosocial psychotherapy, occupational therapy, artistic painting, drawing, and Hata-Yoga workshops, psycho-educational workshops for relatives, group dynamics therapy with responsible relatives, and unifamilial psychotherapy); there were assessments at the beginning and at end of the study. Objective To evaluate the efficacy of an interdisciplinary and integral program in these patients, with respect to a control group that received the usual medical-psychiatric treatment. Evaluation was carried out according to: a) Severity of psychiatric symptoms, b) Treatment compliance, c) Everyday performance, d) Psychosocial functioning, e) Global activity, f) Home occupational activities, g) Expressed emotion and attribution of the illness, and h) Patterns of communication and relationship within the family. The goals of this program were to reduce the disabilities and to profit from the conserved functions, as well as to develop other skills in order to increase the quality of life of patients. Methods This was a quasi-experimental pretest-postest prospective study where an experimental group and a control group were compared. The control group (n=39) received the usual psychiatric management, while the experimental group (n=39), participated in addition to this management, in a one-year integral rehabilitation program at the outpatient service of the institute. The sample was obtained in a non-probabilistic and sequential way, according to the established inclusion and exclusion criteria. Variables:Efficacy was evaluated through: a) Severity of psychiatric symptoms; b) Treatment compliance; c) Everyday functioning; d) Psychosocial functioning; e) Occupational activities at home; f) Expressed emotion; g) Patterns of communication and relationship within the family. Instruments: Composite International Diagnostic Interview (CIDI), Positive and Negative Syndrome Scale (PANNS), Clinical Interview and File, Everyday Unemployment Scale, Psychosocial Functioning Scale, Global Assessment Scale, Assessment and Follow-up Questionnaire, Patient Labor Performance Scale, Social Behavior Assessment Schedule (SBAS), Five Minute Speech Sample (FMSS), Verification of the Performance in Occupational Activities for Schizophrenic Patients, Extrapyramidal Symptom Scale. Procedures: a) Incorporation of patients and relatives to the study; b) Stabilization of clinical symptoms; c) Initial assessment; d) Program application; e) Final assessment. Results Demographic data: There were 47 subjects in the final sample, 25 in the experimental group, and 22 controls. There were more males than females in both groups (76% in the experimental group and 63.6% in controls). Being single was the most frequent marital status among patients (88% in the experimental group and 91% in controls). Education was slightly higher in the experimental group, were 40% had a bachelor´s degree as opposed to 27.2% in controls. Treatment compliance: The program had a final efficiency of 64% for the experimental group and 56% for controls. Some of the experimental subject's characteristics at the beginning of the program were related with treatment compliance: age, years of illness history, and number of different diagnoses. It was determined that 62% of the patients who completed the program were less than 30 years old, and in 80% of the cases the onset of the illness was less than 10 years ago. Regarding the number of diagnoses per patient, 60% of those who completed the study had one diagnosis, 40% had two or more. On the contrary, 30% of the patients who abandoned the study had one diagnosis and 70% had two or more. In other words, almost three fourths of the sub-sample that abandoned the Program had more than one diagnosis: 31% had two, 31% had three, and 10% had four or more. Clinical area: In the clinical area, there were no significant differences between groups. However, patients in the experimen-tal group had a higher level of clinical adaptation and treatment compliance. Everyday performance: The everyday performance was improved in patients from the experimental group, with statistically significant changes in 71.5% of the pretest-postest evaluated areas, with emphasis on self-care, family and interpersonal relationships, and remunerated work. In the control group, there was an improvement only in 28.5% of the areas. Psychosocial functioning: Global and by-area psychosocial functioning showed statistically significant differences in the experimental group in all functioning areas; there was an improvement from three to two, the latter number meaning feeling satisfied. This was not the case in the control group. Behavior at home: In the experimental group, the perception in families was that occupational behavior at home was improved, according to the final score. Family assessment: Relatives in the experimental group attributed the problems they had with the patient to personality characteristics. These problems were diminished at the end of the study, but not in the control group. When relatives attributed problems to the way of being and attitudes of patients, there was a decrease of problems from 31.6% to 26.3%. Emotional Expression in relatives from the experimental group was observed in 79.2% at the beginning of the treatment program, which decreased to 33.3% at the end of the study, with a significant difference of p <0.006, as opposed to relatives in the control group, who did not show statistically significant differences. Clinical assessment of families: At the beginning of the program, this group established reiterative communication patterns. The patient showed rejection to communication. Relatives blamed schizophrenia for the lack of communication. At the end of the program, patterns of communication had importantly improved. Conclusions Demographic data in our sample are similar to those described in previous reports for male:female ratio, marital status, and education. Some characteristics of the patients, in particular age, years from onset of illness, and psychiatric comorbidity assessed at recruitment were associated with completing or not the program. At the end of the study it was clear the program reached its goals of reducing the patients' disabilities and profiting of conserved functions: 64% of the patients in the experimental group were more stable in clinical terms, and treatment compliance was better. Also, everyday performance was notably improved. In the experimental group there were pretest-postest statistically significant differences in 71.5% of the studied area, especially in self-care and interpersonal relationships. In the control group there were significant changes only in 28.5% of the areas. One level of improvement was observed in global and by-area psychosocial functioning in the experimental group, but not in controls. Patients at the end of the study had switched from a score of three (neutral, unconcerned) to level two (satisfied with their own functioning). In the control group there were no statistically significant differences. Emotional expression in relatives in the experimental group significantly decreased at the end of the study (p< .006), but not in the control group, given that the latter did not show statistically significant differences. Occupational activities at home were also improved in the experimental group, with better scores at the end of the study. Regarding the assessment of occupational therapy, there were significant differences in four areas. Other areas with positive changes were: disease attribution to the patient, and patterns of communication in the family. The areas with better results were self-care, socialization, and family dynamics, which are frequently altered in schizophrenic patients. These results showed the efficacy of the program in its integral version (pluridimensional). Once the proposed objectives are reached, we propose to continue this program with important modifications of the method, which will be described in future publications.
ABSTRACT
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Summary Background: Between 1% and 1.5% of the world population is affected by schizophrenia. In Mexico, it has been estimated that between 619,550 and 1,239,101 (1-2%) individuals suffered from schizophrenia in 2000. The condition is more common among male teenagers and young adults. The main features of schizophrenia are the positive and negative symptoms closely associated with a psychosocial functioning impairment. In addition, between 25% and 80% of the psychiatric population uses addictive substances, with alcohol, at 50%, being one of the most highly used. These substances use is closely associated with a poor psychosocial functioning; when alcohol use is accompanied by schizophrenia, psychosocial functioning is even more disrupted. In the last few years, it has been shown that an early reinsertion of schizophrenic individuals into their social and familial environment causes a lesser degree of impairment in their psychosocial functioning. This functioning is evaluated through the acquisition of new skills to move about in familial, social and work environments. The latter is called psychosocial treatment. In this sense, psychosocial functioning is described as each individual's ability to adapt, function, move about and interact in a social and personal environment. This functioning evaluates the social, occupational, economic, sexual and familial areas. Objective: The objective of this study was to establish the association between schizophrenic patients' psychosocial functioning according to their alcohol use and the severity of schizophrenia. Methodology: Eighty schizophrenic, psychiatrically stable, subjects were selected during a 14-month period of time. All of them were submitted only once to the Psychosocial Functioning Scale (PFS), the Composite International Diagnostic Interview (CIDI), the Positive and Negative Symptoms Scale (PANSS) and the Alcohol Use Disorders Identification Test (AUDIT). These scales were used in order to confirm the schizophrenia diagnostic and its severity, to measure the psychosocial functioning of this population, to identify early on problems related to alcohol use and to perform an alcohol use/dependency diagnostic on those individuals who met such diagnostic criteria. A Chi squared, Mann-Whitney's U, the t test, Kruskal-Wallis and the one-way ANOVA were used for statistical analysis purposes. Results: Seventy-one percent of the subjects were males and 29% females; 87% were single and 70% were unemployed or had an informal job. Thirty-one years was the average age among males and 34 among females. Subjects started suffering schizophrenia when they were between 12 and 30 years (average: 23 years; SD: 6.36), and 94% of them started using alcohol while they were at this very same age range (average: 20 years; SD: 4. 98). Seventy-six percent of the subjects presented a schizophrenia evolution of less than ten years. Comparing alcohol use with psychosocial functioning according to the AUDIT, the social and familial were the more affected areas, both of which showed statistically significant differences. As to the period of evolution of schizophrenia and psychosocial functioning, the 16-20 year group was the one which showed less satisfaction. Schizophrenia severity did not show any statistical significance when compared to the type of alcohol use. Conclusion: Results from this research are similar to those from other Mexican and international studies which have found out that schizophrenia onset is more common during teenage, that more men than women are affected by the condition and that most subjects suffer it first when they are between 16 and 25 years. On the other hand, it has been found out that alcohol use is starting at increasingly early ages, with men being the main users. Such an association has lead many researchers to think that schizophrenia onset is highly associated with alcohol use, be it because the negative symptoms of schizophrenia promote the initial use of alcohol or because alcohol use triggers the early onset of schizophrenia. In this study it was not possible to prove such an hypothesis given the reduced number of subjects in the sample. This was not either the main objective of the study and given the fact that some other type of methodology is required to identify such an association. However, it is clear that there is a high non-diagnosed comorbidity between schizophrenia and alcohol use which, as a result, is not treated and translates, ultimately, into a bigger impairment of the psychosocial functioning. Among the scales employed, AUDIT is an excellent screening instrument to detect subjects at risk of becoming alcoholics and to identify incipient alcohol use patterns and the problems associated with it. Thus, it is suggested that it could be used both in first and third level hospitals. Finally, although no statistically significant results were found out in any of the variables, there is enough evidence where the association between schizophrenia and alcohol leads to an accumulated effect influencing the psychosocial functioning impairment. In the light of this, it is suggested that clinicians inquire about alcohol use in patients showing some mental pathology to research more in depth the schizophrenia-alcohol comorbidity phenomenon and its association with psychosocial functioning so as to design adequate prevention, treatment and rehabilitation programs for the schizophrenic population.