Dificultades interpersonales en los trastornos alimentarios: un modelo psiconeurobiológico explicativo/comprensivo / Interpersonal difficulties in eating disorders: an explanatory/ comprehensive psychoneurobiological model

RESUMEN: Antecedentes: Los trastornos alimentarios (TCA) presentan entre sus síntomas disfunciones psicosociales como ansiedad social, alexitimia y falta de asertividad. Objetivo: Se propone un modelo explicativo/comprensivo que integra aspectos de psiconeurobiología y comportamiento útil para la clínica. Método: Se evaluó una revisión de la literatura en Medline / PubMed, SciELO y bases de datos de textos especializados con criterios de calidad. Fueron seleccionados conceptos centrales para construir una coherencia que permitiera la lectura psiconeurobiológica del fenómeno y su aplicación clínica. Resultados: Cuatro factores fueron dispuestos a significar: 1- sistema de alarma; 2- sistema de recompensa 3- cerebro social; 4-mecanismos de control (inhibición/excitación). Se dispusieron mostrando la complejidad de su interacción psicofisiológica. Se sugiere que la ingesta de alimentos podría funcionar como una forma primaria de equilibrio cuando hay fallas en alguno de los sistemas expuestos. Conclusión: Se presenta un modelo de integración psiconeurobiológico útil para explicar la dificultad interpersonal en TCA. Esta forma de comprensión facilita: la conexión entre las investigaciones emergentes en TCA y DI; la toma de decisiones clínicas y orientan el pronóstico y las alternativas de tratamiento.

ABSTRACT Background: Eating disorders (ED) are characterized by psychosocial disfunctions, like social anxiety, alexithymia and lack of assertiveness. Objective: To propose a comprehensive integrative model including neurobiology and behavior aspects. Method: A literature review on Medline/PubMed, SciELO and specialized texts databases were assessed against quality criteria. Core concepts were extracted and coherence articulated. Results: Four factors were disposed to meaning: alarm and reward system with social brain and control (inhibition/excitation) mechanisms. They were articulate in a complex psychophysiological interplay. They were associated with social behaviours achieved/not achieved during development. Food intake could operate like a pathological balance to psychopathological effects Conclusion: An explanatory/comprehensive psychoneurobiological model to understand social function in ED is proposed. This form of understanding facilitates: the connection between emerging research in eating disorders and ID; clinical decision-making and guide the prognosis and treatment alternatives.

Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study

BACKGROUND@#Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates.@*METHODS@#Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being.@*RESULTS@#86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (β = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (β = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (β = -0.096, 95% CI -0.176, -0.033), multiple ACEs (β = -0.338, 95% CI -0.498, -0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being.@*CONCLUSIONS@#Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems.

Formulación diagnóstica integrativa y multidimensional en psiquiatría de niños y adolescentes: presentación de un caso / Case formulation comprehensive model in child and adolescent psychiatry: a case example

Resumen En la clínica psiquiátrica infanto juvenil se aconseja realizar evaluaciones en contexto del funcionamiento individual, familiar, escolar y relacional. Es así que, una formulación de diagnósticos clínicos que cuente con un método integrativo y de múltiples perspectivas de análisis, organizada además por medio de marcos de referencias, aportará a un mejor conocimiento del estado de salud del paciente y de la multifactorialidad causal habitual de los problemas mentales. Un modelo de formulación diagnóstica (FD) se puede constituir como un componente esencial en una evaluación psiquiátrica integral guiando al psiquiatra y al residente en formación en el análisis clínico inicial de su caso, conduciéndolos desde la obtención de la información clínica y el planteamiento diagnóstico global hasta la confección de un plan de intervención. El presente articulo da cuenta del análisis clínico de un caso de una adolescente consultante a un centro de salud mental cuyo equipo de atención está constituido por residentes de un programa de psiquiatría de niños adolescentes de primer año y sus supervisores. El equipo utiliza en el análisis del caso un modelo integrativo y multidimensional de formulación diagnóstica, basado en un análisis clínico de factores de riesgo ordenado temporalmente (modelo 7P), complementado con una perspectiva de modelos psicopatológicos y un modelo de funcionamiento individual. El conocimiento de cómo realizar una FD puede estimular el pensamiento reflexivo de los residentes de psiquiatría en su práctica clínica y puede constituirse como una herramienta útil para que los supervisores clínicos guíen su enseñanza.

In psychiatric clinical practice it is recommended to assess children and adolescents in the context of their individual, familial, academic and interpersonal functioning. Therefore, the formulation of clinical diagnoses using an integrative method with multiple analytical perspectives organized by frames of reference, will contribute to a better understanding of the patient's health status and the common multifactorial causation of mental health problems. A diagnostic formulation model can constitute an essential component of the integrative psychiatric assessment, guiding the psychiatrist and resident in training in the initial clinical analysis of their case, leading them from the gathering of clinical information and global diagnostic approach to the construction of an intervention plan. The present article demonstrates the clinical analysis of a case of an adolescent who presents to a mental health center, whose care team is composed of first year residents in a child and adolescent psychiatry program and their supervisors. In the analysis of the case, the team uses an integrative and multidimensional model of diagnostic formulation based on a clinical analysis of chronologically ordered risk factors (7P model), which is complemented from the perspective of psychopathological models and an individual functioning grid. Knowing how to conduct a diagnostic formulation can stimulate psychiatry residents to think reflexively in their clinical practice and can serve as a useful tool to guide clinical supervisors in their teaching.

The latent structure and reliability of the emotional trait section of the Affective and Emotional Composite Temperament Scale (AFECTS)

Abstract Background The Emotional and Affective Composite Temperament (AFECT) model describes originally six traits of volition, anger, inhibition (fear and caution subordinate factors), control, sensitivity, and coping. However, fear and caution have shown opposite relatioships with criteria-variables, indicating factor independence. Objective The current investigation aimed to advance in the evaluation of the psychometric properties of the emotional trait section of the Emotional and Affective Composite Temperament Scale (AFECTS) by examining the suitability of a 7-factor structure and the reliability of each scale using data from a population-based sample. Methods AFECTS was administered via face-to-face assessments in a single-session, population-based cross-sectional survey. Samples was composed of teenagers and adults (14 to 35 years). The latent structure and reliability were analyzed via structural equation modeling: confirmatory factor analysis was used to test the a priori correlated 7-factor model (with fear and caution designed as single-factors) and trait-scores reliability was assessed by the estimation of information curves. Results Findings attested the suitability of the 7-factor model presumed to underline the item set of the traits section of AFECTS and information curve interpretation showed adequate levels of reliability for all trait-scores. Discussion The 7-factor model showed robust indicators of construct validity for the AFECTS.

Health belief model for coronavirus infection risk determinants / Modelo de crença em saúde para determinantes de risco para contaminação por coronavírus

ABSTRACT OBJECTIVE To use the advantages of a ratio scale with verbal anchors in order to measure the risk perception in the novel coronavirus infection, which causes covid-19, in a health belief model-based questionnaire, as well as its validity and reproducibility. METHOD We used the health belief model, which explores four dimensions: perceived susceptibility (five questions), perceived severity (five questions), perceived benefits (five questions), and perceived barriers (five questions). Additionally, we included a fifth dimension, called pro-health motivation (four questions). The questions composed an electronic questionnaire disseminated by social networks for an one-week period. Answers were quantitative values of subjective representations, obtained by a psychophysically constructed scale with verbal anchors ratio (CentiMax ® ). Mean time for total filling was 12 minutes (standard deviation = 1.6). RESULTS We obtained 277 complete responses to the form. One was excluded because it belonged to a participant under 18 years old. Reproducibility measures were significant for 22 of the 24 questions in our questionnaire (Cronbach's α = 0.883). Convergent validity was attested by Spearman-Brown's split half reliability coefficient (r = 0.882). Significant differences among groups were more intense in perceived susceptibility and severity dimensions, and less in perceived benefits and barriers. CONCLUSION Our health belief model-based questionnaire using quantitative measures enabled the confirmation of popular beliefs about covid-19 infection risks. The advantage in our approach lays in the possibility of quickly, directly and quantitatively identifying individual belief profiles for each dimension in the questionnaire, serving as a great ally for communication processes and public health education.

RESUMO OBJETIVO Neste estudo buscamos utilizar as vantagens de uma escala de razão por ancoragem verbal para medidas da percepção de risco de contágio pelo novo coronavírus, causador da covid-19, em um questionário baseado no modelo de crença em saúde, assim como avaliar sua validade e reprodutibilidade. MÉTODO Utilizamos o modelo de crença em saúde, o qual explora quatro dimensões: percepção individual de susceptibilidade percebida (cinco questões), severidade percebida (cinco questões), benefícios percebidos (cinco questões) e barreiras percebidas (cinco questões). Adicionalmente, incluímos uma quinta dimensão, a qual denominamos motivação pró-saúde (quatro questões). As questões definiram um questionário eletrônico que foi divulgado por redes sociais pelo período de uma semana. As respostas foram valores quantitativos de representações subjetivas, obtidas por meio de uma escala psicofísica de razão com ancoragem verbal (CentiMax ® ). O tempo médio total de preenchimento foi de 12 minutos (desvio-padrão = 1,6). RESULTADOS Obtivemos 277 respostas completas ao formulário. Uma foi excluída por se tratar de participante com menos de 18 anos de idade. Medidas de reprodutibilidade foram significantes para 22 das 24 questões de nosso questionário (α de Cronbach = 0,883). A validade convergente foi atestada pelo coeficiente de correlação de Spearman-Brown split half (r = 0,882). Diferenças significantes entre grupos foram encontradas mais intensamente nas dimensões susceptibilidade percebida e severidade percebida, e menos intensamente para benefícios percebidos e barreiras percebidas. CONCLUSÃO Nosso questionário baseado no modelo de crença em saúde utilizando medidas quantitativas permitiu evidenciar as crenças populares sobre os riscos de contágio por covid-19. A vantagem de nossa abordagem é a possibilidade de se identificar os perfis de crença individuais para cada dimensão do questionário de forma rápida, direta e quantitativa, podendo ser uma grande aliada em processos de comunicação e educação em saúde pública.

Comparación de las percepciones del cáncer entre pacientes oncológicos y personal de salud / Comparison of social representations about cancer between cancer patients and health professional

El cáncer es una de las principales causas de muerte en el mundo. Las percepciones sobre esta enfermedad impactan en la calidad de vida de los pacientes y del personal de salud. El objetivo de esta investigación fue conocer la percepción del cáncer en pacientes oncológicos y profesionales de la salud y compararlas entre sí. La investigación se realizó en un centro oncológico del estado de Querétaro, México, y se trató de un estudio cualitativo, en el que se utilizó la técnica "listados libres" de la antropología cognitiva. Constó de 10 pacientes con cáncer y 10 profesionales de la salud. El instrumento utilizado fue el de "listados libres". El análisis realizado fue perceptual cualitativo categorizando las palabras mencionadas en "listados libres" y un análisis de contenido temático. Se analizaron frecuencias y porcentajes de categorías y posteriormente se compararon entre personal y pacientes. En los resultados, se identificaron categorías de emociones displacenteras, afrontamiento, tratamientos y oportunidad en ambos grupos. Las diferencias identificadas fueron que los profesionales incluían emociones displacenteras en ellos mismos, elementos de relación médico paciente y aspectos administrativos-económicos. Se concluye que existen similitudes entre profesionales de salud y pacientes en la percepción del cáncer, sin embargo, hay diferencias que deben ser tomadas en cuenta, como que el personal de salud también presenta malestar emocional.

In Mexico and the world, cancer is one of the leading causes of death. Associations with this disease can have an impact on the quality of life of patients and health professionals practising oncology. As a result, it was considered relevant to study the social representations (SR) of cancer and to make a comparison between oncology patients and health professionals. Methods: The study was conducted in an oncology centre in the state of Querétaro, Mexico, and the sample consisted of 10 patients and 10 health professionals. Using qualitative perceptual analysis, it categorised the words mentioned in "free listings" and thematic analysis. Results: Categories of unpleasant emotions, coping, treatment and opportunity were identified in both groups. There were differences between SRs of cancer patients and health professionals; professionals included displeasing emotions in themselves (in addition to patients), elements of the doctor-patient relationship and administrative-economic aspects. Conclusions: There are some similarities between health professionals and cancer patients in terms of cancer perception; however, there are differences that should be considered. One of them is that health staff also present emotional discomfort (even if they are not the ones who have the disease), patients did not present the category "death". In contrast, health staff did, this as well as the administrative-economic category. These findings allow us to explore the perceptions of staff and patients to determine future lines of research.

Modelos Mentales de Clima Escolar en Docentes y Estudiantes de Básica Primaria / Mental Models of School Climate in Elementary School Teachers and Students

Las conductas violentas en el noviazgo de adolescentes han sido objeto de especial interés en las últimas décadas. En su estudio se han abordado diversos factores individuales, relacionales, familiares y sociales. En el caso de los aspectos familiares, se ha sugerido que la vivencia de experiencias negativas en el seno familiar podría funcionar como factor de riesgo para la aparición de conductas violentas. Por ello, el presente estudio explora las diferencias por sexo en cuanto a la violencia sufrida y cometida, así como la posible asociación entre la cohesión y la adaptabilidad familiar con la frecuencia de conductas violentas cometidas o sufridas en una muestra participantes. Participaron 161 mujeres y 151 hombres, con edades entre los 15 y 19 años (M= 16.73; DT=1.093), originarios del estado de Colima, México. Entre los diversos resultados obtenidos destaca que no se hallaron diferencias estadísticamente significativas en los diversos tipos de violencia evaluados, aunque los hombres señalaron haber sufrido más violencia que las mujeres. Añadido a ello, ambos sexos señalaron mayor frecuencia en conductas específicas de control hacia su pareja y presión para sostener relaciones sexuales. Con respecto a la asociación teórica entre funcionamiento familiar, evaluado a través de la cohesión y adaptabilidad, y la violencia cometida y sufrida, solo se hallaron correlaciones muy débiles. Se discuten los resultados enfatizando la prevención de la minimización o normalización de conductas específicas de control entre los y las jóvenes.

Violent behavior in adolescent dating has been an object of special interest in recent decades. Individual, relational, family and social factors have been prioritized in its research. In the case of family aspects, it has been suggested that the experience of negative experiences in the family could work as a risk factor for the manifestation of violent behavior. Therefore, the present study explores the differences by sex in terms of violence suffered and committed, as well as the possible association between cohesion and family adaptability with the frequency of violent behaviors committed or suffered in the participating sample. 161 women and 151 men participated, aged between 15 and 19 years (M = 16.73; DT = 1.093), originating in the state of Colima, Mexico. Among the various results obtained, it is pointed out that no statistically significant differences were found in the different types of violence evaluated, although men indicated that they suffered more violence than women. Besides, both sexes indicated greater frequency in specific behaviors of control towards their partner and pressure to sustain sexual relations. With respect to the theoretical association between family functioning, assessed through cohesion and adaptability, and the violence committed and suffered, only very weak correlations were found. The results are discussed emphasizing the prevention of the minimization or normalization of specific control behaviors among young people

Relationship among mental models, theories of change, and metacognition: structured clinical simulation / Relación entre modelos mentales, teorías del cambio y metacognición: Simulación clínica estructurada

Abstract Learning is a change in the way of thinking that lasts over time and allows for solving problems; on the other hand, education based on structured clinical simulation is a pedagogic mediation between the classroom and clinical practice, which allows experience, reflection, monitoring, control, and restructuring of thought, which can contribute to deep and lasting learning. It is desirable that students, both undergraduate and graduate, are given the opportunity to be trained under structured simulation.

Resumen El aprendizaje es el cambio en el pensamiento que perdura en el tiempo y permite la solución de problemas; por su parte, la educación basada en simulación clínica estructurada es una mediación pedagógica entre el aula de clase y la práctica clínica, que permite experiencia, reflexión, monitoreo, control y reestructuración del pensamiento, lo que puede aportar en aprendizajes profundos y duraderos. Es deseable que los estudiantes, tanto en pregrado como en posgrado, tengan la oportunidad de ser formados con simulación estructurada.

Investigating the Spectra constellations of the Hierarchical Taxonomy of Psychopathology (HiTOP) model for personality disorders based on empirical data from a community sample

Objective: The Hierarchical Taxonomy of Psychopathology (HiTOP) posits that psychopathology is hierarchically structured. For personality disorder (PD) traits, there are five spectra: internalizing, thought disorder, disinhibited externalizing, antagonistic externalizing, and detachment. Empirical findings suggest a sixth group, compulsivity. In this research, we tried to recover the five HiTOP spectra, plus compulsivity, specifically for PD traits. Methods: The sample was composed of 4,868 Brazilians (54.9% women, age ranging from 18 to 70; mean = 25.7; SD = 9.64). All participants answered the Dimensional Clinical Personality Inventory 2 (IDCP-2), a self-report inventory for adults, developed in Brazil, for assessment of pathological personality traits. Results: Parallel analysis yielded up to nine factors. On exploratory structural equation modeling (E-SEM), the balance between interpretability and fit index suggested the six-factor solution as the best solution. The fit indexes for the confirmatory factor analysis were slightly less adjusted in comparison to the empirical model. Conclusion: The hypothesis was confirmed, as we did find the groups proposed at the spectrum level of the HiTOP. We also found a compulsivity factor, encompassing the main traits from the conscientiousness dimension of IDCP-2, which is related to obsessive-compulsive PD. Finding the six groupings of traits in the HiTOP model contributes to the validity of this model, and confirms the existence of proposed spectra.

Perfil de desregulación definido mediante el instrumento Child Behavior Checklist en preescolares / Dysregulation profile defined by Child Behavior Checklist in a sample of preschool children

INTRODUCCIÓN: El perfil de desregulación (PD) es una entidad clínica de interés en el área infantojuvenil, puesto que se asocia a psicopatología futura. El PD se define a partir del instrumento Child Beha vior Checklist (CBCL), combinando síntomas internalizantes (ansiedad/depresión) y externalizantes (agresividad, problemas de atención). OBJETIVO: Estudiar la frecuencia del perfil de PD por CBCL en una muestra de preescolares chilenos. PACIENTES Y MÉTODO: Se aplicó una encuesta sociodemográfica y Cuestionario CBCL 1% - 5 a cuidadores de niños entre 30 y 48 meses de edad, en una muestra representativa nacional de usuarios de red pública. Se estimó la frecuencia utilizando el método de Kim y colaboradores y se realizó un modelo explicativo mediante regresión logística binaria del PD utilizando variables del cuidador, del niño y del contexto. RESULTADOS: La muestra fue de 1429 pre escolares y sus cuidadores. La frecuencia de PD fue de 11,6% (IC 95% 9,9-13,5%). Las variables que permiten predecir el PD en un 88,6% fueron: Síntomas depresivos actuales en el cuidador principal (OR: 2,24; IC95%: 1,37-3,67); Número de eventos vitales estresantes vividos por el cuidador principal (p = 0,005); Número de elementos disponibles para estimulación en el hogar (p = 0,001); Número de enfermedades crónicas del niño (p = 0,006). CONCLUSIONES: PD tiene una frecuencia alta en preesco lares, lo que implica una carga en salud mental relevante, apuntando a la necesidad de intervenciones en esta área, además de seguimiento longitudinal de esta subpoblación.

INTRODUCTION: The dysregulation profile (DP) is a relevant clinical entity in the children and ado lescent area since its association with future psychopathology. DP is defined by the Child Behavior Checklist (CBCL), combining internalizing symptoms (anxiety/depression) and externalizing ones (aggressiveness, attention problems). OBJECTIVES: To study the frequency of CBCL-DP in a sample of Chilean preschoolers. PATIENTS AND METHOD: A sociodemographic survey and CBCL 1.5-5 was applied to caregivers of children aged 30 to 48 months in a national representative sample of public health system users. Frequency was estimated using the Kim et al. method and an explanatory model was made using binary logistic regression of DP using the child, caregiver, and contextual variables. RESULTS: The sample size was n = 1,429 preschool children and their caregivers. The frequency of DP was 11.6% (95% CI 9.9-13.5%). The variables that allow to classify DP in 88.6% of cases were: current depressive symptoms in the main caregiver (OR: 2.24; 95% CI 1.37-3.67); number of stressful events experienced by the main caregiver (p = 0.005); number of available elements for child development stimulation in the home (p = 0.001); number of chronic diseases of the child (p = 0.006). CONCLUSIONS: DP has a high frequency in preschoolers, which implies a relevant mental health burden. This finding points to the need for interventions in this area and also longitudinal monitoring of this subgroup.

Suicide risk configuration system in a clustered clinical sample: a generalized linear model obtained through the LASSO technique

Objective: To identify clinical and sociodemographic factors that increase or decrease suicidal risk in a clinical sample of subjects seeking mental health care. Method: A cross-sectional study was performed at three health centers in Santiago, Chile. The Parental Bonding Instrument (PBI), Depressive Experience Questionnaire (DEQ), Outcome Questionnaire (OQ-45.2), Reasons for Living Inventory (RFL), and State Trait Anger Expression Inventory (STAXI-2), in addition to a sociodemographic survey, were applied to 544 participants (333 with suicidal behavior and 211 without current suicidal behavior). Through hierarchical clustering analysis, participants were grouped by similarity regarding suicidal risk. Then, a regression analysis was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) technique, and factors that decrease or increase suicide risk (SR) were identified for each cluster. Results: The resultant clusters were grouped mainly by the age of participants. The most important protective factor was having confidence in one's own coping skills in difficult situations. Relevant risk factors were major depressive disorder (MDD), poor anger management, and difficulties in interpersonal relationships. Conclusions: Suicidal risk manifests differently throughout the life cycle, and different types of bonds may protect from or increase risk of suicide.

Tipos Psicológicos y Estilos de Aprendizaje en Estudiantes de la Carrera de Odontología en la Universidad de La Frontera, Chile / Psychological Types and Learning Styles in Students of the Dental Graduation Program at Universidad de La Frontera, Chile

RESUMEN: El objetivo fue establecer los tipos psicológicos y estilos de aprendizaje de los estudiantes que cursaron de primer a sexto año de la Carrera de Odontología de la Universidad de La Frontera, Temuco, Chile. Se realizó un diseño cualitativo, correlacional, descriptivo y transeccional estableciendo la existencia de correlación entre los tipos psicológicos, sexo y nivel curricular aplicando dos instrumentos: tipos psicológicos de Myers y Briggs forma M versión español (MBTI, 2012) y el Inventario de Estilos de Aprendizaje de Kolb (IEA de Kolb). Se incluyeron 372 sujetos, 208 (56 %) del sexo femenino y 164 (44 %) del sexo masculino. Según el estilo de aprendizaje, los sujetos se caracterizaron mayoritariamente por ser divergentes (63 % de la muestra), seguido del grupo acomodador (26 % de la muestra) y finalmente le siguieron el grupo asimilador y convergente con un 8 % y 3 % respectivamente. Al avanzar de nivel curricular e ingresar en las asignaturas de clínicas odontológicas y tratar con pacientes, el tipo psicológico cambió gradualmente con predominancia de la dimensión extroversión e incremento de la dimensión Juicio a un ESTJ. El estilo de aprendizaje en los niveles cuarto, quinto y sexto fue más divergente para finalizar con un estiloacomodador en los estudiantes de sexto año. Se puede concluir que los tipos psicológicos y estilos de aprendizaje no fueron homogéneos en los distintos niveles curriculares.

ABSTRACT: The aim was to establish the psychological types and learning styles of the students between the first to sixth year of the Graduation Program in Dentistry at the University of La Frontera, Temuco, Chile. A qualitative, correlational, descriptive and transectional design was made to observe the existence of correlation between the psychological types, sex and curricular level applying two instruments: psychological types of Myers and Briggs form M Spanish version (MBTI, 2012) and the Inventory of Styles of Learning from Kolb (IEA of Kolb). Were included 372 subjects, 208 (56 %) female and 164 (44 %) male. According to the learning style, the subjects were characterized mainly by divergent (63 % of the sample), followed by the accommodating group (26 % of the sample) and finally followed by the assimilating and convergent group with 8 % and 3 % respectively. In more advance curricular level, mainly at dental clinics level and dealing with patients, the psychological type gradually changed with predominance of the extroversion dimension and increase of the Judgment dimension to an ESTJ. The learning style at the fourth, fifth and sixth levels was more divergent to end with an accommodating style in sixth grade students. It can be concluded that the psychological types and learning styles were not homogeneous at the different curricular levels.

A structural model of well-being, spontaneity and self-efficacy: Italian validation between adolescents and young adults / Um modelo estrutural entre bem-estar, espontaneidade e autoeficácia: validação italiana entre adolescentes e adultos jovens

Abstract Introduction: The passage from adolescence to young adulthood introduces many challenges and chances aimed at promoting independence, financial self-sufficiency, assumption of responsibilities and separation from parents. Literature shows that in the continuum between these two phases of life, many factors intervene, producing significant differentiations. Methods: This study considered three dimensions - well-being, measured through the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM); spontaneity, measured through the Spontaneity Assessment Inventory-Revised (SAI-R); and self-efficacy, measured through the General Self-Efficacy scale (GSE). The study involved two groups of Italian participants: 495 adolescents, aged between 13 and 19 years, selected at a high school; and 368 young adults, aged between 18 and 30 years, recruited by snowball sampling. Results: Results of confirmatory factor analysis for each instrument in each group indicate the validity of the three instruments for both age groups. No significant differences were found between adolescents and young adults on total or subtotal scores of the CORE-OM, except for the risk factor. Conversely, the mean scores obtained with SAI-R and GSE were very different between adolescents and young adults. Conclusions: The results of path analysis show a significant mediation of spontaneity in the link between self-efficacy and all specific psychological distress domains for adolescents. Instead, there is a significant mediation of spontaneity between self-efficacy and all specific psychological distress domains except the risk domain for young adults.

Resumo Introdução: A transição da adolescência para a idade adulta envolve muitos desafios e oportunidades de promover independência, autossuficiência financeira, assunção de responsabilidades e a saída da casa dos pais. A literatura mostra que, na passagem entre essas duas fases do ciclo vital, muitos fatores podem intervir, gerando mudanças significativas. Métodos: Este estudo considerou três dimensões psíquicas: bem-estar, investigado através do Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM); espontaneidade, investigada através do Spontaneity Assessment Inventory-Revised (SAI-R); e autoeficácia, investigada por meio da escala General Self-Efficacy (GSE). O estudo envolveu dois grupos de participantes italianos: 495 adolescentes com idade entre 13 e 19 anos, selecionados em uma escola de ensino médio; e 368 jovens adultos com idade entre 18 e 30 anos, recrutados por meio de amostragem em bola de neve. Resultados: Os resultados da análise fatorial confirmatória para cada instrumento em cada grupo indicaram a validade dos três instrumentos para as duas faixas etárias. Não foram observadas diferenças significativas entre adolescentes e jovens adultos nos resultados total e subtotal do CORE-OM, exceto pelo fator risco. Por outro lado, os resultados médios obtidos nos instrumentos SAI-R e GSE foram muitos diferentes entre adolescentes e jovens adultos. Conclusões: Os resultados da análise fatorial mostram uma mediação significativa da espontaneidade entre a autoeficácia e todos os domínios das dificuldades psicológicas específicas dos adolescentes. Em contraste, há uma mediação significativa da espontaneidade entre a autoeficácia e todos os domínios específicos das dificuldades psicológicas dos jovens adultos, exceto para o domínio risco.

Modelos psicopatológicos integrativos para la formulación diagnóstica en psiquiatría de niños y adolescentes / Integrative psychopathological models for diagnostic formulation in child and adolescent psychiatry

Resumen: la psiquiatría de niños y adolescentes si quiere tener una línea de acción clínica más efectiva necesita de paradigmas o modelos de comprensión de los fenómenos psicopatológicos. La elección de un modelo o de una perspectiva de análisis ante un determinado caso en muchas ocasiones es un desafío. Aunque el psiquiatra haya sido formado en una teoría o un modelo determinado, la práctica psiquiátrica muchas veces lo insta a buscar modelos más pluralistas e integrativos que den cuenta de un modo más global de la realidad que vive el niño o adolescente psíquicamente afectado. El propósito de este artículo es realizar una reflexión teórica - clínica de distintos modelos de comprensión psicopatológica que pueden ser útiles de considerar cuando se procede a realizar una formulación diagnóstica en psiquiatría infanto juvenil. Se revisan los modelos psicopatológicos tradicionales básicos y se describen algunos modelos complementarios que pueden servir de apoyo a la evaluación psiquiátrica. Se espera que el artículo sea un aporte fundamentalmente para los nuevos profesionales que se están formando en la especialidad y que necesitan de orientaciones clínicas para la realización de un diagnóstico psiquiátrico. (AU)

Abstract: child and adolescent psychiatry needs frameworks or explanatory models for psychopathologic phenomena in order to achieve a more effective clinical course. Oftentimes, choosing a model or an analysis perspective when facing a case can be challenging. Although the psychiatrist may adscribe to a particular model or theory, the psychiatric practice will lead him or her to look for more comprehensive models that account in a global manner for the experience of the affected child or adolescent. The purpose of this article is to pursue both a theoretical and clinical reflection on the different explanatory models of psychopathological comprehension that may be useful to consider when preparing a case formulation in child and adolescent psychiatry. We emphasize the description of some complementary models to the more traditional, foundational psychopathological ones, which may provide support in a clinical psychiatric evaluation. We hope this article will be useful especially to the new professionals that are being trained in the specialty and that need clinical guidance in the formulation of a psychiatric diagnosis.(AU)

Estrutura conceptual do envelhecimento em diferentes etnias / Estructuras conceptuales del envejecimiento en diferentes etnias / Conceptual structure of aging in different ethnicities

Resumo OBJETIVO Elaborar uma estrutura conceptual que explique como idosos de diferentes culturas vivenciam o envelhecimento, formulam conceitos e atribuem valores ao processo de envelhecer. MÉTODO Pesquisa de abordagem qualitativa, realizada com 33 idosos, em município da tríplice fronteira. Os dados foram coletados no período entre fevereiro e agosto de 2011, utilizando como estratégia teórico-metodológica o Interacionismo Simbólico e a Grounded Theory. RESULTADOS Identificou-se o tema central "Tendo que envelhecer: as práticas socioculturais direcionando o envelhecimento em diferentes etnias", constituído por subprocessos que caracterizam os conceitos estruturais do estudo: A velhice concebida por multifatores (físicos, biopsíquicos e socioculturais); Vivenciando o envelhecer no processo de adaptação cultural; Vivenciando o envelhecer como a continuidade da vida; Redefinindo os papeis sociais e; A cultura influenciando hábitos e costumes no cuidado à saúde. CONCLUSÕES A experiência de envelhecer revelou-se um processo singular a cada indivíduo e os valores atribuídos ao mesmo são influenciáveis pela cultura.

Resumen OBJETIVO Elaborar una estructura conceptual que explique cómo ancianos de diferentes culturas sienten el envejecimiento, formulan conceptos y atribuyen valores en el proceso de envejecer. MÉTODO Investigación de abordaje cualitativa, realizada con 33 ancianos, en un municipio de la triple frontera. Se recolectaron los datos desde febrero hasta agosto del 2011, utilizando como estrategia teórica-metodológica el Interaccionismo Simbólico y el Grounded Theory. RESULTADO La temática central identificada fue: "Teniendo que envejecer: las prácticas socioculturales direccionando el envejecimiento en diferentes etnias", constituido por subprocesos que caracterizan los conceptos estructurales del estudio: La vejez concebida como multifactorial (físicos, biopsíquicos y socioculturales); Vivenciando el envejecimiento en el proceso de adaptación cultural; Vivenciando el envejecimiento como continuación de la vida; Redefiniendo los papeles sociales; y La cultura influenciando hábitos y costumbres en el cuidado a la salud. CONCLUSIÓN La experiencia de envejecer se mostró como un proceso singular de cada individuo y los valores atribuidos al mismo son influenciados por cada cultura.

Abstract OBJECTIVE To develop a conceptual framework that explains how elderly people from different cultures experience aging, formulate concepts and assign values to the process of aging. METHOD Qualitative research conducted with 33 elderly people in a municipality of the triple border. The data were collected between February and August of 2011, using Symbolic Interactionism and the Grounded Theory as the theoretical and methodological strategy. RESULTS The central theme identified was: "Having to age: sociocultural practices guiding aging in different ethnicities", which was made up of sub processes that characterize the study's structural concepts: aging conceived as multifactorial (physical, biopsychic and sociocultural); Experiencing aging in the process of cultural adaptation; Experiencing aging as the continuation of life; Redefining social roles; and The culture influencing habits and customs in healthcare. CONCLUSION The experience of aging proved to be a unique process for each individual and the values assigned to it are influenced by one's own culture.

Latent class profile of psychiatric symptoms and treatment utilization in a sample of patients with co-occurring disorders

Objective: To identify symptom-based subgroups within a sample of patients with co-occurring disorders (CODs) and to analyze intersubgroup differences in mental health services utilization. Methods: Two hundred and fifteen patients with COD from an addiction clinic completed the Symptom Checklist 90-Revised. Subgroups were determined using latent class profile analysis. Services utilization data were collected from electronic records during a 3-year span. Results: The five-class model obtained the best fit (Bayesian information criteria [BIC] = 3,546.95; adjusted BIC = 3,363.14; bootstrapped likelihood ratio test p < 0.0001). Differences between classes were quantitative, and groups were labeled according to severity: mild (26%), mild-moderate (28.8%), moderate (18.6%), moderate-severe (17.2%), and severe (9.3%). A significant time by class interaction was obtained (chi-square [χ2[15]] = 30.05, p = 0.012); mild (χ2[1] = 243.90, p < 0.05), mild-moderate (χ2[1] = 198.03, p < 0.05), and moderate (χ2[1] = 526.77, p < 0.05) classes displayed significantly higher treatment utilization. Conclusion: The classes with more symptom severity (moderate-severe and severe) displayed lower utilization of services across time when compared to participants belonging to less severe groups. However, as pairwise differences in treatment utilization between classes were not significant between every subgroup, future studies should determine whether subgroup membership predicts other treatment outcomes.

Erosión empática durante la formación médica según el género: Estudio transversal / Erosion of empathy during medical training by gender: A cross-sectional study

Introducción. La erosión empática puede ser definida como la disminución brusca de los niveles de empatia que se manifiesta a partir de tercer año y persiste hasta el quinto curso. Según algunos autores, este proceso surge, normalmente, durante la formación médica y podría considerarse como un modelo de comportamiento empático. El objetivo del presente trabajo fue verificar si la erosión empática es un caso general en las facultades de Medicina examinadas y su relación con el género. Diseño. Exploratorio y de corte transversal. Población. Estudiantes de los cursos de primero a sexto año de la carrera de Medicina de la Universidad del Azuay (Cuenca, Ecuador) y de primero a quinto en la Corporación Universitaria Rafael Nuñez (Colombia). Material y métodos. Se estimaron los niveles de empatía general y de cada componente mediante la escala de empatia médica de Jefferson en ambas facultades durante los meses de julio y agosto de 2016. El nivel de significación fue de a < 0, 05. Resultados. Universidad del Azuay: n= 278 (98% del total); mujeres= 112; hombres= 166; Corporación Universitaria Rafael Nuñez: n= 756 (77, 86% del total); mujeres= 434; hombres= 322. El modelo de la erosión empática no se cumple de forma general ni en los propios componentes estudiados por género. Conclusiones. La erosión empática es un caso particular de varios modelos diferentes de la respuesta empática (y la de sus componentes). Los géneros no tienen la misma respuesta empática. Esta respuesta, bajo las condiciones estudiadas, tiene variabilidad.

Introduction. Empathy erosion may be defined as a sudden decline in the levels of empathy that occurs as of the third year of medical school and continues until the fifth year. According to some authors, this process is normal during medical training and may be considered a model of empathic behavior. The objective of this study was to verify whether empathy erosion is a general phenomenon in the schools of medicine included in the study and its relation to gender. Design. Exploratory, cross-sectional study. Population. Students from first through sixth year of the School of Medicine of Universidad del Azuay (Cuenca, Ecuador) and from first through fifth year of the School of Medicine of Corporación Universitaria Rafael Nuñez (Colombia). Material and methods. The levels of overall empathy and of each component were estimated using the Jefferson Scale of Empathy, which was administered in both schools during July and August of 2016. The significance level was established at a < 0.05. Results. Universidad del Azuay: n= 278 (98% of all students); women= 112; men= 166; Corporación Universitaria Rafael Nuñez: n= 756 (77.86% of all students); women= 434; men= 322. The model of erosion of empathy is not fulfilled at the level of overall empathy or of each studied component according to gender. Conclusions. Empathy erosion is a specific element of several different models of empathic response (and of its components). Men and women do not have the same empathic response. Such response, in the studied conditions, is variable.

Perfectionism and negative/positive affect associations: the role of cognitive emotion regulation and perceived distress/coping / Associação entre perfecionismo e afeto negativo e positivo: o papel da regulação emocional cognitiva e do stresse/coping percebidos

Abstract Objective To explore 1) if perfectionism, perceived distress/coping, and cognitive emotion regulation (CER) are associated with and predictive of negative/positive affect (NA/PA); and 2) if CER and perceived distress/coping are associated with perfectionism and if they mediate the perfectionism-NA/PA associations. There is a distinction between maladaptive and adaptive perfectionism in its association with NA/PA. CER and perceived distress/coping may mediate the maladaptive/adaptive perfectionism and NA/PA associations. Methods 344 students (68.4% girls) completed the Hewitt & Flett and the Frost Multidimensional Perfectionism Scales, the Composite Multidimensional Perfectionism Scale, the Profile of Mood States, the Perceived Stress Scale, and the Cognitive Emotion Regulation Questionnaire. Results NA predictors were maladaptive/adaptive perfectionism, maladaptive CER and perceived distress (positively), positive reappraisal and planning, and perceived coping (negatively). PA predictors were maladaptive/adaptive perfectionism and perceived distress (negatively), positive reappraisal and planning, positive refocusing and perceived coping (positively). The association between maladaptive perfectionism and NA was mediated by maladaptive CER/low adaptive CER, perceived distress/low coping. Maladaptive perfectionism and low PA association was mediated by perceived distress. High PA was determined by low maladaptive perfectionism and this association was mediated by adaptive REC and coping. Adaptive perfectionism and NA association was mediated by maladaptive CER and perceived distress. Conclusion CER and perceived distress/coping are associated and mediate the perfectionism-NA/PA associations.

Resumo Objetivo Explorar 1) se o perfeccionismo, o estresse/copingpercebidos e a regulação emocional cognitiva (REC) estão associadas e predizem o afeto negativo/positivo (AN/AP); e 2) se a REC e o estresse/copingestão associados e mediam a relação perfeccionismo-AN/AP. Existe uma distinção entre o perfeccionismo mal-adaptativo/adaptativo na associação com o AN/AP. A REC e o estresse/copingpoderão mediar as associações entre o perfeccionismo mal-adaptativo/adaptativo-AN/AP. Métodos 344 estudantes (68.4% do sexo feminino) completaram as Escalas Multidimensionais do Perfeccionismo de Hewitt & Flett e de Frost, a Escala Multidimensional de Perfeccionismo Compósita, o Perfil dos Estados de Humor, a Escala de Estresse Percebido e o Questionário da Regulação Emocional Cognitiva. Resultados Os preditores do AN foram o perfeccionismo adaptativo/mal-adaptativo, a REC mal-adaptativa e o estresse percebido (positivamente), a reavaliação positiva e planeamento e o coping(negativamente). Os preditores do AP foram o perfeccionismo adaptativo/mal-adaptativo e o estresse percebido (negativamente), a reavaliação positiva e planeamento, a refocalização positiva e o copingpercebido (positivamente). A associação entre o perfeccionismo mal-adaptativo e o AN foi mediada pela REC mal-adaptativa/baixa REC adaptativa, pelo estresse/baixo copingpercebidos. A associação entre o perfeccionismo mal-adaptativo/adaptativo e baixo AP foi mediada pelo estresse percebido. O elevado AP foi determinado pelo baixo perfeccionismo mal-adaptativo e esta associação foi mediada pela REC adaptativa e pelo coping. A associação entre o perfeccionismo adaptativo e o AN foi mediada pela REC mal-adaptativa e pelo estresse percebido. Conclusão A REC e o estresse/copingpercebidos estão associados e medeiam as associações entre o perfeccionismo e AN/AP.

Nivel Socioeconómico y conductas externalizadas en preescolares: el rol del mediador parental / Socioeconomical level and behavior in school-age children: the mediating role of parents

Un determinante de particular relevancia en el desarrollo humano es el nivel socioeconómico y, en específico, el nivel socioeconómico (NSE) bajo y la pobreza. El entorno familiar es asimismo fundamental en el desarrollo de niños y niñas, y un potencial mediador o moderador del efecto de condiciones sociales más amplias. Objetivo: Analizar el rol del estrés parental como variable mediadora de la relación del NSE con conductas externalizadas e internalizadas en niños y niñas preescolares. Sujetos y Método: Estudio descriptivo de base secundaria basado en la Encuesta Longitudinal de Primera Infancia Chilena que seleccionó una muestra estratificada, representativa por clusters, de 9.996 niños y niñas de 3 a 5 años y sus cuidadoras(es), los(as) que completaron una batería de instrumentos para la medida de las variables de NSE, estrés parental y conductas externalizadas e internalizadas. El análisis utilizó un modelo lineal con estimación por mínimos cuadrados. Como prueba de hipótesis, se usó la Dm, una adaptación de la prueba F para imputación múltiple. Resultados: El modelo de mediación del estrés parental en la relación entre NSE y conductas externalizadas e internalizadas se corroboró para las segundas; respecto de las conductas externalizadas se observó un modelo de moderación, siendo menor la influencia del estrés en el NSE bajo. Conclusiones: El estrés parental mostró una clara relación con la presencia de conductas externalizadas e internalizadas, más fuerte que el NSE; la relación entre NSE y estrés parental resulta de importancia para comprender los procesos que afectan el desarrollo de niños y niñas.

A determinant of particular relevance in human development is the socioeconomic status (SES) and, specifically, low SES and poverty. Likewise, family environment is essential in the development of children and a potential mediator or moderator of the effect of broader social conditions. Objective: To analyze the role of parenting stress as a mediating variable of the relationship between SES and both externalized and internalized behaviors in preschool children. Subjects and Method: Descriptive secondary base study based on the Longitudinal Survey of Chilean First Infancy that selected a stratified sample, representative by clusters, of 9.996 children from 3 to 5 years old and their caregivers, that completed a battery of instruments for measuring SES variables, parenting stress and externalized and internalized behaviors. The analysis used a linear model with least square estimate. As hypothesis testing, the Dm (an adaptation of the F-test for multiple imputation method) was used. Results: The mediation model of parenting stress in the relationship between SES and both externalized and internalized behaviors was confirmed for the latter; regarding externalized behaviors a model of moderation was observed, being the stress influence lower on the low SES. Conclusions: Parental stress showed a clear relationship with the presence of externalized and internalized behaviors, stronger than the SES. The relationship between SES and parenting stress is very important to understand the processes that affect children’s development.