Mindfulness y la relación clínica: pasos hacia una resiliencia en medicina / Mindfulness and the clinical relationship: steps to a resilience in medicine

Medical resilience is a dynamic capacity, which has the potential to improve the well-being of physicians and to enhance the quality of the clinical relationship. Strategies to promote resilience are important to achieve a sustainable medical practice and improve patient care. Mindfulness training has demonstrated to be an effective tool to promote resilience in physicians. This paper contextualizes the place of mindfulness in medical practice and describes the ways through which it can contribute to resilience in medicine. The concept of mindfulness, its relationship with health practice is reviewed and the benefits of the practice of mindfulness in the clinical relationship are described. We suggest that the benefits achieved through a mindfulness-based medical practice are mediated by two axes. One is the nonspecific and specific effect of mindfulness-based practices and the other is the integration of explicit and implicit knowledge of clinical practice. We conclude that medical practice that integrates mindfulness can contribute to the challenge of achieving greater levels of individual, staff and institutional resilience. There is a need to have continuing mindfulness training programs for health professionals and to integrate this concept in the curriculum of health care professionals.

Análisis de la validez del programa de simulación 3D My-School para la detección de alumnos en riesgo de consumo de drogas y acoso escolar / Analysis of the validity of the My-School 3D simulation program for the detection of students at risk of drug use and bullying

Resumen El presente escrito está dirigido al análisis de las propiedades psicométricas del programa de simulación 3D My-School (MS), el cual fue diseñado para detectar alumnos en riesgo de consumo de drogas y acoso escolar. En concreto, se han llevado a cabo dos estudios empíricos encaminados a evaluar, por un lado, la validez de contenido de las escenas, y por otro la validez de criterio (predictiva) del programa informático. Si atendemos a la evaluación de la validez de contenido, los resultados mostraron la existencia de un acuerdo sustancial entre el total de jueces expertos con respecto a la relevancia, coherencia, claridad y poca tendenciosidad de las situaciones. Con respecto a la validez de criterio, no existieron diferencias entre las respuestas dadas en el programa y las entrevistas, el programa informático MS habría mostrado poseer adecuadas propiedades de validez para detectar alumnos en riesgo de consumo de sustancias y acoso escolar.

Abstract The present paper analyses the psychometric properties of the My-School (MS) 3D simulation program, which was designed to detect students at risk of drug abuse and bullying. In particular, two empirical studies have been carried out to evaluate, on the one hand, the content validity of the scenes, and on the other, the validity criterion (predictive) of the software. Specifically, in terms of the evaluation of content validity, the results showed the existence of a substantial agreement among the expert judges regarding the relevance, coherence, clarity and low bias of situations. In relation to the criterion validity, there were no differences between the answers given in the program and the interviews. The MS software thus has adequate validity properties for detecting students at risk of substance use and bullying.

Mindfulness y promoción de la salud mental en adolescentes: efectos de una intervención en el contexto educativo / Effects of a mindfulness intervention in Chilean high schoolers

Background: Mindfulness has been conceptualized as paying attention to present moment experience in a non-judgmental manner, and the practice of developing that skill. Aim: To determine the impact of a mindfulness-based intervention on negative emotional states of anxiety, stress, and depression in Chilean high schoolers. Material and Methods: Eighty-eight teenagers aged 13 ± 0.6 years (46 females) were randomly assigned to a mindfulness group or a control (41 and 47, respectively). The mindfulness intervention consisted in eight weekly 45-minute sessions. A depression, anxiety, and stress scale (DASS-21) was applied at baseline, after the intervention, and at three and six-month follow-up. Results: There was a significant reduction in anxiety, depression, and general symptomatology in the experimental group compared to the control group. However, these changes were not sustained at follow-up. Conclusions: These preliminary results suggest the feasibility and effectiveness of a mindfulness intervention in Chilean schools as a strategy to reduce negative emotional states and prevent risk factors in adolescent population groups.

Fundamentos y controversias en la diferenciación entre alucinaciones en población clínica y normal / Foundations and controversies in the differentiation of hallucinations in clinical and non-clinical populations

En la actualidad las alucinaciones son un síntoma primordial en Psicopatología. De hecho, cierto tipo de ellas, pueden ser suficientes para el diagnóstico de trastornos graves como la esquizofrenia. Igualmente, pueden estar presentes en diversas entidades como la demencia, depresión, trastornos de personalidad, etc. Sin embargo, a pesar de su relevancia, también presentan una serie de dificultades que tienen que ver tanto con su significado como con la etiología de las mismas. Asimismo, en los últimos años han cobrado gran relevancia los estudios que analizan la continuidad de este tipo de experiencias entre la población sin un diagnóstico psicopatológico y la población clínica. De este modo, el objetivo del presente trabajo va encaminado a determinar cuáles son las principales aportaciones que se han hecho en los últimos años en este terreno y también cuales son los principales problemas y conclusiones que se pueden sacar hasta el momento. Así, cuestiones fundamentales como ¿es escuchar voces patognomónico de un trastorno mental?, ¿tener un síntoma "psicótico" es la antesala a desarrollar un desorden clínico?, ¿las alucinaciones no auditivas siguen el mismo mecanismo que las auditivas?, ¿estamos hablando del mismo fenómeno alucinatorio en pacientes que en no pacientes, es decir, son comparables?, son aspectos centrales en la literatura actual que requieren una revisión.

Nowadays, hallucinations are an essential symptom in Psychopathology. In fact, some kind of them may be sufficient to a serious disorder diagnosis, such as schizophrenia, and may be present in several diseases such as dementia, depression or personality disorders. However, hallucinations present some difficulties related to their meaning and etiology. In recent years, studies analyzing the frequency of hallucinations in populations with no psychopathological diagnosis and in clinical ones have become important. For this reason, the present study aims at determining the principal contributions to this field in the last years, and the main problems and conclusions to date. Among relevant questions in this field requiring a revision, there can be found the following: is hearing voices patognomonic of a mental disorder? is having a psychotic symptom the previous step to a clinical disorder?; do non-auditory hallucination have the same mechanism than the auditory ones?; can the same hallucinatory phenomenon be found in diagnosed and in non-diagnosed people?.