ABSTRACT
INTRODUCTION: Pathological confidence in one's thoughts is a key mechanism of chronic paranoid thinking. For this reason, many of the current therapies focus on trying to reduce it. In fact, the way some antipsychotics (e.g., haloperidol) work seems to be through the induction of doubt. Because of the impact of these pathological thoughts on positive health, studying the well-being of people who experience paranoid thoughts is fundamental. The first objective of this research is to apply the Complete State Model of Health (CSMH) to a sample of patients characterized by the presence of paranoid thinking. Our second objective is to evaluate the impact of therapies based on reducing pathological confidence on patients' well-being. METHODS: Sixty participants with SCID-5 confirmed DSM-5 diagnosis related with paranoid thinking and without mood symptoms were recruited. In order to test the existence of a two continua model of mental health (CSMH), we conducted a parallel analysis and an exploratory factor analysis. To test our hypothesis regarding the partially mediating role of doubt between paranoid thinking and patients' well-being, we conducted a biased corrected bootstrapping procedure. RESULTS: As expected, two different unipolar dimensions emerged from the measures used to assess paranoid thinking and positive health (two continua model of mental health). When patients received metacognitive and pharmacological treatment, more paranoid thinking led to more doubt in all thoughts, which in turn affected well-being. The analyses carried out confirmed the partial mediating role of doubt. CONCLUSION: Despite the efficacy shown by both metacognitive therapies and antipsychotics, it seems that they not only reduce pathological confidence, but can also affect other thoughts not linked to delirium. This effect of generalization of doubt in all thoughts negatively affected patients' well-being and quality of life.
ABSTRACT
El trastorno bipolar (TB) es una enfermedad mental grave, de carácter crónico y altamente incapacitante. La clínica principal se basa en severos cambios del ánimo que tienen una duración de semanas a meses. Las descompensaciones agudas de la enfermedad requieren con frecuencia una hospitalización, debido a la presencia de síntomas psicóticos, el alto riesgo de conductas suicidas, o las alteraciones de conductas de los pacientes. Los episodios maniacos o hipomaniacos son los que determinan el diagnóstico, los cuales estarán intercalados por episodios depresivos y periodos de recuperación total o parcial. En el caso de TBI observaremos episodios maniacos y, en TB II, episodios hipomaniacos. Estos cambios anímicos son los que provocan en el paciente un importante deterioro social, laboral y personal. En el presente trabajo nos centramos en 2subtipos de TB, el tipo I y el tipo II. Realizaremos una revisión bibliográfica sobre las variables clínicas, evolutivas y pronósticas
Bipolar disorder (BD) is a chronic and highly disabling mental illness. The clinical signs include severe alterations in the mood of the patient, which can last from few days to weeks. The decompensation of the disease often requires hospital admission because of the presence of psychotic symptoms, the high risk of suicidal, and alterations in behaviour. The manic or hypomanic episodes determine the diagnosis. It should be noted that the treatment is characterised by intermittent episodes where the patient feels depressive, and periods where the recovery can seem to be total. While manic episodes can be observed in the case of BD I, in BD II hypomanic episodes could appear. These changes in the mood of the patients are the main cause of a significant deterioration in the social, work and personal life. The present work focuses on the mentioned 2subtypes of BD, carrying out a review of the literature dealing with clinical, evolutionary, and prognostic variables
Subject(s)
Humans , Bipolar Disorder/classification , Bipolar and Related Disorders/diagnosis , Prognosis , Psychotic Disorders/diagnosis , Symptom Assessment , Symptom Flare Up , Depressive Disorder/diagnosis , Diagnosis, Differential , Psychosocial DeprivationABSTRACT
Introducción. La optimización del abordaje terapéutico y preventivo del trastorno bipolar tipoi es esencial. En diversos estudios se ha observado una posible relación entre determinados factores genéticos y la respuesta de los pacientes al litio. Planteamos como objetivo realizar una revisión sistemática de la evidencia disponible sobre esta asociación. Material y métodos. Se plantea una revisión según las recomendaciones PRISMA para revisiones sistemáticas. Se emplean las bases Pubmed, Scopus, Web of Science y PsycInfo. Resultados. De los 396 artículos encontrados, finalmente se realiza la lectura crítica de 5 artículos. De los estudios analizados, 2 tienen calidad media y 3, baja, principalmente por la calidad deficiente de la metodología. Discusión. Al igual que los resultados previamente incluidos en la introducción, se subraya el beneficio posible, de cara a una mejor planificación terapéutica, de identificar biomarcadores genéticos de la respuesta al litio. Conclusiones. Las variantes rs17026651, GADL1 IVS8+48delG y rs17026688 y los pacientes portadores de una o más variantes de baja actividad del gen 5-HTT podrían ser biomarcadores útiles en la respuesta al tratamiento con litio en pacientes con trastorno bipolar tipoI, siendo precisa la realización de más estudios que permitan comprobar estos resultados y analizar más posibilidades genéticas relacionadas (AU)
Introduction. The optimisation of the treatment and the prevention of bipolar disorder typeI is essential. Several studies have described a possible relationship between genetic factors and lithium responders. The aim of this study is to present a systematic review on the evidence of this relationship. Material and methods. The review is based on PRISMA recommendations. The PubMed, Scopus, Web of Science and PsycInfo databases were used. Results. A total of 396 articles were found, of which only 5 were critically read, 2 of medium quality and the rest of low quality (due to the methods). Discussion. Like the studies included in the introduction, it can be shown that biomarkers of lithium response could lead to individualised treatment. Conclusions. Variants rs17026651, GADL1 IVS8+48delG and rs17026688 and patients carrying 5-HTT polymorphisms associated with reduced transcriptional activity could be useful biomarkers of lithium response in patients with bipolar disorder typeI. Further studies are required in order to check these results and to analyse other genetic relationships (AU)
