Urgencias psiquiátricas en la COVID-19: un estudio observacional durante 2019-2021 / Psychiatric emergencies in COVID-19: an observational study in 2019-2021

Introducción: En los primeros meses de la pandemia de la COVID-19 se reportó un descenso de las consultas en Urgencias Psiquiátricas (UP) en diferentes países. Este estudio describe la situación de las UP en un hospital público de Valencia (España) durante 2019-2021. Metodología: El diseño fue observacional y retrospectivo, e incluyó 1161 consultas en UP (M = 40.08 años; DT = 15.64; 51.7% mujeres). Se establecieron seis períodos temporales para la comparación: dos globales (no pandemia/pandemia) y cuatro intrapandémicos. Resultados: la media de consultas diarias fue similar entre el período anterior a la pandemia y el período pandémico; sin embargo, durante el confinamiento se dieron menos consultas/día que en el resto de los períodos intrapandemia. En la pandemia se recibieron más consultas relacionadas con el espectro psicótico y menos con los trastornos depresivos. El 30.74% de las consultas en UP de todos los períodos evaluados requirieron hospitalización psiquiátrica. Conclusiones: La situación de las UP parece estabilizarse durante el año posterior a la declaración del estado de alarma en España, aunque sigue siendo necesario examinar los factores que determinan la asistencia a UP en situaciones de emergencia. (AU)

Introduction: In the first months of the COVID-19 pandemic, a decrease in consultations in Psychiatric Emergencies (PE) was reported in different countries. This study describes the situation of PE in a public hospital in Valencia (Spain) during 2019-2021. Methodology: The design was observational and retrospective. 1161 PE's consultations were included (M = 40.08 years; DT =15.64; 51.7% women). Six time periods were established for comparison: two global (non-pandemic/pandemic) and four intra-pandemic periods. Results: Mean daily consultations were similar before and during pandemic. However, there were less consultations in lockdown than in post-lockdown periods. In the pandemic, more consultations were related to the psychotic spectrum and fewer to depressive disorders. Up to 30.74% of PE consultations in the examined periods required psychiatric hospitalization. Conclusions: The situation of PE seems to stabilize during the year after the declaration of the alarm state in Spain, although the factors that determine attendance in emergency situations need further attention. (AU)

Fases temporales y variables motivacionales: dos perspectivas complementarias en el proceso de búsqueda de ayuda por enfermedad mental / Temporary stages and motivational variables: Two complementary perspectives in the help-seeking process for mental disorders

Introducción: La búsqueda de ayuda profesional por enfermedad mental es un proceso complejo, con etapas y momentos temporales diferentes, en el que desempeñan un papel especialmente relevante los aspectos motivacionales. Sin embargo, no hay instrumentos de evaluación que permitan valorar tanto las variables temporales como las motivacionales. El objetivo de este estudio es ofrecer información detallada sobre ambos conjuntos de variables, mediante un instrumento específicamente diseñado para ello, de tal manera que se pueda comprender mejor el proceso de búsqueda de tratamiento. Material y métodos: Participaron 152 pacientes ambulatorios que habían solicitado ayuda profesional en una unidad de salud mental del SNS. Los diagnósticos principales fueron: trastorno obsesivo-compulsivo (n=71), agorafobia (n=21), trastorno depresivo mayor (n=18), anorexia nerviosa (n=20) y dependencia a cocaína (n=22). Los pacientes fueron evaluados mediante una entrevista estructurada, específicamente diseñada para el estudio. Asimismo, se obtuvieron datos sobre gravedad y calidad de vida. Resultados: Los pacientes con agorafobia y depresión mayor tardaron menos en reconocer los síntomas que los pacientes de los otros grupos. Asimismo, los pacientes con depresión mayor demoraron menos en solicitar ayuda profesional. Las variables motivacionales se agruparon en 3 conjuntos: motivos de consulta, relacionados con el malestar y la falta de control; motivos de demora de la consulta, relacionados con la minimización del problema; y motivos asociados al estigma. Conclusiones: Los resultados indican la necesidad de valorar las distintas variables motivacionales implicadas en las diferentes etapas del proceso de búsqueda de ayuda profesional. La entrevista que presentamos ha mostrado ser útil para ello

Introduction: Help-seeking for mental disorders is a complex process, which includes different temporary stages, and in which the motivational variables play an especially relevant role. However, there is a lack of instruments to evaluate in depth both the temporary and motivational variables involved in the help-seeking process. This study aims to analyse in detail these two sets of variables, using a specific instrument designed for the purpose, to gain a better understanding of the process of treatment seeking. Material and methods: A total of 152 patients seeking treatment in mental health outpatient clinics of the NHS were individually interviewed: 71 had Obsessive-Compulsive Disorder, 21 had Agoraphobia, 18 had Major Depressive Disorder), 20 had Anorexia Nervosa, and 22 had Cocaine Dependence. The patients completed a structured interview assessing the help-seeking process. Disorder severity and quality of life was also assessed. Results: The patients with agoraphobia and with major depression took significantly less time in recognising their mental health symptoms. Similarly, patients with major depression were faster in seeking professional help. Motivational variables were grouped in 3 sets: motivators for seeking treatment, related to the negative impact of symptoms on mood and to loss of control over symptoms; motivators for delaying treatment, related to minimisation of the disorder; and stigma-associated variables. Conclusions: The results support the importance of considering the different motivational variables involved in the several stages of the help-seeking process. The interview designed to that end has shown its usefulness in this endeavour

Temporary stages and motivational variables: Two complementary perspectives in the help-seeking process for mental disorders. / Fases temporales y variables motivacionales: dos perspectivas complementarias en el proceso de búsqueda de ayuda por enfermedad mental.

INTRODUCTION: Help-seeking for mental disorders is a complex process, which includes different temporary stages, and in which the motivational variables play an especially relevant role. However, there is a lack of instruments to evaluate in depth both the temporary and motivational variables involved in the help-seeking process. This study aims to analyse in detail these two sets of variables, using a specific instrument designed for the purpose, to gain a better understanding of the process of treatment seeking. MATERIAL AND METHODS: A total of 152 patients seeking treatment in mental health outpatient clinics of the NHS were individually interviewed: 71 had Obsessive-Compulsive Disorder, 21 had Agoraphobia, 18 had Major Depressive Disorder), 20 had Anorexia Nervosa, and 22 had Cocaine Dependence. The patients completed a structured interview assessing the help-seeking process. Disorder severity and quality of life was also assessed. RESULTS: The patients with agoraphobia and with major depression took significantly less time in recognising their mental health symptoms. Similarly, patients with major depression were faster in seeking professional help. Motivational variables were grouped in 3 sets: motivators for seeking treatment, related to the negative impact of symptoms on mood and to loss of control over symptoms; motivators for delaying treatment, related to minimisation of the disorder; and stigma-associated variables. CONCLUSIONS: The results support the importance of considering the different motivational variables involved in the several stages of the help-seeking process. The interview designed to that end has shown its usefulness in this endeavour.

The long and complex road in the search for treatment for mental disorders: An analysis of the process in five groups of patients.

Seeking treatment for mental-health problems is a complex process, with different underlying motives in each stage. However, the entire process and these motives have hardly been investigated. This study aims to analyze the different stages of the help-seeking process and their underlying motives in five groups of patients with different mental disorders. In all, 156 patients seeking treatment in outpatient mental health clinics were individually interviewed: 71 had Obsessive-Compulsive Disorder (OCD), 21 had Agoraphobia (AGO), 18 had Major Depressive Disorder (MDD), 20 had Anorexia Nervosa (AN), and 22 had Cocaine Dependence (COC). The AGO and MDD patients delayed significantly less time in recognizing their mental health symptoms. Moreover, MDD patients disclosed their symptoms and searched for professional help faster than the other groups. The most relevant variables in the recognition of disorders were the loss of control over the symptoms, the interference produced by these symptoms, and their negative impact on the person's emotional state. The most frequent barriers to seeking treatment were related to minimizing the symptoms and fear of stigma. Finally, the most important motivator for seeking treatment was the awareness that minimizing the symptoms did not help to reduce them, lessen their interference, or make them disappear.

Discovering what is hidden: The role of non-ritualized covert neutralizing strategies in Obsessive-Compulsive Disorder.

BACKGROUND AND OBJECTIVES: Neutralizing strategies are secondary to obsessions and an additional cause of distress and interference, but they have received little attention in theories and research, especially the non-ritualized covert strategies. This study focuses on the comparative impact of non-ritualized covert and compulsive-overt strategies in the course of OCD. METHODS: Eighty-two OCD adult patients completed measures assessing distress, interference, appraisals and overt and covert neutralizing strategies to control obsessions. Thirty-eight patients who had completed cognitive therapy were assessed again after treatment. RESULTS: Only overt compulsions are associated with OCD severity. Nonetheless, considering the main symptom dimension, covert strategies are also associated with severity in patients with moral-based obsessions. Patients who used covert strategies more frequently, compared to those who use them less, reported more sadness, guilt, control importance, interference, and dysfunctional appraisals. Regarding the overt strategies, patients who used them more reported more anxiety and ascribed more personal meaning to their obsessions than the patients who used them less. After treatment, recovered patients decreased their use of both covert and overt strategies, while non-recovered patients did not. There was a higher rate of non-recovered patients among those who used more non-ritualized covert strategies before treatment. LIMITATIONS: Emotions and appraisals were assessed with a single item. OCD symptom dimensions were only assessed by the Obsessive-Compulsive Inventory. CONCLUSIONS: In addition to studying overt compulsions, the impact of covert neutralizing strategies on the OCD course and severity warrants more in-depth study.

Group versus individual cognitive treatment for Obsessive-Compulsive Disorder: changes in non-OCD symptoms and cognitions at post-treatment and one-year follow-up.

Current cognitive approaches postulate that obsessions and compulsions are caused and/or maintained by misinterpretations about their meaning. This assumption has led to the development of cognitive therapeutic (CT) procedures designed to challenge the dysfunctional appraisals and beliefs patients have about their obsessions. Nonetheless, few studies have compared the efficacy of individual and group CT in changing the dysfunctional cognitions that hypothetically underlie Obsessive-Compulsive Disorder (OCD). In this study, 44 OCD patients were assigned to individual (n=18) or group (n=24) CT. Sixteen completed the individual CT, and 22 completed the group CT. The effects of the two CT conditions on depression and worry tendencies were comparable. Individual treatment was more effective than group treatment in decreasing scores on dysfunctional beliefs (responsibility, overestimation of threat, and intolerance to uncertainty) and the use of suppression as a thought control strategy. The post-treatment changes were maintained one year later. The correlations between symptom improvement (OCD severity change) and belief changes were moderate: in the individual treatment the greatest associations were with beliefs about thoughts (importance and control), whereas in the group treatment the greatest associations were with beliefs related to anxiety in general (threat overestimation and intolerance to uncertainty).

Dysfunctional belief domains related to obsessive-compulsive disorder: a further examination of their dimensionality and specificity.

International consensus has been achieved on the existence of several dysfunctional beliefs underlying the development and/ or maintenance of the Obsessive-Compulsive Disorder (OCD). Nevertheless, questions such as the dimensionality of the belief domains and the existence of OCD-specific dysfunctional beliefs still remain inconclusive. The present paper addresses these topics through two different studies. Study 1: A series of confirmatory factor analyses (N = 573 non-clinical subjects) were carried out on the Obsessive Beliefs Spanish Inventory-Revised (OBSI-R), designed to assess dysfunctional beliefs hypothetically related to OCD. An eight-factor model emerged as the best factorial solution: responsibility, over-importance of thoughts, thought-action fusion-likelihood, thought action fusion-morality, importance of thought control, overestimation of threat, intolerance of uncertainty and perfectionism. Study 2: The OBSI-R and other symptom measures were administered to 75 OCD patients, 22 depressed patients, and 25 non-OCD anxious patients. Results indicated that, although OCD patients differed from their non-clinical counterparts on all of the OBSI-R subscales, no evidence of OCD-specificity emerged for any of the belief domains measured, as the OCD subjects did not differ from the other two clinical groups of patients.

Dysfunctional belief domains related to obsessive-compulsive disorder: a further examination of their dimensionality and specificity

International consensus has been achieved on the existence of several dysfunctional beliefs underlying the development and/or maintenance of the Obsessive-Compulsive Disorder (OCD). Nevertheless, questions such as the dimensionality of the belief domains and the existence of OCD-specific dysfunctional beliefs still remain inconclusive. The present paper addresses these topics through two different studies. Study 1: A series of confirmatory factor analyses (N= 573 non-clinical subjects) were carried out on the Obsessive Beliefs Spanish Inventory-Revised (OBSI-R), designed to assess dysfunctional beliefs hypothetically related to OCD. An eight-factor model emerged as the best factorial solution: responsibility, over-importance of thoughts, thought-action fusion-likelihood, thought action fusion-morality, importance of thought control, overestimation of threat, intolerance of uncertainty and perfectionism. Study 2: The OBSI-R and other symptom measures were administered to 75 OCD patients, 22 depressed patients, and 25 non-OCD anxious patients. Results indicated that, although OCD patients differed from their non-clinical counterparts on all of the OBSI-R subscales, no evidence of OCD-specificity emerged for any of the belief domains measured, as the OCD subjects did not differ from the other two clinical groups of patients (AU)

Hay un consenso internacional sobre la existencia de ciertas creencias disfuncionales que subyacen al desarrollo y/o al mantenimiento del trastorno obsesivo-compulsivo (TOC). No obstante, temas tales como la dimensionalidad de tales creencias y si son específicas del TOC, siguen pendientes de resolución. Este artículo examina estos aspectos mediante dos estudios diferentes: Estudio 1: Se realizaron análisis factoriales confirmatorios (573 sujetos no clínicos) del Inventario Español de Creencias Obsesivas-Revisado (ICO-R), que fue diseñado para evaluar creencias disfuncionales relacionadas con el TOC. La mejor solución factorial posible fue la de 8 factores: responsabilidad; importancia de los pensamientos; fusión pensamiento-acción probabilidad; fusión pensamiento-acción, moralidad; importancia de controlar los pensamientos; sobrestimar el peligro; intolerancia a la incertidumbre; y perfeccionismo. Estudio 2: El ICO-R se administró, junto con otros cuestionarios de síntomas, a 75 pacientes TOC, 22 deprimidos, y 25 pacientes con trastornos de ansiedad no-TOC. Los resultados indican que, si bien los pacientes TOC difieren de la población no clínica en todas las subescalas del ICO-R, ninguno de los dominios de creencias es específico del TOC, dado que estos pacientes no se diferenciaron de los otros dos grupos en ninguna de las subescalas del ICO-R (AU)

Cognitive therapy for autogenous and reactive obsessions: clinical and cognitive outcomes at post-treatment and 1-year follow-up.

This study provides data about the differential effectiveness of cognitive therapy (CT) for obsessive-compulsive disorder (OCD) symptom presentation. Two OCD manifestations, autogenous and reactive, are considered. Seventy OCD patients started CT; 81.40% completed it and 72.85% were available 1 year later. Fifteen of the 57 treatment completers had autogenous obsessions, whereas 33 had reactive obsessions. Nine patients had both obsession modalities. Reactive patients were more severe, as they scored higher on thought suppression and on the dysfunctional beliefs of intolerance to uncertainty and perfectionism. Autogenous patients scored higher on the over-importance of thoughts beliefs. Although CT was effective in reducing OCD severity and the ascription to dysfunctional beliefs and neutralizing strategies in both the autogenous and the reactive patients, a significantly better outcome was observed for the autogenous patients, both at post-treatment (with 73.33% recovering versus 33.33% for reactives) and 1 year later.

Group versus individual cognitive treatment for obsessive-compulsive disorder: Changes in severity at post-treatment and one-year follow-up.

BACKGROUND: Very few studies have compared the efficacy of individual and group cognitive behaviour therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) by taking into consideration the change in OCD severity in both the short and long term. AIMS: To conduct an open trial of individual versus group CBT for OCD, comparing the clinical and statistically significant changes in severity both at post-treatment and one year later. METHOD: Forty-two OCD subjects were assigned to individual (n = 18) or group CBT (n = 24, in four groups). Sixteen and 22 subjects completed the treatment in the individual and group conditions, respectively. The Yale-Brown Obsessive Compulsive Scale was recorded at pre-treatment, post-treatment and at the one-year follow-up. RESULTS: At the end of treatment, the clinically significant change was comparable for the two treatment conditions and remained stable at the one-year follow-up. Of the 16 participants who completed the individual CBT treatment, 68.75% were classified as recovered at post-treatment, compared to 40.9% of those receiving group CBT. At follow-up the rate of recovery decreased to 62.5% in individual CBT and to 31.8% in group CBT. CONCLUSIONS: Group CBT is effective in decreasing OCD severity. The post-treatment changes were maintained one year later. Nevertheless, these changes were higher in the individual delivery of CBT.

To seek advice or not to seek advice about the problem: the help-seeking dilemma for obsessive-compulsive disorder.

BACKGROUND: Although obsessive-compulsive disorder (OCD) is associated with considerable distress, it has been reported that OCD patients delay considerably in seeking treatment for their problem. The present study aimed to explore some variables hypothetically involved in the help-seeking process among OCD patients. METHODS: Twenty-six OCD patients without comorbid conditions completed the Interview of Help-Seeking, specifically designed for this study, which assesses to what extent patients delay seeking treatment for their problem, and three group of variables: factors influencing the recognition of the problem, reasons for delaying the treatment-seeking, and reasons for finally seeking treatment. Participants also completed OCD measures, as well as a questionnaire on thought control strategies. RESULTS: The mean length of delay in seeking treatment was 39.38 (SD = 50.95) months, and a great variety of reasons for delaying were observed. The OCD patients who delayed consultation longer, in comparison with patients who delayed less time, used fewer social control strategies, and they were less aware of the interference and behavioral changes associated with the problem. CONCLUSIONS: To gain more insight about the problem and to experience greater interference from the symptoms were determinants in the active search for help. Conversely, the main barriers to the help-seeking were the fears of stigma and the meaning of the thought contents. Additionally, the fact that patients are willing to disclose their obsessions to other people may favor an adequate representation of the problem and the need to seek mental health treatment.