Longitudinal mental health state during the COVID-19 pandemic. Longitudinal change of mental symptoms and its predictors during the COVID-19 pandemic: A prospective longitudinal study on Spanish population.

OBJECTIVE: The general objective of this study is to analyze the change in mental health and post-traumatic symptoms over 6 months during the COVID-19 pandemic in a Spanish community sample, with a particular focus on individual differences in longitudinal change in symptoms and its predictors. METHOD: This longitudinal prospective study surveyed a Spanish community sample three times (T1: during the initial outbreak, T2: after 4 weeks and T3: after 6 months). Four thousand one hundred and thirty-nine participants from all the Spanish regions completed the questionnaires. However, the longitudinal analysis was performed only with participants which responded at least two times (1,423 participants). Mental health assessments included depression, anxiety, and stress (measured by the Depression, Anxiety and Stress Scale (DASS-21) and post-traumatic symptoms were assessed by the Impact of Event Scale-Revised (IES-R). RESULTS: All the mental health variables achieved worse results at T2. Depression, stress, and posttraumatic symptoms did not recover at T3 when compared with the initial measure, while anxiety was practically stable across the timeline. Women, younger age, having a previous mental health diagnosis and contact with individuals with COVID-19 were linked to worse psychological evolution during the 6-months period. A good perception of one's physical health may be a protective factor. CONCLUSIONS: After 6 months of the pandemic, the general population's mental health was still worse than at the initial outbreak for most of the variables analyzed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Immediate Psychological Response during the Very Early Stage of the Coronavirus Pandemic (COVID-19) in a Spanish Community Sample.

The World Health Organization declared a pandemic due to COVID-19 on 11 March 2020 and remarked on the relevance of studying its consequences on mental health. A cross-sectional study was conducted to evaluate the immediate psychological response to the pandemic and quarantine in Spain.

Respuesta psicológica inmediata durante una etapa muy temprana de la pandemia por coronavirus (COVID-19) en una muestracomunitaria española / Immediate Psychological Response during the Very Early Stage of the Coronavirus Pandemic (COVID-19) in a Spanish Community Sample

Introducción: La Organización Mundial de la Salud declaró la pandemia por COVID-19 el 11 de marzo de 2020 ysubrayó la importancia de estudiar sus consecuencias en lasalud mental de la población. Se presenta un estudio transversal evaluando las respuestas psicológicas a la primera olade la pandemia en España.Metodología. Entre el 23 y 28 de marzo, se realizó unaencuesta online en una muestra española seleccionada trasun muestreo en bola de nieve. Se recogieron variables sociodemográficas, de salud y comportamentales. Se evaluaron laansiedad y depresión a través de la Escala de Depresión, Ansiedad y Estrés (DASS-21), los síntomas postraumáticos a través de la Escala de Impacto del Evento Revisada (IES-R) y lospatrones de autocuidado con la Escala de Autocuidado (SCS).Resultados. Se incluyeron 3524 participantes, 24,1 %mostraron síntomas postraumáticos moderados o severos,21,9 % refirieron síntomas depresivos moderados, severos o extremadamente severos y 32 % síntomas ansiososmoderados, severos o extremadamente severos. El génerofemenino, la menor edad, menor nivel educativo, diagnóstico psiquiátrico previo, peor salud física, contacto con COVID-19, falta de rutinas y algunos síntomas psicológicos serelacionaron con peores respuestas psicológicas.Conclusiones. Se confirma el impacto sobre la saludmental que la primera ola de la pandemia tuvo en España yse identifican algunas variables relacionadas con peor respuesta que pueden resultar útiles en la prevención en salud mental en futuras situaciones equivalentes. (AU)

Introduction: The World Health Organization declared apandemic due to COVID-19 on 11 March 2020 and remarkedon the relevance of studying its consequences on mentalhealth. A cross-sectional study was conducted to evaluatethe immediate psychological response to the pandemic andquarantine in Spain.Methods. From March 23 to 28, an online survey wasconducted in a Spanish community sample. Sociodemographic,health and behavioral variables were surveyed. Depressionand anxiety sypmtoms were measured by the Depressión,Anxiety and Stress Scale (DASS-21), posttraumatic symptomsby the Impact of Event Scale-Revised (IES-R) and self-carepatterns by the Self-Care Scale (SCS).Results. 3524 respondents were included, 24.1%showed moderate or severe psychological impact, 21.9%reported moderate, severe or extremely severe depressionand 32% moderate, severe or extremely severe anxiety.Female gender, younger age, low education, psychiatricdiagnosis, worse physical health, contact history, lack ofroutines, and some psychological symptoms were related toworse psychological responses.Conclusions. This study provides evidence for a negativemental health impact of the pandemic in the Spanishcommunity that started at the early stages and identifiessome variables linked to worse psychological response. (AU)

Psychological Responses According to Gender during the Early Stage of COVID-19 in Spain.

BACKGROUND: Current research has pointed out an increased risk of mental health problems during the COVID-19 pandemic in women compared to men, however the reason for this difference remains unclear. The aim of this research is to study early psychological responses to the pandemic in the Spanish general population, focusing on gender differences. METHODS: Nine to 14 days after the declaration of a state of emergency an online survey was conducted assessing sociodemographic, health, behavioral and COVID-19-related variables. Mental health status was evaluated by the Depression, Anxiety and Stress Scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the Self-Care Scale (SCS). RESULTS: The study included 3520 respondents: 2611 women and 909 men. Women scored significantly higher in DASS-21 and IES-R (p < 0.05) and were more likely to somatize, suffer from hypochondriasis, sleeping disturbances and claustrophobia (p < 0.05). Being a woman can be considered a risk factor for intrusive thoughts, avoidance mechanisms, stress and anxiety (Odd Ratio = 2.7/2.3/2.3/1.6). The risk of presenting posttraumatic symptoms and emotional distress was greater in women (Odd Ratio = 6.77/4.59). General linear models to predict IES-R and DASS-21 scores clarified which variables were gender specific, such as main concerns. CONCLUSIONS: This study provides evidence that at early stages of the pandemic, women mental health was more impacted and that both genders show different concerns. Gender perspective in secondary and tertiary prevention strategies must be taken into account when facing the distress associated with the pandemic.

How did Different Generations Cope with the COVID-19 Pandemic? Early Stages of the Pandemic in Spain / ¿Cómo se Enfrentaron las Diferentes Generaciones a la Pandemia por COVID-19? Primeras Etapas de la Pandemia en España

BACKGROUND: The World Health Organization has highlighted the importance of studying the consequences of the COVID-19 pandemic on mental health. The aim of this study is to examine the role of age in the early psychological responses to the pandemic in a Spanish community sample, focusing on how different generations coped with it. METHOD: An online survey was conducted during the early stages of the quarantine. Sociodemographic, health and behavioral variables were compared for five age groups. Mental health was assessed by the Depression, Anxiety and Stress Scale (DASS-21) and psychological impacts were assessed by the Impact of Event Scale-Revised (IES-R). RESULTS: 3,524 participants were included (Mage = 39.24, SDage = 12.00). Participants aged between 18 and 33 years old showed more hyperactivation and evitation, were more depressed, anxious and stressed. Those aged between 26 and 33 years old showed more intrusion. Those aged between 18 and 25 years old suffered more sleep disturbances, claustrophobia and somatization and maintained worse routines. Elderly people showed better psychological responses in general. CONCLUSIONS: This study provides initial evidence that the negative psychological impact of COVID-19 pandemic hits young people harder. These results should be taken into account when developing specific evidence-based strategies

ANTECEDENTES: la Organización Mundial de la Salud ha destacado la importancia de estudiar sus consecuencias sobre la salud mental de la COVID-19. Esta investigación estudia el papel de la edad sobre las respuestas psicológicas tempranas a la pandemia. MÉTODO: se realizó una encuesta online en la población adulta de España durante la cuarentena. Las variables sociodemofráficas, de salud y conductuales fueron estudiadas en 5 grupos de edad. El estado mental se estudió a través del DASS-21 (Depression, Anxiety and Stress Scale) y el impacto psicológico a través del IES-R (Impact of Event Scale-Revised). RESULTADOS: 3.524 participantes fueron incluidos (Medad = 39.24, DTedad = 12.00). Los participantes entre 18 y 33 se mostraban más hiperactivados, evitativos, ansiosos, deprimidos y estresados. Aquellos entre 26 y 33 años presentaban más intrusión. Los participantes entre 18 y 25 años dormían peor, presentaban más claustrofobia y somatizaciones, mayores dificultades para mantener rutinas, mientras que los mayores presentaban mejores respuestas en general. CONCLUSIONES: este estudio indica que la población española más joven se ha visto más afectada por las consecuencias psicológicas de la pandemia. Algunas de las diferencias en conductas y preocupaciones que dependieron de la edad deberían tenerse en cuenta para elaborar estrategias de intervención

How did Different Generations Cope with the COVID-19 Pandemic? Early Stages of the Pandemic in Spain.

BACKGROUND: The World Health Organization has highlighted the importance of studying the consequences of the COVID-19 pandemic on mental health. The aim of this study is to examine the role of age in the early psychological responses to the pandemic in a Spanish community sample, focusing on how different generations coped with it. METHOD: An online survey was conducted during the early stages of the quarantine. Sociodemographic, health and behavioral variables were compared for five age groups. Mental health was assessed by the Depression, Anxiety and Stress Scale (DASS-21) and psychological impacts were assessed by the Impact of Event Scale-Revised (IES-R). RESULTS: 3,524 participants were included (Mage = 39.24, SDage = 12.00). Participants aged between 18 and 33 years old showed more hyperactivation and evitation, were more depressed, anxious and stressed. Those aged between 26 and 33 years old showed more intrusion. Those aged between 18 and 25 years old suffered more sleep disturbances, claustrophobia and somatization and maintained worse routines. Elderly people showed better psychological responses in general. CONCLUSIONS: This study provides initial evidence that the negative psychological impact of COVID-19 pandemic hits young people harder. These results should be taken into account when developing specific evidence-based strategies.

Risk Factors for Disease Recurrence in Women With Phyllodes Tumors of the Breast in Southern Colombia: A Nine-Year Cohort Study.

Introduction Phyllodes tumors (PTs) are uncommon fibroepithelial breast tumors that occur in middle-aged women, and they tend to vary in biologic behavior. Surgical management is the standard therapy for the condition, but factors associated with recurrence remain unclear. The aim of this study was to evaluate clinical and surgical characteristics related to PT recurrences. Methods This retrospective cohort study included patients in southern Colombia who were diagnosed with PT and managed at a level I teaching and referral hospital over a nine-year period. Factors associated with recurrence were determined by Cox regression analysis. Results This study included 61 patients; their median age was 46 years [interquartile range (IQR): 39-55 years]. Pathologically, 37 tumors (60.7%) were classified as low-grade. The median tumor size was 7 cm (IQR: 4-11.5 cm). Thirty-nine (63.9%) patients underwent quadrantectomy. Nine patients (14.8%) experienced tumor recurrence, with the median time to recurrence being one year (IQR: 0.5-2 years). Distant metastasis was observed in four patients (6.6%) at a median of nine months (IQR: 0.4-2.5 years). Univariate analyses showed that patients with high-grade tumors [hazard ratio (HR): 2.90, p = 0.148] and those who underwent mastectomy (HR: 2.90, p = 0.460) were at higher risk of recurrence. Conclusion PT recurrence may be associated with biological features, the extent of local excision, tumor size, and negative margins. However, multicenter data are needed to confirm these findings.

Más allá de las células CAR-T, inmunoterapia con linfocitos natural killer / Beyond CAR-T cells: Natural killer cells immunotherapy

A pesar de la mejoría en el pronóstico del cáncer infantil, la recaída o la refractariedad a los tratamientos convencionales todavía condicionan un mal pronóstico. En el momento actual, la investigación en el área de la inmunoterapia, con medicamentos como los inhibidores de puntos críticos de control inmunitario y los linfocitos T modificados genéticamente, tisagenlecleucel o axicabtagene ciloleucel, están revolucionando el tratamiento del cáncer. En paralelo, se están desarrollando otras inmunoterapias, como la terapia celular con linfocitos natural killer (NK). La rápida y potente actividad citotóxica de las células NK respetando las células sanas y la posibilidad de expandirlas, manipularlas y combinarlas con otros tratamientos, hacen de estas células una poderosa herramienta terapéutica a desarrollar, con un perfil de seguridad muy alto. Además, se están desarrollando nuevas estrategias para incrementar el beneficio terapéutico de estas células, como la manipulación genética para la expresión de receptores de antígeno quiméricos

Children and adolescents suffering from refractory leukaemia, relapse after stem cell transplantation, solid metastatic tumour or refractory to conventional treatments still condition a dismal prognosis. The critical role of the immune system in the immunosurveillance of cancer is becoming relevant with the development of new treatments such as the checkpoint inhibitor drugs and genetic modified T lymphocytes, tisagenlecleucel or axicabtagene ciloleucel. In addition, other immunotherapies are being developed such as cell therapy with natural killer (NK) lymphocytes. The rapid and potent cytotoxic activity of NK cells respecting healthy cells and the possibility of expansion, manipulating them and combining them with other treatments, make these cells a powerful therapeutic tool to be developed, with a very high safety profile. Furthermore, new strategies are being developed to increase the therapeutic benefit of NK cells such as genetic manipulation for the expression of chimeric antigen receptors

Study protocol for a phase II, multicentre, prospective, non-randomised clinical trial to assess the safety and efficacy of infusing allogeneic activated and expanded natural killer cells as consolidation therapy for paediatric acute myeloblastic leukaemia.

INTRODUCTION: Acute myeloblastic leukaemia (AML) constitutes the second most common haematological malignancy in the paediatric population. Current treatment regimens are based on the administration of polychemotherapy, combining high doses of cytarabine with anthracyclines and topoisomerase inhibitors. Allogeneic haematopoietic stem cell transplantation (HSCT) is an option for high-risk patients with AML (and for intermediate-risk patients if a sibling donor is available). With this strategy, AML survival has increased substantially; however, it has remained stagnant at approximately 60%, with relapse being the principal culprit. The predominant role of the immune system and natural killer (NK) cells in controlling paediatric AML has gained importance within the context of HSCT. In this protocol, we propose incorporating this cell therapy as an adjuvant treatment through the infusion of activated and expanded haploidentical NK (NKAE) cells in paediatric patients with AML who are in cytological remission after completing consolidation therapy, and with no indication for HSCT. METHODS AND ANALYSIS: Patients up to 30 years of age, diagnosed with AML, in their first cytological remission, who have completed both the induction and the consolidation phases of chemotherapy and do not meet the criteria for allogeneic HSCT are eligible. The patients will receive two doses of NKAE cells once a week, using a GMP K562-mbIL15-41BBL stimulus from a haploidentical donor and interleukin 2 subcutaneously. The patients will then be followed up for 36 months to assess the primary endpoint, which is the probability of relapse after NK cell infusion. ETHICS AND DISSEMINATION: This clinical trial was approved by the Clinical Research Ethics Committee of La Paz University Hospital and The Spanish Agency of Medicines and Medical Devices. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. TRIAL REGISTRATION NUMBER: EudraCT code: 2015-001901-15, ClinicalTrials.gov Identifier: NCT02763475.

Beyond CAR-T cells: Natural killer cells immunotherapy. / Más allá de las células CAR-T, inmunoterapia con linfocitos natural killer.

Children and adolescents suffering from refractory leukaemia, relapse after stem cell transplantation, solid metastatic tumour or refractory to conventional treatments still condition a dismal prognosis. The critical role of the immune system in the immunosurveillance of cancer is becoming relevant with the development of new treatments such as the checkpoint inhibitor drugs and genetic modified T lymphocytes, tisagenlecleucel or axicabtagene ciloleucel. In addition, other immunotherapies are being developed such as cell therapy with natural killer (NK) lymphocytes. The rapid and potent cytotoxic activity of NK cells respecting healthy cells and the possibility of expansion, manipulating them and combining them with other treatments, make these cells a powerful therapeutic tool to be developed, with a very high safety profile. Furthermore, new strategies are being developed to increase the therapeutic benefit of NK cells such as genetic manipulation for the expression of chimeric antigen receptors.

The role of emotion dysregulation in Conversion Disorder.

INTRODUCTION: The role that emotion regulation plays in Conversion Disorders (CD) is not well known. This research deepens in this subject and describes the main differences between a group of conversion patients and a control group on different measures of emotion regulation and other clinical variables. METHODS: A case-control study was conducted including 43 patients suffering from CD and 42 healthy controls. Both groups went thought two psychiatric interviews and fulfilled 6 questionnaires assessing depression, anxiety, alexithymia, emotion dysregulation, affect intensity, psychoform and somatoform dissociation. RESULTS: Patients suffering from CD scored significantly higher on all the six questionnaires (p<0.001). Negative reactivity and negative intensity were also higher in patients (p<0.01), while cases and controls did not show any significant differences on positive affectivity and serenity. Anxiety, alexithymia and emotional dysregulation were the most relevant factors (OR=5.85/3.50/3.23 respectively). Anxiety and difficulties in emotion regulation were the most explicative variables for conversion in the regression analysis performed. Within the five factors assessing difficulties in emotion regulation, lack of emotional control and interference in goal directed behaviors were the most relevant. Positive and negative conversion where correlated to different emotional impairments. CONCLUSIONS: People suffering from CD show several emotional impairments when compared to healthy controls. Emotion dysregulation can be considered a relevant aspect in CD. The existence of specific emotional patterns for different conversion manifestations is suspected.

El papel de la desregulación emocional en el Trastorno Conversivo / The role of emotion dysregulation in Conversion Disorder

Introducción. El papel que juega la regulación de las emociones en la etiopatogénesis del Trastorno Conversivo (TC) es todavía poco conocido. Esta investigación pretende profundizar en este tema, buscando describir las diferencias principales que existen entre un grupo de pacientes con TC y un grupo control en lo que concierne a la forma de regular sus emociones así como a otras variables clínicas fundamentales. Métodos. Se ha realizado un estudio de tipo casos (n=43) y controles (n=42). Ambos grupos se sometieron a dos entrevistas psiquiátricas y completaron 6 cuestionarios autoadministrados evaluando la depresión, ansiedad, alexitimia, desregulación emocional, intensidad efectiva, así como la disociación psicomorfa y somatomorfa. Resultados. Los pacientes con TC puntuaron significativamente más alto en las seis variables estudiadas a través de los cuestionarios (p<0.001). La reactividad y la intensidad emocional negativas fueron mayores en el grupo de pacientes (p<0.01) mientras que ambos grupos puntuaron de manera similar en afectividad positiva y serenidad. La ansiedad, la alexitimia y la desregulación emocional fueron los factores de riesgo más importantes identificados (OR=5.85/3.50/3.23 respectivamente). La ansiedad y las dificultades en la regulación de las emociones fueron las variables que mejor explicaron la pertenencia al grupo de pacientes en los modelos de regresión logística calculados. Entre los 5 factores que midieron diferentes dificultades en la regulación emocional los más relevantes fueron la falta de control emocional y la interferencia en conductas orientadas a una meta. La sintomatología conversiva positiva y la sintomatología conversiva negativa se correlacionaron con distintos patrones de regulación emocional. Conclusiones. Los pacientes con TC sufrieron múltiples dificultades a la hora de regular sus emociones, comparados con el grupo control. La desregulación emocional puede ser considerada un factor de riesgo para padecer un TC. Se discute la posibilidad de que existan diferentes patrones de regulación emocional en pacientes con distintos tipos de sintomatología conversiva

Introduction. The role that emotion regulation plays in Conversion Disorders (CD) is not well known. This research deepens in this subject and describes the main differences between a group of conversion patients and a control group on different measures of emotion regulation and other clinical variables. Methods. A case-control study was conducted including 43 patients suffering from CD and 42 healthy controls. Both groups went thought two psychiatric interviews and fulfilled 6 questionnaires assessing depression, anxiety, alexithymia, emotion dysregulation, affect intensity, psychoform and somatoform dissociation. Results. Patients suffering from CD scored significantly higher on all the six questionnaires (p<0.001). Negative reactivity and negative intensity were also higher in patients (p<0.01) while cases and controls did not show any significant differences on positive affectivity and serenity. Anxiety, alexithymia and emotional dysregulation were the most relevant factors (OR=5.85/3.50/3.23 respectively). Anxiety and difficulties in emotion regulation were the most explicative variables for conversion in the regression analysis performed. Within the five factors assessing difficulties in emotion regulation, lack of emotional control and interference in goal directed behaviors were the most relevant. Positive and negative conversion where correlated to different emotional impairments. Conclusions. People suffering from CD show several emotional impairments when compared to healthy controls. Emotion dysregulation can be considered a relevant aspect in CD. The existence of specific emotional patterns for different conversion manifestations is suspected

Validaty and reliability of the Spanish version of the Somatoform Dissociation Questionnaire (SDQ-20) / Validez y fiabilidad de la versión española del Somatoform Dissociation Questionnaire (SDQ-20)

BACKGROUND: The Somatoform Dissociation Questionnaire (SDQ-20) is a self-reported questionnaire measuring somatoform dissociation. The aim of this study is to analyze the psychometric properties of the Spanish version of the SDQ-20 and its short version (SDQ-5). METHODS: Validity and reliability were examined in a sample of 360 psychiatric outpatients: 38 dissociative (conversion) disorders, 30 dissociative (psychoform) disorders, and 292 patients suffering from other disorders. Dissociative disorders were diagnosed using the SCID-D and a specific interview for conversion disorders. RESULTS: Subjects meeting criteria for any dissociative or conversion disorder scored significantly higher in the SDQ-20 (criterion validity). Somatoform dissociation, psychoform dissociation and early trauma were significantly correlated (construct validity). An alpha coefficient of .866 (reliability) and a test-retest correlation of 0.91 were obtained. The cut-off score maximizing sensitivity and specificity was 27.5 for psychoform dissociative disorders (sensitivity of 81.6% and specificity of 71.0%) and 29.5 for conversion disorders (81.6% and 71.0%). For the SDQ-5, the coefficient alpha was 0.561 and the selected cut-off score was 5.5 (sensitivity of 73.33% and specificity of 70.41%). CONCLUSIONS: The Spanish version of the SDQ-20 presents good psychometric properties while the SDQ-5 shows worse characteristics and its use with Spanish samples is not recommended

ANTECEDENTES: SDQ-20 (Somatoform Dissociation Questionnaire) es un autoinforme que mide la presencia de disociación somatomorfa. Se analizan las propiedades psicométricas de la versión española de la SDQ-20 y su versión abreviada (SDQ-5). MÉTODO: su validez y fiabilidad han sido examinadas en una muestra de 360 pacientes: 38 trastorno disociativo (de conversión), 30 trastorno disociativo (psicomorfo) y 292 diagnosticados de otros trastornos. El diagnóstico de trastorno disociativo se realizó mediante la SCID-D-TR y una entrevista específica para los trastornos conversivos. RESULTADOS: los sujetos que cumplieron criterios de trastorno disociativo o conversivo puntuaron significativamente más alto en la SDQ-20 (criterio de validez). La disociación psicomorfa y somatomorfa y el trauma temprano se correlacionaron significativamente (validez del constructo). Se obtuvieron un coeficiente alpha de 0.866 (fiabilidad) y una correlación test-retest de 0,91. El punto de corte para los trastornos disociativos fue 27,5 (sensibilidad 81,6% y especificidad 71%) y 29,5 para los trastornos conversivos (81,6% y 71%). En la SDQ-5 se obtuvo un coeficiente alpha de 0,561 y un punto de corte de 5,5 (sensibilidad 73,33% y especificidad 70,41%). CONCLUSIONES: la versión española de la SDQ-20 presenta buenas propiedades psicométricas. La SDQ-5 muestra peores características y su uso en muestras españolas no se recomienda

Validity and reliability of the Spanish version of the Somatoform Dissociation Questionnaire (SDQ-20).

BACKGROUND: The Somatoform Dissociation Questionnaire (SDQ-20) is a self-reported questionnaire measuring somatoform dissociation. The aim of this study is to analyze the psychometric properties of the Spanish version of the SDQ-20 and its short version (SDQ-5). METHODS: Validity and reliability were examined in a sample of 360 psychiatric outpatients: 38 dissociative (conversion) disorders, 30 dissociative (psychoform) disorders, and 292 patients suffering from other disorders. Dissociative disorders were diagnosed using the SCID-D and a specific interview for conversion disorders. RESULTS: Subjects meeting criteria for any dissociative or conversion disorder scored significantly higher in the SDQ-20 (criterion validity). Somatoform dissociation, psychoform dissociation and early trauma were significantly correlated (construct validity). An alpha coefficient of .866 (reliability) and a test-retest correlation of 0.91 were obtained. The cut-off score maximizing sensitivity and specificity was 27.5 for psychoform dissociative disorders (sensitivity of 81.6% and specificity of 71.0%) and 29.5 for conversion disorders (81.6% and 71.0%). For the SDQ-5, the coefficient alpha was 0.561 and the selected cut-off score was 5.5 (sensitivity of 73.33% and specificity of 70.41%). CONCLUSIONS: The Spanish version of the SDQ-20 presents good psychometric properties while the SDQ-5 shows worse characteristics and its use with Spanish samples is not recommended.

Integrating neurobiology of emotion regulation and trauma therapy: reflections on EMDR therapy.

Emotion dysregulation is a frequent feature in trauma-related disorders. Different kinds of emotion dysregulation seem to be linked to particular psychiatric conditions, and there is growing evidence of the association between neurobiological correlates and those dysregulation patterns. Nevertheless, many of the recent findings from the field of the neurobiology have not been translated into clinical practice and are insufficiently contemplated in trauma-oriented therapies. The aim of this article is to review recent developments in the field of emotion regulation connecting these issue with the practical implementation of psychotherapeutic procedures. The evaluation of emotion dysregulation patterns can guide decision making during the therapy independently to the approach, but there are some findings that can be especially useful for some concrete modalities of therapy. In this article we will focus our discussion on how emotion dysregulation may influence eye movement desensitization and reprocessing (EMDR) treatment in trauma-related disorders. EMDR is a well-defined and protocol-based intervention, with a strong empirical support for post-traumatic stress disorder (PTSD). We describe how different patterns of emotion dysregulation may influence EMDR treatment and procedures, and also how the application of EMDR beyond non-dissociative PTSD should take into account the predominant emotion-regulation strategies in specific posttraumatic disorders.

[Clinical and microbiological characteristics of complicated intra-abdominal infection in Colombia: a multicenter study]. / Características clínicas y microbiológicas de la infección intra-abdominal complicada en Colombia: un estudio multicéntrico.

INTRODUCTION: Complicated community-acquired intra-abdominal infections (CA-cIAI) are a common cause of acute abdomen. OBJECTIVE: To identify the clinical and microbiology profile of CA-cIAI in four Colombian hospitals. METHODS: This is a prospective, descriptive study, between 08-2012 and 09-2014, including patients with CA-cIAI > 15 years. Data collected included: socio-demographic, clinical, diagnosis, and isolates of the first culture obtained aseptically during surgery with antimicrobial susceptibility. RESULTS: 192 patients were included, 62% men, median age 47.3 years. Co-morbidities were present in 38.4%, 13% had been hospitalized in the previous year 13%, and 9.4% had received antibiotics in the last 6 months; 44.3% were admitted for appendicitis, 17.7% for peritonitis and 16.7% for bowel perforation. CA-cIAI were assessed as moderate in 64.1% of the cases and were treated with ampicillin/sulbactam (SAM) and ertapenem. In 70.8% of cases a bacteria was isolated: 65.1% were gramnegative rods (80.0% Escherichia coli, 44.8% of them susceptible to pipercillin/tazobactam, 65.7% to SAM; 11.2 % were K.pneumoniae, 85% was susceptible for SAM; 16.7% were grampositive cocci (28.1% Streptococci viridans group). The median hospital stay was 7 days and 15.1% died. CONCLUSIONS: E. coli, K. pneumoniae and S. viridans were the main organisms to consider in an empiric therapy for CA-cIAI and it is important to know the local epidemiology in order to choose the right antibiotic.

Características clínicas y microbiológicas de la infección intra-abdominal complicada en Colombia: un estudio multicéntrico / Clinical and microbiological characteristics of complicated intra-abdominal infection in Colombia: a multicenter study

Introducción: La infección intra-abdominal complicada adquirida en la comunidad (IIAc-AC) es una causa frecuente de abdomen agudo. Objetivo: Identificar el perfil clínico y microbiológico de la IIAc-AC en cuatro hospitales de Colombia. Métodos: Estudio descriptivo, prospectivo entre 07-2012 y 09-2014 en pacientes de 15 o más años con IIAc-AC. Se midieron las frecuencias de variables socio-demográficas, clínicas, diagnóstico, aislamientos y susceptibilidad antimicrobiana del primer cultivo obtenido asépticamente del sitio de infección. Resultados: 192 pacientes incluidos, 62% hombres, edad media 47,3 años; 38,4% con co-morbilidad, 13% hospitalizados en el último año y 9,4% recibieron antimicrobianos en los últimos seis meses. Fueron admitidos 44,3%, por apendicitis 17,7% por peritonitis y 16,7% por perforación intestinal. El 64,1% de las IIAc-AC fue moderada y tratada con ampicilina/sulbactam (SAM) y ertapenem. En 70,8% se aisló al menos un microorganismo en: 65,1% bacilos gramnegativos (80,0% Escherichia coli, 44,8% susceptible a piperacilina/tazobactam, 65,7% a SAM y 11,2% Klebsiella pneumoniae, 85% susceptibles a SAM) y en 16,7% especies grampositivas (28,1% Streptococcus grupo viridans). La mediana de hospitalización fue siete días y 15,1% fallecieron. Conclusión: Escherichia coli y K. pneumoniae en IIAc-AC son los principales microorganismos a cubrir en la terapia empírica y es necesario conocer la susceptibilidad antimicrobiana en cada región para seleccionar un tratamiento empírico adecuado.

Introduction: Complicated community-acquired intra-abdominal infections (CA-cIAI) are a common cause of acute abdomen. Objective: To identify the clinical and microbiology profile of CA-cIAI in four Colombian hospitals. Methods: This is a prospective, descriptive study, between 08-2012 and 09-2014, including patients with CA-cIAI > 15 years. Data collected included: socio-demographic, clinical, diagnosis, and isolates of the first culture obtained aseptically during surgery with antimicrobial susceptibility. Results: 192 patients were included, 62% men, median age 47.3 years. Co-morbidities were present in 38.4%, 13% had been hospitalized in the previous year 13%, and 9.4% had received antibiotics in the last 6 months; 44.3% were admitted for appendicitis, 17.7% for peritonitis and 16.7% for bowel perforation. CA-cIAI were assessed as moderate in 64.1% of the cases and were treated with ampicillin/sulbactam (SAM) and ertapenem. In 70.8% of cases a bacteria was isolated: 65.1% were gramnegative rods (80.0% Escherichia coli, 44.8% of them susceptible to pipercillin/tazobactam, 65.7% to SAM; 11.2 % were K.pneumoniae, 85% was susceptible for SAM; 16.7% were grampositive cocci (28.1% Streptococci viridans group). The median hospital stay was 7 days and 15.1% died. Conclusions: E. coli, K. pneumoniae and S. viridans were the main organisms to consider in an empiric therapy for CA-cIAI and it is important to know the local epidemiology in order to choose the right antibiotic.

Emotion regulation strategies in trauma-related disorders: pathways linking neurobiology and clinical manifestations.

Emotion regulation impairments with traumatic origins have mainly been studied from posttraumatic stress disorder (PTSD) models by studying cases of adult onset and single-incident trauma exposure. The effects of adverse traumatic experiences, however, go beyond the PTSD. Different authors have proposed that PTSD, borderline personality, dissociative, conversive and somatoform disorders constitute a full spectrum of trauma-related conditions. Therefore, a comprehensive review of the neurobiological findings covering this posttraumatic spectrum is needed in order to develop an all-encompassing model for trauma-related disorders with emotion regulation at its center. The present review has sought to link neurobiology findings concerning cortico-limbic function to the field of emotion regulation. In so doing, trauma-related disorders have been placed in a continuum between under- and over-regulation of affect strategies. Under-regulation of affect was predominant in borderline personality disorder, PTSD with re-experiencing symptoms and positive psychoform and somatoform dissociative symptoms. Over-regulation of affect was more prevalent in somatoform disorders and pathologies characterized by negative psychoform and somatoform symptoms. Throughout this continuum, different combinations between under- and over-regulation of affect strategies were also found.

Excitatory and inhibitory conversive experiences: neurobiological features involving positive and negative conversion symptoms.

Previous reviews have focused on neurobiological and physiological mechanisms underlying conversion disorder, but they do not usually distinguish between negative and positive conversion symptoms. Some authors have proposed that different phenomena should underlie both situations and that diverse emotion regulation strategies (under- vs. overregulation of affect) should be related to different internal experiences (excitatory experiences with hyperarousal manifestations vs. inhibitory experiences coexisting with hypoarousal states, respectively). After a careful review of the literature, we conclude that there is not a unique theory comprising all findings. Nevertheless, we have also collected some replicated findings that should be salient. Patients manifesting positive conversion symptoms tended to present with limbic hyperfunction, not sufficiently counteracted by prefrontal control. This leads to underregulation of affect mechanisms, increased emotional reactivity and autonomic hyperarousal. The opposite pattern (with a prefrontal overfunction working as a cognitive brake over the limbic system) has been described during negative conversion manifestations. We also highlight the influence of fronto-limbic circuits over cortico-striato-thalamo-cortical circuits' regulation, whose horizontal and vertical synchronization has been at the spotlight of the genesis of conversion and dissociative disorders.