Identifying Adolescents at Risk for Emotional Disorders with Latent Profile Analysis: A Personalized, Transdiagnostic Preventive Intervention.

It can be challenging to assign patients to the appropriate intervention programs, as risk and protective factors for developing emotional disorders are multiple and shared across disorders. This study aimed to provide a theoretical and empirical approach to identify and categorise adolescents into different levels of severity. The risk of developing emotional symptoms was assessed in 1425 Spanish adolescents (M = 14.34, SD = 1.76; 59.9% women). Latent Profile Analysis (LPA) was conducted to identify subgroups based on their emotional symptom severity, risk, and resilience factors. Results revealed four profiles: at low risk (emotionally healthy), moderate risk (for selective interventions), high risk (for indicated interventions), and severe risk (for clinical referral). Older age and especially female gender were predictors of higher risk clusters, and there were differences in the levels of psychopathology and health-related quality of life across clusters. Identification of at-risk adolescents for emotional disorders by means of LPA may contribute to designing personalised and tailored prevention programs that match adolescents' specific needs.

A 12-Month Follow-Up of PROCARE+, a Transdiagnostic, Selective, Preventive Intervention for Adolescents At-Risk for Emotional Disorders.

Few studies have reported long-term follow-up data on selective preventive interventions for adolescents. No follow-up selective preventive transdiagnostic studies for adolescents at-risk for emotional disorders, such as anxiety and depression, have been reported. To fill this gap, this study aims to provide the first follow-up assessment of a randomized controlled trial (RCT) studying selective transdiagnostic prevention in at-risk adolescents. A 12-month follow-up assessment was conducted with subjects who originally received either PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), PROCARE+, which includes the PROCARE protocol along with personalized add-on modules or an active control condition (ACC) based on emotional psychoeducation, and their respective booster session for each experimental condition. 80 subjects (47.5% girls) aged between 12 and 18 years (M = 14.62; SD 1.43) who completed these treatment conditions were available for the 12-month follow-up. The results demonstrate the superior long-term efficacy of the PROCARE+ intervention in mitigating emotional symptoms and obsessive-compulsive symptomatology compared to the PROCARE and ACC conditions, with effect sizes notably exceeding those commonly observed in preventive programs. While the three treatments demonstrated beneficial impacts, the pronounced results associated with PROCARE+ at the 12-month follow-up emphasized the importance of personalized treatment modules and the sustained benefits of booster sessions in the realm of preventive psychological interventions. The findings also highlight the potential role of add-on modules in enhancing the effects of the PROCARE+ condition.

Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders.

Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents' risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 208 adolescents (48.5% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Data from 153 adolescents who completed all assessments in the different phases of the study were analyzed. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6 month follow-up was carried out, together with a 1 month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE + in the short and long term. Interventions were acceptable in terms of acceptability, with good satisfaction rates. Tailored targeted selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.

Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders.

Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, online-delivered, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session, to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents' risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 286 adolescents (53.3% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6-month follow-up was carried out, together with a 1-month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE +. Interventions were excellent in terms of acceptability, with good satisfaction rates. Tailored selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.

The state of psychological treatments for social anxiety disorder in children and adolescents: An Umbrella Review / Estado de los tratamientos psicológicos para el Trastorno de Ansiedad Social en población infanto-juvenil: Revisión de revisiones

Social Anxiety Disorder (SAD) is a very common disorder in childhood and adolescence. Many studies have examined various types of CognitiveBehavioral Therapy (CBT), meaning there is a need for a study exploring the efficacy of CBT. The objectives of this study are to determine whattreatments and factors can improve treatment outcomes for SAD. We performed an umbrella review of the effectiveness of psychological interventions in treating SAD in children and adolescents. Nine databases were searched using a combination of keywords. Risk of bias was assessed usingAMSTAR-2. Six systematic reviews and meta-analysis were selected and reported. All of those studies assessed the efficacy of CBT in children andadolescents with SAD, demonstrating its short- and long-term effectiveness. The components that seem to be most effective are exposure in anymodality and social skills training. Other considerations to take into account are addressed in the discussion. (AU)

El Trastorno de Ansiedad Social (TAS) es un trastorno muy común en la infancia y adolescencia. Muchos estudios han analizado los diferentes tipos de TerapiaCognitivo-Conductual (TCC) para dicho trastorno, pero ello hace necesario estudiar la eficacia de TCC. El objetivo de esta revisión de revisioneses determinar que tratamientos y que factores son más eficaces para el TAS en población infanto-juvenil. Se realizó una revisión de revisiones sobrela efectividad de las intervenciones psicológicas para tratar el TAS en niños y adolescentes. Para ello, se realizó una búsqueda en nueve bases dedatos utilizando una combinación de palabras clave. El riesgo de sesgo se evaluó mediante la herramienta AMSTAR-2. Se seleccionaron y analizaronseis revisiones sistemáticas y meta-análisis. Todos los estudios seleccionados evaluaron la eficacia de la TCC en niños y adolescentes con SAD,demostrando su efectividad a corto y largo plazo. Los componentes que parecen ser más efectivos son la exposición en cualquier modalidad y elentrenamiento en habilidades sociales. Otras consideraciones a tener en cuenta se abordan en la discusión. (AU)

Screening Social Anxiety in Adolescents Through the Eyes of Their Carers.

Despite the availability of efficacious treatment and screening protocols, social anxiety disorder (SAD) in adolescents is considerably under-detected and undertreated. Our main study objective was to examine a brief, valid, and reliable social anxiety measure already tested to serve as self-report child measure but administered via Internet aimed at listening to the ability of his or her parent to identify social anxiety symptomatology in his or her child. This parent version could be used as a complementary measure to avoid his or her overestimation of children of social anxiety symptomatology using traditional self-reported measures. We examined the psychometric properties of brief and valid social anxiety measure in their parent format and administered via the Internet. The sample included 179 parents/legal guardians of adolescents (67% girls) with a clinical diagnosis of SAD (mean age: 14.27; SD = 1.33). Findings revealed good factor structure, internal consistency, and construct validity. Data support a single, strength-based factor on the SPAIB-P, being structure largely invariant across age and gender. The limited number of adolescents with a performance-only specifier prevented examining the utility of scale to screen for this recently established specifier. It is crucial to evaluate if these results generalize to different cultures and community samples. The findings suggest that the SPAIB-P evidences performance comparable with child-reported measure. Parents can be reliable reports of the social anxiety symptomatology of the adolescent. The SPAIB-P may be useful for identifying clinically disturbed socially anxious adolescents.

Validation of the Structured Interview for the Assessment of Expressed Emotion (E5) in a Sample of Adolescents and Young Adults From the General Population.

Expressed emotion (EE) is an index of significant others' attitudes, feelings, and behavior toward an identified patient. EE was originally conceptualized as a dichotomous summary index. Thus, a family member is rated low or high on how much criticism, hostility, and emotional overinvolvement (EOI) s/he expresses toward an identified patient. However, the lack of brief, valid measures is a drawback to assess EE. To cover this gap, the E5 was designed. The objective of this study is to provide psychometric properties of a recent measured in adolescents to be used to tap perceived high levels of EE. The sample was composed by 2,905 adolescents aged from 11-19years; 57% girls. Results demonstrate good factor structure, reliability, construct validity and invariance across gender and age revealed a good fit. As a result, E5 is a brief, valid and reliable measure for assessing expressed emotion in parents of adolescent children.

Can parent training for parents with high levels of expressed emotion have a positive effect on their child's social anxiety improvement?

The role that parents' involvement may play in improving their child's social anxiety is still under debate. This paper aimed to investigate whether training parents with high expressed emotion (EE) could improve outcomes for adolescent social anxiety intervention. Fifty-two socially anxious adolescents (aged 13-18 years), whose parents exhibited high levels of expressed emotion, were assigned to either (a) a school-based intervention with an added parent training component, or (b) a school-based program focused solely on intervening with the adolescent (no parental involvement). Post-treatment and 12-month follow-up findings showed that school-based intervention with parent training was superior to the adolescent-specific program, yielding significant reductions in diagnosis remission, social and depressive symptomatology, particularly when the EE status of parents changed. Overall, the findings suggest that high-EE parents of children with social anxiety need to be involved in their child's therapy.

La medición de la Inteligencia Emocional en adolescentes españoles con trastorno de ansiedad / The Measurement of Perceived Emotional Intelligence for Spanish Adolescents with Social Anxiety Disorder Symptoms

La Inteligencia Emocional (IE) es un concepto que ha sido discutido durante décadas en Psicología pero no ha recibido apoyo empírico hasta hace pocos años, a pesar de ello parece que en las últimas décadas es-te concepto está suscitando mucho interés entre las diversas áreas de la Psicología. Con este creciente interés, el concepto de percepción de la Inteligencia Emocional está recibiendo mayor atención. Debido a interés mostrado en este concepto, este artículo tiene como objetivo explorar dos aspectos importantes del mismo: la medida de la percepción de la IE y las implicaciones que la percepción de la IE puede tener en adolescentes con un trastorno de Ansiedad Social (TAS). Este estudio explora un cuestionario muy utilizado para evaluar el PEI, llamado Trait Meta-Mood Scale (TMMS). La versión española reducida de dicho cuestionario (TMMS-24) y una serie de cuestionarios muy utilizados para evaluar el TAS fueron administrados a 425 adolescentes españoles. Los resultados del estudio corroboraron que el TMMS-24 posee buenas propiedades psicométricas en adolescentes y que el componente de regulación emocional parece que está involucrado en la ansiedad social (AU)

Emotional Intelligence (EI) is a concept that has been discussed for decades in Psychology but has received very little empirical study until recently. And with this growing interest, its accompanying concept, Perceived Emotional Intelligence (PEI), has also received more attention. It is due to this growing interest in PEI that this paper explores two important aspects of the PEI: the measurement of PEI and the implications PEI may have for adolescent anxiety disorder symptomology. This study explores a well-known questionnaire of PEI, namely the Trait Meta-Mood Scale questionnaire (TMMS). The Spanish shortened version of the Trait Meta-Mood Scale questionnaire (TMMS-24) and a series of well-known questionnaires of Social Anxiety Disorder symptomology were administrated to 425 Spanish high-school adolescents. The results of this study corroborated that the TMMS-24 has good psychometric properties in adolescents, and that one of its three scales (Emotional Repair) appears to be involved in adolescent SAD symptomology (AU)

Psychometric properties of the screen for child anxiety related emotional disorders for socially anxious and healthy Spanish adolescents.

Socially anxious and healthy Spanish adolescents were studied in order to test the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED). Confirmatory factor analyses were employed to test measurement invariance between these two populations, Cronbach's alphas were calculated to determine the reliabilities of the scales, and partial eta-square tests calculated the effect size of the differences between socially anxious and healthy adolescents and between the adolescent boys and girls. The psychometric properties of the SCARED were good, as demonstrated by having acceptable reliabilities (ranging from .75 - .41) and a moderate multivariate effect size (η(p)(2) = .08) between the adolescent boys and girls. Most importantly, it was demonstrated that the SCARED could differentiate between socially anxious and healthy Spanish adolescents as demonstrated by measurement invariance (χ(2) = 254.27, df = 1343, GFI = .884, AGFI = .872, RMR = .031) and the large effect size (η(p)(2) = .22) between the samples.

Selective intentional forgetting in adolescents with social anxiety disorder.

Anxiety in young adults has recently been linked to reduced capacities to inhibit the processing of non-affective perceptual distractors. However, no previous research has addressed the relationship between social anxiety disorder (SAD) and the ability to intentionally inhibit no longer relevant memories. In an experimental study with adolescents diagnosed with SAD and matched nonclinical controls, a selective directed forgetting procedure was used to assess the extent to which anxious individuals showed lower memory impairment for to-be-forgotten information than their non-anxious counterparts. The results revealed that while the nonclinical sample group demonstrated the ability to selectively forget when instructed, the anxious adolescents demonstrated good memory for to-be-forgotten material and therefore failed to forget. Interestingly, more severe SAD symptomatology inversely predicted a degree of forgetting. We conclude that the main difference between socially anxious and non-anxious participants is specifically related to the ability to intentionally forget and could reflect cognitive functioning that is associated with vulnerability to anxiety. Impairment of the ability to make unwanted memories less retrievable could prompt some individuals to initiate or maintain anxiety disorders. Future psychological treatments could benefit from including modules on memory control training.

Psychometric properties of the screen for child anxiety related emotional disorders for socially anxious and healthy Spanish adolescents

Socially anxious and healthy Spanish adolescents were studied in order to test the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED). Confirmatory factor analyses were employed to test measurement invariance between these two populations, Cronbach’s alphas were calculated to determine the reliabilities of the scales, and partial eta-square tests calculated the effect size of the differences between socially anxious and healthy adolescents and between the adolescent boys and girls. The psychometric properties of the SCARED were good, as demonstrated by having acceptable reliabilities (ranging from .75 - .41) and a moderate multivariate effect size (çp2 = .08) between the adolescent boys and girls. Most importantly, it was demonstrated that the SCARED could differentiate between socially anxious and healthy Spanish adolescents as demonstrated by measurement invariance (÷2 = 254.27, df = 1343, GFI = .884, AGFI = .872, RMR = .031) and the large effect size (çp2 = .22) between the samples (AU)

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Inhibición conductual y su relación con los trastornos de ansiedad infantil / Behavioral inhibition and relationship with childhood anxiety disorders

La literatura científica ha mostrado que la inhibición conductual (IC) se caracteriza por la presencia de ansiedad ante estímulos desconocidos, lo que conlleva conductas de retraimiento y evitación social. El presente estudio realiza una revisión bibliográfica sobre la IC y su relación con los trastornos de ansiedad en la infancia. Dado que la IC puede observarse en edades muy tempranas, la literatura ha examinado su papel predictor en el desarrollo de trastornos de ansiedad. Pese a ello, los estudios revisados apuntan a que no todos los niños ansiosos muestran un comportamiento inhibido ni todos los niños con IC sufren trastornos de ansiedad. Dada esta disparidad, sería necesario estudiar qué otros factores están implicados. Asimismo, los datos apuntan a que una detección precoz de la IC permitiría desarrollar programas de prevención de los trastornos de ansiedad en la infancia.

The literature has revealed that Behavioral inhibition (BI) is characterized by the presence of anxiety to unknown stimuli, which leads to withdrawal behaviors and social avoidance. The present study is aimed at revising the state-of-the-art on BI and examining its role that plays of childhood anxiety disorders. As the IB can be observed at very early ages, the literature has examined its predictive role in the development of anxiety disorders. Despite this, the reviewed studies suggest that not all anxious children show comorbid BI nor all inhibited children have anxiety disorders. Given this disparity, it would be necessary to consider what other factors are involved in the anxiety disorders. Furthermore, the data suggest that early detection of the BI would contribute to develop prevention programs for anxiety disorders in childhood.

Validación del "Inventario de ansiedad y fobia social-forma breve" (SPAI-B) en jóvenes adultos españoles / Validation of the Social Phobia and Anxiety Inventory-Brief form (SPAI-B) in Spanish young adults

Este trabajo presenta las propiedades psicométricas del "Inventario de ansiedad y fobia social-forma breve" (Social Phobia and Anxiety Inventory-Brief form, SPAI-B) en jóvenes adultos estudiantes universitarios y analiza la viabilidad de su aplicación online. El estudio 1 incluyó 310 estudiantes universitarios. Se aplicaron el SPAI-B, la "Escala de miedo a la evaluación negativa, versión breve" (BFNE) y la "Escala de afecto positivo y negativo" (PANAS). Los resultados apoyaron la estructura original unidimensional del SPAI-B, su consistencia interna (0,89-0,94) y la validez concurrente con la BFNE (0,60) y con el afecto negativo (0,47). Las mujeres presentaron puntuaciones significativamente más elevadas que los hombres. En el estudio 2 participaron 76 estudiantes universitarios, que cumplimentaron el SPAI-B y la "Escala rasgo de metaconocimiento emocional" (TMMS-24) online. Esta aplicación resultó equivalente a la aplicación de lápiz y papel, mostrando una estructura factorial similar, valores de consistencia interna semejantes (0,92) y puntuaciones medias equivalentes. Los hallazgos de los estudios 1 y 2 apoyan la fiabilidad y validez del SPAI-B para la evaluación de la ansiedad social en población universitaria (AU)

This article describes the psychometric properties of the Social Phobia and Anxiety Inventory-Brief form (SPAI-B) in college young adults and examines the feasibility of the Internet administration. Study 1 included 310 college students. The SPAI-B, the Brief Version of the Fear of Negative Evaluation Scale (BFNE), and the Positive and Negative Affect Schedule (PANAS) were administered. Results supported the original unidimensional structure of the SPAI-B, its internal consistency (0.89-0.94), and the concurrent validity, paired with BFNE (0.60) and negative affect (0.47). Women had significantly higher scores than men in the SPAI-B. For study 2, 76 college students completed the SPAI-B and the Trait Meta-Mood Scale-24 Scale via Internet administration. Results indicated that the online administration was equivalent to traditional paper-and-pencil measure, showing similar factor structure, internal consistency ​​(0.92) and mean scores. Taken together, the findings of studies 1 and 2 provide initial support for the reliability and validity of the SPAI-B for the assessment of social anxiety in college young adults

Exploring the relevance of expressed emotion to the treatment of social anxiety disorder in adolescence.

The role that the involvement of parents may play in the treatment outcome of their children with anxiety disorders is still under debate. Some studies dealing with other disorders have examined the role that the expressed emotion (EE) construct (parental overinvolvement, criticism and hostility) may play in treatment outcome and relapse. Given that some of these aspects have been associated with social anxiety for a long time, it was hypothesized that EE may be associated with lower treatment outcome. The sample was composed of 16 adolescents who benefited from a school-based, cognitive-behavioural intervention aimed at overcoming social anxiety. Then, parents were classified with high or low EE. The results revealed that the adolescents whose parents had low EE showed a statistically significant reduction of their social anxiety scores at posttest, as opposed to adolescents of parents with high expressed emotion. These findings suggest that parental psychopathology (parents with high EE) should be taken into consideration to prevent poor adolescent treatment outcome.

Ansiedad infantil e implicación de los padres: una revisión / Childhood anxiety and parents’ involvement: a review

En el presente artículo se realiza una revisión del papel que juegan los padres tanto en el origen, desarrollo y mantenimiento de los trastornos de ansiedad infantil como en el tratamiento y la prevención de los mismos. Determinadas pautas educativas, tales como el rechazo y, sobre todo, el excesivo control de los padres se han relacionado con la presencia de ansiedad en los niños. Otro aspecto a tener en cuenta es la presencia de algún trastorno de ansiedad en los propios padres. En relación al tratamiento y la prevención se dispone ya de datos que muestran la eficacia que tiene la intervención al incluir a los padres en la misma, entrenándolos en determinadas estrategias y habilidades. Sin embargo, a pesar de que cada vez van apareciendo más estudios sobre esta temática, aún se puede decir que es muy escasa, requiriendo más investigación en los diferentes ámbitos de estudio (AU)

This paper presents a review of the role that parents play in the ethiology and maintenace of child anxiety and in their treatment and prevention. Some educative patterns, such as rejection and, above all, parents’ excessive over-protection behaviour, have been related to the presence of anxiety in children. In fact, a related issue to take into account would be the presence of any type of anxiety disorder in the parents themselves. As far as the child anxiety treatment and its prevention are concerned, data show that training parents in certain strategies and skills and including them in the intervention programme increase the effectiveness of the treatment outcome. Despite the research conducted in the field, the number of publications is still limited. Thus, further investigation is encouraged

Temporal performance in 4-8 year old children. The effect of chronometric information in task execution.

The present study explores temporal performance in children between 4 and 11 years of age. In order to optimise the children's performance, verbal instructions and demonstrations were used to specify the temporal requirement of the task. Moreover, specific feedback was given, which indicated the success of a response, or, in case of a mistake, indicated the type of error made. The task was presented in two phases: training and experimental. In the first phase, the child practised until a learning criterion was reached. In the experimental phase, four conditions were defined according to the information provided to the children. In general, the results of the training phase showed an improvement in performance with advancing age. Significant differences were found in children between 7 and 8 years of age, which points to an important transition period. Results of the experimental phase showed a pronounced impact of instructions on the performance of the task and on the strategies used to control timing behaviour. Specifically, the instructions that contained chronometric information caused an impairment in task performance and a change in the strategy used.

Time estimation during prolonged sleep deprivation and its relation to activation measures.

This is the first study to analyze variations in time estimation during 60 h of sleep deprivation and the relation between time estimation performance and the activation measures of skin resistance level, body temperature, and Stanford Sleepiness Scale (SSS) scores. Among 30 healthy participants 18 to 24 years of age, for a 10-s interval using the production method, we found a lengthening in time estimations that was modulated by circadian oscillations. No differences in gender were found in the time estimation task during sleep deprivation. The variations in time estimation correlated significantly with body temperature, skin resistance level, and SSS throughout the sleep deprivation period. When body temperature is elevated, indicating a high level of activation, the interval tends to be underestimated, and vice versa. When the skin resistance level or SSS is elevated (low activation), time estimation is lengthened, and vice versa. This lengthening is important because many everyday situations involve duration estimation under moderate to severe sleep loss. Actual or potential applications of this research include transportation systems, emergency response work, sporting activities, and industrial settings in which accuracy in anticipation or coincidence timing is important for safety or efficiency.

Aplicaciones clínicas de la privación de sueño en el tratamiento de la depresión / Clinical applications of sleep deprivation on the treatment of depression

El 40-60 por ciento de los sujetos depresivos muestran una respuesta positiva después de una noche de privación de sueño. Sin embargo, esta mejoría es sólo transitoria. Habitualmente ocurre una recaída después de la noche de sueño posterior. En el presente artículo se analizan seis posibles aplicaciones clínicas de la privación de sueño: acelerar el comienzo de acción de otros tratamientos, potenciar la respuesta de otros tratamientos, prevenir ciclos rápidos de estado de ánimos, constituir una alternativa a otros tratamientos, servir de prueba diagnóstica y de predictor de la respuesta a otros tratamientos. Se revisan los estudios disponibles sobre la eficacia de cada una de estas aplicaciones. Existe evidencia empírica aunque limitada de que la privación de sueño puede acelerar el comienzo de acción de la medicación antidepresiva y también potenciar la respuesta a la misma. Otras aplicaciones clínicas han resultado también prometedoras como la posibilidad de utilizar la privación de sueño en el tratamiento disfórico premenstrual, en el diagnóstico diferencial de la depresión y de la demencia en personas de avanzada edad. Sin embargo, las limitaciones metodológicas observadas en muchos de estos estudios impiden, por el momento, llegar a conclusiones del todo definitivas.