EPA guidance on mental health and economic crises in Europe.

This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.

Changing trends in hospitalization rates associated with psychosis: Spain, 1980-2009.

PURPOSE: To analyze the prevalence of hospitalization attributable to psychosis in Spain over the last three decades. METHODS: Longitudinal analysis (1980-2009) of age-adjusted hospital discharges rates associated with psychosis (ICD9 290-8) in all Spanish hospitals. DATA SOURCE: Spanish Hospital Morbidity Survey. RESULTS: The hospitalization rate associated with psychotic episodes had been gradually increasing since 1980 until 2004; an abrupt turnaround observed in 2004 marks the beginning of a steady decline in the rate. The turning point described is not observed for each of the psychotic diagnoses separately analyzed. However, it is clearly seen when data are grouped in diagnosis-related groups (organic-psychosis, functional psychosis and substance-induced psychosis) since the time course of the diseases within the major diagnostic groups are interrelated as evidenced by shared turning points which collectively display a common time course pattern. Main hospital indicators and antipsychotic drug prescriptions were analyzed for any possible turning point in mid-2000s. Psychiatric hospital beds and length of stays remained stable by 2004; the hospitalizations associated with non-psychotic psychiatric pathologies show no turning point in 2004. However, an abrupt change on antipsychotic drug prescriptions is precisely observed in 2004. CONCLUSIONS: After decades of linear growth, hospitalizations for psychotic patients begin to decline in 2004, coinciding with the start of last generation atypical antipsychotic drug consumption in Spain. Some of the psychotic diagnostic rates evolve in an interrelated manner which calls into question the diagnosis and nosological boundaries between some of these pathologies.

Efficacy and effectiveness of individual family intervention on social and clinical functioning and family burden in severe schizophrenia: a 2-year randomized controlled study.

BACKGROUND: Empirical evidence of the efficacy and effectiveness of psychosocial family intervention and of the specificity of its effects on the course of schizophrenia is limited. The aim was to study the efficacy and effectiveness of psychosocial family intervention with regard to clinical and social functioning and family burden after controlling for compliance and several prognostic factors. METHOD: A 2-year randomized controlled trial with blind assessments. Fifty patients with DSM-IV schizophrenia and persistent positive symptoms and/or previous clinical relapse were allocated to psychosocial family intervention, individual counselling and standard treatment versus individual counselling and standard treatment. RESULTS: Family intervention was associated with fewer clinical relapses, hospitalizations and major incidents, and an improvement in positive and negative symptoms, social role performance, social relations, employment and family burden. The reduction in hospitalizations in the family intervention group was significantly greater than that observed in the group of patients who refused to participate but this was not the case for the control group. The effects of family intervention were independent of compliance and prognostic factors. CONCLUSIONS: Family intervention is effective in severe schizophrenia independently of compliance and prognostic factors.

Motor speed predicts stability of cognitive deficitsin both schizophrenic and bipolar I patients at oneyearfollow-up

Background: We examined whether motor speed assessed by the fingertapping test predicts generalized and specific stable deficits because of a common pathogenicprocess in bipolar and schizophrenic patients.Methods: One hundred and two patients underwent a battery of neuropsychologicaltests. Patients with a score of less than one standard deviation from their siblings’ samplein two assessments with an interval of one year were defined as suffering from stabledeficits because of a common pathogenic process. In addition to univariate analyses, factoranalyses, ordinal logistic regression, and multiple linear regressions were used. A generalscore was also calculated. Results: No differences were found between schizophrenic and bipolar patients in thedeficits of verbal fluency, shift reasoning ability and executive attention. Schizophrenicpatients had greater persistent cognitive deficit because of a common pathogenic factor inthe verbal memory dimension than bipolar patients. Motor speed predicted the specificdeficits of verbal fluency, shift reasoning, executive attention and the general deficit ofboth bipolar I and schizophrenic patients. Bipolar patients suffered a lesser specific deficitin the verbal memory dimension than schizophrenic patients did, this domain not beingpredicted by motor speed. Motor speed predicted the generalized deficit and the specificdimensions in which schizophrenic and bipolar patients showed no differences.Conclusions: These results suggest the presence of general and specific stable cognitivedeficits because of a common pathogenic factor related to psychomotor slowness. Motorspeed seems to be suitable endophenocognitype for schizophrenia and bipolar disorder (AU)

A 6-month prospective, observational, naturalistic, uncontrolled study to evaluate the effectiveness and tolerability of oral ziprasidone in patients with schizophrenia.

This multicenter, uncontrolled, naturalistic study evaluated the effectiveness and tolerability of 6 months of treatment with ziprasidone in 1266 patients with a diagnosis of schizophrenia. The percentage of responders (at least 30% reduction in PANSS total score) in the primary analysis sample (n=1022) was 47.3% (95% CI 44.2-50.4) at the end of the study. Patients showed a significant and clinically relevant reduction in the PANSS total, positive, negative and general psychopathology subscales scores (effect size of 1.60, 1.83, 0.62 and 1.40 respectively). Overall, 453 (35.8%) patients withdrew from the study; 9.3% withdrew owing to adverse events. Ziprasidone doses greater than 120 mg/day were associated with a lower risk of discontinuation for any cause (OR 0.46, 95% CI 0.33-0.65) Ziprasidone was well tolerated. Most common side effects were: insomnia, somnolence and nervousness. The effectiveness and tolerability of ziprasidone in clinical practice are consistent to those previously shown in the more restricted and homogeneous populations of clinical trials.

Validez del trastorno autodestructivo de la personalidad DSM-III-R / Validity of DSM-III-R self-defeating personality disorder

Introducción: El trastorno autodestructivo de personalidad se introdujo en el DSM-III-R como una categoría propuesta para estudio adicional, siendo retirada de la cuarta edición del DSM debido a las dudas en torno a su validez. Objetivos: El objetivo de esta revisión es examinar la justificación de dicha decisión. Se presenta y discute la historia del trastorno, así como las bases para su inclusión como una categoría provisional del DSM-III-R. También se exponen los resultados de un estudio llevado a cabo por nuestro equipo con el objetivo de verificar la existencia del trastorno. Sujetos y métodos: Tras la evaluación de una muestra aleatoria de 200 pacientes psiquiátricos atendidos en un centro de salud mental, se seleccionaron 15 casos con sospecha clínica de rasgos autodestructivos para ser evaluados por un panel de expertos, mediante la historia clínica y la información aportada por el Personality Assessment Schedule(PAS). Resultados: Se identificaron dos casos, ambos comórbidos con el trastorno de personalidad dependiente. Seis sujetos más fueron diagnosticados como casos subumbral de acuerdo con los criterios DSM, presentando todos ellos comorbilidad en el eje 11. Conclusión: El trastorno "autodestructivo de personalidad parece existir; probablemente con una baja prevalencia y una alta comorbilidad, pero es necesario llevar acabo una mayor investigación para clarificar estos aspectos

lntroduction: Self-defeating Personality Disorder was introduced in DSM-III-R classificationas a category in need offurther study and then removedfrom DSM-IV edition because of its doubt ul validity. Objectives: The aim of this review is to examine the justification of such a decision. The history of the disorder as well as the bases for its inclusion as a provisional categoryin DSM-III-R are presented and discussed. Then, the results of a study carried outby our team with the aim of verifying the existence of the disorder are presented. Subjects and method: 15 patients with clinical suspicion of self-defeating traits were selected from a random sample of two hundred psychiatric outpatients and the information obtained from Personality Assessment Schedule (PAS) and clinical interview was assessed by a panel of experts. Results: Two cases were identified, both comorbid with Dependent Personality Disordel: Six more subjects were diagnosed as subthreshold cases according to DSM criteria. All of them presented other comorbidities. Conclusion: Self-defeating Personality Disorder seems to exist, though probably with a low prevalence and a high comorbidity, but further research is necessary to clarify these aspects

Recall and recognition confabulation in psychotic and bipolar disorders: evidence for two different types without unitary mechanisms.

Several forms of confabulation have been identified recently in schizophrenic patients, but it has not yet been investigated whether these forms are specific to schizophrenia. Furthermore, the origin of confabulation is unclear. The present study investigated recall and recognition confabulation and their relations with symptomatology, cognitive domains (abstraction and flexibility, verbal fluency, verbal memory, motor activity, and visual-motor processing/attention), computed tomographic (CT) measures (ventricular, cerebral, and Sylvian fissure size), and auditory event-related potentials (amplitudes and latencies of peak components in oddball paradigms) in 33 schizophrenic patients, 35 bipolar I patients, eight schizoaffective patients, and seven patients with other psychotic disorders. We found that neither type of confabulation was specific of any diagnostic group. Recall confabulation was mainly predicted by the predominance of positive symptoms, while recognition confabulation was predicted by a delay in P300 latency and the doses of antipsychotics used. Our results suggest two different mechanisms for both types of confabulation based on interference with the adequate retrieval of information and slowness in early stimulus detection.

Preferencia motora y esquizofrenia (II) / Motor preferency and schizophrenia (II)

Este artículo corresponde a la segunda parte de una revisión de la literatura sobre preferencia manual y esquizofrenia. A pesar de la falta de datos definitivos, el mayor número de trabajos apuntan a que en la esquizofrenia existe una alteración del patrón normal de preferencia manual, con un incremento de los zurdos o nodiestros. Se describen las asociaciones entre preferencia manual y las distintas variables clínicas de la esquizofrenia. Al final, se discuten las implicaciones de estos estudios en la etiología biológica de la esquizofrenia. En cualquier caso, parece evidente la importancia de conocer esta variable en los pacientes esquizofrénicos, dentro del contexto de la práctica clínica y de la investigación básica (AU)

Preferencia motora y esquizofrenia (I) / Motor preferency and schizophrenia (I)

Este trabajo es la primera parte de una revisión crítica acerca de los diferentes estudios sobre la preferencia motora en la esquizofrenia. Se analizan y discuten los métodos de medición de la preferencia manual y las características muestrales de los trabajos (AU)

Similar effect of family history of psychosis on Sylvian fissure size and auditory P200 amplitude in schizophrenic and bipolar subjects.

Several cerebral studies point to the non-specificity of structural and functional changes described in schizophrenia and bipolar disorders. Furthermore, the origin of these changes is still unclear. The present study investigated the effect of a family history (FH) of psychotic disorders in first-degree relatives on computed tomographic (CT) measures (ventricular, cerebral and Sylvian fissure size) and auditory event-related potentials (amplitudes and latencies of peak components in oddball paradigms) in 30 schizophrenic patients and 24 bipolar type I patients. We found a significant correlation between FH and the size of the right Sylvian fissure, and between FH and auditory P200 amplitude. More specifically, the schizophrenic and bipolar patients with negative FH (n=36) had larger right Sylvian fissures and smaller P200 amplitude than patients with positive FH (n=18). These findings were independent of the specific diagnosis, gender, and age of subjects. Our results suggest some underlying process common to schizophrenia and bipolar I disorder, and they provide support for the continuum view of the nosologic structure of psychotic illness.

Correlates of symptom dimensions in schizophrenia obtained with the Spanish version of the Manchester scale.

In the last decade, a significant number of studies have been published which suggest a multifactorial psychopathological structure in schizophrenia. Seventy-eight acute and chronic schizophrenic patients diagnosed in accordance with DSM-III-R criteria were studied with the Manchester Scale, Premorbid Adjustment Scale, Family History-RDC Interview, Digit Span, Mini-Mental State and computerized tomography (CT). A factorial analysis of the symptoms as recorded with the Spanish version of the Manchester Scale was carried out. Three factors ('positive', 'negative' and 'disorganization') accounted for 79% of the total variance. Poor premorbid adjustment was associated with high scores for the 'positive' dimension. The 'disorganization' dimension was significantly associated with lower scores in the Mini-Mental and attention test than the rest. However, CT did not differentiate between these symptom dimensions. This study of a sample of mostly outpatients corroborates the hypothesis of three clinical dimensions in schizophrenia.

Early age of onset, brain morphological changes and non-consistent motor asymmetry in schizophrenic patients.

Previous data suggest abnormalities in the consistence of motor dominance in schizophrenia (e.g. mixed-handedness, poor correlation between hand, eye and foot preferences and an increase of hand-eye crossed dominance). The aim of this work is to examine the clinical significance of hand-eye and hand-foot crossed dominance in a sample of 61 right-handed schizophrenic patients. The application of multivariate analysis revealed that 23 right-handed and non-right-eyed patients (crossed hand-eye dominant group) had a significant earlier clinical onset and smaller brain size, global and frontal area, than 38 right-handed and right-eyed schizophrenics (consistent hand-eye dominance group). These findings are discussed within the context of neurodevelopmental disorders.

Prevalence, comorbidity, risk factors and service utilisation of disruptive behaviour disorders in a community sample of children in Valencia (Spain).

BACKGROUND: The importance of cultural and adverse family-environment variables as risk factors for Disruptive Behaviour Disorder has been repeatedly shown, and hence a variation in rates and risk factors between cultures could be expected. Lower rates should be found in countries with strong and stable family ties, such as Spain. OBJECTIVE: Prevalence rate, severity and comorbidity of Disruptive Behaviour Disorder, as well as risk factors and help-seeking behaviour relating to this disorder, were studied in a general population random sample of 387 10 year-old children living in Valencia (Spain). METHODS: DSM-III-R diagnosis was established by means of the KIDDY-SADS (Kiddy Schedule for affective diseases and Schizophrenia (epidemiological version)) interview and severity of the disorder was evaluated with the General Assessment Functioning (GAF) Scale. Other variables measured were: sex, number of siblings, parental occupation, single-parent home, school failure, socioeconomic level, chronic somatic ailments and use of mental health services. RESULTS: Prevalence and severity parameters were low (for GAF70, prevalence = 11.1; for GAF60, prevalence = 4.9), albeit falling within the range reported in other countries. Morbidity profile and use of services did not substantially depart from the findings reported in other cultures. Different risk factors were associated with Attention Deficit Hyperactivity Disorder, Conduct Disorder and Oppositional Defiant Disorder, thus confirming the validity of considering them as separate dimensions. CONCLUSIONS: The findings did not support the hypothesis of lower rates and different risk factors and morbidity patterns in the Spanish sample studied.

Relationship between empathic family attitude and relapse in schizophrenia: a 2-year followup prospective study.

Empathy plays a central role in social relationships, and lack of empathy has been suggested as part of expressed emotion in the relatives of patients with schizophrenia. The aim of this research is to measure empathy in the relatives of schizophrenia patients and to establish the relationship between lack of empathy and relapse. Eighty schizophrenia patients were followed up in a 2-year prospective cohort study. Relatives' empathy, defined as the ability to perceive the patient's mood state, was measured at the beginning of the study with a questionnaire given after a 10-minute interaction between the patient and his or her relative. Several other attitudinal, clinical, and social variables were also measured. A significant relationship was found between poor empathic attitude and relapse. Lack of treatment compliance, negative symptoms, unemployment, and poor premorbid adjustment were also associated with relapse. In a multivariate analysis, the association between poor empathic attitude and relapse was maintained. Statistical control of the relatives' critical attitude showed that each kind of attitude predicts relapse independently.

[Child rearing patterns in mothers with postpartum depression]. / Estilo de crianza en madres con depresión postparto.

INTRODUCTION: Postpartum Depression is a psychiatric syndrome with a prevalence of 10-15%. The studies show that depressive mothers have a "negative" relation with their children. METHOD: 205 primiparous women are analyzed, of them, we take a group of "cases" (23 depressive mothers) and a "control" group (37 women without psychiatric symptoms). Childrearing in the first postpartum year is analyzed. RESULTS: 13.5% of the studied women have a Postpartum Depression within the first six postpartum months. There aren't sociodemographics differences between both groups. Childrearing of depressive mothers is lower in affect and care than control mothers. CONCLUSIONS: Childrearing of depressive mothers in postpartum period is lower in Affect and Care than non depressive mothers in the same period.

Mortality among psychiatric patients referred to the mental health services in Valencia.

The rate of survival and causes of mortality in a cohort of 2103 psychiatric patients registered on a psychiatric case register and followed up for 7 years are compared with those of a general population sample (n = 2382) randomly extracted from the municipal census in Valencia (Spain). Using multivariate analysis by Cox regression, patients suffering organic psychoses and those diagnosed with drug abuse or dependency exhibited a greater risk of death than the general population for the total causes of death; no interaction was found between sociodemographic variables and psychiatric pathology. In terms of the causes of death, and controlling for the effect of age and sex, organic psychoses involved a greater risk of death due to cardiovascular and respiratory causes, and a greater risk of non-natural deaths than the general population. Schizophrenia and related conditions, the abuse of alcohol/ other drugs, and neurosis/personality disorders all presented a higher risk of death from liver disease. The major affective disorders involved a greater risk of death due to suicide or accidents. The study concludes with a discussion of the possible explanations of these results.

Clinical interview skills and identification of emotional disorders in primary care.

OBJECTIVE: The aim of this research was to study the relationship between the clinical interview skills of primary care physicians and their psychodiagnostic ability during office visits. METHOD: Ten doctors took part in the study, and 233 patients were assessed. The patients were seen and diagnosed by their physicians and interviewed afterward by a psychiatrist using the Present State Examination. All the interviews with the primary care physicians were recorded on videotape, and the Physician's Skills Observation Scale was used to analyze 10 interviews per doctor, five psychiatric cases and five nonpsychiatric cases. RESULTS: The physician's active listening (eye contact, posture, and absence of verbal interruptions) and ability to ask questions with psychological content were associated with the ability to identify the patient's emotional problems. This association was shown to be independent of the physician's characteristics (social, academic, attitudinal, and professional), the sociodemographic characteristics of the patients, the time spent in exploration during the office visit, and the severity of the emotional or somatic disorder. CONCLUSIONS: The findings of this research highlight the need to train primary care physicians in specific interview skills, in order to improve their ability to identify mental disorders in their practices.

Social adjustment in schizophrenia: factors predictive of short-term social adjustment in a sample of schizophrenic patients.

A sample of 60 Spanish schizophrenic patients was studied in order to ascertain the relationship between their relatives' expressed emotion (EE) and social adjustment after 2 years of follow-up. The average extent of the disability did not increase over time, and differences in dysfunction rates between the various specific social roles were identified. No differences in social outcome were detected between patients with high EE and low EE families. Three factors which predict social adjustment outcome were obtained using logistic regression analysis, namely clinical conditions, baseline social adjustment and the occurrence of a psychotic relapse during the follow-up period.

[Intentions and behaviors of risky drug consumption in users at the rehabilitation centers in Valencia]. / Intenciones y prácticas de consumo de riesgo en usuarios de centros de deshabituación de drogas en Valencia.

A study was made of the factors associated with high-risk behavior and intention to change among 126 intravenous drug users (IVDU) seen at drug treatment centers. Needle-sharing in the last month was associated with intravenous cocaine use, whereas sharing water or drug preparations was associated with variables related to the level of instruction or the reduction in the number of syringes shared in the last month. The intention to abandon high-risk behavior was not associated with the information, attitudes, or norms of the group, but was associated with the perception of personal capacity for reducing high-risk behavior. Finally, the importance and applications of these results in health counseling for IVDUs is discussed.