Validation of the spanish version of the discrimination and stigma scale (DISC 12).

AIMS: The "Discrimination and Stigma Scale" (DISC) was the first instrument specifically designed to evaluate reported experiences of discrimination by people with mental disorders. This study aims to validate DISC-12 version in Spanish population with Schizophrenia and, as specific objectives, to do the external validation with the Self-Stigma Questionnaire (SSQ) scale and Link PDD scale and to validate their internal consistency, temporal and inter-rater reliability. METHODS: 86 individuals with schizophrenia were interviewed at two time points (between one to two weeks) by two raters. Additionally to assess their sociodemographic and clinical characteristics, following scales were administered: DISC 12, SSQ, PDD, Social Functioning Scale (SFS) and Global Assessment of Function (GAF). RESULTS: Internal consistency as a whole results a Cronbach a between 0.741 and 0.850. Subscales "Unfair treatmen" and "Positive treatment" have a Cronbach a higher than 0.79, but the both subscales "Stopping Self" and "Overcoming stigma" do not have in themselves an adequate consistency. Test-retest reliability shows that four subscales have values higher than 0.67. Inter-rater reliability assessment result that 21 items score values above 0.8, 10 between 0.6-0.8 and one lower than 0.6. DISC-12 was significantly related with the second factor of the PDD (self-stigma) and SSQ. CONCLUSIONS: The Spanish version of the DISC 12 scale is valid, has good internal consistency, is reliable both in terms of test-retest and inter-rater reliability and has good convergent validity with the SSQ and PDD, and the "Unfair treatment" and "Positive Treatment" subscales were the most robust of the four subscales.

Validación de la versión española de la escala de discriminación y estigma (DISC 12) / Validation of the spanish version of the discrimination and stigma scale (DISC 12)

Objetivos. La "Escala de Discriminación y Estigma" (DISC) fue el primer instrumento diseñado para evaluar experiencias de discriminación referidas por pacientes con trastornos mentales. El objetivo principal de este estudio es validar la versión española de la escala DISC 12 en población con esquizofrenia y, como objetivos específicos, realizar la validación externa con el Cuestionario de Autoestigma (SSQ) y la Escala de Link (PDD) y validar su consistencia interna y la fiabilidad temporal y entre observadores. Métodos. 86 individuos con esquizofrenia fueron entrevistados en dos tiempos (entre una y dos semanas) por dos evaluadores. Se estudiaron sus características sociodemo-gráficas y clínicas y se aplicaron las escalas: DISC-12, SSQ, PDD, Escala de Funcionamiento Social (SFS) y Evaluación del Funcionamiento (GAF). Resultados. La consistencia interna resultó un a Cronbach entre 0,741 y 0,850. Las subescalas "Trato injusto" y "Trato positivo" tuvieron a Cronbach superior a 0,79, pero las subscalas "Anticipación de la discriminación" y "Superación del estigma" no tuvieron adecuada consistencia. La fiabilidad test-retest de las cuatro subescalas fue superior a 0,67. La fiabilidad entre evaluadores mostró que 21 ítems tuvieron puntuación superior a 0,8, 10 entre 0,6-0,8 y uno, menos de 0,6. DISC-12 se relacionó significativamente con el Segundo factor de PDD (self-stigma) y con SSQ. Conclusiones. La versión española de la escala DISC 12 es válida, tiene una buena consistencia interna, buena fiabilidad test-retest y entre evaluadores y tiene una buena validez convergente con la SSQ y PDD. Las subescalas "Trato injusto" y "Trato positivo" son las más robustas"

Aims. The "Discrimination and Stigma Scale" (DISC) was the first instrument specifically designed to evaluate reported experiences of discrimination by people with mental dis-orders. This study aims to validate DISC-12 version in Spanish population with Schizophrenia and, as specific objectives, to do the external validation with the Self-Stigma Questionnaire (SSQ) scale and Link PDD scale and to validate their internal consistency, temporal and inter-rater reliability. Methods. 86 individuals with schizophrenia were interviewed at two time points (between one to two weeks) by two raters. Additionally to assess their sociodemographic and clinical characteristics, following scales were administered: DISC 12, SSQ, PDD, Social Functioning Scale (SFS) and Global Assessment of Function (GAF).Results. Internal consistency as a whole results a Cronbach a between 0.741 and 0.850. Subscales "Unfair treatment" and "Positive treatment" have a Cronbach a higher than 0.79, but the both subscales "Stopping Self" and "Over-coming stigma" do not have in themselves an adequate consistency. Test-retest reliability shows that four subscales have values higher than 0.67. Inter-rater reliability assessment result that 21 items score values above 0.8, 10 be-tween 0.6-0.8 and one lower than 0.6. DISC-12 was significantly related with the second factor of the PDD (self-stigma) and SSQ. Conclusions. The Spanish version of the DISC 12 scale is valid, has good internal consistency, is reliable both in terms of test-retest and inter-rater reliability and has good convergent validity with the SSQ and PDD, and the "Unfair treatment" and "Positive Treatment" subscales were the most robust of the four subscales

Valoración psiquiátrico-forense del riesgo de radicalización terrorista en el enfermo mental / Forensic-psychiatric assessment of the risk of terrorist radicalisation in the mentally ill patient

Introducción: La valoración psiquiátrico-forense del riesgo de radicalización terrorista en el enfermo mental tiene especial interés para la evaluación de la peligrosidad criminal; especialmente a raíz de las recientes investigaciones sobre los denominados lobos solitarios, que indican una elevada prevalencia de enfermedad mental dentro de este tipo de terroristas. Metodología: Análisis de la validez predictiva del Protocolo de Evaluación de Radicalización Terrorista (TRAP-18) para predecir futuros incidentes violentos de carácter extremista en una muestra representativa de 44 pacientes con trastorno mental grave en situación de exclusión social y con antecedentes penitenciarios. Resultados: El análisis de curvas ROC indicó que la puntuación total de la TRAP-18 (AUC 1,00, p = 0,018) tiene una alta validez predictiva. Conclusiones: El TRAP-18 podría resultar una útil herramienta para la valoración del riesgo de radicalización terrorista en el enfermo mental; especialmente en el colectivo de personas con trastorno mental grave en situación de exclusión social y con antecedentes penitenciarios, los cuales presentan un mayor riesgo potencial de radicalización terrorista como lobos solitarios

Introduction: The forensic-psychiatric assessment of the risk of terrorist radicalisation in the mentally ill patient is of special interest for the evaluation of criminal dangerousness. This particularly relevant in ligh of the recent investigations into so-called lone-wolves, which indicate a high prevalence of mental illness within this type of terrorist. Methodology: Analysis of the predictive validity of the Terrorist Radicalisation Assessment Protocol (TRAP-18) to predict future violent incidents of an extremist nature in a representative sample of 44 patients with severe mental illness in situations of social exclusion and with a prison history. Results: The ROC Curves analysis indicated that the total score of TRAP-18 (AUC 1.00, P=.018) has a high predictive validity. Conclusions: TRAP-18 could be a useful tool for assessing the risk of terrorist radicalisation in the mentally ill patient,; especially in the group of people with severe mental illness in situations of social exclusion and with a prison record, who have a greater potential risk of terrorist radicalistion as lone-wolves

Neuropsychological findings in recent onset schizophrenia and borderline personality disorder: a comparison study.

INTRODUCTION: Neurocognitive impairment is considered an essential symptom of schizophrenia, particularly in its early stages. Nonetheless, the neuropsychological features of borderline personality disorder (BPD) could cast doubt on the specificity of neurocognitive dysfunctions. The aim of this study is to determine whether neurocognitive deficits are specific to schizophrenia-spectrum conditions as compared to a similarly severe psychiatric illness like BPD. METHOD: A battery of neuropsychological tests was used to assess the abilities for attention, verbal memory and executive functions in a group of 34 borderline personality disorder (BPD) patients, 24 patients with first episode of a schizophrenia-spectrum disorder (FEP) and a group of 19 controls. RESULTS: ANOVA for multiple measures with subsequent post-hoc tests demonstrated significant effect sizes between controls and patients for all cognitive domains. However, the effect sizes of comparisons between both groups of patients were not significant. CONCLUSIONS: Results show significant neuropsychological impairment in both disorders when compared with normal controls, but no specific pattern of neurocognitive deficits for schizophrenia-spectrum disorders was found.

Perfil neuropsicológico en primeros episodios de esquizofrenia y trastorno límite de la personalidad: un estudio comparativo / Neuropsychological findings in recent onset schizophrenia and borderline personality disorder: a comparison study

Introducción. El deterioro neurocognitivo es considerado un síntoma esencial de la esquizofrenia, especialmente en sus fases iniciales. Sin embargo, las características neuropsicológicas del trastorno límite de la personalidad (TLP) podrían poner en duda la especificidad de estas disfunciones cognitivas. El objetivo de este estudio es determinar si los déficits cognitivos son específicos del espectro de la esquizofrenia comparado con trastornos igualmente graves como el TLP. Metodología. Se administró una batería de pruebas neuropsicológicas para evaluar atención, memoria verbal y funciones ejecutivas a un grupo de 34 pacientes con TLP, 24 pacientes con primeros episodios psicóticos (PEP) y 19 controles. Resultados. Las pruebas ANOVA realizadas con sus correspondientes pruebas mostraron diferencias significativas entre controles y pacientes en todos los aspectos. Sin embargo, las diferencias entre los dos grupos de pacientes no fueron significativas. Conclusiones. Los resultados muestran un deterioro neuropsicológico significativo en ambos trastornos en comparación con los controles, pero no indican un patrón de déficit neurocognitivo específico para los trastornos del espectro de la esquizofrenia

Introduction. Neurocognitive impairment is considered an essential symptom of schizophrenia, particularly in its early stages. Nonetheless, the neuropsychological features of borderline personality disorder (BPD) could cast doubt on the specificity of neurocognitive dysfunctions. The aim of this study is to determine whether neurocognitive deficits are specific to schizophrenia-spectrum conditions as compared to a similarly severe psychiatric illness like BPD. Method. A battery of neuropsychological tests was used to assess the abilities for attention, verbal memory and executive functions in a group of 34 borderline personality disorder (BPD) patients, 24 patients with first episode of a schizophrenia-spectrum disorder (FEP) and a group of 19 controls. Results. ANOVA for multiple measures with subsequent post-hoc tests demonstrated significant effect sizes between controls and patients for all cognitive domains. However, the effect sizes of comparisons between both groups of patients were not significant. Conclusions. Results show significant neuropsychological impairment in both disorders when compared with normal controls, but no specific pattern of neurocognitive deficits for schizophrenia-spectrum disorders was found

Conducta delictiva en las personas sin hogar con trastorno mental grave / Criminal behavior among homeless individuals with severe mental illness

Introducción. Varios estudios estadounidenses han investigado la conducta delictiva en las personas sin hogar con trastorno mental grave. Pero hasta la fecha ninguno se ha realizado en España. Metodología. Estudio observacional retrospectivo, en una muestra de 118 pacientes, seleccionados de un programa de atención psiquiátrica para personas sin hogar con trastorno mental grave. Se analizaron los factores asociados a la conducta delictiva mediante la comparación de 2 grupos, con y sin antecedentes penales. Resultados. El 24,6% de la muestra tenía algún antecedente penal y el 58,6% de este grupo había ingresado en prisión. Se encontraron diferencias significativas entre ambos grupos para las variables: sexo, condenas pendientes, duración del sinhogarismo, comorbilidad con politoxicomanía, conciencia de enfermedad y gravedad de los síntomas psicóticos. Conclusiones. En la población de personas sin hogar con trastorno mental grave, con independencia del sexo, la coexistencia de comorbilidad con politoxicomanía y una duración prolongada del sinhogarismo, constituyen el factor de riesgo más importante para la conducta delictiva

Introduction. Several US studies have investigated the criminal behaviour among homeless individuals with severe mental illness. But to date, no studies have been carried out in Spain. Method. A retrospective observational study was conducted on a sample of 118 patients selected from a psychiatric care program for homeless individuals with severe mental illness. Factors associated with criminal behaviour were analysed by comparing 2 groups, with and without criminal records. Results. Of the total sample studied, 24.6% had a criminal record, and 58.6% of them had entered prison. Significant differences between groups were found for the variables of gender, pending sentences, duration of homelessness, multiple substance use, disease awareness, and severity of psychotic symptoms. Conclusions. In the population of homeless individuals with severe mental illness, regardless of gender, the co-existence of comorbidity with multiple substance use, and a prolonged duration of homelessness, is the most important risk factor for criminal behavior

Tratamiento de la Psicosis Cicloide en fase aguda: Estudio sobre una muestra de pacientes libres de medicación hospitalizados por un Primer Episodio Psicótico (PEP) / Acute treatment of Cycloid Psychosis: Study on a sample of naive hospitalized patients with FirstEpisode Psychosis (FEP)

Introducción. A pesar de la relevancia histórica, clínica y terapéutica de las psicosis cicloides, hasta el momento actual no se han realizado estudios controlados sobre su tratamiento. La terapia electroconvulsiva ha sido clásicamente de elección y los antipsicóticos de primera generación no han estado indicados. El presente estudio tiene como objetivo analizar el tratamiento agudo (y la respuesta al mismo) de las psicosis cicloides. Metodología. En una muestra de 75 pacientes libres de medicación hospitalizados y tratados por presentar un Primer Episodio Psicótico (PEP), se detectaron los posibles casos de psicosis cicloides utilizando los criterios diagnósticos operativos de Perris y Brockington. Se dividió la muestra en 'cicloides' y 'no cicloides' y se compararon ambos grupos en función de variables clínicas y terapéuticas. Resultados. Todos los pacientes fueron tratados con antipsicóticos de segunda generación. No se encontraron diferencias significativas (p=0,17; t-1,39) en la dosis de antipsicótico pautado (equivalentes de clorpromacina), pero si se observaron diferencias significativas en la mejoría al alta hospitalaria (CGI-S), con una mejor respuesta en el grupo de los ‘cicloides’ (p=0,002; u=162). También se observaron diferencias significativas en la dosis de benzodiacepinas, siendo notablemente mayor para el grupo de ‘cicloides’ (p>0,001; u=28). Conclusiones. Sin contradecir la idea clásica del tratamiento de las psicosis cicloides, el presente estudio contribuye a abrir una nueva expectativa terapéutica. De manera que en el tratamiento agudo de las psicosis cicloides, el uso de antipsicóticos de segunda generación podría tener un efecto particularmente beneficioso, especialmente si se combina con benzodiacepinas a dosis altas. Si bien es preciso la realización de estudios controlados que confirmen este dato

Introduction. In spite of the historic, clinical and therapeutic importance of cycloid psychosis, no controlled studies have been performed as yet on its treatment. Electroconvulsive therapy has classically been the treatment of choice and the first generation antipsychotics have not been indicated. This study has aimed to analyze the acute treatment (and response to it) of cycloid psychoses. Methodology. In a sample of 75 hospitalized medication-naive patients treated for a First Psychotic Episode (FPE), possible cases of cycloid psychoses were detected using the Perris and Brockington operative diagnostic criteria. The sample was divided into 'cycloids' and 'non-cycloids' and both groups were compared based on clinical and therapeutic variables. Results. All the patients were treated with second generation antipsychotics. No significant differences (p=0.17; t-1.39) were found in the antipsychotic dose prescribed (equivalents of chlorpromazine). However, significant differences were observed in the improvement on hospital discharge (clinical global impression severity: CGI-S), with better response in the "cycloid" group(p=0.002; u=162). Significant differences were also observed in the dose of benzodiazepines, there being significantly greater improvement for the ‘cycloid’ group (p>0.001; u=28). Conclusions. Without contradicting the classical idea of the treatment of cycloid psychoses, the present study contributes to the opening of a new therapeutic prospect. Thus, the use of second generation antipsychotics could have a particularly beneficial effect, especially if combined with high doses of benzodiazepines in the acute treatment of cycloid psychoses. However, controlled studies need to be carried out to confirm this

Acute treatment of cycloid psychosis: study on a sample of naive hospitalized patients with first-episode psychosis (FEP).

INTRODUCTION: In spite of the historic, clinical and therapeutic importance of cycloid psychosis, no controlled studies have been performed as yet on its treatment. Electroconvulsive therapy has classically been the treatment of choice and the first generation antipsychotics have not been indicated. This study has aimed to analyze the acute treatment (and response to it) of cycloid psychoses. METHODOLOGY: In a sample of 75 hospitalized medication- naive patients treated for a First Psychotic Episode (FPE), possible cases of cycloid psychoses were detected using the Perris and Brockington operative diagnostic criteria. The sample was divided into “cycloids” and “non-cycloids” and both groups were compared based on clinical and therapeutic variables. RESULTS: All the patients were treated with second generation antipsychotics. No significant differences (p=0.17; t-1.39) were found in the antipsychotic dose prescribed (equivalents of chlorpromazine). However, significant differences were observed in the improvement on hospital discharge (clinical global impression severity: CGI-S), with better response in the “cycloid” group” (p=0.002; u=162). Significant differences were also observed in the dose of benzodiazepines, there being significantly greater improvement for the “cycloid” group (p>0.001; u=28). CONCLUSIONS: Without contradicting the classical idea of the treatment of cycloid psychoses, the present study contributes to the opening of a new therapeutic prospect. Thus, the use of second generation antipsychotics could have a particularly beneficial effect, especially if combined with high doses of benzodiazepines in the acute treatment of cycloid psychoses. However, controlled studies need to be carried out to confirm this.

La valoración del riesgo autolítico y sus repercusiones médico-legales / Self-harm risk assessment and its medical and legal implications

Valoración del riesgo autolítico. Existen numerosas guías clínicas que especifican las variables que deben registrarse en los informes clínicos para evaluar el riesgo autolítico. Sin embargo, estas recomendaciones no siempre se siguen. Repercusiones médico-legales. La evaluación del riesgo autolítico da lugar a frecuentes demandas de responsabilidad profesional. No obstante, en las sentencias del Tribunal Supremo son escasas las condenas tanto en el campo penal como en el civil. Conclusiones. En el informe clínico de una tentativa de suicidio, se recomienda una evaluación clínica completa, conforme a la lex artis. Además, emplear protocolos y escalas clínicas puede tener valor legal y puede ser muy útil para mejorar la forma en que se documente la información, así como aumentar la exhaustividad de la evaluación clínica. Con independencia de los instrumentos utilizados para la evaluación, siempre debe dejarse constancia en la historia clínica de los resultados de dicha evaluación(AU)

Self-harm risk assessment. Numerous clinical guidelines specify the variables that must be recorded in the clinical reports to assess the risk of self-harm. However, these recommendations are not always implemented. Medical and legal implications. This assessment involves frequent professional liability claims. However, with regard to Supreme Court judgments, convictions are rare in both criminal and civil law. Conclusions. When compiling a clinical report of a suicide attempt, we recommend a complete clinical evaluation according to the lex artis. In addition, following protocols and clinical scales can have legal value and be very useful to improve the way information is documented, as well as improve the completeness of the clinical evaluation. Regardless of the tools used for assessment, results should always be recorded in the medical record(AU)

[Brief Suicide Questionnaire. Inter-rater reliability]. / Protocolo breve de evaluación del suicidio: fiabilidad interexaminadores.

INTRODUCTION: Inter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behavior (Brief Suicide Questionnaire) and to examine whether the inter-examiner agreement when multiple ratings are made on a single subject is an efficient method to assess the reliability of an instrument. METHOD: In the context of designing a multicenter clinical trial, 32 psychiatrists assessed a videotaped clinical interview of a patient with suicidal behavior. In order to identify those items in which a greater level of discordance existed and detect the examiners whose ratings differed significantly from the average ratings, we used the DOMENIC method (Detecion of Multiple Examiners Not in Consensus). RESULTS: Inter-rater agreement was between poor (<70%) to excelent (90-100%. Inter-rater agreement in Brugha's list of threatening experiences ranged from 75.5 and 100%; in the Global Assessment of Functioning (GAF) Scale was 82.58%; in the Beck's Suicidal Intent Scale, ranged from 67.5 and 97%; in the Beck's Scale for Suicide Ideation, ranged from 63.5 and 100%; and in the Lethality Rating Scale was 88.39%. On the whole, the level of agreement among raters, both in general scores and in particular items, was appropriate. CONCLUSION: The proposed design allows the assessment of the inter-rater agreement in an efficient way (only in one session). In addition, regarding the Brief Suicide Questionnaire, inter-raters agreement was appropriate.

Protocolo breve de evaluación del suicidio: fiabilidad interexaminadores / Brief Suicide Questionnaire. Inter-rater reliability

Introducción. El acuerdo entre-examinadores es un aspecto fundamental en la planificación de cualquier trabajo de investigación donde la principal herramienta diagnóstica es la entrevista clínica. El objetivo de este estudio es valorar el acuerdo entre-examinadores de un instrumento de evaluación de la conducta suicida (Protocolo breve de evaluación del suicidio) utilizando las valoraciones de múltiples observadores en una sola sesión. Método. Durante la fase piloto de un estudio clínico multicéntrico centrado en la monitorización de intentos de suicidio, 32 examinadores evaluaron el vídeo de la entrevista clínica a un paciente simulado con conducta suicida. Para identificar los ítems en los que existía una mayor discordancia y a los examinadores cuyo criterio se alejaba más del acuerdo general, se utilizó el método Detection Of Multiple Examiners Not In Consensus (DOMENIC). Resultado. El acuerdo interexaminadores osciló entre pobre (<70%) y excelente (90-100%). En la escala de acontecimientos vitales estresantes el nivel de acuerdo osciló entre 48,4 y 97%; en la escala problemas psicosociales del DSM-IV, entre 75,5 y 100%; en la escala de evaluación de la actividad global fue de 82,58%; en la escala de intencionalidad suicida, osciló entre 67,5 y 97%; en la escala de ideación suicida, entre 63,5 y 100% y en la escala de letalidad del intento de suicidio fue de 88,39%. En general, los examinadores mostraron un nivel de acuerdo adecuado tanto en las puntuaciones globales de cada escala como en cada ítem en particular. Conclusiones. El diseño propuesto permite evaluar el acuerdo entre-examinadores de una forma eficiente (en una única sesión). Además, con respecto al Protocolo breve de evaluación del suicidio, el acuerdo entre-examinadores fue apropiado(AU)

Introduction. Inter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behaviour (Brief Suicide Questionnaire) and to examine whether the inter-examiner agreement when multiple ratings are made on a single subject is an efficient method to assess the reliability of an instrument. Method. In the context of designing a multicenter clinical trial, 32 psychiatrists assessed a videotaped clinical interview of a patient with suicidal behaviour. In order to identify those items in which a greater level of discordance existed and detect the examiners whose ratings differed significantly from the average ratings, we used the DOMENIC method (Detecion of Multiple Examiners Not in Consensus). Results. Inter-rater agreement was between poor (<70%) to excellent (90-100%. Inter-rater agreement in Brugha's list of threatening experiences ranged from 75.5% to 100%; in the Global Assessment of Functioning (GAF) Scale was 82.58%; in Beck's Suicidal Intent Scale, ranged from 67.5% to 97%; in Beck's Scale for Suicide Ideation, ranged from 63.5% to 100%; and in the Lethality Rating Scale was 88.39%. On the whole, the level of agreement among raters, both in general scores and in particular items, was appropriate. Conclusion. The proposed design allows the assessment of the inter-rater agreement in an efficient way (only in one session). In addition, regarding the Brief Suicide Questionnaire, inter-raters agreement was appropriate(AU)