Retraumatización en los servicios de salud mental: una revisión y propuesta de actuación alternativa / Retraumatization in Mental Health Services: A Review and Alternative Proposals

Las experiencias traumáticas son muy frecuentes entre las personas que acu-den a los servicios de salud mental. Hay evidencia de que las circunstancias vitales de las personas juegan un papel fundamental en el desarrollo y el mantenimiento de los problemas psicológicos, emocionales y conductuales. Sin embargo, las experiencias trau-máticas se infradetectan en los servicios de salud mental y, con frecuencia, ni los servi-cios ni las prácticas que se realizan en ellos están adaptadas a esta realidad. Existe una diversidad de prácticas, desde el modelo de comprensión de lo que le ocurre a la persona hasta experiencias relacionadas con el trato o la coerción, que pueden retraumatizar. Se realiza una revisión narrativa sobre la presencia del trauma en las personas que acuden a los servicios de salud mental, las prácticas retraumatizantes y las propuestas para avanzar hacia servicios conscientes del trauma. (AU)

Traumatic experiences are very common among people attending mental heal-th services. There is evidence that people's life circumstances play a fundamental role in the development and maintenance of psychological, emotional and behavioral problems. However, traumatic experiences are underdetected in mental health services and, fre-quently, neither the services nor the practices carried out in them are adapted to this rea-lity. There is a diversity of practices, from the model of understanding what is happening to the person to experiences related to treatment or coerción, that can retraumatize. A narrative review on the presence of trauma in people attending mental health services is carried out. Retraumatizing practices and some proposals to move towards trauma-informed services are examined. (AU)

El proceso del estrés y el afrontamiento en cuidadores informales de personas con diagnóstico del espectro de la esquizofrenia. Un estudio longitudinal / The process of stress and coping in informal caregivers of people diagnosed with the schizophrenia spectrum. A longitudinal study

El objetivo de este estudio longitudinal fue analizar el papel del estrés y las estrategias de afrontamiento en la explicación de la carga y la depresión de familiares cuidadores de personas con diagnóstico del espectro de la esquizofrenia. Fueron evaluados 30 pacientes este diagnóstico y sus cuidadores informales (n= 30). Los participantes fueron evaluados en tres momentos temporales: línea base, a los 5 meses y a los 10 meses. Se encontró una disminución de los niveles de carga subjetiva con el paso del tiempo. Asimismo, la carga subjetiva y la depresión del cuidador mostraron una mayor relación con aquellas variables del paciente relacionadas con la sintomatología negativa. A nivel longitudinal, la evitación y la resignación mostraron una notable relación con la carga subjetiva y la depresión. Los posibles cambios en la evaluación de las demandas que el trastorno plantea y en las estrategias de afrontamiento empleadas por los cuidadores sugieren el desarrollo de un proceso de adaptación al trastorno por parte del cuidador. (AU)

The goal of this study was to analyze the role of stress factors and coping strategies in explaining the burden and depression of family caregivers of people diagnosed with a schizophrenia spectrum disorder through a longitudinal design. An evaluation was made of thirty patients with a diagnosis on the spectrum of schizophrenia and thirty informal caregivers. Participants were assessed at three successive moments: baseline, after 5 months, and after 10 months. A decrease in caregivers´ levels of subjective burden across time was found. At longitudinal level, most of the caregivers’ coping strategies showed a relevant relationship with subjective burden and depression at some assessment time. In addition, subjective burden and depression showed a higher relationship with the patient´s negative symptomatology. At longitudinal level, avoidant and resignation showed a relevant relationship with subjective burden and depression. The changes in the evaluation of the demands that the disorder placed on the caregivers and in their coping strategies suggest the development of a process of adaptation to the disorder by the caregiver. (AU)

Spanish Versions of the Outcome Rating Scale and the Session Rating Scale: Normative Data, Reliability, and Validity.

Routine outcome monitoring (ROM) uses standardized measures to both track and inform mental health service delivery. Use of ROM has been shown to improve the outcome of psychotherapy when applied to different types of patients. The present research was designed to determine the reliability and validity of the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) in a sample of Spanish patients. After a controlled process of translation into the Spanish that is spoken and written in Spain (i.e., in Europe, as distinct from, e.g., Latin American Spanish), both measures were completed by patients of an outpatient mental health unit during eight sessions of psychotherapy. Sixty mental health patients filled out the ORS and 59 the SRS. In addition, the ORS was completed by 33 people who constituted the non-clinical sample. The cut-off of the ORS was 24.52 points, and the Reliable Change Index (RCI) was 9.15 points. ORS and SRS scores exhibited excellent internal consistency. The temporal stability of the SRS was adequate. The convergent and discriminant validity of the two measures were adequate. Regarding the factorial validity of the ORS and the SRS, in the third psychotherapy session, confirmatory factor analyses evidenced the existence of a unifactorial model. The predictive validity of SRS was acceptable. The ORS was sensitive to changes in patients' symptoms. In conclusion, compared to the original English versions of the ORS and SRS measures, the Spanish versions of the measures are also reliable and valid.

[Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain]. / Salud mental y derechos humanos: La experiencia de los profesionales en formación en el uso de sujeciones mecánicas en Madrid, España.

Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice.

La sujeción mecánica en psiquiatría es un procedimiento permitido en España que despierta importantes conflictos éticos. Diversos estudios sostienen que su uso depende de factores no clínicos, como las experiencias de los profesionales y las influencias del contexto, más que de factores clínicos (diagnósticos o síntomas). El objetivo del estudio es comprender las experiencias de profesionales de salud mental en formación en relación con el uso de sujeciones en la red de salud mental de Madrid. Es un estudio cualitativo de tipo fenomenológico mediante grupos focales, realizados en 2017. Las entrevistas fueron transcritas para su discusión y análisis temático mediante Atlas.ti. Los resultados descriptivos sugieren que estas medidas producen malestar y conflicto con relación al rol de cuidador y se observan estrategias de adaptación a los mismos. A partir de los hallazgos, se reflexiona acerca de aspectos de sus experiencias y del contexto que influyen en su uso, así como de las contradicciones del cuidado en la práctica clínica.

Salud mental y derechos humanos: La experiencia de los profesionales en formación en el uso de sujeciones mecánicas en Madrid, España / Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain

RESUMEN La sujeción mecánica en psiquiatría es un procedimiento permitido en España que despierta importantes conflictos éticos. Diversos estudios sostienen que su uso depende de factores no clínicos, como las experiencias de los profesionales y las influencias del contexto, más que de factores clínicos (diagnósticos o síntomas). El objetivo del estudio es comprender las experiencias de profesionales de salud mental en formación en relación con el uso de sujeciones en la red de salud mental de Madrid. Es un estudio cualitativo de tipo fenomenológico mediante grupos focales, realizados en 2017. Las entrevistas fueron transcritas para su discusión y análisis temático mediante Atlas.ti. Los resultados descriptivos sugieren que estas medidas producen malestar y conflicto con relación al rol de cuidador y se observan estrategias de adaptación a los mismos. A partir de los hallazgos, se reflexiona acerca de aspectos de sus experiencias y del contexto que influyen en su uso, así como de las contradicciones del cuidado en la práctica clínica

ABSTRACT Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice

Bridging the mental health treatment gap: effects of a collaborative care intervention (matrix support) in the detection and treatment of mental disorders in a Brazilian city.

OBJECTIVE: To analyse temporal trends in diagnosis and treatment of mental disorders in primary care following implementation of a collaborative care intervention (matrix support). DESIGN: Dynamic cohort design with retrospective time-series analysis. Structured secondary data on medical visits to general practitioners of all study clinics were extracted from the municipal electronic records database. Annual changes in the odds of mental disorders diagnoses and antidepressants prescriptions were estimated by multiple logistic regression at visit and patient-year levels with diagnoses or prescriptions as outcomes. Annual changes during two distinct stages of the intervention (stage 1 when it was restricted to mental health (2005-2009), and stage 2 when it was expanded to other areas (2010-2015)) were compared by adding year-period interaction terms to each model. SETTING: 49 primary care clinics in the city of Florianópolis, Brazil. PARTICIPANTS: All adults attending primary care clinics of the study setting between 2005 and 2015. RESULTS: 3 131 983 visits representing 322 100 patients were analysed. At visit level, the odds of mental disorder diagnosis increased by 13% per year during stage 1 (OR 1.13, 95% CI 1.11 to 1.14, p<0.001) and decreased by 5% thereafter (OR 0.95, 95% CI 0.94 to 0.95, p<0.001). The odds of incident mental disorder diagnoses decreased by 1% per year during stage 1 (OR 0.99, 95% CI 0.98 to 1.00, p=0.012) and decreased by 7% per year during stage 2 (OR 0.93, 95% CI 0.92 to 0.93, p<0.001). The odds of antidepressant prescriptions in patients with a mental disorder diagnosis increased by 7% per year during stage 1 (OR 1.07, 95% CI 1.05 to 1.20, p<0.001); this was driven by selective serotonin reuptake inhibitor prescriptions which increased 14% per year during stage 1 (OR 1.14, 95% CI 1.12 to 1.18, p<0.001) and 9% during stage 2 (OR 1.09, 95% CI 1.08 to 1.10, p<0.001). The odds of incident antidepressant prescriptions did not increase during stage 1 (OR 1.00, 95% CI 0.97 to 1.02, p=0.665) and increased by 3% during stage 2 (OR 1.03, 95% CI 1.00 to 1.04, p<0.001). Changes per year were all significantly greater during stage 1 than stage 2 (p values for interaction terms <0.05), except for antidepressant prescriptions during visits (p=0.172). CONCLUSION: The matrix support intervention may increase diagnosis and treatment of mental disorders when inter-professional collaboration is adequately supported. Competing demands to the primary care teams can subsequently reduce these effects. Future studies should assess clinical outcomes and identify active components and factors associated with successful implementation.

[Components of matrix support and collaborative mental health care: a narrative review]. / Componentes do apoio matricial e cuidados colaborativos em saúde mental: uma revisão narrativa.

Collaborative care between mental health and primary care is effective in improving health outcomes. The matrix support has similarities with collaborative care little explored in the literature. This article compares the two models and analyzes the matrix support from evidence on collaborative care. Narrative review. Components of each model (activities and dimensions) were identified and compared. Evidence on collaborative care informed analysis of similar components of matrix support. The dimensions of the matrix support - educational support, specialized care, regulation, co-management - and collaborative care - multiprofessional care, systematic communication, structured care, organizational support - were identified. The main similarity between the models lies in the direct collaborative activities around clinical problems which is related to effectiveness in collaborative care studies. Direct collaborative activities are a positive aspect of matrix support. Structured care and support at the organizational level should be encouraged. Future studies should refine the proposed categories and explore their use for the development of matrix support.

Cuidados colaborativos entre saúde mental e atenção primária são efetivos em melhorar desfechos de saúde. O apoio matricial tem semelhanças com cuidados colaborativos pouco exploradas na literatura. Este artigo compara os dois modelos e analisa o apoio matricial a partir de evidências sobre cuidados colaborativos. Revisão narrativa. Componentes de cada modelo (atividades e dimensões) foram identificados e comparados. Evidências sobre cuidados colaborativos informaram análise de componentes semelhantes do apoio matricial. Foram identificadas dimensões do apoio matricial ­ suporte educacional, cuidado especializado, regulação, cogestão ­ e dos cuidados colaborativos ­ cuidado multiprofissional, comunicação sistemática, cuidado estruturado, suporte organizacional. A principal semelhança entre os modelos está nas atividades colaborativas diretas em torno de problemas clínicos, relacionadas a efetividade em estudos sobre cuidados colaborativos. Atividades colaborativas diretas são ponto positivo do apoio matricial. Cuidado estruturado e suporte em nível organizacional devem ser encorajados. Futuros estudos devem refinar as categorias propostas e explorar seu uso para desenvolvimento do apoio matricial.

Componentes do apoio matricial e cuidados colaborativos em saúde mental: uma revisão narrativa / Components of matrix support and collaborative mental health care: a narrative review

Resumo Cuidados colaborativos entre saúde mental e atenção primária são efetivos em melhorar desfechos de saúde. O apoio matricial tem semelhanças com cuidados colaborativos pouco exploradas na literatura. Este artigo compara os dois modelos e analisa o apoio matricial a partir de evidências sobre cuidados colaborativos. Revisão narrativa. Componentes de cada modelo (atividades e dimensões) foram identificados e comparados. Evidências sobre cuidados colaborativos informaram análise de componentes semelhantes do apoio matricial. Foram identificadas dimensões do apoio matricial - suporte educacional, cuidado especializado, regulação, cogestão - e dos cuidados colaborativos - cuidado multiprofissional, comunicação sistemática, cuidado estruturado, suporte organizacional. A principal semelhança entre os modelos está nas atividades colaborativas diretas em torno de problemas clínicos, relacionadas a efetividade em estudos sobre cuidados colaborativos. Atividades colaborativas diretas são ponto positivo do apoio matricial. Cuidado estruturado e suporte em nível organizacional devem ser encorajados. Futuros estudos devem refinar as categorias propostas e explorar seu uso para desenvolvimento do apoio matricial.

Abstract Collaborative care between mental health and primary care is effective in improving health outcomes. The matrix support has similarities with collaborative care little explored in the literature. This article compares the two models and analyzes the matrix support from evidence on collaborative care. Narrative review. Components of each model (activities and dimensions) were identified and compared. Evidence on collaborative care informed analysis of similar components of matrix support. The dimensions of the matrix support - educational support, specialized care, regulation, co-management - and collaborative care - multiprofessional care, systematic communication, structured care, organizational support - were identified. The main similarity between the models lies in the direct collaborative activities around clinical problems which is related to effectiveness in collaborative care studies. Direct collaborative activities are a positive aspect of matrix support. Structured care and support at the organizational level should be encouraged. Future studies should refine the proposed categories and explore their use for the development of matrix support.

Carga, depresión y familismo en cuidadores informales colombianos de pacientes con esquizofrenia y pacientes con demencia / Burden, depression and familism in Colombian informal caregivers of patients with schizophrenia and patients with dementia

El objetivo de este estudio se centra en comparar los niveles de carga y depresión, así como las relaciones entre estas variables y dos factores del familismo (obligación familiar y apoyo esperado de la familia), entre cuidadores colombianos de personas diagnosticadas de esquizofrenia y cuidadores de personas diagnosticadas de demencia. Fueron evaluados 70 cuidadores informales de pacientes con esquizofrenia y 63 cuidadores informales de pacientes con demencia. Se hallaron diferencias significativas en el nivel de carga entre los cuidadores de personas con esquizofrenia y los cuidadores de personas con demencia, siendo mayor el nivel de carga en demencia. Ambos grupos informaron sobre sintomatología depresiva. Se encontró una correlación positiva entre la obligación familiar y la carga y la depresión en el caso de los cuidadores de pacientes con esquizofrenia, a diferencia de lo observado en la muestra de cuidadores de personas con demencia donde no se halló dicha correlación. Estos resultados subrayan la necesidad de evaluar el papel de variables mediadoras entre el familismo, la carga y la depresión en ambos grupos de cuidadores

The goal of this study was to compare the burden and depression levels, as well as the relationships between these variables and two factors of familism ("familial obligations" and "expected support from the family"), among Colombian caregivers of people diagnosed with schizophrenia and caregivers of people diagnosed of dementia. We evaluated 70 informal caregivers of patients with schizophrenia and 63 informal caregivers of patients with dementia in the variables of burden, depression and familism. Significant differences were found in the level of burden among caregivers of people with schizophrenia and caregivers of people with dementia, with the level of burden in dementia being higher. In addition, both groups reported depressive symptoms. The results revealed a positive correlation between the factor of "family obligation" and the burden and depression in the case of caregivers of patients with schizophrenia, unlike the sample of caregivers of people with dementia where no such correlation was found. These results underscore the need to evaluate the role of mediating variables between familism, burden and depression in both groups of caregivers

ESAMEN: descripción y medida de la estructura de los servicios de atención comunitaria en salud mental / ESAMEN: description and assessment of the structure of communityoriented mental health services

La estructura básica de los servicios de salud mental orientados a la comunidad se compone de cuatro tipos de dispositivos: las unidades de salud mental en los hospitales generales, los hospitales de día, los centros de salud mental y los centros de rehabilitación psicosocial, complementados con el apoyo social aportado por los servicios sociales especializados. Debido a que los dispositivos pueden acoger actividades muy diversas que pueden implicar a varios sectores de la Administración y del Tercer Sector simultánea o sucesivamente, y también debido a su implantación geográfica irregular, la gestión de los servicios de salud mental es un asunto complejo sobre el que todavía no se ha alcanzado un acuerdo. En el momento actual disponemos de varios instrumentos de medida y clasificación de los servicios para facilitar su evaluación, pero ninguno de ellos ha logrado popularizarse. El objetivo de este trabajo consiste en dar cuenta de un nuevo instrumento, ESAMEN, para describir y medir la estructura de los servicios de salud mental comunitaria, y someterlo a un estudio de viabilidad. Este método no se basa en la clasificación de los dispositivos como se ha hecho hasta ahora, sino en la clasificación de las 32 actividades o módulos de atención que se practican en ellos. Para este estudio de viabilidad, se remitió una encuesta a los coordinadores de 380 dispositivos de salud mental de Andalucía, Euskadi y Madrid, solicitándoles información sobre el área de cobertura y el número de profesionales de cada uno de los módulos dispensados en su dispositivo. Con estos datos se elaboraron indicadores de capacidad (expresada como el tiempo máximo de dedicación por habitante y unidad de tiempo) y alcance (proporción del total de habitantes que es potencialmente beneficiaria del módulo). Las tablas de resultados muestran con claridad y sencillez la estructura de los servicios, valorando cada módulo según su capacidad y alcance poblacional, evidenciando desequilibrios en su distribución, permitiendo comparaciones entre áreas y comunidades, y dejando la puerta abierta al refinamiento de los indicadores y a la inclusión de nuevos módulos de actividad que se puedan desarrollar en el futuro

The basic structure of community-oriented mental health services consists of four types of facilities: mental health units in general hospitals, day hospitals, mental health centres, and psychosocial rehabilitation centres, complemented by social support provided by specialized social services. Due to the fact that these facilities can host very diverse health activities that may involve several sectors of the Administration and the Third Sector, simultaneously or successively, and also due to their irregular geographical implementation, the management of mental health services is a complex issue on which no agreement has yet been reached. At present, we have several instruments for measuring and classifying services to facilitate their management, but none of them has become popular. The aim of this work is to report on ESAMEN, a tool to classify and measure the structure of community mental health services, and to subject it to a feasibility study. This instrument is not based on the classification of facilities as has been done so far, but on the classification of the 32 activities or modules of care that are practiced in them. For this feasibility study, a survey was sent to the coordinators of 380 mental health facilities from Andalusia, Euskadi and Madrid, requesting information on the area of coverage and the number of professionals in each of the modules dispensed in their facility. With these data, indicators of capacity (expressed as the maximum time of professional dedication per inhabitant and unit of time) and scope (proportion of the total number of inhabitants who are potentially beneficiaries of the module) were elaborated. Results tables show with clarity and simplicity the structure of the services, evaluating each module according to its capacity and population scope, showing imbalances in its distribution, allowing comparisons between areas and Communities, and leaving the door open to the refinement of the indicators and the inclusion of new activity modules that may be developed in the future

¿Por qué hablar de psicoterapias en el sector público? / Why should we talk about psychotherapies in the public health care system?

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Psicoterapias en la red comunitaria de atención a la salud mental. La óptica de las narrativas / Psychotherapies in the community mental health network. The narrative approach

En este artículo, se discuten los requerimientos especiales que presenta la práctica de la psicoterapia en las redes de atención a la salud mental comunitaria. Se propone un modelo de intervención que integra aportaciones procedentes de diferentes escuelas y diferentes campos del conocimiento desde una concepción de la psicoterapia como práctica narrativa. Se exponen los principios básicos de esta propuesta y los componentes de los programas de formación en la misma

The special requirements that the practice of psychotherapy in community mental health networks involves are discussed. An intervention model that integrates contributions from different schools and different fields of knowledge, based on a conception of psychotherapy as a narrative practice, is proposed. The basic principles of this proposal and the components of the training programs related are set forth

Diálogo con atención plena: integrando mindfulness y narrativas / Dialogue with full attention: integrating mindfulness and narratives

Se desarrolla una propuesta de integración de narrativas y mindfulness basándonos en la naturaleza lingüística del ser humano y su capacidad de apertura al campo de la conciencia. Se describen otros programas psicoterapéuticos en el mundo que han integrado mindfulness. Se aportan datos de investigación a nivel nacional e internacional. Se comparte la experiencia de nuestro grupo al trabajar en la clínica e investigar con esta perspectiva en la sanidad pública española. Se hace hincapié en la importancia de desarrollar programas de formación para los profesionales de la salud mental que sean rigurosos y profundos

A proposal to integrate narratives and mindfulness based on the linguistic nature of human beings and their ability of openness to the consciousness field is made. Other international psychotherapeutic programs that have integrated mindfulness into their practice are described. Research evidence from both national and international studies is provided. In this paper we share our experience working from this perspective both in research and in the clinical practice. The importance of developing rigorous and in-depth training programs for mental health professionals is pointed out

Experiencia y actitudes de los profesionales de salud mental en torno a las prácticas coercitivas directas: revisión bibliográfica de estudios cualitativos / Experience and attitudes of mental health professionals toward coercive practices: a literature review of qualitative studies

Esta revisión bibliográfica de estudios cualitativos trata de explorar cuáles son las experiencias y actitudes que tienen los profesionales del ámbito de la salud mental sobre prácticas coercitivas como la contención mecánica. Existen múltiples estudios que indagan en las experiencias de los usuarios; sin embargo, parece necesario conocer la actitud de los profesionales si se desea trabajar por un cambio de paradigma. Se incluyeron 27 estudios que cumplían los criterios de inclusión y de calidad CASPe para estudios cualitativos. En general, los profesionales sienten malestar hacia las prácticas coercitivas, aunque existe cierta inclinación a justificar estas medidas como inevitables ante determinadas situaciones. Aparece una tendencia en los profesionales a atribuir a factores internos de los pacientes las potenciales situaciones desencadenantes. Se Identifican también propuestas comunes (a nivel estructural, formativo, organizativo y educacional) para una reducción en el uso de las medidas señaladas

The aim of this qualitative literature review is to explore mental health professionals' experiences and attitudes toward direct coercive practices such as mechanical restraint and seclusion. Besides the studies on the patients' own experiences, awareness of the professionals' attitude is needed in order to achieve a paradigm shift. Twenty-seven studies meeting the CASPe inclusion and quality criteria for qualitative studies were included in this review. Overall, it was found that professionals feel distressed about the use of coercive interventions. Yet, there is a trend to justify these measures as inevitable under certain conditions. Mental health professionals tend to link the situations that give rise to coercion to patients' internal determinants. Additionally, this review points out shared proposals that aim to reduce these practices

Variables demográficas y clínicas relacionadas con la carga y el afrontamiento de los cuidadores de personas diagnosticadas de esquizofrenia / Clinical and Demographic Variables Associated Coping and the Burden of Caregivers of Schizophrenia Patients

RESUMEN Objetivo: Analizar la relación de la carga y las estrategias de afrontamiento con las características demográficas de los cuidadores de personas con esquizofrenia, así como las variables demográficas y clínicas de los pacientes. Métodos: Estudio transversal correlacional multicéntrico en el que se evaluó a 70 personas diagnosticadas de esquizofrenia o trastorno esquizoafectivo y 70 cuidadores informales primarios con la escala de sobrecarga del cuidador de Zarit, el cuestionario de estrategias familiares de afrontamiento, la escala para la evaluación de síntomas positivos, la escala para la evaluación de síntomas negativos y la escala breve de evaluación de la discapacidad. Resultados: En este estudio, la carga se correlacionó positivamente con el deterioro del funcionamiento ocupacional y social y presentó asociación negativa con la escolaridad de los pacientes. El escape, la coerción y la comunicación positiva presentaron correlaciones positivas con el deterioro del funcionamiento ocupacional y social de los pacientes. Asimismo, el interés social y las amistades mostraron asociación positiva con la escolaridad de los cuidadores. Además, la ayuda espiritual presentó correlaciones negativas con el deterioro del funcionamiento social y la edad de los pacientes, y la resignación se correlacionó negativamente con la duración del trastorno y la escolaridad de los pacientes. Conclusiones: La carga y la adopción de estrategias de afrontamiento disfuncionales, como el escape y la coerción, se asocian con el deterioro del funcionamiento de los pacientes. Estos hallazgos indican la necesidad de brindar a los cuidadores apoyos ajustados al nivel de funcionamiento del paciente que prevengan la carga del cuidado.

ABSTRACT Objective: To analyze of the relationship between burden of illness and coping strategies and the demographic variables of caregivers, and the demographic and clinical variables of people diagnosed with schizophrenia. Methods: Multicentre correlational cross-sectional study including 70 people diagnosed with schizophrenia, or a schizoaffective disorder, and 70 primary informal caregivers. They were evaluated using Zarit Caregiver Burden Inventory, Family Coping Strategies Questionnaire, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and the brief Disability Assessment Scale. Results: Burden of illness positively associated with patient impairment in occupational and social functioning, and negatively with education level. Avoidance, coercion and positive communication were positively associated with impairment in occupational and social functioning of patients. Social interest and friendships showed a positive association with the education level of caregivers. Spiritual assistance negatively correlated with impairment in social functioning and patient age, and resignation was negatively associated with length of the disorder and patient education level. Conclusions: Burden and dysfunctional coping strategies, such as avoidance and coercion, are associated with functional impairment of the patient. These findings suggest the need to provide support to caregivers, adjusted to the functional level of the patient, in order to prevent burden of care.

Clinical and Demographic Variables Associated Coping and the Burden of Caregivers of Schizophrenia Patients. / Variables demográficas y clínicas relacionadas con la carga y el afrontamiento de los cuidadores de personas diagnosticadas de esquizofrenia.

OBJECTIVE: To analyse of the relationship between burden of illness and coping strategies and the demographic variables of caregivers, and the demographic and clinical variables of people diagnosed with schizophrenia. METHODS: Multicentre correlational cross-sectional study including 70 people diagnosed with schizophrenia, or a schizoaffective disorder, and 70 primary informal caregivers. They were evaluated using Zarit Caregiver Burden Inventory, Family Coping Strategies Questionnaire, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and the brief Disability Assessment Scale. RESULTS: Burden of illness positively associated with patient impairment in occupational and social functioning, and negatively with education level. Avoidance, coercion and positive communication were positively associated with impairment in occupational and social functioning of patients. Social interest and friendships showed a positive association with the education level of caregivers. Spiritual assistance negatively correlated with impairment in social functioning and patient age, and resignation was negatively associated with length of the disorder and patient education level. CONCLUSIONS: Burden and dysfunctional coping strategies, such as avoidance and coercion, are associated with functional impairment of the patient. These findings suggest the need to provide support to caregivers, adjusted to the functional level of the patient, in order to prevent burden of care.

Patient-Therapist Perspective of the Working Alliance in Psychotherapy.

This study aimed to examine perceptions of the working alliance in a sample of Spanish patients and therapists. The alliance was measured after the third and tenth psychotherapy sessions using patient and therapist versions of the Spanish adaptation of the Working Alliance Inventory (WAI). After both sessions, correlations between the patients' and therapists' ratings, both of total alliance and of the various dimensions of the alliance, were moderate at best. Moreover, after the third psychotherapy session, patients' scores for the total alliance and the Goal and Task subscales were significantly higher than the scores from their therapists in these dimensions. Following the tenth session, patient ratings exceeded those of their therapists only on the Task subscale. Finally, in contrast to the ratings of patients, therapists' alliance ratings increased significantly between the third and tenth sessions of psychotherapy. Certain recommendations are presented to improve the study of patient and therapist perceptions of the working alliance and to increase the convergence between them with regard to this central treatment variable.

Relationship between olfactory function and social cognition in euthymic bipolar patients.

OBJECTIVE/INTRODUCTION: There is a close functional and neuroanatomical relationship between olfactory ability and emotional processing. The present study seeks to explore the association between olfactory ability and social cognition, especially facial emotion perception, in euthymic bipolar patients. METHODS: Thirty-nine euthymic outpatients meeting DSM-IV-TR criteria for bipolar disorder and 40 healthy volunteers matched on socio-demographic criteria were recruited. Both groups were assessed at one time point with the University of Pennsylvania Smell Identification Test (UPSIT), the Emotion Recognition Test, and The Faux Pas Recognition Test, as well as measures of general cognition and functioning. RESULTS: The bipolar patients showed a significant impairment in olfactory identification (UPSIT) and social cognition measures compared to healthy controls. Analyses revealed significant relationships between olfactory identification and facial emotion recognition, theory of mind, general cognition, and a trend-level relationship with functioning. Controlling for age and cigarettes smoked, relationships remained significant between olfactory function and facial emotion recognition. CONCLUSION: There is a deficit of olfactory identification in euthymic patients with bipolar disorder that is correlated with a deficit in both verbal and non-verbal measures of social cognition.

La medida de la capacidad reflexiva: instrumentos disponibles en castellano y tareas pendientes / The measurement of reflective capacity: instruments available in spanish and pending tasks

Introducción: La medida de la función reflexiva se ha convertido en un aspecto central para la evaluación e investigación de procesos en psicoterapia. Material y método: Se realizó una revisión sistemática de los instrumentos propuestos para la medida de la función reflexiva, actualizando la realizada por Luyten en el año 2011. Se realizó también una revisión de los instrumentos validados en lengua castellana. Resultados: Se encontraron cuestionarios, entrevistas, pruebas experimentales y proyectivas indicadas para la medida de función reflexiva. Conclusiones: En el momento actual faltan instrumentos validados en castellano para poder realizar investigaciones en este campo. Por esta razón, se hacen recomendaciones sobre formación de evaluadores, la puesta a prueba de instrumentos ya validados en muestras clínicas y la validación de instrumentos no disponibles en castellano (AU)

Introduction: The measurement of reflective functioning has become a centralaspect for evaluation and processes investigation in psychotherapy. Material and method: A systematic review of the proposed instruments for measuring reflective functioning was performed, updating that one realized by Luyten in 2011. A review of validated instruments in Spanish was also performed. Results: Questionnaires, interviews, experimental and projective tests indicated for the measurement of reflective functioning were found. Conclusions: At the current time, instruments validated in Spanish are absent to be able to perform investigations in this field. For this reason, recommendations for evaluators training, testing validated instruments in clinical samples and validation of non-available instruments in Spanish are performed (AU)

Spanish adaptation of the Revised Helping Alliance Questionnaire (HAq-II).

BACKGROUND: The working or helping alliance is one of the most widely studied constructs in psychotherapy process research. AIM: The aim of this study was to adapt the patient and therapist forms of the Revised Helping Alliance Questionnaire II (HAq-II-P and HAq-II-T, respectively) into Spanish. METHOD: The two measurement instruments were adapted through a systematic translation process, a pilot study and a clinical study. The psychometric properties were examined following the third psychotherapy session. RESULTS: Mean scores on the Spanish-language HAq-II-P and HAq-II-T were high. The corrected item-total correlations for >94% of the items were >0.30. Cronbach's α values for internal consistency were 0.88 and 0.93, respectively. Correlations for convergent validity with the respective versions of the Spanish-language Working Alliance Inventory were 0.80 and 0.87, respectively. In terms of predictive validity, there was a significant correlation between HAq-II-T and the patients' residual gain scores on the Spanish-language Beck Depression Inventory after the tenth psychotherapy session. CONCLUSIONS: These results are consistent with studies using the original English versions of the HAq-II.