Controversias en torno al tiempo de psicosis no tratada como variable pronóstica independiente del curso evolutivo de las psicosis esquizofrénicas / Controversies about duration of untreated psychosis as independent prognostic variable of the evolutive course of schizophrenic psychoses

El objetivo del presente trabajo es detallar aquellos aspectos, a nuestro entender más relevantes, extraídos de la creciente literatura sobre el tiempo de psicosis no tratada (DUP), incidiendo sobre dos aspectos nucleares y objeto de una creciente controversia, como son: a) aquellas razones que a lo largo de la última década han llevado a catapultar el DUP a la primera plana de la investigación en el terreno de los primeros episodios psicóticos, y b) el papel último del DUP a la hora de vertebrar el diseño y las diferentes estrategias de actuación en los programas de intervención precoz sobre las psicosis. Se aportan datos correspondientes a la evaluación del DUP, como variable pronóstica independiente, en una muestra de 231 pacientes, con un diagnóstico de trastorno esquizofrénico y/o trastorno esquizofreniforme (criterios DSM-IV) y un seguimiento de 24 meses. La conclusión final es que el DUP funciona más como un marcador de riesgo que como una variable pronóstica independiente, determinante del curso evolutivo de las psicosis esquizofrénicas. En este sentido su papel dentro de los programas de intervención precoz en las psicosis debería revisarse

This study reviews recent literature on duration of untreated psychosis (DUP) and its most relevant characteristics and controversial issues, such as: a) why DUP has been pointed out as a main variable in first-episode psychosis research, and b) the role of DUP in designing intervention programs for the design and different action strategies in early intervention programs in psychoses. The authors also present data from a 2 year follow-up study of 231 patients with a diagnosis of schizophrenia and/or schizophreniform disorder (according to DSM-IV criteria). Results are included, analyzing DUP as prognostic factor for clinical outcome. Our conclusions suggest that DUP is a risk marker but not an independent prognostic factor determining follow-up in schizophrenic psychoses. Therefore, DUP's role in early intervention programs should be redefined

[Controversies about duration of untreated psychosis as independent prognostic variable of the evolutive course of schizophrenic psychoses]. / Controversias en torno al tiempo de psicosis no tratada como variable pronóstica independiente del curso evolutivo de las psicosis esquizofrénicas.

This study reviews recent literature on duration of untreated psychosis (DUP) and its most relevant characteristics and controversial issues, such as: a) why DUP has been pointed out as a main variable in first-episode psychosis research, and b) the role of DUP in designing intervention programs for the design and different action strategies in early intervention programs in psychoses. The authors also present data from a 2 year follow-up study of 231 patients with a diagnosis of schizophrenia and/or schizophreniform disorder (according to DSM-IV criteria). Results are included, analyzing DUP as prognostic factor for clinical outcome. Our conclusions suggest that DUP is a risk marker but not an independent prognostic factor determining follow-up in schizophrenic psychoses. Therefore, DUP's role in early intervention programs should be redefined.

[Training in social skills in patients with acquired brain damage]. / Entrenamiento en habilidades sociales en pacientes con daño cerebral adquirido.

INTRODUCTION: Brain damaged patients have cognitive deficits, behaviour disorders and personality changes which affect socio-familial behaviour. Frequently, these changes generate considerable disturbance between family members and make it very difficult to return to work. OBJECTIVE: We describe a pilot study which led to the development and application of a focal rehabilitation programme aimed at retraining this group in social skills. PATIENTS AND METHODS: The programme was intensive (3 months) and included 6 outpatients (5 men and 1 woman) who took part in programmes of neuropsychological rehabilitation after traumatic or vascular cerebral lesions (X = 19.2 months after the lesion occurred). The average age of the patients was 27.2 years and their average IQ 109.2. Individual and group interventions were combined (role-playing, 'make-believe' work, video filming) emphasizing particularly the processes of learning without making mistakes and the extension of achievements to the natural setting (controlled trials). RESULTS AND CONCLUSIONS: We state and describe the relationship between the nature of neuropsychological and psychopathological deficits, and the characteristics of the limitations in social behaviour. The patients showed a significant reduction in the level of anxiety and aggressive behaviour and improvement in consciousness of their defects. Some improvement was seen in expressing opinions and emotions, and in ability to adapt social conduct to different situations (flexible behaviour). Finally we describe the conclusions drawn as to this treatment for future review and improvement of the programme.

Entrenamiento en habilidades sociales en pacientes con daño cerebral adquirido / Training in social skill in patients with acquired brain damage

Introduction. Brain damaged patients have cognitive deficits, behaviour disorders and personality changes which affect socio-familial behaviour. Frequently, these changes generate considerable disturbance between family members and make it very difficult to return to work. Objective. We describe a pilot study which led to the development and application of a focal rehabilitation programme aimed at retraining this group in social skills. Patients and methods. The programme was intensive (3 months) and included 6 outpatients (5 men and 1 woman) who took part in programmes of neuropsychological rehabilitation after traumatic or vascular cerebral lesions (X= 19.2 months after the lesion occurred). The average age of the patients was 27.2 years and their average IQ 109.2. Individual and group interventions were combined (role-playing, ‘makebelieve’ work, video filming) emphasizing particularly the processes of learning without making mistakes and the extension of achievements to the natural setting (controlled trials). Results and conclusions. We state and describe the relationship between the nature of neuropsychological and psychopathological deficits, and the characteristics of the limitations in social behaviour. The patients showed a significant reduction in the level of anxiety and aggressive behaviour and improvement in consciousness of their defects. Some improvement was seen in expressing opinions and emotions, and in ability to adapt social conduct to different situations (flexible behaviour). Finally we describe the conclusions drawn as to this treatment for future review and improvement of the programme (AU)

Introducción. Los pacientes con daño cerebral presentan déficit cognitivos, conductuales y cambios de personalidad que condicionan su funcionamiento sociofamiliar. Estos cambios generan con frecuencia enorme malestar entre familiares y representan serias dificultades para el restablecimiento de la actividad laboral. Objetivo. Describir una experiencia piloto que supuso el desarrollo y aplicación de un programa de rehabilitación focal dirigido al reentrenamiento de las habilidades sociales de este colectivo. Pacientes y métodos. El programa intensivo (3 meses) contó con seis pacientes ambulatorios (5 varones y 1 mujer), participantes en programas de rehabilitación neuropsicológica tras sufrir lesiones cerebrales de origen traumático o vascular (X= 19,2 meses desde la lesión). La media de edad era de 27,2 años y el CI medio de 109,2. Se combinaron intervención individual y grupal (role-playing, trabajo de supuestos, filmación en vídeo), poniendo especial hincapié en los procesos de aprendizaje sin error y en la generalización de los logros al entorno natural (ensayos controlados). Resultados y conclusiones. Se comprueba y describe la relación existente entre la naturaleza de los déficit neuropsicológicos y psicopatológicos y las características de las limitaciones en el funcionamiento social. Los pacientes mostraron una significativa reducción del nivel de ansiedad y de conductas agresivas y una mejora de la conciencia sobre los déficit. Asimismo, se observó una discreta mejora en la expresión de opiniones y emociones, y en la capacidad de adecuar la conducta social a las diferentes situaciones (flexibilidad conductual). Finalmente, se describen las conclusiones terapéuticas que extrajo el equipo para la futurarevisión y mejora del programa (AU)