The mediating role of reflective functioning in the association between childhood trauma and suicide attempt.

BACKGROUND: Childhood trauma is intimately related with suicidal behaviour. Patients who have suffered childhood trauma develop impaired Reflective Functioning (RF), which refers to the capacity to understand ourselves and others in terms of intentional mental states. An improvement in RF has been associated with a reduction in suicidal attempts, but the mediating role of RF between childhood trauma and suicidal behaviour has not been addressed so far. OBJECTIVE: We aim to examine the potential mediating effect of RF among childhood trauma and suicide attempts. METHOD: We included 748 patients who had attempted suicide at least once. They were asked to complete the Reflective Functioning Questionnaire (RFQ-8), the Columbia-Suicide Severity Rating scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). We conducted linear regressions by simple mediating model to examine the role of RF in the indirect association between childhood trauma and the number of suicide attempts. RESULTS: Our results show significant indirect effects through hypo and hypermentalizing between Emotional Abuse (EA) and Sexual Abuse (SA) in childhood and the number of suicide attempts in lifetime. These results indicate that ineffective RF significantly mediates the association between childhood trauma and suicidality. CONCLUSION: This is the first study supporting the mediational role of RF in the relationship between EA and SA, and the number of suicide attempt in lifetime. These findings have important implications for reducing suicide rates and preventing future re-attempts. Further studies analysing this mediating role and focusing efforts on increasing RF-based interventions are required.

Intervenciones psicoterapéuticas y psicosociales para el manejo del estrés en esclerosis múltiple: aportación de intervenciones basadas en mindfulness / Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions

La presencia de depresión o ansiedad asociada al diagnóstico de esclerosis múltiple (EM) se ha relacionado con una peor evolución de la enfermedad, con mayor número de brotes, con peor adherencia al tratamiento y una mayor disregulación del sistema inmune. Estudios recientes indican que intervenciones psicoterapéuticas dirigidas al manejo del estrés, entre ellas, intervenciones basadas en mindfulness (Mindfulness-Based Interventions, MBI), pueden mejorar la calidad de vida, la depresión, la ansiedad y la fatiga en pacientes con diagnóstico de EM. Mindfulness o atención plena fomenta la capacidad para observar las experiencias tal y como son y mejora la regulación emocional. Esta habilidad o actitud se aprende por entrenamiento y tiene la ventaja sobre otras intervenciones de que el efecto puede prolongarse a lo largo del tiempo al depender de la práctica personal. El objetivo del presente artículo es revisar la evidencia disponible sobre la eficacia de intervenciones psicosociales y psicoterapéuticas, específicamente MBI, en el manejo de la sintomatología ansioso-depresiva y del estrés percibido en pacientes con diagnóstico de EM

Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients

Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions.

Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients.

Mindfulness-based narrative therapy for depression in cancer patients.

UNLABELLED: Mindfulness-based narrative therapy (MBNT) is a therapeutic intervention for the treatment of depression in cancer patients. In a previous randomized controlled trial, MBNT was found to ameliorate anxiety and depression, improve functional dimensions of quality of life, and enhance treatment adherence. In this review, we describe MBNT and its technical characteristics in the context of other psychotherapeutic interventions for depression in cancer patients. We highlight needed adjustments to other narrative approaches and recommend clinical modifications tailored to the needs of cancer patients that are intended to encompass the client's initial depressive narrative. The narrative construction is supported by emotional regulation and attachment relationships on the one hand and by individual and social linguistic capabilities on the other. Through destabilization of the depressive narrative, MBNT facilitates the emergence of new meanings using both verbal and non-verbal techniques based on mindfulness. The attitude and practice of mindfulness are integrated throughout the therapeutic process. In summary, MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. KEY PRACTITIONER MESSAGE: In this review, we describe mindfulness-based narrative therapy (MBNT) for the treatment of depression in cancer patients. In a previous controlled trial, we found significant benefits of MBNT in terms of reducing depressive symptoms and improving treatment adherence and quality of life in depressed, non-metastatic cancer patients. Narrative construction is socially and neurobiologically derived. MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. MBNT is proposed as an interesting and promising intervention, particularly for patients with somatic pathologies.

Combined therapy versus usual care for the treatment of depression in oncologic patients: a randomized controlled trial.

OBJECTIVE: To compare narrative therapy (NT) plus escitalopram versus escitalopram plus usual care on quality of life and depressive symptomatology of depressed patients with oncologic disease. METHODS: A total of 72 subjects (mean age 54.6 years), predominantly female with non-metastatic breast, lung and colon cancer and depressive disorder (DSM-IV-TR) were randomized to receive treatment with NT plus escitalopram (n=39) or escitalopram (10-20 mg QD) plus usual care (n=33). Main endpoints were improvement in dimensions of quality of life measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 and reduction of depressive symptoms using the Hospital Anxiety and Depression Scale at weeks 12 and 24. RESULTS: The combined therapy group showed significantly greater improvement in all the functioning dimensions (p<0.01), pain scale (p=0.02), global health (p=0.02), and global quality of life (p=0.007) at weeks 12 and 24. There were no statistically significant differences in depressive symptomatology between the groups. From week 12 to week 24 study retention was higher in the combined treatment group (p=0.01). CONCLUSIONS: Brief NT in combination with escitalopram was superior to usual care and escitalopram in improving functioning dimensions of quality life.

Intervenciones sobre problemas relacionados con el duelo para profesionales de Atención Primaria (II): intervenciones desde Atención Primaria de salud / Interventions about problems related to grief for Primary Health Care physicians (II): interventions in Primary Health Care

Ésta es la segunda parte de un trabajo de dos en el que se revisan diferentes concepciones del duelo, y se propone un modelo por el que éste es considerado como un trabajo a realizar por la persona y su entorno. Se describen los problemas de salud mental asociados a las dificultades encontrados en este proceso y las tareas a llevar a cabo por la persona en duelo (AU)

Intervenciones sobre problemas relacionados con el duelo para profesionales de Atención Primaria (I): el proceso del duelo / Interventions about problems related to grief for Primary Health Care physicians (I): the grief process

Ésta es la primera parte de un trabajo de dos en el que se revisan diferentes concepciones del duelo, y se propone un modelo por el que éste es considerado como un trabajo a realizar por la persona y su entorno. Se describen los problemas de salud mental asociados a las dificultades encontradas en este proceso y las tareas a llevar a cabo por la persona en duelo (AU)

Síntomas de ansiedad y depresión en un grupo de pacientes oncológicos y en sus cuidadores

Objetivos: Determinar la prevalencia de los síntomas de ansiedad y depresión en un grupo de 534 pacientes oncológicos españoles y 371 cuidadores familiares. Método: Se utilizó un cuestionario sociodemográfico así como la Escala de Ansiedad y Depresión Hospitalaria (HADS) con el fin de evaluar la presencia e intensidad de estos síntomas. Resultados: Se observó que el 15,7 por ciento de los pacientes dieron positivo en la subescala de ansiedad, incluida dentro de la escala de ansiedad y depresión hospitalaria (HADS), al utilizar un punto de corte mayor o igual a 11 y el 14,6 por ciento lo hicieron en la subescala de depresión. En cuanto a los cuidadores familiares, el 36,4 por ciento de ellos obtuvieron altas puntuaciones en la subescala de ansiedad y el 9,2 por ciento lo hicieron en la subescala de depresión. Conclusiones: Nuestros resultados confirman la alta prevalencia de los síntomas de ansiedad y depresión en ambos grupos y por lo tanto, la necesidad de diseñar intervenciones terapéuticas que incluyan de forma sistemática una evaluación familiar para contribuir a que los pacientes y sus familias puedan hacer frente a este tipo de problemas. (AU)

Psicoterapia en atención primaria: consejo interpersonal para la depresión / Psychotherapy in Primary Health Care: interpersonal counselling for depression

En este trabajo se describen las líneas generales de actuación del médico de Atención Primaria ante uno de los trastornos de mayor prevalencia en su práctica diaria como es la depresión. Se expone el marco general de esta intervención, descrita minuciosamente en el manual original de Klerman y colaboradores y que ha sido posteriormente adapta da al contexto de AP. Se describen los cuatro focos entorno a los que se articula la intervención: duelo, transiciones de rol, disputas interpersonales y déficits interpersonales, aportando ejemplos de cada uno de ellos procedentes de la práctica clínica (AU)

Parental rearing and intimate relations in women's depression.

Bowlby has suggested that attachment behavior is not restricted to early childhood but can remain valid through the life span. This study was designed to test whether recall of parental rearing (Parental Bonding Instrument) and perception of marital relationship (Dyadic Adjustment Scale) is significantly different between 2 groups of women: one with non-bipolar depressive disorder (DSM-III-R) compared with another (control) of healthy women from a primary practice setting. We also examined the hypothesis that exposure to dysfunctional parenting is associated with negative intimate relationships in adulthood. Our results partially support these hypotheses. We discuss the significance of these findings in the prevention and treatment of depressive disorders.

[Stress factors in psychiatric hospitalization]. / Factores de estrés en el ingreso psiquiátrico.

The incidence of stressful life events in the six months previous to psychiatric hospitalization is studied in a group of patients allotted to different diagnostic categories but which held in common that they were at their first episode of inpatient treatment. The presence of early life events during childhood and of chronic stress during the last year is also investigated. The different kind of responses to LE are described, classified in several categories. The incidence of LE in the patients is compared with that of a group of acute traumatologic hospital inpatients. In every case it has been used the Paykel LE rating scale, the Brown and Harris interview schedule and the GAF. Results are analyzed and their implications in preventive and treatment programs in Mental Health are discussed.