Effects of intensity, attention and medication on auditory-evoked potentials in patients with fibromyalgia.

Fibromyalgia (FM) has been associated to an increased processing of somatosensory stimuli, but its generalization to other sensory modalities is under discussion. To clarify this, we studied auditory event-related potentials (AEPs) to stimuli of different intensity in patients with FM and healthy controls (HCs), considering the effects of attention mechanisms and medication. We performed two experiments: In study 1 (n = 50 FM, 60 HCs), the stimuli were presented randomly within the sequence; in study 2 (n = 28 FM, 30 HCs), they were presented in blocks of the same intensity. We analyzed intensity and group effects on N1-P2 amplitude and, only for the FM group, the effect of medication and the correlation between AEPs and clinical variables. Contrary to the expectation, the patients showed a trend of reduced AEPs to the loudest tones (study 1) or no significant differences with the HCs (study 2). Medication with central effects significantly reduced AEPs, while no significant relationships between the N1-P2 amplitude/intensity function and patients' symptoms were observed. The findings do not provide evidence of augmented auditory processing in FM. Nevertheless, given the observed effect of medication, the role of sensory amplification as an underlying pathophysiological mechanism in fibromyalgia cannot be discarded.

Áreas de mejora en el manejo clínico de la depresión: perspectiva de pacientes, familiares y profesionales / Areas for improvement in the management of depression: perspectives of patients, families and professionals

Introducción. Actualmente existe consenso en que la atención a la depresión requiere entender las experiencias, expectativas y preferencias de los pacientes e incorporar la visión de los profesionales implicados en su manejo. El objetivo de este estudio fue explorar y comparar las perspectivas de pacientes, familiares y profesionales respecto de las principales áreas de mejora de la práctica clínica de la depresión. Material y métodos. Se realizaron 4 grupos focales (2 con pacientes con depresión mayor, uno con familiares y uno con profesionales). Para la captación de los participantes se contó con la colaboración del Servizo Galego de Saúde y de la Federación de Asociaciones de Familiares y Personas con Enfermedad Mental. El contenido de las transcripciones se analizó temáticamente. Resultados. Se identificaron 5 temas principales y 18 subtemas: los retos diagnósticos, la necesidad de un abordaje integral, las mejoras en la coordinación y seguimiento, el establecimiento de un espacio y relación terapéutica adecuados y, por último, el impacto del estigma. Los pacientes, familiares y profesionales aportaron información parcialmente coincidente y complementaria sobre estos temas principales. Conclusiones. El manejo de la depresión es una labor compleja que requiere la puesta en marcha de medidas de diferente naturaleza. Incorporar las perspectivas de los principales agentes implicados es fundamental y se hace patente la necesidad de seguir trabajando en modelos de atención a la depresión que optimicen las experiencias de los pacientes y que tengan en cuenta sus preferencias y expectativas (AU)

Introduction. There is currently a consensus that depression care requires understanding the experiences, expectations, and preferences of patients, and incorporating the views of the professionals involved in its management. The aim of this study was to explore and compare the perspectives of patients, families, and health professionals on the main areas for improvement in the clinical practice of depression. Material and methods. Four focus groups were performed (2 with patients with major depression, one with family members, and one with professionals). Participants were recruited with the collaboration the Galician Health Service and the Federation of Associations of Relatives and Persons with Mental Disease. The content of the transcripts were analysed thematically. Results. Five themes and 18 sub-themes emerged, including, diagnostic challenges, the need for a comprehensive approach, improvements in the coordination and monitoring, the establishment of an adequate relationship and therapeutic space and, finally, the impact of stigma. Patients, families and professionals provided partially overlapping and complementary information on these main themes. Conclusions. The management of depression is a complex task, which requires the implementation of measures of a different nature. The incorporation of the perspectives of key stakeholders is essential and it is necessary to continue working on models of care for depression that optimise the experiences of patients, and take into account their preferences and expectations (AU)

[Areas for improvement in the management of depression: perspectives of patients, families and professionals]. / Áreas de mejora en el manejo clínico de la depresión: perspectiva de pacientes, familiares y profesionales.

INTRODUCTION: There is currently a consensus that depression care requires understanding the experiences, expectations, and preferences of patients, and incorporating the views of the professionals involved in its management. The aim of this study was to explore and compare the perspectives of patients, families, and health professionals on the main areas for improvement in the clinical practice of depression. MATERIAL AND METHODS: Four focus groups were performed (2 with patients with major depression, one with family members, and one with professionals). Participants were recruited with the collaboration the Galician Health Service and the Federation of Associations of Relatives and Persons with Mental Disease. The content of the transcripts were analysed thematically. RESULTS: Five themes and 18 sub-themes emerged, including, diagnostic challenges, the need for a comprehensive approach, improvements in the coordination and monitoring, the establishment of an adequate relationship and therapeutic space and, finally, the impact of stigma. Patients, families and professionals provided partially overlapping and complementary information on these main themes. CONCLUSIONS: The management of depression is a complex task, which requires the implementation of measures of a different nature. The incorporation of the perspectives of key stakeholders is essential and it is necessary to continue working on models of care for depression that optimise the experiences of patients, and take into account their preferences and expectations.

Filtering out repetitive auditory stimuli in fibromyalgia: a study of P50 sensory gating.

BACKGROUND: It has been suggested that fibromyalgia (FM) patients show increased sensory processing of nociceptive and non-nociceptive stimuli and also reduced habituation. Although this pattern of increased reactivity has been established for the somatosensory modality, its generalization to other sensory modalities remains controversial. METHODS: Auditory evoked potentials were obtained using a paired-stimuli paradigm from a sample of 52 FM female patients and 55 healthy women matched for age and socio-economic status. Sensory gating of the P50 component, as indicated by P50 suppression rates to the second identical stimuli, was analysed in relation to clinical indices of FM, including algometry of tender points and a number of self-reported questionnaires. RESULTS: Sensory gating mechanisms in FM patients proved to be normal, robust and as efficient as those recorded in control subjects. There was no correlation between P50 suppression rates and indices of clinical or experimental (threshold or tolerance) pain. In addition, P50 sensory gating was not related to the other main symptoms of FM, including fatigue, sleep dysfunction or co-morbid depression, nor to hypersensitivity to noise or headache. CONCLUSIONS: The results indicate that FM patients do not present significant deficits in early sensory gating when processing auditory stimuli, and therefore challenge the 'generalized hypersensitivity' hypothesis of FM.

Convergence between the 1990 and 2010 ACR diagnostic criteria and validation of the Spanish version of the Fibromyalgia Survey Questionnaire (FSQ).

(1) To assess the degree of convergence between the 1990 and 2010 American College of Rheumatology (ACR) diagnostic criteria; (2) To evaluate the validity and reliability of the 2010 ACR criteria; (3) To validate the Spanish version of the Fibromyalgia Survey Questionnaire (FSQ); and (4) To assess the utility of the FSQ to differentiate fibromyalgia (FM) subgroups by disease severity. In the first study, agreement between the 1990 and 2010 ACR criteria for FM diagnosis was analyzed in a sample of 80 FM patients and 59 healthy controls. Algometry (mean threshold and tender points count) and the 2010 ACR indices [Symptom Severity Scale (SSS), Widespread Index (WPI) and Polysymptomatic Distress Scale (PSD)] were correlated with the key symptoms of FM and with indices of disease interference and quality of life. In a second study, we evaluated the validity and internal consistency of the Spanish version of the FSQ, as well as its ability to discriminate between groups of FM patients with low and high symptom severity. There is good agreement between the 1990 and 2010 ACR criteria for FM diagnosis. The 2010 ACR indices (SSS, WPI and PSD) demonstrated very adequate construct validity and appeared to be useful in the assessment of disease severity and global impact of FM. The FSQ had good internal consistency and validity and showed 100 % concordance with 2010 ACR criteria applied by a clinician. In addition, the FSQ proved to be useful in differentiating FM severity subgroups.

Satisfacción y utilidad percibidas por pacientes y familiares acerca de la información sobre prevención de suicidio / Perceived satisfaction and usefulness of suicide prevention information for patients and relatives

Objetivo: Evaluar la satisfacción de personas con conducta suicida y de sus familiares con la información incluida en la «Guía de práctica clínica de prevención y tratamiento de la conducta suicida». Método: Los participantes fueron reclutados a través de un programa de prevención de suicidio (Programa de intervención intensiva en conducta suicida [PII]) y de una Asociación (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES]). Se diseñó un cuestionario ad hoc para conocer el grado de satisfacción y utilidad percibidas con la información incluida en la guía. Resultados: La muestra estuvo formada por 57 pacientes con ideación o conducta suicidas y 52 familiares. Los pacientes puntuaron significativamente más bajo que los familiares en las 2 dimensiones: formato y utilidad; sin embargo, no se encontraron diferencias significativas entre ambos grupos en el nivel de satisfacción general. Las variables sociodemográficas no influyeron en los resultados. Tampoco se encontraron diferencias entre pacientes con y sin antecedentes de conducta suicida. Conclusiones: En general, tanto pacientes como familiares mostraron un alto nivel de satisfacción con el documento. Los participantes destacaron la atención primaria como el ámbito más adecuado para la difusión de este tipo de información. Suministrar información de estas características a pacientes con ideación y/o conducta suicida podría actuar como herramienta preventivo-educativa (AU)

Objective: To assess the satisfaction of persons with suicidal behaviour and their relatives using patient information material included in the Clinical Practice Guidelines on Prevention and Treatment of Suicidal Behaviour. Method: The sample was made up of 57 patients with suicidal ideation or behaviour, and 52 relatives. The participants were recruited through a suicide prevention programme (Programa de intervención intensiva en conducta suicida [PII] - Suicidal Behaviour IntensiveIntervention Programme) and a family association (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES] - Galician Federation of Associations of Relatives and Persons with mental diseases). An ad-hoc questionnaire was designed to ascertain the degree of perceived satisfaction and usefulness of using the information included in the guidelines. Results: The descriptive data of the sample is presented, along with an exploratory factorial analysis of the questionnaire that yielded two dimensions, i.e., format and usefulness. Patients scored significantly lower than the relatives in two dimensions; nevertheless, no significant differences were found between the two groups in the level of general satisfaction. The sociodemographic variables did not influence the results. Similarly, no differences were observed between patients with and without history of suicidal behaviour. Participants stressed that Primary Care was the setting best suited for dissemination of this type of information. Conclusions: In general, both patients and relatives displayed a high level of satisfaction with the patient information material assessed. Furnishing information of this type to patients with suicidal ideation and/or behaviour could act as a preventive-educational tool (AU)

[Perceived satisfaction and usefulness of suicide prevention information for patients and relatives]. / Satisfacción y utilidad percibidas por pacientes y familiares acerca de la información sobre prevención de suicidio.

OBJECTIVE: To assess the satisfaction of persons with suicidal behaviour and their relatives using patient information material included in the Clinical Practice Guidelines on Prevention and Treatment of Suicidal Behaviour. METHOD: The sample was made up of 57 patients with suicidal ideation or behaviour, and 52 relatives. The participants were recruited through a suicide prevention programme (Programa de intervención intensiva en conducta suicida [PII] - Suicidal Behaviour Intensive Intervention Programme) and a family association (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES] - Galician Federation of Associations of Relatives and Persons with mental diseases). An ad-hoc questionnaire was designed to ascertain the degree of perceived satisfaction and usefulness of using the information included in the guidelines. RESULTS: The descriptive data of the sample is presented, along with an exploratory factorial analysis of the questionnaire that yielded two dimensions, i.e., format and usefulness. Patients scored significantly lower than the relatives in two dimensions; nevertheless, no significant differences were found between the two groups in the level of general satisfaction. The socio-demographic variables did not influence the results. Similarly, no differences were observed between patients with and without history of suicidal behaviour. Participants stressed that Primary Care was the setting best suited for dissemination of this type of information. CONCLUSIONS: In general, both patients and relatives displayed a high level of satisfaction with the patient information material assessed. Furnishing information of this type to patients with suicidal ideation and/or behaviour could act as a preventive-educational tool.