Psychological treatment of PTSD with comorbid substance use disorder (SUD): expert recommendations of the European Society for Traumatic Stress Studies (ESTSS).

Background: Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are often comorbid and difficult to treat. The availability of evidence-based treatment guidelines is very limited and there is significant uncertainty about what best practice looks like.Objective: This paper describes the methodology used to develop expert recommendations for the assessment and psychological treatment of PTSD and comorbid SUD and presents the final recommendations.Methodology: A small committee of experts in the field of PTSD and SUD was formed on behalf of the European Society for Traumatic Stress Studies (ESTSS) Board. The committee developed recommendations based on a two-stage process. In the first stage a systematic review of randomised controlled trials of psychological interventions aimed at treating PTSD-SUD comorbidity was completed, and other recent relevant reviews systematic were also considered. To complement the recommendations based on systematic review, the second stage involved the review and collation of existing guidance, good practice and consensus recommendations made in methodologically rigorous clinical practice guidelines.Results: The two-stage process resulted in 9 recommendations related to assessment and 21 recommendations related to treatment planning and delivery.Conclusions: To our knowledge, this is the first attempt to provide expert recommendations based on a systematic review of the literature and through collation of guidance provided in other authoritative and reliable sources. These expert recommendations will provide helpful guidance to clinicians and service providers in both addiction and mental health settings about appropriate clinical care for those with PTSD SUD comorbidity.

This project aimed to develop expert recommendations for the assessment and psychological treatment of PTSD and comorbid substance use disorder.Trauma-focused psychological intervention combined with treatment for SUD is the most effective treatment for PTSD symptoms and for alcohol use disorder treatment benefits appear to be strongest when combined with alcohol targeted pharmacotherapy.The presence of co-occurring SUD should not prevent or exclude individuals from receiving established evidence-based treatments for PTSD and readiness to engage in evidence-based treatment should be evaluated on an individual basis.

Tratamiento psicológico grupal para pacientes con sintomatología de Covid persistente: protocolo para un ensayo controlado aleatorizado / Psychological group treatment for patients with long covid Symptoms: randomized controlled trial’s protocol

La sintomatología de Covid persistente aparece en 1-2 de cada 10 personas infectadas por el virus SARS-CoV-2 y pueden presentar severas dificultades de adaptación a su nueva condición de salud. Por un lado, este artículo presenta nuestra propuesta de tra-tamiento psicológico grupal basada en la ya conocida terapia de aceptación y compromiso. Se ha descrito brevemente el contenido de la psicoterapia sesión a sesión y se han detallado los aspectos formales para su correcta implementación y posibilidad de repli-cación. Por otro lado, se describen las particularidades metodológicas de un ensayo controlado aleatorizado: diseño experimental pre-post con asignación aleatoria a dos modalidades de tratamiento; criterios de inclusión y exclusión de la muestra; proceso de reclutamiento y aleatorización, procedimiento, variables e instrumentos de evalua-ción y análisis y contraste estadístico de los resultados. El protocolo que hemos elaborado pretende evaluar, de forma metodológicamente rigurosa, la efectividad de un tratamiento espe-cíficamente dirigido a mejorar la calidad de vida y el funcionamiento psicosocial de las personas que sufren síntomas persistentes de Covid-19. Los resultados permitirán saber si dicho tratamiento es realmente eficaz.(AU)

Long Covid symptoms appear in 1-2 out of 10 people infected by the SARS-CoV-2 virus. They may well present severe difficulties when it comes to adapting to their new health condition.On the one hand this article presents a Psychological group treatment for patients with Long Covid symptoms based on the well-known acceptance and commitment therapy. The content of psychotherapy session after session has been briefly described. What’s more, the formal aspects for both its correct implementation and the possibility of replication have also been detailed.On the other hand, the methodological characteristics of a randomized controlled trial are described. This includes: pre-post experimental design with two treatment modalities assigned ran-domly; sample inclusion and exclusion criteria; patient recruitment and randomisation; procedure and instruments of evaluation and analysis and statistical contrast of the results.The developed protocol aims to evaluate, in a methodologically rigorous manner, the effectivity of an intervention that specifically aspires to improve psychosocial functioning and life quality of people suffering from Long Covid symptoms. The results will allow us to know if this treatment has been objectively successf.(AU)

Eficacia de los tratamientos psicológicos para los comportamientos autolesivos suicidas y no suicidas en adolescentes / Efficacy of psychological treatments for suicidal and non-suicidal self-injurious behaviors in adolescents

Los comportamientos autolesivos y suicidas en adolescentes, por su creciente prevalencia como por sus fatales consecuencias, son en nuestrosdías un problema de salud pública que requiere de intervenciones eficaces. Con el objetivo de dilucidar los tratamientos psicológicos que, hasta lafecha, mejor funcionan para reducir o eliminar estos comportamientos, se realizó una revisión de estudios de metaanálisis y revisiones sistemáticasen las bases de datos PsycArticles, PsycInfo y MEDLINE. Los criterios de elegibilidad establecidos permitieron la selección final de 10 registros.Los resultados mostraron una elevada heterogeneidad y un alcance limitado de los tratamientos psicológicos con tamaños del efecto de pequeñosa moderados tanto para las conductas autolesivas, como para la ideación suicida, la suicidabilidad y especialmente para la intención suicida. Estosefectos tendían a debilitarse o desaparecer en el medio y largo plazo. La Terapia Dialéctica Conductual (TDC) resultó ser comparativamente la quemejores resultados obtuvo de las intervenciones analizadas. El alcance restringido de los resultados y las importantes limitaciones metodológicashalladas alertan de la necesidad de más investigación, así como del futuro diseño de intervenciones específicas para este tipo de problemas. (AU)

Self-injurious and suicidal behaviors in adolescents are nowadays a public health problem that requires effective interventions. In order to elucidate the psychological treatments that, to date,work best to reduce or eliminate these behaviors, a review of meta-analysis and systematic reviews was carried out in the PsycArticles, PsycInfo andMEDLINE databases. The established eligibility criteria allowed the final selection of 10 records. The results showed high heterogeneity and poorresults for the psychological treatments with small to moderate effect sizes for self-injurious behaviors, suicidal ideation, suicidality and especiallyfor suicidal attempts. These effects tended to weaken or disappear in the medium to long term. Dialectical Behavior Therapy (DBT) proved to becomparatively the best performing of the interventions analyzed. The limited scope of the results and the important methodological limitations alertus to the need for further research and the future design of specific interventions for this type of problems. (AU)

Mindfulness-based cognitive therapy versus psychoeducational intervention in bipolar outpatients: Results from a randomized controlled trial.

INTRODUCTION: Few controlled trials have assessed the impact of Mindfulness Based Cognitive Therapy (MBCT) on symptoms and functioning in bipolar disorder (BD). This study aims to evaluate the effectiveness of MBCT adjunctive group treatment. MATERIAL AND METHODS: Randomized, prospective, multicenter, single-blinded trial that included BP-outpatients with subthreshold depressive symptoms. Participants were randomly assigned to three arms: treatment as usual (TAU); TAU plus psychoeducation; and TAU plus MBCT. Primary outcome was change in Hamilton-D score; secondary endpoints were change in anxiety, hypo/mania symptoms and functional improvement. Patients were assessed at baseline (V1), 8 weeks (V2) and 6 months (V3). Main hypothesis was that adjunctive MBCT would improve depressive symptoms more than psychoeducation. RESULTS: Eighty-four participants were recruited (MBCT=40, Psychoeducation=34, TAU=10). Depressive symptoms improved in the three arms between V1 and V2 (p<0.0001), and between V1 and V3 (p<0.0001), and did not change between V2 and V3. At V3 no significant differences between groups were found. There were no significant differences in other measures either. CONCLUSIONS: In our BD population we did not find superiority of adjunctive MBCT over adjunctive Psychoeducation or TAU on subsyndromal depressive symptoms; neither on anxiety, hypo/mania, relapses, or functioning.

Tratamiento psicológico aplicado a niños con encopresis

RESUMEN Introducción: La encopresis infantil es la defecación involuntaria en el niño, sin causa orgánica que lo justifique. Puede originarse por una incontinencia fisiológica, aparecer después de la adquisición del control de esfínter o consistir en la deposición deliberada de heces en lugares inadecuados existiendo un control de esfínter normal. Es un trastorno con repercusión psicológica de particular importancia en la vida del niño y familia. Objetivos: Describir el tratamiento psicológico aplicado a niños con encopresis. Métodos: Estudio descriptivo de corte transversal con enfoque cualitativo que se desarrolló en el Hospital Pediátrico Provincial "Eduardo Agramonte Piña" de la Ciudad de Camagüey, en la consulta externa de psicología de dicho centro, en el período comprendido entre mayo 2019 y enero de 2020. Resultados: Las áreas de conflictos fundamentales para el niño con encopresis fueron la familiar, la individual y la escolar. Destacan como conflictos primordiales, el divorcio mal manejado por los padres: 38,4 % de los niños, la demanda de afecto de la figura materna: 30,7 % y las dificultades con los estudios: 26,9 % de los menores. Conclusiones: El tratamiento psicológico consiste en la realización de acciones terapéuticas para desarrollar el hábito eliminatorio en el niño, en intervenciones con los padres para el tratamiento adecuado de la separación, comunicación positiva con el niño y fomento de su independencia según la etapa de la vida. Se enfatiza en la búsqueda de estilos educativos adecuados y atención a las dificultades escolares.

ABSTRACT Introduction: Children encopresis is involuntary defecation of the child, without organic cause that justifies it. It can be caused by physiological incontinence, and appear after the acquisition of sphincter control or being the deliberate deposition of feces in inappropriate places with normal sphincter control. It is a disorder with a psychological impact of particular importance in the life of the child and family. Objectives: Describe the psychological treatment applied to children with encopresis. Methods: A descriptive cross-sectional study with a qualitative approach was carried out at "Eduardo Agramonte Piña" Provincial Pediatric Hospital in the city of Camaguey, in the psychology outpatient clinic of the center, in the period from May 2019 to January 2020. Results: The areas of fundamental conflict for the child with encopresis were the family area, the individua areal and the school area. Divorce mismanaged by parents (38.4%), the demand for affection of the mother figure (30.7%) and difficulties with studies (26.9%) stands out as primary conflicts. Conclusions: Psychological treatment consists of carrying out therapeutic actions to develop the elimination of feces habit in the child, in interventions with the parents for the adequate treatment of separation, positive communication with the child and promotion of their independence according to the stage of life. Emphasis is placed on the search for appropriate educational styles and attention to school difficulties.

Does psychological therapy improve the mental health of people with borderline personality disorder and substance abuse disorder? / ¿Mejora la terapia psicológica la salud mental de las personas con trastorno límite de la personalidad y trastorno por abuso de sustancias? Una revisión sistemática

Abstract Introduction: People with comorbid borderline personality disorder (BPD) and substance abuse disorder (SUD) show great affectation and poorer treatment outcomes. Objective: The aim was to examine useful psychological treatments for people with co-morbid BPD and SUD. Method: The Cochrane Library, ISOC, Psychodoc, ProQuest Central, Pubmed, Web of Science and Scopus databases were consulted using a systematic literature review following PRISMA standards. A 185 articles were obtained, of which 12 were selected taking into account the inclusion criteria. The process was carried out by two independent evaluators and the level of agreement was excellent. Results: there are a variety of therapeutic options that, in general, improve the symptoms associated with BPD but not with SUD. Conclusion: more research is needed to evaluate the usefulness of psychological therapies in these patients.

Resumen Introducción: Las personas con trastorno límite de la personalidad (TLP) y trastorno por uso y abuso de sustancias (TUS) muestran una gran afectación emocional y peores resultados en el tratamiento psicológico. Objetivo: El objetivo fue examinar los tratamientos psicológicos útiles para las personas con TLP y TUS. Método: Se consultaron las bases de datos Cochrane Library, ISOC, Psychodoc, ProQuest Central, Pubmed, Web of Science y Scopus mediante una revisión bibliográfica sistemática siguiendo las normas PRISMA. Se obtuvieron 185 artículos, de los cuales se seleccionaron 12 teniendo en cuenta los criterios de inclusión. El proceso fue realizado por dos evaluadoras independientes y el nivel de acuerdo fue excelente. Resultados: existe una variedad de opciones terapéuticas que, en general, mejoran los síntomas asociados al TLP pero no al TUS. Conclusión: se necesita más investigación para evaluar la utilidad de las terapias psicológicas en estos pacientes.

Mental health interventions for healthcare workers during the first wave of COVID-19 pandemic in Spain.

OBJECTIVE: In order to reduce distress associated with working with COVID-19 patients, several psychological intervention programmes for healthcare workers have been developed in Spain. We aimed to describe the main characteristics and components of these programmes for healthcare workers treating COVID-19 patients in Spanish hospitals. MATERIAL AND METHODS: An online survey was designed to evaluate the main characteristics of psychological intervention programmes for healthcare workers during the first wave of COVID-19 pandemic. RESULTS: Valid responses were received from 36 hospitals. Most of these programmes offered both in-person and online therapy. The most common aim of these interventions was emotional regulation, which was treated by psychoeducational and cognitive-behavioural techniques in individual interventions. Group interventions mainly used psychoeducation and mindfulness. Only half of the teams that offered in-person interventions received training in the proper use of personal protective equipment. CONCLUSIONS: Several hospitals in Spain have developed mental health interventions for healthcare workers during the COVID-19 pandemic, deploying a wide range of therapeutic modalities and techniques. The rapid implementation of these programmes during the pandemic suggests that safety may not have received sufficient attention. The planning and development of interventions for healthcare workers during pandemics merits greater attention by national and regional authorities and institutions.

Mental health interventions for healthcare workers during the first wave of COVID-19 pandemic in Spain

Objective: In order to reduce distress associated with working with COVID-19 patients, several psychological intervention programmes for healthcare workers have been developed in Spain. We aimed to describe the main characteristics and components of these programmes for healthcare workers treating COVID-19 patients in Spanish hospitals.Material and methodsAn online survey was designed to evaluate the main characteristics of psychological intervention programmes for healthcare workers during the first wave of COVID-19 pandemic.ResultsValid responses were received from 36 hospitals. Most of these programmes offered both in-person and online therapy. The most common aim of these interventions was emotional regulation, which was treated by psychoeducational and cognitive-behavioural techniques in individual interventions. Group interventions mainly used psychoeducation and mindfulness. Only half of the teams that offered in-person interventions received training in the proper use of personal protective equipment.ConclusionsSeveral hospitals in Spain have developed mental health interventions for healthcare workers during the COVID-19 pandemic, deploying a wide range of therapeutic modalities and techniques. The rapid implementation of these programmes during the pandemic suggests that safety may not have received sufficient attention. The planning and development of interventions for healthcare workers during pandemics merits greater attention by national and regional authorities and institutions. (AU)

Objetivo: Para reducir el malestar psicológico asociado a tratar pacientes con COVID-19, se han desarrollado numerosos programas de intervención en España. Este estudio pretende describir las principales características y componentes de los programas para trabajadores sanitarios que atienden COVID-19 en hospitales españoles.Material y métodosSe elaboró y distribuyó una encuesta online para evaluar las principales características de los programas de intervención psicológica para trabajadores sanitarios durante la primera ola de la pandemia de COVID-19.ResultadosSe recibieron respuestas válidas de 36 hospitales. La mayoría de los programas ofrecían intervención presencial y online/telefónica. El principal objetivo de estos programas fue mejorar la regulación emocional. Las intervenciones individuales emplearon principalmente psicoeducación y técnicas cognitivo-conductuales, mientras que las grupales emplearon psicoeducación y mindfulness. Solo la mitad de los equipos que ofrecían intervenciones presenciales habían recibido la formación adecuada para usar equipos de protección individual.ConclusionesNumerosos hospitales en España han desarrollado intervenciones de salud mental para trabajadores sanitarios durante la pandemia por COVID-19, empleando una gran variedad de modalidades terapéuticas. La rápida implementación de estos programas durante la pandemia sugiere que la necesidad de seguridad ha podido subestimarse. La planificación y desarrollo de intervenciones psicológicas durante las pandemias merece mayor atención por parte de las autoridades competentes. (AU)

Psychological treatment approaches for improvement of maladaptive eating behaviors in bariatric surgery patients: A systematic review / Tratamientos psicológicos para el mejoramiento de las conductas alimentarias desadaptativas en pacientes de cirugía bariátrica: revisión sistemática

Introduction: Maladaptive eating behaviors (MEB) are highly prevalent among bariatric surgery patients and have been demonstrated to be important contributors for weight loss outcomes. A systematic review was conducted to evaluate the effectiveness of psychological treatment approaches on MEB in bariatric surgery patients. Materials and Methods: This systematic review was registered in PROSPERO. Literature review was performed in the databases PubMed, ScienceDirect, Cochrane Library, and Web of Science. We included studies published between January 1st 1990 and October 18th 2019, with pre- or postoperative psychological treatment approaches in bariatric surgery patients aimed to improve MEB. Results: A total of 15 studies met the inclusion criteria (eight RCT and seven pretest-posttest studies), 752 participants were identified, 80.3% were female and the average participant’s age was 46.1 years (SD ± 6.6). Follow-up period after intervention ranged from six weeks to 48 months. Five out of eight RCT reported a positive and significant effect (P <0.05) on MEB and four had medium to large effect size between the groups receiving psychotherapeutic interventions and the control group. Six out of seven pretest-posttest studies reported significant difference (P <0.05) on MEB and had small to large effect size after receiving psychotherapeutic interventions. Conclusion: Overall, the quality of the evidence ranged from low to moderate. Psychological treatments in bariatric surgery patients are inconsistent, though most results indicate improvement on MEB. Well-designed long-term studies and other approaches strategies are warranted to assess the long-term effects on MEB and weight loss in bariatric surgery patients.(AU)

Introducción: Las conductas alimentarias desadaptativas (CAD) son altamente prevalecientes en los pacientes de cirugía bariátrica y han sido demostradas ser contribuyentes importantes en los resultados de la pérdida de peso. Una revisión sistemática fue realizada para evaluar la efectividad de los enfoques de tratamientos psicológicos en CAD, en pacientes de cirugía bariátrica. Materiales y métodos: Esta revisión sistemática fue registrada en PROSPERO. La revisión de la literatura fue realizada en las bases de datos de PubMed, ScienceDirect, Cochrane Library y Web of Science. Incluimos estudios publicados entre 1 de enero de 1990 y 18 de octubre de 2019, con enfoques de tratamiento psicológico pre o posoperatorio en pacientes de cirugía bariátrica destinados a mejorar las CAD. Resultados: Un total de 15 estudios reunieron los criterios de inclusión (ocho ensayos clínicos aleatorizados (ECA) y y siete estudios preprueba-postprueba),752 participantes fueron identificados, 80.3% fueron mujeres y la edad promedio de los participantes fue de 46.1 años (DE ± 6.6). El periodo de seguimiento después de la intervención varió de seis semanas a 48 meses. Cinco de ocho ECA informaron un efecto positivo significativo (P <0.05) en las CAD y cuatro tuvieron un efecto de medio a alto entre los grupos que recibieron intervenciones psicoterapeúticas y el grupo control. Seis de los siete estudios preprueba-postprueba reportaron diferencias significativas (P <0.05) en las CAD y tuvieron un tamaño de efecto de bajo a alto después de recibir intervenciones psicoterapéuticas. Conclusión: En suma, la calidad de la evidencia varió de baja a moderada. Los tratamientos psicológicos en pacientes de cirugía bariátrica son inconsistentes, aunque la mayoría de los resultados indican un mejoramiento en las CAD. Estudios bien diseñados y otras estrategias de enfoque son garantizados para para evaluar...(AU)

Mental health interventions for healthcare workers during the first wave of COVID-19 pandemic in Spain.

OBJECTIVE: In order to reduce distress associated with working with COVID-19 patients, several psychological intervention programmes for healthcare workers have been developed in Spain. We aimed to describe the main characteristics and components of these programmes for healthcare workers treating COVID-19 patients in Spanish hospitals. MATERIAL AND METHODS: An online survey was designed to evaluate the main characteristics of psychological intervention programmes for healthcare workers during the first wave of COVID-19 pandemic. RESULTS: Valid responses were received from 36 hospitals. Most of these programmes offered both in-person and online therapy. The most common aim of these interventions was emotional regulation, which was treated by psychoeducational and cognitive-behavioural techniques in individual interventions. Group interventions mainly used psychoeducation and mindfulness. Only half of the teams that offered in-person interventions received training in the proper use of personal protective equipment. CONCLUSIONS: Several hospitals in Spain have developed mental health interventions for healthcare workers during the COVID-19 pandemic, deploying a wide range of therapeutic modalities and techniques. The rapid implementation of these programmes during the pandemic suggests that safety may not have received sufficient attention. The planning and development of interventions for healthcare workers during pandemics merits greater attention by national and regional authorities and institutions.

Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review.

Carers of patients with borderline personality disorder (BPD) experience high levels of distress. Several studies have been carried out on interventions designed to decrease their burden. However, the evidence from these studies has not been summarized. The objective of this work is to explore the clinical utility of interventions developed for family members of patients with BPD. A systematic review was conducted following the PRISMA guidelines (registration number CRD42018107318), including psychological interventions focused on relatives of patients with BPD. The following databases were used: PsycINFO, PubMed, EBSCOhost, and Web of Science. Two independent researchers reviewed the studies to determine whether the eligibility criteria were met. A total of 2,303 abstracts were identified. After duplicates had been removed, 1,746 studies were screened. Finally, 433 full-text articles were reviewed, yielding 11 studies that satisfied the inclusion criteria. Results show that these interventions with different clinical formats and settings are effective. The quality of the included studies varies, and the empirical support for these programs is still preliminary. The results help to establish a general framework for interventions specifically developed for family members of patients with BPD, but additional efforts should be made to improve the methodological quality of this field of research and more solidly determine the utility of these interventions. Given the paucity of data so far, this information may open up new lines of research to improve the effectiveness of future programs for carers of patients with BPD and help to reduce their burden.

Los familiares de pacientes con trastorno límite de la personalidad (TLP) experimentan elevados niveles de estrés. Se han llevado a cabo varios estudios sobre intervenciones diseñadas para disminuir su carga. Sin embargo, los datos obtenidos de estos estudios no se han expuesto. El objetivo de este trabajo es explorar la utilidad clínica de las intervenciones desarrolladas para los familiares de los pacientes con TLP. Se realizó una revisión sistemática siguiendo las directrices de PRISMA (número de registro CRD42018107318), que incluyó intervenciones psicológicas centradas en los familiares de los pacientes con TLP. Se utilizaron las siguientes bases de datos: PsycINFO, PubMed, EBSCOhost, y Web of Science. Dos investigadores independientes revisaron los estudios para determinar si se cumplían los criterios de elegibilidad. Se identificaron un total de 2303 resúmenes. Después de extraer los duplicados, se evaluaron 1746 estudios. Finalmente, se revisaron 433 artículos de texto completo, lo que dio lugar a 11 estudios que cumplían los criterios de inclusión. Los resultados demuestran que estas intervenciones con diferentes formatos y orientaciones clínicas son eficaces. La calidad de los estudios incluidos varía, y el apoyo empírico para estos programas es todavía preliminar. Los resultados contribuyen a establecer un marco general para las intervenciones desarrolladas específicamente para los familiares de los pacientes con TLP, pero se deberían realizar esfuerzos adicionales para mejorar la calidad metodológica de este campo de investigación y determinar con mayor solidez la utilidad de estas intervenciones. Dada la escasez de datos hasta el momento, esta información puede abrir nuevas líneas de investigación para mejorar la eficacia de los futuros programas para los cuidadores de los pacientes con TLP y ayudar a reducir su carga.

Tratamiento del trastorno por déficit de atención con hiperactividad en la práctica clínica habitual: Estudio retrospectivo / Treatment of attention-deficit/hyperactivity disorder in clinical practice. A retrospective study

El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo, de carácter crónico, de etiología multifactorial, principalmente debida a factores genéticos y ambientales. Realizamos un estudio analítico retrospectivo del tratamiento de niños diagnosticados de TDAH. Se estudió una muestra de 82 niños diagnosticados de TDAH (74.4% niños y 25.6% niñas). El 96.3% de los casos presentaba algún trastorno asociado. El tratamiento farmacológico fue el tratamiento de elección (90.2%). El 46.0% recibía metilfenidato de liberación inmediata, un 51.4% metilfenidato de liberación sostenida y la atomoxetina solo se recetó en un 2.7% de los casos. El 20.3% de la muestra abandonó en algún momento el tratamiento farmacológico. El tratamiento farmacológico fue la opción más utilizada en nuestra muestra, y el metilfenidato de liberación inmediata el fármaco de elección para inicio del tratamiento. Se utilizan poco las alternativas a los estimulantes. No se encontraron diferencias significativas entre el tipo de tratamiento y el subtipo de TDAH o el género, aunque sí en cuanto a la edad de inicio del tratamiento.

Attention deficit hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disorder, of a chronic nature, of multifactorial etiology, mainly due to genetic and environmental factors. We conducted a retrospective analytical study of the t herapeutic management of children diagnosed with ADHD. A sample of 82 children diagnosed with ADHD (74.4% children and 25.6% girls) was studied. 96.3% of the cases presented some associated disorder. Pharmacological treatment was the treatment of choice (90.2%). 46.0% received immediate release methylphenidate, 51.4% sustained release methylphenidate and atomoxetine was only prescribed in 2.7% of patients. 20.3% of the sample abandoned pharmacological treatment at some point. Pharmacological treatment was the most frequent option in our sample, and methylphenidate immediate release the drug of choice for treatment initiation. The alternatives to stimulants are used in very low percentage of the patient. No significant differences were found between the type of treatment regarding the subtype of ADHD or gender, but we found significant difference in relation with the age of onset of treatment.

Elementos relevantes en la intervención terapéutica de jóvenes que cometen infracciones sexuales: la percepción de adolescentes chilenos egresados de un programa especializado / Relevant elements in the therapeutic intervention of young people who have committed sexual offences: perception of the Chilean adolescents emerging from a specialized program / Elementos relevantes na intervenção terapêutica de jovens que cometem infrações sexuais: a percepção de adolescentes chilenos egressos de um programa especializado

Resumen El objetivo de la investigación es estudiar la percepción de jóvenes chilenos egresados de un programa dirigido a adolescentes que cometen actos sexualmente abusivos. En el estudio se aplicó una metodología de tipo cualitativa, utilizando como instrumentos de producción de información la entrevista semi-estructurada y la revisión documental de fichas clínicas. El análisis se realizó mediante la técnica de la Teoría Fundamentada. Los resultados alcanzados apuntan a la importancia en la especialización de las metodologías y técnicas aplicadas, tanto en la evaluación diagnóstica como en el proceso terapéutico. Se observó también la relevancia que tiene la figura del terapeuta como elemento facilitador del éxito en la intervención, y la imperativa necesidad de perfeccionamiento en las técnicas para abordar los contenidos asociados al reconocimiento y responsabilización del hecho abusivo. Finalmente, se concluye la necesidad de mayor investigación sobre las distintas trayectorias de adolescentes que cometen delitos sexuales, a modo de generar terapias con mayor nivel de especialización.

Abstract The objective of this investigation is to study the perception of young Chilean people; they are emerging from a program addressed to adolescents who have committed sexually abusive acts. This study implements a qualitative methodology; semi-structured interview and medical records document review were used as information production instruments. The analysis was conducted by means of the grounded theory technique. The achieved results point to the importance in the specialization of methodologies and applied techniques, in both the diagnostic evaluation and the therapeutic process. It was observed the relevance of the therapist figure as a facilitator element of the success in the intervention; and also the imperious necessity of enhancing the techniques to approach the contents associated with the recognition and accountability of the abusive act. Finally, this concludes that further research is required with regard to the different trajectories of adolescents who have committed sexual offences, so therapies with a higher level of specialization to be generated.

Resumo O objetivo da pesquisa é analisar a percepção dos jovens chilenos egressos de um programa dirigido a adolescentes que cometem atos sexualmente abusivos. No estudo foi utilizada uma metodologia qualitativa, usando como instrumentos para a coleta de dados a entrevista semiestruturada e a revisão documental de fichas clínicas. A análise realizou-se por meio da técnica de teoria fundamentada. Os resultados obtidos apontam a importância da especialização das metodologias e técnicas aplicadas, tanto na avaliação diagnóstica quanto no processo terapêutico. Observaram-se também a relevância da figura do terapeuta como facilitador para o sucesso da intervenção e a imperativa necessidade de aperfeiçoamento das técnicas para a abordagem dos conteúdos associados ao reconhecimento e responsabilização do ato abusivo. Finalmente, concluise que é necessária uma pesquisa mais ampla acerca das distintas trajetórias de adolescentes que cometem delitos sexuais, de modo que sejam fomentadas terapias com maior nível de especialização.

Effective therapies for the treatment of complex posttraumatic stress disorder: A qualitative systematic review / Terapias eficaces para el tratamiento de estrés postraumático complejo: Una revisión sistemática cualitativa

Abstract: Background: Current literature shows that posttraumatic stress disorder and complex posttraumatic stress disorder symptoms differ. Although the psychological treatments available for posttraumatic disorder are well established, little is known about the effectiveness of those aimed at the treatment of complex posttraumatic stress. Objective: To evaluate the efficacy of psychological treatments for complex posttraumatic stress disorder. Method: A systematic qualitative search was conducted according to PRISMA guidelines, searching four psychological and health electronic databases: Medline, Pilots, PsycINFO, and Pubmed. Three reviewers independently selected the studies in two phases: preselection (criteria for complex posttraumatic stress disorder, replicable psychological treatment, and treatment effect) and selection (additional criteria: type of study, participants, and treatment). Results: Of the 615 studies reviewed, 25 were preselected, eight of which met the inclusion and methodological quality criteria. Five studies explored adult populations (with one exception, all were randomized clinical trials) and three child populations (clinical studies with pre- post-treatment design, with and without control group). Most studies with adult populations included psychoeducation, cognitive restructuration, and exposure therapy. The studies with child samples included EMDR and mindfulness as the most frequent treatment components. Discussion and conclusion: The evidence was insufficient to determine the most effective treatment. More research on this issue is required.

Resumen: Antecedentes: La literatura actual muestra una diferenciación entre los síntomas de trastorno por estrés postraumático y estrés postraumático complejo (TEPTC). Si bien los tratamientos psicológicos para el primer tipo de sintomatología están claramente establecidos, son menos conocidas las intervenciones para el TEPTC. Objetivo. Evaluar la eficacia de las terapias psicológicas para reducir los síntomas del TEPTC. Método: Se realizó una revisión sistemática cualitativa basada en la guía de publicación PRISMA. Se usaron cuatro bases de datos: Medline, Pilots, Psycinfo y Pubmed. Con base en criterios previamente definidos, tres revisores independientes eligieron los trabajos en dos fases: preselección (criterios para TEPTC, tratamiento psicológico replicable, datos sobre efectos) y selección (considerando tres criterios adicionales: tipo de estudio, de participantes y de intervención). Resultados: De los 615 encontrados, se preseleccionó un total de 25 artículos para revisión de texto completo, de los cuales se seleccionaron un total de ocho. Cinco trabajos incluyeron población adulta (a excepción de un estudio, todos eran ensayos clínicos controlados aleatorizados) y el resto infantil (diseño pre-post-tratamiento, con o sin grupo control). Mayoritariamente, los componentes de los tratamientos para adultos fueron: psicoeducación, reestructuración cognitiva y exposición. Los estudios con muestras infantiles incluyeron técnicas más heterogéneas, si bien el uso del EMDR y mindfulness fueron comunes a dos de las intervenciones. Discusión y conclusión: Dada la escasez de estudios encontrados y los problemas de control metodológico, no es posible destacar un tratamiento de elección para el TEPCT con eficacia superior al resto. Se requiere de más investigación en este ámbito.

Current psychological therapeutic approaches for gambling disorder with psychiatric comorbidities: A narrative review / Tratamientos psicológicos actuales para el trastorno del juego c on comorbilidad psiquiátrica: una revisión narrativa

Abstract: Background: Although the presence of a gambling disorder (GD) together with another mental disorder poses special treatment challenges, such as relapses, severe outcomes for patients and families, and increased number of hospitalizations, there are only a few critical reviews in the literature. Objective: To review empirical evidence of psychological approaches to cope specifically with these dual disorders. Method: A narrative review of the relevant bibliography on this topic was carried out. A systematic search of original articles (2010-October 2017) was conducted in MEDLINE and PsycInfo. Key terms were: 1. gambling/gamblers, 2. treatment/intervention/therapy/therapeutics, and 3. dual diagnosis/comorbidity. Results: Current treatment for GD involves a number of different options, including inpatient treatments, intensive outpatient therapy, individual and group cognitive-behavioral options (CBT), self-help groups, and pharmacotherapy. Inpatient care is generally limited to patients with severe acute crises, treatment failures, and severe comorbid disorders, particularly depression and attempted suicide. Treatment for GD with other mental disorder needs more research. CBT, motivational enhancement therapy and self-help groups have some empirical support when GD is comorbid with other addiction, mood disorder, or schizophrenia. Programs that combine pharmacotherapy and psychosocial treatments for GD into a single comprehensive package are most likely to have good treatment outcomes, at least with regard to treatment retention. Discussion and conclusion: Interventions should be tailored to the needs of the patients. Future research should be concerned about the statistical power of the studies, implement motivational strategies for patients with poor medication adherence, and design measures to study treatment fidelity in the CBT groups.

Resumen: Antecedentes: La presencia comórbida del juego patológico (JP) con otro trastorno mental plantea diversos desafíos al tratamiento, como las recaídas, las repercusiones negativas para los pacientes y sus familias y un mayor número de hospitalizaciones. Objetivo: Revisar la evidencia empírica existente sobre el papel que cumplen las terapias psicológicas en el tratamiento de estos trastornos duales. Método: Se realizó una revisión narrativa de la bibliografía relevante sobre este tema. Se llevó a cabo una búsqueda sistemática de artículos originales (2010-octubre 2017) en MEDLINE y PsycInfo con las palabras clave: 1. gambling or gamblers, 2. Treatment, intervention, therapy or therapeutics, y 3. dual diagnosis or comorbidity. Resultados: Hay diversas terapias para el JP: tratamiento hospitalario, terapia intensiva ambulatoria, terapia cognitivo-conductual (TCC) individual y en grupo, Jugadores Anónimos y farmacoterapia. La hospitalización se limita a los pacientes con una crisis aguda, fracasos terapéuticos previos y trastornos comórbidos graves, como la depresión y los intentos de suicidio. El tratamiento para el JP comórbido con otro trastorno (depresión, abuso de sustancias o esquizofrenia) requiere más investigación. Las terapias más efectivas en estos casos son al parecer la TCC, la entrevista motivacional y los grupos de autoayuda. Los programas que combinan farmacoterapia con tratamientos psicológicos parecen aumentar la retención del tratamiento. Discusión y conclusión: La intervención debe adaptarse a las necesidades específicas de cada paciente y la investigación debe mejorar las estrategias motivacionales cuando los pacientes muestran una deficiente adherencia a la medicación, así como diseñar medidas para mejorar la fidelidad al tratamiento psicológico.

Hombres violentos contra la pareja: ¿tienen un trastorno mental y requieren tratamiento psicológico? / Male batterers: are they mentally ill and are they needed of psychological treatment?

Hay muchas razones por las que los hombres maltratadores contra la pareja deben recibir tratamiento psicológico. En este artículo se analizan los transtornos más relevantes, tales como el abuso de alcohol/drogas, los celos patológicos y los transtornos de personalidad (antisocial, límite, narcisista y paranoide), así como los déficits psicológicos de estas personas, tales como el descontrol de la ira, las dificultades emocionales, las distorsiones cognitivas, la baja autoestima y los déficits de comunicación y de solución de problemas. Se describen las tipologías de hombres maltratadores más relevantes y se señala su importancia para la planificación del tratamiento individualizado. La inclusión de medidas penales y de tratamiento psicológico es posible. Se analiza la motivación para el tratamiento y se señalan las principales vías de intervención terapéutica, así como los resultados obtenidos. Por último, se comentan las líneas de investigación más urgentes para el futuro.

There are many reasons why men who batter should be psychologically treated. In this paper the most relevant mental disorders, such as substance use disorder, pathological jealousy, and antisocial, borderline, narcissistic and paranoid personality disorders, and psychological deficits of batterer men, such as anger, emotional difficulties, cognitive distortions, low self-esteem and deficits in social skills and problem solving, are analyzed. Male domestic violence offender typologies according to the most relevant classifications are commented. The role of these typologies for treatment is pointed out. An analysis of how to combine court intervention and psychological treatment to rehabilitate abusive men is also carried out. Motivational enhancement strategies and effective therapy for men who batter are discussed. Finally, the future perspectives and the most relevant goals of research are commented on.

Orientação psicológica on-line: percepção dos profissionais sobre a relação com os clientes / Online psychological counseling: the perception of professionals about the relationship with clients / Orientación psicológica online: percepción de los profesionales sobre la relación con los clientes

Os atendimentos psicológicos pela internet são uma prática recente, que vem recebendo crescente atenção de profissionais e pesquisadores. Há poucos estudos sobre o tema no Brasil, sendo necessário investigá-lo e compreendê-lo. A resolução 012/2005 do Conselho Federal de Psicologia regulamenta os serviços psicológicos mediados por computador, entre os quais destaca-se a orientação psicológica on-line. O presente estudo, de delineamento qualitativo e exploratório, teve por objetivo investigar a percepção dos profissionais acerca da orientação psicológica on-line, com foco na relação estabelecida com os clientes. Participaram da pesquisa quatro profissionais, homens e mulheres, com diferentes idades, práticas e tempo de atuação profissional. Para coleta dos dados foram utilizadas entrevistas on-line individuais semiestruturadas. Os participantes foram selecionados a partir de sites de atendimento on-line regulamentados pelo CFP. A análise dos dados foi feita através da análise de conteúdo de Bardin. Em relação aos resultados, foi possível perceber que essa prática possui limites e potencialidades. Conclui-se que o vínculo estabelecido nessa relação é diferenciado, mas possibilita a realização dos objetivos do atendimento e o acolhimento do cliente. Os atendimentos pela internet constituem uma prática nova, que necessita ser estudada, a fim de gerar maior entendimento e esclarecimento na área, para profissionais e clientes...

Psychological online treatments are a recent practice which has been receiving growing attention from professionals and researchers. There are few studies on this subject in Brazil, and further investigation to better understand it is needed. Resolution 012/2005 of the Federal Council of Psychology regularizes the computer-mediated psychological services, among which online counseling is highlighted. Using a qualitative and exploratory design, the present study aimed to investigate the perception of professionals about online counseling, focusing on the relationship established with clients. Four professionals, men and women, of different ages, practices and time of professional exercise were interviewed. Semi-structured online individual interviews were used for data collection. Participants were chosen from regularized sites registered at the Federal Council of Psychology. Content analysis of Bardin was carried out for data analysis. Regarding the study results, it was possible to observe that this practice presents both limits and potentialities. We concluded that the bond established in this relationship is different from that observed in regular clinical practice, but it allows for achievement of treatment goals and fulfillment of clients' expectancies. Online treatments constitute a new practice which needs to be studied in order to generate greater understanding and enlightenment to the area, representing benefits for both professionals and clients...

Los tratamientos psicológicos por Internet son una práctica reciente, que ha sido objeto de una atención cada vez mayor por parte de profesionales e investigadores. Existen pocos estudios sobre este tema en Brasil, por lo tanto es necesario investigarlo y comprenderlo. Por Resolución 012/2005 del Consejo Federal de Psicología se regulan los servicios psicológicos mediados por ordenador, entre los que destaca el asesoramiento psicológico online. El presente estudio, de diseño cualitativo y exploratorio, tuvo como objetivo investigar las percepciones de los profesionales sobre el asesoramiento psicológico online, centrándose en la relación establecida con los clientes. Los participantes fueron cuatro profesionales, hombres y mujeres, de diferentes edades, prácticas y tiempo de actuación profesional. Para la recolección de datos, se usaron entrevistas individuales online, semi-estructuradas. Los participantes fueron seleccionados de entre sites de tratamiento online regulados por el Consejo Federal de Psicología. El análisis de datos se realizó mediante análisis de contenido de Bardin. En cuanto a los resultados, se reveló que esta práctica tiene límites y potencialidades. Se concluye que el vínculo que se establece en esta relación es diferente, pero permite la realización de los objetivos del tratamiento y la acogida del cliente. Los tratamientos por Internet son una nueva práctica, que debe ser estudiada con el fin de generar un mayor entendimiento y aclaración en el área de conocimiento, para profesionales y clientes...

Orientação psicológica on-line: percepção dos profissionais sobre a relação com os clientes / Online psychological counseling: the perception of professionals about the relationship with clients / Orientación psicológica online: percepción de los profesionales sobre la relación con los clientes

Os atendimentos psicológicos pela internet são uma prática recente, que vem recebendo crescente atenção de profissionais e pesquisadores. Há poucos estudos sobre o tema no Brasil, sendo necessário investigá-lo e compreendê-lo. A resolução 012/2005 do Conselho Federal de Psicologia regulamenta os serviços psicológicos mediados por computador, entre os quais destaca-se a orientação psicológica on-line. O presente estudo, de delineamento qualitativo e exploratório, teve por objetivo investigar a percepção dos profissionais acerca da orientação psicológica on-line, com foco na relação estabelecida com os clientes. Participaram da pesquisa quatro profissionais, homens e mulheres, com diferentes idades, práticas e tempo de atuação profissional. Para coleta dos dados foram utilizadas entrevistas on-line individuais semiestruturadas. Os participantes foram selecionados a partir de sites de atendimento on-line regulamentados pelo CFP. A análise dos dados foi feita através da análise de conteúdo de Bardin. Em relação aos resultados, foi possível perceber que essa prática possui limites e potencialidades. Conclui-se que o vínculo estabelecido nessa relação é diferenciado, mas possibilita a realização dos objetivos do atendimento e o acolhimento do cliente. Os atendimentos pela internet constituem uma prática nova, que necessita ser estudada, a fim de gerar maior entendimento e esclarecimento na área, para profissionais e clientes.(AU)

Psychological online treatments are a recent practice which has been receiving growing attention from professionals and researchers. There are few studies on this subject in Brazil, and further investigation to better understand it is needed. Resolution 012/2005 of the Federal Council of Psychology regularizes the computer-mediated psychological services, among which online counseling is highlighted. Using a qualitative and exploratory design, the present study aimed to investigate the perception of professionals about online counseling, focusing on the relationship established with clients. Four professionals, men and women, of different ages, practices and time of professional exercise were interviewed. Semi-structured online individual interviews were used for data collection. Participants were chosen from regularized sites registered at the Federal Council of Psychology. Content analysis of Bardin was carried out for data analysis. Regarding the study results, it was possible to observe that this practice presents both limits and potentialities. We concluded that the bond established in this relationship is different from that observed in regular clinical practice, but it allows for achievement of treatment goals and fulfillment of clients' expectancies. Online treatments constitute a new practice which needs to be studied in order to generate greater understanding and enlightenment to the area, representing benefits for both professionals and clients.(AU)

Los tratamientos psicológicos por Internet son una práctica reciente, que ha sido objeto de una atención cada vez mayor por parte de profesionales e investigadores. Existen pocos estudios sobre este tema en Brasil, por lo tanto es necesario investigarlo y comprenderlo. Por Resolución 012/2005 del Consejo Federal de Psicología se regulan los servicios psicológicos mediados por ordenador, entre los que destaca el asesoramiento psicológico online. El presente estudio, de diseño cualitativo y exploratorio, tuvo como objetivo investigar las percepciones de los profesionales sobre el asesoramiento psicológico online, centrándose en la relación establecida con los clientes. Los participantes fueron cuatro profesionales, hombres y mujeres, de diferentes edades, prácticas y tiempo de actuación profesional. Para la recolección de datos, se usaron entrevistas individuales online, semi-estructuradas. Los participantes fueron seleccionados de entre sites de tratamiento online regulados por el Consejo Federal de Psicología. El análisis de datos se realizó mediante análisis de contenido de Bardin. En cuanto a los resultados, se reveló que esta práctica tiene límites y potencialidades. Se concluye que el vínculo que se establece en esta relación es diferente, pero permite la realización de los objetivos del tratamiento y la acogida del cliente. Los tratamientos por Internet son una nueva práctica, que debe ser estudiada con el fin de generar un mayor entendimiento y aclaración en el área de conocimiento, para profesionales y clientes. .(AU)

[Clinical Psychology in Primary Care: A Descriptive Study of One Year of Operation]. / Psicología Clínica en Atención Primaria: descripción de un año de asistencia.

OBJECTIVE: Our aim is to present the first year of operation of a Clinical Psychology service in a Primary Care setting. MATERIAL AND METHOD: A descriptive study was performed by analysing the requests and the care intervention of the Psychology Service, in collaboration with 36 general practitioners (33% of the staff), belonging to 6 health centres. Within the one year period, 171 outpatients from 15 years and older were referred with mild psychological disorders (> 61 in the global assessment functioning scale, APA, 2002). RESULTS: A total of 111 outpatients received psychological care. The main diagnoses were adaptation disorder, affective disorder, and anxiety. More than half (54.82%) of them achieved a full recovery. After a year follow up, a drop of 25.19% was observed in medicines use. CONCLUSIONS: The Primary Care Psychology team is a halfway unit between Primary Care practitioners and specialised units in order to deal with mild mental symptomatology which otherwise could be undertreated. It represents an important support for practitioners. Secondly, the early intervention can prevent mental problems becoming chronic, as shown by the drop in medication use. In spite of the not very high agreement between the practitioner's diagnoses and those made by the Psychology unit, it has set up an important means of communication and with direct and immediate interdisciplinary action. This should eventually lead to savings in economic resources and human suffering.

Nuevos retos en el tratamiento del juego patológico / New challenges in the treatment of disordered gambling

En este artículo se señalan los avances y retos de futuro en el tratamiento del juego patológico. El objetivo terapéutico (abstinencia o juego moderado) es actualmente objeto de controversia. Los tratamientos para la ludopatía incluyen la terapia hospitalaria, los tratamientos cognitivo-conductuales individuales o grupales, Jugadores Anónimos y la farmacoterapia, así como la prevención de recaídas. La terapia cognitivo-conductual presenta unas tasas de éxito del 50 por ciento al 80 por ciento de los casos tratados en un seguimiento a largo plazo. La farmacoterapia es un complemento cuando los pacientes tienen un estado de ánimo deprimido o un elevado nivel de impulsividad. El juego controlado puede ser una alternativa terapéutica para los jugadores jóvenes o que no presentan aún una dependencia severa. Se requiere más información sobre el tratamiento del juego on-line y de poblaciones específicas (mujeres y jóvenes). Se comentan las implicaciones de esta revisión para la práctica clínica y para las investigaciones futuras.

This paper deals with the new developments in the treatment of disordered gambling, as well as with the challenges for further research. Abstinence versus moderated gambling is an issue that raises many concerns and that needs to be addressed. Current treatment for disordered gambling involves a number of different options, including inpatient treatments, individual and group cognitive-behavioral options, Gamblers Anonymous and pharmacotherapy, as well as an intervention in relapse prevention. Cognitive-behavioral therapy may have asuccess rate ranging from 50 percent to 80 percent of treated patients in a long-term follow-up. Psychopharmacological therapy may have incremental benefit when patients have comorbid depression or high impulsivity. Responsible gambling may be a therapeutic option for young gamblers or people without a severe dependence. Further information is required about treatment for online gambling addictions and for dealing with specific populations (women and young people). Unanswered questions for future research in this field are commented upon.