Relación entre discurso desorganizado, funciones cognitivas y funcionamiento social en personas con esquizofrenia / Relationship between disorganized speech, cognitive functions and social functioning in people with schizophrenia

La esquizofrenia comprende un gran abanico de disfunciones cognitivas, conductuales y emocionales; entre otras dificultades las personas con esquizofrenia muestran discurso desorganizado, también llamado trastorno formal del pensamiento o trastorno del discurso. El objetivo de este trabajo consiste en analizar y encontrar asociaciones entre el discurso desorganizado, la atención, la alteración cognitiva, y la relación que tienen con la gravedad y la funcionalidad social y adaptativa de los pacientes con esquizofrenia de evolución crónica que residen en una institución. Se utilizó un diseño descriptivo correlacional y explicativo para la investigación, con 71 pacientes diagnosticados de esquizofrenia crónica con diferentes escalas clínicas, escalas de evaluación cognitivas y escalas de funcionamiento social. Los resultados muestran que las personas con esquizofrenia tienen dificultades en todas las áreas evaluadas. Se observa que el habla desconectada o desorganizada correlaciona de manera positiva con la función cognitiva, la gravedad clínica y el funcionamiento social. Como conclusión, se observan una serie de asociaciones entre estas variables y es necesario tenerlas en cuenta para realizar una correcta intervención con esta población. (AU)

People with schizophrenia exhibit a wide range of cognitive, behavioral, and emotional dysfunctions; among other difficulties, people with schizophrenia show disorganized speech, also called formal thought disorder or discourse disorder. The aim of this work is to analyze and find associations between disorganized speech, attention, cognitive impairment, and their relationship with the severity and social and adaptive functioning of patients with schizophrenia of chronic evolution living in an institution. A descriptive correlational and quantitative explanatory design is carried out with 71 patients diagnosed with chronic schizophrenia with different clinical scales, cognitive assessment scales and social functioning scales. The results show that people with schizophrenia have difficulties in all the areas assessed. Disconnected or disorganized speech is found to correlate positively with cognitive function, clinical severity, and social functioning. In conclusion, several associations between these variables are observed and need to be considered for proper intervention with this population. (AU)

Clinical symptoms and social functioning in schizophrenia.

INTRODUCTION: The aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms. MATERIAL AND METHODS: A cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S). RESULTS: SOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05-0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms. CONCLUSIONS: Our findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community.

Clinical symptoms and social functioning in schizophrenia / Síntomas clínicos y funcionamiento social en la esquizofrenia

Introduction: The aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms. Material and methods: A cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S). Results: SOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05–0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms. Conclusions: Our findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community. (AU)

Introducción: El objetivo del presente estudio fue evaluar la relación entre el funcionamiento social y los síntomas en las personas esquizofrénicas, analizando la influencia del funcionamiento social global y los aspectos específicos del funcionamiento social, la asertividad y las competencias de comunicación en la explicación del tipo de síntomas. Material y métodos: Se realizó un estudio descriptivo transversal integrado por 125 personas con diagnóstico de esquizofrenia. Se evaluó a los pacientes utilizando Communication Skills Questionnaire (CSQ), Gambrill and Richey Assertiveness Inventory (GR), Global Assessment of Functioning Scale (GAF) y Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale y Clinical Global Impression scale for Schizophrenia (CGI-S). Resultados: SOFAS, LSP y GR están relacionadas con cada una de las sub-escalas y puntuaciones totales de los síntomas (p<0,05-0,001). Las regresiones múltiples muestran que SOFAS y GR justifican el 59% de los síntomas totales. SOFAS y GR, que representan el 65% de la varianza, explican los síntomas positivos. GR y SOFAS justificaron el 34% de la varianza de síntomas negativos. SOFAS, CSQ y LSP, que representaron el 20% de la varianza, justificaron los síntomas depresivos. SOFAS justificó el 46% de la varianza de los síntomas cognitivos. Conclusiones: Nuestros hallazgos sugieren la utilidad de la evaluación del funcionamiento social para explicar los síntomas clínicos de las personas esquizofrénicas. Además, nuestros resultados apuntan que, no solo deberían considerarse en el proceso de rehabilitación los síntomas negativos y cognitivos, sino también los síntomas positivos y depresivos, a fin de mejorar la adaptación del paciente dentro de la comunidad. (AU)

Las dimensiones del apego predicenel funcionamiento social en personascon trastornos del espectro de laesquizofrenia, independientemente dela gravedad de los síntomas / Attachment Dimensions predict Social Functioning in persons with Schizophrenia-Spectrum Disorders, regardless of Symptom Severity

Introducción: Los patrones de apego y las adversidadesen la infancia son relevantes para entender la vulnerabilidady desarrollo de la psicosis. El primer objetivo del estudio fueprobar si una medida dimensional del apego, el CAMIR, puede diferenciar los estilos de apego comparando un grupo depacientes psicóticos con una muestra no clínica. Hipotetizamos que las dimensiones del apego predecirían el Funcionamiento Social (FS) dentro del grupo clínico.Método. 79 personas fueron evaluadas con la versiónespañola reducida (CAMIR-R). El alfa de Cronbach se utilizó para probar su fiabilidad. Se realizaron pruebas t paraevaluar diferencias entre grupos. Se ejecutaron múltiples regresiones lineales y análisis de mediación para explorar losposibles predictores del FS.Resultados. Se encontró mayor apego inseguro en elgrupo clínico (73.8% versus 33.3%). Las dimensiones delapego diferenciaron ambas muestras con grandes tamaños del efecto. La psicopatología y la interferencia parental pronosticaron el FS general (R2 = 0.30; p < 0.05) y lapreocupación familiar predijo mayor aislamiento social (R2= 0.19; p = 0.02) y peor situación ocupacional (R2 = 0.45;p < 0.01). Permisividad parental y traumatismo infantilpredijeron peor nivel educativo (R2 = 0.31; p < 0.05). Losanálisis de mediación revelaron un efecto directo de lasdimensiones del apego sobre el FS, independientementede los síntomas.Conclusiones. El CAMIR-R resultó fiable para evaluar el apego en psicosis. Las personas con trastornos psicóticos muestranimportantes déficits en FS y mayor prevalencia de apego inseguro. Varias dimensiones del apego predicen áreas específicas del FS, independientemente de la gravedad de los síntomas. (AU)

Introduction: Attachment patterns and early-lifeadversities are relevant to understand the role of psychosocialfactors in the vulnerability and the development ofpsychosis. The first aim of the study was to test whethera dimensional attachment instrument, the CAMIR (fromFrench; Cartes: Modèles Individuels de Relation), maydifferentiate attachment styles by comparing a group ofpsychotic patients with a non-clinical sample. Also, wehypothesised that attachment dimensions would predictSocial Functioning (SF) within the clinical group.Methods. Seventy-nine persons were assessed by thereduced Spanish version (CAMIR-R). We used Cronbach’ alphato test reliability. A t-test was performed to assess differencesbetween groups. Multiple linear regressions and Mediationanalyses were conducted within the clinical group to exploreattachment dimensions as possible predictors of SF.Results. A more insecure attachment was found in theclinical group (73.8% versus 33.3%). Attachment dimensionsdifferentiated between both samples with large effect sizes.Psychopathology and parental interference predicted generalSF (R² = 0.30; p < 0.05) as family concern predicted moresocial isolation (R² = 0.19; p = 0.02) and worse employmentstatus (R² = 0.45; p < 0.01). Parental permissiveness and child traumatism inversely predicted educational level (R² = 0.31;p < 0.05). Mediation analyses revealed that attachmentdimensions were linked to SF regardless of symptoms.Conclusions. CAMIR-R was reliable to assess attachmentin psychosis. Persons with schizophrenia-spectrum disordersshow a significant impaired SF and a higher prevalence ofinsecure attachment. Several attachment dimensions predictspecific areas of SF, regardless of symptom severity. (AU)

Clinical symptoms and social functioning in schizophrenia.

INTRODUCTION: The aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms. MATERIAL AND METHODS: A cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S). RESULTS: SOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05-0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms. CONCLUSIONS: Our findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community.

Funcionamiento social y cognitivo en pacientes con esquizofrenia / Social and cognitive functioning in patients with schizophrenia

La presente investigación corresponde a un estudio no experimental, transversal y correlacional, cuyo objetivo fue identificar si existe relación entre funcionamiento social (FS) y cognitivo (FC) en pacientes con esquizofrenia, mediante la evaluación del funcionamiento social (SFS) y deterioro cognitivo (MoCA y SCIP-S) en una muestra de 12 pacientes (11 hombres y 1 mujer) entre los 22 y 70 años, de Medellín (Colombia), mediante muestreo no probabilístico por conveniencia. Se encontró que más de la mitad (n = 7) presenta un nivel superior de FS y casi el total de la muestra presenta deterioro cognitivo. Al correlacionar FS y FC se encontró que sólo SFS y MoCA se relacionan significativamente, mientras que la SCIP-S no presenta relación con SFS ni con MoCA. Aunque estos hallazgos no pueden ser concluyentes ni generalizables debido a limitaciones metodológicas, pueden ser usados como antecedente para futuros estudios.

A non-experimental, cross-sectional and correlational study was made, whose objective was to identify if there is a relationship between social functioning (SF) and cognitive functioning (CF) in patients with schizophrenia, through the evaluation of social functioning (SFS) and cognitive impairment (MoCA and SCIPS) in a sample of 12 patients (11 men and 1 woman) between 22 and 70 years old, from Medellín (Colombia), selected by non-probabilistic sampling for convenience. It was found that more than half of the participants (n = 7) present a higher level of SF and almost the total of the sample presents cognitive impairment. When correlating SF and CF it was found that only SFS and MoCA are significantly related, whereas SCIP-S has no relation with SFS or with MoCA. Although these findings cannot be conclusive or generalizable due to methodological limitations, they can be used as a background for future studies.

Effectiveness of behavioral family therapy in people with schizophrenia: a randomized, controlled clinical trial / Efectividad de la terapia familiar conductual en personas con esquizofrenia. Un ensayo clínico controlado aleatorizado

Abstract Objective To evaluate the effectiveness of FBT in comparison with usual care in people with schizophrenia treated at an outpatient psychiatric department of a public hospital in Chile. Method Quantitative study, with a randomized, controlled clinical trial design (CTCT) and pre-post measurements, with two arms. Fifty-four people with schizophrenia and their primary caregivers, randomly assigned to experimental and control groups, were studied. The main outcome variable was social functioning. As secondary outcomes, clinical symptoms and treatment adherence in people with schizophrenia were evaluated. Expressed emotion was evaluated in the primary caregiver. Results FBT was effective in improving the social functioning of people with schizophrenia and decreasing expressed emotion in the primary caregiver, with a large effect size (d > 0.80). Conclusions The implementation of FBT as a protocolized intervention, complementing usual care, helps to improve psychosocial outcomes in people with schizophrenia and their caregivers.

Resumen Objetivo Evaluar la efectividad de la TFC, respecto de los cuidados usuales, en personas con esquizofrenia atendidas en un servicio de psiquiatría ambulatorio de un hospital público de Chile. Método Estudio cuantitativo, longitudinal, con diseño de ensayo clínico controlado aleatorizado (ECCA) y mediciones pre-post, a dos brazos. Se estudiaron 54 personas con esquizofrenia y sus cuidadores principales, asignados aleatoriamente a grupo control y experimental. La variable de resultado primaria fue el funcionamiento social; como resultados secundarios se evaluaron la sintomatología clínica y la adherencia a tratamiento del paciente y la emoción expresada en el cuidador principal. Resultados La TFC fue efectiva en el mejoramiento del funcionamiento social de la persona con esquizofrenia y en la disminución de la emocionalidad expresada en el cuidador principal, con un tamaño de efecto grande (d > 0.80). Conclusiones La implementación de la TFC, como intervención protocolizada y complementaria a los cuidados usuales, contribuye a mejorar resultados psicosociales en personas con esquizofrenia y en sus cuidadores.

Características clínicas de mujeres con depresión mayor que sufrieron abuso sexual en la infancia.

INTRODUCCIÓN: Aunque el abuso sexual en la infancia (ASI) es un factor de riesgo para desarrollar depresión mayor en la vida adulta de las mujeres, la información sobre las características clínicas asociadas con este evento es escasa. OBJETIVO: Evaluar la historia de ASI y su asociación con algunas manifestaciones clínicas en mujeres con depresión mayor. MÉTODO: Se seleccionaron 71 mujeres adultas con depresión mayor en un centro comunitario de salud mental. Fueron evaluadas con Mini Entrevista Neuropsiquiátrica Internacional, Inventario de Depresión de Beck, Escala de Autoevaluación de Adaptación Social, Índice de Maltrato Físico e Índice de Abuso Sexual en la Infancia. RESULTADOS: 53.5 % había sufrido alguna forma de ASI. No hubo diferencias significativas en edad, escolaridad, sintomatología depresiva, adaptación social o maltrato físico en la infancia entre las mujeres con y sin historia de ASI, solo mayor frecuencia de comorbilidad con el trastorno por ansiedad social (26 versus 6 %) y mayor proporción de riesgo suicida (68 versus 45.4 %) distinguió a los grupos. CONCLUSIÓN: Pocas características distinguen a las mujeres con depresión mayor con historia de ASI, sin embargo, el pronóstico y las implicaciones terapéuticas del mayor riesgo suicida subrayan la importancia de investigar sistemáticamente la historia de ASI entre las mujeres con depresión mayor. INTRODUCTION: Even when child sexual abuse (CSA) is a risk factor for the development of major depression in adult women, data on the clinical features associated with this traumatic event are scarce. OBJECTIVE: To assess the history of CSA and its association with some clinical manifestations in women with major depression. METHOD: Seventy-one adult women with major depression were selected in a community-based mental health center. They were assessed with the Mini International Neuropsychiatric Interview, the Beck Depression Inventory, the Social Adaptation Self-evaluation Scale, and childhood physical maltreatment and child sexual abuse indices. RESULTS: Some form of CSA had been suffered by 53.5%. There were no significant differences in age, level of education, depressive symptoms, social adaptation or physical maltreatment during childhood between the women with or without a history of CSA, only a higher frequency of comorbid social anxiety disorder (26% versus 6%) and a higher proportion of suicide risk (68% versus 45.4%) differentiated the groups. CONCLUSION: Few characteristics distinguish women with major depression with a history of CSA; however, the prognosis and therapeutic implications of a higher suicide risk underscore the importance of systematically investigating the history of CSA among women with major depression.

Relación entre la emoción expresada por el familiar responsable y la conducta sintomática de pacientes con esquizofrenia, incluido el funcionamiento social / Relationship between expressed emotion of the relative in charge and symptomatic behavior and social functioning of patients with schizophrenia

In the 1950's, several authors carried out a series of studies focusing on the course of schizophrenia rather than its etiology. They found a link between the living conditions to which patients returned after being discharged from the hospital, and their risk of relapse. A higher risk was observed in those patients that returned to their conjugal or parental home, compared to those who returned to other living conditions. This line of work that explored stressful family mechanisms coined a term known as expressed emotion (EE) -high and low- in the family, which refers to the evaluation of the quantity and quality of attitudes and feelings such as criticism, hostility and over-involvement of a family member towards the person diagnosed with schizophrenia. These attitudes among family members have been associated with the presence of relapse in patients two years after being discharged from the hospital when family members and the patient live in the same household and are in contact 35 hours or more per week. It has been proved that these attitudes exert an influence, either increasing or decreasing the exacerbation of symptoms and, in some cases, leading to the patient's rehospitalization. Higher rates of relapse (92%) have been found in patients that spend over 35 hours a week with the relative in charge (RIC) and were not taking antipsychotic medication. It has also been found that when a RIC with high EE is in close contact with the patient, the latter is at risk of experiencing a symptom exacerbation that increases two to four times the probability of relapse. The most typical emotional expressions are critical comments, hostility, and excessive affective involvement. Criticism and over-involvement are usually perceived as stressful. Criticism implies intolerance and disapproval, whereas over-involvement suggests intrusiveness and control, and includes high levels of anxiety in the patient. Some positive aspects are also found, like the demonstration of warm feelings. a) Criticism. Includes comments and statements which due to the way that are expressed by the RIC represent unfavorable comments about the behavior or personality of the individual being referred to. In other words, it shows aversion or disapproval of a person's behavior or characteristics. b)Over-involvement. More commonly found in parents than in other relatives, it includes over-protection or consent, self-sacrifice and emotional distress. The patient is regarded as less competent and more vulnerable. c) Hostility. Generally occurs when there is criticism, which is why it is of little value as an independent predictor. Hostility occurs when the patient is attacked for what he is, rather than for what he does. The main objective of this article is to show the relationship between the level of expressed emotion (EE) (high or low) of the relative in charge with symptomatic behavior (SB) and social functioning (SF) of the patient with schizophrenia. It also includes a proposal of a conceptual model to evaluate the predictive factors of high EE. A transversal non-probabilistic study of 33 relatives of patients with schizophrenia was carried out. The relatives were contacted through the Schizophrenia Clinic in the outpatient unit at the hospital of The National Institute of Psychiatry Ramón de la Fuente in Mexico City. The instruments used were: 1. The Social Behavior Assessment Schedule (SBAS) and 2. The Questionaire for Measuring the Level of Expressed Emotion (Cuestionario-encuesta, evaluación del nivel de EE [CEEE]). The results indicated that 14 (42.4%) of the interviewed relatives had high EE and 19 (57.6%) had low EE. The main characteristics associated with high EE in RIC were: living in the same household with the patient's mean age of 54.8 years, having less than 12 years of education, being employed and not having a spouse. The most frequent expressed emotions were criticism, hostility and over-involvement. In patients, the main characteristics were: being male, young, with a mean age of 29.2 years, single and without employment alternatives, with two or more relapses and with a diagnosis of schizophrenia for five or more years. The presence of symptoms in the patient's according to relatives with low EE was 31.6% as opposed to 74.1% reported by RIC with high EE. Relatives with high EE mentioned greater personal neglect, irritability, violent behavior and isolation on the part of the patient, whereas relatives with low EE reported more fears, forgetfulness, dependence and strange ideas as problematic behaviors in the patients. The differences found between relatives with high and low EE regarding the patients' functioning were clearly demonstrated. Relatives with low EE reported better functioning in patients' performance of chores, demonstration of affect, involvement in leisure activities and better communication skills. Relatives with low EE reported that the persistence of the symptoms in their patients was 31.6%, whereas for those with high EE it was 71.4%. A logistic regression was used to identify the best predictors of EE, where the dependent variable was the total EE score, and the predictors were the continuous variables for social functioning and symptomatic behavior. A significant association was found between the two variables. Poor social functioning, symptomatic instability in the patient and being the patient's sibling explained 46% of the variance in RIC with high EE. The predictors had high levels of statistical significance. The model revealed the independent contribution of each variable and its interaction with the others. The level of family EE can be considered as the best predictor of relapse in patients with schizophrenia. Thus, EE acquires a special relevance: when high EE causes relapse, the reduction of the level of EE will lead to a decrease in relapse rates. Although the traditional means of measuring EE through the CFI has been found to be highly effective, it takes a long time to apply and classify the answers of the instrument. Another alternative is the CEEE that has been used in this study, since it has been used in other clinical trials due to the brief time required for training, application and classification of the data.

La línea de estudios que contempla los mecanismos familiares estresantes utiliza un concepto denominado Emoción Expresada (EE) en el ambiente familiar, que se refiere a la evaluación de la cantidad y calidad de las actitudes y sentimientos relacionados con la crítica, hostilidad y sobreinvolucramiento que uno de los familiares expresa acerca de uno o varios miembros de la familia diagnosticado con esquizofrenia. Estas actitudes de los familiares se han asociado con la presencia de recaídas en los pacientes a los dos años de haber sido dados de alta, especialmente cuando los miembros de la familia y el paciente conviven en el mismo espacio y pueden tener contacto por lo menos 35 horas o más semanales. Las expresiones emocionales más características comprenden: comentarios críticos, hostilidad, exceso de involucramiento afectivo y aspectos positivos como la calidez, los cuales son percibidos en general como estresantes. La crítica implica intolerancia y desaprobación, el sobreinvolucramiento sugiere intrusividad y control, que incluyen niveles altos de ansiedad en el paciente y que se describen de la siguiente manera: a) La crítica. Originalmente fue definida como aquellos comentarios o aseveraciones los cuales, por la manera en que son expresados, constituyen comentarios desfavorables sobre la conducta o personalidad del individuo a quién se refiere. Es decir, muestran aversión o desaprobación de la conducta o las características de una persona. b) El sobreinvolucramiento o sobreprotección. Se presenta más comúnmente en los padres que en algún otro familiar; está compuesta por aspectos de sobreprotección o consentimiento, autosacrificio y malestar emocional, es similar al trato que generalmente se le da a un niño sobreprotegido, con niveles inapropiados de preocupación por parte del familiar. El paciente es visto como menos competente que antes y más vulnerable. c) La hostilidad. Se presenta cuando existe crítica, por lo que tiene poco valor como predictor independiente. Se considera que está presente cuando el paciente es atacado por lo que es, más que por lo que hace, lo que refleja una dificultad para tolerar y algunas veces para comprender la situación del familiar enfermo. El propósito de este trabajo consiste en mostrar la relación entre el tipo de Emoción Expresada (EE) (tanto alta como baja) por el familiar responsable (FR), y la Conducta Sintomática (CS), así como con el Funcionamiento Social (FS) del paciente con esquizofrenia. Se plantea también un modelo conceptual para evaluar los factores predictores de la EE alta. Se utilizó un diseño transversal de una muestra no probabilística y de tipo circunstancial, la selección fue de manera secuencial, los sujetos de estudio fueron 33 familiares responsables de pacientes con esquizofrenia, que asistían a la consulta externa de la Clínica de Esquizofrenia del Instituto Nacional de Psiquiatría Ramón de la Fuente, en la Ciudad de México. Los instrumentos empleados fueron: 1. Cédula de evaluación de la conducta del paciente (SBAS) y 2. Cuestionario-encuesta, evaluación del nivel de Emoción Expresada (CEEE). Los resultados indicaron que los familiares con EE alta observaron un mayor descuido personal, irritabilidad, violencia y aislamiento por parte del paciente, en tanto que los familiares con EE baja reportaron más miedos o temores, olvidos, dependencia e ideas extrañas como las conductas problemáticas de las personas enfermas. En los familiares con EE baja se observó un mejor funcionamiento en el desempeño de tareas domésticas, en la demostración de afecto, en las actividades realizadas en el tiempo libre, en la conversación y en la demostración de apoyo entre el informante y el paciente. El modelo de estudio demostró que la mayor presencia de CS y el menor nivel de FS del paciente, fueron variables predictoras de una interacción familiar con características de mayor demostración de crítica, hostilidad y/o sobreinvolucramiento, que explicó 46% de la varianza con niveles de significancia estadística.

Evaluación del funcionamiento social en pacientes de un centro de salud / Social functioning evaluation of patients in a health center

En este artículo se presentan las principales características de la Escala de Funcionamiento Social (EFS) la descripción, el contenido y la metodología utilizada para diseñar la escala-que fue aplicada a una muestra de 320 pacientes de un centro de salud. El funcionamiento social se evalúa a través de una entrevista, en la cual el paciente reporta el grado de satisfacción en relación a su desempeño de roles en la áreas ocupacional, social, económica, sexual, económica, sexual y familiar. Se obtuvo un alto grado de confiabilidad y validez de la escala. Las correlaciones de todas las áreas fueron superiores de 0.80 (p=0.01). De la misma forma el análisis factorial con rotación varimax arrojó cinco factores para la validez de constructo; los reactivos de la misma área cargaron con un solo factor. Esto explicó, a su vez, el 52 por ciento de la varianza. Se recominda el uso de la escala, ya que se cuenta con un instrumento válido y confiable que puede se aplicado no solamente en México, sino también en otros países de habla hispana