Perfiles fenomenológicos de evocación autobiográfica en individuos con depresión / Phenomenological profiles of autobiographical memories in individuals with depression / Perfis fenomenológicos da evocação autobiográfica em indivíduos com depressão

Los recuerdos autobiográficos se encuentran en íntima relación con los procesos de regulación emocional y con la concepción del sí mismo. Por otro lado, el acceso a los componentes fenomenológicos específicos se vería disminuido de ocurrir alteraciones afectivas. Se llevó a cabo un muestro no probabilístico intencional de 94 individuos con depresión mayor y de 188 individuos sanos de la ciudad de Buenos Aires, Argentina. Fueron comparados los componentes fenomenológicos de los recuerdos autobiográficos significativos en cuanto a su cantidad e intensidad. Asimismo, se comparó el rendimiento dentro del grupo depresivo, de acuerdo a la presencia o ausencia de episodios depresivos previos, tratamiento psicofarmacológico y severidad sintomatológica. Se encontraron diferencias significativas en la Cantidad e Intensidad Total de los componentes fenomenológicos evocados, presentando el grupo clínico una evocación reducida (p<.001). Las dimensiones Valencia, Imaginería Visual, Sensorialidad, Intersubjetividad y Claridad también presentaron diferencias significativas. No se encontraron diferencias al realizar los análisis secundarios de acuerdo a las variables clínicas. Los individuos con depresión manifestaron un patrón distintivo de evocación fenomenológica de sus recuerdos en comparación a individuos sanos. Considerar las modalidades fenomenológicas de evocación autobiográfica a la luz de los modelos cognitivos en Mindfulness e Imaginería posee implicancias clínicas de relevancia.

Autobiographical memories are deeply linked with emotional regulation processes and self-concept. Conversely, in case of affective disorders, the access to specific phenomenological components would be impaired. Intentional non-probabilistic sampling was carried out, involving 94 individuals with major depression and 188 healthy individuals in the city of Buenos Aires, Argentina. The phenomenological components of significant autobiographical recollections were contrasted, considering their quantity and intensity. In addition, the depressive individuals' performances were compared according to the presence or absence of previous depressive episodes, psychopharmacological treatment and severity of symptoms. Statistically significant differences were found in the total amount and intensity of the recalled phenomenological components, in which the clinical group presented reduced memory (p< .001). Besides, the dimensions: Valence, Visual Imagery, Sensoriality, Inter-subjectivity and Clarity also presented significant differences. Notwithstanding, non-significant differences were observed during the secondary analysis in relation to the clinical variables. Individuals with depression showed a distinctive phenomenological memory pattern in comparison to controls. Considering phenomenological memory modalities in the light of cognitive models of Mindfulness and Imagery entails relevant clinical implications.

Os registos autobiográficos encontram-se em relação íntima com os procesoss de regulação emocional e com a concepção de si mesmo. Por outro lado, os procesos de acesso aos componentes fenomenológicos específicos estariam alterados durante a ocorrência de alterações afetivas. A amostra não probabilística intencional foi constituída por 94 indivíduos com depressão maior e 188 indivíduos sãos, provenientes da cidade de Buenos Aires, Argentina. Foram comparados os componentes fenomenológicos das memorias autobiográficas significativas quanto à sua quantidade e intensidade. Ao mesmo tempo, comparou-se o rendimento do grupo depressivo de acordo com a presença ou ausência de episódios depressivos prévios, tratamento psicofarmacológico e severidade dos sintomas. Encontraram-se diferenças significativas na Quantidade e Intensidade Totais dos componentes fenomenológicos evocados, apresentando o grupo clínico uma evocação reduzida (p<0,001). Ao mesmo tempo, as dimensões Valencia, Imagem Visual, Sensorialidade, Intersubjetividade e Claridade também apresentaram diferenças significativas. Contudo, não se encontraram diferenças significativas ao realizar as análises secundárias de acordo com as variáveis clínicas. Os individuos com depressão mostraram um padrão distintivo de evocação fenomenológica de suas memórias em comparação com os controles. Considerar as modalidades fenomenológicas de evocação autobiográfica à luz dos modelos cognitivos em Mindfulness e Imagem tem implicações clínicas relevantes.

Perfiles fenomenológicos de evocación autobiográfica en individuos con depresión / Perfis fenomenológicos da evocação autobiográfica em indivíduos com depressão

Los recuerdos autobiográficos se encuentran en íntima relación con los procesos de regulación emocional y con la concepción del sí mismo. Por otro lado, el acceso a los componentes fenomenológicos específicos se vería disminuido de ocurrir alteraciones afectivas. Se llevó a cabo un muestro no probabilístico intencional de 94 individuos con depresión mayor y de 188 individuos sanos de la ciudad de Buenos Aires, Argentina. Fueron comparados los componentes fenomenológicos de los recuerdos autobiográficos significativos en cuanto a su cantidad e intensidad. Asimismo, se comparó el rendimiento dentro del grupo depresivo, de acuerdo a la presencia o ausencia de episodios depresivos previos, tratamiento psicofarmacológico y severidad sintomatológica. Se encontraron diferencias significativas en la Cantidad e Intensidad Total de los componentes fenomenológicos evocados, presentando el grupo clínico una evocación reducida (p<.001). Las dimensiones Valencia, Imaginería Visual, Sensorialidad, Intersubjetividad y Claridad también presentaron diferencias significativas. No se encontraron diferencias al realizar los análisis secundarios de acuerdo a las variables clínicas. Los individuos con depresión manifestaron un patrón distintivo de evocación fenomenológica de sus recuerdos en comparación a individuos sanos. Considerar las modalidades fenomenológicas de evocación autobiográfica a la luz de los modelos cognitivos en Mindfulness e Imaginería posee implicancias clínicas de relevancia.(AU)

Os registos autobiográficos encontram-se em relação íntima com os procesoss de regulação emocional e com a concepção de si mesmo. Por outro lado, os procesos de acesso aos componentes fenomenológicos específicos estariam alterados durante a ocorrência de alterações afetivas. A amostra não probabilística intencional foi constituída por 94 indivíduos com depressão maior e 188 indivíduos sãos, provenientes da cidade de Buenos Aires, Argentina. Foram comparados os componentes fenomenológicos das memorias autobiográficas significativas quanto à sua quantidade e intensidade. Ao mesmo tempo, comparou-se o rendimento do grupo depressivo de acordo com a presença ou ausência de episódios depressivos prévios, tratamento psicofarmacológico e severidade dos sintomas. Encontraram-se diferenças significativas na Quantidade e Intensidade Totais dos componentes fenomenológicos evocados, apresentando o grupo clínico uma evocação reduzida (p<0,001). Ao mesmo tempo, as dimensões Valencia, Imagem Visual, Sensorialidade, Intersubjetividade e Claridade também apresentaram diferenças significativas. Contudo, não se encontraram diferenças significativas ao realizar as análises secundárias de acordo com as variáveis clínicas. Os individuos com depressão mostraram um padrão distintivo de evocação fenomenológica de suas memórias em comparação com os controles. Considerar as modalidades fenomenológicas de evocação autobiográfica à luz dos modelos cognitivos em Mindfulness e Imagem tem implicações clínicas relevantes.(AU)

Neuropsychological performance and affective temperaments in Euthymic patients with bipolar disorder type II.

Affective temperament has been suggested as a potential mediator of the effect between genetic predisposition and neurocognitive functioning. As such, this report seeks to assess the extent of the correlation between affective temperament and cognitive function in a group of bipolar II subjects. 46 bipolar II outpatients [mean age 41.4 years (SD 18.2); female 58.9%] and 46 healthy controls [mean age 35.1 years (SD 18); female 56.5%] were evaluated with regard to their demographic and clinical characteristics, affective temperament, and neurocognitive performance. Crude bivariate correlation analyses and multiple linear regression models were constructed between five affective temperament subscales and eight neurocognitive domains. Significant correlations were identified in bipolar patients between hyperthymic temperament and verbal memory and premorbid IQ; cyclothymic temperament and attention; and irritable temperament, attention, and verbal fluency. In adjusting for potential confounders of the relationship between temperament and cognitive function, the strongest mediating factors among the euthymic bipolar patients were found to be residual manic and depressive symptoms. It is therefore concluded that affective temperaments may partially influence the neurocognitive performance of both healthy controls and euthymic patients with bipolar disorder type II in several specific domains.

[Evaluation of Significant Autobiographical Memories Scale: Design and structural validation at an exploratory level]. / Escala de Evaluación de Recuerdos Autobiográficos Significativos: diseno y validación estructural a nivel exploratorio.

Personal memories are multimodal cognitive representations. Nowadays, psychometric instruments which aim to assess signifcant memories phenomenological features are scarce. Consequently, the Evaluation of Signifcant Autobiographical Memories Scale was constructed and structural validated at an exploratory level. A total of 404 individuals from Buenos Aires city (Argentina) participated in the research. Initially, an expert judgment and a pilot study administration were carried out. Next, a homogeneity and a principal components analysis were implemented. To assess the scale reliability, Cronbach's alphas coefficients were analyzed. The fnal version has 30 Likert response items gathered in 8 dimensions. Satisfactory psychometric proprieties were obtained - internal consistency of .892 and a total explained variance of 65.78%. The scale provides two main scores regarding the total quantity and intensity of the phenomenological components as well as a partial score per each dimension. It is stated that the test will prove to be useful in the research feld as well as in the clinical area.

[Neuroprogression and cognition in Bipolar Disorders: A systematic review of cognitive performance in euthymic patients]. / Neuroprogresión y cognición en los trastornos bipolares: una revisión sistemática del rendimiento cognitivo en pacientes eutímicos.

In recent years, investigators have begun to consider the possibility of explaining the physiopathology of bipolar disorder from a neuroprogressive perspective. The evidence that supports the feasibility of such an approach is varied, and arises from neuroimaging studies, batteries of neurocognitive evaluations, and tests to identify the specific biomarkers of the disorder. The present article seeks to perform a review of the research that investigates the cognitive deficits in bipolar disorder. A bibliographic revision was performed of articles published between 1990 and 2015. Levels of cognitive performance were explored in both cross-sectional and longitudinal studies. The compiled studies signal the presence of altered cognitive function, even during periods of euthymia. However, there are contradictory results as to whether bipolar disorder presents a degenerative course. New lines of investigation suggest that only a percentage of individuals with bipolar disorder are affected in a progressive manner. It is of paramount importance to perform new longitudinal studies in high-risk populations, so as to validate or refute a neuroprogressive model of cognitive deficits in patients with bipolar disorder.

Clinical characteristics of bipolar disorder: a comparative study between Argentina and the United States.

BACKGROUND: Bipolar disorder presents with diverse clinical manifestations. Numerous investigators have sought to identify variables that may predict a more severe illness course. METHODS: With the objective of studying the clinical characteristics of bipolar patients between South and North America, a comparison was performed between a sample from Argentina (n = 449) and a sample from the United States (n = 503) with respect to demographics and clinical characteristics, including presence of comorbidities. RESULTS: The Argentinian sample had more unfavorable demographics and higher rates of prior psychiatric hospitalization and prior suicide attempt but a better social outcome. However, the sample from the United States had a higher rate of prior year rapid cycling, as well as younger bipolar disorder onset age (mean ± SD, 17.9 ± 8.4 vs. 27.1 ± 11.4 years) and more severe clinical morbidity, though there was no significant difference in terms of the total duration of the illness. Argentinian compared to American patients were taking more mood stabilizers and benzodiazepines/hypnotics, but fewer antipsychotics and other psychotropic medications, when considering patients in aggregate as well as when stratifying by illness subtype (bipolar I versus bipolar II) and by illness onset age (≤21 vs. >21 years). However, there was no significant difference in rate of antidepressant prescription between the two samples considered in aggregate. CONCLUSIONS: Although possessing similar illness durations, these samples presented significant clinical differences and distinctive prescription patterns. Thus, though the Argentinian compared to North American patients had more unfavorable demographics, they presented a better social outcome and, in several substantive ways, more favorable illness characteristics. In both samples, early onset (age ≤ 21 years) was a marker for poor prognosis throughout the illness course, although this phenomenon appeared more robust in North America.

Theory of mind and functionality in bipolar patients with symptomatic remission.

INTRODUCTION: Functional deficits are commonly observed in bipolar disorder after symptomatic remission. Social cognition deficits have also been reported, which could contribute to dysfunction in patients with bipolar disorder in remission. MATERIAL AND METHODS: Twelve bipolar disorder patients in symptomatic remission (7 patients with bipolar disorder type I and 5 with bipolar disorder type II) and 12 healthy controls completed the Reading the Mind in the Eyes Test and the Faux Pas Test to evaluate theory of mind (ToM). Both groups also completed the Functional Assessment Short Test (FAST). RESULTS: The performance of the bipolar patients in the cognitive component of ToM was below normal, although the difference between the control group was not statistically significant (P=.078), with a trend to a worse performance associated with a higher number of depressive episodes (P=.082). There were no statistically significant differences between groups for the emotional component of ToM. Global functionality was significantly lower in bipolar patients compared to the control group (P=.001). Significant differences were also observed between both groups in five of the six dimensions of functionality assessed. No significant correlation was found between functionality and theory of mind. CONCLUSIONS: Bipolar patients in symptomatic remission exhibit impairments in several areas of functioning. Cognitive ToM appears more affected than emotional ToM. Deficits in ToM were not related to functional impairment.

Psychosocial interventions in bipolar disorder: a review.

INTRODUCTION: Multiple psychosocial interventions for bipolar disorder have been proposed in recent years. Therefore, we consider that a critical review of empirically validated models would be useful. METHODS: A review of the literature was conducted in Medline/PubMed for articles published during 2000-2010 that respond to the combination of "bipolar disorder" with the following key words: "psychosocial intervention", "psychoeducational intervention" and "psychotherapy". RESULTS: Cognitive-behavioral, psychoeducational, systematic care models, interpersonal and family therapy interventions were found to be empirically validated. All of them reported significant improvements in therapeutic adherence and in the patients' functionality. CONCLUSIONS: Although there are currently several validated psychosocial interventions for treating bipolar disorder, their efficacy needs to be specified in relation to more precise variables such as clinical type, comorbid disorders, stages or duration of the disease. Taking into account these clinical features would enable a proper selection of the most adequate intervention according to the patient's specific characteristics.

Depression: point-prevalence and sociodemographic correlates in a Buenos Aires community sample.

BACKGROUND: Since the current epidemiology of depression is not well documented in Latin America, we conducted a community-based survey study in Argentina. METHODS: The Beck Depression Inventory (BDI) and a general health questionnaire were completed by 1335 adult participants, representing most of the neighborhoods of Buenos Aires. RESULTS: Prevalence of high total BDI scores (≥13) indicating probable current clinically significant depression was 20.0% (women: 20.6%; men: 19.6%). Probable depression was associated with being unmarried and older, less educated, reporting recent stressors and significant medical illness. LIMITATIONS: Sampling was cross-sectional and by convenience; probable depression was not verified by clinical assessment. CONCLUSIONS: Within methodological limits, probable current clinically significant depression was highly prevalent in an urban community sample in Argentina, at rates and with risk factors similar to those found in other world regions.

[Screening for symptoms of depression during postpartum and the long term follow up: temporal stability and associated factors]. / Detección de síntomas depresivos durante el postparto inmediato y el seguimiento a largo plazo: estabilidad temporal y factores asociados.

AIMS: To describe the frequency of depressive symptoms compatible with a postpartum depression diagnosis, the associated factors and the temporal stability. METHODS: During 2006-2007 398 hospitalized puerperal women who attended CEMIC were interviewed 5 days after childbirth using the Edinburgh Postnatal Depression Scale and a socio-demographic questionnaire. A logistic regression analysis was performed to identify associated factors with a positive screening. During the following 6-12 months a follow up was carried with two groups of similar characteristics. RESULTS: The frequency of depressive symptoms at post partum was 17.8% (cut off = 10). Depressive history and neonatal intensive care were significantly related to a positive screening. From the 110 interviewed women, 24 were positive in the follow-up. CONCLUSION: The prevalence of risk for postpartum depression in the sample of patients surveyed is within the parameters reported in international literature. At the 6 month follow up, 6 previously asymptomatic women during the first screening turned on positive. It is theorize the existence of potential postpartum depression cases that can manifest up to a year after childbirth.

Public knowledge, beliefs and attitudes towards patients with schizophrenia: Buenos Aires.

OBJECTIVE: The purpose of our study was to assess the knowledge, social distance and perception of social discrimination towards persons with schizophrenia in the general adult population of Buenos Aires, Argentina. METHODS: One thousand two-hundred fifty-four persons were surveyed at different neighborhoods of the city of Buenos Aires. Their knowledge about schizophrenia, personal social distance and perception of social discrimination were assessed with several questions. Afterwards, a scale for each one of these measures was built. RESULTS: Almost half of the general population believed that patients with schizophrenia suffer from split personality and that most of them are dangerous and violent. Knowledge about schizophrenia in the general population was moderate and it was associated with age and education. Almost 80% of the population had less than one-third of the maximum possible social distance score, but their perception of social discrimination was high. Social distance was greater in the elderly. Knowledge was correlated weakly with social distance. Respondents directly related with patients suffering from schizophrenia were more knowledgeable about the illness, but had the same social distance and perception of social discrimination than the rest of the general population. CONCLUSIONS: The persons surveyed felt their own attitudes are more favorable to people with schizophrenia than 'most other people's' attitudes. The elderly should be specifically addressed in specially designed anti-stigma campaigns.

[First psychotic episode in bipolar disorder: clinical differentiation and functional impact in an Argentinean national sample]. / Primer episodio psicótico en trastorno bipolar: diferenciación clínica e impacto funcional en una muestra argentina.

BACKGROUND: Bipolar disorder in its early phase results in a diagnostic and therapeutic challenge for the clinician. Individuals with bipolar disorder can be grouped according with their different clinical features such as the presence or absence of psychotic symptoms. Early illness detection and treatment is usually associated with a better prognosis. OBJECTIVE: The main objective of this study was to compare the clinical features, functionality and stigma of patients with bipolar disorder with psychotic symptoms at onset. METHOD: A total sample of 175 bipolar disorder outpatients completed clinical assessment (YMRS and HAM-D), functionality (FAST), and stigma (ISE) scales. All patients were clinically stable for at least three months and were following active maintenance treatment regimens. RESULTS: The psychotic group consisted of 70 patients and the non-psychotic group 105 patients. Statistical significant differences were found between patients with and without psychotic features regarding sex, age at diagnosis, perceived stigma and functional impairment. Bipolar patients with psychotic symptoms at onset received an early treatment. DISCUSSION: Clinical differences found in both groups of bipolar patients have therapeutic implications which may account for different outcomes. Differential interventions could be designed according to each clinical group. Special attention should be paid to bipolar first episode features.

[Stigmatization towards schizophrenia and other mental illnesses]. / Estigmatización en la esquizofrenia y otros trastornos mentales.

INTRODUCTION: Stigma surrounding mental illness is one of the main barriers for patients' reintegration into the community. Stigmatization is a social process characterized by different kinds of prejudices, stereotypes and discrimination. METHOD: A review and synthesis of articles about mental illness stigmatization published in Medline in the past two decades was done. Key areas were identified and grouped under specific categories. RESULTS AND CONCLUSIONS: Schizophrenia is one of the mental illnesses that is most affected by stigmatization. The more private and closer the situation is, the more rejection is to be expected. The rate for public rejection increases with the closeness and intimacy in the relationship. People with a psychiatric illness are disadvantaged with regard to housing and employment opportunities. Public in general is not well informed about mental disorders distinct features. The influence of social desirability in the obtained responses leads to a discrepancy between participants' attitudes expressed in the survey and their actual behavior. An important methodological challenge persists due to the fact that only behavioral intentions have been assessed, not how people actually behave. Patients' involvement in the planning and development of social interventions is essential for their success.