La terapia cognitivo conductual y los síntomas negativos en la esquizofrenia / Cognitive behavioral therapy and negative symptoms in schizophrenia

INTRODUCCIÓN: La esquizofrenia constituye un problema sanitario y social de grandes dimensiones que afecta no sólo al paciente sino a su entorno familiar y social. Dentro de las aproximaciones psicoterapéuticas dirigidas a pacientes con esquizofrenia, las terapias cognitivo conductuales (TCC) son las que cuentan con mayor evidencia de efectividad para diferentes propósitos y etapas del trastorno. OBJETIVO: Analizar las técnicas y efectos específicos sobre síntomas negativos de las principales TCC para pacientes con esquizofrenia: Psicoeducación, Entrenamiento en Habilidades Sociales, Rehabilitación Cognitiva, TCC para Síntomas Positivos y TCC orientada a la Recuperación (TCC-R). MÉTODO: Se llevó a cabo una búsqueda y análisis de literatura científica en PSYCLIT, MEDLINE, EBSCO-HOST y PROQUEST publicada entre 1990 y 2014 en revistas indexadas en inglés y español, utilizando como palabras clave los nombres de las diferentes TCC para la esquizofrenia que se cruzaron en todos los casos con el diagnóstico. Se recopiló también la literatura relevante citada en estos artículos, sobre todo en las revisiones de literatura antecedentes. RESULTADOS: A pesar de los avances que han presentado las TCC en la recuperación de pacientes con diagnóstico de esquizofrenia, los problemas generados por la sintomatología negativa no han sido resueltos por completo. DISCUSIÓN Y CONCLUSIÓN: La TCC-R se considera un estilo terapéutico prometedor para alcanzar los objetivos de recuperación de los pacientes con bajo funcionamiento psicosocial y predominio de sintomatología negativa.

INTRODUCTION: Schizophrenia is a health and social problem of great dimensions, affecting not only the patient but their family and social environment. Within the psychotherapeutic approaches for patients with schizophrenia, Cognitive Behavioral Therapy (CBT) has most evidence of effectiveness for different porpoises and stages of the disorder. OBJECTIVE: Analyze the specific techniques and outcome on negative symptoms of the major CBT for patients with schizophrenia: Psychoeducation, Social Skills Training, Cognitive Remediation, CBT for positive symptoms and Cognitive Behavioral Recovery Oriented Therapy (CBT-R). METHOD: A searching and analysis of scientific literature published in English and Spanish between 1990 and 2014 were performed in PSYCLIT, MEDLINE, EBSCO-HOST and PROQUEST, employing as key words the names of the different CBT for schizophrenia and the diagnosis. Relevant literature included in review articles was also included. RESULTS: Despite the advances of CBT, the problems generated by negative symptoms of patients with schizophrenia are not completely solved. DISCUSSION AND CONCLUSION: CBT-R is considered a promising therapeutic style to achieve the objectives of recovery in patients with low psychosocial functioning and predominance of negative symptomatology.

[Anxiety and depression in patients with chronic pain: neuropathic and nociceptive]. / Ansiedad y depresión por dolor crónico neuropático y nociceptivo.

OBJECTIVE: To describe and compare anxiety and depression symptoms between two group patients with neuropathic and nociceptive pain those arrive for first time to a clinic of pain. METHODS: Non-experimental, exploratory and descriptive design. Seventy-eight patients that arrive the first time to a clinic of pain were evaluated; those patients were divided in two groups: neuropathic pain with 44 patients and nociceptive pain with 34 patients. To evaluate anxiety and depression we use the Anxiety and Depression Scale (HAD), this scale is adapted and validated in Mexico. RESULTS: From the 78 patients in the study, the 76.9% were female and 23.1% were male. The age average was (56.9 +/- 16.8 year-old for neuropathic pain and 63.1 +/- 17.2 year-old for nociceptive pain). The reliability of the scale HAD was evaluated by the Chronbach's alpha analysis with an r = 0.826. There was no significance difference in anxiety and depression between types of pain, but after analyzing all of the patients we found that anxiety was more frequent than depression p < 0.0001. CONCLUSIONS: Independently of the algological diagnosis, patients presented almost the same affective symptoms.

[Burden, anxiety and depression in patient's caregivers with chronic pain and in palliative care]. / Sobrecarga, ansiedad y depresión en cuidadores primarios de pacientes con dolor crónico y terminales.

BACKGROUND: In Mexico there are few studies about the psychological characteristics of the person that voluntary and in a complete sense assumes the role of responsible of a patient. The purpose of this study was to assess and compare the levels of burden, anxiety and depression of 56 caregivers of patients with chronic pain with the ones of 35 caregivers of terminally ill patients. METHODS: The study was conduced at the Chronic Pain and Palliative Medicine Department of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". We used the Spanish version of the Burden Interview and the Informal Primary Caregiver Health Survey. RESULTS: Both groups went over the cut off point of the Burden Scale even though no significative differences between groups were found nor in burden or in anxiety. The caregivers of terminal patients had more depression symptoms and a greater perception of the impact of the care activity in their mood. Positive correlations between burden and depression, depression and anxiety and burden and anxiety were found. CONCLUSIONS: All caregivers reported multiple depression symptoms--greater if they cared terminally ill patients--so, it may suggest that the patient's illness directly influences the depression symptoms of their caregivers. This study can help to develop intervention programs directed to help this population that is the principal support of the patient's treatment.