Intervenciones psicoterapéuticas y psicosociales para el manejo del estrés en esclerosis múltiple: aportación de intervenciones basadas en mindfulness / Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions

La presencia de depresión o ansiedad asociada al diagnóstico de esclerosis múltiple (EM) se ha relacionado con una peor evolución de la enfermedad, con mayor número de brotes, con peor adherencia al tratamiento y una mayor disregulación del sistema inmune. Estudios recientes indican que intervenciones psicoterapéuticas dirigidas al manejo del estrés, entre ellas, intervenciones basadas en mindfulness (Mindfulness-Based Interventions, MBI), pueden mejorar la calidad de vida, la depresión, la ansiedad y la fatiga en pacientes con diagnóstico de EM. Mindfulness o atención plena fomenta la capacidad para observar las experiencias tal y como son y mejora la regulación emocional. Esta habilidad o actitud se aprende por entrenamiento y tiene la ventaja sobre otras intervenciones de que el efecto puede prolongarse a lo largo del tiempo al depender de la práctica personal. El objetivo del presente artículo es revisar la evidencia disponible sobre la eficacia de intervenciones psicosociales y psicoterapéuticas, específicamente MBI, en el manejo de la sintomatología ansioso-depresiva y del estrés percibido en pacientes con diagnóstico de EM

Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients

Toward a comprehensive care of HIV patients: finding a strategy to detect depression in a Spanish HIV cohort.

Depression is a common but frequently undiagnosed feature in individuals with HIV infection. To find a strategy to detect depression in a non-specialized clinical setting, the overall performance of the Hospital Anxiety and Depression Scale (HADS) and the depression identification questions proposed by the European AIDS Clinical Society (EACS) guidelines were assessed in a descriptive cross-sectional study of 113 patients with HIV infection. The clinician asked the two screening questions that were proposed under the EACS guidelines and requested patients to complete the HADS. A psychiatrist or psychologist administered semi-structured clinical interviews to yield psychiatric diagnoses of depression (gold standard). A receiver operating characteristic (ROC) analysis for the HADS-Depression (HADS-D) subscale indicated that the best sensitivity and specificity were obtained between the cut-off points of 5 and 8, and the ROC curve for the HADS-Total (HADS-T) indicated that the best cut-off points were between 12 and 14. There were no statistically significant differences in the correlations of the EACS (considering positive responses to one [A] or both questions [B]), the HADS-D ≥ 8 or the HADS-T ≥ 12 with the gold standard. The study concludes that both approaches (the two EACS questions and the HADS-D subscale) are appropriate depression-screening methods in HIV population. We believe that using the EACS-B and the HADS-D subscale in a two-step approach allows for rapid, assumable and accurate clinical diagnosis in non-psychiatric hospital settings.

Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions.

Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients.

Mindfulness-based narrative therapy for depression in cancer patients.

UNLABELLED: Mindfulness-based narrative therapy (MBNT) is a therapeutic intervention for the treatment of depression in cancer patients. In a previous randomized controlled trial, MBNT was found to ameliorate anxiety and depression, improve functional dimensions of quality of life, and enhance treatment adherence. In this review, we describe MBNT and its technical characteristics in the context of other psychotherapeutic interventions for depression in cancer patients. We highlight needed adjustments to other narrative approaches and recommend clinical modifications tailored to the needs of cancer patients that are intended to encompass the client's initial depressive narrative. The narrative construction is supported by emotional regulation and attachment relationships on the one hand and by individual and social linguistic capabilities on the other. Through destabilization of the depressive narrative, MBNT facilitates the emergence of new meanings using both verbal and non-verbal techniques based on mindfulness. The attitude and practice of mindfulness are integrated throughout the therapeutic process. In summary, MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. KEY PRACTITIONER MESSAGE: In this review, we describe mindfulness-based narrative therapy (MBNT) for the treatment of depression in cancer patients. In a previous controlled trial, we found significant benefits of MBNT in terms of reducing depressive symptoms and improving treatment adherence and quality of life in depressed, non-metastatic cancer patients. Narrative construction is socially and neurobiologically derived. MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. MBNT is proposed as an interesting and promising intervention, particularly for patients with somatic pathologies.

[Clinical pathways for the care of multiple sclerosis patients]. / Diseño de una vía clínica para la atención a los pacientes con esclerosis múltiple.

INTRODUCTION: clinical pathways are standard health care methods to coordinate clinical work, reduce inter-clinician variability, improve patient care and increase staff and patient satisfaction. The aim of this study is to develop a clinical pathway capable of organising and developing standard procedures for diagnosis, treatment and care in patients with multiple sclerosis and to coordinate all medical specialists involved in this disease. METHODS: a multidisciplinary unit for the care of MS patients was developed. All of them and quality specialists analysed some international evidence-based studies, clinical guides, international guidelines and other clinical neurological pathways in several meetings and designed several documents for the clinical pathways. RESULTS: a clinical pathway was created consisting of a scientific-technical framework, which arranges the care in relation to the diagnosis and reatment. The framework is accompanied by various patient-information documents on the disease, an information sheet on diagnostic procedures and a map of the process. Quality standards were established to achieve continuous improvement in patient care. CONCLUSIONS: a clinical pathway for the care of MS patients in a multidisciplinary unit homogenises and organises the care which the MSpatient should receive from the initial symptoms to the progressive stages. This clinical pathway improves the quality of patient care, reduces the variability in work protocols and rationalises the use of the available health care resources.

Diseño de una vía clínica para la atención a los pacientes con esclerosis múltiple / Clinical pathways for the care of multiple sclerosis patients

Introducción: Las vías clínicas (VC) son herramientas para coordinar el trabajo asistencial, reducir la variabilidad entre el personal sanitario y mejorar la atención y el cuidado del paciente. La esclerosis múltiple (EM) es una enfermedad neurológica crónica que afecta a pacientes jóvenes y es incapacitante. El objetivo es desarrollar una vía clínica para mejorar el diagnóstico, el tratamiento y la atención de los pacientes con EM y, asimismo, facilitar la coordinación de todos los especialistas implicados en este proceso. Método: Siguiendo el modelo FOCUS-PDCA se organiza un equipo de trabajo integrado por diferentes profesionales implicados en la atención del paciente con EM. Se realiza una revisión bibliográfica exhaustiva y se llega a consenso; así, se diseñan los documentos de la VC con base en la evidencia científica. Resultados: Se crea una vía clínica compuesta por los siguientes elementos: una matriz temporal con una serie de anexos para ordenar el proceso diagnóstico y el tratamiento, un impreso de información a los pacientes sobre las pruebas diagnósticas, una hoja de información sobre la enfermedad y un mapa de procesos, una encuesta de evaluación de la calidad percibida y un documento con indicadores de calidad para evaluar la VC. Conclusiones: El desarrollo de una VC de EM facilita la atención multidisciplinaria y mejora la calidad asistencial. Esta propuesta es novedosa al enfocar la atención integral de la EM desde su inicio, tanto en aspectos diagnósticos como terapéuticos, incluyendo el ámbito ambulatorio (AU)

Introduction: Clinical pathways are standard health care methods to coordinate clinical work, reduce inter-clinician variability, improve patient care and increase staff and patient satisfaction. The aim of this study is to develop a clinical pathway capable of organising and developing standard procedures for diagnosis, treatment and care in patients with multiple sclerosis and to coordinate all medical specialists involved in this disease. Methods: A multidisciplinary unit for the care of MS patients was developed. All of them and quality specialists analysed some international evidence-based studies, clinical guides, international guidelines and other clinical neurological pathways in several meetings and designed several documents for the clinical pathways. Results: A clinical pathway was created consisting of a scientific-technical framework, which arranges the care in relation to the diagnosis and reatment. The framework is accompanied by various patient-information documents on the disease, an information sheet on diagnostic procedures and a map of the process. Quality standards were established to achieve continuous improvement in patient care. Conclusions: A clinical pathway for the care of MS patients in a multidisciplinary unit homogenises and organises the care which the MSpatient should receive from the initial symptoms to the progressive stages. This clinical pathway improves the quality of patient care, reduces the variability in work protocols and rationalises the use of the available health care resources (AU)

Inventario Infanto-Juvenil de Temperamento y Carácter / Junior Temperament and Character Inventory

El Inventario Infanto-Juvenil de Temperamento y Carácter fue creado para evaluar las dimensiones del temperamento (búsqueda de novedades, evitación del daño, dependencia de la recompensa y persistencia) y las dimensiones del carácter (autodirección, cooperación, fantasía y espiritualidad) en niños y adolescentes, basado en el modelo de Cloninger de personalidad. El objetivo de este estudio es validar una versión española del Inventario Infanto-Juvenil de Temperamento y Carácter en una población infantil. La muestra fue de 827 niños de tres colegios de la Comunidad de Madrid. La consistencia interna, medida con el coeficiente α de Cronbach, fue aceptable para la mayoría de las dimensiones (por encima de 0,60). La prueba de fiabilidad test-retest se evaluó en una muestra independiente de 61 niños que realizaron el cuestionario en dos ocasiones, con cuatro semanas de diferencia. Las correlaciones entre las dimensiones fueron de moderadas a altas. La versión española del Inventario Infanto-Juvenil de Temperamento y Carácter podría ser útil en la práctica clínica y en los programas psicopedagógicos

The Junior Temperament and Character Inventory was developed to assess the temperament dimensions (novelty seeking, harm avoidance, reward dependence and persistence) and the character dimensions (selfdirectedness, cooperativeness, fantasy and spirituality) in children and adolescents based upon Cloninger's model of personality. The objective of the study is to validate a Spanish version of the Junior Temperament and Character Inventory in a child population. The sample was 827 children from three schools from the Region of Madrid. Internal consistency, measured using Cronbach α, was acceptable for the majority of the dimensions (above 0.60). The reliability test-retest was evaluated in an independent sample of 61 children who were given the Junior Temperament and Character Inventory on two occasions, four weeks apart. Correlations among dimensions were moderate to high. The Spanish version of the Junior Temperament and Character Inventory could be useful in clinical practice and in psycho-pedagogical programs

Temperamento, ansiedad y depresión en población infantil / No disponible

Introducción: el objetivo principal de este estudio es investigar la relación entre los rasgosde temperamento y carácter y síntomas de ansiedad y depresión en población general infantil. Material y métodos: se administró el Inventario infanto juvenil de temperamento y carácterde Cloninger, el inventario de depresión infantil de Kovacs y el cuestionario autoaplicadode ansiedad estado/rasgo de Spielberger a 827 niños entre 9 y 13 años de edad, 342 niñas y 481 niños. Resultados: todas las dimensiones del temperamento y carácter presentaron correlaciones estadísticamente significativas con las puntuaciones en los cuestionarios de ansiedad y depresión. Los valores más elevados fueron con evitación del daño y autodirección, que resultaronser positivo y negativo respectivamente.Conclusiones: el inventario infanto juvenil de temperamento y carácter de Cloninger puede resultar una herramienta interesante para la detección de niños en riesgo de padecer algún trastorno psicopatológico (AU)

Introduction: the main aim of this study is to investigate the relation between the traits of temperament and character and symptoms of anxiety and depression in the general child population. Material and methods: Junior Temperament and Character Inventory, Kovacs´s Children Depression Inventory and Spielberger´s State-Trait Anxiety Inventory for Children were administeredto 827 children of between 9 and 13 years, 342 girls and 481 boys. Results: all the dimensions of temperament and character presented statistically significant correlations with the scores in the questionnaires of anxiety and depression. We found the highest values in harm avoidance and self-directedness, which resulted positive and negative respectively. Conclusions: the Junior Temperament and Character Inventory of Cloninger could be aninteresting tool to detect children in risk of suffering some psychopathologycal disorder (AU)

[Liaison programs in drug abuse-AIDS]. / Programas de enlace en toxicomanías--SIDA.

AIDS has acquired a growing importance for psychiatry because of the number of infected people and the increasing attention that these patients need. The major risk group in Spain is the drug users one. These patients share management problems when they are in general hospitals settings, both for their psychiatric aspects and for the consequences of drug abusing. A consultation liaison psychiatry service system improves the attention to these patients and reduces the emergency interventions and the hostility against the staff. The consultation liaison psychiatry system has generated an overall improvement in our hospital to fulfil the patients need and the relations and atmosphere among the therapeutic team.

[Neuropsychiatric aspects of HIV infection]. / Aspectos neuropsiquiátricos de la infección por VIH.

The results of a study about psychiatric morbility in patients suffering from HIV infection treated in a psychiatric consulting department of a general hospital are presented. Out of one hundred of individuals studied, 93 showed a diagnosis in Axle I according to DSM-IIIR criteria for mental disorders classification. The diagnosis most frequently found was the one of disorders due to drugs dependence, in 41%; organic mental disorder in 29%; adaptation disorders in 15% and affective one in 5% of cases. In sixteen patients of the sample a follow-up was carried out finding ad evolution towards dementia. Diagnostic difficulties of this population and usefulness of carrying out a revision of diagnostic classifications usually employed are debated.

Psychiatric aspects of patients with HIV infection in the general hospital.

The study describes the psychiatric disorders found in 100 HIV-positive patients, in different stages of the illness, at the psychiatric consultation service of a general hospital in Madrid. Eighty-five percent of the sample fell within the intravenous drug addicts risk group, which coincides with the epidemiological characteristics of Spain's HIV-positive population. The most frequently noted psychiatric diagnosis was substance dependence disorder (41%), followed by organic mental disorder (29%), adjustment disorder (15%), and affective disorder (5%). Fifteen percent of the subjects had depressive symptoms, and 11% expressed suicidal ideation. A follow-up conducted on part of the sample showed a development towards dementia, emphasizing diagnostic difficulties in the initial evaluation of these patients.

Between 5 and 9 years' follow-up in the treatment of anorexia nervosa.

The paper reports on the clinical characteristics, treatment and results of a group of 41 patients suffering from anorexia nervosa. All patients were diagnosed according to DSM-III criteria. Mean age was 18.6 years, within a range from 12 to 33 years. The group was formed by 40 female patients and 1 male. Twenty-nine percent of the patients had previously received treatment. Duration of treatment fell within a range of 10-36 months, 18-24 being the most frequent. Forty-four and a half percent of the patients were admitted to hospital with a 59-day mean time of hospitalization and treatment was positive in over 80% of cases. Two patients suffered a relapse during the first 2 or 3 years, but later recovered. Five years after the beginning of treatment, 1 patient suffered a relapse and received supplementary treatment.

Atypical chest pain and panic disorder.

Cardiovascular symptoms are often present in descriptions of patients with panic disorder, and are considered a central element in current diagnostic criteria. These patients often visit emergency wards complaining of chest pain or discomfort. In many cases, a possible psychiatric diagnosis is not considered, and these patients are often incorrectly diagnosed and treated. The aim of this study is to examine the presence of panic disorder in those patients who visit a general hospital emergency ward with chest pain, and are then released after no organic pathology is found. We present the results obtained from the examination of 112 patients with these characteristics who were given a structured interview developed for the diagnosis of affective and anxiety disorders. In the sample studied, panic disorder was found in 47.3% of the subjects.