Opinion, Use and Knowledge About Transcranial Magnetic Stimulation in Spain: A National Survey of Mental Health Professionals.

Transcranial magnetic stimulation (TMS) is a non-invasive method of neuromodulation with heterogeneous usage between countries, which may be potentially influenced by healthcare professionals' opinions. This study aimed to assess the knowledge, acceptability, and attitudes of mental health professionals in Spain towards TMS. A cross-sectional multicentric study was conducted using an online survey, with 219 participants including psychiatrists, psychologists, and residents. Nearly 100% of participants correctly answered theoretical aspects related to the rationale and indications of TMS. Although only 55% considered TMS effective, 80% would refer patients if TMS were available at their workplace, and 74% would undergo TMS if experiencing depression. 85% believed neuromodulation training should be increased in residency, and 73% demanded TMS inclusion in public hospitals. Teaching staff and psychologists defined TMS as a last resort (p = 0.03 and 0.045). Both disagreed on its ease of use (p < 0.001) and patient referral (p = 0.01), considering an impact on the therapeutic bond (p = 0.029). Previous TMS training, clinical experience, or availability of TMS at the workplace, were associated with better knowledge, a higher perception of efficacy and utility in treating resistant patients (all p < 0.05). In conclusion, surveyed mental health professionals in Spain demonstrated good knowledge of the technique and positive opinions regarding its utility. Findings emphasized limited clinical experience of the sample, a call for training programs, and the demand for the inclusion of TMS in the portfolio of Spanish public hospitals.

Attentional engagement and inhibitory control according to positive and negative symptoms in schizophrenia: An emotional antisaccade task.

Despite schizophrenia (SZ) is characterized by a high psychopathological heterogeneity, the underlying psychological mechanisms that result in different clinical profiles are unclear. This study examined the cognitive processing of emotional faces (angry, happy, neutral, and sad) by means of assessing inhibitory control (antisaccade task) and attentional engagement (prosaccade task) with the eye-tracking paradigm. Firstly, two clinical SZ subgroups classified according to the predominance of positive (PSZ; n = 20) or negative symptoms (NSZ; n = 34) and a control group of 32 individuals were compared. Secondly, the association between prosaccade and antisaccade measurements and the severity of positive and negative symptoms were analyzed. The PSZ group showed slower antisaccades when angry faces were displayed, and higher positive symptoms were associated with slower prosaccade latencies to ones. Conversely, the NSZ group made overall slower prosaccades with an emotional advantage for angry faces, and higher negative symptoms were associated with faster antisaccade latencies to ones. Hence, whereas positive SZ profile is related to a lack of attentional engagement and an impaired inhibitory control to threatening information; negative SZ profile is linked to a lack of attentional engagement to faces, mainly with non-threat ones, and with an advantage to ignore distracting threatening stimuli. These findings support affective information-processing theories suggesting a hypersensitivity to threat for positive SZ profiles, and a desensitization to socio-emotional information for negative ones. Consequently, characterizing psychological mechanisms of SZ may allow improving current treatments to threat management when positive symptoms are predominant, or emotion sensitization when negative symptoms prevail.

Attentional processing biases to threat in schizophrenia: Evidence from a free-viewing task with emotional scenes.

Attentional biases to threatening stimuli have been suggested to play a key role in the onset and course of schizophrenia. However, current research has not completely demonstrated this assumption. The aim of this eye-tracking study was to shed light on the underlying psychological mechanisms of schizophrenia by examining the attentional processing of socio-emotional information. Forty-four individuals with schizophrenia and 47 healthy controls were assessed in a 3-s free-viewing task with a social scene (i.e., happy, threatening, or neutral) in competition with a non-social one to determine the effects of emotional information on the different stages of the attentional processing. The location and latency of initial fixations (i.e., initial orienting), the firs-pass fixations and gaze duration (i.e., attentional engagement), and the percentage of total duration and total fixations (i.e., attentional maintenance) were analyzed. It was found that the schizophrenia group showed longer first-pass gaze duration, as well as higher percentage of total fixations and total duration toward threatening scenes in relation to the non-social ones, compared to controls. Therefore, an attentional bias toward threatening scenes in schizophrenia was found in the attentional maintenance and engagement, but not in the initial orienting of attention. Of note, the threat-related attentional bias was not associated with positive symptoms of schizophrenia. These findings offer empirical support to affective-information processing models stating that threatening information may confer psychological vulnerability to develop schizophrenia. Moreover, the results can improve psychological treatments, such as attentional bias modification paradigms or cognitive-behavior interventions managing maladaptive schemas related to threat.

Manipulating feedback on schizophrenia: Evidence from a Posner task.

Individuals with schizophrenia show difficulties in achieving vital objectives. Abnormal behavioral and emotional responses to environmental feedback may be some of the psychological mechanisms underlying this lack of goal attainment in schizophrenia. The present study aims to assess how different types of feedback may affect performance in a computerized affective Posner task (non-monetary vs. monetary rewards; contingent vs. non-contingent feedback). The sample was composed of 32 patients with schizophrenia and 35 controls. Reaction times and error rates were the behavioral measurements. The emotional experience was assessed through self-reported affective scales. The results indicated that: ii) the performance with monetary rewards was better than with non-monetary ones in all participants, especially in patients with schizophrenia when higher attentional resources are required (invalid trials). Second, all participants demonstrated faster reaction times, but higher error rates, with non-contingent feedback (frustration condition). Significantly, the schizophrenia group only equaled the controls performance in the non-contingent condition with monetary rewards. Additionally, the higher the negative symptoms were in patients, the worse performance they had under frustration. Third, discrepancies between performance and self-report affect were found in patients. Specifically, after the induction of frustration, the patients reported feeling better and having no arousal changes. Therefore, the findings suggest that, in schizophrenia: i) non-monetary rewards are relatively less important; ii) monetary rewards lessen the negative effects of frustration, iii) discrepancies in self-reported affective scales suggest an unrealistic self-evaluation made under frustration. These findings shed light on the underlying mechanisms of the lack of goal attainment in schizophrenia.

Attentional biases to emotional scenes in schizophrenia: An eye-tracking study.

Attentional biases to emotional information may play a key role in the onset and course of schizophrenia. The aim of this experiment was to examine the attentional processing of four emotional scenes in competition (happy, neutral, sad, threatening) in 53 patients with schizophrenia and 51 controls. The eye movements were recorded in a 20-seconds free-viewing task. The results were: (i) patients showed increased attention on threatening scenes, compared to controls, in terms of attentional engagement and maintenance; (ii) patients payed less attention to happy scenes than controls, in terms of attentional maintenance; (iii) whereas positive symptoms were associated with a late avoidance of sad scenes, negative symptoms were associated with heightened attention to threat. The findings suggest that a threat-related bias and a lack of sensitivity to positive information may represent an underlying psychological mechanism of schizophrenia. Importantly, schizophrenia symptoms modulated the attentional biases, which has aetiological and therapeutic implications.

Vivir con un trastorno bipolar. ¿Qué opinan los pacientes? / Living with a bipolar disorder. the patient´s view

Fundamentos. El trastorno bipolar genera un creciente interés dadas sus elevadas repercusiones e implicaciones clínicas. Fruto de ello han aparecido unidades específicas destinadas a su estudio, así como asociaciones de pacientes y familiares. Conocer el punto de vista del paciente resulta un asunto clave en la práctica clínica que puede redundar en una mejoría en el curso clínico. Método. 122 pacientes diagnosticados de trastorno bipolar completaron un cuestionario que recogía datos sociodemográficos y clínicos, junto con aspectos variados de la enfermedad como actitud del paciente frente al tratamiento farmacológico, terapia electroconvulsiva y grupos psicoeducativos, demandas y propuestas, impacto personal, laboral y social, y causas, entre otras cuestiones. Resultados. Destacaron aspectos como un elevado error diagnóstico inicial, un retraso considerable en el diagnóstico, un mayor temor a las fases depresivas, un alto porcentaje de antecedentes de abandono del tratamiento, un avance con los fármacos más recientes, y la percepción de un alto grado de disfunción en distintos ámbitos, entre otras conclusiones. Estos resultados y una revisión de la literatura en torno a estos temas permitió extraer algunas conclusiones orientadas a mejorar la atención clínica y la evolución de estos pacientes. Conclusiones. Se debe realizar un esfuerzo a la hora de reconocer y diagnosticar adecuadamente el trastorno bipolar. Tener en cuenta el punto de vista del paciente, su actitud ante la enfermedad y considerar sus demandas debe formar parte de la práctica clínica diaria. Una información adecuada sobre el trastorno resulta indispensable; en este sentido los grupos psicoeducativos ejercen un apoyo fundamental

Background. Over the last fwe years there has been increasing interest in bipolar disorder due to its high level of repercussions and clinical implications. This has resulted in the appearance of units specifically devoted to its study and organisations for patients and relatives. Understanding the patient´s point of view is vital in everyday clinical practice and can lead to improvements in clinical progress. Methods. 122 bipolar patients answered a survey that collected data on demographic and clinical characteristics and various aspects of the illness such as attitudes towards pharmacological treatment, electroconvulsive therapy and psychoeducative, groups, needs and suggestions, impact on work, personal and social life, and causes, among other questions. Results. The chief points were a high percentage of mistaken initial diagnosis, long delays between the onset of symptoms and diagnosis, greater fear to the depressive phases, a high percentage of voluntary cessation of medication, a sense of improvement with the most recent drugs and the perception of a high degree of dysfunction in various different fields, among other conclusions. These results, and a review of literature on the subject, made it possible to draw some conclusions aimed at improving the clinical treatment and prognosis of these patients. Conclusions. Efforts must be made correctly to recognise and diagnose bipolar disorder. Taking our patients´ demands and points of view into consideration can help us in everyday clinical practice and improve their prognosis and quality of life. Along with other medical interventions, psychoeducative groups, providing the necessary information about the disorder, offer essential support