Investigating in VigiBase over 6000 cases of pneumonia in clozapine-treated patients in the context of the literature: focus on high lethality and the association with aspiration pneumonia.

BACKGROUND: The literature associates clozapine with pneumonia/aspiration pneumonia. RESEARCH DESIGN AND METHODS: The international pharmacovigilance database (VigiBase™) uses the information component (IC) as statistical signal. VigiBase clozapine reports were analyzed for pneumonia/aspiration pneumonia from introduction to 10 May 2023. RESULTS: There were 6392 cases of all types of pneumonia (5572 cases of pneumonia, 775 of aspiration pneumonia, and 45 combined). The IC was 3.52 for aspiration pneumonia, introduced as a VigiBase label in 2003, and 1.91 for pneumonia. Patients were reclassified as 3628 with no signs of aspiration and 1533 with signs. Signs of aspiration were strongly associated with some co-medications: olanzapine, odds ratio (OR) = 23.8, 95% confidence interval (CI), 14.9-38.0; risperidone OR = 18.6, CI, 11.4-30.4; valproic acid, OR = 5.5, CI, 4.5-6.6; and benzodiazepines OR = 5.5, CI, 4.5-6.6. In 2415 cases with completed data, fatal outcomes made up 45% (signs of aspiration made no difference), but there was wide variability from 0% (females <45 years of age; duration ≤30 days) to 76% (males >64 years of age; duration >1 year). During the first week, pneumonia was associated with 1) very high titration doses, 2) very small doses in Parkinson's disease, and 3) Japan vs other countries. CONCLUSIONS: In clozapine-treated patients: 1) at least 30% of pneumonia cases may be aspiration pneumonia, 2) stopping some co-medications may decrease the risk of aspiration pneumonia, 3) average lethality in pneumonia was 45% but may be around 75% in geriatric patients with long-term treatment, and 4) safer titrations may sometimes require 5-mg tablets.

What is the Link Between Different Components of Empathy and Burnout in Healthcare Professionals? A Systematic Review and Meta-Analysis.

Research on healthcare shows that the relationship between empathy and burnout is complex. The aim of this systematic review and meta-analysis is to clarify the link between different empathic components and burnout components in healthcare professionals. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. The search strategy was applied in PubMed, PsycINFO, CINAHL, Scopus, and Medline, from January 1990 to January 2021. Population included nurses and doctors. Key inclusion criteria were articles addressing the relationship between different components of empathy and professional performance and wellbeing or burn out, or studies using burnout and empathy measures with validity support from commonly accepted sources of evidence. Risk of bias was assessed using the Mixed Methods Appraisal Tool. From 1159 references identified, 22 studies were included in the systematic review, and 5 studies in the meta-analysis. Empathic Concern was significantly correlated with Depersonalization and Personal Accomplishment. Moreover, the links between Perspective Taking, Depersonalization and Personal Accomplishment were statistically significant. In conclusion, exploring and understanding the complex links between empathy and burnout could help healthcare professionals as well as institutions to reduce the risk of suffering burnout.

Psychometric Properties of the WHO-5 Well-Being Index among Nurses during the COVID-19 Pandemic: A Cross-Sectional Study in Three Countries.

Nurses' well-being has been increasingly recognised due to the ongoing pandemic. However, no validation scales measuring nurses' well-being currently exist. Thus, we aimed to validate the WHO-5 Well-Being Index (WHO-5) in a sample of nurses. A cross-sectional multinational study was conducted, and a total of 678 nurses who worked during the COVID-19 pandemic in Spain (36.9%), Chile (40.0%) and Norway (23.1%) participated in this study. The nurses completed the WHO-5, the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder-2 (GAD-2) and three questions about the quality of life (QoL). The WHO-5 demonstrated good reliability and validity in the three countries. Cronbach's alphas ranged from 0.81 to 0.90. High correlations were found between the WHO-5 and the psychological well-being dimension of QoL, and negative correlations between the WHO-5 and PHQ-2. The unidimensional scale structure was confirmed in all the countries, explaining more than 68% of the variance. The item response theory likelihood ratio model did not show discernible differences in the WHO-5 across the countries. To conclude, the WHO-5 is a psychometrically sound scale for measuring nurses' well-being during a pandemic. The scale showed strong construct validity for cross-cultural comparisons; however, more research is required with larger sample sizes.

The Mediating Role of Resilience in the Relationship between Perceived Stress and Mental Health.

The COVID-19 pandemic has created great uncertainty around the world, and due to the pandemic, nurses have been exposed to an increase in highly stressful clinical situations. This study examines the relationships between perceived stress and emotional disorders among nurses who have provided direct patient care during the COVID-19 pandemic and explores the mediating role of resilience in these relationships. In an online cross-sectional design, we asked Spanish nurses (N = 214) to complete self-reported scales, and we performed correlation and mediation analyses between perceived stress (Perceived Stress Scale, PSS-4), resilience (Wagnild Resilience Scale, RS-14), wellbeing (World Health Organization Wellbeing Index, five items, WHO-5), anxiety (PHQ-2) and depression (GAD-2). The nurses self-reported moderate levels of perceived stress, considerable psychological distress and high resilience. We found resilience to be significantly negatively correlated with the reported levels of perceived stress, anxiety and depression (p < 0.001). The mediating analysis revealed that resilience played a protective role in the direct relationships of stress with depression, anxiety, and psychological distress. To conclude, our findings supported the hypothesis that resilience mediated the relationship between stress and mental health.

Changes in Brain Activation through Cognitive-Behavioral Therapy with Exposure to Virtual Reality: A Neuroimaging Study of Specific Phobia.

BACKGROUND: Cognitive-behavioral therapy (CBT) with exposure is the treatment of choice for specific phobia. Virtual reality exposure therapy (VRET) has shown benefits for the treatment and prevention of the return of fear in specific phobias by addressing the therapeutic limitations of exposure to real images. METHOD: Thirty-one participants with specific phobias to small animals were included: 14 were treated with CBT + VRET (intervention group), and 17 were treated with CBT + exposure to real images (active control group). Participants' scores in anxiety and phobia levels were measured at baseline, post-treatment, and 3-month follow-up, and brain activation was measured through functional magnetic resonance imaging (fMRI) baseline and post-treatment. RESULTS: Both groups showed a significant decrease in anxiety and phobia scores after the therapy and were maintained until follow-up. There were no significant differences between both groups. Overall, fMRI tests showed a significant decrease in brain activity after treatment in some structures (e.g., prefrontal and frontal cortex) and other structures (e.g., precuneus) showed an increasing activity after therapy. However, structures such as the amygdala remained active in both groups. CONCLUSIONS: The efficacy of CBT + VRET was observed in the significant decrease in anxiety responses. However, the results of brain activity observed suggest that there was still a fear response in the brain, despite the significant decrease in subjective anxiety levels.

Exploring patterns in psychiatric outpatients' preferences for involvement in decision-making: a latent class analysis approach.

BACKGROUND: Shared decision-making (SDM), a collaborative approach that includes and respects patients' preferences for involvement in decision-making about their treatment, is increasingly advocated. However, in the practice of clinical psychiatry, implementing SDM seems difficult to accomplish. Although the number of studies related to psychiatric patients' preferences for involvement is increasing, studies have largely focused on understanding patients in public mental healthcare settings. Thus, investigating patient preferences for involvement in both public and private settings is of particular importance in psychiatric research. The objectives of this study were to identify different latent class typologies of patient preferences for involvement in the decision-making process, and to investigate how patient characteristics predict these typologies in mental healthcare settings. METHODS: We conducted latent class analysis (LCA) to identify groups of psychiatric outpatients with similar preferences for involvement in decision-making to estimate the probability that each patient belonged to a certain class based on sociodemographic, clinical and health belief variables. RESULTS: The LCA included 224 consecutive psychiatric outpatients' preferences for involvement in treatment decisions in public and private psychiatric settings. The LCA identified three distinct preference typologies, two collaborative and one passive, accounting for 78% of the variance. Class 1 (26%) included collaborative men aged 34-44 years with an average level of education who were treated by public services for a depressive disorder, had high psychological reactance, believed they controlled their disease and had a pharmacophobic attitude. Class 2 (29%) included collaborative women younger than 33 years with an average level of education, who were treated by public services for an anxiety disorder, had low psychological reactance or health control belief and had an unconcerned attitude toward medication. Class 3 (45%) included passive women older than 55 years with lower education levels who had a depressive disorder, had low psychological reactance, attributed the control of their disease to their psychiatrists and had a pharmacophilic attitude. CONCLUSIONS: Our findings highlight how psychiatric patients vary in pattern of preferences for treatment involvement regarding demographic variables and health status, providing insight into understanding the pattern of preferences and comprising a significant advance in mental healthcare research.

Understanding the Links between Inferring Mental States, Empathy, and Burnout in Medical Contexts.

It is generally accepted that empathy should be the basis of patient care. However, this ideal may be unrealistic if healthcare professionals suffer adverse effects when engaging in empathy. The aim of this study is to explore the effect of inferring mental states and different components of empathy (perspective-taking; empathic concern; personal distress) in burnout dimensions (emotional exhaustion; depersonalization; personal accomplishment). A total of 184 healthcare professionals participated in the study (23% male, Mage = 44.60; SD = 10.46). We measured participants' empathy, the inference of mental states of patients, and burnout. Correlation analyses showed that inferring mental states was positively associated with perspective-taking and with empathic concern, but uncorrelated with personal distress. Furthermore, emotional exhaustion was related to greater levels of personal distress and greater levels of inferences of mental states. Depersonalization was associated with greater levels of personal distress and lower levels of empathic concern. Personal accomplishment was associated with the inference of mental states in patients, lower levels of personal distress, and perspective-taking. These results provide a better understanding of how different components of empathy and mental state inferences may preserve or promote healthcare professionals' burnout.

Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE / Evaluación de la toma de decisiones compartidas en la atención comunitaria de salud mental: validación de CollaboRATE

BACKGROUND/OBJECTIVE: CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care. METHOD: A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables. RESULTS: Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (Alpha Cronbach = .95, Guttman's Lambda = .93, and Omega = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE. CONCLUSIONS: This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM

ANTECEDENTES/OBJETIVO: CollaboRATE es un autoinforme de tres ítems que permite al paciente valorar su experiencia en la toma de decisiones compartidas (TDC) sobre su tratamiento. El objetivo de este estudio fue evaluar las propiedades psicométricas de CollaboRATE en la atención comunitaria de salud mental. MÉTODO: Se realizó un estudio transversal en una Unidad de Salud Mental del Servicio Canario de la Salud. Doscientos cincuenta pacientes psiquiátricos ambulatorios consecutivos fueron invitados a participar y 191 aceptaron (76,40%). Los pacientes completaron el CollaboRATE, la Escala de Preferencias de Control (EPC), y un formulario con variables sociodemográficas y clínicas. RESULTADOS: El análisis factorial exploratorio ratificó la unidimensionalidad de la medida. Se encontró una alta consistencia interna (alfa Cronbach = 0,95; Guttman's lambda = 0,93; y omega = 0,95). Se registraron significativas correlaciones positivas (p < 0,0001) entre CollaboRATE y el EPC. Solo el 39,80% de los encuestados dieron la mejor puntuación posible en CollaboRATE. CONCLUSIONES: La versión en español de CollaboRATE es una medida fiable y válida de TDC, rápida de completar y factible para su uso en Psiquiatría comunitaria. En la actualidad, pocos pacientes psiquiátricos son involucrados en TDC. CollaboRATE puede ser una herramienta clave para evaluar e implementar la TDC en la atención psiquiátrica ambulatoria

Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE.

BACKGROUND/OBJECTIVE: CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care. METHOD: A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables. RESULTS: Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE. CONCLUSIONS: This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.

ANTECEDENTES/OBJETIVO: CollaboRATE es un autoinforme de tres ítems que permite al paciente valorar su experiencia en la toma de decisiones compartidas (TDC) sobre su tratamiento. El objetivo de este estudio fue evaluar las propiedades psicométricas de CollaboRATE en la atención comunitaria de salud mental. MÉTODO: Se realizó un estudio transversal en una Unidad de Salud Mental del Servicio Canario de la Salud. Doscientos cincuenta pacientes psiquiátricos ambulatorios consecutivos fueron invitados a participar y 191 aceptaron (76,40%). Los pacientes completaron el CollaboRATE, la Escala de Preferencias de Control (EPC), y un formulario con variables sociodemográficas y clínicas. RESULTADOS: El análisis factorial exploratorio ratificó la unidimensionalidad de la medida. Se encontró una alta consistencia interna (α Cronbach = 0,95; Guttman's λ = 0,93; y ω = 0,95). Se registraron significativas correlaciones positivas (p < 0,0001) entre CollaboRATE y el EPC. Solo el 39,80% de los encuestados dieron la mejor puntuación posible en CollaboRATE. CONCLUSIONES: La versión en español de CollaboRATE es una medida fiable y válida de TDC, rápida de completar y factible para su uso en Psiquiatría comunitaria. En la actualidad, pocos pacientes psiquiátricos son involucrados en TDC. CollaboRATE puede ser una herramienta clave para evaluar e implementar la TDC en la atención psiquiátrica ambulatoria.

The necessity-concern framework in the assessment of treatment adherence of psychiatric patients and the role of polypharmacy in a Spanish sample.

OBJECTIVE: This study compares three measures (necessity and concern scores, the necessity-concern differential, and a skeptical attitude vs. three other attitudes) for studying the relationship between the necessity-concern framework and treatment adherence after considering the number of prescribed drugs. METHODS: The sample included 588 consecutive adult psychiatric outpatients in the Canary Islands, Spain. The necessity-concern framework was assessed using a specific subscale of the Beliefs about Medicines Questionnaire. Adherence (yes/no) to 1,101 prescribed psychiatric drugs was assessed using the Sidorkiewicz adherence tool. RESULTS: In the three logistic regression models including 1,101 drugs, with adherence as the dependent variable, the highly significant odds ratios (ORs) and their 95% confidence intervals (CIs) were (a) OR = 1.57 (CI = 1.37-1.79) for necessity and OR = 0.747 (CI = 0.660-0.847) for concern; (b) OR = 1.44 (CI = 1.32-1.58) for the necessity-concern differential; and (c) OR = 0.452 (CI = 0.343-0.597) for a skeptical attitude (yes/no), defined as low necessity and high concern. In patients taking five or six drugs, adherence was associated with extremely high/low ORs for necessity, concern, and the differential. CONCLUSION: If replicated, our results suggest clinicians need to pay careful attention to each drug in each patient taking five or six drugs, emphasize necessity, and listen carefully to patient concerns.

The Equivalence between Virtual and Real Feared Stimuli in a Phobic Adult Sample: A Neuroimaging Study.

The clinical use of virtual reality (VR) has proven its efficacy, especially when used as an exposure technique. A prominent property of VR's utility is its equivalence with the reality it represents. In this study, we explored this equivalence in a clinical context using neuroimaging. A sample of 32 adults with specific phobias (i.e., to cockroaches, spiders, or lizards) was divided into two groups: One was exposed to phobic stimuli using VR and the other was exposed to real phobic images (RI). We used brain activations as a dependent measure, focusing specifically on brain areas usually associated with fear processing. Whole-brain analysis detected higher activations for RI in the hippocampus, occipital, and calcarine areas. A specific analysis of the amygdala and insula also detected higher activations and extensions in response to RI, but VR stimuli also activated those areas in a significant manner. These results suggest that even in those cases where RI stimuli activate all of the brain's fear-processing circuits, VR stimuli do so as well. This implies that VR can be useful as an exposure technique similar to RI and applied as more than a mere training mechanism.

Comparing Traditional and Digitized Cognitive Tests Used in Standard Clinical Evaluation - A Study of the Digital Application Minnemera.

The purpose of this study was to compare a new digitized cognitive test battery, Minnemera, with its correspondent traditional paper-based cognitive tests. Eighty-one healthy adults between the ages of 21 and 85 participated in the study. Participants performed the two different test versions (traditional paper-based and digitized) with an interval of four weeks between the tests. Test presentation (the order of the test versions presented) was counterbalanced in order to control for any possible test learning effects. The digitized tests were constructed so that there were only minor differences when compared to the traditional paper-based tests. Test results from the paper-based and digitized versions of the cognitive screening were compared within individuals by means of a correlation analysis and equivalence tests. The effects of demographic variables (age, gender and level of education) and test presentation were explored for each test measure and each test version through linear regression models. For each test measure, a significant correlation between traditional and digitized version was observed ranging between r = 0.34 and r = 0.67 with a median of r = 0.53 (corresponding to a large effect size). Score equivalence was observed for five out of six tests. In line with previous traditional cognitive studies, age was found to be the most prominent predictor of performance in all digitized tests, with younger participants performing better than older adults. Gender was the second strongest predictor, where women outperformed men in tests measuring verbal memory; men performed better than women in tests with a strong visual component. Finally, the educational level of the test subjects had an effect on executive functions, with a higher educational level linked to a better inhibition response and working memory span. This study suggests that the tests in the Minnemera cognitive screening battery are acceptably comparable to the traditional paper-based counterparts.

Funciones ejecutivas y ajuste clínico en adolescentes colombianos policonsumidores / Executive functions and clinical adjustment in Colombian adolescents polydrug

Resumen El estudio tuvo como objetivo analizar el funcionamiento ejecutivo y el ajuste clínico en una muestra de adolescentes colombianos policonsumidores. Se efectuó un estudio ex post facto con 204 participantes entre 12 y 17 años (M = 14,50, DT = 1,71). Se aplicó la Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales BANFE-2 y para la evaluación clínica se utilizó la Escala de Autoestima de Rosenberg, Cuestionario de Afrontamiento COPE, Escala de Impulsividad de Dickman y Cuestionario de 90 Síntomas SCL-90-R. Se identificó un rendimiento significativamente inferior del grupo policonsumidor en las funciones ejecutivas, bajos niveles de autoestima, altos niveles de impulsividad disfuncional y de diversidad psicopatológica, así como estilo de afrontamiento a través del consumo de sustancias. Así mismo, se detectó un efecto predictor de la interacción edad x tiempo de consumo en el funcionamiento ejecutivo, observándose un menor rendimiento de los policonsumidores más jóvenes a medida que se incrementaba el tiempo de consumo.

Abstract The research aim was to analyze the executive functioning and the clinical adjustment in a sample of Colombian teen polydrug users. An ex post facto study was carried out with 204 participants, 12-17 years old (M= 14,50, SD = 1,71). The neuropsychological test BANFE-2 was applied for analyzing frontal lobes and executive functioning and the Rosenberg self esteem scale, a COPE questionnaire, the Dickman impulsivity scale and the SCL-90-R questionnaire were used for clinical adjustment respectively. A lower executive functioning throughput were observed in polydrug users. Low self-esteem, high dysfunctional impulsivity, high diverse psychopathologies and coping strategies for drug use were also observed. A predictor effect between age and consumption time on the executive functioning were also determined. A lower throughput in younger polydrug users increase through consumption time.

Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach.

PURPOSE: To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients' adherence to psychopharmacological medications. METHOD: A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. RESULTS: Structural equation modeling demonstrated that psychiatric patients' treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients' trust in their psychiatrists (doctors' subscale), 3) negatively with patients' belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. CONCLUSION: This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients' adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients' psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.

Efectos del método de entrenamiento en ajedrez, entrenamiento táctico versus formación integral, en las competencias cognitivas y sociopersonales de los escolares / Effects of Chess Training Method, Comprehensive Training Versus Tactical Training, in Cognitive and Socio-Emotional Competences of Schoolchildren

Se analiza el efecto del entrenamiento en ajedrez según se utilice una metodología sensible con el desarrollo de competencias cognitivas y sociopersonales frente a otra focalizada en el entrenamiento táctico, en una muestra de educación obligatoria. Se utiliza un diseño cuasi-experimental con: grupo ajedrez 1: formación integral (n= 110); grupo ajedrez 2: formación centrada en el tablero (n= 60); y grupo de comparación: baloncesto y fútbol (n= 60). Las variables, medidas al inicio y final de curso académico, son: competencia cognitiva, evaluada mediante prueba de rendimiento; competencia socio-afectiva, mediante test auto-evaluativo; y competencia en ajedrez, mediante prueba de rendimiento. Los resultados muestran que el grupo de formación integral mejora no solo en competencias cognitivas básicas (atención y memoria), como ocurre en el grupo 2, sino también en competencias cognitivas más complejas (asociación, análisis y síntesis, planeamiento y previsión, entre otras). Igualmente mejora en el ámbito sociopersonal no solo en somatizaciones y comportamiento en clase, sino también en autoestima, motivación y actitud ante el estudio. Se concluye que los escolares que practican el ajedrez obtienen resultados significativamente superiores, en contraste con los que practican otras actividades (fútbol o baloncesto), en competencias cognitivas y sociopersonales, especialmente cuando se utiliza una metodología sensible con una formación integral.

It is analyzed the effect of chess training using a methodology focused on development of cognitive and socio-emotional competences or focused on tactical training, with a sample of compulsory education. In a quasi-experimental design: chess group 1, focused on comprehensive training (n= 110); chess group 2, focused on tactical training (n= 60); and comparison group, basketball and football activities (n= 60). Dependent variables analyzed, applied at the beginning and end of the academic course, were: cognitive competence, as assessed by performance testing; socio-emotional competence, through self-evaluation test; and chess competence, through performance test. Results showed that comprehensive training group improves not only in basic cognitive skills (attention and memory), as the group 2, but also in more complex cognitive skills (association, analysis and synthesis, planning and forecasting, etc). In socio-emotional level, not only in somatizations and classroom behavior, but also in self-esteem, motivation and attitude toward study. It is concluded that school children who practice chess obtained significantly superior results, in contrast to those who practice other activities (football or basketball), in cognitive and socio-personal skills, especially when a sensible comprehensive training methodology used.

What do psychiatric patients believe regarding where control over their illness lies? Validation of the multidimensional health locus of control scale in psychiatric outpatient care.

Patients' perceived control constructs are important factors moderating health-related behaviors. We established the psychometric properties of the Spanish version of the Form C Multidimensional Health Locus of Control Scale (C-MHLC) and assessed the usefulness of these measures in the clinical setting. A cross-sectional survey querying about patients' health locus of control (HLOC) beliefs was offered to 607 psychiatric outpatients, of whom 507 accepted. The C-MHLC scale and the General Perceived Self-Efficacy Scale were completed. The psychiatric patients believe that their psychiatrist plays a crucial role in improving their state of health. The men scored higher than the women in internal dimension; the women scored higher in other people external dimension. Age, treatment time, and number of psychoactive drugs used showed significant differences in HLOC dimensions. Self-efficacy correlated positively with internal dimension and negatively with external dimensions. The results showed the validity of the four-factor structure of the Spanish version of the C-MHLC.

Puntos de corte de la versión española del Cuestionario de Cualidades y Dificultades (SDQ) / Cutt-offs of the Spanish version of the Strength and Difficulties Questionnaire (SDQ)

INTRODUCCIÓN: El Cuestionario de Cualidades y Dificultades (SDQ) es un instrumento breve de evaluación de trastornos mentales en la infancia y la adolescencia. Ha sido desarrollado en el Instituto de Psiquiatría de Londres en los años 90. Se administra a padres y profesores con una única versión para ambos. Consta de 25 ítems y valora 5 aspectos: hiperactividad, síntomas emocionales, problemas de comportamiento, problemas de relaciones con iguales y conducta prosocial. Su sencilla administración e interpretación lo convierte en una herramienta muy útil en pediatría. Se encuentra traducido y validado en muchos idiomas, incluido el español. Es muy utilizado para estudios epidemiológicos, de despistaje y clínicos. Sus propiedades psicométricas han demostrado ser adecuadas para estos aspectos. MATERIAL Y MÉTODOS: Se recogieron las contestaciones del SDQ de padres y profesores de una muestra comunitaria de 597 niños entre 7 y 10 años, estando igualmente representados ambos sexos. Se realizó el análisis estadístico para identificar los puntos de corte. Para cada escala se determinaron los rangos de normalidad, límite y anormalidad. RESULTADOS: Los resultados obtenidos en la presente investigación revelan unos puntos de corte sensiblemente distintos a los obtenidos para las versiones en otros idiomas distintos al español. CONCLUSIONES: La traducción española se presenta como un instrumento igual de útil que el Cuestionario inglés original y el traducido a otros idiomas

INTRODUCTION: The Strengths and Difficulties Questionnaire (SDQ) was developed by Professor Robert Goodman at the Institute of Psychiatry (UK) in the 1990's. It is a brief behavioural screening instrument internationally used for the screening of mental health problems in children and adolescents. It consists in a 25 item questionnaire with 5 different scales: emotional symptoms, conduct problems, hyperactivity / inattention peer relationship problems and prosocial behaviours. Its simple administration and interpretation has made it a very useful tool in paediatrics. The SDQ has been translated and validated in more than 70 languages, these includes a Spanish version. It is widely used as an adequate tool for epidemiological, early detection and clinical studies, as demonstrated by its psychometric properties. MATERIAL AND METHODS: Parents and teachers ratings of SDQ were collected for a community-based sample of 597 children between 7 and 10 years, in which both genders were equally represented. Statistical evaluation of cutt-offs were performed. Bandings identifying normal, borderline, and clinical ranges were defined for each scale. RESULTS: The present study reveal cut off results sensibly different to those obtained in other languages.CONCLUSIONS: The Spanish translation seems to be a similarly useful tool as the original English and other languages questionnaire

Psychometric properties of the Spanish version of the Children Assertive Behavior Scale

The main goal of this study was to analyze the psychometric properties and factor structure of the Cuestionario para Evaluar la Asertividad (CEA-ESO). This questionnaire is the Spanish version of the Children’s Assertive Behavior Scale (CABS) on which students self-rate their inhibited, assertive, and aggressive relational styles. The questionnaire was administered to 640 students of Compulsory Secondary Education (CSE) aged between 11 and 16 years old, from various schools of the province of Barcelona, Spain. The homogeneity analysis carried out suggests a bidimensional structure in contrast to the tridimensional structure proposed for the original version of the CABS, that is, the CEA-ESO is effective for the discrimination of students’ assertive and aggressive behaviors, but inhibition is weakly represented. The reliability analyses of the questionnaire reveal a scale originally targeting students over 15 years of age, but with adequate internal consistency also for age groups between 12 and 14 years. The advantages of using a single instrument for the entire period of CSE are commented on. The Spanish adaptation of the CABS is considered an adequate instrument to assess assertiveness at school, but further research is required to confirm its capacity to discriminate students’ three interpersonal relational styles (AU)

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The benefits of chess for the intellectual and social-emotional enrichment in schoolchildren.

This paper examines the benefits of regularly playing chess for the intellectual and social-emotional enrichment of a group of 170 schoolchildren from 6-16 years old. It is based on a quasi-experimental design, where the independent variable was the extracurricular activity of chess (n = 170) versus extracurricular activities of soccer or basketball (n = 60). The dependent variable was intellectual and socio-affective competence, which was measured by an IQ test (WISC-R), a self-report test (TAMAI) and a hetero-report questionnaire (teacher-tutor's criterion) applied at the beginning and the end of the academic year. In contrast to the comparison group, it was found that chess improves cognitive abilities, coping and problem-solving capacity, and even socioaffective development of children and adolescents who practice it. The results are modulated, particularly in the area socioaffective, by the personal profile of students who choose practice this activity.