A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare.

BACKGROUND: Determining the mental capacity of psychiatric patients for making healthcare related decisions is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make medical care decisions. METHODS: Systematic review of review articles following PRISMA recommendations. PubMed, Scopus, CINAHL and PsycInfo were electronically searched up to 31 January 2020. Free text searches and medical subject headings were combined to identify literature reviews and meta-analyses published in English, and summarising studies on the capacity of patients with serious mental illnesses to make healthcare and treatment related decisions, conducted in any clinical setting and with a quantitative synthesis of results. Publications were selected as per inclusion and exclusion criteria. The AMSTAR II tool was used to assess the quality of reviews. RESULTS: Eleven publications were reviewed. Variability on methods across studies makes it difficult to precisely estimate the prevalence of decision-making capacity in patients with mental disorders. Nonetheless, up to three-quarters of psychiatric patients, including individuals with serious illnesses such as schizophrenia or bipolar disorder may have capacity to make medical decisions in the context of their illness. Most evidence comes from studies conducted in the hospital setting; much less information exists on the healthcare decision making capacity of mental disorder patients while in the community. Stable psychiatric and non-psychiatric patients may have a similar capacity to make healthcare related decisions. Patients with a mental illness have capacity to judge risk-reward situations and to adequately decide about the important treatment outcomes. Different symptoms may impair different domains of the decisional capacity of psychotic patients. Decisional capacity impairments in psychotic patients are temporal, identifiable, and responsive to interventions directed towards simplifying information, encouraging training and shared decision making. The publications complied satisfactorily with the AMSTAR II critical domains. CONCLUSIONS: Whilst impairments in decision-making capacity may exist, most patients with a severe mental disorder, such as schizophrenia or bipolar disorder are able to make rational decisions about their healthcare. Best practice strategies should incorporate interventions to help mentally ill patients grow into the voluntary and safe use of medications.

[Evaluation of the psychometric properties of the Spanish version of 5 questionnaires for the evaluation of post-traumatic stress syndrome]. / Evaluación de las propiedades psicométricas de la versión española de cinco cuestionarios para la evaluación del trastorno de estrés postraumático.

AIM: To determine the psychometric properties of the Spanish versions of the following scales for assessing PTSD patients: TQ, CAPS-DX, DTS, TOP-8, and DGRP. METHODS: Data from 63 PTSD patients and 23 healthy subjects were analysed. Internal consistency and test-retest reliability (after 15 days) were calculated. Convergent validity was analysed by correlating subjects' scores with the number of symptoms (DSM-IV) and scores on the CGI scale. Discriminative capability was analysed by comparing TQ, CAPS-DX, DTS, TOP-8, and DGRP patients' scores with scores from healthy subjects, and between patients' subgroups according to the presence or absence of psychiatric comorbidity and to the degree of severity as determined by the CGI-S. RESULTS: CAPS-DX, DTS, TOP-8, and DGRP showed an adequate internal consistency (Cronbach alpha: 0.74-0.91) and all of them obtained ICC between 0.77 and 0.93. The five questionnaires were able to discriminate between patients and healty subjects, and between the patients' subgroups. CONCLUSIONS: The Spanish versions of the TQ, CAPS-DX, DTS, TOP-8, and DGRP have shown adequate reliability and validity for assessing PTSD patients in daily clinical practice. CAPS-DX seems to be more adequate a diagnostic and DTS a severity rating scale.

[Neuropsychic injury: neuropsychological evaluation]. / Daño neuropsíquico: evaluación neuropsicológica.

Traditionally assessment of cognitive function has not been employed adequately in our medical community. In the last two decades the neuropsychological assessment has experimented an evolution in order to improvement in specificity and sensitivity. In this paper we present a compendium of neuropsychological test that could be evaluate cognitive function adequately.

Evaluación de las propiedades psicométricas de la versión española de cinco cuestionarios para la evaluación del trastorno de estrés postraumático / Evaluation of the psychometric properties of the Spanish version of five questionnaires for the assessment of post-traumatic stress disorders

Objetivo: Evaluar las propiedades psicométricas de la versión española de los instrumentos de medida TQ, CAPSDX, DTS, TOP-8 y DGRP para su uso en la investigación y la práctica asistencial con pacientes que padecen trastorno de estrés postraumático (TEPT). Métodos: 63 pacientes diagnosticados de TEPT y 23 individuos sanos fueron reclutados y valorados. Se analizó la fiabilidad en términos de consistencia interna y test-retest (a los 15 días). La validez concurrente se analizó mediante análisis correlacionales con el número de síntomas según criterios DSM-IV y la escala CGI. La validez discriminante se evaluó comparando la puntuación obtenida en los cuestionarios de evaluación de TEPT entre pacientes y controles y entre subgrupos de pacientes según presencia de trastornos psiquiátricos concomitantes y el estado de salud en la escala CGI. Resultados: Todas las subescalas de los cinco cuestionarios mostraron una adecuada consistencia interna (alfa de Cronbach: 0,74-0,91), excepto el cuestionario TQ y los criterios B y C del cuestionario TOP-8. Además, todas mostraron adecuada fiabilidad test-retest (CCI= 0,77-093), excepto la subescala del criterio D del cuestionario TOP-8. Los cinco cuestionarios discriminaron entre pacientes y controles y entre subgrupos de pacientes según comorbilidad y el nivel de gravedad medido mediante la escala CGI. Conclusiones: La versión española de los cuestionarios TQ, CAPS-DX, DTS, TOP-8 y DGRP ha mostrado poseer adecuada fiabilidad y validez en la evaluación de pacientes con TEPT, aunque la entrevista CAPS-DX parece ser más adecuada para ayuda diagnóstica y el cuestionario DTS para la evaluación en la práctica asistencial habitual. (AU)

Daño neuropsíquico: evaluación neuropsicológica / Neuropsychic injury: Neuropsychological evaluation

En la práctica clínica diaria, en nuestro medio hospitalario, la exploración de las funciones cognitivas es muy somera y casi nunca se llega a valorar de forma exhaustiva la totalidad de las funciones superiores. En las últimas dos décadas los procedimientos de la neuropsicología han evolucionado hacia una mayor sensibilidad y especificidad, en su papel de apoyo al diagnóstico clínico. En este trabajo presentamos distintas pruebas que con una alta fiabilidad pueden valorar el estado de los pacientes que sufren un deterioro sintomático o ideopático de sus capacidades cognoscitivas (AU)

El CAMDEX-R en la evaluación clínica de las demencias / CAMDEX-R in the clinical evaluation of dementias

El CAMDEX ha sido de gran utilidad tanto para estudios clínicos como epidemiológicos en el campo de las demencias. Sin embargo, la evolución de los conocimientos sobre este tema comporta que en la actualidad este instrumento presente ciertas limitaciones. Una reciente versión, el CAMDEX-R, ha adaptado e introducido los elementos suficientes para satisfacer las necesidades actuales. El presente trabajo describe los cambios y las nuevas aportaciones que se han realizado en el instrumento (AU)

Violence in inpatients with schizophrenia: a prospective study.

Accurate evaluations of the dangers posed by psychiatric inpatients are necessary, although a number of studies have questioned the accuracy of violence prediction. In this prospective study, we evaluated several variables in the prediction of violence in 63 inpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder. Nurses rated violent incidents with the Overt Aggression Scale. During hospitalization, sociodemographic variables, clinical history, neurological soft signs, community alcohol or drug abuse, and electroencephalographic abnormalities did not differ between violent and nonviolent groups. Violent patients had significantly more positive symptoms as measured by the Positive and Negative Syndrome Scale (PANSS), higher scores on the PANSS general psychopathology scale, and less insight in the different constructs assessed. A logistic regression was performed to discriminate between violent and nonviolent patients. Three variables entered the model: insight into symptoms, PANSS general psychopathology score, and violence in the previous week. The actuarial model correctly classified 84.13 percent of the sample; this result is significantly better than chance for the base rate of violence in this study. At hospital admission, clinical rather than sociodemographic variables were more predictive of violence. This finding has practical importance because clinical symptoms are amenable to therapeutic approaches. This study is the first to demonstrate that insight into psychotic symptoms is a predictor of violence in inpatients with schizophrenia.