Motivaton for change as a predictor of treatment response for dysthymia / Motivación para el cambio como predictor de la respuesta terapéutica en la distimia

OBJECTIVE: Dysthymia constitutes a chronic, mild affective disorder characterized by heterogeneous treatment effects. Several predictors of clinical response and attendance have been postulated, although research on the role of the psychological variables involved in this mental disorder is still scarce. METHOD: Fifty-four adult patients, who met criteria for dysthymia completed an ongoing naturalistic treatment based on the brief interpersonal psychotherapy (IPT-B), which was delivered bimonthly over 16 months. As potential predictor variables, the therapeutic alliance, coping strategies, perceived self-efficacy, and motivation for change were measured at baseline. Outcome variables were response to treatment (Clinical Global Impression and Beck's Depression Inventory) and treatment attendance. RESULTS: stepwise multiple linear regression analyses revealed that higher motivation for change predicted better response to treatment. Moreover, higher motivation for change also predicted treatment attendance. Therapeutic alliance was not a predictor variable of neither clinical response nor treatment attendance. CONCLUSIONS: These preliminary findings support the adjunctive use of motivational interviewing (MI) techniques in the treatment of dysthymia. Further research with larger sample size and follow-up assessment is warranted

OBJETIVO: la distimia constituye un trastorno afectivo crónico caracterizado por una respuesta heterogénea al tratamiento. Se han postulado diversas variables predictoras de dicha respuesta terapéutica, aunque la investigación acerca del papel de las variables psicológicas es todavía escasa. MÉTODO: cincuenta y cuatro pacientes diagnosticados de distimia completaron un tratamiento naturalístico bimensual de 16 meses de duración basado en la psicoterapia interpersonal. Como posibles variables predictoras se evaluó al inicio del tratamiento la alianza terapéutica, las estrategias de afrontamiento, la autoeficacia percibida y la motivación para el cambio. Las variables de tratamiento fueron la respuesta terapéutica (Escala de Impresión Clínica Global e Inventario de Depresión de Beck) y la adherencia terapéutica. RESULTADOS:los análisis de regresión múltiple indicaron que una mayor motivación para el cambio predijo una mejor respuesta al tratamiento. Por otra parte, una mayor motivación para el cambio también predijo una mayor adherencia al tratamiento. La alianza terapéutica no fue una variable predictora ni de la respuesta ni de la adherencia al tratamiento. CONCLUSIONES: estos resultados preliminares apoyan el uso complementario de la entrevista motivacional en el tratamiento de la distimia. Son necesarios estudios adicionales con un mayor tamaño muestral y evaluaciones adicionales durante el seguimiento postratamiento

Motivation for change as a predictor of treatment response for dysthymia.

OBJECTIVE: Dysthymia constitutes a chronic, mild affective disorder characterized by heterogeneous treatment effects. Several predictors of clinical response and attendance have been postulated, although research on the role of the psychological variables involved in this mental disorder is still scarce. METHOD: Fifty-four adult patients, who met criteria for dysthymia completed an ongoing naturalistic treatment based on the brief interpersonal psychotherapy (IPT-B), which was delivered bimonthly over 16 months. As potential predictor variables, the therapeutic alliance, coping strategies, perceived self-efficacy, and motivation for change were measured at baseline. Outcome variables were response to treatment (Clinical Global Impression and Beck’s Depression Inventory) and treatment attendance. RESULTS: Stepwise multiple linear regression analyses revealed that higher motivation for change predicted better response to treatment. Moreover, higher motivation for change also predicted treatment attendance. Therapeutic alliance was not a predictor variable of neither clinical response nor treatment attendance. CONCLUSIONS: These preliminary findings support the adjunctive use of motivational interviewing (MI) techniques in the treatment of dysthymia. Further research with larger sample size and follow-up assessment is warranted.

Traumatismo craneoencefálico en pacientes con síndrome psicótico: etiopatogenia y estatus nosológico / Traumatic brain injury in patients with psychotic syndrome: etiopathogenesis and nosological status

Introducción. Uno de los debates nosológicos más controvertidos en el ámbito de la Neuropsiquiatría versa sobre el diagnóstico diferencial entre psicosis adquiridas e idiopáticas"(esquizofrenia) en pacientes que previamente han sufrido un traumatismo craneoencefálico (TCE). Caso clínico. Se expone el caso de un varón de 15 años, sin antecedentes psiquiátricos personales ni familiares, que a los 5 meses de sufrir un TCE con pérdida de conciencia desarrolló un síndrome psicótico crónico caracterizado por sintomatología positiva, siendo ésta resistente a todos los tratamientos psicofarmacológicos prescritos. No se evidenció lesión cerebral focalizada a través de neuroimagen estructural. Discusión. El TCE puede actuar como agente etiopatogénico primario (psicosis debida a un TCE) o precipitante (esquizofrenia) en los cuadros psicóticos manifestados. Los dos criterios externos que contribuyen en mayor medida a la distinción de ambos trastornos son la escasa sintomatología negativa y la baja vulnerabilidad genética entre las personas con psicosis debida a un TCE. Con relativa frecuencia, tanto el periodo de latencia TCE-psicosis como los correlatos neurocognitivos y neurobiológicos asociados apenas permiten esclarecer el estatus nosológico del síndrome psicótico. Son necesarios ensayos clínicos controlados para valorar la eficacia de los antipsicóticos en aquellos sujetos con psicosis debida a un TCE (AU)

Introduction. One of the most controversial nosological issues in neuropsychiatry deals with the differential diagnosis between acquired and idiopathic psychosis (schizophrenia) in patients who have previously undergone a traumatic brain injury (TBI). Case report. A 15 year-old man, without personal or family psychiatric history, developed a chronic syndrome characterized by positive psychotic symptoms 5 months after suffering a TBI with loss of consciousness. The syndrome was refractory to all psychopharmacological treatments prescribed. There was no brain alteration detected through structural imaging. Discussion. TBI may play a role either as primary etiopathogenic agent (psychosis due to TBI) or as triggering factor (schizophrenia) in the development of psychotic symptoms. Fewer negative symptoms as well as lower genetic vulnerability contribute to differentiate the former group from the latter one. Usually, neither the latency period between TBI-psychosis onset nor the neurocognitive and neurobiological correlates allow to clarify the nosological status. Further controlled clinical trials are needed to assess the efficacy of antipsychotics in those subjects with psychosis due to TBI (AU)

Acerca del papel de los organismos de inspección médica en la evolución de las personas con problemas de salud mental / No disponible

No disponible

Evaluación y tratamiento ambulatorio de la acumulación compulsiva en un paciente con patología del espectro psicótico / Evaluation and outpatient treatment of compulsive hoarding in a patient with psychotic spectrum disorder

Introducción: los pacientes con acumulación compulsiva primaria tienden a presentar escasa adherencia y respuesta al tratamiento conductual ambulatorio, desconociéndose el papel que la patología comórbida del espectro psicótico pudiera ejercer en su abordaje terapéutico. Así mismo, la valoración de su gravedad y evolución clínica suele hallarse limitada a autoinformes. Caso clínico: se expone el caso de un varón de mediana edad, con antecedentes de acumulación compulsiva de 30 años de evolución, que desarrolló posteriormente un trastorno esquizoafectivo. Tras la implementación de psicoterapia conductual monitorizada en el domicilio por la pareja, se objetivó una remisión parcial de la acumulación compulsiva al cabo de 12 meses de tratamiento ambulatorio. Conclusiones: el uso de fotografías constituye una herramienta evaluativa que permite determinar con mayor precisión el diagnóstico clínico y la evolución de los sujetos con acumulación compulsiva. La presencia de sintomatología negativa comórbida debe estimular la supervisión de las pautas psicoterapéuticas en el propio domicilio del paciente (AU)

Introduction: patients with primary compulsive hoarding normally have a poor adherence and response to outpatient behavioral treatment, not knowing the role that comorbid psychotic spectrum psychopathology could exercise in its therapeutic approach. Likewise, the assessment of its severity and clinical course is usually limited to self-reports. Case report: we describe the case of a middle-aged male with a 30 years evolution of compulsive hoarding, which subsequently developed schizoaffective disorder. After implementing behavioral therapy monitored at home by the couple, a partial remission of compulsive hoarding was obtained during 12 months of outpatient treatment. Discussion: the use of photographs is an assessment tool for determining more accurately the clinical diagnosis and the evolution of patients with compulsive hoarding. The presence of comorbid negative symptoms should stimulate psychotherapeutic supervision in patient’s home (AU)

Estatus nosológico de la acumulación compulsiva: ¿subtipo de trastorno obsesivo-compulsivo o entidad clínica independiente? / Nosological status of compulsive hoarding: obsessive-compulsive disorder subtype or independent clinical entity

En el presente estudio teórico se revisan los principales hallazgos e investigaciones respecto al estatus nosológico de la acumulación compulsiva. En concreto, se exponen las evidencias empíricas disponibles para poder determinar su independencia o no del trastorno obsesivo compulsivo (TOC), patología mental donde tradicionalmente ha sido incluida como un subtipo o dimensión más de la misma. En relación a esta cuestión, los resultados recogidos en la literatura científica sostienen que las personas con acumulación compulsiva, a diferencias de "otros" sujetos con TOC, presentan características distintivas en diversos criterios externos, a saber: variables sociodemográficas, personalidad premórbida, grado de insight, factores genéticos y neuroanatómicos, correlatos neuropsicológicos, curso y nivel de disfuncionalidad y, por último, respuesta al tratamiento. Dichas conclusiones son discutidas valorando la propuesta de creación de una nueva entidad clínica denominada "trastorno por acumulación"

This theoretical study reviews the main research and findings on the nosological status of compulsive hoarding. Specifically, it describes available empirical evidence in order to determine their independence or inclusion within the obsessive-compulsive disorder (OCD), a mental disorder in which it has traditionally been included as one more subtype or dimension. Regarding this issue, the results found in the scientific literature show that persons with compulsive hoarding have distinct characteristics indifferent external criteria like sociodemographic variables, premorbid personality, degree of insight, neuroanatomical and genetic factors, neuropsychological profile, clinical course, levels of dysfunctionality and finally, treatment outcome. These conclusions are discussed and the proposal for the creation of a new clinical entity called "hoarding disorder" is evaluated

Nosological status of compulsive hoarding: obsessive-compulsive disorder subtype or independent clinical entity.

This theoretical study reviews the main research and findings on the nosological status of compulsive hoarding. Specifically, it describes available empirical evidence in order to determine their independence or inclusion within the obsessive-compulsive disorder (OCD), a mental disorder in which it has traditionally been included as one more subtype or dimension. Regarding this issue, the results found in the scientific literature show that persons with compulsive hoarding have distinct characteristics in different external criteria like sociodemographic variables, premorbid personality, degree of insight, neuroanatomical and genetic factors, neuropsychological profile, clinical course, levels of dysfunctionality and finally, treatment outcome. These conclusions are discussed and the proposal for the creation of a new clinical entity called "hoarding disorder" is evaluated.

Trauma, posttraumatic stress disorder and psychosis: Etiopatho-genic and nosological implications

Background and Objectives: The relationship between trauma, post-traumatic stress disorder (PTSD), and psychosis has promoted heterogeneous research lines, in both etiopathogenic and nosological areas. The main aim of this review is to provide a systematic framework that encompasses this theoretical gap in the literature. Methods: A literature research was carried out through PubMed and PsycINFO between 1980 and May 2013. One hundred and thirteen articles were recruited. A first part of this review describes the role of trauma in the development of psychosis. The second part focuses on research about PTSD and psychosis. Results: Longitudinal and cross-sectional studies with clinical and community samples confirm that childhood trauma (CT) is a vulnerability factor for schizophrenia and psychotic-like symptoms in adulthood. More empirical research is needed in order to assess the role of trauma as precipitant of acute psychosis. There is also preliminary evidence with cross-sectional samples that suggests that PTSD and psychosis are a risk factor for each other, with studies about post-psychotic PTSD (PP-PTSD) being outstanding. Finally, results from different comparative research studies postulate a subtype of PTSD with psychotic features (PTSD-SP). Conclusions: The role of trauma in psychosis is more conclusive as predispositional rather than as trigger factor. Nosological status of acute psychoses remains a focus of controversy unresolved. The association between PTSD and psychosis is complex, requiring more prospective research in order to determine causal relationships between these pathologies. Also, research in nosological status of PTSD-SP must encourage more comparative studies not limited to neurobiological variables (AU)

No disponible

[Comorbidity between obsessive-compulsive disorder and schizophrenia: prevalence, explanatory theories, and nosological status]. / Comorbilidad entre trastorno obsesivo-compulsivo y esquizofrenia: prevalencia, teorías explicativas y estatus nosológico.

This theoretical study reviews the main findings and research on comorbidity between obsessive-compulsive disorder (OCD) and schizophrenia. On the one hand, it is argued that high prevalence of comorbidity implies common risk factors (neuroanatomical and neuropsychological correlates) and a causal relationship between these mental illnesses, OCD usually preceding schizophrenia. On the other hand, independent nosological status of this "comorbidity" is supported on the basis of several external criteria (negative symptomatology, depressed mood, psychosocial impairment, neurobiological and neuropsychological correlates), which distinguish this mixed clinical entity from OCD and schizophrenia separately. These conclusions are discussed, considering the lack of recognition of "schizo-obsessive disorder" within the current diagnosis reference manuals.

Comorbilidad entre trastorno obsesivo-compulsivo y esquizofrenia: prevalencia, teorías explicativas y estatus nosológico / Comorbidity between obsessive-compulsive disorder and schizophrenia: Prevalence, explanatory theories, and nosological status

En el presente estudio teórico se revisan los principales hallazgos e investigaciones sobre la comorbilidad entre trastorno obsesivo-compulsivo (TOC) y esquizofrenia. Por una parte, se señala que la alta prevalencia de esta comorbilidad obedece tanto a factores de riesgo comunes (correlatos neuroanatómicos y neuropsicológicos) como a una relación causal entre ambas patologías mentales, precediendo generalmente el TOC a la psicosis. Por otro lado, se sostiene el estatus nosológico independiente de esta comorbilidad sobre la base de diversos criterios externos (sintomatología negativa, humor depresivo, disfuncionalidad psicosocial, correlatos neurobiológicos y neuropsicológicos), los cuales diferencian esta entidad clínica mixta de la esquizofrenia y el TOC por separado. Dichas conclusiones son discutidas considerando la falta de reconocimiento nosológico del denominado "trastorno esquizo-obsesivo"

This theoretical study reviews the main findings and research on comorbidity between obsessive compulsive disorder (OCD) and schizophrenia. On the one hand, it is argued that high prevalence of comorbidity implies common risk factors (neuroanatomical and neuropsychological correlates) and a causal relationship between these mental illnesses, OCD usually preceding schizophrenia. On the other hand, independent nosological status of this "comorbidity" is supported on the basis of several external criteria (negative symptomatology, depressed mood, psychosocial impairment, neurobiological and neuropsychological correlates), which distinguish this mixed clinical entity from OCD and schizophrenia separately. These conclusions are discussed, considering the lack of recognition of "schizo-obsessive disorder" within the current diagnosis reference manuals

Eventos traumáticos en pacientes con trastorno obsesivocompulsivo: implicaciones etiopatogénicas, nosológicas y terapéuticas / Traumatic events in patients with obsessive-compulsive disorder: Etiopathogenic, nosological, and therapeutic implications

INTRODUCCIÓN. El trastorno obsesivo-compulsivo (TOC) es una patología neuropsiquiátrica en donde se propugna un papel accesorio de los factores de riesgo psicosociales. A pesar de ello, existe un subgrupo de pacientes cuya etiopatogenia, fenomenología, diagnóstico y terapéutica se halla condicionada por la presencia de eventos traumáticos (ET). CASO CLÍNICO. Se expone el caso de una mujer adulta joven que desarrolló una psicopatología compatible con TOC y trastorno por estrés postraumático (TEPT) tras sufrir abusos sexuales durante la adolescencia temprana. Aunque se implementaron tratamientos farmacológicos y psicoterapéuticos convencionales, su curso fue fluctuante, exacerbándose en el contexto de una nueva agresión sexual. CONCLUSIONES. Los ET constituyen un factor de riesgo inespecífico para el TOC, ya sea como variable predisponente o precipitante. Adicionalmente, pueden determinar su patoplastia, siendo el ejemplo más paradigmático la presencia de obsesiones de “polución mental” tras sufrir abusos sexuales. A nivel nosológico, existen evidencias preliminares para postular una entidad clínica nueva (“trastorno obsesivo-compulsivo postraumático”), la cual englobe aquellos sujetos con comorbilidad entre TOC y TEPT tras un ET. En el plano interventivo, los pacientes con obsesiones de “polución mental” precisan estrategias psicoterapéuticas adicionales a las implementadas en sus homólogos de naturaleza más neurobiológica (AU)

INTRODUCTION. Obsessivecompulsive disorder (OCD) is a neuropsychiatric condition where an accessory role of psychosocial risk factors is advocated. However, there is a subgroup of obsessive patients whose etiology, phenomenology, diagnosis and therapeutic features are conditioned by the presence of traumatic events (TE). CLINICAL CASE. A young adult woman developed OCD and posttraumatic stress disorder (PTSD) after suffering sexual abuse during early adolescence. Although psychotropic and psychotherapeutic conventional treatments were implemented, the course was fluctuating, exacerbated in the context of a new sexual assault. CONCLUSIONS. TE constitute a nonspecific risk factor for OCD, either predisposing or precipitating variable. Additionally, they can determine their pathoplasty, the best example being the presence of “mental pollution” obsessions after suffering sexual abuse. There is preliminary evidence to postulate a new clinical entity (“posttraumatic obsessive-compulsive disorder”), which encompasses subjects with OCD and PTSD comorbidity after TE. Obsessions in patients with “mental pollution” require additional psychotherapeutic strategies compared to neurobiological homonyms (AU)

Anticonceptivos orales en pacientes con psicopatología alimentaria: implicaciones etiopatogénicas y terapéuticas / Oral contraceptives in patients with eating psychopathology: Etiopathogenic and therapeutic implications

Introducción: El papel de los anticonceptivos orales (ACO) en el ámbito de la psiquiatría apenas ha sido objeto de atención clínica. En concreto, existe una ínfima literatura científica respecto a su rol en la etiopatogenia y terapéutica de la psicopatología alimentaria. Caso clínico: Se expone el caso de una mujer de 16 años que desarrolla una anorexia nerviosa tras la administración de un ACO para el tratamiento de un hirsutismo hiperandrogénico leve. Con la implementación de terapia cognitivo-conductual y psicofarmacológica (ISRS) se objetivó una restauración del peso, encapsulándose las cogniciones anorexígenas y remitiendo las conductas alimentarias disfuncionales. Conclusiones: El estudio de los ACO en el ámbito de la psicopatología alimentaria se halla en fase embrionaria, postulándose la regulación androgénica como principal variable mediadora de esta asociación. En pacientes con anorexia nerviosa, es preceptivo implementar investigaciones longitudinales, dadas las pruebas preliminares que sugieren la participación de los ACO como factor de riesgo psicopatológico, ya sea a través de la disminución de los niveles de testosterona y/o del mayor temor a engordar entre aquellas usuarias con ganancia ponderal tras su administración(AU)

Introduction: The role of oral contraceptives (OC) in psychiatry illness has been object of little attention. In particular, there is scarce scientific literature regarding its influence in the pathogenesis and treatment of eating psychopathology. Clinical case: We describe the case of a 16 yearsold woman, who developed an anorexia nervosa after the administration of an OC for the treatment of a mild hyperandrogenic hirsutism. After the implementation of cognitive-behavioral and psychopharmacological (SSRI) interventions, weight restoration was attained, disappearing anorectic cognitions and dysfunctional eating behaviors. Conclusions: The study of OC in eating psychopathology is in an early stage, being androgenic regulation postulated as main factor mediating this association. In patients with anorexia nervosa, is mandatory carrying out longitudinal research, given preliminary evidence suggesting the involvement of OC as a risk factor, either through decreased levels of testosterone or greater fear of gaining weight among those users with weight gain after its administration(AU)

Manía unipolar crónica. A propósito de un caso / Chronic unipolar mania. A case report

Introducción. El trastorno bipolar es una patología mental de naturaleza fásica, caracterizada por la presencia de episodios (hipo) maníacos, depresivos y/o mixtos que se suceden a lo largo del curso de la enfermedad. Caso clínico. Se expone el caso de un varón de mediana edad, sin antecedentes de episodios depresivos, que inició en la adolescencia un cuadro de características maniformes de 18 años de evolución. A pesar de los numerosos tratamientos farmacológicos prescritos, no se apreció mejoría alguna, presentando un curso tórpido, tendente a la cronicidad. Conclusiones. La manía unipolar crónica es una entidad clínica representada de una manera residual en la nosología psiquiátrica actual. Su ínfima prevalencia dificulta la investigación orientada a dilucidar su naturaleza subordinada o independiente del trastorno bipolar. Se hace necesaria una evaluación sistematizada de la efectividad de la terapia electroconvulsiva con estos pacientes (AU)

Introduction. Bipolar disorder is a phasic mental disorder characterized by the presence of (hypo) maniac, depressive and/or mixed episodes during the course of the disease. Clinical case. A middle-age man, with no prior history of depressive episodes, began to suffer a picture of manic characteristics as an adolescent that has lasted for 18 years. Despite the numerous drug treatments prescribed, there has been no improvement, and the disorder has followed a torpid and chronic course. Conclusions. Chronic unipolar mania is a clinical entity appearing as a residual characteristic in the current psychiatric nosology. Its low prevalence makes it difficult to carry out research aimed at elucidating whether it has a subordinate or independent relationship with the bipolar disorder. A systematic assessment of the effectiveness of electroconvulsive therapy is needed in these patients (AU)

Chronic unipolar mania. A case report.

INTRODUCTION: Bipolar disorder is a phasic mental disorder characterized by the presence of (hypo) maniac, depressive and/or mixed episodes during the course of the disease. CLINICAL CASE: A middle-age man, with no prior history of depressive episodes, began to suffer a picture of manic characteristics as an adolescent that has lasted for 18 years. Despite the numerous drug treatments prescribed, there has been no improvement, and the disorder has followed a torpid and chronic course. CONCLUSIONS: Chronic unipolar mania is a clinical entity appearing as a residual characteristic in the current psychiatric nosology. Its low prevalence makes it difficult to carry out research aimed at elucidating whether it has a subordinate or independent relationship with the bipolar disorder. A systematic assessment of the effectiveness of electroconvulsive therapy is needed in these patients.