Adaptation and validation of the semi-structured interview for Psychological Autopsy (SSIPA) in Spanish.

OBJECTIVES: The aim of this work was to adapt and validate into Spanish the Semi-Structured Interview for Psychological Autopsy (SSIPA). METHOD: The SSIPA consists of 69 items distributed into four modules: precipitants and/or stressors, motivation, lethality, and intentionality. The original instrument was translated from Portuguese into Spanish and backtranslated by bilinguals persons. The resulting questionnaire was compared with the original and discussed by an expert panel. The adapted instrument was then applied to the relatives of 26 presumed suicide cases in Ourense (Spain) who voluntarily accepted to participate. Interviews were digitally recorded and evaluated using a decision-making algorithm by the interviewer and two independent judges blind to the results of the others. RESULTS: Interrater agreement was measured using Kappa statistics. Participation in the study (27.6%) was similar to that obtained in the original study in Brazil >(20%). The Kappa values obtained were statistically significant. Correlation index was considered good (k>0.60) or very good (k> 0.80) in 15 steps including 3 out of 4 final steps of each module and the final result of the autopsy; moderate (k> 0.40) in 8 steps, 3 of them located in the motivation's module; and weak (k> 0.20) just in 2 steps. CONCLUSIONS: The Spanish version of the SSIPA is a reliable instrument for psychological autopsy studies. Low correlation in two of the algorithm steps for decision making may be due to the lack of accuracy of the questionnaire and should be improved.

Adaptación y Validación de la Semi-Structured Interview for Psychological Autopsy (SSIPA) en Español / Adaptation and Validation of the Semi- Structured Interview for Psychological Autopsy (SSIPA) in Spanish

Introducción: Objetivo. El objetivo de este trabajo es adaptar y validar en español la Semi-structured Interview for Psychological Autopsy (SSIPA) (Entrevista Semi-Estructurada para Autopsia Psicológica). Métodos. El instrumento está constituido por 69 ítems divididos en 4 módulos: precipitantes y estresores, motivación, letalidad e intencionalidad. Se realizó traducción y retrotraducción del instrumento original, y discusión del cuestionario resultante por un grupo de expertos. El instrumento adaptado se ha empleado para entrevistar a los familiares que voluntariamente aceptaron participar de 26 personas fallecidas presumiblemente por suicidio en la provincia de Ourense. Las entrevistas fueron grabadas digitalmente y después valoradas por medio de un formulario de toma de decisiones de forma ciega por el entrevistador y por dos evaluadores independientes. Resultados. El grado de concordancia entre evaluadores se midió por medio del estadístico kappa. La participación en el trabajo (27,6%) ha sido similar a la obtenida en Brasil (20%) en el estudio original. Los valores de kappa obtenidos son estadísticamente significativos. Se considera el grado de correlación como bueno (k> 0,60) o muy bueno (k> 0,80) en 15 pasos incluyendo 3 de los 4 pasos finales de cada módulo y el resultado final de la autopsia; moderado (k> 0,40) en 8 pasos, de los que 3 se localizan en el módulo de motivación y débil (k> 0,20) en tan sólo 2 pasos. Conclusión. La versión española de la SSIPA es un instrumento fiable para la realización de autopsia psicológica. La baja concordancia en dos de los pasos del algoritmo de toma de decisiones puede deberse a falta de precisión del cuestionario y debe mejorarse (AU)

Introduction: objectives. The aim of this work was to adapt and validate into Spanish the Semi-Structured Interview for Psychological Autopsy (SSIPA). Method. The SSIPA consists of 69 items distributed into four modules: precipitants and/or stressors, motivation, lethality, and intentionality. The original instrument was translated from Portuguese into Spanish and back translated by bilinguals persons. The resulting questionnaire was compared with the original and discussed by an expert panel. The adapted instrument was then applied to the relatives of 26 presumed suicide cases in Ourense (Spain) who voluntarily accepted to participate. Interviews were digitally recorded and evaluated using a decision-making algorithm by the interviewer and two independent judges blind to the results of the others. Results. Interrater agreement was measured using Kappa statistics. Participation in the study (27.6%) was similar to that obtained in the original study in Brazil>(20%). The Kappa values obtained were statistically significant. Correlation index was considered good (k>0.60) or very good (k> 0.80) in 15 steps including 3 out of 4 final steps of each module and the final result of the autopsy; moderate (k> 0.40) in 8 steps, 3 of them located in the motivation’s module; and weak (k> 0.20) just in 2 steps.Conclusions. The Spanish version of the SSIPA is are liable instrument for psychological autopsy studies. Low correlation in two of the algorithm steps for decision making may be due to the lack of accuracy of the questionnaire and should be improved (AU)

Paradoxical recovery in a bilingual patient with aphasia after right capsuloputaminal infarction.

We report the case of a bilingual dextral patient, who presented with an uncommon pattern of aphasic deficit following a right capsulo-putaminal infarction. In this patient, the linguistic deficit concerned the use of her mother tongue (Galician, L1) much more than the lesser practised second language (Spanish, L2). Our patient presented spontaneous fluent speech in L2 but not in L1, automatic translation into L2, and impaired repetition in L1, whereas comprehension was spared in both L1 and L2. Reading and writing were less valuable due to educational interference (reduced schooling). Spontaneous speech 16 months after the stroke showed the stability of the impairment. This is the first reporting of a crossed subcortical aphasia in a bilingual patient.

Alteración en el reconocimiento de emociones faciales en un caso de demencia frontotemporal de predominio derecho / Impaired facial emotion recognition in a case of right frontotemporal dementia

Introducción. Tras la descripción de su compromiso en lesiones amigdalinas, en la última década se ha producido un creciente interés por la exploración neuropsicológica de las alteraciones del reconocimiento emocional en diferentes patologías. El propósito de nuestro trabajo ha sido demostrar por medio de una batería experimental la existencia de alteraciones en el reconocimiento emocional en un caso de demencia frontotemporal de predominio temporal derecho. Caso clínico. Se presenta un caso de demencia frontotemporal de predominio temporal derecho de 7 años de evolución, clínicamente caracterizado por alteraciones conductuales, como pérdida de hábitos higiénicos, consumo de alimentos en mal estado, aproximación a grupos marginales y otras alteraciones psiquiátricas (ideación delirante megalomaníaca). Se realiza la descripción de la exploración psiquiátrica, neurológica, neuropsicológica y de neuroimagen. Métodos. Las alteraciones del reconocimiento de emociones faciales son evaluadas por medio de una batería experimental derivada de la prueba de Ekman y Friesen (1976), comparando los resultados con los obtenidos en tres controles pareados por edad y nivel educativo. Resultados. El caso que presentamos presenta alteraciones en la discriminación, emparejamiento, selección y denominación de emociones faciales especialmente negativas (ira, miedo, tristeza y asco). El compromiso fue más llamativo en los paradigmas de selección y denominación. La emoción más afectada fue la ira. Se hipotetiza si la alteración del reconocimiento emocional podría estar en la base de determinadas alteraciones conductuales del paciente como el acercamiento a grupos marginales

Introduction. After the description of its involvement in amydalin lesions, there has been growing interest in the last decade on the neuropsychological examination of impaired emotional recognition in different diseases. This study aims to demonstrate the existence of emotional recognition impairment in a case of frontotemporal dementia affecting right temporal lobe structures with an experimental battery. Clinical case. The case of 7 year long frontotemporal dementia with right temporal predominance, clinically characterized by behavior disorders such as loss of hygiene habits, eating food in bad condition, approach to marginal groups and other psychiatric disorders (megalomanic delusional ideation) is presented. The psychiatric, neurological, neuropsychological and neuroimaging examination are described. Methods. Facial recognition impairments were assessed with a modification of Ekman and Friesen Task (1976). The results were compared with those obtained in three controls matched by age, and educational level. Results. The case we report showed marked impairment in discrimination, matching, selection and naming of negative facial emotions (anger, fear, sadness and disgust). The impairment was more striking in the selection and naming paradigms. Anger was the most affected emotion. It was hypothesized if the impairment of emotional recognition could be in the base of certain behavior disturbances of the patient such as approach to marginal groups

[Impaired facial emotion recognition in a case of right frontotemporal dementia]. / Alteración en el reconocimiento de emociones faciales en un caso de demencia frontotemporal de predominio derecho.

INTRODUCTION: After the description of its involvement in amydalin lesions, there has been growing interest in the last decade on the neuropsychological examination of impaired emotional recognition in different diseases. This study aims to demonstrate the existence of emotional recognition impairment in a case of frontotemporal dementia affecting right temporal lobe structures with an experimental battery. CLINICAL CASE: The case of 7 year long frontotemporal dementia with right temporal predominance, clinically characterized by behavior disorders such as loss of hygiene habits, eating food in bad condition, approach to marginal groups and other psychiatric disorders (megalomanic delusional ideation) is presented. The psychiatric, neurological, neuropsychological and neuroimaging examination are described. METHODS: Facial recognition impairments were assessed with a modification of Ekman and Friesen Task (1976). The results were compared with those obtained in three controls matched by age, and educational level. RESULTS: The case we report showed marked impairment in discrimination, matching, selection and naming of negative facial emotions (anger, fear, sadness and disgust). The impairment was more striking in the selection and naming paradigms. Anger was the most affected emotion. It was hypothesized if the impairment of emotional recognition could be in the base of certain behavior disturbances of the patient such as approach to marginal groups.

Validation of the Spanish version of the Addenbrooke's Cognitive Examination in a rural community in Spain.

BACKGROUND: The Addenbrooke's Cognitive Examination (ACE) is a brief cognitive test battery designed to detect and differentiate Alzheimer's disease (AD) and frontotemporal dementia (FTD). Translations of this instrument into French and Malayalam have been recently published OBJECTIVE: To adapt and validate the ACE into Spanish in a rural population of low-educational level. SUBJECTS: A clinical group, composed of 70 patients affected by dementia and 25 patients with memory complaints without dementia, was compared with 72 controls matched for gender, age and educational level METHOD: The clinical group was studied with standard neuropsychological instruments, all patients underwent neuroimaging [Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI), and Single Photon Emission Tomography (SPECT) in all cases of suspected FTD], as well as routine neurological examination. Both groups were studied with the ACE and Clinical Dementia Rating scale (CDR). Sensitivity, specificity, area under curve, reliability and Verbal-Language/ Orientation-Memory (VLOM) ratio were calculated. Subsequently, the sample was stratified regarding educational level in two groups. Receiver Operating Characteristics (ROC) curves were calculated for these conditions. Different cut-off points were calculated addressing educational level. RESULTS: ROC curves demonstrated the superiority of the ACE in the sub sample of patients that finished school at over 14 years old. VLOM ratio confirmed its usefulness for differential diagnosis between AD and FTD CONCLUSIONS: The Spanish version of the ACE is a useful instrument for dementia diagnosis. In our sample VLOM ratio results were useful for differential diagnosis between AD and FTD. Different cut-off points must be used for different educational levels.

Conscious compensations for thought insertion.

Thought insertion and other experiences of alien control have been explained as a source monitoring deficit, that results from a disconnection between a cognitive system for willed actions and a different system that monitors them. The case we present is a schizophrenic patient that in order to consciously avoid feeling his thoughts as not belonging to himself performs them as a motor act of speech. We suggest an interpretation for this conscious compensation following C. Frith's neuropsychological model of schizophrenia.

Hacia una neurobiología de los procesos de duelo / Towards neurobiology in bereavement processes

El propósito de este trabajo ha sido sugerir un nuevo armazón teórico para los procesos de duelo basado en los recientes avances en neurobiología. En ese camino hemos seguido los pasos de Bowlby tratando de integrar su teoría del vínculo con las recientes aproximaciones de LeDoux, Damasio y Rolls sobre la biología de las emociones. Para ello hemos aplicado en primer lugar la circuitería descrita por LeDoux para emociones como el miedo, hipotetizando cuáles serían las consecuencias, con respecto al proceso de duelo, de lesiones selectivas en las estructuras implicadas. Finalmente, sugerimos que estrategias corticales: cognitivas, lingüísticas y conscientes, utilizadas en el trabajo de duelo son, a medida que el duelo avanza, cada vez más eficaces a la hora de controlar emociones no conscientes elicitadas por la amígdala. Además sugerimos que el relato de las experiencias vividas durante la muerte de un ser querido funcionan de manera parecida a una desensibilización sistemática con el propósito de obtener el alivio (AU)