Humanised care in acute psychiatric hospitalisation units: Definition, values and strategic initiatives from the perspective of persons with mental health problems, primary carers and professionals.

INTRODUCTION: Humanised care refers to the holistic approach to the person, considering their bio-psycho-social and behavioural dimensions. It becomes more complex when the person has mental health problems that may affect his or her will, cognition and relationship to the world. The literature on the humanisation of mental health is scarce and only offers the view of professionals. AIM: To analyse the concept, values and strategic initiatives of humanised care in acute psychiatric units from the perspective of persons with mental health problems, carers and professionals. METHOD: Qualitative grounded-theory approach. Data were collected through focus groups and in-depth interviews among persons with mental health problems, carers and professionals. RESULTS: Thirteen focus groups and three in-depth staff interviews were performed, with a total of 61 participants. Humanised care is defined as quality care of an individualised, ethical and safe nature, empowering persons/carers to involve them in their health process, helping them resist the stigma of mental illness through a therapeutic relationship, bond and communication. Formal training, teamwork and effective communication are required. Six values and strategic initiatives were identified. DISCUSSION: Each value and strategic initiatives acquires full meaning when connected with the rest. Without this interconnection, humanised care would be impossible.

Humanization of care in acute psychiatric hospitalization units: A scoping review.

WHAT IS KNOWN ON THE SUBJECT?: Humanizing the world of health is a complex process that includes all the dimensions of the person. When a person has from a mental illness, the humanization of care becomes more important, as the disorder itself prevents the person to participate in their health process, even when showing self-harm or aggressive behaviours. These situations jointly with other factors related with professionals (insufficient ratio, inadequate treatment or lack of training) may cause the patient admitted to the acute psychiatric hospitalization unit to require the use of restrictive measures (involuntary admissions, mechanical restraints or forced administration of medication). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We identify the relevance of the perception the patient and family have regarding the care received, as well as the relevance of factors related to the professionals, among which the attitude, the staff ratio, the nursing time of direct dedication, and the therapeutic environment and safety of the patient and the professionals. All patients must be treated with dignity, respect, regardless of the aggressive manifestations caused by their pathology. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A greater understanding of the care offered to admitted people affected by a mental disorder, their families and professionals who care for them in acute mental health units, giving greater importance to "caring" and not exclusively to "curing." ABSTRACT: INTRODUCTION: Humanization in Mental Health refers to give the same relevance to the clinical needs and to the social, emotional and psychological needs. AIM: To identify the published knowledge on current care models related to the humanization of care in acute psychiatric units. METHOD: Scoping review based on the methodological model of Arksey and O'Malley, and PRISMA methodology. Database searches (Pubmed, Cinahl, Virtual Library, Cuiden, Academic Google and PsycInfo) with the terms: "Humanization," "Hospitals Psychiatric," "Emergency Psychiatric," "Psychiatric Service" and "Psychiatric intensive care units." RESULTS: Twenty-two articles met the inclusion criteria. Four thematic units were identified: aspects related to (i) patient perceptions; (ii) Government policies and hospitality organizational culture; (iii) external factors such as the environment, family or associations; and (iv) safety and security. DISCUSSION: Only one of the articles mentions the concept analysed, although all of them contribute with key aspects of healthcare humanization, such as the empowerment of the patient, the care model, the staff ratio, the therapeutic relationship, the nursing time of direct dedication to the patient, the therapeutic environment, safety and patient and staff perception of feeling safe. IMPLICATIONS FOR PRACTICE: The present study can help to improve the care offered in acute mental health units.

Differences in Screen Addiction in the Past 15 Years.

The use of information and communication technologies (ICTs) has become widespread in recent years, leading to an increase in addiction cases. A total of 118 patients who attended the Behavioral Addictions Unit of Consorci Sanitari de Terrassa (Barcelona, Spain) between October 2005 and December 2021 were included in the study. The sample was divided into three groups according to the time period in which they started treatment: between 2005 and 2010 (before the rise in new technologies, named the pre-ICT period), between 2011 and 2019 (a time of major ICT development, named the ICT period) and between 2020 and 2021 (with massive use of the internet due to effects of the pandemic, named the COVID-19 period). We found an increase in the incidence of screen addiction cases related to the development of technology throughout the study years, and this increase was accentuated during the COVID-19 period. This increase was not equal for all types of content consumed via the internet, with patients with video game addiction increasing to a greater extent than patients with internet/social network addiction. In addition, patients with video game addiction were younger and had started gaming at a younger age than those with internet/social network addiction. These results contribute to a better understanding of the phenomenon of technology addiction and to the design of appropriate treatment protocols and preventive programs.

Predictive processing in depression: Increased prediction error following negative valence contexts and influence of recent mood-congruent yet irrelevant experiences.

BACKGROUND: Novel theoretical models of depression have recently emerged based on an influential new perspective in neuroscience known as predictive processing. In these models, depression may be understood as an imbalance of predictive signals in the brain; more specifically, a dominance of predictions leading to a relative insensitivity to prediction error. Despite these important theoretical advances, empirical evidence remains limited, and how expectations are generated and used dynamically in individuals with depression remains largely unexplored. METHODS: In this study, we induced facial expression predictions using emotion contexts in 34 individuals with depression and 34 healthy controls. RESULTS: Compared to controls, individuals with depression perceived displayed facial expressions as less similar to their expectations (i.e., increased difference between expectations and actual sensory input) following contexts evoking negative valence emotions, indicating that depressed individuals have increased prediction error in such contexts. This effect was amplified by recent mood-congruent yet irrelevant experiences. LIMITATIONS: The clinical sample included participants with comorbid psychopathology and taking medication. Additionally, the two groups were not evaluated in the same setting, and only three emotion categories (fear, sadness, and happiness) were explored. CONCLUSIONS: Our results shed light on potential mechanisms underlying processing abnormalities regarding negative information, which has been consistently reported in depression, and may be a relevant point of departure for exploring transdiagnostic vulnerability to mental illness. Our data also has the potential to improve clinical practice through the implementation of novel diagnostic and therapeutic tools based on the assessment and modulation of predictive signals.

Current Addiction in Youth: Online Sports Betting.

Background: Gambling landscape has changed in recent years with the emergence of online gambling (OG). Greater accessibility and availability of this betting modality can increase the risk of developing a gambling disorder (GD). Online sports betting (OSB) is currently the most common type of OG, but little is known about the clinical characteristics of OSB compared to slot-machine (SM) gamblers, the most common offline gambling disorder. Methods: This was a prospective study conducted between October 2005 and September 2019, and included outpatients diagnosed with GD seen in a Pathological Gambling and Behavioral Addictions referral unit. Only patients with OSB and SM disorders were included. The main objective was to assess the clinical profile of OSB compared to SM gamblers, and to define clinical predictors for developing OSB gambling disorder. Logistic regression was performed to determine the effects of variables on the likelihood of this disorder. Results: Among 1,186 patients attended in our Unit during the study period, 873 patients were included; 32 (3.7%) were OSB gamblers and 841 (96.3%) were SM gamblers. Overall, mean age was 45 ± 13 years and 94.3% were men. Compared to SM patients, OSB patients were younger (34.9 ± 9.5 vs. 45.3 ±13), more frequently single (43.8 vs. 20.6%) and had a university education level (43.8 vs. 4.5%); they were also more frequently non-smokers (18.7 vs. 66.7%) and had fewer psychiatric comorbidities (12.5 vs. 29.4%) than SM gamblers. GD duration before treatment initiation was shorter in OSB patients than in SM gamblers, most of them (81.3 vs. 42.4%) with ≤ 5 years of GD duration. OSB gamblers showed significant differences in weekly gambling expenditure, spending higher amounts than SM patients. Younger age (OR: 0.919; 95% CI: 0.874-0.966), university education level (OR: 10.658; 95% CI: 3.330-34.119), weekly expenditure >100€ (OR: 5.811; 95% CI:1.544-21.869), and being a non-smoker (OR:13.248; 95% CI:4.332-40.517) were associated with an increased likelihood of OSB gambling behavior. Conclusions: We identified different profiles for OSB and SM gamblers. Younger age, university education level, higher weekly expenditure, and non-smoking habit were associated with OSB compared to SM disorders. Prevention strategies should help young people become aware of the severe risks of OSB.

Impulsivity profiles in pathological slot machine gamblers.

INTRODUCTION: In gambling disorder (GD), impulsivity has been related with severity, treatment outcome and a greater dropout rate. The aim of the study is to obtain an empirical classification of GD patients based on their impulsivity and compare the resulting groups in terms of sociodemographic, clinical and gambling behavior variables. METHODS: 126 patients with slot machine GD attending the Pathological Gambling Unit between 2013 and 2016 were included. The UPPS-P Impulsive Behavior Scale was used to assess impulsivity, and the severity of past-year gambling behavior was established with the Screen for Gambling problems questionnaire (NODS). Depression and anxiety symptoms and executive function were also assessed. A two-step cluster analysis was carried out to determine impulsivity profiles. RESULTS: According to the UPPS-P data, two clusters were generated. Cluster 1 showed the highest scores on all the UPPS-P subscales, whereas patients from cluster 2 exhibited only high scores on two UPPS-P subscales: Negative Urgency and Lack of premeditation. Additionally, patients on cluster 1 were younger and showed significantly higher scores on the Beck Depression Inventory and on the State-Trait Anxiety Inventory questionnaires, worse emotional regulation and executive functioning, and reported more psychiatric comorbidity compared to patients in cluster 2. With regard to gambling behavior, cluster 1 patients had significantly higher NODS scores and a higher percentage presented active gambling behavior at treatment start than in cluster 2. CONCLUSIONS: We found two impulsivity subtypes of slot machine gamblers. Patients with high impulsivity showed more severe gambling behavior, more clinical psychopathology and worse emotional regulation and executive functioning than those with lower levels of impulsivity. These two different clinical profiles may require different therapeutic approaches.

The efficacy of Motivational Intervention and Cognitive-Behavioral Therapy for Pathological Gambling. / Eficacia de la intervención Motivacional y la Terapia Cognitivo-conductual para el tratamiento del Juego Patológico.

The aim of the current study is to determine the effectiveness of an individual psychological intervention based on the motivational interview and cognitive-behavioral therapy for the treatment of pathological gambling. A sample of 18 participants, diagnosed of pathological gambling and without any other associated comorbidity, were assessed, attended at the publicly-funded Gambling and Behavioral Addictions Unit (Consorci Sanitari de Terrassa). Median age was 46 years (SD = 12). All the patients achieved abstinence and completed follow-up. The Screen for Gambling Problems (NODS), Quality of Life Enjoyment and Satisfaction (Q-LES-Q), Impulsive Behavior Scale (UPPS-P), Sheehan Disability Inventory (SDI), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were administered pre- and posttreatment. Results showed that patients significantly reduced the problems related to gambling behavior according to the NODS score (p < .000). Regarding impulsive behavior (UPPS-P), we found significant differences in negative urgency (p < .001), positive urgency (p < .001), (lack of) premeditation (p < .029) and (lack of) perseverance (p < .048). Some relevant aspects of quality of life as assessed by the Q-LES-Q had improved. In conclusion, the study shows that psychological intervention based on the motivational interview and cognitive-behavioral therapy not only significantly reduces gambling-related behavior problems but also leads to improvements in impulsivity and quality of life. .

El propósito del presente estudio es analizar la eficacia de una intervención psicológica individual basada en Entrevista Motivacional y Terapia cognitivo-conductual en el tratamiento del Juego Patológico, y evaluar la eficacia de esta intervención psicológica sobre la impulsividad y la calidad de vida de los pacientes. La muestra se compone de 18 pacientes atendidos en la Unidad de Juego Patológico del Consorci Sanitari Terrassa, diagnosticados de Juego Patológico, y sin comorbilidad asociada. La media de edad fue de 46 años (SD=12). Todos ellos alcanzaron la abstinencia y se encontraban en fase de seguimiento. Se administraron pre y post tratamiento los siguientes cuestionarios: Screen for Gambling Problems (NODS), Quality of Life Enjoyment and Satisfaction (Q-LES-Q), UPPS-P Impulsive Behavior Scale, Sheehan Disability Inventory (SDI), Beck Depression Inventory (BDI), State-trait Anxiety Inventory (STAI). Los resultados muestran una reducción significativa de los problemas asociados a la conducta de juego (p<.000). También se encontraron diferencias significativas en la impulsividad (UPPS-P) pre-post: urgencia negativa (p<.001), urgencia positiva (p<.001), (falta de) premeditación (p<.029) y (falta de) perseverancia (p<.048). Así mismo, hay una mejoría significativa en la calidad de vida (Q-LES-Q) de nuestros pacientes en distintas áreas. En conclusión, el estudio pone de manifiesto que la intervención psicológica basada en Entrevista Motivacional y Terapia Cognitivo-conductual permite una mejora significativa del Juego Patológico que repercute no sólo en la conducta de juego sino que también implica otros aspectos como la impulsividad y la calidad de vida.

Eficacia de la intervención Motivacional y la Terapia Cognitivo-conductual para el tratamiento del Juego Patológico / The efficacy of Motivational Intervention and Cognitive-Behavioral Therapy for Pathological Gambling

El propósito del presente estudio es analizar la eficacia de una intervención psicológica individual basada en Entrevista Motivacional y Terapia cognitivo-conductual en el tratamiento del Juego Patológico, y evaluar la eficacia de esta intervención psicológica sobre la impulsividad y la calidad de vida de los pacientes. La muestra se compone de 18 pacientes atendidos en la Unidad de Juego Patológico del Consorci Sanitari Terrassa, diagnosticados de Juego Patológico, y sin comorbilidad asociada. La media de edad fue de 46 años (SD=12). Todos ellos alcanzaron la abstinencia y se encontraban en fase de seguimiento. Se administraron pre y post tratamiento los siguientes cuestionarios: Screen for Gambling Problems (NODS), Quality of Life Enjoyment and Satisfaction (Q-LES-Q), UPPS-P Impulsive Behavior Scale, Sheehan Disability Inventory (SDI), Beck Depression Inventory (BDI), Statetrait Anxiety Inventory (STAI). Los resultados muestran una reducción significativa de los problemas asociados a la conducta de juego (p<.000). También se encontraron diferencias significativas en la impulsividad (UPPS-P) pre-post: urgencia negativa (p<.001), urgencia positiva (p<.001), (falta de) premeditación (p<.029) y (falta de) perseverancia (p<.048). Así mismo, hay una mejoría significativa en la calidad de vida (Q-LES-Q) de nuestros pacientes en distintas áreas. En conclusión, el estudio pone de manifiesto que la intervención psicológica basada en Entrevista Motivacional y Terapia Cognitivoconductual permite una mejora significativa del Juego Patológico que repercute no sólo en la conducta de juego sino que también implica otros aspectos como la impulsividad y la calidad de vida

The aim of the current study is to determine the effectiveness of an individual psychological intervention based on the motivational interview and cognitive-behavioral therapy for the treatment of pathological gambling. A sample of 18 participants, diagnosed of pathological gambling and without any other associated comorbidity, were assessed, attended at the publicly-funded Gambling and Behavioral Addictions Unit (Consorci Sanitari de Terrassa). Median age was 46 years (SD = 12). All the patients achieved abstinence and completed follow-up. The Screen for Gambling Problems (NODS), Quality of Life Enjoyment and Satisfaction (Q-LES-Q), Impulsive Behavior Scale (UPPS-P), Sheehan Disability Inventory (SDI), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were administered pre- and posttreatment. Results showed that patients significantly reduced the problems related to gambling behavior according to the NODS score (p < .000). Regarding impulsive behavior (UPPS-P), we found significant differences in negative urgency (p < .001), positive urgency (p < .001), (lack of) premeditation (p < .029) and (lack of) perseverance (p < .048). Some relevant aspects of quality of life as assessed by the Q-LES-Q had improved. In conclusion, the study shows that psychological intervention based on the motivational interview and cognitive-behavioral therapy not only significantly reduces gambling-related behavior problems but also leads to improvements in impulsivity and quality of life

Sudden gains in exposure-focused cognitive-behavioral group therapy for panic disorder.

In the context of psychological treatment, a sudden gain is a large and enduring improvement in symptom severity that occurs between two single therapy sessions. The influence of sudden gains on long-term outcomes and functional impairment in anxiety disorders is not well understood, and little is known with regard to panic disorder in particular. In addition, previous research on patients with anxiety disorders has produced inconsistent results regarding the relationship between sudden gains and cognitive change. We examined the incidence of sudden gains in a large sample (n = 116) of panic disorder patients undergoing exposure-focused cognitive-behavioral group therapy, and compared panic severity, functional impairment, and cognitive change in patients with and without sudden gains at posttreatment and 6-month follow-up. Participants who experienced sudden gains displayed lower levels of panic severity and functional impairment at posttreatment and 6-month follow-up than those who did not experience sudden gains. However, we observed no difference in cognitive changes between groups, either at posttreatment or at follow-up. Our results demonstrate that the beneficial effects of sudden gains on therapeutic outcomes not only extend to long-term and functional outcome measures but are also evident in less cognitive (i.e., exposure-focused) forms of psychological treatment. KEY PRACTITIONER MESSAGE: Sudden gains are common in panic disorder patients undergoing exposure-based cognitive-behavioral group therapy. Sudden gains during exposure-focused therapy are linked to greater improvement in panic disorder severity and functional impairment. The positive impact of sudden gains on panic disorder severity and functional impairment is maintained in the long term.

Computer-assisted cognitive remediation therapy in schizophrenia: Durability of the effects and cost-utility analysis.

The durability of computer-assisted cognitive remediation (CACR) therapy over time and the cost-effectiveness of treatment remains unclear. The aim of the current study is to investigate the effectiveness of CACR and to examine the use and cost of acute psychiatric admissions before and after of CACR. Sixty-seven participants were initially recruited. For the follow-up study a total of 33 participants were enrolled, 20 to the CACR condition group and 13 to the active control condition group. All participants were assessed at baseline, post-therapy and 12 months post-therapy on neuropsychology, QoL and self-esteem measurements. The use and cost of acute psychiatric admissions were collected retrospectively at four assessment points: baseline, 12 months post-therapy, 24 months post-therapy, and 36 months post-therapy. The results indicated that treatment effectiveness persisted in the CACR group one year post-therapy on neuropsychological and well-being outcomes. The CACR group showed a clear decrease in the use of acute psychiatric admissions at 12, 24 and 36 months post-therapy, which lowered the global costs the acute psychiatric admissions at 12, 24 and 36 months post-therapy. The CACR is durable over at least a 12-month period, and CACR may be helping to reduce health care costs for schizophrenia patients.

Correction: Predicting Response Trajectories during Cognitive-Behavioural Therapy for Panic Disorder: No Association with the BDNF Gene or Childhood Maltreatment.

[This corrects the article DOI: 10.1371/journal.pone.0158224.].

Predicting Response Trajectories during Cognitive-Behavioural Therapy for Panic Disorder: No Association with the BDNF Gene or Childhood Maltreatment.

BACKGROUND: Anxiety disorders are highly prevalent and result in low quality of life and a high social and economic cost. The efficacy of cognitive-behavioural therapy (CBT) for anxiety disorders is well established, but a substantial proportion of patients do not respond to this treatment. Understanding which genetic and environmental factors are responsible for this differential response to treatment is a key step towards "personalized medicine". Based on previous research, our objective was to test whether the BDNF Val66Met polymorphism and/or childhood maltreatment are associated with response trajectories during exposure-based CBT for panic disorder (PD). METHOD: We used Growth Mixture Modeling to identify latent classes of change (response trajectories) in patients with PD (N = 97) who underwent group manualized exposure-based CBT. We conducted logistic regression to investigate the effect on these trajectories of the BDNF Val66Met polymorphism and two different types of childhood maltreatment, abuse and neglect. RESULTS: We identified two response trajectories ("high response" and "low response"), and found that they were not significantly associated with either the genetic (BDNF Val66Met polymorphism) or childhood trauma-related variables of interest, nor with an interaction between these variables. CONCLUSIONS: We found no evidence to support an effect of the BDNF gene or childhood trauma-related variables on CBT outcome in PD. Future studies in this field may benefit from looking at other genotypes or using different (e.g. whole-genome) approaches.

Telephone Management Program for Patients Discharged From an Emergency Department After a Suicide Attempt: A 5-Year Follow-Up Study in a Spanish Population.

AIM: In a previous controlled study, the authors reported on the significant beneficial effects of a telephone intervention program for prevention of suicide attempts by patients for up to 1 year. This study reports the 5-year follow-up data. Outcomes were number of recurrences and time to recurrence. METHOD: The intervention was carried out on patients discharged from the emergency room (ER) following attempted suicide (Sabadell). It consisted of a systematic, 1-year telephone follow-up program: after 1 week, and thereafter at 1-, 3-, 6-, 9-, and 12-month intervals to assess the risk of suicide and encourage adherence to treatment. The population in the control group (Terrassa) received treatment as usual after discharge, without additional telephone contact. RESULTS: The effect of reattempt prevention observed in the first year was not maintained over the long term. CONCLUSION: A telephone management program for patients discharged from an ER after attempted suicide could be considered a useful strategy in delaying further suicide attempts and reducing the rate of reattempts in the first year. However, results showed that the beneficial effects were not maintained at the 5-year follow-up.

Predicting treatment failure in pathological gambling: the role of personality traits.

INTRODUCTION: The aim of this study was twofold: First, to assess the personality profile of treatment-seeking adult outpatients with pathological gambling compared to a matched control group under the Alternative Five Factor Model perspective, and second, to determine which personality variables would predict treatment outcome. METHODS: The final total sample consisted of 44 consecutive treatment-seeking pathological gamblers (PGs) and 88 controls paired by age and sex who completed the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Twelve months after starting an open program of individual cognitive-behavioral therapy, PGs were categorized as abstinent or treatment failure. RESULTS: PGs scored significantly higher on Neuroticism-Anxiety. Those who had relapsed or dropped out showed higher Impulsivity and Sensation Seeking scores. Impulsivity emerged as a significant predictor of treatment failure. Treatment-seeking PGs scored higher on Neuroticism-Anxiety and Impulsivity appeared as a risk factor of relapsing or dropping out. CONCLUSIONS: Our findings support the importance of individual differences in personality on therapy outcomes. The ZKPQ may constitute a useful tool to identify these individual differences that might be considered when making personalized treatment decisions to improve the effectiveness and quality of treatment interventions.

Pathological gambling: understanding relapses and dropouts.

There is little available information on the factors that influence relapses and dropouts during therapy for pathological gambling (PG). The aim of this study was to determine socio-demographic, clinical, personality, and psychopathological predictors of relapse and dropout in a sample of pathological gamblers seeking treatment. A total of 566 consecutive outpatients diagnosed with PG according to DSM-IV-TR criteria were included. All patients underwent an individualized cognitive-behavioral treatment program. We analyzed predictors of relapse during 6months of treatment and during the subsequent 6months of follow-up, and predictors of dropout over the entire therapeutic program. Eighty patients (14.1%) experienced at least one relapse during the entire follow-up of the study: 50 (8.8%) within the treatment period and 12 (2.1%) during the subsequent 6-month follow-up period. The main predictors of relapse were single marital status, spending less than 100euros/week on gambling, active gambling behavior at treatment inclusion, and high scores on the TCI-R Harm Avoidance personality dimension. One hundred fifty-seven patients (27.8%) missed 3 or more therapeutic sessions over the entire therapeutic program. The main predictors of dropout were single marital status, younger age, and high scores on the TCI-R Novelty Seeking personality dimension. The presence of these factors at inclusion should be taken into account by physicians dealing with PG patients.

Psychometric properties of the Spanish self-report version of the panic disorder severity scale.

OBJECTIVE: The goal of the study was to assess the psychometric properties and the factor structure of the Spanish self-report version of the Panic Disorder Severity Scale (PDSS-SR). METHOD: One hundred and twenty four patients meeting DSM-IV criteria for panic disorder were assessed with the Spanish PDSS-SR, the Anxiety Sensitivity Index-3 (ASI-3), the Sheehan Disability Inventory (SDI) and the Beck Depression Inventory-II (BDI-II). Cronbach's alpha was used to evaluate internal consistency. Pearson correlations were used to evaluate test-retest reliability, convergent and divergent validity. Sensitivity to change data was obtained for 91 patients that had completed a cognitive behavioural therapy. The factor structure was analysed using a confirmatory factor analysis (CFA). RESULTS: The Spanish PDSS-SR showed excellent internal consistency, good test-retest reliability and adequate convergent validity. Regarding divergent validity, the correlation with the BDI-II was larger than expected. The Spanish PDSS-SR was sensitive to change. Our CFA suggested a two-factor model for the scale. CONCLUSIONS: The Spanish PDSS-SR has similar psychometric properties as the previous versions of the PDSS-SR and it can become a useful instrument to assess panic symptoms in clinical and research settings in Spanish-speaking countries.

Computer-assisted cognitive remediation therapy: cognition, self-esteem and quality of life in schizophrenia.

BACKGROUND: Quality of life (QoL) is an important outcome in the treatment of schizophrenia. Cognitive deficits have an impact on functional outcomes. Cognitive remediation therapy is emerging as a psychological intervention that targets cognitive impairment, but the effect of computer-assisted cognitive remediation on neuropsychology and social functioning and wellbeing remains unclear. The aim of the current study is to investigate the neurocognitive outcomes of computer-assisted cognitive remediation (CACR) therapy in a sample of schizophrenia patients, and to measure the quality of life and self-esteem as secondary outcomes. METHODS: Sixty-seven people with schizophrenia were randomly assigned to computer-assisted cognitive remediation or an active control condition. The main outcomes were neuropsychological measures and secondary outcomes (self-esteem and quality of life). Measurements were recorded at baseline and post-treatment. RESULTS: The CACR therapy group improved in speed of processing, working memory and reasoning and problem-solving cognitive domains. QoL and self-esteem measures also showed significant improvements over time in this group. CONCLUSIONS: Computer-assisted cognitive remediation therapy for people with schizophrenia achieved improvements in neuropsychological performance and in QoL and self-esteem measurements.

The role of personality in the prediction of treatment outcome in pathological gamblers: a follow-up study.

The aim of the present study was to determine which domains in NEO Personality Inventory-Revised would predict relapse and dropout in treatment-seeking slot-machine pathological gamblers after 1-year follow-up. The NEO PI-R was completed by 73 consecutive treatment-seeking outpatients before they began an open program of individual cognitive-behavioral therapy. Twelve months after starting treatment, patients were categorized in groups as abstinent versus relapsed or completers versus dropouts. At 1-year follow-up, 29% of patients were abstinent, and 48% had completed treatment. Those who had relapsed showed higher significant scores on Neuroticism and lower scores on Conscientiousness. The dropout group scored significantly higher on Neuroticism and lower on Agreeableness and Conscientiousness than the completer group. Low scores on Conscientiousness emerged as a significant predictor of relapse; while low scores on Conscientiousness and Agreeableness were significant predictors of dropout. It seems as if low Conscientiousness could be considered as a predictor of treatment failure measured by either relapses or dropouts, whereas, low Agreeableness seems to be a prognostic domain specifically for dropouts. Pathological gamblers with lower Conscientiousness and lower Agreeableness seem to be at risk of prematurely dropping out of treatment. Our findings support the importance of individual differences in personality on therapy outcomes. The NEO PI-R may constitute an important tool to identify treatment-seeking pathological gamblers who may be at risk of relapsing or dropping out of treatment.

Effectiveness of a telephone management programme for patients discharged from an emergency department after a suicide attempt: controlled study in a Spanish population.

OBJECTIVE: To determine the effectiveness over one year of a specific telephone management programme on patients discharged from an emergency department (ED) after a suicide attempt. We hypothesized that the programme will reduce the percentage of patients re-attempting suicide and delay the time between attempts. DESIGN: A multicentre, case-control, population-based study. The effect of the 1-year intervention on the main outcome measures was evaluated with respect to a 1-year baseline period and a control group. SETTING: Two hospitals with distinct catchment areas in Catalonia (Spain). PARTICIPANTS: A total of 991 patients discharged from the ED of either hospital after a suicide attempt during the baseline year and the intervention year. INTERVENTION: The intervention was carried out on patients discharged from the ED for attempted suicide (Sabadell). It consisted of a systematic, one-year telephone follow-up programme: after 1 week, thereafter at 1, 3, 6, 9 and 12-month intervals, to assess the risk of suicide and increasing adherence to treatment. The population in the control group (Terrassa) received treatment as usual after discharge, without additional telephone management. MAIN OUTCOME MEASURES: Time elapsed between initial suicide attempt and subsequent one, and changes in the annual rate of patients who reattempted suicide in the year of the intervention and the preceding one. RESULTS: The telephone management programme delayed suicide reattempts in the intervention group compared to the baseline year (mean time in days to first reattempt, year 2008=346.47, sd=4.65; mean time in days to first reattempt, year 2007=316.46, sd=7.18; P<0.0005; χ²=12.1, df=1) and compared to the control population during the same period (mean time in days to first reattempt, treatment period=346.47, sd=4.65; mean time in days to first reattempt, pre-treatment period=300.36, sd=10.67; P<0.0005; χ²=16.8, df=1). The intervention reduced the rate of patients who reattempted suicide in the experimental population compared to the previous year (Intervention 6% (16/296) v Baseline 14% (39/285) difference 8%, 95% confidence interval 2% to 12%) and to the control population (Intervention 6% (16/296) v Control 14% (31/218) difference 8%, -13% to -2%) LIMITATIONS: One of the main obstacles was the difficulty to contact all patients within the established deadlines. Another limitation of our study was that patients under the age of 18 underwent an intensive intervention in the day hospital, although their number was very small (13/319 in 2008) and did not significantly influence the results. But the main limitation of our study was that it was performed within the EAAD project. This project includes a comprehensive multilevel intervention practically in the same experimental area and aimed at an early diagnosis and treatment of depression, which is the main psychiatric disorder associated with suicide. Moreover, longer-term studies should be encouraged to determine whether such interventions really reduce suicide CONCLUSION: A telephone management programme for patients discharged from an ED after a suicide attempted would be a useful strategy in delaying further suicide attempts and in reducing the rate of reattempts, which is known as the highest risk factor for suicide completion.