Particularidades del funcionamiento afectivo-motivacional de pacientes prediabéticos / Particularities of the motivational and affective functioning in prediabetic patients

Introducción: La prevención en el progreso de la prediabetes hacia la diabetes, debe hacerse desde un enfoque holístico y considerar el funcionamiento afectivo - motivacional de quienes la padecen. Objetivo: Determinar las particularidades del funcionamiento afectivo - motivacional de pacientes prediabéticos. Métodos: Se desarrolló un estudio exploratorio descriptivo con metodología mixta, se integraron los análisis cuantitativo y cualitativo; la muestra quedó conformada por 10 sujetos prediabéticos. Para la pesquisa se realizó el análisis psicológico de los pacientes, según su historia clínica y se aplicaron el Registro de la Actividad. Método Directo e Indirecto (RAMDI), la Escala Dembo-Rubinstein, las Técnicas de Completamiento de Frases y de Composición, así como la entrevista semiestructurada. Resultados: Los sujetos prediabéticos no se reconocen como enfermos, no valoran los riesgos que contraen por esa condición y no se comprometen con un cambio de estilo de vida. Conclusiones: En los pacientes prediabéticos la categoría salud no es un motivo rector que oriente y regule su conducta de modo estable; predominó la actitud de «no aceptación de la enfermedad», con una marcada tendencia a la autovaloración inadecuada que limita la responsabilidad personal ante la condición mórbida.

Introduction: the prevention of the progression from prediabetes to diabetes must be done from a holistic approach considering the motivational and affective functioning of the patients who suffer from this condition. Objective: to determine the particularities of the motivational and affective functioning of prediabetic patients. Methods: a descriptive exploratory study was carried out with a mixed-method research where quantitative and qualitative analyzes were integrated; the sample was made up of 10 prediabetic subjects. A psychological assessment was made based on their clinical history and the Register of the Activity. Direct and Indirect Method (RAMDI in Spanish), the Dembo-Rubinstein Scale, the Sentence Completion and the Composition Techniques, as well as the semi-structured interview were applied for screening. Results: the prediabetic subjects do not recognize themselves as sick, do not value the risks they incur with their condition, and do not commit to a lifestyle change. Conclusions: health category in prediabetic patients is not a guiding motive that guides and regulates their behaviour in a stable way; a predominance of an attitude of "non-acceptance of the disease", with a marked tendency to inadequate self-assessment that limited personal responsibility for the morbid condition.

Prevalence of psychological symptoms and associated risk factors in a Spanish sample of HIV-positive youth compared to uninfected peers.

INTRODUCTION: The aim of the study was twofold: a) to determine the prevalence of symptoms of depression and anxiety and sleep disturbances in young patients with vertically-transmitted HIV infection compared to uninfected peers, and b) to identify sociodemographic, psychosocial and medication-related variables and other clinical risk and protective factors related to psychological symptoms. METHODS: We conducted a cross-sectional study in two groups with independent measures (36 youth with vertically transmitted HIV infection and 39 HIV-negative peers). We used 3 standardised assessment tools and a sociodemographic/psychosocial questionnaire (STAI, BDI, PSQI and adapted sociodemographic test). We performed univariate and multivariable analyses. RESULTS: The univariate analysis did not find significant differences between groups either in psychosocial factors or in the clinical scores. The multivariable analysis found that the presence of psychological symptoms was strongly associated with sociodemographic factors and past events. CONCLUSIONS: Psychosocial factors and the social environment seemed to correlate more strongly to psychological symptoms than HIV status and to explain better the current psychological state of individuals.

Prevalencia y factores de riesgo de síntomas psicológicos en una muestra española de jóvenes con VIH en comparación con pares no infectados / Prevalence of psychological symptoms and associated risk factors in a Spanish sample of HIV-positive youth compared to uninfected peers

Introducción: Los objetivos principales del estudio fueron dos: a)identificar la prevalencia de síntomas depresivos y de ansiedad y trastornos del sueño en pacientes jóvenes con infección por VIH de transmisión vertical en comparación con un grupo de pares no infectados, y b)identificar factores sociodemográficos, psicosociales y relacionados con la medicación y otros factores de riesgo y protectores relacionados con los síntomas psicológicos. Métodos: Estudio transversal en dos grupos con medidas independientes: 36 sujetos con VIH (transmisión vertical) y 39 sin VIH (no infectados). Se emplearon tres instrumentos de evaluación estandarizados y un cuestionario sociodemográfico/psicosocial (STAI, BDI, PSQI y test sociodemográfico adaptado). Se realizó análisis univariante y multivariante. Resultados: El análisis univariante no reveló diferencias significativas entre los dos grupos en las variables psicosociales o las escalas clínicas. El análisis multivariante encontró que los síntomas psicológicos se asociaban con fuerza a factores sociodemográficos y experiencias del pasado. Conclusiones: El entorno y las variables psicosociales parecen estar asociados más estrechamente con los síntomas psicológicos que el estado de VIH y podrían explicar mejor el estado psicológico actual del individuo. (AU)

Introduction: The aim of the study was twofold: (i)to determine the prevalence of symptoms of depression and anxiety and sleep disturbances in young patients with vertically-transmitted HIV infection compared to uninfected peers, and (ii)to identify sociodemographic, psychosocial and medication-related variables and other clinical risk and protective factors related to psychological symptoms. Methods: We conducted a cross-sectional study in two groups with independent measures (36 youth with vertically transmitted HIV infection and 39 HIV-negative peers). We used three standardised assessment tools and a sociodemographic/psychosocial questionnaire (STAI, BDI, PSQI and adapted sociodemographic test). We performed univariate and multivariable analyses. Results: The univariate analysis did not find significant differences between groups either in psychosocial factors or in the clinical scores. The multivariable analysis found that the presence of psychological symptoms was strongly associated with sociodemographic factors and past events. Conclusions: Psychosocial factors and the social environment seemed to correlate more strongly to psychological symptoms than HIV status and to explain better the current psychological state of individuals. (AU)

Longitudinal impact of caregiver transition and family caregiving on psychiatric symptoms and psychosocial functioning among persons with schizophrenia in rural China.

This study examines the 21-year longitudinal impacts and predictive effects of family caregiver transition and the presence of family caregiving on the clinical status of persons with schizophrenia (PwSs) in a rural area of China. Using panel data derived from the Chengdu Mental Health Project (CMHP), 250 dyads of PwSs and their family caregivers were investigated in 1994 and 2015. The Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) were utilized. The generalized linear model (GLM) approach was used. The results of this study showed that more severe symptoms in PwSs were found to be significantly predicted by older age and nonmarried status at baseline. Compared with "spousal caregiving in two waves," the PANSS score was significantly higher in the "transition into sibling caregiving" group. A higher degree of psychosocial functioning was found to be significantly predicted by marital status, shorter duration of illness, and better mental status. Compared with "spousal caregiving in two waves," the GAF score was significantly lower in the "transition into parental caregiving" group. The presence of family caregiving was not a significant predictor of the severity of symptoms or psychosocial functioning in the PwSs. In conclusion, this study shows the 21-year predictive effects of family caregiver transition on the mental status of PwSs but not the presence of family caregiving. Psychosocial interventions and specific guidance should be provided to family caregivers to enhance their quality of caregiving and improve the prognosis of PwSs during long periods of home care.

En este estudio se analizan los efectos longitudinales a 21 años y los efectos pronósticos de la transición de los cuidadores familiares y la presencia de cuidado familiar en el estado clínico de las personas con esquizofrenia en un área rural de China. Utilizando datos de panel extraídos del Proyecto de salud mental de Chengdu (Chengdu Mental Health Project, CMHP), se investigaron 250 díadas de personas con esquizofrenia y sus cuidadores familiares en 1994 y 2015. Se utilizó la Escala de síndrome positivo y negativo (Positive and Negative Syndrome Scale, PANSS) y la Evaluación global del funcionamiento (Global Assessment of Functioning, GAF). También se utilizó el método de modelo lineal generalizado. Los resultados de este estudio demostraron que los síntomas más intensos en las personas con esquizofrenia fueron pronosticados principalmente por la edad avanzada y el estado de soltería en el momento basal. En comparación con el grupo de "cuidado de los cónyuges en dos intervalos", el puntaje de la PANSS fue considerablemente más alto en el grupo de "transición al cuidado de los hermanos". Se descubrió que principalmente el estado civil, la duración más corta de la enfermedad y un mejor estado mental pronosticaron un grado más alto de funcionamiento psicosocial. En comparación con el grupo de "cuidado de los cónyuges en dos intervalos", el puntaje de la GAF fue considerablemente más bajo en el grupo de "transición al cuidado de los padres". La presencia de cuidado familiar no fue un factor pronóstico importante de la intensidad de los síntomas ni del funcionamiento psicosocial en las personas con esquizofrenia. En resumen, en este estudio se muestran los efectos pronósticos a 21 años de la transición de los cuidadores familiares en el estado mental de las personas con esquizofrenia, pero no la presencia de cuidado familiar. Deben ofrecerse intervenciones psicosociales y orientación específica a los cuidadores familiares para mejorar su calidad de cuidado y mejorar el pronóstico de las personas con esquizofrenia durante los periodos prolongados de cuidado en el hogar.

Validación de instrumentos para medir percepciones y comportamientos vinculados al SARS-COV 2 en Bolivia / Instrument validation for SARS-COV 2 related perception and behavior measurement

INTRODUCCIÓN: la pandemia COVID-19 ha sido un evento misceláneo, que afectó la percepción de los individuos como sujetos y las relaciones intersubjetivas, el estado como referente de representación/identidad se vio trastocado, y las condiciones de salud/enfermedad se externalizaron como resultados de las relaciones sociales, Los trastornos del estado de ánimo, el marcaje social y el miedo son efectos predecibles, por lo que conocer instrumentos validados disponibles para estudiarlos cobra relevancia. OBJETIVO PRINCIPAL: evaluar la validez del DASS-21, FCV-19S y el cuestionario de estigma COVID-19 en el medio urbano boliviano. MÉTODO: este trabajo examina la validez de tres instrumentos: DASS-21, FCV-19S y una traducción al español del cuestionario COVID-19 Stigma, para el contexto urbano boliviano, en un estudio piloto en la ciudad de Cochabamba compuesto por 30 sujetos aleatorizados, basado en el alfa de Cronbach y el análisis factorial. RESULTADOS: después de considerar el contexto, se encontró consistencia interna y validez en el cuestionario DASS-21 y Estigma, bajo condiciones sociodemográficas similares a las del piloto. CONCLUSIÓN: los instrumentos validados son aptos para su aplicación en Bolivia, con las consideraciones adecuadas para optimizar su efectividad.

INTRODUCTION: COVID-19 pandemic has been a miscellaneous event, affecting individuals' perception as subjects and intersubjective relations, the state as a referent of representation/identity was disrupted, and health/disease conditions were externalized as results of social relations, Mood disorders, social marking and fear are predictable effects, which is why knowing available validated instruments to study them becomes relevant. Main objective: Asses the validity of DASS-21, FCV-19S y the COVID-19 Stigma questionnaire in urban Bolivian setting. METHOD: this paper examines the validity of three instruments: DASS-21, FCV-19S and a Spanish translation of the COVID-19 Stigma questionnaire, for urban Bolivian context, on a pilot study in Cochabamba city comprised by 30 randomized subjects, based on Cronbach's alpha and factorial analysis. RESULTS: after considering context, internal consistency and validity was found on DASS-21 and Stigma questionnaire, under sociodemographic conditions similar to those of the pilot. CONCLUSIONS: the validated instruments are apt to apply in Bolivia, with proper considerations to optimize effectiveness.

Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis.

INTRODUCTION: Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS: In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS: We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS: The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.

Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis / Exploración de la estructura factorial de la escala Mini-ICF-APP en una muestra clínica de pacientes hospitalizados con arreglo al diagnóstico psiquiátrico

Introduction Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. Materials and methods In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. Results We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. Conclusions The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.(AU)

Introducción El funcionamiento psicosocial es un factor clave que determina el pronóstico, la gravedad, el deterioro y la calidad de vida de las personas con trastornos mentales. La escala Mini-ICF-APP fue desarrollada para aportar una clasificación estandarizada del funcionamiento e incapacidad. Sin embargo, a pesar de su creciente popularidad, se conoce poco su estructura y desempeño. Este documento examina la estructura de Mini-ICF-APP, utilizando técnicas de análisis factoriales. Materiales y métodos En una muestra clínica de 3.178 pacientes, con diagnósticos psiquiátricos de diversas categorías ICD-10, analizamos la consistencia interna, inter-correlaciones de ítems y estructura factorial de los datos, con referencia a las categorías diagnósticas ICD-10, trastornos neurocognitivos, trastornos de abuso de alcohol, trastornos de consumo de substancias, esquizofrenia y trastornos psicóticos, trastorno bipolar, trastorno depresivo mayor, trastorno depresivo, trastornos de ansiedad, trastornos de personalidad y trastornos neuroevolutivos. Resultados Encontramos buena consistencia interna e inter-correlaciones de ítems (alfa de Cronbach=0,92) para Mini-ICF-APP. Pudimos identificar dominios fundamentales (flexibilidad, asertividad y relaciones íntimas), que demostraron influencias subumbrales en otros dominios. El análisis factorial produjo un modelo unifactorial ideal para la muestra total y para todas las categorías diagnósticas. Para algunas de estas, los datos sugirieron un modelo de dos o tres factores, aunque, sin embargo, con peores índices de ajuste. Conclusiones La estructura factorial de la escala Mini-ICF-APP parece modificarse con arreglo a los principales diagnósticos. Sin embargo, un modelo unifactorial demuestra un mejor ajuste, independientemente de la categoría diagnóstica. Por tanto, ... (AU)

Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis.

INTRODUCTION: Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS: In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS: We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS: The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.

[Prevalence of psychological symptoms and associated risk factors in a Spanish sample of HIV-positive youth compared to uninfected peers]. / Prevalencia y factores de riesgo de síntomas psicológicos en una muestra española de jóvenes con VIH en comparación con pares no infectados.

INTRODUCTION: The aim of the study was twofold: (i)to determine the prevalence of symptoms of depression and anxiety and sleep disturbances in young patients with vertically-transmitted HIV infection compared to uninfected peers, and (ii)to identify sociodemographic, psychosocial and medication-related variables and other clinical risk and protective factors related to psychological symptoms. METHODS: We conducted a cross-sectional study in two groups with independent measures (36 youth with vertically transmitted HIV infection and 39 HIV-negative peers). We used three standardised assessment tools and a sociodemographic/psychosocial questionnaire (STAI, BDI, PSQI and adapted sociodemographic test). We performed univariate and multivariable analyses. RESULTS: The univariate analysis did not find significant differences between groups either in psychosocial factors or in the clinical scores. The multivariable analysis found that the presence of psychological symptoms was strongly associated with sociodemographic factors and past events. CONCLUSIONS: Psychosocial factors and the social environment seemed to correlate more strongly to psychological symptoms than HIV status and to explain better the current psychological state of individuals.

Psychometric study of the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG). / Estudio psicométrico de la Escala de valoración de los Niveles de Atención Requerida para personas con Trastorno Mental Grave (ENAR-TMG).

INTRODUCTION: People with severe mental disorder have significant difficulties in everyday life that involve the need for continued support. These needs are not easily measurable with the currently available tools. Therefore, a multidimensional scale that assesses the different levels of need for care is proposed, including a study of its psychometric properties. METHOD: One-hundred and thirty-nine patients (58% men) with a severe mental disorder were assessed using the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG), the Camberwell Assessment of Need scale, and the Health of the Nation Outcome Scales. ENAR-TMG's psychometric features were examined by: a) evaluating 2 sources of validity evidence (evidence based on internal structure and evidence based on relations to other variables), and b) estimating the internal consistency, temporal stability, inter-rater reliability, and sensitivity to change of scores of the ENAR-TMG's subscales. RESULTS: Exploratory factor analyses revealed a one-factor structure for each of the theoretical dimensions of the scale, in which all but one showed a significant and positive correlation with the Camberwell Assessment of Need (range of r: 0.143-0.557) and Health of the Nation Outcome Scales (range of r: 0.241-0.474) scales. ENAR-TMG subscale scores showed acceptable internal consistency (range of ordinal α coefficients: 0.682-0.804), excellent test-retest (range of intraclass correlation coefficients: 0.889-0.999) and inter-rater reliabilities (range of intraclass correlation coefficients: 0.926-0.972), and satisfactory sensitivity to treatment-related changes (range of η2: 0.003-0.103). CONCLUSIONS: The satisfactory psychometric behaviour of the ENAR-TMG makes the scale a promising tool to assess global functioning in people with a severe mental disorder.

Adherence predicts symptomatic and psychosocial remission in schizophrenia: Naturalistic study of patient integration in the community. / La adherencia predice la remisión sintomática y psicosocial en esquizofrenia: estudio naturalístico de la integración de los pacientes en la comunidad.

INTRODUCTION: Psychosocial functioning in patients with schizophrenia attended in daily practice is an understudied aspect. The aim of this study was to assess the relationship between symptomatic and psychosocial remission and adherence to treatment in schizophrenia. METHODS: This cross-sectional, non-interventional, and multicenter study assessed symptomatic and psychosocial remission and community integration of 1,787 outpatients with schizophrenia attended in Spanish mental health services. Adherence to antipsychotic medication in the previous year was categorized as≥80% vs.<80%. RESULTS: Symptomatic remission was achieved in 28.5% of patients, and psychosocial remission in 26.1%. A total of 60.5% of patients were classified as adherent to antipsychotic treatment and 41% as adherent to non-pharmacological treatment. During the index visit, treatment was changed in 28.4% of patients, in 31.1% of them because of low adherence (8.8% of the total population). Adherent patients showed higher percentages of symptomatic and psychosocial remission than non-adherent patients (30.5 vs. 25.4%, P<.05; and 32 vs. 17%, P<.001, respectively). Only 3.5% of the patients showed an adequate level of community integration, which was also higher among adherent patients (73.0 vs. 60.1%, P<.05). CONCLUSIONS: Adherence to antipsychotic medication was associated with symptomatic and psychosocial remission as well as with community integration.

Emotion regulation and Residual Depression Predict Psychosocial Functioning in Bipolar Disorder: Preliminary Study / Regulación de las emociones y la depresión residual predicen el funcionamiento psicosocial en el trastorno bipolar: estudio preliminar

This study explores the predictive value of various clinical, neuropsychological, functional, and emotion regulation processes for recovery in Bipolar Disorder. Clinical and demographic information was collected for 27 euthymic or residually depressed BD participants. Seventy one percent of the sample reported some degree of impairment in psychosocial functioning. Both residual depression and problems with emotion regulation were identified as significant predictors of poor psychosocial functioning. In addition, to residual depression, the results of the current study introduce a variable of emotion dysregulation to account for poor psychosocial functioning among BD populations. Improving emotion regulation strategies, in particular, concentration and task accomplishment during negative emotional states could have important consequences for improving overall psychosocial functioning among this population, helping to reduce both the economic burden and high costs to personal wellbeing associated with BD.

Este estudio explora el valor predictivo de los diversos procesos de regulación clínicos, neuropsicológicos, funcionales y emocionales para la recuperación en el Trastorno Bipolar. La información clínica y demográfica se recogió de 27 participantes de TB eutímicos o residualmente deprimidos. Setenta y uno por ciento de la muestra reportó algún grado de deterioro en el funcionamiento psicosocial. Tanto la depresión residual y problemas con la regulación de las emociones fueron identificados como predictores significativos de mal funcionamiento psicosocial. Además de la depresión residual, los resultados del presente estudio introducen una variable de disregulación emocional para dar cuenta del pobre funcionamiento psicosocial en las poblaciones de TB. La mejora de las estrategias de regulación emocional, en particular, la concentración y la realización de tareas durante los estados emocionales negativos podrían tener consecuencias importantes para mejorar el funcionamiento psicosocial global en esta población ayudando a reducir tanto la carga económica y los altos costos para el bienestar personal asociado con TB.

Organización vital de una muestra clínica que demanda atención psicológica / Life Functioning among a Clinical Sample Demanding Psychological Treatment

La asociación entre trastornos psicopatológicos y variables de funcionamiento psicosocial ha sido documentada, pero son escasos los estudios que evalúan su impacto sobre la eficacia de los tratamientos psicológicos. El objetivo de este estudio fue evaluar la organización vital de 78 pacientes de un servicio de atención psicológica y examinar la relación con variables clínicas y con el éxito del tratamiento. Esta organización se evaluó mediante una escala confeccionada ad hoc para este estudio. El área de pareja resultó la menos organizada frente a la familiar y personal, con las mayores puntuaciones. La organización vital se relacionó de forma significativa con distintos ejes del DSM-IV-TR. Se confirmó que pacientes con baja organización vital requieren un mayor número de objetivos terapéuticos.

The association between psychological disorders and psychosocial functioning variables has been previously documented, but relatively few studies have examined the impact of these variables on psychological treatment outcomes. The aim of this study was to assess the life functioning of 78 patients from a psychological service centre, and to examine its relationship with clinical variables and treatment success. Life functioning was evaluated with a scale elaborated ad hoc for this study. The partner area of functioning was the most impaired while family and personal areas obtained the highest functioning scores. Patient's life functioning was significantly associated with several axis of DSM-IV-TR. It was confirmed that patients with poorer life functioning required a greater number of treatment objectives.

Remisión sintomática y recuperación funcional en pacientes que padecen esquizofrenia / Symptomatic remission and recovery in patients with schizophrenia

A recently proposed definition for remission and recovery in schizophrenia is receiving increased attention by clinicians and researchers. The interest on these issues is based on the recent proposed definition for symptomatic remission, and the development of operational criteria for its assessment, by the Remission in Schizophrenia Working Group (RSWG), in the United States, in 2005. Remission is assessed using eight items of the Positive and Negative Syndrome Scale (PANSS), all of which have to be scored with a symptom severity of <3 points (mild or better), sustained for a minimum duration of six months. In Europe, since 2006, proposed definition criteria about response and remission were introduced. Response can be assessed, with the PANSS, using a cut-off of at least 50% reduction of the baseline score for the acutely ill, and a cut-off of at least of 25% reduction for refractory patients. Remission could be assessed using a formula for calculating percentage PANSS reduction from baseline. Definition criteria have also been introduced to assess functional recovery that includes the combination of clinical and social outcomes for two consecutive years, including dimensions such as psychosocial functioning, cognition, and quality of life. The purpose of this review is to examine existing research on symptomatic remission and functional recovery in schizophrenia. We included clinical and epidemiological studies, reviews and meta-analyses published between January 1970 and July 2013. Sixty two studies on remission and recovery were included, with a total of 94 940 patients, comprising six months to 37 years follow-up. Thirty two studies on functional recovery were included, with a total of 6 483 patients with a range of six months to 42 years follow-up. Research indicates that symptomatic remission can be achieved in 20-97%, and functional recovery in 10-68% of people with schizophrenia. The use of remission and recovery criteria has ...

Recientemente los conceptos de remisión sintomática y recuperación funcional en los pacientes que padecen esquizofrenia han recibido una considerable atención por parte de los clínicos y los investigadores. El interés en estos aspectos tiene que ver con la propuesta realizada en el 2005 por el "Grupo de trabajo para evaluar la remisión en esquizofrenia", con el objetivo de proponer una definición de remisión sintomática, así como el desarrollo de criterios operacionales para su evaluación. La remisión sintomática se evalúa utilizando ocho reactivos de la escala PANSS, los cuales deben puntuar tres o menos, con una duración mínima de seis meses de remisión. En Europa, desde el 2006, también se han propuesto criterios para evaluar la respuesta al tratamiento, así como la remisión sintomática. La remisión se puede evaluar usando una fórmula para calcular el porcentaje de reducción de síntomas desde el inicio del tratamiento de acuerdo al PANSS. También se han desarrollado criterios para evaluar la recuperación funcional que incluyen la combinación de aspectos clínicos y psicosociales, que se deben mantener por lo menos por dos años consecutivos, incluyendo dimensiones como el funcionamiento psicosocial, el funcionamiento cognitivo y la calidad de vida. En el presente artículo se revisa la investigación respecto a los conceptos de remisión sintomática y recuperación funcional en los pacientes afectados por esta patología, incluyendo estudios clínicos, epidemiológicos, estudios de revisión y meta-análisis publicados entre enero de 1970 a julio de 2013. Se incluyeron 62 estudios sobre remisión sintomática/recuperación funcional, con un total de 94 940 pacientes, con un seguimiento de seis meses a 37 años. También se incluyeron 32 estudios de recuperación funcional, con un total de 6 483 pacientes, con un seguimiento de dos a 42 años. Los resultados indican que entre el 20 y el 97% de los pacientes pueden lograr la remisión sintomática, mientras que entre el 10 y el 68% alcanzan la recuperación funcional. Se ha recomendado el uso de estos criterios en la práctica clínica y en la investigación científica.

Funcionamiento psicosocial en los trastornos de la conducta alimentaria: Ansiedad social, alexitimia y falta de asertividad / Psychosocial functioning in eating disorders: Social anxiety, alexithymia and lack of assertiveness

Existe una gran cantidad de información concluyente sobre el déficit del funcionamiento psicosocial en las pacientes con trastornos de la conducta alimentaria (TCA). Objetivo: Describir la evidencia acerca de la influencia de la ansiedad social, la alexitimia y la falta de asertividad como factores predisponentes, desencadenantes y perpetuantes de la sintomatología de los TCA y el deterioro de las conductas y/o actitudes sociales de pacientes portadoras de anorexia nerviosa y/o bulimia nerviosa. Método: Revisión exhaustiva de la literatura especializada nacional e internacional. Resultados: La ansiedad social que puede manifestarse como fobia social (evitación del contacto interpersonal), la alexitimia (dificultad para identificar y/o expresar sentimientos y sensaciones) que puede asociarse principalmente a la depresión y la falta de asertividad (discapacidad en la competencia social para confrontar los eventos comunicacionales) alcanzan cifras de prevalencia significativamente más altas en las pacientes alimentarias comparadas con sujetos controles. Conclusiones: La evidencia apoya la interferencia significativa en las habilidades sociales, en el manejo terapéutico y en el desenlace de las pacientes con TCA relacionada con estas comorbilidades. Es imperativo su identificación y abordaje clínico precoz para prevenir la aparición de los TCA.

There is a great conclusive amount of information about the deficit of psychosocial functioning in eating disordered patients. Objective: To describe the evidence on the influence of social anxiety, alexithymia and lack of assertiveness as predisposing, triggering and perpetuating factors of eating disorders (ED) symptomatology and the impairment of social behaviors and/or attitudes in patients suffering from anorexia nervosa and/or bulimia nervosa. Method: An exhaustive review of the national and international specialized literature was made. Results: Social anxiety that may become a social phobia (avoidance of interpersonal contact), alexithymia (difficulty to identify and/or express feelings and sensations) that may be associated to depression and lack of assertiveness (discapacity in social competence to confront communicational events) reach significatively higher prevalence rates in eating disordered patients compared to control subjects. Conclusions: The evidence supports the significant interference in social skills, in the therapeutic management and in the outcome of eating disordered patients related to these comorbidities. It is imperative its early identification and clinical approach in order to prevent the emergence of ED.

Funcionamiento psicosocial de pacientes esquizofrénicos de acuerdo con su consumo de alcohol

resumen está disponible en el texto completo

Summary Background: Between 1% and 1.5% of the world population is affected by schizophrenia. In Mexico, it has been estimated that between 619,550 and 1,239,101 (1-2%) individuals suffered from schizophrenia in 2000. The condition is more common among male teenagers and young adults. The main features of schizophrenia are the positive and negative symptoms closely associated with a psychosocial functioning impairment. In addition, between 25% and 80% of the psychiatric population uses addictive substances, with alcohol, at 50%, being one of the most highly used. These substances use is closely associated with a poor psychosocial functioning; when alcohol use is accompanied by schizophrenia, psychosocial functioning is even more disrupted. In the last few years, it has been shown that an early reinsertion of schizophrenic individuals into their social and familial environment causes a lesser degree of impairment in their psychosocial functioning. This functioning is evaluated through the acquisition of new skills to move about in familial, social and work environments. The latter is called psychosocial treatment. In this sense, psychosocial functioning is described as each individual's ability to adapt, function, move about and interact in a social and personal environment. This functioning evaluates the social, occupational, economic, sexual and familial areas. Objective: The objective of this study was to establish the association between schizophrenic patients' psychosocial functioning according to their alcohol use and the severity of schizophrenia. Methodology: Eighty schizophrenic, psychiatrically stable, subjects were selected during a 14-month period of time. All of them were submitted only once to the Psychosocial Functioning Scale (PFS), the Composite International Diagnostic Interview (CIDI), the Positive and Negative Symptoms Scale (PANSS) and the Alcohol Use Disorders Identification Test (AUDIT). These scales were used in order to confirm the schizophrenia diagnostic and its severity, to measure the psychosocial functioning of this population, to identify early on problems related to alcohol use and to perform an alcohol use/dependency diagnostic on those individuals who met such diagnostic criteria. A Chi squared, Mann-Whitney's U, the t test, Kruskal-Wallis and the one-way ANOVA were used for statistical analysis purposes. Results: Seventy-one percent of the subjects were males and 29% females; 87% were single and 70% were unemployed or had an informal job. Thirty-one years was the average age among males and 34 among females. Subjects started suffering schizophrenia when they were between 12 and 30 years (average: 23 years; SD: 6.36), and 94% of them started using alcohol while they were at this very same age range (average: 20 years; SD: 4. 98). Seventy-six percent of the subjects presented a schizophrenia evolution of less than ten years. Comparing alcohol use with psychosocial functioning according to the AUDIT, the social and familial were the more affected areas, both of which showed statistically significant differences. As to the period of evolution of schizophrenia and psychosocial functioning, the 16-20 year group was the one which showed less satisfaction. Schizophrenia severity did not show any statistical significance when compared to the type of alcohol use. Conclusion: Results from this research are similar to those from other Mexican and international studies which have found out that schizophrenia onset is more common during teenage, that more men than women are affected by the condition and that most subjects suffer it first when they are between 16 and 25 years. On the other hand, it has been found out that alcohol use is starting at increasingly early ages, with men being the main users. Such an association has lead many researchers to think that schizophrenia onset is highly associated with alcohol use, be it because the negative symptoms of schizophrenia promote the initial use of alcohol or because alcohol use triggers the early onset of schizophrenia. In this study it was not possible to prove such an hypothesis given the reduced number of subjects in the sample. This was not either the main objective of the study and given the fact that some other type of methodology is required to identify such an association. However, it is clear that there is a high non-diagnosed comorbidity between schizophrenia and alcohol use which, as a result, is not treated and translates, ultimately, into a bigger impairment of the psychosocial functioning. Among the scales employed, AUDIT is an excellent screening instrument to detect subjects at risk of becoming alcoholics and to identify incipient alcohol use patterns and the problems associated with it. Thus, it is suggested that it could be used both in first and third level hospitals. Finally, although no statistically significant results were found out in any of the variables, there is enough evidence where the association between schizophrenia and alcohol leads to an accumulated effect influencing the psychosocial functioning impairment. In the light of this, it is suggested that clinicians inquire about alcohol use in patients showing some mental pathology to research more in depth the schizophrenia-alcohol comorbidity phenomenon and its association with psychosocial functioning so as to design adequate prevention, treatment and rehabilitation programs for the schizophrenic population.