Patient-Therapist Perspective of the Working Alliance in Psychotherapy.

This study aimed to examine perceptions of the working alliance in a sample of Spanish patients and therapists. The alliance was measured after the third and tenth psychotherapy sessions using patient and therapist versions of the Spanish adaptation of the Working Alliance Inventory (WAI). After both sessions, correlations between the patients' and therapists' ratings, both of total alliance and of the various dimensions of the alliance, were moderate at best. Moreover, after the third psychotherapy session, patients' scores for the total alliance and the Goal and Task subscales were significantly higher than the scores from their therapists in these dimensions. Following the tenth session, patient ratings exceeded those of their therapists only on the Task subscale. Finally, in contrast to the ratings of patients, therapists' alliance ratings increased significantly between the third and tenth sessions of psychotherapy. Certain recommendations are presented to improve the study of patient and therapist perceptions of the working alliance and to increase the convergence between them with regard to this central treatment variable.

Relationship between olfactory function and social cognition in euthymic bipolar patients.

OBJECTIVE/INTRODUCTION: There is a close functional and neuroanatomical relationship between olfactory ability and emotional processing. The present study seeks to explore the association between olfactory ability and social cognition, especially facial emotion perception, in euthymic bipolar patients. METHODS: Thirty-nine euthymic outpatients meeting DSM-IV-TR criteria for bipolar disorder and 40 healthy volunteers matched on socio-demographic criteria were recruited. Both groups were assessed at one time point with the University of Pennsylvania Smell Identification Test (UPSIT), the Emotion Recognition Test, and The Faux Pas Recognition Test, as well as measures of general cognition and functioning. RESULTS: The bipolar patients showed a significant impairment in olfactory identification (UPSIT) and social cognition measures compared to healthy controls. Analyses revealed significant relationships between olfactory identification and facial emotion recognition, theory of mind, general cognition, and a trend-level relationship with functioning. Controlling for age and cigarettes smoked, relationships remained significant between olfactory function and facial emotion recognition. CONCLUSION: There is a deficit of olfactory identification in euthymic patients with bipolar disorder that is correlated with a deficit in both verbal and non-verbal measures of social cognition.

Spanish adaptation of the Revised Helping Alliance Questionnaire (HAq-II).

BACKGROUND: The working or helping alliance is one of the most widely studied constructs in psychotherapy process research. AIM: The aim of this study was to adapt the patient and therapist forms of the Revised Helping Alliance Questionnaire II (HAq-II-P and HAq-II-T, respectively) into Spanish. METHOD: The two measurement instruments were adapted through a systematic translation process, a pilot study and a clinical study. The psychometric properties were examined following the third psychotherapy session. RESULTS: Mean scores on the Spanish-language HAq-II-P and HAq-II-T were high. The corrected item-total correlations for >94% of the items were >0.30. Cronbach's α values for internal consistency were 0.88 and 0.93, respectively. Correlations for convergent validity with the respective versions of the Spanish-language Working Alliance Inventory were 0.80 and 0.87, respectively. In terms of predictive validity, there was a significant correlation between HAq-II-T and the patients' residual gain scores on the Spanish-language Beck Depression Inventory after the tenth psychotherapy session. CONCLUSIONS: These results are consistent with studies using the original English versions of the HAq-II.

Familiarity and face emotion recognition in patients with schizophrenia.

OBJECTIVE: To assess the emotion recognition in familiar and unknown faces in a sample of schizophrenic patients and healthy controls. METHODS: Face emotion recognition of 18 outpatients diagnosed with schizophrenia (DSM-IVTR) and 18 healthy volunteers was assessed with two Emotion Recognition Tasks using familiar faces and unknown faces. Each subject was accompanied by 4 familiar people (parents, siblings or friends), which were photographed by expressing the 6 Ekman's basic emotions. Face emotion recognition in familiar faces was assessed with this ad hoc instrument. In each case, the patient scored (from 1 to 10) the subjective familiarity and affective valence corresponding to each person. RESULTS: Patients with schizophrenia not only showed a deficit in the recognition of emotions on unknown faces (p=.01), but they also showed an even more pronounced deficit on familiar faces (p=.001). Controls had a similar success rate in the unknown faces task (mean: 18 +/- 2.2) and the familiar face task (mean: 17.4 +/- 3). However, patients had a significantly lower score in the familiar faces task (mean: 13.2 +/- 3.8) than in the unknown faces task (mean: 16 +/- 2.4; p<.05). In both tests, the highest number of errors was with emotions of anger and fear. Subjectively, the patient group showed a lower level of familiarity and emotional valence to their respective relatives (p<.01). CONCLUSIONS: The sense of familiarity may be a factor involved in the face emotion recognition and it may be disturbed in schizophrenia.

Prevalence and characteristics of intimate partner violence against women with severe mental illness: a prevalence study in Spain.

This study examined the prevalence and characteristics of intimate partner violence (IPV) towards women with a severe mental illness (SMI). The sample consisted of 142 adult women with SMI treated in public mental health services in three districts of Madrid (Spain). The prevalence of IPV in the 12 months preceding the interview was 30.3% and over the lifespan was 79.6%. 32.7% of women victims of violence do not qualify themselves as battered women. 48.5% of battered women do not talk about their abusive situation with anyone or come to any resource or service. Women victims of abuse have low social support. Women who have suffered physical abuse in childhood are at 2.22 times higher risk of being victims of IPV in the past year. Mental health professionals identified 50% of recent abuse cases. This research highlights the extent of IPV experienced by women with SMI.

Impact of mindfulness training on attentional control and anger regulation processes for psychotherapists in training.

OBJECTIVES: Little empirical literature focuses on psychotherapists' cultivation of internal states of mind necessary for controlling attention and responding empathically to the client. We explore the effects of mindfulness training on emotional and attentional measures in Spanish resident intern psychiatrists and clinical psychologists. METHOD: One hundred and three residents were assigned to an experimental group (n = 60) that completed an 8-week mindfulness training versus a wait-list control group (n = 43). We evaluated emotional variables (sadness, anxiety, and anger, using standard instruments), state of mindfulness (using the Mindfulness Awareness Attention Scale), and attentional control variables using objective measures such as a continuous performance task and the Stroop task before and after mindfulness training. RESULTS: Our study provides data that suggest that mindfulness training significantly improves measures of trait anger and attentional control. CONCLUSIONS: Further research is needed to replicate these findings, explore the effects of mindfulness training on other aspects of emotional regulation and cognition, and evaluate the impact of these effects within clinical situations.

Absence of protective ethnic density effect on Ecuadorian migrants' mental health in a recent migration setting: a multilevel analysis.

PURPOSE: We aimed to study the association between the Ecuadorians' ethnic density (EED) of the areas of residence (AR) with the mental health of Ecuadorians in Spain. METHODS: Multilevel study of 568 Ecuadorian adults in 33 AR randomly selected from civil registries and interviewed at home. Possible psychiatric case (PPC) was measured by scoring ≥5 in General Health Questionnaire-28. Ecuadorians' ethnic density was dichotomized in high and low EED (<6 %). Multilevel logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: Prevalence of PPC, 24 % (95 %CI 20-28 %), varied by area of residence. Ecuadorians' ethnic density varied by area of residence ranging from 0.9 to 19.5 %. PPC prevalence in High Ecuadorians' ethnic density AR was 29.5 and 20.4 % in low EED AR (p 0.013). Ecuadorians from High EED AR had higher odds of PPC than those from Low EED AR (OR 1.65 95 %CI 1.01-2.72). Adjusting for individual confounders (largely self-perceived discrimination), OR decreased to 1.48 (95 %CI 0.87-2.55). The final model, adjusted by area of residence and educational level, yielded an OR 1.37 (95 %CI 0.78-2.40). CONCLUSIONS: No protective association between the Ecuadorians' ethnic density of the Area of residence and Ecuadorian migrants' mental health was found. Mechanisms underlying beneficial ethnic density effects may be absent in recent migration settings.

Differences in depressed oncologic patients' narratives after receiving two different therapeutic interventions for depression: a qualitative study.

BACKGROUND: This study aims to explore differences in personal narratives of the experience of illness and treatment in depressed oncologic patients who received either combined treatment for depression (psychotherapy plus antidepressants) or standard treatment (antidepressants alone). METHODS: We employed a qualitative research design based on grounded theory. Data were collected from eight videotaped focus groups and semi-structured interviews with a total of 28 participants. The research team reviewed interview transcripts and categorized the participants' responses using the ATLAS.ti (ATLAS.ti Scientific Software Development GmbH Hardenbergstr. 7 D-10623, Berlin) software package. RESULTS: Compared with patients in the standard treatment group, patients in the combined treatment group were better able to relate their experiences of physical and emotional discomfort and find meaning in the experience of illness by viewing cancer as a transformative experience. In addition, patients in the combined treatment group tended to use more active coping strategies based on acceptance of their situation and emphasized that psychotherapy had been helpful. CONCLUSIONS: Qualitative analysis is an efficient method of examining the meaning of quantitative results in depth, particularly patients' perspectives on quality of life. Patients undergoing combined treatment consider psychotherapy to be a helpful tool and exhibit more personal growth than do patients undergoing standard treatment.

Social cognition and global functioning in bipolar disorder.

The purpose of this study was to assess the role of social cognition, together with other relevant clinical variables and measures of general cognition, in the global functioning of euthymic bipolar patients. Thirty-nine euthymic outpatients fulfilling DSM-IV-TR criteria for bipolar disorder type I or II were recruited and were divided in two groups: high (n = 19) and low (n = 20) global functioning. Both groups' performance was compared in verbal and nonverbal social cognition (Faux pas test and Facial Emotion Recognition test), sustained attention and executive function. The low-functioning group showed a significant impairment in both verbal and nonverbal measurements of social cognition compared with the high-functioning group. Globally, both bipolar groups showed a significant impairment in facial emotion recognition compared with a similar sample of healthy volunteers. Social cognition may play a significant role in the clinical-functional gap of bipolar patients.

Mental health in Ecuadorian migrants from a population-based survey: the importance of social determinants and gender roles.

PURPOSE: To describe the prevalence of and the risk factors for poor mental health in female and male Ecuadorian migrants in Spain compared to Spaniards. METHOD: Population-based survey. Probabilistic sample was obtained from the council registries. Subjects were interviewed through home visits from September 2006 to January 2007. Possible psychiatric case (PPC) was measured as score of ≥5 on the General Health Questionnaire-28 and analyzed with logistic regression. RESULTS: Of 1,122 subjects (50% Ecuadorians, and 50% women), PPC prevalence was higher in Ecuadorian (34%, 95% CI 29-40%) and Spanish women (24%, 95% CI 19-29%) compared to Ecuadorian (14%, 95% CI 10-18%) and Spanish men (12%, 95% CI 8-16%). Shared risk factors for PPC between Spanish and Ecuadorian women were: having children (OR 3.1, 95% CI 1.4-6.9), work dissatisfaction (OR 4.1, 95% CI 1.6-10.5), low salaries (OR 2.5, 95% CI 1.1-5.9), no economic support (OR 1.8, 95% CI 0.9-3.4), and no friends (OR 2.2, 95% CI 1.1-4.2). There was an effect modification between the nationality and educational level, having a confidant, and atmosphere at work. Higher education was inversely associated with PPC in Spanish women, but having university studies doubled the odds of being a PPC in Ecuadorians. Shared risk factors for PPC in Ecuadorian and Spanish men were: bad atmosphere at work (OR 2.4, 95% CI 1.3-4.4), no economic support (OR 3.5, 95% CI 1.3-9.5), no friends (OR 2.5, 95% CI 0.9-6.6), and low social support (OR 1.6, 95% CI 0.9-2.9), with effect modification between nationality and partner's emotional support. CONCLUSIONS: Mental health in Spanish and Ecuadorian women living in Spain is poorer than men. Ecuadorian women are the most disadvantaged group in terms of prevalence of and risk factors for PPC.

Spanish Versions of the Outcome Rating Scale and the Session Rating Scale: Normative Data, Reliability, and Validity.

Routine outcome monitoring (ROM) uses standardized measures to both track and inform mental health service delivery. Use of ROM has been shown to improve the outcome of psychotherapy when applied to different types of patients. The present research was designed to determine the reliability and validity of the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) in a sample of Spanish patients. After a controlled process of translation into the Spanish that is spoken and written in Spain (i.e., in Europe, as distinct from, e.g., Latin American Spanish), both measures were completed by patients of an outpatient mental health unit during eight sessions of psychotherapy. Sixty mental health patients filled out the ORS and 59 the SRS. In addition, the ORS was completed by 33 people who constituted the non-clinical sample. The cut-off of the ORS was 24.52 points, and the Reliable Change Index (RCI) was 9.15 points. ORS and SRS scores exhibited excellent internal consistency. The temporal stability of the SRS was adequate. The convergent and discriminant validity of the two measures were adequate. Regarding the factorial validity of the ORS and the SRS, in the third psychotherapy session, confirmatory factor analyses evidenced the existence of a unifactorial model. The predictive validity of SRS was acceptable. The ORS was sensitive to changes in patients' symptoms. In conclusion, compared to the original English versions of the ORS and SRS measures, the Spanish versions of the measures are also reliable and valid.

[Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain]. / Salud mental y derechos humanos: La experiencia de los profesionales en formación en el uso de sujeciones mecánicas en Madrid, España.

Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice.

La sujeción mecánica en psiquiatría es un procedimiento permitido en España que despierta importantes conflictos éticos. Diversos estudios sostienen que su uso depende de factores no clínicos, como las experiencias de los profesionales y las influencias del contexto, más que de factores clínicos (diagnósticos o síntomas). El objetivo del estudio es comprender las experiencias de profesionales de salud mental en formación en relación con el uso de sujeciones en la red de salud mental de Madrid. Es un estudio cualitativo de tipo fenomenológico mediante grupos focales, realizados en 2017. Las entrevistas fueron transcritas para su discusión y análisis temático mediante Atlas.ti. Los resultados descriptivos sugieren que estas medidas producen malestar y conflicto con relación al rol de cuidador y se observan estrategias de adaptación a los mismos. A partir de los hallazgos, se reflexiona acerca de aspectos de sus experiencias y del contexto que influyen en su uso, así como de las contradicciones del cuidado en la práctica clínica.

Effectiveness of a structured training program in psychotherapeutic skills used in clinical interviews for psychiatry and clinical psychology residents.

The authors evaluated a training program based on a structured manual of psychotherapeutic skills, using a randomized controlled design. The experimental group consisted of 135 residents from 12 teaching units in Spain. To control the improvement in therapeutic skills that could be attributed to the training received during the residency, the authors compared the experimental group with a control group of 35 residents from three teaching units. Two types of assessment instruments were used: a paper-and-pencil questionnaire based on clinical cases and a videotape of a role-playing interview. Both were given before and after the experimental group attended the training program. The experimental group shows a statistically significant improvement compared with the control group in both measurements.

[Methodology and fieldwork logistics of a multilevel research study on the influence of neigbourdhood's characteristics on natives and Ecuadorian's mental health in Spain]. / Metodología y logística de campo de un estudio multinivel sobre la influencia en España de las características medioambientales en la salud mental de población autóctona y ecuatoriana inmigrante.

The methodological design, characteristics and fieldwork stage of a multilevel research study on the impact of the environmental characteristics on mental health in an autochthonous and immigrant population are described in this paper. Individual data were obtained using a core questionnaire 40 minutes length from home interviews of Spanish and Ecuadorian adults from September 2006 to January 2007. A random sample of 1186 people aged 18-55, with equal distribution of gender and nationality was obtained from Civil Registers of 33 areas (municipalities or neighbourhoods) of Madrid, Alicante, Almeria and Murcia, chosen by ethnic density and socioeconomic criteria. Previously, a pilot study was carried out. Socioeconomic indicators of neighbourhoods and selected communities were obtained from Municipal Registers and other secondary sources. Finally, 1144 people were interviewed (96%). Each person was contacted at home at two different times. The global response rate was 61%, higher among Ecuadorians (69%), who presented more problems of localisation (34%). Analyzing methods and fieldwork process the conclusion is that sample strategies for this type of population studies should be evaluated using feasibility criteria given time and money constraints, against the need to obtain representative samples of the target populations. There were serious shortcomings in the availability of social integration indicators at the neighbourhood level.

Clinical and Demographic Variables Associated Coping and the Burden of Caregivers of Schizophrenia Patients. / Variables demográficas y clínicas relacionadas con la carga y el afrontamiento de los cuidadores de personas diagnosticadas de esquizofrenia.

OBJECTIVE: To analyse of the relationship between burden of illness and coping strategies and the demographic variables of caregivers, and the demographic and clinical variables of people diagnosed with schizophrenia. METHODS: Multicentre correlational cross-sectional study including 70 people diagnosed with schizophrenia, or a schizoaffective disorder, and 70 primary informal caregivers. They were evaluated using Zarit Caregiver Burden Inventory, Family Coping Strategies Questionnaire, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and the brief Disability Assessment Scale. RESULTS: Burden of illness positively associated with patient impairment in occupational and social functioning, and negatively with education level. Avoidance, coercion and positive communication were positively associated with impairment in occupational and social functioning of patients. Social interest and friendships showed a positive association with the education level of caregivers. Spiritual assistance negatively correlated with impairment in social functioning and patient age, and resignation was negatively associated with length of the disorder and patient education level. CONCLUSIONS: Burden and dysfunctional coping strategies, such as avoidance and coercion, are associated with functional impairment of the patient. These findings suggest the need to provide support to caregivers, adjusted to the functional level of the patient, in order to prevent burden of care.

[Clinical practice guideline on bipolar disorder: drug and psychosocial therapy. Asociación Española de Neuropsiquiatría]. / Guía de práctica clínica sobre el trastorno bipolar: tratamiento farmacológico y psicosocial.

Bipolar disorder is a chronic and recurrent mood disorder, which may severely impact on the patient's global functioning. It has been estimated that approximately 1.6% of the population is affected. A long delay in diagnosis and an excessive disparity in the treatment of these patients have been detected. Within the Quality Plan of the Spanish National Health System, one of the key strategies is to improve clinical practice through the development and use of clinical practice guidelines (CPGs). In this context, the CPG on bipolar disorder arises from an agreement between the Ministry of Health and the University of Alcalá, involving the Spanish Association of Neuropsychiatry as developer and project manager. Its main objective is to develop recommendations on the diagnostic, therapeutic and rehabilitative care for patients with bipolar disorder, primarily applicable in the public mental health services. In this paper we present the main recommendations on pharmacological and psychosocial interventions in bipolar disorder.

Deficits in recognition, identification, and discrimination of facial emotions in patients with bipolar disorder.

OBJECTIVE: To analyze the recognition, identification, and discrimination of facial emotions in a sample of outpatients with bipolar disorder (BD). METHODS: Forty-four outpatients with diagnosis of BD and 48 matched control subjects were selected. Both groups were assessed with tests for recognition (Emotion Recognition-40 - ER40), identification (Facial Emotion Identification Test - FEIT), and discrimination (Facial Emotion Discrimination Test - FEDT) of facial emotions, as well as a theory of mind (ToM) verbal test (Hinting Task). Differences between groups were analyzed, controlling the influence of mild depressive and manic symptoms. RESULTS: Patients with BD scored significantly lower than controls on recognition (ER40), identification (FEIT), and discrimination (FEDT) of emotions. Regarding the verbal measure of ToM, a lower score was also observed in patients compared to controls. Patients with mild syndromal depressive symptoms obtained outcomes similar to patients in euthymia. A significant correlation between FEDT scores and global functioning (measured by the Functioning Assessment Short Test, FAST) was found. CONCLUSIONS: These results suggest that, even in euthymia, patients with BD experience deficits in recognition, identification, and discrimination of facial emotions, with potential functional implications.

Variables demográficas y clínicas relacionadas con la carga y el afrontamiento de los cuidadores de personas diagnosticadas de esquizofrenia / Clinical and Demographic Variables Associated Coping and the Burden of Caregivers of Schizophrenia Patients

RESUMEN Objetivo: Analizar la relación de la carga y las estrategias de afrontamiento con las características demográficas de los cuidadores de personas con esquizofrenia, así como las variables demográficas y clínicas de los pacientes. Métodos: Estudio transversal correlacional multicéntrico en el que se evaluó a 70 personas diagnosticadas de esquizofrenia o trastorno esquizoafectivo y 70 cuidadores informales primarios con la escala de sobrecarga del cuidador de Zarit, el cuestionario de estrategias familiares de afrontamiento, la escala para la evaluación de síntomas positivos, la escala para la evaluación de síntomas negativos y la escala breve de evaluación de la discapacidad. Resultados: En este estudio, la carga se correlacionó positivamente con el deterioro del funcionamiento ocupacional y social y presentó asociación negativa con la escolaridad de los pacientes. El escape, la coerción y la comunicación positiva presentaron correlaciones positivas con el deterioro del funcionamiento ocupacional y social de los pacientes. Asimismo, el interés social y las amistades mostraron asociación positiva con la escolaridad de los cuidadores. Además, la ayuda espiritual presentó correlaciones negativas con el deterioro del funcionamiento social y la edad de los pacientes, y la resignación se correlacionó negativamente con la duración del trastorno y la escolaridad de los pacientes. Conclusiones: La carga y la adopción de estrategias de afrontamiento disfuncionales, como el escape y la coerción, se asocian con el deterioro del funcionamiento de los pacientes. Estos hallazgos indican la necesidad de brindar a los cuidadores apoyos ajustados al nivel de funcionamiento del paciente que prevengan la carga del cuidado.

ABSTRACT Objective: To analyze of the relationship between burden of illness and coping strategies and the demographic variables of caregivers, and the demographic and clinical variables of people diagnosed with schizophrenia. Methods: Multicentre correlational cross-sectional study including 70 people diagnosed with schizophrenia, or a schizoaffective disorder, and 70 primary informal caregivers. They were evaluated using Zarit Caregiver Burden Inventory, Family Coping Strategies Questionnaire, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and the brief Disability Assessment Scale. Results: Burden of illness positively associated with patient impairment in occupational and social functioning, and negatively with education level. Avoidance, coercion and positive communication were positively associated with impairment in occupational and social functioning of patients. Social interest and friendships showed a positive association with the education level of caregivers. Spiritual assistance negatively correlated with impairment in social functioning and patient age, and resignation was negatively associated with length of the disorder and patient education level. Conclusions: Burden and dysfunctional coping strategies, such as avoidance and coercion, are associated with functional impairment of the patient. These findings suggest the need to provide support to caregivers, adjusted to the functional level of the patient, in order to prevent burden of care.

Violence in adulthood and mental health: gender and immigrant status.

The aim of this study was to describe perceived abuse in adult Spanish and Ecuadorian women and men and to assess its association with mental health. A population-based survey was conducted in Spain in 2006. Data were taken from a probabilistic sample allowing for an equal number of men and women, Spaniards and Ecuadorians. Mental disorder was measured with the General Health Questionnaire-28. The nine questions on exposure to physical, sexual, and psychological abuse during the previous year were self-administered. Multivariate logistic regression was used to assess the association between exposure to abuse and poor mental health, adjusting for potential confounders. The sample was composed of 1,059 individuals aged 18 to 54, 104 of whom reported physical, psychological, or sexual abuse. Some 6% refused to answer the questions on abuse. Overall, reported abuse ranged from 13% in Ecuadorian women to 5% in Spanish men. Psychological abuse was the most frequent. Half the abused women, both Spanish and Ecuadorian, reported intimate partner violence (IPV), as did 22% of abused men. Poor mental health was found in 61% of abused Spanish women (adjusted Odds Ratio [ORa] = 5.1; 95% CI: 1.8-14.4), and 62% abused Ecuadorian women (ORa = 4; 95% CI: 2-7.9), in 36% of abused Spanish men (ORa = 3; 95% CI: 0.9-10.7) and in 30% abused Ecuadorian men (ORa = 2.8; 95% CI: 1-7.7). Interpersonal violence is frequent in relations with the partner, the family, and outside the family, and it seriously affects the mental health. Ecuadorian women stand out as the most vulnerable group.

Social-cognitive bias and depressive symptoms in outpatients with bipolar disorder.

A deficit of social cognition in bipolar disorder has been shown, even when patients are stable. This study compares the attribution of intentions (social-cognitive bias) in a group of 37 outpatients with bipolar disorder with 32 matched control subjects. Bipolar patients scored significantly higher in the Ambiguous Intentions Hostility Questionnaire, showing an angry and intentionality bias (P = .001, P = .02). Differences in blame scale and hostility bias did not reach statistical significance, but a trend was found (P = .06). Bipolar patients with depressive symptoms presented a higher score in the angry bias scale (P = .03) and aggressivity bias scale (P = .004). The global functioning (GAF) correlates significantly with intentionality (P = .005), angry (P = .027), and aggressivity (P = .020) biases. Bipolar patients show a social-cognitive bias that may play a role in their functional outcome.