Systemic neurophysiological entrainment to behaviorally relevant rhythmic stimuli.

Physiological oscillations, such as those involved in brain activity, heartbeat, and respiration, display inherent rhythmicity across various timescales. However, adaptive behavior arises from the interaction between these intrinsic rhythms and external environmental cues. In this study, we used multimodal neurophysiological recordings, simultaneously capturing signals from the central and autonomic nervous systems (CNS and ANS), to explore the dynamics of brain and body rhythms in response to rhythmic auditory stimulation across three conditions: baseline (no auditory stimulation), passive auditory processing, and active auditory processing (discrimination task). Our findings demonstrate that active engagement with auditory stimulation synchronizes both CNS and ANS rhythms with the external rhythm, unlike passive and baseline conditions, as evidenced by power spectral density (PSD) and coherence analyses. Importantly, phase angle analysis revealed a consistent alignment across participants between their physiological oscillatory phases at stimulus or response onsets. This alignment was associated with reaction times, suggesting that certain phases of physiological oscillations are spontaneously prioritized across individuals due to their adaptive role in sensorimotor behavior. These results highlight the intricate interplay between CNS and ANS rhythms in optimizing sensorimotor responses to environmental demands, suggesting a potential mechanism of embodied predictive processing.

Influential Relationship Questionnaire (IRQ): psychometric characteristics of an abbreviated Spanish version.

BACKGROUND: The relevance of family relationships in the outcome of various disorders has been highlighted from different domains. Specifically, empirical studies on the relationship between the outcome of schizophrenia and various affective dimensions of family relationships have allowed the identification of particularly relevant aspects: criticism, hostility, and over-protection. AIMS: The present study aims to adapt and validate an abbreviated Spanish version of the Influential Relationship Questionnaire (IRQ), an instrument that measures the patient's own perception of the affective dimensions of family relationships. METHOD: Participants were 188 patients (63.8% male) of the Public Health Service in Andalusia (Spain) with a diagnosis of schizophrenia or a related disorder. One hundred and thirty-six participants provided data related to both father and mother, and 52 only related to mother or father, so the analyses were carried out with a total of 324 questionnaires. Simultaneously, in 130 participants, the Perceived Criticism Scale was applied, and in 50 cases, relatives were asked to complete the Family Attitudes Scale. RESULTS: Principal component analysis allowed for the identification of four factors that explained 61.53% of the total variance (criticism, over-protection, restriction, and care). The values of Cronbach's alpha coefficient, as well as the omega coefficient, showed high consistency. The temporal reliability for an interval of 3 months was high. The correlations between the IRQ dimensions and the other variables included in the study were significant and in the expected direction. CONCLUSIONS: The results support the reliability and validity of the abbreviated version of the IRQ.

Psychosocial factors associated with treatment preference in mental health.

BACKGROUND: Studies examining the effects of incorporating patients' preferences into treatment outcomes highlight their impact on crucial aspects such as reduced dropout rates and enhanced effectiveness. Recognizing individuals' rights to participate in decisions about their treatments underscores the importance of studying treatment preferences and the factors influencing these choices. AIM: This study aims to identify treatment preferences (psychological, pharmacological, or combined) among a sample of patients and to discern the psychosocial and clinical factors influencing these preferences. METHODS: A total of 2,133 individuals receiving care at a community mental health unit completed assessments on anxious-depressive symptoms, social and occupational adjustment, and their treatment preference. Data analysis was conducted using SPSS, with descriptive statistics, Chi-square tests, and one-way ANOVA applied. RESULTS: Preferences for treatments were distributed as follows: Combined (49.8%), psychological (33%), and pharmacological (10.6%). Factors such as diagnosis, severity of depressive and anxious symptoms, and functional impact were related to treatment preference with a moderate effect size. Meanwhile, various sociodemographic factors correlated with the selected treatment, though with a weak effect size. CONCLUSIONS: There is a pronounced preference for combined treatments. The significance of psychological treatments is evident, as four out of five participants favored them in their choices. Addressing these preferences calls for an exploration within the broader context of prescription freedom in mental health.

Systemic neurophysiological signals of auditory predictive coding.

Predictive coding framework posits that our brain continuously monitors changes in the environment and updates its predictive models, minimizing prediction errors to efficiently adapt to environmental demands. However, the underlying neurophysiological mechanisms of these predictive phenomena remain unclear. The present study aimed to explore the systemic neurophysiological correlates of predictive coding processes during passive and active auditory processing. Electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), and autonomic nervous system (ANS) measures were analyzed using an auditory pattern-based novelty oddball paradigm. A sample of 32 healthy subjects was recruited. The results showed shared slow evoked potentials between passive and active conditions that could be interpreted as automatic predictive processes of anticipation and updating, independent of conscious attentional effort. A dissociated topography of the cortical hemodynamic activity and distinctive evoked potentials upon auditory pattern violation were also found between both conditions, whereas only conscious perception leading to imperative responses was accompanied by phasic ANS responses. These results suggest a systemic-level hierarchical reallocation of predictive coding neural resources as a function of contextual demands in the face of sensory stimulation. Principal component analysis permitted to associate the variability of some of the recorded signals.

Sources of social support and clinical and functional evolution of people with schizophrenia.

PURPOSE: The impact of social support on comprehensive measures of results (clinical and functional) of the course of schizophrenia was studied, understood and evaluated as a multidimensional construct differentiating sources of support (family vs. nonfamily). METHODS: One hundred fifty-two patients diagnosed with schizophrenia were assessed with the Mannheim Interview on Social Support (MISS) and the Social Functioning Scale (SFS). The hypotheses were explored in a prospective longitudinal design, using a causal correlational analysis for their evaluation by applying structural equation models. RESULTS: The only explanatory factor of social functioning was Nonfamily social support, while the only explanatory factor of clinical result measurements was Family social support, observing a clearly differentiated impact of the different sources of support on the schizophrenia result measurements. It was also found that while Family social support explained 6.8% of the variance in the clinical result measurements, Nonfamily social support explained 13.7% of the variance in social functioning. CONCLUSION: The results confirmed the differential importance of social support variables (family vs. nonfamily) in the clinical and functional result measurements of people with schizophrenia.

Survival of patients with severe mental disorders: Influence of social functioning.

BACKGROUND: Patients with severe mental disorders have a high risk of premature death due to the interaction of various factors. Social functioning is a strategic functional factor in understanding the course of psychotic disorders. AIM: Analyze the relationship between social functioning and its various dimensions and survival during a 10-year follow-up. METHOD: The Social Functioning Scale (SFS) was administered to 163 close relatives of patients under treatment at a Community Mental Health Unit. Survival was described by Kaplan-Meier analysis and any differences in survival by level of social functioning were found by long-rank analysis. Finally, Cox regression was used to predict premature mortality. RESULTS: Significant differences in mortality were identified in the interpersonal behavior dimension of social functioning, while there were no significant gender or diagnostic differences in the rest of the dimensions. The interpersonal behavior dimension and age were found to be factors predicting premature death. CONCLUSION: These findings show the protective effect of social functioning retained by patients with psychotic disorders on their survival, and the need to apply evidence-based psychotherapy focused on recovery of social functioning in the early stages of the disorder.

Personal Beliefs about Illness Questionnaire-Revised (PBIQ-R): Spanish adaptation in a clinical sample with psychotic disorders.

BACKGROUND: The way people with psychosis psychologically adapt and manage the diagnosis of such a mental disorder has been considered a key factor that contributes to the emergence and aggravation of emotional problems. These beliefs about illness can be very important due to their possible association with stigma and its implications in terms of loss of roles and social status. Given the importance of these personal beliefs about the specific diagnosis of psychosis, the Personal Beliefs about Illness Questionnaire (PBIQ) and PBIQ-R have been developed. AIMS: The present study aims to explore the psychometric characteristics of the Spanish version of the PBIQ-R in a sample of patients with a diagnosis of psychosis-related disorders. METHOD: Participants were 155 patients (54.8% male) of the Public Health Service in Andalusia (Spain). Those who consented to participate filled in the PBIQ-R, the Social Comparison Scale, and the PHQ-9 and GAD-7 to measure emotional symptoms. RESULTS: All dimensions showed adequate internal consistency values: Cronbach's alpha extends between .81 and .88; and McDonald's omega ranges between .87 and .92. The temporal reliability for an interval of 3-4 weeks was high. The correlations between the PBIQ-R dimensions and the other variables included in the study were significant and in the expected direction. The factor analysis of the principal components of the PBIQ-R dimensions revealed a single factor in each of the dimensions that explained 64-74%. CONCLUSIONS: The results support the reliability and validity of the Spanish version of the PBIQ-R.

Ten-year follow-up of social functioning and behaviour problems in people with schizophrenia and related disorders.

BACKGROUND: In recent years, several variables in the course of schizophrenia and related psychotic disorders have been studied. However, an instrumental analysis of the evolution of social functioning and behaviour problems has scarcely been explored. AIM: To analyse the evolution of social functioning and behaviour problems and find any diagnosis or gender differences. METHOD: The Social Functioning Scale (SFS) and the Behaviour Problems Inventory (BPI) were administered in Stages I (2003-2007) and II (2014-2017) to 100 close relatives of patients under treatment at a Community Mental Health Unit. A related samples t-test, analysis of variance and multivariate analysis of variance were performed to study the evolution and differences in social functioning and behaviour problems. Then a stepwise multiple linear regression analysis was done to predict the evolution of social functioning. RESULTS: No deterioration in the evolution of social functioning or behaviour problems was observed, and schizophrenia patient scores were lower. Women scored higher in withdrawal/social engagement, interpersonal behaviour, independence-performance, independence-competence and total social functioning, with no significant differences in behaviour problems. Previous social functioning, underactivity/social withdrawal and education are predictive factors in the evolution of social functioning. Conclusion: The results show the need for implementing psychosocial intervention programs that promote functional recovery and keep problems from becoming chronic.

Work and Social Adjustment Scale (WSAS): psychometric characteristics of a Spanish adaptation in a clinical population.

BACKGROUND: The Work and Social Adjustment Scale (WSAS) is an instrument that can be easily applied for routine evaluation of the impact of mental disorders on patient functioning. In spite of the interest in its use, there is very little information available on its psychometric characteristics and even less in Spanish. AIMS: The objective of this study was to analyse its psychometric characteristics. METHOD: The sample consisted of 441 patients treated in a community mental health unit. They filled out the WSAS and two psychopathology measures, one for anxiety and the other for depression. Fifty-five of them, chosen at random, were asked to fill out the scale again a second time to explore its temporal reliability. RESULTS: The scale showed high internal consistency, a single factor that explained 60.4% of the variance, and temporal reliability of .78 for the total score. Significant correlations were found between the WSAS scores and the psychopathological measures, as well as significant differences between those working and those on leave. CONCLUSIONS: The results confirm the validity and reliability of the scale and support its possible use for routine evaluation of the functional impact of mental disorders.

Spanish Validation of the Recovery Assessment Scale (RAS-24).

BACKGROUND: Recovery is an essential construct in healthcare treatment for patients diagnosed with severe mental illnesses (SMI). Of all the psychometric instruments available for measuring recovery, the 41-item Recovery Assessment Scale (RAS) is the most widely used. Several brief versions have been proposed, including the 24-item version. In this study, the RAS-24 was adapted to European Spanish and validated in a clinical sample. METHOD: Participants ( N = 309) diagnosed with SMI were recruited from a community mental health center and a work guidance center. The participants completed the RAS-24 and the Social Functioning Scale (SFS), both self-reported and family-reported versions. RESULTS: The results showed good indices of fit for the original five-factor structure, acceptable internal consistency (α = .93; ω = .95), temporal reliability ( ICC = .89, p <.01), and significant correlation with most of the SFS scales (total SFS self-report r = .50, p <.01; total SFS family reported r =.49, p <.01). CONCLUSIONS: These data support the use of this Spanish version as a measure of recovery in the Spanish clinical population.

Validation of a Spanish version of the Brief Experiential Avoidance Questionnaire (BEAQ) in clinical population.

BACKGROUND: The Brief Experiential Avoidance Questionnaire (BEAQ) has been suggested as the most appropriate instrument for measuring experiential avoidance. However, no Spanish validation has been published. The aim of this study was to validate a Spanish version of the BEAQ in a clinical sample treated at a community mental health unit. METHODS: Participants ( N = 332) completed the BEAQ as well as other self-report measures of experiential avoidance and psychopathology. RESULTS: Internal consistency was satisfactory (α = .82). No statistically significant gender differences were found in the BEAQ scores. The data also showed high test-retest reliability after four to six weeks, acceptable concurrent validity with another experiential avoidance measure and acceptable convergent validity with the psychopathology measure. The principal component analysis, forcing the one factor solution proposed in the original scale, produced indicators similar to the English version of the BEAQ. CONCLUSIONS: These results firmly support the reliability and validity of this Spanish validation, stressing its usefulness as a measure of experiential avoidance in clinical populations.

Social support and clinical and functional outcome in people with schizophrenia.

PURPOSE: The impact of Social Support (SS) on the clinical and functional evolution of patients diagnosed with schizophrenia was studied from a multidimensional concept of SS in the framework of the vulnerability-stress model. METHODS: In total, 152 patients diagnosed with schizophrenia according to the International Classification of Diseases, Tenth Edition (ICD-10) treated in a Community Mental Health Unit were assessed using the Mannheim Interview on Social Support (MISS) and the Brief Psychiatric Rating Scale (BPRS). Then they were followed up for 3 years with a final assessment for the period using the Social Functioning Scale. The impact of SS was explored in clinical and functional measurements with a multiple regression analysis in a 3-year longitudinal prospective design. RESULTS: The quality of Global Social Support (GSS) and satisfaction with GSS appeared to be protective factors from frequency and duration of hospital admissions, with explanatory intensity varying from 9% in survival time to relapse to 13% in number of relapses. Concerning functional measurements, GSS quantity, quality and satisfaction showed an explanatory power for several different dimensions of social functioning, varying from 12% in isolation to 20% in communication. CONCLUSION: The results confirm SS as a protective factor in the evolution of schizophrenia patients and enable the SS variables with the most explanatory power in their clinical and functional evolution to be identified.

Behavior Problems Inventory (BPI): Psychometric characteristics of an instrument for routine assessment of persons with psychoses and related disorders.

This study explores the psychometric characteristics of the Behavior Problems Inventory (BPI), an instrument for routine clinical assessment of behavior problems in outpatients with psychosis based on information provided by key family informants. Six hundred and twenty-one patients diagnosed with psychosis and bipolar affective disorder (ICD-10 F20-F31) attended at Community Mental Health Units were evaluated in routine reviews using the BPI and the Social Functioning Scale (SFS). Twenty-five subjects were simultaneously administered the Social Behavior Schedule (SBS) and 28 were again administered the BPI eight weeks later. The instrument shows adequate psychometric characteristics with high internal consistency and robust temporal reliability, as well as satisfactory concurrent and construct validity. Factor analysis identified three factors: Underactivity/Social Withdrawal, Active Problems and Lack of Impulse Control, with adequate saturation of the items on each of the factors. The BPI is easy to apply, reliable and valid, takes up little of valuable clinical time, allowing routine assessment in public service contexts for persons diagnosed with psychosis and bipolar affective disorder for whom key family informants are available.

Relationship between behavioural problems and use of mental health services in patients with severe mental illness and the mediating role of the perceived burden of care.

Mental health models proposed for predicting more use of mental health resources by patients with severe mental illness are including a wider variety of predictor variables, but there are still many more remaining to be explored for a complete model. The purpose of this study was to enquire into the relationship between two variables, behaviour problems and burden of care, and the use of mental health resources in patients with severe mental illness. Our hypothesis was that perceived burden of care mediates between behaviour problems of patients with serious mental illness and the use of mental health resources. The Behaviour Problem Inventory, which was filled out by the main caregiver, was used to evaluate 179 patients cared for in a community mental health unit. They also answered a questionnaire on perceived family burden. A structural equation analysis was done to test our hypothesis. The results showed that both the behaviour problems and perceived burden of care are good predictors of the use of mental health resources, where perceived burden of care mediates between behaviour problems and use of resources. These variables seem to be relevant for inclusion in complete models for predicting use of mental health resources.

Predictors in use of mental health resources: The role of behaviour problems in patients with severe mental illness.

BACKGROUND: In recent years, more variables are being included in the use of mental health resource prediction models. Some studies have shown that how well the patient can function is important for this prediction. However, the relevance of a variable as important as behaviour problems has scarcely been explored. AIM: This study attempted to evaluate the effect of behaviour problems in patients with severe mental illness on the use of mental health resources. METHOD: A total of 185 patients at a Community Mental Health Unit were evaluated using the Behaviour Problem Inventory. Later, a bivariate logistic regression was done to identify what behaviour problems could be specific predictors of use of mental health resources. RESULTS: The results showed that the general index of behaviour problems predicts both use of hospitalization resources and outpatient attention. Underactivity/social withdrawal is the best predictor of all the different areas. CONCLUSION: These results confirm the role of behaviour problems as predictors of the use of mental health resources in individuals with a severe mental illness.

Social functioning as a predictor of the use of mental health resources in patients with severe mental disorder.

Previous studies have tried to determine the factors causing greater use of health resources by patients with mental disorders. These studies have essentially focused on socio-economic variables. Nevertheless, many other variables, such as social functioning, have not yet been explored. This study aims to assess the effect of social functioning on mental health service use in a sample of patients with severe mental disorder (schizophrenia, other psychotic disorders or bipolar affective disorder) in an area of Spain. The Social Functioning Scale (SFS) was administered to 172 family members of patients with a severe mental disorder who were receiving care at a community mental health unit. Analysis of bivariate logistic regression identified specific areas as predictors of the use of mental health resources over a 12-month follow-up period. The overall social functioning score predicted need for hospital admissions. In addition, interpersonal behaviour had a major role in the number of outpatient visits, while social isolation significantly predicted the need for hospitalization. These results point out the necessity for including psychosocial variables, such as social functioning in current mental health resource use models.

Beck Anxiety Inventory: psychometric characteristics in a sample from the clinical Spanish population.

Even though the Beck Anxiety Inventory (BAI) is one of the most popular instruments to assess anxiety today, only limited data is available about its psychometric characteristics and normative values in clinical Spanish populations. A study was conducted to test the psychometric characteristics of a Spanish adaptation of the Beck Anxiety Inventory (BAI) in a sample of 918 outpatients being treated at a community mental health center in Spain. Results confirmed the adaptation's high internal consistency (∝ = .91), substantial test-retest reliability at 8-10 weeks (r = .84, p < .01), and satisfactory convergent validity with the Anxiety (r = .86, p < .01), Somatization (r = .81, p < .01), Obsessive-compulsive (r = .60, p < .01), and Phobic Anxiety (r = .63, p < .01) dimensions of the SCL-90-R, and with the Anxious Thoughts Inventory (r = .57, p < .01). Gender differences in BAI scores did occur, so normative values appear separately for each gender.