Does COVID-19 psychological fatigue exist? Results of three online cross-sectional studies conducted in Spain from April 2020 to March 2021.

Background: A previously published meta-analysis found that about one-third of the general population experienced some mental health problem during the early phase of the COVID-19 pandemic, potentially leading to a late mental health crisis. We aimed to describe the acute, short-term, and long-term effects of the COVID-19 pandemic on mental health. Methods: A one-year online survey (S) was conducted in Spain (April 2020 - March 2021). We recruited 18 180 subjects using a virtual respondent-driven snowball sampling method (S1 April 2020, n = 6108; S2 October-November 2020, n = 6418; S3 March 2021, n = 5654). Participants completed the Spanish Depression, Anxiety, and Stress Scale (DASS-21). Results: Overall, our results suggest a progressive increase in the prevalence of anxiety and stress throughout the pandemic waves and relative stability of depression. Women had a greater probability of having depression, anxiety, or stress than men in each survey (P < 0.001). The youngest group (aged 18-24) reported a higher probability (P < 0.05) of having depression, anxiety, or stress than the older groups in S1 and S2. Middle-aged people (25-59) had a greater probability of being a case in the DASS-21 scales than the oldest group (60+), except for depression in men (P = 0.179). In S3, the trend changed: the youngest group showed a decrease in depression and stress while the oldest group showed a dramatic increase (anxiety: men = 664.5%, women = 273.52%; stress: men = 786%, women = 431.37%). Conclusions: It is plausible to conclude that COVID-19 psychological fatigue exists, especially in middle-aged and older adults. Strategies to assist people who have fewer coping skills should be implemented in the near future.

Early psychological impact of the 2019 coronavirus disease (COVID-19) pandemic and lockdown in a large Spanish sample.

BACKGROUND: Epidemic outbreaks have significant impact on psychological well-being, increasing psychiatric morbidity among the population. We aimed to describe the early psychological impact of COVID-19 and its contributing factors in a large Spanish sample, globally and according to mental status (never mental disorder NMD, past mental disorder PMD, current mental disorder CMD). METHODS: An online questionnaire was conducted between 19 and 26 March, five days after the official declaration of alarm and the lockdown order. Data included sociodemographic and clinical information and the DASS-21 and IES questionnaires. We analysed 21 207 responses using the appropriate descriptive and univariate tests as well as binary logistic regression to identify psychological risk and protective factors. RESULTS: We found a statistically significant gradient in the psychological impact experienced in five domains according to mental status, with the NMD group being the least affected and the CMD group being the most affected. In the three groups, the depressive response was the most prevalent (NMD = 40.9%, PMD = 51.9%, CMD = 74.4%, F = 1011.459, P < 0.001). Risk factors were female sex and classification as a case in any psychological domain. Protective factors were younger age and ability to enjoy free time. Variables related to COVID-19 had almost no impact except for having COVID-19 symptoms, which was a risk factor for anxiety in all three groups. CONCLUSIONS: Our results can help develop coping strategies addressing modifiable risk and protective factors for each mental status for early implementation in future outbreaks.

Does ICD-11 improve the epidemiological and nosological purposes of mental, behavioral and developmental disorders? / ¿Mejora la CIE-11 los propósitos epidemiológicos y nosológicos de los Trastornos mentales, del comportamiento y del desarrollo?

Editorial of vol 31(3).

Editorial del vol 31(3).

Could structural changes in the retinal layers be a new biomarker of mental disorders? A systematic review and thematic synthesis. / Los cambios estructurales de la retina, ¿nuevos biomarcadores de los trastornos mentales? Una revisión sistemática y síntesis temática de la literatura.

It has recently been suggested that alterations of the layers of the retina could be a biomarker of specific mental disorders since they originate in the same embryonic layer as the brain and both are interconnected through the optic nerve. The purpose of this article is to offer a systematic review of the literature and a thematic synthesis on the current state of the alterations of the retina layers identified by optical coherence tomography in patients with schizophrenia, bipolar disorder and major depression. For this purpose, we performed a bibliographic search, a systematic review of the studies and a thematic synthesis of the reported findings. Patients with schizophrenia have more abnormal findings followed by patients with bipolar disorder, with very few findings in depression. The nerve fiber layer is the retinal layer with more abnormal findings both in schizophrenia and in bipolar disorder, while no study in major depression found alterations in it. Of the clinical parameters, the duration of the illness correlates significantly and inversely with the thickness of the different layers in all disorders. When interpreting these data, it is necessary to take into account the limitations and differences of the studies, especially the mean length of the disorders. Given that this was very different among the 3 disorders (more than doubled in the case of schizophrenia respect to major depression), the differences in the results found could be due more to the effect of the length of illness than to the disorder itself. In summary, optical coherence tomography findings are promising, since they could provide biomarkers of neurodegeneration and/or neuroprogression of both schizophrenia and bipolar disorder.

Spanish validation of the Negative Symptom Assessment-16 (NSA-16) in patients with schizophrenia. / Validación española de la escala de evaluación de los síntomas negativos-16 (NSA-16) en pacientes con esquizofrenia.

INTRODUCTION: Negative symptoms are prevalent in schizophrenia and associated with a poorer outcome. Validated newer psychometric instruments could contribute to better assessment and improved treatment of negative symptoms. The Negative Symptom Assessment-16 (NSA-16) has been shown to have strong psychometric properties, but there is a need for validation in non-English languages. This study aimed to examine the psychometric properties of a Spanish version of the NSA-16 (Sp-NSA-16). MATERIAL AND METHOD: Observational, cross-sectional validation study in a sample of 123 outpatients with schizophrenia. ASSESSMENTS: NSA-16, PANSS, HDRS, CGI-SCH and PSP. RESULTS: The results indicate appropriate psychometric properties, high internal consistency (Cronbach's alpha=0.86), convergent validity (PANSS negative scale, PANSS Marder Negative Factor and CGI-negative symptoms r values between 0.81 and 0.94) and divergent validity (PANSS positive scale and the HDRS r values between 0.10 and 0.34). In addition, the NSA-16 also exhibited discriminant validity (ROC curve=0.97, 95% CI=0.94 to 1.00; 94.3% sensitivity and 83.3% specificity). CONCLUSIONS: The Sp-NSA-16 is reliable and valid for measuring negative symptoms in patients with schizophrenia. This provides Spanish clinicians with a new tool for clinical practice and research. However, it is necessary to provide further information about its inter-rater reliability.

Psychometric properties of a Spanish-version of the Schizophrenia Objective Functioning Instrument (Sp-SOFI).

The Schizophrenia Objective Functioning Instrument (SOFI) is an interviewer-administered scale designed to objectively assess the actual level of patient functioning and to measure community functioning related to cognitive impairment and psychopathology. The aim was to examine the psychometric properties of the Spanish version of the SOFI (Sp-SOFI) in a sample of 155 Spanish outpatients with schizophrenia disorder. The instruments applied were Sp-SOFI, Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia Scale (CGI-SCH), Personal and Social Performance Scale (PSP), and Global Assessment of Functioning (GAF). The discrimination indexes of the Sp-SOFI items range from .21 to .77. Exploratory factor analysis showed an essentially one-dimensional structure. Cronbach's alpha was .93. Test-retest reliability for the Sp-SOFI total score was .87 (p < .001). The canonical correlation between SP-SOFI domains and PSP dimensions was .83. The multiple correlation coefficient between Sp-SOFI domains and GAF score was .84. Sp-SOFI scores were significantly different between high and low scores on the PANSS scales (p < .001). Sp-SOFI measures discriminated among patients with doubtful, mild, moderate, and severe schizophrenia disorder according to CGI-SCH scales (p < .001). New evidence about the validity of the SOFI was provided. The Sp-SOFI is a reliable and valid tool for using in clinical practice.

El Instrumento de Funcionamiento Objetivo para la Esquizofrenia (SOFI) es una entrevista para evaluar el nivel de funcionamiento comunitario en relación con el daño cognitivo y los síntomas psicopatológicos. El objetivo del estudio consistió en examinar las propiedades psicométricas de la versión española de la SOFI (Sp-SOFI) en una muestra de 155 pacientes ambulatorios con esquizofrenia. Los índices de discriminación de la Sp-SOFI oscilaron entre 0,21 y 0,77. El análisis factorial exploratorio mostró una estructura esencialmente unidimensional. El alfa de Cronbach fue 0,93. El coeficiente de fiabilidad test-retest fue 0,87 (p < 0,001). La correlación canónica entre la Sp-SOFI y la Escala de Funcionamiento Personal y Social (PSP) fue 0,83. El coeficiente de correlación múltiple entre la Sp-SOFI y la Escala de Evaluación de la Actividad Global (EEAG) fue 0,44. Las puntuaciones en la Sp-SOFI fueron significativamente diferentes entre los pacientes con puntuaciones altas y bajas en la Escala del Síndrome Positivo y Negativo (PANSS) (p < 0,001). La Sp-SOFI discriminó entre pacientes con trastorno de esquizofrenia dudoso, leve, moderado y grave de acuerdo con la Escala de Impresión Clínica Global de Esquizofrenia (CGI-SCH) (p < 0,001). La Sp-SOFI es un instrumento fiable y válido para la práctica clínica.

Psychometric evaluation of the negative syndrome of schizophrenia.

In this paper, we reviewed the available instruments for assessing the negative syndrome of schizophrenia, describing their strengths and weaknesses. Current instruments were classified into two categories according to their content validity and assessment approach as first- or second-generation instruments. The BPRS, SANS, the SENS and the PANSS belong to the first generation, while the BNSS, the CAINS and the MAP-SR belong to the second generation. The NSA can be considered a transitional instrument between the two. First-generation instruments have more content validity problems than second-generation instruments do, as they do not accurately reflect the currently accepted negative syndrome (they do not include all negative symptoms and signs or they include symptoms from other dimensions). They also have more problems relative to the use of behavioural referents instead of internal experiences of deficits when assessing symptoms, which may lead to measuring functioning instead of negative symptoms. Further research needs to be done in this area in order to ensure the evaluation of primary negative symptoms and internal experiences involved in negative symptoms rather than external behaviours.

[Development of the Spanish brief-version of the University of California Performance Skills Assessment (Sp-UPSA-Brief) in patients with schizophrenia and bipolar disorder]. / Desarrollo de la versión española de la Escala Breve para la Evaluación de la Capacidad Funcional [Sp-UPSA-Brief] para pacientes con esquizofrenia y trastorno bipolar.

INTRODUCTION: In patients with severe mental disorders outcome measurement should include symptoms, cognition, functioning and quality of life at least. Shorter and efficient instruments have greater potential for pragmatic and valid clinical utility. Our aim was to develop the Spanish UPSA Brief scale (Sp-UPSA-Brief). MATERIAL AND METHODS: Naturalistic, 6-month follow-up, multicentre study. 139 patients with schizophrenia, 57 with bipolar disorder and 31 controls were evaluated using the Sp-UPSA, CGI-S, GAF, and PSP. We conducted a multivariate linear regression model to identify candidate subscales for the Sp-UPSA-Brief. RESULTS: The stepwise regression model for patients with schizophrenia showed that communication and transportation Sp-UPSA subscales entered first and second at p<0.0001 (R(2)=0.88, model df=2, F=395.05). In patients with bipolar disorder transportation and communication Sp-UPSA subscales entered first and second at p<0.0001 (R(2)=0.87, model df=2, F=132.32). Cronbach's alpha was 0.78 in schizophrenia and 0.64 in bipolar patients. Test-retest was 0.66 and 0.64 (p<0.0001) respectively. Pearson correlation coefficients between Sp-UPSA and Sp-UPSA-Brief were 0.93 for schizophrenia and 0.92 for bipolar patients (p<0.0001).The Sp-UPSA-Brief discriminated between patients and controls. In schizophrenia patients it also discriminated among different levels of illness severity according to CGI-S scores. CONCLUSION: The Sp-UPSA-Brief is an alternate instrument to evaluate functional capacity that is valid and reliable. Having a shorter instrument makes it more feasible to assess functional capacity in patients with severe mental disorders, especially in everyday clinical practice.

Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack?

The aim of this review was to update and summarize the scientific knowledge on the long term outcomes of the different pharmacological treatment options for opioid dependence currently available and to provide a critical discussion on the different treatment options based on these results. We performed a literature search using the PubMed databases and the reference lists of the identified articles. Data from research show that the three pharmacological options reviewed are effective treatments for opioid dependence with positive long term outcomes. However, each one has its specific target population and setting. While methadone and buprenorphine are first line options, heroin-assisted treatment is a second line option for those patients refractory to treatment with methadone with concomitant severe physical, mental, social and/or functional problems. Buprenorphine seems to be the best option for use in primary care offices. The field of opioid dependence treatment is poised to undergo a process of reinforcement and transformation. Further efforts from researchers, clinicians and authorities should be made to turn new pharmacological options into clinical reality and to overcome the structural and functional obstacles that maintenance programmes face in combatting opioid dependence.

The state of psychiatry in Spain.

The 1986 General Health Act and the so-called 'psychiatric reform' were key issues in the development of the mental healthcare system (MHCS) in Spain. The World Health Organization Declaration and Action Plan on Mental Health in 2005 gave it a revitalizing impetus and resulted in the first National Health System (NHS) Mental Health Strategy in 2006. A literature search was performed using MEDLINE, Spanish journals, reference lists, national databases, and European and Spanish official documents to describe the current state of the MHCS in Spain. The main results were: (1) existence of great variability among the autonomous communities with respect to mental health resources and provision of care; (2) lack of national epidemiological information on mental disorders with the exception of substance use disorders and suicide, which comprise powerful longitudinal national data, (3) training in psychiatry is well established, although there is no specialism of child and adolescent psychiatry, and (4) a dramatic increase in scientific productivity in the last decade among research groups, in part due to the creation of the Spanish Mental Health Network, the Centro de Investigación Biomédica en Red en el Área de Salud Mental (CIBERSAM). Quantifiable and reliable indicators are needed to provide efficient monitoring and analysis of epidemiological events and subsequently to understand the status of the Spanish MHCS.

[Long term effectiveness of methadone maintenance treatments in persons with addiction to opiates]. / Efectividad a largo plazo de los tratamientos de mantenimiento con metadona en personas con adicción a derivados opiáceos.

There is no large prospective cohort studies using different therapeutic doses and standardized distal outcomes, however there is a fair amount of evidence on the effectiveness of methadone as a long-term treatment for the addiction to opiates. Strengths include less illegal drug use, decreased criminal activity and better general functioning. Also physical and mental health seems to be more preserved and recovered. Since patients undergoing methadone treatment exhibit diminished likelihood of suffering from cardiovascular conditions, HIV, HCV, HBV and other infections, and lesser psychiatric comorbidity. This Editorial intends to define and guide the therapeutic statement to address the management of persons with opiate abuse or dependence. These proposals have been grounded in the main long-term studies, systematic analysis and meta-analytic approaches on the effectiveness of methadone. Thereby it is recommended, with the maximum level of evidence, methadone maintenance treatments in spite of its weaknesses (ie. Toxicity, cardiovascular risk, sedation problems and cognitive impairment), considering the clinical history, general health status, and willingness and preferences of the patient.

Psychometric properties of the Spanish version of the Body Weight, Image and Self-Esteem Evaluation Questionnaire in patients with severe mental disorders.

OBJECTIVE: Clinicians need brief and valid instruments to monitor the psychosocial impact of weight gain in persons with psychiatric disorders. We examined the psychometric properties of the Spanish version of the Body Weight, Image and Self-Esteem Evaluation (B-WISE) questionnaire in patients with severe mental disorders. METHOD: The data come from a naturalistic, cross-sectional, validation study conducted at 6 centres in Spain. A total of 211 outpatients with severe mental disorders, 118 with schizophrenia and 93 with bipolar disorder, were evaluated using the B-WISE, the Visual Analogue Scale for Weight and Body Image, and the Clinical Global Impression-Severity (CGI-S). The body mass index was also obtained. RESULTS: The principal component analysis confirms 3 components explaining 50.93% of the variance. The Cronbach α values for B-WISE scales ranged between .55 and .73. Significant Pearson correlations were found between B-WISE total score and CGI-S (r = -0.25; P < .001) and Visual Analogue Scale for Weight and Body Image (r = 0.47; P < .001). The B-WISE discriminates among patients with mild, moderate, and severe mental disorders according to CGI-S scores (F = 6.52; P < .005). Body mass index categorization significantly influenced total B-WISE scores (F = 3.586, P < .050). The B-WISE score corresponding to the 5th and 10th percentiles was 22. CONCLUSIONS: We were able to demonstrate that the Spanish version of the B-WISE is a valid instrument for assessing psychosocial impact of weight gain in patients with severe mental disorders in daily clinical practice.

[Need for the assessment of dual diagnosis in prisons]. / Necesidad de evaluación de la patología dual en contexto penitenciario.

INTRODUCTION: Data show that 92.5% of prison inmates report drug or alcohol use. In spite of this, only 2% of dual diagnosis research has been carried out in the prison context. Therefore, the aim of this descriptive cross-sectional study was to analyze the profiles of dual diagnosis in a Spanish prison and test the feasibility of two assessment instruments. METHOD: The sample was made up of 152 drug-addicts imprisoned in the Villabona Penitentiary Center (Asturias, Spain) who volunteered to be interviewed. The sixth version of the Addiction Severity Index and the International Neuropsychiatric Interview - MINI- were used for the assessment of inmates' psychopathological status and drug problems. RESULTS: The results show that, in general, the offender's profile is: male, 34 years old, unmarried, with children and with an average time spent in prison of approximately five years. Only 4.5% of respondents did not use drugs at the time of the study. In the remainder, the most widely used substances are cocaine (37.6%), heroin (29.9%) and alcohol (10.8%), with 52.7% reporting having used drugs in the last month. With regard to psychopathological state, only 12.9% have no associated disorders, and the most prevalent symptoms correspond to antisocial personality disorder (65.6%), risk of suicide (45.2%), depression (35.9%) and anxiety (25.5%). CONCLUSION: The instruments proposed (ASI-6 and MINI) are feasible tools for detecting addiction severity and associated psychopathology in this context.

[Spanish adaptation of the EAS Temperament Survey for the assessment of child temperament]. / Adaptación española del EAS Temperament Survey para la evaluación del temperamento infantil.

Better understanding of child temperament is essential, as it may predict subsequent development of psychopathology. Questionnaires which have been adapted to Spanish population include a rather restricted age range. The Emotionality Sociability and Activity (EAS) Temperament Survey has been widely used in child temperament genetic research. A Spanish version of the scale was administered to a sample of 229 mothers and to their children at 18 and 42 months of age. Its psychometric features were examined. Results showed accuracy indices akin to that obtained in prior studies. Findings suggest a three-factor structure for the assessment of temperament.

Psychometric properties of the Spanish version of the Changes in Sexual Functioning Questionnaire Short-Form (CSFQ-14) in patients with severe mental disorders.

INTRODUCTION: Sexual dysfunction in patients with severe mental disorders is often underestimated or overlooked by psychiatrists. A brief and valid self-report instrument for assessing sexual functioning may well contribute to changing this situation. AIMS: To validate the Short Form of the Changes in Sexual Functioning Questionnaire (CSFQ-14) in Spanish patients with severe mental disorders. METHODS: Naturalistic, cross-sectional, multicenter, validation study. Eighty-nine patients with schizophrenia and 82 with bipolar disorder were evaluated using the CSFQ-14, the Visual Analogue Scale for Sexual Functioning Satisfaction (VAS-SFS), and the Clinical Global Impression-Severity scales for mental disorders (CGI-S) and for Sexual Dysfunction (CGI-SSD). MAIN OUTCOME MEASURES: The 14-item Changes in Sexual Functioning Questionnaire. RESULTS: Internal reliability (Cronbach's alpha) = 0.90. Construct validity = 3 principal components, of which the first, arousal-orgasm, explained 46.4% of the total variance. Convergent validity: Pearson correlation coefficients between CSFQ-14 and VAS-SFS = 0.33 (P < 0.01) and between CSFQ-14 and CGI-SDS = -0.71 (P < 0.01). Discriminant validity: The CSFQ-14 was able to discriminate among patients with no, mild, moderate, and severe sexual dysfunction according to CGI-SDS scores, both in males (P < 0.001) and females (P < 0.001). In males, the area under the curve (AUC) was 0.833 and a cutoff point of 49 provided a sensitivity of 92.9% and a specificity of 59.5%. In females, the AUC was 0.834 and a cutoff point of 43 provided a sensitivity of 91.9% and a specificity of 62.5%. CONCLUSION: The Spanish version of the CSFQ-14 is a reliable and valid instrument for assessing sexual functioning in patients with severe mental disorders. As a brief, self-rated instrument, the CSFQ-14 scale seems to be appropriate for use in everyday clinical practice as a means of identifying and monitoring changes in sexual functioning.