Sexual orientation knowledge and attitudes and its association with therapy satisfaction among lesbian, gay, and bisexual + Hispanic Puerto Ricans.

This study aimed to examine the difference in therapy satisfaction between lesbian, gay, and bisexual + (LGB +) individuals and heterosexual individuals, and to identify the association between therapy satisfaction and the perception of knowledge and attitudes of their last therapist among the LGB + participants. Through an exploratory design with a comparative group, 125 LGB + and 75 heterosexual participants were recruited online by availability. Results indicate that the participants' sexual orientation has no significant relation on therapy satisfaction. However, there was a significant positive association between satisfaction with therapy and the LGB + participants' perception that their therapist demonstrated knowledge and positive attitudes. This research highlights the importance for continuous education and curriculum efforts on LGB + issues.

Comparison of semiology in patients with psychogenic nonepileptic seizures or with epilepsy in Puerto Rico.

PURPOSE: The aims of this study were to develop a descriptive profile of patients with psychogenic nonepileptic seizures (PNES) in Puerto Rico who have been evaluated using an epilepsy monitoring unit. The other aim was to establish comparisons between the clinical manifestation of PNES and events of generalized epilepsy (GE). METHOD: A retrospective study was conducted to evaluate the information of patients who passed through the Epilepsy Unit in Caguas, Puerto Rico. In the first phase, sociodemographic information of 100 patients with PNES was collected. In the second phase, a sample of 51 cases was obtained; 37 cases with a final diagnosis of PNES and 14 cases with the diagnosis of GE. Observations were made with the objective of viewing and comparing the semiology and clinical manifestation presented through video encephalograms (vEEG) in both subsamples. RESULTS: Patients with PNES and epilepsy demonstrated different semiological patterns. Psychogenic nonepileptic seizures is predominant in females (95%). Most patients with epilepsy presented a relatively short seizure (<2 min) compared with patients with PNES (79% vs. 46%). Patients with epilepsy showed a slow return to their baseline manifestation (100% vs. 11%). Specifically, having their eyes closed, extreme asynchronous limb movements, and rigidity were statistically significant. CONCLUSION: These findings provide evidence that the semiology of patients with PNES is different from those displaying an epileptic seizure. This study supports the idea that the semiology of Latino patients with PNES is similar to the characteristics reported in other countries.

The role of clinical experience, diagnosis, and theoretical orientation in the treatment of posttraumatic and dissociative disorders: A vignette and survey investigation.

Controversy exists regarding the merits of exposure-based treatments for posttraumatic stress disorder (PTSD) versus a phased approach when prominent dissociative symptoms are present. The first aim of this study was to examine the degree to which diagnosing dissociation in two traumatized patients' vignettes influenced clinicians' preference for phase-oriented treatment and whether clinicians' treatment experience contributed to their treatment preference. The second aim was to assess the extent to which participants had observed traumatized patients worsen when treated with exposure therapy or phase-oriented therapy and whether the theoretical orientation and treatment experience of the clinician were related to the observed deterioration. In the tradition of expert and practitioner surveys, 263 clinicians completed a survey of their diagnoses and treatment preferences for two vignettes and their treatment experience, theoretical orientation, and observations of patients' deterioration. When a marked degree of dissociation was noted in the PTSD vignette, respondents favored phased approaches regardless of the diagnosis given. Reports of having observed patient deterioration during both exposure and phased therapy were predicted by years of experience. Psychodynamic therapists reported more observations of worsening during exposure therapy than cognitive behavior therapy therapists. Clinical experience treating PTSD may heighten awareness of negative therapeutic effects, potentially because experienced clinicians have a lower threshold for detecting such effects and because they are referred more challenging cases.

Clinical Profile of Patients with Psychogenic Non-epileptic Seizures in Puerto Rico.

OBJECTIVE: Specialized epilepsy clinics receive many cases (20%-30% of total cases) in which the patients are diagnosed with psychogenic non-epileptic seizures (PNES). In Puerto Rico, there has been a lack of research on and data about patients with PNES. This study examined the clinical profile of 34 patients with a confirmed diagnosis of PNES. METHODS: A secondary analysis of 34 clinical records of patients with PNES was conducted. The resulting profile was based on clinical interviews, the behavioral presentation of seizures, the history of traumatic experiences or abuse, and the relationship between PNES events and life stressors. Also, the Beck Depression Inventory-II was used to explore depressive symptoms. RESULTS: Seventy six percent (n = 26) of the patients were female, with an average age of 34.32. All the patients in this sample experienced a PNES episode that was induced in the office through hypnotic imagery. In most cases, seizures consistently manifested PNES semiology: 82% presented unsynchronized and violent limb movements and featured vocalizations, pronounced ictal pelvic thrusting, and sideto-side head movements. Furthermore, 47% of the patients reported histories of trauma related to sexual, physical or emotional abuse. Moreover, 94% stated that most of their convulsions were triggered by stressful life events. Additionally, 50% of the patients presented symptoms of depression. CONCLUSION: The clinical profile of patients with PNES reveals that a considerable number of them presented a history of multiple traumatic experiences and most seizures seemed to be induced by stressful events. It is recommended that additional clinical research be conducted on PNES, with the aim of achieving the effective detection and diagnosis of the disorder, as well as increasing the focus of the healthcare industry on developing evidence-based interventions.

Dissociative identity disorder: An empirical overview.

OBJECTIVE: Despite its long and auspicious place in the history of psychiatry, dissociative identity disorder (DID) has been associated with controversy. This paper aims to examine the empirical data related to DID and outline the contextual challenges to its scientific investigation. METHODS: The overview is limited to DID-specific research in which one or more of the following conditions are met: (i) a sample of participants with DID was systematically investigated, (ii) psychometrically-sound measures were utilised, (iii) comparisons were made with other samples, (iv) DID was differentiated from other disorders, including other dissociative disorders, (v) extraneous variables were controlled or (vi) DID diagnosis was confirmed. Following an examination of challenges to research, data are organised around the validity and phenomenology of DID, its aetiology and epidemiology, the neurobiological and cognitive correlates of the disorder, and finally its treatment. RESULTS: DID was found to be a complex yet valid disorder across a range of markers. It can be accurately discriminated from other disorders, especially when structured diagnostic interviews assess identity alterations and amnesia. DID is aetiologically associated with a complex combination of developmental and cultural factors, including severe childhood relational trauma. The prevalence of DID appears highest in emergency psychiatric settings and affects approximately 1% of the general population. Psychobiological studies are beginning to identify clear correlates of DID associated with diverse brain areas and cognitive functions. They are also providing an understanding of the potential metacognitive origins of amnesia. Phase-oriented empirically-guided treatments are emerging for DID. CONCLUSIONS: The empirical literature on DID is accumulating, although some areas remain under-investigated. Existing data show DID as a complex, valid and not uncommon disorder, associated with developmental and cultural variables, that is amenable to psychotherapeutic intervention.

Psychometric properties of the Cambridge depersonalization scale in Puerto Rico.

Depersonalization experiences have been studied in the United States and Europe, but there is a dearth of investigations with Latino populations. In the current study we examined the psychometric properties of the Spanish version of the Cambridge Depersonalization Scale (CDS) in 300 adult individuals from the community and compared the results with those reported previously with non-Latino clinical populations. Discrepant findings have been reported with respect to the factor structure of the CDS. We performed exploratory and confirmatory factor analyses on the CDS items and compared our results with published analyses on other populations. Results revealed that the psychometric properties of the CDS, such as reliability, seem adequate, although the factor structure of the CDS seems to be inconsistent across studies. We selected a 4-factor solution that was most parsimonious and best fit our data. Furthermore, we obtained a moderate, statistically significant relationship (r = .64, p = .001) between the CDS and the Dissociative Experiences Scale. Our results, utilizing a nonclinical sample of Puerto Rican adults, suggest that depersonalization experiences can be reliably measured in a Latino and Spanish-speaking population.

Post-traumatic stress disorder, dissociation, and neuropsychological performance in Latina victims of childhood sexual abuse.

This study compared the memory, attention/concentration, and executive functioning of 12 women with histories of child sexual abuse with a control group of 12 women without childhood abuse. Participants completed a neuropsychological test battery and various instruments assessing post-traumatic stress disorder and dissociation. The child sexual abuse group had lower performance than the control group on long- and short-term visual and verbal memory and presented more limited performance on executive functioning tasks. Functioning in these areas showed a negative correlation with post-traumatic stress disorder and dissociative symptoms. These findings suggest that child sexual abuse is associated with memory and executive functioning deficits and supports the idea that people with trauma histories and increased post-traumatic stress disorder and dissociation symptoms may have alterations in neuropsychological functioning.

Dissociation in sexually abused Puerto Rican children: a replication utilizing social workers as informers.

This study explores dissociative symptoms in 3 different groups of Puerto Rican children. Data were collected on 40 children with documented sexual abuse history, 39 children with psychiatric disorders but without a history of sexual abuse, and 40 community control children. Dissociative symptoms were assessed with the child using the Trauma Symptom Checklist for Children (TSCC); a social worker answered the Child Dissociative Checklist (CDC). Results indicated that children with sexual abuse obtained significantly different scores on both the TSCC and the CDC. Further analysis indicated that child and social worker reports of dissociative symptoms were highly correlated (r = .73). Furthermore, 30% of the children in the sexual abuse group scored at or above the cutoff point of 12 on the CDC, which is indicative of a dissociative disorder. None of the children in the other 2 groups obtained such a score. The results suggest that children with documented sexual abuse victimization demonstrate a significant number of dissociative phenomena that not only are subjectively experienced but also can be observed by a non-family member. Finally, as nearly a third of the abused children obtained a score of 12 or higher on the CDC, the next step is to prepare clinicians to conduct a proper and formal diagnosis assessment of dissociative disorders.

Effect of the Management of LGBTT+ Identity on Psychological Wellbeing.

The current study, guided by the Minority Stress Model (Meyer, 2003), seeks to examine the effect of sexual orientation or gender identity management (disclosure or concealment) in the relationship between internalized negative ideals (internalized homonegativity and internalized transnegativity) and psychological wellbeing in LGBTT+ people in Puerto Rico. Four instruments were translated from English to Spanish, two of them relating to the management of the minority identity, and two regarding the internalized negative ideals. Additionally, reliability measures were calculated for each instrument. The sample consisted of 203 participants, 165 identified as cisgendered, and 38 identified themselves as trans or another gender. Results suggested that internalized negative ideals predicted the minority identity management in LGBTT+ people. However, the relationship between the internalized negative ideals and psychological wellbeing was only confirmed in terms of sexual orientation and not of gender identity, which suggests that other factors may better explain wellbeing in trans people. A discussion is presented on these results' implications and the study's challenges and limitations due to the Covid-19 pandemic, and suggestions for further studies.

La presente investigación, guiada por el Modelo de Estrés de Minorías (Meyer, 2003), busca examinar el efecto del manejo de la orientación sexual o identidad de género, entiéndase divulgación u ocultación, en la relación de homonegatividad internalizada/transfobia internalizada con el bienestar psicológico en personas LGBTT+ en Puerto Rico. Se tradujeron cuatro instrumentos, dos relacionados al manejo de la identidad minoritaria (ocultación o divulgación), y dos sobre los ideales negativos internalizados, y se calculó su confiabilidad. La muestra consistió de 203 participantes, donde 165 se identificaron como cisgénero, y 38 como trans u otro género. Los hallazgos mostraron que los ideales negativos internalizados predijeron el manejo de la identidad minoritaria para las personas LGBTT+. No obstante, la relación entre los ideales negativos internalizados y el bienestar psicológico solo se confirmó para los ideales de la orientación sexual, y no de la identidad de género, lo cual sugiere que otros factores pueden explicar de forma más significativa el bienestar en las personas transgénero. Se presenta una discusión de las implicaciones de estos resultados. A su vez, se describen los retos y las limitaciones del estudio debido al COVID-19, así como recomendaciones para futuros estudios.

COVID-19 in Puerto Rico: Preliminary observations on social distancing and societal response toward a novel health stressor.

Countries worldwide are making wide-ranging attempts to stymie the outbreak of the 2019 novel coronavirus (COVID-19), and most of their efforts depend on the financial, structural, and social resources available. Given the increase in documented cases of COVID-19 in Puerto Rico, the extension of an aggressive and restrictive quarantine has been the correct step to slow down the potential contagion. Nevertheless, in this article, we discuss additional concrete actions that should be considered. This unprecedented scenario provides us the opportunity to rethink our limited resources based on a socioecological perspective, with the aim of creating efficiency and reducing the inequities that could accompany the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

[Psychosocial characteristics of an initial sample of Puerto Rican centenarians]. / Caracteristicas psico-sociales de una muestra inicial de centenarios puertoriqueños.

This is the first research done in Puerto Rico presenting a basic socio-demographic profile of a sample of Puerto Rican centenary elderly that also includes psychological characteristics. The sample consist of eleven subjects, divided in five women and six men (mean age sample = 102.4 years) evaluated with a battery of psychological instrument that include the Symptom Checklist 90-R (SCL-90-R); the Beck Depressive Inventory (BDI-II); the Beck Suicide Scale (BSS); the Beck Hopelessness Scale (BHS); the Beck Anxiety Inventory (BAI) and the Folstein Mini-Mental. Main findings demonstrate that, with the exception of anxiety and hopelessness symptomatology, this particular sample is with a good psychological health. It is recommended to continue this type of research with a bigger sample and include other psychological and psychiatric screening instruments.

Sex differences in traumatic events and psychiatric morbidity associated to probable posttraumatic stress disorder among Latino prisoners.

Latinos comprised 17.1% of the U.S. population and 33.1% of US prisoners, yet they are underrepresented in the psychopathology literature. Despite higher rates of trauma among incarcerated individuals than in the general population, most of the previous research in this area focused primarily on women samples, and very few studies examined sex differences in PTSD and traumatic experiences. In addition, there is a need for research assessing traumatic experiences and probable PTSD in men and women Latino inmates to inform culturally competent care and sex sensitive care for this vulnerable and underserved population. Our study examined whether men and women Latino inmates with probable Posttraumatic Stress Disorder (PTSD), based on the cut off 40 or more symptoms on the Davidson Trauma Scale (DTS), differed significantly by the number of event types experienced, the type of potentially traumatizing event, and in co-occurring psychiatric conditions. A multi-stage sample design was used to select a probabilistic sample of 1,331 inmates from 26 penal institutions in PR of which 1179 participated in the study. Bivariate associations were calculated for each type of traumatic event and probable PTSD. Mean number of types of potentially traumatizing event experienced was comparable for both sexes (F = 3.83, M = 3.74) yet sex differences were found in the nature of the event. Women with probable PTSD had higher rates of experiencing rape and sexual abuse. Men had higher rates of experiencing combat in war, a life-threatening accident, of witnessing violence, and being threatened with a weapon. Men with significant ADHD symptoms in childhood and with Generalized Anxiety Disorder (GAD) during adulthood were almost 5 and 7 times as likely to score above threshold on the DTS whereas women were >3 times as likely in the presence of ADHD symptoms in childhood or depression during adulthood. This study underscores the need to improve understanding of the clinical manifestations of trauma and co-occurring psychiatric conditions for appropriate sex sensitive interventions targeting Latinos living in prisons.

ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents.

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.

A spanish version of the barber suggestibility scale for the puerto rican population.

Currently in Puerto Rico, there are no reliable and valid instruments to assess hypnotic responsiveness. The most widely utilized scales have not been scientifically translated and adapted with Puerto Ricans. In the present study, the Barber Suggestibility Scale (BSS) was translated and adapted using back-translation and decentralization. The translated BSS (the ESB) was individually administered to Puerto Rican college students (N = 85). No significant differences were found among the mean scores for the current sample on the ESB and the 1965 sample on the BSS. Both samples had similar score distributions. The internal consistency of the ESB was adequate, and there were significant correlations among scale items and total scores. The authors conclude that the ESB is an adequate instrument to measure hypnotic response within the Puerto Rican population.

Prevalence and factors associated to sexual behavior in Puerto Rican adolescents.

Sexual relations with intercourse (ASR-I) and high prevalence of teen pregnancies (19.2%, in 2002) among adolescents in Puerto Rico constitute a serious biopsychosocial problem. Studying the consequences and correlates of ASR-I in community and mental health samples of adolescents is important in designing and implementing sexual health programs. Randomized representative cross-sectional samples of male and female adolescents from 11-18 years old (N = 994 from the general community, N = 550 receiving mental health services) who had engaged in ASR-I were the subjects of this study. Demographic, family, and sexual data and the DISC-IV were collected from individual interviews. Logistic regression models, bivariate odds ratios, Chi-squares, and t tests were used in the statistical analysis. The mental health sample showed higher rates of ASR-I, lifetime reports of pregnancy and lower age of ASR-I onset for females. No gender difference in the prevalence of ASR-I was observed in both samples. Older adolescents from the community sample meeting psychiatric diagnosis criteria, and with lower parental monitoring, were more likely to engage in ASR-I, whereas in the mental health sample, adolescents with lower parental monitoring and parental involvement reported significantly more ASR-I. Prevalence of ASR-I and Risky Sexual Behavior (RSB) were almost identical. Adolescents with mental health disorders initiate and engage in ASR-I earlier and more frequently regardless of gender. Older adolescents are more likely to engage in ASR-I and parent-child relationships emerged as a highly relevant predictor of adolescent sexual behavior. The high correspondence between ASR-I and RSB has important clinical implications.