Temporal evolution of stress in the year prior to the onset of depressive disorders.

BACKGROUND: We investigate how the stress levels in a sample of patients with depressive disorders vary in the year prior to the onset of symptoms. DESIGN: Observational study of the case/control type. Fifty patients whose first depressive episode began in the 6 months prior to the interview METHOD: The LEDS was applied to all the subjects. A calculation was made of the evolution week by week of stress throughout the year prior to the onset. RESULTS: Notable differences were detected in the temporal profile of the stress between the depressive patients and control groups. The differences between them were especially far-reaching in the 26 weeks prior to the onset of the symptoms, with a tendency to increase in the 7 weeks immediately before the onset.

Patients who miss initial appointments in community psychiatry? A Spanish community analysis.

OBJECTIVES: To identify factors that predict which patients, when referred by their GP, make a first appointment at a Mental Health Centre and then fail to attend. METHOD: Sequential observational study in which data was collected for one year on all the people (1311) with an arranged date for an initial appointment at an urban Community Mental Health Centre. RESULTS: Approximately 25% of patients who request an initial appointment fail to attend. The variables that predict non-attendance are: the lack of a telephone number for contact, the time lapse before the appointment, and when drug-addiction is the reason for requesting the appointment. One variable that results in a specific kind of behaviour is the timing of the initial appointment, since males and females tend to miss at different times. We also found that missing the appointment followed a seasonal pattern. CONCLUSIONS: In order to optimise the service, it is necessary to discover the proportion of probable misses, and aim to arrange the appointment with the shortest possible time lapse and to take into consideration the sex of the patient when fixing the time of the interview.

[Translation and adaptation in the Spanish environment of the Altman Self-Rating Mania Scale]. / Traducción y adaptación de la Altman Self-Rating Mania Scale al ámbito español.

INTRODUCTION: The aim of the present study is the translation, adaptation and validation in the Spanish environment of a self-rating of mania scale, the Altman Self-Rating Scale for Mania (ASRM), to fulfill a need in our environment in the self-rating of mania. METHODS: The scale was translated, and then a back translation was done. This was sent to the author of the original scale. The scale was administered to a sample of 74 patients with bipolar disorder, divided into two groups, one formed by patients with acute mania (n=35) and the other one constituted by asymptomatic patients (n=39). Concurrently we applied the Clinician Administered Rating Scale for Mania (CARS-M) and the Numeric Evaluation Scale (NES). RESULTS: High internal consistency, high and significant correlation with the CARS-M mania sub-scale, as well as with the NES and very significant differences between the two groups in the scale score were found. The ROC curve indicates excellent adjustment of the scale, when discriminating among bipolar patients with and without manic symptoms. The factorial analysis provided a single factor that accounts for 62% of the total variance. CONCLUSIONS: The Altman Self-Rating Mania Scale is shown to be a reliable and valid self-rating instrument to assess the presence and intensity of manic symptoms. It makes it possible to carry out simple and quick assessments of the patient's state, can be used for research as clinical objectives and can also be a screening instrument.

On the convergent validity of two Parental Rearing Behaviour Scales: EMBU and PBI.

The EMBU and PBI are two of the most used Parental Rearing Behaviour questionnaires. The literature assumes a high correlation between homonymous and assimilable factors (PBI Care and EMBU Affectional Warmth, PBI Control and EMBU Overprotection). Using a sample of 796 subjects the authors carried out the joint application of both scales in order to determine their concurrent validity. The correlation obtained between the scales barely reaches significance on average levels of correlation. The same can be deduced for the applied Multidimensional Scaling. In conclusion, the most extreme precaution is recommended when considering the homonymous scales of both questionnaires, and their joint use in meta-analysis is not advised.

[Bipolar disorder: helping the treatment]. / Trastorno bipolar: ayudando al tratamiento.

INTRODUCTION: [corrected] Psychoeducation programs for bipolar patients try to give them a theoretical and practical system to understand and cope with the consequences of this disorder. The published studies reviewed support the idea that patients included in this therapeutic approach present higher treatment compliance. METHODOLOGY: The purpose of our study is to specify the benefits of the psychoeducation programs, comparing the degree of knowledge of the illness (Measured by means of the Understanding Mood Disorder Questionnaire Gavazzi et al, 1997, Spanish version of Livianos and Rojo, 1998) of 10 patients included in our program with that of another 10 patients who attended the same lithium clinic, but were not included in the psychoeducation program. RESULTS: There are statistically significant differences in the total of the scale as well as on the mania scale and known facts, but no differences on the depression scale. CONCLUSION: The results allow us to stress the impact of the psychoeducation programs on the knowledge of illness.

[New mood stabilizers and reproductive cycle]. / Nuevos eutimizantes y ciclo reproductivo.

INTRODUCTION: The use of new mood stabilizers in the treatment of bipolar disorder has supposed a revolution, especially due to its more favorable profile in many aspects. Nevertheless, therapeutic decisions on treatment during pregnancy and the breastfeeding period are still being debated. Since these new anticonvulsants appeared in the decade of 1990, less naturalistic experience in its use exists during these periods than with other older anticonvulsants. METHODS: A Medline and Embase search was conducted from 1970 to 2003 to review the articles published on the use of the new mood stabilizers during pregnancy and breastfeeding, and its effects on contraception. Neurology and psychiatry text chapters and abstracts of the Annual Meeting of the American Psychiatric Association (years 2001-2003) were also reviewed. RESULTS: Although some recent articles suggest that new mood stabilizers could have a smaller risk of congenital defects, and therefore could be used with smaller risks in women in fertile age, most of articles reviewed indicate that there is not enough knowledge on the safety of the new mood stabilizers in pregnancy and breastfeeding. CONCLUSIONS: The risks and benefits of continuing with the new mood stabilizers during pregnancy and breastfeeding must be weighed carefully, and the severity of the disease and the previous answer to treatment should be taken into account.

[The influence of emotions on upbringing memories: a before-after study with a parental bonding instrument (PBI)]. / La influencia de las emociones en la rememoración de la crianza: un estudio antes-después con el Parental Bonding Instrument (PBI).

A common idea is the that the patients with affective and anxiety disorders recover in a partial way their memories in function of their state. This particular fact can influence the remembrance of the upbringing so that the memory is facilitated for facts congruent with their current affects. The authors apply a questionnaire of upbringing (PBI) to a group of anxious and depressive patients at the beginning of the treatment and when the improvement has taken place. There are not variations for the punctuations in the scale of upbringing, which is invariant with the changes of the humour.

[Validation of the SRQ in mental health examinations of the general public]. / Validación del SRQ en los exámenes de salud mental en la población general.

The utility of the SRQ on the mental health screening in a general population sample is tested on this paper. In terms of a better sensibility/specificity adjustment, and greater adequacy the results show that the best cut-off point is found on 3 affirmative answers. The results are discussed in relation to some others found at the literature.

[Familiar Munchausen syndrome: an unusual presentation]. / Síndrome de Munchausen familiar: una presentación inusual.

Munchausen syndrome is a subtype included in factitious disorders in which somatic signs and symptoms predominate. The patient self-inflicts damage with the only objective of assuming a <

Rearing style and depressive disorder in adulthood: a controlled study in a Spanish clinical sample.

OBJECTIVE: The aim of this study was to investigate the style of rearing in a sample of depressive patients and compare it with a control group of normal subjects of similar age, sex, and civil status. The hypothesis to verify was that among the depressives the style of rearing is characterised by a deficit in Emotional Warmth and an excess of Rejection and Protection. We analysed whether the severity of the depression - Major Depressive Disorders versus Depressive Disorders Not Otherwise Specified - was associated with differences in the perceived rearing conditions. DESIGN: It was an observational study of the case/control type. There were 50 patients, whose first depressive episode (DSM-III-R criteria) began in the 6 months prior to the interview. They were entered sequentially into the study sample. The control group comprised 50 subjects with no depressive pathology, matched by age, sex, and social class. METHOD: The EMBU questionnaire was applied to all the subjects. RESULTS: Only 35% of all depressive patients, as against 64% of the controls, had experienced an optimum upbringing. It is shown that a deficit in Emotional Warmth and a high level of Rejection constitute parental attitudes that are significantly more frequent among depressives than among subjects with no psychiatric pathology. Type of depression or degree of intimacy did not influence the scores obtained in the subscales of the EMBU. Depressives pertaining to lower social classes tended to score higher in Overprotection and Rejection scales.

[Psychiatrist's burnout. A survey]. / El desgaste profesional del psiquiatra: resultados de una encuesta entre profesionales.

INTRODUCTION: This work seeks to know the state of the Burnout syndrome among Spanish psychiatrists' with the purpose of having some national reference values. It also sought to elucidate the sociodemographic and work-related variables which can influence the burnout syndrome. METHODS: A survey (which includes sociodemographic, work-related variables and the Maslach Burnout Inventory) is applied to a sample of psychiatrists assisting at the National Congress of Psychiatry held in Valencia. The statistical analysis comprises parametric, non parametric and multivariate methods. RESULTS: The results of the three subscales included in the Maslach Burnout Inventory is offered along their relationship with the sociodemographic and work-related variables studied. The multivariate analysis shows that only the variable sex can influence the probability of obtaining high scores in the depersonalization subscale. CONCLUSIONS: The scores obtained in the three subscales of the of Maslach Burnout Inventory are higher than those published to date. These prior studies were carried out with autonomous samples. The possible relationship of these high scores with the current spanish situation is considered.

The role of stress in the onset of depressive disorders. A controlled study in a Spanish clinical sample.

BACKGROUND: We conducted the present study to evaluate the impact of stressful events on the onset of depressive disorders in a Spanish clinical sample, compared to a control group matched for age, sex, civil status and social class. We compared our results with those of other studies carried out with samples that were both clinically and culturally similar to ours. METHOD: Fifty depressed patients that were diagnosed with a depressive episode in the 6 months prior to the interview and 50 healthy controls were included in the study. Both groups were compared on the "Life Events and Difficulties Schedule" (LEDS). RESULTS: Of the depressive patients, 68 % compared to only 18 % of the control individuals experienced at least one provoking agent in the 12 months prior to the onset of the symptoms. The risk of developing a depressive disorder was 9.7 % greater in subjects exposed to such provoking agents. Chronic difficulties are equally important to the genesis of depressive disorders as severe life events. No significant differences were seen between the two diagnostic subgroups of depressed patients in the accumulation of severe events, major difficulties or provoking agents. CONCLUSION: The results support the view that stress is a major factor in the aetiology of depressive disorders. The amount of stress suffered by the patients, however, was less than that found in our healthy sample. Important issues about the model of interaction between stress and depression are discussed.

[The Spanish version of the Manchester Nurse Rating Scales]. / La Escala de Manía de Manchester: su adaptación a nuestro medio.

INTRODUCTION: There is no Nursing-staff Mania Rating Scale adapted to the Spanish language. The present work is the result of the adaptation we have carried out. METHODOLOGY: The scale has been translated and the back-translation compared with the original version. It has been applied on 670 occasions to a sample of 59 patients. Simultaneously the patients were rated with the Manic Interpersonal Interaction Scale, two versions of the Visual Analogue Scale and the Numeric Rating Scale. RESULTS: The coefficient Alpha of Cronbach is 0.94. The interrater's correlation coefficient for the total of the scale is 0.84. The factorial analysis gives a single factor that explains 65% of the variance. The Area under the ROC Curve is 0,87. CONCLUSIONS: The scale shows excellent psychometric properties, with great homogeneity of the scale items and good discriminate properties between bipolar patient and those affected by other psychoses.