Reliability and Validity of the List of Mental Health Items (LISMEN).

BACKGROUND: The detection of risk factors is a key element in the prevention of mental health disorders. It is widely known that in the formation of personality and its disorders, relational experiences (vital events) in childhood condition both neurological and emotional development. The accumulation of these circumstances brings about altered life trajectories, which make people more vulnerable to mental health disorders. METHOD: A structured interview called LISMEN was designed based on the scientific literature to detect the risk of developing mental health disorders. A descriptive, reliability, and validity statistical study was carried out on four samples, one of which was the control group. There were 372 subjects in total. RESULTS: The technique was highly reliable (kappa coefficient 0.7 [p<0.05]) and internally consistent (Cronbach's alpha between 0.80 and 0.98). Sensitivity and specificity were high (AUC [Area Under Curve] OR =1.18 [1]), with the cut-off point between 9 and 10. CONCLUSIONS: LISMEN is a useful tool for detecting the risk of developing mental health disorders. A score of 10 or higher indicates that the subject belongs to the most sensitive or vulnerable population group at risk.

[Review of risks factors in childhood for schizophrenia and severe mental disorders in adulthood]. / Una revisión sobre los factores de riesgo en la infancia para la esquizofrenia y los trastornos mentales graves del adulto.

AIM: To provide scientific evidence, using a literature review on psychosocial risk factors in mental health, that a high exposure to psychosocial stress situations in childhood increases the risk of mental disorders in adulthood,. DESIGN: A literature review up to December 2011 in the electronic databases from Medline, Universitat de Barcelona, and the Universitat Autonoma de Barcelona. The keywords used were: childhood, prenatal, vulnerability, risk, abuse, neglect, child mental disorder, schizophrenia, and prevention. Inclusion criteria for the studies reviewed: 1) designed to investigate childhood risk factors; 2) Comparative studies with persons without risk factors; 3) Studies with sufficient statistical significance; 4) Studies with "n" participants equal to o more than 30 persons. RESULTS: There are a group of easily identifiable mental health risk factors in childhood that can help in the prevention of mental disorders in the adulthood. They can be grouped into four categories: A) Pregnancy, birth and perinatal problems; B) Poor interpersonal relations with parents; C) Adverse life events in the first two years of life; D) Cognitive deficits in primary school, and social isolation during school years. CONCLUSIONS: There are life events that may increase the possibilities of suffering some kind of Psychopathology. It is necessary to consider those events as Risk Factors for Mental Health. The accumulation of these Risk Factors increases vulnerability to Mental Disorders.

Attachment style predicts 6-month improvement in psychoticism in persons with at-risk mental states for psychosis.

AIM: Insecure attachment may influence vulnerability to and outcome of psychotic symptomatology. The present study examined whether attachment style predicted symptoms and functioning of at-risk mental state (ARMS) patients after 6 months of psychosocial intervention, over and above the effects of initial clinical severity and premorbid social adjustment (PSA). METHODS: Symptoms and functioning were assessed at baseline and 6 months later in 31 ARMS patients (mean age = 15.7). No patient received antipsychotic medication, but all engaged in intense psychosocial needs-adapted treatment. Clinicians (unaware of the aims of the study) rated attachment, PSA, symptoms, and functioning. RESULTS: Attachment was not related to baseline clinical severity. However, improvement in psychoticism was predicted by attachment (in particular by secure, preoccupied and dismissing) beyond the effects of baseline clinical severity and PSA. Secure attachment also predicted improvements in disorganization and functioning. Poor PSA predicted less improvement in disorganization and negative symptoms but did not impact psychoticism. CONCLUSIONS: The three attachment prototypes that predicted improvement in psychoticism (secure, preoccupied and dismissing) share the existence of at least one positive psychological model (either about self or about others). It may be that the psychosocial intervention helped ARMS patients to disconfirm negative models and/or reinforce positive ones. Patients' attachment styles were not related to baseline clinical severity but impacted improvement of positive symptoms. These findings appear consistent with evidence that impaired self-esteem and dysfunctional self and others schemas constitute risk factors for reality distortion.

At-risk mental state (ARMS) detection in a community service center for early attention to psychosis in Barcelona.

AIM: To describe the strategy and some results in at-risk mental state (ARMS) patient detection as well as some of the ARMS clinical and socio-demographical characteristics. The subjects were selected among the patients visited by an Early Care Equipment for patients at high risk of psychoses, in Barcelona (Spain) during its first year in operation. METHODS: Descriptive study of the community-team relations, selection criteria and intervention procedure. Description of patient's socio-demographic and symptomatic characteristics according to the different instruments used in detection and diagnoses, taking account of four principal origins of referrals: mental health services, primary care services, education services and social services. RESULTS: Twenty of 55 referred people fulfilled the at-risk mental state criteria, showing an incidence of 2.4 cases per 10,000 inhabitants. They were mainly adolescent males referred from health, education and social services. Overall, negative symptoms were predominant symptoms and the more frequent specific symptoms were decrease of motivation and poor work and school performance, decreased ability to maintain or initiate social relationships, depressed mood and withdrawal. CONCLUSIONS: It is possible to detect and to provide early treatment to patients with prodromal symptoms if the whole matrix of the community--including the social services--contributes to the process. The utilization of a screening instrument and a two-phase strategy--the second carried out by the specialized team--seems to be an appropriate approach for early psychosis and ARMS detection.

Neighborhood differences in psychoses: prevalence of psychotic disorders in two socially-differentiated metropolitan areas of Barcelona.

INTRODUCTION: The prevalence of schizophrenia and other psychoses can vary between close geographic locations and can be biased by the use of epidemiological designs. With data derived from a public mental health centre with close relations to primary care teams we have compared the distribution of psychotic disorders in two neighborhoods in Barcelona with marked psycho-social differences. METHODS: Using a computerized database from Barcelona's National Health Service covering 5 basic health-care areas with a total population of 103,615 inhabitants, we have accessed case records showing any psycho-pathology between the years of 1982 and 2000. RESULTS: From the case records of 21,536 registered patients showing any psycho-pathology, and using strict diagnostic, clinical and assistance criteria, we found that there were 476 patients diagnosed as "schizophrenic" and 362 that were "affected by other psychoses." Despite being evaluated by the same mental health personal, the same research team using identical criteria and over the same period of time (thus precluding operator and selection bias) the prevalence of these disorders was twice as high in La Mina (a district with a marked accumulation of psycho-social risk-factors) as compared to the neighboring district of La Verneda. CONCLUSIONS: When assessing prevalence of psychoses, it is necessary to consider the impact of social and psycho-social factors, even in neighboring communities.

[Schizophrenic disorders in primary care mental health]. / Trastornos esquizofrénicos en la atención primaria a la salud mental.

OBJECTIVES: To determine the prevalence and incidence of schizophrenia and other psychoses in a mental health unit (MHU) closely connected to primary health care. DESIGN: Retrospective longitudinal study of the register of all patients with psychiatric illnesses detected in a specific geo-demographic and health care area. SETTING: Five basic health care areas of Barcelona (103 615 inhabitants). PARTICIPANTS: MHU patients who had attended clinics due to mental health disorders during the period from 1982-2000 (N=21 236). Strict health and diagnostic criteria based on the DSM-4 classification were applied. All cases were validated using clinical history review and concensus. MEASUREMENTS: Incidence (in the last 3 years) and prevalence of schizophrenia and other psychoses in the whole period of study, both in the general population and in the risk population age group (15-54 years). RESULTS: In total, 838 patients complied with the diagnosis of suffering from schizophrenia (N=476) or other psychoses (N=362). The incidence of schizophrenia was 3.47/10,000 (95% confidence interval [CI], 2.3-4.6) in the general population and 5.09/10,000, 95% CI, 3.2-6.9) in the population at risk, and the prevalence of schizophrenia was 54.9/10,000 (95% CI, 41.8-50.1) in the general population and 80.7/10,000 (95% CI, 73.5-88) in the population at risk. CONCLUSIONS: The MHU-primary health care interface can be a good place to detect and study schizophrenic syndromes and other psychoses, as long as they comply with the agreed health and research criteria.