Effectiveness of a multimodal training programme to improve general practitioners' burnout, job satisfaction and psychological well-being.

BACKGROUND: The changes in the models of care for mental disorders towards a community focus and deinstitutionalisation might have risen General practitioners' (GPs) workload, increasing their mental health concerns and the need for solutions. Pragmatic research into improving GPs' work-related health and psychological well-being is limited by focusing mainly on stressors and through not providing systematic attention to the development of positive mental health via interventions that develop psychological resources and capacities. The aim of this study was twofold: a) to determine the effectiveness of an intensive multimodal training programme for GPs designed to improve their management of mental-health patients; and b) to ascertain if the program could be also useful to improve the GPs management of their own burnout, job satisfaction and psychological well-being. METHOD: Eighteen GPs constituted a control group that underwent the routine clinical Mental health support programme for primary care. An experimental group (N = 20) additionally received a Multimodal training programme (MTP) with an Integrated Brief Systemic Therapy (IBST) approach. Through questionnaires and a clinical interview, level of burnout, professional satisfaction, psychopathological state and various indicators of the quality of administrative and healthcare management were analysed at baseline and 10 months after the programme. RESULTS: In relation to government of mental-health patients indicators, on the one hand MTP group showed statistically significant improvements in certain administrative health parameters, but on the other it did not improve opinions and attitudes towards mental illness. Regarding GPs management of their own burnout, job satisfaction and psychological well-being assessments, the MTP presented better scores on global psychopathological state and better evolution of satisfaction at work; psychopharmacology use dropped in both groups; in contrast, the MTP did not improve burnout levels. CONCLUSIONS: Findings of this preliminary study are promising for the MTP (with an IBST approach) practice in primary care. More research evidence is required from larger samples and randomized controlled trials to support both the hypothetical adoption of MTP (with an IBST approach) as a part of a continuing professional-training programme for GPs' management of mental-health patients and its positive effects on work-related health factors.

The functional neuroanatomy of blood-injection-injury phobia: a comparison with spider phobics and healthy controls.

BACKGROUND: Most neuroimaging studies of specific phobia have investigated the animal subtype. The blood-injection-injury (BII) subtype is characterized by a unique biphasic psychophysiological response, which could suggest a distinct neural substrate, but direct comparisons between phobia types are lacking. METHOD: This study compared the neural responses during the presentation of phobia-specific stimuli in 12 BII phobics, 14 spider (SP) phobics and 14 healthy controls using functional magnetic resonance imaging (fMRI). RESULTS: Subjective ratings showed that the experimental paradigm produced the desired symptom-specific effects. As in many previous studies, when viewing spider-related stimuli, SP phobics showed increased activation in dorsal anterior cingulate and anterior insula, compared to BII phobics and healthy controls. However, when viewing images of blood-injection-injuries, participants with BII phobia mainly showed increased activation in the thalamus and visual/attention areas (occipito-temporo-parietal cortex), compared with the other two groups. The degree of provoked anxiety and disgust by phobia-relevant images was strongly associated with activation in several common regions across the two phobia groups (thalamus, cerebellum, occipito-temporal regions) but only correlated with activation in the dorsal anterior cingulate gyrus and the anterior insula in the SP phobics. CONCLUSIONS: These results suggest partially distinct neurobiological substrates of animal and BII phobias and support their current classification as two distinct subtypes in the DSM-IV-TR. Further research is needed to better understand the precise neurobiological mechanisms in BII phobia and particularly the fainting response.

Influence of individual differences in the Behavioral Inhibition System and stimulus content (fear versus blood-disgust) on affective startle reflex modulation.

Inconsistencies among affective startle reflex modulation studies may be due to differences in the startle potentiation produced by the specific content of the images used, to individual differences in sensitivity to negative stimuli, or to the interaction of both factors. To explore this interaction, 52 undergraduates obtaining extreme scores on a self-report measure of the Behavioral Inhibition System (BIS) participated in an affective startle reflex modulation paradigm. A significant interaction between BIS group (high versus low) and image content emerged from the MANOVA. Comparing startle magnitude between fear and pleasant images, low BIS participants did not seem to show startle potentiation, whereas high BIS participants did. Both groups displayed potentiated startle during blood-disgust images. The present results suggest the importance of considering personality variables and their interaction with image content in the affective startle modulation paradigm.

Relationship between frustration intolerance and personality dimensions

Frustration is a negative state triggered by unexpected reward loss with behavioral, emotional and motivational components. Frustration Intolerance (FI) has been considered a vulnerability marker for psychopathology, its impact being modulated by personality dimensions. In this study, the relationship between FI and personality dimensions was analyzed in 640 undergraduate students. The reduced version of the Revised NEO Personality Inventory and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire assessed personality dimensions. The Investigative Scale of Tolerance to Frustration, the Frustration Discomfort Scale, and the Frustrative Nonreward Responsiveness Scale assessed the behavioral, emotional and motivational components of FI, respectively. Descriptive, reliability, Pearson and partial correlation analyses were conducted. Regardless of the frustration component assessed, FI consistently and positively correlated with Neuroticism, Sensitivity to Punishment and Sensitivity to Reward. The relationship between FI and other personality dimensions seemed to be dependent on the particular FI assessment instrument used and on the corresponding component involved: Behavioral FI correlated positively with Extraversion and negatively with Openness and Agreeableness, whereas the relationship between these personality dimensions and emotional and motivational FI was not so clear. Therefore, a systematic analysis of the components of FI seems to be necessary to understand its relationship with personality

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Predicting outcome of lithium added to antidepressants in resistant depression.

This study was conducted to assess the predictive value of different variables including the response to dexamethasone suppression test (DST), in 105 patients with resistant depression after the addition of lithium (600 to 800 mg/day) for 4 weeks to antidepressant medication. Clinical remission was observed in 57 patients and no improvement in 48. A dramatic and rapid relief of depression occurred in 12 patients. Variables with significant or marginally significant differences between responders and non-responders were included in a stepwise logistic regression model. Weight loss (P = 0.0013) and depressive psychomotor activity (P = 0.045) in the Newcastle diagnostic index (NDI) scale, and overall score of the Hamilton Rating Scale for Depression (HRSD) before adding the lithium (P = 0.0039) were significantly associated with clinical remission. The difference in post-DST cortisol plasma levels between both groups was marginally significant. The logistic equation resulted in a sensitivity of 78% and a specificity of 65% and total correct classification of the lithium-added response of 72%. The clinical profile of patients who improve with the addition of lithium may include significant weight loss, psychomotor retardation and possibly, poor control of cortisol secretion. Partial remission before adding lithium as well as endogenomorphic traits according to NDI may also be considered additional criteria for response.

Psychometric properties of a Spanish version of the McGill Pain Questionnaire in several Spanish-speaking countries.

OBJECTIVE: Versions of the McGill Pain Questionnaire are available in a several languages and are used in clinical studies and sociocultural or ethnic comparisons of pain issues. However, there is a lack of studies that compare the validity and reliability of the instrument in the countries where it is used. The current study investigates the psychometric properties of a Spanish version of the McGill Pain Questionnaire in five Spanish-speaking countries. DESIGN: The authors conducted a multicenter and transnational study with one investigator in each center. Patients were evaluated once with a Spanish version of the McGill Pain Questionnaire, a visual analog scale, and a verbal rating scale. SETTING: The study was performed in pain clinics and acute pain units of four Latin American countries (Argentina, Costa Rica, Mexico, and Panama) and Spain. PATIENTS: The study included 205 patients (84 with acute pain, 121 with chronic pain) from Latin America. Their data were compared with those of 282 Spanish patients. INTERVENTIONS: The McGill Pain Questionnaire, visual analog scale, and verbal rating scale were administered once to all patients. The McGill Pain Questionnaire was administered again to patients from Latin America countries to ascertain descriptor comprehension. OUTCOME MEASURES: Demographic data, McGill Pain Questionnaire parameters, and visual analog scale and a verbal rating scale scores were obtained from patients with chronic and acute pain. Psychometric properties of the Spanish version of the McGill Pain Questionnaire were established for each country by calculating the ordinal consistency by means of rank-scale correlation (Spearman test), intercategory correlation, and interparameter correlation (Pearson test). Concurrent validity was also calculated by comparing scores from the visual analog scale (Pearson test) and verbal rating scale (Spearman test) with questionnaire parameters (qualitative-to-quantitative comparisons). RESULTS: The Spanish version of the McGill Pain Questionnaire maintained a high internal validity when tested in different countries. Ordinal consistency, intercategory, interparameter, and qualitative-to-quantitative parameter correlations were similar in all countries. Few descriptors were considered to be inappropriate or difficult to understand. CONCLUSIONS: The psychometric properties of the Spanish version of the McGill Pain Questionnaire assessed in different Latin-American countries suggest that the questionnaire may be used to evaluate Spanish-speaking patients. The validity of this test should be extended with reliability studies to further establish its usefulness in the evaluation of pain.

Standardization of the Hare Psychopathy Checklist-Revised in a Spanish prison sample.

This investigation examined the reliability, validity, and factor structure of the Hare Psychopathy Checklist-Revised (PCL-R) in male adult Spanish prison populations (n = 117). The interrater reliability and internal consistency coefficients were high, and similar to those obtained in other countries. This data provides support for the homogeneity and unidimensionality of the psychopathy construct in Spanish male prison samples. The analysis of factor structure also replicated the two factor solution of previous studies. The two factors showed different patterns of intercorrelations with several self-report measures of personality, demographic, and criminal history variables, which confirmed the construct validity of PCL-R. The results confirm the psychometric properties of the PCL-R as a measure of psychopathy in Spanish male inmates, and suggest that psychopathy is a construct also observed in Southern European countries.

[Measurement of postoperative pain: analysis of the sensitivity of various self-evaluation instruments]. / Medida del dolor postoperatorio: análisis de la sensibilidad de diversos instrumentos de autovaloración.

OBJECTIVES: This study compared the sensitivity of two one-dimensional scales (a visual analog scale [VAS] and a verbal scale of pain intensity [VSPI]) and one multidimensional scale (McGill Pain Questionnaire-Spanish Version [MPQ-SV]) for detecting changes in pain after a variety of surgical procedures with postoperative analgesia provided by one of two methods. PATIENTS AND METHODS: Forty-two patients who underwent abdominal surgery, hysterectomy, cesarean, inguinal herniorrhaphy, subcostal or medial laparoscopic cholecystectomy were studied. Postoperative analgesia consisted of 1 mg/Kg of intravenous pethidine every 4 h in group one (n = 20) and intramuscular diclofenac every 12 h in group two. Assessment was at 24 h and/or at 48 and 72 h using the VAS, the VSPI and the MPQ-SV. RESULTS: All the scales were useful for assessing postoperative pain, giving estimates that were sensitive to variations in pain on days after the operation. The MPQ-SV was able to detect different pain-producing capacities for the surgical procedures more effectively than were the one-dimensional scales. The MPQ-SV was also able to discriminate the qualitative and quantitative differences among the mechanisms of action of opioid and nonsteroidal anti-inflammatory drugs, whereas the one-dimensional scales were unable to distinguish therapeutic approach. CONCLUSIONS: All the scales were sensitive to changes in postoperative pain, but the MPQ-SV gave more precise information of differences between analgesic treatments and among operations.

Striatum gray matter reduction in males with an overactive behavioral activation system.

Using optimized voxel-based morphometry, we studied the relationship between gray matter volume in brain areas associated with reward and scores on a behavioral activation system measure (the Sensitivity to Reward scale) in a sample of 50 male undergraduates. Voxel-based morphometry analysis revealed a negative correlation between Sensitivity to Reward scores and gray matter volume in the dorsal striatum and prefrontal cortex. Results indicate that a reduced volume in the striatum might be associated with enhanced reward sensitivity and deficits in inhibitory control.

Behavioral Inhibition System activity is associated with increased amygdala and hippocampal gray matter volume: A voxel-based morphometry study.

Recent research has examined anxiety and hyperactivity in the amygdala and the anterior hippocampus while processing aversive stimuli. In order to determine whether these functional differences have a structural basis, optimized voxel-based morphometry was used to study the relationship between gray matter concentration in the brain and scores on a Behavioral Inhibition System measure (the Sensitivity to Punishment scale) in a sample of 63 male undergraduates. Results showed a positive correlation between Sensitivity to Punishment scores and gray matter volume in the amygdala and the hippocampal formation, that is, in areas that Gray, J.A., and McNaughton, N.J. (2000). The neuropsychology of anxiety. Oxford: Oxford Medical Publications. associated with the Behavioral Inhibition System.

Neurotransmitter systems and personality measurements: a study in psychosomatic patients and healthy subjects.

A comparative study performed in psychosomatic patients (PG) and healthy subjects (HG) reveals several correlations between personality measurements (Minnesota Multiphasic Personality Inventory, Sensation Seeking Scale, Susceptibility to Punishment), and biochemical variables (in serum: MHPG, acetylcholinesterase, calcium, melatonin; and in platelets: monoamine oxidase B, serotonin, calcium proteins). The relationship between some Sensation Seeking subscales and the enzymatic activities evaluated (negative with MAO and positive with AChase) and the opposite sign relationship between serotonin and some scales of MMPI in both groups studied (negative in the PG and positive in the HG) are noteworthy.

Thyroid hormone correlates of sensation seeking and anxiety in healthy human females.

The present study explores the relationships among a number of personality measures (the Sensation-Seeking Scale, SSS; the State-Trait Anxiety Inventory, and the Susceptibility to Punishment Scale) and some parameters of the pituitary-thyroid axis. The study was carried out on a group of 37 physically and mentally fit female volunteers, none of whom had a personal history of psychiatric or endocrinologic illness. The subjects were controlled for the menstrual cycle. The most relevant result was a significant negative relationship between the SSS score and plasma basal levels of thyroxine (T4) and thyroid-stimulating hormone (TSH). Interaction between T4 and TSH levels with trait anxiety was also observed.

Gonadal hormone correlates of sensation seeking and anxiety in healthy human females.

The present study focused on exploring the relationship between a number of personality measures (Sensation Seeking Scale, SSS; State-Trait Anxiety Inventory, STAI; and Susceptibility to Punishment Scale, SP) and some parameters of the pituitary-gonadal axis (FSH, LH and 17 beta-estradiol). The study was carried out with a group of 37 female volunteers. The subjects were physically and mentally fit. None of them had a personal history of psychiatric or endocrine illness. All subjects were studied at the beginning of the follicular phase. The most relevant results showed an 'inverted U shape' relationship between sensation seeking and plasma FSH levels. Lower Thrill and Adventure Seeking (TAS) scores were also found in subjects with higher levels of 17 beta-estradiol.

Correlation of thyroxine and thyroid-stimulating hormone with personality measurements: a study in psychosomatic patients and healthy subjects.

A comparative study performed in psychosomatic patients and healthy subjects reveals different profiles of thyroxine (T4) and thyroid-stimulating hormone (TSH) correlations with personality measurements (Minnesota Multiphasic Personality Inventory (MMPI); Sensation-Seeking Scale (SSS), and Susceptibility to Punishment Scale (SP). Three distinct sets of results may be enumerated, namely: (1) a negative correlation between sensation-seeking and TSH; (2) a positive correlation between the most indicative scales predisposing to depression-anxiety (hypochondriasis, depression, social introversion, susceptibility to punishment) and T4, and (3) the Hypomania Scale (Ma) showed a significant negative correlation with T4 in the patient group and a positive but nonsignificant relationship in the healthy group.

Psychometric analysis of behavior pattern A in the Spanish population and its relationship with personality variables.

As a first step in the epidemiological study for CHD prevention among the Spanish population, the authors have analyzed two of the instruments for the assessment of the behavior pattern A (JAS and Bortner questionnaires). From a student sample (n = 302), a factor analysis of items and scales was made, relating pattern A scores to Eysenck's personality variables (EPQ). The importance of an accurate psychometric study of pattern A was emphasized, in order to select A subjects as specifically as possible.

Medida del dolor postoperatorio: análisis de la sensibilidad de diversos instrumentos de autovaloración / Measurement of postoperative pain: an analysis of the sensitivity of several self assessment instruments

OBJETIVOS: El presente estudio comparó la sensibilidad de las escalas unidimensionales (escala visual analógica o EVA, Escala verbal de intensidad del dolor o EVID) y multidimensionales (McGill Pain Questionnaire-Spanish Versión o MPQ-SV), para detectar los cambios del dolor postoperatorio tras diferentes procedimientos quirúrgicos y analgesia postoperatoria. PACIENTES Y MÉTODOS: Se estudiaron 42 pacientes intervenidos de cirugía abdominal, histerectomía, cesárea, herniorrafia inguinal, colecistectomía subcostal o laparotomía media. La analgesia postoperatoria consistió en el primer grupo (n=22) en 1 mg/kg de petidina iv cada 4 h, mientras que en el segundo (n=20) se administró diclofenaco a dosis de 10 mg im cada 12 h. La evaluación se realizó a las 24 h y/o a las 48-72 h utilizando los instrumentos EVA, EVID y MPQ-SV. RESULTADOS: Todas las escalas fueron útiles para valorar el dolor postoperatorio, produciendo estimaciones de dolor sensibles a las variaciones que se producen durante los días subsiguientes a la intervención. El MPQ-SV fue capaz de determinar la distinta capacidad algógena de los procedimientos quirúrgicos empleados, con más eficacia que las escalas unidimensionales. Del mismo modo, el MPQ-SV fue capaz de discriminar las diferencias cualitativas y cuantitativas que existen entre los mecanismos de acción entre fármacos opioides y AINE, sin que las escalas unidimensionales pudieran establecer diferencias dependientes del abordaje terapéutico empleado. CONCLUSIONES: Todos los instrumentos mostraron su sensibilidad para detectar las diferencias en el dolor postoperatorio, pero el MPQ-SV permite obtener información más precisa sobre las diferencias entre tratamientos y entre intervenciones quirúrgicas (AU)

Experiencia de tutorías de alumnos con gran fracaso académico en su primer año en los estudios de medicina / Tutorship experience with medical students who had drastically failed the first year of their course

El presente artículo describe una experiencia de tutorías personalizadas llevadas a cabo en la Facultad de Medicina de la Universidad Autónoma de Barcelona con el objetivo de aumentar el éxito académico de los alumnos de primer curso que, durante el año anterior, habían tenido un gran fracaso académico. En la experiencia, llevada a cabo durante el curso 1997-1998, participaron de forma voluntaria 13 profesores y 19 alumnos. Los estudiantes fueron asignados de forma aleatoria a los diferentes tutores. Éstos debían orientar a los alumnos para optimizar sus aprendizajes y evitar un nuevo fracaso. La mayoría de los estudiantes participantes tuvieron un éxito total y sólo uno de ellos volvió a tener un gran fracaso. Así mismo, la mayoría de estudiantes en la misma situación que no habían participado en la experiencia volvieron a fracasar. A partir de los resultados obtenidos y de la satisfacción de los participantes, la experiencia fue valorada como muy positiva (AU)