Desde la publicación de DSM-5, se ha vuelto más importante llevar a cabo un diagnóstico diferencial para distinguir a las personas con TEA de los trastornos de personalidad del grupo C. El objetivo de la presente investigación fue identificar un perfil de personalidad de sujetos con trastorno del espectro autista (TEA) utilizando el Inventario de Personalidad Multifásico de Minnesota (MMPI) para llevar a cabo dicho diagnóstico diferencial. La muestra del estudio consistió en un total de 178 sujetos divididos en cuatro grupos de comparación. El grupo TEA obtuvo un perfil de personalidad MMPI con un código característico 2-0 que era específico para esta muestra de personas con TEA leve, y puntuaciones más altas en las escalas 6, 7 y 8 en relación con las otras puntuaciones de la escala. Se identificó un perfil de personalidad MMPI específico para los sujetos con TEA que diferenció a este grupo de los otros grupos estudiados. (AU)
Since the publication of DSM-5, it has become more important to carry out a differential diagnosis to distinguish people with autism spectrum disorder (ASD) from cluster C personality disorders. The aim of the present research study was to identify a personality profile of adults with ASD using the Minnesota Multiphasic Personality Inventory (MMPI) in order to carry out this differential diagnosis. The study sample consisted of a total of 178 subjects divided into four groups for comparison purposes. The ASD group obtained a MMPI personality profile with a characteristic 2-0 code that was specific to this sample of people with mild ASD, and higher scores in scales 6, 7 and 8 relative to the other scale scores. A specific MMPI personality profile was identified for ASD subjects, which differentiated this group from the other groups studied. (AU)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Autism Spectrum Disorder , Personality Disorders , Spain , Diagnosis, Differential , MMPI , Epidemiology, Descriptive , Cross-Sectional Studies , Retrospective Studies
BACKGROUND: The treatment of schizophrenia requires a prolonged, multidimensional intervention that includes antipsychotic drugs. Treatment adherence is essential to effectively control the disorder. Shared decision-making (SDM) is a strategy, supported by numerous practical and ethical arguments, that seeks to involve patients in the therapeutic process to improve treatment adherence and satisfaction. The use of this model in mental health has been limited for many intrinsic and extrinsic reasons. The results of clinical trials conducted to date have largely been disappointing, potential due to study design-related limitations. AIM/QUESTION: To evaluate the efficacy, in terms of treatment adherence and improvement in clinical variables, such as severity of symptoms, days of hospitalization or insight, of a carefully timed SDM model initiated immediately prior to hospital discharge in patients with schizophrenia. METHODS: Single-blind, randomized clinical trial in an acute psychiatric care unit within the Andalusian Health Department to compare SDM (experimental group) to treatment as usual (TAU; control group) in a sample of patients hospitalized for an acute episode of schizophrenia or schizoaffective disorder. The study was performed between January 2014 and June 2017. The experimental group participated in SDM sessions prior to discharge with regular booster sessions over the one-year follow-up. The health care team responsible for SDM was predisposed to concordance (LatCon II scale) and received specific training in SDM. A hierarchical multiple linear regression analysis was performed to evaluate the factors independently associated with adherence, controlling for sociodemographic, clinical, and admission-related variables. Variables were assessed at admission, discharge and at 3, 6 and 12 months after discharge during the one year follow up. BARS, DAI, WAI-S, COMRADE and PANSS were used to evaluate adherence, attitude to treatment, therapeutic alliance, satisfaction and confidence with decision and clinical status, respectively. RESULTS: A total of 227 schizophrenic patients hospitalized with acute decompensation were evaluated; of these, 102 met all inclusion criteria and were included in the study. Most patients (95%) had prior experience with antipsychotics and most (82%) had experienced related side effects. Despite randomization, psychopathologic severity was greater in the experimental group, with a mean (SD) PANSS score of 104.08 (80) vs. 93.45 (20.30) (p < 0.05). The final regression model to explain adherence was significant (adjusted R2 = 0.384; F [df= 6] = 4.386; p < 0.001), with a direct, significant and independent association with SDM mediated by the number of booster sessions. DISCUSSION: Shared decision making with booster sessions appears to increase treatment adherence in patients with severe mental disorders. IMPLICATION ON PRACTICE: Ethical, practical, and clinical reasons support the use of strategies designed promote the use of long-term, shared decision-making in psychiatric patients, especially in schizophrenia spectrum disorder.
Antipsychotic Agents , Schizophrenia , Humans , Decision Making, Shared , Single-Blind Method , Schizophrenia/drug therapy , Antipsychotic Agents/therapeutic use , Patients , Decision Making , Patient Participation
Social Cognition (SC) impairment is part of the deficit syndrome of schizophrenia. The Observable Social Cognition: A Rating Scale (OSCARS) evaluates the perceived SC through an external reference informant. The aim of this paper is to analyze the psychometric properties of validity and reliability of its cross-cultural adaptation for the Spanish population.
Schizophrenia , Humans , Psychometrics , Reproducibility of Results , Social Cognition
Introducción: El deterioro en la Cognición Social (CS)forma parte del síndrome deficitario de la esquizofrenia. LaObservable Social Cognition: A Rating Scale (OSCARS) evalúala CS percibida a través de un informador externo clave. Elobjetivo del estudio es analizar las propiedades psicométricasde validez y fiabilidad de su adaptación transcultural parapoblación española.Metodología. Estudio observacional y transversal en unamuestra de pacientes ambulatorios con esquizofrenia (n =109) seleccionados mediante muestreo simple aleatorizado.Instrumentos seleccionados: Tarea de Hinting, batería cognitiva de conceso MATRICS, escala de impresión clínica global(CGI-SCH) y cuaderno de datos ad hoc.Resultados. El Análisis Factorial Exploratorio identificóun modelo de dos factores, igual al original, que explican el59,02% del total de la varianza: sesgo cognitivo social y habilidad cognitiva social. Al igual que en la versión original, nose encontraron resultados de correlación con otras medidasde CS: tarea de Hinting (r: 0,085; p = 0,382) o MSCEIT dela MATRICS (r: 0,015; p = 0,877). No se observaron correlaciones significativas con otros dominios neurocognitivos. Elcoeficiente alpha de Cronbach fue de 0,82 (0,75 y 0,76, paracada factor). El valor de kappa ponderado medio fue 0,43. Lapuntuación del Coeficiente de Correlación Intraclases, 0,84(IC95%: 0,76 0,88; p<0,001)Conclusiones. Los hallazgos apoyan la validez y fiabilidad de la adaptación transcultural de la OSCARS como unaherramienta de propiedades psicométricas equivalentes a laoriginal que permite la evaluación de la CS mediante un informante referente en individuos con esquizofrenia. (AU)
Introduction: Social Cognition (SC) impairment is part ofthe deficit syndrome of schizophrenia. The Observable SocialCognition: A Rating Scale (OSCARS) evaluates the perceivedSC through an external reference informant. The aim of thispaper is to analyze the psychometric properties of validityand reliability of its cross-cultural adaptation for the Spanishpopulation.Methods. Observational and cross-sectional study in asample of outpatients with schizophrenia (n = 109), selected by simple randomized sampling. Selected instruments:Hinting task, MATRICS cognitive consensus battery, clinicalglobal impression scale (CGI-SCH) and specific data collection logbook.Results. Exploratory Factor Analysis identified a two-factor model, like the original version, that explains 59.02% ofthe total variance: social cognitive bias and social cognitiveability. As in the original version, no correlation results werefound with other SC measures: Hinting task (r: - 0.085; pvalue = 0.382) or MSCEIT of the MATRICS (r: 0.015; p value 0.877). No specific correlations were observed with otherneurocognitive domains. Cronbachs alpha coefficient was0.82 (0.75 and 0.76, for each factor). The mean weighted kappa value was 0.43. Intraclass Correlation Coefficient score, 0.84 (95% CI: 0.76 - 0.88; p <0.001). Conclusions. These findings support the validity and thereliability of the cross-cultural adaptation of the OSCARSa tool to assess SC by a referent informant in individualswith schizophrenia with similar psychometric properties tothe original version. (AU)
Humans , Psychometrics , Reproducibility of Results , Schizophrenia , Patients
These two articles analyse the importance of J.J. Moreau de Tours' work and its influence on the development of descriptive psychopathology from the mid-nineteenth century to the present. The first article focused on biographical aspects and presented Moreau's main works in their social and cultural contexts. This second article critically analyses Moreau's contributions from different perspectives: epistemological, psychopathological, clinical, therapeutic, and it also discusses his role as a public figure.
Psychopathology/history , Psychotherapy/history , France , History, 19th Century , Humans , Psychiatry/history , Psychopharmacology/history
WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized. Previous studies that have investigated the impact of organizational factors and changes in these protocols are often short and not conducted within a framework designed to establish a long-term plan for reducing the use of mechanical restraint. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We demonstrate that the implementation of administrative and protocol changes in our psychiatric unit significantly reduced the use of mechanical restraint, thus laying the foundations for a regulatory framework. Our analysis shows that the profile of patients who require mechanical restraint is highly variable, but that certain clinical and institutional aspects within the framework of a long-term plan for the reduction in mechanical restraint can be targeted with long-lasting positive effects. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizational changes focussed on training staff, promoting family support and requiring the registration and close monitoring of episodes empower the role of the nursing staff in the prevention, monitoring and regulation of mechanical restraint. ABSTRACT: Introduction Mechanical restraint is a controversial restrictive practice to manage agitation or violent behaviour. Numerous studies have evaluated the factors and organizational changes that influence on mechanical restraint, but only for short time periods. None of those studies have assessed the effects of measures applied within the framework of a long-term plan to reduce the use of mechanical restraint. Given the lack of specific legislation in Spain, more data are required for its proper regulation. Aim/Question To evaluate the risk factors associated and the impact of specific measures designed to minimize the application of mechanical restraint in an acute mental health unit over an 8-year period and previous observation of 5 years. Methods Cross-sectional study based on a retrospective analysis of mechanical restraint records. We compared admissions requiring ≥one episode of restraint versus admissions not requiring this coercive measure. Results Between 2007 and 2014, 412 admissions (12%) required mechanical restraint. The data show that the measures applied in the previous five years had significantly reduced the total hours of restraint per semester. The factors associated with admissions requiring mechanical restraint were involuntary, unscheduled and longer admissions. The best predictor of restraint was involuntary admission (OR = 6.37), followed by the diagnosis of personality disorder (OR = 5.01). Discussion Identification of the factors associated with mechanical restraint would allow for early detection strategies. Our results provide additional evidence on the usefulness of organizational changes to reduce coercive measures, even in a country without specific legislation. Implications for Practice Organizational changes, such as staff training and increased family support during admission of episodes of mechanical restraint, can reduce the use of this measure. These measures also give the nursing staff greater responsibility in terms of their role in registering and monitoring the restrictive practice, thus helping to prevent or minimize the use of mechanical restraint.
Mental Disorders , Mental Health , Cross-Sectional Studies , Hospitalization , Humans , Restraint, Physical , Retrospective Studies
This is the first of two articles analysing the importance of J.J. Moreau de Tours' work and its influence on the development of descriptive psychopathology from the mid-nineteenth century to the present. Part 1 focuses on biographical aspects and presents Moreau's main works in their social and cultural context, with special emphasis on his book Du Hachisch et de l'Aliénation mentale, published in 1845. The second article will concentrate on Moreau as a psychopathologist.
Books/history , Psychopathology/history , France , History, 19th Century , Humans
OBJECTIVES: The aim of this study was to identify independent predictors of satisfaction with antipsychotics in patients with schizophrenia spectrum disorders treated in a mental health catchment area. METHODS: Observational analytical study of patients (n = 150) recruited through a convenience sampling method from five mental health units. Satisfaction with the antipsychotic as a medication was evaluated using the Treatment Satisfaction Questionnaire for Medication (TSQM). Therapeutic alliance was assessed by the Working Alliance Inventory Short Form (WAI-S). Patient-perceived participation in decision-making was assessed using COMRADE (Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness). A multiple linear regression analysis was performed to identify variables independently associated with the TSQM 'Global Satisfaction' total score. RESULTS: Two variables - age and higher level of self-perceived participation in treatment decision-making - were directly, significantly, and independently associated (ß coefficient values: 0.209 and 0.432, respectively) with a higher TSQM Global satisfaction score. In addition, the severity of psychotic symptoms was inversely associated with satisfaction (ß coefficient value: -0.205) (R2 = 0.355; R2 adj. = 0.291; F(13) = 5.554; p < 0.01). CONCLUSIONS: These findings suggest that involving the patient in treatment decision-making and optimising the treatment to reduce symptoms, especially in younger patients, could increase satisfaction with antipsychotic treatment.Key PointsPatient involvement in shared decision-making is relevant for treatment satisfaction.Current evidence suggests that improving the doctor-patient relationship optimises antipsychotics outcomes.Self-perceived participation in decision-making predicts satisfaction with antipsychotic medication.Types of antipsychotics do not determine consistent differences in satisfaction.
Antipsychotic Agents , Patient Satisfaction , Schizophrenia , Antipsychotic Agents/therapeutic use , Decision Making , Humans , Patient Participation/psychology , Patient Satisfaction/statistics & numerical data , Physician-Patient Relations , Schizophrenia/drug therapy , Therapeutic Alliance
The Coercion Experience Scale (CES) is a questionnaire that evaluates the subjective experience of coercion during psychiatric hospitalization. This study aimed to assess a short version of the Coercion Experience Scale (CES-18) in a Spanish Sample (Nâ¯=â¯114). Two authors independently selected the items, choosing those that could also be applied to the experience of coercion after the use of forced medication. Reliability was estimated using internal consistency coefficients. Internal validity was assessed by means of a factorial analysis based on the method of extraction of main components and using orthogonal rotation VARIMAX. Convergent and discriminatory validity was evaluated by correlation between the total score of the CES-18 with the original CES and a Visual Analogue Scale, The Davidson Trauma Scale and the Client Assessment of Treatment Scale. The CES-18 showed adequate internal consistency (Cronbach αâ¯=â¯0.940). Factor analysis resulted in a two-factor solution (Coercion and Humiliation and Fear) explaining 64.2% of the total variance. The correlation between the original CES and CES-18 was adequate (râ¯=â¯0.968). The scores suggested good divergent and convergent validity. The Spanish language CES-18 demonstrated adequate psychometric proprieties in order to assess perceived coercion during psychiatric hospitalization.
Coercion , Hospitals, Psychiatric , Mental Disorders/therapy , Psychometrics/instrumentation , Adult , Female , Humans , Male , Middle Aged , Psychometrics/standards , Reproducibility of Results , Spain
OBJECTIVE: The aim of this paper is to provide evidence of the validity and reliability of the COMRADE scale (Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness) in patients suffering from schizophrenia spectrum disorders. METHOD: 150 patients recruited at five mental health centers were assessed using a cross-sectional study design. The COMRADE, WAIS-S (therapeutic alliance) and TSQM (satisfaction with medication) scales were used. RESULTS: Exploratory Factor Analysis identified three factors from the COMRADE (F1: "Risk communication"; F2: "Confidence in decision" and F3: "Knowledge of decisional balance") which explain 45.2, 8.5 and 6% of the variance, respectively. Statistically significant correlations were observed between the scores of the COMRADE subscales with the subscales of the WAI-S and the TSQM. The internal consistency observed for each of the factorial scores of the COMRADE were (Cronbach's alpha values) 0.90, 0.89 and 0.74, respectively. CONCLUSION: The COMRADE scale offers appropriate psychometric properties for its use as a measure of perceived patient involvement in the shared decision making process in antipsychotic treatment. PRACTICE IMPLICATIONS: The use of the COMRADE measure in psychiatric clinical practice and in research studies provides an outcome measure of interventions from the shared decision making model.
Antipsychotic Agents/therapeutic use , Decision Making , Patient Participation , Schizophrenia/drug therapy , Adult , Factor Analysis, Statistical , Female , Humans , Male , Medication Adherence , Psychiatric Status Rating Scales , Reproducibility of Results , Therapeutic Alliance
La agitación de origen psiquiátrico ocurre principalmente en pacientes con trastornos psicóticos como la esquizofrenia, el trastorno esquizoafectivo y la fase maníaca del trastorno bipolar. Los métodos tradicionales para el control de los pacientes agitados incluyen la contención verbal, la contención farmacológica y la contención mecánica. En este estudio se ha estimado el coste directo sanitario asociado a la aplicación de las técnicas de contención mecánica de origen psiquiátrico en España. La cuantificación se realizó en función del tiempo empleado por profesional o número de visitas. La valoración de los recursos se realizó a partir de costes unitarios y datos epidemiológicos publicados. La aplicación de un procedimiento de contención mecánica a un paciente psiquiátrico supone un coste total por episodio de 513-1.160 Euros (considerando una duración de 4 a 12 h, respectivamente). El coste total anual se ha estimado en 27 millones de euros, considerando una duración por episodio de 4 h (AU)
Agitation is a group of psychiatric symptoms that commonly occur in patients with psychotic disorders, including schizophrenia, schizoaffective disorder and manic phase of bipolar disorder. Traditional methods of controlling agitated patients include verbal de-escalation, mechanical and pharmacological restraints. This study attempts to determine the direct medical costs attributable to psychiatric mechanical restraint in Spain. This resource was evaluated using published unit costs and national epidemiological data. The estimated direct costs of a restraint episode ranged from Euros 513-Euros 1,160 (4 -12 h per episode duration, respectively). Total annual costs of psychiatric mechanical restraint considering a duration of 4 h per episode were estimated at Euros 27 million (AU)
Humans , Male , Female , Cost Control/organization & administration , Cost Control/standards , Cost Control , Psychomotor Agitation/diagnosis , Psychomotor Agitation/economics , Psychomotor Agitation/therapy , Costs and Cost Analysis/economics , Costs and Cost Analysis/methods , Costs and Cost Analysis/standards , Restraint, Physical/methods , Restraint, Physical/statistics & numerical data , Clinical Protocols , Biological Psychiatry/methods , Biological Psychiatry/organization & administration , Biological Psychiatry/trends
Introducción: La mayoría de estudios sobre personas con Trastornos del Espectro Autista (TEA) se centran en encontrar déficits en estas personas. La personalidad apenas ha recibido atención en este grupo de pacientes aunque con frecuencia una proporción de personas con TEA, aquellos que no tienen retraso mental, suelen confundirse con Trastornos de la Personalidad. El objetivo de este trabajo es conocer los rasgos de personalidad de un grupo de personas diagnosticadas con TEA y observar si existe un patrón de rasgos clínicos que se repita en los mismos. Material y método: Se utilizó para la evaluación de la personalidad el Inventario Multifásico de Personalidad de Minnesota (MMPI-2). Para conocer el Cociente Intelectual se recurrió a la Escala de Inteligencia Wechsler para Adultos (WAIS-III). Igualmente se utilizaron las Escala de Observación para el Diagnóstico de Autismo (ADOS) y la Entrevista para el Diagnóstico del Autismo revisada (ADIR) para confirmar el diagnóstico de TEA. Se evaluaron 10 personas adultas con trastorno del espectro autista (TEA) de manera individualizada. Igualmente se utilizó a un grupo control de 10 personas sin diagnóstico de salud mental. Resultados: Los resultados muestran puntuaciones elevadas en las escalas de validez L (mentira) y F (Incoherencia) y muy bajas en K (Factor Corrector). Igualmente se encuentran puntuaciones altas en las escalas clínicas 2 (Depresión) y 0 (Aislamiento Social) y en las escalas de contenido ANX (Ansiedad) SOD (Malestar Social) y OBS (Obsesividad) respecto al grupo control. Conclusiones: Los resultados manifiestan un perfil de personalidad que incluye un solapamiento de síntomas notable con las características del Síndrome de Asperger. El MMPI-2 se revela como una potencial prueba de cribaje para dicho trastorno (AU)
Introduction: The majority of studies into people with Autism Spectrum Disorders (ASD) focus on finding deficits in such people. Personality has scarcely received any attention in this group of patients, even though a proportion of people with ASD, those who have no mental delay, are often mistaken for people with Personality Disorders. The aim of this study is twofold: to identify the personality traits of a group of people diagnosed with ASD and also to determine whether there is a pattern of clinical traits in such a group. Material and methods: The Minnesota Multiphasic Personality Inventory (MMPI-2)was used to measure personality. The Wechsler Adult Intelligence Scale (WAIS-III) was used to determine intelligence quotient. To confirm the ASD diagnosis the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADIR) were used. Ten adults with Autism Spectrum Disorder (ASD) were individually evaluated. A control group of ten people with no mental health diagnosis was also used. Results: Results show higher scores in ASP patients than controls in L (lie) and F (incoherence) validity scales, 2 (Depression) and 0 (Social isolation) clinical scales and ANX (Anxiety), SOD (Social Discomfort) and OBS (Obsessiveness) content scales, and lower scores in K (correction) factor. Conclusions: Data obtained from this preliminary study show a personality profile similar to that of people with Asperger Syndrome. The MMPI-2 emerges as a test to be considered when diagnosing adults with this syndrome (AU)
Humans , Male , Female , Adult , Personality/physiology , Autistic Disorder/complications , Autistic Disorder/diagnosis , Asperger Syndrome/complications , Asperger Syndrome/epidemiology , Assertiveness , Human Characteristics , Social Support , Social Isolation
El uso del tabaco en la Unidades Psiquiátricas de Agudos ha sido, hasta hace bien poco, una anomalía generalizada en los establecimientos sanitarios. En el presente trabajo se describe la experiencia llevada a cabo en la Unidad Psiquiátrica de Agudos del Hospital de Jerez de la Frontera (Cádiz) para prohibir totalmente el uso del tabaco en sus instalaciones. Además, se analizan las distintas etapas del proceso que llevó a dicha prohibición, así como los obstáculos y las medidas tomadas para solventarlos. Finalmente, se aportan datos del coste de la medida y de los beneficios aportados(AU)
Smoking in psychiatric inpatient units has been, until recently, a widespread anomaly among health settings. A total smoking ban was implemented in the Acute Psychiatric Unit at Jerez Hospital (Cadiz) and this experience is here described. Different stages of the implementation process, caveats and ways of sorting them out, are then described. Finally, cost and advantages are also presented(AU)
Humans , Male , Female , Smoking/epidemiology , Smoking/prevention & control , Tobacco Use Disorder/psychology , Tobacco Smoke Pollution/adverse effects , Tobacco Smoke Pollution/prevention & control , Tobacco Use Cessation/methods , Tobacco Use Cessation/psychology , Tobacco Use Cessation Devices/trends , Tobacco Use Cessation Devices , Preventive Psychiatry/methods , Psychiatric Department, Hospital/organization & administration , Tobacco Use Cessation/economics , Tobacco Use Cessation/statistics & numerical data , Tobacco Use Cessation Devices/economics , Tobacco Use Cessation Devices/standards
INTRODUCTION: Confabulations, or the production of false memories without deliberate intent to lie, is an intriguing phenomenon for which an attempt has been made to explain it since they were first described. Confabulations are a good example for illustrating the reconstructive character of memory. Nevertheless, their exact nature and the way in which they are produced are still controversial. OBJECTIVE: To review the different models proposed to explain the appearance of confabulations. DEVELOPMENT: Neuropsychological models that currently have some theoretical development and empirical evidence are reviewed. In addition, a brief reference to motivational models, that have recently begun to recover popularity, are presented. We conclude by presenting the last version of the strategic retrieval model that makes it possible to integrate the relevant elements from the others. CONCLUSIONS: Early models of confabulations, which considered them a result of the need to fill memory gaps, are outdated nowadays. Nevertheless, emotional processes are taken into account to explain their content. From neuropsychological approaches, it is possible to distinguish models that consider confabulation as a result of a temporal or contextual problem, and those which consider that the main problem is on the memory retrieval process. More specifically, the strategic retrieval hypothesis states that confabulations are the result of a dysfunction in a complex system of monitoring the recovered information. This model would make it possible to integrate explanations and evidences coming from the other proposals.
Memory Disorders/psychology , Models, Psychological , Humans
Introducción. Las confabulaciones o la producción de falsos recuerdos, sin la intención de mentir de forma deliberada, resultan un fenómeno intrigante que se ha intentado explicar desde que fueran descritas por primera vez. El fenómeno de las confabulaciones es un buen ejemplo del carácter reconstructivo de la memoria, sin embargo, aún es controvertida su naturaleza exacta y la forma en que se producen. Objetivo. Revisar los diferentes modelos propuestos para explicar la aparición de confabulaciones. Desarrollo. Se revisan los modelos neuropsicológicos que en la actualidad cuentan con cierto desarrollo teórico y evidencia empírica. También se hace referencia a modelos motivacionales, que han empezado a recuperar su popularidad recientemente, para terminar desarrollando la última versión del modelo de recuperación estratégica, que permite integrar los elementos relevantes de los otros. Conclusiones. Los primeros modelos sobre confabulaciones, que las consideraban resultado de la necesidad de rellenar lagunas de memoria, están hoy día superados, aunque los elementos emocionales se están teniendo en cuenta para explicar su contenido. Dentro de la neuropsicología, podríamos distinguir aquellos modelos que consideran la confabulación como resultado de un problema temporal o contextual, y aquellos que ponen el problema en los procesos de recuperación de la memoria. En concreto la hipótesis de recuperación estratégica plantea que las confabulaciones son el resultado de una disfunción de complejos sistemas de monitorización de la información recuperada. Este modelo permitiría integrar explicaciones y evidencias procedentes de otras propuestas (AU)
Introduction. Confabulations, or the production of false memories without deliberate intent to lie, is an intriguing phenomenon for which an attempt has been made to explain it since they were first described. Confabulations are a good example for illustrating there constructive character of memory. Nevertheless, their exact nature and the way in which they are produced are still controversial. Objective. To review the different models proposed to explain the appearance of confabulations. Development. Neuropsychological models that currently have some theoretical development and empirical evidence are reviewed. In addition, a brief reference to motivational models, that have recently begun to recover popularity, are presented. We conclude by presenting the last version of the strategic retrieval model that makes it possible to integrate the relevant elements from the others. Conclusions. Early models of confabulations, which considered them a result of the need to fill memory gaps, are outdated nowadays. Nevertheless, emotional processes are taken into account to explain their content. From neuropsychological approaches, it is possible to distinguish models that consider confabulation as a result of a temporal or contextual problem, and those which consider that the main problem is on the memory retrieval process. More specifically, the strategic retrieval hypothesis states that confabulations are the result of a dysfunction in a complex system of monitoring the recovered information. This model would make it possible to integrate explanations and evidences coming from the other proposals (AU)
Humans , Mental Recall , Fantasy , Memory Disorders/psychology , Affective Symptoms/psychology , Neuropsychological Tests , Social Behavior
Introducción. Una definición operativa de confabulaciones sería aquella que los describe como falsos recuerdos resultado de un problema de recuperación, de los que el paciente no es consciente, y cuya creencia en la veracidad del recuerdo es genuina. Han sido descritos varios tipos de confabulaciones, utilizando una gran diversidad de criterios. Las confabulaciones pueden llegar a verse en trastornos neurológicos muy distintos, existiendo controversia en torno a sus mecanismos patofisiológicos. Objetivo. Realizar una revisión actualizada en castellano sobre la definición, tipos, regiones cerebrales implicadas y correlatos neuropsicológicos de las confabulaciones. Desarrollo. Tras revisar el concepto y los distintos tipos de confabulaciones, se describen las regiones cerebrales dañadas en dos patologías donde pueden aparecer confabulaciones, el síndrome de Korsakoff y pacientes con rupturas de aneurismas de la arteria comunicante anterior. Se revisan posteriormente los correlatos neuropsicológicos asociados a las mismas. Conclusiones. Las confabulaciones son un fenómeno complejo y de difícil definición. Probablemente la clasificación más aceptada es la que, atendiendo al modo en que aparecen, distingue las confabulaciones espontáneas de las provocadas, aunque no está clara la validez de esta distinción. En cuanto a las regiones cerebrales cruciales implicadas en las confabulaciones, parece que lesiones en el córtex prefrontal, específicamente en áreas ventromediales y orbitofrontales, son necesarias para que el fenómeno aparezca. La evidencia neuropsicológica sugiere la presencia, en la mayoría de los casos, de disfunción ejecutiva y al menos cierto grado de disfunción de memoria como mecanismos subyacentes a las mismas; sin embargo, las características específicas de estas disfunciones neuropsicológicas no son bien conocidas (AU)
Introduction. A working definition of confabulation could be that of describing them as false memories due to a recovery problem, where the patient is unaware that he/she is confabulating, and has the belief that the memory is true. Several types of confabulations have been described, according to a broad variety of criteria. Confabulations can be seen in very different neurological conditions, which have lead to a controversy on their pathophysiological mechanisms. Objective: To obtain an updated revision in Spanish of the definitions, types, brain regions involved and neuropsychological correlates of the confabulations. Development. After reviewing the concept and several types of confabulations, the damaged brain regions associated to two conditions where confabulations occur, such as Korsakoff syndrome and patients with anterior communicating artery aneurysm, are described. The neuropsychological correlates associated to them are then reviewed. Conclusions. Confabulations are a difficult-to-define complex phenomenon. Probably, the most accepted classification, in accordance with how they appear, would be that which distinguishes spontaneous from provoked confabulations, although the validity of this distinction is not clear. Regarding to crucial cerebral regions involved in the confabulations, it seems that prefrontal cortex lesions, specifically in ventromedial and orbitofrontal areas, are necessary. Neuropsychological evidence suggests the presence in most of the cases of executive dysfunction and at least some degree of memory dysfunction as an underlying mechanism of confabulation. Nevertheless, the specific characteristics of these neuropsychological dysfunctions are not well-known (AU)
Humans , Mental Recall , Memory Disorders/psychology , Prefrontal Cortex/physiopathology , Ventromedial Hypothalamic Nucleus/physiopathology
INTRODUCTION: A working definition of confabulation could be that of describing them as false memories due to a retrieval problem, where the patient is unaware that he/she is confabulating, and has the belief that the memory is true. Several types of confabulations have been described, according to a broad variety of criteria. Confabulations can be seen in very different neurological conditions, which have lead to a controversy on their pathophysiological mechanisms. OBJECTIVE: To obtain an updated revision in Spanish of the definitions, types, brain regions involved and neuropsychological correlates of the confabulations. DEVELOPMENT: After reviewing the concept and several types of confabulations, the damaged brain regions associated to two conditions where confabulations occur, such as Korsakoff syndrome and patients with anterior communicating artery aneurysm, are described. The neuropsychological correlates associated to them are then reviewed. CONCLUSIONS: Confabulations are a difficult-to-define complex phenomenon. Probably, the most accepted classification, in accordance with how they appear, would be that which distinguishes spontaneous from provoked confabulations, although the validity of this distinction is not clear. Regarding to crucial cerebral regions involved in the confabulations, it seems that prefrontal cortex lesions, specifically in ventromedial and orbitofrontal areas, are necessary. Neuropsychological evidence suggests the presence in most of the cases of executive dysfunction and at least some degree of memory dysfunction as an underlying mechanism of confabulation. Nevertheless, the specific characteristics of these neuropsychological dysfunctions are not well-known.
Brain Diseases/complications , Memory Disorders/etiology , Mental Disorders/complications , Brain Diseases/psychology , Humans , Memory Disorders/classification
En respuesta a un artículo anterior se argumenta a favor de una psicopatología crítica que tenga en cuenta los factores socioculturales que intervienen en los procesos de formación, consolidación e inteleccióón del síntoma psiquiátrico, en detrimento de una crítica de la psicopatología como empresa científica que asume una postura nominalista extrema, un concepto de trastorno mental exclusivamente evaluativo y, por tanto, reduccionista sociológico, soslaya el debate actual acerca del propio concepto de trastorno mental y adopta una postura cercana a la denominada pospsiquiatría (AU)
Psychopathology/methods , Psychopathology/organization & administration , Psychopathology/standards , Mental Disorders/diagnosis , Mental Disorders/psychology , Mental Disorders/therapy , Psychopathology , Psychopathology/trends , Psychopathology/classification
El síndrome de la fibromialgia (FM) es un trastorno de dolor crónico cuya etiología se desconoce. Tradicionalmente se ha señalado la alta incidencia de psicopatología en los pacientes fibromiálgicos. No obstante existe controversia acerca del tipo de psicopatología predominante (algunos estudios apuntan que los cuadros depresivos se dan con mayor frecuencia en la FM que en otros cuadros de dolor crónico, mientras que otros autores no encuentran diferencias) y a su significación (psicopatología como reacción de estrés ante el dolor crónico o parte del mismo mecanismo fisiopatológico). El presente trabajo revisa la literatura al respecto e incluye los datos preliminares de un proyecto en marcha de colaboración entre las secciones de Reumatología y Psiquiatría del Hospital de Jerez (Cádiz) del Servicio Andaluz de Salud, que tiene como objetivo el estudio de los aspectos psicopatológicos de los cuadros reumáticos cronificados entre los que la FM tiene una importante incidencia asistencial. Los resultados apuntan a una relación entre ansiedad y fibromialgia en detrimento de la relevancia de la depresión (AU)
Humans , Fibromyalgia/etiology , Mental Disorders/complications , Fibromyalgia/psychology , Mental Disorders/psychology , Anxiety/complications , Anxiety/psychology , Depression/complications , Depression/psychology , Chronic Disease
