Communication skills training for medical residents: Enhancing a psychosocial approach of patient care.

OBJECTIVES: One of the issues that has increasingly become relevant to medical practice is the ability to communicate well with patients. Better communication results in better care for the patient, as well as greater satisfaction for the physician. For this reason, the aim of this study was to assess the efficacy of a communication skills training program for medical residents (MR). METHOD: Eighty-six MR underwent a 6-month training program in three phases: a 12-h theory and practice workshop, a period of real practice, and a 4-h workshop in which the most challenging scenarios were role played with an actress. In each phase (T0, T1, and T2), participants' beliefs about their competence in caring for patients' psychosocial aspects and their self-confidence in communication skills were assessed. RESULTS: No differences were found between T0 and T1 in participants' beliefs of self-competence in psychosocial care. However, this competence significantly improved after completion of the entire program. Only 7 of the 12 areas explored in communication skills significantly improved between T0 and T1. However, after T2 completion, significant improvements were observed in all 12 areas. SIGNIFICANCE OF RESULTS: The research results highlight the usefulness and importance of training young doctors to foster their psychosocial approach to patient care and improve their confidence in their own communication skills. The results also show the appropriateness of the structure of the training: the key features of the programme were the follow-up of the participants in three phases over 6 months, and a focus on the needs of the residents and the resolution of difficult clinical cases, with the support of an actress. Therefore, the training presented in this study may become a guide for other trainings in other contexts with similar objectives.

Brain volumetric and metabolic correlates of electroconvulsive therapy for treatment-resistant depression: a longitudinal neuroimaging study.

Recent research suggests that neuroplastic and neuroinflammatory changes may account for the mode of action of electroconvulsive therapy (ECT), although extant data do not allow for a clear disambiguation between these two hypotheses. Multimodal neuroimaging approaches (for example, combining structural and metabolic information) may help in clarifying this issue. Here we aimed to assess longitudinal changes in (i) regional gray matter (GM) volumes and (ii) hippocampal metabolite concentrations throughout an acute course of bitemporal ECT, as well as (iii) to determine the association between imaging changes and clinical improvement. We assessed 12 patients with treatment-resistant depression (TRD) at four time points (pre-treatment, after the first ECT session, after the ninth ECT session and 15 days after ECT course completion) and 10 healthy participants at two time points, 5 weeks apart. Patients with TRD showed bilateral medial temporal lobe (MTL) and perigenual anterior cingulate cortex volume increases. Left MTL volume increase was associated with (i) a hippocampal N-acetylaspartate concentration decrease, (ii) a hippocampal Glutamate+Glutamine concentration increase and (iii) significant clinical improvement. The observed findings are, in part, compatible with both neuroplastic and neuroinflammatory changes induced by ECT. We postulate that such phenomena may be interrelated, therefore reconciling the neuroplasticity and neuroinflammatory hypotheses of ECT action.

Structural covariance of the neostriatum with regional gray matter volumes.

The caudate and putamen nuclei have been traditionally divided into dorsal and ventral territories based on their segregated patterns of functional and anatomical connectivity with distributed cortical regions. Activity-dependent structural plasticity may potentially lead to the development of regional volume correlations, or structural covariance, between the different components of each cortico-striatal circuit. Here, we studied the whole-brain structural covariance patterns of four neostriatal regions belonging to distinct cortico-striatal circuits. We also assessed the potential modulating influence of laterality, age and gender. T1-weighted three-dimensional magnetic resonance images were obtained from ninety healthy participants (50 females). Following data pre-processing, the mean signal value per hemisphere was calculated for the 'seed' regions of interest, located in the dorsal and ventral caudate and the dorsal-caudal and ventral-rostral putamen. Statistical parametric mapping was used to estimate whole-brain voxel-wise structural covariance patterns for each striatal region, controlling for the shared anatomical variance between regions in order to obtain maximally specific structural covariance patterns. As predicted, segregated covariance patterns were observed. Age was found to be a relevant modulator of the covariance patterns of the right caudate regions, while laterality effects were observed for the dorsal-caudal putamen. Gender effects were only observed via an interaction with age. The different patterns of structural covariance are discussed in detail, as well as their similarities with the functional and anatomical connectivity patterns reported for the same striatal regions in other studies. Finally, the potential mechanisms underpinning the phenomenon of volume correlations between distant cortico-striatal structures are also discussed.

Aspectos clínicos diferenciales de la depresión en pacientes ancianos hospitalizados / Differential clinical features of depression among elderly hospitalized patients

OBJETIVO: Comparar aspectos clínicos y pronósticos de la depresión entre pacientes hospitalizados mayores y menores de 65 años. PACIENTES Y MÉTODO: Estudio observacional retrospectivo. La muestra inicial se compone de 214 pacientes que han requerido hospitalización por depresión de forma consecutiva en 2 años. Se excluyen los reingresos producidos durante el período observacional. Cumplían criterios DSM-IV de trastorno depresivo mayor 143 pacientes. En éstos se comparan las siguientes variables por grupos de edad: sexo, existencia de episodios previos, presencia de síntomas melancólicos o psicóticos, comorbilidad en el eje II, coexistencia de alguna enfermedad médica severa y evaluación de la actividad global en el ingreso y el alta. RESULTADOS: Entre los pacientes con trastorno depresivo mayor (n = 143) se observa una mayor proporción de mujeres respecto a varones (2:1), sin diferencias significativas entre los grupos de edad comparados. Los pacientes ancianos con trastorno depresivo mayor (n = 71) presentaron con más frecuencia que los menores de 65 años (n = 72) episodios depresivos previos (no significativos [NS]), características melancólicas (p < 0,001), síntomas psicóticos (p = 0,021), más enfermedades médicas asociada (NS) y una menor comorbilidad con diagnósticos en el eje II. Los pacientes ancianos con trastorno depresivo mayor ingresaron con puntuaciones en la evaluación de la actividad global más bajas que los menores de 65 años (p = 0,003), que en el momento del alta se equipararon entre ambos grupos de edad. CONCLUSIONES: Los resultados obtenidos orientan a una mejoría alcanzable similar en la actividad global en el momento del alta hospitalaria y a la posible existencia de aspectos clínicos diferenciales en los episodios depresivos entre pacientes menores y mayores de 65 años hospitalizados (AU)