Restrictive Diets in Patients with Fibromyalgia: State of the Art.

Around 20-30% of Fibromyalgia patients modify their dietary habits after diagnosis, including avoiding certain food groups such as cereals. In this systematic review, we used the PRISMA guidelines to select the main studies that have evaluated the effectiveness of restrictive diets, including elimination and vegetarian diets, in patients with Fibromyalgia. Data on vegetarian/vegan diets are more consistent than data on elimination diets due to higher quality and better results of the published studies. Although the results are favorable in most of the studies, their heterogenicity and the scarce and low quality of the evidence (small number of patients included, often non-randomized and uncontrolled studies and multiple confounding factors and biases) does not allow for a positive recommendation about these restrictive diets in Fibromyalgia patients. Several factors other than food restriction could influence the symptomatic and functional improvements observed after restrictive diets, such as the placebo effect, weight loss that often occurs, coexistence with gastrointestinal diseases and positive effects of unrestricted foods. We must advance more and improve in our knowledge of the effectiveness of restrictive diets and variables related to them before recommending them systematically to all patients with Fibromyalgia. Randomized, placebo-controlled trials with large sample sizes, longer follow-up periods and standardized outcome measures that explore predictors of dietary response are needed to better understand the relationship between Fibromyalgia and nutrition.

Suicidal risk, hopelessness and depression in patients with schizophrenia and internalized stigma.

BACKGROUND: Internalized stigma has negative consequences on subjective and objective aspects of the recovery in people diagnosed with mental disorders. Despite its relevance, it has been poorly studied in patients with schizophrenia. METHODS: A sample of 71 outpatients with a diagnosis of schizophrenia who attended Psychosocial Rehabilitation Centers of Gran Canaria, Spain, were evaluated. We assessed the prevalence of internalized stigma and its possible association with sociodemographic, clinical, psychological and psychopathological variables, as well as suicidal behaviour and suicidal ideation. RESULTS: 21.1% of the patients had internalized stigma. Internalized stigma was associated with higher prevalence of suicidal ideation during the last year, higher number of suicide attempts, higher current suicidal risk, worse self-compassion, higher self-esteem, higher scores on depression, higher prevalence of depression and higher hopelessness. After multivariate analysis, hopelessness and the existence of depression were independently associated with internalized stigma, although depression showed trend towards significance. CONCLUSIONS: The association between internalized stigma and higher hopelessness, depression and higher suicidal risk suggests the necessity to systematically assess internalized stigma in patients with schizophrenia, and to intervene to reduce it.

Riesgo suicida, desesperanza y depresión en pacientes con esquizofrenia y autoestigma / Suicidal risk, hopelessness and depression in patients with schizophrenia and internalized stigma

Introducción. El autoestigma tiene efectos negativos en aspectos subjetivos y objetivos de la recuperación en las personas con trastornos mentales. A pesar de su importancia, ha sido poco estudiado en la esquizofrenia. Metodología. Evaluamos el autoestigma en 71 pacientes diagnosticados de esquizofrenia, en Centros de Día de Rehabilitación Psicosocial de Gran Canaria. Se evaluó su prevalencia y su posible asociación con variables sociodemográficas, clínicas generales, psicopatológicas y aspectos psicológicos, así como la conducta suicida e ideación suicida. Resultados. El 21,1% de los pacientes presentaron autoestigma. El autoestigma se asoció a mayor prevalencia de ideación suicida en el último año, mayor número total de tentativas suicidas, mayor riesgo suicida actual, peor autocompasión, mayor autoestima y peores puntuaciones en depresión, mayor prevalencia de depresión y mayor desesperanza. En el análisis multivariante, la desesperanza y la existencia de depresión se asociaron de manera independiente con el autoestigma, si bien la depresión lo hizo con tendencia a la significación. Conclusiones. La asociación entre autoestigma y mayor desesperanza, depresión y riesgo suicida sugiere la necesidad de evaluar sistemáticamente el autoestigma en los pacientes con esquizofrenia, e intervenir para su reducción

Background. Internalized stigma has negative consequences on subjective and objective aspects of the recovery in people diagnosed with mental disorders. Despite its relevance, it has been poorly studied in patients with schizophrenia. Methods. A sample of 71 outpatients with a diagnosis of schizophrenia who attended Psychosocial Rehabilitation Centers of Gran Canaria, Spain, were evaluated. We assessed the prevalence of internalized stigma and its possible association with sociodemographic, clinical, psychological and psychopathological variables, as well as suicidal behavior and suicidal ideation. Results. 21.1% of the patients had internalized stigma. Internalized stigma was associated with higher prevalence of suicidal ideation during the last year, higher number of suicide attempts, higher current suicidal risk, worse self-compassion, higher self-esteem, higher scores on depression, higher prevalence of depression and higher hopelessness. After multivariate analysis, hopelessness and the existence of depression were independently associated with internalized stigma, although depression showed trend towards significance. Conclusions. The association between internalized stigma and higher hopelessness, depression and higher suicidal risk suggests the necessity to systematically assess internalized stigma in patients with schizophrenia, and to intervene to reduce it