Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis.

BACKGROUND: Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years. METHODS: The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis. RESULTS: At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively). CONCLUSIONS: Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.

Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: a 5-year controlled clinical trial.

OBJECTIVE: The aim of this research, which represents an additional and longer follow-up to a previous trial, was to evaluate a 5-year follow-up study of a combined treatment (pharmacological+psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder. METHOD: Forty patients were randomly assigned to either an Experimental group-under combined treatment - or a Control group - under pharmacological treatment. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation time points. RESULTS: Between-group differences were significant at all evaluation time points after treatment. Experimental group had less hospitalization events than Control group in the 12-month evaluation (P=0.015). The Experimental group showed lower depression and anxiety in the 6-month (P=0.006; P=0.019), 12-month (P=0.001; P<0.001) and 5-year (P<0.001, P<0.001) evaluation time points. Significant differences emerged in mania and misadjustment already in the post-treatment evaluation (P=0.009; P<0.001) and were sustained throughout the study (6-month: P=0.006, P<0.001; 12-month: P<0.001, P<0.001; 5-year: P=0.004, P<0.001). After 5-year follow-up, 88.9% of patients in the Control group and 20% of patients in the Experimental group showed persistent affective symptoms and/or difficulties in social-occupational functioning. CONCLUSIONS: A combined therapy is long-term effective for patients with refractory bipolar disorder. Suggestions for future research are commented.

Predictors of pathological gambling severity taking gender differences into account.

BACKGROUND: The current study aims to identify predictors of pathological gambling (PG) severity, taking gender differences into account, in an outpatient sample of pathological gamblers seeking treatment. METHODS: The sample for this study consisted of 103 subjects (51 women and 52 men) meeting current DSM-IV-TR criteria for PG. Linear and logistic regression analyses were used to examine different risk factors (gender, age, impulsivity, sensation seeking, self-esteem) and risk markers (depression, anxiety, gambling-related thoughts, substance abuse) as predictors of PG severity. RESULTS: Impulsivity, maladjustment in everyday life and age at gambling onset were the best predictors in the overall sample. When gender differences were taken into account, duration of gambling disorder in women and depression and impulsivity in men predicted PG severity. In turn, a high degree of severity in the South Oaks Gambling Screen score was related to older age and more familiy support in women and to low self-esteem and alcohol abuse in men. Female gamblers were older than male gamblers and started gambling later in life, but became dependent on gambling more quickly than men. CONCLUSIONS: Further research should examine these data to tailor treatment to specific patients' needs according to sex and individual characteristics.

One-year psychosocial functioning in patients in the early vs. late stage of bipolar disorder.

OBJECTIVE: The aim of this 1-year follow-up study was to compare functional outcome as well as clinical differences between patients with first- and multiple-episode bipolar disorder. METHOD: Bipolar disorder patients with first (n = 60) and multiple episodes (n = 59) were recruited from two hospitals in Spain. The Functioning Assessment Short Test (FAST) was used to assess functioning. The Hamilton Depression Rating Scale (HAMD) and the Young Mania Rating Scale (YMRS) were administered to assess mood symptoms. RESULTS: As expected, patients with first episode experienced a greater functioning compared to patients with multiple episodes (11.26 ± 10.94 vs. 26.91 ± 13.96; t = 6.436, P < 0.001). There were significant demographic and clinical differences between both groups. Baseline depressive symptoms (F = 9.553, df = 4, 102; P < 0.001) and age (F = 14.145, df = 4, 103; P < 0.001) were significantly associated with poor functional recovery at 6-month and 12-month assessment, respectively, in a group of patients with multiple episodes. CONCLUSION: Our data give support to the model of staging in bipolar disorder, showing that the enduring neurotoxicity of repeated episodes may contribute to sustained impairment in multiple areas of psychosocial functioning.

La reformulación de los trastornos de la personalidad en el DSM-V / New criteria for personality disorders in DSM-V

El diagnóstico de los trastornos de personalidad en la actual edición del DSM-IV implica dos aspectos centrales. El primero es el referido al concepto mismo de trastorno de la personalidad, que es definido como un patrón de conductas y de experiencias internas que está generalizado, es estable y se mantiene al menos desde la adolescencia. El segundo aspecto se refiere a la identificación de un trastorno de personalidad en una lista de diez, con una categoría adicional de “no específico”. Hay muchos problemas con el sistema actualmente vigente: los diferentes tipos de personalidad aparecen definidos de una forma muy pobre y hay un gran solapamiento de los criterios diagnósticos. La revisión propuesta en el borrador del DSM-V resulta más bien compleja y tiene tres características principales: una nueva definición de lo que es un trastorno de personalidad, centrada en los fallos de adaptación, que implican alteraciones de la identidad o en las relaciones interpersonales efectivas; cinco categorías diagnósticas (antisocial/psicópata, evitativo, límite, obsesivo-compulsivo y esquizotípico); y una serie de seis dominios de personalidad, cada uno de los cuales con un subconjunto de facetas o rasgos. Este nuevo sistema propuesto para el diagnóstico de los trastornos de la personalidad puede resultar controvertido. Por último, se comentan los desafíos para el próximo futuro (AU)

Diagnosing personality disorders in the current edition of the DSM-IV involves two central features. The first is the concept of a personality disorder, which currently is defined as a pattern of inner experiences and behaviors that is generalized, is stable, and has been maintained at least since adolescents. The second aspect involves defining what type of personality disorder is present among a list of ten, with a catch-all “not otherwise specified category.” There are many problems with the existing system: the different personality types are poorly defined and the diagnostic criteria overlap heavily. The proposed revision on the DSM-V website appears quite complicated and has three major facets: a new definition for personality disorder, focused on “adaptive failures ”involving “impaired sense of self-identity” or “failure to develop effective interpersonal functioning;” five personality types (Antisocial/Psychopathic, Avoidant, Borderline, Obsessive-Compulsive, and Schizotypal); and a series of six personality “trait domains,” each of them with a subset of facets. This new proposed system for personality disorder diagnosis may be controversial. Finally, challenges for the near future are discussed (AU)

New criteria for personality disorders in DSM-V.

Diagnosing disorders in the current edition of the DSMIV involves two aspects. The first is the concept of a personality disorder, which currently is defined as a pervasive, stable and presents at least from adolescence pattern of "inner experience and behavior" that is deviant from a person's cultural norms. The second aspect involves defining what type of personality disorder is present among a list of ten, with a catch-all "not otherwise specified category". There are many problems with the existing system: the different personality types are poorly defined and the diagnostic criteria overlap heavily. The proposed revision on the DSM-V website appears quite complicated and has three major facets: a new definition for personality disorder, focused on "adaptive failure" involving "impaired sense of self-identity" or "failure to develop effective interpersonal functioning"; five personality types (Antisocial/Psychopathic, Avoidant, Borderline, Obsessive-Compulsive, and Schizotypal); and a series of six personality "trait domains", each of them with a subset of facets. This new proposed system for personality disorder diagnosis may be controversial. Finally challenges for the next future are discussed.

Violence and personality disorders: clinical and forensic implications.

Several studies have provided strong evidence that personality disorders (PD) represent a significant clinical risk for violence. This review has aimed to examine the relationship of greater risk for violence among persons with certain PD in terms of four fundamental personality dimensions: 1) impulse control; 2) affect regulation; 3) threatened egotism or narcissism; and 4) paranoid cognitive personality style. Two of these dimensions -impulse control and affect regulation- are probably substantially affected by virtually all PDs linked to violence. Narcissism or threatened egotism and paranoid cognitive personality style have also been empirically linked to violence and mental disorder. PD symptoms have proven to be even stronger predictors of violence than the PDs per se. In fact, increased symptoms of DSM-IV cluster A or cluster B PD, such as paranoid, narcissistic and antisocial PD symptoms, correlate significantly with violence. Finally, there are three important principles about the relationship between PDs and violence: 1) PDs are rarely egosyntonic; 2) most patients and violent situations that come to clinical attention involve comorbid conditions; and 3) violence and risk of violence are often associated with substance abuse. Implications of this review for further research are discussed.

Impact of psychiatric and neuropsychological sequelae of traumatic brain injury on the duration of legal time periods.

INTRODUCTION: In the forensic setting, diagnosis of sequels and determination of the legal periods are central to the assessment of traumatic brain injury (TBI). The analysis of the relationship between descriptors of TBI and legal periods is undertaken. METHOD: Retrospective study of 50 TBI. Demographic information, severity and characteristics of the TBI, neuroimaging data, treatments, legal periods and sequels were gathered. Descriptive statistics and correlational analysis were performed. RESULTS: Glasgow Comma Scale was available in 47 cases but coma duration and posttraumatic amnesia only in 21. There was information on early TAC in 48 cases and followup neuroimaging (after three months) was available in 46. 26 patients received the diagnosis organic personality disorder and this correlated with longer legal periods. Affective disorder (N=6), anxiety disorder (N=5) and postconcussional syndrome (N=5) were less prevalent. Average "time in hospital" was longer than two months. "Healing time" and "disability time" were on average longer than a year. "Healing time" and "time in hospital" were longer with left sided lesions. CONCLUSION: In the forensic assessment of TBI, availability of information regarding the duration of coma and posttraumatic amnesia should be improved. Left sided lesions and the presence of organic personality disorder predict longer legal periods. Understanding of these facts requires a more detailed analysis.

Violencia y trastornos de la personalidad: implicaciones clínicas y forenses / Violence and personality disorders: clinical and forensic implications

En diversos estudios se ha demostrado que los trastornos de la personalidad (TP) representan un riesgo clínico significativo para las conductas violentas. El objetivo de este artículo es examinar la relación entre los TP y la violencia en función de cuatro dimensiones de personalidad fundamentales:1) la impulsividad; 2) la falta de regulación emocional;3) el narcisismo y las amenazas al yo; y 4) el estilo de personalidad paranoide. Dos de estas dimensiones –la impulsividad y la falta de regulación emocional- están implicadas en todos los TP relacionados con la violencia. El narcisismo o las amenazas al yo y el estilo de personalidad paranoide se han asociado empíricamente a la violencia y a los trastornos mentales. Los síntomas de los TP han mostrado ser mejores predictores de la violencia que los TP por sí mismos. De hecho, los síntomas del clúster A o B de los TP, tales como los síntomas paranoides, narcisistas y antisociales, correlacionan de forma significativa con la violencia. Por último, hay tres principios fundamentales sobre la relación entre los TP y la violencia: 1) los TP son habitualmente egosintónicos; 2)los TP muestran comorbilidad con otros trastornos del Eje I o del Eje II; y 3) la violencia y el riesgo de violencia están asociados con frecuencia al abuso de drogas. Se comentan las implicaciones de esta revisión para la investigación futura (AU)

Several studies have provided strong evidence that personality disorders (PD) represent a significant clinical risk for violence. This review has aimed to examine the relationship of greater risk for violence among persons with certain PD in terms of four fundamental personality dimensions: 1) impulse control; 2) affect regulation; 3) threatened egotism or narcissism; and 4) paranoid cognitive personality style. Two of these dimensions-impulse control and affect regulation- are probably substantially affected by virtually all PDs linked to violence. Narcissism or threatened egotism and paranoid cognitive personality style have also been empirically linked to violence and mental disorder. PD symptom shave proven to be even stronger predictors of violence than the PDs per se. In fact, increased symptoms of DSMIV cluster A or cluster B PD, such as paranoid, narcissistic and antisocial PD symptoms, correlate significantly with violence. Finally, there are three important principles about the relationship between PDs and violence: 1) PDs are rarely egosyntonic; 2) most patients and violent situations that come to clinical attention involve comorbid conditions; and 3) violence and risk of violence are often associated with substance abuse. Implications of this review for further research are discussed (AU)

Impacto de las secuelas psiquiátricas y neuropsicológicas de los traumatismos craneoencefálicos sobre la duración de los tiempos legales / Impact of psychiatric and neuropsychological consequences of traumatic brain injury on the duration of the legal periods

Introducción. En la peritación de los traumatismos cráneoencefálicos (TCE), la determinación de las secuelas y de los tiempos legales (tiempo de hospitalización, de impedimento y de curación) son clave. Se analiza la relación de éstos con descriptores generales de los TCE y con las secuelas psíquicas. Metodología. Estudio retrospectivo de 50 TCE. Se recogió información sociodemográfica, antecedentes, severidad y caracterización del traumatismo, neuroimagen, tratamientos,t iempos legales y secuelas. Las características de los 50 casos se describen utilizando estadística descriptiva, índices de correlación o chi cuadrado. Resultados. En 47 casos consta la escala de coma de Glasgow; sólo en 21 se dispone de la duración del coma o de la amnesia postraumática. En 48 casos consta la tomografía axial computarizada (TAC) temprana y en 46 hay neuroimagen después de los 3 meses. Se diagnosticó un trastorno orgánico de la personalidad en 26 casos y su presencia se correlaciona con tiempos de curación y de impedimento más dilatados. Los trastornos del ánimo (n = 6), los trastornos de ansiedad (n = 5) y los trastornos postconmocionales (n = 5)fueron menos frecuentes. La media del tiempo de hospitalización supera los dos meses. Tanto las medias del tiempo de impedimento como las de curación superan el año. Los tiempos de curación y de hospitalización son superiores si la lesión es izquierda. Conclusiones. Aspectos a mejorar en la peritación de los TCE son la disponibilidad de información relativa a la duración de la amnesia postraumática y la duración del coma. La lesión cerebral izquierda y la presencia de trastorno orgánico de la personalidad predicen tiempos legales más dilatados. Su comprensión merece un estudio pormenorizado (AU)

Introduction. In the forensic setting, diagnosis of sequels and determination of the legal periods are central to the assessment of traumatic brain injury (TBI). The analysis of the relationship between descriptors of TBI and legal periods is undertaken. Method. Retrospective study of 50 TBI. Demographic information, severity and characteristics of the TBI, neuroimaging data, treatments, legal periods and sequels were gathered. Descriptive statistics and correlational analysis were performed. Results. Glasgow Comma Scale was available in 47cases but coma duration and posttraumatic amnesia only in 21. There was information on early TAC in 48 cases and follow-up neuroimaging (after three months) was available in 46. 26 patients received the diagnosis organic personality disorder and this correlated with longer legal periods. Affective disorder (N=6), anxiety disorder (N=5) and postconcussional syndrome (N=5) were less prevalent. Average “time in hospital” was longer than two months.“Healing time” and “disability time” were on average longer than a year. “Healing time” and “time in hospital” were longer with left sided lesions. Conclusion. In the forensic assessment of TBI, availability of information regarding the duration of coma and posttraumatic amnesia shoud be improved. Left sided lesions and the presence of organic personality disorder predict longer legal periods. Understanding of these facts requires a more detailed analysis (AU)

Guía para la evaluación clínico-forense del daño psíquico consecutivo a los traumatismos craneoencefálicos / Guide to forensic assessment of psychological impairment after traumatic brain injury

En el ámbito de la Medicina Forense la evaluaciónclínica y funcional de las secuelas consecutivas a los traumatismoscraneoencefálicos tiene importantes y trascendentesrepercusiones en los distintos órdenes judiciales(penal, civil y laboral). Así, en el orden civil, la obligaciónde indemnización por daños origina la necesidad deValoración del Daño Corporal. El juzgador establece laindemnización teniendo en cuenta la duración de lostiempos “legales” (de hospitalización, de curación o estabilizaciónlesional en su caso y de impedimento), asícomo la presencia de secuelas y su cuantificación. Lavaloración del daño psíquico (neuropsicológico y neuropsiquiátrico)entraña una especial dificultad por cuantoen muchas ocasiones el daño no es fácilmente objetivabley cuantificable. Nuestro objetivo ha sido facilitar laevaluación clínico-forense de los traumatismos craneoencefálicos,protocolizando la evaluación y proponiendo unaguía clínica y funcional de las secuelas neuropsicológicasy neuropsiquiátricas. Para ello se ha llevado a cabo unaamplia revisión de los aspectos teóricos relativos a lostraumatismos craneoencefálicos, que ha servido de basepara la elaboración de la guía. En ésta se describen lasprincipales secuelas y su forma de evaluación (clínica ymediante tests estandarizados en el caso de secuelas neuropsicológicas)(AU)

In Forensic Medicine, clinical and functionalassessment of sequelae after traumatic brain injury hassignificant medico-legal implications. The duty tocompensate for the damage caused leads to the“assessment of the organic and psychological harminflicted”. Judges establish financial compensation accordingto the duration of the “legal periods” (time ofhospitalization, time till cure or time to lesion stabilization)and the quantification of the permanent squeals.Assessment of psychological impairment (neuropsychologicaland neuropsychiatric) is particularly difficult due to the lack ofobjective and quantifiable data. The aim of this work is tofacilitate the forensic assessment by proposing a clinical andfunctional guide that helps to standardize the evaluation ofneuropsychiatric and neuropsychological squeals. A widereview of the literature has been the basis for the proposedprotocol. Neuropsychological tests as well asneuropsychiatric diagnostic tools are included(AU)

Secuelas emocionales en víctimas de abuso sexual en la infancia / Emotional consequences in victims of sexual abuse in childhood

En este estudio se hace un análisis sobre las consecuencias del abuso sexual a corto y largo plazo, así como sobre el impacto inmediato de la victimización y de las repercusiones a largo plazo en la salud mental. Se revisan asimismo las situaciones de alto riesgo y los factores protectores que pueden amortiguar el impacto del abuso sexual. Se comentan las implicaciones de este estudio para la investigación clínica y la práctica forense

In this study the immediate and long-term impact of sexual abuse in children and the psychological consequences on their mental health during adult life are reviewed. High-risk situations, as well as protective factors that may minimize the impact of sexual abuse, are analyzed. Implications of these findings for clinical research and forensic practice are commented upon

Ludopatía y trabajo : análisis de las repercusiones laborales de los jugadores patológicos de máquinas tragaperras / Ludopaty and work: analysis of work consequences for slot-machine pathological gamblers

En este artículo se presenta un estudio sobre las alteraciones laborales en una muestra de 121 jugadores patológicos de máquinas tragaperras. LAs principales repercusiones laborales identificadas son, por orden de importancia, las siguientes: absentismo laboral, problemas de concentración y disminución del rendimiento, hurtos en el trabajo, conflictos con los compañeros, despido o no renovación del contrato, dificultades para encontrar un nuevo empleo, cambios de puesto por problemas derivados del juego y, por último, accidentabilidad laboral. Se comentan las implicaciones de este estudio para la investigación y para el desarrollo de la psicopatología laboral como disciplina científica (AU)

Long-term outcome of cognitive therapy's contribution to self-exposure in vivo to the treatment of generalized social phobia.

The aim of this work was to test the contribution of cognitive therapy to exposure in vivo in the group treatment of generalized social phobia. Seventy-one severely disabled social phobics, selected according to DSM-III-R criteria, were assigned at random to: (a) self-exposure in vivo, (b) self-exposure in vivo with cognitive therapy, or (c) a waiting-list control group. A multigroup experimental design with repeated measures of assessment (pretreatment, posttreatment, and 1-, 3-, 6-, and 12-month follow-ups) was used. Additionally, half of the patients in both therapeutic groups were given self-help manuals for managing anxiety. Most patients that were treated (64%) showed significant improvement at the 12-month follow-up, but there were no differences between the two therapeutic models. No improvement was shown by the control-group participants at the 6-month follow-up. The results of the present trial do not support the beneficial effects of adding cognitive therapy or a self-help manual to exposure alone. Finally, several topics that may contribute to future research in this field are discussed.

Psychological treatment of chronic posttraumatic stress disorder in victims of sexual aggression.

The aim of this research was to test the comparative effectiveness of two therapeutic modalities in the treatment of chronic posttraumatic stress disorder in victims of sexual aggression: (a) self-exposure and cognitive restructuring and (b) progressive relaxation training. The sample consisted of 20 patients (victims of rape in adulthood or adult victims of childhood sexual abuse) selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures (pretreatment, posttreatment, and 1-, 3-, 6-, and 12-month follow-up) was used. Most treated patients improved, but the success rate was higher in all measures in the exposure and cognitive restructuring group immediately on posttreatment and at follow-up. Implications of this study for clinical practice and future research in this field are commented on.