Cognitive Behavioral Therapy Plus a Serious Game as a Complementary Tool for a Patient With Parkinson Disease and Impulse Control Disorder: Case Report.

BACKGROUND: Impulse control disorders (ICDs) are commonly developed among patients who take dopamine agonist drugs as a treatment for Parkinson disease (PD). Gambling disorder and hypersexuality are more frequent in male patients with PD, with a prevalence over 4% in dopamine agonists users. Although impulsive-compulsive behaviors are related to antiparkinsonian medication, and even though ICD symptomatology, such as hypersexuality, often subsides when the dopaminergic dose is reduced, sometimes ICD persists in spite of drug adjustment. Consequently, a multidisciplinary approach should be considered to address these comorbidities and to explore new forms of complementary interventions, such as serious games or therapies adapted to PD. OBJECTIVE: The aim of this study is to present the case of a patient with ICD (ie, hypersexuality) triggered by dopaminergic medication for PD. A combined intervention was carried out using cognitive behavioral therapy (CBT) for ICD adapted to PD, plus an intervention using a serious game-e-Estesia-whose objective is to improve emotion regulation and impulsivity. The aim of the combination of these interventions was to reduce the harm of the disease. METHODS: After 20 CBT sessions, the patient received the e-Estesia intervention over 15 sessions. Repeated measures, before and after the combined intervention, were administered to assess emotion regulation, general psychopathology, and emotional distress and impulsivity. RESULTS: After the intervention with CBT techniques and e-Estesia, the patient presented fewer difficulties to regulate emotion, less emotional distress, and lower levels of impulsivity in comparison to before the treatment. Moreover, the frequency and severity of the relapses also decreased. CONCLUSIONS: The combined intervention-CBT and a serious game-showed positive results in terms of treatment outcomes.

Delay Discounting in Gambling Disorder: Implications in Treatment Outcome.

Impulsive choice, measured by delay discounting (DD) tasks, has been shown in patients with gambling disorders (GD). However, the impact of DD and treatment outcome has been scarcely explored in GD patients. The aims of this study were: (1) to examine the baseline association between DD and clinical variables in GD patients depending on their age and gambling preferences (strategic vs. non-strategic); and (2) to estimate the predictive role of DD on poorer outcomes of cognitive-behavioral therapy (CBT) when considering also the effect of other clinical variables. 133 treatment-seeking male GD patients were evaluated at baseline with a DD task and measures of GD severity, personality traits and psychopathology. Treatment outcome was measured in terms of dropout from CBT and relapses. Results showed baseline associations between DD and GD severity (correlation coefficient R = 0.408 among strategic gamblers and R = 0.279 among mixed gamblers) and between DD and positive/negative urgency (R = 0.330 for the youngest patients, R = 0.244 for middle age, and around R = 0.35 for gamblers who reported preferences for strategic games). Other personality traits such as high harm avoidance and low cooperativeness were also related to DD at baseline (R = 0.606 among strategic gamblers). Regarding treatment outcome, a steeper discount rate predicted a higher risk of relapses in strategic gamblers (odds ratio OR = 3.01) and middle-age ones (OR = 1.59), and a higher risk of dropout in younger gamblers (OR = 1.89), non-strategic gamblers (OR = 1.70) and mixed gamblers (R = 4.74). GD severity mediated the associations between age, DD, personality traits and poor CBT outcome. In conclusion, impulsive choice affects treatment response in individuals with GD and may interfere with it to a significant extent. Considering DD in GD, patients seeking treatment could help control its impact on treatment adherence and relapses.

What single reports from children and parents aggregate to attention deficit-hyperactivity disorder and oppositional defiant disorder diagnoses in epidemiological studies.

OBJECTIVE: To analyze information on attention deficit-hyperactivity disorder (ADHD)-oppositional defiant disorder (ODD) and its consequences, provided separately or in combination by children and their parents in a longitudinal prospective study of 9-15 year-old children from the general population. METHOD: Cross-sectional and longitudinal epidemiological indexes were compared for single and multiple reports. We evaluated which informant is required for the identification of each DSM-IV criterion. Logistic regressions determined which features were related with the reporting of the "absence" of symptoms. RESULTS: Both informants were required in order to obtain complete psychopathological profiles. Single reports provide infra-estimated prevalences (between 8.8 and 22.9% of ADHD and between 1.7 and 7.6% of ODD), risks (around 3% for ADHD and 2% for ODD) and comorbidities. Psychological and functional measures analyzed in the study were relatively similar for cases presenting ADHD/ODD diagnosis, regardless of the diagnostic algorithm (based on single or combined reports); however, these clinical profiles were different to those obtained for non-diagnosed children. The main predictors of not reporting the presence of psychopathology were: large families (OR between 2 and 2.5), children that are conflictive at school (OR ranging between 1.3 and 4.3) or those with poor mental health (OR between 1.1 and 1.6). CONCLUSIONS: These results may provide guidance for obtaining accurate diagnostic information, properly identifying children with mental health needs and planning the required preventive and corrective measures.

Dimensional analysis of a categorical diagnostic interview: the DICA-IV / Análisis dimensional de una entrevista diagnóstica categorial: la DICA-IV

The aim of this study is to obtain dimensions from a categorical diagnostic interview. 512 children aged 8 to 17 attending public centers for children’s mental health and presenting some form of psychological disorder were interviewed with the «Diagnostic Interview for Children and Adolescents»(DICA-IV). Analysis of the principal components indicate that a two-dimensional model (externalizing-internalizing) satisfactorily explain the data collected from the children and their parents. The data from the adolescents are better represented by a three-dimensional model (attention problems-internalizing-antisocial behavior). The factor scales show good internal consistency and significantly relate to other criteria of psychopathology and incapacity (concurrent validity). These results show that it is possible to use DICA-IV to obtain categorical and dimensional indicators simultaneously. The latter are particularly sensitive for measuring changes over the course of disorders

El objetivo de este estudio es obtener dimensiones a partir de una entrevista diagnóstica categorial. Se entrevistó con la Entrevista Diagnóstica para Niños y Adolescentes a 512 participantes de entre 8 y 17 años de centros de asistencia primaria pediátrica o psiquiátrica que presentaban algún tipo de psicopatología. El análisis de componentes principales indica que un modelo bidimensional (exteriorizado-interiorizado) explica los datos recogidos de los niños y sus padres. Los datos de los adolescentes quedan mejor representados por un modelo de tres dimensiones (problemas de atención-interiorizados-comportamiento antisocial). Las escalas factoriales muestran una buena consistencia interna y se relacionan de forma significativa con otros criterios de psicopatología e incapacidad (validez concurrente). Los resultados indican que es posible obtener simultáneamente indicadores categoriales y dimensionales de esta entrevista. Estos últimos pueden ser especialmente útiles para medir cambios en el curso de los trastornos

Dimensional analysis of a categorical diagnostic interview: the DICA-IV.

The aim of this study is to obtain dimensions from a categorical diagnostic interview. 512 children aged 8 to 17 attending public centers for children's mental health and presenting some form of psychological disorder were interviewed with the "Diagnostic Interview for Children and Adolescents" (DICA-IV). Analysis of the principal components indicate that a two-dimensional model (externalizing-internalizing) satisfactorily explain the data collected from the children and their parents. The data from the adolescents are better represented by a three-dimensional model (attention problems-internalizing-antisocial behavior). The factor scales show good internal consistency and significantly relate to other criteria of psychopathology and incapacity (concurrent validity). These results show that it is possible to use DICA-IV to obtain categorical and dimensional indicators simultaneously. The latter are particularly sensitive for measuring changes over the course of disorders.

Captura de datos clínicos con verificación aleatoria: una nueva técnica para controlar y mejorar la calidad del registro / Clinical data capture with random verification: a new procedure for controlling and improving the data capture quality

Este trabajo plantea las principales dificultades de la grabación de datos clínicos. Se ha diseñado una experiencia que consiste en capturar en un ordenador, en ausencia de protecciones automáticas, 335 entrevistas estructuradas codificadas previamente a mano por entrevistadores entrenados. El objetivo general del estudio consiste en valorar la eficacia de un nuevo sistema para controlar y mejorar la grabación: la verificación aleatoria (VA) de un porcentaje de cuestionarios, basada en el principio de "feedback". Para ello se han medido y tipificado los errores que cometen operadores profesionales durante la captura. Los objetivos específicos son: 1) valorar la eficacia de la VA respecto a la doble entrada (DE) - esta última constituye la estrategia habitual utilizada para mejorar la calidad del registro-; 2) comprobar qué modalidades de error contienen los datos grabados; 3) valorara la eficacia de los operadores para resolver las discrepancias aparecidas durante la verificación (midiendo qué porcentaje de errores persiste en los campos con discordancias durante la segunda captura de la VA y la DE). Los resultados principales indican que la VA ofrece un rendimiento similar a la DE con distintos operadores, mientras que la entrada simple y la DE con un mismo operador no constituyen sistemas eficaces para garantizar la calidad del registro. En la discusión se destacan qué aspectos de la medición y de la captura de datos se mejoran usando controles informáticos, qué requisitos mínimos de calidad deben prevalecer durante la grabación y qué elementos requieren los sistemas informáticos para operar de forma eficiente (AU)

This work contemplates the main difficulties related to the capture of clinical data into the computer. We have designed an experience that consists of capturing into the computer, in absence of automatic protections, 335 structured interviews coded on paper by trained interviewers. The general objective of this study consists of rating the efficiency of a new computerized system (based on the feedback principle) for controlling and improving the capture: the random verification (RV) of a percentage of questionnaires. To accomplish this objective, we have measured and classified the mistakes that professional operators commit during the data capture. The specific objectives are: 1) to rate the efficiency of the RV compared to double entry (DE) - this last strategy is the most commonly used for improving the quality of the capture - ; 2) to check the types of mistakes contained in the recorded data; and 3) to rate the operators’ efficiency for resolving the discrepancies that appeared during verification (through the measurement of the mistakes that persist in the fields with disagreements during the second capture of the RV and the DE). The principle results obtained indicate that the RV and the DE with different operators offer similar performance, while the simple entry and the DE with only one operator do not constitute effective systems for guaranteeing the quality of the capture. In the discussion we emphasize what aspects of the measurement and the data capture are improved using computerized controls, what minimum quality requirements should be present during the recording and what elements the computerized systems require for operating efficiently (AU)