Toxoplasma gondii Seropositivity Interacts with Catechol-O-methyltransferase Val105/158Met Variation Increasing the Risk of Schizophrenia.

Schizophrenia is a heterogeneous and severe psychotic disorder. Epidemiological findings have suggested that the exposure to infectious agents such as Toxoplasma gondii (T. gondii) is associated with an increased risk for schizophrenia. On the other hand, there is evidence involving the catechol-O-methyltransferase (COMT) Val105/158Met polymorphism in the aetiology of schizophrenia since it alters the dopamine metabolism. A case−control study of 141 patients and 142 controls was conducted to analyse the polymorphism, the prevalence of anti-T. gondii IgG, and their interaction on the risk for schizophrenia. IgG were detected by ELISA, and genotyping was performed with TaqMan Real-Time PCR. Although no association was found between any COMT genotype and schizophrenia, we found a significant association between T. gondii seropositivity and the disorder (χ2 = 11.71; p-value < 0.001). Furthermore, the risk for schizophrenia conferred by T. gondii was modified by the COMT genotype, with those who had been exposed to the infection showing a different risk compared to that of nonexposed ones depending on the COMT genotype (χ2 for the interaction = 7.28, p-value = 0.007). This study provides evidence that the COMT genotype modifies the risk for schizophrenia conferred by T. gondii infection, with it being higher in those individuals with the Met/Met phenotype, intermediate in heterozygous, and lower in those with the Val/Val phenotype.

Paranoia and Suicidality: A Cross-Sectional Study in the General Population.

Paranoia and suicidality seem to be common traits expressing in the general population to varying degrees. This study aims to explore the association between both and to identify determinants of comorbidity. We interviewed a representative sample of the population in Andalusia (n = 4507) and assessed paranoia and suicidality utilizing the Spanish Green's Paranoid Thoughts Scale (S-GPTS) and the suicidality section of the MINI Neuropsychiatric Interview, respectively. We gathered data on socio-demographics, personality, substance abuse, social support, and environmental distress. We found that paranoia and suicidality were rather common with 6.4% (95% CI: 5.7-7.12) of the sample admitting to some (vs. none) level of suicidality. We also found a robust association between paranoia and suicidality, independent of age and sex (F:298.2; p =.0001; Eta2: .065); 0.5% (95% CI: 0.32-0.76) of the sample (n = 21) presented combinedly high levels of paranoia and some suicidality risk and were considered as having paranoia-suicidality comorbidity (PSC). We identified factors associating with PSC, including poor social support, childhood maltreatment, threatening life-events and increasing personality disorder, and nicotine dependence scores. Paranoia and suicidality are common traits in the general population and their comorbidity seems to associate with low social support, environmental adversity and disordered personality. Suicidality and paranoia are common traits present dimensionally in a representative nonclinical sample. Paranoia strongly and independently associates with suicidality risk in a large population-based study. Paranoia and suicidality comorbidity may be commonly determined by poor social support, disordered personality, previous childhood maltreatment, and exposure to threatening life-events.

Cross-cultural neuropsychological assessment in Europe: Position statement of the European Consortium on Cross-Cultural Neuropsychology (ECCroN).

Over the past decades European societies have become increasingly diverse. This diversity in culture, education, and language significantly impacts neuropsychological assessment. Although several initiatives are under way to overcome these barriers - e.g. newly developed and validated test batteries - there is a need for more collaboration in the development and implementation of neuropsychological tests, such as in the domains of social cognition and language.To address these gaps in cross-cultural neuropsychological assessment in Europe, the European Consortium on Cross-Cultural Neuropsychology (ECCroN) was established in 2019.ECCroN recommends taking a broad range of variables into account, such as linguistic factors, literacy, education, migration history, acculturation and other cultural factors. We advocate against race-based norms as a solution to the challenging interpretation of group differences on neuropsychological tests, and instead support the development, validation, and standardization of more widely applicable/cross-culturally applicable tests that take into account interindividual variability. Last, ECCroN advocates for an improvement in the clinical training of neuropsychologists in culturally sensitive neuropsychological assessment, and the development and implementation of guidelines for interpreter-mediated neuropsychological assessment in diverse populations in Europe.ECCroN may impact research and clinical practice by contributing to existing theoretical frameworks and by improving the assessment of diverse individuals across Europe through collaborations on test development, collection of normative data, cross-cultural clinical training, and interpreter-mediated assessment.

A population-based cross-sectional study of cognitive deficits in paranoia.

This study sought to investigate the association between paranoia and performance in a range of neurocognitive domains using a large community sample. We conducted a cross-sectional survey of 4507 individuals within the PISMA-ep Study. We used a large community sample selected after multistage sampling using standard stratification techniques. Socio-demographic variables such as age, gender, educational level, urbanicity, and geographical region were recorded. The Spanish version of the Green Paranoid Thought Scale (S-GPTS) was used to assess paranoid thoughts. The Screening for Cognitive Impairment in Psychiatry (SCIP) was used to assess neurocognitive performance both globally and by domains (i.e., immediate and delayed verbal learning, working memory, verbal fluency and processing speed). Individuals with high S-GPTS paranoia scores showed significantly lower performance on global cognitive function and also on immediate (but not delayed) verbal learning, working memory, verbal fluency and processing speed. These results held statistical significance even after controlling for the effects of education and estimated IQ. We propose that cognitive deficits may be mediators of paranoid thinking formation and need to be considered when assessing patients with high levels of paranoia.

Cultural Bias in Intelligence Assessment Using a Culture-Free Test in Moroccan Children.

OBJECTIVE: Previous research has shown that cognitive tests can lead to misclassification when applying non-representative norms to measure cognitive performance. The objective of this study was to investigate whether this misclassification also occurs with a non-verbal so-called "culture-free" intelligence test administered to different age groups. METHOD: The intelligence of a sample of healthy Moroccan children (N = 147) ages 7, 9, and 11 was assessed using the Coloured Raven's Progressive Matrices (CPM). Raw scores were used to study age differences, as well as misclassifications when applying the norms of three countries culturally different from Morocco (United Kingdom, Spain, and Oman). RESULTS: Intelligence performance was not within the normal range when non-representative norms were applied to the Moroccan raw scores. Misclassifications accounted for a large percentage of the participants that supposedly displayed intelligence deficits, especially when applying the British norms. Up to 15.68% of the healthy children fell within the "intellectually impaired" range, and up to 62.5% fell "below average," with these percentages especially higher at older ages. CONCLUSIONS: Our findings confirm that "culture-free" tests should be adapted to each culture and applied together with their culture's specific norms to prevent misclassification and allow for a better, unbiased neuropsychological assessment.

Severe Mental Illness in Community Mental Health Care in Spain: Prevalence and Related Factors.

The aims of this study were to determine the prevalence of severe mental illness (SMI) in patients in contact with mental health services and to determine the factors associated with SMI. A total of 260 patients who met diagnostic criteria for SMI were assessed using the Global Assessment of Functioning (GAF) scale and Health of the Nation Outcome Scales. The overall prevalence of SMI was 6.08 per thousand. According to the three different cutoff points with GAF, the prevalence of SMI ranged from 5.38 per thousand under the weak criterion (GAF < 70) to 1.01 per thousand under the strict criterion (GAF < 50). In the regression model, the dependent variable (presence of SMI) was defined using a GAF < 60, and the variables independently associated with the dependent variable were years of disease duration since diagnose, mental health service use, alcohol or other substance abuse, and depressive anxiety and other psychological symptoms.

A Cross-Sectional Study on the Prevalence and Risk Correlates of Mental Disorders: The GRANADΣP Study.

This is a cross-sectional study of participants from a population census living in the province of Granada (Spain). A total of 1176 persons were contacted, 367 (31%) refused and 54 (6.7%) needed substitution. A final sample of 809 participants (response rate, 69.3%) were screened for mental disorder (MD) using the MINI International Neuropsychiatric Interview, a comprehensive interview validated to generate diagnoses compatible with ICD-10/DSM-4 criteria. Current (1-month) prevalence for any MD was 11.3% (95% confidence interval [CI], 9.7%-13.4%; affective 8.2%, anxiety 9.6%, psychotic 2.1%, addiction 1.8%, personality disorder 3.6%). Lifetime MD prevalence was 24.6% (95% CI, 21.6-27.6; affective 14.9%, anxiety 15.5%, psychotic 3.4%, addiction 4.4%, personality disorder 3.6%). Female sex was associated with MD, but this appeared partially due to higher levels of neuroticism among women. MD also correlated significantly with cannabis use, family history of MD, higher social adversity, higher suicide risk, poorer physical health, poorer cognitive performance, and personality problems.

A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial.

BACKGROUND: Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. METHODS: Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months. RESULTS: With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. CONCLUSIONS: Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01151982. Registered on June 29, 2010.

A Psychopathological Comparison between Delusional Disorder and Schizophrenia.

OBJECTIVE: To contribute to a better differential clinical categorisation of delusional disorder (DD) versus schizophrenia (SZ) and to add and complete evidence from previous clinical studies of DD compared to schizophrenia. METHODS: A cross-sectional study using a clinical sample of 275 patients (132 patients with DD) was studied. Patients were consecutively attending public clinics located in urban and rural areas in both Andalusia and Catalonia (Spain). All participants met DSM-IV diagnostic criteria for either DD or SZ. Data were gathered on sociodemographics, illness duration, Barona-Index estimation of intelligence quotient (IQ), and global functioning, along with a thorough psychopathological assessment using the Positive and Negative Syndrome Scale (PANSS). Comparisons between both groups were calculated using χ2, Student t, and multivariate analysis of covariance tests. RESULTS: Patients with DD were older (mean [SD], 50.3 [14.6] years vs. 36.6 [11.1] years; t = 8.597; P ≤ 0.0001), were more frequently married (45.4% vs. 10.8%; χ2 = 38.569; P ≤ 0.0001), and had a higher mean estimated premorbid IQ (111.4 vs. 105.4; t = 2.609; P ≤ 0.01). On the other hand, SZ patients were predominantly male (71.4% vs. 48.9%; χ2 = 14.433; P ≤ 0.0001) and had greater work-related disability than DD patients (20.5% vs. 50.3%; χ2 = 19.564; P ≤ 0.001). Overall, the DD group showed a less severe PANSS psychopathology than SZ group. Thus, total mean (SD) PANSS scores for schizophrenia and delusional disorder, respectively, were 76.2 (22.4) versus 54.1 (18.4) ( t = -8.762; P ≤ 0.0001). Moreover, patients with DD showed a better global functioning than those with SZ (62.7 [13.2] vs. 51.9 [16.9]; F = 44.114; P ≤ 0.0001). CONCLUSIONS: DD is a milder and distinct disorder compared to SZ in terms of psychopathology and global functionality.

Protocolo y metodología del estudio epidemiológico de la salud mental en Andalucía: PISMA-ep / Protocol and methodology of study epidemiological mental health in Andalusia: PISMA-ep

Introducción. El presente artículo describe la metodología general de un estudio transversal cuyo principal objetivo consiste en la detección de la prevalencia de los principales trastornos mentales en Andalucía, y el estudio de sus correlatos o posibles factores de riesgo mediante una amplia muestra representativa de adultos que vive en la comunidad. Materiales y métodos. Este es un estudio transversal en el que desarrollamos un muestreo de varias fases utilizando distintos niveles de estratificación habituales y en el que teníamos como objetivo entrevistar a 4.518 participantes seleccionados al azar y representativos de las 8 provincias de la comunidad andaluza, con un enfoque de «llamada a la puerta». Como principal herramienta diagnóstica se utilizó la versión española de la entrevista neuropsiquiátrica internacional MINI, un instrumento válido de detección para el establecimiento de diagnósticos de trastorno mental compatibles con los criterios CIE-10/DSM-IV. Asimismo, se empleó una amplia batería de instrumentos para explorar la funcionalidad global, la comorbilidad médica, las características de la personalidad, la función cognitiva y la exposición a posibles factores de riesgo psicosocial. También se obtuvo una muestra de saliva para extraer ADN para un estudio de asociación genética. Entrevistadores entrenados llevaron a cabo las entrevistas, a pesar de que la mayoría de las medidas son compatibles con entrevistadores legos. Resultados. De los 5.496 hogares seleccionados inicialmente, el 70,8% (3.892) tuvieron que sustituirse por falta de respuesta (37,7%) o por no incluir a ninguna persona que cumpliese las características requeridas (33%). Así, de las nuevas 5.496 personas, a las cuales finalmente se accedió, 4.507 (83,7%) consintieron participar, completaron la entrevista y se las incluyó finalmente en el estudio (n = 4.507), mientras que 4.286 (78%) también proporcionaron una muestra de saliva. Por su parte, 989 (16,3%) rechazaron participar. Discusión. Se trata del estudio de epidemiología de salud mental más amplio desarrollado en la comunidad autónoma más grande y poblada de España (Andalucía). Las tasas de respuesta y representatividad de la muestra son bastante altas. El método empleado es muy completo para este tipo de estudios e incluye tanto valoraciones de personalidad (rasgos y trastorno) como valoración cognitiva, así como un amplio abanico de medidas de riesgo biopsicosocial (AU)

Introduction. This is the general methods describing paper of a cross-sectional study that aims to detect the prevalence of major mental disorders in Andalusia (Southern Spain), and their correlates or potential risk factors, using a large representative sample of community-dwelling adults. Materials and methods. This is a cross-sectional study. We undertook a multistage sampling using different standard stratification levels and aimed to interview 4,518 randomly selected participants living in all 8 provinces of the Andalusian region utilizing a door-knocking approach. The Spanish version of the MINI International Neuropsychiatric Interview, a valid screening instrument ascertaining ICD-10/DSM-IV compatible mental disorder diagnoses was used as our main diagnostic tool. A large battery of other instruments was used to explore global functionality, medical comorbidity, personality traits, cognitive function and exposure to psychosocial potential risk factors. A saliva sample for DNA extraction was also obtained for a sub-genetic study. The interviews were administered and completed by fully trained interviewers, despite most tools used are compatible with lay interviewer use. Results. A total of 3,892 (70.8%) of 5,496 initially attempted households had to be substituted for equivalent ones due to either no response (37.7%) or not fulfilling the required participant quota (33%). Thence, out of 5,496 eligible participants finally approached, 4,507 (83.7%) agreed to take part in the study, completed the interview and were finally included in the study (n=4,507) and 4,286 (78%) participants also agreed and consented to provide a saliva sample for DNA study. On the other hand, 989 (16.3%) approached potential participants refused to take part in the study. Discussion. This is the largest mental health epidemiological study developed in the region of Spain (Andalusia). The response rates and representativeness of the sample obtained are fairly high. The method is particularly comprehensive for this sort of studies and includes both, personality and cognitive assessments, as well as a large array of bio-psycho-social risk measures (AU)

Protocol and methodology of Study epidemiological mental health in Andalusia: PISMA-ep. / Protocolo y metodología del estudio epidemiológico de la salud mental en Andalucía: PISMA-ep.

INTRODUCTION: This is the general methods describing paper of a cross-sectional study that aims to detect the prevalence of major mental disorders in Andalusia (Southern Spain), and their correlates or potential risk factors, using a large representative sample of community-dwelling adults. MATERIALS AND METHODS: This is a cross-sectional study. We undertook a multistage sampling using different standard stratification levels and aimed to interview 4,518 randomly selected participants living in all 8 provinces of the Andalusian region utilizing a door-knocking approach. The Spanish version of the MINI International Neuropsychiatric Interview, a valid screening instrument ascertaining ICD-10/DSM-IV compatible mental disorder diagnoses was used as our main diagnostic tool. A large battery of other instruments was used to explore global functionality, medical comorbidity, personality traits, cognitive function and exposure to psychosocial potential risk factors. A saliva sample for DNA extraction was also obtained for a sub-genetic study. The interviews were administered and completed by fully trained interviewers, despite most tools used are compatible with lay interviewer use. RESULTS: A total of 3,892 (70.8%) of 5,496 initially attempted households had to be substituted for equivalent ones due to either no response (37.7%) or not fulfilling the required participant quota (33%). Thence, out of 5,496 eligible participants finally approached, 4,507 (83.7%) agreed to take part in the study, completed the interview and were finally included in the study (n=4,507) and 4,286 (78%) participants also agreed and consented to provide a saliva sample for DNA study. On the other hand, 989 (16.3%) approached potential participants refused to take part in the study. DISCUSSION: This is the largest mental health epidemiological study developed in the region of Spain (Andalusia). The response rates and representativeness of the sample obtained are fairly high. The method is particularly comprehensive for this sort of studies and includes both, personality and cognitive assessments, as well as a large array of bio-psycho-social risk measures.

Intervention to Prevent Major Depression in Primary Care: A Cluster Randomized Trial.

BACKGROUND: Not enough is known about universal prevention of depression in adults. OBJECTIVE: To evaluate the effectiveness of an intervention to prevent major depression. DESIGN: Multicenter, cluster randomized trial with sites randomly assigned to usual care or an intervention. (ClinicalTrials.gov: NCT01151982). SETTING: 10 primary care centers in each of 7 cities in Spain. PARTICIPANTS: Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each center; 3326 patients consented and were eligible to participate. INTERVENTION: For each patient, PCPs communicated individual risk for depression and personal predictors of risk and developed a psychosocial program tailored to prevent depression. MEASUREMENTS: New cases of major depression, assessed every 6 months for 18 months. RESULTS: At 18 months, 7.39% of patients in the intervention group (95% CI, 5.85% to 8.95%) developed major depression compared with 9.40% in the control (usual care) group (CI, 7.89% to 10.92%) (absolute difference, -2.01 percentage points [CI, -4.18 to 0.16 percentage points]; P = 0.070). Depression incidence was lower in the intervention centers in 5 cities and similar between intervention and control centers in 2 cities. LIMITATION: Potential self-selection bias due to nonconsenting patients. CONCLUSION: Compared with usual care, an intervention based on personal predictors of risk for depression implemented by PCPs provided a modest but nonsignificant reduction in the incidence of major depression. Additional study of this approach may be warranted. PRIMARY FUNDING SOURCE: Institute of Health Carlos III.

A dimensional comparison between delusional disorder, schizophrenia and schizoaffective disorder.

INTRODUCTION: Since the early description of paranoia, the nosology of delusional disorder has always been controversial. The old idea of unitary psychosis has now gained some renewed value from the dimensional continuum model of psychotic symptoms. AIMS: 1. To study the psychopathological dimensions of the psychosis spectrum; 2. to explore the association between psychotic dimensions and categorical diagnoses; 3. to compare the different psychotic disorders from a psychopathological and functional point of view. MATERIAL AND METHODS: This is an observational study utilizing a sample of some 550 patients with a psychotic disorder. 373 participants had a diagnosis of schizophrenia, 137 had delusional disorder and 40 with a diagnosis of schizoaffective disorder. The PANSS was used to elicit psychopathology and global functioning was ascertained using the GAF measure. Both exploratory and confirmatory factor analyses of the PANSS items were performed to extract psychopathological dimensions. Associations between diagnostic categories and dimensions were subsequently studied using ANOVA tests. RESULTS: 5 dimensions - manic, negative symptoms, depression, positive symptoms and cognitive - emerged. The model explained 57.27% of the total variance. The dimensional model was useful to explained differences and similarities between all three psychosis spectrum categories. The potential clinical usefulness of this dimensional model within and between clinical psychosis spectrum categories is discussed.

Spanish adaptation of the Green Paranoid Thought Scales / Adaptación española de las Escalas de Pensamiento Paranoide de Green

BACKGROUND: The aim of this study was to adapt and obtain validity evidence of the Spanish Green Paranoid Thought Scales (S-GPTS). METHOD: 191 Spanish people responded to S-GPTS, Peters Delusions Inventory (PDI), and measures of psychopathology. RESULTS: Principal Component Analyses on the polychoric correlation matrix identified two factors accounting for 71.0% of the cumulative variance. Cronbach alphas for S-GPTS total and its subscales were above .90 in clinical and non-clinical group. The value of the area under the receiver operating characteristic curve was higher for the S-GPTS (.898), than for the PDI (.859). The best S-GPTS threshold to discriminate between cases and non-cases was 92 (sensitivity, 97.35%; specificity, 65%). S-GPTS scores positively correlated with PDI and measures of anxiety and depression. CONCLUSION: The S-GPTS has adequate psychometric properties to provide valid measures of delusional ideation in a Spanish population

ANTECEDENTES: el objetivo del presente estudio fue adaptar y obtener evidencias de validez de la versión española de las escalas de pensamiento paranoide de Green (S-GPTS). MÉTODO: 191 participantes españoles respondieron al S-GPTS, al Inventario de Delirios de Peters (PDI) y a medidas de psicopatología.RESULTADOS: el Análisis de Componentes Principales a partir de la matriz de correlaciones policóricas identificó dos factores que explicaban el 71% de la varianza acumulada. El coeficiente α de Cronbach para el S-GPTS y sus subescalas fue superior a .90 en ambos grupos. El valor del área bajo la curva ROC fue más alto para el S-GPTS (.898) que para el PDI (.859). El punto de corte que mejor discriminaba entre el grupo clínico y el no clínico fue 92 (97,35% de sensibilidad, 65% de especificidad). Las puntuaciones del S-GPTS correlacionaron positivamente con el PDI y con medidas de ansiedad y depresión. CONCLUSIONES: el S-GPTS posee propiedades psicométricas adecuadas para proporcionar una medida válida de la ideación delirante en población española

Spanish adaptation of the Green Paranoid Thought Scales.

BACKGROUND: The aim of this study was to adapt and obtain validity evidence of the Spanish Green Paranoid Thought Scales (S-GPTS). METHOD: 191 Spanish people responded to S-GPTS, Peters Delusions Inventory (PDI), and measures of psychopathology. RESULTS: Principal Component Analyses on the polychoric correlation matrix identified two factors accounting for 71.0% of the cumulative variance. Cronbach alphas for S-GPTS total and its subscales were above .90 in clinical and non-clinical group. The value of the area under the receiver operating characteristic curve was higher for the S-GPTS (.898), than for the PDI (.859). The best S-GPTS threshold to discriminate between cases and non-cases was 92 (sensitivity, 97.35%; specificity, 65%). S-GPTS scores positively correlated with PDI and measures of anxiety and depression. CONCLUSION: The S-GPTS has adequate psychometric properties to provide valid measures of delusional ideation in a Spanish population.

Unmet needs in the management of schizophrenia.

Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists.

Deficits in executive and memory processes in delusional disorder: a case-control study.

OBJECTIVE: Delusional disorder has been traditionally considered a psychotic syndrome that does not evolve to cognitive deterioration. However, to date, very little empirical research has been done to explore cognitive executive components and memory processes in Delusional Disorder patients. This study will investigate whether patients with delusional disorder are intact in both executive function components (such as flexibility, impulsivity and updating components) and memory processes (such as immediate, short term and long term recall, learning and recognition). METHODS: A large sample of patients with delusional disorder (n = 86) and a group of healthy controls (n = 343) were compared with regard to their performance in a broad battery of neuropsychological tests including Trail Making Test, Wisconsin Card Sorting Test, Colour-Word Stroop Test, and Complutense Verbal Learning Test (TAVEC). RESULTS: When compared to controls, cases of delusional disorder showed a significantly poorer performance in most cognitive tests. Thus, we demonstrate deficits in flexibility, impulsivity and updating components of executive functions as well as in memory processes. These findings held significant after taking into account sex, age, educational level and premorbid IQ. CONCLUSIONS: Our results do not support the traditional notion of patients with delusional disorder being cognitively intact.

Preventing the onset of major depression based on the level and profile of risk of primary care attendees: protocol of a cluster randomised trial (the predictD-CCRT study).

BACKGROUND: The 'predictD algorithm' provides an estimate of the level and profile of risk of the onset of major depression in primary care attendees. This gives us the opportunity to develop interventions to prevent depression in a personalized way. We aim to evaluate the effectiveness, cost-effectiveness and cost-utility of a new intervention, personalized and implemented by family physicians (FPs), to prevent the onset of episodes of major depression. METHODS/DESIGN: This is a multicenter randomized controlled trial (RCT), with cluster assignment by health center and two parallel arms. Two interventions will be applied by FPs, usual care versus the new intervention predictD-CCRT. The latter has four components: a training workshop for FPs; communicating the level and profile of risk of depression; building up a tailored bio-psycho-family-social intervention by FPs to prevent depression; offering a booklet to prevent depression; and activating and empowering patients. We will recruit a systematic random sample of 3286 non-depressed adult patients (1643 in each trial arm), nested in 140 FPs and 70 health centers from 7 Spanish cities. All patients will be evaluated at baseline, 6, 12 and 18 months. The level and profile of risk of depression will be communicated to patients by the FPs in the intervention practices at baseline, 6 and 12 months. Our primary outcome will be the cumulative incidence of major depression (measured by CIDI each 6 months) over 18 months of follow-up. Secondary outcomes will be health-related quality of life (SF-12 and EuroQol), and measurements of cost-effectiveness and cost-utility. The inferences will be made at patient level. We shall undertake an intention-to-treat effectiveness analysis and will handle missing data using multiple imputations. We will perform multi-level logistic regressions and will adjust for the probability of the onset of major depression at 12 months measured at baseline as well as for unbalanced variables if appropriate. The economic evaluation will be approached from two perspectives, societal and health system. DISCUSSION: To our knowledge, this will be the first RCT of universal primary prevention for depression in adults and the first to test a personalized intervention implemented by FPs. We discuss possible biases as well as other limitations. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01151982.

Neuropsychological research in delusional disorder: a comprehensive review.

In recent decades, there has been a growing interest in the field of delusions, and different aspects of delusional disorder (DD) have been investigated. However, DD is still one of the most underresearched psychiatric disorders. In this paper, we review the literature on DD and most of the theoretical approaches proposed to explain the development and maintenance of delusions. DD research is infrequent, and delusions in this disorder have been scarcely investigated. We aim to establish the state of the art of delusions research to date and point to the shortage of neuropsychological studies in patients with DD. We also justify the need for future research into the neuropsychological correlates of DD as measured in patients with this disorder given that most previous research has mainly focused on other psychotic conditions.