Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions.

BACKGROUND: Internet and mobile-based interventions provide a unique opportunity to deliver cost-effective, accessible, time-unlimited support to people with psychosis. The aims of this study were to systematically compile and analyze the evidence on the acceptability, feasibility, safety and benefits of online and mobile-based interventions for psychosis. METHODS: Systematic review of peer-reviewed studies examining the usability, acceptability, feasibility, safety or efficacy of user-led, Internet or mobile-based interventions, with at least 80% of participants diagnosed with schizophrenia-spectrum disorders. RESULTS: Of 38 potentially relevant articles, 12 were eligible for inclusion. Interventions included web-based psycho-education; web-based psycho-education plus moderated forums for patients and supporters; integrated web-based therapy, social networking and peer and expert moderation; web-based CBT; personalized advice based on clinical monitoring; and text messaging interventions. Results showed that 74-86% of patients used the web-based interventions efficiently, 75-92% perceived them as positive and useful, and 70-86% completed or were engaged with the interventions over the follow-up. Preliminary evidence indicated that online and mobile-based interventions show promise in improving positive psychotic symptoms, hospital admissions, socialization, social connectedness, depression and medication adherence. CONCLUSIONS: Internet and mobile-based interventions for psychosis seem to be acceptable and feasible and have the potential to improve clinical and social outcomes. The heterogeneity, poor quality and early state of current research precludes any definite conclusions. Future research should investigate the efficacy of online and mobile interventions through controlled, well-powered studies, which investigate intervention and patient factors associated with take-up and intervention effects.

[Forensic neuropsychology at the challenge of the relationship between cognition and emotion in psychopathy]. / La neuropsicología forense ante el reto de la relación entre cognición y emoción en la psicopatía.

INTRODUCTION: The relationship between frontal lobe damage and criminality is especially complex. The neural substrates of psychopathic behavior seem to involve structural and functional abnormalities in the frontal lobes and the limbic system. AIM. To analyze the repercussions that brain structural and functional abnormalities in psychopathic individuals may have for forensic neuropsychology. DEVELOPMENT: Consistent evidence indicate that response inhibition problems in psychopathic subjects are linked to structural or functional damage in the frontal cortex. Furthermore, the prefrontal cortex, along with the amygdala and the hippocampus forms the limbic system, which is an important neural substrate of emotion processing; therefore the psychopath's capacity of affective processing could also be impaired. The theoretical frameworks of the somatic marker and mirror neuron hypotheses, along with the empirical study of executive functions may contribute to explain the inability of the psychopathic subjects to feel empathy, which is one of the main inhibitors of violence and antisocial behavior. CONCLUSIONS: The relationship between frontal lobe dysfunction and antisocial behavior arises an important legal issue. In order to consider some type of minor liability in the case of psychopaths it is suggested to gather further research data about the relationship between frontal lobe dysfunction and the ability to inhibit antisocial behavior by making an adequate use of empathy and emotional ties.

La neuropsicología forense ante el reto de la relación entre cognición y emoción en la psicopatía / Forensic neuropsychology at the challenge of the relationship between cognition and emotion in psychopathy

Introducción. La relación entre daño en el lóbulo frontal y criminalidad es particularmente compleja. El sustrato anatómico subyacente al comportamiento psicopático se refleja en diferencias estructurales y funcionales vinculadas al lóbulo frontal. Objetivo. Analizar las repercusiones de las alteraciones estructurales y funcionales del lóbulo frontal en los sujetos psicópatas para la neuropsicología forense. Desarrollo. Hay un cuerpo de investigación coherente que sugiere que los problemas de inhibición de los psicópatas se vinculan con daños estructurales o funcionales en la corteza frontal. Por otra parte, laamígdala, el hipocampo y la corteza prefrontal se integran en el sistema límbico, que gobierna la expresión de las emociones, por lo que los psicópatas también podrían ver afectada su capacidad de procesamiento afectivo. Las hipótesis de los marcadoressomáticos y de las neuronas espejo, junto con el estudio de la función ejecutiva, podrían revelar las deficiencias de los psicópatas para experimentar empatía, que es uno de los principales inhibidores de la violencia y la conducta antisocial. Conclusiones. La conexión entre disfunción del lóbulo frontal y comportamiento antisocial plantea una importante cuestiónforense. En el caso de los psicópatas, para que se pueda considerar algún tipo de menor responsabilidad legal se sugiere seguir acumulando datos de investigación de la relación entre disfunción del lóbulo frontal y capacidad de inhibir la conducta antisocial haciendo un correcto uso de la empatía y de los vínculos emocionales

Introduction. The relationship between frontal lobe damage and criminality is especially complex. The neural substrates of psychopathic behavior seem to involve structural and functional abnormalities in the frontal lobes and the limbic system. Aim. To analyze the repercussions that brain structural and functional abnormalities in psychopathic individuals may havefor forensic neuropsychology. Development. Consistent evidence indicate that response inhibition problems in psychopathic subjects are linked to structural or functional damage in the frontal cortex. Furthermore, the prefrontal cortex, along with theamygdala and the hippocampus forms the limbic system, which is an important neural substrate of emotion processing; therefore the psychopath’s capacity of affective processing could also be impaired. The theoretical frameworks of the somatic marker and mirror neuron hypotheses, along with the empirical study of executive functions may contribute to explain the inability of the psychopathic subjects to feel empathy, which is one of the main inhibitors of violence and antisocial behavior. Conclusions. The relationship between frontal lobe dysfunction and antisocial behavior arises an important legal issue. In order to consider some type of minor liability in the case of psychopaths it is suggested to gather further research data about the relationship between frontal lobe dysfunction and the ability to inhibit antisocial behavior by making an adequate use of empathy and emotional ties

[Guidelines for the scientific and professional development of forensic neuropsychology]. / Pautas para el desarrollo científico y profesional de la neuropsicología forense.

AIMS: The principal aims of this review are: (a) to offer a perspective of the principal challenges that forensic neuropsychology handles in its scientific and professional development, and the empirical advances that have been developed to deal with these challenges; and (b) analyze the potential effects of these advances on the application of the discipline in the Spanish legal system. DEVELOPMENT: With the purpose of reaching these challenges, a series of methodological strategies and instruments, along with specific recommendations about the use of currently available procedures and the development of new procedures, have been generated within the context of forensic neuropsychology. In this paper, we will review: the advances carried out in the different issues of interest that currently handles the development of the discipline, including: the estimation of premorbid functioning, the development of base rates and norms for forensic populations, the detection of malingerers, the ecological validity of instruments, and the creation of professional practices; we will analyze the potential application of these advances to the assessment of the Spanish forensic population; and we will study the principal application areas of forensic neuropsychology within the Spanish legal context. CONCLUSIONS: Forensic neuropsychology is an emergent discipline that is placed in a key moment of its scientific and professional development. This development should be anchored in the application of specific scientific, professional, and academic strategies.