Hoarding behaviour: special features and complications in real-world clinical practice.

OBJECTIVE: Hoarding behaviour is a common but poorly characterised problem in real-world clinical practice. Although hoarding behaviour is the key component of Hoarding Disorder (HD), there are people who exhibit hoarding behaviour but do not suffer from HD. The aim of the present study was to characterise a clinical sample of patients with clinically relevant hoarding behaviour and evaluate the differential characteristics between patients with and without HD. METHODS: This study included patients who received treatment at the home visitation program in Barcelona (Spain) from January 2013 through December 2020, and scored ≥ 4 on the Clutter Image Rating scale. Sociodemographic, DSM-5 diagnosis, clinical data and differences between patients with and without an HD diagnosis were assessed. RESULTS: A total of 243 subjects were included. Hoarding behaviour had been unnoticed in its early stages and the median length in the sample was 10 years (IQR 15). 100% of the cases had hoarding-related complications. HD was the most common diagnosis in 117 patients (48.1%). CONCLUSIONS: The study found several differential characteristics between patients with and without HD diagnosis. Alcohol use disorder could play an important role among those without HD diagnosis. Home visitation programs could improve earlier detection, preventing hoarding-related complications.

Pain in Older Adults With Dementia: A Survey in Spain.

The risk of suffering pain increases significantly throughout life, reaching the highest levels in its latest years. Prevalence of pain in nursing homes is estimated to range from 40 to 80% of residents, most of them old adults affected with dementia. It is already known that pain is under-diagnosed and under-treated in patients with severe cognitive impairment and poor/absent verbal communication, resulting in a serious impact on their quality of life, psychosocial, and physical functioning. Under-treated pain is commonly the cause of behavioral symptoms, which can lead to misuse of antipsychotic treatments. Here, we present two Regional and National Surveys in Spain (2015-2017) on the current practices, use of observational tools for pain assessment, guidelines, and policies. Results, discussed as compared to the survey across central/north Europe, confirm the professional concerns on pain in severe dementia, due to poor standardization and lack of guidelines/recommendations. In Spain, observational tools are scarcely used because of their difficulty and low reliability in severe dementia, since the poor/absent verbal communication and comprehension are considered limiting factors. Behavioral observation tools should be used while attending the patients, in a situation including rest and movement, should be short (3-5 min) and scored using a numeric scale. Among the pain items to score, "Facial expression" and "Verbalization" were considered essential and very useful, respectively. This was in contrast to "Body movements" and "Vocalizations," respectively, according to the survey in central/north Europe. Scarce time availability for pain assessment and monitoring, together with low feasible and time-consuming tools, can make pain assessment a challenge. The presence of confounding factors, the low awareness and poor knowledge/education of specific tools for this population are worrisome. These complaints draw future directions to improve pain assessment. More time available, awareness, and involvement of the teams would also benefit pain assessment and management in cognitive impairment. The experiences and opinions recorded in these surveys in Spain and other E.U. countries were considered sources of knowledge for designing the "PAIC-15 scale," a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition and the "Observational pain assessment" in older persons with dementia.

Effectiveness of a 4-week sophrology program for primary care patients with moderate to high anxiety levels: a randomised controlled trial.

he aim of this study is to determine the effectiveness of an intensive four-week structured group re- laxation-training program (sophrology’s dynamic relaxation) on anxiety and depression symptoms in primary care patients with moderate and high anxiety levels.

Efectividad de un programa estructurado de sofrología durante 4 semanas en pacientes de Atención Primaria con un nivel medio o alto de ansiedad: estudio randomizado controlado / Effectiveness of a 4-week sophrology program for primary care patients with moderate to high anxiety levels: a randomised controlled trial

OBJETIVO: Valorar la efectividad del programa estructurado Bienestar y Sofrología para reducir los síntomas de ansiedad y depresión en pacientes con un nivel medio o alto de ansiedad que acuden a un centro de asistencia sanitaria CAP. MÉTODO: Estudio prospectivo controlado de 70 pacientes, con una puntuación HAD-A > 8 (Escala de Ansiedad y Depresión Hospitalaria), que fueron distribuidos de forma aleatoria en 2 grupos; el grupo de intervención (N = 35) con el programa Bienestar y Sofrología y el grupo control (N = 35) con el programa Hábitos Saludables a nivel Psicocorporal. El HADS y el Inventario de Ansiedad Estado-Rasgo (STAI) fueron apli-cados al inicio y al final de las 12 sesiones de una hora, asignadas en 3 sesiones a la semana durante 4 semanas seguidas. RESULTADOS: Finalizaron el estudio 66 participantes. El abandono fue 2,9 % para el grupo de intervención (N = 1) y 11,4 % para el grupo control (N = 4). El grupo de intervención mostró mejora estadísticamente significativa a nivel intragrupo (p < 0,001) e intergrupal (p = 0,001 a 0,046), en todos los parámetros del HADS y STAI, independientemente del género y edad. El tamaño del efecto, según la (d) de Cohen para la ansiedad y depresión, fue grande para el grupo de intervención (TE = 0,84 a 1,36) y entre pequeño y medio para el grupo control (TE = 0,28 a 0,49). CONCLUSIÓN: El programa estructurado e intensivo de 4 semanas de duración Bienestar y Sofrología ha mostrado eficacia para reducir los síntomas de ansiedad y depresión en pacientes de asistencia primaria con niveles medio o alto de ansiedad

BACKGROUND: The aim of this study is to determine the effectiveness of an intensive four-week structured group re-laxation-training program (sophrology's dynamic relaxation) on anxiety and depression symptoms in primary care patients with moderate and high anxiety levels. Method. In an experimental study, seventy patients, ac-cording to the Hospital Anxiety Depression Scale - Anxiety subscale (HADS-A), cut-off > 8, were randomized to the "well-being and sophrology" or a control program based on physical and mental health recommendations (PMHR). Hospital Anxiety and Depression Scale (HADS) and the State-trait Anxiety Inventory (STAI) ratings were obtained before and after 12 one-hour sessions for 4 consecutive weeks. RESULTS: Sixty-five patients completed the study. The dropout rate was 2.9 % (N=1) for the intervention group and 11.4% (N=4) for the control group. Sophrology showed statistically significant improvements in all HADS and STAI subscales for with-in group (p < 0.001) and be-tween groups analysis (p = 0.001 to 0.046), regardless of gender or age. The pre-post effect sizes (Cohen's d) for anxiety and depression symptoms were large for sophrology (ES=0.84 to 1.36) and small to moderate for the control (ES=0.28 to 0.49). CONCLUSION: An intensive four-week structured group relaxation-training program "well-being and sophrology" is highly effective in reducing anxiety and depression symptoms in primary care patients with moderate and high anxiety levels

Tesis doctorales en medicina forense en España / Doctoral theses on forensic medicine in Spain

INTRODUCCIÓN: El análisis de las tesis doctorales es un indicador de la actividad científica y de investigación. MATERIAL Y MÉTODO: Análisis descriptivo retrospectivo de las tesis en España sobre medicina forense entre 2000-2019 a partir de TESEO, usando el descriptor «medicina forense». RESULTADOS: Se obtuvieron 179 tesis (9,42 tesis/año). El 51,4% de doctorandos fueron mujeres, presentándose tesis en 33 universidades distintas. La Universidad de Murcia aglutina el 24% de las tesis de la muestra. En 41 tesis hubo un solo director/a, en 118 dos y en 20 tres. El 65,28% de directores/as fueron varones. El 38,55% de tesis pertenecían a patología forense, seguidas de toxicología y psiquiatría forense. DISCUSIÓN: La producción de tesis doctorales sobre medicina forense en España es estable, a excepción del año 2016, por aspectos normativos. Destaca una gran diversidad de temáticas acorde con el carácter multidisciplinar de la medicina legal y forense

INTRODUCTION: The analysis of doctoral theses can be a good indicator of scientific and research activity. METHODS: A descriptive and retrospective analysis of theses in Spain on Forensic Medicine, was conducted between 2000-2019, through the TESEO database, using the descriptor "forensic medicine". RESULTS: A total of 179 theses were identified (9.4 theses per year). Fifty one point four percent of the doctoral students were females, presenting theses in 33 different Spanish Universities (24% from Murcia University). In 41 theses there was only one director, two in 118 and three in 20. Sixty-five point twenty-eight percent of the thesis directors were male. Most frequently the theses related to Forensic Pathology (38.55%), Toxicology or Forensic Psychiatry. DISCUSSION: The production of theses in Forensic Medicine could be considered stable, except for in 2016 in relation to regulatory issues. The wide variety of topics for theses should be highlighted, according to multidisciplinary contents of Forensic and Legal Medicine

Family Features of Social Withdrawal Syndrome (Hikikomori).

Background: Family may play an important role in the origin, maintenance, and treatment of people with social withdrawal. The aim of this study is to analyze family factors related to social withdrawal syndrome. Methods: Socio-demographic, clinical, and family data, including family psychiatric history, dysfunctional family dynamics, and history of family abuse were analyzed in 190 cases of social withdrawal with a minimum duration of 6 months that started an at-home treatment program. Data were analyzed at baseline and at 12 months. Results: In 36 cases (18%) neither the patient nor the family allowed at home evaluation and treatment by the Crisis Resolution Home Treatment (CRHT) team. Patients had high rates of dysfunctional family dynamics (n = 115, 61.5%), and family psychiatric history (n = 113, 59.3%), especially maternal affective (n = 22, 42.9%), and anxiety disorders (n = 11 20.4%). There was a non-negligible percentage of family maltreatment in childhood (n = 35, 20.7%) and single-parent families (n = 66, 37.8%). Most of the cases lived with their families (n = 135, 86%), had higher family collaboration in the therapeutic plan (n = 97, 51.9%) and families were the ones to detect patient isolation and call for help (n = 140, 73.7%). Higher social withdrawal severity (as defined by at least one of: early age of onset, no family collaboration, lack of insight, higher CGSI score, and higher Zarit score), was associated with family psychiatric history, dysfunctional family dynamics, and family abuse history. All of these predictive variables were highly correlated one to each other. Conclusions: There is a high frequency of family psychiatric history, dysfunctional family dynamics, and traumatic events in childhood (family maltreatment), and these factors are closely interrelated, highlighting the potential role of family in the development and maintenance of social withdrawal.

First evidence for an association between joint hypermobility and excitability in a non-human species, the domestic dog.

There is a well-established relationship between joint hypermobility and anxiety in humans, that has not previously been investigated in other species. A population of 5575 assistance dogs were scored for both hip hypermobility and 13 behaviour characteristics using previously validated methods. Our results suggest a positive association between hip joint hypermobility and emotional arousal in domestic dogs, which parallel results found in people.

Alteración reversible del gusto y del olfato asociada con valproato sódico y quetiapina en la depresión bipolar: a propósito de un caso / Reversible taste and smell dysfunction associated with sodium valproate and quetiapine in bipolar depression: a case report

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Joint Hypermobility Classes in 9-Year-Old Children from the General Population and Anxiety Symptoms.

OBJECTIVE: To obtain joint hypermobility classes in children from the general population and to study their characteristics in relation to anxiety measures. METHODS: A total of 336 nine-year-old children from the general population were clinically assessed through 9 items of hypermobility, and their parents reported about the severity of anxiety symptoms. Latent class analysis was estimated to group the children according to the presence of hypermobility symptoms, and the obtained classes were related to anxiety. RESULTS: A 2-class solution, labeled as high hypermobility and low hypermobility, best fitted the data. Children in the high hypermobility group scored higher in separation anxiety, social phobia, physical injury fears, and total anxiety than did those in the low group. When applying the threshold reference scores to the total anxiety score, 7.4% of children in the high hypermobility group versus 6% in the low group were reported to experience clinical elevations on total anxiety. CONCLUSION: High symptoms of hypermobility are associated with higher scores in anxiety symptoms in children from the general population. Children with frequent symptoms of hypermobility may benefit from screening for anxiety symptoms because a subset of them are experiencing clinical elevations and may need comprehensive physical and psychological treatment.

Síntomas neuropsiquiátricos como factor de confusión en la detección de la demencia / No disponible

OBJETIVO: Valorar si los síntomas neuropsiquiátricos interfieren en la detección de deterioro cognitivo por los médicos de familia en atención primaria, así como describir cuáles generan más confusión. DISEÑO: Estudio observacional y descriptivo. Emplazamiento: Equipo de psiquiatría de intervención en domicilio en colaboración con la red de atención primaria de Barcelona. PARTICIPANTES: Un total de 104 pacientes mayores de 65 años derivados desde atención primaria por sus médicos de familia solicitando valoración psiquiátrica en el domicilio por sospecha de enfermedad mental. Mediciones principales: Todos los casos recibieron un diagnóstico según criterios DSM-IV-TR. Se incluyeron en el estudio el Mini Mental State Examination (MMSE), el Inventario Neuropsiquiátrico de Cummings, la escala de Gravedad de Enfermedad Psiquiátrica, la escala de Evaluación de la Actividad Global, la escala de Impresión Clínica Global y el Cuestionario de Evaluación de la Discapacidad de la Organización Mundial de la Salud. RESULTADOS: El 55,8% de los pacientes derivados desde atención primaria tenían el MMSE alterado. Los síntomas neuropsiquiátricos más frecuentemente asociados a la sospecha de deterioro cognitivo fueron los delirios, las alucinaciones, la agitación, la desinhibición, la irritabilidad y la conducta motora sin finalidad. CONCLUSIONES: Cuando se detecten síntomas psiquiátricos propios de trastorno mental severo (TMS) en individuos de edad avanzada sin antecedentes de TMS hay que sospechar un deterioro cognitivo y se debería administrar una prueba de cribado

OBJECTIVE: The aim of the study was to evaluate whether the neuropsychiatric symptoms interfere with cognitive impairment detection in primary care and to describe which of them generate more confusion. DESIGN: Descriptive and observational study. LOCATION: Mobile psychiatric unit in collaboration with primary healthcare centers in Barcelona. PARTICIPANTS: A total of 104 patients over 65 years referred to mobile psychiatric unit from primary healthcare clinicians suspecting mental disease. MAIN MEASUREMENTS: All patients received a DSM-IV-TR diagnosis. We included in the study the Mini Mental State Examination (MMSE), Neuropsichiatric Inventory, Severe Psychiatric Illness scale, Global Assessment of Functioning, Clinical Global Impression and Word Health Organisation Dissability Assessment Schedule. RESULTS: 55.8% of patients referred from primary care had altered MMSE score. Neuropsychiatric symptoms more frequently associated with suspected cognitive impairment were delusions, hallucinations, agitation, disinhibition, irritability and purposeless motor behavior. CONCLUSIONS: When psychiatric symptoms of Severe Mental Disorder (SMD) are detected in elderly individuals with no history of SMD, cognitive impairment should be suspected and a screening test be done

A 12-month study of the hikikomori syndrome of social withdrawal: Clinical characterization and different subtypes proposal.

Social withdrawal is a new mental health problem increasingly common, present in different cultures, whose psychopathology and treatment is not yet established. This study aims to determine the socio-demographic and clinical features and possible clinical subtypes that predict the 12-month outcomes of cases with hikikomori syndrome, a severe form of social withdrawal. Socio-demographic and clinical data at baseline were analysed as well as data obtained for 12 months after at-home treatment in 190 cases. The inclusion criteria were: spending all time at home, avoiding social situations and relationships, significant deterioration due to social isolation, with a minimum duration of 6 months. Six major diagnostic groups were identified: affective, anxiety, psychotic, drug use, personality and other Axis I disorders. The anxiety-affective subgroup demonstrated lower clinical severity, but worse evolution. Less than half of the cases were available for medical follow-up at 12-months. Subjects undergoing intensive treatment had a higher medical follow-up rate and better social networks at 12-months. Therefore, our findings provide data to reach consensus on the specific characteristics of social isolation hikikomori syndrome. The analysis demonstrated the fragility and tendency to relapse and have disengagement, particularly relevant in the anxiety-affective subgroup, suggesting that intensive treatments are more effective.

Psychometric Properties of the Spanish Version of the Panic Disorder Severity Scale.

The Panic Disorder Severity Scale (PDSS) is a well-established measure of panic symptoms but few data exist on this instrument in non north-American samples. Our main goal was to assess the psychometric properties (internal consistency, test re-test reliability, inter-rater reliability, convergent and divergent validity) and the factor structure of the Spanish version. Ninety-four patients with a main diagnosis of panic disorder were assessed with the Spanish version of PDSS, the Anxiety Sensitivity Index-3 (ASI-3), the Panic and Agoraphobia Scale (PAS), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II) the PDSS self-rating form and the Clinical Global Impression-Severity scale (CGI). The Spanish PDSS showed acceptable internal consistency (α = .74), excellent test-retest (total score and items 1-6: α > .58, p .90) and medium to large convergent validity (r = .68, 95% CI [.54, .79], p < .01; r = .80, 95% CI [.70, .87], p < .01; r = .48, 95% CI [.28, .67], p < .01; BAI, PAS and ASI-3 total scores respectively). Data on divergent validity (BDI-II total score: r = .52, 95% CI [.34, .67], p < .01) suggest some need for refinement of the PDSS. The confirmatory factor analysis suggested a two-factor modified model for the scale (nested χ2 = 14.01, df = 12, p < .001). The Spanish PDSS has similar psychometric properties as the previous versions and is a useful instrument to assess panic symptoms in clinical settings in Spanish-speaking populations.

Síntomas neuropsiquiátricos como factor de confusión en la detección de la demencia.

OBJECTIVE: The aim of the study was to evaluate whether the neuropsychiatric symptoms interfere with cognitive impairment detection in primary care and to describe which of them generate more confusion. DESIGN: Descriptive and observational study. LOCATION: Mobile psychiatric unit in collaboration with primary healthcare centers in Barcelona. PARTICIPANTS: A total of 104 patients over 65years referred to mobile psychiatric unit from primary healthcare clinicians suspecting mental disease. MAIN MEASUREMENTS: All patients received a DSM-IV-TR diagnosis. We included in the study the Mini Mental State Examination (MMSE), Neuropsichiatric Inventory, Severe Psychiatric Illness scale, Global Assessment of Functioning, Clinical Global Impression and Word Health Organisation Dissability Assessment Schedule. RESULTS: 55.8% of patients referred from primary care had altered MMSE score. Neuropsychiatric symptoms more frequently associated with suspected cognitive impairment were delusions, hallucinations, agitation, disinhibition, irritability and purposeless motor behavior. CONCLUSIONS: When psychiatric symptoms of Severe Mental Disorder (SMD) are detected in elderly individuals with no history of SMD, cognitive impairment should be suspected and a screening test be done.

Psychometric properties of the Spanish version of the Panic Disorder Severity Scale

The Panic Disorder Severity Scale (PDSS) is a well-established measure of panic symptoms but few data exist on this instrument in non north-American samples. Our main goal was to assess the psychometric properties (internal consistency, test re-test reliability, inter-rater reliability, convergent and divergent validity) and the factor structure of the Spanish version. Ninety-four patients with a main diagnosis of panic disorder were assessed with the Spanish version of PDSS, the Anxiety Sensitivity Index-3 (ASI-3), the Panic and Agoraphobia Scale (PAS), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II) the PDSS self-rating form and the Clinical Global Impression-Severity scale (CGI). The Spanish PDSS showed acceptable internal consistency (α = .74), excellent test-retest (total score and items 1-6: α > .58, p < .01) and inter-rater reliability (most intraclass correlation coefficient values for the total score were > .90) and medium to large convergent validity (r = .68, 95% CI [.54, .79], p < .01; r = .80, 95% CI [.70, .87], p < .01; r = .48, 95% CI [.28, .67], p < .01; BAI, PAS and ASI-3 total scores respectively). Data on divergent validity (BDI-II total score: r = .52, 95% CI [.34, .67], p < .01) suggest some need for refinement of the PDSS. The confirmatory factor analysis suggested a two-factor modified model for the scale (nested χ2 = 14.01, df = 12, p < .001). The Spanish PDSS has similar psychometric properties as the previous versions and is a useful instrument to assess panic symptoms in clinical settings in Spanish-speaking populations

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Gene-environment interaction as a predictor of early adjustment in first episode psychosis.

BACKGROUND: This study aims to explore the gene-environment interaction hypothesis applied to pre-symptomatic neurodevelopmental phenotypes of first episode psychosis (FEP), that is, genetic factors might increase vulnerability to the effects of environmental adverse conditions occurring at later stages of development. METHODS: We constructed a schematic 'two-hit' model, with Val/Val homozygosity for the catechol-O-methyltransferase (COMT) Val158Met polymorphism as the 'first hit' and history of obstetric complications and parental socioeconomic status as 'second hits'. Early adjustment, measured using the Premorbid Adjustment Scale, was considered the main outcome. The study population comprised 221 adolescents and adults with FEP and 191 sex- and age-matched controls. RESULTS: The interaction between the Val/Val COMT genotype and a positive history of obstetric complications plus low parental socioeconomic status was significantly associated with poorer early adjustment. These results were observed both in FEP individuals and in controls, and remained significant after controlling for age, sex, and diagnosis. CONCLUSIONS: Individuals carrying Val/Val seem to be more sensitive to the synergistic effect of environmental factors acting early in neurodevelopment, which leads to vulnerability phenotypes such as impaired early adjustment.

Effectiveness of Short-Term Dynamic Group Psychotherapy in Primary Care for Patients with Depressive Symptoms.

An open prospective controlled study was designed to compare the efficacy of short-term dynamic group psychotherapy with the standard treatment in patients with depressive symptoms attended in the primary care setting. A total of 115 patients with depressive symptoms were assigned to receive psychotherapy (75 min) over 9 months (37 to 39 sessions) (n = 70) or the standard care (n = 45). Outcome measures were the differences between baseline and post-treatment in the 17-item Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HAM-A) and the Short-Form Health Survey (SF-12) questionnaire in the two study groups. At the end of dynamic group psychotherapy, statistically significant improvements in the mean scores of all questionnaires were observed, whereas in control patients, significant improvements were only observed in the HDRS-17 scale and in the Mental Component Summary score of the SF-12. The mean changes after treatment were also higher in the psychotherapy group than in controls in all outcome measures, with statistically significant differences in the mean differences in favour of the psychotherapy group. In summary, implementation of short-term dynamic group psychotherapy run by experienced psychotherapists for patients with depressive symptoms attended in routine primary care centres is feasible and effective. © 2016 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd. KEY PRACTITIONER MESSAGE: Short-term dynamic group psychotherapy was delivered as a non-pharmacological intervention to improve depressive symptoms. Statistically significant differences as compared with a control group were observed in 17-item Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HAM-A) and the Short-Form Health Survey (SF-12) questionnaire. Implementation of short-term dynamic group psychotherapy run by experienced psychotherapists for patients with depressive symptoms attended in routine primary care centres is feasible and effective.

Highly Educated Men Establish Strong Emotional Links with Their Dogs: A Study with Monash Dog Owner Relationship Scale (MDORS) in Committed Spanish Dog Owners.

The characteristics of the human-animal bond may be influenced by both owner-related and dog-related factors. A study was designed to explore the existence of different dog ownership patterns and their related factors. We created an on line questionnaire that included demographic questions about the dog and the owner, a Spanish version of the Monash Dog Owner Relationship Scale (MDORS) and a validated measure of satisfaction with life (Cantril's ladder). We collected 1140 valid responses from adult dog owners, who were recruited using the client databases of Spanish veterinary practices. We explored the presence of groups within the population using Principal Components Analysis (PCA) of the MDORS variables combined with Hierarchical Cluster Analysis (HCA). Two groups were found; Group I having a higher level of emotional involvement with their dogs compared with Group II. Binary logistic regression was used to explore demographic factors that influenced group membership. Four variables were significantly associated with membership of Group I (p<0.0001); male gender of the owner (OR = 32.36), high school level of maximum educational attainment (OR = 0.052), university level of maximum educational attainment (OR = 8.652), and owner Cantril's score (OR = 0.807). The results obtained from this convenience sample demonstrate that different patterns of dog-ownership may be present within a population of owner-dog dyads, and that certain owner characteristics are associated with the type of owner-dog relationship. Future research could apply a similar approach to different types of sample population in order to identify specific patterns of dog-ownership.

Animal Assisted Therapy (AAT) Program As a Useful Adjunct to Conventional Psychosocial Rehabilitation for Patients with Schizophrenia: Results of a Small-scale Randomized Controlled Trial.

Currently, one of the main objectives of human-animal interaction research is to demonstrate the benefits of animal assisted therapy (AAT) for specific profiles of patients or participants. The aim of this study is to assess the effect of an AAT program as an adjunct to a conventional 6-month psychosocial rehabilitation program for people with schizophrenia. Our hypothesis is that the inclusion of AAT into psychosocial rehabilitation would contribute positively to the impact of the overall program on symptomology and quality of life, and that AAT would be a positive experience for patients. To test these hypotheses, we compared pre-program with post-program scores for the Positive and Negative Syndrome Scale (PANSS) and the EuroQoL-5 dimensions questionnaire (EuroQol-5D), pre-session with post-session salivary cortisol and alpha-amylase for the last four AAT sessions, and adherence rates between different elements of the program. We conducted a randomized, controlled study in a psychiatric care center in Spain. Twenty-two institutionalized patients with chronic schizophrenia completed the 6-month rehabilitation program, which included individual psychotherapy, group therapy, a functional program (intended to improve daily functioning), a community program (intended to facilitate community reintegration) and a family program. Each member of the control group (n = 8) participated in one activity from a range of therapeutic activities that were part of the functional program. In place of this functional program activity, the AAT-treatment group (n = 14) participated in twice-weekly 1-h sessions of AAT. All participants received the same weekly total number of hours of rehabilitation. At the end of the program, both groups (control and AAT-treatment) showed significant improvements in positive and overall symptomatology, as measured with PANSS, but only the AAT-treatment group showed a significant improvement in negative symptomatology. Adherence to the AAT-treatment was significantly higher than overall adherence to the control group's functional rehabilitation activities. Cortisol level was significantly reduced after participating in an AAT session, which could indicate that interaction with the therapy dogs reduced stress. In conclusion, the results of this small-scale RCT suggest that AAT could be considered a useful adjunct to conventional psychosocial rehabilitation for people with schizophrenia.

A Pharmacovigilance Study in First Episode of Psychosis: Psychopharmacological Interventions and Safety Profiles in the PEPs Project.

BACKGROUND: The characterization of the first episode of psychosis and how it should be treated are principal issues in actual research. Realistic, naturalistic studies are necessary to represent the entire population of first episode of psychosis attended in daily practice. METHODS: Sixteen participating centers from the PEPs project recruited 335 first episode of psychosis patients, aged 7 to 35 years. This article describes and discusses the psychopharmacological interventions and safety profiles at baseline and during a 60-day pharmacovigilance period. RESULTS: The majority of first episode of psychosis patients received a second-generation antipsychotic (96.3%), orally (95%), and in adjusted doses according to the product specifications (87.2%). A total of 24% were receiving an antipsychotic polytherapy pattern at baseline, frequently associated with lower or higher doses of antipsychotics than the recommended ones. Eight patients were taking clozapine, all in monotherapy. Males received higher doses of antipsychotic (P=.043). A total of 5.2% of the patients were being treated with long-acting injectable antipsychotics; 12.2% of the patients received anticholinergic drugs, 12.2% antidepressants, and 13.7% mood stabilizers, while almost 40% received benzodiazepines; and 35.52% reported at least one adverse drug reaction during the pharmacovigilance period, more frequently associated with higher antipsychotic doses and antipsychotic polytherapy (85.2% vs 45.5%, P<.001). CONCLUSIONS: These data indicate that the overall pharmacologic prescription for treating a first episode of psychosis in Spain follows the clinical practice guideline recommendations, and, together with security issues, support future research of determinate pharmacological strategies for the treatment of early phases of psychosis, such as the role of clozapine, long-acting injectable antipsychotics, antipsychotic combination, and the use of benzodiazepines.