Análisis de redes de síntomas del trastorno de agorafobia en personas mayores de 65 años / Analysis of symptom networks of agoraphobia disorder in people over 65 years of age

El objetivo es realizar un análisis de redes de síntomas del trastorno de agorafobia (con o sin pánico) según la edad y el sexo, en una muestra representativa de 555 personas mayores de 65 años de la Comunidad de Madrid. La red se estimó utilizando el paquete InsingFit que implementa un procedimiento llamado eLasso. Los resultados revelan redes diferenciadas para hombres y mujeres, y para los grupos de edad de 65-74 y 75-84 años, encontrando un mayor porcentaje de ocurrencia en las mujeres tanto en las situaciones como en los síntomas de ansiedad y en las razones para sentir miedo. Las mujeres temen un mayor número de situaciones, mientras que los hombres parecen tener sus miedos más localizados y centralizados en situaciones relacionadas con el transporte y los viajes cuando los hacen solos. Estos resultados pueden ser interesantes para diseñar intervenciones que aborden los síntomas y sus relaciones mutuas más importantes, diferentes y características en función de la edad y el sexo. (AU)

The aim of this study is to conduct a network analysis of agoraphobia disorder symptoms (with or without panic) according to age and gender, in a representative sample of 555 people over 65 years of age in the Community of Madrid. The network was estimated using the InsingFit package that implements a procedure called eLasso. The results reveal differentiated networks for men and women, and for the age groups 65-74 and 75-84 years, finding a higher percentage of occurrence in women in both situations and symptoms of anxiety and reasons for fear. Women fear a greater number of situations, while men seem to have their fears more localized and centralized in situations related to transport and travel when travelling alone. These results may be of interest for designing interventions that address the symptoms and the most important, different and characteristic relationships among them according to age and gender. (AU)

Mental health in a heterogeneous clinical sample. A cross-sectional study of predictors and gender differences.

Introduction: Women have been shown to be a vulnerable group in relation to mental health problems over time. Despite this, gender-focused studies are uncommon. The aim of this research is to study mental health in a sample of people with mental health problems and to analyze the differences and predictors focusing on gender. Methods: A cross-sectional study is conducted in a heterogeneous clinical sample in terms of mental health problems (N = 160). Interviews with hetero-reported standardized questionnaires to collect the data are conducted. Descriptive analyses, mean difference and a regression analysis on mental health are carried out taking into account different sociodemographic, clinical and psychosocial variables. Results: Women in the study present worse levels of mental health and subjective severity of the disorder. The main predictors of mental health are being female, followed by severity, shorter time with the diagnosis and internalized stigma. Conclusion: Being female is the most robust predictor of worse mental health and symptomatology. Recommendations according to the results found proposing a gender perspective are suggested.

Longitudinal study of age-related differences in the psychological impact of confinement as a consequence of COVID-19 in a Spanish sample / Estudio longitudinal de las diferencias relacionadas con la edad en el impacto psicológico del confinamiento como consecuencia de la Covid-19 en una muestra española

This research aims to analyze age-related differences in the psychological impact of the Covid-19 confinement situation in a Spanish sample. A longitudinal study (N= 1,041) was conducted through an online survey with two measurements: at two and five weeks after the declaration of the alarm state in Spain. Post- traumatic stress disorder (PTSD), anxiety and depressive symptoms, spiritual well- being and perceived loneliness were evaluated by screening tests. Means and their confidence intervals (95%) were calculated for all variables in the study, for the three age groups: 18-30, 31-59, 60-80. Linear mixed models with random slopes (Time nested to Subjects) were calculated for each variable. The results indicate that the psychological impact caused by the pandemic persists over time, and even increases in some of the variables studied. The older age group (60-80 years) shows the least impact and the greatest well-being. They presented less depressive, anxious and PTSD symptoms and less loneliness. These results may be explained by the greater resilience of this group to recover from adverse situations, in addition to having a greater number of coping strategies.

Se analizan las diferencias relacionadas con la edad en el impacto psicológico del confinamiento a consecuencia de la Covid-19 en una muestra española. Se realizó un estudio longitudinal (N= 1.041) mediante una encuesta online con dos mediciones: a las dos y cinco semanas de la declaración del estado de alarma en España. Se evaluaron mediante cuestionarios de detección los síntomas de trastorno de estrés postraumático (TEPT), ansiedad y depresión, bienestar espiritual y soledad percibida. Se calcularon las medias y sus intervalos de confianza (95%) para todas las variables del estudio, para los tres grupos de edad: 18-30, 31-59, 60-80. Para cada variable se calcularon modelos lineales mixtos con pendientes aleatorias (tiempo anidado a los sujetos). El impacto psicológico persiste a lo largo del tiempo, aumentando en algunas de las variables. El grupo de mayor edad muestra menor impacto y mayor bienestar. Presentan menos síntomas de depresión, ansiedad y TEPT y menos soledad. Estos resultados pueden explicarse por la mayor resiliencia de este grupo para recuperarse de situaciones adversas, y el mayor número de estrategias de afrontamiento.

The Psychological Impact of the COVID-19 Pandemic in Spain: A Longitudinal Study / Impacto Psicológico de la Pandemia de la COVID-19 en España: un Estudio Longitudinal

Background: This study aims to longitudinally assess the psychologicalimpact of the COVID-19 pandemic in the general Spanish population.It uses four assessment points: two weeks after the start of confinement,one month after, two months after, and one year after the first evaluation.Methods: Evaluations were conducted through an online survey, with asample of 3,480 people at the first data collection and 1,041, 569, and 550people at successive evaluation points. Depressive symptoms (PHQ-2),anxiety (GAD-2), post-traumatic stress (PCL-C-2), social support (EMAS),loneliness (UCLA-3), and discrimination (InDI-d) were evaluated.Results: Significant changes were found in the variables depression and anxiety witha greater presence of this kind of symptomatology after one year (p < .01).There were also significant changes in the variable social support, whichshowed a substantial reduction after one year (p < .001). Similarly, therewere significant variations in the variable intersectional discrimination (p <.001), with greater levels of discrimination. The temporal models show nosignificant differences in terms of post-traumatic symptomatology (p = .12)or loneliness (p = .19). Conclusions: The pandemic had a negative impacton mental health and these effects were further exacerbated one year later.

Antecedentes: el objetivo es evaluar el impactopsicológico de la pandemia generada por la COVID-19 en la poblacióngeneral española longitudinalmente en cuatro momentos: tras dos semanasdel inicio del confinamiento, al mes, a los dos meses y al año. Método: lasevaluaciones se realizaron mediante una encuesta online, se siguió a unamuestra de 3.480 personas en la primera recogida de datos y de 1.041, 569y 550 personas en los sucesivos momentos de evaluación. Se evaluó lapresencia de síntomas depresivos (PHQ-2), de ansiedad (GAD-2), de estréspostraumático (PCL-C-2), el apoyo social (EMAS), la soledad (UCLA-3)y la discriminación (InDI-D). Resultados: se han producido cambios significativos en las variables de depresión y ansiedad con una presenciamayor de dicha sintomatología al año (p < .01), así como en la variable deapoyo social, que muestra una reducción significativa un año después (p <.001), y en la discriminación interseccional, con una mayor discriminación (p < .001). Los modelos temporales no muestran diferencias significativasen cuanto a sintomatología postraumática (p = .12) ni soledad (p = .19).Conclusiones: la pandemia ha tenido un impacto negativo en la saludmental y estos efectos son todavía peores un año después.

Proposed diagnostic criteria for mild cognitive impairment in Down syndrome population.

BACKGROUND: Despite presenting higher risk of dementia, mild cognitive impairment (MCI) is not well defined in Down syndrome population. OBJECTIVE: We aimed to describe cognitive and neuropsychological patterns associated with MCI in Down syndrome individuals. METHOD: Two groups of adults with Down syndrome (control and prodromal) were studied throughout 3 years. Two linear mixed models and a model including the variables that best predicted group membership were built. RESULTS: Behavioural Regulation Index (BRI) (Behaviour Rating Inventory of Executive Function test) and the model composed of BRI, abstraction and delayed verbal memory were the variable and model best predicting group membership, respectively. CONCLUSION: Suggest a diagnosis of MCI when BRI is the earliest change perceived by caregivers and this is combined with low scores in abstract thinking, and when an amnesic pattern in delayed verbal memory is observed, but adaptive skills are preserved.

Evolution of intersectional perceived discrimination and internalized stigma during COVID-19 lockdown among the general population in Spain.

BACKGROUND: Stigma and discrimination have been associated with different diseases and pandemics, with negative consequences for the people who suffered them and for their communities. Currently, COVID-19 has become a new source of stigmatization. AIMS: The aim of the present study is to analyze longitudinally the evolution of intersectional perceived discrimination and internalized stigma among the general population of Spain, at three points in time throughout the confinement. METHOD: Participants completed an online survey. RESULTS: Results show an increase in both variables from the first to the second evaluation, and a slight decrease from the second to the third evaluation. Moreover, these changes are explained by depression, anxiety and family support. CONCLUSIONS: These findings indicate the factors that need to be considered to reduce the perception of discrimination and the internalization of stigma, and their detrimental consequences, during an especially stressful event such as the current pandemic outbreak.

The Role of the Sense of Belonging During the Alarm Situation and Return to the New Normality of the 2020 Coronavirus Pandemic (COVID-19) in Spain.

In this study we intend to understand the impact of the COVID-19 crisis and the subsequent stay-at-home orders, on the Spanish population's sense of belonging at three moments in time: at the beginning of the lockdown, after one month of lockdown and with the return to the "new normality". A cross-sectional study was conducted through an online survey (N0 = 3480; N1 = 1041; N2 = 569). The sense of belonging was evaluated by means of four Likert-type items. These questions included membership in different groups: work/studies, friends, family and neighborhood or community. Sociodemographic and COVID-19-related data were collected. Additionally, mental health, spiritual well-being, loneliness, social support and discrimination were assessed. Descriptive analyses were carried out and linear regression models compiled. The sense of belonging increased significantly during confinement, dropping dramatically with the start of the return to the "new normality" process. The only variable that showed interaction with time and sense of belonging was discrimination. Work condition (not working providing the lowest sense of belonging scores), social support from friends and loneliness were the main predictors of the sense of belonging. The impact caused by the pandemic and the actions adopted during the first weeks regarding the sense of belonging is evident. It has been a key variable in dealing with COVID-19. Actions are now needed to increase our sense of belonging to face the post-epidemic crisis and avoid a greater impact in other areas.

Executive Functions Influence on Memory Process in Patients with Paranoid Schizophrenia and Bipolar Disorders with and without Psychotic Symptoms. A Pilot Study.

The objective of the present study was to evaluate whether declarative memory deficits are related to executive function deficits (EF), since they could be a consequence of a poor organization of the material to memorize. This interaction between both cognitive processes can be studied simultaneously in a single task such as the Test of Memory Strategies (TSM). 23 patients with paranoid schizophrenic disorder, 11 with bipolar disorder with psychotic symptoms, 13 with bipolar disorder without psychotic symptoms and 15 healthy subjects were evaluated with the TSM; with the memory test Texts A and B (subtest of the Barcelona neuropsychological assessment battery), which assesses short-term and immediate recall without the influence of EF; and with the Trail Making Test (TMT): Part A (sustained attention) and Part B (executive control). The patients groups and the control group showed an improvement in memory performance across each of the TSM conditions. However, this facilitating effect of the strategies differed among the groups (the patients with higher EF deficits showed less improvement). Regarding these results, we conclude that this cognitive process cannot be independent of EF. However, due to the pilot nature of this study, it would be recommended to replicate these findings in new studies.

A Network Analysis of Major Depressive Disorder Symptoms and Age- and Gender-Related Differences in People over 65 in a Madrid Community Sample (Spain).

Major depressive disorder (MDD) is one of the most prevalent conditions among mental disorders in individuals over 65 years. People over 65 who suffer from MDD are often functionally impaired, chronically physically ill, and express cognitive problems. The concordance between a clinician-assessed MDD diagnosis in a primary care setting and MDD assessed with a structured clinical interview in older adults is only approximately 18%. Network analysis may provide an alternative statistical technique to better understand MDD in this population by a dimensional approach to symptomatology. The aim of this study was to carry out a network analysis of major depressive disorder (MDD) in people over 65 years old. A symptom network analysis was conducted according to age and gender in 555 people over 65, using a sample from the MentDis_ICF65+ Study. The results revealed different networks for men and women, and for the age groups 65-74 and 75-84. While depressive mood stood out in women, in men the network was more dispersed with fatigue or loss of energy and sleep disturbances as the main symptoms. In the 65-74 age group, the network was complex; however, in the 75-84 age group, the network was simpler with sleep disturbances as the central symptom. The gaps between the networks indicate the different characteristics of MDD in the elderly, with variations by gender and age, supporting the idea that MDD is a complex dynamic system that has unique characteristics in each person, rather than a prototypical classification with an underlying mental disorder. These unique characteristics can be taken into account in the clinical practice for detection and intervention of MDD.

Mental Health Consequences of the Coronavirus 2020 Pandemic (COVID-19) in Spain. A Longitudinal Study.

Background: Covid-19 remains a pandemic that most countries in the world are still dealing with. This is study aims to report the psychological impact of Covid-19 over time on the Spanish population. Methods: A longitudinal study (N = 1041) was carried out with two measurements: after 2 and 5 weeks starting from the declaration of the state of emergency in Spain. The presence of depressive symptoms, anxiety, and posttraumatic stress disease (PTSD) was evaluated by means of screening tests. Sociodemographic data, variables about Covid-19, loneliness, spiritual well-being, social support, discrimination, and a sense of belonging were collected. Results: The data showed how depressive symptomatology increased significantly over time, while anxiety and PTSD did not show statistically significant changes. Spiritual well-being and loneliness were the main predictors of psychological impact. A younger age was a significant predictor of depression and anxiety, while female gender was associated with anxiety and PTSD. Conclusions: The impact of the pandemic is sustained over time, even increasing in depression, and vulnerable groups that need greater psychological health support could be identified.

Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain.

The pandemic caused by Covid-19 has been an unprecedented social and health emergency worldwide. This is the first study in the scientific literature reporting the psychological impact of the Covid-19 outbreak in a sample of the Spanish population. A cross-sectional study was conducted through an online survey of 3480 people. The presence of depression, anxiety and post-traumatic stress disorder (PTSD) was evaluated with screening tests from 14 March. Sociodemographic and Covid-19-related data was collected. Additionally, spiritual well-being, loneliness, social support, discrimination and sense of belonging were assessed. Descriptive analyses were carried out and linear regression models compiled. The 18.7% of the sample revealed depressive, 21.6% anxiety and 15.8% PTSD symptoms. Being in the older age group, having economic stability and the belief that adequate information had been provided about the pandemic were negatively related to depression, anxiety and PTSD. However, female gender, previous diagnoses of mental health problems or neurological disorders, having symptoms associated with the virus, or those with a close relative infected were associated with greater symptomatology in all three variables. Predictive models revealed that the greatest protector for symptomatology was spiritual well-being, while loneliness was the strongest predictor of depression, anxiety and PTSD. The impact on our mental health caused by the pandemic and the measures adopted during the first weeks to deal with it are evident. In addition, it is possible to identify the need of greater psychological support in general and in certain particularly vulnerable groups.

Prevalence and Characterization of Specific Phobia Disorder in People over 65 Years Old in a Madrid Community Sample (Spain) and its Relationship to Quality of Life.

The prevalence of anxiety disorders over the last year among seniors ranged from 3.6% to 17.2%. The most prevalent disorders are specific phobias. Data are needed concerning the consequences of specific phobia disorder on the level of functioning and quality of life of older people, the age of onset of specific phobia disorder, and the duration of episodes. In total, 555 community-dwelling people aged between 65 and 84 years who lived in Madrid (Spain) were assessed (Composite International Diagnostic Interview for people over 65 years (CIDI65+), WHO Disability Assessment Schedule (WHODAS II), Health of the Nation Outcome Scales for Older Adults (HoNOS65+), World Health Organization Quality of Life Brief (WHOQOL-BREF). Prevalence rates and odds ratio, t-tests, binary logistic regression, and point-biserial correlations were calculated. A total of 12.07% of the sample suffered a specific phobia disorder over the last year. The average age at onset of the specific phobia was 38.78 (sd = 21.61) years. The mean duration of the phobia was approximately 20 (sd = 20) years. A significant effect of the specific phobia was found for the current levels of functioning and quality of life: WHOQOL-BREF total score (p < 0.05), WHODAS II overall score (p < 0.01), and HoNOS65+ total score (p < 0.001). Having specific phobia disorder decreased the level of functioning and negatively affected the quality of life. These data suggest the need for primary healthcare professionals to include the detection of specific phobia disorders in their protocols because people do not receive treatment for this problem, and they might carry it throughout their lives.

Confirmatory factor analysis of the Revised UCLA Loneliness Scale (UCLA LS-R) in individuals over 65.

GOALS: The UCLA LS-R is the most extensively used scale to assess loneliness. However, few studies examine the scale's use on older individuals. The goal of the study is to analyse the suitability of the scale´s structure for assessing older individuals. METHOD: The UCLA LS-R scale was administered to a random sample of 409 community-dwelling residents of Madrid (53% women) aged 65-84 years (obtained from the MentDis_ICF65+ study). Confirmatory factor analysis was used to assess the factor structure of the UCLA LS-R. RESULTS: The internal consistency of the scale obtained a Cronbach's alpha of .85. All the analysed models of factor structure of the UCLA LS-R achieved a fairly good fit and RMSEA values over .80. The models that best fit the empirical data are those of Hojat (1982) and Borges et al. (2008). CONCLUSION: The data suggest an equivalent effectiveness of UCLA LS-R in adults under 65 and over 65, which may indicate a similar structure of the loneliness construct in both populations. This outcome is consistent with the idea that loneliness has two dimensions: emotional loneliness and social loneliness. The use of short measures that are easy to apply and interpret should help primary care professionals identify loneliness problems in older individuals sooner and more accurately.

Case Report: Propranolol increases the therapeutic response to temozolomide in a patient with metastatic paraganglioma.

This case report presents the clinical evolution and management of a patient with a hereditary paraganglioma syndrome. This disease is characterized by rare tumors of neural crest origin that are symmetrically distributed along the paravertebral axis from the base of the skull and neck to the pelvis. In addition, these patients may develop renal cancer, gastrointestinal stromal tumors, pituitary adenomas, and bone metastasis in some cases. To date no successful therapeutic treatment has been reported. Total resection with postoperative radiotherapy and chemotherapy have been advocated, especially for the multiple metastasis. Here we show how the combination of high doses of the beta blocker propranolol (3 mg/Kg/day) and the DNA intercalating agent, temozolomide, has been successful in the treatment of a SDHA metastatic paraganglioma.

Knitting Mochilas: A Sociocultural, Developmental Practice in Arhuaco Indigenous Communities.

The purpose of this article is to analyze the psycho-cultural processes involved in knitting "mochilas" (traditional bags), a common craft in the Arhuaco indigenous community located in the Sierra Nevada de Santa Marta, Colombia. The article is structured in three parts, as follows: first, issues related to child development are discussed; then, the analysis method used to study the processes involved in the practice of knitting is presented and, finally, we reflect on the importance of recovering the sense and meaning of this everyday practice as a way to study child development.

Characterizing visual asymmetries in contrast perception using shaded stimuli.

Previous research has shown a visual asymmetry in shaded stimuli where the perceived contrast depended on the polarity of their dark and light areas (Chacón, 2004). In particular, circles filled out with a top-dark luminance ramp were perceived with higher contrast than top-light ones although both types of stimuli had the same physical contrast. Here, using shaded stimuli, we conducted four experiments in order to find out if the perceived contrast depends on: (a) the contrast level, (b) the type of shading (continuous vs. discrete) and its degree of perceived three-dimensionality, (c) the orientation of the shading, and (d) the sign of the perceived contrast alterations. In all experiments the observers' tasks were to equate the perceived contrast of two sets of elements (usually shaded with opposite luminance polarity), in order to determine the subjective equality point. Results showed that (a) there is a strong difference in perceived contrast between circles filled out with luminance ramp top-dark and top-light that is similar for different contrast levels; (b) we also found asymmetries in contrast perception with different shaded stimuli, and this asymmetry was not related with the perceived three-dimensionality but with the type of shading, being greater for continuous-shading stimuli;

Impulsive Driving: Definition and Measurement Using the I-Driving Scale (IDS).

Impulsivity has been widely studied in the context of traffic. The trait is believed to be the root of some accidents, along with other variables like aggression and anger. The present research objective is to develop a new scale - the I-Driving Scale (IDS) - to evaluate and measure the construct of impulsivity in specific driving situations. To that end, two studies were conducted, with 162 and 107 participants, respectively. In both studies, participants were recruited via their social networks, and answered anonymously. In addition to the IDS, they completed the Use the Vehicle to Express Anger subscale of the Driving Anger Expression Inventory (DAX), the Driving Anger Scale (DAS), and the Barratt Impulsivity Scale (BIS11), and also provided demographic information. The final scale had 11 items falling into two factors: impatience, and aggressiveness/abruptness. The results show a high consistency (αT = .81, αI = .70, and αA = .85 in the first study; αT = .83, αI = .80, and αA = .88 in the second study). Statistical results of Exploratory Factor Analysis in the first sample indicated goodness of fit to a two-factor model (RMSR = .057, GFI = .98). The second study confirmed that factorial structure (χ2/df = 80.50/43 = 1.87, RMSEA = .088, CFI = .94, TLI = .92). Correlations with other measures indicated the Impatience subscale is associated with different expressions of anger behind the wheel, and directly correlated with the loss of driver's license points. Furthermore, the Aggressiveness or Abruptness subscale was associated with more mechanical aspects, and correlated inversely with age.

The Relationship Between Educational Years and Phonemic Verbal Fluency (PVF) and Semantic Verbal Fluency (SVF) Tasks in Spanish Patients Diagnosed With Schizophrenia, Bipolar Disorder, and Psychotic Bipolar Disorder.

Semantic and verbal fluency tasks are widely used as a measure of frontal capacities. It has been well described in literature that patients affected by schizophrenic and bipolar disorders present a worse execution in these tasks. Some authors have also noted the importance of educational years. Our objective is to analyze whether the effect of cognitive malfunction caused by apathology is superior to the expected effect of years of education in phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) task execution. A total of 62 individuals took part in this study, out of which 23 were patients with schizophrenic paranoid disorder, 11 suffered from bipolar disorder with psychotic symptomatology, 13 suffered from bipolar disorder without psychotic symptomatology, and 15 participants were nonpathological individuals. All participants were evaluated with the PVF and SVF tests (animals and tools). The performance/execution results were analyzed with a mixed-model ANCOVA, with educational years as a covariable. The effect of education seems to be more determined by PVF FAS tests than by SVF. With PVF FAS tasks, the expected effect of pathology disappears when the covariable EDUCATION is introduced. With SVF tasks, the effect continues to be significant, even though the EDUACTION covariable dims such effect. These results suggest that SVF tests (animals category) are better evaluation tools as they are less dependent on the patients' education than PVF FAS tests.

Impulsive driving: definition and measurement using the I-driving scale (IDS)

Impulsivity has been widely studied in the context of traffic. The trait is believed to be the root of some accidents, along with other variables like aggression and anger. The present research objective is to develop a new scale -the I-Driving Scale (IDS)- to evaluate and measure the construct of impulsivity in specific driving situations. To that end, two studies were conducted, with 162 and 107 participants, respectively. In both studies, participants were recruited via their social networks, and answered anonymously. In addition to the IDS, they completed the Use the Vehicle to Express Anger subscale of the Driving Anger Expression Inventory (DAX), the Driving Anger Scale (DAS), and the Barratt Impulsivity Scale (BIS11), and also provided demographic information. The final scale had 11 items falling into two factors: impatience, and aggressiveness/abruptness. The results show a high consistency (αT = .81, αI = .70, and αA = .85 in the first study; αT = .83, αI = .80, and αA = .88 in the second study). Statistical results of Exploratory Factor Analysis in the first sample indicated goodness of fit to a two-factor model (RMSR = .057, GFI = .98). The second study confirmed that factorial structure (χ2/df = 80.50/43 = 1.87, RMSEA = .088, CFI = .94, TLI = .92). Correlations with other measures indicated the Impatience subscale is associated with different expressions of anger behind the wheel, and directly correlated with the loss of driver's license points. Furthermore, the Aggressiveness or Abruptness subscale was associated with more mechanical aspects, and correlated inversely with age (AU)

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