Mindfulness-based narrative therapy for depression in cancer patients.

UNLABELLED: Mindfulness-based narrative therapy (MBNT) is a therapeutic intervention for the treatment of depression in cancer patients. In a previous randomized controlled trial, MBNT was found to ameliorate anxiety and depression, improve functional dimensions of quality of life, and enhance treatment adherence. In this review, we describe MBNT and its technical characteristics in the context of other psychotherapeutic interventions for depression in cancer patients. We highlight needed adjustments to other narrative approaches and recommend clinical modifications tailored to the needs of cancer patients that are intended to encompass the client's initial depressive narrative. The narrative construction is supported by emotional regulation and attachment relationships on the one hand and by individual and social linguistic capabilities on the other. Through destabilization of the depressive narrative, MBNT facilitates the emergence of new meanings using both verbal and non-verbal techniques based on mindfulness. The attitude and practice of mindfulness are integrated throughout the therapeutic process. In summary, MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. KEY PRACTITIONER MESSAGE: In this review, we describe mindfulness-based narrative therapy (MBNT) for the treatment of depression in cancer patients. In a previous controlled trial, we found significant benefits of MBNT in terms of reducing depressive symptoms and improving treatment adherence and quality of life in depressed, non-metastatic cancer patients. Narrative construction is socially and neurobiologically derived. MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. MBNT is proposed as an interesting and promising intervention, particularly for patients with somatic pathologies.

Social cognition and interaction training (SCIT) for outpatients with bipolar disorder.

INTRODUCTION: Patients with bipolar disorder show social cognition deficits during both symptomatic and euthymic phases of the illness, partially independent of other cognitive dysfunctions and current mood. Previous studies in schizophrenia have revealed that social cognition is a modifiable domain. Social cognition and interaction training (SCIT) is an 18-week, manual-based, group treatment designed to improve social functioning by way of social cognition. METHOD: 37 outpatients with DSM-IV-TR bipolar and schizoaffective disorders were randomly assigned to treatment as usual (TAU)+SCIT (n=21) or TAU (n=16). Independent, blind evaluators assessed subjects before and after the intervention on Face Emotion Identification Task (FEIT), Face Emotion Discrimination (FEDT), Emotion Recognition (ER40), Theory of Mind (Hinting Task) and Hostility Bias (AIHQ). RESULTS: Analysis of covariance revealed significant group effects for emotion perception, theory of mind, and depressive symptoms. The SCIT group showed a small within-group decrease on the AIHQ Blame subscale, a moderate decrease in AIHQ Hostility Bias, a small increase in scores on the Hinting Task, a moderate increase on the ER40, and large increases on the FEDT and FEIT. There was no evidence of effects on aggressive attributional biases or on global functioning. LIMITATION: No follow up assessment was conducted, so it is unknown whether the effects of SCIT persist over time. CONCLUSION: This trial provides preliminary evidence that SCIT is feasible and may improve social cognition for bipolar and schizoaffective outpatients.

Effectiveness of continuity-of-care programs to reduce time in hospital in persons with schizophrenia.

AIMS: To assess the impact of the Continuity-of-Care Program (CCP; a clinical case management model) on hospital use of persons with schizophrenia in three Community Mental Health Services in Madrid (Spain). METHODS: Using data provided by the Psychiatric Case Register, we analyzed the use of hospitalization in 250 individuals before and after the date of inclusion in this program. RESULTS: During the first year after launching the program, there was a 40-69% reduction in the number of admissions, length of each hospital stay, proportion of admitted patients, total number of days in-hospital, proportion of patients visiting the emergency room, and emergency room visits. This drop was maintained over the subsequent 3 years of program functioning. CONCLUSIONS: These results encourage the development and implementation of such programs, even though more studies evaluating the effectiveness of these programs for other endpoints are needed.

Long-term psychopathology changes among the injured and members of the community after a massive terrorist attack.

BACKGROUND AND AIM: To document long-term prevalence trends and changes in post-traumatic stress disorder (PTSD), current major depression (MD), agoraphobia, generalized anxiety disorder (GAD), and panic disorder, in two groups of people with different levels of exposure to a massive terrorist attack. METHODS: Cohort study. Two random samples of people exposed to a terrorist attack, the injured (n=127) and community residents (n=485) were followed and assessed, 2 and 18 months after the event. RESULTS: Among the injured, 2 and 18 months after the attack, the prevalences were respectively, PTSD: 44.1% and 34%, MD: 31.5% and 23.7%, agoraphobia: 23.8% and 20.7%, GAD: 13.4% and 12.4% and panic disorder: 9.4% and 11.3%. The corresponding figures among residents were PTSD: 12.3% and 3.5%, MD: 8.5% and 5.4%, agoraphobia: 10.5% and 8.7%, GAD: 8.6%, and 8.2% and panic disorder 2.1% and 2.7%. CONCLUSIONS: Two months after the event, the prevalence of mental disorders among both injured and residents was higher than expected levels at baseline conditions. Eighteen months after the event, psychopathological conditions did not change significantly among the injured but returned to the expected baseline rates among community residents.

Inventario Infanto-Juvenil de Temperamento y Carácter / Junior Temperament and Character Inventory

El Inventario Infanto-Juvenil de Temperamento y Carácter fue creado para evaluar las dimensiones del temperamento (búsqueda de novedades, evitación del daño, dependencia de la recompensa y persistencia) y las dimensiones del carácter (autodirección, cooperación, fantasía y espiritualidad) en niños y adolescentes, basado en el modelo de Cloninger de personalidad. El objetivo de este estudio es validar una versión española del Inventario Infanto-Juvenil de Temperamento y Carácter en una población infantil. La muestra fue de 827 niños de tres colegios de la Comunidad de Madrid. La consistencia interna, medida con el coeficiente α de Cronbach, fue aceptable para la mayoría de las dimensiones (por encima de 0,60). La prueba de fiabilidad test-retest se evaluó en una muestra independiente de 61 niños que realizaron el cuestionario en dos ocasiones, con cuatro semanas de diferencia. Las correlaciones entre las dimensiones fueron de moderadas a altas. La versión española del Inventario Infanto-Juvenil de Temperamento y Carácter podría ser útil en la práctica clínica y en los programas psicopedagógicos

The Junior Temperament and Character Inventory was developed to assess the temperament dimensions (novelty seeking, harm avoidance, reward dependence and persistence) and the character dimensions (selfdirectedness, cooperativeness, fantasy and spirituality) in children and adolescents based upon Cloninger's model of personality. The objective of the study is to validate a Spanish version of the Junior Temperament and Character Inventory in a child population. The sample was 827 children from three schools from the Region of Madrid. Internal consistency, measured using Cronbach α, was acceptable for the majority of the dimensions (above 0.60). The reliability test-retest was evaluated in an independent sample of 61 children who were given the Junior Temperament and Character Inventory on two occasions, four weeks apart. Correlations among dimensions were moderate to high. The Spanish version of the Junior Temperament and Character Inventory could be useful in clinical practice and in psycho-pedagogical programs

Discrimination and mental health in Ecuadorian immigrants in Spain.

BACKGROUND: The aim of this study was to examine the effects of ethnic discrimination on the mental health of Ecuadorian immigrants in Spain and to assess the roles of material and social resources. METHODS: Data were taken from the "Neighbourhood characteristics, immigration and mental health" survey conducted in 2006 in Spain. Psychological distress measured as "Possible Psychiatric Case" (PPC) was measured by the GHQ-28. A logistic regression was fitted to assess the association between PPC and discrimination. Interactions of discrimination with social and material resources were tested using product terms. RESULTS: Some 28% of the participants met our definition of PPC. About 20% of those who reported no discrimination were PPCs, rising to 30% of those who sometimes felt discriminated against and 41% of those who continually perceived discrimination. The OR for continuous discrimination was 12 (95% CI 3.5 to 40.3) among those with high financial strain, and 10 (2.4 to 41.7) when there was lack of economic support. Emotional support had an independent effect on PPC (OR 1.8, 95% CI 1.0 to 3.6, for those who reported having no friends). Social integration through a community group or association was positively related to the probability of being a PPC (OR 1.7, 95% CI 1.0 to 2.9). CONCLUSION: Ethnic discrimination is associated with psychological distress in these Ecuadorian immigrants in Spain. Discrimination effects may be exacerbated among those facing economic stress and those without economic support. These particularly vulnerable immigrants should be the subject of social and health interventions.

Temperamento, ansiedad y depresión en población infantil / No disponible

Introducción: el objetivo principal de este estudio es investigar la relación entre los rasgosde temperamento y carácter y síntomas de ansiedad y depresión en población general infantil. Material y métodos: se administró el Inventario infanto juvenil de temperamento y carácterde Cloninger, el inventario de depresión infantil de Kovacs y el cuestionario autoaplicadode ansiedad estado/rasgo de Spielberger a 827 niños entre 9 y 13 años de edad, 342 niñas y 481 niños. Resultados: todas las dimensiones del temperamento y carácter presentaron correlaciones estadísticamente significativas con las puntuaciones en los cuestionarios de ansiedad y depresión. Los valores más elevados fueron con evitación del daño y autodirección, que resultaronser positivo y negativo respectivamente.Conclusiones: el inventario infanto juvenil de temperamento y carácter de Cloninger puede resultar una herramienta interesante para la detección de niños en riesgo de padecer algún trastorno psicopatológico (AU)

Introduction: the main aim of this study is to investigate the relation between the traits of temperament and character and symptoms of anxiety and depression in the general child population. Material and methods: Junior Temperament and Character Inventory, Kovacs´s Children Depression Inventory and Spielberger´s State-Trait Anxiety Inventory for Children were administeredto 827 children of between 9 and 13 years, 342 girls and 481 boys. Results: all the dimensions of temperament and character presented statistically significant correlations with the scores in the questionnaires of anxiety and depression. We found the highest values in harm avoidance and self-directedness, which resulted positive and negative respectively. Conclusions: the Junior Temperament and Character Inventory of Cloninger could be aninteresting tool to detect children in risk of suffering some psychopathologycal disorder (AU)

Intervenciones sobre problemas relacionados con el duelo para profesionales de Atención Primaria (II): intervenciones desde Atención Primaria de salud / Interventions about problems related to grief for Primary Health Care physicians (II): interventions in Primary Health Care

Ésta es la segunda parte de un trabajo de dos en el que se revisan diferentes concepciones del duelo, y se propone un modelo por el que éste es considerado como un trabajo a realizar por la persona y su entorno. Se describen los problemas de salud mental asociados a las dificultades encontrados en este proceso y las tareas a llevar a cabo por la persona en duelo (AU)

Intervenciones sobre problemas relacionados con el duelo para profesionales de Atención Primaria (I): el proceso del duelo / Interventions about problems related to grief for Primary Health Care physicians (I): the grief process

Ésta es la primera parte de un trabajo de dos en el que se revisan diferentes concepciones del duelo, y se propone un modelo por el que éste es considerado como un trabajo a realizar por la persona y su entorno. Se describen los problemas de salud mental asociados a las dificultades encontradas en este proceso y las tareas a llevar a cabo por la persona en duelo (AU)

Psicoterapia en atención primaria: consejo interpersonal para la depresión / Psychotherapy in Primary Health Care: interpersonal counselling for depression

En este trabajo se describen las líneas generales de actuación del médico de Atención Primaria ante uno de los trastornos de mayor prevalencia en su práctica diaria como es la depresión. Se expone el marco general de esta intervención, descrita minuciosamente en el manual original de Klerman y colaboradores y que ha sido posteriormente adapta da al contexto de AP. Se describen los cuatro focos entorno a los que se articula la intervención: duelo, transiciones de rol, disputas interpersonales y déficits interpersonales, aportando ejemplos de cada uno de ellos procedentes de la práctica clínica (AU)

[Validation of the Spanish version of PRIME-MD: a procedure for diagnosing mental disorders in primary care]. / Validación de la versión española del PRIME-MD: un procedimiento para el diagnóstico de trastornos mentales en atención primaria.

INTRODUCTION: Psychiatric disorders occurs in at least 20% of patients attending Primary Care settings, however, only 50% of them are detected by primary care physicians. Therefore a tool is required which can help primary care physicians to detect and diagnose psychiatric disorders. PRIME-MD (Primary Care Evaluation of Mental Disorders) is a questionnaire designed with this aim. In this article the results of the validation study of the Spanish version of this questionnaire are presented. MATERIALS AND METHODS: 312 patients were interviewed by primary care physicians using PRIME-MD and by psychiatrists using SCAN (Schedules for Clinical Assessment in Neuropsychiatry). RESULTS: The time most frequently spent in questionnaire application by the physician was 10 minutes. PRIME-MD detected the presence of at least one psychiatric disorder in 44.3% of patients. PRIME-MD diagnoses agree well with SCAN diagnoses for mood disorders (coefficient of agreement: 0.50) and for anxiety disorders (coefficient of agreement: 0.35), but not for somatoform disorders or alcohol-related disorders. CONCLUSIONS: The Spanish version of PRIME-MD questionnaire in a useful tool to identify and diagnose mood and anxiety disorders in Primary Care settings.

[Prevalence of psychiatric disorders in primary care using the PRIME-MD questionnaire]. / Prevalencia de los trastornos psiquiátricos en atención primaria usando el cuestionario PRIME-MD.

OBJECTIVE: To quantify the frequency of psychiatric disorders detected by primary care doctors, using the PRIME-MD questionnaire, and by psychiatrists using a structured clinical interview. DESIGN: An observational, descriptive, crossover study, using a questionnaire. One of each two patients was selected until reaching the total number of patients. SETTING: The study was conducted in five primary care centres in Madrid. PATIENTS: To be included in the study, patients had to consent verbally, be able to understand the questions asked and have been previously diagnosed as psychotic or demented. 395 patients were recruited, of which 312 completed the study. INTERVENTIONS: The primary care doctor administered the PRIME-MD questionnaire to each patient, and then a psychiatrist conducted the SCAN interview. RESULTS: The time spent by the doctor on the PRIME-MD questionnaire was usually 10 minutes. The doctor had previously detected psychiatric pathology in 18.5% of his/her patients; with the PRIME-MD questionnaire he/she detected it in 53.5%. The psychiatrist with the SCAN detected psychiatric pathology in 41.3% of patients. CONCLUSIONS: The high frequency of psychiatric disorders in primary care patients and primary care doctors' lack of ability in detecting these disorders was confirmed by this study. The PRIME-MD questionnaire, an instrument for rapid detection of the most commonly found psychiatric disorders within primary care, may considerably improve this situation.