Do the negative symptoms of schizophrenia reflect reduced responsiveness to reward? Examination using a reward prediction error (RPE) task.

BACKGROUND: A leading theory of the negative symptoms of schizophrenia is that they reflect reduced responsiveness to rewarding stimuli. This proposal has been linked to abnormal (reduced) dopamine function in the disorder, because phasic release of dopamine is known to code for reward prediction error (RPE). Nevertheless, few functional imaging studies have examined if patients with negative symptoms show reduced RPE-associated activations. METHODS: Matched groups of DSM-5 schizophrenia patients with high negative symptom scores (HNS, N = 27) or absent negative symptoms (ANS, N = 27) and healthy controls (HC, N = 30) underwent fMRI scanning while they performed a probabilistic monetary reward task designed to generate a measure of RPE. RESULTS: In the HC, whole-brain analysis revealed that RPE was positively associated with activation in the ventral striatum, the putamen, and areas of the lateral prefrontal cortex and orbitofrontal cortex, among other regions. Group comparison revealed no activation differences between the healthy controls and the ANS patients. However, compared to the ANS patients, the HNS patients showed regions of significantly reduced activation in the left ventrolateral and dorsolateral prefrontal cortex, and in the right lingual and fusiform gyrus. HNS and ANS patients showed no activation differences in ventral striatal or midbrain regions-of-interest (ROIs), but the HNS patients showed reduced activation in a left orbitofrontal cortex ROI. CONCLUSIONS: The findings do not suggest that a generalized reduction of RPE signalling underlies negative symptoms. Instead, they point to a more circumscribed dysfunction in the lateral frontal and possibly the orbitofrontal cortex.

Experiencia de grupo terapéutico durante el confinamiento por COVID-19 en una unidad de agudos de psiquiatría / Therapeutic group experience during confinement by COVID-19 in an acute psychiatry unit

El presente trabajo consiste en la descripciónde las sesiones grupales que se efectuarondurante el confinamiento por COVID-19en la Unidad de Agudos 1 de Psiquiatría generaldel Hospital Sagrat Cor de Martorell,en Barcelona.Se planteó un grupo abierto con aquellospacientes ingresados que voluntariamenteaccedieran a participar, como una propuestaa la alta respuesta emocional del momento.Se efectuó una sesión grupal semanal de unahora de duración a lo largo de seis semanas.El equipo terapéutico quedó constituidotanto por profesionales de la unidad comode los provenientes de recursos ambulatoriostomando un carácter interdisciplinar. Participaronun total de 41 pacientes con unaheterogeneidad diagnóstica; trastornos dela personalidad (26,83%), trastorno bipolar(19.51%), esquizofrenia y otros trastornospsicóticos (19,51%) y trastornos depresivos(14,61%). El porcentaje restante (19,54%)corresponde a otros diagnósticos. El 46,34%del total de los pacientes ha presentadoconsumo de sustancias en comorbilidad. Seaprecian como temas principales: La aceptacióndel ingreso, la compresión de lasnormativas por COVID-19, el manejo de laangustia por el ingreso bajo las condicionesde confinamiento y el desarrollo de capacidadesde diálogo, responsabilidad y cuidadode los participantes. Se describieron en las terapeutas intervenciones más directivas alinicio de las sesiones a intervenciones deacompañamiento y facilitación a medida quese desarrollaba el grupo.ConclusionesLa actividad grupal permitió un espacio decontención emocional, seguridad, información,reflexión, educación e integración paralos participantes. (AU)

The present work consists of the descriptionof the group sessions that were carriedout during the confinement becauseof COVID-19 in the Acute Unit 1 of GeneralPsychiatry of the Hospital Sagrat Cor de Martorell,in Barcelona.An open group was proposed with thoseadmitted patients who voluntarily agreed toparticipate, as a proposal to the high emotionalresponse of the moment. A weeklyone-hour group session was held over sixweeks. The therapeutic team was constitutedby both professionals from the unit andthose from outpatient resources, adoptingan interdisciplinary character. The outstandingthemes extracted from the summariesof each session were described. A total of 41patients with diagnostic heterogeneity participated;personality disorders (26.83%), bipolar disorder (19.51%), schizophreniaand other psychotic disorders (19.51%) anddepressive disorders (14.61%). The remainingpercentage (19.54%) corresponds toother diagnoses. 46.34% of the total of patientshave presented substance use in comorbidity.The main themes are the management ofanxiety due to admission under confinementconditions; compression of regulations becauseof COVID-19; and the development ofa dialogue capacity, responsibility and careof the participants. More directive interventionswere described in the therapists at thebeginning of the sessions towards accompanimentinterventions as the group develops.ConclusionsThe group activity allowed a space foremotional containment, security, information,reflection, education and integrationfor the participants. (AU)

Tratamiento cognitivo-conductual grupal para el trastorno de angustia en un centro de atención primaria: estudio piloto / No disponible

El objetivo del presente estudio fue evaluar la reducción de la sintomatología ansiosa en 40 personas diagnosticadas de trastorno de angustia con y sin agorafobia, que se sometieron a un tratamiento cognitivo-conductual grupal en un centro de atención primaria. Tras 10 sesiones de tratamiento semanal, los participantes redujeron la sintomatología ansiosa, depresiva, ansioso-fóbica, obsesiva-compulsiva y somatforme. Por otro lado, presentaron mejoría en otros ítems evaluados que se describen en este artículo. De este modo, podemos concluir que el tratamiento grupal cognitivo-conductual es eficaz en personas diagnosticadas de trastorno de angustia con y sin agorafobia

The aim of this study was to evaluate the reduction of anxiety symptoms in 40 people diagnosed with panic disorder with and without agoraphobia, who underwent a cognitive-behavioral group treatment in a primary care center. After 10 weekly treatment sessions, participants reduced the anxious, depressed, anxious- phobic, obsessive - compulsive and somatoform symptoms. On the other hand, they showed improvement in other evaluated items described in this article. Thus, we can conclude that cognitive -behavioral group treatment is effective for people diagnosed with panic disorder with and without agoraphobia

Anger in pathological gambling: clinical, psychopathological, and personality correlates

The aim of this study was to explore the association between pathological gambling (PG) and anger by assessing whether psychopathology and personality are related to PG and to evaluate gender differences. The sample comprised 71 PGs and 37 healthy controls. Anger, psychopathology and personality were assessed with the STAXI-2, SCL-90-R and TCI-R respectively. Gender did not affect anger expression after stratifying by diagnostic condition (p > .05). Among PG patients, anger, psychopathology and personality measures were correlated with good effect-size (r > .30). Scores in the Anger Temperament (B = 0.21, p = .038) and Anger External-Expression (B = 0.27, p = .029) scales were positively associated with PG severity scores. Anger expression in PG should be considered in future treatment programs (AU)

No disponible

Anger in pathological gambling: clinical, psychopathological, and personality correlates.

The aim of this study was to explore the association between pathological gambling (PG) and anger by assessing whether psychopathology and personality are related to PG and to evaluate gender differences. The sample comprised 71 PGs and 37 healthy controls. Anger, psychopathology and personality were assessed with the STAXI-2, SCL-90-R and TCI-R respectively. Gender did not affect anger expression after stratifying by diagnostic condition (p > .05). Among PG patients, anger, psychopathology and personality measures were correlated with good effect-size (r > .30). Scores in the Anger Temperament (B = 0.21, p = .038) and Anger External-Expression (B = 0.27, p = .029) scales were positively associated with PG severity scores. Anger expression in PG should be considered in future treatment programs.

Spanish adaptation of the Dimensional Yale-Brown Obsessive-Compulsive Scale.

BACKGROUND: The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a promising new instrument that allows patient and clinician ratings of dimension-specific symptom severity, as well as estimates of global symptom severity in patients with obsessive-compulsive disorder (OCD). The goal of this study was to further explore the psychometric properties of the DY-BOCS in a Spanish sample. METHODS: The internal consistency, reliability, and convergent and divergent validity of the Spanish adaptation of the DY-BOCS were assessed in a sample of 51 Spanish adult patients with OCD. RESULTS: All the subscales of the Spanish DY-BOCS showed high internal consistency. The interrater reliability was excellent for all component scores, and the level of agreement between self-report and expert ratings was high for most symptom dimensions. The subscales of the DY-BOCS were largely independent from one another and from global OCD severity. The convergent and divergent validities of the DY-BOCS subscales were adequate. CONCLUSIONS: The Spanish version of the DY-BOCS is a reliable and valid clinical tool for the assessment of obsessive-compulsive symptom dimensions.

A case-control study of sex differences in strategic processing and episodic memory in obsessive-compulsive disorder.

Although clinical and genetic data for obsessive-compulsive disorder (OCD) support the hypothesis of sexual dimorphism, the neuropsychological findings remain inconclusive. The aim of our study was to determine whether there are differences in cognitive performance between men and women with OCD as compared with healthy controls (HCs). A neuropsychological battery was administered to 50 patients with OCD (31 men and 19 women) and 50 HCs matched by sex, age, and educational level with patients. We evaluated intelligence, attention, episodic memory, and use of organizational strategies during encoding of verbal and nonverbal information. Male patients scored worse than controls did in measures of nonverbal memory tasks, whereas the cognitive performance of women with OCD was consistent with that of their HC counterparts. These results suggest a distinct pattern of cognitive dysfunction specific to the patients' sex.

Age of onset in pathological gambling: clinical, therapeutic and personality correlates.

We aimed to explore the association between age of onset of gambling problems and current psychopathological and clinical status, personality profile and therapeutic outcome in a sample of pathological gamblers. A total of 904 consecutive pathological gambling patients were administered several instruments about gambling behavior, psychopathology and personality. They received a 4-month cognitive-behavioral group treatment. Information of dropouts and relapses during treatment was registered. Older age of onset of gambling problems was associated with higher general psychopathology (SCL-90-R Paranoid Ideation, Psychoticism, Depression; P < 0.015). Younger age of onset was related to greater severity of pathological gambling (P < 0.015), higher novelty seeking, and lower self-directedness (P < 0.015). No statistically significant association was found between age of onset and relapse and dropouts during treatment. Age of onset of gambling problems seems to influence the clinical presentation of pathological gambling but not treatment outcome.

Individual versus group cognitive behavioral treatment for obsessive-compulsive disorder: follow up.

AIM: To compare the effectiveness of two forms of cognitive behavioral treatment (CBT; group and individual) in a sample of patients with obsessive-compulsive disorder (OCD) at 6-month and 12-month follow up. METHOD: Thirty-eight subjects meeting DSM-IV-TR OCD criteria completed 20 sessions of individual and group CBT. They were assessed using the Yale-Brown Obsessive-Compulsive Scale and the Hamilton Anxiety and Depression Scales at baseline, after treatment and at 6-month and 12-month follow up. RESULTS: The clinical improvement obtained at the end of the treatment was maintained at 6-month and 12-month follow up. The clinical outcome of the individual treatment (IT) and the group treatment (GT) was the same. The dropout rates were significantly higher in women than in men, but were similar for IT and GT. CONCLUSIONS: CBT was effective in a sample of OCD patients. Individual and group CBT had similar results at 6-month and 12-month follow up. The clinical implications of these findings are discussed.

Individual versus group cognitive-behavioral treatment for obsessive-compulsive disorder: a controlled pilot study.

This study sought to examine the effectiveness of group and individual cognitive-behavioral treatment (CBT) and to compare the results with those of a wait-list control group among a sample of patients with obsessive-compulsive disorder (OCD). Fifty-seven individuals diagnosed with OCD were evaluated pre- and posttreatment with the Yale-Brown Obsessive Compulsive Scale and the Hamilton Rating Scales for Anxiety and Depression. Both group and individual CBT obtained statistically significant reductions in anxiety and depressive symptoms. Patients in individual treatment achieved a statistically significant reduction in OCD symptoms compared with those in group treatment, but their dropout rate was twice as high. Patients with symmetry and order rituals presented less improvement in anxiety symptoms than those with other rituals. Associated general symptoms were lower in patients receiving either mode of CBT compared with wait-list participants. The authors found that individual treatment is more effective in reducing obsessive-compulsive symptoms than group treatment.

Clinical implications of insight assessment in obsessive-compulsive disorder.

Poor insight has been reported in 15% to 36% of patients with obsessive-compulsive disorder (OCD), but little is known about its clinical correlations. This study examines insight among patients with OCD using a standardized instrument, the Brown Assessment of Beliefs Scale, and analyzes its relationship with clinical factors. Insight was assessed in 132 patients with OCD, before and after pharmacologic treatment, using the Brown Assessment of Beliefs Scale. Differences between patients with good and poor insight on sociodemographic variables, OCD severity, comorbidity, and treatment response were studied. Stability of insight after pharmacologic treatment was also examined. Thirty-nine patients (29.5%) exhibited poor insight. They showed more depressive symptoms (P = .001) and personality disorders (P = .001), especially the schizotypal form, than did good insight subjects, but there were no significant differences in treatment response. Insight significantly improves after treatment (P < .001). Our results suggest that insight in OCD varies widely and constitutes a dynamic phenomenon that can improve after treatment and is influenced by clinical conditions such as affective status or personality.

Verbal and nonverbal memory processing in patients with obsessive-compulsive disorder: its relationship to clinical variables.

Memory deficits have been reported in several neuropsychological studies of obsessive-compulsive disorder (OCD). Dysfunction in nonverbal memory has been consistently reported, whereas findings on verbal memory are more heterogeneous. The authors studied 50 patients with OCD who were matched for sex, age, educational level, and hand dominance with 50 healthy controls (HC). Cognitive performance in both groups was assessed on verbal and nonverbal memory tasks, and several clinical variables were also assessed in the patient group. Patients with OCD showed a pattern of cognitive dysfunction with alterations in areas of nonverbal memory (recall and recognition), and verbal memory (learning and recall). Older age at onset of OCD was associated with poorer performance on verbal memory tasks. Low scores on some verbal memory tasks were associated with severity of OCD, and nonverbal memory was influenced by depressive symptoms. The study suggests the existence of dysfunction in the execution of verbal and nonverbal memory tasks in OCD; the influence of clinical variables depends on the specific neuropsychological function.

Personality dimensions in obsessive-compulsive disorder: relation to clinical variables.

Research on the relationship between personality factors and obsessive-compulsive disorder (OCD) has proved difficult to interpret due to conceptual problems including a lack of consensus on the model of personality employed as a framework as well as a failure to consider the clinical heterogeneity of the disorder. The aim of this study was to examine the dimensional personality profile associated with OCD and to determine whether any relationship exists between personality factors and clinical variables in a sample of 60 OCD outpatients who were administered Cloninger's Temperament and Character Inventory (TCI). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale (HDRS) and the Y-BOCS symptom checklist were used to assess the severity of obsessive-compulsive and depressive symptoms and the presence of the main OCD symptom dimensions. OCD patients showed significantly higher scores in harm avoidance and lower scores in novelty-seeking, self-directedness and cooperativeness than healthy subjects. These results remained unchanged when only pure OCD patients without comorbid psychiatric conditions were considered. Comorbid depressive symptoms and hoarding obsessions and compulsions were significantly associated with high harm avoidance scores. These results support the existence of a dimensional personality profile associated with OCD and characterized by high harm avoidance and low novelty-seeking, self-directedness and cooperativeness scores, but also emphasize the importance of considering the influence of comorbid clinical conditions or symptom subtypes in addressing the role of personality factors in OCD.

Gender differences in obsessive-compulsive symptom dimensions.

The aim of our study was to assess the role of gender in OCD symptom dimensions with a multivariate analysis while controlling for history of tic disorders and age at onset of OCD. One hundred and eighty-six consecutive outpatients with a DSM-IV diagnosis of OCD were interviewed. Yale-Brown Obsessive-Compulsive Scale (YBOC-S), YBOC-S Symptom Checklist, and Hamilton Depression and Anxiety Scales were administered to all patients. Lifetime history of tic disorders was assessed with the tic inventory section of the Yale Global Tic Severity Scale. Age at onset of OCD was assessed by direct interview. Statistical analysis was carried out through logistic regression to calculate adjusted female:male odds ratios (OR) for each dimension. A relationship was found between gender and two main OCD dimensions: contamination/cleaning (higher in females; female:male OR=2.02, P=0.03) and sexual/religious (lower in females; female:male OR=0.41, P=0.03). We did not find gender differences in the aggressive/checking, symmetry/ordering, or hoarding dimensions. We also found a greater history of tic disorders in those patients with symptoms from the symmetry/ordering, dimension (P<0.01). Both symmetry/ordering and sexual/religious dimensions were associated with an earlier age at onset of OCD (P<0.05). Gender is a variable that plays a role in the expression of OCD, particularly the contamination/cleaning and sexual/religious dimensions. Our results underscore the need to examine the relationship between OCD dimensions and clinical variables such as gender, tics, age at onset and severity of the disorder to improve the identification of OCD subtypes.

Obsessive-compulsive and eating disorders: comparison of clinical and personality features.

The aim of the present study was to determine whether anorexia nervosa (AN), bulimia nervosa (BN) and obsessive-compulsive disorder (OCD) share clinical and psychopathological traits. The sample consisted of 90 female patients (30 OCD; 30 AN; 30 BN), who had been consecutively referred to the Department of Psychiatry, University Hospital of Bellvitge, Barcelona. All subjects met DSM-IV criteria for those pathologies. The assessment consisted of the Maudsley Obsessive-Compulsive Inventory (MOCI), Questionnaire of obsessive traits and personality by Vallejo, Eating Attitudes Test-40 (EAT-40), Eating Disorder Inventory (EDI), and Beck Depression Inventory (BDI). ANCOVA tests (adjusted for age and body mass index) and multiple linear regression models based on obsessive-compulsiveness, obsessive personality traits and perfectionism, as independent variables, were applied to determine the best predictors of eating disorder severity. On ancova several significant differences were found between obsessive-compulsive and eating-disordered patients (MOCI, P < 0.001; EAT, P < 0.001; EDI, P < 0.001), whereas some obsessive personality traits were not eating disorder specific. A total of 16.7% OCD patients presented a comorbid eating disorder, whereas 3.3% eating disorders patients had an OCD diagnosis. In the eating disorder group, the presence of OC symptomatology was positively associated (r = 0.57, P < 0.001) with the severity of the eating disorder. The results were maintained after adjusting for comorbidity. Although some obsessive-compulsive and eating disorder patients share common traits (e.g. some personality traits especially between OCD and AN), both disorders seem to be clinically and psychopathologically different.

Análisis de la eficacia de dos modalidades de tratamiento cognitivo-conductual grupal para el juego patológico / Analysis of the effectiveness of two types of group cognitive-behavioral treatment of pathological gambling

El presente estudio se ha dirigido a analizar la eficacia y la eficiencia de dos programas de tratamiento grupa cognitivo-conductual, así como a determinar los factores predictores de respuesta al tratamiento, en una muestra de jugadores patológicos. Para ello, se incluyeron 194 sujetos que acudieron al Hospital Universitario de Bellvitge (HUB) solicitando tratamiento por su problema. Los resultados evidenciaron que el tratamiento cognitivo-conductual grupal mostraba ser eficaz en la mayoría de pacientes, siendo la tasa de abandonos para la muestra total del 33,0% y la de recaídas del 24,5%. Se observaron, asimismo, cambios significativos entre el pre y el post-test en las medidas de psicopatología y gravedad de la conducta de juego. Se evidenció que el riesgo de abandono y recaída decrecía significativamente tras la quinta sesión de terapia. Finalmente, se identificaron como factores de pobre respuesta al tratamiento la gravedad del problema de juego, la elevada impulsividad y búsqueda de sensaciones, así como la gravedad de la psicopatología asociada. Sin embargo, la persistencia como rasgo de temperamento pareció actuar como factor protector de recaída

The present study aimed to analyze the efficacy and efficiency of two cognitive-behavioral group treatment programs, as well as to determine which factors predict response to treatment, in a sample of pathological gamblers. We included 194 subjects seeking treatment for pathological gambling at Bellvitge University Hospital. The results indicated that our cognitive-behavioral group treatment was efficacious in most patients. The dropout rate for the total sample was 33,0% and the relapse rate was 24,5%. In addition, we observed statistically significant pretreatment- post- treatment changes in some measures of psychopathological state and severity of gambling behavior. The risk of dropouts and relapses decreased significantly after the fifth session of therapy. Finally, severity of gambling behavior, high impulsivity, high novelty seeking, and severity of the psychopathological state were identified as factors predicting poor response to treatment. However, persistence seemed to act as a temperamental protective factor for relapse

Ansiedad y fobia social en anorexia nerviosa: un estudio de casos y controles / Social anxiety and phobia in anorexia nervosa: a case-control study

Con frecuencia, se ha observado ansiedad social y aislamiento en los pacientes con anorexia nerviosa (AN); sin embargo, su relación con este trastorno ha sido raras veces investigada de forma específica. El objetivo del presente estudio es determinar la relevancia de la ansiedad y fobia social en pacientes con AN al ser comparados con un grupo de control. En este estudio participaron 40 pacientes con AN, diagnosticados según criterios DSM-IV, y 32 estudiantes control. Todos ellos fueron evaluados en ansiedad y fobia social (Social Avoidance and Distress Scale), depresión (Beck Depresión Inventory), y sintomatología alimentaria (Eating Attitudes Test; Eating Disorder Inventory). Los resultados indicaron que las pacientes con anorexia presentaban significativamente más ansiedad y fobia social que los sujetos del grupo de control (53 por ciento vs. 9 por ciento). Asimismo, se obtuvo que los pacientes que presentaban tal condición mostraban mayores valores en ineficacia personal (p< 0,001), desconfianza interpersonal (p< 0,001), conciencia interoceptiva (p< 0,001), impulso a la delgadez (p< 0,001) y mayor sintomatolgía depresiva (p< 0,001). Los niveles en ansiedad social y la presencia de sintomatología depresiva mostraron estar positivamente asociados (r= 0,62, p< 0,001). Estos resultados sugieren que los pacientes con anorexia nerviosa, y en especial el subgrupo de pacientes con altos niveles en ansiedad y fobia social, presentarían no sólo una mayor gravedad de su sintomatología alimentaria, sino también una más baja autoestima y mayor sintomatología depresiva (AU)