Complex post-traumatic stress disorder (CPTSD) of ICD-11 in youths with childhood maltreatment: Associations with age of exposure and clinical outcomes.

BACKGROUND: Exposure to childhood maltreatment (CM) increases the risk of psychiatric morbidity in youths. The new Complex Post-Traumatic Stress Disorder (CPTSD) diagnosis captures the heterogeneity and complexity of clinical outcomes observed in youths exposed to CM. This study explores CPTSD symptomatology and its association with clinical outcomes, considering the impact of CM subtypes and age of exposure. METHODS: Exposure to CM and clinical outcomes were evaluated in 187 youths aged 7-17 (116 with psychiatric disorder; 71 healthy controls) following the Tools for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV) structured interview criteria. CPTSD symptomatology was explored by confirmatory factor analysis, considering four subdomains: post-traumatic stress symptoms, emotion dysregulation, negative self-concept and interpersonal problems. RESULTS: Youths exposed to CM (with or without psychiatric disorders) showed greater internalizing, externalizing and other symptomatology, worse premorbid adjustment and poorer overall functioning. Youth with psychiatric disorder and exposed to CM reported more CPTSD symptomatology, psychiatric comorbidity and polypharmacy and earlier onset of cannabis use. Different subtypes of CM and the developmental stage of exposure differentially impact CPTSD subdomains. LIMITATIONS: Small percentage of resilient youths was studied. It was not possible to explore specific interactions between diagnostic categories and CM. Direct inference cannot be assumed. CONCLUSIONS: Gathering information on type and age of exposure to CM is clinically useful to understand the complexity of psychiatric symptoms observed in youths. Inclusion of the CPTSD diagnosis should increase the implementation of early specific interventions, improving youths' functioning and reducing the severity of clinical outcomes.

Risk of Suicidal Behavior in Children and Adolescents Exposed to Maltreatment: The Mediating Role of Borderline Personality Traits and Recent Stressful Life Events.

Childhood maltreatment (CM) is associated with increased non-suicidal self-injury (NSSI) and suicidal behavior (SB), independently of demographic and mental health conditions. Self-Trauma Theory and Linehan's Biopsychosocial Model might explain the emergence of Borderline Personality Disorder (BPD) symptoms as mediators of the association between CM and the risk of SB. However, little is known regarding such relationships when the exposure is recent for young persons. Here, we study 187 youths aged 7-17, with or without mental disorders. We explore CM experiences (considering the severity and frequency of different forms of neglect and abuse), recent stressful life events (SLEs), some BPD traits (emotion dysregulation, intense anger and impulsivity), and the risk of SB (including NSSI, suicide threat, suicide ideation, suicide plan and suicide attempt). We study the direct and mediating relationships between these variables via a structural equation analysis using the statistical software package EQS. Our findings suggest that youths exposed to more severe/frequent CM have more prominent BPD traits, and are more likely to have experienced recent SLEs. In turn, BPD traits increase the risk of SLEs. However, only emotion dysregulation and recent SLEs were found to be correlated with SB. Therefore, targeted interventions on emotion dysregulation are necessary to prevent NSSI or SB in children and adolescents exposed to CM, as is the minimization of further SLEs.

Intervención psicoterapéutica grupal en una Unidad de Hospitalización Breve de Adolescentes desde las terapias contextuales / Group contextual psychotherapy in an Adolescent Inpatient Psychiatric Unit

Las Unidades de Hospitalización Breve de Niños y Adolescentes son dispositivos para el tratamiento de menores en situación de descompensación psicopatológica aguda cuyo objetivo principal es la contención y estabilización del paciente. Las intervenciones psicoterapéuticas en este tipo de recursos, así como las características de la propia población infanto-juvenil, poseen una serie de particularidades a tener en cuenta de cara a maximizar el potencial psicoterapéutico del ingreso. En el presente trabajo se describe la experiencia de una intervención psicoterapéutica grupal en la Unidad de Hospitalización Breve de Adolescentes del Hospital Universitario Puerta de Hierro-Majadahonda (Madrid). A lo largo del manuscrito se exponen las características del modelo de intervención, basado en la Terapia de Aceptación y Compromiso y la Psicoterapia Analítica Funcional, así como su integración con otras actividades de la Unidad. Además, se ilustran las principales dinámicas, dificultades y desafíos que implica la intervención en este contexto psicoterapéutico específico. (AU)

Child and Adolescent Inpatient Psychiatric Units are resources for the treatment of acute psychopathological decompensation. Their main objectives are the global care and the stabilization of the patient. Psychotherapeutic interventions in this specific context, as well as the characteristics of the child and adolescent population, have certain particularities that should be addressed in order to maximize the psychotherapeutic effects of the intervention during hospital admission. This paper describes the experience of a group psychotherapeutic intervention in the Adolescent Inpatient Psychiatric Unit of Puerta de Hierro-Majadahonda University Hospital (Madrid). The characteristics of the intervention model, based both on Acceptance and Commitment Therapy and Functional Analytic Psychotherapy, are described throughout this manuscript. Additionally, its integration with other activities of the Unit is detailed. Potential difficulties during the intervention, as well as main dynamics and challenges when working with adolescents in this specific context, are also presented. (AU)

Modelo conductual-contextual de las relaciones íntimas: aplicabilidad en psicoterapia / Behavioral-contextual model of intimate relationships: applicability in psychotherapy

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Intimate relationships matter for both human's physical and psychological health. Although many theories have been developed to study this topic, there is no consensus about the underlying processes in human relationships. The Interpersonal Process Model, which has well-established empirical support, aims to address the development of intimate relationships describing them as observed behaviors. This has important implications in psychotherapy, especially for those approaches that understand the interpersonal patient-therapist relationship as a tool for change. That is the case of Functional Analytic Psychotherapy. In this paper we articulate a model of intimate relationships based on Interpersonal Process Model and the principles of Functional Behavioral Analysis, connecting it with previous results on the field of intimate relationships. Likewise, a discussion about its implications in psychotherapy and its utility to solve some Functional Analytic Psychotherapy's limitations is presented

Academic outcomes and cognitive performance in problematic Internet users. / Rendimiento académico y cognitivo en el uso problemático de Internet.

Only few studies have examined the relationship between problematic Internet use (PIU) and cognitive and academic performance in adolescents. The aim of this study was to analyze the differences in academic and cognitive performance (perception, attention, memory, verbal fluency and abstract reasoning) between adolescents with and without PIU. A total of 575 students from different high schools of the region of Alicante participated. Students were divided into two groups: adolescents with and without PIU (PIU and NPIU, respectively). Several questionnaires were administered to assess problematic Internet use, as well as students' academic performance. Substance use (alcohol / cannabis) was also assessed as exclusion criteria. A battery of neuropsychological tests was used to assess cognitive abilities. On the one hand, PIU users group obtained poorer academic results than NPIU, in terms of lower marks and more failed subjects. On the other hand, PIU group had a better hit ratio in the perception test than NPIU group. However, PIU adolescents got higher error rates for the abstract reasoning test. This greater number of errors, plus a similar number of hits compared to the NPIU group, could indicated a higher response rate for the PIU group, which may might be associated with greater impulsivity. As occurs in other addictive and non-substance-related problems studies, these results could mean difficulties in impulse control and regulation of response inhibition circuits in PIU users group. Future research is needed to analyze in depth the results presented in this paper.

Son escasos los estudios que hayan analizado la relación entre el uso problemático de Internet (UPI) y el rendimiento cognitivo y académico en adolescentes. El objetivo de este estudio fue analizar las diferencias en rendimiento académico y cognitivo (percepción, atención, memoria, fluidez verbal y razonamiento abstracto) en una muestra de estudiantes de Secundaria con y sin UPI. Participaron un total de 575 estudiantes de diferentes institutos de la provincia de Alicante, que fueron divididos en dos grupos: adolescentes con y sin uso problemático de Internet (UPI y NUPI, respectivamente). Se administraron varios cuestionarios para evaluar el uso problemático de Internet de los sujetos, su rendimiento académico, su consumo de sustancias (alcohol/cannabis) como criterios de exclusión, así como una batería de pruebas neuropsicológicas para evaluar sus habilidades cognitivas. Por un lado, los adolescentes con UPI mostraron un peor rendimiento académico que los estudiantes del grupo NUPI, presentando una nota media más baja y un mayor número de asignaturas suspendidas. Por otro lado, el grupo UPI obtuvo una mayor tasa de aciertos en el test de percepción que el grupo NUPI. Sin embargo, los adolescentes con UPI obtuvieron una mayor tasa de errores para el test de razonamiento abstracto. Este mayor número de errores, sumado a un número similar de aciertos que NUPI, indicaría una mayor tasa de respuesta total para el grupo UPI, que podría estar asociada a mayor impulsividad. Concretamente, tal y como se ha observado en otros problemas adictivos con y sin sustancia, estos resultados podrían indicar en los sujetos del grupo UPI dificultades en el control de impulsos y en la regulación de los circuitos de inhibición de respuesta. Resultan necesarios, no obstante, futuros estudios que profundicen en las conclusiones presentadas en este trabajo.

Rendimiento académico y cognitivo en el uso problemático de Internet / Academic outcomes and cognitive performance in problematic Internet users

Son escasos los estudios que hayan analizado la relación entre el uso problemático de Internet (UPI) y el rendimiento cognitivo y académico en adolescentes. El objetivo de este estudio fue analizar las diferencias en rendimiento académico y cognitivo (percepción, atención, memoria, fluidez verbal y razonamiento abstracto) en una muestra de estudiantes de Secundaria con y sin UPI. Participaron un total de 575 estudiantes de diferentes institutos de la provincia de Alicante, que fueron divididos en dos grupos: adolescentes con y sin uso problemático de Internet (UPI y NUPI, respectivamente). Se administraron varios cuestionarios para evaluar el uso problemático de Internet de los sujetos, su rendimiento académico, su consumo de sustancias (alcohol/cannabis) como criterios de exclusión, así como una batería de pruebas neuropsicológicas para evaluar sus habilidades cognitivas. Por un lado, los adolescentes con UPI mostraron un peor rendimiento académico que los estudiantes del grupo NUPI, presentando una nota media más baja y un mayor número de asignaturas suspendidas. Por otro lado, el grupo UPI obtuvo una mayor tasa de aciertos en el test de percepción que el grupo NUPI. Sin embargo, los adolescentes con UPI obtuvieron una mayor tasa de errores para el test de razonamiento abstracto. Este mayor número de errores, sumado a un número similar de aciertos que NUPI, indicaría una mayor tasa de respuesta total para el grupo UPI, que podría estar asociada a mayor impulsividad. Concretamente, tal y como se ha observado en otros problemas adictivos con y sin sustancia, estos resultados podrían indicar en los sujetos del grupo UPI dificultades en el control de impulsos y en la regulación de los circuitos de inhibición de respuesta. Resultan necesarios, no obstante, futuros estudios que profundicen en las conclusiones presentadas en este trabajo

Only few studies have examined the relationship between problematic Internet use (PIU) and cognitive and academic performance in adolescents. The aim of this study was to analyze the differences in academic and cognitive performance (perception, attention, memory, verbal fluency and abstract reasoning) between adolescents with and without PIU. A total of 575 students from different high schools of the region of Alicante participated. Students were divided into two groups: adolescents with and without PIU (PIU and NPIU, respectively). Several questionnaires were administered to assess problematic Internet use, as well as students' academic performance. Substance use (alcohol / cannabis) was also assessed as exclusion criteria. A battery of neuropsychological tests was used to assess cognitive abilities. On the one hand, PIU users group obtained poorer academic results than NPIU, in terms of lower marks and more failed subjects. On the other hand, PIU group had a better hit ratio in the perception test than NPIU group. However, PIU adolescents got higher error rates for the abstract reasoning test. This greater number of errors, plus a similar number of hits compared to the NPIU group, could indicated a higher response rate for the PIU group, which may might be associated with greater impulsivity. As occurs in other addictive and non-substance-related problems studies, these results could mean difficulties in impulse control and regulation of response inhibition circuits in PIU users group. Future research is needed to analyze in depth the results presented in this paper

Internet Abuse Risk Factors among Spanish Adolescents.

Empirical evidence has revealed various factors that contribute to the development and maintenance of Internet abuse. The aim of this paper was to analyze, on a sample of Spanish adolescents, the relationship between Internet abuse and: (1) Personal and interpersonal risk factors, including social skills in both virtual and real-life contexts; (2) Drug use. A total of 814 high school students aged between 13 and 17 participated in this study, and were divided into two groups: Internet Abusers (IA = 173) and Non-Internet Abusers (NIA = 641). Questionnaires were used to analyze Internet and drug use/abuse, as well as social skills, in virtual and real contexts. Various interpersonal risk factors (family and group of friends) were also assessed. IA showed a more severe pattern of Internet and drug use, as well as poorer social skills in both contexts. Moreover, their groups of friends appeared more likely to become involved in risky situations related to Internet and drug abuse. Both IA and NIA showed more adaptive social skills in the virtual context than in the real one. There is a need for further research to build on these findings, with a view to designing specific preventive programs that promote responsible Internet use.

Internet abuse risk factors among Spanish adolescents

Empirical evidence has revealed various factors that contribute to the development and maintenance of Internet abuse. The aim of this paper was to analyze, on a sample of Spanish adolescents, the relationship between Internet abuse and: (1) Personal and interpersonal risk factors, including social skills in both virtual and real-life contexts; (2) Drug use. A total of 814 high school students aged between 13 and 17 participated in this study, and were divided into two groups: Internet Abusers (IA = 173) and Non-Internet Abusers (NIA = 641). Questionnaires were used to analyze Internet and drug use/abuse, as well as social skills, in virtual and real contexts. Various interpersonal risk factors (family and group of friends) were also assessed. IA showed a more severe pattern of Internet and drug use, as well as poorer social skills in both contexts. Moreover, their groups of friends appeared more likely to become involved in risky situations related to Internet and drug abuse. Both IA and NIA showed more adaptive social skills in the virtual context than in the real one. There is a need for further research to build on these findings, with a view to designing specific preventive programs that promote responsible Internet use (AU)

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