A randomized controlled implementation trial of a multicomponent integrated care program to empower mental health service users and their relatives throughout the recovery process.

This study assessed the effectiveness of a psychosocial multicomponent program designed to empower individuals experiencing severe mental distress and their relatives throughout the recovery process. The program consisted of four consecutive interventions, including orientation, psychoeducation, empowerment, and mutual help. A randomized controlled implementation trial was conducted to investigate the program's impact on the recovery of individuals experiencing mental distress, as well as on the caregiving burden and perceived social support experienced by their relatives. Two hundred twenty-two persons in recovery and one of their relatives from 12 different territories within Catalonia, Spain took part in the study. The intervention group exhibited higher recovery scores compared to the control group at 6 months, although this difference was not sustained at the 12-month follow-up. No statistically significant differences were found for burden and social support scores between experimental groups. However, time effects were found for recovery and burden scores regardless of experimental group membership. Dose-effect analyses showed that participation was related to recovery and burden scores, with no time interactions observed. Upon examining the interaction with sociodemographic variables, we discovered statistically significant group-by-time interactions, suggesting a more positive progression of recovery scores among the experimental group when either the person in recovery was younger, their relative was female, or lived outside of the Barcelona Metropolitan Area. These results allow us to conclude that the program has a positive effect on the recovery journey. However, the lack of effectiveness regarding burden and social support in relatives highlights the necessity of reconsidering implementation and evaluation strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Recovery-oriented Care in Public Mental Health Policies in Spain: Opportunities and Barriers / La atención orientada a la recuperación en las políticas públicas de salud mental en España: oportunidades y barreras

Recovery-oriented care is the proposal incorporated in the new mental health strategic plans of both the World Health Organization and the Spanish National Health System. This article takes a journey from the initial proposals of the recovery model to the way recovery-oriented care is currently defined, understood as a community intervention, person-centred, and based on rights. The existing consensus around the CHIME model is also explained in order to understand what kind of interventions are needed to transform mental health services. Likewise, some of the main existing programs and projects to promote recovery-oriented care are presented, and a number of existing barriers to their implementation are analysed. (AU)

La atención orientada a la recuperación es la propuesta incorporada en los nuevos planes estratégicos de salud mental tanto de la Organización Mundial de la Salud como del Sistema Nacional de Salud español. Este artículo hace un recorrido desde las propuestas iniciales del modelo de recuperación hasta la forma en que se define actualmente la atención orientada a la recuperación, entendida como una intervención comunitaria, centrada en la persona y basada en derechos. También se explica el consenso existente en torno al modelo CHIME para comprender qué tipo de intervenciones se necesitan para transformar los servicios de salud mental. Asimismo, se presentan algunos de los principales programas y proyectos existentes para promover la atención orientada a la recuperación y se analizan ciertas barreras existentes para su implementación. (AU)

Interaction between the Participation in and the Impact on Mental Health Service Users and Their Relatives of a Multicomponent Empowerment-Based Psychosocial Intervention.

Relatives play an important role in the recovery journey of mental health service users. Interventions directed either at service users or their relatives may influence the other person as well. The project 'Activa't per la salut mental' (Get active for mental health) consisted of a series of four interventions addressed at people diagnosed with mental disorders and their relatives to help them in their recovery process, increasing their agency and quality of life. The main objective of the present study is to evaluate the interaction of the participation of service users on their relatives' outcomes and vice versa. The impact of the project was evaluated within a randomised controlled trial. The treatment group had access to all the circuit interventions, while the control group received treatment as usual and could only access one of the interventions. All participants were evaluated at baseline, six months, and twelve months after the end of the first intervention. Service users were evaluated with the Stages of Recovery Instrument, and relatives with the Family Burden Interview Schedule II and the Duke-UNC-11 questionnaires. The interaction of participation and impact between service users and their relatives was analysed by means of correlational analyses within the intervention group (n = 111, service users mean age = 40.6, 40% women; relatives mean age = 56.7, 72% women). Service users' baseline characteristics (being in a relationship, educational level, employment, and younger age) influenced in the level of participation of relatives and vice versa (lower educational level). The results also indicated correlations between participation and outcomes at various points as well as the evolution of service users' recovery and the care burden of relatives. Service users' participation levels interacted with the decrease of relatives' frequency of burden and the first steps of their own recovery journey (moratorium, awareness, and preparation) while relative's participation just interacted with the evolution of two stages of service users' recovery levels (preparation and growth). These results can be extremely helpful in fostering interactive benefits in future projects addressing the wellbeing of mental health service users and their relatives. Future studies could use specific designs to explore the directionality of the causality of these effects.

Caregiver Burden and Perceived Social Support of The Main Caregiver of People with Severe Mental Disorder in Catalonia: Type of Care Tasksand Associated Discomfort

The aim of this study is to show the type of care tasks related to the burden and the social support of the caregiver of a person with a mental disorder. Methods: Cross-sectional study in which data were collected from 224 care units(primary caregiver/patient) who were beingfollowed up in Catalonia. Interviews were conducted using the Family Burden Interview Schedule and the Duke Functional Social Support Scale. An explanatory model ofthe results was sought using multiple linearregression or binomial logistic models.Results: The patient is a 40-year-oldsingle male, while the main caregiver is a60-year-old married woman. Daily livingtasks, enforcement of the patient’s schedulesand routines, and the suicidal behaviorexplain the increased objective and subjectivecaregiver burden.Conclusions: Daily living tasks representsa important part of the objective and subjetivecare burden. The perceived social suportis related to concerns about the patient. (AU)

El objetivo de este estudio es mostrar el tipo de tareas de cuidado relacionadas con la carga y el apoyo social del cuidador de una persona con un trastorno mental. Métodos: Estudio transversal en el que se recogieron datos de 224 unidades de cuidados(cuidador principal/paciente) que estaban en seguimiento en Cataluña. Se realizaron entrevistas utilizando el Family Burden Interview Schedule y la Duke Functional Social Support Scale. Se realizó regresión linealmúltiple o logística binomial para obtener unmodelo explicativo de los resultados.Resultados: El paciente es un hombre solterode 40 años, mientras que el cuidadorprincipal es una mujer casada de 60 años.Las tareas de la vida diaria, el cumplimientode los horarios y rutinas del paciente y laconducta suicida explican el aumento de lacarga objetiva y subjetiva del cuidador.Conclusiones: Las tareas de la vida diariarepresentan una parte importante de la cargaobjetiva y subjetiva del cuidador. El apoyosocial percibido está relacionado con la preocupaciónpor el paciente. (AU)

An Integrated Account of Expert Perspectives on Functioning in Schizophrenia.

An integrated and interdisciplinary care system for individuals with schizophrenia is essential, which implies the need for a tool that assesses the difficulties and contextual factors of relevance to their functioning, and facilitates coordinated working across the different professions involved in their care. The International Classification of Functioning, Disability and Health Core Sets (ICF-CS) cover these requirements. This study aimed to evaluate the content validity of the ICF-CSs for schizophrenia from the perspective of experts. Six three-round Delphi studies were conducted with expert panels from different professional backgrounds which have played a significant role in the treatment of individuals with schizophrenia (psychiatry, psychology, nursing, occupational therapy, social work and physiotherapy). In total, 790 experts from 85 different countries participated in the first round. In total, 90 ICF categories and 28 Personal factors reached expert consensus (reached consensus from four or more professional perspectives). All the categories in the brief version of the ICF-CS for schizophrenia reached consensus from all the professional perspectives considered. As for the comprehensive version, 89.7% of its categories reached expert consensus. The results support the worldwide content validity of the ICF-CSs for schizophrenia from an expert perspective and underline the importance of assessing functioning by considering all the components implied.

Occupational Therapists' Perspective on the International Classification of Functioning, Disability and Health Core Sets (ICF-CS) for Schizophrenia.

IMPORTANCE: The International Classification of Functioning, Disability and Health (ICF) Core Sets (CSs) for schizophrenia are sets of ICF categories that are relevant specifically to the functioning and disability of people with schizophrenia. OBJECTIVE: To identify the problems occupational therapists commonly encounter when treating people with schizophrenia and to validate the ICF-CSs for schizophrenia from their perspective. DESIGN: Three-round Delphi study using online surveys distributed to occupational therapists worldwide. Participants were asked which problems with functioning they considered most relevant when treating people with schizophrenia. PARTICIPANTS: Occupational therapists experienced in the treatment of people with schizophrenia. MEASURES: Responses were linked to the ICF categories by two trained health professionals, and a statistical measure of agreement and κ coefficient were calculated. RESULTS: Ninety-two occupational therapists from 29 countries in all six World Health Organization regions named 2,527 meaningful concepts. After the linking process, 121 ICF categories and 31 Personal Factors were presented to the expert panel, who reached consensus (agreement of ≥75%) on 97 ICF categories and 27 Personal Factors. Consensus was reached on the 25 categories in the Brief ICF-CS for schizophrenia and 89 of the 97 categories in the Comprehensive ICF-CS for schizophrenia. CONCLUSIONS AND RELEVANCE: The ICF Core Sets for schizophrenia were validated from the perspective of occupational therapists and are potentially useful tools for clinical practice because they cover a wide variety of problems that occupational therapists deal with in interventions with people with schizophrenia. WHAT THIS ARTICLE ADDS: The ICF-CSs for schizophrenia are useful guides for describing and classifying functioning, disability, and health to aid occupational therapy intervention with people with schizophrenia. Occupational therapists are essential in the rehabilitation of this client population, and their perspective has contributed to the development and enrichment of the ICF-CSs for schizophrenia.

Functioning in schizophrenia: a Delphi study covering the perspective of physiotherapists.

PURPOSE: This qualitative study explores the barriers, personal characteristics/resources, and environmental factors that experienced physiotherapists identify as relevant in the assessment and treatment of persons living with schizophrenia, and whether the identified aspects are represented in the International Classification of Functioning, Disability and Health Core Sets for schizophrenia. METHODS: A three-round Delphi study with physiotherapists was conducted between April and July 2018. In the first round, participants had to list all the aspects they considered to be relevant when assessing and/or treating individuals with schizophrenia, and they were asked six open-ended questions. Their responses were linked to categories. In the second and third rounds, physiotherapists had to judge whether each category/personal factor was relevant for describing functioning in schizophrenia. RESULTS: Thirteen of 22 eligible physiotherapists from eight countries responded to the first round, and 10 completed all three rounds. Eighty-two (84.5%) of the 97 categories in the Comprehensive Core Set for schizophrenia and all 25 categories in the Brief Core Set were considered relevant. A total of five categories were additionally identified. CONCLUSIONS: The barriers, personal characteristics/resources, and environmental factors from the physiotherapists' perspective have been identified. The results largely confirm the content validity of the Core Sets for schizophrenia.Implications for rehabilitationThis study shows which barriers, personal characteristics/resources, and environmental factors in persons with schizophrenia are relevant from physiotherapists' perspective and should be integrated in the rehabilitation process.The content validity of the Comprehensive and Brief Core Sets for schizophrenia is largely supported from the physiotherapists' perspective and therefore could be used in the assessment of functioning in persons with schizophrenia.The Comprehensive and Brief ICF Core Sets for schizophrenia could be used to plan and assess multidisciplinary rehabilitation interventions.

Towards an ICF Core Set for functioning assessment in severe mental disorders: Commonalities in bipolar disorder, depression and schizophrenia.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) offers an internationally accepted standard for describing and assessing functioning and disability in any health condition. A specific list of ICF categories, an ICF Core Set (CS), has been developed for bipolar disorder, depression and schizophrenia. The aim of this study was to determine commonalities in the ICF-CSs for these three disorders, and to identify relevant categories for the development of tentative ICF-CSs for severe mental disorders in general. METHODS: The ICF categories of all three mental health conditions were examined and compared. RESULTS: Comparison of the Comprehensive ICF-CSs for the three mental health conditions revealed a set of 34 common categories (i.e., 10 from the Body functions component, 14 from the Activities and participation component, and 10 Environmental factors ). These categories formed the proposed Comprehensive ICF-CS for severe mental disorders. A total of 11 categories were common to the Brief ICF-CSs of the three mental health conditions, and these formed the Brief ICF-CS for severe mental disorders (i.e., 3 from the Body functions component, 6 from the Activities and participation component, and 2 Environmental factors ). All the categories included refer to key aspects of functioning for severe mental disorders. CONCLUSIONS: The proposed ICF-CSs for severe mental disorders may be applicable across a number of psychotic and affective disorders and they should prove useful for mental health services whose care remit covers a range of conditions.

Disability in bipolar I disorder: Application of Mokken scaling analysis and the graded response model to the World Health Organization Disability Assessment Schedule 2.0.

BACKGROUND: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) evaluates an individual's functioning and disability within the conceptual framework of the ICF. The present study examines the measurement properties of the WHODAS 2.0 in patients with bipolar disorder using Mokken scaling analysis (i.e., monotone homogeneity and double monotonicity models) and the graded response model. No previous studies applying these models to this instrument were found. METHODS: A sample of 291 patients with bipolar disorder (42.6% males) was tested. RESULTS: The WHODAS 2.0 domains showed strong unidimensionality, with no items being omitted. In addition, the analysis of invariant item ordering showed that the items of each domain formed a hierarchical scale, with the exception of the 'Life activities' items for employed persons or students and item D4.5 'Sexual activities' in the 'Getting along' domain. The WHODAS 2.0 domains and the whole scale also showed excellent reliability in bipolar disorder. LIMITATIONS: Although the study was limited to patients in Spain, the use of non-sample dependent procedures minimizes this limitation since the results are independent of the sample used. CONCLUSIONS: The WHODAS 2.0 contains six strong unidimensional domains that are hierarchical and reliable for detecting disability in bipolar disorder, although caution should be exercised with regard to some items.

Functioning in schizophrenia from the perspective of psychologists: A worldwide study.

Schizophrenia is a severe mental disorder associated with impairment in functioning. A multidisciplinary approach is essential to help individuals with this health condition, and psychological interventions are considered a priority. The International Classification of Functioning, Disability and Health (ICF) offers a theoretical framework for assessing functioning and disability. The ICF Core Sets for schizophrenia are a list of ICF categories describing the most common problems in functioning of persons affected by this health condition. This study aimed to explore the content validity of these ICF Core Sets and to identify the most common problems in people with schizophrenia from the perspective of psychologists. Psychologists with experience of schizophrenia treatment were recruited for a three-round Delphi study in order to gather their views regarding the problems commonly presented by these patients. A total of 175 psychologists from 46 countries covering the six WHO regions answered the first-round questionnaire, and 137 completed all three rounds. The 7,526 concepts extracted from first-round responses were linked to 412 ICF categories and 53 personal factors. Consensus (≥75% agreement) was reached for 76 ICF categories and 28 personal factors. Seventy-three of the 97 ICF categories that form the Comprehensive ICF Core Set for schizophrenia achieved consensus, and only three categories that yielded consensus do not feature in this Core Set. These results support the content validity of these ICF Core Sets from the perspective of psychologists. This provides further evidence of the suitability of the ICF framework for describing functioning and disability in persons with schizophrenia.

An international survey of Psychiatric-Mental-Health Nurses on the content validity of the International Classification of Functioning, Disability and Health Core Sets for Schizophrenia.

The International Classification of Functioning, Disability and Health (ICF) Core Sets for schizophrenia describe the key problems in functioning that are experienced by individuals with this disorder. This study examines the content validity of these Core Sets and aims to identify the most frequent problems faced by people with schizophrenia, considering for this analysis the perspective of Psychiatric-Mental-Health Nurses. The study complied with the COREQ checklist for qualitative studies. A total of 101 nurses from 30 countries covering all six World Health Organization regions participated in a Delphi study. Their responses in Round 1 were linked to ICF categories, retaining those reported by at least 5% of participants. In Round 2, they were asked to rate the relevance of each of these categories to the nursing care of patients with schizophrenia. This process was repeated in Round 3. A total of 2327 concepts were extracted in Round 1 and linked to ICF categories. Following the analysis, 125 categories and 31 personal factors were presented to the experts in rounds 2 and 3. Consensus (defined as agreement ≥75%) was reached for 97 of these categories and 29 personal factors. These categories corresponded to all those (N = 25) in the Brief Core Set and 87 of the 97 categories of the Comprehensive Core Set for schizophrenia. Ten new categories emerged. The Delphi process identified the problems in functioning that nurses encounter when treating individuals with schizophrenia, and the results supported the content validity of the Core Sets. We conclude that these Core Sets offer a comprehensive framework for structuring clinical information and guiding the treatment process.

Functioning in patients with schizophrenia: A multicentre study evaluating the clinical perspective.

Using the WHO International Classification of Functioning, Disability and Health (ICF) as a frame of reference, this study identifies the most common problems of functioning and the environmental factors that are experienced by patients with schizophrenia. An empirical cross-sectional multicentre study was conducted. Data were collected using a case record form, rated by health professionals, that contained 133 ICF categories and which also gathered clinical and sociodemographic information. A total of 127 patients with schizophrenia participated. The categories with a higher prevalence of impairment in the Body functions component were related to mental functions [e.g. b164 Higher-level cognitive functions (97.6%), b152 Emotional functions (88.2%)]. Patients also showed impairment in several categories from the Activities and participation component, reflecting restrictions and limitations in several challenging everyday activities such as solving problems (77.2%), handling stress (87.4%), looking after one's health (63.8%), informal social relationships (70.9%), economic self-sufficiency (68.5%), and leisure (79.5%). Environmental factors were most frequently scored as facilitators. Support from family (94.5%) and health professionals (99.2%), together with antipsychotic medication (96.9%) and social (85.0%) and health services (95.3%), were the most common factors for people with schizophrenia. Our study identified the most common problems in functioning and the environmental factors that are experienced by persons with schizophrenia. This kind of comprehensive approach to the assessment of functioning in schizophrenia could help to shape interventions for improving functioning in this population.

Beyond diagnosis: the Core Sets for persons with schizophrenia based on the World Health Organization's International Classification of Functioning, Disability, and Health.

PURPOSE: Based on the International Classification of Functioning, Disability and Health (ICF), this paper presents the results of the process to develop the Comprehensive and Brief Core Sets for schizophrenia that allow to comprehensively describe functioning in persons with schizophrenia. METHODS: Twenty health professionals from diverse backgrounds participated in a formal and iterative decision-making process during an international consensus conference to develop these Core Sets. The conference was carried out based on evidence gathered from four preparatory studies (systematic literature review, qualitative study, expert survey, and empirical study). The first step of this decision-making and consensus process comprised of discussions and voting in working groups and plenary sessions to develop the comprehensive version. The categories of the Comprehensive ICF Core Set for schizophrenia served as the basis for the second step -a ranking and cutoff procedure to decide on the brief version. RESULTS: Of the 184 candidate categories identified in the preparatory studies, 97 categories were included in the Comprehensive Core Set for schizophrenia. A total of 25 categories were selected to constitute the Brief Core Set. CONCLUSIONS: The formal decision-making and consensus process integrating evidence from four preparatory studies and expert opinion led to the first version of the Core Sets for schizophrenia. Comprehensive and Brief Core Sets for schizophrenia may provide a common language among different health professionals and researchers, and a basic international standard of what to measure, report, and assess the functioning of persons with schizophrenia. Implications for rehabilitation Schizophrenia is a chronic mental disorder that has a tremendous impact on functioning and daily life of persons living with the disorder. The International Classification of Functioning, Disability and Health (ICF) offers an internationally recognized standard for describing the functioning status of these individuals. The Core Sets for schizophrenia have potential use in supporting rehabilitation practice such as for planning mental health services and other interventions or defining rehabilitation goals, and documenting patient care. The Core Sets for schizophrenia may also be used to promote interdisciplinary coordination and facilitate communication between members of a multidisciplinary rehabilitation team. Rehabilitation research is another potential area of application of the Core Sets for schizophrenia. This is valuable, since rehabilitation research provides crucial evidence for optimizing rehabilitation practice.

The Screen for Cognitive Impairment in Psychiatry: Proposal for a polytomous scoring system.

The Screen for Cognitive Impairment in Psychiatry is a simple, fast, and easy to administer scale that has been validated in clinical and community samples. The aim of this study was to propose a polytomous scoring system for the Screen for Cognitive Impairment in Psychiatry and to demonstrate its functioning, thus providing new and complementary information regarding the utility and precision of this screening tool. Three hundred seventy-six Spanish patients diagnosed with schizophrenia spectrum disorder were evaluated. A polytomous scoring system was generated and analyzed by means of the partial credit model. Category assessment revealed optimal functioning after collapsing the 7-category system to 1 with either 5 or 4 categories, depending on the item. The proposed polytomous scoring system shows good psychometric properties and an adequate fit to the partial credit model. These results provide further confirmation of the test's utility in clinical settings and of its suitability for detecting cognitive impairment.

Reflexionando con Benito Menni en el siglo XXI / No disponible

En la situación actual de crisis económica es fácil que a nivel asistencial se presenten conflictos entre distintos valores hospitalarios, debiendo priorizar unos por encima de otros. Ante esa situación se decide estudiar e investigar los valores a los que San Benito Menni daba mayor prioridad, es decir su jerarquía de valores. Para ello, se constituyó un grupo de reflexión que, a través del estudio de la abundante documentación epistolar referida al padre Menni y su enmarque en las diferencias entre el escenario socioeconómico-cultural de finales del siglo XIX y el actual, propone una metodología de consenso deductiva-inductiva cuya síntesis es una carta consejo del padre Menni dirigida a los problemas y conflictos actuales (AU)

In the current economic crisis, conflicts between different hospital values are presented. Given this situation it was decided to study and investigate the hierarchy of values of San Benito Menni. A think tank that studied the abundant epistolary documentation referred to Father Menni and its historical context and cultural socio-economic scenario (late nineteenth century and early twentyfirst century) was formed. This group uses a methodology of deductive-inductive consensus whose synthesis is a Father Menni letter addressed to current conflicts (AU)

Disability in bipolar I disorder: the 36-item World Health Organization Disability Assessment Schedule 2.0.

BACKGROUND: The WHODAS 2.0 is an ICF-based multidimensional instrument developed for measuring disability. The present study analyzes the utility of the 36-item interviewer-administered version in a sample of patients with bipolar disorder. There is no study to date that analyses how the scale works in a sample that only comprises such patients. METHODS: A total of 291 patients with bipolar disorder (42.6% males) according to DSM-IV-TR criteria from a cross-sectional study conducted in outpatient psychiatric clinics were enrolled. In addition to the WHODAS 2.0, patients completed a comprehensive assessment battery including measures on psychopathology, functionality and quality of life. Analyses were centered on providing evidence on the validity and utility of the Spanish version of the WHODAS 2.0 in bipolar patients. RESULTS: Participation domain had the highest percentage of missing data (2.7%). Confirmatory factorial analysis was used to test three models formulated in the literature: six primary correlated factors, six primary factors with a single second-order factor, and six primary factors with two second-order factors. The three models were plausible, although the one formed by six correlated factors produced the best fit. Cronbach's alpha values ranged between .73 for the Self-care domain and .92 for Life activities, and the internal consistency of the total score was .96. Relationships between the WHODAS 2.0 and measures of psychopathology, functionality and quality of life were in the expected direction, and the scale was found to be able to differentiate among patients with different intensity of clinical symptoms and work situation. LIMITATIONS: The percentage of euthymic patients was considerable. However, the assessment of euthymic patients is less influenced by mood. Some psychometric properties have not been studied, such as score stability and sensitivity to change. CONCLUSIONS: The Spanish version of the 36-item WHODAS 2.0 has suitable psychometric properties in terms of reliability and validity when applied to patients with bipolar disorder. Disability in bipolar patients is especially prominent in Cognition, Getting along, Life activities, and Participation domains, so functional remediation interventions should emphasize these areas in order to improve the daily living activities of these patients.

Neurodesarrollo o neurodegeneración: Revisión sobre las teorías de la esquizofrenia / Neurodevelopment or neurodegeneration: Review of theories of schizophrenia

La etiopatogenia de la esquizofrenia ha sido explicada por diversas teorías. La hipótesis del neurodesarrollo anormal se basa en la presencia de alteraciones tanto prenatales como perinatales, diferencias en el coeficiente intelectual, o la existencia de anormalidades genéticas, que al interaccionar con ciertos factores medioambientales, hacen que el trastorno esquizofrénico se manifieste en algún momento del desarrollo. Esta teoría es muy bien acogida por la comunidad científica ya que explica muy bien cómo estos factores dan como resultado una alteración en el desarrollo normal y como pueden derivar en un trastorno de esquizofrenia. Por otra parte, una cantidad menor aunque no menospreciable de estudios sugiere la existencia de un proceso degenerativo y se sustentan en variables como la presencia de neurotoxicidad en los cerebros de individuos con esquizofrenia, las alteraciones estructurales y de conectividad cerebral. En este contexto se revisan los diferentes factores subyacentes a ambas hipótesis, donde algunos son difíciles de catalogaren uno u otro enfoque dada la controversia y falta de consenso en los datos. Finalmente se discute la necesidad de adoptar un modelo alternativo no excluyente que ayude a comprender la evidencia disponible sobre el origen, curso y consecuencias de la enfermedad

Many hypothesis have tried to explain the aetiology of schizophrenia, the abnormal neurodevelopmental hypothesis is one of the most widely acknowledged and is based on the presence of both prenatal and perinatal disorders, differences in IQ or the existence of genetic abnormalities, which, with the interaction of certain environmental factors, schizophrenia could occur at some point in the development. This hypothesis provides a good account of how these factors result in an alteration in the normal development and how they can lead to a disorder of schizophrenia. On the other hand, a smaller but not insignificant number of studies based on variables such as the presence of neurotoxicity in the brains of individuals with schizophrenia, alterations at the structural and brain connectivity, suggest the existence of a degenerative process in the course of this disease. In this work, we review the different factors underlying both hypotheses, some of which are difficult to categorize in either approach given the controversy and lack of consensus in their interpretation of the available data. Finally, we discuss the need for a non-exclusive alternative model to help understand the available evidence on the origin, course and consequences of the disease

Neurodevelopment or neurodegeneration: review of theories of schizophrenia.

Many hypothesis have tried to explain the aetiology of schizophrenia, the abnormal neurodevelopmental hypothesis is one of the most widely acknowledged and is based on the presence of both prenatal and perinatal disorders, differences in IQ or the existence of genetic abnormalities, which, with the interaction of certain environmental factors, schizophrenia could occur at some point in the development. This hypothesis provides a good account of how these factors result in an alteration in the normal development and how they can lead to a disorder of schizophrenia. On the other hand, a smaller but not insignificant number of studies based on variables such as the presence of neurotoxicity in the brains of individuals with schizophrenia, alterations at the structural and brain connectivity, suggest the existence of a degenerative process in the course of this disease. In this work, we review the different factors underlying both hypotheses, some of which are difficult to categorize in either approach given the controversy and lack of consensus in their interpretation of the available data. Finally, we discuss the need for a non-exclusive alternative model to help understand the available evidence on the origin, course and consequences of the disease.