Preventive interventions for children and adolescents of parents with mental illness: A systematic review.

BACKGROUND: Children of parents with mental disorders have a relatively high risk of developing a mental illness or behavioural disorder. OBJECTIVE: The aim of this systematic review was to evaluate the efficacy of preventive psychotherapeutic interventions in children of parents with mental illness. In particular, the development of mental illness and/or psychological symptomatology in this population was assessed. METHOD: This qualitative systematic review looked at interventions targeting children aged 4-18 years without a diagnosed mental disorder, alone or with their families, with a parent with a diagnosed mental disorder. The protocol was pre-registered in Open Science Framework. A total of 1255 references were retrieved from MEDLINE, PsychArticles, PsycINFO, Springer Link, Science Direct, Scopus and WOS databases, and 12 references from grey literature. This search was replicated by an external reviewer. RESULTS: Fifteen studies involving 1941 children and 1328 parents were included. Interventions were based on cognitive-behavioural and/or psychoeducational components, including six randomized controlled trials. Internalizing symptomatology was assessed in 80% of the studies, externalizing and prosocial behaviour in 47%, and coping style in 33%. Only two studies measured the future risk of developing a mental disorder (ORs of 2.37 and 6.6). There was variability in the format of the intervention (group; family) as well as in the type of intervention and its duration (from one session to 12 sessions). CONCLUSIONS: Interventions for children of parents with mental disorder were clinically and statistically significant, especially in preventing internalizing symptomatology at one-year follow-up, with effect sizes ranging from d = -0.28 to 0.57 (95% CI).

A new Algorithm for Detecting Clinical High Risk of Psychosis in Adolescents.

BACKGROUND: The delimitation of the clinical high risk of psychosis (CHRp) is characterized by the wide variety of symptoms assessed from different approaches from the onset of psychosis. This study aimed to create a systematic procedure for an effective and accurate earlydetection of CHRp in educational settings. METHOD: A representative sample of 1,824 adolescents (average age, 15.79; 53.8%, women) was used to develop an online assessment system and a new 3-track, 3-level algorithm that combines symptoms of the main risk approaches: ultra-high risk (UHR), basic symptoms (BS), and anomalies in the subjective self-experience (ASE) with functional deficit. RESULTS: The acceptability and feasibility of the online screening system were confirmed by the data. Of the total participants, 68 (3.7%) were identified as high-risk and 417 (22.9%) were identified as moderate, which also supports the functionality of the proposed algorithm. CONCLUSIONS: The system indicates a dynamic model of progression of the different symptoms in the early stages of psychosis, and it may constitute a first line of identification for severe mental disorders in young people in the earliest stages, allowing application of initial preventive measures.

A new Algorithm for Detecting Clinical High Risk of Psychosis in Adolescents / Un Nuevo Algoritmo para la Detección del Alto Riesgo Clínico de Psicosis en Adolescentes

Background: The delimitation of the clinical high risk of psychosis (CHRp) is characterized by the wide variety of symptoms assessed from different approaches from the onset of psychosis. This study aimed to create a systematic procedure for an effective and accurate earlydetection of CHRp in educational settings. Method: A representative sample of 1,824 adolescents (average age, 15.79; 53.8%, women) was used to develop an online assessment system and a new 3-track, 3-level algorithm that combines symptoms of the main risk approaches: ultra-high risk (UHR), basic symptoms (BS), and anomalies in the subjective self-experience (ASE) with functional deficit. Results: The acceptability and feasibility of the online screening system were confirmed by the data. Of the total participants, 68 (3.7%) were identified as high-risk and 417 (22.9%) were identified as moderate, which also supports the functionality of the proposed algorithm. Conclusions: The system indicates a dynamic model of progression of the different symptoms in the early stages of psychosis, and it may constitute a first line of identification for severe mental disorders in young people in the earliest stages, allowing application of initial preventive measures.(AU)

Antecedentes: La delimitación del alto riesgo clínico de psicosis (CHRp, por sus siglas en inglés) se caracteriza por la gran variedad de síntomas evaluados desde diferentes enfoques y la dificultad que existe para detectar los estadios clínicos más alejados del inicio de la psicosis. Este estudio tiene como objetivo la creación de un procedimiento sistemático para una detección temprana eficaz y precisa del CHRp en entornos educativos. Método: A partir de una muestra representativa de 1.824 adolescentes (edad, media= 15,79 años; 53,8%, mujeres) se ha desarrollado un sistema de evaluación online y un algoritmo de tres vías y tres niveles de riesgo que combina los síntomas de los principales enfoques de riesgo: ultra-alto riesgo (UHR), síntomas básicos (SB) y anomalías en la autoexperiencia subjetiva (ASE), además del déficit funcional. Resultados: A la luz de los datos obtenidos se han confirmado la aceptabilidad y viabilidad del sistema de cribado online. Del total de participantes, 68 (3,7%) fueron identificados como de alto riesgo y 417 (22,9%) como de riesgo moderado, lo que también avala la funcionalidad del algoritmo propuesto. Conclusiones: El sistema apoya la existencia de un modelo dinámico de progresión de los diferentes síntomas en las primeras etapas de la psicosis, y puede constituir una primera línea de identificación de los trastornos mentales graves en los jóvenes en las etapas más tempranas, de cara a la aplicación de las medidas preventivas iniciales.(AU)

The mediating role of metacognitive variables in the relationship between Thought-Action Fusion and obsessive-compulsive symptomatology / El papel mediador de las variables metacognitivas en la relación entre la fusión pensamiento-acción y la sintomatología obsesivo-compulsiva

Diverse studies support the central role of Thought-Action Fusion (TAF) and other metacognitive variables in the understanding of obsessive-compulsive disorder (OCD) symptomatology. However,amore detailed study of the involvement of the sevariables is needed. This article seeks to assess the possible mediating role of the factors of the Metacognitions Questionnaire (MCQ) in the relationship between TAF and OCD symptoms both in clinical and non-clinical samples.A cross-sectional design was used in which120 participants, divided into three groups (two clinical and one non-clinical), completed the questionnaires assessing the constructsof interest. The mediational findings generally supported the proposed mediation model. Specifically, the mediational analyses focused on negative beliefs and the need to control (metacognitive factors of the MCQ) showed that MCQ Negative beliefs mediated the effects of TAF-Total and TAF factors (except for the TAF-Moral) on OCD symptomatology in the OCD group. The MCQ Need to control was non-significantasa mediator of the relationships between TAF and OCD. However, it was observed that this mediation approached significance, with considerable effect sizes. In the clinical-control group, the analyses showed that MCQ Negative beliefs mediated the effects of TAF-Like lihood-One self on OCD symptoms. In the remaining group, neither MCQ Negative beliefs nor MCQ Need to control were found to be significant mediators. It is generally concluded that certain beliefs, such as TAF, can evolve toward more complex metacognitive beliefs, which ultimate ly lead to the development of OCD symptoms.

Diversos estudios han señalado el papel de la fusión pensamiento-acción (TAF) y otras creencias metacognitivas en la comprensión de la sintomatología obsesivo-compulsiva. No obstante, es preciso un estudio más pormenorizado que esclarezca la contribución de estas variables. El objetivo del presente estudio es evaluar el posible papel mediador de los factores del Cuestionario de Metacogniciones (MCQ)en la relación entre la TAF y la sintomatología obsesivo-compulsiva, tanto en muestras clínicas como no clínicas. Con un diseño transversal, 120 participantes divididos entres grupos (dos clínicos y uno no clínico) respondieron a los cuestionarios que evaluaban los constructos de interés. Los resultados apoyaron de manera general el modelo mediacional propuesto. Concretamente, los análisis se centraron en la necesidad de control y las creencias negativas (factores metacognitivos del MCQ) y mostraron los siguientes resultados. En el grupo de sintomatología obsesivo-compulsiva, las creencias negativas mediaron los efectos deTAF-totaly los factores de TAF en la sintomatología obsesivo-compulsiva, a excepción de TAF-moral. El factor necesidad de control no llegó a ser un mediador significativo; no obstante, esta mediación estaba próxima a la significatividad y se contemplaron tamaños del efecto considerables. Respecto al grupo de control clínico, los análisis mostraron que las creencias negativas mediaban los efectos de TAF-probabilidad-uno mismo en la sintomatología obsesivo-compulsiva. En el grupo restante, ni las creencias negativas ni la necesidad de control resultaron ser mediadores significativos. Se concluye, de manera general, que creencias como la TAF pueden evolucionar hacia creencias metacognitivas más complejas que conllevan, en último término, el desarrollo de la sintomatología obsesivo-compulsiva.

Rethinking Schizophrenia in the Context of the Person and Their Circumstances: Seven Reasons.

We know a great deal about schizophrenia, but the current state of the art is one of uncertainty. Researchers are confused, and patients feel misunderstood. This situation has been identified as due largely to the fact that the dominant neurobiological perspective leaves out the person. The aim of the present article is to review and integrate a series of clinical, phenomenological, historical, cultural, epidemiological, developmental, epigenetic, and therapeutic phenomena in support of a suggestion that schizophrenia is above all a disorder of the person rather than of the brain. Specifically, we review seven phenomena, beginning with the conception of schizophrenia as a particular disorder of the self. We continue by looking at its recent origin, as a modern phenomenon, its juvenile onset, related to the formation of the self, the better prognosis in developing countries compared to developed countries, and the high incidence of the disorder among migrants. In the context of these phenomena of a marked socio-cultural nature, we consider the so-called "genetic myth," according to which schizophrenia would have a genetic origin. On reviewing the current genetic emphasis in the light of epigenetics, it emerges that the environment and behavior recover their prominent role in the vicissitudes of development. The seventh reason, which closes the circle of the argument, concerns the role of interpersonal "chemistry" in recovery of the sense of self.

Measuring stages of recovery from psychosis.

BACKGROUND: Mental health consumers invite us to abandon the pathology model, which is tied to pessimism, and instead to embrace a model of personal recovery that goes beyond being free from symptoms, and involves self-management of the illness. The Stages of Recovery Instrument (STORI) is a measure developed from the perspective of consumers according to a conceptual five-stage model of recovery. AIMS: The main aim of this work was to study the psychometric properties of the STORI, but we also set out to compare the stages of recovery in our sample with the five-stage model in the sample with which the scale was developed. METHODS: Our sample consisted of 95 people diagnosed with schizophrenia-spectrum psychoses, with a mean age of 34.74 (SD=9.25). RESULTS: The STORI scores showed adequate psychometric properties in this sample. Cluster analysis indicated that the three-cluster model fitted the data better than the five-cluster model. Internal consistency of the STORI scores ranged between .83 and .87. STORI stages were associated with Recovery Styles Questionnaire scores. DISCUSSION: The results provide empirical validation of the STORI in other countries. Empirical evidence revealed that the stages of recovery found in our own and other clinical samples differ from those found in the samples with which the scale was developed.

Person-based contextual therapy applid to a complex case of schizophrenia / Aplicación de la terapia contextual basada en la persona a un caso complejo de esquizofrenia

BACKGROUND: Psychological therapies are becoming more and more important in schizophrenia, and not as mere adjuncts to medication. The psychotherapy of schizophrenia is taking on a new lease of life in the wake of person-based phenomenological and psychological developments. METHOD: The case in question was a complex one, with variegated symptomatology that had persisted over many years. Approaching the case from the perspective of person-based cognitive therapy allowed us to understand the psychotic symptoms in the biographical context and to apply a therapy focused on the patient's recovery of her sense of self and of life. RESULTS: At the end of the therapy and throughout the 12-month follow-up, the psychotic experiences had practically disappeared, or ceased to be disturbing, and the patient had become re-integrated in social life. CONCLUSIONS: Psychotic symptoms take on meaning in the biographical context. Adopting this perspective can aid the psychopathological explanation of the disorder and provide significant therapeutic help, more focused on recovery. Psychological therapy has shown itself to be viable in complex cases treated within the public-sector healthcare context

ANTECEDENTES: las terapias psicológicas están siendo cada vez más importantes en la esquizofrenia, y no como meras adjuntas a la medicación. La psicoterapia de la esquizofrenia está cobrando nueva vida a la luz de desarrollos fenomenológicos y psicológicos centrados en la persona. MÉTODO: se presenta un caso complejo, de abigarrada sintomatología y larga duración, sin que hasta ahora la medicación produjera cambios clínicos significativos. La formulación del caso de acuerdo con la terapia cognitiva basada en la persona permitió entender los síntomas psicóticos en el contexto biográfico y llevar a cabo una terapia centrada en la recuperación del sentido del yo y de la vida. RESULTADOS: al final de la terapia y en el seguimiento de un año las experiencias psicóticas habían desaparecido prácticamente o dejado de ser perturbadoras y la paciente se había reintegrado en la vida social. CONCLUSIONES: los síntomas psicóticos cobran sentido en el contexto biográfico. Esto puede servir a la explicación psicopatológica y a una ayuda terapéutica significativa, más centrada en la recuperación que en el mero sostenimiento, que fácilmente termina en "abandono" asistencial y existencial. La terapia psicológica muestra ser viable en casos complejos atendidos en dispositivos públicos

Person-based contextual therapy applied to a complex case of schizophrenia.

BACKGROUND: Psychological therapies are becoming more and more important in schizophrenia, and not as mere adjuncts to medication. The psychotherapy of schizophrenia is taking on a new lease of life in the wake of person-based phenomenological and psychological developments. METHOD: The case in question was a complex one, with variegated symptomatology that had persisted over many years. Approaching the case from the perspective of person-based cognitive therapy allowed us to understand the psychotic symptoms in the biographical context and to apply a therapy focused on the patient's recovery of her sense of self and of life. RESULTS: At the end of the therapy and throughout the 12-month follow-up, the psychotic experiences had practically disappeared, or ceased to be disturbing, and the patient had become re-integrated in social life. CONCLUSIONS: Psychotic symptoms take on meaning in the biographical context. Adopting this perspective can aid the psychopathological explanation of the disorder and provide significant therapeutic help, more focused on recovery. Psychological therapy has shown itself to be viable in complex cases treated within the public-sector healthcare context.

The role of magical thinking in hallucinations. Comparisons of clinical and non-clinical groups.

BACKGROUND: Magical thinking consists of accepting the possibility that events that, according to the causal concepts of a culture, cannot have any causal relationship, but might somehow nevertheless have one. Magical thinking has been related to both obsessive-compulsive disorder and schizophrenia. AIMS: The purpose of this study was to investigate the role of magical thinking in hallucinations of patients diagnosed with schizophrenia. METHODS: Four groups were recruited for this purpose from a clinical population (hallucinating schizophrenic patients, patients diagnosed with psychoses who had never hallucinated, obsessive-compulsive disorder patients and a clinical control group) and a non-clinical control group, who were given the Magical Ideation Scale. RESULTS: The results show that magical ideation differentiates the group of schizophrenic patients with auditory hallucinations from the rest of the groups that participated in the design. Items related to "mind reading", to the presence of auditory illusions in response to sound stimuli, and to the sense of sometimes being accompanied by an evil presence are the most closely related to the presence of auditory hallucinations. CONCLUSIONS: Magical thinking, understood as beliefs in non-consensual modes of causation, is closely linked to auditory hallucinations in patients diagnosed with schizophrenia.

Estado actual de la detección e intervención temprana en psicosis / No disponible

La posibilidad de intervenir precozmente en los trastornos psicóticos y alterar con ello el tradicional curso negativo de la enfermedad está generando un creciente interés en la comunidad científica y profesional. En este trabajo, presentamos el momento en que se encuentran las investigaciones y los desarrollos clínicos y de organización de servicios en las distintas fases iniciales de la enfermedad, describiendo tanto las nuevas formas de intervención como sus primeros y esperanzadores resultados (AU)

Early intervention in psychotic disorders in order to alter their typical negative course is nowadays creating a growing interest in the scientific and professional community. In this paper, the state of the art in research and clinical implementation, and the organization of services for the several early phases of the illness are presented; and new methods of intervention as well as the first and promising results are described (AU)

Dissociative experiences as mediators between childhood trauma and auditory hallucinations.

The purpose of this work was to study the relationship between reported traumatic experiences in childhood and positive psychotic symptoms. We hypothesized that dissociative experiences were potential mediators between childhood trauma and hallucinations, but not delusions. The sample comprised 71 patients diagnosed with psychoses. They were assessed with the Dissociative Experiences Scale (DES-II; Carlson & Putnam, 1993), a questionnaire on trauma (TQ; Davidson, Hughes, & Blazer, 1990), and the Positive and Negative Syndrome Scale (PANSS; Kay, Opler, & Lindenmayer, 1988) delusions and hallucinations items. The results showed that childhood trauma was positively associated with the dissociation scale scores (r = .40) and also the hallucination (r = .36) and delusions scale scores (r = .32). Furthermore, it was demonstrated that the dissociation variable was a potential mediator between childhood trauma and hallucinations, but not between childhood trauma and delusions. Of the 3 DES-II factors, only depersonalization showed a mediating relationship between childhood trauma and hallucinations. The main conclusion is that the impact of childhood trauma on hallucinations may not simply be direct, but mediated by dissociative experiences, especially depersonalization. Clinical implications are also briefly discussed.

Relationship of metacognition, absorption, and depersonalization in patients with auditory hallucinations.

OBJECTIVES: The purpose of this work was to study the relationship of metacognition, absorption, and depersonalization in hallucinating patients. DESIGN: A within-subjects correlational design was employed. METHODS: We formed four groups from a clinical population (schizophrenic patients with hallucinations, schizophrenic patients with no hallucinations but with delusions, schizophrenic patients recovered from positive symptoms, and patients with a non-psychotic psychiatric disorder) and a non-clinical control group. All participants were given the Metacognitions Questionnaire (MCQ-30, Wells & Cartwright-Hatton, 2004), the Tellegen Absorption Scale (TAS, Tellegen & Atkinson, 1974) and the Cambridge Depersonalization Scale (CDS, Sierra & Berrios, 2000). RESULTS: Schizophrenic subjects with hallucinations scored significantly higher on the depersonalization scale than any other group, and significantly higher on the absorption scale than any group except for the clinical patient controls. Schizophrenic patients with hallucinations also had significantly more dysfunctional metacognitive beliefs than subjects with no psychiatric pathology. It was further found that the metacognition variable correlated positively with the absorption and depersonalization variables, and that these variables in turn correlated positively with each other. Finally, it should be stressed that the variables that best predict hallucination severity are depersonalization and the MCQ-30 subscale `Need to control thoughts'. CONCLUSIONS: We discuss the role of metacognitive and dissociative variables in understanding hallucinations and suggest some approaches to their treatment.

Depersonalization as a mediator in the relationship between self-focused attention and auditory hallucinations.

The purpose of this work was to study the potentially mediating role of certain dissociative factors, such as depersonalization, between self-focused attention and auditory hallucinations. A total of 59 patients diagnosed with schizophrenic disorder completed a self-focused attention scale ( M. F. Scheier & C. S. Carver, 1985 ), the Cambridge Depersonalization Scale (M. Sierra & G. E. Berrios, 2000), and the hallucination and delusion items on the Positive and Negative Syndrome Scale (S. R. Kay, L. A. Opler, & J. P. Lindenmayer, 1988). The results showed that self-focused attention correlated positively with auditory hallucinations, with delusions, and with depersonalization. It was also demonstrated that depersonalization has a mediating role between self-focused attention and auditory hallucinations but not delusions. In the discussion, the importance of dissociative processes in understanding the formation and maintenance of auditory hallucinations is suggested.

New life for schizophrenia psychotherapy in the light of phenomenology.

Recent contributions to the theoretical conception and empirical evaluation of schizophrenia in the light of phenomenology are opening the way to new perspectives in psychotherapy. The phenomenological conception understands schizophrenia as a disturbance of the basic sense of selfhood (ipseity) characterized by hyper-reflexivity and diminished sense of self. Evaluation consists of examining the anomalous self-experience in a series of domains, which makes the conception presented operable. On this basis, a phenomenologically informed psychotherapy is introduced. Its characteristics are pointed out and early intervention is reviewed (the last frontier in psychosis) from this perspective. Finally, a series of psychotherapies which, although they do not have a phenomenological origin, may be seen from that perspective, are re-examined. These are the narrative, mindfulness and acceptance and commitment therapies.

ESQUIZO-Q: Un Instrumento para la Valoración del "Alto Riesgo Psicométrico" a la Psicosis / ESQUIZO-Q: An Instrument for the Assessment of “Psychometric High Risk” for Psychosis

El paradigma de “alto riesgo psicométrico” tiene como finalidad la detección, mediante la utilización de autoinformes y a partir de su perfil de puntuaciones, de aquellos participantes con una mayor vulnerabilidad teórica de transitar hacia un trastorno psicótico en el futuro. La detección temprana de este tipo de individuos de riesgo pasa por disponer de adecuados instrumentos de evaluación que nos permitan tomar decisiones sólidas y fundadas a partir de sus puntuaciones. El principal objetivo de este estudio fue presentar el proceso de construcción y validación de un autoinforme de reciente creación denominado ESQUIZO-Q: Cuestionario Oviedo para la Evaluación de la Esquizotipia. El análisis de la estructura interna arrojó una solución tridimensional: Distorsión de la Realidad, Anhedonia y Desorganización Interpersonal. Los niveles de consistencia interna para las subescalas del ESQUIZO-Q oscilaron entre 0,62 y 0,90. Ningún ítem presentó un funcionamiento diferencial en función del sexo de los participantes. Asimismo, las subescalas del ESQUIZO-Q correlacionaron de forma moderada con las escalas de otros autoinformes que valoraban depresión, problemas comportamentales y rasgos de los trastornos de la personalidad. El ESQUIZO-Q es un instrumento de medida breve, sencillo y con adecuadas propiedades psicométricas, que puede ser utilizado como herramienta epidemiológica y como método de screening psicopatológico en población general adolescente. Futuras investigaciones deberían realizar estudios longitudinales con la finalidad de examinar la capacidad predictiva del ESQUIZO-Q (AU)

The aim of the “psychometric high risk” paradigm is the detection, by means of self-report measures and based on score profiles, of those individuals with a higher theoretical vulnerability of moving toward a psychotic disorder in the future. The early detection of this type of at-risk individual requires adequate assessment instruments that allow us to make solid and well-founded decisions based on their scores. The main objective of this study was to present the construction and validation of a recently created self-report called ESQUIZO-Q: Cuestionario Oviedo para la Evaluación de la Esquizotipia (The Oviedo Schizotypy Assessment Questionnaire). The analysis of its internal structure revealed a three-factor solution: Distortion of Reality, Anhedonia and Interpersonal Disorganization. The levels of internal consistency for the ESQUIZO-Q subscales ranged from 0.62 to 0.90 No item showed differential functioning as a function of the gender of participants. Likewise, the ESQUIZO-Q subscales correlated moderately with the scales of other selfreports that assess depression, behavioral problems and personality disorder traits. The ESQUIZO-Q is a brief and easy self-report instrument with adequate psychometric properties that can be used as an epidemiological tool and as a psychopathological screening ethod in the general population. Future investigations should conduct longitudinal studies in order to examine the predictive capacity of the ESQUIZO-Q (AU)

Bases Clínicas para un Nuevo Modelo de Atención a las Psicosis / New Trends in Treatment for Psychosis

El objetivo de este artículo es resumir los conocimientos actuales sobre los tratamientos farmacológicos, psicosociales y otros procedimientos terapéuticos que se aplican a las psicosis. Si bien la medicación antipsicótica viene siendo el tratamiento de elección para las psicosis, y en especial para la esquizofrenia, la mejoría obtenida en los síntomas positivos es sólo moderada, y no ha demostrado eficacia en la mejora de los síntomas deficitarios persistentes. Incluso muchos pacientes continúan sufriendo los síntomas positivos y recaídas, especialmente cuando falla el cumplimiento del tratamiento farmacológico. Todo ello, pone en evidencia la necesidad de utilizar otros tratamientos adjuntivos, que ayuden al paciente a comprender y a manejar sus trastornos, a aliviar los síntomas, a mejorar el cumplimiento terapéutico, su funcionamiento social y su calidad de vida, y a resolver los problemas que no logran solución con la medicación. En la actualidad, el tratamiento de las psicosis requiere un enfoque amplio, multimodal, que incluya medicación, psicoterapia y tratamientos psicosociales (psicoeducación e intervenciones dirigidas a la solución de problemas, terapia cognitivo-conductual, rehabilitación cognitiva, entrenamiento en habilidades sociales y terapia asertiva comunitaria), así como ayuda en la búsqueda de alojamiento y recursos económicos que le permitan sobrevivir. En el futuro próximo, deberán desarrollarse intervenciones más adaptadas a las diferentes fases que presentan las psicosis (AU)

The purpose of this paper is to summarize our current knowledge about pharmacological, psychosocial, and other emerging treatments for psychoses. Although antipsychotic medications are the mainstay of treatment for psychoses, and particularly for schizophrenia, the degree of improvement in positive symptoms is moderate, and has no demonstrable efficacy against positive enduring or deficit negative symptoms. Indeed, many patients continue to suffer from persistent positive symptoms and relapses, particularly when they fail to adhere to prescribed medications. This underlines the need for additional treatment methods to help patients understand and manage their disorders, alleviate symptoms, improve adherence, social functioning and quality of life, and solve problems that do not fully respond to medication. Nowadays, comprehensive treatment entails a multi-modal approach, including medication, psychotherapy and social treatments (psychoeducation and coping-oriented interventions, cognitive behaviour therapy, cognitive remediation, social skills training and assertive community treatment), as well as assistance with housing and financial sustenance. In the foreseeable future, phase-specific interventions ought to be pplied to different stages of psychoses (AU)

Symptomatic and functional outcome in youth at ultra-high risk for psychosis: a longitudinal study.

The current report assesses the clinical, functioning and demographic data of a cohort enrolled in the P3 prevention program for psychosis; a Spanish National Health System and Ministry of Science funded program. Comparisons are made between those individuals who had converted to psychosis and those who had not at 3years after an average of 24 treatment sessions. Subjects included 61 participants meeting Structured Interview for Prodromal Syndromes criteria, with ages ranging from 17 to 31, and all meeting criteria for ultra-high risk of psychosis. Prospective follow-up data are reported for patients re-evaluated at 1 and 3years. At 1-year follow-up, the conversion rate to psychosis was 18%, but increased to 23% at 3-year follow-up. The converted sample was older than the non-converted sample and more likely to have higher ratings on subsyndromal psychotic (positive and disorganized), negative and general symptoms, and lower levels of functioning at baseline assessment. Analyses of change over time indicated a clear clinical improvement in both clinically stable patients and in those who showed a transient psychotic state over time. No gender differences in symptom or functioning levels at the three follow-up time points were found; however, the interactions among conversionxgenderxSOPS total scorextime points significantly reflect that the growth profiles of the four groups (no conversion males, no conversion females, conversion males and conversion females) in the SOPS total score are not parallel and that, consequently, the four groups involved different patterns of change over time, males experiencing faster and longer deterioration when psychotic symptoms arise.

Changing relationship with voices: new therapeutic perspectives for treating hallucinations.

A growing body of research on verbal hallucinations shows the importance of beliefs about and relationships with the voices for their pathological course. In particular, beliefs about the omnipotence of the voices and the need to control them, and relationships with them that involve efforts to resist or fight them, have shown themselves to be more pathogenic than effective. Likewise, treatments aimed at eliminating the voices, be they based on medication or 'traditional' cognitive-behavioural therapy, have not always been successful. A series of strategies focused on changing relationships with the voices instead of trying to eliminate them-including mindfulness, acceptance, experiential role plays and re-authoring lives-is emerging as a new perspective for the treatment of hallucinations. All of these strategies are based on the person, not on the syndrome, which also represents a new conception of the problem, in a phenomenological-social perspective, alternative to the predominant medical conception.

La investigación cognitiva del síndrome esquizofrénico / Cognitive research on schizophrenia syndrome

Se revisan las anomalías cognitivas observadas en la esquizofrenia y, específicamente,los déficit encontrados en diversos procesos automáticos y controlados: el filtrado dela información, la atención y vigilancia, la formación de conceptos y la memoria. Sedescriben también diversos paradigmas experimentales utilizados para el estudio de losprocesos ejecutivos centrales; y, finalmente, se describe un modelo cognitivo para lasconductas anormales y los síntomas clínicos de la esquizofrenia (delirios, desorganización,alucinaciones y la pérdida del sentimiento de identidad personal) que sugiere quepueden estar ligados a un trastorno básico de la percepción holística o la interpretaciónde contextos

This review provides a perspective of cognitive disturbances found in schizophreniaand, particularly, of deficits found in several automatic and controlled processes:information filtering, attention and vigilance, concept formation and memory. Severalexperimental paradigms employed in the study of central executive processes are alsodescribed; and, finally, a cognitive model of abnormal behaviours and clinical symptomsof schizophrenia (delusions, disorganization, hallucinations, and the loss of a sense ofpersonal identity) are outlined suggesting that they may be linked to a basic disturbancein comprehensive knowledge or context perception