Attachment styles and associated psychosocial factors in patients at ultra-high risk for psychosis: A systematic review.

BACKGROUND: Patients with an ultra-high risk of psychosis (UHR) are more likely to transition to psychosis. Attachment style has also been associated with psychosis and other symptoms. AIMS: To review attachment styles in UHR patients and to analyze related psychosocial factors. Ours is the first systematic review of attachment in this population. METHOD: We performed a systematic review of attachment and related psychosocial factors in UHR patients following the PRISMA methodology. RESULTS: We identified five studies. The results revealed high rates of insecure attachment in this population (more than 80%). The UHR sample presented high levels of depression, anxiety, social anxiety, emotional reactivity, trauma, and poor mentalization. Premorbid social adjustment was a predictor of improvement in disorganization and negative symptoms. The rate of transition to psychosis was 10%. Attachment patterns accounted for 16.8% of the variance. This vulnerability for psychosis was also associated with poor mentalization. CONCLUSION: Early detection of patients with UHR and insecure attachment is crucial, since early intervention to address symptoms, mentalization, and attachment is feasible and may lead to an improvement in the remaining associated psychosocial related factors (secure style: better global functioning and less affective and anxious symptoms). PROSPERO ID440957.

Experiencias psicóticas autoinformadas: diferencias según la edad y la psicopatología asociada / Self-reported psychotic experiences: differences by age and associated psychopathology

Este trabajo pretende explorar las diferencias en sintomatología psicopatológica que puede haber en la población general adulta con o sin experiencias psicóticas (EP) en función del rango de edad. Se evaluó la presencia de EP, la sintomatología psicopatológica general y diferentes características sociodemográficas y psicosociales en 216 personas sin antecedentes psiquiátricos personales. La muestra se dividió en adultos jóvenes (18-35 años) y maduros (36-60 años). Los jóvenes mostraron una mayor expresión de EP (33,6%). Los adultos maduros con EP presentaban más sintomatología psicopatológica en las dimensiones de hostilidad-ira, somatización, depresión y ansiedad que los adultos maduros sin EP. Los adultos jóvenes con EP mostraron significativamente más síntomas en las mismas dimensiones, así como también en las dimensiones de obsesión-compulsión, ideación paranoide y psicoticismo que los participantes de esta edad sin EP. Las EP son más frecuentes en personas de 18-35 años, sin embargo, pueden estar presentes en distintos rangos de edad y podrían alertar de la presencia de niveles elevados de sintomatología afectiva y de ira-hostilidad. (AU)

This study aims to explore the differences in psychopathological symptoms that may This study aims to explore the differences in psychopathological symptoms that may exist in the general adult population with or without psychotic-like experiences (PLEs), depending on the age range. The presence of PLEs, self-reported general psychopathological symptomatology, and different sociodemographic and psychosocial characteristics were assessed in 216 participants without any record of personal psychiatric antecedents. The sample was divided into young adults (18-35 years) and mature adults (36-60 years). The young adults showed a higher expression of PLEs (33.6%). The mature adults with PLEs presented more psychopathological symptoms in the dimensions of hostility-anger, somatization, depression, and anxiety than mature adults without PLEs. Young adults with PLEs showed significantly more symptoms in the same dimensions, and in the obsession-compulsion dimensions, paranoid ideation, and psychoticism, than participants of this age without PLEs. PLEs are more frequent in people between 18-35 years old; however, PLEs can be present in different age ranges and could serve as an alert to high levels of affective and anger-hostility symptoms. (AU)

Two-year evaluation of a multifamily psychoeducational program (PROTEC) in the family burden and prognosis of bipolar patients.

INTRODUCTION: Bipolar disorder causes a significant burden on the lives of patients and their families. The family is one of the targets for therapeutic intervention, related to the prognosis in patients with bipolar disorder. AIM: To assess the effectiveness of a multifamily psychoeducational program for people with bipolar disorder, in the family burden: objective and subjective and in the variables related to the course of the patients with bipolar disorder (symptoms, adherence, functionality, hospitalizations), comparing it with a control group (CG). MATERIALS AND METHODS: A total of 148 relatives of bipolar patients and 148 bipolar patients were recruited. The sample was randomized (experimental group [EG] and CG) and with single-blind evaluations (baseline, at 5 months and one year). Clinical and sociodemographic variables were collected from families and patients (family burden self-report scale, Strauss-Carpenter Scale, Global Assessment of Functioning, Morisky Green adherence Scale). Both, EG and CG received 8 multifamily sessions, applied exclusively on the relatives of patients with bipolar disorder, but in the EG a psychoeducational treatment was carried out and in the CG only playful and current topics were discussed. Bivariate and logistic regression models were used, among others. RESULTS: The caregivers and patients of the EG and CG did not differ in any of the baseline variables (sociodemographic and clinical) (P>.001). In the total sample, the baseline objective burden was light (mean 0.6±0.4) and the subjective ones was medium-moderate (mean 1.1±0.3). During the follow-up, in relation to the variables of the caregivers, there was a greater reduction in the objective burden in the EG compared to the CG (5 months P=.006; one year P=.002). It was found that the objective burden (P=.006) and the subjective burden (P=.003) were significantly reduced over a year in EG but not in the CG. During the follow-up, the patients whose caregivers belonged to the EG showed a greater increase in the frequency of social activity (P=.008), in the work activity (P=.002), and global functioning (P=.002), and reduced their symptoms (P≤.001). Longitudinal analyses, over a year, showed that patients in the EG had a greater improvement in functionality compared to patients in the CG (P=.001). After the intervention, adherence to pharmacological treatment improved more in EG than in the CG (P≤.001). Regarding hospitalizations, any patients in the CG were hospitalized during the 5 months after the intervention, while 27.8% of the patients in the CG were hospitalized (P≤.001); the difference between groups remained significant in the long term (one year: P≤.001; 2 years: P≤.001). There were no significant differences between groups in the pharmacological treatment of the patients in any of the evaluations. CONCLUSIONS: The multifamily psychoeducational intervention group improved the family burden after the intervention. Likewise, bipolar patients, whose families attended the EG, improved significantly, over a year, the functionality, the frequency of social contacts, the work status, the adherence to treatment, and reduced their symptoms. In addition, in the EG, the percentage of hospitalizations during the 2 years of follow-up was significantly reduced.

COVID-19 pandemic and mental health in Spain: An analysis of their relationship using Google Trends.

INTRODUCTION: This study aims to examine the public interest that exists on Internet regarding various mental health topics and its relationship with evolution of COVID-19 pandemic in Spain. MATERIALS AND METHODS: Google Trends was used to explore relative search volume (RSV) for the following terms related with mental health (TRMH): "anxiety", "depression", "stress", "insomnia" and "suicide"; between January and December 2020. The cross-correlation function was performed to assess association between new COVID-19 cases and RSV levels for TRMH. Finally, Mann-Whitney test was used to examine differences between RSV values for TRMH before and after of state of alarm declarations on March and October 2020. RESULTS: The "anxiety" term showed the highest RSV indices. A significant correlation was found between new COVID-19 cases and RSV for "anxiety" with a time-lag of +1 week (r=0.49; p<.05). Was found an increase of SRV for "anxiety" (U=0.00; p=.01) and a decrease of SRV for "depression" (U=1.00; p=.04) between 4-week period before and after state of alarm of March 2020. Regarding the state of alarm of October 2020, a higher RSV for "anxiety" (U=0.50; p=.02) was found in the four weeks after it compared with a similar previous period. CONCLUSIONS: Anxiety is the mental health topic of greatest public interest on Internet in context of COVID-19 pandemic. Public concern about anxiety rises one week after the increase in COVID-19 cases and is greater after introduction of control measures that entail any type of mobility restriction or activity limitation. There is a greater general need for information on anxiety at specific times in the pandemic evolution.

Vaccination against SARS-CoV-2 and its relationship with public interest in mental health: a study between 2020-2022 in Spain.

The possible relationship between vaccination against SARS-CoV-2 (COVID-19) and mental health has been largely unexplored. We investigated variations in public interest in mental health issues between the different periods of the vaccination campaign against SARS-CoV-2 in Spain and before the initiation of the campaign. Using Google Trends, we explored the relative search volume (RSV) for the terms 'anxiety', 'depression', 'stress', 'insomnia', and 'suicide' between 03/01/2020 and 01/15/2022. The RSV was compared for these terms with respect to four periods: the pre-vaccination pandemic period; the period running from initiation of vaccination until 50% of the population was fully vaccinated (FV); the period running from 50% FV to 70% FV; and the period after 70% FV. Differences in the RSV indices were observed between the studied periods for 'anxiety'(F = 6.07; p = 0.001; ƞ2 = 0.16), 'stress' (F = 7.77; p < 0.001; ƞ2 = 0.19), and 'insomnia' (F = 3.80; p = 0.013; ƞ2 = 0.11). A lower RSV was found for 'anxiety', 'stress', and 'insomnia' after 70% FV compared to the two previous vaccination periods. A lower RSV was also found for 'stress' after achieving the milestone of 70% FV in relation to the period prior to initiation of the campaign. In conclusion, there is less need for information on specific mental health topics in the period after 70% FV. In Spain, reaching this vaccination milestone may have had a positive impact on anxiety, stress, and insomnia levels in the population, as reflected in fewer web searches for information on these psychopathological processes. The promotion of the COVID-19 vaccination campaign could take into account the changes observed in this preliminary study with respect to public interest in stress, anxiety, and insomnia once a large percentage of the population has been vaccinated.

Efficacy of technology-based interventions in psychosis: a systematic review and network meta-analysis.

BACKGROUND: Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis. METHODS: Randomized controlled trials of outcomes of TBIs v. face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis. RESULTS: Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions (g = 0.16, p ≤ 0.0001) and to specific outcomes, namely, neurocognition (g = 0.13, p ≤ 0.0001), functioning (g = 0.25, p = 0.006), and social cognition (g = 0.32, p ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [g = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life (g = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology. CONCLUSIONS: TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.

Psicopatología general en profesionales sanitarios españoles durante la pandemia de Covid-19 y factores sociolaborales y psicológicos asociados / General psychopathology in Spanish health professionals during the Covid-19 pandemic and associated socio-occupational and psychological factors

El objetivo del estudio fue analizar las características sociolaborales, el estrés percibido, las estrategias de afrontamiento y la sintomatología psicopatológica de profesionales sanitarios y la relación entre ellas, durante la pandemia de Covid-19. Participaron 135 sanitarios (médicos, enfermeros y otros), quienes obtuvieron valores superiores a los datos normativos en las puntuaciones medias de las medidas de estrés percibido, ansiedad fóbica y ansiedad. El grupo de médicos mostró un nivel de ansiedad y somatización más bajo que el grupo formado por otros profesionales sanitarios. Ser profesional médico, tener un menor grado de estrés subjetivo percibido, más afrontamiento activo y menos afrontamiento pasivo eran predictores significativos de la presencia de menos síntomas psicopatológicos. La descripción del perfil del profesional sanitario español con un menor riesgo de mostrar sintomatología psicopatológica puede ser de utilidad para identificar a grupos de sanitarios con mayor vulnerabilidad psicológica. Los hallazgos sugieren factores psicológicos específicos de interés a considerar en las intervenciones destinadas al abordaje de las necesidades de salud mental de esta población en el contexto sanitario generado por la Covid-19. (AU)

The objective of this study was to analyze the socio-occupational features, perceived stress, coping strategies and self-reported psychopathological symptoms of different groups of health professionals and the relationship among these variables during the Covid-19 pandemic. One hundred and thirty-five healthcare workers participated (medical staff, nursing staff and other health professionals), who obtained higher values than the normative data in the mean scores of perceived stress, phobic anxiety, and anxiety measures. The medical staff group showed a lower level of anxiety and somatization than the other group of healthcare professionals. Being a medical professional, having a lower level of perceived subjective stress, a greater proportion of active coping and lesser passive coping were significant predictors of fewer psychopathological symptoms. The description of a health professional profile with a lower risk of showing psychopathological symptoms can help identify healthcare groups with greater psychological vulnerability. The findings suggest specific psychological factors of interest to consider in interventions aimed at addressing the mental health needs of this population in the health context generated by Covid-19. (AU)

Neuropsychological functioning and suicidal behaviours in patients with first-episode psychosis: A systematic review.

INTRODUCTION: Suicidal behaviour is particularly frequent in patients with psychosis. Therefore, prevention is a key objective of mental health policies. The aim of the current work is to systematically review the association between neurocognitive functioning and suicidal behaviour in patients with first-episode psychosis (FEP). MATERIAL AND METHODS: Of the 3051 studies reviewed, only 7 met the inclusion criteria. Documents in English from their earliest date of coverage until January 2022 were searched for in the following databases: PubMed, Science Direct, Web of Science, Cochrane Library, PsycINFO (ProQuest), and Springerlink. We used the PICO strategy to collect and categorize the data from each selected manuscript. RESULTS: Overall, the results showed that the risk of suicidal behaviour is higher for FEP patients in the presence of a number of factors: poorer general neuropsychological functioning (except for working memory), poorer social cognition, more depressive symptoms, longer duration of untreated psychosis, higher awareness of the illness, poorer premorbid adjustment, and more frequent cannabis use. DISCUSSION: Comprehensive general neuropsychology and assessment of social cognition, together with routine clinical record keeping, may help to identify FEP patients at a greater risk of attempting suicide.

A Multicentre, Randomised, Controlled Trial of a Combined Clinical Treatment for First-Episode Psychosis.

INTRODUCTION: There is evidence that early intervention contributes to improving the prognosis and course of first-episode psychosis (FEP). However, further randomised treatment clinical trials are needed. OBJECTIVES: The aim of this study was to compare the efficacy of a combined clinical treatment involving Cognitive Behavioural Therapy (CBT) as an adjunctive to treatment-as-usual (TAU) (CBT+TAU) versus TAU alone for FEP. PATIENTS AND METHODS: In this multicentre, single-blind, randomised controlled trial, 177 participants were randomly allocated to either CBT+TAU or TAU. The primary outcome was post-treatment patient functioning. RESULTS: The CBT+TAU group showed a greater improvement in functioning, which was measured using the Global Assessment Functioning (GAF) and Functioning Assessment Short Test (FAST), compared to the TAU group post-treatment. The CBT+TAU participants exhibited a greater decline in depressive, negative, and general psychotic symptoms; a better awareness of the disease and treatment adherence; and a greater increase in brain-derived neurotrophic factor levels than TAU participants. CONCLUSIONS: Early intervention based on a combined clinical treatment involving CBT as an adjunctive to standard treatment may improve clinical and functional outcomes in FEP.

A systematic review of suicide and suicide attempts in adolescents with psychotic disorders.

BACKGROUND: Suicide is the main cause of premature death in patients with psychosis. Therefore, the goal of the present study was to review suicide in adolescents with psychotic disorders by evaluating factors associated with suicidal acts. Ours is the first systematic review of suicide in this population. METHOD: We performed a systematic review of suicide in adolescents (10 to 19 years) with psychotic disorder. RESULTS: We identified 10 studies, only 2 of which were randomized clinical trials. The results revealed high rates of suicidal behaviour in this population: the times of higher risk were the time before admission and the period immediately following discharge. The factors most associated with suicide attempts were depression, distress with psychotic symptoms, fewer negative symptoms at baseline, positive symptoms, and anxiety disorders. Associated factors included previous psychiatric history or psychiatric admissions, female sex, prior suicidal behaviour, family history of completed suicide, and nicotine dependence. LIMITATIONS: Clinical and methodological diversity of the studies. CONCLUSIONS: Adolescents with psychotic disorders had a major risk of suicidal behaviour, and specific factors were associated with the act. Early detection of adolescents with psychosis is vital, since it has been found that early intervention can prevent suicidal acts in young people. However, it is necessary to perform more studies, particularly randomized controlled trials, on suicide and suicide attempts, particularly in adolescents.

Cannabis use and nonuse in patients with first-episode psychosis: A systematic review and meta-analysis of studies comparing neurocognitive functioning.

BACKGROUND: The implications of cannabis use in the onset of early psychosis and the severity of psychotic symptoms have resulted in a proliferation of studies on this issue. However, few have examined the effects of cannabis use on the cognitive symptoms of psychosis (i.e., neurocognitive functioning) in patients with first-episode psychosis (FEP). This systematic review and meta-analysis aim to assess the neurocognitive functioning of cannabis users (CU) and nonusers (NU) with FEP. METHODS: Of the 110 studies identified through the systematic review of 6 databases, 7 met the inclusion criteria, resulting in 14 independent samples and 78 effect sizes. The total sample included 304 CU with FEP and 369 NU with FEP. The moderator variables were age at first use, duration of use, percentage of males, and age. RESULTS: Effect sizes were not significantly different from zero in any neurocognitive domain when users and NU were compared. Part of the variability in effect sizes was explained by the inclusion of the following moderator variables: (1) frequency of cannabis use (ß = 0.013, F = 7.56, p = 0.017); (2) first-generation antipsychotics (ß = 0.019, F = 34.46, p ≤ 0.001); and (3) country where the study was carried out (ß = 0.266, t = 2.06, p = 0.043). CONCLUSIONS: This meta-analysis indicates that cannabis use is not generally associated with neurocognitive functioning in patients with FEP. However, it highlights the deleterious effect of low doses of cannabis in some patients. It also stresses the importance of the type of antipsychotic prescription and cannabis dose as moderator variables in the neurocognitive functioning of CU with FEP.

A systematic review of online interventions for families of patients with severe mental disorders.

BACKGROUND: Several studies show the effectiveness of face-to-face interventions with families in improving the prognosis of patients with severe psychiatric disorders and their relatives; however, the effectiveness of online interventions is poorly understood. The current study aims to provide an overview of evidence for the effectiveness of online treatments (web/app) for patients with severe psychiatric disorders and their families. METHOD: We performed a systematic review of online treatments for informal family caregivers of patients with a severe psychiatric disorder. The study psychological interventions had to have been administered in an exclusively online format (app, internet) and aimed at families of patients with severe mental disorder (at least one of first episode psychosis, schizophrenia, schizoaffective, bipolar disorder, and psychotic disorder). RESULTS: Of a total of 1331 articles, we identified 9 viable studies; 4 randomized clinical trials, and 5 nonrandomized clinical studies. The present study is the first systematic review in this area. Online interventions were well accepted, with good adherence and satisfaction among the caregivers and patients and improved the symptoms of both caregivers and patients. LIMITATIONS: Clinical and methodological diversity of the studies. CONCLUSIONS: Burden improved, and perceived stress decreased in families. Moreover, the severity of positive symptoms decreased and fewer hospitalizations were recorded in patients than in the control group. Therefore, online interventions are a promising therapeutic approach for patients with severe mental disorder and their families. However, more studies-particularly randomized clinical trials-are needed in this area.

Mobile App-Based Intervention for Adolescents With First-Episode Psychosis: Study Protocol for a Pilot Randomized Controlled Trial.

Introduction: Previous studies have shown an improvement in the access to treatment for patients with first-episode psychosis (FEP), specifically young patients, through mobile app-based interventions. The aim of this study is to test the effectiveness of a mobile app-based intervention to improve community functioning in adolescents with FEP. Mobile app-based interventions could increase quality of life and disease awareness, which improve adherence to treatment and reduce the frequency of relapses and rehospitalizations in adolescents with FEP. Methods: This article describes a mobile app treatment and the pilot trial protocol for patients with FEP. We will perform a single-blind randomized clinical trial (RCT) including patients with FEP aged 14-19 years recruited from Gregorio Marañón Hospital, Madrid, Spain. Patients will be randomly assigned to an intervention group, which will receive treatment as usual plus five modules of a psychological intervention through the mobile app (psychoeducation, recognition of symptoms and prevention of relapses, problem solving, mindfulness, and contact wall), or to a control group (standard care). The effectiveness of the intervention will be assessed by means of an extensive battery of clinical tests at baseline and at 3 months of follow-up. The primary outcome is reduction in psychotic and depressive symptoms; secondary outcomes comprise adherence, awareness, use of drugs, and quality of life. Data will be analyzed on an intention-to-treat (ITT) basis. Mixed model repeated-measures analysis will be used to explore the following effect: group × time interaction between the control group and the intervention group for clinical and functional variables during the follow-up period. Discussion: This is an innovative study for the assessment of a psychological intervention through a mobile app for patients with FEP during the critical period. This pilot RCT is intended to be a precursor to larger studies, which in turn could facilitate dissemination of mobile app therapy for patients with FEP. Ethics and Dissemination: The local ethics committee approved the study protocol. All participants must sign the informed consent, to participate. After finalizing the study, the results will be published. Trial registration: NCT03161249. NCT clinicaltrials.gov. Date of registration in primary registry 02 May 2017. clinicaltrials.gov.

Psychometric properties and validation of a four-item version of the Strauss-Carpenter scale in bipolar disorder.

BACKGROUND: Bipolar disorder is a chronic illness that impairs functioning and affects the quality of life of patients. The onset of this illness usually occurs at an early age, and the risk of relapse remains high for decades. Thus, due to the great clinical relevance of identifying long-term predictors of functioning in bipolar disorder, Strauss and Carpenter developed a scale composed of items known to have prognostic value. METHODS: To determine the clinical usefulness of the four-item Strauss-Carpenter scale in bipolar disorder, a 1-year prospective follow-up study was carried out. The internal consistency, convergent and discriminant validity, and test-retest reliability of the scale were assessed. We also compared the Strauss-Carpenter scale with the reference scales Global Assessment Functioning (GAF), Clinical Global Impression for Bipolar Disorder, the Modified Version (CGI-BIP-M) and the Sheehan Disability Scale (Sheehan). Additionally, a cut-off point for remission was established. RESULTS: The total sample was composed of 98 patients with a diagnosis of bipolar disorder. The four-item version of the Strauss-Carpenter scale showed to have appropriate psychometric properties, comparable to those of reference scales. The best cut-off point for remission was 14. CONCLUSIONS: The four-item version of the Strauss-Carpenter scale has suitable validity and reliability for the assessment of functioning in patients with bipolar disorder.

Spanish version of the link´s perceived devaluaton and discrimination scale / Versión española de la escala Perceived Devaluation and Discrimination de Link

BACKGROUND: The aim of this study is to translate, adapt and validate the «Perceived Devaluation and Discrimination Scale» (PDD) in Spanish in a sample of people with schizophrenia. METHOD: A total of 130 people between 18 and 65 years and with a diagnosis of schizophrenia according to DSM-IV-R criteria from Barcelona and Vitoria were included. The patients were assessed with the translated version of the PDD, the Social Functioning Scale (SFS), the Global Assessment of Functioning (GAF), the Clinical Global Impression Scale (CGI-S) and the Self-perception of Stigma Questionnaire for people with schizophrenia (SSQ). RESULTS: The questionnaire scored a Cronbach's a of .868 regarding its internal consistency reliability. Two components were found in the factorial analysis explaining 40% of the variance of the instrument (component 1 associated with individual self-perception and component 2 refers more to social stigma). The stability of the instrument measured using the intraclass correlation coefficient on both occasions oscillated between .415 and .806. Significant correlations were found with SSQ and SFS. CONCLUSIONS: The Spanish version of the PDD seems a good instrument for the assessment of self stigma

ANTECEDENTES: el objetivo de este estudio es traducir, adaptar y validar la «Perceived Devaluation and Discrimination Scale» (PDD) en español en una muestra de personas con esquizofrenia. MÉTODO: se incluyeron un total de 130 personas de entre 18 y 65 años con un diagnóstico de esquizofrenia según los criterios del DSM-IV-R de Barcelona y Vitoria. Los pacientes fueron evaluados con la versión traducida de la PDD, la Escala de Funcionamiento Social (SFS), la Evaluación Global de Funcionamiento (GAF), la escala Clinical Global Impresión (CGI-S) y la autopercepción de Estigma Cuestionario para las personas con esquizofrenia (SSQ). RESULTADOS: la consistencia interna del cuestionario, evaluada utilizando a de Cronbach, fue .868. Dos componentes fueron encontrados en el análisis factorial explicando el 40% de la varianza del instrumento (componente 1 asociado a la auto-percepción y el componente 2 individual se refiere más al estigma social). Los valores de estabilidad temporal medidos utilizando el coeficiente de correlación intraclase en ambas ocasiones oscilan entre .415 y .806. Se encontraron correlaciones significativas con SSQ y SFS. CONCLUSIONES: la versión española de PDD parece un buen instrumento para la evaluación del auto-estigma

Spanish version of the Link's Perceived Devaluation and Discrimination scale.

BACKGROUND: The aim of this study is to translate, adapt and validate the “Perceived Devaluation and Discrimination Scale” (PDD) in Spanish in a sample of people with schizophrenia. METHOD: A total of 130 people between 18 and 65 years and with a diagnosis of schizophrenia according to DSM-IV-R criteria from Barcelona and Vitoria were included. The patients were assessed with the translated version of the PDD, the Social Functioning Scale (SFS), the Global Assessment of Functioning (GAF), the Clinical Global Impression Scale (CGI-S) and the Self-perception of Stigma Questionnaire for people with schizophrenia (SSQ). RESULTS: The questionnaire scored a Cronbach’s a of .868 regarding its internal consistency reliability. Two components were found in the factorial analysis explaining 40% of the variance of the instrument (component 1 associated with individual self-perception and component 2 refers more to social stigma). The stability of the instrument   measured using the intraclass correlation coefficient on both occasions oscillated between .415 and .806. Significant correlations were found with SSQ and SFS. CONCLUSIONS: The Spanish version of the PDD seems a good instrument for the assessment of self stigma.

Integrated treatment of first episode psychosis with online training (e-learning): study protocol for a randomised controlled trial.

BACKGROUND: The integrated treatment of first episode psychosis has been shown to improve functionality and negative symptoms in previous studies. In this paper, we describe a study of integrated treatment (individual psychoeducation complementary to pharmacotherapy) versus treatment as usual, comparing results at baseline with those at 6-month re-assessment (at the end of the study) for these patients, and online training of professionals to provide this complementary treatment, with the following objectives: 1) to compare the efficacy of individual psychoeducation as add-on treatment versus treatment as usual in improving psychotic and mood symptoms; 2) to compare adherence to medication, functioning, insight, social response, quality of life, and brain-derived neurotrophic factor, between both groups; and 3) to analyse the efficacy of online training of psychotherapists. METHODS/DESIGN: This is a single-blind randomised clinical trial including patients with first episode psychosis from hospitals across Spain, randomly assigned to either a control group with pharmacotherapy and regular sessions with their psychiatrist (treatment as usual) or an intervention group with integrated care including treatment as usual plus a psychoeducational intervention (14 sessions). Training for professionals involved at each participating centre was provided by the coordinating centre (University Hospital of Álava) through video conferences. Patients are evaluated with an extensive battery of tests assessing clinical and sociodemographic characteristics (Positive and Negative Syndrome Scale, State-Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, Hamilton Rating Scale for Depression, Scale to Assess Unawareness of Mental Disorders, Strauss and Carpenter Prognostic Scale, Global Assessment of Functioning Scale, Morisky Green Adherence Scale, Functioning Assessment Short Test, World Health Organization Quality of Life instrument WHOQOL-BREF (an abbreviated version of the WHOQOL-100), and EuroQoL questionnaire), and brain-derived neurotrophic factor levels are measured in peripheral blood at baseline and at 6 months. The statistical analysis, including bivariate analysis, linear and logistic regression models, will be performed using SPSS. DISCUSSION: This is an innovative study that includes the assessment of an integrated intervention for patients with first episode psychosis provided by professionals who are trained online, potentially making it possible to offer the intervention to more patients. TRIAL REGISTRATION: NCT01783457 clinical trials.gov. Date of registration in primary registry 23 January 2013.

Mindfulness-based cognitive therapy versus psychoeducational intervention in bipolar outpatients with sub-threshold depressive symptoms: a randomized controlled trial.

BACKGROUND: The presence of depressive subsyndromal symptoms (SS) in bipolar disorder (BD) increases the risk of affective relapse and worsens social, cognitive functioning, and quality of life. Nonetheless, there are limited data on how to optimize the treatment of subthreshold depressive symptoms in BD. Mindfulness-Based Cognitive Therapy (MBCT) is a psychotherapeutic intervention that has been shown effective in unipolar depression. The assessment of its clinical effectiveness and its impact on biomarkers in bipolar disorder patients with subsyndromal depressive symptoms and psychopharmacological treatment is needed. METHODS/DESIGN: A randomized, multicenter, prospective, versus active comparator, evaluator-blinded clinical trial is proposed. Patients with BD and subclinical or mild depressive symptoms will be randomly allocated to: 1) MBCT added to psychopharmacological treatment; 2) a brief structured group psychoeducational intervention added to psychopharmacological treatment; 3) standard clinical management, including psychopharmacological treatment. Assessments will be conducted at screening, baseline, post-intervention (8 weeks) and 4 month follow-up post-intervention. The aim is to compare MBCT intervention versus a brief structured group psychoeducation. Our hypothesis is that MBCT will be more effective in reducing the subsyndromal depressive symptoms and will improve cognitive performance to a higher degree than the psychoeducational treatment. It is also hypothesized that a significant increase of BDNF levels will be found after the MBCT intervention. DISCUSSION: This is the first randomized controlled trial to evaluate the effects of MBCT compared to an active control group on depressive subthreshold depressive symptoms in patients with bipolar disorder. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02133170. Registered 04/30/2014.

Cannabis use and involuntary admission may mediate long-term adherence in first-episode psychosis patients: a prospective longitudinal study.

BACKGROUND: This study aimed to examine factors associated with treatment adherence in first-episode psychosis (FEP) patients followed up over 8 years, especially involuntary first admission and stopping cannabis use. METHODS: This prospective, longitudinal study of FEP patients collected data on symptoms, adherence, functioning, and substance use. Adherence to treatment was the main outcome variable and was categorized as 'good' or 'bad'. Cannabis use during follow-up was stratified as continued use, stopped use, and never used. Bivariate and logistic regression models identified factors significantly associated with adherence and changes in adherence over the 8-year follow-up period. RESULTS: Of the 98 FEP patients analyzed at baseline, 57.1% had involuntary first admission, 74.4% bad adherence, and 52% cannabis use. Good adherence at baseline was associated with Global Assessment of Functioning score (p = 0.019), Hamilton Depression Rating Scale score (p = 0.017) and voluntary admission (p < 0.001). Adherence patterns over 8 years included: 43.4% patients always bad, 26.1% always good, 25% improved from bad to good. Among the improved adherence group, 95.7% had involuntary first admission and 38.9% stopped cannabis use. In the subgroup of patients with bad adherence at baseline, involuntary first admission and quitting cannabis use during follow up were associated with improved adherence. CONCLUSIONS: The long-term association between treatment adherence and type of first admission and cannabis use in FEP patients suggest targets for intervention to improve clinical outcomes.