Mixed symptoms in major depressive and bipolar disorders: A systematic review.

BACKGROUND: The DSM-5 mixed features specifier for mood disorders encourages renewed interest in mixed states and led us to pool research findings regarding prevalence of mixed features in episodes of major depressive (MDD) and bipolar disorders (BD). METHODS: We systematically searched to July 2017 for reports on mixed symptoms in depressive episodes of MDD and in depression and mania or hypomania in types I and II BD. For primary mood-states and diagnostic groups we compared rates of the presence of mixed symptoms: as defined by DSM-5 (≥3 features opposite to the dominant mood-polarity but not overlapping those of the primary disorder) or as having any ≥3 features of opposite polarity. RESULTS: We identified 17 reports, from 13 world regions involving 19,198 participants meeting standard diagnostic criteria for an index major depressive or [hypo]manic episode. Prevalence of cases with ≥3 features of opposite polarity averaged 27.8% [CI: 27.2-28.5] overall, and differed significantly between BD and MDD disorders, ranking: BD-depressed (35.2% [33.8-36.5]) = BD-[hypo]manic (35.1% [32.9-37.3]) > MDD-depressed (23.8% [23.0-24.5]). LIMITATIONS: Available findings were limited to mood disorders with mixed features by particular criteria, with few comparisons to other criteria or to their prognostic or therapeutic implications. CONCLUSIONS: Prevalence of ≥3 features of opposite polarity ranked: depressive = [hypo]manic episodes of BD > depression in MDD.

Perceived Health Control: A Promising Step Forward in Our Understanding of Treatment Adherence in Psychiatric Care.

OBJECTIVE: To examine the role of perceived health control variables in psychiatric patients' adherence to prescribed treatment. METHODS: Cross-sectional study including 966 consecutive adult Spanish psychiatric outpatients attended from October 2013 to April 2014 at community mental health services in the Canary Islands. Diagnoses were made using the ICD-10 criteria. Participants completed the 8-item self-report Morisky Medication Adherence Scale, Form C of the Multidimensional Health Locus of Control Scale, the General Self-Efficacy Scale, and the Hong Psychological Reactance Scale at their regular clinic visit. Sociodemographic and clinical variables were gathered. Logistic regression analyses were conducted to determine the predictive power of the variables studied. RESULTS: The present findings confirm that the control beliefs variables studied are related to psychiatric patients' self-reported adherence and support the dual health control hypothesis. This hypothesis specifies that the balance between internal and external health control beliefs (ie, the extent to which individuals attribute their health to their own actions or to external agents such as doctors, significant other people, or chance) is related to adherence to prescribed treatment. Results from logistic regression analysis indicated that health control beliefs interact with psychological reactance, exerting their effects on patients' adherence (12.8% of the variance explained and 64.2% of patients were correctly classified). It was found that low scores on both internal and external health control beliefs (P < .001) as well as low level of affective (P < .001) and cognitive (P < .001) psychological reactance best predicted self-reported adherence. CONCLUSIONS: The knowledge of control constructs beliefs in psychiatric outpatients could allow the psychiatrist to predict noncompliance, monitor patient progression more closely, and individualize patient education in an effort to increase treatment adherence in patients who have difficulties adhering to treatment plans.

Treatment-related decisional conflict in patients with depressive and anxious disorders.

PURPOSE: To determine the level of treatment-related decisional conflict in patients with emotional disorders and to establish its relationship with sociodemographic and clinical variables. METHODS: We conducted a cross-sectional survey on a convenience sample of 321 consecutive psychiatric outpatients with emotional disorders. All patients completed self-report questionnaires assessing sociodemographic and clinical variables, patients' preference of participation in decision making, perceived decisional conflict about treatment, adherence to prescribed treatment, and satisfaction with the psychiatric care provided. Multiple correspondences analysis was used to investigate relationships of decisional conflict with the variables of interest. RESULTS: Approximately, two-thirds of psychiatric outpatients self-reported decisional conflict regarding their treatment. Interestingly, the presence of decisional conflict did not influence significantly patients' preferences of participation or their adherence to prescribed treatment. Patients without decisional conflict registered significantly higher satisfaction. Multiple correspondences analysis evidenced two clear profiles: patients without decisional conflict received the treatment they preferred, mainly psychotherapy or combined treatment, had been under psychiatric treatment for longer than 5 years, and self-reported high satisfaction with health care received; on the other hand, patients with decisional conflict did not receive the treatment they preferred, were treated with pharmacotherapy alone for a period of time between 1 and 5 years, and self-reported medium satisfaction with received health care. CONCLUSION: The high level of decisional conflict found in patients with depression and anxiety attending a secondary care service could be an important driving force when personalizing and tailoring information and teaching skills to patients about their illnesses and their treatments.

What do psychiatric patients believe regarding where control over their illness lies? Validation of the multidimensional health locus of control scale in psychiatric outpatient care.

Patients' perceived control constructs are important factors moderating health-related behaviors. We established the psychometric properties of the Spanish version of the Form C Multidimensional Health Locus of Control Scale (C-MHLC) and assessed the usefulness of these measures in the clinical setting. A cross-sectional survey querying about patients' health locus of control (HLOC) beliefs was offered to 607 psychiatric outpatients, of whom 507 accepted. The C-MHLC scale and the General Perceived Self-Efficacy Scale were completed. The psychiatric patients believe that their psychiatrist plays a crucial role in improving their state of health. The men scored higher than the women in internal dimension; the women scored higher in other people external dimension. Age, treatment time, and number of psychoactive drugs used showed significant differences in HLOC dimensions. Self-efficacy correlated positively with internal dimension and negatively with external dimensions. The results showed the validity of the four-factor structure of the Spanish version of the C-MHLC.

Las competencias parentales en contextos de riesgo psicosocial / Parental competences in psychosocial risk context

El análisis y la evaluación de las competencias parentales es una tarea central en los Servicios Sociales y concretamente en los Servicios especializados de atención a las familias en situación de riesgo psicosocial. Es imprescindible conocerlas y evaluarlas, entre otros motivos, para tomar medidas de apoyo a la unidad familiar o incluso para determinar si es necesario retirar a un menor de su familia. Paradójicamente, ésta ha sido un área de investigación poco explorada y ha ocupado también un lugar secundario en el campo de la protección de menores. Por ello, es importante clarificar qué se entiende por competencia parental, cuáles son las competencias parentales consideradas básicas para la educación saludable y positiva de los menores y poder contar con directrices claras para que los técnicos puedan llevar a cabo la evaluación de las mismas. El presente artículo pretende dar respuesta a estas cuestiones mencionadas (AU)

The analysis and evaluation of parental competences is a central task for the Social Services and specifically for those services targeted at families living in psychosocial risk circumstances. The evaluation of parental competence can be used, among others motives, to take support measures to the family or even to determine if it is necessary to displace the children from his/her home. Despite of its importance, it is an area of study under exploited that also plays a secondary role in the field of child protection. For this reason, it is important to clarify what is meant by parental competence, which are the parental competences considered as basic for the healthy and positive parenting of the children, as well as to have clear guidelines to profesionals for carrying out the assessment of these competences. The current article tries to give answers to the questions mentioned (AU)