Incidence of Perinatal Post-Traumatic Stress Disorder in Catalonia: An Observational Study of Protective and Risk Factors.

Pregnancy and childbirth have a great impact on women's lives; traumatic perinatal experiences can adversely affect mental health. The present study analyzes the incidence of perinatal post-traumatic stress disorder (PTSD) in Catalonia in 2021 from data obtained from the Registry of Morbidity and Use of Health Resources of Catalonia (MUSSCAT). The incidence of perinatal PTSD (1.87%) was lower than in comparable studies, suggesting underdiagnosis. Poisson regression adjusting for age, income, gestational weeks at delivery, type of delivery, and parity highlighted the influence of sociodemographics, and characteristics of the pregnancy and delivery on the risk of developing perinatal PTSD. These findings underline the need for further research on the risk factors identified and for the early detection and effective management of PTSD in the perinatal setting.

Impact of Delusions and Hallucinations on Clinical Insight Dimensions in Schizophrenia Spectrum Disorders.

INTRODUCTION: Insight in psychosis has been conceptualized as a continuous, dynamic, and multidimensional phenomenon. This study aims to determine the impact of delusions and hallucinations in different dimensions of clinical insight in schizophrenia spectrum disorders. METHODS: Cross-sectional multicenter study including 516 patients (336 men) diagnosed with schizophrenia spectrum disorders. Based on dichotomized scores of Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations), patients were assigned to four groups according to current clear presence of delusions (scores 4 or above 4 in PANSS item P1) and/or hallucinations (scores 4 or above 4 in PANNS item P3). Insight was assessed using the three main dimensions of the Scale of Unawareness of Mental Disorder (SUMD). RESULTS: Around 40% of patients showed unawareness of illness; 30% unawareness of the need for treatment; and 45% unawareness of the social consequences of the disorder. Patients with current clear presence of delusions had higher overall lack of awareness, regardless of current clear presence of hallucinations. Similarly, the clear presence of delusions showed a greater predictive value on insight than the presence of hallucinations, although the implication of both in the prediction was modest. CONCLUSIONS: Our results confirm that lack of insight is highly prevalent in schizophrenia spectrum disorders, particularly when patients experience delusions. This study adds insight-related data to the growing symptom-based research, where specific types of psychotic experiences such as hallucinations and delusions could form different psychopathological patterns, linking the phenomenology of delusions to a lack of clinical insight.

Detección de violencia machista entre las mujeres atendidas por tentativa autolítica en un servicio de urgencias / Detection of interpersonal partner violence among women treated for attempted suicide in an emergency department

Introducción: Existe evidencia sobre una asociación directa entre la Violencia Machista/Violencia de Género (VdG) y el suicidio, e incluso se señala que la VdG es el principal factor precipitante para que una mujer realice una tentativa suicida. Además, se ha demostrado que las mujeres con enfermedades mentales crónicas sufren especialmente más violencia que la población en general. Sin embargo, existen relativamente pocos datos sobre la capacidad de detección de VdG de los servicios de urgencias. En Catalunya, el Programa Código Riesgo de Suicidio (CRS) atendió a 12.596 persones con episodios de conducta suicida y ha demostrado su eficacia en nuestro hospital. Objetivo principal: Cuantificar el grado de detección de la VdG de nuestros registros sanitarios en mujeres visitadas en el servicio urgencias de nuestro hospital por ideación y/o tentativa suicida y que han sido incluidas en el Programa CRS. Hipótesis principal: La detección actual de VdG en las mujeres es <10%. Metodología: Estudio descriptivo retrospectivo basado en registros electrónicos sanitarios. Se identificaron todas las mujeres que habían estado en seguimiento telefónico en los últimos 12 meses por haber acudido al servicio de urgencias de nuestro Hospital por ideación y/o intento suicida. El período de análisis incluyó del 1 de enero al 31 de diciembre de 2020. Se realizó una revisión completa de todos los informes de alta de estas mujeres visitadas en urgencias y de los registros clínicos de todos los profesionales (médicos, psiquiatrías, enfermeras...) disponibles en la historia clínica informatizada. Se realizó un análisis descriptivo simple de los datos. Resultados: Durante el período de estudio, se detectaron cuatro casos de violencia machista/VdG (1,92%) y dos casos de violencia familiar entre las 208 mujeres que se visitaron por ideación y/o intento autolítico...(AU)

Introduction: There is evidence of a direct association between interpersonal partner/sexist/gender violence (IPV) and suicide, and it is even pointed out that IPV is the main precipitating factor for a woman to make a suicide attempt. In addition, it has been shown that women with chronic mental illness suffer especially more violence than the general population. However, there is relatively little data on the IPV detection capacity of emergency departments. In Catalonia, the Suicide Risk Code Program (CRS) treated 12,596 people with episodes of suicidal behaviour and has demonstrated its effectiveness in our hospital. Main objective: To quantify the degree of detection of IPV in our health records in women visited in the emergency department of our hospital for suicidal ideation and/or attempt and who have been included in the CRS Program.Main hypothesis: Current detection of IPV in women is <10%. Methodology: Retrospective descriptive study based on electronic health records. All the women who had been in telephone follow-up in the last 12 months for having gone to the emergency department of our hospital for suicidal ideation and/or attempt were identified. The analysis period included from January 1 to December 31, 2020. A complete review of all the discharge reports of the women visited in the emergency room and of all the clinical records of all the professionals (doctors, psychiatrists, nurses...) available in the computerized medical record was carried out. A simple descriptive analysis of the data was performed. Results: During the study period, four cases of IPV (1.92%) and two cases of family violence were detected among the 208 women who were visited for suicidal ideation and/or attempt. All the women who were detected with IPV were recommended to visit the Women’s Care Center, but it is unknown if they were actually referred to other professionals or if they actually attended...(AU)

Impacto psicológico inicial e incidencia de trastorno mental en torno a las interrupciones voluntarias del embarazo (IVE): un estudio piloto en población general / Initial psychological impact and incidence of mental disorders Around voluntary terminations of pregnancy (vtp): a pilot Study in the general population

Introducción/Antecedentes: Existe todavía una insuficiente evidencia científica sobre los efectos psicológicos/psicopatológicos y emocionales de las interrupciones voluntarias del embarazo (IVE), especialmente en nuestro entorno. Los estudios previos sobre el tema se caracterizan por 1) ofrecer resultados dispares, 2) estudiar depresión, ansiedad, trastorno por estrés postraumático y abuso de sustancias, pero al mismo tiempo 3) existen cuestiones metodológicas que limitan la generalización de los resultados. Objetivos: Describir una muestra de mujeres de población general que realizaron una IVE en un servicio público de Atención a la Sexual y Reproductiva (ASSIR) de Catalunya. Métodos: Estudio piloto de pacientes provenientes de población general y atendidas en nuestras consultas de Ginecología del Servicio de Atención a la Salud Sexual y Reproductiva (ASSIR) de Osona a Vic (Barcelona). Las pacientes fueron evaluadas siguiendo escalas estandarizadas, incluyendo la MINI (Mini Psychiatric Interview) y la Escala de Depresión de Hamilton. El seguimiento fue durante cuatro meses. Se realizó una estadística descriptiva. Resultados: Hasta 23 mujeres fueron incluidas en la muestra piloto. La edad media era joven (31.4 años). La mayoría (62.5%) estaban activas laboralmente y tenías estudios equivalentes al bachillerato o superiores (52.2%). El 26.1% habían tenido IVE previas. La IVE actual fue mayoritariamente farmacológica (73.9%). El principal motivo fue su voluntad (86.9%). Tres mujeres puntuaron más de 7 puntos en la Escala de Depresión de Hamilton. La entrevista diagnóstica MINI identificó diez mujeres con criterios para enfermedad mental en ese momento. De estas diez mujeres, seis no tenían antecedentes familiares ni personales de enfermedad mental, mientras que cuatro ya tenían antecedentes personales de alguna patología mental y ya habían consultado anteriormente en alguna ocasión al Servicio de Psiquiatría...(AU)

Introduction/Background: There is still insufficient scientific evidence on the psychological/psychopathological and emotional effects of voluntary terminations of pregnancy (V.T.P.), especially in our setting. Previous studies on the subject are characterized by 1) mixed results, 2) studying depression, anxiety, post-traumatic stress disorder and substance abuse, but at the same time 3) there are methodological issues that limit the generalizability of the results. Objectives: To describe a sample of women from the general population who underwent an abortion in a public center of the Sexual and Reproductive Assistance Network (ASSIR) of Catalonia. Methodology: Pilot study of patients from the general population attended in our Sexual and Reproductive Health outpatient clinics at the ASSIR of Osona (Vic, Barcelona). Patients were assessed using standardized scales, including the MINI (Mini Psychiatric Interview) and the Hamilton Depression Scale. Follow-up was for four months. Descriptive statistics were performed. Results: Up to 23 women were included in the pilot sample. The average age was young (31.4 years). The majority (62.5%) were active in the labour market and had a high school education or higher (52.2%). 26.1% had had a previous VTP. The current abortion was mostly pharmacological (73.9%). The main reason was willingness (86.9%). Three women scored more than 7 points on the Hamilton Depression Scale. The MINI diagnostic interview identified ten women with criteria for mental illness at that time. Of these ten women, six had no family or personal history of mental illness, while four had a personal history of mental illness and had previously consulted the psychiatric service. After the abortion, during the following four months, only one patient consulted the psychology service and was subsequently discharged...(AU)

Enlentecimiento Obsesivo: Caso clínico y revisión bibliográfica / Obsessional slowness: a clinical case and bibliographic review

Introducción: El Enlentecimiento Obsesivo (EO) es un síndrome caracterizado por un enlentecimiento en la ejecución motora. Se caracteriza por un enlentecimiento conductual, una extrema me-ticulosidad, ausencia de ansiedad prodrómica o disconfort antes, durante o después del comportamiento, con relativa resistencia al mismo, siendo altamente incapacitante.Objetivos: Realizar una revisión bibliográfica del fenómeno del EO en la literatura reciente y mostrar un caso paradigmático aten-dido en nuestro Equipo.Métodos: Se ha realizado un método mixto. Por un lado, de descripción de un paciente diagnosticado de EO y por otro, de re-visión no sistemática mediante la base de datos Pubmed usando la palabra clave: “obsessional slowness”. Se excluyeron los estu-dios de validación de escalas del EO y aquellos estudios en que el EO aparece en otras patologías de manera comórbida como en el síndrome de Tourette, síndrome de Down o enlentecimiento aso-ciado a la depresión. Para la preservación de la confidencialidad y anonimato del paciente, se han modificado aspectos en relación a sus antecedentes biográficos.Resultados: El enlentecimiento obsesivo es una condición nor-malmente secundaria a un Trastorno Obsesivo Compulsivo. Tiene una escasa prevalencia, pero manifiesta casi siempre gravedad y tendencia deterioro. Va asociada a diversas comorbilidades psi-quiátricas (por ejemplo, Trastornos del Espectro Autista y/o Sín-drome de Tourette). Afecta fundamentalmente a hombres y tiene especificidades propias, como la falta de malestar prodrómico, la falta de resistencia subjetiva a la clínica y la presencia de clínica encubierta en ocasiones por las manifestaciones conductuales del enlentecimiento. Discusión Y Conclusiones: El tratamiento ha de ser multitécnico (en la parte más psicológica) y multidisciplinar. En todo caso, se ha de destacar que aún nos falta muchos conocimientos y actualización de los datos disponibles actualmente.(AU)

Introduction: Obsessive Slowness (OS) is a syndrome cha-racterized by a slowing in motor execution. It is characterized by behavioral slowing, extreme meticulousness, absence of prodromal anxiety or discomfort before, during or after the behavior, with rela-tive resistance to it, being highly incapacitating.Objectives: To carry out a bibliographic review of the OS phe-nomenon in the recent literature and to show a paradigmatic case treated in our Team.Methods: A mixed method has been carried out. On the one hand, a description of a patient diagnosed with OE and on the other, a non-systematic review using the Pubmed database using the keyword: “obsessional slowness”. Validation studies of OS scales and those studies in which OS appears in other comorbid patho-logies such as Tourette’s syndrome, Down’s syndrome or depres-sion-associated slowing were excluded. For the preservation of the confidentiality and anonymity of the patient, aspects in relation to his biographical background have been modified.Results: Obsessive slowing is a condition usually secondary to Obsessive Compulsive Disorder. It has a low prevalence, but al-most always manifests severity and a tendency to deterioration. It is associated with various psychiatric comorbidities (for example, Autism Spectrum Disorders and/or Tourette’s Syndrome). It fun-damentally affects men and has its own specificities, such as the lack of prodromal discomfort, the lack of subjective resistance to symptoms, and the presence of symptoms sometimes hidden by the behavioral manifestations of slowness.discussion and conclusion: The treatment must be multi-tech-nical as psychological therapies and multidisciplinary. In any case, it should be noted that we still lack much knowledge and updating of currently available data.(AU)

The Effects of Accompaniment on Maternal Anxiety During Elective Cesarean Delivery: A Quasi-experimental Study.

BACKGROUND: In Spain, allowing women to be accompanied by their partners during cesarean deliveries is a poorly consolidated practice. Going through this experience alone, not only deprives women from the opportunity of sharing the birth with their partners, but also, forces them to face, on their own, one of the most stressful experiences during pregnancy. OBJECTIVE: To analyze whether significant differences exist in levels of anxiety of women who receive an elective cesarean delivery, according to whether they are allowed to be accompanied by their partners. DESIGN: Quasi-experimental, longitudinal, prospective study, comparing a group of 31 women receiving elective cesarean deliveries, without the presence of their partners, with a group of 33 women with elective cesarean deliveries who were accompanied by their partners. Anxiety levels were assessed using the STAI-State/Trait scale. Participants were given a questionnaire to assess their level of satisfaction with the care received. RESULTS: Anxiety measured via total scores on the STAI-S scale was significantly lower (p < 0.004) among the women who were accompanied by their partners during the elective cesarean delivery (median = 25), compared to the group who were not (median = 50). The differences were also significant (p < 0.003) considering the impact of accompaniment upon the group with high scores in the STAI-S (> 31) and continue to be significant when using the cut-off point of very high scores on the STAI-S (> 45). CONCLUSIONS: Presence of partners during elective cesareans is a key factor for decreasing the anxiety caused by the surgery and for improving the overall experience of cesarean deliveries.

What is already known on this subject? Cesarean deliveries are one of the most stressful life experiences. Allowing women to be accompanied by their partners during cesarean deliveries is a poorly consolidated practice in some countries. Otherwise relevant international institutions recommend allowing an accompanying adult, present with the mother in the operating room during the entire process.What this study adds? Presence of partners during elective cesareans is a key factor for decreasing deliveries' anxiety, improving the overall experience, but it needs a mentality change in the obstetric and surgical team. These results could change the services organization in a more humane delivery, with overall positive impact in the patients' care.

Towards the Influence of Media on Suicidality: A Systematic Review of Netflix's 'Thirteen Reasons Why'.

Online streaming series 'Thirteen Reasons Why' (13RW), released in March 2017, was criticized for its sensationalist portrayal of the main character's suicide, leading some people to voice fears of a global contagion of self-harm behaviors. The current investigation provides a systematic review of original studies analyzing the role of 13RW as an influencing factor for suicide. Articles were identified through a systematic search of Medline, Web of Science, Scopus, PsycInfo, and a manual search of reference lists from inception until the 16 January 2023. Twenty-seven published articles were identified from an initial search of 496 studies. The positive effects of watching 13RW included a reduction in suicide stigma and a greater likelihood to discuss mental health concerns and seek for help. However, several studies reported negative outcomes, including significant increases in the rate of deaths by suicide in adolescents, the number of admissions for suicidal reasons, and the prevalence and severity of suicidal ideation and self-harm behaviors in vulnerable viewers. Still, due to methodological limitations, no causal relationship could be established. Preventive measures are required to alert of the risk and should be particularly addressed to susceptible subjects. Psychoeducational programs should be focused on this kind of phenomena in vulnerable populations.

An Exploratory Analysis on the 2D:4D Digit Ratio and Its Relationship with Social Responsiveness in Adults with Prader-Willi Syndrome.

Prader-Willi syndrome (PWS) is a genetic disorder produced by a lack of expression of paternally derived genes in the 15q11-13 region. Research has generally focused on its genetic and behavioral expression, but only a few studies have examined epigenetic influences. Prenatal testosterone or the maternal testosterone-to-estradiol ratio (MaTtEr) has been suggested to play an important role in the development of the 'social brain' during pregnancy. Some studies propose the 2D:4D digit ratio of the hand as an indirect MaTtEr measure. The relationship between social performance and MaTtEr has been studied in other neurodevelopmental conditions such as Autism Spectrum Disorder (ASD), but to our best knowledge, it has never been studied in PWS. Therefore, our study aims to clarify the possible existence of a relationship between social performance-as measured using the Social Responsiveness Scale (SRS)-and MaTtEr levels using the 2D:4D ratio. We found that, as a group, PWS individuals have shorter index and ring fingers than the control group, but no significant difference in the 2D:4D ratios. The 2D:4D ratio showed a correlation only with Restricted Interests and Repetitive Behavior Subscale, where a positive correlation only for male individuals with PWS was found. Considering only PWS with previous GH treatment during childhood/adolescence (PWS-GH), index and ring fingers did not show differences in length with the control group, but the 2D:4D ratio was significantly higher in the right or dominant hand compared to controls.

Initial Impact of Perinatal Loss on Mothers and Their Partners.

(1) Background: Perinatal Loss affects one in ten women worldwide. It is known to have a deep impact on the physical and psychological wellbeing of the mother. Moreover, there is a lack of information in regard to gender differences. The role of culture, environment, personal characteristics, and gender is yet to be determined in most reports; (2) Objective and Methods: Our aim is to study the initial impact of perinatal losses in an unselected sample of couples, focusing on gender differences. We conducted a longitudinal prospective study with 29 mothers and 17 fathers. Upon discharge from the hospital, they filled out the Edinburgh Postnatal Depression Scale (EPDS), among others. After one-month post-loss, they performed the EPDS and the Short Version of the Perinatal Grief Scale. We used descriptive statistics for the sample and non-parametric tests for the comparison of gender; (3) Results: We found no gender differences in initial depressive symptoms, nor in depressive symptoms, perinatal grief symptoms, or grief level (total scores or complicated grief) one month after the loss; (4) Conclusions: we need to better understand the psychological evolution of couples in cases of perinatal loss without falling into preconceived ideas about the influence of gender.

Psychological consequences and daily life adjustment for victims of intimate partner violence.

INTRODUCTION: Intimate partner violence (IPV) is a distressing reality worldwide. Victims of IPV usually experience long-term mental health disorders and maladjustments in their daily lives. AIMS: To examine the prevalence of depression, anxiety, and post-traumatic stress disorder in female victims of IPV that participated in a public mental health care program, and to analyze the relationships between the type of IPV exposure, its psychological consequences, and daily life adjustment. METHOD: Up to 164 female victims of IPV referred by their primary care doctors to the Adult Mental Health Casntre of Sant Cugat del Vallès (Barcelona) between 2010 and 2016 were evaluated using several tests (Index of Spouse Abuse - ISA, Beck Depression Inventory - BDI-II, Sate-Trait Anxiety Inventory - STAI, the Maladjustment Scale - MS, and the Severity Symptom Scale for Post-traumatic Stress Disorder - EGS). RESULTS: Of the 164 referred women, 102 (62.2%) agreed to participate (mean age 44.98 years, range 19-71) and 73% scored above the cut-off point in the physical IPV dimension (ISA). Moreover, 73% had depression symptoms, 77% trait anxiety, and 87% state anxiety altered scores. Prevalence of post-traumatic stress disorder was also high (87%). IPV interfered significantly in all the aspects of the daily lives of 92% of the sample. CONCLUSIONS: The participants of the study experienced many psychological symptoms and a high level of interference with all aspects of their daily lives. These consequences were of similar magnitude amongst victims of emotional abuse compared to those who suffered physical violence.

Riesgo de depresión materna perinatal tras una pérdida gestacional: prevalencia y factores asociados. Un estudio exploratorio / Risk of perinatal maternal depression after pregnancy loss: prevalence and associated factors. An exploratory study

Objetivo: Evaluar la prevalencia del riesgo de depresión materna en el periodo perinatal, y los factores asociados a la misma, en las mujeres atendidas en Parc Taulí Hospital Universitari de Sabadell (Barcelona) que han tenido una pérdida gestacional de más de 13 semanas de gestación. Material y método: Se diseñó un estudio observacional de tipo analítico. Las variables estudiadas fueron: el riesgo de depresión materna perinatal, el tiempo transcurrido entre el diagnóstico y la expulsión, las pérdidas gestacionales previas, la viabilidad fetal, ver y sostener al bebé, la obtención de huellas y fotografías de recuerdo, y percibir contradicciones profesionales. El riesgo de depresión posparto fue evaluado mediante la Escala de Edimburgo. Se realizó un análisis de regresión múltiple por pasos para evaluar el efecto de las variables de estudio sobre la depresión posparto al alta. Resultados: Participaron 29 mujeres entre julio de 2018 y diciembre de 2020. El 37,9 % (n= 11/29) de las participantes al alta y el 26,7 % (n= 4/15) al mes presentaban puntuaciones superiores a 13 en la Escala de Edimburgo. La ecuación de la regresión fue estadísticamente significativa (F(4,23)= 7,31, p <0,001), llegando a explicar el 48,3 % (R2 ajustada) de la varianza de la depresión posparto al alta. El tiempo transcurrido entre el diagnóstico y la expulsión superior a 24 horas (B= 4,91; IC del 95 %= 0,83-8,99), así como las pérdidas gestacionales previas (B= 5,99; IC del 95 %= 1,92-10,06) se asociaron con una mayor puntuación en la Escala de Edimburgo, mientras que ver al hijo/a (B= –5,84; IC del 95 % = –11,55 a –0,12) se asoció con una disminución de la puntuación. (AU)

Objective: To evaluate the prevalence of the risk of maternal depression in the perinatal period and the factors associated with it, in women treated at Hospital Parc Taulí Hospital Universitari of Sabadell (Barcelona), who have had a gestational loss of more than 13 weeks of gestation. Material and method: An analytical observational study was designed. The variables studied were: the risk of perinatal maternal depression, the time elapsed between diagnosis and expulsion, previous pregnancy losses, fetal viability, seeing and holding the baby, obtaining footprints and souvenir photographs, and perceiving professional contradictions. The risk of postpartum depression was assessed using the Edinburgh Scale. A stepwise multiple regression analysis was performed to evaluate the effect of the study variables on postpartum depression at discharge. Results: 29 women participated between July 2018 and December 2020. 37.9% (n= 11/29) of the participants at discharge and 26.7% (n= 4/15) at one month had scores higher than 13 on the Edinburgh Scale. The regression equation was statistically significant (F(4,23)= 7.31, p <0.001) explaining 48.3% (R2 Adjusted) of the variance of postpartum depression at discharge. The time elapsed between diagnosis and expulsion greater than 24 hours (B = 4.91; 95% CI = 0.83 – 8.99), as well as previous pregnancy losses (B = 5.99; 95% CI = 1.92 – 10.06) were associated with a higher score on the Edinburgh Scale, while seeing the child (B = -5.84; 95% CI = -11.55 – -0.12 ) was associated with a decrease in score. (AU)

Ciclación Rápida en el Trastorno Bipolar: una Metarevisión / Rapid cycling in bipolar disorder: a meta-review

El descriptor evolutivo "Ciclación Rápida" (CR) en el Trastorno Bipolar constituye uno de los retos más importantes a la hora de realizar un plan terapéutico. Sin embargo, a pesar de su uso habitual en la clínica y los libros generalistas, existe poca bibliografía original y escasas publicaciones de investigación sobre el tema. La presente metarevisión analiza los datos más recientes al respecto, enfatizando especialmente los aspectos etiopatogénicos, evolutivos y de tratamiento. Para ello, hemos utilizado las revisiones y artículos recogidos en las bases de datos PubMed y Psychinfo en los últimos 10 años (entre abril del 2011 y abril del 2021), publicadas en inglés o castellano. Después de descartar duplicados, por consenso pudimos seleccionar 76 publicaciones que cumplían los criterios de inclusión. Como principales resultados, destacan los estudios que relacionan la futura aparición de CR con un inicio más precoz del trastorno bipolar, la comorbilidad con el trastorno límite de la personalidad y con el consumo de sustancias. Entre los factores biológicos favorecedores, estarían las alteraciones tiroideas, la obesidad, las alteraciones de los ritmos circadianos, la migraña y otros factores inflamatorios y (quizás) los tratamientos antidepresivos continuados. Entre los aspectos terapéuticos, destacan los bajos niveles de recomendación y de evidencia entre las pautas propuestas en las diferentes revisiones y guías terapéuticas, lo cual se corresponde también con las dificultades de tratamiento en la práctica clínica. Por otra parte, se evidencia la falta de ensayos clínicos y estudios randomizados adecuados y específicos para poder extraer mejores conclusiones al respecto.(AU)

The clinical descriptor “Rapid Cycling” (RC) in Bipolar Disorder is one of the most important challenges in designing a therapeutic plan. However, despite its usual use in medical practice and in general books, there is little original literature and few publications related to it. This umbrella review analyses most recent publications referred to Rapid Cycling, emphasizing specially in their etiology, outcomes and treatment aspects. Reviews from the databases PubMed and Psychinfo have been collected, including the ones from the last 10 years (between April 2011 and April 2021), published in English or Spanish. After discharging duplicates, we applied a consensus to finally recruit 76 publications that fulfilled the inclusion criteria.As main results it must be mentioned the studies that relate RC to early age of onset, the ones that relate it with Borderline Personality Disorder comorbidity and finally the ones with Substance Abuse. Biological factors considered for the etiology of RC would be thyroidal disorders, obesity, circadian rhythms disorders and other inflammatory factors, migraine and (maybe) the maintained antidepressant treatments. Among the therapeutic aspects, the low level of recommendation and evidence in the different therapeutic guidelines stands out. This corresponds with the treatment difficulties observed in the clinical practice. Finally, it is important to mention the lack of clinical trials and randomized studies that are necessary to obtain better conclusions in the area.(AU)

An adapted scale to evaluate insight in Prader-Willi Syndrome

ObjectiveTo develop an insight scale for Prader-Willi Syndrome (PWS), a genetically determined neurodevelopmental disorder with different psychopathological and behavioural problems.MethodologyA sample of 36 PWS patients (58.3% women) attended at the Endocrinological Department of the Corporació Sanitària Parc Taulí (Sabadell, Barcelona) was evaluated. Insight was assessed by means of an adapted version of the Scale of Unawareness of Mental Disorder (SUMD), including three general insight dimensions: awareness of having a PWS, awareness of the effects of psychopharmacological medication and awareness of the social consequences, as well as three items that assess awareness of each particular symptom of the disease (obesity/overweight, excessive appetite and excessive food intake).ResultsThe final Scale included six items and demonstrated an adequate internal consistency (Cronbach Alfa of 0.857 for Caregivers and 0.798 for Clinicians) but a high inter-rate variability. External validation using an Analytical-Visual Insight Scale was adequate.ConclusionsThe Adapted version for Prader-Willi patients of the Scale of Unawareness of Mental Disorder (APW-SUD) showed adequate psychometric properties and it is an easy to administer means to assess insight in this population. (AU)

ObjetivoDesarrollar una escala de insight para el síndrome de Prader-Willi (PWS), un trastorno del desarrollo genéticamente determinado, con diferentes problemas psicopatológicos y conductuales.MetodologíaEvaluamos una muestra de 36 PWS (58,3% mujeres), atendidos en el Departamento de Endocrinología de la Corporació Sanitària Parc Taulí (Sabadell, Barcelona). El insight fue valorado mediante una versión adaptada de la Scale of Unawareness of Mental Disorder, incluyendo tres dimensiones generales: conciencia de tener PWS, conciencia de los efectos de la medicación psicofarmacológica, y conciencia de las consecuencias sociales, así como tres ítems que valoran el insight de cada síntoma particular de la enfermedad (obesidad/sobrepeso, excesivo apetito y exceso de ingesta).ResultadosLa escala final incluye seis ítems y ha demostrado una adecuada consistencia interna (alfa de Cronbach de 0,857 para cuidadores y de 0,798 para clínicos), pero una alta variabilidad interobservador. La validación externa usando una escala analítico-visual de insight fue adecuada.ConclusionesLa versión adaptada para pacientes con PWS de la Scale of Unawareness of Mental Disorder muestra adecuadas propiedades psicométricas y es una vía fácil de administrar para evaluar el insight en esta población. (AU)

Experiencias psicológicas de la pandemia covid en mujeres con depresión y/o ansiedad postparto: una serie de casos / Psychological experiences of covid pandemia in postpartum women with depression and anxiety: a case serie

Introducción: Las situaciones ambientales de estrés grave suponen un factor de riesgo conocido para el desarrollo de trastornos mentales durante el embarazo, especialmente emocionales. En este sentido la pandemia mundial del COVID-19 y el estado de emergencia y confinamiento subsiguiente, han podido tener un gran impacto psicológico en las mujeres embarazadas. Nuestro objetivo es realizar un análisis descriptivo de las percepciones de una serie de casos de mujeres embarazadas durante la pandemia COVID-19 que posteriormente han sido diagnosticadas con depresión/ansiedad postparto.Métodos: Descripción de 10 casos de mujeres adultas, embarazadas durante la pandemia y confinamiento, con depresión y/o ansiedad post-parto atendidas consecutivamente en el Programa de Salud Mental Perinatal de la Corporación Sanitaria Parc Taulí y en el Programa de Atención a la Salud Sexual y Reproductiva (ASSIR) del CAP San Fèlix. Todas las mujeres estaban en tratamiento psicológico (individual y grupal). Para medir el estrés específico, administramos el Pandemic-Related Pregnancy Stress Scale (PREPS) que evalúa la extensión y tipo de estrés relacionado con la pandemia en mujeres embarazadas, incluyendo 3 factores: Estrés relacionado con la preparación, Estrés relacionado con el miedo al contagio, y finalmente una dimensión relacionada con la resiliencia, denominada Valoración positiva. De forma opcional se incluyó una pregunta abierta sobre preocupaciones adicionales no incluidas en la Escala. Se realizó un análisis descriptivo y de contenido.Resultados: La mediana de las puntuaciones en las escalas de estrés de preparación y por miedo al contagio fue de 3,07 y 3,80 respectivamente, el 40% y el 50% puntuaron ≥4. La mediana de las puntuaciones en la escala de valoración positiva fue de 2,66, solo un caso puntuó ≥4. En el análisis de contenido de las frases libres, destacan la sensación de abandono, los sentimientos de soledad, desesperanza, miedo e incertidumbre. (AU)

Social Responsiveness and Psychosocial Functioning in Adults with Prader-Willi Syndrome.

Although various studies have investigated symptoms of autism spectrum disorder (ASD) in Prader−Willi syndrome (PWS), little is known about the consequences of these symptoms, especially in psychosocial function. We aimed to explore ASD symptoms in adults with PWS with special attention to psychosocial functionality. This cross-sectional study included 26 adults (15 women) with PWS who attended a reference unit for rare diseases. Participants' primary caregivers completed the Social Responsiveness Scale (SRS), and clinicians assessed multidimensional functioning with the Personal and Social Performance Scale (PSP). Impaired social responsiveness was identified in 20 (76.9%) participants, and manifest to marked difficulties in social functioning were identified in 13 (50%). Participants with impaired social responsiveness (SRS ≥ 60) had significantly worse scores in functionality measured with the PSP (U = 12.5; p = 0.009) and with three of the four PSP main areas. Moreover, scores for the Social Cognition domain of the SRS correlated positively with the Socially useful activities (p < 0.05) and Personal and social relationships (p < 0.01) main areas of the PSP. These results suggest that difficulties in social skills should be assessed in all psychosocial evaluations of patients with PWS.

An adapted scale to evaluate insight in Prader-Willi Syndrome.

OBJECTIVE: To develop an insight scale for Prader-Willi Syndrome (PWS), a genetically determined neurodevelopmental disorder with different psychopathological and behavioural problems. METHODOLOGY: A sample of 36 PWS patients (58.3% women) attended at the Endocrinological Department of the Corporació Sanitària Parc Taulí (Sabadell, Barcelona) was evaluated. Insight was assessed by means of an adapted version of the Scale of Unawareness of Mental Disorder (SUMD), including three general insight dimensions: awareness of having a PWS, awareness of the effects of psychopharmacological medication and awareness of the social consequences, as well as three items that assess awareness of each particular symptom of the disease (obesity/overweight, excessive appetite and excessive food intake). RESULTS: The final Scale included six items and demonstrated an adequate internal consistency (Cronbach Alfa of 0.857 for Caregivers and 0.798 for Clinicians) but a high inter-rate variability. External validation using an Analytical-Visual Insight Scale was adequate. CONCLUSIONS: The Adapted version for Prader-Willi patients of the Scale of Unawareness of Mental Disorder (APW-SUD) showed adequate psychometric properties and it is an easy to administer means to assess insight in this population.

Higher order theory of mind in patients with bipolar disorder and schizophrenia/schizoaffective disorder.

Some evidence suggests that patients with bipolar disorder (BD) have better Theory of Mind (ToM) skills than patients with schizophrenia/schizoaffective disorder (SCH). However, this difference is not consistently reported across studies, so rather than being global, it may be restricted to specific aspects of ToM. Our primary objective was to compare higher order ToM performance between BD and SCH patients using the Hinting Task (HT). Ninety-four remitted patients were recruited (BD = 47, SCH = 47). Intelligence quotient (IQ), attention, memory, executive functions, and processing speed were also assessed. Patients with BD performed better on the HT than patients with SCH, even when the analysis was adjusted for IQ and neurocognition (p < 0.001, [Formula: see text] = 0.144). Regression analysis in the total sample showed that a diagnosis of SCH and lower IQ were associated with lower HT scores (R2 = 0.316, p < 0.001). In the BD group, verbal memory and processing speed were the main predictors of HT performance (R2 = 0.344, p < 0.001). In the SCH group, no variable was significant in explaining HT performance. In the context of previous studies that found no significant differences in the most basic aspects of ToM (e.g., understand other people's thoughts/beliefs), our results suggest that differences between the two disorders might be limited to the more challenging aspects (e.g., understand the intended meaning of indirect requests). No causal inferences can be made in this cross-sectional study. However, regression analyses show that whereas in BD patients, ToM functioning would be partially modulated by neurocognitive performance, in SCH patients, it could be largely independent of the well-known neurocognitive impairment.

Expanding the international conversation with fathers' mental health: toward an era of inclusion in perinatal research and practice.

Paternal mental health is beginning to be recognized as an essential part of perinatal health. Historically, fathers were not recognized as being at risk for perinatal mental illnesses or relevant to maternal and infant health outcomes. The purpose of this paper is to provide an overview of paternal perinatal mental health, leading tools to assess paternal depression and anxiety, the impact of paternal mental health on mother and child health, and future directions for the field. An international team of paternal perinatal mental health experts summarized the key findings of the field. Fathers have an elevated risk of depression and anxiety disorders during the perinatal period that is associated with maternal depression and can impact their ability to support mothers. Paternal mental health is uniquely associated with child mental health and developmental outcomes starting from infancy and continuing through the child lifespan. Tailored screening approaches for paternal mental health are essential to support fathers early in the perinatal period, which would offset health risks for the family. Recommendations on paternal mental health are provided on four key areas to support father perinatal mental health: (1) intervention research, (2) clinical training, (3) national policy, and (4) the inclusion of fathers in the focus of the International Marcé Society for Perinatal Mental Health.

Group and sex differences in social cognition in bipolar disorder, schizophrenia/schizoaffective disorder and healthy people.

BACKGROUND: Impairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences. METHODS: 120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions. RESULTS: Both groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief. LIMITATIONS: The cross-sectional design does not allow for causal inferences. CONCLUSION: BD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.

Multidimensional Evaluation of Awareness in Prader-Willi Syndrome.

There are no studies about insight or awareness of illness in patients with Prader-Willi Syndrome (PWS). The objective of this study was to explore the level of awareness of the disorder, of the need for medication, and of the social consequences of the disease, as well as of its main symptoms in PWS. We also aimed to explore relationships between awareness and sociodemographic and clinical characteristics, and to compare all data with a matched sample of patients with psychosis. Insight was assessed by an Adapted version of the Scale of Unawareness of Mental Disorder in a cross-sectional pilot study at a University Hospital. Thirty-six individuals with PWS (58.3% women) were included. Results showed that PWS patients had a good awareness of the illness and of the effects of medication, in contrast to a lack of awareness of illness' social consequences. Awareness of obesity/overweight was excellent, as was the awareness of excessive appetite. Awareness of excessive food intake was only mild. Insight correlated with age and functionality, but not with BMI. PWS patients showed a better insight into the illness but a similar awareness of the effects of the medication and of the social consequences of the disease as compared to schizophrenia-spectrum patients. This profile of insight may have relevant clinical implications.