A Web-Based App for Emotional Management During the COVID-19 Pandemic: Platform Development and Retrospective Analysis of its Use Throughout Two Waves of the Outbreak in Spain.

BACKGROUND: Quarantines and nationwide lockdowns implemented for containing the spread of the COVID-19 pandemic may lead to distress and increase the frequency of anxiety and depression symptoms among the general population. During the nationwide lockdown of the first wave of the COVID-19 outbreak in Spain, we developed and launched a web-based app to promote emotional self-care in the general population and facilitate contact with health care professionals. OBJECTIVE: This study aimed to describe a web-based app and analyze its utilization pattern throughout 2 successive waves of the COVID-19 outbreak in Spain. METHODS: Our web-based app targeted all individuals aged 18 years or more and was designed by adapting the contents of a mobile app for adjuvant treatment of posttraumatic stress disorder (ie, the PTSD Coach app) to the general population and the pandemic or lockdown scenario. We retrospectively assessed the utilization pattern of the web-based app using data systematically retrieved from Google Analytics. Data were grouped into 3 time periods, defined using Joinpoint regression analysis of COVID-19 incidence in our area: first wave, between-wave period, and second wave. RESULTS: The resulting web-based app, named gesioemocional.cat, maintains the navigation structure of the PTSD Coach app, with three main modules: tools for emotional self-care, a self-assessment test, and professional resources for on-demand contact. The self-assessment test combines the Patient Health Questionnaire-2 and the 7-item Generalized Anxiety Disorder scale and offers professional contact in the advent of a high level of depression and anxiety; contact is prioritized in accordance with a screening questionnaire administered at the time of obtaining individual consent to be contacted. The tools for emotional self-care can be accessed either on-demand or symptom-driven. The utilization analysis showed a high number of weekly accesses during the first wave. In this period, press releases regarding critical events of the pandemic progression and government decisions on containment measures were followed by a utilization peak, irrespective of the sense (ie, positive or negative) of the information. Positive information pieces (eg, relaxation of containment measures due to a reduction of COVID-19 cases) resulted in a sharp increase in utilization immediately after information release, followed by a successive decline in utilization. The second wave was characterized by a lower and less responsive utilization of the web-based app. CONCLUSIONS: mHealth tools may help the general population cope with stressful conditions associated with the pandemic scenario. Future studies shall investigate the effectiveness of these tools among the general population-including individuals without diagnosed mental illnesses-and strategies to reach as many people as possible.

The Fenix II study: A longitudinal study of psychopathology among burn patients.

Psychological symptoms are common among burn survivors. However, knowledge about epidemiology and predictors of psychopathology has shown great heterogeneity in this population. The Fenix-II Project was the first epidemiological study on the psychopathological consequences of burns developed in Spain, providing a detailed analysis of the progression of psychological symptoms during the first six months after injury. Three hundred and thirty-three patients were screened and 183 were included in this study. Posttraumatic, depression and anxiety symptoms showed a general decreasing tendency across time. At 6 months, 34 patients showed clinically significant Posttraumatic Stress Disorder (PTSD) symptoms (20.5% of 166 patients reached at 6 months) as assessed with the MINI Neuropsychiatric Interview. Within this group of patients, anxiety, depression and hyperarousal increased at 30 days, and avoidance 90 days after injury. The most accurate predictors of PTSD were found to be being burned in a Motor Vehicle Crash, risk of social exclusion, low body-image adjustment, anterior trunk location of the burn and life threat perception during the burn-shock period. Considering these factors, clinicians may identify patients at risk of PTSD development, allowing an adequate follow up and preventive interventions which may minimize the psychological consequences of burns.

Substance use and misuse in burn patients: Testing the classical hypotheses of the interaction between post-traumatic symptomatology and substance use.

The authors aimed to test whether the three classical hypotheses of the interaction between post-traumatic symptomatology and substance use (high risk of trauma exposure, susceptibility for post-traumatic symptomatology, and self-medication of symptoms), may be useful in the understanding of substance use among burn patients. Substance use data (nicotine, alcohol, cannabis, amphetamines, cocaine, opiates, and tranquilizers) and psychopathology measures among burn patients admitted to a burn unit and enrolled in a longitudinal observational study were analyzed. Lifetime substance use information (n = 246) was incorporated to analyses aiming to test the high risk hypothesis. Only patients assessed for psychopathology in a 6-month follow-up (n = 183) were included in prospective analyses testing the susceptibility and self-medication hypotheses. Regarding the high risk hypothesis, results show a higher proportion of heroin and tranquilizer users compared to the general population. Furthermore, in line with the susceptibility hypothesis, higher levels of symptomatology were found in lifetime alcohol, tobacco, and drug users during recovery. The self-medication hypothesis could be tested partially due to the hospital stay "cleaning" effect, but severity of symptoms was linked to the amount of caffeine, nicotine, alcohol, and cannabis use after discharge. It was found that the 3 classical hypotheses could be used to understand the link between traumatic experiences and substance use explaining different patterns of burn patient's risk for trauma exposure and emergence of symptomatology.

Prevalence and Predictors of Posttraumatic Stress Symptomatology Among Burn Survivors: A Systematic Review and Meta-Analysis.

Burns can be a traumatic and stressful experience, although each patient may respond in very different ways. The aim of this study was to explore the variability on posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) prevalence and evaluate the specific weight of different variables on PTSD development among adult burn patients. A systematic review was carried out to explore the prevalence of ASD and PTSD and identify their predictors. Meta-analytical methods were used to explore the strength of association between PTSD and the latter. From an initial pool of 190 studies, 24 were used in the systematic review, and only 19 studies could be used for the meta-analysis because of different methodological limitations. The prevalence of ASD at baseline ranged from 2 to 30% and prevalence of PTSD ranged from 3 to 35% at 1 month, 2 to 40% between 3 and 6 months, 9 to 45% in the year postinjury and ranged 7 to 25% more than 2 years later. Life threat perception was the strongest predictor for PTSD occurrence, followed by acute intrusive symptoms and pain associated with burn injuries. Predictive variables identified in this research may be useful in targeting burn patients who are at risk for developing posttraumatic stress symptoms and stress-related psychological symptoms.

Protocolo unificado para la evaluación psiquiátrica y psicológica de candidatosa trasplante de órganos y tejidos, PSI-CAT / Unified Protocol for psychiatric and psychological assessment of candidates for transplantation of organs and tissues, PSI-CAT

Introducción. El trasplante es la opción terapéutica que ofrece mayor supervivencia y calidad de vida frente al fallo de un órgano. Los aspectos psiquiátricos y psicológicos de los candidatos a trasplante son relevantes, especialmente en la etapa de evaluación previa, pues la influencia de estos factores puede dificultar la evolución posquirúrgica, tanto en la supervivencia del órgano implantado como en la calidad de vida de la persona trasplantada. Son de especial importancia los factores vinculados a la patología por uso de sustancias, los trastornos psicopatológicos y el soporte psicosocial. Actualmente, existen pocas Guías que orienten sobre la correcta evaluación de los pacientes candidatos a estos procedimientos complejos. Método. Diecinueve psiquiatras y psicólogos clínicos de 6 hospitales públicos de Cataluña realizaron un trabajo sistemático de consenso para llegar al diseño de un protocolo unificado de evaluación psicológica y psiquiátrica. Se implementó un plan de trabajo anual, se definieron objetivos y se realizó una revisión bibliográfica, se discutieron los criterios de inclusión y exclusión, se seleccionaron los cuestionarios y se elaboró la entrevista estructurada. Resultados. Con el cumplimiento del plan de trabajo, se diseñó el Protocolo de Evaluación que se presenta en este artículo. Conclusiones. El trabajo sistematizado y la colaboración intercentros de psiquiatras y psicólogos clínicos ha facilitado homogeneizar y consensuar un protocolo unificado de evaluación (AU)

Introduction. Transplantation is the treatment option that offers improved survival and quality of life as compared to organ failure. Psychiatric and psychological aspects of transplant candidates are important, especially in the pre-assessment stage, as the influence of these factors can hinder post-surgical outcome in both the implanted organ survival and the quality of life of the transplanted person. Of particular importance, are the factors related to pathology due to substance use, psychopathology, and psychosocial support. There are currently few guidelines on the correct evaluation of patients eligible for these complex procedures. Method. Nineteen psychiatrists and clinical psychologists from six public hospitals in Catalonia conducted a systematic consensus to determine the design of a Unified Protocol psychological and psychiatric evaluation. An annual work plan was implemented, during which; the objectives were defined, a literature review was conducted, the inclusion and exclusion criteria were discussed, questionnaires were selected, and a structured interview was developed. Results. With the implementation of the work plan, the Assessment Protocol presented in this article was designed. Conclusions. systematic work and improving cooperation between psychiatrists and clinical psychologists, has led to homogeneity and consensus on a unified evaluation protocol (AU)

Unified Protocol for psychiatric and psychological assessment of candidates for transplantation of organs and tissues, PSI-CAT.

INTRODUCTION: Transplantation is the treatment option that offers improved survival and quality of life as compared to organ failure. Psychiatric and psychological aspects of transplant candidates are important, especially in the pre-assessment stage, as the influence of these factors can hinder post-surgical outcome in both the implanted organ survival and the quality of life of the transplanted person. Of particular importance, are the factors related to pathology due to substance use, psychopathology, and psychosocial support. There are currently few guidelines on the correct evaluation of patients eligible for these complex procedures. METHOD: Nineteen psychiatrists and clinical psychologists from six public hospitals in Catalonia conducted a systematic consensus to determine the design of a Unified Protocol psychological and psychiatric evaluation. An annual work plan was implemented, during which; the objectives were defined, a literature review was conducted, the inclusion and exclusion criteria were discussed, questionnaires were selected, and a structured interview was developed. RESULTS: With the implementation of the work plan, the Assessment Protocol presented in this article was designed. CONCLUSIONS: systematic work and improving cooperation between psychiatrists and clinical psychologists, has led to homogeneity and consensus on a unified evaluation protocol.

Psychosocial factors and antiepileptic drug use related to delayed diagnosis of refractory psychogenic nonepileptic seizures.

OBJECTIVE: We analyzed clinical and psychosocial factors in patients with refractory psychogenic nonepileptic seizures, seeking characteristics that could hasten diagnosis. BACKGROUND: Psychogenic nonepileptic seizures remain a diagnostic challenge. Prognosis is best if patients are treated within 2 years of symptom onset. Psychosocial factors have been shown to provide important information for differential diagnosis. METHODS: Over a year and 1132 consecutive patients, our hospital's Epilepsy Unit suspected 93 patients of having psychogenic nonepileptic seizures and confirmed refractory psychogenic nonepileptic seizures in 67. We referred these patients to our psychiatric consultation unit for detailed diagnostic interviews, and 53 of the patients followed through. Two months after the psychiatric evaluation we gave them a psychiatric intervention, explaining the diagnosis and treating their comorbidities. We also tracked the patients' use of antiepileptic drugs for 3 months, from just before the psychiatric evaluation until a month after they started the intervention. RESULTS: Women, patients with an inadequate primary support group, and patients who had tried many antiepileptic drugs were most likely to have their diagnosis of psychogenic nonepileptic seizures delayed by >2 years after onset. A stepwise logistic regression showed that the 2 best predictors of late diagnosis were lack of availability of a primary support group and patients trying many antiepileptic drugs. CONCLUSIONS: Clinicians evaluating patients with questionable seizures should raise their suspicion of psychogenic nonepileptic seizures especially in female patients with an insufficient primary support group and a history of taking multiple antiepileptic drugs.

[Psychological repercussion of the scars in the burned patient]. / Repercusión psicológica de las cicatrices en el paciente quemado.

The scars produced by burns have serious consequences for the patient. The repercussions go further than the discomfort, pain and physical restrictions, going as far as causing significant psychological consequences which can restrict the personal and social relationships of those affected. From the accounts told by two burn victims, and the technical analysis carried out by psychologists and psychiatrists specialised in this field, we gain a better understanding of the situation of these patients, on the basis of which we propose a series of nursing interventions designed to improve the care given in the area of wound healing.