Violencia ginecológica-obstétrica / Definition of obstetric violence

El artículo define la violencia ginecológica-obstetrica (VGO) como una forma de violencia estructural, simbólica y de género, que puede experimentarse a lo largo de todo el ciclo vital sexual y reproductivo de las mujeres. A su vez, también menciona la relación entre patriarcado, capitalismo y colonialismo en la salud sexual y reproductiva (SSR) de las mujeres. Por ello, se habla también de los fenómenos de racismo obstétrico y estratificación obstétrica interseccional, que terminan de dar forma al constructo de la VGO y a cómo ésta se acrecienta ante determinadas características de las mujeres (gestantes tardías, adolescentes, migrantes, etc.). Por tanto, la VGO se refiere a un fenómeno complejo que precisa un cambio urgente en la formación sanitaria, no sólo en gineco-obstetricia, sino también en pediatría y anestesiología, así como un cambio en el modelo asistencial para profesionales que atienden la SSR de las mujeres, además de una sensibilización a nivel de ciudadanía. En definitiva, la VGO es hoy día un grave problema de salud pública y salud global que pone en riesgo el bienestar biopsicosocial de madres, bebés y profesionales, al que se debería estar atendiendo seriamente para su prevención y erradicación.(AU)

Relatives' expressed emotion, distress and attributions in clinical high-risk and recent onset of psychosis.

It has been well-demonstrated that Expressed Emotion (EE) in caregivers of schizophrenia patients is related to their illness attributions, but little is known about relatives' cognitive and emotional appraisals at early stages of psychosis. This study examined differences on the relationships of EE with distress and illness attributions in 78 relatives of At-Risk Mental States (ARMS) and First-Episode of Psychosis (FEP) patients, and which of those variables better predicted EE. Criticism and Emotional Over-Involvement (EOI) were associated with distress and with several illness attributions in both groups. Anxiety was more strongly associated with criticism in ARMS than in FEP-relatives, and it was associated with EOI in the ARMS but not in the FEP-group. No differences on the relationships of EE with depression or attributions were found. Furthermore, distress and attributions of blame toward the patients predicted criticism. Attributions of control by the patient and emotional negative representation about the disorder predicted EOI. Findings highlight the need to focus on early family interventions that provide proper information and psychological support in accordance with the illness stage, to help relatives improve their understanding of the disorder, handle difficult thoughts and emotions, reduce negative appraisals, and prevent high-EE over the psychotic process.

A systematic review of family caregiving in eating disorders.

The objective of the study was to review systematically the available new evidence on family caregiving in eating disorders (ED), updating the study of Zabala, Macdonald, and Treasure (2009). Electronic databases were searched from October 2008 until May 2013. Selected studies included carers of people with ED and employed one or more measures of caregiving experience, accommodation and enabling behaviours, expressed emotion, and/or psychological distress. Twenty-nine studies were identified. Most of the studies examined these features in mothers of patients with anorexia. Only a few studies included a control group. The majority of studies found high levels of negative aspects of caregiving, accommodation and enabling behaviours, expressed emotion and psychological distress in carers of people with ED, although positive aspects and emotions were also reported. These features varied depending on some sociodemographic and clinical characteristics of carers and patients; moreover, interesting preliminary cultural and gender differences emerged. Progress has been made in research on family caregiving in ED and there is evidence that these factors can be associated with the outcome of ED. Theoretical, research and clinical implications of the findings are discussed.

Relatives׳ illness attributions mediate the association of expressed emotion with early psychosis symptoms and functioning.

The mechanisms underlying the association between expressed emotion (EE) and the prognosis in early psychosis are still not well understood. Based on the attributional model, this study investigated the association of criticism and Emotional Over-Involvement (EOI) with symptoms and functioning in At-Risk Mental State (ARMS) and First-Episode Psychosis (FEP) patients, and whether these associations were mediated by relatives׳ attributions of control and blame. Forty-four patients (20 ARMS and 24 FEP) and their relatives were included. Findings indicated that relatives׳ criticism was associated with positive, negative, and general symptoms. EOI was related to negative and general symptoms. Both indices were related with impaired functioning. Most of the relations between EE indices and illness severity were mediated by relatives׳ attributions of blame toward the patient. Relatives׳ self-blaming attributions and attributions of control over the disorder by either relatives or patients were not associated with patients׳ variables or EE. Findings highlight the importance of family emotional environment in the early stages of psychosis, as well as the mediating role that relatives׳ beliefs can exert in those relationships. Family interventions aimed to assist relatives to change attributions that blame patient should be included in clinical protocols in order to prevent the entrenchment of high-EE.

Programa psicoeducativo familiar para los rastornos del comportamiento alimentario / Family psychoeducational programme for eating disorders

Se describe un programa de psicoeducación para familiares de pacientes con un trastorno del comportamiento alimentario. Este estudio piloto evaluó la aceptación del programa por parte de 15 cuidadores y si sus dificultades y malestar implicados en este rol cambiaron tras la intervención, así como el impacto del programa sobre los 14 pacientes. Fueron evaluados al inicio del estudio (T0), al terminar la intervención (T1) y tres meses después (T2). Al finalizar el programa, se produjo una mejora en la experiencia subjetiva de cuidado de los familiares y en sus niveles de emoción expresada y malestar psicológico. El proceso de recuperación de los pacientes también se vio afectado positivamente; descendieron las conductas disfuncionales relacionadas con la alimentación y sus síntomas afectivos. Estos cambios se mantuvieron en el tiempo. El programa fue altamente valorado por los cuidadores, expresaron estar bastante satisfechos y haber aprendido a reconocer y entender mejor los síntomas. La intervención promete beneficios tanto para los cuidadores como para los pacientes, si bien se necesita replicación de los resultados con muestras más amplias

This paper describes a psychoeducational intervention programme for relatives of patients with an eating disorder. The pilot study examined the acceptability of the programme among 15 caregivers and whether their difficulties and distress involved in this role changed after intervention. Impact on the 14 eating disorder patients with was also explored. Assessments were undertaken at baseline (T0), at the end of the workshops (T1) and 3 months later (T2). After the intervention programme, the relatives’ subjective caregiving experience, their levels of expressed emotion and distress improved. The patients’ recovery process was also affected postively -dysfunctional eating behaviours and affective symptoms decreased. These changes were maintained over time. The programme was highly valued by the carers, who expressed to be very satisfied and to have learnt to better recognise and understand the symptoms. The intervention is presumed to be beneficial for both caregivers and patients, although results should be replicated with larger samples

Expressed and perceived criticism, family warmth, and symptoms in schizophrenia.

Criticism directed by caregivers towards a family member with schizophrenia, both from the perspective of the patient and of the caregiver, predicts relapse, although both perspectives differ. This study aims to verify if the same applies to a Mediterranean sample, where criticism is not the main attitude of high expressed emotion families. The Camberwell Family Interview was applied to assess the family's perspective, and the Perceived Criticism and the Family Emotional Involvement and Criticism Scales were used to assess the patients' perspective, in 21 dyads. The association between both perspectives and psychotic symptoms was also examined. Results replicated those of previous studies in other countries, revealing that the perspectives on Criticism of patients and families do not match. The fact that family members also presented positive attitudes towards the patient did not cushion the patient's perceived criticism. Thus, it seems that families considered to be critical may not be perceived as such by the patients. Furthermore, only the warmth from the family's perspective correlated with the symptoms: positive affect proved to be more relevant than negative affect. Therefore, the patients' subjective assessments and family warmth should be included in clinical and research proposals.

Expressed and perceived criticism, family warmth, and symptoms in schizophrenia

Criticism directed by caregivers towards a family member with schizophrenia, both from the perspective of the patient and of the caregiver, predicts relapse, although both perspectives differ. This study aims to verify if the same applies to a Mediterranean sample, where criticism is not the main attitude of high expressed emotion families. The Camberwell Family Interview was applied to assess the family’s perspective, and the Perceived Criticism and the Family Emotional Involvement and Criticism Scales were used to assess the patients’ perspective, in 21 dyads. The association between both perspectives and psychotic symptoms was also examined. Results replicated those of previous studies in other countries, revealing that the perspectives on Criticism of patients and families do not match. The fact that family members also presented positive attitudes towards the patient did not cushion the patient’s perceived criticism. Thus, it seems that families considered to be critical may not be perceived as such by the patients. Furthermore, only the warmth from the family’s perspective correlated with the symptoms: positive affect proved to be more relevant than negative affect. Therefore, the patients’ subjective assessments and family warmth should be included in clinical and research proposals (AU)

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Dyadic view of expressed emotion, stress, and eating disorder psychopathology.

Prevailing models of the association between expressed emotion (EE) and relapse conceptualize EE as a form of stress for patients. In eating disorders (ED), there is no research addressed to evaluate the degree to which patients feel stress due to their relatives' EE. It has been neither investigated how the EE and the subsequent stress relate to disordered behaviours and attitudes neither. Using a sample of 77 inpatients with ED, this study aimed to: (1) evaluate patients' reported level of stress as it relates to their caregivers' EE, particularly as associated with carer's criticism, emotional overinvolvement and warmth; (2) examine the associations of stress with the patients' perceptions (self-reported) and the caregivers' perspective (assessed by the Camberwell Family Interview) of the EE; and (3) study how the two views of EE (patients' and caregivers') and the stress due to EE relate to the ED symptoms. The findings indicate that patients judged their carers' critical stance as the most stressful, followed by emotional overinvolvement. Secondly, patients' perceptions of EE, whereas none of the interview indices focused on the caregivers' perspective, were associated to the stress and to the ED symptomatology. Additionally, the patients' stress due to criticism was positively related to the ED symptoms, while the stress associated with emotional overinvolvement and warmth was not. Clinical and research implications are discussed. Findings suggest attention to the ED patients' view of their family environment and support the utility of assessing their appraisals of EE.

Further development of a scale of perceived expressed emotion and its evaluation in a sample of patients with eating disorders.

High expressed emotion (EE) as measured by the Camberwell Family Interview (CFI) predicts the course of eating disorders (ED). Despite its important contribution to the field, the CFI has two major limitations; it is time-consuming and it does not consider the patient's perspective. Obtaining the patient's view may help shed light on the dyadic nature of caregiver's EE and the patient's illness course. The objectives of our study of 77 patients with ED were to develop further a brief measure to assess the patients' perceptions of their caregivers' EE, the patient version of the Brief Dyadic Scale of Expressed Emotion (BDSEE), and to evaluate its psychometric properties. Three clearly separate factors were identified: perceived criticism, perceived emotional overinvolvement, and perceived warmth. The BDSEE also demonstrated good levels of reliability and construct validity. The BDSEE subscales are significantly related to other measures of the perceived family emotional climate and to the CFI, the gold standard in the field of EE. The clinical implications of the ED patients' perceptions of their caregivers' EE are discussed. Findings support the utility of the expanded BDSEE for both research and clinical practise in assessing the perspective of patients with ED.

Esquizotipia y memoria verbal en población general adolescente / Squizotypy and verbal memory in the adolescent general population

El siguiente trabajo analiza la relación existente entre el déficit de memoria verbal y los rasgos de esquizotipia psicométrica en una población no clínica de sujetos adolescentes. En este estudio transversal analítico participaron 139 estudiantes de Secundaria con edades comprendidas entres los 13 y los 16 años (media= 14,35; Des.Est.= 0,548). Tras pasar las pruebas O-LIFE (esquizotipia psicométrica), TAVEC (memoria verbal) y Subtest del WAIS-III de letras y números (memoria de trabajo), se analizaron los datos realizando correlaciones de Pearson y comparaciones de medias. Los resultados mostraron una ausencia de relación entre las medidas de esquizotipia y memoria de trabajo. En cambio, sí encontramos relaciones significativas entre las dimensiones de esquizotipia y memoria verbal. Nuestros resultados apoyan parcialmente la literatura revisada sobre este tema. Aun así, se sugiere profundizar en el estudio de la esquizotipia psicométrica como marcador de riesgo para la esquizofrenia

The following study examines the relationship between verbal memory deficits and schizotypal traits measured psychometrically from a non- clinical adolescent population. In this transversal analytical study participated 139 subjects. They were secondary school students, with ages ranging from 13 to 16 years old (mean= 14, 35; Sta.Dev.= 0, 548). After administrating the scales O-LIFE (psychometrical schizotypy), CVLT (verbal memory), and Letters and Numbers subtest of WAIS-III (working memory), data was analyzed utilizing Pearson correlations and mean comparison test. Results showed lack of relations between schizotypy measures and working memory. Nonetheless, some of the O-LIFE dimensions correlated with verbal memory. These findings support partly the literature reviewed. Yet, more work focused on schizotypy and cognitive deficits as risk factors are suggested

[Schizotypy and verbal memory in the adolescent general population]. / Esquizotipia y memoria verbal en población general adolescente.

The following study examines the relationship between verbal memory deficits and schizotypal traits measured psychometrically from a non- clinical adolescent population. In this transversal analytical study participated 139 subjects. They were secondary school students, with ages ranging from 13 to 16 years old (mean= 14, 35; Sta.Dev.= 0, 548). After administrating the scales O-LIFE (psychometrical schizotypy), CVLT (verbal memory), and Letters and Numbers subtest of WAIS-III (working memory), data was analyzed utilizing Pearson correlations and mean comparison test. Results showed lack of relations between schizotypy measures and working memory. Nonetheless, some of the O-LIFE dimensions correlated with verbal memory. These findings support partly the literature reviewed. Yet, more work focused on schizotypy and cognitive deficits as risk factors are suggested.