Motivation for change as a predictor of treatment response for dysthymia.

OBJECTIVE: Dysthymia constitutes a chronic, mild affective disorder characterized by heterogeneous treatment effects. Several predictors of clinical response and attendance have been postulated, although research on the role of the psychological variables involved in this mental disorder is still scarce. METHOD: Fifty-four adult patients, who met criteria for dysthymia completed an ongoing naturalistic treatment based on the brief interpersonal psychotherapy (IPT-B), which was delivered bimonthly over 16 months. As potential predictor variables, the therapeutic alliance, coping strategies, perceived self-efficacy, and motivation for change were measured at baseline. Outcome variables were response to treatment (Clinical Global Impression and Beck’s Depression Inventory) and treatment attendance. RESULTS: Stepwise multiple linear regression analyses revealed that higher motivation for change predicted better response to treatment. Moreover, higher motivation for change also predicted treatment attendance. Therapeutic alliance was not a predictor variable of neither clinical response nor treatment attendance. CONCLUSIONS: These preliminary findings support the adjunctive use of motivational interviewing (MI) techniques in the treatment of dysthymia. Further research with larger sample size and follow-up assessment is warranted.

Consumo de cocaína y estado de las funciones ejecutivas / Cocaine use and status of executive functions

Diversos estudios han relacionado el consumo de cocaína con alteraciones en las funciones ejecutivas. Objetivos: (1) evaluar las funciones ejecutivas; (2) analizar el patrón neuropsicológico y (3) detectar variables asociadas. El estudio se llevó a cabo con pacientes mayores de 18 años (N=25) que acudían al Centro de Atención y Seguimiento a las Drogodependencias (CAS-D) de Mataró (Barcelona). A todos los pacientes que presentaban una abstinencia mínima se les aplicó un protocolo de evaluación. Los resultados asociaron el consumo de cocaína con alteraciones en la fluidez semántica y fonética y se relacionó un mejor rendimiento en memoria de trabajo con los laboralmente en activo. Consideramos la evaluación de las funciones ejecutivas como un elemento para maximizar las posibilidades de éxito terapéutico

Many studies have linked cocaine use with alterations of executive functions. The aims of this one are: (1) to assess executive functions; (2) to analyse the neuropsychological pattern and (3) to detect associated variables. The study was conducted with patients of over 18 years of age (N = 25) who came to Mataró (Barcelona) Drug Addiction Care Centre. We applied a protocol for assessing executive functions to all patients who had a minimum withdrawal. The results associated cocaine use with deficits in semantic and phonologic fluency and also related better performance in working memory to employed patients. We consider the assessment of executive functions as an issue for maximising the chances of therapeutic success

Estatus nosológico de la acumulación compulsiva: ¿subtipo de trastorno obsesivo-compulsivo o entidad clínica independiente? / Nosological status of compulsive hoarding: obsessive-compulsive disorder subtype or independent clinical entity

En el presente estudio teórico se revisan los principales hallazgos e investigaciones respecto al estatus nosológico de la acumulación compulsiva. En concreto, se exponen las evidencias empíricas disponibles para poder determinar su independencia o no del trastorno obsesivo compulsivo (TOC), patología mental donde tradicionalmente ha sido incluida como un subtipo o dimensión más de la misma. En relación a esta cuestión, los resultados recogidos en la literatura científica sostienen que las personas con acumulación compulsiva, a diferencias de "otros" sujetos con TOC, presentan características distintivas en diversos criterios externos, a saber: variables sociodemográficas, personalidad premórbida, grado de insight, factores genéticos y neuroanatómicos, correlatos neuropsicológicos, curso y nivel de disfuncionalidad y, por último, respuesta al tratamiento. Dichas conclusiones son discutidas valorando la propuesta de creación de una nueva entidad clínica denominada "trastorno por acumulación"

This theoretical study reviews the main research and findings on the nosological status of compulsive hoarding. Specifically, it describes available empirical evidence in order to determine their independence or inclusion within the obsessive-compulsive disorder (OCD), a mental disorder in which it has traditionally been included as one more subtype or dimension. Regarding this issue, the results found in the scientific literature show that persons with compulsive hoarding have distinct characteristics indifferent external criteria like sociodemographic variables, premorbid personality, degree of insight, neuroanatomical and genetic factors, neuropsychological profile, clinical course, levels of dysfunctionality and finally, treatment outcome. These conclusions are discussed and the proposal for the creation of a new clinical entity called "hoarding disorder" is evaluated

Nosological status of compulsive hoarding: obsessive-compulsive disorder subtype or independent clinical entity.

This theoretical study reviews the main research and findings on the nosological status of compulsive hoarding. Specifically, it describes available empirical evidence in order to determine their independence or inclusion within the obsessive-compulsive disorder (OCD), a mental disorder in which it has traditionally been included as one more subtype or dimension. Regarding this issue, the results found in the scientific literature show that persons with compulsive hoarding have distinct characteristics in different external criteria like sociodemographic variables, premorbid personality, degree of insight, neuroanatomical and genetic factors, neuropsychological profile, clinical course, levels of dysfunctionality and finally, treatment outcome. These conclusions are discussed and the proposal for the creation of a new clinical entity called "hoarding disorder" is evaluated.

[Comorbidity between obsessive-compulsive disorder and schizophrenia: prevalence, explanatory theories, and nosological status]. / Comorbilidad entre trastorno obsesivo-compulsivo y esquizofrenia: prevalencia, teorías explicativas y estatus nosológico.

This theoretical study reviews the main findings and research on comorbidity between obsessive-compulsive disorder (OCD) and schizophrenia. On the one hand, it is argued that high prevalence of comorbidity implies common risk factors (neuroanatomical and neuropsychological correlates) and a causal relationship between these mental illnesses, OCD usually preceding schizophrenia. On the other hand, independent nosological status of this "comorbidity" is supported on the basis of several external criteria (negative symptomatology, depressed mood, psychosocial impairment, neurobiological and neuropsychological correlates), which distinguish this mixed clinical entity from OCD and schizophrenia separately. These conclusions are discussed, considering the lack of recognition of "schizo-obsessive disorder" within the current diagnosis reference manuals.

Comorbilidad entre trastorno obsesivo-compulsivo y esquizofrenia: prevalencia, teorías explicativas y estatus nosológico / Comorbidity between obsessive-compulsive disorder and schizophrenia: Prevalence, explanatory theories, and nosological status

En el presente estudio teórico se revisan los principales hallazgos e investigaciones sobre la comorbilidad entre trastorno obsesivo-compulsivo (TOC) y esquizofrenia. Por una parte, se señala que la alta prevalencia de esta comorbilidad obedece tanto a factores de riesgo comunes (correlatos neuroanatómicos y neuropsicológicos) como a una relación causal entre ambas patologías mentales, precediendo generalmente el TOC a la psicosis. Por otro lado, se sostiene el estatus nosológico independiente de esta comorbilidad sobre la base de diversos criterios externos (sintomatología negativa, humor depresivo, disfuncionalidad psicosocial, correlatos neurobiológicos y neuropsicológicos), los cuales diferencian esta entidad clínica mixta de la esquizofrenia y el TOC por separado. Dichas conclusiones son discutidas considerando la falta de reconocimiento nosológico del denominado "trastorno esquizo-obsesivo"

This theoretical study reviews the main findings and research on comorbidity between obsessive compulsive disorder (OCD) and schizophrenia. On the one hand, it is argued that high prevalence of comorbidity implies common risk factors (neuroanatomical and neuropsychological correlates) and a causal relationship between these mental illnesses, OCD usually preceding schizophrenia. On the other hand, independent nosological status of this "comorbidity" is supported on the basis of several external criteria (negative symptomatology, depressed mood, psychosocial impairment, neurobiological and neuropsychological correlates), which distinguish this mixed clinical entity from OCD and schizophrenia separately. These conclusions are discussed, considering the lack of recognition of "schizo-obsessive disorder" within the current diagnosis reference manuals

Randomised controlled trial of cognitive motivational therapy program for the initialphase of schizophrenia: a 6-month assessment

Background and Objectives: The aim of this study is to investigate the relative effectiveness of routine care (RC) in addition to a specific early intervention program (PIPE) compared to routine care alone.Methods: A total of 34 participants in the initial phase of schizophrenia took part in randomized, single-blind controlled trial. Participants were randomized to receive either routine care (RC; n = 13) or routine integrated with Cognitive-Motivational Therapy(PIPE; n = 21). PIPE comprised individual and family Cognitive-Motivational therapyplus routine care for 12 months. In this paper we present preliminary results at 6 months after the beginning of the intervention. Clinical assessments were carried out at pre-treatment,and in this manuscript the results at 3 and 6 months after starting the intervention by external raters are presented, using the Positive and Negative Syndrome Scale, Brief Psychiatry Rating Scale, the Clinical Global Impression Scale, the Global Assessment of Functioning scale, and relapses. Mann-Whitney test and MANOVAs analysis for variance effects were used for the statistical analysis Results: Significant greater clinical effects were observed in those patients treated inRC+PIPE at three months from baseline assessment and at six months in PANSS scale(Mann-Whitney test; p < 0.000). Other benefits of the program included increase in globalactivity, reduced relapse rates, and reduction of the pharmacological treatment.Conclusions: These findings show the effectiveness of a program of routine care integratedwith cognitive-motivational interventions (individual and family therapy) over routine psychiatric care alone for patients who are in the initial phase of schizophrenia (AU)

Las intervenciones motivacionales en el tratamiento psicoterapéutico de la fase inicial de la esquizofrenia / Motivational intervention in the initial phase of schizophrenia

Son muchos los estudios que en los últimos quince años han demostrado la efectividad de los programas de intervención precoz en la esquizofrenia y su impacto sobre el pronóstico de la enfermedad. De hecho, la intervención preventiva en la fase prodrómica y posterior al primer episodio se ha convertido en una de las líneas principales de investigación y de aplicación clínica para el abordaje de la esquizofrenia. Durante la fase inicial de la esquizofrenia, quedan paralizadas muchas áreas de actividad y relacionales a las cuales el paciente deberá enfrentarse durante la fase de recuperación. Su grado de motivación en esta fase será de vital importancia para el tratamiento. En el presente trabajo se presenta una revisión y algunas consideraciones a cerca de las intervenciones motivacionales en la esquizofrenia

Many studies have shown the effectiveness of early intervention programs for schizophrenia and its impact on illness outcome. In fact, the preventive intervention in the prodromical period and after the first episode of psychosis has become the main way for the research and clinical procedures for schizophrenia treatments. During the initial phase of schizophrenia, many activity and relational areas are affected. Patient motivation could be very important to face de treatment during this period. So, the current article presents a literature revision and some considerations about the motivational interventions in the schizophrenia

Las intervenciones motivacionales en el tratamiento psicoterapéutico de la fase inicial de la esquizofrenia / Motivational intervention in the initial phase of schizophrenia

Son muchos los estudios que en los últimos quince años han demostrado la efectividad de los programas de intervención precoz en la esquizofrenia y su impacto sobre el pronóstico de la enfermedad. De hecho, la intervención preventiva en la fase prodrómica y posterior al primer episodio se ha convertido en una de las líneas principales de investigación y de aplicación clínica para el abordaje de la esquizofrenia. Durante la fase inicial de la esquizofrenia, quedan paralizadas muchas áreas de actividad y relacionales a las cuales el paciente deberá enfrentarse durante la fase de recuperación. Su grado de motivación en esta fase será de vital importancia para el tratamiento. En el presente trabajo se presenta una revisión y algunas consideraciones a cerca de las intervenciones motivacionales en la esquizofrenia

Many studies have shown the effectiveness of early intervention programs for schizophrenia and its impact on illness outcome. In fact, the preventive intervention in the prodromical period and after the first episode of psychosis has become the main way for the research and clinical procedures for schizophrenia treatments. During the initial phase of schizophrenia, many activity and relational areas are affected. Patient motivation could be very important to face de treatment during this period. So, the current article presents a literature revision and some considerations about the motivational interventions in the schizophrenia