Effectiveness of family metacognitive training in mothers with psychosis and their adolescent children: a multicenter study protocol.

Background: More than half of women with psychosis take care of their children despite the difficulties caused by the disease. Additionally, these kids have a higher risk of developing a mental health disorder. However, no interventions have been developed to meet these needs. Metacognitive Training (MCT) is a psychological intervention that has demonstrated its efficacy in improving cognitive insight, symptom management and social cognition in people with first-episode psychosis (FEP). Additionally, MCT has shown better results in women than men with FEP. This study aims to adapt and evaluate the efficacy of MCT-F in mothers and adolescent children in an online group context with the main purpose of improving family relationships, cognitive awareness and symptoms in women with psychosis and increase their children's knowledge of the disease and their functioning. As secondary objectives, it also aims to evaluate improvements in metacognition, social cognition, symptoms, protective factors and self-perception of stigma. Materials and methods: A quasi-experimental design with participants acting as their own control will be carried out. Forty-eight mothers with psychosis and their adolescent children (between 12 and 20 years old) recruited from a total of 11 adult mental health care centers will receive MCT-F. Participants will be evaluated 11 weeks before the intervention (T1), at baseline (T2), and post-intervention (T3) with a cognitive insight scale, as a primary outcome. Measures of metacognitive and social cognition, symptoms, cognitive functioning, family and social functioning, protective factors (self-esteem, resilience, and coping strategies) and self-perceived stigma will be addressed as secondary outcomes. Assessment will also address trauma and attachment in mothers and, lastly, the feasibility and acceptability of MCT-F in both participant groups. Discussion: This will be the first investigation of the efficacy, acceptability, and viability of the implementation of MCT-F. The results of this study may have clinical implications, contributing to improving mothers' with psychosis and adolescents' functioning and better understanding of the disease, in addition to the possible protective and preventive effect in adolescents, who are known to be at higher risk of developing severe mental disorders.Clinical trial registration:https://clinicaltrials.gov/, identifier [NCT05358457].

Family Metacognitive Training (MCT-F): Adapting MCT to Mothers with Psychosis and Their Adolescent Children.

Over half of women with psychosis are mothers. Research suggests that mothers with psychosis face unique challenges affecting both their mental health prognosis and their relationship with their children. Moreover, those children have a higher risk of developing a mental disorder. Notwithstanding, interventions specifically tailored to these families remain largely uncovered. Metacognitive Training (MCT) has demonstrated its efficacy in improving cognitive insight, symptom management, and social cognition in people with psychosis. However, there is no evidence of the efficacy of MCT in a family setting (MCT-F). This study describes the first adaptation of MCT for mothers with psychosis and their adolescent children in an online group setting. The phases (assessment, decision, adaptation, production, topical experts' integration) of the ADAPT-ITT model were systematically applied through a participatory approach (n = 22), including a first-person perspective and involving qualitative (e.g., topical expert literature review and consensus groups, interviews, thematic analyses) and quantitative methods. While MCT's core components were retained, participants guided adaptations both in content and delivery. The findings suggest the importance of community engagement and sharing decision-making processes to demonstrate the acceptability and feasibility of the adapted intervention. Employing a structured approach such as the ADAPT-ITT model ensures readiness of the new training for efficacy trials.

The relationship between jumping to conclusions and social cognition in first-episode psychosis.

Jumping to conclusions (JTC) and impaired social cognition (SC) affect the decoding, processing, and use of social information by people with psychosis. However, the relationship between them had not been deeply explored within psychosis in general, and in first-episode psychosis (FEP) in particular. Our aim was to study the relationship between JTC and SC in a sample with FEP. We conducted a cross-sectional study with 121 patients with FEP, with measures to assess JTC (easy, hard, and salient probability tasks) and SC (emotional recognition, attributional style, and theory of mind). We performed Student's t-test and logistic regression in order to analyse these associations.We found a statistically significant and consistent relationship of small-moderate effect size between JTC (all three tasks) and impaired emotional recognition. Also, our results suggest a relationship between JTC and internal attributions for negative events. Relationships between JTC and theory of mind were not found. These results highlight the importance of psychological treatments oriented to work on a hasty reasoning style and on improving processing of social information linked to emotional recognition and single-cause attributions.

Traumatismo craneoencefálico en pacientes con síndrome psicótico: etiopatogenia y estatus nosológico / Traumatic brain injury in patients with psychotic syndrome: etiopathogenesis and nosological status

Introducción. Uno de los debates nosológicos más controvertidos en el ámbito de la Neuropsiquiatría versa sobre el diagnóstico diferencial entre psicosis adquiridas e idiopáticas"(esquizofrenia) en pacientes que previamente han sufrido un traumatismo craneoencefálico (TCE). Caso clínico. Se expone el caso de un varón de 15 años, sin antecedentes psiquiátricos personales ni familiares, que a los 5 meses de sufrir un TCE con pérdida de conciencia desarrolló un síndrome psicótico crónico caracterizado por sintomatología positiva, siendo ésta resistente a todos los tratamientos psicofarmacológicos prescritos. No se evidenció lesión cerebral focalizada a través de neuroimagen estructural. Discusión. El TCE puede actuar como agente etiopatogénico primario (psicosis debida a un TCE) o precipitante (esquizofrenia) en los cuadros psicóticos manifestados. Los dos criterios externos que contribuyen en mayor medida a la distinción de ambos trastornos son la escasa sintomatología negativa y la baja vulnerabilidad genética entre las personas con psicosis debida a un TCE. Con relativa frecuencia, tanto el periodo de latencia TCE-psicosis como los correlatos neurocognitivos y neurobiológicos asociados apenas permiten esclarecer el estatus nosológico del síndrome psicótico. Son necesarios ensayos clínicos controlados para valorar la eficacia de los antipsicóticos en aquellos sujetos con psicosis debida a un TCE (AU)

Introduction. One of the most controversial nosological issues in neuropsychiatry deals with the differential diagnosis between acquired and idiopathic psychosis (schizophrenia) in patients who have previously undergone a traumatic brain injury (TBI). Case report. A 15 year-old man, without personal or family psychiatric history, developed a chronic syndrome characterized by positive psychotic symptoms 5 months after suffering a TBI with loss of consciousness. The syndrome was refractory to all psychopharmacological treatments prescribed. There was no brain alteration detected through structural imaging. Discussion. TBI may play a role either as primary etiopathogenic agent (psychosis due to TBI) or as triggering factor (schizophrenia) in the development of psychotic symptoms. Fewer negative symptoms as well as lower genetic vulnerability contribute to differentiate the former group from the latter one. Usually, neither the latency period between TBI-psychosis onset nor the neurocognitive and neurobiological correlates allow to clarify the nosological status. Further controlled clinical trials are needed to assess the efficacy of antipsychotics in those subjects with psychosis due to TBI (AU)

Niveles de ácidos grasos poliinsaturados (pufa) en la membrana eritrocitaria de una muestra de pacientes con esquizofrenia y su relación con variables clínicas y evolutivas / Erythrocyte membrane polyunsaturated fatty acid (pufa) levels in a sample of patients with schizophrenia and relation with clinical and progression variable

Introducción. Estudios previos han mostrado que las membranas celulares eritrocitarias de pacientes con esquizofrenia presentan una reducción considerable de ácidos grasos omega-3, particularmente EPA (ácido eicosapentaenoico) y DHA (ácido docosahexaenoico), reflejando niveles disminuidos en las membranas neuronales y del sistema nervioso central. Este fenómeno, ligado a factores genéticos, metabólicos o dietéticos, ha sido relacionado con el desarrollo de la esquizofrenia, con el grado de gravedad y con un mayor riesgo de desarrollar síndrome metabólico. Metodología. El presente estudio, es un estudio observacional que se realizó en una muestra de 31 pacientes con esquizofrenia del Centro de Salud Mental de Mataró (Barcelona). El objetivo fue relacionar los niveles eritrocitarios de omega 3 con la severidad clínica del trastorno y los hábitos dietéticos. Se determinaron los niveles de EPA (ácido eicosapentaenoico), DHA (ácido docosahexaenoico) y otros lípidos de membrana, así como medidas de estado psicopatológico, funcionamiento cognitivo y social, evolución previa y finalmente una encuesta de hábitos dietéticos. Resultados. Nuestros resultados no mostraron una correlación estadísticamente significativa entre los niveles de ácidos omega 3 eritrocitarios y las variables de gravedad psicopatológica y clínica. No obstante, se hallaron niveles superiores, estadísticamente significativos, en el grupo de mujeres y en los pacientes con mayor número de días de ingreso en el hospital de día. De forma opuesta, los valores inferiores se obtuvieron en pacientes tratados con antipsicóticos de acción prolongada y en consumidores de aceite de girasol. Conclusiones. A pesar de no haber podido demostrar nuestra hipótesis de trabajo, se han encontrado correlaciones significativas coherentes con los hallazgos en la literatura actual es por ello que se postula la necesidad de realizar estudios con muestras más amplias y presencia de grupos de controles sanos

Introduction. Previous studies have shown that erythrocyte cell membranes in patients with schizophrenia contain considerably less omega-3 fatty acids, particularly EPA eicosapentaenoic acid) and DHA (docosahexaenoic acid), reflecting the lower levels present in neuronal and central nervous system membranes. This phenomenon, linked to genetic, metabolic, or dietary factors, has been associated with the development of schizophrenia and the risk of developing and the severity of metabolic syndrome. Methods. This study is an observational study conducted in a sample of 31 patients with schizophrenia treated at the Mataró Mental Health Center (Barcelona). Its aim was to relate the erythrocyte levels of omega 3 with the clinical severity of schizophrenia and dietary habits. EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid) and other membrane lipid levels were determined, as well as psychopathology, cognitive, and social functioning measures, previous evolution, and finally a survey of dietary habits. Results. Our results did not show a statistically significant correlation between erythrocyte omega-3 levels. and psychopathological and clinical severity variables. Higher, statistically significant, levels were found in the group of women and in subjects with more days of admission to the day hospital. In contrast, lower values were obtained in subjects treated with long-acting antipsychotics and in sunflower oil consumers.Conclusions.Despite not being able to demonstrate our working hypothesis, significant correlations were found that were consistent with published findings in the current literature. The need for studies with larger samples and groups of healthy controls is postulated

Erythrocyte membrane polyunsaturated fatty acid (pufa) levels in a sample of patients with schizophrenia and relation with clinical and progression variables.

INTRODUCTION: Previous studies have shown that erythrocyte cell membranes in patients with schizophrenia contain considerably less omega-3 fatty acids, particularly EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), reflecting the lower levels present in neuronal and central nervous system membranes. This phenomenon, linked to genetic, metabolic, or dietary factors, has been associated with the development of schizophrenia and the risk of developing and the severity of metabolic syndrome. METHODS: This study is an observational study conducted in a sample of 31 patients with schizophrenia treated at the Mataró Mental Health Center (Barcelona). Its aim was to relate the erythrocyte levels of omega 3 with the clinical severity of schizophrenia and dietary habits. EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid) and other membrane lipid levels were determined, as well as psychopathology, cognitive, and social functioning measures, previous evolution, and finally a survey of dietary habits. RESULTS: Our results did not show a statistically significant correlation between erythrocyte omega-3 levels and psychopathological and clinical severity variables. Higher, statistically significant, levels were found in the group of women and in subjects with more days of admission to the day hospital. In contrast, lower values were obtained in subjects treated with long-acting antipsychotics and in sunflower oil consumers. CONCLUSIONS: Despite not being able to demonstrate our working hypothesis, significant correlations were found that were consistent with published findings in the current literature. The need for studies with larger samples and groups of healthy controls is postulated.

Trauma, posttraumatic stress disorder and psychosis: Etiopatho-genic and nosological implications

Background and Objectives: The relationship between trauma, post-traumatic stress disorder (PTSD), and psychosis has promoted heterogeneous research lines, in both etiopathogenic and nosological areas. The main aim of this review is to provide a systematic framework that encompasses this theoretical gap in the literature. Methods: A literature research was carried out through PubMed and PsycINFO between 1980 and May 2013. One hundred and thirteen articles were recruited. A first part of this review describes the role of trauma in the development of psychosis. The second part focuses on research about PTSD and psychosis. Results: Longitudinal and cross-sectional studies with clinical and community samples confirm that childhood trauma (CT) is a vulnerability factor for schizophrenia and psychotic-like symptoms in adulthood. More empirical research is needed in order to assess the role of trauma as precipitant of acute psychosis. There is also preliminary evidence with cross-sectional samples that suggests that PTSD and psychosis are a risk factor for each other, with studies about post-psychotic PTSD (PP-PTSD) being outstanding. Finally, results from different comparative research studies postulate a subtype of PTSD with psychotic features (PTSD-SP). Conclusions: The role of trauma in psychosis is more conclusive as predispositional rather than as trigger factor. Nosological status of acute psychoses remains a focus of controversy unresolved. The association between PTSD and psychosis is complex, requiring more prospective research in order to determine causal relationships between these pathologies. Also, research in nosological status of PTSD-SP must encourage more comparative studies not limited to neurobiological variables (AU)

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Eventos traumáticos en pacientes con trastorno obsesivocompulsivo: implicaciones etiopatogénicas, nosológicas y terapéuticas / Traumatic events in patients with obsessive-compulsive disorder: Etiopathogenic, nosological, and therapeutic implications

INTRODUCCIÓN. El trastorno obsesivo-compulsivo (TOC) es una patología neuropsiquiátrica en donde se propugna un papel accesorio de los factores de riesgo psicosociales. A pesar de ello, existe un subgrupo de pacientes cuya etiopatogenia, fenomenología, diagnóstico y terapéutica se halla condicionada por la presencia de eventos traumáticos (ET). CASO CLÍNICO. Se expone el caso de una mujer adulta joven que desarrolló una psicopatología compatible con TOC y trastorno por estrés postraumático (TEPT) tras sufrir abusos sexuales durante la adolescencia temprana. Aunque se implementaron tratamientos farmacológicos y psicoterapéuticos convencionales, su curso fue fluctuante, exacerbándose en el contexto de una nueva agresión sexual. CONCLUSIONES. Los ET constituyen un factor de riesgo inespecífico para el TOC, ya sea como variable predisponente o precipitante. Adicionalmente, pueden determinar su patoplastia, siendo el ejemplo más paradigmático la presencia de obsesiones de “polución mental” tras sufrir abusos sexuales. A nivel nosológico, existen evidencias preliminares para postular una entidad clínica nueva (“trastorno obsesivo-compulsivo postraumático”), la cual englobe aquellos sujetos con comorbilidad entre TOC y TEPT tras un ET. En el plano interventivo, los pacientes con obsesiones de “polución mental” precisan estrategias psicoterapéuticas adicionales a las implementadas en sus homólogos de naturaleza más neurobiológica (AU)

INTRODUCTION. Obsessivecompulsive disorder (OCD) is a neuropsychiatric condition where an accessory role of psychosocial risk factors is advocated. However, there is a subgroup of obsessive patients whose etiology, phenomenology, diagnosis and therapeutic features are conditioned by the presence of traumatic events (TE). CLINICAL CASE. A young adult woman developed OCD and posttraumatic stress disorder (PTSD) after suffering sexual abuse during early adolescence. Although psychotropic and psychotherapeutic conventional treatments were implemented, the course was fluctuating, exacerbated in the context of a new sexual assault. CONCLUSIONS. TE constitute a nonspecific risk factor for OCD, either predisposing or precipitating variable. Additionally, they can determine their pathoplasty, the best example being the presence of “mental pollution” obsessions after suffering sexual abuse. There is preliminary evidence to postulate a new clinical entity (“posttraumatic obsessive-compulsive disorder”), which encompasses subjects with OCD and PTSD comorbidity after TE. Obsessions in patients with “mental pollution” require additional psychotherapeutic strategies compared to neurobiological homonyms (AU)

Level of distress, somatisation and beliefs on health-disease in newly arrived immigrant patients attended in primary care centres in Catalonia and definition of professional competences for their most effective management: PROMISE Project.

BACKGROUND: Newly arrived immigrant patients who frequently use primary health care resources have difficulties in verbal communication. Also, they have a system of beliefs related to health and disease that makes difficult for health care professionals to comprehend their reasons for consultation, especially when consulting for somatic manifestations. Consequently, this is an important barrier to achieve optimum care to these groups. The current project has two main objectives: 1. To define the different stressors, the level of distress perceived, and its impact in terms of discomfort and somatisation affecting the main communities of immigrants in our area, and 2. To identify the characteristics of cross-cultural competence of primary health care professionals to best approach these reasons for consultation. METHODS/DESIGN: It will be a transversal, observational, multicentre, qualitative-quantitative study in a sample of 980 people from the five main non-European Union immigrant communities residing in Catalonia: Maghrebis, Sub-Saharans, Andean South Americans, Hindustanis, and Chinese. Sociodemographic data, level of distress, information on the different stressors and their somatic manifestations will be collected in specific questionnaires. Through a semi-structured interview and qualitative methodology, it will be studied the relation between somatic manifestations and particular beliefs of each group and how these are associated with the processes of disease and seeking for care. A qualitative methodology based on individual interviews centred on critical incidents, focal groups and in situ questionnaires will be used to study the cross-cultural competences of the professionals. DISCUSSION: It is expected a high level of chronic stress associated with the level of somatisations in the different non-European Union immigrant communities. The results will provide better knowledge of these populations and will improve the comprehension and the efficacy of the health care providers in prevention, communication, care management and management of resources.

Tratamiento psicológico grupal para los trastornos de ansiedad en el ámbito de la salud pública / Group therapy for anxiety disorders in public mental health setting

Este trabajo evalúa los cambios de una intervención psicoterapéutica grupal para pacientes con trastornos de ansiedad generalizada, trastorno de pánico con o sin agorafobia y trastorno adaptativo con sintomatología ansiosa o depresiva asociada. Un total de 107 pacientes participaron en el estudio, de los cuales 73,8% eran mujeres y el 26,2% hombres con edades comprendidas entre los 21 y 62 años, provenientes de un Centro de Salud Mental y un Centro de Atención Primaria del Consorci Sanitari del Maresme (Barcelona). El tratamiento cognitivo-conductual se compuso de 20 sesiones con periodicidad semanal de 90 minutos de duración. Los participantes completaron a través de una entrevista semiestructurada medidas clínicas de ansiedad, depresión, somatización, inteligencia emocional percibida y medidas protectoras de salud tales como autoestima y satisfacción vital. Los resultados obtenidos muestran mejoras significativas en términos de reducción sintomática, además de un incremento de la autoestima y la satisfacción general con la vida para todos los grupos diagnósticos (AU)

The aim of the current study is to assess the outcome of a group psychotherapy intervention in patients with generalized anxiety disorder, panic disorder with or without agoraphobia and adjustment disorder with anxious or depressive symptoms. A total of 107 patients were included in the study, 73,8% were women and 26,2% men, aged form 21 and 62, form a Mental Health Center and a Primary Care Center, both of which are part of the Maresme Sanitary Consortium (Barcelona). The cognitive-behavioral therapy consisted of twenty 90 minute weekly sessions. The participants completed a semistructures interview that included clinical measures of anxiety, depression, somatization, perceived emotional intelligence and other measures related with health (self-esteem and life satisfaction). The results showed significant improvements in symptom reduction, as well as an increase in self-esteem and perceived quality of life (p<0.01) for all diagnostic groups (AU)

Valores personales y profesionales en médicos de familia y su relación con el síndrome del burnout / Personal and professional values in primary care physicians and your relation with burnout syndrome

El objetivo de este estudio es analizar si existen diferencias en los valores de los médicos de Atención Primaria con niveles altos o bajos de burnout. La muestra quedó constituida por 61 médicos que habían participado anteriormente en un estudio longitudinal iniciado en 1999. En la primera evaluación participaron 528 médicos de la provincia de Barcelona y en la presente se han evaluado aquellos que obtuvieron las puntuaciones extremas en desgaste profesional. Para la recogida de datos se aplicó un cuestionario de datos sociodemográficos, la versión española del MBI (Maslach Burnout Inventory) y un cuestionario de valores validado con trabajadores del ICS (Institut Català de la Salut). Se observan diferencias significativas entre ambos grupos en los valores de Altruismo (p=0,01), Confidencialidad (p=0,013) y Abnegación (p=0,036). Asimismo se aprecia una correlación directa entre Inmediatez Cansancio Emocional (p<0,05), una relación inversa entre Altruismo Cansancio Emocional (p<0,01) y Altruismo Despersonalización (p<0,05). En suma, todo parece indicar que algunos valores personales y profesionales se asocian a la presencia o ausencia de burnout. Paralelamente, la percepción de conflicto entre los valores personales y los profesionales podría favorecer la presencia de burnout

The aim of the current study was to analyse the differences in values of Primary Care doctors with high or low scores in burnout. 61 Primary Care doctors with extremely scores in burnout who participated in a longitudinal study started in 1999 were chose. In the first assessment were interviewed 528 subjects from Barcelona’s northern countries. There were used a sociodemographic questionnaire data, the Spanish version of the Maslach Burnout Inventory (MBI) and a values questionnaire that was validated in ICS (Institut Català de la Salut) workers sample. Statistically meaningful differences were observed in the following values between groups: Altruism (p=0,01), Confidentiality (p=0,013) y Abnegation (p=0,036). Data shows a direct correlation between Impatience-Emotional Exhaustion (p<0,05), inverse relations between Altruism Emotional Exhaustion (p<0,01) and Altruism Depersonalisation (p<0,05). The study shows some personal and professional values are associated with high or low levels of burnout. In the same way the conflict perception between personal and professional values could be associated with high scores in burnout

Primeros episodios psicóticos: características clínicas y patrones de consumo de sustancias en pacientes ingresados en una unidad de agudos / First episode psychosis: clinical characteristics and substance abuse style in patients at the acute care unit

Objetivo: observar y describir las características sociodemográficas, clínicas y patrones de consumo de sustancias que presentan los pacientes ingresados por primer episodio psicótico. Método: se incluyeron todos los ingresos realizados de primeros episodios psicóticos entre enero de 2000 y setiembre de 2003. La muestra final estuvo formada por 82 pacientes que ingresaron en la unidad de agudos del servicio de psiquiatría del Hospital de Mataró. Resultados: Del total de la muestra, un 56% de pacientes presentaron abuso de sustancias tóxicas en los últimos años de entre los cuales un 23.2% manifestó un aumento de dicho consumo durante las últimas tres semanas anteriores al ingreso psiquiátrico. Se observa una correlación significativa entre el aumento del consumo de sustancias en las tres últimas semanas y la duración del ingreso psiquiátrico (p=.043, r de Pearson). También entre los antecedentes de consumo de drogas y un debut más temprano del trastorno psicótico (p=.02). Conclusiones: El consumo de drogas en los trastornos psicóticos nos conduce directamente a la eterna reflexión de si la correlación que encontramos entre ambas variables podría ir más allá de una mera asociación y que el consumo fuese un factor predictivo del inicio o de la transición al primer episodio psicótico

Aim: To study the clinical, sociodemographic characteristics and substance abuse style in the first episode of psychosis. Method: Included, were all the first episode cases of psychosis from January 2000 to September 2003. The final sample was formed by 82 patients that were admitted into the acute psychiatric unit of Mataro’s Hospital. Outcomes: Of the total sample, 56% of patients presented abuse of toxic substances in recent years of which 23.2% declared an increase of consumption during the 3 weeks prior to admission. We observed a significant correlation among those patients and the duration of their admittance (p=.043, r Pearson). Also among the drugs consumption history there was an earlier beginning of psychotic disorder (p=.02). Conclusions: The substance abuse in people who have a psychotic disorder, leads us directly to the eternal reflection that if the correlation found between both variables would be able to be more than just a mere association and that the consumption would be a predictive factor to the begin-ning or transition to first episode-psychosis