Males and females with first episode psychosis present distinct profiles of social cognition and metacognition.

Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventions.

Persons with first episode psychosis have distinct profiles of social cognition and metacognition.

Subjects with first-episode psychosis experience substantial deficits in social cognition and metacognition. Although previous studies have investigated the role of profiles of individuals in social cognition and metacognition in chronic schizophrenia, profiling subjects with first-episode psychosis in both domains remains to be investigated. We used latent profile analysis to derive profiles of the abilities in 174 persons with first-episode psychosis using the Beck's Cognitive Insight Scale, the Faces Test, the Hinting Task, the Internal, Personal and Situational Attributions Questionnaire, and the Beads Task. Participants received a clinical assessment and a neuropsychological assessment. The best-fitting model was selected according to the Bayesian information criterion (BIC). We assessed the importance of the variables via a classification tree (CART). We derived three clusters with distinct profiles. The first profile (33.3%) comprised individuals with low social cognition. The second profile (60.9%) comprised individuals that had more proneness to present jumping to conclusions. The third profile (5.7%) presented a heterogeneous profile of metacognitive deficits. Persons with lower social cognition presented worse clinical and neuropsychological features than cluster 2 and cluster 3. Cluster 3 presented significantly worst functioning. Our results suggest that individuals with FEP present distinct profiles that concur with specific clinical, neuropsychological, and functional challenges. Each subgroup may benefit from different interventions.

The situation of infection in the elderly in Spain: a multidisciplinary opinion document.

Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.

[Cognitive-behavioural group therapy for insomnia: evaluation of the results after its implementation in a health department]. / Terapia grupal cognitivo-conductual para el insomnio: evaluación de resultados tras su introducción en un departamento de salud.

INTRODUCTION: Cognitive-behavioural therapy (CBT) is the preferred treatment in cases of chronic insomnia disorder in adults. PATIENTS AND METHODS: Open pragmatic study of 32 patients after eight sessions of group CBT for insomnia. RESULTS: Remission (insomnia severity index: 0-7 points) and response (insomnia severity index drops to > 8) were 31.3% and 46.9% at one month (n = 32) and 42.8% and 52.4% at one year (n = 21), respectively, with an effect size of 1.9 at one month and 2.3 at one year. At one month, 40.6% met the criteria for a case of insomnia (according to the insomnia symptoms questionnaire), and at one year, 19%, with a significant improvement in the symptoms at night and the consequences during the day. The questions of the Pittsburgh Sleep Quality Index on insomnia and sleep efficiency also improved. The pre-sleep arousal scale (n = 7) showed a shift from significant somatic and cognitive arousal to no arousal at one month. In the sleep diaries, total sleep time increased by an average of 53 minutes at one month (n = 14) and 76 minutes at one year (n = 10), with an increase of more than 10% in 71.4% of patients at one month and at one year, and an average sleep efficiency of more than 85%. The effect size for total sleep time and sleep efficiency was between 0.7 and 1. CONCLUSIONS: Group CBT for insomnia appears to be an effective treatment option in a clinical setting.

TITLE: Terapia grupal cognitivo-conductual para el insomnio: evaluación de resultados tras su introducción en un departamento de salud.Introducción. La terapia cognitivo-conductual (TCC) es el tratamiento de elección en el trastorno de insomnio crónico en adultos. Pacientes y métodos. Estudio pragmático abierto de 32 pacientes tras ocho sesiones de TCC grupal para el insomnio. Resultados. La remisión (índice de gravedad del insomnio: 0-7 puntos) y la respuesta (caída del índice de gravedad del insomnio > 8) fue del 31,3% y 46,9% al mes (n = 32) y del 42,8% y 52,4% al año (n = 21), respectivamente, con un tamaño del efecto de 1,9 al mes y 2,3 al año. Al mes, el 40,6% cumplía criterios de caso de insomnio (según el cuestionario de síntomas de insomnio), y al año, el 19%, con una mejoría significativa de síntomas nocturnos y consecuencias diurnas. También mejoraron las preguntas del índice de calidad de sueño de Pittsburgh sobre el insomnio y la eficiencia del sueño. La escala de activación previa al sueño (n = 7) mostró un trasvase desde activación significativa somática y cognitiva a ausencia de activación al mes. En los diarios de sueño, el tiempo total de sueño aumentó 53 minutos de media al mes (n = 14) y 76 al año (n = 10), con un aumento superior al 10% en el 71,4% de los pacientes al mes y al año, y una eficiencia del sueño media superior al 85%. El tamaño del efecto para el tiempo total de sueño y la eficiencia del sueño estuvo entre 0,7 y 1. Conclusiones. La TCC grupal para el insomnio parece una opción terapéutica eficaz en un entorno clínico.

Randomized control trial to assess the efficacy of metacognitive training compared with a psycho-educational group in people with a recent-onset psychosis.

BACKGROUND: Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome. METHOD: A multicenter, randomized, controlled clinical trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive biases and social cognition. RESULTS: Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p = 0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p = 0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions (JTC) improved more in the MCT group than the psycho-educational group (p = 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in the MCT group but not the psycho-educational group (p < 0.001-0.032). CONCLUSIONS: MCT could be an effective psychological intervention for people with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve symptoms, ToM, and personalizing bias.

Confabulation in schizophrenia: a neuropsychological study.

Confabulation has been documented in schizophrenia, but its neuropsychological correlates appear to be different from those of confabulation in neurological disease states. Forty-five schizophrenic patients and 37 controls were administered a task requiring them to recall fables. They also underwent testing with a range of memory and executive tasks. The patients with schizophrenia produced significantly more confabulations than the controls. After correcting for multiple comparisons, confabulation was not significantly associated with memory impairment, and was associated with impairment on only one of eight executive measures, the Brixton Test. Confabulation scores were also associated with impairment on two semantic memory tests. Confabulation was correlated with intrusion errors in recall, but not false positive errors in a recognition task. The findings suggest that confabulation in schizophrenia is unrelated to the episodic memory impairment seen in the disorder. However, the association with a circumscribed deficit in executive function could be consistent with a defective strategic retrieval account of confabulation similar to that of Moscovitch and co-workers, interacting with defective semantic memory.

Descripción clínica y epidemiológica de los primeros casos de la gripe nueva A (H1N1) atendidos en España / New influenza virus A (H1N1) infection in Spain: clinical and epidemiologic description

Objetivo: Describir las consultas atendidas en urgencias durante el primer día de brote de gripe nueva A (H1N1), descripción de los primeros casos diagnosticados, su contexto epidemiológico y la organización que se estableció en urgencias durante las 24 horas de la guardia de dicho día. Método: Se revisan las historias clínicas de las consultas recibidas en urgencias el día 26de abril de 2009 en relación al brote de gripe nueva A (H1N1), y a partir de ella se recogen datos clínicos y epidemiológicos. En los casos sospechosos se realizó una analítica general, una radiología de tórax, un frotis nasal y faríngeo para la detección de ácidos nucleicos del nuevo virus de la la gripe A (H1N1) y una extracción de sangre para la determinación de anticuerpos específicos. Además, se han recogido también las principales medidas organizativas que se tomaron durante la guardia. Resultados: Durante la guardia se atendieron un total de 99 pacientes, de los cuales 12(12%) estuvieron relacionados con el brote de nueva gripe en México. Estos 12 pacientes procedían de 6 viajes diferentes, con un tiempo transcurrido desde el vuelo de retorno de entre 3 y 25 días. De los 12 casos, en cuatro de ellos se consideró que no había contexto epidemiológico compatible, por lo que fueron dados de alta sin realizárseles determinación de ácidos nucleicos. De los ocho restantes, cuatro se ingresaron en el hospital (todos ellos en habitaciones individuales que reúnen los requisitos para el aislamiento respiratorio y de contacto) y cuatro fueron dados de alta. De estos 8 pacientes, tres fueron diagnosticados de gripe nueva A (H1N1), uno de ellos por transmisión secundaria doméstica sin haber estado previamente en México. Las características clínicas del cuadro no difieren de la gripe epidémica humana que habitualmente (..) (AU)

Objective: To describe emergency consultations during the first day of the new influenza outbreak. The description covers the first cases of new influenza virus infection diagnosed, the epidemiologic context, and the organization of emergency services during the first 24 hours of care provided on that day. Material and Methods: The medical records for emergency consultations on April 26, 2009 at an urban tertiary care hospital were reviewed to identify cases related to the new influenza virus. Clinical and epidemiologic data were extracted. When the new influenza was suspected, the attending physician ordered a complete laboratory and blood workup, chest x-ray, and nasal swab and throat swab to detect nucleic acids from new influenza virus A (H1N1). Blood was extracted for influenza viral specific antibodies testing. Information on the main organizational measures taken during the 24-hour period were also recorded. Results: Ninety-nine patients were attended over the course of the day. Twelve (12%) had had some contact with cases of the new Mexican flu outbreak. The 12 cases all bore some relationship with 6 different trips (with between 3 and 25 days passing since the return flight). In 4 cases, it was considered that epidemiologic features were not consistent with a diagnosis of the new influenza. Those patients were therefore discharged without viral antigen testing. Four of there maining 8 patients were admitted (all placed in private rooms that allowed for respiratory and contact isolation), and 4 were discharged. Three of the 8 patients were diagnosed with the new influenza. One case was the result of secondary transmission in the home, as the patient (..) (AU)

Confabulation in schizophrenia and its relationship to clinical and neuropsychological features of the disorder.

BACKGROUND: A form of confabulation has been documented in schizophrenia and appears to be related to the symptom of thought disorder. It is unclear whether it is associated with the same pattern of neuropsychological deficits as confabulation in neurological patients. METHOD: Thirty-four patients with chronic schizophrenia, including those with and without thought disorder, and 17 healthy controls were given a fable recall task to elicit confabulation. They were also examined on a range of executive, episodic and semantic memory tests. RESULTS: Confabulation was seen at a significantly higher rate in the schizophrenic patients than the controls, and predominated in those with thought disorder. Neuropsychologically, it was not a function of general intellectual impairment, and was not clearly related to episodic memory or executive impairment. However, there were indications of an association with semantic memory impairment. CONCLUSIONS: The findings support the existence of a form of confabulation in schizophrenia that is related to thought disorder and has a different neuropsychological signature to the neurological form of the symptom.

Inhalación de humos, gases y vapores irritantes para el aparato respiratorio / Inhalation of smoke, gas and irritant vapours

La inhalación de gases irritantes puede inducir una respuesta inflamatoria sobre el aparato respiratorio, que puede abarcar desde la nariz, faringe y laringe hasta los alveolos, con una expresividad clínica muy variable tanto en su forma de presentación (rinitis) como en la gravedad (edema de glotis, broncoespasmo, edema pulmonar). Los gases más hidrosolubles, como el amoniaco afectan sobre todo a las vías respiratorias altas; mientras que los más liposolubles, como los óxidos de nitrógeno, lesionan de forma predominante las vías bajas. El tratamiento es fundamentalmente sintomático

The inhalation of irritant gases may induce an inflammatory response in the respiratory tract involving the airway from the nose, pharynx and larynx down to the alveoles. This inflammatory response is quite varied in its clinical expression, both regarding the mode of presentation (rhinitis) and also the severity (oedema of the glottis, bronchospasm, lung oedema). The more water-soluble gases, such as ammoniac, predominantly affect the upper airways, while the more liposoluble ones, such as nitrogen oxides, predominantly damage the lower airways. The therapeutic management is mainly symptomatic

Endocarditis infecciosa sobre cable de marcapasos / Infective endocarditis of pacemakers leads

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Niveles sanguíneos de plomo en niños de un barrio de Barcelona

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Perfil de las competencias profesionales del diplomado en nutrición humana y dietética / Profile of profesional skills and abilities of the graduate in nutrition and dietetics

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El traslado secundario de los pacientes contraumatismo craneoencefálico grave / Secundary displacement of patients with servere cranioencephalic

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Profilaxis del síndrome de hipotensión intracraneal y cefalea pospunción lumbar / Prophylasis of intracranial hypotension syndrome and headache following lumbar puncture

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