m-RESIST, una solución m-Health integral para personas con Esquizofrenia Resistente: estudio cualitativo de necesidades y aceptabilidad de usuarios en el área de Barcelona / m-RESIST, a complete m-Health solution for patients with treatment-resistant schizophrenia: a qualitative study of user needs and acceptability in the Barcelona metropolitan area

Introducción. A pesar del creciente potencial teórico de las soluciones m-Health en el tratamiento de pacientes con esquizofrenia, siguen faltando soluciones tecnológicas a nivel práctico. El objetivo de este estudio fue medir las necesidades y aceptabilidad de pacientes, familiares y profesionales hacia un modelo m-Health de intervención integral: Salud Móvil para pacientes con esquizofrenia resistente al tratamiento (m-RESIST). Métodos. Se llevó a cabo un estudio cualitativo en el Parc Sanitari Sant Joan de Déu (Barcelona) de las necesidades y aceptabilidad de pacientes con esquizofrenia resistente. Se analizaron sus opiniones, junto con las de familiares y profesionales, relativas a los servicios inicialmente pensados para formar parte del m-RESIST. Se realizaron cinco grupos focales y ocho entrevistas, usando el análisis del discurso como aproximación analítica. Resultados. Se consideró adecuada la creación de una página web y un foro virtual para obtener información fiable sobre la enfermedad y como apoyo entre usuarios. Para mejorar el contacto con los profesionales, se valoró positivamente el servicio de transmisión de datos, visitas "online" y mensajes instantáneos. Las alertas fueron consideradas útiles como recordatorios de tareas diarias y citas médicas. Las principales sugerencias para mejorar la eficacia fueron: evitar el exceso de alertas para no generar estrés, promover un papel activo del paciente en el manejo de la enfermedad y mantener contacto personal con los profesionales. Conclusiones. La buena aceptabilidad hacia el m-RESIST se relaciona con su utilidad para satisfacer las necesidades del usuario, su capacidad para empoderarles y la posibilidad de mantener contacto humano (AU)

Background. Despite the theoretical potential of m-health solutions in the treatment of patients with schizophrenia, there remains a lack of technological solutions in daily practice. The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to an integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment Resistant Schizophrenia (m-RESIST). Methods. A qualitative study of the needs and acceptability of outpatients with treatment-resistant schizophrenia was carried out in Parc Sanitari Sant Joan de Déu (Barcelona). We analyzed the opinions of patients, informal carers, and clinicians concerning the services initially thought to be part of the solution. Five focus groups and eight interviews were carried out, using discourse analysis as the analytical approach. Results. A webpage and a virtual forum were perceived as suitable to get reliable information on both the disease and support. Data transmission service, online visits, and instant messages were evaluated as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and medical appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions for improving the effectiveness of the solution. Conclusions. Positive acceptance of m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact (AU)

Gender differences in delusional disorder: Evidence from an outpatient sample.

Our objective was to study gender differences in delusional disorder (DD), by comparing potential risk factors, clinical correlates, illness course characteristics, and functionality. The sample was composed of 86 outpatients with DD (according to the SCID-I for DSM-IV criteria). The following assessment instruments were used service use and demographic questionnaires, Standardized Assessment of Personality (SAP), the Positive and Negative Symptom Scale (PANSS), Montgomery-Asberg Depression Rating Scale (MADRS), Mini-Mental State Examination (MMSE), Mini International Neuropsychiatry Interview (MINI), Sheehan Disability Inventory (SDI), and the Global Assessment of Functioning (GAF) scale. The female-to-male ratio was 1.6:1. Men were more likely to be single, while women were more likely to be widows. Men had a greater frequency of schizoid and schizotypal premorbid personality disorders and of premorbid substance abuse. There were no differences for other risk factors (immigration, deafness, late onset, other personality disorders, and family history). Men were younger at onset and more frequently had acute onset of the disorder. Men had more severe symptoms (higher score on the global or separate PANSS scales). There were no gender differences for the remaining symptomatological variables (types of DD, presence and severity of depression, presence of hallucinations, severity of global cognitive functioning and presence of axis I comorbidity). Global and partial (work, family, and social) functioning was significantly poorer among men. Course type and consumption of resources appeared to be similar. We conclude that men with DD had significantly more severe symptoms and worse functionality. They also had a higher frequency of schizoid and schizotypal premorbid personality disorders and premorbid substance abuse.

An empirical study of psychosocial and clinical correlates of delusional disorder: the DELIREMP study.

OBJECTIVE: We aim to describe psychosocial and clinical correlates of delusional disorder (DD) and its types. This approach is important because most knowledge on DD does not come from empirical data collected using a validated systematic research method. METHODS: A cross-sectional study was conducted in a sample of 86 patients fulfilling DSM-IV criteria for DD as established using the SCID-I. Variables were evaluated using a systematic methodology and standardized instruments, and included possible psychosocial risk factors (low socioeconomic status or social isolation, immigration, sensory deficits, older age at onset), family history of psychiatric disorders and premorbid personality (SAP), psychotic psychopathology (PANSS), depressive syndrome (MADRS), global cognitive functioning (MMSE), axis I comorbidity (MINI) and other clinical aspects such as global functionality (GAF), and disability (SDI). A sociodemographic and clinical questionnaire was also completed. RESULTS: The mean age at onset was 39.6 years and 61.6% of the cases were female. The most frequent DD types were persecutory (59.3%) and jealous (22.1%). Nearly 21% had a family history of schizophrenia and 17.4% had DD (significantly higher among those with the jealous subtype). Sixty-four percent had a premorbid personality disorder (38.4% paranoid, 12.8% schizoid). The grandiose type was significantly associated with higher scores on the PANSS positive subscale and the mixed type with lower scores on the PANSS negative subscale. Depression affected 45.3% of subjects (mainly mild depression) and 45.3% had hallucinations (20.9% tactile, 16.3% olfactory), which were more common among somatic cases. The mean MMSE was 27.6±2.5 suggesting a preserved cognitive function. Mean GAF was 63.9±11.3 indicating a moderate degree of disability, which was significantly worse amongst grandiose cases. CONCLUSIONS: This study provides unique empirical and reliable evidence on the real psychosocial, clinical, and psychopathological correlates of DD and its types.

Neurocognitive performance and negative symptoms: are they equal in explaining disability in schizophrenia outpatients?

OBJECTIVE: The aim of this study is to assess if cognitive variables and symptom dimensions can predict disability in a sample of outpatients with schizophrenia. METHOD: A cross-sectional sample of 113 individuals with a diagnosis of schizophrenia (DSM-IV criteria) was selected from a computerized register of five Community Mental Health Centers. Patients were assessed by two trained psychologists, with a neuropsychological battery comprising measures for verbal memory, attention, operative memory and abstraction and flexibility functions. Symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS); a socio-demographic and clinical questionnaire, comprising the Disability Assessment Scale (DAS), was also completed. Test scores were standardized (t scores) to performance of healthy controls. To assess the relationship between clinical and sociodemographic factors and disability and cognitive functioning Pearson's correlation coefficients were computed. In order to establish the predictive capacity of the cognitive, clinical and symptom variables on disability linear regression models were fitted. RESULTS: Mean age of patients was 41.6 years and 68% were male. Higher ratings in the negative dimension were associated with more cognitive deficits. Association with the positive dimension was present but less strong. All disability areas, except for disability in occupational functioning, were partially explained by the negative dimension. Disability in family functioning was also partially explained by attention and number of admissions since onset. CONCLUSION: Negative symptoms are the major source of disability of our sample and are also associated to cognitive functioning. The present findings suggest that further investigation on the mediators between clinical and social outcomes may help to design specific treatments to reduce disability.

[Gender and mental health in a changing world]. / Género y salud mental en un mundo cambiante.

It is well established that human psychological development, violence and sexual abuse, the experience of reproduction and parenting, as well as psychopathology and psychiatric morbidity are different for men and women, both in quality and quantity. In this chapter some of these differences, including disability and the use of services in the Spanish population are described and analysed. Whether there is a need for a new discipline to study psychiatric illness and psychiatric treatment from the point of view of gender is discussed. There has been a deep process of transformation of gender roles in our society. In our opinion this calls for new research efforts aimed at estimating the rates of prevalence and associated risk factors in men and women at present. The results of such research will probably lead to the formulation of new and more relevant hypotheses, and to the development of new research strategies and more valid and reliable measuring instruments.