Patología dual en personas sin hogar en el Área de Salud de Avilés / Dual pathology in homeless people in the Avilés Health Area

El objetivo principal del presente estudio es estimar la prevalencia de trastornos mentales graves y de uso de sustancias en personas en la situación de estar sin hogar. El trabajo se realizó a partir de los datos obtenidos de una muestra representativa de personas sin hogar en Avilés (Asturias) (n=100) utilizando la Entrevista Neuropsiquiátrica Internacional (M.I.N.I.). Los resultados de nuestro estudio ponen de manifiesto una estrecha relación entre el uso de sustancias y el sinhogarismo. Más de la mitad de las personas sin hogar tiene trastornos relacionados con el uso de sustancias en comparación con el uso problemático de sustancias en la población general. Se discute la atención psicosocial y la organización de una red de apoyo a las personas sin hogar. (AU)

The main objective of the present study is to estimate the prevalence of severe mental disorders and substance use in the homeless situation. The work was carried out from the data obtained from a representative sample of homeless people in Avilés (Asturias) (n = 100) using the International Neuropsychiatric Interview (M.I.N.I.). The results of our study reveal a close relationship between substance use and homelessness. More than half of the homeless have substance use disorders compared to problem substance use in the general population. Psychosocial care and the organization of a support network for the homeless are discussed. (AU)

Dual pathology in homeless people in the Avilés Health Area / Patología dual en personas sin hogar en el Área de Salud de Avilés

The main objective of the present study is to estimate the prevalence of severe mental disorders and substance use in the homeless situation. The work was carried out from the data obtained from a representative sample of homeless people in Avilés (Asturias) (n = 100) using the International Neuropsychiatric Interview (M.I.N.I.). The results of our study reveal a close relationship between substance use and homelessness. More than half of the homeless have substance use disorders compared to problem substance use in the general population. Psychosocial care and the organization of a support network for the homeless are discussed. (AU)

El objetivo principal del presente estudio es estimar la prevalencia de trastornos mentales graves y de uso de sustancias en personas en la situación de estar sin hogar. El trabajo se realizó a partir de los datos obtenidos de una muestra representativa de personas sin hogar en Avilés (Asturias) (n=100) utilizando la Entrevista Neuropsiquiátrica Internacional (M.I.N.I.). Los resultados de nuestro estudio ponen de manifiesto una estrecha relación entre el uso de sustancias y el sinhogarismo. Más de la mitad de las personas sin hogar tiene trastornos relacionados con el uso de sustancias en comparación con el uso problemático de sustancias en la población general. Se discute la atención psicosocial y la organización de una red de apoyo a las personas sin hogar. (AU)

Adicción y dolor crónico: ¿cómo prevenir su estigmatización terapéutica? / Addiction and chronic pain: how to prevent itstherapeutic stigmatization?

Tanto el dolor crónico como las adicciones son problemas complejos de salud que en la última década han tomado condiciones epidémicas en los países occidentales. Ello ha condicionado un intenso debate sobre el uso terapéutico de sustancias analgésicas potencialmente adictivas como son los opioides y los cannabinoides. Una consecuencia indeseable de la indeterminación clínica relacionada con estos problemas emergentes es la estigmatización de las personas que sufren dolor crónico, quienes han comenzado a ser el foco de prejuicios sociales que ya sufren los enfermos adictos. Se describe la utilidad del concepto de "alostasis" para evitar el estigma asociado al desconocimiento de estos problemas complejos de salud. Se propone que la neuropsiquiatría entendida desde una perspectiva antropológica puede ayudar en la integración teórica del abordaje y tratamiento del dolor crónico y la adicción como problemas estrechamente relacionados

Chronic pain and addiction disorders are both complex health problems which take epidemic dimension in the last decade in occidental countries. It has conditioned a profound debate on the therapeutic use of potentially addictive analgesic substances as opioids and cannabinoids are. An undesirable consequence of the clinical indeterminacy related with these emergent problems is the stigmatization of persons suffering chronic pain, which are beginning to be the focus of social prejudices the addiction patients are suffering. The utility of the concept "allostasis" to avoid the stigma related to the unknowledge of these complex health problems is described. It is proposed that neuropsychiatry understood under an anthropological perspective can be helpful in the theoretical integration for the management and treatment of chronic pain and addiction as closely related problems

Síndrome de desmoralización. Estimación de la prevalencia en una población de pacientes en cuidados paliativos en domicilio / The demoralisation syndrome. An estimation of its prevalence in patients receiving palliative care at home

OBJETIVO: El síndrome de desmoralización (SD) es una situación psicoemocional que se caracteriza por la desesperanza, el desamparo, la pérdida de sentido y el distrés existencial. Pretendemos conocer la prevalencia del SD en nuestro medio en pacientes avanzados atendidos por un equipo de cuidados paliativos. METODOLOGÍA: Se incluyeron de manera consecutiva 100 pacientes en situación avanzada atendidos por el Equipo de Soporte Domiciliario de Cuidados Paliativos que dieron su consentimiento informado. Mantenían unas condiciones físicas y neuropsicológicas suficientes para completar una entrevista semiestructurada y los cuestionarios específicos (ESASr, termómetro de malestar emocional, PPS, Barthel, HADS).como criterios diagnósticos del SD se emplearon los de Kissane. El estudio recibió la aprobación del Comité Ético del Área de Salud. RESULTADOS: Se encontraron 4 casos de SD, lo que supone una prevalencia del 4% (IC 95%: 2-10%). Estos enfermos que se mostraron diferentes del resto de la muestra en las siguientes características: edad <70 años (p = 0,02), estudios universitarios (p = 0,03), ausencia de actitud religiosa (p = 0,07) y presencia de sufrimiento (p = 0,01). También presentaban una mayor intensidad en síntomas como cansancio (p = 0,01), ansiedad (p <0,001) y desánimo (p = 0,07). CONCLUSIÓN: En nuestro medio hemos encontrado una prevalencia de SD únicamente del 4% en una población de pacientes atendidos por un Equipo Domiciliario de Cuidados Paliativos. Es probable que las condiciones para entrar en el estudio y el empleo de criterios diagnósticos relativamente estrictos hayan influido en este resultado

OBJECTIVE: The demoralisation syndrome (DS) is a psycho-emotional situation characterized by despair, helplessness, loss of meaning, and existential distress. We intend to establish the prevalence of DS in advanced patients treated by a Palliative Care Team in our SETTING: METHODOLOGY: We included 100 consecutive advanced patients treated at home by a Palliative Care Team. To be included we required informed consent, and adequate physical and neuropsychological conditions to complete a semi-structured interview and the questionnaires (ESASr, PPS, Barthel, emotional distress thermometer, HADS). We used Kissane's diagnostic criteria of DS. The study was approved by our Ethics Committee. RESULTS: Four cases of DS were found, representing a prevalence of 4% (95% CI: 2% to 10%). The characteristics of these patients that were different from the rest of the sample were: age <70 years (p = 0.02), university studies (p = 0.03), absence of religious attitude (p = 0.07), presence of suffering (p = 0.01). They also showed greater intensity of symptoms such as asthenia (p = 0.01), anxiety (p < 0.001), and depression (p = 0.07). CONCLUSIONS: In our setting we found a prevalence of DS of only 4% in a population of patients treated by a Home Palliative Care Team. The conditions for entering the study and the use of relatively strict diagnostic criteria may have influenced this result

Cenesthopathy and Subjective Cognitive Complaints: An Exploratory Study in Schizophrenia.

BACKGROUND/AIMS: Cenesthopathy is mainly associated with schizophrenia; however, its neurobiological basis is nowadays unclear. The general objective was to explore clinical correlates of cenesthopathy and subjective cognitive complaints in schizophrenia. METHODS: Participants (n = 30) meeting DSM-IV criteria for psychotic disorder were recruited from a psychiatry unit and assessed with: Association for Methodology and Documentation in Psychiatry (AMDP) system, Positive and Negative Syndrome Scale, Frankfurt Complaint Questionnaire (FCQ), and the Bonn Scale for the Assessment of Basic Symptoms (BSABS). For quantitative variables, means and Spearman correlation coefficients were calculated. Linear regression following backward method and principal component analysis with varimax rotation were used. RESULTS: 83.3% of subjects (73.3% male, mean age, 31.5 years) presented any type of cenesthopathy; all types of cenesthetic basic symptoms were found. Cenesthetic basic symptoms significantly correlated with the AMDP category "fear and anancasm," FCQ total score, and BSABS cognitive thought disturbances. In the regression analysis only 1 predictor, cognitive thought disturbances, entered the model. In the principal component analysis, a main component which accounted for 22.69% of the variance was found. CONCLUSIONS: Cenesthopathy, as assessed with the Bonn Scale (BSABS), is mainly associated with cog-nitive abnormalities including disturbances of thought initiative and mental intentionality, of receptive speech, and subjective retardation or pressure of thoughts.

Mindfulness en perspectiva / Mindfulness into perspective

El Midfulness (Mf) es un tipo de psicoterapia basada en el budismo y que tiene un uso creciente en trastornos de ansiedad, afectivos y por dolor. Una de sus principales técnicas es la focalización de la atención en el momento presente. Al tener una fundamentación explícita en las prácticas espirituales budistas, y al proceder de un entorno cultural oriental, su aplicación clínica debe buscar mecanismos para facilitar su encaje. Se realiza una revisión narrativa con el objetivo de proporcionar la integración del Mf con otras técnicas de psicoterapia. Se clarifican concretamente: 1) los orígenes budistas comunes al Mf y a otras formas de psicoterapia y 2) la integración del conocimiento sobre los mecanismos neurobiológicos del Mf en los actuales modelos de neurociencia. Se concluye que el Mf puede integrarse con otros programas psicoterapéuticos y que sus postulados son falsables en el diálogo científico actual con la neurociencia clínica (AU)

Mindfulnes (Mf) is a Buddhism based type of psychotherapy and has an increasing application in anxiety, affective and pain disorders. Focusing of attention in present moment is one of its mainly techniques. As it has an explicit foundation in Buddhist spiritual practice, and also proceed from an eastern cultural environment, implementation in the clinical practice should be provided. A narrative review is performed in order to facilitate Mf integration with other psychotherapy techniques. Manly to aspects are addressed: 1) Mf common Buddhist origins and other psychotherapy types and 2) inclusion of Mf neurobiological mechanism knowledge in present neuroscience models. We conclude that Mf can be integrated with other psychotherapy programs and that contain falsifiable assumptions on current scientific dialog with clinical neuroscience (AU)

Factores asociados al ingreso hospitalario y evaluación de un programa de gestión de casos para trastorno mental grave mediante un estudio de cohortes históricas / Factors associated with hospital admission and evaluation of a case management program for severe mental disorder by a historical cohort study

Introducción: Las personas con trastorno mental grave (TMG) presentan serias dificultades para desarrollar una vida normalizada, por lo que son necesarios programas de atención comunitaria que mejoren sus condiciones de vida e integración social. Este trabajo pretende evaluar el funcionamiento de un programa de gestión de casos (PGC) en Segovia (España). Metodología: Se realiza una primera fase descriptiva valorando el funcionamiento del PGC en 2011 mediante variables sociodemográficas, asistenciales y clínicas. Se estudian los factores asociados a la ocurrencia de ingreso hospitalario. Finalmente, mediante un diseño de cohortes históricas, se evalúa el riesgo de ingreso del PGC comparando con una cohorte no expuesta. Se emplean técnicas estadísticas bi y multivariantes con cálculo de riesgos relativos e intervalos de confianza. Resultados: En 2011 se atiende a 82 pacientes en el PGC, principalmente hombres de mediana edad. La evolución clínica media es de 19 años y la permanencia media en el PGC superior a los 6 años. El 78% pertenecen al espectro diagnóstico de la esquizofrenia. El ingreso afecta al 27% de los pacientes. Ser mujer, ser atendido por equipos de salud mental I-II, el aumento de visitas domiciliarias y el abandono del seguimiento son los factores predictores de ingreso, mientras la mayor evolución clínica es factor protector. No se detecta efecto protector del PGC frente al ingreso hospitalario en los diferentes análisis del estudio de cohortes históricas. Conclusiones: Es necesario evaluar de forma sistemática los programas de atención comunitaria dirigidos al TMG con el fin de realizar ajustes y modificaciones tendentes a la mejora de su efectividad clínica (AU)

Introduction: People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain).Methodology: We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals. Results: In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78%belong to the diagnosis of schizophrenia spectrum. Income affects 27% of patients. Women, mental health teams I-II, increased home visits and abandonment of monitoring are predictors of income, while the highest level of clinical course is protective. No protective effect of income is detected for the CMP in the different analyzes of the historical cohort study. Conclusions: It is necessary to systematically assess community care programs directed at SMD to make adjustments and modifications aiming at improving their clinical effectiveness (AU)

[Factors associated with hospital admission and evaluation of a case management program for severe mental disorder by a historical cohort study]. / Factores asociados al ingreso hospitalario y evaluación de un programa de gestión de casos para trastorno mental grave mediante un estudio de cohortes históricas.

INTRODUCTION: People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain). METHODOLOGY: We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals. RESULTS: In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78% belong to the diagnosis of schizophrenia spectrum. Income affects 27% of patients. Women, mental health teams I-II, increased home visits and abandonment of monitoring are predictors of income, while the highest level of clinical course is protective. No protective effect of income is detected for the CMP in the different analyzes of the historical cohort study. CONCLUSIONS: It is necessary to systematically assess community care programs directed at SMD to make adjustments and modifications aiming at improving their clinical effectiveness.

Dimensions of attention impairment and negative symptoms in schizophrenia: a multidimensional approach using the conners continuous performance test in a Spanish population.

OBJECTIVES: The aim of this study was to assess the specific features of attention impairment in patients with schizophrenia and the correlation between those features and the patients' clinical status. METHODS: We administered the Conners Continuous Performance Test (CPT-II), with cognitive and clinical scales, to 40 Spanish inpatients with schizophrenia and 40 healthy controls, and used a cross-sectional design to compare the groups' performances. We identified correlations between the measures and used multiple regression analyses to develop models showing how attention impairment contributed to clinical status. RESULTS: The patients with schizophrenia showed significantly poorer performance than controls in 5 CPT-II measures that were related to focused attention. We also found that CPT-II measures primarily linked to focused attention had a significant association with negative symptoms. These CPT-II measures predicted 37% of the variability in negative symptoms in the regression model. We observed a more modest relationship among CPT-II measures of disorganized thought symptoms, global functioning, and general cognitive performance. CONCLUSIONS: Attention impairment in schizophrenia primarily involves difficulty in focusing attention, mainly related to negative symptoms. By contrast, sustained attention and vigilance seem to be affected only as a secondary consequence of the impairment to focusing attention.

"Asignación de relevancia": Una propuesta para el término inglés "Salience" / No disponible

No disponible

Behavioral assessment of the dysexecutive syndrome battery (BADS) in schizophrenia: a pilot study in the Spanish population.

OBJECTIVE: The purposes of this study were to explore the diagnostic features of the behavioral assessment of the dysexecutive syndrome battery (BADS) in the Spanish population of chronic schizophrenia patients, its concurrent validity with other classic neuropsychologic tests of executive dysfunction, and its correlates with clinical variables. METHODS: A cross-sectional study was conducted in a sample of 61 patients with chronic schizophrenia and in a control group of 35 healthy participants. The diagnostic characteristics of the test were studied. An evaluation was performed of the association of BADS with a gold standard battery of executive dysfunction, with the symptoms, and with functional performance. Several regression models were tested to assess the clinical effect of executive impairment in schizophrenia. RESULTS: BADS seems to offer good reliability, a 1-dimensional structure, and good convergent validity. The proportion of schizophrenia patients with impaired executive functioning in our sample was 47%. It was a risk factor for the inpatient status and for more illness severity. CONCLUSIONS: Executive functioning in schizophrenia can be reliably and validly assessed with BADS. The diagnosis of impaired executive functioning may be of clinical usefulness as a marker of more illness severity and poorer functional status.

Battery for assessment of neuropsychological status (RBANS) in schizophrenia: a pilot study in the Spanish population.

OBJECTIVES: The aims of this study were to research the following issues in a Spanish population of patients with schizophrenia. (a) The sensitivity and reliability of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to detect cognitive impairment in schizophrenia. (b) The convergent validity of RBANS on a larger battery of neuropsychological tests sensitive to the cognition disorders typically observed in schizophrenia. (c) The correlates of poor performance in RBANS with clinical features and illness severity. METHOD: Thirty schizophrenia patients, 30 non-psychotic patients and 30 healthy participants were assessed using RBANS (form A). We administered a battery of neuropsychological tests and four scales to evaluate patient's clinical status. RESULTS: Schizophrenia patients and non-psychotic patients performed significantly worse than healthy controls on RBANS, and schizophrenia patients performed slightly worse than non-psychiatric controls, but this difference was not significant. Good inter-test reliability and concurrent validity were found. Only a moderate correlation between RBANS performance and illness severity was observed. CONCLUSIONS: RBANS revealed coherence in identifying cognitive impairment in schizophrenia patients of a different cultural background, and it is shown to be a sensitive, valid and easy-to-perform tool for the neuropsychological assessment of Spanish patients with schizophrenia.