Detection of bipolar disorder in the prodromal phase: A systematic review of assessment instruments.

BACKGROUND: Early detection of prodromal symptoms may contribute to improving the prognosis of patients with bipolar disorder (BD). The main objective of this systematic review is to present the different procedures for the identification of initial and relapse prodromes in these patients. METHODS: PsycINFO, Web of Science and PubMed databases were searched using a predetermined strategy, until January 4, 2022. Then, by means of a regulated process, studies that used a BD prodrome detection procedure, in English-language and all ages participants were selected. Quantitative and qualitative studies were assessed using a modified version of the Newcastle-Ottawa Scale and by Critical Appraisals Skills Programme checklist, respectively. RESULTS: Forty-five studies were selected. Of these, 26 used procedures for identifying initial prodromes (n = 8014) and 19 used procedures for detecting relapse prodromes (n = 1136). The interview was the most used method in the detection of both types of prodromes (k = 30 papers, n = 4068). It was variable in its degree of structure. Mobile applications and digital technologies are gaining importance in the detection of the relapse prodromes. LIMITATIONS: A retrospective design in most papers, small samples sizes, existence of persistent subsyndromal symptoms and difficulty to identify the end of the prodrome and the onset of the disorder. CONCLUSIONS: There is a wide variety of assessment instruments to detect prodromes in BD, among which the clinical interview is most frequently used. Future research should consider development of a brief tool to be applied in different formats to patients and family members.

Emotional processing in patients with single brain damage in the right hemisphere.

BACKGROUND: The interest in the relationship between brain damage and social cognition has increased in recent years. The objectives of the present study were the following: (1) to evaluate and compare emotional facial recognition and subjective emotional experience in patients who have suffered a single ischemic stroke in the right hemisphere (RH) and in healthy people, (2) to analyze the relationship between both variables in both groups of subjects, and (3) to analyze the association between the cerebral location of the stroke and these two variables. METHODS: Emotional facial recognition and the subjective emotional experience of 41 patients who had suffered a single ischemic stroke in the RH and 45 volunteers without previous cerebrovascular pathology were evaluated. RESULTS: Brain damaged patients performed lower in facial emotional recognition and had a less intense subjective emotional response to social content stimuli compared to healthy subjects. Likewise, among patients with RH ischemic stroke, we observed negative associations between facial recognition of surprise and reactivity to unpleasant images, and positive associations between recognition of disgust and reactivity to pleasant images. Finally, patients with damage in the caudate nucleus of the RH presented a deficit in the recognition of happiness and sadness, and those with damage in the frontal lobe exhibited a deficit in the recognition of surprise, compared to those injured in other brain areas. CONCLUSIONS: Emotional facial recognition and subjective emotional experience are affected in patients who have suffered a single ischemic stroke in the RH. Professionals caring for stroke patients should improve their understanding of the general condition of affected persons and their environment, assess for risk of depression, and facilitate their adaptation to work, family, and social environments.

Efficacy of Smartphone Apps in Patients With Depressive Disorders: A Systematic Review.

Background: Digital interventions have become an accessible format in clinical practice to provide better support for patients with mental disorders. However, the clinical efficacy in patients with depressive disorders is not well known. We aimed to determine the efficacy of smartphone applications (apps) in patients diagnosed with a depressive disorder. Method: An electronic database search was performed of PubMed, PsycINFO, and Web of Science, to identify relevant articles up to June 12, 2021. Peer-reviewed articles were screened and selected based on predetermined inclusion and exclusion criteria. Results: Seven articles met the inclusion criteria and therefore were selected for the systematic review, which included a total of 651 patients. The results were heterogeneous, essentially due to the different methodologies used in the selected studies. Conclusions: Digital smartphone-delivered interventions do not appear to reduce depressive symptomatology nor improve the quality of life in patients diagnosed with depressive disorders when compared to an active control group. Taking into account the inherent methodological difficulties and the variability among such studies, it is apparent that further research-with more methodologically refined clinical trials, including larger sample sizes-is needed.

Spanish Versions of the Outcome Rating Scale and the Session Rating Scale: Normative Data, Reliability, and Validity.

Routine outcome monitoring (ROM) uses standardized measures to both track and inform mental health service delivery. Use of ROM has been shown to improve the outcome of psychotherapy when applied to different types of patients. The present research was designed to determine the reliability and validity of the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) in a sample of Spanish patients. After a controlled process of translation into the Spanish that is spoken and written in Spain (i.e., in Europe, as distinct from, e.g., Latin American Spanish), both measures were completed by patients of an outpatient mental health unit during eight sessions of psychotherapy. Sixty mental health patients filled out the ORS and 59 the SRS. In addition, the ORS was completed by 33 people who constituted the non-clinical sample. The cut-off of the ORS was 24.52 points, and the Reliable Change Index (RCI) was 9.15 points. ORS and SRS scores exhibited excellent internal consistency. The temporal stability of the SRS was adequate. The convergent and discriminant validity of the two measures were adequate. Regarding the factorial validity of the ORS and the SRS, in the third psychotherapy session, confirmatory factor analyses evidenced the existence of a unifactorial model. The predictive validity of SRS was acceptable. The ORS was sensitive to changes in patients' symptoms. In conclusion, compared to the original English versions of the ORS and SRS measures, the Spanish versions of the measures are also reliable and valid.

Mentalizing Errors in Patients with Schizophrenia Who Received Psychosocial Rehabilitation: a Case-Control Study.

The main objective of this study was to evaluate the mentalizing performance of patients with schizophrenia who received daily psychosocial rehabilitation treatment compared with healthy controls. Differences in mentalizing performance between men and women, and the relationship between mentalizing deficits, cognitive impairment, symptoms, and global functioning of patients were also examined. A case-control study design was utilized (N = 95). Adults with schizophrenia were recruited from psychosocial rehabilitation clinics (n = 53) and healthy controls were recruited from the community (n = 42). Mentalizing was evaluated with the Movie for the Assessment of Social Cognition, an audiovisual measure with good ecological validity. Measures of cognitive functioning, symptoms, and global functioning were also administered. Patients exhibited significant mentalizing deficits. Specifically, patients made more undermentalizing errors and more no mentalizing errors compared with healthy controls. In patients and healthy controls, no differences were found between men and women in mentalizing abilities. In patients with schizophrenia, lower cognitive functioning (i.e., immediate and delayed verbal learning, verbal fluency, and processing speed) were associated with poorer mentalizing. In patients, processing speed explained 31% of the variance in total mentalizing errors and mentalizing deterioration was associated with poorer overall functioning. Psychosocial rehabilitation interventions in people with schizophrenia should consider mentalizing deficits (especially undermentalizing and no mentalizing difficulties) and their relationship with reduced processing speed in treatment delivery (e.g., direct and organized communication). Integration of treatments targeting mentalizing deficits in a psychosocial rehabilitation setting is recommended to improve functioning in schizophrenia.

Recommendations for the care of patients with bipolar disorder during the COVID-19 pandemic.

In recent months, there has been a rapid spread of coronavirus disease (COVID-19), being now regarded as a global pandemic. In this context, the governments of different countries have established strict containment measures, and subsequent deconfinement measures, with consequential alterations in the rhythms and living habits of the population, including patients with bipolar disorder (BD), who are in an extremely vulnerable situation. The present paper aims to propose a number of recommendations, based on scientific evidence, for mental health professionals who may be in charge of BD patients during this health crisis in the coming months. Among these recommendations, careful monitoring of pharmacological treatment, reinforcing medication adherence, and surveillance of drug-drug interaction risk in cases where the patient is being treated for COVID-19 are of utmost importance.

Prevalence and correlates of major depressive disorder: a systematic review

Objectives: Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD. Methods: A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018. Results: Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies. Conclusions: MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder's prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.

Prevalence and correlates of major depressive disorder: a systematic review.

OBJECTIVES: Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD. METHODS: A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018. RESULTS: Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies. CONCLUSIONS: MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder's prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.

Initial and relapse prodromes in adult patients with episodes of bipolar disorder: A systematic review.

BACKGROUND: Distinguishing prodromes of bipolar disorder (BD) specific to children/adolescents, adults, and elderly patients is essential. The primary objective of this systematic review was to determine initial and relapse prodromes identifying adult patients with BD. METHODS: PubMed, PsycINFO, and Web of Science databases were searched using a predetermined strategy. A controlled process of study selection and data extraction was performed. RESULTS: The 22 articles selected included 1,809 adult patients with BD. Initial prodromes cited most frequently in these studies showed low specificity. Among relapse prodromes cited most frequently, more talkative than usual, increased energy/more goal-directed behavior, thoughts start to race, increased self-esteem, strong interest in sex, increase in activity, and spending too much were identified exclusively before a manic/hypomanic episode, while loss of interest and hypersomnia were detected only before a depressive episode. Initial prodromal phases lasted longer than prodromal relapse phases. In the selected studies, the most used prodrome identification procedure was the clinical interview. CONCLUSIONS: For adult patients with BD, initial and relapse prodromes of manic, hypomanic, and depressive episodes were identified. It is proposed that the most frequent prodromes found in this review be incorporated into a smartphone app that monitors the functioning of people at risk of BD and patients who have already been diagnosed. Data from this app would constitute a relevant source of big data.

The influence of the working alliance on the treatment and outcomes of patients with bipolar disorder: A systematic review.

BACKGROUND: The working alliance plays an essential role in the treatment of patients with different diseases. However, this variable has received little attention in patients with bipolar disorder. Therefore, this systematic review aimed to examine the working alliance's influence on these patients' treatment outcomes, analyze its role in the adherence to pharmacotherapy, and identify the variables that are related to a good working alliance. METHODS: PubMed, PsycINFO, and Web of Science databases were searched until January 5, 2018 using a predetermined search strategy. Then, a formal process of study selection and data extraction was conducted. RESULTS: Seven articles fulfilled the inclusion criteria and they included a total of 3,985 patients with bipolar disorder type I and II. Although the working alliance's ability to predict the duration and presence of manic and depressive symptoms is unclear, a good working alliance facilitates the adherence to pharmacological treatment. In addition, good social support for patients is associated with a strong working alliance. LIMITATIONS: The selected studies used different definitions and measures of the working alliance and adherence, and most used self-reports to assess the working alliance. Furthermore, the relationships found among the variables were correlational. CONCLUSIONS: The working alliance can play an important role in adjunctive psychological therapies and in pharmacological and somatic treatments for patients with bipolar disorder. However, the number of studies on working alliance in bipolar disorder is rather limited and there is methodological heterogeneity between the studies.

Percepción de la población española sobre la depresión / The public perception of depression in Spain

Fundamento. La depresión constituye una de las principales causas mundiales de discapacidad. El objetivo de este estudio fue conocer la opinión de la población española sobre esta enfermedad, su relación con el suicidio, su sintomatología, los pacientes que la padecen, sus causas, los profesionales que la tratan y la medicación antidepresiva. Material y métodos. Se administró telefónicamente un cuestionario elaborado ad hoc por expertos a 1.700 personas mayores de edad en todas las comunidades autónomas españolas, mediante muestreo polietápico, estratificado por conglomerados, con selección de los municipios de forma aleatoria y de las personas por cuotas de sexo, edad y actividad económica de manera representativa a nivel nacional. Resultados. El 18% de los encuestados manifestó que padecía o que había padecido depresión, el 86% la consideraba una enfermedad y el 85% que era causa de suicidio. Los síntomas más conocidos (>95%) de este trastorno fueron la tristeza y la apatía. Los encuestados exhibieron algunas actitudes estigmatizadoras hacia las personas con depresión (60% inestabilidad y 49% debilidad), atribuyeron esta dolencia a causas externas (el 95% a acontecimientos adversos de la vida), opinaron que el psicólogo es más adecuado que el psiquiatra para tratarla (47 vs. 29%) y que la medicación antidepresiva genera dependencia (72%) a pesar de ser eficaz (62%); el 67% de los encuestados depresivos manifestó tomarla. Conclusiones. Las administraciones sanitarias competentes deberían realizar campañas dirigidas a informar sobre la verdadera naturaleza de la depresión, reducir las actitudes estigmatizadoras y clarificar la eficacia y eventuales efectos adversos de la medicación antidepresiva

Background. Depression is one of the main causes of disability worldwide. The aim of this study was to determine the opinions of the Spanish population regarding this disease, its relation to suicide, its symptoms, the people who suffer from it, its causes, the professionals who treat it and antidepressant medication Methods. A questionnaire designed by experts was administered by phone to a representative sample of 1,700 people aged 18 and over in all Spanish autonomous communities using multistage sampling procedure, stratified by clusters, with a random selection of municipalities and population by sex, age and economic activity in a representative way at a national level. Results. Eighteen percent of the people surveyed said they had depression or had suffered from it previously, 86% thought of it is a disease and 85% considered it to be a cause of suicide. The most well-known symptoms (>95%) were sadness and apathy. The people surveyed expressed certain stigmatizing attitudes towards people who suffer from it (60% unstability and 49% weakness). Most stated that the causes of this disease are of external origin (95% due to adverse life events), thought that a psychologist is a more appropriate health specialist for treating depression than a psychiatrist (47 vs. 29%) and that antidepressant medication generates dependency (72%) despite being effective (62%); 67% of depressed patients reported taking it. Conclusions. It is suggested that the relevant health administrations should conduct campaigns aimed at informing the public about the true nature of depression, to reduce stigmatizing attitudes and to clarify the efficacy and possible adverse effects of antidepressant medication

Patient-Therapist Perspective of the Working Alliance in Psychotherapy.

This study aimed to examine perceptions of the working alliance in a sample of Spanish patients and therapists. The alliance was measured after the third and tenth psychotherapy sessions using patient and therapist versions of the Spanish adaptation of the Working Alliance Inventory (WAI). After both sessions, correlations between the patients' and therapists' ratings, both of total alliance and of the various dimensions of the alliance, were moderate at best. Moreover, after the third psychotherapy session, patients' scores for the total alliance and the Goal and Task subscales were significantly higher than the scores from their therapists in these dimensions. Following the tenth session, patient ratings exceeded those of their therapists only on the Task subscale. Finally, in contrast to the ratings of patients, therapists' alliance ratings increased significantly between the third and tenth sessions of psychotherapy. Certain recommendations are presented to improve the study of patient and therapist perceptions of the working alliance and to increase the convergence between them with regard to this central treatment variable.

Spanish adaptation of the Revised Helping Alliance Questionnaire (HAq-II).

BACKGROUND: The working or helping alliance is one of the most widely studied constructs in psychotherapy process research. AIM: The aim of this study was to adapt the patient and therapist forms of the Revised Helping Alliance Questionnaire II (HAq-II-P and HAq-II-T, respectively) into Spanish. METHOD: The two measurement instruments were adapted through a systematic translation process, a pilot study and a clinical study. The psychometric properties were examined following the third psychotherapy session. RESULTS: Mean scores on the Spanish-language HAq-II-P and HAq-II-T were high. The corrected item-total correlations for >94% of the items were >0.30. Cronbach's α values for internal consistency were 0.88 and 0.93, respectively. Correlations for convergent validity with the respective versions of the Spanish-language Working Alliance Inventory were 0.80 and 0.87, respectively. In terms of predictive validity, there was a significant correlation between HAq-II-T and the patients' residual gain scores on the Spanish-language Beck Depression Inventory after the tenth psychotherapy session. CONCLUSIONS: These results are consistent with studies using the original English versions of the HAq-II.

Spanish adaptation of the Working Alliance Inventory (WAI). Psychometric properties of the patient and therapist forms (WAI-P and WAI-T) / Adaptación española del Working Alliance Inventory (WAI). Propiedades psicométricas de las versiones del paciente y del terapeuta (WAI-P y WAI-T)

The working alliance is one of the most widely studied constructs in psychotherapy process research. The purpose of our study was to adapt the patient and therapist forms of the Working Alliance Inventory (WAI-P and WAI-T) into Spanish. Both measurement instruments were translated into Spanish through a systematic translation process. The psychometric properties of the instruments were evaluated in both a pilot study and a clinical study involving Spanish outpatients with depressive disorders and their therapists. In the clinical study, patients completed the Spanish-language Beck Depression Inventory (BDI) prior to initiating therapy and after the third and tenth psychotherapy sessions. High average scores were obtained with the Spanish-language WAI-P and WAI-T. A large number of individual items correlated satisfactorily with the overall score for the corresponding subscale. Both measures demonstrated excellent reliability (internal consistency) and convergent validity. There were some limitations in the discriminant validity of the measures vs. measures of empathy. Regarding predictive validity, the overall WAI-P and the Task subscale of the WAI-T separately explained a moderate percentage of the variance in patient change in the BDI after the tenth psychotherapy session. These results were satisfactory and consistent with those obtained in studies using the English-language WAI

La alianza de trabajo es uno de los constructos más estudiados en investigación de procesos en psicoterapia. El objetivo de nuestra investigación fue adaptar las versiones del paciente y del terapeuta del Working Alliance Inventory (WAI-P y WAI-T) a la lengua española. Ambos instrumentos de medida fueron traducidos al español mediante un proceso reglado de traducción. Sus propiedades psicométricas fueron examinadas en un estudio piloto y en un estudio clínico en el que participaron pacientes ambulatorios con trastornos depresivos y sus correspondientes terapeutas. En el estudio clínico, los pacientes completaron la adaptación española del Beck Depression Inventory (BDI) antes del tratamiento y después de la tercera y de la décima sesión de psicoterapia. El WAI-P y el WAI-T en español exhibieron altas puntuaciones medias. Un elevado número de sus ítems correlacionó de manera adecuada con la puntuación total de su respectiva subescala. Ambas pruebas evidenciaron una excelente fiabilidad (consistencia interna) y una excelente validez convergente. Su validez discriminante exhibió algunas limitaciones cuando ambas medidas correlacionaron con dos pruebas de empatía. En cuanto a la validez predictiva, el WAI-P total y la subescala tareas del WAI-T explicaron por separado un porcentaje moderado de la varianza del cambio de los pacientes en el BDI después de la décima sesión de psicoterapia. Estos resultados fueron satisfactorios y coherentes con los hallados en los estudios que han empleado las correspondientes versiones originales del WAI en inglés

La alianza terapéutica / The therapeutic alliance

Los procedimientos psicoterapéuticos y los componentes de la relación terapéutica constituyen aspectos inseparables en la práctica de la psicoterapia. Entre los ingredientes relacionales, la alianza terapéutica ha sido objeto de diversas formalizaciones y de numerosas investigaciones en lengua inglesa y su uso se ha extendido a distintos modelos psicoterapéuticos. El propósito de este trabajo es proporcionar a psicólogos de cualquier orientación teórica un acercamiento al concepto, características y principales instrumentos de medida de la alianza terapéutica. Se destaca la formulación de Bordin (1979, 1994) como marco de referencia para la explicación de la alianza y sus dimensiones. Asimismo se examina la significativa relación que existe entre la alianza terapéutica y el resultado final de la psicoterapia. Finalmente se sugieren algunas propuestas futuras de investigación

Psychotherapeutic procedures and the components of therapeutic relationship are aspects that go together in psychotherapy practice. Among its relational ingredients, the therapeutic alliance has been subject to a number of formalizations and addressed in literature in English. Its use has spread to different psychotherapeutic approaches. The aim of this paper is to pro vide psychologists regardless of their theoretical orientation with a view of the concept, attributes and major measurement tools of therapeutic alliance. Bordin's formulation (1979, 1994) is highlighted as a frame of reference for the explanation of alliance and its dimensions. Likewise, a significant relationship between therapeutic alliance and psychotherapy's outcome is analyzed. Finally, some suggestions are made for future research