Comparative study of the pencil-and-paper and digital formats of the Spanish DARS scale.

The Dimensional Anhedonia Rating Scale (DARS) is a novel questionnaire to assess anhedonia of recent validation. In this work, we aim to study the equivalence between the traditional paper-and-pencil and the digital format of DARS. Sixty-nine patients filled the DARS in a paper-based and digital versions. We assessed differences between formats (Wilcoxon test), validity of the scales [Kappa and intraclass correlation coefficients (ICCs)], and reliability (Cronbach's alpha and Guttman's coefficient). We calculated the comparative fit index and the root mean squared error (RMSE) associated with the proposed one-factor structure. Total scores were higher for paper-based format. Significant differences between both formats were found for three items. The weighted Kappa coefficient was approximately 0.40 for most of the items. Internal consistency was greater than 0.94, and the ICC for the digital version was 0.95 and 0.94 for the paper-and-pencil version (F = 16.7, p < 0.001). Comparative Adjustment Index was 0.97 for the digital DARS and 0.97 for the paper-and-pencil DARS, and RMSE was 0.11 for the digital DARS and 0.10 for the paper-and-pencil DARS. We concluded that the digital DARS is consistent in many respects with the paper-and-pencil questionnaire, but equivalence with this format cannot be assumed without caution.

Stressful life events as proximal risk factors for a suicide crisis: Case-control study.

Suicide is one of the main challenges worldwide. Every year 800,000 people die by suicide. There is evidence that life stressful events are associated to suicidal behaviour. Our aim in this case-control study is to explore their role as triggers of suicidal behaviour.

Acontecimientos vitales estresantescomo factores de riesgo proximalespara una crisis suicida: Estudio decasos y controles / Stressful life events as proximal risk factors for a suicide crisis: Case-control study

Introducción: El suicidio produce casi un millón demuertes al año en todo el mundo. Los acontecimientos vitales estresantes podrían jugar un papel clave en las últimasfases de la trayectoria suicida. Nuestro objetivo en este estudio de casos y controles es explorar su papel como factoresprecipitantes de la conducta suicida.Metodología. Este estudio se realizó en el Departamento de Psiquiatría de la Fundación Jiménez Díaz. El grupo decasos consiste en 320 pacientes adultos atendidos en el servicio de la Fundación tras realizar un intento de suicidio. Elgrupo control son 640 pacientes psiquiátricos adultos atendidos por cualquier otro motivo. La variable principal fueel intento de suicidio y la variable independiente fue haberexperimentado un acontecimiento vital estresante (AVE) enlos últimos 6 meses. Para medir los AVEs, se utilizó el List ofThreatening Experiences.Resultados. Haber experimentado un AVE fue asociado significativamente con cometer un intento de suicidio(RR = 1,475, IC del 95, p = 0,001). Los AVEs específicos quemostraron una asociación positiva estadísticamente fueronhaber roto una relación estable, tener problemas personalescon alguien cercano del entorno y no encontrar empleo osufrir una crisis económica grave. Conclusiones. Sufrir un AVE incrementa significativamente el riesgo de suicidio en los 6 meses siguientes. Haberroto una relación estable se presenta como el más importante. Se necesitan más estudios en el futuro para seguirprofundizando en el papel de los AVEs como desencadenantes proximales de la conducta suicida. (AU)

Introduction: Suicide is one of the main challengesworldwide. Every year 800,000 people die by suicide. There is evidence that life stressful events are associated tosuicidal behaviour. Our aim in this case-control study is toexplore their role as triggers of suicidal behaviour.Methods. This case-control study was carried out in theDepartment of Psychiatry of the Fundación Jiménez Díaz.The case group consists of 320 adult patients treated in theFoundation service after an attempted suicide. The controlgroup consists of 640 adult psychiatric patients treated forany other reason. The main variable has been the suicide attempt and the independent variable has been published inthe last 6 months. To measure the occurrence of a LTE in thelast six months, we used the List of Threatening Experiences.Results. Having experienced a LTE was associated witha suicide attempt (RR = 1.475, 95% CI, p = 0.001). The specific LTE that showed a statistically positive associationwere having broken a stable relationship, having personalproblems with someone close to the environment and notfinding a job or suffering a serious economic crisis.Conclusions. Suffering an LTE significantly increases the risk of suicide in the following 6 months. Havingbroken a stable relationship is presented as the most important. More studies are needed to explore the role of LTEas precipitating factors of suicidal behaviour. (AU)

Jumping to conclusions and suicidal behavior in depression and psychosis.

Suicidal behavior (SB) involves an impairment in decision-making (DM). Jumping to conclusions bias (JTC), described as the tendency to make hasty decisions based on insufficient information, could be considered as analogous of impaired DM. However, the link between JTC and SB in psychosis and other diagnoses (e.g., depression) has never been studied. This study aims to explore the presence of JTC and SB in a sample comprising 121 patients with psychosis and 101 with depression. Sociodemographic and clinical data were collected, including history of SB and symptom-severity scores. JTC was assessed by the beads task, and patients who reached decisions with the second bead or before were considered to exhibit JTC. Age, gender, diagnosis, educational level, symptom severity, substance use, and SB were compared according to JTC presence. Variables found to be significantly different in this comparison were included in a multivariate analysis. JTC was more prevalent in patients with depression than with psychosis: 55.6% in an 85:15 ratio and 64.6% in a 60:40 ratio. When multivariate logistic regression was applied to study the influence of diagnosis (psychosis versus depression), age, and SB, only SB remained statistically significant (OR 2.05; 95% CI 0.99-4.22; p = 0.05). The population studied was assembled by grouping different samples from previous research, and we have not included control variables such as other clinical variables, neurocognitive measurements, or personality traits. JTC may be more closely linked to SB, as a transdiagnostic variable, rather than to a specific diagnosis.

Trastorno límite de personalidad: el reto del manejo de las crisis / Borderline personality disorder: The challenge of crisis management

El manejo del trastorno límite de personalidad puede ser un reto para el clínico, especialmente en el servicio de urgencias hospitalarias, donde se hacen necesarias decisiones rápidas que deben ser además las más beneficiosas y en conjunto con el paciente, favoreciendo su autonomía y participación en la resolución de la crisis. En este artículo pretendemos revisar el manejo de la crisis de una forma práctica y, basándonos en las guías clínicas más recientes, proporcionar una serie de pautas a los clínicos que se enfrentan a estas situaciones para manejar adecuadamente las crisis con recomendaciones basadas en la evidencia científica que tenemos hasta ahora y claves para la valoración de la conducta suicida, que es uno de los motivos más frecuentes por lo que estos pacientes acuden a los servicios de urgencias. Finalmente revisaremos los diferentes manejos y encuadres, repasando las indicaciones de ingreso hospitalario, así como los objetivos del mismo

Managing patients with borderline personality disorder can pose a substantial challenge for psychiatrists. This is especially the case when patients with this disorder are seen in the emergency room, as clinicians must make rapid decisions that balance clinical benefit and the will of the patient, fostering their autonomy and participation. A review is presented in this article of the strategies for practical management of crises. Based on the most recent clinical guidelines, a series of insights are provided for facing these situations, including recommendations based on scientific evidence, as well as the key steps for assessing suicidal behaviour, which is one of the most frequent causes behind visits to the emergency department in this patient population. Finally, a review is presented on the different management approaches and frameworks, analysing the indications and aims of hospital admission

Spanish adaptation of the Dimensional Anhedonia Rating Scale (DARS).

BACKGROUND: Anhedonia is defined as the lack of enjoyment, engagement in, or energy for life's experiences. Only two scales to measure anhedonia have been adapted for use in Spanish-speaking populations. The aim of this study was to determine the reliability and validity of the Dimensional Anhedonia Rating Scale (DARS) following translation and adaptation for Spanish population. METHOD: The study sample included 134 patients over 18 years of age with a range of psychiatric diagnoses. Those with substance use, decompensated medical conditions, illiteracy, or lack of fluency in Spanish were excluded. The structure of the Spanish adaptation was evaluated through factor analysis. Internal reliability was assessed through Cronbach's alpha and validity was measured using Pearson's correlation between total scores for DARS and its subscales and SHAPS score. RESULTS: A strong internal consistency was observed (Cronbach alpha = 0.92 for total scale score and 0.91-0.92 for subscale scores). Similarly, a significant and strong correlation between total scores for DARS and SHAPS was found (r = 0.51, p < 0.01). LIMITATIONS: The heterogeneous distribution of diagnoses included in the study may limit our results. CONCLUSIONS: The Spanish DARS maintains the psychometric properties of the original questionnaire, with strong internal consistency and adequate validity. DARS is a specific questionnaire for evaluating anhedonia, incorporating elements that reflect motivation, interest, and effort, and one which offers possible advantages over other anhedonia scales.

Sex-specific cognitive abnormalities in early-onset psychosis.

OBJECTIVES:: Brain maturation differs depending on the area of the brain and sex. Girls show an earlier peak in maturation of the prefrontal cortex. Although differences between adult females and males with schizophrenia have been widely studied, there has been less research in girls and boys with psychosis. The purpose of this study was to examine differences in verbal and visual memory, verbal working memory, auditory attention, processing speed, and cognitive flexibility between boys and girls. METHODS:: We compared a group of 80 boys and girls with first-episode psychosis to a group of controls. RESULTS:: We found interactions between group and sex in verbal working memory (p = 0.04) and auditory attention (p = 0.01). The female controls showed better working memory (p = 0.01) and auditory attention (p = 0.001) than males. However, we did not find any sex differences in working memory (p = 0.91) or auditory attention (p = 0.93) in the psychosis group. CONCLUSIONS:: These results are consistent with the presence of sex-modulated cognitive profiles at first presentation of early-onset psychosis.

Sex-specific cognitive abnormalities in early-onset psychosis

Objectives: Brain maturation differs depending on the area of the brain and sex. Girls show an earlier peak in maturation of the prefrontal cortex. Although differences between adult females and males with schizophrenia have been widely studied, there has been less research in girls and boys with psychosis. The purpose of this study was to examine differences in verbal and visual memory, verbal working memory, auditory attention, processing speed, and cognitive flexibility between boys and girls. Methods: We compared a group of 80 boys and girls with first-episode psychosis to a group of controls. Results: We found interactions between group and sex in verbal working memory (p = 0.04) and auditory attention (p = 0.01). The female controls showed better working memory (p = 0.01) and auditory attention (p = 0.001) than males. However, we did not find any sex differences in working memory (p = 0.91) or auditory attention (p = 0.93) in the psychosis group. Conclusions: These results are consistent with the presence of sex-modulated cognitive profiles at first presentation of early-onset psychosis.

U-shaped curve of psychosis according to cannabis use: New evidence from a snowball sample.

BACKGROUND: The aim of this study was to investigate the relationship between psychotic-like experiences (PLEs) assessed using the Community Assessment of Psychic Experience (CAPE) questionnaire and the pattern of cannabis use in a non-clinical sample collected by snowball sampling. METHODS: Our sample was composed of 204 subjects, distributed into three groups by their cannabis use pattern: 68 were non-cannabis users, 40 were moderate cannabis users and 96 were daily cannabis users. We assessed the psychotic experiences in each group with the CAPE questionnaire; and then controlled for the effect of possible confounding factors like sex, age, social exclusion, age of onset of cannabis use, alcohol use and other drug use. RESULTS: We found a significant quadratic association between the frequency of cannabis use and positive (ß = -1.8; p = 0.004) and negative dimension scores (ß = -1.2; p = 0.04). The first-rank and mania factors showed a significant quadratic association (p < 0.05), while the voices factor showed a trend (p = 0.07). Scores for the different groups tended to maintain a U-shape in their values for the different factors. When we adjusted for gender, age, social exclusion, age of onset of cannabis use, and use of alcohol and other drugs, only the first-rank experiences remained significant. CONCLUSIONS: We found there was a U-shaped curve in the association between cannabis use and the positive and negative dimensions of the CAPE score. We also found this association in mania and first-rank experiences.

Interpretation, emotional reactions and daily life implications of hallucination-like experiences in clinical and nonclinical populations / Interpretación, reacción emocional e implicaciones en la vida diaria de experiencias de tipo alucinatorias en población clínica y no clínica

BACKGROUND: Research on Hallucination-Like Experiences (HLEs) has not yet explored whether people without psychosis who have HLEs attribute the same level of significance to them. This significance includes whether or not the HLEs elicit similar emotional reactions in people with and without psychosis, or if the HLEs occur in same context between the two groups. The objective of this study was to compare the characteristics of these experiences in a non-clinical group and a clinical group of patients with schizophrenia and schizophrenia spectrum disorders. METHOD: Both groups were evaluated to determine the prevalence of HLEs. After the evaluation, they were interviewed about the characteristics of these experiences. RESULTS: Both groups sought to actively eliminate the HLEs, could identify the presence of a trigger factor, and experienced little perceived control. However, HLEs elicited more anxiety, discomfort and interference in daily life in the clinical group than in the nonclinical group. Furthermore, the clinical group members defined their hallucinations more negatively and were reported to have experienced them under stressful events. CONCLUSIONS: These findings suggest that the two experiences are not entirely equivalent, especially when taking into account the emotional reaction produced by these experiences and the meaning people attach to them

ANTECEDENTES: la investigación en Experiencias de Tipo Alucinatorias (HLEs en inglés) aún no ha explorado si las personas sin psicosis que las experimentan les atribuyen el mismo significado, si estas provocan las mismas reacciones emocionales o si ocurren en los mismos contextos que en la psicosis. El objetivo de este estudio fue comparar las características de estas experiencias entre un grupo no clínico y un grupo clínico de pacientes con esquizofrenia y trastornos del espectro esquizofrénico. MÉTODO: ambos grupos fueron evaluados para determinar la prevalencia de las HLEs, después de lo cual fueron entrevistados sobre las características de estas experiencias. RESULTADOS: ambos grupos buscan activamente eliminar estas experiencias; pueden identificar la presencia de un factor desencadenante, y poco control percibido. Sin embargo, las HLEs provocaron más ansiedad, malestar e interferencia en la vida diaria en el grupo clínico que en el grupo no clínico. Además, el grupo clínico definió sus HLEs como más negativas y experimentadas bajo situaciones estresantes. CONCLUSIONES: estos resultados sugieren que las experiencias de ambos grupos no son completamente equivalentes, especialmente cuando se toman en cuenta las reacciones emocionales producidas por estas experiencias y el significado que las personas les atribuyen

Interpretation, emotional reactions and daily life implications of hallucination-like experiences in clinical and nonclinical populations.

BACKGROUND: Research on Hallucination-Like Experiences (HLEs) has not yet explored whether people without psychosis who have HLEs attribute the same level of significance to them. This significance includes whether or not the HLEs elicit similar emotional reactions in people with and without psychosis, or if the HLEs occur in same context between the two groups. The objective of this study was to compare the characteristics of these experiences in a non-clinical group and a clinical group of patients with schizophrenia and schizophrenia spectrum disorders. METHOD: Both groups were evaluated to determine the prevalence of HLEs. After the evaluation, they were interviewed about the characteristics of these experiences. RESULTS: Both groups sought to actively eliminate the HLEs, could identify the presence of a trigger factor, and experienced little perceived control. However, HLEs elicited more anxiety, discomfort and interference in daily life in the clinical group than in the non-clinical group. Furthermore, the clinical group members defined their hallucinations more negatively and were reported to have experienced them under stressful events. CONCLUSIONS: These findings suggest that the two experiences are not entirely equivalent, especially when taking into account the emotional reaction produced by these experiences and the meaning people attach to them.

Temporal relationship of first-episode non-affective psychosis with cannabis use: a clinical verification of an epidemiological hypothesis.

BACKGROUND: We analyzed the association of age at onset of psychosis treatment (AOPT) with having a history of cannabis use in patients with a first episode of non-affective psychosis. We also investigated the impact on the AOPT of exposure to cannabis in adolescence, compared with young adulthood, and of the additional exposure to cocaine. METHOD: We recruited 112 consecutive patients (66 men and 46 women; age range, 18-57years) with a first psychotic episode. The composite international diagnostic interview (CIDI) was used to assess drug use and to define the age at onset of heaviest use (AOHU) of a drug, defined as the age when drug was used the most for each patient. The effect of cannabis and cocaine AOHU on AOPT was explored through Kruskal-Wallis and Mann-Whitney tests, and logistic regression. Sex-adjusted cumulative hazard curves and Cox regression models were used to compare the AOPT of patients with and without a history of cannabis use, or associated cocaine use. RESULTS: We found that the AOPT was significantly associated with the use of cannabis, independently of sex, use of cocaine, tobacco smoking or excessive alcohol consumption. There was a dose-response relationship between cannabis AOHU and AOPT: the earlier the AOHU the earlier the AOPT. Hazard curves showed that patients with a history of cannabis use had a higher hazard of having a first-episode psychosis than the rest of the patients (sex-adjusted log-rank chi(2)=23.43, df=1, p<0.001). Their respective median AOPT (25th, 75th percentiles) were 23.5 (21, 28) and 33.5years (27, 45) (for log-transformed AOPT, t=5.6, df=110, p<0.001). The sex-adjusted hazard ratio of psychosis onset comparing both groups was 2.66 (95% CI, 1.74-4.05). CONCLUSIONS: Our results are in favor of a catalytic role for cannabis use in the onset of psychosis.