Uso de psicofármacos en personas con discapacidad intelectual en Extremadura, España / Use of Psychotropic Drugs in People with Intellectual Disability in Extremadura, Spain

Resumen El uso de psicofármacos es frecuente en adultos con discapacidad intelectual, a menudo por conductas desafiantes en ausencia de diagnóstico de trastorno mental. Investigaciones previas cuestionan la eficacia de estos tratamientos a falta de una enfermedad psiquiátrica, y destacan sus efectos secundarios. El objetivo de esta investigación es analizar el uso de psicofármacos en función del diagnóstico de enfermedad mental y conducta desafiante, así como la distribución de la población según el uso de psicofármacos en 569 adultos con discapacidad intelectual que presentan enfermedad mental o conductas desafiantes. Los datos acerca de la elevada prescripción de psicofármacos y, especialmente, de antipsicóticos alertan sobre la necesidad de una profunda revisión de la práctica clínica que permita reducir el uso de esta medicación en el tratamiento de la conducta y los trastornos mentales en esta población, para garantizar una atención de calidad y el respeto de los derechos de estas personas.

Abstract The use of psychotropic drugs in adults with an intellectual disability is frequent, often for defiant conduct due to the lack of a diagnosis of a mental disorder. Previous research has questioned the efficacy of such treatments in the absence of a psychiatric illness, and the stress has been on the side effects. The objective of this research is to analyze the use of psychotropic drugs based on the diagnosis of mental illness and behavioral disorders, as well as the distribution of the sample according to the use of psychotropic drugs in 569 adults with an intellectual disability who also suffer a mental illness and/or defiant conduct. Our data about the high prescription of psychotropic drugs and especially antipsychotics, warns of the need for a profound review of the clinical practice that would allow a reduction in the use of psychotropic drugs in the treatment of mental disorders and behaviour in the said collective, so as to guarantee quality mental health care for these persons and respect for their rights.

Psychopathological and neuropsychological disorders associated with chronic primary visceral pain: Systematic review.

The World Health Organization (WHO), in its last review of its International Classification of Diseases, established a new classification for chronic pain. Among the principal categories, of particular interest is chronic primary pain as a new type of diagnosis in those cases in which the etiology of the disease is not clear, being termed as chronic primary visceral pain when it is situated in the thorax, abdomen, or pelvis. Due to the novelty of the term, the objective of the systematic review was to examine the psychopathological and neuropsychological disorders associated with chronic primary visceral pain. We carried out a search of the scientific literature following the PRISMA directives using the Pubmed, Medline, PsycInfo and Scopus databases. A total of 33 articles were selected after applying the inclusion and exclusion criteria. The analysis of the studies showed that most persons with chronic primary visceral pain suffer from at least one psychological disorder; the most prevalent being anxiety, depressive or somatoform disorders. The most frequent psychopathological symptoms are anxiety, depression and somatization. Similarly, the findings are insufficient to determine the existence of deficits in the domains of executive functioning, memory and intelligence. However, the existence of attention biases does seem to be clear. This review supposes a starting point for conceptualizing chronic primary visceral pain. It is necessary to continue further research so as to obtain a better understanding of this pathology and the disorders associated.

Moral Disengagement Mechanisms and Personality Dimensions Implicit to Homophobia.

Recent advances in sexual equality and diversity have not been able to mitigate the serious problem of discrimination suffered by sexual minorities. The most serious cases involve violence and physical or psychological aggression towards sexual orientations that differ from the heterosexual norm. This research analyses the dimensions of the personality and the moral disengagement mechanisms related to homophobia and the predictive value they have for hostile attitudes towards sexual diversity. The sample was made up of 849 university students between 18 and 24 years of age. The instruments used were the Modern Homophobia Scale (MHS), the Mechanisms of Moral Disengagement Scale (MMDS), and the reduced version of the Neo Personality Inventory-Reduced Version (NEO-FFI). The results show the involvement of moral disengagement in homophobia. It highlights evidence of subtle intimidatory behaviour patterns of rejection towards homosexuality. Furthermore, the low levels in the dimensions of a friendly personality and openness to experiences can be seen to predict homophobic behaviour. Thus, young people fall back on diverse mechanisms of moral disengagement to justify harmful attitudes towards the LGTBI collective. The results of the research are particularly relevant and useful for setting up programmes aimed at preventing and mitigating this serious problem of sexual discrimination.

Profile of Subclinical Psychopathy in Spanish University Students.

Psychopaths are portrayed as deceitful, manipulative, domineering and narcissistic; the result of an irregular and irresponsible interpersonal style that harms both the psychopath him/herself and others. Furthermore, psychopathy is frequently associated with both violent and antisocial conduct. However, subclinical psychopaths are known for manifesting this type of profile without committing crimes. The objective of this study is to examine the differences that exist in subclinical psychopathy concerning gender, the number of intimate relationships and the age of the university student. The number of university students participating was 1289. They were given the Integrated/Subclinical Psychopathy Questionnaire (CUPIS). The results show that, in subclinical psychopathy, men present higher scores than women and younger persons have higher scores than older persons. In addition, the scores in psychopathy are higher for students who have had a larger number of intimate relationships. The contributions of this study allow us to determine the profile associated with subclinical psychopathy.

Youth Serial Killers: Psychological and Criminological Profiles.

Serial murder is a specific type of violent crime that falls into the crime category of multicide. According to the nomenclature of the Federal Bureau of Investigation's Violent Crime Classification Manual and Academic Researchers for the Classification of Violent Crimes, most serial killers are adults. However, serial murder is also committed by young people, although to a lesser extent. Young serial killers are a topic of relevance in areas such as psychology, criminology, and the justice system. Given that the study of the variables that could be the basis of such multicide criminality is not conclusive, the need for further research is evident. The homicides perpetrated by children and young people point to a social panorama that is alarming due to their young age. This issue is prevalent enough to conduct a review. The performed review concludes the importance of psychosocial factors to better understand the process by which children and young people commit crimes as serious as serial murders. The scope of the problem of serial murders perpetrated by minors is controversial because it often depends on how the number of real cases is counted. Although official statistics indicate the low prevalence of juvenile serial killers, childhood is a period in which antisocial behaviour can have its beginning. Some authors consider that it is not uncommon for the first murder of this type to occur in adolescence. It is important to consider psychopathy as an influential factor in the various forms of serial criminal conduct committed by children and young people. The research works consulted provide evidence of the special relevance of psychopathy in the generation of serious juvenile delinquency.

Behavioral and Emotional Difficulties and Personal Wellbeing of Adolescents in Residential Care.

This work studies the emotional and behavioural difficulties and the personal wellbeing of adolescents under protective measures. The sample is made up of 151 adolescents in residential care between 11 and 17 years of age. The instruments used were the Strengths and Difficulties Questionnaire (SDQ) and the Personal Wellbeing Index (PWI). The results indicate that a high percentage of adolescents have emotional and behavioural difficulties. We found a greater presence of behavioural rather than emotional problems in the adolescents. Similarly, we also found that females showed more emotional difficulties than the males. As for personal wellbeing, the results indicate that the adolescents are dissatisfied in several areas of their life, they feel insecure and have a pessimistic view of their future and of their achievements. Furthermore, those adolescents who were admitted to residential care due to something other than child abuse have a greater prosocial behaviour. It can be concluded that the more difficulties the adolescents experience (emotional, behavioural and with their peers), the lower the perception of their personal wellbeing will be. This study allows us to design interventions aimed at promoting psychological wellbeing among these adolescents.

Emotional, Behavioural and Executive Functioning Problems in Children in Residential Care.

This research analyses the emotional and behavioural problems, as well as the problems in the executive functions, of children in residential care under protective measures, between 8 and 12 years of age. We analyse the relationship between the problems with their executive functions and their emotional and behavioural problems, as well as the predictive value of the executive functions for the said emotional and behavioural problems. The instruments used were as follows: five digits test (FDT), behavioural assessment of the dysexecutive syndrome in children (BADS-C) and the system of evaluation for children and adolescents (SENA). The results indicate that the children have difficulties in their executive functions, with such problems as in attention control and regulation, impulsiveness, mental rigidity, behavioural organisation and planning and resolving problems. They also have internalising and externalising problems, as well as difficulties in controlling their emotional reactions and understanding the emotions of others. It becomes evident that the difficulties in their executive functions are related to and predict their emotional and behavioural problems. The research demonstrates the need to intervene in the problems detected through the design of therapeutic programmes and interventions in the residential context.

Quality of Working Life, Psychosocial Factors, Burnout Syndrome and Emotional Intelligence.

The objective of this work is to study the quality of working life associated to psychosocial factors and risks, burnout syndrome and emotional intelligence, as well as being able to detect predictors of the said syndrome. The sample consisted of 311 professionals working in direct contact with an intellectual disability from 15 associations of Extremadura (Spain). The Spanish version of the CESQT questionnaire was administered to evaluate burnout syndrome, the Wong & Law Emotional Intelligence Scale (WLEIS) was used to evaluate emotional intelligence, while the UNIPSICO Battery was used to evaluate the psychosocial factors of demands (work-family conflict and psychosomatic problems) and resources, such as social support and work satisfaction. The results indicate average values of burnout, revealing that work satisfaction, emotional intelligence, and social support are related to burnout syndrome. In addition, there are also positive correlations between psychosomatic symptoms and work-family conflict. Satisfaction at work, social support, and emotional intelligence (intrapersonal and interpersonal perception, use and regulation of emotions) predict burnout syndrome. What is more, the psychosomatic symptoms and work-family conflict explain, respectively, 17% and 17.9% of their variance. Thus, there is a need to develop intervention programs that encourage social support and the conciliation of family life, as well as training skills related to emotional intelligence, such as communication and conflict resolution.

Psicópatas versus trastornos de la personalidad: matices clínico-conceptuales y aspectos diferenciales / Psychopaths versus personality disorders: clinical-conceptual nuances and differential aspects

La psicopatía ha sido frecuentemente relacionada con los trastornos de la personalidad, sobre todo con el subtipo antisocial, debido a las características delictivas que, en ocasiones, este implica. A pesar de esta asociación, y sin obviar los matices diferenciales, es importante recordar que los trastornos de la personalidad son diagnósticos clínicos, que vienen amparados por las nosologías psiquiátricas y recogidos en los manuales de trastornos mentales. En este sentido, no se debe entender la psicopatía como un trastorno mental, ni de la personalidad ni de cualquier otra índole psicopatológica. Si bien la psicopatía incorpora algunos rasgos aislados, también característicos de varios trastornos de la personalidad, es necesario establecer con exactitud los perfiles diferenciales entre estos y la psicopatía, ya que hay múltiples matices que podrán ayudar a establecer el diagnóstico diferencial pertinente y a evitar equiparar psicopatía con psicopatologías de la personalidad

Psychopathy has been frequently associated with personality disorders, particularly with the antisocial subtype due to the criminal features that it sometimes entails. Despite this link, and without ignoring the differential nuances, it is important to remember that personality disorders are clinical diagnoses, which are supported by psychiatric nosology and included in manuals of mental disorders. Therefore, psychopathy should not be understood as a mental disorder, neither of personality nor of any other psychopathological nature. Even though psychopathy incorporates some isolated features, also characteristic of several personality disorders, it is necessary to accurately establish the differential profiles between them and psychopathy, since there are multiple nuances that may help to establish the necessary differential diagnosis and to avoid equating psychopathy with personality psychopathologie

Psicopatología, crimen violento, cine y realidad: desmontando mitos sobre psicópatas y psicóticos / Psychopathology, violent crime, cinema and reality: debunking myths about psychopaths and psychotics / Psicopatología, crime violento, cinema e realidade: desmontar os mitos em psicopatas e em psicóticos

Psicosis, esquizofrenia, paranoia, personalidad múltiple y otro sinfín de términos son los que parecen coincidir con los conceptos coloquiales y peyorativos de locos, tarados, etc. Según numerosos autores, parece ser que la psicosis es la enfermedad mental más grave que existe, y, también, es evidente la cantidad de veces que ha sido (mal) utilizada para recrear centenares de películas; el ejemplo más claro de esto mismo lo tenemos en el famoso film de Alfred Hitchcock, Psicosis, que analizamos aquí desde una perspectiva psicológico-forense y criminológica. Por otra parte, el tópico de la psicopatía también ha venido siendo amplia y erróneamente abordado por los medios de comunicación, y mal caracterizado en numerosas películas y series televisivas, todo esto a pesar de que hoy día se trata de un constructo clínico-forense válido y fiable. La relación de la psicopatía con la violencia y la criminalidad es bastante conocida, si bien este aspecto también requiere de una serie de rigurosos matices. En este artículo trataremos de desmontar el mito generalizado de que los enfermos mentales son muy peligrosos, y de que su criminalidad se ciñe exclusivamente a los homicidios, algo que también extienden muchos autores al caso de los psicópatas.

Psychopathology, schizophrenia, paranoia, multiple personality and other endless series of terms are those appearing to allude who in an abusive language and derogatory terms are called "lunatic", "screwy", "moron", and so forth. According to numerous authors, it seems that psychosis is the most serious mental illness known to medicine, and the number of times it has been (mis)used to recreate hundreds of stories and film plots of which one of the clearest examples is the already legendary Alfred Hitchcock's film Psychosis that we are analyzing here from a psychological-forensic and criminological perspective. Moreover, psychopathy has at the same time been addressed both broadly and erroneously as a source and subject by the media and ill-represented in countless films and television series, despite the fact that today it is a valid and reliable clinical-forensic construct. The relationship of psychopathy and violence and criminality is very wellknown today, although in this aspect also rigorous nuances and features are required to approach it. This article is intended to debunk the generalized myth that mental patients are very dangerous and that their criminality is strictly attached to homicides, this being common among many authors in their treatment of psychopaths.

A psicose, a esquizofrenia, o paranóia, a personalidade múltipla e uma infinidade de termos são aqueles que parecem concordar com os conceitos coloquiais e dos pejorativos de loucos, ou tarados, etc. De acordo com numerosos autores, parece ser que a psicose é a doença mental mais séria do que existe, e, também, é evidente a quantidade de vezes que é (mal) usado para recrear centenas de filmes; o exemplo mais claro que tem mesmo é o famoso film de Alfred Hitchcock, Psicose, que nós analisamos aqui desde uma perspectiva psicológico-forense e criminológica. Por outro lado, o tema da psicopatia também foi abordado amplamente e erroneamente pelos meios de comunicação, e mal caracterizado em películas numerosas e séries de TV, tudo embora hoje seja um constructo clínico-forense válido e fiável. A relação da psicopatia com a violência e a criminalidade é bastante conhecida, embora este aspecto requeira também de uma série de matizes rigoroso. Neste artigo nós tentaremos desmontar o mito generalizado de que os pacientes mentais são muito perigosos, e de que sua criminalidade cinge-se exclusivamente aos homicídios, algo que estendem também muitos autores ao caso dos psicopatas.