Towards a comprehensive approach to mentalization-based treatment for children with autism: integrating attachment, neurosciences, and mentalizing.

Autism spectrum disorder (ASD) is diagnosed based on socio-communicative difficulties, which are believed to result from deficits in mentalizing, mainly evidenced by alterations in recognizing and responding to the mental states of others. In recent years, efforts have been made to develop mentalization-based treatment (MBT) models for this population. These models focus on enhancing individuals' ability to understand and reflect on their own mental states, as well as those of others. However, MBT approaches for people with ASD are limited by their existing theoretical background, which lacks a strong foundation grounded in neuroscience-based evidence properly integrated with attachment, and mentalizing. These are crucial aspects for understanding psychological processes in autism, and as such, they play a pivotal role in shaping the development of tailored and effective therapeutic strategies for this specific population. In this paper we review evidence related to the neurobiological, interpersonal, and psychological dimensions of autism and their implications for mentalizing processes. We also review previous mentalization-based frameworks on the psychosis continuum to provide a comprehensive understanding of attachment, neurobiology, and mentalization domains in therapeutic approaches for autism. After presenting a synthesis of the literature, we offer a set of clinical strategies for the work with children with autism. Finally, we provide recommendations to advance the field towards more robust models that can serve as a basis for evidence-based therapeutic strategies.

Digital adaptation of group activities in an outpatient center of a children´s hospital: Adolescent participants' experiences. / Adaptación telemática de las actividades grupales de un hospital de día infanto-juvenil: experiencias de participantes adolescentes.

Introduction: Outpatient centers offer specialized care to users with severe psychiatric disorders. The usual group activities of outpatient centers have been shown to be effective in the child and adolescent population. There are significant access limitations to these services and one way to expand coverage is through digital care. However, there are no studies on digital outpatient care services in Chile. The present study is part of the preparatory phase of a future randomized clinical trial to investigate the effectiveness of digital adaptation of outpatient centers interventions. Objectives: To explore the experience and subjective perception of the pilot intervention participants by identifying central themes, and to evaluate the participant's satisfaction regarding the intervention. Methods: Of the 13 users of the digital group activities, 10 participated in this study. Semi-structured interviews and satisfaction surveys were conducted between August 2020 and January 2021. The interviews were evaluated using content analysis and the surveys were conducted using descriptive statistics. Conclusions and Results: Participants were particularly appreciative of positive social interactions (with peers and therapists). There is a general perception of having improved socioemotional skills and mood. The digital implementation was satisfactory for most participants, who suggested adding activities that promote deeper interactions with their peers. The core elements of this intervention would be the perception of social support (a possible therapeutic mechanism), along with the feeling of improved social skills and mood (possible main outcome).

Introducción: Los hospitales de día ofrecen atención especializada a usuarios con patologías psiquiátricas graves. Las actividades grupales habituales del hospital de día han demostrado efectividad en población infanto-juvenil. Existen importantes limitaciones de acceso a estos servicios y una forma de ampliar la cobertura es a través de la atención telemática. Sin embargo, no existen estudios sobre atención telemática de hospital de día en Chile. El presente estudio es parte de la fase preparatoria de un futuro ensayo clínico aleatorizado para investigar la efectividad de la adaptación telemática de las intervenciones de un hospital de día. Objetivos: Explorar la percepción y experiencia subjetiva de los participantes de la versión piloto de dicha intervención identificando temáticas centrales, y evaluar la satisfacción de los participantes con la intervención. Métodos: De los 13 usuarios de las actividades grupales telemáticas, 10 participaron en este estudio. Se realizaron entrevistas semi-estructuradas y encuestas de satisfacción entre agosto de 2020 y enero de 2021. Las entrevistas fueron evaluadas utilizando análisis de contenido y las encuestas se realizaron con estadísticas descriptivas. Resultados: Se aprecia una especial valoración de los participantes por las interacciones sociales positivas (con pares y terapeutas). Aparece una percepción general de haber mejorado en habilidades socioemocionales y estado de ánimo. La implementación telemática resultó satisfactoria para la mayoría de los participantes, quienes proponen agregar actividades que promuevan interacciones más profundas con sus pares. Conclusiones: Los elementos centrales de esta intervención serían la percepción de apoyo social (posible mecanismo terapéutico), junto con la sensación de mejorar las habilidades sociales y el estado de ánimo (posible resultado principal).

Adaptación telemática de las actividades grupales de un hospital de día infanto-juvenil: experiencias de participantes adolescentes / Digital adaptation of group activities in an outpatient center of a children´s hospital: Adolescent participants' experiences

Introducción Los hospitales de día ofrecen atención especializada a usuarios con patologías psiquiátricas graves. Las actividades grupales habituales del hospital de día han demostrado efectividad en población infanto-juvenil. Existen importantes limitaciones de acceso a estos servicios y una forma de ampliar la cobertura es a través de la atención telemática. Sin embargo, no existen estudios sobre atención telemática de hospital de día en Chile. El presente estudio es parte de la fase preparatoria de un futuro ensayo clínico aleatorizado para investigar la efectividad de la adaptación telemática de las intervenciones de un hospital de día. Objetivos Explorar la percepción y experiencia subjetiva de los participantes de la versión piloto de dicha intervención identificando temáticas centrales, y evaluar la satisfacción de los participantes con la intervención. Métodos De los 13 usuarios de las actividades grupales telemáticas, 10 participaron en este estudio. Se realizaron entrevistas semi-estructuradas y encuestas de satisfacción entre agosto de 2020 y enero de 2021. Las entrevistas fueron evaluadas utilizando análisis de contenido y las encuestas se realizaron con estadísticas descriptivas. Resultados Se aprecia una especial valoración de los participantes por las interacciones sociales positivas (con pares y terapeutas). Aparece una percepción general de haber mejorado en habilidades socioemocionales y estado de ánimo. La implementación telemática resultó satisfactoria para la mayoría de los participantes, quienes proponen agregar actividades que promuevan interacciones más profundas con sus pares. Conclusiones Los elementos centrales de esta intervención serían la percepción de apoyo social (posible mecanismo terapéutico), junto con la sensación de mejorar las habilidades sociales y el estado de ánimo (posible resultado principal).

Introduction Outpatient centers offer specialized care to users with severe psychiatric disorders. The usual group activities of outpatient centers have been shown to be effective in the child and adolescent population. There are significant access limitations to these services and one way to expand coverage is through digital care. However, there are no studies on digital outpatient care services in Chile. The present study is part of the preparatory phase of a future randomized clinical trial to investigate the effectiveness of digital adaptation of outpatient centers interventions. Objectives To explore the experience and subjective perception of the pilot intervention participants by identifying central themes, and to evaluate the participant's satisfaction regarding the intervention. Methods Of the 13 users of the digital group activities, 10 participated in this study. Semi-structured interviews and satisfaction surveys were conducted between August 2020 and January 2021. The interviews were evaluated using content analysis and the surveys were conducted using descriptive statistics. Conclusions Results Participants were particularly appreciative of positive social interactions (with peers and therapists). There is a general perception of having improved socioemotional skills and mood. The digital implementation was satisfactory for most participants, who suggested adding activities that promote deeper interactions with their peers. The core elements of this intervention would be the perception of social support (a possible therapeutic mechanism), along with the feeling of improved social skills and mood (possible main outcome).

Psychobiotic Effects on Anxiety Are Modulated by Lifestyle Behaviors: A Randomized Placebo-Controlled Trial on Healthy Adults.

Psychobiotics are modulators of the Microbiota-Gut-Brain Axis (MGBA) with promising benefits to mental health. Lifestyle behaviors are established modulators of both mental health and the MGBA. This randomized placebo-controlled clinical trial (NCT04823533) on healthy adults (N = 135) tested 4 weeks of probiotic supplementation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175). We assessed effects on wellbeing, quality of life, emotional regulation, anxiety, mindfulness and interoceptive awareness. We then analyzed if lifestyle behaviors modulated probiotic effectiveness. Results showed no significant effects of probiotic intake in whole sample outcomes. Correlational analyses revealed Healthy Behaviors were significantly correlated with wellbeing across scales. Moreover, the linear mixed-effects model showed that the interaction between high scores in Healthy Behaviors and probiotic intake was the single significant predictor of positive effects on anxiety, emotional regulation, and mindfulness in post-treatment outcomes. These findings highlight the relevance of controlling for lifestyle behaviors in psychobiotic and mental health research.

Internet-based peer support interventions for people living with HIV: A scoping review.

Peer support interventions for people living with HIV and AIDS (PLWHA) are effective, but their associated time and material costs for the recipient and the health system make them reachable for only a small proportion of PLWHA. Internet-based interventions are an effective alternative for delivering psychosocial interventions for PLWHA as they are more accessible. Currently, no reviews are focusing on internet-based interventions with peer support components. This scoping review aims to map the existing literature on psychosocial interventions for PLWHA based on peer support and delivered through the internet. We conducted a systematic scoping review of academic literature following methodological guidelines for scoping reviews, and 28 articles met our criteria. We summarized the main characteristics of the digital peer support interventions for PLWHA and how they implemented peer support in a virtual environment. Overall the reported outcomes appeared promising, but more robust evidence is needed.

The 4E approach to the human microbiome: Nested interactions between the gut-brain/body system within natural and built environments.

The complexity of the human mind and its interaction with the environment is one of the main epistemological debates throughout history. Recent ideas, framed as the 4E perspective to cognition, highlight that human experience depends causally on both cerebral and extracranial processes, but also is embedded in a particular sociomaterial context and is a product of historical accumulation of trajectory changes throughout life. Accordingly, the human microbiome is one of the most intriguing actors modulating brain function and physiology. Here, we present the 4E approach to the Human Microbiome for understanding mental processes from a broader perspective, encompassing one's body physiology and environment throughout their lifespan, interconnected by microbiome community structure and dynamics. We review evidence supporting the approach theoretically and motivates the study of the global set of microbial ecosystem networks encountered by a person across their lifetime (from skin to gut to natural and built environments). We furthermore trace future empirical implementation of the approach. We finally discuss novel research opportunities and clinical interventions aimed toward developing low-cost/high-benefit integrative and personalized bio-psycho-socio-environmental treatments for mental health and including the brain-gut-microbiome axis.

Déficits neuropsicológicos en mujeres con trastornos de la conducta alimentaria / Neuropsychological impairment in women with eating disorders

RESUMEN Introducción Antecedentes: La anorexia nerviosa (AN) y la bulimia nerviosa (BN) son enfermedades mentales graves y crónicas que afectan a un alto porcentaje de la población. Un número creciente de estudios han informado de alteraciones neuropsicológicas en esta población, que aparentemente contribuyen a la aparición y progresión del trastorno, y que repercuten en la eficacia del tratamiento y la recuperación. Metodología: El objetivo de esta Revisión Narrativa es resumir los hallazgos relativos al perfil neuropsicológico de las mujeres con AN y BN en diferentes fases de tratamiento. Resultados: La evidencia disponible sugiere que las mujeres con AN y BN presentan un perfil de déficits de cognición ejecutiva y social. Estos resultados son consistentes con la evidencia de los hallazgos de neuroimagen de alteraciones cerebrales estructurales en las áreas frontales y en los circuitos frontales-subcorticales. Conclusiones: El conocimiento de los perfiles neuropsicológicos de las mujeres con AN y BN ofrece información clave para entender la presentación clínica de esta población y los retos en la adherencia y beneficio del tratamiento. Los estudios futuros deberían explorar la eficacia de las intervenciones dirigidas a las deficiencias neuropsicológicas y cómo contribuyen al tratamiento habitual.

Background: Anorexia nervosa (AN) and bulimia nervosa (BN) are severe and chronic mental health illnesses that affect a high percentage of the population. A growing number of studies have reported neuropsychological impairments in this population, apparently contributing to the onset and progression of the disorder, and impacting on treatment efficacy and recovery. Methodology: This Narrative Review aimed to summarize findings regarding the neuropsychological profile of women with AN and BN at different treatment phases. Results: Available evidence suggests that women with AN and BN present a profile of executive and social cognition deficits. These results are consistent with evidence from neuroimaging findings of structural brain alterations in frontal areas and frontal-subcortical circuits. Conclusions: Knowledge about the neuropsychological profiles of AN and BN women offers key information to understand the clinical presentation of this population and challenges in adhering and benefiting from treatment. Future studies should explore the efficacy of interventions targeting neuropsychological impairments and how they contribute to treatment as usual.

Characteristics of psychosocial interventions to improve ART adherence in people living with HIV: A systematic review.

The HIV/AIDS pandemic continues to be a significant global public health crisis. The main HIV/AIDS treatment is the antiretroviral therapy (ART), which is highly effective but depends on the patient's adherence to be successful. However, the adherence to antiretroviral therapy remains unsatisfactory across different populations, which raises considerable difficulties at both individual and collective levels. Suboptimal adherence to ART can be overcome through multidisciplinary management that includes evidence-based psychosocial interventions. Existing reviews on these interventions have focused mainly on studies with experimental designs, overlooking valuable interventions whose evidence comes from different study designs. Here, we aimed to carry out a comprehensive review of the current research on psychosocial interventions for ART adherence and their characteristics including studies with different designs. We conducted a systematic review following PRISMA guidelines. We searched five databases (Pubmed, EBSCO, LILACS, WoS and SCIELO) for articles reporting a psychosocial intervention to improve treatment adherence for people living with HIV (adults). The quality of each study was analyzed with standardized tools, and data were summarized using a narrative synthesis method. Twenty-three articles were identified for inclusion, and they demonstrated good to fair quality. Individual counseling was the most frequent intervention, followed by SMS reminders, education, and group support. Most interventions combined different strategies and self-efficacy was the most common underlying theoretical framework. This review provides insight into the main characteristics of current psychosocial interventions designed to improve ART treatment adherence. PROSPERO number: CRD42021252449.

When technology cares for people with dementia: A critical review using neuropsychological rehabilitation as a conceptual framework.

Clinicians and researchers have become increasingly interested in the potential of technology in assisting persons with dementia (PwD). However, several issues have emerged in relation to how studies have conceptualized who the main technology user is (PwD/carer), how technology is used (as compensatory, environment modification, monitoring or retraining tool), why it is used (i.e., what impairments and/or disabilities are supported) and what variables have been considered as relevant to support engagement with technology. In this review we adopted a Neuropsychological Rehabilitation perspective to analyse 253 studies reporting on technological solutions for PwD. We analysed purposes/uses, supported impairments and disabilities and how engagement was considered. Findings showed that the most frequent purposes of technology use were compensation and monitoring, supporting orientation, sequencing complex actions and memory impairments in a wide range of activities. The few studies that addressed the issue of engagement with technology considered how the ease of use, social appropriateness, level of personalization, dynamic adaptation and carers' mediation allowed technology to adapt to PWD's and carers' preferences and performance. Conceptual and methodological tools emerged as outcomes of the analytical process, representing an important contribution to understanding the role of technologies to increase PwD's wellbeing and orient future research.