The Shipibo Ceremonial Use of Ayahuasca to Promote Well-Being: An Observational Study.

Promoting well-being is one of the main goals to improve health in the world. We examined the well-being and quality of life over the course of one year in a sample that participated in an Indigenous Shipibo healing program where traditional healers work in a series of ayahuasca ceremonies. We also explored the role of decentering as a mediator of psychological well-being. Participants who attended the program responded to an online survey that included a Psychological Well-Being Scale; Oxford Happiness Questionnaire; The World Health Organization Quality of Life Spirituality, Religiousness, and Personal Beliefs scale; the WHO Quality of Life-BREF scale; and Decentering scale. Baseline (T0) and postassessment (T1) were completed by 200 individuals. Of these, 101 completed the follow-up assessment at three months (T2), 91 at 6 months (T3), and 94 at 12 months follow-up (T4) after leaving the center. ANOVA test was performed in a representative subsample to control the passing of time two months before attending the program (T-1). Pearson's test was performed to examine the relationship between psychological well-being and decentering during the period of T0 and T1. A significant increase was observed in all the scales at all time points (p ≤ 0.01). The subgroup analysis performed in a representative subsample allowed us to infer that the significant differences in outcomes are due to the effect of their stay at the center and not the passing of time. We found a relationship between decentering and the improvement of psychological well-being (r = 0.57; p < 0.01). Our results suggest that the Indigenous Shipibo healing work with ayahuasca has value to improve long-term well-being and quality of life for Westerners.

The Effect of Child Sexual Abuse on Social Functioning in Schizophrenia Spectrum Disorders.

The objective of this study was to explore social functioning in schizophrenic patients who have suffered child sexual abuse (CSA) in comparison with those who have not suffered from it in a Spanish sample of 50 patients with schizophrenia or schizoaffective disorder. The Quality of Life (QOL) Scale, the Childhood Trauma Questionnaire (CTQ-SF), and the NEO Five Factor Inventory (NEO-FFI) were administered in this study. We found a CSA prevalence of 22% in our sample. Results showed that QOL global scores reduced by 9.34% at a statistically significant level (p = .037) in sexually abused patients in comparison with those who did not report experiencing sexual abuse. Regression analysis in the QOL scales showed no differences in intrapsychic foundation scores or in the social relations scale. Scores in the instrumental role scale were reduced by 4.42 points in patients with CSA (p = .009). Neither neuroticism nor extraversion results differ between the trauma group and those who did not suffer trauma. Clinical implications of these results are discussed.

Therapeutic potential of ayahuasca in grief: a prospective, observational study.

RATIONALE: Recent studies have assessed the therapeutic potential of ayahuasca for the treatment of depression with promising preliminary results. OBJECTIVES: Here, we examine the course of grief over 1 year of follow-up in a bereaved sample that attended a center in Peru to participate in indigenous Shipibo ayahuasca ceremonies. We also explore the roles of experiential avoidance and decentering as mechanisms of change. METHODS: Bereaved participants who attended the ayahuasca center responded to an online survey that included the Texas Revised Inventory of Grief, Symptom Assessment-45, WHO Quality of Life-Bref, Acceptance and Action Questionnaire, and Decentering. Baseline assessment was completed by 50 individuals (T0). Of these, 39 completed the post-assessment at 15 days (T1), 31 at 3 months (T2), 29 at 6 months (T3), and 27 at 12 months (T4) after leaving the retreat. Pearson's analysis was performed to examine the relationship between the severity of grief and mechanisms of change during the period of T0 and T1. RESULTS: A significant decrease in Texas Revised Inventory was observed at all time points (T1: Cohen's d = 0.84; T2: Cohen's d = 1.38; T3: Cohen's d = 1.16; T4: Cohen's d = 1.39). We found a relationship between experiential avoidance (r = 0.55; p < .01), decentering (r = - 0.47; p < .01), and a reduction in the severity of grief. CONCLUSIONS: Our results suggest that the ceremonial use of ayahuasca has therapeutic value by reducing the severity of grief. Acceptance and decentering are both psychological processes that mediate the improvement of grief symptoms.

Theory of Mind (ToM) Performance in High Functioning Autism (HFA) and Schizotypal-Schizoid Personality Disorders (SSPD) Patients.

The similarities between high functioning autism (HFA) and schizotypal-schizoid personality disorder (SSPD) in terms of social cognition and interpersonal deficits may lead to confusion in symptom interpretation, and consequently result in misdiagnosis. Thus, this study aims to investigate differences in mentalizing with particular interest on the socio-cognitive and socio-affective dimensions. Three Advanced Theory of Mind (ToM) tests were applied in 35 patients with HFA, 30 patients with SSPD and 36 healthy controls. Individuals with HFA showed greater impairment and no dissociation between affective and cognitive ToM components. Conversely, SSPD individuals displayed less difficulties but greater impairments on the cognitive component. Beyond the replicability of ToM impairment in HFA individuals, our findings suggest more impaired cognitive ToM in SSPD participants which further support the sequence of mentalizing development build upon different chronological stages.

Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset.

BACKGROUND: Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension. AIM: To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis. METHODS: Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed. RESULTS: Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained. CONCLUSION: In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

Theory of Mind in Euthymic Bipolar Patients and First-Degree Relatives.

The present study analyzed the capacity for mentalization of patients with bipolar disorder (BD) and their first-degree relatives (FDR) and examined the implications of clinical variables and cognitive deficits. The study recruited 31 patients with type I BD, 18 FDR, and 31 paired healthy controls. Their capacity for mentalization was explored by means of first- and second-order false-belief tasks, the hinting task, and the Movie for the Assessment of Social Cognition (MASC). Patients and FDR were found to have a theory of mind (ToM) deficit when they were evaluated with the MASC, which was also related to a worse neurocognitive performance and to being a patient or FDR. The evidence of ToM deficits in FDRs supports the hypothesis that these deficits could be an independent trait marker for cognitive deficit. Further research is needed on FDR of patients with BD, using sensitive ToM assessment instruments such as the MASC.

Perceived needs and health-related quality of life in people with schizophrenia and metabolic syndrome: a "real-world" study.

BACKGROUND: The complexity of schizophrenia lies in the combination of psychiatric, somatic and social needs requiring care. The aim of the study was to compare perceived needs between groups with absence/presence of metabolic syndrome (MetS) and to analyze the relationship between needs, health-related quality of life (HRQoL) and MetS in people with schizophrenia or schizoaffective disorder. METHODS: A "real-world" cross-sectional study was set up with a comprehensive framework including the following, needs for care (Camberwell Assessment of Need Interview [CAN]), HRQoL (Euro Qol-5D Questionnaire), sociodemographic data, lifestyle habits, psychopathology (Positive And Negative Syndrome Scale [PANSS]), global functioning (Global Assessment of Functioning Scale [GAF]), anthropometric measurements and blood test results were assessed for an outpatient sample (n = 60). RESULTS: The mean number of needs (given by CAN) was identified for both groups. Patients with MetS rated a higher number of needs compared to the group without this condition. Mobility problems (given by EQ-5D) were negatively associated with the number of total and unmet needs. For participants with MetS, HRQoL was related to the number of needs and unmet needs. For people with MetS, positive symptomatology score (given by PANSS) was related to the number of needs and met needs and general symptomatology was associated with total, met and unmet needs. For individuals without MetS, the global functioning score (given by GAF) was significantly inversely related with total, met and unmet needs. CONCLUSIONS: Needs and HRQoL, as well as general symptomatology, were related only in patients with MetS. This has implications for treatment planning at the individual and organizational levels. An analysis of both physical and mental needs could provide a starting point for the extension of facilities in the health care system in order to reach the goal of improving quality of life.

Structural alterations of the pyramidal pathway in schizoid and schizotypal cluster A personality disorders.

AIM: Schizoid (ScPD) and Schizotypal (SPD) personality disorders are rare and severe disorders. They are associated with high liability to schizophrenia and present an attenuated form of its negative symptoms, which are considered a putative endophenotype for schizophrenia. The trans-diagnostic study of negative symptoms in non-psychotic populations such as ScPD/SPD might provide useful markers of a negative-symptom domain; however, little is known about their neurobiological substrates. The aim of the study was to investigate differences in gray and white matter volumes in subjects with ScPD/SPD compared to a group of healthy controls. METHODS: Structural magnetic resonance images were obtained from 20 never-psychotic subjects with ScPD/SPD and 28 healthy controls. Resulting values from clusters of differences were correlated in patients with relevant clinical variables (O-LIFE scale). RESULTS: ScPD/SPD presented greater bilateral white matter volume compared to healthy controls in the superior part of the corona radiata, close to motor/premotor regions, which correlated with the O-LIFE subtest of cognitive disorganization. No differences were found in regional gray matter or global gray/white matter volumes. CONCLUSION: Greater volumes in motor pathways might relate to cognitive symptoms and motor alterations commonly present in schizophrenia-related disorders. Given the established link between motor signs and psychosis, structural alterations in motor pathways are suggested as a putative biomarker of a negative-symptom domain in psychosis subject to further testing.

Seven basic dimensions of personality pathology and their clinical consequences: Are all personalities equally harmful?

OBJECTIVES: Dimensional pathology models are increasingly being accepted for the assessment of disordered personalities, but their ability to predict negative outcomes is yet to be studied. We examine the relative clinical impact of seven basic dimensions of personality pathology through their associations with a wide range of clinical outcomes. METHODS: A sample of 960 outpatients was assessed through a 7-factor model integrating the Cloninger, the Livesley, and the DSM taxonomies. Thirty-six indicators of clinical outcome covering three areas - dissatisfaction, functional difficulties, and clinical severity - were also assessed. The unique contribution of each personality dimension to clinical outcome was estimated through multiple regressions. RESULTS: Overall, personality dimensions explained 17.6% of the variance of clinical outcome, but varied substantially in terms of their unique contributions. Negative Emotionality had the greatest impact in all areas, contributing 43.9% of the explained variance. The remaining dimensions led to idiosyncratic patterns of clinical outcomes but had a comparatively minor clinical impact. A certain effect was also found for combinations of dimensions such as Negative Emotionality × Impulsive Sensation Seeking, but most interactions were clinically irrelevant. CONCLUSIONS: Our findings suggest that the most relevant dimensions of personality pathology are associated with very different clinical consequences and levels of harmfulness. PRACTITIONER POINTS: The relative clinical impact of seven basic dimensions of personality pathology is examined. Negative Emotionality (Neuroticism) is 6-14 times as harmful as other pathological dimensions. The remaining dimensions and their interactions have very specific and comparatively minor clinical consequences. LIMITATIONS: We examine only a handful of clinical outcomes. Our results may not be generalizable to other clinical or life outcomes. Our variables are self-reported and hence susceptible to bias. Our design does not allow us to establish causal relationships between personality and clinical outcomes.

Gender differences in individuals at high-risk of psychosis: a comprehensive literature review.

INTRODUCTION: To date, few studies have focused on the characterization of clinical phenomenology regarding gender in population at high-risk of psychosis. This paper is an attempt to summarize the findings found in the scientific literature regarding gender differences in high-risk populations, taking into account parameters studied in populations with schizophrenia and other psychotic disorders, such as incidence, clinical expression, duration of untreated illness (DUI), social functioning, and cognitive impairment prior to full-blown psychosis development. METHOD: Studies were systematically searched in PubMed. Studies using gender variable as a control variable were excluded. 12 studies met inclusion criteria. RESULTS: Most of the studies found a differential pattern between women and men as regards clinical, social, and cognitive variables in the prodromal phase, with worse performance in men except in cognitive functioning (more severe negative symptoms, worse social functioning, and longer DUI in men). Similar conversion rates over time were found between men and women. CONCLUSIONS: Many of the studies analyzed suggest that differences between men and women in the expression of psychosis extend across a continuum, from the subclinical forms of illness to the debut of psychosis. However, the small number of studies and their significant methodological and clinical limitations do not allow for firm conclusions.

Neurotrophin blood-based gene expression and social cognition analysis in patients with autism spectrum disorder.

Autism spectrum disorders (ASD) comprise neurodevelopmental disorders with clinical onset during the first years of life. The identification of peripheral biomarkers could significantly impact diagnosis and an individualized, early treatment. Although the aetiology of ASD remains poorly understood, there is increasing evidence that neurotrophins and their receptors represent a group of candidate genes for ASD pathophysiology and biomarker research. Total messenger RNA (mRNA) from whole blood was obtained from adolescents and adults diagnosed as ASD (n = 21) according to DSM-IV criteria and confirmed by the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R) algorithms, as well as healthy controls (n = 10). The mRNA expression of neurotrophins (BDNF, NT3 and NT4) and their receptors (TrkA, TrkB and p75 (NTR) ) was determined by quantitative real-time polymerase chain reaction (qRT-PCR). Moreover, social cognition abilities of ASD patients and controls were determined according to three Theory of Mind (ToM) tests (Reading the Mind in the Eyes, Faux pas, and Happé stories). The NT3 and NT4 mRNA expression in the whole blood was significantly lower in ASD compared to healthy controls, while p75(NTR) was higher (P < 0.005). In addition, lower scores in three of the ToM tests were observed in ASD subjects compared to controls. A significant (P < 0.005) ToM impairment in Happé stories test was demonstrated in ASD. Nevertheless, no correlations were observed between neurotrophins and their receptors expressions and measures of ToM. Given their potential as peripheral blood-based biomarkers, NT3, NT4 and p75 (NTR) mRNA expression patterns may be useful tools for a more personalized diagnostics and therapy in ASD. Further investigations with larger numbers of samples are needed to verify these results.

ADHD predominantly inattentive subtype with high sluggish cognitive tempo: a new clinical entity?

OBJECTIVE: The authors investigate differences in the neuropsychological and behavioral profiles of two groups of children with ADHD, one with predominantly inattentive subtype of ADHD (PI) and high sluggish cognitive tempo (SCT; n = 19) and another formed by the rest of the sample (children with ADHD combined subtype and children with PI and low SCT scores; n = 68). METHOD: Instruments included Wechsler Intelligence Scale for Children and subtests from Developmental Neuropsychological Assessment, Conners' Continuous Performance Test, Behavior Rating Inventory of Executive Function, and Achenbach's Child Behavior Checklist for ages 6 to 18. RESULTS: PI with high SCT had fewer problems with sustained attention, and more internalizing problems, anxiety/depression, and withdrawn/depressed behavior, and more executive problems with self-monitoring than the rest of the ADHD sample. CONCLUSION: This study supports revising subtype's criteria and further studying the hypothesis that ADHD with high SCT constitutes a separate clinical entity.

Three-factor model of premorbid adjustment in a sample with chronic schizophrenia and first-episode psychosis.

BACKGROUND: The dimensionality of premorbid adjustment (PA) has been a debated issue, with attempts to determine whether PA is a unitary construct or composed of several independent domains characterized by a differential deterioration pattern and specific outcome correlates. AIMS: This study examines the factorial structure of PA, as well as, the course and correlates of its domains. METHOD: Retrospective study of 84 adult patients experiencing first-episode psychosis (FEP) (n=33) and individuals with schizophrenia (SCH) (n=51). All patients were evaluated with a comprehensive battery of instruments including clinical, functioning and neuropsychological variables. A principal component analysis accompanied by a varimax rotation method was used to examine the factor structure of the PAS-S scale. Paired t tests and Wilcoxon rank tests were used to assess the changes in PAS domains over time. Bivariate correlation analyses were performed to analyse the relationship between PAS factors and clinical, social and cognitive variables. RESULTS: PA was better explained by three factors (71.65% of the variance): Academic PA, Social PA and Socio-sexual PA. The academic domain showed higher scores of PA from childhood. Social and clinical variables were more strongly related to Social PA and Socio-sexual PA domains, and the Academic PA domain was exclusively associated with cognitive variables. CONCLUSION: This study supports previous evidence, emphasizing the validity of dividing PA into its sub-components. A differential deterioration pattern and specific correlates were observed in each PA domains, suggesting that impairments in each PA domain might predispose individuals to develop different expressions of psychotic dimensions.

Expressed and perceived criticism, family warmth, and symptoms in schizophrenia.

Criticism directed by caregivers towards a family member with schizophrenia, both from the perspective of the patient and of the caregiver, predicts relapse, although both perspectives differ. This study aims to verify if the same applies to a Mediterranean sample, where criticism is not the main attitude of high expressed emotion families. The Camberwell Family Interview was applied to assess the family's perspective, and the Perceived Criticism and the Family Emotional Involvement and Criticism Scales were used to assess the patients' perspective, in 21 dyads. The association between both perspectives and psychotic symptoms was also examined. Results replicated those of previous studies in other countries, revealing that the perspectives on Criticism of patients and families do not match. The fact that family members also presented positive attitudes towards the patient did not cushion the patient's perceived criticism. Thus, it seems that families considered to be critical may not be perceived as such by the patients. Furthermore, only the warmth from the family's perspective correlated with the symptoms: positive affect proved to be more relevant than negative affect. Therefore, the patients' subjective assessments and family warmth should be included in clinical and research proposals.

Metabolic syndrome and health-related quality of life in patients with schizophrenia.

The association of metabolic syndrome (MetS) with health-related quality of life (HRQol) in schizophrenia is poorly documented. The relationship between MetS, HRQol and global functioning were examined. For this goal, 76 individuals with schizophrenia and schizoaffective disorder (DSM-IV criteria) were interviewed to obtain sociodemographic data, lifestyle habits, psychopathology (PANSS scale), global functioning (GAF scale), sef-reported quality of life (EQ-5D scale) and the anthropometric measures and blood test results. MetS was defined by the NCEP (2005) criteria. The prevalence of MetS was 36.8%. MetS was directly associated with personal background of dyslipidaemia and diabetes mellitus. Subjects with MetS had greater weight, BMI, waist, blood pressure, triglycerides, fasting glucose and a lower HDL-cholesterol. The MetS is also associated with age, inactive employment status and better self-care. The EQ VAS (visual analogue scale) of EQ-5D shows that subjects with MetS who practice physical activity indicates a better subjctive perception of health, which remarks the necessity of improving healthy lifestyle and an interdisciplinary treatment of the MetS. There is no association between global functioning and HRQol. This is the first study which investigates the relationship between MetS, HRQol and GAF in individuals with schizophrenia in the European context.

Síndrome metabólico y calidad de vida relacionada con la salud en pacientes con esquizofrenia / Metabolic syndrome and health-related quality of life in patients with schizophrenia

La asociación entre el síndrome metabólico (SMet) y la calidad de vida relacionada con salud (CVRS) en individuos con esquizofrenia está poco documentada. Los objetivos fueron estudiar la relación entre SMet, CVRS y funcionamiento global. Fueron evaluados 76 individuos con esquizofrenia y trastorno esquizoafectivo (según criterios DSM-IV) y se registraron también sus características sociodemográficas, estilo de vida, sintomatología psicótica (PANSS), funcionamiento global (GAF), escala de CVRS subjetiva (EQ-5D), medidas antropométricas y análisis de sangre. El SMet fue evaluado según criterios del NCEP (2005). La prevalencia del SMet es de un 36,8%. Se evidenció una asociación directa entre SMet y antecedentes personales de dislipemia y de diabetes mellitus. Los sujetos con SMet presentan mayor peso, IMC, PAb, PA, Trigliceridos y glucosa y menor tasa de HDL-colesterol. También la presencia de SMet está asociada con la edad, con la inactividad laboral y con un mejor “autocuidado”. La EQ VAS (escala análogo-visual) de la EQ-5D muestra que los sujetos con SMet que practican actividad física refieren una mejor autopercepción de salud, lo que refuerza la importancia de promover hábitos saludables y el tratamiento del SMet desde una perspectiva interdisciplinar. No se ha encontrado asociación entre el funcionamiento global y la CVRS. Este es el primer estudio que investiga la asociación entre SMet, CVRSy GAF en sujetos con esquizofrenia en el contexto europeo (AU)

The association of metabolic syndrome (MetS) with health-related quality of life (HRQol) in schizophrenia is poorly documented. The relationship between MetS, HR Qoland global functioning were examined. For this goal, 76individuals with schizophrenia and schizoaffective disorder (DSM-IV criteria) were interviewed to obtain sociodemographic data, lifestyle habits, psychopathology (PANSS scale), global functioning (GAF scale), sef-reported quality of life (EQ-5D scale) and the anthropometric measures and blood test results. MetS was defined by the NCEP (2005) criteria. The prevalence of MetS was 36.8%.MetS was directly associated with personal background of dyslipidaemia and diabetes mellitus. Subjects with MetS had greater weight, BMI, waist, blood pressure, triglycerides, fasting glucose and a lower HDL-cholesterol. The MetS is also associated with age, inactive employment status and better self-care. The EQ VAS (visual analogue scale) of EQ-5Dshows that subjects with MetS who practice physical activity indicates a better subjetive perception of health, which remarks the necessity of improving healthy lifestyle and an interdisciplinary treatment of the MetS. There is no association between global functioning and HRQol. This is the first study which investigates the relationship between MetS, HRQol and GAF in individuals with schizophrenia in the European context (AU)

Psychotic-like symptoms and positive schizotypy are associated with mixed and ambiguous handedness in an adolescent community sample.

The objective of this study was to replicate the association between atypical handedness and psychosis-proneness in a representative sample of adolescents from the general population. It expands previous studies by (1) analyzing a variety of atypical handedness indexes (left, mixed, ambiguous, and inconsistent), (2) measuring comprehensively the multidimensionality of psychosis-proneness, and (3) analyzing the association of different patterns of atypical handedness with nonclinical dimensions of both trait (schizotypy) and sub-clinical symptom (psychotic-like experiences) levels. Seven hundred and twenty-eight adolescents were assessed for handedness by the 12-item self-report Annett Hand Preference Questionnaire and for psychosis-proneness by the Oxford-Liverpool Inventory of Feelings and Experiences and the Community Assessment of Psychic Experiences scales. Writing-hand alone did not detect associations between laterality and psychosis-proneness. Mixed- rather than left-handedness was related to psychosis-proneness, and this was more evident when analyzing subjects with ambiguous handedness exclusively. When analysis was restricted to subjects with non-ambiguous handedness, strong left-handedness was related to psychosis-proneness. The positive dimension showed a stronger association than the negative one with atypical handedness. Results partially support mixed-handedness as a marker of developmental disorders underlying both atypical lateralization and psychosis-proneness. Among various possible mixed-handedness patterns, inconsistent hand use across primary actions, and for the same action across time, seems particularly related to psychosis-proneness and thus requires further exploration.

Spanish validation of the Premorbid Adjustment Scale (PAS-S).

BACKGROUND: The Premorbid Adjustment Scale (PAS) has been the most widely used scale to quantify premorbid status in schizophrenia, coming to be regarded as the gold standard of retrospective assessment instruments. AIMS: To examine the psychometric properties of the Spanish version of the PAS (PAS-S). METHOD: Retrospective study of 140 individuals experiencing a first episode of psychosis (n=77) and individuals who have schizophrenia (n=63), both adult and adolescent patients. Data were collected through a socio-demographic questionnaire and a battery of instruments which includes the following scales: PAS-S, PANSS, LSP, GAF and DAS-sv. The Cronbach's alpha was performed to assess the internal consistency of PAS-S. Pearson's correlations were performed to assess the convergent and discriminant validity. RESULTS: The Cronbach's alpha of the PAS-S scale was 0.85. The correlation between social PAS-S and total PAS-S was 0.85 (p<0.001); while for academic PAS-S and total PAS-S it was 0.53 (p<0.001). Significant correlations were observed between all the scores of each age period evaluated across the PAS-S scale, with a significance value less than 0.001. There was a relationship between negative symptoms and social PAS-S (0.20, p<0.05) and total PAS-S (0.22, p<0.05), but not with academic PAS-S. However, there was a correlation between academic PAS-S and general subscale of the PANSS (0.19, p<0.05). Social PAS-S was related to disability measures (DAS-sv); and academic PAS-S showed discriminant validity with most of the variables of social functioning. PAS-S did not show association with the total LSP scale (discriminant validity). CONCLUSION: The Spanish version of the Premorbid Adjustment Scale showed appropriate psychometric properties in patients experiencing a first episode of psychosis and who have a chronic evolution of the illness. Moreover, each domain of the PAS-S (social and academic premorbid functioning) showed a differential relationship to other characteristics such as psychotic symptoms, disability or social functioning after onset of illness.

Inequalities in the utilization of psychiatric and psychological services in Catalonia: a multilevel approach.

The aim of this study was to analyze individual and contextual inequalities in psychiatrist and psychologist visits in Catalonia. This is a multilevel cross-sectional study using data from the 2006 Catalan Health Interview Survey (n = 15,554). 5.3 % of men and 9.0 % of women visited a psychologist and/or psychiatrist in the last 12 months. People aged 65 years or over were less likely to have visited these professionals and those with a supplemental private health insurance had a higher proportion of having visited. Moreover, people living in lower density regions were less likely to have visited, independently of their level of need. There is a need to develop policies for reducing inequalities in access by people with public health insurance and living in lower density areas.

Expressed and perceived criticism, family warmth, and symptoms in schizophrenia

Criticism directed by caregivers towards a family member with schizophrenia, both from the perspective of the patient and of the caregiver, predicts relapse, although both perspectives differ. This study aims to verify if the same applies to a Mediterranean sample, where criticism is not the main attitude of high expressed emotion families. The Camberwell Family Interview was applied to assess the family’s perspective, and the Perceived Criticism and the Family Emotional Involvement and Criticism Scales were used to assess the patients’ perspective, in 21 dyads. The association between both perspectives and psychotic symptoms was also examined. Results replicated those of previous studies in other countries, revealing that the perspectives on Criticism of patients and families do not match. The fact that family members also presented positive attitudes towards the patient did not cushion the patient’s perceived criticism. Thus, it seems that families considered to be critical may not be perceived as such by the patients. Furthermore, only the warmth from the family’s perspective correlated with the symptoms: positive affect proved to be more relevant than negative affect. Therefore, the patients’ subjective assessments and family warmth should be included in clinical and research proposals (AU)

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