Insight cognitivo y esquizotipia en adolescentes no clínicos / Cognitive insight and schizotypy in non-clinical adolescents

El insight cognitivo es un constructo metacognitivo que ha mostrado utilidad para detectar la vulnerabilidad a trastornos del espectro esquizofrénico, y junto con la esquizotipia, permiten investigar, comprender y ayudar en el tratamiento de estos trastornos. El propósito principal del estudio fue analizar la relación entre insight cognitivo y esquizotipia en una muestra de adolescentes no clínicos, y analizar la sensibilidad y especificidad del insight cognitivo para diferenciar la vulnerabilidad en esquizotipia. Los participantes fueron adolescentes no clínicos seleccionados mediante un muestreo por conglomerados (centro educativo), con selección aleatoria de grupo-clase. Se utilizaron la “Escala Beck de insight cognitivo” y el “Esquizo-Q-A”. Encontramos un perfil de insight cognitivo diferente al encontrado en estudios previos, con una puntuación inferior en autorreflexión y una superior en autocerteza. La autorreflexión y el índice compuesto permitirían clasificar a participantes con puntuaciones de riesgo en distorsión de la realidad y desorganización interpersonal. El insight cognitivo podría ser un constructo útil para detectar la vulnerabilidad a la esquizotipia en adolescentes no clínicos, y permite el diseño de intervenciones eficaces. (AU)

Evaluación de necesidades provocadas por la COVID-19 en personas con trastorno mental grave / Assessment of needs caused by Covid-19 in people with severe mental disorders

La pandemia provocada por la COVID-19 ha mostrado algunas carencias y riesgos asociados en la atención comunitaria de la salud mental a los pacientes más graves. El objetivo de este estudio es analizar las necesidades asistenciales en una muestra de personas con trastorno mental grave durante el pico de la pandemia por COVID-19 en España en la Comunidad de Madrid, la Comunidad Valenciana, Extremadura y el País Vasco. Se utilizó el instrumento Needs of Assesment (NCA) y la Escala de Restricción de Vida (ERVI). La muestra fue de 669 personas y 144 cuidadores familiares convivientes. Los problemas clínicos más frecuentemente encontrados fueron los de ansiedad, seguidos de lentitud, baja actividad y depresión. En el área de destrezas y habilidades, los problemas más frecuentes fueron la estructuración del sueño, la integración comunitaria, la ocupación del tiempo y la capacidad cognitiva. En el área de soportes de apoyo, el principal problema fue la falta de red de apoyo social. Respecto al grado de cobertura, el 71% de los problemas clínicos estuvieron cubiertos. En el área de habilidades, el porcentaje desciende hasta un 68% y en los soportes sociales hasta el 66%. Se concluye que es necesario reforzar los Programas de Rehabilitación Psicosocial para atender las necesidades de pacientes graves de salud mental. Además, los modelos de atención deberían ser adaptados para asegurar su continuidad y permanencia en periodos de distanciamiento de la comunidad. (AU)

The pandemic caused by COVID-19 has revealed some deficiencies and associated risks in Community Mental Health Care for the most severe patients. The objective of this study is to analyze the needs in a sample of people with Severe Mental Illness during the peak of the COVID-19 pandemic in the Communities of Madrid, Valencia, Extremadura, and the Basque Country (in Spain). The Needs of Assessment (NCA) instrument and the Life Restriction Scale (ERVI) were used. The sample consisted of 669 people and 144 cohabiting family caregivers. The clinical problems most frequently encountered were anxiety, followed by slowness, low activity, and depression. In the area of skills and abilities, the most frequent problems were sleep structuring, community integration, time occupation, and cognitive ability. In the area of support, the main problem was the lack of a social support network. Regarding the degree of coverage, 71% of the clinical problems were covered. In the skills area, the percentage drops to 68% and in social media to 66%. It is concluded that it is necessary to reinforce Psychosocial Rehabilitation Programs to meet the needs of serious mental health patients. In addition, the care models should be adapted to ensure their continuity and permanence in periods of distance from the community. (AU)

Effects of Metacognitive Training on Cognitive Insight in a Sample of Patients with Schizophrenia.

Metacognitive training (MCT) is a group intervention that addresses cognitive biases and distortions that could help maintain delusions and hallucinations in people with schizophrenia. This program has proven its effectiveness in reducing the symptoms, but its impact on cognitive insight has scarcely been investigated. Therefore, the aim of the study was to assess the program's impact on cognitive insight in patients with long-term schizophrenia. A sample of 22 patients with schizophrenia was divided into two groups: one received 16 sessions of MCT (n = 11), while the other received the usual treatment (n = 11). They were assessed using the Beck Cognitive Insight Scale which measures two components, self-reflection and self-certainty, and the Positive and Negative Syndrome Scale (PANSS). The experimental group showed high levels of adherence, an increase in self-reflection, and a decrease in self-assurance levels as hypothesized. We found statistically significant differences between the control and experimental groups in excitation, hostility, positive symptomatology total score, hallucinatory behavior, and suspicion. In the usual treatment group, a non-significant decrease in positive symptoms was also observed. The findings showed that the implementation of the MCT program in real clinical settings can contribute to an improvement in the metacognitive ability and symptomatology of people with schizophrenia.

Cognitive insight, neurocognition and life skills in patients with schizophrenia / Insight cognitivo, neurocognición y funcionamiento cotidiano en pacientes con esquizofrenia

BACKGROUND: The concept of cognitive insight refers to the capacity for self-reflectiveness as a mechanism for evaluating one's symptoms and self-certainty, understood as the ability to correct inappropriate interpretations and conclusions. There are no conclusive results regarding about the clinical and neuropsychological variables involved and there are hardly any studies of their impact on functional outcomes. METHOD: The objectives were to analyze the neuropsychological and clinical cognitive insight in a sample of 22 stable patients diagnosed with schizophrenia, to assess its impact on life skills and to analyze whether it can be a mediating variable between cognitive deficits and daily functioning. A neuropsychological battery composed of tests of memory (TAVEC and WAIS-Digits), executive functioning (WCST and Stroop) and vocabulary, the BCIS, a measure of everyday functions (LSP) and the PANSS. RESULTS: We found significant negative correlations between the WAIS vocabulary test, self-assurance, and life skills; although this is influenced to a greater extent by the negative symptomatology and the premorbid general cognitive level. CONCLUSIONS: A greater openness to corrective feedback of distorted thoughts, without specific cognitive capacities, improves the ability of patients with schizophrenia to adapt to the environment

ANTECEDENTES: el concepto de insight cognitivo hace referencia a la capacidad de auto-reflexión como mecanismo de evaluación de los propios síntomas y a la auto-certeza, entendida como capacidad para corregir las interpretaciones y conclusiones inadecuadas. No existen resultados concluyentes en cuanto a las variables clínicas y neuropsicológicas implicadas y apenas hay estudios sobre su impacto en los resultados funcionales. MÉTODO: los objetivos fueron analizar las relaciones neuropsicológicas y clínicas del insight cognitivo en una muestra de 22 pacientes estables con diagnóstico de esquizofrenia, analizar su impacto en el funcionamiento cotidiano y como variable mediadora entre los déficits cognitivos y dicho funcionamiento. Se administró una batería neuropsicológica, compuesta por pruebas de memoria (TAVEC y WAIS-Dígitos), funcionamiento ejecutivo (WCST y Stroop) y vocabulario, la BCIS, una medida de funcionamiento cotidiano (LSP) y la PANSS. RESULTADOS: se encontraron correlaciones significativas de tipo negativo entre la prueba de vocabulario del WAIS, la auto-certeza, y el funcionamiento cotidiano, aunque este es influido en mayor medida por la sintomatología negativa y el nivel cognitivo general premórbido. CONCLUSIONES: una mayor apertura a la retroalimentación correctora de los pensamientos distorsionados, sin que medien capacidades cognitivas específicas, mejora la capacidad de adaptación al medio en pacientes diagnosticados de esquizofrenia

Cognitive insight, neurocognition and life skills in patients with schizophrenia.

BACKGROUND: The concept of cognitive insight refers to the capacity for self-reflectiveness as a mechanism for evaluating one's symptoms and self-certainty, understood as the ability to correct inappropriate interpretations and conclusions. There are no conclusive results regardingabout the clinical and neuropsychological variables involved and there are hardly any studies of their impact on functional outcomes. METHOD: The objectives were to analyze the neuropsychological and clinical cognitive insight in a sample of 22 stable patients diagnosed with schizophrenia, to assess its impact on life skills and to analyze whether it can be a mediating variable between cognitive deficits and daily functioning. A neuropsychological battery composed of tests of memory (TAVEC and WAIS-Digits), executive functioning (WCST and Stroop) and vocabulary, the BCIS, a measure of everyday functions (LSP) and the PANSS. RESULTS: We found significant negative correlations between the WAIS vocabulary test, self-assurance, and life skills; although this is influenced to a greater extent by the negative symptomatology and the premorbid general cognitive level. CONCLUSIONS: A greater openness to corrective feedback of distorted thoughts, without specific cognitive capacities, improves the ability of patients with schizophrenia to adapt to the environment.

Impacto de la "Ley de promoción de la autonomía personal y atención a las personas en situación de dependencia" en las personas con trastorno mental grave / Impact of the "Law on promotion of personal autonomy and care for people dependent" in population with severe mental disorder

La Ley 39/2006, conocida como Ley de Dependencia, ha generado, desde su aprobación, desconfianza por estar enfocada a la atención a la dependencia, siendo la promoción de la autonomía personal un elemento apenas desarrollado y secundario (AU)

Law 39/2006, known as Dependence Law, has generated skepticism since its approval, for being focused on dependancy and barely promoting personal autonomy, treating it as a secondary issue (AU)