Evidencias de validez y fiabilidad de laversión española de la “Observable Social Cognition: A Rating Scale” (OSCARS) en pacientes con esquizofrenia / Evidence of validity and reliability of the Spanish version of the “Observable Social Cognition: A Rating Scale” (OSCARS) in patients with schizophrenia

Introducción: El deterioro en la Cognición Social (CS)forma parte del síndrome deficitario de la esquizofrenia. LaObservable Social Cognition: A Rating Scale (OSCARS) evalúala CS percibida a través de un informador externo clave. Elobjetivo del estudio es analizar las propiedades psicométricasde validez y fiabilidad de su adaptación transcultural parapoblación española.Metodología. Estudio observacional y transversal en unamuestra de pacientes ambulatorios con esquizofrenia (n =109) seleccionados mediante muestreo simple aleatorizado.Instrumentos seleccionados: Tarea de Hinting, batería cognitiva de conceso MATRICS, escala de impresión clínica global(CGI-SCH) y cuaderno de datos ad hoc.Resultados. El Análisis Factorial Exploratorio identificóun modelo de dos factores, igual al original, que explican el59,02% del total de la varianza: sesgo cognitivo social y habilidad cognitiva social. Al igual que en la versión original, nose encontraron resultados de correlación con otras medidasde CS: tarea de Hinting (r: – 0,085; p = 0,382) o MSCEIT dela MATRICS (r: 0,015; p = 0,877). No se observaron correlaciones significativas con otros dominios neurocognitivos. Elcoeficiente alpha de Cronbach fue de 0,82 (0,75 y 0,76, paracada factor). El valor de kappa ponderado medio fue 0,43. Lapuntuación del Coeficiente de Correlación Intraclases, 0,84(IC95%: 0,76 – 0,88; p<0,001)Conclusiones. Los hallazgos apoyan la validez y fiabilidad de la adaptación transcultural de la OSCARS como unaherramienta de propiedades psicométricas equivalentes a laoriginal que permite la evaluación de la CS mediante un informante referente en individuos con esquizofrenia. (AU)

Introduction: Social Cognition (SC) impairment is part ofthe deficit syndrome of schizophrenia. The Observable SocialCognition: A Rating Scale (OSCARS) evaluates the perceivedSC through an external reference informant. The aim of thispaper is to analyze the psychometric properties of validityand reliability of its cross-cultural adaptation for the Spanishpopulation.Methods. Observational and cross-sectional study in asample of outpatients with schizophrenia (n = 109), selected by simple randomized sampling. Selected instruments:Hinting task, MATRICS cognitive consensus battery, clinicalglobal impression scale (CGI-SCH) and specific data collection logbook.Results. Exploratory Factor Analysis identified a two-factor model, like the original version, that explains 59.02% ofthe total variance: social cognitive bias and social cognitiveability. As in the original version, no correlation results werefound with other SC measures: Hinting task (r: - 0.085; pvalue = 0.382) or MSCEIT of the MATRICS (r: 0.015; p value 0.877). No specific correlations were observed with otherneurocognitive domains. Cronbach’s alpha coefficient was0.82 (0.75 and 0.76, for each factor). The mean weighted kappa value was 0.43. Intraclass Correlation Coefficient score, 0.84 (95% CI: 0.76 - 0.88; p <0.001). Conclusions. These findings support the validity and thereliability of the cross-cultural adaptation of the OSCARSa tool to assess SC by a referent informant in individualswith schizophrenia with similar psychometric properties tothe original version. (AU)

Moreau de Tours: organicism and subjectivity. Part 2: Moreau as psychopathologist.

These two articles analyse the importance of J.J. Moreau de Tours' work and its influence on the development of descriptive psychopathology from the mid-nineteenth century to the present. The first article focused on biographical aspects and presented Moreau's main works in their social and cultural contexts. This second article critically analyses Moreau's contributions from different perspectives: epistemological, psychopathological, clinical, therapeutic, and it also discusses his role as a public figure.

Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8-year retrospective analysis.

WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized. Previous studies that have investigated the impact of organizational factors and changes in these protocols are often short and not conducted within a framework designed to establish a long-term plan for reducing the use of mechanical restraint. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We demonstrate that the implementation of administrative and protocol changes in our psychiatric unit significantly reduced the use of mechanical restraint, thus laying the foundations for a regulatory framework. Our analysis shows that the profile of patients who require mechanical restraint is highly variable, but that certain clinical and institutional aspects within the framework of a long-term plan for the reduction in mechanical restraint can be targeted with long-lasting positive effects. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizational changes focussed on training staff, promoting family support and requiring the registration and close monitoring of episodes empower the role of the nursing staff in the prevention, monitoring and regulation of mechanical restraint. ABSTRACT: Introduction Mechanical restraint is a controversial restrictive practice to manage agitation or violent behaviour. Numerous studies have evaluated the factors and organizational changes that influence on mechanical restraint, but only for short time periods. None of those studies have assessed the effects of measures applied within the framework of a long-term plan to reduce the use of mechanical restraint. Given the lack of specific legislation in Spain, more data are required for its proper regulation. Aim/Question To evaluate the risk factors associated and the impact of specific measures designed to minimize the application of mechanical restraint in an acute mental health unit over an 8-year period and previous observation of 5 years. Methods Cross-sectional study based on a retrospective analysis of mechanical restraint records. We compared admissions requiring ≥one episode of restraint versus admissions not requiring this coercive measure. Results Between 2007 and 2014, 412 admissions (12%) required mechanical restraint. The data show that the measures applied in the previous five years had significantly reduced the total hours of restraint per semester. The factors associated with admissions requiring mechanical restraint were involuntary, unscheduled and longer admissions. The best predictor of restraint was involuntary admission (OR = 6.37), followed by the diagnosis of personality disorder (OR = 5.01). Discussion Identification of the factors associated with mechanical restraint would allow for early detection strategies. Our results provide additional evidence on the usefulness of organizational changes to reduce coercive measures, even in a country without specific legislation. Implications for Practice Organizational changes, such as staff training and increased family support during admission of episodes of mechanical restraint, can reduce the use of this measure. These measures also give the nursing staff greater responsibility in terms of their role in registering and monitoring the restrictive practice, thus helping to prevent or minimize the use of mechanical restraint.

Moreau de Tours: organicism and subjectivity. Part 1: Life and work.

This is the first of two articles analysing the importance of J.J. Moreau de Tours' work and its influence on the development of descriptive psychopathology from the mid-nineteenth century to the present. Part 1 focuses on biographical aspects and presents Moreau's main works in their social and cultural context, with special emphasis on his book Du Hachisch et de l'Aliénation mentale, published in 1845. The second article will concentrate on Moreau as a psychopathologist.

Análisis de la experiencia de prohibir el uso de tabaco en la Unidad de Agudos del Hospital de Jerez / Smoking ban in the acute psychiatric unit of Jerez Hospital: analysis of the implementation process

El uso del tabaco en la Unidades Psiquiátricas de Agudos ha sido, hasta hace bien poco, una anomalía generalizada en los establecimientos sanitarios. En el presente trabajo se describe la experiencia llevada a cabo en la Unidad Psiquiátrica de Agudos del Hospital de Jerez de la Frontera (Cádiz) para prohibir totalmente el uso del tabaco en sus instalaciones. Además, se analizan las distintas etapas del proceso que llevó a dicha prohibición, así como los obstáculos y las medidas tomadas para solventarlos. Finalmente, se aportan datos del coste de la medida y de los beneficios aportados(AU)

Smoking in psychiatric inpatient units has been, until recently, a widespread anomaly among health settings. A total smoking ban was implemented in the Acute Psychiatric Unit at Jerez Hospital (Cadiz) and this experience is here described. Different stages of the implementation process, caveats and ways of sorting them out, are then described. Finally, cost and advantages are also presented(AU)

Confabulaciones (II): Modelos explicativos / Confabulations (II): Explicative models

Introducción. Las confabulaciones o la producción de falsos recuerdos, sin la intención de mentir de forma deliberada, resultan un fenómeno intrigante que se ha intentado explicar desde que fueran descritas por primera vez. El fenómeno de las confabulaciones es un buen ejemplo del carácter reconstructivo de la memoria, sin embargo, aún es controvertida su naturaleza exacta y la forma en que se producen. Objetivo. Revisar los diferentes modelos propuestos para explicar la aparición de confabulaciones. Desarrollo. Se revisan los modelos neuropsicológicos que en la actualidad cuentan con cierto desarrollo teórico y evidencia empírica. También se hace referencia a modelos motivacionales, que han empezado a recuperar su popularidad recientemente, para terminar desarrollando la última versión del modelo de recuperación estratégica, que permite integrar los elementos relevantes de los otros. Conclusiones. Los primeros modelos sobre confabulaciones, que las consideraban resultado de la necesidad de rellenar lagunas de memoria, están hoy día superados, aunque los elementos emocionales se están teniendo en cuenta para explicar su contenido. Dentro de la neuropsicología, podríamos distinguir aquellos modelos que consideran la confabulación como resultado de un problema temporal o contextual, y aquellos que ponen el problema en los procesos de recuperación de la memoria. En concreto la hipótesis de recuperación estratégica plantea que las confabulaciones son el resultado de una disfunción de complejos sistemas de monitorización de la información recuperada. Este modelo permitiría integrar explicaciones y evidencias procedentes de otras propuestas (AU)

Introduction. Confabulations, or the production of false memories without deliberate intent to lie, is an intriguing phenomenon for which an attempt has been made to explain it since they were first described. Confabulations are a good example for illustrating there constructive character of memory. Nevertheless, their exact nature and the way in which they are produced are still controversial. Objective. To review the different models proposed to explain the appearance of confabulations. Development. Neuropsychological models that currently have some theoretical development and empirical evidence are reviewed. In addition, a brief reference to motivational models, that have recently begun to recover popularity, are presented. We conclude by presenting the last version of the strategic retrieval model that makes it possible to integrate the relevant elements from the others. Conclusions. Early models of confabulations, which considered them a result of the need to fill memory gaps, are outdated nowadays. Nevertheless, emotional processes are taken into account to explain their content. From neuropsychological approaches, it is possible to distinguish models that consider confabulation as a result of a temporal or contextual problem, and those which consider that the main problem is on the memory retrieval process. More specifically, the strategic retrieval hypothesis states that confabulations are the result of a dysfunction in a complex system of monitoring the recovered information. This model would make it possible to integrate explanations and evidences coming from the other proposals (AU)

Confabulaciones (I): Concepto, clasificación y neuropatología / Confabulations (I): Concept, classification and neuropathology

Introducción. Una definición operativa de confabulaciones sería aquella que los describe como falsos recuerdos resultado de un problema de recuperación, de los que el paciente no es consciente, y cuya creencia en la veracidad del recuerdo es genuina. Han sido descritos varios tipos de confabulaciones, utilizando una gran diversidad de criterios. Las confabulaciones pueden llegar a verse en trastornos neurológicos muy distintos, existiendo controversia en torno a sus mecanismos patofisiológicos. Objetivo. Realizar una revisión actualizada en castellano sobre la definición, tipos, regiones cerebrales implicadas y correlatos neuropsicológicos de las confabulaciones. Desarrollo. Tras revisar el concepto y los distintos tipos de confabulaciones, se describen las regiones cerebrales dañadas en dos patologías donde pueden aparecer confabulaciones, el síndrome de Korsakoff y pacientes con rupturas de aneurismas de la arteria comunicante anterior. Se revisan posteriormente los correlatos neuropsicológicos asociados a las mismas. Conclusiones. Las confabulaciones son un fenómeno complejo y de difícil definición. Probablemente la clasificación más aceptada es la que, atendiendo al modo en que aparecen, distingue las confabulaciones espontáneas de las provocadas, aunque no está clara la validez de esta distinción. En cuanto a las regiones cerebrales cruciales implicadas en las confabulaciones, parece que lesiones en el córtex prefrontal, específicamente en áreas ventromediales y orbitofrontales, son necesarias para que el fenómeno aparezca. La evidencia neuropsicológica sugiere la presencia, en la mayoría de los casos, de disfunción ejecutiva y al menos cierto grado de disfunción de memoria como mecanismos subyacentes a las mismas; sin embargo, las características específicas de estas disfunciones neuropsicológicas no son bien conocidas (AU)

Introduction. A working definition of confabulation could be that of describing them as false memories due to a recovery problem, where the patient is unaware that he/she is confabulating, and has the belief that the memory is true. Several types of confabulations have been described, according to a broad variety of criteria. Confabulations can be seen in very different neurological conditions, which have lead to a controversy on their pathophysiological mechanisms. Objective: To obtain an updated revision in Spanish of the definitions, types, brain regions involved and neuropsychological correlates of the confabulations. Development. After reviewing the concept and several types of confabulations, the damaged brain regions associated to two conditions where confabulations occur, such as Korsakoff syndrome and patients with anterior communicating artery aneurysm, are described. The neuropsychological correlates associated to them are then reviewed. Conclusions. Confabulations are a difficult-to-define complex phenomenon. Probably, the most accepted classification, in accordance with how they appear, would be that which distinguishes spontaneous from provoked confabulations, although the validity of this distinction is not clear. Regarding to crucial cerebral regions involved in the confabulations, it seems that prefrontal cortex lesions, specifically in ventromedial and orbitofrontal areas, are necessary. Neuropsychological evidence suggests the presence in most of the cases of executive dysfunction and at least some degree of memory dysfunction as an underlying mechanism of confabulation. Nevertheless, the specific characteristics of these neuropsychological dysfunctions are not well-known (AU)