Psychopathology in a sample of candidate patients for bariatric surgery.

BACKGROUND: The prevalence of morbid obesity and the popularity of bariatric surgery have grown in recent years. Many surgical protocols require that the candidates undergo a pre-operative psychological evaluation. We describe the psychopathological characteristics of both clinical syndromes (Axis I of the DSM-IV), as well as personality disorders (Axis II of the DSM-IV), in a sample of morbidly obese patients accepted as bariatric surgery candidates and who participate in a specific surgery preparatory programme, and we analyze its relationship with personality clusters. METHODS: The Millon Clinical Multiaxial Inventory-III (MCMI-III) scores from 50 patients attending for bariatric surgery were cluster analyzed in hopes of identifying clinical subgroups corresponding to typical personality profiles. RESULTS: With regard to personality disorders, the highest prevalence was found in the histrionic disorder, followed by obsessive- compulsive disorder. Cluster analysis revealed three personality profiles, which were validated by examining demographics, morphological variables, scores on anxiety and depression psychometric scales, and MCMI-III clinical scales scores. Groups were different in virtually all the MCMI-III clinical scores, as well as in depression and trait anxiety, with Cluster 3 presenting the worst scores. CONCLUSIONS: These findings suggest that morbidly obese patients are heterogeneous in their psychological profiles, highlighting Cluster C disorders.

Differences in the Quality of Life of Patients Recently Diagnosed with Crohn's Disease and Ulcerative Colitis.

Inflammatory bowel diseases (IBD) are chronic diseases, encompassing Crohn's disease (CD) and ulcerative colitis (UC). An IBD diagnosis has an impact on the quality of life of patients; this impact can be different according to the type of disease. OBJECTIVE: This study aimed to analyze the differences in the impact on quality of life in the early stages after diagnosis in patients with CD and UC. PATIENTS AND METHODS: This was an observational, multi-center, and cross-sectional study, with the participation of 156 patients recently diagnosed with IBD (<6 months) from 4 hospitals from the Health Council of the Valencian Community. The patients were assessed through the use of the Inflammatory Bowel Disease Questionnaire (IBDQ-32), which measures the quality of life when living with IBD. RESULTS: The sample was composed of 80 patients with CD (51.0%) and 76 patients with a UC diagnosis. The mean age was 42.3 ± 16.2. The CD patients were more affected (42.5%) in their general quality of life than the UC patients (17.1%) (p = 0.001). In the dimensions of the IBDQ-32, the patients with CD showed significant differences in the systemic, emotional, and social spheres. The bowel dimension scores were similar in both groups. CONCLUSIONS: The patients who were recently diagnosed with CD were more affected regarding their quality of life as compared to those who were diagnosed with UC. Psychological care must be considered to mitigate the impact of an IBD diagnosis.

Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review.

Background/Objective: To assess the differential efficacy between mindfulness-based interventions and cognitive-behavioral Therapy (CBT) on chronic pain across medical conditions involving pain. Method: ProQuest, Science Direct, Google Scholar, Pubmed, and Embase databases were searched to identify randomized clinical trials. Measurements of mindfulness, pain, mood, and further miscellaneous measurements were included. Results: 18 studies met the inclusion criteria (fibromyalgia, n = 5; low back pain, n = 5; headache/migraine, n = 4; non-specific chronic pain, n = 4). In fibromyalgia, mindfulness based stress reduction (MBSR) was superior to the usual care and Fibroqol, in impact and symptoms. In low back pain, MBSR was superior to the usual care, but not to CBT, in physical functionality and pain intensity. There were no studies on differential efficacy between mindfulness and CBT for headache and non-specific chronic pain, but Mindfulness interventions were superior to the usual care in these syndromes. Conclusions: Mindfulness interventions are superior to usual cares in all diagnoses, but it is not possible to conclude their superiority over CBT. Comparisons between mindfulness interventions are scarce, with MBSR being the most studied. In central sensitization syndromes, variables associated with pain tend to improve with treatment. More research is needed to differentiate diagnosis and intervention.

Introducción/Objetivo: Estudiar la eficacia diferencial entre terapias basadas en mindfulness y terapia cognitivo-conductual (TCC) en síndromes asociados a dolor crónico. Método: ProQuest, Science Direct, Google Scholar, Pubmed y Embase fueron las bases utilizadas para identificar los ensayos clínicos aleatorizados. Los resultados fueron medidas de mindfulness, dolor, estado de ánimo y otras. Resultados: 18 estudios cumplieron criterios de inclusión (fibromialgia, n = 5; lumbalgia, n = 5; cefalea/migraña, n = 4; dolor crónico no especificado, n = 4). En fibromialgia, la terapia basada en mindfulness para la reducción del estrés (MBSR, por sus siglas en inglés) fue superior a tratamiento habitual y Fibroqol en impacto y sintomatología. En lumbalgia, MBSR fue superior a tratamiento habitual, pero no frente a TCC, en funcionalidad física e intensidad del dolor. No se encontraron estudios de eficacia diferencial entre mindfulness y TCC en cefalea y dolor crónico no especificado, pero las intervenciones mindfulness fueron superiores a tratamiento habitual en estos síndromes. Conclusiones: Las intervenciones mindfulness son superiores al tratamiento habitual en todos los diagnósticos, pero no es posible concluir su superioridad sobre TCC. Son escasas las comparaciones entre intervenciones mindfulness, siendo MBSR la más estudiada. En síndromes de sensibilización central tienden a mejorar variables asociadas al dolor. Es necesaria más investigación diferenciando diagnóstico e intervención.

Effects of Mindfulness-Based Cognitive Therapy for Chronic Pain: A Multicenter Study.

The prevalence of chronic pain in Spain is 15%. The objective of this study was to evaluate the efficacy of mindfulness-based cognitive therapy on patients with chronic pain. A quasi-experimental design of repeated measures pre- and post-test (N = 57) was carried out at three hospitals from the province of Alicante. Self-reported assessment measurements of pain intensity, anxiety-depression symptoms, perception of health status, interference of pain on sleep, self-efficacy in pain, acceptance, and mindfulness attitude were included. The T-test indicates significant differences in intensity of present pain, mental quality of life, and depression (medium effect sizes), as well as in self-efficacy: total score, symptom management and pain control (medium effect sizes), sleep disturbances and quantity of sleep (large effect sizes). MBCT is effective in reducing many symptoms in patients with chronic pain, although its maintenance needs to be further investigated.

Impact of COVID-19 on the Anxiety Perceived by Healthcare Professionals: Differences between Primary Care and Hospital Care.

The COVID-19 pandemic has had an emotional impact on healthcare professionals at different levels of care, and it is important to understand the levels of anxiety of hospital personnel (HP) compared to those of primary care personnel (PCP). The objectives herein were to assess the differences in anxiety levels between these populations and to detect factors that may influence them. The anxiety levels (measured using the Hospital Anxiety and Depression (HAD) scale) of the HP and PCP groups were compared using data collected from a cross-sectional study. The secondary variables included demographic and health data, confinement factors, contact with COVID-19 patients, having suffered from COVID-19, perceptions of protection, caregiver overload, threat, and satisfaction with management. We found anxiety "case" (35.6%) and "at-risk" (21%), with statistically significant differences in the group "at risk", and higher scores in the PCP group. The factors associated with the perception of threat and protection were significant determinants of an increase in anxiety, with all of them showing statistically significant differences. There were greater symptoms of anxiety in the PCP group than the HP group (32% vs. 18%). The factors associated with the prevalence of anxiety symptoms were the perceptions of threat, protection, management, caregiver overload, and perceived degree of threat associated with COVID-19.

Psychological Therapy in Chronic Pain: Differential Efficacy between Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy.

The objective of this study is to evaluate the differential efficacy between Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavioral Therapy (CBT). A quasi-experimental design of repeated measures before and after the test (n = 57) was used with a non-equivalent control group from a previous cohort treated with CBT (n = 105). The t-test revealed significant differences in subjective quality of life for the MBCT group, and in quantity, optimum, and adequate sleep for the CBT group. The pre-post effect size comparison mostly showed slightly larger effect sizes in the MBCT group. CBT and MBCT had comparable efficacies, although a slight trend towards larger effect sizes in MBCT was found. Likewise, CBT seemed to improve sleep-related variables, while MBCT was associated with improvements in pain and quality of life.

Validation of the Center of Applied Psychology Female Sexuality Questionnaire (CAPFS-Q).

Instruments for the measurement of human sexuality include self-report measures used to assess sexual functioning, but many of them have not yet been validated. The Center of Applied Psychology Female Sexual Questionnaire (CAPFS-Q) is an original self-report instrument. It has been developed for the study of sexuality in specific non-clinical populations, such as female university students of Medicine and other Health Sciences. The CAPFS-Q includes 26 items, organized as follows: sociodemographic and relevant data (four items); aspects of sexual relations with partner (five items); sexual practices (12 from 13 items); and dysfunctional aspects of sexual relations (four items). CAPFS-Q validity and reliability were examined in a sample of Spanish female university students of Health Sciences. Exploratory and confirmatory factor analysis (FA) showed a four-factor structure which explained 71.6% of the variance. This initial version of the CAPFS-Q is a reliable measure of women's sexual behavior, with a dimensionality that replicates the initial theoretical content and with adequate indicators of internal consistency, validity, and test-retest reliability. It is easy to administer and to complete.

Malestar emocional de pacientes y familiares en la Unidad de Cuidados Paliativos de un hospital general: un estudio piloto / Emotional distress of patients and caregivers in a Palliative Care Unit at a general hospital: a pilot study

ANTECEDENTES Y OBJETIVO: La experiencia de una enfermedad avanzada genera malestar emocional en los pacientes y familiares. El objetivo del trabajo consiste en valorar un procedimiento de evaluación del malestar emocional del binomio paciente-cuidador en una UCP-HA de reciente creación, como un primer paso para reducirlo en la medida de lo posible. Sujetos y MÉTODO: Se realizó un muestreo de conveniencia entre noviembre de 2015 y marzo de 2016. Fueron entrevistados 25 pacientes utilizando el índice de Barthel, el Cuestionario de Evaluación de Síntomas Edmonton y el Cuestionario de Detección del Malestar Emocional. Fueron evaluados 25 cuidadores mediante la Escala Hospitalaria de Ansiedad y Depresión y la Escala Zarit reducida. RESULTADOS: Se pudo evaluar al 37% de los pacientes y cuidadores ingresados en la UCP durante el periodo de estudio. Existe un alto nivel de malestar emocional en el 88% de los pacientes. En los cuidadores evaluados aparecen niveles altos de ansiedad y se observa sobrecarga del cuidador en el 80% según la Escala Zarit reducida. CONCLUSIÓN: A pesar de las dificultades que conlleva evaluar a los pacientes con enfermedad avanzada y sus cuidadores, consideramos que estos procedimientos contribuyen a detectar el sufrimiento y promover su bienestar

BACKGROUND AND OBJECTIVE: The experience of an advanced disease causes emotional distress in patients and relatives. The objective of this paper is to assess a process of evaluation of emotional distress of both patients and caregivers in a recently created Palliative Care Unit of a General Hospital, as a first step towards reducing it as far as possible. Subjects and METHODS: A convenience sampling was used, from November 2015 to 2016 March. A total of 25 patients were interviewed using the Barthel Index, the Edmonton Symptom Assessment System and the questionnaire of Detection of Emotional Distress. Also 25 caregivers were interviewed using the Hospital Anxiety and Depression Score and the reduced Zarit Scale. RESULTS: 37% of patients and caregivers admitted in the Palliative Care Unit during the period of study could be evaluated. A high level of emotional distress was detected among 88% of PATIENTS: Caregivers were observed to have high levels of anxiety and burden was detected in 80% according to the reduced Zarit Scale. CONCLUSIONS: Despite the difficulties involved in evaluating patients with advanced disease and their caregivers, we think these procedures contribute to detecting suffering and to promoting their wellness

Creación de la Escala sobre Habilidades de Comunicación en Profesionales de la Salud, EHC-PS / Creation of the communication skills scale in health professionals, CSS-HP

En este trabajo se presenta el proceso de creación de la Escala sobre Habilidades de Comunicación en Profesionales de la Salud, EHC-PS. Este aspecto no se muestra en los procesos de elaboración de instrumentos a pesar de ser considerado una parte fundamental. Por esto, se muestra todo el proceso de creación de la escala, desde la definición operacional del constructo a medir, avalada por un grupo de expertos, como el proceso de creación de los ítems siguiendo las tablas de especificaciones de la escala y de los ítems. Además, se incluye la fase de evaluación cualitativa de los ítems creados por parte del grupo de expertos como los ensayos preliminares de la escala, aspectos fundamentales para la obtención de evidencias de validez de contenido y consenso en el futuro instrumento de medida. Los resultados obtenidos muestran que los expertos valoraron positivamente la definición realizada del constructo, así como los ítems creados a partir de dicha definición, que se modificaron y eliminaron según dichos resultados

This work presents the process of creating the scale on communication skills scale in health professionals, CSS-HP. This aspect is not shown in the process of developing tools despite being considered a fundamental part. For this, it shows the entire process of creating the scale, from the operational definition of the construct to measure, backed by a group of experts, as the process of creating the items following the specification tables of the scale and items. It also includes qualitative evaluation phase of the items created by the group of experts and preliminary trials of the scale, fundamental aspects for obtaining content and consensus validity evidence on the future tool. The results show that experts appreciated positively the construct definition made and items created from that definition, which were modified and eliminated according to these result

[Influence of clinical status in the relationship between alexithymia and emotional recognition: a dimensional study]. / Influencia de la condición clínica en la relación entre la alexitimia y el reconocimiento emocional: un estudio dimensional.

The results of this study are part of an investigation to determine whether the cognitive-emotional process of emotional recognition is deficient as a function of the clinical condition and alexithymia in subjects with somatization. This investigation applied the self-assessment of emotion and used a procedure that minimizes the use of verbal skills and verbal comprehension. The specific goal of this study was to verify whether there were differences in the covariation between alexithymia and self-evaluation of the emotional reaction in clinical and nonclinical subjects. The results of this study highlight the significant differences between clinical and control subjects. There were inverse significant correlations with the affective valence in clinical subjects, whereas in the ratings of the TAS-20 in control subjects, there were direct correlations with activation. In the conclusions, we discuss whether the variability of the results of previous research of the relationship between alexithymia and emotional recognition is a characteristic feature of this relationship or an effect of the different sampling and procedures utilized.

Detección del consumo de alcohol inmediatamente antes del trasplante hepático, ¿recaída o continuidad del consumo? / Detection of alcohol prior to liver transplant, recurrence or continued use?

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Efectos psicológicos de un programa estructurado para preparación de pacientes a cirugía bariátrica / Psychological effects of a structured programme for preparing surgery patients

Se ha diseñado y aplicado un programa de tratamiento cognitivo-conductual para pacientes que van a ser sometidos a cirugía bariátrica. Se presentan los resultados referidos a la ansiedad y la depresión, tres meses después de su aplicación. Cincuenta candidatos a cirugía bariátrica completaron los cuestionarios BDI y STAI (E-R) antes y después de la implementación del programa (grupos 1 y 2), y nuevamente después de tres meses (grupo 2). Se han encontrado diferencias significativas en depresión y en ansiedad-rasgo antes y después de la aplicación del programa en ambos grupos. Asimismo, el Grupo 2 mostró también diferencias significativas entre el pre-programa y el seguimiento, pero no entre el post-programa y el seguimiento. Respecto de la ansiedad-estado, el Grupo 2 sólo mostró diferencias entre el pre-programa y el seguimiento con un tamaño del efecto muy alto. Los resultados muestran una reducción significativa en los niveles de ansiedad y depresión en los pacientes después del tratamiento y antes de ser sometidos a la cirugía bariátrica. Estos resultados no se mantienen estables durante el seguimiento y no se ha podido establecer una relación causal (AU)

A bariatric surgery preparation programme based on cognitive behavioural techniques was designed and implemented in a sample of 50 candidates for bariatric surgery. All participants completed the BDI short-form and STAI (E-R) questionnaires before and after the programme implementation (Groups 1 and 2) and again after a three-month follow-up (Group 2). The programme’s results are presented in terms of its effect on anxiety and depression levels three months after surgery. We found significant differences in depression and trait anxiety between pre- and post-treatment measures in both groups. Group 2 also showed significant differences between the pre-treatment and follow-up measures, but not between the post-treatment and follow-up measures. In the case of state anxiety, Group 2 showed differences between pre-programme implementation and follow-up with a large effect size, but not in the other comparisons. Conclusion: The results show a significant post-treatment reduction of anxiety and depression in bariatric surgery patients before surgery. These results do not remain stable during the follow-up and the authors are not able to establish a causal relationship (AU)

Influencia de la condición clínica en la relación entre la alexitimia y el reconocimiento emocional: un estudio dimensional / Infl uence of clinical status in the relationship between alexithymia and emotional recognition: a dimensional study

Los resultados del presente estudio forman parte de una investigación dirigida a comprobar si el proceso cognitivo-emocional de reconocimiento de la propia emoción es deficitario en función de la condición clínica y la alexitimia en los sujetos que presentan somatizaciones. En dicha investigación se ha solicitado la autoevaluación de la propia emoción y se ha empleado un procedimiento donde se minimiza el empleo de habilidades y comprensión verbal. El objetivo específico del presente trabajo ha sido conocer el grado de covariación entre alexitimia y reconocimiento emocional en participantes clínicos y no clínicos. Los resultados de este estudio ponen de manifiesto la existencia de diferencias significativas entre los participantes clínicos y los controles. Las correlaciones significativas se producen totalmente de forma inversa con la valencia afectiva en los participantes clínicos; mientras que es en las puntuaciones a la TAS-20 en los controles donde se producen correlaciones con la activación, de forma directa. En las conclusiones se discute si la variabilidad de los resultados de la investigación precedente de la relación entre la alexitimia y el reconocimiento emocional es una característica de esta relación, o si depende de los procedimientos y muestras empleados (AU)

The results of this study are part of an investigation to determine whether the cognitive-emotional process of emotional recognition is deficient as a function of the clinical condition and alexithymia in subjects with somatization. This investigation applied the self-assessment of emotion and used a procedure that minimizes the use of verbal skills and verbal comprehension. The specific goal of this study was to verify whether there were differences in the covariation between alexithymia and self-evaluation of the emotional reaction in clinical and nonclinical subjects. The results of this study highlight the significant differences between clinical and control subjects. There were inverse significant correlations with the affective valence in clinical subjects, whereas in the ratings of the TAS- 20 in control subjects, there were direct correlations with activation. In the conclusions, we discuss whether the variability of the results of previous research of the relationship between alexithymia and emotional recognition is a characteristic feature of this relationship or an effect of the different sampling and procedures utilized (AU)