Cognitive impairment in bipolar disorder and schizophrenia: a systematic review.

AIMS: Previous comparisons of cognitive decline among patients with bipolar disorder (BD) and schizophrenia (SZ) have found somehow quite similar profiles of deficits, but results have varied between studies. Therefore an extensive and thoughtful systematic review of the matter is warranted. METHODS: Studies were found through systematic search (PubMed) following PRISMA guidelines. To be included, studies must have assessed the following cognitive functions: executive functions, memory, IQ, attention-concentration, and perceptuomotor function. In order to make comparison between the two entities, studies should include BD patients with operationally defined euthymia, schizophrenic patients in remission, and third group of healthy control patients. Comparisons were made after controlling for years of schooling and residual affective symptoms. RESULTS: We found that overall both SZ and BD patients present deficits on all neurocognitive measures compared to healthy controls. In particular, SZ patients show more severe and pervasive cognitive deficits while BD patients present a milder and more confined impairment. In addition, evidence from the literature suggests that SZ and BD patients share a similar cognitive impairment profile with different degrees of deficits. Therefore, the difference between the two groups seems to be more quantitative (degree of deficit) rather than qualitative (profile), supporting a dimensional approach to the two clinical entities. Limitations of the present review includes the impossibility to control for effects of medication, varying time required for assessment across studies, illness diagnosis reliability, and course severity. CONCLUSION: Patients with BD might exhibit a cognitive impairment that could be similar to SZ in terms of their profile, although patients with SZ may have more severe and widespread impairments.

Detecting mood disorder in resource-limited primary care settings: comparison of a self-administered screening tool to general practitioner assessment.

OBJECTIVES: Although efficacious treatments for mood disorders are available in primary care, under-diagnosis is associated with under-treatment and poorer outcomes. This study compares the accuracy of self-administered screening tests with routine general practitioner (GP) assessment for detection of current mood disorder. METHODS: 197 consecutive patients attending primary care centres in Santiago, Chile enrolled in this cross-sectional study, filling out the Patients Health Questionnaire-9 (PHQ-9) for depression and the Mood Disorder Questionnaire (MDQ) for bipolar disorder, after routine GP assessment. Diagnostic accuracy of these self-administered tools was compared with GP assessment, with gold standard diagnosis established by a structured diagnostic interview with trained clinicians (SCID-I). RESULTS: The sample was 75% female, with a mean age of 48.5 (SD 16.8); 37% had a current mood disorder (positive SCID-I result for depression or bipolar disorder). Sensitivity of the screening instruments (SI) was substantially higher than GP assessment (SI: 0.8, [95% CI 0.71, 0.81], versus GP: 0.2, [95% CI 0.12, 0.25]: p-value < 0.0001), without sacrifice in specificity (SI: 0.9, [95% CI 0.86, 0.96], versus GP: 0.9, [95% CI 0.88, 0.97]: p-value = 0.7). This led to improvement in both positive predictive value (SI: 0.8, [95% CI 0.82, 0.90], versus GP: 0.6, [95% CI 0.50, 0.64]: p-value < 0.001) and negative predictive value (SI: 0.9, [95% CI 0.78, 0.91] versus GP: 0.7, [95% CI 0.56, 0.72]: p-value < 0.01). CONCLUSION: Self-administered screening tools are more accurate than GP assessment in detecting current mood disorder in low-income primary care. Such screening tests may improve detection of current mood disorder if implemented in primary care settings.

Lo ético es transversal y cotidiano: dimensiones éticas en la formación y práctica en psicología comunitaria / Ethical issues are transversal and habitual: ethical dimensions in training and practice for community psychology / O ético é transversal e cotidiano: dimensões éticas na formação e prática em psicologia comunitária

La psicología comunitaria ha vivido grandes transformaciones asociadas al devenir histórico y contextual en nuestro país, comportando una serie de cuestiones éticas que no han sido abordadas ni en la formación ni en la deontología disciplinar. Objetivo de esta investigación fue indagar la percepción de estudiantes y profesionales respecto de la ética en la práctica y la formación en psicología comunitaria. Nuestros participantes fueron expertos chilenos, estudiantes en práctica y estudiantes de dos programas de Magíster en psicología comunitaria con tres fuentes de datos: panel Delphi (8 expertos), entrevistas en profundidad (7 maestrandos) y grupos focales (20 estudiantes en práctica comunitaria). Aplicando los principios de la teoría fundamentada empíricamente, el análisis de datos decantó en la identificación de cuatro temas: noción de lo ético, tipos de situaciones éticas, formación ética y deontología. Entre los resultados destaca el carácter, simultáneamente, “transversal y cotidiano” así como “vago” de la dimensión ética en el discurso de nuestros participantes. Frente a situaciones concretas, éstos identificaron principios éticos generales, verbalizados como Respeto por el Otro y Autonomía.

Community psychology has suffered huge transformations associated to a historical and contextual process in our country, involving a series of ethical issues which have not been dealt with both in training and deontological discipline. The aim of this research was to inquire the perception of students and professionals with respect to ethics in practice and training in community psychology. Our participants were Chilean experts, students in practice and students of two Master programs in community psychology with three data sources: Delphi panel (8 experts), in-depth interviews (7 master students), and focal groups (20 students in community practice). By applying the principles of the theory empirically based, data analysis showed the identifications of four topics: ethical notion, types of ethical situations, ethical training and deontology. Among the results, the simultaneous character of ethical dimensions “transversal and habitual” as well as “vague” was highlighted in the discourse of our participants. Considering concrete situations, these identified general ethical principles, which was verbalized as Respect for the Other and Autonomy.

A psicologia comunitária tem vivido grandes transformações associadas ao devenir histórico e contextual em nosso país, comportando uma série de questões éticas que não foram abordadas nem na formação nem na deontologia disciplinar. Objetivo desta investigação foi indagar a percepção de estudantes e profissionais a respeito da ética na prática e na formação em psicologia comunitária. Nossos participantes foram especialistas chilenos, estudantes em prática e estudantes de dois programas de Mestrado em psicologia comunitária com três fontes de dados: painel Delphi (8 especialistas ), entrevistas em profundidade (7 mestrandos) e grupos focais (20 estudantes em prática comunitária). Aplicando os princípios da teoria fundamentada empiricamente, a análise de dados decantou na identificação de quatro temas: noção do ético, tipos de situações éticas, formação ética e deontologia. Entre os resultados destaca o caráter, simultaneamente, “transversal e cotidiano” assim como “vago” da dimensão ética no discurso de nossos participantes. Frente a situações concretas, estes identificaram princípios éticos gerais, verbalizados como Respeito pelo Outro e Autonomia.

Cuando el bienestar psicológico está en juego: la dimensión ética en la formación profesional de psicólogos y psicólogas en Chile / When psychological well being is at stake: the ethical dimension in the professional training of psychologists in Chile

Recogiendo la relevancia de la ética, en un contexto de globalización y desarrollo tecnológico y comunicacional, nos preguntamos por su lugar en la formación en psicología, apoyándonos en desarrollos teórico-metodológicos surgidos desde la propia disciplina. Se presentan los resultados de una primera etapa de una investigación, en la que analizamos las mallas profesionales y los perfiles profesionales declarados, incorporando preguntas desde la perspectiva de género. Las conclusiones muestran una ausencia casi total de pautas desde una ética normativa y una amplia variedad de formas de incluir la formación ética en las mallas curriculares. En cuanto a los perfiles profesionales declarados hay una mayor proporción que incorpora implícita o explícitamente el énfasis en aspectos ético-valóricos, aunque la perspectiva de género se encuentra casi totalmente ausente. Se concluye respecto de la urgencia de fomentar el diálogo y la discusión al respecto, así como la necesidad de incorporar en el Código de Ética del Colegio de Psicólogos de Chile artículos que refieran específicamente a la formación profesional.