Evaluating the inter-rater reliability of the Scale to Assess Unawareness of Mental Disorder using the DOMENIC method

Insight in psychosis is a complex construct, conceptualized as a continuous and multidimensional phenomenon. It comprises the awareness of having a mental disorder, treatment compliance, the ability to label unusual mental events as symptoms of the disorder, and the awareness of the social conse­quences of the disorder. Insight has an important impact on the outcome of psychosis and has been related to quality of life, psychosocial functioning, severity of symptomatology, therapeutic compliance, and number of readmissions. Thus, insight assessment is crucial in patients with psychosis. But in real-world clinical settings, a single patient being assessed and/or treated by several clinicians is a common situation, and given the complexity of the phenomenon of insight, it is difficult to ensure that all clinicians are referring to the same construct. Using questionnaires could help clinicians to deal with this situation. The Scale to Assess Unawareness of Mental Disorder (SUMD) is a widely used instrument to explore insight in clinical trials and epidemiological studies that has proved to be adequate in terms of validity and reliability with the usual statistical procedures. Nevertheless, it is not easy to use, and heterogeneity across studies can compromise the results (Dumas et al., 2013). We proposed an inter-rater reliability study to explore differences in the assessment of insight using this instrument. Procedures based on the calculation of Kappa coefficients, weighted Kappa, or interclass corre­lation coefficient (ICC) require a sample of several subjects who are evaluated by a small number of examiners and, for our purpose, this reflects an inefficient strategy. Therefore, we used the Detection of Multiple Examiners Not in Consensus (DOMENIC) method, elaborated by Cicchetti et al. (1997), which allows the inter-rater reliability for one single patient and several raters to be deter­mined. By using the DOMENIC method, we can see that items referring to insight of the negative symptoms of psychosis may cause the greatest difficulty for raters, a difficulty that, according to our data, does not seem to be significantly related to their clinical experience. Retraining clinicians in this area could be the best alternative to improve the reli­ability of the appraisals. Thus, the DOMENIC method could be a useful tool in the preparation phases of a study with this type of scale to easily identify areas of disagreement and investigators who need training to improve inter-rater reliability.2023-2

Patients at high risk of suicide before and during a COVID-19 lockdown: ecological momentary assessment study

The coronavirus disease 2019 (COVID-19) outbreak may have affected the mental health of patients at high risk of suicide. In this study we explored the wish to die and other suicide risk factors using smartphone-based ecological momentary assessment (EMA) in patients with a history of suicidal thoughts and behaviour. Contrary to our expectations we found a decrease in the wish to die during lockdown. This is consistent with previous studies showing that suicide rates decrease during periods of social emergency. Smartphone-based EMA can allow us to remotely assess patients and overcome the physical barriers imposed by lockdown.This study received grant support from Instituto de Salud Carlos III (ISCIII PI13/02200; PI16/ 01852; CM19/00026), Delegación del Gobierno para el Plan Nacional de Drogas (20151073), the American Foundation for Suicide Prevention (LSRG-1-005-16), the Ministerio de Ciencia, Innovación y Universidades (RTI2018-099655-B-I00; TEC2017-92552-EXP) and by the Comunidad de Madrid (Y2018/TCS-4705, PRACTICO-CM)

Estilo Atribucional Y Antecedentes De Conducta Suicida En Primeros Episodios Psicóticos

Objetivo: La conducta suicida (CS) es común en personas que han sufrido un primer episodio psicótico (PEP), al igual que las alteraciones neurocognitivas y de cognición social. Respecto a esta, destaca el estilo atribucional. Existe evidencia de que un estilo atribucional desadaptativo respecto a los demás está relacionado con mayor riesgo suicida. A pesar de que hay factores de riesgo bien establecidos para la CS en psicosis, el papel de la neurocognición y la cognición social sigue sin estar claro. Este estudio tiene como objetivo explorar la relación entre antecedentes de CS y aspectos neurocognitivos y de cognición social en personas con PEP, prestando especial atención al estilo atribucional. Método: 190 participantes con PEP fueron reclutados de dos estudios multicéntricos. Se formaron dos grupos en función de la presencia/ausencia de antecedentes de CS para comparar los datos demográficos, clínicos y cognitivos. Se realizó un análisis multivariante y, en aquellas variables estadísticamente significativas (p<0,05), se aplicó un modelo de regresión logística. Resultados: No se encontraron diferencias en las variables demográficas, clínicas ni de funcionamiento neurocognitivo. El estilo atribucional (sesgo externalizador) resultó estadísticamente significativo (t=2,07; p=0,041) y mantuvo significación tras aplicar la regresión logística (OR 0,847; IC 95% 0,734-0,977; p=0,023). Conclusiones: En personas con PEP, el funcionamiento neurocognitivo no se asocia con antecedentes de CS, aunque, respecto a la cognición social, un sesgo externalizador extremadamente bajo parece estar relacionado con antecedentes de CS. Estos resultados sugieren que lo que facilita la aparición de CS no es un mejor o peor funcionamiento cognitivo sino la percepción negativa del trastorno, alimentada por una tendencia a realizar atribuciones internas de los eventos negativos. Esto tiene importantes implicaciones en la práctica clínica por su valor en la prevención de posibles CS.2022-2

Study protocol of a randomised clinical trial testing whether metacognitive training can improve insight and clinical outcomes in schizophrenia

Background: Although insight in schizophrenia spectrum disorders (SSD) has been associated with positive outcomes, the effect size of previous treatments on insight has been relatively small to date. The metacognitive basis of insight suggests that metacognitive training (MCT) may improve insight and clinical outcomes in SSD, although this remains to be established. Methods: This single-center, assessor-blind, parallel-group, randomised clinical trial (RCT) aims to investigate the efficacy of MCT for improving insight (primary outcome), including clinical and cognitive insight, which will be measured by the Schedule for Assessment of Insight (Expanded version) (SAI-E) and the Beck Cognitive Scale (BCIS), respectively, in (at least) n = 126 outpatients with SSD at three points in time: i) at baseline (T0); ii) after treatment (T1) and iii) at 1-year follow-up (T2). SSD patients receiving MCT and controls attending a non-intervention support group will be compared on insight level changes and several clinical and cognitive secondary outcomes at T1 and T2, whilst adjusting for baseline data. Ecological momentary assessment (EMA) will be piloted to assess functioning in a subsample of participants. Discussion: To the best of our knowledge, this will be the first RCT testing the effect of group MCT on multiple insight dimensions (as primary outcome) in a sample of unselected patients with SSD, including several secondary outcomes of clinical relevance, namely symptom severity, functioning, which will also be evaluated with EMA, hospitalizations and suicidal behaviour.This study was supported by the Universidad Autónoma de Madrid and European Union via the Intertalentum Project Grant-Marie Skłodowska Curie Actions (GA 713366) to JDLM who is the Princiapl Investigator. This grant therefore funds both JDLM’s salary and the consumable expenses related to the study. JDLM, VGRR, ASEM, MLBE, LMI, LML, SSA, AAR and EBG’s salaries come from the Hospital Universitario Fundación Jiménez Díaz, where this study is currently being carried out, which therefore provides the necessary institutional/departmental support for its development. Additional departmental support concerning the use of Ecological Momentary Assessment (see Methods section, page 11 -last paragraph- and page 12 –first paragraph-, for details) is provided by the Instituto de Salud Carlos III (Madrid, Spain) (ISCIII PI16/01852) and the Madrid Regional Government (Madrid, Spain) (B2017/BMD-3740 AGES-CM 2CM; Y2018/TCS-4705 PRACTICO-CM). ASD acknowledges funding supports from University College London, which covers his salar

What seems to explain suicidality in Yucatan Mexican young adults? findings from an app-based mental health screening test using the SMART-SCREEN protocol

The relationship between suicidality, depression, anxiety, and well-being was explored in young adults (median age 20.7 years) from the State of Yucatan (Mexico), which has a suicide rate double that of other Mexican states. A cross-sectional study was carried out in 20 universities in Yucatan and 9,366 students were surveyed using validated questionnaires built into a smartphone app, applying partial least squares structural equation models. High suicide risk was assessed in 10.8% of the sample. Clinically relevant depression and anxiety levels were found in 6.6% and 10.5% of the sample, respectively, and 67.8% reported high well-being. Comparably higher levels of suicide risk, depression and anxiety, and lower well-being were found in women, who were also somewhat older than men in our study. Furthermore, path analysis in the structural equation model revealed that depression was the main predictor of suicidal behaviour as well as of higher anxiety levels and lower self-perceived well-being in the total sample and in both genders. Our findings draw attention to the association between suicidality, depression, anxiety, and well-being in Yucatan young adults and gender differences with this regard. Mental health screening via smartphone might be a useful tool to reach large populations and contribute to mental health policies, including regional suicide prevention effortsOpen Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. No funding was received for this stud

Disponibilidad y promoción de alcohol según la tipología de los locales y las condiciones socioeconómicas del área

Smoking and substance use during pregnancy are major preventable causes of mortality and morbidity, having a bidirectional and deleterious relationship with the mental health of the mother and child. As part of the WOMAP (Woman Mental Health and Addictions on Pregnancy) initiative, our study aimed to describe the prevalence of co-occurring mental illness and substance use problems, diagnoses and severity of those considered at risk and rates of treatment.A screening of 2,014 pregnant women was done using the AC-OK scale and they were asked about their smoking habits and services use for mental health/substance abuse. Of these, 170 women were considered at risk of co-occurring mental illness and substance use problems (≥ 2 positive responses to the AC-OK-Mental Health subscale, ≥ 1 positive response to the AC-OK-Substance Abuse subscale and/or smoking more than once a month and no use of specialized services) and were assessed with a more extensive battery of measures (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Posttraumatic stress disorder [PTSD] Checklist for DSM-5 [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] and Fagerström).In the last year, 614 women (30.5%) smoked tobacco (42.5% daily) and 9.8% were positive for both substance use and mental illness per the AC-OK. Only 11.1% of them received specific treatment in the previous three months while another 13.6% were scheduled to attend services in the following month. From the subsample assessed in depth, 62(36.5%) endorsed at least moderate depression, 35(20.6%) endorsed at least moderate anxiety, 32(18.8%) endorsed PTSD on the PCL, and 37 out of 88 alcohol users scored above the threshold in AUDIT (≥ 3).In conclusion, high prevalence and low treatment rates suggest that effective detection mechanisms should be integrated into usual care, allowing for early interventions. ------------------------------------------------------------------ El tabaquismo y el consumo de sustancias durante el embarazo son importantes causas prevenibles de morbimortalidad, teniendo una relación bidireccional y deletérea con la salud mental de la madre y el niño. Como parte de la iniciativa WOMAP (Woman Mental Health and Addictions on Pregnancy), se estudiaron 2014 embarazadas buscando describir la prevalencia de trastornos mentales y por uso de sustancias concurrentes, las tasas de tratamiento y los diagnósticos y la gravedad. Las participantes fueron evaluadas con la escala AC-OK y se les preguntó sobre sus hábitos tabáquicos y uso de servicios de salud mental/sustancias. De las participantes, 170 mujeres resultaron positivas para un trastorno mental y por uso de sustancias concurrentes (≥ 2 positivos a la subescala AC-OK-Salud Mental, ≥ 1 positivos a la subescala AC-OK-Sustancias y/o fumar más de una vez al mes y no estar en tratamiento) y fueron evaluadas en profundidad mediante una batería de escalas (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Post-traumatic stress disorder Checklist [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] y Fagerström). En el último año, 614 mujeres (30,5 %) fumaron tabaco (42,5 % diariamente) y el 9,8 % fueron positivas para problemas por uso de sustancias y salud mental según la AC-OK. Solo el 11,1 % había recibido tratamiento en los tres meses previos y solo un 13,6 % tenía una cita en el siguiente mes. De las 170 pacientes evaluadas secundariamente, 62(36,5 %) presentaron al menos depresión moderada, 35(20,6 %) al menos ansiedad moderada, 32(18,8 %) fueron positivas a la PCL-5, y 37 de las 88 que reconocieron uso de alcohol puntuaron por encima del umbral en AUDIT (≥ 3). En conclusión, la combinación de una prevalencia significativa junto con bajas tasas de tratamiento, remarcan la necesidad de mecanismos de detección efectivos en la atención habitual, permitiendo una intervención temprana.2020-2

Consumo de cannabis y otros factores ambientales en el primer episodio de psicosis

Tesis Univ. Granada. Programa Oficial de Doctorado en: Psiquiatría y Cuidados Comunitario

Combining continuous smartphone native sensors data capture and unsupervised data mining techniques for behavioral changes detection: a case series of the evidence-based behavior (eB2) study

Background: The emergence of smartphones, wearable sensor technologies, and smart homes allows the nonintrusive collection of activity data. Thus, health-related events, such as activities of daily living (ADLs; eg, mobility patterns, feeding, sleeping, ...) can be captured without patients' active participation. We designed a system to detect changes in the mobility patterns based on the smartphone's native sensors and advanced machine learning and signal processing techniques. Objective: The principal objective of this work is to assess the feasibility of detecting mobility pattern changes in a sample of outpatients with depression using the smartphone's sensors. The proposed method processed the data acquired by the smartphone using an unsupervised detection technique. Methods: In this study, 38 outpatients from the Hospital Fundacion Jimenez Diaz Psychiatry Department (Madrid, Spain) participated. The Evidence-Based Behavior (eB(2)) app was downloaded by patients on the day of recruitment and configured with the assistance of a physician. The app captured the following data: inertial sensors, physical activity, phone calls and message logs, app usage, nearby Bluetooth and Wi-Fi connections, and location. We applied a change-point detection technique to location data on a sample of 9 outpatients recruited between April 6, 2017 and December 14, 2017. The change-point detection was based only on location information, but the eB(2) platform allowed for an easy integration of additional data. The app remained running in the background on patients' smartphone during the study participation. Results: The principal outcome measure was the identification of mobility pattern changes based on an unsupervised detection technique applied to the smartphone's native sensors data. Here, results from 5 patients' records are presented as a case series. The eB(2) system detected specific mobility pattern changes according to the patients' activity, which may be used as indicatorsThis study was partly supported by Ministerio de Economía of Spain under project: AID (TEC2014-62194-EXP) and aMBITION (TEC2017-92552-EXP), the Ministerio de Economía of Spain jointly with the European Commission under projects ADVENTURE (TEC2015-69868-C2-1-R) and CAIMAN (TEC2017-86921-C2-2-R), the Comunidad de Madrid under project CASI-CAM-CM (S2013/ICE-2845), Fundación Jiménez Díaz Hospital, Instituto de Salud Carlos III (PI16/01852), Delegación del Gobierno para el Plan Nacional de Drogas (20151073), American Foundation for Suicide Prevention (LSRG-1-005-16), the French Embassy in Madrid, Spain, the fondation de l’Avenir, and the Fondation de France. The work of PMM has been supported by FPI grant BES-2016-077626.Publicad

Psicothema

Resumen tomado de la publicaciónAntecedentes: la investigación en Experiencias de Tipo Alucinatorias (HLEs en inglés) aún no ha explorado si las personas sin psicosis que las experimentan les atribuyen el mismo significado, si estas provocan las mismas reacciones emocionales o si ocurren en los mismos contextos que en la psicosis. El objetivo de este estudio fue comparar las características de estas experiencias entre un grupo no clínico y un grupo clínico de pacientes con esquizofrenia y trastornos del espectro esquizofrénico. Método: ambos grupos fueron evaluados para determinar la prevalencia de las HLEs, después de lo cual fueron entrevistados sobre las características de estas experiencias. Resultados: ambos grupos buscan activamente eliminar estas experiencias; pueden identificar la presencia de un factor desencadenante, y poco control percibido. Sin embargo, las HLEs provocaron más ansiedad, malestar e interferencia en la vida diaria en el grupo clínico que en el grupo no clínico. Además, el grupo clínico definió sus HLEs como más negativas y experimentadas bajo situaciones estresantes. Conclusiones: estos resultados sugieren que las experiencias de ambos grupos no son completamente equivalentes, especialmente cuando se toman en cuenta las reacciones emocionales producidas por estas experiencias y el significado que las personas les atribuyenUniversidad de Oviedo. Biblioteca de Psicología; Plaza Feijoo, s/n.; 33003 Oviedo; Tel. +34985104146; Fax +34985104126; [email protected]

Use of ecological momentary assessment through a passive smartphone-based app (eB2) by patients with schizophrenia: Acceptability study

Background: Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability. Objective: The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance. Methods: The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on being user versus nonuser (acceptability), which was the main outcome measure. Results: Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=01) survived the multivariable regression model, thus predicting eB2 acceptability. Conclusions: Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment.This study was supported by the Universidad Autónoma de Madrid and European Union via the Intertalentum Project Grant-Marie Skodowska Curie Actions (GA 713366) to JDLM who is the principal investigator. This grant, therefore, funds both JDLM's salary and the consumable expenses related to the study. MLB, VGRR, ASEM, PJEA, SSA, LMI, LML, and EBG's salaries come from the Hospital Universitario Fundación Jiménez Díaz, where this study is currently being carried out, which therefore provides the necessary institutional/departmental support for its development. Additional departmental support concerning the use of EMA is provided by the Instituto de Salud Carlos III (Madrid, Spain) (ISCIII PI16/01852), the Madrid Regional Government (Madrid, Spain) (B2017/BMD-3740 AGES-CM 2CM; Y2018/TCS-4705 PRACTICO-CM), and the Spanish Ministerio de Ciencia, Innovación y Universidades (TEC2017-92552-EXP). ASD acknowledges funding support from University College London, which covers his salary. The funders had no role in hypothesis generation, study design, decision to publish, or the manuscript writing. No funder has a conflict of interest in relation to the study's results and findings. The funding bodies supported the peer review for this manuscript