Impact of IPDE-SQ personality disorders on the healthcare and societal costs of fibromyalgia patients: A cross-sectional study

Background: Data is lacking on comorbid personality disorders (PD) and fibromyalgia syndrome (FMS) in terms of prevalence, and associated healthcare and societal costs. The main aim of this study was to assess the prevalence of PD in FMS patients and to analyse whether the presence of comorbid PD is related to worse functional impairment and greater healthcare (medical visits, drug consumption, and medical tests) and societal costs. Methods: A cross-sectional study was performed using the baseline data of 216 FMS patients participating in a randomized, controlled trial carried out in three primary health care centres situated in the region of Barcelona, Spain. Measurement instruments included the International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ), the Fibromyalgia Impact Questionnaire (FIQ), the Client Service Receipt Inventory (CSRI), and a socio-demographic questionnaire. Results: Most patients (65 %) had a potential PD according to the IPDE-SQ. The most prevalent PD were the avoidant (41.4 %), obsessive-compulsive (33.1 %), and borderline (27 %). We found statistically significant differences in functional impairment (FIQ scores) between FMS patients with potential PD vs non-PD (59.2 vs 51.1; p < 0.001). Multivariate regression analyses revealed that higher FIQ total scores and the presence of potential PD were related to more healthcare costs (primary and specialised care visits). Conclusions: As expected, PD are frequent comorbid conditions in patients with FMS. Our results suggest that the screening of comorbid PD in patients with FMS might be recommendable in order to detect potential frequent attenders to primary and specialised care

Cost-utility of a psychoeducational intervention in fibromyalgia patients compared with usual care: an economic evaluation alongside a 12-month randomized controlled trial

Objective: To determine the effectiveness of adding psychoeducational treatment implemented in general practice to usual care for patients with fibromyalgia (FM), and to analyze the cost-utility of the intervention from health care and societal perspectives. Methods: Twelve-month randomized controlled trial. A total of 216 primary care patients meeting the American College of Rheumatology criteria for FM participated in the study. The intervention included 9, 2-hour sessions of psychoeducation (5 sessions of education about the illness + 4 sessions of autogenic relaxation) added to usual care provided by a multidisciplinary group in general practice was compared to usual care in the public health system. Results: At 12-month follow-up, patients who received psychoeducation showed greater improvement in global functional status (Cohen d = 0.36; -2.49 to 3.81), physical functioning (Cohen d = 0.56; 0.08 to 1.00), days feeling well (Cohen d = 0.40; -0.16 to 1.02), pain (Cohen d = 0.35; -0.04 to 0.80), morning fatigue (Cohen d = 0.24; -0.20 to 0.76), stiffness (Cohen d = 0.34; -0.10 to 0.87), and depression (Cohen d = 0.30; -0.26 to 0.93). Mean incremental cost per person receiving the intervention was €-215.49 (-615.13 to 287.81) from the health care perspective, and €-197.32 (-785.12 to 395.74) from the societal perspective. The incremental gain in quality-adjusted life-years per person was 0.12 (0.06 to 0.19), yielding a "dominant" intervention from both perspectives. The sensitivity analysis suggested that the intervention was cost-effective even imputing all missing data. Discussion: Our findings demonstrate the long-term clinical effectiveness of a psychoeducational treatment program for FM implemented at primary care level and the cost-utility from a health care and societal perspective

Aprehensión cognitiva en problemas de generalización de patrones visuales

The objective of this study was to identify cognitive apprehensions used by fifth- and sixth-grade students (10–12-year-olds) when answering far generalization questions in two problems of visual pattern generalization. A total of 81 students solved two linear generalizing problems, presented in two different configurations, in a succession of figures (square tables or trapezoid tables). The results showed that students used different types of cognitive apprehensions to solve problems and that these apprehensions sometimes changed according to the configuration of the sequence of figures. This finding indicates that configurations could determine apprehensions used by students, which in some cases led to the emergence of algebraic thinking. In addition, difficulties in modifying apprehension and a lack of coordination between spatial and numerical structures could explain some students’ difficulties in far generalization.El objetivo de este estudio era identificar las formas de aprehensión cognitiva utilizadas por estudiantes de 5º y 6º curso (entre 10 y 12 años) para responder a preguntas de generalización lejana en dos problemas de generalización de patrones visuales. Un total de 81 estudiantes resolvieron dos problemas de generalización lineal cuya diferencia estaba en la configuración de la sucesión de figuras (mesas cuadradas y en forma de trapecio). Los resultados muestran que los estudiantes utilizaron distintas formas de aprehensión cognitiva para resolver los problemas y que, en ocasiones, estas variaban en función de la configuración de la secuencia de figuras. Estos resultados indican que las configuraciones podrían determinar las formas de aprehensión utilizadas por los estudiantes favoreciendo, en algunos casos, la emergencia del pensamiento algebraico. Asimismo, la dificultad para modificar la aprehensión y la falta de coordinación entre la estructura espacial y la numérica podrían explicar algunas de las dificultades que los estudiantes experimentan con la generalización lejana.This research was carried out with the support of EDU2017-87411-R from MINECO/FEDER (Spain) and PROMETEO/2017/135 from Generalitat Valenciana (Spain)