Relevancia de los factores cognitivos en los juegos de azar, 2015

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico I (Personalidad, Evaluación y Psicología Clínica), leída el 15-12-2015Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaTRUEunpu

Premature termination of psychological treatment for anxiety disorders in a clinical setting

Background: Empirically supported psychological treatments (ESTs) have demonstrated their effectiveness and clinical utility for the treatment of anxiety disorders (AD) but few studies have assessed the factors associated with premature termination in ESTs for AD. Method: The goals of this study, which involved 291 patients with a diagnosis of anxiety who had received outpatient psychological care, consisted of examining premature termination of treatment (PTT), comparing the individual characteristics of the patients who successfully completed treatment with those who terminate it prematurely, and analyzing the predictors of PTT. Results: Of the sample, 8.2% refused to start treatment, 28.5% dropped out before completing it, and 63.2% successfully completed treatment. In 50% of the cases, PTT occurred during the first 7 sessions, and in 80%, before the 15th session. Alternatively, 76.4% of the patients who complete treatment successfully do so before session 20. We found that patients with PTT attended a significantly lower number of treatment sessions and attended the sessions more irregularly and unpunctually. Presenting a generalized anxiety disorder (GAD), problems with punctuality and with task performance were predictors of failure to complete treatment. Conclusions: These findings suggest the need to reinforce early adherence to treatments to help patients remain in treatment

FACTORS INTERFERING WITH THE COURSE OF TREATMENT FOR ANXIETY DISORDERS: PROLONGATION AND PREMATURE TERMINATION OF TREATMENT

The efficacy and the effectiveness of anxiety disorder treatments have been proven. However, the desired results are not always achieved. Studying the factors that interfere with the natural course of the treatments could help to correct and to adapt them. Two of these factors are the unnecessary prolongation of treatments and their premature termination. As expected, the duration of the treatment depends on the nature of the problem and the existence of comorbid problems, however treatments that are too ambitious (an excess of techniques) or combined with pharmacological treatments (increasing sessions by up to 21%) also have a longer duration. Premature termination is around 30-35% and patients “announce” the dropout by displaying poorer task performance and more irregular attendance from the beginning. More than 50% of the therapeutic dropout occurs before the eighth session and 80% of successful treatments are completed before the 20th sessio

Regulatory sites for splicing in human basal ganglia are enriched for disease-relevant information

Genome-wide association studies have generated an increasing number of common genetic variants associated with neurological and psychiatric disease risk. An improved understanding of the genetic control of gene expression in human brain is vital considering this is the likely modus operandum for many causal variants. However, human brain sampling complexities limit the explanatory power of brain-related expression quantitative trait loci (eQTL) and allele-specific expression (ASE) signals. We address this, using paired genomic and transcriptomic data from putamen and substantia nigra from 117 human brains, interrogating regulation at different RNA processing stages and uncovering novel transcripts. We identify disease-relevant regulatory loci, find that splicing eQTLs are enriched for regulatory information of neuron-specific genes, that ASEs provide cell-specific regulatory information with evidence for cellular specificity, and that incomplete annotation of the brain transcriptome limits interpretation of risk loci for neuropsychiatric disease. This resource of regulatory data is accessible through our web server, http://braineacv2.inf.um.es/

Identification of novel risk loci, causal insights, and heritable risk for Parkinson's disease: a meta-analysis of genome-wide association studies

Background Genome-wide association studies (GWAS) in Parkinson's disease have increased the scope of biological knowledge about the disease over the past decade. We aimed to use the largest aggregate of GWAS data to identify novel risk loci and gain further insight into the causes of Parkinson's disease. Methods We did a meta-analysis of 17 datasets from Parkinson's disease GWAS available from European ancestry samples to nominate novel loci for disease risk. These datasets incorporated all available data. We then used these data to estimate heritable risk and develop predictive models of this heritability. We also used large gene expression and methylation resources to examine possible functional consequences as well as tissue, cell type, and biological pathway enrichments for the identified risk factors. Additionally, we examined shared genetic risk between Parkinson's disease and other phenotypes of interest via genetic correlations followed by Mendelian randomisation. Findings Between Oct 1, 2017, and Aug 9, 2018, we analysed 7·8 million single nucleotide polymorphisms in 37 688 cases, 18 618 UK Biobank proxy-cases (ie, individuals who do not have Parkinson's disease but have a first degree relative that does), and 1·4 million controls. We identified 90 independent genome-wide significant risk signals across 78 genomic regions, including 38 novel independent risk signals in 37 loci. These 90 variants explained 16–36% of the heritable risk of Parkinson's disease depending on prevalence. Integrating methylation and expression data within a Mendelian randomisation framework identified putatively associated genes at 70 risk signals underlying GWAS loci for follow-up functional studies. Tissue-specific expression enrichment analyses suggested Parkinson's disease loci were heavily brain-enriched, with specific neuronal cell types being implicated from single cell data. We found significant genetic correlations with brain volumes (false discovery rate-adjusted p=0·0035 for intracranial volume, p=0·024 for putamen volume), smoking status (p=0·024), and educational attainment (p=0·038). Mendelian randomisation between cognitive performance and Parkinson's disease risk showed a robust association (p=8·00 × 10−7). Interpretation These data provide the most comprehensive survey of genetic risk within Parkinson's disease to date, to the best of our knowledge, by revealing many additional Parkinson's disease risk loci, providing a biological context for these risk factors, and showing that a considerable genetic component of this disease remains unidentified. These associations derived from European ancestry datasets will need to be followed-up with more diverse data. Funding The National Institute on Aging at the National Institutes of Health (USA), The Michael J Fox Foundation, and The Parkinson's Foundation (see appendix for full list of funding sources)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

El papel de las cogniciones en el juego de azar: distorsiones o sesgos cognitivos

El abuso de Internet puede interferir negativamente en la vida cotidiana de algunas personas y afectar al rendimiento académico, al laboral, a la calidad de las relaciones sociales y a una ocupación sana del tiempo libre.Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaTRUEpu

Cognitive distortions in gamblers and non-gamblers of a representative Spanish sample

Cognitive biases or distortions related to gambling, present in all people, are considered a relevant factor in the development of gambling-related problems. Objective: to establish whether the presence of these biases or cognitive distortions, in gamblers and nongamblers, is related to the presence of gambling problems. Method: 3000 people aged 18–81 years, representative of the Spanish adult population, underwent a structured survey. Results: the presence of distortions was relevant to distinguish gamblers according to their level of gambling engagement and problems. There is a constant and significant tendency to have more cognitive distortions as gambling problems increase. But not all distortions have the same ability to distinguish between the different groups of gamblers. The results seem to group gamblers into three groups according to the presence of cognitive distortions, from less to more: (1) non-gamblers, (2) low-risk and at-risk gamblers, and (3) problem and pathological gamblers. The relevance of this research and its practical implications for both treatment and prevention work is discussed.Sociedad Española de Apuestas y Loterías del EstadoDepto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaTRUEpu

Factors associated with prolonging psychological treatment for anxiety disorders

Background: Anxiety disorders are one of the disorders most frequently requested for psychological attention. The purpose of this study is to identify the factors that can explain a longer duration of psychological treatment for anxiety disorders. Method: 202 patients from the University Psychology Clinic of the Complutense University of Madrid were analyzed. Results: Multivariate regression analysis showed that the presence of obsessive-compulsive disorder and the application of arousal control techniques followed by modeling and other specifi c techniques were the best predictors of treatment duration. Conclusion: Reducing as much as possible the number of techniques applied without reducing intervention effi cacy is suggested. In some disorders that produce a greater life disorganization, it may be useful to try to organize the patient´s life either as a fi rst goal or at the same time as the intervention program, so as to increase its effectiveness and reduce the number of sessions.Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaTRUEpu