Diferencias de género en cognición y cognición social en pacientes afectos de psicosis en proceso de rehabilitación psicosocial

Objectives: The objectives of our study were to explore gender differences in Cognition and Social Cognition in patients affected by Psychosis in process of psychosocial rehabilitation and to establish a model of the relationship between Psychopathology, Cognition and Social Cognition in function of the gender, and attending to relevant clinical, sociodemographics and outcome factors.Methodology: Cross-sectional observational study with 124 Non-Affective Schizophrenia Spectrum patients included consecutively in Community Rehabilitation Program at XXXXXXXXXXXXXXX (XXXXX, XXXXXXXXX), assessed through PANSS (using Wallwork's factors) and Matrics Cognitive Consensus Battery.Results: Participants had a mean age of 40.2 years, 57.3% men and mainly Schizophrenia (71.0%). We found gender differences favour to men in attention (p=0.045), working memory (p=0.013) and reasoning/problem solving (p=0.002) domains. No differences in Social Cognition was founded. Linear regression model shows different participations for different domains, with a predominance of the influence of the Cognitive/Disorganized Wallwork's factor and patient's age. In the subsample of men, the model were quite similar to that of total sample, but the influence of the Disorganized factor decreases and that of age remains. In women subsample, the model had even less influence of Disorganized factor or age. In general, women's models explain less variance.Objetivos: Explorar diferencias de género en cognición y cognición social en pacientes afectos de psicosis en proceso de rehabilitación psicosocial y establecer un modelo de relación entre psicopatología, cognición y cognición social en función del género y de factores clínicos, sociodemográficos y evolutivos relevantes. Metodología: Estudio observacional transversal con 124 pacientes del espectro de la esquizofrenia incluidos en el Programa de Rehabilitación Comunitaria de la Corporaciò Sanitària Parc Tauí (Sabadell, Barcelona), evaluados mediante PANSS (factores de Wallwork) y la batería cognitiva MATRICS. Resultados: Edad media 40.2 años, 57.3% hombres, principalmente esquizofrenia (71.0%). Encontramos diferencias de género a favor de los hombres en la atención (p = 0.045), memoria de trabajo (p = 0.013) y razonamiento/resolución de problemas (p = 0.002). No se encontraron diferencias en la cognición social. El modelo de regresión lineal muestra diferentes participaciones para diferentes dominios, con un predominio de la influencia del factor de Wallwork cognitivo/desorganizado y la edad del paciente. En la submuestra de hombres, el modelo fue bastante similar al de la muestra total, pero la influencia del factor desorganizado disminuye y la de la edad permanece. En la submuestra femenina, el modelo tuvo, incluso, menos influencia del factor desorganizado o la edad. En general, los modelos de mujeres explican menos varianza. Conclusión: Los hombres afectos de esquizofrenia e incluidos en el Programa de Rehabilitación Comunitaria de nuestra muestra presentan mejor atención, memoria de trabajo y razonamiento/resolución de problemas que las mujeres, sin diferencias en la cognición social. En general, los modelos explican menos varianza en las mujeres.

The neurobiological basis of cognitive side effects of electroconvulsive therapy : a systematic review

Altres ajuts: M.C. is founded by the Sara Borrell postdoctoral contract [CD20/00189].Decades of research have consistently demonstrated the efficacy of electroconvulsive therapy (ECT) for the treatment of major depressive disorder (MDD), but its clinical use remains somewhat restricted because of its cognitive side effects. The aim of this systematic review is to comprehensively summarize current evidence assessing potential biomarkers of ECT-related cognitive side effects. Based on our systematic search of human studies indexed in PubMed, Scopus, and Web of Knowledge, a total of 29 studies evaluating patients with MDD undergoing ECT were reviewed. Molecular biomarkers studies did not consistently identify concentration changes in plasma S-100 protein, neuron-specific enolase (NSE), or Aβ peptides significantly associated with cognitive performance after ECT. Importantly, these findings suggest that ECT-related cognitive side effects cannot be explained by mechanisms of neural cell damage. Notwithstanding, S-100b protein and Aβ40 peptide concentrations, as well as brain-derived neurotrophic factor (BDNF) polymorphisms, have been suggested as potential predictive biomarkers of cognitive dysfunction after ECT. In addition, recent advances in brain imaging have allowed us to identify ECT-induced volumetric and functional changes in several brain structures closely related to memory performance such as the hippocampus. We provide a preliminary framework to further evaluate neurobiological cognitive vulnerability profiles of patients with MDD treated with ECT

Adaptació al model sanitari català de la guia de pràctica clínica sobre el maneig de la depressió major en l’adult

Depressió; Diagnòstic; Model sanitari catalàDepression; Diagnosis; Catalan healthcare systemDepresión; Diagnóstico; Modelo sanitario catalánAdaptació al model sanitari català de la guia de pràctica clínica sobre el maneig de la depressió major en l’adult elaborada per l’agència d’avaluació de tecnologies sanitàries Avalia-t, de Galícia, dins del Pla de qualitat del sistema nacional de salut i inclosa en el projecte GuíaSalud. Aquesta adaptació s’ha fet per iniciativa del Pla director de salut mental i addiccions del Departament de Salut de la Generalitat de Catalunya, amb dos objectius definits: adaptar les recomanacions de la guia a l’estructura dels serveis assistencials catalans i facilitar el desplegament del Programa de Cartera de Serveis de Salut Mental en Atenció Primària per tal d’incrementar la capacitat resolutiva de l’atenció primària, evitar la medicalització inadequada del malestar emocional, afavorir l’adequació de les intervencions terapèutiques en temps i intensitat, facilitar la coordinació entre diferents professionals i assegurar una atenció de qualitat de forma equitativa.Adaptación al modelo sanitario catalán de la guía de práctica clínica sobre el maneo de la depresión mayor en el adulto elaborada por la agencia de evaluación de tecnologías sanitarias Avalia-t, de Galicia, dentro del Pla de qualitat del sistema nacional de Salut y incluido en el proyecto GuíaSalud. Esta adaptación se ha realizado por iniciativa del Pla director de salut mental i addiccions del Departament de Salut de la Generalitat de Catalunya con dos objetivos definidos: Adoptar las recomendaciones de la guia a la estructura de servicios asistenciales catalanes y facilitar el desplegamiento del Programa de Cartera de Servicios de Salud Mental en Atención Primaria para incrementar la capacidad resolutiva de la atención primaria, evitar la medicalización inadecuada del malestar emocional, favorecer la adecuación de las intervenciones terapéuticas en tiempo y intensidad, facilitar la coordinación entre distintos profesionales y asegurar una atención de cualidad de forma equitativa

Adaptació al model sanitari català de la guia de pràctica clínica sobre el maneig de la depressió major en l'adult

Depressió; Salut mental; CatalunyaDepression; Mental health; CataloniaDepresión; Salud mental; CataluñaEls objectius de l’adaptació de la Guia de pràctica clínica sobre el maneig de la depressió major en l'adult són incrementar la capacitat resolutiva de l’atenció primària, evitar la medicalització inadequada del malestar emocional, afavorir l’adequació de les intervencions terapèutiques en temps i intensitat, facilitar la coordinació entre diferents professionals i assegurar una atenció de qualitat de forma equitativa

The MABIC project: An effectiveness trial for reducing risk factors for eating disorders

Challenges in the prevention of disordered eating field include moving from efficacy to effectiveness and developing an integrated approach to the prevention of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. This effectiveness trial tested whether this program has effects when previously trained community providers in an integrated approach to prevention implement the intervention. The research design involved a multi-center non-randomized controlled trial with baseline, post-test and 1-year follow-up measures. The sample included girls in the 8th grade from six schools (n = 152 girls) in a city near Barcelona (intervention group), and from eleven schools (n = 413 girls) in four neighboring towns (control group). The MABIC risk factors of disordered eating were assessed as main outcomes. Girls in the intervention group showed significantly greater reductions in beauty ideal internalization, disordered eating attitudes and weight-related teasing from pretest to 1-year follow-up compared to girls in the control group, suggesting that this program is effective under real-world conditions

Dealing with heterogeneity of cognitive dysfunction in acute depression : a clustering approach

Heterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients. In a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping. Treatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-resistant patients with preserved cognitive functioning (n = 68, 39%); cluster 2 was formed by treatment-resistant patients with selective cognitive deficits (n = 66, 38%) and cluster 3 consisted of resistant (n = 23, 58%) and non-resistant (n = 17, 42%) acute patients with significant deficits in all neurocognitive domains (n = 40, 23%). The findings provide evidence upon the existence of cognitive heterogeneity across patients in an acute depressive episode. Therefore, assessing cognition becomes an evident necessity for all patients diagnosed with MDD, and although treatment resistant is associated with greater cognitive dysfunction, non-resistant patients can also show significant cognitive deficits. By targeting not only mood but also cognition, patients are more likely to achieve full recovery and prevent new relapses

Emergency response times, response provider and patient satisfaction data for individuals in three Peruvian health care facilities

Questionnaire and results of a study of service quality and promptness of health care formulary used in study of patients involved in road traffic incidents in three different Peruvian cities between August – September 2009

Cognitive Biases Questionnaire for Psychosis (CBQp): Spanish Validation and Relationship With Cognitive Insight in Psychotic Patients

Introduction: Cognitive biases are key factors in the development and persistence of delusions in psychosis. The Cognitive Biases Questionnaire for Psychosis (CBQp) is a new self-reported questionnaire of 30 relevant situations to evaluate five types of cognitive biases in psychosis. In the context of the validation of the Spanish version of the CBQp, our objectives were to (1) analyze the factorial structure of the questionnaire with a confirmatory factor analysis (CFA), (2) relate cognitive biases with a widely used scale in the field of delusion cognitive therapies for assessing metacognition, specifically, Beck's Cognitive Insight Scale (BCIS) (1), and, finally, (3) associate cognitive biases with delusional experiences, evaluated with the Peters Delusions Inventory (PDI) (2). Materials and Methods: An authorized Spanish version of the CBQp, by a translation and back-translation procedure, was obtained. A sample of 171 patients with different diagnoses of psychoses was included. A CFA was used to test three different construct models. Associations between CBQp biases, the BCIS, and the PDI were made by correlation and mean differences. Comparisons of the CBQp scores between a control group and patients with psychosis were analyzed. Results: The CFA showed comparative fit index (CFI) values of 0.94 and 0.95 for the models with one, two, and five factors, with root mean square error of approximation values of 0.031 and 0.029. The CBQp reliability was 0.87. Associations between cognitive biases, self-certainty, and cognitive insight subscales of the BCIS were found. Similarly, associations between total punctuation, conviction, distress, and concern subscales of the PDI were also found. When compared with the group of healthy subjects, patients with psychoses scored significantly higher in several cognitive biases. Conclusion: Given the correlation between biases, a one-factor model might be more appropriate to explain the scale's underlying construct. Biases were associated with a greater frequency of delusions, distress, conviction, and concern as well as worse cognitive insight in patients with psychosis

Group and sex differences in social cognition in bipolar disorder, schizophrenia/schizoaffective disorder and healthy people

Background: Impairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences. Methods: 120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions. Results: Both groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief. Limitations: The cross-sectional design does not allow for causal inferences. Conclusion: BD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH