Eficacia de la terapia cognitivo conductual en la prevención de la depresión posparto

Objetivo: Evaluar la eficacia de la terapia cognitivo conductual (TCC) en la prevención de la depresión posparto (DPP) en mujeres embarazadas consideradas en riesgo de padecerla. Método: Revisión bibliográfica en PubMed, Medline, PsychInfo, Embase y de la Cochrane Library de publicaciones efectuadas entre enero de 1991 y junio de 2012 respecto de investigaciones sobre la eficacia de la TCC en la prevención de la DPP. Resultados: De la literatura analizada se concluye que la depresión en el embarazo requiere de un manejo eficiente tanto para tratar los síntomas de la depresión preparto (DAP), como de prevenir la DPP. Mientras diversos estudios han demostrado la eficacia de la TCC en el tratamiento de la DPP, sólo pocos estudios controlados se han centrado sobre su eficacia en la prevención de la DPP. La eficacia en la prevención de la DPP en mujeres en riesgo durante el embarazo ha sido apoyada sólo por pocos estudios, los cuales presentan algunas limitaciones metodológicas. Conclusión: Resultan necesarios estudios clínicos para confirmar la eficacia de tal estrategia de prevención psicoterapéutica en las mujeres en riesgo de DPP. Aims: To evaluate the efficacy of cognitive-behavioral therapy (CBT) in the prevention of postnatal depression (PD) in pregnant women at risk. Methods: PubMed, Medline, PsychInfo, Embase, and the Cochrane Library data bases were searched from January 1991 to June 2011 to review studies on the efficacy of CBT in the prevention of PD. Results: The literature analyzed recommends that depression in pregnancy requires an efficient management to provide mother's symptoms relief as well as to prevent PD. While several studies demonstrated the efficacy of CBT in the treatment of PD, only a few controlled studies focused on its efficacy in the prevention of PD in women identified at risk during pregnancy. The efficacy of CBT in preventing PD in pregnant women at risk is supported by only a few studies, presenting some methodological flaws. Conclusion: Better designed trials are needed to strongly support the efficacy of such psychotherapeutic preventive strategy in women at risk for PD

Coherencia sistémica e identitaria en mujeres con vaginismo primario

El vaginismo es una disfunción sexual femenina que genera gran impacto en la relación de pareja. En el presente artículo se busca describir, desde la psicología cognitiva post-racionalista, aquellas características identitarias y de personalidad observadas en 50 mujeres diagnosticadas con vaginismo primario sin antecedentes de alteraciones físicas o ginecológicas y con una historia de vida sin traumas ni abusos sexuales. De acuerdo a lo observado, se trata de mujeres con una positiva visión de sí mismas, que se orientan hacia la consecución del control entre dos necesidades típicamente contrapuestas, la de ser protegidas y la de sentirse libres e independientes. Por ello tienden a centrarse en la regulación de la distancia entre acercamiento y alejamiento respecto de los demás, sobrecontrolando sus emociones. Así, el vaginismo constituiría una forma en la cual se limita la intromisión y la constricción por parte del otro, a la vez que se evita la dependencia del mismo, y se ejerce control sobre el compromiso emocional mediante la no entrega completa de sí misma durante la relación sexual. Vaginismus is female sexual dysfunction that generates big impact on the relationship. The present article seeks to describe, from the post-rationalist cognitive psychology, those identity and personality characteristics observed in 50 women diagnosed with primary vaginismus without history of physical or gynecological disorders and a history of life without trauma or sexual abuse. According to observations, it is women with a positive view of themselves, which are oriented towards control between two typically conflicting requirements, that of being protected and to feel free and independent. Therefore tend to focus on the regulation of the distance between rapprochement and estrangement from others, overcontrolling their emotions. So, vaginismus constitute a form in which the intrusion is limited and constrained by the other, while avoiding dependence thereof, and exercised control over emotional engagement through full delivery not herself during intercourse

Evaluación de la calidad de vida en mujeres con vaginismo primario mediante el WHOQOL-BREF

Antecedentes: El vaginismo es una disfunción sexual que impide Ia penetración y que afecta a cerca de un 5% de las mujeres y que les genera malestar tanto a ellas como a sus parejas. Objetivo: Conocer la calidad de vida de mujeres con vaginismo primario y comparar con un grupo control. Método: Aplicación presencial del WHOQOL-BREF a 50 mujeres con vaginismo primario y a 47 mujeres sin patología, socio-demográficamente similares. Resultados: El nivel de calidad de vida en las mujeres con vaginismo fue menor a aquella del grupo de comparación respecto a la calidad general de la vida y la salud, y en tres de los cuatro dominios del WHOQOL-BREF. Conclusión: El vaginismo es una condición que afecta la calidad de vida de las mujeres con ese diagnóstico. Background: Vaginismus is a sexual dysfunction that prevents the penetration and affects about 5% of women and makes them feel upset both them and their partners. Objective: Determine the quality of life of women with primary vaginismus and compared with a control group. Method: Application of the WHOQOL-BREF to 50 women with primary vaginismus and 47 women without pathology and similar demographically status. Results: The level of quality of life in women with vaginismus was lower than that of the comparison group regarding the overall quality of life and health, and in three of the four domains of the WHOQOL-BREF. Conclusion: Vaginismus is a condition that affects the quality of life of women with this diagnosis

Irrelevant Features of a Stimulus Can Either Facilitate or Disrupt Performance in a Working Memory Task: The Role of Fluid Intelligence

It has been shown that fluid intelligence (gf) is fundamental to overcome interference due to information of a previously encoded item along a task-relevant domain. However, the biasing effect of task-irrelevant dimensions is still unclear as well as its relation with gf. The present study aimed at clarifying these issues. Gf was assessed in 60 healthy subjects. In a different session, the same subjects performed two versions (letter-detection and spatial) of a three-back working memory task with a set of physically identical stimuli (letters) presented at different locations on the screen. In the letter-detection task, volunteers were asked to match stimuli on the basis of their identity whereas, in the spatial task, they were required to match items on their locations. Cross-domain bias was manipulated by pseudorandomly inserting a match between the current and the three back items on the irrelevant domain. Our findings showed that a task-irrelevant feature of a salient stimulus can actually bias the ongoing performance. We revealed that, at trials in which the current and the three-back items matched on the irrelevant domain, group accuracy was lower (interference). On the other hand, at trials in which the two items matched on both the relevant and irrelevant domains, the group showed an enhancement of the performance (facilitation). Furthermore, we demonstrated that individual differences in fluid intelligence covaries with the ability to override cross-domain interference in that higher gf subjects showed better performance at interference trials than low gf subjects. Altogether, our findings suggest that stimulus features irrelevant to the task can affect cognitive performance along the relevant domain and that gf plays an important role in protecting relevant memory contents from the hampering effect of such a bias

Apathy, but Not Depression, Reflects Inefficient Cognitive Strategies in Parkinson\u27s Disease

Background The relationship between apathy, depression and cognitive impairment in Parkinson\u27s disease (PD) is still controversial. The objective of this study is to investigate whether apathy and depression are associated with inefficient cognitive strategies in PD. Methods In this prospective clinical cohort study conducted in a university-based clinical and research movement disorders center we studied 48 PD patients. Based on clinical evaluation, they were classified in two groups: PD with apathy (PD-A group, n = 23) and PD without apathy (PD-NA group, n = 25). Patients received clinical and neuropsychological evaluations. The clinical evaluation included: Apathy Evaluation Scale-patient version, Hamilton Depression Rating Scale-17 items, the Unified Parkinson\u27s Disease Rating Scale and the Hoehn and Yahr staging system; the neuropsychological evaluation explored speed information processing, attention, working memory, executive function, learning abilities and memory, which included several measures of recall (immediate free, short delay free, long delay free and cued, and total recall). Findings PD-A and PD-NA groups did not differ in age, disease duration, treatment, and motor condition, but differed in recall (p\u3c0.001) and executive tasks (p\u3c0.001). Immediate free recall had the highest predictive value for apathy (F =  10.94; p = 0.002). Depression and apathy had a weak correlation (Pearson index  = 0.3; p\u3c0.07), with three items of the depression scale correlating with apathy (Pearson index between .3 and.4; p\u3c0.04). The depressed and non-depressed PD patients within the non-apathetic group did not differ. Conclusion Apathy, but not depression, is associated with deficit in implementing efficient cognitive strategies. As the implementation of efficient strategies relies on the fronto-striatal circuit, we conclude that apathy, unlike depression, is an early expression of executive impairment in PD

Cohort study of prevalence and phenomenology of tremor in dementia with Lewy bodies

To study prevalence, specific patterns and response to treatment of tremor in dementia with Lewy bodies (DLB), in comparison with other tremulous disorders prevalence, qualitative and quantitative features of tremor were studied in an incident cohort of 67 dopaminergic treatment naive DLB, 111 Parkinson’s Disease (PD) and 34 Essential Tremor (ET) patients. Tremulous DLB patients (tDLB) were compared with tremulous PD (tPD) and ET patients and followed for 2 years. Double blind placebo-controlled acute drug challenge with l-Dopa and alcohol was performed in all ET, 24 tDLB and 27 tPD. Effects of dopaminergic chronic treatment in all tDLB and tPD patients and primidone in 8 tDLB were also assessed. Tremor occurred in 44.76 % of DLB patients. The tDLB patients presented a complex pattern of mixed tremors, characterized by rest and postural/action tremor, including walking tremor and standing overflow in 50 % tDLB. Standing tremor with overflow was characteristic of tDLB (p \u3c 0.001). Head tremor was more frequent in tDLB than tPD and ET (p = 0.001). The tDLB tremors were reduced by acute and chronic dopaminergic treatments (p \u3c 0.01) but not by alcohol or primidone. Tremor occurs commonly in DLB patients with a complex mixed tremor pattern which shows a significant response to acute and chronic dopaminergic treatments. Recognizing that there is a clinical category of tremulous DLB may help the differential diagnosis of tremors. Electronic supplementary material The online version of this article (doi:10.1007/s00415-013-6853-y) contains supplementary material, which is available to authorized users

Movement Preparation and Bilateral Modulation of Beta Activity in Aging and Parkinson’s Disease

In previous studies of young subjects performing a reaction-time reaching task, we found that faster reaction times are associated with increased suppression of beta power over primary sensorimotor areas just before target presentation. Here we ascertain whether such beta decrease similarly occurs in normally aging subjects and also in patients with Parkinson’s disease (PD), where deficits in movement execution and abnormalities of beta power are usually present. We found that in both groups, beta power decreased during the motor task in the electrodes over the two primary sensorimotor areas. However, before target presentation, beta decreases in PD were significantly smaller over the right than over the left areas, while they were symmetrical in controls. In both groups, functional connectivity between the two regions, measured with imaginary coherence, increased before the target appearance; however, in PD, it decreased immediately after, while in controls, it remained elevated throughout motor planning. As in previous studies with young subjects, the degree of beta power before target appearance correlated with reaction time. The values of coherence during motor planning, instead, correlated with movement time, peak velocity and acceleration. We conclude that planning of prompt and fast movements partially depends on coordinated beta activity of both sensorimotor areas, already at the time of target presentation. The delayed onset of beta decreases over the right region observed in PD is possibly related to a decreased functional connectivity between the two areas, and this might account for deficits in force programming, movement duration and velocity modulation

Neural Activations during Visual Sequence Learning Leave a Trace in Post-Training Spontaneous EEG

Recent EEG studies have shown that implicit learning involving specific cortical circuits results in an enduring local trace manifested as local changes in spectral power. Here we used a well characterized visual sequence learning task and high density-(hd-)EEG recording to determine whether also declarative learning leaves a post-task, local change in the resting state oscillatory activity in the areas involved in the learning process. Thus, we recorded hd-EEG in normal subjects before, during and after the acquisition of the order of a fixed spatial target sequence (VSEQ) and during the presentation of targets in random order (VRAN). We first determined the temporal evolution of spectral changes during VSEQ and compared it to VRAN. We found significant differences in the alpha and theta bands in three main scalp regions, a right occipito-parietal (ROP), an anterior-frontal (AFr), and a right frontal (RFr) area. The changes in frontal theta power during VSEQ were positively correlated with the learning rate. Further, post-learning EEG recordings during resting state revealed a significant increase in alpha power in ROP relative to a pre-learning baseline. We conclude that declarative learning is associated with alpha and theta changes in frontal and posterior regions that occur during the task, and with an increase of alpha power in the occipito-parietal region after the task. These post-task changes may represent a trace of learning and a hallmark of use-dependent plasticity

Apathy, but Not Depression, Reflects Inefficient Cognitive Strategies in Parkinson's Disease

The relationship between apathy, depression and cognitive impairment in Parkinson's disease (PD) is still controversial. The objective of this study is to investigate whether apathy and depression are associated with inefficient cognitive strategies in PD.In this prospective clinical cohort study conducted in a university-based clinical and research movement disorders center we studied 48 PD patients. Based on clinical evaluation, they were classified in two groups: PD with apathy (PD-A group, n = 23) and PD without apathy (PD-NA group, n = 25). Patients received clinical and neuropsychological evaluations. The clinical evaluation included: Apathy Evaluation Scale-patient version, Hamilton Depression Rating Scale-17 items, the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr staging system; the neuropsychological evaluation explored speed information processing, attention, working memory, executive function, learning abilities and memory, which included several measures of recall (immediate free, short delay free, long delay free and cued, and total recall).PD-A and PD-NA groups did not differ in age, disease duration, treatment, and motor condition, but differed in recall (p<0.001) and executive tasks (p<0.001). Immediate free recall had the highest predictive value for apathy (F = 10.94; p = 0.002). Depression and apathy had a weak correlation (Pearson index= 0.3; p<0.07), with three items of the depression scale correlating with apathy (Pearson index between .3 and.4; p<0.04). The depressed and non-depressed PD patients within the non-apathetic group did not differ.Apathy, but not depression, is associated with deficit in implementing efficient cognitive strategies. As the implementation of efficient strategies relies on the fronto-striatal circuit, we conclude that apathy, unlike depression, is an early expression of executive impairment in PD