Clinica Y Salud最新文献

Blood phobia could be defined by the presence of fear and a number of avoiding or escaping behaviors regarding places, objects and situations related to the sight of blood, needles or injuries, with nearly an 80% of cases having a history of fainting. This phobia has a prevalence of 31‰ and usually implies a great impact on the subject's life. The present study is a review of the most outstanding literature in the field, addressing the explanatory variables along with the most effective treatments. Then, literature has been searched along three research lines: sensitivity to disgust, the role of hyperventilation, and the attentional bias. Also, the most effective procedures in the field have being reviewed. The results show that there is not a significant difference between the Applied Tension (AT) and the Exposure (E) alone – the most efficient techniques to treat this phobia. Regarding the three research lines mentioned above, the more significant procedures used over the last few years have been the role of hyperventilation and the attentional bias. Finally, a set of guidelines to work with these patients are put forward regarding these findings.

This study is an adaptation in a Spanish sample of the Mindful Attention Awareness Scale (MAAS) (Brown & Ryan, 2003). The study was conducted with a clinical sample of patients with anxiety disorders, depressive disorders and borderline personality disorder (N = 100), a sample of the general population (N = 100), and a sample of university students (N = 54). The criterion validity was verified using correlations with CBAS, BDI-II, BAI, and AAQ-II. The results indicate a high degree of internal consistency (α = .88), equivalent to those obtained in studies conducted in other countries with samples consisting primarily of students. Significant statistical differences were found between the scores of the sample groups. The general population sample demonstrated a higher degree of mindfulness as measured by the MAAS than the student sample, which in turn demonstrated a higher degree of mindfulness than the clinical sample.

Objective

Though difficulties in emotional processing have been associated to eating disorders (EDs), the debate as to whether these difficulties are antecedents or consequence of EDs remains a contentious issue. Most studies have focused on long-term adult patients, but few studies have assessed adolescent patients. This study compared difficulties in emotional recognition and regulation in adult and adolescent patients to determine if they were predisposing factors and/or maintenance factors.

Method

A total of 48 patients (27 adults, 21 adolescents) were compared with 41 healthy controls (13 adults, and 28 adolescents) using the Toronto Alexithymia Scale (TAS-20) and the Difficulties in Emotion Regulation Scale (DERS).

Results

All of the patients exhibited more difficulties in emotional recognition (alexithymia) and regulation than controls. No differences were observed among patients in terms of body mass index (BMI). The intensity of these difficulties was modulated by age and the severity of the disorder. Alexithymia was more intense in adult patients than in adolescent patients, but both groups showed similar difficulties in emotional acceptance and regulation. Severely affected patients (adult and adolescents) exhibited higher levels of alexithymia, rejection, and emotional dysfunction.

Conclusion

It is crucial that emotional therapeutic interventions are carried out from the commencement of treatment. Prevention programmes should enhance recognition, emotional acceptance, and regulation in individuals at risk.

In this research, the relationship between attachment and psychopathology was studied in a sample of 40 adolescents and young adults who have suffered from intrafamily maltreatment. Attachment was assessed with Bartholomew's RQ, which distinguishes four attachment styles depending on the positive or negative image of the self and others: secure, preoccupied, fearful and dismissive attachment. Results show that insecure attachment, particularly the dismissive subtype, is the most prevalent one. Slightly more than half of the sample (52.5%) shows clinically significant symptoms (as assessed with the SCL-90-R), particularly hostility, obsessive-compulsive, paranoid ideation, psychoticism, and interpersonal sensitivity. Attachment styles with a negative vision of the self (preoccupied and fearful) tend to show more psychopathological symptoms. The clinical implications of these results are also discussed.

Symptom validity test (SVT) results should be resistant against sociodemographic variables. Healthy, cooperative respondents should be able to pass these tests. The purpose of the study was to collect reference data for a selection of SVTs (Medical Symptom Validity Test, Structured Inventory of Malingered Symptomatology, Amsterdam Short-Term Memory Test, Emotional Numbing Test, Reliable Digit Span, Maximum Span Forward). A representative population-based sample of 100 German speaking Swiss citizens from 18 to 60 years of age was investigated. Multiple regression analyses revealed that age and verbal intelligence had an effect on various SVTs, whereas sex and education did not. The rate of positive test scores ranged from 1% (Emotional Numbing Test, Structured Inventory of Malingered Symptomatology) to 4% (Maximum Span Forward). One of the pertinent questions is if such positive results in reference or normative samples represent false positives or true positives and how to deal with the problem.

In spite of the economic and social relevance of the prevalence of malingering in temporary incapacity, there are very few studies in Spain dealing with this problem. The aim of the present paper is to address this matter by looking into those pathologies that according to professionals show the highest rates of malingering in the medico-legal context. For this purpose, we used an incidental sample of 161 doctors (56% of them were women) from 26 different Spanish provinces, with an age range of 30 to 59 (M = 43.6, SD = 6.5) and an average seniority on the job of 17 years (SD = 6.3). They were asked to complete a brief questionnaire indicating those pathologies in which they thought malingering was more frequent, what percentage of these conditions they thought was simulated, the sociodemographic profile of malingerers (age, income, occupation, etc.), and what data they considered to be an indication for suspicion. The results showed that the doctors perceived the highest rates of malingering to be associated with chronic pain conditions (cervical sprain, lumbago, neck and shoulder pain, fibromyalgia) and affective/emotional conditions (anxiety and depression). The prototypical sociodemographic profile was a middle-aged person, with an unstimulating job and a low or moderate income, and who once had an injury or disorder and decided to prolong it over time in order to maintain the benefits obtained. These results are presented within the frame of the adaptive malingering model and linked to the need to develop specific malingering protocols which minimize the risk of false positives and false negatives in the assessment process.

The purpose of this study is to search for a validity scale for detecting social desirability bias in the MMPI-2-RF. To that end, data from scales considered as underreporting on the MMMPI-2-RF, such as the Edwards and Wiggins Social Desirability (Esd and Wsd respectively) scales, the Other Deception (ODecp) scale of Nichols & Greene, the Superlative (S) scale of Butcher and Han, and Uncommon Virtues (L-r) and Adjustment Validity (K-r) scales, was analyzed comparatively. The sample was taken from the Spanish adaptation of the MMPI-2 database, with the corresponding item selection made from the restructured MMPI-2-RF. Two groups of participants were established: The honest group and the dissimulator group, participants of the latter being instructed to give socially desirable responses. A Receiver Operating Characteristic (ROC) methodology was used to suggest a scale that offers more diagnostic accuracy.

A multidimensional study on symptom exaggeration in fibromyalgia patients is presented. The main aim is to detect discriminant patterns of malingered pain-related disability in order to develop a detailed protocol for the assessment of suspected malingering in cases of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Overall sample (N = 113) consisted of four groups: fibromyalgia patients not involved in litigation (n = 36), fibromyalgia patients involved in litigation (n = 26), analogue fibromyalgia-instructed participants (n = 21), and control group (n = 30). Several medical and psychological tests were administered to participants, including medical complementary tests, the Spanish adaptation of the General Self-Efficacy Scale (Baessler and Schwarzer, 1996), the Life Personal Self-Report Scale (González-Ordi, Santamaría, & Casado-Morales, 2012), the Spanish adaptation of the Fibromyalgia Impact Questionnarie (FIQ, Monterde, Salvat, Montull, & Fernández-Ballart, 2004), the Spanish version of the SF-36 Health Survey (Alonso, Prieto, & Antó, 1995), the Spanish adaptation of the Structured Inventory of Malingered Symptomatology (SIMS, González Ordi and Santamaría, 2009), and the Spanish adaptation of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF, Ben-Porath and Tellegen, 2008a). Data on mean group differences and predictive accuracy of the instruments used are presented. A protocol for the detection of malingering based on the differential profile scores between fibromyalgia non-litigants and litigants are also addressed.

The aim of this preliminary study is to find a symptom exaggeration pattern in patients diagnosed of mixed anxiety-depressive disorder and adjustment disorder in the medico-legal context. Overall sample (n = 26) was divided in two groups: bona fide patients (n = 12) and suspected of malingering patients (n = 14). The Spanish adaptations of the Structured Inventory of Malingered Symptomatology (SIMS) and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) were administered to all participants. Regarding the SIMS scores, the best discriminant scales found between groups were Total scale, Neurological Impairment (NI), Amnesic Disorders (AM), and Affective Disorders (AF) scales. Regarding the MMPI-2-RF scores, the best discriminant validity scales were, in order, Fs, Fp-r, F-r and FBS-r, and the best discriminant substantive scales were those regarding somatic complaints (RC1, HPC, NUC, and COG), thought disorders (THD, RC8, and PSYC-r), and mood disorders (Rcd and ACT). Results support the use of both SIMS and MMPI-2-RF as a convergent source of information for the detection of symptom exaggeration in mixed anxiety-depressive disorder and adjustment disorder in the medico-legal context.