Actas espanolas de psiquiatria最新文献

Objective: This study aimed to investigate the effects of electroencephalographic biofeedback (EEG-BF) treatment on cognitive function, sleep quality, anxiety and depression levels and quality of life in patients with vascular cognitive impairment-no dementia (VCI-ND).

Methods: This study was a retrospective study that included a total of 128 patients diagnosed with VCI-ND at the Affiliated Hospital of North Sichuan Medical College from July 2022 to July 2024. The patients were divided into an EEG-BF group and a control group in accordance with whether they received EEG-BF treatment or not. Both groups received standard vascular risk factor management. The EEG-BF group separately received EEG-BF intervention two times a week for 12 weeks. Propensity score matching (PSM) was used to perform 1:1 nearest-neighbour matching between the two groups with respect to baseline characteristics. The matching variables included age; education; place of residence; family income; type of health insurance; number of underlying diseases; and pre-intervention scores on the Montreal Cognitive Assessment (MoCA), Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). The main outcome measures were the PSQI, MoCA, SAS, 36-item Short-Form Questionnaire (SF-36) and SDS before and after treatment.

Results: After PSM, the baseline covariates between the two groups were well balanced, with no significant differences. The Love plot showed a significant decrease in standardised differences in covariates after matching. After 12 weeks of intervention, the EEG-BF group was significantly better than the control group in terms of MoCA scores (p = 0.013), SAS scores (p = 0.002), SDS scores (p = 0.004) and some of the SF-36 dimensions, and the within-group before and after comparisons was statistically different (p < 0.05). The sleep quality of the EEG-BF group improved after treatment, whereas that of the control group exhibited no notable variation before and after the intervention (p > 0.05).

Conclusion: EEG-BF may help improve cognitive function, sleep quality, emotional state and life quality in patients with VCI-ND, offering a promising individualised non-pharmacological intervention for this population. Future multicentre, prospective studies are needed to further validate its prolonged therapeutic effect and neuromodulatory mechanisms.

Background: The course of bipolar disorder (BD) may be disabling on several occasions, whereas management of BD may be challenging due to poor treatment adherence and high service-disengagement rates. Such challenges in the treatment of BD may be even more relevant in rural settings. In rural Greece, treatment of mental disorders may be almost exclusively delivered by the interdisciplinary Mobile Mental Health Units (MMHUs). The objective of the study was to explore treatment of BD by a MMHU in a rural setting in Greece.

Methods: All medical records of BD patients that have been examined by the MMHU of Ioannina and Thesprotia (MMHU I-T) over a 17-year period (2007-2023) were assessed retrospectively. The studied outcomes were 1-year treatment engagement; treatment engagement at the study endpoint; and changes in hospitalizations and length of hospital stay in treatment-engaged patients.

Results: From a total of 62 examined patients, data was analyzed for 48 cases. The 1-year engagement rate was 81.3%, which dropped to 52.1% at the study endpoint, with a mean follow-up of 7.2 ± 4.0 years. Treatment-engaged patients were more likely to receive a mood stabilizer than disengaged patients. In treatment-engaged patients a significant reduction in total and voluntary hospitalizations was observed, whereas involuntary admissions remained unchanged. Length of hospital stay was significantly reduced after treatment engagement.

Conclusions: The results of the study are in line with previous research in Greek rural settings. The impact of the care by MMHUs on involuntary admissions in BD patients warrants further study. Future research should be multi-centered, with prospective design, and should address additional outcomes.

This overview aims to explore the key screening tools for detecting bipolar disorders (BDs): the Mood Disorder Questionnaire (MDQ), Bipolar Spectrum Diagnostic Scale (BSDS), Hypomania Checklist (HCL-32), and Rapid Mood Screener (RMS), while offering guidance to healthcare professionals in selecting the most appropriate tool for each clinical scenario. The MDQ is widely utilized due to its high specificity (0.90) for identifying Bipolar Disorder (BD) in psychiatric consultations, although it is more sensitive to bipolar I than bipolar II. The BSDS, designed to encompass a wider range of bipolar spectrum symptoms, exhibits a sensitivity of 0.70 and specificity of 0.89, which makes it a complementary tool to the MDQ. The HCL-32 concentrates on detecting hypomanic traits in Major Depressive Disorder (MDD) patients, showing good sensitivity (80%) but lower specificity (51%). It is particularly effective for distinguishing BD from unipolar depression, although it cannot differentiate between Bipolar Disorder type I (BDI) and Bipolar Disorder type II (BDII). The RMS is a newer tool that quickly screens for manic symptoms and risk factors, boasting a sensitivity of 0.88 and a specificity of 0.80. Together, these screening instruments facilitate the early identification of BDs, though positive results should always be followed by a thorough clinical evaluation. Employing multiple tools simultaneously can improve diagnostic accuracy and more effectively capture the diverse presentations of BDs.

Background: The Universal Access to Explicit Health Guarantees (AUGE) program in Chile provides clinical guidelines for the treatment of the first episode of Schizophrenia. This study contextualizes these guidelines within Chilean mental health policies and the theoretical framework of cultural biology, examining the balance between biomedical models and person-centered approaches.

Methods: Critical discourse analysis was employed to explore the AUGE guidelines, identifying strengths and limitations in their formulation and implementation. This methodology allowed for the examination of the underlying power dynamics and ideological assumptions embedded within the guidelines.

Results: The findings reveal that the Clinical Guidelines reinforce a normative character through grammatical constructions that often present patients as objects of intervention. Analysis of the social context shows an emphasis on a biomedical perspective and pharmacological interventions, potentially overshadowing rights-based and gender approaches in favor of international guidelines which may not be adequate in Chilean context. The guidelines also lack specific considerations for cultural particularities of ethnic minority, indigenous, and rural individuals. Finally, the guideline's narrative emphasizes deficits and dysfunctions, potentially contributing to stigma and positioning health professionals as the primary decision-makers. This may limit a truly participatory and empowering model of care.

Conclusion: The study underscores the necessity of a shift towards relational trust and co-construction in therapeutic practices. Recommendations on the formulation of mental health care Guidelines for Schizophrenia are proposed. Future guidelines should focus on increasing funding and support for community-based mental health services, implementing mandatory training for healthcare professionals on person-centered and culturally sensitive approaches and establishing mechanisms for ongoing patient and community feedback to ensure policy responsiveness and relevance.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease frequently associated with psychological comorbidities such as anxiety and depression.

Objective: This study aimed to analyse the influence of anxiety and depression on dermatological symptoms and inflammatory cytokines in patients with AD.

Methods: A retrospective cross-sectional analysis was conducted on the clinical records of 241 patients with AD treated at our hospital from December 2022 to December 2024, selected from an initial pool of 320 patients with AD. Sixty-one patients with anxiety/depression comprised the study group, whereas the remaining 180 served as controls. The patients were evaluated using the visual analogue scale (VAS) for pruritus and the Scoring Atopic Dermatitis (SCORAD), and the correlations of anxiety and depression levels with VAS and SCORAD scores were analysed. In addition, inflammatory cytokine levels (interleukin-6 [IL-6] and tumour necrosis factor-α [TNF-α]) were measured in both groups, and their associations with anxiety/depression scores were analysed.

Results: Among the 241 patients with AD, the study identified 19 cases of anxiety, 16 cases of depression and 26 cases of comorbid anxiety and depression. The study group presented significantly higher Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale, Depression Self-Rating Scale for Children (DSRSC) and Screen for Child Anxiety Related Emotional Disorders scores than the control group (p < 0.05). The study group had notably higher VAS and SCORAD scores than the control group (p < 0.05). Significant moderate positive correlations of anxiety/depression scores with VAS/SCORAD scores were found (p < 0.05). All anxiety/depression scores showed significant but generally weak to moderate positive correlations with IL-6 levels (all p < 0.05). For TNF-α, only HAMD demonstrated a moderate correlation (r = 0.4228, p < 0.0001), and DSRSC showed a weak but significant association (r = 0.2424, p = 0.0040).

Conclusion: Anxiety and depression are common among patients with AD, and these emotional states are significantly associated with skin rash and pruritus symptoms and inflammatory responses in patients. Therefore, the psychological well-being of patients should be given due consideration.

Background: Borderline Personality Disorder (BPD) may include rigid thoughts, interpersonal difficulties, unstable identity, and the presentation of intense and volatile emotions; the leading indicator for this condition is symptom severity (SS). Within this spectrum, there could be subjective cognitive complaints (SCC) that may worsen the severity of the clinical condition. The present study aimed to compare SCC scores between BPD participants and a group of control subjects (CS) and to determine the association between BPD symptom severity and SCC in participants with BPD.

Methods: 102 participants with BPD and 73 CS participants from Ramon de la Fuente Muñiz National Institute of Psychiaty were included. In order to measure symptom severity, participants responded to the Borderline Evaluation of Severity Over Time (BEST) scale, and for SCC through the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) scale.

Results: COBRA total scores were higher in participants with BPD (26.9 ± 9.3) compared to CS (12.9 ± 6.8; t = -10.8, p < 0.001). Positive correlations resulted between the COBRA total score and the BEST dimensions of thoughts and feelings (r = 0.38, p < 0.001), Negative behaviors (r = 0.30, p < 0.002), and the Total BEST score (r = 0.38, p < 0.001).

Conclusion: Participants of this study experience high levels of SS, which includes the constant presence of harmful and intrusive thoughts and feelings, as well as dysfunctional behaviors. This clinical context correlates positively with a high report of SCC, thus highlighting the importance of evaluating SCC as a relevant factor of patients' clinical experience and considering it within their personal needs to improve the course and prognosis throughout their treatment.

Background: Motor stereotypies (MS) are highly prevalent in children with autism spectrum disorders (ASD) and, although they tend to decrease with age, may persist into adulthood. The primary objective of this study was to describe the frequency, severity, number, and types of MS in adolescents and adults with ASD, to retrospectively evaluate their evolution over time, as well as to examine their relationship with sociodemographic and clinical variables.

Methods: A sample of 90 adolescents and adults with ASD were included in a cross-sectional and retrospective study. Rojahn's Stereotypic Behavior Scale (SBS) was used to measure the frequency, severity, and types of MS, while the Achenbach System of Empirically Based Assessment (ASEBA) inventories were utilized to assess psychiatric comorbidity.

Results: MS were observed in 86.5% of cases. The most frequent MS in adolescents and adults with ASD were complex hand and finger movements and pacing (both of which were the most persistent over time) and repetitive body movements (which decreased in periodicity over time). Other, more socially inappropriate MS diminished over time. A significant reduction in the frequency and severity of MS was observed. No correlation was found between age and frequency of MS, and no differences were observed between men and women. Individuals with ASD and intellectual disability (ID) exhibited more types of MS per case and more frequent MS than those without ID, although these differences were not statistically significant. The ASD group with psychopathological comorbidities showed greater frequency and severity of MS, as well as more types of MS per case.

Conclusions: MS decreased in frequency and severity over time but persisted in ASD, particularly those that are more specific to ASD. The most socially inappropriate MS tended to disappear. The presence of MS in adolescents and adults with ASD was not influenced by age or sex. Adolescents and adults with ASD and ID or psychopathological comorbidities exhibited a greater variety of stereotypies, with the psychopathological comorbidities group showing higher frequency and severity of MS. Understanding the characteristics of MS could aid in predicting their progression, designing more targeted treatments (if needed), and identifying phenotypic subgroups to facilitate the discovery of associated risk genes.

Background: Attachment styles may exert an influence on emotional regulation, specifically, secure attachment has been associated with more adaptative emotion regulation strategies and enhanced adult well-being. Despite the recognized importance of secure attachment in promoting mental health and well-being, little is known about how attachment styles manifest and evolve in adults with autism spectrum disorder (ASD). This systematic review examines "What is the connection between attachment styles and psychological, relational, and clinical variables in individuals with ASD or autistic traits, according to scientific research?".

Methods: A literature search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed across PubMed, Web of Science and ProQuest Central databases. Using HubMeta, 12 studies were selected based on set criteria. Two independent reviewers conducted the entire process, from searching and selecting studies to extracting data and assessing quality. Inter-rater agreement was high, with kappa values ranging from 0.94 to 1.

Results: The sample included 91,078 (98.99%) women and 346 (0.38%) men. Studies assessed attachment, ASD or autistic traits (Broader Autism Phenotype, BAP), intelligence quotient (IQ), depression, anxiety, stress, marital and relationship satisfaction, emotional availability and intelligence, empathy, ASD difficulties, personality traits and motivational processes, and gaming disorder. Individuals with ASD show higher rates of insecure attachment than general population and this could have an impact on their mental health and well-being. Parents with ASD also show difficulties when establishing the bond with their children.

Conclusion: This review highlights the importance of developing interventions with adults with ASD with the aim to establish better bonding and reaching greater well-being and mental health. The PROSPERO Registration: CRD42024628086, (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024628086).

Background: The pathophysiological mechanisms and relevant biological markers for epileptic seizures largely remained unknown. However, several studies have reported elevated levels of inflammatory factors in the serum of individuals with epileptic seizures. Therefore, this study aims to explore the relationship between inflammatory factors and epileptic seizures.

Methods: We retrieved relevant literature published in various databases, including Embase, PubMed, Cochrane Library, Web of Science, China Wanfang, HowNet, Chinese Biomedical Literature, and VIP, from inception to December 2023. The relationship between inflammatory factors, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), and epileptic seizure was assessed. The selected manuscripts were evaluated based on the predetermined inclusion and exclusion criteria, and relevant data were extracted for meta-analysis using Rev Man 5.0 software (RevMan, Oxford, UK) and Stata 12.

Results: We observed that individuals with epileptic seizures had significantly elevated levels of IL-1β (random-effects model, Standardized Mean Difference (SMD) = 1.87, 95% confidence interval (CI) = [1.17, 2.56], I2 = 96.6%, p = 0.010), IL-6 (SMD = 1.73, 95% CI = [0.41, 3.05], I2 = 96.9%, p = 0.010), and TNF-α (random-effects model, SMD = 2.16, 95% CI = [1.13, 3.18], I2 = 96.5%, p = 0.010). Moreover, the subgroup analysis indicated significant differences between the two groups for the country (origin of publication) (SMD = 1.87, 95% CI = [1.17, 2.56], I2 = 96.6%, p < 0.001), sampling time (SMD = 1.87, 95% CI = [1.17, 2.56], I2 = 96.6%, p = 0.010), and sample source (SMD = 1.87, 95% CI = [1.17, 2.56], I2 = 96.6%, p = 0.010).

Conclusion: The IL-1β, IL-6, and TNF-α levels are increased in individuals with epileptic seizures, which could serve as effective biomarkers for epileptogenesis.