Publications by authors named "María-Fe Bravo-Ortiz"

24 Publications

  • Page 1 of 1

Association between perceived discrimination and mental health outcomes among health workers during the initial COVID-19 outbreak.

Rev Psiquiatr Salud Ment 2021 Jun 18. Epub 2021 Jun 18.

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States; Department of Psychiatry, Clinical Psychology and Mental Health, Hospital Universitario La Paz, Madrid, Spain.

Background: During the initial COVID-19 outbreak, health systems faced unprecedented organizational stress. Meanwhile, reports of episodes of discrimination and violence towards healthcare workers increased globally. This study explores the association between perceived discrimination and mental health outcomes in a large sample of healthcare workers in Spain.

Materials And Methods: Healthcare workers from inpatient and outpatient facilities (N=2,053) filled an on-line questionnaire in May or June 2020. Mental health outcomes included depression symptoms (Patient Health Questionnaire [PHQ-9]), psychological distress (General Health Questionnaire [GHQ-12]) and death thoughts (Columbia Suicide Severity Rating Scale [C-SSRS]). We also measured perceived discrimination and/or stigmatization due to being a healthcare worker since pandemic onset. Regression models adjusted for potential confounding sources (age, sex, history of a mental health diagnosis and type of job) were fitted.

Results: Thirty percent of the respondents reported discrimination and/or stigmatization. Perceived discrimination was associated with higher depression (B=2.4, 95 percent CI: 1.8, 2.9) and psychological distress (B=1.1, 95 percent CI: 0.7, 1.4) scores, and with a 2-fold increase in risk of reporting death thoughts (OR=2.0, 95 percent CI: 1.4, 3.1).

Conclusions: Perceived discrimination is a modifiable driver of mental health problems among healthcare workers. Mass media, legislators, and healthcare institutions must put in place prevention and restoration strategies to limit discrimination towards healthcare workers and reduce its mental health impact.
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http://dx.doi.org/10.1016/j.rpsm.2021.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253602PMC
June 2021

[Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain].

Salud Colect 2021 Mar 23;17:e3045. Epub 2021 Mar 23.

Psiquiatra. Profesor Honorífico, Universidad de Alcalá, Alcalá de Henares, España.

Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice.
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http://dx.doi.org/10.18294/sc.2021.3045DOI Listing
March 2021

How does neighbourhood socio-economic status affect the interrelationships between functioning dimensions in first episode of psychosis? A network analysis approach.

Health Place 2021 May 18;69:102555. Epub 2021 Mar 18.

Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. Electronic address:

The links between psychosis and socio-economic disadvantage have been widely studied. No previous study has analysed the interrelationships and mutual influences between functioning dimensions in first episode of psychosis (FEP) according to their neighbourhood household income, using a multidimensional and transdiagnostic perspective. 170 patients and 129 controls, participants in an observational study (AGES-CM), comprised the study sample. The WHO Disability Assessment Schedule (WHODAS 2.0) was used to assess functioning, whereas participants' postcodes were used to obtain the average household income for each neighbourhood, collected by the Spanish National Statistics Institute (INE). Network analyses were conducted with the aim of defining the interrelationships between the different dimensions of functioning according to the neighbourhood household income. Our results show that lower neighbourhood socioeconomic level is associated with lower functioning in patients with FEP. Moreover, our findings suggest that "household responsibilities" plays a central role in the disability of patients who live in low-income neighbourhoods, whereas "dealing with strangers" is the most important node in the network of patients who live in high-income neighbourhoods. These results could help to personalize treatments, by allowing the identification of potential functioning areas to be prioritized in the treatment of FEP according to the patient's neighbourhood characteristics.
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http://dx.doi.org/10.1016/j.healthplace.2021.102555DOI Listing
May 2021

Mindfulness-based mobile app reduces anxiety and increases self-compassion in healthcare students: A randomised controlled trial.

Med Teach 2021 06 28;43(6):686-693. Epub 2021 Feb 28.

Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain.

Objective: To compare the effect of a mindfulness-based mobile application versus an in-person mindfulness-based training program in terms of reducing anxiety and increasing empathy, self-compassion, and mindfulness in a population of healthcare students.

Methods: The authors conducted a single-blind, randomised controlled trial with three parallel groups. Participants were allocated to the mobile app, the in-person mindfulness-based program (IMBP), or a control group. Assessments at baseline and postintervention (8 weeks) included measures of anxiety, empathy, self-compassion, and mindfulness.

Results: Of 168 students randomised, 84 were analysed on an intention-to-treat basis (app:  = 31; IMBP:  = 23; control:  = 30). The mobile app group showed a large effect size for reductions in trait anxiety compared with controls ( = 0.85,  = 0.003), and a medium, nonsignificant effect compared with the IMBP group ( = 0.52,  = 0.152). Participants from both interventions experienced a significant increase in self-compassion and mindfulness compared with controls. Levels of empathy remained unchanged for the 3 arms.

Conclusions: A mobile app can be as effective as an IMBP in reducing anxiety and increasing self-compassion and mindfulness among healthcare students.
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http://dx.doi.org/10.1080/0142159X.2021.1887835DOI Listing
June 2021

The interplay between functioning problems and symptoms in first episode of psychosis: An approach from network analysis.

J Psychiatr Res 2021 04 15;136:265-273. Epub 2021 Feb 15.

Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. Electronic address:

The relationship between psychotic symptoms and global measures of functioning has been widely studied. No previous study has assessed so far the interplay between specific clinical symptoms and particular areas of functioning in first-episode psychosis (FEP) using network analysis methods. A total of 191 patients with FEP (age 24.45 ± 6.28 years, 64.9% male) participating in an observational and longitudinal study (AGES-CM) comprised the study sample. Functioning problems were assessed with the WHO Disability Assessment Schedule (WHODAS), whereas the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Network analysis were conducted with the aim of analysing the patterns of relationships between the different dimensions of functioning and PANSS symptoms and factors at baseline. According to our results, the most important nodes were "conceptual disorganization", "emotional withdrawal", "lack of spontaneity and flow of conversation", "delusions", "unusual thought content", "dealing with strangers" and "poor rapport". Our findings suggest that these symptoms and functioning dimensions should be prioritized in the clinical assessment and management of patients with FEP. These areas may also become targets of future early intervention strategies, so as to improve quality of life in this population.
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http://dx.doi.org/10.1016/j.jpsychires.2021.02.024DOI Listing
April 2021

People with psychosis improve affective social cognition and self-care after a mindfulness-based social cognition training program (SocialMIND).

Psychiatr Rehabil J 2021 Feb 11. Epub 2021 Feb 11.

Hospital La Paz Institute for Health Research (IdiPAZ), Neuroscience Research Area.

Objective: This study explores whether social cognition and social functioning improve after a mindfulness-based social cognition training (SocialMIND).

Methods: Thirty-eight outpatients with psychosis completed an assessment with social cognition (Eyes Test, Ambiguous Intentions and Hostility Questionnaire [AIHQ], and Hinting Task) and social functioning tasks (Personal and Social Performance [PSP] scale) before and after eight SocialMIND weekly sessions. Mean differences between timepoints were standardized and 95% confidence intervals were obtained with a paired samples t-test.

Results: The scores of the Eyes Test (95% CI [.43, 3.32], d = .48), the Hostility Bias subscale (AIHQ) (95% CI [-.29, -.01], d = .44), and the self-care difficulties subscale (PSP) (95% CI [-.77, -.09], d = .45) improved after the intervention.

Conclusions: and Implications for practice: The results of SocialMIND-8 are very promising in terms of developing comprehensive rehabilitation programs. Further trials must address its effectiveness against a control group during longer follow-up periods. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/prj0000466DOI Listing
February 2021

Implementation of a Mindfulness-Based Crisis Intervention for Frontline Healthcare Workers During the COVID-19 Outbreak in a Public General Hospital in Madrid, Spain.

Front Psychiatry 2020 30;11:562578. Epub 2020 Oct 30.

Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain.

The COVID-19 outbreak is having an impact on the well-being of healthcare workers. Mindfulness-based interventions have shown effectiveness in reducing stress and fostering resilience and recovery in healthcare workers. There are no studies examining the feasibility of brief mindfulness-based interventions during the COVID-19 outbreak. This is an exploratory study with a post intervention assessment. We describe an on-site brief mindfulness intervention and evaluate its helpfulness, safety, and feasibility. One thousand out of 7,000 (14%) healthcare workers from La Paz University Hospital in Madrid (Spain) participated in at least one session. One hundred and fifty out of 1,000 (15%) participants filled out a self-report questionnaire evaluating the helpfulness of the intervention for on-site stress reduction. Ninety two subjects (61%) participated in more than one session. Most of the participants were women (80%) with a mean age of 38.6 years. Almost half of the sample were nurses (46%). Sessions were perceived as being helpful with a mean rating of 8.4 on a scale from 0 to 10. Only 3 people (2%) reported a minor adverse effect (increased anxiety or dizziness). Our data supports the utility, safety and feasibility of an on-site, brief mindfulness-based intervention designed to reduce stress for frontline health workers during a crisis. There is a need to continue testing this type of interventions, and to integrate emotion regulation strategies as an essential part of health workers' general training. NCT04555005.
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http://dx.doi.org/10.3389/fpsyt.2020.562578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673433PMC
October 2020

Implementation of a Mindfulness-Based Crisis Intervention for Frontline Healthcare Workers During the COVID-19 Outbreak in a Public General Hospital in Madrid, Spain.

Front Psychiatry 2020 30;11:562578. Epub 2020 Oct 30.

Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain.

The COVID-19 outbreak is having an impact on the well-being of healthcare workers. Mindfulness-based interventions have shown effectiveness in reducing stress and fostering resilience and recovery in healthcare workers. There are no studies examining the feasibility of brief mindfulness-based interventions during the COVID-19 outbreak. This is an exploratory study with a post intervention assessment. We describe an on-site brief mindfulness intervention and evaluate its helpfulness, safety, and feasibility. One thousand out of 7,000 (14%) healthcare workers from La Paz University Hospital in Madrid (Spain) participated in at least one session. One hundred and fifty out of 1,000 (15%) participants filled out a self-report questionnaire evaluating the helpfulness of the intervention for on-site stress reduction. Ninety two subjects (61%) participated in more than one session. Most of the participants were women (80%) with a mean age of 38.6 years. Almost half of the sample were nurses (46%). Sessions were perceived as being helpful with a mean rating of 8.4 on a scale from 0 to 10. Only 3 people (2%) reported a minor adverse effect (increased anxiety or dizziness). Our data supports the utility, safety and feasibility of an on-site, brief mindfulness-based intervention designed to reduce stress for frontline health workers during a crisis. There is a need to continue testing this type of interventions, and to integrate emotion regulation strategies as an essential part of health workers' general training. NCT04555005.
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http://dx.doi.org/10.3389/fpsyt.2020.562578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673433PMC
October 2020

Adapting mental health care after the COVID-19 outbreak: Preliminary findings from a public general hospital in Madrid (Spain).

Psychiatry Res 2020 May 12;289:113077. Epub 2020 May 12.

Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain; Autonomous University of Madrid (UAM), Madrid, Spain.

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http://dx.doi.org/10.1016/j.psychres.2020.113077DOI Listing
May 2020

Clinical trials of psychological interventions cancelled due to the COVID-19 outbreak: how should we respond?

Actas Esp Psiquiatr 2020 09 1;48(5):233. Epub 2020 Sep 1.

Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) Po Castellana, 261 C.P. 28046 Madrid (España) Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) Po Castellana, 261 C.P. 28046 Madrid (España) Hospital Universitario La Paz Po Castellana, 261 C.P. 28046 Madrid (España) Universidad Autónoma de Madrid (UAM) C/ Arzobispo Morcillo, 4 C.P. 28046 Madrid (España).

The measures to contain the spread of the COVID-19 outbreak have no precedent in the recent history of many countries. Around 2,000 million people in the world are in isolation or quarantine, and gatherings of people have been expressly banned in many countries. In Spain, this prohibition affects workplaces, schools, and the national health system, where most of the healthcare is being provided either on the phone or online.
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September 2020

Clinical trials of psychological interventions cancelled due to the COVID-19 outbreak: how should we respond?

Actas Esp Psiquiatr 2020 09 1;48(5):233. Epub 2020 Sep 1.

Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) Po Castellana, 261 C.P. 28046 Madrid (España) Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) Po Castellana, 261 C.P. 28046 Madrid (España) Hospital Universitario La Paz Po Castellana, 261 C.P. 28046 Madrid (España) Universidad Autónoma de Madrid (UAM) C/ Arzobispo Morcillo, 4 C.P. 28046 Madrid (España).

The measures to contain the spread of the COVID-19 outbreak have no precedent in the recent history of many countries. Around 2,000 million people in the world are in isolation or quarantine, and gatherings of people have been expressly banned in many countries. In Spain, this prohibition affects workplaces, schools, and the national health system, where most of the healthcare is being provided either on the phone or online.
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September 2020

Mindfulness-based social cognition training (SocialMIND) versus psychoeducational multicomponent intervention for people with a first episode of psychosis: a study protocol for a randomised controlled trial.

BMC Psychiatry 2019 07 29;19(1):233. Epub 2019 Jul 29.

Psychiatry and Mental Health Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.

Background: People who suffer a first episode of psychosis experience higher levels of distress and suffering. Early intervention programs combine pharmacological and psychosocial strategies that include different components, such as cognitive-behavioural therapy, psychosocial interventions, medication adherence, family psychoeducation, counselling, etc. Among the complementary approaches, mindfulness-based interventions help participants to cultivate a radical acceptance of their psychotic experiences within a person-centered framework. They show promising results for people with longer duration of psychosis, but there is still no evidence for people who have recently experienced their first episode of psychosis.

Methods: The present parallel-group, single-blind (evaluator), randomised (1:1 ratio), controlled (versus active comparator), superiority, clinical trial will compare the effectiveness of SocialMIND on social functioning as measured by the Personal and Social Performance (PSP) scale. The active comparator will be a psychoeducational multicomponent intervention (PMI) that incorporates elements of early intervention programs that are effective for people who have suffered a first episode of psychosis. Both SocialMIND and PMI encompass eight weekly sessions, four bi-weekly sessions, and five monthly sessions. Changes in primary and secondary outcomes will be measured after weekly (8th week), bi-weekly (16th week) and monthly sessions (56th week), and 3 months after completing the intervention (68th week). Secondary outcomes include symptoms of psychosis, anxiety and depression, as well as indicators of general functioning. Tertiary outcomes are measures of social cognition, neurocognition, mindfulness, and indicators of inflammation and oxidative stress. A final sample of 80 participants is proposed to detect clinically significant differences in social functioning.

Discussion: This is the first mindfulness-based social cognition training for people with psychosis. SocialMIND aims to generate changes in the real-life functioning of people who have experienced a first episode of psychosis, and to be at least as effective as a psychoeducational multicomponent program. Adherence to the interventions is a common problem among young people with psychosis, so several difficulties are anticipated, and some methodological issues are discussed.

Trial Registration: The trial was registered in ClinicalTrials.gov in October 2018 (NCT03309475).
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http://dx.doi.org/10.1186/s12888-019-2206-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664759PMC
July 2019

Mindfulness-Based Social Cognition Training (SocialMind) for People With Psychosis: A Feasibility Trial.

Front Psychiatry 2019 2;10:299. Epub 2019 May 2.

Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.

Difficulties in social functioning are common among people with psychosis. Negative symptoms such as blunted affect or social withdrawal are often linked to these difficulties and worsen real-life outcomes. One important dimension associated with social functioning is social cognition, which refers to the psychological processes that are necessary to perceive, encode, store, retrieve, and regulate social information. Mindfulness-based interventions for people with psychosis are safe and effective in improving anxiety and depressive symptoms; however, no mindfulness-based interventions addressing social cognition have yet been developed. A pilot, single-arm, nonrandomized, noncontrolled feasibility trial is proposed. The main objectives are to assess the tolerability of mindfulness-based social cognition training (SocialMind) and to test the feasibility of a further randomized controlled trial. A final sample of 25 outpatients with schizophrenia spectrum disorders was included. Attrition rate was lower than usual for this population, and most participants completed the training. No adverse effects were identified in terms of hospitalizations, emergency room visits, dissociative and psychotic symptoms, or state of anxiety during the sessions. This is the first implementation of SocialMind, which is the first mindfulness-based social cognition training. It is well tolerated by participants with schizophrenia spectrum disorders, and a further randomized controlled trial is proposed for people who have suffered their first episode of psychosis within the past 5 years. www.ClinicalTrials.gov, identifier NCT03434405.
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http://dx.doi.org/10.3389/fpsyt.2019.00299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506722PMC
May 2019

Mindfulness-Based Social Cognition Training (SocialMind) for People With Psychosis: A Feasibility Trial.

Front Psychiatry 2019 2;10:299. Epub 2019 May 2.

Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.

Difficulties in social functioning are common among people with psychosis. Negative symptoms such as blunted affect or social withdrawal are often linked to these difficulties and worsen real-life outcomes. One important dimension associated with social functioning is social cognition, which refers to the psychological processes that are necessary to perceive, encode, store, retrieve, and regulate social information. Mindfulness-based interventions for people with psychosis are safe and effective in improving anxiety and depressive symptoms; however, no mindfulness-based interventions addressing social cognition have yet been developed. A pilot, single-arm, nonrandomized, noncontrolled feasibility trial is proposed. The main objectives are to assess the tolerability of mindfulness-based social cognition training (SocialMind) and to test the feasibility of a further randomized controlled trial. A final sample of 25 outpatients with schizophrenia spectrum disorders was included. Attrition rate was lower than usual for this population, and most participants completed the training. No adverse effects were identified in terms of hospitalizations, emergency room visits, dissociative and psychotic symptoms, or state of anxiety during the sessions. This is the first implementation of SocialMind, which is the first mindfulness-based social cognition training. It is well tolerated by participants with schizophrenia spectrum disorders, and a further randomized controlled trial is proposed for people who have suffered their first episode of psychosis within the past 5 years. www.ClinicalTrials.gov, identifier NCT03434405.
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http://dx.doi.org/10.3389/fpsyt.2019.00299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506722PMC
May 2019

Mindfulness-Based Social Cognition Training (SocialMind) for People With Psychosis: A Feasibility Trial.

Front Psychiatry 2019 2;10:299. Epub 2019 May 2.

Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.

Difficulties in social functioning are common among people with psychosis. Negative symptoms such as blunted affect or social withdrawal are often linked to these difficulties and worsen real-life outcomes. One important dimension associated with social functioning is social cognition, which refers to the psychological processes that are necessary to perceive, encode, store, retrieve, and regulate social information. Mindfulness-based interventions for people with psychosis are safe and effective in improving anxiety and depressive symptoms; however, no mindfulness-based interventions addressing social cognition have yet been developed. A pilot, single-arm, nonrandomized, noncontrolled feasibility trial is proposed. The main objectives are to assess the tolerability of mindfulness-based social cognition training (SocialMind) and to test the feasibility of a further randomized controlled trial. A final sample of 25 outpatients with schizophrenia spectrum disorders was included. Attrition rate was lower than usual for this population, and most participants completed the training. No adverse effects were identified in terms of hospitalizations, emergency room visits, dissociative and psychotic symptoms, or state of anxiety during the sessions. This is the first implementation of SocialMind, which is the first mindfulness-based social cognition training. It is well tolerated by participants with schizophrenia spectrum disorders, and a further randomized controlled trial is proposed for people who have suffered their first episode of psychosis within the past 5 years. www.ClinicalTrials.gov, identifier NCT03434405.
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http://dx.doi.org/10.3389/fpsyt.2019.00299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506722PMC
May 2019

Mindfulness-Based Social Cognition Training (SocialMind) for People With Psychosis: A Feasibility Trial.

Front Psychiatry 2019 2;10:299. Epub 2019 May 2.

Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.

Difficulties in social functioning are common among people with psychosis. Negative symptoms such as blunted affect or social withdrawal are often linked to these difficulties and worsen real-life outcomes. One important dimension associated with social functioning is social cognition, which refers to the psychological processes that are necessary to perceive, encode, store, retrieve, and regulate social information. Mindfulness-based interventions for people with psychosis are safe and effective in improving anxiety and depressive symptoms; however, no mindfulness-based interventions addressing social cognition have yet been developed. A pilot, single-arm, nonrandomized, noncontrolled feasibility trial is proposed. The main objectives are to assess the tolerability of mindfulness-based social cognition training (SocialMind) and to test the feasibility of a further randomized controlled trial. A final sample of 25 outpatients with schizophrenia spectrum disorders was included. Attrition rate was lower than usual for this population, and most participants completed the training. No adverse effects were identified in terms of hospitalizations, emergency room visits, dissociative and psychotic symptoms, or state of anxiety during the sessions. This is the first implementation of SocialMind, which is the first mindfulness-based social cognition training. It is well tolerated by participants with schizophrenia spectrum disorders, and a further randomized controlled trial is proposed for people who have suffered their first episode of psychosis within the past 5 years. www.ClinicalTrials.gov, identifier NCT03434405.
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http://dx.doi.org/10.3389/fpsyt.2019.00299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506722PMC
May 2019

Differences in mother-to-infant bonding according to type of C-section: Elective versus unplanned.

Early Hum Dev 2017 12 13;115:93-98. Epub 2017 Oct 13.

Universidad Autónoma de Madrid, Spain; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.

Aim To compare the mother-to-infant bond of mothers who gave birth by elective C-section versus urgent C-section in the first 48-72h of life and 10-12weeks after delivery.

Methods: This is a cohort prospective study of women giving birth by C-section. 48-72h after delivery, sociodemographic variables were collected, Mother-to-Infant Bonding Scale and newborn's response to separation test were performed. 10-12weeks after delivery Mother-to-Infant Bonding Scale and questions about baby's feeding were completed.

Results: A total of 116 dyads were recruited, 58 in each group. No significant differences between the two C-sections in bonding, newborn response to separation or type of feeding were observed at any time points. However, those dyads presenting with an abnormal bond at time 1 had more frequently an abnormal bond at time 2 (50% versus 8.1%, p=0.000).

Conclusions: No differences in mother-to-infant bond were found according to type of C-section.
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http://dx.doi.org/10.1016/j.earlhumdev.2017.09.020DOI Listing
December 2017

Effectiveness, efficiency and efficacy in the multidimensional treatment of schizophrenia: Rethinking project.

Rev Psiquiatr Salud Ment 2017 Jan - Mar;10(1):4-20. Epub 2016 Oct 22.

Servicio de Psiquiatría del Niño y Adolescente, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España.

Schizophrenia is a clinically heterogeneous syndrome affecting multiple dimensions of patients' life. Therefore, its treatment might require a multidimensional approach that should take into account the efficacy (the ability of an intervention to get the desired result under ideal conditions), the effectiveness (the degree to which the intended effect is obtained under routine clinical practice conditions or settings) and the efficiency (value of the intervention as relative to its cost to the individual or society) of any therapeutic intervention. In a first step of the process, a group of 90 national experts from different areas of health-care and with a multidimensional and multidisciplinary perspective of the disease, defined the concepts of efficacy, effectiveness and efficiency of established therapeutic interventions within 7 key dimensions of the illness: symptomatology; comorbidity; relapse and adherence; insight and subjective experience; cognition; quality of life, autonomy and functional capacity; and social inclusion and associated factors. The main conclusions and recommendations of this stage of the work are presented herein.
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http://dx.doi.org/10.1016/j.rpsm.2016.09.001DOI Listing
January 2018

Mindfulness-based cognitive therapy versus psychoeducational intervention in bipolar outpatients with sub-threshold depressive symptoms: a randomized controlled trial.

BMC Psychiatry 2014 Aug 15;14:215. Epub 2014 Aug 15.

University Hospital La Paz, IDIPAZ, Madrid, Spain.

Background: The presence of depressive subsyndromal symptoms (SS) in bipolar disorder (BD) increases the risk of affective relapse and worsens social, cognitive functioning, and quality of life. Nonetheless, there are limited data on how to optimize the treatment of subthreshold depressive symptoms in BD. Mindfulness-Based Cognitive Therapy (MBCT) is a psychotherapeutic intervention that has been shown effective in unipolar depression. The assessment of its clinical effectiveness and its impact on biomarkers in bipolar disorder patients with subsyndromal depressive symptoms and psychopharmacological treatment is needed.

Methods/design: A randomized, multicenter, prospective, versus active comparator, evaluator-blinded clinical trial is proposed. Patients with BD and subclinical or mild depressive symptoms will be randomly allocated to: 1) MBCT added to psychopharmacological treatment; 2) a brief structured group psychoeducational intervention added to psychopharmacological treatment; 3) standard clinical management, including psychopharmacological treatment. Assessments will be conducted at screening, baseline, post-intervention (8 weeks) and 4 month follow-up post-intervention. The aim is to compare MBCT intervention versus a brief structured group psychoeducation. Our hypothesis is that MBCT will be more effective in reducing the subsyndromal depressive symptoms and will improve cognitive performance to a higher degree than the psychoeducational treatment. It is also hypothesized that a significant increase of BDNF levels will be found after the MBCT intervention.

Discussion: This is the first randomized controlled trial to evaluate the effects of MBCT compared to an active control group on depressive subthreshold depressive symptoms in patients with bipolar disorder.

Trial Registration: ClinicalTrials.gov: NCT02133170. Registered 04/30/2014.
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http://dx.doi.org/10.1186/s12888-014-0215-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154516PMC
August 2014

Discordance between two national health statistics sources (EMH and EESCRI, 1990-2009). Analysis of psychiatric morbidity.

Rev Psiquiatr Salud Ment 2016 Jan-Mar;9(1):22-30. Epub 2014 Jul 4.

Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, España.

Introduction: Two statistical sources provide data on hospital stays and discharges for all Spanish hospitals: Hospital Morbidity Survey (acronym in Spanish: EMH) and Statistics of Health Establishments providing Inpatient Care (acronym in Spanish: EESCRI). Our aim is to contrast these two statistical sources to define their accuracy and relevance in psychiatric epidemiology studies.

Material And Methodology: The analysis is based on two aspects: 1.- Compare the number of psychiatric stays and hospital discharges from 1990-2009, 2.- Analyze and compare how the average stay is provided.

Results: The differences between the two statistical sources are significant and increase over time. In 2005-2009 the EMH records 121% of hospitalizations (577,078 vs. 475,414) and 46% (14,239,527 vs. 30,821,412) of psychiatric stays, compared with EESCRI. Moreover, the average stay estimated by EESCRI shows serious methodological problems, particularly in settings of prolonged hospitalization (psychiatric hospitals); the estimations are potentially below the real value.

Conclusions: Surprisingly, the questionnaires completed by hospitals to develop the EESCRI provide data on assisted morbidity quite different from that provided by the EMH, despite both statistical sources having the same inpatient records for data processing. It is difficult to attribute these differences to sampling error, as the EMH has a very high sampling fraction, which minimizes the sampling error. Given the mismatch between sources, we recommend using the EMH, as it offers more reliable data and allows an accurate determination of the length of stays.
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http://dx.doi.org/10.1016/j.rpsm.2014.05.002DOI Listing
February 2017

Influence of type of treatment on the well-being of Spanish patients with schizophrenia and their caregivers.

Int J Psychiatry Clin Pract 2011 Nov 19;15(4):286-95. Epub 2011 Sep 19.

Psychiatry Department, Hospital Universitario La Paz. Universidad Autonoma de Madrid, Spain.

Objective: This study aimed to investigate quality of life and burden on caregivers in Spanish outpatients with schizophrenia, treated with different antipsychotics.

Methods: Sociodemographic and clinical data were collected for 1865 patients diagnosed with schizophrenia. Patients answered the EuroQol-5D questionnaire and caregivers answered questionnaires assessing caregiver burden. Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression of Severity (CGI-S), and clinician's satisfaction were also recorded. The same data were also collected at months 3 and 6.

Results: According to EQ-5D results, usual activities (29.6%) and anxiety/depression (31.1%) were the most relevant reported problems. Good overall scores (5-7) on EQ-5D were reported by 47/118 (39.8%) of risperidone long-acting injectable (LAI) patients compared to 52/218 (23.9%) for oral conventional antipsychotics, 51/194 (26.2%) for injectable conventional antipsychotics, and 332/1110 (29.9%) for oral atypical antipsychotics. Significant benefits of risperidone LAI vs. other types of antipsychotic were also found in caregiver burden and clinician-derived outcome measures. At months 3 and 6, retention was > 85%, and score on the EQ5D improved for the overall sample.

Conclusions: In Spanish patients with schizophrenia, activities of daily living and anxiety/depression were more relevant reported problems. Risperidone LAI was associated with better quality-of-life outcomes and lower caregiver burden compared to other types of antipsychotic.
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http://dx.doi.org/10.3109/13651501.2011.608469DOI Listing
November 2011