The assessment of transdiagnostic dimensions of emotional disorders: Validation of the Multidimensional Emotional Disorders Inventory (MEDI) in adolescents with subthreshold anxiety and depression

BACKGROUND

The transdiagnostic approach to psychopathology has emerged as an alternative to traditional taxonomic approaches. The Multidimensional Emotional Disorders Inventory (MEDI) is a specifically designed self-report to measure the transdiagnostic dimensions proposed by Brown and Barlow (2009). This study aims to analyse the psychometric properties of the MEDI scores in adolescents with subthreshold anxiety and depression.

METHOD

The sample consisted of a total of 476 students. The mean age was 13.77 years (SD = 1.43) (range 10 to 18 years), 73.9 % were females. Several questionnaires assessing positive affect, negative affect, mental health difficulties, and quality of life were used.

RESULTS

The original 9-factor structure of the MEDI was confirmed with good fit indices. Satisfactory levels of internal consistency were observed in most of the MEDI scores using McDonald's Omega, ranging from 0.58 to 0.87. The MEDI dimensions were associated with psychopathology, positive affect, negative affect, and quality of life.

LIMITATIONS

Reliance on self-reported data, a cross-sectional design limiting temporal assessment, and a 73.9 % female gender imbalance.

CONCLUSION

The MEDI scores showed adequate psychometric properties among adolescents with subclinical emotional symptoms. The results found might have potential clinical implications for conceptualization, assessment, intervention, and prevention of emotional disorders at both clinical and research levels.

"Social support and stressful life events: risk factors for antenatal depression in nulliparous and multiparous women"

Nulliparous (pregnant women who are giving birth for the first time) and multiparous (women who have multiple children) may have different concerns, which may be associated with risk of antenatal depression. This study aims to examine the role of social support and stressful life events as risk factors for antenatal depression in nulliparous and multiparous women. The sample included 1,524 pregnant women recruited from an obstetrics setting at the end of the first trimester of pregnancy from two Spanish tertiary-care public hospitals. The sample completed the Patient Health Questionnaire (PHQ-9), and the "social support" and "stressful life events" subscales of the Postpartum Depression Predictor Inventory-Revised (PDPI-R). Nulliparous women reported a lower prevalence of depressive symptoms (15.6 percent) compared to multiparous mothers (20.1 percent). In both groups, marriage/partner problems (NP: β = 0.178, p < .01 vs MP: β = 0.164, p < .01) and a perceived lack of instrumental support from friends (NP: β = -0.154, p < .01 vs MP: β = -0.154, p < .01) were significant risk factors for antenatal depression. However, nulliparous women have more risk factors such as unemployment (β = 0.096, p < .05), job change (β = 0.127, p < .01), financial problems (β = 0.145, p < .01) and lack of instrumental support from partner (β = -0187, p < .01). For multiparous women, moving (β = 0.080, p < .05) and lack of instrumental support from family (β = -0.151, p < .01) were risk factors. These results suggest the critical need for screening and designing preventive interventions adapted and taking into consideration parity to provide more effective health care during pregnancy.

Dual alcohol and cannabis use in male and female adolescents: Relationships with family variables

Family dynamics influence adolescents' use of alcohol and other substances, such as cannabis. The aim of this study was to understand the relationship between family variables and alcohol use, dual use of alcohol and cannabis, and non-use in adolescents according to sex. A cross-sectional study was conducted. The sample comprised 879 adolescents (56.4 % boys; M(SD)age = 14.25 (1.88) years). Multinomial regression analysis showed that for boys, the presence of family conflict increased the likelihood of being an alcohol (OR = 1.19) and dual (OR = 1.23) user rather than a non-user. For girls, communication reduced the probability of being an alcohol user (OR = 0.88), and the presence of consequences for breaking rules reduced the probability of being a dual user rather than a non-user (OR = 0.83) or an alcohol user (OR = 0.84). These findings highlight the importance of family prevention of adolescents' substance use, bearing in mind the participants' sex.

Tobacco use in first-episode psychosis, a multinational EU-GEI study

BACKGROUND

Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis.

METHODS

The sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use.

RESULTS

After controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1-3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2-2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (β = -2.3; p ⩽ 0.001; 95% CI [-3.7 to -0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0-1.8]); however, these results were no longer significant after controlling for cannabis use.

CONCLUSIONS

Tobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.

Youth screening depression: Validation of the Patient Health Questionnaire-9 (PHQ-9) in a representative sample of adolescents

BACKGROUND

Depression symptoms and mood disorders constitute one of the major public health challenges among youths. Thus, early prevention and intervention for depression should be a priority. The main goal of the present study was to validate the Patient Health Questionnaire-9 (PHQ-9) scores in a school-based sample of non-clinical adolescents.

METHOD

Stratified random sampling was conducted. Participants were 2235 students (M = 14.49, SD =1.76, range= 12-18 years), 52.9 % were female, from 34 secondary schools in Spain. Several previously validated self-reported questionnaires of mental health and psychopathology were administrated.

RESULTS

The unidimensional factorial model of the PHQ-9 items showed adequate goodness of fit indices. Strong measurement invariance across gender was found. Omega for the PHQ-9 total score was 0.87. The PHQ-9 total score was positively associated with anxiety symptoms and emotional and behavioral problems, and negatively associated with prosocial behavior and quality of life.

CONCLUSIONS

The PHQ-9 is a brief, easy, and reliable tool for assessing self-reported depressive symptoms in both clinical and school settings. PHQ-9 may be used as a screening tool for universal early detection and monitorization of depression symptoms during adolescence.

Protocol for a Trial Assessing the Efficacy of a Universal School-Based Prevention Program for Addictive Behaviors

BACKGROUND

"Juego de Llaves" [ Set of Keys ] is a universal school-based prevention program for adolescents aged 12-15. It is aimed at reducing drug use and other addictive behaviors. This paper describes the full protocol for the evaluation design, instruments, randomization procedure, follow-ups, and primary outcomes.

METHOD

Non-Randomized Control Cluster Trial in a set of Spanish secondary schools, with follow-ups at 12-, 24- and 36-months. Participants will be allocated to an experimental or control group. Using a digital application designed for the study, a battery of instruments will be used to assess addictive behaviors, sociodemographic variables, school climate and other transdiagnostic psychological variables.

RESULTS

A pilot test will be carried out to test the implementation protocol and to calculate the sample size needed for outcome evaluation. After implementing the program, longitudinal statistical approaches will be used to report intervention efficacy and potential moderators and mediators.

CONCLUSIONS

There is a lack of assessments on the effectiveness of school prevention programs, and this paper is expected to improve monitoring and ongoing evaluation in prevention.

Family Conflict and the Use of Conventional and Electronic Cigarettes in Adolescence: the Role of Impulsivity Traits

Adolescents’ use of tobacco is a worldwide problem due to the negative consequences on their physical and psychosocial development. One contextual variable related to tobacco use is family conflict. Previous research has suggested that the relationship between family conflict and tobacco use could be mediated by personality traits. The aim of this study is to examine the direct and indirect effects of family conflict on tobacco use (conventional and electronic cigarettes) through specific impulsivity constructs. The sample comprised 879 adolescents (56.4% male; M(SD)age = 14.25 (1.88) years). Multiple mediational analysis showed that there was no significant direct effect between family conflict and tobacco use; however, an indirect effect was found between family conflict and conventional cigarette use through sensation seeking and premeditation. With electronic cigarettes, a significant indirect effect was found via sensation seeking. These findings have implications in terms of prevention and treatment of tobacco use during adolescence.

Quality of Life and the International Convention on the Rights of Persons With Disabilities: Consensus Indicators for Assessment

BACKGROUND

The quality of life construct provides an ideal conceptual framework for translating such abstract concepts as self-determination, equity, accessibility, and inclusion. Through consultation with expert raters, we sought to develop and validate a bank of indicators and items, based on the quality of life conceptual framework, to be used as a means of evaluating and implementing the Articles of the Convention on the Rights of Persons with Disabilities (CRPD).

METHOD

Thirty-two experts in the field of intellectual and developmental disabilities participated, rating the suitability, importance, and clarity of a bank of 296 items, as well as the relevance of controlling for 70 sociodemographic variables.

RESULTS

After qualitative and quantitative analysis of the data, the final selection comprised 60 sociodemographic variables and 153 items that scored highly on all criteria and produced an excellent level of agreement between the experts.

CONCLUSIONS

This bank of items and set of sociodemographic variables constitute the pilot version of a CRPD assessment and monitoring instrument with sufficient evidence of content validity, which may be useful in developing evidence-based practices and in detecting rights violations.

Mindfulness on Daily Life Coping in People Experiencing Psychosis: A Randomized Controlled Trial

Background/Objective

Cognitive Behavior Therapy for psychosis (CBTp) is a recommended treatment for psychoses whose effect is mediated by coping. Mindfulness (MBI) have shown positive effects in psychosis. This study examines the hypothesis that combining CBTp+MBI could improve coping with day-to-day life in psychosis better than CBTp alone in people attending a public community rehabilitation center.

Method

Fifty-six outpatients were recruited and randomly allocated either to CBTp or CBTp+MBI. Measures comprised PANSS interview and COPE Inventory. Data were analyzed using a repeated measures ANOVA and RCI calculation.

Results

There were no statistical differences between groups at pre-treatment. Significant statistical differences were found for the interaction Treatment x Time in Mental disengagement (F = 5.65, p = .021, η² = .102), Acceptance (F = 7.69, p = .008, η² = .133), and Suppressing competing activities (F = 4.62, p = .037, η² = .085).

Conclusions

MBI promotes specific coping styles in people who experience psychosis that otherwise are not improved with CBTp. Only the MBI group improved acceptance of the presence of the stressor and reduced mental disengagement from the context. The intervention is feasible and effective for public healthcare settings.

Mindfulness improves theory of mind in people experiencing psychosis: A pilot randomized clinical trial

Impaired Theory of Mind (ToM) ability is a core feature of psychotic disorders that challenges psychosis treatment. We aimed to explore the effect of a Mindfulness-Based Intervention (MBI) on ToM ability in a randomized clinical trial (RCT). A sample of 36 participants diagnosed with psychotic disorder were recruited from a community center and randomly allocated to Integrated Rehabilitation Treatment (IRT) or IRT+MBI. ToM skills were assessed through the Hinting Test and the Reading the Mind in the Eyes Test (RMET). IRT+MBI scored higher in RMET than IRT at posttreatment. MBI is a promising tool for improving ToM ability in psychosis.

Clinical symptoms and personality traits predict subpopulations of treatment-seeking substance users

BACKGROUND

The heterogeneity of treatment-seeking substance users represents a challenge, as most studies include participants having problems with specific substances or merge polysubstance users into the same category without considering differences between profiles. Considering the inconsistent literature on predictors of treatment outcomes, this study aimed to identify subpopulations of individuals with substance use disorders (SUDs) and analyze the association among class membership, previous relapses, and treatment retention.

METHODS

The study recruited a total of 159 participants (mean age = 40.60, SD = 8.70; 85.5% males) from two treatment facilities (outpatient daycare and inpatient residential centers). The baseline assessment gathered lifetime and current substance use, and personality and psychopathology measures. The study performed a latent class analysis to identify subpopulations of substance users and explored predictors of class membership using a multinomial regression analysis.

RESULTS

The study found six different classes of substance users based on their diagnosis and pattern of substance use: class 1 (6.92% of participants): individuals with cannabis as primary substance, alcohol/cocaine as secondary substance and additional use of stimulants or other drugs; class 2 (30.82%): cocaine as primary substance, alcohol as secondary and additional cannabis use; class 3 (20.13%): alcohol as primary substance, cocaine as secondary and additional cannabis use; class 4 (17.61%): cocaine as primary substance, cannabis as secondary and additional alcohol/other drugs use; class 5 (16.35%): alcohol as primary and cannabis as secondary substance; class 6 (8.18%): heroin as primary substance, cocaine as secondary and additional alcohol use. Several traits and clinical symptoms predicted distinct class memberships. Participants pertaining to class 6 presented the highest number of relapses (M = 2.54, SD = 1.56).

CONCLUSIONS

These results have several clinical implications. Belonging to class 6 was associated with a greater number of previous relapses. Also, specific psychopathological symptoms and personality traits may impact SUD treatment response, which may help clinicians to guide initial assessment and treatment allocation.

Alcohol use and risk factors for self-harm behavior in Spanish adolescents

Self-harm behaviors in children and adolescents constitute an important public health problem with prevalence figures in the clinical population between 40 and 80%. The objectives of the study were to analyze and compare the Spanish sub-samples of two studies, SEYLE and WE-STAY to determine prevalence, self-harm patterns and factors associated with self-harm behaviors, notably the use of alcohol or drugs. The questionnaires used in both studies were the Global School Health Survey (GSHS), the Beck Depression Inventory (BDI-II), the Strengths and Difficulties Questionnaire (SDQ). The self-harm behaviors were evaluated with a modified 6-item version of s the Deliberate Self-Harm Inventory (DSHI). The independence of the study's categorical variables was assessed using the Chi-square test. The change in the relative risk of self-harm between the SEYLE study and WE-STAY was evaluated through the odds ratio (OR) calculation. Two different logistic regression models were calculated in order to establish the factors associated with self-harm behaviors in each study. In the present study, the rates of DSH vary according to study and sex, ranging from 0.58% to 2.08%, and different patterns of self-harm are evidenced by sex, with males self-injuring more frequently by self-inflicted blows and burns, while young women more often cut themselves. The presence of depressive symptoms and alcohol use were the factors most strongly associated with an increased risk of DSH.

Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis

BACKGROUND

Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.

METHODS

The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.

RESULTS

At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively).

CONCLUSIONS

Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.

Prevention of recurrent suicidal behavior: Case management and psychoeducation

BACKGROUND

Development of effective programs for suicide prevention is a global priority. This study evaluated the differential effectiveness of the combination of several strategies to prevent repetition of suicide attempts.

METHODS

Participants were patients who entered the Emergency Department after a non-fatal suicide attempt. A total of 163 participants (68.1% females, mean age = 41.39) met the inclusion criteria and were spread across three groups: One group received a passive strategy consisting of preventive information, a second group received the passive strategy combined with an active component of case management (MAC), and a third group received the passive strategy, case management and a psychoeducational programme (PSyMAC). Randomization of participants was not possible. The study included assessments at the beginning, and follow-ups every six months up to 30 months.

RESULTS

The study showed no significant differences between groups in the number of re-attempts. Logistic regression showed a positive effect for MAC.

CONCLUSIONS

The present study showed that the use of case management could be a promising strategy, but more research is needed.

Predictive factors of alcohol consumption in adolescents: data from 1-year follow-up prospective study

Alcohol use/abuse is a health problem in adolescents. The last Survey on use of drugs in Secondary Schoolers carried out in Spain (ESTUDES 2014-2015), reveals that 76.8% of adolescents aged 14 to 18 years consumed alcohol in the previous year and 68.2% in the last month. The aim of this study is to determine the medium-term factors associated with alcohol consumption in a sample of Spanish adolescents. The present study was carried out as a part of the Saving and Empowering Young Lives project in Europe (SEYLE) project. The final sample was composed of 708 students, assessed at two times [basal (T0) and one year later (T1)] [males: 51.98%, basal mean age (SD)=4.43 (0.67)]. Univariate and multivariate regression analyses were performed in order to investigate relationships between possible predictive variables found at time T0 and alcohol consumption at time T1. At basal time (T0) the prevalence of alcohol abuse was 25.56%, whereas the prevalence one year later was 49.72% (T1). Variables that significantly predict alcohol abuse within a year are: previous alcohol abuse at T0 (p&lt;0.001), previous abuse of drugs (p=0.011), parents attending their sporting events (p=0.005), peer problems (p=0.019), and lack of prosocial behaviour (p=0.043). In the light of our results, it can be concluded that, in adolescents, externalizing disorders seem to be determining factors of medium-term alcohol consumption.

Smoking does not impact social and non-social cognition in patients with first episode psychosis

BACKGROUND

Many studies having shown significant improvements in non-social and social cognitive performance in smoking FEP patients compared to non-smoking FEP patients. The findings are controversial. This study analyzed the effects of tobacco use on non-social and social cognitive function in a large group of FEP patients and a matched healthy control group.

METHODS

A sample of 335 patients with FEP and 253 healthy controls was divided into four subgroups: control tobacco users (CTU), control non-tobacco users (CNTU), patient tobacco users (PTU) and patient non-tobacco users (PNTU). Demographic variables, tobacco use variables (presence or absence, frequency and duration of tobacco use), neurocognitive (non-social) performance and social cognition were assessed.

RESULTS

Comparison of 4 subgroups in non-social cognitive function revealed significant differences after controlling for covariables in executive functions (F=13.45; p≤0.001) and working memory domains (F=4.30; p=0.005). CTU and CNTU subgroups scored higher in all the domains compared to the PTU and the PNTU subgroups respectively. Social cognitive function was also significantly different within the four subgroups, with control subgroups showing better social cognition than patient subgroups. Significant differences in the executive functions domain were observed when comparing PTU and CTU groups (F=19.60; p≤0.001). No significant differences were revealed in the comparison between the patient groups.

CONCLUSIONS

This large study suggests that tobacco use in FEP patients is not related to better non-social or social cognitive performance.

Suicide, unemployment, and economic recession in Spain

INTRODUCTION

The aim of the present work is to determine the association between unemployment and suicide, and to investigate whether this association is affected by changes in the economic cycle or other variables such as age and sex.

METHODS

A time-trend analysis was conducted to study changes in the number of suicides between 1999 and 2013 in Spain. Pearson's correlation coefficients and regression models were used to find the association between unemployment and suicide.

RESULTS

A significant positive association was found between unemployment and suicide in the pre-crisis period in men. In that period (1999-2007), each 1% annual increase in unemployment was associated with a 6.90% increase in the annual variation of suicide in the total population, and with a 9.04% increase in the annual variation of suicide in working age men.

CONCLUSIONS

The correlation between unemployment and suicide is significant in periods of economic stability, but has weakened during the recent financial crisis. Unemployment and suicide have a complex relationship modulated by age, sex and economic cycle.

Substance use or abuse, internet use, psychopathology and suicidal ideation in adolescents

Substance and Internet use or abuse, psychopathology and suicidal ideation appear to be related. The aim of this study is to investigate the association between use of psychotropic substances, inadequate Internet use, suicidal ideation and other psychopathological symptoms within the adolescent population. The present study was carried out as part of the Saving and Empowering Young Lives in Europe (SEYLE) project, funded by the European Union. The sample is composed of 1026 adolescents aged between 14 and 16 years from 12 state schools in Asturias (530 men and 496 women). This study adds to the possibility of knowing whether the SEYLE data is confirmed in a relatively isolated and recession hit province of Spain. In the present study the following consumption rates were obtained: a) alcohol 11.89% in males and 7.86% in females; b) tobacco: 4.15% and 5.44 % in males and females respectively; c) other drugs: 6.98% in males and 4.44% in females; d) maladaptive or pathological Internet use: 14.53% and 20.77% in males and females respectively. The variables that predict suicide ideation in the logistic regression model were: previous suicide attempts, depression, maladaptive or pathological Internet use, peer problems and alcohol consumption.

Gender differences in addiction severity

Gender has been associated with substance use disorders (SUD). However, there are few studies that have evaluated gender differences in a global and a standardized way, and with a large sample of patients with SUD. Our goal is to analyze the role of gender in addiction severity throughout multiple life domains, using the Addiction Severity Index-6 (ASI-6). A naturalistic, multicenter and prospective study was conducted. A total of 221 patients with SUD (80.1% men) were interviewed with the ASI-6. Our results indicate that the Recent Summary Scores (RSSs) of men and women are similar, with the exception of Psychiatric and Partner- Problems, where women showed higher severity (p = .017 and p = .013, respectively). Statistically significant gender differences were found in certain aspects of the ASI-6 domains: men have more problems of physical health, legal issues, and alcohol and other substance use; and woman score higher in problems of mental health, social network, subjective evaluations of SUD consequences, and treatment needs. These results should be taken into account to improve the identification, prevention, and treatment of SUD.

Tobacco and cognitive performance in schizophrenia patients: the design of the COGNICO study

People with schizophrenia constitute a substantial part of the people who still smoke. Regarding cognitive performance, the self-medication hypothesis states that patients smoke to improve their cognitive deficits based on the stimulating effects of nicotine. The aim of this paper is to describe in detail the methodology used in the COGNICO study. A quasi-experimental, observational, prospective, multicenter study with follow-ups over 18 months was conducted in three cities in northern Spain (Oviedo, Ourense and Santiago de Compostela). A total of 81 outpatient smokers with schizophrenia were recruited with a mean age 43.35 years (SD = 8.83), 72.8% of them male. They were assigned to 3 groups: a) control group (smokers); b) patients who quit smoking using nicotine patches; c) patients who quit smoking with Varenicline. The MATRICS neuropsychological battery was applied as a primary measure. In addition, a comprehensive assessment of patients was performed, including the number of cigarettes per day, physical and psychological dependence on nicotine and CO expired. Clinical evaluation (PANSS, HDRS, CGI, C-SSRS), anthropometric measurements and vital signs assessment was also performed. The aim is to identify the relationship between the pattern of tobacco use and cognitive performance by comparing scores on the neuropsychological battery MATRICS during the follow-up periods (3, 6, 12 and 18months). The importance of this study lies in addressing a topical issue often ignored by clinicians: the unacceptably high rates of tobacco use in patients with severe mental disorders.

Effects of nicotine abstinence on clinical symptoms. Study at 3 and 6-months follow-up of outpatients with schizophrenia

Introduction

Tobacco use has been associated with more excitement and agitation symptoms, greater severity of global psychopathology as measured by the Clinical General Impression (CGI) Scale, and psychotic symptoms in patients with schizophrenia.

Aim

To assess the effects of nicotine abstinence versus nicotine maintenance on the clinical symptoms of a sample of outpatients smokers diagnosed with schizophrenia.

Methods

Sample: 81 outpatients with schizophrenia [72.8% males; mean age (SD) = 43.35 (8.82)] currently smoking tobacco [no. of cigarettes (SD) = 27.96 (12.29)]. Desing: non-randomized, open-label, 6-month follow-up and multi-center study conducted at 3 sites in Spain (Oviedo, Santiago de Compostela and Orense). Instruments: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression for Schizophrenia (CGI-SCH), Hamilton Depression Rating Scale (HDRS). Antropometric measures: Body mass index (BMI) and waist circumference. Vital sings: heart rate. Procedure: Patients were assigned to 2 conditions:

– control group = patients continuing their tobacco use;

– experimental group = patients participated in vareniclina or nicotine patches treatment for smoking cessation.

Patients were evaluated at baseline (all patients smoking) and after 3 and 6 months.

Results

No significant differences (P>.05) were found between groups at baseline evaluation. Likewise, there were no significant differences between smokers and non-smokers after treatment (3 and 6 months follow-up) in their clinical symptomatology (according to PANSS, HDRS and CGI-SCH), anthropometric measures and heart rate.

Conclusions

No significant differences were found in the clinical symptoms after a period of nicotine abstinence. Therefore, clinicians should motivate and help their patients to quit smoking (CIBERSAM - FIS PI11/01891).

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychometric properties of a Spanish-version of the Schizophrenia Objective Functioning Instrument (Sp-SOFI)

The Schizophrenia Objective Functioning Instrument (SOFI) is an interviewer-administered scale designed to objectively assess the actual level of patient functioning and to measure community functioning related to cognitive impairment and psychopathology. The aim was to examine the psychometric properties of the Spanish version of the SOFI (Sp-SOFI) in a sample of 155 Spanish outpatients with schizophrenia disorder. The instruments applied were Sp-SOFI, Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia Scale (CGI-SCH), Personal and Social Performance Scale (PSP), and Global Assessment of Functioning (GAF). The discrimination indexes of the Sp-SOFI items range from .21 to .77. Exploratory factor analysis showed an essentially one-dimensional structure. Cronbach's alpha was .93. Test-retest reliability for the Sp-SOFI total score was .87 (p < .001). The canonical correlation between SP-SOFI domains and PSP dimensions was .83. The multiple correlation coefficient between Sp-SOFI domains and GAF score was .84. Sp-SOFI scores were significantly different between high and low scores on the PANSS scales (p < .001). Sp-SOFI measures discriminated among patients with doubtful, mild, moderate, and severe schizophrenia disorder according to CGI-SCH scales (p < .001). New evidence about the validity of the SOFI was provided. The Sp-SOFI is a reliable and valid tool for using in clinical practice.

[Dual diagnosis in anxiety disorders: pharmacologic treatment recommendations]

Anxiety disorders and substance use disorders are highly comorbid (between 18% and 37%), and such comorbidity complicates treatment and worsens prognosis (including higher suicide risk). There are not many research works on the specific pharmacologic treatment of dual comorbid anxiety disorders. Most authors recommend a simultaneous approach of both, anxiety and substance use, disorders. Research data on pharmacotherapy suggest that psychotropics used in the treatment of anxiety disorders are also effective in dual diagnosis. SSRIs are considered first-line therapy in the treatment of dual anxiety while benzodiacepines should be avoided. New generation antiepileptic have shown efficacy in case series and open label studies in the latest years, thus being a promising treatment option for dual comorbid anxiety disorders, specially pregabalin in generalized anxiety disorder.

Suicide prevention for youth--a mental health awareness program: lessons learned from the Saving and Empowering Young Lives in Europe (SEYLE) intervention study

Background

The Awareness program was designed as a part of the EU-funded Saving and Empowering Young Lives in Europe (SEYLE) intervention study to promote mental health of adolescents in 11 European countries by helping them to develop problem-solving skills and encouraging them to self-recognize the need for help as well as how to help peers in need.

Methods

For this descriptive study all coordinators of the SEYLE Awareness program answered an open-ended evaluation questionnaire at the end of the project implementation. Their answers were synthesized and analyzed and are presented here.

Results

The results show that the program cultivated peer understanding and support. Adolescents not only learned about mental health by participating in the Awareness program, but the majority of them also greatly enjoyed the experience.

Conclusions

Recommendations for enhancing the successes of mental health awareness programs are presented. Help and cooperation from schools, teachers, local politicians and other stakeholders will lead to more efficacious future programs.

A cross-cultural comparison between Spain and the USA: temperament and character distribution by sex and age

The Unified Biosocial Theory of Personality developed by Cloninger has been applied in different cultures. Distribution by age and sex of the Temperament and Character Inventory (TCI) dimensions were assessed cross-culturally for samples in Spain and the USA. Three non-clinical samples were included: i) 404 participants from Asturias (Spain); ii) 240 participants from Burgos (Spain); and iii) 300 adults from St. Louis (USA). Each participant was assessed by means of the TCI. A significant negative correlation between NS and both HA (r=-0.329; P<0.01) and P (r=-0.217; P<0.01) was found in the study sample, as well as significant effects of age in NS, HA, RD, and C for women and in NS and HA for men, and also of sex in HA and RD. Personality dimensions for the two Spanish samples appear to be similar (differences in HA4 and RD) compared to those for the US sample (differences in NS, HA, RD and P). Findings support Cloninger's theory about differences between men and women, but not regarding the intercorrelations between temperament dimensions.

Suicide attempts and suicide ideation in adolescents: SDQ scores in the Spanish sample of “saving and empowering young lives in Europe” (SEYLE) project

Introduction

Behaviour disorders in adolescents are a risk factor associated with suicidal behavior.

Aim

To examine the distribution of the Strengths and Difficulties Questionnaire (SDQ) scores in the Spanish sample of adolescents from the “Saving and Empowering Young Lives in Europe” (SEYLE) project and study the differences according to the gender and the relationship with both suicide attempts (SA) and suicidal ideation (SI).

Method

875 pupils from 12 secondary schools sited in Asturias (Spain) [50.7% males; mean age (SD) =14.5 (0.72)] were assessed through the SDQ and Paykel Suicide Scale (PSS).

Results

No significant differences were found in the SDQ total score by gender, but were found (p< 0.001) in some subscales as emotional symptoms (t=-6.769) (women scoring higher), hyperactivity (t=3.283) and prosocial (t=5.260) (men scoring higher). Regarding PSS, 3.1% tried to take their life during past six months. No significant differences were found in SA by gender but were found (p< 0.050) for the thought that life not worth (t=-3.597), women scoring higher, and about wish to be dead (t=-2.630), men scoring higher. Previous SA were significant related (p< 0.001) with SDQ total score (X2=38,437), emotional symptoms (X2=25,528), hyperactivity (X2=13,572) and behaviour disorders (X2=7,505). SI was significant related (p< 0.001) with SDQ total score (X2=38,437), emotional symptoms (X2=31,077), behaviour disorders (X2=33,011), peer problems (X2=35,161) and prosocial behavior (X2=17,978).

Conclusion

SA and SI were related with difficulties (SDQ criteria), mainly on emotional symptoms and behaviour disorders. Prevention strategies in high risk groups are likely to become increasingly important.

Differences Observed by ASI-6 among users of Alcohol, Cocaine and Opiates

Aim:

To identify the differences in the ASI-6 scores according to main substance of consumption among patients with drug use disorder who were included at the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.

Method:

Multicentre, observational, longitudinal, prospective study. 186 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.

Results:

Main substance of consumption: 57% alcohol, 19.9% cocaine and 19.4% opiates. Men were 77.4% vs. 81.1% vs. 83.3% (p n.s.), mean ages were 47.12 (SD 10.18) vs. 32.62 (SD 8.20) vs. 36.47 (SD 8.04) years (p< 0.001), and 25.5% vs. 64.9% vs. 55.6% were single (p< 0.001). The greatest severity was found in the Alcohol area in the case of alcohol users (56.86) and in the Family/Social Partner Problems area in the case of cocaine and the opiate users (50.43 and 51.22). Alcohol users had statistically significant greater severity than the other two groups in the Alcohol area (56.86 vs. 49.38 vs. 45.17, p< 0.001) and tended to have lower severity in the Legal area than cocaine users (46.78 vs. 48.43, p 0.079).

Conclusions:

Cocaine users were the youngest and used to be single. The ASI-6 only differentiated in the severity of the Alcohol area. Further studies including a higher proportion of cocaine and opiate users are needed.

Sociodemographic Profile and Clinical Data of Suicide Attempters from the Emergency Room of the Central Hospital of Asturias (Northern Spain)

Objectives:

i.

Method:

1,633 suicide attempters who attended the Emergency Room of the University Central Hospital of Asturias during the period 2003-2005 were included in the study. Evaluation of these patients was made using the WHO/Euro Multicentre Study Protocol. Psychiatric diagnoses were made following ICD-10 criteria.

Results:

Sociodemographic data: mean age (SD) = 38.66 (15.13); females: 62%; single: 39.8%; living with their family: 83.8%; lowest educational level: 67%; economically inactive: 33.8%. More prevalent psychiatric diagnoses were affective disorders (24.1%) and anxiety disorders (21.6%). Previous SA were present in 49.2% and 40% repeat the attempt during the monitoring period. Severity of the attempt (lethality of method and intentionality) was related with repetition of the behaviour during the monitoring period (p = 0.001). More frequent methods were overdose (74.8%) followed by cutting (18.5%).

Conclusions:

SA was more prevalent in a single woman with age between 30 and 50 years who suffering for affective or anxiety disorders. Many of the patients repeat the suicidal behaviour and this was related to the severity of the attempt. Individuals appear to use the methods that are available to them to attempt suicide.

Physical Health of Patients with Drug use Disorders

Aim:

To describe the physical health profile of patients with drug use disorders who were included in the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.

Method:

Multicentre, observational, longitudinal, prospective study. A total of 194 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.

Results:

Men were 79.9%, mean ages were 41.08 (SD 11.64), 42.3% were single and 87.6% were acute patients. The severity score in the Physical Health area was 44.32 (SD 9.51). The most prevalent diseases were: 25.3% hepatitis, 11.9% had high blood pressure, 8.2% cirrhosis or hepatic disease, 6.7% epilepsy or convulsions and 5.7% tuberculoses. No statistically significant differences were found according to gender. Acute patients had statistically significant higher proportion of pregnant woman (2.3% vs. 0% p< 0.05) and lower proportion of diabetes (3.5% vs. 12.5% p= 0.05).

Conclusions:

Patients with drug use disorders have a mild-moderate severity of physical health. Physical health is not influenced by gender, but it is by the clinical state.