1
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Sobregrau P, Peri JM, Sánchez del Valle R, Molinuevo JL, Barra B, Pintor L. Psychiatric and Psychosocial Characteristics of a Cohort of Spanish Individuals Attending Genetic Counseling Due to Risk for Genetically Conditioned Dementia. J Alzheimers Dis Rep 2022; 6:461-478. [PMID: 36186729 PMCID: PMC9484134 DOI: 10.3233/adr-210067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Predictive genetic tests are presently effective over several medical conditions, increasing the demand among patients and healthy individuals. Considering the psychological burden suspected familial dementia may carry on individuals, assessing personality, coping strategies, and mental health could aid clinicians in findings the appropriate time for delivering genetic test results and predict compliance regarding genetic counseling and expectations towards the genetic condition depending on the outcome. Objective: To describe the psychiatric, psychological, and coping characteristics of a sample of Spanish individuals at risk of familial dementia before genetic test results were given. Methods: We included 54 first degree relatives of patients diagnosed with Alzheimer’s disease, lobar frontotemporal degeneration, or prion diseases. The NEO-FFI-R, COPE, and HADS tests evaluated personality, coping strategies, and psychological distress, respectively. Results: Anxiety and depression were below the cut-off point for mild severity. Conscientiousness and Agreeableness were the most preponderant personality factors, while Neuroticism was the least. Positive reinterpretation and Acceptance were the most frequent coping strategies, and Denial and Alcohol and drug use were the least used. Ongoing medical pathologies increased depression, while psychiatric disorders worsened psychological distress. Conclusion: Contrary to our expectations, PICOGEN candidates showed psychological distress and personality traits within normative ranges, and the use of problem-focused coping strategies prevailed over avoidance coping strategies. Nevertheless, clinicians should pay particular attention to individuals attending genetic counseling who are women, aged, and present an ongoing psychiatric disorder and psychiatric history at inclusion to ensure their mental health and adherence throughout the process.
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Affiliation(s)
- Pau Sobregrau
- Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Psychology Faculty, University of Barcelona (UB), Barcelona, Spain
| | - Josep M. Peri
- Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Raquel Sánchez del Valle
- Neurology Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Bernardo Barra
- Clínica Universidad de Los Andes, Servicio de Salud Mental, Santiago, Chile
- Psychiatric Department, School of Medicine, Andrés Bello University, Santiago, Chile
| | - Luís Pintor
- Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Psychology Faculty, University of Barcelona (UB), Barcelona, Spain
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
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2
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Gutiérrez F, Peri JM, Baillès E, Sureda B, Gárriz M, Vall G, Cavero M, Mallorquí A, Ruiz Rodríguez J. A Double-Track Pathway to Fast Strategy in Humans and Its Personality Correlates. Front Psychol 2022; 13:889730. [PMID: 35756215 PMCID: PMC9218359 DOI: 10.3389/fpsyg.2022.889730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
The fast-slow paradigm of life history (LH) focuses on how individuals grow, mate, and reproduce at different paces. This paradigm can contribute substantially to the field of personality and individual differences provided that it is more strictly based on evolutionary biology than it has been so far. Our study tested the existence of a fast-slow continuum underlying indicators of reproductive effort-offspring output, age at first reproduction, number and stability of sexual partners-in 1,043 outpatients with healthy to severely disordered personalities. Two axes emerged reflecting a double-track pathway to fast strategy, based on restricted and unrestricted sociosexual strategies. When rotated, the fast-slow and sociosexuality axes turned out to be independent. Contrary to expectations, neither somatic effort-investment in status, material resources, social capital, and maintenance/survival-was aligned with reproductive effort, nor a clear tradeoff between current and future reproduction was evident. Finally, we examined the association of LH axes with seven high-order personality pathology traits: negative emotionality, impulsivity, antagonism, persistence-compulsivity, subordination, and psychoticism. Persistent and disinhibited subjects appeared as fast-restricted and fast-unrestricted strategists, respectively, whereas asocial subjects were slow strategists. Associations of LH traits with each other and with personality are far more complex than usually assumed in evolutionary psychology.
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Affiliation(s)
- Fernando Gutiérrez
- Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacións Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep M Peri
- Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eva Baillès
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Bárbara Sureda
- Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miguel Gárriz
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Gemma Vall
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain.,Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Myriam Cavero
- Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aida Mallorquí
- Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - José Ruiz Rodríguez
- Department of Clinical Psychology and Psychobiology, Personality, Evaluation and Psychological Treatment Section, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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3
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Gutiérrez F, Aluja A, Ruiz Rodríguez J, Peri JM, Gárriz M, Garcia LF, Sorrel MA, Sureda B, Vall G, Ferrer M, Calvo N. Borderline, where are you? A psychometric approach to the personality domains in the International Classification of Diseases, 11th Revision (ICD-11). Personal Disord 2022; 14:355-359. [PMID: 35737563 DOI: 10.1037/per0000592] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The inclusion of the borderline pattern in the International Classification of Diseases, 11th Revision (ICD-11) dimensional classification of personality disorders (PDs) has caused controversy. Unease about leaving out these clinically challenging patients seems to conflict with the need of an evidence-based and credible diagnostic system. However, the accommodation of borderline within the new diagnostic system has not yet been studied in depth. To this end, we examine in a sample of 1799 general population and clinical subjects the joint structure of the five initial ICD-11 domains and the borderline pattern. Regression and item-level factor analyses reveal that borderline criteria do not form a separate construct and are indissociable from negative affectivity. Furthermore, borderline adds nothing to the remaining domains when it comes to predict PD severity. The borderline pattern appears as largely superfluous and even misguiding, unless their criteria are properly integrated within the structure of personality pathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Anton Aluja
- Lleida Institute for Biomedical Research Dr. Pifarre Foundation
| | | | | | | | - Luis F Garcia
- Lleida Institute for Biomedical Research Dr. Pifarre Foundation
| | | | | | - Gemma Vall
- Lleida Institute for Biomedical Research Dr. Pifarre Foundation
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4
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Gutiérrez F, Aluja A, Rodríguez C, Gárriz M, Peri JM, Gallart S, Calvo N, Ferrer M, Gutiérrez-Zotes A, Soler J, Pascual JC. Severity in the ICD-11 personality disorder model: Evaluation in a Spanish mixed sample. Front Psychiatry 2022; 13:1015489. [PMID: 36699492 PMCID: PMC9868964 DOI: 10.3389/fpsyt.2022.1015489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Severity is the main component of the ICD-11 personality disorder (PD) classification, but pertinent instruments have only recently been developed. We analyzed the psychometric properties of the ICD-11 Personality Disorder Severity scale (PDS-ICD-11) in a mixed sample of 726 community and clinical subjects. We also examined how the different components of the ICD-11 PD system -five trait domains, the borderline pattern specifier, and severity, all of them measured through self-reports- are interconnected and operate together. PDS-ICD-11 properties were adequate and similar to those of the original instrument. However, regressions and factor analyses showed a considerable overlap of severity with the five personality domains and the borderline specifier (72.6%). Bifactor modeling resulted in a general factor of PD (g-PD) that was not equivalent to severity nor improved criterion validity. The whole ICD-11 PD system, i.e., five personality domains, borderline, and severity, explained an average of 43.6% of variance of external measures of well-being, disability, and clinical problems, with severity contributing 4.8%. Suggestions to further improve the ICD-11 PD taxonomy include remodeling the present definition of severity to give more weight to the real-life consequences of traits.
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Affiliation(s)
- Fernando Gutiérrez
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacións Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anton Aluja
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain.,Department of Psychology, University of Lleida, Lleida, Spain
| | - Claudia Rodríguez
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Miguel Gárriz
- Neuropsychiatry and Drug Addiction Institute, Parc de Salut Mar, Barcelona, Spain
| | - Josep M Peri
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Salvador Gallart
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain
| | - Natalia Calvo
- Department of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marc Ferrer
- Department of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Pere Virgili Health Research Institute (IISPV), CERCA, Reus, Spain.,Pere Mata Psychiatric University Hospital, Reus, Spain
| | - Joaquim Soler
- Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Pascual
- Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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5
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Andreu A, Flores L, Molero J, Mestre C, Obach A, Torres F, Moizé V, Vidal J, Navinés R, Peri JM, Cañizares S. Patients Undergoing Bariatric Surgery: a Special Risk Group for Lifestyle, Emotional and Behavioral Adaptations During the COVID-19 Lockdown. Lessons from the First Wave. Obes Surg 2021; 32:441-449. [PMID: 34791617 PMCID: PMC8598099 DOI: 10.1007/s11695-021-05792-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 01/07/2023]
Abstract
Objectives
To determine how the COVID-19 lockdown influenced the lifestyle, eating behavior, use of substances, mental health, and weight in patients who had undergone bariatric surgery (BS) and explore the self-perception of one’s own health and fears related to COVID-19. Methods We performed a cross-sectional exploratory study in obesity patients who had undergone BS surgery > 1 year previously in a university hospital. Assessment was performed 40 days after initiating lockdown and included 2 periods: from April 24 until May 8 and during the initial de-escalation period: from May 9 until 22, 2020. A structured telephone interview and an online survey were administered. Results
One hundred eighty-eight patients were interviewed; 156 also responded to the online survey (77% females, mean age 53.46 ± 10.48 years, mean follow-up 5.71 ± 4.30 years). Dietary habits were affected in 72% of the participants, with 15% reporting better diet planning; 83.5% reported having more sedentary behaviors; 27% and 36% showed depression and anxiety, respectively; and 45% of participants reported bad sleep quality. In relation to changes in the use of any substance, the use increased in the majority of patients who were previously users. Self-perception of one’s own health and fears related to COVID-19 were only moderate. Finally, emotional eating and time since BS were statistically significant risk factors for predicting weight gain. Conclusions Lockdown during COVID-19 pandemic negatively influenced the lifestyle, mental health, substance use, and weight in BS patients. These alterations were somewhat similar to those observed in the general population but more severe and with important clinical implications. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05792-1.
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Affiliation(s)
- Alba Andreu
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios office 9, 08036, Barcelona, Spain.,CIBER Obesity and Nutrition (CIBEROBN), Barcelona, Spain
| | - Lilliam Flores
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios office 9, 08036, Barcelona, Spain.,CIBER Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Judit Molero
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios office 9, 08036, Barcelona, Spain
| | - Carla Mestre
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios office 9, 08036, Barcelona, Spain
| | - Amadeu Obach
- Section of Clinical Health Psychology, Psychiatry and Psychology Department, Hospital Clinic, 140 Rosellón Street, 08036, Barcelona, Spain
| | - Ferran Torres
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain
| | - Violeta Moizé
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios office 9, 08036, Barcelona, Spain.,CIBER Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Josep Vidal
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios office 9, 08036, Barcelona, Spain.,CIBER Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Ricard Navinés
- Section of Clinical Health Psychology, Psychiatry and Psychology Department, Hospital Clinic, 140 Rosellón Street, 08036, Barcelona, Spain
| | - Josep M Peri
- Section of Clinical Health Psychology, Psychiatry and Psychology Department, Hospital Clinic, 140 Rosellón Street, 08036, Barcelona, Spain
| | - Silvia Cañizares
- Section of Clinical Health Psychology, Psychiatry and Psychology Department, Hospital Clinic, 140 Rosellón Street, 08036, Barcelona, Spain. .,Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.
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6
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Gutiérrez F, Vicente E, Aluja A, Peri JM, Gutiérrez-Zotes A, Baillés E, Edo Villamón S, Ruipérez Rodríguez MÁ, Meliá de Alba A, Vall G, Gallardo-Pujol D. A third hierarchical level of narrower traits for the Dimensional Assessment of Personality Pathology-Basic Questionnaire. Personal Ment Health 2021; 15:239-251. [PMID: 33871181 DOI: 10.1002/pmh.1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022]
Abstract
Current dimensional taxonomies of personality disorder show a stronger empirical grounding than categories, but may lack the necessary level of detail to make accurate predictions and case formulations. We need to further develop the lower levels of the hierarchy until reaching the building blocks of personality pathology. The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) is well-suited to this purpose due to its multilayered structure and its agreement with the official dimensional classifications. We disaggregated the 18 DAPP-BQ mid-level facets through exploratory and confirmatory factor analysis in a sample of 3233 community subjects and outpatients. We obtained a set of 72 clinically relevant, narrower subfacets, which were reliable, well-fitted to the data, and invariant between clinical and community subjects and between the sexes. This third level of abstraction increases by 4.7% the capacity to predict DSM categorical personality disorders, gives a particular advantage in capturing dependent, histrionic, paranoid, obsessive, and schizoid features and can provide the detailed information that clinical decisions demand.
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Affiliation(s)
- Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain
| | - Enrique Vicente
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Psychiatry and Psychology Service, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anton Aluja
- Department of Psychology, University of Lleida, Lleida, Spain.,Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Josep M Peri
- Clinical and Health Psychology Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Eva Baillés
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Silvia Edo Villamón
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | | | - Amanda Meliá de Alba
- Higher Institute of Psychological Studies (ISEP), Valencia, Spain.,CEDINSALUD, Valencia, Spain
| | - Gemma Vall
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain.,Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa María, Lleida, Spain
| | - David Gallardo-Pujol
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences (UBNeuro), Barcelona, Spain
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7
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Díaz-Batanero C, Aluja A, Sayans-Jiménez P, Baillés E, Fernández-Calderón F, Peri JM, Vall G, Lozano ÓM, Gutiérrez F. Alternative DSM-5 Model for Personality Disorders Through the Lens of an Empirical Network Model. Assessment 2021; 28:773-787. [PMID: 31928067 DOI: 10.1177/1073191119897118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Alternative Model for Personality Disorders defined in Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) has recently attracted considerable interest in empirical research, with different hypotheses being proposed to explain the discordant results shown in previous research. Empirical network analysis has begun to be applied for complementing the study of psychopathological phenomena according to a new perspective. This article applies this analysis to personality facets measured in a sample of 626 patients with mental disorders and a 1,034 normative sample, using the Personality Inventory for DSM-5. The results reveal five substructures partially equivalent to domains defined in the DSM-5. Discordant facets (suspiciousness, hostility, rigid perfectionism, attention seeking, and restricted affectivity) play the role of connectors between substructures. Invariance between clinical and community networks was found except for the connection between unusual beliefs and perceptual dysregulation (stronger in the clinical sample). Considering the strength centrality index, anxiousness, emotional lability, and depressivity can be highlighted for their relative importance within both clinical and normative networks.
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Affiliation(s)
| | | | | | - Eva Baillés
- Universitat Pompeu i Fabra, Barcelona, Spain
| | | | | | | | | | - Fernando Gutiérrez
- Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
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8
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Gutiérrez F, Peri JM, Gárriz M, Vall G, Arqué E, Ruiz L, Condomines J, Calvo N, Ferrer M, Sureda B. Integration of the ICD-11 and DSM-5 Dimensional Systems for Personality Disorders Into a Unified Taxonomy With Non-overlapping Traits. Front Psychiatry 2021; 12:591934. [PMID: 33889093 PMCID: PMC8055818 DOI: 10.3389/fpsyt.2021.591934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
The promise of replacing the diagnostic categories of personality disorder with a better-grounded system has been only partially met. We still need to understand whether our main dimensional taxonomies, those of the International Classification of Diseases, 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are the same or different, and elucidate whether a unified structure is possible. We also need truly independent pathological domains, as they have shown unacceptable overlap so far. To inquire into these points, the Personality Inventory for DSM-5 (PID-5) and the Personality Inventory for ICD-11 (PiCD) were administered to 677 outpatients. Disattenuated correlation coefficients between 0.84 and 0.93 revealed that both systems share four analogous traits: negative affectivity, detachment, dissociality/antagonism, and disinhibition. These traits proved scalar equivalence too, such that scores in the two questionnaires are roughly interchangeable. These four domains plus psychoticism formed a theoretically consistent and well-fitted five-factor structure, but they overlapped considerably, thereby reducing discriminant validity. Only after the extraction of a general personality disorder factor (g-PD) through bifactor analysis, we could attain a comprehensive model bearing mutually independent traits.
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Affiliation(s)
- Fernando Gutiérrez
- Institute of Neuroscience, Hospital Clinic, Barcelona, Spain.,Institut d'Investigacións Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep M Peri
- Institute of Neuroscience, Hospital Clinic, Barcelona, Spain
| | - Miguel Gárriz
- Neuropsychiatry and Drug Addiction Institute, Parc de Salut Mar, Barcelona, Spain
| | - Gemma Vall
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain.,Biomedical Research Institute, Lleida, Spain
| | - Estela Arqué
- La Coma Therapeutic Community, ATRA Group, Barcelona, Spain
| | - Laura Ruiz
- La Coma Therapeutic Community, ATRA Group, Barcelona, Spain
| | | | - Natalia Calvo
- Psychiatry Department, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marc Ferrer
- Psychiatry Department, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Bárbara Sureda
- Institute of Neuroscience, Hospital Clinic, Barcelona, Spain
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9
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Gutiérrez F, Aluja A, Ruiz J, García LF, Gárriz M, Gutiérrez-Zotes A, Gallardo-Pujol D, Navarro-Haro MV, Alabèrnia-Segura M, Mestre-Pintó JI, Torrens M, Peri JM, Sureda B, Soler J, Pascual JC, Vall G, Calvo N, Ferrer M, Oltmanns JR, Widiger TA. Personality Disorders in the ICD-11: Spanish Validation of the PiCD and the SASPD in a Mixed Community and Clinical Sample. Assessment 2020; 28:759-772. [PMID: 32583685 PMCID: PMC7961637 DOI: 10.1177/1073191120936357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The International Classification of Diseases–11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α = .75 to .84) but less so in the SASPD (α = .64 and .73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition–anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them.
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Affiliation(s)
| | - Anton Aluja
- University of Lleida, Lleida, Spain.,Biomedical Research Institute of Lleida, Lleida, Spain
| | - José Ruiz
- University of Barcelona, Barcelona, Spain
| | - Luis F García
- Biomedical Research Institute of Lleida, Lleida, Spain.,Autonomous University of Madrid, Madrid, Spain
| | - Miguel Gárriz
- Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
| | | | - David Gallardo-Pujol
- University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, Barcelona, Spain
| | - Maria V Navarro-Haro
- University of Zaragoza, Zaragoza, Spain.,Aragón Health Research Institute, Zaragoza, Spain
| | | | - Joan Ignasi Mestre-Pintó
- IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Torrens
- IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain
| | | | | | - Joaquim Soler
- Universitat Autònoma de Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Pascual
- Universitat Autònoma de Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Vall
- Biomedical Research Institute of Lleida, Lleida, Spain.,GSS-Hospital Santa Maria, Lleida, Spain
| | - Natalia Calvo
- Universitat Autònoma de Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ferrer
- Universitat Autònoma de Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
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10
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Abstract
On the path to developing dimensional models of personality disorder (PD), we are at risk of leaving key diagnostic aspects behind. The general criteria for PD may be important ones because they reflect the defining aspects of personality pathology: long duration, independence from psychopathological states, and harmfulness. We assessed these criteria by interview in a sample of 362 psychiatric outpatients after administering the Personality Diagnostic Questionnaire-4+. The result was a 42.5% fall in self-reported endorsements, due to misinterpretations (11.5%), short duration of traits or contamination by state psychopathology (9.8%), and traits being non-harmful (21.2%). However, not all personality traits and disorders underwent correction to the same extent, and ultimately, the interview did not improve the prediction of clinical variables. These findings raise doubts about the practical relevance of the general criteria for PD and support the role of self-report questionnaires for diagnostic purposes.
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Affiliation(s)
- Josep M Peri
- Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ana Muñoz-Champel
- Department of Legal Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona
| | - Rafael Torrubia
- Department of Legal Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona
| | - Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clínic de Barcelona, and Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Barcelona
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Muñoz-Champel A, Gutiérrez F, Peri JM, Torrubia R. Personality Disorders Are Not as We Thought: Hierarchical Factor Structure at the Criterion Level. J Pers Assess 2017. [DOI: 10.1080/00223891.2017.1278700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ana Muñoz-Champel
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Spain
| | - Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Josep M. Peri
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain
| | - Rafael Torrubia
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Spain
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Gutiérrez F, Aluja A, Peri JM, Calvo N, Ferrer M, Baillés E, Gutiérrez-Zotes JA, Gárriz M, Caseras X, Markon KE, Krueger RF. Psychometric Properties of the Spanish PID-5 in a Clinical and a Community Sample. Assessment 2016; 24:326-336. [PMID: 26391204 DOI: 10.1177/1073191115606518] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Personality Inventory for DSM-5 (PID-5) measures the trait part (Criterion B) of the alternative model for personality disorders proposed in Section III of DSM-5. Although its psychometric properties have proven adequate thus far, evidence is limited in other languages and in clinical samples. The Spanish PID-5 was examined in two samples comprising 446 clinical and 1,036 community subjects. Facet scales showed good internal consistency in both samples (median α = .86 and .79) and were unidimensional under exploratory and confirmatory approaches. They were also able to distinguish between clinical and community subjects with a mean standardized difference of z = 0.81. All facets except for Risk Taking were unipolar, such that the upper poles indicated pathology and the lower poles reflected normality, rather than the opposite pole of abnormality. The entire PID-5 hierarchical structure, from one to five factors, was confirmed in both samples with Tucker's congruence coefficients over .95.
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Affiliation(s)
- Fernando Gutiérrez
- 1 Hospital Clínic de Barcelona, Barcelona, Spain.,2 IDIBAPS, Barcelona, Spain
| | - Antón Aluja
- 3 University of Lleida-Biomedical Research Institute, Lleida, Spain
| | - Josep M Peri
- 1 Hospital Clínic de Barcelona, Barcelona, Spain
| | - Natalia Calvo
- 4 Hospital Vall d'Hebrón-CIBERSAM, Barcelona, Spain.,5 Universidad Autónoma de Barcelona, Bellaterra, Spain
| | - Marc Ferrer
- 4 Hospital Vall d'Hebrón-CIBERSAM, Barcelona, Spain.,5 Universidad Autónoma de Barcelona, Bellaterra, Spain
| | - Eva Baillés
- 6 Universitat Pompeu Fabra, Barcelona, Spain
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Vall G, Gutiérrez F, Peri JM, Gárriz M, Ferraz L, Baillés E, Obiols JE. Seven basic dimensions of personality pathology and their clinical consequences: Are all personalities equally harmful? Br J Clin Psychol 2015; 54:450-68. [DOI: 10.1111/bjc.12091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Gemma Vall
- Department of Psychiatry; Mental Health and Addiction; GSS - Hospital Santa Maria - IRB; Lleida Spain
- Department of Clinical and Health Psychology; Autonomous University of Barcelona; Spain
| | - Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neurosciences; Hospital Clinic of Barcelona; Spain
- IDIBAPS (August Pi Sunyer Biomedical Research Institute); Barcelona Spain
| | - Josep M. Peri
- Institute of Neurosciences; Hospital Clinic of Barcelona; Spain
| | - Miguel Gárriz
- INAD (Institute of Neuropsychiatry and Addiction); MAR Health Park Barcelona Spain
| | - Liliana Ferraz
- Department of Clinical and Health Psychology; Autonomous University of Barcelona; Spain
| | - Eva Baillés
- Department of Experimental and Health Sciences; Pompeu Fabra University; Barcelona Spain
| | - Jordi E. Obiols
- Department of Clinical and Health Psychology; Autonomous University of Barcelona; Spain
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15
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Gutiérrez F, Gárriz M, Peri JM, Ferraz L, Sol D, Navarro JB, Barbadilla A, Valdés M. Fitness costs and benefits of personality disorder traits. EVOL HUM BEHAV 2013. [DOI: 10.1016/j.evolhumbehav.2012.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Callejas MA, Grimalt R, Mejía S, Peri JM. [Results of video-assisted thoracoscopic sympathectomy for facial blushing]. Actas Dermosifiliogr 2012; 103:525-31. [PMID: 22482739 DOI: 10.1016/j.ad.2012.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 12/29/2011] [Accepted: 01/29/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Involuntary craniofacial erythema, or blushing, due to autonomic dysfunction can be a cause of psychological distress. Although anecdotal reports have suggested that pharmacologic treatments or cognitive behavioral therapy can be used to treat the condition, no rigorous analyses of their efficacy have been reported. OBJECTIVES To assess the efficacy of video-assisted thoracoscopic sympathectomy and to study phobic anxiety and other personality traits in a series of patients with involuntary facial blushing. MATERIALS AND METHODS We carried out a retrospective observational study of patients treated with bilateral video-assisted thoracoscopic sympathectomy for blushing over a 7-year period (2001-2008). All the patients were treated by a dermatologist, a psychologist, and a thoracic surgeon and were informed of the predicted outcomes. RESULTS A total of 204 patients with a mean age of 34 years (range, 15-67 years) were included; the numbers of males and females were similar. Only 10% had unpredicted outcomes; in such cases, either the procedure was insufficiently effective or postoperative reflex sweating developed (and was considered serious in 2%). There were no deaths and only 1 case of transient Horner syndrome. Video-assisted thoracotomy was required for pleural symphysis in 1 patient; 5 patients developed pneumothorax, but only 1 of them required pleural drainage. CONCLUSIONS Video-assisted sympathectomy is a safe, effective and definitive treatment for disabling blushing. Anxiety that is detected before surgery is a reaction to blushing rather than a cause of it.
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Affiliation(s)
- M A Callejas
- Unidad de Cirugía Torácica de Acceso Mínimo, Hospital Platón, Barcelona, España.
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Gutiérrez F, Peri JM, Torres X, Caseras X, Valdés M. Three dimensions of coping and a look at their evolutionary origin. Journal of Research in Personality 2007. [DOI: 10.1016/j.jrp.2007.01.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Molinuevo JL, Pintor L, Peri JM, Lleó A, Oliva R, Marcos T, Blesa R. Emotional reactions to predictive testing in Alzheimer's disease and other inherited dementias. Am J Alzheimers Dis Other Demen 2005; 20:233-8. [PMID: 16136847 PMCID: PMC10833295 DOI: 10.1177/153331750502000408] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This work describes the reasons and emotional responses of healthy descendants after counseling for presenilin mutations in early-onset familial Alzheimer's disease (EOFAD), tau mutations in familial frontotemporal dementia (FTD), and prion mutations in fatal familial insomnia (FFI). A multidisciplinary protocol following Huntington's disease counseling guidelines and a post-test follow-up program were developed to counsel healthy descendants of affected families. The psychological consequences, anxiety levels, and depression status were assessed through validated scales before and after disclosing the information. Nine people from three different families, one with EOFAD, another with FTD, and the other with FFI came for counseling. Their main reason for testing was to initiate early treatment in the future. Disclosing the information decreased anxiety in two carriers, increased it temporarily in one, and had no effect in another. All noncarriers felt relieved. Overall, after a mean of 30 months of follow-up, no negative psychological reactions were observed. All participants positively valued the program. Although preliminary, our observations suggest that predictive testing in EOFAD, FTD, and FFI is safe and may be of benefit when performed with a delicate approach under strict pretest counseling protocols and post-test follow-up programs. The emotional reactions were similar, although the diseases, their phenotype, and mutation characteristics were different.
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Affiliation(s)
- José L Molinuevo
- Unidad Memoria-Alzheimer, Institut Clínic de Neurociencies, Hospital Clínic i Universitari, Barcelona, Spain
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Lladó A, León L, Valls-Solé J, Mena P, Callejas MA, Peri JM. Changes in the sympathetic skin response after thoracoscopic sympathectomy in patients with primary palmar hyperhidrosis. Clin Neurophysiol 2005; 116:1348-54. [PMID: 15978496 DOI: 10.1016/j.clinph.2005.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Revised: 01/13/2005] [Accepted: 02/10/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate whether thoracic sympathectomy induced any change in the pattern of abnormalities or in the waveform of the sudomotor skin response (SSR) in patients with primary palmar hyperhidrosis (PPH). METHODS We recorded the SSR to median nerve electrical stimuli before and after bilateral thoracoscopic sympathectomy in 27 patients with PPH. We analyzed the changes in amplitude, type of waveform and pattern of abnormality. RESULTS All patients reported symptomatic improvement. The amplitude of the SSR decreased significantly in patients examined within 1 year after surgery, but was not different in patients examined after 1 year. The number of abnormally enhanced responses reduced after surgery, but there was no significant change in the number of patients with enhanced excitability recovery or with double-peak responses to single stimuli. There was a significant increase in the number of SSRs with a predominantly negative waveform after surgery. CONCLUSIONS The persistence of SSR abnormalities after surgery suggests that the central nervous system dysfunction is not modified by sympathectomy. The change of the waveform to predominantly negative type after surgery could be the consequence of the decrease in the production of sweating. SIGNIFICANCE Our results show the effects of sympathectomy on the SSR and on its abnormal patterns in patients with PPH.
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Affiliation(s)
- A Lladó
- Neurology Department, Hospital Clínic, University of Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
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González M, de Pablo J, Fuente E, Valdés M, Peri JM, Nomdedeu M, Matrai S. Instrument for Detection of Delirium in General Hospitals: Adaptation of the Confusion Assessment Method. Psychosomatics 2004; 45:426-31. [PMID: 15345788 DOI: 10.1176/appi.psy.45.5.426] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Delirium is a common and severe disorder that is often misdiagnosed. The use of screening instruments is advisable for its early detection and treatment. In this study, the authors present an adaptation of the Confusion Assessment Method in order to improve its psychometric properties. One hundred fifty-three elderly inpatients were assessed in a four-phase procedure. Interrater reliability was high (kappa = 0.89). Sensitivity was 90%, and specificity was 100%; the value for negative predictive accuracy was 97%, and the value for positive predictive accuracy was 100%. The adaptation has convergent agreement with two other mental status tests, the Mini-Mental Status Examination and the Delirium Rating Scale. Our results suggest that the adaptation of the Confusion Assessment Method is sensitive, specific, reliable, and easy to use by clinicians.
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Affiliation(s)
- M González
- IDIBAPS Clinical Institute of Psychiatry and Psychology, Internal Medicine Department, Hospital Clinic, University of Barcelona, Spain
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Molinuevo JL, Perez-Basallo B, Peri JM, Antón S, Rami L. P2-408 Psychological impact of Alzheimer's disease diagnosis disclosure: preliminary results. Neurobiol Aging 2004. [DOI: 10.1016/s0197-4580(04)81149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gómez-Gil E, Vidal A, Panés J, Jaén J, Peri JM, Fernández-Egea E, Piqué JM. [Relationship between patient's subjective stress perception and the course of inflammatory bowel disease]. Gastroenterol Hepatol 2003; 26:411-6. [PMID: 12887854 DOI: 10.1016/s0210-5705(03)70382-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Studies examining the relationship between stress secondary to adverse life events (ALE) and inflammatory bowel disease (IBD) have produced controversial data. The aim of this study was to explore the subjective perception of this relationship in IBD patients. PATIENTS AND METHODS Seventy consecutive patients suffering from IBD (40 Crohn's disease, 30 ulcerative colitis) were assessed using a self-rating questionnaire related to demographic variables, clinical characteristics, subjective perception of the influence of ALE on the course of IBD, psychiatric background, and the HAD scale. The results of this scale were compared with a group of 25 relatives. RESULTS Forty-two patients (60%) perceived that there was relationship between ALE and the onset of their disease, forty-nine (70%) between ALE and the increasing IBD symptoms severity, and fifty-one patients (72.9%) with disease activity. Sixteen of the patients (22.9%) had been visited by a psychiatrist during relapses of IBD. Twenty-five patients (42.4%) reached a score of 11 or higher on the depression or anxiety subscales of the HAD, indicating a probable psychological disorder. CONCLUSIONS IBD patients perceive a strong relationship between ALE and the course of IBD. We have found a high prevalence of anxiety and depression symptoms in these patients. If this observation is confirmed with objective measurements, it will be important to consider psychiatric intervention for these patients.
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Affiliation(s)
- E Gómez-Gil
- Institut Clínic de Psiquiatria i Psicologia. Hospital Clínic. Barcelona. España.
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Abstract
The present study aims to validate the Spanish version of the Hospital Anxiety and Depression Scale (HADS) and to determine the use of this tool for screening mood and anxiety disorders. Psychometric properties of the HADS were assessed in different groups of general medical outpatients attending the Hospital Clínic in Barcelona (N=385), and psychiatric diagnoses were made using DSM-IV criteria. A two-factor solution corresponding to the original two subscales of the HADS was found. The Spanish version of the HADS had good internal consistency and external validity, with favorable sensitivity and specificity in identifying cases of psychiatric disorder as defined by the Structured Clinical Interview for DSM-IV (SCID-I). The psychometric properties of the HADS and its brevity make it useful for screening for psychiatric disorders in the medically ill.
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Affiliation(s)
- M J Herrero
- Clinical Institute of Psychiatry and Psychology, Hospital Clínic de Barcelona, Spain, Barcelona, Spain.
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Alijotas J, Alegre J, Fernández-Solà J, Cots JM, Panisello J, Peri JM, Pujol R. [Consensus report on the diagnosis and treatment of chronique fatigue syndrome in Catalonia]. Med Clin (Barc) 2002; 118:73-6. [PMID: 11809151 DOI: 10.1016/s0025-7753(02)72286-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jaume Alijotas
- Unitat d'Atencio Hospitalaria, Area Sanitaria, Servei Catala de Salut, Universitat de Barcelona, Spain.
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Blanch J, Martínez E, Rousaud A, Blanco JL, García-Viejo MA, Peri JM, Mallolas J, De Lazzari E, De Pablo J, Gatell JM. Preliminary data of a prospective study on neuropsychiatric side effects after initiation of efavirenz. J Acquir Immune Defic Syndr 2001; 27:336-43. [PMID: 11468421 DOI: 10.1097/00126334-200108010-00003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess baseline variables able to predict neuropsychiatric side effects (NPSEs) associated with the initiation of an efavirenz (EFV)-containing regimen in HIV-1-infected patients. DESIGN Open-label, prospective, observational study. METHODS Consecutive HIV-1-infected outpatients in whom EFV was prescribed underwent a psychiatric interview. At baseline and at 2, 4, and 12 weeks, patients completed the Symptoms Check List-90-Revised (SCL-90-R), the Medical Outcome Study for HIV-positive patients (MOS-HIV), and a standardized questionnaire concerning potential NPSEs. RESULTS Preliminary data showed that discontinuation of EFV because of NPSEs occurred in 4 of 31 patients (13%). Patients who completed the follow-up showed a decrease in SCL-90-R total score (p =.004) and in several subscales such as Interpersonal Sensitivity (p =.009), Depression (p =.001), and Anxiety (p =.040), whereas no changes in MOS-HIV were observed. Having fewer years of education (p =.006), having fewer baseline central nervous symptoms (p =.000), reporting better baseline physical status (p =.013), and having higher baseline scores in the Heath Transition subscale of the MOS-HIV (p =.000) and in the Somatization subscale of the SCL-90-R (p =.002) were associated with more NPSEs. CONCLUSION Patients maintained on EFV showed a decrease in psychologic distress related to self-image, depression, and anxiety, without any effect on quality of life. Patients with a lower level of education, those who feel physically and psychologically better at baseline than in the past, and those who suffer from more distress as a result of physical complaints may be at greater risk of reporting more NPSEs after EFV initiation.
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Affiliation(s)
- J Blanch
- Clinical Institute of Psychiatry and Psychology, Institut De Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Fundació Clinic per a la Recerca Biomédica, Hospital Clínic Universitari de Barcelona, Spain.
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Marcos T, Salamero M, de Azpiazu P, Pujol J, Boget T, Peri JM, Lázaro ML. [Neuropsychological pattern of cognitive impairment in Alzheimer type dementia and vascular dementia]. Med Clin (Barc) 2000; 114:566-70. [PMID: 10846674 DOI: 10.1016/s0025-7753(00)71365-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cummings et al, 1987, hypothesized that Alzheimer dementia type (ADT) patients would present poorer performances than vascular dementia (VD) patients on the neuropsychological tests that mainly involve cortical neurological structures, and that VD would perform worse on tests that mainly involve subcortical structures. The main purpose of the research was to identify a cognitive impairment pattern that discriminates the type of dementia in the initial stages. METHOD Two groups of patients, one affected by mild ADT (n = 30) and the other by multi-infarct dementia (VD, n = 30) were given a neuropsychological battery. The battery was composed by Temporal Orientation (Benton et al.); Vocabulary, Similarities, Digits, Coding and Kohs (WAIS) of Wechsler; the Colour-Form Test of Weigh; the Trail Making Test (A and B) (Halstead-Reitan Neuropsychological Battery); Tapping (McQuarrie); Logical Memory, Visual Memory and Paired Association (Wechsler Memory Scale) of Wechsler; Delayed Memory (Russell). The two groups were similar in age and socio-cultural features. The z-score and its statistical significance on the Mann-Whitney test were made and we performed an exploratory discriminant analysis to the classification. RESULTS In general, results were poorer in the ADT group. But we detected no significant differences in the tests, although some test (Immediate Visual Memory and Kohs' Blocks) almost reached significance. The discriminant analysis reached a classification of the 67% of the subjects into the ADT group and the 70% of the subjects into the VD group. CONCLUSIONS In the initial stages of dementia it is difficult to differentiate between a cortical pattern of cognitive impairment in ADT and a subcortical pattern in VD, a distinction that the other researchers have reported. When complex tests were used the performance depended on the coordination of multiple related systems. These findings are in agreement with the holistic models of higher mental functions.
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Affiliation(s)
- T Marcos
- Servicio de Psicología Clínica, Hospital Clínic, Barcelona
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27
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Peri JM, Soltó C, Bayés R. [Factors facilitating changes in HIV risk behavior in parenteral drug users]. Med Clin (Barc) 1994; 102:237-8. [PMID: 8159063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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San L, Camí J, Fernández T, Ollé JM, Peri JM, Torrens M. Assessment and management of opioid withdrawal symptoms in buprenorphine-dependent subjects. Br J Addict 1992; 87:55-62. [PMID: 1311974 DOI: 10.1111/j.1360-0443.1992.tb01900.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The spontaneous physical dependence of buprenorphine was assessed in opioid addicts who switched from heroin to sublingual or intravenous buprenorphine. Twenty-two patients were randomly assigned to double-blind administration of methadone (n = 11) or placebo (n = 11) for 13 days after abrupt withdrawal of buprenorphine. Methadone was administered according to four pre-established dosing schedules depending on the previous amount of daily consumed buprenorphine. No methadone-treated patient required modification of the therapeutic regimen, whereas eight of eleven placebo-treated patients needed treatment with methadone. Buprenorphine withdrawal syndrome was of opioid type, began somewhat more slowly, and showed a peak until day 5. The occurrence, time-course and characteristics of buprenorphine withdrawal syndrome make it necessary to reconsider the abuse potential of this analgesic.
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Affiliation(s)
- L San
- Sección de Toxicomanias, Hospital del Mar, Barcelona, Spain
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Abstract
Naltrexone and placebo as adjuvant treatment of opioid dependence were compared in a double-blind, controlled clinical trial in 50 heroin addicts. The overall efficacy was assessed by the degree of treatment acceptance, percentage of relapse in heroin consumption, presence of side effects, and overall retention on naltrexone. A total of 50 patients of both sexes, aged from 18 to 30 years, who fulfilled DSM-III-R criteria for opioid dependence were included in the study. All patients completed detoxification with clonidine on an inpatient basis for 2 weeks and subsequently, on an out-patient basis, received oral naltrexone (350 mg per week) for a month. At the beginning of the second month patients were randomly allocated to treatment with naltrexone (28 patients) or placebo (22 patients) until a 6-month treatment period in a double-blind fashion had been completed. During the study period (1 year) all patients followed the same therapeutic schedule. Patients in both groups were comparable in terms of socio-demographic data and toxicological history. The efficacy of naltrexone was not superior to that of placebo as there were no significant differences in acceptance of treatment, retention rates, opioid and other drug consumption, drug compliance or side effects.
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Affiliation(s)
- L San
- Sección de Toxicomanías, Hospital del Mar, Barcelona, Spain
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Abstract
Abuse of cocaine is becoming a major problem among heroin addicts in Spain. Between 1987 and 1988, 75% of patients admitted as inpatients for detoxification from opiate dependence had consumed cocaine during the 6 months prior to admission and 25% had abused cocaine daily or several times/week. These cocaine abusers showed more toxicologic and psychopathologic problems than opiate addicts who did not abuse cocaine. The opiate addicts who also abused cocaine had begun using illicit drugs earlier and showed a higher frequency of anti-HIV antibodies. They also had more antisocial personality disorders and persistence of depressive symptoms during opiate detoxification than heroin addicts who did not abuse cocaine. Based on these findings, we insist on the need to develop different treatments for detoxifying patients with this dual addiction.
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Affiliation(s)
- M Torrens
- Section of Drug Addiction, Hospital del Mar, Autonomous University of Barcelona, Spain
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31
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San L, Camí J, Peri JM, Mata R, Porta M. Efficacy of clonidine, guanfacine and methadone in the rapid detoxification of heroin addicts: a controlled clinical trial. Br J Addict 1990; 85:141-7. [PMID: 1968773 DOI: 10.1111/j.1360-0443.1990.tb00634.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The efficacy of clonidine, methadone, and guanfacine in rapid detoxification of heroin inpatients was assessed in a randomized controlled clinical trial. Signs and symptoms of abstinence and of side effects were analysed in 90 heroin addicts successfully completing a 12-day inpatient trial. All patients fit DSM-III criteria for opioid dependence, the age range being 18 to 36 years. All three drugs were effective in controlling abstinence; however, the course of abstinence was different in the methadone group as compared to the adrenergic agonists, the latter showing limitations in their ability to suppress withdrawal manifestations. While mean number of withdrawal signs and symptoms was significantly lower during days 2 to 5 in the methadone group (p less than 0.01), adrenergic agonists were slightly more effective at the end of the trial. Incidence of side effects was closely related to the dose administered. Hypotensive action of adrenergic agonists was more marked in orthostatic position. The present results suggest that methadone is superior to adrenergic agonists. Between these drugs clonidine appears to be less effective than guanfacine in controlling some withdrawal manifestations, and causes more side effects, mainly of cardiovascular nature.
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Affiliation(s)
- L San
- Section of Toxicomanias, Hospital del Mar, Universidad Autónoma de Barcelona, Spain
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Abstract
Predictors of either detoxification success or failure were evaluated during an inpatient trial that compared the efficacy of methadone, clonidine and guanfacine for rapid heroin detoxification. The analysis of such predictors was stimulated by the fact that in order to achieve 90 patients who completed the study (30 in each group), a total of 170 patients had to be included. Of 80 detoxification failures, 10 occurred in the methadone group, 32 in the guanfacine group, and 38 in the clonidine group. Voluntary request for discontinuation of the detoxification schedule was the first cause of failure. There were not statistically significant differences with regard to sociodemographic characteristics and pattern of drug consumption among patients in the three groups who completed detoxification with success or failure. The treatment drug, the type of schedule and the score obtained from the Symptom Checklist-90/Revised (SCL-90/R) were the only predictors of either detoxification success or failure. Inpatient opioid detoxification would be a useful strategy for patients with more severe psychological symptoms.
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