Insight assessment in psychosis and psychopathological correlates: validation of the Spanish version of the Schedule for Assessment of Insight - Expanded Version

Background and Objectives: Lack of insight is a cardinal feature of psycho­sis. Insight has been found to be a multidimensional concept, including awareness of having a mental illness, ability to relabel psychotic phenomena as abnormal and compliance with treatment., which can be measured with the Schedule for Assessment of Insight (SAI-E). The aim of this study was to validate the Spanish version of SAI-E. Methods: The SAI-E was translated into Spanish and back-translated into English, which was deemed appropriate by the original scale author. Next, the Spanish version of the SAI-E was administered to 39 patients with schizophrenia or schizoaffective disorder (DSM-IV criteria) from a North Peruvian psychiatric hospital. The Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and the Scale of Unawareness of Mental Disorder (SUMD) were also administered. Specifically, internal consistency and convergent validity were assessed. Results: Internal consistency between the 11 items of the SAI-E was found to be good to excellent (α = 0.942). Compliance items did not contribute to internal consistency (A = 0.417, B = 572). Inter-rater reliability was excellent (ICC = 0.99). Regarding concurrent validity, the SAI-E total score correlated negatively with the lack of insight and judgement item of the PANNS (r = -0.91, p <0.01) and positively with the SUMD total score (r = 0.92, p <0.001). Conclusions: The Spanish version of the SAI-E scale was demonstrated to have both excellent reliability and external validity in our sample of South American Spanish-speaking patients with schizophrenia spectrum disorders.

Evaluating Public Knowledge of the NCRMD Defence

The not criminally responsible on account of mental disorder (NCRMD) defence is used when claims can be made that offenders are not responsible for their actions due to symptoms of a mental disorder. Bill C-14, now enacted in Canada, has implemented changes making it more difficult for NCRMD defendants to be released back into the public. This enactment appears to have been primarily due to public perceptions rather than actual knowledge of the defence. Thus it seems important to assess what members of the public actually know about the defence. To assess this, 127 participants completed a survey assessing their knowledge of the illnesses generally involved in the NCRMD defence, crimes committed, and punishments received. On average, only 31.6% of responses were answered within 20% of the factual statistics. Results suggest a general lack of knowledge about the defence and demonstrate why important changes should be based on factual information rather than public opinion.

Public Attitudes and Perceptions toward the NCRMD Defense

In Canada today, a person who performs an illegal act that is deemed to be the result of a mental illness is eligible for the not criminally responsible on account of mental disorder (NCRMD) defense. This defense can remove the blame and responsibility from an individual for an act that would otherwise be considered criminal. The present study examines possible factors that may influence people’s opinions on the defense and the treatment of mentally ill offenders in general. A sample of 257 participants (190 women, 38 men, 29 gender unknown) with ages ranging from 18-73 (M = 26.59, SD = 12.59) completed an online survey that assessed attitudes, opinions, and knowledge of mental illness, mentally ill offenders, and the NCRMD defense. Results showed that several factors were related to how positive or negative participants considered the defense to be, including experience with mental illness or the justice system and knowledge of schizophrenia or the sentences associated with the NCRMD defense. Findings suggest education is important in attaining more positive views of mentally ill offenders and the NCRMD defense.

Processus d’adaptation des personnes vivant avec la schizophrénie et ayant un soutien social limité

Résumé : La schizophrénie est un trouble mental grave qui affecte toutes les facettes de la vie de la personne. En outre, le manque de soutien social est un problème important qui contribue à l’aggravation de la maladie, notamment en influençant négativement la capacité d’adaptation. Chez les personnes atteintes de schizophrénie, la capacité à utiliser des stratégies d’adaptation adéquates et efficaces est essentielle afin d’améliorer la santé, le bien-être et la prévention des rechutes. Cette recherche utilise la conception de l’adaptation de Roy (2009). De nombreuses études confirment la présence de difficultés d’adaptation chez ces personnes. De plus, le processus d’adaptation lui-même reste mal connu. La question de recherche était : Quel est le processus d’adaptation des personnes vivant avec la schizophrénie lorsque leur soutien social est limité ? Cette question sous-tendait deux objectifs : 1) décrire le processus d’adaptation des personnes atteintes de schizophrénie dans un contexte de soutien social limité et 2) contribuer au développement du modèle de Roy dans le contexte des troubles mentaux graves. Le devis de recherche était la théorisation ancrée constructiviste, auprès de 30 personnes vivant avec la schizophrénie. Les données étaient composées d’entrevues et de résultats de trois questionnaires qui ont contribué à décrire de façon plus détaillée le profil des participants. Les résultats sont une modélisation du processus d’adaptation nommée « les filtres dans le processus d’adaptation des personnes vivant avec la schizophrénie ». Cette modélisation met en lumière le fait que le potentiel d’adaptation des personnes vivant avec la schizophrénie est affecté à la fois par des éléments de l’environnement social et des éléments inhérents à la maladie elle-même. Ces éléments altèrent la possibilité et la capacité à utiliser des stratégies d’adaptation adéquates et efficaces. Ces résultats de recherche pourraient permettre d’améliorer l’évaluation des personnes atteintes de schizophrénie et de diminuer les « inconnues » dans l’effet des interventions, tout comme de favoriser les actions visant à lutter contre les conditions sociales qui nuisent à l’adaptation.

Criminels ou patients? La non-responsabilité criminelle pour cause de troubles mentaux : Le difficile mariage entre justice et santé

Cet essai est une analyse du régime juridique applicable aux accusés qui ont été reconnus non-responsables criminellement pour cause de troubles mentaux en vertu de l'article 16 du Code criminel. Nous exposons tout d'abord l'historique dudit verdict lequel mène à un suivi à double volets, soit juridique et médical, dont nous détaillons le cadre normatif dans une seconde partie. Le premier volet est assuré par une instance administrative alors que le second relève d'un hôpital. Le suivi à double volets sous-tend donc la cohabitation de deux domaines aux objectifs distincts, à savoir la protection de la société à l'égard d'un accusé ayant commis un acte criminel pour l'un et le traitement d'un patient psychiatrique pour l'autre. Les hôpitaux, et plus particulièrement les psychiatres, se retrouvent ainsi avec l'obligation de jongler avec le droit criminel, tout en poursuivant leur objectif principal, soit le traitement de leurs patients. Dans ce contexte, le présent essai tente d'étudier les conséquences potentielles de la rencontre de ces deux domaines sur les droits des accusés. En effet,la mise en place du suivi à double volets visait un respect plus adéquat des droits et libertés des accusés ainsi qu'une meilleure prise en charge médicale de leurs besoins aux fins de leur offrir un traitement approprié. Toutefois, les tensions existant entre le domaine juridique et celui de la santé permettent-elles vraiment d'atteindre de tels objectifs?

Los internamientos no voluntarios por razón de trastorno psíquico: especial consideración al procedimiento a seguir en los casos de urgencia médica

La ambigüedad y carencias de la regulación sobre internamientos no voluntarios por razón de trastorno psíquico, unidas a la declaración de inconstitucionalidad que afecta a algunas de sus disposiciones por carecer del debido rango legal, exigen la elaboración de una normativa completa y bien estructurada de la materia. La reciente STC 141/2012, de 2 de julio, enjuicia por primera vez un caso de internamiento psiquiátrico urgente desde la óptica del derecho fundamental a la libertad personal, y el TC aprovecha la coyuntura para desarrollar minuciosamente las garantías que han de respetarse en tales casos con el fin de evitar vulneraciones arbitrarias del mismo. Este trabajo analiza la novedosa doctrina que sienta el TC en dicha sentencia.

A importância da psicoeducação na alteração do humor no doente depressivo

A depressão é uma perturbação mental que provoca um impacto negativo na vida dos doentes. O tratamento desta patologia pode ser realizado através de terapêutica farmacológica, ou de intervenções psicoterapêuticas. A Psicoeducação é uma modalidade de tratamento, que tem vindo a ganhar um lugar em destaque no processo de recuperação de determinadas doenças mentais. Esta abordagem tem como principal objetivo fornecer informações ao doente sobre a sua situação clínica e disponibilizar ferramentas para lidar com as particularidades do problema de saúde. As intervenções psicoeducativas são realizadas através de sessões expositivas de conhecimentos técnicos sobre a depressão. Assim, o objetivo do presente trabalho é apresentar um programa de psicoeducação, dando principal enfoque ao papel dos vários métodos e técnicas pedagógicas utilizadas no mesmo; Abstract: The importance of psychoeducation in changing the mood in depressed patients Depression is a mental disorder that causes a negative impact on patients' lives. Treatment of this condition may be achieved through drug therapy, or psychotherapeutic intervention. The Psychoeducational is a treatment modality that has gained importance because of the positive impact it has on the recovery of certain mental illness process. This approach aims to provide information to the patient about their medical situation and provide tools to deal with the particularities of the health problem. The psychoeducational interventions are carried out through expository sessions of technical knowledge about depression. The objective of this study is to present a psychoeducation program, giving primary focus to the role of various educational methods and techniques used in it.

RGS14 (414)-mediated prevention of an episodic memory loss: a study of molecular mechanism

A large proportion of human populations suffer memory impairments either caused by normal aging or afflicted by diverse neurological and neurodegenerative diseases. Memory enhancers and other drugs tested so far against memory loss have failed to produce therapeutic efficacy in clinical trials and thus, there is a need to find remedy for this mental disorder. In search for cure of memory loss, our laboratory discovered a robust memory enhancer called RGS14(414). A treatment in brain with its gene produces an enduring effect on memory that lasts for lifetime of rats. Therefore, current thesis work was designed to investigate whether RGS14(414) treatment can prevent memory loss and furthermore, explore through biological processes responsible for RGS-mediated memory enhancement. We found that RGS14(414) gene treatment prevented episodic memory loss in rodent models of normal aging and Alzheimer´s disease. A memory loss was observed in normal rats at 18 months of age; however, when they were treated with RGS14(414) gene at 3 months of age, they abrogated this deficit and their memory remained intact till the age of 22 months. In addition to normal aging rats, effect of memory enhancer treatment in mice model of Alzheimer´s disease (AD-mice) produced a similar effect. AD-mice subjected to treatment with RGS14(414) gene at the age of 2 months, a period when memory was intact, showed not only a prevention in memory loss observed at 4 months of age but also they were able to maintain normal memory after 6 months of the treatment. We posit that long-lasting effect on memory enhancement and prevention of memory loss mediated through RGS14(414) might be due to a permanent structural change caused by a surge in neuronal connections and enhanced neuronal remodeling, key processes for long-term memory formation. A neuronal arborization analysis of both pyramidal and non-pyramidal neurons in brain of RGS14(414)-treated rats exhibited robust rise in neurites outgrowth of both kind of cells, and an increment in number of branching from the apical dendrite of pyramidal neurons, reaching to almost three times of the control animals. To further understand of underlying mechanism by which RGS14(414) induces neuronal arborization, we investigated into neurotrophic factors. We observed that RGS14 treatment induces a selective increase in BDNF. Role of BDNF in neuronal arborization, as well as its implication in learning and memory processes is well described. In addition, our results showing a dynamic expression pattern of BDNF during ORM processing that overlapped with memory consolidation further support the idea of the implication of this neurotrophin in formation of long-term memory in RGS-animals. On the other hand, in studies of expression profiling of RGS-treated animals, we have demonstrated that 14-3-3ζ protein displays a coherent relationship to RGS-mediated ORM enhancement. Recent studies have demonstrated that the interaction of receptor for activated protein kinase 1 (RACK1) with 14-3-3ζ is essential for its nuclear translocation, where RACK1-14-3-3ζ complex binds at promotor IV region of BDNF and promotes an increase in BDNF gene transcription. These observations suggest that 14-3-3ζ might regulate the elevated level of BDNF seen in RGS14(414) gene treated animals. Therefore, it seems that RGS-mediated surge in 14-3-3ζ causes elevated BDNF synthesis needed for neuronal arborization and enhanced ORM. The prevention of memory loss might be mediated through a restoration in BDNF and 14-3-3ζ protein levels, which are significantly decreased in aging and Alzheimer’s disease. Additionally, our results demonstrate that RGS14(414) treatment could be a viable strategy against episodic memory loss.

Vulnerability factors for disaster-induced child post-traumatic stress disorder : the case for low family resilience and previous mental illness

Objective: The aim of the present study was to investigate whether parent report of family resilience predicted children’s disaster-induced post-traumatic stress disorder (PTSD) and general emotional symptoms, independent of a broad range of variables including event-related factors, previous child mental illness and social connectedness. ---------- Methods: A total of 568 children (mean age = 10.2 years, SD = 1.3) who attended public primary schools, were screened 3 months after Cyclone Larry devastated the Innisfail region of North Queensland. Measures included parent report on the Family Resilience Measure and Strengths and Difficulties Questionnaire (SDQ)–emotional subscale and child report on the PTSD Reaction Index, measures of event exposure and social connectedness. ---------- Results: Sixty-four students (11.3%) were in the severe–very severe PTSD category and 53 families (28.6%) scored in the poor family resilience range. A lower family resilience score was associated with child emotional problems on the SDQ and longer duration of previous child mental health difficulties, but not disaster-induced child PTSD or child threat perception on either bivariate analysis, or as a main or moderator variable on multivariate analysis (main effect: adjusted odds ratio (ORadj) = 0.57, 95% confidence interval (CI) = 0.13–2.44). Similarly, previous mental illness was not a significant predictor of child PTSD in the multivariate model (ORadj = 0.75, 95%CI = 0.16–3.61). ---------- Conclusion: In this post-disaster sample children with existing mental health problems and those of low-resilience families were not at elevated risk of PTSD. The possibility that the aetiological model of disaster-induced child PTSD may differ from usual child and adolescent conceptualizations is discussed.

Mental Health nurses' attitudes towards personality disorder

The importance of the impact of nurses views towards personality disorder and their place in acute mental health environments are surveyed.A total of 49 registrants were surveyed all with at least one years experience and all on part one of the active register. Overall 66% of respondents did not feel that patients with a personality disorder should be treated in an acute inpatient setting, with only 36% reporting feeling confident in their abilities when working with this patient group. Almost all respondents 98% called for more training which the authors feel is a positive reflection on the profession.

Mental health treatment seeking by military members with posttraumatic stress disorder : findings on rates, characteristics, and predictors from a nationally representative Canadian military sample

Objective: The goal of this study was to identify rates, characteristies, and predictors of mental health treatment seeking by military members with posttraumatic stress disorder (PTSD). Method: Our sample was drawn from the 2002 Canadian Community Health Survey-Canadian Forces Supplement (CCHS-CF) dataset. The CCHS-CF is the first epidemiologic survey of PTSD and other mental health conditions in the Canadian military and includes 8441 nationally representative Canadian Forces (CF) members. Of those, 549 who met the criteria for lifetime PTSD were included in our analyses. To identify treatment rates and characteristics, we examined frequency of treatment contact by professional and facility type. To identify predictors of treatment seeking, we conducted a binary logistic regression with lifetime treatment seeking as the outcome variable. Results: About two-thirds of those with PTSD consulted with a professional regarding mental health problems. The most frequently consulted professionals, during both the last year and lifetime, included social workers and counsellors, medical doctors and general practitioners, and psychiatrists. Consultations during the last year most often took place in a CF facility. Treatment seeking was predicted by cumulative lifetime trauma exposure, index traumatic event type, PTSD symptom interference, and comorbid major depressive disorder. Those with comorbid depression were 3.75 times more likely to have sought treatment than those without. Conclusions: Although a significant portion of military members with PTSD sought mental health treatment, 1 in 3 never did. Trauma-related and illness and (or) need factors predicted treatment seeking. Of all the predictors of treatment seeking, comorbid depression most increased the likelihood of seeking treatment.

Mental contamination in obsessive–compulsive disorder

It was recently proposed that feelings of contamination can arise in the absence of physical contact with a contaminant. Currently, there are limited data regarding this construct of ‘mental contamination’ although it is hypothesised to be relevant to obsessive compulsive disorder(OCD) where compulsive washing in response to contamination fear is a common presentation (Rachman,2006). This research examined the presence of mental contamination in OCD. Participants (N=177) with obsessive compulsive symptoms completed questionnaires to assess mental contamination, OCD symptoms and thought-action fusion (TAF). Findings indicated that 46% of participants experienced mental contamination, and severity was associated with severity of OCD symptoms and TAF. Mental contamination in the absence of contact contamination was reported by 10.2% of participants. Similar findings were reported in a sub-sample of participants who had received a formal diagnosis of OCD (N=54). These findings suggest that mental contamination is a distinct construct that overlaps with, but is separate from, contact contamination, and provide preliminary empirical support for the construct.

Mental health, coping and family-functioning in parents of young people with obsessive-compulsive disorder and with anxiety disorders

Objective. To compare mental health, coping and family-functioning in parents of young people with obsessive-compulsive disorder (OCD), anxiety disorders, and no known mental health problems. Method. Parents of young people with OCD (N=28), other anxiety disorders (N=28), and no known mental health problems (N=62) completed the Brief Symptom Inventory (Derogatis, 1993), the Coping Responses Inventory (Moos, 1990), and the McMaster family assessment device (Epstein, Baldwin, & Bishop, 1983). Results. Parents of children with OCD and anxiety disorders had poorer mental health and used more avoidant coping than parents of non-clinical children. There were no group differences in family-functioning. Conclusion. The similarities across the parents of clinically referred children suggest that there is a case for encouraging active parental involvement in the treatment of OCD in young people.

Bioethics and Mental Health: The Rights of Patients With a Disorder

Bioethics can be included in the context of psychiatric patients' recovery of dignity and rights, creating a therapeutic interface of social rehabilitation, respect and closeness between professionals and the treated persons. The completion of the analysis of the facts occurred by reviewing 22 articles dated between 1999-2011, from a prior reading, selecting the ones that mention bioethics and mental health. Before the Psychiatric Reform, often, a lack of commitment to the mentally ill was noticed, isolating the patient from a social life. Before the Psychiatric Reform, often, a lack of commitment to the mentally ill was noticed by isolating the patient from a social life. After the Reform, the person with mental illness began to receive a more attentive care. It can be concluded that the Reform tried to bring life to those who had no respect and attention, these patients who needed to be included in a social and urban interaction.

A genome-wide search for chromosomal loci linked to mental health wellness in relatives at high risk for bipolar affective disorder among the Old Order Amish

Bipolar affective disorder (BPAD; manic-depressive illness) is characterized by episodes of mania and/or hypomania interspersed with periods of depression. Compelling evidence supports a significant genetic component in the susceptibility to develop BPAD. To date, however, linkage studies have attempted only to identify chromosomal loci that cause or increase the risk of developing BPAD. To determine whether there could be protective alleles that prevent or reduce the risk of developing BPAD, similar to what is observed in other genetic disorders, we used mental health wellness (absence of any psychiatric disorder) as the phenotype in our genome-wide linkage scan of several large multigeneration Old Order Amish pedigrees exhibiting an extremely high incidence of BPAD. We have found strong evidence for a locus on chromosome 4p at D4S2949 (maximum genehunter-plus nonparametric linkage score = 4.05, P = 5.22 × 10−4; sibpal Pempirical value <3 × 10−5) and suggestive evidence for a locus on chromosome 4q at D4S397 (maximum genehunter-plus nonparametric linkage score = 3.29, P = 2.57 × 10−3; sibpal Pempirical value <1 × 10−3) that are linked to mental health wellness. These findings are consistent with the hypothesis that certain alleles could prevent or modify the clinical manifestations of BPAD and perhaps other related affective disorders.