Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism.

Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism. Azorin JM, Bowden CL, Garay RP, Perugi G, Vieta E, Young AH. Source Department of Psychiatry, CHU Sainte Marguerite, Marseilles, France. Abstract About half of all bipolar patients have an alcohol abuse problem at some point of their lifetime. However, only one randomized, controlled trial of pharmacotherapy (valproate) in this patient population was published as of 2006. Therefore, we reviewed clinical trials in this indication of the last four years (using mood stabilizers, atypical antipsychotics, and other drugs). Priority was given to randomized trials, comparing drugs with placebo or active comparator. Published studies were found through systematic database search (PubMed, Scirus, EMBASE, Cochrane Library, Science Direct). In these last four years, the only randomized, clinically relevant study in bipolar patients with comorbid alcoholism is that of Brown and colleagues (2008) showing that quetiapine therapy decreased depressive symptoms in the early weeks of use, without modifying alcohol use. Several other open-label trials have been generally positive and support the efficacy and tolerability of agents from different classes in this patient population. Valproate efficacy to reduce excessive alcohol consumption in bipolar patients was confirmed and new controlled studies revealed its therapeutic benefit to prevent relapse in newly abstinent alcoholics and to improve alcohol hallucinosis. Topiramate deserves to be investigated in bipolar patients with comorbid alcoholism since this compound effectively improves physical health and quality of life of alcohol-dependent individuals. In conclusion, randomized, controlled research is still needed to provide guidelines for possible use of valproate and other agents in patients with a dual diagnosis of bipolar disorder and substance abuse or dependence.

Paranoia and post-traumatic stress disorder in the months after a physical assault: a longitudinal study examining shared and differential predictors.

Background: Being physically assaulted is known to increase the risk of the occurrence of post-traumatic stress disorder (PTSD) symptoms but it may also skew judgements about the intentions of other people. The objectives of the study were to assess paranoia and PTSD after an assault and to test whether theory-derived cognitive factors predicted the persistence of these problems. Method: At 4 weeks after hospital attendance due to an assault, 106 people were assessed on multiple symptom measures (including virtual reality) and cognitive factors from models of paranoia and PTSD. The symptom measures were repeated 3 and 6 months later. Results: Factor analysis indicated that paranoia and PTSD were distinct experiences, though positively correlated. At 4 weeks, 33% of participants met diagnostic criteria for PTSD, falling to 16% at follow-up. Of the group at the first assessment, 80% reported that since the assault they were excessively fearful of other people, which over time fell to 66%. Almost all the cognitive factors (including information-processing style during the trauma, mental defeat, qualities of unwanted memories, self-blame, negative thoughts about self, worry, safety behaviours, anomalous internal experiences and cognitive inflexibility) predicted later paranoia and PTSD, but there was little evidence of differential prediction. Conclusions: Paranoia after an assault may be common and distinguishable from PTSD but predicted by a strikingly similar range of factors.

Towards the Construction of a Multi-agent Approach for Discovering the Meaning of Natural Language Collaborative Conversations

Peer-reviewed

Individual differences in control of language interference in late bilinguals are mainly related to general executive abilities

Background: Recent research based on comparisons between bilinguals and monolinguals postulates that bilingualism enhances cognitive control functions, because the parallel activation of languages necessitates control of interference. In a novel approach we investigated two groups of bilinguals, distinguished by their susceptibility to cross-language interference, asking whether bilinguals with strong language control abilities ('non-switchers") have an advantage in executive functions (inhibition of irrelevant information, problem solving, planning efficiency, generative fluency and self-monitoring) compared to those bilinguals showing weaker language control abilities ('switchers"). Methods: 29 late bilinguals (21 women) were evaluated using various cognitive control neuropsychological tests [e.g., Tower of Hanoi, Ruff Figural Fluency Task, Divided Attention, Go/noGo] tapping executive functions as well as four subtests of the Wechsler Adult Intelligence Scale. The analysis involved t-tests (two independent samples). Non-switchers (n = 16) were distinguished from switchers (n = 13) by their performance observed in a bilingual picture-naming task. Results: The non-switcher group demonstrated a better performance on the Tower of Hanoi and Ruff Figural Fluency task, faster reaction time in a Go/noGo and Divided Attention task, and produced significantly fewer errors in the Tower of Hanoi, Go/noGo, and Divided Attention tasks when compared to the switchers. Non-switchers performed significantly better on two verbal subtests of the Wechsler Adult Intelligence Scale (Information and Similarity), but not on the Performance subtests (Picture Completion, Block Design). Conclusions: The present results suggest that bilinguals with stronger language control have indeed a cognitive advantage in the administered tests involving executive functions, in particular inhibition, self-monitoring, problem solving, and generative fluency, and in two of the intelligence tests. What remains unclear is the direction of the relationship between executive functions and language control abilities.

Profiles of Second Language Learners in Bilingual Education: A Comparative Study of the Characteristics of Finnish and American Students

The purpose of this comparative study is to profile second language learners by exploring the factors which have an impact on their learning. The subjects come from two different countries: one group comes from Milwaukee, US, and the other from Turku, Finland. The subjects have attended bilingual classes from elementary school to senior high school in their respective countries. In the United States, the subjects (N = 57) started in one elementary school from where they moved on to two high schools in the district. The Finnish subjects (N = 39) attended the same school from elementary to high school. The longitudinal study was conducted during 1994-2004 and combines both qualitative and quantitative research methods. A Pilot Study carried out in 1990-1991 preceded the two subsequent studies that form the core material of this research. The theoretical part of the study focuses first on language policies in the United States and Finland: special emphasis is given to the history, development and current state of bilingual education, and the factors that have affected policy-making in the provision of language instruction. Current language learning theories and models form the theoretical foundation of the research, and underpin the empirical studies. Cognitively-labeled theories are at the forefront, but sociocultural theory and the ecological approach are also accounted for. The research methods consist of questionnaires, compositions and interviews. A combination of statistical methods as well as content analysis were used in the analysis. The attitude of the bilingual learners toward L1 and L2 was generally positive: the subjects enjoyed learning through two languages and were motivated to learn both. The knowledge of L1 and parental support, along with early literacy in L1, facilitated the learning of L2. This was particularly evident in the American subject group. The American subjects’ L2 learning was affected by the attitudes of the learners to the L1 culture and its speakers. Furthermore, the negative attitudes taken by L1 speakers toward L2 speakers and the lack of opportunities to engage in activities in the L1 culture affected the American subjects’ learning of L2, English. The research showed that many American L2 learners were isolated from the L1 culture and were even afraid to use English in everyday communication situations. In light of the research results, a politically neutral linguistic environment, which the Finnish subjects inhabited, was seen to be more favorable for learning. The Finnish subjects were learning L2, English, in a neutral zone where their own attitudes and motivation dictated their learning. The role of L2 as a means of international communication in Finland, as opposed to a means of exercising linguistic power, provided a neutral atmosphere for learning English. In both the American and Finnish groups, the learning of other languages was facilitated when the learner had a good foundation in their L1, and the learning of L1 and L2 were in balance. Learning was also fostered when the learners drew positive experiences from their surroundings and were provided with opportunities to engage in activities where L2 was used.

Näkökulmia kielen oppimisen käytäntöihin. Turun yliopiston kielikeskus 30 vuotta - Perspectives on Language Learning in Practice. University of Turku Language Centre 30-year Celebration

Tämä julkaisu ilmestyy Turussa 18.–19.5.2009 järjestettävien valtakunnallisten kielikeskuspäivien yhteydessä. Turun yliopiston kielikeskus viettää samaan aikaan 30-vuotisjuhlaansa. Erään luokittelun mukaan 30–45-vuotias elää varsinaista keski-ikäänsä, kun taas joissakin katsotaan, että 28–35 vuoden ikä on vasta ns. jäsentymisen vaihe ja että varhainenkin keski-ikä sijoittuu vasta ikävuosiin 35–42. Voitaneen siis sanoa, että kielikeskus on ainakin ohittanut nuoruusvuodet ja on jäsentymässä tai siirtymässä keski-ikään. Tämä tuo mukanaan tietynlaista kypsymistä, itsensä varaan asettumista, imagon ja profiilin vakiintumista. Tähän kasvuun saattaa liittyä myös jonkinlainen aikuistumisen kriisi. Sen myötä kuitenkin ymmärrys lisääntyy ja oman paikan rakentaminen yliopistoyhteisössä voimistuu. Arvo- ja ajatusmaailmaan tulee uusia kehityspiirteitä: olemassaolon ja toiminnan syvemmät perustelut, illuusioiden väheneminen, hallinnan tunne, tyydytys onnistuneesta toiminnasta ja realistinen voiman tunto. Laitos esittäytyy julkaisussa 13 kirjoituksen välityksellä. Tekstit ovat sisällöltään ja käsittelytavaltaan hyvin erilaisia, mutta juuri sellaisina ne valottavat monipuolisesti laitoksen ja sen henkilökunnan toimintaa ja tuntemuksia. Kuvaukset valaisevat laitoksen erikoisluonnetta ja kuvailevat henkilökunnan erilaisia tehtäviä. Kielikeskus paljastuu dynaamisemmaksi ja heterogeenisemmaksi yksiköksi kuin ensi silmäyksellä saattaa luulla, mutta juuri siinä piilee sen voima ja rikkaus. Juhlakirjaan toivottiin kirjoituksia kielikeskuksen opetukseen tai toimintaan liittyvistä aiheista. Kirjaan sisältyy selontekojen ja kuvausten lisäksi muutamia tiukan tieteellisiä artikkeleita. Joukossa on myös joitakin esseitä, jotka koskettelevat kielen ja kulttuurin välisiä suhteita ja luovat katsauksia kielikeskuksen monikulttuuriseen arkeen. Useassa kirjoituksessa käsitellään kielipedagogisia ja -didaktisia kysymyksiä. Erityisesti tulee esiin kielikeskuksessa viime vuosina tehty uudistustyö opetuksen ja oppimisedellytysten parantamiseksi. Samalla kun muun muassa opetusteknologiaa ja kielen oppimisen käytäntöjä virtuaalisissa oppimisympäristöissä on kehitetty, opettajan rooli on muovautunut uudentyyppiseksi: perinteisen opetushenkilöstön ja muun henkilökunnan tehtävät ja toimenkuva ovat selvästi lähentyneet toisiaan. Tämä suuntaus on jatkunut jo kauan ja jatkunee tulevaisuudessakin. Kolmekymmentä viime vuotta ovat olleet yliopistossa erittäin nopean muutoksen aikaa. Tämä on näkynyt erityisesti kielikeskuksen toiminnan laajenemisessa ja kehityksessä, joissa tosin on ollut notkahduksiakin. Varsinkin nopea kansainvälistyminen, Euroopan yhteisön laajentuminen ja koko maailman avautuminen ovat tuoneet mukanaan uusia haasteita, joihin kielikeskus on heti tarttunut: kielivalikoimaa on laajennettava, kielitaitoa kohennettava ja erilaisia kulttuureja tunnettava ja ymmärrettävä syvällisemmin. Turun yliopiston kielikeskus pyrkii omalta osaltaan täyttämään nämä velvoitteet ja luomaan toiminnallaan mahdollisimman hyvät edellytykset yliopiston kansainvälistymiselle. Nämä seikat on otettu huomioon laitoksen toimintalinjojen suunnittelussa ja kehittämisessä. Kieli-ja viestintäopintojen rakenteiden uudistamista jatketaan yhteistyössä tiedekuntien kanssa. Opintojen valinnaisuutta ja vapaaehtoisuutta pyritään lisäämään sekä turvaamaan kielivalintojen monipuolisuus ja kieliosaamisen laajaalaisuus resurssien mukaan. Toimintaa kehitetään niin, että siinä otetaan entistä paremmin huomioon yhteiskunnan monikulttuuristuminen ja Euroopan komission tavoite, jonka mukaan jokaisen EU- kansalaisen tulisi osata oman äidinkielensä lisäksi vähintään kahta yhteisön kieltä. Samalla otetaan huomioon globalisaation tuomat uudet haasteet tukemalla tärkeimpien Euroopan yhteisön ulkopuolisten kielten opetusta (mm. venäjä, kiina, japani, arabia). Edelleen kielikeskus seuraa tarkoin keskustelua Suomen kielikoulutuspolitiikan perusteista ja tavoitteista ja ottaa toimintansa suunnittelussa huomioon valtakunnalliset suositukset Suomen kielikoulutuksen uudistamiseksi vastaamaan nykypäivän ja tulevaisuuden tarpeita ja tavoitteita. Se että kielikeskus on viime vuosina selvästikin vakiinnuttanut asemansa yliopiston strategisesti tärkeänä yksikkönä, ei tarkoita sitä, että nyt voitaisiin turvautua pelkästään vanhoihin toimintamalleihin ja rutiineihin. Päinvastoin, koko maailmassa, suomalaisessa yhteiskunnassa ja yliopistojen toiminnassa tapahtuneet ja tapahtuvat suuret muutokset edellyttävät kielikeskustoimintojen vireää kehittämistä ja uudistusmieltä. Laitos onkin ilmoittanut tulossopimuksessaan tukevansa opetuskokeiluja ja innovatiivisia ratkaisuja. Opettajajohtoisen opetuksen ohella on voimakkaasti kehitetty myös ohjattua itseopiskelua, monimuotoopetusta sekä vaihtoehtoisia ja uudentyyppisiä oppimismuotoja. Uutta opetusteknologiaa käytetään tehokkaasti hyväksi ja kehitetään edelleen. Opetuksessa ja ohjauksessa käytetään suomalaisten ja ulkomaisten opiskelijoiden työpanosta. Laitoksen suunnittelu- ja kehittämistyössä opiskelijat ovat toimineet viime vuosina aktiivisesti ja ansiokkaasti: yhteistyö ylioppilaskunnan kanssa toimii erinomaisesti, ja sitä on tarkoitus vielä tehostaa. Laitos on saanut runsaasti kiitosta korkealaatuisesta toiminnastaan: muun muassa v. 1998 ja 2008 Turun yliopiston vuoden opettajan palkinnon, v. 1999 Turun yliopiston parhaan koulutusyksikön palkinnon ja v. 2007 vuoden opintojaksopalkinnon. On toivottavaa, että tämä tuloksellinen työ jatkuisi ja entisestäänkin paranisi tulevina vuosina. Hyvät tulokset on saavutettu kovilla ponnistuksilla ja tiukalla sitoutumisella työhön. Aina se ei ole ollut aivan helppoa nopeiden muutosten myllerryksessä, tiukentuneessa resurssitilanteessa ja vaatimusten ja odotusten ristiriidoissa. Toivon, että pääosin hyvin sujunut yhteistyö yliopiston johdon, tiedekuntien ja opiskelijoiden kanssa sekä henkilökunnan keskuudessa voisi säilyä ja kehittyä ja että alkava vuosikymmen kielikeskuksen historiassa voisi olla entistä parempi. Hyvä yhteistyö on hyvien tulosten edellytys. Suurten uudistusten vuosi 2010 sisältää mahdollisuuden parempaan, mutta se on samalla myös riski ehkä hyvinkin paljon muuttuvassa toimintaympäristössä. Lainaan lopuksi roomalaisen historioitsijan Sallustiuksen sanat: Concordia res parvae crescunt, discordia maximae dilabuntur. Yksimielisyys saa pienetkin asiat kukoistamaan, eripura suuretkin tuhoaa. Turun yliopistolla on hyvä kielikeskus, jota kannattaa vaalia ja tukea. Kiitän kaikkia kirjoittajia ja juhlajulkaisun toimittajia Minna Maijalaa, Timo Hulkkoa ja Jane Honkaa tämän julkaisun synnystä. Samoin esitän kiitokset kielikeskuksen kirjallisen viestinnän lehtoreille, Markus Lahdelle ja Arja Lampiselle, jot ka ovat nähneet vaivaa tekstien kielellisinä korjaajina. Koko kielikeskuksen nykyistä ja aikaisempaa henkilökuntaa kiitän työstä, jota laitoksen hyväksi on tehty kuluneiden 30 vuoden aikana. Erityisen kiitoksen ansaitsee laitoksen juhlatoimikunta kaikista juhlavuoden järjestelyistä.

Is there a relationship between bilingual language switching and executive functions in bilingualism? Introducing a within-group analysis approach

Several studies have suggested a bilingual advantage in executive functions, presumably due to bilinguals' massive practice with language switching that requires executive resources, but the results are still somewhat controversial. Previous studies are also plagued by the inherent limitations of a natural groups design where the participant groups are bound to differ in many ways in addition to the variable used to classify them. In an attempt to introduce a complementary analysis approach, we employed multiple regression to study whether the performance of 30- to 75-year-old FinnishSwedish bilinguals (N = 38) on tasks measuring different executive functions (inhibition, updating, and set shifting) could be predicted by the frequency of language switches in everyday life (as measured by a language switching questionnaire), L2 age of acquisition, or by the self-estimated degree of use of both languages in everyday life. Most consistent effects were found for the set shifting task where a higher rate of everyday language switches was related to a smaller mixing cost in errors. Mixing cost is thought to reflect top-down management of competing task sets, thus resembling the bilingual situation where decisions of which language to use has to be made in each conversation. These findings provide additional support to the idea that some executive functions in bilinguals are affected by a lifelong experience in language switching and, perhaps even more importantly, suggest a complementary approach to the study of this issue.

Self-assessment of individual differences in language switching

Language switching is omnipresent in bilingual individuals. In fact, the ability to switch languages (code switching) is a very fast, efficient, and flexible process that seems to be a fundamental aspect of bilingual language processing. In this study, we aimed to characterize psychometrically self-perceived individual differences in language switching and to create a reliable measure of this behavioral pattern by introducing a bilingual switching questionnaire. As a working hypothesis based on the previous literature about code switching, we decomposed language switching into four constructs: (i) L1 switching tendencies (the tendency to switch to L1; L1-switch); (ii) L2 switching tendencies (L2-switch); (iii) contextual switch, which indexes the frequency of switches usually triggered by a particular situation, topic, or environment; and (iv) unintended switch, which measures the lack of intention and awareness of the language switches. A total of 582 SpanishCatalan bilingual university students were studied. Twelve items were selected (three for each construct). The correlation matrix was factor-analyzed using minimum rank factor analysis followed by oblique direct oblimin rotation. The overall proportion of common variance explained by the four extracted factors was 0.86. Finally, to assess the external validity of the individual differences scored with the new questionnaire, we evaluated the correlations between these measures and several psychometric (language proficiency) and behavioral measures related to cognitive and attentional control. The present study highlights the importance of evaluating individual differences in language switching using self-assessment instruments when studying the interface between cognitive control and bilingualism.

First- and second-language phonological representations in the mental lexicon

Performance-based studies on the psychological nature of linguistic competence can conceal significant differences in the brain processes that underlie native versus nonnative knowledge of language. Here we report results from the brain activity of very proficient early bilinguals making a lexical decision task that illustrates this point. Two groups of SpanishCatalan early bilinguals (Spanish-dominant and Catalan-dominant) were asked to decide whether a given form was a Catalan word or not. The nonwords were based on real words, with one vowel changed. In the experimental stimuli, the vowel change involved a Catalan-specific contrast that previous research had shown to be difficult for Spanish natives to perceive. In the control stimuli, the vowel switch involved contrasts common to Spanish and Catalan. The results indicated that the groups of bilinguals did not differ in their behavioral and event-related brain potential measurements for the control stimuli; both groups made very few errors and showed a larger N400 component for control nonwords than for control words. However, significant differences were observed for the experimental stimuli across groups: Specifically, Spanish-dominant bilinguals showed great difficulty in rejecting experimental nonwords. Indeed, these participants not only showed very high error rates for these stimuli, but also did not show an error-related negativity effect in their erroneous nonword decisions. However, both groups of bilinguals showed a larger correctrelated negativity when making correct decisions about the experimental nonwords. The results suggest that although some aspects of a second language system may show a remarkable lack of plasticity (like the acquisition of some foreign contrasts), first-language representations seem to be more dynamic in their capacity of adapting and incorporating new information. &

A Case-based reasoning approach to validate grammatical gender and number agreement in Spanish language

Across Latin America 420 indigenous languages are spoken. Spanish is considered a second language in indigenous communities and is progressively introduced in education. However, most of the tools to support teaching processes of a second language have been developed for the most common languages such as English, French, German, Italian, etc. As a result, only a small amount of learning objects and authoring tools have been developed for indigenous people considering the specific needs of their population. This paper introduces Multilingual–Tiny as a web authoring tool to support the virtual experience of indigenous students and teachers when they are creating learning objects in indigenous languages or in Spanish language, in particular, when they have to deal with the grammatical structures of Spanish. Multilingual–Tiny has a module based on the Case-based Reasoning technique to provide recommendations in real time when teachers and students write texts in Spanish. An experiment was performed in order to compare some local similarity functions to retrieve cases from the case library taking into account the grammatical structures. As a result we found the similarity function with the best performance

Predictors and consequences of adherence to the treatment of pediatric patients with attention-deficit/hyperactivity disorder in Central Europe and East Asia.

PURPOSE: To assess baseline predictors and consequences of medication non-adherence in the treatment of pediatric patients with attention-deficit/hyperactivity disorder (ADHD) from Central Europe and East Asia. PATIENTS AND METHODS: Data for this post-hoc analysis were taken from a 1-year prospective, observational study that included a total of 1,068 newly-diagnosed pediatric patients with ADHD symptoms from Central Europe and East Asia. Medication adherence during the week prior to each visit was assessed by treating physicians using a 5-point Likert scale, and then dichotomized into either adherent or non-adherent. Clinical severity was measured by the Clinical Global Impressions-ADHD-Severity (CGI-ADHD) scale and the Child Symptom Inventory-4 (CSI-4) Checklist. Health-Related Quality of Life (HRQoL) was measured using the Child Health and Illness Profile-Child Edition (CHIP-CE). Regression analyses were used to assess baseline predictors of overall adherence during follow-up, and the impact of time-varying adherence on subsequent outcomes: response (defined as a decrease of at least 1 point in CGI), changes in CGI-ADHD, CSI-4, and the five dimensions of CHIP-CE. RESULTS: Of the 860 patients analyzed, 64.5% (71.6% in Central Europe and 55.5% in East Asia) were rated as adherent and 35.5% as non-adherent during follow-up. Being from East Asia was found to be a strong predictor of non-adherence. In East Asia, a family history of ADHD and parental emotional distress were associated with non-adherence, while having no other children living at home was associated with non-adherence in Central Europe as well as in the overall sample. Non-adherence was associated with poorer response and less improvement on CGI-ADHD and CSI-4, but not on CHIP-CE. CONCLUSION: Non-adherence to medication is common in the treatment of ADHD, particularly in East Asia. Non-adherence was associated with poorer response and less improvement in clinical severity. A limitation of this study is that medication adherence was assessed by the treating clinician using a single item question.

Predictors of remission in the treatment of major depressive disorder: real-world evidence from a 6-month prospective observational study

BACKGROUND: This study examined potential predictors of remission among patients treated for major depressive disorder (MDD) in a naturalistic clinical setting, mostly in the Middle East, East Asia, and Mexico. METHODS: Data for this post hoc analysis were taken from a 6-month prospective, noninterventional, observational study that involved 1,549 MDD patients without sexual dysfunction at baseline in 12 countries worldwide. Depression severity was measured using the Clinical Global Impression of Severity and the 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Depression-related pain was measured using the pain-related items of the Somatic Symptom Inventory. Remission was defined as a QIDS-SR16 score ≤5. Generalized estimating equation regression models were used to examine baseline factors associated with remission during follow-up. RESULTS: Being from East Asia (odds ratio [OR] 0.48 versus Mexico; P<0.001), a higher level of depression severity at baseline (OR 0.77, P=0.003, for Clinical Global Impression of Severity; OR 0.92, P<0.001, for QIDS-SR16), more previous MDD episodes (OR 0.92, P=0.007), previous treatments/therapies for depression (OR 0.78, P=0.030), and having any significant psychiatric and medical comorbidity at baseline (OR 0.60, P<0.001) were negatively associated with remission, whereas being male (OR 1.29, P=0.026) and treatment with duloxetine (OR 2.38 versus selective serotonin reuptake inhibitors, P<0.001) were positively associated with remission. However, the association between Somatic Symptom Inventory pain scores and remission no longer appeared to be significant in this multiple regression (P=0.580), (P=0.008 in descriptive statistics), although it remained significant in a subgroup of patients treated with selective serotonin reuptake inhibitors (OR 0.97, P=0.023), but not in those treated with duloxetine (P=0.182). CONCLUSION: These findings are largely consistent with previous reports from the USA and Europe. They also highlight the potential mediating role of treatment with duloxetine on the negative relationship between depression-related pain and outcomes of depression.

Clinical usefulness of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) scale in patients with type I bipolar disorder

Background: The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results: Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations: The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion: With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.