Katherine Alvear

Cognitive impairment in bipolar disorder and schizophrenia: a systematic review

Aims: Previous comparisons of cognitive decline among patients with bipolar disorder (BD) and schizophrenia (SZ) have found somehow quite similar profiles of deficits, but results have varied between studies. Therefore an extensive and thoughtful systematic review of the matter is warranted. Methods: Studies were found through systematic search (PubMed) following PRISMA guidelines. To be included, studies must have assessed the following cognitive functions: executive functions, memory, IQ, attention-concentration, and perceptuomotor function. In order to make comparison between the two entities, studies should include BD patients with operationally defined euthymia, schizophrenic patients in remission, and third group of healthy control patients. Comparisons were made after controlling for years of schooling and residual affective symptoms. Results: We found that overall both SZ and BD patients present deficits on all neurocognitive measures compared to healthy controls. In particular, SZ patients show more severe and pervasive cognitive deficits while BD patients present a milder and more confined impairment. In addition, evidence from the literature suggests that SZ and BD patients share a similar cognitive impairment profile with different degrees of deficits. Therefore, the difference between the two groups seems to be more quantitative (degree of deficit) rather than qualitative (profile), supporting a dimensional approach to the two clinical entities. Limitations of the present review includes the impossibility to control for effects of medication, varying time required for assessment across studies, illness diagnosis reliability, and course severity. Conclusion: Patients with BD might exhibit a cognitive impairment that could be similar to SZ in terms of their profile, although patients with SZ may have more severe and widespread impairments.

Detecting mood disorder in resource-limited primary care settings: comparison of a self-administered screening tool to general practitioner assessment.

Objectives Although efficacious treatments for mood disorders are available in primary care, under-diagnosis is associated with under-treatment and poorer outcomes. This study compares the accuracy of self-administered screening tests with routine general practitioner (GP) assessment for detection of current mood disorder. Methods 197 consecutive patients attending primary care centres in Santiago, Chile enrolled in this cross-sectional study, filling out the Patients Health Questionnaire-9 (PHQ-9) for depression and the Mood Disorder Questionnaire (MDQ) for bipolar disorder, after routine GP assessment. Diagnostic accuracy of these self-administered tools was compared with GP assessment, with gold standard diagnosis established by a structured diagnostic interview with trained clinicians (SCID-I). Results The sample was 75% female, with a mean age of 48.5 (SD 16.8); 37% had a current mood disorder (positive SCID-I result for depression or bipolar disorder). Sensitivity of the screening instruments (SI) was substantially higher than GP assessment (SI: 0.8, [95% CI 0.71, 0.81], versus GP: 0.2, [95% CI 0.12, 0.25]: p-value < 0.0001), without sacrifice in specificity (SI: 0.9, [95% CI 0.86, 0.96], versus GP: 0.9, [95% CI 0.88, 0.97]: p-value = 0.7). This led to improvement in both positive predictive value (SI: 0.8, [95% CI 0.82, 0.90], versus GP: 0.6, [95% CI 0.50, 0.64]: p-value < 0.001) and negative predictive value (SI: 0.9, [95% CI 0.78, 0.91] versus GP: 0.7, [95% CI 0.56, 0.72]: p-value < 0.01). Conclusion Self-administered screening tools are more accurate than GP assessment in detecting current mood disorder in low-income primary care. Such screening tests may improve detection of current mood disorder if implemented in primary care settings.

Querer No Basta: Deberes Éticos en la Práctica, Formación e Investigación en Psicología Comunitaria

Se expone una sintesis de los resultados del proyecto de investigacion FONDECYT N° 1080528, en el que se indago la dimension etica en la practica, formacion e investigacion en psicologia comunitaria (PC) en Chile. Se utilizo una muestra opinatica e intencionada de fuentes primarias (93 participantes -usuarios/as, estudiantes y psicologos/as-) y fuentes secundarias de informacion (194 documentos -programas de asignaturas, tesis y codigos-). Del empleo de diversas tecnicas de recoleccion de datos y estrategias cualitativas de analisis emerge como resultado relevante el principio de respeto por el otro y la participacion de la comunidad para la identificacion y enfrentamiento de problemas eticos. Asimismo, se hallaron divergencias respecto del concepto de PC y de los deberes eticos en este campo. Finalmente, se sugieren orientaciones eticas para la practica, formacion e investigacion en PC.

The International Mood Network (IMN) Nosology Project: differentiating borderline personality from bipolar illness

The differential diagnosis of bipolar illness vs. borderline personality is controversial. Both conditions manifest impulsive behavior, unstable interpersonal relationships, and mood symptoms. This study examines whether and which mood clinical features can differentiate between both conditions.

Lo ético es transversal y cotidiano: dimensiones éticas en la formación y práctica en psicología comunitaria

Community psychology has suffered huge transformations associated to a historical and contextual process in our country, involving a series of ethical issues which have not been dealt with both in training and deontological discipline. The aim of this research was to inquire the perception of students and professionals with respect to ethics in practice and training in community psychology. Our participants were Chilean experts, students in practice and students of two Master programs in community psychology with three data sources: Delphi panel (8 experts), in-depth interviews (7 master students), and focal groups (20 students in community practice). By applying the principles of the theory empirically based, data analysis showed the identifications of four topics: ethical notion, types of ethical situations, ethical training and deontology. Among the results, the simultaneous character of ethical dimensions “transversal and habitual” as well as “vague” was highlighted in the discourse of our participants. Considering concrete situations, these identified general ethical principles, which was verbalized as Respect for the Other and Autonomy.

Ethical issues are transversal and habitual: ethical dimensions in training and practice for community psychology

Community psychology has suffered huge transformations associated to a historical and contextual process in our country, involving a series of ethical issues which have not been dealt with both in training and deontological discipline. The aim of this research was to inquire the perception of students and professionals with respect to ethics in practice and training in community psychology. Our participants were Chilean experts, students in practice and students of two Master programs in community psychology with three data sources: Delphi panel (8 experts), in-depth interviews (7 master students), and focal groups (20 students in community practice). By applying the principles of the theory empirically based, data analysis showed the identifications of four topics: ethical notion, types of ethical situations, ethical training and deontology. Among the results, the simultaneous character of ethical dimensions “transversal and habitual” as well as “vague” was highlighted in the discourse of our participants. Considering concrete situations, these identified general ethical principles, which was verbalized as Respect for the Other and Autonomy.

O ético é transversal e cotidiano: dimensões éticas na formação e prática em psicologia comunitária

Community psychology has suffered huge transformations associated to a historical and contextual process in our country, involving a series of ethical issues which have not been dealt with both in training and deontological discipline. The aim of this research was to inquire the perception of students and professionals with respect to ethics in practice and training in community psychology. Our participants were Chilean experts, students in practice and students of two Master programs in community psychology with three data sources: Delphi panel (8 experts), in-depth interviews (7 master students), and focal groups (20 students in community practice). By applying the principles of the theory empirically based, data analysis showed the identifications of four topics: ethical notion, types of ethical situations, ethical training and deontology. Among the results, the simultaneous character of ethical dimensions “transversal and habitual” as well as “vague” was highlighted in the discourse of our participants. Considering concrete situations, these identified general ethical principles, which was verbalized as Respect for the Other and Autonomy.