Mari Aguilera

Childhood abuse, the BDNF-Val66Met polymorphism and adult psychotic-like experiences

BACKGROUND The well-established relationship between childhood adversity and psychosis is likely to involve other factors such as genetic variants that can help us to understand why not everyone exposed to adverse events develops psychotic symptoms later in life. AIMS We investigated the influence of childhood abuse and neglect on positive and negative psychotic-like experiences in adulthood and the potential moderating effect of the BDNF-Val66Met polymorphism. METHOD Psychotic-like experiences and childhood adversity were assessed in 533 individuals from the general population. RESULTS Childhood abuse showed a strong independent effect on the positive dimension of psychotic-like experiences (β = 0.16, s.e. = 0.05, P = 0.002). Furthermore, this association was moderated by the BDNF-Val66Met polymorphism (β = 0.27, s.e. = 0.10, P = 0.004). CONCLUSIONS Individuals exposed to childhood abuse are more likely to report positive psychotic-like experiences. Met carriers reported more positive psychotic-like experiences when exposed to childhood abuse than did individuals carrying the Val/Val genotype. Therefore, the observed gene-environment interaction effect may be partially responsible for individual variation in response to childhood abuse.

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

BackgroundDepression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence.Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression.DesignA therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions).MethodParticipants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used.DiscussionWe expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression.Trial registrationISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Increased familiarity of intellectual deficits in early-onset schizophrenia spectrum disorders

Abstract Objectives. Early-onset schizophrenia is considered to be neurobiologically similar to adult-onset forms, although it represents a more severe expression of the disorder. In the present study, we explored putative larger familial vulnerability of intellectual impairments in early-onset schizophrenia spectrum disorders (EOS) when compared to adult-onset (AOS) families. Methods. A sample of 340 subjects including schizophrenia spectrum disorder patients, their first degree relatives and age-matched healthy controls was assessed on intelligence quotient (IQ). We used linear regression analysis and intraclass correlation coefficients (ICC) to explore familial aggregation of IQ across age at onset groups. Results. The relationship between IQ level of patients and their first-degree relatives showed positive linear association (β = 0.43, P < 0.01). High significant familial aggregation was found for intelligence quotient in EOS families (ICC = 0.618, P < 0.01), while AOS families responded to lower estimates (ICC = 0.204, P = 0.26; between ICC comparison z = 1.993, P < 0.05). Conclusions. High aggregation of intellectual performance in the EOS group suggests larger familial vulnerability in early-onset forms of the disease when cognitive functions are considered. Within a continuum of psychopathology in schizophrenia spectrum disorders, specific genetic effects are discussed for distinct onset forms that might be in line with a neurodevelopmental model of the disease.

A DILEMMA-FOCUSED INTERVENTION FOR DEPRESSION: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL WITH A 3-MONTH FOLLOW-UP.

Since long ago it has been asserted that internal conflicts are relevant to the understanding and treatment of mental disorders, but little research has been conducted to support the claim. The aim of this study was to test the differential efficacy of group cognitive behavioral therapy (CBT) plus an intervention focused on the dilemma(s) detected for each patient versus group individual CBT plus individual CBT for treating depression. A comparative controlled trial with a 3‐month follow‐up was conducted.

Maltrato y reconstrucción de la identidad en la psicoterapia constructivista de la fibromialgia

espanolRecientemente ha crecido el interes de los tratamientos psicologicos en Fibromialgia (FM). Hay pocas evidencias de como el maltrato afecta al proceso psicoterapeutico. El objetivo es investigar si el maltrato afecta de manera diferencial al desarrollo de una terapia constructivista. 20 mujeres con FM fueron evaluadas antes y despues de la terapia utilizando la Tecnica de Rejilla y otras medidas clinicas. Las 13 pacientes que habian sufrido maltrato presentaban antes del tratamiento mayor severidad de sintomas y una construccion mas negativa de los otros. Despues de la terapia, este grupo reduce los sintomas de manera significativa y se ven mas similares a los otros. La historia de maltrato parece ser un factor relevante en la terapia constructivista en fibromialgia. EnglishInterest in psychological treatments in Fibromyalgia (FM) has increased lately. Little evidences are available about whether having experienced maltreatment affects psychotherapy outcome. Our aim is to investigate the effect of maltreatment on outcome during constructivist therapy in FM. 20 women were assessed before and after therapy using Repertory Grid Technique and clinical measures of which 13 had suffered maltreatment. Those with a history of maltreatment had higher levels of symptoms and a negative construction of others at pre-treatment assessment in comparison to those with no report of maltreatment. After therapy, only those who had been maltreated reduced symptoms and achieved a more integrated construction of others. Maltreatment seemed to affect differently the outcome in constructivist therapy in FM.

NEUROCOGNITIVE PROFILE AND AGE OF ONSET OF PSYCHOSIS: RESULTS FROM A FAMILY-BASED STUDY

Ximena Goldberg Hermo1, Mar Fatjo-Vilas2 , Ma Jose Minano3, Ma Jose Munoz3, Silvia Campanera4 , Mari Aguilera2, Ma Eulalia Navarro3, Salvador Miret4, Neus Barrantes-Vidal5 , Lourdes Fananas2 1University of Barcelona, Faculty of Biology, Barcelona; 2Facultat de Biologia, Universitat de Barcelona., Barcelona; 3Area d’Adolescents. Benito Menni, Complex Assistencial en Salut Mental., Sant Boi de Llobregat; 4Servei de Psiquiatria i Drogodependencies. Hospital Santa Maria., Lleida; 5Facultat de Psicologia, Universitat Autonoma de Barcelona, Barcelona, Spain xgoldberg@ub.edu