Ramón Gracia

Are there subtypes of suicidal schizophrenia? A prospective study

BACKGROUND Tragically, suicide is not uncommon in schizophrenia. The principal objective of this study was to examine possible subtypes of suicidal schizophrenic patients and identify their clinical and psychopathological profiles at long-term follow-up. METHOD The study involved 62 patients diagnosed with schizophrenia according to ICD-10 criteria, who were consecutively admitted following a suicide attempt. Of these subjects, 47 (75.8%) could be re-evaluated after 1 year. Sociodemographic, general clinical, and psychopathological variables were evaluated. RESULTS Two predominant subgroups were identified according to suicidal motivation: psychotic motivation and depressive motivation. At re-evaluation after 1 year, the depressive motivation subgroup showed higher depression and hopelessness scores. This subgroup also had greater educational level, age, and duration of illness, and more frequent existence of previous suicide attempts compared to the psychotic motivation subgroup. Of note in the psychotic motivation subgroup was the presence of hopelessness. The variables of educational level, duration of illness, and previous suicide attempts were the ones that best distinguished these subgroups. CONCLUSION These findings reinforce the notion that meaningful subgroups occur among suicidal schizophrenic patients. The different psychopathological profiles of the two prominent subgroups suggest the need for a different management approach in each case. The identification of these profiles in both subtypes at long-term follow-up may facilitate their detection by clinicians and, therefore, foster the adoption of appropriate preventive measures against subsequent suicidal behavior.

A psychopathological study of a group of schizophrenic patients after attempting suicide. Are there two different clinical subtypes

Fifty-six schizophrenic patients at the moment of their suicidal attempt were compared to a control group of 60 patients. Schizophrenic suicidal attempters showed an identifiable clinical profile at the acute phase. Two main groups could be differentiated in regard to their reasons (depressive or psychotic) for attempting suicide.

Efficacy of an internet-based psychological treatment for agoraphobia with minimal therapist contact

This study deals with the efficacy of an Internet-based computer therapy compared with an in-person cognitive-behavioral therapy, in the treatment of agoraphobia. Patients in the Internet group only had minimal initial contact with a therapist. The sample was composed of 44 adult patients with a diagnosis of agoraphobia. The Internet group and in-person groups underwent an 11-session intervention program. Agoraphobic cognitions, body sensations, social fear (as mobility test), and depression level were used as outcome measures. Results showed higher attrition rates in the Internet group. The in-person group exhibited improvements in all dependent measures, with moderate effect sizes (0.63 to 0.77 cohen’s d). The Internet group showed improvements in body sensations and depression level (moderate effect sizes). Intergroup comparisons showed a higher efficacy of in-person therapy, with moderate to large effect sizes ( 2 = 0.15 to 0.40). After the intervention, the Internet group exhibited better results than the control group and comparable results to the in-person group in body sensations, social fears/mobility, and depression level. These results are discussed considering the limited extent of internet-based therapy.

P-941 - Factor structure of the MCMI-III in a psychiatric patients sample

Introduction The convenience of a dimensional Axis II in the DSM-5 has been discussed, since there is criticism about the current categorical model, such as the high comorbidity or the scarce interrater agreement. Some think that those flaws could be attributed to the lack of an underlying theoretical model. To this respect, there are evidences that show that the personality disorders could be considered as extreme cases of normal personality traits. We try to find out if the factor analysis of a personality disorder scale (MCMI-III) reflects normal personality factors. Method Participants and procedure: we analyzed the MCMI-III (Millon, 1998) profiles of 50 Personality Disorders patients and 50 controls. Principal Components Factor Analyses with varimax rotation were computed globally and separately for each sample. Results A three factor structure (paranoid introversion, self control and insecurity) was found when analyzing both samples together. The separated samples analysis showed the same structure in controls, while in patients we found a three factor structure: neurotic introversion, hostility and self control. Both structures were basically equivalent, and differences among them could be qualified by a test bias (namely, higher averages for patients in the anxious and psychotic-like disorders). Conclusions Factor structures did not reflect the DSM-IV cluster division, and neither did it reflect Millons classification. Conversely, the factors we found were consistent with personality traits previously described by normal personality models (e.g.: Cattell, 1957; Costa y McCrae, 1990; Eysenck, 1981).

206. The role of virtual reality exposure procedure in a combined treatment of agoraphobia

The interpretation of non-verbal social signals relies heavily on the ability to perceive biological motion (BM). The posterior superior temporal sulcus (p-STS) is an important part of the network involved in the processing of BM. It is unclear, whether a motion-based topography map exists within p-STS, or whether responses to various body parts are mapped in the same sites. Here, we study whether different complex and socially relevant, biological motion stimuli can activate the same neural loci within p-STS in a fmri experiment. To accomplish this, a conjunction analysis is performed based on the responses to dynamic fearful facial expressions and to body actions represented with pointlights stimuli, for 13 normal subjects. The results indicate that a region inside the p-STS exhibited common activation to both facial motion and point-light animations. These findings indicate certain areas of the p-STS can codify different kinds of BM stimuli, thus offering a high-level visual representation and not a body part specific map. Additionally, adjacent areas were activated topographically (body-part specific response), which could provide an intermediate level of BM visual representation.