Rosa Elena Ulloa

Validity of the Spanish version of the Personal and Social Performance scale in schizophrenia.

BACKGROUND The Personal and Social Performance (PSP) scale is a reliable and valid instrument that utilizes objective parameters for the assessment of social functioning in patients with schizophrenia. OBJECTIVE The aim of this study was to determine the validity and reliability of the Spanish version of the PSP scale. METHOD In total, 100 patients with DSM-IV diagnoses of schizophrenia and schizoaffective disorder were recruited and assessed with the PSP, the GAF, the PANSS, and the CGI. Internal consistency for the PSP was obtained and discriminant validity was assessed by comparing PSP scores between inpatients and outpatients; correlations between PSP scores, the GAF, and the five factors of the PANSS were used to evaluate the convergent validity of the scale; reliability was evaluated with intra-class correlation coefficients and temporal stability was obtained using correlation coefficients between the PSP and CGI scores on a follow up assessment. RESULTS The Cronbachs alpha coefficient of the PSP was 0.843. Inpatients showed lower scores on the PSP than did outpatients. Patients with low scores on the PSP reported fewer years of education, were more frequently unemployed, had a longer duration of illness, and had a shorter duration of antipsychotic treatment. The PSP scores showed a positive correlation with the GAF and a negative correlation with the cognitive, negative, and positive factors derived from the PANSS. The PSP scores showed significant correlations with the severity and improvement CGI scores at follow-up. Good inter-rater reliability was obtained. CONCLUSION These findings support the Spanish version of PSP to be a reliable and valid instrument for the assessment of social functioning in patients with schizophrenia.

Minimum effective doses of haloperidol for the treatment of first psychotic episode: a comparative study with risperidone and olanzapine

Minimum doses of haloperidol might show similar efficacy and side-effects compared to atypical antipsychotics. The objectives of this study were to compare the efficacy of minimum doses of haloperidol with standard doses of risperidone and olanzapine on a 6-month open trial in first psychotic episode patients and to examine the effect of compliance on their outcome. Forty-two patients were recruited and started on flexible doses of these drugs. Olanzapine was given with no cost to the patients. Efficacy and side-effects were monitored every 3 months using standardized assessments. Thirty patients completed the study. All treatment groups showed improvement in positive, negative and depressive symptoms. There were no differences in side-effects among them. The haloperidol group required higher doses of anticholinergics. The rate of treatment discontinuation was higher in the risperidone group due to the direct cost. Minimum doses of haloperidol might prove to be a good choice of treatment for patients with a first episode of psychosis.

Evaluation of children with ADHD on the Ball-Search Field Task

Searching, defined for the purpose of the present study as the displacement of an individual to locate resources, is a fundamental behavior of all mobile organisms. In humans this behavior underlies many aspects of everyday life, involving cognitive processes such as sustained attention, memory and inhibition. We explored the performance of 36 treatment-free children diagnosed with attention-deficit hyperactivity disorder (ADHD) and 132 children from a control school sample on the ecologically based ball-search field task (BSFT), which required them to locate and collect golf balls in a large outdoor area. Children of both groups enjoyed the task and were motivated to participate in it. However, performance showed that ADHD-diagnosed subjects were significantly less efficient in their searching. We suggest that the BSFT provides a promising basis for developing more complex ecologically-derived tests that might help to better identify particular cognitive processes and impairments associated with ADHD.

Construct validity and parent–child agreement of the six new or modified disorders included in the Spanish version of the kiddie Schedule for Affective Disorders and Schizophrenia present and Lifetime Version DSM-5 (K-SADS-PL-5)

Changes to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) incorporate the inclusion or modification of six disorders: Autism Spectrum Disorder, Social Anxiety Disorder, Intermittent Explosive Disorder, Disruptive Mood Dysregulation Disorder, Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder. The objectives of this study were to assess the construct validity and parent-child agreement of these six disorders in the Spanish language Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL-5) in a clinical population of children and adolescents from Latin America. The Spanish version of the K-SADS-PL was modified to integrate changes made to the DSM-5. Clinicians received training in the K-SADS-PL-5 and 90% agreement between raters was obtained. A total of 80 patients were recruited in four different countries in Latin America. All items from each of the six disorders were included in a factor analysis. Parent-child agreement was calculated for every item of the six disorders, including the effect of sex and age. The factor analysis revealed 6 factors separately grouping the items defining each of the new or modified disorders, with Eigenvalues greater than 2. Very good parent-child agreements (r>0.8) were found for the large majority of the items (93%), even when considering the sex or age of the patient. This independent grouping of disorders suggests that the manner in which the disorders were included into the K-SADS-PL-5 reflects robustly the DSM-5 constructs and displayed a significant inter-informant reliability. These findings support the use of K-SADS-PL-5 as a clinical and research tool to evaluate these new or modified diagnoses.

Adversidad psicosocial, psicopatología y funcionamiento en hermanos adolescentes en alto riesgo (HAR) con y sin trastorno por déficit de atención con hiperactividad (TDAH)

Introduccion. El trastorno por deficit de atencion con hiperactividad (TDAH) es un trastorno del neurodesarrollo altamente heredable. La determinacion de las caracteristicas clinicas, los factores de adversidad y el nivel de funcionamiento en hermanos de probandos con TDAH, denominados en alto riesgo (HAR), podria ayudar a establecer el riesgo al cual estan sometidos. Objetivo. Determinar la frecuencia de TDAH y otros trastornos psiquiatricos en HAR. Como objetivos secundarios, establecer los factores de adversidad psicosocial que predicen el TDAH en HAR y determinar la magnitud del efecto sobre el funcionamiento y otros trastornos psiquiatricos cuando los hermanos tienen TDAH (HAR TDAH +) comparados con quienes no lo tienen (HAR TDAH -). Material y metodo. Este estudio multicentrico es descriptivo, transversal y analitico. La muestra (n=84) se conformo por hermanos adolescentes de probandos diagnosticados con TDAH que compartian a ambos padres. Resultados. El 45.2% (n=38) tuvo TDAH. El 17.9% (n=15) no presento trastorno psiquiatrico alguno. Ser HAR TDAH+ incremento al menos cuatro veces mas la probabilidad de presentar trastorno negativista desafiante (RM=4.3; IC 95% 1.3-14.8), dato que mantuvo significancia al ajustarse por sexo, edad y numero de adversidades (RM=3 IC 95% 1.8–10.9). Ser HAR TDAH+ incremento casi cinco veces la probabilidad de presentar disfuncion academica (RM=4.84 IC 95% 1.41-16.63). El promedio general de adversidades fue 3.3 (DE=1.4). Encontramos psicopatologia en ambos padres en el 51.2% de la muestra (ES=0.055). La disfuncion familiar grave incremento 2.5 veces la probabilidad de presentar TDAH en los HAR (IC 95% 1.06–6.25). Al comparar los grupos con tres o mas adversidades psicosociales, no existieron diferencias significativas (81.6% vs. 65.2%; p=0.14). Conclusiones. El estudio clinico de los HAR para TDAH es necesario debido a las distintas implicaciones que tiene a nivel de la prevencion, la atencion oportuna y la mejoria del pronostico de estos sujetos

A novel experimental paradigm to evaluate children and adolescents diagnosed with attention-deficit/hyperactivity disorder: Comparison with two standard neuropsychological methods

ABSTRACT Introduction: In this study we evaluated a recently developed test, the Ball Search Field Task (BSFT) as a neuropsychological tool for measuring cognitive and behavioral performance of individuals with disorders such as attention-deficit/hyperactivity disorder (ADHD), which are frequently accompanied by cognitive deficits and a lack of behavioral inhibition. The task provides a complementary method of assessment that attempts ecological validity by drawing on challenges faced in real-world situations. In this task, energetic costs and gross sensorimotor feedback are involved, as participants are required to search for targets in a large open area. Method: We compared performance on the BSFT in a clinical sample of children and adolescents with a diagnosis of ADHD with their scores on two widely used neuropsychological tools, the Tower of London (ToLo) and the Behavior Rating Inventory of Executive Function (BRIEF). Results: We found no correlations between scores on the BRIEF and those on either the BSFT or ToLo. However, we found moderate correlations between rule violations on ToLo and several BSFT variables, suggesting the capacity of these tests to detect common aspects of executive dysfunction. Conclusions: These findings, although modest, encourage further study of tasks like the BSFT, which may help assess cognitive dysfunction found in neurodevelopmental disorders such as ADHD in ecologically valid situations.