Salvador Cervera-Enguix

Functional neuroanatomy of sustained attention in schizophrenia: Contribution of parietal cortices

Deficits in sustained attention have been frequently described in schizophrenia. The neuroanatomical basis reported previously have included altered levels of activation in cingulate and prefrontal cortex, but the contribution of further regions remains unclear. We explored the full neuroanatomy underlying the sustained attentional deficits observed in naïve schizophrenics compared with controls. Participants included 10 controls and 11 patients. The experimental design included rest, auditory stimulation using clicks, and two counting tasks. Subjects were instructed to mentally count the clicks, and then to count forward at the same frequency they heard previously when listening to the clicks. Relative cerebral blood flow (relCBF) was measured by means of PET 15O‐water. Differences were observed between both groups at superior temporal cortex, superior parietal gyrus, and cerebellum during tasks requiring listening. During all counting conditions, additionally to supplementary motor area (SMA), dorsolateral prefrontal cortex (DLPCF), precentral gyrus, cingulate, cerebellum, and inferior parietal (IP) gyrus, patients engaged other frontal structures including inferior, medial, and superior frontal areas. When counting with no auditory stimulation (C; requires components of working memory and time estimation), significant differences were observed in the level of activation of frontal and IP regions. Our naïve patients presented abnormal activation of auditory associative pathways. They failed to activate prefrontal and parietal regions at a similar level during tasks requiring increased cognitive effort, and they required a higher activation of inferior frontal regions to properly respond to cognitive demands. Hum. Brain Mapping 17:116–130, 2002.

Lymphocyte subsets and lymphokine production in patients with melancholic versus nonmelancholic depression.

Several studies have reported immune changes during depression, but the results have not been fully consistent. Some of these changes could be related to the presence of melancholic features. A total of 42 depressed patients (melancholic [MEL] and nonmelancholic [non-MEL]) and 20 healthy controls participated in the study. We detected a higher CD4+ lymphocyte subset in MEL patients than in controls during the depressive state, which disappeared after clinical remission. We also found an increase in interleukin-2 (IL-2) production both in MEL and non-MEL patients, but these values did not differ from control values after clinical remission. Some of these changes may be related to the melancholic characteristics of depression.

Monocytic parameters in patients with dysthymia versus major depression

BACKGROUND The studies on monocytic function during depression are controversial. A better knowledge of affective disorders may improve the differential diagnosis of depression subtypes. Our goals are to examine if there are differences in monocytic function in patients with major depression and dysthymia. METHOD Twenty-two depressed patients (12 dysthymia and 10 major depression) and 15 healthy controls participated in the study. We analyzed monocyte count, monocyte subsets (CD14+, CD16+, and HLA class-II+), respiratory burst activity, phagocytic index and the interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNFalpha) production. RESULTS Depressed patients showed elevated IL-1beta (P<0.05) and IL-6 (P<0.01), elevated monocytic respiratory burst activity (P<0.01); and reduced surface molecule expression HLA class-II and phagocytosis (P<0.01) compared with controls. We found no differences in any monocytic parameters between dysthymia and major depression. LIMITATIONS The small sample size and the short wash-out reduce the reliability of the results. CONCLUSIONS Major depression and dysthymia show similar signs of both monocytic activation and suppression. These alterations may be due to the depressive syndrome and not to the characteristics of depression subtypes studied.

A Spanish version of the Family Assessment Device

AbstractIntroductionThis paper presents the results of a study on the psychometric properties of an authorized Spanish version of the McMaster Family Assessment Device, a self-report measure of family functioning.Materials and MethodsThe study sample comprised 60 psychiatric patients and their family member and 60 controls, without mental health problems, and their family member.ResultsCompared to other studies, all subscales displayed adequate temporal stability and acceptable reliability. While the instrument discriminated well between the two groups of families on all subscales, the results nevertheless indicated limitations in the inter-item discriminant capacity of the “Roles” subscale. Factor analysis resulted in a three-factor model that does not coincide with the established structure of this instrument.ConclusionProposals to improve and adapt questionnaire are discussed with a view to make it applicable to cultures other than the one it was developed. Theoretical models relating to psychosocial aspects such as family functioning, albeit compatible in some areas, should be viewed with caution in cultures different to that in which the model originates.

Differences in interleukins' patterns between dysthymia and major depression

We assessed whether cytokine production-interleukin (IL)-1beta, IL-6 and tumour necrosis factor-alpha (TNFalpha)-is affected in depressed patients, dysthymia (Dt) and major depression (MD), and its association with various parameters of severity and clinical course. We found a possible different pattern of interleukin production between Dt and MD.

Validación del cuestionario Eating Attitudes Test (EAT) como prueba de cribado de trastornos de la conducta alimentaria en la población general

Fundamento y objetivo Validar un punto de corte alternativo de la version espanola del Eating Attitudes Test (EAT-40) para el cribado de casos de trastornos de la conducta alimentaria en la poblacion general. Sujetos y metodo Se administro el cuestionario traducido a una muestra representativa de 2.734 mujeres estudiantes de entre 13 y 22 anos de edad. Se entrevisto a las participantes cuya puntuacion en el cuestionario fue superior a 21 y a una muestra aleatoria del resto. Se estimaron los parametros de validez interna y externa obtenidos con puntos de corte distintos de 30, que es el utilizado habitualmente en el EAT. Resultados La mejor prediccion diagnostica se obtuvo con 21 puntos (sensibilidad del 73,3% y especificidad del 85,1%). El valor predictivo positivo fue del 20% y el valor predictivo negativo, del 98,4%. Conclusiones La mejor prediccion diagnostica del EAT-40 en un entorno no clinico se obtiene con un punto de corte de 21 puntos, algo inferior al recomendado por los autores del cuestionario.

The development and validation of a Spanish version of the quality of life in depression scale (QLDS)

Abstract Objective: The adaptation of the Quality of Life in Depression Scale, the QLDS, into Spanish. Methods: The original UK version of the QLDS was considered by two translation panels, who produced a Spanish translation. Priority was given to conceptual rather than semantic equivalence. This version was then field-tested with 15 depressed patients. The final stage of the research involved a postal survey of 62 patients, who were asked to complete the measure on two occasions. Results: The Spanish QLDS was found to be appropriate and acceptable by depressed patients. The questionnaires test-retest reliability and internal consistency were both high, and QLDS scores correlated as predicted with scores on sections of the Nottingham Health Profile. The measure was sensitive to different levels of depression as assessed by the Hospital Anxiety and Depression Scale. Conclusion: The Spanish version of the QLDS is suitable for use in clinical trials and for monitoring individual patients in routine clinical practice.

Confirmatory Factor Analysis, Reliability, and Validity of a Spanish Version of FACES III

This study tested the properties of a Spanish version of the Family Adaptability and Cohesion Scales III (FACES III) in a Spanish sample. Participants were 632 adults with children attending several school institutions from day care to undergraduate university. Confirmatory factor analyses replicated the factor structure of the original American version. Reliability coefficients were higher for the cohesion ( f = .72) than the adaptability scale ( f = .68). Convergent and discriminant validity was supported through a MTMM approach. The Spanish FACES III seems to be a valid and reliable measure.

Parámetros de inmunidad natural como marcadores biológicos de la depresión

Introduccion Durante la depresion se producen cambios en la respuesta inmunitaria natural. Conocer mejor estas alteraciones en el laboratorio podria ayudarnos como complemento en el diagnostico clinico de la depresion. El objetivo fue seleccionar que parametros inmunitarios pueden ser mas utiles como marcadores biologicos de la depresion. Sujetos y metodo Hemos estudiado distintos parametros inmunitarios de 42 pacientes deprimidos durante la fase aguda y despues de la respuesta al tratamiento, y los comparamos con un grupo de 20 controles sanos. Los parametros estudiados fueron: recuento de monocitos y de celulas natural killer (NK), expresion de moleculas de superficie monocitaria HLA-II, CD14, y CD16, produccion de citocinas monocitarias (IL-1β, IL-6, y TNF-α), actividad oxidativa e indice de fagocitosis monocitarios, y actividad citotoxica de celulas NK. Resultados En los pacientes deprimidos se produjo un aumento de monocitos CD16+, celulas NK, capacidad oxidativa monocitaria y produccion de las citocinas estudiadas (IL-1β, IL-6 y TNF-α), y un descenso de la expresion de HLA-II y del indice de fagocitosis monocitario. De estos parametros, el indice de fagocitosis (especificidad del 90%; valor predictivo negativo del 99%) y, en menor medida, la produccion de TNF-α (especificidad del 85%; valor predictivo negativo del 98,9%) fueron los que mas podrian ayudar en el diagnostico clinico de la depresion. Conclusiones Los resultados indican que el indice de fagocitosis y la produccion de TNF-α podrian ser marcadores biologicos utiles en la depresion, tanto para el diagnostico como para el seguimiento evolutivo.

Quality of Life in 833 outpatients with major depression treated with open-label venlafaxine extended release: An observational 24-week study

BACKGROUND Quality of Life (QoL) assessments are common in medicine and, recently, in psychiatry, mostly in patients with chronic mental illness. We evaluated QoL in depressed outpatients treated with venlafaxine-XR over a period of 24 weeks. METHOD We evaluated 833 patients with DSM-IV major depression using the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Montgomery-Åsberg Depression Rating Scale (MÅDRS), and the QoL in Depression Scale (QLDS). The patients received venlafaxine-XR and we evaluated them after 4, 8, and 24 weeks of treatment. RESULTS HAM-D scores decreased from a baseline of 24.6 - 6.3 to 6.0 - 5.5 (mean - SD; P <0.0001) after 24 weeks. HAM-A scores decreased from a baseline of 32.3 - 7.9 to 6.8 - 6.8 ( P <0.0001) after 24 weeks. QLDS scores decreased from a baseline of 25.8 - 5.8 to 6.6 - 7.5 ( P <0.0001) after 24 weeks, indicating improvement in QoL. The response after 4 weeks was also significant and continued improving during the study. Venlafaxine-XR was shown to be safe and well tolerated. DISCUSSION Open-label venlafaxine-XR was safe, effective, well tolerated, and improved not only depression and anxiety symptoms, but also QoL, in outpatients with major depression. This study has the limitations of any non-randomized, non-blinded multiple-site clinical trial.