Virginia Guillén

Shame, sensitivity to punishment and psychiatric disorders

- Background and objectives: Various studies have found significant correlations between feelings of shame and psychopathologies, as depression or eating disorders. Since some authors have shown an association between inhibition, neuroticism and shame, we hypothesize that Sensitivitybility to Punishment (SP) would relate positively to shame. We also propose that patients diagnosed with depression should score higher in shame domain than the rest of the diagnostic groups. Finally we predict that psychotic patients, since they have poor self-consciousness, should score the lowest in shame proneness. Methods: The Spanish version of the TOSCA, the Sensitivity to Punishment and Reward Questionnaire (SPSRQ) and The Clinical Global Impressions (CGI) were applied to a sample of 172 individuals, from which 93 were university students and 79 were patients receiving psychiatric treatment. Results: In the Sensitivity to Punishment domain we found statistically significant mean differences between patients with Major Depression and the comparative group. We have found a positive correlation between Sensitivity to Punishment and Shame in the general population and also for the Major depressive subgroup. The relation between depression and shame proneness was statistically significant. Shame and Guilt correlated in the TOSCA and the Major Depressive patients scores higher on both domains. Bipolar and schizophrenics patients showed lower scores in Shame than depressives. Conclusions: Among other conclussions we recomend that future studies in the field should use dimensional diagnoses besides the categorial ones.

Toronto alexithymia scale for patients with eating disorder: Of performance using the non-parametric item response theory ,

BACKGROUND The aim of this study was to investigate the performance of the Toronto Alexithymia Scale (TAS-20) in patients with eating disorders. As a secondary objective, we analyzed a subset of items in order to determine whether the total score is a good tool for classifying these patients and whether the items are ordered according to the difficulty of choosing a particular answer depending on the severity of the patients condition. SUBJECTS AND METHODS We administered the TAS-20 to 103 consecutive patients who met DSM-IV-R criteria for anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Mokken scale analysis, nonparametric item response theory (NIRT), and confirmatory factor analysis (CFA) were used to test the psychometric properties of the scale. To improve our understanding of the structure underlying the TAS-20, we used an automated item selection procedure based on the Mokken scale. RESULTS We identified a subset of 13 independent and clinically interpretable items that are potentially sufficient to rate patients with alexithymia. This subset was considered a unidimensional reduction of the TAS-20. However, the scale composed of this subset needs to be validated. Thirteen of the 20 items were maximally related to alexithymia because they have a one-dimensional structure. The NIRT and CFA enabled us to identify a maximal subset of items that conform to the requirements for good measurement of alexithymia in patients with eating disorders.

Cognitive improvement of acetylcholinesterase inhibitors in schizophrenia

Background: Schizophrenia is a severe, persistent mental disorder, and a leading cause of disability worldwide. Cognitive impairments presented in schizophrenia lead to a worse prognostic, thus treatments targeted to enhance cognition in schizophrenia may be clinically relevant. Aims: The purpose of this study was to assess the efficacy of acetylcholinesterase inhibitors as add-on medication to antipsychotics on cognition in patients with schizophrenia. Methods: Search strategies were developed for Medline, Embase and Cochrane Central Register of Controlled Trials, and are current to March 2018. We included randomised controlled trials that compared antipsychotics plus acetylcholinesterase inhibitors versus antipsychotics plus placebo on prespecified cognitive domains (speed of processing, attention and working memory). Two review authors independently evaluated study eligibility, extracted data and assessed the risk of bias of included studies. We used random-effects model for meta-analyses and assessed the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We included nine randomised controlled trials. Six randomised controlled trials (n=219) presented evidence that acetylcholinesterase inhibitors improve speed of processing (standardised mean difference −0.52, 95% confidence interval (−0.79 to −0.25); p value=0.0002). However, eight randomised controlled trials (n=252) did find placebo was better than acetylcholinesterase inhibitors in the attention domain (−0.43, (−0.72 to −0.13); p value=0.005) and eight randomised controlled trials (n=273) did not find differences in the working memory (−0.14, (−0.51 to 0.24), p value=0.47). Conclusions: The current evidence is too weak to base recommendations on the use of acetylcholinesterase inhibitors as adjunctive treatments to antipsychotics to improve basic cognitive functions. We have limited confidence in the effect estimates.