Validación de las versiones en español de la Montgomery-Asberg Depression Rating Scale y la Hamilton Anxiety Rating Scale para la evaluación de la depresión y de la ansiedadValidation of the Spanish versions of the Montgomery-Asberg Depression and Hamilton Anxiety rating scales
Fundamento
Los trastornos del estado de ánimo (TEA) y los trastornos de ansiedad (TA) constituyenlas alteraciones psiquiátricas más comunes en la población general. En este estudio se han evaluado,por primera vez, las propiedades psicométricas de las versiones en español de la Montgomery-AsbergDepression Rating Scale (MADRS) y la Hamilton Anxiety Rating Scale (HARS), ampliamente utilizadasen la práctica asistencial y en investigación clínica.
Pacientes y método
Se diseno un estudio de cohortes, observacional, prospectivo y multicentrico enpacientes con TEA o TA, clinicamente estables o inestables. Las escalas se administraron en la visitade inclusion en el estudio y en una segunda visita realizada a la semana .en el caso de pacientes estables.o dos meses despues –en pacientes inestables–. Se evaluaron la estructura factorial, la validez(convergente y discriminante), la fiabilidad (consistencia interna, estabilidad temporal y entre observadores)y la sensibilidad al cambio de ambas escalas.
Resultados
Se incluyo a 108 pacientes con TEA y a 106 pacientes con TA en 10 centros de asistenciapsiquiatrica con amplia distribucion geografica. Ambas escalas presentaron una adecuada: a) validezdiscriminante (MADRS/HARS-Impresion Clinica Global de Gravedad: p < 0,001); b) validez convergente(MADRS-Hamilton Depression Rating Scale: p < 0,05 y 0,01, respectivamente;MADRS/HARS-EuroQoL 5D: p < 0,05; HARS-State Trait Anxiety Inventory: p < 0,05); c) consistenciainterna (α de Cronbach: MADRS = 0,88; HARS = 0,89); d) fiabilidad test-retest y entre observadores(coeficiente de correlacion intraclase: MADRS = 0,94 y 0,98, respectivamente; HARS = 0,92 y0,92), y e) sensibilidad al cambio (tamano del efecto: MADRS = 2,05; HARS = 1,36).
Conclusiones
Las versiones en espanol de la MADRS y de la HARS presentan buenas propiedades psicometricas,similares a las de las escalas originales, por lo que resultan apropiadas para su uso en lapractica asistencial y en investigacion clinica en Espana.
Background
Affective and anxiety disorders (AfD & AnD) are the most common psychiatric diseases inthe general population. This study's aim was to assess for the first time the psychometric properties ofthe Spanish translated versions of the Montgomery-Asberg Depression Rating Scale (MADRS) and theHamilton Anxiety Rating Scale (HARS), which are widely used both in medical care and clinical research.
Patients and method
A cohort, observational, prospective and multicentre study was conducted in clinicallystable or unstable patients with AfD and AnD. The scales were administered at baseline and ina second study visit one week or 2 months later (to stable or unstable patients, respectively). The internalconsistency, temporary stability, inter-raters reliability, factorial structure, convergent and discriminantvalidity, and sensitivity to change were all assessed for both scales.
Results
One hundred and eight AfD patients and 106 AnD patients were recruited in 10 psychiatrycare centres from a wide geographical distribution. Both scales showed adequate properties in termsof: a) discriminant validity (MADRS/HARS-Clinical Global Impression: p < 0.001); b) convergent validity(MADRS-Hamilton Depression Rating Scale: p < 0.05 and 0.01; MADRS/HARS-EuroQoL 5D: p > 0.05; HARS-State Trait Anxiety Inventory: p < 0.05); c) internal consistency (Cronbach's alpha:MADRS = 0.88; HARS = 0.89); d) test-retest and inter-raters reliability (intraclass correlation coefficient:MADRS = 0.94 and 0.98, respectively; HARS = 0.92 and 0.92), and, e) sensitivity to change(effect size: MADRS = 2.05; HARS = 1.36).
Conclusions
Spanish versions of MADRS and HARS scales showed good psychometric properties, similarto those of the original scales. Therefore, these scales are suitable for use in clinical practiceand research in Spain.
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Acculturation and clinical symptoms of schizophrenia among Latine adults in the United States
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The analysis involved cross-sectional data from Latine (n = 120) and non-Latine White (n = 60) adults with schizophrenia in San Diego, California. Participants completed the Short Acculturation Scale for Hispanics (SASH), Positive and Negative Symptom Scale, and Hamilton Depression Rating Scale in their preferred language. Univariate linear regressions were implemented to identify proxy measures as predictors of acculturation scores. Analyses of variance were conducted to analyze the relationship of SASH scores and proxy measures of acculturation to symptom severity.
Latine participants presented more symptom severity than non-Latine Whites. When categorized by acculturation status (Spanish-preferring, bicultural, and English-preferring), Spanish-preferring participants presented similar psychiatric symptoms to the non-Latine group and less severe symptoms than both other Latine groups. Analyses identified study language as the strongest proxy measure for the SASH. Latine participants assessed in English had significantly worse positive and depressive symptoms than those assessed in Spanish. Nativity status moderated the relationship between study language and symptomatology.
Findings support an association between acculturation and symptom severity among Latine individuals with schizophrenia. The use of proxy measures of acculturation may be useful in settings where time is constrained. Future research should continue to explore acculturation and symptomatology in Latine communities.
Evaluation of a group intervention based on Mindfulness in patients with anxiety and depression cared for in mental health community center: a quasy-experimental study
2024, Enfermeria ClinicaEvaluar la efectividad de una intervención grupal basada en mindfulness en pacientes con ansiedad y depresión atendidos en un centro de salud mental comunitario. Secundariamente, valorar la calidad de vida y la adherencia a la intervención.
Estudio cuasi experimental con evaluaciones pre y postintervención llevado a cabo entre marzo de 2015 y diciembre de 2019 en personas mayores de 18 años atendidas en el Centro de Salud Mental de Adultos (CSMA) de Les Corts, Barcelona.
Como criterios de inclusión se tomaron en cuenta: 1) sintomatología de ansiedad (Escala de Ansiedad de Hamilton [HARS] > 10 puntos) y 2) firma de consentimiento informado. Las variables recogidas fueron 1) ansiedad, 2) depresión (Inventario de Depresión de Beck [BDI]), 3) calidad de vida (EuroQoL [EQ-5D]) y 4) adherencia a la intervención. La intervención fue de nueve sesiones semanales de 75 min y fue realizada por dos enfermeras. Cada grupo estaba formado por 10-15 pacientes.
Un total de 128 usuarios fueron incluidos, de los cuales 103 eran mujeres con una edad media de 52,23 (desviación estándar [DE] 12,78). Al comparar medidas pre y post, se observaron mejoras en relación con la sintomatología ansiosa, depresiva y la calidad de vida general (p < 0,001) y sus dimensiones de ansiedad-depresión (EQ-5D) (p = 0,003). La media de sesiones asistidas fue de 6,17 (DE 2,31) y estaban correlacionadas de forma estadísticamente significativa y positiva con una mejora de la sintomatología ansiosa (p < 0,001) y depresiva (p = 0,021). No se observaron diferencias entre grupos de edad.
La intervención grupal basada en mindfulness mejora la sintomatología ansiosa y depresiva, así como la calidad de vida. Esto se asocia con una mayor adherencia a la intervención.
To evaluate the effectiveness of a group intervention based on Mindfulness in patients with anxiety and depression treated in a community mental health center. Secondarily, to evaluate quality of life and adherence to the intervention.
Quasi-experimental study with evaluations pre-post intervention in people over 18 years of age treated at the Les Corts Adult Mental Health Center (AMHC), Barcelona, between March 2015 and December 2019.
Inclusion criteria: 1) anxiety symptoms (Hamilton Anxiety Rating Scale > 10 points); 2) sign informed consent. Variables collected: 1) anxiety; 2) depression (Beck Depression Inventory); 3) quality of life (EuroQoL [EQ-5D]) and 4) adherence to the intervention. The intervention (9 weekly sessions; 75 minutes) was carried out by two nurses. Each group consisted of 10-15 patients.
128 patients were included, of which 103 were women with a mean age of 52.23 years (SD 12.78). Comparisons pre and post measures, its showed improvements in relation to anxiety, depressive symptoms and general quality of life (p < 0.001) and in its dimensions of anxiety-depression (EQ-5D) (p = 0.003). The mean number of sessions attended was 6.17 (SD 2.31), and they were statistically significant and positively correlated with an improvement in anxiety (p < 0.001) and depressive symptoms (p = 0.021). There were no differences between age groups.
The intervention group based on Mindfulness improves anxiety and depressive symptoms, as well as the quality of life. This improvement in the symptomatology is associated with a greater adherence to the intervention.
Analizar la repercusión del antidepresivo vortioxetina sobre la función sexual, frente a inhibidores selectivos de la recaptación de serotonina (ISRS) e inhibidores selectivos mixtos de la recaptación de serotonina y noradrenalina (IRSN o Duales) en pacientes con depresión.
Estudio analítico, observacional, longitudinal y prospectivo en el que se incluyeron hombres y mujeres mayores de 18 años con trastorno depresivo y actividad sexual en pareja, separándolos en dos grupos: 1) de estudio: inician tratamiento con vortioxetina; 2) control: mantienen tratamiento con ISRS o Duales. Se realizaron tres visitas: inclusión, seguimiento a las 4 semanas y final 3 meses desde la inclusión. El periodo total de seguimiento fue de 3 meses.
Se incluyeron 87 pacientes (edad media, 46,85 años). Al final del estudio se hallaron diferencias significativas (DS) en el valor medio de la suma de las puntuaciones de los dominios evaluadores de la respuesta sexual del cuestionario de Función Sexual de la Mujer (FSM-2) entre el grupo de estudio y el de control (22,42 ± 4,39 y 16,13 ± 7,76, respectivamente), con menor riesgo de disfunción sexual en las mujeres tratadas con vortioxetina. También menor riesgo de disfunción sexual en estas mismas mujeres en los dominios de deseo, lubricación, orgasmo, frecuencia sexual y satisfacción sexual. Estas diferencias no se hallaron al evaluar la función sexual masculina.
Las mujeres tratadas con vortioxetina presentaron mejor función sexual que las tratadas con ISRS o Duales y menor riesgo de disfunción sexual.
To analyze the impact of the antidepressant vortioxetine on sexual function, compared to selective serotonin reuptake inhibitors (SSRIs) and mixed selective serotonin and norepinephrine reuptake inhibitors (IRSN or Dual) in patients with depression.
Analytical, observational, longitudinal and prospective study, which included men and women over 18 years of age, with depressive disorder and sexual activity with a partner, separating them into two groups: (i) study, starting treatment with vortioxetine; (2) control, maintaining treatment with SSRIs or Duals. Three visits were made: inclusion, follow-up at 4 weeks and final 3 months from inclusion. The total follow-up period was 3 months.
A total of 87 patients were included (mean age 46.85 years). At the end of the study, significant differences (SD) were found in the mean value of the sum of the scores of the evaluative domains of the sexual response of the Women's Sexual Function Questionnaire (FSM-2) between the study group and the control (22.42 ± 4.39 and 16.13 ± 7.76, respectively), with a lower risk of sexual dysfunction in women treated with vortioxetine. Also, lower risk of sexual dysfunction in these same women in the domains of desire, lubrication, orgasm, sexual frequency and sexual satisfaction. These differences were not found when assessing male sexual function.
Women treated with vortioxetine presented better sexual function than those treated with SSRIs or Duals and a lower risk of sexual dysfunction.
Tools for comprehensive evaluation of sexual function in patients with multiple sclerosis
2023, NeurologiaLa esclerosis múltiple (EM) es una enfermedad desmielinizante del sistema nervioso central (SNC) que afecta a adultos jóvenes, ocasionando una variedad de síntomas (motores, visuales, control de esfínteres, alteraciones de la marcha) que impactan la funcionalidad del paciente; sin embargo, otros síntomas, como la disfunción sexual (DS), también pueden tener un efecto sobre la calidad de vida.
La DS puede presentarse en cualquier momento del curso de la enfermedad, su prevalencia varía entre 50 y 90%, puede ser secundaria a lesiones desmielinizantes en médula espinal y/o cerebro, ocasionada por síntomas que no incluyen directamente el sistema nervioso —fatiga, aspectos psicológicos, sociales y culturales—. Si bien se ha logrado establecer su prevalencia y su impacto sobre la calidad de vida, la DS todavía es una condición frecuentemente subestimada, razón por la cual en este artículo se revisan las diferentes escalas que ayudan a evaluar la presencia o la severidad de esta para dar un manejo multidisciplinario temprano, según corresponda.
Cinco cuestionarios han sido evaluados y/o diseñados para pacientes con EM, los cuales podrían identificar la presencia de DS, su etiología y, con esto, determinar posibilidades de tratamiento. La EM debe ser comprendida como una enfermedad compleja que abarca y compromete diferentes aspectos de la salud de los pacientes, y va más allá de solo medir escalas de discapacidad.
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) that affects young adults, causing a variety of symptoms (motor alterations, visual alterations, loss of sphincter control, gait alterations) that impair the patient's functional status. However, other symptoms, such as sexual dysfunction, can also have an effect on quality of life.
Sexual dysfunction can occur at any time during the course of the disease; its prevalence varies between 50% and 90%, and it can be secondary to demyelinating lesions in the spinal cord and/or brain or caused by symptoms that do not directly involve the nervous system (fatigue; psychological, social, and cultural factors; etc.). Although its prevalence and impact on quality of life are well known, sexual dysfunction is still frequently underestimated. Therefore, in this article we review the different scales for assessing presence or severity of sexual dysfunction, in order to offer early multidisciplinary management.
We evaluated 5 questionnaires that could identify the presence of sexual dysfunction in patients with MS and determine its aetiology, assisting in treatment decision making. MS must be understood as a complex disease that encompasses and compromises different aspects of patients’ health, and goes beyond simply measuring disability.
Quality of life and mental health in multiple sclerosis patients during the COVID-19 Pandemic
2023, Multiple Sclerosis and Related DisordersThe COVID-19 pandemic had a profound impact on mental health symptoms and quality of life (QoL) in the general population due to necessary public health restrictions such as social distancing. The psychosocial effect of the pandemic on vulnerable groups such as people living with Multiple Sclerosis (PwMS) has been scarcely explored in countries with additional socioeconomical burdens such as access to healthcare disparities
A questionnaire exploring sociodemographic variables, quality of life, mental health determinants and sleep quality was applied to 92 PwMS to explore changes prior and during the pandemic regarding these domains
58.8% of the subjects were female, median age was 37.1 (± 8.5) years and relapsing-remitting MS was the predominant clinical subtype (83.5%). Unemployment rate significantly increased during the pandemic (12.3% vs 27.8%; p= 0.001). Only 46.4% received medical follow-up care during the pandemic. QoL was affected predominantly due to limitations in instrumented activities of daily life (IADL). Neuropsychiatric symptoms, requiring healthcare during the pandemic, anxiety prior to the pandemic and restricted IADL were predictors of MS-related physical impact worsening, while decreased physical/emotional wellbeing selfcare, neuropsychiatric symptoms, bad sleep quality, anxiety prior to the pandemic and restricted non-instrumental ADL predicted aggravation of MS-related psychological impact measured by the MSIS-29. Curiously, specific items regarding anxiety were more prevalent prior to the pandemic (anxious mood; p=0.02, helplessness; p=0.01), sleep problems; p=0.001 and cardiovascular symptoms; p=0.001, nevertheless, stability was observed for most items. Importantly, 77.3% of PwMS reported at least one neuropsychiatric symptom
The deleterious effects of the COVID-19 pandemic on psychosocial wellbeing in PwMS, QoL and mental health outcomes are frequently overseen in vulnerable populations such as PwMS. Albeit the limitations of this study, our results may help implement policies that prevent negative outcomes on psychosocial wellbeing due to public health measures (e.g., social distancing) in MS and other neurological diseases that inexorably need constant follow-up.
Executive dysfunction in eating disorders: Relationship with clinical features
2023, Progress in Neuro-Psychopharmacology and Biological PsychiatryEating disorders (ED) are severe mental disorders that may result in significant functional impairment and disability. Neuropsychological studies have consistently found impaired executive function (EF) among ED patients. EF is particularly involved in fundamental skills of daily living and in behavioral and emotional regulation. In this study, impairment of executive functioning is investigated in patients with eating disorders and the associations with clinical features and clinical subtypes are analyzed.
75 female patients (m = 22.01 years, sd = 9.15) with eating disorder (43 restrictive anorexia, 30 binge-eating anorexia and 13 bulimia nervosa) and 37 healthy controls (m = 18.54 years, sd = 4.21) were included in the study. An extensive assessment of executive function domains (verbal fluency, set shifting, attention span, selective attention, working memory, inhibitory control and processing speed) was carried out in both groups. Clinical scales for food intake restriction, binge-eating/purging, depression, anxiety and impulsivity were also administered and correlated with scores on executive function tests.
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