Scielo RSS http://scielo.isciii.es/rss.php?pid=0213-616320070003&lang=pt vol. 21 num. 3 lang. pt http://scielo.isciii.es/img/en/fbpelogp.gif http://scielo.isciii.es http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000300001&lng=pt&nrm=iso&tlng=pt Background and Objectives: With one of the highest rates of suicide in the world and high rates of suicidal ideation in the population, we set out to pilot a study to ascertain whether it is possible to conduct a randomised controlled trial. Secondly we aimed to study whether Cognitive Behavioural Therapy (CBT) for suicidal ideation is better than treatment as usual (TAU). Method: Those with suicidal ideation (identified by a population survey using GHQ-30 and Beck's suicidal ideation scale) were randomly allocated to 3-6 sessions of structured Cognitive Behavioural Therapy. The CBT was provided using a manual in primary care settings. Results: Of the two groups (CBT = 5, TAU = 4) the group which had received CBT showed a greater reduction in Beck's Suicidal Intent Score (from mean 11.2 to 0.2) and in GHQ-30 (from 22.0 to 10.8) in three months. Conclusions: The pilot study indicates that it is possible to conduct CBT and RCT in developing countries. The implications of this are discussed. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000300002&lng=pt&nrm=iso&tlng=pt Background: The impact of totalitarian legacy on present changes in legal regulation of mental health care and the interplay between legal and cultural factors in involuntary psychiatric treatment in post-totalitarian states have not been systematically analyzed, neither worked through. Objectives: To assess the characteristics of the legal system and social practices concerning involuntary psychiatric treatment in Bulgaria from historical perspective, parallel with the legal developments in other European countries. Methods: Review of relevant research and historical sources, cultural reference framework, and legal norms. Results: Cultural and legal developments are far from being parallel. Totalitarian legacy in the area of patients' rights and coercion in psychiatric treatment is coped with in a milieu of transitional rules where the basic challenges concern more cultural aspects rather than legislative ones. While legal changes in non-Soviet post-totalitarian states nowadays could be best described as normalization (illustrated with Bulgarian legal traditions as an example), the major cultural shift concerning health care impacts novel concepts, e.g. autonomy vs. paternalism, and high tolerance to insecurity vs. fatalism, which mobilize defences and provoke confusion. Conclusions: Culture, and de-culturation in times of transition for that matter, is the limiting factor for practical implementation of law, and contributes to the discrepancy between written law and applicable law. Problematic issues subject to current changing legislation, such as informed consent, legal competence, disability, guardianship, and compulsory placement and treatment, could be understood and resolved if viewed in the context of a changing culture. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000300003&lng=pt&nrm=iso&tlng=pt Background: We previously noted a significantly higher degree of retrospective and contemporaneous shyness and sociability troubles in patients with schizophrenia than controls in a community-based stable outpatient sample and greater relative resting right frontal EEG activity (a trait marker of stress) in patients with schizophrenia who were shy. Objective: Here we conducted a preliminary investigation to examine the stability of shyness and sociability in a sample of 37 stable outpatients with schizophrenia, some of whom were either exposed (n = 17) or not exposed (n = 20) to weekly social skills training over a seven month period. Results: We found that shyness and sociability remained stable across all patients, although when the two groups were considered separately, only shyness remained stable in both groups. Sociability was not stable in those patients exposed to social skills training. We also found that, although measures of shyness indexed prior to exposure to the social skills training program significantly predicted pre- and post-social skills training measures, sociability was not related to pre- or post-social skills measures. Individuals with schizophrenia who scored high on trait shyness prior to exposure to social skills training still exhibited problems related to social adjustment following training. Conclusions: The present study appears to be the first to examine the stability of trait-like shyness in schizophrenia. Findings are discussed in terms of their implications for understanding the stability of shyness and sociability and their role in the heterogeneity of symptom profiles and pervasive social dysfunction in community outpatients with schizophrenia. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000300004&lng=pt&nrm=iso&tlng=pt Background and Objectives: To examine the influence of gender on social functioning in patients with schizophreni Methods: A sample of 318 schizophrenic (216 men and 102 women) (DSM-IV criteria) outpatients from four Spanish centres were administered the following instruments: Positive and Negative Symptom Scale (PANSS), Disability Assessment Scale (DAS-sv), and Global Assessment of Functioning (GAF) Scale. A regression model was created with DAS and GAF as dependent variables, and gender, and other predictor variables as independent variables. Separate regression models were then generated for females and males. Results: Women had a better social functioning than men, and after adjusting for others predictor variables gender was a significant predictor specially for occupational functioning. In gender specific analyses, we found that the predictive variables for social functioning have more similarities than differences between men and women. Conclusions: In our sample, women showed a better social functioning than men specially in occupational functioning. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000300005&lng=pt&nrm=iso&tlng=pt Background and Objectives: In clinical psychiatry genetic anomalies are infrequently part of the differential diagnosis, especially in the elderly. Two case reports are used to illustrate the relevance of a genetic workup for diagnosis, treatment and prognosis. Methods: A female and a male patient, aged 81 and 68 year respectively, were admitted because of psychotic symptoms. Despite their relatively low level of intelligence together with autistic-like behaviour in the female patient and dysmorphias in the male patient, a genetic disorder was previously never considered. Results: In the female patient a balanced translocation between chromosomes X and 19 was found, while in the male patient a mosaic trisomy 8 was demonstrated. Conclusions: Genetic analysis is indicated in patients with autism, lower intelligence, unexplained somatic anomalies and dysmorphias. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000300006&lng=pt&nrm=iso&tlng=pt Objective: Individuals with schizophrenia and other chronic mental illnesses present a series of risk factors, that predispose them to extensive medical comorbidity. The aim of this study was to determine the risk factors for respiratory disease in chronic psychiatric inpatients. Methods: All patients at a long-term mental institution were invited to participate in this study. Socio-demographic data, tobacco and alcohol consumption, respiratory symptoms and chest x-rays were collected from 154 patients. Sputum microscopy and cultures for M. tuberculosis were done in specific cases. Results: The symptoms reported were cough (58%); expectoration (44.2%); dyspnea (28.6%); hemoptysis (9.7%), and chest pain (20.1%). There were chest x-ray changes in 57.1% of patients. These were suggestive of chronic obstructive pulmonary disease (COPD) in 31.2% and an interstitial pattern in 19.1%. The prevalence of tuberculosis in this sample was 4.5%. Schizophrenia was the most common mental illness (43.5%), followed by an organic mental disorder (32.5%). We found a positive relationship between schizophrenia and cigarette smoking (odds ratio 2.30, 95% CI 1.11 to 4.76), and schizophrenia and x-ray changes (odds ratio 2.35, 95% CI 1.15 to 4.83). There was no significant relationship with other psychiatric disorders. Conclusions: The high prevalence of respiratory morbidity in patients with chronic mental illness hospitalized in long-term care facilities, is probably due to factors such as extreme poverty, tobacco consumption, overcrowding, and nutritional deficit. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000300007&lng=pt&nrm=iso&tlng=pt Background and Objectives: Negative symptoms emerge in many patients with psychotic disorders long before the onset of the acute illness. These symptoms are often impossible to differentiate from certain Cluster A personality traits. Methods: The current study examines the extent to which premorbid negative symptoms are contributing factors to the development of primary and secondary negative symptomatology. Participants were 84 neuroleptic-naïve patients experiencing the occurrence of their first acute psychotic episode. Symptoms of psychopathology were assessed at two points: at admission and after remission of the acute episode. The Spanish version of the PANSS scale was administered. Premorbid personality assessment was considered as a proxy measure to evaluate each participant's negative symptomatology prior to the onset of the illness. Potential causes of secondary negative symptomatology, such as depression and extrapyramidal symptoms, were also examined. Results: 'Non-respondent' or 'residual' negative symptoms at discharge were significantly predicted by primary negative symptoms. To a lesser extent, disorganization and depressive symptoms at discharge and the Schizoid dimension of premorbid personality predicted residual negative symptoms. Conclusions: The severity of negative symptoms at the onset of the psychotic episode varied across patients. After controlling for 'respondent' and 'non-respondent' primary negative symptoms and other potential causes of negative symptoms, premorbid negative symptoms had a slight, but significant predictive relationship with residual negative symptoms. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000300008&lng=pt&nrm=iso&tlng=pt Background and Objectives: Negative symptoms emerge in many patients with psychotic disorders long before the onset of the acute illness. These symptoms are often impossible to differentiate from certain Cluster A personality traits. Methods: The current study examines the extent to which premorbid negative symptoms are contributing factors to the development of primary and secondary negative symptomatology. Participants were 84 neuroleptic-naïve patients experiencing the occurrence of their first acute psychotic episode. Symptoms of psychopathology were assessed at two points: at admission and after remission of the acute episode. The Spanish version of the PANSS scale was administered. Premorbid personality assessment was considered as a proxy measure to evaluate each participant's negative symptomatology prior to the onset of the illness. Potential causes of secondary negative symptomatology, such as depression and extrapyramidal symptoms, were also examined. Results: 'Non-respondent' or 'residual' negative symptoms at discharge were significantly predicted by primary negative symptoms. To a lesser extent, disorganization and depressive symptoms at discharge and the Schizoid dimension of premorbid personality predicted residual negative symptoms. Conclusions: The severity of negative symptoms at the onset of the psychotic episode varied across patients. After controlling for 'respondent' and 'non-respondent' primary negative symptoms and other potential causes of negative symptoms, premorbid negative symptoms had a slight, but significant predictive relationship with residual negative symptoms.