Escala de Riesgo Psicosocial FEAFES Castilla y León (ERP): procedimiento de construcción mediante... more Escala de Riesgo Psicosocial FEAFES Castilla y León (ERP): procedimiento de construcción mediante metodología cualitativa y presentación de la escala FEAFES Castilla León Psychosocial Risk Scale (PRS): construction procedure using qualitative methodology and presentation of the scale Resumen: Objetivos: El envejecimiento es un problema prioritario de salud en las personas con enfermedad mental, especialmente en la generación que actualmente se acerca a la edad geriátrica y que ha sido atendida en el marco de la reforma psiquiátrica y de la desinstitucionalización. El objetivo es crear una escala que detecte de manera válida, fiable y eficiente el riesgo psicosocial asociado al envejecimiento en personas con enfermedad mental. Metodología: se ha utilizado metodología cualitativa mediante grupos nominales. Han participado 106 personas de todas las provincias de Castilla y León, de poblaciones de distinto tamaño. Han participado tanto enfermos como familiares y profesionales. Resultados: Se han detectado 40 necesidades, que se han priorizado. Conclusiones: Los 10 ítems que componen la escala son: recursos económicos, tratamiento farmacológico, vivienda, equipo de salud mental, familia, equipo de atención primaria, autonomía personal, hábitos de salud, ocupación y entorno.
People with severe mental disorder (SMD) have serious difficulties in developing a normal life, s... more People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain). We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals. In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78% belong to the diagnosis of schizophrenia spectrum. Income affect...
(SMD) is a health problem that associates specific psychosocial risk factors. The FEAFES Castilla... more (SMD) is a health problem that associates specific psychosocial risk factors. The FEAFES Castilla y León Psychosocial Risk Scale (PRS) is a tool specifically constructed to measuring this risk. The objective is to study the reliability and validity of the scale and its dimensional structure, as well as reporting normative data for its clinical use. Method. The scale was used in a simple of 74 SMD people in Castilla y León. Its internal consistence, dimensional structure, inter-rater reliability, test-retest reliability and association with the psychosocial functioning level (GAF), symptoms severity (CGI, BPRS), disease-related problems (HoNOS) and healthy global level (SF-36) were studied. Results. PRS is a reliable scale, with internal consistence Cronbach´s alpha of 0,783. Equally it has a high test-retest and inter-rater reliability and a moderate association with related constructs. PRS structure explains for 60% of the variance in three dimensions: Personal autonomy, health sup...
Background: There is a paucity of research examining the longterm impact of cannabis use on the h... more Background: There is a paucity of research examining the longterm impact of cannabis use on the human brain. We have previously reported significant reduction in hippocampal volume in long-term heavy cannabis users1. Hippocampal alterations are implicated in psychosis and significant numbers of patients also use cannabis. In this study we performed hippocampal shape analysis in the same cohort of healthy cannabis users and a sample of patients with schizophrenia with and without comorbid cannabis use. Methods: Participants were recruited from the general community to form the following groups for comparison: long-term heavy cannabis users (THC: n = 16, 1 female, mean age 39 yrs, 21 yrs regular use, near daily); non-user controls (CON: n = 18, 2 female, 35 yrs); cannabis users with schizophrenia (SZ + THC: n=10, 2 female, 35 yrs, 19 yrs regular use, near daily); and nonusers with schizophrenia (SZ-THC: n=12, 3 female, 42 yrs). Groups did not differ in age, education or IQ (p > 0.05) and THC and SZ + THC were matched on cannabis use parameters and alcohol and tobacco use. Hippocampal volumes were traced from 3T magnetic resonance images and shape analysis was undertaken using the University of North Carolina toolkit. Segmented 3D binaries underwent morphological closing and minimal smoothing, and were subjected to spherical harmonic shape description (SPHARM-PDM). All surfaces were uniformly sampled into sets of 1002 surface points each and aligned to a study-averaged template with normalization for head size. To compare structural shape between groups, we computed the local Hotelling T2 two-sample mean difference, and corrected for multiple comparisons using false discovery rate. We generated mean difference magnitude displacement maps and significance maps of the local p-values in raw format, and corrected for multiple comparisons. Results: Significant differences between groups were found bilaterally in the hippocampus as follows. Compared to CON: THC showed a significant shape change in right hippocampus (p < 0.05) but only a trend in left hippocampus (p < 0.08); SZ-THC showed a marginally significant shape change for left hippocampus (p < 0.056) but not right hippocampus (p > 0.2); SZ + THC showed a highly significant change in left hippocampus (p < 0.003) and a marginal change in right hippocampus (p < 0.058). When THC were compared to SCZ + THC, there was a significant difference on the left (p < 0.05) and a trend on the right (p = 0.077). There was no significant shape difference between THC and SCZ-THC for either left or right hippocampus (p > 0.3). Significant regional changes were not confined to a particular subregion of the hippocampus, tending to be dispersed. Relationships with various cannabis use parameters and symptom measures were also observed. Discussion: Our findings continue to challenge the widespread perception of cannabis as having limited or no neuroanatomical sequelae. We found highly significant shape changes in the left hippocampus of patients with schizophrenia and comorbid cannabis use compared to controls, and some evidence of hippocampal shape alterations in healthy cannabis users and non-users with schizophrenia. These showed differentially lateralised effects in each group, suggesting specific effects associated with cannabis use and with schizophrenia per se, and an interaction effect evident in the cannabis-using group with schizophrenia. Shape analysis provides further information beyond simple volumetric analysis and this study is the first to report an additional adverse effect of cannabis use on brain structure in chronic schizophrenia, in this instance specific to hippocampus. 1.
Self-perceived stress in 293 psychotic patients (schizophrenic, toxic and brief reactive psychose... more Self-perceived stress in 293 psychotic patients (schizophrenic, toxic and brief reactive psychoses) and a control group of 40 sane individuals was evaluated by means of the Frankfurt Complaint Questionnaire. For this purpose, scores obtained in 6 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;complementary items&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; of third version of this questionnaire were studied, both in global and in detailed form. These items reflect coping mechanisms exerted towards situations perceived as stressful which can produce clinical manifestations similar to the well-known &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;negative symptoms&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; of schizophrenia. Results show that self-perceived stress in all groups of patients is significantly higher than in the control group. In contrast, no significant differences among the three groups of patients are obtained. In conclusion, we point out the relevance of studying the psychotic patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s self-perceived stress in order to detect and minimize or even avoid the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s risk situations, independent of his/her diagnosis. This will be especially useful to obtain optimal conditions for rehabilitation.
1. Gregg, L., C. Barrowclough, and G. Haddock, Reasons for increased substance use in psychosis. ... more 1. Gregg, L., C. Barrowclough, and G. Haddock, Reasons for increased substance use in psychosis. Clin Psychol Rev, 2007. 27(4): p. 494-510. 2. Talamo, A., et al., Comorbid substance-use in schizophrenia: relation to positive and negative symptoms. Schizophr Res, 2006. 86(1-3): p. 251-5.
The objective of this paper was to verify if a specific psychopathological profile for toxic psyc... more The objective of this paper was to verify if a specific psychopathological profile for toxic psychoses exists. A total of 120 Spanish psychotic patients classified into three different groups were studied: toxic, schizophrenic and brief reactive psychoses, with 40 patients each. A control group of 40 normal subjects was also included. A subjective and objective approach were used by means
Objective: The purposes of this study were to explore the diagnostic features of the behavioral a... more Objective: The purposes of this study were to explore the diagnostic features of the behavioral assessment of the dysexecutive syndrome battery (BADS) in the Spanish population of chronic schizophrenia patients, its concurrent validity with other classic neuropsychologic tests of executive dysfunction, and its correlates with clinical variables.
Objectives: The aim of this study was to assess the specific features of attention impairment in ... more Objectives: The aim of this study was to assess the specific features of attention impairment in patients with schizophrenia and the correlation between those features and the patients' clinical status.
Objectives: The aims of this study were to research the following issues in a Spanish population ... more Objectives: The aims of this study were to research the following issues in a Spanish population of patients with schizophrenia. (a) The sensitivity and reliability of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to detect cognitive impairment in schizophrenia. (b) The convergent validity of RBANS on a larger battery of neuropsychological tests sensitive to the cognition disorders typically observed in schizophrenia. (c) The correlates of poor performance in RBANS with clinical features and illness severity. Method: Thirty schizophrenia patients, 30 non-psychotic patients and 30 healthy participants were assessed using RBANS (form A). We administered a battery of neuropsychological tests and four scales to evaluate patient's clinical status. Results: Schizophrenia patients and non-psychotic patients performed significantly worse than healthy controls on RBANS, and schizophrenia patients performed slightly worse than non-psychiatric controls, but this difference was not significant. Good inter-test reliability and concurrent validity were found. Only a moderate correlation between RBANS performance and illness severity was observed. Conclusions: RBANS revealed coherence in identifying cognitive impairment in schizophrenia patients of a different cultural background, and it is shown to be a sensitive, valid and easy-to-perform tool for the neuropsychological assessment of Spanish patients with schizophrenia.
Los objetivos del estudio son proyectar el valor de la tasa de mortalidad materna por 100,000 nac... more Los objetivos del estudio son proyectar el valor de la tasa de mortalidad materna por 100,000 nacidos vivos para el año 2015 bajo un escenario de tendencia y encontrar la opción más costo-eficiente para alcanzar la meta del milenio de reducir esta tasa en ¾, lo que implica, en el caso de Bolivia, reducirla hasta el valor de 104.
El corredor de conservación Amboró-Madidi es de prioridad global debido a su alta biodiversidad y... more El corredor de conservación Amboró-Madidi es de prioridad global debido a su alta biodiversidad y endemismo. Al mismo tiempo, las tierras fiscales de la región son apreciadas por migrantes sin tierra del altiplano. En este documento contrastamos la necesidad de tierra para ...
Escala de Riesgo Psicosocial FEAFES Castilla y León (ERP): procedimiento de construcción mediante... more Escala de Riesgo Psicosocial FEAFES Castilla y León (ERP): procedimiento de construcción mediante metodología cualitativa y presentación de la escala FEAFES Castilla León Psychosocial Risk Scale (PRS): construction procedure using qualitative methodology and presentation of the scale Resumen: Objetivos: El envejecimiento es un problema prioritario de salud en las personas con enfermedad mental, especialmente en la generación que actualmente se acerca a la edad geriátrica y que ha sido atendida en el marco de la reforma psiquiátrica y de la desinstitucionalización. El objetivo es crear una escala que detecte de manera válida, fiable y eficiente el riesgo psicosocial asociado al envejecimiento en personas con enfermedad mental. Metodología: se ha utilizado metodología cualitativa mediante grupos nominales. Han participado 106 personas de todas las provincias de Castilla y León, de poblaciones de distinto tamaño. Han participado tanto enfermos como familiares y profesionales. Resultados: Se han detectado 40 necesidades, que se han priorizado. Conclusiones: Los 10 ítems que componen la escala son: recursos económicos, tratamiento farmacológico, vivienda, equipo de salud mental, familia, equipo de atención primaria, autonomía personal, hábitos de salud, ocupación y entorno.
People with severe mental disorder (SMD) have serious difficulties in developing a normal life, s... more People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain). We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals. In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78% belong to the diagnosis of schizophrenia spectrum. Income affect...
(SMD) is a health problem that associates specific psychosocial risk factors. The FEAFES Castilla... more (SMD) is a health problem that associates specific psychosocial risk factors. The FEAFES Castilla y León Psychosocial Risk Scale (PRS) is a tool specifically constructed to measuring this risk. The objective is to study the reliability and validity of the scale and its dimensional structure, as well as reporting normative data for its clinical use. Method. The scale was used in a simple of 74 SMD people in Castilla y León. Its internal consistence, dimensional structure, inter-rater reliability, test-retest reliability and association with the psychosocial functioning level (GAF), symptoms severity (CGI, BPRS), disease-related problems (HoNOS) and healthy global level (SF-36) were studied. Results. PRS is a reliable scale, with internal consistence Cronbach´s alpha of 0,783. Equally it has a high test-retest and inter-rater reliability and a moderate association with related constructs. PRS structure explains for 60% of the variance in three dimensions: Personal autonomy, health sup...
Background: There is a paucity of research examining the longterm impact of cannabis use on the h... more Background: There is a paucity of research examining the longterm impact of cannabis use on the human brain. We have previously reported significant reduction in hippocampal volume in long-term heavy cannabis users1. Hippocampal alterations are implicated in psychosis and significant numbers of patients also use cannabis. In this study we performed hippocampal shape analysis in the same cohort of healthy cannabis users and a sample of patients with schizophrenia with and without comorbid cannabis use. Methods: Participants were recruited from the general community to form the following groups for comparison: long-term heavy cannabis users (THC: n = 16, 1 female, mean age 39 yrs, 21 yrs regular use, near daily); non-user controls (CON: n = 18, 2 female, 35 yrs); cannabis users with schizophrenia (SZ + THC: n=10, 2 female, 35 yrs, 19 yrs regular use, near daily); and nonusers with schizophrenia (SZ-THC: n=12, 3 female, 42 yrs). Groups did not differ in age, education or IQ (p > 0.05) and THC and SZ + THC were matched on cannabis use parameters and alcohol and tobacco use. Hippocampal volumes were traced from 3T magnetic resonance images and shape analysis was undertaken using the University of North Carolina toolkit. Segmented 3D binaries underwent morphological closing and minimal smoothing, and were subjected to spherical harmonic shape description (SPHARM-PDM). All surfaces were uniformly sampled into sets of 1002 surface points each and aligned to a study-averaged template with normalization for head size. To compare structural shape between groups, we computed the local Hotelling T2 two-sample mean difference, and corrected for multiple comparisons using false discovery rate. We generated mean difference magnitude displacement maps and significance maps of the local p-values in raw format, and corrected for multiple comparisons. Results: Significant differences between groups were found bilaterally in the hippocampus as follows. Compared to CON: THC showed a significant shape change in right hippocampus (p < 0.05) but only a trend in left hippocampus (p < 0.08); SZ-THC showed a marginally significant shape change for left hippocampus (p < 0.056) but not right hippocampus (p > 0.2); SZ + THC showed a highly significant change in left hippocampus (p < 0.003) and a marginal change in right hippocampus (p < 0.058). When THC were compared to SCZ + THC, there was a significant difference on the left (p < 0.05) and a trend on the right (p = 0.077). There was no significant shape difference between THC and SCZ-THC for either left or right hippocampus (p > 0.3). Significant regional changes were not confined to a particular subregion of the hippocampus, tending to be dispersed. Relationships with various cannabis use parameters and symptom measures were also observed. Discussion: Our findings continue to challenge the widespread perception of cannabis as having limited or no neuroanatomical sequelae. We found highly significant shape changes in the left hippocampus of patients with schizophrenia and comorbid cannabis use compared to controls, and some evidence of hippocampal shape alterations in healthy cannabis users and non-users with schizophrenia. These showed differentially lateralised effects in each group, suggesting specific effects associated with cannabis use and with schizophrenia per se, and an interaction effect evident in the cannabis-using group with schizophrenia. Shape analysis provides further information beyond simple volumetric analysis and this study is the first to report an additional adverse effect of cannabis use on brain structure in chronic schizophrenia, in this instance specific to hippocampus. 1.
Self-perceived stress in 293 psychotic patients (schizophrenic, toxic and brief reactive psychose... more Self-perceived stress in 293 psychotic patients (schizophrenic, toxic and brief reactive psychoses) and a control group of 40 sane individuals was evaluated by means of the Frankfurt Complaint Questionnaire. For this purpose, scores obtained in 6 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;complementary items&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; of third version of this questionnaire were studied, both in global and in detailed form. These items reflect coping mechanisms exerted towards situations perceived as stressful which can produce clinical manifestations similar to the well-known &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;negative symptoms&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; of schizophrenia. Results show that self-perceived stress in all groups of patients is significantly higher than in the control group. In contrast, no significant differences among the three groups of patients are obtained. In conclusion, we point out the relevance of studying the psychotic patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s self-perceived stress in order to detect and minimize or even avoid the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s risk situations, independent of his/her diagnosis. This will be especially useful to obtain optimal conditions for rehabilitation.
1. Gregg, L., C. Barrowclough, and G. Haddock, Reasons for increased substance use in psychosis. ... more 1. Gregg, L., C. Barrowclough, and G. Haddock, Reasons for increased substance use in psychosis. Clin Psychol Rev, 2007. 27(4): p. 494-510. 2. Talamo, A., et al., Comorbid substance-use in schizophrenia: relation to positive and negative symptoms. Schizophr Res, 2006. 86(1-3): p. 251-5.
The objective of this paper was to verify if a specific psychopathological profile for toxic psyc... more The objective of this paper was to verify if a specific psychopathological profile for toxic psychoses exists. A total of 120 Spanish psychotic patients classified into three different groups were studied: toxic, schizophrenic and brief reactive psychoses, with 40 patients each. A control group of 40 normal subjects was also included. A subjective and objective approach were used by means
Objective: The purposes of this study were to explore the diagnostic features of the behavioral a... more Objective: The purposes of this study were to explore the diagnostic features of the behavioral assessment of the dysexecutive syndrome battery (BADS) in the Spanish population of chronic schizophrenia patients, its concurrent validity with other classic neuropsychologic tests of executive dysfunction, and its correlates with clinical variables.
Objectives: The aim of this study was to assess the specific features of attention impairment in ... more Objectives: The aim of this study was to assess the specific features of attention impairment in patients with schizophrenia and the correlation between those features and the patients' clinical status.
Objectives: The aims of this study were to research the following issues in a Spanish population ... more Objectives: The aims of this study were to research the following issues in a Spanish population of patients with schizophrenia. (a) The sensitivity and reliability of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to detect cognitive impairment in schizophrenia. (b) The convergent validity of RBANS on a larger battery of neuropsychological tests sensitive to the cognition disorders typically observed in schizophrenia. (c) The correlates of poor performance in RBANS with clinical features and illness severity. Method: Thirty schizophrenia patients, 30 non-psychotic patients and 30 healthy participants were assessed using RBANS (form A). We administered a battery of neuropsychological tests and four scales to evaluate patient's clinical status. Results: Schizophrenia patients and non-psychotic patients performed significantly worse than healthy controls on RBANS, and schizophrenia patients performed slightly worse than non-psychiatric controls, but this difference was not significant. Good inter-test reliability and concurrent validity were found. Only a moderate correlation between RBANS performance and illness severity was observed. Conclusions: RBANS revealed coherence in identifying cognitive impairment in schizophrenia patients of a different cultural background, and it is shown to be a sensitive, valid and easy-to-perform tool for the neuropsychological assessment of Spanish patients with schizophrenia.
Los objetivos del estudio son proyectar el valor de la tasa de mortalidad materna por 100,000 nac... more Los objetivos del estudio son proyectar el valor de la tasa de mortalidad materna por 100,000 nacidos vivos para el año 2015 bajo un escenario de tendencia y encontrar la opción más costo-eficiente para alcanzar la meta del milenio de reducir esta tasa en ¾, lo que implica, en el caso de Bolivia, reducirla hasta el valor de 104.
El corredor de conservación Amboró-Madidi es de prioridad global debido a su alta biodiversidad y... more El corredor de conservación Amboró-Madidi es de prioridad global debido a su alta biodiversidad y endemismo. Al mismo tiempo, las tierras fiscales de la región son apreciadas por migrantes sin tierra del altiplano. En este documento contrastamos la necesidad de tierra para ...
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