El asma bronquial. Consideraciones clínicas,ideológicas y terapéuticas

RESUMEN

En los últimos años se viene observando la importancia creciente de la práctica e investigación psicológica en un campo poco tratado, la medicina. Hoy en día, gracias al desarrollo de la investigación psicofisiológica, ya nadie pone en duda que las influencias psicológicas actúan como mecanismos agravantes o desencadenantes cuando no, en muchos casos, como factores etiológicos muy delimitados. El objetivo de este trabajo es, precisamente, el de analizar algunos de los aspectos psicológicos en un trastorno psicofiológico bien caracterizado: el asma bronquial. Se presenta una breve caracterización de dicho trastorno, las aproximaciones terapéuticas, tanto fisiológicas como psicofisiológicas, el análisis funcional del trastorno y las técnicas y procedimientos terapéuticos dentro de la modificación de conducta.     

Visuo-haptic transfer for object recognition in children with periventricular leukomalacia and bilateral cerebral palsy

Object recognition is a complex adaptive process that can be impaired in children with neurodevelopmental disabilities. Recently, we found a significant effect of time on the development of unimodal and crossmodal recognition skills for common objects in typical children and this was a starting point for the study of visuo-haptic object recognition skills in impaired populations. In this study, we investigated unimodal visual information, unimodal haptic information and visuo-haptic information transfer in 30 children, from 4.0 to 10.11 years of age, with bilateral Periventricular Leukomalacia (PVL) and bilateral cerebral palsy. Results were matched with those of 116 controls. Participants were tested using a clinical protocol, adopted in the previous study, involving visual exploration of black-and-white photographs of common objects, haptic exploration of real objects and visuo-haptic transfer of these two types of information. Results show that in the PVL group as in controls, there is an age-dependent development of object recognition abilities for visual, haptic and visuo-haptic modalities, even if PVL children perform worse in all the three conditions, in comparison with the typical group. Furthermore, PVL children have a specific deficit both in visual and haptic information processing, that improves with age, probably thanks to everyday experience, but the visual modality shows a better and more rapid maturation, remaining more salient compared to the haptic one. However, multisensory processes partially facilitate recognition of common objects also in PVL children and this finding could be useful for planning early intervention in children with brain lesion.     

Time processing in children with Tourette’s syndrome

Background

Tourette syndrome (TS) is characterized by dysfunctional connectivity between prefrontal cortex and sub-cortical structures, and altered meso-cortical and/or meso-striatal dopamine release. Since time processing is also regulated by fronto-striatal circuits and modulated by dopaminergic transmission, we hypothesized that time processing is abnormal in TS.

Methods

We compared time processing abilities between nine children with TS-only (i.e. without major psychiatric comorbidities) and 10 age-matched healthy children, employing a time reproduction task in which subjects actively reproduce different temporal intervals, and a time comparison task in which subjects judge whether a test interval is longer or shorter than a reference interval. IQ, sustained and divided attention, and working memory were assessed in both groups using the Leiter International Performance Scale-Revised, and the Digit Span sub-test of the WISC-R.

Results

Children with TS-only reproduced in an overestimated fashion over-second, but not sub-second, time intervals. The precision of over-second intervals reproduction correlated with tic severity, in that the lower the tic severity, the closer the reproduction of over-second time intervals to their real duration. Time reproduction performance did not significantly correlate with IQ, attention and working memory measures in both groups. No differences between groups were documented in the time comparison task.

Conclusions

The improvement of time processing in children with TS-only seems specific for the over-second range of intervals, consistent with an enhancement in the ‘cognitively controlled’ timing system, which mainly processes longer duration intervals, and depends upon dysfunctional connectivity between the basal ganglia and the dorso-lateral prefrontal cortex. The absence of between-group differences on time comparison, moreover, suggests that TS patients manifest a selective improvement of ‘motor’ timing abilities, rather than of perceptual time abilities. Our data also support an enhancement of cognitive control processes in TS children, probably facilitated by effortful tic suppression.     

Mental Health of Parents of Children with Congenital Zika Virus Syndrome in Brazil

This study aims to analyze the potential impact of taking care of a child with congenital Zika virus syndrome (CZS) on the mental health of parents. Specifically, three objectives were formulated: (a) to assess the level of mental health of the parents; (b) to examine the influence of subjective well-being and fatigue as predictors of parents’ mental health; and (c) to identify the impact of sociodemographic variables on parents’ mental health. Sixty-nine mothers (M_age?=?26.38; SD?=?6.23) and 17 fathers (M_age?=?31.41; SD?=?7.57) of children diagnosed with CZS took part in this study. They answered a questionnaire containing measures of positive and negative affects, life satisfaction, fatigue, mental health, as well as sociodemographic questions. The results indicated that approximately 7% of the participants had low levels of mental health and probable emotional disorder. In addition, higher levels of fatigue and negative affects and lower levels of life satisfaction significantly predict a lower level of mental health. Finally, comparative analysis showed significant differences between fathers and mothers: mothers reported experiencing fewer positive and more negative affects, a lower level of satisfaction with life, a higher level of fatigue and worse mental health. In summary, this article presents an overview of the mental health of mothers and fathers of children with CZS and points the way to devising strategies for psychological intervention that promote the adaptation of parents to this kind of developmental disability in the family.     

A Clinical Decision Support Tool to Predict Cancer Risk for Commonly Tested Cancer-Related Germline Mutations

The rapid drop in the cost of DNA sequencing led to the availability of multi-gene panels, which test 25 or more cancer susceptibility genes for a low cost. Clinicians and genetic counselors need a tool to interpret results, understand risk of various cancers, and advise on a management strategy. This is challenging as there are multiple studies regarding each gene, and it is not possible for clinicians and genetic counselors to be aware of all publications, nor to appreciate the relative accuracy and importance of each. Through an extensive literature review, we have identified reliable studies and derived estimates of absolute risk. We have also developed a systematic mechanism and informatics tools for (1) data curation, (2) the evaluation of quality of studies, and (3) the statistical analysis necessary to obtain risk. We produced the risk prediction clinical decision support tool ASK2ME (All Syndromes Known to Man Evaluator). It provides absolute cancer risk predictions for various hereditary cancer susceptibility genes. These predictions are specific to patients’ gene carrier status, age, and history of relevant prophylactic surgery. By allowing clinicians to enter patient information and receive patient-specific cancer risks, this tool aims to have a significant impact on the quality of precision cancer prevention and disease management activities relying on panel testing. It is important to note that this tool is dynamic and constantly being updated, and currently, some of its limitations include (1) for many gene-cancer associations risk estimates are based on one study rather than meta-analysis, (2) strong assumptions on prior cancers, (3) lack of uncertainty measures, and (4) risk estimates for a growing set of gene-cancer associations which are not always variant specific. All of these concerns are being addressed on an ongoing basis, aiming to make the tool even more accurate.     

Stimulus-driven attentional capture: An empirical comparison of display-size and distance methods

Four experiments examined attentional capture by colour as assessed by two different investigative methods. Subjects performed a visual search task for a vertical-target line embedded among tilted-distractor lines, presented inside 4, 8, or 12 coloured discs. Interestingly, when the colour singleton was task irrelevant, and data were analysed by means of the display-size method combined with the zero-slope criterion, no evidence for attentional capture by colour was found. However, when data were analysed by means of the distance method, which consists of monitoring the spatial relationship between the target and the singleton, results showed that the target was found faster and/or more accurately when it was inside the singleton than when it was in a nonsingleton location. This provided evidence for a stimulus-driven attentional capture. In addition, the application of signal detection methodology showed that attentional capture, as revealed by the distance method, resulted from a perceptual modulation at the singleton location, rather than from a criterion shift. We conclude that, at least with the kind of stimuli used here, the display-size method combined with the zero-slope criterion is less than ideal for investigating how static discontinuities can affect the automatic deployment of visual attention.     

Perfectionism in depression, obsessive-compulsive disorder and eating disorders

High levels of perfectionism have been observed in major depression, anxiety disorders and eating disorders. Though few studies have compared levels of perfectionism across these disorders, there is reason to believe that different dimensions of perfectionism may be involved in eating disorders than in depression or anxiety [Bardone-Cone, A. M. et al. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27, 84-405]. The present study compared patients with major depression, obsessive-compulsive disorder, and eating disorders on dimensions of perfectionism. Concern over Mistakes was elevated in each of the patient groups while Pure Personal Standards was only elevated in the eating disorder sample. Doubts about Actions was elevated in both patients with obsessive-compulsive disorder and eating disorders, but not in depressed patients. Analyses of covariance indicated that Concern over Mistakes accounted for most of the variance in the relationship of perfectionism to these forms of psychopathology.