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Background: In recent years some studies have been published supporting the efficacy of light exposure, physical activity, sleep control and a Mediterranean diet pattern on the improvement or prevention of Depression. However, to our knowledge, there have been no studies using all these measures together as an adjuvant antidepressant strategy. Methods: Multicenter, randomized, controlled, two arm-parallel, clinical trial. Eighty depressed patients undergoing standard antidepressant treatment will be advised to follow four additional hygienic-dietary recommendations about exercise, diet, sunlight exposure and sleep. Outcome measures will be assessed before and after the 6 month intervention period. Discussion: We expect the patients in the active recommendations group to experience a greater improvement in their depressive symptoms. If so, this would be a great support for doctors who might systematically recommend these simple and costless measures, especially in primary care., We wish to thank the Instituto de Salud Carlos III of the Spanish Ministry of Health for funding the study (FIS no PI07 0544). We also thank Charles O'Brien's help in translating the manuscript.

The objective of this study was to validate the Spanish version of the Othmer and DeSouza Screening Test for Somatization Disorder. We have designed a validity study using the Standardized Polyvalent Psychiatric Interview, an instrument specifically designed to diagnose psychiatric morbidity in medical settings as the 'golden rule'. The control group displayed 'functional' and 'presenting' somatization. The Othmer and DeSouza Screening Test, with a threshold of three symptoms, shows 88% sensitivity, 78% specificity and a misclassification rate of 17%. It is concluded that Othmer and DeSouza's screening test, with a threshold of three symptoms, is a useful tool for the diagnosis of somatization disorder in medical and primary care settings in Spain. Discrepancies with US findings are discussed on a cross-cultural basis.

Background Tobacco dependence management is a multi-component intervention that includes pharmacological treatments such as Nicotine Substitution Therapy (NST) or bupropion, and psychological therapy. There are some preliminary reports on topiramate efficacy for tobacco dependence. The aim of this study is to determine whether topiramate is as effective as the standard NST treatment for tobacco cessation at 1-year follow-up in patients with depression. Method/design Design: A randomised, controlled trial involving two groups, one of which is the control group consisting of patients on the standard pharmacological treatment for tobacco cessation (NST) and the other is the intervention group consisting of patients on topiramate as pharmacological treatment. Setting: 29 primary care health centres in the city of Zaragoza, Spain. Sample: 180 patients, aged 18–65 years, diagnosed with major depression, smoke more than 20 cigarettes/day, who have voluntarily asked for tobacco cessation therapy. Intervention: A multi-component programme for tobacco cessation is offered to all of the patients in the study. This programme is made up of pharmacological therapy + group cognitive-behavioural therapy. Pharmacological therapy consists of NST for the control group and topiramate (200 mg/day) for the intervention group. Psychological therapy is made up of 16 sessions of manualised group therapy. Measurements: Cessation will be assessed by patient self-declared abstinence, expired air carbon monoxide levels, and cotinine levels in saliva. Questionnaires on tobacco dependence, anxiety, depression, impulsiveness and self-efficacy will be administered. The interviewers will not know which group the patient belongs to (blind). The assessments will be carried out at baseline, D (cessation day) -1, D+1, weeks 1, 2, 3, 4, 6, 8, 10 and 13, and months 4, 5, 6, 8, 10 and 12. Main variables: Tobacco cessation rates and tobacco dependence. Analysis: The analysis will be per intent to treat. We will use the general linear models of the SPSS version 15 statistical package, to analyse the effect of the treatment on the result variable (tobacco cessation rate). Discussion It is necessary to develop new and more effective pharmacological treatments for tobacco cessation. This randomised clinical trial will determine whether topiramate is effective for tobacco cessation in patients with depression. Trial registration Current Controlled Trials ISRCTN93532081

The aim of this study was to determine whether attributional style is a stable pattern in somatizers, to analyse the sociodemographic and psychopathological characteristics that can modify it, and to study the relationship between attributional pattern and outcome. A total of 147 somatizers and 46 psychologizers from a representative sample (n=1559) of primary care patients in Zaragoza, Spain were followed up for 1 year. Attribution of somatic symptoms was a stable construct in somatizers. Patients who modified attribution were younger (by 15 years on average), tended to be without a partner, and had a shorter illness duration (by 20 months on average) than those who maintained it. Attribution showed no correlation with outcome at the 1-year follow-up.

BackgroundThis is the first attempt to study the prevalence and clinical characteristics of somatisation (ST) in a representative primary care sample in Spain.MethodThe sample consisted of 1559 consecutive patients attending eight randomly selected health centres in Zaragoza, Spain, examined by two-phase screening. First phase (lay interviewers): Spanish versions of GHQ–28, CAGE questionnaire, substance abuse, Mini-Mental State Examination. Second phase (research clinicians and psychiatrists): Standardised Polyvalent Psychiatric Interview, which permits the reliable coding of Bridges & Goldberg's ST criteria.ResultsThe prevalence of somatisers was 9.4% (34.5% of the cases) and most patients (68.7%) were diagnosed in the depression or anxiety DSM–IV categories. The severity was moderate in 40.1 % and 66.6% were chronic (six or more months). No significant demographic differences were found with non-cases. Backache was the most frequent somatic presentation (71.4%).ConclusionsST in primary care is a much broader phenomenon than categories such as somatoform disorders reflect. It may be less influenced by sociodemographic factors, but more chronic than previously reported.

Introduction Cognitive behavioral therapy (CBT) and U.S. Food and Drug Administration (FDA)-recommended pharmacologic treatments (RPTs; pregabalin, duloxetine, and milnacipran) are effective treatment options for fibromyalgia (FM) syndrome and are currently recommended by clinical guidelines. We compared the cost-utility from the healthcare and societal perspectives of CBT versus RPT (combination of pregabalin + duloxetine) and usual care (TAU) groups in the treatment of FM. Methods The economic evaluation was conducted alongside a 6-month, multicenter, randomized, blinded, parallel group, controlled trial. In total, 168 FM patients from 41 general practices in Zaragoza (Spain) were randomized to CBT (n = 57), RPT (n = 56), or TAU (n = 55). The main outcome measures were Quality-Adjusted Life Years (QALYs, assessed by using the EuroQoL-5D questionnaire) and improvements in health-related quality of life (HRQoL, assessed by using EuroQoL-5D visual analogue scale, EQ-VAS). The costs of healthcare use were estimated from patient self-reports (Client Service Receipt Inventory). Cost-utility was assessed by using the net-benefit approach and cost-effectiveness acceptability curves (CEACs). Results On average, the total costs per patient in the CBT group (1,847€) were significantly lower than those in patients receiving RPT (3,664€) or TAU (3,124€). Patients receiving CBT reported a higher quality of life (QALYs and EQ-VAS scores); the differences between groups were significant only for EQ-VAS. From a complete case-analysis approach (base case), the point estimates of the cost-effectiveness ratios resulted in dominance for the CBT group in all of the comparisons performed, by using both QALYs and EQ-VAS as outcomes. These findings were confirmed by bootstrap analyses, net-benefit curves, and CEACs. Two additional sensitivity analyses (intention-to-treat analysis and per-protocol analysis) indicated that the results were robust. The comparison of RPT with TAU yielded no clear preference for either treatment when using QALYs, although RPT was determined to be more cost-effective than TAU when evaluating EQ-VAS. Conclusions Because of lower costs, CBT is the most cost-effective treatment for adult FM patients. Implementation in routine medical care would require policymakers to develop more-widespread public access to trained and experienced therapists in group-based forms of CBT. Trial registration Current Controlled Trials ISRCTN10804772. Registered 29 September 2008. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0451-y) contains supplementary material, which is available to authorized users.

Objective The aim of this paper is to explore the prevalence of psychiatric morbidity in different immigrant groups in Spain. In keeping with prior studies carried out in Europe, it is expected that the immigrant population will have elevated levels of psychopathology, with some variation across immigrant groups. Method Design: Multicenter, observational, cross-sectional study. Setting: Primary care settings of two Spanish regions. Sample: N= 1.503 immigrants paired with the same number of Spanish controls, adjusted by gender and age. Variables: Demographic variables, MINI International Neuropsychiatric Interview and Standardized Polyvalent Psychiatric Interview, somatic symptoms section. Student's t tests, ORs and logistic regressions were used to analyze the data. Results No differences in psychiatric morbidity were found (native born 30.9%, population vs. immigrants 29.6%, OR=.942, CI=.806–1.100) when comparing immigrants to native born Spaniards. Relative to Spaniards (30.9%), Latin American immigrants had significantly higher levels of psychopathology (36.8%), Sub-Saharan Africans (24.4%) and Asians (16%) had significantly lower levels, and Eastern Europeans (31.4%) and North Africans (26.8%) showed no significant difference. Conclusions The hypotheses were only partially supported. Although overall immigrants did not differ from the native born population, when analyzed by geographic origin, only Latin Americans had higher levels of psychopathology. It is concluded that multiple factors need to be taken into consideration when studying the mental health of immigrants given that different immigrant groups have different levels of psychopathology.

Lucid dreaming, a specific phenomenon of dream consciousness, refers to the experience being aware that one is dreaming. The primary aim of this research was to validate a Spanish version of the Lucidity and Consciousness in Dreams scale (LuCiD). A secondary aim was to explore whether meditation experience and mindfulness trait were related to LuCiD scores. Data from 367 Spanish men (34.6%) and women (65.4%) who completed LuCiD, the Five Facets of Mindfulness Questionnaire (FFMQ), and the Positive and Negative Affect Schedule (PANAS) were examined. From the total sample, 40.3% indicated some experience with formal meditation (meditators), while 59.7% did not have any meditation experience (non-meditators). A random subsample of 101 participants, who completed LuCiD for a second time after a period of 10–15days, was used for test–retest reliability analysis. The LuCiD scale comprises 28 items distributed across eight factors: insight, control, thought, realism, memory, dissociation, negative emotion, and positive emotion. Factor structure, reliability by both internal consistency and test–retest reliability, and construct and concurrent validity were tested. Confirmatory factor analysis (CFA) confirmed the original eight-factor model, showing goodness of fit in contrast to a single-factor model. Item 15 was deleted from theDissociationfactor as it performed poorly (i.e., skewness and kurtosis, non-normal distribution of responses, and corrected item–total correlation under 0.40). The scale showed adequate values of internal consistency (betweenα=0.65 forMemoryandα=0.83 forPositive Emotion) and test–retest reliability by significant Pearson correlations (pInsightandDissociationfactors, in contrast to those of non-meditators. TheObservingfacet of mindfulness was positively associated with all LuCiD factors, exceptRealismandPositive Emotion, and theActing with Awarenessfacet showed a negative correlation with the LuCiD factorRealism. Finally, positive and negative affects was associated with the LuCiD factorsPositive EmotionandNegative Emotion. This study provides a valid and reliable measure for exploring lucidity and consciousness in dreams for a Spanish population, Moreover, the results suggest a relationship with meditation experience, mindfulness trait, and positive and negative affect.

Background Although diverse definitions have been construed for burnout syndrome, most authors consider it to be a single phenomenon, the result of chronic work-related stress. However, in order to enable specific intervention strategies to be adopted, it is first necessary to establish different profiles for the syndrome. In this respect, have been proposed three burnout types ("frenetic", "underchallenged" and "worn-out"), each of which requires different means of dealing with frustration in the workplace. This study is an attempt to define and systematize the properties that characterize this typology proposal. Methods For this purpose, the documents considering preliminary typology were examined by means of qualitative content analysis supported by grounded theory. Semiotic analysis was then performed on the core category resulting from the previous analysis. Results A classification criterion, made up of three different burnout subtypes ("frenetic", "underchallenged", and "worn-out") capable of integrating the entire proposal was formulated. Discussion Understanding the development of burnout syndrome, as a succession of stages characterized by the progressive diminishing of dedication to work, could serve for the establishment of specific therapies and for the prevention of the syndrome.

Background Perceived incongruity between the individual and the job on work-life areas such as workload, control, reward, fairness, community and values have implications for the dimensions of burnout syndrome. The “Areas of Work-life Scale” (AWS) is a practical instrument to measure employees´ perceptions of their work environments. AIMS: Validate a Spanish translation of the AWS, and it relationship with Masclach Burnout Inventory dimensions. Methods The study was conducted in three medium-sized hospitals and seven rural and urban Primary Care centres (N = 871) in Spain. The “Maslach Burnout Inventory General Survey” (MBI-GS) and AWS were applied. We developed a complete psychometric analysis of its reliability, and validity. Results Data on the reliability supported a good internal consistency (Cronbach α between .71, and .85). Construct validity was confirmed by a six factor model of the AWS as a good measure of work environments (χ2(352) = 806.21, p

Background: Changes in diet and exercise have been separately demonstrated to improve Depression, although scientific evidence available is scarce. In a previously published controlled study, just recommending these and other lifestyle measures (sleep restriction and sunlight exposure) in combination once, patients experienced improvements in their depressive symptoms six months later. In this sample, one in three depressive patients had metabolic syndrome (MetS) at baseline. First line treatment of MetS condition is hygienic-dietetic, being Mediterranean diet and exercise especially important. Therefore we analyzed if lifestyle recommendations also improved their metabolic profile. Findings. During the sixth month evaluation, a smaller number of patients from the group receiving hygienic-dietary recommendations met MetS criteria comparing with the control group. Conclusions: This study suggests that costless lifestyle recommendations, such as exercise and Mediterranean diet, have the capacity to promote both mental and physical health in a significant proportion of depressive patients. Further research is needed to confirm or discard these preliminary findings.