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Introduction. Social defeat (SD) is defined as a feeling of having lost the fight leading to a loss of valuable status or of important personal goals, and has been associated to depression and suicidal behavior, among other disorders. Furthermore, it has been proposed as a mediating variable between social and clinical elements. Objective. To adapt and validate a Spanish version of the Defeat Scale. Method. A back translation into Spanish was carried out. SD, hopelessness, and social well-being were measured in 546 university students ( Mean age = 20.93 years, SD = 2.98; 68.7% females). Results. An exploratory factor analysis offered a two-dimension structure in the scale made up by the dimension defeat and triumph . A confirmatory factor analysis found good fit indicators for the two-dimension model ( df = 89; χ 2 = 188.96; CFI = .942; RMSEA = .061; IFI = .943). Both dimensions present good internal consistency (Cronbach’s alpha > .70). SD was associated to higher levels of hopelessness and lower levels of social well-being. Discussion and conclusion. The Spanish version of the Defeat Scale presents good psychometric properties. Its use can help deepen the understanding of psychopathological phenomena and their link to social elements within the context of Spanish speaking countries.

Research on the multidimensionality of hallucination-like experiences (HLEs) can contribute to the study of psychotic risk. The Launay-Slade Hallucinations Scale-Extended (LSHS-E) is one of the most widely used tools for research in HLEs, but the correspondence of its paper and online formats has not been established yet. Therefore, we studied the factorial structure and measurement invariance between online and paper-and-pencil versions of LSHS-E in a Chilean population. Two thousand eighty-six completed the online version, and 578 students completed the original paper-and-pencil version. After matching by sex, age, civil status, alcohol and cannabis consumption, and psychiatric treatment received, we selected 543 students from each group. We conducted a confirmatory factor analysis of a four-factor model and a hierarchical model that included a general predisposition to hallucination, explaining the strong relationship between the different types of hallucinations. Both models showed a good fit to the data and were invariant between paper-and-pencil and online versions. Also, the LSHS-E has good reliability in both online and paper-and-pencil formats. This study shows that the online LSHS-E possesses psychometric properties equivalent to the paper-and-pencil version. It should be considered a valuable tool for research of psychosis determinants in the COVID-19 era.

Hallucination-like experiences (HLEs) are typically defined as sensory perceptions in the absence of external stimuli. Multidimensional tools, able to assess different facets of HLEs, are helpful for a better characterization of hallucination proneness and to investigate the cross-national variation in the frequencies of HLEs. The current study set out to establish the validity, factor structure, and measurement invariance of the Launay-Slade Hallucinations Scale-Extended (LSHS-E), a tool to assess HLEs. A total of 4419 respondents from 10 countries were enrolled. Network analyses between the LSHS-E and the 3 dimensions of the Community Assessment of Psychic Experiences (CAPE) were performed to assess convergent and divergent validity of the LSHS-E. Confirmatory factor analysis was used to test its measurement invariance. The best fit was a 4-factor model, which proved invariant by country and clinical status, indicating cross-national stability of the hallucination-proneness construct. Among the different components of hallucination-proneness, auditory-visual HLEs had the strongest association with the positive dimension of the CAPE, compared with the depression and negative dimensions. Participants who reported a diagnosis of a mental disorder scored higher on the 4 LSHS-E factors. Small effect size differences by country were found in the scores of the 4 LSHS-E factors even after taking into account the role of socio-demographic and clinical variables. Due to its good psychometric properties, the LSHS-E is a strong candidate tool for large investigations of HLEs. Keywords: hallucination proneness, cross-national, measurement invariance Issue Section: supplement articles © The Author(s) 2019. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Attachment theory provides key elements for understanding the psychosocial vulnerability for and response to the emergence of psychosis. This study examined (1) whether pre-treatment attachment styles are differentially associated with clinical and functional outcome in at-risk mental state (ARMS) for psychosis patients across one year of psychosocial treatment, and (2) whether clinical change is associated with changes in attachment ratings beyond the effect of baseline symptom severity. Thirty-eight ARMS patients (mean age=16.7, S.D.=5.9) identified from a psychosocial needs-adapted treatment were evaluated with the Positive and Negative Syndrome Scale, the Global Assessment of Functioning, and the Relationships Questionnaire. Lower levels of insecure-avoidant attachment predicted better clinical outcomes, whereas higher levels of secure attachment predicted improvement in functioning. A decrease in preoccupied-anxious attachment was associated with symptom amelioration. The findings suggest that the intensity of insecure attachment plays a significant role in the clinical outcome of ARMS patients involved in psychosocial treatment. Reducing the levels of insecure attachment in the therapeutic setting probably favors a better course in the early phases of psychosis. Furthermore, the finding that negative models of the self and others were associated with symptom outcome is consistent with current psychosocial models of psychosis.

ObjectiveTo determine and compare the prevalence and other characteristics of delusional disorder (DD) in two adjacent neighborhoods of Barcelona, La Verneda and La Mina, which differ greatly in their socioeconomic level and psychosocial risk factors.MethodsCross-sectional study, by neighborhood, of all cases recorded between 1982 and 2000 in the electronic Case Registry of the La Verneda–La Mina Mental Health Unit. This unit of the Primary Health Care system serves 103,615 inhabitants and has high levels of accessibility.ResultsOf 21,536 mental health case records, 209 patients fulfilled the DD definition according to SASPE criteria (DSM-IV-TR), representing a population prevalence of 0.20% and 0.97% of case records. The DD case prevalence was significantly greater in the neighborhood characterized by an overload of psychosocial risk factors, than in the middle- and working-class neighborhood.Conclusions(1) The prevalence of DD indicated in the present community study is much higher than the prevalence r...

Aim: Insecure attachment may influence vulnerability to and outcome of psychotic symptomatology. The present study examined whether attachment style predicted symptoms and functioning of at-risk mental state (ARMS) patients after 6 months of psychosocial intervention, over and above the effects of initial clinical severity and premorbid social adjustment (PSA). Methods: Symptoms and functioning were assessed at baseline and 6 months later in 31 ARMS patients (mean age = 15.7). No patient received antipsychotic medication, but all engaged in intense psychosocial needs-adapted treatment. Clinicians (unaware of the aims of the study) rated attachment, PSA, symptoms, and functioning. Results: Attachment was not related to baseline clinical severity. However, improvement in psychoticism was predicted by attachment (in particular by secure, preoccupied and dismissing) beyond the effects of baseline clinical severity and PSA. Secure attachment also predicted improvements in disorganization and functioning. Poor PSA predicted less improvement in disorganization and negative symptoms but did not impact psychoticism. Conclusions: The three attachment prototypes that predicted improvement in psychoticism (secure, preoccupied and dismissing) share the existence of at least one positive psychological model (either about self or about others). It may be that the psychosocial intervention helped ARMS patients to disconfirm negative models and/or reinforce positive ones. Patients' attachment styles were not related to baseline clinical severity but impacted improvement of positive symptoms. These findings appear consistent with evidence that impaired self-esteem and dysfunctional self and others schemas constitute risk factors for reality distortion.

The authors describe the characteristics and the preliminary findings of the Early Care Team for At‐Risk of Psychosis Patients (EAPPP), within the public Primary Health Care System of Barcelona, Spain. The community‐focused work and the psychological and inter‐paradigmatic framework are highlighted as core components of the EAPPP unit in the field of Early Care of Psychosis. Some initial findings in relation to three groups of patients are presented.

Aim: To describe the strategy and some results in at-risk mental state (ARMS) patient detection as well as some of the ARMS clinical and socio-demographical characteristics. The subjects were selected among the patients visited by an Early Care Equipment for patients at high risk of psychoses, in Barcelona (Spain) during its first year in operation. Methods: Descriptive study of the community–team relations, selection criteria and intervention procedure. Description of patient's socio-demographic and symptomatic characteristics according to the different instruments used in detection and diagnoses, taking account of four principal origins of referrals: mental health services, primary care services, education services and social services. Results: Twenty of 55 referred people fulfilled the at-risk mental state criteria, showing an incidence of 2.4 cases per 10 000 inhabitants. They were mainly adolescent males referred from health, education and social services. Overall, negative symptoms were predominant symptoms and the more frequent specific symptoms were decrease of motivation and poor work and school performance, decreased ability to maintain or initiate social relationships, depressed mood and withdrawal. Conclusions: It is possible to detect and to provide early treatment to patients with prodromal symptoms if the whole matrix of the community – including the social services – contributes to the process. The utilization of a screening instrument and a two-phase strategy – the second carried out by the specialized team – seems to be an appropriate approach for early psychosis and ARMS detection.

Introduction The prevalence of schizophrenia and other psychoses can vary between close geographic locations and can be biased by the use of epidemiological designs. With data derived from a public mental health centre with close relations to primary care teams we have compared the distribution of psychotic disorders in two neighborhoods in Barcelona with marked psycho-social differences. Methods Using a computerized database from Barcelona's National Health Service covering 5 basic health-care areas with a total population of 103,615 inhabitants, we have accessed case records showing any psycho-pathology between the years of 1982 and 2000. Results From the case records of 21,536 registered patients showing any psycho-pathology, and using strict diagnostic, clinical and assistance criteria, we found that there were 476 patients diagnosed as “schizophrenic” and 362 that were “affected by other psychoses.” Despite being evaluated by the same mental health personal, the same research team using identical criteria and over the same period of time (thus precluding operator and selection bias) the prevalence of these disorders was twice as high in La Mina (a district with a marked accumulation of psycho-social risk-factors) as compared to the neighboring district of La Verneda. Conclusions When assessing prevalence of psychoses, it is necessary to consider the impact of social and psycho-social factors, even in neighboring communities.

Introduccion: El suicidio es un problema de salud publica. Pese a los avances en salud mental, las tasas de suicidio han aumentado en Chile en la ultima decada. El presente estudio busca identificar factores psicologicos que medien la influencia de la sintomatologia depresiva en la ideacion e intento de suicidio en pacientes de salud mental. Metodo: 96 pacientes de salud mental, de servicios publicos y consulta particular, 67% mujeres, con edad promedio de 30,7 anos (DS = 12,2) respondieron los cuestionarios de salud de Goldberg (GHQ-12), de desesperanza de Beck (BHS) y de afrontamiento a situaciones estresantes (CISS-21). Se realizaron analisis de regresion logistica y de mediacion para determinar la influencia de los factores psicologicos en la ideacion e intento suicida de los pacientes evaluados. Resultados: Un 22,9% de los pacientes encuestados habia pensado en quitarse la vida en los ultimos seis meses y un 41,7% habia intentado suicidarse al menos una vez durante su vida. Los resultados de las regresiones logisticas muestran que, controlando la sintomatologia depresiva, la desesperanza influye sobre ideacion suicida, y el afrontamiento centrado en la tarea sobre el antecedente de intento de suicidio. La desesperanza media la relacion entre sintomas depresivos e ideacion suicida, y el afrontamiento centrado en la tarea media entre la sintomatologia depresiva y antecedente de intento de suicidio. Conclusiones: Factores psicologicos como desesperanza y afrontamiento centrado en la tarea mediarian la relacion entre sintomatologia depresiva, y conducta suicida no letal, por lo que deben ser considerados de forma especifica en el tratamiento de pacientes con riesgo suicida.

Insecure attachment may influence vulnerability to and outcome of psychotic symptomatology. The present study examined whether attachment style predicted symptoms and functioning of at-risk mental state (ARMS) patients after 6 months of psychosocial intervention, over and above the effects of initial clinical severity and premorbid social adjustment (PSA).Symptoms and functioning were assessed at baseline and 6 months later in 31 ARMS patients (mean age = 15.7). No patient received antipsychotic medication, but all engaged in intense psychosocial needs-adapted treatment. Clinicians (unaware of the aims of the study) rated attachment, PSA, symptoms, and functioning.Attachment was not related to baseline clinical severity. However, improvement in psychoticism was predicted by attachment (in particular by secure, preoccupied and dismissing) beyond the effects of baseline clinical severity and PSA. Secure attachment also predicted improvements in disorganization and functioning. Poor PSA predicted less improvement in disorganization and negative symptoms but did not impact psychoticism.The three attachment prototypes that predicted improvement in psychoticism (secure, preoccupied and dismissing) share the existence of at least one positive psychological model (either about self or about others). It may be that the psychosocial intervention helped ARMS patients to disconfirm negative models and/or reinforce positive ones. Patients' attachment styles were not related to baseline clinical severity but impacted improvement of positive symptoms. These findings appear consistent with evidence that impaired self-esteem and dysfunctional self and others schemas constitute risk factors for reality distortion.

To describe the strategy and some results in at-risk mental state (ARMS) patient detection as well as some of the ARMS clinical and socio-demographical characteristics. The subjects were selected among the patients visited by an Early Care Equipment for patients at high risk of psychoses, in Barcelona (Spain) during its first year in operation.Descriptive study of the community-team relations, selection criteria and intervention procedure. Description of patient's socio-demographic and symptomatic characteristics according to the different instruments used in detection and diagnoses, taking account of four principal origins of referrals: mental health services, primary care services, education services and social services.Twenty of 55 referred people fulfilled the at-risk mental state criteria, showing an incidence of 2.4 cases per 10,000 inhabitants. They were mainly adolescent males referred from health, education and social services. Overall, negative symptoms were predominant symptoms and the more frequent specific symptoms were decrease of motivation and poor work and school performance, decreased ability to maintain or initiate social relationships, depressed mood and withdrawal.It is possible to detect and to provide early treatment to patients with prodromal symptoms if the whole matrix of the community--including the social services--contributes to the process. The utilization of a screening instrument and a two-phase strategy--the second carried out by the specialized team--seems to be an appropriate approach for early psychosis and ARMS detection.