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Martinez-Aran A.,Clinical Institute of Neuroscience | Torrent C.,Bipolar Disorders Program | Sole B.,Bipolar Disorders Program | Mar Bonnin C.,Bipolar Disorders Program | And 3 more authors.
Clinical Practice and Epidemiology in Mental Health | Year: 2011

Neurocognitive impairment constitutes a core feature of bipolar illness. The main domains affected are verbal memory, attention, and executive functions. Deficits in these areas as well as difficulties to get functional remission seem to be increased associated with illness progression. Several studies have found a strong relationship between neurocognitive impairment and low functioning in bipolar disorder, as previously reported in other illnesses such as schizophrenia. Cognitive remediation strategies, adapted from work conducted with traumatic brain injury patients and applied to patients with schizophrenia, also need to be adapted to individuals with bipolar disorders. Early intervention using functional remediation, involves neurocognitive techniques and training, but also psychoeducation on cognition-related issues and problem-solving within an ecological framework. © Martínez- Arán et al. Source

Vazquez G.H.,University of Buenos Aires | Kapczinski F.,Federal University of Rio Grande do Sul | Magalhaes P.V.,Federal University of Rio Grande do Sul | Cordoba R.,El Rosario University | And 4 more authors.
Journal of Affective Disorders | Year: 2011

Objective: The aim of this study was to investigate the impact of self-rated stigma and functioning in patients with bipolar disorder in Latin-America. Methods: Two-hundred and forty-one participants with bipolar disorder were recruited from three Latin American countries (Argentina, Brazil, and Colombia). Functional impairment was assessed with the Functioning Assessment Short Test (FAST) and experiences with and impact of perceived stigma was evaluated using the Inventory of Stigmatizing Experiences (ISE). Results: Higher scores of self-perceived stigma were correlated with lower scores of functioning. After multiple regression analysis, being on disability benefit, current mood symptoms and functioning were associated with self-perceived stigma. Conclusions: This is the first study to demonstrate an association between stigma and poor functioning in bipolar disorder. Possible implications of such findings for practitioners are discussed. Limitations: The main limitation of this study is that the Inventory of Stigmatizing Experiences has not yet been validated in a population of bipolar patients in our countries. The sample size and heterogeneous clinical subjects from different countries and cultures limit the generalization of the present findings. © 2010 Elsevier B.V. Source

Rametti G.,Clinical Institute of Neuroscience | Rametti G.,Institute of Biomedical Research August Pi i Sunyer | Carrillo B.,University of Barcelona | Gomez-Gil E.,University of Barcelona | And 6 more authors.
Journal of Psychiatric Research | Year: 2011

Background: Diffusion tensor imaging (DTI) has been shown to be sensitive in detecting white matter differences between sexes. Before cross-sex hormone treatment female to male transsexuals (FtM) differ from females but not from males in several brain fibers. The purpose of this paper is to investigate whether white matter patterns in male to female (MtF) transsexuals before commencing cross-sex hormone treatment are also more similar to those of their biological sex or whether they are more similar to those of their gender identity. Method: DTI was performed in 18 MtF transsexuals and 19 male and 19 female controls scanned with a 3 T Trio Tim Magneton. Fractional anisotropy (FA) was performed on white matter of the whole brain, which was spatially analyzed using Tract-Based Spatial Statistics. Results: MtF transsexuals differed from both male and female controls bilaterally in the superior longitudinal fasciculus, the right anterior cingulum, the right forceps minor, and the right corticospinal tract. Conclusions: Our results show that the white matter microstructure pattern in untreated MtF transsexuals falls halfway between the pattern of male and female controls. The nature of these differences suggests that some fasciculi do not complete the masculinization process in MtF transsexuals during brain development. © 2010 Elsevier Ltd. Source

Lopez-Pelayo H.,Clinical Institute of Neuroscience | Batalla A.,Clinical Institute of Neuroscience | Batalla A.,University of Barcelona | Balcells M.M.,Clinical Institute of Neuroscience | And 2 more authors.
Psychological Medicine | Year: 2015

Background. Cannabis use and misuse have become a public health problem. There is a need for reliable screening and assessment tools to identify harmful cannabis use at an early stage. We conducted a systematic review of published instruments used to screen and assess cannabis use disorders. Method. We included papers published until January 2013 from seven different databases, following the PRISMA guidelines and a predetermined set of criteria for article selection. Only tools including a quantification of cannabis use and/or a measurement of the severity of dependence were considered. Results. We identified 34 studies, of which 25 included instruments that met our inclusion criteria: 10 scales to assess cannabis use disorders, seven structured interviews, and eight tools to quantify cannabis use. Both cannabis and substance use scales showed good reliability and were validated in specific populations. Structured interviews were also reliable and showed good validity parameters. Common limitations were inadequate time-frames for screening, lack of brevity, undemonstrated validity for some populations (e.g. psychiatric patients, female gender, adolescents), and lack of relevant information that would enable routine use (e.g. risky use, regular users). Instruments to quantify consumption did not measure grams of the psychoactive compounds, which hampered comparability among different countries or regions where tetrahydrocannabinol concentrations may differ. Conclusions. Current instruments available for assessing cannabis use disorders need to be further improved. A standard cannabis unit should be studied and existing instruments should be adapted to this standard unit in order to improve cannabis use assessment. Copyright © Cambridge University Press 2014. Source

Zubiaurre-Elorza L.,University of Barcelona | Zubiaurre-Elorza L.,Institute of Biomedical Research August Pi i Sunyer IDIBAPS | Junque C.,University of Barcelona | Junque C.,Institute of Biomedical Research August Pi i Sunyer IDIBAPS | And 3 more authors.
Journal of Sexual Medicine | Year: 2014

Introduction: Untreated transsexuals have a brain cortical phenotype. Cross-sex hormone treatments are used to masculinize or feminize the bodies of female-to-male (FtMs) or male-to-female (MtFs) transsexuals, respectively. Aim: A longitudinal design was conducted to investigate the effects of treatments on brain cortical thickness (CTh) of FtMs and MtFs. Methods: This study investigated 15 female-to-male (FtMs) and 14 male-to-female (MtFs) transsexuals prior and during at least six months of cross-sex hormone therapy treatment. Brain MRI imaging was performed in a 3-Tesla TIM-TRIO Siemens scanner. T1-weighted images were analyzed with FreeSurfer software to obtain CTh as well as subcortical volumetric values. Main Outcome Measures: Changes in brain CTh thickness and volumetry associated to changes in hormonal levels due to cross-sex hormone therapy. Results: After testosterone treatment, FtMs showed increases of CTh bilaterally in the postcentral gyrus and unilaterally in the inferior parietal, lingual, pericalcarine, and supramarginal areas of the left hemisphere and the rostral middle frontal and the cuneus region of the right hemisphere. There was a significant positive correlation between the serum testosterone and free testosterone index changes and CTh changes in parieto-temporo-occipital regions. In contrast, MtFs, after estrogens and antiandrogens treatment, showed a general decrease in CTh and subcortical volumetric measures and an increase in the volume of the ventricles. Conclusions: Testosterone therapy increases CTh in FtMs. Thickening in cortical regions is associated to changes in testosterone levels. Estrogens and antiandrogens therapy in MtFs is associated to a decrease in the CTh that consequently induces an enlargement of the ventricular system. © 2014 International Society for Sexual Medicine. Source

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