RESUMEN
Diseases with complex determinism, bipolar disorders, involve at the same time environmental and genetic factors of vulnerability. The characterization of these vulnerabilities would allow a better knowledge of their etiology and envisage the development of therapeutics, more specialized, even preventive. The research in genetic psychiatry allowed to highlight endophenotype candidates associated to bipolar disorders. They are endogenous clinical or biological features, biologically more elementary than phenotypes and more directly bound to the physiological consequences of genes and their polymorphisms. Targeting some of them with specific psychotherapy and psychosocial interventions could reduce the consequences of their expression and so have an action on the course of the disease and also preventive.
Asunto(s)
Trastorno Bipolar/genética , Trastorno Bipolar/terapia , Endofenotipos , Psicoterapia , Trastornos de Ansiedad/genética , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Trastorno Bipolar/psicología , Carácter , Trastornos del Conocimiento/genética , Trastornos del Conocimiento/psicología , Trastornos del Conocimiento/terapia , Terapia Cognitivo-Conductual , Terapia Familiar , Interacción Gen-Ambiente , Predisposición Genética a la Enfermedad/genética , Predisposición Genética a la Enfermedad/psicología , Humanos , Conducta Impulsiva/genética , Conducta Impulsiva/psicología , Conducta Impulsiva/terapia , Neuroticismo , Educación del Paciente como Asunto , Polimorfismo Genético/genética , Pronóstico , Educación Compensatoria , Ajuste Social , SocializaciónRESUMEN
Cognitive deficits are routinely evident in schizophrenia, and are of sufficient magnitude to influence functional outcomes in work, social functioning and illness management. Cognitive remediation is an evidenced-based non-pharmacological treatment for the neurocognitive deficits seen in schizophrenia. Narrowly defined, cognitive remediation is a set of cognitive drills or compensatory interventions designed to enhance cognitive functioning, but from the vantage of the psychiatric rehabilitation field, cognitive remediation is a therapy which engages the patient in learning activities that enhance the neurocognitive skills relevant to their chosen recovery goals. Cognitive remediation programs vary in the extent to which they reflect these narrow or broader perspectives but a metaanalytic study reports moderate range effect sizes on cognitive test performance, and daily functioning. Reciprocal interactions between baseline ability level, the type of instructional techniques used, and motivation provide some explanatory power for the heterogeneity in patient response to cognitive remediation. Recent studies indicate that intrinsic motivation mediates the relationship between neurocognition and functional outcomes. Results of these studies suggest that intrinsic motivation should be a viable treatment target in cognitive remediation intervention. In this perspective, NEAR (Neuropsychological Educational Approach to Remediation) program was created to enhance intrinsic motivation by employing more engaging and interesting software packages for cognitive practice, involving consumers in choosing the focus of training and having the NEAR leader serve as a coach to engage the consumers in active guidance of their own treatment program.
Asunto(s)
Trastornos del Conocimiento/terapia , Terapia Cognitivo-Conductual , Educación del Paciente como Asunto , Esquizofrenia/terapia , Psicología del Esquizofrénico , Antipsicóticos/uso terapéutico , Trastornos del Conocimiento/psicología , Terapia Combinada , Instrucción por Computador , Medicina Basada en la Evidencia , Humanos , Motivación , Psicoterapia , Autocuidado/psicología , Ajuste Social , Programas Informáticos , Resultado del TratamientoRESUMEN
Schizophrenia affects 1% of the general population. In addition to disabling clinical symptoms, cognitive deficits have also been updated. It has further been proposed that the well-known diversity of schizophrenia in terms of functional outcome and recovery from acute episode is best characterized by cognitive deficits, but not by its classical symptoms. DSM-V acknowledges the importance of cognition in schizophrenia, and could recommend a formal neuropsychological assessment in individuals with psychosis. Schizophrenic patient's cognitive functioning has been studied extensively in the domain of memory and executive control. To date, the studies highlight important deficits in both of these domains. However, within the memory systems, some of them remain unaffected. Altogether, the data invalidate the hypothesis of a global damage and are in favor of specific cognitive deficits. The observed deficits would depend on the dominant symptoms and pre-morbid functioning. The interest of these results was to give impulse to the development of comprehensive assessment battery designed to evaluate the cognitive profiles of each patient and develop a personalized program of cognitive remediation.