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      Validez y pertinencia de la semiología de las psicosis en Castilla del Pino Translated title: Validity and pertinence of the semiology of psychosis in Castilla del Pino

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          Abstract

          Resumen: En las últimas décadas, la psicopatología y, con ella, la semiología psiquiátrica han sido sustituidas por las nosografías predominantes (CIE y DSM). En contraposición, existen modelos alternativos que ofrecen explicaciones de la conducta humana en el contexto relacional. Uno de ellos, el Modelo Judicativo de la Conducta, de Castilla del Pino, supone una herramienta válida para establecer los criterios que deben cumplir los actos de conducta calificados de psicóticos. En este artículo se describen los conceptos fundamentales de este modelo con el fin de objetivar las formaciones psicóticas, capturar los síntomas, diferenciarlos y establecer su validez en el diagnóstico de las conductas consideradas psicóticas, así como en los estados previos y en la deconstrucción. Se explicitan los aspectos necesitados de actualización y desarrollo, y se correlacionan conceptos de otros campos teóricos: niveles semiológicos, metáfora-metonimia, saliencia, saliencia aberrante e hiperreflexividad.

          Translated abstract

          Abstract: In recent decades, psychopathology and, with it, psychiatric semiology have been replaced by the predominant nosographies (ICD and DSM). In contrast, there are alternative models that offer explanations of human behavior in the relational context. One of them, the Castilla del Pino´s Modelo Judicativo de Conducta, is a valid tool to establish the criteria that behaviors classified as psychotic must meet. The fundamental concepts of this model are described to objectify the psychotic formations, capture the symptoms, differentiate them, and establish their validity in the diagnosis of behaviors considered as psychotic, as well as in the previous states and in the deconstruction. Aspects in need of updating and development are made explicit and correlations with concepts from other theoretical fields, such as, semiological levels, metaphor-metonymy, salience, aberrant salience and hyperreflexivity, are examined.

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          Most cited references73

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          A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder.

          A systematic review of all reported incidence and prevalence studies of population rates of subclinical psychotic experiences reveals a median prevalence rate of around 5% and a median incidence rate of around 3%. A meta-analysis of risk factors reveals associations with developmental stage, child and adult social adversity, psychoactive drug use, and also male sex and migrant status. The small difference between prevalence and incidence rates, together with data from follow-up studies, indicates that approximately 75-90% of developmental psychotic experiences are transitory and disappear over time. There is evidence, however, that transitory developmental expression of psychosis (psychosis proneness) may become abnormally persistent (persistence) and subsequently clinically relevant (impairment), depending on the degree of environmental risk the person is additionally exposed to. The psychosis proneness-persistence-impairment model considers genetic background factors impacting on a broadly distributed and transitory population expression of psychosis during development, poor prognosis of which, in terms of persistence and clinical need, is predicted by environmental exposure interacting with genetic risk.
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            Psychosis as a State of Aberrant Salience: A Framework Linking Biology, Phenomenology, and Pharmacology in Schizophrenia

            The clinical hallmark of schizophrenia is psychosis. The objective of this overview is to link the neurobiology (brain), the phenomenological experience (mind), and pharmacological aspects of psychosis-in-schizophrenia into a unitary framework.
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              Preventing the second episode: a systematic review and meta-analysis of psychosocial and pharmacological trials in first-episode psychosis.

              The majority of first-episode psychosis (FEP) patients reach clinical remission; however, rates of relapse are high. This study sought to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the effectiveness of pharmacological and non-pharmacological interventions to prevent relapse in FEP patients. Systematic review and meta-analysis of RCTs. Of 66 studies retrieved, 18 were eligible for inclusion. Nine studies investigated psychosocial interventions and 9 pharmacological treatments. The analysis of 3 RCTs of psychosocial interventions comparing specialist FEP programs vs treatment as usual involving 679 patients demonstrated the former to be more effective in preventing relapse (odds ratio [OR]=1.80, 95% confidence interval [CI]=1.31-2.48; P<.001; number needed to treat [NNT]=10). While the analysis of 3 different cognitive-behavioral studies not specifically intended at preventing relapse showed no further benefits compared with specialist FEP programs (OR=1.95, 95% CI=0.76-5.00; P=.17), the combination of specific individual and family intervention targeted at relapse prevention may further improve upon these outcomes (OR=4.88, 95% CI=0.97-24.60; P=.06). Only 3 small studies compared first-generation antipsychotics (FGAs) with placebo with no significant differences regarding relapse prevention although all individual estimates favored FGAs (OR=2.82, 95% CI=0.54-14.75; P=.22). Exploratory analysis involving 1055 FEP patients revealed that relapse rates were significantly lower with second-generation antipsychotics (SGAs) compared with FGAs (OR=1.47, 95% CI=1.07-2.01; P<.02; NNT=10). Specialist FEP programs are effective in preventing relapse. Cognitive-based individual and family interventions may need to specifically target relapse to obtain relapse prevention benefits that extend beyond those provided by specialist FEP programs. Overall, the available data suggest that FGAs and SGAs have the potential to reduce relapse rates. Future trials should examine the effectiveness of placebo vs antipsychotics in combination with intensive psychosocial interventions in preventing relapse in the early course of psychosis. Further studies should identify those patients who may not need antipsychotic medication to be able to recover from psychosis. © The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.
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                Author and article information

                Journal
                neuropsiq
                Revista de la Asociación Española de Neuropsiquiatría
                Rev. Asoc. Esp. Neuropsiq.
                Asociación Española de Neuropsiquiatría (Madrid, Madrid, Spain )
                0211-5735
                2340-2733
                December 2023
                : 43
                : 144
                : 225-250
                Affiliations
                [1] Jerez de la Frontera Jerez de la Frontera, Cádiz orgnameHospital San Juan Grande España
                [2] Jerez de la Frontera Jerez de la Frontera, Cádiz orgnameUnidad Salud Mental Comunitaria de Jerez España
                Article
                S0211-57352023000200013 S0211-5735(23)04314400013
                10.4321/s0211-57352023000200013
                9d881dd4-2847-4b3f-a1f6-c15dfd0b7f3e

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 11 August 2023
                : 10 June 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 74, Pages: 26
                Product

                SciELO Spain

                Categories
                Dossier (Coordinado por Francisco del Río Noriega, José Mª Valls Blanco y Mariano Hernández Monsalve)

                Castilla del Pino,hyperreflexivity,salience,metonymy,hiperreflexividad,saliencia,metonimia,metáfora,semiología,psicosis,psicopatología,metaphor,semiology,psychosis,psychopathology

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