Adventure Therapy (AT) is a therapeutic intervention utilizing the natural environment and adventure activities as tools for psychotherapeutic interventions. It has been demonstrated to be appropriate for the intervention of patients with borderline personality disorder (BPD). This study aims to evaluate the response to AT treatment compared with the response to treatment as usual (TAU), based on cognitive behavioural therapy, in the short and long term, assessing clinical, psychosocial, and functional outcomes; quality of life; and physical health levels. This study extends the sample of and is a follow-up to a pilot study published in 2021, with a sample of 30 patients in the AT group and 10 in the control group. It does not allow us to affirm that AT provides better outcomes than TAU, as the positive effects observed immediately after therapy seem to be attenuated in the long term. Therefore, the effectiveness of long-term psychotherapy did not show differences between AT and TAU therapies in the treatment of BPD patients. However, the effects of intangibles observed during therapy by professionals and patients were not reflected in the measurements collected. Therefore, we believe it is necessary to increase the programme duration, complement treatment with a specific physical health programme, assess results with more specific instruments, and/or move towards a qualitative methodology to measure perceived changes in clinical improvement. New studies are needed to evaluate the results of the proposed changes.

The behavioural variant of Frontotemporal Dementia (bvFTD) is a neurodegenerative condition characterized by behavioural and cognitive symptoms. Mood disturbances, including manic-like episodes, can occur in bvFTD, posing diagnostic and therapeutic challenges. This case report presents a 62-year-old male with bvFTD exhibiting weekly mood fluctuations alternating between manic and depressive-like states. While initial treatment with quetiapine and trazodone showed partial improvement, the periodicity of mood fluctuations persisted. Subsequently, lithium was introduced, resulting in a notable reduction in symptom severity for both manic and depressive episodes. This report highlights the potential use of lithium as a mood stabilizer in bvFTD patients with periodic mood fluctuations, refractory to standard treatments. Further research is needed to elucidate the mechanisms underlying lithium’s efficacy in bvFTD and to establish treatment guidelines.

Extracellular vesicles (EVs) are tiny membranous structures that mediate intercellular communication. The role(s) of these vesicles have been widely investigated in the context of neurological diseases; however, their potential implications in the neuropathology subjacent to human psychiatric disorders remain mostly unknown. Here, by using next-generation discovery-driven proteomics, we investigate the potential role(s) of brain EVs (bEVs) in schizophrenia (SZ) by analyzing these vesicles from the three post-mortem anatomical brain regions: the prefrontal cortex (PFC), hippocampus (HC), and caudate (CAU). The results obtained indicate that bEVs from SZ-affected brains contain region-specific proteins that are associated with abnormal GABAergic and glutamatergic transmission. Similarly, these vesicles from the analyzed regions were implicated in synaptic decay, abnormal brain immunity, neuron structural imbalances, and impaired cell homeostasis. Our findings also provide evidence, for the first time, that networks of molecular exchange (involving the PFC, HC, and CAU) are potentially active and mediated by EVs in non-diseased brains. Additionally, these bEV-mediated networks seem to have become partially reversed and largely disrupted in the brains of subjects affected by SZ. Taken as a whole, these results open the door to the uncovering of new biological markers and therapeutic targets, based on the compositions of bEVs, for the benefit of patients affected by SZ and related psychotic disorders.

Extracellular vesicles (EVs) constitute a sophisticated molecular exchange mechanism highly regarded for their potential as a next-generation platform for compound delivery. However, identifying sustainable and biologically safe sources of EVs remains a challenge. This work explores the emergence of novel sources of plant and bacterial-based EVs, such as those obtained from food industry by-products, known as BP-EVs, and their potential to be used as safer and biocompatible nanocarriers, addressing some of the current challenges of the field. These novel sources exhibit remarkable oral bioavailability and biodistribution, with minimal cytotoxicity and a selective targeting capacity toward the central nervous system, liver, and skeletal tissues. Additionally, we review the ease of editing these recently uncovered nanocarrier-oriented vesicles using common EV editing methods, examining the cargo-loading processes applicable to these sources, which involve both passive and active functionalization methods. While the primary focus of these novel sources of endogenous EVs is on molecule delivery to the central nervous system and skeletal tissue based on their systemic target preference, their use, as reviewed here, extends beyond these key applications within the biotechnological and biomedical fields.

IntroductionThe COVID-19 pandemic has forced changes in patient care in Mental Health Day Hospitals (MHDHs). ObjectivesTo study the interventions performed in MHDHs during the pandemic in comparison with those performed in other facilities and to analyze the new hospital admissions in both groups. MethodA retrospective multicenter cohort study comparing the interventions received by a group of 161 patients admitted in MHDHs during the lockdown period in Spain with the interventions of another group of 109 patients who were treated at other facilities during lockdown. ResultsMHDHs reduced their face-to-face interventions during lockdown just as much as other facilities but implemented telematic intervention methods to a greater extent. Patients attached to MHDHs during lockdown were admitted significantly less and presented fewer urgent consultations in the following 6 months. ConclusionThe use of telepsychiatry made it feasible to adapt MHDHs to periods of lockdown, being useful to improve the continuity of care during the pandemic. In addition, it was possible to maintain a reduction in hospital admissions in patients treated at MHDHs.

The current study examined the psychometric properties (factor structure, reliability and validity) of the Psychopathy Checklist: Youth Version (PCL:YV; Forth et al., 2003) in Spanish samples of male justice-involved youths between 15 and 22-years old. The PCL:YV was administered to two groups of youths who were incarcerated ( n = 62; n = 95) and a sample of youth on probation ( n = 122). Confirmatory factor analyses showed acceptable-to-good fit for three- and four-factor models. The four-factor hierarchical model with a second-order higher factor representing the whole psychopathy construct was considered for further analyses. PCL:YV scores showed high internal consistency and inter-rater reliability. Low-to-moderate convergence with other measures of psychopathic traits evinced an adequate convergent validity. Convergent and discriminant validity of the PCL:YV total scores were also confirmed considering several measures of psychopathology and personality traits. Importantly, the differential external correlates of the PCL:YV factors provide support for a multidimensional conceptualization of the psychopathy construct. Altogether, these results reveal adequate psychometric properties of the PCL:YV in Spanish population of justice-involved youths and justifies its use to assess psychopathic traits in this kind of populations.

Adventure therapy (AT) is a therapeutic intervention that has demonstrated effectiveness in different populations, but there are no studies on this therapy in borderline personality disorder (BPD). The objective of this study was to assess the response to AT in comparison with treatment as usual (based on cognitive-behavioural therapy) in patients with BPD. Regarding the comparison of the differences post-therapy-pre-therapy between both groups, some metabolic variables improved more in the AT group, with medium-large effect sizes. Almost all psychometric variables evolved better in the AT group, with negligible effects. AT could be considered in BPD treatment because it results in healthier lifestyle habits and increases functionality and quality of life in patients who are prone to self-destruction. © 2021 John Wiley & Sons, Ltd.

Episodic ataxia is an autosomal dominant disorder characterized by episodes of ataxia that last hours. Comorbid and psychiatric disorders of atypical presentation have been described in these patients, which may delay diagnosis. Read on to find out more.

The Clinical Assessment of Prosocial Emotions: Version 1.1 (CAPE 1.1) uses structured clinical judgments to diagnose the “with limited prosocial emotions” specifier for Conduct Disorder. This study examined (a) the internal consistency and interrater agreement, and (b) the convergent and divergent validity of the CAPE 1.1 in 72 young males who were incarcerated in two Spanish juvenile detention centers (age range = 14–22 years). The CAPE 1.1 showed good interrater agreement for making the diagnosis of the specifier and adequate internal consistency. The CAPE 1.1 was associated with other measures of callous–unemotional traits, but less consistently associated with other dimensions of psychopathy. Youth who met diagnostic criteria for the specifier scored higher on externalizing problems, but did not differ from other youth who were incarcerated on internalizing problems. These results provide preliminary support for the psychometric properties of the CAPE 1.1 for the clinical assessment of the specifier.

Resumen: Introducción: Shadowing patients es una de las propuestas educativas para mantener y experimentar empatía en estudiantes de Medicina. Se trata de observar, sin intervenir, a un paciente durante una visita médica. El objetivo de este estudio piloto es analizar las emociones percibidas y observadas en los pacientes durante la experiencia de shadowing patients y su relación con la empatía médica. Métodos: Veintitrés estudiantes de quinto de Medicina (69,6% mujeres, edad 22,6 ± 1,1 años) participaron en el taller teórico-práctico basado en la observación e identificación de las emociones de los pacientes en una sala de espera hospitalaria. Se aplicó la Jefferson Scale of Physician Empathy (Hojat, 2002) y la Self-Assessment Manikin (Bradley y Lang, 1994) Resultados: La mayoría de los estudiantes experimentaron tristeza (87%) y observaron en los pacientes tristeza (87%) e impaciencia (8,7%). No se objetivó correlación estadísticamente significativa entre empatía médica y valencia/arousal de las emociones experimentadas. Discusión: El taller de shadowing patients es de bajo coste y de fácil implementación, consigue estimular la capacidad de observación para identificar las emociones de los pacientes y ayuda al estudiante de Medicina a ser más consciente de sus habilidades empáticas, por lo que complementa la formación teórica de este. Abstract: Introduction: Shadowing patients is one of the educational proposals to maintain and experience empathy in medical students. It is about observing, from the sidelines, a patient during a medical visit. The objective of this pilot study is to analyze the perceived and observed patients’ emotions during the experience of shadowing patients, and their relationship with medical empathy. Methods: Twenty-three fifth-year medical students (69.6% women, aged 22.6 ± 1.1 years) participated in the theoretical-practical workshop based on the observation and identification of patients’ emotions in a hospital waiting room. The Jefferson Scale of Physician Empathy (Hojat, 2002) and the Self-Assessment Manikin (Bradley and Lang, 1994) were applied. Results: Most students experienced sadness (87%), and observed sadness (87%) and impatience (8.7%) in the patients. No statistically significant correlation between medical empathy and valence/arousal of experienced emotions was observed. Discussion: The workshop of shadowing patient was low cost and easy to implement, stimulated the observation ability to identify the patients’ emotions, helped medical student to be more aware of their empathic skills, and complemented the theoretical training of medical students. Palabras clave: Empatía, Educación médica, Emoción, Estudiantes de Medicina, Keywords: Empathy, Medical education, Emotion, Medical students

RESUMEN Introducción. La empatía es la capacidad de identificar los pensamientos y sentimientos de los demás, y responder con una emoción adecuada. El modelo multidimensional permite discriminar entre la empatía cognitiva y afectiva. Si hay un bloqueo en la regulación emocional, la empatía puede transformarse en ansiedad y dolor. Objetivos. Explorar el modelo multidimensional de la empatía y plantear propuestas de regulación emocional en función del género y de los valores extremos de empatía. Métodos. Estudio observacional en una muestra de 151 estudiantes universitarios. Se evalúa el modelo multidimensional de la empatía mediante las subescalas del Interpersonal Reactivity Index: empatía cognitiva (IRI-Perspective Taking, IRI-Fantasy Scale) y empatía afectiva (IRI-Empathetic Concern, IRI-Personal Distress). La escala Empathy Quotient permite detectar los valores extremos de empatía. Resultados. La mayoría de los participantes, 110 (78.8%) eran mujeres. 130 (86.1%) tenían niveles de empatía medios, 11 (7.3%) mostraron empatía baja y 10 (6.6%) empatía muy alta. La empatía fue mayor en mujeres en IRI-Fantasy Scale (p=0.042), IRI-Empathetic Concern (p=0.002) y en Empathy Quotient (0.047). Los sujetos con empatía muy alta tenían puntuaciones mayores en IRI-Perspective Taking (p=0.005) y en IRI-Empathetic Concern (p<0.001). Discusión. Los resultados de este estudio permiten plantear propuestas de regulación emocional de la empatía en función del género y valores extremos. En hombres y sujetos con empatía baja se propone entrenar la empatía cognitiva, y en mujeres y en sujetos con empatía muy alta se propone modular la empatía afectiva, reeducando la respuesta emocional inadecuada y ofrecer soporte en la elaboración de experiencias personales. ABSTRACT Introduction. Empathy is the ability to identify and understand the thoughts and feelings of others and to respond with appropriate emotions. The multidimensional model allows discriminating between cognitive and affective empathy. If there is a blockage of the emotional regulation, empathy can be transformed into anxiety and pain. Aims. Explore the multidimensional model of empathy, and put forward proposals for emotional regulation based on gender and the extreme values of empathy. Methods. Observational study in a sample of 151 university students. The multidimensional model of empathy is evaluated using the subscales of the Interpersonal Reactivity Index: cognitive empathy (IRI-Perspective Taking, IRI-Fantasy Scale) and affective empathy (IRI-Empathetic Concern, IRI-Personal Distress). The Empathy Quotient allows detection of extreme values of empathy. Results. Most participants 110 (78.8%) were women, 130 (86.1%) had average scores of empathy, 11 (7.3%) showed low empathy and 10 (6.6%) very high scores of empathy. Empathy scores were higher in women in IRI-Fantasy Scale (p = 0.042), IRI-Empathetic Concern (p = 0.002) and in Empathy Quotient (0.047). Participants with very high empathy scores had higher scores in IRI-Perspective Taking (p = 0.005) and in IRI-Empathetic Concern (p <0.001). Discussion. The results of this study allow making proposals for emotional regulation of empathy, based on gender and extreme values. We propose training cognitive empathy (putting yourself in the place of another in a fictional context) and modulating affective empathy (re-educate inadequate emotional response and offer support in the elaboration of personal experiences).

Given the influence that personality can have on empathy, this study explores the relationship between empathy and personality, using three different measures of empathy, and taking into account gender and specialty preference.

espanolObjetivo. Identificar las emociones que experimentan los estudiantes de medicina en el contexto de deprivacion sensorial para mejorar la empatia. Sujetos y metodos. Se presenta el programa del taller (deprivacion visual, auditiva y discapacidad fisica). Se identifican y se miden las emociones mediante la escala Self-Assessment Manikin, y se mide la empatia medica mediante la escala de empatia medica de Jefferson. Resultados y conclusiones. La deprivacion sensorial permite experimentar diferentes tipos de emociones. Identifi carlas permite al estudiante de medicina ser mas sensible a las personas con discapacidad y aumentar la empatia. EnglishAim. To identify emotions experienced by medical students in a workshop of sensory deprivation to enhance empathy. Subjects and methods. The workshop program (visual deprivation, auditory deprivation and physical disabilities) is presented. Emotions are identifi ed and measured by Self-Assessment Manikin scale. Medical empathy is measured by Jefferson Scale of Physician Empathy. Results and conclusions. Sensory deprivation can experience different types of emotions.Identify them allows medical students to be more sensitive to people with disabilities and increase empathy

Introduction: The evolution of empathy among medical students according to gender and specialty preference is explored using several validated scales. The value of our feedback to the medical students at the end of the study is also assessed. Materials and methods: A total of 151 students completed the initial questionnaire, including the following scales: Jefferson Scale of Physician Empathy (JSPE), Interpersonal Reactivity Index (IRI), and Empathy Quotient (EQ). The final questionnaire was completed by 99 of them. Results: According to the EQ classification, it was found that 7.3% of students had low empathy, 49.7% average, 36.4% above average, and 6.6% very high. Empathy was higher among women in IRI-FS, IRI-EC, and EQ. Students who preferred people-oriented specialties score higher in JSPE and EQ. The IRI-Fantasy Scale was the only scale that shows increased scores on follow-up and in students with preference for people-oriented specialties. Discussion: This study shows that most of the medical students in our sample had a good level of empathy. Empathy was unchanged throughout the follow-up. Medical students had different profiles of empathy. In extreme profiles, feedback could offer advice in the process of choosing a specialty to best suit their empathic skills. Resumen: Introducción: Se explora la evolución de la empatía en estudiantes de medicina utilizando a la vez varias escalas validadas, teniendo en cuenta el sexo y la preferencia de especialidad. Al final del estudio se realizó feedback de los resultados a los estudiantes. Materiales y métodos: Ciento cincuenta y un estudiantes de medicina completaron el cuestionario inicial con las siguientes escalas: Jefferson Scale of Physician Empathy, Interpersonal Reactivity Index (IRI), Empathy Quotient (EQ) y Systemizing Quotient. Noventa y nueve de ellos finalizaron el estudio de seguimiento. Resultados: Según la clasificación de la EQ encontramos un 7,3% de estudiantes con baja empatía, un 49,7% media, un 36,4% por encima de la media y un 6,6% muy alta. La empatía fue mayor en mujeres en IRI-Fantasy Scale, IRI-Empathetic Concern y EQ. En los estudiantes con preferencia de especialidad orientada a las personas la empatía fue mayor en Jefferson Scale of Physician Empathy y EQ. IRI-Fantasy Scale fue la única escala que aumentó durante el seguimiento y en los estudiantes con orientación a las personas. Discusión: Este estudio mostró que la mayoría de los estudiantes de medicina de nuestra muestra tenían un buen nivel de empatía, y que la empatía apenas se modificó durante el período de seguimiento. Los estudiantes de medicina tenían diferentes perfiles de empatía, algunos de ellos con valores extremos. En estos perfiles el feedback permite ofrecer asesoramiento en el proceso de elegir una especialidad para adaptarse mejor a sus habilidades empáticas. Keywords: Empathy, Feedback, Medical education, Medical students, Medical specialties, Palabras clave: Empatía, Feedback, Educación médica, Estudiantes de medicina, Especialidades médicas

Technical advances, particularly the integration of wearable and embedded sensors, facilitate tracking of physiological responses in a less intrusive way. Currently, there are many devices that allow gathering biometric measurements from human beings, such as EEG Headsets or Health Bracelets. The massive data sets generated by tracking of EEG and physiology may be used, among other things, to infer knowledge about human moods and emotions. Apart from direct biometric signal measurement, eye tracking systems are nowadays capable of determining the point of gaze of the users when interacting in ICT environments, which provides an added value research on many different areas, such as psychology or marketing. We present a process in which devices for eye tracking, biometric, and EEG signal measurements are synchronously used for studying both basic and complex emotions. We selected the least intrusive devices for different signal data collection given the study requirements and cost constraints, so users would behave in the most natural way possible. On the one hand, we have been able to determine basic emotions participants were experiencing by means of valence and arousal. On the other hand, a complex emotion such as empathy has also been detected. To validate the usefulness of this approach, a study involving forty-four people has been carried out, where they were exposed to a series of affective stimuli while their EEG activity, biometric signals, and eye position were synchronously recorded to detect self-regulation. The hypothesis of the work was that people who self-regulated would show significantly different results when analyzing their EEG data. Participants were divided into two groups depending on whether Electro Dermal Activity (EDA) data indicated they self-regulated or not. The comparison of the results obtained using different machine learning algorithms for emotion recognition shows that using EEG activity alone as a predictor for self-regulation does not allow properly determining whether a person in self-regulation its emotions while watching affective stimuli. However, adequately combining different data sources in a synchronous way to detect emotions makes it possible to overcome the limitations of single detection methods.

Neuropsychological deficits in executive functions (EF) have been linked to antisocial behavior and considered to be cardinal to the onset and persistence of severe antisocial and aggressive behavior. However, when psychopathy is present, prior evidence suggests that the dorsolateral prefrontal cortex is unaffected leading to intact EF. Ninety-one male offenders with Antisocial Personality Disorder (ASPD) and 24 controls completed the Wisconsin Card Sorting Test (WCST). ASPD individuals were grouped in three categories according to Psychopathy Checklist-Revised (PCL-R) scores (low, medium and high). We hypothesized that ASPD offenders with high PCL-R scores will not differ from healthy controls in EF and will show better EF performance in comparison with subjects with low PCL-R scores. Results showed that ASPD offenders with low PCL-R scores committed more perseverative errors and responses than controls and offenders with high PCL-R scores, which did not differ from healthy controls. Moreover, scores on Factor 1 and the interpersonal facet of the PCL-R were predictors of better WCST performance. Our results suggest a modulatory role of psychopathy in the cognitive performance of ASPD offenders, and provide further evidence supporting that offenders with ASPD and psychopathy are characterized by a cognitive profile different from those with ASPD without psychopathy.

Individuals with psychopathy present deficits in the recognition of facial emotional expressions. However, the nature and extent of these alterations are not fully understood. Furthermore, available data on the functional neural correlates of emotional face recognition deficits in adult psychopaths have provided mixed results. In this context, emotional face morphing tasks may be suitable for clarifying mild and emotion-specific impairments in psychopaths. Likewise, studies exploring corresponding anatomical correlates may be useful for disentangling available neurofunctional evidence based on the alleged neurodevelopmental roots of psychopathic traits. We used Voxel-Based Morphometry and a morphed emotional face expression recognition task to evaluate the relationship between regional gray matter (GM) volumes and facial emotion recognition deficits in male psychopaths. In comparison to male healthy controls, psychopaths showed deficits in the recognition of sad, happy and fear emotional expressions. In subsequent brain imaging analyses psychopaths with better recognition of facial emotional expressions showed higher volume in the prefrontal cortex (orbitofrontal, inferior frontal and dorsomedial prefrontal cortices), somatosensory cortex, anterior insula, cingulate cortex and the posterior lobe of the cerebellum. Amygdala and temporal lobe volumes contributed to better emotional face recognition in controls only. These findings provide evidence suggesting that variability in brain morphometry plays a role in accounting for psychopaths’ impaired ability to recognize emotional face expressions, and may have implications for comprehensively characterizing the empathy and social cognition dysfunctions typically observed in this population of subjects.

Background Psychopathy is characterized by a distinctive interpersonal style that combines callous-unemotional traits with inflexible and antisocial behavior. Traditional emotion-based perspectives link emotional impairment mostly to alterations in amygdala-ventromedial frontal circuits. However, these models alone cannot explain why individuals with psychopathy can regularly benefit from emotional information when placed on their focus of attention and why they are more resistant to interference from nonaffective contextual cues. The present study aimed to identify abnormal or distinctive functional links between and within emotional and cognitive brain systems in the psychopathic brain to characterize further the neural bases of psychopathy. Methods High-resolution anatomic magnetic resonance imaging with a functional sequence acquired in the resting state was used to assess 22 subjects with psychopathy and 22 control subjects. Anatomic and functional connectivity alterations were investigated first using a whole-brain analysis. Brain regions showing overlapping anatomic and functional changes were examined further using seed-based functional connectivity mapping. Results Subjects with psychopathy showed gray matter reduction involving prefrontal cortex, paralimbic, and limbic structures. Anatomic changes overlapped with areas showing increased degree of functional connectivity at the medial-dorsal frontal cortex. Subsequent functional seed-based connectivity mapping revealed a pattern of reduced functional connectivity of prefrontal areas with limbic-paralimbic structures and enhanced connectivity within the dorsal frontal lobe in subjects with psychopathy. Conclusions Our results suggest that a weakened link between emotional and cognitive domains in the psychopathic brain may combine with enhanced functional connections within frontal executive areas. The identified functional alterations are discussed in the context of potential contributors to the inflexible behavior displayed by individuals with psychopathy.