Metacognición, apego y sintomatología en esquizofrenia primer episodio
PDF

Palabras clave

metacognition
attachment
symptomatology
schizophrenia metacognición
apego
sintomatología
esquizofrenia

Cómo citar

Vergara-Ramírez, S., & León-Uribe , A. (2020). Metacognición, apego y sintomatología en esquizofrenia primer episodio. Terapia Psicológica, 38(2), 131-152. https://doi.org/10.4067/S0718-48082020000200131

Resumen

Los sujetos con Esquizofrenia experimentan menoscabo en la capacidad para formar ideas complejas sobre sí mismos y otros, definido como déficits metacognitivos. El presente estudio evaluó las correlaciones entre metacognición, apego y síntomas en pacientes con Esquizofrenia primer episodio en el Hospital Regional de Talca entre 2016 y 2018. Se diseñó un estudio cuantitativo, relacional, prospectivo, transversal y observacional. Treinta y un individuos fueron evaluados utilizando la Metacognitive Assessment Scale-Abbreviated para metacognición. También se evaluó apego y sintomatología. Se encontraron bajos puntajes metacognitivos y la mayoría de los participantes fueron catalogados como apego evitante. Menores capacidades metacognitivas se correlacionaron significativamente con mayor sintomatología negativa y de desorganización. Conclusiones. Nuestros resultados respaldan la inclusión de los déficits metacognitivos y patrones de apego en los modelos de Esquizofrenia, lo que podría mejorar nuestra comprensión de los síntomas negativos y de desorganización. Además, se discute sobre su aporte al desarrollo de intervenciones psicoterapéuticas en Esquizofrenia desde el primer episodio.

https://doi.org/10.4067/S0718-48082020000200131
PDF

Citas

Bagaric, D., Brecic, P., Ostojic, D., Jukic, V., y Goles, A. (2013). The relationship between depressive syndrome and suicidal risk in patients with acute schizophrenia. Croatian Medical Journal, 54(5), 436-443. https://doi.org/10.3325/cmj.2013.54.436

Bleuler, E. (2011). Dementia praecox o el grupo de las esquizofrenias. Buenos Aires, Argentina: Polemos.

Brent, B.K., Holt, D.J., Keshavan, M.S., Seidman, L.J., y Fonagy, P. (2014). Mentalization-based treatment for psychosis: linking an attachment-based model to the psychotherapy for impaired mental state understanding in people with psychotic disorders. The Israel Journal of Psychiatry and Related Sciences, 51(1), 17–24. https://tinyurl.com/ybrmfljd

Bucci, S., Emsley, R., y Berry, K. (2017). Attachment in psychosis: A latent profile analysis of attachment styles and association with symptoms in a large psychosis cohort. Psychiatry Research, 247, 243-249. https://doi.org/10.1016/j.psychres.2016.11.036.

Buck, K.D., Warman, D.M., Huddy, V., y Lysaker, P.H. (2012). The relationship of metacognition with jumping to conclusions among persons with Schizophrenia spectrum disorders. Psychopathology, 45(5), 271-275. https://doi.org 10.1159/000330892

Davis, L.W., Eicher, A.C., y Lysaker, P.H. (2011). Metacognition as a predictor of therapeutic alliance over 26 weeks of psychotherapy in Schizophrenia. Schizophrenia Research, 129(1), 85-90. https://doi.org10.1016/j.schres.2011.02.026.

Dimaggio, G., y Lysaker, P.H. (2015). Metacognition and Mentalizing in the psychotherapy of patients with psychosis and personality disorders. Journal of Clinical Psychology, 71(2), 117-124. https://doi.org/10.1002/jclp.22147

Dozier, M., Stovall-McClough, C., y Albus, K. E. (2008). Attachment and psychopatology in adulthood. En J. Cassidy y P. Shaver (Eds.). Handbook of attachment. Theory, research, and clinical applications. (pp. 718-744). New York, USA: Guilford Press.

Flavell, J.H. (1979). Metacognition and cognitive monitoring. A new area of cognitive-developmental inquiry. American Psychologist, 34(10), 906-911. https://doi.org/ 10.1037/0003-066x.34.10.906.

Garrido, L., Santelices, M. P., Pierrehumbert, B., y Armijo, I. (2009). Validación chilena del cuestionario de evaluación de apego en el adulto CAMIR. Revista Latinoamericana de Psicologia, 41(1), 81–98.

Griffiths, H., y McLeod, H. (2020). Promoting recovery from negative symptoms. An attachment theory perspective. En K. Berry, S. Bucci y A. Danquah (Eds.). Attachment Theory and Psychosis. (pp. 62-83). London, UK: Routledge.

Gumley, A., y Schwannauer, M. (2008). Volver a la normalidad después de un Trastorno Psicótico. Un modelo cognitivo-relacional para la recuperación y la prevención de recaídas. Bilbao, España: Editorial Desclée de Brouwer.

Gumley, A.I., Schwannauer, M., MacBeth, A., Fisher, R., Clark, S., Rattrie, L., y Birchwood, M. (2014). Insight, duration of untreated psychosis and attachment in first-episode psychosis: Prospective study of psychiatric recovery over 12-month follow-up. British Journal of Psychiatry, 205(1), 60–67. https://doi.org/10.1192/bjp.bp.113.126722

Gumley, A., y Liotti, G. (2019). An Attachment perspective on Schizophrenia: The role of disorganized attachment, dissociation, and mentalization. En A. Moskowitz, M. Dorahy y I. Schäfer (Eds.). Psychosis, Trauma and Dissociation. (pp. 97-116). Hoboken, NJ, USA: John Wiley & Sons.

Hamm, J.A., Renard, S.B., Fogley, R.L., Leonhardt, B.L., Dimaggio, G., Buck, K.D., y Lysaker, P.H. (2012). Metacognition and Social Cognition in Schizophrenia: Stability and relationship to current and prospective symptom assessment. Journal of Clinical Psychology, 68(12), 1303-1312. https://doi.org/10.1002/jclp.21906

Harder, S., y Daniel, S. (2014). The relationship between metacognitive profile, attachment pattern , and intersubjective process in psychotherapy of a person recovering from first-episode schizophrenia. En P.H Lysaker, G. Dimaggio y M. Brüne (Eds.). Social Cognition and Metacognition in Schizophrenia. Psychopathology and Treatment Approaches. (pp. 261-283). London, UK: Academic Press.

Hernández, R. (2010). Metodología de la Investigación. Mexico. D.F, Mexico: McGraw-Hill.

Kay, S.R., Fiszbein, A., y Opler, L.A. (1987). The Positive and negative syndrome scale (PANSS) for Schizophrenia. Schizophrenia Bulletin. 13(2), 261-276. https://doi.org/10.1093/schbul/13.2.261

Lecannelier, F. (2012). Conocimiento & complejidad: Una perspectiva evolucionista. Santiago, Chile: LOM Ediciones.

Lecannelier, F. (2009). Apego e intersubjetividad. Segunda parte: la teoría del apego. Santiago, Chile: LOM Ediciones.

Lysaker P.H., Clements C.A., Plascak-Hallberg C.D., Knipscheer S.J., y Wright D.E. (2002). Insight and Personal Narrative of Illness in Schizophrenia. Psychiatry, 65(3), 197-206. https://doi.org/10.1521/psyc.65.3.197.20174

Lysaker, P.H., Carcione, A., Dimaggio, G., Johannesenn, J.K., Nicolò, G., Procacci, M., y Semerari, A. (2005). Metacognition amidst narratives of self and illness in Schizophrenia: Associations with neurocognition, symptoms, insight and quality of life. Acta Psychiatrica Scandinavica, 112(1), 64-71.https://doi.org/10.1111/j.1600-0447.2005.00514.x

Lysaker, P.H., y Salyers, M.P. (2007). Anxiety symptoms in schizophrenia spectrum disorders: Associations with social function, positive and negative symptoms, hope and trauma history. Acta Psychiatrica Scandinavica, 116(4), 290–298. https://doi.org/10.1111/j.1600-0447.2007.01067.x.

Lysaker, P.H., Dimaggio, G., Carcione, A., Procacci, M., Buck, K.D., Davies, L.W.,…y Nicolò, G. (2010a). Metacognition and schizophrenia: the capacity for self -reflexivity as a predictor for prospective assessment of work performance over six months. Schizophrenia Research, 122(1-3), 124-130. https://doi.org/ 10.1016/j.schres.2009.04.024

Lysaker, P.H., Shea, A.M., Buck, K.D., Dimaggio, G., Nicolò, G., Procacci, M.,…y Rand, K.L. (2010b). Metacognition as a mediator of the effects of impairments in neurocognition on social function in Schizophrenia spectrum disorders. Acta Psychiatrica Scandinavica, 122(5), 405-413. https://doi.org/10.1111/j.1600-0447.2010.01554.x

Lysaker, P.H., Erickson, M.A., Buck, B., Buck, K.D., Olesek, K., Grant, M.L.,… y Dimaggio, G. (2011). Metacognition and social function in schizophrenia: associations over a period of five months. Cognitive Neuropsychiatry, 16(3), 241-255. https://doi.org/ 10.1080/13546805.2010.530470

Lysaker, P.H., y Dimaggio, G. (2014a). Metacognitive Capacities for Reflection in Schizophrenia: Implications for developing treatments. Schizophrenia Bulletin, 40(3), 487-491. https://doi.org/10.1093/schbul/sbu038

Lysaker, P.H., Leonhardt, B.L., Pijnenborg, M., van Donkersgoed, R., de Jong, S., y Dimaggio, G. (2014b). Metacognition in Schizophrenia Spectrum Disorders: Methods of assessment and associations with neurocognition, symptoms, cognitive style and function. The Israel Journal of Psychiatry and Related Sciences, 51(1), 54-62. https://tinyurl.com/y9trlesw

Lysaker, P.H., Vohs, J., Minor, K.S., Irarrázaval, L., Leonhardt, B., Hamm, J.A.,… y Dimaggio, G. (2015). Metacognitive Deficits in Schizophrenia. Presence and associations with psychosocial outcomes. The Journal of Nervous and Mental Disease, 203(7), 530-536. https://doi.org/10.1097/NMD.0000000000000323

Lysaker, P. H., Buck, K., y Hamm, J. (2016). Escala de Evaluación de la Metacognición: Una breve visión general y Manual de Codificación para la versión abreviada (EEM-A) v 2015. Revista Gaceta de Psiquiatría Universitaria, 12(2), 174-190. https://tinyurl.com/y8d35gwj

Lysaker, P.H., Irarrázaval, L., Gagen, E.C., Armijo, I., Ballerini, M., Mancini, M.,… y Stanghellini, G. (2018). Metacognition in schizophrenia disorders: comparisons with community controls and bipolar disorder: replication with a Spanish language Chilean sample. Psychiatry Research 267, 528-534. https://doi.org/10.1016/j.psychres.2018.06.049

MacBeth, A., Gumley, A., Schwannauer, M., y Fisher, R. (2011). Attachment states of mind, mentalization, and their correlates in a first-episode psychosis sample. Psychology and Psychotherapy, 84(1), 42–57. https://doi.org/10.1348/147608310X530246.

MacBeth, A., Gumley, A., Schwannauer, M., Carcione, A., Fisher, R., McLeod, H.J., y Dimaggio, G. (2014). Metacognition, symptoms and premorbid functioning in a first episode psychosis sample. Comprehensive Psychiatry, 55(2), 268-273. https://doi.org/10.1016/j.comppsych.2013.08.027

MacBeth, A., Gumley, A., Schwannauer, M., Carcione, A., McLeod, H.J., y Dimaggio, G. (2015). Metacognition in first episode psychosis: Item level analysis of associations with symptoms and engagement. Clinical Psychology and Psychotherapy, 23(4), 329-339. https://doi.org/10.1002/cpp.1959.

Main, M. (1991). Metacognitive knowledge, metacognitive monitoring, and singular (coherent) vs. multiple (incoherent) model of attachment. En C. Murray, J. Stevenson y P. Marris. (Eds.). Attachment across the life cycle. (pp 127-159). London, UK: Routledge.

Ministerio de Salud. (2009). Guía Clínica para el tratamiento de personas desde primer episodio de Esquizofrenia. Guías Clínicas MINSAL. https://tinyurl.com/ybnsq4gk

Nicolò, G., Dimaggio, G., Popolo, R., Carcione, A., Procacci, M., Hamm, J.,… y Lysaker, P.H. (2012). Associations of Metacognition with symptoms, isight and neurocognition in Schizophrenia in an Italian replication study. The Journal of Nervous and Mental Disease, 200(7), 644-647. https://doi.org/10.1097/NMD.0b013e31825bfb10

Peralta, V., y Cuesta, M.J. (1994). Psychometric properties of the positive and negative syndrome scale (PANSS) in schizophrenia. Psychiatry Research, 53(1), 31–40. https://doi.org/10.1016/0165-1781(94)90093-0

Salvatore, G., Dimaggio, G., y Lysaker, P.H. (2007). An intersubjective perspective on negative symptoms of schizophrenia: implications of simulation theory. Cognitive Neuropsychiatry, 12(2), 144-164. https://doi.org/10.1080/13546800600819921

Salvatore, G., Dimaggio, G., Ottavi, P., y Popolo, R. (2017). Terapia Metacognitiva Interpersonale della Schizofrenia. La procedura formalizzata di intervento. Milán, Italia: FrancoAngeli.

Semerari, A. (Ed). (2002). Psicoterapia cognitiva del paciente grave. Metacognición y relación terapéutica. Bilbao: Desclée de Brouwer.

Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo, G., Procacci, M., y Alleva, G. (2003). How to Evaluate Metacognitive Functioning in Psychotherapy? The Metacognition Assessment Scale and its Applications. Clinical Psychology and. Psychotherapy, 10(4), 238-261. https://doi.org/10.1002/cpp.362

Tas, C., Brown E.C., Aydemir, O., Brüne, M., y Lysaker, P.H. (2014). Metacognition in Psychosis: Comparison of Schizophrenia with Bipolar Disorder. Psychiatry Research. 219(3), 464-469. https://doi.org/10.1016/j.psychres.2014.06.040

Trauelsen, A.M., Gumley, A., Jansen, J.E., Pedersen, M.B., Nielsen, H.L., Trier, C.H.,… y Simonsen, E. (2016). Metacognition in first episode psychosis and its association with positive and negative symptom profiles. Psychiatry Research, 238, 14-23. https://doi.org/10.1016/j.psychres.2016.02.003

Van der Gaag, M., Hoffman, T., Remijsen, M., Hijman, R., De Haan, L., Van Meijel, B.,… y Wiersma, D. (2006). The five factor model of the Positive and Negative Syndrome Scale II: A ten-fold cross-validation of a revised model. Schizophrenia Research, 85(1-3), 280-287. https://doi.org/10.1016/j.schres.2006.03.021

Vergara, S. (2018). Metacognición en Esquizofrenia: déficits metacognitivos y psicoterapia. Revista Chilena de Neuro-Psiquiatría, 56(4), 269-278. https://doi.org/10.4067/s0717-92272018000400269

Vohs, J.L., Lysaker, P.H., Francis, M.M., Hamm, J., Buck, K.D., Olasek, K.,… y Breier, A. (2014). Metacognition, social cognition and symptoms in patients with first episode and prolonged psychosis. Schizophrenia Research, 153(1-3), 54-59. https://doi.org/10.1016/j.schres.2014.01.012

Vohs, J.L., George, S., Leonhardt, B.L., y Lysaker, P.H. (2016). An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments. Expert Review of Neurotherapeutics, 16(10), 1193-1204. https://doi.org/10.1080/14737175.2016.1199275

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.

Derechos de autor 2020 Array

SCImago Journal & Country Rank