The main objective of this study is to identify fibromyalgia syndrome (FMS) clusters using the Revised Fibromyalgia Impact Questionnaire (FIQR), and to examine whether the clusters differ in sociodemographic characteristics, clinical measures, direct and indirect costs, levels of inflammatory markers, and brain morphometry. A hierarchical cluster analysis was performed to classify a large, pooled Spanish sample of patients with FMS (N = 947) using the FIQR as clustering variable. A latent profile analysis was subsequently conducted to confirm the optimal number of FMS clusters. To examine external validity, a battery of clinical measures, economic costs, inflammatory markers, and gray matter volumes of relevant cortical and subcortical areas were analyzed. We also compared the discriminant validity of the clusters with the original FIQR severity categories. To promote the implementation in real-world clinical practice, we built a free online cluster calculator. Our findings indicated that a four-cluster solution more clearly captured the heterogeneity of FIQR data and provided the best fit. This cluster solution allowed for detection of differences for most clinical outcomes and economic costs. Regarding the inflammatory and brain-based biomarkers, differences were found in C-reactive protein, and tendencies were found in the right medial prefrontal cortex, the right parahippocampal gyrus, and the right middle cingulate cortex; brain regions associated with executive functions and pain processing. The original FIQR categories presented similar results, although their precision in discriminating among the nonextreme categories (ie, moderate and severe) was not sound. These findings are discussed in relation to previous research on FMS clustering.

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In this paper we illustrate the potential of the repertory grid technique as an instrument for case formulation and understanding of the personal perception and meanings of people with a diagnosis of psychotic disorders. For this purpose, the case of James is presented: A young man diagnosed with schizophrenia and personality disorder, with severe persecutory delusions and other positive symptoms that have not responded to antipsychotic medication, as well with depressive symptomatology. His case was selected because of the way his symptoms are reflected in his personal perception of self and others, including his main persecutory figure, in the different measures that result from the analysis of his repertory grid. Some key clinical hypotheses and possible targets for therapy are discussed.

SUMMARYA method for studying cognitive conflicts using the repertory grid technique is presented. By means of this technique, implicative dilemmas can be identified, cognitive structures in which a personal construct for which change is wished for implies undesirable change on another construct. We assessed the presence of dilemmas and the severity of symptoms in 46 participants who met criteria for dysthymia and compared then to a non-clinical group composed of 496 participants. Finally, an analysis of the specific content of the personal constructs forming such dilemmas was also performed. Implicative dilemmas were found in almost 70% of the dysthymic participants in contrast to 39% of controls and in greater quantity. In addition, participants in both groups with this type of conflict showed more depressive symptoms and general distress than those without dilemmas. Furthermore, a greater number of implicative dilemmas was associated with higher levels of symptom severity. Finally, content analysis results showed that implicative dilemmas are frequently composed of a constellation of moral values and emotion, indicating that symptoms are often related to moral aspects of the self and so change processes may be hindered. Clinical implications of targeting implicative dilemmas in the therapy context are discussed.Key words: Dysthymia, Repertory Grid Technique, cognitive conflicts, implicative dilemmas, content analysis, personal constructs. RESUMENEn este estudio se presenta un método para el estudio de los conflictos cognitivos utilizando la técnica de rejilla. Por medio de ella, se identificaron los dilemas implicativos, una estructura cognitiva en la que un constructo personal en el que se desea un cambio se asocia con otro constructo en el que el cambio no es deseable. Se evaluó la presencia de dilemas y la gravedad sintomatológica en una muestra de 46 participantes que cumplían criterios diagnósticos para la distimia y se comparó con un grupo control compuesto por 496 participantes. Por último, se llevó a cabo un análisis del contenido de los constructos personales que forman los dilemas. Se encontraron dilemas en casi 70% de la muestra clínica frente a 39% de la muestra control y en mayor cantidad. Por otro lado, los participantes de ambos grupos con este tipo de conflicto mostraron un nivel mayor de sintomatología depresiva y malestar general que aquellos sin dilemas. Además, se encontró una alta correlación entre el número de dilemas implicativos y la gravedad de los síntomas. Los resultados del análisis de contenido mostraron que los dilemas estaban frecuentemente formados por una constelación de valores morales y constructos emocionales indicando que a menudo los síntomas están asociados a aspectos positivos del sí mismo, por lo que el proceso de cambio puede verse bloqueado. Se discuten las implicaciones clínicas de abordar los dilemas en el contexto terapéutico.

BackgroundSocial functioning impairment is one of the core features for schizophrenia diagnosis and are also present in other psychotic spectrum disorders, being determinant for disability. This impairment has multiple domains, which are linked but separate. Previous research has shown that social functioning is multiply determined by neurocognition, social cognition and symptoms, being social cognition the domain that accounts for more of the variance in daily functioning. However, cognitive rigidity in interpersonal perception has received less attention and much variance remains unexplained. The aim of this study was to test the role of interpersonal cognitive rigidity, as measured with the Repertory Grid Technique (RGT) in social functioning in psychosis.MethodsSample of 40 out-patients with a psychotic spectrum diagnosis from the network of mental health services of Parc Sanitari Sant Joan de Déu (Barcelona, Spain). Cross-sectional study, assessment was carried out by a predoctoral researcher (GMH), using a sociodemographic questionnaire, the Social Functioning Scale (SFS), the Hinting Task (Theory of Mind, ToM), the Beck Cognitive Insight Scale (BCIS), and the RGT (to measure interpersonal cognitive rigidity, two indices were selected: Percentage of Variance Accounted for the First Factor, PVAFF, and Polarization). Pearson correlations and multiple regression analysis were performed.ResultsResults showed that social engagement/withdrawal was explained by PVAFF, accounting for 16% of the variance. Independence-competence was explained by polarization, explaining 14.6% of the variance and by sex, which accounted for 11.1% of the variance. Independence-performance was explained by theory of mind, explaining 22.5% of variance. Employment/occupation was explained by years of illness accounting for 21.6% of variance, and by polarization (beta=-0.318, p=0.026) which explained 10% of variance. Finally, the total score of the SFS was explained by polarization, explaining 14.4% of variance, and sex, which accounted for 12.6% of variance. For prosocial activities and interpersonal communication, none of the variables entered for the linear regression analysis.DiscussionDespite ToM and cognitive insight are common variables reported in the research literature, in our study the cognitive rigidity measures of the RGT, based on the patients’ own terms (personal constructs) in rating their significant others, were better predictors of social functioning. These findings support the importance and utility of an idiographic instrument like the RGT to investigate cognitive processes related to social perception and their impact on functioning. Regarding PVAFF, a higher tendency to perceive the interpersonal world from a unidimensional manner predicted a worse outcome in social relationships/withdrawal. Regarding interpersonal polarized thinking, it was the best cognitive predictor of social functioning measures. Our results suggest that a dichotomous thinking style in interpersonal perception might also be relevant for...