Trastornos del ánimo y trastornos por uso de sustancias: una comorbilidad compleja y frecuente / Mood disorders and substance use disorders: a complex and frequent comorbidity

La comorbilidad entre trastornos del ánimo (TA) y trastornos por uso de sustancias (TUS) es frecuente, empeora el pronóstico de ambos cuadros y dificulta su tratamiento. El reconocimiento y manejo de síntomas anímicos en usuarios de sustancias significa un desafío en la práctica clínica. Si bien existen los trastornos anímicos secundarios a la patología por consumo, la evidencia muestra que la mayor parte de las veces en que ambas patologías coexisten, el trastorno anímico es primario, por lo tanto, el uso de sustancias activo no debiese impedir un tratamiento oportuno del TA, sin descuidar el manejo específico del uso de sustancias, ya que el tratamiento del cuadro afectivo por sí sólo no resuelve el TUS. Existe acuerdo en la necesidad de realizar un tratamiento integrado de ambos trastornos, que incorpore intervenciones farmacológicas y psicoterapéuticas ya validadas para el tratamiento de ambos trastornos por separado, y especialmente aquellas que han mostrado efectividad en la comorbilidad. El tratamiento debe tener un enfoque en la recuperación, que promueva la adherencia y reinserción social. Se requiere mayor investigación sobre el pronóstico y el tratamiento de la comorbilidad entre Trastorno anímicos y por uso de sustancias, y el fortalecimiento de la red de salud general y salud mental en la pesquisa y manejo de estos cuadros.

Comorbidity between Mood Disorders (MD) and Substance Use Disorders (SUD) are common and it worsens the prognosis of both conditions. The recognition and management of mood symptoms in SUD patients is a usual challenge in clinical practice. As opposed to the usual belief, most mood disorders in TUS patients are primary disorders and therefore the use of active substances should not prevent timely treatment of MD, without neglecting the specific management of substance use, since that the treatment of the affective condition alone does not resolve your SUD. There is agreement on the need to perform an integrated treatment of both disorders, which incorporates pharmacological and psychotherapeutic interventions already validated for the treatment of both disorders, and especially those that have shown effectiveness in comorbidity. Treatment should have a focus on recovery, which promotes adherence and social reintegration. More research is required on the prognosis and treatment of comorbidity between mood and substance use disorders, and the strengthening of the general health and mental health network in the research and management of these conditions.

Factores determinantes en el éxito de un tratamiento antitabaco / Factors associated with abstinence in a smoking cessation program

Smoking cessation programs have an efficacy of approximately 30 percent. Different factors related to the patients may influence this figure. Aim To identify determinant factors for smoking cessation after one year of treatment and to determine if bupropion and nicotine substitutes are effective in smoking cessation treatments. Material and methods: Follow up of 68 patients that attended a smokers clinic at a General Hospital. The patients filled up a questionnaire which included demographic, morbid and smoking habits data. They were subjected to a psychiatric interview to determine their treatment. One year later, patients were contacted by telephone and were asked if they remained without smoking. Results: After one year, 41 percent of patients responded that they were abstinent. On univariate analysis, male gender appeared as a protective factor associated to abstinence. On multivariate analysis, the use of bupropion appeared as a protective factor. A high score on the automatic item of the smoking motivation questionnaire appeared as a risk factor. The presence of respiratory diseases and the male gender were borderline significant protective factors. Nicotine substitutes were not associated with better abstinence rates. Conclusions: In this sample of smokers, the use of bupropion was associated with better abstinence rates and a high motivation to smoke appeared as a risk factor to continue smoking.