Functional impairment as a defining feature of: amnestic MCI cognitive, emotional, and demographic correlates.

BACKGROUND: Early definitions of mild cognitive impairment (MCI) excluded the presence of functional impairment, with preservation of a person's ability to perform activities of daily living (ADL) as a diagnostic criterion. However, recent studies have reported varying degrees of functional impairment associated with MCI. Hence, we aimed to test the potential functional impairment associated with MCI and its predictors. METHODS: Sixty-nine healthy elderly subjects, 115 amnestic single-domain MCI subjects (a-MCI), and 111 amnestic multi-domain MCI subjects (md-MCI) were assessed using a battery of neuropsychological tests including measures of attention, memory, working memory, executive functions, language, and depression. Additionally, functional ability was assessed by both qualitative (WHO-DAS II) and quantitative (CHART) instruments. Cognitive and functional performance was compared between groups, and regression analyses were performed to identify predictors of functional ability. RESULTS: The md-MCI group was more impaired than the a-MCI group, and both were more impaired than healthy subjects in all cognitive measures, in total CHART score, CHART cognitive and mobility subscores, and WHO-DAS II communication and participation subscales. For the rest of the functional measures, the md-MCI group was more impaired than healthy controls. Prediction of functional ability by cognitive measures was limited to md-MCI subjects and was higher for the CHART than for the WHO-DAS II. The WHO-DAS II was largely influenced by depressive symptoms. CONCLUSIONS: Functional impairment is a defining feature of MCI and is partially dependent on the degree of cognitive impairment. Quantitative measures of functional ability seem more sensitive to functional impairment in MCI than qualitative measures, which seem to be more related to depression.

Self-Change Strategies in Smokers and Former Smokers: Spanish Adaptation of the SCS-CS and SCS-FS

The purpose of this study was to validate and adapt the Self-Change Strategies in Current Smokers (SCS-CS)and the Self-Change Strategies in Former Smokers (SCS-FS) (Christie & Etter, 2005) to the Spanish population.We also wished to analyze the differences in the self-change strategies used as a function of gender. Participants were 370 subjects (190 smokers and 180 former smokers) who were recruited by means of the «snowball» method. The alpha coefficients for the SCS-CS and the SCS-FS were .86 and .87, respectively. Both scales present satisfactory psychometric properties, so they are shown to be useful instruments to use in the Spanish population. The SCS-CS score showed that male smokers used more self-change strategies than females (46.6vs. 11.9, p < .01), specifically, more cognitive strategies. In the SCS-CS, men scored higher than women (49vs. 12.08, p < .01), in both the group of cognitive and behavioral strategies. The psychological mechanisms used to control the smoking habit are the same in men as in women, but the men tend to use a larger number of strategies. Treatments to quit smoking do not need to be substantially different, but they should be more intensive in the case of women smokers (AU)

El objetivo de este estudio fue validar y adaptar a la población española la Self-Change Strategies in CurrentSmokers (SCS-CS) y la Self-Change Strategies in Former Smokers (SCS-FS) (Christie & Etter, 2005). También tratamos de analizar las diferencias de las estrategias de autocambio empleadas en función del género. Participaron 370 sujetos (190 fumadores y 180 exfumadores) que fueron reclutados mediante el método «bola de nieve». Los coeficientes alfa para las escalas SCS-CS y SCS-FS fueron de 0,86 y 0,87 respectivamente. Ambas escalas presentan, por tanto, buenas propiedades psicométricas, por lo que se muestran como instrumentos útiles para utilizar en población española. La puntuación en la SCS-CS mostró que los hombres fumadores utilizan más estrategias de autocambio que las mujeres (46,6 frente a 11,9) (p<0,01), en particular, más estrategias de tipo cognitivo. En la escala SCS-FS, los hombres volvieron a puntuar más alto (49 frente a 12,08) (p<0,01), tanto en el grupo de estrategias cognitivas como en las conductuales. Los mecanismos psicológicos que se emplean para controlar el hábito de fumar son los mismos en hombres que en mujeres, pero los hombres tienden a utilizar mayor número de estrategias. Los tratamientos para dejar de fumar no deben ser sustancialmente diferentes, aunque sí más intensivos en el caso de las mujeres fumadoras (AU)

Association study of serotonin 2A receptor (5-HT2A) and serotonin transporter (5-HTT) gene polymorphisms with schizophrenia.

OBJECTIVE: To investigate (i) the association between four serotonergic polymorphisms (A-1438G and T102C of the 5-HT2A receptor gene, and 5-HTT VNTR and 5-HTTLPR of the 5-HT transporter gene) and schizophrenia and (ii) the potential interaction of those polymorphisms in the development of schizophrenia. SUBJECTS AND METHODS: 227 outpatients with schizophrenia (DSM-IV criteria) and 420 unrelated healthy controls from Asturias (Northern Spain) were genotyped using standard methods. RESULTS: Both groups showed Hardy-Weinberg equilibrium for the analyzed genetic variability. A-1438G and T102C polymorphisms are in complete linkage disequilibrium in our population. There was an apparent difference in the distribution of genotypes for the A-1438G (or T102C) polymorphisms (p=0.018, not significant after a Bonferroni correction). The 5-HT2A -1438A (or 102T) allele was significantly more frequent in patients than controls (0.53 and 0.45, respectively; corrected p=0.028, OR=1.39 (95% CI=1.11-1.75)). Genotype and allele distributions for 5-HTT polymorphisms were similar in both groups. However, assessment of the combined influence of 5-HT2A A-1438G and 5-HTTLPR polymorphisms demonstrated a significant effect (chi(2) (3)=11.51, p=0.009), whereby the combination of -1438A and 5-HTTLPR S alleles was associated with schizophrenia. CONCLUSIONS: Our findings support a possible synergistic effect of genetic factors influencing serotonergic neurotransmission on susceptibility to schizophrenia.

Evaluación de trastornos de la personalidad en pacientes heroinómanos mediante el International Personality Disorders Examination (IPDE) / Assessment of personality disorders in heroin abusers using the International Personality Disorders (IPDE)

Objetivos. Determinar 1. Prevalencia de trastornos de la personalidad (TP) en pacientes adictos a opiáceos 2. Factores involucrados en la retención terapeútica a medio plazo (6 meses) 3. Índices de validez del módulo de screening del IPDE 4. Estabilidad diagnóstica a medio plazo del IPDE. Pacientes. 262 pacientes (135 procedentes de centro público y 127 de centro privado), que consecutivamente demandaron tratamiento entre septiembre de 1996 y mayo de 1998. Dichos pacientes fueron asignados a las siguientes modalidades terapeúticas: Programa de Mantenimiento con Metadona (PMM) en centro público (n= 53), Programa de Mantenimiento con Naltrexona (PMN) en centro público (n= 82) y PMN en centro privado (n=127). Evaluación. Versión Europea del Addiction Severity Index (EuropASI) e International Personality Disorders Examination (IPDE). Resultados y conclusiones. Estudio basal: mayor prevalencia de TP en los pacientes sometidos a PMM. Los a distribución de TP varía en función de la modalidad terapeútica, así en PMM los TP más prevalentes son el disocial, límite y paranoide, en PMN público el disocial, ansioso y límite y en PMN privado el límite, disocial e impulsivo. En líneas generales, los adictos a opiáceos que cumplen criterios IPDE de TP presentan una mayor gravedad de su adicción. Estudio de seguimiento: el perfil de los pacientes que abandonan precozmente el tratamiento en PMN privado se caracteriza por: mayor dosis inicial de heroína consumida, mayor gravedad de la adicción (áreas de alcohol, drogas y estado psiquiátrico del EuropASI) y mayor número de diagnósticos IPDE de TP. Estudio de validez del IPDE: El módulo de screening del IPDE ha demostrado elevada sensibilidad y moderada especificidad. El IPDE se ha mostrado como un instrumento dotado de una adecuada estabilidad diagnóstica a medio plazo (6 meses) (AU)