Rendimiento neuropsicológico en la adicción a la cocaína: una revisión crítica / Neuropsychological performance in cocaine addiction: a critical review

Introducción. El uso crónico de cocaína se ha asociado con un amplio rango de déficits neuropsicológicos que afectan a laatención, la memoria, el aprendizaje o las funciones ejecutivas, aunque no se ha encontrado un perfil único de afectaciónasociado a la adicción a esta sustancia.Objetivo. Revisar los principales estudios de rendimiento neurocognitivo en adictos a la cocaína, con especial atención almétodo de investigación empleado.Desarrollo. Existe una gran diversidad metodológica en la investigación del déficit cognitivo asociado a la adicción a lacocaína. Estas diferencias dificultan la comparación de resultados y la obtención de un perfil claro de alteraciones neurocognitivas.Aun así, la mayoría de investigaciones encuentran déficit neuropsicológico, casi siempre de tamaño medio,asociado a la adicción a la cocaína. Este déficit afecta a la atención, memoria verbal y visual, y funciones ejecutivas (memoriade trabajo, flexibilidad mental, fluidez verbal, inhibición y toma de decisiones). Algunos estudios arrojan resultadoscon un perfil de ejecución cognitiva disociado.Conclusiones. El uso crónico de cocaína se asocia con un peor rendimiento cognitivo. Por lo tanto, la valoración cognitiva deadictos a la cocaína puede mejorar la comprensión de la naturaleza de las dificultades que estos pacientes exhiben en su vidacotidiana y, además, puede servir de referencia para orientar su tratamiento. Es posible que sutiles alteraciones cognitivasconlleven importantes consecuencias en la conducta de estos pacientes. Sin embargo, la evaluación neuropsicológica noforma parte aún de los protocolos habituales de evaluación de este trastorno. Por lo tanto, se propone incluir una evaluaciónneuropsicológica en los protocolos de evaluación inicial de estos pacientes y adaptar el tratamiento al déficit encontrado (AU)

Introduction. Chronic use of cocaine has been associated with a wide range of neuropsychological deficits affecting attention,memory, learning and executive functions. However, it has not been found a unique profile of impairment associatedwith cocaine addiction.Aim. To review the studies about neurocognitive performance in cocaine addicted patients, with special attention to theresearch method used Development. A great diversity in the research methodology of cognitive deficits associated with cocaine addiction hasbeen used. These differences make difficult to compare results and obtain a clear profile of neuropsychological deficits.Even though, most of studies find neuropsychological deficits (mainly of medium size) associated with cocaine addiction.These problems are usually related to attention, verbal and visual memory and executive functions (working memory,mental flexibility, verbal fluency, inhibition and decision making). Moreover, in some studies a dissociated profile ofcognitive performance has been found.Conclusions. Chronic use of cocaine is associated with worse cognitive performance. Therefore, the cognitive assessmentof cocaine addicted patients can improve the understanding of the nature of the difficulties that these patients exhibit ineveryday life and also can help to guide the treatment. Probably, the presence of subtle cognitive changes has importantconsequences on the behaviour of these patients. However, neuropsychological performance is not usually assessed inthe assessment guidelines of this disorder. Therefore, it is proposed to include a neuropsychological assessment for initialassessment of cocaine addicted patients, as well as to tailor treatment to the found deficit (AU)

[Neuropsychological performance in cocaine addiction: a critical review]. / Rendimiento neuropsicológico en la adicción a la cocaína: una revisión crítica.

INTRODUCTION: Chronic use of cocaine has been associated with a wide range of neuropsychological deficits affecting attention, memory, learning and executive functions. However, it has not been found a unique profile of impairment associated with cocaine addiction. AIM: To review the studies about neurocognitive performance in cocaine addicted patients, with special attention to the research method used. DEVELOPMENT: A great diversity in the research methodology of cognitive deficits associated with cocaine addiction has been used. These differences make difficult to compare results and obtain a clear profile of neuropsychological deficits. Even though, most of studies find neuropsychological deficits (mainly of medium size) associated with cocaine addiction. These problems are usually related to attention, verbal and visual memory and executive functions (working memory, mental flexibility, verbal fluency, inhibition and decision making). Moreover, in some studies a dissociated profile of cognitive performance has been found. CONCLUSIONS: Chronic use of cocaine is associated with worse cognitive performance. Therefore, the cognitive assessment of cocaine addicted patients can improve the understanding of the nature of the difficulties that these patients exhibit in everyday life and also can help to guide the treatment. Probably, the presence of subtle cognitive changes has important consequences on the behaviour of these patients. However, neuropsychological performance is not usually assessed in the assessment guidelines of this disorder. Therefore, it is proposed to include a neuropsychological assessment for initial assessment of cocaine addicted patients, as well as to tailor treatment to the found deficit.

[Cocaine addiction and personality disorders: a study with the MCMI-II]. / Adicción a la cocaína y trastornos de personalidad: un estudio con el MCMI-II.

This paper explores the personality disorders most commonly related to cocaine addiction. The samples used were 60 cocaine-addicted patients, who were assessed with the MCMI-II before treatment, and 50 normative participants from the general population with the same demographic features (age, sex and socioeconomic level). According to the results, 36.7% of the clinical sample (versus 16% of the normative sample) showed at least one personality disorder. The most prevalent disorders in the cocaine sample were Passive-Aggressive Personality Disorder and Dependent Personality Disorder (10% in each case), followed by Obsessive-Compulsive Personality Disorder and Histrionic Personality Disorder (6.7% each). Moreover, 15% of the clinical sample showed more than one personality disorder. Finally, the implications of this study for clinical practice and future research in this field are discussed.

Adicción a la cocaína y trastornos de personalidad: un estudio con el MCMI-II / Cocaine addiction and personality disorders: a study with the MCMI-II

En este artículo se lleva a cabo un estudio de los trastornos de personalidad asociados a la adicción a la cocaína. Para ello se contó con una muestra de 60 pacientes cocainómanos, que cumplimentaron el MCMI-II antes del tratamiento, y de 50 sujetos de la población normal con las mismas características demográficas (edad, sexo y nivel socioeconómico). El 36,7% de la muestra clínica (frente al 16% de la muestra normativa) presentaba, al menos, un trastorno de personalidad. Los trastornos de mayor prevalencia entre los cocainómanos fueron el trastorno pasivo-agresivo de la personalidad y el trastorno dependiente de la personalidad (10% cada uno de ellos), seguidos del trastorno obsesivo-compulsivo y el histriónico (6,7% cada uno). Asimismo, el 15%de la muestra clínica presentaba simultáneamente dos o más trastornos. Por último, se comentan las implicaciones de este estudio para la práctica clínica y para las investigaciones futuras (AU)

This paper explores the personality disorders most commonly related to cocaine addiction. The samples used were 60 cocaine-addicted patients, who were assessed with the MCMI-II before treatment, and 50 normative participants from the general population with the same demographic features (age, sex and socioeconomic level). According to the results, 36.7% of the clinical sample (versus 16% of the normative sample) showed at least one personality disorder. The most prevalent disorders in the cocaine sample were Passive-Aggressive Personality Disorder and Dependent Personality Disorder (10% in each case), followed by Obsessive-Compulsive Personality Disorder and Histrionic Personality Disorder (6.7% each). Moreover, 15% of the clinical sample showed more than one personality disorder. Finally, the implications of this study for clinical practice and future research in this field are discussed (AU)

Evaluation of a therapeutic community treatment program: a long-term follow-up study in Spain.

The aims of this study is to carry out a long-term follow-up evaluation of a well-established therapeutic community treatment for addictions in Navarre (Spain) and to make a comparison between the program completers and the dropouts, as well as between relapsing and nonrelapsing patients, on a broad set of variables. A long-term follow-up design (mean of 6 years after leaving treatment) was used to analyze the outcomes of the therapeutic program. The sample consisted of 155 subjects (113 completers and 42 dropouts). A personal interview was carried out with each one of the located subjects. The interviews took place between September 2000 and September 2004. Treatment "dropouts" manifested a higher and earlier rate both of relapses, and of new treatments for their drug addiction than the completion group. The program was also effective in reducing criminal behavior and improving the state of health. Significant differences were found across outcome variables when comparison was made between treatment completers and "dropouts." All subjects improved on outcome variables after receiving the treatment. When relapsing and nonrelapsing patients were compared, significant outcome differences were also found between groups. The study's limitations are noted and future needed research is suggested.

Comorbilidad psicopatológica en la adicción a la cocaína: resultados con el SCL-90-R / Psychopathological comorbidity in cocaine addiction: results with the SCL-90-R

En este artículo se lleva a cabo un análisis del perfil de consumo y de la comorbilidad psicopatológica en 60 pacientes cocainómanos que acuden en busca de tratamiento a un programa ambulatorio de Proyecto Hombre de Navarra. Para la evaluación de los pacientes se utilizan los criterios diagnósticos del DSM-IV-TR para la dependencia alcohólica, el EuropASI, para valorar la gravedad de la dependencia, y el SCL-90-R, como medida de la sintomatología asociada. Los resultados obtenidos muestran la presencia de numerosa sintomatología psicopatológica, con elevaciones significativas en la mayoría de las dimensiones del SCL-90-R, tanto en los hombres como en las mujeres de la muestra. La comparación con las muestras normativas refleja que los cocainómanos de la muestra presentan más síntomas psicopatológicos que la población normal, pero menos que la población psiquiátrica. Por último, se comentan las implicaciones de este estudio para la práctica clínica y para la investigación futura (AU)

In this paper an analysis of the consumption profile and of the psychopathological comorbidity in 60 outpatient treatment-seeking cocaine addicts from “Proyecto Hombre de Navarra” (Project Mankind) is carried out. For the assessment of the patients, the DSM-IV-TR diagnosis criteria for cocaine dependence, the EuropASI, in order to assess the severity of the dependence, and the SCL-90-R, as measure of the associated symptoms, were used. Results showed a high level of psychopathological symptoms, with significant scores in most of the dimensions of the SCL-90-R, the same for men as for women of the sample. Comparison with normative samples reflects that the cocaine addicts of the sample present more psychopathological symptoms than the normal population, but less than the psychiatric population. Lastly, implications of this study for further research and clinical practice are commented upon

Relapse precipitants in addictions:results in a therapeutic community.

In this paper, a study examining high-risk situations for relapse is presented. The sample consisted of 72 participants (51 male and 21 female) who had relapsed after having received a residential psychological treatment for drug addition in a therapeutic community in Spain. In order to analyze what personal, environmental or social factors were the most immediate triggers of relapse, a personal interview, using the Relapse Interview, was administered to each one of the relapsed patients. Results showed that most of the relapses took place during the first year after completing the treatment program. Likewise, the factors most frequently cited for relapse were the following: to cope with negative emotional states (49.5%), to be unable to resist temptations or impulses to consume (17.5%), to test personal control (10.3%) and to cope with interpersonal conflicts (9.3%). Results indicate thatmost factors were of an intrapersonal nature. Implications of these results for further research and clinical practice are commented upon.

Alteraciones neuropsicológicas en alcohólicos: un estudio exploratorio / Neuropsychological disorders in alcoholics: an exploratory study

En este estudio se evaluó la presencia de alteraciones neuropsicológicas en 50 pacientes alcohólicos, en comparación con un grupo de control de 50 sujetos de la población normal, apareados en edad, sexo y nivel socioeconómico. Para ello, se aplicó una batería neuropsicológica compuesta por la Escala de Memoria de Wechsler (subtest: control mental, dígitos, localización espacial y memoria lógica), el Trail Making Test de la batería Halstead-Reitan, el test de dibujo de una Figura Compleja de Rey, el test de palabras y colores de Stroop y el subtest de evocación categorial del Test Barcelona. Los resultados obtenidos reflejaron que la ejecución en la mayoría de las pruebas era equiparable en ambos grupos. Las únicas diferencias significativas entre los grupos se observaron en el subtest de memoria lógica, tanto en el recuerdo inmediato como diferido, y en el tiempo empleado en la ejecución de la copia de la Figura de Rey. En ambos casos la muestra de alcohólicos presentaba una peor ejecución, con una afectación de la memoria en cuanto a la capacidad de realizar nuevos aprendizajes. Los resultados descartaron la existencia de un déficit cognoscitivo generalizado en los pacientes alcohólicos. La ausencia de otras alteraciones cognoscitivas, sobre todo en las funciones ejecutivas, contrasta con los hallazgos de otras investigaciones

This study evaluates the presence of neuropsychological disorders in 50 alcoholic patients compared with a control group of 50 subjects from the normal population, matched on age, sex, and socioeconomic level. The neuropsychological assessment battery comprised the Wechsler Memory Scale (subtest: mental control, digits, space localisation and logical memory), the Trail Making Test from the Halstead-Reitan Battery, the Rey Complex Figure drawing test, the Stroop words and colours test and the Barcelona Test subtest on categorical evocation. The results showed that carrying out the tasks was similar for both groups. The only significant differences between the groups were observed in the logic memory subtest, both in the immediate and in the delayed memory, and in the time taken to copy the Rey figure. In both cases, the alcoholic patients fared worse, with memory being affected in respect of the ability to learn new skills. The results do not show the existence of a generalised cognitive deficit in alcoholic patients. The absence of other cognitive distortions, mainly in the executive functions, contrast with the findings of previous studies

Personality disorders in alcoholics: a comparative pilot study between the IPDE and the MCMI-II.

In this paper, the most frequent personality disorders (PDs) related to alcoholism are described. 105 participants took part in the study (50 consecutively recruited treatment-seeking alcoholics and 55 subjects from the general population). All subjects were assessed with the IPDE and the MCMI-II. According to the results in the IPDE, 22% of alcoholics, versus 7.27% of the normal sample, showed at least one PD. The most prevalent PDs were the Avoidance personality disorder (10%), followed by the Non-specified (8%) and Borderline (6%). When the MCMI-II was used a significantly higher prevalence of PDs was observed (52% in alcoholics and 18.1% in the normal sample), without coincidence in the kind of PDs diagnosed. This lack of consistency is probably related to the assessment tools, mainly the IPDE, which is more accurate and conservative than self-report inventories, which present a tendency for over-diagnosis.

Trastornos de personalidad en alcohólicos un estudio con el IPDE / Personality disorders in alcoholics: a study using the IPDE

En este artículo se lleva a acabo una descripción de los trastornos de personalidad que aparecen con mayor frecuencia en el alcoholismo. Para ello se cuenta con una muestra de 50 alcohólicos, evaluados con el IPDE en el transcurso de la evaluación pretratamiento, y de 55 sujetos de la población normal, apareados en edad, sexo y clase social. Los resultados muestran que el 22% de la muestra clínica (frete al 7,27 % del grupo de control) presenta, al menos, un trastorno de personalidad. Más en concreto, el trastorno de mayor prevalencia es el trastorno de la personalidad por evitación (10%) , seguido del trastorno de personalidad no especificado (8%), del trastorno límite de la personalidad (6%) y, por último, del trastorno antisocial y del trastorno narcisista (2% cada uno de ellos). Finalmente, se comentan las implicaciones de este estudio para la práctica clínica y para las investigaciones futuras, así como la necesidad de utilizar entrevistas diagnósticas y no autoinformes, en la evaluación de los trastornos de la personalidad

In this paper, the personality disorders most frequently related to alcoholism are described. A sample of 50 alcoholics seeking treatment, who were assessed with the IPDE in the course of the pre-treatment assessment, and 55 normal subjects from the general population with the same demographic features (age, sex and socioeconomic level) were selected. According to the results, 22% of the clinical sample (versus 7,27% of the normal sample) showed at least one personality disorder. The most prevalent disorder was the Avoidance Personality Disorder (32%), followed by the Non Specified (8%) the Borderline (6%) and the Antisocial together with the Narcissistic (2% each). The implications of this study for clinical practice and future research in this field, as well as the necessity to use diagnostic interviews instead of self reports in the evaluation of personality disorders, are commented upon