Identifying internalizing transdiagnostic profiles through motivational and cognitive control systems: Relations with symptoms, functionality, and quality of life.

BACKGROUND: The diversity of patients' symptomatology among people seeking treatment on community-based mental health services poses significant challenges to traditional models of care. Recent approaches favor identifying transdiagnostic factors that allow a better understanding of patient heterogeneity and designing more effective and quality interventions. This study examines the heterogeneity of patients with internalizing symptoms based on profiles identified with cognitive and motivational control variables. Differences between these profiles on dimensional measures of psychopathology and quality of life are examined. METHODS: 263 patients were selected by non-probabilistic sampling procedures on mental health services in the province of Huelva (Spain). A latent class analysis on the standardized scale scores of The Behavioral Inhibition/Behavioral Activation System Scales and the Effortful Control Scale of the Adult Temperament Questionnaire Short-Form was conducted. Profiles were compared on the scores of the Inventory of Depression and Anxiety Symptoms-II, the WHO Disability Assessment Schedule II, and the Health Assessment Questionnaire SF-36. RESULTS: The four latent profile solution is the one that showed the best fit indicators and substantive interpretability, with a kappa of 0.94 in the cross-validation procedure with 75% of the sample. No sex differences were found between the profiles (χ32 5.17, p = .160). Profiles #1 and #3, both characterized by an imbalance between low activation and high inhibition, had lower well-being, lower functionality, and quality of life. When comparing profile #2 (featuring the highest inhibitory control) lower scores on most internalizing scales are observed, specially claustrophobia, social anxiety, panic mania. Profile #4 (low control, high activation, and high inhibition) showed greater scores on both mania and euphoria and lower scores on emotional role. CONCLUSIONS: We identified four distinctive profiles that had overly increased behavioral inhibition (as expected in internalizing disorders) and differed in the degree of imbalance between inhibition and activation systems, and between motivational systems and top-down cognitive control. The profile characterized by high activation and reduced cognitive (inhibitory) control was the one showing greater mood-related symptoms and lower levels of quality of life. These profiles could be generated by treatment providers to guide clinical management in an evidence-based manner.

Assessing Internalizing Symptoms and Their Relation with Levels of Impairment: Evidence-Based Cutoffs for Interpreting Inventory of Depression and Anxiety Symptoms (IDAS-II) Scores.

Tests and scales measuring psychological disorders should provide information about how scores relate to other constructs such as quality of life or functional impairment. Such information is necessary to allow that their scores contribute to clinical decision making. The current study analyzes the clinical utility of the Spanish version of the Inventory for Depression and Anxiety Symptoms (IDAS-II) to discriminate between different levels of functional impairment and identify the IDAS-II scales that contribute most to explaining impairment. The total sample (N = 1390) consists of two subsamples: a community sample of the general population (n = 1072) selected by random sampling; and a sample of patients (n = 318) from public and private mental health services. The Spanish IDAS-II for measuring internalizing symptoms and WHODAS 2.0 for measuring impairment were administered to all participants. All scales show statistically significant higher scores in the patient sample, with Cohen's d effect sizes values greater than 0.30, except for well-being (d = 0.19). The cutoff values and their confidence intervals do not overlap with the means of either the community or patient sample. AUC values for most of the scales are above .70, except for appetite gain, ordering, euphoria, cleaning, and well-being. Multiple linear regression model using IDAS-II scales explain 57.1% of the variance of the WHODAS 2.0 (F 12.1377 = 155.305; p < .001). Cutoff values provided allow us to reliably differentiate between the patients and community samples. Spanish IDAS-II scores show greater sensitivity and specificity in detecting those with greater impairment. General Depression, Lassitude, Panic and Claustrophobia contribute to impairment in a greater extent. Knowledge of which symptoms are most related with impairment, allows healthcare providers to improve treatment planning based on empirical evidence.

Cocaine use disorder criteria in a clinical sample: an analysis using Item Response Theory, factor analysis, and network analysis.

Background: The conceptualization of substance use disorders (SUDs) was modified in successive editions of the DSM. Dimensionality and inclusion/exclusion of several criteria was studied using various analytic approaches.Objective: The study aimed to deepen our knowledge of the interrelationships between the diagnostic criteria for cocaine use disorder (CUD), applying three different analytical techniques: factor analysis, Item Response Theory (IRT) models, and network analysis.Methods: 425 (85.4% male) outpatients were evaluated for CUD using the Substance Dependence Severity Scale. Confirmatory Factor Analysis, 2-parameter logistic model (IRT) and network analysis were applied to analyze the relationships between the diagnostic criteria.Results: The results show that "legal problems" criterion is not congruent with the CUD measure on three analyses. Also, network analysis suggests the usefulness of the "craving" criterion. The criterion "quit/control" is the one that presents the best centrality indices and expected influence, showing strong relationships with the criteria of "craving," "tolerance," "neglect roles" and "activities given up."Conclusions: Network analysis appears to be a useful and complementary technique to factor analysis and IRT for understanding CUD. The "quit/control" criterion emerges as a central criterion to understand CUD.

Initial orientation vs maintenance of attention: Relationship with the severity of dependence and therapeutic outcome in a sample of cocaine use disorder patients.

The visual probe paradigm allows for evaluating attentional bias (AB), distinguishing between approach vs avoidance patterns of attention and assessing two different processes when the exposure time to images is manipulated: initial orienting and maintenance of attention. The present study aimed to analyze the predictive capacity of these two processes for substance use disorder severity and therapeutic outcomes of patients with cocaine use disorder in treatment. The sample consisted of 70 outpatients who were starting treatment at a public service. AB was evaluated using a task based on the visual probe (VP) paradigm with images presented under two conditions: 200 ms vs 1000 ms. Cocaine and alcohol use disorder severity, craving, retention in treatment and relapse in consumption were recorded. Cocaine AB in the 1000 ms condition was negatively correlated with the cocaine use disorder severity (r = -0.26), whilst a positive correlation was found between cocaine craving and cocaine AB (r = 0.29). Alcohol use disorder severity negatively correlated with cocaine AB in the 200 ms condition (r = -0.24). Logistic regression analysis revealed that, after controlling for gender, age, and substance use disorder severity, cocaine AB in the 200 ms condition predicted dropout and relapse. Our results suggest that patients who adhere to treatment and remain abstinent tend to show avoidance in the 200 ms condition, with effect sizes of r = 0.29 and 0.30 respectively. The results suggest that training in avoidance strategies could be a valuable way of maintaining adherence and abstinence, as well as improving control of craving.

Decision making in substance use disorder patients: Reliability, convergent validity and sensitivity to change of a new behavioral measure.

OBJECTIVE: The Iowa Gambling Task (IGT) and the Delay Discounting Test (DDT) are two of the most widely used decision-making tests within the field of addiction research. The IGT creates a context of uncertainty where immediate rewards or long-term benefits are chosen, whilst the DDT measures the change in value of a reward as the time taken to obtain it increases. The objective of this study was to analyze the psychometric properties of a new task: Deciding about your health (DAYH), which integrates both components. METHOD: Longitudinal observational study. The sample was composed of 97 patients being treated for cocaine use disorder. The DAYH, IGT, DDT and other instruments for measuring dependence severity were administered. Relapse was evaluated within 3 and 6 months after the baseline assessment. RESULTS: Reliability was indicated by an intraclass correlation coefficient (r) of. 80. DAYH scores showed significant relationships with IGT (r = -.237; p <.05), although not with DDT (r =.048) scores. A relationship was also found between DAYH and dependency severity (r = -.213; p <.05) and craving (r = -.231; p <.05). The DAYH scores showed sensitivity to change, and the capacity to predict relapse. CONCLUSIONS: These findings indicate the utility of DAYH for exploring decision-making in patients with substance use disorders. The relationships with IGT and DDT also indicate the need to further investigate how decisions are made in various contexts of choice.

Spanish Adaptation of the Inventory of Depression and Anxiety Symptoms (IDAS-II) and a study of its psychometric properties.

BACKGROUND: The Inventory of Depression and Anxiety Symptoms (IDAS-II) is composed of 99 items organized into 18 specific scales that provides dimensional assessment of depression, anxiety and bipolar symptoms. To date, IDAS-II is only available in the English and Turkish population. The main purpose of this study is to adapt the IDAS-II to the Spanish population and to assess the psychometric properties. METHODS: Participants included community adults (n = 620) and college students (n = 378). All participants completed the Beck Depression Inventory-II, Beck Anxiety Inventory, Hypomania Check List-32, Post-traumatic Stress Disorder Checklist-Civilian Version and Obsessive-Compulsive Inventory-Revised, in addition to the Spanish version of the IDAS-II. RESULTS: The results indicate good internal consistency and high temporal stability of the Spanish version of the IDAS-II. Confirmatory factor analyses show for the first time that the three-factor structure of the IDAS-II (Distress, Obsessions/Fear, and Positive Mood) loads on a second order factor, labeled "Internalizing" according to the Hierarchical Taxonomy Of Psychopathology (HiTOP). LIMITATIONS: Study was conducted exclusively on student and community samples and some of the measures used as gold-standard have presented limitations CONCLUSIONS: According to previous studies, the results supported the convergent and discriminant validity of the majority of IDAS-II scales. IDAS-II is useful in assessing the severity of depression, anxiety and bipolar symptoms in research contexts in a Spanish population according to the HiTOP model. However, more evidence is required to prove the adequate functioning of the IDAS-II in clinical samples.

Aproximaciones metodológicas en la investigación nosológica del trastorno por uso de sustancias / Methodological approaches to nosology research in substance use disorders

Introducción. La investigación sobre los fundamentos teóricos de los trastornos por consumo de sustancias se está incrementando en los últimos años. La aplicación de nuevos modelos estadísticos y psicométricos están aportando nuevas formas de conceptualizar dichos trastornos. Objetivo. El objetivo de este trabajo es ofrecer los principales resultados que se obtienen tras la aplicación de estos modelos a los trastornos por consumo de sustancias. Método. Se realizó una revisión de artículos en PubMed y PsycInfo, con finalización en el mes de marzo de 2012. Los términos de búsqueda fueron "nosology" "dimensionality", "factorial structure", combinados con las diferentes drogas. Resultados. Los estudios cuestionan el sistema categorial de diagnóstico, reconociendo la existencia de diferentes perfiles. Por otro lado, las evidencias empíricas apoyan la creación de un trastorno por consumo de sustancias, en el que se incluyen los criterios de abuso y dependencia. Conclusiones. Las evidencias empíricas obtenidas apoyan la introducción de modificaciones en el proceso diagnóstico de los trastornos por uso de sustancias. Tales modificaciones, en cierta medida recogidas para el DSM-V, deben contemplar también su aplicabilidad en el ámbito clínico (AU)

Introduction. Research on nosology of substance use disorders has been increased in recent years. New statistical and psychometric models are providing new ways to understand these disorders. Objective. The aim of this work is providing the main results from a review concerning the application of these models to Substance Use Disorders. Method. A review was conducted in PubMed and PsycInfo with completion in March 2012. Keywords used: 'nosology', 'dimensionality' and 'factorial structure' with different substances. Results. Studies challenge the categorical system for diagnosis, recognizing the existence of different severity profiles. Moreover, the empirical evidence supports a continuum of substance use disorders, whit abuse and dependence criteria included. Conclusions. Empirical evidence supports modifications in the diagnosis process of Substance Use Disorders for DSM-V. Such changes should also be considered regarding to their applicability in the clinical setting (AU)

Self-regulation and treatment retention in cocaine dependent individuals: a longitudinal study.

BACKGROUND: We aimed to explore the association between baseline executive functioning and treatment outcome in Therapeutic Communities (TCs). METHODS: We used a longitudinal descriptive design: a baseline neuropsychological assessment was performed within the first 30 days of treatment in TCs. Once participants finished or abandoned treatment, the information about time of stay in treatment was computed for each individual. The study was conducted across six TCs located in the region of Andalusia (Spain): Cartaya, Almonte, Mijas, Los Palacios, La Línea, and Tarifa. Participants were 131 patients with cocaine dependence who initiated and finished treatment in TCs between January 2009 and December 2010 (2 years). Cognitive assessment was composed of general measures of executive functioning: Letter Number Sequencing (working memory) and Similarities (reasoning), and executive tasks sensitive to ventromedial prefrontal cortex dysfunction, including the Delis-Kaplan Stroop test (inhibition/cognitive switching), the Revised-Strategy Application Test (strategy application/multitasking), and the Iowa Gambling Task (decision-making). The outcome measure was retention, defined as time in TC treatment (number of days). RESULTS: Poor executive functioning significantly predicted shorter treatment retention in cocaine dependent individuals on TC residential treatment (14% of explained variance). Reduced performance on the R-SAT, a multitasking test taxing the ability to develop and apply the best strategy to organize multiple sub-routine tasks in order to achieve a long-term goal, was the most powerful predictor of treatment retention. CONCLUSIONS: Self-regulation deficits predict the capacity to remain in residential treatment among cocaine dependents.

Health-related quality of life in young cocaine users and associated factors.

AIM: To analyse drug consumption patterns and demographic and medical factors associated with health-related quality of life (HRQL) in a nonclinical sample of regular cocaine consumers. METHODS: Face-to-face interviews with 687 young regular cocaine users (aged 18-30 years) in three Spanish cities: Barcelona, Madrid and Seville. HRQL was measured using the Nottingham Health Profile (NHP), and degree of dependence through the Severity of Dependence Scale (SDS). Bivariate analyses were conducted using nonparametric techniques, and a Tobit regression analysis was carried out to determine which variables best explained HRQL. RESULTS: Most participants showed a good HRQL, but differences in HRQL were found for sociodemographic (gender), medical (days stayed in bed during the previous 12 months) and consumption-pattern related variables (length of drug use, intravenous drug use, crack use, SDS). In multivariate analyses cocaine dependence measured by SDS explained the greatest amount of HRQL variation. Although women declared worse HRQL (13.6 versus 9.7, P < 0.01), in the final model with interactions no gender differences were observed, except that HRQL for women worsened with the number of days they had stayed in bed in the previous 12 months. CONCLUSIONS: Even in early phases of dependence, deterioration in HRQL is observed, mainly related to drug-use history and patterns.