Preliminary study for the validation of the Spanish version of the Personality Belief Questionnaire

Introduction. Dysfunctional beliefs are defined as cognitive schemas that drive an abnormal perception and interpretation of reality, being present in all personality disorders. Beck and Beck developed the Personality Belief Questionnaire (PBQ) in order to measure the degree to which individuals endorse basic beliefs associated with personality disorders, providing unique information about the intensity of the dysfunctional beliefs that must be addressed during treatment. Objective. The aims of this study are, first, to develop a Spanish version of the PBQ and to evaluate its psychometric properties in a sample from the normal population, and second, to examine if PBQ's indexed intensity of dysfunctional beliefs may discriminate between subgroups of individuals within the extreme tails of their corresponding personality traits (measured by a gold standard, the MCMI-III). Methods. We administered the PBQ and the MCMI-III to a sample of 63 undergraduate students of Spanish nationality. Results. Results showed that the Spanish adaptation of the PBQ have sound psychometric properties. Furthermore, we showed that there is a good fit between the personality traits measured with the gold standard and the intensity of dysfunctional beliefs measured with the PBQ, since this questionnaire was able to discriminate between individuals with high vs. low levels of the corresponding personality traits. Conclusions. We conclude that the Spanish adaptation of the PBQ presents adequate psychometric properties (in terms of reliability and construct validity) and holds an important potential for application to clinical populations, in which it may assist the treatment process (AU)

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Análisis de las diferencias en el perfil y patrón de consumo de drogas de hombres y mujeres que asisten a fiestas rave / Analysis of the differences in the profile and drug use patterns between male and female who attend raves

Objetivo. Estudios poblacionales muestran un consumo diferencial de drogas entre hombres y mujeres. Algunos trabajos han apuntado hacia las raves como una cultura andrógina donde las diferencias de género se diluyen. No obstante, las evidencias empíricas sobre el patrón diferencial según género en este contexto son escasas. Este estudio tiene como objetivo analizar las diferencias en el patrón de consumo de drogas y el perfil sociodemográfico de hombres y mujeres que asisten a fiestas rave. Material y método. Se entrevistó a 252 asistentes a fiestas rave en Andalucía (España). Se administró un cuestionario en el que se recogía información sobre el patrón de consumo de 15 drogas distintas y el perfil sociodemográfico. Resultados. Los resultados muestran un elevado consumo y policonsumo de drogas entre los participantes, no encontrándose diferencias significativas en el patrón de consumo y el perfil sociodemográfico según el género. Como media, los hombres han consumido alguna vez 9,9 drogas frente a 9,5 las mujeres. En el último mes, 7,3 frente a 6,9, y en la última rave, 5 frente a 4,9. Conclusiones. Al contrario de lo que sucede en la población general, donde la prevalencia de consumo de drogas de los hombres es superior a la de las mujeres, este trabajo no ha encontrado diferencias significativas en el patrón de consumo entre ambos géneros. Este hecho debe ser considerado para el diseño de estrategias preventivas de reducción de riesgos y daños en este colectivo (AU)

Objective. Population studies show differential drug consumption between male and female. Some studies point to rave as an androgynous culture, where gender differences disappear. Nonetheless, in this context, empirical evidences on differential patterns of drug use by gender are scarce. The purpose of this study is to analyze differences in drug use patterns and sociodemographic profile between male and female who attend raves. Material and method. Two hundred and fifty-two people who went to raves in Andalucía (Spain) were interviewed. It was administered a questionnaire to collect information on use patterns of 15 different drugs and sociodemographic profile. Results. Results show a high substance and polysubstance use between ravers. No significant differences by gender were found in drug use patterns or sociodemographic profile. The average number of drug consumed for male "some time in their lives" were 9.9, versus 9.5 for female. In the last month, 7.3 versus 6.9, and last rave, 5 versus 4.9. Conclusions. Opposite to what it happens in general population, where drug use prevalence of male is higher than female, this study haven´t found significant differences by gender. This fact must be considered in order to design risk and harm reduction preventive strategies (AU)

Estimation of cutoff for the Severity of Dependence Scale (SDS) for opiate dependence by ROC analysis.

BACKGROUND: The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence in several types of substances. Optimal cutoff points on the SDS indicative of clinically significant dependence have been determined for a large range of substance types, however, to date no data have been reported on its performance in a population with opiate dependence. SAMPLE: A structured interview was administered to 315 opiate-dependent patients in treatment. METHOD: The diagnostic performance of the SDS was measured via Receiver Operating Characteristic (ROC) analysis according to the DSM-IV diagnosis of heroin dependence, as measured by section 12 of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). RESULTS: ROC analysis revealed the SDS to be a test of high diagnostic utility for the measurement of opiate dependence (Area Under Curve =0.8875). The cut-off point on the SDS at which there is optimal discrimination between the presence and absence of a diagnosis of heroin dependence was found to be 5 (i.e. a score of 5 or more). This score provides the best trade-off between sensitivity (83.15%) and specificity (84.51%). Similar results were found for heroin current consumption (AUC = 0.8325; cut-off = 5; sensitivity = 77.94 and specificity = 77.33). CONCLUSION: The SDS can be recommended as an effective short instrument for the discrimination of the degree of dependency and heroin consumption in the clinical area.

Estimación de un punto de corte para la Escala de Severidad de la Dependencia (SDS) para la adicción a opiáceos mediante análisis ROC / Estimation of cutoff for the Severity of Dependence Scale (SDS) for opiate dependence by ROC analysis

Contexto. La escala de severidad de la dependencia (SDS)es una escala de cinco ítems que ha mostrado su fiabilidad y validez como instrumento de cribado de la dependencia en varios tipos de sustancias. El punto de corte óptimo de la SDS indicativo de la significación clínica de la dependencia ha sido determinado para un rango amplio de drogas, pero a día de hoy no se ha informado del valor del mismo para el caso de la dependencia a opiáceos. Muestra. Se ha administrado una entrevista estructurada a 315 personas con dependencia a opiáceos en tratamiento. Método. La capacidad diagnóstica de la SDS ha sido evaluada a través de análisis de la curva característica operativa del receptor (ROC) tomando como estándar el diagnóstico de dependencia según criterios DSM-IV a través dela sección 12 del SCAN. Resultados. El análisis ROC presenta la SDS como una prueba de alta utilidad diagnóstica para la valoración de la dependencia de opiáceos (Área Bajo la Curva = 0,8875). El punto de corte óptimo de la SDS para la discriminación entre la presencia y ausencia de diagnóstico de dependencia de opiáceos ha sido de 5 (una puntuación mayor o igual a 5), el cual presenta el mejor balance comparativo entre la sensibilidad (83,15%) y la especificidad (84,51%). Similares resultados se han encontrado para el consumo actual de heroína (ABC = 0,8325; Punto de corte = 5; Sensibilidad =77,94% y Especificidad = 77,33%).Conclusión. La escala SDS puede ser recomendada como un instrumento breve efectivo para la discriminación del grado de dependencia y consumo de heroína en el ámbito clínico (AU)

Background. The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence in several types of substances. Optimal cutoff points on the SDS indicative of clinically significant dependence have been determined for a large range of substance types, however, to date no data have been reported on its performance in a population with opiate dependence. Sample. A structured interview was administered to315 opiate-dependent patients in treatment. Method. The diagnostic performance of the SDS was measured via Receiver Operating Characteristic (ROC) analysis according to the DSM-IV diagnosis of heroin dependence, as measured by section 12 of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN).Results. ROC analysis revealed the SDS to be a test of high diagnostic utility for the measurement of opiate dependence (Area Under Curve =0.8875). The cut-off point on the SDS at which there is optimal discrimination between the presence and absence of a diagnosis of heroin dependence was found to be 5 (i.e. a score of 5or more). This score provides the best trade-off between sensitivity (83.15%) and specificity (84.51%). Similar results were found for heroin current consumption (AUC = 0.8325; cut-off = 5; sensitivity = 77.94 and specificity = 77.33).Conclusion. The SDS can be recommended as an effective short instrument for the discrimination of the degree of dependency and heroin consumption in the clinical area (AU)

Diagnóstico del trastorno por déficit de atención e hiperactividad (TDAH) en pacientes adultos con dependencia de cocaína: utilidad de los nuevos síntomas de funcionamiento ejecutivo de Barkley / Diagnosing adult attention-deficit/hyperactivity disorder in patients with cocaine dependence: usefulness of new Barkley executive function symptoms

Objetivos: Estimación de la prevalencia del trastorno por déficit de atención e hiperactividad (TDAH) del adulto en una muestra de dependientes de cocaína y evaluación de la utilidad de los síntomas de funcionamiento ejecutivo de Barkley para diferenciar entre pacientes dependientes de cocaína con y sin TDAH. Métodos: Diseño observacional transversal. Se evaluó un total de 70 sujetos dependientes de cocaína que ingresaron para tratamiento en una comunidad terapéutica. Los sujetos seleccionados fueron citados para una entrevista cara a cara entre los días 15.º y 20.º del ingreso. Se utilizó una técnica de muestreo consecutivo no aleatorio. Se reclutó a los sujetos según acudían a la comunidad terapéutica y cumplían los criterios de selección. El instrumento de medida empleado para diagnosticar TDAH en la edad adulta fue la Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID). Los trastornos psiquiátricos comórbidos fueron evaluados según criterios DSM-IV-TR mediante la versión española de la entrevista Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). Para la evaluación del "funcionamiento ejecutivo" empleamos el Current Behavior Scale Self-Report de Russell A. Barkley. Resultados: La prevalencia de TDAH observada en nuestra muestra fue del 14,3 % (intervalo de confianza [IC] 95 %: 6,1-22,5). Las puntuaciones medias en todos los ítems de la escala de Barkley son superiores en el grupo de pacientes diagnosticados de TDAH y dependencia a la cocaína, en comparación con los sujetos que sólo presentan dependencia a la esta sustancia, con diferencias estadísticamente significativas. Conclusiones: La prevalencia observada de TDAH en nuestra muestra fue elevada y se sitúa dentro del rango de las encontradas por otros autores en muestras similares. Los datos del estudio apoyan la teoría de Barkley en esta población (AU)

Objectives: Estimation of the prevalence of adult attention-deficit/hyperactivity disorder (ADHD) in a sample of cocaine users treated in a therapeutic community and evaluation of the usefulness of Barkley executive function symptoms in differentiating cocaine-dependent patients with and without ADHD. Methods: A transversal observation design was used. A total of 70 cocaine-dependent subjects who were admitted for treatment in a therapeutic community were assessed. Non-random consecutive sampling was used, recruiting the subjects as they arrived at the therapeutic community and met the selection criteria. Subjects included in the study were given an appointment for a face-to-face interview from 15 to 20 days after admission. The measurement instrument used for diagnosing adult ADHD was Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID). Comorbid psychiatric disorders were evaluated according to DSM-IV-TR criteria using the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). For assessment of the "executive function", we used the Current Behavior Scale Self-Report by Russell A. Barkley. Results: The prevalence of ADHD observed in our sample was 14.3 % (confidence interval [CI] 95 %: 6.1-22.5). The mean scores on all the items on the Barkley scale are higher in the group of cocaine-dependent patients diagnosed with ADHD than for subjects who were cocaine-dependent only by a statistically significant difference. Conclusions: The high prevalence of ADHD observed in our sample was within the range found by other authors in similar samples. The study data support Barkley's theory in this population (AU)

Análisis cualitativo de la percepción del tratamiento con buprenorfina sublingual para la retirada del tratamiento con metadona / Qualitative analysis of patient perception of tapering off methadone treatment with sublingual buprenorphine

Objetivo. Diversos autores han puesto de relieve la importancia de incorporar a los estudios sobre tratamiento en drogodependencias indicadores que tomen en cuenta la percepción del paciente hacia el tratamiento y su satisfacción con el mismo. La percepción sobre el tratamiento influye sobre su aceptabilidad y, por lo tanto, sobre el seguimiento y la adherencia, modulando así su efectividad. El objetivo de este estudio es conocer la percepción y la satisfacción de los pacientes que participan en un estudio piloto de tratamiento con buprenorfina en comunidades terapéuticas y en un centro ambulatorio. Material y métodos. El estudio se ha desarrollado con una metodología cualitativa. Los participantes en el estudio han sido 18 pacientes que recibieron tratamiento en régimen residencial y ambulatorio, a los que se les realizó una entrevista semiestructurada. El análisis de los resultados se ha realizado a través del método de comparación constante, propuesto por la Teoría Fundamentada. Resultados. Los resultados obtenidos reflejan que los pacientes perciben una mayor comodidad en la retirada del tratamiento con buprenorfina, en comparación con la de metadona. Además, los pacientes perciben que el tratamiento con buprenorfina es más fácil de adaptar a la vida cotidiana, a lo que contribuiría una posible dispensación en farmacias. Igualmente, relatan que el estigma percibido asociado a este fármaco es menor en comparación con lo que representa estar en tratamiento con metadona. Conclusiones. Los participantes consideran que estas características y el menor efecto euforizante y sedante facilitan su proceso de incorporación social (AU)

Objective. Various authors have emphasized the importance of including treatment indicators that take into account patient perception of the treatment and his satisfaction with it in studies on drug addiction. Perception of the treatment influences its acceptability and therefore, whether it is followed and adhered to, thus modulating its effectiveness. The purpose of this study is to find outpatient perception and satisfaction with a pilot buprenorphine treatment study in therapeutic communities and one outpatient centre. Material and methods. The study was carried out with a qualitative methodology. The participants in the study were 18 patients that received treatment in therapeutic communities and one outpatient centre who were give n a semi-structured interview. Results: were analysed using the Constant Comparison Method, proposed by the Grounded Theory. Results. The results obtained show that the patients perceive they are more comfortable during withdrawal treatment with buprenorphine than with methadone. The patients further perceive that the buprenorphine treatment is easier to adapt to their daily lives, to which the possibility of dispensing it in pharmacies would contribute. They also say that the stigma associated with this pharmaceutical is less than with methadone. Conclusions. Patients think these characteristics and the absence of opioid effects facilitates the process of their incorporation in society (AU)

Development of a specific health-related quality of life test in drug abusers using the Rasch rating scale model.

A test has recently been designed for the measurement of health-related quality of life in drug abusers (Health-Related Quality of Life for Drug Abusers Test - HRQOLDA Test) based on the bi-axial concept of addiction. The aim of this work is to find out the metric properties of the test by applying the polytomous Rasch Rating Scale Model (RSM). The HRQOLDA Test was given to a sample of 358 drug abusers who began treatment in a Therapeutic Community. The Rating Scale Model (RSM) and the WINSTEPS programme were used for the analysis of its metric properties. The results shown here are an overall fit of data to the model. The items are adequately distributed over the HRQOL continuum. The response categories appear to be in order except for the category 'a little'. The test region which measures most accurately, and is most informative, is in the middle of the continuum. The test properties studied confirm the adequacy of the RSM for accurate measurement of HRQOL in drug abusers, providing a test for measuring this specific construct in this population.

Inducción a buprenorfina sublingual desde metadona: estudio clínico descriptivo en una muestra de pacientes tratados en una comunidad terapéutica / Induction from methadone to sublingual buprenorphine: a descriptive clinical trial in a methadone patients sample treated in therapeutic communities

Objetivo. Descripción y evaluación clínica del proceso de inducción a buprenorfina sublingual (Subutex®) en el contexto de una comunidad terapéutica, en pacientes que venían tomando metadona. Material y métodos. Estudio observacional (descriptivo), longitudinal prospectivo y abierto (diseño antes-después). Se utilizó un procedimiento de muestreo consecutivo no probabilístico. Una muestra de pacientes en tratamiento con metadona que ingresaron en una comunidad terapéutica fueron transferidos a buprenorfina sublingual (Subutex®). Posteriormente, las dosis de este fármaco se fueron reduciendo hasta su retirada dentro de un período de 16 semanas. Los pacientes cumplían criterios DSM-IV de dependencia de opiáceos, eran mayores de edad y firmaron un consentimiento informado. Todos los pacientes fueron evaluados antes y después de la toma de buprenorfina durante los cinco días que duró la inducción. El protocolo del estudio fue aprobado por el Comité Autonómico de Ensayos Clínicos de Andalucía y se ha desarrollado de acuerdo con la Declaración de Helsinki. Como medidas se han utilizado la Objective Opiate Withdrawal Scale (OOWS), la Subjective Opiate Withdrawal Scale (SOWS), el Test para la Evaluación de la Calidad de Vida en Adictos a Sustancias Psicoactivas (TECVASP), el General Health Questionnaire (GHQ-28), el Opiate Treatment Index (OTI) y el Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Resultados. Un total de 119 pacientes cumplieron los criterios de selección. De éstos, 46 sujetos fueron transferidos desde metadona a buprenorfina, mientras que los 73 restantes decidieron permanecer en tratamiento con metadona. Se observa una reducción de casi dos tercios en las puntuaciones de las escalas de abstinencia entre ambos momentos de la evaluación. Esta diferencia fue estadísticamente significativa tanto para el síndrome de abstinencia a opiáceos (SAO) objetivo (t = 4,679; g.l. = 44; p < 0,000) como para el SAO subjetivo (t = 4,886; grados de libertad (g.l.) = 44; p < 0,000). A medida que se incrementaban día a día las dosis medias de Subutex® los síntomas de abstinencia fueron disminuyendo durante los tres primeros días y, a partir del cuarto día, el SAO prácticamente habían desaparecido. Conclusiones. Los datos de este trabajo aportan más evidencias sobre la efectividad farmacológica, la seguridad y la comodidad del proceso de transferencia desde el tratamiento con metadona al de buprenorfina

Objective. Description and clinical assessment of buprenorphine induction in a sample of opiate-dependent patients transferred from methadone in therapeutic communities. Material and methods. Observational (descriptive), open longitudinal prospective study («before-after» design). A non-probabilistic consecutive sampling procedure was used. A sample of patients in treatment with methadone who were admitted to five therapeutic communities was transferred to buprenorphine induction (Subutex®). When it was considered appropriate, gradual reduction was begun to reduce the buprenorphine dose to 0 mg within 16 weeks. The patients met DSM-IV-TR criteria for Opiate Dependence, were adults and signed an informed consent release. All of the patients were evaluated at three times; baseline assessment (Mo), after one month of treatment (M1) and after three months (M2). The study protocol was approved by the Andalusian Regional Committee for Clinical Trials, and was conducted in accordance with the Declaration of Helsinki. The measurement instruments are: The Objective Opiate Withdrawal Scale (OOWS), the Subjective Opiate Withdrawal Scale (SOWS), the Health Related Quality of Life for Drug Abusers Test (HRQoLDA Test), the General Health Questionnaire (GHQ-28), the Opiate Treatment Index (OTI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Results. A total of 119 patients met the selection criteria. Of these, 46 subjects were transferred from methadone to buprenorphine, while the remaining 73 decided to stay on their methadone maintenance treatment. A clinically significant reduction in opiate withdrawal scores between assessment points was observed. This differences was statistically significant too for objective OWS (t = 4,679; g.l. = 44; p < 0,000) and for subjective OWS (t = 4,886; g.l. = 44; p < 0,000). The day by day increment of Subutex® doses was associated to go down withdrawal symptoms during the first three days. From fourth day to forward the OWS symptoms was negligible. Conclusions. Data of this paper provide more evidences about pharmacologic effectiveness, security and comfort of transfer from methadone to buprenorphine process

Test para la Evaluación de la Calidad de Vida en Adictos a Sustancias Psicoactivas (TECVASP): estudios de fiabilidad y validez / Assessment of the quality of life in psychoactive substance addicts test: reliability and validity studies

Objetivo. Estudiar la fiabilidad y aportar evidencias de validez del Test para la Evaluación de la Calidad de Vida en Adictos a Sustancias Psicoactivas (TECVASP). Método. En la investigación participaron 359 pacientes de cinco comunidades terapéuticas gestionadas por la Fundación Andaluza para la Atención a las Drogodependencias. Además del TECVASP, se aplicó la sección de «uso de sustancias» de la versión española del Maudsley Addiction Profile (MAP) y se recogió información sociodemográfica de los pacientes. Resultados. La estimación de fiabilidad, calculada con el coeficiente alfa de Cronbach, fue adecuada, con un valor de 0,861. En los tres estudios de validación se muestran evidencias a favor del uso de las puntuaciones del test para el objetivo previsto, ya que se detectan diferencias en la calidad de vida relacionada con la salud (CVRS) en pacientes: 1) incluidos en programa de desintoxicación con la de otros que están en deshabituación, 2) consumidores de «rebujo» (mezcla de heroína y cocaína base) que están en programa de tratamiento con metadona con la de otros que no están en tratamiento con metadona, y 3) al ingreso en comunidad terapéutica y al finalizar el tratamiento. Conclusiones. Las propiedades métricas obtenidas señalan la pertinencia del TECVASP para medir la CVRS de personas drogodependientes, recomendando su uso cuando se quiera estimar la CVRS de pacientes que se encuentran en distintas fases del tratamiento de la dependencia

Objective. In this work, different studies of the metric properties —estimate of reliability and evidences of validity— of Test for the Evaluation of the Quality of Life in Addicts to Psychoactive Substances (TEQLAPS) is carried out. Method. In the investigation 359 patients of five therapeutic communities participated egotiated by the Andalusian Foundation for Attention to Drugs Addictions. Besides the TEQLASP, the section of «use of substances» of the Spanish version of the Maudsley Addiction Profile (MAP) were delivered, and the patients’ sociodemographics information was picked up. Results. The estimate of reliability, calculated with Cronbach alpha coefficient, it was adequate, with a value of 0,861. In the three studies of validation evidences are shown in favour of test use for foreseen objective, since: 1) differences in the Health Related Quality of Live (HRQL) between patients in detoxification and dishabituation program are detected; 2) differences in the HRQL between heroin with base cocaine abusers that are in treatment program with methadone and not in treatment with methadone are detected; and, 3) differences in the HRQL from the patients to the entrance in the therapeutic communities and when concluding the treatment are detected. Conclusions. The obtained metric properties point out the relevancy of the TEQLASP to measure the HRQL of drug addict people, recommending their use when the HRQL of patients that are in different phases of the treatment of the dependence to differ