Cognitive predictors of illness course at 12 months after first-episode of depression.

Major Depressive Disorder (MDD) entails cognitive dysfunction in many cognitive domains, but it is still uncertain whether such deficits are present in the early stages. The purpose of the study is to determine the cognitive performance in first episode depression (FED) exploring the presence of different cognitive profiles, and the role of cognition in FED at baseline and long-term. Ninety subjects (18-50 years) were included, 50 patients with a FED and 40 healthy controls. Participants were assessed with a neuropsychological battery, covering language, attention, verbal memory, processing speed and executive domains. Neuropsychological group comparisons were performed with MANOVAs. A hierarchical cluster analysis was run to identify clusters of patients with similar neuropsychological performance. Two generalized linear models were built to predict baseline HDRS-17 and changes at 12 months. Patients performed significantly worse than healthy controls in language, attention/working memory, verbal memory, processing speed and executive functioning, with moderate to large effect sizes (0.5 - 1). Two clusters were found: cognitively preserved patients (n=37) and cognitively impaired patients (n=13). Large effect sizes of cognitive impairment in FED were observed between the two cognitive clusters (preserved and impaired). Depressive symptoms at baseline were predicted by verbal memory (p=0.003), while 12-month changes were predicted by executive function (p=0.041) and language (p=0.037). Cognitive performance predicted depressive symptoms at baseline and at follow-up, pointing to the usefulness of cognitive assessment even at the commencement of the illness.

Encuesta sobre la satisfacción de los pacientes dependientes de heroína de la Comunidad de Valencia con los centros de tratamiento con metadona / A survey about the satisfaction of heroin-dependent patients from Valencia region (Spain) with methadone treatment centres

Objetivo. Valorar multidimensionalmente la satisfacción de los pacientes dependientes de heroína con los centros de tratamiento con metadona de la Comunidad de Valencia. Método. Se solicitó a 278 pacientes que llegaron consecutivamente a los 12 centros (9 convencionales y 3 unidades móviles) seleccionados aleatoriamente, su participación en una encuesta que incluía la Escala de Verona para valorar la Satisfacción con los Servicios en los centros de Tratamiento con Metadona (VSSS-MT). Resultados. Ciento sesenta y seis (59,7%) pacientes aceptaron participar. La media global de las puntuaciones en la VSSS-MT fue 3,5 (DT = 0,6), siendo el rango de puntuaciones de dicha escala 1-5 (1: malísima y 5: excelente). El porcentaje de pacientes que se sintió satisfecho (VSSS-MT > 3) fue, por categorías, el siguiente: valoración global, 82,4%; intervenciones básicas 80,6%; intervenciones específi cas 59,3%; habilidades de los trabajadores sociales 66,3%; habilidades de los psicólogos 71,7%. En un análisis de regresión múltiple, los predictores independientes de la satisfacción con el tratamiento de mantenimiento con metadona (TMM) fueron: hallarse en régimen de take-home o dosis para llevar a casa, un menor número de días desde el último ajuste de dosis, y recibir el TMM en un centro convencional -y no en unidad móvil-. Este modelo de regresión explicó el 9% de la varianza de las puntuaciones totales de la VSSS-MT. Conclusiones. Los pacientes dependientes de opioides de la Comunidad de Valencia se sienten ligeramente satisfechos con los centros de tratamiento con metadona. Las variables más intensamente asociadas con tal satisfacción explican un limitado porcentaje de la varianza de la puntuación global de la VSSS-MT (AU)

Objective. To multidimensionally assess heroin-dependent patients' satisfaction with methadone treatment centres from Valencia Region (Spain). Method. An independent interviewer recruited 278 consecutively arriving patients from 12 randomly selected centres (9 conventional centres and 3 mobile methadone clinics) to participate in a survey that included the Verona Service Satisfaction Scale for Methadone Treatment (VSSS-MT). Results. One hundred sixty-six (59.7%) patients agreed to participate. Mean overall VSSS-MT score was 3.5 (SD = 0.6), on a 1-5 point scale (1 = terrible; 5 = excellent). The percentage of patients who felt satisfied (VSSS-MT scores > 3) was, by category: overall satisfaction, 82.4%; basic interventions, 80.6%; specific interventions, 59.2%; social worker skills, 66.3%; psychologist skills, 71.6%. In a multiple regression analysis, methadone take-home privileges, lower number of days from the last dose adjustment, and being treated in a conventional (not mobile) methadone clinic appeared as independent predictors of satisfaction with methadone maintenance treatment. This regression model accounted for 9% of the variance in VSSS-MT overall scores. Conclusions. The survey results show that heroin-dependent patients from Valencia Region are slightly satisfied with methadone treatment centres. The variables most strongly related to this satisfaction accounted for only a limited amount of the variance in VSSS-MT overall scores (AU)

Técnicas de intervención cognitivo-conductuales para el tratamiento de la dependencia de la cocaína / Cognitive-behavioral therapy for the treatment of cocaine dependence

Las dos últimas décadas se han caracterizado por un notable avance en el desarrollo de terapias cognitivo-conductuales efectivas para la dependencia de cocaína, trastorno para el cual aún no se han identificado tratamientos farmacológicos efectivos. Se revisa la creciente literatura sobre la eficacia de diferentes tipos de técnicas cognitivoconductuales para el tratamiento de los trastornos por uso de cocaína (la integración del abordaje de refuerzo comunitario y las técnicas de manejo de contingencias, el tratamiento de exposición a estímulos, las técnicas de prevención de recaídas y la entrevista motivacional) y se comentan algunos de los desafíos y dificultades que surgen al transferir a la práctica clínica dichas intervenciones cognitivo-conductuales. En conjunto, la presente revisión describe un área pujante de investigación que todavía tiene mucho que aportar al tratamiento de los trastornos por uso de cocaína

The past two decades have been characterized by marked progress in the development of effective cognitive- behavioral therapies for cocaine dependence, for which no generally effective pharmacotherapies have been identified. The increasing literature on the efficacy of several types of cognitive-behavioral therapies (community reinforcement approach plus vouchers, cue exposure treatment, relapse prevention therapy and motivational interviewing) for cocaine use disorders is reviewed, followed by discussion of a number of issues that arise when integrating these cognitive-behavioral interventions into clinical practice. Overall, this review describes a vigorous area of research that has much to contribute to the treatment of cocaine use disorders

[Cognitive-behavioral therapy for the treatment of cocaine dependence]. / Técnicas de intervención cognitivo-conductuales para el tratamiento de la dependencia de la cocaína.

The past two decades have been characterized by marked progress in the development of effective cognitive- behavioral therapies for cocaine dependence, for which no generally effective pharmacotherapies have been identified. The increasing literature on the efficacy of several types of cognitive-behavioral therapies (community reinforcement approach plus vouchers, cue exposure treatment, relapse prevention therapy and motivational interviewing) for cocaine use disorders is reviewed, followed by discussion of a number of issues that arise when integrating these cognitive-behavioral interventions into clinical practice. Overall, this review describes a vigorous area of research that has much to contribute to the treatment of cocaine use disorders.

Estadios de cambio en los trastornos de la conducta alimentaria: consideraciones sobre su conceptualización y evaluación / Stages of change in eating disorders: consideration about its conceptualization and assessment

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Methadone tapering plus amantadine to detoxify heroin-dependent inpatients with or without an active cocaine use disorder: two randomised controlled trials.

The efficacy of methadone tapering plus amantadine to detoxify heroin-dependent patients with or without an active cocaine use disorder was studied in a closed unit with two successive double-blind, placebo-controlled, 14-day trials. In the first trial, 40 heroin-dependent inpatients with an active cocaine use disorder were treated using methadone tapering, as well as amantadine (200-300 mg per day) or placebo. In the second trial, 40 heroin-dependent inpatients without an active cocaine use disorder received the same treatment. In both the trials, amantadine did not have a statistically significant effect on treatment completion, nor did it contribute, in completers, to a more rapid reduction in craving and opiate withdrawal. In the first trial, women were six times more likely than men to be non-completers, and on the last day of treatment, the first trial's completers and non-completers presented a comparable clinical state.

A controlled trial of daily versus thrice-weekly buprenorphine administration for the treatment of opioid dependence.

This study was aimed at determining whether thrice-weekly administration of buprenorphine is as effective as daily administration for treating opioid dependence. A total of 60 treatment-seeking opioid addicts were randomly assigned to take buprenorphine tablets sublingually either every day (8 mg) or thrice-weekly (16 mg on Mondays and Wednesdays and 24 mg on Fridays) over the course of a 12-week, double-blind, parallel trial. The buprenorphine dosing schedule had no significant effect on treatment retention. The rates of opioid-positive urine tests were significantly higher among those subjects who were given buprenorphine thrice weekly (58.5%) than among those who took it daily (46.6%). An analysis of the completers did not detect a significant effect of buprenorphine dosing schedule. The results obtained in our clinical trials indicate the advisability of daily doses of buprenorphine, at least at the beginning of a maintenance programme.

Processes of change assessment in heroin addicts following the Prochaska and DiClemente transtheoretical model.

The processes of change dimension of Prochaska and DiClemente's transtheoretical model of change is tested in a sample of opiate addicts for the first time. A self-report (The Processes of Change Inventory for Opiate Addicts, PCI-OA) designed to assess the frequency of processes of change was administered in a sample of 178 heroin addicts in order to study its reliability, validity and discriminative efficiency. An alpha-reliability coefficient of 0.87 was obtained. A principal component analysis of the measure revealed a three-component solution which accounted for 34% of the variance: 'contemplation and preparation processes', 'processes of action', and 'processes of the final part of the action phase and maintenance'. Comparisons between abstinent and non-abstinent subjects revealed significant differences (P < 0.0001) in two of the ten processes considered: counterconditioning and stimulus control. A stepwise discriminant analysis yielded a linear combination of eight processes that correctly identified 78% of the total sample. Theoretical and clinical implications of the results are discussed, suggesting that the PCI-OA can be considered as a useful self-report instrument for identifying which processes of change are being used by a specific opiate-dependent patient.

Cocaine use immediately prior to entry in an inpatient heroin detoxification unit as a predictor of discharges against medical advice.

Detection of benzyolecgonine, the major metabolite of cocaine, in the urinalysis conducted on the first day of an inpatient heroin detoxification treatment program was studied as a predictor of discharge against medical advice (AMA). With this aim, we conducted a chart-review procedure of 275 heroin dependents (DSM-III-R) who received methadone or dextropropoxyphene chlorhydrate to treat Opioid Withdrawal Syndrome. Data were analyzed following a case-control design. The 49 (17.8%) patients who did not complete the treatment due to discharged AMA were characterized by having achieved total heroin abstinence during fewer months from the time they began consumption of this substance to the time of hospitalization (p = .001). Moreover, those patients who requested discharge AMA were characterized by more frequent detection of benzoylecgonine in their urine on the day of admission (p = .004). The value of the odds ratio of this association was 3.81 (95% CI; 1.30 to 11.04). Lastly, noncompleters due to discharge AMA were more likely to be single than ever married (p = .037). The logistic regression model confirmed that there is a significant relationship between an AMA event and the presence of benzoylecgonine in urine upon beginning detoxification and to a shorter duration of the period of total heroin abstinence. In the discussion, the influence that recent interruption of cocaine consumption has on the decision to drop out of a detoxification program AMA is considered.

[Situation determinants of heroin consumption in opiate-dependent subjects: a psychometric approach]. / Determinantes situacionales del consumo de heroína en sujetos dependientes de opiáceos: una aproximación psicométrica.

Evaluation of the situations related to heroin-taking, and the consequent delimitation and characterization of the patient's drug-taking pattern, should be one of the first stages in the design of an individualized treatment in the context of a cognitive-behavioural therapeutic approach. The Inventory of Drug-Taking Situations (Heroin) (IDTS[H]; Annis y Martin, 1985) was administered to a sample of 124 opiate dependent patients in order to study its reliability and factor structure. An Alpha reliability coefficient of .93 was obtained. A principal component analysis of the measure revealed a five-component solution which accounted for 50.6% of the variance. Nevertheless, a confirmatory factor analysis of the self-report showed that the original eight-factor model provides an acceptable fit to the data. Lastly, the frequency at which each of the eight original IDTS(H) subscales appeared as the highest risk situation in the profile was calculated, showing the predominance of Negative Emotional States (35%) and Social Pressure to Use (18%) as the two most important high-risk situations. Theoretical and clinical implications of the results are discussed.

The apomorphine test in heroin addicts.

Chronic administration of opiates to laboratory animals induces supersensitivity of the dopamine receptors in the cerebral areas innervated by the mesotelencephalic dopamine pathways. In humans, the in vivo study of the sensitivity of the dopamine neurotransmitter system in Parkinson's patients can be done by means of the apomorphine test, which consists of measuring the number of yawns induced by the subcutaneous administration of low doses of apomorphine (0.005 mg/kg). If chronic opiate use in humans, as in experimental animals, results in supersensitivity of the dopamine systems, the apomorphine test could differentiate between heroin addicts and healthy volunteers, with the former showing greater number of yawns. In order to test this hypothesis we carried out the apomorphine test in two groups of subjects: a group of male heroin addicts attending our Addiction Treatment Centre for detoxification and the other group consisting of healthy volunteer male university students. Results showed that subcutaneous apomorphine administration induced a greater number of yawns (p < 0.05) in the group of heroin addicts as compared with the group of healthy volunteers, suggesting that heroin addicts present an enhanced sensitivity of the dopamine nuerotransmitter system.

[Impulsive behaviors in opiate-dependent subjects treated with naltrexone]. / Conductas impulsivas en sujetos dependientes de opíaceos tratados con naltrexona.

Thirty three heroin dependents (DSM-III-R) attending a naltrexone clinic were assessed to see if their histories of bulimic and non-suicidal self-aggressive behaviours would allow to predict the therapeutic response of the opioid antagonist. Neither these impulsive behaviours non previous suicide attempts or over-doses could predict such a response, which was evaluated according to the time spent under treatment with naltrexone. Before the administration of naltrexone, one or more of the studied impulsive conducts were detected in 87.8% of the sample (n = 29). None of the patients combined enough criteria to be diagnosed of bulimia (DSM-III-R). In 32 patients the occurrence of changes in the impulsive behaviours studied during the treatment period with the opioid antagonist were determined. These variations were not related to the determinations of abuse drugs in urine or with intake of psychoactive drugs. During the treatment with naltrexone, 15 patients ceased to present self-injuries without suicidal purposes and none of the patients began these behaviours for the first time. However, some patients without a previous history of bulimic behaviour developed this condition during the administration of the opioid antagonist. In this sense, four subgroups of patients can be differentiated according to the moment in which the bulimic behaviour appeared: subgroup A includes 7 individuals (21.7%) who discontinued this behaviour upon receiving the antagonist, while subgroup B (n = 3; 9.3%) is made up of those who presented this behaviour during both heroin consumption and the administration of naltrexone.(ABSTRACT TRUNCATED AT 250 WORDS)