Tiaprida, una alternativa de tratamiento en el trastorno por uso de alcohol: a propósito de un caso / Tiapride, an alternative treatment in alcohol use disorder: a case report

Objetivo: Exponer a través de un caso clínico el uso de tiaprida para la desintoxicación de alcohol en un paciente con diagnóstico de trastorno por consumo de alcohol grave 303.90 (F10.20).Caso clínicoUna mujer de 50 años, en seguimiento en la Unidad de Conductas Adictivas desde septiembre de 2016 hasta la actualidad, con diagnósticos de trastorno de adaptación 309.4 (F43.25) con alteración mixta de las emociones o de la conducta, trastorno por consumo de alcohol grave 303.90 (F10.20) y descompensación maniforme, al cual se le instaura el tratamiento con tiaprida.ResultadosLos estudios consultados demuestran la eficacia y seguridad de tiapride para el síndrome de abstinencia a alcohol tanto en ámbito ambulatorio como hospitalario, en monoterapia o en politerapia con benzodiacepinas y/o antiepilépticos, siendo usado también en la agitación y/o la sintomatología psicótica.ConclusionesSe ha observado que en el síndrome de abstinencia a alcohol la tiaprida es eficaz, pudiendo incluso tenerlo en cuenta como tratamiento coadyuvante a benzodiacepinas o anticonvulsivantes. Con vistas a futuro, se deberían tener en cuenta la farmacogenética que afectan al trastorno por consumo de alcohol, con lo que se podría beneficiar de menores efectos adversos una terapia personalizada individualizada. (AU)

Objective: Present a clinical case report on the use of tiapride for alcohol detoxification in a patient with a diagnosis of severe alcohol use disorder 303.90 (F10.20).Clinical case report50 year-old female, under follow-up in the Addictive Behavior Unit from September 2016 to present, with diagnoses of adjustment disorder 309.4 (F43.25)Mixed disturbance of emotions or behavior, severe alcohol use disorder 303.90 (F10.20) and severe decompensation, who is treated with tiapride.ResultsThe studies consulted demonstrate the efficacy and safety of tiapride for alcohol withdrawal syndrome in both outpatient and inpatient settings, in monotherapy or in polytherapy with benzodiazepines and/or antiepileptics, being also used in agitation and/or psychotic symptomatology.ConclusionsIn alcohol withdrawal syndrome, tiapride has been found to be effective and can even be considered as an adjunctive treatment to benzodiazepines or anticonvulsants. With a view to the future, pharmacogenetics affecting alcohol use disorder should be taken into account, so that individualized personalized therapy could benefit from fewer adverse effects. (AU)

Patología dual en pacientes inmigrantes con Trastorno por Uso de Alcohol: seguimiento tras dos años de tratamiento / Dual pathology in immigrant patients with Alcohol Use Disorder: follow-up after two years of treatment

Introducción: Existe una elevada prevalencia de trastornos psiquiátricos en el trastorno por uso de alcohol. Lapresencia de patología dual en el paciente disminuye el mantenimiento de la abstinencia y aumenta la probabilidad derecaída, lo que complica el tratamiento. Los objetivos de esteestudio son: Analizar la evolución a dos años de tratamiento de una población de pacientes inmigrantes con trastorno por uso de alcohol asociado a trastornos psiquiátricos,comparándola con una muestra de pacientes inmigrantes sinpatología dual e investigar los diagnósticos de patología psiquiátrica asociada al trastorno por uso de alcohol.Metodología. Se compararon dos poblaciones de pacientes inmigrantes con trastorno por uso de alcohol (DSM-5),una con trastornos psiquiátricos asociados, compuesta por219 pacientes y otra de 169 pacientes sin patología dual.Resultados y conclusiones. Los trastornos psiquiátricosmás frecuentes asociados al trastorno por uso de alcoholson el de personalidad (51,6%), el adaptativo y depresivo(22,8%), los de ansiedad (15,5%), los de conducta alimentaria y obsesivos compulsivos (5,9%), el bipolar (5%) y el deesquizofrenia (2,3%). El seguimiento a 2 años de tratamientopresenta que el 27% de la población inmigrante con patología dual se mantiene en abstinencia frente al 41,4% de la quesolo padece trastorno por uso de alcohol: Se constata unapeor evolución en los pacientes con patología dual. (AU)

Introduction: There is a high prevalence of comorbidpsychiatric disorders in alcohol abuse disorder. The presenceof dual diagnosis in patients decreases the maintenance ofabstinence and increases the likelihood of relapse, whichmakes treatment more complicated. The aims of thisstudy are: to investigate the progression along two yearsof treatment of a sample of migrant patients affected byalcohol abuse disorder associated with psychiatric disorders,comparing it with a sample of migrant patients withoutdual diagnosis and investigating the diagnoses of comorbidpsychiatric pathology with alcohol abuse disorder.Methods. Two populations of migrant patients withalcohol abuse disorder (DSM-5) were compared, one withcomorbid psychiatric disorders consisting of 219 patientsand the other of 169 patients without dual diagnosis.Results and conclusions. The most frequent psychiatricdisorders associated with alcohol use disorder are personalitydisorders (51,6%), adjustment and depressive disorders(22,8%), anxiety disorders (15,5%), eating disorders andobsessive-compulsive disorders (5,9%), bipolar disorders(5%) and schizophrenia (2,3%). The two-year follow-uptreatment shows that 27% of immigrant sample with dualdiagnosis remains in abstinence compared to 41,4% of thosewho only suffer from alcohol use disorder: Worse outcomesare observed in patients with dual diagnosis. (AU)

Tiapride, una alternativa de tratamiento para el trastorno por el uso de alcohol: a propósito de un caso / Tiapride, an alternative treatment for alcohol use disorder: a case report

Objetivo: Exponer a través de un caso clínico el uso de tiapride para la desintoxicación de alcohol en un paciente con diagnóstico de trastorno por el uso de alcohol.Caso clínicoUna mujer de 50 años, en seguimiento en la Unidad de Conductas Adictivas desde septiembre de 2016 hasta la actualidad, con diagnósticos de trastorno de adaptación con alteración mixta de las emociones, trastorno por consumo de alcohol y descompensación maniforme, ante lo cual se le instaura el tratamiento con tiapride.ResultadosLos estudios consultados demuestran la eficacia y seguridad de tiapride para el síndrome de abstinencia al alcohol, tanto en el ámbito ambulatorio como hospitalario, en monoterapia o en politerapia con benzodiacepinas y/o antiepilépticos, siendo usado también en la agitación y/o sintomatología psicótica.ConclusionesEn el síndrome de abstinencia al alcohol se ha observado que el tiapride es eficaz, pudiendo incluso tenerlo en cuenta como un tratamiento coadyuvante a las benzodiacepinas o los anticonvulsivantes. Con vistas al futuro, se deberían tener en cuenta la farmacogenética que afecta al trastorno por consumo de alcohol, con lo que se podría beneficiar, con menores efectos adversos, a una terapia personalizada individualizada. (AU)

Objective: To present a case report on the use of tiapride for alcohol detoxification in a patient diagnosed with alcohol use disorder.Clinical caseA 50-year-old woman, under follow-up in the Addictive Behaviour Unit from September 2016 to date, with a diagnosis of adjustment disorder with mixed emotional disturbance, alcohol use disorder and mood decompensation, for which treatment with tiapride was initiated.ResultsThe studies consulted demonstrate the efficacy and safety of tiapride for alcohol withdrawal syndrome, in both outpatient and inpatient settings, in monotherapy or in polytherapy with benzodiazepines and/or antiepileptics, and used for agitation and/or psychotic symptoms.ConclusionsTiapride has been found to be effective in alcohol withdrawal syndrome and could even be considered adjunctive treatment to benzodiazepines or anticonvulsants. Looking to the future, pharmacogenetics affecting alcohol use disorder should be considered, and this could result in tailored, personalised therapy, with fewer adverse effects. (AU)

Trastorno por Uso de Alcohol enpacientes inmigrantes: seguimiento a2 años de tratamiento / Alcohol Use Disorder in immigrant patients: 2-years of follow-up treatment

Introducción: En las últimas décadas, la poblacióninmigrante ha aumentado sensiblemente en los paísesoccidentales, que no solo les influye culturalmente sinotambién en su patrón de consumo de alcohol. El transcursode la inmigración puede originar estrés social, que es posibleque cause desarraigo, frustración de sus expectativas omarginalidad, que son factores de riesgo para un aumentodel consumo de alcohol, posiblemente con el fin de afrontarsus diferentes problemas. Los objetivos de este trabajo son:investigar la evolución a dos años de tratamiento de unapoblación de pacientes inmigrantes con Trastorno por Uso deAlcohol, comparándola con una muestra de origen español,y analizar la evolución de los pacientes inmigrantes según elárea geográfica de origen.Metodología. Se compararon dos poblaciones conTrastorno por Uso de Alcohol (DSM-V), una de inmigrantescompuesta por 388 pacientes y otra de control, de origenespañol, compuesta por 262 pacientes. Asimismo, se estudióla evolución de los pacientes según el área geográfica a laque pertenecen.Resultados y conclusiones. El 45,4 % de los pacientes dela población española se mantiene en abstinencia a los 2 añosde tratamiento frente al 33,8 % de la población inmigrante.Los pacientes que consiguen una mayor abstinencia sonlos de origen árabe (52,3 %). Sin embargo, hay una mayoradherencia en América del Sur/Cono Sur (67,7 %). Los paísesque tienen una peor evolución en la abstinencia son los deAmérica del Sur/Países del Norte (26,2 %) y los que procedende Europa Oriental (29,1 %). (AU)

Introduction: In recent decades the immigrant populationhas increased significantly in Western countries, which notonly influences the former culturally but also in their alcoholconsumption patterns. The course of immigration can causesocial stress, which can lead to uprooting, frustration oftheir expectations or marginality, which are risk factors foran increase in alcohol consumption, possibly in order toface their different problems. The aims of this study are: toinvestigate the progression along two years of treatment ofa sample of immigrant patients with Alcohol Use Disorder,to compare it with a sample of Spanish natives and toanalyze the evolution of immigrant patients according tothe geographical area of origin.Methods. Two samples of individuals with AlcoholUse Disorder (DSM-V) were compared: one sample of 388immigrant patients and a control sample composed of262 Spanish patients. Likewise, the patients were studiedaccording to the geographical area to which they belong.Results and conclusions. 45.4% of patients in theSpanish sample remain in abstinence after 2 years oftreatment compared to 33.8% in the immigrant sample.Patients who achieve greater abstinence are those of Araborigin (52.3%). However, there is a better adherence in SouthAmerica/Southern Cone (67.7%). The countries with theworst outcomes in abstinence are those in South America/Northern countries (26.2%) and those in Eastern Europe(29.1%). (AU)

Therapeutic dilemma: alcohol withdrawal syndrome and concurrent hepatic encephalopathy. A case report. / Dilema terapéutico: síndrome de abstinencia alcohólica y encefalopatía hepática concurrentes. A propósito de un caso.

Alcohol use disorder is one of the main causes of morbidity and mortality in the world. Alcoholic liver disease is a common complication of this disorder, and hepatic encephalopathy is a serious complication of alcoholic cirrhosis. Precipitating factors may be related to infection, gastrointestinal bleeding, dehydration or the effects of psychotropic drugs (e.g. benzodiazepines and non-benzodiazepine hypnotics). We present a case of the hospital management of a patient with a severe alcohol use disorder, cirrhosis and hepatic encephalopathy who developed alcohol withdrawal symptoms while in hospital, and discuss the complexity of the antagonistic management of a GABAergic delirium characteristic of hepatic encephalopathy in the context of a glutamatergic-noradrenergic delirium due to alcohol withdrawal.

Dilema terapéutico: síndrome de abstinencia alcohólica y encefalopatía hepática concurrentes. A propósito de un caso / Therapeutic dilemma: alcohol withdrawal syndrome and concurrent hepatic encephalopathy. A case report

RESUMEN El trastorno por consumo de alcohol es una de las principales causas de morbimortalidad en el mundo. La enfermedad hepática alcohólica es una complicación común de este trastorno y la encefalopatía hepática es una seria comorbilidad de la cirrosis alcohólica. Los factores precipitantes pueden relacionarse con infección, sangrado gastrointestinal, deshidratación o efectos de psicofármacos (p. ej., benzodiacepinas e hipnóticos no benzodiacepínicos). Se expone un caso del manejo hospitalario de un paciente con un trastorno severo por consumo de alcohol, cirrosis y encefalopatía hepática, quien desarrolla síntomas de abstinencia alcohólica durante su hospitalización y la complejidad del manejo antagónico de un delirium gabaérgico propio de la encefalopatía hepática en el contexto de un delirium glutamatérgico-noradrenérgico por abstinencia alcohólica.

ABSTRACT Alcohol use disorder is one of the main causes of morbidity and mortality in the world. Alcoholic liver disease is a common complication of this disorder, and hepatic encephalopathy is a serious complication of alcoholic cirrhosis. Precipitating factors may be related to infection, gastrointestinal bleeding, dehydration or the effects of psychotropic drugs (e.g. benzodiazepines and non-benzodiazepine hypnotics). We present a case of the hospital management of a patient with a severe alcohol use disorder, cirrhosis and hepatic encephalopathy who developed alcohol withdrawal symptoms while in hospital, and discuss the complexity of the antagonistic management of a GABAergic delirium characteristic of hepatic encephalopathy in the context of a glutamatergic-noradrenergic delirium due to alcohol withdrawal.

Incidence rates of admissions associated with alcohol withdrawal syndrome in Spain: Analysis of minimum basic data set 1999-2010. / Tasas de incidencia de ingresos asociados a síndrome de abstinencia alcohólica en España: análisis del conjunto mínimo básico de datos 1999-2010.

BACKGROUND: There are no data on the incidence of admissions associated with alcohol withdrawal syndrome (AWS) or about its trend over time in Spain. OBJECTIVE: To analyze the characteristics, incidence rates and trends over time of hospital admissions associated with AWS in Spanish public hospitals. MATERIAL AND METHOD: Analysis from the Spanish public hospitals minimum basic data set of hospital admissions with AWS (CIE9-MC 291.81), alcohol withdrawal delirium (CIE9-MC 291.0) and alcohol withdrawal hallucinosis (CIE9-MC 291.3), since 1999 to 2010. RESULTS: We identified 56,395 admissions associated with AWS. Mean age was 50.9 (SD 12.5) and 88% were male. The most frequent admission department was Internal Medicine (24.9%). The mean hospital stay was 12.6 days (SD 14.4) and mortality was 4.7%; 62.6% of cases developed AWS during an admission for another reason, mostly due to alcohol-related pathologies. Secondary diagnoses in patients hospitalized for AWS were related to alcohol consumption in more than half of the cases. The incidence rate of admissions associated with AWS in Spain remained stable from 1999 to 2010, with a small decline in the last 3 years of the period. The communities with the highest incidence were the Canary Islands, the Balearic Islands and Galicia. CONCLUSIONS: The incidence rate of admissions associated with AWS in Spanish public hospitals in the period 1999-2010 has remained stable with slight changes. There are differences in the incidence of AWS among the different autonomous communities.

Epidemiological and sociodemographic factors associated with complicated alcohol withdrawal syndrome. / Factores epidemiológicos y sociodemográficos asociados al síndrome de abstinencia alcohólica complicado.

OBJECTIVES: To analyse the influence of epidemiological and sociodemographic factors in complicated alcohol withdrawal syndrome (AWS). MATERIAL AND METHODS: A multicentre, observational prospective study was conducted on consecutively added patients with AWS hospitalised in internal medicine departments. We recorded sociodemographic, epidemiological, clinical and progression data. Complicated AWS was defined as that which progressed with seizures or delirium tremens. RESULTS: We studied 228 episodes of AWS in 219 patients. The mean age was 54.5 years (SD, 11.5), and 90.8% were men. AWS was the cause for hospitalisation in 39.9% of the patients. Some 27.1% of the cases presented seizures, and 32.4% presented delirium tremens. The daily quantity of alcohol ingested was 17.8 standard drink units (SD, 21.4), with 16.6 years of dependence (SD, 11.3). The pattern of alcohol abuse was regular in 82.8% of the patients. Some 38.4% of the patients were married or had a partner, and 45.6% had children. Some 72.7% of the patients were unemployed or retired. Some 68.5% had only completed primary studies. Some 4.8% consumed cannabis, 5.2% consumed cocaine and 3% consumed opioids. The independent variables related to complicated AWS were consumption of a drug other than alcohol (OR, 5.3; 95% CI 1.5-18.7), low education level (OR, 3.4; 95% CI 1.6-7.3) and hospitalisation for AWS (OR, 2.9; 95% CI 1.5-5.6). The model's receiver operating characteristic area was 0.718 (95% CI 0.643-0.793). CONCLUSIONS: Concomitant drug abuse and a low educational level could help identify patients at risk of complicated AWS.

Manejo del síndrome de abstinencia alcohólica en los pacientes críticos / Management of the syndrome of alcohol withdrawal in critical patients

El manejo del síndrome de abstinencia alcohólica es un desafío en los pacientes críticos. Con frecuencia, se desconocen los antecedentes de consumo de alcohol o este dato es incompleto, lo que limita la identificación de quienes pueden desarrollar este síndrome. El cese abrupto del consumo de alcohol coloca a estos pacientes en alto riesgo de sufrir síndrome de abstinencia alcohólica grave. Típicamente, las benzodiacepinas son consideradas las drogas de primera línea para el manejo de estos casos. Sin embargo, si el paciente progresa a un estado más grave con convulsiones o delirium tremens, puede ser necesario administrar medicación adyuvante a las benzodiacepinas, como el propofol o la dexmedetomidina, o emplear estas últimas drogas como terapias alternativas en aquellos que no responden a las benzodiacepinas. La aparición de convulsiones representa un fuerte factor de riesgo para la progresión a un síndrome de abstinencia alcohólica grave, con el desarrollo posterior de delirium tremens hasta en el 30% de los casos. El delirium tremens es el cuadro más grave y ocurre en el 5-20% de los pacientes con este síndrome, con una mortalidad hasta del 25% sin tratamiento y que se reduce al 0-1% con tratamiento. Es importante conocer el antecedente del consumo de alcohol para evitar el síndrome de abstinencia alcohólica o tratar rápidamente sus síntomas más graves, y mejorar la supervivencia de estos pacientes.(AU)

Alcohol withdrawal syndrome (AWS) is a well-known and a challenging condition occurring in critically ill patients. Frequently, history of alcohol abuse is unknown when the patient is admitted to the intensive care unit, limiting the identification of those who could develop AWS. The abrupt cessation of a heavy or constant drinking put these patients in high risk of suffering from this syndrome in its severe form. Typically, benzodiazepines are considered the first line of treatment. However, if clinical conditions progress to epileptic seizures or delirium tremens or are refractory to benzodiazepines, adjuvant drugs like propofol or dexmedetomidine might be an option to control the severe symptoms. Delirium tremens can occur in up to 30% of patients; it is the most severe picture with a mortality of 25% without treatment and that can be reduced to almost 0-1% with treatment. It is important to appropriately identify alcohol abuse in order to avoid the early clinical manifestations of AWS or rapidly treat its most severe symptoms and improve survival.(AU)

Inpatient alcohol withdrawal syndrome. / Síndrome de abstinencia alcohólica en pacientes hospitalizados.

A 55-year-old man was admitted for a femur fracture; an alcohol fetor was noted on admission. The following day, the patient began to experience tremors and nervousness. Intravenous haloperidol was administered. Shortly afterwards, the patient experienced two generalized seizures and then began to experience delirium and uncontrollable agitation. The patient was diagnosed with alcohol withdrawal syndrome; high doses of intravenous midazolam were prescribed and infused. A few hours later, the patient presented signs of respiratory depression, requiring a transfer to the intensive care unit. After a review of the medical history, it was determined that the patient had been admitted on 3 previous occasions due to alcohol withdrawal and had progressed to delirium tremens after experiencing seizures. Can the risk of alcohol withdrawal syndrome and the need for prophylactic treatment be assessed on admission? Were appropriate monitoring and treatment measures employed? Would it have been possible to change his outcome?

Estilos de vida de un grupo de alcohólicos abstinentes / Life styles in an abstemious alcoholics group

Introducción: una limitación importante de los estudios precedentes sobre la temática del alcoholismo desde un modelo de factores favorecedores y de riesgo, es el hecho de no considerar lo suficiente los mecanismos autorreguladores de la personalidad y cómo estos se interrelacionan con otras categorías de expresión más comportamental, como lo representan los estilos de vida, escasamente estudiados en alcohólicos en abstinencia; limitaciones superadas en la presente investigación. Para ello se trascendió el enfoque conductual hacia uno personológico que facilitó la comprensión de las dinámicas psicológicas que subyacen en la personalidad de individuos en proceso de rehabilitación psicosocial, a punto de partida de un estudio anterior. Objetivo: caracterizar el estilo de vida de un grupo de 10 alcohólicos abstinentes Métodos: investigación cualitativa-descriptiva de corte transversal y con diseño no experimental. Se emplearon la Entrevista, el Cuestionario de Factores, así como los test psicológicos Registro de la Actividad y Método Directo e Indirecto y la Escala autovalorativa Dembo-Rubinstein. Resultados: los estilos de vida de los alcohólicos abstinentes se caracterizaron por ser óptimos en 9 de los participantes y adecuado en uno de ellos, es decir, vinculados laboralmente, en ocasiones con más de una actividad económica, escaso tiempo libre, con familias reconstruidas, afiliación a grupos sociales diversos, y una amplia red de vínculos sociales. Se constató un funcionamiento psicosocial muy favorable, en las áreas social, familiar, laboral y personal, adherencia terapéutica, reinserción social y signos de desarrollo personal, focalizados en el cultivo de valores y la superación de cualidades negativas del carácter. La comparación de los estilos de vidas de este grupo con uno de alcohólicos en recuperación permitió apreciar diferencias notables entre ambos grupos con relación a las variables exploradas.Conclusión: por tanto, la rehabilitación....(AU)

Introduction: an important impediment of former studies from a model of favorable and risk factors is the fact of do not have into consideration the auto regulative mechanism of personality and how these mechanism are interrelated with other categories of behavior expression , such as lifestyle, shortage studied on abstemious alcoholic. This insufficiency was gained in the present research, behaviour focal point towards a personologic that easies the understanding of the psychological dynamics that underlies on the personality of individuals on psychosocial rehabilitation process which is a point of start of a former study. Objective: to describe the lifestyle of a group of ten abstemious alcoholics. Methods: a transversal cut and quality-descriptive research with non experimental design was carried out. Interview, Factors questionnaire, as well as, Activity Register, Indirect and Direct Method and Dembo–Rubinstein Scale psychological tests were used. Results: the lifestyles of the abstemious alcoholic were characterized for being optimum on 9 participants and adequate on one of them. It means that they are working and in occasions with more than one economic activity, recovered families, lack of free time, association to social groups and a wide social relation.A very favorable psychosocial function concerning to the social, familiar work and personal areas, as well as, treatment fulfillment, social reinsertion and personal development signs centered on the creation of values and the overcome of negative qualities of the character.The comparison of the lifestyles of this group with one group of the alcoholics in recovery phase allowed appreciating remarkable differences on both groups in relation with the explored variables. Conclusion: thus, psychosocial rehabilitation of alcoholic is visible through the quality of lifestyles and its psychosocial functioning(AU)

Factores psicológicos favorecedores de la abstinencia alcohólica en un grupo de alcohólicos rehabilitados / Positive psychological factors in the alcoholic abstinence on a group of rehabilitated alcoholic individuales

Objetivos: Caracterizar los factores psicológicos favorecedores de la abstinencia alcohólica en un grupo de abstinentes alcohólicos, los específicos, caracterizar los mecanismos autorreguladores de la personalidad de los abstinentes (sistema motivacional, autovaloración y dimensión temporal), e identificar las diferencias entre abstinentes y consumidores con relación a las variables de estudio. Métodos: investigación cualitativa-descriptiva de corte transversal y con diseño no experimental. Se emplearon la Entrevista, el Cuestionario de Factores, así como los tests psicológicos Registro de la Actividad y Métodos Directo e Indirecto y la Escala autovalorativa Dembo-Rubinstein. Resultados: Se evidenciaron diferencias en ambos grupos con respecto a las categorías de estudio y se observó un predominio de factores favorecedores de la abstinencia alcohólica en los abstinentes, mientras que en los consumidores predominaron los factores de riesgo de la abstinencia.Conclusiones: Los mecanismos autorreguladores de la personalidad en abstinentes alcohólicos se caracterizan por una motivación por el cambio muy buena, una autovaloración, perspectiva temporal y dimensión temporal adecuadas.Los factores psicológicos favorecedores de la abstinencia alcohólica en los alcohólicos abstinentes son: optimismo ante situaciones difíciles, solidaridad con otros alcohólicos, asistencia regular a grupos de Alcohólicos Anónimos (AA) y/o psicoterapéuticos, autovaloración positiva hacia el autocontrol emocional, la dimensión temporal y empleo útil del tiempo, conciencia de enfermedad, confianza en la rehabilitación, no creen poder consumir alcohol con control, creen en Dios o en poder superior, desarrollan valores morales, estables en pareja, laboral, buen humor, con planes futuros, entre otros(AU)

Objectives: to characterize the specific positive psychological factors in the alcoholic abstinence on a group of rehabilitated alcoholic individuals; to characterize the personality self regulators mechanisms of the abstinent individuals (motivational system, self assessment and temporal dimension); to identify the difference between abstinent individual and consumers according to the study variable. Methods: a non experimental design, transversal and descriptive- qualitative research was carried out. The questionnaire of Factors, Interview and the psychological tests Register of Activities and Direct and Indirect Methods and Dembo Rubenstein Self –Assessment Scale were used.Results: there were found differences between both groups according to the categories of study and a prevalence of positive factors in the alcoholic abstinence on the group of alcoholic individual, meanwhile on the group of consumers the risks of the abstinence prevailed. Conclusions: the personality self regulators mechanisms of the abstinent individuals are: optimism before complex situations, positive self assessment towards emotional self control, temporal dimension, useful use of time, awareness of the disease, trust on rehabilitation therapy, they do not believe that they are able to consume alcohol with control, they believe in God or in a Superior Divinity Power, they develop moral principles, they become stable with their couple and also with their work´s duties, they become liable with other alcoholic individuals, they are able to make plans for the future and to have a good disposition, they also have a regular participation to Anonym Alcoholic Groups or to Psychotherapy Groups among other characteristics(AU)

Guía de práctica clínica para la detección temprana, diagnóstico y tratamiento de la fase aguda de intoxicación de pacientes con abuso o dependencia del alcohol Parte I: Tamización, detección temprana y factores de riesgo en pacientes con abuso o dependencia del alcohol / Clinical practice guide for early detection, diagnosis and treatment of the acute intoxication phase in patients with alcohol abuse or dependencepart i: screening, early detection and risk factors in patients with alcohol abuse or dependence

Introducción: El alcohol es la segunda sustancia psicotrópica más usada en el mundo y el tercer factor de riesgo para muerte prematura y discapacidad. Su uso nocivo es un problema de salud pública mundial, dado su impacto personal, laboral, familiar, económico y social. Hasta el 70 % de las personas en riesgo de tener problemas con el alcohol no se detectan en la práctica médica, lo que hace pensar que se requieren medidas de tamizaje específicas que permitan la detección temprana y lleven a un tratamiento oportuno. Este artículo presenta la evidencia encontrada en tamización de abuso y dependencia de alcohol y en tamización e identificación de factores de riesgo; también presenta la evidencia relacionada con síndrome de abstinencia, delirium tremens y encefalopatía de Wernicke, con el fin promover una de detección temprana y un tratamiento oportuno. Método: Revisiones sistemáticas de la evidencia disponible y evaluación de las guías pertinentes identificadas en la literatura, para decidir, en cada pregunta, si se adopta o se adapta a una recomendación ya existente, o si se desarrollan recomendaciones de novo. Para las recomendaciones de novo y aquellas adaptadas, se realizó una síntesis de la evidencia, se elaboraron tablas de evidencia y se formularon las recomendaciones basadas en evidencia. Resultados: Se encuentra evidencia y se realizan recomendaciones para tamización pertinente y búsqueda de factores de riesgo, con el fin de realizar un diagnóstico y un manejo oportuno de abuso y dependencia a alcohol y sus complicaciones: síndrome de abstinencia, delirium tremens y encefalopatía de Wernicke...

Introduction: Worldwide, alcohol is the second most-used psychotropic substance and the third risk factor for early death and disability. Its noxious use is a world public health problem given its personal, labor, family, economic and social impact. 70 % of people under risk of having alcohol problems go undetected in medical practice, a fact that underlines the need for specific screening measures allowing early detection leading to timely treatment. This article presents evidence gathered by alcohol abuse and dependence screening as well as by risk factor identification and screening. It also presents evidence concerning withdrawal symptoms, delirium tremens and Wernicke’s encephalopathy in order to promote early detection and timely treatment. Methodology: Systematic revision of the evidence available together with an evaluation of pertinent guidelines found in literature so as to decide whether to adopt or adapt the existing recommendation for each question or to develop de novo recommendations. For de novo recommendations as well as those adapted, it was carried out an evidence synthesis, together with evidence tables and formulation of recommendations based on the evidence. Results: Evidence was found and recommendations were made for the pertinent screening and search of risk factors, in order to perform a diagnosis and carry out a timely management of alcohol abuse, dependence and ensuing complications: withdrawal syndrome, delirium tremens and Wernicke’s encephalopathy...

Guía de práctica clínica para la detección temprana, diagnóstico y tratamiento de la fase aguda de intoxicación de pacientes con abuso o dependencia del alcohol: Parte II: Evaluación y manejo de los pacientes con intoxicación aguda por alcohol / Clinical practice guide for early detection, diagnosis and treatment of the acute intoxication phase in patients with alcohol abuse or dependence Part II: evaluation and management of patients with acute alcohol intoxication

Introducción: El alcohol es la segunda sustancia psicotrópica más usada en el mundo y el tercer factor de riesgo para muerte prematura y discapacidad. Su uso nocivo es un problema de salud pública mundial, dado su impacto personal, laboral, familiar, económico y social. Es de suma importancia la identificación de intoxicación aguda por alcohol, el síndrome de abstinencia alcohólica y sus complicaciones, como delirium tremens y encefalopatía de Wernicke, para garantizar de esta manera un tratamiento oportuno para estos pacientes. Este artículo busca presentar la evidencia encontrada para el abordaje y el tratamiento de estas presentaciones clínicas. Método: Revisiones sistemáticas de la evidencia disponible y se evaluaron las guías pertinentes identificadas en la literatura, para decidir, en cada pregunta, si se adopta o se adapta a una recomendación ya existente, o bien, si se desarrollan recomendaciones de novo. Para las recomendaciones de novo y aquellas adaptadas, se realizó una síntesis de la evidencia, se elaboraron tablas de evidencia y se formularon las recomendaciones basadas en evidencia. Resultados: Se encuentra evidencia y se realizan recomendaciones para abordaje y tratamiento pertinente de intoxicación alcohólica aguda, síndrome de abstinencia, delirium tremens y encefalopatía de Wernicke...

Introduction: Worldwide, alcohol is the second most-used psychotropic substance and the third risk factor for early death and disability. Its noxious use is a world public health problem given its personal, labor, family, economic and social impact. The identification of acute alcohol intoxication is extremely important, as well as the alcohol withdrawal syndrome and its complications, such as delirium tremens and Wernicke’s encephalopathy in order to grant a timely treatment for those patients. This article introduces the evidence found so as to face and treat these clinic manifestations. Methodology: Systematic revision of the evi dence available together with an evaluation of pertinent guidelines found in literature so as to decide whether to adopt or adapt the existing recommendation for each question or to develop de novo recommendations. For de novo recommendations as well as those adapted, it was carried out an evidence synthesis, together with evidence tables and formulation of recommendations based on the evidence. Results: Evidence was found and recommendations were made for the diagnosis and treatment of acute alcohol intoxication, withdrawal syndrome, delirium tremens and Wernicke’s encephalopathy...

Recuperación de la adicción al alcohol: una transformación para promover la salud / Recovering from Alcohol Addiction: A Transformation to Promote Health / Recuperação do vício no álcool: uma transformação para promover a saúde

Se presenta una metasíntesis cuyo objetivo es establecer las características del proceso de recuperación en las personas que tienen adicción al alcohol. La metodología metasintética se fundamenta en la integración e interpretación de los hallazgos de algunos estudios cualitativos que permiten reconocer elementos sustanciales en la creación de nuevas interpretaciones en el fenómeno de recuperación de la adicción al alcohol. Para ubicar las fuentes se realizó una búsqueda en las bases de datos Ovid, Medline, Cinalh, Psych Info, Lilacs y Scielo, que comprendió el periodo 1988 a 2008, y en el que se ubicaron once artículos mediante las palabras clave: abuso de alcohol, adicción, dependencia, recuperación, experiencia e investigación cualitativa; de estos únicamente seis cumplieron con los criterios de calidad para ser incluidos en la metasíntesis. Los hallazgos permiten señalar que la recuperación es concebida como una trasformación con movimiento ascendente, conceptualización que implica reconocer la potencialidad de los aspectos positivos de las personas, alcanzar la madurez psicológica y espiritual, y lograr la paz y la libertad para actuar. En conclusión, este proceso de transformación inmerso en la recuperación debe ser reconocido por el profesional de enfermería para establecer, entre ese otro y ella, una fructífera interacción que permita el desarrollo del cuidado.

A meta-synthesis is presented to determine the features of the recovery process in persons who are addicted to alcohol. The metasynthesis method is founded on the integration and interpretation of findings from certain qualitative studies that shed light on substantial elements in the creation of new interpretations of the phenomenon of recovery from alcoholism. A search of the Ovid, Medline, Cinalh, PsychInfo, Lilacs and Scielo databases, covering the period from 1988 to 2008, was conducted to locate these sources and eleven (11) articles were found using the key words: alcohol abuse, addiction, dependency, recovery, experience and qualitative research. Only six of these words met the quality criteria to be included in the meta-synthesis. The findings indicate recovery is perceived as a transformation with an upward movement, a notion that implies recognizing the potential of a person's positive aspects, achieving psychological and spiritual maturity, and acquiring the peace and freedom to act. In conclusion, nursing professionals must recognize this process of transformation immersed in the recovery process, so as to establish fruitful interaction between themselves and the other person that allows care to develop.

Este artigo apresenta metassíntese, cujo objetivo é estabelecer as características do processo de recuperação nas pessoas que são viciadas no álcool. A metodologia metassintética se fundamenta na integração e interpretação dos descobrimentos de alguns estudos qualitativos que permitem reconhecer elementos substanciais na criação de novas interpretações no fenômeno de recuperação do vício no álcool. Para localizar as fontes, realizou-se uma busca nas bases de dados Ovid, Medline, Cinalh, Psych Info, Lilacs e SciELO, que compreendeu o período de 1988 a 2008, na qual se localizaram onze artigos a partir das palavras-chave: abuso de álcool, vício, dependência, recuperação, experiência e pesquisa qualitativa; destes onze, unicamente seis cumpriam os critérios de qualidade para serem incluídos na metassíntese. Os descobrimentos indicam que a recuperação é concebida como uma transformação com movimento ascendente, conceptualização que implica reconhecer a potencialidade dos aspectos positivos das pessoas, atingir a maturidade psicológica e espiritual, bem como a paz e a liberdade para agir. Em conclusão, esse processo de transformação imerso na recuperação deve ser reconhecido pelo profissional de enfermagem para estabelecer, entre este outro e ela, uma frutífera interação que permita o desenvolvimento do cuidado.

[Clinical Practice Guide for Early Detection, Diagnosis and Treatment of the Acute Intoxication Phase in Patients with Alcohol Abuse or Dependence: Part II: Evaluation and Management of Patients with Acute Alcohol Intoxication]. / Guía de práctica clínica para la detección temprana, diagnóstico y tratamiento de la fase aguda de intoxicación de pacientes con abuso o dependencia del alcohol: Parte II: Evaluación y manejo de los pacientes con intoxicación aguda por alcohol.

INTRODUCTION: Worldwide, alcohol is the second most-used psychotropic substance and the third risk factor for early death and disability. Its noxious use is a world public health problem given its personal, labor, family, economic and social impact. The identification of acute alcohol intoxication is extremely important, as well as the alcohol withdrawal syndrome and its complications, such as delirium tremens and Wernicke's encephalopathy in order to grant a timely treatment for those patients. This article introduces the evidence found so as to face and treat these clinic manifestations. METHODOLOGY: Systematic revision of the evidence available together with an evaluation of pertinent guidelines found in literature so as to decide whether to adopt or adapt the existing recommendation for each question or to develop de novo recommendations. For de novo recommendations as well as those adapted, it was carried out an evidence synthesis, together with evidence tables and formulation of recommendations based on the evidence. RESULTS: Evidence was found and recommendations were made for the diagnosis and treatment of acute alcohol intoxication, withdrawal syndrome, delirium tremens and Wernicke's encephalopathy.

[Clinical Practice Guide for Early Detection, Diagnosis and Treatment of the Acute Intoxication Phase in Patients with Alcohol Abuse or Dependence: Part I: Screening, Early Detection and Risk Factors in Patients with Alcohol Abuse or Dependence]. / Guía de práctica clínica para la detección temprana, diagnóstico y tratamiento de la fase aguda de intoxicación de pacientes con abuso o dependencia del alcohol: Parte I: Tamización, detección temprana y factores de riesgo en pacientes con abuso o dependencia del alcohol.

INTRODUCTION: Worldwide, alcohol is the second most-used psychotropic substance and the third risk factor for early death and disability. Its noxious use is a world public health problem given its personal, labor, family, economic and social impact. 70 % of people under risk of having alcohol problems go undetected in medical practice, a fact that underlines the need for specific screening measures allowing early detection leading to timely treatment. This article presents evidence gathered by alcohol abuse and dependence screening as well as by risk factor identification and screening. It also presents evidence concerning withdrawal symptoms, delirium tremens and Wernicke's encephalopathy in order to promote early detection and timely treatment. METHODOLOGY: Systematic revision of the evidence available together with an evaluation of pertinent guidelines found in literature so as to decide whether to adopt or adapt the existing recommendation for each question or to develop de novo recommendations. For de novo recommendations as well as those adapted, it was carried out an evidence synthesis, together with evidence tables and formulation of recommendations based on the evidence. RESULTS: Evidence was found and recommendations were made for the pertinent screening and search of risk factors, in order to perform a diagnosis and carry out a timely management of alcohol abuse, dependence and ensuing complications: withdrawal syndrome, delirium tremens and Wernicke's encephalopathy.

Estrategias de sostén de la abstinencia de alcohol en un grupo de dependientes rehabilitados / Alcohol Abstinence Support Strategies on a Rehabilitated Group of Dependant Patients

A un grupo de 10 hombres y 10 mujeres dependientes alcohólicos, con dos o más años de abstinencia, les aplicamos un cuestionario general, un test de afrontamiento de Lazarus y uno al informante clave. Se pretendió identificar las estrategias que estos sujetos han estado empleando para mantenerse abstinentes, resultando que: Todos reconocen la imposibilidad de consumir alcohol controladamente; se deprimieron en las etapas de consumo, varias veces el 100 por ciento de los hombres y el 75 por ciento de las mujeres, estas últimas por más de 3 meses, mientras que el 76 por ciento de los hombres solo por días o semanas. Las mujeres le atribuyeron su recuperación en primer lugar a Dios, a los médicos y a la familia, mientras que los hombres se comportan de manera similar, pero se atribuyen a si mismos la causa principal de su abstinencia. Todos valoraron positivamente la experiencia adictiva para su crecimiento personal; adquirieron nuevas metas y modificaron estilos de vida; muestran estilos de afrontamiento con predominio de la reevaluación positiva, aceptación de la responsabilidad y la búsqueda de apoyo social, este último muy alto en ambos grupos. Las estrategias empleadas incluyen afiliarse a grupos de autoayuda como son alcohólicos anónimos, iglesias evangélicas, instituciones de salud, culturales y al apoyo familiar. La resignificación de sus vidas, la superación de los defectos de carácter, asumir valores morales, metas para su desarrollo personal y compromisos sociales de ayudar a otros; los resultados indican que el alcoholismo puede devenir en oportunidad para incentivar el desarrollo humano(AU)

To a group of 20 persons, 10 males and 10 female alcohol dependents with 2 or more years in abstinence were applied a basic survey, a Lazaruss coping styles test and a one to a closely informant in order to identify the strategies they have been using to maintain abstinent themselves. Results were that all of them recognize the impossibility to consume alcohol with complete control; they all got depressed during the consumption period many times the 100 percent of men and the 75 percent of women, the last one for more than 3 month period, meanwhile the 76 percent of men got depressed for hardly day or week periods. Women attributed her recovering to God in the first place, then to doctors and family, meanwhile men behave alike but attributing themselves in the first place the successful in recovering alcohol dependence. All of them evaluated positively the addiction experience in order to reach a personal growing, got new goals and modified their life styles; use to express coping strategies characterized by a positive re-evaluation, assuming responsibility and the searching of social support, this last one considerable high in both groups.Strategies used were the affiliation to self help groups like Alcoholic Anonyms, Evangelic churches, Health Centres, Cultural Societies, and family support. The re-examinations of their own lives, the overcoming of character defects, assuming moral values, social engages to help others and goals led to a personal growing. These results indicate alcoholism may become an opportunity to stimulate a personal development(AU)