Cognitive functioning in patients with alcohol use disorder who start outpatient treatment. / Funcionamiento cognitivo en pacientes con trastorno por uso de alcohol que inician tratamiento ambulatorio de deshabituación alcohólica.

The main objective of the present study is to analyze the presence of cognitive impairment associated with alcohol consumption in patients with moderate or severe alcohol use disorder seeking outpatient treatment for their dependence. To do this, we compared a sample of 111 patients with active alcohol use disorder who initiated ambulatory treatment with 100 healthy controls. We compared sociodemographic and clinical variables associated with alcohol consumption, such as alcohol craving and impulsivity. A systematized battery of cognitive tests was also used in the comparison, which allowed the evaluation of the following functions: Attention, anterograde memory, processing speed, verbal fluency, executive function and implicit attitude towards alcoholic beverages. Compared with healthy controls, patients with moderate or severe alcohol use disorder performed significantly worse in all tests used, and therefore in all cognitive functions evaluated, but for two tests, the Iowa Gambling Test and the Implicit Association Test. The analysis through a correlation matrix of the patient group indicates that patients who report more impulsivity and more chronic alcohol abuse and with more addiction are those who suffer greater deterioration in their cognitive function. Cognitive damage associated with alcohol consumption was distributed heterogeneously among patients. The present study confirms the presence of cognitive deterioration associated with alcohol consumption in patients seeking outpatient treatment.

El objetivo principal del presente estudio es analizar la presencia del deterioro cognitivo asociado al consumo de alcohol en los pacientes con trastorno por uso de alcohol moderado o grave que demandan tratamiento de deshabituación alcohólica ambulatorio. Para ello, se comparó una muestra de 111 pacientes con trastorno por uso de alcohol activo que iniciaban tratamiento ambulatorio versus 100 controles sanos. Se compararon variables sociodemográficas y clínicas asociadas al consumo de alcohol, como el craving de alcohol y la impulsividad. También se empleó en la comparación una batería sistematizada de pruebas cognitivas que permitía valorar las siguientes funciones: atención, memoria anterógrada, velocidad de procesamiento, fluidez verbal, función ejecutiva y actitud implícita ante las bebidas alcohólicas. En comparación con los controles sanos, los pacientes con trastorno por uso de alcohol moderado o grave presentaban un rendimiento significativamente inferior en todas las pruebas utilizadas, y por ello en todas las funciones cognitivas evaluadas, con la excepción de dos pruebas, el Iowa Gambling Test y el Implicit Association Test. El análisis a través de una matriz de correlaciones del grupo de pacientes indica que los pacientes que refieren más impulsividad y un consumo abusivo de alcohol más cronificado y con más adicción son los que presentan un mayor deterioro en su función cognitiva. El daño cognitivo asociado al consumo de alcohol se distribuyó de forma heterogénea entre los pacientes. El presente estudio confirma la presencia del deterioro cognitivo asociado al consumo de alcohol en los pacientes que demandan tratamiento ambulatorio.

Funcionamiento cognitivo en pacientes con trastorno por uso de alcohol que inician tratamiento ambulatorio de deshabituación alcohólica / Cognitive functioning in patients with alcohol use disorder who start outpatient treatment

El objetivo principal del presente estudio es analizar la presencia del deterioro cognitivo asociado al consumo de alcohol en los pacientes con trastorno por uso de alcohol moderado o grave que demandan tratamiento de deshabituación alcohólica ambulatorio. Para ello, se comparó una muestra de 111 pacientes con trastorno por uso de alcohol activo que iniciaban tratamiento ambulatorio versus 100 controles sanos. Se compararon variables sociodemográficas y clínicas asociadas al consumo de alcohol, como el craving de alcohol y la impulsividad. También se empleó en la comparación una batería sistematizada de pruebas cognitivas que permitía valorar las siguientes funciones: atención, memoria anterógrada, velocidad de procesamiento, fluidez verbal, función ejecutiva y actitud implícita ante las bebidas alcohólicas. En comparación con los controles sanos, los pacientes con trastorno por uso de alcohol moderado o grave presentaban un rendimiento significativamente inferior en todas las pruebas utilizadas, y por ello en todas las funciones cognitivas evaluadas, con la excepción de dos pruebas, el Iowa Gambling Test y el Implicit Association Test. El análisis a través de una matriz de correlaciones del grupo de pacientes indica que los pacientes que refieren más impulsividad y un consumo abusivo de alcohol más cronificado y con más adicción son los que presentan un mayor deterioro en su función cognitiva. El daño cognitivo asociado al consumo de alcohol se distribuyó de forma heterogénea entre los pacientes. El presente estudio confirma la presencia del deterioro cognitivo asociado al consumo de alcohol en los pacientes que demandan tratamiento ambulatorio

The main objective of the present study is to analyze the presence of cognitive impairment associated with alcohol consumption in patients with moderate or severe alcohol use disorder seeking outpatient treatment for their dependence. To do this, we compared a sample of 111 patients with active alcohol use disorder who initiated ambulatory treatment with 100 healthy controls. We compared sociodemographic and clinical variables associated with alcohol consumption, such as alcohol craving and impulsivity. A systematized battery of cognitive tests was also used in the comparison, which allowed the evaluation of the following functions: Attention, anterograde memory, processing speed, verbal fluency, executive function and implicit attitude towards alcoholic beverages. Compared with healthy controls, patients with moderate or severe alcohol use disorder performed significantly worse in all tests used, and therefore in all cognitive functions evaluated, but for two tests, the Iowa Gambling Test and the Implicit Association Test. The analysis through a correlation matrix of the patient group indicates that patients who report more impulsivity and more chronic alcohol abuse and with more addiction are those who suffer greater deterioration in their cognitive function. Cognitive damage associated with alcohol consumption was distributed heterogeneously among patients. The present study confirms the presence of cognitive deterioration associated with alcohol consumption in patients seeking outpatient treatment

Measurement equivalence of PROMIS depression in Spain and the United States.

In this study, we assessed the psychometric properties of the Spanish Patient-Reported Outcomes Measurement Information System (PROMIS) Depression in an adult population-representative sample from Spain (n = 1,503). We tested unidimensionality and local independence item response theory (IRT) assumptions with confirmatory factor and bifactor models under the exploratory structural equations modeling framework. We evaluated item monotonicity assumption with Mokken scaling analysis. We calibrated the items with an IRT-graded response model and assessed score reliability and test information, and evidence of validity with regard to scores on external measures. To examine differential item functioning by age, sex, education, and country (United States vs. Spain, N = 2,271), we used ordinal logistic regression. Results support compliance with IRT assumptions. We found few signs of differential item functioning: Only one item showed country differential functioning between the United States (n = 768) and Spain, with minimal impact on the overall score. Information values were equivalent to reliabilities over 0.90 from -1 (low depression) to +4 SD (high depression) around the population score mean. Evidence of validity in relation to concurrent measures was supported by the expected correlation pattern with external variables of depression, but higher than expected correlations with anxiety were found. Results indicate that the Spanish version of PROMIS Depression is adequate for assessing and monitoring depression levels in the general population and that PROMIS Depression is especially suitable for cross-national comparisons. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of co-occurring psychiatric disorders on retention in a methadone maintenance program: an 18-month follow-up study.

We assess the influence of co-occurring psychiatric disorders on retention in 189 opioid dependent patients in a methadone maintenance treatment (MMT) and determine the incidence of psychiatric co-morbidity during an 18-month follow-up period. About 68.5 % were retained in the MMT. Neither co-occurring mental disorders (chi-square = 0.303, df = 1, p = 0.622) nor methadone doses [85 (88.9) vs. 79.2 (85) mg/day, p = 0.672] were related to retention. In the follow-up period 19 new diagnoses were made, mainly major depression and antisocial and borderline personality disorders. Co-occurring psychiatric disorders should be assessed during MMT follow-up.

Impact of substance dependence and dual diagnosis on the quality of life of heroin users seeking treatment.

In 189 opioid-dependent subjects on methadone maintenance treatment in Barcelona (Spain), we assessed the prevalence of co-occurrence substance use and non-substance-use disorders (dual diagnosis) by the Psychiatric Research Interview for Substance and Mental Disorders [PRISM], and the impact on quality of life (HRQoL) by the SF-12 (PCS-12 and MCS-12 scales). Rates of substance and non-substance-use diagnoses were 59% and 32%, respectively. Mean scores for PCS-12 and MCS-12 were 44.1+/-10.1 and 39.9+/-11.7, without differences by presence or absence of dual diagnosis. Heroin users on methadone treatment showed a high prevalence of dual diagnosis and a very impaired HRQoL.

Dual diagnosis in an inpatient drug-abuse detoxification unit.

In Spain, detoxification in general hospitals plays an important role in the medical care of patients. We aim to provide clinicians with information on the prevalence and correlates of psychiatric co-morbidity in drug abusers in detoxification. A sample of 115 substance-abuse inpatients (mean age 31.9 +/- 6.4 years) in a Detoxification Unit of a general university hospital was studied using the Spanish version of the PRISM. Most of the patients had multiple dependence diagnoses and co-morbid axis I or axis II psychiatric disorders. Patients with dual diagnosis showed lower psychosocial functioning than patients without co-morbidity and more dependence diagnoses due to cannabis and sedatives. A total of 80% of the patients successfully completed the detoxification process. The present results enhance the value of detoxification in a general hospital as a first step of the overall treatment strategy.

Comorbilidad psiquiátrica y trastorno por dependencia de opiáceos: del diagnóstico al tratamiento / Psychiatric comorbidity and opioid dependence disorder: from diagnosis to treatment

En los últimos años, las graves consecuencias sanitarias y sociales de la coexistencia de otros trastornos psiquiátricos en pacientes dependientes de opiáceos, han incrementado el interés por mejorar el diagnóstico y el tratamiento de estos trastornos. La identificación fiable y válida de otro trastorno psiquiátrico concomitante en los sujetos con drogodependencias ha mejorado sustancialmente con la utilización de los criterios DSM-IV y la utilización de la entrevista diagnóstica “Psychiatric Research Interview for Substance and Mental Disorders”, especialmente diseñada para ello. Tomando como “patrón oro” los diagnósticos realizados con el método LEAD, mediante la entrevista PRISM-IV se obtuvieron diagnósticos válidos de depresión mayor, psicosis inducida, trastornos de ansiedad y trastornos de personalidad antisocial y límite. Así mismo, los diagnósticos obtenidos mediante la PRISM-IV mostraron mejores índices kappa que con la entrevista SCID-IV. La revisión de la literatura muestra que entre los sujetos dependientes de opiáceos que acuden a tratamiento se ha detectado una elevada prevalencia de comorbilidad psiquiátrica (47%-93%), siendo los trastornos depresivos y de ansiedad así como los trastornos de personalidad antisocial y límite los diagnósticos más frecuentes. Si bien se reconoce la necesidad de realizar tratamiento adecuado de los trastornos comórbidos, todavía no hay suficientes estudios controlados que aporten datos concluyentes sobre las pautas terapéuticas más adecuadas. En el caso de la depresión comórbida, la revisión sistemática de los ensayos clínicos controlados disponibles, avala la necesidad de nuevos estudios para clarificar las pautas de tratamiento (AU)

Diagnosing and treating psychiatric comorbidity in substance abusers has become increasingly important in the last 10 years because of important consequences from a health and social point of view. The identification of reliable and valid diagnosis of psychiatric co morbidity in substance abusers has being improved using the “Psychiatric Research Interview for Substance and Mental Disorders” for DSM-IV criteria. This instrument is a structured interview designed “ad hoc” to diagnoses nonsubstance use disorders in substance abuser population. Compared to the Longitudinal, Expert, All Data (LEAD) procedure, as a “gold standard”, the Spanish version of PRISM-IV seemed to be a valid instrument for diagnosing major depression, induced psychosis, anxiety disorders, antisocial and borderline personality disorders. Also the Spanish PRISM-IV resulted in better kappa statistics than the Spanish version of SCID-IV for diagnosing major depression, and borderline personality disorders in substance abusers. Many clinical studies have revealed a high degree of co-occurrence of opioid dependence and other psychiatric disorders, ranging from 44% to 93%. Major depression, anxiety disorders, antisocial and borderline personality disorders are the most prevalent non-substance use disorders in opioid dependent subjects. Most studies are needed to determinate the evidence based treatments for comorbid psychiatric disorders in opioid dependence. In the case of comorbid major depression in opioid abusers, after a systematic review of the randomized and controlled clinical trials available, new studies to clarify the evidence based treatments are required (AU)

Diagnosing comorbid psychiatric disorders in substance abusers: validity of the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV.

OBJECTIVE: The authors' goal was to assess the validity of DSM-IV diagnoses obtained with the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) and the Structured Clinical Interview for DSM-IV (SCID) compared with the longitudinal, expert, all data (LEAD) procedure in a group of substance abusers. METHOD: A total of 105 substance abusers recruited at a drug abuse treatment center in Barcelona, Spain, were assessed. The PRISM and SCID were administered blindly by independent research interviewers. LEAD diagnoses were made by two senior psychiatrists who were blind to PRISM and SCID diagnoses. The kappa statistic was used to measure concordance between the LEAD procedure and the PRISM and SCID. RESULTS: Affective and anxiety disorders were diagnosed more frequently by the PRISM and SCID than by the LEAD procedure. Use of the PRISM resulted in more diagnoses of substance-induced depression, and use of the SCID resulted in more diagnoses of primary major depression than the LEAD procedure. Kappas between the LEAD procedure and the PRISM in current major depression, past substance-induced depression, and borderline personality disorder were better than those obtained between the LEAD procedure and the SCID. The concordance among the three methods for diagnoses of current dependence disorders was good or excellent for alcohol, anxiolytic, cocaine, and heroin dependence and fair for cannabis dependence. Abuse diagnoses showed poor concordance. CONCLUSIONS: Using the LEAD procedure as a "gold standard," the authors conclude that the Spanish version of the PRISM seems to be a better instrument than the Spanish version of the SCID for diagnosing major depression and borderline personality disorders in substance abusers.