Neuropsychological Performance in Polyconsumer Men Under Treatment. Influence of Age of Onset of Substance Use.

Neurocognition is a key factor in the development and maintenance of Substance Use Disorders (SUD). However, there are still several aspects that need to be studied in this area. In this study, we elucidate the influence of age of onset of substance use (OSU) on the clinical course and neuropsychological performance of substance use disorder (SUD) patients, as well as to explore the influence of years of education, duration of drug use and premorbid intelligence quotient (IQ) on the cognitive results obtained. An exhaustive neuropsychological battery was used to assess different cognitive domains in 80 male polyconsumers, 41 with earlier OSU (16 years or before: OSU ≤ 16) and 39 with later OSU (17 years or later: OSU ≥ 17). The patients were under treatment with at least 4 months of abstinence confirmed by urinalysis. The OSU ≤ 16 group presented a worse clinical state, as well as a lower premorbid IQ and worse performance in processing speed, visual perception and planning skills. The duration of drug use may account for the differences in planning and processing speed. In this work we discuss the premorbid or acquired nature of the cognitive deficits found.

Strategies to cope with treatment in substance use disorder male patients with and without schizophrenia.

Coping strategies (CS) are the efforts made by an individual to manage the internal and external demands of stressful situations. Studies showed that in patients with Substance Use Disorder (SUD), adaptive and problem-focused CS are related to fewer relapses and better treatment outcomes. Considering the high rates of comorbidity between SUD and schizophrenia (SZ), and the deficiencies observed in SZ patients in the use of active problem-focused CS, this study aims to explore CS used by SUD patients with and without SZ to deal with treatment. 82 males (18-55 year) under treatment for a SUD were considered in two groups: SUD without psychiatric comorbidity (SUD; N=43) and SUD with SZ (SZ+; N=39) and assessed through The Coping Strategies Inventory (CSI). Our results indicated that SUD and SZ+ patients only differed in the amount of Engagement strategies they used. Compared to SUD, SZ+ patients showed lesser use of Problem Solving, Social Support and Self-Criticism, and lower Self-Perceived Capacity to engage the Problem. Besides, compared to norms, SUD and SZ+ patients were less likely to use adaptive CS, although this was more remarkable for SZ+ group. Further studies are needed to explore possible benefits of improving CS as part of treatment outcomes.

Neuropsychological functioning and age-related changes in schizophrenia and/or cocaine dependence.

Although little is known about the combined effects of Schizophrenia (SZ) and Substance Use Dependence (SUD) in neurocognitive functioning, the current literature points out that performance depends on the specific cognitive domains, the age of individuals and the type of substance of abuse. Our aim is to elucidate, in a sample with SZ and/or cocaine dependent individuals in remission for more than 4 months, their performance in attention, verbal memory and speed of processing, taking into account the possible effect of both age and duration of SUD. The total sample consisted of 95 male patients, aged 20 to 60 years, divided in three groups: one group with SZ and cocaine dependence (SZ+), another group with SZ without cocaine dependence (SZ-) and a third group with cocaine dependence without psychiatric comorbidity (COC). Our results show that those SZ+ who were abstinent for more than four months did not differ from their SZ- counterparts in the neuropsychological functioning. Both SZ groups performed significantly worse than the COC group. A negative impact of age on the neuropsychological performance was found in the SZ+ group, suggesting additive later cognitive deficits in SZ+ patients due to the long-term brain damage of SUD.

Executive functioning in individuals with schizophrenia and/or cocaine dependence.

OBJECTIVE: Although little is known about neurocognition in Dual Diagnosis, it has been suggested that Schizophrenia (SZ) patients with comorbid substance use belong to a subgroup with lower genetic vulnerability to develop SZ and, consequently, they show better executive and social premorbid functioning. The first aim of this study was to assess the executive functioning, and the second one was to explore the effect of age of onset of substance use in neurocognition in SZ patients with cocaine dependence. METHODS: The total sample consisted of 95 male patients, aged 20 to 60 years, divided in three groups: one group with SZ and cocaine dependence (SZ+; n = 30), another group with SZ without cocaine dependence (SZ-; n = 30), and a control group with cocaine dependence without psychiatric comorbidity (COC; n = 35). RESULTS: We found a better executive functioning in both SZ+ and COC than SZ-. We observed a worse performance of SZ+ patients compared with COC in cognitive set-shifting regardless the age of onset of consumption. CONCLUSIONS: The results agree with the hypothesis of a lower genetic vulnerability in SZ+ patients to develop psychosis compared with SZ-, who develop it without any additional trigger. However, future research is needed to clarify the current knowledge gaps.

Health-related quality of life in patients with dual diagnosis: clinical correlates.

BACKGROUND: Although the studies published so far have found an affectation in the Health Related Quality of Life (HRQOL) in both psychiatric and substance use dependence disorders, very few studies have applied HRQOL as an assessment measure in patients suffering both comorbid conditions, or Dual Diagnosis. The aim of the current study was to assess HRQOL in a group of patients with Dual Diagnosis compared to two other non-comorbid groups and to determine what clinical factors are related to HRQOL. METHODS: Cross-sectional assessment of three experimental groups was made through the Short Form - 36 Item Health Survey (SF-36). The sample consisted of a group with Dual Diagnosis (DD; N = 35), one with Severe Mental Illness alone (SMI; N = 35) and another one with Substance Use Dependence alone (SUD; N = 35). The sample was composed only by males. To assess the clinical correlates of SF-36 HRQOL, lineal regression analyses were carried out. RESULTS: The DD group showed lower scores in most of the subscales, and in the mental health domain. The group with SUD showed in general a better state in the HRQOL while the group with SMI held an intermediate position with respect to the other two groups. Daily medication, suicidal attempts and daily number of coffees were significantly associated to HRQOL, especially in the DD group. CONCLUSIONS: The DD group showed lower self-reported mental health quality of life. Assessment of HRQOL in dual patients allows to identify specific needs in this population, and may help to establish therapeutic goals to improve interventions.

Neuropsychological aspects of dual diagnosis.

Dual diagnosis (DD) has been described as the coexistence of a severe mental health condition and a drug abuse and/or dependence disorder. In the last decades, there has been a growing interest in the prevalence and characteristics of dual diagnosis, since it has been argued that DD patients show more clinical treatment difficulties and higher morbidity. Few works have studied the neuropsychological aspects of patients with DD, although neuropsychological deficits have been widely described both in patients showing a severe mental health condition and in those with a drug abuse and/or dependence disorder. Knowledge of the type and severity of potential neuropsychological deficits in patients with DD is of great relevance since it could be an interviewing factor for clinical treatment and prognosis. The present work aims to review the main data on attention, memory, and executive functions in dual diagnosis patients, from an explanatory point of view. We focus on the diagnoses of Schizophrenia and Bipolar Disorder since these have shown the highest prevalence and severity in DD and have provided a wealth of data. We describe the differences in neuropsychological performance found in these patients and the implications for clinical treatment and psychosocial functioning. Finally, we propose possible working ideas for future studies in order to improve our present knowledge of the neuropsychological aspects of DD.