Inclusion of Alcoholic Associations Into a Public Treatment Programme for Alcoholism Improves Outcomes During the Treatment and Continuing Care Period: A 6-Year Experience.

AIMS: To investigate whether inclusion of self-help groups into the hospital treatment programme improves the prognosis of alcohol dependence through the treatment period; and to examine therapeutic adherence and prognosis during continuing care. METHOD: Patients attending the treatment programme at the 'Hospital 12 de Octubre' were randomized into two groups. In Group A (n = 123), patients received the usual treatment included in our programme, whereas in Group B (n = 126), patients also attended self-help groups. Patients were assessed with psychological scales at baseline, at the end of the treatment period and after completing the continuing care visits. Data were collected over a total of 6 years. RESULTS: During the treatment period, patients in Group B accumulated more months of abstinence and dropped out less. During continuing care, patients in Group B accumulated more months of abstinence and therapeutic adherence was higher. Variables that were associated with these results during the continuing care period were: visits to the GP, scores on anxiety, impulsivity and meaning of life scales, and belonging to the group that attended the alcoholic associations. CONCLUSIONS: Mutual help groups incorporated into a public treatment programme appear to improve outcomes during treatment and on into continuing care. This experience supports cooperation between public health centres and alcoholic associations in treating alcoholism. SHORT SUMMARY: Including alcoholic associations into the public treatment programme for alcoholism of the 'Hospital 12 de Octubre' in Madrid was shown to be associated with better outcomes in terms of months of accumulated abstinence, dropout rates and therapeutic adherence, during the treatment and continuing care periods.

Factor structure and psychometric properties of the TFEQ in morbid obese patients, candidates to bariatric surgery.

BACKGROUND: To analyze the factor structure and psychometric properties of the TFEQ in a morbid obese Spanish sample of bariatric surgery candidates. METHOD: Multi-trait/ multi-item analyses and alpha coefficients were conducted to test the convergent /discriminant validity and the internal consistency reliability. Principal components analyses (varimax) were used to explore the factor structure. Sub-group factor analyses by gender, age and body mass index (BMI) were conducted to identify unstable items. RESULTS: The internal structure of the original TFEQ factors was unsatisfactory, especially the Disinhibition Scale. Most Disinhibition and Hunger items were grouped on one factor labeled “Dysregulation Eating”. Cognitive Restraint was split into two factors. The first one, related to the behavioral component of Restraint, labeled “Restrained Behaviour” and the second one related to weight and eating concerns called “Predisposition to Restraint”. CONCLUSIONS: The original factor structure of the TFEQ was not replicated. A revised 23-item instrument, representing the three new derived factors is offered as a valid screening instrument for severely obese patients.

Factor structure and psychometric properties of the TFEQ in morbid obese patients, candidates to bariatric surgery / Estructura factorial y propiedades psicométricas del TFEQ en pacientes con obesidad mórbida candidatos a cirugía bariátrica

BACKGROUND: To analyze the factor structure and psychometric properties of the TFEQ in a morbid obese Spanish sample of bariatric surgery candidates. METHOD: Multi-trait/ multi-item analyses and alpha coefficients were conducted to test the convergent /discriminant validity and the internal consistency reliability. Principal components analyses (varimax) were used to explore the factor structure. Sub-group factor analyses by gender, age and body mass index (BMI) were conducted to identify unstable items. RESULTS: The internal structure of the original TFEQ factors was unsatisfactory, especially the Disinhibition Scale. Most Disinhibition and Hunger items were grouped on one factor labeled «Dysregulation Eating». Cognitive Restraint was split into two factors. The first one, related to the behavioral component of Restraint, labeled «Restrained Behaviour» and the second one related to weight and eating concerns called «Predisposition to Restraint». CONCLUSIONS: The original factor structure of the TFEQ was not replicated. A revised 23-item instrument, representing the three new derived factors is offered as a valid screening instrument for severely obese patients

ANTECEDENTES: analizar la estructura factorial y las propiedades psicométricas del TFEQ en una muestra española de obesos mórbidos candidatos a cirugía bariátrica. MÉTODO: se realizó un análisis multi-rasgo/multi-ítem y de coeficientes alpha para probar la validez convergente/discriminante y la consistencia interna. Se utilizó un análisis de componentes principales (varimax) para estudiar la estructura factorial. Se llevó a cabo también un análisis de factores de subgrupos por género, edad e IMC para identificar aquellos ítems inestables. RESULTADOS: la estructura interna original de los 3 factores TFEQ fue insatisfactoria, especialmente en la escala de Desinhibición. La mayoría de los ítems de Desinhibición y Hambre se agruparon en un mismo factor denominado «Desregulación en la ingesta». La Restricción Cognitiva se dividió en dos factores. El primero, relacionado con el componente de Restricción, se denominó «Restricción Activa» y el segundo, relacionado con el peso y las preocupaciones de la ingesta, se llamó «Predisposición a la Restricción». CONCLUSIONES: la estructura factorial original del TFEQ no se replica. En este artículo se presenta un instrumento revisado de 23 ítems, que representa los tres nuevos factores derivados, como instrumento de cribado válido para pacientes obesos graves

Startle-response based tasks and laboratory measures of impulsivity in abstinent alcoholic patients.

AIMS: It is well known that impulsivity is a risk factor for the development of Addictive Disorders, and more specifically Alcohol Use Disorders (AUD). Recently, the Startle-Response Based Tasks (SRBT) and its different forms of plasticity have been found to be impaired in the alcoholic population. This is the first study to explore the correlation between impulsivity laboratory tasks and the SRBT test, in order to determine whether impulsivity and startle response (SR) could be related and in turn, explain their association with Alcohol Dependence (AD). SUBJECTS: 40 men, who met DSM-IV criteria for AD and had been abstinent for at least one month. Impulsivity was assessed using three laboratory tests: Continuous Performance Test (CPT), Stop-Signal Task (SST) and Differential Reinforcement for Low-Rate Responding (DRL6). Patients also underwent the SR test. They were compared to 40 matched controls. RESULTS: Impulsivity laboratory measures tasks (SST and commissions of the CPT) correlated positively with the magnitude of SR (P < 0.05) and with habituation (P < 0.05). Scores on DRL6 correlated negatively with the magnitude of SR (P < 0.05). This was not found in the control group. CONCLUSIONS: The fact that impulsivity laboratory measures and the SR are correlated in patients but not in controls, could imply the existence of a common link for these two measures in alcoholic patients. Our findings support the hypothesis of the existence of two different vulnerability pathways for the development of AUD: anxiety and disinhibitory behaviour.

[Integration of self-guidance groups for relatives in a public program of alcoholism treatment]. / Integración de los grupos de autoayuda para familiares en un programa público de tratamiento del alcoholismo.

Interventions with relatives of alcohol-dependent patients have shown effectiveness in engaging unmotivated patients into treatment. The Federation of ex-alcoholics, in the Community of Madrid, has a network of self-help centers (Centers to Promote Psychosocial Alternatives against Addictions, CPAA) spread throughout the Madrid's region where alcohol-dependent patients and their families receive attention. The aim of this study was to demonstrate that the integration of these facilities could improve the psychological condition of the relatives and the outcome on the patients' treatment. 188 patients attending the treatment program at "Hospital 12 de Octubre" and their relatives were randomized into two groups: Group A (n=94) (Standard program for patients and relatives delivered at our facility) and Group B (n=94) (where patients were treated with the standard program in our facilities and relatives attended a family group intervention at the CPAA) After 12 weeks, the CPAA conditions were significantly more effective than our standard program in improving psychological distress of relatives and in engaging patients into treatment. Patients belonging to group B had fewer drinking days during the treatment period. Our results support that psychological interventions delivered at CPAA centers are useful in improving psychological conditions of alcoholic patients' relatives than when undertaking the public alcoholism program. This intervention also improves outcome of alcoholic patients. The integration of these centers within public alcoholism treatment programs could provide a new way to treat alcoholism, based on collaboration of public facilities and patient associations.

Integración de los grupos de autoayuda para familiares en un programa público de tratamiento del alcoholismo / Integration of self-guidance groups for relatives in a public program of alcoholism treatment

Las intervenciones con familiares de pacientes dependientes del alcohol han demostrado su eficacia para mejorar el pronóstico de la dependencia alcohólica. En la Comunidad de Madrid, la Federación de exalcohólicos ha creado la Red de centros de alternativas psicosociales a las adicciones (Red CAPA) en cuyos dispositivos se atiende a los dependientes del alcohol y a sus familiares. El objetivo de este estudio ha sido el de demostrar quela integración de terapias familiares mejoraba la salud psicológica de los familiares y el pronóstico del tratamiento de los pacientes dependientes. Fueron seleccionados 188 pacientes de nuestro programa del tratamiento del Hospital 12 de Octubre con sus respectivos familiares y se aleatorizaron en dos grupos. Un grupo A (n=94) recibía el tratamiento habitual para pacientes y familiares de nuestro programa de tratamiento, mientras que en un grupo B (n=94) los pacientes eran atendidos en nuestro programa de tratamiento pero sus familiares acudían a un grupo de familias de la Red CAPA. Al cabo de 12 semanas los familiares del grupo B tenían mejor salud psicológica y los pacientes tuvieron menos días de consumo y menores tasas de abandonos del programa de tratamiento que los del grupo A. Los grupos para familiares de la Red CAPA son útiles en mejorar la salud psicológica de los familiares y en mejorar el pronóstico de la dependencia. La integración de estos centros dentro de los programas públicos de tratamiento del alcoholismo podría proporcionar una nueva forma de tratar el alcoholismo, basada en la colaboración de los establecimientos públicos y asociaciones de pacientes(AU)

Interventions with relatives of alcohol-dependent patients have shown effectiveness in engaging unmotivated patients into treatment. The Federation of ex-alcoholics, in the Community of Madrid, has a network of self-help centers(Centers to Promote Psychosocial Alternatives against Addictions, CPAA) spread throughout the Madrid’s region where alcohol-dependent patients and their families receive attention. The aim of this study was to demonstrate that the integration of these facilities could improve the psychological condition of the relatives and the outcome on the patients’ treatment. 188 patients attending the treatment program at “Hospital 12 de Octubre” and their relatives were randomized into two groups: Group A (n=94) (Standard program for patients and relatives delivered at our facility) and Group B (n=94) (where patients were treated with the standard program in our facilities and relatives attended a family group intervention at the CPAA) After 12 weeks, the CPAA conditions were significantly more effective than our standard program in improving psychological distress of relatives and in engaging patients into treatment. Patients belonging to group B had fewer drinking days during the treatment period. Our results support that psychological interventions delivered at CPAA centers are useful in improving psychological conditions of alcoholic patients’ relatives than when undertaking the public alcoholism program. This intervention also improves outcome of alcoholic patients. The integration of these centers within public alcoholism treatment programs could provide a new way to treat alcoholism, based on collaboration of public facilities and patient associations(AU)

Variables involved in the cue modulation of the startle reflex in alcohol-dependent patients.

Cue modulation of the startle reflex is a paradigm that has been used to understand the emotional mechanisms involved in alcohol dependence. Attenuation of the startle reflex has been demonstrated when alcohol-dependent subjects are exposed to alcohol-related stimuli. However, the role of clinical variables on the magnitude of this response is unknown. The objective of this study was to determine the relationship between a number of clinical variables-severity of alcoholism, family history of alcoholism (FHA+), personality traits related to the sensitivity to reward-and the startle reflex response when subjects with alcohol dependence were viewing alcohol-related cues. After detoxification, 98 participants completed self-report instruments and had eye blink electromyograms measured to acoustic startle probes [100-millisecond burst of white noise at 95 dB(A)] while viewing alcohol-related pictures, and standardised appetitive, aversive and neutral control scenes. Ninety-eight healthy controls were also assessed with the same instruments. There were significant differences on alcohol-startle magnitude between patients and controls. Comparisons by gender showed that women perceived alcohol cues and appetitive cues more appetitive than men. Male and female patients showed more appetitive responses to alcohol cues when compared with their respective controls. Our patients showed an appetitive effect of alcohol cues that was positively related to severity of alcohol dependence, sensitivity to reward and a FHA+. The data confirmed that the pattern of the modulation of the acoustic startle reflex reveals appetitive effects of the alcohol cues and extended it to a variety of clinical variables.

Psychopathologic differences between cannabis-induced psychoses and recent-onset primary psychoses with abuse of cannabis.

The study aims to identify psychopathologic variables in cannabis-induced psychosis and recent-onset primary psychoses using the Symptom Checklist-90-R and the Psychiatric Research Interview for Substance and Mental Disorders. A sample of 181 subjects with psychotic symptoms and cannabis use referred to the psychiatry inpatient units of 3 university general hospitals were assessed. The final sample included 50 subjects with a diagnosis of cannabis-induced psychotic disorder (CIPD) and 104 subjects with primary psychotic disorders. Using receiver operating characteristic curves, the most efficient psychopathologic variables for classifying CIPD were interpersonal sensitivity, "depression," phobic anxiety, and Scale to Assess Unawareness of Mental Disorders subscales. The area under the receiver operating characteristic curve of the model including depression and "misattribution" scores was 96.78% (95% confidence interval, 94.43-99.13). Depressive symptoms could be used to distinguish CIPD from other primary psychotic disorders. Clinical variables related to "neurotic" symptoms could be involved in the susceptibility to cannabis-induced psychosis.

Coping strategies and quality of life among liver transplantation candidates / Estrategias de afrontamiento y calidad de vida en candidatos para trasplante de hígado

The maintenance of self-reported quality of life (QL) among people on the liver transplantation waiting list is one of the priority objectives of transplantation teams. Although there are different determinant factors of QL, results are not conclusive. In our study, the goal was to evaluate both the influence of cirrhosis etiology (ethylic and non-ethylic) and the coping strategies used concerning QL. A sample of 93 patients was selected, divided into two groups: ethylic cirrhosis (EC) and non-ethylic cirrhosis (NEC). QL was evaluated through the SF-36 Health Survey, and coping strategies through the Medical Coping Modes Questionnaire (MCMQ). Our results indicated that subjects with EC obtained similar QL levels to subjects with NEC, on all the SF-36 and MCMQ subscales. Furthermore, negative correlations were found between avoidance and acceptance-resignation coping strategies with the SF-36 components. Consequently, the acceptance-resignation strategy was associated with a worse perception of physical functioning, general and mental health, and vitality and role-emotional. Overall, these results suggest that cirrhosis etiology is not a determinant factor of QL, whereas the acceptance-resignation coping strategy might lead to lower self-perception of QL (AU)

El mantenimiento de la calidad de vida (CV) autopercibida en las personas en lista de espera para trasplante hepático es uno de los objetivos prioritarios de los equipos de trasplante. Aunque existen diferentes factores que determinan la CV, los resultados no son concluyentes. Nuestro objetivo fue evaluar la influencia de la etiología (cirrosis etílica y no-etílica) y las estrategias de afrontamiento empleadas sobre la CV. Seleccionamos una muestra de 93 pacientes, dividida en dos grupos: cirrosis etílica (CE) y cirrosis no-etílica (CNE). La CV se evaluó mediante la Escala de Salud SF-36 y las estrategias de afrontamiento con el Cuestionario Médico de Estrategias de Afrontamiento (MCMQ). Nuestros resultados indicaron que los sujetos con CE obtenían niveles de CV similares a los sujetos con CNE, en todas las escalas del SF-36 y MCMQ. Además, se encontraron correlaciones negativas entre las estrategias de afrontamiento de evitación y aceptación-resignación, con los componentes del SF- 36. Así, aceptación-resignación se asociaba con una peor percepción del funcionamiento físico, salud general y mental, vitalidad y rol-emocional. Estos resultados sugieren que la etiología de la cirrosis no es determinante de la CV, mientras que la aceptación-resignación como estrategia de afrontamiento conllevaría una autopercepción de la CV más baja (AU)

Coping strategies and quality of life among liver transplantation candidates.

The maintenance of self-reported quality of life (QL) among people on the liver transplantation waiting list is one of the priority objectives of transplantation teams. Although there are different determinant factors of QL, results are not conclusive. In our study, the goal was to evaluate both the influence of cirrhosis etiology (ethylic and non-ethylic) and the coping strategies used concerning QL. A sample of 93 patients was selected, divided into two groups: ethylic cirrhosis (EC) and non-ethylic cirrhosis (NEC). QL was evaluated through the SF-36 Health Survey, and coping strategies through the Medical Coping Modes Questionnaire (MCMQ). Our results indicated that subjects with EC obtained similar QL levels to subjects with NEC, on all the SF-36 and MCMQ subscales. Furthermore, negative correlations were found between avoidance and acceptance-resignation coping strategies with the SF-36 components. Consequently, the acceptance-resignation strategy was associated with a worse perception of physical functioning, general and mental health, and vitality and role-emotional. Overall, these results suggest that cirrhosis etiology is not a determinant factor of QL, whereas the acceptance-resignation coping strategy might lead to lower self-perception of QL.