Variables implicadas en la abstinencia de alcohol a largo plazo: cuáles son y cuándo juegan un papel más importante / Variables involved in the long-term alcohol abstinence: Which variables are involved and at what point of time?

Diversas variables psicológicas están implicadas en el pronóstico de los pacientes con dependencia de alcohol, durante el tratamiento y después del alta. Sin embargo, aún no conocemos el papel que juegan estas variables en la consecución y mantenimiento de la abstinencia y, si éstas, se modifican a lo largo del tiempo. Metodología: Se recogieron datos longitudinalmente relacionados con ansiedad, depresión, impulsividad, estrategias de afrontamiento, sentido de la vida (SV) y asistencia a las asociaciones de ayuda-mutua (AM) de pacientes ambulatorios con dependencia de alcohol (N=159, 66% varones, edad media=42.54 años). Se realizaron evaluaciones basalmente, al alta (después de 2 años de tratamiento), a los 2 y a los 4 años después del alta. Las variables relacionadas con el consumo de alcohol fueron evaluadas con el método Timeline Followback. Resultados: En la evaluación basal, el estilo de afrontamiento evitativo y la impulsividad se asociaron con los meses de abstinencia acumulada a los 4 años. Al alta, y a los 2 años de seguimiento, las puntuaciones altas en el SV se asociaron con los meses de abstinencia acumulada a los 4 años. Los modelos de mediación encontraron que el SV incrementaba los meses de abstinencia acumulada a los 4 años a través del estilo de afrontamiento evitativo y una reducción de los niveles de depresión. Conclusiones: El SV es un componente determinante en la abstinencia a largo plazo. Dado que las asociaciones de AM promueven el SV, éstas deberían ser recomendadas como una parte esencial de un tratamiento integrado de la dependencia de alcohol. (AU)

Several psychological variables have been associated with the prognosis during alcohol dependence treatment and after discharge. However, we still do not know the role that these variables play in the achievement of abstinence and if they modify throughout time. Method: Longitudinal survey data related to anxiety, depression, impulsivity, coping, meaning in life (MiL) and attendance to mutual-help groups were collected from outpatients with alcohol dependence (N= 159, 66% male, mean age=42.54 years). Assessment points were the following: baseline, at discharge (after 2-years of treatment), and 2-years and 4-years follow-up after discharge. Drinking outcomes were evaluated with the Timeline Followback Method Assessment. Results: At baseline, levels of avoidance coping and impulsivity were associated with months of accumulated abstinence at 4-years-follow-up. However, at discharge and at two-years follow-up, higher scores in MiL were consistently associated with months of accumulated abstinence at 4-years of follow-up. Mediation models showed that MiL increased accumulated abstinence at 4 years-follow-up by increasing avoidance coping and reducing levels of depression. Conclusions: MiL is a determining component in the long-term sustained abstinence. Our results support the key role of MiL and point to a new mechanism through which it influences the maintenance of sobriety. Because mutual-help groups have consistently demonstrated to promote MiL, they should be implemented and recommended as an essential part of an integrated treatment of alcohol dependence. (AU)

Variables involved in the long-term alcohol abstinence: Which variables are involved and at what point of time? / Variables implicadas en la abstinencia de alcohol a largo plazo: cuáles son y cuándo juegan un papel más importante

Diversas variables psicológicas están implicadas en el pronóstico de los pacientes con dependencia de alcohol, durante el tratamiento y después del alta. Sin embargo, aún no conocemos el papel que juegan estas variables en la consecución y mantenimiento de la abstinencia y, si éstas, se modifican a lo largo del tiempo. Metodología: Se recogieron datos longitudinalmente relacionados con ansiedad, depresión, impulsividad, estrategias de afrontamiento, sentido de la vida (SV) y asistencia a las asociaciones de ayuda-mutua (AM) de pacientes ambulatorios con dependencia de alcohol (N=159, 66% varones, edad media=42.54 años). Se realizaron evaluaciones basalmente, al alta (después de 2 años de tratamiento), a los 2 y a los 4 años después del alta. Las variables relacionadas con el consumo de alcohol fueron evaluadas con el método Timeline Followback. Resultados: En la evaluación basal, el estilo de afrontamiento evitativo y la impulsividad se asociaron con los meses de abstinencia acumulada a los 4 años. Al alta, y a los 2 años de seguimiento, las puntuaciones altas en el SV se asociaron con los meses de abstinencia acumulada a los 4 años. Los modelos de mediación encontraron que el SV incrementaba los meses de abstinencia acumulada a los 4 años a través del estilo de afrontamiento evitativo y una reducción de los niveles de depresión. Conclusiones: El SV es un componente determinante en la abstinencia a largo plazo. Dado que las asociaciones de AM promueven el SV, éstas deberían ser recomendadas como una parte esencial de un tratamiento integrado de la dependencia de alcohol. (AU)

Several psychological variables have been associated with the prognosis during alcohol dependence treatment and after discharge. However, we still do not know the role that these variables play in the achievement of abstinence and if they modify throughout time. Method: Longitudinal survey data related to anxiety, depression, impulsivity, coping, meaning in life (MiL) and attendance to mutual-help groups were collected from outpatients with alcohol dependence (N= 159, 66% male, mean age=42.54 years). Assessment points were the following: baseline, at discharge (after 2-years of treatment), and 2-years and 4-years follow-up after discharge. Drinking outcomes were evaluated with the Timeline Followback Method Assessment. Results: At baseline, levels of avoidance coping and impulsivity were associated with months of accumulated abstinence at 4-years-follow-up. However, at discharge and at two-years follow-up, higher scores in MiL were consistently associated with months of accumulated abstinence at 4-years of follow-up. Mediation models showed that MiL increased accumulated abstinence at 4 years-follow-up by increasing avoidance coping and reducing levels of depression. Conclusions: MiL is a determining component in the long-term sustained abstinence. Our results support the key role of MiL and point to a new mechanism through which it influences the maintenance of sobriety. Because mutual-help groups have consistently demonstrated to promote MiL, they should be implemented and recommended as an essential part of an integrated treatment of alcohol dependence. (AU)

Molecular Changes Associated with Suicide.

Suicide is a serious global public health problem, with a worrying recent increase in suicide rates in both adolescent and adult populations. However, it is essential to recognize that suicide is preventable. A myriad of factors contributes to an individual's vulnerability to suicide. These factors include various potential causes, from psychiatric disorders to genetic and epigenetic alterations. These changes can induce dysfunctions in crucial systems such as the serotonergic, cannabinoid, and hypothalamic-pituitary-adrenal axes. In addition, early life experiences of abuse can profoundly impact an individual's ability to cope with stress, ultimately leading to changes in the inflammatory system, which is a significant risk factor for suicidal behavior. Thus, it is clear that suicidal behavior may result from a confluence of multiple factors. This review examines the primary risk factors associated with suicidal behavior, including psychiatric disorders, early life adversities, and epigenetic modifications. Our goal is to elucidate the molecular changes at the genetic, epigenetic, and molecular levels in the brains of individuals who have taken their own lives and in the plasma and peripheral mononuclear cells of suicide attempters and how these changes may serve as predisposing factors for suicidal tendencies.

Molecular Alterations of the Endocannabinoid System in Psychiatric Disorders.

The therapeutic benefits of the current medications for patients with psychiatric disorders contrast with a great variety of adverse effects. The endocannabinoid system (ECS) components have gained high interest as potential new targets for treating psychiatry diseases because of their neuromodulator role, which is essential to understanding the regulation of many brain functions. This article reviewed the molecular alterations in ECS occurring in different psychiatric conditions. The methods used to identify alterations in the ECS were also described. We used a translational approach. The animal models reproducing some behavioral and/or neurochemical aspects of psychiatric disorders and the molecular alterations in clinical studies in post-mortem brain tissue or peripheral tissues were analyzed. This article reviewed the most relevant ECS changes in prevalent psychiatric diseases such as mood disorders, schizophrenia, autism, attentional deficit, eating disorders (ED), and addiction. The review concludes that clinical research studies are urgently needed for two different purposes: (1) To identify alterations of the ECS components potentially useful as new biomarkers relating to a specific disease or condition, and (2) to design new therapeutic targets based on the specific alterations found to improve the pharmacological treatment in psychiatry.

La respuesta de sobresalto y la inhibición preplso en los trastornos por uso de alcohol. Implicaciones para la práctica clínica / Startle response and prepulse inhibition in alcohol use disorders. Implications for the clinical practice

Los trastornos por uso de alcohol (TUA) están siendo estudiados empleando distintos paradigmas neurofisiológicos y neuropsicológicos, entre los que se encuentran el paradigma de la respuesta de sobresalto (RS) y la inhibición prepulso (IPP). En este artículo presentamos los resultados que nuestro grupo ha obtenido después de desarrollar varias líneas de investigación en relación a la RS y la IPP en pacientes con TUA. Elprimer estudio se realizó con 19 pacientes con dependencia de alcohol, a los que se evaluó la RS y la IPP a nivel basal y a los 14 días, después de haber completado de manera satisfactoria el proceso de desintoxicación. El segundo estudio incluyó a 60 pacientes con dependencia de alcohol y que mantenían una abstinencia de al menos un mes, que fueron testados mediante el test de sobresalto y comparados con un grupo control. En el tercer estudio, 40 pacientes procedentes del segundo estudio fueron evaluados mediante pruebas de impulsividad, correlacionando posteriormente las variables de la RS y las variables de impulsividad. Nuestros estudios han demostrado que los pacientes con dependencia de alcohol presentan una menor magnitud de la RS y una alteración de la IPP cuando son comparados con sujetos sanos. Las alteraciones de la IPP son más marcadas cuando los pacientes presentan un consumo activo de alcohol y se encuentran en las fases iniciales del síndrome de abstinencia, tendiendo a recuperarse parcialmente una vez que se ha completado de manera satisfactoria un tratamiento de desintoxicación, aunque en ningún caso se llegan a alcanzar los porcentajes de IPP mostrados por el grupo de controles sanos. Por último, hemos encontrado que los paradigmas de la RS y las variables de impulsividad se correlacionan en pacientes con dependencia de alcohol, pero no es sujetos sanos. Se concluye que el test de la RS y la IPP pueden ser una herramienta útil a la hora de evaluar a pacientes con dependencia de alcohol, pudiendo ser consideradas como variables neurofisiológicas que podrían constituir marcadores de vulnerabilidad para el desarrollo de alcoholismo o bien el reflejo de los efectos neurotóxicos que el alcohol ejerce sobre el sistema nervioso central

In recent years, the addictive processes and more specifically Alcohol Use Disorders (AUD) have been studied using different neuropsychological and neurophysiological approaches, including the Startle Response (SR) and the Prepulse Inhibition (PPI). In this article we present the results of three studies carried out by our group. The first study included 19 male patients who had alcohol dependence and were detoxified for a period of 10-14 days, undergoing testing for SR and PPI at baseline and after the detoxification treatment. The second study included 60 abstinent alcoholic men who had been abstinent for more than a month and who were compared with healthy controls. The sample of the third studied included 40 alcohol dependent men, who proceeded from study 2, and who were assessed with laboratory impulsivity paradigms after having been tested on SR and PPI. Our studies have found that alcohol dependent patients exhibit a reduced magnitude of the SR and impairments in the PPI compared to healthy controls. Impairments in the PPI are even more evident when the subject is actively consuming alcohol and during early detoxification, and tend to partially improve after the detoxification process is successfully completed, although percentages of PPI do not reach the levels of healthy controls. Finally, we found that ariables of the SR and variables of impulsivity were correlated in abstinent alcohol dependent patients, but not in controls. In conclusion, SR and PPI could be useful tools for the assessment of patients withalcohol dependence. They could either be considered as vulnerability markers for the development ofalcohol or be an index of alcohol neurotoxicity in the central nervous system