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)

Cognitive Alterations in Addictive Disorders: A Translational Approach.

The cognitive decline in people with substance use disorders is well known and can be found during both the dependence and drug abstinence phases. At the clinical level, cognitive decline impairs the response to addiction treatment and increases dropout rates. It can be irreversible, even after the end of drug abuse consumption. Improving our understanding of the molecular and cellular alterations associated with cognitive decline could be essential to developing specific therapeutic strategies for its treatment. Developing animal models to simulate drug abuse-induced learning and memory alterations is critical to continue exploring this clinical situation. The main aim of this review is to summarize the most recent evidence on cognitive impairment and the associated biological markers in patients addicted to some of the most consumed drugs of abuse and in animal models simulating this clinical situation. The available information suggests the need to develop more studies to further explore the molecular alterations associated with cognitive impairment, with the ultimate goal of developing new potential therapeutic strategies.

Diagnostic concordance between Primary Care and Mental Health.

To analyse the diagnostic concordance index between Primary Care and Mental Health.

Concordancia diagnóstica entre Atención Primaria y Salud Mental / Diagnostic concordance between Primary Care and Mental Health

Objetivo: Analizar la concordancia diagnóstica entreAtención Primaria (AP) y Salud Mental (SM).Metodología. Estudio descriptivo y retrospectivo realizado en el Centro de SM de Villaverde, Madrid, España.La muestra está conformada por 1050 pacientes adultosnuevos consecutivos derivados desde AP a SM desde eneroa diciembre del año 2016. Se registraron las siguientes variables: Centro de AP de origen de la derivación, edad, sexo,tipo de actividad solicitante en la derivación (Psiquiatría oPsicología), diagnóstico establecido por AP y diagnósticoestablecido por SM.Resultados. La concordancia diagnóstica entre AP y SMpresentó un coeficiente de kappa global de 0,383 (IC 95 %0,333-0,433). Los grupos diagnósticos con menor concordancia fueron el trastorno adaptativo (kappa: 0,200), eltrastorno de ansiedad (kappa: 0,242) y el trastorno afectivodepresivo (kappa: 0,340). Los grupos diagnósticos con mayorconcordancia fueron el trastorno bipolar (kappa: 0,816) y eltrastorno psicótico (kappa: 0,689). El trastorno adaptativofue el diagnóstico más frecuentemente diagnosticado en SMentre los no coincidentes con AP (38,99 %).Conclusiones. La concordancia diagnóstica entre AP ySM es baja, lo cual podría afectar a la calidad asistencialofrecida a los pacientes. Se considera necesario el planteamiento de nuevas estrategias que permitan aumentar estaconcordancia. (AU)

Objetive: To analyse the diagnostic concordance indexbet-ween Primary Care and Mental Health.Methodology. Retrospective and descriptive study inMental Health Centre of Villaverde, Madrid, Spain. The sample consists of 1050 consecutive new adult patients referredfrom Primary Care to Mental Health Center from Januaryto December 2016. The following variables were recorded:Primary Health Center of origin, age, sex, type of activityrequested in the referral (Psychiatry or Psychology), diagnosis established by Primary Care and diagnosis established byMental Health.Results. Diagnostic concordance between Primary Careand Mental Health presented a global kappa coefficient of0.383 (IC 95 % 0.333-0.433). The diagnostic groups with thelowest concordance were adaptive disorder (kappa: 0.200),anxiety disorder (kappa: 0.242) and depressive affective disorder (kappa: 0.340). The diagnostic groups with the highestconcordance were bipolar disorder (kappa: 0.816) and psychotic disorder (kappa: 0.689). Adaptive disorder was themost frequently diagnostic in Mental Health among thosewho did not coincide with Primary Care (38.99 %).Conclusions. Diagnostic concordance between PrimaryCare and Mental Health is low, which could affect the quality of care offered to patients. New strategies are needed to increase this diagnostic concordance. (AU)

ASSISTete: Evalúa el tipo de consumo que realizas con algunas drogas

Herramienta de cribado e intervención breve guiada online, para la detección precoz y el tratamiento inicial de algunos problemas relacionados con el consumo de sustancias. Se basa en el test ASSIST (Alcohol, Smoking and Substance Involvement Screenning Test) desarrollado por la Organización Mundial de la Salud (OMS) para la detección precoz de problemas con sustancias adictivas. Al realizar el test, el usuario obtendrá unas puntuaciones que determinan el riesgo, que su patrón actual de consumo, puede tener sobre su salud. Aquellos usuarios que tengan riegos leves o moderados relacionados con la sustancia que estén consumiendo tienen la posibilidad de disminuir o suprimir su consumo, de forma guiada, a lo largo de tres sesiones, en la misma web.

Web-Based Alcohol, Smoking, and Substance Involvement Screening Test Results for the General Spanish Population: Cross-Sectional Study.

BACKGROUND: Information technology in health sciences could be a screening tool of great potential and has been shown to be effective in identifying single-drug users at risk. Although there are many published tests for single-drug screening, there is a gap for concomitant drug use screening in general population. The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) website was launched on February 2015 in Madrid, Spain, as a tool to identify those at risk. OBJECTIVE: The aim of this study was to describe the use of a tool and to analyze profiles of drug users, their consumption patterns, and associated factors. METHODS: Government- and press-released launching of a Spanish-validated ASSIST test from the World Health Organization (WHO) was used for voluntary Web-based screening of people with drug-related problems. The tests completed in the first 6 months were analyzed . RESULTS: A total of 1657 visitors of the 15,867 visits (1657/15,867, 10.44%) completed the whole Web-based screening over a 6-month period. The users had an average age of 37.4 years, and 78.87% (1307/1657) screened positive for at least one of the 9 drugs tested. The drugs with higher prevalence were tobacco (840/1657, 50.69%), alcohol (437/1657, 26.37%), cannabis (361/1657, 21.79%), and sedatives or hypnotics (192/1657, 11.59%). Polyconsumption or concomitant drug use was stated by 31.80% (527/1657) of the users. Male respondents had a higher risk of having alcohol problems (odds ratio, OR 1.55, 95% CI 1.18-2.04; P=.002) and double the risk for cannabis problems (OR 2.07, 95% CI 1.46-2.92; P<.001). Growing age increased by 3 times the risk of developing alcohol problems for people aged between 45 and 65 years (OR 3.01, 95% CI 1.89-4.79; P<.001). CONCLUSIONS: A Web-based screening test could be useful to detect people at risk. The drug-related problem rates detected by the study are consistent with the current literature. This tool could be useful for users, who use information technology on a daily basis, not seeking medical attention.

Inhibitory capacity assessment in alcohol dependent patients: translation from a modified stop signal task.

INTRODUCTION: Inhibitory control is clearly impaired in alcohol dependent individuals, being associated to the addiction process establishment and abstinence maintenance difficulties. Inhibitory control assessment tasks involving responses to neutral stimuli are available, although a Spanish version task including contextual cues influence on inhibition capacity has not been performed yet. Alcohol related stimuli can modify behavioural inhibition performance. Thus, the purpose of this study was the Spanish translation of a modified stop signal task that assessed inhibitory control, as well as the degree of interference produced by the presence of alcohol related words. METHODOLOGY: A modified stop signal reaction task, based on a fast lexical decision paradigm was employed. Stimuli used were translated from Zack et al.1, according to frequency of use in Spanish, including neutral words, pseudowords and alcohol-related words. Task was applied to 85 alcohol dependent patients, with a minimum of 28 days of abstinence and to 27 healthy participants constituting the control group. RESULTS: Patients showed a poorer performance, with a lower stop signal mean delay comparing to control group, in presence of neutral and alcohol-related words. CONCLUSIONS: Alcohol dependent individuals exhibit a lower behavioural inhibition performance, added to a significant influence of contextual cues on the stop signal task, resulting in impulsive behaviour, only in the patients group.

Evaluación de la capacidad de inhibición en dependientes de alcohol: traducción de la tarea de la señal de stop modificada / Inhibitory capacity assessment in alcohol dependent patients: translation from a modified stop signal task

Introducción. La capacidad inhibitoria se encuentra claramente alterada en personas dependientes del alcohol, asociándose a conductas que contribuyen al establecimiento de la dependencia y dificultando el mantenimiento de la abstinencia. Se dispone de tareas que evalúan la capacidad inhibitoria cuando un estímulo neutro desencadena la respuesta, como la tarea de la señal de stop, aunque no existe una prueba en castellano que incorpore la influencia de claves contextuales en la capacidad inhibitoria. La presencia de estímulos relacionados con el alcohol modifica la capacidad de inhibición conductual. Así, el objetivo de este trabajo fue traducir al castellano una tarea de señal de Stop Modificada que evaluara, además del control inhibitorio, el grado de interferencia que produciría la presencia de palabras relacionadas con el alcohol. Metodología. Se empleó la tarea de la señal de stop modificada, basada en un paradigma de decisión léxica rápida. Los estímulos empleados fueron traducidos de la tarea de Zack et al.1, en función de la frecuencia de uso en castellano, incluyendo palabras neutras, pseudopalabras y relacionadas con el alcohol. Se aplicó a 85 pacientes dependientes del alcohol, con 28 días de abstinencia mínimos y a un grupo control de 27 sujetos. Resultados. Los pacientes presentaron un peor rendimiento, teniendo menores demoras medias ante la señal de stop que el grupo control, ante palabras neutras y relacionadas con el alcohol. Conclusiones. Las personas dependientes del alcohol tienen menor capacidad de inhibición conductual, con influencia contextual significativa solo para los pacientes, que interfiere claramente dando lugar a conductas impulsivas

Introduction. Inhibitory control is clearly impaired in alcohol dependent individuals, being associated to the addiction process establishment and abstinence maintenance difficulties. Inhibitory control assessment tasks involving responses to neutral stimuli are available, although a Spanish version task including contextual cues influence on inhibition capacity has not been performed yet. Alcohol related stimuli can modify behavioural inhibition performance. Thus, the purpose of this study was the Spanish translation of a modified stop signal task that assessed inhibitory control, as well as the degree of interference produced by the presence of alcohol related words. Methodology. A modified stop signal reaction task, based on a fast lexical decision paradigm was employed. Stimuli used were translated from Zack et al.1, according to frequency of use in Spanish, including neutral words, pseudowords and alcohol-related words. Task was applied to 85 alcohol dependent patients, with a minimum of 28 days of abstinence and to 27 healthy participants constituting the control group. Results. Patients showed a poorer performance, with a lower stop signal mean delay comparing to control group, in presence of neutral and alcohol-related words. Conclusions. Alcohol dependent individuals exhibit a lower behavioural inhibition performance, added to a significant influence of contextual cues on the stop signal task, resulting in impulsive behaviour, only in the patients group

Psychiatric comorbidity in a sample of cocaine-dependent outpatients seen in the Community of Madrid drug addiction care network.

The objective of this study was to estimate the current prevalence of psychiatric disorders in cocaine-dependent patients who attend different treatment centres in the Community of Madrid. A prospective multicentre study was used, and a total of 197 cocaine-dependent subjects were assessed. The assessment instrument used for diagnosis was the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). The main findings of this study were a high prevalence of psychiatric comorbidity in cocaine-dependent patients seeking treatment (64.0%). The most common Non Substance Use Disorders found were attention-deficit/hyperactivity Disorders (34.5%) and depressive disorders (13.7%). The most common Substance Use Disorder was alcohol dependence (28.4%). Cocaine-dependent patients who had a depressive disorder and were alcohol dependent presented a more severe clinical profile and a higher degree of psychopathology, measured using different assessment tools, than the patients who were only cocaine dependent. These data suggest that the presence of psychiatric comorbidity could constitute a risk factor associated with the severity of cocaine dependence. The clinical heterogeneity found also indicates the need to search for individualised treatments that more specifically fit the needs of this population.

El objetivo de este estudio fue estimar la prevalencia actual de trastornos psiquiátricos en pacientes dependientes de cocaína atendidos en los diferentes centros de tratamiento en la Comunidad de Madrid. Se trata de un estudio multicéntrico prospectivo realizado con una muestra de 197 sujetos con dependencia de cocaína. El instrumento de evaluación utilizado fue la Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) (Entrevista de Investigación Psiquiátrica para Trastornos Mentales y Sustancias). La prevalencia actual de comorbilidad psiquiátrica encontrada fue del 64.0%. Los trastornos psiquiátricos más frecuentes no relacionados con el consumo fueron el trastorno por déficit de atención e hiperactividad (34,5%) y los trastornos depresivos (13,7%). El trastorno por uso de sustancias más frecuente fue la dependencia del alcohol (28.4%). Los pacientes dependientes de cocaína que presentaron un trastorno depresivo y los que presentaron dependencia del alcohol mostraron un perfil clínico de mayor gravedad y un mayor grado de psicopatología medido a través de diferentes instrumentos de evaluación en relación con los pacientes que sólo presentaban dependencia de la cocaína. Estos datos sugieren que la presencia de comorbilidad psiquiátrica podría constituir un factor de riesgo asociado a la gravedad de la dependencia de la cocaína. La heterogeneidad clínica encontrada recomienda la búsqueda de tratamientos individualizados que se ajusten de manera mas especifica a las necesidades de esta población.

Comorbilidad psiquiátrica en una muestra de pacientes con dependencia de cocaína atendidos ambulatoriamente en la red drogas de la Comunidad de Madrid / Psychiatric comorbidity in a sample of cocaine-dependent outpatients seen in the Community of Madrid drug addiction care network

El objetivo de este estudio fue estimar la prevalencia actual de trastornos psiquiátricos en pacientes dependientes de cocaína atendidos en los diferentes centros de tratamiento en la Comunidad de Madrid. Se trata de un estudio multicéntrico prospectivo realizado con una muestra de 197 sujetos con dependencia de cocaína. El instrumento de evaluación utilizado fue la Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) (Entrevista de Investigación Psiquiátrica para Trastornos Mentales y Sustancias). La prevalencia actual de comorbilidad psiquiátrica encontrada fue del 64.0%. Los trastornos psiquiátricos más frecuentes no relacionados con el consumo fueron el trastorno por déficit de atención e hiperactividad (34,5%) y los trastornos depresivos (13,7%). El trastorno por uso de sustancias más frecuente fue la dependencia del alcohol (28.4%). Los pacientes dependientes de cocaína que presentaron un trastorno depresivo y los que presentaron dependencia del alcohol mostraron un perfil clínico de mayor gravedad y un mayor grado de psicopatología medido a través de diferentes instrumentos de evaluación en relación con los pacientes que sólo presentaban dependencia de la cocaína. Estos datos sugieren que la presencia de comorbilidad psiquiátrica podría constituir un factor de riesgo asociado a la gravedad de la dependencia de la cocaína. La heterogeneidad clínica encontrada recomienda la búsqueda de tratamientos individualizados que se ajusten de manera mas especifica a las necesidades de esta población

The objective of this study was to estimate the current prevalence of psychiatric disorders in cocaine-dependent patients who attend different treatment centres in the Community of Madrid. A prospective multicentre study was used, and a total of 197 cocainedependent subjects were assessed. The assessment instrument used for diagnosis was the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). The main findings of this study were a high prevalence of psychiatric comorbidity in cocaine-dependent patients seeking treatment (64.0%). The most common Non Substance Use Disorders found were attention-deficit/hyperactivity Disorders (34.5%) and depressive disorders (13.7%). The most common Substance Use Disorder was alcohol dependence (28.4%). Cocaine-dependent patients who had a depressive disorder and were alcohol dependent presented a more severe clinical profile and a higher degree of psychopathology, measured using different assessment tools, than the patients who were only cocaine dependent. These data suggest that the presence of psychiatric comorbidity could constitute a risk factor associated with the severity of cocaine dependence. The clinical heterogeneity found also indicates the need to search for individualised treatments that more specifically fit the needs of this population

Validación de la versión española del Test Stroop de Alcohol / Validation of the Spanish Version of the Alcohol Stroop Test

El sesgo atencional para el alcohol se ha mostrado útil para identificar a personas con consumo patológico así como a personas dependientes con altas probabilidades de recaída. El objetivo de este trabajo fue validar la versión española del Test Stroop de Alcohol diseñado para evaluar el sesgo atencional en pacientes dependientes del alcohol. La muestra estuvo compuesta por 173 participantes divididos en dos grupos: Un grupo de pacientes (n = 88) cumpliendo criterios de dependencia alcohólica y un grupo control (n = 85) con riesgo bajo de consumo de alcohol, que realizaron el Test de palabras y colores de Stroop (Stroop clásico), el Test de Stroop neutro y el Test de Stroop de Alcohol. Se observaron diferencias estadísticamente significativas en las interferencias para el Stroop Clásico y el Stroop de Alcohol. Los pacientes con dependencia, en comparación a los participantes control, mostraron mayores interferencias para estímulos de contenido alcohólico que para estímulos de contenido neutro. Este efecto fue explicado por un sesgo atencional para información relacionada con el alcohol en pacientes con dependencia. Se calcularon curvas COR, observándose áreas bajo la curva estadísticamente significativas para las interferencias del Stroop clásico y del Stroop de alcohol. Este trabajo sirvió para validar la versión española del Test Stroop de Alcohol para evaluar sesgos atencionales hacia el alcohol en personas con problemas de consumo y dependencia alcohólica

Attention bias for alcohol has proved useful to distinguish people with a pathological consumption of people who do not, and dependents who are more likely to fall in consumption. The aim of this study was to validate the Spanish version of the Alcohol Stroop test, designed to evaluate attention biases for alcohol in alcohol-dependent patients. The sample was composed by 173 participants divided into 2 groups: 1) “Patients” (n = 88) meeting criteria for alcohol dependence; and 2) “Control” (n = 85) having a low risk for alcohol consumption, that completed the Stroop color naming Task (Classic Stroop), the Neutral Stroop test and the alcohol Stroop test. Statistically significant differences were found in the interference effects calculated for the Classic and Alcohol Stroop tests. Patients compared to control participants showed a higher interference effect for alcohol-related stimuli than for neutral stimuli. These effects were accounted by an attention bias for alcohol-related information in patients. ROC curves were calculated for the three interference effects, showing an area under the curve statistically significant in the Classic Stroop interference and the Alcohol Stroop interference. This study provides the validation of the Spanish version of the Alcohol Stroop test that allows to evaluate attention biases for alcohol stimuli in individuals with both pathologic alcohol consumption and alcohol dependence

Changes on the Modulation of the Startle Reflex in Alcohol-Dependent Patients after 12 Weeks of a Cognitive-Behavioral Intervention.

AIMS: Little is known about changes in the modulation of the startle reflex when patients go through an alcohol-dependence treatment in an outpatient facility. In the current study, the affective modulation of the cue-related startle reflex has been used to evaluate changes in the emotional processing of alcohol-related stimuli that occurred after a standard cognitive-behavioral intervention, and to assess the outcome of this intervention. We hypothesized a 'normalization' of the startle inhibition for the alcohol-related cues during the period of treatment. We also assumed that higher startle inhibition at baseline elicited by alcohol cues would predict the relapse on alcohol consumption during treatment. PARTICIPANTS: A total of 98 alcohol-dependent subjects were included who fulfilled DSM-IV criteria for alcohol dependence. A control group of 72 subjects was selected to match demographic characteristics. MEASUREMENTS: All patients received a standard cognitive-behavioral therapy once a week throughout the study period. FINDINGS: Results show that the startle response differed significantly after 12 weeks of treatment for alcohol-related, neutral and aversive stimuli between alcohol-dependent patients and controls. Low startle responses at baseline to alcohol cues predicted relapse. CONCLUSIONS: These results may indicate that the startle reflex is referred to enduring and permanent processes of cue reactivity, and that the emotional processing of alcohol-associated cues assessed with the affect-modulated startle reflex is less altered by interventions attempting to influence explicit cognitions. Furthermore, lower values of the baseline startle reflex elicited by alcohol-associated stimuli were associated with higher probability of relapse on alcohol use.

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

Implicaciones de la introducción del Nalmefeno en el tratamiento de la dependencia alcohólica en España / No disponible

Nalmefeno es el primer tratamiento aprobado por la Unión Europea para reducir el consumo de alcohol en dependientes del alcohol con consumo de riesgo prescrito en el contexto de un abordaje motivacional. Nalmefeno mejoraba los días de consumo y las cantidades de alcohol más que el placebo. Es un fármaco bien tolerado. Su utilización puede aumentar el número de pacientes dependientes. Su introducción supone ofrecer un nuevo abordaje terapéutico basado en el paradigma de la disminución del daño

Nalmefene is the first pharmacological therapy approved in the EU to reduce alcohol consumption in alcohol-dependent subjects with a high drinking risk level in the context of a motivational approach. Nalmefene significantly reduced both the number of heavy drinking days and total alcohol consumption in alcohol-dependent patients. Also, this compound is generally well tolerated. This type of intervention has the potential to engage more patients in treatment, and also implies the implementation of the paradigm based on harm reduction

Validation of the Spanish version of the alcohol smoking and substance involvement screening test (ASSIST) / Validación de la versión española del Test de Detección de Uso de Alcohol, Tabaco y otras Sustancias (ASSIST)

BACKGROUND: There is a growing interest in designing instruments to assess obsessive-compulsive symptoms in children. The Obsessive-Compulsive Inventory-Child Version (OCI-CV) has showed to be a valid in the evaluation of OCD in clinical and nonclinical populations. The main goal in this study was to analyze factor structure and psychometric properties of the OCI-CV in a community Spanish sample. METHOD: Data were collected from 914 children/adolescents with a mean age of 13.01 (SD = 1.96; Males = 51.3%). Exploratory factor analysis was carried out in order to study the internal structure of the OCI-CV Spanish version. Further, internal consistency, test-retest reliability, and convergent and discriminant validity of the total score and the factors obtained were examined. Finally, age and gender differences were also explored. RESULTS: Exploratory factor analysis yielded a similar structure to the original OCI-CV with the following six factors: Washing/Checking, Obsession, Ordering, Doubting, Neutralizing, and Hoarding. The internal consistency was strong for the total score, but moderate for the subscales. The Spanish version of the OCI-CV showed evidences of test-retest reliability and convergent and discriminant validity. CONCLUSION: The Spanish version of the OCI-CV is an instrument with adequate psychometric properties to assess obsessions and compulsions in Spanish children/adolescents

ANTECEDENTES: existe un creciente interés en el diseño de instrumentos que evalúen los síntomas obsesivo-compulsivos en niños. El Inventario Obsesivo Compulsivo-Versión para Niños (OCI-CV) ha demostrado ser válido para evaluar estos síntomas en población clínica y no clínica. El objetivo de este estudio fue analizar la estructura factorial y las propiedades psicométricas del OCI-CV en población española comunitaria. MÉTODO: se recogieron datos de 914 niños/adolescentes con una edad media de 13,01 años (DT = 1.96; 51.3% varones). Se realizó un análisis factorial exploratorio. Posteriormente se examinó la consistencia interna, la fiabilidad test-retest y la validez convergente y divergente de la puntuación total del instrumento y de los factores obtenidos. Finalmente, se comprobó la existencia de diferencias en función del sexo y la edad de los participantes. RESULTADOS: los resultados mostraron una estructura similar a la del OCI-CV original, compuesta por los siguientes factores: Lavado/Comprobación, Obsesión, Orden, Duda, Neutralización y Acumulación. La consistencia interna fue buena para la puntuación total, aunque moderada para las diferentes subescalas. La versión en castellano del OCI-CV mostró evidencias de fiabilidad test-retest y validez convergente y discriminante. CONCLUSIONES: OCI-CV es una herramienta con adecuadas propiedades psicométricas para la valoración de obsesiones y compulsiones en niños/adolescentes españoles

Relationship between measures of inhibitory processes in patients with schizophrenia: role of substance abuse disorders.

Disruption of prepulse inhibition of the startle response (PPI) has been widely identified in patients with schizophrenia, as well as impairment in many domains of cognitive functioning. However, there is some controversy regarding the relationship between PPI and the different neuropsychological tasks assessing inhibition. This controversy may be due to the influence of other variables, such as substance abuse. We aimed to determine whether differences in inhibition in schizophrenia subjects were related to their pattern of substance use and whether there was a correlation between the changes in each process. PPI and neuropsychological functioning were studied in three groups of subjects with schizophrenia (N=73): tobacco dependents (ToD; n=22), multiple substance abusers (MSUD; n=31) and non-substance abusers (non-SUD; n=20). All subjects were assessed using PPI and neuropsychological tests (Stroop and Wisconsin Card Sorting Test [WCST]). ToD showed better pre-attentive inhibitory function compared to the other two groups, and MSUD showed lower resistance to interference. Furthermore, significant correlations were found between PPI, Stroop, and WCST. Our data suggest that there is a relationship between the different tasks assessing inhibition in schizophrenia, being affected by substance abuse history. We also found differences in inhibition capacity depending on substance abuse in patients with schizophrenia.

Validación de la Escala sobre el Deseo de Beber - EDB / Validation of the Desire to Drink Scale - dds

Se presenta la validación de la Escala sobre el Deseo de Beber (EDB), instrumento de medida de nueva creación, en una muestra de 126 alcohólicos en distintos tipos de tratamiento de su dependencia. Este instrumento ha reflejado una elevada consistencia interna (alfa de Cronbach de 0.917). Los factores obtenidos del análisis factorial proporcionan una estructura de contenido que permite realizar una medida holística del constructo. La EDB y los factores que se derivan de ella correlacionan de forma alta, significativa y positiva con la Escala de la Intensidad de la Dependencia Alcohólica (EIDA) y sus subescalas. Por todo ello podemos decir que este instrumento posee condiciones adecuadas para su uso en la medida del constructo "deseo de beber" y gran aplicabilidad en el ámbito clínico y de investigación

The validation of the Desire to Drink Scale (DDS) is presented. This original version of the instrument has been applied to a sample of 126 alcoholics participating in different programs designed to treat their alcohol dependence. Cronbach´s alpha scores suggest a high internal consistency (alpha= 0.917). Factor analysis reveals the presence of different factors, providing a content structure that allows us to make a global measurement of the construct. correlation between DDS (and its factors) and the Intensity of alcohol Dependence (IADS) (and associated scales) is significantly high. We can therefore conclude that this new instrument is adequate for clinical and research purposes since it provides a good measure of the desire-to-drink construct