Reading abilities in preterm children: a systematic review and meta-analysis.

It is well recognized that children born preterm have specific learning difficulties. The objective of this study is to carry out a systematic review and meta-analysis on preterm children's reading ability performance. Of the 486 studies identified, 53 met the inclusion criteria, resulting in 143 effect sizes. 33,500 children between 5 and 18 years were included of whom 13,765 were preterm infants and 19,735 were full-term infants. Among preterm-born children without neurodevelopmental disorders significant differences and larger effect sizes were found in the reading subcategories, letter-word knowledge, reading comprehension, and spelling, whereas no significant differences were found in phonological awareness and rapid automatized naming. Extremely preterm children showed larger effect size. The present meta-analysis, which includes a much larger number of studies, shows that preterm children have lower performance than full-term children in reading and spelling. This fact underlines the need to design, develop and implement neuroeducational programs that take into account the characteristics of preterm born students.

Phonological and semantic verbal fluency test: Scoring criteria and normative data for clustering and switching strategies for Colombian children and adolescents.

BACKGROUND: Verbal fluency tests (VFT) are highly sensitive to cognitive deficits. Usually, the score on VFT is based on the number of correct words produced, yet it alone gives little information regarding underlying test performance. The implementation of different strategies (cluster and switching) to perform efficiently during the tasks provide more valuable information. However, normative data for clustering and switching strategies are scarce. Moreover, scoring criteria adapted to Colombian Spanish are missing. AIMS: (1) To describe the Colombian adaptation of the scoring system guidelines for clustering and switching strategies in VFT; (2) to determine its reliability; and (3) to provide normative data for Colombian children and adolescents aged 6-17 years. METHODS & PROCEDURES: A total of 691 children and adolescents from Colombia completed phonological (/f/, /a/, /s/, /m/, /r/ and /p/) and semantic (animals and fruits) VFT, and five scores were calculated: total score (TS), number of clusters (NC), cluster size (CS), mean cluster size (MCS) and number of switches (NS). The intraclass correlation coefficient was used for interrater reliability. Hierarchical multiple regressions were conducted to investigate which strategies were associated with VFT TS. Multiple regressions were conducted for each strategy, including as predictors age, age2 , sex, mean parents' education (MPE), MPE2 and type of school, to generate normative data. OUTCOMES & RESULTS: Reliability indexes were excellent. Age was associated with VFT TS, but weakly compared with strategies. For both VFT TS, NS was the strongest variable, followed by CS and NC. Regarding norms, age was the strongest predictor for all measures, while age2 was relevant for NC (/f/ phoneme) and NS (/m/ phoneme). Participants with higher MPE obtained more NC, and NS, and larger CS in several phonemes and categories. Children and adolescents from private school generated more NC, NS and larger CS in /s/ phoneme. CONCLUSIONS & IMPLICATIONS: This study provides new scoring guidelines and normative data for clustering and switching strategies for Colombian children and adolescents between 6 and 17 years old. Clinical neuropsychologists should include these measures as part of their everyday practice. WHAT THIS PAPER ADDS: What is already known on the subject VFT are widely used within the paediatric population due to its sensitivity to brain injury. Its score is based on the number of correct words produced; however, TS alone gives little information regarding underlying test performance. Several normative data for VFT TS in the paediatric population exist, but normative data for clustering and switching strategies are scarce. What this paper adds to existing knowledge The present study is the first to describe the Colombian adaptation of the scoring guidelines for clustering and switching strategies, and provided normative data for these strategies for children and adolescents between 6 and 17 years old. What are the potential or actual clinical implications of this work? Knowing VFT's performance, including strategy development and use in healthy children and adolescents, may be useful for clinical settings. We encourage clinicians to include not only TS, but also a careful analysis of strategies that may be more informative of the underlying cognitive processes failure than TS.

Problematic Internet use and Internet gaming disorder: Overlap and relationship with health-related quality of life in adolescents. / Uso problemático de Internet y trastorno de juego por Internet: Solapamiento y relación con la calidad de vida relacionada con la salud en adolescentes.

General Problematic Internet Use (GPIU) is a dysfunctional use of Internet handling and management in general. In contrast, Internet Gaming Disorder (IGD) is a specific behaviour linked to online videogames. Both problems are becoming common in adolescents, but they have hardly been studied simultaneously, and the joint relationship of the two constructs with Health-Related Quality of Life (HRQoL) is unknown. The general objective of this study is to analyse the relationship between GPIU and IGD and their association with HRQoL. The study is analytical and cross-sectional with 2,024 participants (46.4% boys, n = 939) from 16 schools of 7 Spanish regions. The mean age and standard deviation were 14.20±1.42, with a range of 11-18 years. The Spanish versions of the KIDSCREEN-10, the Revised Generalized and Problematic Internet Use Scale 2 and the Internet Gaming Disorder Scale were used. Of the total sample evaluated, 15.5% of the participants had high levels of GPIU, and 3.3% of video game players presented IGD. The dimensions of GPIU are strongly associated with those of IGD. HRQoL correlated significantly and negatively with all the dimensions of GPIU and IGD (p <.001). Participants who reported problems with GPIU or IGD, individually or conjointly, had significantly lower scores in HRQoL than those with no problems.

El Uso problemático general de Internet (GPIU) supone un uso disfuncional del manejo y la gestión de Internet en general. En cambio, el Trastorno de juego por Internet (IGD) es una conducta específica vinculada a los videojuegos en línea. Ambos problemas comienzan a ser frecuentes en adolescentes, pero apenas han sido estudiados simultáneamente ni se conoce el papel conjunto de ambos constructos sobre Calidad de vida relacionada con la salud (CVRS). El objetivo general de este estudio es analizar la relación entre el GPIU y el IGD y su asociación con la CVRS. El estudio es analítico y transversal con 2024 participantes (46,4% chicos, n = 939) procedentes de 16 colegios en 7 regiones españolas. La media de edad y desviación típica fue de 14,20±1,42 en un rango de 11-18 años. Se usaron las versiones españolas del KIDSCREEN-10, del Revised Generalized and Problematic Internet Use Scale 2 y del Internet Gaming Disorder Scale. Un 15,5% del total de la muestra evaluada reportó niveles altos de GPIU y un 3,3% de los jugadores de videojuegos presentó IGD. Las dimensiones del GPIU están altamente asociadas a las del IGD. La CVRS correlacionó significativa y negativamente con todas las dimensiones del GPIU y del IGD (p <,001). Los participantes que reportaron problemas en el GPIU o el IGD, individual o conjuntamente, presentan puntuaciones significativamente más bajas en la CVRS.

Reward sensitivity and hazardous alcohol consumption in women: The parallel mediation effect of self-control and impulsivity traits.

Introduction: Little research has been carried out on the associations between several individual factors and hazardous alcohol use in women. The aim of this study was first, to study the relationship between reward sensitivity (RS) and alcohol use in both women with and without hazardous drinking separately. Second, to explore the potential mediating roles of the impulsivity and self-control traits in this relationship. Method: The study was analytical and cross-sectional and included 645 female participants (mean age = 19.14; standard deviation (SD)=1.60). All women were divided into two groups (286, 44.3%, with hazardous drinking, HDW; and 359, 55.7%, with light drinking, LDW). Correlation analyses were carried out to explore the associations between the variables, and parallel mediation analyses were performed to investigate the potential mediating roles of impulsivity and self-control in the RS-alcohol use associations in each group separately. Results: A significant association was observed between RS and alcohol use in HDW, contrary to that observed in their counterparts. In addition, both higher impulsivity and less self-control mediated the association between RS and alcohol use only in HDW. Conclusions: Impulsivity and self-control differently affect alcohol use under the condition of high reward sensitivity, only in HDW, suggesting alterations of the dual top-down and bottom-up mechanisms and a possible imbalance between the competing reflexive and impulsive brain systems. More research is needed regarding the individual factors that affect women's drinking to develop sensitive measures for the assessment of alcohol use and more efficient interventions for women.

Assessment of executive functions as a measure of impairments in everyday functioning in persons with HIV.

Persons with HIV can often present cognitive disorders such as those related to executive functioning, which could affect the daily life activities. The present study was designed to explore the predictive relationship between executive functions according to Miyake's model and the basic and instrumental skills of everyday functioning in a group of persons with HIV (PWH). Participants were recruited from outpatient treatment Hospital and assessed using a neuropsychological battery, a modified version of the Lawton and Brody basic and instrumental activities of daily life (ADL) scale and the Hospital Anxiety and Depression Scale (HADS). The results showed a low score in the executive function and significant relationship between executive functioning and the instrumental skills of the patients, with set-shifting being one of the most powerful predictors. The processes of executive functioning, particularly set-shifting, are related to the level of functioning in the skills required for independent living in the community, but not the skills of independent living in the home. This study seems to suggest the utility of assessing executive functions as a preventive measure for the development of dependencies in normal daily instrumental skills and as the focus of interdisciplinary interventions.

Cocaine and depressive disorders: When standard clinical diagnosis is insufficient. / Trastorno por uso de cocaína y depresión: Cuando el diagnóstico clínico no es suficiente.

BACKGROUND: Cocaine use is a growing global health problem and patients with cocaine use disorders (CUD) present several complications, including high rates of major depression. These subjects present two types of major depressive disorder (MDD): primary major depressive disorder (P-MDD) and cocaine-induced major depressive disorder (CI-MDD). To improve treatment, it is necessary to distinguish between both types. The aim of this study was to assess the differences in depressive symptomatology criteria (P-MDD vs CI-MDD) in CUD patients. METHODS: Secondary data analysis was carried out with a cross-sectional sample of 160 patients presenting CUD and MDD. Clinical assessment was performed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). A differential diagnosis was obtained between P-MDD and CI-MDD. RESULTS: Men represented 80% of the sample, the mean age was 38.61 years, and 64.5% had elementary studies. CI-MDD diagnosis (61.3%) was more frequent than P-MDD (38.7%). There was a younger age of CUD onset in CI-MDD patients. In addition, 79.4% of the patients had another substance use disorder diagnosis. The criterion "Changes in weight or appetite" was more prevalent (57.1%) in P-MDD group. CONCLUSIONS: We found differences in the criterion "Changes in weight or appetite". Further research is needed in this field to establish a differential diagnosis and thus provide better treatment for CUD patients.

Antecedentes: El consumo de cocaína es un creciente problema de salud en todo el mundo. Además, los pacientes con trastorno por consumo de cocaína (TCC) presentan una alta comorbilidad con el trastorno depresivo mayor (TDM). Estos pacientes pueden presentar dos tipos de TDM: trastorno depresivo mayor primario (TDM-P) y trastorno depresivo mayor inducido por cocaína (TDM-IC). El objetivo de este estudio es evaluar las diferencias en la sintomatología depresiva (TDM-P vs. TDM- IC) en los pacientes con TCC para mejorar su tratamiento. Métodos: Se llevó a cabo un análisis secundario en una muestra transversal de 160 pacientes que presentaban TCC y algún TDM. La evaluación clínica, así como el diagnóstico diferencial entre TDM-P y TDM-IC, se realizó utilizando la entrevista PRISM. Resultados: Los hombres representaron el 80% de la muestra con una edad media de 38,61 años y el 64,5% sólo tenía estudios primarios. El diagnóstico de TDM-IC (61,3%) fue más frecuente que el de TDM-P (38,7%). Los pacientes con TDM-IC mostraron una edad de aparición más temprana para el TCC. El 79,4% de los pacientes cumplían criterios para otro trastorno por consumo de sustancias. Únicamente el criterio "Cambios en el peso o en el apetito" fue estadísticamente más prevalente (57,1%) en los pacientes con TDM-P. Conclusiones: Existen diferencias en el criterio "Cambios en el peso o en el apetito" entre TDM-P y TDM-IC. Se necesita más investigación a fin de obtener un diagnóstico diferencial entre los dos tipos de depresión y proporcionar un mejor tratamiento para los pacientes con TCC.

Predictive Outcome Validity of General Health Questionnaire (GHQ-28) in Substance Abuse Patients Treated in Therapeutic Communities.

Objective: The use of psychoactive substances has been one of the most important global public health problems over the last few decades. Among the problems associated with substance use, dual diagnosis is one of the most relevant. This study aims to investigate the predictive validity of the GHQ-28 (General Health Questionnaire-28; "probable psychiatric cases") in relation to poor treatment outcome measured by (a) "early treatment dropout" and (b) "nonclinically relevant improvement at discharge." Methods: A longitudinal prospective design was used. A sample of 219 substance use disorder patients, who received treatment in a therapeutic community, was selected. Patients were assessed using the GHQ-28 and the outcome variables were registered. A hierarchical logistic regression model was performed to identify factors independently associated with the outcome measure ("early treatment dropout" and "nonclinically relevant improvement at discharge"). Results: Of the total sample, 79 subjects (36%) were considered "early treatment dropouts" and 56.6% (102) presented a "nonclinically relevant improvement at discharge." The two hierarchical logistic regression results show that being classified as a "probable psychiatric case" was significantly and directly associated with "early treatment dropout" and "nonclinically relevant improvement at discharge," as a poor in-treatment outcome indicator. Conclusions: The results of this study support the notion that the probable psychiatric cases identified by the GHQ-28 scale have a greater probability of "early treatment dropout" and have a greater probability of "nonclinically relevant improvement in discharge" of the therapeutic community. These data indicate that GHQ-28 is a suitable clinical instrument for predicting dropout and treatment effect in residential substance use disorder treatment.

Effectiveness of the “Trisquel” board game intervention program for patients with schizophrenia spectrum disorders.

Schizophrenia spectrum disorders present emotional, cognitive and/or behavioural alterations relat- ed to daily functioning. Therefore, it is necessary to develop intervention programs focused on the improvement of these constructs. The aim of this work is to analyse the effect of the intervention program “Trisquel” on cognitive functioning, symptomatologic perception and psychosocial functioning.

Objective memory as an indicator of functional impairment in native Spanish-speaking patients with HIV infection.

Objective memory is one of the most affected cognitive areas in patients with HIV and perhaps one of the best predictors of daily functioning problems. Its relationship with biological markers, mood symptoms, and cognitive complaint is unclear and has received little attention in native Spanish-speakers. The goal of this study is to explore the relationships between the above-mentioned variables and their prediction of objective memory performance in native Spanish-speakers. HIV-related biological markers, mood symptoms, cognitive complaint, and objective memory were assessed in a sample native Spanish-speaking HIV patient with possible cognitive impairment. The results revealed deficit in short- and long-term memory while recognition was retained. Hierarchical regression analysis showed that the combination of independent variables significantly predicted performance in recognition, indicating that the pattern of impairment in short- and long-term memory is related to a difficulty to learn new information discriminately. The non-prediction of short- and long-term memory performance may be related to the inability to estimate the deficit in objective memory. These results show the need to perform specific interventions in mnesic processes, in view of the relation between this cognitive process and patients' daily functioning.

[Consensus statement on the clinical management of human immunodeficiency virus-associated neurocognitive disorders]. / Documento de consenso sobre el manejo clínico de los trastornos neurocognitivos asociados a la infección por el virus de la inmunodeficiencia humana (enero 2013).

OBJECTIVE: To develop a consensus document containing clinical recommendations for the management of human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND). METHODS: We assembled a panel of experts appointed by GeSIDA and the Secretariat of the National AIDS Plan (PNS), including internal medicine physicians with expertise in the field of HIV, neuropsychologists, neurologists and neuroradiologists. Scientific information was reviewed to October 2012 in publications and conference papers. In support of the recommendations using two levels of evidence: the strength of the recommendation in the opinion of the experts (A, B, C) and the level of empirical evidence (I, II, III), two levels based on the criteria of the Infectious Disease Society of America, already used in previous documents GeSIDA/SPNS. RESULTS: Multiple recommendations for the clinical management of these disorders are provided, including two graphics algorithms, considering both the diagnostic and possible therapeutic strategies. CONCLUSIONS: Neurocognitive disorders associated with HIV infection is currently highly prevalent, are associated with a decreased quality of life and daily activities, and given the possibility of occurrence of an increase in the coming years, there is a need to adequately manage these disorders, from a diagnostic as well as therapeutic point of view, and always from a multidisciplinary perspective.

Impact of psychiatric comorbidity on the in-treatment outcomes of cocaine-dependent patients in therapeutic communities.

BACKGROUND: This study aimed to explore the association between psychiatric comorbidity and treatment outcomes in therapeutic communities (TCs). METHODS: A prospective longitudinal descriptive design was used. A baseline psychopathological assessment was performed within the first 15 to 20 days of treatment in the TCs. The length of treatment stay was computed for each individual. The study was conducted in the region of Andalusia (Spain). The participants were 218 cocaine-dependent individuals. Psychopathological assessment was performed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). The outcome measures were retention, defined as the time in TC treatment (number of days), and the patient's assessment upon leaving the TC. RESULTS: The number of psychopathological comorbidities present in the last year among the patients was high (57.8%) and was associated with a worse response to treatment (P =.004). The patients with co-occurring psychiatric disorders had a decreased probability of remaining in the TCs compared with patients who only presented with substance use disorders (hazards ratio = 1.61). CONCLUSIONS: Psychiatric comorbidity predicts cocaine-dependent individuals' likelihood of remaining in residential treatment.

Harm reduction behaviors among young polysubstance users at raves.

BACKGROUND: Raves may be considered recreational settings in which drug use and health risks related to polydrug use are higher than in others. Harm reduction behaviors implemented by ravers are of particular relevance in reducing such risks. This study analyzes harm reduction behaviors and their relationship to raver polysubstance use patterns. METHODS: Cross-sectional study of 248 ravers recruited at underground raves in Andalusia (Spain). A questionnaire was developed to collect information about their sociodemographics, drug use, and harm reduction behaviors. RESULTS: The results show that ravers employ harm reduction behaviors for minimizing drug-related harm. Nevertheless, only a small minority of the participants frequently employed harm reduction behavior for polysubstance use as well. Ravers identified as high polysubstance users protected themselves significantly less than those identified as low polysubstance users. CONCLUSIONS: This study provides empirical information that may be useful for harm reduction intervention in a hidden and hard-to-reach population like rave attendees. The results point to the need to inform and increase harm reduction behavior specifically aimed at polysubstance use by ravers, especially among more frequent users. Future directions for research are also suggested.

[Psychopathological comorbidity in cocaine users in outpatient treatment]. / Comorbilidad psicopatológica en consumidores de cocaína en tratamiento ambulatorio.

Cocaine addiction is a growing health problem and among its complications highlights the high prevalence of mental disorders co-occurring with abuse and dependence. This psychopathological comorbidity varies according to the time of consumption and the age of the patient. Early detection of psychopathological disorders associated with drug consumption is necessary to optimize health care and to improve the prognosis. The main aim of the present study was to estimate the prevalence and characteristics of psychopathological comorbidity in a population of subjects seeking outpatient treatment for cocaine use. We recruited 110 subjects using cocaine by nasal insufflations evaluated with the PRISM (Psychiatric Research Interview for Substance and Mental Disorders), a semi-structured diagnostic interview that differentiates primary mental disorders from those induced by the drug. This population presented 86.4% male and had a mean age of 36.5. They displayed a pathological use of cocaine of 7 years and the presence of psychopathology was associated with a higher number of DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders- IV-TR) criteria for substance dependence. The lifetime prevalence of some psychopathological comorbidity was 61.8%, highlighting mood disorders (34.5%), followed by anxiety disorders (22.7%) and psychotic disorders (15.5%). About 20% showed antisocial personality disorder and 21% borderline personality disorder. From among mood and psychotic disorders, the induced disorders were more frequent, while the primary disorders were more prevalent in anxiety.

Assessing predictors of adequate individual buprenorphine maintenance dosage for the treatment of opioid use disorder: Listening to the patient.

OBJECTIVE: Dose optimization plays a key role in determining clinical outcomes in patients on opioid agonist treatment (OAT). The objective of this study was to identify the variables independently associated with buprenorphine/naloxone (B/N) dose adequacy in patients with opiate use disorder (OUD). METHOD: Cross-sectional study of a convenience sample of patients with OUD treated with B/N (n = 315) in four regions in Spain. The Opiate Dosage Adequacy Scale (ODAS) was used to determine B/N dose adequacy. The ODAS evaluate the six components of the "dose adequacy" construct, as follows: continued use of heroin; narcotic blockade or crossed tolerance; objective opioid withdrawal symptoms (OWS); subjective OWS; craving for heroin; and overmedication. A binomial logistic regression analysis was performed to identify the variables associated with the condition "ODAS Adequate B/N dose". Participants completed a battery of instruments to assess sociodemographic, substance use, clinical, and treatment variables. RESULTS: The B/N dose was considered adequate in 231 of the 315 participants (73.3 %). Two variables, satisfaction with B/N as a medication (OR=5.764, 95 % CI=2.211-15.030) and patient-perceived participation in B/N dose decisions (OR=1.790, 95 % CI=1221-2623), were independently, significantly, and positively associated with the "ODAS Adequate B/N dose" condition. While the severity of heroin dependence was significantly associated with buprenorphine dose adequacy in the bivariate analyses, significance was lost in the full regression model. CONCLUSION: Satisfaction with B/N as a medication and patient-perceived involvement in the dose decision are associated with clinician-assessed dose adequacy. In the context of good clinical practice, it is important to take into account both of these variables to individualize the prescribed dose through a shared decision-making process.

Evaluation of plasma-free endocannabinoids and their congeners in abstinent cocaine addicts seeking outpatient treatment: impact of psychiatric co-morbidity.

Cocaine is associated with serious health problems including psychiatric co-morbidity. There is a need for the identification of biomarkers for the stratification of cocaine-addicted subjects. Several studies have evaluated circulating endocannabinoid-related lipids as biomarkers of inflammatory, metabolic and mental disorders. However, little is known in substance use disorders. This study characterizes both free N-acyl-ethanolamines (NAEs) and 2-acyl-glycerols in abstinent cocaine addicts from outpatient treatment programs who were diagnosed with cocaine use disorder (CUD; n = 88), and age-/gender-/body mass-matched healthy control volunteers (n = 46). Substance and mental disorders that commonly occur with substance abuse were assessed by the semi-structured interview 'Psychiatric Research Interview for Substance and Mental Diseases' according to the 'Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision' (DSM-IV-TR) and plasma-free acyl derivatives were quantified by a liquid chromatography-tandem mass spectrometry system. The results indicate that plasma acyl derivatives are altered in abstinent cocaine-addicted subjects with CUD (CUD subjects). While NAEs were found to be increased, 2-acyl-glycerols were decreased in CUD subjects compared with controls. Multivariate predictive models based on these lipids as explanatory variables were developed to distinguish CUD subjects from controls providing high discriminatory power. However, these alterations were not influenced by the DSM-IV-TR criteria for cocaine abuse and dependence as cocaine trait severity measure. In contrast, we observed that some free acyl derivatives in CUD subjects were found to be affected by the diagnosis of some co-morbid psychiatric disorders. Thus, we found that the monounsaturated NAEs were significantly elevated in CUD subjects diagnosed with mood [N-oleoyl-ethanolamine and N-palmitoleoyl-ethanolamine (POEA)] and anxiety (POEA) disorders compared with non-co-morbid CUD subjects. Interestingly, the coexistence of alcohol use disorders did not influence the circulating levels of these free acyl derivatives. In summary, we have identified plasma-free acyl derivatives that might serve as reliable biomarkers for CUD. Furthermore, we found that monounsaturated NAE levels are also enhanced by co-morbid mood and anxiety disorders in cocaine addicts. These findings open the way for the development of new strategies for cocaine addiction diagnosis and treatment.

[Relationship between psychopathological comorbidity and outcomes variables in-treatment cocaine dependent subject in therapeutic community]. / Relación entre la comorbilidad psicopatológica y las variables de resultados en dependientes de cocaína tratados en comunidad terapéutica.

Over the last years, the therapeutic community treatment with people who have cocaine problems and psychopathological comorbidity has been increasing and it is important to know more about the success of these treatments. The aim of this paper is to study the psychopathological profile of cocaine-dependent patients and its association with outcome variables. It is interviewed by the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) a total sample of 218 patients who sought treatment at any of the six public therapeutics community of Andalusia (Spain). The results show that the retention rate after three months of 68.3% (149), 43.5% that leaves the resource with a therapeutic discharge and 52.8% with clinically significant changes. Besides, the 57.8% have psychopathological comorbidity. Finally, there is a higher treatment success (measured by days of stay, type of discharge and therapeutic community outcome clinical impression) among people without psychopathological comorbidity. These data show the need to adapt the therapeutic communities to treat people with comorbid psychopathology and, thus, improve therapeutic success.

Multivariate Base Rates of Low Score on Neuropsychological Tests of Individuals with Coca Paste Use Disorder.

OBJECTIVE: The aim of this study was to determine the prevalence of low scores on eight commonly used neuropsychological tests to evaluate learning and memory, language, and executive functions in individuals with coca paste use disorders (CPUD) and to identify the differences with respect to a group of healthy nonconsuming subjects (HCs). METHODS: 162 Colombian adults with CPUD and a group of 162 Colombian adult HCs participated in this comparative study. Eight tests (eighteen test scores) were grouped into three categories: learning and memory, language, and executive functions. Each participant was categorized based on the number of low scoring tests in specific percentile cut-off groups (25th, 16th, 10th, 5th, and 2nd). RESULTS: In the learning and memory domain, 89.5% of individuals with CPUD and 55.6% of HCs scored below the 25th percentile on at least one of the five test scores, in the language domain, 80.7% of individuals with CPUD and 58% of HCs and in the executive function domain, 92% of individuals with CPUD and 67.3% of HCs. Having two or more scores below the 10th percentile or 10 or more at the 5th percentile shows an optimal cut-off for determining the sensitivity and specificity for discriminating between the two groups. CONCLUSIONS: The individuals with CPUD had a higher percentage of low scores than the HCs in the domains of learning and memory, language, and executive function. It is important for clinicians to be aware of low scores in individuals with CPUD to avoid false-positive diagnoses of cognitive impairment.

Cocaine Effect Expectancies among Patients with Cocaine Use Disorder with and without Adult Attention Deficit Hyperactivity Disorder: Are There Any Relevant Differences?

Cocaine use could be modulated by drug expectancies based on previously experienced subjective effects. Some patients perceive a paradoxical calming effect after cocaine use. This study was performed to explore cocaine effect expectancies in patients diagnosed with cocaine use disorder, with and without co-occurring adult attention deficit hyperactivity disorder (ADHD). Secondly, we sought to empirically determine the presence of this paradoxical calming effect after cocaine use in patients with co-occurring adult ADHD to identify the individuals most at risk of cocaine use and relapse. Cross-sectional study using a consecutive sampling method of patients diagnosed with cocaine use disorder (n = 221) treated at public therapeutic communities in Andalusia (Spain). Participants completed a battery of instruments to assess the following variables: cocaine effect expectancies, paradoxical calming effect, adult ADHD, and other co-occurring psychiatric disorders. A multivariate binary logistic regression analysis showed that two variables, the paradoxical calming effect and antisocial personality disorder (ASPD), were independently associated with the probability of being diagnosed with adult ADHD (OR = 3.43, 95% CI = 1.88-6.26 and OR = 3.42, 95% CI = 1.30-8.95, respectively). The presence of a paradoxical calming reaction to cocaine and/or a diagnosis of ASPD in patients with cocaine use disorder increases the diagnostic suspicion of co-occurring adult ADHD.

Efficacy of the Therapeutic Game "Trisquel" in the Treatment of Patients With Substance-Related Disorders Randomized Clinical Study.

Substance-related disorders (SRD) have been consistently associated with alterations both in cognitive and executive functions, which affect to patients' quality of life. The main objective of this work was to test the beneficial cognitive effects on patients with SRD after the implementation of "Trisquel," an intervention program in board game format. To check the effectiveness of Trisquel program, a group of people diagnosed with SRD was randomly assigned either to the experimental group or to the control group. The experimental group performed Trisquel structured sessions twice a week during 3 months, while the control group performed routinely conventional therapeutic activities with the same frequency and duration. Neuropsychological tests were done to both groups before and after the intervention. After the 3 months of intervention the experimental group showed the following statistically significant improvements for WAIS-III subtests: number key, symbol search, arithmetic, direct digits, inverse digits, total digits, letters-numbers in the processing speed index and in the working memory index. Regarding STROOP tests, statistically significant progress was observed in the phonetic fluency letter P, phonetic fluency letter M, phonetic fluency letter R subtests, word-reading and word-color subtests. The control group only obtained improvements for WAIS-III subtests of arithmetic, letters-numbers and in the working memory index. The results of this study confirm that "Trisquel" is an effective intervention program for people diagnosed with SRD, getting improvements in processing speed (psychomotor and reading), attentional subprocesses (focused and sustained) and executive functions (updating and inhibition).

Diagnosing adult attention deficit/hyperactivity disorder in patients with cocaine dependence: discriminant validity of Barkley executive dysfunction symptoms.

OBJECTIVE: To estimate the prevalence of adult attention deficit/hyperactivity disorder (ADHD) in a sample of cocaine-dependent patients, and to examine the discriminant validity of the Barkley's executive dysfunction scale in differentiating cocaine-dependent patients with and without ADHD. METHODS: A cross-sectional design was used. A total of 166 cocaine-dependent subjects were assessed. The assessment instruments included: Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID), Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and 9 items from Current Behavior Scale Self-Report by Russell A. Barkley. RESULTS: 14.5% (CI95%: 9.2-19.8%) prevalence of ADHD was observed in our sample. The Barkley's executive dysfunction items showed statistically significant differences between cocaine-dependent patients with ADHD and those patients without ADHD diagnosis. CONCLUSIONS: The study data support Barkley's model - which posits the relevance of executive dysfunction among ADHD patients within a sample of cocaine dependents, and provides evidence of the discriminant validity of the Current Behavior Scale Self-Report for identifying ADHD symptoms in cocaine users.