[Effects of the COVID-19 pandemic on the mental health of patients with pre-existing psychopathology]. / Efectos de la pandemia de la COVID-19 en la salud mental de pacientes con psicopatología previa.

OBJECTIVE: Several studies stated greater impact on mental health among psychiatric population during the first wave of the COVID-19 pandemic. The aim of this paper was to study the pandemic effects more than a year after its outbreak on the mental state of adult patients with pre-existing psychopathology attending a Mental Health Center in Madrid (Spain). METHODS: A cross-sectional observational study was carried out with a sample of fifty-eight patients using a questionnaire that collected different descriptive variables. Results of the PHQ-9 Depression Scale, the GAD-7 Anxiety Scale, the IES-R Impact of Event Scale-Revised, the Clinical Global Impression scale CGI-GI, and the assessment of the professionals responsible for the patients about their clinical state were also collected. A descriptive analysis and binary logistic regression models were performed. RESULTS: There was a prevalence of 70% anxiety, 76% depression and 57% stress due to a stressful event more than one year after the start of the pandemic. Likewise, associations were found between the symptoms and certain clinical, mediating variables and gender. CONCLUSIONS: The psychological state of patients with pre-existing psychopathology attended at the Mental Health Center is negatively affected by the COVID-19 pandemic up to a year and a half after its onset.

OBJETIVO: Numerosos estudios han confirmado que las personas con un diagnóstico psiquiátrico se vieron más afectadas en su salud mental que la población general en una primera fase de la pandemia de la COVID-19. El objetivo de este trabajo fue estudiar los efectos de la pandemia, más de un año después de su inicio, en el estado psíquico de pacientes adultos con psicopatología previa de un Centro de Salud Mental (CSM) en Madrid. METODOS: Se realizó un estudio observacional transversal en una muestra de cincuenta y ocho pacientes mediante un cuestionario que recogía diferentes variables descriptivas. Se administraron la Escala de Depresión PHQ-9, la Escala de Ansiedad GAD-7, la Escala Revisada de Impacto del Estresor EIE-R, la Escala de Impresión Clínica Global CGI-GI y la valoración de los facultativos responsables de los pacientes sobre su estado clínico. Se realizó un análisis descriptivo y se aplicaron modelos de regresión logística binaria. RESULTADOS: Hubo una prevalencia de 70% de ansiedad, 76% de depresión y 57% de estrés por evento estresante más de un año después de iniciarse la pandemia. Asimismo, se encontró asociación de los síntomas clínicos con determinadas variables clínicas, con variables mediadoras y con el género. CONCLUSIONES: El estado psíquico de los pacientes con psicopatología previa atendidos en el CSM se ve negativamente afectado por la pandemia de la COVID-19 hasta año y medio después de su inicio.

Self-reported increase in alcohol and drugs intake as a coping strategy in hospital workers during COVID-19 outbreak: A cross-sectional study. / Incremento de la ingesta de alcohol y drogas como estrategia de afrontamiento en trabajadores hospitalarios durante el brote de COVID-19: Estudio transversal.

Situations of psychological stress, such as the current COVID-19 pandemic, could lead to an increase in the consumption of alcohol and other drugs of abuse as an inadequate coping strategy in health workers. This study aimed to investigate the intake of alcohol and drugs of abuse in hospital workers during the first wave of COVID-19. A further focus was to define the worker profile most vulnerable to this behavior through a logistic regression analysis. A cross-sectional study in a tertiary hospital in Madrid, Spain, during the first wave of COVID-19 was designed. Information was collected from a sample (n = 657) of healthcare workers (n = 536) and non-healthcare workers (n = 121). An online survey (including questions about basic health habits, working environment conditions, sociodemographic data, and the 12-item version of the General Health Questionnaire as a measure of psychological well-being) was conducted. Increased consumption of alcohol and/or drugs of abuse during the analyzed period of the pandemic was reported by 17.1% of workers. The following variables were associated with a higher probability of increased consumption of alcohol and/or drugs of abuse: male gender (p = .044), living alone or without dependents (p = .005), staff physician or resident (p = .010), having worked on the COVID frontline (p = .058), poor nutritional habits (p = .004) and self-prescription of psychotropic drugs to manage anxiety and insomnia (p = .003). A significant percentage of hospital workers increased their consumption of alcohol and drugs of abuse during the first wave of the COVID-19 pandemic. A professional risk profile can be defined for this practice.

Las situaciones de estrés psicológico, como la actual pandemia COVID-19, pueden implicar un aumento del consumo de alcohol y otras drogas de abuso como estrategia inadecuada de afrontamiento en profesionales sanitarios. Esta investigación tiene como objetivo estudiar el incremento de la ingesta de alcohol y drogas de abuso en los trabajadores hospitalarios. Persigue también, mediante un análisis de regresión logística, definir qué perfil de trabajador es el más vulnerable a este comportamiento. Para ello se realizó un estudio transversal en un hospital terciario en Madrid, España, durante la primera oleada de COVID-19. Participaron en el estudio un total de 657 trabajadores del hospital, 536 de ellos sanitarios y 121 no sanitarios. La recogida de datos se realizó a través de una encuesta en línea que incluía preguntas sobre hábitos básicos de salud, condiciones del entorno laboral, datos sociodemográficos, así como la versión de 12 ítems del Cuestionario de Salud General. El 17,1% declaró haber aumentado su consumo de alcohol y/o drogas de abuso durante el período analizado. Se asoció a una mayor probabilidad de dicho incremento: sexo masculino (p = ,044), vivir sin personas dependientes a cargo (p = ,005), ser médico adjunto o residente (p = ,010), haber trabajado en primera línea de COVID (p = ,058), presentar malos hábitos nutricionales (p = ,004) y realizar autoprescripción de fármacos psicotrópicos para controlar la ansiedad y el insomnio (p = ,003). Un porcentaje significativo de los trabajadores hospitalarios ha aumentado su consumo de alcohol y drogas de abuso durante la primera oleada de la pandemia COVID-19, existiendo un perfil de mayor riesgo para esta práctica.

Antiretroviral treatment adherence and mental disorders: observational case-control study in people living with HIV in Spain.

Mental disorders hamper immunological control of HIV infection by exerting a negative influence on antiretroviral therapy (ART) adherence. We sought to address the possible relationship between non-adherence to antiretroviral treatment (ART), mental disorders and substance use in people living with HIV/AIDS (PLWHA) in Spain, which presents a high prevalence of intravenously transmitted HIV infection. We assessed 125 PLWHA attending regular outpatient follow-up. The main adherence measure was pill collection from the Hospital Pharmacy. We included sociodemographic variables, mental disorders diagnosis, and substance use in the 12 months prior to the assessment. Harmful alcohol consumption (OR: 6.834; 95% CI: 2.008-23.257; p = 0.002), suffering from depression (OR: 5.851; 95% CI: 1.470-23.283; p = 0.012) and being at risk of suicide (OR: 3.495; 95% CI: 1.136-10.757; p = 0.029) increased the likelihood of non-adherence. 29.6% of the sample had been infected via blood contact. HCV co-infection was present in 46.4% of the study sample, increasing the likelihood of non-adherence (OR: 3.223; 95% CI: 1.119-9.286; p = 0.030). Harmful alcohol use and some serious mental disorders (especially depression and suicide risk) are consistently associated with non-adherence to ART. HCV co-infection could be an important risk marker of non-adherence among PLWHA with a high prevalence of intravenous drug use.

Psychological Impact of COVID-19 Pandemic and Related Variables: A Cross-Sectional Study in a Sample of Workers in a Spanish Tertiary Hospital.

Introduction: We intend to objectify the psychological impact of the COVID-19 pandemic on the workers of a tertiary hospital. Methods: All the workers were invited to an online survey. In total, 657 workers were recruited, including 536 healthcare workers (HCWs) and 121 non-healthcare workers (nHCWs). General Health Questionnaire-12 items (GHQ-12) was used as a screening tool. Sociodemographic data, working environmental conditions, and health behaviors were also analyzed. Results: inadequate sleep, poor nutritional and social interaction habits, misuse of psychotropics, female gender, COVID-19 clinical diagnosis, and losing a relative by COVID-19 were variables associated with higher probability of GHQ-12 positive screening. Significant differences between "frontline workers" and the rest were not found, nor was higher the probability of psychological distress in healthcare workers compared to non-healthcare workers. After 3 months from the peak of the pandemic, 63.6% of participants screening positive in GHQ-12 reported remaining "the same or worse." Limitations: Causal inferences cannot be established. Retrieval and selection biases must be considered as the survey was not conducted during the peak of the outbreak. Conclusions: psychological impact of COVID-19 has been broad, heavy, and persistent in our institution. Proper assessment and treatment must be offered to all hospital workers.

Personality and adherence to antiretroviral therapy in HIV-infected adult patients.

OBJECTIVE: Antiretroviral therapy (ART) has been able to transform HIV infection into a chronic disease. However, ART adherence remains an important barrier and personality traits have been postulated as a factor to be considered. This study aims to identify personality traits that can affect ART adherence, taking into account other potentially influencing factors. METHODS: Case-control study. Controls and cases were classified using the percentage ART dispensation as recorded in the Hospital Pharmacy database. Controls were defined as people living with HIV/AIDS (PLWHA) with percentage ART dispensation during the last year >95% and cases were defined as PLWHA with percentage ART dispensation during the last year <90%. Sociodemographic, clinical parameters of HIV infection, psychopathological and neuropsychological factors were collected. Personality was assessed using the NEO PI-R Personality Inventory, questionnaire based on the Five Factor Model of Personality. Statistical analysis was performed using logistic regression (SPSS v.22). RESULTS: 125 PLWHA were included: 79 controls and 46 cases. After adjusting for confounding variables, logistic regression analysis showed that poor adherence was associated with Neuroticism (OR 1.2, 95%CI: 1.021-1.385) and Impulsivity (N5) (OR 1.5, 95%CI: 1.066-2.163). In contrast, each additional point in Order (C2) (OR 0.8, 95%CI: 0.679-0.992) or Values (O6) (OR 0.8, 95%CI: 0.710-0.974) were associated with good ART adherence. CONCLUSIONS: Personality is a variable to be considered in ART adherence. Implementation of the personality in the assessment of PLWHA helps identify those individuals potentially more likely to exhibit poorer ART adherence.

Influence of substance use and cognitive impairment on adherence to antiretroviral therapy in HIV+ patients. / Influencia del consumo de sustancias y el deterioro cognitivo en la adherencia al tratamiento antirretroviral en pacientes VIH.

Strict adherence to antiretroviral treatment (ART) is needed to ensure the effectiveness of HIV treatment. The adverse effects of substance abuse and neurocognitive impairment on medication adherence have both been suggested by several studies. Therefore, the aim of this research is to study the relationship among adherence to ART, cognitive dysfunction, and abuse of certain substances (alcohol, heroin, cocaine, other stimulants, cannabis and benzodiazepines) and/or methadone treatment in our social environment. We performed an observational case-control study with a sample of 125 HIV+ patients, who were classified as patients with poor adherence (cases) and subjects with adequate compliance (controls). Adherence was defined by the Hospital Pharmacy and verified with the Simplified Medication Adherence Questionnaire (SMAQ) and the reference physician's clinical impression. Cognitive functioning was measured with the Zoo Map Test and Trail Making Test (TMT). Substance abuse was collected through a semi-structured clinical interview protocol. Statistical analysis was made using a binary logistic regression model. The results indicate that both alcohol abuse and neurocognitive impairment measured by Zoo Map Test were significantly associated with poorer adherence to ART. No significant association was found between adherence and other substance use, or between adherence and TMT score. Screening of cognitive impairment measured by the Zoo Map Test and alcohol abuse may lead to the development of strategies to improve de adherence to ART in HIV+ patients.

La adherencia estricta al tratamiento antirretroviral (TAR) es imprescindible para que este sea eficaz en la disminución de la morbimortalidad asociada al VIH. Se ha sugerido que el consumo de sustancias y el deterioro cognitivo constituyen factores de riesgo para una mala adherencia. En este sentido, el objetivo de este estudio es evaluar cuál es la influencia sobre la adherencia al TAR de la disfunción cognitiva, así como del consumo de determinadas sustancias (alcohol, heroína, cocaína, otros estimulantes, cannabis y benzodizepinas) y/o el tratamiento con metadona, en el marco concreto de una población española de referencia. Se realizó un estudio observacional tipo casos y controles con una muestra de 125 pacientes VIH+, que se dividieron en sujetos malos adherentes (casos) y buenos adherentes al TAR (controles). La adherencia se evaluó mediante el reporte de Farmacia Hospitalaria, contrastada con la escala Simplified Medication Adherence Questionnaire (SMAQ) y la opinión del profesional médico de referencia. La función cognitiva fue evaluada con el Test del Mapa del Zoo y el Trail Making Test (TMT), y el consumo de sustancias, mediante un protocolo de historia clínica semi-estructurada. El análisis estadístico se realizó mediante regresión logística binaria. Los resultados mostraron que el abuso de alcohol y el deterioro en la función cognitiva ejecutiva, medida por el Test del Mapa del Zoo, constituyen factores de riesgo independientes para una mala adherencia. No se ha demostrado relación de la adherencia al TAR con el consumo de otras sustancias ni con la puntuación obtenida en el TMT. La detección de deterioro cognitivo mediante el Test del Mapa del Zoo, así como del consumo de alcohol, podrían ayudar a desarrollar estrategias de mejora del cumplimiento terapéutico en pacientes VIH+.

Relationship between alcohol consumption, whether linked to other substance use or not, and antiretroviral treatment adherence in HIV+ patients. / Relación entre la adherencia al tratamiento antirretroviral en pacientes VIH+ y el consumo de alcohol, asociado o no al uso de otras sustancias.

Hazardous alcohol consumption is a common diagnosis among people living with HIV infection. The relationship between alcohol consumption and poor adherence to antiretroviral therapy has been highlighted in different studies, yet few of them performed a parallel analysis of other substance use. In Spain, alcohol consumption is frequently associated with other substance use, mainly cannabis and cocaine. The aim of this study is to assess the influence of hazardous alcohol consumption both combined with other substances (cocaine, heroin, methadone and/or cannabis) or alone on antiretroviral therapy adherence in our social environment. We performed an observational case-control study including 119 HIV+ individuals. We recruited 40 non-adherent patients, defined by less than 90% compliance according to hospital pharmacy refill data, and corroborated by the Simplified Medication Adherence Questionnaire (SMAQ) and referring professional's opinion. Control cases (n=79) were defined as those patients with similar characteristics but considered adherent according to the same parameters. Data collection took place between May 2013 and September 2015. Statistical analysis was performed using a binary logistic regression model. Our results indicate that alcohol consumption decreases adherence to antiretroviral therapy. The use of methadone represents a statistically significant increased risk of poor adherence. No significant differences were found between adherent and non-adherent groups regarding cocaine, heroin or cannabis use in this study. In summary, the detection of substance use and especially alcohol consumption in HIV+ patients can improve the effectiveness of antiretroviral therapy by identifying and treating at-risk individuals for a poor therapeutic adherence.

El consumo perjudicial de alcohol es un diagnóstico de elevada prevalencia en pacientes VIH+. Distintos estudios han destacado la influencia negativa del mismo sobre la adherencia al tratamiento antirretroviral, aunque pocos de ellos valoran además el consumo de otras sustancias. En España, el consumo de alcohol se presenta frecuentemente en situación de policonsumo, fundamentalmente de cannabis y cocaína. El objetivo es comprobar cómo influye el consumo de alcohol, asociado o no al uso de otras sustancias (cocaína, heroína, metadona y/o cannabis), en la adherencia al tratamiento antirretroviral en nuestro entorno. Se ha realizado un estudio observacional tipo casos y controles sobre una muestra de 119 individuos VIH+. Conforman los casos (n=40) sujetos no adherentes al tratamiento farmacológico según reporte de Farmacia Hospitalaria, corroborado por el Simplified Medication Adherence Questionnaire (SMAQ) y la opinión del profesional de referencia. Se consideran controles (n=79) una muestra de pacientes de características similares con buena adherencia terapéutica según los mismos métodos de valoración. La recogida de datos se hizo entre mayo 2013 y septiembre 2015. El análisis estadístico se realizó mediante regresión logística binaria. Los resultados muestran que el consumo de alcohol empeora la adherencia al tratamiento antirretroviral. El uso de metadona supone un incremento estadísticamente significativo del riesgo de no adherencia. No se han encontrado diferencias significativas entre los grupos del estudio respecto a los consumos de cocaína, heroína o cannabis. Por tanto, la detección del consumo de sustancias, especialmente de alcohol, y su abordaje en pacientes VIH+ puede repercutir positivamente en el cumplimiento terapéutico, en beneficio de una mayor efectividad de la terapia antirretroviral.

Altered fine motor control and manual dexterity in people with cocaine dependence: An observational study.

BACKGROUND/AIM: Cocaine consumption may result in irreversible structural changes in the brain. The long-term effects of cocaine are related to a wide range of deteriorated cognitive functions. This study aimed to examine the fine motor control and hand-function in cocaine users compared to healthy controls. METHODS: An observational study was conducted. Sociodemographic variables, substance consumption, the Purdue Pegboard and the Jebsen-Taylor Hand-function Test were evaluated bilaterally in 35 participants who were cocaine users and in 35 healthy participants. Differences between sides (dominant and non-dominant hands) and groups were analysed with analysis of variance (ANOVA). RESULTS: The ANOVA revealed significant differences between groups (P < 0.001) and between sides (dominant and non-dominant hands) (P = 0.005) for the one-hand pin placement subtest of the Purdue Pegboard Test. Also, ANOVA tests showed significant differences between sides, but not groups, for the simulated feeding (P < 0.001) and stacking checkers (P < 0.001) Jebsen-Taylor subtests. Cocaine user participants exhibited significantly lower scores in bilateral pin placement and required more time for the Jebsen-Taylor subtests compared to healthy participants. CONCLUSIONS: Cocaine user participants display deficits of fine motor control and some aspects of manual dexterity when compared to healthy controls. These findings show the convenience of incorporating functional rehabilitation by occupational therapists as a key component within the treatment of cocaine users. This study therefore opens a new field of practice for occupational therapy based on the assessment and treatment of motor deficits in the hand and the upper limb of people who consume cocaine.

[The Need of a New Integral Approach to the Care of Patient with Severe Mental Disorder Thirty Years after the Psychiatric Reform]. / Necesidad de un nuevo enfoque en la atención integral a los pacientes con trastorno mental grave treinta años después de la reforma psiquiátrica.

More than thirty years have passed since the beginning of the psychiatric reform, a period of intense and relevant social, scientific and cultural changes which have directly impacted on mental disorders and their management. Improvement in psychopharmacological treatment, a new model of physician-patient relationship, patient´s empowerment as a key issue and the fight against social stigma related to mental health disorders, changes in clinical governance and health policy, the assistential burden derived from the treatment of less severe pathology in mental health community centers, improvements in teamwork and coordination with other resources involved… are some of the relevant changes which determine the scene of community-based mental health assistance. We think this is a right time to check the state of the community-based care programmes for severe mental disorders, and the role of mental health center. We propose to have a reflexion about two relevant topics: where we are and where we are heading.

Han pasado más de 30 años desde el inicio de los procesos de reforma psiquiátrica, periodo además de importantes e intensos cambios sociales, científicos y culturales que afectan de manera directa a la enfermedad mental grave y a su manejo. Las mejoras del tratamiento farmacológico, un nuevo modelo de relación médico-paciente, el empoderamiento del paciente como elemento clave y la lucha contra el estigma social de la enfermedad, los cambios en la gestión de los recursos, el incremento de la carga que suponen los pacientes con patología menor en los centros de salud mental, las mejoras en el trabajo en equipo y en la coordinación de los recursos implicados… son algunas de las modificaciones importantes que condicionan el escenario de la atención en salud mental comunitaria. Se nos antoja, por tanto, como un buen momento para revisar el estado de los programas de gestión del trastorno mental grave en el adulto y de los centros de salud mental, y plantear dos cuestiones sencillas a la par que relevantes: dónde estamos y hacia dónde nos dirigimos.

[Predictors of the therapeutic discharge in patients with dual pathology admitted to a therapeutic community with a psychiatric unit]. / Variables predictivas del alta terapéutica entre pacientes con patologia dual grave atendidos en una comunidad terapéutica de drogodependencias con unidad psiquiátrica.

This study aims to analyze the variables on which depends therapeutic discharge, in patients with a severe dual diagnosis admitted to a professional therapeutic community where their pathology is treated. 325 patients admitted between June 2000 and June 2009 to the therapeutic community. This is a retrospective, cross-sectional study with no control group, based on the detailed analysis of the information collected in a model of semi-structured clinical interview designed in the therapeutic community. The 29.5% of the individuals included in the sample were therapeutically discharged. Of all the variables introduced in this analysis the most significant ones were gender, age at the beginning of treatment, education level, opiate dependence, polidrug abuse, and the presence of psychotic disorders and borderline personality disorder. In our study, gender determines the type of discharge, being therapeutic discharge more frequent among women. A higher educational also increases a better prognosis with a higher rate of therapeutic discharge among individuals with higher education level. A later age at the beginning of the treatment reduces the likelihood of therapeutic discharge. Likewise, polidrug abuse, diagnosis of psychotic disorders and borderline personality disorder are associated to a lower rate of therapeutic discharge. Recognizing these characteristics will allow the early identification of those patients more at risk of dropping treatment hastily, while trying to prevent it by increasing the therapeutic intensity.

[Cognitive and executive dysfunctions in cocaine dependence: a case-control study]. / Alteraciones de funciones cognitivas y ejecutivas en pacientes dependientes de cocaína: estudio de casos y controles.

INTRODUCTION: In the past, various studies have related chronic cocaine use to diverse types of neuropsychological impairment. However, the majority of these studies offer partial results using batteries of tests of little ecological weight. AIM: To investigate neuropsychological impairment (and of executive functions in particular) amongst severe chronic cocaine users, measured by means of more ecological tests and in a more global manner, taking confounding factors into account, such as age, years of schooling, gender, race, opioid dependence and alcohol consumption. SUBJECTS AND METHODS: We performed an observational study, comparing the cocaine dependence group (n = 24) with a non-cocaine use control group (n = 27). RESULTS: The principal results revealed significant differences in the direct and reverse digit span tests (p = 0.008 and p < 0.001 respectively), and in the Cards Test (p < 0.001). They also showed a significance result in the Zoo Map Test (p = 0.001), and in different measurements but not in all forming part of the Wisconsin test (number of correct responses and number of errors). CONCLUSIONS: These results confirm that the chronic use of cocaine per se causes neuropsychological impairment that is manifested in classical and ecologically-valid tests. This impairment may influence patients' functionality and prognosis, and also therapeutic failure.

[Capgras syndrome: a proposal of neuropsychological battery for assessment]. / Propuesta de una batería neuropsicológica para la exploración del síndrome de Capgras.

Capgras syndrome is the most prevalent of the delusional misidentification syndromes. It appears in both psychiatric illness and organic brain damage. Cognitive and neuropsychiatric models (lateralization and disconnection) have been proposed to explain the syndrome. From a neuropsychological point of view Capgras syndrome seems to be due to damage of bifrontal and right limbic and temporal regions. Memory, feeling of familiarity, monitoring of self and reality would be altered. All of these cause a failure to adequately integrate the information about emotions and facial recognition. Relative preservation of the left frontal lobe may be necessary for the development of delusional response. There does not seem to be a differential pattern as regards the aetiology, but there is a common underlying neuropsychiatric mechanism. Based on theoretic models, and clinics features, we propose a neuropsychological battery to assess the Capgras syndrome, that should be sensitive to the main expected deficits.

Executive dysfunction in chronic cocaine users: an exploratory study.

INTRODUCTION: Chronic cocaine use is associated with some executive deficits. We assessed executive functions using ecologically valid tests in chronic cocaine users. OBJECTIVES: To investigate the relationship between executive deficits and three measures of severity of cocaine use: years of use, quantity used, and frequency of use. METHODS: Twenty-four cocaine users were compared with twenty-seven community controls. We used Student's t-test and Chi-squared to compare means and categorical variables, respectively. Linear regression analyses for the adjusted comparative analysis between cases and controls, and severity of cocaine use among cocaine users were performed. RESULTS: Chronic cocaine users performed worse on measures of attention and working memory (Forward and Backward Digit Span, p<.001), set-shifting abilities (difference score between the Trail Making B and A, TMB-A, p=.006), cognitive test of mental flexibility and response inhibition (Rule Shift Cards) (p<.001), and prefrontal functioning (Wisconsin Card Sorting Test, WCST, p=.023) than controls. Years of cocaine use were associated with deficits in the Backward Digit Span (p=.041; CI 95%: -.760 to -.002), the TMB-A (p=.026; CI 95%: .687 to 9.761), the Zoo Map (p=.034; CI 95%: -.480 to -.021), and the Rule Shift Cards (p=.006; CI 95%: -.836 to -.164), among others. Quantity of cocaine use was associated with executive deficits measured by the Forward Digit Span (p=.007; CI 95%: -.727 to -.133), the TMB-A (p=.021; CI 95%: 5.304-57.945), and the number of perseverative errors in the WSCT (p=.002; CI 95%: -10.654 to -2.800). Frequency of cocaine was associated with deficits in the Backward Digit Span (p=.042; CI 95%: -1.548 to -.030). CONCLUSIONS: Chronic use of cocaine is associated with executive deficits, which may influence patients' functionality, prognosis, and therapeutic failure.

[Managing the use of cannabis in a young population in primary care]. / Manejo del consumo de cannabis en población joven en Atención Primaria.

Cannabis is currently the most frequently used illicit drug substance in developed societies, just behind legal alcohol and tobacco. In this article clinical implications concerning cannabis use, particularly in young people, are approached. It also points out ways to make a correct diagnosis in Primary Care, with special emphasis on prevention and treatment. This is the first level of care in most cases.

Falacias, controversias y realidades acerca del consumo de marihuana: [revisión] / Cannabis consumption: falacies, controversies and reality: [review]

La marihuana es la droga ilegal más ampliamente consumida a nivel mundial, tan sólo por detrás de las legales alcohol y tabaco. A pesar de que las encuestas entre usuarios señalan un buen conocimiento de los efectos que produce, la impresión de los profesionales que atienden a los consumidores es que tal información es claramente escasa, parcial, cuando no directamente incorrecta. Lamentablemente, esta misma desinformación se advierte en algunos profesionales que atienden a los pacientes, o entre educadores y padres de jóvenes consumidores. En el presente artículo se abordan de manera científica una serie de controversias respecto del consumo de marihuana y sus consecuencias, con el objetivo de clarificar la información y ayudar a la prevención y tratamiento del consumo de dicha sustancia. Se persigue, igualmente, llamar la atención sobre la gravedad de su consumo, no sólo en cuanto a prevalencia sino también en cuanto a sus consecuencias.

[Capgras delusion: a review of aetiological theories]. / Delirio de Capgras: una revision de las teorias etiologicas.

INTRODUCTION AND AIMS: Features of the Capgras delusion, the most common among the delusional misidentification syndromes, are reviewed. We describe its phenomenology in psychiatric and organic diseases, its prevalence and comorbidity with other reduplicative disorders and review aetiological models in order to elucidate the origins of the delusion from both the cognitive psychology and psychodynamics precepts, as the neuropsychiatry and anatomical basis. DEVELOPMENT: According to cognitive models, Capgras syndrome cannot be exclusively conceived as a dysfunction in facial recognition but in recognizing a person globally considered. Feeling of familiarity is absent due to the inability to integrate successive memories about a person along episodic experiences, thus generating delusional doubles in accordance to the patient's needs or drives. From the neuropsychiatry point of view Capgras delusion arises from the failure in reconciling information about identification of the person and its associated emotions by the disconnection between frontal lobes and right temporo-limbic regions (hippocampus), in addition to bilateral frontal damage. Delusions are more commonly associated with right hemisphere lesions because of the impairment of several functions such as self monitoring, reality monitoring, memory and feelings of familiarity as well as the necessary preservation of the left hemisphere. CONCLUSIONS: Aetiology of Capgras delusion should include the conjoint involvement of clinical, neuropsychiatric and neuropsychological data with different theoretical models.

[Cyclical hyperemesis secondary to cannabis abuse]. / Vómitos cíclicos secundarios al consumo de cannabis.

Cannabinoid hyperemesis is characterized by recurring episodes of nausea and vomiting, with a stereotyped pattern, related to cannabis consumption. This syndrome is a paradoxical reaction to cannabis that develops in susceptible chronic cannabis users after several years of exposure. There is a direct relationship between cannabis use and the onset of the hyperemesis and between cessation of cannabis use and symptom resolution. The first cases were described in 2004. Since then, several new cases have been reported, although there are few studies of this syndrome. We report a case of chronic cannabis use with nausea and cyclic vomiting for 7 years. The symptoms were relieved by hot baths. A complete gastroenterological study was performed and no alterations were found. Cannabis use and its cessation are related to the presence or absence of the symptoms.

[Use of cocaine and neuropsychological damage. Clinical implications]. / Consumo de cocaína y daño neuropsicológico. Implicaciones clínicas.

The use of cocaine is a worldwide problem, not only because of its high prevalence but also because of the serious medical and social repercussions. The brain is one of the organs more directly affected by the consumption of cocaine. It provokes vascular damage, but especially alterations at the level of receptors and neuromodulators, that have severe repercussion on cognitive functioning. These alterations play an essential role in the social conduct of the individual and in his daily functioning, as well as in the perpetuation of the addiction and prognosis. Moreover, they determine the therapeutic results and the model of psychological intervention on a definitive way. This work tries to summarize and update the existing evidences concerning the neuropsychological damage provoked by the consumption of cocaine, its functional impact and clinical implications, as well as the questioned reversibility with the continued abstinence.

[High-dose methadone detoxification in a hospital unit. Clinical experience]. / Desintoxicacion de dosis elevadas de metadona en una Unidad de Desintoxicacion Hospitalaria (UDH). Experiencia clinica.

The increase in opiate addicts in treatment with methadone, coupled with improved survival of HIV patients, has meant an increase in the demand for detoxification from this substance in our environment. It is common practice in hospital detoxification units to request a maximum dose of methadone (around 40 mg) on beginning detoxification treatment. However this is not always possible, due to the time needed for a gradual decrease for outpatients making daily visits to the methadone dispensing centres, due to the appearance of withdrawal symptoms, or because the patient starts out from very high doses of methadone. Reported here is an experience with 22 inpatients who over the last two years underwent detoxification from methadone without requesting from their treatment centres a maximum-limit dose at the start of their treatment. During the detoxification they are given treatment with clonidine and benzodiazepines (dosage being adjusted according to concomitant use of alcohol, benzodiazepines and cocaine) and non-opiate-based painkillers. On the seventh day they are given 50 mg of naltrexone. Of these addicts, 21 completed the detoxification adequately.