Clinical validation of the Allen's Cognitive Level Screen in acquired brain injury.

BACKGROUND: The evaluation of functional cognition is a central concern in clinical practice. However, there are few standardized or validated tools, and many of them take too long, requiring screening tests. AIMS: To explore the convergent validity of the ACLS-5 with other cognitive screening test and functional independence test in a sample of people with acquired brain injury. Moreover, to examine the prediction of ACLS-5 on functioning and cognitive performance outcomes. MATERIALS AND METHODS: A cross-sectional design was applied following the guidelines of the STROBE checklist. A consecutive sample of people with acquired brain injury was recruited from rehabilitation centers. A cognitive screening test and daily living activity tests were implemented, such as ACLS-5, MoCA, Barthel, and FIM+FAM. Data were analyzed using non-parametric methods. In addition, a structural analysis and simple regression models were performed. RESULTS: Eighty patients with chronic acquired brain injury, with a mean age of 52, were recruited. All tests are significantly related to the ACLS-5 score, a moderate effect size for MoCA (ρ = 0.36), and a strong effect size for the other two (ρ > 0.50). CONCLUSIONS: ACLS-5 predicts functional and cognitive performance quickly and effectively, optimizing assessment time and avoiding mental fatigue or physical exhaustion.

Reliability and Validity of the Spanish Version of the Executive Function Performance Test (EFPT) in Assessing People in Treatment for Substance Addiction.

IMPORTANCE: Assessing people's executive function (EF) during addiction treatment makes it possible to design individualized occupational goals. OBJECTIVE: To determine the reliability and validity of the Spanish version of the Executive Function Performance Test (EFPT) in the occupational assessment of people being treated for substance addiction. DESIGN: Cross-sectional, observational study to determine the EFPT's internal consistency as well as its convergent and discriminant validity with complementary tests. SETTING: A public, free addiction treatment center operated by Madrid Salud (Madrid City Council, Spain). PARTICIPANTS: Fifty-two people referred to an occupational therapy department for evaluation and intervention. Inclusion was based on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) criteria for substance abuse or dependence; the exclusion criterion consisted of any circumstances that made it difficult for a person to understand or perform the test. OUTCOMES AND MEASURES: The EFPT, other occupational tests (Allen Cognitive Level Screen-5, Lowenstein Occupational Therapy Cognitive Assessment), and a battery of neuropsychological EF tests. RESULTS: The EFPT had an unequivocal unifactorial structure and showed strong correlations between its components and adequate consistency with the scales and the complete test. As expected, the EFPT correlated with the neuropsychological tests with a considerable effect size (-.40 < r < -.60). CONCLUSIONS AND RELEVANCE: The EFPT's psychometric properties are adequate to assess the EF of people being treated for substance addiction from an occupational perspective using real activities of daily living (ADLs). WHAT THIS ARTICLE ADDS: The results show that the EFPT can be used to assess performance of ADLs without needing to use tests from disciplines other than occupational therapy. Further studies in different sociocultural settings are needed to generalize the results.

Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones, instant messaging and social networks using MULTICAGE-TIC. / Tecnologías de la Información y la Comunicación (TIC): abuso de Internet, videojuegos, teléfonos móviles, mensajería instantánea y redes sociales mediante el MULTICAGE-TIC.

Use/abuse of Information and Communications Technologies (ICT) has in recent years become a topic of great interest. Current discussion addresses whether it must be considered addictive behaviour and if it is a problem that primarily affects adolescents and youth. This study aims to understand the problems that affect people of all ages in controlling the use of these ICTs and whether they are related to mental health problems, stress and difficulties in executive control of behaviour. A survey was administered through social networks and email, using the MULTICAGE-ICT, a questionnaire that explores problems in the use of Internet, mobile phones, video games, instant messaging and social networks. Additionally, the Prefrontal Symptom Inventory, General Health Questionnaire and Perceived Stress Scale were administered. The sample was comprised of 1,276 individuals of all ages from different Spanish-speaking countries. The results indicate that about 50% of the sample, regardless of age or other variables, presents significant problems with the use of these technologies, and that these problems are directly related to symptoms of poor prefrontal functioning, stress and mental health problems. The results reveal the need for reconsidering whether we are facing an addictive behaviour or a new problem demanding environmental, psychological, sociological and sociopolitical explanations; therefore, it is necessary to reformulate actions to be implemented to address and refocus our understanding of the problem.

El uso/abuso de las Tecnologías de la Información y la Comunicación (TIC) es un tema que suscita enorme interés en los últimos años. Está en discusión si debe recibir la consideración de conducta adictiva y si es un problema que afecte prioritariamente a adolescentes y jóvenes. El presente estudio pretende conocer los problemas que afectan a las personas de todas las edades en el control del uso de estas TICs y si están relacionados con problemas de salud mental, estrés y dificultades en el control superior del comportamiento. Se realiza una encuesta a través de redes sociales y correo electrónico, en el que se administra el cuestionario MULTICAGE-TIC, que explora problemas en el uso de Internet, teléfono móvil, videojuegos, mensajería instantánea y redes sociales. Adicionalmente se administra el Inventario de Síntomas Prefrontales, el Cuestionario de Salud General y la Escala de Estrés Percibido. Se obtiene una muestra de 1.276 sujetos de todas las edades y diferentes países de habla hispana. Los resultados apuntan a que alrededor del 50% de la muestra presenta importantes problemas en el uso de estas tecnologías, y que esos problemas se relacionan directamente con síntomas de mal funcionamiento prefrontal, estrés y problemas de salud mental, independientemente de la edad u otras variables. Estos resultados sugieren reconsiderar si se trata de una patología adictiva o si estamos ante un problema novedoso que requiere de explicaciones de índole ambiental, psicológica, sociológica y sociopolítica, debiendo reformular las acciones a emprender para reorientar la comprensión y el abordaje del problema.

Loewenstein Occupational Therapy Cognitive Assessment to Evaluate People with Addictions.

BACKGROUND: The LOTCA (Loewenstein Occupational Therapy Cognitive Assessment) battery is a cognitive screening test which is widely used in occupational health. However, no work has been found that explores its use in addiction treatment. OBJECTIVES OF STUDY: To explore the convergent validity of LOTCA with neuropsychological tests that assess related cerebral functional areas. METHODS: The LOTCA, along with a battery of neuropsychological tests, was administered to a sample of 48 subjects who start a treatment by substance or gambling addictions. FINDINGS: A correlational pattern was observed of a considerable magnitude between the effects of the LOTCA scales and those of some neuropsychological tests, but not with others. There is barely any convergence in measures with memory and executive function tests. RELEVANCE TO CLINICAL PRACTICE: There is a lack of research applying test of occupational assessment to populations of patients treated by addictive behaviors. The LOTCA seems to be a reliable and valid test for preliminary screening of function in certain cognitive areas, easy, and quick to use (around 30 minutes). However, it must be supplemented with other tests for a full and ecological assessment of patients. LIMITATIONS: An incident, small-size sample. RECOMMENDATIONS FOR FURTHER RESEARCH: New studies are needed to explore the applicability, diagnostic validity, and whole psychometric quality of the test in addiction-related treatment.

Systematic Review of Occupational Therapy in the Treatment of Addiction: Models, Practice, and Qualitative and Quantitative Research.

OBJECTIVE: The authors conducted a systematic review of theoretical models, professional practice, and research findings to understand occupational therapy's role in the treatment of addiction. METHOD: PubMed, Academic Search Premier, CINAHL, ERIC, OTseeker, and Google Scholar were searched to identify scientific journal articles, book chapters, or any other similar literature published from 1970 through July 2015 that addressed theoretical approaches, intervention models, and professional roles or were qualitative or quantitative studies in which occupational therapy had a central role. RESULTS: The literature search yielded 16 theoretical and professional role studies, 8 qualitative studies, and 14 quantitative studies. All studies had low levels of evidence, and all were case series, sometimes with very small samples. CONCLUSION: Although occupational therapy has been involved in the treatment of people with substance addiction and, more recently, with behavioral addictions for more than half a century, the research that has been published is poor.

Allen Cognitive Level Screen for the classification of subjects treated for addiction.

Introduction The Cognitive Disabilities Model (CDM) is an occupational approach that can allow the classification of the functional-cognitive abilities of persons with addictions. The objective of the study was to explore the applicability of the ACLS-5 to assess a sample of persons undergoing addiction-rehabilitation treatment. Methods A sample of 232 participants was recruited from an outpatient treatment centre in Madrid (Spain). The ACLS-5, the Montreal Cognitive Assessment (MoCA), and the Prefrontal Symptom Inventory (PSI) were administered. Sociodemographic and addiction-related data were also obtained. Results Half of the sample showed serious deficits in functional cognition, which ultimately could be related to problems in their daily performance. Scores of ACLS-5 showed significant correlations with the severity of addiction, with those obtained with the MoCA, and with attentional symptoms on the PSI scale. Conclusions The data suggest the applicability of the ACLS-5 in assessing the degree of functional cognition in subjects treated for addiction, providing evidence to support ecological validity and facilitating the development of well-targeted cognitive rehabilitation programmes from an occupational perspective. The use of occupational-based instruments to assess the functioning of those with addictions is a requirement of occupational therapy professionals working in this general area.

Terapia ocupacional en adicciones: de la teoría a la práctica / Occupational therapy in addiction: from theory to practice

La Terapia Ocupacional es una disciplina cuyo marco conceptual, objetivos y métodos están bien establecidos. Uno de los ámbitos en los que interviene es el de la adicción. Sin embargo, los textos y artículos ocupacionales disponibles carecen, en muchos casos, de un marco explicativo propio, recurriendo con demasiada frecuencia a otros importados de disciplinas preponderantes. Ello lleva, por una parte, a una pobre producción científica y, por otra, a un rol secundario de nuestra disciplina en los programas terapéuticos. El presente trabajo recoge la propuesta de un marco explicativo de la adicción desde una perspectiva ocupacional. Algunos autores parten de considerar que la propia adicción es, en sí misma, una ocupación, en la medida en que proporciona un rol y una significación al propio adicto. Desde esta perspectiva, toman sentido ocupacional paradigmas experimentales recientes, como el del enriquecimiento ambiental, o conceptos como el de empoderamiento. La rehabilitación cognitiva funcional, ampliamente aplicada en clínica del daño cerebral, representa otro enfoque complementario en la clínica de la adicción. Existen instrumentos de evaluación propios que cuantifican o sistematizan las variables ocupacionales relevantes. La Terapia Ocupacional está en condiciones de asumir un rol propio, protagonista e irrenunciable en el tratamiento de la adicción.

Occupational Therapy is a discipline whose conceptual framework, objectives and methods are well established. Addiction is one of the areas in that is involved. However, the available occupational texts lacking in many cases its own explanatory framework, resorting too often to other imported from prevailing disciplines. This leads, on the one hand, to a poor scientific production and, on the other one, to a secondary role for our discipline in therapeutic programs. This paper presents a proposed explanatory framework of addiction from an occupational perspective. Some authors start considering that addiction is itself an occupation, to the extent that it provides a role and significance to the addict himself. From this perspective, it makes occupational sense some recent experimental paradigms, such as environmental enrichment, or concepts such as empowerment. The functional cognitive rehabilitation, widely applied in clinical of brain injury, represents another complementary approach to addiction clinic. There are own assessment instruments that measure or systematize the relevant occupational variables. Occupational Therapy is able to take its own role, main and indispensable prominence in the treatment of addiction.

[Cognitive reserve in substance addicts in treatment: relation to cognitive performance and activities of daily living]. / Reserva cognitiva en adictos a sustancias en tratamiento: relacion con el rendimiento cognitivo y las actividades cotidianas.

INTRODUCTION: The concept of cognitive reserve has gradually attracted more interest as a greater body of evidence has been collected on its relationship with the resistance of the brain to decline in its functioning when faced with neurological threats or disorders. Although a large amount of research has been conducted on (degenerative, traumatic, psychopathological) conditions, very few studies relate cognitive reserve with substance addiction, a multidimensional process with a clear neurological base. AIMS: To explore the cognitive reserve of patients undergoing treatment for addiction to drugs of abuse by relating it with their cognitive performance in neuropsychological tests and in activities of daily living. PATIENTS AND METHODS: The study involved a sample of 57 patients being treated for substance abuse at a centre set up for this specific purpose. The cognitive reserve questionnaire, the Montreal cognitive assessment and the prefrontal symptoms inventory were administered, and variables related with the addiction were collected. RESULTS: A positive relation was found between the cognitive reserve and the time of abstinence, and a negative one was seen with the severity of the addiction. Significant differences were observed according to the cognitive reserve in neuropsychological performance (especially in certain cognitive domains) and in daily activities. CONCLUSIONS: The cognitive reserve appears as a variable related to addiction and the cognitive deficits that accompany it. It is thus a potential target for rehabilitation activities and is linked to the environmental enrichment paradigm, as a strategy for enhancing resistance against the cognitive impairment that favours and maintains the addiction, and for lowering the reinforcing potential of the behaviour of consuming.

TITLE: Reserva cognitiva en adictos a sustancias en tratamiento: relacion con el rendimiento cognitivo y las actividades cotidianas.Introduccion. El concepto de reserva cognitiva ha ido ganando interes en la medida en que se ha acumulado evidencia sobre su relacion con la resistencia del cerebro a declinar en su funcionamiento ante amenazas o alteraciones neurologicas. Aunque se ha estudiado en un gran numero de alteraciones (degenerativas, traumaticas, psicopatologicas), pocos trabajos relacionan la reserva cognitiva con la adiccion a sustancias, un proceso multidimensional con clara base neurologica. Objetivo. Explorar la reserva cognitiva de pacientes en tratamiento por adiccion a drogas, relacionandolo con su rendimiento cognitivo en pruebas neuropsicologicas y en actividades de la vida diaria. Pacientes y metodos. Muestra de 57 pacientes en tratamiento por adiccion a sustancias en un centro especifico. Se administraron el cuestionario de reserva cognitiva, la evaluacion cognitiva de Montreal y el inventario de sintomas prefrontales, y se recogieron variables relacionadas con la adiccion. Resultados. Se encontro una relacion positiva entre la reserva cognitiva y el tiempo de abstinencia, y negativa con la gravedad de la adiccion. Aparecieron diferencias significativas segun la reserva cognitiva en rendimiento neuropsicologico (especialmente en ciertos dominios cognitivos) y en actividades cotidianas. Conclusiones. La reserva cognitiva aparece como una variable relacionada con la adiccion y los deficits cognitivos que la acompañan; resulta ser una potencial diana de las actividades rehabilitadoras, vinculada al paradigma de enriquecimiento ambiental, como estrategia para potenciar la resistencia frente al deterioro cognitivo que favorece y mantiene la adiccion y para disminuir el potencial reforzador de la conducta de consumo.

Assessment of motor and process skills in daily life activities of treated substance addicts.

AIM: The purpose of this study was to apply the Assessment of Motor and Process Skills (AMPS) in a sample of people in treatment for addictive behaviours and to study the results. METHODS: The test was applied to a sample of 101 outpatients in treatment for addiction to substances. The results were studied in relation to gender, age, level of education, and variables related to addiction. RESULTS: Motor and cognitive performance was negatively related to time of addiction and its severity. Sixty per cent of the sample reached suboptimal scores and 25% showed scores suggesting significant deterioration, especially with regard to cognitive processing skills. CONCLUSIONS: The AMPS seems to be a useful instrument to estimate the cognitive and motor impairment associated with addiction in daily life activities. The present work is the first to consider its applicability to drug users under treatment. The percentage of subjects affected and the magnitude of the observed impairment in the sample suggest the need to consider taking these deficits into account in treatment programmes and the convenience of incorporating functional rehabilitation as a basic element of the treatment of persons with addictions. Future studies should develop this instrument in larger samples, increasing the representativeness and generalizability of the results.

[Prefrontal symptoms and personality disorders in substance abusers]. / Sintomatologia prefrontal y trastornos de la personalidad en adictos a sustancias.

INTRODUCTION: Neuroimaging findings associate personality traits and their disorders with an altered functioning of certain areas of the brain, especially in the frontal lobe. There is a need for instruments that can be applied in clinical practice to explore these relations based on their behavioural manifestations. PATIENTS AND METHODS: The sample was composed of 371 subjects with substance abuse/dependence. The Prefrontal Symptoms Inventory (PSI) and the Millon Clinical Multiaxial Inventory II (MCMI-II) were administered and diagnostic interviews were carried out to determine the existence of disorders affecting axis II (personality disorders). RESULTS: Criteria satisfying a diagnosis of some personality disorder were present in 43.9% of the sample. The results show a broad correlational pattern between the prefrontal symptoms scales and those of personality disorders. The variance in up to eight of the 13 scales of the MCMI-II is predicted in over 20%, based on the combination of scales from the PSI. The personality disorders diagnosed by means of a clinical interview present differential prefrontal symptomatological profiles that were consistent with what was expected. CONCLUSIONS: The results support the hypothesis of a relationship between the diagnosis of personality disorders and frontal malfunctioning, thus suggesting new lines for studying and approaching them in clinical practice. Such new paths could involve the use of cognitive rehabilitation to improve day-to-day functioning and modify the neurological substrates underlying personality disorders.

[Prefrontal Symptoms Inventory for clinical evaluation of addictions in everyday life: development process and psychometric properties]. / Inventario de sintomas prefrontales para la evaluación clinica de las adicciones en la vida diaria: proceso de creación y propiedades psicométricas.

INTRODUCTION: Research has provided evidence of the presence of prefrontal symptoms in addicts, although they are usually evaluated using questionnaires that were created for acquired brain injury. AIMS: To produce a specific instrument for evaluating those symptoms in subjects with addictions. SUBJECTS AND METHODS: For the study, 1624 participants were recruited (445 addicts and 1179 from the general population) and were given a 100-item inventory to complete based on the three spheres of human activity (cognition, emotion and behaviour) in relation to the three great prefrontal syndromes (dorsolateral, ventromedial and orbital). The preliminary analyses ruled out those that did not prove to have sufficient discriminating power, which resulted in the Prefrontal Symptoms Inventory (PSI) consisting of 46 items. The Dysexecutive Questionnaire (DEX-Sp) and the Perceived Stress Scale (PSS) were administered in order to study the convergent validity. RESULTS: The data show the three-factor structure of the questionnaire: problems with executive control (with three sub-factors: problems with motivation, control and attention), problems with social behaviour and problems with emotional control. The relationships between the scores on the PSI and sociodemographic and consumption variables, as well as with the DEX-Sp and the PSS were analysed. A reduced 20-item version is provided for screening. CONCLUSIONS: The PSI relates the ('subject-centred') self-evaluation of persons with the a priori ('brain-centred') theoretical formulation, the results showing adequate psychometric properties. We recommend its use when it comes to exploring the prefrontal symptoms of addicts, as well as other clinical or subclinical populations with similar cognitive profiles.

[Neuropsychological characterization of functional and dysfunctional impulsivity in drug addicts: clinical implications]. / Caracterización neuropsicológica de la impulsividad funcional y disfuncional en adictos a sustancias: implicaciones clínicas.

Impulsivity is a stable correlate throughout the course of drug addiction. However, it has always been studied as a negative condition, linked to psychopathology. Dickman (1990) proposed two subdimensions of impulsivity, dysfunctional (DI) and functional (FI). He defines the latter as the tendency for rapid, goal-oriented decision-making characterized by well calculated risks. Only a few studies have attempted to differentiate between these two subdimensions using classical neuropsychological tests. Fifty two drug addicts in treatment were tested using Dickman's Impulsivity Inventory and a battery of classical neuropsychological tests. FI shows moderate to high correlations with many classical neuropsychological test scores in relation to enhanced executive functioning, whereas DI reveals surprisingly weak and scarce correlations with indicators of impaired executive functioning. DI appears to be a trait related to some difficulties in classical neuropsychological tests, while FI emerges as a consistent and much stronger predictor of higher attention capacity, lower distractibility, better precision, fewer errors, and better maintenance of goal-oriented strategies. Thus, functional impulsivity is related to positive conditions and more efficient cognitive functioning. Implications for the treatment of drug addictions are suggested.

[A proposal for a protocol of neuropsychological assessment for use in addictions]. / Propuesta de un protocolo para la evaluación neuropsicológica de las adicciones.

INTRODUCTION: Interest in the brain processes involved in establishing, maintaining and overcoming addictions has led to the development, in recent years, of a number of neurocognitive models with a substantial amount of empirical support. However, agreement still needs to be reached regarding the clinical evaluation tests that can be administered and the reason for doing so. The aim of this work is to outline some of the most useful neuropsychological tests for evaluating addicts, as well as the scales of day-to-day symptoms and occupational performance tests that have been validated in Spanish for this population. DEVELOPMENT: The cognitive sub-processes addressed in this work, which have proved to be useful in the syndromic diagnosis of addictions, are processing speed, selective and sustained attention, alternating and divided attention, attentional amplitude and central executive, memory, cognitive flexibility and fluency, response inhibition, planning, abstraction, decision-making and, lastly, theory of mind. A protocol involving two 50-minute sessions is proposed, where the second session is optional depending on the needs and suitability in each case. CONCLUSIONS: This protocol offers several important advantages for physicians, including systemisation, the possibility of replication and convergence among evaluators or delimitation of the sub-processes that can be evaluated by sharing the same scheme. Moreover, it can all be carried out in sessions that are short enough to allow them to be offered by nearly all services that attend to addicts who request treatment.

[Evaluation of occupational performance in everyday life in addicted population. Development of a measuring instrument: the ADO]. / Evaluación del desempeño ocupacional en la vida cotidiana en adictos. Creación de un instrumento de medida: el ADO.

Addiction is a complex disorder of brain function, which involves primarily the frontal cortex as a structure responsible for the organization of intentional behavior. The performance of everyday life activity is one of the key factors in assessing the impact of cognitive impairment. There are no validated instruments in Spanish applicable to addicts for assessing self-perceived efficacy in the performance of everyday activities. Based on the Occupational Self-Assessment, a questionnaire was developed for the exploration of: perceived level of performance quality, evaluation of competences and the influence of environment on performance. For the study, a sample of 425 non-clinical participants and 300 patients treated for substance addiction was used. The Occupational Performance Self- Report (ADO) has 37 items and showed adequate internal consistency (Alpha = 0.93, 0.75 and 0.87 for the subscales) and a stable structure in confirmatory factor analysis. The self-assessment of performance showed consistent correlation with dysexecutive symptoms in daily life (-0.54 < r < -0.66). The ADO emerges as a reliable and valid instrument for the exploration of self-perceived level of performance in the everyday lives of individuals with substance addiction, and may be useful for establishing treatment goals in conditions of high ecological validity.

[Prefrontal symptoms assessment: psychometric properties and normative data of the Dysexecutive Questionnaire (DEX) in a sample from the Spanish population]. / Evaluación de los síntomas prefrontales: propiedades psicométricas y datos normativos del cuestionario disejecutivo (DEX) en una muestra de población española.

INTRODUCTION: Research on the deficits derived from alterations in the prefrontal circuits has been conducted almost exclusively from a categorical perspective, which differentiates normal from pathological functioning. The functioning of the prefrontal cortex, however, can be seen as a continuous dimension. The Dysexecutive Questionnaire (DEX) was created with the intention of being useful as a qualitative measure of the symptoms of 'dysexecutive syndrome' in day-to-day life. AIM. To explore the psychometric properties of the self-reported DEX in a broad sample of the non-clinical population with a view to providing interpretations that can be of use in clinical practice. SUBJECTS AND METHODS: The Spanish version of the DEX was administered to 1013 non-clinical individuals living in Madrid, Saragossa, Asturias, Navarre and Seville (380 males and 633 females). RESULTS: The factorial study conducted in parallel reveals the existence of two factors with adequate consistency and internal validity indices: items that explore difficulties in beginning, maintaining and organising behaviour (disorganisation/apathy) and items related with the interruption of behaviour in situations where it is inappropriate (disinhibition/impulsivity). The distribution according to age matches the developmental premises. The following cut-off points are proposed: < 10, optimal functioning; 10-18, sub-optimal functioning within normality; 19-28, moderately dysexecutive functioning that requires identification of the possible causes, and > 28, important degree of dysexecutive disorder that would include severe pathologies. CONCLUSIONS: The DEX may be useful as an instrument for detecting subjects with demonstrable brain disorders and those with deficient executive functioning without the presence of any known or identifiable pathology.

[Personality differences between alcohol abusers and matched controls: Relation to frontal symptoms and subtypes of addicts]. / Diferencias de personalidad entre adictos al alcohol y controles emparejados: relación con sintomatología frontal y subtipos de adictos.

Epidemiological studies usually show a link between personality disorders and addictions. Dimensional models of personality, such as that of Cloninger, are able to diagnose and discriminate between transient dysfunctional behavior styles and relatively more stable traits. Certain brain areas have been proposed, as trait locations, based on their activation. This paper explores differences in personality traits among a sample of alcohol abusers (N= 95) and a control group of non-clinical population (N= 95), matched in sociodemographic variables, using the TCI-R-67 and the FrSBe-Sp. It is hypothesized that such differences are associated with frontal symptomatology. The existence of different subgroups of addicts based on certain combinations of traits is also analyzed. Results showed significant differences in two temperament traits (Novelty Seeking and Harm Avoidance) and a characterial trait (Self-Direction). We also found a correlation with a large effect size between these traits and frontal symptomatology. Cluster analysis classified the participants into several subtypes with different combinations of traits that matched diverse frontal symptomatology. Possible neurobiological explanations of these differences and their importance in the clinical practice are discussed.

[Personality and frontal symptomatology in addicts and nonclinical population: toward a neuropsychology of personality]. / Personalidad y sintomatología frontal en adictos y población no clínica: hacia una neuropsicología de la personalidad.

OBJECTIVE: For many years now, Neuropsychology and the Psychology of Personality have developed in parallel, without any attempt to integrate the knowledge provided by the two disciplines. This paper sets out to analyze the relationship between the presence of symptoms in daily life related to the functioning of the brain's frontal lobes and individuals' personality patterns. PARTICIPANTS AND METHODS: The Dysexecutive Questionnaire (DEX-Sp), the Frontal System Behavior Scale (FrSBe- Sp) and the Inventory of Temperament and Character Revised (TCI-R) were administered to 421 non-clinical participants and 246 individuals in treatment for substance abuse or dependence. RESULTS: Significant correlations were found between symptoms for all frontal syndromes (mesial, dorsolateral and orbital) and some personality traits (novelty seeking, harm avoidance and self-directedness), even more than 50% of the variance being predicted. DISCUSSION AND CONCLUSIONS: Results suggest that frontal performance should be seen as a continuous dimensional variable, ranging from optimal to non-adaptive performance, without a neat cut-off point. Addiction would be related to an increase in frontal symptoms, both mesial (apathy) and orbital (disinhibition), as well as dorsolateral (dysexecutive syndrome), and this would result in changes in the previous personality pattern. These data seriously question the supposed genetic basis of temperamental traits, and suggest hypotheses of great relevance for clinicians.

[Neuropsychological profile in cocaine addiction: issues about addict's social environment and predictive value of cognitive status in therapeutic outcomes]. / Perfil neuropsicológico en la adicción a la cocaína: consideraciones sobre el ambiente social próximo de los adictos y el valor predictivo del estado cognitivo en el éxito terapéutico.

INTRODUCTION AND OBJECTIVE: This study analyses the neuropsychological profile of a sample of cocaine addicts and compares it with a control group from the same social environment. Also, it explores the predictive power of some neuropsychological tests on treatment outcome six months after the exploration. PARTICIPANTS AND METHOD: We administered a neuropsychological battery to 30 patients with a diagnosis of cocaine abuse or cocaine dependence, and to 30 control participants with no history of drug abuse from the same social environment. RESULTS: Verbal learning (p<0.001), immediate visual memory (p<0.05), attentional resources management (p<0.05), phonologic fluency (p<0.01), abstraction (p<0.001), complex problem-solving (p<0.05) and mental flexibility (p<0.05) are the functions most affected by cocaine use. DISCUSSION AND CONCLUSIONS: The alterations found in the addict participants were small and non-pathognomonic, though the deficits can be correlated with impact on quality of life and on everyday occupational performance. The neuropsychological exploration showed a certain predictive capacity of abstinence after 6 months (the addict participants with better verbal mnesic performance and greater mental flexibility at the beginning of the treatment seem to benefit more from this). Finally, the results suggest that addicts live in a cognitively poor social environment. It is suggested that drug use increases previous deficits, probably of an educational or environmental origin, that are common to their immediate social context.

[Spanish version of the Dysexecutive Questionnaire (DEX-Sp): psychometric properties in addicts and non-clinical sample]. / Versión española del Cuestionario Disejecutivo (DEX-Sp): propiedades psicométricas en adictos y población no clínica.

OBJECTIVE: Several studies have shown evidence of executive function impairment associated with substance abuse. This suggests the potential usefulness of a baseline assessment measure to screen for dysexecutive impairments in individuals beginning treatment. The Dysexecutive Questionnaire (DEX) is a test widely used to estimate executive dysfunction. The main objective of this work is to study the psychometric properties of the Spanish version of the Dysexecutive Questionnaire (DEX-Sp). A complementary goal is to study its potential utility for initial screening in addicted individuals seeking treatment. METHOD: A sample of 131 non-clinical and 127 clinical individuals meeting the DSM-IV-TR substance abuse or dependence criteria were recruited. RESULTS: Internal consistency of the questionnaire was assessed (Cronbach's Alfa=0.91), as well as other reliability indicators. Exploratory and confirmatory factor analysis offers four- and five-factor solutions. Also tested were the dimensionality and structural model and its convergent and discriminant validity with other instruments. Differences between clinical and non-clinical individuals and total scores were also analyzed. CONCLUSIONS: The data suggest that the Spanish version of the DEX is a useful measure for assessing general symptoms of dysexecutive syndrome, and a valid, reliable and adequate screening test for estimating cognitive impairment associated with substance abuse.

[Social values and addiction: applicability and psychometric properties of VAL-89 questionnaire]. / Valores sociales y adiccion: aplicabilidad y propiedades psicometricas del cuestionario VAL-89.

OBJECTIVE: To study the psychometric properties of the VAL-89 questionnaire and its possible use in addict individuals who ask for treatment. METHOD: Analysis of the psychometric properties of the questionnaire and its factorial structure, applying it to 792 individuals. 365 of them were substance users seeking treatment and 427 were general population. RESULTS: Reliability of the questionnaire is confirmed, although its factorial structure appears to be different from the original. In our study appear 12 factors, instead of the original 10. These factors are named: Power, Stimulation, Submission, Tradition, Spirituality, Self-Sufficience, Hedonism, Sociability, Universality, Convencionalism, Idealism and Self-Realization. These factors are distributed through several dimensions represented by four axis: individual-social, dominance-equality, tradition-pleasure and great values-anomie. CONCLUSIONS: The VAL-89 questionnaire seems to be a useful tool to explore which are the more appreciated social values, being of special interest to know which are specially selected by addict individuals.