Alcohol Use Disorder in immigrant patients: 2-years of follow-up treatment.

In recent decades the immigrant population has increased significantly in Western countries, which not only influences the former culturally but also in their alcohol consumption patterns. The course of immigration can cause social stress, which can lead to uprooting, frustration of their expectations or marginality, which are risk factors for an increase in alcohol consumption, possibly in order to face their different problems. The aims of this study are: to investigate the progression along two years of treatment of a sample of immigrant patients with Alcohol Use Disorder, to compare it with a sample of Spanish natives and to analyze the evolution of immigrant patients according to the geographical area of origin.

Cognitive Effects of Combined Amisulpride and Quetiapine Treatment in Patients With Refractory Schizophrenia: A Naturalistic, Prospective Study.

BACKGROUND: Regarding the treatment of patients with resistant schizophrenia, different options exit, although they are supported by limited evidence. In this study, antipsychotic polypharmacy, comprising 1200 mg of amisulpride and 600 mg of quetiapine, was used. Clinical change evaluation was performed using neurocognitive evaluations. STUDY QUESTION: The use of amisulpride and quetiapine will imply a clinical improvement in patients affected by schizophrenia, which will be specially reflected in a cognitive improvement. STUDY DESIGN: Naturalistic and prospective study. Twenty-six patients were applied and assessed by a battery of neurocognitive evaluations since the pretreatment baseline until 6-month treatment. The patients had no biological response to medication, high social maladjustment, and a long clinical history of the disease. Kane and Brenner criteria for treatment-resistant schizophrenia were applied to choose the subjects. MEASURES AND OUTCOMES: The cognitive improvement will imply a significant betterment, from the pretreatment baseline until 6-month treatment, in the following cognitive tests: Stroop Test, WAIS Coding Subtest, and Comprehensive Trail Making Test (CTMT). An improvement in the Calgary Depression Scale, Simpson-Angus Scale, and Visual Analogue Scale (EVA) will also be observed. This scales were been used during the baseline, 3 months after, and then, 6 months. RESULTS: Subjects, after 6-month treatment with amisulpride and quetiapine, did show statistically significant differences in the assessed areas: WAIS Coding Subtest (P < 0.001), CTMT A and B (CTMT A P < 0.034; CTMT B P < 0.000), and Stroop Tests: Word (P < 0.001), Word-Color (P < 0.007), and Interference (P < 0.039). Furthermore, they showed a statistically significant difference in the Calgary Depression Scale (P < 0.002), Simpson-Angus Scale (P < 0.019), and EVA (P < 0.001). CONCLUSIONS: The results of this report show a cognitive and clinical improvement in refractory patients after the administration of amisulpride and quetiapine.

Executive Functions Influence on Memory Process in Patients with Paranoid Schizophrenia and Bipolar Disorders with and without Psychotic Symptoms. A Pilot Study.

The objective of the present study was to evaluate whether declarative memory deficits are related to executive function deficits (EF), since they could be a consequence of a poor organization of the material to memorize. This interaction between both cognitive processes can be studied simultaneously in a single task such as the Test of Memory Strategies (TSM). 23 patients with paranoid schizophrenic disorder, 11 with bipolar disorder with psychotic symptoms, 13 with bipolar disorder without psychotic symptoms and 15 healthy subjects were evaluated with the TSM; with the memory test Texts A and B (subtest of the Barcelona neuropsychological assessment battery), which assesses short-term and immediate recall without the influence of EF; and with the Trail Making Test (TMT): Part A (sustained attention) and Part B (executive control). The patients groups and the control group showed an improvement in memory performance across each of the TSM conditions. However, this facilitating effect of the strategies differed among the groups (the patients with higher EF deficits showed less improvement). Regarding these results, we conclude that this cognitive process cannot be independent of EF. However, due to the pilot nature of this study, it would be recommended to replicate these findings in new studies.

Patología dual en pacientes inmigrantes con Trastorno por Uso de Alcohol: seguimiento tras dos años de tratamiento / Dual pathology in immigrant patients with Alcohol Use Disorder: follow-up after two years of treatment

Introducción: Existe una elevada prevalencia de trastornos psiquiátricos en el trastorno por uso de alcohol. Lapresencia de patología dual en el paciente disminuye el mantenimiento de la abstinencia y aumenta la probabilidad derecaída, lo que complica el tratamiento. Los objetivos de esteestudio son: Analizar la evolución a dos años de tratamiento de una población de pacientes inmigrantes con trastorno por uso de alcohol asociado a trastornos psiquiátricos,comparándola con una muestra de pacientes inmigrantes sinpatología dual e investigar los diagnósticos de patología psiquiátrica asociada al trastorno por uso de alcohol.Metodología. Se compararon dos poblaciones de pacientes inmigrantes con trastorno por uso de alcohol (DSM-5),una con trastornos psiquiátricos asociados, compuesta por219 pacientes y otra de 169 pacientes sin patología dual.Resultados y conclusiones. Los trastornos psiquiátricosmás frecuentes asociados al trastorno por uso de alcoholson el de personalidad (51,6%), el adaptativo y depresivo(22,8%), los de ansiedad (15,5%), los de conducta alimentaria y obsesivos compulsivos (5,9%), el bipolar (5%) y el deesquizofrenia (2,3%). El seguimiento a 2 años de tratamientopresenta que el 27% de la población inmigrante con patología dual se mantiene en abstinencia frente al 41,4% de la quesolo padece trastorno por uso de alcohol: Se constata unapeor evolución en los pacientes con patología dual. (AU)

Introduction: There is a high prevalence of comorbidpsychiatric disorders in alcohol abuse disorder. The presenceof dual diagnosis in patients decreases the maintenance ofabstinence and increases the likelihood of relapse, whichmakes treatment more complicated. The aims of thisstudy are: to investigate the progression along two yearsof treatment of a sample of migrant patients affected byalcohol abuse disorder associated with psychiatric disorders,comparing it with a sample of migrant patients withoutdual diagnosis and investigating the diagnoses of comorbidpsychiatric pathology with alcohol abuse disorder.Methods. Two populations of migrant patients withalcohol abuse disorder (DSM-5) were compared, one withcomorbid psychiatric disorders consisting of 219 patientsand the other of 169 patients without dual diagnosis.Results and conclusions. The most frequent psychiatricdisorders associated with alcohol use disorder are personalitydisorders (51,6%), adjustment and depressive disorders(22,8%), anxiety disorders (15,5%), eating disorders andobsessive-compulsive disorders (5,9%), bipolar disorders(5%) and schizophrenia (2,3%). The two-year follow-uptreatment shows that 27% of immigrant sample with dualdiagnosis remains in abstinence compared to 41,4% of thosewho only suffer from alcohol use disorder: Worse outcomesare observed in patients with dual diagnosis. (AU)

Trastorno por Uso de Alcohol enpacientes inmigrantes: seguimiento a2 años de tratamiento / Alcohol Use Disorder in immigrant patients: 2-years of follow-up treatment

Introducción: En las últimas décadas, la poblacióninmigrante ha aumentado sensiblemente en los paísesoccidentales, que no solo les influye culturalmente sinotambién en su patrón de consumo de alcohol. El transcursode la inmigración puede originar estrés social, que es posibleque cause desarraigo, frustración de sus expectativas omarginalidad, que son factores de riesgo para un aumentodel consumo de alcohol, posiblemente con el fin de afrontarsus diferentes problemas. Los objetivos de este trabajo son:investigar la evolución a dos años de tratamiento de unapoblación de pacientes inmigrantes con Trastorno por Uso deAlcohol, comparándola con una muestra de origen español,y analizar la evolución de los pacientes inmigrantes según elárea geográfica de origen.Metodología. Se compararon dos poblaciones conTrastorno por Uso de Alcohol (DSM-V), una de inmigrantescompuesta por 388 pacientes y otra de control, de origenespañol, compuesta por 262 pacientes. Asimismo, se estudióla evolución de los pacientes según el área geográfica a laque pertenecen.Resultados y conclusiones. El 45,4 % de los pacientes dela población española se mantiene en abstinencia a los 2 añosde tratamiento frente al 33,8 % de la población inmigrante.Los pacientes que consiguen una mayor abstinencia sonlos de origen árabe (52,3 %). Sin embargo, hay una mayoradherencia en América del Sur/Cono Sur (67,7 %). Los paísesque tienen una peor evolución en la abstinencia son los deAmérica del Sur/Países del Norte (26,2 %) y los que procedende Europa Oriental (29,1 %). (AU)

Introduction: In recent decades the immigrant populationhas increased significantly in Western countries, which notonly influences the former culturally but also in their alcoholconsumption patterns. The course of immigration can causesocial stress, which can lead to uprooting, frustration oftheir expectations or marginality, which are risk factors foran increase in alcohol consumption, possibly in order toface their different problems. The aims of this study are: toinvestigate the progression along two years of treatment ofa sample of immigrant patients with Alcohol Use Disorder,to compare it with a sample of Spanish natives and toanalyze the evolution of immigrant patients according tothe geographical area of origin.Methods. Two samples of individuals with AlcoholUse Disorder (DSM-V) were compared: one sample of 388immigrant patients and a control sample composed of262 Spanish patients. Likewise, the patients were studiedaccording to the geographical area to which they belong.Results and conclusions. 45.4% of patients in theSpanish sample remain in abstinence after 2 years oftreatment compared to 33.8% in the immigrant sample.Patients who achieve greater abstinence are those of Araborigin (52.3%). However, there is a better adherence in SouthAmerica/Southern Cone (67.7%). The countries with theworst outcomes in abstinence are those in South America/Northern countries (26.2%) and those in Eastern Europe(29.1%). (AU)

The Relationship Between Educational Years and Phonemic Verbal Fluency (PVF) and Semantic Verbal Fluency (SVF) Tasks in Spanish Patients Diagnosed With Schizophrenia, Bipolar Disorder, and Psychotic Bipolar Disorder.

Semantic and verbal fluency tasks are widely used as a measure of frontal capacities. It has been well described in literature that patients affected by schizophrenic and bipolar disorders present a worse execution in these tasks. Some authors have also noted the importance of educational years. Our objective is to analyze whether the effect of cognitive malfunction caused by apathology is superior to the expected effect of years of education in phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) task execution. A total of 62 individuals took part in this study, out of which 23 were patients with schizophrenic paranoid disorder, 11 suffered from bipolar disorder with psychotic symptomatology, 13 suffered from bipolar disorder without psychotic symptomatology, and 15 participants were nonpathological individuals. All participants were evaluated with the PVF and SVF tests (animals and tools). The performance/execution results were analyzed with a mixed-model ANCOVA, with educational years as a covariable. The effect of education seems to be more determined by PVF FAS tests than by SVF. With PVF FAS tasks, the expected effect of pathology disappears when the covariable EDUCATION is introduced. With SVF tasks, the effect continues to be significant, even though the EDUACTION covariable dims such effect. These results suggest that SVF tests (animals category) are better evaluation tools as they are less dependent on the patients' education than PVF FAS tests.

A Multisite, Randomized Controlled Clinical Trial of Computerized Cognitive Remediation Therapy for Schizophrenia.

The effectiveness of cognitive remediation therapy (CRT) for the neuropsychological deficits seen in schizophrenia is supported by meta-analysis. However, a recent methodologically rigorous trial had negative findings. In this study, 130 chronic schizophrenic patients were randomly assigned to computerized CRT, an active computerized control condition (CC) or treatment as usual (TAU). Primary outcome measures were 2 ecologically valid batteries of executive function and memory, rated under blind conditions; other executive and memory tests and a measure of overall cognitive function were also employed. Carer ratings of executive and memory failures in daily life were obtained before and after treatment. Computerized CRT was found to produce improvement on the training tasks, but this did not transfer to gains on the primary outcome measures and most other neuropsychological tests in comparison to either CC or TAU conditions. Nor did the intervention result in benefits on carer ratings of daily life cognitive failures. According to this study, computerized CRT is not effective in schizophrenia. The use of both active and passive CCs suggests that nature of the control group is not an important factor influencing results.