Validation and psychometric properties of the State Impulsivity Scale (SIS).

INTRODUCTION: Impulsivity is a complex phenomenon that can be evaluated from a trait or state perspective. Impulsive trait is a predisposition relatively stable over time, but not always perceptible by behavior. However, the impulsivity state covers transient variations on impulsivity levels that are dependent on environmental or biologic conditions. OBJECTIVE: This study has aimed to validate a scale to assess impulsivity as a state in a Spanish sample. METHOD: State Impulsivity Scale (SIS) was designed based on three experimental models: Reward, Automatism and Attentional. All the items in the SIS explore the presence and frequency of impulsive behaviors. Statistical analyses of reliability and validity were done. Convergent validity was examined by means of correlations among SIS and Barratt Impulsiveness Scale (BIS-11), Sensitivity to the punishment and sensitivity to the reward questionnaire (SPSRQ) and Sensations Seeking Scale type V (SSS). RESULTS: We used a Spanish sample of 70 patients who had at least one diagnosis of Impulse Control Disorder (IP), 73 psychiatric patients without impulsive disorders (NIP) and 150 control subjects (CS). The values obtained reveal the high reliability of the SIS (Cronbach's alpha coefficients 0.884), factor analysis confirmed the theoretical three-dimensional structure and convergent validity was excellent. SIS also demonstrated its capacity for discrimination among IP group and NIP and CS groups. CONCLUSIONS: SIS is a new impulsive behavior assessment instrument validated in Spanish population. The results obtained indicate adequate psychometric properties for its use in the clinical and research fields. Key Words: State Impulsivity, Trait, Evaluation, Scale.

[Usefulness of carbohydrate-deficient transferrin in alcohol-elated problems]. / Utilidad de la transferrina deficiente en carbohidratos en los problemas por uso de alcohol.

BACKGROUND: Carbohydrate-Deficient Transferrin (CDT) is a new marker for excessive alcohol drinking. It appears to be useful to detect alcoholism, harmful consumption and relapse. It have been introduced in our country recently. METHOD: Recent studies about utility of CDT have been reviewed. RESULTS: Sensitivity and specificity of CDT level as a marker of alcoholism were 72-97% and 31-81% respectively. As a marker of harmful consumption its sensitivity was 15-69% and its sensitivity was higher than 82%. CDT was demonstrated to be a effective maker for evaluating alcoholic abstinence in alcoholic patients. CONCLUSIONS: CDT determinations have a high specificity for screening heavy drinking in different settings. Problems related to its sensitivity are discussed.

[Treatment of schizophrenia in subjects with substance use disorders: A review]. / Revisión del tratamiento de la esquizofrenia en individuos con abuso de drogas.

BACKGROUND: Schizophrenic patients have a high comorbidity with substance use disorders. However, there are few studies on the efficacy of antipsychotics on psychopathology and on their repercutions on substance abuse. METHODS: All studies about pharmacological treatment of schizophrenic patients with substance abuse, included in Medline over the last ten years were analyzed. RESULTS: Of the 17 studies reviewed, most were prospective with small samples (< 30 patients, 5 studies) or case reports (7 studies). Objectives were to assess the efficacy on schizophrenic symptoms and the effect of the treatment on substance use. Atypical antipsychotics were the most studied. These pharmacological agents were effective at reducing symptoms and had few side effects. They also managed lo reduce substance abuse in 66-75% of patients. CONCLUSIONS: In spite of underlyng methodological problems of these studies, the findings suggest that atypical antipsychatics could be the treatment of choice in these patients.

[Psychiatric manifestations in patients with erythematosus systemic lupus]. / Manifestaciones psiquiátricas en pacientes con lupus eritematoso sistémico.

Psychiatric diagnostics were examined in 34 patients with Systemic lupus erythematosus (SLE) sent to Psychiatric Unit of La Paz Hospital. At the moment of interview, the Adaptative disorders were the most frequent (50%), in second place were the Organic psychiatric disorders (38.2). In 24 patients with a follow-up period, all patients had chronic psychiatric disorders and the adaptative disorders were the most frequent too. Twenty patients had neuropsychiatric manifestations. We analyse the difference in SEL with and without nervous system involvement.

[Naltrexone use in the treatment of alcoholism in Spain]. / Utilización de naltrexona en el tratamiento del alcoholismo en España.

To analyse the causes that prompted health care professionals to select naltrexone to treat alcoholism. One-year multicentric, prospective study conducted with 221 doctors specialized in alcoholism treatment and analysis of data derived from 1,396 patients attended. Naltrexone was not prescribed to 446 patients. The medical barriers to the prescription of naltrexone included the mode of understanding alcoholism by doctors (20 % of doctors), patients reluctance to take naltrexone (26.9 % of patients), the presence of a concomitant condition (27.6 %) and barriers associated with health care system (6 % of patients). The logistic regression model explained why doctors tended not to prescribe naltrexone when patients had a long course of their disease or had previously received acamprosate.

[Validation of the Alcohol Use Disorders Identification Test (AUDIT) in primary care]. / Validación de la prueba para la identificación de trastornos por uso de alcohol (AUDIT) en Atención Primaria.

The results of the validation for the AUDIT (Alcohol Use Disorders Identification Test) in Primary Care are here reported. A total of 326 patients who attended two primary care centers were interviewed. In a first interview they answered the AUDIT questions and later were classified on the basis of disturbances caused by alcohol use: abuse or dependency. The diagnosis of abuse or dependency was obtained with the structured interview for DSM-III-R. Reliability was determined by the test-retest correlation and internal consistency by Cronbach's alpha coefficient. Efficacy was calculated by means of the area under the curve (receiver operating characteristics). A quarter of the interviewed patients were diagnosed of some disturbance caused by alcohol use. The internal reliability of the test was acceptable (Cronbach's alpha coefficient 0.86). The test-retest correlation coefficient was 0.90. All the questions acceptably correlated with the total in the scale. A cut-off point of 8 was the most efficient for the whole sample (90% sensitivity and 90% specificity). For females, the most efficient cut-off point was 6. For patients aged over 60 years, the most efficient cut-off point was 5 for both sexes. This study confirms the usefulness of AUDIT for screening alcohol-related problems in Primary Care.

[The age of onset of alcohol-related problems as a prognostic factor in abstinence in patients admitted to a general hospital]. / La edad de inicio de los problemas por el alcohol como factor pronóstico de abstinencia en pacientes ingresados en el Hospital General.

Seventy-three inpatients of a general hospital were studied prospectively. Detection of alcohol problems was done by non-psychiatrist physicians. The psychiatrist, after evaluating the problem recommended an outpatient centre for treatment. One year after this 15% of them remained abstinent. Age onset of alcohol-related problems correlated positively with abstinence days number. Abstinence was associated with an late age onset of alcohol-related problems and contacting with the outpatient center. Thirty-seven years age was the cutoff point with more specificity and sensibility. Hypothesis for this results are discussed.

[Liaison programs in drug abuse-AIDS]. / Programas de enlace en toxicomanías--SIDA.

AIDS has acquired a growing importance for psychiatry because of the number of infected people and the increasing attention that these patients need. The major risk group in Spain is the drug users one. These patients share management problems when they are in general hospitals settings, both for their psychiatric aspects and for the consequences of drug abusing. A consultation liaison psychiatry service system improves the attention to these patients and reduces the emergency interventions and the hostility against the staff. The consultation liaison psychiatry system has generated an overall improvement in our hospital to fulfil the patients need and the relations and atmosphere among the therapeutic team.

[Attention-deficit hyperactivity disorder and vulnerability to the development of alcoholism: use of the Wender-Utah Rating Scale for retrospective diagnostic of ADHD in the childhood of alcoholic patients]. / Trastorno por déficit de atención e hiperactividad y vulnerabilidad al desarrollo de alcoholismo: empleo de la Wender-Utah Rating Scale (WURS) para el diagnóstico retrospectivo de TDAH en la infancia de pacientes alcohólicos.

UNLABELLED: In the last years, it has been accumulated data about an important association between addictions and attention-deficit hyperactivity disorder (ADHD). Both disorders share clinic aspects and relevant biological markers, and for both it has been postulated alterations in the same cerebral systems. OBJECTIVE: To evaluate the rate of possible ADHD in the early ages of adult alcoholic patients, in contrast with controls. METHOD: It was realized an adaptation of Wender-Utah Rating Scale (WURS) and it was analyzed its psychometric characteristics. It was administered to 117 alcoholic patients and to 52 controls. RESULTS: The mean score of WURS is significatively higher in alcoholic group than in the control one (32.26 vs. 16.55, p< 0.0001). The percentage of alcoholic patients who has a score upper the different cut-off points (36 and 46) is also higher in alcoholic group than in the control one (36.75% vs 7.69%; p< 0.0005; 18.8% vs. 1.92%; p< 0.01, respectively). The mean score is higher in alcoholics with other comorbid addiction than in alcoholics without it (37.61 vs. 29.17; p< 0.018), and is higher in alcoholic patients who usually have intoxicated states in an high-moderate grade than those who have it in a low-nule one. CONCLUSIONS: Among alcoholic patients exists an important group with high scores in the WURS, it could indicate high rates of ADHD in early ages. It was discused the clinic and etiopathogenetics implications, and the convenience of advancing in the developemnt of diagnostic tools.

[Prevalence of psychiatric disturbances and psychopathologic status in patients with systemic lupus erythematosus]. / Prevalencia de trastornos psiquiátricos y estado psicopatológico en pacientes con lupus eritematoso sistémico.

BACKGROUND: Psychiatric disorders are commonly associated with systemic lupus erythematosus (SLE). Some authors consider that these disorders can be associated with cognitive impairment. OBJECTIVES: The objectives of this study were to establish the particular prevalence of psychiatric disorders in these patients and to investigate the relationship between psychiatric disorders, cognitive impairment, life quality, psychological status and adjustment to illness. MATERIAL AND METHODS: A cross-sectional study is reported of 46 spanish patients with systemic lupus erythematosus (SLE) attending the outpatients clinics of the Internal Medicine and Rheumatology Departments at a University Hospital. The following instruments were used: a Structured Clinical Interview for DSM-III-R, the Nottingham Health Profile, the Symptom Check-List 90-Revised, the Psychological Adjustment to Illness Scale and the Integrated Program of Neuropsychological Assessment Test-Barcelona. RESULTS: The prevalence of psychiatric disorders at interview was 33%. The most common diagnoses were affective disorders and psycho-organic syndrome. Affective disorders were associated with a poorer life quality, number of hospitalizations and psychiatric background. Adjustment to illness accounted for the psychologic status of the patients.