Relationship between craving and impulsivity in patients with alcohol dependence with or without dual disorders in an outpatient treatment center: a descriptive study.

OBJECTIVES: To compare alcohol and other drugs abuse, state impulsivity, craving and the relationship between craving and impulsivity in alcohol-dependent patients with or without dual disorder attending to an alcohol treatment center in Cadiz town. METHOD: An observational, descriptive and transversal study performed on 112 alcohol dependent patient sample who were seeking treatment in ARCA outpatient treatment center in Cadiz. The sample was divided in two groups, according to present dual diagnosis or not. The sample was assessed with an AdHoc sociodemographic and clinical questionnaire and specific scales and interviews that included: 5.0 Mini International Neuropsychiatric Interview results (MINI), State Impulsivity Scale (SIS), and Multidimensional Alcohol Craving Scale (MACS). RESULTS: The prevalence of dual diagnosis was 50%, being the most prevalent disorders: Current and recurrent Major Depressive Episode Mood Disorder, Current Dysthymic Mood Disorder, Panic Disorder and Anxiety Disorder. 52,7% of the total sample had a positive result on the State Impulsivity Scale. No statistically significant results were found on the Craving Scale (neither in the score or in the sub-sections). A relationship between craving and impulsivity were found for all groups and researched items. CONCLUSIONS: As a relationship between craving and impulsivity was observed, these aspects should be considered as main factors for the treatment and evolution of alcohol- dependent patients.

Cocaine relapse and health-related quality of life: a 23 weeks study.

INTRODUCTION: Cocaine dependence is a disorder where relapses are frequently presented and many factors are involved. Furthermore, cocaine dependence is associated with poor health-related quality of life (HRQoL) outcomes. This study aims to explore perceived HRQoL as an indicator of drug relapse in cocaine-dependent patients (CDP). SUBJECTS AND METHODS: A longitudinal study was carried out in CDP during 23 weeks. A consecutive sampling method was applied, 39 participants composed the initial sample (mean age 35.6 years), only 15 participants completed outpatient follow-up period. CDP were assessed with psychiatric and HRQoL instruments (SCID-I, SCID-II, BDI, STAI scale and SF-36) in different points of the study. The patients were followed up, and cocaine relapses were assessed. The sample was divided according with the relapse (early vs. late relapse). Data were compared and analyzed in order to evaluate whether HRQoL measure could be related to cocaine relapse. RESULTS: There are differences in perceived HRQoL measures between CDP with/without early relapse, especially in Mental health and Social functioning dimensions (p<0.05). Furthermore, Late/relapse-patients have higher improvement of HRQoL than patients with early relapse. CONCLUSIONS: Perceived HRQoL might predict early relapse and could be a possible predictor tool of potential future relapses. More research in this field is needed.

Harm reduction program use, psychopathology and medical severity in patients with methadone maintenance treatment. / Uso de reducción de daños y gravedad psicopatológica y médica en pacientes en programa de mantenimiento con metadona.

Methadone maintenance programs (MMP) for opioid dependence treatment have been widely used due to their effective therapeutic outcomes. Harm reduction programs (HRP) are complementary programs for severe patients with high risk behaviors and when abstinence is not possible. This study aims to compare patients in MMP that use HRP (MMP-HRP) and patients in MMP who do not use HRP (MMP-NO HRP). The sample was composed of 143 patients (MMP-HRP = 42 vs. MMP-NO HRP = 101). An additional subanalysis was performed with patients under 45 years of age (n = 116; MMP-HRP = 38 vs. MMP-NO HRP = 78). All patients were assessed with an ad hoc socio-demographic questionnaire, EuropASI, SCID-I, and SCID-II. Results show that MMP-HRP patients were younger with more frequent use of intravenous drugs and with a high prevalence of Cluster B personality disorders. MMP-NO HRP patients had lower methadone doses compared to MMP-HRP patients and preferred to use drugs by smoked route more frequently. In the subanalysis of patients under 45, MMP-HRP patients were younger, had a higher prevalence of liver diseases, more intravenous drug use, greater severity on the drug use scale, less social and family support in the suescales of EUROP-ASI than compared to patients under 45 years in the group MMP-NO HRP. In conclusion, MMP-HRP patients are younger compared to MMP-NO HRP patients, they also receive higher doses of methadone and had more intravenous use. The above findings imply that the early onset of high risk drug use and long-term exposure to heroin have more severe outcomes such as higher comorbidities (e.g. infectious diseases, medical and psychiatric disorders), and consequently, these patients are a more vulnerable group with a worse prognosis.

Los programas de mantenimiento con metadona (PMM) para el tratamiento de la dependencia a opiáceos han demostrado elevada eficacia, siendo los más utilizados en la actualidad. La Reducción de Daños (REDAN) se refiere a tratamientos y abordajes complementarios en personas con graves dificultades para la abstinencia y conductas de riesgo. El objetivo del presente trabajo es comparar pacientes en PMM que utilizan servicios REDAN (PMM-REDAN) versus pacientes en PMM que no utilizan servicios REDAN (PMM-NO REDAN). Se incluyó un total de 143 pacientes en PMM (PMM-REDAN = 42, PMM-NO REDAN = 101) y se realizó un subanálisis de los menores de 45 años (n = 116; 38 PMM-REDAN, 78 PMM-NO REDAN). Se hizo una evaluación de datos socio-demográficos, EuropASI, SCID-I y SCID-II. Los pacientes PMM-REDAN son más jóvenes, utilizan la vía parenteral y presentan trastornos de personalidad Clúster B comórbidos a la adicción. Los PMM-NO REDAN consumen más por vía fumada y tienen dosis bajas de metadona. Los menores de 45 años PMM-REDAN son más jóvenes, tienen mayor prevalencia de enfermedades hepáticas, utilizan más la vía parenteral, tienen un consumo de drogas más grave y menos soporte socio-familiar en las subescalas EUROP-ASI que los menores de 45 años PMM-NO REDAN. En conclusión, los pacientes PMM-REDAN son más jóvenes, reciben dosis mayores de metadona y utilizan vías de mayor riesgo, hecho que implica un inicio temprano en prácticas de consumo de riesgo, mayor tiempo de exposición a la heroína, con consecuencias de mayor gravedad de la adicción, mayor comorbilidad infecciosa, médica y psiquiátrica, siendo un grupo vulnerable y con pronóstico desfavorable.

HIV And HCV infection among opiate-dependent patients and methadone doses: the PROTEUS study.

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are prevalent infections in opiate-dependent patients. Opiate replacement treatment (ORT) with methadone or buprenorphine is associated with several important outcomes among patients with opiate dependence. However, little is known about outcomes in patients with HIV and/or HCV infections that are in ORT. Also, it is not well established whether the presence of HCV or HIV infection could be associated with higher methadone doses. This paper reanalyzes the database of PROTEUS study, using two principal variables: methadone dose and presence of HIV and/or HCV infection. PROTEUS recruited 621 patients (84.1% were male, mean age: 38.9 years, SD: 7.9), information about the presence of HIV in status was available for 390 patients. Of those, 134 (34.4%) were HIV-infected. Whilst, information about HCV infection was available for 377 patients. Of those, 315 (83.6%) were HCV-infected. Information on HIV/HCV coinfection was available for 376 patients, of those, 112 (29.8%) had this coinfection. HIV-infected and HIV/HCV-coinfected patients received higher methadone doses than those without these infections. Antiretroviral therapy (ART) was used in 80% of patients with HIV infection. The proportion of patients taking antiretroviral drugs was significantly higher for patients treated with higher methadone doses (p < 0.01). Findings suggest that HIV-infected and HIV/HVC-coinfected patients in ORT require higher methadone dose.

The role of dual diagnosis in health-related quality of life among treatment-seeking patients in Spain.

PURPOSE: The comorbidity of any substance use disorder and another mental disorder is defined as dual diagnosis. Dual diagnosis is very common and clinical and therapeutic consequences have been described. This cross-sectional study aimed to analyse health-related quality of life (HRQoL) according to clinical characteristics and psychiatric comorbidities in patients with substance dependence. METHODS: A total of 1276 substance-dependent patients seeking treatment were recruited. HRQoL was evaluated by the Short-Form 36 (SF-36) questionnaire. The SCID-I, SCID-II and Conners' adult ADHD diagnostic interview were used to evaluate dual diagnosis. A visual analogue scale was used to measure craving. Bivariate and multivariate analyses were performed, and correction for multiple tests was conducted. RESULTS: Substance-dependent patients had impaired quality of life, especially in the mental component. SF-36 physical and mental component scores were 47.7 ± 10.9 and 36.1 ± 14.1, respectively. Furthermore, 65% of the patients had dual diagnosis, 51% had an Axis I DSM-IV-TR mental disorder and 35% had some personality disorder. Impaired physical quality of life was independently associated with medical condition, age, being female, depressive disorder and anxiety disorder. Depression disorder, any personality disorder, active consumption last month, Attention deficit hyperactivity disorder, anxiety disorder, suicide attempt were independently associated with worse mental quality of life. CONCLUSION: These findings emphasize the significance of dual diagnosis in the impairment of HRQoL in substance-dependent patients, particularly with regard to mental component. In addicted patients with low scores on SF-36, psychiatric comorbidity should be evaluated and treated in an integrated approach.

Administrative prevalence of insomnia and associated clinical features in patients with addiction during active substance use.

INTRODUCTION: A bidirectional relation between substance use and insomnia has been described, although there are few studies examining insomnia in the population of people with addiction. The aim of this study was to describe the prevalence of insomnia during active substance use in patients with addiction and its associated clinical features. PATIENTS AND METHODS: Descriptive study in patients diagnosed with substance dependence disorder admitted to a Hospital Detoxification Unit. The existence of insomnia prior to admission was assessed using the Oviedo Sleep Questionnaire (OSQ). Demographic variables, consumptionrelated clinical variables, and diagnostic variables were collected and the SCID-I and -II (Structured Clinical Interview for DSM-IV) and CAADID (Conners’ Adult ADHD Diagnostic Interview for DSM-IV) were administered to evaluate the psychiatric diagnoses. Bivariate and multivariate analyses were made of the data. RESULTS: 481 patients (72.6% men, age 40.6±10.1 years) were enrolled. 64.3% of the patients reported insomnia during active substance use. The most common type of insomnia was fragmented nocturnal sleep (49.9%). The factors significantly associated with insomnia were polysubstance drug use, medical comorbidities (most notably, infectious diseases), anxiety disorder, personality disorder (particularly cluster C), a greater number of previous admissions for detoxication, and early age at onset of substance use. CONCLUSIONS: Insomnia is highly prevalent in patients with addiction during active use of the substance. Fragmented nocturnal sleep was the most common type of insomnia. Patients with addiction and comorbid anxiety disorder, medical comorbidity, and early onset of dependence were more likely to experience insomnia.

Relevant Differences in Perception and Knowledge of Professionals in Different Spanish Autonomous Communities Regarding Availability of Resources for Patients with Dual disorders.

OBJECTIVES: To assess the knowledge of health professionals attending patients with dual disorders about specific resources for patients with this condition in different Spanish regions. METHODS: Observational, cross-sectional, multicenter study to compare the perceptions of healthcare professionals (n=659) with reality regarding specific resources available for patients with dual disorders in Spain. The professionals completed an online questionnaire. Nineteen commissioners and managers responsible for national and regional substance abuse programs also completed the questionnaire. RESULTS: A representative sample of professionals from each community (553 centers in 235 Spanish cities) participated in the study. Most participants (93.2%) felt that specific resources for patients with dual disorders are needed. High percentages of professionals thought that there were no specific workshops (88.4%), subacute units (83.1%), day hospitals (82.8%), specific day centers (78.5%), or outpatient programs (73.2%) for patients with dual disorders. The real knowledge of professionals regarding the existence of specific resources varied according to the type of resource and autonomous community. The professionals generally underestimated the number of units available in their communities. CONCLUSIONS: There were clear differences in the real knowledge that healthcare professionals had about the resources available for patients with dual disorders in relation to the autonomous community where they were practicing. Actions are needed to harmonize knowledge nationally, for example, a single registry, white paper, or a national program for patients with dual disorders.

Substance Use among Medical Students: A Literature Review 1988- 2013.

The use of legal and illegal substances by medical students is a phenomenon that is only partially known. The aim of this paper was to review the literature published internationally in the last 25 years about the use of legal and illegal substances by medical students. A systematic search was made of MEDLINE and LILACS. One hundred and six manuscripts were evaluated, which included a population of 88,413 medical students. We validated 74,001 questionnaires, which represented 83.7% of responses. The methodology and the rigor of its application are not the same in all the publications. There are many regional variations, most studies being made in America and Europe. With the exception of alcohol in some areas of the Western world, medical students use substances less than university students in general and the general population. The substances used are mainly alcohol (24%), tobacco (17.2%), and cannabis (11.8%). The use of hypnotic and sedative drugs also is common (9.9%). The rate of use of stimulants is 7.7% and of cocaine, 2.1%; opiate use being very low (0.4%). In some parts of Latin America, up to 14.1% use inhalants. Students in the last years of school have a higher rate of substance use. The use of substances, except for hypnotics and sedatives, is more common among men than women. The use of substances by medical students is a phenomenon that should be evaluated systematically due to its prevalence and potential impact.

Motivational interviewing group at inpatient detoxification, its influence in maintaining abstinence and treatment retention after discharge.

The relapse rate after discharge from inpatient detoxification is high. The objective of this pilot study is to assess the sociodemographic, clinical and therapeutic factors associated with maintaining abstinence in patients who participated in a brief motivational interviewing group during admission for detoxification. A total of 46 patients, diagnosed substance dependent according to DSM -IV, and admitted to the Hospital Detoxification Unit, participated in a brief motivational interviewing group. Sociodemographic, clinical, motivation to change (University of Rhode Island Change Assessment, URICA) and satisfaction with the treatment group (Treatment Perceptions Questionnaire, CPT) data were collected. Abstinence and treatment retention two months after discharge were assessed by weekly telephone calls. A survival analysis was performed. Being male, having more cognitions of the maintenance stage of change at discharge, being satisfied with group therapy and therapist during hospitalization are associated with longer abstinence after discharge. The brief motivational interviewing group approach with patients admitted for detoxification is related to greater likelihood of maintaining abstinence and subsequent treatment retention.

La tasa de recaída en el consumo al alta de una Unidad de Desintoxicación Hospitalaria es elevada. El objetivo de este estudio piloto es valorar los factores sociodemográficos, clínicos y terapéuticos asociados al mantenimiento de la abstinencia de pacientes que han participado en un grupo psicoterapéutico breve de corte motivacional durante su ingreso para la desintoxicación.Un total de 46 pacientes con diagnóstico de trastorno por dependencia a sustancias, según DSM-IV, ingresados en Unidad de Desintoxicación Hospitalaria participaron en un grupo breve de corte motivacional. Se midieron variables sociodemográficas y clínicas, así como la motivación al cambio (University of Rhode Island Change Assessment, URICA) y la satisfacción con el tratamiento grupal (Cuestionario de Percepciones de Tratamiento, CPT). El mantenimiento de la abstinencia y la retención al tratamiento, dos meses tras el alta, se evaluaron mediante llamadas telefónicas semanales. Se realizó un análisis de supervivencia. Los resultados muestran que ser varón, tener cogniciones del estadio de mantenimiento del cambio al alta y tener una buena satisfacción con la terapia grupal y su terapeuta durante el ingreso, se asocia con mayor tiempo en abstinencia tras el alta. El abordaje psicoterapéutico grupal breve de corte motivacional, en pacientes ingresados para la desintoxicación, se relaciona con mayor probabilidad de mantenimiento de abstinencia y de retención al tratamiento posterior.

Neuroticism and impulsivity: their hierarchical organization in the personality characterization of drug-dependent patients from a decision tree learning perspective.

OBJECTIVE: Neuroticism and impulsivity are the personality variables most consistently associated with drug-dependent patients. To date, no data mining procedures have been applied to explore the differential role of personality variables in this population. METHODS: The personality profile of 336 drug-dependent patients was compared with that of a sample of community participants in the context of a decision tree learning approach using the Alternative Five Factor Model. The resulting discriminant model was cross-validated. RESULTS: Neuroticism and impulsivity were the most relevant variables in the resulting model, but their association appeared to be hierarchically organized. In the personality characterization of these patients, neuroticism became the main discriminant dimension, whereas impulsivity played a differential role, explained by means of an interaction effect. Decision tree learning models appear to be a heuristic theoretical and empirical approximation to the study of relevant variables, such as personality traits, in drug-dependency research.

Dual diagnosis resource needs in Spain: a national survey of professionals.

OBJECTIVE: Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and another mental health disorder) is an important challenge in mental health, this study assessed health care professionals' perceptions and knowledge of the current state of specific resources for patients with dual pathology in Spain. METHODS: We conducted a national survey of health care professionals seeing patients with dual pathology in treatment facilities throughout Spain. Participants completed a specific online questionnaire about the needs of and available resources for patients with dual pathology. RESULTS: A total of 659 professionals, mostly psychologists (n = 286, 43.4%) or psychiatrists (n = 217, 32.9%), participated in the study. Nearly all participants who responded to these items reported that specific resources for dual pathology were needed (n = 592/635, 93.2%); 76.7% (n = 487) identified intermediate resources, 68.8% (n = 437) acute detoxification units, and 64.6% (n = 410) medium-stay rehabilitation units as particularly necessary. In the opinion of 54.0% of respondents (n = 343), integrated mental health and addiction treatment services were available. Of the participants who answered these items, only a small proportion (n = 162/605, 26.8%) reported that there were appropriate outpatient programs for dual pathology, 30.4% (n = 184/605) specific hospitalization units, 16.9% (n = 99/587) subacute inpatient units, 34.2% (n = 201/587) outpatient intermediate resources, 15.5% (n = 91/587) day hospitals, and 21.5% (n = 126/587) day centers. Conversely, 62.5% (n = 378/587) of participants reported a greater presence of specific detoxification/withdrawal units, 47.3% (n = 286/587) psychiatric acute admission units, and 41.9% (n = 246/587) therapeutic communities. In the professionals' opinion, the presence of specialty programs was low; 11.6% of respondents (n = 68/587) reported that vocational programs and 16.7% (n = 98/587) reported that occupational rehabilitation programs were available. Employee turnover was common: 51.9% of respondents (n = 314/605) stated that employee turnover was occasional to frequent. CONCLUSIONS: According to the professionals surveyed, specific health care resources for the management of dual pathology are currently insufficient, underlining the need for additional efforts and strategies for treating individuals with comorbid disorders.

Treatment adherence to treatment in substance users referred from Psychiatric Emergency service to outpatient treatment.

OBJECTIVES: The main objective was to evaluate the treatment adherence of patients attended at the Psychiatric Emergency Room and referred to an Outpatient Drug Clinic. Our aim was to describe the degree of adherence and the factors related to it. METHODS: A naturalistic study was conducted through examination of the clinical records of the patients attended in the Psychiatric Emergency Room of our hospital during one year (n=5052). Inclusion criteria consisted of substance dependence meeting DSM-IV criteria, belonging to our district, referral when discharged to an Outpatient Drug Clinic, and absence of previous treatment for Drug Addiction follow-ups (n=72). We evaluated further to the center link, adherence to the deviceduring the next year. RESULTS: 33.4% of the patients referred to an Outpatient Drug Clinic didn't request for a visit. From those who requested a first appointment, 20.83% didn't attend. From those who attended the first appointment, 47.37% abandoned treatment in the first 12 months. No differences between substance of use or time of the year of referral were observed. DISCUSSION: Independently to the accessibility to the Outpatient Clinic, difficulties in the adherence to drug addiction treatment exist. Inicial adherence to drug addiction treatment is medium. Patient's attendance to the clinics are important due to it's relation with retention doubling. Efforts should be made to improve the compliance with pharmacologic and nonpharmacologic treatment.

[Risk factors for relapse in drug-dependent patients after hospital detoxification]. / Factores de riesgo de recaída en pacientes drogodependientes tras desintoxicación hospitalaria.

This work describes the profile of patients with relapse after hospital detoxification at six months of outpatient follow-up. An observational and prospective study was carried out in patients with substance-dependence disorder who were in the Detoxification Unit of the Vall d'Hebron University Hospital (Barcelona) between June 2009 and October 2010. Demographic, clinical, diagnostic and therapeutic variables were assessed. The criterion for relapse was a return to use of the substance that had led to hospitalization, and relapse was assessed by means of anamnesis, breathalyzer and/or urine analysis. Study variables were compared between patients who relapsed and those who did not. Of the 165 patients included, 108 patients finished the study (75% males, age 37.7 ± 9.5 years). A total of 72.2% had relapsed at the 6-month follow-up. Profile of patients who relapsed was: hospitalized for heroin detoxification (91.7% vs 8.3%, p = .038), polyconsumers (71.4% vs 32%, p = .05), high substance use in the hours prior to admission as a "farewell" (61.5% vs 39.5%, p = .04), patients with comorbidity (44.9% vs 23.3%, p = .04) and patients with affective disorders (19.5% vs 3.2%, p = .005). Detoxification from opiates and use in the hours prior to admission were associated independently with relapse at 6 months. There is a high percentage of relapses after hospital detoxification. Patients most likely to relapse are those dependent on opiates and those with compulsive use immediately prior to hospitalization.

Mood Disorders and Severity of Addiction in Alcohol-Dependent Patients Could Be Mediated by Sex Differences.

Background: Alcohol dependence is highly prevalent in the general population; some differences in alcohol use and dependence between women and men have been described, including outcomes and ranging from biological to social variables. This study aims to compare the severity of alcohol dependence with clinical and psychopathological characteristics between sexes. Methods: A cross-sectional descriptive study was conducted in alcohol-dependent outpatients; the recruitment period was 7 years. The assessment of these patients was carried out by obtaining sociodemographic characteristics and using the Semi-structured Clinical Interview for Axis I and II (SCID-I and SCID-II), European version of the Addiction Severity Index (EuropASI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) scales. Variables were compared and analyzed. Results: The sample was composed of 178 patients (74.2% males and 25.8% females) with a mean age of 46.52 ± 9.86. No sociodemographic differences were found between men and women. Females had a higher rate of suicide attempts and depression symptoms at the treatment onset. When results of EuropASI were compared, females had worse psychological and employment results than males. According to consumption variables, males had an earlier onset of alcohol use, had more regular alcohol use, and develop alcohol dependence earlier than females. Conclusions: According to results, there are sex-dependent differences (severity and other variables such as mood or suicide) in alcohol dependence. Thus, this may implicate the need of future specific research and treatment programs based on the specific necessities of each sex.

Substance-induced psychotic symptoms in Borderline Personality Disorder among substance use disorder samples in Spain.

Substance-induced psychosis (SIP) is frequent in substance use disorder patients. However, little is known about the presence of SIP in Borderline Personality Disorder (BPD) and what the risk factors for the development of SIP in this population would be. A sample of 91 BPD drug-dependent patients attending an outpatient substance use disorder unit was evaluated. Comorbidity with Axis I and II was assessed using SCID-I and SCID-II. Psychoactive drug related variables were registered as well as the presence of the ninth criterion of DSM-IV-TR as a code of psychotic symptoms. A total of 50.5% of the sample were women. The most prevalent drug consumed was cocaine (67%) followed by cannabis (47.3%) and then alcohol (39.6%). A total of 62.8% people with BPD registered substance-induced psychosis symptoms in their lifetime. Notably, this study found these symptoms were not associated with the presence of psychotic symptoms registered in ninth criterion. Cocaine and cannabis consumption are associated with the presence of SIP in SUD-BPD patients. No other clinical variables were related in this sample. Further research studies are needed to find other risk factors for SIP in this patient group.

Anxiety and Depression in Drug-Dependent Patients with Cluster C Personality Disorders.

OBJECTIVE: Comorbidity between personality disorders (PD) and substance-use disorders (SUD) is one of the most common findings in the psychiatric field. The patients with Cluster C disorders present maladjustment traits often characterized by high levels of anxiety. The main aim of this study was to find evidences about higher anxiety and depression prevalence on Cluster C than others Clusters, analyzing similarities and differences within, with other Cluster A and B PD patients and patients without PD. METHOD: A total of 822 substance dependent patients (ages18-78; Mean = 38.35, SD = 10.14) completed the structured clinical interview for DSM-IV Axis I and Axis II disorders, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS: Results supported poly-consumption in Cluster C patients, being greater alcohol consumption as well as abuse of both stimulants and depressants. Anxiety and depression did not show just one pattern for all patients with SUD-Cluster C PD. There was a relation between anxiety and depression for all the groups except for the Dependent-PD. CONCLUSION: Interventions should focus on aspects like depression and anxiety more than on the substance consumed.

Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders.

Risks factors for suicide are multiple and highly prevalent in addicted patients (previous suicide attempts, substance abuse, impulsivity, history of sexual abuse and other factors). The aim of this study is to identify and to compare the clinical and socio-demographic profile of SUD outpatients with lifetime suicidal behavior (previous suicidal ideation and/or suicide attempts) and to analyze the factors related to it. A retrospective cohort study of 696 addicted patients, according to DSM-IV-TR criteria (APA, 2000) were collected from the Addiction Unit of Vall d'Hebron University Hospital. Lifetime suicidal ideation in addicted patients is associated with presence of: borderline personality disorder (BPD), depressive disorders, sexual abuse, polydrug abuse, attention-deficit hyperactivity disorder, and motor impulsivity. The factors associated with suicide attempts were: borderline personality disorder, lifetime abuse (whether emotional, physical or sexual), co-occurrent psychotic disorders, polydrug abuse, anxiety disorders and depressive symptoms. We conclude that previous suicidal ideation and lifetime suicide attempts should be considered in the clinical care of addicted patients. Factors related to both suicidal behaviors share similarities and differences according to our findings and need to be deeply explored in the future.

Alcohol use disorder and cognitive impairment in old age patients: A 6 months follow-up study in an outpatient unit in Barcelona.

There has been little research about deleterious effects, including cognitive impairment, related to hazardous long-term alcohol use in old adults. This study aims to assess cognitive decline in old patients with alcohol use disorder and changes in cognitive state at 6 months follow-up, achieving or not abstinence. A six-month follow-up study was conducted in an outpatient center in Barcelona on a sample of old adults (≥65 years old) who had hazardous alcohol use. The sample was compared with healthy volunteers adjusted for age, sex and years of education. A neuropsychological protocol was performed at baseline and after 6 months follow-up covering four cognitive domains: attention, visuospatial abilities, memory and executive functions. Several domains were significant impaired at baseline: visual immediate and delayed recall, working memory, immediate verbal learning, total words learned, set switching and sustained attention. At 6 months reassessment, alcohol abstinence was achieved in 93.5% of patients and it was detected a trend towards improvement in direct mean scores of all cognitive areas, although it was not significant. The current study points out a cognitive impairment in many areas secondary to alcohol long-term hazardous use in old adults. A trend towards cognitive improvement after recovery was detected in most patients.

Peripheral levels of BDNF and opiate-use disorder: literature review and update.

Several neurobiological factors are related to opiate-use disorder (OUD), and among them, neurotrophins have a relevant role. Brain-derived neurotrophic factor (BDNF) is a central neurotrophin involved in many neuronal processes, and it has been related to several psychiatric diseases and addictive disorders. BDNF can be measured in plasma and serum; its levels may reflect BDNF concentrations in the central nervous system (CNS) and, indirectly, CNS processes. Hence, peripheral BDNF could be a biomarker in clinical practice. This manuscript explores the findings about peripheral BDNF and OUD in humans. Opiates induce neurotoxicity in the CNS, which may be correlated with modifications in BDNF expression. Thus, basal levels of peripheral BDNF in OUD patients may be altered, which could be modified with abstinence. Also, opiates may modify epigenetic processes that may be associated with peripheral concentrations of BDNF, and in this line, withdrawal could reflect recovering processes in the CNS. Additionally, treatment modifies the peripheral concentrations of BDNF, but the clinical implications of those changes are yet not elucidated. No specific conclusion can be performed and more investigation in this area is necessary to elucidate the real potential of peripheral BDNF as a biomarker.

Psychiatric comorbidities in opioid-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study.

Opioid-dependent patients show a high rate of psychiatric comorbidities. The prevalence and characteristics of patients with dual diagnosis have not been well established in Spanish opioid agonist treatment (OAT) programmes. Thus, 621 opioid-dependent patients enrolled in OAT programmes were assessed, using the EuropASI questionnaire, for psychiatric comorbidities, which were detected in 67% of patients (anxiety 53%, mood disorders 48%, sleep disorders 41%, substance-related disorders 36%). In addition, compared with patients without a dual diagnosis, patients with dual pathology were significantly older, used benzodiazepines and cannabis in significantly greater percentages, and showed significantly more frequent infectious and non-infectious comorbidities, worse overall working status, a lower proportion of drivers and higher levels of severity regarding medical, employment, alcohol, legal, family and psychological issues. Therefore, the data showed a very high prevalence of psychiatric comorbidity in opioid-dependent patients receiving OAT in Spain and several problems frequently associated with patients with dual diagnosis. Physicians treating opioid-dependent patients should be aware of these facts to correctly identify and manage patients with a dual diagnosis.