Gender and addiction and other mental disorders comorbidity: sociodemographic, clinical, and treatment differences.

The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high, but the details are uncertain in Spain. The objective of the present study was to know the prevalence of this comorbidity, as well as the pharmacological treatment, both in specific addiction treatment networks and in mental health networks, with a gender perspective. Observational, multicenter study, with a randomized sample, of patients under treatment for SUD or OMD in Spain (N = 1783). A specific questionnaire, collecting sociodemographic and clinical variables, diagnosed SUD and OMD, and prescribed psychotropic drugs, was completed by treating clinicians. Differences between females and males were searched. A high prevalence of OMD was found in those patients treated for their SUD (71%), and also of diagnoses of SUD (59%) in people treated for OMD. Significant relationships between addiction to certain substances and specific mental disorders were found (with no main differences between women and men). The treatments for OMD were very common in the addiction treatment networks, but that of SUDs in those patients treated in the mental health networks was less than expected. A high prescription of benzodiazepines was found. Women were less frequently diagnosed with cannabis, opioid, and especially cocaine use disorders, and they had fewer psychotic disorders and more affective, anxiety, sleep, and eating disorders, with the rest being the same, including personality disorders. Women had fewer treatments with agonists and more with antagonists, and more prescriptions of anxiolytics and antidepressants. This study provides preliminary information on the coexistence in routine clinical practice of addictive disorders and other mental disorders in Spain, and on the treatment provided, and shows differences in prevalence and clinical characteristics, and especially in treatment approaches between women and men. Thus, should be useful to adapt the treatment response with greater precision, and with a gender perspective.

What's old is new again: updated findings on personality disorders and substance use disorders.

PURPOSE OF REVIEW: Personality disorders, mental disorders marked by long-term deviations from societal expectations that cause distress, and substance use and related disorders (SUDs), mental disorders marked by engaging with substances or behaviors that activate the brain's reward system to the point that normal activities are neglected, are common debilitating conditions. Personality disorders and SUDs are highly comorbid, potentially resistant to treatment, and their presence increases all-cause mortality, particularly when found together. RECENT FINDINGS: The present review highlights the most notable findings on prevalence, comorbidity, biological and behavioral pathways between the disorders, impact on incarcerated people and treatment for the disorders. SUMMARY: Personality disorders and SUDs are relatively common, highly comorbid, and increase the risk of all-cause mortality: particularly in those who have both conditions. Possible shared pathways between personality disorders and SUDs include emotional dysregulation, shared genes, and certain neurotransmitters. Personality disorders and SUDs are common in people who have been incarcerated, and this morbidity and comorbidity has been found throughout the world. Finally, comorbidity between personality disorders and SUDs greatly complicates treatment, with emerging treatment modalities such as mentalization-based treatment, schema modes, and attentional training showing potential, but lacking strong evidence of efficacy.

Factors Associated with Unplanned Early Discharges from a Dual Diagnosis Inpatient Detoxification Unit in Israel.

OBJECTIVES: Currently, Israel has a single governmental inpatient dual diagnosis detoxification unit. We provide a cross-section of patient profiles in this study as well as explore possible associations between clinical/demographic factors and the unplanned early discharge of patients from the unit, aiming at improving rehabilitation success rates. METHODS: In this retrospective study, medical records of all patients admitted to the unit between January 1, 2012, and July 1, 2013, were examined (N = 323). ICD-10 was used for diagnosis. Statistical analysis was carried out using Pearson's chi-squared test and binary logistic regression. RESULTS: Patients admitted to our unit were affected by schizophrenia (31.8%), personality disorder (25%), and depression (18.3%). Substances in use included alcohol (67.5%), cannabis (8.35%), and benzodiazepines (9%). Almost half of the patients were polysubstance users (48.9%). The unit had high rates of immigrants, mainly ex-USSR- and Ethiopian-born. It had low rates of individuals who had served in the army (52.8%), despite the service being mandatory in Israel. Sixty-eight percent of patients completed the program as planned, and 32% were discharged early: 8.6% discharged due to drug use in detoxification settings, violence, or hospitalization for clinical reasons and 23.2% discharged against medical advice. Immigrants had increased rates of completing the program as scheduled. Of the 46.7% of patients with severe mental illness, 44.3% were discharged early. Higher education and a diagnosis of depression were associated with program completion as planned. Using logistic regression, we found that patients with disability pensions (odds ratio [OR] = 0.36; 95% confidence interval [CI] [0.14-0.91]; p = .03) and polysubstance use (OR = 0.39; 95% [CI] [0.23, 0.66], p < .001) had a higher risk of early discharge. Upon completion of individual programs, 52% were referred to an ambulatory addiction center and 13% to a nationally sponsored dual diagnosis therapeutic community. CONCLUSIONS: Israel's single official dual diagnosis detox inpatient unit has satisfactory annual program completion rates when compared to similar institutions. A suboptimal treatment regimen may contribute to the early discharge of patients with polysubstance use and diagnosed personality disorders. An association between early discharges and a disability pension warrant further investigation, as there is no apparent connection between the two.

Personality disorders: patient characteristics and level of outpatient treatment service.

BACKGROUND: In this naturalistic study, patients with personality disorders (N = 388) treated at Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region of Denmark were allocated to two different kinds of treatment: a standardized treatment package with a preset number of treatment hours (basic hospital service) and 2: a specialized treatment program for the most severely affected patients without a predetermined restricted number of treatment hours and significantly more individual psychotherapy (regional specialized hospital services). AIMS: To investigate patient characteristics associated with clinicians' allocation of patients to the two different personality disorder services. METHODS: Patient characteristics across eight domains were collected in order to study whether there were systematic differences between patients allocated to the two different treatments. Patient characteristics included measures of symptom severity, personality pathology, trauma and socio-demographic characteristics. Significance testing and binary regression analysis were applied to identify important predictors. RESULTS: Patient characteristics on fifteen variables differed significantly, all in the expected direction, with patients in regional specialized hospital services showing more pathology and psychosocial problems. In the regression model, only age and two variables capturing psychosocial functioning remained significant predictors of allocation. DISCUSSION: The finding that younger age was the most significant predictor of longer treatment replicates an earlier finding of allocation to treatment for personality disorder. Overall, this study therefore lends further support to the importance of demographic and social contextual factors in clinicians' allocation of patients to different treatment services for personality disorder.

Pharmacotherapy for borderline patients: business as usual or by default?

In their analysis of a representative sample from the Prescribing Observatory for Mental Health in the UK health services, Paton et al found that 92% of patients with borderline personality disorder (BPD) received prescriptions for psychotropic medications. Although international guidelines recommend pharmacotherapy for comorbid psychiatric disorders whenever necessary, 82% of the UK BPD patients without such comorbid conditions nevertheless received pharmacotherapy "by default," mostly off-label polypharmacy without adequate psychiatric controls for effectiveness and tolerability. Business as usual? Bad care? International practice guidelines for the treatment of BPD all recommend evidence-based psychological treatment whenever possible (especially manualized psychotherapy like dialectical behavior therapy, schema-focused therapy, mentalization-based treatment, transference-focused psychotherapy) as the first-choice treatment.

Trastornos de la personalidad en adultos jóvenes dependientes del cannabis en tratamiento: un estudio comparativo / Personality disorders in young adult cannabis-dependent treatment seekers: a comparative study

En este artículo se determina la tasa de comorbilidad de trastornos de la personalidad en adultos jóvenes dependientes del cannabis en tratamiento. La muestra consta de 141 pacientes diagnosticados de dependencia del cannabis en el grupo experimental, de 140 pacientes no-adictos en el grupo clínico de control y de 140 sujetos, con las mismas características demográficas (edad, sexo y nivel socioeconómico), en el grupo normativo de control. Los instrumentos de evaluación para los trastornos de la personalidad son el MCMI-II y el IPDE y la entrevista con los criterios diagnósticos del DSM-IV-TR. Sólo se considera trastorno de personalidad cuando un sujeto puntúa positivo en ambas pruebas y el trastorno es coincidente. Los resultados muestran que el 32,8% de los pacientes del grupo experimental presentan trastornos de la personalidad, frente al 23,7% del grupo clínico de control y el 10% del grupo normativo de control. Los trastornos de mayor prevalencia para el grupo experimental son el trastorno narcisista (11,3%), seguido del antisocial (9,9%) y el esquizotípico (9,9%). Se comentan las líneas futuras de investigación para este tema (AU)

n this paper the most frequent personality disorders related to young adult cannabis-dependent treatment seekers are described. A sample of 141 cannabis-dependent patients was compared to 140 clinical patients with non-addictive disorders and to 140 normative subjects from the general population with the same demographic features (age, sex and socioeconomic level) to find out the prevalence of personality disorders. All subjects were assessed with the IPDE and the MCMI-II (for personality disorders) and with an interview for DSM-IV-R. According to the results, 32.8% of the clinical sample of cannabis-dependent patients and 23.7% of the general clinical sample (versus 10% of the normative sample) showed at least one personality disorder. The most prevalent ones were the narcissistic personality disorder (11.3%), followed by the antisocial and schizotypal personality disorder (9.9% each). Finally, implications of this study for clinical practice and future research in this field are discussed

Substance use disorders among personality disordered patients admitted for day hospital treatment. Implications for service developments.

Personality disorders (PD) and substance use disorders (SUD) are highly comorbid conditions. However, their treatment services are often separated. The aims of this study was to investigate how extensive this separation was prior to a Norwegian health reform (2004) that promoted integration, and to discuss clinical challenges for an integrated treatment of PD and SUD. All patients with a diagnosis of PD (n=1783) admitted to 10 day hospital treatment programs (1993-2003) were examined. Diagnoses were assessed by Mini International Neuropsychiatric Interview and Structured Clinical Interview for DSM-IV interviews. Socio-demographic data, psychosocial functioning (Global Assessment of Functioning Scale), symptom distress (Symptom Check List-90-Revised), interpersonal problems (Circumplex of Interpersonal Problems) and treatment course were recorded. The majority of patients were females (72%) and the prevalence of SUD was low (14%). SUD occurred among all PD categories. Patients with borderline PD were over-represented and patients with cluster C disorders were under-represented in the SUD sample. The SUD sample contained more men and it was associated with more previous violence against self and others. The reported violence was partly explained by gender (males) and diagnoses (borderline and SUD). PD patients with SUD also displayed more aggression during treatment and dropped out more frequently. The findings demonstrate that the female dominated specialized psychiatric treatment services for PD to a large extent had excluded PD patients who also had SUD. The reasons are probably related to the surplus problems that characterized the SUD sample and gender issues. Implications for the development of the PD and SUD services with respect to an integrated treatment for these comorbid conditions are discussed.

[Dropout behavior in inpatient psychosomatic rehabilitation: how and when do inpatients terminate psychotherapy?]. / Behandlungsabbrüche in der stationären psychosomatischen Rehabilitation: Auf welche Art und wann beenden Patienten vorzeitig eine stationäre Psychotherapie?

UNLABELLED: Despite its clinical and health economic importance, only few studies have analyzed the problem of dropout behavior from treatment in psychosomatic medicine and psychotherapy. For quality-assurance purposes and in light of limited resources in our medical system, it is important to identify future dropouts and to intervene appropriately during ongoing inpatient treatment. In a representative sample taken from inpatient psychosomatic rehabilitation, we evaluated the prevalence of dropout behavior as well as characteristics of patients who drop out compared to patients who complete the treatment regularly. OBJECTIVES: Data of 2059 inpatients from the Psychosomatic Hospital Bad Neustadt/Saale were analyzed as to rates and dates of dropout and other patient characteristics. RESULTS: Overall 15.7 % of the patients dropped out of inpatient psychosomatic rehabilitation after a mean treatment duration of 28 days. Patients who dropped out tended to be younger, reported less distress, were less motivated, and had been diagnosed less often with an affective disorder as main diagnosis. Compared with patients who completed therapy regularly, they also profited less from both self- as well as external assessment of symptom change. It was shown that it is useful to differentiate the method and time of dropout. CONCLUSIONS: A differentiation of dropout characteristics is important for developing interventions to reduce dropout rates.

Concordancia en el diagnóstico entre atención primaria y salud mental / Diagnostic concordance between primary care and mental health

Objetivo. Analizar el índice de concordancia diagnóstica entre atención primaria y salud mental. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Centro de Salud Mental de Estella (Navarra). Participantes. Inclusión de pacientes adultos nuevos consecutivos remitidos a salud mental (n = 1.005) entre julio de 2002 y marzo de 2005. Mediciones principales. Análisis de los diagnósticos realizados en atención primaria y salud mental en el período de tiempo establecido. Cálculo del índice kappa de concordancia interjueces. Resultados. La concordancia global diagnóstica tiene un índice kappa = 0,385 (± 0,018). En los trastornos por uso de alcohol y otras sustancias y los trastornos psicóticos se obtienen índices de concordancia elevados (kappa > 0,7). Los trastornos de la alimentación y el trastorno mental orgánico reflejan una concordancia moderada (índice kappa entre 0,4 y 0,7). Sin embargo, en los trastornos de ansiedad, adaptativos y afectivos se obtiene una concordancia baja (kappa < 0,3). Conclusiones. En general, la concordancia entre los diagnósticos realizados en atención primaria y salud mental es baja. En concreto, destaca la dificultad para identificar adecuadamente los trastornos adaptativos, y se observa una importante tendencia por parte de atención primaria a filiar como cuadros ansiosos o afectivos estos trastornos

Objective. To analyse the diagnostic concordance index between primary care and mental health. Design. Retrospective and descriptive study. Setting. Mental health centre, Estella, Navarra, Spain. Participants. New consecutive adults patients referred to mental health (n=1005) from july 2002 to march 2005. Main Measurements. Analysis of diagnoses made in primary care and mental health during the time period. Calculation of kappa index for inter-observer concordance. Results. General diagnostic concordance had a kappa index =0.385 (±0.018). High concordance index (>0.7) was obtained for alcohol and other substance use disorders and psychotic disorders. Moderate concordance index (0.4-0.7) was obtained for eating disorders and organic mental disorders. However, low concordance index (<0.3) was obtained for anxiety, adaptative, and affective disorders. Conclusions. In general, diagnostic concordance between primary care and mental health is weak. Particularly noticeable was difficulty in identifying adaptative disorders adequately. There was a strong tendency in primary care to identify these disorders as anxiety or affective disorders

Metacognitive interpersonal therapy in a case of obsessive-compulsive and avoidant personality disorders.

Metacognitive interpersonal therapy (MIT) for personality disorders is aimed at both improving metacognition--the ability to understand mental statesand modulating problematic interpersonal representations while building new and adaptive ones. Attention to the therapeutic relationship is basic in MIT. Clinicians recognize any dysfunctional relationships with patients and work to achieve attunement to make the latter aware of their problematic interpersonal patterns. The authors illustrate here the case of a man suffering from obsessive-compulsive and avoidant personality disorders with dependent traits. He underwent combined individual and group therapies to (a) modulate his perfectionism, (b) prevent shifts towards avoiding responsibilities to protect himself from feared negative judgments, and (c) help him acknowledge suppressed desires. We show how treatment focused on the various dysfunctional personality aspects.

Generalized social phobia and avoidant personality disorder: meaningful distinction or useless duplication?

Participants with generalized social phobia (GSP) with (n=36) and without (n=19) avoidant personality disorder (AVPD) were compared via contrasts of group means and classification analysis on purported core features of AVPD. GSP-AVPD participants proved to be more severely impaired or distressed on some group contrasts. Cluster analysis identified two groups in the sample, with group membership significantly correlated to AVPD diagnosis. However, almost all significant findings were nullified when severity of social phobia was statistically controlled. Thus, at least where participants with social phobia are concerned, it seems most parsimonious to consider AVPD a severe form of GSP rather than a separate diagnostic category.

Psychopharmacologic management of suicidality in personality disorders.

OBJECTIVE: To review the evidence for the efficacy of pharmacotherapy and other biological treatments in suicidality associated with personality disorders, chiefly borderline personality disorder. METHOD: Systematic review of the literature. RESULTS: Studies evaluating treatment of suicidality in personality disorders are absent. However, several studies examine the efficacy of pharmacotherapy for core symptom clusters that are closely associated with suicidal behaviour. Efficacy exists with transient psychotic episodes, flashbacks and dissociations, affective dysregulation, impulsivity, and anger and hostility. CONCLUSIONS: Modest efficacy of pharmacologic treatments adjuvant to psychosocial treatments can be shown for clusters of symptoms related to borderline personality disorder.

[Impact of personality on the alcohol withdrawal syndrome intensity: a preliminary study with the Cloninger's model]. / Impact de la personnalité sur l'intensité du syndrome de sevrage alcoolique: une étude préliminaire avec le modèle de Cloninger.

INTRODUCTION: The personality of alcohol dependant patients as a factor influencing the intensity of the alcohol withdrawal syndrome has been seldom examined. Cloninger's biosocial model of personality describes four temperaments (novelty seeking, harm avoidance, reward dependence, persistence) which, except for persistence, are admittedly linked to specific central neurotransmitters, and three characters. Novelty seeking is linked with low levels of mesencephalic dopamine, harm avoidance with high levels of serotonin in the septo-hippocampic system and reward dependence with low levels of noradrenaline in the ascending pathways from the locus coeruleus to the limbic system. The same neurotransmitters pathways are known to be involved in alcohol withdrawal, with a decrease of dopaminergic activity in the mesolimbic system, a decrease of serotonergic activity in the nucleus accumbens and an increase of the noradrenergic system. In view of the similarities between the neurobiological systems involved in Cloninger's model and in the neurobiological changes occurring during the withdrawal period, one would expect to observe severe withdrawal symptoms more frequently for patients with high novelty seeking, low harm avoidance and low reward dependence. METHODS: To test this hypothesis, alcohol dependent patients according to DSM IV classification criteria who have drunk in the last twenty four hours were included in the study and received a standardized withdrawal treatment. The withdrawal syndrome intensity was examined with repeated measures of CIWA-Ar, the scores of which were correlated with TCI-R. RESULTS: Twenty eight patients, between 30 et 65 years old and drinking 22,2 +/- 12 standard drinks per day were included. Antidepressant drugs, benzodiazepines and neuroleptics treatment introduced before hospitalisation were stopped or decreased as much as possible. A correlation matrix was carried out between all the variables which could influence withdrawal intensity (age at the hospitalisation, age at the begining of the dependance, ratio between the time of the dependance and the patients' age, the number of alcohol withdrawals carried out and the number of standard drinks per day), and showed a positive correlation between the number of standard drinks per day and withdrawal intensity at day 3 (r=0.7, p<0.000), at day 4 (r=0.52, p<0.005), at day 7 (r=0.41, p<0.036) and at day 8 (r=0.44, p<0.02); as between the ratio between the time of the dependance and the patients' age and withdrawal intensity at day 2 (r=0.43, p<0.03) and at day 5 (r=0.5, p<0.01). Therefore, partial correlations were calculated between the dimensions of personality and withdrawal intensity. The study showed a positive correlation between withdrawal intensity and harm avoidance from day 5 onwards (r=0.6 and P<0.003 at day 5, r=0.59 and P<0.004 at day 6, r=0.56 and P<0.006 at day 7, r=0.66 and P<0.001 at day 8), a negative correlation between withdrawal intensity and reward dependence at day 7 and 8 (r=- 0.45 and P<0.037 at day 7, r=- 0.49 and P<0.02 at day 8) and a negative correlation between withdrawal intensity and persistence from day 6 onwards (r=- 0.5 and P<0.017 at day 6, r=- 0.5 and P<0.019 at day 7, r=- 0.51 and P<0.014 at day 8). No correlation was found between withdrawal intensity and novelty seeking. The same relevant results were found again with the 22 patients without anti-depressant drugs' population. DISCUSSION: Personality dimensions seem to influence alcohol withdrawal intensity once the severe symptomatology is over, while high doses of anti withdrawal treatment in the first days of abstinence may decrease the influence of personality on withdrawal symptoms. The positive correlation between harm avoidance and withdrawal intensity seems to invalidate our neurobiological hypotheses, but can be explained by clinical observations and corroborate studies assessing the influence of personality in benzodiazepine withdrawal intensity and in pain perception. This result encourages the introduction of support therapy during withdrawal and a cognitive-behavioural therapy before withdrawal in order to decrease patients' sensitivity to anxiety. The negative correlation between reward dependence and withdrawal intensity confirms the neurobiological hypotheses, but the weak correlation demands to be cautious in the interpretation of the results. The negative correlation between persistence and withdrawal intensity was expected. CONCLUSION: The characteristics associated with persistence seem to act as protective factors during alcohol withdrawal, whereas those associated with harm avoidance appear to increase the symptoms of alcohol withdrawal. In contrast, the neurobiological hypotheses are only partially confirmed.

Do comorbid personality disorders moderate panic-focused psychotherapy? An exploratory examination of the American Psychiatric Association practice guideline.

OBJECTIVE: The American Psychiatric Association (APA) practice guideline for panic disorder recommends psychodynamic psychotherapy for panic disorder patients with comorbid personality disorders. No data underlie this recommendation. This exploratory study assessed the moderating effect of personality disorder on psychodynamic and non-psychodynamic psychotherapy outcome. METHOD: Forty-nine subjects with primary DSM-IV panic disorder were randomly assigned to 12 weeks of twice-weekly Panic-Focused Psychodynamic Psychotherapy or Applied Relaxation Training. The primary outcome measure was the Panic Disorder Severity Scale; the moderating effect of Axis II psychopathology on the Sheehan Disability Scale was also tested. The trial was conducted between February 2000 and January 2005. RESULTS: Twenty-four subjects (49%) met DSM-IV criteria for a Structured Clinical Interview for DSM-IV Axis II Disorders-diagnosed personality disorder, of whom 19 (79%) had a cluster C diagnosis. Presence of a cluster C diagnosis moderated treatment outcome. Such subjects experienced greater improvements in Panic-Focused Psychodynamic Psychotherapy than subjects without cluster C comorbidity. CONCLUSIONS: Despite its small sample size, this exploratory analysis provides initial preliminary evidence corroborating the APA practice guideline recommendation. Future panic disorder clinical trials should explore Axis II moderator effects. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier NCT00128388.

Psychopathology among cannabis-dependent treatment seekers and association with later substance abuse treatment.

We determined the proportion of psychiatric treatments for disorders not due to substance use among a cohort of subjects (n = 3,114) seeking treatment for cannabis dependence. Data were retrieved from Danish treatment registers. Cases were compared with a representative sample, which was randomly selected from the general population according to age and gender (n = 15,570). Cannabis users were followed, and reentry into substance abuse treatment was used as an outcome deploying Cox regression analysis. The proportion of treatment for all psychiatric disorders was much higher among cases than among controls: schizophrenia (odds ratio [OR] = 7.9; 95% confidence interval [95% CI] = 6.1-10.2), bipolar disorders (OR = 4.9; 95% CI = 2.8-8.5), other affective disorders (OR = 7.6; 95% CI = 6.1-9.5), and personality disorders (OR = 17.3; 95% CI = 14.5-20.5). All in all, 40.7% of cases, compared with 5.2% of controls, had received psychiatric treatment (OR = 12.5; 95% CI = 11.3-13.8). A history of psychiatric treatment was associated with increased rates of reentry into substance abuse treatment, in general (OR = 1.35; 95% CI = 1.20-1.53), specifically for cannabis (OR = 1.26; 95% CI = 1.07-1.48) and opioid (OR = 1.56; 95% CI = 1.23-1.99) dependence. This is the first study to show that the proportion of psychiatric treatment is much elevated among subjects seeking treatment for cannabis dependence, and that a history of psychiatric problems is associated with higher rates of reentry into substance abuse treatment.

Eating attitudes, body esteem, perfectionism and anxiety of judo athletes and nonathletes.

The aim of the study was to examine the prevalence and relationships between disordered eating, menstrual irregularity, musculoskeletal injuries and psychological characteristics in 24 judo athletes (12 females and 12 males) and 31 controls (14 females and 17 males). All these parameters were assessed by a health/medical, dieting and menstrual history questionnaire, the Eating Attitudes Test (EAT-26), the Multidimensional perfectionism scale, the Rosenberg Self-esteem, the Body esteem scale, and the Profile of Mood States. Body mass index (BMI) was also computed. Twenty-five percent of female athletes would be "at risk" of EDs (EAT-26 > 20) and 0 % in the other sample groups. Bone injuries sustained over the judo athlete career were reported by 25 % of females and 33.3 % of males, while 35.7 % of the female controls reported bone injuries. The total frequency of menstrual dysfunction among judo athletes was 58.3 %, while 7.1 % of female controls reported oligoamenorrhea. Regression analyses showed that BE-Weight Satisfaction and BMI contributed to 54.6 % and 17 % of the variance, respectively, in the prediction of log-transformed Global EAT scores among female judo athletes. These data indicate that while the prevalence of clinical eating disorders is low in judo athletes, many are "at risk" for an eating disorder, which places them at an increased risk for menstrual irregularity and bone injuries. This study also highlights the relevance of body esteem to eating disorder symptoms.

Validación del Cuestionario de Variables de Interacción Psicosocial (VIP): hacia un modelo de tratamiento de las conductas adictivas «guiado por la personalidad» / Validation of the Psychosocial Interaction Variables Questionnaire: towards a «personality guided therapy» model of addiction treatment

Objetivo: La personalidad puede estudiarse a 3 niveles: el clínico (trastornos), el de rasgos y el nivel de variables interaccionales. Hay instrumentos válidos para la medida de los 2 primeros, pero no disponemos de alguno que explore de forma conjunta el nivel interaccional. Proponemos un modelo de tratamiento de las conductas adictivas «guiado por la personalidad» en la línea propuesta por Millon para los trastornos del eje II, que se basa en la función que cumple la droga con relación al patrón de personalidad general. El objetivo del estudio ha sido diseñar y validar un cuestionario que explore de forma adecuada y sencilla un cierto número de variables de interacción psicosocial en los individuos que realizan tratamiento por abuso o dependencia de sustancias. Escogemos como variables: autoestima, autoeficacia general, optimismo, locus de control, habilidades sociales, autocontrol y estilos de afrontamiento del estrés. Material y métodos: Se describe el proceso de creación del Cuestionario de Variables de Interacción Psicosocial (VIP), hasta alcanzar su forma definitiva, con 84 ítems. Se validó sobre una muestra de 776 sujetos, 569 en tratamiento por abuso/dependencia de heroína, cocaína, alcohol, cannabis, benzodiazepinas y ludopatía, y 197 sujetos de población general. Resultados: Todos los participantes cumplimentan el VIP y diversos cuestionarios complementarios para el estudio de validez. La consistencia interna global es de 0,93 y la de las escalas que lo componen se sitúa entre 0,82 y 0,91, salvo las de afrontamiento centrado en la búsqueda de apoyo social (5 ítems), 0,78, y la de locus de control (3 ítems), 0,65. La consistencia temporal de las escalas (entre 4 y 6 semanas) es de 0,92 para población general y de 0,80 para sujetos sometidos a tratamiento. Se estudia la validez aparente, de contenido, de constructo, convergente y discriminante, que resultan adecuadas. Las escalas del VIP predicen una media del 45% de la varianza de los síndromes clínicos del eje I y el 33% de los patrones de personalidad patológica (alcanzando más del 50% en 5 de ellos) estimados mediante el MCMI-II. Conclusiones: Consideramos que el VIP es un instrumento de utilidad para el estudio de las variables nucleares de la personalidad, que permite la comprensión del valor funcional de la conducta adictiva con relación al patrón general de comportamiento de los sujetos, y puede facilitar el diseño y evaluación de los tratamientos específicos, aunque se puede aplicar en otros ámbitos

Objective: The personality can be studied at three levels: clinical (disorders), traits and the level of interactive variables. There are valid instruments for the measurement of both first, but we do not have any that explores in a combined way the interactional level. We propose a model of «personality guided treatment» for the addictive behaviours in the direction of the one proposed by Millon for axis II disorders, based on function of drug in relation to its personality pattern. The aim of the study is to design and validation of a questionnaire that explores in a suitable and simple way a certain number of psycho-social interaction variables in the individuals that are in treatment by abuse/dependency of substances and gambling. We choose as variables: self-esteem, general self-efficacy, optimism, locus of control, social abilities, self-control and coping styles. Material and methods: It is described the creation process of the Questionnaire of Variables of Psycho-social Interaction (VIP), until reaching its definitive form, with 84 items. We validate on a sample of 776 subjects, 569 in treatment by abuse/dependency of heroin, cocaine, alcohol, cannabis, benzodiazepines and compulsive gambling; and 197 subjects of general population. Results: All participants compliment the VIP and diverse complementary questionnaires for the validity study. The global internal consistency is 0.93 and the one of the scales that compose it locates between 0.82 and 0.91, except for those of coping oriented to search of social support (5 items), 0.78; and the one of locus of control (3 items), 0.65. The temporary consistency of the scales (between 4 and 6 weeks) is 0.92 for general population and 0.80 for subjects in treatment. The apparent, content, convergent and discriminative and construct validity studies, are suitables. The scales of the VIP predict an average of 45% of the variance of the clinical syndromes of axis I, and 33% of pathological personality patterns (reaching more of 50% in 5 of them) considered by means of the MCMI-II. Conclusions: We considered that the VIP is an instrument of utility for the core personality variables study, that allows the understanding of functional value of the addictive behaviours in relation to the persons general behaviour pattern, and can facilitate the design and evaluation of the specific treatments, although can be applied in other scopes

Assessment of mindfulness by self-report: the Kentucky inventory of mindfulness skills.

A self-report inventory for the assessment of mindfulness skills was developed, and its psychometric characteristics and relationships with other constructs were examined. Participants included three samples of undergraduate students and a sample of outpatients with borderline personality disorder Based on discussions of mindfulness in the current literature, four mindfulness skills were specified: observing, describing, acting with awareness, and accepting without judgment. Scales designed to measure each skill were developed and evaluated. Results showed good internal consistency and test-retest reliability and a clear factor structure. Most expected relationships with other constructs were significant. Findings suggest that mindfulness skills are differentially related to aspects of personality and mental health, including neuroticism, psychological symptoms, emotional intelligence, alexithymia, experiential avoidance, dissociation, and absorption.

Essential fatty acids and their role in the treatment of impulsivity disorders.

Essential fatty acids (EFAs) have been shown to benefit patients with depression, schizophrenia and dementia. More recently, their role in disorders characterised by impulsivity has attracted some attention. The psychiatric conditions of attention-deficit hyperactivity disorder and borderline personality disorder as well as the phenomena of deliberate self-harm and violence have been ameliorated by the supplementation of EFAs in a number of recent clinical trials. This paper summarises the burgeoning clinical and basic research indicating the existence of significant deficits of EFAs in impulsivity disorders and the supplementation studies of EFAs in these diverse conditions, all of which remain a major therapeutic challenge.

Prevalencia e intensidad de trastornos de personalidad en adictos a sustancias en tratamiento en un centro de atención a las drogodependencias / Prevalence and severity of personality disorders in substance abuse outpatient treatment program

Objetivo: Evaluar la presencia y gravedad de los trastornos de la personalidad en sujetos que realizan tratamiento por abuso o dependencia de sustancias en un dispositivo ambulatorio especializado. Material y métodos: Estudio transversal sobre 150 sujetos, consumidores de heroína (N = 71), cocaína (N = 36), alcohol (N = 37) y Cannabis (N = 6), de los que se excluye a 9 por no cumplir los criterios de validez del cuestionario. Todos ellos cumplimentaron voluntariamente el MCMI-II de Millon y se atiende a la Entrevista de Valoración Inicial y a la historia clínica para obtener las variables sexo, edad actual, edad de inicio en el consumo, tiempo de consumo y momento de tratamiento en que se encuentran. Sobre las puntuaciones directas del test se realizan todas las correcciones propuestas por el autor hasta obtener las puntuaciones de tasa base. Resultados: El 83 por ciento de los sujetos presentan puntuaciones criterio para la estimación de presencia de algún trastorno de la personalidad, siendo el más frecuente entre los varones el pasivo/agresivo y entre las mujeres el dependiente. Los tres trastornos graves están poco representados siendo sólo significativo entre los consumidores de cocaína (31,3 por ciento), en especial en aquéllos que inician tratamiento (40 por ciento). No se confirman las tasas de prevalencia obtenidas por otros métodos propios del enfoque categorial en trastornos como el antisocial, que no alcanza el 32 por ciento en nuestra muestra. Se aprecian diferencias, especialmente en cuanto a la gravedad, entre los sujetos que inician tratamiento y quienes ya se encuentran en fases avanzadas del mismo. También se aprecian diferencias en relación a los subgrupos según la droga que motiva la demanda de tratamiento, siendo especialmente significativa la presencia de trastornos agresivos en los consumidores de cocaína, con una importante gravedad. Discusión: Se comentan algunas debilidades apreciadas en la estructura del MCMI-II que proporcionan resultados discrepantes con la teoría sobre la que se sustentan, como la existencia de criterios para la estimación simultánea de trastornos teóricamente incompatibles como el esquizoide y el histriónico. Estudiamos las posibles causas de los diferentes resultados cuando se utilizan entrevistas adscritas al método categorial (p. ej., SCID-II) e instrumentos referidos al modelo dimensional, como puede ser la atención de los primeros a conductas observables mientras los segundos centran su atención en rasgos patológicos de personalidad. Se formulan hipótesis explicativas de las diferencias observadas en relación a la droga consumida y al momento de tratamiento (AU)