Self-reported increase in alcohol and drugs intake as a coping strategy in hospital workers during COVID-19 outbreak: A cross-sectional study. / Incremento de la ingesta de alcohol y drogas como estrategia de afrontamiento en trabajadores hospitalarios durante el brote de COVID-19: Estudio transversal.

Situations of psychological stress, such as the current COVID-19 pandemic, could lead to an increase in the consumption of alcohol and other drugs of abuse as an inadequate coping strategy in health workers. This study aimed to investigate the intake of alcohol and drugs of abuse in hospital workers during the first wave of COVID-19. A further focus was to define the worker profile most vulnerable to this behavior through a logistic regression analysis. A cross-sectional study in a tertiary hospital in Madrid, Spain, during the first wave of COVID-19 was designed. Information was collected from a sample (n = 657) of healthcare workers (n = 536) and non-healthcare workers (n = 121). An online survey (including questions about basic health habits, working environment conditions, sociodemographic data, and the 12-item version of the General Health Questionnaire as a measure of psychological well-being) was conducted. Increased consumption of alcohol and/or drugs of abuse during the analyzed period of the pandemic was reported by 17.1% of workers. The following variables were associated with a higher probability of increased consumption of alcohol and/or drugs of abuse: male gender (p = .044), living alone or without dependents (p = .005), staff physician or resident (p = .010), having worked on the COVID frontline (p = .058), poor nutritional habits (p = .004) and self-prescription of psychotropic drugs to manage anxiety and insomnia (p = .003). A significant percentage of hospital workers increased their consumption of alcohol and drugs of abuse during the first wave of the COVID-19 pandemic. A professional risk profile can be defined for this practice.

Las situaciones de estrés psicológico, como la actual pandemia COVID-19, pueden implicar un aumento del consumo de alcohol y otras drogas de abuso como estrategia inadecuada de afrontamiento en profesionales sanitarios. Esta investigación tiene como objetivo estudiar el incremento de la ingesta de alcohol y drogas de abuso en los trabajadores hospitalarios. Persigue también, mediante un análisis de regresión logística, definir qué perfil de trabajador es el más vulnerable a este comportamiento. Para ello se realizó un estudio transversal en un hospital terciario en Madrid, España, durante la primera oleada de COVID-19. Participaron en el estudio un total de 657 trabajadores del hospital, 536 de ellos sanitarios y 121 no sanitarios. La recogida de datos se realizó a través de una encuesta en línea que incluía preguntas sobre hábitos básicos de salud, condiciones del entorno laboral, datos sociodemográficos, así como la versión de 12 ítems del Cuestionario de Salud General. El 17,1% declaró haber aumentado su consumo de alcohol y/o drogas de abuso durante el período analizado. Se asoció a una mayor probabilidad de dicho incremento: sexo masculino (p = ,044), vivir sin personas dependientes a cargo (p = ,005), ser médico adjunto o residente (p = ,010), haber trabajado en primera línea de COVID (p = ,058), presentar malos hábitos nutricionales (p = ,004) y realizar autoprescripción de fármacos psicotrópicos para controlar la ansiedad y el insomnio (p = ,003). Un porcentaje significativo de los trabajadores hospitalarios ha aumentado su consumo de alcohol y drogas de abuso durante la primera oleada de la pandemia COVID-19, existiendo un perfil de mayor riesgo para esta práctica.

Antiretroviral treatment adherence and mental disorders: observational case-control study in people living with HIV in Spain.

Mental disorders hamper immunological control of HIV infection by exerting a negative influence on antiretroviral therapy (ART) adherence. We sought to address the possible relationship between non-adherence to antiretroviral treatment (ART), mental disorders and substance use in people living with HIV/AIDS (PLWHA) in Spain, which presents a high prevalence of intravenously transmitted HIV infection. We assessed 125 PLWHA attending regular outpatient follow-up. The main adherence measure was pill collection from the Hospital Pharmacy. We included sociodemographic variables, mental disorders diagnosis, and substance use in the 12 months prior to the assessment. Harmful alcohol consumption (OR: 6.834; 95% CI: 2.008-23.257; p = 0.002), suffering from depression (OR: 5.851; 95% CI: 1.470-23.283; p = 0.012) and being at risk of suicide (OR: 3.495; 95% CI: 1.136-10.757; p = 0.029) increased the likelihood of non-adherence. 29.6% of the sample had been infected via blood contact. HCV co-infection was present in 46.4% of the study sample, increasing the likelihood of non-adherence (OR: 3.223; 95% CI: 1.119-9.286; p = 0.030). Harmful alcohol use and some serious mental disorders (especially depression and suicide risk) are consistently associated with non-adherence to ART. HCV co-infection could be an important risk marker of non-adherence among PLWHA with a high prevalence of intravenous drug use.

Psychological Impact of COVID-19 Pandemic and Related Variables: A Cross-Sectional Study in a Sample of Workers in a Spanish Tertiary Hospital.

Introduction: We intend to objectify the psychological impact of the COVID-19 pandemic on the workers of a tertiary hospital. Methods: All the workers were invited to an online survey. In total, 657 workers were recruited, including 536 healthcare workers (HCWs) and 121 non-healthcare workers (nHCWs). General Health Questionnaire-12 items (GHQ-12) was used as a screening tool. Sociodemographic data, working environmental conditions, and health behaviors were also analyzed. Results: inadequate sleep, poor nutritional and social interaction habits, misuse of psychotropics, female gender, COVID-19 clinical diagnosis, and losing a relative by COVID-19 were variables associated with higher probability of GHQ-12 positive screening. Significant differences between "frontline workers" and the rest were not found, nor was higher the probability of psychological distress in healthcare workers compared to non-healthcare workers. After 3 months from the peak of the pandemic, 63.6% of participants screening positive in GHQ-12 reported remaining "the same or worse." Limitations: Causal inferences cannot be established. Retrieval and selection biases must be considered as the survey was not conducted during the peak of the outbreak. Conclusions: psychological impact of COVID-19 has been broad, heavy, and persistent in our institution. Proper assessment and treatment must be offered to all hospital workers.

Personality and adherence to antiretroviral therapy in HIV-infected adult patients.

OBJECTIVE: Antiretroviral therapy (ART) has been able to transform HIV infection into a chronic disease. However, ART adherence remains an important barrier and personality traits have been postulated as a factor to be considered. This study aims to identify personality traits that can affect ART adherence, taking into account other potentially influencing factors. METHODS: Case-control study. Controls and cases were classified using the percentage ART dispensation as recorded in the Hospital Pharmacy database. Controls were defined as people living with HIV/AIDS (PLWHA) with percentage ART dispensation during the last year >95% and cases were defined as PLWHA with percentage ART dispensation during the last year <90%. Sociodemographic, clinical parameters of HIV infection, psychopathological and neuropsychological factors were collected. Personality was assessed using the NEO PI-R Personality Inventory, questionnaire based on the Five Factor Model of Personality. Statistical analysis was performed using logistic regression (SPSS v.22). RESULTS: 125 PLWHA were included: 79 controls and 46 cases. After adjusting for confounding variables, logistic regression analysis showed that poor adherence was associated with Neuroticism (OR 1.2, 95%CI: 1.021-1.385) and Impulsivity (N5) (OR 1.5, 95%CI: 1.066-2.163). In contrast, each additional point in Order (C2) (OR 0.8, 95%CI: 0.679-0.992) or Values (O6) (OR 0.8, 95%CI: 0.710-0.974) were associated with good ART adherence. CONCLUSIONS: Personality is a variable to be considered in ART adherence. Implementation of the personality in the assessment of PLWHA helps identify those individuals potentially more likely to exhibit poorer ART adherence.

Influence of substance use and cognitive impairment on adherence to antiretroviral therapy in HIV+ patients. / Influencia del consumo de sustancias y el deterioro cognitivo en la adherencia al tratamiento antirretroviral en pacientes VIH.

Strict adherence to antiretroviral treatment (ART) is needed to ensure the effectiveness of HIV treatment. The adverse effects of substance abuse and neurocognitive impairment on medication adherence have both been suggested by several studies. Therefore, the aim of this research is to study the relationship among adherence to ART, cognitive dysfunction, and abuse of certain substances (alcohol, heroin, cocaine, other stimulants, cannabis and benzodiazepines) and/or methadone treatment in our social environment. We performed an observational case-control study with a sample of 125 HIV+ patients, who were classified as patients with poor adherence (cases) and subjects with adequate compliance (controls). Adherence was defined by the Hospital Pharmacy and verified with the Simplified Medication Adherence Questionnaire (SMAQ) and the reference physician's clinical impression. Cognitive functioning was measured with the Zoo Map Test and Trail Making Test (TMT). Substance abuse was collected through a semi-structured clinical interview protocol. Statistical analysis was made using a binary logistic regression model. The results indicate that both alcohol abuse and neurocognitive impairment measured by Zoo Map Test were significantly associated with poorer adherence to ART. No significant association was found between adherence and other substance use, or between adherence and TMT score. Screening of cognitive impairment measured by the Zoo Map Test and alcohol abuse may lead to the development of strategies to improve de adherence to ART in HIV+ patients.

La adherencia estricta al tratamiento antirretroviral (TAR) es imprescindible para que este sea eficaz en la disminución de la morbimortalidad asociada al VIH. Se ha sugerido que el consumo de sustancias y el deterioro cognitivo constituyen factores de riesgo para una mala adherencia. En este sentido, el objetivo de este estudio es evaluar cuál es la influencia sobre la adherencia al TAR de la disfunción cognitiva, así como del consumo de determinadas sustancias (alcohol, heroína, cocaína, otros estimulantes, cannabis y benzodizepinas) y/o el tratamiento con metadona, en el marco concreto de una población española de referencia. Se realizó un estudio observacional tipo casos y controles con una muestra de 125 pacientes VIH+, que se dividieron en sujetos malos adherentes (casos) y buenos adherentes al TAR (controles). La adherencia se evaluó mediante el reporte de Farmacia Hospitalaria, contrastada con la escala Simplified Medication Adherence Questionnaire (SMAQ) y la opinión del profesional médico de referencia. La función cognitiva fue evaluada con el Test del Mapa del Zoo y el Trail Making Test (TMT), y el consumo de sustancias, mediante un protocolo de historia clínica semi-estructurada. El análisis estadístico se realizó mediante regresión logística binaria. Los resultados mostraron que el abuso de alcohol y el deterioro en la función cognitiva ejecutiva, medida por el Test del Mapa del Zoo, constituyen factores de riesgo independientes para una mala adherencia. No se ha demostrado relación de la adherencia al TAR con el consumo de otras sustancias ni con la puntuación obtenida en el TMT. La detección de deterioro cognitivo mediante el Test del Mapa del Zoo, así como del consumo de alcohol, podrían ayudar a desarrollar estrategias de mejora del cumplimiento terapéutico en pacientes VIH+.

Relationship between alcohol consumption, whether linked to other substance use or not, and antiretroviral treatment adherence in HIV+ patients. / Relación entre la adherencia al tratamiento antirretroviral en pacientes VIH+ y el consumo de alcohol, asociado o no al uso de otras sustancias.

Hazardous alcohol consumption is a common diagnosis among people living with HIV infection. The relationship between alcohol consumption and poor adherence to antiretroviral therapy has been highlighted in different studies, yet few of them performed a parallel analysis of other substance use. In Spain, alcohol consumption is frequently associated with other substance use, mainly cannabis and cocaine. The aim of this study is to assess the influence of hazardous alcohol consumption both combined with other substances (cocaine, heroin, methadone and/or cannabis) or alone on antiretroviral therapy adherence in our social environment. We performed an observational case-control study including 119 HIV+ individuals. We recruited 40 non-adherent patients, defined by less than 90% compliance according to hospital pharmacy refill data, and corroborated by the Simplified Medication Adherence Questionnaire (SMAQ) and referring professional's opinion. Control cases (n=79) were defined as those patients with similar characteristics but considered adherent according to the same parameters. Data collection took place between May 2013 and September 2015. Statistical analysis was performed using a binary logistic regression model. Our results indicate that alcohol consumption decreases adherence to antiretroviral therapy. The use of methadone represents a statistically significant increased risk of poor adherence. No significant differences were found between adherent and non-adherent groups regarding cocaine, heroin or cannabis use in this study. In summary, the detection of substance use and especially alcohol consumption in HIV+ patients can improve the effectiveness of antiretroviral therapy by identifying and treating at-risk individuals for a poor therapeutic adherence.

El consumo perjudicial de alcohol es un diagnóstico de elevada prevalencia en pacientes VIH+. Distintos estudios han destacado la influencia negativa del mismo sobre la adherencia al tratamiento antirretroviral, aunque pocos de ellos valoran además el consumo de otras sustancias. En España, el consumo de alcohol se presenta frecuentemente en situación de policonsumo, fundamentalmente de cannabis y cocaína. El objetivo es comprobar cómo influye el consumo de alcohol, asociado o no al uso de otras sustancias (cocaína, heroína, metadona y/o cannabis), en la adherencia al tratamiento antirretroviral en nuestro entorno. Se ha realizado un estudio observacional tipo casos y controles sobre una muestra de 119 individuos VIH+. Conforman los casos (n=40) sujetos no adherentes al tratamiento farmacológico según reporte de Farmacia Hospitalaria, corroborado por el Simplified Medication Adherence Questionnaire (SMAQ) y la opinión del profesional de referencia. Se consideran controles (n=79) una muestra de pacientes de características similares con buena adherencia terapéutica según los mismos métodos de valoración. La recogida de datos se hizo entre mayo 2013 y septiembre 2015. El análisis estadístico se realizó mediante regresión logística binaria. Los resultados muestran que el consumo de alcohol empeora la adherencia al tratamiento antirretroviral. El uso de metadona supone un incremento estadísticamente significativo del riesgo de no adherencia. No se han encontrado diferencias significativas entre los grupos del estudio respecto a los consumos de cocaína, heroína o cannabis. Por tanto, la detección del consumo de sustancias, especialmente de alcohol, y su abordaje en pacientes VIH+ puede repercutir positivamente en el cumplimiento terapéutico, en beneficio de una mayor efectividad de la terapia antirretroviral.

[Predictors of the therapeutic discharge in patients with dual pathology admitted to a therapeutic community with a psychiatric unit]. / Variables predictivas del alta terapéutica entre pacientes con patologia dual grave atendidos en una comunidad terapéutica de drogodependencias con unidad psiquiátrica.

This study aims to analyze the variables on which depends therapeutic discharge, in patients with a severe dual diagnosis admitted to a professional therapeutic community where their pathology is treated. 325 patients admitted between June 2000 and June 2009 to the therapeutic community. This is a retrospective, cross-sectional study with no control group, based on the detailed analysis of the information collected in a model of semi-structured clinical interview designed in the therapeutic community. The 29.5% of the individuals included in the sample were therapeutically discharged. Of all the variables introduced in this analysis the most significant ones were gender, age at the beginning of treatment, education level, opiate dependence, polidrug abuse, and the presence of psychotic disorders and borderline personality disorder. In our study, gender determines the type of discharge, being therapeutic discharge more frequent among women. A higher educational also increases a better prognosis with a higher rate of therapeutic discharge among individuals with higher education level. A later age at the beginning of the treatment reduces the likelihood of therapeutic discharge. Likewise, polidrug abuse, diagnosis of psychotic disorders and borderline personality disorder are associated to a lower rate of therapeutic discharge. Recognizing these characteristics will allow the early identification of those patients more at risk of dropping treatment hastily, while trying to prevent it by increasing the therapeutic intensity.

[Cognitive and executive dysfunctions in cocaine dependence: a case-control study]. / Alteraciones de funciones cognitivas y ejecutivas en pacientes dependientes de cocaína: estudio de casos y controles.

INTRODUCTION: In the past, various studies have related chronic cocaine use to diverse types of neuropsychological impairment. However, the majority of these studies offer partial results using batteries of tests of little ecological weight. AIM: To investigate neuropsychological impairment (and of executive functions in particular) amongst severe chronic cocaine users, measured by means of more ecological tests and in a more global manner, taking confounding factors into account, such as age, years of schooling, gender, race, opioid dependence and alcohol consumption. SUBJECTS AND METHODS: We performed an observational study, comparing the cocaine dependence group (n = 24) with a non-cocaine use control group (n = 27). RESULTS: The principal results revealed significant differences in the direct and reverse digit span tests (p = 0.008 and p < 0.001 respectively), and in the Cards Test (p < 0.001). They also showed a significance result in the Zoo Map Test (p = 0.001), and in different measurements but not in all forming part of the Wisconsin test (number of correct responses and number of errors). CONCLUSIONS: These results confirm that the chronic use of cocaine per se causes neuropsychological impairment that is manifested in classical and ecologically-valid tests. This impairment may influence patients' functionality and prognosis, and also therapeutic failure.

[Pilot study on the prevalence of dual pathology in community mental health and substance misuse services in Madrid]. / Estudio piloto sobre la prevalencia de patología dual en pacientes en tratamiento en la Comunidad de Madrid.

AIM: To evaluate retrospectively the comorbidity of mental and addictive disorders in community mental health and substance misuse services in Madrid. METHODS: The medical records of 400 patients from mental health and substance misuse services in Madrid were evaluated. Records were examined for the last 20 patients from each service unit. RESULTS: Dual pathology was constituted when a current diagnosis of mental and addictive disorders, excluding nicotine addiction, appeared on the patient's records. Prevalence of dual pathology was 34%. There were differences in the prevalence figures for the two kinds of service: 36.78% in substance misuse services, and 28.78% in mental health services. There was an association of dual diagnosis with alcohol or cocaine dependence, but not with opioid dependence. The mental disorders more prevalent in dually diagnosed than in non-dually diagnosed patients were mood disorders, personality disorders, and schizophrenia. CONCLUSION: There is a high prevalence of dual pathology in those seeking treatment, being higher in substance misuse services than in mental health services, and higher in patients with alcohol or cocaine dependence. These findings could be of help in the planning of care resource policies for these patients.

Executive dysfunction in chronic cocaine users: an exploratory study.

INTRODUCTION: Chronic cocaine use is associated with some executive deficits. We assessed executive functions using ecologically valid tests in chronic cocaine users. OBJECTIVES: To investigate the relationship between executive deficits and three measures of severity of cocaine use: years of use, quantity used, and frequency of use. METHODS: Twenty-four cocaine users were compared with twenty-seven community controls. We used Student's t-test and Chi-squared to compare means and categorical variables, respectively. Linear regression analyses for the adjusted comparative analysis between cases and controls, and severity of cocaine use among cocaine users were performed. RESULTS: Chronic cocaine users performed worse on measures of attention and working memory (Forward and Backward Digit Span, p<.001), set-shifting abilities (difference score between the Trail Making B and A, TMB-A, p=.006), cognitive test of mental flexibility and response inhibition (Rule Shift Cards) (p<.001), and prefrontal functioning (Wisconsin Card Sorting Test, WCST, p=.023) than controls. Years of cocaine use were associated with deficits in the Backward Digit Span (p=.041; CI 95%: -.760 to -.002), the TMB-A (p=.026; CI 95%: .687 to 9.761), the Zoo Map (p=.034; CI 95%: -.480 to -.021), and the Rule Shift Cards (p=.006; CI 95%: -.836 to -.164), among others. Quantity of cocaine use was associated with executive deficits measured by the Forward Digit Span (p=.007; CI 95%: -.727 to -.133), the TMB-A (p=.021; CI 95%: 5.304-57.945), and the number of perseverative errors in the WSCT (p=.002; CI 95%: -10.654 to -2.800). Frequency of cocaine was associated with deficits in the Backward Digit Span (p=.042; CI 95%: -1.548 to -.030). CONCLUSIONS: Chronic use of cocaine is associated with executive deficits, which may influence patients' functionality, prognosis, and therapeutic failure.

[Managing the use of cannabis in a young population in primary care]. / Manejo del consumo de cannabis en población joven en Atención Primaria.

Cannabis is currently the most frequently used illicit drug substance in developed societies, just behind legal alcohol and tobacco. In this article clinical implications concerning cannabis use, particularly in young people, are approached. It also points out ways to make a correct diagnosis in Primary Care, with special emphasis on prevention and treatment. This is the first level of care in most cases.

Falacias, controversias y realidades acerca del consumo de marihuana: [revisión] / Cannabis consumption: falacies, controversies and reality: [review]

La marihuana es la droga ilegal más ampliamente consumida a nivel mundial, tan sólo por detrás de las legales alcohol y tabaco. A pesar de que las encuestas entre usuarios señalan un buen conocimiento de los efectos que produce, la impresión de los profesionales que atienden a los consumidores es que tal información es claramente escasa, parcial, cuando no directamente incorrecta. Lamentablemente, esta misma desinformación se advierte en algunos profesionales que atienden a los pacientes, o entre educadores y padres de jóvenes consumidores. En el presente artículo se abordan de manera científica una serie de controversias respecto del consumo de marihuana y sus consecuencias, con el objetivo de clarificar la información y ayudar a la prevención y tratamiento del consumo de dicha sustancia. Se persigue, igualmente, llamar la atención sobre la gravedad de su consumo, no sólo en cuanto a prevalencia sino también en cuanto a sus consecuencias.

[Cyclical hyperemesis secondary to cannabis abuse]. / Vómitos cíclicos secundarios al consumo de cannabis.

Cannabinoid hyperemesis is characterized by recurring episodes of nausea and vomiting, with a stereotyped pattern, related to cannabis consumption. This syndrome is a paradoxical reaction to cannabis that develops in susceptible chronic cannabis users after several years of exposure. There is a direct relationship between cannabis use and the onset of the hyperemesis and between cessation of cannabis use and symptom resolution. The first cases were described in 2004. Since then, several new cases have been reported, although there are few studies of this syndrome. We report a case of chronic cannabis use with nausea and cyclic vomiting for 7 years. The symptoms were relieved by hot baths. A complete gastroenterological study was performed and no alterations were found. Cannabis use and its cessation are related to the presence or absence of the symptoms.

[Use of cocaine and neuropsychological damage. Clinical implications]. / Consumo de cocaína y daño neuropsicológico. Implicaciones clínicas.

The use of cocaine is a worldwide problem, not only because of its high prevalence but also because of the serious medical and social repercussions. The brain is one of the organs more directly affected by the consumption of cocaine. It provokes vascular damage, but especially alterations at the level of receptors and neuromodulators, that have severe repercussion on cognitive functioning. These alterations play an essential role in the social conduct of the individual and in his daily functioning, as well as in the perpetuation of the addiction and prognosis. Moreover, they determine the therapeutic results and the model of psychological intervention on a definitive way. This work tries to summarize and update the existing evidences concerning the neuropsychological damage provoked by the consumption of cocaine, its functional impact and clinical implications, as well as the questioned reversibility with the continued abstinence.