Correlates of Control Preferences, Participation in Decision-making and Activation in Patients with Substance Use Disorder.

BACKGROUND: Treatment of Substance Use Disorder (SUD) is complex and therefore including patients in the therapeutic process is needed. Patient-Centered Care (PCC) and Shared Decision-Making (SDM) have been associated with greater satisfaction, self-control, and less substance use. However, correlates of SDM have not been investigated in this population. METHOD: A cross-sectional analysis was carried out in 214 SUD patients to identify sociodemographic, clinical and psychological correlates of preferences and perceptions about participation in SDM and degree of activation. The Control Preference Scale (CPS), the Shared Decision-Making Questionnaire (SDM-9-Q) and the Patient Activation Measure (PAM) were used to assess the PCC elements. Multinomial logistic regression was used to analyze the correlates of the CPS variables (preferred role, perceived role, and role matching). For SDM-9-Q and PAM, multilevel linear regression was used. RESULTS: Preferring an active role, compared to a shared one, was significantly associated with higher educational level, lower neuroticism, absence of affective and alcohol use disorders, and higher quality of life. Perceiving greater participation was significantly associated with not being a new patient, having fewer legal problems, higher severity of alcohol consumption, not presenting polydrug use and main substance use different than opioids or sedatives. Activation was associated with higher scores in the personality trait activity, a preference for an active role and greater perception of being involved in the decision process. CONCLUSIONS: Patients with milder clinical profiles prefer an active role compared to a shared one. Patients who prefer or perceive a shared or passive role did not show relevant differences. Greater activation was related to preference for an active role and the perception of having been involved in decisions.

Long-acting injectable buprenorphine in the real world: case report on dual disorders.

OBJECTIVES: Long-acting injectable buprenorphine (LAIB) has demonstrated a good profile for opioid use disorder (OUD) management. However, there is scarce information on LAIB in OUD patients with comorbid mental disorders (dual disorder patients). METHODS: We present a case report on OUD patients with a comorbid mental disorder who have received LAIB for at least 3 months. RESULTS: Two women and one man with OUD and another comorbid mental disorder were prescribed with LAIB ranging from three to twelve months. Good adherence and opioid abstinence were observed during the follow-up. Psychopathological issues related to comorbid mental disorders were stabilized. A deep discussion on LAIB in this profile of patients is conducted. CONCLUSIONS: LAIB in OUD patients with comorbid mental disorders may be a safe and well tolerated option, similar to OUD patients without comorbid mental disorders. LAIB's impact on psychopathological issues requires further high-quality research to understand the real impact of LAIB on OUD and comorbid mental disorders.

Comparing nurses attending a specialised mental health programme with and without substance use disorder: a retrospective, observational study in Spain.

OBJECTIVES: To analyse the differences between nurses with and without substance use disorders (SUDs) admitted to a specialised mental health programme. DESIGN: Retrospective, observational study. SETTING: Specialised mental health treatment programme for nurses in Catalonia, Spain. PARTICIPANTS: 1091 nurses admitted to the programme from 2000 to 2021. INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOMES: Sociodemographic, occupational and clinical variables were analysed. Diagnoses followed Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision criteria. RESULTS: Most nurses admitted to the programme were women (88%, n=960) and came voluntarily (92.1%, n=1005). The mean age at admission was 45 (SD=10.4) years. The most common diagnoses were adjustment disorders (36.6%, n=399), unipolar mood disorders (25.8%, n=282), anxiety disorders (16.4%, n=179) and SUDs (13.8%, n=151). Only 19.2% (n=209) of the sample were hospitalised during their first treatment episode. After multivariate analysis, suffering from a SUD was significantly associated with being a man (OR=4.12; 95% CI 2.49 to 6.82), coming after a directed referral (OR=4.55; 95% CI 2.5 to 7.69), being on sick leave at admission (OR=2.21; 95% CI 1.42 to 3.45) and needing hospitalisation at the beginning of their treatment (OR=12.5; 95% CI 8.3 to 20). CONCLUSIONS: Nurses with SUDs have greater resistance to voluntarily asking for help from specialised mental health treatment programmes and have greater clinical severity compared with those without addictions. SUDs are also more frequent among men. More actions are needed to help prevent and promote earlier help-seeking behaviours among nurses with this type of mental disorder.

Disentangling heterogeneity in substance use disorder: Insights from genome-wide polygenic scores.

Substance use disorder (SUD) is a global health problem with a significant impact on individuals and society. The presentation of SUD is diverse, involving various substances, ages at onset, comorbid conditions, and disease trajectories. Current treatments for SUD struggle to address this heterogeneity, resulting in high relapse rates. SUD often co-occurs with other psychiatric and mental health-related conditions that contribute to the heterogeneity of the disorder and predispose to adverse disease trajectories. Family and genetic studies highlight the role of genetic and environmental factors in the course of SUD, and point to a shared genetic liability between SUDs and comorbid psychopathology. In this study, we aimed to disentangle SUD heterogeneity using a deeply phenotyped SUD cohort and polygenic scores (PGSs) for psychiatric disorders and related traits. We explored associations between PGSs and various SUD-related phenotypes, as well as PGS-environment interactions using information on lifetime emotional, physical, and/or sexual abuse. Our results identify clusters of individuals who exhibit differences in their phenotypic profile and reveal different patterns of associations between SUD-related phenotypes and the genetic liability for mental health-related traits, which may help explain part of the heterogeneity observed in SUD. In our SUD sample, we found associations linking the genetic liability for attention-deficit hyperactivity disorder (ADHD) with lower educational attainment, the genetic liability for post-traumatic stress disorder (PTSD) with higher rates of unemployment, the genetic liability for educational attainment with lower rates of criminal records and unemployment, and the genetic liability for well-being with lower rates of outpatient treatments and fewer problems related to family and social relationships. We also found evidence of PGS-environment interactions showing that genetic liability for suicide attempts worsened the psychiatric status in SUD individuals with a history of emotional physical and/or sexual abuse. Collectively, these data contribute to a better understanding of the role of genetic liability for mental health-related conditions and adverse life experiences in SUD heterogeneity.

Abstinence duration and psychopathology among addiction outpatients during 18 months of COVID-19.

Background: The COVID-19 pandemic has impacted the mental health of patients with substance use disorder (SUD). However, few longitudinal studies have been done which examine associations between the pandemic, SUD patients' mental health and their drug use. Objectives: This study aimed to examine duration of abstinence according to psychiatric status among SUD outpatients followed-up for 18 months from the pandemic related lockdown. Methods: A follow-up study of 316 SUD outpatients was undertaken. Sociodemographic features, and clinical and consumption related variables were recorded. Pre, during and post lockdown information was evaluated. Abstinence/substance use was monitored at the patient's scheduled follow-up appointments, and psychiatric disorders and psychological variables were revaluated at 18 months. Results: Survival analyses were used to compare the duration of abstinence (in months) from the beginning of the lockdown. It was observed that 70% of patients consumed the main substance for which they were being treated at some point during the follow-up. Men, younger patients, those with more symptoms of anxiety and personality disorders, and patients who experienced increased craving during follow-up, showed shorter duration of abstinence. While patients who had previously maintained at least one year of abstinence, achieved better results. Conclusions: During the first year and a half of the pandemic, SUD outpatients presented alterations in mental health, such us anxiety, depression and maladaptive personality traits and a high rate of relapse. For this reason, despite the health and social crisis and their restrictive measures, a comprehensive treatment should be ensured.

Efectividad de tianeptina en pacientescon depresión mayor y trastorno poruso de sustancias / Effectiveness of tianeptine in patients with major depressive disorder and substance use disorder

Introducción: La depresión coexiste frecuentemente conlos trastornos por uso de sustancias (TUS), lo que conllevaun peor pronóstico. Existe una importante falta de evidenciasobre las intervenciones terapéuticas más efectivas para estacomorbilidad. Los estudios existentes sugieren que los antidepresivos disponibles actualmente son poco eficaces paraestos pacientes. La disponibilidad terapéutica de antidepresivos con mecanismos neurobiológicos diferentes podría seruna alternativa. El objetivo es describir la evolución de ungrupo de pacientes con esta comorbilidad que han realizadotratamiento con tianeptina en condiciones de práctica clínica habitual en consultas de deshabituación.Metodología. Se diseñó un estudio postautorización,multicéntrico, retrospectivo y observacional de práctica clínica habitual. Se revisaron las historias clínicas de los 100últimos pacientes diagnosticados de depresión mayor y TUS,tratados con tianeptina durante al menos 3 meses. Se evaluaron en tres ocasiones (inicial, intermedia y final a los 3meses) las siguientes escalas: Escala de Evaluación para laDepresión de Hamilton (HDRS), Escala de Impresión ClínicaGlobal (ICG) y Escala de Gravedad de la Adicción (SDS).Resultados. La mayoría de los pacientes fueron tratadoscon una combinación de psicofármacos y psicoterapia. Alfinal del seguimiento 70 pacientes (70 %) obtuvieron unaremisión clínica según la escala HDRS y 76 pacientes (76 %)se clasificaron con mucha o moderada mejoría según ICG.Respecto al consumo, los descensos más destacados se produjeron en los trastornos por uso de alcohol y cocaína.Conclusión. Tianeptina, en monoterapia o en combinación, puede ser un tratamiento de utilidad para pacientescon depresión dual de forma conjunta con otras medidasterapéuticas que traten de forma integrada estos pacientescomplejos. (AU)

Introduction: The depressive disorder coexists in a highprevalence with a substance-related disorder, which is associated with a worst prognosis. The therapeutic interventions for this co-morbidity lack of the appropriate scientificsupport. The existing evidence suggest that the currentlyavailable anti-depressive drugs are of minor efficacy in thisgroup of patients. An alternative would be the use of different drugs with distinctive neurobiological mechanismof action. The aim of this study was to describe the clinicaldevelopment of a series of patients affected by this comorbidity under treatment with tianeptine under usual clinicalpractices.Methods. Study design corresponds to a post-authorization, observational, retrospective, multicentric, study underusual clinical practice study. The clinical history of the lastconsecutive 100 patients diagnosed of major depressive andsubstance-related disorders under treatment with tianeptinefor at least 3 months was reviewed. The following scales wereevaluated in 3 times (basal, intermediate, final): HDRS, ICGand SDS. Results. Most patients were treated by a combinationof anti-depressive drugs together with psychotherapy. Atthe end of follow-up, 70 % patients had a clinical remissionin accordance with HDRS and 76 % of them had a mild orsignificant improvement in ICG. Regarding the use of substances, the most remarkable decreases were obtained in theconsumption of alcohol, and cocaine.Conclusion. Tianeptine could be a useful drug for thetreatment of patients with dual diagnosis of depression andsubstance-related disorder, together with other therapeuticinterventions. (AU)

Psychosis induced by abuse of ayahuasca: a case report / Psicosis inducida por el abuso de la ayahuasca: un caso clínico

A B S T R A C T Ayahuasca is a psychotropic infusion prepared by boiling the bark of Amazonian plants and has many psychopharmacological effects not fully understood. Some of those effects are used as treatment for different diseases. However, the side effects of ayahuasca, including ayahuasca-induced psychosis, are an important issue. Here we report the case of a patient who had a psychotic episode after taking ayahuasca and who was successfully treated with antipsychotic medication. Given the current spread of ayahuasca consumption in developed societies, the present case highlights the need for better understanding and regulation of the social-legal condition of ayahuasca and the need for further research. Additionally, psycho-education seems advisable in order to create awareness of the potential risks of the use of ayahuasca.

RESUMEN La ayahuasca es una bebida psicotrópica preparada a través de la cocción de plantas de la cuenca amazónica que tiene muchos efectos psicofarmacológicos no del todo estudiados. Algunos de esos efectos son usados como tratamiento de diversas patologías. Sin embargo, existen efectos secundarios de la ayahuasca que deben ser tenidos en cuenta, entre ellos psicosis inducida por ayahuasca. Reportamos un caso de un paciente que, tras autoadministración de ayahuasca, presentó un episodio psicótico y que fue satisfactoriamente tratado con antipsicóticos. Dada el uso cada vez más frecuente de ayahuasca en las sociedades desarrolladas, el caso actual resalta las necesidades de entender, regular e investigar el uso de la ayahuasca. Además, crear conciencia de los potenciales riesgos del uso de ayahuasca a través de la psicoeducación debería ser implementado.

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

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

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

Percepción de los profesionales sobre el uso de la clozapina en pacientes con psicosis dual / Professional perception of clozapine use in patients with dual psychosis

INTRODUCCIÓN. Los pacientes con trastornos psicóticos presentan con frecuencia trastornos por uso de sustancias y otras adicciones. El objetivo de este estudio fue conocer la situación actual del tratamiento de estos pacientes con el foco puesto en la clozapina, que ha sido propuesta en la mayoría de los consensos como antipsicótico de primera elección en esta indicación. MATERIAL Y MÉTODOS. Se elaboró una encuesta con 14 preguntas sobre aspectos relacionados con el tratamiento y manejo de la patología dual, haciendo hincapié en el papel de la clozapina en esta enfermedad. RESULTADOS: La encuesta fue respondida por 199 exper-tos en enfermedades mentales (90,5% médicos y 9,5% psicólogos). Un 88,4% de los encuestados tenía posibilidad de prescribir la clozapina, pero la mayoría (89,4%) la administraba a pacientes con esquizofrenia resistente sin considerar una patología dual. Solo un 30,8% planteó el uso de la clozapina a pacientes con psicosis dual. La infrautilización de la clozapina en estos pacientes se atribuyó principalmente a los controles del plan de farmacovigilancia, incluido el recuento leucocitario frecuente (57,1%), y a la falta de formación sobre el fármaco (35,6%). Las principales medidas propuestas para incrementar su uso son tener que hacer menos controles hemáticos (29,3%), mayor formación (27,8%) y tener menos problemas administrativos (25,1%). CONCLUSIONES: Para mejorar el tratamiento de los pacientes con psicosis dual es necesario simplificar la terapia e incrementar la formación de los profesionales sobre el uso de antipsicóticos atípicos, especialmente la clozapina, considerada como el fármaco de elección en los principales consensos de expertos

INTRODUCTION: Patients with psychotic disorders often have substance use disorders and other addictions. The objective of this study was to know the current treatment situation of these patients focusing on clozapine, which was proposed in most consensus as antipsychotic of first choice in this indication. MATERIAL AND METHODS: A survey with 14 questions on aspects related to the treatment and management of the dual disorders was developed, emphasizing the role of clozapine in this disease. RESULTS: The survey was answered by 199 experts in mental illnesses (90.5% physicians and 9.5% psychologists). A total of 88.4% of experts were able to prescribe clozapine, but the majority (89.4%) administered the drug to patients with resistant schizophrenia without considering a dual dis-order. Only 30.8% considered the use of clozapine in patients with dual psychosis. The underutilization of clozapine in these patients was mainly attributed to controls of the pharmacovigilance plan, including frequent leukocyte count (57.1%), and lack of drug education (35.6%). The main measures proposed to increase its use are fewer blood tests (29.3%), more training (27.8%), and fewer administrative problems (25.1%). CONCLUSIONS: In order to improve the treatment of patients with dual psychosis, it is necessary to simplify the therapy and increase the training of professionals in the use of atypical antipsychotics, especially clozapine, designed to be the drug of choice in the main expert consensus

Psicosis inducidas por quinolonas: una revisión actualizada / Quinolone-induced psychosis: an updated review

Las quinolonas son un grupo de antibióticos amplia-mente usado por su perfil antibacteriano y de seguridad. Sin embargo, se han descrito algunos efectos secundarios neuropsiquiátricos, entre ellos episodios psicóticos asociados a su uso. Este efecto adverso ha sido poco estudiado, a pesar de su relevancia clínica. Por ello, realizamos una revisión de la literatura usando la guía PRISMA, la búsqueda se realizó en PubMed y ScienceDirect incluyendo manuscritos entre el 01/01/1962 hasta el 31/01/2019 donde se describieran trastorno psicótico inducido por medicamentos/sustancias según el DSM-5, y que además la sintomatología psicótica fuese principalmente atribuible a una quinolona, que los pacientes no tuvieran antecedentes de trastorno psiquiátrico primario que curse con psicosis, y que la sintomatología predominante no fuese atribuible a un estado confusional agudo (delirium) ni a otros trastornos psiquiátricos inducidos. Se detectaron 459 artículos de los que 27 publicaciones cumplían los criterios de inclusión y exclusión (n = 27 pacientes, edad media 36,15±16,96). Las tres quinolonas más frecuentemente relacionadas con episodios psicóticos fueron: ciprofloxacino, levofloxacino y ofloxacino. Las vías de administración más comunes eran la oral e intravenosa. Se puede concluir que clínicamente es importante tener en cuenta este efecto adverso dada la alta frecuencia de prescripción de estos fármacos y la gravedad que implica la presencia de síntomas psicóticos. En general, este cuadro puede remitir rápidamente en pocos días con el retiro de la quinolona y realizando un soporte sintomático si es necesario. Finalmente, es importante realizar más investigaciones en esta área

Quinolones are an antibiotic group widely used due to their antimicrobial action and security profile, however, it has been described neuropsychiatric adverse effects, being induced-psychotic episodes one of the most clinically relevant. Nevertheless, this secondary effect has been scarcely studied. A literature search using PRISMA guidelines was performed between 01/01/1962 and 01/31/2019 on PubMed and ScienceDirect, including manuscripts which described substance-induced psychotic disorder according to DSM-5 and in which the symptomatology was not attributable to an acute confusional state (delirium) or to other induced psychiatric disorders. 459 articles were found, but only 27 manuscripts fulfilled inclusion criteria (n = 27 patients, median age of 36.15±16.96 years). Ciprofloxacin, levofloxacin and ofloxacin were the main antibiotics implicated. Quinolone-induced psychosis is a clinical relevant issue due to the high prescription of these antibiotics and the severity of this clinical syndrome. In general, this syndrome can remit in a few days with the withdrawal of the quinolone and per-forming symptomatic support if it is necessary. Finally, it is important to perform further research on this issue

Self-perceived quality of life in cocaine dependents with or without dual diagnosis / Calidad de vida autopercibida en pacientes dependientes de cocaína con o sin diagnóstico de patología dual

INTRODUCTION: Although impairment in the quality of life is common among cocaine dependent patients, there are but a few researches about the interaction between addiction and quality of life. OBJECTIVE: To study different parameters of quality of life in a sample of cocaine dependent patients and to compare patients with or without dual diagnosis. Also, to promote the importance of subjectivity in the quality of life and to propose to incorporate patients' self-perception into their treatment. METHOD: Three diagnostic interviews were administered (SCID-I, SCID-II and PRISM) and a quality of life questionnaire (SF-36) was applied between two different patient groups: Group I (cocaine dependent patients) and Group II (cocaine dependent patients with other mental disorder). RESULTS: Patients diagnosed with dual disorders (Group II) showed broader differences in perceptions of their quality of life in comparison with their clinicians. The perception of quality of life may vary depending on the presence and severity of mental disorders, and these different appreciations may explain the difficulties that clinicians face in understanding their patients' expectations and motivations. DISCUSSION AND CONCLUSION: A systematic evaluation of the subjective quality of life should be included in the management of cocaine dependent patients in order to more accurately understand the patients' perception of their treatment, motivations and expectations.

INTRODUCCIÓN: La calidad de vida de los pacientes dependientes a la cocaína se encuentra alterada y hay poca información acerca de cómo interactúa la dependencia a sustancias y la calidad de vida. OBJETIVO: Estudiar los diferentes parámetros de calidad de vida en pacientes dependientes a la cocaína con o sin diagnóstico de patología dual. Asimismo, señalar la importancia de la subjetividad en la calidad de vida y proponer la incorporación de la autopercepción de los pacientes en su tratamiento. MÉTODO: Se realizaron tres entrevistas diagnósticas (SCID-I, SCID-II y PRISM) y un cuestionario de calidad de vida (SF-36) entre dos grupos diferentes de pacientes: Grupo I (pacientes con dependencia a la cocaína solamente) y Grupo II (pacientes dependiente a la cocaína con otro trastorno mental). RESULTADOS: Los pacientes diagnosticados con patología dual (Grupo II) mostraban amplias diferencias en la percepción de la calidad de vida comparada con la percepción de sus terapeutas. La percepción de la calidad de vida podría variar dependiendo de la presencia y gravedad de los trastornos mentales asociados. Además, estas diferentes apreciaciones podrían explicar las dificultades que tiene el clínico para entender las expectativas y motivaciones del paciente de cara a su tratamiento. DISCUSIÓN Y CONCLUSIÓN: En pacientes dependientes a la cocaína debería realizarse de forma sistemática una evaluación de la calidad de vida subjetiva con el fin de conocer con mayor precisión la percepción que tienen los pacientes de su tratamiento, así como sus motivaciones y expectativas.

Grupo motivacional en unidad hospitalaria desintoxicación, su influencia en mantenimiento de la abstinencia y retención al tratamiento tras alta / Motivational interviewing group at inpatient detoxification, its influence in maintaining abstinence and treatment retention after discharge

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

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

Recaída en el uso de cocaína y calidad de vida relacionada con la salud: un estudio de 23 semanas de seguimiento / Cocaine relapse and health-related quality of life: a 23 weeks study

Introducción. Las recaídas son frecuentes en la dependencia a cocaína, múltiples factores están involucrados en ellas. Además, la dependencia a cocaína se relaciona con un peor pronóstico en relación a la calidad de vida relacionada con la salud (CVRS). Este estudio explora la CVRS percibida como un indicador de recaída en pacientes con dependencia a cocaína. Metodología. Se llevó a cabo un estudio longitudinal en pacientes con dependencia a cocaína durante 23 semanas. En total 39 pacientes participaron (edad media 35,6 años), aunque solamente 15 completaron el periodo de seguimiento. Se utilizaron varias escalas e instrumentos psicométricos (SCID-I, SCID-II, BDI, STAI y la SF-36) en diferentes puntos del estudio. Los pacientes fueron seguidos y se evaluaron las recaídas. La muestra fue dividida de acuerdo con el momento de recaída (temprano vs. tardía). La información fue comparada y analizada para poder evaluar si la CVRS se podía relacionar con la recaída de cocaína. Resultados. Hubo diferencias en la CVRS percibida entre los pacientes con y sin recaída temprana, especialmente en las dimensiones de Salud Mental y Funcionamiento Social (p<0,05). Además, los pacientes con recaídas tardías presentaban una mejoría de la CVRS percibida si se comparaba con los que recaían de forma temprana. Conclusiones. La CVRS percibida podría predecir parcialmente las recaídas tempranas y su medición podría ser una herramienta para evaluar posibles recaídas en el futuro. Sin embargo, es necesaria más investigación en esta área

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

Diferencias relevantes en la percepción y el grado de conocimiento de los profesionales de las distintas Comunidades Autónomas españolas sobre la existencia de recursos para pacientes con patología dual / Relevant Differences in Perception and Knowledge of Professionals in Different Spanish Autonomous Communities Regarding Availability of Resources for Patients with Dual disorders

Objetivos. Evaluar el grado de conocimiento de los profesionales sanitarios que atienden a pacientes con patología dual acerca de recursos específicos disponibles para esta patología en las diferentes comunidades autónomas españolas. Metodología. Estudio observacional, transversal y multicéntrico para comparar la percepción de los profesionales sanitarios (n=659) con la realidad en cuanto a los recursos específicos disponibles para los pacientes con patología dual en España, mediante un cuestionario on-line, que fue cumplimentado también por los 19 comisionados y gestores responsables de los planes nacionales y regionales de drogas. Resultados: Participó en el estudio una muestra representativa de profesionales de cada comunidad, procedentes de 553 centros de 235 ciudades españolas. La mayoría de participantes (93,2%) opinó que es necesaria la existencia de recursos específicos en patología dual. Porcentajes elevados de profesionales consideraron que no existían talleres específicos (88,4%), unidades de subagudos (83,1%), hospitales de día (82,8%), centros de día específicos (78,5%) o programas ambulatorios (73,2%). El grado de conocimiento sobre la existencia de recursos específicos varió en función del tipo de recursos y comunidad autónoma. En general, los profesionales subestimaban el número de unidades ofrecidas en sus comunidades. Conclusiones. Existen claras diferencias en el grado de conocimiento de los recursos para pacientes con patología dual entre los profesionales, en función de la comunidad autónoma donde ejercen. Son necesarias actuaciones de armonización a nivel nacional, como un registro unificado, un libro blanco o un plan nacional para patología dual

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

Factores asociados a la incapacidad laboral temporal en peritajes psiquiátricos / Risk factors for temporary work disability

Introducción. La relación entre dificultades laborales y trastornos psiquiátricos es estrecha y bidireccional. Sin embargo, los datos disponibles sobre patología psiquiátrica en los procesos de incapacidad laboral temporal (ILT) en España no son concluyentes. Por dicho motivo, los objetivos del presente trabajo son describir el porcentaje de decisión de revocar una ILT, tras un peritaje psiquiátrico de trabajadores de Cataluña, y comparar las características sociodemográficas, clínicas y terapéuticas en función de la decisión de revocar la ILT. Metodología. Se realizó un estudio descriptivo en pacientes en situación de ILT por trastorno mental peritados durante un año, que acudían a valoración psiquiátrica tras un período acumulado de ILT (media de 5 meses). Los peritos psiquiatras debían valorar la capacidad laboral en función de la interferencia de los síntomas psiquiátricos del diagnóstico psiquiátrico principal que motivó el inicio de la baja laboral. Resultados. Se incluyeron 380 pacientes (66,8% mujeres, 42±10,9 años). El 87,9% recibió el alta laboral. No existieron factores sociodemográficos y terapéuticos asociados a la continuidad de ILT. El diagnóstico mayoritario de los pacientes que recibían el alta laboral fue el trastorno adaptativo (66,2% vs 13%, p=0,001) y el de los pacientes con continuidad de ILT el trastorno depresivo mayor (45,7% vs 3,9%, p=0,001). Conclusiones. Existe un elevado porcentaje de pacientes que reciben el alta laboral tras un peritaje psiquiátrico. El trastorno depresivo mayor es el diagnóstico que más se asocia con la continuidad de ILT

Introduction. The relationship among labor difficulties and psychiatric disorders is important and bidirectional. However, current information about the influence of psychiatric disorders in temporary work disability in Spain is inconclusive. For this reason, we aimed to describe the prevalence of the conclusions of psychiatric expert’s reports including maintain o revoke the temporary disability (TD). We also aimed to compare sociodemographic, clinical and therapeutic variables according with the decision of maintain or revoke this condition. Methodology. A descriptive study was conducted in psychiatric patients that were examined by psychiatric experts during one year. At the examination time, the patients had a sick leave mean of 5 months. The psychiatric experts assessed their ability to work according to the interference of the psychiatric symptoms. Results. A total of 380 patients were included (66.8% women, 42±10.9 years), 87.9% had a result of revoke the temporary work disability. No sociodemographic or therapeutic factors were associated with the continuity of sick leave. The most common diagnosis of patients who obtained a revoked temporary work disability was adjustment disorder (66.2% vs 13%, p=0.001) and patients who maintained the temporary work disability was major depressive disorder (45.7% vs 3.9%, p=0.001). Conclusions. After a psychiatric expert’s examination the most of the results suggest to revoke the temporary work disability. Major depressive disorder is the most commonly diagnostic associated to continue sick leave

Prevalencia administrativa del insomnio en pacientes adictos durante el consumo activo de las sustancias y características clínicas asociadas / Administrative prevalence of insomnia and associated clinical features in patients with addiction during active substance use

Introducción. Se ha descrito una relación bidireccional entre el uso de sustancias y el insomnio, aunque existen escasos estudios sobre el insomnio en la población adicta. El objetivo es describir la prevalencia de insomnio durante el consumo activo de las sustancias en pacientes adictos y sus características clínicas asociadas. Pacientes y Metodología. Estudio descriptivo en pacientes diagnosticados de trastorno por dependencia de sustancias que ingresaron en una Unidad Hospitalaria de Desintoxicación. Se evaluó el insomnio previo al ingreso mediante el Cuestionario de Oviedo de Calidad del Sueño (COS). Se recogieron variables demográficas, clínicas referidas al consumo y diagnósticas y se realizaron las entrevistas SCID-I y II y CAADID para evaluar los diagnósticos psiquiátricos. Se realizó un análisis bivariante y multivariante de los datos. Resultados. Se incluyeron 481 pacientes (72,6% varones, edad 40,6±10,1 años). El 64,3% de los pacientes refirieron insomnio durante el consumo activo de la sustancia. El tipo de insomnio más frecuente fue el sueño nocturno fragmentado (49,9%). Los factores relacionados significativamente con el insomnio fueron policonsumidores, comorbilidad médica (destacando enfermedades infecciosas), trastorno de ansiedad, trastorno de personalidad (destacando cluster C), mayor número de ingresos de desintoxicación previos y edad de inicio del consumo más temprana. Conclusiones. El insomnio es muy prevalente en pacientes adictos durante el consumo activo de la sustancia. El sueño nocturno fragmentado es el tipo de insomnio más frecuente. Los pacientes adictos con trastorno de ansiedad comórbido, comorbilidad médica e inicio precoz de la dependencia tienen mayor probabilidad de presentar insomnio

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

Evaluación de las alteraciones del sueño en pacientes drogodependientes hospitalizados / Evaluation of sleep disorders in drug dependent inpatients

Fundamento y objetivo: Estudiar los trastornos del sueño en pacientes drogodependientes ingresados, en función del tipo de consumo y la existencia de desintoxicaciones previas. Pacientes y método: Se evaluaron 150 adictos ingresados en una unidad de desintoxicación hospitalaria mediante la entrevista SCID-I. Completaron un cuestionario autoaplicado de 11 ítems (tipo Likert de 1-mínimo a 7-máximo) que evaluó las alteraciones del sueño y su relación con el consumo. Resultados: El 75,3% eran varones. La sustancia principal de ingreso fue en un 39% el alcohol, en el 34,67% cocaína, en el 30% politoxicómanos, en el 22,67% opiáceos, en el 18% benzodiacepinas y en el 14% cannabis. El 68,1% presentaron alteraciones del sueño y el 80,1% relacionaron sus problemas del sueño con la dependencia. Todos los pacientes con ingresos previos (47,3%) mostraban preocupación por presentar alteraciones del sueño durante el ingreso y referían mayor insomnio (43,7 frente a 22,8%, p<0,05). Los politoxicómanos presentaban más alteraciones del sueño (57,8 frente a 24,3%, p<0,05) que el resto. El insomnio fue referido principalmente por los alcohólicos (61%). El 86% utilizaron benzodiacepinas, el 75,4% sin prescripción. Conclusiones: Las alteraciones del sueño en drogodependientes son muy frecuentes. Los pacientes con ingresos previos y los politoxicómanos son los que presentan más alteraciones del sueño (AU)

Background and objective: We aimed to study the relationship between sleep disorders and the type of substance use and the number of previous hospitalizations in patients admitted in a detoxification unit. Patients and methods: We evaluated 150 drug-dependent inpatients with SCID-I. Patients were asked to complete an 11-item questionnaire measure (Likert scales from 1-minimum to 7-maximum) designed to assess the relationship between sleep disorders and drug use. Results: 75.3% were men. 39% were alcoholic, 34,67% cocaine-users, 30% poly-drug users, 22.6% opioid, 18% benzodiazepine and 14% cannabis-dependent patients. 68.1% reported experiencing sleep problems. 80.1% related sleep disorders to drug consumption. Worry about sleep problems was found in all patients with previous hospitalizations (47.3%). This group experienced more insomnia than those who had never been hospitalized (43.7 vs 22.8%, P<.05). Poly-drug users perceived more sleep disorders (57.8 vs 24.3%, P<.05). Insomnia was referred by 61% of alcoholic patients. 86% of the sample used benzodiazepines, 75.4% used them without prescription. Conclusions: The perception of suffering from disordered sleep is frequent in drug addicts. Patients with poly-drug use and previous hospitalizations were the most affected (AU)

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

El presente trabajo pretende comparar las características entre los pacientes que recaen en el consumo y los que se mantienen abstinentes, a los seis meses de seguimiento ambulatorio tras terminar una desintoxicación hospitalaria. Se realizó un estudio observacional y prospectivo en pacientes con trastorno por dependencia de sustancias que ingresaron en la Unidad Hospitalaria de Desintoxicación del Hospital Universitario de Vall d’Hebron desde junio 2009 hasta octubre 2010. Durante el ingreso se recogieron variables demográficas, clínicas, diagnósticas y terapéuticas, y se realizó la entrevista SCID. Se consideró recaída el reinicio del consumo de la sustancia que fue motivo de ingreso y se evaluó por anamnesis y alcohotest y/o urinoanálisis. Las variables de estudio se compararon entre los pacientes que recayeron y los que no. De 165 pacientes incluidos, 108 finalizaron el estudio (75% varones, edad 37,7±9,5 años). 72,2% recayeron a los 6 meses. El perfil de pacientes que recayeron fue: pacientes que ingresaban para desintoxicación de heroína (91,7% vs 8,3%, p = .038), policonsumidores (71,4% vs 32%, p = .05), pacientes que consumían horas previas al ingreso a modo de despedida (61,5% vs 39,5%, p = .04), aquellos con comorbilidad médica (44,9% vs 23,3%, p = .04), y con trastornos afectivos comórbidos (19,5% vs 3,2%,p = .005). La desintoxicación de opiáceos y el consumo en horas previas se asociaron de forma independiente con la recaída a los 6 meses. Existe un alto porcentaje de recaídas tras desintoxicación hospitalaria. Ingresar para desintoxicación de opiáceos y/o consumir de forma compulsiva antes del ingreso, están relacionados con el mayor riesgo de recaída(AU)

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 Valld’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 165patients 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(AU)

Tratamiento ambulatorio grupal para dependientes de cocaína combinando terapia cognitivo conductual y entrevista motivacional / Ambulatory group treatment for cocaine dependent patients combining cognitive behavioral therapy and motivational interviewing

Las intervenciones psicológicas en pacientes con dependencia de cocaína han demostrado ser eficaces, destacando el Manejo de Contingencias y la Terapia Cognitivo-Conductual [TCC], siendo la falta de adherencia la limitación más importante. La Entrevista Motivacional [EM] mejora la adherencia. El objetivo de este estudio es evaluar la retención y abstinencia con tratamiento combinado de EM y TCC grupal en pacientes cocainómanos que han alcanzado el estadio de mantenimiento según el modelo transteórico de Prochaska y DiClemente (1982). Para ello se realizó un estudio longitudinal, en dependientes de cocaína con o sin trastorno mental concomitante. Se realizó un grupo abierto de 12 sesiones con periodicidad semanal. Se incluyeron 19 pacientes (78,9% hombres, edad media 36,58 años), el 95% consumía vía intranasal y el 47% tenía otra comorbilidad psiquiátrica. La tasa de retención fue del 84%. Durante el tratamiento y el primer mes de seguimiento todos los pacientes se mantuvieron abstinentes, mientras que entre el primer y tercer mes de seguimiento tres pacientes recayeron. Los datos avalan que el tratamiento combinado de EM+TCC para dependientes de cocaína en estadio de mantenimiento mejora la adherencia y es eficaz para mantener la abstinencia (AU)

Psychological interventions in cocaine dependent patients have demonstrated efficacy. Remarkable approaches are Contingency Management (CM) and Cognitive Behavioral Therapy (CBT). Lack of treatment adherence is the most important limitation. Motivational Interview (MI) has been shown to be an adherence enhancer. The objective of this study is to evaluate retention and abstinence in a combined CM and CBT group treatment in patients who have reached maintenance stage according to Prochaska and DiClemente’s transtheoretical model (1982). Therefore, a longitudinal study was carried out with cocaine dependent patients with or without concomitant mental health disease. A 12-session open group was conducted weekly. Nineteen patients were included (78.9% men, mean age 36.6 years), 95% consumed intranasally and 47% had another psychiatric comorbidity. Treatment retention was 84%. During treatment and the first month of follow-up, all patients remained abstinent whereas at three months, 3 patients relapsed. These data confirm that using combined CM and CBT group therapy in cocaine dependents undergoing maintenance treatment enhances adherence and is effective to achieve abstinence (AU)