A 35-year follow-up study of patients admitted to methadone treatment between 1982-1984 in Asturias, Spain. / Estudio de seguimiento de 35 años de pacientes admitidos a tratamiento con metadona entre 1982-1984 en Asturias, España.

The objective was to evaluate outcomes in a heroin-dependent population 35 years after first enrolment in methadone maintenance treatment (MMT).  An ad hoc protocol was used to assess drug misuse, treatment, and drug-related morbidity in the survivor sample. The standardized mortality ratio (SMR) and 95% confidence interval (CI) were calculated.  A total of 214 heroin-dependent patients entered MMT between 1982 and 1984 in the Asturias Public Health Service. Information was received on 195 subjects, of whom 146 were deceased.  Men accounted for 77.5% of the study cohort. Over the 35-year follow-up period, the SMR was 11.75 (95% CI = 9.95 - 13.77). In the survivor sample, 5.7% were still enrolled in MMT; human immunodeficiency virus (HIV) was diagnosed in 38.77% and hepatitis B/C in 73.46%. No differences were found between sexes in mortality or HIV and hepatitis B/C status. None of the female survivors were using heroin at the 35-year follow-up compared with 5.26% of males. In conclusion, our study confirms the high long-term mortality rate of heroin addicts, even after enrollment in MMT.

El objetivo fue evaluar el estado de una población dependiente a la heroína 35 años después de su primera inscripción en un tratamiento de mantenimiento con metadona (TMM). Se utilizó un protocolo ad hoc para evaluar morbilidad, consumo y tratamiento de la adicción en la muestra de supervivientes. Se calculó la razón de mortalidad estandarizada (RME) con un intervalo de confianza (IC) del 95%. Un total de 214 pacientes ingresaron en TMM entre 1982 y 1984 en el Servicio de Salud Pública de Asturias. Se recibió información sobre 195 sujetos, de los cuales 146 habían fallecido. Los hombres representaron el 77,5% de la cohorte del estudio. Durante el período de seguimiento de 35 años, la RME fue de 11,75 (IC 95% = 9,95 ­ 13,77). En la muestra de supervivientes, el 5,7% todavía estaba inscrito en TMM; el virus de inmunodeficiencia humana (VIH) se diagnosticó en un 38,77% y la hepatitis B/C en un 73,46%; el consumo actual de heroína se informó en un 4,1%. No hubo diferencias de género en la mortalidad o la condición de VIH y hepatitis B/C. Ninguna de las mujeres consumía heroína en el seguimiento de 35 años en comparación con el 5,26% de los hombres. En conclusión, nuestro estudio confirma la alta tasa de mortalidad a largo plazo, incluso después de la inscripción en TMM.

Cognitive functioning after six months of follow-up in a sample of alcohol use disorder outpatients. / Funcionamiento cognitivo después de seis meses de seguimiento en una muestra de pacientes ambulatorios con trastorno por uso de alcohol.

Until now, no follow-up studies had simultaneously evaluated executive functions, other non-executive functions related cognitive functions, and impulsivity in a large enough sample of moderate to severe alcohol use disorder (AUD) patients. The main objective of the present study was to compare neuropsychological performance and its relation to alcohol use in patients with AUD and healthy controls, and to determine the evolution of cognitive impairment and alcohol use over time. For this purpose, a 6-month follow-up study was designed to compare a sample of 100 outpatients with AUD (DSM-5 criteria) with 100 matched healthy controls. The patient group was recruited from three different health centres in Spain located in Orense, Gijón and Barcelona. The assessment consisted of a systematic battery of cognitive tests to evaluate the following functions: attention, anterograde memory, processing speed, verbal fluency, executive function, and implicit attitude toward alcoholic beverages. We also compared clinical variables associated with alcohol use, such as alcohol craving and impulsivity. After 6 months, anterograde memory, working memory, and resistance to interference improved remarkably in AUD patients, although not enough to match the normal population. With regard to clinical variables, there was a small but significant cognitive improvement related to a reduction in alcohol use and impulsivity. Executive dysfunction and other non-executive functions related cognitive functions impairment can be considered prognostic factors in outpatients with moderate to severe AUD.

Hasta la fecha, ningún estudio de seguimiento había evaluado simultáneamente la función ejecutiva, otras funciones no ejecutivas relacionadas con funciones cognitivas y la impulsividad en una muestra suficientemente grande de pacientes con trastorno por uso de alcohol (TUA) entre moderado y grave. Este estudio tuvo como objetivo principal comparar el desempeño neuropsicológico y su relación con el uso de alcohol en pacientes con TUA y en controles sanos, y determinar la evolución del deterioro cognitivo y el uso de alcohol a largo plazo. Con este fin, se diseñó un estudio de seguimiento de seis meses para comparar una muestra de 100 pacientes ambulatorios con TUA (criterios del DSM-5) emparejados con 100 controles sanos. Los pacientes se reclutaron de tres centros sanitarios diferentes de España, Orense, Gijón y Barcelona. La evaluación consistió en una batería sistematizada de pruebas cognitivas para evaluar las siguientes funciones: atención, memoria anterógrada, velocidad de procesamiento, fluidez verbal, función ejecutiva y actitud implícita hacia bebidas alcohólicas. También se compararon variables clínicas asociadas al consumo de alcohol, como el craving y la impulsividad. Después de seis meses, la memoria anterógrada, memoria de trabajo y resistencia a la interferencia mejoraron notablemente en los pacientes con TUA, aunque no llegaron a igualar la población general. Respecto de las variables clínicas, hubo una pequeña pero significativa mejoría cognitiva relacionada con una reducción del consumo de alcohol y de la impulsividad. La disfunción ejecutiva y otras funciones no ejecutivas relacionadas con el deterioro cognitivo pueden considerarse factores pronósticos en pacientes ambulatorios con TUA entre moderado y grave.

The Multi-Component Smoking Cessation Support Programme (McSCSP) is effective in patients with severe mental disorder without gender differences. / El programa multicomponente de apoyo para el cese del tabaquismo (McSCSP) es efectivo en pacientes con trastorno mental grave sin diferencias de género.

High prevalence of smoking in people with severe mental disorders (SMD) contributes to their medical morbidity and reduced life expectancy. Despite the evidence of gender differences in smoking cessation, few studies have tested those differences among people with SMD. This is a non-randomized, open-label, prospective, 9-month follow-up multicentre trial to examine gender differences in the efficacy, safety and tolerability of a Multi-Component Smoking Cessation Support Programme (McSCSP). The results showed that there were no significant differences in short- (males 44.9% vs females 57.7%, chi-square = 1.112, p = 0.292) or long-term efficacy (week 24: males 40.8%, females 42.3%, chi-square = 0.016, p = 0.901; week 36: males 36.7%, females 38.5%, chi-square = 0.022, p = 0.883) between gender, neither controlled by diagnosis or treatment. Regarding safety and tolerability, there was significant increase in abdominal perimeter in males [from 105.98 (SD 13.28) to 108.52 (SD 14.01), t = -3.436, p = 0.002)], but not in females. However, there were no significant gender differences in adverse events (constipation, abnormal/vivid dreams, nausea/vomiting or skin rash/redness around patch site). In conclusion, we have demonstrated that is effective and safe to help either male or female patients with stabilized SMD to quit smoking. However, it might be a tendency in females to respond better to varenicline treatment in the short-term. Future research with larger samples is required to more clearly determine whether or not the there are differences, in addition to their reliability and robustness.

La elevada prevalencia del tabaquismo en personas con trastorno mental grave (TMG) contribuye a su morbilidad médica y reduce su esperanza de vida. A pesar de la existencia de diferencias de género en el cese del tabaquismo, pocos estudios han evaluado esas diferencias en personas con TMG. Este es un ensayo multicéntrico de seguimiento prospectivo, no aleatorizado, abierto de 9 meses para examinar las diferencias de género en la eficacia, seguridad y tolerabilidad de un programa multicomponente de apoyo para el cese del tabaquismo (McSCSP). Los resultados mostraron que no hubo diferencias de género significativas en la eficacia a corto (hombres 44,9% vs mujeres 57,7%, chi cuadrado = 1,112, p = ,292) ni a largo plazo (semana 24: hombres 40,8%, mujeres 42,0.3%, chi cuadrado = 0.016, p = ,901; semana 36: hombres 36,7%, mujeres 38,5%, chi cuadrado = 0,022, p = ,883), incluso controlando por diagnóstico o tratamiento.  Con respecto a la seguridad y la tolerabilidad, hubo un aumento significativo en el perímetro abdominal en los hombres [de 105,98 (DT 13,28) a 108,52 (DT 14,01), t = -3,436, p = ,002)], pero no en las mujeres. Sin embargo, no hubo diferencias de género significativas en los eventos adversos (estreñimiento, sueños anormales/vívidos, náuseas/vómitos o erupción cutánea/enrojecimiento alrededor de la zona del parche). En conclusión, hemos demostrado que es efectivo y seguro ayudar a los hombres y mujeres con TMG estabilizados a dejar de fumar.  Sin embargo, podría haber una tendencia en las mujeres a responder mejor al tratamiento con vareniclina a corto plazo. Se requiere investigación futura con muestras más amplias para determinar con más claridad la existencia de diferencias, además de la fiabilidad y robustez.

"Readiness to Change" Predicts Efficacy of Reduction among Smokers with Severe Mental Illness.

AIMS: Smoking cessation in subjects with a severe mental illness (SMI) is a challenging but attainable goal. Furthermore, the identification of variables involved in the quitting process is a highly relevant factor in clinical practice. This study aimed to analyze the influence of smokers' motivation in smoking reduction and cessation and select the most suitable way of measuring motivation. METHODS: This is a secondary analysis of a 9-month, multicenter trial examining a Multicomponent Smoking Cessation Program in 82 adult outpatients with SMI. At the end of the preparation stage, the smokers' motivational level was evaluated with the University of Rhode Island Change Assessment Scale. This allowed us to rate subjects using a continuous measure ("Readiness to Change," RTC) and group them in "Stages of Change" (SOC). Regression analyses were carried out to identify predictors of the efficacy outcomes: a reduction in at least 50% of the cigarettes smoked per day (CPD), a reduction in the expired carbon monoxide (CO), and complete abstinence from smoking. RESULTS: We studied differences in measurements of motivational levels independently (RTC and SOC) for patients who had a reduction in at least 50% of the CPD and for patients who achieved complete abstinence from smoking. However, these differences did not reach statistical significance during the follow-up study with a logistic mixed-effects model. In a linear mixed-effects model, the reduction of expired CO was significantly associated with RTC, at the end of the active treatment phase and during follow-up (ß: -1.51; SD 0.82; p < 0.01). CONCLUSION: The motivation level achieved in the preparation phase predicted the reduction of expired CO over a given period when calculated by a continuous measure (RTC).

[Dual diagnosis in anxiety disorders: pharmacologic treatment recommendations]. / Patología dual en trastornos de ansiedad: recomendaciones en el tratamiento farmacológico.

Anxiety disorders and substance use disorders are highly comorbid (between 18% and 37%), and such comorbidity complicates treatment and worsens prognosis (including higher suicide risk). There are not many research works on the specific pharmacologic treatment of dual comorbid anxiety disorders. Most authors recommend a simultaneous approach of both, anxiety and substance use, disorders. Research data on pharmacotherapy suggest that psychotropics used in the treatment of anxiety disorders are also effective in dual diagnosis. SSRIs are considered first-line therapy in the treatment of dual anxiety while benzodiacepines should be avoided. New generation antiepileptic have shown efficacy in case series and open label studies in the latest years, thus being a promising treatment option for dual comorbid anxiety disorders, specially pregabalin in generalized anxiety disorder.

Differential blood-based biomarkers of psychopathological dimensions of schizophrenia. / Biomarcadores sanguíneos diferenciales de las dimensiones psicopatológicas de la esquizofrenia.

Symptomatology of schizophrenia is heterogeneous, there is not any pathognomonic symptom. Moreover, the diagnosis is difficult, since it is based on subjective information, instead of markers. The purpose of this study is to provide a review of the current status of blood-based biomarkers of psychopathological dimensions of schizophrenia. Inflammatory, hormonal or metabolic dysfunctions have been identified in patients with schizophrenia and it has attempted to establish biomarkers responsible for these dysfunctions. The identification of these biomarkers could contribute to the diagnosis and treatment of schizophrenia.