ABSTRACT
INTRODUCTION: Current literature does not dispose from a widely accepted definition of recovery in alcohol use disorder (AUD), and most proposals originate from anglophone countries. This study introduces a pioneering consensus in Spain on the definition of recovery in AUD. METHOD: The Delphi method was used. The expert panel, comprising 54 multidisciplinary professionals from the Community of Madrid. RESULTS: A high level of consensus (≥80% agreement) was reached for 45% of the items and majority (≥60%) for 84%. Recovery is understood as a dynamic, personalized, and voluntary process, potentially enduring throughout one's lifespan. It entails a transformative lifestyle shift aimed at achieving a significant improvement in overall quality of life, encompassing physical and mental health, interpersonal relationships, and environmental factors. The journey of recovery is marked by heightened psychological well-being, is characterized by empowerment, personal growth, existential purpose, and positive identity reconstruction. Recovery is supported by substance use management, requires proactive individual agency and involves both personal and societal responsibilities. CONCLUSIONS: This study represents a milestone as it is the first consensus in the Community of Madrid on the meaning of recovery in AUD. The proposed definition of recovery could be a potential reference for similar regions within Spain or even for other countries with cultural similarities. The elucidation of a clear framework of recovery provides a solid basis for future research efforts and clinical interventions in the Spanish AUD landscape.
Subject(s)
Alcoholism , Delphi Technique , Humans , Spain , Alcoholism/rehabilitation , Alcoholism/psychology , Consensus , Female , MaleABSTRACT
Diversas variables psicológicas están implicadas en el pronóstico de los pacientes con dependencia de alcohol, durante el tratamiento y después del alta. Sin embargo, aún no conocemos el papel que juegan estas variables en la consecución y mantenimiento de la abstinencia y, si éstas, se modifican a lo largo del tiempo. Metodología: Se recogieron datos longitudinalmente relacionados con ansiedad, depresión, impulsividad, estrategias de afrontamiento, sentido de la vida (SV) y asistencia a las asociaciones de ayuda-mutua (AM) de pacientes ambulatorios con dependencia de alcohol (N=159, 66% varones, edad media=42.54 años). Se realizaron evaluaciones basalmente, al alta (después de 2 años de tratamiento), a los 2 y a los 4 años después del alta. Las variables relacionadas con el consumo de alcohol fueron evaluadas con el método Timeline Followback. Resultados: En la evaluación basal, el estilo de afrontamiento evitativo y la impulsividad se asociaron con los meses de abstinencia acumulada a los 4 años. Al alta, y a los 2 años de seguimiento, las puntuaciones altas en el SV se asociaron con los meses de abstinencia acumulada a los 4 años. Los modelos de mediación encontraron que el SV incrementaba los meses de abstinencia acumulada a los 4 años a través del estilo de afrontamiento evitativo y una reducción de los niveles de depresión. Conclusiones: El SV es un componente determinante en la abstinencia a largo plazo. Dado que las asociaciones de AM promueven el SV, éstas deberían ser recomendadas como una parte esencial de un tratamiento integrado de la dependencia de alcohol. (AU)
Several psychological variables have been associated with the prognosis during alcohol dependence treatment and after discharge. However, we still do not know the role that these variables play in the achievement of abstinence and if they modify throughout time. Method: Longitudinal survey data related to anxiety, depression, impulsivity, coping, meaning in life (MiL) and attendance to mutual-help groups were collected from outpatients with alcohol dependence (N= 159, 66% male, mean age=42.54 years). Assessment points were the following: baseline, at discharge (after 2-years of treatment), and 2-years and 4-years follow-up after discharge. Drinking outcomes were evaluated with the Timeline Followback Method Assessment. Results: At baseline, levels of avoidance coping and impulsivity were associated with months of accumulated abstinence at 4-years-follow-up. However, at discharge and at two-years follow-up, higher scores in MiL were consistently associated with months of accumulated abstinence at 4-years of follow-up. Mediation models showed that MiL increased accumulated abstinence at 4 years-follow-up by increasing avoidance coping and reducing levels of depression. Conclusions: MiL is a determining component in the long-term sustained abstinence. Our results support the key role of MiL and point to a new mechanism through which it influences the maintenance of sobriety. Because mutual-help groups have consistently demonstrated to promote MiL, they should be implemented and recommended as an essential part of an integrated treatment of alcohol dependence. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Alcohol Abstinence/psychology , Adaptation, Psychological , Anxiety , Depression , Quality of LifeABSTRACT
Diversas variables psicológicas están implicadas en el pronóstico de los pacientes con dependencia de alcohol, durante el tratamiento y después del alta. Sin embargo, aún no conocemos el papel que juegan estas variables en la consecución y mantenimiento de la abstinencia y, si éstas, se modifican a lo largo del tiempo. Metodología: Se recogieron datos longitudinalmente relacionados con ansiedad, depresión, impulsividad, estrategias de afrontamiento, sentido de la vida (SV) y asistencia a las asociaciones de ayuda-mutua (AM) de pacientes ambulatorios con dependencia de alcohol (N=159, 66% varones, edad media=42.54 años). Se realizaron evaluaciones basalmente, al alta (después de 2 años de tratamiento), a los 2 y a los 4 años después del alta. Las variables relacionadas con el consumo de alcohol fueron evaluadas con el método Timeline Followback. Resultados: En la evaluación basal, el estilo de afrontamiento evitativo y la impulsividad se asociaron con los meses de abstinencia acumulada a los 4 años. Al alta, y a los 2 años de seguimiento, las puntuaciones altas en el SV se asociaron con los meses de abstinencia acumulada a los 4 años. Los modelos de mediación encontraron que el SV incrementaba los meses de abstinencia acumulada a los 4 años a través del estilo de afrontamiento evitativo y una reducción de los niveles de depresión. Conclusiones: El SV es un componente determinante en la abstinencia a largo plazo. Dado que las asociaciones de AM promueven el SV, éstas deberían ser recomendadas como una parte esencial de un tratamiento integrado de la dependencia de alcohol. (AU)
Several psychological variables have been associated with the prognosis during alcohol dependence treatment and after discharge. However, we still do not know the role that these variables play in the achievement of abstinence and if they modify throughout time. Method: Longitudinal survey data related to anxiety, depression, impulsivity, coping, meaning in life (MiL) and attendance to mutual-help groups were collected from outpatients with alcohol dependence (N= 159, 66% male, mean age=42.54 years). Assessment points were the following: baseline, at discharge (after 2-years of treatment), and 2-years and 4-years follow-up after discharge. Drinking outcomes were evaluated with the Timeline Followback Method Assessment. Results: At baseline, levels of avoidance coping and impulsivity were associated with months of accumulated abstinence at 4-years-follow-up. However, at discharge and at two-years follow-up, higher scores in MiL were consistently associated with months of accumulated abstinence at 4-years of follow-up. Mediation models showed that MiL increased accumulated abstinence at 4 years-follow-up by increasing avoidance coping and reducing levels of depression. Conclusions: MiL is a determining component in the long-term sustained abstinence. Our results support the key role of MiL and point to a new mechanism through which it influences the maintenance of sobriety. Because mutual-help groups have consistently demonstrated to promote MiL, they should be implemented and recommended as an essential part of an integrated treatment of alcohol dependence. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Alcohol Abstinence/psychology , Adaptation, Psychological , Anxiety , Depression , Quality of LifeABSTRACT
Introduction: The consensus on recovery from alcohol use disorder (AUD) has shifted toward encompassing psychological wellbeing and quality of life dimensions. However, few studies have explored the long-term recovery process and its dimensions, timing, styles, and modes. The aim of this study was to investigate the extent, timing, and process of psychological wellbeing and quality of life recovery in alcohol use disorder (AUD) patients, as well as the relationship with classic dimensions of AUD recovery. Method: A cross-sectional study has been carried out with 348 participants with AUD, in different abstinence periods (1 month-28 years), and 171 control subjects. Participants underwent a psychological evaluation, which included self-informed measures of psychological wellbeing, quality of life, negative emotionality, and coping strategies related to alcohol consumption avoidance. Statistical analysis included linear and non-linear regression models between psychological dimensions and maintenance of abstinence, as well as matching the scores of the sample with AUD to those of controls. Scatter plots were used to explore inflection points. In addition, mean comparison tests were performed between participants with AUD and controls and by gender. Results: In general, according to the regression models, there were pronounced increases in indices of wellbeing and coping strategies (and pronounced decreases in negative emotionality) during the first 5 years of abstinence, followed by less pronounced improvements. The matching of AUD subjects in wellbeing and negative emotionality indices with controls occurs at different times: (a) 1 year or less: physical health; (b) 1-4 years: psychological health; (c) 4-10 years: social relationships, wellbeing, and negative emotionality; and (d) more than 10 years: autonomy and self-acceptance. There are statistically significant differences by gender for the negative emotionality and physical health variables. Conclusion: Recovery from AUD is a long process that involves improvements in wellbeing and quality of life. Four stages can be described in this process, with the most pronounced changes occurring during the first 5 years of abstinence. However, AUD patients take more time to obtain similar scores to controls in several psychological dimensions.
ABSTRACT
The cognitive decline in people with substance use disorders is well known and can be found during both the dependence and drug abstinence phases. At the clinical level, cognitive decline impairs the response to addiction treatment and increases dropout rates. It can be irreversible, even after the end of drug abuse consumption. Improving our understanding of the molecular and cellular alterations associated with cognitive decline could be essential to developing specific therapeutic strategies for its treatment. Developing animal models to simulate drug abuse-induced learning and memory alterations is critical to continue exploring this clinical situation. The main aim of this review is to summarize the most recent evidence on cognitive impairment and the associated biological markers in patients addicted to some of the most consumed drugs of abuse and in animal models simulating this clinical situation. The available information suggests the need to develop more studies to further explore the molecular alterations associated with cognitive impairment, with the ultimate goal of developing new potential therapeutic strategies.
ABSTRACT
El objetivo de este trabajo es comprobar si las recaídas dificultan lasecuencia de la recuperación psicológica y reconstruir la secuenciade la recuperación de pacientes graves que solicitan tratamiento.Los participantes fueron 159 pacientes tratados durante dos años enun programa ambulatorio intensivo y tras ser dados de alta fueronseguidos durante cuatro años. En función de la presencia o no derecaída durante el seguimiento se configuraron dos grupos, elde abstinentes (n = 80) y el de pacientes que recaen (n = 79). Lasevaluaciones se realizaron: basal, al alta del tratamiento, al 2.º y 4.ºaño de seguimiento. Las variables fueron: conductas de evitación,ansiedad, depresión, impulsividad y sentido de la vida. Se incluyó ungrupo de control (n = 74) que fue evaluado con la misma cadencia quelos pacientes. Los resultados indican una recuperación más lenta en elgrupo con recaídas frente a los abstinentes, en todas las dimensionespsicológicas y los períodos estudiados. A los dos años de seguimiento,los pacientes abstinentes obtuvieron puntuaciones en depresiónsimilares a los controles, además de puntuaciones superiores ensentido de la vida (MiL) a partir del final del tratamiento. Al menosen pacientes con dependencia grave del alcohol, nuestros resultadosapoyan una secuencia de recuperación que podría continuar másallá de los cuatro años de seguimiento. Se inicia con la evitaciónde situaciones de riesgo y continúa con el resto de las dimensiones(ansiedad, depresión, impulsividad). (AU)
The aim of this work is to determine if relapses can hinder thesequence of psychological recovery and to rebuild this sequence inpatients with severe alcohol dependence that seek treatment. Thesample was comprised of 159 patients seeking an intensive outpatienttreatment of two years duration and who were subject to follow-upduring four years after discharge. Patients were grouped accordingto the presence of relapse during follow-up, resulting in abstainers(n = 80) and relapsers (n = 79). Assessments were carried out in thefollowing periods: baseline, at discharge, and at the second- andfourth-year follow-ups. The measurement variables were avoidancebehavior, anxiety, depression, impulsivity and meaning in life (MiL).A control group (n = 74) was evaluated at the same periods as thepatients. Results indicate a slower recovery in relapsers in comparisonto abstainers in all psychological dimensions and periods assessed. Atthe second-year follow-up, the abstainers achieved similar scores indepression as the control participants, in addition to higher scoresin Meaning in Life at the end of treatment. In patients with severealcohol dependence, our data supports a sequence of recovery thatcould continue beyond the four years of follow-up after treatment.This sequence would begin with the avoidance of risk situations andcontinue with the rest of dimensions (anxiety, depression, impulsivity). (AU)
Subject(s)
Humans , Mental Health Recovery , Treatment Outcome , Treatment Adherence and Compliance/psychology , Alcoholism/psychology , Alcoholism/rehabilitation , Alcoholism/therapy , Alcohol Abstinence/psychology , Quality of Life/psychologyABSTRACT
The aim of this work is to determine if relapses can hinder the sequence of psychological recovery and to rebuild this sequence in patients with severe alcohol dependence that seek treatment. The sample was comprised of 159 patients seeking an intensive outpatient treatment of two years duration and who were subject to follow-up during four years after discharge. Patients were grouped according to the presence of relapse during follow-up, resulting in abstainers (n = 80) and relapsers (n = 79). Assessments were carried out in the following periods: baseline, at discharge, and at the second- and fourth-year follow-ups. The measurement variables were avoidance behavior, anxiety, depression, impulsivity and meaning in life (MiL). A control group (n = 74) was evaluated at the same periods as the patients. Results indicate a slower recovery in relapsers in comparison to abstainers in all psychological dimensions and periods assessed. At the second-year follow-up, the abstainers achieved similar scores in depression as the control participants, in addition to higher scores in Meaning in Life at the end of treatment. In patients with severe alcohol dependence, our data supports a sequence of recovery that could continue beyond the four years of follow-up after treatment. This sequence would begin with the avoidance of risk situations and continue with the rest of dimensions (anxiety, depression, impulsivity).
El objetivo de este trabajo es comprobar si las recaídas dificultan la secuencia de la recuperación psicológica y reconstruir la secuencia de la recuperación de pacientes graves que solicitan tratamiento. Los participantes fueron 159 pacientes tratados durante dos años en un programa ambulatorio intensivo y tras ser dados de alta fueron seguidos durante cuatro años. En función de la presencia o no de recaída durante el seguimiento se configuraron dos grupos, el de abstinentes (n = 80) y el de pacientes que recaen (n = 79). Las evaluaciones se realizaron: basal, al alta del tratamiento, al 2.º y 4.º año de seguimiento. Las variables fueron: conductas de evitación, ansiedad, depresión, impulsividad y sentido de la vida. Se incluyó un grupo de control (n = 74) que fue evaluado con la misma cadencia que los pacientes. Los resultados indican una recuperación más lenta en el grupo con recaídas frente a los abstinentes, en todas las dimensiones psicológicas y los períodos estudiados. A los dos años de seguimiento, los pacientes abstinentes obtuvieron puntuaciones en depresión similares a los controles, además de puntuaciones superiores en sentido de la vida (MiL) a partir del final del tratamiento. Al menos en pacientes con dependencia grave del alcohol, nuestros resultados apoyan una secuencia de recuperación que podría continuar más allá de los cuatro años de seguimiento. Se inicia con la evitación de situaciones de riesgo y continúa con el resto de las dimensiones (ansiedad, depresión, impulsividad).
Subject(s)
Alcoholism , Humans , Follow-Up Studies , Alcoholism/therapy , Alcoholism/psychology , Outpatients , Anxiety/therapy , Anxiety Disorders , RecurrenceABSTRACT
The heterogeneity of the population with alcohol use disorder (AUD) sometimes makes the knowledge generated in areas such as neuroscience appear to be contradictory. One aspect that may help elucidate this apparent contradiction is controlling for certain variables that are not usually controlled, such as the abstinence time in people with AUD. This research aims to study the neuroelectrical oscillations in people with AUD with longer and shorter abstinence time in comparison with healthy individuals. We recruited twenty-nine individuals with AUD with abstinence time longer than fifteen days and shorter than six months (STA), twenty-six individuals with AUD with abstinence time longer than six months and shorter than thirteen months (LTA), and sixteen healthy individuals (HC). All participants underwent electroencephalographic recording in resting-state with eyes closed. The oscillatory activity obtained was analyzed to obtain the spectral power and phase synchronization level. Regarding the obtained spectral power results, these revealed that the STA group showed higher theta band power and lower alpha band power than the LTA and HC groups. The obtained results at the phase synchronization level also show two main results. On the one hand, the STA group showed lower alpha band phase synchronization than the LTA and HC groups. On the other hand, the HC group showed higher beta band phase synchronization than the STA and LTA groups. In conclusion, the obtained results reflect that abstinence maintenance for six or more months appears to produce an important oscillatory brain functioning normalization in people with AUD.
Subject(s)
Alcohol Abstinence , Alcoholism , Alcohol Drinking , Brain , Electroencephalography , HumansABSTRACT
Recovery from alcohol use disorder involves achieving certain resources for positive lifestyle changes, well-being, and long-term abstinence. The present study aims to translate and validate the Assessment Capital Recovery (ARC) in a Spanish clinical sample of individuals with alcohol use disorder, in abstinence. The participants were 184 patients who attended outpatient treatments. They were evaluated with the adapted version of the ARC (Spanish abbreviation: "Valoración del Capital de Recuperación, VCR") and by WHOQOL-BREF (quality of life scale), in one session. Statistical analysis included the calculation of reliability, convergent validity (relationship with WHOQOL-BREF), specificity and sensitivity, as well as validity based on internal structure (confirmatory factor analysis). VCR scores show appropriate values for reliability (α = .90), and a low convergent validity with WHOQOL-BREF (Rho = .33-.53). The VCR appears to distinguish between patients with early and stable sobriety (χ2 = 20.55, p < .01). The ROC curve indicates significant discrimination values (p < .05) for stable recovery (5 years of abstinence) and sensitivity of 85.2% and specificity of 71.2%. Further, confirmatory factor analysis suggests the presence of a single factor, with relatively acceptable values of goodness of fit and factor loadings. We used ULS parameter estimation to study VCR properties, an appropriate tool for assessing recovery in clinical populations of individuals with alcohol use disorder in abstinence.
Subject(s)
Alcoholism , Humans , Psychometrics , Quality of Life , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
Structural brain damages caused by chronic alcohol consumption have been extensively reported. However, the neuroimaging findings in people with alcohol use disorder (AUD) are relatively inconsistent. This inconsistency may be due to the influence of different variables that are not always considered, such as the presence of a family history of alcoholism (FHA). The main aim of this research is to study the gray (GM) and white matter (WM) volumes in male participants with AUD without FHA compared to healthy control males (HC) without FHA. For this study, we included 19 participants with AUD without FHA and 18 HC males without FHA. T1-weighted images were acquired with a General Electric Signa Exite 1.5 T scanner. GM and WM tissues were calculated using Diffeomorphic Anatomical Registration Through Exponentiated Lie algebra (DARTEL). All analyses were controlled for age and total brain volume. The statistical threshold was calculated with AlphaSim and further adjusted to account for the non-isotropic smoothness of structural images, according to Hayasaka et al. (2004). The obtained main results showed that, relative to the HC group, the participants with AUD without FHA had significantly lower GM in several brain structures, reflecting relatively purely the effects of chronic alcohol intake on brain volume. GM structure integrity is relevant for the efficient functioning of low and high-order cognitive processes used in everyday life, and its damage seems to be related to the severity/intensity/chronicity of the AUD. As such, it becomes relevant to assess and follow brain structural changes through the dependence course.
Subject(s)
Alcoholism , Alcohol Drinking , Alcoholism/diagnostic imaging , Alcoholism/psychology , Brain/diagnostic imaging , Gray Matter/diagnostic imaging , Humans , Magnetic Resonance Imaging/methods , Male , NeuroimagingABSTRACT
Recovery from alcohol use disorder involves achieving certain resources for positive lifestyle changes, well-being, and long-term abstinence. The present study aims to translate and validate the Assessment Capital Recovery (ARC) in a Spanish clinical sample of individuals with alcohol use disorder, in abstinence. The participants were 184 patients who attended outpatient treatments. They were evaluated with the adapted version of the ARC (Spanish abbreviation: Valoración del Capital de Recuperación, VCR) and by WHOQOL-BREF (quality of life scale), in one session. Statistical analysis included the calculation of reliability, convergent validity (relationship with WHOQOL-BREF), specificity and sensitivity, as well as validity based on internal structure (confirmatory factor analysis). VCR scores show appropriate values for reliability (α = .90), and a low convergent validity with WHOQOL-BREF (Rho = .33.53). The VCR appears to distinguish between patients with early and stable sobriety (χ2 = 20.55, p < .01). The ROC curve indicates significant discrimination values (p < .05) for stable recovery (5 years of abstinence) and sensitivity of 85.2% and specificity of 71.2%. Further, confirmatory factor analysis suggests the presence of a single factor, with relatively acceptable values of goodness of fit and factor loadings. We used ULS parameter estimation to study VCR properties, an appropriate tool for assessing recovery in clinical populations of individuals with alcohol use disorder in abstinence. (AU)
Subject(s)
Humans , Alcoholism , Psychometrics , Quality of Life , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
OBJECTIVES: Psychological factors influence clinical outcomes in patients with coronary artery disease (CAD). Therefore, psychological interventions (PIs) may have beneficial effects in these patients. We evaluated the efficacy of PIs based on cognitive-behavioral therapy (CBT) and positive psychology therapy (PPT) on clinical and laboratory outcomes in CAD. METHODS: Randomized controlled trials evaluating CBT or PPT in CAD patients published until May 2020 were systematically reviewed and analyzed. Primary outcomes were all-cause mortality, cardiovascular mortality, any cardiovascular event, myocardial infarction (MI), stroke, coronary revascularization, angina, and readmission. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as risk ratios (RR) or standardized mean difference (SMD) with 95% confidence intervals (CIs). RESULTS: Twenty-five trials were included (n = 8119); 22 evaluating the effects of multi-component CBT (n = 7909), and three PPT (n = 210). Thirteen RCTs were at high risk of bias due to limitations in randomization or blinding. Compared with control groups any cardiovascular event (RR 0.82; 0.70 to 0.97; 5 studies), MI (RR 0.72; 0.52 to 0.98; 9 studies), and angina duration and intensity (SMD -0.64; -0.98 to -0.30; 4 studies; and -0.64; -1.17 to -0.11; 2 trials) were significantly reduced with PIs at the end of follow-up. PIs had no effect on other primary outcomes, laboratory or anthropometrical results and presented a moderate to high heterogeneity. CONCLUSIONS: CBT- and PPT-based PIs reduce the risk of cardiovascular events, MI and angina in patients with CAD. Future research should assess the individual role of CBT and PPT in CAD populations.
Subject(s)
Cognitive Behavioral Therapy , Coronary Artery Disease , Myocardial Infarction , Coronary Artery Disease/therapy , Humans , Myocardial Infarction/therapy , Psychosocial InterventionABSTRACT
El trastorno depresivo mayor (TDM) constituye una complicación común del embarazo y el período posparto. Aproximadamente un 5% de mujeres que presentan un TDM durante la gestación o el periodo postparto cumplen criterios paradepresión resistente, asociándose con un incremento de lamorbilidad tanto en el recién nacido como en la propia gestante. En la actualidad disponemos de diferentes opcionesterapéuticas para el tratamiento del TDM durante el embarazo si bien en los casos de resistencia durante el embarazolos criterios de tratamiento no se encuentran tan bien establecidos.Presentamos el caso de una mujer de 36 años de edadque desarrolló un episodio de depresión mayor resistente altratamiento farmacológico. Durante el episodio actual y trascuatro ciclos de tratamiento farmacológico fallido se quedóembarazada. A las 16 semanas de gestación fue tratada conestimulación magnética transcraneal repetitiva (EMTr) debaja frecuencia. Tras 30 sesiones de tratamiento, con buenatolerancia, la paciente presentó una recuperación completade la sintomatología depresiva, dando a luz a un recién nacido sano. La EMTr constituye una buena alternativa frente a laTerapia Electroconvulsiva en algunos casos de TDM resistentedurante la gestación. A pesar de estos hallazgos prometedores, se requiere de un mayor número de estudios controlados,doble ciego que incluyan muestras amplias de pacientes embarazadas, con parámetros EMTr bien diseñados, e inclusoestudios prospectivos (siguiendo a mujeres embarazadas ysus descendientes) para confirmar la ausencia de efectos secundarios a largo plazo. (AU)
Major depressive disorder (MDD) is a common complication of pregnancy and the postpartum period. Approximately 5% of women who have MDD during pregnancy orthe postpartum period meet criteria for resistant depression,associated with increased morbidity in both the newbornand the pregnant woman. Currently we have different therapeutic options for the treatment of MDD during pregnancy,although in cases of resistance during that period the treatment criteria are not that well established.We set out the case of a 36-year-old woman who presents an episode of major depression resistant to pharmacotherapy. During the current episode and after four cycles offailed pharmacological treatment she became pregnant. Inthe 16th week of gestation, she was treated with low-frequency repetitive transcranial magnetic stimulation (rTMS).After 30 treatment sessions, with good tolerance, the patient presented a complete recovery from the depressivesymptoms, giving birth to a healthy newborn. rTMS is a goodalternative to Electroconvulsive Therapy in some cases ofresistant MDD during pregnancy. Despite these promisingfindings, further double-blind controlled studies with broadsamples of pregnant women are required, with well-designed rTMS parameters, and even prospective studies (following pregnant women and their offspring) to confirm theabsence of long-term side effects. (AU)
Subject(s)
Humans , Female , Adult , Pregnancy , Drug Therapy , Depressive Disorder, Major , PatientsABSTRACT
Major depressive disorder (MDD) is a common complication of pregnancy and the postpartum period. Approximately 5% of women who have MDD during pregnancy or the postpartum period meet criteria for resistant depression, associated with increased morbidity in both the newborn and the pregnant woman. Currently we have different therapeutic options for the treatment of MDD during pregnancy, although in cases of resistance during that period the treatment criteria are not that well established.
Subject(s)
Depression, Postpartum , Depressive Disorder, Major , Pregnancy Complications , Antidepressive Agents/therapeutic use , Depression , Depressive Disorder, Major/drug therapy , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications/drug therapyABSTRACT
BACKGROUND: The benefits of cognitive-behavioral treatment (CBT) and positive psychology therapy (PPT) in patients with cardiovascular disease are still not well defined. We assessed the efficacy of CBT and PPT on psychological outcomes in coronary artery disease (CAD) patients. METHODS: Randomized controlled trials evaluating CBT or PPT in CAD patients published until May 2018 were systematically analyzed. Primary outcomes were depression, stress, anxiety, anger, happiness, and vital satisfaction. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as standardized mean difference (SMD) or mean differences (MD) with their 95% confidence intervals (CIs); risk of bias was assessed with the Cochrane tool. RESULTS: Nineteen trials were included (n = 1956); sixteen evaluated CBT (n = 1732), and three PPT (n = 224). Compared with control groups, depressive symptoms (13 trials; SMD -0.80; 95% CI -1.33 to -0.26), and anxiety (11 trials; SMD -1.26; 95% CI -2.11 to -0.41) improved after the PI, and depression (6 trials; SMD -2.08; 95% CI -3.22 to -0.94), anxiety (5 trials; SMD -1.33; 95% CI -2.38 to -0.29), and stress (3 trials; SMD -3.72; 95% CI -5.91 to -1.52) improved at the end of follow-up. Vital satisfaction was significantly increased at follow-up (MD 1.30, 0.27, 2.33). Non-significant effects on secondary outcomes were found. Subgroup analyses were consistent with overall analyses. CONCLUSION: CBT and PPT improve several psychological outcomes in CAD patients. Depression and anxiety improved immediately after the intervention while stress and vital satisfaction improve in the mid-term. Future research should assess the individual role of CBT and PPT in CAD populations.
Subject(s)
Cognitive Behavioral Therapy , Coronary Artery Disease/psychology , Psychosocial Intervention , Anxiety/therapy , Depression/therapy , Humans , Stress, Psychological/psychologyABSTRACT
Studying the functioning of the frontal lobe during the performance of an inhibitory activity according to automatic tendency of action would allow a better understanding of the relationship between the reflexive and impulsive system described in the dual-process models. This study aims to prove which is the inhibitory capacity and the underlying brain activity of people with alcohol-use disorder in abstinence with a greater avoidance tendency compared to those with a higher approach tendency and healthy controls. In order to group participants with AUD, the total approach/avoidance index (TAAI) - obtained from the modified alcohol approach/avoidance task - was used, therefore resulting in three groups: TAAI- (TAAI < Percentile 35: nâ¯=â¯20), TAAI± (TAAIâ¯=â¯Percentile 35-65: nâ¯=â¯20) and TAAI+ (TAAI > Percentile 65: nâ¯=â¯20). In addition to this, 15 healthy controls were recruited. They all had an electroencephalographic recording while completing the modified stop-signal task. The results showed that the TAAI+ group had a worse inhibition compared to healthy controls. Moreover, the TAAI+ group showed a hyperactivation of the inferior frontal gyrus, precentral gyrus and orbital gyrus compared to the healthy controls group and the TAAI- group. The results obtained reflect that those people with AUD with a tendency to approach alcohol have a worse inhibitory capacity and a frontal hyperactivation. Moreover, people with AUD with an avoidance tendency to alcohol have also been found to have a similar inhibitory capacity and frontal activation to healthy controls.
Subject(s)
Alcoholism , Inhibition, Psychological , Frontal Lobe , Humans , Impulsive Behavior , Prefrontal CortexABSTRACT
Addiction management is complex, and it requires a bio-psycho-social perspective, that ought to consider the multiple etiological and developmental factors. Because of this, a large amount of resources has been allocated to assess the vulnerability to dependence, i.e., to identify the processes underlying the transition from substance use to dependence, as well as its course, in order to determine the key points in its prevention, treatment, and recovery. Consequently, knowledge \from neuroscience must be taken into account, which is why different initiatives have emerged with this objective, such as the "Research Domain Criteria" (RDoC), and the "Addiction Neuroclinical Assessment" (ANA). Particularly, neuropsychophysiological measures could be used as markers of cognitive and behavioral attributes or traits in alcohol dependence, and even trace clinical change. In this way, the aim of this narrative review is to provide an overview following ANA clinical framework, to the most robust findings in neuropsychophysiological changes in alcohol dependence, that underlie the main cognitive domains implicated in addiction: incentive salience, negative emotionality, and executive functioning. The most consistent results have been found in event-related potential (ERP) analysis, especially in the P3 component, that could show a wide clinical utility, mainly for the executive functions. The review also shows the usefulness of other components, implicated in affective and substance-related processing (P1, N1, or the late positive potential LPP), as well as event-related oscillations, such as theta power, with a possible use as vulnerability or clinical marker in alcohol dependence. Finally, new tools emerging from psychophysiology research, based on functional connectivity or brain graph analysis could help toward a better understanding of altered circuits in alcohol dependence, as well as communication efficiency and effort during mental operations. This review concludes with an examination of these tools as possible markers in the clinical field and discusses methodological differences, the need for more replicability studies and incipient lines of work. It also uses consistent findings in psychophysiology to draw possible treatment targets and cognitive profiles in alcohol dependence.
ABSTRACT
There is supporting evidence of alcohol negative effects on the brain: neuroimaging and psychophysiological studies finding anatomical and functional connectivity (FC) changes associated with the dependence process. Thus, the aim of this work was to evaluate brain FC and network characteristics of alcohol-dependent individuals in resting state. For this study, we included males diagnosed with alcohol dependence (N = 25) and a group of healthy individuals (N = 23). Simultaneous EEG-MEG (electroencephalographic and magnetoencephalographic) activity was recorded in 5 min of eyes-closed resting state. EEG-MEG activity was preprocessed and FC was computed through the leakage-corrected version of phase locking value (ciPLV). Additionally, local (degree, efficiency, clustering) and global (efficiency, characteristic path length) network parameters were computed. Connectivity analysis showed an increase in phase-lagged synchronization, mainly between frontal and frontotemporal regions, in high beta band, and a decrease in interhemispheric gamma, for alcohol-dependent individuals. Network analysis revealed intergroup differences at the local level for high beta, indicating higher degree, clustering, and efficiency, mostly at frontal nodes, together with a decrease in these measures at more posterior sites for patients' group. The hyper-synchronization in beta, next to the hypo-synchronization in gamma, could indicate an alteration in communication between hemispheres, but also a possible functional compensation mechanism in neural circuits. This could be also supported by network characteristic data, where local alterations in communication are observed.
Subject(s)
Alcoholism/diagnosis , Alcoholism/physiopathology , Electroencephalography/methods , Frontal Lobe/physiopathology , Magnetoencephalography/methods , Nerve Net/physiopathology , Adult , Alcoholism/therapy , Female , Humans , Male , Middle Aged , Rest/physiologyABSTRACT
The high heterogeneity of psychiatric disorders leads to a lack of diagnostic precision. Therefore, the search of biomarkers is a fundamental aspect in psychiatry to reach a more personalized medicine. The endocannabinoid system (ECS) has gained increasing interest due to its involvement in many different functional processes in the brain, including the regulation of emotions, motivation, and cognition. This article reviews the role of the main components of the ECS as biomarkers in certain psychiatric disorders. Studies carried out in rodents evaluating the effects of pharmacological and genetic manipulation of cannabinoid receptors or endocannabinoids (eCBs) degrading enzymes were included. Likewise, the ECS-related alterations occurring at the molecular level in animal models reproducing some behavioral and/or neuropathological aspects of psychiatric disorders were reviewed. Furthermore, clinical studies evaluating gene or protein alterations in post-mortem brain tissue or in vivo blood, plasma, and cerebrospinal fluid (CSF) samples were analyzed. Also, the results from neuroimaging studies using positron emission tomography (PET) or functional magnetic resonance (fMRI) were included. This review shows the close involvement of cannabinoid receptor 1 (CB1r) in stress regulation and the development of mood disorders [anxiety, depression, bipolar disorder (BD)], in post-traumatic stress disorder (PTSD), as well as in the etiopathogenesis of schizophrenia, attention deficit hyperactivity disorder (ADHD), or eating disorders (i.e. anorexia and bulimia nervosa). On the other hand, recent results reveal the potential therapeutic action of the endocannabinoid tone manipulation by inhibition of eCBs degrading enzymes, as well as by the modulation of cannabinoid receptor 2 (CB2r) activity on anxiolytic, antidepressive, or antipsychotic associated effects. Further clinical research studies are needed; however, current evidence suggests that the components of the ECS may become promising biomarkers in psychiatry to improve, at least in part, the diagnosis and pharmacological treatment of psychiatric disorders.
ABSTRACT
The use of the cognitive-bias modification (CBM) method has emerged as a therapeutic complement in the treatment of alcoholism, producing changes at behavioral and brain level. Nevertheless, the impact of the CBM procedure could be improved by the memory retrieval-extinction process (REP). Different studies have demonstrated that the retrieval of drug memories before extinction training later reduced the reinstatement of drug-seeking behavior. The main aim of this work was to study the effect of the CBM procedure itself, as well as in combination with the activation of alcohol-related memories, on the brain oscillatory activity of abstinent patients with alcohol-use disorder. The study sample comprised 33 patients divided into three groups: A-CBM (alcohol-related memory activationâ¯+â¯CBM), N-CBM (neutral memory activationâ¯+â¯CBM) and N-INT (no-intervention) groups. A resting-state EEG was obtained before and after each protocol, along with the assessment of the automatic action tendencies. A-CBM group showed a general alpha synchronization increase after the protocol, while the other groups did not show any significant change. Besides, A-CBM group showed significant intra and inter-group differences in the automatic action tendencies after the protocol, reflected in higher avoidance bias toward appetitive, aversive and without context alcohol-related stimuli. The alpha phase synchronization increase could be the neural manifestation of the conditioning produced between the alcohol-related stimuli and the automatic avoidance response. Moreover, the activation of the alcohol-related memories favors this conditioning with those alcohol-related stimuli associated with the activated memories, because it increases their threat level for the abstinence maintenance.