Assessment of the Effectiveness of an Exposure Technique Intervention in a Case of Amaxophobia

Amaxophobia, or driving phobia, is an anxiety disorder; more specifically a situational phobia (SP). Main symptoms of SP may include an excessive and irrational fear to certain stimuli, to which exposure produces high anxiety levels, as well as the development of avoidance mechanisms or confrontation, at the expense of a high distress. Its prognosis is chronic in the absence of treatment, but empirical evidence reveals a high efficacy of psychological interventions based on exposure techniques. The case of a 47 years old female requesting treatment for an intense driving fear is presented. The assessment was made through an ad hoc self-report of anxiogenic episodes, the Short Form Health Survey (SF-12), the General Health Questionnaire (GHQ-28), the Perceived Stress Scale (PSS-14), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). It was conducted a cognitive-behavioral intervention based on imagination and real life exposure techniques, along with breathing and relaxation techniques. After 10 sessions her anxiety levels and her negative affects decreased significantly, allowing her to resume driving and revealing the efficacy of the intervention (AU)

Impact of quality management systems in the performance of educational centers: educational policies and management processes.

In this paper, the findings of an I + D + i research are presented. In this study, an analysis was conducted to assess 14 educational centers where in one of two distinct quality systems had been implemented: the EFQM (European Foundation Quality Management) and el Proyecto de Calidad Integrado (PCI)-the Integrated Quality Project-promoted by the Horrêum Foundation (Álvarez and Santos, 2003; Villa and Marauri, 2004). The EFQM was first used by businesses before being recently transferred to the academics. It comprised nine factors that were translated in an educational context: leadership, policy and strategy, people, alliances and resources, processes, impact on people, impact on clients, impact on society, and key impacts of an organization. The first five factors examine the way activities are carried out and improved, and the final four focus on the impact, i.e., the effect of the organization's activities. Improvement is achieved through learning and innovation. The PCI (Muñoz and Sarasúa, 2005) has its educational origins in the Effective School Improvement model. Seven factors are analyzed (Sarasola et al., 2003; Villa et al., 2004): institutional approach, organizational structures, relationships and living together, counseling and tutoring, curriculum, family and the community (Martínez and Galíndez, 2003), and management and services. The study looks at the impact that the two aforementioned quality systems (EFQM and PCI) have had on educational centers. The term "impact" is understood as the changes experienced both inside and outside an educational center. It must be sustainable overtime, considering the changes and effects achieved, as evidence of improvement. The quantitative analysis focuses on two dimensions. The first addresses three key factors of educational policy: educational planning, communication, and support and rewards for teachers. The second comprises three factors linked to management processes in educational institutions: organizational climate, teaching and learning processes, and relationships with the community.

Olanzapina y consumo de cocaína en programas de mantenimiento con metadona: nuevos resultados / Olanzapine and cocaine consumption in methadone maintenance programs: new results

OBJETIVO: Evaluar el uso de olanzapina como tratamiento de reducción del uso de cocaína en programas de mantenimiento con metadona. PACIENTES Y MÉTODO: Se ha aplicado un diseño de cuadrado latino sobre 45 sujetos adscritos a tres programas de mantenimiento con metadona. Se utilizaron dos variables de bloqueo; la dosis de dispensación de metadona (con tres concentraciones: 81 mg/día) y la frecuencia de consumo de cocaína durante los 3 meses previos al inicio del tratamiento (también con tres concentraciones: sin consumo, 21 por ciento de determinaciones en orina positivas). La variable independiente dosis de olanzapina (con tres niveles: 0, 5 y 10 mg/día) se aplicó según el protocolo del diseño. Los sujetos recibían, junto a su dosis diaria de metadona, el tratamiento de olanzapina correspondiente a su asignación en el diseño. La variable resultado fue el porcentaje de consumos de cocaína estimado por control de orinas mediante inmunoanálisis, durante los 3 meses posteriores al inicio del tratamiento. Durante este período se recogió una prueba de orina semanal; en 37 sujetos se hicieron 12 controles y en 8 casos 13. RESULTADOS: El análisis de la varianza por descomposición de las fuentes de variación propio de un diseño de cuadrado latino ha ofrecido un efecto significativo para el tratamiento (F(2,36) = 17,19; p < 0,001) y para un efecto de interacción (F(2,36) = 12,47; p < 0,001). La proporción media de controles positivos entre los sujetos sin tratamiento ha sido del 22,6 por ciento, y entre los que han recibido tratamiento con olanzapina ha sido del 4,2 por ciento en los sujetos con dosis de 5 mg/día, y de 3,8 por ciento entre los tratados con 10 mg/día. CONCLUSIONES: Se evidencia un efecto significativo del tratamiento con olanzapina en la reducción del consumo de cocaína en usuarios participantes en un programa de mantenimiento con metadona. No obstante, la presencia de efectos de interacción obliga a ser cautos en la valoración de los resultados, y sería conveniente que se realizaran nuevos diseños que permitieran un mayor control de los efectos de las variables intervinientes (AU)

Evaluación de la satisfacción con el tratamiento en un centro ambulatorio de drogodependencias a través del 'Treatment Perceptions Questionnaire' (TPQ) / Evaluation of a 'Community drug service' treatment satisfaction using the 'Treatment Perceptions Questionnaire' (TPQ)

Se valora mediante el 'Treatment Perceptions Questionnaire (TPQ)' el nivel de satisfacción reflejado por 100 usuarios de un Centro de Tratamiento de Toxicomanías, así como las posibles diferencias manifestadas en dos programas específicos del mismo: el Programa Libre de Drogas (n=50) y el Programa de Mantenimiento con Metadona (n=50). Para ello se realiza un estudio observacional de corte transversal donde los sujetos son seleccionados de forma sistematizada. Los resultados muestran un nivel aceptable de satisfacción, que se expresa en mayor medida entre los usuarios del programa libre de drogas tanto respecto a la puntuación total del instrumento como atendiendo a sus dos dimensiones: satisfacción con el programa y satisfacción con el equipo terapeútico. La comparación de los resultados de la muestra total con los datos ofrecidos en otras tres muestras europeas evidencia una equivalencia en las puntuaciones totales de satisfacción, pero diferencias en las puntuaciones por subdimensiones. El TPQ se muestra como un instrumento útil el cual nos permite con un mínimo de requerimiento personal y de tiempo obtener una visión más clara de cómo nos perciben nuestros usuarios (AU)

Satisfaction level reflected by 100 Drug Treatment Centre users is evaluated through a Treatment Perceptions Questionnaire (TPQ), in addition to the possible differences shown in two specific programmes within the TPQ: the Free Drugs Programme (n=50) and the Methadone Maintenance Programme (n=50). Cross section observational study is carried out with a systematic selection of subjects. The results show an acceptable level of satisfaction, expressed mainly among the drug-free programme users, with regard to the total instrument score, as well as its two dimensions: satisfaction with the programme and satisfaction with the therapist staff. Total sample results compared with three other European sample data show equivalence in the total satisfaction score, but differences in the sub-dimension scores. The TPQ is shown to be a useful instrument, which with a minimum number of personnel and time, enables us to obtain a clearer view of how our users see us (AU)

Ecstasy-induced psychotic disorder: six-month follow-up study.

OBJECTIVE: To describe the psychiatric symptoms manifested by persons diagnosed for the first time as having ecstasy-induced psychotic disorder and to explore the evolution of their symptoms over a 6-month period. DESIGN: Observational study with a 6-month follow-up. METHOD: The subjects studied were 32 ecstasy consumers who were treated at two drug-dependency outpatient centers for hallucinatory-delusive manifestations and who were diagnosed as having ecstasy-induced psychotic disorder according to DSM-IV criteria. For the assessment of the intensity of the syndrome and its follow-up, the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI) were used at the outset and after 1, 3 and 6 months. All subjects received treatment with olanzapine. RESULTS: The treatment program was completed by 96.9% of the patients. At the baseline assessment, a high incidence of symptoms of a severe psychiatric disorder was observed. From the first month the psychotic symptoms (BPRS) were considerably reduced with treatment, with the most severe positive symptoms remitting in the first 3 months. The three assessment indicators (BPRS, HDRS and CGI) showed a statistically significant clinical reduction over the 6 months of the assessment period. Furthermore, no relevant side effects were noted. CONCLUSIONS: In its initial manifestations, a drug-induced psychotic syndrome includes marked symptoms meeting the criteria of a severe psychotic disorder, with the presence of considerable positive and negative symptoms. Olanzapine has been shown to be very effective in these situations and its use is suggested as first-choice therapy.

Consumo de sustancias durante un programa de mantenimiento con metadona / Drug use during a methadone maintenance program

OBJETIVO: Examinar el grado de consumo de heroína y cocaína durante la permanencia en un programa de mantenimiento con metadona (PMM), así como explorar los factores asociados con el uso de estas sustancias. MÉTODO: Se utilizó un diseño longitudinal prospectivo sobre 376 pacientes en metadona, de quienes se obtuvieron datos sociodemográficos, de historia adictiva y de tratamiento, así como determinaciones en orina de metadona, heroína y cocaína durante un período de 13 meses. RESULTADOS Y CONCLUSIONES: El estudio refleja una considerable prevalencia de consumo de sustancias durante el tratamiento. La heroína es consumida en alguna ocasión por un 72,9 por ciento, de forma continuada por un 9 por ciento y con alta frecuencia por un 27,4 por ciento. Por su parte, la cocaína es consumida en alguna ocasión por un 46,1 por ciento, de forma continua por un 10,8 por ciento y con alta frecuencia por un 20,9 por ciento. Los análisis de regresión lineal presentan como factores predictores del consumo de heroína el consumo al mismo tiempo de cocaína (beta = 0,33) y la permanencia en el programa (beta = -0,10). Análogamente, el único predictor del consumo de cocaína ha sido el consumo de heroína (beta = 0,33). (AU)

Formas de afrontamiento y afectividad en personas con VIH/SIDA. Diferencias entre toxicómanos y no toxicómanos / Ways of coping and their effectiviness in people with HIV/AIDS. Differences between drug users and non-drug users

Objetivo: Examinar las diferencias en las formas de afrontamiento de la seropositividad a VIH entre personas toxicómanas y no toxicómanas afectadas, y explorar la relación entre las formas de afrontamiento de la seropositividad y la afectividad. DISEÑO.- Transversal, comparación de dos grupos. Método: 105 sujetos seropositivos a VIH (50 toxicómanos y 55 no-toxicómanos) son evaluados a través de un cuestionario que agrupa escalas de afrontamiento de la seropositividad, variables del estado de ánimo (depresión, ansiedad y afectividad) y el apoyo social objetivo y subjetivo. Resultados: No se encuentran diferencias en la forma de afrontar la seropositividad entre los grupos, ni tampoco respecto a la afectividad. Un análisis correlacional muestra que las formas de afrontamiento activas, tanto cognitivas como conductuales, están asociadas (p<0,05) a una mayor afectividad positiva (r=0,45) y a una menor ansiedad (r=-0,24), mientras las formas evitantes están asociadas a una mayor depresión (r=0,31), afectividad negativa (r=0,31), ansiedad rasgo (r=0,33), y ansiedad estado (r=0,21). Conclusión: Los resultados del estudio guardan concordancia con los encontrados en la literatura, que muestran una relación positiva entre las formas activas y la afectividad, así como una asociación negativa de ésta con las formas evitantes (AU)

Olanzapina y consumo de cocaína en programa de mantenimiento con metadona / Olanzapine and cocaine consumption in a methadone maintenance program

OBJETIVOS: Se evalúa el tratamiento con olanzapina de 27 pacientes en programa de metadona con consumos reiterados de cocaína sin sintomatología psicótica. PACIENTES Y MÉTODO: Los pacientes son seleccionados entre aquellos que reiteradamente presentan análisis de orina positivos a cocaína durante un período de 6 meses. Los pacientes que aceptan ser incluidos en el estudio recibieron 10 mg/24 h de olanzapina durante los 6 meses siguientes. RESULTADOS: Se produjo una disminución muy significativa de los resultados de los análisis de orina positivos tanto a cocaína como a heroína (cocaína, el 36,73 frente al 2,38 por ciento; heroína, el 16,60 frente al 4,35 por ciento); asimismo, se registró una disminución de la dosis media de metadona entre los 6 meses previos y los seis durante los que se administró olanzapina. De los 27 pacientes, cinco abandonaron el estudio. DISCUSIÓN: Parece ser que la olanzapina puede favorecer el cumplimiento del programa de metadona, ya que disminuye de forma importante el consumo de cocaína y/o heroína, y permite una reducción de la dosis diaria de metadona (AU)

Formas de afrontamiento y afectividad en personas con VIH/SIDA / Coping and affectivity in persons with HIV/AIDS

Objetivo: Examinar las diferencias en las formas de afrontamiento de la seropositividad a VIH entre personas toxicómanas y no toxicómanas afectadas, y explorar la relación entre las formas de afrontamiento de la seropositividad y la afectividad. Diseño: Transversal, comparación de dos grupos. Método: 105 sujetos seropositivos a VIH (50 toxicómanos y 55 no-toxicómanos) son evaluados a través de un cuestionario que agrupa escalas de afrontamiento de la seropositividad, variables del estado de ánimo (depresión, ansiedad y afectividad) y el soporte social objetivo y subjetivo. Resultados: No se encuentran diferencias en la forma de afrontar la seropositividad entre los grupos, ni tampoco respecto a la afectividad. Un análisis correlacional muestra que las formas de afrontamiento activas, tanto cognitivas como conductuales, están asociadas (p<0,05) a una mayor afectividad positiva (r=0,45) y a una menor ansiedad (r=-0,24), mientras las formas evitantes están asociadas a una mayor depresión (r-0,3'1). afectividad negativa (r=0,31), ansiedad rasgo (r=0,33), y ansiedad estado (r=0,21). Conclusión: Los resultados del estofo son concordantes con los encontrados en la literatura, que muestran una relación positiva entre las formas activas y la afectividad, así como una asociación negativa de ésta con las formas evitantes (AU)

Cognitive and behavioural factors as predictors of abstinence following treatment for alcohol dependence.

AIM: To assess how far causal attributions about abstinence and relapse, drinking self-efficacy, drinking locus of control expectancy and coping behaviour discriminate abstainers from relapsers following treatment for alcohol dependence. DESIGN: A multicentre 6-month follow-up study. SETTING: Mental health centres and self-help groups in Vizcaya (Spain). PARTICIPANTS: The sample was formed by 201 alcoholics who were assessed at their centres and groups on two occasions: while they were in treatment and 6 months later. MEASUREMENTS: During treatment, participants completed several questionnaires related to cognitive and behavioural variables. Drinking problem and background variables were also assessed. Six months later their drinking status and treatment attendance were examined. FINDINGS: Multivariate tests showed that self-efficacy expectancy and long previous time in abstinence independently discriminated alcoholics who maintained abstinence from those who did not. Other cognitive-behavioural variables showed bivariate association with abstinence, but did not add predictive power to these two measures. CONCLUSIONS: The results of this study are consistent with the extensive literature that confirms the predictor power of self-efficacy. Unexpectedly, it did not find independent positive relationships between other psychological variables and abstinence. Given that self-efficacy can predict outcome in the medium term, it is suggested that treatment could target this variable.

Gypsies and drug addictions. Study of the adherence to treatment.

AIMS: To compare the retention in a Naltrexone Maintenance Programme (NMP) between a gipsy and a 'paya' (non-gypsy) population in the province of Alava (Basque Country, Spain). HYPOTHESIS: The exposure factor 'to be a gypsy' is no different from the factor 'to be "payo" (non-gypsy)' with regard to the response in the continuation of treatment with opiate antagonists. DESIGN AND PARTICIPANTS: Based on a retrospective follow-up study, two cohorts were considered based on the ethnic group to which one belonged. The cohort of gypsies was made up of 52 cases, for whom by means of a matching process 52 'payo' (non-gypsy) subjects were selected to form the other cohort. The matching variables were age, sex, the family support, and HIV+ status. After a period of detoxification, all the subjects participated in a NMP and the retention in this programme was evaluated. FINDINGS: The survival analysis showed a continuation probability that was higher for the non-gypsy group than for the gypsy group, even though the differences were not significant but they did show a tendency (p < 0.06). The post- hoc tests showed differences between the continuations shown by both cohorts between 4 and 8 weeks, with this not being observed at other times. A subsequent proportional risks regression analysis showed a strong influence of the previous treatments variable, the effect of which was greater in the gypsy group, with this finally causing a correction in the continuation curves that reduced the differences. CONCLUSIONS: The results are discussed with regard to the context of the gypsy ethnic group, and suggestions are made with regard to the need for establishing preventive and informative measures that manage to reach the idiosyncrasy of the gypsy culture.

A randomized trial of adding fluoxetine to a naltrexone treatment programme for heroin addicts.

AIMS: The purpose of the study was to assess whether fluoxetine would enhance retention in a naltrexone (NTX) treatment programme. DESIGN: Randomized clinical trial. SETTING: The clinical trial was conducted in two Drug Dependence Centres (DCs) of the Basque Country, Spain over a 1-year period. These DCs routinely used naltrexone as part of their treatment. PARTICIPANTS: A total of 112 heroin addicts included in a naltrexone treatment programme were randomly allocated to two groups of 56 patients each. INTERVENTION: One group received 20 mg/24 h of fluoxetine for the first 6 months, while the remaining 56 patients were used as controls. No placebo was used. MEASUREMENTS: Retention rates and hazard functions were estimated. The risk difference and relative risk were also calculated at 6 and 12 months. FINDINGS: The survival functions showed significantly higher retention rates in the fluoxetine group than among the controls. The risk difference at both 6 months (RD6 = 0.23, CI 95% = 0.06-0.42) and 12 months (RD12 = 0.21, CI 95% = 0.09-0.39) favoured the fluoxetine group, with a greater dropout risk at both times among the controls (RR6 = 1.81, CI 95% = 1.11-2.94; RR12 = 1.46, CI 95% = 1.04-2.04). CONCLUSIONS: The study showed that the combination of fluoxetine and naltrexone produced significantly greater retention than in patients given only naltrexone. Placebo-controlled trials are warranted to assess how far this reflects a specific pharmacological effect.