Identifying internalizing transdiagnostic profiles through motivational and cognitive control systems: Relations with symptoms, functionality, and quality of life.

BACKGROUND: The diversity of patients' symptomatology among people seeking treatment on community-based mental health services poses significant challenges to traditional models of care. Recent approaches favor identifying transdiagnostic factors that allow a better understanding of patient heterogeneity and designing more effective and quality interventions. This study examines the heterogeneity of patients with internalizing symptoms based on profiles identified with cognitive and motivational control variables. Differences between these profiles on dimensional measures of psychopathology and quality of life are examined. METHODS: 263 patients were selected by non-probabilistic sampling procedures on mental health services in the province of Huelva (Spain). A latent class analysis on the standardized scale scores of The Behavioral Inhibition/Behavioral Activation System Scales and the Effortful Control Scale of the Adult Temperament Questionnaire Short-Form was conducted. Profiles were compared on the scores of the Inventory of Depression and Anxiety Symptoms-II, the WHO Disability Assessment Schedule II, and the Health Assessment Questionnaire SF-36. RESULTS: The four latent profile solution is the one that showed the best fit indicators and substantive interpretability, with a kappa of 0.94 in the cross-validation procedure with 75% of the sample. No sex differences were found between the profiles (χ32 5.17, p = .160). Profiles #1 and #3, both characterized by an imbalance between low activation and high inhibition, had lower well-being, lower functionality, and quality of life. When comparing profile #2 (featuring the highest inhibitory control) lower scores on most internalizing scales are observed, specially claustrophobia, social anxiety, panic mania. Profile #4 (low control, high activation, and high inhibition) showed greater scores on both mania and euphoria and lower scores on emotional role. CONCLUSIONS: We identified four distinctive profiles that had overly increased behavioral inhibition (as expected in internalizing disorders) and differed in the degree of imbalance between inhibition and activation systems, and between motivational systems and top-down cognitive control. The profile characterized by high activation and reduced cognitive (inhibitory) control was the one showing greater mood-related symptoms and lower levels of quality of life. These profiles could be generated by treatment providers to guide clinical management in an evidence-based manner.

Aproximaciones metodológicas en la investigación nosológica del trastorno por uso de sustancias / Methodological approaches to nosology research in substance use disorders

Introducción. La investigación sobre los fundamentos teóricos de los trastornos por consumo de sustancias se está incrementando en los últimos años. La aplicación de nuevos modelos estadísticos y psicométricos están aportando nuevas formas de conceptualizar dichos trastornos. Objetivo. El objetivo de este trabajo es ofrecer los principales resultados que se obtienen tras la aplicación de estos modelos a los trastornos por consumo de sustancias. Método. Se realizó una revisión de artículos en PubMed y PsycInfo, con finalización en el mes de marzo de 2012. Los términos de búsqueda fueron "nosology" "dimensionality", "factorial structure", combinados con las diferentes drogas. Resultados. Los estudios cuestionan el sistema categorial de diagnóstico, reconociendo la existencia de diferentes perfiles. Por otro lado, las evidencias empíricas apoyan la creación de un trastorno por consumo de sustancias, en el que se incluyen los criterios de abuso y dependencia. Conclusiones. Las evidencias empíricas obtenidas apoyan la introducción de modificaciones en el proceso diagnóstico de los trastornos por uso de sustancias. Tales modificaciones, en cierta medida recogidas para el DSM-V, deben contemplar también su aplicabilidad en el ámbito clínico (AU)

Introduction. Research on nosology of substance use disorders has been increased in recent years. New statistical and psychometric models are providing new ways to understand these disorders. Objective. The aim of this work is providing the main results from a review concerning the application of these models to Substance Use Disorders. Method. A review was conducted in PubMed and PsycInfo with completion in March 2012. Keywords used: 'nosology', 'dimensionality' and 'factorial structure' with different substances. Results. Studies challenge the categorical system for diagnosis, recognizing the existence of different severity profiles. Moreover, the empirical evidence supports a continuum of substance use disorders, whit abuse and dependence criteria included. Conclusions. Empirical evidence supports modifications in the diagnosis process of Substance Use Disorders for DSM-V. Such changes should also be considered regarding to their applicability in the clinical setting (AU)