Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones, instant messaging and social networks using MULTICAGE-TIC. / Tecnologías de la Información y la Comunicación (TIC): abuso de Internet, videojuegos, teléfonos móviles, mensajería instantánea y redes sociales mediante el MULTICAGE-TIC.

Use/abuse of Information and Communications Technologies (ICT) has in recent years become a topic of great interest. Current discussion addresses whether it must be considered addictive behaviour and if it is a problem that primarily affects adolescents and youth. This study aims to understand the problems that affect people of all ages in controlling the use of these ICTs and whether they are related to mental health problems, stress and difficulties in executive control of behaviour. A survey was administered through social networks and email, using the MULTICAGE-ICT, a questionnaire that explores problems in the use of Internet, mobile phones, video games, instant messaging and social networks. Additionally, the Prefrontal Symptom Inventory, General Health Questionnaire and Perceived Stress Scale were administered. The sample was comprised of 1,276 individuals of all ages from different Spanish-speaking countries. The results indicate that about 50% of the sample, regardless of age or other variables, presents significant problems with the use of these technologies, and that these problems are directly related to symptoms of poor prefrontal functioning, stress and mental health problems. The results reveal the need for reconsidering whether we are facing an addictive behaviour or a new problem demanding environmental, psychological, sociological and sociopolitical explanations; therefore, it is necessary to reformulate actions to be implemented to address and refocus our understanding of the problem.

El uso/abuso de las Tecnologías de la Información y la Comunicación (TIC) es un tema que suscita enorme interés en los últimos años. Está en discusión si debe recibir la consideración de conducta adictiva y si es un problema que afecte prioritariamente a adolescentes y jóvenes. El presente estudio pretende conocer los problemas que afectan a las personas de todas las edades en el control del uso de estas TICs y si están relacionados con problemas de salud mental, estrés y dificultades en el control superior del comportamiento. Se realiza una encuesta a través de redes sociales y correo electrónico, en el que se administra el cuestionario MULTICAGE-TIC, que explora problemas en el uso de Internet, teléfono móvil, videojuegos, mensajería instantánea y redes sociales. Adicionalmente se administra el Inventario de Síntomas Prefrontales, el Cuestionario de Salud General y la Escala de Estrés Percibido. Se obtiene una muestra de 1.276 sujetos de todas las edades y diferentes países de habla hispana. Los resultados apuntan a que alrededor del 50% de la muestra presenta importantes problemas en el uso de estas tecnologías, y que esos problemas se relacionan directamente con síntomas de mal funcionamiento prefrontal, estrés y problemas de salud mental, independientemente de la edad u otras variables. Estos resultados sugieren reconsiderar si se trata de una patología adictiva o si estamos ante un problema novedoso que requiere de explicaciones de índole ambiental, psicológica, sociológica y sociopolítica, debiendo reformular las acciones a emprender para reorientar la comprensión y el abordaje del problema.

Tecnologías de la Información y la Comunicación (TIC): abuso de Internet, videojuegos, teléfonos móviles, mensajería instantánea y redes sociales mediante el MULTICAGE-TIC / Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones, instant messaging and social networks using MULTICAGE-TIC

El uso/abuso de las Tecnologías de la Información y la Comunicación (TIC) es un tema que suscita enorme interés en los últimos años. Está en discusión si debe recibir la consideración de conducta adictiva y si es un problema que afecte prioritariamente a adolescentes y jóvenes. El presente estudio pretende conocer los problemas que afectan a las personas de todas las edades en el control del uso de estas TICs y si están relacionados con problemas de salud mental, estrés y dificultades en el control superior del comportamiento. Se realiza una encuesta a través de redes sociales y correo electrónico, en el que se administra el cuestionario MULTICAGE-TIC, que explora problemas en el uso de Internet, teléfono móvil, videojuegos, mensajería instantánea y redes sociales. Adicionalmente se administra el Inventario de Síntomas Prefrontales, el Cuestionario de Salud General y la Escala de Estrés Percibido. Se obtiene una muestra de 1.276 sujetos de todas las edades y diferentes países de habla hispana. Los resultados apuntan a que alrededor del 50% de la muestra presenta importantes problemas en el uso de estas tecnologías, y que esos problemas se relacionan directamente con síntomas de mal funcionamiento prefrontal, estrés y problemas de salud mental, independientemente de la edad u otras variables. Estos resultados sugieren reconsiderar si se trata de una patología adictiva o si estamos ante un problema novedoso que requiere de explicaciones de índole ambiental, psicológica, sociológica y sociopolítica, debiendo reformular las acciones a emprender para reorientar la comprensión y el abordaje del problema

Use/abuse of Information and Communications Technologies (ICT) has in recent years become a topic of great interest. Current discussion addresses whether it must be considered addictive behaviour and if it is a problem that primarily affects adolescents and youth. This study aims to understand the problems that affect people of all ages in controlling the use of these ICTs and whether they are related to mental health problems, stress and difficulties in executive control of behaviour. A survey was administered through social networks and email, using the MULTICAGE-ICT, a questionnaire that explores problems in the use of Internet, mobile phones, video games, instant messaging and social networks. Additionally, the Prefrontal Symptom Inventory, General Health Questionnaire and Perceived Stress Scale were administered. The sample was comprised of 1,276 individuals of all ages from different Spanish-speaking countries. The results indicate that about 50% of the sample, regardless of age or other variables, presents significant problems with the use of these technologies, and that these problems are directly related to symptoms of poor prefrontal functioning, stress and mental health problems. The results reveal the need for reconsidering whether we are facing an addictive behaviour or a new problem demanding environmental, psychological, sociological and sociopolitical explanations; therefore, it is necessary to reformulate actions to be implemented to address and refocus our understanding of the problem

La "Escala de estrés percibido": estudio psicométrico sin restricciones en población no clínica y adictos a sustancias en tratamiento / The Perceived Stress Scale: an unrestricted approach to its psychometric properties in non-clinical population and treated substance-addicts

La "Escala de estrés percibido" (EEP) es uno de los autoinformes más utilizados en la actualidad para estimar el grado en que las personas sienten que controlan las circunstancias de la vida o se ven desbordadas por ellas. Se realizó un análisis factorial exploratorio sin restricciones sobre una muestra de participantes de población general (n= 1023) y un análisis confirmatorio en una muestra clínica de personas con adicción a drogas en tratamiento (n= 542). De las tres versiones de la EEP (14, 10 y 4 ítems), la de 10 ítems es la que presenta mejores propiedades psicométricas en ambas muestras. Los sujetos clínicos mostraron mayores niveles de estrés percibido, asociados con estrategias de afrontamiento pasivas (evitación) y con más sintomatología comportamental de origen prefrontal en la vida cotidiana. La EEP-10 presenta suficientes garantías psicométricas para su utilización tanto en población general como aplicada a muestras clínicas, permitiendo estimar una variable crucial en el estudio de aspectos relacionados con el estrés, como la disfunción prefrontal y las estrategias que se utilizan ante dificultades de la vida

The Perceived Stress Scale (PSS) is currently one of the most used selfreports to estimate the extent to which people feel that they control the challenges of life or are overwhelmed by them. An unrestricted exploratory factor analysis over a sample of participants from the general population (n= 1023) and a confirmatory analysis in a clinical sample of drug addicts in treatment (n= 542) were performed. From the three versions (14, 10 and 4 items), the results suggest that the 10-item version is the one has better psychometric fit indicators in both samples. Addicted people showed higher levels of perceived stress in all age groups, which was associated with passive coping strategies (avoidance) and higher levels of prefrontal behavioral symptoms in everyday life. In conclusion, the 10-item version of the PSS presents enough psychometric properties for its use in estimating the perceived stress, applied both to general population and clinical samples. Its use allows to estimate a crucial variable in the study of stress-related conditions such as prefrontal dysfunction and strategies that the people used to cope with the difficulties of life

[Prefrontal symptoms and personality disorders in substance abusers]. / Sintomatologia prefrontal y trastornos de la personalidad en adictos a sustancias.

INTRODUCTION: Neuroimaging findings associate personality traits and their disorders with an altered functioning of certain areas of the brain, especially in the frontal lobe. There is a need for instruments that can be applied in clinical practice to explore these relations based on their behavioural manifestations. PATIENTS AND METHODS: The sample was composed of 371 subjects with substance abuse/dependence. The Prefrontal Symptoms Inventory (PSI) and the Millon Clinical Multiaxial Inventory II (MCMI-II) were administered and diagnostic interviews were carried out to determine the existence of disorders affecting axis II (personality disorders). RESULTS: Criteria satisfying a diagnosis of some personality disorder were present in 43.9% of the sample. The results show a broad correlational pattern between the prefrontal symptoms scales and those of personality disorders. The variance in up to eight of the 13 scales of the MCMI-II is predicted in over 20%, based on the combination of scales from the PSI. The personality disorders diagnosed by means of a clinical interview present differential prefrontal symptomatological profiles that were consistent with what was expected. CONCLUSIONS: The results support the hypothesis of a relationship between the diagnosis of personality disorders and frontal malfunctioning, thus suggesting new lines for studying and approaching them in clinical practice. Such new paths could involve the use of cognitive rehabilitation to improve day-to-day functioning and modify the neurological substrates underlying personality disorders.

Cribado neurocognitivo en adictos a sustancias: la evaluación cognitiva de Montreal / Neurocognitive screening in substance addicts: the Montreal Cognitive Assessment

Introducción. La detección de alteraciones neurocognitivas en adictos permitiría la asignación de los sujetos con deterioro funcional a programas de rehabilitación cognitiva. La evaluación cognitiva de Montreal (MoCA) es una prueba de cribado que puede ser útil en este tipo de pacientes. Objetivo. Utilizar la MoCA con una muestra de sujetos con adicciones en tratamiento y comparar los resultados obtenidos con los baremos propuestos para población general, deterioro cognitivo leve y demencias tempranas, así como la validez concurrente con pruebas de ejecución global y su relación con variables sociodemográficas y relativas a la adicción. Pacientes y métodos. Se administraron la MoCA y la prueba de cribado de los niveles cognitivos de Allen-5 (ACLS-5) a una muestra de 79 pacientes con adicción que iniciaban tratamiento en un centro específico. Resultados. Sólo un 29,1% de los participantes presentó un rendimiento normal comparado con los baremos propuestos por los autores. El resto se situó en puntuaciones por debajo del punto de corte, mostrando muchos de ellos un rendimiento alarmantemente bajo, incluso comparado con los baremos para deterioro cognitivo leve y demencias tempranas. La MoCA mostró validez concurrente con la ACLS-5 y correlación con el nivel académico, pero no con variables relativas a la adicción. Conclusiones. La MoCA es una prueba rápida, sencilla de administrar y corregir, que permite detectar a los sujetos con un rendimiento cognitivo bajo mínimos que requieren intervenciones neuropsicológicas y ocupacionales para la rehabilitación cognitiva, que incremente la adhesión al tratamiento y el aprovechamiento de otras intervenciones con importantes demandas cognitivas, como la psicoterapia de prevención de recaídas (AU)

Introduction. The detection of neurocognitive disorders in addicts would allow subjects with functional impairment to be assigned to cognitive rehabilitation programmes. The Montreal Cognitive Assessment (MoCA) is a screening test that can be a valuable aid with this kind of patient. Aims. To use the MoCA with a sample of subjects with addictions who are receiving treatment and to compare the results with the criteria proposed for the general population, mild cognitive impairment and early dementias. It also intends to examine the concurrent validity with global execution tests and the relationship with socio-demographic variables and others related to addiction. Patients and methods. The MoCA and the Allen Cognitive Level Screen-5 (ACLS-5) test were administered to a sample of 79 patients with addiction who were beginning treatment in a specific centre. Results. Only 29.1% of the participants presented normal performance in terms of the criteria proposed by the authors. The others achieved scores below the cut-off point, many of them displaying an alarmingly low score, even when compared with criteria for mild cognitive impairment and early dementias. The MoCA showed concurrent validity with the ACLS-5 and correlation with academic level, but not with variables related to addiction. Conclusions. The MoCA is a test that is quick and simple to administer and correct. It allows the detection of subjects with extremely low cognitive performance that require neuropsychological and occupational interventions for cognitive rehabilitation, which increases treatment compliance and the benefits to be gained from other interventions with important cognitive demands, such as relapse prevention psychotherapy (AU)

Sintomatología prefrontal y trastornos de la personalidad en adictos a sustancias / Prefrontal symptoms and personality disorders in substance abusers

Introducción. Los hallazgos de neuroimagen asocian los rasgos de la personalidad y sus trastornos al funcionamiento alterado de determinadas localizaciones cerebrales, especialmente en el lóbulo frontal. Se requieren instrumentos aplicables en la clínica que exploren estas relaciones a partir de sus manifestaciones comportamentales. Pacientes y métodos. La muestra estuvo compuesta por 371 sujetos con abuso/dependencia de sustancias. Se administraron el inventario de síntomas prefrontales (ISP) y el inventario clínico multiaxial de Millon-II (MCMI-II), y se realizaron entrevistas diagnósticas para estimar la existencia de trastornos del eje II (trastornos de la personalidad). Resultados. El 43,9% presentó criterios para el diagnóstico de algún trastorno de la personalidad. Los resultados muestran un amplio patrón correlacional entre las escalas de síntomas prefrontales y las de trastornos de la personalidad. La varianza de hasta ocho de las 13 escalas del MCMI-II se predice en más de un 20% a partir de la combinación de escalas del ISP. Los trastornos de la personalidad diagnosticados mediante entrevista clínica presentan perfiles de sintomatología prefrontal diferenciales y congruentes con lo esperado. Conclusiones. Los resultados sostienen la hipótesis de la relación entre el diagnóstico de trastornos de la personalidad y mal funcionamiento frontal, sugiriendo nuevas vías para su estudio y abordaje en la clínica, como el uso de la rehabilitación cognitiva para mejorar el funcionamiento cotidiano y modificar los sustratos neurológicos de los trastornos de la personalidad(AU)

Introduction. Neuroimaging findings associate personality traits and their disorders with an altered functioning of certain areas of the brain, especially in the frontal lobe. There is a need for instruments that can be applied in clinical practice to explore these relations based on their behavioural manifestations. Patients and methods. The sample was composed of 371 subjects with substance abuse/dependence. The Prefrontal Symptoms Inventory (PSI) and the Millon Clinical Multiaxial Inventory II (MCMI-II) were administered and diagnostic interviews were carried out to determine the existence of disorders affecting axis II (personality disorders). Results. Criteria satisfying a diagnosis of some personality disorder were present in 43.9% of the sample. The results show a broad correlational pattern between the prefrontal symptoms scales and those of personality disorders. The variance in up to eight of the 13 scales of the MCMI-II is predicted in over 20%, based on the combination of scales from the PSI. The personality disorders diagnosed by means of a clinical interview present differential prefrontal symptomatological profiles that were consistent with what was expected. Conclusions. The results support the hypothesis of a relationship between the diagnosis of personality disorders and frontal malfunctioning, thus suggesting new lines for studying and approaching them in clinical practice. Such new paths could involve the use of cognitive rehabilitation to improve day-to-day functioning and modify the neurological substrates underlying personality disorders(AU)

Inventario de síntomas prefrontales para la evaluación clínica de las adicciones en la vida diaria: proceso de creación y propiedades psicométricas / Prefrontal Symptoms Inventory for clinical evaluation of addictions in everyday life: development process and psychometric properties

Introducción. La investigación evidencia la presencia de sintomatología prefrontal en los adictos, aunque en su valoraciónse suelen usar cuestionarios creados para el daño cerebral sobrevenido.Objetivo. Elaborar un instrumento específico para la evaluación de dicha sintomatología en sujetos con adicciones. Sujetos y métodos. Se reclutaron 1.624 participantes (445 adictos y 1.179 de población general) a los que se aplicó un inventariode 100 ítems basados en las tres esferas de la actividad humana (cognición, emoción y conducta) en relación con los tres grandes síndromes prefrontales (dorsolateral, ventromedial y orbital). Los análisis preliminares descartaron aquellos que no mostraron suficiente capacidad discriminante, configurando el inventario de síntomas prefrontales (ISP) de 46 ítems. Se administraron el cuestionario disejecutivo (DEX-Sp) y la escala de estrés percibido (EEP) para estudiar su validezconvergente. Resultados. Los datos muestran la estructura trifactorial del cuestionario: problemas en el control ejecutivo (con tressubfactores; problemas motivacionales, de control y atencionales), problemas en la conducta social y problemas en elcontrol emocional. Se analizan las relaciones entre las puntuaciones en el ISP con variables sociodemográficas y del consumo, así como con el DEX-Sp y la EEP. Se proporciona una versión reducida de 20 ítems como cribado. Conclusiones. El ISP relaciona la autoevaluación de las personas (‘sujetocéntrica’) con la formulación teórica a priori (‘cerebrocéntrica’), mostrando unas propiedades psicométricas adecuadas. Se propone su uso a la hora de explorar la sintomatología prefrontal de los adictos, así como en otras poblaciones clínicas o subclínicas con perfiles cognitivos similares (AU)

Introduction. Research has provided evidence of the presence of prefrontal symptoms in addicts, although they are usuallyevaluated using questionnaires that were created for acquired brain injury. Aims. To produce a specific instrument for evaluating those symptoms in subjects with addictions. Subjects and methods. For the study, 1624 participants were recruited (445 addicts and 1179 from the general population) and were given a 100-item inventory to complete based on the three spheres of human activity (cognition, emotion andbehaviour) in relation to the three great prefrontal syndromes (dorsolateral, ventromedial and orbital). The preliminaryanalyses ruled out those that did not prove to have sufficient discriminating power, which resulted in the Prefrontal Symptoms Inventory (PSI) consisting of 46 items. The Dysexecutive Questionnaire (DEX-Sp) and the Perceived Stress Scale (PSS) were administered in order to study the convergent validity. Results. The data show the three-factor structure of the questionnaire: problems with executive control (with three subfactors: problems with motivation, control and attention), problems with social behaviour and problems with emotional control. The relationships between the scores on the PSI and sociodemographic and consumption variables, as well as withthe DEX-Sp and the PSS were analysed. A reduced 20-item version is provided for screening. Conclusions. The PSI relates the (‘subject-centred’) self-evaluation of persons with the a priori (‘brain-centred’) theoretical formulation, the results showing adequate psychometric properties. We recommend its use when it comes to exploring the prefrontal symptoms of addicts, as well as other clinical or subclinical populations with similar cognitive profiles (AU)

[Prefrontal Symptoms Inventory for clinical evaluation of addictions in everyday life: development process and psychometric properties]. / Inventario de sintomas prefrontales para la evaluación clinica de las adicciones en la vida diaria: proceso de creación y propiedades psicométricas.

INTRODUCTION: Research has provided evidence of the presence of prefrontal symptoms in addicts, although they are usually evaluated using questionnaires that were created for acquired brain injury. AIMS: To produce a specific instrument for evaluating those symptoms in subjects with addictions. SUBJECTS AND METHODS: For the study, 1624 participants were recruited (445 addicts and 1179 from the general population) and were given a 100-item inventory to complete based on the three spheres of human activity (cognition, emotion and behaviour) in relation to the three great prefrontal syndromes (dorsolateral, ventromedial and orbital). The preliminary analyses ruled out those that did not prove to have sufficient discriminating power, which resulted in the Prefrontal Symptoms Inventory (PSI) consisting of 46 items. The Dysexecutive Questionnaire (DEX-Sp) and the Perceived Stress Scale (PSS) were administered in order to study the convergent validity. RESULTS: The data show the three-factor structure of the questionnaire: problems with executive control (with three sub-factors: problems with motivation, control and attention), problems with social behaviour and problems with emotional control. The relationships between the scores on the PSI and sociodemographic and consumption variables, as well as with the DEX-Sp and the PSS were analysed. A reduced 20-item version is provided for screening. CONCLUSIONS: The PSI relates the ('subject-centred') self-evaluation of persons with the a priori ('brain-centred') theoretical formulation, the results showing adequate psychometric properties. We recommend its use when it comes to exploring the prefrontal symptoms of addicts, as well as other clinical or subclinical populations with similar cognitive profiles.

[Neuropsychological characterization of functional and dysfunctional impulsivity in drug addicts: clinical implications]. / Caracterización neuropsicológica de la impulsividad funcional y disfuncional en adictos a sustancias: implicaciones clínicas.

Impulsivity is a stable correlate throughout the course of drug addiction. However, it has always been studied as a negative condition, linked to psychopathology. Dickman (1990) proposed two subdimensions of impulsivity, dysfunctional (DI) and functional (FI). He defines the latter as the tendency for rapid, goal-oriented decision-making characterized by well calculated risks. Only a few studies have attempted to differentiate between these two subdimensions using classical neuropsychological tests. Fifty two drug addicts in treatment were tested using Dickman's Impulsivity Inventory and a battery of classical neuropsychological tests. FI shows moderate to high correlations with many classical neuropsychological test scores in relation to enhanced executive functioning, whereas DI reveals surprisingly weak and scarce correlations with indicators of impaired executive functioning. DI appears to be a trait related to some difficulties in classical neuropsychological tests, while FI emerges as a consistent and much stronger predictor of higher attention capacity, lower distractibility, better precision, fewer errors, and better maintenance of goal-oriented strategies. Thus, functional impulsivity is related to positive conditions and more efficient cognitive functioning. Implications for the treatment of drug addictions are suggested.

Caracterización neuropsicológica de la impulsividad funcional y disfuncional en adictos a sustancias: implicaciones clínicas / Neuropsychological characterization of functional and dysfunctional impulsivity in drug addicts: clinical implications

La impulsividad es una de las variables más consistentemente vinculadas a las distintas fases del proceso adictivo. Sin embargo, casi siempre se ha estudiado como una condición negativa, vinculada a psicopatología. Dickman (1990) propuso dos tipos de impulsividad, una disfuncional (ID) y otra funcional (IF). A ésta última la definió como la tendencia a tomar decisiones rápidas, orientadas a metas, mediante un proceso de toma de decisiones con riesgo calculado. Pocos estudios han abordado la caracterización neuropsicológica de ambas variantes, relacionándolas con el rendimiento en pruebas clásicas. Una muestra de 52 sujetos adictos en tratamiento cumplimentó el Dickman Impulsivity Inventory y una batería de pruebas neuropsicológicas clásicas. Se observaron correlaciones de débiles a moderadas entre la IF e indicadores de éxito en las tareas neuropsicológicas, mientras que la ID mostró una relación difusa y débiles correlaciones con indicadores de mal rendimiento en todas las tareas. La ID se mostró como una disposición que dificulta la realización de las tareas de forma global, sin interferencia específica, en tanto que la IF se relacionó consistentemente con mayor precisión, menor número de errores y mejor mantenimiento de los planes, y ello a partir de una mejor gestión atención al y una mayor resistencia al ruido. Se sugieren las implicaciones de cara a los tratamientos de las adicciones(AU)

Impulsivity is a stable correlate through out the course of drug addiction. However, it has always been studied as a negative condition, linked to psychopathology. Dickman (1990) proposed two sub dimensions of impulsivity, dysfunctional (DI) and functional (FI). He defines the latter as the tendency for rapid, goal-oriented decision-making characterized by well calculated risks. Only a few studies have attempted to differentiate between these two sub dimensions using classical neuropsychological tests. Fifty two drug addicts in treatment were tested using Dickman’s Impulsivity Inventory and a battery of classical neuropsychological tests. FI shows moderate to high correlations with many classical neuropsychological test scores in relation to enhanced executive functioning, whereas DI reveals surprisingly weak and scarce correlations with indicators of impaired executive functioning. DI appears to be a traitrelated to some difficulties in classical neuropsychological tests, while FI emerges as a consistent and much stronger predictor of higher attention capacity, lower distractibility, better precision, fewer errors, and better maintenance of goal-oriented strategies. Thus, functional impulsivity is related to positive conditions and more efficient cognitive functioning. Implications for the treatment of drug addictions are suggested(AU)

[A proposal for a protocol of neuropsychological assessment for use in addictions]. / Propuesta de un protocolo para la evaluación neuropsicológica de las adicciones.

INTRODUCTION: Interest in the brain processes involved in establishing, maintaining and overcoming addictions has led to the development, in recent years, of a number of neurocognitive models with a substantial amount of empirical support. However, agreement still needs to be reached regarding the clinical evaluation tests that can be administered and the reason for doing so. The aim of this work is to outline some of the most useful neuropsychological tests for evaluating addicts, as well as the scales of day-to-day symptoms and occupational performance tests that have been validated in Spanish for this population. DEVELOPMENT: The cognitive sub-processes addressed in this work, which have proved to be useful in the syndromic diagnosis of addictions, are processing speed, selective and sustained attention, alternating and divided attention, attentional amplitude and central executive, memory, cognitive flexibility and fluency, response inhibition, planning, abstraction, decision-making and, lastly, theory of mind. A protocol involving two 50-minute sessions is proposed, where the second session is optional depending on the needs and suitability in each case. CONCLUSIONS: This protocol offers several important advantages for physicians, including systemisation, the possibility of replication and convergence among evaluators or delimitation of the sub-processes that can be evaluated by sharing the same scheme. Moreover, it can all be carried out in sessions that are short enough to allow them to be offered by nearly all services that attend to addicts who request treatment.

[Evaluation of occupational performance in everyday life in addicted population. Development of a measuring instrument: the ADO]. / Evaluación del desempeño ocupacional en la vida cotidiana en adictos. Creación de un instrumento de medida: el ADO.

Addiction is a complex disorder of brain function, which involves primarily the frontal cortex as a structure responsible for the organization of intentional behavior. The performance of everyday life activity is one of the key factors in assessing the impact of cognitive impairment. There are no validated instruments in Spanish applicable to addicts for assessing self-perceived efficacy in the performance of everyday activities. Based on the Occupational Self-Assessment, a questionnaire was developed for the exploration of: perceived level of performance quality, evaluation of competences and the influence of environment on performance. For the study, a sample of 425 non-clinical participants and 300 patients treated for substance addiction was used. The Occupational Performance Self- Report (ADO) has 37 items and showed adequate internal consistency (Alpha = 0.93, 0.75 and 0.87 for the subscales) and a stable structure in confirmatory factor analysis. The self-assessment of performance showed consistent correlation with dysexecutive symptoms in daily life (-0.54 < r < -0.66). The ADO emerges as a reliable and valid instrument for the exploration of self-perceived level of performance in the everyday lives of individuals with substance addiction, and may be useful for establishing treatment goals in conditions of high ecological validity.

Evaluación de los síntomas prefrontales: propiedades psicométricas y datos normativos del cuestionario disejecutivo (DEX) en una muestra de población española / Prefrontal symptoms assessment: psychometric properties and normative data of the Dysexecutive

Introducción. El estudio de los déficit derivados de las alteraciones en los circuitos prefrontales se ha desarrollado casi exclusivamente desde una perspectiva categorial, que diferencia el funcionamiento normal del patológico; sin embargo, el funcionamiento de la corteza prefrontal puede contemplarse como una dimensión continua. El cuestionario disejecutivo DEX) se creó con la intención de servir de medida cualitativa de los síntomas del ‘síndrome disejecutivo’ en la vida diaria. Objetivo. Explorar las propiedades psicométricas del DEX autoinformado en una amplia muestra de población no clínica de cara a proporcionar interpretaciones de interés para la clínica. Sujetos y métodos. Se administró la versión española del DEX a 1.013 individuos de población no clínica con residencia en Madrid, Zaragoza, Asturias, Navarra y Sevilla (380 varones y 633 mujeres). Resultados. El estudio factorial paralelo muestra la existencia de dos factores con adecuados índices de consistencia y validez interna: ítems que exploran dificultades en el inicio, mantenimiento y organización de la conducta (desorganización/ apatía) e ítems relacionados con la interrupción de la conducta en situaciones donde ésta es inadecuada (desinhibición/ impulsividad). La distribución por edad se ajusta a los presupuestos evolutivos. Se proponen como puntos de corte: < 10, funcionamiento óptimo; 10-18, funcionamiento subóptimo dentro de la normalidad; 19-28, funcionamiento moderadamente disejecutivo que requiere identificar las posibles causas, y > 28, alteración disejecutiva importante que incluiría patologías de gravedad. Conclusiones. El DEX puede ser un instrumento útil para detectar tanto a sujetos con alteraciones cerebrales evidenciables como a aquéllos con un funcionamiento ejecutivo deficiente sin que conlleve una patología conocida o identificable (AU)

Introduction. Research on the deficits derived from alterations in the prefrontal circuits has been conducted almost exclusively from a categorical perspective, which differentiates normal from pathological functioning. The functioning of the prefrontal cortex, however, can be seen as a continuous dimension. The Dysexecutive Questionnaire (DEX) was created with the intention of being useful as a qualitative measure of the symptoms of ‘dysexecutive syndrome’ in day-today life. Aim. To explore the psychometric properties of the self-reported DEX in a broad sample of the non-clinical population with a view to providing interpretations that can be of use in clinical practice. Subjects and methods. The Spanish version of the DEX was administered to 1013 non-clinical individuals living in Madrid, Saragossa, Asturias, Navarre and Seville (380 males and 633 females). Results. The factorial study conducted in parallel reveals the existence of two factors with adequate consistency and internal validity indices: items that explore difficulties in beginning, maintaining and organising behaviour (disorganisation/apathy) and items related with the interruption of behaviour in situations where it is inappropriate (disinhibition/impulsivity). The distribution according to age matches the developmental premises. The following cut-off points are proposed: < 10, optimal functioning; 10-18, sub-optimal functioning within normality; 19-28, moderately dysexecutive functioning that requires identification of the possible causes, and > 28, important degree of dysexecutive disorder that would include severe pathologies. Conclusions. The DEX may be useful as an instrument for detecting subjects with demonstrable brain disorders and those with deficient executive functioning without the presence of any known or identifiable pathology (AU)

[Prefrontal symptoms assessment: psychometric properties and normative data of the Dysexecutive Questionnaire (DEX) in a sample from the Spanish population]. / Evaluación de los síntomas prefrontales: propiedades psicométricas y datos normativos del cuestionario disejecutivo (DEX) en una muestra de población española.

INTRODUCTION: Research on the deficits derived from alterations in the prefrontal circuits has been conducted almost exclusively from a categorical perspective, which differentiates normal from pathological functioning. The functioning of the prefrontal cortex, however, can be seen as a continuous dimension. The Dysexecutive Questionnaire (DEX) was created with the intention of being useful as a qualitative measure of the symptoms of 'dysexecutive syndrome' in day-to-day life. AIM. To explore the psychometric properties of the self-reported DEX in a broad sample of the non-clinical population with a view to providing interpretations that can be of use in clinical practice. SUBJECTS AND METHODS: The Spanish version of the DEX was administered to 1013 non-clinical individuals living in Madrid, Saragossa, Asturias, Navarre and Seville (380 males and 633 females). RESULTS: The factorial study conducted in parallel reveals the existence of two factors with adequate consistency and internal validity indices: items that explore difficulties in beginning, maintaining and organising behaviour (disorganisation/apathy) and items related with the interruption of behaviour in situations where it is inappropriate (disinhibition/impulsivity). The distribution according to age matches the developmental premises. The following cut-off points are proposed: < 10, optimal functioning; 10-18, sub-optimal functioning within normality; 19-28, moderately dysexecutive functioning that requires identification of the possible causes, and > 28, important degree of dysexecutive disorder that would include severe pathologies. CONCLUSIONS: The DEX may be useful as an instrument for detecting subjects with demonstrable brain disorders and those with deficient executive functioning without the presence of any known or identifiable pathology.

Diferencias de personalidad entre adictos al alcohol y controles emparejados: relación con sintomatología frontal y subtipos de adictos / Personality differences between alcohol abusers and matched controls: Relation to frontal symptoms and subtypes of addicts

Los estudios epidemiológicos muestran estrecha relación entre trastornos de personalidad y adicciones. Los modelos dimensionales de la personalidad, como el de Cloninger, permiten formular diagnósticos capaces de discriminar entre estilos de conducta disfuncionales transitorios y rasgos relativamente más estables. Se han propuesto determinadas localizaciones cerebrales, como sustratos de los rasgos, basados en la activación de zonas cerebrales específicas. Este trabajo explora las diferencias en rasgos de personalidad entre una muestra de adictos al alcohol (N= 95) y un grupo de control de población no-clínica (N= 95), emparejados a partir de variables sociodemográficas, utilizando el TCI-R-67 y la FrSBe-Sp. Se hipotetiza que tales diferencias se relacionan con sintomatología frontal y se estudia la existencia de diversos subgrupos de adictos a partir de determinadas combinaciones de rasgos. Los resultados muestran diferencias significativas en dos rasgos temperamentales (Búsqueda de Novedad y Evitación del Daño) y uno caracterial (Autodirección). Se encontró una correlación con gran tamaño del efecto entre estos rasgos y sintomatología frontal. El análisis de clusters clasificó a los participantes en diversos subtipos con diferentes combinaciones de rasgos que se corresponden con sintomatología frontal variada. Se discuten las posibles explicaciones neurobiológicas de las diferencias y su importancia en la clínica (AU)

Epidemiological studies usually show a link between personality disorders and addictions. Dimensional models of personality, such as that of Cloninger, are able to diagnose and discriminate between transient dysfunctional behavior styles and relatively more stable traits. Certain brain areas have been proposed, as trait locations, based on their activation. This paper explores differences in personality traits among a sample of alcohol abusers (N= 95) and a control group of nonclinical population (N= 95), matched in sociodemographic variables, using the TCI-R-67 and the FrSBe- Sp. It is hypothesized that such differences are associated with frontal symptomatology. The existence of different subgroups of addicts based on certain combinations of traits is also analyzed. Results showed significant differences in two temperament traits (Novelty Seeking and Harm Avoidance) and a characterial trait (Self-Direction). We also found a correlation with a large effect size between these traits and frontal symptomatology. Cluster analysis classified the participants into several subtypes with different combinations of traits that matched diverse frontal symptomatology. Possible neurobiological explanations of these differences and their importance in the clinical practice are discussed (AU)

Evaluación del desempeño ocupacional en la vida cotidiana en adictos. Creación de un instrumento de medida: el ADO / Evaluation of occupational performance in everyday life in addicted population. Development of a measuring instrument: the ADO

La adicción es una alteración compleja del funcionamiento cerebral, que implica de forma prioritaria al córtex frontal como estructura encargada de la organización de la conducta intencional. El desempeño de la actividad en la vida cotidiana es uno de los factores claves a la hora de valorar el impacto del deterioro cognitivo. No contamos con instrumentos validados en español aplicables en adictos que valoren la autopercepción de eficacia en el desempeño de actividades en la vida cotidiana. Basándonos en el Occupational Self-Assessment, se desarrolla un cuestionario que evalúa: nivel percibido de calidad en la ejecución, valoración de las competencias e influencia del ambiente en el desempeño. Para el estudio se obtuvo una muestra de 425 sujetos de población no clínica y 300 de población tratada por adicción a sustancias. El Autoinforme de Desempeño Ocupacional (ADO) consta de37 ítems y ha mostrado adecuada consistencia interna (α = 0,93, entre0,75 y 0,87 para las subescalas) y una estructura estable en el análisis factorial confirmatorio. Las medidas de autoevaluación en la calidad del desempeño muestran correlaciones consistentes con sintomatología disejecutiva en la vida cotidiana (-0,54 < r < -0,66). El ADO se presenta como un instrumento fiable y válido para la exploración del nivel autopercibido de desempeño en la vida cotidiana de sujetos con adicción a sustancias y puede ser de utilidad para el establecimiento de objetivos de tratamiento en condiciones de elevada validez ecológica (AU)

Addiction is a complex disorder of brain function, which involves primarily the frontal cortex as a structure responsible for the organization of intentional behavior. The performance of everyday life activity is one of the key factors in assessing the impact of cognitive impairment. There are no validated instruments in Spanish applicable to addicts for assessing self-perceived efficacy in the performance of everyday activities. Based on the Occupational Self-Assessment, a questionnaire was developed for the exploration of: perceived level of performance quality, evaluation of competences and the influence of environment on performance. For the study, a sample of 425 non-clinical participants and 300 patients treated for substance addiction was used. The Occupational Performance Self-Report (ADO) has 37 items and showed adequate internal consistency (α = 0.93, 0.75 and 0.87 for the subscales) and a stable structure in confirmatory factor analysis. The self-assessment of performance showed consistent correlation with dysexecutive symptoms in daily life (-0.54

Prevalencia del trastorno por déficit de atención/hiperactividad en adictos a sustancias: del cribado al diagnóstico / Prevalence of attention-deficit hyperactivity disorder in substance addiction: from screening to diagnosis

Introducción. Existe abundante bibliografía sobre la coexistencia de criterios diagnósticos para el trastorno por déficit de atención/hiperactividad (TDAH) y el abuso/dependencia de sustancias. La prevalencia encontrada en diversos trabajos difiere considerablemente. Objetivo. Aplicar un algoritmo que considere todos los criterios necesarios para un adecuado diagnóstico y explorar las condiciones asociadas a los falsos positivos. Pacientes y métodos. Se aplicó el algoritmo diagnóstico, utilizando diversas pruebas en las distintas fases: la Attention Deficit Hyperactivity Disorder Self-Report Scale para el cribado, la Wender-Utah Rating Scale y la Parents’ Rating Scale para el diagnóstico retrospectivo, y la escala de comportamiento frontal, versión española autoadministrada, y la escala de estrés percibido para el estudio de verdaderos/falsos positivos. Se exploraron también síntomas de otros trastornos del eje I y se administró una batería de pruebas neuropsicológicas clásicas. Todo ello sobre una muestra de 696 sujetos que iniciaron tratamiento en un centro de atención a drogodependientes. Resultados. La prevalencia encontrada finalmente fue del 6,89%. Los falsos positivos en la prueba de cribado se asemejaban en su sintomatología previa al consumo a los verdaderos negativos, pero aquélla era similar en el momento actual a la de los verdaderos positivos, con quienes no mostraban diferencias en el rendimiento neuropsicológico. El trastorno de ansiedad generalizada fue el que mostró mayor relación con los falsos positivos. Conclusiones. La categoría diagnóstica de TDAH suele utilizarse indiscriminadamente para clasificar a sujetos con alteraciones neurológicas de aparición temprana y a quienes presentan similares manifestaciones tras la fase de adicción activa a sustancias. Se requiere un estudio neurológico y neuropsicológico que vaya más allá de los meros síntomas para caracterizar y tratar adecuadamente un conjunto de manifestaciones sintomatológicas similares, pero con componentes evolutivos y etiopatogénicos muy diversos (AU)

Introduction. There is a rich body of literature on the coexistence of diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and substance abuse/dependence. Prevalence, however, varies considerably from one work to another. Aims. To apply an algorithm that takes into account all the criteria needed to reach an adequate diagnosis and to explore the conditions associated with false positives. Patients and methods. The diagnostic algorithm was applied using several tests in the different phases, i.e. the Attention Deficit Hyperactivity Disorder Self-Report Scale was used for screening, the Wender-Utah Rating Scale and the Parents’ Rating Scale were administered for the retrospective diagnosis, and the self-administered Spanish version of the frontal behaviour scale and the perceived stress scale were used to study false positives. Symptoms of other axis I disorders were also explored and a battery of classic neuropsychological tests was administered. All this was carried out with a sample of 696 subjects whose treatment began in a care centre for drug addicts.Results. The final prevalence was found to be 6.89%. The symptoms of the false positives in the screening test prior to consumption were similar to those of the true negatives, but in that moment those symptoms were similar to those of the true positives, with whom no differences were found in the neuropsychological performance. Generalised anxiety disorder was the one that showed the highest relation with false positives. Conclusions. The diagnostic category of ADHD is usually utilised indiscriminately to classify subjects with early-onset neurological disorders and those who present similar manifestations following the phase of active addiction to substances. There is a need for a neurological and neuropsychological study that goes beyond the mere symptoms so as to be able to carry out a suitable characterisation and treatment of a set of similar symptomatic manifestations, but with a very wide range of developmental and aetiopathogenic components (AU)

[Personality differences between alcohol abusers and matched controls: Relation to frontal symptoms and subtypes of addicts]. / Diferencias de personalidad entre adictos al alcohol y controles emparejados: relación con sintomatología frontal y subtipos de adictos.

Epidemiological studies usually show a link between personality disorders and addictions. Dimensional models of personality, such as that of Cloninger, are able to diagnose and discriminate between transient dysfunctional behavior styles and relatively more stable traits. Certain brain areas have been proposed, as trait locations, based on their activation. This paper explores differences in personality traits among a sample of alcohol abusers (N= 95) and a control group of non-clinical population (N= 95), matched in sociodemographic variables, using the TCI-R-67 and the FrSBe-Sp. It is hypothesized that such differences are associated with frontal symptomatology. The existence of different subgroups of addicts based on certain combinations of traits is also analyzed. Results showed significant differences in two temperament traits (Novelty Seeking and Harm Avoidance) and a characterial trait (Self-Direction). We also found a correlation with a large effect size between these traits and frontal symptomatology. Cluster analysis classified the participants into several subtypes with different combinations of traits that matched diverse frontal symptomatology. Possible neurobiological explanations of these differences and their importance in the clinical practice are discussed.

Personalidad y sintomatología frontal en adictos y población no clínica: hacia una neuropsicología de la personalidad / Personality and frontal symptomatology in addicts and nonclinical population: toward a neuropsychology of personality

Objetivo. Desde hace años, la Neuropsicología y la Psicología de la Personalidad han discurrido por senderos paralelos sin que se haya prestado atención a la integración del conocimiento aportado por las diferentes disciplinas. El presente trabajo pretende analizar las relaciones entre la presencia de síntomas en la vida cotidiana relacionados con el funcionamiento de los lóbulos frontales del cerebro y el patrón de personalidad de los individuos. Sujetos y método. Se administró el Cuestionario Disejecutivo (DEX-Sp), la Escala de Comportamiento de los Sistemas Frontales (FrSBe-Sp) y el Inventario del Temperamento y el Carácter Revisado (TCIR)a 421 sujetos de población no clínica y 246 sujetos en tratamiento por abuso o dependencia de sustancias. Resultados. Aparecen importantes correlaciones entre la sintomatología relacionada con los tres síndromes frontales (mesial, orbital y dorsolateral) y algunos rasgos de la personalidad (búsqueda de novedad, evitación del daño y autodirección) llegando incluso a predecirse mutuamente más del 50% de la varianza. Discusión y conclusiones. Los resultados sugieren que el rendimiento frontal debe ser contemplado como una variable dimensional continua, que abarca desde el rendimiento óptimo hasta el desadaptativo, sin que pueda establecerse claramente un punto de corte entre ambos. Las adicciones se relacionarían con un incremento de la sintomatología frontal, tanto mesial (apatía), como orbital (desinhibición) y dorsolateral (síndrome disejecutivo), y ello se traduciría en cambios en el patrón de personalidad previo. Estos datos ponen en cuestión la pretendida base genética de los rasgos temperamentales y sugieren hipótesis de interés para la clínica (AU)

Objective. For many years now, Neuropsychology and the Psychology of Personality have developed in parallel, without any attempt to integrate the knowledge provided by the two disciplines. This paper sets out to analyze the relationship between the presence of symptoms in daily life related to the functioning of the brain’s frontal lobes and individuals’ personality patterns. Participants and Methods. The Dysexecutive Questionnaire (DEX-Sp), the Frontal System Behavior Scale (FrSBe-Sp) and the Inventory of Temperament and Character Revised (TCI-R)were administered to 421 non-clinical participants and 246 individuals in treatment for substance abuse or dependence. Results. Significant correlations were found between symptoms for all frontal syndromes(mesial, dorsolateral and orbital) and some personality traits (novelty seeking, harm avoidance and self-directedness), even more than 50% of the variance being predicted. Discussion and Conclusions. Results suggest that frontal performance should be seen as a continuous dimensional variable, ranging from optimal to non-adaptive performance, without an eat cut-off point. Addiction would be related to an increase in frontal symptoms, both mesial (apathy) and orbital (disinhibition), as well as dorsolateral (dysexecutive syndrome), and this would result in changes in the previous personality pattern. These data seriously question the supposed genetic basis of temperamental traits, and suggest hypotheses of great relevance for clinicians (AU)

[Personality and frontal symptomatology in addicts and nonclinical population: toward a neuropsychology of personality]. / Personalidad y sintomatología frontal en adictos y población no clínica: hacia una neuropsicología de la personalidad.

OBJECTIVE: For many years now, Neuropsychology and the Psychology of Personality have developed in parallel, without any attempt to integrate the knowledge provided by the two disciplines. This paper sets out to analyze the relationship between the presence of symptoms in daily life related to the functioning of the brain's frontal lobes and individuals' personality patterns. PARTICIPANTS AND METHODS: The Dysexecutive Questionnaire (DEX-Sp), the Frontal System Behavior Scale (FrSBe- Sp) and the Inventory of Temperament and Character Revised (TCI-R) were administered to 421 non-clinical participants and 246 individuals in treatment for substance abuse or dependence. RESULTS: Significant correlations were found between symptoms for all frontal syndromes (mesial, dorsolateral and orbital) and some personality traits (novelty seeking, harm avoidance and self-directedness), even more than 50% of the variance being predicted. DISCUSSION AND CONCLUSIONS: Results suggest that frontal performance should be seen as a continuous dimensional variable, ranging from optimal to non-adaptive performance, without a neat cut-off point. Addiction would be related to an increase in frontal symptoms, both mesial (apathy) and orbital (disinhibition), as well as dorsolateral (dysexecutive syndrome), and this would result in changes in the previous personality pattern. These data seriously question the supposed genetic basis of temperamental traits, and suggest hypotheses of great relevance for clinicians.