Emotional Processing Profile in Patients with First Episode Schizophrenia: The Influence of Neurocognition.

This study sought to investigate the influence of neurocognition on the emotional processing profiles of patients with first-episode schizophrenia, using the 4-branch Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) (Perceiving Emotions; Facilitating Emotions; Understanding Emotions and Managing Emotions). A sample of 78 patients with first-episode schizophrenia and a group of 90 non-psychiatric control subjects were included in this work. The initial results showed that patients had lower scores than controls for the "Understanding Emotions" and "Managing Emotions" MSCEIT branches. However, after controlling for neurocognition, the only deficits were found on the "Managing Emotions" branch of the MSCEIT. This branch can be considered as measuring a more sophisticated level of emotional processing, which may constitute a deficit in itself. In conclusion, patients with first-episode schizophrenia present deficits in social cognition at the highest level that seem to be independent from neurocognition. These findings support the inclusion of the "Managing Emotions" branch of the MSCEIT as part of the MCCB.

Impact of Negative Symptoms on Functioning and Quality of Life in First Psychotic Episodes of Schizophrenia.

Negative symptoms are not considered a unitary construct encompassing two different domains, diminished expression, and avolition-apathy. The aim of this study was to explore the relationships between each domain and psychosocial functioning and quality of life in people with a first psychotic episode of schizophrenia. In total, 61 outpatients were assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS), The Functioning Assesment Short Test (FAST) and The Quality of Life Scale (QLS). The mean global score for CAINS was 21.5 (SD: 15.6), with a CAINS Avolition-Apathy (MAP) score of 17.0 (SD: 11.8), and CAINS Diminished Expression (EXP) score of 4.5 (SD: 5.0). The mean FAST score was 31.9 (SD: 18.9), and 41.1 (SD: 17.9) for QLS. Linear regression analysis revealed a significant (F(4,53) = 15.65, p < 0.001) relationship between MAP and EXP CAINS' score and FAST score. CAINS-MAP was more predictive of FAST scores (ß = 0.44, p = 0.001) than CAINS-EXP (ß = 0.37, p = 0.007). Linear regression analysis for QLS revealed a significant model (F(4,56) = 29.29, p < 0.001). The standardized regression weight for the CAINS-MAP was around three times greater (ß = -0.63, p < 0.001) than for CAINS-EXP (ß = -0.24, p = 0.024). The two different domains are associated differently with functionality and quality of life.

Antidepressant effect r TMS during pregnancy in a case of Major Depression Resistant to Pharmacological Treatment.

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.

Nota clínica: Efecto antidepresivo de la EMTrdurante el embarazo en un caso de Depresión Mayor Resistente al Tratamiento Farmacológico / Clinical note: Antidepressant effect of rTMS during pregnancy in a case of drug-resistant major depression. during pregnancy in a case of Medication-Resistant Major Depression

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)

Digital Technology for Internet Access by Patients With Early-Stage Schizophrenia in Spain: Multicenter Research Study.

BACKGROUND: Digital technology and social networks are part of everyday life in the current internet age, especially among young people. To date, few studies have been published worldwide on the pattern of use of digital technology devices and applications in patients with early-stage schizophrenia and even fewer comparing them with healthy participants (not using data from general population surveys) from the same demographic areas. In Spain, no such study has been carried out. OBJECTIVE: The aim of this study was to analyze how patients with early-stage schizophrenia use internet and social networks compared with healthy participants matched by age and gender and also to examine which devices are utilized to access internet resources. METHODS: A cross-sectional, multicentric study was carried out through a semistructured interview asking about the use of digital technology devices and internet. The sample comprised 90 patients and 90 healthy participants. The semistructured interview was conducted on 30 outpatients and 30 healthy subjects in each of the 3 different cities (Madrid, Alicante, and Cuenca). Student t test was used for continuous variables and chi-square test for categorical variables. In the case of ordinal variables, nonparametric Mann-Whitney U and Kruskal-Wallis H tests for independent samples were performed to compare groups. RESULTS: The results indicated that a large proportion of patients with early-stage schizophrenia have access to different digital devices and use them frequently. In addition, both groups coincide in the order of preference and the purpose for which they use the devices. However, a lower frequency of use of most digital technology devices was detected in patients compared with healthy participants. In the case of some devices, this was due to the impossibility of access and not a lack of interest. CONCLUSIONS: To our knowledge, this is the first study to analyze patterns of internet access and use of digital technology devices and applications in Spanish patients with early-stage schizophrenia compared with healthy participants from the same demographic areas. The results on significant access and use of digital technology and internet shown in this cross-sectional study will allow enhanced and more efficient treatment strategies to be planned, utilizing digital technology devices, for patients with early-stage schizophrenia.

Psychological symptomatology and impaired prepulse inhibition of the startle reflex are associated with cannabis-induced psychosis.

BACKGROUND: Cannabis-induced psychotic disorder (CIPD) is a psychiatric disorder induced by cannabis consumption. The psychological and psychophysiological features of this disorder are still unknown. We aimed to examine the psychological, personality and psychophysiological features of patients with CIPD. This study is an analytical extension of our previously published data, which previously found prepulse inhibition (PPI) deficits in the CIPD group used in this current paper. METHODS: We used a sample of 45 patients with CIPD. After 9 months of follow up, these patients were assessed with a Symptom Checklist-90-R (SCL-90-R) questionnaire of psychopathology, with the Eysenck Personality Questionnaire, and with a psychophysiological paradigm of inhibition of the startle reflex (PPI). These results were compared with a group of patients with schizophrenia and cannabis abuse (SCHZ) ( n = 54); patients with cannabis dependence (CD) ( n = 21); and healthy controls ( n = 50). RESULTS: CIPD patients obtained significant higher scores in the SCL-90-R subscale of neuroticism. These patients showed PPI percentages similar to SCHZ patients within early attentional levels (30 ms). The variables with greater correlation, and that appeared in the CIPD group were interpersonal sensitivity, depression and phobia. CONCLUSIONS: Neurotic symptomatology and difficulties in inhibition of the startle reflex might be risk factors for developing CIPD.

The Modulation of the Startle Reflex as Predictor of Alcohol Use Disorders in a Sample of Heavy Drinkers: A 4-Year Follow-Up Study.

BACKGROUND: Previous studies demonstrated that patients with alcohol use disorders (AUDs) show altered startle reflex responses to alcohol-related stimuli. However, there is little information about the role of these altered responses in the development of AUDs. This study examined the startle reflex response to different visual stimuli and the role of these patterns in the development of AUDs in a 4-year follow-up. METHODS: Two hundred and thirty-nine (nondependent) heavy-drinking participants were selected. In the baseline period, the startle reflex responses to alcohol-related, aversive, appetitive, and neutral pictures were assessed. Startle reflex responses to these pictures were used as predictive variables. Status drinking (alcohol dependence and nondependence) assessed at 4-year follow-up was used as outcome measure. RESULTS: At the 4-year follow-up assessment, 46% of participants fulfilled DSM-IV alcohol abuse or dependence criteria. Alcohol dependence status was predicted by an attenuated startle reflex response to alcohol-related and aversive pictures. CONCLUSIONS: This study revealed that an attenuated modulation of startle reflex response to alcohol-related and aversive stimuli could be used as a clinical marker to predict the development of AUDs in participants with previous alcohol consumption.

Psychiatric comorbidity in a sample of cocaine-dependent outpatients seen in the Community of Madrid drug addiction care network.

The objective of this study was to estimate the current prevalence of psychiatric disorders in cocaine-dependent patients who attend different treatment centres in the Community of Madrid. A prospective multicentre study was used, and a total of 197 cocaine-dependent subjects were assessed. The assessment instrument used for diagnosis was the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). The main findings of this study were a high prevalence of psychiatric comorbidity in cocaine-dependent patients seeking treatment (64.0%). The most common Non Substance Use Disorders found were attention-deficit/hyperactivity Disorders (34.5%) and depressive disorders (13.7%). The most common Substance Use Disorder was alcohol dependence (28.4%). Cocaine-dependent patients who had a depressive disorder and were alcohol dependent presented a more severe clinical profile and a higher degree of psychopathology, measured using different assessment tools, than the patients who were only cocaine dependent. These data suggest that the presence of psychiatric comorbidity could constitute a risk factor associated with the severity of cocaine dependence. The clinical heterogeneity found also indicates the need to search for individualised treatments that more specifically fit the needs of this population.

El objetivo de este estudio fue estimar la prevalencia actual de trastornos psiquiátricos en pacientes dependientes de cocaína atendidos en los diferentes centros de tratamiento en la Comunidad de Madrid. Se trata de un estudio multicéntrico prospectivo realizado con una muestra de 197 sujetos con dependencia de cocaína. El instrumento de evaluación utilizado fue la Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) (Entrevista de Investigación Psiquiátrica para Trastornos Mentales y Sustancias). La prevalencia actual de comorbilidad psiquiátrica encontrada fue del 64.0%. Los trastornos psiquiátricos más frecuentes no relacionados con el consumo fueron el trastorno por déficit de atención e hiperactividad (34,5%) y los trastornos depresivos (13,7%). El trastorno por uso de sustancias más frecuente fue la dependencia del alcohol (28.4%). Los pacientes dependientes de cocaína que presentaron un trastorno depresivo y los que presentaron dependencia del alcohol mostraron un perfil clínico de mayor gravedad y un mayor grado de psicopatología medido a través de diferentes instrumentos de evaluación en relación con los pacientes que sólo presentaban dependencia de la cocaína. Estos datos sugieren que la presencia de comorbilidad psiquiátrica podría constituir un factor de riesgo asociado a la gravedad de la dependencia de la cocaína. La heterogeneidad clínica encontrada recomienda la búsqueda de tratamientos individualizados que se ajusten de manera mas especifica a las necesidades de esta población.

Increased vulnerability to ethanol consumption in adolescent maternal separated mice.

The purpose of this study was to evaluate the effects of early life stress on the vulnerability to ethanol consumption in adolescence. To this aim, mice were separated from their mothers for 12 hours/day on postnatal days 8 and 12. Emotional behavior (light-dark box, elevated plus maze and tail suspension tests) and pre-attentional deficit (pre-pulse inhibition) were evaluated in adolescent maternal separated (MS) mice. Alterations of the corticotropin-releasing factor (CRF), glucocorticoid receptor (NR3C1), tyrosine hydroxylase (TH), mu-opioid receptor (MOr), brain-derived neurotrophic factor (BDNF), neuronal nuclei (NeuN), microtubule-associated protein 2 (MAP2) and neurofilament heavy (NF200)-immunoreactive fibers were studied in the paraventricular nucleus of the hypothalamus (PVN), ventral tegmental area (VTA), nucleus accumbens (NAc) or hippocampus (HIP). The effects of maternal separation (alone or in combination with additional stressful stimuli) on ethanol consumption during adolescence were evaluated using the oral ethanol self-administration paradigm. MS mice presented mood-related alterations and pre-attentional deficit. Increased CRF, MOr and TH, and reduced BDNF, NR3C1, NeuN, MAP2 and NF200-immunoreactive fibers were observed in the PVN, NAc and HIP of adolescent MS mice. In the oral ethanol self-administration test, adolescent MS mice presented higher ethanol consumption and motivation. Exposure to additional new stressful stimuli during adolescence significantly increased the vulnerability to ethanol consumption induced by maternal separation. These results clearly demonstrated that exposure to early life stress increased the vulnerability to ethanol consumption, potentiated the effects of stressful stimuli exposure during adolescence on ethanol consumption and modified the expression of key targets involved in the response to stress, ethanol reinforcing properties and cognitive processes.

Comorbilidad psiquiátrica en una muestra de pacientes con dependencia de cocaína atendidos ambulatoriamente en la red drogas de la Comunidad de Madrid / Psychiatric comorbidity in a sample of cocaine-dependent outpatients seen in the Community of Madrid drug addiction care network

El objetivo de este estudio fue estimar la prevalencia actual de trastornos psiquiátricos en pacientes dependientes de cocaína atendidos en los diferentes centros de tratamiento en la Comunidad de Madrid. Se trata de un estudio multicéntrico prospectivo realizado con una muestra de 197 sujetos con dependencia de cocaína. El instrumento de evaluación utilizado fue la Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) (Entrevista de Investigación Psiquiátrica para Trastornos Mentales y Sustancias). La prevalencia actual de comorbilidad psiquiátrica encontrada fue del 64.0%. Los trastornos psiquiátricos más frecuentes no relacionados con el consumo fueron el trastorno por déficit de atención e hiperactividad (34,5%) y los trastornos depresivos (13,7%). El trastorno por uso de sustancias más frecuente fue la dependencia del alcohol (28.4%). Los pacientes dependientes de cocaína que presentaron un trastorno depresivo y los que presentaron dependencia del alcohol mostraron un perfil clínico de mayor gravedad y un mayor grado de psicopatología medido a través de diferentes instrumentos de evaluación en relación con los pacientes que sólo presentaban dependencia de la cocaína. Estos datos sugieren que la presencia de comorbilidad psiquiátrica podría constituir un factor de riesgo asociado a la gravedad de la dependencia de la cocaína. La heterogeneidad clínica encontrada recomienda la búsqueda de tratamientos individualizados que se ajusten de manera mas especifica a las necesidades de esta población

The objective of this study was to estimate the current prevalence of psychiatric disorders in cocaine-dependent patients who attend different treatment centres in the Community of Madrid. A prospective multicentre study was used, and a total of 197 cocainedependent subjects were assessed. The assessment instrument used for diagnosis was the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). The main findings of this study were a high prevalence of psychiatric comorbidity in cocaine-dependent patients seeking treatment (64.0%). The most common Non Substance Use Disorders found were attention-deficit/hyperactivity Disorders (34.5%) and depressive disorders (13.7%). The most common Substance Use Disorder was alcohol dependence (28.4%). Cocaine-dependent patients who had a depressive disorder and were alcohol dependent presented a more severe clinical profile and a higher degree of psychopathology, measured using different assessment tools, than the patients who were only cocaine dependent. These data suggest that the presence of psychiatric comorbidity could constitute a risk factor associated with the severity of cocaine dependence. The clinical heterogeneity found also indicates the need to search for individualised treatments that more specifically fit the needs of this population

Stress induced by the socially evaluated cold-pressor test cause equivalent deficiencies of sensory gating in male subjects with schizophrenia and healthy controls.

It is known that patients with schizophrenia show a deficiency in the prepulse inhibition reflex (PPI). These patients display abnormalities in autonomic nervous system and hypothalamic-pituitary-adrenal function and may have an altered sensitivity to stress. To date, no studies have been carried out to determine the effect of acute stress on the PPI. We investigated whether there was a differential response in reactivity to acute stress caused by the socially evaluated cold-pressor test (SECPT) in a sample of 58 chronic male patients with schizophrenia and 28 healthy control subjects. PPI, salivary cortisol and heart rate (HR) were measured. The patients were evaluated in two sessions (with and without the SECPT) 72 h apart and basal measurements were carried out and 30 min post-startle probe. We found an increase in salivary cortisol levels and the HR with SECPT condition in both groups and a significantly lower PPI% in patients with schizophrenia. The most relevant findings of this study are that the impairment of the PPI is increased by stress. Stress-induced increase in cortisol in both groups, mainly in healthy control group which allows us to hypothesize that at least such deterioration may be due to the hypercortisolemia caused by the SECPT.

Clinical and Demographic Characteristics of Binge Drinkers Associated with Lack of Efficacy of Brief Intervention and Medical Advice.

UNLABELLED: Brief Counseling Intervention (BCI) and Medical advice (MA) are psychotherapeutic approaches used for the treatment of binge drinkers in Primary Care. Although binge drinking is a common pattern of alcohol misuse in Europe and in the US, no studies have evaluated those subjects who do not respond to Brief Counseling Interventions or Medical Advice. OBJECTIVE: To determine the clinical and demographic characteristics of binge drinkers in whom BCI or MA are not effective in reducing harmful alcohol use. METHODS: This is a secondary analysis of data from a randomized alcohol brief intervention trial with a 12-month follow-up period. A total of 674 subjects (89%) participated right through to the end of the study. The primary outcome measure was change in harmful alcohol use from baseline to 12 months. RESULTS: The strongest baseline predictors of harmful alcohol use during follow-up were educational status, young adults, and high number of cigarettes smoked, present family history of alcoholism, treatment condition and number of drinks per episode of binge drinking. CONCLUSIONS: Binge drinkers are a heterogeneous group that responds to brief intervention or MA but in a subgroup of them these interventions fail to prevent harmful alcohol use. Other interventions should be implemented for these subjects.

La Intervención Breve (IB) y el Consejo Médico simple (CM) son intervenciones psicoterapéuticas usadas para el tratamiento del consumo de alcohol por atracones en Atención Primaria. A pesar de la frecuencia de este patrón de abuso en Europa y en los Estados Unidos, ningún estudio ha evaluado las características de los sujetos que no responden a esas dos técnicas. Objetivo. Determinar las características demográficas y clínicas de los bebedores por atracones en los que la IB y el CM no son efectivos para la reducción del consumo perjudicial de alcohol. Métodos. Se trata de un análisis secundario de los datos obtenidos en un ensayo aleatorizado de intervención breve en alcohol con un período de seguimiento de 12 meses. Un total de 674 sujetos (89%) participaron durante todo el estudio hasta el final. La variable principal fue el cambio en el uso perjudicial de alcohol tras 12 meses de seguimiento. Resultados. Para ambos grupos de tratamiento las variables que predecían la continuidad en el consumo perjudicial tras el seguimiento eran: bajo nivel educativo, ser jóvenes, el número de cigarrillos fumados, la historia familiar de alcoholismo y la gravedad del consumo de alcohol basalmente. Conclusiones. Las características clínicas y sociodemográficas de los sujetos con un patrón de consumo de alcohol por atracones atendidos en Atención primaria influyen en el pronóstico de las Intervenciones breves y del Consejo Médico.

Changes on the Modulation of the Startle Reflex in Alcohol-Dependent Patients after 12 Weeks of a Cognitive-Behavioral Intervention.

AIMS: Little is known about changes in the modulation of the startle reflex when patients go through an alcohol-dependence treatment in an outpatient facility. In the current study, the affective modulation of the cue-related startle reflex has been used to evaluate changes in the emotional processing of alcohol-related stimuli that occurred after a standard cognitive-behavioral intervention, and to assess the outcome of this intervention. We hypothesized a 'normalization' of the startle inhibition for the alcohol-related cues during the period of treatment. We also assumed that higher startle inhibition at baseline elicited by alcohol cues would predict the relapse on alcohol consumption during treatment. PARTICIPANTS: A total of 98 alcohol-dependent subjects were included who fulfilled DSM-IV criteria for alcohol dependence. A control group of 72 subjects was selected to match demographic characteristics. MEASUREMENTS: All patients received a standard cognitive-behavioral therapy once a week throughout the study period. FINDINGS: Results show that the startle response differed significantly after 12 weeks of treatment for alcohol-related, neutral and aversive stimuli between alcohol-dependent patients and controls. Low startle responses at baseline to alcohol cues predicted relapse. CONCLUSIONS: These results may indicate that the startle reflex is referred to enduring and permanent processes of cue reactivity, and that the emotional processing of alcohol-associated cues assessed with the affect-modulated startle reflex is less altered by interventions attempting to influence explicit cognitions. Furthermore, lower values of the baseline startle reflex elicited by alcohol-associated stimuli were associated with higher probability of relapse on alcohol use.

Startle-response based tasks and laboratory measures of impulsivity in abstinent alcoholic patients.

AIMS: It is well known that impulsivity is a risk factor for the development of Addictive Disorders, and more specifically Alcohol Use Disorders (AUD). Recently, the Startle-Response Based Tasks (SRBT) and its different forms of plasticity have been found to be impaired in the alcoholic population. This is the first study to explore the correlation between impulsivity laboratory tasks and the SRBT test, in order to determine whether impulsivity and startle response (SR) could be related and in turn, explain their association with Alcohol Dependence (AD). SUBJECTS: 40 men, who met DSM-IV criteria for AD and had been abstinent for at least one month. Impulsivity was assessed using three laboratory tests: Continuous Performance Test (CPT), Stop-Signal Task (SST) and Differential Reinforcement for Low-Rate Responding (DRL6). Patients also underwent the SR test. They were compared to 40 matched controls. RESULTS: Impulsivity laboratory measures tasks (SST and commissions of the CPT) correlated positively with the magnitude of SR (P < 0.05) and with habituation (P < 0.05). Scores on DRL6 correlated negatively with the magnitude of SR (P < 0.05). This was not found in the control group. CONCLUSIONS: The fact that impulsivity laboratory measures and the SR are correlated in patients but not in controls, could imply the existence of a common link for these two measures in alcoholic patients. Our findings support the hypothesis of the existence of two different vulnerability pathways for the development of AUD: anxiety and disinhibitory behaviour.

Características clínicas y demográficas de bebedores "por atracones" que se relacionan con una falta de eficacia de la intervención breve y el consejo médico / Clinical and Demographic Characteristics of Binge Drinkers Associated with Lack of Efficacy of Brief Intervention and Medical Advice

La Intervención Breve (IB) y el Consejo Médico simple (CM) son intervenciones psicoterapéuticas usadas para el tratamiento del consumo de alcohol por atracones en Atención Primaria. A pesar de la frecuencia de este patrón de abuso en Europa y en los Estados Unidos, ningún estudio ha evaluado las características de los sujetos que no responden a esas dos técnicas. Objetivo:. determinar las características demográficas y clínicas de los bebedores por atracones en los que la IB y el CM no son efectivos para la reducción del consumo perjudicial de alcohol. Métodos:. Se trata de un análisis secundario de los datos obtenidos en un ensayo aleatorizado de intervención breve en alcohol con un período de seguimiento de 12 meses. Un total de 674 sujetos (89%) participaron durante todo el estudio hasta el final. La variable principal fue el cambio en el uso perjudicial de alcohol tras 12 meses de seguimiento. Resultados:. Para ambos grupos de tratamiento las variables que predecían la continuidad en el consumo perjudicial tras el seguimiento eran: bajo nivel educativo, ser jóvenes, el número de cigarrillos fumados, la historia familiar de alcoholismo y la gravedad del consumo de alcohol basalmente. Conclusiones:. Las características clínicas y sociodemográficas de los sujetos con un patrón de consumo de alcohol por atracones atendidos en Atención primaria influyen en el pronóstico de las Intervenciones breves y del Consejo Médico

Brief Counseling Intervention (BCI) and Medical advice (MA) are psychotherapeutic approaches used for the treatment of binge drinkers in Primary Care. Although binge drinking is a common pattern of alcohol misuse in Europe and in the US, no studies have evaluated those subjects who do not respond to Brief Counseling Interventions or Medical Advice. Objective: To determine the clinical and demographic characteristics of binge drinkers in whom BCI or MA are not effective in reducing harmful alcohol use. Methods: This is a secondary analysis of data from a randomized alcohol brief intervention trial with a 12-month follow-up period. A total of 674 subjects (89%) participated right through to the end of the study. The primary outcome measure was change in harmful alcohol use from baseline to 12 months. Results:. The strongest baseline predictors of harmful alcohol use during follow-up were educational status, young adults, and high number of cigarettes smoked, present family history of alcoholism, treatment condition and number of drinks per episode of binge drinking. Conclusions:. Binge drinkers are a heterogeneous group that responds to brief intervention or MA but in a subgroup of them these interventions fail to prevent harmful alcohol use. Other interventions should be implemented for these subjects

Characterizing cannabis-induced psychosis: a study with prepulse inhibition of the startle reflex.

Cannabis-induced psychotic disorder (CIPD) refers to psychotic symptoms that arise in the context of cannabis intoxication. Prepulse inhibition (PPI) deficits have been extensively identified in schizophrenia and in cannabis abusers. We aimed to characterize PPI in CIPD patients. We used a sample of 48 CIPD patients, 54 schizophrenia patients and cannabis abuse (SCHZ), 44 cannabis dependents (CD), and 44 controls. CIPD, SCHZ and CD were abstinent of cannabis consumption for 9 months. Participants were assessed with PPI at 30, 60, and 120 ms. At 30 ms, CIPD showed lower PPI levels than controls, and SCHZ obtained worse functioning than controls and CD. At 60 ms, only SCHZ exhibited worse PPI percentages (of object) than controls. Finally, at 120 ms, CIPD showed higher PPI levels than SCHZ, and SCHZ obtained lower percentages than controls. We found that CIPD and SCHZ patients showed deficits at the most pre-attentional levels, whereas CIPD patients performed better than SCHZ at higher attentional levels. These results suggest that CIPD constitutes a different group of patients than that of SCHZ. Deficits in PPI functioning at 30 ms could be a useful psychophysiological measure to detect CIPD patients, who are frequently confused with cannabis abusers whose symptoms may mimic that of schizophrenia.

Validation of the Spanish version of the alcohol smoking and substance involvement screening test (ASSIST) / Validación de la versión española del Test de Detección de Uso de Alcohol, Tabaco y otras Sustancias (ASSIST)

BACKGROUND: There is a growing interest in designing instruments to assess obsessive-compulsive symptoms in children. The Obsessive-Compulsive Inventory-Child Version (OCI-CV) has showed to be a valid in the evaluation of OCD in clinical and nonclinical populations. The main goal in this study was to analyze factor structure and psychometric properties of the OCI-CV in a community Spanish sample. METHOD: Data were collected from 914 children/adolescents with a mean age of 13.01 (SD = 1.96; Males = 51.3%). Exploratory factor analysis was carried out in order to study the internal structure of the OCI-CV Spanish version. Further, internal consistency, test-retest reliability, and convergent and discriminant validity of the total score and the factors obtained were examined. Finally, age and gender differences were also explored. RESULTS: Exploratory factor analysis yielded a similar structure to the original OCI-CV with the following six factors: Washing/Checking, Obsession, Ordering, Doubting, Neutralizing, and Hoarding. The internal consistency was strong for the total score, but moderate for the subscales. The Spanish version of the OCI-CV showed evidences of test-retest reliability and convergent and discriminant validity. CONCLUSION: The Spanish version of the OCI-CV is an instrument with adequate psychometric properties to assess obsessions and compulsions in Spanish children/adolescents

ANTECEDENTES: existe un creciente interés en el diseño de instrumentos que evalúen los síntomas obsesivo-compulsivos en niños. El Inventario Obsesivo Compulsivo-Versión para Niños (OCI-CV) ha demostrado ser válido para evaluar estos síntomas en población clínica y no clínica. El objetivo de este estudio fue analizar la estructura factorial y las propiedades psicométricas del OCI-CV en población española comunitaria. MÉTODO: se recogieron datos de 914 niños/adolescentes con una edad media de 13,01 años (DT = 1.96; 51.3% varones). Se realizó un análisis factorial exploratorio. Posteriormente se examinó la consistencia interna, la fiabilidad test-retest y la validez convergente y divergente de la puntuación total del instrumento y de los factores obtenidos. Finalmente, se comprobó la existencia de diferencias en función del sexo y la edad de los participantes. RESULTADOS: los resultados mostraron una estructura similar a la del OCI-CV original, compuesta por los siguientes factores: Lavado/Comprobación, Obsesión, Orden, Duda, Neutralización y Acumulación. La consistencia interna fue buena para la puntuación total, aunque moderada para las diferentes subescalas. La versión en castellano del OCI-CV mostró evidencias de fiabilidad test-retest y validez convergente y discriminante. CONCLUSIONES: OCI-CV es una herramienta con adecuadas propiedades psicométricas para la valoración de obsesiones y compulsiones en niños/adolescentes españoles

Validation of the Spanish version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).

BACKGROUND: To evaluate the psychometric properties of the Spanish version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and its effectiveness as a screening tool for problematic alcohol, tobacco and other psychoactive substance use in groups of low, moderate, and high risk users. METHODS: A test battery including the ASSIST and several standardized screening, assessment, and diagnostic instruments was administered to 485 patients recruited in different primary health-care facilities and specialized addiction treatment units from Health Area 11 in Madrid. RESULTS: ASSIST cut-off scores show a good sensitivity and specificity for discrimination between substance use and abuse and between abuse and dependence. Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the Mini-International Neuropsychiatric Interview (MINI-Plus), the Alcohol Use Disorders Identification Test (AUDIT), the Revised Fagerstrom Tolerance Questionnaire (RTQ) and the Severity of Dependence Scale (SDS). CONCLUSIONS: Psychometric properties of the Spanish version of the ASSIST indicate that is a valid screening test for identifying substance use disorders in various health-care settings.

[Integration of self-guidance groups for relatives in a public program of alcoholism treatment]. / Integración de los grupos de autoayuda para familiares en un programa público de tratamiento del alcoholismo.

Interventions with relatives of alcohol-dependent patients have shown effectiveness in engaging unmotivated patients into treatment. The Federation of ex-alcoholics, in the Community of Madrid, has a network of self-help centers (Centers to Promote Psychosocial Alternatives against Addictions, CPAA) spread throughout the Madrid's region where alcohol-dependent patients and their families receive attention. The aim of this study was to demonstrate that the integration of these facilities could improve the psychological condition of the relatives and the outcome on the patients' treatment. 188 patients attending the treatment program at "Hospital 12 de Octubre" and their relatives were randomized into two groups: Group A (n=94) (Standard program for patients and relatives delivered at our facility) and Group B (n=94) (where patients were treated with the standard program in our facilities and relatives attended a family group intervention at the CPAA) After 12 weeks, the CPAA conditions were significantly more effective than our standard program in improving psychological distress of relatives and in engaging patients into treatment. Patients belonging to group B had fewer drinking days during the treatment period. Our results support that psychological interventions delivered at CPAA centers are useful in improving psychological conditions of alcoholic patients' relatives than when undertaking the public alcoholism program. This intervention also improves outcome of alcoholic patients. The integration of these centers within public alcoholism treatment programs could provide a new way to treat alcoholism, based on collaboration of public facilities and patient associations.

Integración de los grupos de autoayuda para familiares en un programa público de tratamiento del alcoholismo / Integration of self-guidance groups for relatives in a public program of alcoholism treatment

Las intervenciones con familiares de pacientes dependientes del alcohol han demostrado su eficacia para mejorar el pronóstico de la dependencia alcohólica. En la Comunidad de Madrid, la Federación de exalcohólicos ha creado la Red de centros de alternativas psicosociales a las adicciones (Red CAPA) en cuyos dispositivos se atiende a los dependientes del alcohol y a sus familiares. El objetivo de este estudio ha sido el de demostrar quela integración de terapias familiares mejoraba la salud psicológica de los familiares y el pronóstico del tratamiento de los pacientes dependientes. Fueron seleccionados 188 pacientes de nuestro programa del tratamiento del Hospital 12 de Octubre con sus respectivos familiares y se aleatorizaron en dos grupos. Un grupo A (n=94) recibía el tratamiento habitual para pacientes y familiares de nuestro programa de tratamiento, mientras que en un grupo B (n=94) los pacientes eran atendidos en nuestro programa de tratamiento pero sus familiares acudían a un grupo de familias de la Red CAPA. Al cabo de 12 semanas los familiares del grupo B tenían mejor salud psicológica y los pacientes tuvieron menos días de consumo y menores tasas de abandonos del programa de tratamiento que los del grupo A. Los grupos para familiares de la Red CAPA son útiles en mejorar la salud psicológica de los familiares y en mejorar el pronóstico de la dependencia. La integración de estos centros dentro de los programas públicos de tratamiento del alcoholismo podría proporcionar una nueva forma de tratar el alcoholismo, basada en la colaboración de los establecimientos públicos y asociaciones de pacientes(AU)

Interventions with relatives of alcohol-dependent patients have shown effectiveness in engaging unmotivated patients into treatment. The Federation of ex-alcoholics, in the Community of Madrid, has a network of self-help centers(Centers to Promote Psychosocial Alternatives against Addictions, CPAA) spread throughout the Madrid’s region where alcohol-dependent patients and their families receive attention. The aim of this study was to demonstrate that the integration of these facilities could improve the psychological condition of the relatives and the outcome on the patients’ treatment. 188 patients attending the treatment program at “Hospital 12 de Octubre” and their relatives were randomized into two groups: Group A (n=94) (Standard program for patients and relatives delivered at our facility) and Group B (n=94) (where patients were treated with the standard program in our facilities and relatives attended a family group intervention at the CPAA) After 12 weeks, the CPAA conditions were significantly more effective than our standard program in improving psychological distress of relatives and in engaging patients into treatment. Patients belonging to group B had fewer drinking days during the treatment period. Our results support that psychological interventions delivered at CPAA centers are useful in improving psychological conditions of alcoholic patients’ relatives than when undertaking the public alcoholism program. This intervention also improves outcome of alcoholic patients. The integration of these centers within public alcoholism treatment programs could provide a new way to treat alcoholism, based on collaboration of public facilities and patient associations(AU)