Differences between substance-induced psychotic disorders and non-substance-induced psychotic disorders and diagnostic stability. / Diferencias y estabilidad diagnóstica entre trastornos psicóticos inducidos por sustancias y trastornos psicóticos no inducidos.

Several hypotheses have been proposed to explain the comorbidity between psychotic disorders and substance use, one of them being the capacity of some to induce psychotic symptoms, although the transition from psychotic episodes induced by substances to schizophrenia has been less studied. In this study, differential variables between patients with induced and non-induced psychosis are determined, and the evolution and change of diagnosis of those induced to schizophrenia in the follow-up is analyzed. This is an observational case-control study with 238 patients admitted to the acute care unit for psychotic episodes between December 2003 and September 2011. The group of non-substance-induced psychotic disorders (NSIPD) included 127 patients, with 111 in the substance-induced (SIPD) group, according to the International Classification of Diseases. Sociodemographic and clinical characteristics, personal and family history, substance use, diagnostic stability and progression were compared. The NSIPD group showed higher scores in severity and in negative symptoms and more family history of psychosis. The SIPD group presented more personal history of personality disorder and family history of addictions and more positive symptoms At 6 years of follow-up, 40.9% of ISDP changed to a diagnosis of schizophrenia, presenting more family history of psychotic disorders and worse progression with more visits to the emergency department and readmissions, than subjects who maintained diagnostic stability. Therefore, special attention should be paid to this group of patients because of the potential severity and the increased risk of developing a chronic psychotic disorder.

Se han propuesto distintas hipótesis para explicar la comorbilidad entre trastornos psicóticos y por consumo de sustancias, siendo una de ellas la capacidad de algunas de inducir cuadros psicóticos, aunque la transición de episodios psicóticos inducidos por sustancias a esquizofrenia ha sido menos estudiada. En este trabajo se determinan variables diferenciales entre individuos con psicosis inducidas y no inducidas, y se analiza la evolución y el cambio de diagnóstico de las inducidas a esquizofrenia en el seguimiento. Es un estudio observacional de casos y controles con 238 pacientes ingresados en la unidad de agudos de un Hospital General de Madrid (España) por episodios psicóticos entre diciembre de 2003 y septiembre de 2011. Se incluyeron 127 en el grupo de trastornos psicóticos no inducidos por sustancias (TPNIS) y 111 en el de inducidos por sustancias (TPIS), según la Clasificación Internacional de Enfermedades. Se compararon características sociodemográficas, clínicas, antecedentes personales y familiares, de consumo de sustancias, estabilidad diagnóstica y evolución. El grupo de TPNIS presentó mayores puntuaciones en gravedad y sintomatología negativa mientras que el de TPIS tuvo más antecedentes personales de trastorno de personalidad y familiares de adicciones, y más sintomatología positiva. A los seis años un 40,9% de TPIS cambió a diagnóstico de esquizofrenia, presentando más antecedentes familiares de trastornos psicóticos y de adicciones, y una peor evolución con más visitas a urgencias y reingresos que los sujetos con estabilidad diagnóstica. Por tanto, habrá que prestar especial atención a este grupo de sujetos por su potencial gravedad y por el mayor riesgo de desarrollar un trastorno psicótico crónico.

A 3-Year Retrospective Study of the Impact of Integrating an Addiction Liaison Team into an Outpatient Alcoholism Treatment Programme.

BACKGROUND: The number of inpatients with alcohol and other substance-related problems (ASRP) in the general hospital population at any time is vast. To meet the needs of those patients, most hospitals have an Addiction Liaison Team (ALT) that diagnoses and initiates the treatment of the addictive disorder. In our hospital, this team is part of a more extensive and intensive Outpatient Alcoholism Treatment Programme that facilitates the continuity of care. AIM: the main goal of this study is to evaluate the performance and effectiveness of our inpatient ALT. METHODOLOGY: we carried out an observational cohort study of patients with ASRP admitted to the hospital from 2015 to 2017. We evaluated the performance and effectiveness of our ALT: referrals to the programme, inpatients mortality, readmissions to hospital, hospital length of stay (LOS) and medical or surgical treatment adherence. RESULTS: out of 133,181 admissions, 17,387 (13.14%) were positive for ASRP, and 615 (3.54%) were referred to the ALT. Referred patients had less in-hospital mortality, shorter LOS and lower risk of readmissions during the first year of follow-up. Subjects treated in the programme had better therapeutic adherence. CONCLUSIONS: integrating the ALT into an outpatient programme facilitates an earlier detection and initiation of treatment during the hospital stay and the continuity of care. Alcohol misuse conditions affect the patient's prognosis and health outcomes, so appropriate care is needed. Inclusion in the programme was associated with less risk of hospital mortality, fewer readmissions and a lower LOS.

Cannabinoid receptor type 2 gene is associated with comorbidity of schizophrenia and cannabis dependence and fatty acid amide hydrolase gene is associated with cannabis dependence in the Spanish population. / El gen del receptor cannabinoide tipo 2 se asocia con la comorbilidad entre esquizofrenia y dependencia de cannabis y el gen de la enzima amidohidrolasa de ácidos grasos se asocia con la dependencia de cannabis en población española.

The endocannabinoid system has been associated with various psychiatric disorders, such as schizophrenia or addictive disorders. Recent studies have found that some polymorphisms in the cannabinoid receptor type 2 (CNR2), cannabinoid receptor type 1 (CNR1) and fatty acid amide hydrolase (FAAH) genes could play an important role as risk factors in the etiology of these diseases. We analysed different cannabinoid gene polimorphisms from non-substance using patients diagnosed with schizophrenia (n = 379), schizophrenic patients with cannabis use disorders (n = 124), cannabis users who did not have psychoses (n = 71), and 316 controls from various Spanish hospitals and health centres. We found a statistical association between polymorphisms rs35761398 and rs12744386 in the CNR2 gene and comorbidity of schizophrenia and cannabis dependence, as well as an association between loss of heterozygosity (overdominance) for polymorphism rs324420 in the FAAH gene and cannabis dependence in a Spanish population sample. The rs35761398 and rs12744386 polymorphisms in the CNR2 gene are genetic risk factors for schizophrenia in cannabis-dependent subjects. Loss of heterozygosity for polymorphism rs324420 in the FAAH gene is a genetic risk factor for cannabis dependence in this population.

El sistema cannabinoide se ha asociado con varios trastornos psiquiátricos como la esquizofrenia y las adicciones. Diversos estudios han observado que algunos polimorfismos del receptor cannabinoide tipo 2 (CNR2), del receptor cannabinoide tipo 1 (CNR1) y del gen de la enzima amido hidrolasa de ácidos grasos (FAAH) pueden ser factores de riesgo de estos trastornos. Hemos analizado diversos polimorfismos del sistema cannabinoide en pacientes diagnosticados de esquizofrenia sin trastorno por uso de sustancias (n = 379), esquizofrenia con trastorno por uso de cannabis (n = 124), dependientes de cannabis sin psicosis asociada (n = 71) y un grupo de control (316) procedentes de diversos hospitales y centros de asistencia sanitaria españoles. Hemos encontrado una asociación entre los polimorfismos rs35761398 y rs12744386 del CNR2 con la presencia de esquizofrenia y trastorno por uso de cannabis comórbido y una pérdida de heterocigosidad en el polimorfismo rs324420 del gen FAAH con la dependencia de cannabis en población española. Los polimorfismos rs35761398 y rs12744386 en CNR2 son factores de riesgo para esquizofrenia en sujetos dependientes de cannabis. La pérdida de heterocigosidad en el polimorfismo rs324420 en el gen FAAH es un factor de riesgo para la dependencia de cannabis.

El gen del receptor cannabinoide tipo 2 se asocia con la comorbilidad entre esquizofrenia y dependencia de cannabis y el gen de la enzima amidohidrolasa de ácidos grasos se asocia con la dependencia de cannabis en población española / Cannabinoid receptor type 2 gene is associated with comorbidity of schizophrenia and cannabis dependence and fatty acid amide hydrolase gene is associated with cannabis dependence in the Spanish population

El sistema cannabinoide se ha asociado con varios trastornos psiquiátricos como la esquizofrenia y las adicciones. Diversos estudios hanobservado que algunos polimorfismos del receptor cannabinoide tipo2 (CNR2), del receptor cannabinoide tipo 1 (CNR1) y del gen de la enzima amido hidrolasa de ácidos grasos (FAAH) pueden ser factores deriesgo de estos trastornos. Hemos analizado diversos polimorfismos delsistema cannabinoide en pacientes diagnosticados de esquizofrenia sintrastorno por uso de sustancias (n = 379), esquizofrenia con trastornopor uso de cannabis (n = 124), dependientes de cannabis sin psicosisasociada (n = 71) y un grupo de control (316) procedentes de diversoshospitales y centros de asistencia sanitaria españoles. Hemos encontrado una asociación entre los polimorfismos rs35761398 y rs12744386 delCNR2 con la presencia de esquizofrenia y trastorno por uso de cannabis comórbido y una pérdida de heterocigosidad en el polimorfismors324420 del gen FAAH con la dependencia de cannabis en poblaciónespañola. Los polimorfismos rs35761398 y rs12744386 en CNR2 son factores de riesgo para esquizofrenia en sujetos dependientes de cannabis.La pérdida de heterocigosidad en el polimorfismo rs324420 en el genFAAH es un factor de riesgo para la dependencia de cannabis. (AU)

The endocannabinoid system has been associated with various psychiatric disorders, such as schizophrenia or addictive disorders. Recent studies have found that some polymorphisms in the cannabinoid receptortype 2 (CNR2), cannabinoid receptor type 1 (CNR1) and fatty acid amide hydrolase (FAAH) genes could play an important role as risk factorsin the etiology of these diseases. We analysed different cannabinoidgene polimorphisms from non-substance using patients diagnosed withschizophrenia (n = 379), schizophrenic patients with cannabis use disorders (n = 124), cannabis users who did not have psychoses (n = 71),and 316 controls from various Spanish hospitals and health centres.We found a statistical association between polymorphisms rs35761398and rs12744386 in the CNR2 gene and comorbidity of schizophreniaand cannabis dependence, as well as an association between loss ofheterozygosity (overdominance) for polymorphism rs324420 in theFAAH gene and cannabis dependence in a Spanish population sample.The rs35761398 and rs12744386 polymorphisms in the CNR2 gene aregenetic risk factors for schizophrenia in cannabis-dependent subjects.Loss of heterozygosity for polymorphism rs324420 in the FAAH gene isa genetic risk factor for cannabis dependence in this population. (AU)

Efectos del confinamiento en el hogar debido a la pandemia por COVID-19 en el consumo en pacientes en tratamiento en un programa de deshabituación de alcohol / Effects of the lockdown due to the COVID-19 pandemic on alcohol consumption in patients under treatment in an alcohol relapse prevention programme

Durante la pandemia producida por la infección por el Covid-19 se produjeron una serie de cambios sociosanitarios excepcionales para evitar su propagación como el confinamiento en el hogar y la supresión de los servicios asistenciales sanitarios habituales. Se consideró que estos cambios podrían implicar un incremento en el consumo de alcohol y un mayor riesgo de recaídas para los pacientes en tratamiento. El objetivo de este estudio fue valorar los cambios en el consumo durante el período de confinamiento (marzo a mayo de 2020) en los pacientes en tratamiento en el programa de alcohol del Hospital Doce de Octubre de Madrid. Fueron valorados 311 pacientes mediante entrevista telefónica dentro de la práctica clínica habitual durante ese período. Un 76 % de los pacientes no presentaron cambios en su situación de consumo, un 9,2% de estos cesaron en el consumo, algunos de ellos con cuadros de abstinencia graves, y un 7,5% recayeron. El sexo femenino, el consumo en solitario o en el hogar, en atracón, o el de otras drogas de forma concomitante y el no estar en terapia grupal o no asistir a grupos de las asociaciones de ayuda mutua por videoconferencia durante el confinamiento fueron factores predictores de mal pronóstico. Un 31,6% presentó alteraciones psicopatológicas debidas al confinamiento, sobre todo, aquellos pacientes con comorbilidad psiquiátrica. Por lo tanto, en situaciones similares a esta, la mayoría de los pacientes en tratamiento no modifican el patrón de consumo, pero, ciertas características identifican un subgrupo de sujetos más vulnerables. (AU)

During the COVID-19 pandemic, several exceptional measures were put in place in order to avoid virus propagation, such as lockdown and the discontinuation of usual health care assistance services. It was considered that these changes might be associated with an increase in alcohol consumption and a higher risk of relapse for patients under treatment. The aim of this study was to assess changes in alcohol consumption during the lockdown period (between March and May, 2020) in patients following treatment under the Alcohol Use Disorders Programme at the “Hospital 12 de Octubre” in Madrid. A total of 311 patients were assessed through interviews carried out by telephone in accordance with usual clinical practice during that period. 76% of the total number of patients did not experience changes in their alcohol consumption, 9.2% stopped drinking and some experienced severe withdrawal syndrome, while 7.5% relapsed. The risk factors found for worsening the prognosis of the patients were: being female, drinking alcohol alone or at home, binge drinking, concomitant substance misuse and failure to attend therapy groups or self-help groups online during the lockdown. 31.6% of the sample described psychopathological symptoms due to the lockdown, especially those who already had psychiatric comorbidities. For this reason, we can conclude that during the lockdown as a result of the pandemic, most of our alcohol dependent patients did not modify their drinking patterns, but specific factors enabled us to identify a more vulnerable subgroup. (AU)

Diferencias y estabilidad diagnóstica entre trastornos psicóticos inducidos por sustancias y trastornos psicóticos no inducidos / Differences between substance-induced psychotic disorders and non-substance-induced psychotic disorders and diagnostic stability

Se han propuesto distintas hipótesis para explicar la comorbilidad entre trastornos psicóticos y por consumo de sustancias, siendo una de ellas la capacidad de algunas de inducir cuadros psicóticos, aunque la transición de episodios psicóticos inducidos por sustancias a esquizofrenia ha sido menos estudiada. En este trabajo se determinan variables diferenciales entre individuos con psicosis inducidas y no inducidas, y se analiza la evolución y el cambio de diagnóstico de las inducidas a esquizofrenia en el seguimiento. Es un estudio observacional de casos y controles con 238pacientes ingresados en la unidad de agudos de un Hospital General de Madrid (España) por episodios psicóticos entre diciembre de 2003 y septiembre de 2011. Se incluyeron 127 en el grupo de trastornos psicóticos no inducidos por sustancias (TPNIS) y 111 en el de inducidos por sustancias (TPIS), según la Clasificación Internacional de Enfermedades. Se compararon características sociodemográficas, clínicas, antecedentes personales y familiares, de consumo de sustancias, estabilidad diagnóstica y evolución. El grupo de TPNIS presentó mayores puntuaciones en gravedad y sintomatología negativa mientras que el de TPIS tuvo más antecedentes personales de trastorno de personalidad y familiares de adicciones, y más sintomatología positiva. A los seis años un 40,9% de TPIS cambió a diagnóstico de esquizofrenia, presentando más antecedentes familiares de trastornos psicóticos y de adicciones, y una peor evolución con más visitas a urgencias y reingresos que los sujetos con estabilidad diagnóstica. Por tanto, habrá que prestar especial atención a este grupo de sujetos por su potencial gravedad y por el mayor riesgo de desarrollar un trastorno psicótico crónico. (AU)

Several hypotheses have been proposed to explain the comorbidity betweenpsychotic disorders and substance use, one of them being the capacity ofsome to induce psychotic symptoms, although the transition from psychoticepisodes induced by substances to schizophrenia has been less studied. In thisstudy, differential variables between patients with induced and non-induced psychosis are determined, and the evolution and change of diagnosis of those induced to schizophrenia in the follow-up is analyzed. This is an observational case-control study with 238 patients admitted to the acute care unit for psychotic episodes between December 2003 and September 2011.The group of non-substance-induced psychotic disorders (NSIPD) included127 patients, with 111 in the substance-induced (SIPD) group, according to the International Classification of Diseases. Sociodemographic and clinical characteristics, personal and family history, substance use, diagnostic stability and progression were compared. The NSIPD group showed higherscores in severity and in negative symptoms and more family history ofpsychosis. The SIPD group presented more personal history of personality disorder and family history of addictions and more positive symptoms At 6years of follow-up, 40.9% of ISDP changed to a diagnosis of schizophrenia, presenting more family history of psychotic disorders and worse progression with more visits to the emergency department and readmissions, than subjects who maintained diagnostic stability. Therefore, special attention should be paid to this group of patients because of the potential severity and the increased risk of developing a chronic psychotic disorder. (AU)

Effects of the lockdown due to the COVID-19 pandemic on alcohol consumption in patients under treatment in an alcohol relapse prevention programme. / Efectos del confinamiento en el hogar debido a la pandemia por COVID-19 en el consumo en pacientes en tratamiento en un programa de deshabituación de alcohol.

During the COVID-19 pandemic, several exceptional measures were put in place in order to avoid virus propagation, such as lockdown and the discontinuation of usual health care assistance services. It was considered that these changes might be associated with an increase in alcohol consumption and a higher risk of relapse for patients under treatment. The aim of this study was to assess changes in alcohol consumption during the lockdown period (between March and May, 2020) in patients following treatment under the Alcohol Use Disorders Programme at the "Hospital 12 de Octubre" in Madrid. A total of 311 patients were assessed through interviews carried out by telephone in accordance with usual clinical practice during that period. 76% of the total number of patients did not experience changes in their alcohol consumption, 9.2% stopped drinking and some experienced severe withdrawal syndrome, while 7.5% relapsed. The risk factors found for worsening the prognosis of the patients were: being female, drinking alcohol alone or at home, binge drinking, concomitant substance misuse and failure to attend therapy groups or self-help groups online during the lockdown. 31.6% of the sample described psychopathological symptoms due to the lockdown, especially those who already had psychiatric comorbidities. For this reason, we can conclude that during the lockdown as a result of the pandemic, most of our alcohol dependent patients did not modify their drinking patterns, but specific factors enabled us to identify a more vulnerable subgroup.

Durante la pandemia producida por la infección por el Covid-19 se produjeron una serie de cambios sociosanitarios excepcionales para evitar su propagación como el confinamiento en el hogar y la supresión de los servicios asistenciales sanitarios habituales. Se consideró que estos cambios podrían implicar un incremento en el consumo de alcohol y un mayor riesgo de recaídas para los pacientes en tratamiento. El objetivo de este estudio fue valorar los cambios en el consumo durante el período de confinamiento (marzo a mayo de 2020) en los pacientes en tratamiento en el programa de alcohol del Hospital Doce de Octubre de Madrid. Fueron valorados 311 pacientes mediante entrevista telefónica dentro de la práctica clínica habitual durante ese período. Un 76 % de los pacientes no presentaron cambios en su situación de consumo, un 9,2% de estos cesaron en el consumo, algunos de ellos con cuadros de abstinencia graves, y un 7,5% recayeron. El sexo femenino, el consumo en solitario o en el hogar, en atracón, o el de otras drogas de forma concomitante y el no estar en terapia grupal o no asistir a grupos de las asociaciones de ayuda mutua por videoconferencia durante el confinamiento fueron factores predictores de mal pronóstico. Un 31,6% presentó alteraciones psicopatológicas debidas al confinamiento, sobre todo, aquellos pacientes con comorbilidad psiquiátrica. Por lo tanto, en situaciones similares a esta, la mayoría de los pacientes en tratamiento no modifican el patrón de consumo, pero, ciertas características identifican un subgrupo de sujetos más vulnerables.

Una aproximación al panorama actual de las nuevas formas de consumo de drogas / New forms of drug use: An overview

El consumo de drogas está muy arraigado en la “cultura” occidental y su consumo se relaciona con tradiciones, celebraciones o espacio de ocio. Sin embargo, estos consumos no están exentos de riesgos que dependen de la cantidad, frecuencia y patrón de consumo, así como de las características de la persona consumidora como edad, sexo y algunas condiciones de salud. Mientras la evidencia científica acumula pruebas de la toxicidad de las drogas, sigue existiendo una creciente oferta y demanda de las mismas debido principalmente a la aparición o el redescubrimiento de nuevas sustancias psicoactivas y “el atractivo” de las nuevas formas o patrones de consumo. Paradójicamente, pese a la creciente preocupación que suscitan estos nuevos patrones de consumo son muy pocos los trabajos realizados en nuestro país que analizan esta temática. Si bien sabemos que la adolescencia suele ser un momento de búsqueda y experimentación y que muchos jóvenes prueban sustancias sin que eso implique necesariamente que tengan un problema de adicción, la evidencia disponible apunta a la aparición de conductas adictivas a edades cada vez más tempranas (Rial, Golpe, Barreiro, Gómez e Isorna, 2020). La última Encuesta Estatal sobre uso de Drogas en Enseñanza Secundaria (ESTUDES, 2021), señala una discreta disminución en el consumo de todas las sustancias psicoactivas en general. Sin embargo, la población juvenil española consume más alcohol y cannabis que la media europea (ESPAD, 2019) y otras formas de consumo como el cigarrillo electrónico (CE) continúa ganando adeptos. Por lo tanto, nuestro objetivo es revisar estas nuevas formas y patrones de consumo y sus posibles implicaciones sociosanitarias, fundamentalmente para los más jóvenes.(AU)

Drug use is deeply rooted in Western ‘culture’ and its use is related to traditions, celebrations or leisure space. However, such use is not free of risks that depend on the amount, frequency and pattern of consumption, as well as the characteristics of the consumer such as age, sex and some health conditions.Despite mounting scientific evidence proving the toxicity of drugs, their supply and demand for them continues to grow, mainly due to the appearance or rediscovery of new psychoactive substances and the ‘attractiveness’ of new forms or patterns of use. Paradoxically, although concern aroused by these new consumption patterns is rising, very few studies have been carried out in Spain that analyze this issue.While we know that adolescence is usually a time of searching and experimentation, and that many young people try substances without necessarily implying that they have an addiction problem, the available evidence points to the appearance of addictive behaviours at increasingly younger ages (Rial, Golpe, Barreiro, Gómez & Isorna, 2020). Although the latest Spanish national survey on drug use in secondary education (Encuesta Estatal sobre uso de Drogas en Enseñanza Secundaria, ESTUDES, 2021) shows that the consumption of all psychoactive substances in general is decreasing slightly, alcohol and cannabis use among the young Spanish population is higher than the European average (ESPAD, 2019), and other forms of consumption such as electronic cigarettes (EC) continue to gain popularity. Our aim was therefore to review these new forms and patterns of use and their possible social health implications, especially for the youngest.(AU)

¿Es posible crear la adecuada sensación de riesgo entre los consumidores de cannabis medicinal? / Can we increase risk perception among medical cannabis users?

Es cada vez mayor el número de investigaciones relacionadas con las posibles aplicaciones terapéuticas de los cannabinoides. Aunque en algunas enfermedades los resultados obtenidos son esperanzadores, la investigación en desarrollo está en sus etapas iniciales. Para algunos síntomas se ha probado la efectividad medicinal de los cannabinoides. Pero, en muchos casos no se dispone todavía de la adecuada evidencia al respecto, ni son suficientes los datos existentes sobre los riesgos asociados al consumo de cannabis medicinal. (AU)

COVID-19-Related Neuropsychiatric Symptoms in Patients With Alcohol Abuse Conditions During the SARS-CoV-2 Pandemic: A Retrospective Cohort Study Using Real World Data From Electronic Health Records of a Tertiary Hospital.

Patients with an alcohol abuse disorder exhibit several medical characteristics and social determinants, which suggest a greater vulnerability to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and a worse course of the coronavirus disease 2019 (COVID-19) once infected. During the first wave of the COVID-19, most of the countries have register an increase in alcohol consumption. However, studies on the impact of alcohol addiction on the risk of COVID-19 infection are very scarce and inconclusive. This research offers a descriptive observational retrospective cohort study using real world data obtained from the Electronic Health Records. We found that patients with a personal history of alcohol abuse were 8% more likely to extend their hospitalization length of stay for 1 day (95% CI = 1.04-1.12) and 15% more likely to extend their Intensive Care Unit (ICU) length of stay (95% CI = 1.01-1.30). They were also 5.47 times more at risk of needing an ICU admission (95% CI = 1.61-18.57) and 3.54 times (95% CI = 1.51-8.30) more at risk of needing a respirator. Regarding COVID-19 symptoms, patients with a personal history of alcohol abuse were 91% more likely of exhibiting dyspnea (95% CI = 1.03-3.55) and 3.15 times more at risk of showing at least one neuropsychiatric symptom (95% CI = 1.61-6.17). In addition, they showed statistically significant differences in the number of neuropsychiatric symptoms developed during the COVID-19 infection. Therefore, we strongly recommend to warn of the negative consequences of alcohol abuse over COVID-19 complications. For this purpose. Clinicians should systematically assess history of alcohol issues and drinking habits in all patients, especially for those who seek medical advice regarding COVID-19 infection, in order to predict its severity of symptoms and potential complications. Moreover, this information should be included, in a structured field, into the Electronic Health Record to facilitate the automatic extraction of data, in real time, useful to evaluate the decision-making process in a dynamic context.

Therapeutic Cannabis and COVID-19: between opportunism and infoxication. / Cannabis terapéutico y COVID-19: entre el oportunismo y la infoxicación.

Editorial.

Editorial.

Cannabis terapéutico y COVID-19: entre el oportunismo y la infoxicación / Therapeutic Cannabis and COVID-19: between opportunism and infoxication

No disponible

Altered fine motor control and manual dexterity in people with cocaine dependence: An observational study.

BACKGROUND/AIM: Cocaine consumption may result in irreversible structural changes in the brain. The long-term effects of cocaine are related to a wide range of deteriorated cognitive functions. This study aimed to examine the fine motor control and hand-function in cocaine users compared to healthy controls. METHODS: An observational study was conducted. Sociodemographic variables, substance consumption, the Purdue Pegboard and the Jebsen-Taylor Hand-function Test were evaluated bilaterally in 35 participants who were cocaine users and in 35 healthy participants. Differences between sides (dominant and non-dominant hands) and groups were analysed with analysis of variance (ANOVA). RESULTS: The ANOVA revealed significant differences between groups (P < 0.001) and between sides (dominant and non-dominant hands) (P = 0.005) for the one-hand pin placement subtest of the Purdue Pegboard Test. Also, ANOVA tests showed significant differences between sides, but not groups, for the simulated feeding (P < 0.001) and stacking checkers (P < 0.001) Jebsen-Taylor subtests. Cocaine user participants exhibited significantly lower scores in bilateral pin placement and required more time for the Jebsen-Taylor subtests compared to healthy participants. CONCLUSIONS: Cocaine user participants display deficits of fine motor control and some aspects of manual dexterity when compared to healthy controls. These findings show the convenience of incorporating functional rehabilitation by occupational therapists as a key component within the treatment of cocaine users. This study therefore opens a new field of practice for occupational therapy based on the assessment and treatment of motor deficits in the hand and the upper limb of people who consume cocaine.

Estudio piloto sobre la prevalencia de patología dual en pacientes en tratamiento en la Comunidad de Madrid / Pilot study on the prevalence of dual pathology in community mental health and substance misuse services in Madrid

El objetivo ha sido valorar la presencia de diagnósticos comórbidos de trastornos mentales y adictivos de forma retrospectiva en la historia clínica de pacientes en tratamiento en las redes asistenciales de salud mental o de adicciones en la Comunidad de Madrid. Material y métodos: Se valoraron las historias clínicas de 400 pacientes en tratamiento en Centros de Atención al Drogodependiente (CAD), Centros de Atención Integral al Drogodependiente (CAID), Centros de Salud Mental (CSM) o servicios de psiquiatría de Hospitales de Madrid. Se recogieron de forma retrospectiva los datos de las últimas 20 historias clínicas de cada centro seleccionado. Resultados: La prevalencia de patología dual, considerando como tal la presencia de un diagnóstico actual de trastorno mental y de trastorno por uso de sustancias distinto al tabaco, fue del 34%. Había diferencias en la prevalencia entre las dos redes asistenciales, un 36.78% de los pacientes en tratamiento en la red de drogas fueron considerados duales frente a un 28.78% en la red de salud mental. Había una asociación entre el diagnóstico de patología dual y el consumo perjudicial o dependencia de alcohol o cocaína pero no con el de heroína. Los trastornos mentales más frecuentes en los pacientes duales que en los no duales fueron los trastornos del humor, los trastornos de personalidad y la esquizofrenia. Conclusión: Por lo tanto, existe una elevada prevalencia de pacientes con patología dual entre los sujetos que buscan tratamiento, siendo mayor en la red de atención al drogodependiente y mayor entre aquellos con dependencia de alcohol o cocaína. Estos datos pueden ayudar a la horade planificar los recursos asistenciales para este tipo de pacientes (AU)

Aim: To evaluate retrospectively the comorbidity of mental and addictive disorders in community mental health and substance misuse services in Madrid. Methods: The medical records of 400 patients from mental health and substance misuse services in Madrid were evaluated. Records were examined for the last 20 patients from each service unit. Results: Dual pathology was constituted when a current diagnosis of mental and addictive disorders, excluding nicotine addiction, appeared on the patient’s records. Prevalence of dual pathology was 34%. There were differences in the prevalence figures for the two kinds of service: 36.78% in substance misuse services, and 28.78% in mental health services. There was an association of dual diagnosis with alcohol or cocaine dependence, but not with opioid dependence. The mental disorders more prevalent in dually diagnosed than in non-dually diagnosed patients were mood disorders, personality disorders, and schizophrenia. Conclusion: There is a high prevalence of dual pathology in those seeking treatment, being higher in substance misuse services than in mental health services, and higher in patients with alcohol or cocaine dependence. These findings could be of help in the planning of care resource policies for these patients (AU)

[Pilot study on the prevalence of dual pathology in community mental health and substance misuse services in Madrid]. / Estudio piloto sobre la prevalencia de patología dual en pacientes en tratamiento en la Comunidad de Madrid.

AIM: To evaluate retrospectively the comorbidity of mental and addictive disorders in community mental health and substance misuse services in Madrid. METHODS: The medical records of 400 patients from mental health and substance misuse services in Madrid were evaluated. Records were examined for the last 20 patients from each service unit. RESULTS: Dual pathology was constituted when a current diagnosis of mental and addictive disorders, excluding nicotine addiction, appeared on the patient's records. Prevalence of dual pathology was 34%. There were differences in the prevalence figures for the two kinds of service: 36.78% in substance misuse services, and 28.78% in mental health services. There was an association of dual diagnosis with alcohol or cocaine dependence, but not with opioid dependence. The mental disorders more prevalent in dually diagnosed than in non-dually diagnosed patients were mood disorders, personality disorders, and schizophrenia. CONCLUSION: There is a high prevalence of dual pathology in those seeking treatment, being higher in substance misuse services than in mental health services, and higher in patients with alcohol or cocaine dependence. These findings could be of help in the planning of care resource policies for these patients.

Evolución de alteraciones psicopatológicas en pacientes con obesidad mórbida tras cirugía bariátrica / Evolution of psychopathologycal alterations in patients with morbid obesity after bariatric surgery

Fundamento y objetivo: Los objetivos del presente estudio son conocer la prevalencia de las alteraciones psicopatológicas de los pacientes con obesidad mórbida (OM) y los criterios de cirugía bariátrica atendidos en este centro, analizar el valor pronóstico de estas alteraciones en los resultados de la cirugía y estudiar su evolución tras alcanzar la estabilización ponderal. Pacientes y método: Se incluyó en el estudio un total de 145 pacientes del Hospital Universitario Fundación Alcorcón (122 mujeres) candidatos a cirugía bariátrica (108 finalmente intervenidos). Se realizó una entrevista clínica y se aplicaron varias escalas de psicopatología precirugía y poscirugía: BDI (Beck Depression Inventory escala de depresión de Beck ), BAI (Beck anxiety inventory escala de ansiedad de Beck ), MOCI (Maudsley Obsessional-Compulsive Inventory inventario de obsesiones-compulsiones de Maudsley ), BIS (Barratt Impulsiveness Scale escala de impulsividad de Barrat ), EDI (Eating Disorders Inventory inventario de trastornos de la alimentación ), EAT (Eating Attitudes Test test de actitudes hacia la comida ), BITE (Bulimic Investigatory Test Edimburgh test de bulimia de Edimburgo ) y BSQ (Body Shape Questionnaire cuestionario sobre la figura corporal ). Se realizó una comparación de muestras emparejadas entre las puntuaciones iniciales y finales de las pruebas psicométricas y se llevó a cabo un análisis de regresión logística para valorar las variables predictivas de evolución positiva de la cirugía, definida como porcentaje de sobrepeso perdido superior al 50% e índice de masa corporal final inferior a 35kg/m2. Resultados: Se observó una mejoría en la puntuación de la BDI, la BAI y en las subescalas del EDI: EDI-DT (drive for thinness impulso a la delgadez ) y EDI-BD (body dissatisfaction insatisfacción corporal ). Para el resto de las pruebas psicométricas las diferencias no fueron estadísticamente significativas (AU)

Background and objective: The aims of this study were to know the prevalence of the psychopathological alterations among patients with morbid obesity (MO) candidates for bariatric surgery in our centre, to analyze its predictive value on the surgical outcome and to study the evolution after weight stabilization was achieved. Patients and methods: One hundred and forty five patients of the University Hospital Foundation Alcorcón (122 women) candidates for bariatric surgery (108 finally operated) were included in the study. A clinical interview was carried and several scales of psychopathology were applied before and after surgery: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigation Test Edinburg (BITE), and Body Shape Questionnaire (BSQ). A comparison of means between the initial and final scores of the psychometric tests and a logistic regression analysis to identify the predictive variables of positive evolution after surgery (defined as percentage of lost overweight> 50% and final IMC <35) were performed. Results: An improvement in the scores of BDI, BAI and in the subscales of EDI, Impulse to the thinness (EDI-DT) and corporal Dissatisfaction (EDI-BD) was observed. The differences were not significant for the rest of the psychometric tests. The multivariate analysis identified 3 predictive factors for postsurgical evolution: BDI (OR 0.91, IC95% 0.82 1.02), BIS (OR 1.08, IC 95% 1.0 1.16) y EDI-DT (OR 1.18, IC 95% 1.0 1.39). Conclusions: In our study, the scales of depression, anxiety, impulse to thinness and corporal dissatisfaction improved in patients with MO after bariatric surgery. Some baseline psychometric variables may predict a favourable postsurgical evolution of these patients (AU)

[Evolution of psychopathological alterations in patients with morbid obesity after bariatric surgery]. / Evolución de alteraciones psicopatológicas en pacientes con obesidad mórbida tras cirugía bariátrica.

BACKGROUND AND OBJECTIVE: The aims of this study were to know the prevalence of the psychopathological alterations among patients with morbid obesity (MO) candidates for bariatric surgery in our centre, to analyze its predictive value on the surgical outcome and to study the evolution after weight stabilization was achieved. PATIENTS AND METHODS: One hundred and forty five patients of the University Hospital Foundation Alcorcón (122 women) candidates for bariatric surgery (108 finally operated) were included in the study. A clinical interview was carried and several scales of psychopathology were applied before and after surgery: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigation Test Edinburg (BITE), and Body Shape Questionnaire (BSQ). A comparison of means between the initial and final scores of the psychometric tests and a logistic regression analysis to identify the predictive variables of positive evolution after surgery (defined as percentage of lost overweight> 50% and final IMC <35) were performed. RESULTS: An improvement in the scores of BDI, BAI and in the subscales of EDI, Impulse to the thinness (EDI-DT) and corporal Dissatisfaction (EDI-BD) was observed. The differences were not significant for the rest of the psychometric tests. The multivariate analysis identified 3 predictive factors for postsurgical evolution: BDI (OR 0.91, IC95% 0.82-1.02), BIS (OR 1.08, IC 95% 1.0-1.16) y EDI-DT (OR 1.18, IC 95% 1.0-1.39). CONCLUSIONS: In our study, the scales of depression, anxiety, impulse to thinness and corporal dissatisfaction improved in patients with MO after bariatric surgery. Some baseline psychometric variables may predict a favourable postsurgical evolution of these patients.

[Cannabinoid system and feeding regulation]. / Sistema cannabinoide y regulacion de la conducta alimentaria.

There is increasing evidence to suggest that the cannabinoid system is a crucial mechanism in the regulation of feeding and metabolism. It is against this background that a cannabinoid antagonist, rimonabant, is about to come onto the market for the treatment of obesity. Moreover, in addition to weight-loss effect, this drug has a beneficial effect on the so-called metabolic syndrome, with changes in the lipid and glucidic metabolism not observed for other anti-obesity drugs currently available. We present a review of current knowledge in this field and data from our own studies: genetic studies of this system in eating disorders and in obesity and studies of localization of cannabinoid receptors at sites related to feeding. These studies support a state of cannabinoid hyperactivity in obesity; furthermore, such hyperactivity can constitute a prognostic factor.