Trastorno por déficit de atención e hiperactividad y patología dual. Neurobiología y factores comunes de vulnerabilidad / Attention deficit hyperactivity disorder and dual pathology. Neurobiology and shared vulnerability factors

Los pacientes con Trastorno por déficit de atención e hiperactividad (TDAH) presentan una elevada prevalencia de trastorno por consumo de sustancias (TCS), a la vez que los sujetos con TCS presentan con mayor frecuencia de la esperada un diagnóstico comórbido con TDAH, dificultando la clínica, evolución, pronóstico y por tanto el abordaje terapéutico. En el presente trabajo se pretende explorar la relación entre el TDAH y los TCS, fundamentalmente desde el punto de vista neurobiológico, mostrando factores y sustratos cerebrales comunes, genes implicados, precipitantes de ambas manifestaciones, así como la relación con la neurobiología de los circuitos de recompensa. La alta comorbilidad del TDAH con los TCS, indica tal como evidencian estudios de neuroimagen, estudios genéticos y estudios de experimentación, algunos sustratos neurobiológicos subyacentes compartidos, si bien sobre todo parece existir una influencia a nivel genético que se traduciría en alteraciones neuroquímicas, neuroanatómicas y neurofisiológicas comunes. Conociendo estos sustratos se podrá aumentar la comprensión de la patología dual en un futuro y ayudar en el diagnóstico y tratamiento de la enfermedad (AU)

Patients with attention deficit hyperactivity disorder (ADHD) have a high prevalence of substance use disorder (SUD), and likewise individuals with SUD show more commonly than expected a comorbid diagnosis of ADHD, thus presenting a more complex symptom presentation, clinical outcome and overall prognosis, as well a more difficult management. In the present paper, it is aimed to explore the evidence on the relationship between ADHD and SUDs, focusing on the neurobiological basis, discussing common brain factors and substrates, genes involved, shared precipitating factors to both disorders, as well as the neurobiology of the reinforcement pathway. The elevated comorbidity of SUD with ADHD, indicates, as shown in neuroimaging, genetic and experimental studies, the presence of some shared underlying neurobiological substrates. In particular, there appears to exist a strong genetic influence that may underlie a series of common neurochemical, neuroanatomical and neurophysiological alterations. A better understanding of these substrates would be of great help to an improved learning of this dual diagnosis in a future and help in its diagnosis and treatment (AU)

Impact of involuntary out-patient commitment on reducing hospital services: 2-year follow-up.

Aims and method To evaluate whether involuntary out-patient commitment (OPC) in patients with severe mental disorder reduces their use of hospital services. This is a retrospective case-control study comparing a group of patients on OPC (n = 75) and a control group (n = 75) which was composed of patients whose sociodemographic variables and clinical characteristics were similar to those of the OPC group. Each control case is paired with an OPC case, so the control case must have an involuntary admission in the month that the index OPC case admission occurred. Emergency room visits, admissions and average length of hospital stay over a 2-year follow-up after the initiation of OPC were compared. Results No statistically significant evidence was found in the use of mental healthcare services between the two groups. Different reasons for admission found between the groups limit similarity when comparing the two. Clinical implications The findings cast doubt over the effectiveness of this legal measure to reduce emergency visits, the number of admissions and the length of stay in the hospital.

Involuntary outpatient treatment (iot) for severe mental patients: current situation in Spain.

Involuntary Outpatient Treatment (IOT) expects to improve treatment compliance and, therefore, prevent the impairment of patients with severe mental illness, as well as the risk for them and others. Besides IOT introduction defenders and opponent's states, scientific literature offers contradictory results. Legislative changes have been taken in the vast majority of our neighbouring countries in order to regulate IOT application. There is no legal regulation in Spain; however, OIT application is possible in certain Spanish cities. This article reviews IOT in Spain and surrounding countries.

Situacion en España del tratamiento ambulatorio involuntario (TAI) para enfermos mentales graves / Involuntary outpatient treatment (IOT) for severe mental patients: current situation in Spain

El tratamiento ambulatorio involuntario (TAI) pretende mejorar la adherencia al tratamiento y, por tanto, prevenirlas recaídas y el deterioro de las personas con enfermedad mental grave. Además de las posiciones manifestadas a favor y en contra con la introducción del TAI, los estudios publicados en la literatura médica obtienen también resultados contradictorios. En la mayoría de los países de nuestro entorno, se han producido cambios legislativos que regulan su aplicación. En la actualidad no existe en España una normativa legal, sin embargo, es posible su aplicación en el ámbito local de algunas ciudades españolas. En este artículo se pretende hacer una revisión del TAI en los países de nuestro entorno y España (AU)

Involuntary Outpatient Treatment (IOT) expects to improve treatment compliance and, therefore, prevent the impairment of patients with severe mental illness, as well as the risk for them and others. Besides IOT introduction defenders and opponent’s states, scientific literature offers contradictory results. Legislative changes have been taken in the vast majority of our neighbouring countries in order to regulate IOT application. There is no legal regulation in Spain; however, OIT application is possible in certain Spanish cities. This article reviews IOT in Spain and surrounding countries (AU)