Can personality disorder be accurately assessed in older age? A differential item functioning analysis of ICD-11 inventories.

OBJECTIVES: The contested categorical personality disorder (PD) criteria are not well suited to inform PD diagnoses in older adults. Yet, the classification of PDs is undergoing a critical transition phase with a paradigm shift to a dimensional approach for diagnosing PDs. No special attention was given to the expression of PDs in older age when the dimensional ICD-11 model was developed. Given that PDs are highly prevalent in older adults, there is an urgent need to examine if ICD-11 related instruments are able to adequately assess for PDs in older adults. METHODS: The age-neutrality of ICD-11 measures was examined in a sample of 208 Dutch community-dwelling adults (N = 208, M age = 54.96, SD = 21.65), matched on sex into 104 younger (age range 18-64) and 104 older (age range 65-93) adults. An instrument is considered not to be age-neutral if a collective large level of differential item functioning (DIF) exists in a group of items of an instrument (i.e., 25% or more with DIF). We therefore set out to detect possible DIF in the following ICD-11 self-report measures: the Standardized Assessment of Severity of Personality Disorder (SASPD), the Personality Inventory for ICD-11 (PiCD), and the Borderline Pattern Scale (BPS). RESULTS: DIF analyses using a non-parametric odds ratio approach demonstrated that SASPD, PiCD, and BPS were age-neutral with less than 25% of items showing DIF. Yet, impact of DIF at scale level, examined by way of differential test functioning (DTF), indicated a DTF effect on the SASPD total score. CONCLUSIONS: These results of age-neutrality of the PiCD and BPS are promising for measuring ICD-11 traits and the borderline pattern. Yet, the age-neutral measurement of PD severity requires further research. With a rapidly aging population, its accurate assessment across the entire adult life span, including older age, is a prerequisite for an adequate detection of PDs.

Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission.

INTRODUCTION: Patients with cocaine use disorders have very high readmission rates. Our aim was to model the relationships between attributes of patients with cocaine use disorder at the beginning of treatment, therapeutic process indicators of time in treatment or proportion of appointments attended, and treatment outcomes, including outcomes at discharge and non-readmissions posttreatment as indicators of therapeutic success. METHOD: A retrospective observational design was used with 10,298 cocaine use disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n = 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) for modeling relationships between the variables. RESULTS: Patients attributes at intake (e.g., legal services as the source of referral) were of limited significance in explaining time in treatment, proportion of appointments attended, and treatment outcomes. Time in treatment and proportion of appointments attended emerged as significant factors in explaining outcomes at discharge. However, readmissions were primarily explained by time in treatment and outcomes at discharge, although referrals to addiction centers by health services also appeared to be relevant for explaining readmission. DISCUSSION/CONCLUSION: Our study has shown that maintaining a sufficient appointment attendance rate and remaining in treatment for a longer duration are critical therapeutic process indicators for explaining outcomes at the point of discharge and therapeutic success, as indicated by a reduced likelihood of readmissions. Patients who remained in treatment for an extended period were found to have a reduced risk of future readmissions. In addition, our study highlights the importance of maintaining a satisfactory appointment attendance rate to attain successful short- and medium-term therapeutic discharge outcomes. These guidelines could help to increase the efficiency of patient treatment and alleviate the suffering of both patients and their families.

Differentiation of Self and Interpersonal Functioning with the Level of Personality Functioning Scale - Brief Form 2.0.

Research on Criterion A of the alternative model for personality disorders is recently expanding and provides mixed results concerning the unidimensional operational definition of severity by the model, characterized by impaired self (identity and self-direction) and interpersonal (empathy and intimacy) functioning. Studies resulted in one, as well as two or more factor structures. The present study demonstrated the importance of the structural and relational differentiation of self and interpersonal dimensions of personality functioning. One thousand seventy-four participants (community and clinical mixed sample) completed the Level of Personality Functioning Scale - Brief Form 2.0 (LPFS-BF 2.0), the Personality Inventory for DSM-5 Short Form and the Questionnaire for the World Health Organization Disability Assessment. An LPFS-BF 2.0 two-factor structure with self and interpersonal functioning factors was corroborated by confirmatory factor analyses and bifactor modeling. Joint Exploratory Factor Analysis of the LPFS-BF 2.0 domains with maladaptive personality domains clearly differentiated the personality functioning factors. While the self-functioning factor was more closely linked to negative affect (and to disinhibition and psychoticism), the interpersonal functioning factor connected to detachment. Self-functioning predicted functional impairment along and beyond personality domains. The LPFS-BF 2.0 appears a useful tool for clinical routine monitoring of both self and interpersonal functioning.

Comparison of Emotional Processing Between Patients with Substance Use Disorder and Those with Dual Diagnosis: Relationship with Severity of Dependence and Use During Treatment.

This study analyzed, in a Spanish sample, the differences in emotional processing in patients diagnosed with substance use disorder (SUD) and patients with a dual diagnosis (DD), and tested whether alterations in emotional regulation were related to the severity of dependence and consumption during treatment. A descriptive follow-up study was conducted with 88 adult outpatients (83% men) who were receiving treatment for alcohol and cocaine SUD. Of the sample, 43.2% presented dual diagnosis according to DSM-IV-TR criteria. Emotional processing was assessed with the IAPS, and dependence severity with the SDSS. Consumption was determined with self-reports and toxicological tests. Regression analyses revealed that the DD group had more difficulties in identifying the valence and arousal of the images than patients with SUD. Patients with DD presented more difficulty in identifying images in which valence was manipulated, but not in those in which arousal was manipulated. Cocaine use during treatment was associated with difficulties in identifying unpleasant (U = 734.0; p < .05) and arousing (U = 723.5; p < .05) images. Although these results are preliminary, findings suggest that impaired emotional processing is aggravated in dual patients, although it may be a common transdiagnostic factor in SUD and other comorbid mental disorders. Findings highlight the importance of evaluating emotional regulation to better understand its possible role in the maintenance of substance use.

Operational definitions and measurement of externalizing behavior problems: An integrative review including research models and clinical diagnostic systems.

Measurement of externalizing disorders such as antisocial disorders, attention-deficit/hyperactivity disorder or borderline disorder have relevant implications for the daily lives of people with these disorders. While the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) have provided the diagnostic framework for decades, recent dimensional frameworks question the categorical approach of psychopathology, inherent in traditional nosotaxies. Tests and instruments develop under the DSM or ICD framework preferentially adopt this categorical approach, providing diagnostic labels. In contrast, dimensional measurement instruments provide an individualized profile for the domains that comprise the externalizing spectrum, but are less widely used in practice. Current paper aims to review the operational definitions of externalizing disorders defined under these different frameworks, revise the different measurement alternatives existing, and provide an integrative operational definition. First, an analysis of the operational definition of externalizing disorders among the DSM/ICD diagnostic systems and the recent Hierarchical Taxonomy of Psychopathology (HiTOP) model is carried out. Then, in order to analyze the coverage of operational definitions found, a description of measurement instruments among each conceptualization is provided. Three phases in the development of the ICD and DSM diagnosis systems can be observed with direct implications for measurement. ICD and DSM versions have progressively introduced systematicity, providing more detailed descriptions of diagnostic criteria and categories that ease the measurement instrument development. However, it is questioned whether the DSM/ICD systems adequately modelize externalizing disorders, and therefore their measurement. More recent theoretical approaches, such as the HiTOP model seek to overcome some of the criticism raised towards the classification systems. Nevertheless, several issues concerning this model raise mesasurement challenges. A revision of the instruments underneath each approach shows incomplete coverage of externalizing disorders among the existing instruments. Efforts to bring nosotaxies together with other theoretical models of psychopathology and personality are still needed. The integrative operational definition of externalizing disorders provided may help to gather clinical practice and research.

Monitoring adherence and abstinence of cannabis use disorder patients: Profile identification and relationship with long-term treatment outcomes.

BACKGROUND: Patients with cannabis use disorder (CUD) show heterogeneous sociodemographic and consumption patterns. Although previous studies, focused on identifying subgroups of CUD patients using input variables, have yielded useful results for planning individualized treatments, no published research has analyzed the profiles of CUD patients according to their therapeutic progress. This study therefore aims to identify subgroups of patients using adherence and abstinence indicators and to explore whether these profiles are associated with sociodemographic characteristics, consumption variables, and long-term therapeutic outcomes. METHODS: This was a retrospective observational study with a multisite sample of 2055 CUD outpatients who were beginning treatment. The study monitored patient data at two-year follow-up. We conducted latent profiles analysis on the appointment attendance ratio and percentage of negative cannabis tests. RESULTS: A three profile solution emerged: i) moderate abstinence/moderate adherence (n = 997); ii) high abstinence/moderate adherence (n = 613); and iii) high abstinence/high adherence (n = 445). The study found the most marked differences at the beginning of treatment for education level (chi2 (8) = 121.70, p < .001), source of referral (chi2 (12) = 203.55, p < .001), and frequency of cannabis use (chi2 (10) = 232.39, p < .001). Eighty percent of patients from the "high abstinence/high adherence" group were relapse-free at two year follow-up. This percentage decreased to 24.3 % in the "moderate abstinence/moderate adherence" group. CONCLUSIONS: Research has shown adherence and abstinence indicators to be useful for identifying subgroups of patients with different prognoses regarding long-term success. Recognizing the sociodemographic and consumption variables associated with these profiles at the beginning of treatment could help to inform the design of more individualized interventions.

Psychometric properties of the Spanish adaptation of the Externalizing Spectrum Inventory-Brief Form (ESI-BF).

The Externalizing Spectrum Inventory-Brief Form (ESI-BF) measures tendencies toward disinhibition, lack of control, aggression, and substance use. This study adapts the ESI-BF to the Spanish population and assesses its psychometric properties. The study included 742 community adults obtained by stratified random sampling with proportional allocation according to gender, age, and geographical area of the Spanish territory and a clinical sample consisting of 333 patients. All participants completed the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PID-5) and the Alcohol Substance Dependence Severity Scale, in addition to the Spanish version of the ESI-BF. Reliability was quantified using McDonald's omega and Cronbach's α reliability coefficients. Validity evidences were studied applying confirmatory factor analysis (CFA) and correlations. Results indicated adequate reliability of scores on the ESI-BF's general factors and most of its facets. Regarding internal structure, and in line with previous studies, both symmetric and S-1 hierarchical two-subfactor (bifactor) emerged as the best-fitting models. Considering both criticisms of symmetric models and parsimony, the S-1 bifactor model, which showed configural invariance across gender and samples, was retained. Validity evidence based on the relationship with other measures of personality and alcohol consumption show correlations values theoretically expected in both clinical and community samples. Findings suggest that the Spanish adaptation of the ESI-BF shows functional near-equivalence to the original version. Its effective psychometric properties make it useful instrument for further research related to the externalizing spectrum. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comparison of Different Sexual Behaviors According to Sexual Orientation and the Mediating Role of Attitudes toward Sexual Behaviors between Sexual Orientation and Sexual Behaviors in Young Adults.

Objectives: To explore the relationship between sexual orientation and specific sexual and risk behaviors, compare the number of sexual behaviors and attitudes among people of different sexual orientations, and test the mediating effect of attitudes toward sexual behaviors in the relationship between sexual orientation and the number of sexual behaviors. Methods: A total of 2288 participants completed a checklist of sexual behaviors, indicators of sexual risk behaviors, and a scale of attitudes toward sexual behaviors. Results: Bisexual women engaged in a greater number of sexual behaviors and had more positive attitudes toward sexual behaviors than heterosexual women. Homosexual men engaged in a greater number of sexual behaviors than heterosexual men, and homosexual and bisexual men had more positive attitudes toward sexual behaviors than heterosexuals. Finally, we show the mediating role of attitudes toward sexual behaviors in the relationship between sexual orientation and the number of sexual behaviors engaged in. Conclusions: The importance of considering sexual orientation when analyzing sexual behaviors and attitudes is highlighted.

Alcohol Protective Behavioral Strategies in Young Spanish Adults in the Community: A Prospective Study of Perceived Efficacy and Social Norms.

BACKGROUND: Protective behavioral strategies (PBS) have been shown to be useful for reducing excessive alcohol use and alcohol-related problems. However, research on the explanatory factors of PBS is limited. This paper prospectively examines the contribution of perceived efficacy of PBS in reducing alcohol-related consequences and perceived descriptive norms of close peers´ PBS use in young adults. The mediating role of perceived efficacy of PBS between descriptive norms of PBS use and personal PBS use is also examined. METHOD: Targeted sampling was used to recruit a community-based sample of 339 young Spanish adults aged 18-25 years, who completed baseline and two-month follow-up questionnaires. Three types of PBS (serious harm reduction-SHR, manner of drinking-MOD, and stopping/limiting drinking-SLD) were measured. RESULTS: Both perceived efficacy and descriptive norms at baseline were positively associated with personal PBS use (SHR, MOD and SLD) at follow-up. A partial mediation effect of perceived efficacy between descriptive norms and personal PBS use was found for the three PBS subscales. CONCLUSIONS: Our findings support the usefulness of correcting misperceptions of PBS use by peers in interventions aimed at reducing excessive drinking and alcohol-related consequences in young adults in the community. Moreover, PBS perceived efficacy should be included as a component of these interventions.

Harm Reduction Strategies among University Students Who Use Alcohol and Cannabis, and Related Psychological Variables: A Systematic Review.

This systematic review identifies the psychological variables associated with the use of harm reduction strategies (HRS) among university students who use alcohol or cannabis. The reviewed studies are categorized according to the psychological variables studied and the different analytic approaches used (direct effects, mediation, and moderation). Among the empirical peer-reviewed studies identified (n = 76), most (94.7%) were cross-sectional studies conducted in the US (90.8%) with samples of alcohol-using university students (86.8%). Five categories were identified: mental health, motives/expectancies, personality, social cognition, and self-efficacy. The most studied constructs were motives, anxiety and depression, impulsivity, and social norms. Most studies conducted mediation or moderation analyses including psychological variables, HRS and alcohol outcomes. Social, enhancement and coping motives, impulsivity, and social norms of alcohol use were associated with lower use of HRS, which, in turn, was associated with a higher number of alcohol/cannabis outcomes. The results of moderation studies consistently suggest that HRS use was more protective for students with poor mental health, high impulsivity, and low self-regulation. The synthesis of evidence provided in this review could be useful for guiding future research and informing the design of interventions aimed at promoting the use of HRS among university students who use alcohol and/or cannabis.

A longitudinal study among young adults into the predictive effect of perceived efficacy of behavioural strategies and the moderating role of drinking motives on use of protective behavioural strategies.

INTRODUCTION: Although protective behavioural strategies (PBS) have shown to be effective in minimising alcohol-related negative consequences, research on the explanatory factors of their use is very scarce. Perceived efficacy has been demonstrated to be one of the most relevant explanatory factors in the use of health-related protective behaviours. The present study prospectively examines the relationship between the perceived efficacy of PBS in reducing alcohol-related negative consequences and the use of PBS in a community-based sample of young adults. In addition, the moderating role of drinking motives in this relationship is also examined. METHODS: Prospective design with a baseline assessment and a 2-month follow up. Using a targeted sampling procedure, 339 young adults were recruited from the community [mean age: 21.1 (SD = 2.21); female = 50.7%] and completed questionnaires to measure perceived efficacy of PBS and drinking motives at baseline and PBS use at follow up. RESULTS: Perceived efficacy of PBS at baseline was positively associated with PBS use at follow up, and these relationships were weaker as social, enhancement and coping motives scores increased. DISCUSSION AND CONCLUSIONS: Our findings support the need to include the perceived efficacy of PBS to reduce alcohol-related negative consequences in future interventions aimed at promoting PBS use. Moreover, these interventions should be personalised according to the initial levels of participants' drinking motives, incorporating elements that allow for neutralising their negative effects on PBS use (e.g. training in coping skills for those with strong coping motives).

Changes in Drug-Related Implicit Associations during Substance Use Disorder Treatment: The Role of the Therapeutic Context.

BACKGROUND: Implicit cognition has been linked to relapse in substance use disorder (SUD). Studies on attentional bias have found different outcomes related to the therapeutic context, finding an association with relapse in inpatients but not in outpatients. There are no similar studies that use associations in semantic memory as a measure of implicit cognition. OBJECTIVES: (i) to analyze the relationship between a measure of associations in semantic memory and relapse in inpatients and outpatients; (ii) to compare the evolution of these associations between inpatients and outpatients after 3 months of treatment. METHODS: Eighty nine outpatients and 94 inpatients with SUD for cocaine and alcohol participated in this study. We employed a longitudinal design with a baseline evaluation and follow-up after three months, using the Word Association Task for Drug Use Disorder (WAT-DUD). RESULTS: The choice of drug-related words predicted relapse in cocaine (odds ratio = 1.97, z = 2.01, p = .045) and alcohol-cocaine (odds ratio = 2.39, z = 2.55, p = .011) use. Follow-up at 3 months revealed a reduction in the choice of drug-related words in inpatients (Z = 2.031, p = .042). CONCLUSIONS: A greater choice of drug-associated words in the presence of ambiguous images was related to relapse in inpatients but not in outpatients. The inpatients group showed a reduction in the semantic association with drugs during the first three months of treatment.

Alcohol Protective Behavioral Strategies in Young Spanish Adults in the Community: A Prospective Study of Perceived Efficacy and Social Norms / Uso de Estrategias Conductuales de Protección Entre Jóvenes-Adultos Españoles: un estudio Prospectivo de la Eficacia Percibida y las Normas Sociales

Background: Protective behavioral strategies (PBS) have been shown tobe useful for reducing excessive alcohol use and alcohol-related problems. However, research on the explanatory factors of PBS is limited. This paperprospectively examines the contribution of perceived efficacy of PBS inreducing alcohol-related consequences and perceived descriptive normsof close peers ́ PBS use in young adults. The mediating role of perceivedefficacy of PBS between descriptive norms of PBS use and personal PBS use is also examined. Method: Targeted sampling was used to recruit acommunity-based sample of 339 young Spanish adults aged 18-25 years,who completed baseline and two-month follow-up questionnaires. Threetypes of PBS (serious harm reduction-SHR, manner of drinking-MOD, andstopping/limiting drinking-SLD) were measured. Results: Both perceivedefficacy and descriptive norms at baseline were positively associated withpersonal PBS use (SHR, MOD and SLD) at follow-up. A partial mediationeffect of perceived efficacy between descriptive norms and personal PBS use was found for the three PBS subscales.Conclusions: Our findingssupport the usefulness of correcting misperceptions of PBS use by peersin interventions aimed at reducing excessive drinking and alcohol-relatedconsequences in young adults in the community. Moreover, PBS perceivedefficacy should be included as a component of these interventions.

Antecedentes: las estrategias conductuales de protección (ECP)han mostrado utilidad para reducir el consumo excesivo de alcohol y sus problemas asociados, aunque la investigación sobre sus factores explicativos es escasa. Este trabajo examina la contribución de la eficacia percibida delas ECP para reducir las consecuencias negativas del alcohol, y la norma descriptiva percibida del uso de PBS de los iguales, en adultos jóvenes. Además, analiza el papel mediador de la eficacia percibida entre norma descriptiva y ECP. Método: mediante muestreo dirigido a poblacionesdiana, 339 jóvenes españoles (18-25 años) comunitarios cumplimentaron cuestionarios basal y de seguimiento (dos meses), midiéndose tres tipos deECP (reducción de daños-RR, forma de beber-FB, parar/limitar el consumo-PLC). Resultados: eficacia y norma se asociaron positivamente con el uso deECP (RR/FB/PLC) en el seguimiento. Para los tres tipos de ECP se detectóun efecto de mediación parcial de la eficacia percibida entre la norma y el usode ECP. Conclusiones: corregir percepciones erróneas del uso de ECP de losiguales puede ser útil en las intervenciones dirigidas a reducir el uso excesivode alcohol y sus consecuencias en adultos jóvenes comunitarios, al igual quela inclusión de la eficacia percibida como uno de sus componentes.

Norms According to Age and Gender for the Spanish Version of the Inventory of Depression and Anxiety Symptoms (IDAS-II).

Inventory of Depression and Anxiety Symptoms-II (IDAS-II) constitutes a useful measurement tool with demonstrated psychometric properties that is contributing to the advancement of knowledge of emotional disorders within transdiagnostic models. To implement its use in clinical settings it is important that the scores can be interpreted in order to guide clinical decisions. This study aims to develops normative data for the Spanish version of the IDAS-II. An anonymous online survey was applied to 1,072 subjects, recruited through a stratified random sampling procedure taking into account population gender, age, and geographical region of Spain. Results show that women tend to score higher than men, particularly on the Dysphoria, General Depression, Appetite Gain, and Lassitude scales. Largest effect sizes for differences in the scores according to age were found for Lassitude, Dysphoria, and General Depression. Therefore, normative data according to gender and age group for each IDAS-II scale is provided. The norms provided in this work complement those already available, facilitating the decision-making of clinical professionals. Evidence of unidimensionality is provided for the 19 IDAS-II scales that allows researchers and clinicians to use specific IDAS-II scales independently.

Predictive Utility of Protective Behavioral Strategies for Alcohol-Related Outcomes in a Community Sample of Young Adults.

OBJECTIVE: Although previous studies have shown that protective behavioral strategies (PBS) predict alcohol use and its related consequences in college students, it is not known whether a broader population of young adults also benefit from PBS use. We longitudinally examined the relationship between PBS use and alcohol-related outcomes in a community sample of young adults composed of college students and noncollege individuals. METHOD: Targeted sampling was used to access 339 young adults in the community (mean age = 21.1 [SD = 2.21], 50.7% female; 59.0% college students) who completed baseline and 2-month follow-up measures. Three types of PBS were examined: manner of drinking, stopping/limiting drinking, and serious harm reduction. Regression analyses were conducted to test the predictive utility of PBS use on alcohol-related consequences, frequency and quantity of alcohol used, and binge drinking. RESULTS: Manner of drinking strategies were the strongest predictors of decreased alcohol consumption and alcohol-related negative consequences. Baseline manner of drinking scores were negatively associated with quantity of alcohol used, binge drinking, and alcohol-related consequences at follow-up. Serious harm reduction was longitudinally related to a lower frequency of alcohol consumption, stopping/limiting drinking was not associated with any outcome, and total PBS score was associated with all study outcomes. CONCLUSIONS: Our findings could benefit health promotion by informing the design of preventive interventions for reducing alcohol use and attendant health-related negative consequences in the young adult community. These results may also be of value in extending the applicability of PBS findings to a broader alcohol-using population of young adults beyond those exclusively composed of college students.

Impact of Cluster B Personality Disorders in Drugs Therapeutic Community Treatment Outcomes: A Study Based on Real World Data.

BACKGROUND: The impact of dual pathology on treatment outcomes is unclear, with the literature reporting both favorable and unfavorable evidence. The main aim of this study was to determine how dual pathology affects treatment outcomes using real world data obtained from inpatients that began treatment in therapeutic communities. METHOD: The data of 2458 inpatients were used. Clinical information was obtained from electronic medical records. Reliability of diagnosis was checked and revealed a mean kappa value of 0.88. RESULTS: Of the sample, 41.8% were discharged after achieving the therapeutic objectives. Patients diagnosed with Cluster B personality disorders were found to have a higher risk of dropping out of treatment (HR = 1.320; z = 2.61; p = 0.009). CONCLUSIONS: Personality traits exhibited by Cluster B patients can interfere with treatment in therapeutic communities. There is a need to develop specific interventions for these inpatient groups, which could be implemented in therapeutic communities.

Coordinated treatment between addiction and mental health services vs. uncoordinated treatment for patients with dual diagnosis: higher dropout rates but lower impairement of functional disability.

Dual pathology is often found in addiction and mental health centers. Although there are integrated services for these patients, most countries have developed joint action protocols between addiction and mental health centers. The objective is to analyze the progress of patients diagnosed with dual pathology, comparing the therapeutic outcomes of those who exclusively attend either addiction or mental health centers with those patients who follow a program in which the two services are coordinated. It is hypothesized that patients assisted in coordinate manner will present a better evolution on psychopathological symptomatology, drug use and functional impairment.

Tratamiento coordinado entre centros de adicciones y salud mental vs. tratamiento no coordinado para pacientes con patología dual: mayor abandono, pero menor deterioro de la discapacidad funcional / Coordinated treatment between centres addiction and mental health centres vs. uncoordinated treatment for patients with dual pathology: greater dropout, but less deterioration of functional disability

Introducción: Los pacientes con patología dual son generalmente tratados en centros de salud mental y adicciones.Aunque hay servicios integrados para estos pacientes, lo máscomún es desarrollar protocolos de actuación conjunta entreestos centros. El objetivo de este estudio es analizar el progreso terapéutico de pacientes diagnosticados de patologíadual, comparando los resultados de pacientes atendidos enlos centros de adicciones exclusivamente, de salud mentalo bien atendidos de manera coordinada entre ambos servicios. La hipótesis es que los pacientes atendidos de maneracoordinada presentarán una mejor evolución en términos dela sintomatología psicopatológica, consumo de drogas y discapacidad funcional.Método. La muestra está formada por 182 pacientesatendidos en centros de adicción (n = 62), de salud mental (n= 51) y tratados a través del protocolo de actuación conjunta(n = 62). Los instrumentos administrados fueron la WHODAS2.0, BSI-18 y la SDSS.Resultados. No se encontraron diferencias estadísticamente significativas entre la evaluación basal y el seguimiento ni en la WHODAS 2.0 ni en el BSI-18. Se encontróun incremento del consumo de cocaína en los tres grupos,aunque fue estadísticamente significativa en los pacientesde adicciones y de salud mental. Hubo una mayor tasa deabandono del tratamiento en los pacientes atendidos de manera coordinada. En términos de cambio fiable, entre los pacientes atendidos de manera coordinada hubo más pacientesque mejoraron en la WHODAS 2.0.Conclusiones. Los hándicaps de asistir a dos redes asistenciales pueden estar explicando el mayor abandono de lospacientes que siguen el protocolo de actuación conjunta. Sinembargo, los pacientes que se mantienen en esta modalidadterapéutica muestran un menor deterioro de la funcionalidad en comparación con las otras dos modalidades. (AU)

Background: Dual pathology is often found in addictionand mental health centers. Although there are integratedservices for these patients, most countries have developedjoint action protocols between addiction and mental healthcenters. The objective is to analyze the progress of patientsdiagnosed with dual pathology, comparing the therapeuticoutcomes of those who exclusively attend either addictionor mental health centers with those patients who followa program in which the two services are coordinated. It ishypothesized that patients assisted in coordinate mannerwill present a better evolution on psychopathological symptomatology, drug use and functional impairment. Methods. The sample was 182 dual pathology patientstreated in addictions centers (n=62), mental health centers(n=51) and treated in a coordinated manner (n=62). The instruments administered was WHODAS 2.0, BSI-18 and SDSS.Results. In general, no statistically significant differences were found between baseline and follow up inWHODAS and BSI-18. More cocaine use was found inthree groups but was statistically significant in patientsattended by addictions center and mental health centers.High percentages of abandonment were found in patientsattending coordinate services. In terms of reliable change, among those receiving the coordinated treatment,there were more patients who showed improvements inthe WHODAS 2.0 dimensions.Conclusions. The inconvenience caused by going to different treatment networks may partially explain these resultsrelated with abandonment. However, patients who remain intreatment in coordinated services, show lower functionalitydeterioration than patients in other modalities. (AU)

Alternative DSM-5 Model for Personality Disorders Through the Lens of an Empirical Network Model.

The Alternative Model for Personality Disorders defined in Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) has recently attracted considerable interest in empirical research, with different hypotheses being proposed to explain the discordant results shown in previous research. Empirical network analysis has begun to be applied for complementing the study of psychopathological phenomena according to a new perspective. This article applies this analysis to personality facets measured in a sample of 626 patients with mental disorders and a 1,034 normative sample, using the Personality Inventory for DSM-5. The results reveal five substructures partially equivalent to domains defined in the DSM-5. Discordant facets (suspiciousness, hostility, rigid perfectionism, attention seeking, and restricted affectivity) play the role of connectors between substructures. Invariance between clinical and community networks was found except for the connection between unusual beliefs and perceptual dysregulation (stronger in the clinical sample). Considering the strength centrality index, anxiousness, emotional lability, and depressivity can be highlighted for their relative importance within both clinical and normative networks.

Impairments in Executive Functioning in Patients with Comorbid Substance Use and Personality Disorders: A Systematic Review.

OBJECTIVE: The purpose of this systematic review was to examine the evidence for impaired executive functioning in patients diagnosed with a dual pathology of personality disorder (PD) and substance use disorder, and to identify whether differences exist in comparison to those with a single diagnosis. Methods: A systematic search was conducted to identify studies using measures of executive functioning in patients with PD-substance use disorder dual pathology. Sixteen studies were selected. Results: The results indicate that dual pathology patients with Cluster C personality disorder do not differ from controls, and that the presence of dual pathology does not influence the updating domain of executive functioning. The findings were inconclusive with regard to dual pathology patients with Cluster B personality disorders. Whilst the various studies consistently show that these patients show worse performance than the control groups, here are contradictory results with regard to whether Cluster B personality disorders add more alterations in executive functioning to those that already appear in substance use disorder. Conclusions: The results suggest the need for further research that more adequately controls variables such as time in treatment, medication, and sample size, whilst there is also a need to employ longitudinal designs that include more patients from Clusters A and C.