Larger Gray Matter Volume in the Basal Ganglia of Heavy Cannabis Users Detected by Voxel-Based Morphometry and Subcortical Volumetric Analysis.

Background: Structural imaging studies of cannabis users have found evidence of both cortical and subcortical volume reductions, especially in cannabinoid receptor-rich regions such as the hippocampus and amygdala. However, the findings have not been consistent. In the present study, we examined a sample of adult heavy cannabis users without other substance abuse to determine whether long-term use is associated with brain structural changes, especially in the subcortical regions. Method: We compared the gray matter volume of 14 long-term, heavy cannabis users with non-using controls. To provide robust findings, we conducted two separate studies using two different MRI techniques. Each study used the same sample of cannabis users and a different control group, respectively. Both control groups were independent of each other. First, whole-brain voxel-based morphometry (VBM) was used to compare the cannabis users against 28 matched controls (HC1 group). Second, a volumetric analysis of subcortical regions was performed to assess differences between the cannabis users and a sample of 100 matched controls (HC2 group) obtained from a local database of healthy volunteers. Results: The VBM study revealed that, compared to the control group HC1, the cannabis users did not show cortical differences nor smaller volume in any subcortical structure but showed a cluster (p < 0.001) of larger GM volume in the basal ganglia, involving the caudate, putamen, pallidum, and nucleus accumbens, bilaterally. The subcortical volumetric analysis revealed that, compared to the control group HC2, the cannabis users showed significantly larger volumes in the putamen (p = 0.001) and pallidum (p = 0.0015). Subtle trends, only significant at the uncorrected level, were also found in the caudate (p = 0.05) and nucleus accumbens (p = 0.047). Conclusions: This study does not support previous findings of hippocampal and/or amygdala structural changes in long-term, heavy cannabis users. It does, however, provide evidence of basal ganglia volume increases.

Severity factors associated with borderline personality disorder among misusers in an outpatient sample in Spain.

The comorbidity between substance-use disorders and borderline personality disorder (SUD-BPD) with other psychiatric disorders has been little studied. A total of 937 drug-dependent patients were evaluated using semistructured interviews and 13.7% were SUD-BPD patients. After multivariate analysis, gender, Affective Disorder (OR 2.59), Anxiety Disorder (OR 1.90), Eating Disorders (OR 4.29), Cocaine (OR 2.16), benzodiazepine dependence (OR 1.90), early age of onset of drug consumption (OR 0.94), and dependent (OR 4.04), paranoid (OR 3.70) and antisocial personality disorders (OR 3.46) were associated with SUD-BPD. Several psychiatric comorbidities are the norm in SUD-BPD patients; therefore these patients are a challenge for clinicians.

Motivational interviewing group at inpatient detoxification, its influence in maintaining abstinence and treatment retention after discharge.

The relapse rate after discharge from inpatient detoxification is high. The objective of this pilot study is to assess the sociodemographic, clinical and therapeutic factors associated with maintaining abstinence in patients who participated in a brief motivational interviewing group during admission for detoxification. A total of 46 patients, diagnosed substance dependent according to DSM -IV, and admitted to the Hospital Detoxification Unit, participated in a brief motivational interviewing group. Sociodemographic, clinical, motivation to change (University of Rhode Island Change Assessment, URICA) and satisfaction with the treatment group (Treatment Perceptions Questionnaire, CPT) data were collected. Abstinence and treatment retention two months after discharge were assessed by weekly telephone calls. A survival analysis was performed. Being male, having more cognitions of the maintenance stage of change at discharge, being satisfied with group therapy and therapist during hospitalization are associated with longer abstinence after discharge. The brief motivational interviewing group approach with patients admitted for detoxification is related to greater likelihood of maintaining abstinence and subsequent treatment retention.

La tasa de recaída en el consumo al alta de una Unidad de Desintoxicación Hospitalaria es elevada. El objetivo de este estudio piloto es valorar los factores sociodemográficos, clínicos y terapéuticos asociados al mantenimiento de la abstinencia de pacientes que han participado en un grupo psicoterapéutico breve de corte motivacional durante su ingreso para la desintoxicación.Un total de 46 pacientes con diagnóstico de trastorno por dependencia a sustancias, según DSM-IV, ingresados en Unidad de Desintoxicación Hospitalaria participaron en un grupo breve de corte motivacional. Se midieron variables sociodemográficas y clínicas, así como la motivación al cambio (University of Rhode Island Change Assessment, URICA) y la satisfacción con el tratamiento grupal (Cuestionario de Percepciones de Tratamiento, CPT). El mantenimiento de la abstinencia y la retención al tratamiento, dos meses tras el alta, se evaluaron mediante llamadas telefónicas semanales. Se realizó un análisis de supervivencia. Los resultados muestran que ser varón, tener cogniciones del estadio de mantenimiento del cambio al alta y tener una buena satisfacción con la terapia grupal y su terapeuta durante el ingreso, se asocia con mayor tiempo en abstinencia tras el alta. El abordaje psicoterapéutico grupal breve de corte motivacional, en pacientes ingresados para la desintoxicación, se relaciona con mayor probabilidad de mantenimiento de abstinencia y de retención al tratamiento posterior.

Grupo motivacional en unidad hospitalaria desintoxicación, su influencia en mantenimiento de la abstinencia y retención al tratamiento tras alta / Motivational interviewing group at inpatient detoxification, its influence in maintaining abstinence and treatment retention after discharge

La tasa de recaída en el consumo al alta de una Unidad de Desintoxicación Hospitalaria es elevada. El objetivo de este estudio piloto es valorar los factores sociodemográficos, clínicos y terapéuticos asociados al mantenimiento de la abstinencia de pacientes que han participado en un grupo psicoterapéutico breve de corte motivacional durante su ingreso para la desintoxicación. Un total de 46 pacientes con diagnóstico de trastorno por dependencia a sustancias, según DSM-IV, ingresados en Unidad de Desintoxicación Hospitalaria participaron en un grupo breve de corte motivacional. Se midieron variables sociodemográficas y clínicas, así como la motivación al cambio (University of Rhode Island Change Assessment, URICA) y la satisfacción con el tratamiento grupal (Cuestionario de Percepciones de Tratamiento, CPT). El mantenimiento de la abstinencia y la retención al tratamiento, dos meses tras el alta, se evaluaron mediante llamadas telefónicas semanales. Se realizó un análisis de supervivencia. Los resultados muestran que ser varón, tener cogniciones del estadio de mantenimiento del cambio al alta y tener una buena satisfacción con la terapia grupal y su terapeuta durante el ingreso, se asocia con mayor tiempo en abstinencia tras el alta. El abordaje psicoterapéutico grupal breve de corte motivacional, en pacientes ingresados para la desintoxicación, se relaciona con mayor probabilidad de mantenimiento de abstinencia y de retención al tratamiento posterior

The relapse rate after discharge from inpatient detoxification is high. The objective of this pilot study is to assess the sociodemographic, clinical and therapeutic factors associated with maintaining abstinence in patients who participated in a brief motivational interviewing group during admission for detoxification. A total of 46 patients, diagnosed substance dependent according to DSM -IV, and admitted to the Hospital Detoxification Unit, participated in a brief motivational interviewing group. Sociodemographic, clinical, motivation to change (University of Rhode Island Change Assessment, (URICA) and satisfaction with the treatment group (Treatment Perceptions Questionnaire, CPT) data were collected. Abstinence and treatment retention two months after discharge were assessed by weekly telephone calls. A survival analysis was performed. Being male, having more cognitions of the maintenance stage of change at discharge, being satisfied with group therapy and therapist during hospitalization are associated with longer abstinence after discharge. The brief motivational interviewing group approach with patients admitted for detoxification is related to greater likelihood of maintaining abstinence and subsequent treatment retention

[Risk factors for relapse in drug-dependent patients after hospital detoxification]. / Factores de riesgo de recaída en pacientes drogodependientes tras desintoxicación hospitalaria.

This work describes the profile of patients with relapse after hospital detoxification at six months of outpatient follow-up. An observational and prospective study was carried out in patients with substance-dependence disorder who were in the Detoxification Unit of the Vall d'Hebron University Hospital (Barcelona) between June 2009 and October 2010. Demographic, clinical, diagnostic and therapeutic variables were assessed. The criterion for relapse was a return to use of the substance that had led to hospitalization, and relapse was assessed by means of anamnesis, breathalyzer and/or urine analysis. Study variables were compared between patients who relapsed and those who did not. Of the 165 patients included, 108 patients finished the study (75% males, age 37.7 ± 9.5 years). A total of 72.2% had relapsed at the 6-month follow-up. Profile of patients who relapsed was: hospitalized for heroin detoxification (91.7% vs 8.3%, p = .038), polyconsumers (71.4% vs 32%, p = .05), high substance use in the hours prior to admission as a "farewell" (61.5% vs 39.5%, p = .04), patients with comorbidity (44.9% vs 23.3%, p = .04) and patients with affective disorders (19.5% vs 3.2%, p = .005). Detoxification from opiates and use in the hours prior to admission were associated independently with relapse at 6 months. There is a high percentage of relapses after hospital detoxification. Patients most likely to relapse are those dependent on opiates and those with compulsive use immediately prior to hospitalization.

Factores de riesgo de recaída en pacientes drogodependientes tras desintoxicación hospitalaria / Risk factors for relapse in drug-dependent patients after hospital detoxification

El presente trabajo pretende comparar las características entre los pacientes que recaen en el consumo y los que se mantienen abstinentes, a los seis meses de seguimiento ambulatorio tras terminar una desintoxicación hospitalaria. Se realizó un estudio observacional y prospectivo en pacientes con trastorno por dependencia de sustancias que ingresaron en la Unidad Hospitalaria de Desintoxicación del Hospital Universitario de Vall d’Hebron desde junio 2009 hasta octubre 2010. Durante el ingreso se recogieron variables demográficas, clínicas, diagnósticas y terapéuticas, y se realizó la entrevista SCID. Se consideró recaída el reinicio del consumo de la sustancia que fue motivo de ingreso y se evaluó por anamnesis y alcohotest y/o urinoanálisis. Las variables de estudio se compararon entre los pacientes que recayeron y los que no. De 165 pacientes incluidos, 108 finalizaron el estudio (75% varones, edad 37,7±9,5 años). 72,2% recayeron a los 6 meses. El perfil de pacientes que recayeron fue: pacientes que ingresaban para desintoxicación de heroína (91,7% vs 8,3%, p = .038), policonsumidores (71,4% vs 32%, p = .05), pacientes que consumían horas previas al ingreso a modo de despedida (61,5% vs 39,5%, p = .04), aquellos con comorbilidad médica (44,9% vs 23,3%, p = .04), y con trastornos afectivos comórbidos (19,5% vs 3,2%,p = .005). La desintoxicación de opiáceos y el consumo en horas previas se asociaron de forma independiente con la recaída a los 6 meses. Existe un alto porcentaje de recaídas tras desintoxicación hospitalaria. Ingresar para desintoxicación de opiáceos y/o consumir de forma compulsiva antes del ingreso, están relacionados con el mayor riesgo de recaída(AU)

This work describes the profile of patients with relapse after hospital detoxification at six months of outpatient follow-up. An observational and prospective study was carried out in patients with substance dependence disorder who were in the Detoxification Unit of the Valld’Hebron University Hospital (Barcelona) between June 2009 and October 2010. Demographic, clinical, diagnostic and therapeutic variables were assessed. The criterion for relapse was a return to use of the substance that had led to hospitalization, and relapse was assessed by means of anamnesis, breathalyzer and/or urine analysis. Study variables were compared between patients who relapsed and those who did not. Of the 165patients included, 108 patients finished the study (75% males, age 37.7 ± 9.5 years). A total of 72.2% had relapsed at the 6-month follow-up. Profile of patients who relapsed was: hospitalized for heroin detoxification (91.7% vs 8.3%, p = .038), polyconsumers (71.4% vs 32%, p = .05), high substance use in the hours prior to admission as a "farewell" (61.5% vs 39.5%, p = .04), patients with comorbidity (44.9% vs 23.3%, p = .04) and patients with affective disorders (19.5% vs 3.2%, p = .005). Detoxification from opiates and use in the hours prior to admission were associated independently with relapse at 6 months. There is a high percentage of relapses after hospital detoxification. Patients most likely to relapse are those dependent on opiates and those with compulsive use immediately prior to hospitalization(AU)