Measurement instruments of online gaming disorder in adolescents and young people according to DSM-5 criteria: a systematic review. / Instrumentos de medida del trastorno de juego en internet en adolescentes y jóvenes según criterios DSM-5: una revisión sistemática.

The inclusion of Internet Gaming Disorder (IGD) in the DSM-5 has generated controversy over its diagnosis, and it therefore seems necessary to establish a clear cut-off point to identify when excessive gaming becomes problematic. Such identification is especially difficult in adolescents and young people, who frequently dedicate a great deal of time to online games. The goal of this systematic review was to analyze the instruments developed to assess IGD in adolescents and young people since its inclusion in the DSM-5. We identified 13 studies which included validations of seven assessment instruments for IGD in adolescents and young people. Each instrument and its validations in different languages are described. In comparison to previous reviews, a lower diversity of assessment instruments, a reduction in the number of items and a more uniform form of measurement was observed, maintaining high internal consistency and good criterion validity. However, problems related to sample selection, the lack of sensitivity and specificity studies, and the establishment of cut points and profiles of gamers remain. Advances in the analysis of the psychometric qualities of the instruments and their validation in different countries are needed, and cultural differences should be considered in order to allow the prevalence of this problem to be compared.

La inclusión del Trastorno de Juego en Internet (TJI) en el DSM-5 ha generado polémica sobre su diagnóstico, no obstante parece necesario establecer un punto de corte claro para identificar cuando este juego excesivo se convierte en problemático. Esta identificación se hace especialmente difícil en adolescentes y jóvenes, entre los que suele ser frecuente la dedicación a este tipo de juegos. El objetivo de esta revisión sistemática fue analizar los instrumentos que desarrollados para la evaluación del TJI en adolescentes y jóvenes desde su inclusión en el DSM-5. Se identificaron 13 estudios que incluían validaciones de 7 instrumentos de evaluación del TJI en adolescentes y jóvenes. Se describió cada instrumento y sus validaciones en distintos idiomas. En relación con revisiones previas, se observó una menor diversidad de instrumentos de evaluación, una reducción en el número de ítems y una forma de medida más uniforme, manteniéndose una alta consistencia interna y una buena validez de criterio. Sin embargo, siguen presentes los problemas referidos a la selección de muestras, la falta de estudios de sensibilidad y especificidad, y el establecimiento de puntos de corte y perfiles de jugadores. Se recomienda avanzar en el análisis de las cualidades psicométricas de los instrumentos, y su validación en distintos países para considerar las diferencias culturales y poder comparar la presencia de este problema.

Instrumentos de medida del trastorno de juego en internet en adolescentes y jóvenes según criterios DSM-5: una revisión sistemática / Measurement instruments of online gaming disorder in adolescents and young people according to DSM-5 criteria: a systematic review

La inclusión del Trastorno de Juego en Internet (TJI) en el DSM-5 ha generado polémica sobre su diagnóstico, no obstante parece necesario establecer un punto de corte claro para identificar cuando este juego excesivo se convierte en problemático. Esta identificación se hace especialmente difícil en adolescentes y jóvenes, entre los que suele ser frecuente la dedicación a este tipo de juegos. El objetivo de esta revisión sistemática fue analizar los instrumentos que desarrollados para la evaluación del TJI en adolescentes y jóvenes desde su inclusión en el DSM-5. Se identificaron 13 estudios que incluían validaciones de 7 instrumentos de evaluación del TJI en adolescentes y jóvenes. Se describió cada instrumento y sus validaciones en distintos idiomas. En relación con revisiones previas, se observó una menor diversidad de instrumentos de evaluación, una reducción en el número de ítems y una forma de medida más uniforme, manteniéndose una alta consistencia interna y una buena validez de criterio. Sin embargo, siguen presentes los problemas referidos a la selección de muestras, la falta de estudios de sensibilidad y especificidad, y el establecimiento de puntos de corte y perfiles de jugadores. Se recomienda avanzar en el análisis de las cualidades psicométricas de los instrumentos, y su validación en distintos países para considerar las diferencias culturales y poder comparar la presencia de este problema

The inclusion of Internet Gaming Disorder (IGD) in the DSM-5 has generated controversy over its diagnosis, and it therefore seems necessary to establish a clear cut-off point to identify when excessive gaming becomes problematic. Such identification is especially difficult in adolescents and young people, who frequently dedicate a great deal of time to online games. The goal of this systematic review was to analyze the instruments developed to assess IGD in adolescents and young people since its inclusion in the DSM-5. We identified 13 studies which included validations of seven assessment instruments for IGD in adolescents and young people. Each instrument and its validations in different languages are described. In comparison to previous reviews, a lower diversity of assessment instruments, a reduction in the number of items and a more uniform form of measurement was observed, maintaining high internal consistency and good criterion validity. However, problems related to sample selection, the lack of sensitivity and specificity studies, and the establishment of cut points and profiles of gamers remain. Advances in the analysis of the psychometric qualities of the instruments and their validation in different countries are needed, and cultural differences should be considered in order to allow the prevalence of this problem to be compared

Factores que interfieren en el curso del tratamiento de los problemas de ansiedad: La prolongación y la terminación prematura del tratamiento / Factors interfering with the course of treatment for anxiety disorders: Prolongation and premature termination of treatment

El tratamiento de los trastornos de ansiedad ha demostrado su eficacia y efectividad. Sin embargo, no siempre se consiguen los resultados deseados. Estudiar aquellos factores que interfieren en el curso natural del tratamiento contribuirá a tomar medidas oportunas. Dos de estos factores son la prolongación innecesaria de los tratamientos y el fenómeno de la terminación prematura. Como es esperable, la duración del tratamiento depende de la naturaleza del problema y de la existencia de problemas comórbidos, pero también de planificaciones demasiado ambiciosas (exceso de técnicas) o la combinación con psicofármacos (con incrementos de hasta un 21% de sesiones). La terminación prematura se sitúa entorno al 30-35% y los pacientes "anuncian el desenlace" con peor ejecución de tareas y asistencias más irregulares desde el principio. Aproximadamente 50% de los abandonos ocurren antes de la sesión 8 y entorno al 80% de los tratamientos completados exitosamente concluyen antes de la sesión 20

The efficacy and the effectiveness of anxiety disorder treatments have been proven. However, the desired results are not always achieved. Studying the factors that interfere with the natural course of the treatments could help to correct and to adapt them. Two of these factors are the unnecessary prolongation of treatments and premature termination. As expected, the duration of the treatment depends on the nature of the problem and the existence of comorbid problems, however also treatments that are too ambitious (an excess of techniques) or combined with pharmacological treatments (increasing sessions by up to 21%) have a longer duration. Premature termination was around 30-35% and patients "announce" their drop-out by displaying poorer task performance and more irregular attendance from the beginning. More than 50% of the therapeutic dropout occurs before the eighth session and 80% of successful treatments were completed before the 20th session

Psychometric properties of a brief on-line screening instrument to detect at-risk gamblers / Propiedades psicométricas de un instrumento de cribado breve on-line para la detección de jugadores de riesgo

Background: Gambling facilitates the development of psychopathological problems in some gamblers. Rapid and easy detection of the presence of these problems, or the risk of their development, will allow early action at the beginning of the problem, including preventive action. For this purpose, we developed the "Sistema de Cribado de Riesgo de Problemas de Juegos" (SCRI-PJ [Risk of Gambling Problems Screening System]), an on-line instrument for the detection of people who have, or may develop, gambling problems. The goal of this work is to present and validate the SCRI-PJ. Method: 85 people with gambling problems undergoing treatment and 119 people from the general population were assessed with the SCRI-PJ and the DSM-RT Diagnostic Criteria for Pathological Gambling questionnaire. Results: the SCRI-PJ showed high internal consistency (α= .96), sensitivity (94.2%) specificity (91.4%), with a negative predictive value of 98.6%. Conclusion: the SCRI-PJ is a brief and effective screening instrument to detect people with gambling problems or who are at risk of developing them (AU)

Antecedentes: los juegos de azar facilitan el desarrollo de problemas psicopatológicos en algunos jugadores. Detectar de forma rápida y sencilla la presencia de estos problemas, o el riesgo de su desarrollo, permitirá actuar precozmente al inicio del problema, incluso de forma preventiva. Con este propósito se ha desarrollado el Sistema de Cribado de Riesgo de Problemas de Juego (SCRI-PJ), un instrumento on-line para la detección de personas que tengan o puedan desarrollar problemas con el juego. El objetivo de este trabajo es presentar y validar el SCRI-PJ. Método: 85 personas con problemas de juego en tratamiento y 119 personas de la población general fueron evaluados mediante el SCRI-PJ y el cuestionario Criterios diagnósticos DSM-IV-TR para el Juego Patológico. Resultados: el SCRI-PJ mostró una alta consistencia interna (α= .96), sensibilidad (94,2%) y especificidad (91,4%), con un valor predictivo negativo del 98,6%. Conclusión: el SCRI-PJ es un instrumento de cribado breve y eficaz para detectar a las personas con problemas de juego o en riesgo de desarrollarlos (AU)

Psychometric properties of a brief on-line screening instrument to detect at-risk gamblers.

BACKGROUND: Gambling facilitates the development of psychopathological problems in some gamblers. Rapid and easy detection of the presence of these problems, or the risk of their development, will allow early action at the beginning of the problem, including preventive action. For this purpose, we developed the “Sistema de Cribado de Riesgo de Problemas de Juegos” (SCRI-PJ [Risk of Gambling Problems Screening System]), an on-line instrument for the detection of people who have, or may develop, gambling problems. The goal of this work is to present and validate the SCRI-PJ. METHOD: 85 people with gambling problems undergoing treatment and 119 people from the general population were assessed with the SCRI-PJ and the DSM-RT Diagnostic Criteria for Pathological Gambling questionnaire. RESULTS: the SCRI-PJ showed high internal consistency (α= .96), sensitivity (94.2%) specificity (91.4%), with a negative predictive value of 98.6%. CONCLUSION: the SCRI-PJ is a brief and effective screening instrument to detect people with gambling problems or who are at risk of developing them.

Premature termination of psychological treatment for anxiety disorders in a clinical setting / Terminación prematura del tratamiento psicológico para los trastornos de ansiedad en el contexto clínico

BACKGROUND: Empirically supported psychological treatments (ESTs) have demonstrated their effectiveness and clinical utility for the treatment of anxiety disorders (AD) but few studies have assessed the factors associated with premature termination in ESTs for AD. METHOD: The goals of this study, which involved 291 patients with a diagnosis of anxiety who had received outpatient psychological care, consisted of examining premature termination of treatment (PTT), comparing the individual characteristics of the patients who successfully completed treatment with those who terminate it prematurely, and analyzing the predictors of PTT. RESULTS: Of the sample, 8.2% refused to start treatment, 28.5% dropped out before completing it, and 63.2% successfully completed treatment. In 50% of the cases, PTT occurred during the first 7 sessions, and in 80%, before the 15th session. Alternatively, 76.4% of the patients who complete treatment successfully do so before session 20. We found that patients with PTT attended a significantly lower number of treatment sessions and attended the sessions more irregularly and unpunctually. Presenting a generalized anxiety disorder (GAD), problems with punctuality and with task performance were predictors of failure to complete treatment. CONCLUSIONS: These findings suggest the need to reinforce early adherence to treatments to help patients remain in treatment

ANTECEDENTES: los tratamientos psicológicos empíricamente apoyados (TEAs) han demostrado utilidad clínica para el abordaje de los trastornos de ansiedad (TA), pero pocos estudios han evaluado los factores asociados a la terminación prematura (TPT). MÉTODO: se examinaron las tasas de TPT, sus predictores y las características de aquellos pacientes que terminaron prematuramente frente a los que completan, en una muestra de 291 pacientes, en atención ambulatoria y diagnosticados de algún trastorno de ansiedad. RESULTADOS: el 8,2% de los participantes rechazaron comenzar el tratamiento, el 28,5% abandonaron antes de completarlo y el 63,2% completaron con éxito. El 50% de los casos de TPT se produce durante las 7 primeras sesiones y en el 80% antes de la sesión 15. El 76,4% de los pacientes que finalizan con éxito su tratamiento lo hacen antes de la sesión 20. El grupo TPT acudió a un número significativamente menor de sesiones y asistieron de manera más irregular e impuntual. Resultaron predictores de no completar el tratamiento presentar un Trastorno de Ansiedad Generalizada, problemas de puntualidad y en la ejecución de tareas. CONCLUSIONES: los resultados apuntan la necesidad de reforzar la adhesión temprana a los tratamientos para ayudar a los pacientes a mantenerse en los mismos

Premature termination of psychological treatment for anxiety disorders in a clinical setting.

BACKGROUND: Empirically supported psychological treatments (ESTs) have demonstrated their effectiveness and clinical utility for the treatment of anxiety disorders (AD) but few studies have assessed the factors associated with premature termination in ESTs for AD. METHOD: The goals of this study, which involved 291 patients with a diagnosis of anxiety who had received outpatient psychological care, consisted of examining premature termination of treatment (PTT), comparing the individual characteristics of the patients who successfully completed treatment with those who terminate it prematurely, and analyzing the predictors of PTT. RESULTS: Of the sample, 8.2% refused to start treatment, 28.5% dropped out before completing it, and 63.2% successfully completed treatment. In 50% of the cases, PTT occurred during the first 7 sessions, and in 80%, before the 15th session. Alternatively, 76.4% of the patients who complete treatment successfully do so before session 20. We found that patients with PTT attended a significantly lower number of treatment sessions and attended the sessions more irregularly and unpunctually. Presenting a generalized anxiety disorder (GAD), problems with punctuality and with task performance were predictors of failure to complete treatment. CONCLUSIONS: These findings suggest the need to reinforce early adherence to treatments to help patients remain in treatment.

Characteristics of demand and psychological treatments in a university clinic / Características de la demanda y de los tratamientos psicológicos en una clínica universitaria

The objectives of this study are to describe the most common characteristics of patients receiving psychological treatment and the treatments administered. We analyzed a sample of 856 patients at the University Psychology Clinic of the Complutense University of Madrid. Five diagnostic categories accounted for 78.4% of demand: anxiety disorders (31.9%), no diagnosis (15.4%), other problems requiring clinical attention (14.2%), mood disorders (9.5%) and adaptive disorders (7.4%). A total of 17.7% presented a comorbid diagnosis and 49.3% had received treatment previously. The mean of assessment and treatment sessions was 3.5 and 12.7, respectively. The most commonly applied techniques included psychoeducation (95.1%), cognitive restructuring (74.8%), relaxation (74.4%), and control of internal dialogue (68.1%).Of the patients that had finished contact with the clinic, 68.3% were a therapeutic success. We discuss the generalization of the results and the implications for the profession and clinical practice

Los objetivos del estudio son describir las características de los pacientes que acuden a tratamiento psicológico y de los tratamientos aplicados. Se analiza una muestra de 856 pacientes de la Clínica Universitaria de Psicología de la Universidad Complutense. Cinco categorías diagnósticas cubren el 78.4% de la demanda: trastornos de ansiedad (31.9%), sin diagnóstico (15.4%), otros problemas objeto de atención clínica (14.2%), trastornos del estado de ánimo (9.5%) y trastornos adaptativos (7.4%). El 17.7% presentaba un diagnóstico comórbido y el 49.3% habían recibido un tratamiento previo. La media de sesiones de evaluación fue de 3.5 y 12.7, respectivamente. Las técnicas más utilizadas fueron psicoeducación (95.1%), reestructuración cognitiva (74.8%), relajación (74.4%) y control del diálogo interno (68.1%).De los pacientes que habían finalizado el contacto con el centro el 68.3% obtuvo el alta terapéutica. Se discute la generalización de los resultados e implicaciones para la profesión y la práctica clínica

Factors associated with prolonging psychological treatment for anxiety disorders.

BACKGROUND: Anxiety disorders are one of the disorders most frequently requested for psychological attention. The purpose of this study is to identify the factors that can explain a longer duration of psychological treatment for anxiety disorders. METHOD: 202 patients from the University Psychology Clinic of the Complutense University of Madrid were analyzed. RESULTS: Multivariate regression analysis showed that the presence of obsessive-compulsive disorder and the application of arousal control techniques followed by modeling and other specific techniques were the best predictors of treatment duration. CONCLUSION: Reducing as much as possible the number of techniques applied without reducing intervention efficacy is suggested. In some disorders that produce a greater life disorganization, it may be useful to try to organize the patient´s life either as a first goal or at the same time as the intervention program, so as to increase its effectiveness and reduce the number of sessions.

Factors associated with prolonging psychological treatment for anxiety disorders / Factores asociados a la prolongación del tratamiento psicológico en los trastornos de ansiedad

BACKGROUND: Anxiety disorders are one of the disorders most frequently requested for psychological attention. The purpose of this study is to identify the factors that can explain a longer duration of psychological treatment for anxiety disorders. METHOD: 202 patients from the University Psychology Clinic of the Complutense University of Madrid were analyzed. RESULTS: Multivariate regression analysis showed that the presence of obsessive-compulsive disorder and the application of arousal control techniques followed by modeling and other specific techniques were the best predictors of treatment duration. CONCLUSION: Reducing as much as possible the number of techniques applied without reducing intervention efficacy is suggested. In some disorders that produce a greater life disorganization, it may be useful to try to organize the patient's life either as a first goal or at the same time as the intervention program, so as to increase its effectiveness and reduce the number of sessions

ANTECEDENTES: uno de los motivos más frecuentes de atención psicológica son los trastornos de ansiedad. El objetivo de este trabajo es identificar los factores que pueden explicar una mayor duración del tratamiento psicológico en los problemas de ansiedad. MÉTODO: se analizaron los datos de 202 pacientes de la Clínica Universitaria de Psicología de la Universidad Complutense de Madrid. RESULTADOS: el análisis de regresión multivariado mostró que los mayores predictores de la duración del tratamiento eran la presencia de un diagnóstico principal de Trastorno Obsesivo-Compulsivo y la aplicación de técnicas para el control de la activación seguidas de modelado y otras técnicas específicas. CONCLUSIONES: se recomienda reducir en la medida de lo posible el número de técnicas aplicadas sin que se reduzca la eficacia de la intervención. En algunos trastornos que producen una mayor desestructuración puede ser conveniente intentar organizar la vida del paciente antes o durante el programa de intervención para incrementar la efectividad y reducir el número de sesiones

Probability and predictors of remission from life-time prescription drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

While prescription drug use disorders (PDUD) has become an important and growing public health problem, little is known about their course. This study aims to estimate cumulative probability of remission from sedatives, tranquilizers, opioids and stimulants, and to identify predictors of remission across substances. Analyses were done for the sub-sample of individuals with lifetime history of abuse or dependence on sedatives (n = 402), tranquilizers (n = 372), opioids (n = 521), and stimulants (n = 765) at Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Cumulative probability estimates and hazard ratios for remission from PDUD were obtained for the general population. Lifetime cumulative probability estimates of remission were above 96% for all substances assessed. Half of the cases of PDUD remitted between 4 and 5 years after onset. Remission from PDUD was greater for younger individuals. Males exhibited lower hazards of remission for stimulants use disorder. A diagnosis of personality disorders decreased probability of remission for sedatives and stimulants. Only abuse or dependence on some prescription drugs decreased the probability of remission from other PDUD, whereas other drug disorders did not predict remission. A significant proportion of individuals with PDUD achieve remission at some point in their life-time. Predictors of remission were found to be mostly substance-specific rather than common across substances. The lower rates of remission among some subgroups of the population highlight the need to strengthen preventive and intervention efforts among vulnerable population subgroups.