Personality Traits among the Various Profiles of Substance Use Disorder Patients: New Evidence Using the DSM-5 Section III Framework.

BACKGROUND: The specialized literature provides solid evidence that substance use disorders (SUD) and personality disorders (PD) are interrelated. Given the relative novelty of the Alternative Model for PD, there are still few studies that have analyzed the relationship between the different facets, substance use disorder, and the various consumption profiles. OBJECTIVE: This paper analyzes the relationship between the facets of the Alternative Model for PD and different substance use disorder profiles, using the facet scores obtained in a sample of substance use disorder patients and comparing these with normative scores. A comparison is also conducted between types of patients. METHOD: The Personality Inventory for DSM-5-SF was administered to a sample of 289 patients diagnosed with SUD who began treatment for alcohol (ALC), cannabis (CAN), cocaine (COC), or heroin (HER) use disorder. A latent class analysis was conducted and scores obtained for each of the classes were compared with normative scores. Logistic regression analyzes were carried out to determine which facets and domains show the greatest explanatory capacity of belonging to each latent class. RESULTS: Four patient profiles were identified on the basis of their SUD: polydrug use (POLY), COC-HER, ALC, and CAN. When comparing the groups with the normative population, POLY presented higher scores on all the domains, COC-HER and ALC on all domains except antagonism, and CAN showed higher scores on detachment and psychoticism. The CAN cluster presented lower scores than the other 3 groups in different domains. No statistically significant differences were observed on any domain between the groups POLY and COC - HER, while differences were found between the classes POLY and ALC for the detachment domain. CONCLUSIONS: The results help to identify the personality profiles associated with various SUD profiles. In particular, patients from the groups POLY, COC-HER, and ALC present high scores on pathological facets related to borderline PD and schizotypal PD (all 3), and antisocial PD (POLY), while the CAN cluster is more normalized and its pathological facets are related to the schizotypal PD. Patients with POLY have a greater tendency toward pathological personality, with the involvement of a large number of facets, while COC-HER and ALC show a slightly less severe profile, and CAN users are characterized by lower scores, but high detachment and psychoticism.

Classical test theory and item response theory produced differences on estimation of reliable clinical index in World Health Organization Disability Assessment Schedule 2.0.

OBJECTIVE: World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is currently one of the most used instruments in disability assessment. The objective of this study was to analyze the clinically reliable change of WHODAS 2.0 by applying both Classical Test Theory (CTT) and the Item Response Theory (IRT). STUDY DESIGN AND SETTING: The sample consisted of 179 patients with dual pathology. The standard error of measurement (SEM) was estimated using the CTT and the rating testlet model. RESULTS: Reliability estimated by Cronbach's alpha provided acceptable values for all domains. The Rasch analysis revealed an adequate capacity to discriminate between people with high and low disability in terms of total scores but not in terms of domains. The SEM varies according to the baseline scores, failing to detect clinically reliable change in patients with lower scores. Kappa coefficients are low for the most of dimensions (except participation) and adequate for total scores. CONCLUSION: The use of total WHODAS 2.0 scores may be useful from a clinical perspective; however, more evidence is required for domain scores to support its usefulness. The decision to use the CTT or the IRT impacts in terms of calculating clinically reliable change.

Attentional bias toward alcohol stimuli as a predictor of treatment retention in cocaine dependence and alcohol user patients.

BACKGROUND: Attentional bias towards substance-related stimuli has shown to be involved in the development and maintenance of cocaine dependence. The relationship between alcohol use and cocaine dependence shown in literature justify the need of study these two substances jointly. METHODS: This paper analyzes patterns of attentional bias in 71 patients with cocaine dependence and compares these patterns according to whether occasional or problematic concurrent alcohol use is taken into account. It also analyzes whether attentional bias towards alcohol and cocaine-related stimuli predicts treatment retention. Attentional bias was evaluated with a visual probe task between 15 and 20days after admission to treatment. Treatment status was recorded at a three-month follow-up. Severity of dependence and cocaine and alcohol craving were also measured. RESULTS: Results show that patients with cocaine dependence and problematic alcohol use show a pattern of approach towards alcohol stimuli (M=8.32, SD=27.01). In contrast, patients with cocaine dependence with occasional consumption of alcohol exhibit a pattern of avoidance of such stimuli (M=-7.23, SD=19.20) (t=2.79, p=0.007). Logistic regression indicates that alcohol attentional bias is the only variable with predictive capacity (OR=1.05, 95% CI=[1.01, 1.09]). It should also be noted that there is a pattern of avoidance of alcohol stimuli in patients who drop out of treatment. CONCLUSION: The results of this study suggest the need to delve into whether therapeutic strategies involving deeper emotional processing or avoidance strategies are more suitable for preventing relapse.

Desarrollo de diferentes marcos de referencia espacial para la orientación en entornos a pequeña escala / Development of different spatial frames of reference for orientation in small-scale environments

Background: Previous studies show that there is a developmental transition in the frames of reference children use to orientate from a body-centered to an allocentric strategy. However, there is no agreement concerning the age at which they begin to integrate and flexibly use both strategies in small scale environments. Method: 6-10-year-old children and adults were trained to locate a hidden object in an arm-maze placed within a small-scale model, which maintained stable relationships with the frames of reference provided by the experimental room and by the subject (Experiment 1), and in a situation of inconsistency between the frame provided by the small scale model and the other two (Experiment 2). Results: When the frames of reference provided by the room and by the subject conflict with that of the manipulative space, the performance deteriorates compared to the situation when multiple frames of reference can be used cooperatively to locate the goal. The flexible use of the information provided by the model (i.e., the cues surrounding the maze and the geometrical features) emerged at 10 years. Conclusions: Through development, children acquire new spatial abilities and increasing flexibility in the conjoint use of egocentric and allocentric frames of reference in small-scale environments (AU)

Antecedentes: estudios previos muestran una transición durante el desarrollo en las estrategias que los niños utilizan para orientarse, aunque no hay consenso en la edad de inicio para emplear conjuntamente estrategias alocéntricas y egocéntricas en entornos a pequeña escala. Método: niños de 6-10 años y adultos fueron entrenados para encontrar un objeto escondido en un laberinto radial ubicado en una maqueta que mantiene una relación constante con los marcos de referencia proporcionados por la habitación experimental y por el participante (experimento 1), y en una situación de inconsistencia entre el marco de referencia del entorno a pequeña escala y los de la habitación y el sujeto (experimento 2). Resultados: cuando los marcos de referencia de la habitación y el sujeto entran en conflicto con el del espacio manipulativo, la ejecución empeora respecto a una situación en que múltiples marcos de referencia cooperan para localizar la meta. Desde los 10 años los niños usan la información del espacio manipulativo, tanto las claves que rodean al laberinto como la geometría de dicho entorno. Conclusiones: durante el desarrollo los niños adquieren nuevas habilidades espaciales y mayor flexibilidad en el uso conjunto de marcos de referencia egocéntricos y alocéntricos en entornos a pequeña escala(AU)

Development of different spatial frames of reference for orientation in small-scale environments.

BACKGROUND: Previous studies show that there is a developmental transition in the frames of reference children use to orientate from a body-centered to an allocentric strategy. However, there is no agreement concerning the age at which they begin to integrate and flexibly use both strategies in small-scale environments. METHOD: 6-10-year-old children and adults were trained to locate a hidden object in an arm-maze placed within a small-scale model, which maintained stable relationships with the frames of reference provided by the experimental room and by the subject (Experiment 1), and in a situation of inconsistency between the frame provided by the small-scale model and the other two (Experiment 2). RESULTS: When the frames of reference provided by the room and by the subject conflict with that of the manipulative space, the performance deteriorates compared to the situation when multiple frames of reference can be used cooperatively to locate the goal. The flexible use of the information provided by the model (i.e., the cues surrounding the maze and the geometrical features) emerged at 10 years. CONCLUSIONS: Through development, children acquire new spatial abilities and increasing flexibility in the conjoint use of egocentric and allocentric frames of reference in small-scale environments.

Aspectos clínicos y modelos teóricos en el Síndrome de Neglect / Clinicalaspects and theoretical models in Neglect Syndrome

En este trabajo se revisa y discute el síndrome de neglect considerando diferentes modelos teóricos explicativos; de dirección atencional, de asimetrías hemisféricas cerebrales, del sesgo atencional o el modelo de atención selectiva. Se consideran los aspectos cognitivos, emocionales y neuroconductuales. El Síndrome de Neglect generalmente es consecuencia de un accidente cerebrovascular, afecta al hemisferio cerebral derecho y señala directamente al lóbulo parietal. Este es el resultado de una definición anatómica vasta más que una unidad fisiológica o funcional. El síndrome se manifiesta por déficits en la atención perceptiva y en la respuesta a estímulos presentados en el hemicampo contralesional. Es un síndrome heterogéneo. Pese a la preponderancia de las teorías de déficits atencionales, las explicaciones de déficits perceptivos y de representación del espacio están presentes. Son variaciones del síndrome la heminatención, la extinción, la hemicinesia y el neglect hemiespacial. Se resalta la importancia de incluir los aspectos emocionales y neuroconductuales junto con los cognitivos y la rehabilitación motora en el proceso de rehabilitación neuropsicológica del síndrome. Son característicos los síntomas de anosognosia, extinción, desinhibición de conducta, conducta de utilización o la falta de afecto. En cuanto a la recuperación y a cómo ocurre esta, se discuten varias explicaciones alternativas y se apunta el papel de la motivación como factor importante en el éxito de los tratamientos.

This paper reviews the syndrome Neglect considering different theoretical models: attentional direction; of cerebral hemispheric asymmetry, attentional bias, selective attention model. The cognitive, emotional and neurobehavioral characteristics are high lighted. Neglect syndrome usually results from a stroke that affects the right cerebral hemisphere and points directly to the parietal lobe. This is the result of an extensive anatomical definition more than that one functional unit or physiological. The syndrome is manifested by deficits in attention and perceptual responses to stimuli presented in the contralesional hemispace. Neglect is a heterogeneous syndrome. Despite the preponderance of theories of the attentional deficit, explanations of perceptual deficits and representation of space are present. The syndrome manifestations are the heminatención, the extinction, the hemispatial hemicinesia and the neglect. They are very important the emotional aspects as the cognitive, neurobehavioral and motor rehabilitation, in the neuropsychological rehabilitation process of syndrome. Symptoms of anosognosia, extinction, behavioral disinhibition, and the utilization behavior or lack of affection are the most prominent in the syndrome. In terms of recovery, how to happen this? We discuss several alternative explanations and the role of motivation as an important factor in the success of treatments.