Criteria and Concurrent Validity of DIVA 2.0: A Semi-Structured Diagnostic Interview for Adult ADHD.

Objective: The aim of this study was to assess for the first time the criterion validity of the semi-structured Diagnostic Interview for ADHD in adults (DIVA 2.0), and its concurrent validity in comparison with the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) and other ADHD severity scales, following the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Method: A transversal study was performed on 40 out-patients with ADHD to check the criteria and concurrent validity of the DIVA 2.0 compared with the CAADID. Results: The DIVA 2.0 interview showed a diagnostic accuracy of 100% when compared with the diagnoses obtained with the CAADID interview. The concurrent validity demonstrated good correlations with three self-reported rating scales: the Wender Utah Rating Scale (WURS; r = .544, p < .0001), the ADHD-Rating Scale (r = .720, p < .0001), and Sheehan's Dysfunction Inventory (r = .674, p < .0001). Conclusion: The DIVA 2.0 is a reliable tool for assessing and diagnosing Adult ADHD and is the only one that offers free online access for clinical and research purposes.

Estudio de prevalencia de Trastornos de Personalidad en una muestra de presos con Trastorno por Uso de Sustancias usando el autoinforme PDQ-4+ / Study of prevalence of Personality Disorders in inmate men sample with Substance Use Disorders using of PDQ-4+ Self-Report

Introducción. Este estudio tiene como objetivo estudiar la prevalencia de Trastornos de Personalidad (TP) en 51 hombres presos en una unidad penitenciaria especialidad en Trastorno por Uso de Sustancias (TUS). Método. Los instrumentos administrados eran la Entrevista Clínica para Trastornos del Eje I del DSM-IV y el autoinforme Personality Diagnostic Questionnaire-4+. Resultados. El tipo de delito más frecuentemente cometido entre los presos era el robo (76.5%), incluyendo robo con violencia. El 45.1% de los sujetos puntuaban como positivos para el TP Antisocial, seguido por el 35.3% de TP Paranoide y 23.5% TP Obsesivo-Compulsivo. Los resultados indican una muestra de hombres encarcelados con un perfil clínico caracterizado por TUS y TPs, presentando casi la mitad de la muestra un TP Antisocial. Conclusiones. La presencia de TP Antisocial y Paranoide con TUS sugieren un perfil de personalidad más complejo, con tendencia a presentar delitos más graves, incluyendo el robo con violencia. Una valoración más amplia de los TP debería ser realizada en muestras penitenciarias para poder identificar aquellos sujetos más peligrosos con mayor riesgo de reincidencias

Introduction. The study focused on examining the prevalence of Personality Disorders (PD) in 51 male inmates diagnosed with Substance Use Disorders (SUDs) lifetime within a specialized unit at a prison. Methods. The instruments administered included the Structured Clinical Interview for DSM-IV Axis I and the Personality Diagnostic Questionnaire-4+. Results. The type of crime most frequently committed by the incarcerated was the robbery (76.5%), including robbery with violence. 45.1% of the patients screened positive for Antisocial PD, followed by 35.3% for Paranoid and 23.5% for Obsessive Compulsive PD. The results reflect a male inmate sample exhibiting a clinical profile characterized by SUDs and PD, with almost half of the total sample presenting Antisocial PD. Conclusions. The presence of Antisocial and Paranoid PD with SUD suggests a more complex personality profile, with a tendency to carry out more aggressive crimes, including robbery with violence. A more comprehensive PD assessment should be carried out in prison settings in order to identify dangerous individuals who are at risk of recidivism

Study of prevalence of Personality Disorders in inmate men sample with Substance Use Disorders using of PDQ-4+ Self-Report.

INTRODUCTION: The study focused on examining the prevalence of Personality Disorders (PD) in 51 male inmates diagnosed with Substance Use Disorders (SUDs) lifetime within a specialized unit at a prison. METHODS: The instruments administered included the Structured Clinical Interview for DSM-IV Axis I and the Personality Diagnostic Questionnaire-4+. RESULTS: The type of crime most frequently committed by the incarcerated was the robbery (76.5%), including robbery with violence. 45.1% of the patients screened positive for Antisocial PD, followed by 35.3% for Paranoid and 23.5% for Obsessive Compulsive PD. The results reflect a male inmate sample exhibiting a clinical profile characterized by SUDs and PD, with almost half of the total sample presenting Antisocial PD. CONCLUSIONS: The presence of Antisocial and Paranoid PD with SUD suggests a more complex personality profile, with a tendency to carry out more aggressive crimes, including robbery with violence. A more comprehensive PD assessment should be carried out in prison settings in order to identify dangerous individuals who are at risk of recidivism.

Dual diagnosis among physicians: a clinical perspective.

Co-occurrence of mental disorders and substance use disorders (dual diagnosis) among doctors is a cause of serious concern due to its negative personal, professional, and social consequences. This work provides an overview of the prevalence of dual diagnosis among physicians, suggests a clinical etiological model to explain the development of dual diagnosis in doctors, and recommends some treatment strategies specifically for doctors. The most common presentation of dual diagnosis among doctors is the combination of alcohol use disorders and affective disorders. There are also high rates of self-medication with benzodiazepines, legal opiates, and amphetamines compared to the general population, and cannabis use disorders are increasing, mainly in young doctors. The prevalence of nicotine dependence varies from one country to another depending on the nature of public health policies. Emergency medicine physicians, psychiatrists, and anaesthesiologists are at higher risk for developing a substance use disorder compared with other doctors, perhaps because of their knowledge of and access to certain legal drugs. Two main pathways may lead doctors toward dual diagnosis: (a) the use of substances (often alcohol or self-prescribed drugs) as an unhealthy strategy to cope with their emotional or mental distress and (b) the use of substances for recreational or other purposes. In both cases, doctors tend to delay seeking help once a problem has been established, often for many years. Denial, minimization, and rationalization are common defense mechanisms, maybe because of the social stigma associated with mental or substance use disorders, the risk of losing employment/medical license, and a professional culture of perfectionism and denial of emotional needs or failures. Personal vulnerability interacts with these factors to increase the risk of a dual diagnosis developing in some individuals. When doctors with substance use disorders accept treatment in programs specifically designed for them (Physicians' Health Programs), they show better outcomes than the general population. However, physicians with dual diagnosis have more psychological distress and worse clinical prognosis than those with substance use disorders only. Future studies should contribute to a better comprehension of the risk and protective factors and the evidence-based treatment strategies for doctors with dual diagnosis.

Inpatient physicians and nurses with dual diagnosis: an exploratory study.

OBJECTIVE: This study explored the clinical features of physicians and nurses with dual diagnosis.   METHODS: We conducted a retrospective review of 150 medical records of physicians (n = 120) and nurses (n = 30) admitted from February 2008 to February 2011 to the Barcelona Psychiatric Inpatient Unit for Health Professionals. Routine intake included the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and a clinical interview.   RESULTS: The mean age of participants was 48.59 (SD = 8.9) years and 57.3% were male. Patients experienced substance dependence with alcohol (n = 112, 74.7%), sedatives (n = 59, 39.3%), cocaine (n = 24, 16%), other stimulants (n = 15, 10%), and opiates other than heroin (n = 16, 10.7%). About 41% (n = 61) also met criteria for a mental health disorder, mainly major depressive disorder (n = 42, 28%), while 8% (n = 12) had attention deficit hyperactivity disorder. A high proportion of physicians (n = 95, 79.2%) and nurses (n = 25, 83.3%) had nicotine dependence. The most common comorbidity was alcohol dependence and major depressive disorder. No differences were found between groups in the prevalence of substance use disorders, mental health disorders, and dual diagnosis.   CONCLUSIONS: Dual diagnosis is a common condition among inpatient physicians and nurses with substance use disorders and its clinical presentation may be similar in both groups.

Doctors admitted to a Physicians' Health Program: a comparison of self-referrals versus directed referrals.

OBJECTIVE: To compare the profile of doctors with mental disorders admitted to a Physicians' Health Program (PHP) depending on their type of referral. DESIGN: Retrospective chart review. METHOD: We analysed 1545 medical records of doctors admitted to the Barcelona PHP (PAIMM) from 1 February 1998 to 31 December 2012. RESULTS: Most doctors (83.2%) were self-referred to the programme. Patients non-self-referred were older ([Formula: see text]=55 vs [Formula: see text]=49.6 years; t=6.96, p<0.01) than those self-referred and there were more men (68.3%) than women (45.8%; OR=0.39; 95% CI 0.29 to 0.52). Self-referrals were more frequent among patients with non-addictive disorders (84.6% vs 15.4%; OR=4.52; 95% CI 3.23 to 28.45). Self-referred patients needed less inpatient admissions (16.8% vs30.9%; OR=2.22; 95% CI 1.63 to 3.01) and the length of their treatment episodes was shorter ([Formula: see text]=24.3 vs [Formula: see text] = 32.4 months; t=3.34; p<0.01). Logistic regression showed a significant model (χ(2)=67.52; df=3; p<0.001). Age, gender and diagnosis were statistically associated with type of referral to the programme. CONCLUSIONS: Type of referral to a PHP may be influenced not only by sick doctors' personal traits but also by each programme's design and how it is perceived by service users. Our findings should be taken into account when designing treatment and preventive interventions for this professional group.

Promoting voluntary help-seeking among doctors with mental disorders.

OBJECTIVES: To explore if the Barcelona Integral Care Program for Doctors with mental disorders (PAIMM, in Catalan) has achieved its goal of enhancing earlier and voluntary help-seeking amongst sick doctors. MATERIAL AND METHODS: We conducted a retrospective chart review of 1363 medical records of physicians admitted to the inpatient and outpatient units of the PAIMM from February 1st, 1998 until December 31st, 2011. The sample was divided into 3 time periods: 1998-2004, 2005-2007 and 2008-2011 (477, 497, and 389 cases, respectively). RESULTS: The mean age at admission decreased (F = 77.57, p < 0.001) from the first period (x = 54.18; SD = 10.28 years) to the last period (x = 44.81; SD = 10.65 years), while voluntary referrals increased from 81.3% to 91.5% (Chi(2) = 17.85, p < 0.001). Mental disorders other than substance use disorders grew from 71% during the 1998-2003 period, to 87.4% (2004-2007), and 83.9% in the last period (Chi2 = 29.01, p < 0.001). Adjustment disorders increased their prevalence, while inpatient treatment progressively represented less of the overall clinical activity. CONCLUSIONS: Sick doctors may feel encouraged to seek help in non-punitive programs specially designed for them and where treatment becomes mandatory only when there is risk or evidence of malpractice.

Addressing the lack of studies in attention-deficit/hyperactivity disorder in adults.

Attention-deficit/hyperactivity disorder (ADHD) is commonly known to occur during childhood, characterized by excessive inattention and/or hyperactivity and impulsivity as well as lack of emotional self-control and motivation. The prevalence of adult ADHD in the general population is estimated to be between 2-5%. The aim of this review is to provide an overview regarding current controversies related to ADHD within the adult population. The concept of ADHD in adults has been questioned and criticized by professionals over the last years. Overall, adult ADHD is well evidenced based on epidemiological data, genetic data, neuroimaging, psychosocial impairment and treatment effectiveness. Although, research within this field has been significantly improved, suggestions for future research are provided, in order to be able to clarify the remaining questions regarding this disorder throughout adulthood. One of the most important changes to be made in the near future should be to increase educational training on ADHD in adults.

Procedencia del medio rural como un factor de riesgo para la aparición de Osteoporosis: utilidad del ultrasonido del tobillo para el despistaje inicial

Objetivos: Realizar el despistaje y diagnóstico de la osteoporosis en un grupo de mujeres, procedentes de la población rural del municipio Los Taques, Estado Falcón, quienes presentaban para el momento de la entrevista dos o más factores de riesgo para el desarrollo de osteoporosis. Métodos: A través de diferentes medios de comunicación (radio, prensa y televisión regional) se convocó a una campaña de despistaje de la Osteoporosis dirigida a todas las mujeres mayores de 40 años, procedentes del municipio Los Taques (Falcón), con el objeto de realizar el despistaje de la osteoporosis. Se incluyeron para este estudio únicamente las primeras 100 mujeres que presentaban durante la entrevista clínica 2 o más factores de riesgo para la enfermedad. A todas las 100 pacientes incluidas en el estudio se les practicó una prueba de densitometría mediante el método de ultrasonido del tobillo o calcáneo (US). De las pacientes que presentaron un resultado positivo en el US, se escogieron al azar a 50 para el ulterior estudio confirmatorio del diagnóstico mediante la densitometría dual de rayos X (DEXA) de cadera. Resultados: De las 100 mujeres estudiadas, 67 presentaron una prueba de US positivo o alterado. El estudio densitométrico de la cadera (DEXA) realizado en 50 de estas pacientes, seleccionadas al azar, demostró una confirmación diagnóstica en el 80% de los casos se encontró con correlación significativa entre los resultados obtenidos por US y por DEXA (p< 0.05). Entre los factores de riesgo encontrados en las pacientes con diagnóstico confirmado de osteoporosis mediante DEXA, se encontraron: edad mayor de 60 años, historia de menopausia no tratada, un peso corporal menor de 60 Kg y antecedentes de ingesta escasa de leche. Cabe destacar que el porcentaje de pacientes procedentes de este municipio rural, con 2 o más factores de riesgo y que presentaron una prueba de US positiva, fue muy superior (67%) comparado con la frecuencia encontrada por este grupo de investigadores en la población urbana de Punto Fijo, capital del Municipio Los Taques (33%). Conclusiones: Nuestros resultados sugieren que la procedencia del medio rural, concretamente del municipio los Taques, es de por si un factor de riesgo epidemiológico para la presentación de la osteoporosis. El US de tobillo demostró ser una herramienta bastante precisa, de fácil uso y bajo costo, para realizar despistaje de osteoporosis en personas con factores de riesgo.

Abstract Objectives: The present investigation had for aim the identification and diagnoses of osteoporosis, in a group of habitants from a rural area of Los Taques, in Falcon state. Methods: All patients presented two or more risk factors for the development of osteoporosis previous to the study. In order to identify the presence of osteoporosis, an ultrasound of the ankle (AS) was employed, and to confirm the previous diagnosis, a dual ray densitometer (DEXA) of the hip was utilized. Results: It was found that there is a larger number of people with positive AS in the rural area (67%) than in urban areas (33%), p<0.005. A significant correlation between the positive results obtained with the AS and those obtained with DEXA of the hip was found, (p<0.05). The most prevalent risk factors found were: being older than 60years of age, have a background of menopause that have not been treated, weight lighter than 60kg, and a lack consume of milk. To sum up, it was found that rural area, specifically Los Taques, is a very important risk factor for osteoporosis that should be considered when choosing patients to diagnose osteoporosis. In our study, we have also demonstrated that ultrasound of the ankle is a very reliable tool when we compare it with DEXA of hip, which is “the standard gold instrument for the diagnosis of osteoporosis “. Conclusions: We will like to make a call to the local authorities to introduce preventive measures in areas like Los Taques to identify early and treat osteoporosis. More research needs to be done under similar conditions, in order to confirm these kinds of findings.