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1.
Eur Neuropsychopharmacol ; 29(6): 795-802, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31085060

RESUMO

Emotional lability is strongly associated with Attention Deficit Hyperactivity Disorder (ADHD), represents a major source of impairment and predicts poor clinical outcome in ADHD. Given that no specific genes with a role in the co-occurrence of both conditions have been described, we conducted a GWAS of emotional lability in 563 adults with ADHD. Despite not reaching genome-wide significance, the results highlighted genes related with neurotransmission, cognitive function and a wide range of psychiatric disorders that have emotional lability as common clinical feature. By constructing polygenic risk scores on mood instability in the UK Biobank sample and assessing their association with emotional lability in our clinical dataset, we found suggestive evidence of common genetic variation contributing to emotional lability in general population and in clinically diagnosed ADHD. Although not conclusive, these tentative results are in agreement with previous studies that suggest emotion dysregulation as a transdiagnostic construct and highlight the need for further investigation to disentangle the genetic basis of mood instability in ADHD and co-occurring psychiatric disorders.

2.
Actas esp. psiquiatr ; 47(2): 37-44, mar.-abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-181338

RESUMO

Introducción. Las recaídas son frecuentes en la dependencia a cocaína, múltiples factores están involucrados en ellas. Además, la dependencia a cocaína se relaciona con un peor pronóstico en relación a la calidad de vida relacionada con la salud (CVRS). Este estudio explora la CVRS percibida como un indicador de recaída en pacientes con dependencia a cocaína. Metodología. Se llevó a cabo un estudio longitudinal en pacientes con dependencia a cocaína durante 23 semanas. En total 39 pacientes participaron (edad media 35,6 años), aunque solamente 15 completaron el periodo de seguimiento. Se utilizaron varias escalas e instrumentos psicométricos (SCID-I, SCID-II, BDI, STAI y la SF-36) en diferentes puntos del estudio. Los pacientes fueron seguidos y se evaluaron las recaídas. La muestra fue dividida de acuerdo con el momento de recaída (temprano vs. tardía). La información fue comparada y analizada para poder evaluar si la CVRS se podía relacionar con la recaída de cocaína. Resultados. Hubo diferencias en la CVRS percibida entre los pacientes con y sin recaída temprana, especialmente en las dimensiones de Salud Mental y Funcionamiento Social (p<0,05). Además, los pacientes con recaídas tardías presentaban una mejoría de la CVRS percibida si se comparaba con los que recaían de forma temprana. Conclusiones. La CVRS percibida podría predecir parcialmente las recaídas tempranas y su medición podría ser una herramienta para evaluar posibles recaídas en el futuro. Sin embargo, es necesaria más investigación en esta área


Introduction. Cocaine dependence is a disorder where relapses are frequently presented and many factors are involved. Furthermore, cocaine dependence is associated with poor health-related quality of life (HRQoL) outcomes. This study aims to explore perceived HRQoL as an indicator of drug relapse in cocaine-dependent patients (CDP). Subjects and Methods. A longitudinal study was carried out in CDP during 23 weeks. A consecutive sampling method was applied, 39 participants composed the initial sample (mean age 35.6 years), only 15 participants completed outpatient follow-up period. CDP were assessed with psychiatric and HRQoL instruments (SCID-I, SCID-II, BDI, STAI scale and SF-36) in different points of the study. The patients were followed up, and cocaine relapses were assessed. The sample was divided according with the relapse (early vs. late relapse). Data were compared and analyzed in order to evaluate whether HRQoL measure could be related to cocaine relapse. Results. There are differences in perceived HRQoL measures between CDP with/without early relapse, especially in Mental health and Social functioning dimensions (p<0.05). Furthermore, Late/relapse-patients have higher improvement of HRQoL than patients with early relapse. Conclusions. Perceived HRQoL might predict early relapse and could be a possible predictor tool of potential future relapses. More research in this field is needed


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Fumar Cocaína/psicologia , Transtornos Relacionados ao Uso de Cocaína/psicologia , Qualidade de Vida/psicologia , Estudos Longitudinais , Recidiva , Prognóstico , Psicometria/métodos , Ansiedade/diagnóstico , Ansiedade/psicologia , Depressão/diagnóstico , Depressão/psicologia , Transtornos Relacionados ao Uso de Cocaína/terapia
3.
Actas Esp Psiquiatr ; 47(2): 37-44, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31017271

RESUMO

INTRODUCTION: Cocaine dependence is a disorder where relapses are frequently presented and many factors are involved. Furthermore, cocaine dependence is associated with poor health-related quality of life (HRQoL) outcomes. This study aims to explore perceived HRQoL as an indicator of drug relapse in cocaine-dependent patients (CDP). SUBJECTS AND METHODS: A longitudinal study was carried out in CDP during 23 weeks. A consecutive sampling method was applied, 39 participants composed the initial sample (mean age 35.6 years), only 15 participants completed outpatient follow-up period. CDP were assessed with psychiatric and HRQoL instruments (SCID-I, SCID-II, BDI, STAI scale and SF-36) in different points of the study. The patients were followed up, and cocaine relapses were assessed. The sample was divided according with the relapse (early vs. late relapse). Data were compared and analyzed in order to evaluate whether HRQoL measure could be related to cocaine relapse. RESULTS: There are differences in perceived HRQoL measures between CDP with/without early relapse, especially in Mental health and Social functioning dimensions (p<0.05). Furthermore, Late/relapse-patients have higher improvement of HRQoL than patients with early relapse. CONCLUSIONS: Perceived HRQoL might predict early relapse and could be a possible predictor tool of potential future relapses. More research in this field is needed.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/psicologia , Qualidade de Vida/psicologia , Adulto , Cocaína , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Recidiva , Índice de Gravidade de Doença , Adulto Jovem
4.
Transl Psychiatry ; 9(1): 42, 2019 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-30696812

RESUMO

Genetic factors are strongly implicated in the susceptibility to develop externalizing syndromes such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, and substance use disorder (SUD). Variants in the ADGRL3 (LPHN3) gene predispose to ADHD and predict ADHD severity, disruptive behaviors comorbidity, long-term outcome, and response to treatment. In this study, we investigated whether variants within ADGRL3 are associated with SUD, a disorder that is frequently co-morbid with ADHD. Using family-based, case-control, and longitudinal samples from disparate regions of the world (n = 2698), recruited either for clinical, genetic epidemiological or pharmacogenomic studies of ADHD, we assembled recursive-partitioning frameworks (classification tree analyses) with clinical, demographic, and ADGRL3 genetic information to predict SUD susceptibility. Our results indicate that SUD can be efficiently and robustly predicted in ADHD participants. The genetic models used remained highly efficient in predicting SUD in a large sample of individuals with severe SUD from a psychiatric institution that were not ascertained on the basis of ADHD diagnosis, thus identifying ADGRL3 as a risk gene for SUD. Recursive-partitioning analyses revealed that rs4860437 was the predominant predictive variant. This new methodological approach offers novel insights into higher order predictive interactions and offers a unique opportunity for translational application in the clinical assessment of patients at high risk for SUD.


Assuntos
Predisposição Genética para Doença , Receptores Acoplados a Proteínas-G/genética , Receptores de Peptídeos/genética , Transtornos Relacionados ao Uso de Substâncias/genética , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Estudos Longitudinais , Masculino , Polimorfismo de Nucleotídeo Único , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
5.
Mol Psychiatry ; 2019 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-30610198

RESUMO

Attention-deficit/hyperactivity disorder (ADHD) is a severely impairing neurodevelopmental disorder with a prevalence of 5% in children and adolescents and of 2.5% in adults. Comorbid conditions in ADHD play a key role in symptom progression, disorder course and outcome. ADHD is associated with a significantly increased risk for substance use, abuse and dependence. ADHD and cannabis use are partly determined by genetic factors; the heritability of ADHD is estimated at 70-80% and of cannabis use initiation at 40-48%. In this study, we used summary statistics from the largest available meta-analyses of genome-wide association studies (GWAS) of ADHD (n = 53,293) and lifetime cannabis use (n = 32,330) to gain insights into the genetic overlap and causal relationship of these two traits. We estimated their genetic correlation to be r2 = 0.29 (P = 1.63 × 10-5) and identified four new genome-wide significant loci in a cross-trait analysis: two in a single variant association analysis (rs145108385, P = 3.30 × 10-8 and rs4259397, P = 4.52 × 10-8) and two in a gene-based association analysis (WDPCP, P = 9.67 × 10-7 and ZNF251, P = 1.62 × 10-6). Using a two-sample Mendelian randomization approach we found support that ADHD is causal for lifetime cannabis use, with an odds ratio of 7.9 for cannabis use in individuals with ADHD in comparison to individuals without ADHD (95% CI (3.72, 15.51), P = 5.88 × 10-5). These results substantiate the temporal relationship between ADHD and future cannabis use and reinforce the need to consider substance misuse in the context of ADHD in clinical interventions.

6.
Neuropsychopharmacology ; 44(5): 890-897, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30568281

RESUMO

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in childhood and persists into adulthood in 40-65% of cases. Given the polygenic and heterogeneous architecture of the disorder and the limited overlap between genetic studies, there is a growing interest in epigenetic mechanisms, such as microRNAs, that modulate gene expression and may contribute to the phenotype. We attempted to clarify the role of microRNAs in ADHD at a molecular level through the first genome-wide integrative study of microRNA and mRNA profiles in peripheral blood mononuclear cells of medication-naive individuals with ADHD and healthy controls. We identified 79 microRNAs showing aberrant expression levels in 56 ADHD cases and 69 controls, with three of them, miR-26b-5p, miR-185-5p, and miR-191-5p, being highly predictive for diagnostic status in an independent dataset of 44 ADHD cases and 46 controls. Investigation of downstream microRNA-mediated mechanisms underlying the disorder, which was focused on differentially expressed, experimentally validated target genes of the three highly predictive microRNAs, provided evidence for aberrant myo-inositol signaling in ADHD and indicated an enrichment of genes involved in neurological disease and psychological disorders. Our comprehensive study design reveals novel microRNA-mRNA expression profiles aberrant in ADHD, provides novel insights into microRNA-mediated mechanisms contributing to the disorder, and highlights promising candidate peripheral biomarkers.

7.
J Stud Alcohol Drugs ; 79(6): 844-852, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30573014

RESUMO

OBJECTIVE: Adverse health effects including cognitive impairment have been described in older adults with benzodiazepine misuse, although the literature about this issue is scarce. The present study aimed to assess cognitive decline in older adults with benzodiazepine use disorder and changes in cognitive state at the 6-month follow-up, as well as whether patients achieved abstinence. METHOD: A 6-month follow-up longitudinal study was conducted in an outpatient drug center in Barcelona in a sample of older adults (≥65 years old) who had benzodiazepine use disorder. The sample was compared with an equivalent control group. A neuropsychological protocol was performed at baseline and after 6-month follow-up covering the most important cognitive domains. RESULTS: The final sample comprised 33 patients with an average age of 73.5 years. At baseline, patients presented impairment in several domains compared with the control group: visual immediate recall (p < .001), visual delayed recall (p < .001), copy (p < .001), working memory (p < .003), immediate verbal learning (p < .002), total words learned (p < .009), set switching (p < .001), verbal fluency (p < .007), speed processing (p < .002), solving problems (p < .006), nonverbal fluency (p < .004), and sustained attention in all three areas omissions (p < .001), variability (p < .001), and perseverance (p < .005). At 6-month follow-up, patients achieving abstinence showed improvement compared with patients in active consumption in visual delayed recall (p < .006), total words learned (p < .010), and verbal fluency (p < .013). CONCLUSIONS: Benzodiazepine misuse in older adults may produce negative effects on cognitive skills. Recovery of some of these cognitive deficits may be possible with benzodiazepine abstinence.


Assuntos
Benzodiazepinas/efeitos adversos , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/psicologia , Pacientes Ambulatoriais/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Idoso , Idoso de 80 Anos ou mais , Atenção/efeitos dos fármacos , Atenção/fisiologia , Disfunção Cognitiva/epidemiologia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Memória de Curto Prazo/efeitos dos fármacos , Memória de Curto Prazo/fisiologia , Testes Neuropsicológicos , Espanha/epidemiologia , Centros de Tratamento de Abuso de Substâncias/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores de Tempo , Aprendizagem Verbal/efeitos dos fármacos , Aprendizagem Verbal/fisiologia
8.
Psychiatry Res ; 270: 1157-1165, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30551310

RESUMO

Substance use disorder (SUD) is a worldwide concern that has its own particularities regarding age and sex. This study aims to assess the differences between old SUD women and men regarding socio-demographics, clinical factors and outcomes. A 6-months follow-up longitudinal study was conducted in an outpatient center, on a convenience sample of 115 SUD old adults (≥65 years old, average age of 71.57). Descriptive, bivariate, and multivariate analyses were performed. Data showed statistical significant differences between men and women related to sociodemographic variables (marital status, coexistence, criminal records and stress factors), medical and psychiatric conditions (women suffer higher rates of depression and anxiety, with worse health-related quality of life), family records (women had more presence of family psychiatric records) and SUD related parameters (men tend to use more alcohol, had an early onset, consume higher doses, report more craving and more tobacco life use while women had higher rates of prescription drugs use). At 6-month follow-up, the whole sample showed excellent rates of adherence and abstinence, without sex differences. The study points out sex differences on several sociodemographic and clinical variables, indicating their specific needs. This research could facilitate better approaches by considering a sex perspective in SUD old adults.


Assuntos
Fatores Etários , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/etiologia , Idoso , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/psicologia
9.
Addiction ; 113(11): 2073-2086, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30003630

RESUMO

BACKGROUND AND AIMS: Cannabis is one of the most commonly used substances among adolescents and young adults. Earlier age at cannabis initiation is linked to adverse life outcomes, including multi-substance use and dependence. This study estimated the heritability of age at first cannabis use and identified associations with genetic variants. METHODS: A twin-based heritability analysis using 8055 twins from three cohorts was performed. We then carried out a genome-wide association meta-analysis of age at first cannabis use in a discovery sample of 24 953 individuals from nine European, North American and Australian cohorts, and a replication sample of 3735 individuals. RESULTS: The twin-based heritability for age at first cannabis use was 38% [95% confidence interval (CI) = 19-60%]. Shared and unique environmental factors explained 39% (95% CI = 20-56%) and 22% (95% CI = 16-29%). The genome-wide association meta-analysis identified five single nucleotide polymorphisms (SNPs) on chromosome 16 within the calcium-transporting ATPase gene (ATP2C2) at P < 5E-08. All five SNPs are in high linkage disequilibrium (LD) (r2  > 0.8), with the strongest association at the intronic variant rs1574587 (P = 4.09E-09). Gene-based tests of association identified the ATP2C2 gene on 16q24.1 (P = 1.33e-06). Although the five SNPs and ATP2C2 did not replicate, ATP2C2 has been associated with cocaine dependence in a previous study. ATP2B2, which is a member of the same calcium signalling pathway, has been associated previously with opioid dependence. SNP-based heritability for age at first cannabis use was non-significant. CONCLUSION: Age at cannabis initiation appears to be moderately heritable in western countries, and individual differences in onset can be explained by separate but correlated genetic liabilities. The significant association between age of initiation and ATP2C2 is consistent with the role of calcium signalling mechanisms in substance use disorders.

10.
PeerJ ; 6: e4442, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29576944

RESUMO

Quinoa cultivation has been expanded around the world in the last decade and is considered an exceptional crop with the potential of contributing to food security worldwide. The exceptional nutritional value of quinoa seeds relies on their high protein content, their amino acid profile that includes a good balance of essential amino acids, the mineral composition and the presence of antioxidants and other important nutrients such as fiber or vitamins. Although several studies have pointed to the influence of different environmental stresses in certain nutritional components little attention has been paid to the effect of the agroecological context on the nutritional properties of the seeds what may strongly impact on the consumer food's quality. Thus, aiming to evaluate the effect of the agroecological conditions on the nutritional profile of quinoa seeds we analyzed three quinoa cultivars (Salcedo-INIA, Titicaca and Regalona) at different locations (Spain, Peru and Chile). The results revealed that several nutritional parameters such as the amino acid profile, the protein content, the mineral composition and the phytate amount in the seeds depend on the location and cultivar while other parameters such as saponin or fiber were more stable across locations. Our results support the notion that nutritional characteristics of seeds may be determined by seed's origin and further analysis are needed to define the exact mechanisms that control the changes in the seeds nutritional properties.

11.
Sci Rep ; 8(1): 1881, 2018 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-29382897

RESUMO

Methylphenidate (MPH) is the most frequently used pharmacological treatment in children with attention-deficit/hyperactivity disorder (ADHD). However, a considerable interindividual variability exists in clinical outcome. Thus, we performed a genome-wide association study of MPH efficacy in 173 ADHD paediatric patients. Although no variant reached genome-wide significance, the set of genes containing single-nucleotide polymorphisms (SNPs) nominally associated with MPH response (P < 0.05) was significantly enriched for candidates previously studied in ADHD or treatment outcome. We prioritised the nominally significant SNPs by functional annotation and expression quantitative trait loci (eQTL) analysis in human brain, and we identified 33 SNPs tagging cis-eQTL in 32 different loci (referred to as eSNPs and eGenes, respectively). Pathway enrichment analyses revealed an over-representation of genes involved in nervous system development and function among the eGenes. Categories related to neurological diseases, psychological disorders and behaviour were also significantly enriched. We subsequently meta-analysed the association with clinical outcome for the 33 eSNPs across the discovery sample and an independent cohort of 189 ADHD adult patients (target sample) and we detected 15 suggestive signals. Following this comprehensive strategy, our results provide a better understanding of the molecular mechanisms implicated in MPH treatment effects and suggest promising candidates that may encourage future studies.

12.
Psychiatry Res ; 261: 361-366, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29353762

RESUMO

There has been little research about deleterious effects, including cognitive impairment, related to hazardous long-term alcohol use in old adults. This study aims to assess cognitive decline in old patients with alcohol use disorder and changes in cognitive state at 6 months follow-up, achieving or not abstinence. A six-month follow-up study was conducted in an outpatient center in Barcelona on a sample of old adults (≥65 years old) who had hazardous alcohol use. The sample was compared with healthy volunteers adjusted for age, sex and years of education. A neuropsychological protocol was performed at baseline and after 6 months follow-up covering four cognitive domains: attention, visuospatial abilities, memory and executive functions. Several domains were significant impaired at baseline: visual immediate and delayed recall, working memory, immediate verbal learning, total words learned, set switching and sustained attention. At 6 months reassessment, alcohol abstinence was achieved in 93.5% of patients and it was detected a trend towards improvement in direct mean scores of all cognitive areas, although it was not significant. The current study points out a cognitive impairment in many areas secondary to alcohol long-term hazardous use in old adults. A trend towards cognitive improvement after recovery was detected in most patients.


Assuntos
Alcoolismo/psicologia , Disfunção Cognitiva/etiologia , Idoso , Abstinência de Álcool/psicologia , Atenção , Função Executiva , Feminino , Seguimentos , Humanos , Masculino , Memória de Curto Prazo , Pacientes Ambulatoriais/psicologia , Espanha , Fatores de Tempo , Aprendizagem Verbal
14.
Expert Rev Clin Pharmacol ; 10(4): 443-455, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28276775

RESUMO

INTRODUCTION: The complexity of the endocannabinoid (eCB) system is becoming better understood and new drivers of eCB signaling are emerging. Modulation of the activities of the eCB system can be therapeutic in a number of diseases. Research into the eCB system has been paralleled by the development of agents that interact with cannabinoid receptors. In this regard it should be remembered that herbal cannabis contains a myriad of active ingredients, and the individual cannabinoids have quite distinct biological activities requiring independent studies. Areas covered: This article reviews the most important current data involving the eCB system in relation to human diseases, to reflect the present (based mainly on the most used prescription cannabinoid medicine, THC/CBD oromucosal spray) and potential future uses of cannabinoid-based therapy. Expert commentary: From the different therapeutic possibilities, THC/CBD oromucosal spray has been in clinical use for approximately five years in numerous countries world-wide for the management of multiple sclerosis (MS)-related moderate to severe resistant spasticity. Clinical trials have confirmed its efficacy and tolerability. Other diseases in which different cannabinoids are currently being investigated include various pain states, Alzheimer's disease, Parkinson's disease, Huntington's disease and epilepsy. The continued characterization of individual cannabinoids in different diseases remains important.


Assuntos
Agonistas de Receptores de Canabinoides/administração & dosagem , Endocanabinoides/metabolismo , Extratos Vegetais/administração & dosagem , Administração Oral , Animais , Canabidiol , Agonistas de Receptores de Canabinoides/farmacologia , Agonistas de Receptores de Canabinoides/uso terapêutico , Dronabinol , Combinação de Medicamentos , Desenho de Drogas , Humanos , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Transdução de Sinais/efeitos dos fármacos
15.
Eur Arch Psychiatry Clin Neurosci ; 267(6): 541-549, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27658669

RESUMO

Common environmental etiological factors between borderline personality disorder (BPD) and attention deficit/hyperactivity disorder (ADHD) have not been fully studied. The main aim of this study was to investigate the relationship between childhood trauma histories, assessed by the Childhood Trauma Questionnaire-Short Form (CTQ-SF), with adult BPD, ADHD or BPD-ADHD diagnoses. Comorbid BPD-ADHD patients exhibited significantly higher clinical severity and higher scores in the Total Neglect Scale, compared to BPD and ADHD patients, and only a marginal difference was observed for Sexual Abuse when BPD and ADHD patients were compared. Physical Trauma Scales were associated with ADHD diagnosis, whereas Emotional Abuse and Sexual Abuse Scales were associated with BPD or BPD-ADHD diagnoses. The study findings support the association between experiencing traumatic events in childhood and a higher clinical severity of BPD in adulthood. Furthermore, physical trauma history in childhood could be associated with the persistence of ADHD in adulthood and emotional or sexual abuse with later development of BPD or comorbid BPD-ADHD. Whereas experiencing childhood traumas is associated with later development of more general psychopathology, our study supports that a specific type of traumatic event could increase the risk for the consolidation of a concrete psychiatric disorder in the trajectory from childhood to adulthood of vulnerable subjects.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno da Personalidade Borderline/etiologia , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno da Personalidade Borderline/diagnóstico , Feminino , Humanos , Masculino , Risco , Índice de Gravidade de Doença , Adulto Jovem
16.
J Addict Dis ; 36(2): 93-96, 2017 Apr-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28001490

RESUMO

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.


Assuntos
Transtorno da Personalidade Borderline/epidemiologia , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Comorbidade , Diagnóstico Duplo (Psiquiatria)/estatística & dados numéricos , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Fatores de Risco , Espanha/epidemiologia , Adulto Jovem
17.
Rev. neurol. (Ed. impr.) ; 64(supl.1): s117-s122, 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-163045

RESUMO

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno del neurodesarrollo altamente prevalente, presenta una elevada comorbilidad con sintomatología afectiva y ansiosa, afecta a la funcionalidad de la persona que lo padece, tienen una baja adhesión terapéutica y genera unos costes sociales y personales elevados. El mindfulness es un tratamiento psicológico que ha demostrado ser eficaz para el TDAH. La realidad virtual es un tratamiento altamente utilizado en fobias y extendido a otras patologías con resultados positivos. Objetivo. Desarrollar el primer tratamiento con realidad virtual y mindfulness para el TDAH en la edad adulta, que suponga un aumento en la adhesión terapéutica y reduzca costes. Pacientes y métodos. Estudio piloto de 25 pacientes tratados con realidad virtual, mediante cuatro sesiones de 30 minutos, y 25 mediante psicoestimulantes. Se tomarán medidas de evaluación pretratamiento, postratamiento y postratamiento a los 3 y 12 meses, tanto de TDAH como de depresión, ansiedad, funcionalidad y calidad de vida. Se analizarán posteriormente con el programa SPSS v. 20 y se realizará un ANOVA de grupos independientes para ver las diferencias entre tratamientos y un test-retest para detectar el mantenimiento de los cambios. Resultados y conclusiones. Es necesaria la utilización de tratamientos que sean efectivos, supongan una reducción en los costes y un aumento en la adhesión terapéutica. El tratamiento con realidad virtual se plantea como una alternativa a los tratamientos clásicos, que sea más breve y atractiva para los pacientes (AU)


Introduction. Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder, which presents a high comorbidity with anxiety and affective signs and symptoms. It has repercussions on the functioning of those suffering from it, who also have low therapy compliance and generate a significant cost both at a personal level and for society. Mindfulness is a psychological treatment that has proved to be effective for ADHD. Virtual reality is widely used as treatment in cases of phobias and other pathologies, with positive results. Aims. To develop the first treatment for ADHD in adults based on virtual reality and mindfulness, while also resulting in increased treatment adherence and reduced costs. Patients and methods. We conducted a pilot study with 25 patients treated by means of virtual reality, in four 30-minute sessions, and 25 treated with psychostimulants. Measures will be taken pre-treatment, post-treatment and at 3 and 12 months post-treatment, to evaluate both ADHD and also depression, anxiety, functionality and quality of life. Data will be later analysed with the SPSS v. 20 statistical program. An ANOVA of independent groups will be performed to see the differences between treatments and also a test-retest to detect whether the changes will be maintained. Results and conclusions. It is necessary to use treatments that are effective, reduce costs and increase therapy adherence. Treatment with virtual reality is an interesting alternative to the classical treatments, and is shorter and more attractive for patients (AU)


Assuntos
Humanos , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapia de Exposição à Realidade Virtual/métodos , Terapia de Exposição à Realidade Virtual/tendências , Atenção Plena/métodos , Atenção Plena/tendências , Projetos Piloto , Análise de Variância , Adesão à Medicação , Psicoterapia Centrada na Pessoa/métodos , Psicoterapia Centrada na Pessoa/tendências , Terapia Cognitivo-Comportamental/métodos , Resultado do Tratamento
18.
Psychiatry Res ; 246: 587-592, 2016 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-27839828

RESUMO

The aim of this study is to compare the features of two groups of cocaine dependent patients in treatment, one of them with co-morbid diagnosis of antisocial personality disorder and the other not. Cross-sectional design, with 143 cocaine-dependent patients attending a drug unit, distributed in two groups: patients with and without Antisocial Personality Disorder. As results, we found that the 15.38% of the sample were diagnosed with an Antisocial Personality Disorder. In relation to socio-demographic variables, Antisocial Personality Disorder patients have less probability of being working or studying (9.1% vs. 47.9%). After multivariate analysis it was found that significantly Antisocial Personality Disorder patients have more opiates dependence (OR: 0.219; 95% IC 0.072-0.660), sedative dependence (OR: 0.203; 95% IC 0.062-0.644) and in more cases show Borderline Personality Disorder (OR: 0.239; 95% IC 0.077-0.746). This study highlights significant differences between cocaine addicts with or without an Antisocial Personality Disorder. All these differences are good indicators of the complexity of the patients with this personality disorder. Better knowledge of their profile will help us to improve the design of specific treatment programs.


Assuntos
Transtorno da Personalidade Antissocial/diagnóstico , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Adulto , Transtorno da Personalidade Antissocial/complicações , Transtorno da Personalidade Antissocial/psicologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/psicologia , Avaliação de Sintomas
19.
Patient Prefer Adherence ; 10: 1855-1868, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27698553

RESUMO

BACKGROUND: There is a need to evaluate the professionals' perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders. METHODS: An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addictions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted. RESULTS: Most professionals perceived the existence of noncompliance among dual diagnosis patients. Almost all of these professionals (99%) perceived that noncompliance leads to a worsening of the progression of the patient's disorder, in both the exacerbation of mental disorders and the consumption of addictive substances. Most of the professionals (69.2%) considered therapeutic alliance as the main aspect to take into account to improve the prognosis in this population. The primary purpose of treatment must be the improvement of psychotic-phase positive symptoms, followed by the control of behavior disorders, reduction of craving, improvement of social and personal performances, and reduction of psychotic-phase negative symptoms. CONCLUSION: Most professionals perceived low adherence among dual diagnosis patients. This lack of adherence is associated with a worsening of their disease evolution, which is reflected in exacerbations of the psychopathology and relapse in substance use. Therefore, we propose to identify strategies to improve adherence.

20.
Actas esp. psiquiatr ; 44(5): 178-182, sept.-oct. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-156059

RESUMO

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 (AU)


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 (AU)


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Transtornos da Personalidade/complicações , Transtornos da Personalidade/epidemiologia , Prisioneiros , Autoimagem , Transtornos Relacionados ao Uso de Substâncias/complicações , Testes de Personalidade , Prevalência
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