Adictividad: una dimensión independiente en el síndrome psicótico. Presentación de la Escala de Evaluación de la Adictividad en el Síndrome Psicótico (EASP) / Addictiveness: an independent dimension in the psychotic syndrome. Presentation of the Addictiveness in the Psychotic Syndrome Assessment Scale (APSAS)

Los modelos de patología dual suelen considerar a los trastornos por uso de sustancias (TUS) y al resto de trastornos mentales como dos entidades nosológicas que coinciden en una misma persona. Este estudio adopta un punto de partida diferente y estima que la adictividad sería una novena dimensión clínica independiente en los trastornos psicóticos, que se añadiría a las de alucinaciones, delirio, habla desorganizada, conducta psicomotriz anormal, síntomas negativos, déficit cognitivo, depresión y manía. Todas ellas derivarían, en último término, de una disfunción fronto-subcortical común con implicación dopaminérgica, glutamatérgica y gabaérgica. Se presenta la Escala de Evaluación de la Adictividad en el Síndrome Psicótico (EASP), que busca ser un instrumento integrado y sencillo para la evaluación de la adictividad en los trastornos psicóticos. Se basa en la recogida de datos sobre el primer uso, el tiempo de consumo, el último consumo, la frecuencia de consumo y la intensidad de la adicción de doce tipos de sustancias o conductas adictivas. Los resultados de la aplicación de la EASP a una muestra de 105 sujetos psicóticos sugieren unas buenas características psicométricas, así como la independencia de la adictividad respecto a otras dimensiones clínicas. (AU)

Models of dual pathology habitually consider substance-use disorders (SUD) and the rest of mental disorders as two pathological conditions coincident in a same person. This study adopts a different point of view and accept adictivity as the nineth clinical dimension in the psychotic disorders to be added to hallucinations, delusion, disorganised speech, abnormal psychomotor behaviour, negative symptoms, cognitive deficit, depression, and mania. In the last term, all of them seems to derive from a common fronto-subcortical disfunction with dopaminergic, glutamatergic and gabaergic implication. The Addictiveness in the Psychotic Syndrome Assessment Scale (APSAS) is presented. It wants to be an integrated and easy to use tool for evaluating adictivity in the psychotic disorders. It is based in data collected with respect of first use, length of use, last use, frequency of use and addiction intensity regarding twelve types of substances or addictive behaviours. Results of the application of APSAS on a sample of 105 psychotic subjects suggest good psychometric characteristics as well as the independency of adictivity respect with other clinical dimensions. (AU)

Addictiveness: an independent dimension in the psychotic syndrome. Presentation of the Addictiveness in the Psychotic Syndrome Assessment Scale (APSAS) / Adictividad: una dimensión independiente en el síndrome psicótico. Presentación de la Escala de Evaluación de la Adictividad en el Síndrome Psicótico (EASP)

Models of dual pathology habitually consider substance-use disorders (SUD) and the rest of mental disorders as two pathological conditions coincident in a same person. This study adopts a different point of view and accept adictivity as the nineth clinical dimension in the psychotic disorders to be added to hallucinations, delusion, disorganised speech, abnormal psychomotor behaviour, negative symptoms, cognitive deficit, depression, and mania. In the last term, all of them seems to derive from a common fronto-subcortical disfunction with dopaminergic, glutamatergic and gabaergic implication. The Addictiveness in the Psychotic Syndrome Assessment Scale (APSAS) is presented. It wants to be an integrated and easy to use tool for evaluating adictivity in the psychotic disorders. It is based in data collected with respect of first use, length of use, last use, frequency of use and addiction intensity regarding twelve types of substances or addictive behaviours. Results of the application of APSAS on a sample of 105 psychotic subjects suggest good psychometric characteristics as well as the independency of adictivity respect with other clinical dimensions. (AU)

Los modelos de patología dual suelen considerar a los trastornos por uso de sustancias (TUS) y al resto de trastornos mentales como dos entidades nosológicas que coinciden en una misma persona. Este estudio adopta un punto de partida diferente y estima que la adictividad sería una novena dimensión clínica independiente en los trastornos psicóticos, que se añadiría a las de alucinaciones, delirio, habla desorganizada, conducta psicomotriz anormal, síntomas negativos, déficit cognitivo, depresión y manía. Todas ellas derivarían, en último término, de una disfunción fronto-subcortical común con implicación dopaminérgica, glutamatérgica y gabaérgica. Se presenta la Escala de Evaluación de la Adictividad en el Síndrome Psicótico (EASP), que busca ser un instrumento integrado y sencillo para la evaluación de la adictividad en los trastornos psicóticos. Se basa en la recogida de datos sobre el primer uso, el tiempo de consumo, el último consumo, la frecuencia de consumo y la intensidad de la adicción de doce tipos de sustancias o conductas adictivas. Los resultados de la aplicación de la EASP a una muestra de 105 sujetos psicóticos sugieren unas buenas características psicométricas, así como la independencia de la adictividad respecto a otras dimensiones clínicas. (AU)

Dual Diagnosis and Application Problems in the Use of the Construct: A Review of Literature.

Dual diagnosis (DD) commonly identifies a condition of co-occurrence of substance use disorders and psychological or psychiatric disorders. Many scholars have tried to explain this phenomenon, yet no agreement has been found: methodologies of intervention and treatment are numerous, but there is no uniformity of methodology. Our work aims to search critical aspects linked to this fragmented framework, to facilitate those who use the construct of DD. We have elaborated a literary review focused on specific critical contributions to the theoretical and methodological complexity of the construct. Scopus, PubMed, and Scholar were used as search engines. Our research reveals significant problems around several thematic areas: Defining, Operative and Treatment; Economic and Policy; Pharmacological Approach; and Patients' Perspectives Issues. Consistent issues are discussed with regard to DD: innovation should start from its limits. Future research should look for alternative theoretical formulations and consequent intervention experiences to provide new perspectives.

Patología dual: drogodependencia y depresión / Dual Diagnosis: Drug Dependence and Depresion

Es muy común encontrar una concurrencia entre patologías debidas al consumo y otras psicopatologías en personas con dependencia a sustancias. Esto se conoce como patología dual. Una de las patologías que más frecuentemente se asocia al consumo, debido a la gran prevalencia en dependencias, es la depresión. En el presente estudio se detallan las características sociales, de consumo y psicológicas de una muestra de 34 participantes internos en la Comunidad Terapéutica de Los Palacios (Sevilla). También se examina la prevalencia y el nivel de depresión de los participantes mediante el Inventario de Depresión de Beck (BDI), y la relación de la puntuación en este test con las características detalladas en el estudio. Los resultados obtenidos en el BDI reflejaron una alta prevalencia de depresión (55'88%) en los participantes. Además, destaca la influencia de las redes de apoyo en el grado de depresión. Esto indica la importancia de un diagnóstico a tiempo para comenzar un tratamiento individualizado y, al mismo tiempo, grupal, debido a la importancia del grupo de apoyo

It is very common to find pathologies due to substance use and another pathologies at the same time in people with substance dependence. This is known as Dual Diagnosis. Depression, due to the high prevalence in dependencies, is one of the most frequently pathologies associated with consumption. This study details the social, consumption and psychological characteristics of a sample of 34 participants which were in internal regimen in the therapeutic community of Los Palacios (Seville). The prevalence and level of depression of the participants are also examined using Beck Depression Inventory (BDI), and the relation between the score of this test and the characteristics detailed in the study. The results achieved in BDI showed a high prevalence of depression (55.88%). In addition, the study shows the influence of support networks on the level of depression. It denotes how important is an early diagnosis to begin individualized and, at the same time, group treatment, due to the importance of the support group

Análisis del polimorfismo rs1051730 de CHRNA3 en pacientes con patología dual en población mexicana / Analysis of polymorphism rs1051730 of CHRNA3 in patients with dual pathology in a Mexican population

Introducción: Estudios epidemiológicos han descrito una alta comorbilidad de los trastornos de uso de sustancias con otro trastorno psiquiátrico, al cual se le ha llamado patología dual. Sin embargo, los mecanismos etiológicos de esta asociación continúan siendo difíciles de entender. Objetivo: Realizar un estudio preliminar del efecto del polimorfismo rs1051730 del grupo de genes CHRNA5-CHRNA3-CHRNB4 a través de un estudio de casos y controles. Sujetos y métodos. Se seleccionó a un total de 225 sujetos, divididos en tres grupos: con diagnóstico de trastorno bipolar, con dependencia a la nicotina y sujetos sin dependencia a la nicotina o cualquier otro trastorno psiquiátrico. La genotipificación se realizó mediante reacción en cadena de la polimerasa en tiempo real. El análisis de asociación genética se realizó mediante pruebas de chi cuadrado y regresiones logísticas multivariables. Resultados: Al comparar las frecuencias alélicas con el grupo control, encontramos que el polimorfismo rs1051730 se asoció con el grupo de dependencia a la nicotina (p = 0,03), pero no con el de trastorno bipolar (p = 0,94). Conclusión: La variante rs1051730 se asoció con dependencia a la nicotina en la población mexicana y mostró el mismo efecto en la patología dual. Sin embargo, se recomiendan estudios adicionales para tener resultados concluyentes

Introduction: Epidemiological studies have described a high comorbidity of substance use disorders with another psychiatric disorder, which has been called dual pathology. However, the aetiological mechanisms underlying this association are still not fully understood. Aim: To carry out a preliminary study of the effect of polymorphism rs1051730 of the gene group CHRNA5-CHRNA3-CHRNB4 through a case-control study. Subjects and methods. A total of 225 subjects were selected and divided into three groups: those diagnosed with bipolar disorder, those with nicotine dependence, and subjects without nicotine dependence or any other psychiatric disorder. Genotyping was performed by real-time polymerase chain reaction. Genetic association analysis was performed using chisquare tests and multivariate logistic regressions. Results: On comparing allelic frequencies with the control group, we found that polymorphism rs1051730 was associated with nicotine dependence (p = 0.03), but not with bipolar disorder (p = 0.94). Conclusion: Variant rs1051730 was associated with nicotine dependence in the Mexican population and showed the same effect in dual pathology. However, further studies are recommended to obtain conclusive results

Criminal offending and associated factors in dual diagnosis patients.

Dual diagnosis patients perpetrate crime more often than healthy individuals. Crime perpetration has major mental health consequences for the victim. Knowledge of factors related to perpetration is needed for the development of prevention programs. However, in dual diagnosis patients, very little is known about factors explaining criminal behavior. The current study investigated cross-sectional associations between demographic and clinical factors and perpetration of three crime types (violence, threat, and property crime) in 243 treatment-seeking dual diagnosis patients. In our sample, perpetration of violence was independently associated with younger age, severity of alcohol use problems, lifetime trauma exposure, and higher manic symptom scores. Expression of threat was independently associated with severity of alcohol use problems and higher manic symptom scores. Perpetration of property crime was independently associated with severity of alcohol and drug use problems. Remarkably, gender was not associated with any type of perpetration. These findings indicate that criminal offending is a significant problem among dual diagnosis patients and are a first step towards understanding the complex causal networks that lead to criminal perpetration. Future longitudinal research should investigate additional risk factors and establish causality to support the development of treatment programs to prevent criminal offending by dual diagnosis patients.

Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: Systematic review and meta-analysis of frequency, correlates, and outcomes.

Comorbid epilepsy and psychogenic nonepileptic seizures (PNES) represent a serious challenge for the clinicians. However, the frequency, associations, and outcomes of dual diagnosis of epilepsy and PNES are unclear. The aim of the review was to determine the frequency, correlates, and outcomes of a dual diagnosis. A systematic review of all published observational studies (from inception to Dec. 2016) was conducted to determine the frequency, correlates, and outcomes of dual diagnosis. We included studies of individuals of any age reporting a dual diagnosis of epilepsy and PNES. All observational study designs were included with the exception of case reports and case series with fewer than 10 participants. The mean frequency of epilepsy in patients with PNES across all studies was 22% (95% confidence intervals [CI] 20 to 25%, range: 0% to 90%) while the mean frequency of PNES in patients with epilepsy was 12% (95% CI 10 to 14%, range: 1% to 62%). High heterogeneity means that these pooled estimates should be viewed with caution. A number of correlates of dual diagnosis were reported. Some studies delineated differences in semiology of seizures in patients with dual diagnosis vs. PNES or epilepsy only. However, most of the correlates were inconclusive. Only a few studies examined outcome in patients with dual diagnosis. Dual diagnosis is common in clinical practice, especially among patients referred to specialized services, and requires careful diagnosis and management.

Uso de sustancias y curso del trastorno bipolar en una muestra de pacientes hospitalizados / Substance use and course of bipolar disorder in an inpatient sample

Introducción. Los pacientes con trastorno bipolar (TB) presentan un consumo de sustancias comórbido con elevada frecuencia. Nuestro estudio pretende establecer una relación entre el consumo de sustancias y el TB, en cuanto a una mayor dificultad diagnóstica, un peor pronóstico y cambios en la prescripción farmacológica. Métodos. La muestra estuvo compuesta por 394 sujetos que a lo largo de veinte años fueron hospitalizados con un diagnóstico de TB en la unidad de agudos de Psiquiatría de un hospital general (10,6% del total de 3704 pacientes ingresados). Las historias clínicas fueron analizadas para obtener datos demográficos, clínicos y relativos al grupo familiar de los sujetos. Resultados. Se obtuvieron datos completos de 319 pacientes. De ellos 165 (51,7%) presentaban antecedentes personales de consumo de sustancias (abuso/dependencia). Este fue más frecuente en hombres (79,7% vs. 34,2%), en menores de 65 años (58,4% vs. 16,7%) y en el TB tipo I respecto al II (55% vs. 35%). Los pacientes consumidores de sustancias presentaban una edad de inicio de la enfermedad más precoz así como más dificultades diagnósticas. Respecto al tratamiento, recibían al alta más estabilizadores del estado de ánimo y más antipsicóticos, así como dosis más elevadas de la mayoría de ellos. Conclusiones. Los casos de patología dual fueron detectados en más de la mitad de la muestra, siendo los más graves y con peor pronóstico, presentando además un debut más temprano de la enfermedad. La asociación TB / consumo de sustancias fue más frecuente en hombres y en menores de 65 años

Introduction. Patients with bipolar disorder (BD) have a comorbid substance use with high frequency. Our study aims to establish a relationship between substance use and BD, in terms of greater diagnostic difficulty, a worse prognosis and changes in pharmacological prescription. Methods. The sample consisted of 394 subjects over twenty years were hospitalized with a diagnosis of BD in acute psychiatry unit of a general hospital (10.6% of total of 3,704 patients). The medical records were analyzed for demographic, clinical and family group relating to data subjects. Results. Complete data were obtained from 319 patients. Of these 165 (51.7%) had a history of drug consumption (abuse/dependence). This was more frequent in men (79.7% vs. 34.2%), in patients under 65 years (58.4% vs. 16.7%) and BD type I compared to type II (55% vs. 35%). Consumers substance patients had an age of onset of the disease earlier and more diagnostic difficulties. Regarding treatment, receiving discharge more mood stabilizers and antipsychotics than nonusers, and higher doses of most of them. Conclusions. The cases of dual pathology were detected in more than half of the sample, being the most serious and poorer prognosis patients, besides presenting a debut earlier disease. BD / substance use association was more common in men and in patients under 65 years

Impact of substance use disorder on gray matter volume in schizophrenia.

Substance use may confound the study of brain structure in schizophrenia. We used voxel-based morphometry (VBM) to examine whether differences in regional gray matter volumes exist between schizophrenia patients with (n = 92) and without (n = 66) clinically significant cannabis and/or alcohol use histories compared to 88 healthy control subjects. Relative to controls, patients with schizophrenia had reduced gray matter volume in the bilateral precentral gyrus, right medial frontal cortex, right visual cortex, right occipital pole, right thalamus, bilateral amygdala, and bilateral cerebellum regardless of substance use history. Within these regions, we found no volume differences between patients with schizophrenia and a history of cannabis and/or alcohol compared to patients with schizophrenia without a clinically significant substance use history. Our data support the idea that a clinically meaningful history of alcohol or cannabis use does not significantly compound the gray matter deficits associated with schizophrenia.

The role of dual diagnosis in health-related quality of life among treatment-seeking patients in Spain.

PURPOSE: The comorbidity of any substance use disorder and another mental disorder is defined as dual diagnosis. Dual diagnosis is very common and clinical and therapeutic consequences have been described. This cross-sectional study aimed to analyse health-related quality of life (HRQoL) according to clinical characteristics and psychiatric comorbidities in patients with substance dependence. METHODS: A total of 1276 substance-dependent patients seeking treatment were recruited. HRQoL was evaluated by the Short-Form 36 (SF-36) questionnaire. The SCID-I, SCID-II and Conners' adult ADHD diagnostic interview were used to evaluate dual diagnosis. A visual analogue scale was used to measure craving. Bivariate and multivariate analyses were performed, and correction for multiple tests was conducted. RESULTS: Substance-dependent patients had impaired quality of life, especially in the mental component. SF-36 physical and mental component scores were 47.7 ± 10.9 and 36.1 ± 14.1, respectively. Furthermore, 65% of the patients had dual diagnosis, 51% had an Axis I DSM-IV-TR mental disorder and 35% had some personality disorder. Impaired physical quality of life was independently associated with medical condition, age, being female, depressive disorder and anxiety disorder. Depression disorder, any personality disorder, active consumption last month, Attention deficit hyperactivity disorder, anxiety disorder, suicide attempt were independently associated with worse mental quality of life. CONCLUSION: These findings emphasize the significance of dual diagnosis in the impairment of HRQoL in substance-dependent patients, particularly with regard to mental component. In addicted patients with low scores on SF-36, psychiatric comorbidity should be evaluated and treated in an integrated approach.

Executive control in schizophrenia: a preliminary study on the moderating role of COMT Val158Met for comorbid alcohol and substance use disorders.

BACKGROUND: A functional polymorphism in the catechol-O-methyltransferase (COMT) gene (Val158Met) appears to influence cognition in people with alcohol/substance use disorders (AUD/SUD) and in those with psychosis. METHODS: To explore the potential moderating effect of these factors, a cross-sectional study was conducted, randomly recruiting subjects with DSM-IV diagnosis of schizophrenia. AUD/SUD was rigorously assessed, as well as COMT Val158Met polymorphism. Executive control functioning was measured using the Intra-Extra Dimensional Set Shift (IED). The effect of a possible interaction between comorbid AUD/SUD and COMT Val158Met polymorphism on IED scores was explored. RESULTS: Subjects with schizophrenia, comorbid AUD/SUD, and MetMet carriers for SNP rs4680 of the COMT gene showed worse performance on IED completed stages scores, as compared with individuals with ValVal genotype. However, among subjects without AUD/SUD, those with the MetMet variant performed better than people carrying ValVal genotype. CONCLUSIONS: This study is the first to date examining the impact of COMT on cognition in a highly representative sample of people with schizophrenia and comorbid AUD/SUD. Differential moderating effects of COMT Val/Met genotype variations may similarly influence executive functions in people with schizophrenia and comorbid AUD/SUD.

El diagnóstico de la psicosis en adultos con trastornos del espectro autista / Diagnosing psychosis in adults with autism spectrum disorders

Existe cierta controversia en el diagnóstico diferencial de dos entidades aparentemente bien delimitadas como son la psicosis y el autismo, especialmente cuando se trata de población adulta. Se presentan tres casos de pacientes en edad adulta que fueron atendidos en una unidad de internamiento breve y en los que se evidenció la presencia de un posible trastorno del espectro autista de base. En la evaluación de la presencia de un trastorno psicótico en el autismo se debe atender a las características particulares de cada diagnóstico. El pensamiento rígido y el discurso idiosincrásico del paciente con autismo pueden confundirse respectivamente con la convicción delirante y la desorganización típicas de la esquizofrenia. Un análisis exhaustivo de la historia evolutiva del paciente es imprescindible para el diagnóstico diferencial. Se hace necesaria una mayor investigación sobre la comorbilidad entre ambos trastornos (AU)

There is some controversy in the differential diagnosis of two apparently distinct entities such as psychosis and autism, especially when it comes to adult population. We present three cases of adult patients who were seen in a brief hospitalization unit and where the presence of a possible autism spectrum disorder was evident. In assessing the presence of a psychotic disorder in autism must be addressed the particular characteristics of each diagnosis. Rigid thinking and idiosyncratic speech in the autistic patient may respectively be confused with the typical delusional conviction and disorganization of schizophrenia. An exhaustive analysis of the developmental history of the patient is essential for differential diagnosis. More research on the comorbidity between the two disorders is necessary (AU)

Mielinólisis central pontina inducida por antipsicóticos en un sujeto con hiperplasia suprarrenal congénita / Antypsychotic-induced central pontine myelinolysis in a congenital adrenal hyperplasia subjec

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Mental disorder comorbidity and treatment utilization.

OBJECTIVE: Effective interventions have been developed for myriad common psychological and substance use disorders, though they remain highly underutilized. Previous research has shown that the likelihood of treatment utilization varies across disorder diagnosis. However, studies that focus on individual disorders have resulted in a large, piecemeal literature that neglects the high rates of multivariate comorbidity. The current study investigated the association between treatment utilization and transdiagnostic comorbidity factors. METHODS: In a nationally representative sample of the United States adult population (N=34,653), we applied the internalizing-externalizing latent comorbidity model to examine its association with lifetime utilization of various treatments for mood, anxiety, and substance use disorders. RESULTS: Both internalizing and externalizing transdiagnostic factors were positively associated with all forms of treatment utilization. Stronger within-domain domain (e.g., internalizing's association with mood or anxiety treatment) than between-domain (e.g., internalizing's association with substance use disorder treatment) associations were found. Significant antagonistic internalizing-by-externalizing interactions were also observed. CONCLUSIONS: These results underscore the importance of applying a nuanced approach to modeling comorbidity when predicting treatment utilization. Clinical implications are discussed.

No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder.

Prior reviews of behavioral treatments for individuals with comorbid alcohol and drug use disorders (substance use disorder SUD) and posttraumatic stress disorder (PTSD) have not systematically considered whether comparison conditions are matched to target treatments on time and attention. A systematic literature search using PubMed MESH terms for alcohol and substance use disorders, PTSD, and treatment identified relevant behavioral randomized clinical trials (RCTs) that evaluated PTSD-oriented exposure-based treatments, addiction-focused treatments, and coping-based treatments that do not involve exposure to trauma memories. Information pertaining to within-subject changes over time and between-subject differences, quality of control condition, recruitment efficiency, and assessment and treatment retention was synthesized. Alcohol and drug outcomes were described separately when possible. Twenty-four behavioral RCTs were identified: 7 exposure based, 6 addiction focused, and 11 coping based. Seven studies included SUD intervention comparison conditions matched to the target intervention on time and attention. Most of the 24 studies found that participants in both the experimental and control conditions improved significantly over time on SUD and PTSD outcomes. No study found significant between-group differences in both SUD and PTSD outcomes favoring the experimental treatment. Despite greater treatment dropout, there was greater improvement in some PTSD outcomes for exposure-based interventions than the control conditions, including when the control conditions were matched for time and attention. Addiction-focused and coping-based interventions did not generally show an advantage over comparably robust controls, although some coping-based interventions yielded better drug use outcomes than control conditions. When available, interventions that integrate exposure-based PTSD treatment and behavioral SUD treatment are recommended as they are associated with better PTSD outcomes than SUD care matched for time and attention. However, the results of this critical review also suggest that people with SUD/PTSD can benefit from a variety of treatment options, including standard SUD care.

La carga familiar de los cuidadores de personas jóvenes y adultas diagnosticadas de discapacidad intelectual y trastorno mental: una revisión sistemática / The family burden of caregivers of young and adult people diagnosed with intellectual disability and mental disorders: a systematic review

El presente artículo recoge y analiza la información publicada sobre la carga familiar en cuidadores de personas jóvenes y adultas diagnosticadas de discapacidad intelectual y trastorno mental asociado. El objetivo del presente trabajo es recopilar y promover la investigación sobre dicha temática. Se han seleccionado los estudios existentes en referencia a los factores que contribuyen a una mayor carga familiar, como son las variables clínicas y diagnósticas, los factores psicológicos y sociales, así como los factores facilitadores encaminados a reducir la carga familiar. La búsqueda bibliográfica se realizó en las bases de datos MEDLINE, PsycINFO, Social Services Abstracts y PSICODOC con los siguientes términos: discapacidad intelectual, trastorno mental, carga familiar y adultos. Se encontró un total de 99 estudios, de los cuales se seleccionaron 8 para su revisión. Los resultados evidencian que la carga familiar es más prevalente cuando se asocia con la comorbilidad entre discapacidad intelectual y trastorno psiquiátrico. Además, el impacto familiar tiene como consecuencia repercusiones emocionales, psicológicas, sociales y de salud en los cuidadores. Los estudios analizados enfatizan la necesidad de futuros estudios para ampliar la investigación tanto a nivel clínico y diagnóstico, para priorizar una detección precoz y un tratamiento adecuado, como a nivel psicosocial, con el fin de identificar las necesidades y el apoyo necesario para reducir la carga familiar global percibida por los cuidadores (AU)

This paper collects and analyses the published information on the family burden of caregivers of young and adult people with intellectual disability and mental disorders. The aim of this study is to compile and promote research into this subject. A selection has been made of existing studies that refer to the factors that contribute to a greater family burden, such as clinical and diagnostic variables, psychological and social factors, as well as those factors that tend to reduce the family burden. A bibliographic research has been carried out in the databases MEDLINE, PsycINFO, Social Services Abstracts and PSICODOC bases using the following terms: intellectual disability, mental disorder, family burden, and adult. A total of 99 studies were found, 8 of which were selected for review. The results demonstrate that the family burden is more prevalent when it is associated with comorbidity between intellectual disability and psychiatric disorder. Moreover the family burden has emotional, psychological, social, and health repercussions on the caregivers. The analysed studies emphasise the need of further research in order to broaden the investigation at a clinical and diagnostic level, so that early detection and appropriate treatment are prioritised. This should also be at a psychosocial level, which would help to identify the needs and the support aimed at reducing the overall family burden perceived by the caregivers (AU)

Outcome of patients with dual diagnosis in secondary psychiatric care.

BACKGROUND: Dual diagnosis (DD) is a common co-morbidity of mental illness and substance use disorder (SUD) and patients with DD are prone to complications. Better knowledge on the outcome, mortality and management of patients with DD in usual secondary psychiatric care would help to inform improved treatment strategies in the future. AIMS: To explore the functional outcome and mortality of patients with DD receiving psychiatric treatment. To assess the recognition of substance use disorders (SUDs) in terms of diagnosis, and the associations of clinically diagnosed SUDs with treatment-related variables. METHODS: The sample of 330 patients was collected by screening all currently treated patients with the Alcohol Use Disorders Identification Test (AUDIT) and a question about other substances used. The inclusion criteria were AUDIT >7 and/or reported use of other substances during the preceding 12 months. The Global Assessment of Functioning scale was used to assess functional outcomes during a 2-year follow-up. Information concerning treatment and patient characteristics was collected retrospectively. RESULTS: Level of functioning remained stable among all study patients during follow-up. The mortality rate was not increased. Effective medication use was associated with improved functional outcomes. SUDs were underdiagnosed. A clinically diagnosed SUD seemed to have an impact on the regularity of appointments and the doses of prescribed medications. CONCLUSIONS: Given our results suggesting a stable level of functioning, patients with DD appear to be well managed within secondary psychiatric care. Attention should be paid to more precise diagnostics of SUDs and to effective use of medication.

Negativismo, ansiedad y retraimiento social como predictores de la sintomatología del déficit de atención con Hiperactividad / Negativity, anxiety and social withdrawal as predictors of symptoms of attention deficit hyperactivity disorder

Se analiza la capacidad predictora de la ansiedad, la socialización, la autoestima y el negativismo respecto a los déficit de atención e hiperactividad, considerando en primer lugar, población normal y, posteriormente, individuos con sospecha de déficit de atención con hiperactividad (TDAH). Han participado 259 niños (M=13,05; DT=1,92) y 241 niñas (M=12,90; DT=2,04). Se han diferenciado dos grupos a partir de la información aportada por los profesores a través de la "Escala para la evaluación del TDAH" (ADHD Rating Scale-IV; DuPaul, Power, Anastopoulos y Reid, 1998). Los resultados muestran índices de varianza explicada entre el 33,5%, F(6, 349)= 30,854; p= 0,008, de la puntuación en inatención y el 45,2%, F(3,102)= 29,901; p= 0,008, en sintomatología combinada. Destacan síntomas de negativismo, ansiedad estado y retraimiento social, como las variables más relevantes con tendencia a incrementar las puntuaciones en inatención e impulsividad. La autoestima escolar y consideración con los demás resultan las principales variables moderadoras de la sintomatología hiperactiva

Predictive ability of anxiety, socialization, self-esteem and negativism for attentional deficiencies and hyperactivity was analyzed, considering firstly a normal population and then individuals with suspected attentiondeficit/ hyperactivity disorder (ADHD). 259 children (M= 13.05, SD= 1.92) and 241 girls (M= 12.90, SD= 2.04) have participated in this study. Two groups have been differentiated from the information provided by teachers through the ADHD Rating Scale-IV (DuPaul, Power, Anastopoulos y Reid, 1998). The results show variance explained rates between 33.5%, F(6, 349)= 30.854, p= 008, inattention score and 45.2%, F(3,102)= 29.901, p= .008, combined symptoms. Symptoms of negativism, state anxiety and social withdrawal stand out, as the most relevant variables that tend to increase scores on inattention and impulsivity. The school esteem and consideration to others are the main moderating variables of overactive symptoms

Terapia dialéctica conductual para un caso de adicción a la cocaína / Behavioral dialectic therapy for a case of cocaine dependent disorder

El objetivo de este trabajo es describir y analizar la aplicación de la TDC en un cliente con adicción a la cocaína. Luis acude por problemas familiares. Consume continuadamente cocaína durante 10 años, además de alcohol, tabaco y conductas de ludopatía. Muestra dificultades emocionales, en control de impulsos, en tolerancia a la frustración y un deterioro de las áreas vitales. La desregulación emocional y la escasa tolerancia a la frustración presentes en el patrón de adicción a la cocaína han propiciado que se aplique la terapia dialéctica conductual (TDC). Se aplicó un programa de entrenamiento de habilidades TDC durante 12 meses, tanto individual y grupal. Se realizan seguimientos a los 12 y 24 meses. El paciente se mantuvo abstinente a lo largo de los 12 meses de tratamiento y a los 12 y 24 meses de seguimiento. Se redujo la sintomatológica general, aumento las actividades alternativas al consumo y se alcanzó una mayor aceptación y regulación de los estados emocionales. La TDC resulto ser una terapia adecuada para tratar la adicción a la cocaína a largo plazo de Luis, debido a que propicio la abstinencia, facilito la regulación emocional y genero una vida alternativa al consumo

The aim of the current study is to describe and analyze the application of the TDC in a client with cocaine addiction. Luis comes for consultation because of family problems. Cocaine use has continued for 10 years, in addition to alcohol, smoking and gambling behavior. He suffers emotional difficulties, impulsivity problems, poor distress tolerance and deterioration of main areas in his life. The emotional dysregulation and low distress tolerance skill, as central dimensions in cocaine disorder, have led to the application of dialectical behavior therapy (DBT). A DBT skills training program has been applied for 12 months, both individually and in group. There has been 12- and 24-month follow-up. The patient has presented continuous abstinence for 12 months of treatment and at 12- and 24- month follow-up. Also, he showed a general symptomatic reduction, increased alternative activities to consumption and a greater acceptance and a better regulation of emotional states. The TDC is presented as an appropriate long-term treatment for the cocaine addiction of Luis, as it helps him to maintain abstinence, provides him a better emotional regulation and generates an alternative life against consumption