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Hetland J, Lundervold AJ, Erga AH. Cognitive impairment as a predictor of long-term psychological distress in patients with polysubstance use disorders: a prospective longitudinal cohort study. BMC Psychiatry 2024; 24:143. [PMID: 38378466 PMCID: PMC10880353 DOI: 10.1186/s12888-024-05600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The association between polysubstance use disorder (pSUD), mental illness, and cognitive impairments is well established and linked to negative outcomes in substance use disorder treatment. However, it remains unclear whether cognitive impairment predicts long-term psychological distress among treatment seeking patients with pSUD. This study aimed to investigate the associations and predictive ability of cognitive impairment on psychological distress one and 5 years after treatment initiation. METHODS N = 164 treatment seeking patients with pSUD were sampled at treatment initiation. We examined associations between cognitive impairment according to Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) administered at treatment initiation and psychological distress defined by the Symptom Check List-90-Revised (SCL-90-R) at treatment initiation, one and five years later. We ran hierarchical logistic regressions to assess the predictive ability of the respective cognitive instruments administered at treatment initiation on psychological distress measured one and five years later including psychological distress at treatment initiation and substance intake at the time-points of the measurements as covariates. RESULTS The main results was that MoCA® and BRIEF-A predicted psychological distress at years one and five, but BRIEF-A lost predictive power when accounting for psychological distress at treatment initiation. WASI predicted psychological distress at year one, but not at year five. CONCLUSIONS Results from MoCA® and WASI was found to be less sensitive to the effect of psychological distress than BRIEF-A. Cognitive impairment at treatment initiation may hold predictive value on later psychological distress, yet its clinical utility is uncertain.
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Affiliation(s)
- Jens Hetland
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Aleksander H Erga
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Institute of Social Sciences, University of Stavanger, Stavanger, Norway
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Miguel N, Marquez-Arrico JE, Jodar M, Navarro JF, Adan A. Neuropsychological functioning of patients with major depression or bipolar disorder comorbid to substance use disorders: A systematic review. Eur Neuropsychopharmacol 2023; 75:41-58. [PMID: 37453267 DOI: 10.1016/j.euroneuro.2023.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Major depression disorder (MDD) and bipolar disorder (BD) are usual comorbidities in patients with substance use disorders (SUD), a condition known as dual disorder (DD). MDD, BD and SUD are associated with cognitive impairment, potentially leading to a greater functional impairment in the context of DD. OBJECTIVES To review the existing data on the cognitive impairment in DD patients with comorbid MDD or BD, considering the influence of the depressive symptomatology. METHODS Following the PRISMA protocol 19 studies were selected from the last 17 years, 13 of which focused on BD, five on MDD and one included both diagnoses. RESULTS Studies based in BD+SUD showed that the most affected cognitive domains were attention and executive functions, but not all of them found a greater impairment due to the comorbidity. While fewer studies were found for depression, MDD+SUD works point to a similar impairment cognitive pattern. Furthermore, depression improvement could be associated to better cognitive performance. LIMITATIONS More standardized research is needed regarding the influence of depression on cognitive performance of DD patients, especially on those with comorbid MDD. Factors such as main substance, abstinence, or MDD/BD-related variables should be considered. Unstudied factors, like gender or circadian rhythms, are proposed to improve knowledge in this area. CONCLUSIONS Current studies suggest that DD could potentiate cognitive impairment in BD, MDD and SUD. However, additional research is needed to improve the understanding of comorbidity to apply more individualized therapies in the treatment of these patients, considering the interference of their neurocognitive functioning.
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Affiliation(s)
- Nuria Miguel
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain
| | - Julia E Marquez-Arrico
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain; Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Spain
| | - Mercè Jodar
- Neurology Service, Hospital Universitari Parc Taulí, Sabadell, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud mental (CIBERSAM), Instituto de salud Carlos III, Madrid, Spain
| | | | - Ana Adan
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain; Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Spain.
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Cuartas-Arias M. Exploring Dual Pathology: Opportunities and Challenges. Int J Psychol Res (Medellin) 2023; 16:1-4. [PMID: 37545652 PMCID: PMC10402640 DOI: 10.21500/20112084.6405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Exploring Dual Pathology: Opportunities and Challenges
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Affiliation(s)
- Mauricio Cuartas-Arias
- Department of Psychology, School of Arts and Humanities, Universidad EAFIT. Medellín, Colombia.Universidad EAFITDepartment of Psychology, School of Arts and HumanitiesUniversidad EAFITMedellínColombia
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Adan A, Navarro JF. Protocol for Characterization of Addiction and Dual Disorders: Effectiveness of Coadjuvant Chronotherapy in Patients with Partial Response. J Clin Med 2022; 11:1846. [PMID: 35407454 PMCID: PMC8999756 DOI: 10.3390/jcm11071846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/04/2022] Open
Abstract
This protocol aims to characterize patients with dual disorders (DD; comorbid major depression and schizophrenia) compared with patients with only a diagnosis of substance use disorder (SUD) and those with only a diagnosis of severe mental illness (SMI; major depression and schizophrenia), evaluating clinical and personality characteristics, circadian rhythmic functioning, genetic polymorphism and neuropsychological performance in order to obtain a clinical endophenotype of differential vulnerability for these diagnostic entities. Patients will be divided into three groups: DD (45 men with comorbid schizophrenia, 45 men and 30 women with major depression), SUD (n = 90, with a minimum of 30 women) and SMI males (45 with schizophrenia, 45 with major depression). All patients will be under treatment, with at least three months of SUD abstinence and/or with SMI in remission or with stabilized symptoms. Outpatients of both sexes with insufficient restoration of circadian rhythmicity with SUD (n = 30) and dual depression (n = 30) will be asked to participate in a second two-month study, being alternately assigned to the condition of the chronobiological adjuvant approach to the treatment of regular hour habits and exposure to light or to the usual treatment (control). The effect of the intervention and patient compliance will be monitored with a Kronowise KW6® ambulatory device during the first two weeks of treatment and again at weeks 4 and 8 weeks. After completing the evaluation, follow-up of the clinical evolution will be carried out at 3, 6 and 12 months. This project will allow us to analyze the functional impact of DD comorbidity and to develop the first study of chronobiological therapy in the treatment of SUD and dual depression, with results transferable to the clinical setting with cost-effective recommendations for a personalized approach.
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Affiliation(s)
- Ana Adan
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d’Hebrón 171, 08035 Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, 08035 Barcelona, Spain
| | - José Francisco Navarro
- Department of Psychobiology, School of Psychology, University of Málaga, Campus de Teatinos s/n, 29071 Málaga, Spain;
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Rezapour T, Hatami J, Farhoudian A, Noroozi A, Daneshmand R, Sofuoglu M, Baldacchino A, Ekhtiari H. Baseline executive functions and receiving cognitive rehabilitation can predict treatment response in people with opioid use disorder. J Subst Abuse Treat 2021; 131:108558. [PMID: 34366202 DOI: 10.1016/j.jsat.2021.108558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Impaired cognitive functions, particularly executive function, predicts poor treatment success in people with substance use disorders. The current study investigated the effect of receiving adjunct cognitive rehabilitation and baseline executive function (EF) measures on treatment response among people with opioid use disorder (OUD). METHOD The analysis sample consisted of 113 participants with OUD who were discharged from a compulsory court-mandated methadone maintenance treatment (MMT) and followed for 3 months. We used the Backward digit span/Auditory verbal learning, Stroop, and Trail making tests to assess the three measures of EF, including working memory, inhibition, and shifting, respectively. Treatment response was operationalized as (1) treatment retention and (2) the number of positive urine tests for morphine during 3-month follow-up periods. The study used Cox's proportional hazards model and linear mixed model to identify predictive factors. RESULTS Lower Stroop interference scores predicted increased length of stay in treatment (χ2 = 33.15, P < 0.001). The linear mixed model showed that scores on auditory verbal learning test and group intervention predicted the number of positive urine tests during a 3-month follow-up. CONCLUSION Working memory and inhibitory control, as well as receiving cognitive rehabilitation, could be potentially considered as predictors of treatment response for newly MMT admitted patients with OUD. Assessment of EF before treatment initiation may inform treatment providers about patient's cognitive deficits that may interfere with therapeutic interventions.
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Affiliation(s)
- Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Javad Hatami
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Daneshmand
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Alex Baldacchino
- University of St Andrews, School of Medicine, Division of Population and Behavioral Sciences, St Andrews, Scotland, UK
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA.
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Dugmore L, Bauweraerts S. When policy fails try something different integrated practice improve outcomes for dual diagnosis co-occurring service users accessing mental health services. DRUGS AND ALCOHOL TODAY 2021. [DOI: 10.1108/dat-06-2020-0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings.
Design/methodology/approach
In clinical practice, shared treatment has proved challenging in light of different service models (Laker, 2006). Substance misuse works on the premise of change comes from the individual, where recovery models in mental health offer a formalised approach. One of the challenges faced by services has been the inability for mental health services to recruit and services become overstretched (Rimmer, 2018); this gave an opportunity for a new method of working to be considered. This led to the development of a new service model.
These changes were:
• Improving the interface with substance misuse services to improve access to community substance misuse services for mental health clients.
• To provide specialist staff within the dual diagnosis field to provide a clinic jointly with local drug and alcohol services.
• Introduction of substance misuse workers as team members on acute mental health and rehab wards.
• Group Substance Misuse programmes.
Findings
Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group.The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge.For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances.
Originality/value
Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups.
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Beerten-Duijkers JC, Vissers CT, Rinck M, Egger JI. Self-Regulation in Dual Diagnosis: A Multi-Method Approach of Self-Awareness, Error-Monitoring and Emotional Distress. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Self-regulatory actions direct the achievement of life goals. Awareness of one's state is needed to adequately self-regulate one's life. Methods: The self-regulatory actions of (cognitive/emotional) self-awareness and (error-)monitoring were assessed in patients with Dual Diagnosis and healthy controls. A multi-method approach was applied. Results: Patients with Dual Diagnosis reported lower capacity to identify, verbalize and interpret emotions in a cognitive manner. Both groups reported experiencing arousal of emotions, but patients showed less cognitive elaboration on them and they reported more negatively labeled emotions. Patients with Dual Diagnosis signaled errors less adequately, but did not differ in the number of errors. Discussion: The abundance of negative emotions may overwhelm patients and trigger substance use to handle this negativity. Especially because they do in fact experience the arousal of emotions, but they find it harder to timely identify, interpret and verbalize these emotions. Training self-awareness and emotion regulation may be beneficial.
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9
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Beerten-Duijkers JCLM, Vissers CTWM, Rinck M, Egger JIM. Inhibitory Control and Craving in Dual Disorders and Recurrent Substance Use. Preliminary Findings. Front Psychiatry 2021; 12:569817. [PMID: 33613336 PMCID: PMC7886692 DOI: 10.3389/fpsyt.2021.569817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: In Dual Disorders (DD), which involves the co-occurrence of a disorder in substance use and a mental disorder, recurrent struggles with addictive behavior are frequent. Neuropsychological knowledge concerning the profile of inhibitory control and the irresistible urge to use substances (craving) within the DD patient group may contribute to the prevention of this recurrent addictive behavior. Methods: Inhibitory control and craving were assessed in 25 patients with DD and 25 healthy controls (HC). Inhibitory control tasks (Go/No-go task and Stop Signal Task) were performed combined with brain measurements (Event Related Potentials) mapping inhibitory control. Moreover, implicit and explicit measures concerning craving were administered. Statistical DD and HC comparisons, correlational and regression analyses on exploratory base were conducted. Results: DD patients committed more inhibitory control errors than HC when confronted with (alcohol) consumption-related picture stimuli. Furthermore, patients with DD showed higher levels of implicit and explicit craving. The number of inhibitory control errors was positively related to levels of implicit and explicit craving. Moreover, explicit craving and impulsivity (as a dimension of inhibitory control) predicted the severity of addictive behavior. Event Related Potential analyses did not show differences in inhibitory control-associated brain activity between DD patients and HC; both groups showed reduction of P300 amplitudes in response to alcohol pictures. Conclusions: Impulsivity and craving are elevated in DD patients and show predictive value for the severity of addictive behavior. One's level of impulsive action tendency may trigger less effort to control (recurrent) substance use. The findings may contribute to existing DD treatment indications by the promotion of impulse control training via "stop-think-act" methods for DD patients.
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Affiliation(s)
- Judith C L M Beerten-Duijkers
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands.,Centre of Excellence for Korsakoff and Alcohol Related Cognitive Dysfunctions/Addiction Care, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands
| | - Constance Th W M Vissers
- Kentalis Academy, Royal Dutch Kentalis, Sint-Michielsgestel, Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jos I M Egger
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands.,Centre of Excellence for Korsakoff and Alcohol Related Cognitive Dysfunctions/Addiction Care, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands.,Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands.,Stevig Specialized and Forensic Care for People With Intellectual Disabilities, Dichterbij, Oostrum, Netherlands
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Moraleda-Barreno E, Cáceres Pachón MDP, Lozano ÓM, Pérez Moreno PJ, Lorca Marín JA, Fernández-Calderón F, Díaz Batanero C, Gómez-Bujedo J. Impairments in Executive Functioning in Patients with Comorbid Substance Use and Personality Disorders: A Systematic Review. J Dual Diagn 2021; 17:64-79. [PMID: 33092494 DOI: 10.1080/15504263.2020.1829769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this systematic review was to examine the evidence for impaired executive functioning in patients diagnosed with a dual pathology of personality disorder (PD) and substance use disorder, and to identify whether differences exist in comparison to those with a single diagnosis. Methods: A systematic search was conducted to identify studies using measures of executive functioning in patients with PD-substance use disorder dual pathology. Sixteen studies were selected. Results: The results indicate that dual pathology patients with Cluster C personality disorder do not differ from controls, and that the presence of dual pathology does not influence the updating domain of executive functioning. The findings were inconclusive with regard to dual pathology patients with Cluster B personality disorders. Whilst the various studies consistently show that these patients show worse performance than the control groups, here are contradictory results with regard to whether Cluster B personality disorders add more alterations in executive functioning to those that already appear in substance use disorder. Conclusions: The results suggest the need for further research that more adequately controls variables such as time in treatment, medication, and sample size, whilst there is also a need to employ longitudinal designs that include more patients from Clusters A and C.
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Affiliation(s)
- Enrique Moraleda-Barreno
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | | | - Óscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Pedro J Pérez Moreno
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - José Andrés Lorca Marín
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Carmen Díaz Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Jesús Gómez-Bujedo
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
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Luciana M. Risks versus consequences of adolescent and young adult substance use: A focus on executive control. CURRENT ADDICTION REPORTS 2020; 7:453-463. [PMID: 33816055 PMCID: PMC8014909 DOI: 10.1007/s40429-020-00341-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This review examines the role of executive control processes in the liability for substance misuse and whether substance use, once initiated, leads to subsequent decrements as proposed by neurotoxicity models of substance use disorder (SUD). RECENT FINDINGS As indicated by a number of recent meta-analyses, executive control processes, which include working memory, cognitive flexibility and numerous aspects of attentional, behavioral and emotional control, are impaired in the context of active SUD. Longitudinal studies of behaviorally disinhibited children, individuals with familial risks for SUD, and twins within whom genetic versus environmental influences on behavior can be modeled robustly indicate that relatively poor control is a vulnerability factor for early substance use initiation, binge patterns of use, and subsequent SUD. Evidence of further declines in executive control, once substance use is initiated, is mixed, although a growing number of neuroimaging studies indicate that frontostriatal, frontolimbic, and frontocerebellar systems are altered as a consequence of use. SUMMARY Together these patterns suggest strategies for identifying children and adolescents at high risk for SUD, avenues through which substance-related neurotoxicities can be more reliably detected, and the need to structure prevention efforts in a manner that is developmentally appropriate and perhaps personalized to individual vulnerabilities.
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Affiliation(s)
- Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis MN, 55455 USA
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Lees B, Stapinski LA, Prior K, Sunderland M, Newton N, Baillie A, Teesson M, Mewton L. Exploring the complex inter-relations between internalising symptoms, executive functioning and alcohol use in young adults. Addict Behav 2020; 106:106351. [PMID: 32145497 DOI: 10.1016/j.addbeh.2020.106351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Globally, the prevalence of hazardous drinking peaks in young adulthood, and there is mixed evidence on whether internalising symptoms and executive functioning deficits are associated with this increased risk. This study tested whether internalising symptoms in interaction with executive functioning deficits are associated with high alcohol use disorder symptoms in emerging adulthood, via drinking motives to cope with negative affect and alcohol consumption. METHOD An Australian sample of 155 young adults aged 17 to 24 years (M = 20.97, SD = 2.40) provided self-report data on internalising symptom severity and alcohol-related outcomes (n = 155), and neuropsychological data measuring executive functioning (n = 104). Confirmatory factor analyses were conducted to identify two latent variables representing internalising symptoms and executive functions. A series of latent moderated structural equation models and a latent mediated moderation structural equation model examined the inter-relations between internalising symptoms, executive functions and alcohol measures. RESULTS High levels of internalising symptoms in interaction with executive functioning deficits were associated with strong drinking motives to cope with negative affect, high past month alcohol consumption and greater alcohol use disorder symptoms. Drinking motives to cope with negative affect and alcohol consumption mediated the relationship between the internalising symptoms and executive functioning latent interaction term with alcohol use disorder symptoms. CONCLUSIONS This research highlights greater executive functioning resources are associated with low desires to drink hazardous amounts of alcohol as a maladaptive way to cope with negative feelings among young people. It therefore may be useful to target executive functioning ability alongside internalising symptomology in alcohol prevention and intervention initiatives.
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The association of GABRB2 SNPs with cognitive function in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2020; 270:443-449. [PMID: 30706170 DOI: 10.1007/s00406-019-00985-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/09/2019] [Indexed: 12/21/2022]
Abstract
Cognitive impairment is one of the core symptoms of schizophrenia. Multiple domains of cognition are affected in patients with schizophrenia, which has a major effect on the functional outcome. Recent studies indicate that SNPs in the gamma-aminobutyric acid type A receptor beta 2 subunit (GABRB2) gene are associated with the risk of schizophrenia, however, the effect of these SNPs on cognitive function in patients with schizophrenia has not been explored. In this study, we first performed a case-control analysis of three SNPs (rs187269 allele A vs. G, rs252944 allele C vs. G, and rs194072 allele A vs. G) in 100 patients and 90 controls, then conducted a meta-analysis and found the SNP rs194072 was associated with schizophrenia (OR = 0.86, P = 0.0119), and survived after Bonferroni correction. The haplotype analysis suggested that the haplotype ACA, comprising the three SNPs (rs187269, rs252944 and rs194072) was also significantly associated with schizophrenia (P = 0.049).Then, we performed an association analysis of three SNPs (rs187269, rs252944 and rs194072) in GABRB2 gene with cognitive performance in patients with first episode schizophrenia. We found that the allele G of rs187269 in the GABRB2 gene was significantly associated with better cognitive flexibility (P = 0.005), a major aspect of executive function, in patients with first episode schizophrenia. The haplotype ACA was significantly associated with cognitive flexibility in patients with schizophrenia (P = 0.023). Our study showed that SNPs in GABRB2 may have a significant effect on cognitive function in patients with schizophrenia, suggesting that modulating GABRB2 may have therapeutic potential to improve cognitive function of patients with schizophrenia.
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Neurocognitive Impairment and Personality Traits in Alcohol Addiction: Effect of Dual Pathology. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Beerten-Duijkers JC, Vissers CT, Rinck M, Barkley RA, Egger OI. Self-Directedness Positively Contributes to Resilience and Quality of Life: Findings From a Mixed Psychiatric Sample. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2020. [DOI: 10.1521/jscp.2020.39.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: This study zoomed into the relation between self-regulation, resilience and quality of life (QOL) within a mixed psychiatric sample of patients with Dual-Diagnosis (DD) or an Autism spectrum disorder (ASD). Method: Patients with DD or ASD participated and healthy control (HC) data were present. The Barkley Deficits in Executive Functioning Scale (BDEFS), Shortened Temperament and Character Inventory and Manchester Short Assessment of Quality of Life were administered. Results: The BDEFS revealed more executive problem reporting by DD or ASD patients than by HC. Both patient groups revealed that, the more problems were reported in executive self-regulation (like self-motivation, problem-solving), the lower QOL was experienced. The resilience aspect of self-directedness (goal-directed, responsible attitude) was positively related to higher QOL and to lesser experience of self-motivational and problem-solving problems. But, the more harm-avoidant, the lesser one was self-directed and the more self-motivational and problem-solving problems were reported. Discussion: Self-regulation and harm-avoidance problems were related to lower QOL in DD and ASD. Self-directedness, executive self-motivation and problem-solving predicted higher QOL. Treatment focus on self-directedness, executive self-regulation and resilience is recommended.
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Affiliation(s)
| | - Constance Th.W.M. Vissers
- Kentalis Academy, Royal Dutch Kentalis, Sint-Michielsgestel, The Netherlands Radboud University Nijmegen, The Netherlands
| | - Mike Rinck
- Radboud Univserity Nijmegen, The Netherlands
| | | | - Os I.M. Egger
- Radboud University Nijmegen, The Netherlands Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands JStevig Specialized and Forensic Care for People with Intellectual Disabilities, Dichterbij, Oostrum, The Netherlands
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BEERTEN-DUIJKERS JUDITHCLM, VISSERS CONSTANCETHWM, RINCK MIKE, BARKLEY RUSSELLA, EGGER JOSIM. Dutch translation and adaptation of the Barkley Deficits in Executive Functioning Scale (BDEFS). ARCH CLIN PSYCHIAT 2019. [DOI: 10.1590/0101-60830000000202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - MIKE RINCK
- Radboud University Nijmegen, Netherlands
| | | | - JOS I. M. EGGER
- Radboud University Nijmegen, Netherlands; Vincent van Gogh Institute for Psychiatry, Netherlands; Vincent van Gogh Institute for Psychiatry, Netherlands; Stevig Specialized and Forensic Care for People with Intellectual Disabilities, Netherlands
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Khokhar JY, Todd TP. Behavioral predictors of alcohol drinking in a neurodevelopmental rat model of schizophrenia and co-occurring alcohol use disorder. Schizophr Res 2018; 194:91-97. [PMID: 28285734 PMCID: PMC5591749 DOI: 10.1016/j.schres.2017.02.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 12/31/2022]
Abstract
Alcohol use disorder commonly occurs in patients with schizophrenia and contributes greatly to its morbidity. Unfortunately, the neural and behavioral underpinnings of alcohol drinking in these patients are not well understood. In order to begin to understand the cognitive and reward-related changes that may contribute to alcohol drinking, this study was designed to address: 1) latent inhibition; 2) conditioning; and 3) extinction of autoshaping in a neurodevelopmental rat model with relevance to co-occurring schizophrenia and alcohol use disorders, the neonatal ventral hippocampal lesioned (NVHL) rat. NVHL lesions (or sham surgeries) were performed on post-natal day 7 (PND7) and animals were given brief exposure to alcohol during adolescent (PND 28-42). Latent inhibition of autoshaping, conditioning and extinction were assessed between PND 72-90. On PND90 animals were given alcohol again and allowed to establish stable drinking. Latent inhibition of autoshaping was found to be prolonged in the NVHL rats; the NVHL rats pre-exposed to the lever stimulus were slower to acquire autoshaping than sham pre-exposed rats. NVHL rats that were not pre-exposed to the lever stimulus did not differ during conditioning, but were slower to extinguish conditioned responding compared to sham controls. Finally, the NVHL rats from both groups drank significantly more alcohol than sham rats, and the extent of latent inhibition predicted future alcohol intake in the pre-exposed animals. These findings suggest that the latent inhibition of autoshaping procedure can be used to model cognitive- and reward-related dysfunctions in schizophrenia, and these dysfunctions may contribute to the development of co-occurring alcohol use.
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Affiliation(s)
- Jibran Y Khokhar
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, United States.
| | - Travis P Todd
- Department of Psychological and Brain Sciences, Dartmouth College, United States
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Adan A, Capella MDM, Prat G, Forero DA, López-Vera S, Navarro JF. Executive Functioning in Men with Schizophrenia and Substance Use Disorders. Influence of Lifetime Suicide Attempts. PLoS One 2017; 12:e0169943. [PMID: 28099526 PMCID: PMC5242526 DOI: 10.1371/journal.pone.0169943] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/21/2016] [Indexed: 01/28/2023] Open
Abstract
Background Lifetime suicide attempts in patients with comorbidity between psychotic disorders and Substance Use Disorder (SUD), known as dual diagnosis, was associated with a worse clinical and cognitive state, poor prognosis and premature death. However, to date no previous study has examined the cognitive performance of these patients considering as independent the presence or absence of lifetime suicide attempts. Methods We explore executive functioning differences between suicide attempters and non-attempters in dual schizophrenia (DS) patients and the possible related factors for both executive performance and current suicide risk. Fifty DS male patients in remission of SUD and clinically stables, 24 with and 26 without lifetime suicide attempts, were evaluated. We considered Z scores for all neuropsychological tests and a composite summary score for both premorbid IQ and executive functioning. Results DS patients showed low performance in set-shifting, planning and problem solving tasks. Those with suicide attempts presented lower composite summary scores, together with worse problem solving skills and decision-making, compared with non-attempters. However, after controlling for alcohol dependence, only differences in decision-making remained. Executive functioning was related to the premorbid intelligence quotient, and several clinical variables (duration, severity, months of abstinence and relapses of SUD, global functioning and negative symptoms). A relationship between current suicide risk, and first-degree relatives with SUD, insight and positive symptoms was also found. Conclusions Our results suggest that problem solving and, especially, decision-making tasks might be sensitive to cognitive impairment of DS patients related to presence of lifetime suicide attempts. The assessment of these executive functions and cognitive remediation therapy when necessary could be beneficial for the effectiveness of treatment in patients with DS. However, further research is needed to expand our findings and overcome some limitations of this study.
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Affiliation(s)
- Ana Adan
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Maria Del Mar Capella
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Gemma Prat
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Diego A Forero
- Laboratory of NeuroPsychiatric Genetics, Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño. Bogotá, Colombia
| | - Silvia López-Vera
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
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