The role of personality disorders on drug dependence treatment outcomes following inpatient detoxification

Aims

The present 6 month follow-up study was conducted to investigate the possible influence of comorbid personality disorders on drug treatment, as well as associated psychopathology and HIV-related risk behaviors outcomes.

Subjects and methods

Data were collected initially from a consecutive sample of 74 patients with a diagnosis of opiate abuse or dependence, admitted for inpatient detoxification.

Result

During intake, 80.9% of patients reported at least one HIV-related risk behavior in the previous 6 months. Not using condoms during sexual intercourse was the most common and the only risk behavior that showed a statistically significant reduction over the follow-up period. A total of 58.1% of subjects had at least one personality disorder (PD). Borderline PD was the most prevalent. However, antisocial PD was the only PD that influenced substance use outcomes. The presence of this diagnosis increased the chance of worse opiate use outcomes, but decreased likelihood of not using condoms. Patients with low obsessive–compulsive PD dimensional scores showed a significant increase in the number of risk behaviors. However, these influences were only seen at the 3-month follow-up assessment.

Conclusions

These results suggest that personality disorders need to be considered when planning effective interventions for opiate dependent individuals and when preparing and evaluating HIV risk-reduction interventions, particularly for the more severe substance dependent patients.

Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: cluster randomised controlled trial in primary care

BACKGROUND

Benzodiazepines are extensively used in primary care, but their long-term use is associated with adverse health outcomes and dependence.

AIMS

To analyse the efficacy of two structured interventions in primary care to enable patients to discontinue long-term benzodiazepine use.

METHOD

A multicentre three-arm cluster randomised controlled trial was conducted, with randomisation at general practitioner level (trial registration ISRCTN13024375). A total of 532 patients taking benzodiazepines for at least 6 months participated. After all patients were included, general practitioners were randomly allocated (1:1:1) to usual care, a structured intervention with follow-up visits (SIF) or a structured intervention with written instructions (SIW). The primary end-point was the last month self-declared benzodiazepine discontinuation confirmed by prescription claims at 12 months.

RESULTS

At 12 months, 76 of 168 (45%) patients in the SIW group and 86 of 191 (45%) in the SIF group had discontinued benzodiazepine use compared with 26 of 173 (15%) in the control group. After adjusting by cluster, the relative risks for benzodiazepine discontinuation were 3.01 (95% CI 2.03-4.46, P<0.0001) in the SIW and 3.00 (95% CI 2.04-4.40, P<0.0001) in the SIF group. The most frequently reported withdrawal symptoms were insomnia, anxiety and irritability.

CONCLUSIONS

Both interventions led to significant reductions in long-term benzodiazepine use in patients without severe comorbidity. A structured intervention with a written individualised stepped-dose reduction is less time-consuming and as effective in primary care as a more complex intervention involving follow-up visits.

[The role of genetics in the personality and its disorders: a clinical point of view]

The most important bibliography on the role of genetics in personality and its disorders has been reviewed from a clinical point of view. Following the introduction, the most relevant findings on genetics and the personality dimensions are compiled, focusing on Cloninger's Psychobiological Model. Regarding personality disorder, studies have been found on cluster A, mainly related to the schizotypal personality disorder, and on cluster B, mainly related to antisocial personality and borderline disorders. The bibliography on cluster C PD was limited. The review concludes with a discussion that stresses the possible usefulness of personality dimensions, considered as interphenotypes regarding both diagnostic aspects and treatment.

Comorbidity on disorders with loss of impulse-control: pathological gambling, addictions and personality disorders

OBJECTIVES

To analyze the comorbidity of pathological gamblers, mainly in disorders with loss of impulse-control as addictions and personality disorders (PD). Also, to discuss addictive and impulsive characteristics of pathological gambling (PG), and their implications in prognosis and treatment.

MATERIAL AND METHOD

Cross-sectional study on 162 patients with PG admitted for treatment in a specific residential unit. The SCID-I and II were used for the addiction and the PD diagnosis. For the diagnosis and evaluation of PG the SOGS, AGQ III and the Gambling Severity Index were also used.

RESULTS

The 61.1 % of the patients presented some PD, where the cluster B ones (impulsive group) were more frequent, followed by C and A ones. 63.3% of patients had had in their lives substance dependence criteria, where alcohol dependence was the most prevalent. The presence of PD is related to the gravity of the addiction by the dependence to more than one substance (chi2=7.15; p<0.008).

DISCUSSION

TP and substance-related disorders (SRD) are frequent comorbidities of the PG. Their co-presentation could mean worse prognosis of this patients. The PG as impulsive disorder could help to the understanding of the etiopathogenia of this disorder, but also of the prognosis. This hypothesis will add to the addictive one other treatment approaches that should be included in future studies of PG.