Learning and verbal memory: A comparison between patients with alcohol use disorder and major depressive disorder

Brain damage related to alcohol consumption is associated with impairments in cognitive functions, among which memory and verbal learning stand out. The main objective is to evaluate memory and verbal learning in a sample of 111 patients with alcohol use disorder (AUD) versus 78 with major depressive disorder (MDD) and 100 healthy controls. The evaluation included sociodemographic and clinical variables, the Hamilton Depression Scale (HDRS) and the California Verbal Learning Test (CVLT). One-way ANOVA was used for comparisons between the 3 groups and two-way ANCOVAS including different covariates. The one-way ANOVA shows that patients with AUD and MDD had scores similar to each other and lower than those of the control group (p < 0.001), with the exception of the Cued CVLT (worse scores in MDD vs AUD, p < 0.001). After including age, sex and years of completed studies as covariates, the differences between the AUD and MDD groups persisted compared to the control group (p ≤ 0.003) in all indices except for the Immediate Free CVLT and the Cued CVLT (worse performance in MDD vs AUD, p = 0.022 and p = 0.035, respectively). In the second ANCOVA, after controlling for depression severity, differences were only detected between AUD patients and healthy controls (p ≤ 0.007). Patients with AUD present a significant impairment in learning and verbal memory when compared with patients with MDD and with healthy people.

Patients'satisfaction and experience in treatment with opioid substitution therapy in Spain. The PREDEPO study

The aim of this study was to compare patients' satisfaction, experience, objectives, and opinion based on their current opioid substitution therapy (OST) (buprenorphine/naloxone (B/N) or methadone). The PREDEPO study is an observational, cross-sectional, multicentric study performed in Spain. Adult patients diagnosed with opioid use disorder (OUD) receiving OST were included. They were asked to fill in a questionnaire regarding their current OST. A total of 98 patients were enrolled (B/N: 50%, methadone: 50%). Mean age was 47 ± 8 years old and 80% were male. Treatment satisfaction was similar between groups. The most frequently reported factor for being "very/quite satisfied" was "being able to distribute the dose at different times throughout the day" (44% B/N vs. 63% methadone; p = .122). A significantly lower proportion of patients in the B/N group versus the methadone group reported that having to collect the medication daily was "very/quite annoying" (19% vs. 52%, p = .032). Treatment objectives reported by the majority of patients were similar between groups ("not feeling in withdrawal anymore", "reduce/definitely stop drug use", "improve my health", and "stop thinking about using daily") except for "not having money problems anymore" (73% B/N vs. 92% methadone; p = .012).  These results suggest there are several unmet expectations regarding current OST. There is a need for new treatments that reduce the burden of OUD, avoid the need for daily dosing, and are less stigmatizing which in turn could improve patient management, adherence and, quality of life.

Suicide deaths and substance use in the Galician provinces between 2006 and 2020

Background

Suicide is a serious public health problem that affects our entire country, including the Galician provinces. The aim of this research was to study the variation in completed suicide rates, between 2006 and 2020, in the different Galician provinces and their relationship with the consumption of addictive substances.

Methods

Completed suicide data from the Spanish Office for National Statistics and the Institute of Legal Medicine of Galicia were analyzed with a Joinpoint regression model to determine time trends. The relationship between the variation in completed suicide rates with sociodemographic variables obtained from the Spanish Office for National Statistics and variables related to the consumption of substances obtained from the survey on alcohol and other drugs in Spain (EDADES) of the Government Delegation for the National Plan on Drugs was also analyzed.

Results

The Joinpoint regression model did not reveal any point of significant change in the period studied for any Galician province. The following variables correlated positively with the variation in completed suicide rates in the Galician provinces: masculinity ratio, average age, daily alcohol consumption and daily illegal substance consumption.

Conclusion

Applying preventive strategies on the daily consumption of alcohol and illegal substances would help reduce the rates of completed suicide in the Galician provinces.

Mortality in patients addicted to opioids across 30-year follow-up

The maintenance of premature mortality among opioid users is a highly significant public health issue. The main objective is to study the causes and age of mortality recorded in the population of opiate addicts (n = 1,998) treated at the Cangas Drug Addiction Assistance Unit (Pontevedra) over more than 30 years. The causes of mortality are classified into 4 groups: overdose, disease, suicide and trauma. The average age of mortality of the patients is compared with that of the general population residing in the same health area. Throughout the study, the premature mortality of these patients remained high, although with a tendency to decrease over time: up to 1998, the mean age of death was 31.8 years compared to 47.7 years since 1998. The mean age of death was always lower than that of the general population. Disease is the most prevalent cause of mortality (84% of the deceased) with a great difference compared to the other 3 groups. Despite the reduction in infections associated with parenteral use, there are still factors associated with an unhealthy lifestyle that, together with the aging of this population, explain to a large extent why the average age of death of these patients is not equal to that of the general population, which seems to force us to review the objectives of health and social intervention.

Meta-analysis of the effects of adjuvant drugs in co-occurring bipolar and substance use disorder

BACKGROUND

Individuals with bipolar disorder (BD) often have co-occurring substance use disorders (SUDs), which substantially impoverish the course of illness. Despite the importance of this dual diagnosis, the evidence of the efficacy and safety of adjuvant treatments is mostly unknown.

OBJECTIVE

To perform a meta-analysis to evaluate the efficacy and safety of adjuvant drugs in patients with co-occurring BD and SUD.

METHODS

We searched PubMed, Scopus, and Web of Knowledge until 30th April 2022 for randomized clinical trials (RCT) evaluating the efficacy and safety of adjuvant drugs compared to placebo in patients with a dual diagnosis of BD and SUD. We meta-analyzed the effect of adjuvant drugs on general outcomes (illness severity, mania, depression, anxiety, abstinence, substance craving, substance use, gamma-GT, adherence, and adverse events) and used the results to objectively assess the quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. For completeness, we also report the specific effects of specific adjuvant drugs in patients with specific substance disorders.

RESULTS

We included 15 RCT studies (9 alcohol, 3 cocaine, 2 nicotine, and 1 cannabis) comprising 628 patients allocated to treatment and 622 to placebo. There was low-quality evidence that adjuvant drugs may reduce illness severity (g=-0.25, 95% CI: -0.44, -0.06), and very-low quality evidence that they may decrease substance use (g=-0.23, 95% CI: -0.44, -0.02) and increase substance abstinence (g=0.21, 95% CI: 0.04, 0.38).

DISCUSSION

There is low-quality evidence that adjuvant drugs may help reduce illness severity, probably via facilitating abstinence and lower substance use. However, the evidence is weak; thus, these results should be considered cautiously until better evidence exists.

Proposed Recommendations for the Management of Depression in Adults with Epilepsy: An Expert Consensus

INTRODUCTION

Experts agree that there is a need for protocols to guide health professionals on how to best manage psychiatric comorbidities in patients with epilepsy (PWE). We aimed to develop practical recommendations for key issues in the management of depression in PWE.

METHODS

This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations on those issues without available evidence; and (4) drafting and approving the final recommendations. A scientific committee (one neurologist and one psychiatrist) was responsible for the development of the project and its scientific integrity. The scientific committee selected a panel of experts (nine neurologists and nine psychiatrists with experience in this field) to be involved in the nominal group meetings and to formulate final recommendations.

RESULTS

Fifteen recommendations were formulated. Four on the screening and diagnosis: screening and diagnosis of depression, evaluation of the risk of suicide, and diagnosis of depression secondary to epilepsy; nine on the management of depression: referral to a psychiatrist, selection of the antiseizure medication, change of antiseizure medication, antidepressant treatment initiation, selection of antidepressant, use of antidepressants during pregnancy, use of psychotherapy, antidepressant treatment duration, and discontinuation of antidepressant treatment; two on the follow-up: duration of the follow-up under usual conditions, and follow-up of patients at risk of suicide.

CONCLUSION

We provide recommendations based on expert opinion consensus to help healthcare professionals assess depression in PWE. The detection and treatment of major depressive disorders are key factors in improving epilepsy outcomes and avoiding suicide risk.

The Influence of Psychopathy on Incarcerated Inmates’ Cognitive Empathy

(1) Background: there is an ongoing debate about whether psychopathic traits increase or decrease cognitive empathy/Theory of Mind. (2) Methods: using a representative sample of 204 Spanish convicted inmates incarcerated at the Pereiro de Aguiar Penitentiary in Ourense, Spain, we investigated the relationship between two tools for the assessment of psychopathy, the Psychopathy Checklist-Revised (PCL-R) and the Comprehensive Assessment of Psychopathic Personality (CAPP), and the Reading the Mind in the Eyes Test (RMET), a well-known measure of cognitive empathy. (3) Results: The results showed no clear connection between the scores on the psychopathy assessment tools and RMET performance. This lack of association was stronger when the age variable was included in the multivariate analysis. (4) Conclusions: the results of this study failed to detect any clear link between psychopathy and cognitive empathy performance. Accordingly, our results indicate that psychopathy neither improves nor worsens cognitive empathy.

Clinical practice guideline on pharmacological and psychological management of adult patients with bipolar disorder and comorbid substance use

This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid bipolar disorder (BD) and substance use disorders (SUDs) while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus mood symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Very few of the randomized trials performed so far have provided consistent evidence for the management of both mood symptoms and substance use in patients with a BD. No clinical trials are available for bipolar patients using cannabis. Some treatments have shown benefit for mood symptoms without benefits for alcohol or illicit substance use. Our results suggest that 1) we can (weakly) recommend the use of adjuvant valproate or naltrexone to improve symptoms of alcohol use disorder; 2) Lamotrigine add-on therapy seems to reduce cocaine-related symptoms and is therefore recommended (moderate strength); and 3) Varenicline is (weakly) recommended to improve nicotine abstinence. Integrated group therapy is the most-well validated and efficacious approach on substance use outcomes if substance use is targeted in an initial treatment phase.

Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use

Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). This review synthesizes the pharmacological and psychosocial interventions conducted in ADHD and SUDs, and provides clinical recommendations using the GRADE approach. Our results suggest: 1) In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms (weak recommendation) and alcohol craving (weak recommendation). 2) In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to reduce cannabis use (weak recommendation). 3) In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or to reduce cocaine use (weak recommendation). 4) In patients with ADHD and comorbid nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms (weak recommendation). Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation). In these patients, the use of atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to decrease substance use (weak recommendation) or to improve retention to treatment (strong recommendation). Atomoxetine and psychostimulants appear to be safe in patients with any SUD (strong recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite and conclusive evidence.

Clinical practice guideline on pharmacological and psychological management of adult patients with depression and a comorbid substance use disorder

Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence.

Clinical practice guideline on pharmacological and psychological management of adult patients with an anxiety disorder and comorbid substance use

This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid anxiety disorders and SUDs while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus anxiety symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Clinical trials are only available for posttraumatic stress disorder (PTSD) and for social anxiety. Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram). Our results suggest that 1) we can (weakly) recommend the use of desipramine over paroxetine to alleviate symptoms of anxiety in patients with a PTSD and alcohol use; 2) In these patients, the use of naltrexone to reduce symptoms of anxiety is also recommended (weak strength); and 3) SSRI antidepressants vs placebo can be recommended to reduce alcohol use (weak recommendation). Our review highlights the need for more research in this area and for larger, multisite studies with generalizable samples to provide more definite guidance for clinical practice.

Perception of a New Prolonged-Release Buprenorphine Formulation in Patients with Opioid Use Disorder: The PREDEPO Study

AIM

The aim of the study was to assess the acceptance of patients with opioid use disorder (OUD) to switching their opioid dependence treatment (ODT) for a prolonged-release buprenorphine (PRB) injection according to their prior ODT (buprenorphine/naloxone [B/N] or methadone).

METHODS

This was an observational, retrospective/cross-sectional, multicentre study of adult patients diagnosed with OUD on ODT. Data collected from diaries were analysed to know their interest and opinion on PRB. Questions with fixed response options were included, and several Likert scales were used.

RESULTS

A total of 98 patients were enrolled (B/N: 50.0%, methadone: 50.0%). The mean age was 46.9 ± 8.43 years and 79.6% were males. PRB was similarly perceived by both groups in most variables analysed, receiving a mean score of 7.2/10 (B/N: 7.4, methadone: 7.0; p = 0.520), and approximately 65% of patients said they were willing to switch to PRB (B/N: 63.3%, methadone: 65.3%; p = 0.833). Of these, a higher percentage in the B/N group considered that switching would be easy/very easy (B/N: 90.3%, methadone: 46.9%; p < 0.001) and that they would start PRB when available (B/N: 64.5%, methadone: 34.3%; p = 0.005). More than 90% would prefer the monthly injection (B/N: 93.6%, methadone: 100%; p = 0.514). One-third of patients in both groups were unsure/would not switch their ODT to PRB (B/N: 36.7%, methadone: 34.7%; p = 0.833). The main reason was administration by injection.

CONCLUSION

Two-thirds of patients would switch their treatment for PRB, and most patients on B/N considered that switching would be easy. PRB could be a suitable alternative for OUD management.

Cognitive functioning after six months of follow-up in a sample of alcohol use disorder outpatients

Until now, no follow-up studies had simultaneously evaluated executive functions, other non-executive functions related cognitive func-tions, and impulsivity in a large enough sample of moderate to severe alcohol use disorder (AUD) patients. The main objective of the present study was to compare neuropsychological performance and its relation to alcohol use in patients with AUD and healthy controls, and to determine the evolution of cognitive impairment and alcohol use over time. For this purpose, a 6-month follow-up study was designed to compare a sample of 100 outpatients with AUD (DSM-5 criteria) with 100 matched healthy controls. The patient group was recruited from three different health centres in Spain located in Orense, Gijón and Barcelona. The assessment consisted of a systematic battery of cognitive tests to evaluate the following functions: attention, anterograde memory, processing speed, verbal fluency, executive function, and implicit attitude toward alcoholic beverages. We also compared clinical variables associated with alcohol use, such as alcohol craving and impulsivity. After 6 months, anterograde memory, working memory, and resistance to interference improved remarkably in AUD patients, although not enough to match the normal population. With regard to clinical variables, there was a small but significant cognitive improve-ment related to a reduction in alcohol use and impulsivity. Executive dysfunction and other non-executive functions related cognitive func-tions impairment can be considered prognostic factors in outpatients with moderate to severe AUD.

Genetic predisposition to alcohol dependence: The combined role of polygenic risk to general psychopathology and to high alcohol consumption

BACKGROUND

High alcohol consumption and alcohol dependence are only partly genetically correlated and they differ considerably in their correlations with other traits. The existence of genetic correlation among alcohol dependence and psychiatric disorders may be attributed to the presence of a general psychopathology factor, the p factor. This study investigates the relationship of polygenic risk to general psychopathology and to high alcohol consumption on alcohol dependence.

METHODS

Participants were 524 alcohol-dependent patients and 729 controls. Polygenic risk scores (PRS) were computed for alcohol consumption (drinks per week) and nine psychiatric disorders. Principal component analysis (PCA) applied to the psychiatric PRS was used to calculate the first principal component as a proxy of the polygenic p factor.

RESULTS

Both the polygenic p factor and the drinks per week PRS were associated with alcohol dependence in our sample. Both variables are only weakly correlated, contributing additively to the risk for alcohol dependence. Sensitivity analyses showed that the polygenic p factor was also associated with alcohol dependence in the subset of patients without any psychiatric or substance use comorbidity.

CONCLUSIONS

Polygenic risk for alcohol dependence can be split at least into two components, involved in general psychopathology and high alcohol consumption. The first component of PCA based on PRS for different psychiatric disorders allows estimation of the contribution of the polygenic p factor to alcohol dependence. The pleiotropic effects of genetic variants across psychiatric disorders are mainly manifested as alcohol dependence in some patients.

Cognitive functioning in patients with alcohol use disorder who start outpatient treatment

The main objective of the present study is to analyze the presence of cognitive impairment associated with alcohol consumption in patients with moderate or severe alcohol use disorder seeking outpatient treatment for their dependence. To do this, we compared a sample of 111 patients with active alcohol use disorder who initiated ambulatory treatment with 100 healthy controls. We compared sociodemographic and clinical variables associated with alcohol consumption, such as alcohol craving and impulsivity. A systematized battery of cognitive tests was also used in the comparison, which allowed the evaluation of the following functions: Attention, anterograde memory, processing speed, verbal fluency, executive function and implicit attitude towards alcoholic beverages. Compared with healthy controls, patients with moderate or severe alcohol use disorder performed significantly worse in all tests used, and therefore in all cognitive functions evaluated, but for two tests, the Iowa Gambling Test and the Implicit Association Test. The analysis through a correlation matrix of the patient group indicates that patients who report more impulsivity and more chronic alcohol abuse and with more addiction are those who suffer greater deterioration in their cognitive function. Cognitive damage associated with alcohol consumption was distributed heterogeneously among patients. The present study confirms the presence of cognitive deterioration associated with alcohol consumption in patients seeking outpatient treatment.

Factors associated with tobacco consumption in patients with depression

Smoking and depression are related in a bidirectional way: smoking is the primary avoidable cause of illness and death in patients with depression, and depression is one of the most consistent risk factors for smoking. The main objective of this study is to investigate the relationship between smoking and depression, analyzing sociodemographic and clinical variables such as severity of symptoms, subtype of affective disorder, and its impact on suicidal behavior in the clinical population.A sample of 201 patients, over 18 years of age [mean age (SD) = 53.76 (10.36) years; women = 132 (65.7%)], with a history of depressive episode (unipolar or bipolar) or dysthymia (ICD 10 criteria) was studied.Current smoking prevalence was 43.2% and life-time prevalence 61.2%. No statistically significant differences in smoking prevalence between men and women were found (X2 = 3.896, p = 0.143). The average age of onset was 17.81 (5.60) years. There was a tendency towards a linear association between number of cigarettes/day consumed and severity of depression according to the Hamilton Depression Scale (HDRS) in current smokers (Pearson's R = 0.298, p = 0.050). Multinomial logistic regression analysis showed that current tobacco consumption was associated with higher HDRS scores, with each additional point on the HDRS increasing the likelihood of smoking by 0.062 [p = 0.032; OR (95% CI) = 1.064 (1.005-1.125)].Our results showed that depressed patients present higher prevalence of current smoking than the general population, also suggesting a relationship between severity of consumption and severity of depressive symptoms.

Does ICD-11 improve the epidemiological and nosological purposes of mental, behavioral and developmental disorders?

Editorial of vol 31(3).

Clinical implications of cognitive impairment and alcohol dependence

Editorial of vol. 31-1.

Novel validity evidence of the Psychopathy Checklist- Revised (PCL-R) in a representative sample of Spanish inmates

Psychopathy Checklist-Revised (PCL-R) validation studies have been conducted mainly in non representative samples of North American adult male serious offenders. Research in other samples is needed to test the generalizability of PCL-R construct validity. PCL-R psychometric properties and construct validity were evaluated in a representative sample of 204 Spanish sentenced inmates. These inmates had served at least 6 months of their sentence at Pereiro de Aguiar prison. This sample was heterogeneous with respect to type of official charges and was representative, as all offenders who met the inclusion and exclusion criteria were invited to participate. Classical test theory indexes of reliability, correlations between PCL-R items, factors and facets, external correlations, and factor structure analysis demonstrated that PCL-R affective, interpersonal and lifestyle dimensions were more reliable and valid for the psychopathy than the antisocial construct in this Southern European sample.

Genome wide analysis of rare copy number variations in alcohol abuse or dependence

Genetics plays an important role in alcohol abuse/dependence. Its heritability has been estimated as 45-65%. Rare copy number variations (CNVs) have been confirmed as relevant genetic factors in other neuropsychiatric disorders, such as autism spectrum disorders, schizophrenia, epilepsy, or Tourette syndrome. In the present study, we analyzed the role of rare CNVs affecting exons of coding genes in a sample from Northwest Spain genotyped using the Illumina Infinium PsychArray Beadchip. After rigorous genotyping quality control procedure, 712 patients with alcohol abuse or dependence and 804 controls were used for CNV detection. CNV calling was performed using PennCNV and cnvPartition, and analyses were restricted to CNVs of at least 100 kb and including at least 10 single nucleotide polymorphisms. Logistic regression was used to test for the effect of CNV as well as number of genes affected by CNVs on case/control status, after adjustment for demographic and experimental covariates. We have found an excess of deletions (p = 0.008) and genes affected by deletions (p = 0.017) in cases. This effect was restricted to the 14.8% of affected genes that are intolerant to loss-of-function mutations (gene count p = 0.009). The importance of this subset of genes is emerging in other psychiatric disorders of neurodevelopmental origin, suggesting that disturbance in neurodevelopment mediated by genetic alterations may be a risk factor for alcohol use disorder.

Relationships between substance abuse/dependence and psychiatric disorders based on polygenic scores

Genetic susceptibility to substance use disorders (SUDs) is partially shared between substances. Heritability of any substance dependence, estimated as 54%, is partly explained by additive effects of common variants. Comorbidity between SUDs and other psychiatric disorders is frequent. The present study aims to analyze the additive role of common variants in this comorbidity using polygenic scores (PGSs) based on genome-wide association study discovery samples of schizophrenia (SCZ), bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, major depressive disorder and anxiety disorders, available from large consortia. PGSs were calculated for 534 patients meeting DSM-IV criteria for dependence of a substance and abuse/dependence of another substance between alcohol, tobacco, cannabis, cocaine, opiates, hypnotics, stimulants, hallucinogens and solvents; and 587 blood donors from the same population, Iberians from Galicia, as controls. Significance of the PGS and percentage of variance explained were calculated by logistic regression. Using discovery samples of similar size, significant associations with SUDs were detected for SCZ PGS. SCZ PGS explained more variance in SUDs than in most psychiatric disorders. Cross-disorder PGS based on five psychiatric disorders was significant after adjustment for the effect of SCZ PGS. SCZ PGS was significantly higher in women than in men abusing alcohol. Our findings indicate that SUDs share genetic susceptibility with SCZ to a greater extent than with other psychiatric disorders, including externalizing disorders such as attention-deficit/hyperactivity disorder. Women have lower probability to develop substance abuse/dependence than men at similar PGS probably because of a higher social pressure against excessive drug use in women.

Clinician ratings of the Comprehensive Assessment of Psychopathic Personality (CAPP) in a representative sample of Spanish prison inmates: New validity evidence

The Comprehensive Assessment of Psychopathic Personality (CAPP) is a concept map of psychopathic personality disorder (PPD). The CAPP- Institutional Rating Scale (IRS) is a tool designed to assess CAPP symptoms in institutional settings. The CAPP contains 33 personality traits organized in six domains: attachment, behavioural, cognitive, dominance, emotional and self. Until now, much of the CAPP research has been conducted out of clinical, forensic and correctional settings using self-ratings. In the current study, the psychometric properties and construct validity of the CAPP-IRS were evaluated in a non-convenience sample of 204 Spanish convicts. Clinician ratings were employed. Participants had been imprisoned for at least 6 months at Pereiro de Aguiar Penitentiary. This group of inmates was heterogeneous with respect to type of official charges, and representative as all convicts interned for at least 6 months in this prison were screened for participation. Classical test theory indexes of reliability, correlations between CAPP items and domains and external correlations and structural analyses demonstrated that CAPP assessment is a solid and robust way of evaluating psychopathy in a correctional setting. Best fit was found for a three-factor model: attachment and emotional items associated with a callous and unemotional trait, dominance and self items associated with a pathological interpersonal style, and behavioural and residual items from other domains associated with impulsivity.

Diagnosing Psychopathy through Emotional Regulation Tasks: Heart Rate Variability versus Implicit Association Test

BACKGROUND

Nowadays, the assessment of psychopathy relies on semistructured interviews plus file reviews. In order to improve the predictive validity of psychopathy at the individual level, tools that are not based on the rating of signs and symptoms are in great need.

SAMPLING AND METHODS

The present study was conducted in a representative sample of 204 Spanish sentenced inmates. These inmates have served at least 6 months of their sentence at the Pereiro de Aguiar (Ourense, Spain) penitentiary. Psychopathy signs and symptoms were scored through interview and file review. The Implicit Association Test (IAT) and heart rate variability (HRV) experiments were also conducted. The Iowa Gambling Task (IGT) was performed as a control measure.

RESULTS

Spectral HRV indices were able to detect psychopathic inmates at a significant level, while IAT experiments and the IGT could not discriminate them. HRV indices showed a more significant difference when assessing the affective-interpersonal dimensions of psychopathy.

CONCLUSIONS

An HRV experiment is better than IAT in order to detect psychopathy in a representative sample of Spanish inmates.

Impulsivity, implicit attitudes and explicit cognitions, and alcohol dependence as predictors of pathological gambling

Impulsivity, implicit attitudes and explicit cognitions regarding gambling, and alcohol abuse have been pointed out by past research as significant contributors to the development and maintenance of gambling disorders. In this study, we tested the relationship among these contributors and pathological gambling. Forty-four pathological gamblers (DSM-5 criteria), of whom 23 were active gamblers and 17 were alcohol dependent, were compared with 100 controls, consisting of patients with a lifetime history of alcohol use disorder in remission for at least 2 years. The following protocol was used for the comparison: National Opinion Research Center Diagnostic Screen for Gambling Disorders, Barratt Impulsiveness Scale Version 11 (BIS-11), Gambling Related Cognitions Scale (GRCS), Obsessive Compulsive Drinking Scale, Alcohol Use Disorders Identification Test, and Gambling Implicit Association Test (IAT). Impulsivity (BIS-11) and changes in implicit attitudes (IAT) were able to discriminate between pathological gamblers and controls, the latter being less impulsive and having fewer implicit attitudes towards gambling. Cognitive impulsivity (BIS-11), explicit gambling cognitions (GRCS), and alcohol dependence were able to discriminate between active and non-active pathological gamblers, the latter having less cognitive impulsivity and less explicit gambling cognitions and alcohol dependence. Using these simple tools can help clinicians in the assessment of pathological gambling.

Tobacco and cognitive performance in schizophrenia patients: the design of the COGNICO study

People with schizophrenia constitute a substantial part of the people who still smoke. Regarding cognitive performance, the self-medication hypothesis states that patients smoke to improve their cognitive deficits based on the stimulating effects of nicotine. The aim of this paper is to describe in detail the methodology used in the COGNICO study. A quasi-experimental, observational, prospective, multicenter study with follow-ups over 18 months was conducted in three cities in northern Spain (Oviedo, Ourense and Santiago de Compostela). A total of 81 outpatient smokers with schizophrenia were recruited with a mean age 43.35 years (SD = 8.83), 72.8% of them male. They were assigned to 3 groups: a) control group (smokers); b) patients who quit smoking using nicotine patches; c) patients who quit smoking with Varenicline. The MATRICS neuropsychological battery was applied as a primary measure. In addition, a comprehensive assessment of patients was performed, including the number of cigarettes per day, physical and psychological dependence on nicotine and CO expired. Clinical evaluation (PANSS, HDRS, CGI, C-SSRS), anthropometric measurements and vital signs assessment was also performed. The aim is to identify the relationship between the pattern of tobacco use and cognitive performance by comparing scores on the neuropsychological battery MATRICS during the follow-up periods (3, 6, 12 and 18months). The importance of this study lies in addressing a topical issue often ignored by clinicians: the unacceptably high rates of tobacco use in patients with severe mental disorders.

Psychopathy, Addictions, Interpersonal Violence and Antisocial Behavior, a mixed relationship

Editorial of vol 28-2.

A Prototypicality Validation of the Comprehensive Assessment of Psychopathic Personality (CAPP) Model Spanish Version

The Comprehensive Assessment of Psychopathic Personality (CAPP) is a newly developed, lexically based, conceptual model of psychopathy. The content validity of the Spanish language CAPP model was evaluated using prototypicality analysis. Prototypicality ratings were collected from 187 mental health experts and from samples of 143 health professionals and 282 community residents. Across the samples the majority of CAPP items were rated as highly prototypical of psychopathy. The Self, Dominance, and Attachment domains were evaluated as being more prototypical than the Behavioral and Cognitive domains. These findings are consistent with findings from similar studies in other languages and provide further support for the content validation of the CAPP model across languages and the lexical approach.

First-time admissions for opioid treatment: cross-sectional and descriptive study of new opioid users seeking treatment

BACKGROUND

The purpose of this study was to gain an understanding of the profiles of the new treatment demands posed by opioid addicts between 2005 and 2010 at the addictive disorders assistance units in Galicia, Spain.

METHODS

A cluster analysis was performed using data from 1,655 treatment entrants. Clusters were constructed using sociodemographic and medicolegal variables. A cluster analysis was also conducted according to age. Once clusters were defined, their association with the following variables was analyzed: age at first use of opioids, years of use, frequency of opioid use in the previous month, psychiatric treatment, cocaine use, existence of a drug-dependent partner, and source of referral.

RESULTS

Four clusters were obtained in the main analysis. Cluster 1 (34.01%) consisted of young males, cluster 2 (16.19%) consisted of not-so-young males, cluster 3 (32.62%) consisted mainly of older males and a small group of females, and cluster 4 (17.18%) was made up entirely of women. With regard to age-related clusters, two clusters were obtained in those under the age of 30 years: cluster 1 (73%) without medicolegal complications and cluster 2 (27%) with medicolegal complications. For those over the age of 30 years, two clusters were obtained: cluster 1 (53.92%) with hardly any medicolegal complications and cluster 2 (46.08%) with medicolegal complications.

CONCLUSION

Cluster analysis suggests that there have been no substantial changes in variables indicating greater severity in this new group of patients. Women are likely to seek help earlier, which reduces their duration of opioid use. The younger the patient, the shorter the duration of opioid use and the greater the likelihood of cessation of intravenous use. Public health systems should use a two-pronged treatment strategy of short but intense cessation therapies for women and younger treatment entrants and longer maintenance and replacement therapies for older treatment entrants with more psychosocial and medical complications.

Predictors of posttreatment drinking outcomes in patients with alcohol dependence

AIM

This cohort study examined how predictors of alcohol dependence treatment outcomes work together over time by comparing pretreatment and posttreatment predictors.

METHODS

A sample of 274 alcohol-dependent patients was recruited and assessed at baseline, 6 months after treatment initiation (end of the active intervention phase), and 18 months after treatment initiation (end of the 12-month research follow-up phase). At each assessment point, the participants completed a battery of standardized tests [European Addiction Severity Index (EuropASI), Obsessive Compulsive Drinking Scale (OCDS), Alcohol Timeline Followback (TLFB), Fagerström, and International Personality Disorder Examination (IPDE)] that measured symptom severity and consequences; biological markers of alcohol consumption were also tested at each assessment point. A sequential strategy with univariate and multivariate analyses was used to identify how pretreatment and posttreatment predictors influence outcomes up to 1 year after treatment.

RESULTS

Pretreatment variables had less predictive power than posttreatment ones. OCDS scores and biological markers of alcohol consumption were the most significant variables for the prediction of posttreatment outcomes. Prior pharmacotherapy treatment and relapse prevention interventions were also associated with posttreatment outcomes.

CONCLUSIONS

The findings highlight the positive impact of pharmacotherapy during the first 6 months after treatment initiation and of relapse prevention during the first year after treatment and how posttreatment predictors are more important than pretreatment predictors.

Psychiatric Comorbidity in Patients from the Addictive Disorders Assistance Units of Galicia: The COPSIAD Study

The objective of this study is to assess the prevalence of psychiatric comorbidity in patients under treatment within the addictive disorders assistance units of Galicia (Spain).

MATERIAL AND METHODS

A total of 64 healthcare professionals performed clinical diagnosis of mental disorders (on DSM IV-TR criteria) in 2300 patients treated throughout March 2010 in 21 addictive disorders assistance units.

RESULTS

56.3% of patients with substance abuse/dependency also showed some other mental disorder, 42.2% of patients suffering from at least an Axis I condition and 20.2% from some Axis II condition. Mood and anxiety disorders and borderline and antisocial personality disorders were the most frequent disorders in both axes.

CONCLUSIONS

A high comorbidity was found between mental and substance use disorders (SUD) in patients seen at the addictive disorders assistance units of Galicia.

Role of serotonergic-related systems in suicidal behavior: Data from a case-control association study

OBJECTIVE

To investigate whether functional polymorphisms directly (HTR2A and SLC6A4 genes) or indirectly (IL-1 gene complex, APOE and ACE genes) related with serotonergic neurotransmission were associated with suicidal behavior.

SUBJECTS AND METHODS

227 suicide attempters, 686 non-suicidal psychiatric patients, and 420 healthy controls from a homogeneous Spanish Caucasian population were genotyped using standard methods.

RESULTS

There were no differences in genotype frequencies between the three groups. The -1438A/G [χ(2) (df)=9.80 (2), uncorrected p=0.007] and IL-1α -889C/T [χ(2) (df)=8.76 (2), uncorrected p=0.013] genotype frequencies between impulsive and planned suicide attempts trended toward being different (not significant after Bonferroni correction). Suicide attempts were more often impulsive in the presence of -1438G/G or IL-1α -889C/T or C/C genotypes. There was interaction between the polymorphism 5-HTTLPR and age [LRT (df)=6.84 (2), p=0.033] and between the polymorphisms APOE and IL-1RA (86bp)(n) [LRT (df)=12.21 (4), p=0.016] in relation to suicide attempt lethality.

CONCLUSION

These findings further evidence the complexity of the association between genetics and suicidal behavior, the need to study homogenous forms of the behavior and the relevance of impulsive and aggressive traits as endophenotypes for suicidal behavior.

[The Short Nicotine Dependence Syndrome Scale (NDSS-S) in Spanish smokers]

We present a brief scale derived from the Nicotine Dependence Syndrome Scale (NDSS). We used a sample of 1.061 daily smokers, which was obtained from five Primary Care Health Centers, a Unit of Alcoholism, and a Smoking Cessation Unit. All smokers were evaluated with the NDSS and the SCID to assess nicotine dependence according to DSM-IV criteria. The results indicate the existence of a general factor of nicotine dependence according to the NDSS. We selected the items with a higher factor loading (>.50), obtaining a short scale of 6 items. With this brief scale, we obtained results similar to those of the total scale in the diverse variables (sociodemographic and smoking) of the study. Scale reliability is satisfactory (a= .79), the correlation between the short and the total scale is very high (r=.95, p<.001) and the short scale discriminates the smokers in terms of cigarette consumption and nicotine dependence, as assessed with the SCID. The operation under the ROC curve is excellent (area under the curve .84). The data indicate the usefulness of this brief scale (NDSS-S) to assess nicotine dependence in smokers.

Topiramate for the treatment of alcohol dependence: comparison with naltrexone

BACKGROUND

A 6-month naturalistic, randomized and open-label, trial of topiramate versus naltrexone was conducted, with assessments at enrollment and after 3 and 6 months of treatment. 182 alcohol-dependent patients who had been drinking heavily during the past month were included.

METHODS

Outcome was measured using tools that assessed alcohol intake, cravings, disability, and quality of life; changes in biomarkers of alcohol intake were also used.

RESULTS

At the 6-month evaluation, patients taking topiramate had significantly lower scores on the OCDS (all subscales), the EuropASI (medical, alcohol, family/social, and psychiatric) and the WHO/DAS (employment/social). More patients taking topiramate remained in the abstinence group and the moderate drinking without problems group.

CONCLUSIONS

Topiramate at a mean dose of 200 mg/day was better than naltrexone at a mean dose of 50 mg/day at reducing alcohol intake and cravings throughout the study.

[Amisulpride for the treatment of alcohol dependence]

BACKGROUND

6-month naturalistic, open-label trial to compare amisulpride versus topiramate and naltrexone as a treatment for patients with alcohol dependence, with assessments at enrolment and after 3 and 6 months of treatment.

METHODS

274 alcohol-dependent patients who had been drinking heavily during the past month were included. Once detoxified, patients were assigned to one of three treatment groups (naltrexone 50 mgr per day, topiramate 200 mgr per day or amisulpride 100 mgr per day). Patients were assessed at baseline and after 3 and 6 months of follow-up. Outcome was measured using tools that assessed alcohol intake (EuropASI and Alcohol Timeline Followback), craving (OCDS), disability (WHO/DAS), and quality of life (EQ-5D); changes in biomarkers of alcohol intake were also noted.

RESULTS

at the 6-month follow-up patients taking amisulpride had poorer results than those taking topiramate in direct measures of alcohol intake (OCDS, alcohol intake, number of drinks per day and heavy drinking days), but no significant differences were found in these measures on comparing the amisulpride patients with those taking naltrexone.

CONCLUSIONS

in this study, amisulpride, at a dose of 100 mgr per day, was less effective than topiramate, at a dose of 200 mg per day, but as effective as naltrexone, at a dose of 50 mg per day, for reducing alcohol intake and craving over the period of the study.

[Psychometric performance of the 6th version of the Addiction Severity Index in Spanish (ASI-6)]

This work analysed the psychometric properties of the 6th version of the Addiction Severity Index (ASI-6) translated and adapted to the Spanish language. A multicentre, observational and prospective design was used. A total of 258 participants were included, 217 were patients (35 stable patients and 182 unstable patients), and 41 were controls. The results show satisfactory psychometric performance of the ASI-6. The degree of the internal consistency of the standardized objective scores ranged between .47 and .95. As for test-retest reliability, the values were acceptable, varying from .36 to 1. The study of the internal structure revealed a good fit to a unidimensional solution for all scales taken independently. Regarding convergent-discriminant validity, the correlations between the primary and secondary scales of the ASI-6 and the Clinic Global Impression score were low, with values from .01 to .26. Likewise, 8 of the 15 scales differentiated between controls and unstable patients. The psychometric properties of the ASI-6 Spanish version seem to be acceptable, though it is necessary to carry out new studies to test metric quality with independent samples of patients.

[Psychometric properties of the Nicotine Dependence Syndrome Scale (NDSS) in a sample of smokers treated for their alcohol dependence]

The assessment of nicotine dependence with brief instruments is of great relevance for the better detection of this disorder. Here we present the results with the Nicotine Dependence Syndrome Scale (NDSS) by Shiffman, Waters and Hickcox (2004) in a sample of 183 patients treated at an Alcohol Dependence Unit who were also cigarette smokers. The results indicate that the general factor which evaluates nicotine dependence (NDSS-T) has good reliability (Cronbach's alpha = 0.80). Factor analysis identifies four of the five factors proposed in the original version, those of drive, priority, continuity and stereotypy. Reliability of the scales derived ranges from very good (0.80) to moderate (0.63). The NDSS-T correlates significantly with the Fagerström Tolerance Questionnaire (FTQ), with the DSM-IV criteria for nicotine dependence assessed through the SCID, and with the number of cigarettes smoked per day. The ROC curves indicate an NDSS-T score of 0.80 under the curve (0.70 for the FTND), showing that it adequately predicts nicotine dependence. This study confirms the utility of this new instrument for assessing nicotine dependence in smokers who also abuse or depend upon alcohol.

Differences Observed by ASI-6 among users of Alcohol, Cocaine and Opiates

Aim:

To identify the differences in the ASI-6 scores according to main substance of consumption among patients with drug use disorder who were included at the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.

Method:

Multicentre, observational, longitudinal, prospective study. 186 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.

Results:

Main substance of consumption: 57% alcohol, 19.9% cocaine and 19.4% opiates. Men were 77.4% vs. 81.1% vs. 83.3% (p n.s.), mean ages were 47.12 (SD 10.18) vs. 32.62 (SD 8.20) vs. 36.47 (SD 8.04) years (p< 0.001), and 25.5% vs. 64.9% vs. 55.6% were single (p< 0.001). The greatest severity was found in the Alcohol area in the case of alcohol users (56.86) and in the Family/Social Partner Problems area in the case of cocaine and the opiate users (50.43 and 51.22). Alcohol users had statistically significant greater severity than the other two groups in the Alcohol area (56.86 vs. 49.38 vs. 45.17, p< 0.001) and tended to have lower severity in the Legal area than cocaine users (46.78 vs. 48.43, p 0.079).

Conclusions:

Cocaine users were the youngest and used to be single. The ASI-6 only differentiated in the severity of the Alcohol area. Further studies including a higher proportion of cocaine and opiate users are needed.

Physical Health of Patients with Drug use Disorders

Aim:

To describe the physical health profile of patients with drug use disorders who were included in the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.

Method:

Multicentre, observational, longitudinal, prospective study. A total of 194 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.

Results:

Men were 79.9%, mean ages were 41.08 (SD 11.64), 42.3% were single and 87.6% were acute patients. The severity score in the Physical Health area was 44.32 (SD 9.51). The most prevalent diseases were: 25.3% hepatitis, 11.9% had high blood pressure, 8.2% cirrhosis or hepatic disease, 6.7% epilepsy or convulsions and 5.7% tuberculoses. No statistically significant differences were found according to gender. Acute patients had statistically significant higher proportion of pregnant woman (2.3% vs. 0% p< 0.05) and lower proportion of diabetes (3.5% vs. 12.5% p= 0.05).

Conclusions:

Patients with drug use disorders have a mild-moderate severity of physical health. Physical health is not influenced by gender, but it is by the clinical state.

Using topiramate or naltrexone for the treatment of alcohol-dependent patients

BACKGROUND

To compare topiramate versus naltrexone in the treatment of alcohol dependence.

METHODS

A 6-month naturalistic, randomized and open-label, trial of topiramate versus naltrexone, with assessments at enrollment and after 3 and 6 months of treatment. The setting was an outpatient alcohol clinic. One hundred and two alcohol-dependent patients who had been drinking heavily during the past month were included. Two randomized groups were created. In one, naltrexone was used as the therapeutic agent and, in the other, topiramate was chosen as the therapeutic agent. Both groups received psychological relapse prevention therapy. Outcome was measured using tools that assessed alcohol intake, cravings, disability, and quality of life; changes in biomarkers of alcohol intake were also used. With all the data, a secondary composite measure was created in order to assess each patient's global alcohol intake and its consequences.

RESULTS

Both groups showed substantial reduction in their drinking. Naltrexone patients had higher nicotine consumption throughout the study. Topiramate was better at reducing alcohol-related cravings throughout the study. Both treatments had a similar mean cost throughout the study.

CONCLUSIONS

Both topiramate and naltrexone were efficacious in the treatment of alcohol dependence, and the treatment costs were similar. There is a trend for topiramate to be superior to naltrexone on critical measures of drinking; however, the study did not have adequate statistical power to establish this fact.

Immunological diagnosis of echinococcosis

Our results with the immunofluorescence technique in the diagnosis of hydatid disease are reported. The sera of 28 patients with surgically proven hydatid disease, of 30 healthy individuals, and of 1 patient with cysticercosis were used. With a dilution of 1:100 a sensitivity of 96% was obtained in the patients affected by the disease. In the control group all but one of the sera were negative. A brief review of the immunological methods used at present for the diagnosis of echinococcosis is made. The most important problems connected with the immunodiagnosis of this disease are discussed.

Percutaneous rhizotomy of the articular nerve of Luschka for low back and sciatic pain

The results of percutaneous facet rhizotomy for the treatment of low back and sciatic pain in 30 patients are reported. Satisfactory results were obtained in 76% of cases. No complications were found. This procedure should be tried in every patient with low back and extremity pain and no major neurological deficit before resorting to laminectomy.

Increased intracranial pressure associated with spinal cord tumours

Two cases of spinal cord tumour associated with increased intracranial pressure are reported and the 44 cases described in the literature are reviewed. The different hypotheses produced to explain the pathogenic mechanism of this syndrome are discussed. We think that several factors working together, rather than an isolated mechanism, take part in the production of this syndrome.

Changes in serum and cerebrospinal fluid enzyme activity after head injury

We studied simultaneously in serum (S) and CSF (L) the enzyme activities of GOT, GPT, LDH, ICDH, MDH, ALD, and CPK in 28 patients with head injuries divided into three groups according to the severity of the trauma. We found a correlation between severity of brain lesion and enzyme activity. The best correlation was found for SGOT, SCPK, LGOT, LLDH, LMDH and LCPK. We do not believe that enzyme activity is of prognostic value. We think that further studies should be made of the specific isoenzymes of the Central Nervous System.

The occult intrasacral meningocele

Three cases of occult intrasacral meningocele, one of them with an intrasacral and presacral neurofibroma, are reported. The literature is briefly reviewed. Pathogenesis, clinical picture, radiological findings and surgical treatment are discussed.