Patología dual. Conocimiento actual y retos futuros.

Los pacientes con PD en tratamiento y abstinentes durante más de tres meses presentan menor amplitud circadiana, peor rendimiento neuropsicológico (atención, memoria, funcionamiento ejecutivo y toma de decisiones) y calidad de vida relacionada con la salud, así como estrategias de afrontamiento al tratamiento más desadaptativas respecto a los pacientes sólo con TUS o TMS. Ello es especialmente patente con TMS de esquizofrenia. Además su patrón de personalidad es mixto respecto al perfil que caracteriza al TUS y al TMS comórbido, pudiéndose destacar la elevada Impulsividad, Búsqueda de Sensaciones y Evitación del Riesgo, así como la baja Persistencia y Dependencia a la Recompensa. Entre las variables moduladoras destaca la edad, los intentos de suicidio, el tratamiento psicofarmacológico y el consumo de cafeína. Todo ello sugiere que la PD es una entidad diagnóstica con características idiosincráticas y no la mera adición de las características asociadas al TUS y al TMS. Considerar aspectos rítmicos, cognitivos y de personalidad en los pacientes con PD puede beneficiar su respuesta al tratamiento y minimizar las recaídas, la cronificación y los problemas psicosociales que presentan.La patología dual (PD), considerada como la coexistencia de un trastorno por uso de sustancias (TUS) y un trastorno mental severo (TMS), supone en la actualidad un reto tanto en el ámbito de conocimiento básico como en el clínico. La prevalencia de PD es muy elevada, a pesar de que no se considere como entidad en los manuales diagnósticos psiquiátricos. Así, datos recientes en España la sitúan entre el 65-85% en la red de atención a las drogodependencias y en el 45% en la de salud mental. La PD se asocia a peor adherencia y respuesta al tratamiento, mayor tasa de recaídas y aumento de los problemas familiares, sociales y legales. En la actualidad queda mucho camino por recorrer en la caracterización de estos pacientes así como en el estudio de aspectos comunes y diferenciales respecto a la existencia de un único diagnóstico, bien sea TUS o TMS. En esta conferencia se expondrá un resumen del trabajo realizado durante los últimos 6 años en nuestro grupo de investigación, formado por investigadores del área de Psicobiología de la Universidad de Barcelona y la Universidad de Málaga.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

¿Mejora la cafeína nuestro rendimiento?

La cafeína es la sustancia con efecto estimulante más consumida en todo el mundo. Esta se halla integrada en la dieta. Los preparados más utilizados son el café y el té, aunque también existe un consumo relevante de yerba mate, refrescos de cola y bebidas energéticas

The circadian typology is related to differences in emotional intelligence

This study examines the relationships between circadian typology and emotional intelligence taking into account the possible interactions between sex and physical exercise, and controlling for age. A sample of 1011 participants (649 women; 26.92 ± 6.53 yr) completed the reduced Morningness-Eveningness Questionnaire and the Trait Meta-Mood Scale-24. Women showed higher emotional attention scores, while men showed higher emotional repair scores (p< .035). Subjects who do physical exercise weekly showed higher emotional repair scores (p=.001). Morning-type had lower emotional attention than evening and neither-type; neither-type exhibited lower emotional repair than morning-type, and lower emotional clarity than both evening and morning-type (p<.046). Circadian typology modulated sex differences in emotional attention, only morning-type group men showed lower emotional attention scores than women. Morning typology may be a protective factor in terms of general health, while we should be aware that the neither-type may present a vulnerability to develop psychological problemsCTS-19

Patología Dual y rasgos de personalidad:situación actual y líneas futuras de trabajo

Dual diagnosis (DD) is the co-occurrence, in the same person, of a mental disorder (MD) and a substance use disorder (SUD). Nowadays, the study of the personality with DD is realized mainly from a categorical view, focusing on the detection of personality disorders and not on the traits associated to DD and the possible differential profile compared to those patients with only MD or SUD. Studies analyzing personality traits of patients with DD and their possible differential profile are very limited. However, existing data indicates that DD patients show higher levels of Sensation Seeking, Impulsivity, Harm Avoidance and Neuroticism; and lower levels of Persistence, Self-Direction, Self-Transcendence and Cooperation. Therefore, DD is associated to personality characteristics that suggest more disruptive behaviors, fewer resources for recovering and keeping abstinent and worse prognosis compared to those with only one disorder. Progress in the characterization of personality traits in DD, taking into consideration the methodological aspects to be improved could allow better adaptation of the integrated treatment of these patients in the future

Tipología circadiana y problemas de salud mental

La tipología circadiana (matutina, vespertina o intermedia) es una diferencia individual que se ha relacionado con numerosos aspectos de la salud mental. En este estudio se revisan los principales hallazgos publicados en el área. Tras la búsqueda bibliográfica en las principales bases de datos se seleccionaron un total de 70 artículos publicados en castellano e inglés entre los años 1990 y 2012, recogidos en las bases de datos ISI, Scopus y Medline, donde se muestra que los individuos vespertinos presentan una mayor prevalencia de trastorno afectivo estacional, depresión mayor, trastorno bipolar, esquizofrenia, trastornos de la conducta alimentaria, trastornos del sueño, conductas adictivas, TDAH y mayores niveles de ansiedad que los matutinos. La tipología vespertina se perfila como un factor de riesgo y la matutina como un factor protector para el desarrollo de diversas psicopatologías, apuntándose como posibles causas polimorfismos de los genes reloj, el jet-lag social y algunos rasgos de personalidad. La tipología circadiana debe considerarse en la evaluación, tratamiento y prevención de las psicopatologías, pues afecta al inicio, curso, remisión y recaída de las mismas. La utilización de terapia cronobiológica es un factor a tener en cuenta en el abordaje terapéutico cuando la expresión rítmica circadiana se halla alterada

Health-related quality of life in male patients under treatment for substance use disorders with and without major depressive disorder: Influence in clinical course at one-year follow-up

Health-related quality of life (HRQoL) assessment has interest as an indicator of degree of affectation and prognosis in mental disorders. HRQoL is impaired in both Substance Use Disorder (SUD) and Major Depressive Disorder (MDD), two conditions highly prevalent, although less studied when both are coexisting (SUD + MDD). Hence, we decided to explore HRQoL with the SF-36 survey in a sample of 123 SUD and 114 SUD + MDD patients (51 symptomatic and 63 asymptomatic of depressive symptoms) under treatment. We performed analyses to examine HRQoL among groups, and its predictive value at 3-, 6- and 12-month follow-ups through regression models. Patients with SUD + MDD had worse HRQoL than SUD patients and population norms. For Mental Health, Vitality, and General Health dimensions, lower scores were observed for SUD + MDD regardless the presence/absence of depressive symptoms. For Physical Functioning and Health Change, depressive symptomatology and not the comorbidity of SUD + MDD diagnoses explained HRQoL limitations. At 3-, 6- and 12-month follow-ups we observed two predictors of relapses, General Health for asymptomatic SUD + MDD, and Physical Functioning for SUD. Improving HRQoL in SUD + MDD may be targeted during patient's treatment; future studies should explore the influence of HRQoL on patient's prognosis taking into account the presence/absence of depressive symptomatology

Neuropsychological performance in polyconsumer men under treatment. Influence of age of onset of substance use

Neurocognition is a key factor in the development and maintenance of Substance Use Disorders (SUD). However, there are still several aspects that need to be studied in this area. In this study, we elucidate the influence of age of onset of substance use (OSU) on the clinical course and neuropsychological performance of substance use disorder (SUD) patients, as well as to explore the influence of years of education, duration of drug use and premorbid intelligence quotient (IQ) on the cognitive results obtained. An exhaustive neuropsychological battery was used to assess different cognitive domains in 80 male polyconsumers, 41 with earlier OSU (16 years or before: OSU ≤ 16) and 39 with later OSU (17 years or later: OSU ≥ 17). The patients were under treatment with at least 4 months of abstinence confirmed by urinalysis. The OSU ≤ 16 group presented a worse clinical state, as well as a lower premorbid IQ and worse performance in processing speed, visual perception and planning skills. The duration of drug use may account for the differences in planning and processing speed. In this work we discuss the premorbid or acquired nature of the cognitive deficits found

Circadian Rhythmic Characteristics in Men With Substance Use Disorder Under Treatment. Influence of Age of Onset of Substance Use and Duration of Abstinence

here is evidence of the reciprocal influence between the alteration of circadian rhythms and Substance Use Disorders (SUD), and part of the success of the SUD treatment lays in the patient's rhythmic recovery. We aim to elucidate the effect of the SUD treatment in circadian rhythmicity considering, for the first time, the age of onset of substance use (OSU) and duration of abstinence. We registered the sleep-wake schedules, the chronotype and the distal skin temperature of 114 SUD patients with at least 3 months of abstinence, considering whether they had begun consumption at age 16 or earlier (OSU ≤ 16, n = 56) or at 17 or later (OSU ≥ 17, n = 58), and duration of abstinence as short (SA: 3 to 5 months, n = 38), medium (MA: 6 to 9 months, n = 35) or long (LA: more than 9 months, n = 41). Moreover, we compared the patients' distal skin temperature pattern with a similar sample of healthy controls (HC, n = 103). SUD patients showed a morningness tendency and higher night values, amplitude and stability, a better adjustment to the cosine model and lower minimum temperature and circadianity index in the distal skin temperature rhythm, in contrast to the HC group. The OSU ≥ 17 and LA groups showed a more robust distal skin temperature pattern, as well as milder clinical characteristics when compared to the OSU ≤ 16 and SA groups, respectively. The circadian disturbances associated to substance consumption seem to improve with treatment, although the age of OSU and the duration of abstinence are modulating variables. Our results highlight the need to include chronobiological strategies that boost circadian rhythmicity both in SUD prevention and rehabilitation programs. The measurement of distal skin temperature rhythm, a simple and reliable procedure, could be considered an indicator of response to treatment in SUD patient

Temperament and character profile and its clinical correlates in male patients with dual schizophrenia

Personality traits are relevant in understanding substance use disorders (SUD) and schizophrenia (SZ), but few works have also included patients with dual schizophrenia (SZ+) and personality traits. We explored personality profile in a sample of 165 male patients under treatment, using the Temperament and Character Inventory-Revised. The participants were assigned to three groups of 55 patients each, according to previous diagnosis: SUD, SZ- and SZ+ (without/with SUD). We analyzed their clinical characteristics, relating them to personality dimensions. The SUD and SZ+ groups scored higher than SZ- in Novelty/Sensation Seeking. SZ- and SZ+ presented higher Harm Avoidance and lower Persistence than the SUD group. SZ+ patients showed the lowest levels of Self-directedness, while SZ- and SZ+ had higher scores in Self-transcendence than the SUD group. Several clinical characteristics were associated with personality dimensions depending on diagnosis, and remarkably so for psychiatric symptoms in the SZ- and SZ+ groups. The three groups had a maladaptive personality profile compared to general population. Our results point to different profiles for SUD versus SZ, while both profiles appear combined in the SZ+ group, with extreme scores in some traits. Thus, considering personality endophenotypes in SZ+ could help in designing individualized interventions for this group