El autorreporte de funcionamiento ejecutivo media la asociación entre la obesidad y suicidalidad reciente: una encuesta en línea

The study intended to test for mediation effects of self-reported executive function (EF) between obesity and past 30-days suicide-behaviors. A web-based survey was conducted diffusing it to the general Mexican population via social media. Suicide was evaluated with the corresponding module of the Mini International Neuropsychiatric Interview, and a short form of the Behavioral Rating Inventory of Executive Functions-Adults for EF. Body mass index was computed from the self-reported height/weight. Causal-mediation analyses was performed for each of the suicide variables, including obesity and EF as predictor and mediator, respectively. Data from 1234 participants was analyzed, 274 classified as having obesity. EF partially mediated 20% of the effect of obesity on suicide behaviors. As the BMI progresses to the categories of obesity, EF deficiencies may be insufficient to cope optimally with the emotional and social stressors associated to obesity, thus leading to more frequent or intense suicide ideation, planning or attemptsEl presente estudio tuvo como objetivo evaluar el efecto de mediación del autorreporte de funcio-namiento ejecutivo (FE) entre la obesidad y la conducta suicida en los 30 días previos. Se condujo una encuesta a través de la web, la cual se difundió a la población general de México a través de redes sociales. El suicidio fue evaluado con el módulo correspondiente de la Mini Entrevista Neuropsiquiá-trica Internacional, y el FE con una versión breve de la Evaluación Conductual de la Función Ejecutiva para adultos. El índice de masa corporal se calculó del autorreporte de talla y peso. Se realizó análisis de mediación causal para cada una de las variables de suicidio, incluyendo la obesidad y el FE como predictores respectivamente. Se analizaron los datos de 1234 participantes, de los cuales 274 fueron clasificados dentro del grupo con obesidad. El FE mediaba aproximadamente el 20% del efecto de la obesidad en la conducta suicida. Los resultados sugieren que conforme el índice de Masa Corporal incrementa hacía la obesidad, el FE puede ser insuficiente para poder afrontar de forma óptima con los estresores emocionales y sociales asociados al incremento del peso, lo cual, trae como consecuencia una ideación, planeación intentos de suicidio más frecuentes o intenso

Is the Mini-Mental State Examination (MMSE) useful for eligibility screening of research participants with substance use disorder?

Introduction: the MMSE is used for eligibility screening of potential research participants diagnosed with substance use disorder (SUD), as abilities needed to provide a valid informed consent or accurate information could be impaired in these clinical populations. Knowledge about the capacity of the MMSE to detect impairment in these abilities or at least to assess impact of SUD on its total score, however, is rather diffuse. This has important ethical and methodological implications. Objective: to analyze effects of SUD only, main substances of abuse, age of onset of substance use, recent substance use, and psychiatric comorbidity upon MMSE outcome. The overall purpose of the study was to assess the utility of the MMSE for eligibility screening of potential research participants with SUD. Method: individuals were recruited from residential facilities for substance use treatment. A demographic questionnaire, MMSE and Mini International Neuropsychiatric Interview were used. Results: A total of 601 participants were gathered for main analysis. Controlling for education, no differences in MMSE score were detected within main substances of abuse (F=1.25[4,529], p=.28), nor between SUD only versus SUD with psychiatric comorbidity (F=.58[1,597], p=.44). Effects of age of onset and recent use of specific substances upon MMSE score were also absent. Discussion and conclusions: If there is some cognitive impairment in this clinical population, it may not be pertinently assessed by the MMSE, thus casting doubt on its pertinence for eligibility screening.----------------------- Introducción: el Mini Examen del Estado Mental (MMSE) está recomendado para tamizaje de elegibilidad de potenciales participantes con diagnóstico de trastorno por uso de sustancias (TUS) en protocolos de investigación, debido a que las habilidades necesarias para proveer consentimiento informado válido o información precisa pueden estar deterioradas por el abuso crónico de sustancias y la presencia de algunos trastornos psiquiátricos. Hay poco conocimiento sobre la utilidad del MMSE para evaluar la alteración de estas habilidades o cuando menos sobre su capacidad de registrar efecto de TUS sobre su resultado principal. Esto tiene importantes implicaciones éticas y metodológicas. Objetivo: analizar los efectos del TUS, las principales sustancias de abuso, la edad de inicio de consumo, el consumo reciente y la comorbilidad psiquiá- trica sobre el MMSE. El propósito final fue evaluar la utilidad del MMSE en el tamizaje de potenciales participantes de investigación. Método: los participantes fueron reclutados en centros de tratamiento para consumo de sustancias. Se administró cuestionario demográfico, MMSE y Mini Entrevista Neuropsiquiátrica Internacional. Resultados: se analizaron 601 casos para objetivo principal. Controlando grado de educación, no se encontraron efectos de edad de inicio de consumo ni de consumo reciente de sustancias específicas sobre puntaje del MMSE, según regresión lineal. Tampoco se hallaron diferencias en desempeño en MMSE con relación a las sustancias principales de abuso (F=1.25[4,529], p=.28) ni al comparar TUS con y sin comorbilidad psiquiátrica (F=.58[1,597], p=.44). Discusión y conclusiones: si de hecho existe deterioro cognitivo en esta población clínica, éste no es evaluado de forma pertinente por el MMSE. Esto arroja dudas sobre su utilidad en el tamizaje de elegibilidad

Developing an App to screen for dual disorders: a tool for improving treatment services in Mexico

Background: previous studies in Mexico undertaken at residential facilities for treating substance use disorders (SUDs) reported that the prevalence of Dual Disorders (DDs) is over 65%. DDs pose a major challenge for the Mexican health system, particularly for community-based residential care facilities for SUDs, due to the shortage of certified professionals to diagnose and treat these patients. Moreover, the lack of standardized algorithms for screening for and evaluating DDs to refer patients to specialized services (whether private or public) hinders timely care, delaying the start of integrated treatment. The use of new technologies provides a strategic opportunity for the timely detection of DDs through the development of standardized digital applications for the timely detection of DDs. Objective: to develop an app to screen for DDs, which will contribute to referral to specialized services in keeping with the level of severity of psychiatric and addictive symptomatology, and be suitable for use by community-based residential care facilities for SUDs. Method: the research project was implemented in two stages. Stage 1 involved obtaining the psychometric properties of the Dual Diagnosis Screening Interview (DDSI). Stage 2 consisted of two steps to test the Beta version of the app and the quality of version 1.0. Results: The DDS obtained sensitivity and specificity scores above 85%. The app and its algorithm to screen for and refer DDs proved to be efficient and easy to apply with satisfactory community acceptance. Conclusion: the app promises to be a useful screening tool at residential addiction treatment centers

Psychological distress in a Mexican sample across stages of the COVID-19 pandemic

Longitudinal study to evaluate changes in event-related stress, anxiety and depression during the COVID-19 pandemic in a Mexican sampl

Effects of a Dosed Exercise Intervention in Craving and Anhedonia: A Secondary Analysis from the STRIDE-CTN 0037 Clinical Trial

This is a secondary analysis from the project “CTN-0037-Stimulant Reduction Intervention Using Dosed Exercise (STRIDE)”. We aimed to test the effects of a Vigorous Intensity High Dose Exercise Augmentation (VIHD) when compared to a health education intervention (HEI) in stimulant drug-cravings and anhedonia. Three-hundred and two participants were randomized (VIHD = 152, DEI =150). No significant Time x Treatment interaction was found neither for craving nor anhedonia. For craving scores, a positive Time and negative Age effects were found. The results suggest that craving increases over time, and that younger individuals had higher craving scores across the trial. In the case of anhedonia scores, Gender had a positive direct effect, and the interaction Time x Gender had a negative effect. . Weighting the current evidence about exercise interventions for substance use, is possible that a particular patient profile and high adherence are required to be successful. Future research should focus on the identification of variables to identify who could benefit from systematic exercise programs

Assessment of neurocognitive disorder in studies of cognitive impairment due to substance use disorder: A systematic review

<p>Background: Cognitive impairments induced by substance use disorders (SUDs) are broadly documented. Evidence for these effects ought to be considered with regard to the new classification of neurocognitive disorders (NCDs). Failing to assess diagnostic criteria for NCD could be a limitation of studies addressing the effects of SUDs on cognition, resulting in misdiagnosis and inaccurate prevalence estimation. Methods: A systematic search of original articles (2000–2016) was conducted in Web of Knowledge and Science Direct. Key terms were: NCD and associated terms, and SUDs or alcohol, marijuana, cocaine and inhalants. Results: 59 cross-sectional and five prospective studies were reviewed. Criterion A.1 (evaluation of subjective concern of cognitive decline relative to a baseline), and criterion B (evaluation of impairment in daily life activities due to cognitive impairment) were not effectively evaluated in any of the studies. All studies addressed criterion A.2 (objective evidence of cognitive decline) via heterogeneous neuropsychological testing. Criteria C (absence of delirium) and D (absence of other possible etiologies) were frequently considered for control of confounding effects, mostly via methodological procedures (e.g. abstinence before evaluation, and exclusion of participants with comorbid disorders). Conclusion: These findings highlight the need to develop and disseminate standard procedures for assessment of substance-induced NCD.</p

Latent Impulsivity Subtypes in Substance Use Disorders and Interactions with Internalizing and Externalizing Co-Occurring Disorders

This study explored the clinical importance of latent impulsivity subtypes within a sample of individuals with substance use disorders (SUDs) and high rates of co-occurring disorders (CODs) receiving residential treatment, aiming to assess the heterogeneity of the associations between SUDs and CODs across such impulsivity subtypes. The abbreviated Barratt impulsiveness scale was used to assess motor and cognitive (attentional and nonplanning) impulsivity, a structured interview for diagnosis of SUD and CODs, and other clinimetric measures for severity of substance use. Latent class analysis was conducted to extract subgroups of impulsivity subtypes and Poisson regression to analyze effects of interactions of classes by CODs on severity of substance use. 568 participants were evaluated. Results featured a four-class model as the best-fitted solution: overall high impulsivity (OHI); overall low impulsivity; high cognitive-low motor impulsivity; and moderate cognitive-low motor impulsivity (MC-LMI). OHI and MC-LMI concentrated on most of the individuals with CODs, and individuals within OHI and MC-LMI showed more severity of substance use. The expression of this severity relative to the impulsivity subtypes was modified by their interaction with internalizing and externalizing CODs in very heterogeneous ways. Our findings suggest that knowing either the presence of trait-based subtypes or CODs in individuals with SUDs is not enough to characterize clinical outcomes, and that the analysis of interactions between psychiatric categories and behavioral traits is necessary to better understand the expressions of psychiatric disorders