Perfiles clínicos en las adicciones comportamentales en mujeres y pacientes con patología dual

[spa] La tesis se plantea como un proyecto empírico para el estudio de los mecanismos implicados en las adicciones comportamentales en grupos de alta vulnerabilidad en el espectro de las adicciones comportamentales, concretamente en mujeres con problemas asociados al Trastorno de Juego (TJ) y la Compra Compulsiva (CC), y en pacientes con patología dual (TJ con esquizofrenia). Se analizan aspectos del perfil clínico de pacientes que solicitan ayuda terapéutica en un centro de referencia para tratamiento de adicciones sin sustanciam, y se valoran los resultados que se obtienen con terapia cognitivo-conductual (TCC). El proyecto de tesis se presenta como un compendio de cuatro trabajos empíricos publicados en revistas indexadas en el Journal Citation Reports. El primer trabajo explora los perfiles de mujeres que solicitan tratamiento para el TJ, en función de un conjunto de indicadores que incluyen características sociodemográficas, rasgos de personalidad, estado clínico en el momento de la consulta y los resultados de la terapia cognitivo-conductual. El segundo artículo explora la existencia de clases empírcas latentes de mujeres con TJ y CC, en base a su evolución durante la intervención, y también identifica predictores de las diferentes trayectorias evolutivas en función de los perfiles sociodemográficos y clínicos en la línea base. El tercer estudio estima la prevalencia del diagnóstico dual (TJ con esquizofrenia) y las diferencias en los perfiles de pacientes con TJ con y sin concurrencia de esquizofrenia. El cuarto estudio utiliza metodología de redes para identificar los nodos con mayor centralidad en pacientes con patología dual, incluyendo síntomas específicos del TJ (criterios DSM-5), medidas de deterioro relacionadas con el TJ (deudas y actos ilegales), síntomas específicos de psicosis (ideación psicótica y paranoide), malestar psicopatológico global, uso de sustancias y perfil de personalidad. Los resultados de los estudios que se incluyen en esta tesis doctoral han evidenciado la existencia de tres perfiles de mujeres con TJ: a) el primero está caracterizado por niveles medios de gravedad de sintomatología del juego de apuesta y mejor funcionamiento psicopatológico; b) el segundo por niveles menores de gravedad de síntomas en el TJ y puntuaciones medias de funcionamiento psicopatológico; y c) el tercero por mayor gravedad y peor estado psicopatológico. Estos resultados evidencian la heterogeneidad que existe en el grupo de mujeres que solicitan tratamiento por TJ. Cuando se realiza un estudio de clasificación entre mujeres con TJ y problemas de CC, se identifican cuatro perfiles asociados a la progresión de la sintomatología adictiva durante la intervención con TCC. Estas trayectorias se diferencian en función del tipo de respuesta, y más concretamente por la inclusión de pacientes con alta versus baja probabilidad de abandono y/o recaída. En los estudios con pacientes que presentan patología dual de TJ con esquizofrenia, se observó que esta compleja condición clínica se asocia a género masculino, estado civil soltero, menor nivel educativo, situación laboral inactiva, desventaja económica, menor edad cronológica, inicio más temprano de los problemas de juego, peor estado psicopatológico global y perfil de personalidad más disfuncional. Además, el análisis de redes evidencia que los nodos con mayor impacto en la estructura subyacente fueron dos rasgos de personalidad: búsqueda de novedad y autotrascendencia. Este análisis también permitió identificar cuatro agrupaciones modulares de nodos, cada una de las cuales incluye información relevante sobre diferentes dominios de funcionalidad

Latent Classes for the Treatment Outcomes in Women with Gambling Disorder and Buying/Shopping Disorder

Background: The risk for behavioral addictions is rising among women within the general population and in clinical settings. However, few studies have assessed treatment effectiveness in females. The aim of this work was to explore latent empirical classes of women with gambling disorder (GD) and buying/shopping disorder (BSD) based on the treatment outcome, as well as to identify predictors of the different empirical groups considering the sociodemographic and clinical profiles at baseline. Method: A clinical sample of n = 318 women seeking treatment for GD (n = 221) or BSD (n = 97) participated. Age was between 21 to 77 years. Results: The four latent-classes solution was the optimal classification in the study. Latent class 1 (LT1, good progression to recovery) grouped patients with the best CBT outcomes (lowest risk of dropout and relapses), and it was characterized by the healthiest psychological state at baseline, the lowest scores in harm avoidance and self-transcendence, and the highest scores in reward dependence, persistence, self-directedness and cooperativeness. Latent classes 3 (LT3, bad progression to drop-out) and 4 (LT4, bad progression to relapse) grouped women with the youngest mean age, earliest onset of the addictive behaviors, and worst psychological functioning. Conclusions: GD and BSD are complex conditions with multiple interactive causes and impacts, which need wide and flexible treatment plans. Specific interventions should be designed according to the specific profiles of women for achieving early inclusion, retention and well-maintained long-term effects

Clustering treatment outcomes in women with gambling disorder

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classifcation system, was applied to a sample of n=163 women of ages ranging from 20 to 73 yearsold, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identifed. Cluster C1 (n=67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n=63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n=33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profle at preand post-treatment. Person-centered treatments should include specifc strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women

The prevalence and features of schizophrenia among individuals with gambling disorder

Background-objectives: Few studies have analyzed the comorbid presence of gambling disorder (GD) with schizophrenia, its sociodemographic correlates and clinical implications. This study estimated the prevalence of the dual diagnosis (GD with schizophrenia) and the differences in the profiles of patients with and without the dual condition. Method: The sample included n = 3,754 patients consecutively accepted for treatment for GD. Sociodemographics, gambling-related variables, psychopathological state and personality traits were assessed and compared between the groups. Results: The prevalence of schizophrenia within patients who met clinical criteria for GD was 4.4% (95% confidence interval: 3.8%-5.1%). Variables related to the dual presence of GD with schizophrenia were single marital status, lower education level, inactive working status, socioeconomic disadvantage, younger age, earlier onset of gambling problems, worse global psychopathological state and more dysfunctional personality profile (higher level in harm avoidance and lower level in cooperativeness, reward dependence, persistence and selfdirectedness). Conclusion: The presence of schizophrenia among patients with GD was around 4 times higher than the prevalence rate estimated in the reference general population. The differences in the profiles of GD patients with and without schizophrenia suggest that individuals with the dual diagnosis condition require unique assessment considerations and tailored treatment interventions specifically designed for the clinical and functioning higher risk

Women and gambling disorder: Assessing dropouts and relapses in cognitive behavioral group therapy

Background: Gender-specific literature focused on gambling disorder (GD) is scarce, and women with GD have been understudied. Therefore, the aim of this study was to estimate the short-term effectiveness in women with GD (n = 214) of a group standardized cognitive-behavioral therapy (CBT) and to identify the most relevant predictors of the primary therapy outcomes (dropout and relapse). Methods: The manualized CBT consisted of 16 weekly outpatient group sessions. Women were provided with resources to obtain a better understanding of the GD, to improve self-control and to manage risk situations. Results: The dropout risk was higher for women with lower GD severity and higher psychopathological distress. Among other factors, lower education levels were a significant predictor of the relapse risk and and the frequency of relapses was higher for divorced women with a preference for non-strategic gambling and with substances consumption. Conclusions: Our findings evidence women-specific predictors of the primary therapy outcomes. The results highlight the need to design psychological interventions that address dropout and relapse risk factors in women

Network Analysis of the Structure of the Core Symptoms and Clinical Correlates in Comorbid Schizophrenia and Gambling Disorder

Altres ajuts: Delegación del Gobierno para el Plan Nacional sobre Drogas (2019I47 and 2021I031). CIBER Fisiología Obesidad y Nutrición (CIBERobn) is an initiative of Intituto de Salud Carlos III. ZD's contribution was supported by the Hungarian National Research, Development and Innovation Ofce (KKP126835, K131635).The online version contains supplementary material available.Few studies have analyzed the clinical profle of treatment-seeking patients with the comorbid presence of schizophrenia (SCZ) and gambling disorder (GD), which warrants new research to assess the network structure of this complex mental condition. The aim of this study was to explore the organization of the symptoms and other clinical correlates of SCZ with GD. Network analysis was applied to a sample of N = 179 SCZ patients (age range: 19-70 years, mean=39.5, SD=9.9) who met clinical criteria for gambling disorder-related problems. Variables included in the network were the core GD symptoms according to the DSM-5, psychotic and paranoid ideation levels, global psychological distress, GD severity measures (debts and illegal behavior related with gambling), substances (tobacco, alcohol, and illegal drugs), and personality profle. The nodes with the highest authority in the network (variables of highest relevance) were personality traits and psychological distress. Four empirical modules/clusters were identifed, and linkage analysis identifed the nodes with the highest closeness (bridge nodes) to be novelty seeking and reward dependence (these traits facilitate the transition between the modules). Identifcation of the variables with the highest centrality/linkage can be particularly useful for developing precise management plans to prevent and treat SCZ with GD

Motherhood and Treatment Outcome in Female Patients with Compulsive Buying-Shopping Disorder

Motherhood has been proposed as an internal facilitating factor for the recovery of women with mental disorders. However, at the same time, there are significant barriers that may be interfering with the access and adherence to treatment for these women. The present longitudinal study aimed to deepen the sociodemographic and clinical profile of women with children and compulsive buying-shopping disorder (CBSD), and to explore the association between motherhood and response to treatment. The total sample included 77 women with a diagnosis of CBSD (n = 49 mothers) who received cognitive behavioral therapy (CBT) for 12 weeks. No association between psychopathology and motherhood was observed. The group of mothers reported an older age of onset of the CBSD, a lower amount of money spent per compulsive-buying episode, and a higher likelihood of family support for the CBSD. Moreover, this group showed lower risk of relapse. The findings support the theoretical proposal that considers motherhood as an internal facilitating factor for recovery and treatment adherence of mothers with addictions