Evaluación de una entrevista de cribado para la detección de comorbilidad psiquiátrica en sujetos consumidores de sustancias de abuso

Antecedentes: La prevalencia de trastornos psiquiátricos es elevada entre los consumidores de sustancias de abuso, esto tiene importantes consecuencias en el pronóstico y, además, su diagnóstico es problemático. La Psychiatric Research Interview for Substance and Mental Disorders (PRISM para DSM-IV) es un instrumento útil, válido y fiable para el diagnóstico psiquiátrico entre los consumidores de sustancias de abuso. Sin embargo, su administración puede durar 2-3 horas y requiere de un especialista en salud mental entrenado. Este estudio evaluó la sensibilidad y la especificidad de un nuevo instrumento de cribado, la Entrevista de Cribado de Diagnóstico Dual (ECDD) para la detección de comorbilidad psiquiátrica entre los consumidores de sustancias de abuso, en centros asistenciales y no asistenciales. Sujetos y métodos: Se evaluaron un total de 827 consumidores de sustancias (66,4% varones, edad media de 28,55 ± 9,87 años) con la PRISM y una versión modificada de la sección de cribado de la CIDI (Composite International Diagnostic Interview) S-CIDI para obtener el nuevo instrumento de cribado. La ECDD fue administrada de manera ciega a los resultados de la PRISM. Los diagnósticos obtenidos con la ECDD se compararon con los diagnósticos a lo largo de la vida obtenidos con el PRISM. También se analizaron la sensibilidad, especificidad, valores predictivos negativos y positivos de la nueva entrevista. Resultados: La ECDD mostró una alta sensibilidad y especificidad (iguales o superiores al 80%) en todos los diagnósticos. Se necesitan 20 minutos para administrar la ECDD después de un corto entrenamiento en su administración. Conclusiones: La ECDD es una entrevista de cribado válida para la detección de comorbilidad psiquiátrica en consumidores de drogas.Background: The prevalence of psychiatric disorders is high among substance users, this has important implications for prognosis and further diagnosis is problematic. The Psychiatric Research Interview for Substance and Mental Disorders (DSM-IV PRISM) is a useful, valid and reliable psychiatric diagnosis interview among substance users. However, its administration can last 2-3 hours and requires a trained mental health specialist. This study evaluated the sensitivity and specificity of a new screening instrument, the Diagnostic Screening Interview Dual (ECDD) for the detection of psychiatric comorbidity among substance users in primary care facilities . Subjects and methods: We evaluated a total of 827 drug users (66.4% male, mean age 28.55 ± 9.87 years) with the PRISM and a modified version of the screening section of the CIDI (Composite International Diagnostic Interview) S -CIDI to get the new screening tool. The ECDD was administered blindly to the results of the PRISM. The diagnoses obtained with the ECDD diagnoses were compared over the life diagnoses obtained with the PRISM. We also analyzed the sensitivity, specificity, positive and negative predictive values of the new interview. Results: The ECDD showed high sensitivity and specificity (greater than or equal to 80%) in all diagnoses. It takes 20 minutes to administer ECDD after a short training in its administration. Conclusions: The ECDD is a valid screening for the detection of psychiatric comorbidity among drug users.Antecedents: La prevalença de trastorns psiquiàtrics és elevada entre els consumidors de substàncies d'abús, això té importants conseqüències en el pronòstic i, a més, el seu diagnòstic és problemàtic. La Psychiatric Research Interview for Substance and Mental Disorders (PRISM per DSM-IV) és un instrument útil, vàlid i fiable per al diagnòstic psiquiàtric entre els consumidors de substàncies d'abús. No obstant això, la seva administració pot durar 2-3 hores i requereix d'un especialista en salut mental entrenat. Aquest estudi va avaluar la sensibilitat i l'especificitat d'un nou instrument de cribratge, la Entrevista de Cribratge de Diagnòstic Dual (ECDD) per a la detecció de comorbiditat psiquiàtrica entre els consumidors de substàncies d'abús, en centres assistencials i no assistencials. Subjectes i mètodes: Es van avaluar un total de 827 consumidors de substàncies (66,4% homes, edat mitjana de 28,55 ± 9,87 anys) amb la PRISM i una versió modificada de la secció de cribratge de la CIDI (Composite International Diagnostic Interview) S -CIDI per obtenir el nou instrument de cribratge. La ECDD va ser administrada de manera cega als resultats de la PRISM. Els diagnòstics obtinguts amb la ECDD es van comparar amb els diagnòstics al llarg de la vida obtinguts amb el PRISM. També es van analitzar la sensibilitat, especificitat, valors predictius negatius i positius de la nova entrevista. Resultats: La ECDD va mostrar una alta sensibilitat i especificitat (iguals o superiors al 80%) en tots els diagnòstics. Es necessiten 20 minuts per administrar la ECDD després d'un curt entrenament en la seva administració. Conclusions: La ECDD és una entrevista de cribratge vàlida per a la detecció de comorbiditat psiquiàtrica en consumidors de drogues

Patología dual en Depresión: recomendaciones en el tratamiento

Comorbidity between substance use disorders (SUD) and major depression (MD) is the most common dual pathology in the field of addiction to substances and has prevalence rates ranging between 12% and 80%, which complicates the response to treatment and worsens the prognosis of patients. Differentiating between diagnoses of induced depressive episodes and primary depressive episodes concurrent to substance use is especially relevant for therapeutic management. This article presents the state of the art of the currently available pharmacologic treatments of comorbid depression in patients with SUD, taking into account the safety and risk of abuse of antidepressant drugs. Due to the fact that comorbidity of MD and SUD is frequent and presents greater psychopathological and medical severity, as well as worse social functioning, it is crucial to treat MD and SUD simultaneously using the integrated treatment model and not to treat both conditions separatel

Evaluación de una entrevista de cribado para la detección de comorbilidad psiquiátrica en sujetos consumidores de sustancias de abuso

Antecedentes: La prevalencia de trastornos psiquiátricos es elevada entre los consumidores de sustancias de abuso, esto tiene importantes consecuencias en el pronóstico y, además, su diagnóstico es problemático. La Psychiatric Research Interview for Substance and Mental Disorders (PRISM para DSM-IV) es un instrumento útil, válido y fiable para el diagnóstico psiquiátrico entre los consumidores de sustancias de abuso. Sin embargo, su administración puede durar 2-3 horas y requiere de un especialista en salud mental entrenado. Este estudio evaluó la sensibilidad y la especificidad de un nuevo instrumento de cribado, la Entrevista de Cribado de Diagnóstico Dual (ECDD) para la detección de comorbilidad psiquiátrica entre los consumidores de sustancias de abuso, en centros asistenciales y no asistenciales. Sujetos y métodos: Se evaluaron un total de 827 consumidores de sustancias (66,4% varones, edad media de 28,55 ± 9,87 años) con la PRISM y una versión modificada de la sección de cribado de la CIDI (Composite International Diagnostic Interview) S-CIDI para obtener el nuevo instrumento de cribado. La ECDD fue administrada de manera ciega a los resultados de la PRISM. Los diagnósticos obtenidos con la ECDD se compararon con los diagnósticos a lo largo de la vida obtenidos con el PRISM. También se analizaron la sensibilidad, especificidad, valores predictivos negativos y positivos de la nueva entrevista. Resultados: La ECDD mostró una alta sensibilidad y especificidad (iguales o superiores al 80%) en todos los diagnósticos. Se necesitan 20 minutos para administrar la ECDD después de un corto entrenamiento en su administración. Conclusiones: La ECDD es una entrevista de cribado válida para la detección de comorbilidad psiquiátrica en consumidores de drogas.Background: The prevalence of psychiatric disorders is high among substance users, this has important implications for prognosis and further diagnosis is problematic. The Psychiatric Research Interview for Substance and Mental Disorders (DSM-IV PRISM) is a useful, valid and reliable psychiatric diagnosis interview among substance users. However, its administration can last 2-3 hours and requires a trained mental health specialist. This study evaluated the sensitivity and specificity of a new screening instrument, the Diagnostic Screening Interview Dual (ECDD) for the detection of psychiatric comorbidity among substance users in primary care facilities . Subjects and methods: We evaluated a total of 827 drug users (66.4% male, mean age 28.55 ± 9.87 years) with the PRISM and a modified version of the screening section of the CIDI (Composite International Diagnostic Interview) S -CIDI to get the new screening tool. The ECDD was administered blindly to the results of the PRISM. The diagnoses obtained with the ECDD diagnoses were compared over the life diagnoses obtained with the PRISM. We also analyzed the sensitivity, specificity, positive and negative predictive values of the new interview. Results: The ECDD showed high sensitivity and specificity (greater than or equal to 80%) in all diagnoses. It takes 20 minutes to administer ECDD after a short training in its administration. Conclusions: The ECDD is a valid screening for the detection of psychiatric comorbidity among drug users.Antecedents: La prevalença de trastorns psiquiàtrics és elevada entre els consumidors de substàncies d'abús, això té importants conseqüències en el pronòstic i, a més, el seu diagnòstic és problemàtic. La Psychiatric Research Interview for Substance and Mental Disorders (PRISM per DSM-IV) és un instrument útil, vàlid i fiable per al diagnòstic psiquiàtric entre els consumidors de substàncies d'abús. No obstant això, la seva administració pot durar 2-3 hores i requereix d'un especialista en salut mental entrenat. Aquest estudi va avaluar la sensibilitat i l'especificitat d'un nou instrument de cribratge, la Entrevista de Cribratge de Diagnòstic Dual (ECDD) per a la detecció de comorbiditat psiquiàtrica entre els consumidors de substàncies d'abús, en centres assistencials i no assistencials. Subjectes i mètodes: Es van avaluar un total de 827 consumidors de substàncies (66,4% homes, edat mitjana de 28,55 ± 9,87 anys) amb la PRISM i una versió modificada de la secció de cribratge de la CIDI (Composite International Diagnostic Interview) S -CIDI per obtenir el nou instrument de cribratge. La ECDD va ser administrada de manera cega als resultats de la PRISM. Els diagnòstics obtinguts amb la ECDD es van comparar amb els diagnòstics al llarg de la vida obtinguts amb el PRISM. També es van analitzar la sensibilitat, especificitat, valors predictius negatius i positius de la nova entrevista. Resultats: La ECDD va mostrar una alta sensibilitat i especificitat (iguals o superiors al 80%) en tots els diagnòstics. Es necessiten 20 minuts per administrar la ECDD després d'un curt entrenament en la seva administració. Conclusions: La ECDD és una entrevista de cribratge vàlida per a la detecció de comorbiditat psiquiàtrica en consumidors de drogues

Dual disorders in the consultation liaison addiction service: Gender perspective and quality of life

Dual disorders (DD) and gender differences comprise an area of considerable concern in patients with substance use disorder (SUD). This study aims to describe the presence of DD among patients with SUD admitted to a general hospital and attended by a consultation liaison addiction service (CLAS), in addition to assessing its association with addiction severity and quality of life from a gender perspective, between 1 January and 30 September 2020. The dual diagnosis screening interview (DDSI), the severity of dependence scale (SDS), and the WHO well-being index were used to evaluate the patients. In the overall sample, DD prevalence was 36.8%, (women: 53.8% vs. men: 32.7%, NS). In both genders the most prevalent DD was depression (33.8%, women: 46.2% vs. men: 30.9%, p = 0.296). Women presented more panic disorders (46.2% vs. 12.7%, p = 0.019) and generalized anxiety (38.5% vs. 10.9%, p = 0.049) than men. When DD was present, women had worse quality of life than men (21.7 vs. 50 points, p = 0.02). During lockdown period 77 patients were attended to and 13 had COVID-19 infection, with no differences in relation to sociodemographic and consumption history variables. The study confirms a high prevalence of DD among patients with SUD admitted to a general hospital for any pathology, and its being associated with worse quality of life, particularly in women

CANreduce-SP-adding psychological support to web-based adherence-focused guided self-help for cannabis users: study protocol for a three-arm randomized control trial

Background: cannabis is the most-frequently used illicit drug in Europe. Over the last few years in Spain, treatment demand has increased, yet most cannabis users do not seek treatment despite the related problems. A web-based self-help tool, like CANreduce 2.0, could help these users to control their consumption. Methods: this study protocol describes a three-arm randomized controlled trial (RCT) comparing the effectiveness of three approaches, in terms of reducing cannabis use among problematic cannabis users, the first two treatment arms including the Spanish version of CANreduce 2.0 (an adherence-focused, guidance-enhanced, web-based self-help tool) (1) with and (2) without psychological support; and the third group (3) treatment as usual (TAU). Study hypotheses will be tested concerning the primary outcome: change in the number of days of cannabis use over the previous week, comparing assessments at 6 weeks and 3 and 6 months follow-up between groups and against baseline. Secondary outcomes related to cannabis use will be tested similarly. Mental disorders will be explored as predictors of adherence and outcomes. Analyses will be performed on an intention-to-treat basis, then verified by complete case analyses.tDiscussion: this study will test how effective the Spanish version of CANreduce 2.0 (CANreduce-SP) is at reducing both the frequency and quantity of cannabis use in problematic users and whether adding psychological support increases its effectiveness

Violencia de género en mujeres con consumo de sustancias ingresadas en el hospital general: cribado y prevalencia

La violencia de género (VG) es un problema de salud pública a escala mundial. Existen determinados factores asociados a un aumento de la prevalencia, como el consumo de sustancias. Se realizó un estudio transversal con el objetivo de determinar la prevalencia de VG en las mujeres que ingresaron en el Hospital del Mar (Barcelona) por cualquier motivo médico/quirúrgico y con el diagnóstico de trastorno por consumo de sustancias. Secundariamente, se pretendió validar la versión en español del cuestionario Hurt, Insulted, Threatened with Harm, Screamed (HITS). Se evaluaron a todas las pacientes mediante dos cuestionarios de detección de VG, el Composite Abuse Scale (CAS) y el HITS. De las 52 pacientes entrevistadas durante el período de estudio, 46 respondieron ambos cuestionarios. Según el cuestionario CAS, 23 pacientes (50%) presentaron VG alguna vez en la vida y 11 (23,9%) en el último año. El consumo de cannabis se asoció a una mayor gravedad de la VG (IC95% 3,5-28,9, p = .013). La prevalencia de VG, según el HITS, fue de 39,1% (18 pacientes) en los últimos 12 meses. El HITS mostró en relación al CAS una especificidad del 100% y una sensibilidad del 78%. Un punto de corte x∈ [6,7], obtenido mediante el análisis ROC, fue el que mejor discriminó al 91% de las víctimas y al 100% de las no-víctimas. Los resultados obtenidos demostraron una elevada prevalencia de VG entre las mujeres consumidoras de más de una sustancia de abuso. Por ese motivo, se recomienda incorporar el cribado sistemático mediante el cuestionario HITS.Intimate partner violence (IPV) is a public health problem worldwide. Several factors have been found to be associated with an increased prevalence of IPV, such as substance use. A cross-sectional study was conducted with the aim of determining the prevalence of IPV among women entering Hospital del Mar (Barcelona) for any medical/surgical reason, and who had a diagnosis of substance use disorder. Secondly, it was intended to psychometrically validate the Spanish version of the Hurt, Insulted, Threatened with Harm, Screamed (HITS) questionnaire. All patients were assessed by two IPV questionnaires, the Composite Abuse Scale (CAS) and HITS. Out of 52 patients interviewed, 46 answered both questionnaires. According to the CAS questionnaire, 23 patients (50%) experienced IPV at some point in their lives and 11 (23.9%) in the last year. Cannabis consumption was also associated with an increased severity of IPV (95% CI 3.5-28.9, p = .013).According to the HITS questionnaire, there was a prevalence of 39.1% (18 patients) in the last 12 months. HITS had a specificity of 100% and a sensitivity of 78% relative to the CAS questionnaire. A cut-off score x∈ [6.7], derived through ROC analysis, correctly discriminated 91% of the victims and 100% of the non-victims. The results obtained showed that the prevalence of IPV was very high among women who suffered from more than one substance use disorder. Therefore, it is highly recommended to systematically screen for IPV victimization by putting the HITS questionnaire into practice.Este trabajo fue parcialmente financiado por el proyecto: RD12/0028/009 del Fondo de Investigaciones Sanitarias, Instituto Carlos III-FEDER y la AGAUR (2014 SGR790

Violencia de género en mujeres con consumo de sustancias ingresadas en el hospital general: cribado y prevalencia

La violencia de género (VG) es un problema de salud pública a escala mundial. Existen determinados factores asociados a un aumento de la prevalencia, como el consumo de sustancias. Se realizó un estudio transversal con el objetivo de determinar la prevalencia de VG en las mujeres que ingresaron en el Hospital del Mar (Barcelona) por cualquier motivo médico/quirúrgico y con el diagnóstico de trastorno por consumo de sustancias. Secundariamente, se pretendió validar la versión en español del cuestionario Hurt, Insulted, Threatened with Harm, Screamed (HITS). Se evaluaron a todas las pacientes mediante dos cuestionarios de detección de VG, el Composite Abuse Scale (CAS) y el HITS. De las 52 pacientes entrevistadas durante el período de estudio, 46 respondieron ambos cuestionarios. Según el cuestionario CAS, 23 pacientes (50%) presentaron VG alguna vez en la vida y 11 (23,9%) en el último año. El consumo de cannabis se asoció a una mayor gravedad de la VG (IC95% 3,5-28,9, p = .013). La prevalencia de VG, según el HITS, fue de 39,1% (18 pacientes) en los últimos 12 meses. El HITS mostró en relación al CAS una especificidad del 100% y una sensibilidad del 78%. Un punto de corte x∈ [6,7], obtenido mediante el análisis ROC, fue el que mejor discriminó al 91% de las víctimas y al 100% de las no-víctimas. Los resultados obtenidos demostraron una elevada prevalencia de VG entre las mujeres consumidoras de más de una sustancia de abuso. Por ese motivo, se recomienda incorporar el cribado sistemático mediante el cuestionario HITS.Intimate partner violence (IPV) is a public health problem worldwide. Several factors have been found to be associated with an increased prevalence of IPV, such as substance use. A cross-sectional study was conducted with the aim of determining the prevalence of IPV among women entering Hospital del Mar (Barcelona) for any medical/surgical reason, and who had a diagnosis of substance use disorder. Secondly, it was intended to psychometrically validate the Spanish version of the Hurt, Insulted, Threatened with Harm, Screamed (HITS) questionnaire. All patients were assessed by two IPV questionnaires, the Composite Abuse Scale (CAS) and HITS. Out of 52 patients interviewed, 46 answered both questionnaires. According to the CAS questionnaire, 23 patients (50%) experienced IPV at some point in their lives and 11 (23.9%) in the last year. Cannabis consumption was also associated with an increased severity of IPV (95% CI 3.5-28.9, p = .013).According to the HITS questionnaire, there was a prevalence of 39.1% (18 patients) in the last 12 months. HITS had a specificity of 100% and a sensitivity of 78% relative to the CAS questionnaire. A cut-off score x∈ [6.7], derived through ROC analysis, correctly discriminated 91% of the victims and 100% of the non-victims. The results obtained showed that the prevalence of IPV was very high among women who suffered from more than one substance use disorder. Therefore, it is highly recommended to systematically screen for IPV victimization by putting the HITS questionnaire into practice.Este trabajo fue parcialmente financiado por el proyecto: RD12/0028/009 del Fondo de Investigaciones Sanitarias, Instituto Carlos III-FEDER y la AGAUR (2014 SGR790

A gender perspective of addictive disorders

Purpose of review: Substance use disorders (SUD) affect differentially women and men. Although the prevalence has been reported higher in men, those women with addictive disorders present a more vulnerable profile and are less likely to enter treatment than men. The aim of this paper is to present an overview of how sex and gender may influence epidemiology, clinical manifestations, social impact, and the neurobiological basis of these differences of women with SUD, based on human research. Recent findings: The differences in prevalence rates between genders are getting narrower; also, women tend to increase the amount of consumption more rapidly than men, showing an accelerated onset of the SUD (telescoping effect). In respect to clinical features, the most important differences are related to the risk of experience psychiatric comorbidity, the exposure to intimate partner violence, and the associated high risks in sexual and reproductive health; and those who are mothers and addicted to substances are at risk of losing the custody of children accumulating more adverse life events. Some of these differences can be based on neurobiological differences: pharmacokinetic response to substances, sensitivity to gonadal hormones, differences in neurobiological systems as glutamate, endocannabinoids, and genetic differences. Summary: Specific research in women who use drugs is very scarce and treatments are not gender-sensitive oriented. For these reasons, it is important to guarantee access to the appropriate treatment of women who use drugs and a need for a gender perspective in the treatment and research of substance use disorders

BDNF and cortisol in the diagnosis of cocaine-induced depression

Background: Major depressive disorder (MDD) and cocaine use disorder (CUD) are related with disability and high mortality rates. The assessment and treatment of psychiatric comorbidity is challenging due to its high prevalence and its clinical severity, mostly due to suicide rates and the presence of medical comorbidities. The aim of this study is to investigate differences in brain derived neurotrophic factor (BDNF) and cortisol plasmatic levels in patients diagnosed with CUD-primary-MDD and CUD-induced-MDD and also to compare them to a sample of MDD patients (without cocaine use), a sample of CUD (without MDD), and a group of healthy controls (HC) after a stress challenge. Methods: A total of 46 subjects were included: MDD (n = 6), CUD (n = 15), CUD-primary-MDD (n = 16), CUD-induced-MDD (n = 9), and 21 HC. Psychiatric comorbidity was assessed with the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders IV (PRISM-IV), and depression severity was measured with the Hamilton Depression Rating Scale (HDRS). Patients were administered the Trier Social Stress Test (TSST) before and after the biological measures, including BDNF, and cortisol levels were obtained. Results: After the TSST, Cohen's d values between CUD-primary-MDD and CUD-induced-MDD increased in each assessment from 0.19 post-TSST to 2.04 post-90-TSST. Pairwise differences among CUD-induced-MDD and both MDD and HC groups had also a large effect size value in post-30-TSST and post-90-TSST. In the case of the BDNF concentrations, CUD-primary-MDD and CUD-induced-MDD in post-90-TSST (12,627.27 ± 5488.09 vs.17,144.84 ± 6581.06, respectively) had a large effect size (0.77). Conclusion: Results suggest a different pathogenesis for CUD-induced-MDD with higher levels of cortisol and BDNF compared with CUD-primary-MDD. Such variations should imply different approaches in treatment.This work was supported by grants from the Instituto de Salud Carlos III–ISCIII Red de Trastornos Adictivos 2016 (RD16/0017/0010 and RD16/0017/0003); Fondo de Investigación Sanitaria (FIS) (PI09/02121, PI12/01838, PI16/00603); National R + D+I and funded by the Instituto de Salud Carlos III (ISCIII) and the European Regional Development Fund (FEDER) grant Juan Rodes (JR 16/00020); Ministerio de Sanidad, Política Social e Igualdad, Plan Nacional Sobre Drogas (PNSD) (2012I054); Suport Grups de Recerca AGAUR-Gencat (2017 SGR 316, 2017 SGR 530); Ministerio de Economía y Competitividad (MTM2015-64465-C2-1-R); ISCIII-Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS); Red de Investigación en Atención Primaria de Adicciones (RIAPAd), grant number RD21/0009/0001. The funding agencies had no role in study design, data collection, interpretation, and no influence on the writing