Antonio Verdejo García

Psychiatric comorbidity in cocaine users treated in therapeutic community: Substance-induced versus independent disorders

This is a cross-sectional study of 227 cocaine dependent individuals in six different therapeutic communities (TCs) within a single treatment network in Andalusia (Spain). The primary aim of the study is to examine the prevalence of lifetime psychiatric comorbidity in this sample using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Diagnoses were assessed 15-20 days after admission. The data indicate that more than 65% of the sample experienced a lifetime co-occurring psychiatric comorbidity. Substance-induced mood (21.6%) and psychotic (11.5%) disorders were more prevalent in this population than independent mood (12.3%) and psychotic (7.5%) disorders. These data suggest the need to introduce changes in these centers, both in the diagnostic aspects and in the treatment programs.

Diagnosing Adult Attention Deficit/Hyperactivity Disorder in Patients with Cocaine Dependence: Discriminant Validity of Barkley Executive Dysfunction Symptoms

Objective: To estimate the prevalence of adult attention deficit/hyperactivity disorder (ADHD) in a sample of cocaine-dependent patients, and to examine the discriminant validity of the Barkley’s executive dysfunction scale in differentiating cocaine-dependent patients with and without ADHD. Methods: A cross-sectional design was used. A total of 166 cocaine-dependent subjects were assessed. The assessment instruments included: Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID), Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and 9 items from Current Behavior Scale Self-Report by Russell A. Barkley. Results: 14.5% (CI95%: 9.2–19.8%) prevalence of ADHD was observed in our sample. The Barkley’s executive dysfunction items showed statistically significant differences between cocaine-dependent patients with ADHD and those patients without ADHD diagnosis. Conclusions: The study data support Barkley’s model – which posits the relevance of executive dysfunction among ADHD patients within a sample of cocaine dependents, and provides evidence of the discriminant validity of the Current Behavior Scale Self-Report for identifying ADHD symptoms in cocaine users.

Psychopathological Stability of Personality Disorders in Substance Abuse Patients Treated in a Therapeutic Community

The objective of this study is to explore the stability of personality dimensions in a selection of psychoactive substance abuse patients during treatment in therapeutic communities. The baseline assessment was conducted 15 to 20 days from the start of therapeutic community treatment, and the second assessment was conducted 3 months after admission. The Millon Clinical Multiaxial Inventory III was used to assess personality dimensions. At 3 months, a reduction was observed in the mean severity scores of most personality dimensions in both patterns and clinical syndromes. Caution should be exercised when assessing and diagnosing personality disorders in a drug addict population because one must consider the presence of abuse concomitant factors that may erroneously increase the comorbidity of personality disorders and related substance abuse disorders.

Aspectos diferenciales del riesgo de abandono al inicio del tratamiento de la adicción a la cocaína en pacientes con trastornos de la personalidad

El objetivo de este trabajo fue conocer el riesgo de abandono del tratamiento de pacientes en tratamiento por su adiccion a la cocaina en funcion de variables como la psicopatologia en el Eje II, el nivel de gravedad del ajuste psicologico o la impulsividad. La muestra estaba compuesta por 95 pacientes, de los que el 53.7 % presentaba un trastorno de la personalidad. Se utilizo una metodologia descriptiva que nos permitio conocer las correlaciones entre diferentes variables, su capacidad predictiva y las diferencias entre grupos con respecto a variables relacionadas con el abandono del tratamiento. Este trabajo muestra que el riesgo de abandono durante los dos primeros meses no viene determinado por la presencia de un trastorno de la personalidad. En relacion a los perfiles cognitivos de personalidad se comprueba que el antisocial presenta mas riesgo de abandono. El perfil de paciente con mas riesgo de abandono del tratamiento al iniciar el tratamiento presenta un menor nivel de calidad de vida autopercibida y niveles mas elevados de impulsividad, en especial la experiencia de fuertes impulsos bajo condiciones de afectos positivos. Se ha comprobado que la presencia de sentimientos adversos como afectos, emociones, sensaciones y sentimientos que afectan al paciente es la dimension que tiene un papel mas destacado en el analisis del riesgo de abandono del tratamiento. Este trabajo permite poner de relieve las variables que deben atenderse con mas especificidad desde el inicio del tratamiento porque se han relacionado mas claramente con un mayor riesgo de abandono del tratamiento.

Psychoeducation as a strategy to improve family support perceived from patient with alcohol dependence and personality disorder

The aim of this study was to prospectively analyze the impact of psychoeducation with relatives of addicted patients with personality disorders. We measured the impact of the psychoeducational intervention using a self-report questionnaire designed to assess perceived familiar support. The sample was composed by 37 patients with alcohol dependence following outpatient treatment. They underwent a cognitive-behavioral therapy relapse prevention program especially tailored for addicted individuals with comorbid personality disorders. 56.8% of patients followed individual therapy, and 43.2% followed group therapy. The relatives of the subgroup patients following group therapy simultaneously received the psychoeducational intervention. The analyses of the familiar support questionnaire across treatment showed a significant difference between groups as a function of treatment modality. Patients whose relatives followed the psychoeducational intervention had greater perception of familiar support throughout the treatment process.