Miguel Pérez 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.

Neuropsychological Evaluation of Everyday Memory

The evaluation of everyday memory (EM) was reviewed and reconceptualized. EM has established new objectives of study and the development of new methods to reach these objectives . At the basic level, this approach has already produced important discoveries and the development of new principles about memory and functioning. At the clinical level, this new area of investigation has resulted in evaluating deficits of EM, which is defined as what daily life functions remain impaired after a deficit pathology has occurred. A type of evaluation has evolved that is oriented toward treatment and extremely useful in designing rehabilitation programs for individuals with alterations in memory.

Variables modulating stress and coping that discriminate drug consumers from low or nondrug consumers.

The present study assesses how certain stress and coping variables relate to drug use. A total of 124 subjects (85 men, 39 women) took part. They were divided into two groups: consumers and low or nonconsumers. Results indicate that consumers show significantly lower scores in self-control than low or nonconsumers. This research is of interest because it analyzes the relationship among assertiveness, self-control, self-efficacy, and drug use. We consider it worthwhile to take these variables into account when planning prevention 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.

The impacts of maternal iron deficiency and being overweight during pregnancy on neurodevelopment of the offspring

Both maternal Fe deficiency (ID) and being overweight or obese (Ow/Ob, BMI≥25 kg/m2) may negatively affect offspring brain development. However, the two risk factors correlate and their independent effects on infant neurodevelopment are unclear. PREOBE is a prospective observational study that included 331 pregnant Spanish women, of whom 166 had pre-gestational Ow/Ob. Fe status was analysed at 34 weeks and at delivery, and babies were assessed using Bayley III scales of neurodevelopment at 18 months. In confounder-adjusted analyses, maternal ID at 34 weeks was associated with lower composite motor scores at 18 months (mean 113·3 (sd 9·9) v. 117·1 (sd 9·2), P=0·039). Further, the offspring of mothers with ID at delivery had lower cognitive scores (114·0 (sd 9·7) v. 121·5 (sd 10·9), P=0·039) and lower receptive, expressive and composite (99·5 (sd 8·6) v. 107·6 (sd 8·3), P=0·004) language scores. The negative associations between maternal ID at delivery and Bayley scores remained even when adjusting for maternal Ow/Ob and gestational diabetes. Similarly, maternal Ow/Ob correlated with lower gross motor scores in the offspring (12·3 (sd 2·0) v. 13·0 (sd 2·1), P=0·037), a correlation that remained when adjusting for maternal ID. In conclusion, maternal ID and pre-gestational Ow/Ob are both negatively associated with Bayley scores at 18 months, but independently and on different subscales. These results should be taken into account when considering Fe supplementation for pregnant women.

Association between executive function and outcome measure of treatment in therapeutic community among cocaine dependent individuals

The aim of this study was to examine the association between baseline executive functioning and outcome measure of treatment in 226 cocaine dependent individuals who initiated treatment in therapeutic communities TCs. The study was conducted across six TCs located in the region of Andalusia (southern Spain). Neuropsychological testing included tests of working memory, reasoning, inhibition, switching, attention interference and decision making. The outcome measures were type of discharge (treatment dropout vs. therapeutic discharge) and clinical impression of the TC outcome (clinically significant vs. non-significant changes). In the present study a prospective comparative design was used. We found significant performance differences on selective executive components which account for the type of discharge: treatment quitters had poorer attention response inhibition and attention switching than non-quitters, and the individuals who failed to achieve therapeutic objectives had poorer attention interference and inhibitory control than compliers. No significant differences were found between the outcome measure and the neuropsychological performance score on the other tasks. The results provide important information about the impact of executive components on in-treatment follow-up outcomes among dependence disorders in TC.

Colestasis intrahepática del embarazo: diagnóstico y manejo

Resumen La colestasis intrahepatica del embarazo es una forma reversible no obstructiva de colestasis intrahepatica. Los acidos biliares son eliminados de forma incompleta por el higado de las gestantes, lo que aumenta sus concentraciones en sangre y liquido amniotico. Es una patologia benigna para la gestante que se asocia con un incremento de la muerte fetal intrautero.

Validation of neuropsychological consequences in victims of intimate partner violence in a Spanish population using specific effort tests

Abstract Neuropsychological consequences in female survivors of intimate partner violence are being used in courts as evidence of acquired injury and for criminal exculpation. To support the validity of neuropsychological test performance and the veracity of victim testimony, effort tests can be used by expert witnesses. Nevertheless, no study has evaluated whether the two principle types of effort tests, Symptom validity tests or Performance validity tests, are most adequate for this population. The study’s objective was to compare the false positive rates of a Performance validity test (Test of Memory Malingering: TOMM) and a Symptom validity test (Structured Inventory of Malingered Symptomatology: SIMS). The sample included 68 female intimate partner violence victims and 40 control females. SIMS showed a significantly higher rate of false positives in victims on four of five subtests, reaching a 59.3% in the total score. There were 0% false positives in both groups on the TOMM. Findings indicate that the SIMS may incorrectly score female IPV victims, undermining the victim’s testimony in judicial cases.