Miquel Monras

Attrition in group therapy with alcoholics: a survival analysis

Three hundred and twenty-nine alcohol dependent patients, diagnosed according to DSM. III-R criteria who had participated in one of five different psychotherapy groups over a 5-year period, were studied using survival analysis statistics. Patients were followed-up until their discharge or withdrawal from the group to determine their retention in therapy, and to examine the effect of gender, age and family situation on compliance. Retention rates at 6, 12 and 24 months were 61%, 49% and 37%, respectively. Median retention time was 46 weeks. Women remained longer in treatment than men (median period 98 vs. 34 weeks), and this was due mainly to lower dropout rates in the first 3 months. Dropout rates were also higher in patients aged 35 years or younger. The first 3 months seem to be crucial in the process of deciding whether or not to remain in therapy.

Guía clínica de evaluación de pacientes con conductas adictivas para trasplante hepático

Liver transplantation is the only effective treatment for advanced cirrhosis. Nevertheless, the number of potential recipients far exceeds that of available donors. Therefore, liver transplant candidates must be carefully selected to optimize donor utilization. Candidate selection is complex in patients with addictive and/or psychopathological disorders. Alcohol consumption causes one-third of advanced liver disease in our environment and comorbid consumption of other addictive substances is frequent in these patients. The use or abuse of these substances in transplant recipients can be associated with graft loss. Despite the importance of this subject, there is no well established protocol in our environment for the evaluation and selection of candidates with addictive and/or psychopathological disorders. Therefore, a specific diagnostic and therapeutic strategy must be established for these patients. Hospital Clínic in Barcelona has an active liver transplantation program (90 transplantations in 2007). Since the start of this program in 1988, candidates with addictive and/or psychopathological disorders have been evaluated jointly by the Hepatology Service and Alcohol Unit, including psychiatrists, psychologists and social workers. We present the protocol approved by the Committee for Liver Transplantation and the Ethics Committee of Hospital Clínic in 2007 for the evaluation, selection and follow-up of transplant candidates with addictive and/or psychopathological disorders. This protocol includes a description of the evaluation process and defines the inclusion and exclusion criteria with respect to consumption of toxic substances, the social and family situation and psychiatric disorders. In addition, recommendations for the follow-up of these patients are provided.

Alcoholismo en el hospital general: detección y tratamiento

Fundamento y objetivo Estudiar la deteccion y el tratamiento de los pacientes alcoholicos ingresados en hospitales generales. Pacientes y metodo Se han efectuado analisis de las 212 interconsultas por consumo de alcohol recibidas en una unidad de alcohologia durante 1998 y una comparacion con la prevalencia estimada. Resultados El 80% de las interconsultas se concentran en 4 servicios y no llegan al 3% de sus ingresos. El 72% presenta trastornos psicosociales, el 46% ingresos y el 21%, interconsultas previas. No se ofrece tratamiento tras el alta al 20% de los enfermos debido al deterioro psicosocial y organico, mientras que un 17% lo rechaza. Conclusiones En los hospitales se detectan alcoholicos en fases avanzadas de su dependencia alcoholica, sujetos a tratamientos ambulatorios poco efectivos. Los alcoholicos menos graves, que podrian obtener tratamientos eficaces, son infradetectados.

Características de personalidad en pacientes alcohÓlicos candidatos a trasplante hepático

BACKGROUND AND OBJECTIVE: Although the characteristics of personality have been scarcely investigated in alcoholic patients who are candidates for liver transplantation (LT), a psychopathological evaluation is necessary in them. PATIENTS AND METHOD: The personality questionnaire Mini-Mult was administered to 53 alcoholic and 20 non-alcoholic patients who were candidates for LT, and was re-administered to 18 alcoholic and 4 non-alcoholic patients at 1-3 months after LT. RESULTS: Abnormal values in at least 1 of the 8 clinical Mini-Mult scales were observed in 62% of alcoholic patients. However, no significant differences were observed between alcoholic and non-alcoholic patients in relation to the intensity and frequency of abnormal Mini-Mult values. In those alcoholic patients re-evaluated shortly after transplantation, there was not a significant improvement in any of the Mini-Mult scales, with the exception of scale K (self-image). CONCLUSIONS: Alcoholic patients candidates for LT show common alterations in some areas of the personality but the intensity is moderate and without significant differences with respect to non-alcoholic patients also evaluated as candidates for LT.

Causas de los ingresos en prisión por delitos contra la seguridad vial: ¿enfermedad o irresponsabilidad?

principal mecanismo de eliminación es la glucuronidación mediada por la UGT1A1. Dado que el raltegravir no es sustrato de ninguna de las enzimas del citocromo P450, ni inductor o inhibidor de las mismas, no serı́a esperable que se produjeran interacciones entre dicho fármaco y aquellos que son sustratos del citocromo P450. En conclusión, en esta paciente la administración conjunta de benznidazol y tratamiento antirretroviral basado en raltegravir ha sido segura y eficaz. En ausencia de información sobre las interacciones entre benznidazol y TARGA parece recomendable evitar regı́menes que incluyan IP e ITINAN a fin de prevenir la ausencia de eficacia del benznidazol y evitar la aparición de toxicidad relacionada con él. La posibilidad de poder usar conjuntamente benznidazol y tratamientos antirretrovirales que incluyan raltegravir tiene importantes implicaciones en la práctica clı́nica.

Enfermedades relacionadas con el consumo de alcohol: seguimiento a los dos años de la hospitalización

Fundamento y objetivo Analizar la evolucion y el cumplimiento del tratamiento medico y alcohologico postalta de los pacientes con alcoholismo identificados en un hospital general. Pacientes y metodo Estudio de cohorte prospectivo a 2 anos de las 100 interconsultas solicitadas durante el primer semestre de 1998 por problemas medicos relacionados con el consumo de alcohol. Resultados Habian fallecido 9 pacientes y se habia derivado a 14 a otros recursos asistenciales. El cumplimiento del tratamiento medico 2 anos despues del ingreso era del 46% y el del alcohologico, del 10%. El rechazo desde el principio fue del 15 y el 31% respectivamente. Todos los pacientes que han seguido el tratamiento alcohologico tambien cumplen con el medico. La probabilidad de supervivencia en el tratamiento alcohologico a los 2 anos es del 19%, y es mayor entre los pacientes que han tenido interconsultas previas o trastornos psicosociales. La probabilidad de mantenerse vivo es del 86,9%. Conclusiones Se identifica a pocos pacientes con alcoholismo y de elevada gravedad que pueden beneficiarse de las psicoterapias alcohologicas disponibles, lo que da lugar a una elevada y rapida mortalidad. El cumplimiento de tratamientos postalta es bajo, estando relacionado el tratamiento medico con el alcohologico. Los pacientes que rechazan el tratamiento reingresan frecuentemente y vuelven a intentarse intervenciones terapeuticas, que son del tipo de reduccion de danos.