Oscar Martín Lozano Rojas

Measuring the Impact of Psychoactive Substance on Health-Related Quality of Life: An Update

BACKGROUND The number of publications dealing with measurement of the quality of life and health in the area of drug dependence has increased in recent years. Its main application is as an indicator of the effectiveness of intervention in harm reduction, although there are also comparative and methodological studies. DATA SOURCES AND STUDY SELECTION The literature was reviewed to identify studies on abuse or substance dependence and HRQoL. The bibliographic sources used for the review are PubMed, EMBASE, CINAHL and PsycInfo. Additional articles were identified from references to relevant articles. RESULTS 111 articles were identified. The HRQoL of people who abuse or are dependent on substances is lower than the general population. The presence of physical and psychiatric comorbidity also affects patients dependent on opiates, and substitution programs improve HRQoL. CONCLUSION The measurement of HRQoL in the area of drug dependence is a suitable complement for finding out the deterioration caused by substance use, abuse or dependence. It is also a useful indicator for evaluating therapeutic results in this population.

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.

Prejudiced Attitude Measurement Using the Rasch Rating Scale Model

There have been two basic approaches for the study of minority group prejudice against the majority: to adapt instruments from the majority group, and to use qualitative techniques by analyzing the content of the discourse of the groups involved. Neither of these procedures solves the problem of measuring intergroup attitudes of majorities and minorities in interaction. This study shows the result of a prejudice scale which was developed to measure the attitude of both the minority and majority groups. Prejudice is conceived as an attitude which requires the beliefs or opinions about the out-group, the emotions it elicits, and the behavior or intentional behavior toward it to be known for its evaluation. The innovation in this work is that the psychometric development of the scale was based on the item response theory, and more specifically, the rating scale model.

Comorbilidad psiquiátrica en una muestra de pacientes con dependencia de opiáceos tratados con buprenorfina sublingual en régimen de comunidad terapéutica

INTRODUCTION The purpose of this work is to estimate the prevalence of psychiatric cases in a sample of opiate-dependent patients treated with sublingual buprenorphine in a therapeutic community regime, and to describe their progress during the first month of treatment. METHODS An observational, longitudinal, prospective study was conducted. Of the 119 opiate-dependent patients selected, 46 agreed to start treatment with buprenorphine. For organisational reasons, the psychopathological assessment was carried out on 36 of these patients. The measurement tools used were the MINI, GHQ-28, IPDE and Assessment of the Quality of Life in Psychoactive Substance Addicts (TEQLASP). RESULTS The prevalence rate of any psychiatric disorder was 78%. The prevalence of Axis I diagnoses was 69.4%. The prevalence of cases in Axis II was 58.3%, and 50% of patients had concomitant Axis I and Axis II disorders. The patients with Axis I psychiatric disorders showed a significant reduction in the mean scores of the GHQ-28 scale, and in the B (anxiety/unease), C (social dysfunction), and D (depression) subscales of the GHQ-28. The differences observed between the patients with no psychiatric disorders after one month of treatment were not significant. An improvement in the quality of life wad observed in both groups, although these changes were of a lower magnitude in the group with psychiatric disorders. DISCUSSION The results of this study show a very high frequency of psychiatric disorders. For this reason, psychiatric illness must be actively looked for whenever we assess a drug-dependent patient.

Classical test theory and item response theory produced differences on estimation of reliable clinical index in World Health Organization Disability Assessment Schedule 2.0

OBJECTIVE World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is currently one of the most used instruments in disability assessment. The objective of this study was to analyze the clinically reliable change of WHODAS 2.0 by applying both Classical Test Theory (CTT) and the Item Response Theory (IRT). STUDY DESIGN AND SETTING The sample consisted of 179 patients with dual pathology. The standard error of measurement (SEM) was estimated using the CTT and the rating testlet model. RESULTS Reliability estimated by Cronbachs alpha provided acceptable values for all domains. The Rasch analysis revealed an adequate capacity to discriminate between people with high and low disability in terms of total scores but not in terms of domains. The SEM varies according to the baseline scores, failing to detect clinically reliable change in patients with lower scores. Kappa coefficients are low for the most of dimensions (except participation) and adequate for total scores. CONCLUSION The use of total WHODAS 2.0 scores may be useful from a clinical perspective; however, more evidence is required for domain scores to support its usefulness. The decision to use the CTT or the IRT impacts in terms of calculating clinically reliable change.

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.

Psychiatric comorbidity in a sample of opiate-dependent patients treated with sublingual buprenorphine in a therapeutic community regime.

Abstract Introduction The purpose of this work is to estimate the prevalence of psychiatric cases in a sample of opiate-dependent patients treated with sublingual buprenorphine in a therapeutic community regime, and to describe their progress during the first month of treatment. Methods An observational, longitudinal, prospective study was conducted. Of the 119 opiatedependent patients selected, 46 agreed to start treatment with buprenorphine. For organisational reasons, the psychopathological assessment was carried out on 36 of these patients. The measurement tools used were the MINI, GHQ-28, IPDE and Assessment of the Quality of Life in Psychoactive Substance Addicts (TEQLASP). Results The prevalence rate of any psychiatric disorder was 78%. The prevalence of Axis I diagnoses was 69.4%. The prevalence of cases in Axis II was 58.3%, and 50% of patients had concomitant Axis I and Axis II disorders. The patients with Axis I psychiatric disorders showed a significant reduction in the mean scores of the GHQ-28 scale, and in the B (anxiety/unease), C (social dysfunction), and D (depression) subscales of the GHQ-28. The differences observed between the patients with no psychiatric disorders after one month of treatment were not significant. An improvement in the quality of life wad observed in both groups, although these changes were of a lower magnitude in the group with psychiatric disorders. Discussion The results of this study show a very high frequency of psychiatric disorders. For this reason, psychiatric illness must be actively looked for whenever we assess a drug-dependent patient.