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Clinical and Translational Science Award (CTSA) TL1 trainees and KL2 scholars were surveyed to determine the immediate impact of the COVID-19 pandemic on training and career development. The most negative impact was lack of access to research facilities, clinics, and human subjects, plus for KL2 scholars lack of access to team members and need for homeschooling. TL1 trainees reported having more time to think and write. Common strategies to maintain research productivity involved time management, virtual connections with colleagues, and shifting to research activities not requiring laboratory/clinic settings. Strategies for mitigating the impact of the COVID-19 pandemic on training and career development are described.
To evaluate the effect of pregabalin as a tapering therapy over the subjective sleep quality of patients who underwent a benzodiazepine withdrawal program.
This was a secondary analysis of a 12-week, prospective, and observational study carried out in patients aged 18 years or over, who met DSM-IV-TR criteria for benzodiazepine dependence without other major psychiatry disorder. Evaluations included the Benzodiazepine Withdrawal Symptom Questionnaire, the Hamilton Anxiety Rating Scale, the Clinical Global Impression scale, and the MOS-Sleep Scale. Changes from baseline to the endpoint in the different scales’ scores as well as correlations of these changes with those of the MOS-Sleep scores were calculated.
282 patients met the criteria for analysis. Mean pregabalin dose was 315 (166) mg/day at end-of-trial. We observed a significant and clinically relevant improvement in sleep outcomes at the study endpoint as measured with the MOS-Sleep Summary Index, that was reduced from 55.8 (18.9) pts at baseline to 25.1 (18.0) pts at week 12 (55% reduction), as well as with the six dimensions of the MOS-Sleep Scale. Moderate correlations were observed between Summary Index and sleep domains with improvements in the anxiety symptoms and in the disease severity as well. Also, sleep ameliorations were observed in the 52% successfully benzodiazepines withdrawals but, although to a lesser extent, in the remaining failures as well.
Pregabalin treatment improves subjective sleep quality in patients who underwent a benzodiazepine withdrawal program and this effect appears partly independent of the improvement of anxiety or withdrawal symptoms.
Benzodiazepines are widely used drugs. However, their chronic use has revealed that they can lead to dependence. The objective of this study is to review the different pharmacological strategies used in the management of benzodiazepine dependence and new trends in pharmacological interventions.
We searched in MEDLINE and in the Cochrane Database System Review, selecting studies from 1980 until the present, in which a pharmacological intervention was made for benzodiazepine detoxification in mono-dependence cases.
There is a consensus about gradual rather than abrupt tapering benzodiazepines in benzodiazepine discontinuation. Other extended traditional strategy has been switching from short half-life to long half-life benzodiazepines before gradual taper. A great variety of agents have been used as adjuvant medication in Benzodiazepine Withdrawal Syndrome (BWS) with varying degrees of success. In the last years research has focus in the use of anticonvulsant drugs. Both carbamzepine and valproate, have demonstrated to be beneficial in benzodiazepine discontinuation. Also, preliminary data suggest that new anticonvulsant agents (gabapentin, pregabalin, oxcarbazepine and topiramate) could be helpful.
Although multiple drugs have been investigated for pharmacological management of BWS, only few have demonstrated significant efficacy. Anticonvulsant drugs are one of them. Both, carbamazepine and valproate, have shown benefits in reducing withdrawal severity. The available data currently support the use of new anticonvulsant (gabapentin, pregabalin, oxacarbazepine and topiramate), in the treatment of different drug-dependences such as alcohol, cocaine and opiate dependence. Moreover, there is a growing trend in the literature toward the use of these agents in benzodiazepine mono-dependence.
Startle reflex (SR) is a defensive response to sudden, intense stimuli. Prepulse inhibition (PPI) refers to the ability of innocuous sensory events to reduce SR. PPI has been described as an operational measure of sensorimotor gating that is reduced in several neuropsychiatric disorders, such as schizophrenia, but there is no extensive experience in addictions and alcoholism. The objective of this study was to examine the existence of impairments on SR and PPI in abstinent alcoholic males.
Subjects were 40 abstinent alcoholic males, aged 18 to 65 years (mean age 44.73), who had met DSM-IV criteria for Alcohol Dependence, being abstinent for more than a month at the moment they were tested. Participants underwent testing for PPI. Subjects were then compared with 35 equal controls.
Magnitudes of the SR were lower in abstinent alcoholic males when compared with controls. This differences were significant (p< 0,05) in trials with prepulse presented 30, 60 or 120 msec before the onset of startle stimulus. There was a significant less percentage of PPI when prepulse was presented 30 msec before the startle stimulus (p< 0,05).
Abstinent alcoholic males exhibit a decrease in the startle response magnitude and in the PPI of the SR. These data suggest that sensory information processing mechanisms could be damaged in abstinent alcoholic patients. The fact that these findings are common to other psychiatric disorders, could indicate the existence of a common vulnerability marker, and could explain the important comorbidity between alcoholism and other mental illness.
To estimate the prevalence of depression and anxiety in caregivers of dependent grade II and III of a health center. Calculate the perceived social support for caregivers. Estimating the degree of caregiver stress. Assess the socio-demographic factors associated.
Descriptive and transversal.
Primary Health Care.
We selected 55 dependent caregivers grade II and III consecutive sample, according to the law of dependence, belonging to the health center Algeciras-North and were registered in the database of the Center on January 31, 2009. Exclude those who would not participate in the study, did not understand the Spanish language or could not contact with them.
We conducted through a questionnaire that contained heteroadministrated Hamilton scales for depression and anxiety, social support scale of the Duke, caregiver overload of Zarit and sociodemographic variables. The accomplishment was held at the home of the caregiver.
We detected the presence of depressive disorders in 47.3% (95% 14,6-39%) respondents and anxiety disorders in 25.5% (95% 23-6-61,1%). 36.4% (CI 95% 23,8-50,4%) of caregivers had low social support and overhead was 57.1% (CI 95% 43,2-70,9%).
Caregivers of Dependent grade II and III in our area are at risk of depressive disorders and anxiety. At the same time, they feel helpless, so we think it would be interesting to be given greater attention from health centers in order to identify them early.
Impulsivity is associated with different types of disorders, included substance used disorders. The purposed of this study is get to know if alcohol and cocaine affect in the same way to the impulsivity paradigms or if they strength each other or if there are specific bias associated to each one of the substances.
Material and methods
This is a 380 heavy drinker patient's sample recruited from twelve primary care centers. The patients were screened using The Alcohol Use Disorders Identification Test (AUDIT > 8). Neuropsicological tests done at the base line and after the 4 years of the study were the Continous Performance Test (CPT) and the Barrat Impulsivity scale. The alcohol and cocaine consume accumulated along the four years was also study.
The two variables of the CPT (ommission and commission errors) had a significant correlation with the alcohol and cocaine use accumulated in these four years. The variable that was associated with a greater risk of making more commission and ommission errors was the cocaine risk consumption. The years of study were protective variable.
The most important conclusion of this study is that alcohol and cocaine use produces a modification in the conductual paradigm of impulsivity characterized by the inhibition difficulties measured by the CPT. Also, the cocaine use effects are added respect to the alcohol ones and finally that cocaine plus alcohol effects over the number of ommission and commission errors are more potent that the ones made only with alcohol.
Impulsivity has been considered as a risk factor for alcohol dependence. Recent research is focusing on paradigms of the startle response (SR), specifically prepulse inhibition (PPI) and startle habituation (SH), as vulnerability markers for alcoholism. It has been demonstrated impairments in the PPI and the SH in offspring of alcoholics. It has also been shown, using personality questionnaires, that faster habituation may be associated with tendency toward impulsivity and behavioral disinhibition. Our goal is to study the correlation between impulsivity laboratory measures and the SR paradigms, in order to see if they could share a common base as endophenotypes for alcoholism.
The subjects were 40 abstinent alcoholic males, aged 18 to 65 years (mean age 44.73) and who had met DSM-IV criteria for Alcohol Dependence, being abstinent for more than a month at the moment they were tested. Participants underwent testing for PPI and habituation of the acoustic startle response. Impulsivity was assessed with three different laboratory measures: Continuous Performance Test (CPT), Stop-Signal Task and Differential Reinforcement for Low-Rate Responding (DRL6). Analyses were performed using SPSS v.10.0.
We found a significant positive correlation between CPT-tasks and SH (p< 0,01), and Stop-Signal Task-tasks and SH (p< 0,05), but not with DRL6-tasks. No significant correlation was demonstrated between impulsivity measures and PPI.
Our findings suggest the existence of a common base between impulsivity and SH as vulnerability markers for alcohol dependence. Further studies are needed to assess if both could share a common genetic origin.
To explore a cognitive bias-Jumping to Conclusions-in patients with schizophrenia and to compare with non-psychotic siblings and healthy controls by means of the Picture Decision Task (PDT).
42 patients with schizophrenia, 20 non-psychotic siblings and 77 healthy controls were compared in the PCT. This task consists of showing drawings of common objects that are displayed on a computer screen in decreasing degrees of fragmentation: new features are added in eight successive stages, until the entire object is eventually manifest. There are two kinds of trials (“cued” and “uncued”; that is, with and without interpretative clues). According to the responses, five parameters were calculated: Jumping To Conclusions at first stage-that is, with the very first drawing-(JTC-1), Plausibility Rating at first stage (PR-1), Draws To Decision (DTD), Time Response at first stage (TR-1) and Time Response for Draw to Decision (TR-DTD)
In comparison with siblings and controls, more of the schizophrenia patients made a definitive decision at the first stage (represented by a significantly higher JTC-1), and they showed a higher Plausibility Rating (represented by a higher PR-1) than siblings and controls. For the uncued trials, patients needed fewer stages (a lower DTD) when making a decision than siblings (5.53±0.20 vs. 7.04±0.28; p=0.001) and controls (5.53±0.20 vs. 6.83±0.14; p=0.001).
These results suggest that patients make quick decisions with a high level of conviction and may manifest a data-gathering bias. Our results may indicate some degree of faulty appraisal and an inability to tolerate ambiguity when faced with decision-making.
Alcoholism is a chronic relapsing disorder characterized by compulsive drinking, alcohol seeking, loss of control over alcohol consumption, and impaired social and occupational functioning. Treatment of Alcohol Dependence (AD) comprises two steps, detoxification and relapse prevention (RP). Traditionally, long half-life benzodiazepines have been the most widely used agents for alcohol detoxification. On the other hand, disulfiram, naltrexone and acamprosate are the three drugs that have been approved for relapse prevention. In the last decades, nevertheless, there is a growing interest in the use of anticonvulsant drugs in the management of both, detoxification and relapse prevention of alcohol.
To review the different pharmacological strategies in which an anticonvulsant was used in the management of AD.
We searched in MEDLINE and in the Cochrane Database System Review, selecting all studies from 1980 until present, in which a pharmacological intervention with anticonvulsant agents was made for alcohol detoxification or RP.
The most tested anticonvulsant drugs are the classical Carbamazepine and Valproate. Both have demonstrated to be efficacious in Alcohol Withdrawal Syndrome and RP. However, the use of these agents has been limited by their hepatic and hematologic toxicity. Novel anticonvulsants such as Gabapentin, Pregabalin, Topiramate, Oxcarbazepine and Zonisamide have also been found to be effective, with the advantage of rapid onset of action, lower toxicity and fewer side effects.
Anticonvulsants are efficacious and safe agents in the management of AD. Further randomized, double-blind, placebo-controlled trials are warranted to increase the evidence of the use of these agents.
Two laboratory paradigms identifying two behavioral processes have been used to measure impulsivity. The first relates to behavioral inhibition, i.e., the ability to inhibit thoughts or actions appropriately. The second pertains to the degree to which immediate rewarding consequences have more control over behavior than delayed consequences. Behavioral impulsivity disorders have been associated with alcohol dependence. Topiramate has been used to treat many disorders characterized by impulsivity symptoms. Reports also suggest that topiramate has utility in treating a variety of addictive disorders. Little is known, however, about whether its anticraving effects are related to its impulsivity-reducing actions. The aim of this preliminary study was to investigate which type/dimension of behavioral impulsivity was associated with topiramate's anticraving effects. A 12-week, double-blind, placebo-controlled pilot study of topiramate for treating alcohol dependence was conducted. Subjects were men recruited from alcoholism treatment units (topiramate=21; placebo=20). The continuous performance test and stop-signal task assessed behavioural inhibition. Differential reinforcement for low-rate responding was used to evaluate the delay discounting dimension. Alcohol craving and the amount of alcohol consumed during the study also were assessed. Topiramate-treated patients had lower rates of alcohol consumption and significantly lower alcohol craving scale scores than controls, and exhibited greater improvements in the behavioural inhibition and delay discounting paradigms. Improvement in alcohol craving was associated with better performance on the behavioural inhibition paradigm. Our findings suggest that topiramate's anticraving actions could be related to its effects on behavioural inhibition. More studies are needed to confirm and understand this link.
The study of the acoustic startle reflex modulation in alcoholics subjects in the presence of positive, aversive, neutral images and images related to alcohol consumption will allow us to measure the implicit affective valence of theses cues.
To compare the emotional valence of the stimuli related to alcohol consumption between two groups of alcoholic patients (abstainers vs relapsers).
55 alcoholic patients (29 abstainers and 26 relapsers) were exposed to acoustic startle test after three weeks of detoxification treatment. Difference between the amplitude of the startle reflex associated to images related to alcohol and the one associated to neutral images was used as dependent variable (motivational value of alcohol cues=startle amplitude in the presence of alcohol images-startle amplitude of neutral images).
Abstainers patients showed a decrease of the startle reflex in the presence of visualization of alcohol associated stimuli compared to the registered ones in the presence of neutral stimuli (μ=-0.041). For the group of relapsers an increase (μ=0.034) of the amplitude of the startle reflex when they were exposed to alcohol related images was registered in contrast with the amplitude registered in the presence of neutral images. Differences between groups were significant (p<0.01).
Abstainers process alcohol-related images as positive stimuli. Conversely, relapsers will stop processing alcohol-related images as appetizing or positive stimuli.
Different neuropsychological studies have consistently found an attention, memory and executive function deficit in schizophrenic patients. The Positive and Negative Syndrome Scale (PANSS) evaluates different clinical aspects of schizophrenia. Factor analyses of this scale suggest the existence of a “cognitive factor”, constituted by several items pertaining to the different subscales. In order to have an acceptable concurrent validity, this “cognitive factor” should correlate with the execution of neuropsychological tasks. Our objective was to study the correlation between the PANSS “cognitive factor” and the execution of neuropsychological tasks evaluating attention, memory and executive functions.
Thirty-five schizophrenic patients were evaluated using the Continuous Performance Test (CPT), the Rey-Osterrieth Complex Figure Test (Rey CFT) and the Wisconsin Card Sorting Test (WCST). Bivariate partial correlation between the neuropsychological variables and the PANSS “cognitive factor” was examined. In order to obtain this cognitive component, and based on previous studies, items P2, N5, PG10 and PG11 were used.
The PANSS “cognitive factor” was significantly correlated to CPT omission errors (r=0.45; p=0.006), Rey CFT recall after 5 minutes (r=-0.34; p=0.049), Rey CFT recall after 30 minutes (r=-0.40; p=0.020), WCST perseverative responses (r=0.36; p=0.035), and WCST perseverative errors (r=0.35; p=0.041).
The existence of significant correlations between the PANSS “cognitive factor” and performance on neuropsychological tasks evaluating attention (CPT), memory (Rey CFT) and executive functions (WCST) supports the concurrent validity of this factor.
A high prevalence of childhood attention-deficit/hyperactivity disorder (ADHD) history has been found in alcoholic patients. Patients with this history have an earlier onset and greater intensity of alcohol use, more polysubstance use and a poorer prognosis. Our objective was to study differences in neuropsychological functioning in a group of alcoholic patients according to the presence or absence of a history of childhood ADHD.
A sample of 136 male alcoholic patients and 56 male control subjects were evaluated using the Continuous Performance Test (CPT); execution in both groups was compared. The sample of alcoholic patients was then divided into two subgroups according to the presence or absence of a history of childhood ADHD, namely the ADHD+ OH subgroup (61 patients with childhood ADHD history) and the ADHD- OH subgroup (75 patients without this history); CPT execution in these two subgroups was also compared.
The group of alcoholic patients made more omission (p=0.008) and commission (p=0.009) errors in the CPT than the control group. When comparing subgroups, ADHD+ OH patients made more omission and commission errors than ADHD- OH patients, although the differences did not reach statistical significance.
Alcoholic patients perform more poorly on the CPT than control subjects. In the sample of alcoholic patients, a history of childhood ADHD was not associated to significant differences in the execution of this test.
Different types of behavioural impulsivity have been associated with the development of substance use disorders but little is know about what type of impulsivity is provoked by the effect of chronic use of substances.
Determine what type of behavioural impulsivity was associated with the use of alcohol and cocaine.
Design and measurements:
A prospective cohort study was conducted to identify changes on behavioural impulsivity. Non-dependent heavy drinkers (N=471) were recruited from primary care centres. The following assessments were used at baseline and at the end of the 4-year follow-up period: The continuous performance test (CPT) and stop-signal task (SST) assessed behavioural inhibition. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay discounting dimension. Diagnoses were rendered using the Structured Interview for DSM-IV.
Amounts on alcohol and cocaine consumption during follow-up correlated positively with changes on all impulsivity measures. Logistic regression analysis indicated that cocaine used was associated specifically with poor performance on CPT and SST and amount of alcohol used during follow-up was related to changes on DRLR.
Substances provoke different pattern of behavioural impulsivity: chronic cocaine use provokes changes mainly on behavioural inhibition dimension and alcohol use induces changes on delay discounting paradigm.
Alcohol Craving Scale-3Factors (ACS-3F) retrospectively assesses the period during which the subject consumed alcohol. It includes 33 descriptions grouped in three scales: positive reinforcement, negative reinforcement and impaired control. Tiffany emphasized the poor correlation between self-reported drug urges and the physiological effects of drug-associated stimuli. Our main objective in this project was to investigate the psychophysiological relationship between ACS-3F and the startle reflex modulation.
We hypothesized that the assessment of self-reported craving with ACS-3F would correlate with the non-conscious emotional response to these cues represented by the modulation of the acoustic startle response.
Sample and Methods:
55 alcoholic patients (29 abstainers and 26 relapsers) were exposed to acoustic startle test after three weeks of detoxification treatment. In this study, the difference between the amplitude of the startle reflex associated to images related to alcohol and the one associated to neutral images was used as dependent variable (motivational value of alcohol cues [MVAC]=startle amplitude in the presence of alcohol images-startle amplitude of neutral images).
The abstainer group showed a significant inverse correlation (r=-0.475, p<0.05) between craving total score in ACS-3F and the motivational value of alcohol cues [MVAC]. With regards to craving, the group of relapsers did not correlate with startle modulation.
ACS-3F has adequate properties of concurrent validity. Results in abstainers showed a good correlation between retrospective craving self-reported and non-conscious emotional response to alcohol cues.
The Positive and Negative Syndrome Scale (PANSS) evaluates different psychopathological aspects of schizophrenic patients. Scores on the negative subscale of the PANSS have been associated with clinical and neuropsychological differences in these patients. Our aim was to study the relationship between PANSS negative scores and different clinical and neuropsychological variables in a sample of schizophrenic patients.
Our sample of 174 schizophrenic patients was split into two groups according to scores on the negative subscale of the PANSS: a group of 85 patients (55 male and 30 female; mean age 38.0 years, SD 9.3) with scores below the median (“low negative PANSS” group), and a group of 89 patients (58 male and 31 female; mean age 37.3, SD 8.4) with scores above the median (“high negative PANSS” group). The neuropsychological task used was the Wisconsin Card Sorting Test.
Significant clinical differences were found between both groups. In the “high negative PANSS” group a lower age of illness onset was found (p=0.030), as well as a lower age at first psychiatric admission (p=0.002) compared to the “low negative PANSS” group, without there being significant differences in current age (p=0.570). Regarding cognitive functions, “high negative PANSS” patients achieved fewer categories (p=0.005) and made more perseverative errors (p=0.031) than “low negative PANSS” patients.
Schizophrenic patients with higher scores on the negative subscale of the PANSS had an earlier age of onset of their illness and exhibited poorer cognitive functioning than patients with lower scores.
The link between impulsivity and alcohol use disorders has been established in longitudinal and cross-sectional studies, but little is know about the role of behavioural impulsivity in the development of substance use disorders.
Determine the role of behavioural measures of impulsivity in the development of alcohol use disorders.
Design and measurements:
A prospective cohort study was conducted to identify the risk factors associated with alcohol dependence. Non-dependent heavy drinkers (N=471) and healthy controls (N=149) were recruited from primary care centres. They were assessed at the end of the 4-year follow-up period. Diagnoses were rendered using the Structured Interview for DSM-IV. The continuous performance test (CPT) and stop-signal task (SST) assessed behavioural inhibition. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay discounting dimension.
HD participants have significant impairments on all laboratory measures of impulsivity. In the logistic regression model, impairment on DRLR (delay discounting dimension) was the only measure that classified accurately HD. Baseline behavioural measures of impulsivity correlated positively with amount of alcohol consumption during the follow-up period. Logistic regression analysis indicated that performance on inhibitory control (SST) (behavioural inhibition dimension) was a significant predictor (odds=1.52[1.08-2.31]) for developing alcohol dependence.
Our data support the link between behavioural measures of impulsivity and alcohol use disorders. Delay discounting dimension may be a risk factor for begin alcohol use heavily and behavioural inhibition impairment is more involved in the development of dependence.
Impulsivity has been associated with alcohol dependence, but impulsivity in alcohol-dependent subjects has not been well characterized.
Using a variety of laboratory measures of impulsivity, we assessed whether alcohol-dependent patients (ADP) were more impulsive than control subjects, and the role of Cluster-B personality disorders in impulsivity measurements.
Design and measurements:
A cross-sectional patient survey with a community comparison group. Diagnoses were made using the Structured Interview for DSM-IV. Sustained attention and rapid-response impulsivity were assessed using the continuous performance test (CPT). Inhibitory control was measured by the stop-signal task (SST). Ability to delay reward task was assessed using differential reinforcement for low-rate responding (DRLR).
Participants and setting:
A final sample of 253 males with alcohol-dependence recruited from two alcoholism treatment centres was compared with a matched non-substance-abusing comparison group (n=96).
Patients with alcohol dependence were more impulsive across all behavioural tasks. Alcohol-dependent subjects without personality disorders showed lower efficiency in DRLR than control subjects. Patients with Cluster-B personality disorder performed worse in inhibitory control, but subjects with borderline personality disorder in particular demonstrated increased rates of omission and commission errors in CPT. Inability to delay gratification was associated with antisocial personality disorder.
Our findings support the suggestion of two paradigms in alcohol dependence. The first, based on inability to delay gratification, might be a vulnerability marker for alcohol dependence. The second was related to inhibitory control, and might be specific for antisocial and borderline personality disorders.
Known by many different names-culture broker, community interpreter, medical interpreter, and communication facilitator-the intercultural mediator has as a primary task the facilitation of communication and the therapeutic relationship in the presence of linguistic and/or cultural difference. The Immigration Plan of “la Caixa” Social and Cultural Outreach Projects has undertaken an ambitious project to train all of the cultural mediators in Spain, including both those currently working and those newly entering the field, to meet existing needs. In the first phase of the project, the training was developed in Catalunya, in collaboration with the the Catalan Department of Health, executed by the Psychiatry Department of the Vall d'Hebron University Hospital (Autonomous University of Barcelona) and certified by the Health Studies Institute of the Department of Health. Drawing from the four years experience of the NGO SURT and the Department of Psychiatry of the Vall d'Hebron University Hospital, the program provides 200 hours of theoretical and 1200 hours of practical training. 50 currently employed intercultural mediators and 30 novices are being trained. In subsequent phases the training will be adapted to needs of other autonomous regions of Spain. Modules include medical anthropology, Western biomedicine, community health, linguistic interpretation, cultural competence, professional identity, and ethics. Small group supervision provides a supportive environment to facilitate the application of theory to practice. Finally, high quality training materials were developed specifically for the course. Preliminary evaluations of the project are positive despite some unanticipated complications.