Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente

Francisco Arias, Nestor Szerman, Pablo Vega, Beatriz Mesias, Ignacio Basurte, Consuelo Morant, Enriqueta Ochoa, Félix Poyo, Francisco Babín

Resumen


Se valora la prevalencia y características de los pacientes de patología dual (diagnóstico actual de un trastorno mental y de un trastorno por uso de sustancias (TUS)): en las redes asistenciales de Salud Mental y Drogodependencias de la Comunidad de Madrid. Se consigue una muestra de 837 sujetos (208 de la red de Salud Mental y 629 de la red de Drogodependencias). Se usó la entrevista MINI (Mini International Neuropsychiatric Interview) y el cuestionario PDQ4+ (Personality Disorder Questionnaire) para la valoración de los trastornos del eje I y II. Se hallaron 517 (61,8%) pacientes con patología dual (un 36,1% en la red de salud mental y un 70,3% en la red de drogas). Al compararlos con el grupo de sujetos con TUS sin patología dual (n=194), había entre los duales menos varones y peor situación laboral, siendo las drogas más consumidas el alcohol y cannabis. Al compararlos con el grupo de trastornos mentales sin uso de sustancias (n=126), encontramos diferencias en todas las características sociodemográficas analizadas y los casos de patología dual son diagnosticados más frecuentemente como trastorno bipolar, agorafobia, trastorno por ansiedad generalizada, trastorno por estrés postraumático, mayor riesgo de suicidio y distintos trastornos de personalidad. Por lo tanto, la presencia de patología dual es elevada en sujetos en tratamiento y presentan unas características diferenciales, tales como mayor riesgo de suicidio y situación laboral precaria que hacen pensar en un peor pronóstico, cuestión a considerar para el desarrollo de recursos asistenciales adecuados.

Palabras clave


Dependencia de drogas; patología dual; trastornos de personalidad; trastorno bipolar; trastornos de ansiedad

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Referencias


Agrawal, A., Lynskey, M. T., Madden, P. A., Bucholz, K. K. y Heath, A. C.

(2007) A latent class analysis of illicit drug abuse/dependence:

results from the National Epidemiological Survey on Alcohol and

Related Conditions. Addiction, 102, 94-104.

Alegría, A. A., Hasin, D. S., Nunes, E. V., Liu, S. M., Davies, C., Grant, B. F.

y Blanco, C. (2010) Comorbidity of generalized anxiety disorder and substance use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 71, 1187-95. doi: 10.4088/JCP.09m05328gry.

Barnes, T. R., Mutsatsa, S. H., Hutton, S. B., Watt, H. C. y Joyce, E. M. (2006) Comorbid substance use and age at onset of schizophrenia. British Journal of Psychiatry, 188, 237-42. doi 10.1192/bjp. bp.104.007237.

Bauer, M. S., Altshuler, L., Evans, D. R., Beresford, T., Williford, W. O. y

Hauger, R. (2005) Prevalence and distinct correlates of anxiety,substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder. Journal of Affective Disorders, 85, 301–31. doi.org/10.1016/j.jad.2004.11.009.

Blanco, C., Alegría, A. A., Liu, S. M., Secades-Villa, R., Sugaya, L., Davies, C. y Nunes, E. V. (2012) Differences among major depressive disorder

with and without co-occurring substance use disorders and substance-induced depressive disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 73, 865-73. doi: 10.4088/JCP.10m06673.

Bowden-Jones, O., Iqbal, M. Z., Tyrer, P., Seivewright, N., Cooper, S., Judd, A. y Weaver, T., COSMIC study team. (2004) Prevalence of personality disorder in alcohol and drug services and associated comorbidity. Addiction, 99, 1306-14.

Brady, K. T. y Lydiard, R. B. (1992) Bipolar affective disorder and substance abuse. Journal of Clinical Psychopharmacology, 12, 17S- 22S.

Brown, E.S. (2005) Bipolar disorder and substance abuse. Psychiatric Clinics of North America, 28, 415-25.

Burns, L. y Teesson, M. (2002) Alcohol use disorders comorbid with anxiety, depression and drug use disorders. Findings from the Australian National Survey of Mental Health and Well Being. Drug and Alcohol Dependence, 68, 299-307. doi.org/10.1016/S0376-8716(02)00220-X.

Calvo, N., Caseras, X., Gutierrez, F. y Torrubia, R. (2002). Spanish version

of the personality diagnostic questionnaire-4+ (PDQ-4+). Actas Españolas de Psiquiatría, 30, 7–13.

Chan, Y. F., Dennis, M. L. y Funk, R. R. (2008) Prevalence and comorbidity

of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment. Journal of Substance Abuse and Treatment, 34, 14-24. doi.org/10.1016/j.jsat.2006.12.031.

Compton, W. M., Conway, K. P., Stinson, F. S., Colliver, J. D. y Grant, B. F.

(2005) Prevalence, correlates, and comorbidity of DSM-IV antisocial

personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66, 677-85.

Compton, W. M., Thomas, Y. F., Stinson, F. S. y Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSMIV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 64, 566-76. doi:10.1001/archpsyc.64.5.566.

Comtois, K. A., Russo, J. E., Roy-Byrne, P. y Ries, R. K. (2004) Substance

Abuse as Predictors of Suicidal Behavior in Acutely Hospitalized Psychiatric Inpatients. Biological Psychiatry, 56, 757–763.

Dhossche, D. M., Meloukheia, A. M. y Chakravorty, S. (2000) The Association of Suicide Attempts and Comorbid Depression and Substance Abuse in Psychiatric Consultation Patients. General Hospital Psychiatry, 22, 281–288. doi.org/10.1016/S0163-8343(00)00085-2.

Dragt, S., Nieman, D. H., Schultze-Lutter, F., van der Meer, F., Becker, H., de Haan, L.... Linszen, D. H. (2012) Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatrica Scandinavica, 125, 45-53. doi: 10.1111/j.1600-0447.2011.01763.x.

Echeburúa, E., De Medina, R. B. y Aizpiri, J. (2007) Comorbidity of alcohol

dependence and personality disorders: a comparative study. Alcohol and Alcoholism, 42, 618-22. doi: 10.1093/alcalc/agm050.

Fernández-Montalvo, J., Landa, N., López-Goñi, J. J. y Lorea, I. (2006)

Personality disorders in alcoholics: a comparative pilot study between the IPDE and the MCMI-II. Addictive Behavior, 31, 1442-8. doi.org/10.1016/j.addbeh.2005.09.014.

Fetzner, M. G., McMillan, K. A., Sareen, J. y Asmundson, G. J. (2011) What

is the association between traumatic life events and alcohol abuse/ dependence in people with and without PTSD? Findings from a nationally representative sample. Depression and Anxiety, 28, 632-8. doi: 10.1002/da.20852.

Goldstein, R. B., Compton, W. M., Pulay, A. J., Ruan, W. J., Pickering, R. P., Stinson, F. S. y Grant, B. F. (2007) Antisocial behavioral syndromes and DSM-IV drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence, 90, 145-58. doi: 10.1016/j.drugalcdep.2007.02.023

González-Saiz, F., Lozano, O. M., Martín, J., Bilbao, I., Ballesta, R., Gutiérrez, J. (2011) Comorbilidad psiquiátrica en una muestra de pacientes con dependencia de opiáceos tratados con buprenorfina sublingual en régimen de comunidad terapéutica. Revista de Psiquiatría y Salud Mental, 04, 81-7.

Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C.,

Compton, W…. Kaplan, K. (2004) Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61, 807-16. doi:10.1001/archpsyc.61.8.807.

Gual, A. (2007). Dual Diagnosis in Spain. Drug and Alcohol Review, 26, 65-71.

Jacobsen, L. K., Southwick, S. M. y Kosten, T. R. (2001) Substance use

disorders in patients with posttraumatic stress disorder: a review of the literature. American Journal of Psychiatry, 158, 1184-90. doi 10.1176/appi.ajp.158.8.1184

Kandel, D. B., Huang, F. Y. y Davies, M. (2001) Comorbidity between

patterns of substance use dependence and psychiatric syndromes.

Drug and Alcohol Dependence, 64, 233–241. doi.org/10.1016/S0376-

(01)00126-0.

Kessler, R. C. (2004) The epidemiology of dual diagnosis. Biological

Psychiatry, 56, 730-7. .doi.org/10.1016/j.biopsych.2004.06.034.

Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R. y Walters, E. E.

(2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-27. doi:10.1001/archpsyc.62.6.617.

Khan, A. A., Jacobson, K. C., Gardner, C. O., Prescott C. A. y Kendler K.

S. (2005) Personality and comorbidity of common psychiatric disorders. British Journal of Psychiatry, 186, 190-196. doi 10.1192/bjp.186.3.190.

Kranzler, H. R., Kadden, R. M., Burleson, J. A., Babor, T. F., Apter, A. y

Rounsaville B. J. (1995) Validity of psychiatric diagnoses in patients with substance use disorders: is the interview more important than the interviewer? Comprehensive Psychiatry, 36, 278-88. doi.

org/10.1016/S0010-440X(95)90073-X.

Lehman, A. F., Myers, C. P., Thompson, J. W. y Corty, E. (1993) Implications of mental and substance use disorders. A comparison of single and dual diagnosis patients. Journal of Nervous and Mental Diseases,

, 365-70.

Levin, F. R. y Hennessy, G. (2004) Bipolar disorder and substance abuse. Biological Psychiatry, 56, 738-48. doi.org/10.1016/j.biopsych.2004.05.008.

Li, D, Zhao, H., Kranzler, H. R., Oslin, D., Anton, R. F., Farrer, L. A. y

Gelernter, J. (2012) Association of COL25A1 with Comorbid Antisocial Personality Disorder and Substance Dependence. Biological Psychiatry, 71, 733–740.

Magidson, J. F., Liu, S. M., Legues, C. W. y Blanco, C. (2012) Comparison of the course of substance use disorders among individuals with and without generalized anxiety disorder in a nationally representative sample. Journal of Psychiatric Research, 46, 659-66. doi: 10.1016/j. jpsychires.2012.02.011.

Marsden, J., Gossop, M., Stewart, D., Rolfe, A. y Farrell, M. (2000) Psychiatric symptoms among clients seeking treatment for drug dependence. Intake data from the National Treatment Outcome Research Study. British Journal of Psychiatry, 176, 285-9. oi:10.1192/bjp.176.3.285.

Morojele, N. K., Saban, A. y Seedat, S. (2012) Clinical presentations and

diagnostic issues in dual diagnosis disorders.. Current Opinion in Psychiatry, 25, 181-6. doi: 10.1097/YCO.0b013e328351a429.

O´Brien, C. P., Charney, D. S., Lewis, L., Cornish, J. W., Post, R. M., Woody,G. E. … Weisner, C. (2004) Priority actions to improve the care of

persons with co-ocurring substance abuse and other mental disorders: A call to action. Biological Psychiatry, 56, 703-713. doi:10.1016/j.biopsych.2004.10.002.

Pedrero-Pérez, E. J., Puerta-García, C., Lagares, A. y Sáez-Maldonado, A.

(2003) Prevalencia e intensidad de los trastornos de personalidad en

adictos a sustancias en tratamiento en un centro de atención a las

drogodependencias. Trastornos Adictivos, 5, 241-255.

Pietrzak, R. H., Goldstein, R. B., Southwick, S. M. y Grant, B. F. (2011)

Prevalence and Axis I comorbidity of full and partial posttraumatic

stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Anxiety Disorders, 25, 456-65. doi: 10.1016/j.janxdis.2010.11.010.

Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L.

L. y Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA, 264, 2511-8. doi:10.1001/ jama.1990.03450190043026.

Robinson, J., Sareen, J., Cox, B. J. y Bolton, J. M. (2011) Role of selfmedication in the development of comorbid anxiety and substance

use disorders: a longitudinal investigation. Archives of General Psychiatry, 68, 800-7. doi: 10.1001/archgenpsychiatry.2011.75.

Ross, H. E., Glaser, F. B. y Germanson, T. (1988) The prevalence of

psychiatric disorders in patients with alcohol and other drug problems. Archives of General Psychiatry, 45, 1023-31. doi:10.1001/

archpsyc.1988.01800350057008.

Rush, B. y Koegl, C. J. (2008) Prevalence and profile of people with

co-occurring mental and substance use disorders within a comprehensive mental health system. Canadian Journal of Psychiatry, 53, 810-21.

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E. … Dunbar, G. C. (1998) The Mini-International Neuropsychiatric

Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59 Suppl 20, 22-33.

Szerman, N., Arias, F., Vega, P., Babin, F., Mesias, B., Basurte, I. … Poyo,

F. (2011) Estudio piloto sobre la prevalencia de patología dual en pacientes en tratamiento en la Comunidad de Madrid. Adicciones, 23, 249-256.

Szerman, N., Lopez-Castroman, J., Arias, F., Morant, C., Babín, F., Mesías,

B., … Baca-García, E. (2011) Dual Diagnosis and Suicide Risk in a Spanish Outpatient Sample. Substance Use & Misuse, 48, 1–7. doi:

3109/10826084.2011.636135.

Torrens, M., Gilchrist, G. y Domingo-Salvany, A. (2011) Psychiatric comorbidity in illicit drug users: Substance-induced versus independent disorders. Drug and Alcohol doi: 10.1016/j.drugalcdep.2010.07.013. Dependence, 113, 147–156. doi: 10.1016/j.drugalcdep.2010.07.013.

Vergara-Moragues, E., González-Saiz, F., Lozano, O. M., Betanzos, P., Fernández, F., Bilbao-Acebos, I., Pérez, M., Verdejo, A. (2012) Psychiatric comorbidity in cocaine users treated in therapeutic community: Substance-induced versus independent disorders. Psychiatry Research, 200, 734-41. doi: 10.1016/j.psychres.2012.07.043.

Verheul, R. (2001) Co-morbidity of personality disorders in individuals with substance use disorders. European Psychiatry, 16, 274-82. doi. org/10.1016/S0924-9338(01)00578-8.

Volkow, N. D (2004). The reality of comorbidity: depression and drugabuse. Biological Psychiatry, 56, 714-7. doi:10.1016/j. biopsych.2004.07.007.

Volkow, N. D (2007). Addiction and Co-ocurring mental disorders. Director`s perspective. NIDA Notes, 21, 2.

Weaver, T., Madden, P., Charles, V., Stimson, G., Renton, A., Tyrer, P. …

Ford, C. (2003). Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry, 183, 304–313. doi: 10.1192/02-623.

Westermeyer, J. (2006) Comorbid schizophrenia and substance abuse: a

review of epidemiology and course. American Journal of Addictions,

, 345-55.

Winokur, G., Turvey, C., Akiskal, H., Coryell, W., Solomon, D., Leon, A.

… Keller, M. (1998) Alcoholism and drug abuse in three groups-- bipolar I, unipolars and their acquaintances. Journal of Affective Disorders, 50, 81-9.




DOI: https://doi.org/10.20882/adicciones.59

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