Dependencia alcohólica con y sin trastornos psiquiátricos asociados

Autores/as

  • Pedro Cuadrado Callejo Psiquiatra. Coordinador del Programa de Problemas Relacionados con el Alcohol. Servicio de Salud Mental Retiro. Consejería de Sanidad. Comunidad de Madrid.

DOI:

https://doi.org/10.20882/adicciones.648

Palabras clave:

dependencia alcohólica, comorbilidad, pronóstico, resultados

Resumen

Objetivos. Determinar si la presencia de comorbilidad influye en la respuesta al tratamiento y evolución asi como si es un criterio útil para establecer subtipos dentro de la dependencia alcohólica. Diseño. Se compararon dos submuestras de dependientes del alcohol: A (n = 120) con comorbilidad, B (n = 41) sin comorbilidad, en función de variables sociodemográficas, clínicas, respuesta al tratamiento y evolución 5-7 años. Setting. Programa de tratamiento ambulatorio de problemas relacionados con el alcohol en un servicio de salud mental de Madrid. Participantes. 161 casos nuevos que iniciaron tratamiento entre 1989 y 1991, con un diagnóstico de dependencia alcohólica. Medidas. Criterios diagnósticos DSM III-R, patrones de consumo según Miller y Marlatt, cuestionario de personalidad EPQ (A), tasas de abandono y tasas de abstinencia absoluta como criterios de respuesta al tratamiento y evolución. Hallazgos. Una menor edad en los dependientes del alcohol con comorbilidad. No diferencias en las características clínicas, respuesta al tratamiento y evolución entre dependientes con y sin comorbilidad asociada. Conclusiones. La comorbilidad en su conjunto no influye en la respuesta al tratamiento y evolución ni es un criterio útil para establecer subtipos dentro de la dependencia alcohólica.

Citas

O’Sullivan K, Whillans P, Daly M, Carroll B, Clare A, Cooney, J. A comparison of alcoholics with and without coexisting affective disorder. Br J Psychiatry, 1983; 143: 133-138.

Schuckit MA. The clinical implicatios of primary diagnostic groups among alcoholics. Arch Gen Psychiatry 1985; 42: 1043-1049.

Schuckit MA, Tipp JE, Bergman M, Reich W, HesselbrockVM, Smith TL. Comparisson of induced and independent major depressive disorders in 2945 alcoholics, Am J Psychiatry 1997; 154: 948-957.

Lewis CE, Rice J, Helzer JE. Diagnostic interactions. Alcoholism and antisocial personality. J Nerv Ment Dis 1983; 171 (2): 105-111.

Liskow B, Powell BJ, Nickel E, Penick E. Antisocial alcoholics are there clinically significant diagnostic subtypes. J Stud Alcohol 1991; 52: 62-69.

Kushner M, Sher K, Beitman B. The relation between alcohol problems and the anxiety disorders. Am J Psychiatry 1990; 146: 685-695.

Suzuki K, Higuchi S, Yamada K, Mizutani Y, Kono, H. Young female alcoholics with and without eating disorders: A comparative study in Japan. Am J Psychiatry 1993; 150: 1053-1058.

Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) study. JAMA 1990; 264: 2511-2518.

Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HV, Kendler KS. Lifetime and 12-month prevalence of DSM III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 8-19.

Bland RC, Stephen CN, Russell JM, Orn HT (eds.). Epidemiology of psychiatric disorders in Edmonton: phenomenology and comorbidity. Acta Psychiatr Scand 1994; 89, suppl.376.

Ross HE. DSM III-R alcohol abuse and dependence and psychiatric comorbidity in Ontario: results from the mental health supplement to the Ontario Health Survey. Drug Alc Depend 1995; 39: 111-128.

Hesselbrock MN, Meyer RE, Keener JJ. Psychopathology in hospitalized alcoholics. Arch Gen Psychiatry 1985; 42: 1050-1055.

Penick EC, Powell BJ, Nickel EJ, Bingham SF, Riesenmy KR, Read MR, Campbell J. Comorbidity of lifetime psychiatric disorder among male alcoholic patients. Alc Clin Exp Res 1994; 18: 1289-1293.

Tomasson K, Vaglum P. A nationwide representative simple of treatment seeking alcoholics: a study of psychiatric comorbidity. Acta Psychiatr Scand 1995; 12: 378-385.

Cuadrado, P. Un estudio de la comorbilidad psiquiátrica en la dependencia alcohólica. Actas Luso-Esp Neurol Psiquiatr 1998; 26: 173-179.

Powell BJ, Penick EC, Othmer E, Bingham SF, Rice AS. Prevalence of additional psychiatric syndromes among male alcoholics. J Clin Psychiatry 1982; 43: 404-407.

Penick EC, Powell BJ, Othmer E, Bingham SF, Rice AS, Liese BS. Subtyping alcoholics by coexisting psychiatric syndromes: Course, family history, outcome. En Goodwin DW, Van Dusen KT, Mednick SA (eds) Longitudinal research in alcoholism. Boston: Kluwer Nijhoff Publishing, 1984: 167- 196.

Penick EC, Nickel EJ, Cantrell PF, Powell BJ, Read MR, Thomas MM. The Emerging concept of dual diagnosis: An overview and implications. J Chem Depend Treat 1990; 3: 1-54.

Penick EC, Powell BJ, Liskow BI, Jackos JO, Nickel EJ. The stability of coexisting psychiatric syndromes in alcoholic men after one year. J Stud Alcohol 1988; 49: 395- 405.

Brady KT, Grice DE, Dustan L, Randall C. Gender differences in substance use disorders. Am J Psychiatry 1993; 150: 1707-1711.

Lewis CE, Bucholz KK, Spitznagel E, Shoyka JJ. Effects of gender and comorbidity on problem drinking in a community sample. Alc Clin Exp Res 1996; 20: 466-476.

Ross HE, Glaser FB, Germanson T. The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Arch Gen Psychiatry 1988; 45: 1023-1031.

Hasin DS, Grant BF, Endicott J. Lifetime psychiatric comorbidity in hospitalized alcoholics: Subjects and familial correlates. Int J Addiction 1988; 23 (8): 827-850.

Blow FC, Cook CAL, Booth BM, Falcon JP, Friedman MJ. Age- related psychiatric comorbidities and level of functioning in alcohol veterans seeking outpatient treatment, Hosp Comm Psychiatry 1992; 43: 990-999.

Kessler RC, Crum RM, Warner CA, Nelson CB, Schulenberg J, Anthony JC. Lifetime Co-occurrence of DSM IIIR alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997; 54: 313-321.

Westreich L, Guedj P, Galanter M, Baird D. Differences between men and women in dual-diagnosis treatment. Am J Addiction 1997; 6 (4): 311-317.

Powell BJ, Penick EC, Nickel EJ, Liskow BI, Riesenmy KD, Campion SL, Brown EF. Outcomes of co-morbid alcoholic men. A 1-year follow-up, Al Clin Exp Res 1992; 16: 131-138.

Kesch KL, Klein DN. The relatioship between age at onset and comorbidity in psychiatric disorders. J Nerv Ment Dis 1996; 184: 703-707.

Cook BL, Winokur G, Fowler RC, Liskow BI. Classification of alcoholism with reference to comorbidity. Compr Psychiatry 1994; 35: 165-170.

McGue M, Shutsake W, Taylor J, Iacono WG. Personality and substance use disorders. I. Effects of gender and alcoholism subtype. Alc Clin Exp Res 1997; 21 (3): 513-520.

Roy A, DeJong J, Lamparski D, Adinoff B, George T, Moore V, Garrett D, Kerich M, Linnoila M. Mental disorders among alcoholics. Relationship to age of onset and cerebrospinal fluid neuropeptides. Arch Gen Psychiatry 1991; 48: 423-427.

Rimmer J, Reich T, Winokur G. Alcoholism: V. Diagnosis and clinical variation among alcoholics. Q J Stud Alcohol 1972; 33: 658-666.

Lewis CE, Robins L, Rice J. Association of alcoholism with antisocial personality in urban men. J Nerv MentDis 1985; 173: 166-174.

Morgenstern J, Langenbucher J, Labouvie E, Miller KJ. The comorbidity af alcoholism and personality disorders in a clinical population: prevalence rates and relation to alcohol typology variables. J Abnorm Psychol 1997; 106: 74-84.

Kendler KS, Davis CG, Kessler RC. The familial aggregation of common psychiatric and substance use disorder in the National Comorbidity Survey: a family study. Br J Psychiatry 1997; 170: 541-548.

O’Sullivan K, Rynne C, Miller J, O’Sullivan S, Fitzpatrick V, Hux M, Cooney J, Clare A. A follow-up study on alcoholics with and without co-existing affective disorder. Br J Psychiatry 1988; 152: 813-819.

Ross H, Shirley M. Life-time problem drinking and psychiatric co-morbidity among Ontario women. Addiction 1997; 98: 183-196.

Dickey B, Azeni H. Persons with dual diagnosis of substance abuse and major mental illness: their excess costs of psychiatric care. Am J Public Health 1996; 86: 973-977.

Rounsaville BJ, Dolinsky ZS, Babor TF, Meyer RE. Psychopathology as a predictor of treatment outcome in alcoholics. Arch Gen Psychiatry 1987; 44: 505-513.

Verhene R, van den Brink W, Hartgers C. Personality disorders predict relapse in alcoholic patients, Addic Behav 1998; 23 (69): 809-822.

Kranzler HR, Del Boca FK, Rounsaville BJ. Comorbid psychiatric diagnosis predicts three-year outcomes in alcoholics. A posttreatment natural history study. J Stud Alcohol 1996; 57: 619-626.

Brown TG, Seraganian P, Tremblay J. Alcohol and cocaine abusers 6 months after traditional treatment: do they fare as well as problem drinkers ?. J Subs Abuse Treat 1993; 10: 545-552.

Loosen PT, Dew BW, Prange AJ. Long-term predictors of outcome in abstinent alcoholic men. Am J Psychiatry 1990; 147: 1662-1666.

Kranzler HR, Del Boca FK, Rounsaville BJ. Comorbid psychiatric diagnosis predicts three-year outcomes in alcoholics. A posttreatment natural history study, J Stud Alcohol 1996; 57: 619-626.

Sellman JD, Joyce PR. Does depression predict relapse in the 6 months following treatment for men with alcohol dependence. Austr N Zel J Psychiatry 1996; 30: 573-578.

Eysenck HJ, Eysenck SBG. Cuestionario de Personalidad para niños y adultos. Madrid: TEA Ediciones SA, 1986.

Miller WR, Marlatt GA. Manual for the Comprehensive Drinker Profile. Odessa, Florida: Psychological Assesment Resources Inc, 1984.

Cuadrado P, García R, Pata MD, Noval MJ. Respuesta de la dependencia alcohólica a un programa comunitario de tratamiento. Psiquiatría Pública 1998; 10 (3): 162-168.

SPSS INC. SPSS/PC + Update for V 3.1. Chicago: SPSS INC ed.,1984.

Cuadrado P. Evolución de la dependencia alcohólica en tratamiento. Factores predictivos en un seguimiento de 5 a 7 años. Adicciones 1998; 10: 335-341.

Cuadrado P. Enfermos con dependencia al alcohol y comorbilidad psiquiátrica: un grupo heterogéneo. Actas Esp Psiquiatr 1999; 27: 235-244.

Cuadrado P. Comorbilidad psiquiátrica en la dependencia alcohólica. II. Implicaciones clínicas y terapéuticas. Actas Luso-Esp Neurol Psiquiatr 1997; 25: 34-44.

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Publicado

2000-09-15

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