TRASTORNO POR USO DE ALCOHOL Y TRASTORNO MENTAL. LA COMORBILIDAD COMO FACTOR PREDICTOR DE LA EVOLUCIÓN TERAPÉUTICA

INTRODUCCION El pronóstico y evolución en el Trastorno por Uso de Alcohol (TUA) y Trastorno Mental (TM) está condicionada por la multifactorialidad: falta de adherencia, recaídas, y complicaciones orgánicas. OBJETIVOS Identificar patología psiquiátrica concomitante. Analizar las tasas de adherencia a consulta y tratamiento. Correlacionar patología psiquiátrica con índices de retención. METODO Estudio descriptivo observacional longitudinal. Referencia muestral: 77 pacientes con TUA de 472 incluidos en Plan de Microeliminación del VHC de San Miguel Adicciones (2017 a 2020). Variables de estudio: sociodemográficas, clínicas y de consumo e indicadores de cumplimiento y retención. RESULTADOS Muestra: 62% hombres y 38% mujeres (34 y 70 años). Inicio del consumo de alcohol entre 15 y 18 años. Presentan Patología Dual 69% mujeres y 42% hombres. 85% de pacientes con TUA presentan un solo TM concomitante (95% hombres, 80% mujeres). Patología psiquiátrica predominante: Trastorno Depresivo 22% (H:53%;M:47%), Trastorno de Ansiedad 7% (H:60%;M:40%), Trastorno Ansioso Depresivo 8% (H:34%;M:66%). Destacar la prevalencia de un 18% de mujeres con Trastorno Psicótico. El 58% de mujeres han realizado uno o más Gesto Autolítico. Acuden por Iniciativa Propia 49%, derivación MAP (25%), Especializada 9%. Trastorno Depresivo: 82% de adherencia a consulta, 47% de retención superior a 6 meses. Trastorno de Ansiedad (20%) y 60% de retención entre 6 y 12 meses. CONCLUSIONES Mujeres con TUA presentan más comorbilidad psiquiátrica. La prevalencia de más de un Trastorno Mental es superior en mujeres. El Trastorno Depresivo es el de mayor incidencia con TUA. Escasa derivación desde los Servicios Especializados. References 1. Corrêa Filho JM, Baltieri DA. Psychosocial and clinical predictors of retention in outpatient alcoholism treatment. Braz J Psychiatry. 2012 -12;34(4):413-21. 2. Graff FS, Morgan TJ, Epstein EE, McCrady BS, Cook SM, Jensen NK, et al. Engagement and retention in outpatient alcoholism treatment for women. Am J Addict. 2009 Jul-Aug;18(4):277-88.

TRASTORNO POR USO DE ALCOHOL Y TRASTORNO MENTAL. INFLUENCIA DE LA CONCOMITANCIA EN LA EFECTIVIDAD DE LA INTERVENCIÓN AMBULATORIA

INTRODUCCION La Patología Dual (PD) en el consumo de alcohol condiciona el pronóstico, adherencia y retención en la intervención ambulatoria. OBJETIVOS Conocer prevalencia de patología dual. Determina tasas de adherencia a consulta y tratamiento. Analizar correlación PD cumplimiento y efectividad terapéutica. METODO Estudio descriptivo observacional longitudinal. Referencia muestral: 77 pacientes con TUA de 472 incluidos en Plan de Microeliminación del VHC de San Miguel Adicciones (2017 a 2020). Variables de estudio: sociodemográficas, clínicas y de consumo e indicadores de cumplimiento y retención. RESULTADOS Muestra: 62% hombres y 38% mujeres (34 y 70 años). 52% Patología Dual (69%M; 42%H). Patologías psiquiátricas: 22% trastorno depresivo (53%H;47%M), 7% ansiedad (60%H;40%M), 8% síndrome ansioso depresivo (34%H;66%M). Tentativas autolíticas 16%, (42%H;58%M), 7% más de un trastorno psiquiátrico. Acuden por Iniciativa Propia 49%, derivación MAP (25%), Especializada 9%. La retención es superior en los pacientes que no tienen PD (>12 meses). Menor índice de retención en pacientes con trastorno psiquiátrico 40%. Trastorno Depresivo: 82% de adherencia a consulta (AC), 47% de retención (R) > 6 meses, 29% abandona (A) y 24% alta terapéutica (AT). Trastorno de Ansiedad: 20%(AC), 60% (R) >6 meses, 40% (A), 0% (AT). Trastorno Ansioso-Depresivo: 10% (AC), 67%(R) > 6 meses, 50% (A) y 33% (AT). CONCLUSIONES Predominio de trastornos afectivos: depresión, ansiedad. Diferencia en el factor género en TUA y PD. Prevalencia de más de un Trastorno Mental superior en mujeres. Escasa derivación desde los Servicios Especializados. La concurrencia PD-TUA incide de manera desfavorable en pronóstico, evolución y efectividad terapéutica. References 1. Corrêa Filho JM, Baltieri DA. Psychosocial and clinical predictors of retention in outpatient alcoholism treatment. Braz J Psychiatry. 2012 -12;34(4):413-21. 2. Graff FS, Morgan TJ, Epstein EE, McCrady BS, Cook SM, Jensen NK, et al. Engagement and retention in outpatient alcoholism treatment for women. Am J Addict. 2009 Jul-Aug;18(4):277-88.

The Alcoholism Treatment Centre in Bratislava-Dúbravka – Its Establishment and Operation

BACKGROUND: In post-war Czechoslovakia, as in other countries, alcoholism was one of the gravest social problems. In addition to medical interventions, legislative and organisational measures were needed to deal with this problem, including the creation of specialised facilities for the long-term treatment of alcoholics. AIMS: To shed light on the process of the establishment and shaping of the Alcoholism Treatment Centre of the Municipal Institute of National Health in Bratislava-Dúbravka and to analyse its activities over the period 1961-1966. METHOD: This work is based on the study and content analysis of original archive materials, especially those stored at the Slovak National Archive in Bratislava, as well as focused articles from the specialist literature of the period. The authors’ aim is to place the Alcoholism Treatment Centre in Bratislava-Dúbravka into the legislative and institutional developmental framework of the battle against alcoholism in Czechoslovakia and in Slovakia. RESULTS AND CONCLUSION: Since the attention of psychiatric clinics and departments was especially dedicated to the treatment of acute complications linked to alcoholism and other addictions, the establishment of specialised facilities for the long-term treatment of alcoholics was a very valuable step. The Alcoholism Treatment Centre of the Municipal Institute of National Health in Bratislava- -Dúbravka was founded in 1961 by Michal Turček, MD, who headed it until 1965. The centre, with a capacity of 25 beds, provided comprehensive healthcare to patients with an alcohol addiction. In addition to the inpatient care, the centre also included outpatient care with alcohol counselling and sobering-up centres. After the Treatment Centre closed in 1966, its inpatient section was transferred to the Regional Psychiatric Treatment Centre in Pezinok. Despite its short-lived operation, the activity of the Treatment Centre was considered to have made a positive contribution, and it represents a significant period in the development of the prevention and treatment of alcoholism in Slovakia.

A temporal profile of pro-abstinence-oriented constructs from the modified theory of planed behavior in a Slovenian clinical sample of treated alcoholics – an 18-year follow-up

IntroductionUsing the modified Theory of Planned Behaviour (mTPB), different indicators of therapeutic success were studied to understand pro-abstinence behavioural orientation during an 18-year after-care period following a 3-month intensive alcoholism treatment. The indicators were: perceived needs satisfaction (NS), normative differential (ND), perceived alcohol utility (UT), beliefs about treatment programme benefits (BE) and behavioural intentions (BI).MethodsThe sample of 167 patients who consecutively started an intensive alcoholism treatment programme has been followed-up for 18 years, using standardised ailed instruments at the end of the treatment, and in the years 4-5, 9 and 18 of follow-up. The last data collection was completed by 32 subjects in 2010. The analysis followed the standard explore-analyse-explore approach. After the initial descriptive exploration of data, multivariate analysis of variance (MANOVA) in SPSS statistical package was set to explore between-groups and within-groups differences over time.ResultsAt the between-group level, BI remained stable at the same level as at the end of the treatment programme, whereas BE and UT robustly changed over time and levelled off after 10 years of follow-up. NS and ND show a trend of pro-abstinent orientation and level off after 10 years of follow-up, although the trend is not significant. The same results were confirmed by the within-subject level.ConclusionsStudied constructs stabilised after ten years of follow-up, apart from BI. The latter suggests that BI level needed for completion of an intensive treatment programme suffices for the maintenance of abstinence when accompanied by the change in perception of alcohol usefulness.

A temporal profile of pro-abstinence-oriented constructs from the modified theory of planed behavior in a Slovenian clinical sample of treated alcoholics – an 18-year follow-up

Introduction Using the modified Theory of Planned Behaviour (mTPB), different indicators of therapeutic success were studied to understand pro-abstinence behavioural orientation during an 18-year after-care period following a 3-month intensive alcoholism treatment. The indicators were: perceived needs satisfaction (NS), normative differential (ND), perceived alcohol utility (UT), beliefs about treatment programme benefits (BE) and behavioural intentions (BI). Methods The sample of 167 patients who consecutively started an intensive alcoholism treatment programme has been followed-up for 18 years, using standardised ailed instruments at the end of the treatment, and in the years 4-5, 9 and 18 of follow-up. The last data collection was completed by 32 subjects in 2010. The analysis followed the standard explore-analyse-explore approach. After the initial descriptive exploration of data, multivariate analysis of variance (MANOVA) in SPSS statistical package was set to explore between-groups and within-groups differences over time. Results At the between-group level, BI remained stable at the same level as at the end of the treatment programme, whereas BE and UT robustly changed over time and levelled off after 10 years of follow-up. NS and ND show a trend of pro-abstinent orientation and level off after 10 years of follow-up, although the trend is not significant. The same results were confirmed by the within-subject level. Conclusions Studied constructs stabilised after ten years of follow-up, apart from BI. The latter suggests that BI level needed for completion of an intensive treatment programme suffices for the maintenance of abstinence when accompanied by the change in perception of alcohol usefulness.