Psychiatric disorders are commonly associated with systemic lupus erythematosus (SLE). Some autho... more Psychiatric disorders are commonly associated with systemic lupus erythematosus (SLE). Some authors consider that these disorders can be associated with cognitive impairment. The objectives of this study were to establish the particular prevalence of psychiatric disorders in these patients and to investigate the relationship between psychiatric disorders, cognitive impairment, life quality, psychological status and adjustment to illness. A cross-sectional study is reported of 46 spanish patients with systemic lupus erythematosus (SLE) attending the outpatients clinics of the Internal Medicine and Rheumatology Departments at a University Hospital. The following instruments were used: a Structured Clinical Interview for DSM-III-R, the Nottingham Health Profile, the Symptom Check-List 90-Revised, the Psychological Adjustment to Illness Scale and the Integrated Program of Neuropsychological Assessment Test-Barcelona. The prevalence of psychiatric disorders at interview was 33%. The most common diagnoses were affective disorders and psycho-organic syndrome. Affective disorders were associated with a poorer life quality, number of hospitalizations and psychiatric background. Adjustment to illness accounted for the psychologic status of the patients.
Seventy-three inpatients of a general hospital were studied prospectively. Detection of alcohol p... more Seventy-three inpatients of a general hospital were studied prospectively. Detection of alcohol problems was done by non-psychiatrist physicians. The psychiatrist, after evaluating the problem recommended an outpatient centre for treatment. One year after this 15% of them remained abstinent. Age onset of alcohol-related problems correlated positively with abstinence days number. Abstinence was associated with an late age onset of alcohol-related problems and contacting with the outpatient center. Thirty-seven years age was the cutoff point with more specificity and sensibility. Hypothesis for this results are discussed.
To evaluate Cloninger's classification in a sample of alcoholic Spanish men. A cr... more To evaluate Cloninger's classification in a sample of alcoholic Spanish men. A cross-sectional study was carried out on subjects diagnosed as alcoholics. Out-patient units specializing in the treatment of alcoholics and the psychiatry unit of a general hospital. One hundred and ninety-eight males diagnosed as alcoholics. The mean age was 44.4 +/- 11.6 years and 98% were from urban areas. Participants were interviewed using the Structured Clinical Interview for DSM-III-R(SCID). They were classified using type 1 and type 2 criteria of Cloninger's classification. Only one-third of our sample could be classified by Cloninger's type 1 and type 2 criteria. Patients classified as belonging to type 2 had an earlier onset of regular drinking compared to type 1 patients. Type 2 subjects presented a higher percentage of alcohol-related problems as well as problems related to drugs other than alcohol and they also presented a higher percentage of antisocial personality disorder. No differences in alcoholism family history were found between the groups. Criteria showing the poorest discriminative ability between both groups were "failure to keep abstinent" and "benders lasting at least two days". Our results do not support Cloninger's etiological hypotheses for alcoholism. Cultural differences may be responsible for the different drinking patterns observed.
The results of the validation for the AUDIT (Alcohol Use Disorders Identification Test) in Primar... more The results of the validation for the AUDIT (Alcohol Use Disorders Identification Test) in Primary Care are here reported. A total of 326 patients who attended two primary care centers were interviewed. In a first interview they answered the AUDIT questions and later were classified on the basis of disturbances caused by alcohol use: abuse or dependency. The diagnosis of abuse or dependency was obtained with the structured interview for DSM-III-R. Reliability was determined by the test-retest correlation and internal consistency by Cronbach's alpha coefficient. Efficacy was calculated by means of the area under the curve (receiver operating characteristics). A quarter of the interviewed patients were diagnosed of some disturbance caused by alcohol use. The internal reliability of the test was acceptable (Cronbach's alpha coefficient 0.86). The test-retest correlation coefficient was 0.90. All the questions acceptably correlated with the total in the scale. A cut-off point of 8 was the most efficient for the whole sample (90% sensitivity and 90% specificity). For females, the most efficient cut-off point was 6. For patients aged over 60 years, the most efficient cut-off point was 5 for both sexes. This study confirms the usefulness of AUDIT for screening alcohol-related problems in Primary Care.
Carbohydrate-Deficient Transferrin (CDT) is a new marker for excessive alcohol drinking. It appea... more Carbohydrate-Deficient Transferrin (CDT) is a new marker for excessive alcohol drinking. It appears to be useful to detect alcoholism, harmful consumption and relapse. It have been introduced in our country recently. Recent studies about utility of CDT have been reviewed. Sensitivity and specificity of CDT level as a marker of alcoholism were 72-97% and 31-81% respectively. As a marker of harmful consumption its sensitivity was 15-69% and its sensitivity was higher than 82%. CDT was demonstrated to be a effective maker for evaluating alcoholic abstinence in alcoholic patients. CDT determinations have a high specificity for screening heavy drinking in different settings. Problems related to its sensitivity are discussed.
The ascertainment of patients who consume important amounts of alcohol admitted to a hospital is ... more The ascertainment of patients who consume important amounts of alcohol admitted to a hospital is essential to prevent medical and psychological complications. Carbohydrate deficient transferrin (CDT) is a new marker of alcohol consumption which requires validation in the hospital setting. The values of carbohydrate deficient transferrin (CDT), glutamic oxalacetic transaminase (GOT), gamma glutamil transpeptidase (GGT) and mean corpuscular volume (MCV) were measured in 101 consecutive patients admitted to the Internal Medicine and Surgery Departments. Considering amounts higher than 60 g/day of ethanol for male patients and higher than 40 g/day for female patients as risk consumption, the values for sensitivity, specificity and area under the curve were calculated for the different biological tests. Twenty-six percent of patients reported a consumption of risk. The sensitivity of the tests were lower than 50% and specificities higher than 77%. CDT had the lowest sensitivity (15%) but it was very specific (98%). CDT had a better sensitivity among women than among men. None of the tests had an area under the curve with adequate efficiency levels. CDT among the hospitalized patients and other biological markers of alcohol consumption have a low efficiency.
Actas luso-españolas de neurología, psiquiatría y ciencias afines
Ecstasy use have raised in recent years and it have been related to psychopathological symptoms. ... more Ecstasy use have raised in recent years and it have been related to psychopathological symptoms. The comsumption pattern associated with psychiatric complications is unknown. Thirty-six case reports about psychiatric complications due to ecstasy and published from 1985 to 1997 were studied. The disorders with higher prevalence were psychosis (n = 21), panic attacks (n = 12) and depressive symptoms (n = 3). Seventy two per cent were substance abusers. Urinary drugs screening were present in 28%, only in two subjects might detect amphetamine. Men had higher MDMA doses compsumption and higher prevalence of background psychiatric disorders than women. Subjects with psychotic symptomatology had more psychiatric background, higher doses of MDMA comsumption and for a long time than individuals with depressive or panic attacks symptomatology. The review of the case reports of psychiatric complications related to ecstasy use do not allow to conclude that ecstasy use was the main responsible factor for psychiatric symptoms. They could be related to an individual vulnerability and or to lasting of comsumption.
Schizophrenic patients have a high comorbidity with substance use disorders. However, there are f... more Schizophrenic patients have a high comorbidity with substance use disorders. However, there are few studies on the efficacy of antipsychotics on psychopathology and on their repercutions on substance abuse. All studies about pharmacological treatment of schizophrenic patients with substance abuse, included in Medline over the last ten years were analyzed. Of the 17 studies reviewed, most were prospective with small samples (< 30 patients, 5 studies) or case reports (7 studies). Objectives were to assess the efficacy on schizophrenic symptoms and the effect of the treatment on substance use. Atypical antipsychotics were the most studied. These pharmacological agents were effective at reducing symptoms and had few side effects. They also managed lo reduce substance abuse in 66-75% of patients. In spite of underlyng methodological problems of these studies, the findings suggest that atypical antipsychatics could be the treatment of choice in these patients.
Psychiatric disorders are commonly associated with systemic lupus erythematosus (SLE). Some autho... more Psychiatric disorders are commonly associated with systemic lupus erythematosus (SLE). Some authors consider that these disorders can be associated with cognitive impairment. The objectives of this study were to establish the particular prevalence of psychiatric disorders in these patients and to investigate the relationship between psychiatric disorders, cognitive impairment, life quality, psychological status and adjustment to illness. A cross-sectional study is reported of 46 spanish patients with systemic lupus erythematosus (SLE) attending the outpatients clinics of the Internal Medicine and Rheumatology Departments at a University Hospital. The following instruments were used: a Structured Clinical Interview for DSM-III-R, the Nottingham Health Profile, the Symptom Check-List 90-Revised, the Psychological Adjustment to Illness Scale and the Integrated Program of Neuropsychological Assessment Test-Barcelona. The prevalence of psychiatric disorders at interview was 33%. The most common diagnoses were affective disorders and psycho-organic syndrome. Affective disorders were associated with a poorer life quality, number of hospitalizations and psychiatric background. Adjustment to illness accounted for the psychologic status of the patients.
Seventy-three inpatients of a general hospital were studied prospectively. Detection of alcohol p... more Seventy-three inpatients of a general hospital were studied prospectively. Detection of alcohol problems was done by non-psychiatrist physicians. The psychiatrist, after evaluating the problem recommended an outpatient centre for treatment. One year after this 15% of them remained abstinent. Age onset of alcohol-related problems correlated positively with abstinence days number. Abstinence was associated with an late age onset of alcohol-related problems and contacting with the outpatient center. Thirty-seven years age was the cutoff point with more specificity and sensibility. Hypothesis for this results are discussed.
To evaluate Cloninger's classification in a sample of alcoholic Spanish men. A cr... more To evaluate Cloninger's classification in a sample of alcoholic Spanish men. A cross-sectional study was carried out on subjects diagnosed as alcoholics. Out-patient units specializing in the treatment of alcoholics and the psychiatry unit of a general hospital. One hundred and ninety-eight males diagnosed as alcoholics. The mean age was 44.4 +/- 11.6 years and 98% were from urban areas. Participants were interviewed using the Structured Clinical Interview for DSM-III-R(SCID). They were classified using type 1 and type 2 criteria of Cloninger's classification. Only one-third of our sample could be classified by Cloninger's type 1 and type 2 criteria. Patients classified as belonging to type 2 had an earlier onset of regular drinking compared to type 1 patients. Type 2 subjects presented a higher percentage of alcohol-related problems as well as problems related to drugs other than alcohol and they also presented a higher percentage of antisocial personality disorder. No differences in alcoholism family history were found between the groups. Criteria showing the poorest discriminative ability between both groups were "failure to keep abstinent" and "benders lasting at least two days". Our results do not support Cloninger's etiological hypotheses for alcoholism. Cultural differences may be responsible for the different drinking patterns observed.
The results of the validation for the AUDIT (Alcohol Use Disorders Identification Test) in Primar... more The results of the validation for the AUDIT (Alcohol Use Disorders Identification Test) in Primary Care are here reported. A total of 326 patients who attended two primary care centers were interviewed. In a first interview they answered the AUDIT questions and later were classified on the basis of disturbances caused by alcohol use: abuse or dependency. The diagnosis of abuse or dependency was obtained with the structured interview for DSM-III-R. Reliability was determined by the test-retest correlation and internal consistency by Cronbach's alpha coefficient. Efficacy was calculated by means of the area under the curve (receiver operating characteristics). A quarter of the interviewed patients were diagnosed of some disturbance caused by alcohol use. The internal reliability of the test was acceptable (Cronbach's alpha coefficient 0.86). The test-retest correlation coefficient was 0.90. All the questions acceptably correlated with the total in the scale. A cut-off point of 8 was the most efficient for the whole sample (90% sensitivity and 90% specificity). For females, the most efficient cut-off point was 6. For patients aged over 60 years, the most efficient cut-off point was 5 for both sexes. This study confirms the usefulness of AUDIT for screening alcohol-related problems in Primary Care.
Carbohydrate-Deficient Transferrin (CDT) is a new marker for excessive alcohol drinking. It appea... more Carbohydrate-Deficient Transferrin (CDT) is a new marker for excessive alcohol drinking. It appears to be useful to detect alcoholism, harmful consumption and relapse. It have been introduced in our country recently. Recent studies about utility of CDT have been reviewed. Sensitivity and specificity of CDT level as a marker of alcoholism were 72-97% and 31-81% respectively. As a marker of harmful consumption its sensitivity was 15-69% and its sensitivity was higher than 82%. CDT was demonstrated to be a effective maker for evaluating alcoholic abstinence in alcoholic patients. CDT determinations have a high specificity for screening heavy drinking in different settings. Problems related to its sensitivity are discussed.
The ascertainment of patients who consume important amounts of alcohol admitted to a hospital is ... more The ascertainment of patients who consume important amounts of alcohol admitted to a hospital is essential to prevent medical and psychological complications. Carbohydrate deficient transferrin (CDT) is a new marker of alcohol consumption which requires validation in the hospital setting. The values of carbohydrate deficient transferrin (CDT), glutamic oxalacetic transaminase (GOT), gamma glutamil transpeptidase (GGT) and mean corpuscular volume (MCV) were measured in 101 consecutive patients admitted to the Internal Medicine and Surgery Departments. Considering amounts higher than 60 g/day of ethanol for male patients and higher than 40 g/day for female patients as risk consumption, the values for sensitivity, specificity and area under the curve were calculated for the different biological tests. Twenty-six percent of patients reported a consumption of risk. The sensitivity of the tests were lower than 50% and specificities higher than 77%. CDT had the lowest sensitivity (15%) but it was very specific (98%). CDT had a better sensitivity among women than among men. None of the tests had an area under the curve with adequate efficiency levels. CDT among the hospitalized patients and other biological markers of alcohol consumption have a low efficiency.
Actas luso-españolas de neurología, psiquiatría y ciencias afines
Ecstasy use have raised in recent years and it have been related to psychopathological symptoms. ... more Ecstasy use have raised in recent years and it have been related to psychopathological symptoms. The comsumption pattern associated with psychiatric complications is unknown. Thirty-six case reports about psychiatric complications due to ecstasy and published from 1985 to 1997 were studied. The disorders with higher prevalence were psychosis (n = 21), panic attacks (n = 12) and depressive symptoms (n = 3). Seventy two per cent were substance abusers. Urinary drugs screening were present in 28%, only in two subjects might detect amphetamine. Men had higher MDMA doses compsumption and higher prevalence of background psychiatric disorders than women. Subjects with psychotic symptomatology had more psychiatric background, higher doses of MDMA comsumption and for a long time than individuals with depressive or panic attacks symptomatology. The review of the case reports of psychiatric complications related to ecstasy use do not allow to conclude that ecstasy use was the main responsible factor for psychiatric symptoms. They could be related to an individual vulnerability and or to lasting of comsumption.
Schizophrenic patients have a high comorbidity with substance use disorders. However, there are f... more Schizophrenic patients have a high comorbidity with substance use disorders. However, there are few studies on the efficacy of antipsychotics on psychopathology and on their repercutions on substance abuse. All studies about pharmacological treatment of schizophrenic patients with substance abuse, included in Medline over the last ten years were analyzed. Of the 17 studies reviewed, most were prospective with small samples (< 30 patients, 5 studies) or case reports (7 studies). Objectives were to assess the efficacy on schizophrenic symptoms and the effect of the treatment on substance use. Atypical antipsychotics were the most studied. These pharmacological agents were effective at reducing symptoms and had few side effects. They also managed lo reduce substance abuse in 66-75% of patients. In spite of underlyng methodological problems of these studies, the findings suggest that atypical antipsychatics could be the treatment of choice in these patients.
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