Severity factors associated with borderline personality disorder among misusers in an outpatient sample in Spain C. Barral, C. Daigre, D. Bachiller, Natàlia Calvo, E. Ros-Cucurull, Beatriz Gancedo, L. Grau-López, M. Ferrer, M. Casas, C. Roncero Journal of Addictive Diseases, 2017 The comorbidity between substance-use disorders and borderline personality disorder (SUD-BPD) with other psychiatric disorders has been little studied. A total of 937 drug-dependent patients were evaluated using semistructured interviews and 13.7% were SUD-BPD patients. After multivariate analysis, gender, Affective Disorder (OR 2.59), Anxiety Disorder (OR 1.90), Eating Disorders (OR 4.29), Cocaine (OR 2.16), benzodiazepine dependence (OR 1.90), early age of onset of drug consumption (OR 0.94), and dependent (OR 4.04), paranoid (OR 3.70) and antisocial personality disorders (OR 3.46) were associated with SUD-BPD. Several psychiatric comorbidities are the norm in SUD-BPD patients; therefore these patients are a challenge for clinicians.
A Highly Polymorphic Copy Number Variant in the NSF Gene is Associated with Cocaine Dependence J. Cabana-Domínguez, C. Roncero, L. Grau-López, L. Rodríguez-Cintas, C. Barral, A. Abad, Galina A. Erikson, N. Wineinger, B. Torrico, C. Arenas, M. Casas, M. Ribasés, B. Cormand, N. Fernàndez‐Castillo Scientific Reports, 2016 Cocaine dependence is a complex psychiatric disorder involving both genetic and environmental factors. Several neurotransmitter systems mediate cocaine's effects, dependence and relapse, being the components of the neurotransmitter release machinery good candidates for the disorder. Previously, we identified a risk haplotype for cocaine dependence in the NSF gene, encoding the protein N-Ethylmaleimide-Sensitive Factor essential for synaptic vesicle turnover. Here we examined the possible contribution to cocaine dependence of a large copy number variant (CNV) that encompasses part of the NSF gene. We performed a case-control association study in a discovery sample (359 cases and 356 controls) and identified an association between cocaine dependence and the CNV (P = 0.013), that was confirmed in the replication sample (508 cases and 569 controls, P = 7.1e-03) and in a pooled analysis (P = 1.8e-04), with an over-representation of low number of copies in cases. Subsequently, we studied the functional impact of the CNV on gene expression and found that the levels of two NSF transcripts were significantly increased in peripheral blood mononuclear cells (PBMC) along with the number of copies of the CNV. These results, together with a previous study from our group, support the role of NSF in the susceptibility to cocaine dependence.
Impulsive clinical profile of Borderline Personality Disorder with comorbid Substance Use Disorder Actas Espanolas De Psiquiatria, 2016
Reliability of the Beck Depression Inventory in opiate-dependent patients C. Barral, L. Rodríguez-Cintas, N. Martínez-Luna, D. Bachiller, J. Pérez-Pazos, J. Alvarós, M. Casas, C. Roncero Journal of Substance Use, 2016 Background: The prevalence of depressive disorder in opioid-dependent patients in methadone treatment has been found to be between 19 to 74.3%. Beck Depression Inventory (BDI) is commonly used as a screening for depressive symptoms. The objective of this study is assessing BDI in opiate-dependent patients. Methods: A total of 415 patients over 18 years old in a methadone maintenance program that is part of an outpatient drug clinic treated with stable doses of methadone in the last month were assessed using Structured Clinical Interview for Axis I Disorders of the DSM-IV (SCID-I) and BDI. Results: A sample of 118 patients completed the evaluation; 77.96% showed depressive symptoms (N: 92) (BDI scores ≥ 10). Patients who met criteria for depression with SCID-I and BDI (6.7%) showed a higher score in BDI which did not reach significance. Statistical differences were found in the depressive group. Predictive value of BDI was 6.61% with a cut-off point of BDI ≥ 10, growing to 11.7% with a cut-off point of BDI > 30. Conclusions: BDI is not effective for diagnosing depressive disorder. An adequate psychometric tool is needed to improve the detection of depressive symptoms and depressive diagnosis in opiate-dependent patients in order to reduce risk of relapse and improve treatment strategies.
Psychotic symptoms associated with the use of dopaminergic drugs, in patients with cocaine dependence or abuse C. Roncero, A. Abad, Antonio Padilla-Mata, E. Ros-Cucurull, C. Barral, M. Casas, L. Grau-López Current Neuropharmacology, 2016 Background In the field of dual diagnosis, physicians are frequently presented with pharmacological questions. Questions about the risk of developing psychotic symptoms in cocaine users who need treatment with dopaminergic drugs could lead to an undertreatment. Objective Review the presence of psychotic symptoms in patients with cocaine abuse/dependence, in treatment with dopaminergic drugs. Methods Systematic PubMed searches were conducted including December 2014, using the keywords: “cocaine”, dopaminergic drug (“disulfuram-methylphenidate-bupropion-bromocriptine-sibutramine-apomorphine-caffeine”) and (“psychosis-psychotic symptoms-delusional-paranoia”). Articles in English, Spanish, Portuguese, French, and Italian were included. Articles in which there was no history of cocaine abuse/dependence, absence of psychotic symptoms, systematic reviews, and animal studies, were excluded. Results 313 papers were reviewed. 7 articles fulfilled the inclusion-exclusion criteria. There is a clinical trial including 8 cocaine-dependent patients using disulfiram in which 3 of them presented psychotic symptoms and 6 case-reports: disulfuram (1), methylphenidate (1), disulfiram with methylphenidate (2), and bupropion (2), reporting psychotic symptoms, especially delusions of reference and persecutory ideation. Conclusion Few cases have been described, which suggests that the appearance of these symptoms is infrequent. The synergy of dopaminergic effects or the dopaminergic sensitization in chronic consumption are the explanatory theories proposed by the authors. In these cases, a relationship was found between taking these drugs and the appearance of psychotic symptoms. Given the low number of studies found, further research is required. The risk of psychotic symptoms seems to be acceptable if we compare it with the benefits for the patients but a closer monitoring seems to be advisable.
Cocaine-induced psychosis and brain-derived neurothrophic factor in patients with cocaine dependence: Report of two cases C. Roncero, R. Palma-Álvarez, E. Ros-Cucurull, C. Barral, B. Gonzalvo, M. Corominas-Roso, M. Casas, L. Grau-López Clinical Psychopharmacology and Neuroscience, 2016 Brain-derived neurotrophic factor (BDNF) is linked to numerous brain functions. In addition, BDNF alterations contribute to neurological, mental, and addictive disorders. Cocaine dependence has received much attention recently due to its prevalence and psychological effects. Symptoms of psychosis are one of the most serious adverse events precipitated by cocaine use. It is particularly important to identify patients at risk of developing cocaine-induced psychosis (CIP). We described two cases of patients with cocaine dependence who presented with CIP and had changes in their BDNF levels during the psychotic episode. BDNF levels were initially low in both patients, and then decreased by more than 50% in association with CIP. The relationship between BDNF and psychosis is described in the literature. These cases revealed that BDNF levels decreased during a CIP episode and, thus, it is necessary to investigate BDNF and its relationship with CIP further.
Relevant differences in perception and knowledge of professionals in different Spanish autonomous communities regarding availability of resources for patients with dual disorders Actas Espanolas De Psiquiatria, 2016
Regional analysis of health service utilisation by persons with borderline personality disorders: Implications for evidence-informed policy Journal of Mental Health Policy and Economics, 2015
Driving and legal status of Spanish opioid-dependent patients Carlos Roncero, F Javier Álvarez, Carmen Barral, Susana Gómez-Baeza, Begoña Gonzalvo, Laia Rodríguez-Cintas, M Teresa Brugal, Carlos Jacas, Anna Romaguera, Miguel Casas Substance Abuse Treatment Prevention and Policy, 2013
Gender differences in dually diagnosed outpatients Laia Miquel, Carlos Roncero, Gloria García-García, Carmen Barral, Constanza Daigre, Lara Grau-López, Diana Bachiller, Miguel Casas Substance Abuse, 2013
Borderline personality disorder (BPD) diagnosis with the self-report personality diagnostic questionnaire-4+(PDQ-4+): Confirmation of the 3-faetor structure Actas Espanolas De Psiquiatria, 2012
Therapeutic management and comorbidities in opiate-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study Heroin Addiction and Related Clinical Problems, 2011
