La respuesta de sobresalto y la inhibición prepulso en los trastornos por uso de alcohol. Implicaciones para la práctica clínica Los trastornos por uso de alcohol (TUA) están siendo estudiados empleando distintos paradigmas neurofisiológicos y neuropsicológicos, entre los que se encuentran el paradigma de la respuesta de sobresalto (RS) y la inhibición prepulso (IPP). En este artículo presentamos los resultados que nuestro grupo ha obtenido después de desarrollar varias líneas de investigación en relación a la RS y la IPP en pacientes con TUA. El primer estudio se realizó con 19 pacientes con dependencia de alcohol, a los que se evaluó la RS y la IPP a nivel basal y a los 14 días, después de haber completado de manera satisfactoria el proceso de desintoxicación. El segundo estudio incluyó a 60 pacientes con dependencia de alcohol y que mantenían una abstinencia de al menos un mes, que fueron testados mediante el test de sobresalto y comparados con un grupo control. En el tercer estudio, 40 pacientes procedentes del segundo estudio fueron evaluados mediante pruebas de impulsividad, correlacionando posteriormente las variables de la RS y las variables de impulsividad. Nuestros estudios han demostrado que los pacientes con dependencia de alcohol presentan una menor magnitud de la RS y una alteración de la IPP cuando son comparados con sujetos sanos. Las alteraciones de la IPP son más marcadas cuando los pacientes presentan un consumo activo de alcohol y se encuentran en las fases iniciales del síndrome de abstinencia, tendiendo a recuperarse parcialmente una vez que se ha completado de manera satisfactoria un tratamiento de desintoxicación, aunque en ningún caso se llegan a alcanzar los porcentajes de IPP mostrados por el grupo de controles sanos. Por último, hemos encontrado que los paradigmas de la RS y las variables de impulsividad se correlacionan en pacientes con dependencia de alcohol, pero no es sujetos sanos. Se concluye que el test de la RS y la IPP pueden ser una herramienta útil a la hora de evaluar a pacientes con dependencia de alcohol, pudiendo ser consideradas como variables neurofisiológicas que podrían constituir marcadores de vulnerabilidad para el desarrollo de alcoholismo o bien el reflejo de los efectos neurotóxicos que el alcohol ejerce sobre el sistema nervioso central.
Background:The link between impulsivity and alcohol use disorders has been established in longitudinal and cross-sectional studies, but little is know about the role of behavioural impulsivity in the development of substance use disorders.Objectives:Determine the role of behavioural measures of impulsivity in the development of alcohol use disorders.Design and measurements:A prospective cohort study was conducted to identify the risk factors associated with alcohol dependence. Non-dependent heavy drinkers (N=471) and healthy controls (N=149) were recruited from primary care centres. They were assessed at the end of the 4-year follow-up period. Diagnoses were rendered using the Structured Interview for DSM-IV. The continuous performance test (CPT) and stop-signal task (SST) assessed behavioural inhibition. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay discounting dimension.Results:HD participants have significant impairments on all laboratory measures of impulsivity. In the logistic regression model, impairment on DRLR (delay discounting dimension) was the only measure that classified accurately HD. Baseline behavioural measures of impulsivity correlated positively with amount of alcohol consumption during the follow-up period. Logistic regression analysis indicated that performance on inhibitory control (SST) (behavioural inhibition dimension) was a significant predictor (odds=1.52[1.08-2.31]) for developing alcohol dependence.Conclusions:Our data support the link between behavioural measures of impulsivity and alcohol use disorders. Delay discounting dimension may be a risk factor for begin alcohol use heavily and behavioural inhibition impairment is more involved in the development of dependence.
Resumen: El sesgo atencional para el alcohol se ha mostrado útil para identificar a personas con consumo patológico así como a personas dependientes con altas probabilidades de recaída. El objetivo de este trabajo fue validar la versión española del Test Stroop de Alcohol diseñado para evaluar el sesgo atencional en pacientes dependientes del alcohol. La muestra estuvo compuesta por 173 participantes divididos en dos grupos: Un grupo de pacientes (n = 88) cumpliendo criterios de dependencia alcohólica y un grupo control (n = 85) con riesgo bajo de consumo de alcohol, que realizaron el Test de palabras y colores de Stroop (Stroop clásico), el Test de Stroop neutro y el Test de Stroop de Alcohol. Se observaron diferencias estadísticamente significativas en las interferencias para el Stroop Clásico y el Stroop de Alcohol. Los pacientes con dependencia, en comparación a los participantes control, mostraron mayores interferencias para estímulos de contenido alcohólico que para estímulos de contenido neutro. Este efecto fue explicado por un sesgo atencional para información relacionada con el alcohol en pacientes con dependencia. Se calcularon curvas COR, observándose áreas bajo la curva estadísticamente significativas para las interferencias del Stroop clásico y del Stroop de alcohol. Este trabajo sirvió para validar la versión española del Test Stroop de Alcohol para evaluar sesgos atencionales hacia el alcohol en personas con problemas de consumo y dependencia alcohólica. Palabras clave: Sesgo atencional; alcohol; alcoholismo; dependencia; Stroop de alcohol.Title: Validation of the Spanish Version of the Alcohol Stroop Test. Abstract: Attention bias for alcohol has proved useful to distinguish people with a pathological consumption of people who do not, and dependents who are more likely to fall in consumption. The aim of this study was to validate the Spanish version of the Alcohol Stroop test, designed to evaluate attention biases for alcohol in alcohol-dependent patients. The sample was composed by 173 participants divided into 2 groups: 1) "Patients" (n = 88) meeting criteria for alcohol dependence; and 2) "Control" (n = 85) having a low risk for alcohol consumption, that completed the Stroop color naming Task (Classic Stroop), the Neutral Stroop test and the alcohol Stroop test. Statistically significant differences were found in the interference effects calculated for the Classic and Alcohol Stroop tests. Patients compared to control participants showed a higher interference effect for alcohol-related stimuli than for neutral stimuli. These effects were accounted by an attention bias for alcohol-related information in patients. ROC curves were calculated for the three interference effects, showing an area under the curve statistically significant in the Classic Stroop interference and the Alcohol Stroop interference. This study provides the validation of the Spanish version of the Alcohol Stroop test that allows to evaluate attention biases for alcohol stimuli in individuals with both pathologic alcohol consu...
Background:Different types of behavioural impulsivity have been associated with the development of substance use disorders but little is know about what type of impulsivity is provoked by the effect of chronic use of substances.Objectives:Determine what type of behavioural impulsivity was associated with the use of alcohol and cocaine.Design and measurements:A prospective cohort study was conducted to identify changes on behavioural impulsivity. Non-dependent heavy drinkers (N=471) were recruited from primary care centres. The following assessments were used at baseline and at the end of the 4-year follow-up period: The continuous performance test (CPT) and stop-signal task (SST) assessed behavioural inhibition. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay discounting dimension. Diagnoses were rendered using the Structured Interview for DSM-IV.Results:Amounts on alcohol and cocaine consumption during follow-up correlated positively with changes on all impulsivity measures. Logistic regression analysis indicated that cocaine used was associated specifically with poor performance on CPT and SST and amount of alcohol used during follow-up was related to changes on DRLR.Conclusions:Substances provoke different pattern of behavioural impulsivity: chronic cocaine use provokes changes mainly on behavioural inhibition dimension and alcohol use induces changes on delay discounting paradigm.
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