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.
RationaleGray's theory of personality distinguishes two personality dimensions: Behavioral Activation System (BAS) and Behavioral Inhibition System (BIS). This construct has been widely used in the field of addictions and the study of impulsivity. BIS and BAS can be measured using the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). This questionnaire has been carried out in cross-sectional studies related to alcohol misuse, eating disorders, pathological gambling and cannabis misuse.ObjectivesTo study Sensitivity to Reward and Sensitivity to Punishment as factors that could predict the development of Alcohol Dependence.Methods380 subjects completed the SPSRQ at the beginning of the study and were followed-up for 4 years. At this point, participants completed a protocol that assessed drinking-related variables and drinking patterns. Statistic was performed using regression analysis.ResultsLow scores obtained in the Reward Sensitivity Subscale was a significant predictor for developing an Alcohol Use Disorder (AUD). High scores obtained in the Punishment Sensitivity Subscale were not significantly related to the subsequent development of an AUD.ConclusionsLow scores obtained in the Reward Sensitivity Subscale predict a higher risk for the development of Alcohol Dependence. This could be due to more difficulties that these individuals exhibit, despite the negative consequences, when they have to inhibit their seeking behavior and intake of alcohol.
IntroductionIt is well known that impulsivity and stress are risk factors for the development of addictive disorders, and more specifically alcohol dependence. Impulsivity has two dimensions: behavioural inhibition and delay of reward. The Fear- Conditioning paradigm of the Startle response (SR), which refers to the potentiation of the startle amplitude after the exposure to aversive stimulus, can be used as a stress test. The aim of this study was to explore the correlation between impulsivity laboratory tasks and the Fear-Conditioning (FC) paradigm of the SR as risk factors for the development of alcohol dependence.MethodsThe sample included 40 abstinent alcoholic men, who met DSM-IV criteria for Alcohol Dependence and had been abstinent for at least one month. Impulsivity was assessed using two laboratory tests: Stop-Signal Task (SST) and Differential Reinforcement for Low-Rate Responding (DRL6). The FC paradigm of the SR was used as a stress test. Patients were compared to 40 matched controls.ResultsWe found a positive correlation between SST tasks and the FC paradigm of the SR (p < 0,05) and a negative correlation between the DRL6 tasks and the FC paradigm of the SR (p < 0,05) in the patient's group. This significant correlation was not found in controls.ConclusionsImpulsivity and stress are significantly correlated in alcohol dependent patients. This means that while healthy subjects cope with stress, alcohol dependent patients react with higher impulsivity when they are exposed to stress situations and this could lead them to drink alcohol to relieve anxiety and depressive symptoms.
BackgroundThere is a growing trend to consider pathological gambling (PG) as an addictive behavior. Attentional bias (AB) occurs when the attentional channeling is directed towards emotionally valued stimuli despite an individual's effort to ignore them. This paradigm has been widely used to assess other addictions such as alcoholism and cocaine misuse. AB has been assessed in PG using the modified Stroop procedure. Despite that, to date, other procedures such as the dot-probe task have not been used.ObjectiveTo develop a dot-probe task to assess AB in PG.MethodsWe selected 38 gambling-related pictures that were validated using the Self-Assessment Manikin Visual Analogical Scale (SAM-VAS). This scale measures the pleasure, arousal, and dominance associated with a person's affective reaction to a wide variety of stimuli. We applied the scale to 20 subjects who met DSM-IV criteria for PG and to 20 matched control subjects.ResultsFrom 38 preselected pictures, 25 had an affective valence and enough intensity to be selected for the subsequent development of the dot-probe task.ConclusionsTo date, the modified Stroop procedure has been the only task carried out to assess AB in gamblers. These gambling-related pictures will be used to develop a dot-probe task to assess AB in pathological gamblers. In addition, we will assess the Eye movement task and Event-related Potentials, as direct measures of AB.
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