Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil.
Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil.
Drug Alcohol Depend. 2019 Apr 1;197:255-261. doi: 10.1016/j.drugalcdep.2019.01.013. Epub 2019 Feb 16.
The severity of substance use disorder (SUD) is currently defined by the sum of DSM-5 criteria. However, little is known about the validity of this framework or the role of additional severity indicators in relapse prediction. This study aimed to investigate the relationship between DSM-5 criteria, neurocognitive functioning, substance use variables and cocaine relapse among inpatients with cocaine use disorder (CUD).
128 adults aged between 18 and 45 years were evaluated; 68 (59 males, 9 females) had CUD and 60 (52 males, 8 females) were healthy controls. For the group with CUD, the use of other substances was not an exclusion criterion. Participants were tested using a battery of neurocognitive tests. Cocaine relapse was evaluated 3 months after discharge.
Scores for attention span and working memory were worse in patients compared to controls. Earlier onset and duration of cocaine use were related to poorer inhibitory control and global executive functioning, respectively; recent use was related to worse performance in inhibitory control, attention span and working memory. More DSM-5 criteria at baseline were significantly associated with relapse.
Recent cocaine use was the most predictive variable for neurocognitive impairments, while DSM-5 criteria predicted cocaine relapse at three months post treatment. The integration of neurocognitive measures, DSM-5 criteria and cocaine use variables in CUD diagnosis could improve severity differentiation. Longitudinal studies using additional biomarkers are needed to disentangle the different roles of severity indicators in relapse prediction and to achieve more individualized and effective treatment strategies for these patients.
目前，物质使用障碍（SUD）的严重程度由 DSM-5 标准的总和来定义。然而，对于该框架的有效性或其他严重程度指标在复发预测中的作用知之甚少。本研究旨在探讨 DSM-5 标准、神经认知功能、物质使用变量与可卡因使用障碍（CUD）住院患者复发之间的关系。
评估了 128 名年龄在 18 至 45 岁之间的成年人；68 名（59 名男性，9 名女性）患有 CUD，60 名（52 名男性，8 名女性）为健康对照。对于 CUD 组，使用其他物质不是排除标准。参与者接受了一系列神经认知测试。在出院后 3 个月评估可卡因复发情况。
与对照组相比，患者的注意力持续时间和工作记忆得分更差。可卡因使用的较早发病和持续时间分别与较差的抑制控制和整体执行功能相关；最近的使用与抑制控制、注意力持续时间和工作记忆的表现更差有关。基线时更多的 DSM-5 标准与复发显著相关。
最近的可卡因使用是神经认知障碍的最具预测性变量，而 DSM-5 标准预测了治疗后三个月的可卡因复发。在 CUD 诊断中整合神经认知测量、DSM-5 标准和可卡因使用变量可以改善严重程度的区分。需要进行纵向研究，使用其他生物标志物来阐明严重程度指标在复发预测中的不同作用，从而为这些患者实现更个体化和有效的治疗策略。
