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EL USO DE DROGAS Y LOS TRASTORNOS DUALES

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Secretaría de Salud
Instituto Mexiquense Contra Las Adicciones
Día internacional de la lucha contra el uso indebido y el tráfico ilícito de drogas
Foro Académico: Piensa Sano Sin Drogas
28 De Junio De 2010
"EL USO DE DROGAS Y LOS TRASTORNOS DUALES"
Dr. Armando Patrón Vargas

Published in: Health & Medicine
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EL USO DE DROGAS Y LOS TRASTORNOS DUALES

  1. 1. Día internacional de la lucha contra el uso indebido y el tráfico ilícito de drogasForo académico“Piensa sano sin drogas”El uso de drogas y los trastornos dualesUna breve revisión<br />Dr. Armando Patrón Vargas<br />Dirección Técnica en Adicciones, STCONADIC<br />Toluca, Estado de México. 28 de junio de 2010<br />
  2. 2. CONCEPTOS Y TERMINOLOGÍA<br />
  3. 3. Definición de adicción<br />
  4. 4. Conceptualización de adicción<br />
  5. 5. Conceptos generales<br />
  6. 6. FACTORES DE RIESGO:COMPARTIDOS E INTERACTIVOS<br />
  7. 7. Acceso a oportunidades y problemas de salud mental en adolescentes<br />Las adicciones y los (demás) trastornos psiquiátricos comparten factores de riesgo<br />Corina Benjet, Guilherme Borges, María Elena Medina-Mora, Clara Fleiz, Enrique Méndez<br />
  8. 8. Prioridad temporal de los trastornos de ansiedad y la dependencia a drogas<br />Probabilidad de desarrollar dependencia a drogas cuando anteceden trastornos de ansiedad<br />%<br />OR<br />Además son factores de riesgo los unos para los otros<br />
  9. 9. MÚLTIPLES MANERAS DE COEXISTIR<br />
  10. 10. Algunos escenarios<br />
  11. 11. Algunos escenarios<br />
  12. 12. Tienen mayor <br />discapacidad<br />No hay <br />respuesta <br />terapéutica<br />a la medida<br />Requieren<br />más <br />internamientos<br />Pacientes con<br />comorbilidad<br />Emplean más<br />recursos<br />terapéuticos<br />Mayor riesgo<br />de problemas<br />legales y<br />médicos<br />Presentan <br />mayor<br />vulnerabilidad<br />Mayor riesgo<br />de suicidio<br />Complicaciones de la comorbilidad<br />Hay que hacérsela<br />Basado en Woody, 1996<br />
  13. 13. EPIDEMIOLOGÍA<br />
  14. 14. Epidemiología<br />
  15. 15. Epidemiología<br />
  16. 16. Epidemiología<br />De los 5 a los 10 años<br /><ul><li>Comportamiento anti social
  17. 17. Desórdenes de conducta
  18. 18. Depresión
  19. 19. Ansiedad</li></ul>De 12 a 25 años<br /><ul><li>Abuso de drogas </li></ul>Abuso de drogas<br />De 13 a 20 años <br /><ul><li>Fobias sociales
  20. 20. Trastorno de Pánico
  21. 21. Desorden bipolar </li></ul>Menos de 5 años<br /><ul><li>Trastorno por déficit de atención con hiperactividad
  22. 22. Autismo </li></ul>< de 12 años<br />de 12 a 17 años<br />de 18 a 25 años<br />> De 25 años<br />(en rojo aparecen los trastornos que son a su vez factores de riesgo para desarrollar abuso )<br />
  23. 23. Epidemiología: desde el tabaco<br />
  24. 24. Epidemiología: desde el alcohol<br />
  25. 25. Epidemiología: desde el alcohol<br />Trastornos atribuibles (DSM-IV)<br />
  26. 26. Epidemiología: desde otras drogas<br />
  27. 27. Epidemiología: desde la psiquiatría<br />Trastornos del control de impulsos<br /><ul><li>Sobresale la asociación con la ludopatía (cerca del 50%), la cleptomanía, el trastorno por atracón y las compras compulsivas.</li></ul>Trastornos de conducta<br /><ul><li>Encontrados en 50% a 80% del total de casos atendidos de adolescentes dependientes de diversas sustancias (Kaminer, 1999; Saavedra, 1997)</li></ul>Trastorno por déficit de atención e hiperactividad. <br /><ul><li>Quienes padecen TDAH en la infancia presentan el doble de prevalencia de consumo de tabaco que la población general.</li></li></ul><li>Epidemiología: desde la psiquiatría<br />Trastornos bipolares<br /><ul><li>Prevalencia: entre 1.3% y 5% de la población general.
  28. 28. El 15% de los pacientes se suicidan.
  29. 29. Esta cifra se duplica entre los enfermos bipolares farmacodependientes.</li></ul>Esquizofrenia<br /><ul><li>El 47% de los pacientes con esquizofrenia presentan un trastorno por abuso de sustancias a lo largo de su vida (sin incluir la nicotina)</li></li></ul><li>Epidemiología: desde la psiquiatría<br />Trastornos de ansiedad<br /><ul><li>Prevalencia entre 10% y 50% de la población general.
  30. 30. Comorbilidad más frecuente con ansiedad social.</li></ul>Fobia social<br /><ul><li>Se asocian en un 8 a 56% de los casos (promedio 13.3%).
  31. 31. El 13.9% son usuarios habituales de cocaína.
  32. 32. La fobia social suele preceder el consumo de sustancias.</li></li></ul><li>Epidemiología: desde la psiquiatría<br />Trastorno por estrés postraumático<br /><ul><li>Asociación con alcoholismo: 51.9% en hombres y 27.9 % en mujeres.
  33. 33. Comorbilidad con drogas ilegales: 34.5%.</li></li></ul><li>Epidemiología: desde la psiquiatría<br />Trastorno de pánico<br /><ul><li>36% de los pacientes con trastornos de pánico son usuarios de sustancias.
  34. 34. Es común que el uso de sustancias precedaal trastorno de pánico.
  35. 35. El uso de sustancias como la cocaína, las anfetaminas y la cafeína, así como el alcohol y las benzodiacepinas y la abstinencia de éstos dos últimos, pueden precipitar ataques de pánico.</li></li></ul><li>Epidemiología: desde la psiquiatría<br />Trastorno obsesivo compulsivo<br /><ul><li>Se asocia con consumo de alcohol en 3 al 12 % de los casos.
  36. 36. Existe 5.6 veces más riesgo de desarrollar Trastorno Obsesivo Compulsivo en usuarios de marihuana y cocaína.</li></li></ul><li>Epidemiología en EEUU<br />La Substance Abuse and Mental Health Services Administration (SAMSA) en su reporte del Congreso para la Prevención y el Tratamiento de los Trastornos Duales del 2002, estima que en Estados Unidos existen alrededor de 10 millones de individuos que sufren alguna forma de desorden mental y de consumo de sustancias.<br />Estos pacientes ingresan a servicios donde se les atiende por separado la patología psiquiátrica y el consumo de sustancias.<br />Lo cual implica menor efectividad, pues no se atiende como un fenómeno integral.<br />En términos de costo beneficio es mucho más caro duplicar esfuerzosal tener que pagar dos tratamientos.<br />
  37. 37. Epidemiología en México y el mundo<br />Otros estudios de corte internacional y nacional constatan lo reportado por los estudios norteamericanos:<br />International Consortium in Psychiatric Epidemiology(Merikangas y cols., 1998)<br />Encuesta Nacional de Epidemiología Psiquiátrica (Medina- Mora y cols., 2003)<br />Los trastornos más frecuentes en la población mexicana son los de ansiedad, seguidos de los afectivos y finalmente los relacionados con consumo de sustancias, así como la comorbilidad entre los mismos. <br />
  38. 38. EL ABORDAJE EFICAZ<br />
  39. 39. Eficacia del tratamiento de las adicciones sin comorbilidad<br />Diabetes<br />Hipertensión<br />Adicción<br />Índices similares de éxito con el tratamiento a los observados para otras enfermedades crónicas altamente prevalentes<br />NIDA Treatment Research Institute<br />
  40. 40. Nuevas Propuestas<br />psicofarmacológicas<br />Para la comorbilidad:<br />Tratamiento integrado<br />
  41. 41. Tratamiento integrado:<br />Cuadrantes de atención<br />Mayor<br />Severidad<br />Substance abuse and Mental Health Services Administration (SAMHSA) and Center for Substance Abuse Center (2005)<br />Categoría III<br />Trastorno mental menos severo<br />Trastorno por consumo de sustancias más severo<br />Locus de atención<br />Centros de Atención para la dependencia a sustancias<br />Categoría IV<br />Trastorno mental más severo<br />Trastorno por consumo de sustancias más severo<br />Locus de atención<br />Hospitales psiquiátricos, prisiones <br />Consumo de alcohol y otras drogas<br />Categoría I<br />Trastorno mental menos severo<br />Trastorno por consumo de sustancias menos severo<br />Locus de atención<br />Centros de Atención primaria <br />Categoría II<br />Trastorno mental más severo<br />Trastorno por consumo de sustancias menos severo<br />Locus de atención<br />Centros de Atención en Salud Mental<br />Menor<br />Severidad<br />Mayor<br />Severidad<br />Enfermedad Mental<br />
  42. 42. Algunas conclusiones<br />
  43. 43. Algunas conclusiones<br />

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