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      Pronóstico y recaída alcohólica en el hospital psiquiátrico n°14 de la caja nacional de salud Translated title: Prognosis and alcoholic relapse at the Hospital Psiquiátrico N° 14, Caja Nacional de Salud


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          Objetivo: Estimar el tiempo de recaída alcohólica de pacientes internados en el hospital psiquiátrico N° 14 y construir un modelo predictivo de aquellos factores; pronóstico que cotidianamente se evalúan y registran en la historia clínica. Material y Métodos: Cohorte histórica descriptiva. La cohorte se construyó a través de la información contenida en 70 fichas clínicas de pacientes internados por intoxicación y dependencia alcohólica. El inicio del estudio fue el momento de la internación y se consideró un tiempo de seguimiento de 6 meses. Se usó el estimador de Kaplan Meier y regresión de Cox para los factores pronósticos. Resultados: El promedio de edad fue de 44.5 años, de 23.1 meses el tiempo de bebedor y de 16.2 días la ingesta de alcohol previa recaída. El 61% presenta una pareja legal y a los 6 meses, el 51% de los pacientes presentaron a lo menos una recaída. Controlando por factores de confusión, los factores predictores de recaída son la edad (HR 0.7 IC95%0.5, 0.99), tiempo de bebedor (HR 1.5 IC95% 1.1, 2.2), tiempo de ingesta previa recaída (HR 1.2 IC95% 0.97, 1.5), tenencia de pareja (HR<0.002 IC95% <0.004, 0.05), buena relación con la pareja (HR 0.002 IC95% <0.006, 0.4) y uso de drogas (HR 58.6IC95% 1.2, 2977). Conclusión: El tiempo estimado para la primera recaída de los pacientes del hospital psiquiátricos es de 5.8 meses. Controlando por factores de confusión, los factores de mal pronóstico son el uso asociado de drogas, mayor tiempo de bebedor e ingesta alcohol previa a la recaída.

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          Abstract Objective: To estimate the time to alcoholic relapse at the psychiatric hospital No. 14 and to estimate a predictive model of prognostic factors in clinical records. Methods: This is a historical cohort descriptive study. The cohort was constructed with the information contained in 70 clinical records. The onset of the study was considered when the patient was admitted for the first time and considered a follow-up period of 6 months. The time to alcoholic relapse and predictive model was estimated with the Kaplan-Meier estimator and Cox regression model. Results: The mean age was 44.5 years, 23.1 months for the time of alcohol intake and 16.2 drinking days and alcohol intake before the relapse. The 61% of the patients were married. At 6 months, 51% of patients experienced at least one alcoholic relapse. Controlling for confounders, predictors of relapse were age (HR 0.7CI95% 0.5, 0.99), time of alcohol intake (HR 1.5 CI95% 1.1,2.2), while previous intake relapse (HR 1.2 95% 0.97, 1.5) having a partner (HR <0.002 95% <0.004, 0.05), good relationship with partner (HR 0.002 95% <0.006, 0.4) and drug use (HR 58.6IC95% 1.2, 2977). Conclusion: The estimated time to first alcoholic relapse of psychiatric hospital patients is 5.8 months. Controlling for confounders, the predictors of first relapse are drug use, longer drinking and alcohol intake prior to a relapse

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          A simple score for predicting alcohol relapse after liver transplantation: results from 387 patients over 15 years.

          Alcohol relapse can negatively influence the outcome after liver transplantation (LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT.
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            Stress, vulnerability and adult alcohol relapse.

            Alcoholics experiencing highly threatening or chronic psychosocial stress following treatment are more likely to relapse than abstaining individuals not experiencing such stress. Expanding upon this stress-relapse hypothesis, we predicted that individual risk and protective characteristics would contribute to vulnerability to relapse in alcoholic men confronted with significant life adversity. The present investigation examined the relationship between psychosocial vulnerability and return to drinking. A group of abstinent male alcoholics (N = 67) who experienced marked life adversity that posed a severe and/or chronic threat participated in this study. Men completed a psychosocial assessment first as an inpatient in treatment for alcohol dependence, and again at 3 months and 1 year following discharge. Among alcoholic men exposed to severe psychosocial stressors, those with higher composite psychosocial vulnerability scores were more likely to subsequently relapse than those with lower vulnerability scores. Additionally, men who improved in psychosocial functioning following treatment had better outcomes than men whose vulnerability increased. In particular, coping, self-efficacy and social support most consistently predicted relapse among this sample of severely stressed abstaining alcoholics. These findings supported the stress-vulnerability model of relapse. Results indicated that improvement in psychosocial domains (e.g., coping skills, social networks, perceived ability to tolerate relapse-risk situations) enhanced the ability of these men to remain abstinent despite severe stress. This study highlights the importance of cognitive and behavioral interventions for increasing improvement in these psychosocial domains.
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              Predicting relapse to alcohol and drug abuse via quantitative electroencephalography.

              A sensitive and specific screening test that would identify the subset of substance-abusing patients at highest risk for relapse would constitute an important advance for treatment planning. This study examined the relative value of quantitative electroencephalography as a rapid, inexpensive, and noninvasive measure of relapse potential. The subjects were 107 substance-dependent patients enrolled in residential treatment programs. All were unmedicated and free of the complicating effects of major medical and neurological disorders. Structured clinical interview data and a 5-minute recording of the resting, eyes-closed electroencephalogram were obtained after patients had verifiably maintained abstinence for 1-5 months. Patients were then monitored for relapse or successful abstinence by research staff for an ensuing 6-month period. ANCOVAs of EEG power spectral density within pre-defined frequency bands revealed an enhanced amount of high frequency (19.5-39.8 Hz) beta activity among the 48 patients who later relapsed compared to both 59 patients who maintained abstinence and 22 additional subjects with no history of substance dependence. Importantly, in subsequent logistic regression analyses, fast beta power was found to be superior to severity of illness, depression level, and childhood conduct problems in predicting relapse. With fast beta power as the sole predictor, the sensitivity, specificity, and positive and negative predictive value parameters for discriminating outcomes were 0.61, 0.85, 0.75, and 0.74, respectively. Additional ANCOVAs revealed that the EEG difference between relapse-prone and abstinence-prone groups was related to the interaction of two premorbid factors, viz., childhood Conduct Disorder and paternal alcoholism. The enhancement of fast beta electroencephalographic activity in patients who will later relapse most likely originates from a premorbid and subtle dysfunction involving frontal brain regions.

                Author and article information

                Cuadernos Hospital de Clínicas
                Cuad. - Hosp. Clín.
                Universidad Mayor de San Andrés, Facultad de Medicina (La Paz, , Bolivia )
                : 55
                : 1
                : 07-12
                [02] orgnameCaja Nacional de Salud orgdiv1Médico Especialista Medicina Familiar Policlínico Miraflores
                [01] orgnameUniversidad de Chile.Santiago orgdiv1Universidad de Los Andes
                [03] orgnameCaja Nacional de Salud orgdiv1Médico Especialista Medicina Familiar Policlínico Villa Adela
                S1652-67762014000100002 S1652-6776(14)05500100002

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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