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Tratamiento coordinado entre centros de adicciones y salud mental vs. tratamiento no coordinado para pacientes con patología dual: mayor abandono, pero menor deterioro de la discapacidad funcional

  • Juan José Mancheño [1] ; Sergio Navas-León [2] ; Fermín Fernández-Calderón [3] ; Marisa Gutiérrez [1] ; Manuel Sánchez-García [3] ; Carmen Díaz-Batanero [3] ; Enrique Moraleda-Barreno [3] ; Juan Ramírez-López [4] ; José Andrés Lorca [3] ; OscarM. Lozano Rojas [3]
    1. [1] Community Mental Health Units. Juan Ramón Jiménez Hospit
    2. [2] Department of Psychology. University of Loyol
    3. [3] Department of Clinical and Experimental Psychology. University of Huelv
    4. [4] Provincial Drug Addiction Services, Huelv
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  • Localización: Actas españolas de psiquiatría, ISSN 1139-9287, Vol. 49, Nº. 2, 2021, págs. 71-80
  • Idioma: español
  • Títulos paralelos:
    • Coordinated treatment between addiction and mental health services vs. uncoordinated treatment for patients with dual diagnosis: Higher dropout rates but lower impairement of functional disability
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  • Resumen
    • español

      Introducción. Los pacientes con patología dual son ge-neralmente tratados en centros de salud mental y adicciones. Aunque hay servicios integrados para estos pacientes, lo más común es desarrollar protocolos de actuación conjunta entre estos centros. El objetivo de este estudio es analizar el pro-greso terapéutico de pacientes diagnosticados de patología dual, comparando los resultados de pacientes atendidos en los centros de adicciones exclusivamente, de salud mental o bien atendidos de manera coordinada entre ambos servi-cios. La hipótesis es que los pacientes atendidos de manera coordinada presentarán una mejor evolución en términos de la sintomatología psicopatológica, consumo de drogas y dis-capacidad funcional.

      Método. La muestra está formada por 182 pacientes atendidos en centros de adicción (n = 62), de salud mental (n = 51) y tratados a través del protocolo de actuación conjunta (n = 62). Los instrumentos administrados fueron la WHODAS 2.0, BSI-18 y la SDSS.

      Resultados. No se encontraron diferencias estadística-mente significativas entre la evaluación basal y el segui-miento ni en la WHODAS 2.0 ni en el BSI-18. Se encontró un incremento del consumo de cocaína en los tres grupos, aunque fue estadísticamente significativa en los pacientes de adicciones y de salud mental. Hubo una mayor tasa de abandono del tratamiento en los pacientes atendidos de ma-nera coordinada. En términos de cambio fiable, entre los pa-cientes atendidos de manera coordinada hubo más pacientes que mejoraron en la WHODAS 2.0.

      Conclusiones. Los hándicaps de asistir a dos redes asis-tenciales pueden estar explicando el mayor abandono de los pacientes que siguen el protocolo de actuación conjunta. Sin embargo, los pacientes que se mantienen en esta modalidad terapéutica muestran un menor deterioro de la funcionali-dad en comparación con las otras dos modalidades.

    • English

      Background. Dual pathology is often found in addiction and mental health centers. Although there are integrated services for these patients, most countries have developed joint action protocols between addiction and mental health centers. The objective is to analyze the progress of patients diagnosed with dual pathology, comparing the therapeutic outcomes of those who exclusively attend either addiction or mental health centers with those patients who follow a program in which the two services are coordinated. It is hypothesized that patients assisted in coordinate manner will present a better evolution on psychopathological symp-tomatology, drug use and functional impairment.

      Methods. The sample was 182 dual pathology patients treated in addictions centers (n=62), mental health centers (n=51) and treated in a coordinated manner (n=62). The ins-truments administered was WHODAS 2.0, BSI-18 and SDSS.

      Results. In general, no statistically significant diffe-rences were found between baseline and follow up in WHODAS and BSI-18. More cocaine use was found in three groups but was statistically significant in patients attended by addictions center and mental health centers. High percentages of abandonment were found in patients attending coordinate services. In terms of reliable chan-ge, among those receiving the coordinated treatment, there were more patients who showed improvements in the WHODAS 2.0 dimensions.

      Conclusions. The inconvenience caused by going to diffe-rent treatment networks may partially explain these results related with abandonment. However, patients who remain in treatment in coordinated services, show lower functionality deterioration than patients in other modalities.

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