Subtipos de adolescentes con trastornos por uso de sustancias y comorbilidad psiquiátrica utilizando los análisis de cluster y discriminante de perfiles MMPI-A

Ernesto Magallón-Neri, Rosa Díaz, María Forns, Javier Goti, Gloria Canalda, Josefina Castro-Fornieles

Resumen


El objetivo principal de este estudio fue replicar y ampliar los resultados
de estudios previos sobre subtipos de adolescentes con trastorno por uso de sustancias (TUS), de acuerdo con sus perfiles de personalidad en el Minnesota Multiphasic Personality Inventory for adolescents (MMPI-A). Sesenta pacientes con TUS y comorbilidad psiquiátrica (41.7% hombres, edad media = 15.9 años) completaron el MMPI-A, el Teen Addiction Severity Index (T-ASI), el Child Behaviour Checklist (CBCL), y entrevistas para obtener diagnósticos DSM-IV y medidas del nivel de uso de sustancias. El perfil general de personalidad MMPI-A mostró elevaciones moderadas en las escalas de Desviación Psicopática, Depresión e Histeria. El análisis de cluster jerárquico reveló cuatro perfiles (acting-out, 35% de la muestra; disorganized-conflictive, 15%; normative-impulsive, 15%; y deceptive-concealed, 35%). Se encontraron asociaciones entre el cluster 1, la sintomatología externalizante a nivel clínico del CBCL y los trastornos de conducta, así como entre el cluster 2 y un nivel clínico de síntomas internalizantes y externalizantes del CBCL. El análisis discriminante mostró que las escalas del MMPI-A Depresión, Desviación Psicopática y Psicastenia, clasificaron correctamente el 90% de los pacientes dentro de los subgrupos obtenidos.

Palabras clave


trastorno por uso de sustancias (TUS); MMPI-A; análisis de cluster jerárquico; análisis discriminante; adolescentes

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Referencias


Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18,

YSR, and TRF profiles. Burlington, VT: University of Vermont, Department of Psychology.

Albores-Gallo, L., Lara-Muñoz, C., Esperón-Vargas, C., Cárdenas Zetina,

J. A., Pérez Soriano, A.M. & Villanueva Colin, G. (2007). Validity and Reliability of the CBCL/6-18. Includes DSM scales. Actas Españolas de Psiquiatría, 35, 393-399.

American Psychiatric Association. (2002). Diagnostic and statistical manual of mental disorders (4th ed. rev.). Washington, D.C.: APA.

Archer, R. P. (2005). MMPI-A: Assessing adolescent psychopathology.

(3rd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

Babor, T. F., Hofmann, M., Del Boca, F. K., Hesselbrock, V., Meyer, R.,

Dolinsky, Z. S. & Rousanville, B. (1992). Types of alcoholics, I: Evidence for an empirically derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry, 49, 599-608. doi:10.1001/archpsyc.1992.01820080007002.

Ball, S. A., Tennen, H., Poling, J. C., Kranzler, H. R. & Rousanville, B. J. (1997). Personality, temperament and character dimensions and the DSM-IV personality disorders in substance abusers. Journal of Abnormal Psychology, 106, 545-553. doi:10.1037/0021-843X.106.4.545.

Beck, A. T., Freeman, A., Davis, D. D., et al. (2004). Cognitive therapy of

personality disorders. (2nd ed.). New York, NY: The Guilford Press. Butcher, J., Williams, C., Graham, J., Archer, R., Tellegen, A., Ben-Porath, Y. & Kaemmer, B. (1992). MMPI-A: Minnesota Multiphasic Personality Inventory-Adolescent: Manual for administration, scoring and interpretation. Minneapolis: University of Minnesota Press.

Calvete, E. & Estévez, A. (2009). Consumo de drogas en adolescentes:

El papel del estrés, la impulsividad y los esquemas relacionados con la falta de límites. Adicciones, 21, 49-56.

Conrod, P. J., Castellanos-Ryan, N. & Strang, J. (2010). Brief, personality-targeted coping skills interventions and survival as a non-drug user over a 2-year period during adolescence. Archives of General Psychiatry, 67, 85-93. doi:10.1001/ archgenpsychiatry.2009.173.

Couwenbergh, C., Van den Brink, W., Zwart, K., Vreugdenhil, C., Van

Wijngaarden-Cremers, P. & Van der Gaag, R. J. (2006). Comorbid

psychopathology in adolescents and young adults treated for substance use disorders: A review. European Child & Adolescent Psychiatry, 15, 319-328. doi:10.1007/s00787-006-0535-6.

Díaz, R., Castro-Fornieles, J., Serrano, L., González, L., Calvo, R., Goti, J., Kaminer, Y. & Gual, A. (2008). Clinical and research utility of Spanish Teen-Addiction Severity Index (T-ASI). Addictive Behaviors, 33, 188-195. doi:10.1016/j.addbeh.2007.06.002.

EMCDDA (2010). Informe anual 2010: el problema de la drogodependencia

en Europa. Lisboa, Portugal: European Monitoring Centre for Drugs and Drug Addiction.

Espelage, D. L., Cauffman, E., Broidy, L., Piquero, A. R., Mazerolle, P.

& Steiner, H. (2003). A cluster-analytic investigation of MMPI profiles of serious male and female juvenile offenders. Journal of American Academy of Child & Adolescent Psychiatry, 42, 770-777. doi:10.1097/01.CHI.0000046877.27264.F6.

Estévez, E. & Emler, N. (2011). Assessing the links among adolescent

and young offending, antisocial behaviour, victimization, drug use and gender. International Journal of Clinical and Health Psychology, 11, 269-289.

Ferguson, C. J. (2009). An effect size primer: a guide for clinicians and

researchers. Professional Psychology: Research and Practice, 40, 532-538. doi:10.1037/a0015808.

Gallucci, N. T. (1997). On identification of patterns of substance abuse with the MMPI-A scales. Psychological Assessment, 9, 224-232. doi:10.1037/1040-3590.9.3.224.

Hawkins, E. H. (2009). A tale of two systems: Co-occurring mental health and substance abuse disorders treatment for adolescents. Annual Review of Psychology, 60, 197-227. doi:10.1146/annurev. psych.60.110707.163456.

Hesselbrock, M., Easton, C., Bucholz, K. K., Schuckit, M. & Hesselbrock,

V. (1999). A validity study of the SSAGA-a comparison with the SCAN. Addiction, 94, 1361−1370. doi:10.1046/j.1360-0443.1999.94913618.x.

Jiménez-Gómez, F. & Ávila-Espada, A. (2003). MMPI-A: Inventario Multifásico de personalidad de Minnesota para adolescentes of Butcher, J. et al., 1992. Madrid: TEA.

Kaminer, Y. (2008). The Teen Addiction Severity Index around the globe: The tower of Babel revisited. Substance Abuse, 29, 89-94.

doi:10.1080/08897070802219230.

King, S. M., Iacono, W. G. & McGue, M. (2004). Childhood externalizing and internalizing psychopathology in the prediction of early substance abuse. Addiction, 99, 1548-1559. doi:10.1111/j.1360-0443.2004.00893.x.

Kirisci, L., Tarter, R., Mezzich, A. & Vanyukov, M. (2007). Development

trajectory classes in substance use disorder etiology. Psychology of Addictive Behaviors, 21, 287-296. doi:10.1037/0893-164X.21.3.287.

Kosten, T. R. & Kosten, T. A. (2004). New medication strategies for comorbid substance use and bipolar affective disorders. Biological Psychiatry, 56, 771-777. doi:10.1016/j.biopsych.2004.07.019.

Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C. E. & Greenbaum, P.

E. (2009). Multidimensional family therapy for young adolescent substance abuse: twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77, 12-25. doi:10.1037/a0014160.

Martel, M. M., Pierce L., Nigg, J. T., Jester, J. M., Adams, K., Puttler, L.I., … Zucker, R. A. (2009). Temperament pathways to childhood disruptive behavior and adolescent substance abuse: Testing a Cascade Model. Journal of Abnormal Child Psychology, 37, 363-393. doi: 10.1007/s10802-008-9269-x.

Martino, S., Carroll, K., Kostas, D., Perkins, J. & Rounsaville, B. (2002).

Dual Diagnosis Motivational Interviewing: a modification of Motivational Interviewing for substance-abusing patients with psychotic disorders. Journal of Substance Abuse Treatment, 23, 297-308. doi: 10.1016/S0740-5472(02)00295-7.

Massey, R. F., Walfish, S. & Krone, A. (1992). Cluster analysis of MMPI

profiles of adolescents in treatment for substance abuse. Journal of Child and Adolescent Substance Abuse, 2, 23-33. doi:10.1300/J272v02n02_03.

Micucci, J. A. (2002). Accuracy of MMPI-A scales ACK, MAC-R and PRO in

detecting comorbid substance abuse among psychiatric inpatients. Assessment, 9, 111-122. doi: 10.1177/10791102009002001.

Mohíno, S., Kirchner, T. & Forns, M. (2008). Personality and coping in

young inmates: a cluster typology. Psychopathology, 41, 157-164.

doi: 10.1159/000115953.

Muñoz-Rivas, M. J., Graña, J. L., Peña, M. E. & Andreu, J. M. (2002).

Influencia de la conducta antisocial en el consumo de drogas ilegales en población adolescente. Adicciones, 14, 313-320.

Passetti, L. (2002). MMPI-A profiles of adolescents at admission to residential substance abuse treatment. Chicago, ILL: Department of Psychology of Illinois State University.

Sher, K., Grekin, E. & Williams, N. (2005). The development of alcohol

use disorders. Annual Review of Clinical Psychology, 1, 493-523.

doi: 10.1146/annurev.clinpsy.1.102803.144107.

Shrier, L. A., Harris, S. K., Kurland, M. & Knight, J. R. (2003). Substance use problems and associated psychiatric symptoms among adolescents in primary care. Pediatrics, 111, 699-705. doi:10.1542/peds.111.6.e699.

Stein, L. A. & Graham, J. R. (2005). Ability of substance abusers to escape detection on the Minnesota Multiphasic Personality Inventory – Adolescent (MMPI-A) in a juvenile correctional facility. Assessment, 12, 28-39. doi:10.1177/1073191104270838.

Ulloa, R. E., Ortiz, S., Higuera, F., Nogales, I., Fresán, A., Apiquian, R.,…de la Peña, F. (2006). Estudio de fiabilidad interevaluador de la versión en español de la entrevista Schedule for Affective Disorders and Schizophrenia for School-Age-Children-Present and Lifetime version (K-SDAS-PL). Actas Españolas de Psiquiatría, 34, 36-40.

Waldron, H. B. & Turner, C. W. (2008). Evidence-based psychosocial

treatments for adolescent substance abuse. Journal of Clinical Child and Adolescent Psychology, 37, 238-261. doi:10.1080/15374410701820133.

Walfish, S., Massey, R. & Krone, A. (1990). MMPI profiles of adolescent

substance abusers in treatment. Adolescence, 25, 567-572.

Winters, K. C., Stinchfield, R. D., Latimer, W. W. & Stone, A. (2008).

Internalizing and externalizing behaviors and their association with the treatment of adolescents with substance use disorders. Journal of Substance Abuse Treatment, 35, 269-278. doi: 10.1016/j.jsat.2007.11.002.




DOI: https://doi.org/10.20882/adicciones.93

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