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Medicine, Nursing and Health Sciences Cognitive impairment and cognitive recovery in substance related disorders A/Prof. Antonio Verdejo-Garcia Catania, July 2015
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Cognition and Outcomes2 Outline 1.Cognition -- What is it (for)? 2.Subtyping/Matching 3.Prediction 4.Cognitive remediation
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Cognition and Outcomes3 Updating and management OF input-independent info FOR goal-achievement and decision-making
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Cognition and Outcomes4 3 D 5 B 1 H / 1 3 5 B D H D X D RED GREEN BLUE
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Cognition and Outcomes5 Moreno-López et al. (2012)
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6 Gray Matter White Matter Moreno-López et al. (2012)
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Factor Analysis of Executive Functions ComponentsMeasuresFactor Load h2h2 UpdatingLetter Number Sequencing 0.5-0.80.53-0.73 InhibitionStroop0.7-0.80.51-0.63 SwitchingWisconsin Card Sorting Test 0.5-0.90.45-0.74 Decision-makingIowa Gambling Task 0.90.83 Verdejo-García & Perez-Garcia (2007)
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Stimulants vs Opiate users Verdejo-García & Perez-Garcia (2007)
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Cognition and Outcomes9 ComponentsPrevalence RateDrug of choice w/greater deficits Working memory62.2 %C=H Response Inhibition38.3 %C>H Shifting27.3 %C>H Global Impairment68.8 %
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Focus of current interventions (MI or CBT) Life goals Self-control and self-monitoring Avoid risk Cognition and Outcomes10
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Focus of current interventions (MI or CBT) Life goals Self-control and self-monitoring Avoid risk Cognition and Outcomes11 Mismatch between impaired working memory, inhibition or decision-making and treatment requisites
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What cognition may add… Subtyping/Matching Prediction Focused interventions Cognition and Outcomes12 Neuropsychological Assessment Cognitive Rehabilitation
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Cognition and Outcomes13 Albein-Urios et al. (2013, 2014)
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Cognition and Outcomes14 LCA of trait and cognitive impulsivity scores in 96 addiction clients Albein-Urios et al. (2014)
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Cognition and Outcomes15 Z scores Albein-Urios et al. (2013)
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Cognition and Outcomes16 Z scores Albein-Urios et al. (2013)
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Cognition and Outcomes17 Z scores Albein-Urios et al. (2013)
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Cognition and Outcomes18 Z scores Albein-Urios et al. (2013)
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Medicine, Nursing and Health Sciences Prediction of at risk clients
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Key cognitive processes Delay Discounting Decision-making Cognition and Outcomes20
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Delay discounting 28th February 2011Presentation title21 Marshmallows! http://www.youtube.com/watch?v=QX_oy9614HQ http://www.youtube.com/watch?v=QX_oy9614HQ Peters and Buchel (2011) TICS: 11(5)
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22 Christakou et al. (2011)
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Delay discounting in addiction Presentation title23 Albein-Urios et al. (2014)
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Delay Discounting longitudinally predicts who stay in treatment Cognition and Outcomes24 Stevens, Verdejo-Garcia et al. (2014)
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Treatment readiness correlate with brain fitness 28th February 2011Cognition and Outcomes25 Moreno-Lopez et al. (2014)
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Bechara et al. (2005) Decision-making
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Bechara et al. (2005)
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Decision-making in addiction 28 Verdejo-Garcia et al. (2007)
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Association with severity of cocaine use 29 Verdejo-Garcia et al. (2007)
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Using the Iowa Gambling Task to predict relapse Baseline assessments (~2 weeks after treatment commencement) and classification: Insensitivity to future consequences Hypersensitivity to reward Intact Follow-up –3 months after baseline assessments, to provide a 3 cm hair sample to assess drug relapse. Cognition and Outcomes30 Verdejo-Garcia et al. (2014)
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Outcome: Cocaine hair concentrations 3 months after treatment onset 31 Verdejo-Garcia et al. 2014
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32 Verdejo-Garcia et al. 2014 Outcome: Cocaine hair concentrations 3 months after treatment onset
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Medicine, Nursing and Health Sciences Cognitive enhancement interventions Cognition Clinical Outcomes Amenable to Interventions ✔ ✔ ?
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28th February 2011Presentation title34
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Wiers and colleagues
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Cognitive training of skills needed to: Set personal goals – tailored (“mental blackboard”) Resist interference (“automatic pilot”) Boredom Stress Habits Quality control – from external to self-generated feedback Practice when and how utilise them in daily life
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D B C A Automatic pilot STOP! Present Mindedness Back to Goal State your Decision Quality control! GMT Alfonso et al. (2011)
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D B C A Automatic pilot STOP! Present Mindedness Meditation motives (e.g., endurance, willpower) When distracted Back to motive Interoceptive scanning Decision- making MFN Alfonso et al. (2011)
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STOP! ** Goal Management Training Long-term goals Decision-making in the Iowa Gambling Task Alfonso et al. (2011)
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Conclusions Most substance dependent clients have executive thinking deficits Deficient skills are paradoxically prerequisites of addiction treatments we currently apply There is potential to recovery, and cognitive training can improve treatment outcomes TP Nov 2013Cognition and Outcomes42
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Acknowledgements Funding –Monash Strategic Grant Scheme –Red de Trastornos Adictivos, Universidad de Granada Turning Point Drug and Alcohol Centre –Dan Lubman –Victoria Manning Verdejo-Garcia’s group: –MJ Fernandez-Serrano –Laura Moreno-Lopez –Jose M Martinez-Gonzalez –Jose C Perales –Oscar Lozano –Natalia Albein 43
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Thank you! 44
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