2003, Number 6
La figura compleja de Rey en adolescentes que consumen disolventes inhalables
Lara MA, Galindo G, Romero M, Salvador J, Domínguez M
Full text
Language: Spanish
References: 25
Page: 27-26
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ABSTRACT
In Mexico, inhalants, together with marijuana and cocaine, are the most commonly used drugs among secondary students. The abuse of inhalants is recognized as posing an enormous morbidity and mortality risk in adolescents throughout the world. Among other damages, there is evidence that the chronic use of inhalants produces neuro-psychological alterations.According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), the “examination of the individual who chronically uses inhalants may reveal a number of neurological deficits, including generalized weakness and peripheral neuropathies. Cerebral atrophy, cerebellar degeneration and white matter lesions resulting in cranial nerve or pyramidal tract signs have been reported among individuals with heavy use” (DSM IV, p. 141). Sharp et al. (1992) report that although most solvents produce non-specific effects derived from extremely high concentrations, some produce fairly specific neurological syndromes that are either peripheral or linked to the central nervous system with low levels of chronic exposure that include peripheral neuropathy and encephalopathy (in Medina Mora, 2001).
Tapert and Brown (1999) and Van Gorp et al. (1999) claim that studies of young inhalant abusers provide the strongest evidence for cognitive deficits related to substance use. Verbal abilities appear intact, but tasks of attention, declarative memory, fine motor, psychomotor speed and visual and spatial skills are impaired relative to demographically matched controls. Similar findings regarding memory and concentration impairment, as well as attention problems, disorientation and motor and perceptual difficulties have been reported by Castro et al. (1985) and Ortiz et al. (1985). Ortiz et al. (1992) also report euphoria, seizures, optic neuropathy, cerebellum ataxia, and probable dementia in toluene users.
The aim of this paper is to present the results of the application of the Mexican standardization of the Rey Complex Figure Test (RCFT) to evaluate the viso-constructive skill of a group of adolescents that use inhalants as their drug of preference, in order to assess their neuro-psychological status and the sensitivity of the instrument in screening tests, with a view to its implementation in intervention programs.
The subjects were contacted through a combined convenience and snowball procedure. The sample comprised ten males and four females (F1), contacted at schools, and eight women in treatment centers and community work with a lower social status (F2). The selection criteria for substance use was defined as nonexperimental use of solvents for at least six months prior to the study, at least twice a week, without taking into account the use of any other substances. Other criteria for inclusion included attending school or not having left school for over six months prior to the study and living with the family. The RCFT was applied individually after an interview. The figures were applied, rated, and interpreted according to Mexican psychometric and qualitative standards, drawn up by Galindo and collaborators (Galindo et al., 1996; Cortés et al. 1996; Salvador et al., 1996). The RCFT has been widely studied by this group in the Mexican population.
Results showed that the inhalants consumed were thinner, cement, PVC and toluene; 23% of the interviewees did so every day and the remainder at least twice a week. Other substances consumed by them include marijuana, alcohol, cocaine and medical drugs.
The comparisons, using T tests, of the means of the subjects with the normative parameters of the Mexican population of the RCFT showed significantly lower scores among the former, in total data, as well as in separate copy and memory scores. A comparison of the two groups of females, using the Mann-Whitney U test, showed that the group with the greatest deficiencies (F2) obtained significantly lower scores than Group F1 in the total scores, as well as in copy and memory production. A comparison between the groups of males failed to reveal any significant differences between men and women in Group F1, although significant differences were observed between the males and females in Group F2 in copy production and total scores.
The analysis of the qualitative characteristics of the RCFT, which estimates the number of cases with scores over the 90 percentile, showed a significant deviation among inhalants in comparison with the normative population. In copy production, the entire sample of users drew uncoordinated lines. Over half the sample drew a particular perceptual unit in the wrong place, while just under half rotated 45ºa perceptual unit, failed to complete a unit or omitted it and displayed problems of tangency. In memory production, 20 of the 22 users drew uncoordinated lines, while nearly half rotated 45ºa perceptual unit, drew a particular unit in the wrong place within the context or displayed errors of angling. Finally, four representative cases of the highest and lowest scores on the RCFT are presented, showing how the amount of use does not seem to be related to performance on the test, although certain living conditions probably are.
It can be concluded that, as a group, among these young inhalants, the viso-constructive skill is affected and secondly, subjects that develop within a more favorable environment appear to have a better chance of neuro-psychological development, meaning that they are more resistant to the damage caused by the use or abuse of toxic substances. At the same time, the qualitative analysis of the RCFT showed that the most significant deficits occurred in fine motor coordination and the perceptual integration of the figure, in both visual and spatial terms. From a practical point of view, this study shows the usefulness of the RCFT as a screening instrument for studying neuro-psychological alterations in teenagers using substances, on the basis of normative data on the Mexican population. It may also constitute an extremely important tool for evaluating cognitive aspects, to develop intervention programs, in order to design them more specifically, bearing in mind the cognitive capacity or neuro-psychological status of the people for whom they are designed.
In keeping with the information published, these results suggest that subjects display in all cases cognitive deficits, to a greater or lesser extent, at least in terms of visual-spatial management and fine coordination. The cross-sectional nature of the study means that it is impossible to determine whether these deficits occurred prior to or after consumption, psychosocial factors appear to play a role in the qualitative performance.
REFERENCES
ORTIZ A, CAUDILLO C: Alteraciones cognoscitivas en menores usuarios crónicos de sustancias inhalables. Informe de un estudio experimental. En: Ortiz A, Sosa R, Caudillo C (eds). Estudio de seguimiento de usuarios y no usuarios de sustancias inhalables en población abierta: comparación de sus rendimientos cognoscitivos. Psiquiatría, 2:165-178, 1988.