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REVISIÓN
Revisión de la eficacia de los tratamientos para el trastorno bipolar en comorbilidad con el abuso de sustancias
Review of the efficacy of treatments for bipolar disorder and substance abuse
Adrián Secades-Álvarez
Autor para correspondencia
adriansecades13@gmail.com

Autor para correspondencia.
, Concepción Fernández-Rodríguez
Departamento de Psicología, Universidad de Oviedo, Oviedo, Asturias, España
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a otro<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">8</span></a>&#46; Algunos estudios muestran c&#243;mo el consumo de alcohol en estos sujetos se asocia a mayores d&#233;ficits cognitivos&#44; especialmente en memoria visual y verbal y en funcionamiento ejecutivo y habilidades de razonamiento<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; mientras que el consumo de tabaco o cannabis parece asociarse a un empeoramiento de la sintomatolog&#237;a en el TB<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Alternativamente&#44; varios trabajos se&#241;alan la abstinencia temprana de cualquier consumo como predictor favorable de una mejor evoluci&#243;n de la persona con TB<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">13</span></a>&#46; En todo caso&#44; las personas con diagn&#243;sticos concomitantes de TB y TUS suelen tener mayor actividad criminal y peor funcionamiento en la vida social que aquellas que solo cursan con bipolaridad&#44; llegando a equipararse a las personas con un diagn&#243;stico de esquizofrenia sin TUS<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">14&#44;15</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En el abordaje de esta afecci&#243;n se han planteado una serie de tratamientos farmacol&#243;gicos&#44; como el litio<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">16</span></a>&#44; la carbamazepina<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">17</span></a>&#44; la quetiapina<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">18&#44;19</span></a> o la lamotrigina<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">20</span></a>&#44; as&#237; como algunos psicol&#243;gicos&#44; tales como las terapias de grupo&#44; familiar&#44; cognitivo-conductual&#44; de prevenci&#243;n de reca&#237;das&#44; etc&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">21&#8211;24</span></a>&#46; Aun as&#237;&#44; no parece haber un tratamiento de eficacia probada para esta clase de pacientes&#46; Esto&#44; junto con la t&#237;pica divisi&#243;n dicot&#243;mica de los sistemas atencionales &#8211;para trastornos mentales o para drogadicciones&#8211;&#44; as&#237; como de los acercamientos terap&#233;uticos &#8211;farmacol&#243;gico o psicol&#243;gico&#8211;&#44; se&#241;ala la conveniencia de analizar en profundidad las diferentes intervenciones actualmente disponibles para abordar estas situaciones&#46; El presente estudio tiene como objetivo la descripci&#243;n de los procedimientos que han demostrado ser &#250;tiles en el tratamiento del TB en comorbilidad con el consumo de sustancias y ofrecer as&#237; una perspectiva general del estado de la investigaci&#243;n actual a este respecto&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">M&#233;todo</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; una b&#250;squeda general &#40;2005-2015&#41; en las bases de datos Medline y PsycINFO utilizando como descriptores los t&#233;rminos&#58; &#40;&#171;bipolar disorder&#187; AND &#171;substance use disorder&#187; AND &#171;treatment&#187;&#41;&#46; Se han delimitado los &#250;ltimos 10 a&#241;os por considerarse un per&#237;odo de tiempo adecuado para ofrecer una visi&#243;n actualizada sobre la tem&#225;tica que trata el presente trabajo&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Como resultado&#44; se obtuvieron 8&#46;431 art&#237;culos&#46; A partir de estos documentos&#44; se realiz&#243; una criba en la que se seleccionaron investigaciones con base en los siguientes criterios de inclusi&#243;n&#58; 1&#41; trabajos cuyo objetivo de estudio fuese la evaluaci&#243;n de alguna modalidad de tratamiento para el TB y el TUS&#59; 2&#41; que&#44; en relaci&#243;n con la modalidad terap&#233;utica estudiada&#44; empleasen el m&#233;todo experimental y&#47;o controlado para determinar el beneficio terap&#233;utico&#59; 3&#41; que informaran de forma clara de las caracter&#237;sticas de la muestra&#44; las variables y los instrumentos utilizados en su medici&#243;n&#44; el dise&#241;o experimental y la significaci&#243;n estad&#237;stica de los resultados&#44; as&#237; como de la muerte experimental&#59; 4&#41; escritos en ingl&#233;s&#44; espa&#241;ol&#44; italiano&#44; franc&#233;s o alem&#225;n&#46; Delimitando los criterios comentados&#44; se identificaron un total de 30 estudios experimentales&#44; que se analizan en el presente trabajo&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se describe el proceso de selecci&#243;n y exclusi&#243;n de los estudios&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">De los 30 estudios experimentales que cumpl&#237;an los criterios metodol&#243;gicos exigidos&#44; 19 se refieren a tratamientos farmacol&#243;gicos y 11 a tratamientos psicol&#243;gicos&#46; En ellos&#44; se realiza una evaluaci&#243;n pre-pos con un seguimiento de entre 2 meses y 5 a&#241;os&#44; siendo la droga m&#225;s frecuentemente consumida el alcohol&#44; seguida de la coca&#237;na&#44; el cannabis y la metanfetamina&#46; No obstante&#44; la mayor&#237;a de los sujetos que conforman las muestras analizadas no se limitan a consumir una sola droga&#44; sino que son politoxic&#243;manos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Entre los estudios de intervenciones farmacol&#243;gicas revisados&#44; divalproex&#44; quetiapina y lamotrigina son los f&#225;rmacos m&#225;s habitualmente empleados&#46; La problem&#225;tica del TB en comorbilidad con el consumo de alcohol se analiza en 6 estudios&#44; y otros 4 trabajos atienden al consumo de otras drogas&#46; En todos los casos se utiliza un dise&#241;o doble ciego aleatorizado&#44; controlado con placebo<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">25&#8211;34</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">&#218;nicamente se hallaron 2 estudios experimentales de comparaci&#243;n entre grupos con dise&#241;o aleatorizado doble ciego<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">35&#44;36</span></a>&#44; cuyos resultados se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Por &#250;ltimo&#44; se identificaron 7 trabajos cuasiexperimentales no controlados que ofrecen mejores resultados en la reducci&#243;n de la sintomatolog&#237;a psiqui&#225;trica y el consumo de drogas y <span class="elsevierStyleItalic">craving</span>&#44; pero con mayores limitaciones a nivel metodol&#243;gico<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">37&#8211;43</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En lo que respecta al tratamiento psicol&#243;gico&#44; no parece haber un patr&#243;n claro de tratamiento&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> se recogen 4 trabajos experimentales aleatorizados con grupos paralelos que examinan la eficacia de diferentes t&#233;cnicas<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">44&#8211;47</span></a>&#44; mientras que la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a> agrupa 7 investigaciones que proponen y eval&#250;an intervenciones espec&#237;ficas<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">48&#8211;54</span></a>&#46; Sin embargo&#44; estos estudios adolecen de grupo control y otras garant&#237;as metodol&#243;gicas&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">La mayor parte de los estudios analizados centran sus resultados en medidas de la sintomatolog&#237;a psiqui&#225;trica y el consumo de sustancias&#46; Entre las pruebas utilizadas para cuantificar estas variables parece haber un gran consenso en el uso del <span class="elsevierStyleItalic">Young Mania Rating Scale</span><a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">55</span></a>&#44; habiendo gran disparidad en los instrumentos de medida sobre consumo de drogas y depresi&#243;n y escasa informaci&#243;n sobre las garant&#237;as de estas pruebas&#46; Sin embargo&#44; se desatienden otra serie de cuestiones&#44; como la adhesi&#243;n al tratamiento o la percepci&#243;n de eficacia de los propios participantes y su satisfacci&#243;n con la intervenci&#243;n&#44; condiciones que resultan de especial importancia&#44; considerando la alta tasa de abandono del tratamiento y la falta de implicaci&#243;n y motivaci&#243;n en la intervenci&#243;n&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Esta revisi&#243;n pretende mostrar el panorama terap&#233;utico actual en el abordaje de los casos de TB con TUS&#46; Desde el an&#225;lisis de las garant&#237;as metodol&#243;gicas de los estudios experimentales publicados en la &#250;ltima d&#233;cada&#44; se valora la utilidad de las intervenciones farmacol&#243;gicas y psicol&#243;gicas&#46; As&#237;&#44; se ha visto que el valproato<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">34</span></a> y la lamotrigina<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">27</span></a> pueden ser &#250;tiles para frenar el consumo de alcohol y otras drogas&#44; respectivamente&#46; Para aliviar s&#237;ntomas psiqui&#225;tricos y el <span class="elsevierStyleItalic">craving</span>&#44; la quetiapina como f&#225;rmaco &#250;nico o principal<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">32&#44;36&#44;38</span></a> y la risperidona<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">36</span></a> o la olanzapina<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">37</span></a> tambi&#233;n han ofrecido buenos resultados&#46; Sin embargo&#44; la citicolina ha demostrado abordar estos s&#237;ntomas adem&#225;s de favorecer una mayor adhesi&#243;n al tratamiento<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">26</span></a>&#44; aunque estos resultados no se confirman por otros grupos de trabajo<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">33</span></a>&#46; En estudios con pacientes con TB de ciclaci&#243;n r&#225;pida donde la lamotrigina no ha resultado efectiva<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">27</span></a>&#44; el tratamiento cl&#225;sico con litio s&#237; ha demostrado serlo en lo que respecta a la sintomatolog&#237;a psiqui&#225;trica<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">33</span></a>&#46; Estas investigaciones fundamentan sus conclusiones en la utilizaci&#243;n de grupo control y el empleo de pruebas o instrumentos similares para medir las variables dependientes&#44; a pesar de adolecer de muestras en ocasiones escasas y de grandes tasas de abandono&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se podr&#237;a decir&#44; a la vista de los resultados estudiados&#44; que la quetiapina es el f&#225;rmaco m&#225;s s&#243;lidamente ligado a una mejora en la sintomatolog&#237;a psiqui&#225;trica para el TB&#44; y la combinaci&#243;n litio-valproato&#44; la m&#225;s eficaz para la reducci&#243;n del consumo de alcohol y las reca&#237;das&#46; Aun as&#237;&#44; muchos trabajos resultan contradictorios y utilizan diferentes formas de medir las variables y distintas muestras y medicaciones concomitantes&#44; lo que podr&#237;a explicar dichas diferencias&#46; Los estudios que carecen de un dise&#241;o doble ciego ofrecen resultados prometedores para todos los f&#225;rmacos&#44; lo cual podr&#237;a deberse a un menor control de la situaci&#243;n experimental y&#44; por tanto&#44; a una menor validez interna&#46; Por ello&#44; es recomendable verificar dichos resultados con estudios m&#225;s s&#243;lidos metodol&#243;gicamente antes de afirmar la eficacia de los tratamientos&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Por lo que respecta a las intervenciones psicol&#243;gicas&#44; adem&#225;s de ser m&#225;s escasas que las farmacol&#243;gicas&#44; cabe destacar que se ponen a prueba en estudios m&#225;s modestos y con mayores limitaciones metodol&#243;gicas&#46; En muchas ocasiones&#44; carecen de grupo control y cuentan con muestras peque&#241;as y gran muerte experimental&#46; Comparando diferentes intervenciones&#44; se ha visto que la terapia integrada de grupo <span class="elsevierStyleItalic">community friendly</span> resulta m&#225;s eficaz que el grupo de asesoramiento sobre drogas&#44; ayudando a reducir el consumo de sustancias&#44; la sintomatolog&#237;a psiqui&#225;trica y dando un mejor resultado cl&#237;nico general<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">46</span></a>&#46; No obstante&#44; tanto el grupo de asesoramiento sobre drogas como la terapia integrada de grupo muestran una aparente eficacia en el abordaje del trastorno dual<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">47</span></a>&#46; El manejo de contingencias tambi&#233;n result&#243; adecuado para atenuar el consumo de alcohol y estimulantes&#44; adem&#225;s de para incrementar la mejor&#237;a en s&#237;ntomas man&#237;acos y depresivos<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">44</span></a>&#46; Asimismo&#44; la intervenci&#243;n familiar para patolog&#237;a dual result&#243; m&#225;s beneficiosa en educaci&#243;n sobre los trastornos&#44; sintomatolog&#237;a psiqui&#225;trica y severidad de consumo que la educaci&#243;n familiar<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">45</span></a>&#46; Otros estudios sin grupo de comparaci&#243;n tambi&#233;n han aportado resultados prometedores&#44; pero al igual que en el caso de los f&#225;rmacos&#44; son necesarios estudios con mayor rigor metodol&#243;gico para poder concluir su eficacia&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Pr&#225;cticamente la totalidad de las intervenciones psicol&#243;gicas abogan por un acercamiento integrado que act&#250;e sobre ambos diagn&#243;sticos&#46; Varios autores<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">44&#44;45</span></a> apoyan tambi&#233;n estos principios&#44; ya que se entiende que en la pr&#225;ctica cl&#237;nica resulta m&#225;s acertado considerar ambos diagn&#243;sticos como interrelacionados dada su frecuente aparici&#243;n conjunta<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Sorprende&#44; a la vista de esta aparentemente extendida premisa&#44; que no existan estudios que traten de evaluar la eficacia de tratamientos igualmente integrados&#44; que conjuguen los efectos de la terapia farmacol&#243;gica y la psicol&#243;gica para compararlos con los resultantes de un tratamiento &#250;nico aislado&#46; Parece razonable pensar que&#44; debido a la complejidad de la psicopatolog&#237;a y al presunto consenso por un abordaje integrado&#44; una intervenci&#243;n complementaria que act&#250;e con amplitud sobre todos los aspectos de la problem&#225;tica podr&#237;a ser la mejor actuaci&#243;n&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Es destacable tambi&#233;n el hecho de que todos estos tratamientos psicol&#243;gicos forman parte de las terapias llamadas &#171;multicomponente&#187;&#46; Esto quiere decir que todas ellas est&#225;n conformadas de varios componentes activos que&#44; juntos&#44; tratan de abordar todos los aspectos posibles de la intervenci&#243;n&#46; Sin embargo&#44; esto supone una limitaci&#243;n importante&#44; ya que es imposible saber a qu&#233; componentes se debe la eficacia mostrada&#46; Esto es un problema recurrente a&#250;n no resuelto en el estudio de algunas intervenciones psicol&#243;gicas&#44; invitando a los investigadores a aislar dichos ingredientes terap&#233;uticos y a comprobar los beneficios que ofrecen o no al resultado final&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Una gran limitaci&#243;n de todos los estudios revisados que puede explicar&#44; en parte&#44; las diferencias en los resultados es la falta de consideraci&#243;n de la fase &#8211;depresiva&#44; man&#237;aca o mixta&#8211; en la que se encuentran los sujetos en cada momento de la intervenci&#243;n &#40;inicio&#44; durante&#44; final&#44; o en el seguimiento&#41;&#46; Se sabe que&#44; dependiendo de la fase en la que el paciente se encuentre&#44; son m&#225;s adecuados unos f&#225;rmacos que otros&#46; Kosten y Kosten<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">56</span></a> dan las claves de una medicaci&#243;n ideal para estos casos&#58; bajo riesgo&#44; dosis infrecuentes&#44; buena tolerancia y con pocos efectos secundarios&#46; Proponen&#44; as&#237;&#44; el valproato o la carbamazepina como f&#225;rmacos adecuados para la fase man&#237;aca&#44; mientras que para la depresiva consideran m&#225;s acertado el uso de antidepresivos&#46; Sin embargo&#44; el efecto de estos f&#225;rmacos no ha sido puesto a prueba en comparaci&#243;n con los tratamientos psicol&#243;gicos&#44; as&#237; como tampoco se ha evaluado suficientemente la mejora que puede suponer el tratamiento combinado con respecto a uno que solo incluya f&#225;rmacos o terapia psicol&#243;gica&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La falta de control experimental en muchos casos tambi&#233;n constituye una limitaci&#243;n importante que puede distorsionar los resultados&#44; habiendo incluso estudios con una pobre especificaci&#243;n de las variables medidas o de la significaci&#243;n de los datos<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">57</span></a>&#44; o el empleo de f&#225;rmacos concomitantes que no se tienen en cuenta a la hora de extraer conclusiones&#44; as&#237; como la diferencia en la dosis administrada a cada sujeto en funci&#243;n de la severidad del trastorno&#46; Cabe resaltar aqu&#237; tambi&#233;n que no es frecuente especificar en estos estudios la severidad de la sintomatolog&#237;a de los pacientes&#44; por lo que incluirlos a todos en la misma investigaci&#243;n puede modificar la fidelidad de los datos aportados&#46; Lo mismo ocurre con las drogas&#44; ya que la mayor&#237;a de los sujetos son politoxic&#243;manos y con diferentes niveles de abuso o dependencia&#44; y se obvia el hecho de que las diferentes drogas son consideradas equivalentes al no ser separadas en los an&#225;lisis de resultados&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Otro gran problema de las investigaciones revisadas&#44; quiz&#225; el mayor&#44; es la amplia tasa de abandono&#44; algo presente en la totalidad de los estudios revisados y ya tratado ampliamente como una importante limitaci&#243;n del trastorno dual en general<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">58</span></a>&#46; Se han descrito incluso predictores del abandono&#44; como la presencia de un episodio man&#237;aco&#44; depresivo o mixto reciente y el pobre nivel educativo<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">59</span></a>&#44; as&#237; como la presencia de trastornos de la personalidad&#44; s&#237;ntomas psic&#243;ticos o el tratamiento con litio<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">60</span></a>&#46; El dise&#241;o de un programa espec&#237;fico que forme e implique al sujeto en el tratamiento podr&#237;a suponer una mejora cualitativa para favorecer su estabilidad y su apego a este&#46; La creaci&#243;n de una intervenci&#243;n complementaria que beneficie la adhesi&#243;n al tratamiento principal&#44; como es el caso del programa para la mejora de la adherencia&#44; tambi&#233;n podr&#237;a resultar &#250;til<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">50</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Por tanto&#44; parece de especial inter&#233;s el desarrollo de nuevas investigaciones que profundicen en la eficacia de diferentes abordajes que traten el trastorno psiqui&#225;trico al mismo tiempo que tratan de promover la abstinencia temprana y la desintoxicaci&#243;n de las drogas de consumo<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">13</span></a>&#46; En este sentido&#44; ser&#225; tambi&#233;n conveniente la detecci&#243;n previa y la prevenci&#243;n atendiendo a factores de riesgo sociodemogr&#225;ficos&#44; como el sexo masculino&#44; la juventud&#44; el bajo nivel educativo&#44; el diagn&#243;stico previo de trastorno del &#225;nimo o una historia parental de TUS<a class="elsevierStyleCrossRefs" href="#bib0625"><span class="elsevierStyleSup">61&#8211;63</span></a>&#44; as&#237; como a otros m&#225;s recientemente planteados&#58; la historia de abuso f&#237;sico o sexual<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">64</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A modo de conclusi&#243;n&#44; se pone de relieve la necesidad de implementar el rigor metodol&#243;gico de las investigaciones a realizar&#44; especificando las variables e instrumentos de medida&#44; utilizando muestras grandes y con grupo control&#44; controlando variables contaminadoras como los tratamientos complementarios o la pobre delimitaci&#243;n de la gravedad de los sujetos&#44; midiendo rigurosamente la adhesi&#243;n al tratamiento y la potencial influencia de algunos aspectos de la intervenci&#243;n en su abandono&#44; as&#237; como la unificaci&#243;n de los criterios y m&#233;todos empleados para cuantificar el consumo de drogas o la sintomatolog&#237;a psiqui&#225;trica&#46; Como tratamiento de elecci&#243;n&#44; la quetiapina y el valproato han demostrado superioridad en la mejora de los s&#237;ntomas psiqui&#225;tricos y en la reducci&#243;n del consumo de alcohol&#44; respectivamente&#44; mientras que las terapias psicol&#243;gicas grupales con psicoeducaci&#243;n&#44; prevenci&#243;n de reca&#237;das e inclusi&#243;n de la familia tambi&#233;n han resultado beneficiosas a la hora de reducir la sintomatolog&#237;a y favorecer la abstinencia y la adherencia al tratamiento&#46; A pesar de la presencia de estudios que se&#241;alan estas pautas de intervenci&#243;n como preferentes&#44; la literatura actual evidencia que no existe un tratamiento bien establecido para el abordaje de esta afecci&#243;n&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicto de intereses</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En este trabajo se analiza la utilidad de diferentes intervenciones psicol&#243;gicas y farmacol&#243;gicas empleadas en el abordaje de pacientes con trastorno bipolar y abuso de sustancias&#46; Se realiz&#243; una b&#250;squeda bibliogr&#225;fica en las bases de datos Medline y PsycINFO &#40;2005-2015&#41;&#46; Un total de 30 estudios experimentales se describen agrupados seg&#250;n el tipo de modalidad terap&#233;utica &#40;farmacol&#243;gica 19&#59; psicol&#243;gica 11&#41;&#46; La quetiapina y el valproato han demostrado superioridad en la mejora de los s&#237;ntomas psiqui&#225;tricos y en la reducci&#243;n del consumo de alcohol&#44; respectivamente&#46; Las terapias psicol&#243;gicas grupales con psicoeducaci&#243;n&#44; prevenci&#243;n de reca&#237;das e inclusi&#243;n de la familia han resultado favorables para reducir la sintomatolog&#237;a y favorecer la abstinencia y la adherencia al tratamiento&#46; La abundancia de terapias multicomponente&#44; la falta de especificaci&#243;n de las caracter&#237;sticas cl&#237;nicas de los participantes durante la intervenci&#243;n&#44; la elevada tasa de abandono o la falta de control experimental de algunos estudios comprometen la posibilidad de considerar las actuales pautas de intervenci&#243;n recomendadas como tratamientos bien establecidos&#46;</p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to provide a descriptive overview of different psychological and pharmacological interventions used in the treatment of patients with bipolar disorder and substance abuse&#44; in order to determine their efficacy&#46; A review of the current literature was performed using the databases Medline and PsycINFO &#40;2005-2015&#41;&#46; A total of 30 experimental studies were grouped according to the type of therapeutic modality described &#40;pharmacological 19&#59; psychological 11&#41;&#46; Quetiapine and valproate have demonstrated superiority on psychiatric symptoms and a reduction in alcohol consumption&#44; respectively&#46; Group psychological therapies with education&#44; relapse prevention and family inclusion have also been shown to reduce the symptomatology and prevent alcohol consumption and dropouts&#46; Although there seems to be some recommended interventions&#44; the multicomponent base&#44; the lack of information related to participants during treatment&#44; experimental control or the number of dropouts of these studies suggest that it would be irresponsible to assume that there are well established treatments&#46;</p></span>"
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo para la b&#250;squeda sistem&#225;tica de estudios&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">AIMS&#58; <span class="elsevierStyleItalic">Abnormal Involuntary Movement Scale&#59;</span> ALT&#58; <span class="elsevierStyleItalic">alanine aminotranferase&#59;</span> ASI&#58; <span class="elsevierStyleItalic">Addiction Severity Index&#59;</span> AST&#58; <span class="elsevierStyleItalic">aspartate aminotransferase&#59;</span> BAC&#58; <span class="elsevierStyleItalic">breath alcohol concentration&#59;</span> BARS&#58; <span class="elsevierStyleItalic">Barnes Akathisia Rating Scale&#59;</span> BAS&#58; <span class="elsevierStyleItalic">Barnes Akathisia Scale&#59;</span> BSCS&#58; <span class="elsevierStyleItalic">Brief Substance Craving Scale&#59;</span> BRMS&#58; <span class="elsevierStyleItalic">Bech-Rafaelsen Mania Scale&#59;</span> CBT&#58; <span class="elsevierStyleItalic">Cognitive Behavioral Therapy&#59;</span> CCQ&#58; <span class="elsevierStyleItalic">Cocaine Craving Questionnaire&#59;</span> CGI&#58; <span class="elsevierStyleItalic">Clinical Global Impression &#40;Severity &#91;CGI-S&#93; and Improvement &#91;CGI-I&#93;&#41;&#59;</span> CIWA-Ar&#58; <span class="elsevierStyleItalic">Clinical Institute Withdrawal Assessment of Alcohol revised&#59;</span> DSM-IV&#58; <span class="elsevierStyleItalic">Diagnostic and Statistical Manual of Mental Disorders&#44; 4th edition&#59;</span> GAF&#58; <span class="elsevierStyleItalic">Global Assessment of Functioning Scale&#59;</span> GAS&#58; <span class="elsevierStyleItalic">Global Assessment Scale&#59;</span> GC&#58; grupo control&#59; GE&#58; grupo experimental&#59; GGT&#58; <span class="elsevierStyleItalic">gamma-glutamyltranferase&#59;</span> HAM-A&#58; <span class="elsevierStyleItalic">Hamilton Rating Scale for Anxiety&#59;</span> HAM-D&#58; <span class="elsevierStyleItalic">Hamilton Scale for Depression&#59;</span> HRSD-17&#58; <span class="elsevierStyleItalic">Hamilton Rating Scale for Depression-17</span>&#59; HRSD-25&#58; <span class="elsevierStyleItalic">Hamilton Rating Scale for Depression&#59;</span> HVTL&#58; <span class="elsevierStyleItalic">Hopkins Auditory Verbal Learning Test&#59;</span> IDS-C&#58; <span class="elsevierStyleItalic">Inventory of Depressive Symptomatology Clinician-rated</span>&#59; IDS-SR<span class="elsevierStyleInf">30</span>&#58; <span class="elsevierStyleItalic">Inventory of Depressive Symptomatology-Self-Report 30-item version&#59;</span> MADRS&#58; <span class="elsevierStyleItalic">Montgomery-Asberg Depression Rating Scale-25&#59;</span> MINI&#58; <span class="elsevierStyleItalic">Mini International Neuropsychiatric Interview&#59;</span> MQACS&#58; <span class="elsevierStyleItalic">Modified Quantitative Alcohol Inventory&#47;Craving Scales&#59;</span> OCDS&#58; <span class="elsevierStyleItalic">Obsessive Compulsive Drinking Scale&#59;</span> PACS&#58; <span class="elsevierStyleItalic">Penn Alcohol Craving Scale&#59;</span> PRD-III&#58; <span class="elsevierStyleItalic">Psychobiology of Recovery in Depression <span class="elsevierStyleSmallCaps">III</span>-Somatic Symptom Scale&#59;</span> QIDS-SR&#58; <span class="elsevierStyleItalic">Quick Inventory of Depressive Symptomatology&#59;</span> Q-LES-Q&#58; <span class="elsevierStyleItalic">Quality of Life Enjoyment and Satisfaction Questionnaire&#59;</span> RAVLT&#58; <span class="elsevierStyleItalic">Rey Auditory-Verbal Learning Test&#59;</span> SAD-TB&#58; trastorno bipolar &#43; trastorno esquizoafectivo&#59; SAS&#58; <span class="elsevierStyleItalic">Simpson-Angus Scale&#59;</span> SCID&#58; <span class="elsevierStyleItalic">Structured Clinical Interview &#40;DSM-<span class="elsevierStyleSmallCaps">IV</span>&#41;&#59;</span> SCID-CV&#58; <span class="elsevierStyleItalic">Structured Clinical Interview-Clinical Version &#40;DSM-IV&#41;&#59;</span> SCMAF&#58; <span class="elsevierStyleItalic">Symptoms Checklist and Medication Adherence Form&#59;</span> SDS&#58; <span class="elsevierStyleItalic">Sheehan Disability Scale&#59;</span> TB&#58; trastorno bipolar&#59; TBI&#58; trastorno bipolar tipo I&#59; TBII&#58; trastorno bipolar tipo II&#59; TDM&#58; trastorno depresi&#243;n mayor&#59; TLFB&#58; <span class="elsevierStyleItalic">timeline follow-back&#59;</span> TM&#58; tama&#241;o muestral&#59; UDS&#58; <span class="elsevierStyleItalic">Urine Drug Screens&#59;</span> WSHAQ&#58; <span class="elsevierStyleItalic">Modified Quantitative Alcohol Inventory&#47;Craving Scales&#59;</span> YMRS&#58; <span class="elsevierStyleItalic">Young Mania Rating Scale&#46;</span></p>"
          "tablatextoimagen" => array:2 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Muestra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Trastorno psiqui&#225;trico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sustancia de abuso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables dependientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Limitaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brown et al&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">25</span></a> &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; quetiapina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&#41;<br>GC&#58; placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;&#58;</span> HRSD-17&#44; IDS-SR<span class="elsevierStyleInf">30</span>&#44; YMRS&#44; CIWA-Ar&#44; PACS&#44; PRD-III&#44; AIMS&#44; SAS&#44; BARS&#44; TLFB&#44; AST&#44; ALT&#44; GGT&#44; UDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No se encontraron diferencias significativas en <span class="elsevierStyleItalic">craving</span> o consumo de alcohol<br>No se vieron diferencias en s&#237;ntomas psiqui&#225;tricos a excepci&#243;n de en IDS-SR<span class="elsevierStyleInf">30</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#41; a favor de GE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Los sujetos manten&#237;an sus medicaciones anteriores<br>Baja adherencia al f&#225;rmaco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brown y Gabrielson<span class="elsevierStyleSup">26</span> &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;<br>TDM &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Metanfetamina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; citicolina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41;<br>GC&#58; placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;&#58;</span> SCID&#44; IDS-C&#44; HVTL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora del GE en sintomatolog&#237;a depresiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;<br>GE con mayor adhesi&#243;n al tratamiento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Heterogeneidad de la muestra y amplio abandono<br>Los resultados podr&#237;an deberse al tratamiento con antidepresivos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brown et al&#46;<span class="elsevierStyleSup">27</span> &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;SCID-CV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Coca&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; lamotrigina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;<br>GC&#58; placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;10 sem&#41;&#58;</span> HRSD&#44; TLFB&#44; QIDS-SR&#44; YMRS&#44; PRD-III&#44; CCQ&#44; UDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Descenso en dinero gastado en coca&#237;na al inicio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y final del seguimiento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; en GE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UDS semanalmente&#44; limitando el encuentro de diferencias entre grupos<br>Solo 63 sujetos completaron el estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tolliver et al&#46;<span class="elsevierStyleSup">28</span> &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI<br>TBII &#40;MINI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; acamprosato &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;<br>GC&#58; placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;8 sem&#41;&#58;</span> evaluaci&#243;n m&#233;dica&#44; biomarcadores de alcohol&#44; TLFB&#44; OCDS&#44; MADRS&#44; YMRS&#44; CGI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No se encuentran mejoras significativas ni diferencias entre grupos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y corta duraci&#243;n del estudio<br>La heterogeneidad de la muestra y el poco consumo base de alcohol pueden incrementar el error tipo <span class="elsevierStyleSmallCaps">ii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stedman et al&#46;<span class="elsevierStyleSup">29</span> &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>362&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; litio y divalproex<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>quetiapina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>176&#41;<br>GC&#58; litio y divalproex<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>186&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;&#58;</span> TLFB&#44; YMRS&#44; MADRS&#44; CGI-S&#44; CGI-I&#44; HAM-A&#44; GGT&#44; Q-LES-Q&#44; SDS&#44; OCDS&#44; BSCS&#44; SAS&#44; BARS y pruebas biol&#243;gicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No hay diferencias significativas en ninguna medida entre ambos grupos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No incluye pacientes con TBII ni con consumo muy severo de alcohol&#44; lo que hace poco generalizables los datos<br>Quetiapina como tratamiento adjunto en lugar de &#250;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">Wang et al&#46;<span class="elsevierStyleSup">30</span> &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">Ciclaci&#243;n r&#225;pida TBI&#47;TBII &#40;DSM-IV y MINI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">No especificado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">GE&#58; litio y divalproex<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>lamotrigina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;<br>GC&#58; litio y divalproex<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;&#58;</span> MADRS&#44; YMRS&#44; CGI&#44; GAF&#44; ASI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">No hay diferencias significativas en sintomatolog&#237;a psiqui&#225;trica ni en funcionamiento general&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">TM y gran abandono del tratamiento &#40;N final<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;<br>Inclusi&#243;n &#250;nicamente de sujetos de ciclaci&#243;n r&#225;pida y farmacorresistentes al tratamiento inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brown et al&#46;<span class="elsevierStyleSup">31</span> &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI<br>TBII &#40;MINI y SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; CBT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>naltrexona &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;<br>GC&#58; CBT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;</span>&#58; MINI&#44; HAM-D&#44; IDS-SR<span class="elsevierStyleInf">30</span>&#44; YMRS&#44; PACS&#44; PRD-III&#44; ASI y pruebas biol&#243;gicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No se encontraron diferencias significativas entre los grupos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y abandono de tratamiento &#40;N final<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;<br>Resultados confusos por uso de medicaci&#243;n concomitante y CBT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brown et al&#46;<span class="elsevierStyleSup">32</span> &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;<br>TBII &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; &#40;MINI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; quetiapina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41;<br>GC&#58; placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;</span>&#58; HAM-D&#44; YMRS&#44; PACS&#44; TLFB <span class="elsevierStyleItalic">for recent drinking</span>&#44; AIMS&#44; SAS y BAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora en sintomatolog&#237;a depresiva favoreciendo al GE &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; pero no en man&#237;aca ni en consumo de alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Heterogeneidad de la muestra y bajo nivel de consumo de alcohol al comienzo del estudio<br>Sin especificaci&#243;n de tratamiento complementario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brown et al&#46;<span class="elsevierStyleSup">33</span> &#40;2007&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#41;<br>TBII &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;<br>SAD-TB &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; &#40;MINI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Coca&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; citicolina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;<br>GC&#58; placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;&#58;</span> IDS-SR<span class="elsevierStyleInf">30</span>&#44; YMRS&#44; RAVLT&#44; PRD-III&#44; UDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE con mejor ejecuci&#243;n en lista alternativa de palabras del RAVLT &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;<br>Menor probabilidad del GE de consumir coca&#237;na &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y poca adherencia al tratamiento<br>Gran variedad de tratamiento concomitante<br>Heterogeneidad de la muestra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Salloum et al&#46;<span class="elsevierStyleSup">34</span> &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; litio<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>valproato &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#41;<br>GC&#58; litio<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>placebo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;</span>&#58; BRMS&#44; HRSD-25&#44; GAS&#44; TLFB <span class="elsevierStyleItalic">for recent drinking</span>&#44; MQACS&#44; WSHAQ&#44; SCMAF&#44; BAC y UDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Menos d&#237;as de consumo abusivo de alcohol &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; y per&#237;odos mayores hasta reca&#237;da &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41; en el GE con respecto al GC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y falta de potencia estad&#237;stica para detectar diferencias entre los tratamientos<br>No distinci&#243;n entre episodio &#40;man&#237;aco&#44; depresivo o mixto&#41; al inicio del estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Estudios experimentales aleatorizados&#44; con grupo control placebo y dise&#241;o doble ciego</p>"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">ASI&#58; <span class="elsevierStyleItalic">Addiction Severity Index&#59;</span> ECG&#58; electrocardiograma&#59; ECI&#58; <span class="elsevierStyleItalic">Extensive Clinical Interview&#59;</span> GAS&#58; <span class="elsevierStyleItalic">Global Assessment Scale&#59;</span> HAM-D&#58; <span class="elsevierStyleItalic">Hamilton Scale for Depression&#59;</span> IDS-C-30&#58; <span class="elsevierStyleItalic">30-item Inventory of Depressive Symptomatology-Clinician-rated&#59;</span> MINI&#58; <span class="elsevierStyleItalic">Mini International Neuropsychiatric Interview&#59;</span> SCID-CV&#58; <span class="elsevierStyleItalic">Structured Clinical Interview-Clinical Version &#40;DSM-IV&#41;&#59;</span> SCQ-10&#58; <span class="elsevierStyleItalic">10-item self-reported Stimulant Craving Questionnaire&#59;</span> PRD-<span class="elsevierStyleSmallCaps">III&#58;</span><span class="elsevierStyleItalic">Psychobiology of Recovery in Depression <span class="elsevierStyleSmallCaps">III&#59;</span></span> TB&#58; trastorno bipolar&#59; TBI&#58; trastorno bipolar tipo I&#59; TBII&#58; trastorno bipolar tipo II&#59; TM&#58; tama&#241;o muestral&#59; UDS&#58; <span class="elsevierStyleItalic">Urine Drug Screens&#59;</span> YMRS&#58; <span class="elsevierStyleItalic">Young Mania Rating Scale&#46;</span></p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Muestra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Trastorno psiqui&#225;trico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sustancia de abuso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables dependientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Limitaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kemp et al&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">35</span></a> &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ciclado r&#225;pido TB &#40;ECI y MINI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&#44; cannabis&#44; coca&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&#58; litio<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>divalproex &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;<br>G2&#58; litio &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;6 meses&#41;&#58;</span> HAM-D&#44; YMRS&#44; GAS&#44; ASI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora de s&#237;ntomas depresivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; man&#237;acos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y funcionamiento global &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en ambos grupos&#44; pero sin diferencias entre ellos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y poca adherencia al tratamiento<br>Falta de control con placebo y escasa potencia estad&#237;stica para captar peque&#241;as diferencias<br>No se tomaron medidas de cambios en consumo de drogas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nejtek et al&#46;<span class="elsevierStyleSup">36</span> &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI y TBII &#40;SCID-CV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Coca&#237;na&#44; metanfetamina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&#58; quetiapina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;<br>G2&#58; risperidona &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;20 sem&#41;&#58;</span> YMRS&#44; SCQ-10&#44; IDS-C-30&#44; PRD-III&#44; ECG&#44; UDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora en s&#237;ntomas man&#237;acos y depresivos y reducci&#243;n del <span class="elsevierStyleItalic">craving</span> &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0005&#41; en ambos grupos&#44; pero sin diferencias entre ellos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Falta de control con placebo<br>TM relativamente peque&#241;o por gran abandono del tratamiento &#40;solo 14 lo completan&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudios experimentales aleatorizados&#44; con grupos paralelos y dise&#241;o doble ciego</p>"
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">AIMS&#58; <span class="elsevierStyleItalic">Abnormal Involuntary Movement Scale&#59;</span> ALT&#58; <span class="elsevierStyleItalic">alanine aminotranferase&#59;</span> AST&#58; <span class="elsevierStyleItalic">aspartate aminotransferase&#59;</span> BAS&#58; <span class="elsevierStyleItalic">Barnes Akathisia Scale&#59;</span> Borderline PD&#58; <span class="elsevierStyleItalic">borderline personality disorder&#59;</span> BPRS&#58; <span class="elsevierStyleItalic">Brief Psychiatric Rating Scale&#59;</span> BRMS&#58; <span class="elsevierStyleItalic">Bech-Rafaelsen Mania Scale&#59;</span> CBT&#58; <span class="elsevierStyleItalic">Cognitive Behavioral Therapy&#59;</span> CCQ&#58; <span class="elsevierStyleItalic">Cocaine Craving Questionnaire&#59;</span> CGI&#58; <span class="elsevierStyleItalic">Clinical Global Impression &#40;Severity &#91;CGI-S&#93; and Improvement &#91;CGI-I&#93;&#41;&#59;</span> CIWA-Ar&#58; <span class="elsevierStyleItalic">Clinical Institute Withdrawal Assessment of Alcohol revised&#59;</span> DSM-IV&#58; <span class="elsevierStyleItalic">Diagnostic and Statistical Manual of Mental Disorders&#44; 4th edition&#59;</span> ECG&#58; electrocardiograma&#59; EF&#58; evaluaci&#243;n f&#237;sica&#59; EuropASI&#58; <span class="elsevierStyleItalic">European Addiction Severity Index&#59;</span> GAF&#58; <span class="elsevierStyleItalic">Global Assessment of Functioning Scale&#59;</span> GGT&#58; <span class="elsevierStyleItalic">gamma-glutamyltranferase&#59;</span> HAM-D&#58; <span class="elsevierStyleItalic">Hamilton Scale for Depression&#59;</span> MCV&#58; <span class="elsevierStyleItalic">mean cellular volume&#59;</span> MINI&#58; <span class="elsevierStyleItalic">Mini International Neuropsychiatric Interview&#59;</span> OCDS&#58; <span class="elsevierStyleItalic">Obsessive Compulsive Drinking Scale&#59;</span> PSQI&#58; <span class="elsevierStyleItalic">Pittsburgh Sleep Quality Index&#59;</span> SAD&#58; trastorno esquizoafectivo&#59; SADS&#58; <span class="elsevierStyleItalic">Severity of Alcohol Dependence Scale&#59;</span> SAS&#58; <span class="elsevierStyleItalic">Simpson-Angus Scale&#59;</span> SCID&#58; <span class="elsevierStyleItalic">Structured Clinical Interview &#40;DSM-<span class="elsevierStyleSmallCaps">IV</span>&#41;&#59;</span> SCID I&#58; <span class="elsevierStyleItalic">Structured Clinical Interview Axis I &#40;DSM-<span class="elsevierStyleSmallCaps">IV</span>&#41;&#59;</span> SCID II&#58; <span class="elsevierStyleItalic">Structured Clinical Interview Axis II &#40;DSM-<span class="elsevierStyleSmallCaps">IV</span>&#41;&#59;</span> TB&#58; trastorno bipolar&#59; TB NOS&#58; trastorno bipolar sin especificar&#59; TBI&#58; trastorno bipolar tipo I&#59; trastorno bipolar tipo II&#59; TLFB&#58; <span class="elsevierStyleItalic">timeline follow-back&#59;</span> TM&#58; tama&#241;o muestral&#59; UDS&#58; <span class="elsevierStyleItalic">Urine Drug Screens&#59;</span> VAS&#58; <span class="elsevierStyleItalic">Visual Analogue Scale&#59;</span> YMRS&#58; <span class="elsevierStyleItalic">Young Mania Rating Scale&#46;</span></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Trastorno psiqui&#225;trico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sustancia de abuso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables dependientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Limitaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">37</span></a> &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;DMS-IV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No especificada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Olanzapina &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;8 sem&#41;&#58;</span> YMRS&#44; HAM-D&#44; BPRS&#44; VAS&#44; TLFB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reducci&#243;n significativa de sintomatolog&#237;a man&#237;aca y depresiva &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>Disminuci&#243;n de d&#237;as de abuso de la droga &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y de <span class="elsevierStyleItalic">craving</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Los pacientes manten&#237;an tratamiento farmacol&#243;gico no antipsic&#243;tico previo<br>Alta tasa de abandono &#40;25 sujetos completaron el tratamiento&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Martinotti et al&#46;<span class="elsevierStyleSup">38</span> &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;<br>TBII &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;<br>SAD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;<br>Borderline PD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;<br>&#40;SCID I y II&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Quetiapina &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos &#40;16 sem&#41;&#58;</span> EuropASI&#44; OCDS&#44; VAS&#44; CIWA-Ar&#44; BPRS&#44; YMRS&#44; HRDS&#44; biomarcadores &#40;AST&#44; ALT&#44; GGT&#44; MCV&#41;&#44; CGI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora significativa en sintomatolog&#237;a depresiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y BPRS &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>Reducci&#243;n en los d&#237;as de consumo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; y en OCDS &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>Disminuci&#243;n de <span class="elsevierStyleItalic">craving</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Muestra heterog&#233;nea<br>Ausencia de seguimiento para comprobar si los efectos se mantienen en el tiempo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Salloum et al&#46;<span class="elsevierStyleSup">39</span> &#40;2007&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Coca&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Divalproex &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;8 sem&#41;&#58;</span> ASI&#44; TLFB&#44; BRMS&#44; HAM-D&#44; GAF&#44; PSQI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#225;s d&#237;as de abstinencia de coca&#237;na &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; y alcohol &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;043&#41;<br>Menor consumo de marihuana &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#41; y tabaco &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41;<br>Mejora en s&#237;ntomas psiqui&#225;tricos&#44; funcionamiento y sue&#241;o &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y medicaci&#243;n complementaria<br>Incremento de error tipo <span class="elsevierStyleSmallCaps">i</span> debido al an&#225;lisis estad&#237;stico con una muestra tan escasa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brown et al&#46;<span class="elsevierStyleSup">40</span> &#40;2006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;MINI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Coca&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lamotrigina &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;36 sem&#41;&#58;</span> HAM-D&#44; YMRS&#44; BPRS&#44; CCQ&#44; UDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora significativa en s&#237;ntomas man&#237;acos&#44; depresivos y <span class="elsevierStyleItalic">craving</span> &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>Menor gasto de dinero en coca&#237;na por semana &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medicaci&#243;n complementaria<br>Muestra estudiada en 2 momentos distintos &#40;30 pertenecientes a otro estudio de Brown et al&#46; de 2003&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brown et al&#46;<span class="elsevierStyleSup">41</span> &#40;2006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;<br>TBII &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;<br>TB NOS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; &#40;MINI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Naltrexona &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;16 sem&#41;&#58;</span> HAM-D&#44; YMRS&#44; BPRS&#44; CCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora en s&#237;ntomatolog&#237;a depresiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;028&#41;&#44; man&#237;aca &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#44; <span class="elsevierStyleItalic">craving</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y consumo de alcohol en las &#250;ltimas 2 semanas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y abandono &#40;solo 8 sujetos completaron el tratamiento&#41;<br>Medicaci&#243;n complementaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rubio et al&#46;<span class="elsevierStyleSup">42</span> &#40;2006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;<br>TBII &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; &#40;DSM-IV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lamotrigina &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;&#58;</span> SCID&#44; SADS&#44; VAS&#44; TLFB&#44; CBT&#44; HAM-D&#44; YMRS&#44; BPRS&#44; ECG&#44; EF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Disminuci&#243;n en <span class="elsevierStyleItalic">craving</span> y bebidas&#47;semana &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y en niveles de CBT &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>Mejora en s&#237;ntomas depresivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y man&#237;acos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y medicaci&#243;n complementaria<br>Los sujetos recib&#237;an tratamiento con diferentes f&#225;rmacos psicoactivos no considerados en el estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brown et al&#46;<span class="elsevierStyleSup">43</span> &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI<br>TBII<br>SAD &#40;tipo bipolar&#41; &#40;MINI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Coca&#237;na&#44; alcohol&#44; anfetaminas&#44; cannabis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aripiprazol &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;12 sem&#41;&#58;</span> HAM-D&#44; YMRS&#44; BPRS&#44; VAS&#44; UDS&#44; AIMS&#44; SAS&#44; BAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora en s&#237;ntomas depresivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; y man&#237;acos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;<br>Reducci&#243;n de <span class="elsevierStyleItalic">craving</span> en alcohol &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; y coca&#237;na &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;<br>Menos dinero gastado en alcohol &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medicaci&#243;n complementaria<br>Gran heterogeneidad de la muestra<br>TM y abandono &#40;solo 7 sujetos terminaron el tratamiento&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudios farmacol&#243;gicos cuasiexperimentales</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ABS&#58; <span class="elsevierStyleItalic">Alcohol Breath Samples&#59;</span> ASI&#58; <span class="elsevierStyleItalic">Addiction Severity Index&#59;</span> AUS&#58; <span class="elsevierStyleItalic">Alcohol Use Scale&#59;</span> BPRS&#58; <span class="elsevierStyleItalic">Brief Psychiatric Rating Scale&#59;</span> BSI&#58; <span class="elsevierStyleItalic">Brief Symptom Inventory&#59;</span> CM&#58; <span class="elsevierStyleItalic">contingency management&#59;</span> DUS&#58; <span class="elsevierStyleItalic">Drug Use Scale&#59;</span> ED&#58; <span class="elsevierStyleItalic">Family Education Program&#59;</span> FIDD&#58; <span class="elsevierStyleItalic">Family Intervention for Dual Diagnosis&#59;</span> GAS&#58; <span class="elsevierStyleItalic">Global Assessment Scale&#59;</span> GC&#58; grupo control&#59; GDC&#58; <span class="elsevierStyleItalic">Group Drug Counseling&#59;</span> GE&#58; grupo experimental&#59; HAM-D&#58; <span class="elsevierStyleItalic">Hamilton Rating Scale for Depression&#59;</span> HIV-RBS&#58; <span class="elsevierStyleItalic">HIV Risk Behavior Scale&#59;</span> IGT&#58; <span class="elsevierStyleItalic">integrated group therapy&#59;</span> IGT-CF&#58; <span class="elsevierStyleItalic">integrated group therapy community friendly&#59;</span> LIFE&#58; <span class="elsevierStyleItalic">longitudinal interval follow-up evaluation&#59;</span> MDD&#58; trastorno depresi&#243;n mayor&#59; MINI&#58; <span class="elsevierStyleItalic">Mini International Neuropsychiatric Interview&#59;</span> OSI&#58; <span class="elsevierStyleItalic">on-site immunoassays&#59;</span> PANSS&#58; <span class="elsevierStyleItalic">Positive and Negative Syndrome Scale&#59;</span> SAD&#58; trastorno esquizoafectivo&#59; SASD&#58; <span class="elsevierStyleItalic">schizoaffective-spectrum disorder&#59;</span> SATS&#58; <span class="elsevierStyleItalic">Substance Abuse Treatment Scale&#59;</span> SCID&#58; <span class="elsevierStyleItalic">Structured Clinical Interview &#40;DSM-IV&#41;&#59;</span> SCZD&#58; esquizofrenia&#59; TAU&#58; <span class="elsevierStyleItalic">treatment as usual&#59;</span> TB&#58; trastorno bipolar&#59; TBI&#58; trastorno bipolar tipo I&#59; TBII&#58; trastorno bipolar tipo II&#59; TDM&#58; trastorno depresi&#243;n mayor&#59; TLFB&#58; <span class="elsevierStyleItalic">timeline follow-back&#59;</span> TM&#58; tama&#241;o muestral&#59; TSR&#58; <span class="elsevierStyleItalic">treatment services review&#59;</span> UDS&#58; <span class="elsevierStyleItalic">Urine Drug Screens&#59;</span> YMRS&#58; <span class="elsevierStyleItalic">Young Mania Rating Scale&#46;</span></p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Muestra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Trastorno psiqui&#225;trico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sustancia de abuso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables dependientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Limitaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">McDonell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">44</span></a> &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI y TBII &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41;<br>SASD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69&#41;<br>TDM &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#41; &#40;MINI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anfetaminas&#44; metanfetamina&#44; coca&#237;na&#44; alcohol&#44; cannabis&#44; opi&#225;ceos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; CM<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TAU<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>91&#41;<br>GC&#58; TAU &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos &#40;3 meses&#41;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;3 meses&#41;&#58;</span> SCID&#44; ABS&#44; UDS&#44; OSI&#44; ASI&#44; BSI&#44; PANSS&#44; HIV-RBS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE con menor uso de estimulantes en tratamiento y seguimiento &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y menor uso de alcohol en tratamiento &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;<br>Mejora en s&#237;ntomas psiqui&#225;tricos de GE &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abandono del 59&#37; &#40;GE&#41; y 50&#37; &#40;GC&#41; durante el estudio<br>Validez limitada por muestra poco representativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mueser et al&#46;<span class="elsevierStyleSup">45</span> &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#41;<br>SAD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41;<br>SCZD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41; &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&#44; cannabis&#44; anfetaminas&#44; coca&#237;na&#44; opi&#225;ceos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE&#58; FIDD<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41;<br>GC&#58; ED<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;3 a&#241;os&#41;&#58;</span> TLFB&#44; AUS&#44; DUS&#44; SATS&#44; BPRS&#44; GAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GE con menor severidad en consumo de drogas &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y m&#225;s conocimiento sobre trastornos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41;<br>Mayor reducci&#243;n de sintomatolog&#237;a psiqui&#225;trica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; en GE&#44; as&#237; como mejor funcionamiento global &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#218;nicamente 48 sujetos finalizaron los 3 a&#241;os de tratamiento<br>Pacientes segu&#237;an recibiendo tratamiento anterior al estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weiss et al&#46;<span class="elsevierStyleSup">46</span> &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No especificada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&#58; IGT-CF<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;<br>G2&#58; GDC<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">f</span></a> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos &#40;3 meses&#41;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;3 meses&#41;&#58;</span> ASI&#44; TLFB&#44; UDS&#44; LIFE&#44; HAM-D&#44; YMRS&#44; SCID&#44; TSR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Menor consumo de drogas en tratamiento y seguimiento de G1 &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>G1 con mejora de s&#237;ntomas depresivos en tratamiento &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>G1 con mejor resultado cl&#237;nico &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM peque&#241;o y poco representativo<br>No se especifican las sustancias de abuso<br>Tratamiento farmacol&#243;gico no controlado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weiss et al&#46;<span class="elsevierStyleSup">47</span> &#40;2007&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No especificada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&#58; IGT<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;<br>G2&#58; GDC &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos &#40;20 sem&#41;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;3 meses&#41;&#58;</span> ASI&#44; TLFB&#44; UDS&#44; LIFE&#44; HAM-D&#44; YMRS&#44; SCID&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1 con menos d&#237;as de consumo de drogas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y mayor abstinencia &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; en tratamiento y seguimiento<br>G2 con menos s&#237;ntomas psiqui&#225;tricos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en tratamiento y seguimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tratamiento farmacol&#243;gico no controlado<br>TM y poca adherencia<br>Sustancias de abuso sin especificar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Manejo de contingencias para potenciar la abstinencia&#44; utilizando el control del reforzamiento&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Atenci&#243;n semanal de servicios sociales y de salud mental con medicaci&#243;n psiqui&#225;trica y terapia grupal &#40;sin especificar f&#225;rmacos o terapias concretas&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Compuesta de psicoeducaci&#243;n&#44; entrenamiento en habilidades de comunicaci&#243;n y soluci&#243;n de problemas&#44; <span class="elsevierStyleItalic">role-playing</span>&#44; entrevista motivacional&#44; prevenci&#243;n de reca&#237;das&#46; Act&#250;a sobre ambos diagn&#243;sticos&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Formada por psicoeducaci&#243;n extensa &#40;trastornos&#44; modelo vulnerabilidad-estr&#233;s&#44; experiencias personales&#44; presentaci&#243;n did&#225;ctica de informaci&#243;n&#44; discusiones&#44; etc&#46;&#41;&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Sesiones de 1<span class="elsevierStyleHsp" style=""></span>h durante 20 semanas &#40;12 en la versi&#243;n CF&#41; con un modelo cognitivo-conductual integrado que aborda ambos diagn&#243;sticos &#40;&#233;nfasis en su interrelaci&#243;n y mutua influencia&#41; a la vez&#44; con prevenci&#243;n de reca&#237;das&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "f"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Sesiones de 1<span class="elsevierStyleHsp" style=""></span>h durante 12 semanas centradas en facilitar la abstinencia&#44; aumentar los apoyos y ense&#241;ar habilidades de afrontamiento&#46; Se centra &#250;nicamente en el consumo de drogas&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudios experimentales aleatorizados con grupos paralelos</p>"
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        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">AUDIT&#58; <span class="elsevierStyleItalic">Alcohol Use Disorder Identification Test&#59;</span> BAI&#58; <span class="elsevierStyleItalic">Beck Anxiety Inventory&#59;</span> Beck DI&#58; <span class="elsevierStyleItalic">Beck Depression Inventory&#59;</span> BIS&#58; <span class="elsevierStyleItalic">Barratt Impulsiveness Scale&#59;</span> BT&#58; <span class="elsevierStyleItalic">Blood Test&#59;</span> CARS-M&#58; <span class="elsevierStyleItalic">Clinician-Administered Rating Scale for Mania&#59;</span> CBT&#58; <span class="elsevierStyleItalic">Cognitive Behavioral Therapy&#59;</span> CGAS&#58; <span class="elsevierStyleItalic">Children&#39;s Global Assessment Scale&#59;</span> CSQ-8&#58; <span class="elsevierStyleItalic">Client Satisfaction Questionnaire-8&#59;</span> DAST&#58; <span class="elsevierStyleItalic">Drub Abuse Screening Test&#59;</span> FFT-A&#58; <span class="elsevierStyleItalic">Family-Focused Treatment for Adolescents&#59;</span> HR&#58; Helpfulness Ratings&#59; IDDT-SPD&#58; <span class="elsevierStyleItalic">Integrated Dual Diagnosis Treatment &#40;St&#46; Patrick&#44; Dublin&#41;&#59;</span> ISS&#58; <span class="elsevierStyleItalic">Internal States Scale&#59;</span> ITAP&#58; <span class="elsevierStyleItalic">Improving Treatment Adherence Program&#59;</span> K-SADS&#58; <span class="elsevierStyleItalic">Schedule for Affective Disorders and Schizophrenia&#59;</span> K-SADS-PL&#58; <span class="elsevierStyleItalic">Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version&#59;</span> MDD&#58; trastorno depresi&#243;n mayor&#59; MI-CBT&#58; <span class="elsevierStyleItalic">Motivational Interviewing-Cognitive Behavioral Therapy&#59;</span> OCDS&#58; <span class="elsevierStyleItalic">Obsessive Compulsive Drinking Scale&#59;</span> QIDS-C&#58; <span class="elsevierStyleItalic">Quick Inventory of Depressive Symptomatology-Clinician Version&#59;</span> SCID&#58; <span class="elsevierStyleItalic">Structured Clinical Interview &#40;DSM-IV&#41;&#59;</span> TB&#58; trastorno bipolar&#59; TBI&#58; trastorno bipolar tipo I&#59; trastorno bipolar tipo II&#59; TDM&#58; trastorno depresi&#243;n mayor&#59; TLFB&#58; <span class="elsevierStyleItalic">timeline follow-back&#59;</span> TM&#58; tama&#241;o muestral&#59; UDS&#58; <span class="elsevierStyleItalic">Urine Drug Screens&#59;</span> YMRS&#58; <span class="elsevierStyleItalic">Young Mania Rating Scale&#46;</span></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Muestra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Trastorno psiqui&#225;trico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sustancia de abuso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables dependientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Limitaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Goldstein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">48</span></a> &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;K-SADS-PL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cannabis&#44; alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FFT-A<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;6 meses&#41;&#58;</span> K-SADS&#44; CGAS&#44; TLFB&#44; UDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora de s&#237;ntomas man&#237;acos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; y depresivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>Mejora en el funcionamiento general &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Consumo de diferentes medicaciones<br>TM escaso y limitado a rango de edad 13-18 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Farren et al&#46;<span class="elsevierStyleSup">49</span> &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#41;<br>TDM &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>110&#41; &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IDDT-SPD<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos &#40;4 sem&#41;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;5 a&#241;os&#41;&#58;</span> YMRS&#44; TLFB&#44; Beck DI&#44; BAI&#44; OCDS&#44; AUDIT&#44; DAST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora en depresi&#243;n&#44; OCDS&#44; ansiedad y man&#237;a &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>Menor consumo de alcohol &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sujetos motivados &#40;no representatidad&#41;<br>Falta de pruebas biol&#243;gicas y grupo control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gaudiano et al&#46;<span class="elsevierStyleSup">50</span> &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&#44; coca&#237;na&#44; cannabis&#44; sedantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ITAP<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">c</span></a> &#40;estudio piloto&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;6 meses&#41;&#58;</span> CARS-M&#44; QIDS-C&#44; TLFB&#44; CSQ-8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Completa adherencia al programa<br>Mejora general en s&#237;ntomas psiqui&#225;tricos y en consumo de alcohol y otras drogas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y falta de grupo control y poca representatividad<br>Metodolog&#237;a pobre y falta de conclusiones firmes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jones et al&#46;<span class="elsevierStyleSup">51</span> &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBII<br>TBII &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;<br>Cannabis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MI-CBT integradas<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;6 meses&#41;&#58;</span> FLFB&#44; ISS&#44; Beck DI&#44; BIS&#44; HR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cuatro quintas parte redujeron su consumo de drogas<br>Leve mejora en s&#237;ntomas psiqiu&#225;tricos<br>Buena percepci&#243;n de la terapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TM y falta de grupo control<br>Metodolog&#237;a deficiente y falta de conclusiones firmes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Farren et al&#46;<span class="elsevierStyleSup">52</span> &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB<br>TDM &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IDDT-SPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos &#40;4 sem&#41;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;2 a&#241;os&#41;&#58;</span> TLFB&#44; YMRS&#44; Beck DI&#44; BAI&#44; OCDS&#44; AUDIT&#44; DAST&#44; UDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reducci&#243;n de depresi&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; ansiedad &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; OCDS &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y man&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;<br>Menor consumo de alcohol y unidades de alcohol consumido&#47;d&#237;a &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ausencia de grupo control y poca capacidad de generalizaci&#243;n de los datos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Farren y McElroy<span class="elsevierStyleSup">53</span> &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>183&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TBI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41;<br>TBII &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;<br>TDM &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>99&#41; &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IDDT-SPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos &#40;4 sem&#41;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;6 meses&#41;&#58;</span> YMRS&#44; Beck DI&#44; BAI&#44; OCDS&#44; TLFB&#44; DAST&#44; AUDIT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reducci&#243;n en consumo de alcohol &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y en consumo de otras drogas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;<br>Mejora en depresi&#243;n&#44; OCDS&#44; ansiedad y man&#237;a &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sujetos motivados &#40;no representatividad&#41;<br>No se mide la adherencia a la medicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Farren y McElroy<span class="elsevierStyleSup">54</span> &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TB &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>102&#41;<br>TDM &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>124&#41; &#40;SCID&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IDDT-SPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Evaluaci&#243;n pre-pos &#40;4 sem&#41;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">seguimiento &#40;6 meses&#41;&#58;</span> YMRS&#44; Beck DI&#44; BAI&#44; OCDS&#44; TLFB&#44; BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejora en depresi&#243;n&#44; OCDS&#44; ansiedad y man&#237;a &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<br>Descenso en el consumo de alcohol &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Consumo de medicaci&#243;n concomitante<br>Ausencia de grupo control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1412062.png"
              ]
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          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Formada de psicoeducaci&#243;n&#44; entrenamiento en comunicaci&#243;n&#44; soluci&#243;n de problemas&#44; prevenci&#243;n de reca&#237;das&#44; implicando a familiares y allegados&#46; Act&#250;a sobre ambos diagn&#243;sticos&#44; fomentando adherencia a f&#225;rmacos &#40;9<span class="elsevierStyleHsp" style=""></span>meses&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Basado en FIRESIDE&#46; Se compone de una primera fase de estabilizaci&#243;n y desintoxicaci&#243;n&#44; seguida de otra de psicoeducaci&#243;n&#44; terapia individual interpersonal y de apoyo&#44; sesiones de AA y otros grupos de discusi&#243;n&#44; y prevenci&#243;n de reca&#237;das &#40;7-8 meses&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0045"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Se conforma de una variante de la terapia de aceptaci&#243;n y compromiso y una intervenci&#243;n familiar o con la pareja con seguimiento telef&#243;nico&#46; Es un tratamiento integrado que act&#250;a sobre ambos diagn&#243;sticos &#40;6 meses&#41;&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0050"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Consta de un aumento de la motivaci&#243;n inicial&#44; psicoeducaci&#243;n&#44; estabilizaci&#243;n del ritmo social&#44; entrenamiento en habilidades de afrontamiento&#44; prevenci&#243;n de reca&#237;das y promoci&#243;n de la adherencia a la medicaci&#243;n &#40;6 meses&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudios psicol&#243;gicos cuasiexperimentales</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:64 [
            0 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;R&#46; Merikangas"
                            1 => "H&#46;S&#46; Akiskal"
                            2 => "J&#46; Angst"
                            3 => "P&#46;E&#46; Greenberg"
                            4 => "R&#46;M&#46; Hirschfeld"
                            5 => "M&#46; Petukhova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archpsyc.64.5.543"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Gen Psychiatry&#46;"
                        "fecha" => "2007"
                        "volumen" => "64"
                        "paginaInicial" => "543"
                        "paginaFinal" => "552"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17485606"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
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Información del artículo
ISSN: 18889891
Idioma original: Español
DOI:10.1016/j.rpsm.2015.10.003
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