Impacto de los deterioros neuropsicologicos asociados al consumo de sustancias sobre practica clinica con drogodependientes

FRANÇAIS :
L'objectif de cette étude est, dans un premier temps, de passer en revue les atteintes neuropsychologiques liées à l'abus de drogue chez le toxicomane, particulièrement en ce qui concerne les fonctions exécutives : plannification, prise de décision, contrôle de l'impulsivité. Ensuite, l'influence de ces déficits sur la clinique du toxicomane est abordée en considérant particulièrement la réversibilité potentielle de ces atteintes, la comorbidité avec des troubles de la personnalité et de l'humeur, les états d'anosognosie et les déficits spécifiques de l'impulsivité.
ENGLISH :
Chronic consumption of several drugs of abuse (cannabis, heroin, stimulants) has been clearly associated with the presence of neuropsychological impairments in a wide range of functions, mainly: memory, learning, attention, concentration and reasoning. Nevertheless, in the last years, neuropsychological research related to substance abuse, supported by the development of new technologies (functional neuroimaging, metabolite studies) has been focused on the study of possible impairments in the executive functions localized in the cortex prefrontal lobes, and their influence on the substance abuser's personality, cognitions and behaviours. The objective of our review is, first, to summarize the main neuropsychological impairments showed by classic studies and these new discoveries in executive functions, and second, to consider the mediating role of neuropsychological status on treatment outcomes, analyse the usefulness and impact of these impairments on clinical practice with drug addicts, taking into account such particularly relevant factors as the potential recoverability of the impairments, the co-morbidity with personality and mood disorders and the existence of unawareness and specific alterations in impulsivity. We also highlight the convenience of intervening specifically in those functions more relevant to the abuser's ordinary life, his persistence in consumption and the high risk of relapse that could be explained, at least partially, as resulting from the executive impairment. (Author' s abstract)