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substance related disorder [keywords]
- Pharmacological treatment of attention deficit hyperactivity disorder with co-morbid drug dependence. [JOURNAL ARTICLE]
- J Psychopharmacol 2014 Aug 20.
Drug dependence is frequent in patients with attention deficit hyperactivity disorder (ADHD). Nevertheless, the efficacy and safety of pharmacological treatments in this population are unclear.A systematic review with meta-analysis was performed. Randomised placebo-controlled clinical trials investigating the efficacy of pharmacological treatment in patients with co-occurring ADHD and substance use disorder (SUD) were included. ADHD symptom severity, drug abstinence and all-cause treatment discontinuation were the primary study endpoints. The effects of patient-, intervention- and study-related covariates over the primary outcomes were investigated by means of meta-regression.Thirteen studies were included, enrolling a total of 1,271 patients. A small to moderate reduction of ADHD symptoms was found. Meta-regression analysis identified the presence of a lead-in period as a covariate associated with reduced efficacy. Conversely, no beneficial effect was observed either on drug abstinence or treatment discontinuation. The efficacy on ADHD symptoms was smaller in studies with a lead-in period. A positive correlation between the efficacy for ADHD and that for SUD was found.The efficacy of pharmacological interventions for co-occurring ADHD and SUD has been little investigated. Mixed results were obtained: while pharmacological interventions improved ADHD symptoms, no beneficial effect on drug abstinence or on treatment discontinuation was noted. The strength of the recommendation of pharmacological treatment for co-occurring ADHD and SUD is therefore modest. The study was registered with the international prospective register of systematic reviews (PROSPERO): CRD 4212003414.
- The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment. [Journal Article]
- Harm Reduct J 2014; 11(1):24.
Opioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. This article aims to generate nuanced knowledge about violent crime among a group of imprisoned, OMT-enrolled individuals by exploring their understandings of the role of substances in violent crime prior to and during OMT, moral values related to violent crime, and post-crime processing of their moral transgressions.Twenty-eight semi-structured interviews were undertaken among 12 OMT-enrolled prisoners. The interviews were audio recorded and transcribed verbatim. An exploratory, thematic analysis was carried out with a reflexive and interactive approach.Prior to OMT, substances and, in particular, high-dose benzodiazepines were deliberately used to induce 'antisocial selves' capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Yet, to conduct a (violent) criminal act does not necessarily imply that one is without moral principles. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes.Substances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes. Being simultaneously enrolled in OMT and imprisoned for a (violent) crime might evoke feelings of 'double' shame and guilt for both the criminal behavior prior to treatment and the actual case(s) one is imprisoned for while in OMT. Treatment providers should identify individuals with histories of violent behavior and, together with them, explore concrete episodes of violence and their emotional reactions. Particular attention should be given to potential relationships between substance use and violence and treatment approaches tailored accordingly. What appears as severe antisocial personality disorder may be partly explained by substance use.
- The cumulative effect of different childhood trauma types on self-reported symptoms of adult male depression and PTSD, substance abuse and health-related quality of life in a large active-duty military cohort. [JOURNAL ARTICLE]
- J Psychiatr Res 2014 Aug 4.
History of childhood trauma (CT) is highly prevalent and may lead to long-term consequences on physical and mental health. This study investigated the independent association of CT with symptoms of adult depression and posttraumatic stress disorder (PTSD), mental and physical health-related quality of life (HRQoL), as well as current tobacco consumption and alcohol abuse in a large homogenous cohort of 1254 never-deployed, young male Marines enrolled in the Marine Resiliency Study. Independent effects of CT history, number and type of CT on outcomes were analyzed using hierarchical multivariate logistic regression models. Our results suggested dose-dependent negative effect of an increasing number of trauma types of CT on depression, PTSD and HRQoL. Experience of single CT type demonstrated overall weak effects, while history of multiple CT types distinctively increased the likelihood of adult PTSD symptomology (OR: 3.1, 95% CI: 1.5-6.2), poor mental (OR: 2.3, 95% CI: 1.7-3.1) and physical HRQoL (OR: 1.4, 95% CI: 1.1-1.9). Risk for depression symptoms was similar for both single and multiple CT (OR: 2.2, 95% CI: 1.3-3.8 and OR: 2.1, 95% CI: 1.2-3.5 respectively). CT history had no effects on current tobacco use and alcohol abuse. Our study thus provides evidence for substantial additive effect of different CT types on adult mental and physical health with increasing levels of exposure.
- Treatment for opioid use disorder--reply. [Comment, Letter]
- JAMA 2014 Aug 20; 312(7):751.
- Treatment for opioid use disorder. [Comment, Letter]
- JAMA 2014 Aug 20; 312(7):750-1.
- Sustained care intervention and postdischarge smoking cessation among hospitalized adults: a randomized clinical trial. [Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.]
- JAMA 2014 Aug 20; 312(7):719-28.
Health care systems need effective models to manage chronic diseases like tobacco dependence across transitions in care. Hospitalizations provide opportunities for smokers to quit, but research suggests that hospital-delivered interventions are effective only if treatment continues after discharge.To determine whether an intervention to sustain tobacco treatment after hospital discharge increases smoking cessation rates compared with standard care.A randomized clinical trial compared sustained care (a postdischarge tobacco cessation intervention) with standard care among 397 hospitalized daily smokers (mean age, 53 years; 48% were males; 81% were non-Hispanic whites) who wanted to quit smoking after discharge and received a tobacco dependence intervention in the hospital; 92% of eligible patients and 44% of screened patients enrolled. The study was conducted from August 2010 through November 2012 at Massachusetts General Hospital.Sustained care participants received automated interactive voice response telephone calls and their choice of free smoking cessation medication (any type approved by the US Food and Drug Administration) for up to 90 days. The automated telephone calls promoted cessation, provided medication management, and triaged smokers for additional counseling. Standard care participants received recommendations for postdischarge pharmacotherapy and counseling.The primary outcome was biochemically confirmed past 7-day tobacco abstinence at 6-month follow-up after discharge from the hospital; secondary outcomes included self-reported tobacco abstinence.Smokers randomly assigned to sustained care (n = 198) used more counseling and more pharmacotherapy at each follow-up assessment than those assigned to standard care (n = 199). Biochemically validated 7-day tobacco abstinence at 6 months was higher with sustained care (26%) than with standard care (15%) (relative risk [RR], 1.71 [95% CI, 1.14-2.56], P = .009; number needed to treat, 9.4 [95% CI, 5.4-35.5]). Using multiple imputation for missing outcomes, the RR for 7-day tobacco abstinence was 1.55 (95% CI, 1.03-2.21; P = .04). Sustained care also resulted in higher self-reported continuous abstinence rates for 6 months after discharge (27% vs 16% for standard care; RR, 1.70 [95% CI, 1.15-2.51]; P = .007).Among hospitalized adult smokers who wanted to quit smoking, a postdischarge intervention providing automated telephone calls and free medication resulted in higher rates of smoking cessation at 6 months compared with a standard recommendation to use counseling and medication after discharge. These findings, if replicated, suggest an approach to help achieve sustained smoking cessation after a hospital stay.clinicaltrials.gov Identifier: NCT01177176.
- Childhood Stress Exposure Among Preadolescents With and Without Family Histories of Substance Use Disorders. [JOURNAL ARTICLE]
- Psychol Addict Behav 2014 Aug 18.
Having a family history of substance use disorders (FH+) increases risk for developing a substance use disorder. This risk may be at least partially mediated by increased exposure to childhood stressors among FH+ individuals. However, measures typically used to assess exposure to stressors are narrow in scope and vary across studies. The nature of stressors that disproportionately affect FH+ children and how these stressors relate to later substance use in this population are not well understood. The purpose of this study was to assess exposure to a broad range of stressors among FH+ and FH- children to better characterize how exposure to childhood stressors relates to increased risk for substance misuse among FH+ individuals. A total of 386 children (305 FH+, 81 FH-; ages 10-12) were assessed using the Stressful Life Events Schedule before the onset of regular substance use. Both the number and severity of stressors were compared. Preliminary follow-up analyses were done for 53 adolescents who subsequently reported initiation of substance use. FH+ children reported more frequent and severe stressors than did FH- children, specifically in the areas of housing, family, school, crime, peers, and finances. Additionally, risk for substance use initiation during early adolescence was influenced directly by having a family history of substance use disorders and also indirectly through increased exposure to stressors among FH+ individuals. In conclusion, FH+ children experience greater stress across multiple domains, which contributes to their risk for substance misuse and related problems during adolescence and young adulthood. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
- [Migration status, familial vulnerability for psychiatric disorders, and schizotypal personality traits]. [English Abstract, Journal Article]
- Tijdschr Psychiatr 2014; 56(8):496-504.
The incidence of schizophrenia and related psychotic disorders is considerably raised among certain migrants and ethnic minorities. However, the association between migration status and the risk of psychoses is not yet fully understood.To obtain a better understanding of the increased risk status of migrants by examining the separate and combined effects of migration status and a familial vulnerability to psychiatric disorder in relation to schizotypal personality traits.We conducted a cross-sectional study of two non-clinical samples of 62 Moroccan migrants and 41 Dutch non-migrants who were classified on the basis of a family history of a psychiatric or substance use disorder. We used self-report questionnaires to assess schizotypal traits, as well as measuring substance use, feelings of anxiety or depression, and perceptions of ethnic discrimination.Moroccan migrants with familial vulnerability displayed substantially stronger schizotypal personality traits than Moroccan migrants without familial vulnerability; the latter did not differ significantly from the Dutch non-migrants. In addition, migrants with familial vulnerability reported higher levels of substance use, feelings of anxiety or depression and perceptions of ethnic discrimination. These features were closely linked to the strength of their schizotypal traits.These results support the hypothesis that those migrants who are both intrinsically vulnerable and chronically exposed to stressful social environments, in particular to ethnic discrimination are primarily the ones who run a high risk of psychosis and other psychiatric disorders.
- [Deaths in a Tunisian psychiatric hospital: An eleven-year retrospective study.] [JOURNAL ARTICLE]
- Encephale 2014 Aug 14.
Mortality in patients in psychiatric hospitals is reported to be two to three times as high as in the general population. In Tunisia, we do not have any figures on mortality and causes of death in psychiatric inpatients.The aim of our study was to assess the mortality rate in a psychiatric hospital in comparison to the mortality rate in the general population, to determine the patients' profile, and to identify the causes and risk factors for these deaths.We performed a retrospective, descriptive and comparative study. We examined the records of all patients who died during their stay in the different wards of psychiatry at the Razi Hospital in Tunis. We also scrutinized reports of autopsies in the Forensic Medicine unit at Charles-Nicolle Hospital in Tunis over a period of eleven years from January 1st, 2000 to December 31st, 2010. We conducted a descriptive study to calculate the standardized mortality ratio (SMR) aiming to highlight any existing excess mortality among the psychiatric inpatients compared to the general population. This ratio was obtained by dividing the observed number of deaths by the expected number of deaths. In the analytical study, our sample was compared to a control population made-up of randomly selected living patients among those admitted to the Razi hospital in 2010. This study allowed us to investigate the risk factors for premature mortality in psychiatric inpatients.The average rate of mortality was two deaths per 1000 inpatients per year. Twenty-four percent (24 %) of deaths involved institutionalized patients. Compared to the general population, premature mortality was noted among patients aged less than 40 (SMR=1.9). The older the patients were, the closer to 1 the SMR was. The average age at death was 51.38 years; 65 % of patients were male, 60 % had a low socio-economic level, 54 % had a comorbid medical condition. Forty-two percent (42 %) of deceased patients were diagnosed with schizophrenia with the paranoid form being the most prevalent (44 %), 13 % had bipolar disorder, 22 % had psycho-organic disorders (mental retardation, dementia, delirium). Antipsychotics were the most prescribed psychotropic drugs. High doses were used. Forty percent of cases (40 %) consisted of sudden deaths. A cause for death was identified in 80 % of cases. In 92 % of cases, the death was classified as being "natural". Main causes were respiratory (26 %) and cardiovascular (9 %). Accidental causes accounted for 8 % of deaths. In 20 % of cases, the cause remained undetermined. Three factors were identified as independent predictors of mortality among mental patients: age at death (OR=3.9 among patients older than 40), psychiatric diagnosis (OR=2.9 among patients with psychotic or mood disorders compared to other diagnoses) and combination of antipsychotic drugs (OR=6.09 in patients receiving more than two antipsychotics).Young psychiatric inpatients seem to be at high risk of premature death: the SMR in our study was 1.9. It ranged between 2.15 and 6.55 in other similar studies. This increased risk mainly concerns non-natural deaths. The leading natural cause of death in our population was represented by thromboembolic accidents. Such a high thromboembolic risk may be explained by the mental illness itself, by physical restraint as well as by antipsychotic treatment. Diagnosing medical conditions in psychiatric patients is often a daunting task: history of the patient is sometimes unreliable and clinical features might be modified by psychotropic agents. Patient-related risk factors for premature death include poor socio-economic level, access-to-care difficulties, positive family and personal history of mental and/or medical disorders, smoking, substance abuse, unhealthy diet and lack of physical activity. Moreover, iatrogenic effects of psychotropic drugs (combination of antipsychotics was more common in deceased patients than in controls) and inadequate medical care in psychiatric hospitals (lack of ECG devices, in particular) partly account for such a high mortality.Identifying risk factors for deaths in psychiatric hospitals highlights needed changes in psychiatric management strategies taking into account the patient's characteristics as well as the drugs' safety profile. Further studies with larger samples are needed to better highlight risk factors for premature death in psychiatric inpatients. Identifying such risk factors is necessary to develop efficient preventive strategies.
- Psychiatric disorders, high-risk behaviors, and chronicity of episodes among predominantly african american homeless chicago youth. [Journal Article]
- J Health Care Poor Underserved 2014; 25(3):1201-16.