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The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. J Addict Med 2024; 18:1-56. [PMID: 38669101 PMCID: PMC11105801 DOI: 10.1097/adm.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The American Society of Addiction Medicine/American Academy of Addiction Psychiatry (ASAM/AAAP) Clinical Practice Guideline on the Management of Stimulant Use Disorder provides guidance on evidence-based strategies for the treatment of stimulant use disorders (StUDs), stimulant intoxication, and stimulant withdrawal, as well as secondary and tertiary prevention of harms associated with stimulant use. The Clinical Guideline Committee (CGC) comprised experts from ASAM and AAAP representing a range of clinical settings and patient populations. The guideline was developed following modified GRADE methodology. The process included a systematic literature review as well as several targeted supplemental searches. The CGC utilized Evidence to Decision tables to review available evidence and rate the strength of each recommendation. The clinical practice guideline was revised based on external stakeholder review. Key takeaways included: Contingency management represents the current standard of care for treatment of StUDs; Pharmacotherapies may be utilized off-label to treat StUDs; Acute stimulant intoxication can result in life-threatening complications that should be addressed in an appropriate level of care; Secondary and tertiary prevention strategies should be used to reduce harms related to risky stimulant use.
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Daswani RR, Choles CM, Kim DD, Barr AM. A systematic review and meta-analysis of synthetic cathinone use and psychosis. Psychopharmacology (Berl) 2024; 241:875-896. [PMID: 38446172 DOI: 10.1007/s00213-024-06569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
RATIONALE Synthetic cathinones (SC), commonly referred to as "bath salts", are stimulants resembling the natural alkaloid cathinone found in the khat plant. These substances have the potential to induce serious health risks such as hallucinations, delusions, paranoia and agitation which can lead to substance-induced psychotic disorders. Despite growing concerns, there is a limited understanding of the association between SC consumption and the devolvement of such psychopathologies. METHODS We conducted a systematic review to investigate the frequency of substance-induced psychotic disorder (SIPD) and associated conditions in humans following synthetic cathinone consumption. We qualitatively and quantitatively analyzed SC exposure cases. RESULTS A total of 32 studies were included, with a diverse range of demographics, synthetic cathinone types, and consumption patterns. The proportion of individuals developing psychotic symptoms was reported at 0.380 (Random-effects model, 95% CI 0.289 - 0.475). Additionally, the significant heterogeneity in diagnostic approaches limited our ability to provide a precise estimate of prevalence. CONCLUSIONS Synthetic cathinone consumption is associated with the risk of developing psychotic symptoms as indicated by the prevalence of hallucinations and/or delusions. Due to the lack of information on classifying factors, particularly duration of symptoms, we are unable to conclude synthetic cathinone-induced psychosis. Further research is warranted to elucidate the underlying mechanism linking synthetic cathinone consumption and psychosis. This review underscores the urgency of addressing the growing health risks posed by synthetic cathinone use. Additionally, it highlights the necessity of proper quantification of psychotic symptoms through scales and reporting of classification criteria to accurately diagnose SIPD.
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Affiliation(s)
- Rishika R Daswani
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, V6T1Z3, Canada
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Cassandra M Choles
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, V6T1Z3, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver, BC, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, V6T1Z3, Canada
- British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, V6T1Z3, Canada.
- British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, BC, Canada.
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Kim DD, Procyshyn RM, Jones AA, Gicas KM, Jones PW, Petersson AM, Lee LHN, McLellan-Carich R, Cho LL, Panenka WJ, Leonova O, Lang DJ, Thornton AE, Honer WG, Barr AM. Relationship between drug-induced movement disorders and psychosis in adults living in precarious housing or homelessness. J Psychiatr Res 2024; 170:290-296. [PMID: 38185074 DOI: 10.1016/j.jpsychires.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
BACKGROUND Studies have reported positive associations between drug-induced movement disorders (DIMDs) and symptoms of psychosis in patients with schizophrenia. However, it is not clear which subtypes of symptoms are related to each other, and whether one symptom precedes another. The current report assessed both concurrent and temporal associations between DIMDs and symptoms of psychosis in a community-based sample of homeless individuals. METHODS Participants were recruited in Vancouver, Canada. Severity of DIMDs and psychosis was rated annually, allowing for the analysis of concurrent associations between DIMDs and Positive and Negative Syndrome Scale (PANSS) five factors. A brief version of the PANSS was rated monthly using five psychotic symptoms, allowing for the analysis of their temporal associations with DIMDs. Mixed-effects linear and logistic regression models were used to assess the associations. RESULTS 401 participants were included, mean age of 40.7 years (SD = 11.2) and 77.4% male. DIMDs and symptoms of psychosis were differentially associated with each other, in which the presence of parkinsonism was associated with greater negative symptoms, dyskinesia with disorganized symptoms, and akathisia with excited symptoms. The presence of DIMDs of any type was not associated with depressive symptoms. Regarding temporal associations, preceding delusions and unusual thought content were associated with parkinsonism, whereas dyskinesia was associated with subsequent conceptual disorganization. CONCLUSIONS The current study found significant associations between DIMDs and symptoms of psychosis in individuals living in precarious housing or homelessness. Moreover, there were temporal associations between parkinsonism and psychotic symptoms (delusions or unusual thought content), and the presence of dyskinesia was temporally associated with higher odds of clinically relevant conceptual disorganization.
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Affiliation(s)
- David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Ric M Procyshyn
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Andrea A Jones
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Kristina M Gicas
- Department of Psychology, University of the Fraser Valley, Abbotsford, BC, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Lik Hang N Lee
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel McLellan-Carich
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Lianne L Cho
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William J Panenka
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - William G Honer
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada.
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Astrocyte-derived lactate/NADH alters methamphetamine-induced memory consolidation and retrieval by regulating neuronal synaptic plasticity in the dorsal hippocampus. Brain Struct Funct 2022; 227:2681-2699. [DOI: 10.1007/s00429-022-02563-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
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Kohno M, Dennis LE, McCready H, Hoffman WF. Dopamine dysfunction in stimulant use disorders: mechanistic comparisons and implications for treatment. Mol Psychiatry 2022; 27:220-229. [PMID: 34117366 PMCID: PMC8664889 DOI: 10.1038/s41380-021-01180-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/13/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
Dopamine system deficiencies and associated behavioral phenotypes may be a critical barrier to success in treating stimulant use disorders. Similarities in dopamine dysfunction between cocaine and methamphetamine use disorder but also key differences may impact treatment efficacy and outcome. This review will first compare the epidemiology of cocaine and methamphetamine use disorder. A detailed account of the pharmacokinetic and pharmacodynamic properties associated with each drug will then be discussed, with an emphasis on effects on the dopamine system and associated signaling pathways. Lastly, treatment results from pharmacological clinical trials will be summarized along with a more comprehensive review of the involvement of the trace amine-associated receptor on dopamine signaling dysfunction among stimulants and its potential as a therapeutic target.
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Affiliation(s)
- Milky Kohno
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA. .,Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA. .,Research and Development Service, Veterans Affairs Portland Health Care System, Portland, OR, USA. .,Methamphetamine Abuse Research Center, Oregon Health & Science University and Veterans Affairs Portland Health Care System, Portland, OR, USA.
| | - Laura E. Dennis
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA,Research & Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Holly McCready
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA,Research & Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - William F. Hoffman
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA,Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA,Research & Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon, USA,Mental Health Division, Veterans Affairs Portland Health Care System, Portland, Oregon, USA,Methamphetamine Abuse Research Center, Oregon Health & Science University and Veterans Affairs Portland Health Care System, Portland, Oregon, USA
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MacCallum CA, Eadie L, Barr AM, Boivin M, Lu S. Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain. Front Pharmacol 2021; 12:633168. [PMID: 33995035 PMCID: PMC8120104 DOI: 10.3389/fphar.2021.633168] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Chronic non-cancer pain (CNCP) is estimated to affect 20% of the adult population. Current United States and Canadian Chronic non-cancer pain guidelines recommend careful reassessment of the risk-benefit ratio for doses greater than 90 mg morphine equivalent dose (MED), due to low evidence for improved pain efficacy at higher morphine equivalent dose and a significant increase in morbidity and mortality. There are a number of human studies demonstrating cannabis opioid synergy. This preliminary evidence suggests a potential role of cannabis as an adjunctive therapy with or without opioids to optimize pain control. Methods: In 2017, the Canadian Opioid Guidelines Clinical Tool was created to encourage judicious opioid prescribing for CNCP patients and to reevaluate those who have been chronically using high MED. Mirroring this approach, we draw on our clinical experiences and available evidence to create a clinical tool to serve as a foundational clinical guideline for the initiation of medical cannabis in the management of CNCP patients using chronic opioid therapy. Findings: Following principles of harm reduction and risk minimization, we suggest cannabis be introduced in appropriately selected CNCP patients, using a stepwise approach, with the intent of pain management optimization. We use a structured approach to focus on low dose cannabis (namely, THC) initiation, slow titration, dose optimization and frequent monitoring. Conclusion: When low dose THC is introduced as an adjunctive therapy, we observe better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.
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Affiliation(s)
- Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, Faculty of Medicine, Division of Palliative Care, UBC, Vancouver, BC, Canada.,Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada
| | - Lauren Eadie
- Department of Medicine, Faculty of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, UBC, Vancouver, BC, Canada
| | | | - Shaohua Lu
- Department of Medicine, Faculty of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, BC, Canada
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Gicas KM, Cheng A, Panenka WJ, Kim DD, Yau JC, Procyshyn RM, Stubbs JL, Jones AA, Bains S, Thornton AE, Lang DJ, Vertinsky AT, Rauscher A, Honer WG, Barr AM. Differential effects of cannabis exposure during early versus later adolescence on the expression of psychosis in homeless and precariously housed adults. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110084. [PMID: 32890696 DOI: 10.1016/j.pnpbp.2020.110084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/16/2020] [Accepted: 08/26/2020] [Indexed: 12/20/2022]
Abstract
Longitudinal studies of cannabis exposure during early adolescence in the general population frequently report an increased risk of subsequently developing psychotic symptoms or a psychotic illness. However, there is a dearth of knowledge about the effects of early cannabis exposure on psychosis in homeless and precariously housed adults, who represent a population afflicted with high rates of psychosis. The aim of the present study was to examine how early cannabis exposure (by age 15) compared to later first use (after age 15) affected the expression of adult psychosis in this population. Secondary measures of psychopathology, drug use, cognition and brain structure were also collected. 437 subjects were recruited from single room occupancy hotels in the urban setting of the Downtown Eastside of Vancouver, Canada. Psychiatric diagnoses were determined, and psychotic symptom severity was measured with the 5-factor PANSS. Participants completed a battery of neurocognitive tests, and brain structure was assessed using structural and diffusion tensor imaging MRI scans. Results indicated that early cannabis exposure was associated with an increased risk (OR = 1.09, p < .05) of developing substance induced psychosis, whereas later first use increased risk (OR = 2.19, p < .01) of developing schizophrenia or schizoaffective disorder. There was no group difference in neurocognitive function, although differences were observed in the lateral orbitofrontal cortex and white matter tract diffusivity. These findings indicate that early cannabis exposure in this population may increase the risk of developing drug associated psychoses, which could potentially be mediated in part through altered neurodevelopmental brain changes.
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Affiliation(s)
| | - Alex Cheng
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jade C Yau
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Simran Bains
- Department of Medicine, Imperial College London, United Kingdom
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alexandra T Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alex Rauscher
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
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Hussain MA, Iudicello JE, Morgan EE, Kamat R, Heaton RK, Grant I. Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence. Addict Behav Rep 2021; 13:100331. [PMID: 33521229 PMCID: PMC7820030 DOI: 10.1016/j.abrep.2020.100331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/14/2020] [Accepted: 12/20/2020] [Indexed: 12/13/2022] Open
Abstract
Used an apathy composite T-score approach validated in methamphetamine-dependence. Apathy, above other factors, associated with poorer drug abstinence self-efficacy. Methamphetamine use characteristics unrelated to drug abstinence self-efficacy. Social peer pressure was riskiest situation for potential methamphetamine relapse.
Background Confidence in one’s ability to achieve and maintain drug abstinence (i.e., abstinence self-efficacy) is a strong predictor of substance use treatment outcomes. Neurobehavioral factors that may interfere with abstinence self-efficacy are less well established, particularly in methamphetamine (METH). This study investigated whether apathy, which is highly prevalent during active METH use and periods of abstinence, influences abstinence self-efficacy among METH dependent individuals. Methods Sixty-six participants with lifetime METH dependence and METH abuse/METH dependence diagnoses within the last 18 months (mean age [SD] = 39.5 years [10.7]), and no severe psychiatric or neurological diseases, completed the Methamphetamine Self-Efficacy Scale (MSES), alongside a comprehensive neurobehavioral evaluation. The MSES presents six situations that may lead to relapse and collects self-report ratings for two subscales: “Confidence” (i.e., confidence in one’s ability to abstain from using METH, or METH abstinence self-efficacy) and “Temptation” (i.e., how tempted one is to use METH) with regard to each situation. Apathy was measured using a composite T-score comprised of items and scales from three well-validated, self-report assessments. Results Multivariable linear regression found that higher Apathy T-scores were significantly associated with lower Confidence ratings (i.e., poorer METH abstinence self-efficacy; p < .05), independent of potentially relevant factors (e.g., Temptation to use METH, comorbid HIV disease, and neurocognitive impairment). Conclusions Elevated apathy may adversely impact one’s confidence to abstain from METH use. Findings highlight the importance of addressing apathy in order to improve METH abstinence self-efficacy, which may subsequently increase the likelihood of successful METH treatment outcomes.
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Affiliation(s)
- Mariam A Hussain
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA.,San Diego State University/University of California San Diego Joint Doctoral Program, Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Jennifer E Iudicello
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
| | - Erin E Morgan
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
| | - Rujvi Kamat
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
| | - Robert K Heaton
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
| | - Igor Grant
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
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Lei M, Rintoul K, Stubbs JL, Kim DD, Jones AA, Hamzah Y, Procyshyn RM, Gicas KM, Cho LL, Panenka WJ, Thornton AE, Lang DJ, MacEwan GW, Honer WG, Barr AM. Characterization of Bodily Pain and Use of Both Prescription and Non-Prescription Opioids in Tenants of Precarious Housing. Subst Use Misuse 2021; 56:1951-1961. [PMID: 34338612 DOI: 10.1080/10826084.2021.1958865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
opioid use, which includes both prescribed and non-prescribed drugs, is relatively common amongst marginalized populations. Past research has shown that among those who use non-prescribed or diverted opioids recreationally, many were first exposed to the drug as prescribed pain medication. Objective: to better understand the relationship between pain and opioid use in tenants of precarious housing. Methods: in the present study, 440 individuals from a cohort living in homeless or precariously housed conditions in a neighborhood with high rates of poverty and drug use were interviewed for their bodily pain and opioid use. We examined the relationship between bodily pain levels, assessed using the Maudsley Addiction Profile questionnaire, and prescribed, non-prescribed and combined self-reported opioid use in the prior 28 days assessed using the Timeline Followback and Doctor-Prescribed Medication Timeline Followback questionnaires. Results: Analysis of the results indicated that sex (female), age (younger) and early exposure to opioids (≤ age 18) predicted current opioid use, but there was no association between current bodily pain levels and opioid use. Conclusions: these unexpected findings indicate the complex nature of the relationship between pain and opioid use in this population.
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Affiliation(s)
- Michelle Lei
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn Rintoul
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yasmin Hamzah
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada. PLoS Med 2020; 17:e1003172. [PMID: 32628679 PMCID: PMC7337288 DOI: 10.1371/journal.pmed.1003172] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The "trimorbidity" of substance use disorder and mental and physical illness is associated with living in precarious housing or homelessness. The extent to which substance use increases risk of psychosis and both contribute to mortality needs investigation in longitudinal studies. METHODS AND FINDINGS A community-based sample of 437 adults (330 men, mean [SD] age 40.6 [11.2] years) living in Vancouver, Canada, completed baseline assessments between November 2008 and October 2015. Follow-up was monthly for a median 6.3 years (interquartile range 3.1-8.6). Use of tobacco, alcohol, cannabis, cocaine, methamphetamine, and opioids was assessed by interview and urine drug screen; severity of psychosis was also assessed. Mortality (up to November 15, 2018) was assessed from coroner's reports and hospital records. Using data from monthly visits (mean 9.8, SD 3.6) over the first year after study entry, mixed-effects logistic regression analysis examined relationships between risk factors and psychotic features. A past history of psychotic disorder was common (60.9%). Nonprescribed substance use included tobacco (89.0%), alcohol (77.5%), cocaine (73.2%), cannabis (72.8%), opioids (51.0%), and methamphetamine (46.5%). During the same year, 79.3% of participants reported psychotic features at least once. Greater risk was associated with number of days using methamphetamine (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.05-1.24, p = 0.001), alcohol (aOR 1.09, 95% CI 1.01-1.18, p = 0.04), and cannabis (aOR 1.08, 95% CI 1.02-1.14, p = 0.008), adjusted for demographic factors and history of past psychotic disorder. Greater exposure to concurrent month trauma was associated with increased odds of psychosis (adjusted model aOR 1.54, 95% CI 1.19-2.00, p = 0.001). There was no evidence for interactions or reverse associations between psychotic features and time-varying risk factors. During 2,481 total person years of observation, 79 participants died (18.1%). Causes of death were physical illness (40.5%), accidental overdose (35.4%), trauma (5.1%), suicide (1.3%), and unknown (17.7%). A multivariable Cox proportional hazard model indicated baseline alcohol dependence (adjusted hazard ratio [aHR] 1.83, 95% CI 1.09-3.07, p = 0.02), and evidence of hepatic fibrosis (aHR 1.81, 95% CI 1.08-3.03, p = 0.02) were risk factors for mortality. Among those under age 55 years, a history of a psychotic disorder was a risk factor for mortality (aHR 2.38, 95% CI 1.03-5.51, p = 0.04, adjusted for alcohol dependence at baseline, human immunodeficiency virus [HIV], and hepatic fibrosis). The primary study limitation concerns generalizability: conclusions from a community-based, diagnostically heterogeneous sample may not apply to specific diagnostic groups in a clinical setting. Because one-third of participants grew up in foster care or were adopted, useful family history information was not obtainable. CONCLUSIONS In this study, we found methamphetamine, alcohol, and cannabis use were associated with higher risk for psychotic features, as were a past history of psychotic disorder, and experiencing traumatic events. We found that alcohol dependence, hepatic fibrosis, and, only among participants <55 years of age, history of a psychotic disorder were associated with greater risk for mortality. Modifiable risk factors in people living in precarious housing or homelessness can be a focus for interventions.
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11
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A comparison of regional brain volumes and white matter connectivity in subjects with stimulant induced psychosis versus schizophrenia. Psychopharmacology (Berl) 2019; 236:3385-3399. [PMID: 31230145 DOI: 10.1007/s00213-019-05298-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/05/2019] [Indexed: 12/31/2022]
Abstract
RATIONALE Schizophrenia and stimulant-induced psychosis (SIP) represent two different forms of psychotic disorder, with different etiologies. While many of the symptoms of psychosis are common to both disorders, there have been few direct comparisons between these conditions, especially when controlling for stimulant use in individuals with schizophrenia. OBJECTIVES We directly compared both psychotic disorders with a comprehensive battery of clinical, neurocognitive and neuroanatomical measures. This included one group with SIP (and concurrent stimulant dependence) and two groups with schizophrenia (either with or without concurrent stimulant dependence). METHODS Ninety-six participants were recruited from a marginalized urban population, which included 39 with SIP (and concurrent stimulant dependence), 18 with schizophrenia (without stimulant dependence), and 39 with schizophrenia (with concurrent stimulant dependence). All subjects had extensive clinical and neurocognitive evaluations, complemented with structural MRI including diffusion tensor imaging (DTI) sequences to determine regional brain volumes and white matter connectivity. RESULTS Both positive and negative symptoms were greater in the SZ-dependent group than the other two. Neurocognitive function was broadly similar. The structural brain imaging revealed lateralized changes to the left parietal/temporal lobe, in which regional volumes were smaller in the SZ-dependent than the SZ-non-dependent group. DTI analysis indicated extensive decreases in fractional anisotropy, with parallel increases in radial diffusivity, in the SIP group compared to the SZ-dependent group. CONCLUSIONS These findings reveal both similarities and differences between SIP and schizophrenia. Furthermore, schizophrenia with concurrent stimulant dependence may be associated with a different clinical and neuroanatomical profile as compared to schizophrenia alone.
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Yau JC, Yu SM, Panenka WJ, Pearce H, Gicas KM, Procyshyn RM, MacCallum C, Honer WG, Barr AM. Characterization of mental health in cannabis dispensary users, using structured clinical interviews and standardized assessment instruments. BMC Psychiatry 2019; 19:335. [PMID: 31675939 PMCID: PMC6825348 DOI: 10.1186/s12888-019-2324-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cannabis is commonly used for its medical properties. In particular, cannabis is purported to have beneficial effects on a wide range of neuropsychiatric conditions. Studies assessing mental health in cannabis dispensary users typically evaluate symptoms using self-report check lists, which provide limited information about symptom severity, and whether subjects meet criteria for a psychiatric diagnosis. There is, therefore, a need for studies which assess mental health in dispensary users with standardized and well validated scientific instruments, such as those used in clinical drug trials. METHODS One hundred medical cannabis users were recruited from a community dispensary. All subjects completed a structured clinical interview with the Mini-International Neuropsychiatric Interview (MINI). Subjects also completed the Perceived Stress Scale-10, PROMIS Fatigue Scale, PROMIS Sleep Disturbance Scale, Beck Depression Inventory, the Patient Health Questionnaire-15 and the Brief Pain Inventory. Details about cannabis use were also recorded. RESULTS Lifetime prevalence of mental illness in this cohort was high, and a large proportion of subjects endorsed psychological symptoms. The proportion of subjects who met criteria for classification of a current psychiatric disorder was low for mood disorders, but high for anxiety disorders and substance abuse/dependence. Cannabis use differed between the main psychiatric conditions. CONCLUSIONS The present results indicate that rates of mental illness may be high in medical cannabis dispensary users. Use of structured clinical assessments combined with standardized symptom severity questionnaires provide a feasible way to provide a more rigorous and detailed evaluation of conditions and symptoms in this population.
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Affiliation(s)
- Jade C. Yau
- 0000 0001 2288 9830grid.17091.3eDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Shu Min Yu
- 0000 0001 2288 9830grid.17091.3eDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - William J. Panenka
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Hadley Pearce
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Kristina M. Gicas
- 0000 0004 1936 9430grid.21100.32Department of Psychology, York University, Toronto, Ontario Canada
| | - Ric M. Procyshyn
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Caroline MacCallum
- 0000 0001 2288 9830grid.17091.3eDepartment of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - William G. Honer
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Alasdair M. Barr
- 0000 0001 2288 9830grid.17091.3eDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
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13
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Lappin JM, Sara GE. Psychostimulant use and the brain. Addiction 2019; 114:2065-2077. [PMID: 31321819 DOI: 10.1111/add.14708] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/01/2019] [Accepted: 06/03/2019] [Indexed: 12/18/2022]
Abstract
Psychostimulant users are typically young adults. We have conducted a narrative review of neuropsychiatric harms associated with the psychostimulants methamphetamine/amphetamine, cocaine and 3,4-methylenedioxymethamphetamine (MDMA), focusing on epidemiological factors, common clinical presentations, underlying causal mechanisms and treatment options. The major neuropsychiatric harms of psychostimulant use are stroke, neurocognitive impairment, Parkinson's disease, seizures and psychotic illness. These arise through a combination of acute monoamine release, longer-term neurotransmitter effects and indirect effects. These effects are moderated by factors in the individual and in the pattern of substance use. Neuropsychiatric harms associated with psychostimulant use can thus lead to severe long-term impairment.
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Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Grant E Sara
- InforMH, NSW Ministry of Health, North Ryde, NSW, Australia.,Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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14
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Romain K, Eriksson A, Onyon R, Kumar M. The psychosis risk timeline: can we improve our preventive strategies? Part 2: adolescence and adulthood. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYCurrent understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk factors more likely to be encountered during later childhood, adolescence and adulthood. These include environmental factors, substance misuse, and social and psychopathological aspects.LEARNING OBJECTIVES:After reading this article you will be able to:
•understanding the range of risk factors for development of psychotic symptoms in young people and adults•understand in particular the association between trauma/abuse and subsequent psychosis•appreciate current evidence for the nature and strength of the link between substance misuse and psychosis.DECLARATION OF INTEREST:None.
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15
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Calpe-López C, García-Pardo MP, Aguilar MA. Cannabidiol Treatment Might Promote Resilience to Cocaine and Methamphetamine Use Disorders: A Review of Possible Mechanisms. Molecules 2019; 24:molecules24142583. [PMID: 31315244 PMCID: PMC6680550 DOI: 10.3390/molecules24142583] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 12/12/2022] Open
Abstract
Currently, there are no approved pharmacotherapies for addiction to cocaine and other psychostimulant drugs. Several studies have proposed that cannabidiol (CBD) could be a promising treatment for substance use disorders. In the present work, the authors describe the scarce preclinical and human research about the actions of CBD on the effects of stimulant drugs, mainly cocaine and methamphetamine (METH). Additionally, the possible mechanisms underlying the therapeutic potential of CBD on stimulant use disorders are reviewed. CBD has reversed toxicity and seizures induced by cocaine, behavioural sensitization induced by amphetamines, motivation to self-administer cocaine and METH, context- and stress-induced reinstatement of cocaine and priming-induced reinstatement of METH seeking behaviours. CBD also potentiated the extinction of cocaine- and amphetamine-induced conditioned place preference (CPP), impaired the reconsolidation of cocaine CPP and prevented priming-induced reinstatement of METH CPP. Observational studies suggest that CBD may reduce problems related with crack-cocaine addiction, such as withdrawal symptoms, craving, impulsivity and paranoia (Fischer et al., 2015). The potential mechanisms involved in the protective effects of CBD on addiction to psychostimulant drugs include the prevention of drug-induced neuroadaptations (neurotransmitter and intracellular signalling pathways changes), the erasure of aberrant drug-memories, the reversion of cognitive deficits induced by psychostimulant drugs and the alleviation of mental disorders comorbid with psychostimulant abuse. Further, preclinical studies and future clinical trials are necessary to fully evaluate the potential of CBD as an intervention for cocaine and methamphetamine addictive disorders.
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Affiliation(s)
- Claudia Calpe-López
- Unit of Research "Neurobehavioural mechanisms and endophenotypes of addictive behavior", Department of Psychobiology, University of Valencia, Avda. Blasco Ibañez 21, 46010 Valencia, Spain
| | - M Pilar García-Pardo
- Department of Psychology and Sociology, University of Zaragoza, 44003 Teruel, Spain
| | - Maria A Aguilar
- Unit of Research "Neurobehavioural mechanisms and endophenotypes of addictive behavior", Department of Psychobiology, University of Valencia, Avda. Blasco Ibañez 21, 46010 Valencia, Spain.
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16
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Chang X, Sun Y, Zhang Y, Muhai J, Lu L, Shi J. A Review of Risk Factors for Methamphetamine-Related Psychiatric Symptoms. Front Psychiatry 2018; 9:603. [PMID: 30519197 PMCID: PMC6251327 DOI: 10.3389/fpsyt.2018.00603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/29/2018] [Indexed: 11/30/2022] Open
Abstract
The illegal use of methamphetamine (MA) is a growing public health concern globally and results in a series of negative effects. The prominent detrimental effect of MA use is MA-related psychiatric symptoms (MAP) and is observed at a much higher incidence compared to the general population. MAP often includes multiple dimensions of cognitive impairment and induces adverse consequences such as, violence and suicide. However, the assessment methods for MAP are not standardized. Hence, it is necessary to investigate factors that affect the progression of psychiatric symptoms in individuals who use MA. A review of published studies was performed by searching the following databases: PubMed, EMBASE, and PsycINFO from inception to 31 May, 2018. The search strategy included methamphetamine, dependence, psychiatric symptoms, and risk factor terms. We reviewed the different features of MAP and the various types of assessment instruments and summarized MAP risk factors from MA use-related factors, socio-demographic characteristics, life events, and genetic factors. We found that MAP was consistently and causally associated with MA use, particularly as it relates to the frequency and amount of MA use. Other MAP-related risk factors like life events and genetics were relatively inconsistent in their association with MAP. Hence, causal and longitudinal studies that focus on multilateral comparisons are required. This review provides high quality evidence for MAP risk factors and would be helpful for developing early prevention and treatment strategies for MAP.
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Affiliation(s)
- Xiangwen Chang
- National Institute on Drug Dependence, Peking University, Beijing, China.,Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Yan Sun
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Yang Zhang
- National Institute on Drug Dependence, Peking University, Beijing, China.,Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Jiana Muhai
- National Institute on Drug Dependence, Peking University, Beijing, China.,Department of Medical Experimental Science, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Lin Lu
- National Institute on Drug Dependence, Peking University, Beijing, China.,Peking University Sixth Hospital, Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Jie Shi
- National Institute on Drug Dependence, Peking University, Beijing, China.,Beijing Key Laboratory on Drug Dependence Research, Beijing, China
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Cryan JF, de Wit H. Special issue: recognizing the lifetime scientific contributions of Athina Markou. Psychopharmacology (Berl) 2017; 234:1311-1313. [PMID: 28421256 PMCID: PMC5473252 DOI: 10.1007/s00213-017-4624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John F Cryan
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
| | - Harriet de Wit
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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