Does the pattern of amphetamine use prior to incarceration predict later psychosis?--a longitudinal study of amphetamine users in the Swedish criminal justice system

Rapid and sensitive detection of amphetamine by SERS-based competitive immunoassay coupled with magnetic separation

Amphetamine (AMP), as a psychiatric drug acting on the central nervous system, and has become one of the most common drugs of abuse in the illegal market at present, which adversely affects social public safety. We developed a SERS magnetic immunoassay with high sensitivity, specificity, and rapid and quantitative detection of AMP. We synthesized a high SERS intensity substrate (Au-XP013@Ag) using the "hot spot" effect and combined it with antibodies to form SERS immunotags (Au-XP013@Ag-AMP-mAb). Subsequently, the carboxyl magnetic beads were linked to label antigens as functional magnetic beads (carboxyl magnetic beads-AMP-BSA). Using the principle of competitive immunoassay, the Raman response value of the immune complex formed with SERS tags and functional magnetic beads was detected to realize the quantitative detection of AMP. The detection limit of this method for AMP was 2.28 ng mL^-1. More importantly, a portable Raman instrument was used in this study, which can meet the requirements of point-of-care testing (POCT). Therefore, this SERS-based magnetic immunoassay can provide a favorable scientific basis for the control of drug abuse, monitoring by law enforcement agencies, and determination of drug users.

The Association of High-Frequency Nut Intake With a Low Risk of Psychological Problems in Female Methamphetamine Users

BACKGROUND

Recent years have witnessed a gradual increase in the number of female methamphetamine users. Meanwhile, female methamphetamine users are more likely to have psychological problems than male methamphetamine users. The association between diet and psychological problems have been found among non-methamphetamine user. The present study aims to investigate the relationship between dietary intake frequency and psychological problems in female methamphetamine users.

MATERIALS AND METHODS

A total of 109 female methamphetamine users, collected from a Compulsory Isolated Drug Rehabilitation Centre in northern China, participated in the study. All participants completed the Symptom Checklist 90 (SCL-90) questionnaire to assess psychological status. The relation of dietary intake frequency with the SCL-90 score was tested in partial correlation analysis. Multivariable regression models were used to calculate odds ratios to evaluate the association of dietary intake frequency with psychological problems.

RESULTS

Of the current female methamphetamine population, 33 participants were diagnosed with psychological problems using SCL-90. In the terms of dietary intake frequency, the frequency of nut intake in the psychiatric symptom group was significantly lower than that in the asymptomatic group. However, there was no difference in the frequency of other food intakes between the two groups. The frequency of nut intake was negatively correlated with the total score of SCL-90 and 8 different symptom clusters of psychopathologies on SCL-90. Logistic regression analysis indicated that the increased frequency of nut intake was associated with a lower risk of psychological problems.

CONCLUSION

In the female methamphetamine population, increasing the frequency of nut intake may reduce the risk of psychological problems for female methamphetamine users.

Factors of Negative Affect in Elderly Patients With Substance Use Disorders During COVID-19 Pandemic

Background: The outbreak of the novel coronavirus disease 2019 (COVID-19) has become the greatest public health emergency and has attracted global attention. During the COVID-19 pandemic, the negative affect (NA) of elderly patients with substance use disorders (SUDs) has also become a more serious public concern. The current study aims to clarify the NA and its influencing factors in elderly patients with SUDs during the pandemic. Methods: Two psychiatrists conducted semi-structured interviews with 77 SUD patients aged above 50 years to collect their demographical information and certain drug use characteristics. Barratt Impulse Scale and the Positive and Negative Affect Scale were used to obtain information about patients' self-reported impulsivity and NA. Results: Univariate linear regression analysis showed that NA was positively correlated with the frequency of drug use, type of SUDs, cravings during COVID-19, and impulsivity. Multiple linear regression analysis showed that being female, higher frequency of drug use, stronger cravings, and greater impulsiveness jointly accounted for the variation of NA in elderly patients with SUDs. Conclusions: This study confirmed that, during the COVID-19 pandemic, gender, frequency of drug use, cravings, and impulsivity were associated with NA in elderly patients with SUDs. This study provided a theoretical basis for clinicians to reduce the patients' NA.

Real time detection of amphetamine in oral fluids by MicroNIR/Chemometrics

In this work, a novel coupled approach MicroNIR/Chemometrics based on a miniaturized and portable spectrometer is proposed for the on site detection of amphetamines (AMP) in non pretreated oral fluids. In particular, the coupling of MicroNIR with chemometrics was investigated with the aim of developing a fast and accurate approach able to perform the on-site prediction of AMP abuse. A predictive model to be used in real cases was developed by collecting specimens from volunteers and spiked samples with increasing amounts of AMP were prepared to optimize calibration. Partial Least Square-Discriminant Analysis (PLS-DA) and Partial Least Square regression (PLS) were involved to detect and quantify AMP. Results demonstrated that MicroNIR/Chemometric platform is statistically able to identify AMP abuse in simulated oral fluid samples containing, with the accuracy and sensitivity of the actual proposed official reference methods. The method was checked against false positive and true positive response and results proved to be those required for confirmatory analyses. This method would permit to simplify AMP abuse monitoring for roadside drug testing or workplace surveillance and may be of help at first aid points.

Factors affecting the occurrence of psychotic symptoms in chronic methamphetamine users

Studies of risk for psychotic symptoms in methamphetamine users have focused primarily on drug use immediately before symptoms had appeared. Here we assessed factors reflecting characteristics of lifetime methamphetamine use before the appearance of psychotic symptoms. Four hundred ninety-five methamphetamine users (322 men, 173 women) were studied with consideration of the following features of methamphetamine use: age of initiation, maximum single dose, number of uses at or near the maximum dose, longest period of daily use, average dosage during that period, number of heavy use periods, and number of sustained abstinence periods (>1 month). Use of drugs other than methamphetamine and family history of schizophrenia were also considered. Retrospective self-reports of psychotic symptoms were obtained on the Brief Psychiatric Rating Scale. Factors associated with the occurrence of initial psychotic symptom(s) were identified using logistic regression. Later age of initiation, more uses at maximal or near maximal dosage, and more periods of prolonged abstinence were identified as protective factors. We conclude that early methamphetamine use can promote psychotic symptoms, possibly by altering neurodevelopment, whereas long abstinence periods may protect by allowing recovery. Negative associations of the appearance of psychotic symptom(s) with frequent high-dose administration suggest protection through tolerance.

A systematic review of risk factors for methamphetamine-associated psychosis

OBJECTIVE

Chronic methamphetamine use is commonly associated with the development of psychotic symptoms. The predictors and correlates of methamphetamine-associated psychosis are poorly understood. We sought to systematically review factors associated with psychotic symptoms in adults using illicit amphetamine or methamphetamine.

METHODS

A systematic literature search was performed on MEDLINE (OVID), PsycINFO and EMBASE databases from inception to 8 December 2016. The search strategy combined three concept areas: methamphetamine or amphetamine, psychosis and risk factors. Included studies needed to compare adults using illicit methamphetamine or amphetamine, using a validated measure of psychosis, on a range of risk factors. Of 402 identified articles, we removed 45 duplicates, 320 articles based on abstract/title and 17 ineligible full-text articles, leaving 20 included studies that were conducted in 13 populations. Two co-authors independently extracted the following data from each study: country, setting and design; participant demographic and clinical details; sample size; measure/s used and measures of association between psychosis outcomes and risk factors. Individual study quality was assessed using a modified Newcastle-Ottawa Scale, and strength of evidence was assessed using GRADE criteria.

RESULTS

Frequency of methamphetamine use and severity of methamphetamine dependence were consistently found to be associated with psychosis, and sociodemographic factors were not. There was inconsistent evidence available for all other risk factors. Individual study quality was low-moderate for the majority of studies. Heterogeneity in study outcomes precluded quantitative synthesis of outcomes across studies.

CONCLUSION

The most consistent correlates of psychotic symptoms were increased frequency of methamphetamine use and dependence on methamphetamine. The findings of this review highlight the need for targeted assessment and treatment of methamphetamine use in individuals presenting with psychosis.

Associations between substance use and type of crime in prisoners with substance use problems - a focus on violence and fatal violence

Aim

The present study aimed to study the associations between substance use patterns and types of crimes in prisoners with substance use problems, and specifically whether substance use patterns were different in violent offenders.

Methods

Interview data of prisoners with substance use problems (N=4,202, mean age 33.5 years, SD 9.8), derived from the Addiction Severity Index, were run against criminal register data on main types of crimes in the verdict.

Results

In binary analyses, compared to those with acquisitive and drug crimes, violent offenders had lower prevalence of illicit drugs and homelessness, but higher prevalence of binge drinking, and higher prevalence of sedative use than clients sentenced with drug crimes. Clients with violent crime had lower prevalence of injecting drug use, compared to all other crimes. In logistic regression, binge drinking and sedatives were positively associated with violent crime (as opposed to non-violent crime), whereas heroin, amphetamine, cocaine, and injecting drug use were negatively associated with violent crime. Among violent offenders only, sedatives tended to be associated with fatal violence (p=0.06), whereas amphetamine, homelessness, age, and (marginally significant, p=0.05) heroin were negatively associated with fatal violence, as opposed to non-fatal violence.

Conclusion

Treatment and risk assessment in violent perpetrators with substance use may need to address sedatives and alcohol specifically. Limitations of the study are due to self-reported and cross-sectional data and because a large majority of the prison sample studied here are men.

A Review of Risk Factors for Methamphetamine-Related Psychiatric Symptoms

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.

Key differences in treatment-seeking stimulant users attending a specialised treatment service: a means of early intervention?

OBJECTIVES

Few people who use stimulants seek clinical treatment. This study sought to describe a cohort of stimulant users who attended a stimulant-specific treatment service, Access Point, in Melbourne, Australia between 2008 and 2014.

METHODS

A retrospective audit of the records of adults ( n = 175) who sought treatment for stimulant use at a stimulant-specific outpatient treatment service was conducted.

RESULTS

Service users had a median age of 32 (range = 19-54). Most stimulant users were in part- or full-time employment (53.6%) and had stable accommodation (85%). There was a high rate of mental health comorbidity, with over half (52%) reporting a previous history of mental health problems, while one-third (33%) reported previous suicide attempts. There was a high rate (48%) of previous methamphetamine-associated psychosis, which was significantly correlated with frequency of use ( x² = 13.698, p = 0.008).

CONCLUSIONS

This study supports the potential of a targeted and specialised treatment service as a means of early intervention for stimulant users. The high prevalence of methamphetamine-associated psychosis history in this group suggests that frequent use of stimulants increases the risk of psychosis, even among high-functioning individuals.

Psychosis induced by amphetamines

PURPOSE OF REVIEW

The study reviews publications on the use of methamphetamine and amphetamine in relation to psychotic symptoms, substance-induced psychosis, and primary psychosis published between July 2014 and December 2015. The databases MEDLINE, Embase, and PsycINFO were searched using the terms 'amphetamine psychosis' and 'methamphetamine psychosis' for the time period 1 July 2014 to 31 December 2015.

RECENT FINDINGS

There were 37 studies published on the subject during this time period. Risk factors for psychotic symptoms, substance-induced psychosis, and primary psychosis included patterns of drug use, but results also pointed to the importance of nondrug-related vulnerability. Cognitive impairment is associated with both amphetamine use and psychosis, and the impairment among those with amphetamine-induced psychosis resembles that of schizophrenia. At the neuronal level, GABAergic mechanisms may offer some understanding about the association between stimulant use and psychosis. Several different types of antipsychotic medication are effective for treating agitation and psychosis, but drugs with high DRD2 blockade should be used with caution. Some novel treatments are described, but are not sufficiently repeated to be recommended.

SUMMARY

During the past 18 months, studies have been published that cover risk factors, neuronal mechanisms, and treatment. These recent results do not differ from previous understandings, but the role of cognition and GABAergic dysfunction should be further investigated, and knowledge about resilience factors is still scarce. Also, a clearer evidence base for medical treatment of psychosis with concurrent amphetamine use is warranted. VIDEO ABSTRACT.

Long-term risk factors for substance-induced and primary psychosis after release from prison. A longitudinal study of substance users

PURPOSE

The purpose of this study was to determine long-term risk factors for substance-induced and primary psychosis after release from prison.

MATERIAL

We used a longitudinal register-based cohort study combining European version of Addiction Severity Index (Europ-ASI) interviews and the Swedish inpatient register. The study included 6217 individuals who were in the Swedish criminal justice system from 2001 to 2006.

MEASUREMENTS

The outcomes were substance-induced and primary psychosis as defined by the International Classification of Disease - 10th version. All variables for estimating baseline risk were drawn from the Europ-ASI interview, and included information on substance use, demographics and health. The interview database and the inpatient register were coupled, and groups were compared by using tests of significance and logistic regression.

RESULTS

Polydrug use was the strongest predictor for substance induced psychosis (OR=9.55, 95% CI 3.42-26.67), but all substances imposed an increased risk. Previous psychiatric hospitalization and non-drug related hallucinations were significant, but weaker, risk factors. The only substance variable that predicted primary psychosis was cannabis (OR=2.62, 95% CI 1.39-4.96), but previous psychiatric hospitalization (OR=3.22, 95% CI 2.27-4.54) and non-drug related hallucinations (OR=4.00, 95% CI 2.82-5.67) were even stronger predictors.

CONCLUSIONS

Cannabis use was a risk factor for primary psychosis, but other health related individual risk factors were even more important. Polydrug use was the strongest risk factor for substance-induced psychosis.

Amphetamine-induced psychosis: Transition to schizophrenia and mortality in a small prospective sample

BACKGROUND AND OBJECTIVES

We investigated transition from amphetamine-induced psychosis (AIP) to schizophrenia.

METHODS

A sample of 28 individuals was identified while hospitalized for AIP. We reviewed their hospital records after six years.

RESULTS

During follow-up, seven individuals (25%) died and nine (32%) had moved from the area. Of the remaining 12, four individuals (25%) were diagnosed with schizophrenia. These individuals were, at baseline, characterized by fewer hallucinatory symptoms and more homelessness.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Hospitalization for AIP was a relatively specific risk factor for schizophrenia and the mortality rate in AIP was high.

Distinguishing schizophrenia from posttraumatic stress disorder with psychosis

PURPOSE OF REVIEW

Co-occurrence of psychotic symptoms with symptoms typically thought of as posttraumatic stress disorder (PTSD) is well known, and there has been considerable debate whether this represents a psychotic subtype or a comorbid psychotic disorder.

RECENT FINDINGS

Psychotic symptoms typical of schizophrenia occur with a higher than expected frequency in PTSD. A large genome-wide association study (GWAS) has identified a collection of genes associated with PTSD, and these genes overlap with those identified as increasing the risk of developing schizophrenia.

SUMMARY

Up to 70% of returning veterans experience symptoms of PTSD. These individuals also fall within the peak age range for the onset of schizophrenia. PTSD with psychosis may occur for several reasons: trauma increases one's risk for schizophrenia and PTSD; patients with schizophrenia have a higher incidence of PTSD and may present with characteristic psychotic symptoms overlapping with psychosis in schizophrenia. Secondary to symptom overlap, there may be substantial misdiagnosis of psychotic disorders as PTSD, or nonidentification of a comorbid psychotic disorder. This overlap calls into question traditional diagnostic boundaries with implications for initial and long-term treatment of PTSD and psychosis. This review will discuss the recent literature relating to the association of PTSD with schizophrenia.

Register data in the evaluation and program planning of addiction treatment programs: using Sweden as an example

Data from large-scale registers is often underutilized when evaluating addiction treatment programs. Since many programs collect register data regarding clients and interventions, there is a potential to make greater use of such records for program evaluation. The purpose of this article is to discuss the value of using large-scale registers in the evaluation and program planning of addiction treatment systems and programs. Sweden is used as an example of a country where register data is both available and is starting to be used in national evaluation and program planning efforts. The article focuses on possibilities, limitations and practicalities when using large-scale register data to conduct evaluations and program planning of addiction treatment programs. Main conclusions are that using register data for evaluation provides large amounts of data at low cost, limitations associated to the use of register data may be handled statistically, register data can answer important questions in planning of addiction treatment programs, and more accurate measures are needed to account for the diversity of client populations.