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Rodrigues KL, Scaranni PDODS, Pereira ENGDS, da Silva VVD, Silvares RR, de Araujo BP, Castilho C, Schmidt MI, da Fonseca MDJM, Griep RH, Daliry A. Hair cortisol levels are associated with overweight and obesity in the ELSA-Brasil cohort. Front Endocrinol (Lausanne) 2024; 15:1361715. [PMID: 38654925 PMCID: PMC11035765 DOI: 10.3389/fendo.2024.1361715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/09/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Hair cortisol level has recently been identified as a promising marker for detecting long-term cortisol levels and a marker of hypothalamic-pituitary-adrenal cortex (HPA) axis activity. However, research on the association between obesity and an altered cortisol metabolism remains controversial. Objective This study aimed to investigate the relationship between hair cortisol levels and overweight and obesity in participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods This was a cross-sectional study involving 2,499 participants from the second follow-up (visit 3, 2017-2019) attending research centers in Rio de Janeiro and Rio Grande do Sul states. Hair samples were collected, and cortisol levels were analyzed using enzyme-linked immunosorbent assay (ELISA) kits. Cortisol levels were classified as low (< 40 pg/mg), medium (40-128 pg/mg), or high (> 128 pg/mg). The participants were classified as eutrophic, overweight, or obese according to their weight (kg) and height (m2). Odds ratios (ORs) with 95% confidence intervals (95%CI) were estimated. Results Of the 2499 individuals, 30% had eutrophic weight, 40% were overweight, and 30% were obese. Notably, cortisol levels gradually increased with increasing body weight. Among participants with high hair cortisol levels, 41.2% were classified as overweight and 34.2% as obese. Multinomial logistic regression analysis indicated that participants with high cortisol levels were 43% (OR =1.43; 95%CI: 1.02-2.03) more likely to be overweight and 72% (OR =1.72; 95%CI:1.20-2.47) more likely to be obese than participants with low hair cortisol levels. After adjustment for all covariates, high cortisol levels remained associated with obesity (OR = 1.54; 95%CI:1.02-2.31) and overweight (OR =1.33; 95%CI:0.91-1.94). Conclusion In the ELSA-Brazil cohort, hair stress were positively associated with overweight and obesity. These results underscore the importance of considering stress and cortisol as potential factors in obesity prevention and intervention efforts, and highlight a novel aspect of the complex relationship between stress and obesity in the Brazilian population.
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Affiliation(s)
- Karine Lino Rodrigues
- Laboratory of Clinical and Experimental Physiopathology, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | | - Raquel Rangel Silvares
- Laboratory of Clinical and Experimental Physiopathology, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Beatriz Peres de Araujo
- Laboratory of Clinical and Experimental Physiopathology, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cristina Castilho
- Department of Public Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rosane Harter Griep
- Laboratory of Environmental and Health Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Anissa Daliry
- Laboratory of Clinical and Experimental Physiopathology, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Nigatu YT, Elton-Marshall T, Wickens CM, Hamilton HA. The Association of Frequency of Worry About Financial Debt With Substance Use Among Adults in Ontario, Canada. Subst Use Misuse 2024; 59:1190-1199. [PMID: 38514251 DOI: 10.1080/10826084.2024.2330902] [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] [Indexed: 03/23/2024]
Abstract
BACKGROUND Financial debt and associated stress might increase the risk of substance use problems or exacerbate existing ones. Little evidence is available about the degree of debt stress and its association with substance use. The objective of this study was to examine the associations of the frequency of worry about debt with heavy episodic drinking (HED), daily smoking, e-cigarette use, and cannabis use in the past 30 days. METHODS Data were utilized from the 2020/2022 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The surveys employed a web-based panel survey of 6038 adults and collected data on debt-related stress, HED, tobacco smoking, e-cigarettes, and cannabis use in the past 30 days. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors. RESULTS Overall, 18.4% of respondents reported that they were worried about their debt most or all of the time. Accounting for household income, educational status, employment status, and other factors, the results revealed that there was a dose-response relationship between the frequency of worry about debt and substance use including daily smoking, e-cigarette use, and cannabis use in the past 30 days compared to those who were not worried at all about their debt. Sex differences were also found in the association between worry about debt and e-cigarette use. CONCLUSIONS The frequency of worry about debt might have an important role in substance use, which suggests that financial well-being is vital in substance use prevention and harm reduction.
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Affiliation(s)
- Yeshambel T Nigatu
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
| | - Tara Elton-Marshall
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christine M Wickens
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Hayley A Hamilton
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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3
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Mazhnaya A, Meteliuk A, Pykalo I, Altice FL. Qualitative exploration of the early experiences of opioid use disorder patients from private clinics after Russia's invasion of Ukraine in five major cities in Ukraine. Front Public Health 2023; 11:1238188. [PMID: 38162610 PMCID: PMC10756895 DOI: 10.3389/fpubh.2023.1238188] [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] [Received: 06/11/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Following the full-scale invasion of Ukraine by the Russian Federation on 24 February 2022, over 6,000 patients were at risk of potential disruptions in treatment with medications for opioid use disorder (MOUD) in Ukraine. Before 2022, privatized MOUD clinics had emerged, partly driven by restrictive governmental policies and practices in state-funded facilities. Nevertheless, scant information exists regarding their operation and the patient's experiences, especially during crises. This study seeks to elucidate the initial lived experiences of patients utilizing private MOUD clinics, integrating these insights with an analysis of the responding health system during war. Methods The findings are derived from 20 qualitative semi-structured interviews conducted between March and June 2022, engaging participants from five major Ukrainian cities: Kharkiv, Kyiv, Odesa, Poltava, and Zaporizhzhya. Employing a rapid analysis procedure, we examined the data through descriptive and analytical summaries aligned with the domains of the data collection instrument. Results Emergent themes encompassed stress and uncertainty following the invasion's onset, challenges accessing MOUD, and consequent perceptions concerning state-funded versus private clinics. The study identified disruptions in the operation of private MOUD clinics across most cities examined. Issues pertaining to MOUD medication availability were linked to dosage reductions at state-funded clinics or pharmacy medication shortages or closures. Despite varied experiences at different MOUD clinics and cities, most participants continued their treatment. Discussion This qualitative exploration provides a perspective on lived experiences with MOUD treatment at private clinics amidst the initial months of the invasion, illuminating how the early days' stress, access challenges, varied responses from private MOUD clinics, and precarious conditions informed or altered preferences regarding MOUD treatment options. Moreover, these findings corroborate previously documented efforts by myriad stakeholders to mitigate war-related disruptions to MOUD delivery. These insights contribute to the international understanding of health system navigation and resilience during major crises, offering valuable lessons for preparedness development.
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Affiliation(s)
- Alyona Mazhnaya
- School of Public Health, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Anna Meteliuk
- International Charitable Foundation “Alliance for Public Health”, Kyiv, Ukraine
| | - Iryna Pykalo
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States
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Flannigan K, Murphy L, Pei J. Integrated Supports for Women and Girls Experiencing Substance Use and Complex Needs. Subst Abuse 2023; 17:11782218231208980. [PMID: 37954218 PMCID: PMC10637139 DOI: 10.1177/11782218231208980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
There is strong research to support integrated and gender-sensitive harm reduction approaches for supporting women, girls, and gender diverse people. For individuals who are pregnant, flexible and integrated treatment approaches may be especially important. In this study, we report on an integrated program in rural Canada designed to support pregnant women, girls, and gender diverse people experiencing substance use and other complex needs. Program data (N = 393) from the 2nd Floor Women's Recovery Centre (2nd Floor) at the Lakeland Centre for Fetal Alcohol Spectrum Disorder (LCFASD) was analyzed with several aims. Study goals were to (1) describe characteristics and needs of clients, (2) identify factors associated with program completion, and (3) for a subset of clients, examine resources, wellbeing, and social and behavioral outcomes after treatment. Clients (Mage = 27.4 years, range 15-64) presented at the 2nd Floor with complex medical and mental health needs, and experiences of significant socioenvironmental adversity. However, almost two-thirds (63.4%) successfully completed the program, which was more likely for clients who had stable housing at intake and a possible or confirmed diagnosis of FASD. After treatment, clients reported high levels of wellbeing, and most were connected to health care and community resources. In the year after program completion, clients who were contacted for follow-up maintained strong connection to resources and reported notable improvements in social and behavioral functioning. Many were working or volunteering, most were in stable home environments, rates of substance use and legal involvement were substantially reduced, and many clients were actively caring for their children. This study offers important findings to inform future research, practice, and policy for supporting health and wellbeing for women, children, families, and communities.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Lisa Murphy
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
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5
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Solano JL, Novoa C, Lamprea MR, Ortega LA. Stress effects on spatial memory retrieval and brain c-Fos expression pattern in adults are modulated by early nicotine exposure. Neurobiol Learn Mem 2023; 205:107831. [PMID: 37730099 DOI: 10.1016/j.nlm.2023.107831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/31/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023]
Abstract
The cognitive effects of nicotine are linked to persistent modifications in extended neural systems that regulate cognitive and emotional processes, and these changes occur during development. Additionally, acute stress has modulatory effects on cognition that involve broad neural systems and can be influenced by prior environmental challenges. The effects of nicotine and stress may be interconnected, leading to modifications in a network of shared brain substrates. Here, we explored the interaction between nicotine and stress by evaluating the effects of acute stress exposure in spatial memory retrieval for animals pretreated with nicotine during adolescence or adulthood. Adolescent (35 days old) and adult (70 days old) male Wistar rats were treated for 21 days with one daily subcutaneous injection of nicotine 0.14 mg/ml (free base). 30 days after the last injection, rats were trained in the Barnes maze and tested 24 h later, half the rats were tested under regular conditions, and half of them were exposed to 1 h of restraining stress before the retrieval test, and brain samples were collected and c-Fos immunopositive cells were stained. Prolonged nicotine withdrawal or acute stress improved spatial memory retrieval. Acute stress in nicotine pretreated adults impaired spatial memory retrieval. Nicotine exposure during early adulthood resulted in long-lasting brain adaptations that amplified emotional responses to acute stress after prolonged drug withdrawal.
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Affiliation(s)
- José L Solano
- Laboratorio de Neurociencias, Departamento de Psicología, Facultad de Ciencias Humanas, Universidad Nacional de Colombia, Colombia
| | - Carlos Novoa
- Laboratorio de Neurociencias, Departamento de Psicología, Facultad de Ciencias Humanas, Universidad Nacional de Colombia, Colombia
| | - Marisol R Lamprea
- Laboratorio de Neurociencias, Departamento de Psicología, Facultad de Ciencias Humanas, Universidad Nacional de Colombia, Colombia
| | - Leonardo A Ortega
- Facultad de Psicología, Fundación Universitaria Konrad Lorenz, Colombia.
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Mandelli L, Milaneschi Y, Hiles S, Serretti A, Penninx BW. Unhealthy lifestyle impacts on biological systems involved in stress response: hypothalamic-pituitary-adrenal axis, inflammation and autonomous nervous system. Int Clin Psychopharmacol 2023; 38:127-135. [PMID: 36730700 PMCID: PMC10063190 DOI: 10.1097/yic.0000000000000437] [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: 06/26/2022] [Accepted: 08/12/2022] [Indexed: 02/04/2023]
Abstract
An unhealthy lifestyle has a critical role in the pathogenesis and course of several chronic disorders. It has been hypothesized that lifestyle may also impact biological systems involved in stress response. A global index of unhealthy lifestyle was calculated based on the cumulative presence of five self-reported lifestyle habits (smoking, excessive alcohol use, drug use, low physical activity and short sleep) in 2783 participants (18-65 years) from the Netherlands Study of Depression and Anxiety. The functioning of biological stress systems was based on multiple physiological measures of cortisol, inflammatory cytokines and autonomic cardiac activity. The unhealthy lifestyle index was associated with hyperactivity of hypothalamus-pituitary-adrenal axis and increased inflammation, indicating that with increasing unhealthy habits, the level of biological stress increases. No association with the autonomic nervous system activity was observed; however, the use of drugs increased parasympathetic cardiac activity and significantly impacted on ANS. Results were not impacted by a recent episode of depression or anxiety disorder. An unhealthy lifestyle may unfavorably impact on biological systems involved in stress response, which may underlie progression of several psychiatric as well as somatic chronic disorders.
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Affiliation(s)
- Laura Mandelli
- Department of Biomedical and Neuromotor science, University of Bologna, Bologna, Italy
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sarah Hiles
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, Australia
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor science, University of Bologna, Bologna, Italy
| | - Brenda W. Penninx
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Della Rocca F, Maremmani AGI, Bacciardi S, Pacini M, Lamanna F, Tripodi B, Miccoli M, Maremmani I. Characteristics of Stress Sensitivity in Heroin Use Disorder Patients during Their Opioid Agonist Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4566. [PMID: 36901575 PMCID: PMC10002439 DOI: 10.3390/ijerph20054566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
In the present study, performed on a sample of Heroin Use Disorder (HUD) patients undergoing Opioid Agonist Treatment (OAT), we attempted to explore the relationships between stress sensitivity and heroin addiction-related clinical aspects. HUD patients' stress sensitivity was evaluated with the Heroin/PTSD-Spectrum questionnaire (H/PSTD-S). The Drug Addiction History Questionnaire (DAH-Q), the Symptomatological Check List-90 (SCL-90), and The Behavioural Covariate of Heroin Craving inventory (CRAV-HERO) were all used, as were the Deltito Subjective Wellness Scale (D-SWS), a self-report scale evaluating subjective well-being; the Cocaine Problem Severity Index (CPSI), a questionnaire determining the extent of a cocaine problem; and the Marijuana Craving Questionnaire (MC-Q), an instrument assessing craving for cannabinoids. We checked correlations between stress sensitivity and the extent of HUD clinical features and compared patients with and without problematic stress sensitivity. H/PTSD-S was positively correlated with patients' income, altered mental status, legal problems, the lifetime different treatments index, the current treatment load index, and all SCL-90 indexes and factors. Regarding subjective well-being, stress sensitivity negatively correlated with the contrast best week (last five years) index. Patients with high-stress sensitivity were females with a low income. They exhibited a more severe mental status at treatment entry, greater difficulty in working adaptation, and legal problems during treatment. Additionally, these patients showed a higher level of psychopathology, more impairment in well-being, and more risky behaviours during treatment. Stress sensitivity, as H/PTSD-S, must be considered an outcome of HUD. HUD's addiction history and clinical features are significant risk factors for H/PTSD-S. Therefore, social and behavioural impairment in HUD patients could be considered the clinical expression of the H/PTSD spectrum. In summary, the long-term outcome of HUD is not represented by drug-taking behaviours. Rather, the inability to cope with the contingent environmental conditions is the key feature of such a disorder. H/PTSD-S, therefore, should be seen as a syndrome caused by an acquired inability (increased salience) concerning regular (daily) life events.
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Affiliation(s)
- Filippo Della Rocca
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
| | - Angelo G. I. Maremmani
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
- Department of Psychiatry and Addictions, Section of Psychiatry, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, Via Aurelia 335, 55041 Viareggio, Italy
| | - Silvia Bacciardi
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
- Department of Psychiatry and Addictions, Section of Psychiatry, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, Via Aurelia 335, 55041 Viareggio, Italy
| | - Matteo Pacini
- V.P. Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy
| | - Francesco Lamanna
- Department of Psychiatry and Addictions, Section of Addictions, North-Western Tuscany Local Health Unit, Tuscany NHS, Pisa Zone, Via delle Torri 160, 56124 Pisa, Italy
| | - Beniamino Tripodi
- Department of Mental Health and Addictions, Division of Psychiatry, ASST Crema, Via Largo Dossena 2, 26013 Crema, Italy
| | - Mario Miccoli
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Icro Maremmani
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
- V.P. Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy
- Saint Camillus International University of Health Sciences (UniCamillus), Via di Sant’Alessandro 8, 00131 Rome, Italy
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Leonangeli S, Michelini Y, Montejano GR. [Depression, anxiety and stress in college students before and during the first three months of COVID-19 lockdown]. REVISTA COLOMBIANA DE PSIQUIATRIA 2022:S0034-7450(22)00056-7. [PMID: 35663410 PMCID: PMC9135671 DOI: 10.1016/j.rcp.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/13/2022] [Indexed: 11/22/2022]
Abstract
Introduction: Different psychological symptoms of distress as well as drinking motives have been associated with alcohol use in college students. The COVID-19 lockdown [aislamiento social, preventivo y obligatorio (ASPO)] reduced movement to a minimum, impacting college students' mental health and generating changes in several behaviours, including alcohol use.Objectives: To examine the association between symptoms of anxiety, depression and stress, drinking motives and alcohol use in two groups of Argentinian college students, before and during the first three months of lockdown. In addition, it was examined whether drinking motives mediate the relationship between psychological distress and alcohol use.Methods: Two samples of college students, one before the lockdown (n=125; mean age, 23.87 ± 3.27 years; 73.6% women) and another during the lockdown (n=174; 24.32 ± 3.64 years; 78.2% women) completed an online survey.Results: Alcohol use, as well as social and enhancement motives, decreased in college students during lockdown. The associations between psychological distress and drinking motives with alcohol use were more consistent in the group during lockdown compared with the group after lockdown. At a multivariate level, coping motives explained an increased frequency of alcohol consumption in college students during lockdown.Conclusions: It is necessary to pay special attention to the mental health of college students who have experienced changes in their routines as a result of the restrictions implemented during the pandemic.
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Affiliation(s)
- Sebastian Leonangeli
- Cátedra de Psiquiatría, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Yanina Michelini
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigaciones Psicológicas, IIPsi-CONICET-UNC, Córdoba, Argentina
| | - Gabriela Rivarola Montejano
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigaciones Psicológicas, IIPsi-CONICET-UNC, Córdoba, Argentina
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Cousin L, Roucoux G, Petit AS, Baumann-Coblentz L, Torrente OR, Cannafarina A, Chassany O, Duracinsky M, Carrieri P. Perceived stigma, substance use and self-medication in night-shift healthcare workers: a qualitative study. BMC Health Serv Res 2022; 22:698. [PMID: 35610623 PMCID: PMC9128768 DOI: 10.1186/s12913-022-08018-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Many risk factors related to altered circadian rhythms impact the health of night-shift hospital workers (NSHW), resulting in mental and somatic disorders. Easy access to psychoactive substances (PS) may facilitate addictive behaviors in NSHW. They are also exposed to a stressful work environment, which may further affect sleep quality. This study aimed to explore the link between sleep deprivation, work-related psychosocial stress and psychoactive substance use as a self-medication response in NSHW. Methods Qualitative study to verify the plausibility of the self-medication theory applied to addictive behaviors. Semi-structured interviews (N = 18 NSHW) and thematic analysis, following consolidated criteria for reporting qualitative research recommendations. Results Stigma against NSHW was a primary element of a stressful work environment. The stressful and stigmatizing environment, together with night-shift work, further affected NSHW sleep and their mental and physical health. The use of PS appeared to be for self-medication, encouraged by social and professional environments, source(s) of stress, discrimination, and isolation. The work environment, through aggravated sleep disorders, led NSHW to use non-prescribed sleeping pills. Alcohol after work and smoking were used as a social break but also as a means to reduce stress. Conclusion Anti-stigma interventions in the healthcare setting and screening of mental/somatic disorders in NSHW can help reduce harmful self-medication behaviors and improve hospital care in the COVID-19 era. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08018-x.
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Affiliation(s)
- Lorraine Cousin
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France. .,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France. .,Groupe de Recherche en Psychologie Sociale (UR GRePS), Université Lyon 2, Bron, France.
| | - Guillaume Roucoux
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France
| | - Anne Sophie Petit
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Groupe de Recherche en Psychologie Sociale (UR GRePS), Université Lyon 2, Bron, France
| | | | - Olivia Rousset Torrente
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France
| | - Adriano Cannafarina
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France
| | - Olivier Chassany
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France
| | - Martin Duracinsky
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France.,Département de Médecine Interne Et d'immunologie Clinique, Hôpital Bicêtre, AP-HP, 94275, Kremlin Bicêtre, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Arshad F, Clark L. Immersion in Substance-Related and Behavioural Addictions: Neural Systems and Neurochemical Substrates. Curr Behav Neurosci Rep 2022. [DOI: 10.1007/s40473-021-00242-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Claus BB, Specka M, McAnally H, Scherbaum N, Schifano F, Bonnet U. Is the Urine Cannabinoid Level Measured via a Commercial Point-of-Care Semiquantitative Immunoassay a Cannabis Withdrawal Syndrome Severity Predictor? Front Psychiatry 2020; 11:598150. [PMID: 33343424 PMCID: PMC7744589 DOI: 10.3389/fpsyt.2020.598150] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background: For cannabis-dependent subjects, the relationship between cannabis withdrawal syndrome (CWS) severity and the urine cannabinoid concentrations are unclear; we investigated this using a commercial point-of-care (POC) enzyme immunoassay detecting 11-nor-9-carboxy-Delta-9-tetrahydrocannabinol (THC-COOH). Methods: Observational study of 78 adult chronic cannabis-dependent subjects assessed over a 24-day inpatient detoxification treatment, with 13 serial measurement days. Repeated Measures Correlation and Multilevel Linear Models were employed. Results: Absolute urinary THC-COOH levels significantly correlated with Marijuana Withdrawal Checklist (MWC) scores across the entire study duration (r = 0.248; p < 0.001). Correlation between serial creatinine-adjusted THC-COOH ratios and serial MWC scores emerged as significant only in the sample with higher MWC scores (>11 points) at admission (n = 21; r = 0.247; p = 0.002). The aforementioned significant relationships have persisted when replacing the absolute THC-COOH-levels with the (relative) day-to-day change in urinary THC-COOH levels. MWC scores were significantly correlated with the Clinical Global Impression-Severity (CGI-S; r = 0.812; p < 0.001). Females showed a significantly slower decline in urine THC-COOH levels and prolonged CWS course characterized by substantial illness severity (per CGI-S), occurring in nearly 30% of cases. Conclusion: Urine cannabinoid levels (THC-COOH) determined by POC assay significantly predicted CWS severity (moderate correlation), guiding detoxification treatment duration. In patients with MWC > 11 points upon admission, creatinine-adjusted THC-COOH ratios also significantly predicted CWS severity-again with moderate effect size. Females showed prolonged urinary THC-COOH elimination and cannabis withdrawal.
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Affiliation(s)
- Benedikt Bernd Claus
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, Germany
| | - Michael Specka
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heath McAnally
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
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12
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Giurgescu C, Zhang L, Price M, Dailey R, Frey HA, Walker DS, Zenk SN, Engeland CG, Anderson CM, Misra D. Prenatal cigarette smoking as a mediator between racism and depressive symptoms: The Biosocial Impact on Black Births Study. Public Health Nurs 2020; 37:740-749. [PMID: 32734603 PMCID: PMC7931177 DOI: 10.1111/phn.12780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study examined whether cigarette smoking mediated the association of racial discrimination with depressive symptoms among pregnant Black women. DESIGN Cross-sectional. SAMPLE Two hundred Black women at 8-29 weeks gestation. MEASUREMENTS Women completed questionnaires including the Experiences of Discrimination and the Center for Epidemiologic Studies-Depression (CES-D) scales, as well as questions about sociodemographic characteristics and cigarette smoking. RESULTS The mean age of the sample was 26.9 ± 5.7 years and the mean gestational age at data collection was 15.6 ± 5.7 weeks. Approximately 17% of women reported prenatal cigarette smoking; 27% had prenatal CES-D scores ≥23, which have been correlated with depression diagnoses; and 59% reported ever (lifetime) experiencing discrimination in at least one situation (e.g., at work). Path analysis results indicated that the standardized indirect effect of experiences of racial discrimination on CES-D scores through prenatal smoking was statistically significant (standardized indirect effect = 0.03; 95% CI: 0.001, 0.094; p = .042). CONCLUSION Cigarette smoking during pregnancy partially mediated the association between lifetime experiences of racial discrimination and prenatal depressive symptoms among pregnant Black women. Smoking cessation programs should focus on identifying and treating depressive symptoms among pregnant Black women.
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Affiliation(s)
| | - Liying Zhang
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | - Mercedes Price
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | - Rhonda Dailey
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | - Heather A. Frey
- Department of Obstetrics and Gynecology, Ohio State University College of Medicine
| | | | | | | | | | - Dawn Misra
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
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13
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Kargin M, Hicdurmaz D. Psychoeducation Program for Substance Use Disorder: Effect on Relapse Rate, Social Functioning, Perceived Wellness, and Coping. J Psychosoc Nurs Ment Health Serv 2020; 58:39-47. [PMID: 32609858 DOI: 10.3928/02793695-20200624-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/11/2020] [Indexed: 11/20/2022]
Abstract
The current study was designed to assess the effect of a psychoeducation program on relapse rate, social functioning, perceived wellness, and ways of coping in individuals with substance use disorder (SUD). The study sample comprised 92 individuals (n = 46 intervention group, n = 46 control group) who received SUD treatment, had undergone detoxification, and agreed to participate in the study. A 10-session psychoeducation program was applied to individuals in the intervention group. Data collection included a urine sample and completion of the Personal Information Form, Social Functioning Scale, Perceived Wellness Scale, and Ways of Coping Scale. The relapse rate in the control group was found to be higher than in the intervention group; thus, it was determined that the relapse prevention psychoeducation program led to positive changes in relapse rate, social functioning, perceived wellness, and stress in individuals with SUD. [Journal of Psychosocial Nursing and Mental Health Services, 58(8), 39-47.].
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Ortiz V, Calfa GD, Molina VA, Martijena ID. Resistance to fear memory destabilization triggers exaggerated emotional-like responses following memory reactivation. Prog Neuropsychopharmacol Biol Psychiatry 2019; 93:197-204. [PMID: 30978427 DOI: 10.1016/j.pnpbp.2019.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/12/2019] [Accepted: 04/08/2019] [Indexed: 01/23/2023]
Abstract
Fear memory reactivation does not always lead to memory destabilization-reconsolidation. For instance, fear memories formed following withdrawal from chronic ethanol consumption or a stressful event are less likely to become destabilized after reactivation, with the effect of recall of these memories on the affective state still requiring elucidation. Here, we investigated the negative emotional-like responses following fear memory reactivation in ethanol-withdrawn (ETOH) rats by focusing on the possible role played by destabilization. Our findings indicated that ETOH rats displayed an increased freezing in a novel context and an anxiogenic-like response in the elevated plus maze (EPM) following memory reactivation, whereas the behavior of CON animals was not affected. The destabilization blockade by pre-reactivation nimodipine (16 mg/kg, s.c) administration promoted in CON animals a similar behavior in the EPM and in a novel environment as that exhibited by ETOH rats after the reminder. Moreover, facilitating destabilization by pre-reactivation d-cycloserine (5 mg/kg, i.p) administration prevented the emotional-like disturbances observed in ETOH rats. Finally, using restraint stress, which is also an inductor of a fear memory resistant to destabilization, an increased fear response in an unconditioned environment and an anxiogenic-like state was also found after the presentation of the fear reminder in stressed rats. Our results suggest that, in the context of resistant fear memories, the occurrence of destabilization influences how animals respond to subsequent environmental challenges following reactivation.
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Affiliation(s)
- Vanesa Ortiz
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Farmacología, IFEC-CONICET, Córdoba, Argentina
| | - Gastón Diego Calfa
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Farmacología, IFEC-CONICET, Córdoba, Argentina
| | - Víctor Alejandro Molina
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Farmacología, IFEC-CONICET, Córdoba, Argentina
| | - Irene Delia Martijena
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Farmacología, IFEC-CONICET, Córdoba, Argentina.
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15
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Ghanbari Jolfaei A, Ataei S, Ghayoomi R, Shabani A. High Frequency of Bipolar Disorder Comorbidity in Medical Inpatients. IRANIAN JOURNAL OF PSYCHIATRY 2019; 14:60-66. [PMID: 31114619 PMCID: PMC6505055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Bipolar disorder is a severe, disabling, and recurring disorder. Some studies have shown that the frequency of bipolar disorder in patients with medical diseases is higher than healthy controls. The aim of this study was to investigate the frequency of bipolar disorders in medically ill patients hospitalized in Iranian general hospitals. Method : In this cross sectional study, 697 inpatients (342 men, 49.1%) from different wards of 3 general hospitals, with the mean age of 39.3+-10, were enrolled in the study using nonprobability sampling. Demographic questionnaire, Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) were used. Inclusion criteria were as follow: informed consent, age 18-65 years, ability to speak Persian, and having at least middle school education. Results: The frequency of bipolar disorder was 12.1% and 20.8% based on BSDS and MDQ, respectively. The results of both tests were positive in 7.9% of hospitalized patients. The frequency of bipolar mood disorder was significantly higher in single patients and in those with comorbidity of alcohol and substance use disorders. Conclusion: Considering the high frequency of bipolar mood disorders in hospitalized medically ill patients and its probable effects on compliance and prognosis, early screening, diagnosis, and treatment of bipolar mood disorders is important in these patients.
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Affiliation(s)
- Atefeh Ghanbari Jolfaei
- Minimally Invasive Surgery Research Center, Department of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Ataei
- Minimally Invasive Surgery Research Center, Department of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Raoofeh Ghayoomi
- Department of Community Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Address: Shahid Mansouri Street, Niyayesh Street, Satarkhan Avenue,Tehran, Iran. Postal Code: 1445613111. Tel: 98-2166551655-60, Fax: 98-2166506853,
| | - Amir Shabani
- Mental Health Research Center, Bipolar Disorders Research Group, Iran University of Medical Sciences, Tehran, Iran
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16
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Mallik D, Bowen S, Yang Y, Perkins R, Sandoz EK. Raja yoga meditation and medication-assisted treatment for relapse prevention: A pilot study. J Subst Abuse Treat 2018; 96:58-64. [PMID: 30466550 DOI: 10.1016/j.jsat.2018.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 01/27/2023]
Abstract
The continued need for advancement in evidence-based SUD treatment, as well as increases in treatment expense and decline in support from insurance providers, suggest that brief, innovative, and affordable treatments are needed. Meditation, spirituality, and adherence to medication-assisted treatments have all been shown to support abstinence. The current trial assessed effects of spiritually-based meditation, versus relaxation or standard treatment, on substance abstinence and psychological distress and dysfunction in a partially buprenorphine-supported (41.5%) treatment sample. Participants (N = 40) were recruited from an intensive outpatient treatment program, in which three treatment locations acted as separate experimental conditions. Abstinence was measured through urinalyses at baseline and weekly thereafter for the duration of the intervention. Psychological distress and dysfunction were assessed with a Likert-scaled questionnaire measuring symptoms typically associated with SUD. Co-varying for buprenorphine use, participants in the Meditation condition had better odds of remaining abstinent than participants in the Treatment-as-Usual (TAU) and Relaxation conditions. There were no significant differences in substance abstinence between the Relaxation and TAU conditions. Further, co-varying out baseline there were no significant differences at post-course in psychological distress and dysfunction between the three conditions. Results from this pilot trial suggest that this spiritually-informed approach may offer additive support to individuals in SUD treatment, as an aid to the meditative aspect of the 12 steps, or a non-12-step alternative spiritual supplement to standard SUD treatment.
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Affiliation(s)
- Debesh Mallik
- University of Louisiana at Lafayette, P.O. Box 43644, Lafayette, LA 70504, United States of America.
| | - Sarah Bowen
- Pacific University, United States of America
| | - Yang Yang
- University of Louisiana at Lafayette, United States of America
| | - Richard Perkins
- University of Louisiana at Lafayette, United States of America
| | - Emily K Sandoz
- University of Louisiana at Lafayette, United States of America
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17
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Balkan B, Pogun S. Nicotinic Cholinergic System in the Hypothalamus Modulates the Activity of the Hypothalamic Neuropeptides During the Stress Response. Curr Neuropharmacol 2018; 16:371-387. [PMID: 28730966 PMCID: PMC6018196 DOI: 10.2174/1570159x15666170720092442] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The hypothalamus harbors high levels of cholinergic neurons and axon terminals. Nicotinic acetylcholine receptors, which play an important role in cholinergic neurotransmission, are expressed abundantly in the hypothalamus. Accumulating evidence reveals a regulatory role for nicotine in the regulation of the stress responses. The present review will discuss the hypothalamic neuropeptides and their interaction with the nicotinic cholinergic system. The anatomical distribution of the cholinergic neurons, axon terminals and nicotinic receptors in discrete hypothalamic nuclei will be described. The effect of nicotinic cholinergic neurotransmission and nicotine exposure on hypothalamic-pituitaryadrenal (HPA) axis regulation at the hypothalamic level will be analyzed in view of the different neuropeptides involved. METHODS Published research related to nicotinic cholinergic regulation of the HPA axis activity at the hypothalamic level is reviewed. RESULTS The nicotinic cholinergic system is one of the major modulators of the HPA axis activity. There is substantial evidence supporting the regulation of hypothalamic neuropeptides by nicotinic acetylcholine receptors. However, most of the studies showing the nicotinic regulation of hypothalamic neuropeptides have employed systemic administration of nicotine. Additionally, we know little about the nicotinic receptor distribution on neuropeptide-synthesizing neurons in the hypothalamus and the physiological responses they trigger in these neurons. CONCLUSION Disturbed functioning of the HPA axis and hypothalamic neuropeptides results in pathologies such as depression, anxiety disorders and obesity, which are common and significant health problems. A better understanding of the nicotinic regulation of hypothalamic neuropeptides will aid in drug development and provide means to cope with these diseases. Considering that nicotine is also an abused substance, a better understanding of the role of the nicotinic cholinergic system on the HPA axis will aid in developing improved therapeutic strategies for smoking cessation.
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Affiliation(s)
- Burcu Balkan
- Center for Brain Research, Ege University, Bornova, Izmir, Turkey.,Department of Physiology, School of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Sakire Pogun
- Center for Brain Research, Ege University, Bornova, Izmir, Turkey
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18
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Preston KL, Kowalczyk WJ, Phillips KA, Jobes ML, Vahabzadeh M, Lin JL, Mezghanni M, Epstein DH. Exacerbated Craving in the Presence of Stress and Drug Cues in Drug-Dependent Patients. Neuropsychopharmacology 2018; 43:859-867. [PMID: 29105663 PMCID: PMC5809798 DOI: 10.1038/npp.2017.275] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 10/17/2017] [Accepted: 10/24/2017] [Indexed: 02/07/2023]
Abstract
In addiction, risk factors for craving and use include stress and drug-related cues. Stress and cues have additive or more-than-additive effects on drug seeking in laboratory animals, but, surprisingly, seem to compete with one another (ie, exert less-than-additive effects) in human laboratory studies of craving. We sought heretofore elusive evidence that human drug users could show additive (or more-than-additive) effects of stress and cues on craving, using ecological momentary assessment (EMA). Outpatients (N=182) maintained on daily buprenorphine or methadone provided self-reports of stress, craving, mood, and behavior on electronic diaries for up to 16 weeks. In three randomly prompted entries (RPs) per day, participants reported the severity of stress and craving and whether they had seen or been offered opioids, cocaine, cannabis, methamphetamine, alcohol, or tobacco. In random-effects models controlling for between-person differences, we tested effects of momentary drug-cue exposure and stress (and their interaction) on momentary ratings of cocaine and heroin craving. For cocaine craving, the Stress × Cue interaction term had a positive mean effect across participants (M=0.019; CL95 0.001-0.036), denoting a more-than-additive effect. For heroin, the mean was not significantly greater than 0, but the confidence interval was predominantly positive (M=0.019; CL95 -0.007-0.044), suggesting at least an additive effect. Heterogeneity was substantial; qualitatively, the Stress × Cue effect appeared additive for most participants, more than additive for a sizeable minority, and competitive in very few. In the field, unlike in human laboratory studies to date, craving for cocaine and heroin is greater with the combination of drug cues and stress than with either alone. For a substantial minority of users, the combined effect may be more than additive.
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Affiliation(s)
- Kenzie L Preston
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA,Clinical Pharmacology and Therapeutics Research Branch, NIDA Intramural Research Program, Treatment Section, 251 Bayview Boulevard Suite 200, Baltimore, MD, USA. Tel: +443.740.2326, Fax: +443.740.2318, E-mail:
| | - William J Kowalczyk
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Karran A Phillips
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Michelle L Jobes
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Massoud Vahabzadeh
- Biomedical Informatics Section, Administrative Management Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Jia-Ling Lin
- Biomedical Informatics Section, Administrative Management Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Mustapha Mezghanni
- Biomedical Informatics Section, Administrative Management Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - David H Epstein
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
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19
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Forster SE, Finn PR, Brown JW. Neural responses to negative outcomes predict success in community-based substance use treatment. Addiction 2017; 112:884-896. [PMID: 28029198 PMCID: PMC5382058 DOI: 10.1111/add.13734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/25/2016] [Accepted: 12/22/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Patterns of brain activation have demonstrated promise as prognostic indicators in substance dependent individuals (SDIs) but have not yet been explored in SDIs typical of community-based treatment settings. DESIGN Prospective clinical outcome design, evaluating baseline functional magnetic resonance imaging data from the Balloon Analogue Risk Task (BART) as a predictor of 3-month substance use treatment outcomes. SETTING Community-based substance use programs in Bloomington, Indiana, USA. PARTICIPANTS Twenty-three SDIs (17 male, aged 18-43 years) in an intensive outpatient or residential treatment program; abstinent 1-4 weeks at baseline. MEASUREMENTS Event-related brain response, BART performance and self-report scores at treatment onset, substance use outcome measure (based on days of use). FINDINGS Using voxel-level predictive modeling and leave-one-out cross-validation, an elevated response to unexpected negative feedback in bilateral amygdala and anterior hippocampus (Amyg/aHipp) at baseline successfully predicted greater substance use during the 3-month study interval (P ≤ 0.006, cluster-corrected). This effect was robust to inclusion of significant non-brain-based covariates. A larger response to negative feedback in bilateral Amyg/aHipp was also associated with faster reward-seeking responses after negative feedback (r(23) = -0.544, P = 0.007; r(23) = -0.588, P = 0.003). A model including Amyg/aHipp activation, faster reward-seeking after negative feedback and significant self-report scores accounted for 45% of the variance in substance use outcomes in our sample. CONCLUSIONS An elevated response to unexpected negative feedback in bilateral amygdala and anterior hippocampus (Amyg/aHipp) appears to predict relapse to substance use in people attending community-based treatment.
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Affiliation(s)
- Sarah E. Forster
- Indiana University, Department of Psychological and Brain Sciences,VA Pittsburgh Healthcare System,University of Pittsburgh, Department of Psychiatry
| | - Peter R. Finn
- Indiana University, Department of Psychological and Brain Sciences
| | - Joshua W. Brown
- Indiana University, Department of Psychological and Brain Sciences
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Abstract
The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen
| | - Ulrich W Preuss
- Vitos-Klinik Psychiatrie und Psychotherapie Herborn, Herborn
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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21
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Neigh GN, Felger JC. Editorial introduction: The effects of somatic disease and environmental insults on the stress response. Physiol Behav 2016; 166:1-3. [PMID: 27498283 DOI: 10.1016/j.physbeh.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gretchen N Neigh
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA 23298, USA; Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Jennifer C Felger
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA; Winship Cancer Institute, Atlanta, GA 30322, USA
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