Stress indices in methadone maintenance treatment - Cross sectional and follow up study

A wellbeing program to promote mental health in paediatric burn patients: Study protocol

BACKGROUND

One of the most traumatic injuries a child can experience is a severe burn. Despite improvements in medical treatments which have led to better physical outcomes and reduced mortality rates for paediatric burns patients, the psychological impact associated with experiencing such a traumatic injury has mostly been overlooked. This is concerning given the high incidence of psychopathology amongst paediatric burn survivors.

OBJECTIVES

This project will aim to pilot test and evaluate a co-designed trauma-focused intervention to support resilience and promote positive mental health in children and adolescents who have sustained an acute burn injury. Our first objective is to collect pilot data to evaluate the efficacy of the intervention and to inform the design of future trauma-focussed interventions. Our second objective is to collect pilot data to determine the appropriateness of the developed intervention by investigating the changes in mental health indicators pre- and post-intervention. This will inform the design of future interventions.

METHODS

This pilot intervention study will recruit 40 children aged between 6-17 years who have sustained an acute burn injury and their respective caregivers. These participants will have attended the Stan Perron Centre of Excellence for Childhood Burns at Perth Children's Hospital. Participants will attend a 45-minute weekly or fortnightly session for six weeks that involves building skills around information gathering, managing reactions (behaviours and thoughts), identifying, and bolstering coping skills, problem solving and preventing setbacks. The potential effects and feasibility of our intervention will be assessed through a range of age-appropriate screening measures which will assess social behaviours, personal qualities, mental health and/or resilience. Assessments will be administered at baseline, immediately post-intervention, at 6- and 12-months post-intervention.

CONCLUSION

The results of this study will lay the foundation for an evidence-based, trauma-informed approach to clinical care for paediatric burn survivors and their families in Western Australia. This will have important implications for the design of future support offered to children with and beyond burn injuries, and other medical trauma populations.

A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment

Introduction

This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions.

Materials and Methods

Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUC_G). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables.

Results

The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUC_G.

Conclusion

The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.

Association between opioid use disorder and blunted heart rate variability among opioid-treated chronic pain patients

Given the severity of the ongoing opioid epidemic, it is essential to understand the mechanisms of risk for development and maintenance of opioid use disorder (OUD). The aim of the current large-scale psychophysiological investigation was to test whether patients with OUD had lower resting-state high-frequency heart rate variability (HF-HRV) than those without OUD, controlling for sociodemographic and clinical confounds. Additionally, we tested whether HF-HRV was associated with opioid craving in this population. Participants in this cross-sectional study were 490 chronic pain patients (50.4% female) treated with long-term opioid therapy. OUD diagnosis was determined by psychiatric interview. HF-HRV was measured at resting baseline. We computed the association between OUD and resting-state HF-HRV, controlling for age, gender, race, pain severity, emotional distress and opioid dose. Opioid craving was measured with visual analogue scales to assess whether HF-HRV was associated with craving. Results showed that resting HF-HRV was significantly lower for patients with OUD than for those without OUD (p < 0.001, d = 0.36), indicating deficits in autonomic flexibility. OUD diagnosis (p = 0.002) and OUD severity (p = 0.03) were associated with lower HF-HRV in regression models accounting for a range of confounders. Additionally, lower HF-HRV was significantly (but weakly) correlated with heightened opioid craving (r = -0.166, p < 0.001). Overall, findings suggest that resting-state HF-HRV may serve as a valid biomarker of addiction among people on long-term opioid therapy.

Is There an Association Between Salivary Cortisol and Dropping Out of Inpatient Substance Addiction Treatments? A Prospective Repeated Measures Study

Several studies have found an association between salivary cortisol levels and dropping out of inpatient substance addiction treatment programs. The results are mixed due to variations in the study design and the lack of standardized routines for cortisol assessment. The aim of this study was to investigate whether there was (1) an association between salivary cortisol levels and dropping out from inpatient substance addiction treatments; (2) higher predictive validity for dropout in one of the cortisol indexes: Area Under the Curve with respect to ground (AUC_G) or Daily Cortisol Slope (DCS); (3) an interaction effect with time for each cortisol index; and (4) different dropout rates for sex and patients in short-term versus long-term treatment programs. This was a prospective, repeated-measures observational study. Patients (n = 173) were recruited from 2 inpatient facilities in the central region of Norway between 2018 and 2021. Salivary cortisol was measured 4 times during the treatment period, with 8 samples collected over 2 consecutive days at each time point. Cortisol levels were calculated using the cortisol indices AUC_G and DCS. Dropout was used as the outcome measure at each time point. Associations were calculated using a logistic linear regression. The results suggest a main effect of AUC_G, whereby higher levels reduce dropout risk (OR = 0.92, P = .047). An interaction with time in treatment also revealed a higher dropout risk (OR = 1.09, P = .044) during week 4 of the treatment, depending on the AUC_G. These results support using AUC_G as the recommended index when assessing cortisol, and that the relationship between cortisol levels and length of treatment should be further investigated.

Improvement in Cognitive Performance after One Year of Methadone Maintenance Treatment

Individuals with substance use disorders are known to suffer from stress, poor sleep, and cognitive impairment. We investigated whether individuals with opioid use disorder would improve cognitive performance following a year of methadone maintenance treatment (MMT). Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), and a standardized computerized cognitive battery were administered at admission (T0) to 29 patients, and repeatedly following one year of MMT (T1) by 19 patients. Admission measures did not differ between those who studied once or twice. Patients who perceived very high stress levels (PSS ≥24) at T0 (11, 37.9%) had lower computerized global cognitive scores (67.6±16.2 vs. 90.9±12.5 p≤0.0005). At T1, PSS and PSQI scores improved significantly among 11 patients with no substance abuse, but worsened among 8 with substance abuse (PSS p(interaction)=0.009, p(groups)=0.005, PSQI p(interaction)=0.01, p(groups)=0.04). Global cognitive score improved at T1 for the entire sample (81.8±20.1 to 89.2±13.8, p=0.05). Differentiation by high stress at T0 or by substance abuse at T1 subgroups showed that improvement was observed by those with very low cognitive scores at T0. Patients with poor cognition may improve following one year of MMT, due to stress and substance abuse reduction. Interventions for stress reduction are recommended.