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Zerdazi EH, Curis E, Karsinti E, Icick R, Fortias M, Batel P, Cottencin O, Orizet C, Gay A, Coeuru P, Deschenau A, Lack P, Moisan D, Pelissier-Alicot AL, Plat A, Trabut JB, Kousignian I, Boumendil L, Vicaut E, Prince N, Laplanche JL, Bellivier F, Lépine JP, Marie-Claire C, Brousse G, Vorspan F, Bloch V. Occurrence and severity of cocaine-induced hallucinations: Two distinct phenotypes with shared clinical factors but specific genetic risk factors. Drug Alcohol Depend 2022; 232:109270. [PMID: 35124387 DOI: 10.1016/j.drugalcdep.2022.109270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 11/15/2022]
Abstract
UNLABELLED Cocaine-induced transient hallucinations (CIH) are a frequent complication following cocaine intake that is associated with addiction severity. METHODS Two hundred and forty-two non-psychotic and Caucasian lifetime cocaine users were included in a French multicentric study. Clinical variables and dopamine pathway genotype data were extracted and tested with CIH scores using a zero-inflated binomial model, which allows for the exploration of factors associated with occurrence and severity separately. RESULTS Cocaine dependence (poccurrence= 6.18 × 10-5, pseverity= 9.25 × 10-8), number of cocaine dependence DSM IV-Tr criteria (poccurrence= 1.22 × 10-7, pseverity= 5.09 × 10-6), and frequency of intake during the worst period of misuse (poccurrence= 8.51 × 10-04, pseverity= 0.04) were associated with greater occurrence and higher severity of CIH. The genetic associations did not yield significant results after correction for multiple tests. However, some nominal associations of SNPs mapped to the VMAT2, DBH, DRD1, and DRD2 genes were significant. In the multivariate model, the significant variables were the number of cocaine dependence criteria, lifetime alcohol dependence, and the nominally associated SNPs. CONCLUSION Our study shows that CIH occurrence and severity are two distinct phenotypes, with shared clinical risk factors; however, they likely do not share the same genetic background.
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Affiliation(s)
- El-Hadi Zerdazi
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France; APHP, Hôpitaux Universitaires Henri Mondor, DMU IMPACT, Hôpital Emile ROUX, Service d'addictologie, Limeil Brévannes 94450, France.
| | - Emmanuel Curis
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France; EA 7537 BioSTM, Faculté de Pharmacie, Université Paris Descartes, USPC, Paris 75006, France
| | - Emily Karsinti
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France; APHP, GHU Nord-Université de Paris, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologigue, Paris 75010, France; Université Paris Nanterre, Laboratoire Clipsyd, Nanterre 92000, France
| | - Romain Icick
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France; APHP, GHU Nord-Université de Paris, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologigue, Paris 75010, France
| | - Maeva Fortias
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France; APHP, GHU Nord-Université de Paris, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologigue, Paris 75010, France
| | - Philippe Batel
- Centre Hospitalier Camille Claudel, Service d'Addictologie de la Charente, La Couronne 16400, France
| | - Olivier Cottencin
- University of Lille, Inserm U-1172, CHU Lille, Department of Psychiatry and Addiction Medicine, Lille 59000, France
| | - Cyrille Orizet
- APHP, GHU Centre-Université de Paris, Hôpital Européen Georges Pompidou, CSAPA Monte-Cristo, Paris 75015, France
| | - Aurélia Gay
- CHU Saint-Etienne, Service d'Addictologie, Saint-Etienne 42000, France
| | | | - Alice Deschenau
- Hôpital Paul Guiraud, CSAPA Clinique Liberté, Ivry-sur-Seine 94200, France
| | - Philippe Lack
- Hôpital de la Croix Rousse, CSAPA, Lyon 69004, France
| | - Delphine Moisan
- APHP, GHU Nord-Université de Paris, Hôpital Beaujon, UTAMA, Clichy 92110, France
| | - Anne-Laure Pelissier-Alicot
- APHM, CHU La Timone, Service de Médecine légale, Aix-Marseille Université, Faculté de Médecine, Marseille 13385, France
| | - Arnaud Plat
- APHP, GHU Nord-Université de Paris, Hôpital Beaujon, UTAMA, Clichy 92110, France
| | - Jean-Baptiste Trabut
- APHP, Hôpitaux Universitaires Henri Mondor, DMU IMPACT, Hôpital Emile ROUX, Service d'addictologie, Limeil Brévannes 94450, France
| | - Isabelle Kousignian
- EA 7537 BioSTM, Faculté de Pharmacie, Université Paris Descartes, USPC, Paris 75006, France
| | - Luana Boumendil
- EA 7537 BioSTM, Faculté de Pharmacie, Université Paris Descartes, USPC, Paris 75006, France
| | - Eric Vicaut
- APHP, GHU Nord-Université de Paris, Hôpital Fernand Widal, Unité de Recherche Clinique, Paris 75010, France
| | - Nathalie Prince
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France
| | - Jean-Louis Laplanche
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France; APHP, GHU Nord-Université de Paris, Hôpital Lariboisière, DMU BioGeM, Département de Biochimie et Biologie Moléculaire, Paris 75010, France
| | - Frank Bellivier
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France; APHP, GHU Nord-Université de Paris, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologigue, Paris 75010, France
| | - Jean-Pierre Lépine
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France
| | - Cynthia Marie-Claire
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France
| | - Georges Brousse
- CHU Clermont-Ferrand, Hôpital Gabriel Montpied, Service d'Addictologie et Université d'Auvergne EA 7280, UFR de Médecine, Clermont-Ferrand 63000, France
| | - Florence Vorspan
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France; APHP, GHU Nord-Université de Paris, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologigue, Paris 75010, France
| | - Vanessa Bloch
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris F-75006, France; APHP, GHU Nord-Université de Paris, Hôpital Fernand Widal, Pharmacie Hospitalière, Paris 75010, France
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Kaur N, Bastien G, Gagnon L, Graham J, Mongeau-Pérusse V, Bakouni H, Morissette F, Theriault C, Fischer B, Jutras-Aswad D. Variations of cannabis-related adverse mental health and addiction outcomes across adolescence and adulthood: A scoping review. Front Psychiatry 2022; 13:973988. [PMID: 36299544 PMCID: PMC9590692 DOI: 10.3389/fpsyt.2022.973988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Evidence supporting associations between cannabis use and many health outcomes is growing, however it remains unclear how such associations vary across the lifespan. We therefore aim to answer the following questions: (1) Are the risks of cannabis's adverse effects on mental health and addiction-related outcomes different in adolescents than in adults? (2) What are the relationships between these cannabis's adverse effects and (a) an individual's age at first cannabis use, (b) age at assessment, and (c) duration of cannabis use? METHODS We searched Medline, Embase, CINAHL, and PsychINFO from inception to 18 October 2021. Two reviewers independently screened studies and descriptively synthesized results. RESULTS We included 140 studies. Cannabis effects on mental health and addiction-related outcomes were worse in adolescents, early cannabis initiators and cannabis users who consumed for longest periods. Evidence of worse long-term adverse effects in adolescents was substantial for psychosis, cannabis, and nicotine use disorders; mixed for depression, suicidality, other substance use and disorders; and limited for anxiety. Additionally, acute cannabis exposure had the opposite trend with adults more often reporting adverse effects than adolescents. CONCLUSION The available evidence suggests that cannabis use should be delayed as late as possible in adulthood and shortened in duration across the lifespan to decrease the risk of negative outcomes, while emphasizing the need for adapted harm reduction approaches. This scoping review provides evidence on the role of age and duration of exposure as determinants of cannabis-related adverse effects, which may inform prevention and harm reduction strategies. SYSTEMATIC REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/BYG72.
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Affiliation(s)
- Navdeep Kaur
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Gabriel Bastien
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Lea Gagnon
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Johann Graham
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Violaine Mongeau-Pérusse
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Hamzah Bakouni
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Florence Morissette
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Camille Theriault
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Benedikt Fischer
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.,Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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Teodósio Valois-Santos N, de Almeida RBF, Jacques IDJAA, Santos DDP, Silva KSDBE, Nappo SA, de Brito AM. Association between alcohol and crack: Prevalence, effects, associated factors and experiences of combined use. PLoS One 2021; 16:e0256414. [PMID: 34473735 PMCID: PMC8412309 DOI: 10.1371/journal.pone.0256414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To estimate the prevalence and factors associated with the effect of alcohol on crack cocaine use and to analyze experiences related to combined use. Materials and methods: sequential mixed methods (qualitative and quantitative) research, carried out between August 2014 and August 2015 with people who use crack. In the quantitative approach, a cross-sectional study was conducted with 1,062 participants. Factors associated with “alcohol use with the effect of increasing the effect of crack/crack craving” were estimated by multiple regression. In the qualitative approach, 39 interviews were conducted using Bardin’s content analysis technique. Results 871 (82.0%) participants reported consuming alcohol, among them, 668 (76.7%) used alcohol combined with crack: 219 (32.8%) reported feeling an effect of reduction in paranoia and/or crack craving and 384 (57.5%) reported feeling an increase in the effect of crack and in the craving to consume the drug. This relationship was also observed in the narratives of the people who use crack, with the possibility of a cyclic effect of consumption of the two substances. Those who related alcohol use to the effect of increasing crack craving (384) were more likely to use alcohol before crack (OR: 1.81; 95%CI: 1.13–2.89); to consume more than 20 stones daily (OR: 1.48; 95%CI: 1.01–2.16); to remain in abstinence from crack for less than one month (OR: 3.20; 95%CI: 1.91–5.35); to use dependence treatment services (OR: 1.85; 95%CI: 1.26–2.71); and to commit physical violence (OR:1.67; 95%CI:1.08–2.56). Conclusion The findings of this study indicate that the modulation of the effect of alcohol use on crack cocaine depends on the moment when the drugs are consumed, and the use of alcohol before crack consumption is associated with characteristics that suggest a greater vulnerability to patterns of harmful crack use. Even though combined use is referred to as a way of reducing the negative effects of crack, the damage of this association may be greater than its possible benefits.
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Affiliation(s)
- Naíde Teodósio Valois-Santos
- Departamento de Saúde Coletiva, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
- * E-mail:
| | | | | | - Daianny de Paula Santos
- Programa de Pós-Graduação em Saúde Pública, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
| | - Keila Silene de Brito e Silva
- Núcleo de Saúde Coletiva, Centro Acadêmico de Vitória, Universidade Federal de Pernambuco, Vitória, Pernambuco, Brazil
| | - Solange Aparecida Nappo
- Centro Brasileiro de Informações sobre Drogas Psicotrópicas (CEBRID), Departamento de Medicina Preventiva and Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Maria de Brito
- Departamento de Saúde Coletiva, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
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Sabe M, Zhao N, Kaiser S. A systematic review and meta-analysis of the prevalence of cocaine-induced psychosis in cocaine users. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110263. [PMID: 33524454 DOI: 10.1016/j.pnpbp.2021.110263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/02/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Affiliation(s)
- M Sabe
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland.
| | - N Zhao
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - S Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
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Association Between Recent Cannabis Consumption and Withdrawal-Related Symptoms During Early Abstinence Among Females With Smoked Cocaine Use Disorder. J Addict Med 2021; 14:e37-e43. [PMID: 31972760 DOI: 10.1097/adm.0000000000000599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effects of cannabis on clinical outcomes of treatment services for other drug use disorders remains unclear. The primary aim of the current study was to investigate the effects of recent cannabis consumption on the severity of cocaine withdrawal and depressive symptoms during a 3-week inpatient treatment program for women with cocaine use disorder. The second goal of this study was to test the effect of recent alcohol or tobacco use on the aforementioned outcomes. METHODS This was a longitudinal study with 2 assessment time points: at enrollment and upon discharge from a medically managed intensive inpatient unit. The sample was composed of 214 early abstinence females with cocaine use disorder. Cocaine withdrawal and depressive symptoms were measured using the Cocaine Selective Severity Assessment (CSSA) and the Beck Depressive Inventory (BDI-II). Recent substance use was evaluated using the Addiction Severity Index (ASI-6). RESULTS Patients with cocaine use disorder and with frequent recent cannabis use reported higher severity of cocaine withdrawal and depressive symptoms after 3 weeks of inpatient treatment. Neither recent alcohol nor tobacco use was associated with increased CSSA or BDI outcomes, suggesting these substances play a minor role compared to recent cannabis use in affecting withdrawal-related symptoms. CONCLUSIONS The assessment of recent cannabis use may help identify patients in need of additional treatment to manage severe cocaine withdrawal symptoms and depressive symptoms during early abstinence.
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Karsinti E, Labaeye M, Piani K, Fortias M, Brousse G, Bloch V, Romo L, Vorspan F. Network analysis of psychotic manifestations among cocaine users. J Psychiatr Res 2020; 130:300-305. [PMID: 32866679 DOI: 10.1016/j.jpsychires.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
Psychotic experiences can be described along a continuum ranging from no psychotic experience at all, to clinical psychotic disorder. Any individual in the general population may encounter psychotic experiences under certain circumstances. Transient Cocaine Induced Psychotic Symptoms (TCIPS) are a well described model of such circumstances. Therefore, our aim was to use a network analysis to get a better knowledge on the architecture of previously described risk factors and how they contributed to two different measures of psychosis (psychosis proneness and transient cocaine induced psychotic symptoms) This study is a secondary analysis conducted among 180 cocaine users in addiction care centers in Paris and Paris suburb, who were evaluated with the PDI (Peters Delusion Inventory) and the SAPS-CIP (Scale for the Assessment of Psychotic Symptoms - Cocaine Induced Psychosis). Schizophrenia diagnosis was extracted from medical record. Relevant variables significantly associated with SAPS-CIP total score or PDI at the first step were included in a network analysis to better figurate their respective associations. The network centrality measures showed that the product preferentially used (crack vs cocaine) was related to TCIPS, psychosis proneness and, to a lesser extent, schizophrenia. Secondly, in this model TCIPS is a mediator between intensive cocaine use and psychosis proneness. Thirdly, this study refines the previous knowledge on heavy cannabis use being a risk factor for TCIPS. The observed link is not direct but mediated by psychosis proneness.
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Affiliation(s)
- Emily Karsinti
- Assistance Publique Hôpitaux de Paris, Hôpital Fernand Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint Denis, Paris, France; INSERM UMR-S 1144, 75006 Paris, Université Paris Descartes, 75006 Paris, Sorbonne Paris Cité, Université Paris Diderot, 75013, Paris, France; Laboratoire CliPsyD, EA4430, Université Paris Nanterre, 200 Avenue de la République, 92001, Cedex Nanterre, France.
| | - Marion Labaeye
- Assistance Publique Hôpitaux de Paris, Hôpital Fernand Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint Denis, Paris, France
| | - Kristel Piani
- Assistance Publique Hôpitaux de Paris, Hôpital Fernand Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint Denis, Paris, France
| | - Maeva Fortias
- Assistance Publique Hôpitaux de Paris, Hôpital Fernand Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint Denis, Paris, France; INSERM UMR-S 1144, 75006 Paris, Université Paris Descartes, 75006 Paris, Sorbonne Paris Cité, Université Paris Diderot, 75013, Paris, France
| | - Georges Brousse
- EA NPsy-Sydo, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Vanessa Bloch
- Assistance Publique Hôpitaux de Paris, Hôpital Fernand Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint Denis, Paris, France; INSERM UMR-S 1144, 75006 Paris, Université Paris Descartes, 75006 Paris, Sorbonne Paris Cité, Université Paris Diderot, 75013, Paris, France
| | - Lucia Romo
- Laboratoire CliPsyD, EA4430, Université Paris Nanterre, 200 Avenue de la République, 92001, Cedex Nanterre, France; GHU Paris Psychiatrie et Neurosciences, CMME, INSERM UMR1266, France
| | - Florence Vorspan
- Assistance Publique Hôpitaux de Paris, Hôpital Fernand Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint Denis, Paris, France; INSERM UMR-S 1144, 75006 Paris, Université Paris Descartes, 75006 Paris, Sorbonne Paris Cité, Université Paris Diderot, 75013, Paris, France; FHU NOR-SUD, Paris, France
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Seiler N, Nguyen T, Yung A, O'Donoghue B. Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry Clin Neurosci 2020; 74:226-246. [PMID: 31846133 DOI: 10.1111/pcn.12966] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
AIM Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'. METHODS EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded. RESULTS A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. DISCUSSION A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.
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Affiliation(s)
- Natalie Seiler
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Tony Nguyen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Alison Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
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8
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Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses. Drug Alcohol Depend 2017; 180:401-416. [PMID: 28982092 DOI: 10.1016/j.drugalcdep.2017.08.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
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Castaldelli-Maia JM, Nicastri S, Cerdá M, Kim JH, de Oliveira LG, de Andrade AG, Martins SS. In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern. Drug Alcohol Rev 2017; 37:273-281. [PMID: 28485092 DOI: 10.1111/dar.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/24/2017] [Accepted: 03/11/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Given a scenario of intense discussion about the legal situation of cannabis users worldwide, this paper aims to investigate the role of cannabis within a drug use sequencing pattern. DESIGN AND METHODS Data came from a representative sample of college students from 27 Brazilian capitals (n = 12 711). We analysed the patterns of transition from/to the first use of cannabis to/from the first use of alcohol, tobacco and seven other illegal drugs. Survival analysis methods were used to analyse age of onset data on all potential drug pairs. Drugs that were not specified as the target drug pair tested in each survival model were included as time-varying covariates in all models. RESULTS We found significant transitions from alcohol [adjusted hazard ratio (aHR) = 1.41, 95% confidence interval (CI) 1.15-1.73, P < 0.001] and inhalants (aHR = 1.56, 95% CI 1.26-1.93, P < 0.001) to cannabis. Moreover, we found significant transitions from cannabis to alcohol (aHR = 2.40, 95% CI 1.47-3.91, P < 0.001), cocaine (aHR = 7.47, 95% CI = 4.26-13.09, P < 0.001), prescription opioids (aHR = 2.16, 95% CI 1.29-3.63, P < 0.01) and tranquilisers (aHR = 1.51, 95% CI 1.11-2.06, P < 0.01). DISCUSSION AND CONCLUSIONS Overall, our findings point to a strategic role of cannabis within drug first use sequence pattern. We had an important and unexpected finding-the bi-directional relationship between alcohol and cannabis. In addition, the first use of cannabis still precedes the first use of cocaine and non-medical use of tranquilisers and prescription opioids. [Castaldelli-Maia JM, Nicastri S, Cerdá M, Kim JH, Oliveira LG, Andrade AG, Martins, SS. In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern. Drug Alcohol Rev 2017;00:000-000].
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Affiliation(s)
- João Mauricio Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, ABC Foundation, Santo André, Brazil.,ABC Center for Mental Health Studies, Santo André, Brazil
| | - Sérgio Nicastri
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - Magdalena Cerdá
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - June H Kim
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | | | - Arthur Guerra de Andrade
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, ABC Foundation, Santo André, Brazil.,ABC Center for Mental Health Studies, Santo André, Brazil
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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10
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Roncero C, Abad AC, Padilla-Mata A, Ros-Cucurull E, Barral C, Casas M, Grau-López L. Psychotic Symptoms Associated with the use of Dopaminergic Drugs, in Patients with Cocaine Dependence or Abuse. Curr Neuropharmacol 2016; 15:315-323. [PMID: 27009114 PMCID: PMC5412693 DOI: 10.2174/1570159x14666160324144912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/29/2015] [Accepted: 03/10/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the field of dual diagnosis, physicians are frequently presented with pharmacological questions. Questions about the risk of developing psychotic symptoms in cocaine users who need treatment with dopaminergic drugs could lead to an undertreatment. OBJECTIVE Review the presence of psychotic symptoms in patients with cocaine abuse/dependence, in treatment with dopaminergic drugs. METHODS Systematic PubMed searches were conducted including December 2014, using the keywords: "cocaine", dopaminergic drug ("disulfuram-methylphenidate-bupropion-bromocriptine-sibutramineapomorphine- caffeine") and ("psychosis-psychotic symptoms-delusional-paranoia"). Articles in English, Spanish, Portuguese, French, and Italian were included. Articles in which there was no history of cocaine abuse/dependence, absence of psychotic symptoms, systematic reviews, and animal studies, were excluded. RESULTS 313 papers were reviewed. 7 articles fulfilled the inclusion-exclusion criteria. There is a clinical trial including 8 cocaine-dependent patients using disulfiram in which 3 of them presented psychotic symptoms and 6 case-reports: disulfuram (1), methylphenidate (1), disulfiram with methylphenidate (2), and bupropion (2), reporting psychotic symptoms, especially delusions of reference and persecutory ideation. CONCLUSION Few cases have been described, which suggests that the appearance of these symptoms is infrequent. The synergy of dopaminergic effects or the dopaminergic sensitization in chronic consumption are the explanatory theories proposed by the authors. In these cases, a relationship was found between taking these drugs and the appearance of psychotic symptoms. Given the low number of studies found, further research is required. The risk of psychotic symptoms seems to be acceptable if we compare it with the benefits for the patients but a closer monitoring seems to be advisable.
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Affiliation(s)
- Carlos Roncero
- Department of Psychiatry, Vall d'Hebron University Hospital Passeig Vall d´Hebron, 119-129, 08035 Barcelona, EU, Spain
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11
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Roncero C, Daigre C, Grau-López L, Barral C, Pérez-Pazos J, Martínez-Luna N, Casas M. An international perspective and review of cocaine-induced psychosis: a call to action. Subst Abus 2015; 35:321-7. [PMID: 24927026 DOI: 10.1080/08897077.2014.933726] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cocaine use can induce transient psychotic symptoms that include suspiciousness, paranoia, hallucinations, and other cocaine-related behaviors. In this commentary, the authors provide an international perspective while reviewing the recent advances in epidemiology, clinical features, and risk factors related to cocaine-induced psychosis exhibited by patients with cocaine use disorders. In some settings, the occurrence of cocaine-induced psychosis has been shown to be as high as 86.5%. Many risk factors have been linked with cocaine-induced psychosis, including the quantity of cocaine consumed, lifetime amount of cocaine use, onset of cocaine dependence, years of use, routes of administration, other substance use disorder comorbidity, weight, gender, comorbidity with other medical and mental health disorders, genetics, and pharmacological interactions. Research has shown that the evaluation of cocaine-induced psychosis in patients with cocaine use is clinically relevant, especially in those patients who consume high amounts of cocaine, have a cannabis dependence history, have antisocial personality disorder, use administration routes other than intranasal, or exhibit attention-deficit/hyperactivity disorder (ADHD) comorbidity. Currently, the literature lacks information regarding the evolution of cocaine dependence or cocaine-dependent patients' risk for developing schizophrenia or other psychotic disorders. Furthermore, clinicians still do not have an evidence-based pharmacological approach to management of cocaine dependence available to them. Additional research is also needed regarding risk factors such as neurobiological markers and personality traits. Finally, we recommend the development of an integrative model including all of the risk factors and protective factors for cocaine-induced psychosis.
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Affiliation(s)
- Carlos Roncero
- a Outpatient Drug Clinic (CAS), Vall Hebron Psychiatry Department , University Hospital Vall d'Hebron-Barcelona Public Health Agency (ASPB) , Barcelona , Spain
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12
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Psychopathology in Substance Use Disorder Patients with and without Substance-Induced Psychosis. JOURNAL OF ADDICTION 2015; 2015:843762. [PMID: 26417473 PMCID: PMC4568375 DOI: 10.1155/2015/843762] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/23/2015] [Indexed: 12/23/2022]
Abstract
Background. Substance-induced psychotic disorder (SIPD) is a diagnosis constructed to distinguish substance-induced psychotic states from primary psychotic disorders. A number of studies have compared SIPD persons with primary psychotic patients, but there is little data on what differentiates substance use disorder (SUD) individuals with and without SIPD. Here, we compared psychopathology, sociodemographic variables, and substance use characteristics between SUD patients with and without SIPD. Methods. A retrospective chart review was conducted on newly admitted patients at a rehabilitation centre between 2007 and 2012. Results. Of the 379 patients included in the study, 5% were diagnosed with SIPD (n = 19) and 95% were diagnosed with SUDs without SIPD (n = 360). More SIPD patients reported using cannabis and psychostimulants, and fewer SIPD patients reported using alcohol than SUDs patients without SIPD. SIPD patients scored higher on the “schizophrenia nuclear symptoms” dimension of the SCL-90R psychoticism scale and exhibited more ClusterB personality traits than SUD patients without SIPD. Discussion. These data are consistent with previous studies suggesting that psychopathology, substance type, and sociodemographic variables play important role in the development of SIPD. More importantly, the results highlight the need for paying greater attention to the types of self-reported psychotic symptoms during the assessment of psychotomimetic effects associated with psychoactive substances.
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13
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Ding Y, He N, Detels R. Adolescent Sexual Debut and Initiation into New-Type Drug Use among a Sample of Young Adults. J Psychoactive Drugs 2015; 47:182-6. [PMID: 26098832 DOI: 10.1080/02791072.2015.1049725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We examined the association between adolescent sexual debut and age at new-type drug initiation among a sample of young adult new-type drug users. A total of 276 participants were recruited using respondent-driven sampling (RDS) in Shanghai, China. The analyses were restricted to a total of 201 participants aged between 18 and 30 years. The average age at sexual debut and age at first new-type drug use were 18.8 and 20.9 years, respectively. About 94% of participants reported having sexual experience (n=188); of those, 137 (72.9%) had sexual debut before they first used new-type drugs, while 32 (17.0%) initiated both events at the same age. After adjustment for age, income, education, and sexual orientation, adolescent sexual debut was independently associated with younger age at new-type drug initiation. Adolescent sexual debut is associated with early onset of new-type drug use. Our findings underscore the importance of implementing sex-education programs for adolescents in schools in China.
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Affiliation(s)
- Yingying Ding
- a Lecturer, Department of Epidemiology , School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University , Shanghai , China
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14
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Viola TW, Tractenberg SG, Wearick-Silva LE, Rosa CSDO, Pezzi JC, Grassi-Oliveira R. Long-term cannabis abuse and early-onset cannabis use increase the severity of cocaine withdrawal during detoxification and rehospitalization rates due to cocaine dependence. Drug Alcohol Depend 2014; 144:153-9. [PMID: 25262527 DOI: 10.1016/j.drugalcdep.2014.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 08/14/2014] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term and early-onset cannabis consumption are implicated in subsequent substance- related problems. The aim of this follow-up study was to investigate whether these patterns of cannabis use could impact cocaine withdrawal severity and cocaine craving intensity during detoxification. In addition, we investigated their impact in the rehospitalization rates due to cocaine dependence 2.5 years after detoxification assessment. METHODS The sample was composed of 93 female cocaine-dependent inpatients who were enrolled in an inpatient detoxification unit. Cocaine withdrawal symptoms were measured at the 4th, 9th and 14th days of detoxification using the cocaine selective severity assessment (CSSA). Data on the age of first years of drug use - alcohol, cannabis and cocaine - and the years of substance abuse were obtained using the Addiction Severity Index (ASI-6). Other relevant clinical variables were also investigated, including a 2.5 years follow-up assessment of number of rehospitalization due to cocaine dependence. RESULTS Early-onset cannabis use and long-term cannabis abuse were associated with an increase instead of a reduction in the severity of cocaine withdrawal symptoms and craving intensity during detoxification. In addition, long-term cannabis abuse predicted higher number of rehospitalization due to cocaine dependence after 2.5 years of the first detoxification assessment. CONCLUSIONS Early-onset cannabis use and long-term cannabis abuse are associated with a worse detoxification treatment response. Our findings may help to identify patients who will struggle more severely to control cocaine withdrawal syndrome during early drug abstinence, and indicate that cannabis use prior to cocaine withdrawal should be considered an adverse factor.
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Affiliation(s)
- Thiago Wendt Viola
- Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil
| | - Saulo Gantes Tractenberg
- Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil
| | - Luis Eduardo Wearick-Silva
- Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil
| | - Caroline Silva de Oliveira Rosa
- Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil
| | - Júlio Carlos Pezzi
- Health Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Rodrigo Grassi-Oliveira
- Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil.
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15
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Roncero C, Daigre C, Barral C, Ros-Cucurull E, Grau-López L, Rodríguez-Cintas L, Tarifa N, Casas M, Valero S. Neuroticism associated with cocaine-induced psychosis in cocaine-dependent patients: a cross-sectional observational study. PLoS One 2014; 9:e106111. [PMID: 25254365 PMCID: PMC4177812 DOI: 10.1371/journal.pone.0106111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/24/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cocaine consumption can induce transient psychotic symptoms, which has been correlated with more severe addiction and aggressive behavior. However, little is known about the nature of the relationship between personality traits and psychotic symptoms in cocaine-dependent patients. This study examined the relationship between neuroticism and cocaine-induced psychosis. METHODS A total of 231 cocaine-dependent patients seeking treatment were recruited to the study. Personality was evaluated by the Zuckerman-Kuhlman Personality Questionnaire. Cocaine-induced psychosis questionnaire, SCID-I, and SCID-II were used to evaluate comorbidity and clinical characteristics. Data analysis was performed in three steps: descriptive, bivariate, and multivariate analyses. RESULTS Cocaine-induced psychosis was reported in 65.4% of the patients and some personality disorder in 46.8%. Two personality dimensions (Neuroticism-Anxiety and Aggression-Hostility) presented a significant effect on the risk of experiencing psychotic symptoms (t(229) = 2.69, p = 0.008; t(229) = 2.06, p = 0.004), and patients with psychotic symptoms showed higher scores in both variables. On the multivariate analysis, only Neuroticism remained as a significant personality factor independently associated with psychotic symptoms (Wald = 7.44, p<0.05, OR = 1.08, CI 95% 1.02-1.16) after controlling for age, gender and number of consumption substances. CONCLUSIONS An association between high neuroticism scores and presence of psychotic symptoms induced by cocaine has been found, independently of other consumption variables. Personality dimensions should be evaluated in cocaine-dependent patients in order to detect high scores of neuroticism and warn patients about the risk of developing cocaine-induced psychotic symptoms.
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Affiliation(s)
- Carlos Roncero
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Constanza Daigre
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Barral
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Ros-Cucurull
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lara Grau-López
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Tarifa
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
| | - Miguel Casas
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergi Valero
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
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