Risk factors and an early prediction model for persistent methamphetamine-related psychiatric symptoms

Individualized prediction models in ADHD: a systematic review and meta-regression

There have been increasing efforts to develop prediction models supporting personalised detection, prediction, or treatment of ADHD. We overviewed the current status of prediction science in ADHD by: (1) systematically reviewing and appraising available prediction models; (2) quantitatively assessing factors impacting the performance of published models. We did a PRISMA/CHARMS/TRIPOD-compliant systematic review (PROSPERO: CRD42023387502), searching, until 20/12/2023, studies reporting internally and/or externally validated diagnostic/prognostic/treatment-response prediction models in ADHD. Using meta-regressions, we explored the impact of factors affecting the area under the curve (AUC) of the models. We assessed the study risk of bias with the Prediction Model Risk of Bias Assessment Tool (PROBAST). From 7764 identified records, 100 prediction models were included (88% diagnostic, 5% prognostic, and 7% treatment-response). Of these, 96% and 7% were internally and externally validated, respectively. None was implemented in clinical practice. Only 8% of the models were deemed at low risk of bias; 67% were considered at high risk of bias. Clinical, neuroimaging, and cognitive predictors were used in 35%, 31%, and 27% of the studies, respectively. The performance of ADHD prediction models was increased in those models including, compared to those models not including, clinical predictors (β = 6.54, p = 0.007). Type of validation, age range, type of model, number of predictors, study quality, and other type of predictors did not alter the AUC. Several prediction models have been developed to support the diagnosis of ADHD. However, efforts to predict outcomes or treatment response have been limited, and none of the available models is ready for implementation into clinical practice. The use of clinical predictors, which may be combined with other type of predictors, seems to improve the performance of the models. A new generation of research should address these gaps by conducting high quality, replicable, and externally validated models, followed by implementation research.

The interplay of childhood trauma, oxytocin, and impulsivity in predicting the onset of methamphetamine use

BACKGROUND

Childhood trauma is associated with substance use disorders, including methamphetamine use disorder (MUD). Oxytocin, involved in social bonding, stress regulation, and reward processing, may influence addiction vulnerability and impulsivity in individuals with a history of childhood trauma.

OBJECTIVE

To investigate the relationships among childhood trauma, oxytocin levels, impulsivity, and the age of first methamphetamine use in individuals with MUD.

PARTICIPANTS AND SETTING

The study included 298 male participants (148 individuals with MUD and 150 healthy controls) from both probation offices and psychiatric clinics.

METHODS

Childhood trauma was assessed using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), impulsivity with the Barratt Impulsiveness Scale-11 (BIS-11), and plasma oxytocin levels were obtained.

RESULTS

Individuals with MUD exhibited higher levels of childhood trauma, impulsivity, and lower plasma oxytocin levels compared to healthy controls. Childhood trauma was associated with a younger age of first methamphetamine use, higher impulsivity, and lower oxytocin levels among individuals with MUD. Plasma oxytocin levels partially mediated the relationship between childhood trauma and both the age of first methamphetamine use and impulsivity. Serial mediation analysis demonstrated that oxytocin levels and impulsivity sequentially mediated the relationship between childhood trauma and the age of first methamphetamine use.

CONCLUSIONS

The findings reveal the complex interplay among childhood trauma, oxytocin, impulsivity, and methamphetamine use, emphasizing the importance of considering these factors in prevention and intervention strategies for MUD. Future research should explore oxytocin and impulsivity-focused interventions to mitigate the effects of childhood trauma and reduce MUD development risk.

Differences in clinical features and gut microbiota between individuals with methamphetamine casual use and methamphetamine use disorder

Background

The transition from methamphetamine (MA) casual use (MCU) to compulsive use is enigmatic as some MA users can remain in casual use, but some cannot. There is a knowledge gap if gut microbiota (GM) play a role in differing MCU from MA use disorder (MUD). We aimed to investigate the clinical features and GM differences between individuals with MCU and MUD.

Method

We recruited two groups of MA users -MCU and MUD - and matched them according to age and body mass index (n=21 in each group). Participants were accessed using the Semi-Structured Assessment for Drug Dependence and Alcoholism, and their fecal samples were undergone 16S ribosomal DNA sequencing. We compared the hosts' clinical features and GM diversity, composition, and structure (represented by enterotypes) between the two groups. We have identified differential microbes between the two groups and performed network analyses connecting GM and the clinical traits.

Result

Compared with the casual users, individuals with MUD had higher incidences of MA-induced neuropsychiatric symptoms (e.g., paranoia, depression) and withdrawal symptoms (e.g., fatigue, drowsiness, and increased appetite), as well as stronger cravings for and intentions to use MA, and increased MA tolerance. The GM diversity showed no significant differences between the two groups, but four genera (Halomonas, Clostridium, Devosia, and Dorea) were enriched in the individuals with MUD (p<0.05). Three distinct enterotypes were identified in all MA users, and Ruminococcus-driven enterotype 2 was dominant in individuals with MUD compared to the MCU (61.90% vs. 28.60%, p=0.03). Network analysis shows that Devosia is the hub genus (hub index = 0.75), which is not only related to the counts of the MUD diagnostic criteria (ρ=0.40; p=0.01) but also to the clinical features of MA users such as reduced social activities (ρ=0.54; p<0.01). Devosia is also associated with the increased intention to use MA (ρ=0.48; p<0.01), increased MA tolerance (ρ=0.38; p=0.01), craving for MA (ρ=0.37; p=0.01), and MA-induced withdrawal symptoms (p<0.05).

Conclusion

Our findings suggest that Ruminococcus-driven enterotype 2 and the genera Devosia might be two influential factors that differentiate MA casual use from MUD, but further studies are warranted.

The predictive role of impulsivity and perceived social support in psychiatric symptoms of women with methamphetamine use disorder

Background

Currently, few studies have examined the mental states of Women methamphetamine patients, and the influence of impulsivity and perceived social support on substance misuse-induced mental disorders is unclear. We want to examine the mental state of women with methamphetamine use disorder and compare it to the Chinese norm value of healthy women. Investigate the connection between impulsivity, perceived social support and mental state of women with methamphetamine use disorder.

Method

Two hundred thirty women subjects with a history of methamphetamine usage were recruited. The Chinese version of the SCL-90-R, (SCL-90) was used to evaluate psychological health problems, while the Multidimensional Scale of Perceived Social Support (MSPSS) and Barratt Impulsiveness Seale-11 (BIS-11) were utilized to evaluate perceived social support and impulsivity, respectively. The t-test, Pearson correlation analysis, multivariable linear regression, stepwise regression models, moderating effect analysis were used to analyze the statistics.

Results

There was a noticeable difference between the Chinese norm and all participants' SCL-90 ratings, especially for Somatization (t = 24.34, p < 0.001), Anxiety (t = 22.23, p < 0.001), Phobic anxiety (t = 26.47, p < 0.001), and Psychoticism (t = 24.27, p < 0.001). In addition, perceived social support levels and impulsivity levels are independently predictive of SCL-90 scores. Lastly, the impact of Impulsivity on SCL-90 can be modulated by perceived social support.

Conclusion

According to this study, women with methamphetamine use disorder have worse mental health conditions compared to healthy subjects. Furthermore, certain psychological symptoms associated with methamphetamine use in women can be aggravated by impulsivity, while perceived social support acts as a protective factor for methamphetamine-related psychiatric symptoms. Specifically, perceived social support weakens the impact of impulsivity on psychiatric symptoms in women with methamphetamine use disorder.

Correlates of anxiety and depression in a community cohort of people who smoke methamphetamine

OBJECTIVE

Anxiety and depression are the most common mental health disorders experienced by Australians. These disorders are commonly found in people who use methamphetamine; however, much of this research has involved participants recruited from treatment settings who inject methamphetamine. We therefore explored (1) the prevalence of moderate to severe anxiety and depression in a community-recruited cohort who smoked methamphetamine and (2) examined potential factors associated with moderate to severe anxiety or depression in this cohort.

METHOD

Data were derived from baseline surveys of 725 participants of the prospective 'VMAX' study, recruited from metropolitan and non-metropolitan areas of Victoria, Australia, via snowball and respondent-driven sampling. Anxiety and depression were measured using the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 instruments. Independent associations between moderate to severe scores on these measures and demographic, socio-economic, substance use and other health and social characteristics were examined using multivariable logistic regression.

RESULTS

More than half (60%) of the participants were classified as experiencing moderate to severe anxiety and/or depression. In the multivariable models, having poor/very poor self-rated health, methamphetamine dependence and being unemployed were associated with higher odds of experiencing both moderate to severe depression and moderate to severe anxiety. Living in a large rural town, identifying as Aboriginal and Torres Strait Islander and smoking methamphetamine were associated with lower odds of experiencing moderate to severe depression. Being female was associated with higher odds of experiencing moderate to severe anxiety.

CONCLUSION

The high rates of anxiety and/or depression found in the VMAX cohort were associated with demographic, socio-economic, substance use and other health and social factors. The prevalence of moderate to severe anxiety is a novel finding that warrants further study. Further work is needed to determine how anxiety and depression change over time among people who smoke methamphetamine, to help identify key intervention points.

Implication of thyroid hormone receptors in methamphetamine neurocognitive effects

Methamphetamine (MA) induces neurocognitive effects via several mechanisms. In the present study, we investigated the alteration of thyroid hormone receptor's expression in the context of MA-induced memory impairment and explored the protective effects of exogenous thyroid hormones (THs). Male wistar rats, received increasing regime of MA (1-10mg/kg, intraperitoneal, twice a day for 10 days), were treated with T3 (40μg/rat/day; intranasal, 2.5μl/nostril) or T4 (20µg/kg/day; intraperitoneal) for 7 days after MA cessation. All rats were subjected to novel object recognition memory test and then the mRNA levels of TH nuclear receptors (TRα1 and TRβ1) and seladin-1, an anti-apoptotic factor, and the protein level of TH cell surface receptor (integrin αvβ3) were measured in the hippocampus of rats. Our results showed that MA-induced memory impairment is concomitant with decreased level of TRα1 mRNA. T3 or T4 treatment significantly alleviated MA-induced memory impairment, but had no significant effect on the mRNA levels of TH nuclear receptors. However, T4 treatment significantly increased the protein level of cell surface receptor (av subunit) in MA-treated rats. These findings suggest that MA neurocognitive effects can be associated with impaired TH signaling in the brain and introduce this pathway as a promising therapeutic approach against MA-induced memory impairment.

Effects of Aerobic Exercise on Cognitive Function in Women With Methamphetamine Dependence in a Detoxification Program in Tianjin, China: A Randomized Controlled Trial

BACKGROUND

Cognitive impairment is prevalent among individuals, especially women, with methamphetamine dependence. Although aerobic exercise has been shown to affect cognitive function in humans and animals, few related studies have focused on subjects with methamphetamine dependence.

PURPOSE

The aim of this study was to assess the detoxification-related effects of aerobic exercise on cognitive function in women with methamphetamine dependence.

METHODS

A randomized controlled trial was used with 98 women with methamphetamine dependence undergoing a detoxification program at a mental hospital. The women were distributed using a computer-generated grouping random method into either the study or control group. The investigator conducting the baseline questionnaire, the neuropsychologist assessing the cognitive function, and the data analyst were blinded to group assignment. In addition to hospital routine care, the study group received an aerobic exercise intervention for 3 months. The control group only received hospital routine care. Attention and working memory were measured using the Trail Making Test and Digit Span Test, verbal memory was measured using Logical Memory (LM) and Memory for Persons Data (MPD), and executive function was measured using the Color-Word Stroop Test.

RESULTS

Forty-nine participants were randomized into each group, and the valid data of 43 participants in the study group and 46 in the control group were analyzed. The study group showed significantly more improvement over time in terms of Digit Span Test, Trail Making Test, LM-delayed, MPD-5 minutes delayed, MPD-30 minutes delayed, and Color-Word Stroop Test than the control group (p < .05). LM-immediate and MPD-immediate scores showed that the effects of time and the interaction between time and group were significant but that the main effect of group was not.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Women undergoing detoxification for methamphetamine dependence may practice aerobic exercise to improve attention, working memory, executive function, and parts of verbal memory. Aerobic exercise may be incorporated into detoxification treatment programs to facilitate the recovery of cognitive functions in women.

Beyond the tip of the iceberg: A narrative review to identify research gaps on comorbid psychiatric disorders in adolescents with methamphetamine use disorder or chronic methamphetamine use

BACKGROUND

Methamphetamine use disorder (MUD) frequently begins in adolescence, often accompanied by other psychiatric or mental disorders. Up to now, no comprehensive review about MUD and comorbid disorders in adolescents is available. We thus aimed to review the literature on comorbid mental disorders and MUD in adolescents in order to identify future research topics. Method: A PubMed search was conducted in July 2019. Relevant comorbidities were defined as attention-deficit disorder with/without hyperactivity, anxiety disorders, depression, eating disorders, post-traumatic stress disorder, psychosis, borderline personality disorder, conduct disorder and antisocial personality disorder, as well as other substance use disorders. For each comorbidity, we summarized prevalence rates, findings on comorbidity mechanisms, and recommended treatment options, if applicable. Results: Few articles focused on MUD in adolescents. Prevalence rates differed largely between comorbid disorders, with tobacco use disorder, conduct disorder, post-traumatic stress disorder, anxiety disorders, and attention-deficit disorders being the most prevalent comorbidities while eating disorders were rare. Examined onset patterns and comorbidity mechanisms indicated three groups of comorbidities: preexisting disorders self-medicated with methamphetamine, disorders induced by chronic methamphetamine use, and disorders arising due to risk factors shared with MUD. Reviewed comorbidities were frequently associated with worse treatment outcomes. Conclusions: The limited evidence is in stark contrast to the presumably high prevalence and relevance of comorbid mental disorders in adolescents with MUD. Suggestions for future research topics, informed by adult findings, include genetic vulnerabilities, biological changes, and consequences of different use patterns. Surprisingly few MUD treatment programs explicitly integrate comorbid mental disorder modules.