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Brouwer A, Carhart‐Harris RL, Raison CL. Psychotomimetic compensation versus sensitization. Pharmacol Res Perspect 2024; 12:e1217. [PMID: 38923845 PMCID: PMC11194300 DOI: 10.1002/prp2.1217] [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: 04/11/2024] [Accepted: 05/08/2024] [Indexed: 06/28/2024] Open
Abstract
It is a paradox that psychotomimetic drugs can relieve symptoms that increase risk of and cooccur with psychosis, such as attention and motivational deficits (e.g., amphetamines), pain (e.g., cannabis) and symptoms of depression (e.g., psychedelics, dissociatives). We introduce the ideas of psychotomimetic compensation and psychotomimetic sensitization to explain this paradox. Psychotomimetic compensation refers to a short-term stressor or drug-induced compensation against stress that is facilitated by engagement of neurotransmitter/modulator systems (endocannabinoid, serotonergic, glutamatergic and dopaminergic) that mediate the effects of common psychotomimetic drugs. Psychotomimetic sensitization occurs after repeated exposure to stress and/or drugs and is evidenced by the gradual intensification and increase of psychotic-like experiences over time. Theoretical and practical implications of this model are discussed.
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Affiliation(s)
- Ari Brouwer
- Department of Human Development and Family Studies, School of Human EcologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Robin L. Carhart‐Harris
- Department of Neurology and PsychiatryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Charles L. Raison
- Department of Psychiatry, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Vail Health Behavioral Health Innovation CenterVailColoradoUSA
- Center for the Study of Human HealthEmory UniversityAtlantaGeorgiaUSA
- Department of Spiritual HealthEmory University Woodruff Health Sciences CenterAtlantaGeorgiaUSA
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Oliver D, Chesney E, Cullen AE, Davies C, Englund A, Gifford G, Kerins S, Lalousis PA, Logeswaran Y, Merritt K, Zahid U, Crossley NA, McCutcheon RA, McGuire P, Fusar-Poli P. Exploring causal mechanisms of psychosis risk. Neurosci Biobehav Rev 2024; 162:105699. [PMID: 38710421 PMCID: PMC11250118 DOI: 10.1016/j.neubiorev.2024.105699] [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: 11/01/2023] [Revised: 02/17/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024]
Abstract
Robust epidemiological evidence of risk and protective factors for psychosis is essential to inform preventive interventions. Previous evidence syntheses have classified these risk and protective factors according to their strength of association with psychosis. In this critical review we appraise the distinct and overlapping mechanisms of 25 key environmental risk factors for psychosis, and link these to mechanistic pathways that may contribute to neurochemical alterations hypothesised to underlie psychotic symptoms. We then discuss the implications of our findings for future research, specifically considering interactions between factors, exploring universal and subgroup-specific factors, improving understanding of temporality and risk dynamics, standardising operationalisation and measurement of risk and protective factors, and developing preventive interventions targeting risk and protective factors.
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Affiliation(s)
- Dominic Oliver
- Department of Psychiatry, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK; OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, UK; Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Cathy Davies
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, UK
| | - George Gifford
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sarah Kerins
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paris Alexandros Lalousis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Yanakan Logeswaran
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Biostatistics & Health Informatics, King's College London, London, UK
| | - Kate Merritt
- Division of Psychiatry, Institute of Mental Health, UCL, London, UK
| | - Uzma Zahid
- Department of Psychology, King's College London, London, UK
| | - Nicolas A Crossley
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK; OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11 5DL, UK
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Cohen-Laroque J, Grangier I, Perez N, Kirschner M, Kaiser S, Sabé M. Positive and negative symptoms in methamphetamine-induced psychosis compared to schizophrenia: A systematic review and meta-analysis. Schizophr Res 2024; 267:182-190. [PMID: 38554698 DOI: 10.1016/j.schres.2024.03.037] [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: 04/26/2023] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The clinical profiles of methamphetamine-induced psychosis (MIP) and schizophrenia are largely overlapping making differentiation challenging. In this systematic review and meta-analysis, we aim to compare the positive and negative symptoms of MIP and schizophrenia to better understand the differences between them. STUDY DESIGN In accordance with our pre-registered protocol (CRD42021286619), we conducted a search of English-language studies up to December 16th, 2022, in PubMed, EMBASE, and PsycINFO, including stable outpatients with MIP and schizophrenia. We used the Newcastle-Ottawa Scale to measure the quality of cross-sectional, case-control, and cohort studies. STUDY RESULTS Of the 2052 articles retrieved, we included 12 studies (6 cross-sectional, 3 case-control, and 2 cohort studies) in our meta-analysis, involving 624 individuals with MIP and 524 individuals with schizophrenia. Our analysis found no significant difference in positive symptoms between the two groups (SMD, -0.01; 95%CI, -0.13 to +0.11; p = 1). However, individuals with MIP showed significantly less negative symptoms compared to those with schizophrenia (SMD, -0.35; 95CI%, -0.54 to -0.16; p = 0.01; I2 = 54 %). Our sensitivity analysis, which included only studies with a low risk of bias, did not change the results. However, our meta-analysis is limited by its cross-sectional approach, which limits the interpretation of causal associations. Furthermore, differences in population, inclusion criteria, methodology, and drug exposure impact our findings. CONCLUSIONS Negative symptoms are less prominent in individuals with MIP. While both groups do not differ regarding positive symptoms, raises the possibility of shared and partly different underlying neurobiological mechanisms related to MIP and schizophrenia.
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Affiliation(s)
| | - Inès Grangier
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Natacha Perez
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Matthias Kirschner
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Stefan Kaiser
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Michel Sabé
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland.
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Takeuchi J, Chan C, MacGibbon J, Broady TR, Lea T, Mao L, Bavinton BR, Holt M. Trends in illicit drug use and their association with HIV transmission risks from behavioural surveillance of Australian gay and bisexual men. Drug Alcohol Rev 2024; 43:539-550. [PMID: 38010830 DOI: 10.1111/dar.13781] [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: 03/08/2023] [Revised: 08/22/2023] [Accepted: 10/29/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Investigating drug trends among Australian gay and bisexual men (GBM) is crucial for understanding levels of use and the potential for harm, including HIV transmission risk. METHOD Using repeated, national, cross-sectional survey data collected between 2012 and 2021 (69,567 surveys), trends of recent (previous 6 months) and frequent (weekly) drug use were analysed, using logistic regression models. The last round of data from each jurisdiction (6709 surveys) was used to compare GBM who reported no use, infrequent (less than weekly) use and frequent (at least weekly) use of party drugs to investigate the association between party drug use and HIV transmission risk, using multinomial logistic regression models. RESULTS There was a significant upward trend in any recent drug use (from 58.4% in 2012 to 64.1% in 2021; p < 0.001). Frequent party drug use remained a minority practice over the period (consistently less than 3%). In cross-sectional analysis, frequent party drug users were more likely to report behaviours with HIV transmission risks, such as condomless anal intercourse without biomedical prevention strategies (30.0% vs. 13.1%; adjusted relative risk ratio [aRRR], 2.08; 95% CI, 1.24-3.47), weekly group sex (16.3% vs. 0.6%; aRRR, 12.36; 95% CI, 5.75-26.56) and more than 20 recent sexual partners (42.5% vs. 5.0%; aRRR, 21.44; 95% CI, 5.82-78.89), compared with GBM who did not use party drugs. DISCUSSION AND CONCLUSION Our findings suggest that the frequent use of party drugs remains a marker of HIV transmission risk among Australian GBM, despite the increased adoption of biomedical HIV prevention strategies over the past few years.
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Affiliation(s)
- Jumpei Takeuchi
- School of Clinical Medicine, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Curtis Chan
- The Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - James MacGibbon
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
| | - Toby Lea
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
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Maes M, Altufaili MF, Alhaideri AF, Moustafa SR, Stoyanova K, Niu M, Zhou B, Li J, Al-Hakeim HK. The General Neurocognitive Decline in Patients with Methamphetamine Use and Transient Methamphetamine-induced Psychosis is Primarily Determined by Oxidative and AGE-RAGE Stress. Curr Top Med Chem 2024; 24:1816-1828. [PMID: 38984578 DOI: 10.2174/0115680266320808240709061445] [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: 05/08/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Chronic Methamphetamine (MA) usage is linked to oxidative and AGE (advanced glycation end products) - RAGE (receptors for AGEs) stress, changes in magnesium, calcium, and copper, increased psychotic symptoms, and neurocognitive deficits. Nevertheless, it is still unclear whether these biological pathways mediate the latter impairments. OBJECTIVE This study aimed to investigate the relationships between neurocognition, the aforementioned biomarkers, and psychotic symptoms. METHODS We recruited 67 participants, namely 40 patients diagnosed with MA-substance use and 27 healthy controls, and assessed the Brief Assessment of Cognition in Schizophrenia (BACS), symptoms of psychosis, excitation, and formal thought disorders, oxidative toxicity (computed as the sum of myeloperoxidase (MPO), oxidized high-density lipoprotein (HDL), oxidized low-DL, and malondialdehyde), antioxidant defenses (catalase, glutathione peroxidase, total antioxidant capacity, zinc, and HDL), and increased AGEs and RAGEs. RESULTS We were able to extract one validated latent vector from the Mini-Mental State Examination score and the BACS test results (including executive functions, verbal fluency, and attention), labeled general cognitive decline (G-CoDe). We found that 76.1% of the variance in the G-CoDe was explained by increased oxidative toxicity, lowered antioxidant defenses, number of psychotic episodes, and MA dose. In patients with MA use, MPO was significantly associated with the GCoDe. CONCLUSION The use of MA induced mild cognitive impairments through MA-induced activation of detrimental outcome pathways, including oxidative and AGE-RAGE stress, and suppression of protective antioxidant pathways. Increased MPO, oxidative, and AGE-RAGE stress are new drug targets to prevent neurocognitive deficits and psychosis due to MA use.
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Affiliation(s)
- Michael Maes
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, 610072, China
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Fitness and Biopsychological Technology Research Unit, Faculty of Medicine Chulalongkorn University, Bangkok, 10330, Thailand
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria
- Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea
- Research and Innovation Program for the Development of MU - PLOVDIV-(SRIPD-MUP), Creation of a Network of Research Higher Schools, National Plan for Recovery and Sustainability, European Union - NextGenerationEU
| | | | | | - Shatha Rouf Moustafa
- Clinical Analysis Department, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Kristina Stoyanova
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria
- Research and Innovation Program for the Development of MU - PLOVDIV-(SRIPD-MUP), Creation of a Network of Research Higher Schools, National Plan for Recovery and Sustainability, European Union - NextGenerationEU
| | - Mengqi Niu
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, 610072, China
| | - Bo Zhou
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, 610072, China
| | - Jing Li
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, 610072, China
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McKetin R, Clare PJ, Castle D, Turner A, Kelly PJ, Lubman DI, Arunogiri S, Manning V, Berk M. How does a family history of psychosis influence the risk of methamphetamine-related psychotic symptoms: Evidence from longitudinal panel data. Addiction 2023; 118:1975-1983. [PMID: 37157055 PMCID: PMC10952942 DOI: 10.1111/add.16230] [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: 06/10/2022] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
AIMS To determine whether the risk of psychotic symptoms during weeks of methamphetamine use was dependent on, increased by, or independent of having a family history of psychosis. DESIGN Secondary analysis of 13 contiguous 1-week periods of data (1370 weeks). A risk modification framework was used to test each scenario. SETTING Geelong, Wollongong and Melbourne, Australia. PARTICIPANTS Participants in a randomized controlled trial of treatment for methamphetamine dependence (n = 148) who did not have a primary psychotic disorder on enrolment. MEASUREMENTS Psychotic symptoms in the previous week were defined as a score of 3+ on any of the Brief Psychiatric Rating Scale items of hallucinations, unusual thought content or suspiciousness. Any (vs no) methamphetamine use in the previous week was assessed using the Timeline Followback method. Self-reported family history of psychosis was assessed using the Diagnostic Interview for Psychosis. FINDINGS The risk of psychotic symptoms in the past week was independently associated with methamphetamine use in that week (relative risk [RR] = 2.3, 95% CI = 1.3-4.3) and with having a family history of psychosis (RR = 2.4, 95% CI = 0.9-7.0); the joint risk among participants with a family history of psychosis during weeks when they were using methamphetamine was large (RR = 4.0, 95% CI = 2.0-7.9). There was no significant interaction between a family history of psychosis and methamphetamine use in predicting psychotic symptoms (interaction RR = 0.7 95% CI = 0.3-1.8), but there was a small non-significant excess risk due to the interaction (0.20 95% CI = -1.63 to 2.03). CONCLUSIONS Among people dependent on methamphetamine, the relative risk of psychotic symptoms during weeks of methamphetamine use does not appear to be dependent on, or increased by, having a family history of psychosis. However, a family history of psychosis does appear to be an independent risk factor that contributes to the absolute risk of psychotic symptoms in this population.
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Affiliation(s)
- Rebecca McKetin
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | - Philip J. Clare
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
- Prevention Research Collaboration, School of Public HealthUniversity of SydneyCamperdownAustralia
- Charles Perkins CentreUniversity of SydneyCamperdownAustralia
| | - David Castle
- Centre for Addiction and Mental Health and Department of PsychiatryUniversity of TorontoTorontoCanada
| | - Alyna Turner
- Deakin University, IMPACT Institute for Innovation in Physical and Mental Health and Clinical TranslationSchool of MedicineGeelongAustralia
| | - Peter J. Kelly
- School of Psychology and Illawarra Health and Medical Research InstituteUniversity of WollongongWollongongAustralia
| | - Dan I. Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
- Turning Point, Eastern HealthRichmondAustralia
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
- Turning Point, Eastern HealthRichmondAustralia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
- Turning Point, Eastern HealthRichmondAustralia
| | - Michael Berk
- Deakin University, IMPACT Institute for Innovation in Physical and Mental Health and Clinical TranslationSchool of MedicineGeelongAustralia
- Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry, and the Florey Institute of Neuroscience and Mental HealthThe University of MelbourneParkvilleAustralia
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Leidl D, Takhar P, Li H. Prescription psychostimulants as a harm reduction and treatment intervention for methamphetamine use disorder and the implications for nursing clinical practice: A scoping review of the literature. Int J Ment Health Nurs 2023; 32:1225-1242. [PMID: 36978242 DOI: 10.1111/inm.13144] [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: 09/16/2022] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
The global rise in methamphetamine use and its negative effects warrants the need for research exploring harm reduction and treatment interventions for individuals with methamphetamine use disorder. Agonist medications have been utilized for years for the treatment of heroin and opioid addiction, but have yet to be incorporated into mainstream Canadian practice for methamphetamine dependence. This review aims to provide an overview of the current trends of prescription psychostimulant usage for individuals with methamphetamine use disorder from a Canadian perspective, identifies the barriers to accessing prescription psychostimulants for methamphetamine use disorder and highlights the nursing clinical practice implications in caring for individuals with the disorder. Discourse on the sustained abstinence and harm reduction debate is presented from the perspective of methamphetamine abuse is provided along with the neuropsychiatric complications of chronic methamphetamine use. The impacts of specific prescription psychostimulants on cognition are discussed as is the use of neuroimaging techniques to assess neuronal damage in methamphetamine users. Sign of toxicity, overdose and the contraindications for use of these prescription psychostimulants is also presented. The implications to nursing clinical practice in caring for this population is provided, touching on the clinical presentation of methamphetamine use, completing thorough assessment and screening and patient education. The findings of this review indicate the need for further research in this area exploring the benefits of prescription psychostimulants as a harm reduction and treatment intervention for the global problem of methamphetamine dependence.
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Affiliation(s)
- Don Leidl
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Pearl Takhar
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Hua Li
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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Rodríguez-Toscano E, Alloza C, Fraguas D, Durán-Cutilla M, Roldán L, Sánchez-Gutiérrez T, López-Montoya G, Parellada M, Moreno C, Gayer-Anderson C, Jongsma HE, Di Forti M, Quattrone D, Velthorst E, de Haan L, Selten JP, Szöke A, Llorca PM, Tortelli A, Bobes J, Bernardo M, Sanjuán J, Luis Santos J, Arrojo M, Tarricone I, Berardi D, Ruggeri M, Lasalvia A, Ferraro L, La Cascia C, La Barbera D, Menezes PR, Del-Ben CM, Rutten BP, van Os J, Jones PB, Murray RM, Kirkbride JB, Morgan C, Díaz-Caneja CM, Arango C. Differences in Patterns of Stimulant Use and Their Impact on First-Episode Psychosis Incidence: An Analysis of the EUGEI Study. Schizophr Bull 2023; 49:1269-1280. [PMID: 37467351 PMCID: PMC10483438 DOI: 10.1093/schbul/sbad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Use of illegal stimulants is associated with an increased risk of psychotic disorder. However, the impact of stimulant use on odds of first-episode psychosis (FEP) remains unclear. Here, we aimed to describe the patterns of stimulant use and examine their impact on odds of FEP. METHODS We included patients with FEP aged 18-64 years who attended psychiatric services at 17 sites across 5 European countries and Brazil, and recruited controls representative of each local population (FEP = 1130; controls = 1497). Patterns of stimulant use were described. We computed fully adjusted logistic regression models (controlling for age, sex, ethnicity, cannabis use, and education level) to estimate their association with odds of FEP. Assuming causality, we calculated the population-attributable fractions for stimulant use associated with the odds for FEP. FINDINGS Prevalence of lifetime and recent stimulant use in the FEP sample were 14.50% and 7.88% and in controls 10.80% and 3.8%, respectively. Recent and lifetime stimulant use was associated with increased odds of FEP compared with abstainers [fully adjusted odds ratio 1.74,95% confidence interval (CI) 1.20-2.54, P = .004 and 1.62, 95% CI 1.25-2.09, P < .001, respectively]. According to PAFs, a substantial number of FEP cases (3.35% [95% CI 1.31-4.78] for recent use and 7.61% [95% CI 3.68-10.54] for lifetime use) could have been prevented if stimulants were no longer available and the odds of FEP and PAFs for lifetime and recent stimulant use varied across countries. INTERPRETATION Illegal stimulant use has a significant and clinically relevant influence on FEP incidence, with varying impacts across countries.
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Affiliation(s)
- Elisa Rodríguez-Toscano
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, IdISSC, School of Medicine, Universidad Complutense, Madrid, Spain
- Faculty of Psychology, Universidad Complutense, Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Clara Alloza
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - David Fraguas
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, IdISSC, School of Medicine, Universidad Complutense, Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Manuel Durán-Cutilla
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Laura Roldán
- Faculty of Psychology, Universidad Complutense, Madrid, Spain
| | | | - Gonzalo López-Montoya
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Faculty of Health Science, Universidad Internacional de la Rioja (UNIR), Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Charlotte Gayer-Anderson
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Hannah E Jongsma
- PsyLife Group, Division of Psychiatry, University College London, London, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marta Di Forti
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Diego Quattrone
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, USA
- Early Psychosis Section, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Early Psychosis Section, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Paul Selten
- Institute for Mental Health, GGZ Rivierduinen, Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Andrei Szöke
- Institut National de la Santé et de la Recherche Médicale, U955, Equipe 15 Neuro-Psychiatrie Translationnelle, Créteil, France
- AP-HP, Pôle de Psychiatrie des Hôpitaux Universitaires Henri Mondor, Créteil, France
- Fondation FondaMental, Créteil, France
| | | | - Andrea Tortelli
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie and Neurosciences, 75014 Paris, France
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, ISPA, INEUROPA, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clínic of Barcelona; Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB); Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS); CIBERSAM, ISCIII, Barcelona, Spain
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital “Virgen de la Luz”, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain
| | - Ilaria Tarricone
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, Alma Mater Studiorium Università di Bologna, Bologna, Italy
| | | | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
- Section of Psychiatry, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Laura Ferraro
- Department of Biomedicine, Neuroscience and advanced Diagnostic (BiND), Psychiatry section, University of Palermo, Palermo, Italy
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and advanced Diagnostic (BiND), Psychiatry section, University of Palermo, Palermo, Italy
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and advanced Diagnostic (BiND), Psychiatry section, University of Palermo, Palermo, Italy
| | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, Universidade de São Paulo, São Paulo, Brazil
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - James B Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, UK
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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9
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Pham TL, Nguyen TL, Nguyen KA, Ekwaru JP, Phan O, Michel L, Khuat THO. Screening for adverse childhood experiences among young people using drugs in Vietnam: related factors and clinical implications. J Public Health (Oxf) 2023; 45:e400-e408. [PMID: 37169578 DOI: 10.1093/pubmed/fdac163] [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: 06/10/2021] [Revised: 10/11/2022] [Accepted: 12/06/2022] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Research evidence shows a strong association between adverse childhood experiences (ACEs) and later-life substance use. But little is known about the prevalence and impact of ACEs among young people using drugs (YPUD) in Vietnam. METHOD A cross-sectional study using respondent-driven sampling and peer recruitment methods was conducted among YPUD aged 16-24 in three cities in Vietnam. Eligible participants were screened for ACEs using the ACE-IQ, tested for HIV and hepatitis C, and assessed for sociodemographic and behavioral characteristics. RESULTS Data were collected on 553 individuals whose median age was 20: 79% were male, 18.3% women and 2.7% transgender. Methamphetamine use was reported by 75.8% of participants. 85.5% reported at least one ACE and 27.5% had four ACEs or more. An ACE score of 4 or higher was associated with female and transgender, lower educational level, methamphetamine use, buying sex, depression, psychotic symptoms and expressed need for mental health support. CONCLUSIONS ACEs were found to be very common among YPUD in Vietnam. It is therefore strongly recommended that these young people should be provided with a comprehensive and secure assessment and care that includes not only essential harm reduction and addiction treatment needs but also addresses their mental health needs.
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Affiliation(s)
- Thanh Luan Pham
- Hanoi Medical University Hospital, Hanoi, Vietnam
- Center for Training and Research on Substance abuse - HIV, Hanoi Medical University, 01 Ton That Tung street, Dong Da District, Hanoi, Vietnam
| | | | - Kieu An Nguyen
- Supporting Community Development Initiative, Hanoi, Vietnam
| | - John Paul Ekwaru
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Olivier Phan
- CESP/Inserm 1018, Centre Pierre Nicole, French Red Cross, Paris, France
| | - Laurent Michel
- CESP/Inserm 1018, Centre Pierre Nicole, French Red Cross, Paris, France
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10
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Baldaçara L, Ramos A, Castaldelli-Maia JM. Managing drug-induced psychosis. Int Rev Psychiatry 2023; 35:496-502. [PMID: 38299647 DOI: 10.1080/09540261.2023.2261544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/18/2023] [Indexed: 02/02/2024]
Abstract
Substance-induced psychosis is a secondary psychotic disorder resulting from drug abuse, characterized by one or more psychotic episodes. Drug-induced psychosis is expected to resolve after a 30-day period of sobriety, however, individuals with this condition are more likely to develop severe drug addiction. Compared to primary psychosis, participants with drug-induced psychosis exhibit poorer family history of psychotic diseases, higher insight, fewer positive and negative symptoms, more depressive symptoms, and greater anxiety. Substance-induced psychosis is strongly associated with the emergence of bipolar illness or schizophrenia spectrum disorder, with an increased chance of developing schizophrenia at a younger age. Episodes of self-harm after substance-induced psychosis are strongly linked to an elevated likelihood of developing schizophrenia or bipolar disorder. Effective treatment involves ruling out emergencies, investigating underlying causes, and addressing acute intoxication and withdrawal. Management includes dynamic assessment, intervention, and vigilant monitoring in cases of suicidal behaviour. Antipsychotics may be used for short term, with gradual discontinuation when a person is in a stable condition. Relapse prevention strategies, both medication and non-medication-based, are crucial in long-term management. Conversion rates to schizophrenia or bipolar disorder can be as high as one in three individuals, with cannabis users and those with early-onset substance abuse at the highest risk.
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Affiliation(s)
- Leonardo Baldaçara
- Federal University of Tocantins, Palmas, Brazil
- Directory Board, Brazilian Psychiatric Association, Rio de Janeiro, Brazil
| | - Artur Ramos
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - João Maurício Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
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11
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Ellilä V, Levola J, Denissoff A, Partanen M, Niemelä S. Psychotic-Like Experiences and Concurrent Substance Use Among People Who Use New Psychoactive Substances. Subst Use Misuse 2023; 58:1606-1614. [PMID: 37482647 DOI: 10.1080/10826084.2023.2236212] [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: 07/25/2023]
Abstract
New psychoactive substances (NPS) are a group of substances that mimic established drugs, e.g., cannabinoids, stimulants, and opioids. NPS use has been associated with psychotic-like experiences, but current research is limited. This study focused on NPS use and psychotic-like experiences in persons attending substance use services in South-West Finland. The primary aim was to evaluate if NPS use associates with psychotic-like experiences, and if the association is independent of comorbid psychotic illness. As a secondary aim, this study evaluated concurrent substance use among people who use NPS. The study was based on a voluntary and anonymous survey administered on-site for people attending substance use services. The survey was conducted in 17 substance use service centers in South-West Finland in 2019, totaling 219 respondents. Information on substance use, service use due to psychotic episodes, and comorbid psychotic illness was collected. A validated PROD questionnaire was used for information on psychotic-like experiences. In all, 17% of 219 participants (n = 38) reported NPS use. After adjustments with comorbid psychotic illness, age, and gender, NPS use associated with PROD-screen positivity, i.e., reporting at least three psychotic-like symptoms. NPS use also associated with service use due to substance-induced psychotic episodes, and extensive use of several substances. In this study, NPS use associated with psychotic-like experiences independently of comorbid psychotic illness. However, as NPS use is also associated with heavy use of several substances, this study implicates concurrent substance use as a confounding factor when studying NPS use, which should be considered in future research.
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Affiliation(s)
- Venla Ellilä
- Department of Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jonna Levola
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
- HUS Brain Centre, Psychiatry, Hospital District of Helsinki and Uusimaa and Helsinki University Hospital, Helsinki, Finland
| | - Alexander Denissoff
- Department of Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland
- Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland
| | | | - Solja Niemelä
- Department of Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland
- Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland
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12
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Anderson AC, Robinson AH, Giddens E, Hartshorn B, Allan E, Rowe C, Lawrence T, Chong TTJ, Lubman DI, Verdejo-Garcia A. Proof-of-concept trial of Goal Management Training + to improve executive functions and treatment outcomes in methamphetamine use disorder. Drug Alcohol Depend 2023; 246:109846. [PMID: 37004463 DOI: 10.1016/j.drugalcdep.2023.109846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/30/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Deficits in executive function are common in methamphetamine use disorder (MUD), likely contributing to difficulties in sustained treatment success. Cognitive remediation interventions are designed to treat such deficits but have not been adapted to the needs of people with MUD. This study presents a proof-of-concept trial to evaluate a new cognitive remediation program for MUD, Goal Management Training+ (GMT+). METHODS This was a cluster-randomised crossover trial comparing GMT+ with a psychoeducation-based control (Brain Health Workshop; BHW). GMT+ is a therapist-administered group-based cognitive remediation for executive dysfunction comprising four 90-minute weekly sessions and daily journal activities. BHW is a lifestyle psychoeducation program matched to GMT+ for therapist involvement, format, and duration. Participants (n = 36; GMT n = 17; BHW n = 19) were recruited from therapeutic communities in Victoria, Australia. Primary outcomes included intervention acceptability, feasibility, and improvements in self-reported executive function. Secondary outcomes included cognitive tests of executive function, severity of methamphetamine dependence, craving, and quality of life. We performed mixed linear modelling and calculated Hedges' g effect sizes. RESULTS GMT+ participant ratings and program retention indicated high acceptability. There was no difference between GMT+ and BHW on self-reported executive function (g = 0.06). Cognitive tasks suggested benefits of GMT+ on information gathering (g = 0.88) and delay-discounting (g = 0.80). Severity of methamphetamine dependence decreased more in GMT+ (g = 1.47). CONCLUSIONS GMT+ was well-accepted but did not improve self-reported executive functioning. Secondary outcomes suggested GMT+ was beneficial for objective cognitive performance and severity of dependence.
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Affiliation(s)
- Alexandra C Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Addiction Research Centre, Monash University, Victoria, Australia
| | - Alex H Robinson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Addiction Research Centre, Monash University, Victoria, Australia
| | - Emily Giddens
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Breanna Hartshorn
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Eric Allan
- Odyssey House Victoria, Melbourne, Victoria, Australia
| | - Carol Rowe
- Odyssey House Victoria, Melbourne, Victoria, Australia
| | | | - Trevor T-J Chong
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Victoria, Australia; Monash Addiction Research Centre, Monash University, Victoria, Australia
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Addiction Research Centre, Monash University, Victoria, Australia.
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13
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Brett J, Knock E, Korthuis PT, Liknaitzky P, Murnane KS, Nicholas CR, Patterson JC, Stauffer CS. Exploring psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder. Front Psychiatry 2023; 14:1123424. [PMID: 36998623 PMCID: PMC10043240 DOI: 10.3389/fpsyt.2023.1123424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Methamphetamine use disorder is a chronic relapsing condition associated with substantial mental, physical, and social harms and increasing rates of mortality. Contingency management and psychotherapy interventions are the mainstays of treatment but are modestly effective with high relapse rates, while pharmacological treatments have shown little to no efficacy. Psilocybin-assisted psychotherapy is emerging as a promising treatment for a range of difficult-to-treat conditions, including substance use disorders; however, no studies have yet been published looking at psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder. Here we review the rationale for psilocybin-assisted psychotherapy as a potential treatment for this indication, and describe practical considerations based on our early experience designing and implementing four separate clinical trials of psilocybin-assisted psychotherapy for methamphetamine use disorder.
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Affiliation(s)
- Jonathan Brett
- Department of Clinical Pharmacology, St. Vincent’s Hospital, Sydney, NSW, Australia
- School of Population Health, Medicines Intelligence Centre of Research Excellence, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Knock
- Alcohol and Drug Service, St. Vincent’s Hospital, Sydney, NSW, Australia
| | - P. Todd Korthuis
- Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Paul Liknaitzky
- Department of Psychiatry, School of Clinical Sciences, Monash University, Caulfield, VIC, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Caulfield, VIC, Australia
| | - Kevin S. Murnane
- Louisiana Addiction Research Center, Department of Pharmacology, Toxicology & Neuroscience, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health, Shreveport, LA, United States
| | - Christopher R. Nicholas
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, United States
| | - James C. Patterson
- Louisiana Addiction Research Center, Department of Pharmacology, Toxicology & Neuroscience, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health, Shreveport, LA, United States
| | - Christopher S. Stauffer
- Department of Mental Health, Veterans Affairs Portland Health Care System, Portland, OR, United States
- Social Neuroscience and Psychotherapy Lab, Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
- *Correspondence: Christopher S. Stauffer,
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14
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Boden JM, Foulds JA, Newton-Howes G, McKetin R. Methamphetamine use and psychotic symptoms: findings from a New Zealand longitudinal birth cohort. Psychol Med 2023; 53:987-994. [PMID: 34134802 DOI: 10.1017/s0033291721002415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study examined the association between methamphetamine use and psychotic symptoms in a New Zealand general population birth cohort (n = 1265 at birth). METHODS At age 18, 21, 25, 30, and 35, participants reported on their methamphetamine use and psychotic symptoms in the period since the previous interview. Generalized estimating equations modelled the association between methamphetamine use and psychotic symptoms (percentage reporting any symptom, and number of symptoms per participant). Confounding factors included childhood individual characteristics, family socioeconomic circumstances and family functioning. Long term effects of methamphetamine use on psychotic symptoms were assessed by comparing the incidence of psychotic symptoms at age 30-35 for those with and without a history of methamphetamine use prior to age 30. RESULTS After adjusting for confounding factors and time-varying covariate factors including concurrent cannabis use, methamphetamine use was associated with a modest increase in psychosis risk over five waves of data (adjusted odds ratio (OR) 1.33, 95% confidence interval (CI) 1.03-1.72 for the percentage measure; and IRR 1.24, 95% CI 1.02-1.50 for the symptom count measure). The increased risk of psychotic symptoms was concentrated among participants who had used at least weekly at any point (adjusted OR 2.85, 95% CI 1.21-6.69). Use of methamphetamine less than weekly was not associated with increased psychosis risk. We found no evidence for a persistent vulnerability to psychosis in the absence of continuing methamphetamine use. CONCLUSION Methamphetamine use is associated with increased risk of psychotic symptoms in the general population. Increased risk is chiefly confined to people who ever used regularly (at least weekly), and recently.
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Affiliation(s)
- Joseph M Boden
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago Christchurch, Christchurch Central City, Christchurch 8011, New Zealand
| | - James A Foulds
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago Christchurch, Christchurch Central City, Christchurch 8011, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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15
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Palis H, Zhao B, Young P, Korchinski M, Greiner L, Nicholls T, Slaunwhite A. Stimulant use disorder diagnosis and opioid agonist treatment dispensation following release from prison: a cohort study. Subst Abuse Treat Prev Policy 2022; 17:77. [PMID: 36434706 PMCID: PMC9694574 DOI: 10.1186/s13011-022-00504-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Concurrent opioid and stimulant use is on the rise in North America. This increasing trend of use has been observed in the general population, and among people released from prison in British Columbia (BC), who face an elevated risk of overdose post-release. Opioid agonist treatment is an effective treatment for opioid use disorder and reduces risk of overdose mortality. In the context of rising concurrent stimulant use among people with opioid use disorder, this study aims to investigate the impact of stimulant use disorder on opioid agonist treatment dispensation following release from prison in BC. METHODS Linked health and corrections records were retrieved for releases between January 1st 2015 and December 29th 2018 (N = 13,380). Hospital and primary-care administrative health records were used to identify opioid and stimulant use disorder and mental illness. Age, sex, and health region were derived from BC's Client Roster. Incarceration data were retrieved from provincial prison records. Opioid agonist treatment data was retrieved from BC's provincial drug dispensation database. A generalized estimating equation produced estimates for the relationship of stimulant use disorder and opioid agonist treatment dispensation within two days post-release. RESULTS Cases of release among people with an opioid use disorder were identified (N = 13,380). Approximately 25% (N = 3,328) of releases ended in opioid agonist treatment dispensation within two days post-release. A statistically significant interaction of stimulant use disorder and mental illness was identified. Stratified odds ratios (ORs) found that in the presence of mental illness, stimulant use disorder was associated with lower odds of obtaining OAT [(OR) = 0.73, 95% confidence interval (CI) = 0.64-0.84)] while in the absence of mental illness, this relationship did not hold [OR = 0.89, 95% CI = 0.70-1.13]. CONCLUSIONS People with mental illness and stimulant use disorder diagnoses have a lower odds of being dispensed agonist treatment post-release compared to people with mental illness alone. There is a critical need to scale up and adapt opioid agonist treatment and ancillary harm reduction, and treatment services to reach people released from prison who have concurrent stimulant use disorder and mental illness diagnoses.
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Affiliation(s)
- Heather Palis
- grid.17091.3e0000 0001 2288 9830BC Centre for Disease Control, University of British Columbia, 655 W 12Th Avenue, BC V5Z 4R4 Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada
| | - Bin Zhao
- grid.17091.3e0000 0001 2288 9830BC Centre for Disease Control, University of British Columbia, 655 W 12Th Avenue, BC V5Z 4R4 Vancouver, Canada
| | - Pam Young
- Unlocking the Gates Services Society, 22838 Lougheed Hwy. Unit 104, Maple Ridge, BC V2X 2V6 Canada
| | - Mo Korchinski
- Unlocking the Gates Services Society, 22838 Lougheed Hwy. Unit 104, Maple Ridge, BC V2X 2V6 Canada
| | - Leigh Greiner
- BC Corrections, 1001 Douglas St, Victoria, BC V8W 2C5 Canada
| | - Tonia Nicholls
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada ,grid.498716.50000 0000 8794 2105BC Mental Health and Substance Use Services, 4949 Heather St, Vancouver, BC V5Z 3L7 Canada
| | - Amanda Slaunwhite
- grid.17091.3e0000 0001 2288 9830BC Centre for Disease Control, University of British Columbia, 655 W 12Th Avenue, BC V5Z 4R4 Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3 Canada
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16
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Al-Hakeim HK, Altufaili MF, Almulla AF, Moustafa SR, Maes M. Increased Lipid Peroxidation and Lowered Antioxidant Defenses Predict Methamphetamine Induced Psychosis. Cells 2022; 11:3694. [PMID: 36429122 PMCID: PMC9688750 DOI: 10.3390/cells11223694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND a significant percentage of methamphetamine (MA) dependent patients develop psychosis. The associations between oxidative pathways and MA-induced psychosis (MIP) are not well delineated. OBJECTIVE the aim of this study is to delineate whether acute MA intoxication in MA dependent patients is accompanied by increased nitro-oxidative stress and whether the latter is associated with MIP. METHOD we recruited 30 healthy younger males and 60 acutely intoxicated males with MA dependence and assessed severity of MA use and dependence and psychotic symptoms during intoxication, and serum oxidative toxicity (OSTOX) biomarkers including oxidized high (oxHDL) and low (oxLDL)-density lipoprotein, myeloperoxidase (MPO), malondialdehyde (MDA), and nitric oxide (NO), and antioxidant defenses (ANTIOX) including HDL-cholesterol, zinc, glutathione peroxidase (GPx), total antioxidant capacity (TAC), and catalase-1. RESULTS a large part (50%, n = 30) of patients with MA dependence could be allocated to a cluster characterized by high psychosis ratings including delusions, suspiciousness, conceptual disorganization and difficulties abstract thinking and an increased OSTOX/ANTIOX ratio. Partial Least Squares analysis showed that 29.9% of the variance in MIP severity (a first factor extracted from psychosis, hostility, excitation, mannerism, and formal thought disorder scores) was explained by HDL, TAC and zinc (all inversely) and oxLDL (positively). MA dependence and dosing explained together 44.7% of the variance in the OSTOX/ANTIOX ratio. CONCLUSIONS MA dependence and intoxication are associated with increased oxidative stress and lowered antioxidant defenses, both of which increase risk of MIP during acute intoxication. MA dependence is accompanied by increased atherogenicity due to lowered HDL and increased oxLDL and oxHDL.
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Affiliation(s)
| | | | - Abbas F. Almulla
- Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf 54001, Iraq
| | - Shatha Rouf Moustafa
- Clinical Analysis Department, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Psychiatry, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
- School of Medicine, Barwon Health, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong VIC 3216, Australia
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17
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Jia X, Wang J, Jiang W, Kong Z, Deng H, Lai W, Ye C, Guan F, Li P, Zhao M, Yang M. Common gray matter loss in the frontal cortex in patients with methamphetamine-associated psychosis and schizophrenia. Neuroimage Clin 2022; 36:103259. [PMID: 36510408 PMCID: PMC9668661 DOI: 10.1016/j.nicl.2022.103259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/08/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND HYPOTHESIS Methamphetamine (MA)-associated psychosis has become a public concern. However, its mechanism is not clear. Investigating similarities and differences between MA-associated psychosis and schizophrenia in brain alterations would be informative for neuropathology. STUDY DESIGN This study compared gray matter volumes of the brain across four participant groups: healthy controls (HC, n = 53), MA users without psychosis (MA, n = 22), patients with MA-associated psychosis (MAP, n = 34) and patients with schizophrenia (SCZ, n = 33). Clinical predictors of brain alterations, as well as association of brain alterations with psychotic symptoms and attention impairment were further investigated. STUDY RESULTS Compared with the HC, the MAP and the SCZ showed similar gray matter reductions in the frontal cortex, particularly in prefrontal areas. Moreover, a stepwise extension of gray matter reductions was exhibited across the MA - MAP - SCZ. Duration of abstinence was associated with regional volumetric recovery in the MAP, while this amendment in brain morphometry was not accompanied with symptom's remission. Illness duration of psychosis was among the predictive factors of regional gray matter reductions in both psychotic groups. Volume reductions were found to be associated with attention impairment in the SCZ, while this association was reversed in the MAP in frontal cortex. CONCLUSIONS This study suggested MA-associated psychosis and schizophrenia had common neuropathology in cognitive-related frontal cortices. A continuum of neuropathology between MA use and schizophrenia was tentatively implicated. Illness progressions and glial repairments could both play roles in neuropathological changes in MA-associated psychosis.
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Affiliation(s)
- Xiaojian Jia
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Jianhong Wang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Wentao Jiang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Zhi Kong
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Huan Deng
- School of International Education, Beijing University of Chemical Technology, Beijing 100029, China
| | - Wentao Lai
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Caihong Ye
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Fen Guan
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Peng Li
- Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Mei Yang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China.
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18
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Huang CL, Tsai IJ, Lee CWS. Risk of psychosis in illicit amphetamine users: a 10 year retrospective cohort study. EVIDENCE-BASED MENTAL HEALTH 2022; 25:163-168. [PMID: 35165118 PMCID: PMC10231478 DOI: 10.1136/ebmental-2021-300300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/18/2021] [Indexed: 11/04/2022]
Abstract
QUESTION Amphetamine use is a risk factor for psychosis, which imposes a substantial burden on society. We aimed to investigate the incidence of psychosis associated with illicit amphetamine use and whether rehabilitation treatments could influence the psychosis risk. STUDY SELECTION AND ANALYSIS A retrospective cohort study was conducted using the population based Taiwan Illicit Drug Issue Database (TIDID) and the National Health Insurance Research Database (NHIRD), from 2007 to 2016. We identified 74 601 illicit amphetamine users as the amphetamine cohort and 2 98 404 subjects as the non-amphetamine cohort. The incidence rate of newly diagnosed psychosis was the main outcome. Cox proportional hazards models were applied to assess the effects of amphetamine, and the Kaplan-Meier method was used to estimate the cumulative psychosis incidence curves. FINDINGS Illicit amphetamine users were 5.28 times more likely to experience psychosis than those without illicit drug use records. The risk was higher for subjects with multiple arrests for amphetamine use. A greater hazard ratio (HR) magnitude was observed in female patients. We also observed a significant decrease in the risk of psychosis in patients receiving rehabilitation treatments during deferred prosecution (adjusted HR 0.74, 95% CI 0.61 to 0.89). CONCLUSIONS Illicit amphetamine use was associated with an increased incidence of psychosis. The risk was identified across all age groups, particularly in women and in those arrested multiple times, and was inversely correlated with rehabilitation treatments for amphetamine misuse.
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Affiliation(s)
- Chieh-Liang Huang
- Tsaotun Psychiatric Centre Ministry of Health and Welfare, Nan-Tou County, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - I-Ju Tsai
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cynthia Wei-Sheng Lee
- Centre for Drug Abuse and Addiction, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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Nickel NC, Enns JE, Freier A, McCulloch SC, Chartier M, Casidsid HJM, Balogun OD, Mulhall D, Dragan R, Sarkar J, Bolton J, Konrad G, Phillips-Beck W, Sanguins J, Shimmin C, McDonald N, Mignone J, Hinds A. Characterising methamphetamine use to inform health and social policies in Manitoba, Canada: a protocol for a retrospective cohort study using linked administrative data. BMJ Open 2022; 12:e062127. [PMID: 36261234 PMCID: PMC9582321 DOI: 10.1136/bmjopen-2022-062127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Rising use of methamphetamine is causing significant public health concern in Canada. The biological and behavioural effects of methamphetamine range from wakefulness, vigour and euphoria to adverse physical health outcomes like myocardial infarction, haemorrhagic stroke, arrhythmia and seizure. It can also cause severe psychological complications such as psychosis. National survey data point to increasing rates of methamphetamine use, as well as increasing ease of access and serious methamphetamine-related harms. There is an urgent need for evidence to address knowledge gaps, provide direction to harm reduction and treatment efforts and inform health and social policies for people using methamphetamine. This protocol describes a study that aims to address this need for evidence. METHODS The study will use linked, whole population, de-identified administrative data from the Manitoba Population Research Data Repository. The cohort will include individuals in the city of Winnipeg, Manitoba, who came into contact with the health system for reasons related to methamphetamine use from 2013 to 2021 and a comparison group matched on age, sex and geography. We will describe the cohort's sociodemographic characteristics, calculate incidence and prevalence of mental disorders associated with methamphetamine use and examine rates of health and social service use. We will evaluate the use of olanzapine pharmacotherapy in reducing adverse emergency department outcomes. In partnership with Indigenous co-investigators, outcomes will be stratified by First Nations and Métis identity. ETHICS AND DISSEMINATION The study was approved by the University of Manitoba Health Research Ethics Board, and access datasets have been granted by all data providers. We also received approval from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Métis Federation. Dissemination will be guided by an 'Evidence 2 Action' group of public rightsholders, service providers and knowledge users who will ensure that the analyses address the critical issues.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Freier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott C McCulloch
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hera J M Casidsid
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Drew Mulhall
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Carolyn Shimmin
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Neil McDonald
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Javier Mignone
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aynslie Hinds
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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20
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Rungnirundorn T, Krusong K, Kalayasiri R, Maes M. Leukocyte telomere length is not shortened in methamphetamine dependence or methamphetamine-induced psychosis but is increased following traumatic events. World J Biol Psychiatry 2022; 23:613-621. [PMID: 34895035 PMCID: PMC9991870 DOI: 10.1080/15622975.2021.2016957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study aims to examine the effects of methamphetamine (MA) use and dependence and MA withdrawal symptoms on the telomere length and whether shortening of the latter is associated with MA-induced psychosis (MIP). METHODS This study included 185 MA-abuse, 118 MA-dependent, and 67 MIP patients, diagnosed using DSM-IV criteria. The Semi-structured Assessment for Drug Dependence and Alcoholism (SSADDA) questionnaire was employed to collect MA-related data. MIP was confirmed using the Methamphetamine Experience Questionnaire (MEQ). The leukocyte telomere length was measured using real-time polymerase chain reaction measuring the Telomere/Single gene ratio (T/S ratio). Data were analysed using multivariate statistical analyses. RESULTS There were no significant associations between the T/S ratio and severity of MA-use, MIP, and MA withdrawal symptoms. MIP was significantly predicted by alcohol dependence, antisocial personality disorder, and MA-use severity. There were significantly positive associations between the T/S ratio and previous traumatic and life-threatening events. The T/S ratio was not affected by alcohol and nicotine dependence. Alcohol and nicotine dependence, antisocial personality disorder, and severity of MA use increased risk of MA withdrawal symptoms. CONCLUSION MIP and MA-use severity are not associated with leukocyte telomere length, but previous traumatic and life-threatening events are associated with increased telomere length.
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Affiliation(s)
| | - Kuakarun Krusong
- Structural and Computational Biology Research Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Rasmon Kalayasiri
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- IMPACT Strategic Research Centre, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
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21
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Brumbaugh S, Tuan WJ, Scott A, Latronica JR, Bone C. Trends in characteristics of the recipients of new prescription stimulants between years 2010 and 2020 in the United States: An observational cohort study. EClinicalMedicine 2022; 50:101524. [PMID: 35812998 PMCID: PMC9257326 DOI: 10.1016/j.eclinm.2022.101524] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Stimulant prescriptions increased by 250% in the United States from 2006-2016 while diagnoses for ADHD minimally increased. There is insufficient data regarding who may be the recipients of these new stimulant prescriptions and safety of stimulants have come under scrutiny in some populations. We aim to describe trends in stimulant prescriptions across biopsychosocial patient level factors between 2010 and 2020. METHODS We applied a retrospective observational cohort design utilizing electronic health records from 52 healthcare organizations sourced from the TriNetX research network database in the United States. We assessed new stimulant prescriptions across biopsychosocial variables for recipients of prescriptions. We utilized linear regression to assess longitudinal trends of all participants and also conducted an age stratified logistic regression analysis. FINDINGS There was an increase in stimulants to people categorized as white (OR 1.24 CI 1.20-1.28), female (OR 1.28 CI 1.23-1.31), and to those with diagnosed anxiety disorders (OR 1.39 CI 1.35-1.44) as well as obesity (OR 1.34 CI 1.28-1.41). The average age of recipients increased throughout the study, and among people sixty-five and older, there was an increase in prescriptions to people with multiple cardiovascular risk factors. INTERPRETATION Prescription stimulant dispensing may have liberalized during the study period in some demographics as a greater number of new prescriptions were dispensed to individuals with risk of adverse outcomes (i.e. older individuals, obese individuals, and geriatric patients with CV risk factors) between 2010 and 2020. Similar trends in prescription medications were witnessed through the opioid epidemic and warrant attention given concerning trends with illicit stimulants. Additional research that investigates patient and provider motivation for stimulant prescriptions, as well as risk perception of stimulants, may be warranted. FUNDING This study was made possible by institutional resources at Penn State Hershey Medical Center.
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Affiliation(s)
- Shannon Brumbaugh
- Penn State Hershey Medical Center, College of Medicine, Hershey, PA, USA
| | - Wen Jan Tuan
- Penn State Hershey Medical Center, Department of Family and Community Medicine, Hershey, PA, USA
| | - Alyssa Scott
- Penn State Hershey Medical Center, College of Medicine, Hershey, PA, USA
| | - James R. Latronica
- University of Pittsburgh School of Medicine, Department of Psychiatry and Department of Family Medicine, Pittsburgh, PA, USA
- Corresponding author at: University of Pittsburgh School of Medicine, Department of Psychiatry, Department of Family Medicine, 3501 Forbes Ave., Suite 860, Pittsburgh, PA 15213, USA.
| | - Curtis Bone
- Penn State Hershey Medical Center, Department of Family and Community Medicine, Hershey, PA, USA
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22
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Shalaby AS, Bahanan AO, Alshehri MH, Elag KA. Sleep Deprivation & Amphetamine Induced Psychosis. PSYCHOPHARMACOLOGY BULLETIN 2022; 52:31-40. [PMID: 35815175 PMCID: PMC9235313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To explore the relationship between sleep deprivation and amphetamine-induced psychosis. METHODS The patient group included 78 patients with a diagnosis of amphetamine (Captagon)-induced psychosis. The control group included 49 patients with no current or past history of amphetamine (Captagon)-induced psychosis. All study subjects underwent the following: a demographic sheet, a structured clinical interview for SM-IV (SCID 1), a drug use questionnaire, a questionnaire to explore any relationship between sleep deprivation and Captagon-induced psychosis, routine medical investigation, and urine screening for detection of drugs. RESULTS The patient group showed significantly higher both regular and maximum daily doses of Captagon. Patients showed more periods of sleep deprivation with the use of Captagon in comparison to controls, especially with the increase of the Captagon dose. Patients believed that the occurrence and termination of sleep deprivation were the cause of the start and end of psychotic experiences (more so than the increase and decrease or stoppage of Captagon doses). CONCLUSION sleep deprivation plays an essential role in the development of psychotic symptoms in patients who are using Captagon.
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Affiliation(s)
- Amr Said Shalaby
- Shalaby, MD, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Department of Neuropsychiatry, Menoufia University, Egypt. Bahanan, M.B.B.CH, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Alshehri, M.B.B.CH, Eradah Complex for Mental Health and Addiction, Eradah services, Jeddah, Saudi Arabia. Elag, MD, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Department of Neuropsychiatry, Ain Shams University, Egypt
| | - Abdullah Osama Bahanan
- Shalaby, MD, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Department of Neuropsychiatry, Menoufia University, Egypt. Bahanan, M.B.B.CH, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Alshehri, M.B.B.CH, Eradah Complex for Mental Health and Addiction, Eradah services, Jeddah, Saudi Arabia. Elag, MD, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Department of Neuropsychiatry, Ain Shams University, Egypt
| | - Mishal Hasan Alshehri
- Shalaby, MD, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Department of Neuropsychiatry, Menoufia University, Egypt. Bahanan, M.B.B.CH, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Alshehri, M.B.B.CH, Eradah Complex for Mental Health and Addiction, Eradah services, Jeddah, Saudi Arabia. Elag, MD, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Department of Neuropsychiatry, Ain Shams University, Egypt
| | - Khaled Ahmed Elag
- Shalaby, MD, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Department of Neuropsychiatry, Menoufia University, Egypt. Bahanan, M.B.B.CH, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Alshehri, M.B.B.CH, Eradah Complex for Mental Health and Addiction, Eradah services, Jeddah, Saudi Arabia. Elag, MD, Eradah Complex for Mental Health and Addiction, Eradah Services, Jeddah, Saudi Arabia. Department of Neuropsychiatry, Ain Shams University, Egypt
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Fakharbad MJ, Moshiri M, Ommati MM, Talebi M, Etemad L. A review of basic to clinical studies of the association between hyperammonemia, methamphetamine. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:921-931. [PMID: 35604430 DOI: 10.1007/s00210-022-02248-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
Methamphetamine (METH), an addictive psychostimulant drug, is the second most widely used type of drug all around the world. METH abusers are more likely to develop a psycho-neurological complication. Hyperammonemia (HAM) causes neuropsychiatric illnesses such as mental state changes and episodes of acute encephalopathy. Recently, there are some shreds of evidence about the relationship between METH complication and HAM. Both METH intoxication and HAM could induce psychosis, agitation, memory impairment, and psycho-neuronal disorders. They also have similar mechanisms of neuronal damages, such as excitotoxicity, oxidative stress, mitochondrial impairments, and inflammation responses, which can subsequently increase the glutamate level of the brain. Hence, the basic to clinical studies of the association between HAM and METH are reviewed by monitoring six case studies and a good body of animal studies literature. All instances of METH-associated HAM had changes in mental state and some level of confusion that were improved when the ammonia serum level returned to the normal level. Furthermore, most of them had typical vital signs. Several studies suggested some sources for METH-associated HAM, including METH-induced liver and renal damages, muscular hyperactivity, gut bacterial overgrowth, co-abuse of other substances, and using some forms of NH3 in METH cooking. In conclusion, it seems that mental status changes in METH abusers may be related to ammonia intoxication or HAM; therefore, it is important to assess the serum level of ammonia in METH intoxicated patients and resolve it.
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Affiliation(s)
- Marzieh Jafari Fakharbad
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Mehdi Ommati
- College of Life Sciences, Shanxi Agricultural University, Taigu, Shanxi, 030801, China
| | - Mehdi Talebi
- Department of Community and Family Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Drug Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Gupta M, Gupta N, Esang M, Antai A, Moll J. Refractory Methamphetamine-Induced Psychosis: An Emerging Crisis in Rural America and the Role of Amantadine in Therapeutics. Cureus 2022; 14:e22871. [PMID: 35392446 PMCID: PMC8979574 DOI: 10.7759/cureus.22871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/05/2022] Open
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Fiorentini A, Cantù F, Crisanti C, Cereda G, Oldani L, Brambilla P. Substance-Induced Psychoses: An Updated Literature Review. Front Psychiatry 2021; 12:694863. [PMID: 35002789 PMCID: PMC8732862 DOI: 10.3389/fpsyt.2021.694863] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/17/2021] [Indexed: 01/22/2023] Open
Abstract
Background: On the current psychopharmacological panorama, the variety of substances able to provoke an episode of acute psychosis is rapidly increasing. Such psychotic episodes are classified according to the major category of symptoms: positive, negative, or cognitive psychotic episodes. On one hand, the abuse of methamphetamines, cannabis, and cocaine plays a big role in increasing the incidence of episodes resembling a psychotic disorder. On the other hand, the progress in terms of pharmacodynamics knowledge has led to the synthesis of new drugs, such as cannabinoids and cathinone's, which have rapidly entered into the common pool of abusers' habits. Regarding these newly synthesized substances of abuse, further clinical studies are needed to understand their psychogenic properties. The topic of this review is complicated due to the frequent abuse of psychotomimetic drugs by patients affected by psychotic disorders, a fact that makes it extremely difficult to distinguish between an induced psychosis and a re-exacerbation of a previously diagnosed disorder. Methods: The present narrative review summarizes results from clinical studies, thus investigating the psychotogenic properties of abused substances and the psychotic symptoms they can give rise to. It also discusses the association between substance abuse and psychosis, especially with regards to the differential diagnosis between a primary vs. a substance-induced psychotic disorder. Findings: Our findings support the theory that psychosis due to substance abuse is commonly observed in clinical practice. The propensity to develop psychosis seems to be a function of the severity of use and addiction. Of note, from a phenomenological point of view, it is possible to identify some elements that may help clinicians involved in differential diagnoses between primary and substance-induced psychoses. There remains a striking paucity of information on the outcomes, treatments, and best practices of substance-induced psychotic episodes.
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Affiliation(s)
- Alessio Fiorentini
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Filippo Cantù
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Camilla Crisanti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Guido Cereda
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Lucio Oldani
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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26
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Liu MT. Pharmacotherapy treatment of stimulant use disorder. Ment Health Clin 2021; 11:347-357. [PMID: 34824959 PMCID: PMC8582769 DOI: 10.9740/mhc.2021.11.347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/16/2021] [Indexed: 01/12/2023] Open
Abstract
Stimulant use disorder (SUD) is a public health problem in the United States that is associated with increased morbidity and mortality. Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the main treatment modality for SUDs and no pharmacotherapy is currently FDA approved for this indication. Although some medications show promising data for the treatment of SUD, the evidence remains inconsistent, and the clinical application is limited due to the heterogenicity of the population and the lack of studies in patients with various comorbidities. Selection of pharmacotherapy treatment for methamphetamine intoxication, persistent methamphetamine-associated psychosis with methamphetamine use disorder, and cocaine use disorder in patients with co-occurring OUD are discussed in 3 patient cases.
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27
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Yang M, Jia X, Zhou H, Ren P, Deng H, Kong Z, Xie C, Hu W, Jiang W, Lai W, Zhang B, Zhao M, Liu T. Brain dysfunction of methamphetamine-associated psychosis in resting state: Approaching schizophrenia and critical role of right superior temporal deficit. Addict Biol 2021; 26:e13044. [PMID: 33957703 DOI: 10.1111/adb.13044] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/05/2021] [Accepted: 03/31/2021] [Indexed: 01/10/2023]
Abstract
Methamphetamine (MA)-associated psychosis (MAP) is highly debilitating and common among individuals who use the drug, yet the underlying neural mechanism is not clear. This study compared brain functions between patients with MAP and those with schizophrenia during resting state and investigated the effect of brain alteration on the association between MA use and psychosis in patients with MAP. Three groups, including 24 patients with MAP, 17 with schizophrenia in first-episode (SCZ) and 31 healthy controls (HCs), were included after receiving a resting-state functional MRI scan. The severity of psychosis was assessed with Positive and Negative Syndrome Scale (PANSS). Imaging data were analysed using regional homogeneity (ReHo) to measure individual's brain function. Compared with the HC subjects, the MAP and SCZ groups had significantly lower ReHo in the cortical regions including left postcentral cortex, right superior temporal gyrus and right rolandic operculum, while had higher ReHo in the left putamen, with brain dysfunctions being more pronounced in the SCZ group. Among the MAP subjects, a mediating effect of ReHo in the right superior temporal gyrus was found on the association between MA use frequency and PANSS positive score. MAP and schizophrenia had a common trend of brain alteration, with the dysfunction being more pronounced in schizophrenia. This finding implicated that MAP might be a condition with neuropathology approaching schizophrenia. The observed critical role of right superior temporal deficit between MA use and psychosis proposed a potential target for interventions.
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Affiliation(s)
- Mei Yang
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
| | - Xiaojian Jia
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
| | - Hongying Zhou
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
- School of Mental Health (Research Institute of Mental Health) Jining Medical University Jining China
| | - Ping Ren
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
| | - Huan Deng
- School of International Education Beijing University of Chemical Technology Beijing China
| | - Zhi Kong
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
| | - Chunyu Xie
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
| | - Wenjun Hu
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
| | - Wentao Jiang
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
| | - Wentao Lai
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
| | - Bin Zhang
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital) Guangzhou China
| | - Min Zhao
- Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Tiebang Liu
- Shenzhen Mental Health Center Shenzhen Kangning Hospital Shenzhen China
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Franke AG, Koller G, Neumann S, Proebstl L, Manz K, Krause D, Kamp F, Hager L, Soyka M. Psychopathology and Attention Performance in Methamphetamine Users with ADHD Symptomology in Childhood. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00682-0] [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: 10/20/2022] Open
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Harnett JT, Dargan PI, Dines AM, Archer JRH, Greene SL, Hunter LJ, Wood DM. Increasing emergency department attendances in central London with methamphetamine toxicity and associated harms. Emerg Med J 2021; 39:463-466. [PMID: 34649939 DOI: 10.1136/emermed-2020-209550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Methamphetamine is a stimulant drug of abuse with increasing prevalence of use worldwide leading to public health concern. While previous research by our group a decade ago found no evidence of increasing harms associated with methamphetamine use in the UK, there are conflicting data on whether or not this is still the case. This paper aims to identify trends in methamphetamine-related harms and characterise the clinical features of ED presentations involving methamphetamine with gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL). METHODS We retrospectively interrogated a database of all toxicology-related presentations to two central London EDs, extracting data on drugs involved for presentations relating to methamphetamine between 2005 and 2018 to enable analysis of trends. Further clinical data were extracted for presentations between 2014 and 2018 to give a 4-year case series. RESULTS A total of 1244 presentations involving the use of methamphetamine were identified. The number of presentations rose from 4 in 2005 (1.9% of all recreational drug presentations) to 294 (16.2%) in 2018. A total of 850 cases were identified for the 2014-2018 case series, 94.9% were male with a median (range) age of 35.1 (16-67) years. The most common clinical features in the methamphetamine presentations were neuropsychiatric: agitation (41.5%), anxiety (35.2%), hallucinations (16.5%) and psychosis (14.8%). GHB/GBL was co-used in 54.2% of presentations and appeared to attenuate the neuropsychiatric features seen. Use of GHB/GBL was associated with a higher Poisoning Severity Score and requirement for level 2/3 (high dependency unit/intensive care unit (ICU)) care. CONCLUSION ED attendances in central London relating to methamphetamine use have risen over the last decade. Combining methamphetamine with GHB/GBL is common and is associated with a higher Poisoning Severity Score and need for ICU level care. Further work is required to establish whether further resources need to be directed at this clinical and public health problem.
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Affiliation(s)
- James T Harnett
- Emergency Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,'Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John R H Archer
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,'Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Shaun L Greene
- Victorian Poisons Information Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Laura J Hunter
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,'Faculty of Life Sciences and Medicine, King's College, London, UK
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Voce A, Burns R, Castle D, Calabria B, McKetin R. A latent class analysis of psychiatric symptom profiles associated with past-month methamphetamine use. Psychiatry Res 2021; 298:113760. [PMID: 33548691 DOI: 10.1016/j.psychres.2021.113760] [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: 04/20/2020] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Abstract
We explored latent psychiatric symptom profiles associated with methamphetamine use, and examined how these corresponded to diagnoses of schizophrenia (SZ) and methamphetamine-associated psychosis (MAP). We assessed psychiatric symptoms among 160 people who had used methamphetamine in the past month. Psychiatric symptoms were defined as a score of 4+ on Brief Psychiatric Rating Scale (BPRS) items. Diagnoses were made using the Composite International Diagnostic Interview (CIDI). Participants were defined as having MAP if they met symptom criteria for SZ, but symptoms were considered to be always the result of substance use. Latent class analysis identified three classes. Class one (44% of participants) had a low probability of most BPRS symptoms; 4% met criteria for SZ, 51% for MAP. Class two (31% of participants) had a higher probability hallucinations and suspiciousness (37-46%); 72% met criteria for MAP, and 7% for SZ. Class three (25% of participants) had the highest probability for all positive psychotic symptoms (hallucinations, suspiciousness, grandiosity, unusual thought content; 32-82%), and reported activation, conceptual disorganisation, and tension (35% met criteria for SZ and 17% for MAP). We found three distinct classes of psychiatric symptom profiles, two of which showed partial alignment with diagnostic constructs of SZ and MAP.
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Affiliation(s)
- Alexandra Voce
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Building 54, Mills Road, Acton, ACT 2601, Australia.
| | - Richard Burns
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Building 54, Mills Road, Acton, ACT 2601, Australia
| | - David Castle
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Bianca Calabria
- Research School of Population Health, Australian National University, Building 54, Mills Road, Acton, ACT 2601, Australia; National Drug and Alcohol Research Centre, University of New South Wales, 22 King Street, Randwick, NSW 2031, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, 22 King Street, Randwick, NSW 2031, Australia
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Wang Q, Wang Y, Zuo J, Zhou Y, Yang WFZ, Liao Y, Tang J, Wang X, Yang Q, Wu Q, Wu HE, Goodman CB, Liu T, Zhang X. Factors of Negative Affect in Elderly Patients With Substance Use Disorders During COVID-19 Pandemic. Front Psychiatry 2021; 12:697472. [PMID: 34354617 PMCID: PMC8329338 DOI: 10.3389/fpsyt.2021.697472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The outbreak of the novel coronavirus disease 2019 (COVID-19) has become the greatest public health emergency and has attracted global attention. During the COVID-19 pandemic, the negative affect (NA) of elderly patients with substance use disorders (SUDs) has also become a more serious public concern. The current study aims to clarify the NA and its influencing factors in elderly patients with SUDs during the pandemic. Methods: Two psychiatrists conducted semi-structured interviews with 77 SUD patients aged above 50 years to collect their demographical information and certain drug use characteristics. Barratt Impulse Scale and the Positive and Negative Affect Scale were used to obtain information about patients' self-reported impulsivity and NA. Results: Univariate linear regression analysis showed that NA was positively correlated with the frequency of drug use, type of SUDs, cravings during COVID-19, and impulsivity. Multiple linear regression analysis showed that being female, higher frequency of drug use, stronger cravings, and greater impulsiveness jointly accounted for the variation of NA in elderly patients with SUDs. Conclusions: This study confirmed that, during the COVID-19 pandemic, gender, frequency of drug use, cravings, and impulsivity were associated with NA in elderly patients with SUDs. This study provided a theoretical basis for clinicians to reduce the patients' NA.
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Affiliation(s)
- Qianjin Wang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, the Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Yingying Wang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, the Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Jinsong Zuo
- School of Life Science and Chemistry, Hunan University of Technology, Zhuzhou, China
| | - Yanan Zhou
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, the Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Winson Fu Zun Yang
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Yanhui Liao
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinsong Tang
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Wang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, the Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Qian Yang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, the Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Qiuxia Wu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, the Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Colin B Goodman
- Department of Psychiatry and Behavioral Sciences, the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Tieqiao Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, the Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Passchier RV, Stein DJ, Uhlmann A, van der Merwe C, Dalvie S. Schizophrenia Polygenic Risk and Brain Structural Changes in Methamphetamine-Associated Psychosis in a South African Population. Front Genet 2020; 11:1018. [PMID: 33133134 PMCID: PMC7566162 DOI: 10.3389/fgene.2020.01018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Background The genetic architecture of psychotic disorders is complex, with hundreds of genetic risk loci contributing to a polygenic model of disease. Overlap in the genetics of psychotic disorders and brain measures has been found in European populations, but has not been explored in populations of African ancestry. The aim of this study was to determine whether a relationship exists between a schizophrenia-derived PRS and (i) methamphetamine associated psychosis (MAP), and (ii) brain structural measures, in a South African population. Methods The study sample consisted of three participant groups: 31 individuals with MAP, 48 with apsychotic methamphetamine dependence, and 49 healthy controls. Using PRSice, PRS was generated for each of the participants with GWAS summary statistics from the Psychiatric Genomics Consortium Schizophrenia working group (PGC-SCZ2) as the discovery dataset. Regression analyses were performed to determine associations of PRS, with diagnosis, whole brain, and regional gray and white matter measures. Results Schizophrenia-derived PRS did not significantly predict MAP diagnosis. After correction for multiple testing, no significant associations were found between PRS and brain measures across all groups. Discussion The lack of significant associations here may indicate that the study is underpowered, that brain volumes in MAP are due to factors other than polygenic risk for schizophrenia, or that PRS derived from a largely European discovery set has limited utility in individuals of African ancestry. Larger studies, that include diverse populations, and more nuanced brain measures, may help elucidate the relationship between schizophrenia-PRS, brain structural changes, and psychosis. Conclusion This research presents the first PRS study to investigate shared genetic effects across psychotic disorders and brain structural measures in an African population. Ancestrally comparable discovery datasets may be useful for future African genetic research.
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Affiliation(s)
- Ruth V Passchier
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Anne Uhlmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, TU Dresden, Dresden, Germany
| | - Celia van der Merwe
- The Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, United States
| | - Shareefa Dalvie
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Le SM, Trouiller P, Duong Thi H, Khuat Thi Hai O, Pham Minh K, Vallo R, Rapoud D, Quillet C, Nguyen TL, Nguyen QD, NhamThi TT, Hoang Thi G, Feelemyer J, Hai VV, Moles JP, Doan HQ, Laureillard D, Des Jarlais DC, Nagot N, Michel L. Daily heroin injection and psychiatric disorders: A cross-sectional survey among People Who Inject Drugs (PWID) in Haiphong, Vietnam. Drug Alcohol Depend 2020; 216:108334. [PMID: 33038638 PMCID: PMC10290903 DOI: 10.1016/j.drugalcdep.2020.108334] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Psychiatric comorbidities are frequent among people who inject drugs, they are associated with a poorer prognosis and need to be addressed. Their interaction with daily heroin injection requires clarification. METHODS A cross-sectional survey was conducted among PWID recruited in the city of Haiphong, Vietnam, by respondent-driven sampling. The inclusion criteria were age 18 or older and current injection drug use, verified by skin marks and positive urine tests for heroin or methamphetamine. Data on socio-demographic characteristics, drug use, sexual behaviour and access to treatment were collected using face-to-face questionnaires by trained interviewers. PWID were screened by trained psychiatrists for depression, psychotic disorder and suicidality, using the MINI questionnaire. RESULTS 418 participants were included in the analyses. All were injected heroin users, 21 % were diagnosed with a current major depressive disorder, 15 % with a current psychotic disorder and 12 % presented a suicide risk. In the bivariate analyses, regular meth use, cannabis use and ketamine use were positively associated with presenting at least one psychiatric condition while daily heroin injection and being currently treated with methadone were negatively associated. In the multivariate model, poly-substance use was positively associated with depression (methamphetamine and drinking in addition to heroin) and psychotic disorder (methamphetamine and/or hazardous drinking in addition to heroin) while daily heroin injection and current methadone treatment were negatively and independently associated with depression and psychotic syndrome. CONCLUSIONS Our survey confirms the burden of methamphetamine use and the protective effect of methadone but also a possible protective effect of daily heroin injection.
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Affiliation(s)
- Sao Mai Le
- Hai Phong University of Medicine and Pharmacy, 72A Nguyễn Bỉnh Khiêm, Đằng Giang, Ngô Quyền, Hai Phong, Viet Nam.
| | - Philippe Trouiller
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, Fench Red Cross, 27 rue Pierre Nicole, 75005 Paris, France.
| | - Huong Duong Thi
- Hai Phong University of Medicine and Pharmacy, 72A Nguyễn Bỉnh Khiêm, Đằng Giang, Ngô Quyền, Hai Phong, Viet Nam.
| | - Oanh Khuat Thi Hai
- Supporting Community Development Initiatives, 240 Mai Anh Tuan, Thanh Cong Ward, Ba Dinh District, Hanoi, Viet Nam.
| | - Khue Pham Minh
- Hai Phong University of Medicine and Pharmacy, 72A Nguyễn Bỉnh Khiêm, Đằng Giang, Ngô Quyền, Hai Phong, Viet Nam.
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France.
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France.
| | - Catherine Quillet
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France.
| | - Thuy Linh Nguyen
- Hai Phong University of Medicine and Pharmacy, 72A Nguyễn Bỉnh Khiêm, Đằng Giang, Ngô Quyền, Hai Phong, Viet Nam.
| | - Quang Duc Nguyen
- Hai Phong University of Medicine and Pharmacy, 72A Nguyễn Bỉnh Khiêm, Đằng Giang, Ngô Quyền, Hai Phong, Viet Nam.
| | - Tuyet Thanh NhamThi
- Supporting Community Development Initiatives, 240 Mai Anh Tuan, Thanh Cong Ward, Ba Dinh District, Hanoi, Viet Nam.
| | - Giang Hoang Thi
- Hai Phong University of Medicine and Pharmacy, 72A Nguyễn Bỉnh Khiêm, Đằng Giang, Ngô Quyền, Hai Phong, Viet Nam.
| | - Jonathan Feelemyer
- New York University College of Global Public Health, 665 Broadway Suite 800, NY 10013 New York, USA.
| | - Vinh Vu Hai
- Dept of Infectious and Tropical Diseases, Viet Tiep Hospital, Số 1 Đường nhà thương - Quận Lê Chân, Haiphong, Viet Nam.
| | - Jean-Pierre Moles
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France.
| | - Hong Quang Doan
- Hai Phong University of Medicine and Pharmacy, 72A Nguyễn Bỉnh Khiêm, Đằng Giang, Ngô Quyền, Hai Phong, Viet Nam.
| | - Didier Laureillard
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France; Infectious Diseases Department, Caremeau University Hospital, Place du Professeur Robert Debré, 30029 Nîmes, France.
| | - Don C Des Jarlais
- New York University College of Global Public Health, 665 Broadway Suite 800, NY 10013 New York, USA.
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France.
| | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, Fench Red Cross, 27 rue Pierre Nicole, 75005 Paris, France.
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Petrović-van der Deen FS, Cunningham R, Manuel J, Gibb S, Porter RJ, Pitama S, Crowe M, Crengle S, Lacey C. Exploring indigenous ethnic inequities in first episode psychosis in New Zealand - A national cohort study. Schizophr Res 2020; 223:311-318. [PMID: 32948382 DOI: 10.1016/j.schres.2020.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION First episode psychosis (FEP) disproportionately affects rangatahi (young) Māori, the Indigenous people of New Zealand, but little is known about factors contributing to this inequity. This study describes a cohort of rangatahi Māori and young non-Māori with FEP, and explores ethnic differences in incidence rates, and the contribution of deprivation, urbanicity and substance use. METHODS Māori and young non-Māori, aged 13-25 at the time of the first recorded psychosis-related diagnoses, were identified from within Statistics NZ's Integrated Data Infrastructure (IDI), between 2009 and 2012. To estimate age-standardised FEP incidence rates, the population-at-risk was estimated using IDI-based usual resident population estimates for 2009-2012, stratified by ethnicity and single year of age. Poisson regression models were used to estimate ethnic differences in FEP incidence adjusted for age, gender, deprivation, and urban-rural area classification. RESULTS A total of 2412 young people with FEP (40% Māori, 60% non-Māori) were identified. Māori were younger, and more likely to live in deprived and rural communities and be diagnosed with schizophrenia. Substance induced psychosis was uncommon. The unadjusted age-standardised FEP incidence rate ratio was 2.48 (95% CI: 2.29-2.69) for rangatahi Māori compared with young non-Māori. While adjusting for age, sex, deprivation and urban rural area classification reduced ethnic differences in incidence, rangatahi Māori were still more than twice as likely to have been diagnosed with FEP compared to young non-Māori. CONCLUSIONS This study confirms previous findings of elevated rates of psychosis among rangatahi Māori. The difference in rates between Māori and non-Māori were attenuated but remained after adjustment for deprivation and urbanicity.
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Affiliation(s)
- Frederieke S Petrović-van der Deen
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand; Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Jenni Manuel
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; Canterbury District Health Board, PO Box 1600, Christchurch 8140, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; Department of Psychological Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; Canterbury District Health Board, PO Box 1600, Christchurch 8140, New Zealand.
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Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada. PLoS Med 2020; 17:e1003172. [PMID: 32628679 PMCID: PMC7337288 DOI: 10.1371/journal.pmed.1003172] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The "trimorbidity" of substance use disorder and mental and physical illness is associated with living in precarious housing or homelessness. The extent to which substance use increases risk of psychosis and both contribute to mortality needs investigation in longitudinal studies. METHODS AND FINDINGS A community-based sample of 437 adults (330 men, mean [SD] age 40.6 [11.2] years) living in Vancouver, Canada, completed baseline assessments between November 2008 and October 2015. Follow-up was monthly for a median 6.3 years (interquartile range 3.1-8.6). Use of tobacco, alcohol, cannabis, cocaine, methamphetamine, and opioids was assessed by interview and urine drug screen; severity of psychosis was also assessed. Mortality (up to November 15, 2018) was assessed from coroner's reports and hospital records. Using data from monthly visits (mean 9.8, SD 3.6) over the first year after study entry, mixed-effects logistic regression analysis examined relationships between risk factors and psychotic features. A past history of psychotic disorder was common (60.9%). Nonprescribed substance use included tobacco (89.0%), alcohol (77.5%), cocaine (73.2%), cannabis (72.8%), opioids (51.0%), and methamphetamine (46.5%). During the same year, 79.3% of participants reported psychotic features at least once. Greater risk was associated with number of days using methamphetamine (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.05-1.24, p = 0.001), alcohol (aOR 1.09, 95% CI 1.01-1.18, p = 0.04), and cannabis (aOR 1.08, 95% CI 1.02-1.14, p = 0.008), adjusted for demographic factors and history of past psychotic disorder. Greater exposure to concurrent month trauma was associated with increased odds of psychosis (adjusted model aOR 1.54, 95% CI 1.19-2.00, p = 0.001). There was no evidence for interactions or reverse associations between psychotic features and time-varying risk factors. During 2,481 total person years of observation, 79 participants died (18.1%). Causes of death were physical illness (40.5%), accidental overdose (35.4%), trauma (5.1%), suicide (1.3%), and unknown (17.7%). A multivariable Cox proportional hazard model indicated baseline alcohol dependence (adjusted hazard ratio [aHR] 1.83, 95% CI 1.09-3.07, p = 0.02), and evidence of hepatic fibrosis (aHR 1.81, 95% CI 1.08-3.03, p = 0.02) were risk factors for mortality. Among those under age 55 years, a history of a psychotic disorder was a risk factor for mortality (aHR 2.38, 95% CI 1.03-5.51, p = 0.04, adjusted for alcohol dependence at baseline, human immunodeficiency virus [HIV], and hepatic fibrosis). The primary study limitation concerns generalizability: conclusions from a community-based, diagnostically heterogeneous sample may not apply to specific diagnostic groups in a clinical setting. Because one-third of participants grew up in foster care or were adopted, useful family history information was not obtainable. CONCLUSIONS In this study, we found methamphetamine, alcohol, and cannabis use were associated with higher risk for psychotic features, as were a past history of psychotic disorder, and experiencing traumatic events. We found that alcohol dependence, hepatic fibrosis, and, only among participants <55 years of age, history of a psychotic disorder were associated with greater risk for mortality. Modifiable risk factors in people living in precarious housing or homelessness can be a focus for interventions.
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Arunogiri S, McKetin R. Comment on Zang et al 2019: The importance of distinguishing between psychotic and general psychiatric symptoms in the context of methamphetamine use. Addict Biol 2020; 25:e12776. [PMID: 31192508 DOI: 10.1111/adb.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Shalini Arunogiri
- Turning Point, Eastern Health Richmond Australia
- Monash Addiction Research Centre (MARC) and Eastern Health Clinical SchoolMonash University Box Hill Australia
| | - Rebecca McKetin
- National Drug Research Institute (NDRI)Curtin University Perth Australia
- National Drug and Alcohol Research CentreUniversity of New South Wales Sydney Australia
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Zhang Y, Sun Y, Yu Z, Sun Y, Chang X, Lu L, Chang S, Shi J. Risk factors and an early prediction model for persistent methamphetamine-related psychiatric symptoms. Addict Biol 2020; 25:e12709. [PMID: 30821087 DOI: 10.1111/adb.12709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 11/27/2022]
Abstract
Methamphetamine (MA)-related psychiatric symptoms (MAP) are serious comorbidities of MA use and result in many social problems such as violence and suicide. We investigated the sociodemographic and genetic risk factors for persistent MAP of MA users (MUs) and constructed an early MAP prediction model. Derivation and replication samples had 1734 and 905 MUs, respectively. Symptom Checklist 90, Childhood Trauma Questionnaire, Attention-Deficit Hyperactivity Disorder (ADHD) Rating Scale-IV, and Social Support Rating Scale were used to assess the past-year prevalence of general MAP and life events retrospectively. Genome-wide association study (GWAS) was used to analyze MAP-related genetic factors. The prediction model was constructed by integrating the risk life events and clinical and genetic features using logistic regression. Of the 2639 MUs, 1293 (48.83%) had past-year MAP. The severity of MA addiction (SMA), childhood trauma, childhood ADHD symptoms, and social support were reliable risk factors for persistent MAP. By integrating these risk factors and the polygenic risk score from GWAS from derivation samples, the area under the curve (AUC) of the predictive model for MAP was 0.754 (95% CI 0.717~0.771). The risk factors and prediction model were also verified in replication samples. In addition, SMA, ADHD, and social support were mediators for the effect of the risk genetic factor on persistent MAP. Our study identified several risk factors for persistent MAP and will be helpful for developing scalable tools for the prevention of persistent and general MAP.
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Affiliation(s)
- Yang Zhang
- National Institute on Drug Dependence; Peking University; Beijing China
- Department of Pharmacology, School of Basic Medical Sciences; Peking University Health Science Center; Beijing China
| | - Yan Sun
- National Institute on Drug Dependence; Peking University; Beijing China
| | - Zhoulong Yu
- National Institute on Drug Dependence; Peking University; Beijing China
- Department of Pharmacology, School of Basic Medical Sciences; Peking University Health Science Center; Beijing China
| | - Yankun Sun
- National Institute on Drug Dependence; Peking University; Beijing China
- Institute of Mental Health/Peking University Sixth Hospital and Key Laboratory of Mental Health, Peking University; Beijing China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Key Laboratory of Mental Health; Ministry of Health (Peking University); Beijing China
| | - Xiangwen Chang
- National Institute on Drug Dependence; Peking University; Beijing China
- Department of Pharmacology, School of Basic Medical Sciences; Peking University Health Science Center; Beijing China
| | - Lin Lu
- National Institute on Drug Dependence; Peking University; Beijing China
- Institute of Mental Health/Peking University Sixth Hospital and Key Laboratory of Mental Health, Peking University; Beijing China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Key Laboratory of Mental Health; Ministry of Health (Peking University); Beijing China
| | - Suhua Chang
- Institute of Mental Health/Peking University Sixth Hospital and Key Laboratory of Mental Health, Peking University; Beijing China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Key Laboratory of Mental Health; Ministry of Health (Peking University); Beijing China
| | - Jie Shi
- National Institute on Drug Dependence; Peking University; Beijing China
- Beijing Key Laboratory on Drug Dependence Research; Beijing China
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Farrell M, Martin NK, Stockings E, Bórquez A, Cepeda JA, Degenhardt L, Ali R, Tran LT, Rehm J, Torrens M, Shoptaw S, McKetin R. Responding to global stimulant use: challenges and opportunities. Lancet 2019; 394:1652-1667. [PMID: 31668409 PMCID: PMC6924572 DOI: 10.1016/s0140-6736(19)32230-5] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 07/31/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022]
Abstract
We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.
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Affiliation(s)
- Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Robert Ali
- Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jürgen Rehm
- Institute Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marta Torrens
- Addiction Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
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Lamyai W, Pono K, Indrakamhaeng D, Saengsin A, Songhong N, Khuwuthyakorn P, Sribanditmongkol P, Junkuy A, Srisurapanont M. Risks of psychosis in methamphetamine users: cross-sectional study in Thailand. BMJ Open 2019; 9:e032711. [PMID: 31615802 PMCID: PMC6797321 DOI: 10.1136/bmjopen-2019-032711] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To determine factors related to recent methamphetamine-associated psychosis (MAP) among individuals recently using methamphetamine (MA). DESIGN Cross-sectional study carried out between July 2015 and June 2017. SETTING Four mental health hospitals and one substance abuse treatment centre in Thailand. PARTICIPANTS Individuals recruited onto the study included those aged 18 years or over, of both sexes, who reported MA use in the month prior to admission. MEASURES Any recent psychosis was confirmed using the Mini International Neuropsychiatric Interview-Plus psychotic module. The Timeline Follow Back was used to determine days of MA use. The severity of MA dependence was assessed using the Severity of Dependence Scale. Quantitative hair analysis was carried out to confirm recent use of MA and to measure the amount of MA use. We compared several characteristics between those who had recently experienced psychosis and those who had not. RESULTS This study included 120 participants without MAP and 113 participants with MAP. The mean age was 28 years and the mean abstinence was 17 days. The levels of MA concentration in hair were not significantly different between groups (p=0.115). Based on the final logistic regression model, the independent factors associated with MAP (OR and 95% CI) included being male (OR 4.03, 95% CI 1.59 to 10.20), ≥16 days of MA use in the past month (OR 2.35, 95% CI 1.22 to 4.52), MA dependence (OR 9.41, 95% CI 2.01 to 44.00) and hospitalisation history related to substance abuse (OR 3.85, 95% CI 2.03 to 7.28). CONCLUSIONS Health professionals should closely monitor the development of MAP in MA-dependent men who frequently use MA and have a history of hospitalisation for substance abuse. The measure of MA concentration levels in the hair may add no benefit for the prediction of the development of MAP.
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Affiliation(s)
- Warot Lamyai
- Nakhon Phanom Rajanagarindra Psychiatric Hospital, Department of Mental Health, Ministry of Public Health, Nakhon Phanom, Thailand
| | - Kitkawee Pono
- Nakhon Phanom Rajanagarindra Psychiatric Hospital, Department of Mental Health, Ministry of Public Health, Nakhon Phanom, Thailand
| | - Danai Indrakamhaeng
- Thanyarak Chiang Mai Hospital, Department of Medical Services, Ministry of Public Health, Chiang Mai, Thailand
| | - Apichat Saengsin
- Galyarajanagarindra Institute, Department of Mental Health, Ministry of Public Health, Nakorn Prathom, Thailand
| | - Nartya Songhong
- Songkhla Rajanagarindra Psychiatric Hospital, Department of Mental Health, Ministry of Public Health, Songkhla, Thailand
| | - Panu Khuwuthyakorn
- Suanprung Psychiatric Hospital, Department of Mental Health, Ministry of Public Health, Chiang Mai, Thailand
| | - Pongruk Sribanditmongkol
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anongphan Junkuy
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Mellsop G, Tapsell R, Holmes P. Mental health service users' progression from illicit drug use to schizophrenia in New Zealand. Gen Psychiatr 2019; 32:e100088. [PMID: 31552389 PMCID: PMC6738695 DOI: 10.1136/gpsych-2019-100088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/09/2019] [Accepted: 08/15/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recently, publications have hypothesised that the demonstrated increase in the incidence of schizophrenia in New Zealand is a side effect of the increased strength of available cannabis derivatives over the last 25+ years and the much more recent increase in the population's use of methamphetamine. AIM To compare the rates of later schizophrenia between age-matched mental health service users with initial diagnoses as alcohol abusers or illicit drug users. METHOD From the PRIMHD comprehensive national database, all users of the mental health services over a 5-year period who received an ICD-10 presenting diagnosis of alcohol or substance use/abuse were identified. For each person identified, the database was examined for the following 3 years to determine the numbers later diagnosed with schizophrenia. RESULTS For the initial alcohol problem people in their twenties, 1.7% were diagnosed as suffering from schizophrenia in the subsequent 3 years. For the initial drug problem people, the rate was 10.9%. Within that drug-using population, the indigenous Maori developed schizophrenia at a higher rate than did the remainder of the population. CONCLUSION These findings in New Zealand require further research into their generalisability, context and explanation.
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Affiliation(s)
| | - Rees Tapsell
- University of Auckland Waikato Clinical School, Hamilton, New Zealand
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Chiang M, Lombardi D, Du J, Makrum U, Sitthichai R, Harrington A, Shukair N, Zhao M, Fan X. Methamphetamine-associated psychosis: Clinical presentation, biological basis, and treatment options. Hum Psychopharmacol 2019; 34:e2710. [PMID: 31441135 DOI: 10.1002/hup.2710] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/03/2019] [Accepted: 06/27/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Methamphetamine associated psychosis (MAP) represents a mental disorder induced by chronic methamphetamine use in a subset of users. The prevalence of the disorder has increased in several countries in Europe and Asia where methamphetamine use has increased. MAP remains difficult to distinguish from primary psychiatric disorders, especially schizophrenia, creating complications in prescribing treatment plans to patients. DESIGN This narrative review sought to summarize difficulties related to MAP diagnosis and highlight the need for a better treatment model. Current best practices are described and potential novel therapies and future research suggested. RESULTS Results suggest that clear biological and clinical differences appear between patients presenting with MAP and schizophrenia and that there may exist distinct subgroups within MAP itself. MAP-specific treatment studies have been few and have focused on the use of antipsychotic medication. Antipsychotic treatment has been shown to alleviate the psychotic symptoms of MAP but produce debilitating adverse effects and fail to adequately address methamphetamine use in patients. CONCLUSIONS Continued identification of subgroups within the heterogenous MAP population may lead to better diagnosis, treatment, and outcomes for patients. Psychosocial therapies should be explored in addressing the cooccurring substance use and psychosis in the treatment of MAP.
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Affiliation(s)
- Mathew Chiang
- UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Domenico Lombardi
- UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiaotong University, Shanghai, China
| | - Ursula Makrum
- Psychiatry, UMass Memorial Health Care, Worcester, Massachusetts
| | - Rangsun Sitthichai
- UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Amy Harrington
- UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nawras Shukair
- UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiaotong University, Shanghai, China
| | - Xiaoduo Fan
- UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts
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McInnis P, Lee A. Methamphetamine use in an early psychosis service: a cross-sectional retrospective cohort study. Australas Psychiatry 2019; 27:383-387. [PMID: 31264898 DOI: 10.1177/1039856219859811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Methamphetamine-associated psychotic symptoms are common among regular users, and can overlap with the emergence of a primary psychotic disorder. In contrast to previous research, this retrospective observational study aims to describe the characteristics of young people experiencing early psychosis who use methamphetamine regularly. We also aimed to investigate associations between regular methamphetamine use and markers of psychosocial functioning, psychosis outcomes and substance use. METHOD This study involved 116 young people (19 using methamphetamine regularly) referred to the Camperdown Early Intervention in Psychosis Service from January 2015 to January 2016. Variables including demographic information, psychosocial functioning and psychosis outcomes were collected on referral to the service, updated throughout treatment and at discharge. RESULTS There were significant associations found between regular methamphetamine use and a criminal history (p<0.001), regular cannabis use (p=0.002) and regular nicotine use (p<0.001). CONCLUSION This study suggests that in early psychosis, regular methamphetamine use could signify a subgroup of young people who use multiple substances and may engage in criminal activity. Addressing substance use in early psychosis may be an important treatment target for this vulnerable group of young people.
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Affiliation(s)
- Peter McInnis
- Rivendell Child Adolescent and Family Mental Health Service, Sydney Local Health District, Concord West, NSW, Australia
| | - Anna Lee
- Early Intervention in Psychosis Service, Sydney Local Health District, Camperdown, NSW, Australia
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Sibanda NC, Kornhaber R, Hunt GE, Morley K, Cleary M. Prevalence and Risk Factors of Emergency Department Presentations with Methamphetamine Intoxication or Dependence: A Systematic Review and Meta-analysis. Issues Ment Health Nurs 2019; 40:567-578. [PMID: 31025889 DOI: 10.1080/01612840.2018.1553003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Methamphetamine intoxication presentations to emergency departments (EDs) including trauma centres, general EDs and psychiatric emergency services have risen world-wide. Objectives: A review of the clinical characteristics of patients presenting to a trauma centre or ED with methamphetamine intoxication or dependence to aid development of health service policy and training for health personnel. Methods: PubMed, PsycINFO, CINAHL and Scopus (1990-2017) were searched. A systematic review of all clinical characteristics was conducted, and a meta-analysis undertaken for variables with standard measures (prevalence, age, gender); 23 studies met the inclusion criteria of which 17 could be used in the meta-analysis. Results: Methamphetamine-related presentations were characterised by cardiac complications, psychiatric symptoms and aggression with safety risk to health personnel. The pooled prevalence of methamphetamine positive cases in emergency settings was higher in studies using toxicology analysis to determine methamphetamine use (8 studies, 22.8% 95% CI 15.4-32.5) compared to self-reporting (9 studies 5.7%, 95% CI 2.8-11.2, Q = 12.42, p < 0.001). Pooled variance of methamphetamine positive cases was 57.1% in men and 42.9% in women. The mean age of those who were methamphetamine positive was 28.4 years and for those methamphetamine negative cases it was 38.4 years. Conclusions: In this review, we found a higher prevalence of methamphetamine use amongst males and in the younger demographic. Targeted training programmes for frontline staff and management approaches for prompt multi-disciplinary service engagement are recommended as well as appropriate resourcing, such as mental health staff in EDs or mental health beds to accommodate this subgroup of the patient cohort.
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Affiliation(s)
- Njabulo Churchill Sibanda
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , New South Wales , Australia
| | - Rachel Kornhaber
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , New South Wales , Australia
| | - Glenn E Hunt
- b Discipline of Psychiatry , University of Sydney , Sydney , New South Wales , Australia
| | - Kirsten Morley
- c Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health , University of Sydney , Sydney , New South Wales , Australia
| | - Michelle Cleary
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , New South Wales , Australia
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Mellsop G, Tapsell R, Menkes DB. Testing a hypothesis arising from the epidemiology of schizophrenia in New Zealand. Gen Psychiatr 2019; 32:e100048. [PMID: 31179434 PMCID: PMC6551442 DOI: 10.1136/gpsych-2019-100048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Graham Mellsop
- Department of Psychological Medicine, University of Auckland, Waikato Clinical School, Hamilton, New Zealand
| | - Rees Tapsell
- Department of Psychological Medicine, University of Auckland, Waikato Clinical School, Hamilton, New Zealand
| | - David Benjamin Menkes
- Department of Psychological Medicine, University of Auckland, Waikato Clinical School, Hamilton, New Zealand
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The prevalence of psychotic symptoms in kratom (Mitragyna speciosa Korth.) Users in Malaysia. Asian J Psychiatr 2019; 43:197-201. [PMID: 31302592 DOI: 10.1016/j.ajp.2019.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/20/2019] [Accepted: 07/05/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Kratom is a traditional medicinal herb widely used in Malaysia and Thailand. Despite its widespread use and statements by regulatory agencies on the potential for kratom-associated psychosis, there is little data regarding the prevalence of psychotic symptoms among kratom users. This study investigated the prevalence of psychosis among kratom users, described psychotic symptomatology and severity, while examining associations between kratom use characteristics and the occurrence of psychotic symptoms. METHODS This cross-sectional clinical survey recruited 150 regular kratom users. The Mini International Neuropsychiatric Interview (MINI) and Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) diagnostic criteria were used to evaluate psychotic symptomatology among kratom users, and the Brief Psychiatric Rating Scale (BPRS) was used to assess the severity of psychiatric symptoms. Chi-square tests with Yate's correction were performed to determine the association between kratom use characteristics and the occurrence of psychotic symptoms among kratom users in this study. RESULTS Six out of 150 kratom users (4%) presented with any psychotic symptoms. The psychotic symptoms reported were positive symptoms and thought alienation, with a mean BPRS score of 33 (i.e., mild severity). Variables related to kratom use (such as intake of kratom with diphenhydramine, duration of kratom use, and quantity and frequency of daily kratom use) were not associated with the occurrence of psychotic symptoms among kratom users. CONCLUSION Although psychotic symptoms could occur among regular kratom users, they were rare and not significantly associated with kratom use characteristics. We found no evidence of elevated psychosis among regular users.
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Voce A, Calabria B, Burns R, Castle D, McKetin R. A Systematic Review of the Symptom Profile and Course of Methamphetamine-Associated Psychosis Substance Use and Misuse. Subst Use Misuse 2019; 54:549-559. [PMID: 30693832 DOI: 10.1080/10826084.2018.1521430] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The psychiatric symptom profile of methamphetamine-associated psychosis (MAP) has varied considerably across studies of different research designs. We performed a systematic review to examine the available evidence for specific psychotic symptoms associated with MAP, including the clinical course and longitudinal changes in this symptom profile. METHODS Five key electronic databases were searched to identify studies that examined the symptom profile or clinical course of MAP in individuals identified as having MAP. The reporting of specific psychiatric symptoms, and duration of symptoms where available, was recorded for each study. RESULTS Ninety-four articles were identified (n = 7387), including case-control (k = 29), cross-sectional (k = 20), experimental (k = 6), case report (k = 29), and longitudinal (k = 20) studies. Persecutory delusions, auditory and visual auditory hallucinations were by far the most commonly reported symptoms (reported in 65-84% of studies). Hostility, conceptual disorganization, and depression were reported in a large proportion of studies (31-53%). Negative symptoms were mostly absent (<20%). The median percentage of participants with persistent psychotic symptoms (>1 month duration) across studies was 25% (excluding case reports). CONCLUSION Persecutory delusions, auditory and visual hallucinations, hostility, depression and conceptual disorganization are central to MAP, whereas negative psychotic symptoms are typically absent. An overrepresentation of institutionalized or male participants may have overemphasized negative symptoms and underreported affective symptoms in past research. Symptoms of MAP may persist beyond one month after drug cessation in some individuals. Clinicians are encouraged to manage affective symptoms in MAP individuals, and monitor for the development of chronic psychotic symptoms.
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Affiliation(s)
- Alexandra Voce
- a Centre for Research on Ageing, Health and Wellbeing , Australian National University , Acton , Australia
| | - Bianca Calabria
- b National Centre for Epidemiology and Population Health , Australian National University , Acton , Australia.,c National Drug and Alcohol Research Centre , University of New South Wales , Randwick , Australia
| | - Richard Burns
- a Centre for Research on Ageing, Health and Wellbeing , Australian National University , Acton , Australia
| | - David Castle
- d St Vincent's Hospital , Fitzroy , Australia.,e Department of Psychiatry , University of Melbourne , Melbourne , Australia
| | - Rebecca McKetin
- c National Drug and Alcohol Research Centre , University of New South Wales , Randwick , Australia.,f National Drug Research Institute , Curtin University , Perth , Australia
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Arunogiri S, Verdejo-Garcia A, McKetin R, Rubenis AJ, Fitzpatrick RE, Lubman DI. Emotion Recognition and Impulsive Choice in Relation to Methamphetamine Use and Psychosis Symptoms. Front Psychiatry 2019; 10:889. [PMID: 31920746 PMCID: PMC6923220 DOI: 10.3389/fpsyt.2019.00889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/12/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The cognitive profiles of people with methamphetamine use disorder are characterized by impulsivity and impairment in social cognition. However, previous studies have not fully accounted for the presence and impact of co-occurring mental health problems on these domains. For instance, psychotic symptoms are commonly experienced by people who use methamphetamine and may influence cognitive performance. We aimed to examine decision making and emotion recognition in individuals with methamphetamine use, compared to healthy controls, to map the nature and degree of impairments in relation to the presence of psychotic symptoms. Method: In this naturalistic study, we assessed reward-based decision-making and facial emotion recognition across three groups, methamphetamine-using individuals with (MAP, n = 29) and without psychotic symptoms (MNP, n = 70), and healthy controls (HC, n = 32). Results: In comparison to healthy controls, methamphetamine-using individuals presented with poorer performance on tasks of decision-making and emotion recognition. Emotion recognition was impaired across all methamphetamine-using individuals, with significantly poorer recognition of anger and sadness in those with psychotic symptoms. Conclusion: We found specific impairments in emotion recognition in relation to psychotic symptoms in people who use methamphetamine regularly. This builds on previous evidence on cognitive profiles in methamphetamine use disorder, highlighting the need to assess co-morbid mental health and psychotic symptoms. Our finding that methamphetamine-using individuals with psychotic symptoms present with particular difficulties recognizing anger has implications for frontline clinicians.
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Affiliation(s)
- Shalini Arunogiri
- Turning Point, Eastern Health, Richmond, VIC, Australia.,Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Adam J Rubenis
- Turning Point, Eastern Health, Richmond, VIC, Australia.,Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Rebecca E Fitzpatrick
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, VIC, Australia.,Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
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Fluyau D, Mitra P, Lorthe K. Antipsychotics for Amphetamine Psychosis. A Systematic Review. Front Psychiatry 2019; 10:740. [PMID: 31681046 PMCID: PMC6804571 DOI: 10.3389/fpsyt.2019.00740] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/16/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Among individuals experiencing amphetamine psychosis, it may be difficult to rule out schizophrenia. The use of antipsychotics for the treatment of amphetamine psychosis is sparse due to possible side effects. Some arguments disfavor their use, stating that the psychotic episode is self-limited. Without treatment, some individuals may not fully recover from the psychosis and may develop full-blown psychosis, emotional, and cognitive disturbance. This review aims to investigate the clinical benefits and risks of antipsychotics for the treatment of amphetamine psychosis. Methods: Electronic search on trials on antipsychotic drugs for amphetamine psychosis from their inception to November 2018 was conducted in PubMed, Scopus, Google Scholar, EBSCOhost, ProQuest, Cochrane Review Database, Medline Ovid, and EMBASE following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The Cochrane risk-of-bias tool assessed the risk of bias, the methodological quality of individual trials was assessed by the Oxford Quality Scoring System, and the quality of evidence for recommendations was judged by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). The results were synthesized qualitatively and quantitatively. Results: The investigation of six randomized controlled trials of 314 participants showed that aripiprazole, haloperidol, quetiapine, olanzapine, and risperidone were able to reduce or control the psychotic episode (positive and negative symptoms) induced by amphetamine use with no adverse event. Although the side-effect profile of these agents varied, no drug was clinically superior to others. Conclusions: This review suggests that antipsychotics seem to be efficacious for amphetamine psychosis on both positive and negative symptoms. Practitioners need to tailor their use based on risks for side effects individually.
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Affiliation(s)
- Dimy Fluyau
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Paroma Mitra
- Langone Health, Department of Psychiatry, NYU, New York, NY, United States
| | - Kervens Lorthe
- Department of Health, Miami Regional University, Miami Springs, FL, United States
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Arunogiri S, McKetin R, Verdejo-Garcia A, Lubman DI. The Methamphetamine-Associated Psychosis Spectrum: a Clinically Focused Review. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9934-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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50
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Gan H, Zhao Y, Jiang H, Zhu Y, Chen T, Tan H, Zhong N, Du J, Zhao M. A Research of Methamphetamine Induced Psychosis in 1,430 Individuals With Methamphetamine Use Disorder: Clinical Features and Possible Risk Factors. Front Psychiatry 2018; 9:551. [PMID: 30459651 PMCID: PMC6232294 DOI: 10.3389/fpsyt.2018.00551] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022] Open
Abstract
Background and Aims: Methamphetamine (MA) abuse is commonly associated with the development of psychotic symptoms. The predictors and related risk factors of MA induced psychosis (MIP) are poorly understood. We investigated the occurrence of MIP, and analyzed the clinical features and possible risk factors among individuals with MA use disorder Method: One thousand four hundred and thirty participants with MA use disorder were recruited from compulsory rehabilitation centers in Shanghai. A structured questionnaire including demographic characteristics, drug use history, visual analog scales, Beck Depression Inventory-13 (BDI-13), and Hamilton anxiety scale-14 (HAMA-14) were used to collect clinical related information. Fifty-six participants had accomplished the test of CogState Battery. Results: Among the 1430 individuals with MA use disorder, 37.1% were diagnosed as MIP according DSM-IV. There were significant differences in age, marital status, age of drug use onset, MA use years, Average MA use dose, interval of MA use, maximum dose, concurrent use of alcohol, and other drugs, VAS score, MA dependence, BDI-13 scores, HAMA-14 scores, verbal learning memory, and visual learning memory between the MIP group and the none MIP group (P < 0.05). The age of drug use onset (OR = 0.978, p = 0.011), average drug use dose (OR = 1.800, p = 0.015), craving score (OR = 1.069, p = 0.031), MA dependence (OR = 2.214, p < 0.001), and HAMA scores (OR = 1.028, p < 0.001) were associated to MIP. Conclusion: Individuals with MIP had more severe drug use problems, emotional symptoms and cognitive impairment. Earlier onset of drug use, higher quantity of drug use, higher craving, middle or severe drug use disorder and more anxiety symptoms may be related risk factors of MIP.
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Affiliation(s)
- Hong Gan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Youwei Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianzhen Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoye Tan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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