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Davies LEM, Jansen-Groot Koerkamp EAW, Koster ES, Dalusong KJ, Koch B, Schellekens A, Heringa M, Bouvy M. Patient perspectives on primary care providers role in long-term opioid therapy. Br J Gen Pract 2024:BJGP.2023.0547. [PMID: 38499298 DOI: 10.3399/bjgp.2023.0547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Over the past decade, long-term use of prescription opioids for chronic non-cancer pain (CNCP) has risen globally despite the associated risks. The majority of opioid users receive their first prescription in primary care. AIM To investigate the perspective of long-term opioid users in primary care regarding the role of healthcare providers (HCP) in their prolonged opioid use. DESIGN AND SETTING Semi-structured interviews in Dutch primary care Methods: We recruited long-term opioid users for CNCP from seven community pharmacies in the Netherlands. In-depth, semi-structured interviews focussed on experiences with long term opioid use, access to opioids, and the guidance of their HCPs. A directed content analysis was conducted on the transcribed interviews using NVivo. RESULTS Participants (n=25) mentioned ways HCPs impacted their long-term use of opioids. These encompassed: 1) the initiation of treatment, 2) chronic use of opioids, 3) discontinuation of treatment. Participants stressed the need for risk counselling during initial prescriptions, ongoing medication evaluations including tapering conversations, and more support from their HCP during a tapering attempt. CONCLUSION Patients' perspective illustrates the important role of HCPs across the spectrum of opioid usage - from initiation to tapering. It underscores the importance of clear risk counselling starting at the initial prescription, continuous medication assessments throughout treatment, addressing tapering at regular intervals and strong support during tapering. These insights carry significant implications for clinical practice, emphasising the importance of informed and patient-centred care when it comes to opioid use for chronic non-cancer pain management.
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Affiliation(s)
- Lisa Eveline Maria Davies
- Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, Netherlands
- SIR Institute for Pharmacy Practice and Policy, Leiden, Netherlands
| | - Elsemiek A W Jansen-Groot Koerkamp
- Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, Netherlands
- SIR Institute for Pharmacy Practice and Policy, Leiden, Netherlands
| | - Ellen S Koster
- Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, Netherlands
- Dutch Society for Internal Medicine, Utrecht, Netherlands
| | - Kelly-Jo Dalusong
- Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, Netherlands
| | - Brigitte Koch
- Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, Netherlands
| | - Arnt Schellekens
- Radboud University Medical Center, Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction, Scientific Director of NISPA, Nijmegen, Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, Netherlands
| | - Marcel Bouvy
- Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, Netherlands
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Everaerd D, Vissers P, van Helvoort M, Schellekens A, van de Maat J, Hoogerwerf J, Tendolkar I. Acute Neuropsychiatric Symptoms During COVID-19: Results From Two Independent Cohort Studies. J Nerv Ment Dis 2023; 211:779-783. [PMID: 37557068 DOI: 10.1097/nmd.0000000000001700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
ABSTRACT Converging evidence suggests that COVID-19 infects not only the respiratory system, but also has a large impact on the central nervous system (CNS), leading to acute neuropsychiatric symptoms (NPSs) such as anxiety and delirium. It is thus far unclear which acute NPSs are most common in COVID-19 and if NPSs are associated with an altered COVID-19 disease course. We used data from two independent retrospective cohort studies performed in an academic hospital. A total of 93 patients with NPS and 125 patients without NPS were included. Main outcome measures consisted of type of acute NPS, COVID-19 severity (based on CT severity score), admission to the intensive care unit (ICU), and mortality. Most common acute NPSs were delirium, anxiety, and mood symptoms. NPS patients were more often admitted to the ICU than patients without NPS. However, there was no difference in duration of ICU admission, CT severity score, and mortality. Somatic comorbidity was similar between the two groups. These data suggest that delirium, anxiety, and mood symptoms were the most common NPS. Independent of other clinical characteristics, ICU admission in COVID-19 patients was associated with NPS. We recommend that all COVID-19 patients should be actively screened for acute NPS such as delirium, anxiety, and mood symptoms, especially when admitted to an ICU.
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Affiliation(s)
| | - Pim Vissers
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marloes van Helvoort
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Josephine van de Maat
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jacobien Hoogerwerf
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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van der Hoorn MMC, Kalkman GA, Weesie YM, Atsma F, Schellekens A. Psychiatric risk factors for chronic high-dose opioid prescribing: register-based cohort study. BJPsych Open 2023; 9:e74. [PMID: 37078115 PMCID: PMC10134259 DOI: 10.1192/bjo.2023.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Chronic high-dose (CHD) prescription opioid use is a major public health concern. Although CHD opioid use has been associated with psychiatric disorders, the causality could go both ways. Some studies have already linked psychiatric disorders to an increased risk of transitioning to chronic opioid use, and longitudinal data identifying psychiatric disorders as predictors of CHD opioid use could shed further light on this issue. AIMS To prospectively examine the relationship between the presence of a psychiatric disorder and subsequent development of CHD opioid use in primary care patients newly receiving opioids. METHOD Data were included from 137 778 primary care patients in The Netherlands. Cox regression modelling was used to examine the association between psychiatric disorders prior to a new opioid prescription and subsequent CHD opioid use (≥90 days; ≥50 mg/day oral morphine equivalents) in the subsequent 2 years. RESULTS Of all patients receiving a new opioid prescription, 2.0% developed CHD opioid use. A psychiatric disorder before the start of an opioid prescription increased the risk of CHD opioid use (adjusted hazard ratio HR = 1.74; 95% CI 1.62-1.88), specifically psychotic disorders, substance use disorders, neurocognitive disorders and multiple co-occurring psychiatric episodes. Similarly, pharmacotherapy for psychosis, substance use disorders and mood and/or anxiety disorders increased the risk of CHD opioid use. Psychiatric polypharmacy conferred the greatest risk of developing CHD opioid use. CONCLUSIONS Psychiatric disorders increase the risk of developing CHD opioid use in patients newly receiving prescription opioids. To reduce the public health burden of CHD opioid use, careful monitoring and optimal treatment of psychiatric conditions are advised when opioid therapy is initiated.
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Affiliation(s)
- Mariëlle M C van der Hoorn
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; and Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerard A Kalkman
- Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; and Radboud Institute for Health Sciences, Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvette M Weesie
- Netherlands Institute for Health Services Research, Nivel, Utrecht, The Netherlands
| | - Femke Atsma
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands; and Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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van Dam CJ, van Velzen M, Kramers C, Schellekens A, Olofsen E, Niesters M, Dahan A. Cannabis-opioid interaction in the treatment of fibromyalgia pain: an open-label, proof of concept study with randomization between treatment groups: cannabis, oxycodone or cannabis/oxycodone combination-the SPIRAL study. Trials 2023; 24:64. [PMID: 36707893 PMCID: PMC9880924 DOI: 10.1186/s13063-023-07078-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Opioids continue to be widely prescribed for chronic noncancer pain, despite the awareness that opioids provide only short-time pain relief, lead to dose accumulation, have numerous adverse effects, and are difficult to wean. As an alternative, we previously showed advantages of using pharmaceutical-grade cannabis in a population of chronic pain patients with fibromyalgia. It remains unknown whether combining an opioid with pharmaceutical-grade cannabis has advantages, such as fewer side effects from lesser opioid consumption in chronic pain. METHODS Trial design: a single-center, randomized, three-arm, open-label, exploratory trial. Trial population: 60 patients with fibromyalgia according to the 2010 definition of the American College of Rheumatologists. INTERVENTION Patients will be randomized to receive up to 4 daily 5 mg oral oxycodone sustained release (SR) tablet, up to 5 times 150 mg inhaled cannabis (Bediol®, containing 6.3% Δ9-tetrahydrocannabinol and 8% cannabidiol), or the combination of both treatments. Treatment is aimed at self-titration with the daily maximum doses given. Treatment will continue for 6 weeks, after which there is a 6-week follow-up period. Main trial endpoint: The number of side effects observed during the course of treatment using a composite adverse effect score that includes the following 10 symptoms: dizziness (when getting up), sleepiness, insomnia, headache, nausea, vomiting, constipation, drug high, hallucinations, and paranoia. Secondary and tertiary endpoints include pain relief and number of oxycodone doses and cannabis inhalations. DISCUSSION The trial is designed to determine whether self-titration of oxycodone and cannabis will reduce side effects in chronic pain patients with fibromyalgia. TRIAL REGISTRATION {2A AND 2B}: EU trial register 2019-001861-33, URL https://www.clinicaltrialsregister.eu , on July 17, 2019; World Health Organization International Clinical Trials Research Platform NL7902, URL https://trialsearch.who.int , on July 26, 2019.
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Affiliation(s)
- Cornelis Jan van Dam
- Tackling and Preventing The Opioid Epidemic (TAPTOE). consortium, Utrecht, the Netherlands ,grid.10419.3d0000000089452978Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique van Velzen
- Tackling and Preventing The Opioid Epidemic (TAPTOE). consortium, Utrecht, the Netherlands ,grid.10419.3d0000000089452978Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Cornelis Kramers
- Tackling and Preventing The Opioid Epidemic (TAPTOE). consortium, Utrecht, the Netherlands ,grid.413327.00000 0004 0444 9008Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands ,grid.10417.330000 0004 0444 9382Department of Pharmacology‑Toxicology and Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arnt Schellekens
- Tackling and Preventing The Opioid Epidemic (TAPTOE). consortium, Utrecht, the Netherlands ,grid.10417.330000 0004 0444 9382Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands ,grid.5590.90000000122931605Donders Center for Medical Neuroscience, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands ,grid.491352.8Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
| | - Erik Olofsen
- grid.10419.3d0000000089452978Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke Niesters
- Tackling and Preventing The Opioid Epidemic (TAPTOE). consortium, Utrecht, the Netherlands ,grid.10419.3d0000000089452978Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert Dahan
- Tackling and Preventing The Opioid Epidemic (TAPTOE). consortium, Utrecht, the Netherlands ,grid.10419.3d0000000089452978Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands ,PainLess Foundation, Leiden, the Netherlands
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Goudriaan AE, Crunelle CL, Wolf C, Schellekens A. [Neural networks in addiction]. Tijdschr Psychiatr 2023; 65:609-612. [PMID: 38174394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Substance use disorders (SUD) are among the most prevalent psychiatric disorders, with high illness costs. A disturbed balance between frontostriatal and stress brain circuitry influences the development of SUD, its continuation, and vulnerability for relapse. AIM To provide a concise overview of neural networks in SUD, and discuss implications for clinical practice. METHOD Narrative literature review on neurobiological mechanisms of neural networks in substance use disorders. RESULTS Changes in frontostriatal circuitry play an important role for sensitivity to substance-related rewards, and can lead to loss of control over substance use. On the other hand, the use of substances affects the brain’s stress system, which affects frontostriatal network functioning. Substance use can activate stress circuitry in the brain, which can lead to an increase in use or relapse. The level at which neural network functioning is affected can differ highly between persons with SUD, and is dependent on the SUD stage and the presence of other psychiatric comorbidity. CONCLUSION Improved understanding of neural networks involved in SUD can lead to the development of new and more personalized treatment- and prevention strategies. Insights in neural networks also provide a transdiagnostic view from which to understand the phenomenological overlap between psychiatric disorders and frequent comorbidity.
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van der Meer PB, Fuentes JJ, Kaptein AA, Schoones JW, de Waal MM, Goudriaan AE, Kramers K, Schellekens A, Somers M, Bossong MG, Batalla A. Therapeutic effect of psilocybin in addiction: A systematic review. Front Psychiatry 2023; 14:1134454. [PMID: 36846225 PMCID: PMC9947277 DOI: 10.3389/fpsyt.2023.1134454] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Psychedelic-assisted therapy [e.g., with lysergic acid diethylamide (LSD)] has shown promising results as treatment for substance use disorders (SUDs). Previous systematic reviews assessing the efficacy of psilocybin in SUDs only included clinical trials conducted in the last 25 years, but they may have missed clinical trials assessing the efficacy of psilocybin that were conducted before the 1980s, given much research has been done with psychedelics in the mid-20th century. In this systematic review, we specifically assessed the efficacy of psilocybin in patients with a SUD or non-substance-related disorder with no publication date restrictions in our search strategy. METHODS A systematic literature search was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines from the earliest published manuscript up to September 2, 2022, in seven electronic databases, including clinical trials in patients with a SUD or non-substance-related disorder evaluating the efficacy of psilocybin. RESULTS A total of four studies (six articles, of which two articles were long-term follow-up results from the same trial) were included in this systematic review. Psilocybin-assisted therapy was administered to n = 151 patients in a dose ranging from 6 to 40 mg. Three studies focused on alcohol use disorder, and one study on tobacco use disorder. In a pilot study (n = 10), the percentage of heavy drinking days decreased significantly between baseline and weeks 5-12 (mean difference of 26.0, 95% CI = 8.7-43.2, p = 0.008). In another single-arm study (n = 31), 32% (10/31) became completely abstinent from alcohol (mean duration of follow-up 6 years). In a double-blind, placebo-controlled randomized controlled trial (RCT, n = 95), the percentage of heavy drinking days during the 32-week double-blind period was significantly lower for psilocybin compared to placebo (mean difference of 13.9, 95% CI = 3.0-24.7, p = 0.01). In a pilot study (n = 15), the 7-day point prevalence of smoking abstinence at 26 weeks was 80% (12/15), and at 52 weeks 67% (10/15). CONCLUSION Only one RCT and three small clinical trials were identified assessing the efficacy of psilocybin combined with some form of psychotherapy in patients with alcohol and tobacco use disorder. All four clinical trials indicated a beneficial effect of psilocybin-assisted therapy on SUD symptoms. Larger RCTs in patients with SUDs need to evaluate whether psilocybin-assisted therapy is effective in patients with SUD.
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Affiliation(s)
- Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.,Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Juan J Fuentes
- Addiction Program, Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar, Barcelona, Spain.,Addiction Research Group, IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, Netherlands
| | - Marleen M de Waal
- Department of Research and Jellinek, Arkin Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Anneke E Goudriaan
- Department of Research and Jellinek, Arkin Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Kees Kramers
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Arnt Schellekens
- Nijmegen Institute for Science Practitioners in Addiction (NISPA), Nijmegen, Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Metten Somers
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Matthijs G Bossong
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Albert Batalla
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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Geuijen P, Schellekens A, Schene A, Atsma F. Substance use disorder and alcohol consumption patterns among Dutch physicians: a nationwide register-based study. Addict Sci Clin Pract 2023; 18:4. [PMID: 36639645 PMCID: PMC9837897 DOI: 10.1186/s13722-022-00356-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/09/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Problematic substance use and Substance Use Disorders (SUD) are common in all layers of the population. Several studies suggest higher prevalence rates of problematic substance use among physicians compared to the general population, which is harmful for themselves and potentially impairs quality of care. However, nationwide comparison with a highly educated reference group is lacking. Using nationwide register data, this study compared the prevalence of clinical SUD diagnoses and alcohol consumption patterns between physicians and a highly educated reference population. METHODS A retrospective study was performed using registry data from 2011 up to and including 2019, provided by Statistics Netherlands. From the data, a highly educated reference group was selected and those with an active medical doctor registration were identified as "physicians". Clinical SUD diagnoses were identified by DSM-IV codes in mental healthcare registries. Benchmark analyses were performed, without statistical testing, to compare the prevalence of SUD diagnoses and alcohol consumption patterns between physicians and the reference population. RESULTS Clinical SUD diagnoses were found among 0.3% of the physicians and 0.5% of the reference population, with higher proportions of sedative use disorder among physician patients. Among drinkers, the prevalence rates of heavy and excessive drinking were respectively 4.0% and 4.3% for physicians and 7.7% and 6.4% for the reference population. CONCLUSION Prevalence rates of SUD diagnoses were fairly comparable between physicians and the highly educated reference population, but physicians displayed more favorable alcohol consumption patterns. The use of sedatives by physicians might deserve attention, given the relatively higher prevalence of sedative use disorder among physicians. Overall, we observed relatively low prevalence rates of SUD diagnoses and problematic alcohol use, which may reflect a treatment gap and social desirable answers.
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Affiliation(s)
- Pauline Geuijen
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands ,grid.491352.8Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Arnt Schellekens
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands ,grid.491352.8Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Aart Schene
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Femke Atsma
- grid.10417.330000 0004 0444 9382Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Palma-Álvarez RF, Barta C, Carpentier PJ, Carruthers S, Crunelle CL, Demetrovics Z, Dom G, Faraone SV, Franck J, Johnson B, Kapitány-Fövény M, Kaye S, Konstenius M, Matthys F, Moggi F, Møller M, Schellekens A, Skutle A, van de Glind G, van Emmerik-van Oortmerssen K, Verspreet S, Schoevers RA, Wallhed S, Levin FR, Grau-López L, Casas M, van den Brink W, Ramos-Quiroga JA. Validity of the ADHD module of the Mini International Neuropsychiatric Interview PLUS for screening of adult ADHD in treatment seeking substance use disorder patients: ADHD screening with MINI-Plus. Span J Psychiatry Ment Health 2023; 16:11-15. [PMID: 32561156 DOI: 10.1016/j.rpsm.2020.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion. METHOD A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus. RESULTS According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60. CONCLUSION The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients. SCIENTIFIC SIGNIFICANCE On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.
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Affiliation(s)
- Raul Felipe Palma-Álvarez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | | | - Susan Carruthers
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Cleo L Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geert Dom
- Antwerp University (UA), Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; Psychiatric Center Mutiversum, Boechout, Belgium
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brian Johnson
- Departments of Psychiatry and of Anesthesia, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Máté Kapitány-Fövény
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary; Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Sharlene Kaye
- National Drug and Alcohol Research Center, University of New South Wales, Sydney, Australia
| | - Maija Konstenius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Merete Møller
- Department for Substance Abuse Treatment, Østfold Hospital Trust, Norway
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | | | - Katelijne van Emmerik-van Oortmerssen
- Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sara Wallhed
- Stockholm Centre for Dependency Disorders, Sweden
| | - Frances R Levin
- Columbia University, the New York State Psychiatric Institute, New York, NY, USA
| | - Lara Grau-López
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Vadaq N, Zhang Y, Meeder E, Van de Wijer L, Gasem MH, Joosten LA, Netea MG, de Mast Q, Matzaraki V, Schellekens A, Fu J, van der Ven AJ. Microbiome-Related Indole and Serotonin Metabolites are Linked to Inflammation and Psychiatric Symptoms in People Living with HIV. Int J Tryptophan Res 2022; 15:11786469221126888. [PMID: 36187510 PMCID: PMC9520182 DOI: 10.1177/11786469221126888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background: People living with HIV (PLHIV) exhibit dysregulation of tryptophan metabolism. Altered gut microbiome composition in PLHIV might be involved. Mechanistic consequences within the 3 major tryptophan metabolism pathways (serotonin, kynurenine, and indoles), and functional consequences for platelet, immune and behavioral functions are unknown. We investigated plasma tryptophan metabolites, gut microbiome composition, and their association with platelet function, inflammation, and psychiatric symptoms. Methods: This study included 211 PLHIV on long-term antiretroviral treatment (ART). Plasma tryptophan pathway metabolites were measured using time-of-flight mass spectrometry. Bacterial composition was profiled using metagenomic sequencing. Platelet reactivity and serotonin levels were quantified by flowcytometry and ELISA, respectively. Circulating inflammatory markers were determined using ELISA. Symptoms of depression and impulsivity were measured by DASS-42 and BIS-11 self-report questionnaires, respectively. Results: Plasma serotonin and indole metabolites were associated with gut bacterial composition. Notably, species enriched in PLHIV were associated with 3-methyldioxyindole. Platelet serotonin concentrations were elevated in PLHIV, without effects on platelet reactivity. Plasma serotonin and indole metabolites were positively associated with plasma IL-10 and TNF-α concentrations. Finally, higher tryptophan, serotonin, and indole metabolites were associated with lower depression and anxiety, whereas higher kynurenine metabolites were associated with increased impulsivity. Conclusion: Our results suggest that gut bacterial composition and dysbiosis in PLHIV on ART contribute to tryptophan metabolism, which may have clinical consequences for immune function and behavior.
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Affiliation(s)
- Nadira Vadaq
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud Institute of Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Center for Tropical and Infectious Diseases (CENTRID), Faculty of Medicine, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
| | - Yue Zhang
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise Meeder
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Lisa Van de Wijer
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud Institute of Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Muhammad Hussein Gasem
- Center for Tropical and Infectious Diseases (CENTRID), Faculty of Medicine, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia.,Department of Internal Medicine, Faculty of Medicine Diponegoro University-Dr. Kariadi Hospital, Semarang, Indonesia
| | - Leo Ab Joosten
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud Institute of Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud Institute of Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Department for Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Quirijn de Mast
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud Institute of Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vasiliki Matzaraki
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud Institute of Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Jingyuan Fu
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - André Jam van der Ven
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud Institute of Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Brynte C, Aeschlimann M, Barta C, Begeman AHA, Bäcker A, Crunelle CL, Daigre C, De Fuentes-Merillas L, Demetrovics Z, Dom G, López LG, Icick R, Johnson B, Joostens P, Kapitány-Fövény M, Karsinti E, Kiefer F, Konstenius M, Levin FR, Luderer M, Markus W, Matthys F, Moggi F, Palma-Alvarez RF, Paraskevopoulou M, Ramos-Quiroga JA, Schellekens A, Soravia LM, Therribout N, Thomas A, van de Glind G, van Kernebeek MW, Vollstädt-Klein S, Vorspan F, van den Brink W, Franck J. The clinical course of comorbid substance use disorder and attention deficit/hyperactivity disorder: protocol and clinical characteristics of the INCAS study. BMC Psychiatry 2022; 22:625. [PMID: 36151539 PMCID: PMC9502646 DOI: 10.1186/s12888-022-04259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Substance use disorders (SUD) often co-occur with attention deficit hyperactivity disorder (ADHD). Although the short-term effects of some specific interventions have been investigated in randomized clinical trials, little is known about the long-term clinical course of treatment-seeking SUD patients with comorbid ADHD. AIMS This paper presents the protocol and baseline clinical characteristics of the International Naturalistic Cohort Study of ADHD and SUD (INCAS) designed and conducted by the International Collaboration on ADHD and Substance Abuse (ICASA) foundation. The overall aim of INCAS is to investigate the treatment modalities provided to treatment-seeking SUD patients with comorbid ADHD, and to describe the clinical course and identify predictors for treatment outcomes. This ongoing study employs a multicentre observational prospective cohort design. Treatment-seeking adult SUD patients with comorbid ADHD are recruited, at 12 study sites in nine different countries. During the follow-up period of nine months, data is collected through patient files, interviews, and self-rating scales, targeting a broad range of cognitive and clinical symptom domains, at baseline, four weeks, three months and nine months. RESULTS A clinically representative sample of 578 patients (137 females, 441 males) was enrolled during the recruitment period (June 2017-May 2021). At baseline, the sample had a mean age (SD) of 36.7 years (11.0); 47.5% were inpatients and 52.5% outpatients; The most prevalent SUDs were with alcohol 54.2%, stimulants 43.6%, cannabis 33.1%, and opioids 14.5%. Patients reported previous treatments for SUD in 71.1% and for ADHD in 56.9%. Other comorbid mental disorders were present in 61.4% of the sample: major depression 31.5%, post-traumatic stress disorder 12.1%, borderline personality disorder 10.2%. CONCLUSIONS The first baseline results of this international cohort study speak to its feasibility. Data show that many SUD patients with comorbid ADHD had never received treatment for their ADHD prior to enrolment in the study. Future reports on this study will identify the course and potential predictors for successful pharmaceutical and psychological treatment outcomes. TRIAL REGISTRATION ISRCTN15998989 20/12/2019.
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Affiliation(s)
- Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden.
| | - Myriam Aeschlimann
- grid.5734.50000 0001 0726 5157University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Csaba Barta
- grid.11804.3c0000 0001 0942 9821Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary
| | | | - Amanda Bäcker
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Cleo Lina Crunelle
- grid.411326.30000 0004 0626 3362Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Constanza Daigre
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura De Fuentes-Merillas
- grid.491352.8Novadic-Kentron Addiction Care; Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
| | - Zsolt Demetrovics
- grid.5591.80000 0001 2294 6276Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary ,grid.513141.30000 0004 4670 111XCentre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Geert Dom
- grid.5284.b0000 0001 0790 3681University of Antwerp, Antwerp, Belgium ,PC Multiversum, Boechout, Belgium
| | - Lara Grau López
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Romain Icick
- grid.508487.60000 0004 7885 7602Université de Paris Cité, Paris, France
| | | | | | - Máté Kapitány-Fövény
- grid.11804.3c0000 0001 0942 9821Faculty of Health Sciences, Semmelweis University, Budapest, Hungary ,National Institute of Mental Health, Neurology and Neurosurgery – Nyírő Gyula Hospital, Budapest, Hungary
| | - Emily Karsinti
- grid.414095.d0000 0004 1797 9913Université Paris-Nanterre, CliPsyD Laboratory FR and APHP, Fernand Widal Hospital, Universitary Department of Psychiatry and Addictology, Paris, France
| | - Falk Kiefer
- grid.7700.00000 0001 2190 4373Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maija Konstenius
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Frances R. Levin
- grid.21729.3f0000000419368729Vagelos College of Physicians and Surgeons, New York City, USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York City, USA
| | - Mathias Luderer
- grid.411088.40000 0004 0578 8220Department of Psychiatry, Psychosomatic Medicine and Psychoterapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Wiebren Markus
- grid.491352.8Iriszorg Addiction Care, Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
| | - Frieda Matthys
- grid.411326.30000 0004 0626 3362Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Franz Moggi
- grid.5734.50000 0001 0726 5157University Hospital of Psychiatry, Translational Research Center, University of Bern, Bern, Switzerland
| | - Raul Felipe Palma-Alvarez
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Maria Paraskevopoulou
- Department of Psychiatry, RadboudumcDonders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - J. Antoni Ramos-Quiroga
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Arnt Schellekens
- Department of Psychiatry, RadboudumcDonders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands ,grid.491352.8Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
| | - Leila M. Soravia
- grid.5734.50000 0001 0726 5157University Hospital of Psychiatry, Translational Research Center, University of Bern, Bern, Switzerland ,Südhang Clinic, Kirchlindach, Switzerland
| | - Norman Therribout
- grid.414095.d0000 0004 1797 9913Université Paris-Nanterre, CliPsyD Laboratory FR and APHP, Fernand Widal Hospital, Universitary Department of Psychiatry and Addictology, Paris, France
| | - Anil Thomas
- Mt. Sinai, Icahn School of Medicine, New York City, USA ,grid.137628.90000 0004 1936 8753NYU Grossman School of Medicine, New York City, USA
| | - Geurt van de Glind
- grid.438049.20000 0001 0824 9343University of Applied Sciences-Utrecht, Utrecht, the Netherlands
| | - Michiel Willem van Kernebeek
- grid.411326.30000 0004 0626 3362Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Sabine Vollstädt-Klein
- grid.7700.00000 0001 2190 4373Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Florence Vorspan
- grid.508487.60000 0004 7885 7602Université de Paris Cité, Paris, France
| | - Wim van den Brink
- grid.509540.d0000 0004 6880 3010Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Johan Franck
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
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11
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van Kernebeek MW, Vorspan F, Crunelle CL, van den Brink W, Dom G, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Ramos-Quiroga JA, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F, Icick R. Consensus International sur le dépistage, le diagnostic et le traitement des patients avec troubles de l’usage de substances en cas de comorbidité avec un trouble du déficit de l’attention avec ou sans hyperactivité. Toxicologie Analytique et Clinique 2022. [DOI: 10.1016/j.toxac.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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López-Toro E, Wolf CJH, González RA, van den Brink W, Schellekens A, Vélez-Pastrana MC. Network Analysis of DSM Symptoms of Substance Use Disorders and Frequently Co-Occurring Mental Disorders in Patients with Substance Use Disorder Who Seek Treatment. J Clin Med 2022; 11:jcm11102883. [PMID: 35629008 PMCID: PMC9145186 DOI: 10.3390/jcm11102883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Substance use disorders (SUD) often co-occur with other psychiatric conditions. Research on SUD and comorbid disorders generally flows from a categorical diagnostic or dimensional latent variable perspective, where symptoms are viewed as independent indicators of an underlying disorder. In contrast, the current study took a network analysis perspective to examine the relationships between DSM symptoms of SUD, ADHD, conduct disorder (CD), depression (MDD), and borderline personality disorder (BPD). In addition, we explored possible gender differences in the network structures of these symptoms. Method: In a sample of 722 adult treatment-seeking patients with SUD from the International ADHD in Substance Use Disorders Prevalence Study (IASP) we estimated the network structure for 41 symptoms of SUD, ADHD, CD, MDD, and BPD. We described the structure of symptom networks and their characteristics for the total sample, and we compared the symptom networks for males and females. Results: Network analyses identified seven clusters of symptoms, largely corresponding with the DSM diagnostic categories. There were some connections between clusters, mainly between some hyperactivity symptoms and CD and depressive symptoms. ADHD hyperactivity was most central in the symptom network. Invariance tests revealed no significant gender differences in the structure of symptom networks. Conclusions: The current findings support the categorical DSM classification of mental disorders in treatment-seeking patients with SUD. Future network analyses should include a broader range of symptoms and prospectively explore changes in the symptoms network of patients during treatment.
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Affiliation(s)
- Edith López-Toro
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, P.O. Box 9023711, San Juan, PR 00902-3711, USA;
| | - Casper J. H. Wolf
- Department of Psychiatry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.J.H.W.); (A.S.)
- Department of Cognitive Neuroscience, Donders Institute for Brain Cognition and Behaviour, Radboud University, 6525 EN Nijmegen, The Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands
| | - Rafael A. González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK;
- Centre for Psychiatry, Imperial College London, London W12 0NN, UK
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands;
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.J.H.W.); (A.S.)
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands
| | - María C. Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, P.O. Box 9023711, San Juan, PR 00902-3711, USA;
- Correspondence: ; Tel.: +1-787-725-6500
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13
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van Eijndhoven P, Collard R, Vrijsen J, Geurts DEM, Vasquez AA, Schellekens A, van den Munckhof E, Brolsma S, Duyser F, Bergman A, van Oort J, Tendolkar I, Schene A. Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET): Protocol for a Cross-sectional Comorbidity Study From a Research Domain Criteria Perspective. JMIRx Med 2022; 3:e31269. [PMID: 37725542 PMCID: PMC10414459 DOI: 10.2196/31269] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/13/2021] [Accepted: 12/06/2021] [Indexed: 09/21/2023]
Abstract
BACKGROUND It is widely acknowledged that comorbidity between psychiatric disorders is common. Shared and diverse underpinnings of psychiatric disorders cannot be systematically understood based on symptom-based categories of mental disorders, which map poorly onto pathophysiological mechanisms. In the Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET) study, we make use of current concepts of comorbidity that transcend the current diagnostic categories. We test this approach to psychiatric problems in patients with frequently occurring psychiatric disorders and their comorbidities (excluding psychosis). OBJECTIVE The main aim of the MIND-SET project is to determine the shared and specific mechanisms of neurodevelopmental and stress-related psychiatric disorders at different observational levels. METHODS This is an observational cross-sectional study. Data from different observational levels as defined in the Research Domain Criteria (genetics, physiology, neuropsychology, system-level neuroimaging, behavior, self-report, and experimental neurocognitive paradigms) are collected over four time points. Included are adult (aged ≥18 years), nonpsychotic, psychiatric patients with a clinical diagnosis of a stress-related disorder (mood disorder, anxiety disorder, or substance use disorder) or a neurodevelopmental disorder (autism spectrum disorder or attention-deficit/hyperactivity disorder). Individuals with no current or past psychiatric diagnosis are included as neurotypical controls. Data collection started in June 2016 with the aim to include a total of 650 patients and 150 neurotypical controls by 2021. The data collection procedure includes online questionnaires and three subsequent sessions with (1) standardized clinical examination, physical examination, and blood sampling; (2) psychological constructs, neuropsychological tests, and biological marker sampling; and (3) neuroimaging measures. RESULTS We aim to include a total of 650 patients and 150 neurotypical control participants in the time period between 2016 and 2022. In October 2021, we are at 95% of our target. CONCLUSIONS The MIND-SET study enables us to investigate the mechanistic underpinnings of nonpsychotic psychiatric disorders transdiagnostically. We will identify both shared and disorder-specific markers at different observational levels that can be used as targets for future diagnostic and treatment approaches.
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Affiliation(s)
- Philip van Eijndhoven
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Rose Collard
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Janna Vrijsen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Pro Persona Mental Health Care, Depression Expertise Centre, Nijmegen, Netherlands
| | - Dirk E M Geurts
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Alejandro Arias Vasquez
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Nijmegen Institute of Scientist-Practitioners in Addiction, Radboud University, Nijmegen, Netherlands
| | - Eva van den Munckhof
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Sophie Brolsma
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Fleur Duyser
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Annemiek Bergman
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Jasper van Oort
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- LVR-Klinikum Essen, Department of Psychiatry and Psychotherapy, University Hospital Essen, Essen, Germany
| | - Aart Schene
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
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14
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Schellekens A, Kramers K, Knuijver T, Belgers M, Donders R, Verkes RJ. Response to Luz & Mash on cardiac toxicity of ibogaine. Addiction 2022; 117:837-838. [PMID: 34859515 DOI: 10.1111/add.15775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kees Kramers
- Radboudumc Afdeling Farmacologie en toxicologie, Nijmegen, Gelderland, the Netherlands
| | | | | | - Rogier Donders
- Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, the Netherlands
| | - Robbert-Jan Verkes
- Donders Centre for Neuroscience, Radboud University Nijmegen Medical Center, the Netherlands
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15
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Knuijver T, Schellekens A, Belgers M, Donders R, van Oosteren T, Kramers K, Verkes R. Safety of ibogaine administration in detoxification of opioid-dependent individuals: a descriptive open-label observational study. Addiction 2022; 117:118-128. [PMID: 33620733 PMCID: PMC9292417 DOI: 10.1111/add.15448] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/15/2020] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Ibogaine is an indole alkaloid used in rituals of the African Bwiti tribe. It is also used in non-medical settings to treat addiction. However, ibogaine has been linked to several deaths, mainly due to cardiac events called torsades des pointes preceded by QTc prolongation as well as other safety concerns. This study aimed to evaluate the cardiac, cerebellar and psychomimetic safety of ibogaine in patients with opioid use disorder. DESIGN A descriptive open-label observational study. SETTING Department of psychiatry in a university medical center, the Netherlands. PARTICIPANTS Patients with opioid use disorder (n = 14) on opioid maintenance treatment with a lasting wish for abstinence, who failed to reach abstinence with standard care. INTERVENTION AND MEASUREMENTS After conversion to morphine-sulphate, a single dose of ibogaine-HCl 10 mg/kg was administered and patients were monitored at regular intervals for at least 24 hours assessing QTc, blood pressure and heart rate, scale for the assessment and rating of ataxia (SARA) to assess cerebellar side effects and the delirium observation scale (DOS) to assess psychomimetic effects. FINDINGS The maximum QTc (Fridericia) prolongation was on average 95ms (range 29-146ms). Fifty percent of subjects reached a QTc of over 500ms during the observation period. In six out 14 subjects prolongation above 450ms lasted beyond 24 hours after ingestion of ibogaine. No torsades des pointes were observed. Severe transient ataxia with inability to walk without support was seen in all patients. Withdrawal and psychomimetic effects were mostly well-tolerated and manageable (11/14 did not return to morphine within 24 hours, DOS scores remained below threshold). CONCLUSIONS This open-label observational study found that ibogaine treatment of patients with opioid use disorder can induce a clinically relevant but reversible QTc prolongation, bradycardia, and severe ataxia.
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Affiliation(s)
- Thomas Knuijver
- IrisZorg verslavingszorgArnhemthe Netherlands,Nijmegen Institute for Science Practitioners in Addiction (NISPA)Nijmegenthe Netherlands,Department of Pharmacology–ToxicologyRadboud UMC NijmegenNijmegenthe Netherlands
| | - Arnt Schellekens
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)Nijmegenthe Netherlands,Department of PsychiatryRadboud UMCNijmegenthe Netherlands
| | - Maarten Belgers
- IrisZorg verslavingszorgArnhemthe Netherlands,Nijmegen Institute for Science Practitioners in Addiction (NISPA)Nijmegenthe Netherlands
| | - Rogier Donders
- Department for Health EvidenceRadboud UMC NijmegenNijmegenthe Netherlands
| | | | - Kees Kramers
- Department of Pharmacology–ToxicologyRadboud UMC NijmegenNijmegenthe Netherlands
| | - Robbert Verkes
- Department of PsychiatryRadboud UMCNijmegenthe Netherlands,Centre of Forensic PsychiatryPompe KliniekNijmegenthe Netherlands
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16
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van Dee V, Janssen EAM, Blom RM, Cahn W, van Mierlo HC, Mihaescu R, van Wullften Palthe J, Zijlstra R, Kok RM, Everaerd DS, Schellekens A, oviP-Consortium C. [Psychiatric symptoms and COVID-19: results of a national case register]. Tijdschr Psychiatr 2022; 64:558-565. [PMID: 36349850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Psychiatric disorders are associated with a more severe course of COVID-19. COVID-19 can also lead to psychiatric symptoms. AIM To gain insight into vulnerabilities and protective factors for the course of COVID-19 in a Dutch (neuro)psychiatric population. METHOD Patients were divided into three groups: patients with pre-existent mental disorders without and with new (neuro)psychiatric symptoms (NPS) during COVID-19 and patients without pre-existent mental disorders who developed de novo NPS during COVID-19. We summarize the characteristics of each group and compare the subgroups with inferential statistics. RESULTS 186 patients were included in the case register. Patients with NPS showed a more severe course of COVID-19. Mortality in patients with NPS was higher in patients with pre-existent mental disorders compared to patients without pre-existent mental disorders. The most frequently reported de novo psychiatric symptoms during COVID-19 were delirium (46-70%), anxiety (53-54%) and insomnia (18-42%). CONCLUSION NPS might be an expression of a more severe COVID-19 episode. In patients who developed NPS during COVID-19 we found evidence for a higher mortality risk in patients with pre-existent mental disorders. Extra vigilance for neuropsychiatric symptoms during COVID-19 is warranted.
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17
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Moska C, Goudriaan AE, Blanken P, van de Mheen D, Spijkerman R, Schellekens A, de Jonge J, Bary F, Vollebergh W, Hendriks V. Youth in transition: Study protocol of a prospective cohort study into the long-term course of addiction, mental health problems and social functioning in youth entering addiction treatment. BMC Psychiatry 2021; 21:605. [PMID: 34863131 PMCID: PMC8642918 DOI: 10.1186/s12888-021-03520-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) are prevalent in the general population, tend to follow a chronic course, are associated with many individual and social problems, and often have their onset in adolescence. However, the knowledge base from prospective population surveys and treatment-outcome studies on the course of SUD in adolescents is limited at best. The present study aims to fill this gap and focuses on a subgroup that is particularly at risk for chronicity: adolescents in addiction treatment. We will investigate the rate of persistent SUD and its predictors longitudinally from adolescence to young adulthood among youth with DSM-5 SUD from the start of their addiction treatment to 2 and 4 years following treatment-entry. In addition to SUD, we will investigate the course of comorbid mental disorders, social functioning, and quality of life and their association with SUD over time. METHODS/DESIGN In a naturalistic, multi-center prospective cohort design, we will include youths (n = 420), who consecutively enter addiction treatment at ten participating organizations in the Netherlands. Inclusion is prestratified by treatment organization, to ensure a nationally representative sample. Eligible youths are 16 to 22 years old and seek help for a primary DSM-5 cannabis, alcohol, cocaine or amphetamine use disorder. Assessments focus on lifetime and current substance use and SUD, non-SUD mental disorders, family history, life events, social functioning, treatment history, quality of life, chronic stress indicators (hair cortisol) and neuropsychological tests (computerized executive function tasks) and are conducted at baseline, end of treatment, and 2 and 4 years post-baseline. Baseline data and treatment data (type, intensity, duration) will be used to predict outcome - persistence of or desistance from SUD. DISCUSSION There are remarkably few prospective studies worldwide that investigated the course of SUD in adolescents in addiction treatment for longer than 1 year. We are confident that the Youth in Transition study will further our understanding of determinants and consequences of persistent SUD among high-risk adolescents during the critical transition from adolescence to young adulthood. TRIAL REGISTRATION The Netherlands National Trial Register Trial NL7928 . Date of registration January 17, 2019.
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Affiliation(s)
- Christina Moska
- grid.491465.bParnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands ,grid.10419.3d0000000089452978Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna E. Goudriaan
- grid.7177.60000000084992262Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands ,grid.491159.10000 0004 0493 7618Amsterdam Institute for Addiction Research, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Peter Blanken
- grid.491465.bParnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - Dike van de Mheen
- grid.12295.3d0000 0001 0943 3265Department of Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands
| | - Renske Spijkerman
- grid.491465.bParnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - Arnt Schellekens
- grid.10417.330000 0004 0444 9382Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, the Netherlands ,grid.491352.8Nijmegen Institute for Science Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
| | - Jannet de Jonge
- grid.431204.00000 0001 0685 7679Research Group Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
| | - Floris Bary
- Netherlands Network of Client Councils in Addiction Care ‘Het Zwarte Gat’, Hollands Kroon, The Netherlands
| | - Wilma Vollebergh
- grid.5477.10000000120346234Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Vincent Hendriks
- grid.491465.bParnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands ,grid.10419.3d0000000089452978Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Leiden, the Netherlands
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18
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Van de Wijer L, van der Heijden W, van Verseveld M, Netea M, de Mast Q, Schellekens A, van der Ven A. Substance use, Unlike Dolutegravir, is Associated with Mood Symptoms in People Living with HIV. AIDS Behav 2021; 25:4094-4101. [PMID: 33903997 PMCID: PMC8602138 DOI: 10.1007/s10461-021-03272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Contradictory data have been reported concerning neuropsychiatric side effects of the first-line antiretroviral drug dolutegravir, which may be partly due to lack of control groups or psychiatric assessment tools. Using validated self-report questionnaires, we compared mood and anxiety (DASS-42), impulsivity (BIS-11), and substance use (MATE-Q) between dolutegravir-treated and dolutegravir-naive people living with HIV (PLHIV). We analyzed 194, mostly male, PLHIV on long-term treatment of whom 82/194 (42.3%) used dolutegravir for a median (IQR) of 280 (258) days. Overall, 51/194 (26.3%) participants reported DASS-42 scores above the normal cut-off, 27/194 (13.5%) were classified as highly impulsive, and 58/194 (29.9%) regularly used recreational drugs. Regular substance use was positively associated with depression (p = 0.012) and stress scores (p = 0.045). We observed no differences between dolutegravir-treated and dolutegravir-naive PLHIV. Our data show that depressed and anxious moods and impulsivity are common in PLHIV and associate with substance use and not with dolutegravir use.
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19
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Meeder E, Matzaraki V, Vadaq N, van de Wijer L, van der Ven A, Schellekens A. Unbiased Metabolomics Links Fatty Acid Pathways to Psychiatric Symptoms in People Living with HIV. J Clin Med 2021; 10:jcm10235466. [PMID: 34884168 PMCID: PMC8658345 DOI: 10.3390/jcm10235466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022] Open
Abstract
Psychiatric symptoms are prevalent in people living with HIV (PLWH), especially depression, anxiety, impulsivity, and substance use. Various biological mechanisms might play a role in the occurrence of psychiatric symptoms in this population. A hypothesis free, data-driven metabolomics approach can further our understanding of these mechanisms. In this study, we identified metabolic pathways associated with impulsivity, depression and substance use in 157 PLWH. First, Spearman’s rank correlations between metabolite feature intensities and psychiatric symptom levels were calculated, while controlling for age, gender and body mass index. Subsequently, a mummichog pathway analysis was performed. Finally, we analyzed which individual metabolites drove the observed effects. In our cohort of PLWH, fatty acid-related pathways were associated with both depressive as well as impulsive symptomatology. Substance use showed most extensive metabolic associations, and was positively associated with short chain fatty acids (SCFA’s), and negatively associated with glutamate levels. These findings suggest that PUFA metabolism might be associated with both internalising and externalising symptomatology in PLWH. Furthermore, glutamate and SCFA’s—microbiome derivatives with known neuroactive properties—might be involved in substance use in these patients. Future studies should explore potential causal mechanisms involved and whether these findings are HIV-specific.
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Affiliation(s)
- Elise Meeder
- Department of Psychiatry, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 HE Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6525 AJ Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-648-021-927
| | - Vasiliki Matzaraki
- Department of General Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (V.M.); (N.V.); (L.v.d.W.); (A.v.d.V.)
| | - Nadira Vadaq
- Department of General Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (V.M.); (N.V.); (L.v.d.W.); (A.v.d.V.)
- Center for Tropical and Infectious Diseases (CENTRID), Faculty of Medicine, Diponegoro University, Dr. Kariadi Hospital, Semarang 1269, Indonesia
| | - Lisa van de Wijer
- Department of General Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (V.M.); (N.V.); (L.v.d.W.); (A.v.d.V.)
| | - André van der Ven
- Department of General Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (V.M.); (N.V.); (L.v.d.W.); (A.v.d.V.)
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 HE Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6525 AJ Nijmegen, The Netherlands
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20
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Vink JM, Treur JL, Pasman JA, Schellekens A. Investigating genetic correlation and causality between nicotine dependence and ADHD in a broader psychiatric context. Am J Med Genet B Neuropsychiatr Genet 2021; 186:423-429. [PMID: 32909657 PMCID: PMC9292706 DOI: 10.1002/ajmg.b.32822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/26/2019] [Accepted: 08/12/2020] [Indexed: 12/28/2022]
Abstract
People with attention-deficit/hyperactivity disorder (ADHD) or other psychiatric disorders show high rates of nicotine dependence (ND). This comorbidity might be (partly) explained by shared genetic factors. Genetic correlations between ND and ADHD (or other psychiatric disorders) have not yet been estimated. A significant genetic correlation might indicate genetic overlap, but could also reflect a causal relationship. In the present study we investigated the genetic correlation (with LD score regression analyses) between ND and ADHD, as well as between ND and other major psychiatric conditions (major depressive disorder, schizophrenia, anxiety, bipolar disorder, autism spectrum, anorexia nervosa, and antisocial behavior) based on the summary statistics of large Genome Wide Association studies. We explored the causal nature of the relationship between ND and ADHD using two-sample Mendelian randomization. We found a high genetic correlation between ND and ADHD (rg = .53, p = 1.85 × 10-13 ), and to a lesser extent also between ND-major depressive disorder (rg = .42, p = 3.6 × 10-11 ) and ND-schizophrenia (rg = .18, p = 1.1 × 10-3 ). We did not find evidence for a causal relationship from liability for ADHD to ND (which could be due to a lack of power). The strong genetic correlations might reflect different phenotypic manifestations of (partly) shared underlying genetic vulnerabilities. Combined with the lack of evidence for a causal relationship from liability for ADHD to ND, these findings stress the importance to further investigate the underlying genetic vulnerability explaining co-morbidity in psychiatric disorders.
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Affiliation(s)
| | - Jorien L. Treur
- Department of Psychiatry, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Joëlle A. Pasman
- Behavioural Science InstituteRadboud UniversityNijmegenThe Netherlands
| | - Arnt Schellekens
- Department of PsychiatryRadoudumc, Donders Centre for Medical NeuroscienceNijmegenThe Netherlands,Nijmegen Institute for Scientist Practitioners in AddictionNijmegenThe Netherlands
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21
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Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, Newcorn JH, Gignac M, Al Saud NM, Manor I, Rohde LA, Yang L, Cortese S, Almagor D, Stein MA, Albatti TH, Aljoudi HF, Alqahtani MMJ, Asherson P, Atwoli L, Bölte S, Buitelaar JK, Crunelle CL, Daley D, Dalsgaard S, Döpfner M, Espinet S, Fitzgerald M, Franke B, Gerlach M, Haavik J, Hartman CA, Hartung CM, Hinshaw SP, Hoekstra PJ, Hollis C, Kollins SH, Sandra Kooij JJ, Kuntsi J, Larsson H, Li T, Liu J, Merzon E, Mattingly G, Mattos P, McCarthy S, Mikami AY, Molina BSG, Nigg JT, Purper-Ouakil D, Omigbodun OO, Polanczyk GV, Pollak Y, Poulton AS, Rajkumar RP, Reding A, Reif A, Rubia K, Rucklidge J, Romanos M, Ramos-Quiroga JA, Schellekens A, Scheres A, Schoeman R, Schweitzer JB, Shah H, Solanto MV, Sonuga-Barke E, Soutullo C, Steinhausen HC, Swanson JM, Thapar A, Tripp G, van de Glind G, van den Brink W, Van der Oord S, Venter A, Vitiello B, Walitza S, Wang Y. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev 2021; 128:789-818. [PMID: 33549739 PMCID: PMC8328933 DOI: 10.1016/j.neubiorev.2021.01.022] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, Psychiatry Research Division, SUNY Upstate Medical University, Syracuse, NY, USA; World Federation of ADHD, Switzerland; American Professional Society of ADHD and Related Disorders (APSARD), USA.
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Child and Adolescent Psychiatrist's Representative, Zentrales-ADHS-Netz, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing, China; Beijing Key Laboratory of Mental Disorders, Beijing, China; Beijing Institute for Brain Disorders, Beijing, China; Asian Federation of ADHD, China; Chinese Society of Child and Adolescent Psychiatry, China
| | - Joseph Biederman
- Clinical & Research Programs in Pediatric Psychopharmacology & Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Jeffrey H Newcorn
- American Professional Society of ADHD and Related Disorders (APSARD), USA; Departments of Psychiatry and Pediatrics, Division of ADHD and Learning Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martin Gignac
- Department of Child and Adolescent Psychiatry, Montreal Children's Hospital, MUHC, Montreal, Canada; Child and Adolescent Psychiatry Division, McGill University, Montreal, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | | | - Iris Manor
- Chair, Israeli Society of ADHD (ISA), Israel; Co-chair of the neurodevelopmental section in EPA (the European Psychiatric Association), France
| | - Luis Augusto Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul, Brazil
| | - Li Yang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton,UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; University of Nottingham, Nottingham, UK
| | - Doron Almagor
- University of Toronto, SickKids Centre for Community Mental Health, Toronto, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | - Mark A Stein
- University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Turki H Albatti
- Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Haya F Aljoudi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Mohammed M J Alqahtani
- Clinical Psychology, King Khalid University, Abha, Saudi Arabia; Saudi ADHD Society, Saudi Arabia
| | - Philip Asherson
- Social Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Lukoye Atwoli
- Department of Mental Health and Behavioural Science, Moi University School of Medicine, Eldoret, Kenya; Brain and Mind Institute, and Department of Internal Medicine, Medical College East Africa, the Aga Khan University, Kenya; African College of Psychopharmacology, Kenya; African Association of Psychiatrists, Kenya
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Cleo L Crunelle
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Dept. of Psychiatry, Brussel, Belgium; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine University of Nottingham, Nottingham, UK; NIHR MindTech Mental Health MedTech Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Søren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany; Zentrales-ADHS-Netz, Germany
| | | | | | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Professional Board, ADHD Europe, Belgium
| | - Manfred Gerlach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Catharina A Hartman
- University of Groningen, Groningen, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands; Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; ADHD Across the Lifespan Network from European College of Neuropsychopharmacology(ECNP), the Netherlands
| | | | - Stephen P Hinshaw
- University of California, Berkeley, CA, USA; University of California, San Francisco, CA, USA
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Chris Hollis
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK; NIHR MindTech MedTech Co-operative, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Scott H Kollins
- Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - J J Sandra Kooij
- Amsterdam University Medical Center (VUMc), Amsterdam, the Netherlands; PsyQ, The Hague, the Netherlands; European Network Adult ADHD, the Netherlands; DIVA Foundation, the Netherlands; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Tingyu Li
- Growth, Development and Mental Health Center for Children and Adolescents, Children's Hospital of Chongqing Medical University, Chongqing, China; National Research Center for Clinical Medicine of Child Health and Disease, Chongqing, China; The Subspecialty Group of Developmental and Behavioral Pediatrics, the Society of Pediatrics, Chinese Medical Association, China
| | - Jing Liu
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; The Chinese Society of Child and Adolescent Psychiatry, China; The Asian Society for Child and Adolescent Psychiatry and Allied Professions, China
| | - Eugene Merzon
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Leumit Health Services, Tel Aviv, Israel; Israeli Society of ADHD, Israel; Israeli National Diabetes Council, Israel
| | - Gregory Mattingly
- Washington University, St. Louis, MO, USA; Midwest Research Group, St Charles, MO, USA
| | - Paulo Mattos
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brazilian Attention Deficit Association (ABDA), Brazil
| | | | | | - Brooke S G Molina
- Departments of Psychiatry, Psychology, Pediatrics, Clinical & Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel T Nigg
- Center for ADHD Research, Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Diane Purper-Ouakil
- University of Montpellier, CHU Montpellier Saint Eloi, MPEA, Medical and Psychological Unit for Children and Adolescents (MPEA), Montpellier, France; INSERM U 1018 CESP-Developmental Psychiatry, France
| | - Olayinka O Omigbodun
- Centre for Child & Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Child & Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Yehuda Pollak
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Israel; The Israeli Society of ADHD (ISA), Israel
| | - Alison S Poulton
- Brain Mind Centre Nepean, University of Sydney, Sydney, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Ravi Philip Rajkumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany; German Psychiatric Association, Germany
| | - Katya Rubia
- World Federation of ADHD, Switzerland; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany
| | - Julia Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany; Zentrales-ADHS-Netz, Germany
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France; International Collaboration on ADHD and Substance Abuse (ICASA), the Netherlands; DIVA Foundation, the Netherlands
| | - Arnt Schellekens
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - Anouk Scheres
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Renata Schoeman
- University of Stellenbosch Business School, Cape Town, South Africa; South African Special Interest Group for Adult ADHD, South Africa; The South African Society of Psychiatrists/Psychiatry Management Group Management Guidelines for ADHD, South Africa; World Federation of Biological Psychiatry, Germany; American Psychiatric Association, USA; Association for NeuroPsychoEconomics, USA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Henal Shah
- Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Mary V Solanto
- The Zucker School of Medicine at Hofstra-Northwell, Northwell Health, Hemstead, NY, USA; Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), USA; American Professional Society of ADHD and Related Disorders (APSARD), USA; National Center for Children with Learning Disabilities (NCLD), USA
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
| | - César Soutullo
- American Professional Society of ADHD and Related Disorders (APSARD), USA; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany; Louis A. Faillace MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hans-Christoph Steinhausen
- University of Zurich, CH, Switzerland; University of Basel, CH, Switzerland; University of Southern Denmark, Odense, Denmark; Centre of Child and Adolescent Mental Health, Copenhagen, Denmark
| | - James M Swanson
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Wales, UK
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Geurt van de Glind
- Hogeschool van Utrecht/University of Applied Sciences, Utrecht, the Netherlands
| | - Wim van den Brink
- Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Saskia Van der Oord
- Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; European ADHD Guidelines Group, Germany
| | - Andre Venter
- University of the Free State, Bloemfontein, South Africa
| | - Benedetto Vitiello
- University of Torino, Torino, Italy; Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Yufeng Wang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
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22
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Özgen H, Spijkerman R, Noack M, Holtmann M, Schellekens A, Dalsgaard S, van den Brink W, Hendriks V. Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review. J Clin Med 2021; 10:jcm10173908. [PMID: 34501355 PMCID: PMC8432200 DOI: 10.3390/jcm10173908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/22/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development of substance abuse and substance use disorders (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment, and is associated with poor treatment outcomes. In this study, we provide a systematic review of controlled studies on the effectiveness of pharmacological, psychosocial, and complementary treatments of ADHD in adolescents with and without comorbid SUD. In addition, we review the longitudinal association between pharmacotherapy for childhood ADHD and the development of SUD in adolescence and early adulthood. We conducted a systematic review of the research literature published since 2000 using Medline, PsycINFO, and the Cochrane Database of Systematic Reviews databases to select randomized clinical trials, observational studies, and meta-analyses. The quality of the evidence from each study was rated using the SIGN grading system. Based on the limited evidence available, strong clinical recommendations are not justified, but provisionally, we conclude that stimulant treatment in children with ADHD may prevent the development of SUD in adolescence or young adulthood, that high-dose stimulant treatment could be an effective treatment for adolescents with ADHD and SUD comorbidity, that cognitive behavior therapy might have a small beneficial effect in these patients, and that alternative treatments are probably not effective. More studies are needed to draw definitive conclusions that will allow for strong clinical recommendations.
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Affiliation(s)
- Heval Özgen
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, 2512 HN The Hague, The Netherlands; (R.S.); (V.H.)
- Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
| | - Renske Spijkerman
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, 2512 HN The Hague, The Netherlands; (R.S.); (V.H.)
| | - Moritz Noack
- Department of Child and Adolescent Psychiatry, LWL-University Hospital, Hamm, Ruhr-University Bochum, 44801 Bochum, Germany; (M.N.); (M.H.)
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry, LWL-University Hospital, Hamm, Ruhr-University Bochum, 44801 Bochum, Germany; (M.N.); (M.H.)
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
- Donders Institute for Brain Cognition and Behavior, Radboud University Nijmegen, 6525 AJ Nijmegen, The Netherlands
- International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, 6500 HE Nijmegen, The Netherlands;
| | - Søren Dalsgaard
- Department of Economics and Business Economics, Aarhus University, DK-8210 Aarhus, Denmark;
| | - Wim van den Brink
- International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, 6500 HE Nijmegen, The Netherlands;
- Amsterdam University Medical Centers, Location Academic Medical Center, 1106 AZ Amsterdam, The Netherlands
| | - Vincent Hendriks
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, 2512 HN The Hague, The Netherlands; (R.S.); (V.H.)
- Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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23
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Langener S, Van Der Nagel J, van Manen J, Markus W, Dijkstra B, De Fuentes-Merillas L, Klaassen R, Heitmann J, Heylen D, Schellekens A. Clinical Relevance of Immersive Virtual Reality in the Assessment and Treatment of Addictive Disorders: A Systematic Review and Future Perspective. J Clin Med 2021; 10:3658. [PMID: 34441953 PMCID: PMC8396890 DOI: 10.3390/jcm10163658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 02/02/2023] Open
Abstract
(1) Background: Virtual reality (VR) has been investigated in a variety of psychiatric disorders, including addictive disorders (ADs); (2) Objective: This systematic review evaluates the current evidence of immersive VR (using head-mounted displays) in the clinical assessment and treatment of ADs; (3) Method: PubMed and PsycINFO were queried for publications up to November 2020; (4) Results: We screened 4519 titles, 114 abstracts and 85 full-texts, and analyzed 36 articles regarding the clinical assessment (i.e., diagnostic and prognostic value; n = 19) and treatment (i.e., interventions; n = 17) of ADs. Though most VR assessment studies (n = 15/19) showed associations between VR-induced cue-reactivity and clinical parameters, only two studies specified diagnostic value. VR treatment studies based on exposure therapy showed no or negative effects. However, other VR interventions like embodied and aversive learning paradigms demonstrated positive findings. The overall study quality was rather poor; (5) Conclusion: Though VR in ADs provides ecologically valid environments to induce cue-reactivity and provide new treatment paradigms, the added clinical value in assessment and therapy remains to be elucidated before VR can be applied in clinical care. Therefore, future work should investigate VR efficacy in randomized clinical trials using well-defined clinical endpoints.
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Affiliation(s)
- Simon Langener
- Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands; (J.V.D.N.); (R.K.); (D.H.)
- Tactus Addiction Centre, 7418 ET Deventer, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
| | - Joanne Van Der Nagel
- Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands; (J.V.D.N.); (R.K.); (D.H.)
- Tactus Addiction Centre, 7418 ET Deventer, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
| | - Jeannette van Manen
- Tactus Addiction Centre, 7418 ET Deventer, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
| | - Wiebren Markus
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- IrisZorg Addiction Care, 6835 HZ Arnhem, The Netherlands
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- Radboud University Medical Centre, 6525 GC Nijmegen, The Netherlands
- Novadic-Kentron, Network for Addiction Treatment Service, 5261 LX Vught, The Netherlands
| | - Laura De Fuentes-Merillas
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- Novadic-Kentron, Network for Addiction Treatment Service, 5261 LX Vught, The Netherlands
| | - Randy Klaassen
- Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands; (J.V.D.N.); (R.K.); (D.H.)
| | - Janika Heitmann
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Dirk Heylen
- Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands; (J.V.D.N.); (R.K.); (D.H.)
| | - Arnt Schellekens
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- Radboud University Medical Centre, 6525 GC Nijmegen, The Netherlands
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Pierce M, van Amsterdam J, Kalkman GA, Schellekens A, van den Brink W. Is Europe facing an opioid crisis like the United States? An analysis of opioid use and related adverse effects in 19 European countries between 2010 and 2018. Eur Psychiatry 2021; 64:e47. [PMID: 34165059 PMCID: PMC8316471 DOI: 10.1192/j.eurpsy.2021.2219] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Given the ongoing opioid crisis in the United States (US), we investigated the opioid situation in Europe. The aims of the study are to provide an overview of trends in prescription opioid (PO) use and opioid-related adversities between 2010 and 2018 for different opioids in 19 European countries and to present a comparison with similar data from the US. Methods A multisource database study with national data from 19 European countries evaluating trends between 2010 and 2018 in (a) PO consumption, (b) high-risk (HR) opioid users, (c) opioid-related hospital admissions, (d) opioid-related overdose deaths, (e) opioid use disorder treatment entries, and (f) patients in opioid substitution therapy (OST). Within and between-country comparisons and comparisons with data from the US were made. Results There was considerable variation between European countries. Most countries showed increased PO consumption with the largest increase and the highest consumption in the United Kingdom (UK) compared to the rest of Europe and the US in 2018 (UK: 58,088 defined daily doses for statistical purposes/1000 population/day). In 2018, Scotland had the highest rates (per 100,000 population) of HR opioid users (16·2), opioid-related hospital admissions (118), opioid-related deaths (22·7), opioid use disorder treatment admissions (190), and OST patients (555) of all included European countries. These rates were similar or even higher than those in the US in 2018. Other countries with high rates of opioid-related adversities were Northern Ireland (synthetic and “other” opioids), Ireland (heroin and methadone), and England (all opioids). All other countries had no or little increase in opioid-related adversities. Conclusions Apart from the British Isles and especially Scotland, there is no indication of an opioid crisis comparable to that in the US in the 19 European countries that were part of this study. More research is needed to identify drivers and develop interventions to stop the emerging opioid crisis in the UK and Ireland.
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Affiliation(s)
- Mimi Pierce
- Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan van Amsterdam
- Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerard A Kalkman
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Clinical Neuroscience, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Clinical Neuroscience, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Schellekens A, Dijkstra B, Vink JM, de Kanter W. [Tobacco use disorder should be considered an addiction, not lifestyle]. Ned Tijdschr Geneeskd 2021; 165:D5920. [PMID: 34346644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Tobacco use disorder is a major contributor to morbidity and mortality worldwide. Yet, in contrast to other substance use disorders, tobacco use disorder is often considered as an unhealthy lifestyle. In this article we argue that tobacco use disorder should be considered similar to other addictive disorders, and summarize supporting arguments from genetics, neuroscience, as well as treatment perspective. Considering Tobacco Use Disorder as an addictive disorder will facilitate awareness among health professionals that patients with this condition should receive proper treatment that should be reimbursed by health insurance. This will reduce the health burden of tobacco use disorder, improve quality of life of individual patients and reduce societal health care costs.
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Affiliation(s)
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen
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26
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Novi M, Paraskevopoulou M, Rooij DV, Schene A, Buitelaar J, Schellekens A. Effects of substance misuse and family history of substance use disorder on brain structure in patients with attention-deficit/hyperactivity disorder and healthy controls. Eur Psychiatry 2021. [PMCID: PMC9471880 DOI: 10.1192/j.eurpsy.2021.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Literature shows overlapping alterations in brain structure in Attention-deficit/Hyperactivity Disorder (ADHD) and substance use disorder (SUD), suggesting shared pathophysiological mechanisms. It is unclear to what extent family history (trait) effects and/or substance misuse (state) effects explain the observed overlap. Objectives Our aim was to examine the effects of (i) SUD family history (FH) and (ii) substance misuse on brain structure in ADHD. Methods We compared structural MRI data (cortical thickness; subcortical volumes) between (i) ADHD subjects and controls with or without FH (ADHD-FH+: n=139; ADHD-FH-: n=86; controls-FH+: n=60; controls-FH-: n=74), and (ii) FH-matched ADHD groups with and without substance misuse and controls (ADHD+SM, ADHD-only and controls, n=68 per group). Furthermore, we explored whether FH effects were more pronounced in subjects with SUD in both parents (n=63) compared to subjects with one SUD parent (n=105) and without FH (n=160). Results There was no main FH effect on brain structure. ADHD+SM showed decreased CT in inferior frontal gyrus (IFG) compared to controls, while no difference was found between ADHD-only and ADHD+SM or controls. Subjects with SUD in both parents showed decreased thickness of IFG and volume of nucleus accumbens (NAcc), compared to those with one SUD parent. Conclusions Substance misuse in ADHD might result in smaller IFG, which is in line with findings in SUD-literature. A contribution of premorbid alterations, due to FH, could not be ruled out, particularly for IFG thickness. Future studies should further investigate the potential role of these regions in treatment and prevention strategies. Disclosure No significant relationships.
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27
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Scheibein F, Stowe MJ, Arya S, Morgan N, Shirasaka T, Grandinetti P, Saad NA, Ghosh A, Vadivel R, Ratta-apha W, Pant SB, Ransing R, Ramalho R, Bruschi A, Maiti T, HA AY, Delic M, Jain S, Peyron E, Siste K, Onoria J, Boujraf S, Dannatt L, Schellekens A, Calvey T. Responding to COVID-19: Emerging Practices in Addiction Medicine in 17 Countries. Front Psychiatry 2021; 12:634309. [PMID: 33796034 PMCID: PMC8009036 DOI: 10.3389/fpsyt.2021.634309] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/15/2021] [Indexed: 01/23/2023] Open
Affiliation(s)
- Florian Scheibein
- School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - M. J. Stowe
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sidharth Arya
- State Drug Dependence Treatment Centre, Institute of Mental Health, Pt Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Nirvana Morgan
- University of the Witwatersrand, Johannesburg, South Africa
| | - Tomohiro Shirasaka
- Department of Psychiatry, Teine Keijinkai Medical Center, Sapporo, Japan
| | - Paolo Grandinetti
- Addiction Services (SerD), Department of Territorial Services, ASL Teramo, Teramo, Italy
| | - Noha Ahmed Saad
- Department of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Abhishek Ghosh
- Drug Deaddiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Sagun Ballav Pant
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri, India
| | - Rodrigo Ramalho
- Department of Social and Community Health, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Angelo Bruschi
- Department of Mental Health, ASL Viterbo, Viterbo, Italy
| | - Tanay Maiti
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anne Yee HA
- Department of Psychological Medicine, University Malaya Centre of Addiction Sciences (UMCAS), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mirjana Delic
- Center for Treatment of Drug Addiction, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
| | - Shobhit Jain
- Department of Psychiatry, Heritage Institute of Medical Sciences (HIMS), Varanasi, India
| | | | - Kristiana Siste
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia-Ciptomangunkusumo Hospital, Jakarta, Indonesia
| | - Joy Onoria
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Saïd Boujraf
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fes, Morocco
| | - Lisa Dannatt
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Tanya Calvey
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Spijkerman R, Crunelle CL, Özgen MH, Begeman AHA, Dom G, van de Glind G, Groenman AP, van Kernebeek MW, Matthys F, Post M, Schellekens A, Staal W, van den Brink W, Hendriks VM. [Adolescents with concurrent ADHD and substance use disorder; international consensus]. Tijdschr Psychiatr 2021; 63:868-874. [PMID: 34978058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Substance use disorder (SUD) is common among youths with attention-deficit/hyperactivity disorder (ADHD). Co-morbid ADHD and SUD in youths complicates screening, diagnosis, and treatment of both disorders and is associated with worse treatment prognosis. Limited research in youths with SUD and co-morbid ADHD provides insufficient basis for firm recommendations. To offer clinicians some guidance on this topic, we present the results of an international consensus procedure. AIM To summarize an international consensus on diagnosis and treatment of young people with comorbid ADHD and SUD. METHOD In a modified Delphi-study, a multidisciplinary, international group of 55 experts strived to reach consensus on 37 recommendations. RESULTS Consensus was reached on 36 recommendations. Routine screening of ADHD and/or SUD is important. For the treatment of co-morbid SUD and ADHD in youths, both psychosocial and pharmacological treatment should be considered. Psychosocial treatment should preferably consist of psychoeducation, motivational interviewing (MI), and cognitive behavioral therapy (CBT) focused on SUD or both disorders. Long-acting stimulants are recommended as first choice pharmacotherapy, preferably embedded in psychosocial treatment. Experts did not agree on the precondition that patients need to be abstinent before starting stimulant treatment. CONCLUSION Clinicians and youths with co-morbid SUD and ADHD can use this international consensus to choose the best possible treatment.
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Geuijen P, de Rond M, Kuppens J, Atsma F, Schene A, de Haan H, de Jong C, Schellekens A. Physicians' norms and attitudes towards substance use in colleague physicians: A cross-sectional survey in the Netherlands. PLoS One 2020; 15:e0231084. [PMID: 32243472 PMCID: PMC7122818 DOI: 10.1371/journal.pone.0231084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Substance use disorders (SUD) in physicians often remain concealed for a long time. Peer monitoring and open discussions with colleagues are essential for identifying SUD. However, physicians often feel uncomfortable discussing substance use with a colleague. We explored physicians' attitudes and norms about substance use (disorders) and their (intended) approach upon a presumption of substance use in a colleague. MATERIALS AND METHODS An online cross-sectional survey concerning "Addiction in physicians" was administered by the Royal Dutch Medical Association physician panel. Overall, 1685 physicians (47%) responded. Data were analyzed by logistic regression to explore factors associated with taking action upon a substance use presumption. RESULTS Most physicians agreed that SUD can happen to anyone (67%), is not a sign of weakness (78%) and that it is a disease that can be treated (83%). Substance use in a working context was perceived as unacceptable (alcohol at work: 99%, alcohol during a standby duty: 91%, alcohol in the eight hours before work: 77%, and illicit drugs in the eight hours before work: 97%). Almost all respondents (97%) intend to act upon a substance use presumption in a colleague. Of the 29% who ever had this presumption, 65% took actual action. Actual action was associated with male gender and older age (OR = 1.81; 95% CI = 1.20-2.74 and OR = 1.03; 95% CI = 1.01-1.05, respectively). CONCLUSIONS About one-third of physicians reported experience with a presumption of substance use in a colleague. Whilst most physicians intend to take action upon such a presumption, two-thirds actually do act upon a presumption. To bridge this intention-behavior gap continued medical education on signs and symptoms of SUD and instructions on how to enter a supportive dialogue with a colleague about personal issues, may enhance physicians' knowledge, confidence, and ethical responsibility to act upon a presumption of substance use or other concerns in a colleague.
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Affiliation(s)
- Pauline Geuijen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
- Physician Health Program ABS-doctors, Royal Dutch Medical Association (RDMA), Utrecht, the Netherlands
- * E-mail:
| | - Marlies de Rond
- Physician Health Program ABS-doctors, Royal Dutch Medical Association (RDMA), Utrecht, the Netherlands
| | - Joanneke Kuppens
- Physician Health Program ABS-doctors, Royal Dutch Medical Association (RDMA), Utrecht, the Netherlands
| | - Femke Atsma
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Aart Schene
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hein de Haan
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
- Tactus Addiction Treatment, Deventer, the Netherlands
| | - Cornelis de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
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Raposo Pereira F, McMaster MTB, Schellekens A, Polderman N, de Vries YDAT, van den Brink W, van Wingen GA. Effects of Recreational GHB Use and Multiple GHB-Induced Comas on Brain Structure and Impulsivity. Front Psychiatry 2020; 11:166. [PMID: 32300311 PMCID: PMC7142256 DOI: 10.3389/fpsyt.2020.00166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND AIMS The regular use of gamma-hydroxybutyrate acid (GHB) can induce GHB-induced comas. Other substance use disorders are associated with alterations in brain structure and impulsivity. Here we aim to investigate if these are also modulated by either regular GHB use or GHB-induced comas. METHODS In a sample of human males, structural and diffusion neuroimaging data were collected for 27 GHB users with ≥4 GHB-induced comas (GHB-Coma), 27 GHB users without GHB-induced comas (GHB-NoComa), and 27 polydrug users who never used GHB (No-GHB). The structural brain parameters were analyzed macroscopically using voxel-based morphometry and microscopically using tract-based spatial statistics (TBSS) and tractography. Impulsivity was assessed with the Barrat Impulsivity Scale. RESULTS In comparison to the other two groups, the GHB-Coma group showed a higher fractional anisotropy in the body of the corpus callosum and a lower mean diffusivity in the forceps minor (i.e., whole-brain TBSS analysis). No macrostructural differences nor microstructural differences, as assessed with tractography, were observed. The GHB-Coma group also reported higher impulsivity, which was more strongly associated with white matter volume and fractional anisotropy in tracts involved in impulse control (post-hoc analysis). GHB use per se was associated neither with differences in brain structure nor with impulsivity. CONCLUSIONS The results suggest that multiple GHB-induced comas, but not GHB use per se, are associated with microstructural alterations in white matter and with higher self-reported impulsivity, which in turn was associated with white matter tracts involved in impulse control.
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Affiliation(s)
- Filipa Raposo Pereira
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Minni T. B. McMaster
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Centre (Radboudumc), Nijmegen, Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, Netherlands
| | - Nikki Polderman
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Yvon D. A. T. de Vries
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Guido A. van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
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Ayu AP, van der Ven M, Suryani E, Puspadewi N, Joewana S, Rukmini E, de Jong C, Schellekens A. Improving medical students' attitude toward patients with substance use problems through addiction medicine education. Subst Abus 2020; 43:47-55. [PMID: 32105582 DOI: 10.1080/08897077.2020.1732512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Patients with addiction often encounter negative attitudes from health care professionals, including medical doctors. Addiction medicine training might improve medical students' attitudes toward patients with addiction problems and change the way they think about addiction. We evaluated the effect of comprehensive addiction medicine training on students' attitudes and illness perceptions and explored which perceptions are most relevant for attitude development. Methods: In a quasi-experimental non-randomized study, fourth-year students (n = 296) participated in either addiction medicine training (intervention) or one of three other blocks (control). We used the Medical Condition Regards Scale to measure attitudes and the Illness Perception Questionnaire Addiction version for perceptions. We analyzed the effect of the intervention using repeated measures MANOVA. The contribution of illness perception to attitude was explored in the intervention group using linear regression analysis. Results: Addiction medicine training improved students' attitudes toward patients with addiction, compared to the control group. After the training, students expressed a less demoralized perception, a stronger perception of a coherent understanding of addiction, addiction as a cyclical condition, and attributed addiction more to psychological factors, compared to the control group. In the intervention group, attitude and emotional representation before training and illness coherence after the training were associated with attitude after the training. Conclusions: Addiction medicine training is effective in improving medical students' attitudes toward patients with addiction and changing their illness perceptions of addiction. The development of an understanding of addiction might be particularly relevant for attitude improvement. These findings underscore the relevance of addiction medicine training as part of medical curricula and argue for including aspects related to attitude development in the curriculum.
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Affiliation(s)
- Astri Parawita Ayu
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.,Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, the Netherlands
| | - Margot van der Ven
- Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, the Netherlands
| | - Eva Suryani
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Natalia Puspadewi
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Satya Joewana
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Elisabeth Rukmini
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Cor de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, the Netherlands
| | - Arnt Schellekens
- Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, the Netherlands.,Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands
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Kapitány-Fövény M, Barta C, Crunelle CL, van den Brink W, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Coetzee C, Luderer M, Schellekens A, Matthys F, Demetrovics Z. [Recommendations for the screening, diagnosis and treatment of patients with comorbid attention deficit hyperactivity- and substance use disorder]. Psychiatr Hung 2020; 35:435-447. [PMID: 33263293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Among patients with substance use disorders (SUD), adult attention deficit hyperactivity disorder (ADHD) is one of the most frequently co-occuring disorder. Those SUD patients with comorbid ADHD show earlier onset of substance use, more severe SUD and poor treatment outcomes. Therefore, early recognition of ADHD is highly rele - vant within this patient population. The results of available screening instruments may lay the foundation of timely ADHD diagnosis. Considering the integrated treatment of patients with a dual ADHD+SUD diagnosis, the applica tion of combined pharmaco- and psychotherapy is recommended. Based on the evidence-and consensus-based suggestions, prescription of long-acting methylphenidate, extended-release amphetamines and atomoxetine with up-titration might be the best choice in the treatment of patients who are either unresponsive to standard dose or characterized by therapy resistance. The main purpose of this manuscript is to establish a standing-ground for the effective screening, diagnosis and treatment of ADHD+SUD patients.
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Affiliation(s)
- Máté Kapitány-Fövény
- Semmelweis Egyetem, Egeszsegtudomanyi Kar, Addiktologiai Tanszek, Budapest, Hungary, E-mail:
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Van de Glind G, Brynte C, Skutle A, Kaye S, Konstenius M, Levin F, Mathys F, Demetrovics Z, Moggi F, Ramos-Quiroga JA, Schellekens A, Crunelle C, Dom G, van den Brink W, Franck J. The International Collaboration on ADHD and Substance Abuse (ICASA): Mission, Results, and Future Activities. Eur Addict Res 2020; 26:173-178. [PMID: 32599579 PMCID: PMC7592924 DOI: 10.1159/000508870] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The International Collaboration on ADHD and Substance Abuse (ICASA) is a network of 28 centers from 16 countries initiated to investigate the link between attention deficit-hyperactivity disorder (ADHD) and substance use disorder (SUD). In this article, we present the mission, the results of finished studies, and the current and future research projects of ICASA. METHODS During the past 10 years, 3 cross-sectional studies were conducted: two International ADHD in Substance use disorders Prevalence (IASP-1 and IASP-2) studies, directed at the screening, diagnosis, and the prevalence of adult ADHD in treatment-seeking patients with SUD, and the Continuous performance test for ADHD in SUD Patients (CASP) study, testing a novel continuous performance test in SUD patients with and without adult ADHD. Recently, the prospective International Naturalistic Cohort Study of ADHD and Substance Use Disorders (INCAS) was initiated, directed at treatment provision and treatment outcome in SUD patients with adult ADHD. RESULTS The IASP studies have shown that approximately 1 in 6 adult treatment-seeking SUD patients also have ADHD. In addition, those SUD patients with adult ADHD compared to SUD patients without ADHD report more childhood trauma exposure, slower infant development, greater problems controlling their temperament, and lower educational attainment. Comorbid patients also reported more risk-taking behavior, and a higher rate of other psychiatric disorders compared to SUD patients without ADHD. Screening, diagnosis, and treatment of this patient group are possible even before abstinence has been achieved. The results of the CASP study are reported separately in this special issue. CONCLUSIONS The ICASA research to date has demonstrated a high prevalence of comorbid ADHD and SUD, associated with elevated rates of additional comorbidities and risk factors for adverse outcomes. More research is needed to find the best way to treat these patients, which is the main topic of the ongoing INCAS study.
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Affiliation(s)
- Geurt Van de Glind
- Director ICASA Foundation, Radboud University Medical Hospital, Nijmegen, The Netherlands,Teacher at Bachelor School of Nursing, Institute for Nursing Studies, University of Applied Science, Utrecht, The Netherlands,*Geurt Van de Glind, Radboudumc/NISPA, Radboud University Medical Hospital, ICASA Foundation, Geert Grooteplein Zuid 10, NL–6525 Nijmegen (The Netherlands),
| | - Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Maija Konstenius
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Frances Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Frieda Mathys
- Department of psychiatry University Hospital Brussels, Free University of Brussels, Brussels, Belgium
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Franz Moggi
- Clinical Psychological Service, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain,Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain Cognition, and Behavior, Nijmegen, The Netherlands
| | - Cleo Crunelle
- Department of Psychiatry, University Hospital Brussels (UZ Jette), Toxicological Center, University of Antwerp, Antwerp, Belgium
| | - Geert Dom
- Antwerp University & Hospital, Addiction Psychiatry, Psychiatric Center Alexian Brothers, Antwerp, Belgium
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Johan Franck
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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González RA, Vélez-Pastrana MC, Blankers M, Bäcker A, Konstenius M, Holtmann M, Levin FR, Noack M, Kaye S, Demetrovics Z, van de Glind G, van den Brink W, Schellekens A. Onset and Severity of Early Disruptive Behavioral Disorders in Treatment-Seeking Substance Use Disorder Patients with and without Attention-Deficit/Hyperactivity Disorder. Eur Addict Res 2020; 26:211-222. [PMID: 32594079 DOI: 10.1159/000508653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2020] [Indexed: 11/19/2022]
Abstract
AIMS This study addressed the age of onset of conduct disorder (CD) and oppositional defiant disorder (ODD) in treatment-seeking substance use disorder (SUD) patients with and without adult attention-deficit/hyperactivity disorder (ADHD) and its association with early onset of SUD. METHODS We examined data from the 2nd International ADHD in Substance Use Disorders Prevalence Study, including 400 adults in SUD treatment from Puerto Rico, Hungary, and Australia. ADHD, SUD, and CD/ODD were assessed with the Conners Adult ADHD Diagnostic Interview for DSM-IV, the MINI International Neuropsychiatric Interview, and the K-SADS, respectively. Cox regression analyses modeled time to emergence of CD/ODD separately for SUD patients with and without adult ADHD. Linear regression models examined associations between age of onset of SUD and presence of ADHD and adjusted for sex, age, and country. To assess the mediating role of CD/ODD on the association of ADHD with onset of SUD, adjusted regression models were estimated. RESULTS Treatment-seeking SUD patients with ADHD presented an earlier onset of CD/ODD compared with those without ADHD. CD/ODD symptom loads were higher among the SUD and ADHD group. Age of first substance use and SUD were significantly earlier in SUD patients with ADHD, and these findings remained significant after adjustment for demographics and coexisting CD/ODD. CONCLUSIONS ADHD is associated with earlier onset of SUD as well as with an earlier onset of more frequent and more severe disruptive behavioral disorders. These findings may inform preventive interventions to mitigate adverse consequences of ADHD.
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Affiliation(s)
- Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom, .,Centre for Psychiatry, Imperial College London, London, United Kingdom,
| | - María C Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico, USA
| | - Matthijs Blankers
- Arkin Mental Health Care, Department of Research, Amsterdam, The Netherlands.,Trimbos institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda Bäcker
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maija Konstenius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Moritz Noack
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geurt van de Glind
- Radboudumc, Donders Centre for Medical Neuroscience, Department of Psychiatry, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnt Schellekens
- Radboudumc, Donders Centre for Medical Neuroscience, Department of Psychiatry, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
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van Helvoort MA, van Dee V, Dirks A, Everaerd DS, Metz MJ, van Schijndel MA, Tendolkar I, Zinkstok JR, Cahn W, Schellekens A. [Not Available]. Tijdschr Psychiatr 2020; 62:739-742. [PMID: 32910443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Course of covid-19 infections and impact on mental health; setting up a national case register.
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Sánchez-García NC, González RA, Ramos-Quiroga JA, van den Brink W, Luderer M, Blankers M, Grau-Lopez L, Levin FR, Kaye S, Demetrovics Z, van de Glind G, Schellekens A, Vélez-Pastrana MC. Attention Deficit Hyperactivity Disorder Increases Nicotine Addiction Severity in Adults Seeking Treatment for Substance Use Disorders: The Role of Personality Disorders. Eur Addict Res 2020; 26:191-200. [PMID: 32564016 DOI: 10.1159/000508545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/07/2020] [Indexed: 11/19/2022]
Abstract
AIMS To examine the role of attention deficit/hyperactivity disorder (ADHD) and impulsive personality disorders in nicotine addiction severity among treatment-seeking substance use disorder (SUD) patients. METHODS In a cross-sectional study, we examined data from the second International ADHD in Substance Use Disorders Prevalence Study (IASP-2) on 402 adults in SUD treatment from Puerto Rico, Hungary, and Australia using diagnostic interviews for ADHD, antisocial (ASP) and borderline (BPD) personality disorders, and the self-report Fagerström Test of Nicotine Dependence (FTND). We compared SUD patients with and without ADHD on nicotine addiction severity. We tested direct and indirect pathways from ADHD to nicotine addiction and mediation through ASP and BPD. RESULTS Overall, 81.4% of SUD patients reported current cigarette smoking. SUD patients with ADHD had higher FTND scores and smoked more cigarettes than those without ADHD, with an earlier onset and more years of smoking. ASP mediated the effect of ADHD on all aspects of nicotine addiction severity, whereas BPD did so only on some aspects of nicotine addiction severity. CONCLUSIONS SUD patients with comorbid ADHD show more severe nicotine addiction than those without, which is largely explained by comorbid impulsive personality disorders. In SUD patients, it is important to screen for adult ADHD and other psychiatric disorders, especially those with impulse control deficits such as ASP and BPD.
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Affiliation(s)
| | - Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Josep A Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wim van den Brink
- Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | - Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lara Grau-Lopez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Frances R Levin
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA.,CUMC/Herbert Pardes Building, New York State Psychiatric Institute, New York, New York, USA
| | - Sharlene Kaye
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Zsolt Demetrovics
- Department of Clinical Psychology and Addictions, Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geurt van de Glind
- Department of Psychiatry, Donders Centre for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands.,Department of Psychiatry, Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Donders Centre for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands.,Department of Psychiatry, Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
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Pinxten WJL, Fitriana E, De Jong C, Klimas J, Tobin H, Barry T, Cullen W, Jokubonis D, Mazaliauskiene R, Iskandar S, Raya RP, Schellekens A. Excellent reliability and validity of the Addiction Medicine Training Need Assessment Scale across four countries. J Subst Abuse Treat 2019; 99:61-66. [PMID: 30797395 DOI: 10.1016/j.jsat.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Addiction is a context specific but common and devastating condition. Though several evidence-based treatments are available, many of them remain under-utilized, among others due to the lack of adequate training in addiction medicine (AM). AM Training needs may differ across countries because of difference in discipline and level of prior AM training or contextual factors like epidemiology and availability of treatment. For appropriate testing of training needs, reliability and validity are key issues. The aim of this study was to evaluate the psychometric properties of the AM-TNA Scale: an instrument specifically designed to develop the competence-based curriculum of the Indonesian AM course. METHODS In a cross-sectional study in Indonesia, Ireland, Lithuania and the Netherlands the AM-TNA was distributed among a convenience sample of health professionals working in addiction care in The Netherlands, Lithuania, Indonesia and General Practitioners in-training in Ireland. 428 respondents completed the AM-TNA scale. To assess the factor structure, we used explorative factor analysis. Reliability was tested using Cronbach's Alpha, ANOVA determined the discriminative validity. RESULTS Validity: factor analysis revealed a two-factor structure: One on providing direct patient treatment and care (Factor 1: clinical) and one factor on facilitating/supporting direct patient treatment and care (Factor 2: non-clinical) AM competencies and a cumulative 76% explained variance. Reliability: Factor 1 α = 0.983 and Factor 2: α = 0.956, while overall reliability was (α = 0.986). The AM-TNA was able to differentiate training needs across groups of AM professionals on all 30 addiction medicine competencies (P = .001). CONCLUSIONS In our study the AM-TNA scale had a strong two-factor structure and proofed to be a reliable and valid instrument. The next step should be the testing external validity, strengthening discriminant validity and assessing the re-test effect and measuring changes over time.
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Affiliation(s)
- W J Lucas Pinxten
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands; Faculty of Psychology and Neuroscience Department of Work and Social Psychology, Maastricht University, the Netherlands.
| | - Efi Fitriana
- Faculty of Psychology, Padjadjaran Universitas, Bandung, Indonesia
| | - Cor De Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, the Netherlands; Behavioral Science Institute Radboud University, Nijmegen, the Netherlands
| | - Jan Klimas
- School of Medicine, University College Dublin, Ireland; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Helen Tobin
- School of Medicine, University College Dublin, Ireland
| | - Tomas Barry
- School of Medicine, University College Dublin, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Ireland
| | - Darius Jokubonis
- Kaunas Addiction Treatment Centre, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ramune Mazaliauskiene
- Department of Psychiatry, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Shelly Iskandar
- Department of Psychiatry, Faculty of Medicine, Padjadjaran Universitas, Bandung, Indonesia
| | | | - Arnt Schellekens
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands
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Crunelle CL, van den Brink W, Schellekens A, van de Glind G, Icasa Consortium B, Matthys F. [International consensus for the screening, diagnosis and treatment of adult patients with substance use disorder and ADHD]. Tijdschr Psychiatr 2019; 61:477-487. [PMID: 31372969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur in adults. Together, they complicate diagnosis and can negatively influence treatment outcome.<br/> AIM: To develop a practical guide to assist professionals with the screening, diagnosis and treatment of adult patients with SUD and ADHD.<br/> METHOD: A literature search and a consensus procedure between several international scientific and clinical experts. This manuscript is an adapted and summarized Dutch version of the International consensus statement on screening, diagnosis and treatment of patients with SUD and comorbid ADHD.<br/> RESULTS: The routine use of adequate screening tools enables ADHD to be detected earlier in adults with SUD. The diagnostic process for ADHD should be initiated as soon as possible in patients with SUD. Integrated treatment, involving a combination of pharmacotherapy and psychotherapy, is preferred. Long-acting stimulants with up-titration to higher dosages may be considered.<br/> CONCLUSION: Early detection of ADHD in patients with SUD is essential for adequate diagnosis and more effective treatment and follow-up for these patients.
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Ilbegi S, Groenman AP, Schellekens A, Hartman CA, Hoekstra PJ, Franke B, Faraone SV, Rommelse NNJ, Buitelaar JK. Substance use and nicotine dependence in persistent, remittent, and late-onset ADHD: a 10-year longitudinal study from childhood to young adulthood. J Neurodev Disord 2018; 10:42. [PMID: 30587104 PMCID: PMC6307241 DOI: 10.1186/s11689-018-9260-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with substance use disorders (SUD; alcohol and/or drug dependence) and nicotine dependence. This study aims to advance our knowledge about the association between SUD, nicotine dependence, and the course of ADHD (persistent versus remittent ADHD and late-onset ADHD). METHODS ADHD, SUD, and nicotine dependence were longitudinally assessed (mean age at study entry 11.3 years, mean age at follow-up 21.1 years) using structured psychiatric interviews and multi-informant questionnaires in a subsample of the Dutch part of the International Multicenter ADHD Genetics study. Individuals with persistent ADHD (n = 62), remittent ADHD (n = 12), late-onset ADHD (n = 18; age of onset after 12 years), unaffected siblings (n = 50), and healthy controls (n = 47) were assessed. Hazard ratios (HR) with 95% confidence intervals (CIs) were estimated by Cox regression and adjusted for clustered family data, gender, follow-up length, and current age. RESULTS Individuals with persistent ADHD were at significantly higher risk of development of SUD relative to healthy controls (HR = 4.56, CI 1.17-17.81). In contrast, levels of SUD in those with remittent ADHD were not different from healthy controls (HR = 1.00, CI .07-13.02). ADHD persisters had also higher prevalence rates of nicotine dependence (24.2%) than ADHD remitters (16.7%) and healthy controls (4.3%). A similar pattern was found in initially unaffected siblings who met ADHD criteria at follow-up ("late-onset" ADHD); they had also a higher prevalence of SUD (33%) compared to stable unaffected siblings (20%) and were at significantly increased risk of development of nicotine dependence compared to healthy controls (HR = 13.04, CI 2.08-81.83). CONCLUSIONS SUD and nicotine dependence are associated with a negative ADHD outcome. Results further emphasize the need for clinicians to comprehensively assess substance use when diagnosing ADHD in adolescents and adults.
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Affiliation(s)
- Shahrzad Ilbegi
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands. .,Donders Center for Neuroscience, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Franke
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, USA
| | - Nanda N J Rommelse
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
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Sluiter RL, Kievit W, van der Wilt GJ, Schene AH, Teichert M, Coenen MJH, Schellekens A. Cost-Effectiveness Analysis of Genotype-Guided Treatment Allocation in Patients with Alcohol Use Disorders Using Naltrexone or Acamprosate, Using a Modeling Approach. Eur Addict Res 2018; 24:245-254. [PMID: 30384381 PMCID: PMC6492516 DOI: 10.1159/000494127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022]
Abstract
Alcohol use disorders (AUD) are a major contributor to the global burden of disease, and have huge societal impact. Some studies show that AUD patients carrying the G-allele of the OPRM1 variant c.118A>G respond better to naltrexone, resulting in reduced relapse rates compared to carriers of the AA genotype. Genotype-guided treatment allocation of these patients carrying a G-allele to naltrexone could potentially improve the treatment outcome. However, cost-effectiveness of this strategy should be investigated before considering clinical implementation. We, therefore, evaluated costs and Quality-Adjusted Life-Years (QALYs), using a modelling approach, from an European perspective, of genotype-guided treatment allocation (G-allele carriers receiving naltrexone; AA homozygotes acamprosate or naltrexone) compared to standard care (random treatment allocation to acamprosate or naltrexone), by using a Markov model. Genotype-guided treatment allocation resulted in incremental costs of EUR 66 (95% CI -28 to 149) and incremental effects of 0.005 QALYs (95% CI 0.000-0.011) per patient (incremental cost-effectiveness ratio of EUR 13,350 per QALY). Sensitivity analyses showed that the risk ratio to relapse after treatment allocation had the largest impact on the cost-effectiveness. Depending on the willingness to pay for a gain of one QALY, probabilities that the intervention is cost-effective varies between 6 and 79%. In conclusion, pharmacogenetic treatment allocation of AUD patients to naltrexone, based on OPRM1 genotype, can be a cost-effective strategy, and could have potential individual and societal benefits. However, more evidence on the impact of genotype-guided treatment allocation on relapse is needed to substantiate these conclusions, as there is contradictory evidence about the effectiveness of OPRM1 genotyping.
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Affiliation(s)
- Reinier L Sluiter
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands,
| | - Wietske Kievit
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department for Health Evidence, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
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Affiliation(s)
- Jacqueline M. Vink
- Behavioural Science Institute, Radboud University, 6525 HR Nijmegen, Gelderland, Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Donders Institute for Brain Cognition and Behavior, Centre for Medical Neuroscience, Radboud University Medical Center, 6525 GA Nijmegen, Netherlands. .,Nijmegen Institute for Scientist Practitioners in Addiction, 6525 HR Nijmegen, Netherlands
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Crunelle CL, van den Brink W, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F. International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder. Eur Addict Res 2018; 24:43-51. [PMID: 29510390 PMCID: PMC5986068 DOI: 10.1159/000487767] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
Abstract
Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.
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Affiliation(s)
- Cleo L. Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Wim van den Brink
- Amsterdam Institute of Addiction Research (AIAR), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Franz Moggi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Frances R. Levin
- Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Corné Coetzee
- Department of Pharmacy, University of Limpopo, Sovenga, South Africa
| | - Mathias Luderer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Sumari-de Boer M, Schellekens A, Duinmaijer A, Lalashowi JM, Swai HJ, de Mast Q, van der Ven A, Kinabo G. Efavirenz is related to neuropsychiatric symptoms among adults, but not among adolescents living with human immunodeficiency virus in Kilimanjaro, Tanzania. Trop Med Int Health 2017; 23:164-172. [PMID: 29220120 DOI: 10.1111/tmi.13021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the relationship between Efavirenz (EFV) and neuropsychiatric symptoms among adults and adolescents living with human immunodeficiency virus (HIV) in Kilimanjaro, Tanzania. METHODS Cross-sectional study among HIV-infected adults (age 18-65) and adolescents (age 12-17) on antiretroviral treatment attending Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Neuropsychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), the Symptom Checklist 90 (SCL-90) and the Mini-International Neuropsychiatric Interview (MINI). manova and chi-squared tests were used to test differences between EFV and non-EFV-treated participants. RESULTS A total of 215 adults and 150 adolescents participated. About 52% of adults and 37% of adolescents used EFV. Among adults, depression scores were higher for those on EFV (HADS (Cohen's D: 0.38; P = 0.02) and SCL-90 (Cohen's D: 0.24; P = 0.03). Among adolescents, those on EFV had lower scores on depression (HADS (Cohen's D: 0.3; P = 0.02) and SCL-90 (Cohen's D: 0.1; P = 0.02). About 10% of adults reported suicidal thoughts, but there was no difference between those on EFV and those without. Lastly, adults on EFV reported higher levels of problematic alcohol use (P = 0.003). CONCLUSIONS In line with the previous studies, EFV is associated with depressive symptoms and problematic alcohol use among HIV-infected adults in Tanzania. In contrast, EFV was associated with lower levels of depressive symptoms in adolescents in Tanzania. Particularly among adults, close monitoring of depressive symptoms and alcohol use is indicated.
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Affiliation(s)
- Marion Sumari-de Boer
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Department of Internal Medicine, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Arnt Schellekens
- Donders Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| | | | | | - Happiness J Swai
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Quirijn de Mast
- Department of Internal Medicine, Radboudumc Nijmegen, Nijmegen, The Netherlands.,Radboud Centre for Infectious Diseases, Nijmegen, The Netherlands
| | - Andre van der Ven
- Department of Internal Medicine, Radboudumc Nijmegen, Nijmegen, The Netherlands.,Radboud Centre for Infectious Diseases, Nijmegen, The Netherlands
| | - Grace Kinabo
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Ayu AP, El-Guebaly N, Schellekens A, De Jong C, Welle-Strand G, Small W, Wood E, Cullen W, Klimas J. Core addiction medicine competencies for doctors: An international consultation on training. Subst Abus 2017; 38:483-487. [PMID: 28718723 DOI: 10.1080/08897077.2017.1355868] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the high prevalence of substance use disorders, associated comorbidities, and the evidence base upon which to base clinical practice, most health systems have not invested in standardized training of health care providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, this study was undertaken to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education. METHODS A total of 13 members of the International Society of 20 Addiction Medicine (ISAM), from 12 different countries (37% response rate), were interviewed over Skype, e-mail survey, or in person at the annual conference. Content analysis was used to analyze interview transcripts, using constant comparison methodology. RESULTS We identified recommendations related to the core set of the addiction medicine competencies at 3 educational levels: (i) undergraduate, (ii) postgraduate, and (iii) continued medical education (CME). The participants described broad ideas, such as knowledge/skills/attitudes towards addiction to be obtained at undergraduate level, or knowledge of addiction treatment to be acquired at graduate level, as well as specific recommendations, including the need to tailor curriculum to national settings and different specialties. CONCLUSIONS Although it is unclear whether a global curriculum is needed, a consensus on a core set of principles for progression of knowledge, attitudes, and skills in addiction medicine to be developed at each educational level amongst medical graduates would likely have substantial value.
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Affiliation(s)
- Astri Parawita Ayu
- a Atma Jaya Catholic University of Indonesia , School of Medicine , Jakarta , Indonesia.,b Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA) , Radboud University , Nijmegen , The Netherlands
| | - Nady El-Guebaly
- c Division of Addiction, Department of Psychiatry , University of Calgary , Calgary , Alberta , Canada
| | - Arnt Schellekens
- b Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA) , Radboud University , Nijmegen , The Netherlands.,d Department of Psychiatry , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Cor De Jong
- b Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA) , Radboud University , Nijmegen , The Netherlands
| | | | - William Small
- f Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
| | - Evan Wood
- g British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,h Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Walter Cullen
- i School of Medicine , University College Dublin , Belfield , Dublin , Ireland
| | - Jan Klimas
- h Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver , British Columbia , Canada.,i School of Medicine , University College Dublin , Belfield , Dublin , Ireland
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Schellekens A. Staging & profiling in addiction, can we cross the gap from bench to bedside? Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Addictive behaviours are highly common (prevalence worldwide about 10%), with major impact on the individual and society (contributing to 5% of overall DALYs and mortality) [1,2]. Though a number of evidence-based treatments are available, relapse rates remain high, up to 50% within one year of treatment [3,4]. Staging of addictive behaviors might contribute to improve this prognosis by indicating which patient could benefit most from which treatment modality.In DSM-5 clinical staging of addictive disorders is limited to grading the severity of the disorder, based on criterion counts [5]. However, addictive disorders are highly heterogeneous, with distinct clinical profiles and neurobiological underpinnings of the disorder. Reward-processing deficits are considered a hallmark of addiction. Several additional neurobiological deficits have been identified in addicted individuals, such as dysfunction of brain stress systems, anterior cingulate cortex and habenula.These neurobiological deficits may identify clinical subgroups of patients with distinct pathophysiology (profiling), or be related to progression of the disorder (staging). This presentation will focus on clinical staging and profiling of addictive behaviors combining neurobiological findings and clinical practice [6].Disclosure of interestThe author has not supplied his declaration of competing interest.
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Martial LC, Aarnoutse RE, Mulder M, Schellekens A, Brüggemann RJM, Burger DM, Schene AH, Batalla A. Dried Blood Spot sampling in psychiatry: Perspectives for improving therapeutic drug monitoring. Eur Neuropsychopharmacol 2017; 27:205-216. [PMID: 28130001 DOI: 10.1016/j.euroneuro.2017.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/02/2016] [Accepted: 01/05/2017] [Indexed: 01/04/2023]
Abstract
Assessment of drug concentrations is indicated to guide dosing of a selected number of drugs used in psychiatry. Conventionally this is done by vena puncture. Novel sampling strategies such as dried blood spot (DBS) sampling have been developed for various drugs, including antipsychotics, antidepressants and mood-stabilizers. DBS sampling is typically performed by means of a finger prick. This method allows for remote sampling, which means that patients are not required to travel to a health care facility. The number of DBS assays for drugs used in psychiatry has increased over the last decade and includes antidepressants (tricyclic and serotonin and/or norepinephrine reuptake inhibitors), mood stabilizers and first- and second-generation antipsychotics. Available assays often comply with analytical validation criteria but are seldom used in routine clinical care. Little attention has been paid to the clinical validation and implementation processes of home sampling. Ideally, not only medicines but also clinical chemistry parameters should be measured within the same sample. This article reflects on the position of DBS remote sampling in psychiatry and provides insight in the requisites of making such a sampling tool successful.
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Affiliation(s)
- Lisa C Martial
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Rob E Aarnoutse
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Martina Mulder
- Radboud University Medical Center, Department of Psychiatry, Reinier Postlaan 10, Route 966, 6500 HB Nijmegen, The Netherlands
| | - Arnt Schellekens
- Radboud University Medical Center, Department of Psychiatry, Reinier Postlaan 10, Route 966, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands; Radboud University, Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands
| | - Roger J M Brüggemann
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - David M Burger
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Aart H Schene
- Radboud University Medical Center, Department of Psychiatry, Reinier Postlaan 10, Route 966, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Albert Batalla
- Radboud University Medical Center, Department of Psychiatry, Reinier Postlaan 10, Route 966, 6500 HB Nijmegen, The Netherlands; Radboud University, Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands.
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Peters M, Smit Duijzentkunst DA, Westendorp H, van de Pol SMG, Kattevilder R, Schellekens A, van der Voort van Zyp JRN, Moerland MA, van Vulpen M, Hoekstra CJ. Adaptive cone-beam CT planning improves long-term biochemical disease-free survival for 125I prostate brachytherapy. Brachytherapy 2017; 16:282-290. [PMID: 28110899 DOI: 10.1016/j.brachy.2016.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Determining the independent effect of additional intraoperative adaptive C-arm cone-beam CT (CBCT) planning vs. transrectal ultrasound (TRUS)-guided interactive planning alone in 125I brachytherapy for prostate cancer (PCa) on biochemical disease-free survival (BDFS). METHODS AND MATERIALS T1/T2-stage PCa patients receiving TRUS-guided brachytherapy from 2000 to 2014 were analyzed. From October 2006, patients received additional intraoperative adaptive CBCT planning for dosimetric evaluation and subsequent remedial seed placement in underdosed areas. Patients were stratified according to the National Comprehensive Cancer Network (NCCN) risk classification. Kaplan-Meier analysis was used to estimate BDFS (primary outcome), overall survival, and PCa-specific survival (secondary outcomes). Cox regression was used to assess the relation between CBCT use and biochemical failure (BF) and overall mortality. RESULTS In all, 1623 patients were included. Median followup was 99 months (interquartile range 70-115) for TRUS patients (n = 613) and 51 months (interquartile range 29-70) for CBCT patients (n = 1010). BF occurred 203 times and 206 patients died, 26 from PCa. For TRUS and CBCT patients, 7-year BDFS was 87.2% vs. 93.5% (log rank: p = 0.04) for low, 75.9% vs. 88.5% (p < 0.001) for intermediate, and 57.1% vs. 85.0% for high-risk patients (p < 0.001). For TRUS and CBCT patients, 7-year PCa-specific survival was 96.0% vs. 100% (p < 0.0001). After Cox regression, CBCT patients had lower hazard of BF: hazard ratio (HR) 0.25 (95% confidence interval [CI]: 0.18-0.33; p < 0.0001). Corrected for confounders, CBCT remained a predictor of BF: HR 0.51 (95% CI: 0.31-0.86; p = 0.01) but not for overall mortality: HR 0.66 (95% CI: 0.40-1.07; p = 0.09). CONCLUSIONS Additional intraoperative adaptive CBCT planning in 125I prostate brachytherapy leads to a significant increase in BDFS in all NCCN risk groups.
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Affiliation(s)
- M Peters
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - H Westendorp
- Department of Radiotherapy, Radiotherapiegroep Deventer, Deventer, The Netherlands
| | - S M G van de Pol
- Department of Radiotherapy, Radiotherapiegroep Deventer, Deventer, The Netherlands
| | - R Kattevilder
- Department of Radiotherapy, Radiotherapiegroep Deventer, Deventer, The Netherlands
| | - A Schellekens
- Department of Radiotherapy, Radiotherapiegroep Deventer, Deventer, The Netherlands
| | | | - M A Moerland
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M van Vulpen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C J Hoekstra
- Department of Radiotherapy, Radiotherapiegroep Deventer, Deventer, The Netherlands
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Quaglio G, Schellekens A, Blankers M, Hoch E, Karapiperis T, Esposito G, Brand H, Nutt D, Kiefer F. A Brief Outline of the Use of New Technologies for Treating Substance Use Disorders in the European Union. Eur Addict Res 2017; 23:177-181. [PMID: 28803249 DOI: 10.1159/000478904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinicians in the field of drug addiction have started to exploit the growth of Technology-Based Interventions (TBIs). However, there is little information on how health personnel evaluate them. METHODS Semi-structured interviews were conducted among 20 European experts. RESULTS All of the interviewees recognised TBIs as a valuable tool to improve the management of substance-use disorders (SUDs). Most interviewees indicated that combining both traditional face-to-face therapist-patient clinic appointment with TBIs is probably the most effective method. Most interviewees agree that TBIs are valuable tools to overcome both physical and social barriers, and hence significantly facilitate the access to treatment. Poor infrastructure and lack of digital literacy are recognised as major barriers to the diffusion of these tools. CONCLUSIONS The application of various forms of technology in SUD treatment is an interesting development for the European Union. Technical and non-technical barriers exist and impede their full exploitation.
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Affiliation(s)
- GianLuca Quaglio
- Scientific Foresight Unit (Science and Technology Options Assessment [STOA]), Directorate-General for Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
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Kamal RM, van Noorden MS, Wannet W, Beurmanjer H, Dijkstra BAG, Schellekens A. Pharmacological Treatment in γ-Hydroxybutyrate (GHB) and γ-Butyrolactone (GBL) Dependence: Detoxification and Relapse Prevention. CNS Drugs 2017; 31:51-64. [PMID: 28004314 DOI: 10.1007/s40263-016-0402-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The misuse of γ-hydroxybutyrate (GHB) for recreational purposes has resulted in an increase in GHB-related problems such as intoxications, dependence and withdrawal in several countries in Europe, Australia and the US over the last decade. However, prevalence rates of misuse of GHB and its precursor, γ-butyrolactone (GBL), are still relatively low. In this qualitative review paper, after a short introduction on the pharmacology of GHB/GBL, followed by a summary of the epidemiology of GHB abuse, an overview of GHB dependence syndrome and GHB/GBL withdrawal syndrome is provided. Finally, the existing literature on management of GHB detoxification, both planned and unplanned, as well as the available management of GHB withdrawal syndrome, is summarized. Although no systematic studies on detoxification and management of withdrawal have been performed to date, general recommendations are given on pharmacological treatment and preferred treatment setting.
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Affiliation(s)
- Rama M Kamal
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Toernooiveld 5, 6525 ED, Nijmegen, The Netherlands.
- Novadic-Kentron Addiction Care Network, Hogedwarsstraat 3, PO Box 243, 5260 AE, Vught, The Netherlands.
| | | | - Wim Wannet
- Scientific Research Committee IrisZorg, Kronenburgsingel 545, 6831 GM, Arnhem, The Netherlands
| | - Harmen Beurmanjer
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Toernooiveld 5, 6525 ED, Nijmegen, The Netherlands
- Novadic-Kentron Addiction Care Network, Hogedwarsstraat 3, PO Box 243, 5260 AE, Vught, The Netherlands
| | - Boukje A G Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Toernooiveld 5, 6525 ED, Nijmegen, The Netherlands
| | - Arnt Schellekens
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Toernooiveld 5, 6525 ED, Nijmegen, The Netherlands
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