1
|
Ng M, Lu M, Chen VC, Ting H, Huang C, Gossop M. Lymphocyte-related ratios in methamphetamine-induced psychotic disorder in Taiwan, comparing with patients with schizophrenia. Addict Biol 2024; 29:e13363. [PMID: 38380726 PMCID: PMC10898829 DOI: 10.1111/adb.13363] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/14/2023] [Accepted: 11/17/2023] [Indexed: 02/22/2024]
Abstract
The lymphocyte-related ratios, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) are new measures of inflammation within the body. Few studies have investigated the inflammatory response of patients with methamphetamine-induced psychotic disorder. Clinically, the psychotic symptoms and behavioural manifestation of methamphetamine-induced psychotic disorder are often indistinguishable from paranoid schizophrenia. We aimed to determine the differences in these inflammatory markers between patients with methamphetamine-induced psychotic disorder, patients with schizophrenia and healthy individuals. A total of 905 individuals were recruited. The NLR and MLR were found to be higher in both patients with methamphetamine-induced psychotic disorders and patients with schizophrenia compared with healthy controls. There was no significant difference between the three groups in PLR. When compared with the control group, the methamphetamine-induced psychotic disorder group was significantly higher in NLR 27% (95%CI = 11 to 46%, p = 0.001), MLR 16% (95%CI = 3% to 31%, p = 0.013) and PLR 16% (95%CI = 5% to 28%, p = 0.005). NLR of the group with methamphetamine-induced psychotic disorder was 17% (95%CI = 73% to 94%, p = 0.004) less than the group with schizophrenia, while MLR and PLR did not differ significantly between the two groups. This is the first study that investigated the lymphocyte-related ratios in methamphetamine-induced psychotic disorder when compared with patients with schizophrenia and healthy individuals. The results showed that both patients with methamphetamine-induced psychotic disorder and patients with schizophrenia had stronger inflammatory responses than the healthy control. Our finding also indicated that the inflammatory response of methamphetamine-induced psychotic disorder was between those of patients with schizophrenia and healthy individuals.
Collapse
Affiliation(s)
- Mei‐Hing Ng
- Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
- Tsaotun Psychiatric CenterMinistry of Health and WelfareNantou CountyTaiwan
| | - Mong‐Liang Lu
- Department of PsychiatryWan‐Fang Hospital & School of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Vincent Chin‐Hung Chen
- Department of PsychiatryChang Gung Medical FoundationChiayi Chang Gung Memorial HospitalChiayi CountyTaiwan
- Department of PsychiatrySchool of MedicineChang Gung UniversityTaiwan
| | - Hua Ting
- Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Physical Medicine and RehabilitationChung‐Shan Medical, University HospitalChung‐Shan Medical UniversityTaichungTaiwan
| | - Chieh‐Liang Huang
- Tsaotun Psychiatric CenterMinistry of Health and WelfareNantou CountyTaiwan
| | - Michael Gossop
- National Addiction CentreInstitute of PsychiatryKing's College LondonLondonUK
| |
Collapse
|
2
|
Lee CTC, Chen VCH, Lee JKW, Wu SI, Cheng G, Kao TM, Wang SY, Gossop M. Substance use before or during pregnancy and the risk of child mortality, perinatal morbidities and congenital anomalies. Epidemiol Psychiatr Sci 2023; 32:e43. [PMID: 37431291 PMCID: PMC10387448 DOI: 10.1017/s2045796023000549] [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: 07/12/2023] Open
Abstract
AIMS We aimed to investigate child mortality, perinatal morbidities and congenital anomalies born by women with substance misuse during or before pregnancy (DP or BP). METHODS Taiwan Birth Registration from 2004 to 2014 linking Integrated Illicit Drug Databases used to include substance misuse participates. Children born by mothers convicted of substance misuse DP or BP were the substance-exposed cohort. Two substance-unexposed comparison cohorts were established: one comparison cohort selected newborns from the rest of the population on a ratio of 1:1 and exact matched by the child's gender, child's birth year, mother's birth year and child's first use of the health insurance card; another comparison cohort matched newborns from exposed and unexposed mothers by their propensity scores calculated from logistic regression. RESULTS The exposure group included 1776 DP, 1776 BP and 3552 unexposed individuals in exact-matched cohorts. A fourfold increased risk of deaths in children born by mothers exposed to substance during pregnancy was found compared to unexposed group (hazard ratio [HR] = 4.54, 95% confidence interval (CI): 2.07-9.97]. Further multivariate Cox regression models with adjustments and propensity matching substantially attenuated HRs on mortality in the substance-exposed cohort (aHR = 1.62, 95% CI: 1.10-2.39). Raised risks of perinatal morbidities and congenital anomalies were also found. CONCLUSIONS Increased risks of child mortality, perinatal morbidities or congenital anomalies were found in women with substance use during pregnancy. From estimates before and after adjustments, our results showed that having outpatient visits or medical utilizations during pregnancy were associated with substantially attenuated HRs on mortality in the substance-exposed cohort. Therefore, the excess mortality risk might be partially explained by the lack of relevant antenatal clinical care. Our finding may suggest that the importance of early identification, specific abstinence program and access to appropriate antenatal care might be helpful in reducing newborn mortality. Adequate prevention policies may be formulated.
Collapse
Affiliation(s)
- Charles Tzu-Chi Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry/Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital at Chiayi, Puzi, Taiwan
- Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | | | - Shu-I Wu
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
- Department of Psychiatry and Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Gillian Cheng
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Tzu-Min Kao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Shih-Yuan Wang
- Department of Exercise Health Science, National Taiwan University of Sports, Taichung City, Taiwan
| | - Michael Gossop
- King's College London, National Addiction Centre, London, UK
| |
Collapse
|
3
|
Chan HL, Hsieh YH, Lin CF, Liang HY, Lee SS, Weng JC, Lee MJ, Chen YL, Chen VCH, Gossop M. Lower Risk of Burn Injury in Children and Adolescents with Autism Spectrum Disorder: A Nationwide Population-Based Study. J Autism Dev Disord 2023; 53:648-655. [PMID: 33474660 DOI: 10.1007/s10803-020-04859-9] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/17/2022]
Abstract
Little research has examined burn injury in the pediatric population with autism spectrum disorder (ASD). We used data from Taiwan's National Health Insurance Research Database to identify 15,844 participants aged <18 years with ASD and 130,860 participants without ASD. Our results revealed that the hazard ratios differed across three age ranges. The ASD group had a lower risk of burn injury than the non-ASD group when they were less than 6 years of age, a higher risk from 6 years to 12 years of age, and no difference when they were older than 12 years of age. More research is required to study the characteristics and causes of burn injury in the pediatric population with ASD.
Collapse
Affiliation(s)
- Hsiang-Lin Chan
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsuan Hsieh
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Chiao-Fan Lin
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yi Liang
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Su-Shin Lee
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jun-Cheng Weng
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Min-Jing Lee
- Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Psychology, Asia University, Taichung, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan. .,Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
4
|
Chen VCH, Kao KL, Chen YL, Wu SI, Lee MJ, Gossop M. Methylphenidate Use and Infectious Diseases in Children With Attention Deficit and Hyperactivity Disorder: A Population-Based Study. Front Med (Lausanne) 2022; 8:787745. [PMID: 35211484 PMCID: PMC8861374 DOI: 10.3389/fmed.2021.787745] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Children with attention deficit hyperactivity disorder (ADHD) have more visits to the emergency department (ED) due to injuries than those without ADHD. However, no study has investigated whether children with ADHD have more ED visits or hospitalizations due to infectious diseases (IDs) and whether methylphenidate (MPH) treatment may reduce the risk. Method The incidence of ID-related ED visits or hospitalizations was defined as the main outcome. The Cox regression and conditional Poisson regression models were calculated to estimate hazard ratios (HRs) in the population level and relative risks for the self-controlled case series design, respectively. Results Children with ADHD had higher rates of emergency visits (HR = 1.25, 95% CI: 1.23~1.27) and hospitalizations (HR = 1.28, 95% CI: 1.26~1.31) due to IDs than those without ADHD. In the ADHD subgroup, those who received MPH treatment have a reduced risk of emergency visits (HR = 0.10, 95% CI: 0.09~0.10) and hospitalizations (HR = 0.73, 95% CI: 0.71~0.75), compared to those without treatment. The risk of ID-related emergency visits decreased to 0.21 (95% CI: 0.21~0.22); and hospitalizations decreased to 0.71 (95% CI: 0.69~0.73). Within self-controlled analysis, it is demonstrated that compared with non-MPH exposed period, children with ADHD had significantly decreased risks for infection-related emergency visits (RR = 0.73, 95% CI: 0.68~0.78) or hospitalizations (RR = 0.19, 95% CI: 0.17~0.21) during MPH-exposed periods. Conclusions and Relevance This is the first study that reported an increased risk of ID-related healthcare utilizations in children with ADHD compared to those without, and that such risks may be significantly reduced in ADHD children that received MPH treatment.
Collapse
Affiliation(s)
- Vincent Chin-Hung Chen
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Liang Kao
- Division of Infectious Diseases, Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Psychology, Asia University, Taichung, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Min-Jing Lee
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| |
Collapse
|
5
|
Cheng S, Siddiqui TG, Gossop M, Wyller TB, Kristoffersen ES, Lundqvist C. The patterns and burden of multimorbidity in geriatric patients with prolonged use of addictive medications. Aging Clin Exp Res 2021; 33:2857-2864. [PMID: 33599959 PMCID: PMC8531043 DOI: 10.1007/s40520-021-01791-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/11/2021] [Indexed: 01/12/2023]
Abstract
Background Multimorbidity and prolonged use of addictive medications are prevalent among older patients, and known to increase the risk of adverse drug events. Yet, the relationship between these two entities has remained understudied. Aims This study explored the association between multimorbidity burden and prolonged use of addictive medications in geriatric patients, adjusted for clinically important covariates. Furthermore, we identified comorbidity patterns in prolonged users. Methods We conducted a cross-sectional study on a consecutive sample of 246 patients, aged 65–90 years, admitted to a large public university hospital in Norway. We defined prolonged use of addictive medications as using benzodiazepines, opioids and/or z-hypnotics beyond the duration recommended by clinical guidelines (≥ 4 weeks). Multimorbidity was assessed with the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), based on diagnoses made by independent physicians. Results Compared to non-prolonged use, prolonged use was significantly more common among patients who had psychiatric (19/27, 70%), liver (19/22, 86%), upper gastrointestinal tract (21/32, 66%), musculoskeletal (52/96, 54%), or nervous system disorders (46/92, 50%). Patients with prolonged use had a higher multimorbidity burden than those without such use (CIRS-G score, mean = 7.7, SD = 2.7 versus mean = 4.6, SD = 2.2, p < 0.001). Multivariable logistic regression indicated a significant association between multimorbidity burden and prolonged addictive medication use (OR = 1.72, 95% CI 1.42–2.08). Predictive margins postestimation showed a systematic increase in the predicted CIRS-G scores when the number of addictive drug used increases. Conclusions Multimorbidity is strongly associated with prolonged use of addictive medications. Multiple substance use may aggravate disease burden of older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01791-5.
Collapse
Affiliation(s)
- Socheat Cheng
- Division of Health Services Research and Psychiatry (AHUSKHP), Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1000, 1478, Lørenskog, Norway.
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway.
| | - Tahreem Ghazal Siddiqui
- Division of Health Services Research and Psychiatry (AHUSKHP), Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1000, 1478, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
6
|
Chen YL, Chen VCH, Gossop M. Reliability and Validity of the Chen ADHD Scale (C-ADHDS). Neuropsychiatr Dis Treat 2021; 17:229-237. [PMID: 33536756 PMCID: PMC7850380 DOI: 10.2147/ndt.s292696] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/11/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE This study aimed to establish the Chen ADHD Scale and to examine its reliability and validity. PATIENTS AND METHODS We recruited 114 individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD) and 39 non-ADHD controls aged between 5 and 18 years. Their parents completed the Chen ADHD Scale, Chinese versions of the SNAP-IV, and Strengths and Difficulties Questionnaire (SDQ). We examined the psychometric properties of Chen ADHD Scale, including test-retest reliability, internal consistency, construct validity, convergent and divergent validity. RESULTS Receiver operating characteristic analysis was performed to calculate the area under the curve (AUC), sensitivity, and specificity of the Chen ADHD Scale for predicting ADHD. The Chen ADHD Scale demonstrated satisfactory test-retest reliability (intraclass correlation = 0.916), internal consistency (alpha = 0.966 to 0.978), a good model fit for a two-factor structure (inattention and hyperactivity-impulsivity) and good convergent and divergent validity with SNAP-IV and SDQ. The AUC of Chen ADHD Scale for predicting ADHD was 0.944. The optimal cut-off value of Chen ADHD Scale with impairment requirement for predicting ADHD was 37 with a sensitivity of 0.87 and a specificity of 0.97. CONCLUSION The Chen ADHD Scale is a reliable and valid instrument for screening ADHD symptoms in clinical settings in Taiwan.
Collapse
Affiliation(s)
- Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Psychology, Asia University, Taichung, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
7
|
Cheng S, Siddiqui TG, Gossop M, Stavem K, Kristoffersen ES, Lundqvist C. Health-related quality of life in hospitalized older patients with versus without prolonged use of opioid analgesics, benzodiazepines, and z-hypnotics: a cross-sectional study. BMC Geriatr 2020; 20:425. [PMID: 33096993 PMCID: PMC7585301 DOI: 10.1186/s12877-020-01838-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients' self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates. METHODS The study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients' self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models. RESULTS Patients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82). In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient - 0.19 (95% CI, - 0.31 to - 0.06). CONCLUSIONS Older patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.
Collapse
Affiliation(s)
- Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Knut Stavem
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
8
|
Hsu YH, Chen VCH, Hsieh CC, Weng YP, Hsu YT, Hsiao HP, Wang WK, Chen HM, Weng JC, Wu SI, Gossop M. Subjective and objective cognitive functioning among patients with breast cancer: effects of chemotherapy and mood symptoms. Breast Cancer 2020; 28:236-245. [PMID: 33030667 DOI: 10.1007/s12282-020-01168-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/20/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous findings regarding declines in cognitive functioning among patients with breast cancer (BC) before and after chemotherapy have been inconsistent. The present study explored the effect of BC and cancer-related chemotherapies on cognitive functioning. METHODS A cross-sectional design was adopted to compare BC patients before their chemotherapy treatment, BC patients 3 ~ 9 months after the completion of chemotherapy, and noncancer controls. Evaluations of cognitive functioning included subjective and objective dimensions, with focus on memory, executive functioning, attention, and language. ANCOVA and Pearson's correlation analysis were used to examine the relationship among cancer, chemotherapy, cognitive performance, and psychological distress. RESULTS After adjustment for intelligence quotient, anxiety, and depression, we found significant differences in the Semantic Association of Verbal Fluency between post-chemotherapy (C/T) patients and noncancer controls. Specifically, post-C/T patients scored lower than controls (p = 0.03, η2 = 0.07). No significant differences were found in other objective cognitive measures. However, both subjective and objective cognitive scores were significantly associated with depression, anxiety, and fatigue. In BC patients, levels of anxiety were positively correlated with measures of executive function. Among pre-C/T patients, self-perceived interference by fatigue was positively associated with better performances in some of the objective cognitive measures. CONCLUSION Our findings suggest cognitive impairments in the domain of executive functioning among patients with BC who received chemotherapy. Providing relevant suggestions or strategies of managements for these negative consequences may help increase the long-term quality of life of patients with BC.
Collapse
Affiliation(s)
- Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi County, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi County, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chuan Hsieh
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- Department of Surgery, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
| | - Yi-Ping Weng
- Breast Center, Chiayi Chang Gung Memorial Hospital and University, Puzi, Chiayi County, Taiwan
| | - Ya-Ting Hsu
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
| | - Han-Pin Hsiao
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
| | - Wen-Ke Wang
- Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Hong-Ming Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan.
- Department of Psychiatry, Mackay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Zhongshan District, Taipei, 104, Taiwan.
| | - Michael Gossop
- Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
9
|
Siddiqui TG, Cheng S, Gossop M, Kristoffersen ES, Grambaite R, Lundqvist C. Association between prescribed central nervous system depressant drugs, comorbidity and cognition among hospitalised older patients: a cross-sectional study. BMJ Open 2020; 10:e038432. [PMID: 32718926 PMCID: PMC7389767 DOI: 10.1136/bmjopen-2020-038432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Central nervous system depressants (CNSDs) such as opioids, benzodiazepine and Z-hypnotics are commonly used. However, CNSDs may influence cognitive function, especially in older hospitalised patients with comorbidities. The aim was to examine the association between CNSD use and cognitive function in older patients. We assessed global and domain specific cognitive function, among hospitalised older patients, including covariates for comorbidity, anxiety and depression. DESIGN Cross-sectional hospital-based study. SETTINGS Data was collected consecutively from inpatients at somatic wards of a general university hospital. PARTICIPANTS Older patients between 65 and 90 years with/without CNSD use for ≥4 weeks. OUTCOME MEASURES The main outcome was cognitive function assessed by Cognistat. Secondary outcomes were routine clinical tests in the wards (mini-mental state examination (MMSE), trail making test (TMT) A and B, and clock drawing tests). Analyses were bivariate and multiple linear regression, adjusted for age, gender, and education. Covariates were comorbidity, depression and anxiety scores. RESULTS The main result indicated that CNSD users (n=100) had (β=-3.4, 95% CI 6.27 to -0.58, p=0.017) lower Cognistat score than non-users (n=146), adjusted for age, gender, education, anxiety and depression, but not significant when including covariate for comorbidity (β= -2.50 - 5.45; -0.46, p=0.097). Comorbidity was associated with cognitive function (β=-0.77, 95% CI -1.22 to -0.14, p=0.014). Cognistat subdimensions associated with CNSD use were language (p=0.017) and calculation (p=0.003). In clock drawing test, users had lower scores than non-users (β=-0.80, 95% CI 1.24 to -0.36, p=0.004), but no significant difference was found with MMSE and TMT A or B. Z-hypnotics were associated with reduced cognitive function. CONCLUSION Among older hospitalised patients, global cognition and specific cognitive functions were associated with long-term use of CNSD medication as well as with somatic comorbidity. TRIAL REGISTRATION NUMBER NCT03162081, 22 May 2017.
Collapse
Affiliation(s)
- Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Michael Gossop
- Centre for Addiction Research, King's College London, London, UK
| | - Espen Saxhaug Kristoffersen
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ramune Grambaite
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| |
Collapse
|
10
|
Cheng S, Siddiqui TG, Gossop M, Kristoffersen ES, Lundqvist C. Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study. BMJ Open 2019; 9:e031483. [PMID: 31492795 PMCID: PMC6731874 DOI: 10.1136/bmjopen-2019-031483] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/20/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Timely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics. DESIGN A prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING Somatic departments of the Akershus University Hospital, Norway. PARTICIPANTS 246 patients aged 65-90 were included. OUTCOME MEASURES Prolonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients' characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence. RESULTS Forty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75-84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88). CONCLUSION CNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs. TRIAL REGISTRATION NUMBER NCT03162081.
Collapse
Affiliation(s)
- Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Michael Gossop
- National Addiction Centre, King's College, London, United Kingdom
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
11
|
Chen VCH, Wu SI, Huang KY, Yang YH, Kuo TY, Liang HY, Huang KL, Gossop M. Herpes Zoster and Dementia: A Nationwide Population-Based Cohort Study. J Clin Psychiatry 2019; 79. [PMID: 29244265 DOI: 10.4088/jcp.16m11312] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 06/26/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Some infectious diseases have been found to be associated with cognitive impairment and dementia. However, the relationship between herpes zoster and dementia has received little attention. This study aimed to investigate this association as well as associations of antiviral treatments for herpes zoster and incident dementia using a large national sample. METHODS Cases were identified from the Taiwan National Health Insurance Research Database with a new diagnosis of herpes zoster (ICD-9-CM code: 053) between 1997 and 2013. Each identified individual with a case of herpes zoster was compared with 1 sex-, age-, and residence-matched control subject. Both groups were followed until the first diagnosis of dementia (ICD-9-CM codes: 290.0 to 290.4, 294.1, 331.0 to 331.2, and 331.82), withdrawal from the registry, or the end of 2013. Cox regression analyses and competing risk model were applied, adjusting for sex, age, residence, depression, autoimmune disease, ischemic stroke, traumatic brain injury, alcohol use disorder, and antiviral treatments for herpes zoster to evaluate the risk of interest. RESULTS A total of 39,205 cases with herpes zoster were identified. Of the 78,410 study and comparison subjects, 4,204 were diagnosed as having dementia during a mean (SD) follow-up period of 6.22 (4.05) years. Herpes zoster was associated with a slightly increased risk of dementia in the fully adjusted model (hazard ratio [HR] = 1.11; 95% CI, 1.04-1.17). Prescriptions of antiviral therapy were associated with a reduced risk of developing dementia following the diagnosis of herpes zoster (HR = 0.55; 95% CI, 0.40-0.77). CONCLUSIONS Herpes zoster was associated with an increased risk of dementia, independent of potential confounding factors. Antiviral treatment might be protective in preventing dementia in patients with herpes zoster.
Collapse
Affiliation(s)
- Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan.,Section of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kuo-You Huang
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Kuo
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hsin-Yi Liang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Lun Huang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Taiwan, 161 Yu-Pin Rd, Caotun Township, Nantou, Taiwan. .,Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Michael Gossop
- National Addiction Center, Institute of Psychiatry, King's College London, London, United Kingdom
| |
Collapse
|
12
|
Cheng S, Siddiqui TG, Gossop M, Kristoffersen ES, Lundqvist C. The Severity of Dependence Scale detects medication misuse and dependence among hospitalized older patients. BMC Geriatr 2019; 19:174. [PMID: 31234786 PMCID: PMC6591833 DOI: 10.1186/s12877-019-1182-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 09/11/2018] [Accepted: 06/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background In older patients, timely recognition and treatment of medication misuse and dependence are crucial to secure medication safety and to avoid increasing health expenditure. Nonetheless, the detection of this condition remains challenging due to the paucity of screening instruments validated for older people. This study assesses diagnostic accuracy, reliability, validity and the factor structure of the Severity of Dependence Scale (SDS) in detecting medication misuse and dependence among hospitalized older patients, focusing on prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics. Methods 246 adults aged 65–90 were recruited consecutively from somatic departments of the Akershus University Hospital, Norway. Among these, 100 patients were identified as prolonged users of CNSDs. Diagnostic accuracy and validity of the SDS were assessed using DSM-IV criteria for substance abuse and dependence as the reference standard. We also performed an exploratory factor analysis and assessment of internal consistency using Cronbach’s alpha. Results The area under the ROC curve was 0.86 (95%CI = 0.79–0.93; p < 0.001). A score of 5.5 was determined as the optimal cutoff for detecting CNSD misuse and dependence among older patients. Cronbach’s alpha obtained was satisfactory (α = 0.73). There was a significant positive correlation between the SDS score and DSM-IV criteria for substance abuse and dependence (Pearson’s correlation coefficient = 0.61, p < 0.001). The uni-dimensionality of the SDS was documented. Conclusions The SDS is reliable, valid and capable of detecting medication misuse and dependence among hospitalized older patients, with good diagnostic performance. The scale thus holds promise for use in both clinical and research contexts. Trial registration ClinicalTrials.gov Identifier: NCT03162081. Registered 3 May 2017. Electronic supplementary material The online version of this article (10.1186/s12877-019-1182-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Socheat Cheng
- Health Services Research Unit (HØKH), Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, PO Box 1000, 1478, Lorenskog, Norway.
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, PO Box 1000, 1478, Lorenskog, Norway
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO Box 48, 4 Windsor Walk, London, SE5 8AF, UK
| | - Espen Saxhaug Kristoffersen
- Health Services Research Unit (HØKH), Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway.,Department of Neurology, Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway.,Department of General Practice, Institute of Health and Society, University of Oslo, 1130 Blindern, 0318, Oslo, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, PO Box 1000, 1478, Lorenskog, Norway.,Department of Neurology, Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway
| |
Collapse
|
13
|
Tien YM, Chen VCH, Lo TS, Hsu CF, Gossop M, Huang KY. Deficits in auditory sensory discrimination among children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2019; 28:645-653. [PMID: 30229307 DOI: 10.1007/s00787-018-1228-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Research into children with attention-deficit/hyperactivity disorder (ADHD) has focused on complex cognitive dysfunction, but less attention has been paid to sensory perception processes underlying the symptoms of ADHD. Based on signal detection theory, the present study compared the sensory discrimination ability and decision bias of children with and without ADHD. It also investigated the differences between ADHD with predominantly inattentive (ADHDi) and combined presentations (ADHDc). The sample of 75 children and adolescents with ADHD (24 ADHDi, 51 ADHDc) (16 females and 59 males) and 22 typical developing controls (TD) (8 females and 14 males) completed an auditory signal detection task. Participants were asked to detect signals against levels of transient background noise (35, 45, 55, and 65 dB). The results showed that with the increase of noise levels, both the ADHD and TD groups demonstrated decreased sensory discrimination. Although both groups successfully detected signal against noise levels from 35 to 55 dB, the ADHD group showed lower discrimination ability than that of the TD group. For decision bias, no group difference was found. Further comparisons regarding the predominant symptom presentation of ADHD sub-groups showed no differences. Current research has suggested that the deficit in ADHD people's signal detection performance can be attributed to sensory discrimination rather than decision bias. We suggest that background noise should be taken into account when using auditory stimuli to investigate cognitive functions in people with ADHD.
Collapse
Affiliation(s)
- Yi-Min Tien
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan.,Room of Clinical Psychology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital and University, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyüan, Taiwan
| | - Tun-Shin Lo
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd, Taichung, 40201, Taiwan.,Speech and Language Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chia-Fen Hsu
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan.,Room of Clinical Psychology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | | | - Kuo-You Huang
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd, Taichung, 40201, Taiwan. .,Speech and Language Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
14
|
Fang CT, Chen VCH, Ma HT, Chao HH, Ho MC, Gossop M. Attentional Bias, "Cool" and "Hot" Executive Functions in Obese Patients: Roles of Body Mass Index, Binge Eating, and Eating Style. J Clin Psychopharmacol 2019; 39:145-152. [PMID: 30742591 DOI: 10.1097/jcp.0000000000001016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE/BACKGROUND Obesity is recognized as an important risk factor for many chronic diseases and is a major health issue. The current study examined attentional bias to food and the "cool" (inhibitory control and mental flexibility) and "hot" (affective decision making) executive functions (EFs) in obese patients preparing for bariatric surgery. In addition to body mass index (BMI), this study examined the impact of the binge-eating tendency and eating styles. METHODS The study population comprised 21 morbidly obese patients preparing to undergo bariatric surgery (BMI ≥30 kg/m) and 21 normal-weight controls (24 kg/m > BMI ≥ 18.5 kg/m). The Visual Probe Task was adopted to examine attentional bias toward food-related cues. The Stop-Signal Task and the Color Trails Test were used to assess inhibitory control and mental flexibility, respectively. The Iowa Gambling Task was administered to assess the affective decision making. RESULTS (1) The obese patients showed poorer performances on cool EFs (for Color Trails Test, P = 0.016, ηp = 0.136; for Stop-Signal Task, P = 0.049, ηp = 0.093) and hot EF (for Iowa Gambling Task, normal controls showed progressed performance, P = 0.012, ηp = 0.077, but obese patients did not show this progress, P = 0.111, ηp = 0.089) compared with the normal controls; (2) participants with low binge-eating tendency had larger attentional biases at 2000 milliseconds than at 200 milliseconds on food-related cues (P = 0.003, ηp = 0.363); and (3) low-restrained participants exhibited attentional bias toward the low-calorie food cues, compared with the high-restrained group (P = 0.009, ηp = 0.158). CONCLUSIONS The current study contributes to the development of a different therapeutic focus on obese patients and binge eaters.
Collapse
Affiliation(s)
| | | | - Hsiang-Ting Ma
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi
| | - Hse-Huang Chao
- Taiwan Center for Metabolic and Bariatric Surgery, Jen-Ai Hospital
| | | | - Michael Gossop
- National Addiction Centre, King's College London, London, United Kingdom
| |
Collapse
|
15
|
Ng MH, Chen VCH, Ting H, Lin TY, Chang SH, Gossop M. Macrocytosis among patients with heroin use disorder. Neuropsychiatr Dis Treat 2019; 15:2293-2298. [PMID: 31496712 PMCID: PMC6697662 DOI: 10.2147/ndt.s211649] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/19/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Few empirical studies have investigated hematological parameters among people with a heroin use disorder. This study explores the prevalence of macrocytosis and associated factors among patients with heroin use disorder who were entering methadone maintenance treatment (MMT) in Taiwan. PATIENTS AND METHODS In this cross-sectional study, hematological parameters were measured and the prevalence of macrocytosis was assessed in a sample of 958 patients with a heroin use disorder entering the MMT program at Tsaotun Psychiatric Center in Taiwan. The demographic characteristics, heroin-related issues, other substance use history, and other clinical variables were analyzed. Univariate analysis was used to assess the association of all variables. Multivariable logistic regression was used to identify the relationship between the significant factors and macrocytosis. RESULTS The study found that nearly one-fifth (19.5%) of the participants had macrocytosis. Older age, longer duration of heroin use, and more days of alcohol use within the previous month were associated with macrocytosis. CONCLUSION We found that concurrent use of alcohol was an important factor related to macrocytosis among people with a heroin use disorder. The prevalence of macrocytosis indicated that alcohol use is common among this population. It is suggested that policies and practices regarding alcohol use should be addressed within methadone maintenance programs.
Collapse
Affiliation(s)
- Mei-Hing Ng
- Institute of Medicine, Chung Shan Medical University , Taichung, Taiwan.,Tsaotun Psychiatric Center, Ministry of Health and Welfare , Nan-Tou County, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan.,Department of Psychiatry, School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University , Taichung, Taiwan.,Department of Physical Medicine and Rehabilitation, Chung-Shan Medical, University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Tsang-Yaw Lin
- Tsaotun Psychiatric Center, Ministry of Health and Welfare , Nan-Tou County, Taiwan
| | - Sheng-Huang Chang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare , Nan-Tou County, Taiwan
| | - Michael Gossop
- National Addiction Center, Institute of Psychiatry, King's College London , London, UK
| |
Collapse
|
16
|
Ho MC, Hsu YC, Lu ML, Gossop M, Chen VCH. 'Cool' and 'Hot' executive functions in suicide attempters with major depressive disorder. J Affect Disord 2018; 235:332-340. [PMID: 29665516 DOI: 10.1016/j.jad.2018.04.057] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 10/21/2017] [Revised: 03/09/2018] [Accepted: 04/05/2018] [Indexed: 01/22/2023]
Abstract
RATIONALE The World Health Organization reports that, by 2030, depression is expected to be the largest contributor to disease burden. Only small proportion of patients with major depressive disorder (MDD) achieves remission and the majority of them do not achieve long-term functional recovery. One of the neuropsychological domains that have been shown to be particularly impaired in depression, is that of executive function (EF). OBJECTIVES We examined whether the patients with MDD with and without suicide attempts had deteriorated 'cool' EF and 'hot' EF. METHODS The study population comprised 34 MDD attempters, 36 MDD non-attempters, and 55 healthy controls. We adopted the symmetry span task (SSPAN) to measure the updating and the affective shifting task (AST) to measure the inhibition and set-shifting in general and in response to emotional material. The Iowa gambling task (IGT) was used to examine the affective decision-making ability. RESULTS After controlling for PHQ-9, Anxiety (HADS), suicidal ideation, education year and gender, we reported that (1) the MDD non-attempters had worse updating than the healthy controls and the MDD attempters; (2) the MDD attempters had worse general inhibition (GI) than the healthy controls and the MDD non-attempters; (3) the MDD non-attempters had worse general set-shifting (GS) than the healthy controls and the MDD attempters; (4) there was no between-group difference in the 'hot' EFs; and (5) MDD attempters with longer durations (over 5 years) since last attempt had worse general inhibition. CONCLUSIONS The disrupted 'cool' EFs patients with MDD are consistent with previous review and meta-analytic studies. On the other hand, the two groups with MDD performed similarly to the healthy controls in the 'hot' EF.
Collapse
Affiliation(s)
- Ming-Chou Ho
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan; Clinical Psychological Room, Chung-Shan Medical University Hospital Taichung, Taiwan
| | - Yi-Chieh Hsu
- Clinical Psychology Center, Dalin Tzu Chi Hospital, Chiayi, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital & School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| |
Collapse
|
17
|
Tsai CJ, Lee CTC, Liang SHY, Tsai PJ, Chen VCH, Gossop M. Risk of ADHD After Multiple Exposures to General Anesthesia: A Nationwide Retrospective Cohort Study. J Atten Disord 2018; 22:229-239. [PMID: 26023173 DOI: 10.1177/1087054715587094] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To study the association between general anesthesia exposure before age 3 years and having a later ADHD diagnosis. METHOD In a birth cohort, data were collected from a nationwide population database for children born between 1997 and 1999 who were exposed to general anesthesia before their third birthday. Age- and gender-matched enrollees without general anesthesia exposure were taken as the comparison. Groups were compared to identify the incidence of ADHD after age 4 and anesthesia-related predictive factors. RESULTS Among the 1,146 exposed children, 74 ADHD cases were identified, and 158 ADHD cases were identified in 3,438 matched controls. After adjusting for comorbid conditions and possible confounding factors, if exposure on more than one occasion or ≥3 hr, an increased likelihood of having a later ADHD diagnosis was found (HR, 1.71 and 2.43, respectively). CONCLUSION Children with multiple or ≥3 hr general anesthesia exposures before age 3 years have an increased likelihood of a later ADHD diagnosis.
Collapse
Affiliation(s)
| | - Charles Tzu-Chi Lee
- 2 Kaohsiung Medical University, Taiwan.,3 National Taiwan Normal University, Taipei, Taiwan
| | - Sophie Hsin-Yi Liang
- 4 Chang Gung Memorial Hospital, Taoyuan, Taiwan.,5 Chang Gung University, Taoyuan, Taiwan
| | | | | | | |
Collapse
|
18
|
Hines LA, Lynskey M, Morley KI, Griffiths P, Gossop M, Powis B, Strang J. The relationship between initial route of heroin administration and speed of transition to daily heroin use. Drug Alcohol Rev 2017; 36:633-638. [PMID: 28470826 DOI: 10.1111/dar.12560] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/18/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND AIMS The effect of heroin administration route on speed of transition to regular use is unknown. This paper aims to determine whether the speed of transition from initiation of heroin use to daily heroin use differs by route of administration (injecting, chasing/inhaling or snorting). DESIGN AND METHODS Privileged access interviewer survey of purposively selected sample of 395 current people who use heroin (both in and not in treatment) in London, UK (historical sample from 1991). Data on age and year of initiation, time from initiation to daily use and routes of administration were collected by means of a structured questionnaire. Generalised ordered logistic models were used to test the relationship between route of initial administration of heroin and speed of transition to daily heroin use. Analyses were adjusted for gender, ethnicity, daily use of other drug(s) at time of initiation, year of initiation and treatment status at interview. RESULTS After adjustment, participants whose initial administration route was injecting had a 4.71 (95% confidence interval 1.34-16.5) increase in likelihood of progressing to daily use within 1-3 weeks of initiation, compared to those whose initial administration route was non-injecting. DISCUSSION AND CONCLUSIONS The speed of transition from first use to daily heroin use is faster if the individual injects heroin at initiation of use. Those who initiate heroin use through injecting have a shorter time frame for intervention before drug use escalation. [Hines LA, Lynskey M, Morley KI, Griffiths P, Gossop M, Powis B, Strang J. The relationship between initial route of heroin administration and speed of transition to daily heroin use. Drug Alcohol Rev 2017;00:000-000].
Collapse
Affiliation(s)
- Lindsey A Hines
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Lynskey
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katherine I Morley
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Michael Gossop
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Beverly Powis
- National Offender Management Service, Wolverhampton, UK
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
19
|
Chen VCH, Ting H, Wu MH, Lin TY, Gossop M. Sleep disturbance and its associations with severity of dependence, depression and quality of life among heroin-dependent patients: a cross-sectional descriptive study. Subst Abuse Treat Prev Policy 2017; 12:16. [PMID: 28320448 PMCID: PMC5360025 DOI: 10.1186/s13011-017-0101-x] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/13/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Sleep disturbance is common and may adversely affect treatment outcome, mental health, and quality of life in heroin-dependent patients. Previous studies have focused upon patients receiving treatment. We conducted a cross-sectional descriptive study to explore the 1-month prevalence of sleep disturbance and its associations with socio-demographic, substance-related characteristics, severity of dependence, severity of depression, and quality of life among heroin-dependent patients before entering treatment program. METHODS The sample (n = 514) comprised individuals with heroin dependence attending the methadone maintenance treatment program and the therapeutic community at a psychiatric center in Nantou, Taiwan between 2008 and 2014. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) with a global score greater than 5 indicating sleep disturbance. Centre for Epidemiologic Studies Depression Scale, Severity of Dependence Scale, and World Health Organization Quality of Life-BREF were also approached. T-test, chi-square tests, and multivariate logistic regression were performed to measure associations between variables and sleep disturbance. RESULTS The 1-month prevalence of sleep disturbance (PSQI > 5) was 76.3% among 514 subjects with heroin dependence. Heroin users with sleep disturbance had significantly more life events in the previous year, higher rate of unemployment, greater cigarette consumption, more substance related criminal convictions, longer length of heroin use, higher rate of injectors, greater severity of dependence, greater severity of depression, and lower quality of life compared to those without sleep disturbance. Severity of dependence, severity of depression, and physical health domain of quality of life remained significantly associated with sleep disturbance after adjusting for other variables. CONCLUSION Heroin-dependent patients had a high 1-month prevalence of sleep disturbance, and this was associated with greater severity of dependence, greater severity of depression, and poorer physical health-related quality of life. Early assessments and interventions for sleep disturbance among patients with heroin dependence are recommended.
Collapse
Affiliation(s)
- Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 613, Chiayi County, Taiwan.,Chang Gung University, 333, Tao-Yuan, Taiwan
| | - Hua Ting
- Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan.,Institude of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Meng-Huan Wu
- Institude of Medicine, Chung-Shan Medical University, Taichung, Taiwan. .,Ministry of Health and Welfare, Tsaotun Psychiatric Center, 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, Republic of China.
| | - Tsang-Yaw Lin
- Ministry of Health and Welfare, Tsaotun Psychiatric Center, 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, Republic of China
| | - Michael Gossop
- King's College London, Institute of Psychiatry, London, SE5 8AF, UK
| |
Collapse
|
20
|
Abstract
Enterovirus (EV) infection is common among children and adolescents. Few studies have investigated the relationship of depression after EV infection. This study explores an association between EV infection and subsequent depression in children and adolescents and assesses the risk of depression after EV infection with central nervous system involvement in a nationwide population-based retrospective cohort.A random sample of 1,000,000 people was derived from Taiwan National Health Insurance Research Database and we identified enrollees less than 18 years with EV infection before 2005 and followed up until December 2009. A total 48,010 cases with EV infection and 48,010 healthy controls matched for sex, age, and residence were obtained. Association between EV infection and depression risk was assessed by Cox proportional hazards models to determine the hazard ratios (HRs) and confidence intervals (CIs). We further stratified EV infection into with central nervous system (CNS) involvement and without and compared with matched cohort.Children and adolescents with EV infection had no elevated risk of depression compared with healthy controls (adjusted HR, aHR = 1.00, 95% CI: 0.83-1.21). However, CNS EV infection was associated with increased risk of depression (aHR = 1.62, 95% CI: 1.02-2.58) in the fully adjusted Cox regression model.To the best of our knowledge, this is the first study investigating depression in children and adolescents with CNS EV infection. The results suggested that children and adolescents with CNS EV infection were a susceptible group for subsequent depressive disorders.
Collapse
Affiliation(s)
- Yin-To Liao
- Department of Psychiatry, Chung Shan Medical University Hospital
- Department of Psychiatry, School of Medicine, Chung Shan Medical University
| | - Ming-Hong Hsieh
- Department of Psychiatry, Chung Shan Medical University Hospital
- Department of Psychiatry, School of Medicine, Chung Shan Medical University
| | - Yao-Hsu Yang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Puzi City, Chiayi
| | | | - Ching-Shu Tsai
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital Chiayi
- Chang Gung University, Taoyuan, Taiwan
| | - Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital Chiayi
- Chang Gung University, Taoyuan, Taiwan
| | | |
Collapse
|
21
|
Abstract
BACKGROUND Breast cancer is the most common cancer in women. Among the survivors, depression is one of the most common psychiatric comorbidities. This paper reports the point prevalence of major depressive disorder among breast cancer patients and the association between family support and major depressive disorder. METHODS Clinical data were collected from a breast cancer clinic of a general hospital in central Taiwan. Participants included 300 patients who were older than 18 years and diagnosed with breast cancer. Among these individuals, we used Mini International Neuropsychiatric Interview (a structural diagnostic tool for psychiatric disorders) to ascertain if they had major depressive disorder. We also used the Family Adaptability, Partnership, Growth, Affection, and Resolve score to assess the family support. RESULTS The point prevalence of major depressive disorder among breast cancer patients was 8.33%, and this was positively associated with insomnia, psychiatric family history, pain severity, and radiotherapy and negatively associated with menopause, cancer duration, hormone therapy, and family support. Family support (adjusted odds ratio =0.87, 95% CI: 0.78-0.98) was found to be an associated factor for major depressive disorder in breast cancer patients after controlling for potential risk factors. CONCLUSION Major depressive disorder is a common comorbidity among breast cancer patients. Family support is an important associated factor for these patients. Health care professionals should evaluate mood problems and family support while treating these patients.
Collapse
Affiliation(s)
- Jian-An Su
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Dah-Cherng Yeh
- Department of Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Ching-Chi Chang
- Institute of Medicine, Chung Shan Medical University and Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tzu-Chin Lin
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ching-Hsiang Lai
- Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan
| | - Pei-Yun Hu
- Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Feng Ho
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou, Taiwan
| | - Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Michael Gossop
- King's College London, Institute of Psychiatry, London, UK
| |
Collapse
|
22
|
Liao YT, Chen CY, Ng MH, Huang KY, Shao WC, Lin TY, Chen VCH, Gossop M. Depression and severity of substance dependence among heroin dependent patients with ADHD symptoms. Am J Addict 2016; 26:26-33. [PMID: 27997065 DOI: 10.1111/ajad.12487] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/30/2016] [Accepted: 12/04/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Comorbid attention deficit hyperactivity disorder (ADHD) symptoms are highly prevalent among heroin-dependent patients. We aim to investigate differences in dependence severity, depression, and quality of life between heroin-dependent patients with and without ADHD-screened positive. METHODS Heroin-dependent participants (n = 447) entering methadone maintenance treatment were divided into ADHD-screened positive (ADHD-P) and ADHD-screened negative (ADHD-N) groups according to scores of Adult ADHD Self-Report Scale (ASRS). Mini-International Neuropsychiatric Interview was used to identify current and lifetime depressive episodes and suicidality. Substance use disorder, depression, family support, and quality of life in two groups were also assessed. RESULTS About 7.8% (n = 35) scored 24 or higher of ASRS indicating highly likely Adult ADHD. More heroin-dependent patients of ADHD-P had a current depressive episode (p = .02). They had higher Center for Epidemiological Studies Depression (CESD) scores (p = .003), and more severe heroin dependence (p = .006). Poorer family support and quality of life in physical, and psychological domains were found in patients of ADHD-P compared to ADHD-N. DISCUSSION AND CONCLUSIONS Heroin-dependent patients of ADHD-P represent a vulnerable minority. They were comorbid with regard to depression, greater substance dependence severity, and poorer quality of life. SCIENTIFIC SIGNIFICANCE Assessment for ADHD symptoms in heroin-dependent patients may be indicated for the effective management of the complex problems of these patients. (Am J Addict 2017;26:26-33).
Collapse
Affiliation(s)
- Yin-To Liao
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Yen Chen
- Department of Health, Tsaotun Psychiatric Center, Nantou, Taiwan
| | - Mei-Hing Ng
- Department of Health, Tsaotun Psychiatric Center, Nantou, Taiwan
| | - Kuo-You Huang
- School of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Chuan Shao
- Department of Health, Tsaotun Psychiatric Center, Nantou, Taiwan
| | - Tsang-Yaw Lin
- Department of Health, Tsaotun Psychiatric Center, Nantou, Taiwan
| | - Vincent Chin-Hung Chen
- Chang Gung University, Kwei-shan, Taiwan.,Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Michael Gossop
- King's College London, Institute of Psychiatry, London, United Kingdom
| |
Collapse
|
23
|
Beswick T, Best D, Bearn J, Rees S, Gossop M, Coomber R, Strang J. From Salt Injection to Naloxone: Accuracy and Myths in Peer Resuscitation Methods for Opiate Overdose. Journal of Drug Issues 2016. [DOI: 10.1177/002204260203200406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One hundred and eight opiate addicts attending an in-patient opiate treatment unit were interviewed, using a mixed quantitative–qualitative approach, to investigate their experiences of witnessing overdoses, the associated interpretations and perceived cause of the overdose. Poly drug use and frequency of witnessed overdose was high among the sample. Use of 14 different combinations of drugs were reported, 8 of which involved the use of alcohol, and 7 benzodiazepines. Perceived cause of overdose involved attributions relating to the use of alcohol, in particular strong lager, small quantities of heroin and low levels of current opiate tolerance. Peer initiated resuscitation techniques revealed a range of responses from the probably valuable (recovery position, summon ambulance, administer naloxone) to the ineffective or frankly harmful (injecting with salt solution, immersing in a cold bath). The findings highlight the need for an overdose prevention program during in-patient detoxification and rehabilitation.
Collapse
|
24
|
Abstract
Diamorphine, with a 129-year history, is one of the longest established medications. In British medicine, diamorphine is sometimes used as a maintenance treatment for opiate addiction but is also routinely used in clinical practice to treat a number of general medical conditions. These ways of using diamorphine are very different but are often confused by observers of the British system. Although the routine clinical use of diamorphine in medicine is unique to the United Kingdom (UK), in other countries there is little awareness of this very British practice. Diamorphine is used in hospitals, primary care settings, and hospices. It may be administered by different routes, including oral, intramuscular, intravenous, subcutaneous, inhaled, epidural, and intrathecal routes. Among its most important medicinal uses is the treatment of severe and/or intractable pain. Discussion of the medical uses of diamorphine is often confused by entanglement of medical practice and illicit drug abuse problems. This article summarizes the history, regulation, and uses of diamorphine in the UK.
Collapse
|
25
|
Lee YC, Yang HJ, Chen VCH, Lee WT, Teng MJ, Lin CH, Gossop M. Meta-analysis of quality of life in children and adolescents with ADHD: By both parent proxy-report and child self-report using PedsQL™. Res Dev Disabil 2016; 51-52:160-172. [PMID: 26829402 DOI: 10.1016/j.ridd.2015.11.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 05/16/2015] [Revised: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 06/05/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a prevalent developmental disorder that seriously and negatively impacts a child's health-related quality of life (HRQOL). However, no meta-analysis has been conducted to examine the magnitude of impact, domains affected and factors moderating the impact. This review included nine studies that compared HRQOL of children or adolescents with ADHD with those with typical development using both child self-reports and parent proxy-reports. Seven among nine studies were meta-analytically synthesized to examine the degree of impact of ADHD on children and adolescents, parent-child discrepancy, and the moderators. The results indicate that ADHD impact a child's or adolescent's HRQOL negatively with a moderate effect in physical and a severe effect in psychosocial (i.e., emotional, social, and school) domains. Parental ratings of overall HRQOL in children or adolescents with ADHD were not significantly different from child's ratings when compared with typically developing children and adolescents. Age was negatively associated with all domains of HRQOL in children and adolescents with ADHD both by parent- and child-ratings, and the strongest effect was found in parental ratings of child's emotional HRQOL, with a moderate correlation. This meta-analysis suggests that HRQOL may be assessed in children and adolescents with ADHD both by parent proxy- and child self-reports, and that interventions may be planned accordingly. Future meta-analysis may explore how measures of HRQOL and other factors including child, parental, familiar and school characteristics influence the impact of ADHD and the parent-child agreement in children and adolescents.
Collapse
Affiliation(s)
- Yi-chen Lee
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan; Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hao-Jan Yang
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Taiwan; Chang Gung University, Taiwan
| | - Wan-Ting Lee
- Department of Rehabilitation, Occupational Therapy Room, Sing Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ming-Jen Teng
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Chung-Hui Lin
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan; Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Michael Gossop
- King's College London, Institute of Psychyatry, London, UK
| |
Collapse
|
26
|
|
27
|
Chen VCH, Wu MH, Lin TY, Ho YF, Wang HY, Gossop M. Comparison of socio-demographic characteristics, substance, and depression among male heroin users attending therapeutic community and methadone maintenance treatment program in Nantou, Taiwan. Subst Abuse Treat Prev Policy 2015; 10:41. [PMID: 26507876 PMCID: PMC4624703 DOI: 10.1186/s13011-015-0037-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022]
Abstract
Background Little is known about differences between the characteristics and psychopathological symptoms of heroin users attending TC or MMT in Asia. This study aimed to compare characteristics and prevalence of depressive disorders among male heroin users in TC and MMT program in Nantou, Taiwan. Methods The study sample (n = 705) comprised male heroin users with heroin dependence recruited from the MMT program and TC program at a psychiatric center in Nantou, Taiwan between 2006 and 2014. Socio-demographic and heroin-related characteristics were obtained from self-report questionnaires. DSM-IV diagnoses of heroin dependence, major depressive disorder, and dysthymic disorder were evaluated by trained interviewers. T-test and chi-square test and multivariate logistic regression were performed to measure the differences on variables between samples of TC and MMT. Results Compared to MMT, TC participants had poorer family support, higher rate of unmarried, higher rate of unemployment, earlier onset of heroin use, longer length of heroin use, and lower daily dosage of heron. MMT heroin users had higher 1-month prevalence of major depressive disorder than TC participants. We found the distribution of current major depression disorder differed between heroin users choosing different treatment models even controlling for other demographic factors, substance related factors and psychosocial factors. The underlying explanations require further investigation. Conclusions This study found differences in the characteristics and prevalence of psychopathology. Further study to explore the effect of these differences on the outcome between MMT and TC is warranted.
Collapse
Affiliation(s)
- Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 613, Chiayi County, Taiwan. .,Chang Gung University, 333, Tao-Yuan, Taiwan.
| | - Meng-Huan Wu
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Tsang-Yaw Lin
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Yi-Feng Ho
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Hsin-Yi Wang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Michael Gossop
- King's College London, Institute of Psychiatry, London, SE5 8AF, UK.
| |
Collapse
|
28
|
Medhus S, Rognli EB, Gossop M, Holm B, Mørland J, Bramness JG. Amphetamine-induced psychosis: Transition to schizophrenia and mortality in a small prospective sample. Am J Addict 2015; 24:586-9. [PMID: 26332037 DOI: 10.1111/ajad.12274] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/12/2015] [Accepted: 08/08/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We investigated transition from amphetamine-induced psychosis (AIP) to schizophrenia. METHODS A sample of 28 individuals was identified while hospitalized for AIP. We reviewed their hospital records after six years. RESULTS During follow-up, seven individuals (25%) died and nine (32%) had moved from the area. Of the remaining 12, four individuals (25%) were diagnosed with schizophrenia. These individuals were, at baseline, characterized by fewer hallucinatory symptoms and more homelessness. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Hospitalization for AIP was a relatively specific risk factor for schizophrenia and the mortality rate in AIP was high.
Collapse
Affiliation(s)
- Sigrid Medhus
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Norway.,Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Eline Borger Rognli
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Norway.,Oslo University Hospital, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Norway
| | - Michael Gossop
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Norway.,Kings College London, National Addiction Centre, London, UK
| | - Bjørn Holm
- Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, Oslo, Norway
| | - Jørgen G Bramness
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Norway
| |
Collapse
|
29
|
Abstract
This paper describes the political origins of the National Treatment Outcomes Research Study (NTORS) and the outputs and impacts of the study. NTORS was designed to meet the request of the Health Secretary and of a Government Task Force for evidence about the effectiveness of the national addiction treatment services. NTORS was a prospective cohort study which investigated outcomes over a 5-year period of drug users admitted to four major treatment modalities: in-patient treatment, residential rehabilitation, methadone reduction and methadone maintenance programmes. The study investigated treatments delivered under day-to-day operating conditions. Outcomes showed substantial reductions in illicit drug use and reduced injecting risk behaviours. These changes were accompanied by improved psychological and physical health and by reductions in criminal behaviour. However, not all outcomes were so positive. There was a continuing mortality rate in the cohort of about 1% per year, and many clients continued to drink heavily throughout the 5-year follow-up. NTORS findings informed and influenced UK addiction treatment policy both at the time and subsequently. The findings were influential in supporting an immediate increase in funding for treatment, and Government Ministers have repeatedly cited NTORS as evidence of the effectiveness of addiction treatment. One finding that received political attention was that of the cost savings provided by treatment through reductions in crime. This important finding led to an unanticipated consequence of NTORS; namely, the greater focus on crime reduction that has increasingly been promoted as a political and social priority for drug misuse treatment.
Collapse
Affiliation(s)
- Michael Gossop
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
30
|
Jackson LA, Buxton JA, Dingwell J, Dykeman M, Gahagan J, Gallant K, Karabanow J, Kirkland S, LeVangie D, Sketris I, Gossop M, Davison C. Improving psychosocial health and employment outcomes for individuals receiving methadone treatment: a realist synthesis of what makes interventions work. BMC Psychol 2014; 2:26. [PMID: 25566385 PMCID: PMC4269989 DOI: 10.1186/s40359-014-0026-3] [Citation(s) in RCA: 7] [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: 04/28/2014] [Accepted: 08/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For over 50 years, methadone has been prescribed to opioid-dependent individuals as a pharmacological approach for alleviating the symptoms of opioid withdrawal. However, individuals prescribed methadone sometimes require additional interventions (e.g., counseling) to further improve their health. This study undertook a realist synthesis of evaluations of interventions aimed at improving the psychosocial and employment outcomes of individuals on methadone treatment, to determine what interventions work (or not) and why. METHODS The realist synthesis method was utilized because it uncovers the processes (or mechanisms) that lead to particular outcomes, and the contexts within which this occurs. A comprehensive search process resulted in 31 articles for review. Data were extracted from the articles, and placed in four templates to assist with analysis. Data analysis was an iterative process and involved comparing and contrasting data within and across each template, and cross checking with original articles to determine key patterns in the data. RESULTS For individuals on methadone, engagement with an intervention appears to be important for improved psychosocial and/or employment outcomes. The engagement process involves attendance at interventions as well as an investment in what is offered. Three intervention contexts (often in some combination) support the engagement process: a) client-centered contexts (or those where clients' psychosocial and/or employment needs/issues/skills are recognized and/or addressed); b) contexts which address clients' socio-economic conditions and needs; and, c) contexts where there are positive client-counselor and/or peer relationships. There is some evidence that sometimes ongoing engagement is necessary to maintain positive outcomes. There is also some evidence that complete abstinence from drugs (e.g., cocaine, heroin) is not necessary for engagement. CONCLUSIONS It is important to consider how the contexts of interventions might elicit and/or support clients' engagement. Further research is needed to explore how an individual's background (e.g., involvement with different interventions over an extended period) may influence engagement. Long-term engagement may be necessary to sustain some positive outcomes although how long is unclear and requires further research. Engagement can occur without complete abstinence from such drugs as cocaine or heroin, but additional research is required as engagement may be influenced by the extent and type of drug use.
Collapse
Affiliation(s)
- Lois A Jackson
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada ; Atlantic Health Promotion Research Centre, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2 Canada
| | - Jane A Buxton
- School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Julie Dingwell
- AIDS Saint John, 62 Waterloo St, Saint John, NB E2L 3P3 Canada
| | - Margaret Dykeman
- University of New Brunswick, 2140 Hanwell Rd, Hanwell, NB B3C 1 M8 Canada
| | - Jacqueline Gahagan
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada ; Atlantic Health Promotion Research Centre, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2 Canada
| | - Karen Gallant
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada
| | - Jeff Karabanow
- School of Social Work, Dalhousie University, Suite 3201-1459 LeMarchant Street, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Susan Kirkland
- Community Health & Epidemiology, Dalhousie University, 5790 University Ave., 4th Floor, Halifax, NS B3H 1 V7 Canada
| | - Dolores LeVangie
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada ; Atlantic Health Promotion Research Centre, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2 Canada
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, 5968 College St, Halifax, NS B3H 4R2 Canada
| | - Michael Gossop
- National Addiction Centre, King's College London, PO48, 4 Windsor Walk, Denmark Hill, London, SE5 8BB UK
| | - Carolyn Davison
- Mental Health, Children's Services, and Addictions Branch, Nova Scotia Department of Health and Wellness, PO Box 488, Halifax, NS B3J 2R8 Canada
| |
Collapse
|
31
|
Abstract
BACKGROUND Open drug scenes are gatherings of drug users who publicly consume and deal drugs. The authors conducted a study of five European cities that have met such scenes constructively. The aim was to investigate shared and non-shared interventions and strategies in order to increase the understanding of this type of problem. METHODS First a description was made for the cities of Amsterdam, Frankfurt, Vienna, Zürich and Lisbon. These descriptions were sent to contact persons in each city prior to visit by the researchers. The methods and strategies in each city were discussed and core choices and efforts extracted. A report was sent to the contact group for corrections and clarifications. The paper analyses shared and non-shared traits and strategies. RESULTS All of the cities had initially a period with conflict between liberal and restrictive policies. A political consensus seems to be a prerequisite for effective action. A core shared characteristic was that drug dependence was met as a health problem and drug use behaviour as a public nuisance problem. Low threshold health services including opioid maintenance treatment were combined with outreach social work and effective policing. CONCLUSION Prevention, harm reduction and treatment should be combined with law enforcement based on cooperation between police, health care and social services. The aim should be "coexistence" between society and users of illegal substances and the strategy based on several years planning and conjoint efforts. The solutions are found in appropriate combinations of harm reduction and restrictive measures.
Collapse
Affiliation(s)
- Helge Waal
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo, Norway.
| | | | | | | |
Collapse
|
32
|
Riksheim M, Gossop M, Clausen T. From methadone to buprenorphine: Changes during a 10year period within a national opioid maintenance treatment programme. J Subst Abuse Treat 2014; 46:291-4. [DOI: 10.1016/j.jsat.2013.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/23/2013] [Accepted: 10/04/2013] [Indexed: 11/16/2022]
|
33
|
Waal H, Gossop M. Making sense of differing overdose mortality: contributions to improved understanding of European patterns. Eur Addict Res 2014; 20:8-15. [PMID: 23921286 DOI: 10.1159/000346781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/30/2012] [Indexed: 11/19/2022]
Abstract
The European Monitoring Centre for Drugs and Drug Addiction, EMCDDA, publishes statistics for overdose deaths giving a European mean number, and ranking nations in a national 'league table' for overdose deaths. The interpretation of differing national levels of mortality is more problematic and more complex than is usually recognised. Different systems are used to compile mortality data and this causes problems for cross-national comparisons. Addiction behaviour can only be properly understood within its specific social and environmental ecology. Risk factors for overdose, such as the type of drug consumed, and the route of administration, are known to differ across countries. This paper describes problems associated with ranking and suggests how mortality data might be used in high-level countries aiming at reduction in the number of overdose deaths.
Collapse
Affiliation(s)
- Helge Waal
- Centre for Addiction Research (SERAF), University of Oslo, Oslo, Norway
| | | |
Collapse
|
34
|
Lin NC, Huang CL, Chen CY, Lin TY, Wang HY, Lu YH, Chen LM, Chen VCH, Gossop M. Effect of amphetamine on corrected-QT interval change during methadone maintenance treatment in Taiwan: a prospective cohort study. Drug Alcohol Rev 2013; 33:194-201. [PMID: 24320220 DOI: 10.1111/dar.12099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 06/30/2013] [Accepted: 11/15/2013] [Indexed: 01/02/2023]
Abstract
INTRODUCTION AND AIMS Previous studies have suggested that methadone is associated with prolonged corrected-QT (QTc) interval, but published prospective research studies in this area are relatively scarce. This study investigates QTc interval change among methadone maintenance patients and possible associated risk factors. One of the aims is to explore the effect of amphetamines. DESIGN AND METHODS This prospective cohort study with six-month follow up assesses the effect of methadone on QTc interval among a sample (n = 170) of heroin users in a methadone maintenance treatment program in Taiwan. Demographic data, substance use history, medical history and laboratory studies were collected at study enrollment. Twelve-lead electrocardiograms were performed for all participants both at study enrollment and six months later. RESULTS The median daily methadone dose was 41 mg. A mean increase of QTc interval (17.1 ms, SD = 50.0, P < 0.001) was found at six-month follow up. QTc interval prolongation in the sample at baseline was 2.9%, and at six months was 12.4%. A positive correlation was found between comorbid amphetamine use frequency in the past month and QTc interval change. Methadone dose was not associated with QTc change. DISCUSSION AND CONCLUSIONS An increase of mean QTc interval was found among methadone maintenance patients at six-month follow up. Electrocardiogram monitoring should be performed among patients who are at risk of frequently using amphetamines during methadone maintenance treatment.
Collapse
Affiliation(s)
- Ni-Chi Lin
- Tsaotun Psychiatric Centre, Ministry of Health and Welfare, Nan-Tou, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Bukten A, Røislien J, Skurtveit S, Waal H, Gossop M, Clausen T. A day-by-day investigation of changes in criminal convictions before and after entering and leaving opioid maintenance treatment: a national cohort study. BMC Psychiatry 2013; 13:262. [PMID: 24131480 PMCID: PMC3856530 DOI: 10.1186/1471-244x-13-262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/20/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Opioid maintenance treatment (OMT) is associated with reduced crime among heroin users, but little is known about how crime changes during different phases of treatment. The aim of this study was to investigate changes in criminal convictions on a day-to-day basis before and after entry or discharge from OMT. METHODS National cohort study of all patients (n = 3221) in OMT in Norway 1997-2003. Patients were followed over a 9-year period, before, during, and after treatment. Criminal convictions were studied on a day-to-day basis in relation to treatment status. A time-continuous estimate of the probability of convictions within the population for all days during observation was calculated. RESULTS Changes in convictions were evident before changes of treatment status. During the 3 years prior to OMT, the convictions rate was approximately 0.4% per day. Prior to OMT, convictions decreased to about 0.2% per day on the day of treatment initiation. During the weeks before dropping out of treatment, convictions increased. The patterns during periods of transition were the same across gender, age and pre-treatment conviction-levels. CONCLUSIONS Changes in convictions often occurred prior to changes in treatment status. Reductions in criminal convictions were found in the period before entry (or re-entry) to OMT, and increases in criminal activity were found in the months prior to treatment interruption.
Collapse
Affiliation(s)
- Anne Bukten
- SERAF–Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, N-0407, Oslo, Norway
| | - Jo Røislien
- SERAF–Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, N-0407, Oslo, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Svetlana Skurtveit
- SERAF–Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, N-0407, Oslo, Norway
- Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Helge Waal
- SERAF–Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, N-0407, Oslo, Norway
| | - Michael Gossop
- SERAF–Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, N-0407, Oslo, Norway
- Kings College London, National Addiction Centre, London, UK
| | - Thomas Clausen
- SERAF–Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, N-0407, Oslo, Norway
| |
Collapse
|
36
|
Ng M, Chou J, Chang T, Lee P, Shao W, Lin T, Chen V, Gossop M. Corrigendum to “High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan” [Addictive Behaviors 38/4 (2013) 2089–2093]. Addict Behav 2013. [DOI: 10.1016/j.addbeh.2013.05.012] [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: 11/29/2022]
|
37
|
Lin TY, Chen VCH, Lee CH, Chen CY, Shao WC, Chang SH, Chou JY, Lai TJ, Ferri CP, Gossop M, Lee CTC. Prevalence, correlates, and risk perception of HIV infection among heroin users in Central Taiwan. Kaohsiung J Med Sci 2013; 29:673-9. [PMID: 24296056 DOI: 10.1016/j.kjms.2013.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/07/2012] [Accepted: 04/25/2013] [Indexed: 11/29/2022] Open
Abstract
We investigated the prevalence and correlated factors of human immunodeficiency virus (HIV) among heroin users attending methadone maintenance treatment (MMT) programs in Central Taiwan, and explored the degree of risk perception of HIV infection among the participants. Our study participants were 781 heroin users seeking treatment at the MMT program at Tsaotun Psychiatric Center in Taiwan. The presence of HIV antibodies was identified by microparticle enzyme immunoassay and confirmed by western blot. Multivariate logistic regression was used to identify the independent correlates of HIV infection. The mean age of the sample was 36.1 years [standard deviation (SD) = 7.6]; of the patients, 710 (90.9%) were men. The prevalence of HIV infection among our study population was 20.7%. Multivariate logistic regression analysis revealed that HIV infection was independently associated with the age of the patients of initial heroin use, heroin injection use, nondrug-related criminal convictions, needle-sharing behaviors, and sharing injection paraphernalia. A strong agreement existed between self-reported HIV serostatus and the results of laboratory analyses, with 88.8% of patients reporting their condition correctly. We found a high rate of HIV infection among patients in the MMT program. Factors associated with HIV infection were mostly related to drug-use behaviors. These findings stress the importance of education regarding drug-risk behaviors.
Collapse
Affiliation(s)
- Tsang-Yaw Lin
- Tsaotun Psychiatric Center, Department of Health, Nan-Tou, Taiwan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Affiliation(s)
- Michael Gossop
- National Addiction Centre, King's College London, London, SE5 8AF, UK.
| |
Collapse
|
39
|
Opaleye ES, Noto AR, Sanchez ZM, Amato TC, Locatelli DP, Gossop M, Ferri CP. Nonprescribed use of tranquilizers or sedatives by adolescents: a Brazilian national survey. BMC Public Health 2013; 13:499. [PMID: 23705991 PMCID: PMC3664606 DOI: 10.1186/1471-2458-13-499] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/16/2013] [Indexed: 11/10/2022] Open
Abstract
Background Although the nonprescribed use of tranquilizers or sedatives by adolescents is a cause for concern in many countries, there is a shortage of data from low and middle income countries (LAMIC). The present study aims to estimate the prevalence of nonprescribed use of tranquilizers/sedatives by adolescents in Brazil, and to assess how socioeconomic and demographic circumstances, as well as indicators of access to these substances are associated with their use and with risk perception. Methods A cross-sectional study was conducted using a multi-stage probability sample of 18131 high school students from public and private schools from all 27 Brazilian state capitals. A self-reporting questionnaire was used to obtain information on social and economic circumstances, nonprescribed use of tranquilizers or sedatives and risk perception of their use. Results Lifetime nonprescribed use of tranquilizers or sedatives was reported by 5% of respondents, more commonly among females (OR: 2.19, 95% CI: 1.75-2.75) and those attending private schools (OR: 1.47, 95% CI: 1.17-1.84). The use of tranquilizers/sedatives by relatives or friends was associated with nonprescribed use by the participant (OR: 4.26, 95% CI: 3.46-5.23) and a majority of lifetime users obtained these substances from a family environment (82%). Previous medical prescription was independently associated with nonprescribed use (OR: 6.61, 95% CI: 4.87-8.98) and with low risk perception (OR: 2.42, 95% CI: 1.12-5.24). Conclusions A substantial proportion of Brazilian adolescents use nonprescribed tranquilizers/sedatives. Easy access to these substances seems to play an important role in this use and should be tackled by preventive and treatment interventions.
Collapse
Affiliation(s)
- Emerita S Opaleye
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Botucatu, 862- 1° andar, São Paulo CEP 04023-062, Brasil
| | | | | | | | | | | | | |
Collapse
|
40
|
Ng MH, Chou JY, Chang TJ, Lee PC, Shao WC, Lin TY, Chen VCH, Gossop M. High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan. Addict Behav 2013; 38:2089-93. [PMID: 23403277 DOI: 10.1016/j.addbeh.2013.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/30/2012] [Accepted: 01/10/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study investigates the prevalence and correlates of hepatitis C virus (HCV) infections among heroin dependent individuals who received methadone maintenance therapy in Taiwan. Also, we investigate users' awareness of HCV. METHODS Participants were 773 heroin users entering the methadone maintenance treatment (MMT) program at Tsaotun Psychiatric Center in Taiwan. The presence of HCV antibodies was detected. Multivariate logistic regression was used to identify the relationship between HCV infection and correlates. RESULTS The prevalence of HCV infection was 90.8%. All participants who were HIV-positive were also infected with HCV. Multivariate logistic regression analysis showed that the route of heroin administration (injection), HIV-infection, and criminal records were significantly related to HCV infection. Few (34.8%) HCV positive heroin users were aware of their infection. CONCLUSION An extremely high prevalence of HCV infection but low awareness of their infection status was found among MMT patients in Taiwan. These findings highlight the importance of education regarding risky behaviors and the necessity for HCV treatment for this population in Taiwan.
Collapse
Affiliation(s)
- Mei-Hing Ng
- Tsaotun Psychiatric Center Department of Health, Nan-Tou 542, Taiwan.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Skeie I, Brekke M, Clausen T, Gossop M, Lindbaek M, Reinertsen E, Thoresen M, Waal H. Increased somatic morbidity in the first year after leaving opioid maintenance treatment: results from a Norwegian cohort study. Eur Addict Res 2013; 19:194-201. [PMID: 23257574 DOI: 10.1159/000345229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 10/09/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Some patients on opioid maintenance treatment (OMT) leave treatment temporarily or permanently. This study investigated whether patients interrupting their OMT differed from non-interrupters in sociodemographic and drug-use characteristics and examined acute/sub-acute somatic morbidity among the interrupters, prior to, during, and after OMT. METHODS Cohort design. OBSERVATION PERIOD: 5 years prior to, up to first 5 years during, and up to 5 years after interruption of OMT. PARTICIPANTS The sample (n = 200) comprised 51 OMT interrupters and 149 non-interrupters. Data on patient characteristics were obtained from interviews and OMT register information. Data on somatic morbidity were gathered from hospital records. MEASUREMENTS Key patient characteristics among OMT interrupters and non-interrupters. Incidence rates of acute and sub-acute somatic disease incidents leading to hospital treatment (drug-related/non-drug-related/injuries) prior to/during/after OMT. RESULTS Interrupters and non-interrupters did not differ in sociodemographic characteristics, while longer duration of amphetamine and benzodiazepine dependence predicted OMT interruption. Interrupters scored significantly higher on drug-taking and overdose during OMT but still had a significant 41% reduction in drug-related treatment, episodes. After interruption of treatment, such episodes increased markedly and were 3.6 times more frequent during the first post-OMT year compared to the pre-OMT period (p < 0.001). This increase was highest during the first months after OMT interruption. 2-5 years after interruption there was no significant increase. CONCLUSIONS Increased somatic morbidity was found among OMT interrupters during the first year after OMT, and especially during the immediate post-treatment period.
Collapse
Affiliation(s)
- I Skeie
- Centre for Addiction Treatment, Oslo University Hospital, Oslo, Norway.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Manning V, Best D, Faulkner N, Titherington E, Morinan A, Keaney F, Gossop M, Strang J. Does active referral by a doctor or 12-Step peer improve 12-Step meeting attendance? Results from a pilot randomised control trial. Drug Alcohol Depend 2012; 126:131-7. [PMID: 22677458 DOI: 10.1016/j.drugalcdep.2012.05.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Active engagement in 12-Step self-help groups (SHG) is associated with improvements in substance use outcomes during and after treatment, yet levels of participation in SHG meetings in the U.K. remain low. METHOD An RCT investigating the impact of active referral to SHG, delivered by doctors or 12-Step peers during inpatient treatment on both inpatient and post-treatment meeting attendance was conducted. 151 inpatients with alcohol, opiate, crack-cocaine or benzodiazepine dependence undergoing detoxification, received one of two active referral interventions: 12-Step peer intervention (PI), doctor intervention (DI), or no intervention (NI). 83% of the sample was followed up, 2-3 months following discharge. RESULTS Active referral interventions significantly increased attendance at 12-Step meetings during inpatient treatment (88% versus 73%, p<.05). Rates of post-discharge meeting attendance were PI=64%, DI=48%, NI=33%, with those in the PI group significantly (OR=3.6; CI=1.3, 9.8) more likely to have attended. Inpatient meeting attenders were three times as likely to have attended meetings post-discharge (59% versus 20%, p<.01), and post-discharge meeting attenders reported significantly higher abstinence rates (60.8% versus 39.2%, p<.05) at follow-up. However, abstinence rates did not differ significantly across intervention groups (44% [PI], 41% [DI] and 36% [NI]). CONCLUSION Attendance at 12-Step SHGs is associated with greater rates of abstinence and active referral, especially by 12-Step peers, increases 12-Step SHG attendance rates. However, improved clinical outcomes among attendees might not occur until stronger recovery peer support networks are established. These results show promise for the benefit of incorporating Twelve Step Facilitation into U.K. treatment settings.
Collapse
Affiliation(s)
- Victoria Manning
- Kings College London, National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, 4 Windsor Walk, London SE5 8BB, UK.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Havnes I, Bukten A, Gossop M, Waal H, Stangeland P, Clausen T. Reductions in convictions for violent crime during opioid maintenance treatment: a longitudinal national cohort study. Drug Alcohol Depend 2012; 124:307-10. [PMID: 22382045 DOI: 10.1016/j.drugalcdep.2012.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 01/29/2012] [Accepted: 02/01/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although opioid maintenance treatment (OMT) has been found to reduce crime, less is known about its associations with violent crime. This study investigates changes in violent crime convictions prior to, during, and after OMT, and examines the relationship between violent crime convictions prior to OMT with the risk of violent and non-violent crime convictions during treatment. METHODS The cohort comprised all who started OMT (n=3221) in Norway between 1997 and 2003. Treatment data were cross linked with the national Crime Registry. Convictions for violent crime 3 years prior to, during, and after treatment were studied. RESULTS Violent crime rates were significantly reduced during OMT compared with before treatment, for both men and women. The rate of convictions for violent crime during OMT was halved amongst those who remained in treatment. The reduction was less pronounced for those who left treatment: for this group, the rate of violent convictions after OMT was higher than before treatment. The risk of convictions for violent and non-violent crime during OMT was highest for those with violent convictions prior to treatment. CONCLUSIONS Violent crime is reduced during OMT. Screening for violent behaviour and violence risk assessment should be implemented in the treatment system.
Collapse
Affiliation(s)
- Ingrid Havnes
- SERAF-Norwegian Centre for Addiction Research, University of Oslo, Kirkevn 166, N-0407 Oslo, Norway.
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
Naltrexone is an opioid receptor antagonist that blocks the reinforcing effects of opioids and reduces alcohol consumption and craving. It has no abuse potential, mild and transient side effects, and thus appears an ideal pharmacotherapy for opioid dependence. Its effectiveness in alcohol dependence is less evident, but compliance with naltrexone combined with psychosocial support has been repeatedly shown to improve drinking outcomes. Limited compliance with oral naltrexone treatment is a known drawback. Several naltrexone implant and injectable depot formulations are being investigated and provide naltrexone release for at least 1 month. Studies among opioid-dependent patients indicate significant reductions in heroin use, but sample sizes are usually small. In alcohol dependence, two large multicenter trials report alcohol and craving reductions for naltrexone and placebo groups, indicating a significant but moderate effect. The pharmacokinetic profile of the injectable formulation indicates reliable naltrexone release over 1 month at therapeutic levels. Implant formulations releasing naltrexone up to 7 months are reported. Findings on safety and tolerability confirm the generally mild adverse effects described for naltrexone tablets. However, further research on therapeutic levels (i.e., opioid blocking) is warranted. The majority of naltrexone implants lacks approval for regular clinical use and larger longitudinal studies are needed. The available naltrexone depot formulations have the potential to significantly improve medication compliance in opioid and alcohol dependence. In certain circumstances, they may constitute a promising new treatment option.
Collapse
|
45
|
Lobmaier PPK, Berman AH, Gossop M, Ravndal E. Substance use and problem awareness among drug-involved prisoners in Norway. Journal of Substance Use 2012. [DOI: 10.3109/14659891.2012.661022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
46
|
Bukten A, Skurtveit S, Gossop M, Waal H, Stangeland P, Havnes I, Clausen T. Engagement with opioid maintenance treatment and reductions in crime: a longitudinal national cohort study. Addiction 2012; 107:393-9. [PMID: 21883606 DOI: 10.1111/j.1360-0443.2011.03637.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This study investigates changes in criminal involvement among patients in opioid maintenance treatment (OMT) over a 7-year period prior to, during and after treatment, particularly in relation to differences in treatment engagement. DESIGN, SETTING AND PARTICIPANTS Treatment data on all patients who started OMT in Norway between 1997 and 2003 (n = 3221) were cross-linked with national criminal records. The period of observation was divided into four phases; pre-treatment, in-treatment, between treatments and post-treatment. FINDINGS During OMT, rates of criminal convictions for the cohort were reduced to fewer than half of waiting-list levels [incidence rate (IR) 0.63 versus 1.57]. Patients in continuous treatment had the fewest convictions (IR 0.47) during treatment. The highest rates were found among patients out of treatment after several treatment episodes (IR 1.52). All groups had significantly fewer criminal convictions during treatment compared to before treatment. Staying in OMT for 2 years or more was associated with significantly reduced rates of convictions during treatment. Younger age and pre-treatment criminal convictions were associated with significantly (P < 0.001) more convictions during treatment. Those who left treatment, permanently or temporarily, relapsed into high levels of convictions outside treatment. CONCLUSIONS Criminal activity appears to be reduced in Norway during opiate maintenance treatment. Younger age and prior history of criminal activity are important risk factors for continued criminal activity during treatment.
Collapse
Affiliation(s)
- Anne Bukten
- SERAF-Norwegian Centre for Addiction Research, University of Oslo, Norway.
| | | | | | | | | | | | | |
Collapse
|
47
|
Gjersing L, Waal H, Røislien J, Gossop M, Clausen T. Variations in treatment organisation, practices and outcomes within the Norwegian Opioid Maintenance Treatment Programme. Nor J Epidemiol 2011. [DOI: 10.5324/nje.v21i1.1434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Variations within and between opioid maintenance programmes have been identified in other countries such as US and the UK. The aim of this study was to assess possible differences in treatment organisation, practices and outcomes between 14 regional centres within the Norwegian Opioid Maintenance Treatment programme, which were subject to the same government standards. This was a national ecological study conducted in November 2008 in Norway. Marked variations between the centres in caseload, choice of agonists, prescribing doctor, as well as in the use of supervised dispensing and urine drug screening were found. Only prescribed agonist dose was consistent across all centres. Centres in which patients had more illicit drug use had fewer patients with long-term living arrangements, more unemployment, and more patients who reported social security benefits as main income. The differences occurred despite government regulations, policies and guidelines, and frequent national meetings between centre managers. These findings show how government standards may be interpreted and implemented differently
Collapse
|
48
|
Bukten A, Skurtveit S, Gossop M, Waal H, Stangeland P, Clausen T. The influence of programme differences on crime reduction in opioid maintenance treatment. An analysis of regional patterns in Norway. Nor J Epidemiol 2011. [DOI: 10.5324/nje.v21i1.1432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
<strong><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><strong><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><strong><span style="font-size: x-small;"><p><em>Aims: </em></p></span></strong></span></strong></span></strong><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><span style="font-size: x-small;"></span></span></span><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><span style="font-size: x-small;"><p><em><strong>Design</strong>: </em>Official national criminal records were cross linked with all patients who started opioid maintenance treatment in Norway from 1997-2003 (n=3221), including patients from four different health regions in Norway; the Eastern region (n=1717), the Southern region (n=751), the Western region (n=586) and the Central-Northern region (n=167). Patients in each region were divided into separate groups according to whether they were retained or not retained in continuous treatment.</p><p><strong><em>Findings: </em></strong>During opioid maintenance treatment, patients in all four treatment regions had a considerable reduction in criminal convictions compared to pre-treatment levels. Criminal convictions during treatment were associated with retention in treatment. Among patients in continuous treatment, significant differences were found in levels of criminal convictions among the four treatment regions during treatment. Compared to patients in the Eastern region, patients in the Southern and the Central-Northern region had respectively 44 and 81 percent less criminal convictions during treatment, and patients in the Western region had 60 percent more convictions. For patients not in continuous treatment, no statistically significant differences were found between the four regions during treatment.</p><p><strong><em>Conclusions: </em></strong>Differences in criminal convictions during treatment may be related to regional differences in treatment practice within the national OMT system. In all regions, criminal convictions during OMT were higher for patients dropping out of treatment. It is suggested that clinical staff should offer more support to patients at risk of dropping out of treatment.</p></span></span></span><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><span style="font-size: x-small;"><em><strong>Background</strong>: </em></span></span></span><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><span style="font-size: x-small;">Reduced criminal activity is an important outcome for opioid maintenance treatment (OMT).</span></span></span><em><em><em><em><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><em><span style="font-family: TimesNewRomanPS-BoldItalicMT; font-size: x-small;"><em></em></span></em></span></em></em></em></em>
Collapse
|
49
|
Bukten A, Skurtveit S, Stangeland P, Gossop M, Willersrud AB, Waal H, Havnes I, Clausen T. Criminal convictions among dependent heroin users during a 3-year period prior to opioid maintenance treatment: A longitudinal national cohort study. J Subst Abuse Treat 2011; 41:407-14. [DOI: 10.1016/j.jsat.2011.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 03/21/2011] [Accepted: 06/22/2011] [Indexed: 12/18/2022]
|
50
|
Roux P, Carrieri PM, Cohen J, Ravaux I, Spire B, Gossop M, Comer SD. Non-medical use of opioids among HIV-infected opioid dependent individuals on opioid maintenance treatment: the need for a more comprehensive approach. Harm Reduct J 2011; 8:31. [PMID: 22123176 PMCID: PMC3286372 DOI: 10.1186/1477-7517-8-31] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/28/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Opioid maintenance treatment (OMT) has a positive impact on substance use and health outcomes among HIV-infected opioid dependent patients. The present study investigates non-medical use of opioids by HIV-infected opioid-dependent individuals treated with buprenorphine or methadone. METHODS The MANIF 2000 study is a longitudinal study that enrolled a cohort of 476 HIV-infected opioid-dependent individuals. Data were collected in outpatient hospital services delivering HIV care in France. The sample comprised all patients receiving OMT (either methadone or buprenorphine) who attended at least one follow-up visit with data on adherence to OMT (N = 235 patients, 1056 visits). Non-medical use of opioids during OMT was defined as having reported use of opioids in a non-medical context, and/or the misuse of the prescribed oral OMT by an inappropriate route of administration (injection or sniffing). After adjusting for the non-random assignment of OMT type, a model based on GEE was then used to identify predictors of non-medical use of opioids. RESULTS Among the 235 patients, 144 (61.3%) and 91 (38.9%) patients were receiving buprenorphine and methadone, respectively, at baseline. Non-medical use of opioids was found in 41.6% of visits for 83% of individual patients. In the multivariate analysis, predictors of non-medical use of opioids were: cocaine, daily cannabis, and benzodiazepine use, experience of opioid withdrawal symptoms, and less time since OMT initiation. CONCLUSIONS Non-medical use of opioids was found to be comparable in OMT patients receiving methadone or buprenorphine. The presence of opioid withdrawal symptoms was a determinant of non-medical use of opioids and may serve as a clinical indicator of inadequate dosage, medication, or type of follow-up. Sustainability and continuity of care with adequate monitoring of withdrawal symptoms and polydrug use may contribute to reduced harms from ongoing non-medical use of opioids.
Collapse
Affiliation(s)
- Perrine Roux
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Patrizia M Carrieri
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Julien Cohen
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Isabelle Ravaux
- Hôpital La Conception, Service des Maladies Infectieuses, 147 boulevard Baille, 13005 Marseille, France
| | - Bruno Spire
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Michael Gossop
- King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Sandra D Comer
- Division on Substance Abuse, New York State Psychiatric Institute and Columbia University, NY, USA
| |
Collapse
|