1
|
Andreu M, Balcells-Olivero M, Alcaraz N, Marco O, Bueno L, Gual A, Barrio P. Destination Matters More: Relapse following Hospital-Based Treatment of Substance Use Disorders With and Without Co-Occurring Disorders. J Dual Diagn 2024; 20:111-121. [PMID: 38367999 DOI: 10.1080/15504263.2024.2311634] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
OBJECTIVES Addressing substance use in psychiatric care encounters significant barriers, but the emergence of specialized services offers an opportunity to advance and scale up the integration of addiction services within psychiatric settings. However, research gaps still exist in this field, particularly in understanding the substance relapse rates of people with co-occurring disorders after a psychiatric hospitalization. This study aimed to investigate and compare the relapse rates of patients under inpatient care with exclusively addiction-related issues and those with co-occurring disorders after a hospitalization in a psychiatric ward and gain insights into differences in outcomes for these two patient groups. METHODS This retrospective analysis examined electronic medical records of patients admitted to the Acute Psychiatry Ward of the Hospital Clinic of Barcelona with a substance use disorder diagnosis between January 2019 and February 2021. Cox regression was used to identify variables independently associated with the first relapse episode. RESULTS From a total of 318 admissions (79.2% with psychiatric comorbidity), 76.1% relapsed during the study follow-up, with a median survival time of 54 days. Younger age, female gender, voluntary admission, and outpatient follow-up were independently associated with relapse. The presence of a co-occurring disorder was not associated with relapse. CONCLUSION This study highlights the need for interventions aimed at improving post-discharge abstinence rates for addiction-related hospitalizations. It also challenges the notion that co-occurring disorders automatically imply a worsened prognosis and emphasizes the importance of addressing addiction and psychiatric comorbidity in a comprehensive, integrated, and specialized manner.
Collapse
Affiliation(s)
- Magalí Andreu
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Doctoral Program of Medicine and Translational Research, University of Barcelona, Barcelona, Spain
| | - Mercè Balcells-Olivero
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Noelia Alcaraz
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Oriol Marco
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Bueno
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antoni Gual
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Barrio
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
2
|
Abstract
BACKGROUND Primary care (PC) is crucial in the care of substance use disorder (SUD) patients. However, the relationship between PC and addiction settings is complex and collaboration issues stand out. Available evidence suggests that integration of SUD and PC services can improve physical and mental health of SUD patients and reduce health expenses. OBJECTIVE To explore the experiences, views and attitudes of PC professionals towards the interaction between PC and SUD services. METHODS Twenty-seven GPs took part in three focus groups. The focus group sessions were audio-taped, transcribed verbatim and analysed using reflexive thematic analysis. Recurrent themes were identified. RESULTS Four main themes were devised: (1) Differences and specificities of SUD patients, (2) Interaction between providers of PC and addiction services, (3) Patient management (4) Addiction stigma. These main themes reflect the consideration that SUD patients are a specific group with specific care needs that yield specific challenges to GPs themselves. Improved training, availability of a shared medical record system, increased feedback between GP and addiction specialists and the efficiency of the circuit are to be considered the main priority for the majority of the participants. CONCLUSIONS An efficient and effective referral circuit, with increased feedback and shared medical records is considered key to GPs. Its implementation should keep in mind the specific features of both SUD patients and GPs.
Collapse
Affiliation(s)
- Magalí Andreu
- Grup de Recerca en Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Noelia Alcaraz
- Grup de Recerca en Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Lidia Segura
- Health and Social Security Department, Program on Substance Abuse, Autonomous Government of Catalonia, Spain
| | - Pablo Barrio
- Grup de Recerca en Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Barcelona, España
| |
Collapse
|
3
|
Flores-León M, Alcaraz N, Pérez-Domínguez M, Torres-Arciga K, Rebollar-Vega R, De la Rosa-Velázquez IA, Arriaga-Canon C, Herrera LA, Arias C, González-Barrios R. Transcriptional Profiles Reveal Deregulation of Lipid Metabolism and Inflammatory Pathways in Neurons Exposed to Palmitic Acid. Mol Neurobiol 2021; 58:4639-4651. [PMID: 34155583 DOI: 10.1007/s12035-021-02434-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022]
Abstract
The effects of the consumption of high-fat diets (HFD) have been studied to unravel the molecular pathways they are altering in order to understand the link between increased caloric intake, metabolic diseases, and the risk of cognitive dysfunction. The saturated fatty acid, palmitic acid (PA), is the main component of HFD and it has been found increased in the circulation of obese and diabetic people. In the central nervous system, PA has been associated with inflammatory responses in astrocytes, but the effects on neurons exposed to it have not been largely investigated. Given that PA affects a variety of metabolic pathways, we aimed to analyze the transcriptomic profile activated by this fatty acid to shed light on the mechanisms of neuronal dysfunction. In the current study, we profiled the transcriptome response after PA exposition at non-toxic doses in primary hippocampal neurons. Gene ontology and Reactome pathway analysis revealed a pattern of gene expression which is associated with inflammatory pathways, and importantly, with the activation of lipid metabolism that is considered not very active in neurons. Validation by quantitative RT-PCR (qRT-PCR) of Hmgcs2, Angptl4, Ugt8, and Rnf145 support the results obtained by RNAseq. Overall, these findings suggest that neurons are able to respond to saturated fatty acids changing the expression pattern of genes associated with inflammatory response and lipid utilization that may be involved in the neuronal damage associated with metabolic diseases.
Collapse
Affiliation(s)
- M Flores-León
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - N Alcaraz
- The Bioinformatics Centre. Department of Biology, University of Copenhagen, Ole Maaloes Vej 5, DK-2200, Copenhagen N, Denmark
- Instituto Nacional de Medicina Genómica, Periférico Sur 4809, Arenal Tepepan, Tlalpan, CP 14610, Mexico City, Mexico
| | - M Pérez-Domínguez
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - K Torres-Arciga
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Avenida San Fernando No. 22, Colonia Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - R Rebollar-Vega
- Genomics Laboratory, Red de Apoyo a La Investigación - CIC, Universidad Nacional Autónoma de México, INMCNSZ, Vasco de Quiroga 15, Belisario Domínguez Secc. 16, Tlalpan, 14080, Mexico City, Mexico
| | - I A De la Rosa-Velázquez
- Genomics Laboratory, Red de Apoyo a La Investigación - CIC, Universidad Nacional Autónoma de México, INMCNSZ, Vasco de Quiroga 15, Belisario Domínguez Secc. 16, Tlalpan, 14080, Mexico City, Mexico
- Next Generation Sequencing Core Facility, Helmholtz Zentrum Muenchen, Ingolstaedter Landstr 1, 85754, Neuherberg, Germany
| | - C Arriaga-Canon
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Avenida San Fernando No. 22, Colonia Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - L A Herrera
- Instituto Nacional de Medicina Genómica, Periférico Sur 4809, Arenal Tepepan, Tlalpan, CP 14610, Mexico City, Mexico
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Avenida San Fernando No. 22, Colonia Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Clorinda Arias
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México.
| | - Rodrigo González-Barrios
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Avenida San Fernando No. 22, Colonia Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico.
| |
Collapse
|
4
|
Affiliation(s)
- N Alcaraz
- Department of Otolaryngology, Mount Sinai School of Medicine, New York,Ny, USA
| | | | | |
Collapse
|
5
|
Abstract
OBJECTIVE To evaluate the use of autogenous maxillary bone for the repair of orbital floor defects secondary to blunt facial trauma. DESIGN Retrospective case series of 41 patients with a mean follow-up of 1.7 years. SETTING Major metropolitan teaching hospital. PATIENTS Forty-one consecutive patients who underwent repair of orbital floor fractures with maxillary antral wall bone grafts. MAIN OUTCOME MEASURES Presence of diplopia, orbital dystopia, implant extrusion, enophthalmos, infection, and donor site complications. RESULTS On follow-up clinical examinations, none of the 41 patients presented with any evidence of orbital dystopia or complications relative to the implant or donor site. Two patients had persistent enophthalmos, and 4 had persistent infraorbital nerve paresthesia. Postoperative computed tomographic scans in 12 patients revealed an adequate maintenance of orbital volume without any evidence of resorption of the graft. CONCLUSION The use of maxillary antral wall bone for the repair of orbital floor fractures is a highly reliable technique that carries minimal morbidity.
Collapse
Affiliation(s)
- H H Lee
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA
| | | | | | | |
Collapse
|
6
|
Rhee JS, Weisz DJ, Hirigoyen MB, Sinha U, Alcaraz N, Urken ML. Intraoperative mapping of sensate flaps. Electrophysiologic techniques and neurosomal boundaries. Arch Otolaryngol Head Neck Surg 1997; 123:823-9. [PMID: 9260547 DOI: 10.1001/archotol.1997.01900080055006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The desirability of restoring sensation to the upper aerodigestive tract has led to an expanded use of sensate flaps for reconstruction of mucosal defects. Sensation can be restored via preformed neural pathways through the anastomosis of recipient and donor nerves, provided that the sensate flap falls within the boundaries of the neurosome for the identified sensory nerve. OBJECTIVES To perform detailed electrophysiologic mappings of neurosomes of potential sensate flap donor sites, to describe their variability, and to investigate the usefulness of intraoperative mapping in terms of flap design and harvesting. DESIGN A case series of 27 patients who were undergoing free flap reconstruction of various postablative head and neck defects were examined. Two silver-silver chloride recording electrodes were placed in direct contact with the dissected sensory nerve, and the overlying skin was either mechanically or electrically stimulated. Auditory feedback, as well as visualization of the responses on an oscilloscope, determined whether the stimulated area fell within the neurosome. This technique was applied to the lateral antebrachial cutaneous nerve of the radial forearm flap (n = 15), the lateral sural cutaneous nerve of the fibula flap (n = 5), the subcostal nerve of the iliac crest flap (n = 6), and the dorsal cutaneous rami of spinal nerve T-1 or T-2 of the scapula flap (n = 1). RESULTS The neurosome of the lateral antebrachial cutaneous nerve was relatively consistent with the variability only at the distal boundary (ie, the dorsum of the hand). The neurosome of the lateral sural cutaneous nerve was more variable, falling into 2 distinct innervation patterns: one showing innervation that was limited to the upper lateral and posterior portions of the calf and the other demonstrating significant extension into the lower half of the calf. The neurosome of the subcostal nerve showed little variability and consistently overlapped the proposed skin paddle. The neurosome of the T-1 or T-2 spinal nerve was mapped in 1 patient and is described. CONCLUSIONS The consistency of neurosomal boundaries is dependent on the donor site. Intraoperative mapping of flap donor sites may not only assure the harvesting of a true sensate flap, but may also allow for intraoperative decision making with regard to possible modifications of flap design and harvesting techniques. Two new sensate flaps from the iliac crest and scapula are accurately described.
Collapse
Affiliation(s)
- J S Rhee
- Department of Otolaryngology, Mount Sinai Medical Center, New York, NY, USA
| | | | | | | | | | | |
Collapse
|