The use of prescription stimulants for cognitive enhancement by healthy university students, identified as the largest cohort of cognitive enhancer (CE) users, is of growing interest. The purpose of this study was to look at the understanding, perception, experience, and level of access of CEs among healthy university students in the United Arab Emirates (UAE).
Methods
The study was conducted in six highly competitive university programmes. Semi-structured interviews were conducted with 18 university students to discuss their own experiences and those of their friends and peers regarding the use of prescription stimulants. In addition, semi-structured interviews were conducted with seven teaching faculty staff members (registered pharmacists and medical doctors) to explore their views on the use of CEs in their university.
Results
Data were analysed thematically for the identification of themes and subthemes within the data using coding. It was found that, ‘Adderall’ was the most common prescribed CE drug and caffeine super strength pills were the most common non-prescribed CE drug, both reported to enhance concentration, motivation, and meet academic deadlines.
Conclusions
It is expected that the findings of this study will be of interest to a wide range of services in UAE universities. This will enable them to raise awareness about the use of CEs among students.
{"title":"Exploring the understanding, source of availability and level of access of cognitive enhancers among university students in the United Arab Emirates: A qualitative study","authors":"Safia Sharif, Suzanne Fergus, Amira Guirguis, Nigel Smeeton, Fabrizio Schifano","doi":"10.1002/hup.2888","DOIUrl":"10.1002/hup.2888","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The use of prescription stimulants for cognitive enhancement by healthy university students, identified as the largest cohort of cognitive enhancer (CE) users, is of growing interest. The purpose of this study was to look at the understanding, perception, experience, and level of access of CEs among healthy university students in the United Arab Emirates (UAE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was conducted in six highly competitive university programmes. Semi-structured interviews were conducted with 18 university students to discuss their own experiences and those of their friends and peers regarding the use of prescription stimulants. In addition, semi-structured interviews were conducted with seven teaching faculty staff members (registered pharmacists and medical doctors) to explore their views on the use of CEs in their university.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data were analysed thematically for the identification of themes and subthemes within the data using coding. It was found that, ‘Adderall’ was the most common prescribed CE drug and caffeine super strength pills were the most common non-prescribed CE drug, both reported to enhance concentration, motivation, and meet academic deadlines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>It is expected that the findings of this study will be of interest to a wide range of services in UAE universities. This will enable them to raise awareness about the use of CEs among students.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":"39 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hup.2888","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138459599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhihao Guo, Chunxiu Chen, Shuhua Deng, Haoyang Lu, Xiaojia Ni, Ming Zhang, Shanqing Huang, Yuguan Wen, Dewei Shang, Zhanzhang Wang
Objectives
To analyze the factors affecting the concentrations of the active moiety of risperidone (RIS) and its active metabolite 9-hydroxyrisperidone (9-OH-RIS) in psychiatric outpatients taking immediate-release formulations.
Methods
This is a retrospective study on the therapeutic drug monitoring (TDM) data regarding RIS and 9-OH-RIS in adult psychiatric outpatients. TDM data with simultaneous RIS and 9-OH-RIS monitoring from March 2018 to February 2020 and relevant medical records (including dosage, dosage form, sex, age, diagnosis, combined medication, and comorbid disease) from 399 adult psychiatric outpatients (223 males and 176 females) were included in this study.
Results
The daily dose of RIS was 5.56 ± 2.05 mg, the concentration of total active moiety was 42.35 ± 25.46 ng/mL, and the dose-adjusted plasma concentration (C/D) of active moiety was 7.83 ± 3.87 (ng/ml)/(mg/day). Dose, sex, and age were identified as important factors influencing concentrations of RIS and 9-OH-RIS in adult psychiatric outpatients.
Conclusions
Individualized medication adjustments should be made according to the specific conditions of psychiatric outpatients. The findings strongly support the use of TDM to guide dosing decisions in psychiatric outpatients taking RIS.
{"title":"Factors influencing concentrations of risperidone and 9-hydroxyrisperidone in psychiatric outpatients taking immediate-release formulations of risperidone","authors":"Zhihao Guo, Chunxiu Chen, Shuhua Deng, Haoyang Lu, Xiaojia Ni, Ming Zhang, Shanqing Huang, Yuguan Wen, Dewei Shang, Zhanzhang Wang","doi":"10.1002/hup.2886","DOIUrl":"10.1002/hup.2886","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To analyze the factors affecting the concentrations of the active moiety of risperidone (RIS) and its active metabolite 9-hydroxyrisperidone (9-OH-RIS) in psychiatric outpatients taking immediate-release formulations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective study on the therapeutic drug monitoring (TDM) data regarding RIS and 9-OH-RIS in adult psychiatric outpatients. TDM data with simultaneous RIS and 9-OH-RIS monitoring from March 2018 to February 2020 and relevant medical records (including dosage, dosage form, sex, age, diagnosis, combined medication, and comorbid disease) from 399 adult psychiatric outpatients (223 males and 176 females) were included in this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The daily dose of RIS was 5.56 ± 2.05 mg, the concentration of total active moiety was 42.35 ± 25.46 ng/mL, and the dose-adjusted plasma concentration (C/D) of active moiety was 7.83 ± 3.87 (ng/ml)/(mg/day). Dose, sex, and age were identified as important factors influencing concentrations of RIS and 9-OH-RIS in adult psychiatric outpatients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individualized medication adjustments should be made according to the specific conditions of psychiatric outpatients. The findings strongly support the use of TDM to guide dosing decisions in psychiatric outpatients taking RIS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":"39 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138176030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-11-08DOI: 10.1002/hup.2884
Jithin T Joseph, Rashmi Vishwanath, Samir Kumar Praharaj
Background: Oedema associated with psychotropics can impose a considerable burden, leading to increased morbidity and cost. Peripheral oedema is sometimes related to the use of antidepressants, which are among the most prescribed psychotropic medications. We reviewed the reported cases of antidepressant-associated oedema to understand the risk factors, aetiology and outcome.
Methods: We searched the Medline, Web of Science and Embase databases to identify reported cases of peripheral oedema associated with antidepressant use. We included studies published in English and those with full-text availability. A systematic review of the reports was done to identify the antidepressants associated with oedema, explore possible risk factors, investigate potential mechanisms, and assess the outcome.
Results: We identified a total of 45 cases (27 case reports and five case series) that reported oedema associated with antidepressant use. Almost all major classes of antidepressants were found to be associated with oedema. Among these drugs, trazodone, mirtazapine, and escitalopram were the most implicated. Older age and female gender were more commonly associated with oedema. Etiologically, antagonism of α1 adrenergic receptors and 5HT2A receptors, leading to vasodilation and oedema, emerged as the most prevalent mechanisms. In most cases, the oedema subsided following the discontinuation of the antidepressants.
Conclusions: Peripheral oedema associated with antidepressant use can represent a significant adverse drug reaction involving various classes of antidepressants. To ensure timely identification and proper management of oedema, regular monitoring is crucial.
背景：与精神药物相关的水肿会造成相当大的负担，导致发病率和费用增加。外周水肿有时与抗抑郁药的使用有关，抗抑郁药是处方最多的精神药物之一。我们回顾了抗抑郁药相关水肿的报告病例，以了解风险因素、病因和结果。方法：我们搜索Medline、Web of Science和Embase数据库，以确定与抗抑郁药使用相关的外周水肿报告病例。我们纳入了以英文发表的研究和全文可用的研究。对这些报告进行了系统回顾，以确定与水肿相关的抗抑郁药，探讨可能的风险因素，研究潜在机制，并评估结果。结果：我们共发现45例（27例病例报告和5个病例系列）报告了与抗抑郁药使用相关的水肿。几乎所有主要类型的抗抑郁药都被发现与水肿有关。在这些药物中，曲唑酮、米氮平和艾司西酞普兰受到的影响最大。年龄较大和女性更常与水肿相关。从病因上讲，α1肾上腺素能受体和5HT2A受体的拮抗作用，导致血管舒张和水肿，成为最普遍的机制。在大多数情况下，水肿在停用抗抑郁药后消退。结论：与使用抗抑郁药相关的外周水肿可能是一种涉及各类抗抑郁药的严重药物不良反应。为了确保及时识别和正确管理水肿，定期监测至关重要。
{"title":"Peripheral edema associated with antidepressant use: Systematic review of case reports.","authors":"Jithin T Joseph, Rashmi Vishwanath, Samir Kumar Praharaj","doi":"10.1002/hup.2884","DOIUrl":"10.1002/hup.2884","url":null,"abstract":"<p><strong>Background: </strong>Oedema associated with psychotropics can impose a considerable burden, leading to increased morbidity and cost. Peripheral oedema is sometimes related to the use of antidepressants, which are among the most prescribed psychotropic medications. We reviewed the reported cases of antidepressant-associated oedema to understand the risk factors, aetiology and outcome.</p><p><strong>Methods: </strong>We searched the Medline, Web of Science and Embase databases to identify reported cases of peripheral oedema associated with antidepressant use. We included studies published in English and those with full-text availability. A systematic review of the reports was done to identify the antidepressants associated with oedema, explore possible risk factors, investigate potential mechanisms, and assess the outcome.</p><p><strong>Results: </strong>We identified a total of 45 cases (27 case reports and five case series) that reported oedema associated with antidepressant use. Almost all major classes of antidepressants were found to be associated with oedema. Among these drugs, trazodone, mirtazapine, and escitalopram were the most implicated. Older age and female gender were more commonly associated with oedema. Etiologically, antagonism of α<sub>1</sub> adrenergic receptors and 5HT<sub>2A</sub> receptors, leading to vasodilation and oedema, emerged as the most prevalent mechanisms. In most cases, the oedema subsided following the discontinuation of the antidepressants.</p><p><strong>Conclusions: </strong>Peripheral oedema associated with antidepressant use can represent a significant adverse drug reaction involving various classes of antidepressants. To ensure timely identification and proper management of oedema, regular monitoring is crucial.</p>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":" ","pages":"e2884"},"PeriodicalIF":1.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71521296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To test the null hypothesis that oral intake of the dietary supplement carboxy alkyl ester (CAE) would have no effect on attention as revealed by mean rapid visual information processing (RVIP) scores.
Methods: In a randomized double-blind cross-over placebo-controlled trial, healthy participants (age 19-66 years) of both sexes were randomly assigned to consume 700 mg of CAE or 700 mg of placebo. They received baseline attention testing via the RVIP task. Then they consumed CAE or placebo followed by RVIP testing. Participants were then given a washout period where they did not consume CAE or placebo. Afterward, individuals who initially consumed CAE were given the placebo and those who initially consumed the placebo were given CAE. Finally, all participants were tested again via RVIP.
Results: A priori statistical computation revealed that 30-day oral intake of CAE improved mean RVIP test scores (t = 2.4, p < .05) relative to that at baseline, which resulted in a rejection of the null hypothesis.
Conclusions: Daily oral intake of the CAE dietary supplement may boost attention and further research is now needed to confirm this observation.
{"title":"Oral intake of carboxy alkyl ester improves attention: A randomized double-blind cross-over placebo-controlled study.","authors":"O'neil W Guthrie, Li Yang","doi":"10.1002/hup.2885","DOIUrl":"10.1002/hup.2885","url":null,"abstract":"<p><strong>Objective: </strong>To test the null hypothesis that oral intake of the dietary supplement carboxy alkyl ester (CAE) would have no effect on attention as revealed by mean rapid visual information processing (RVIP) scores.</p><p><strong>Methods: </strong>In a randomized double-blind cross-over placebo-controlled trial, healthy participants (age 19-66 years) of both sexes were randomly assigned to consume 700 mg of CAE or 700 mg of placebo. They received baseline attention testing via the RVIP task. Then they consumed CAE or placebo followed by RVIP testing. Participants were then given a washout period where they did not consume CAE or placebo. Afterward, individuals who initially consumed CAE were given the placebo and those who initially consumed the placebo were given CAE. Finally, all participants were tested again via RVIP.</p><p><strong>Results: </strong>A priori statistical computation revealed that 30-day oral intake of CAE improved mean RVIP test scores (t = 2.4, p < .05) relative to that at baseline, which resulted in a rejection of the null hypothesis.</p><p><strong>Conclusions: </strong>Daily oral intake of the CAE dietary supplement may boost attention and further research is now needed to confirm this observation.</p>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":" ","pages":"e2885"},"PeriodicalIF":1.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71423272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Solomon, Jeffrey Grierson, Lauren Godier-McBard, Amira Guirguis
Objective
It is unclear how healthcare professionals (HCPs) experience and view the challenges of working with people who use New Psychoactive Substances (PWUNPS), in different healthcare services (HCS). The aim of the study was to explore HCPs' experiences of working with individuals who use NPS across statutory, non-statutory, and private mental health and addiction HCSs.
Methods
HCPs completed in-depth semi-structured interviews. Audio recordings were transcribed verbatim with a mean duration of 30 min 55 s. Data were analysed through thematic analysis.
Results
A purposive sample of 14 HCPs (6 men, 8 women) with a mean age of 42.5 years were interviewed in 2019. Organisational issues, including funding, impacted the treatment for PWUNPS and HCPs perceived a lack of support dependent on their qualifications. They reported a lack of assessment, policy, harm reduction, and awareness of NPS-related symptoms including mental health problems and stigma faced by PWUNPS.
Conclusion
HCPs need better training, education, and assessment processes to manage acute NPS intoxications and address the stigma associated with PWUNPS. There is a need for policy-making opportunities across different HCSs to ensure better healthcare outcomes for PWUNPS.
{"title":"Experience and views of healthcare professionals towards people who use new psychoactive substances: Evidence from statutory, non-statutory, and private mental health and addiction healthcare services","authors":"David Solomon, Jeffrey Grierson, Lauren Godier-McBard, Amira Guirguis","doi":"10.1002/hup.2883","DOIUrl":"10.1002/hup.2883","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>It is unclear how healthcare professionals (HCPs) experience and view the challenges of working with people who use New Psychoactive Substances (PWUNPS), in different healthcare services (HCS). The aim of the study was to explore HCPs' experiences of working with individuals who use NPS across statutory, non-statutory, and private mental health and addiction HCSs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>HCPs completed in-depth semi-structured interviews. Audio recordings were transcribed verbatim with a mean duration of 30 min 55 s. Data were analysed through thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A purposive sample of 14 HCPs (6 men, 8 women) with a mean age of 42.5 years were interviewed in 2019. Organisational issues, including funding, impacted the treatment for PWUNPS and HCPs perceived a lack of support dependent on their qualifications. They reported a lack of assessment, policy, harm reduction, and awareness of NPS-related symptoms including mental health problems and stigma faced by PWUNPS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HCPs need better training, education, and assessment processes to manage acute NPS intoxications and address the stigma associated with PWUNPS. There is a need for policy-making opportunities across different HCSs to ensure better healthcare outcomes for PWUNPS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":"38 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hup.2883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41234858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mirjam A. Riedinger, Nic J. A. van der Wee, Erik J. Giltay, Max de Leeuw
Background
Lithium is widely used as treatment of acute mania and as prophylactic therapy for bipolar disorder. International and national guidelines also consider lithium as a possible treatment of acute bipolar depression. Research on the use of lithium in bipolar depression, however, seems to be limited compared to the data available for its efficacy in the other phases of bipolar disorder.
Objective
To provide a systematic review of the evidence for lithium in the treatment of acute bipolar depression and provide directions for further research.
Method
A systematic review of clinical studies investigating the use of lithium in bipolar depression was performed using preferred reporting items for systematic reviews and meta-analyses guidelines in Pubmed, Embase and Psychinfo using the medical subjects headings and free text terms “lithium,” “bipolar depression,” “dosage,” “serum concentration” and “bipolar disorders.”
Results
This review included 15 studies with a total of 1222 patients, between the age of 18 and 65, suffering from bipolar depression of which 464 were treated with lithium. There are currently only limited and low-quality data on the efficacy of lithium as a treatment of bipolar depression. It appears that there have been no placebo controlled randomized controlled trials with lithium concentrations that are considered to be therapeutic. The older studies suffered from limitations such as small sample sizes, insufficient treatment lengths, and insufficient monitoring of serum concentrations.
Conclusion
In contrast to data for the treatment of mania and prophylaxis, robust data on the efficacy of lithium in bipolar depression is currently lacking, making it impossible to make conclusions regarding efficacy or inefficacy, for which further research is needed.
{"title":"Lithium in bipolar depression: A review of the evidence","authors":"Mirjam A. Riedinger, Nic J. A. van der Wee, Erik J. Giltay, Max de Leeuw","doi":"10.1002/hup.2881","DOIUrl":"10.1002/hup.2881","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lithium is widely used as treatment of acute mania and as prophylactic therapy for bipolar disorder. International and national guidelines also consider lithium as a possible treatment of acute bipolar depression. Research on the use of lithium in bipolar depression, however, seems to be limited compared to the data available for its efficacy in the other phases of bipolar disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To provide a systematic review of the evidence for lithium in the treatment of acute bipolar depression and provide directions for further research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A systematic review of clinical studies investigating the use of lithium in bipolar depression was performed using preferred reporting items for systematic reviews and meta-analyses guidelines in Pubmed, Embase and Psychinfo using the medical subjects headings and free text terms “lithium,” “bipolar depression,” “dosage,” “serum concentration” and “bipolar disorders.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This review included 15 studies with a total of 1222 patients, between the age of 18 and 65, suffering from bipolar depression of which 464 were treated with lithium. There are currently only limited and low-quality data on the efficacy of lithium as a treatment of bipolar depression. It appears that there have been no placebo controlled randomized controlled trials with lithium concentrations that are considered to be therapeutic. The older studies suffered from limitations such as small sample sizes, insufficient treatment lengths, and insufficient monitoring of serum concentrations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In contrast to data for the treatment of mania and prophylaxis, robust data on the efficacy of lithium in bipolar depression is currently lacking, making it impossible to make conclusions regarding efficacy or inefficacy, for which further research is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":"38 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hup.2881","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41121687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew Jones, Amira Guirguis, Alan Watkins, Ceri Bradshaw, Lily Mohamed, Fabrizio Schifano
Introduction
Treatment retention is associated with better outcomes and reduced risk amongst people experiencing opioid use disorder (OUD). Despite this, treatment retention remains low amongst this population.
Methods
We carried out an international cross-sectional survey of substance use disorder (SUD) treatment service workers. We aimed to understand the barriers to treatment retention in the context of OUD from the provider perspective, identify differences in response preference between professional groups, and describe regional differences in treatment provision.
Results
We report data from 497 respondents based in the USA and the UK. Personality disorders, low motivation to change and social problems were the most often reported obstacles to retention. Comorbid SUD, hepatitis and HIV were not reported as often as expected. We identified associations between professional groups and response preferences related to comorbid SUD, low motivation, living arrangements and communication difficulties. UK respondents used behavioural treatments more than their US counterparts. US respondents more often reported using objective methods of measuring retention such as urine analysis, compared to their UK counterparts.
Discussion
The findings from this survey suggest that regional differences exist between US and UK based SUD treatment service workers. Personality disorders represented the most often experienced obstacles to treatment retention amongst patients with OUD, with mental health and social problems more often reported than comorbid drug problems or physical health problems. Statistically significant relationships exist between professional group and obstacles reported. These data may be used to identify additional training needs amongst SUD treatment service staff.
{"title":"Obstacles to treatment retention in opioid use disorder: An international substance use disorder treatment worker survey","authors":"Matthew Jones, Amira Guirguis, Alan Watkins, Ceri Bradshaw, Lily Mohamed, Fabrizio Schifano","doi":"10.1002/hup.2882","DOIUrl":"10.1002/hup.2882","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Treatment retention is associated with better outcomes and reduced risk amongst people experiencing opioid use disorder (OUD). Despite this, treatment retention remains low amongst this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We carried out an international cross-sectional survey of substance use disorder (SUD) treatment service workers. We aimed to understand the barriers to treatment retention in the context of OUD from the provider perspective, identify differences in response preference between professional groups, and describe regional differences in treatment provision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We report data from 497 respondents based in the USA and the UK. Personality disorders, low motivation to change and social problems were the most often reported obstacles to retention. Comorbid SUD, hepatitis and HIV were not reported as often as expected. We identified associations between professional groups and response preferences related to comorbid SUD, low motivation, living arrangements and communication difficulties. UK respondents used behavioural treatments more than their US counterparts. US respondents more often reported using objective methods of measuring retention such as urine analysis, compared to their UK counterparts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The findings from this survey suggest that regional differences exist between US and UK based SUD treatment service workers. Personality disorders represented the most often experienced obstacles to treatment retention amongst patients with OUD, with mental health and social problems more often reported than comorbid drug problems or physical health problems. Statistically significant relationships exist between professional group and obstacles reported. These data may be used to identify additional training needs amongst SUD treatment service staff.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":"38 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hup.2882","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41128056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qun Zhang, Ziping Liu, Ting Wang, Min Yu, Xiaoqian Li
Introduction
N-acetylcysteine (NAC) augmentation of antipsychotic medication has been studied in psychotic disorders but the results are inconsistent. This meta-analysis aimed to evaluate the efficacy and acceptability of NAC as an augmentation strategy for psychotic disorders.
Methods
PubMed, Web of Science, EMBASE, PsycINFO, Cochrane Library, and ClinicalTrials.gov were searched until the date of November 28, 2022. The inclusion criteria were randomized controlled trials (RCTs) comparing NAC and placebo in patients with psychotic disorders. The outcomes were the psychotic symptoms measured by the Positive and Negative Syndrome Scale (PANSS) and drop-out rates.
Results
A total of 594 patients from eight trials were included. The results showed that no difference was found in score changes of PANSS total, positive, negative, or general psychopathology scale scores between the NAC group and placebo group in both time points (≤24 weeks and >24 weeks). There was also no statistical difference in drop-out rates between the two groups.
Conclusion
For the moment, it is not appropriate to recommend NAC as an augmentation of antipsychotic medication to treat psychotic disorders in routine clinical practice.
{"title":"Efficacy and acceptability of adjunctive n-acetylcysteine for psychotic disorders: Systematic review and meta-analysis","authors":"Qun Zhang, Ziping Liu, Ting Wang, Min Yu, Xiaoqian Li","doi":"10.1002/hup.2880","DOIUrl":"10.1002/hup.2880","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>N-acetylcysteine (NAC) augmentation of antipsychotic medication has been studied in psychotic disorders but the results are inconsistent. This meta-analysis aimed to evaluate the efficacy and acceptability of NAC as an augmentation strategy for psychotic disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Web of Science, EMBASE, PsycINFO, Cochrane Library, and ClinicalTrials.gov were searched until the date of November 28, 2022. The inclusion criteria were randomized controlled trials (RCTs) comparing NAC and placebo in patients with psychotic disorders. The outcomes were the psychotic symptoms measured by the Positive and Negative Syndrome Scale (PANSS) and drop-out rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 594 patients from eight trials were included. The results showed that no difference was found in score changes of PANSS total, positive, negative, or general psychopathology scale scores between the NAC group and placebo group in both time points (≤24 weeks and >24 weeks). There was also no statistical difference in drop-out rates between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For the moment, it is not appropriate to recommend NAC as an augmentation of antipsychotic medication to treat psychotic disorders in routine clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":"39 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10591758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vasilios G. Masdrakis, Sofia Konstantopoulou, David S. Baldwin
<p>Suicide is a significant public health issue. Annually, approximately 800,000—1,000,000 people die by suicide: for each one, there are at least 20 others who attempt it. Traditionally, anxiety disorders were considered to be of little importance in suicide. Data indicating that patients with anxiety disorders can die by suicide may surprise clinicians even today—and certainly did during the 1980s when the first relevant reports emerged. This may be because anxious patients often express concerns about their physical health, or—especially in patients with panic attacks—fear imminent death and strive to avoid it through visiting emergency outpatient clinics, persistently seeking reassurance from medical professionals, and/or adopting dysfunctional safety-seeking behaviors (De La Vega et al., <span>2018</span>).</p><p>Khan et al. (<span>2002</span>), using the United States Food and Drug Administration database, assessed suicide risk among patients participating in clinical trials evaluating novel medications for anxiety disorders, obsessive-compulsive disorder and post-traumatic disorder. They found that suicide risk among patients was high regardless of the type of disorder, and overall was higher than in the general population, by a factor of 10 or more. They considered this finding unexpected, especially since patients participating in clinical trials for new medications are selected strictly, so that suicide risk is anticipated to be minimal. Kanwar et al. (<span>2013</span>) reviewed 42 observational studies involving 309,974 patients with anxiety and anxiety-related disorders. Compared to those without anxiety, anxious patients were more likely to have suicidal ideation (OR = 2.89, 95% CI: 2.09, 4.00), attempted suicide (OR = 2.47, 95% CI: 1.96, 3.10), complete suicide (OR = 3.34, 95% CI: 2.13, 5.25), or have any suicidal behaviors (OR = 2.85, 95% CI: 2.35, 3.46): all anxiety disorders, but not obsessive-compulsive disorder, were associated with increased suicide risk.</p><p>However, regarding <i>obsessive-compulsive disorder</i> (OCD), more recent analyses show that around one out of every 10 patients attempts suicide during their life; about one-third have current suicidal ideation; and about half have had suicidal ideation in the past. Concerning <i>adult separation anxiety disorder</i>, it was significantly more frequent among outpatients with other anxiety or mood disorders who had suicidal thoughts compared to those without such thoughts (Pini et al., <span>2021</span>). In ‘psychological autopsy’ studies on deaths by suicide, <i>generalized anxiety disorder</i> (GAD) was present three times more frequently than any other anxiety disorder. Furthermore, in subjects without suicide ideation during the last 12 months at baseline, only lifetime history of generalized anxiety disorder or depression significantly predicted the emergence of suicide ideation within a 6-year follow up. Compared to the lifetime prevalence of suicidal ideation
仅对抑郁症进行筛查会发现多达23%的学生有自杀意念，当对焦虑进行筛查时，这一比例会增加到35%。那些患有“焦虑和无至轻微抑郁”的人自杀未遂的可能性位居第二，仅次于那些患有“抑郁和焦虑”的人。同时患有“抑郁症和焦虑症”的学生自杀未遂率大约是“单独患有抑郁症”的学生的两倍。据报道，焦虑症自杀率增加的潜在临床和生物学相关性。焦虑的患者，尤其是对治疗有抵抗力的患者，可能对治疗努力的徒劳和绝望感抱有不适应的信念，最终可能导致自杀。回避行为是焦虑症的标志，可能会对社会关系产生有害影响，并经常导致社交孤立和孤独，这是自杀的重要风险因素（Herres et al.，2019）。试图自杀的恐慌症患者表现出内囊白质和丘脑辐射的改变（Kim et al.，2015）。患有惊恐障碍的自杀患者的血清总胆固醇和低密度脂蛋白水平低于正常对照组和非自杀性帕金森病患者（Ozer等人，2004）；然而，在GAD患者中没有发现这种关联（De Berardis等人，2017）。与非自杀者相比，患有焦虑症的自杀未遂者表现出明显更高的C反应蛋白和白细胞介素-6水平（Wiebenga等人，2022）。越来越多的证据表明，慢性应激诱导的神经内分泌失调与自杀易感性之间存在联系（O’Connor等人，2020）。临床医生最初对自杀与焦虑症之间的联系持怀疑态度。然而，我们现在知道，高达11.5%的自杀企图可归因于焦虑症，而不考虑其他自杀风险因素。这一点尤其重要，因为焦虑症往往未被诊断和治疗，或被视为“轻微”疾病，尤其是与“严重”疾病（例如精神分裂症）合并时，而且治疗不足。目前的数据使临床医生必须警惕严重抑郁症患者自杀风险增加的迹象，因为在自杀时抑郁的人中，至少有45%在死亡前4周内与初级保健提供者有过接触（O’Rourke et al.，2023）。考虑到抑郁症的有效药物和心理治疗可以降低自杀风险，这一点尤为重要（Zalsman et al.，2016）。同样，临床医生应提高警惕，在最初评估和随访时评估焦虑症、强迫症和创伤后应激障碍患者的自杀行为，并及时处理这些疾病。最后，评估特定的焦虑症状，即使是在非临床样本中，也可以提高识别自杀风险的准确性。Vasilios G.Masdrakis和Sofia Konstanopoulou报告没有利益冲突。大卫·S·鲍德温是《人类精神药理学》的主编。
{"title":"Could improved recognition and treatment of anxiety disorders lead to a reduction in suicide?","authors":"Vasilios G. Masdrakis, Sofia Konstantopoulou, David S. Baldwin","doi":"10.1002/hup.2879","DOIUrl":"10.1002/hup.2879","url":null,"abstract":"<p>Suicide is a significant public health issue. Annually, approximately 800,000—1,000,000 people die by suicide: for each one, there are at least 20 others who attempt it. Traditionally, anxiety disorders were considered to be of little importance in suicide. Data indicating that patients with anxiety disorders can die by suicide may surprise clinicians even today—and certainly did during the 1980s when the first relevant reports emerged. This may be because anxious patients often express concerns about their physical health, or—especially in patients with panic attacks—fear imminent death and strive to avoid it through visiting emergency outpatient clinics, persistently seeking reassurance from medical professionals, and/or adopting dysfunctional safety-seeking behaviors (De La Vega et al., <span>2018</span>).</p><p>Khan et al. (<span>2002</span>), using the United States Food and Drug Administration database, assessed suicide risk among patients participating in clinical trials evaluating novel medications for anxiety disorders, obsessive-compulsive disorder and post-traumatic disorder. They found that suicide risk among patients was high regardless of the type of disorder, and overall was higher than in the general population, by a factor of 10 or more. They considered this finding unexpected, especially since patients participating in clinical trials for new medications are selected strictly, so that suicide risk is anticipated to be minimal. Kanwar et al. (<span>2013</span>) reviewed 42 observational studies involving 309,974 patients with anxiety and anxiety-related disorders. Compared to those without anxiety, anxious patients were more likely to have suicidal ideation (OR = 2.89, 95% CI: 2.09, 4.00), attempted suicide (OR = 2.47, 95% CI: 1.96, 3.10), complete suicide (OR = 3.34, 95% CI: 2.13, 5.25), or have any suicidal behaviors (OR = 2.85, 95% CI: 2.35, 3.46): all anxiety disorders, but not obsessive-compulsive disorder, were associated with increased suicide risk.</p><p>However, regarding <i>obsessive-compulsive disorder</i> (OCD), more recent analyses show that around one out of every 10 patients attempts suicide during their life; about one-third have current suicidal ideation; and about half have had suicidal ideation in the past. Concerning <i>adult separation anxiety disorder</i>, it was significantly more frequent among outpatients with other anxiety or mood disorders who had suicidal thoughts compared to those without such thoughts (Pini et al., <span>2021</span>). In ‘psychological autopsy’ studies on deaths by suicide, <i>generalized anxiety disorder</i> (GAD) was present three times more frequently than any other anxiety disorder. Furthermore, in subjects without suicide ideation during the last 12 months at baseline, only lifetime history of generalized anxiety disorder or depression significantly predicted the emergence of suicide ideation within a 6-year follow up. Compared to the lifetime prevalence of suicidal ideation ","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":"38 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hup.2879","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer M. Cori, Vanessa E. Wilkinson, Melinda Jackson, Justine Westlake, Bronwyn Stevens, Maree Barnes, Philip Swann, Mark E. Howard
Introduction
Driver drowsiness detection technology that assesses eye blinks is increasingly being used as a safety intervention in the transport industry. It is unclear how alcohol consumption to common legal driving limits impacts upon this technology. The aim of the study was to assess the impact of a blood alcohol content (BAC) of 0.05% and of 0.08% on drowsiness detection technology during simulated driving.
Methods
Participants completed a 60-min driving simulation and sleepiness questionnaire under three conditions: 1–0.00% BAC, 2–0.05% BAC and 3–0.08% BAC. During the driving simulation task participants wore a commercial eye blink drowsiness detection technology (Optalert) with the drowsiness alarms silenced.
Results
Twelve participants (3 female) completed all alcohol conditions. Relative to baseline, all eye blink parameters were affected at 0.08% BAC (all p < 0.05), whereas 0.05% BAC only affected the composite eye blink drowsiness measure (the Johns Drowsiness Scale).
Conclusions
Alcohol consumption to 0.08% BAC impaired eye blink measures to a level that would be considered a moderate drowsiness risk. Therefore, employers should be aware that drowsiness alerts from these technologies may increase after alcohol consumption.
{"title":"The impact of alcohol consumption on commercial eye blink drowsiness detection technology","authors":"Jennifer M. Cori, Vanessa E. Wilkinson, Melinda Jackson, Justine Westlake, Bronwyn Stevens, Maree Barnes, Philip Swann, Mark E. Howard","doi":"10.1002/hup.2870","DOIUrl":"10.1002/hup.2870","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Driver drowsiness detection technology that assesses eye blinks is increasingly being used as a safety intervention in the transport industry. It is unclear how alcohol consumption to common legal driving limits impacts upon this technology. The aim of the study was to assess the impact of a blood alcohol content (BAC) of 0.05% and of 0.08% on drowsiness detection technology during simulated driving.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants completed a 60-min driving simulation and sleepiness questionnaire under three conditions: 1–0.00% BAC, 2–0.05% BAC and 3–0.08% BAC. During the driving simulation task participants wore a commercial eye blink drowsiness detection technology (Optalert) with the drowsiness alarms silenced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve participants (3 female) completed all alcohol conditions. Relative to baseline, all eye blink parameters were affected at 0.08% BAC (all <i>p</i> < 0.05), whereas 0.05% BAC only affected the composite eye blink drowsiness measure (the Johns Drowsiness Scale).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Alcohol consumption to 0.08% BAC impaired eye blink measures to a level that would be considered a moderate drowsiness risk. Therefore, employers should be aware that drowsiness alerts from these technologies may increase after alcohol consumption.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":"38 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hup.2870","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9787531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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