Journal of Addictive Diseases最新文献

An increasing number of new psychoactive substances (NPS), such as designer benzodiazepines, are becoming available on the recreational drug market. These are new unregistered substances and thereby an attempt to evade legislation. Often there is very limited clinical information available regarding these NPS, which could result in undesirable clinical outcomes in the management of intoxications, dependencies and withdrawals following NPS use. In this case report we describe a 23-year-old woman, who was admitted to our residential addiction care facility for the detoxification of the designer benzodiazepine bromazolam. Her daily use of 6 mg bromazolam was converted to 20 mg diazepam. Although we expected a higher dose would have been needed, 20 mg was sufficient and was tapered without complications. This case report demonstrates the safe conversion of 6 mg of bromazolam to 20 mg of diazepam by combining the use of fixed-dose and symptom-triggered-dose regimens. More clinical data is necessary to formulate advisory management for the detoxification of bromazolam and other designer benzodiazepines.

Introduction: Substance use disorder (SUD) is a common condition often associated with borderline personality disorder (BPD), and patients with both disorders (SUD + BPD) have more complex presentations and poorer outcomes in treatment. Thus, there is a need to identify more clearly the clinical differences between patients with SUD + BPD and those with SUD only to help clinicians in their diagnostic process.

Methods: Data from medical files of 92 patients with SUD (SUD only: n = 42; SUD + BPD: n = 50) treated in an outpatient psychiatry and addiction treatment center were extracted to compare the differences in terms of sociodemographic characteristics, substance used, psychopathological dimensions, comorbidity prevalence, and functional impairment.

Results: Compared to the SUD only group, patients in the SUD + BPD group were younger, more disabled, and less satisfied with their social life. Regarding substance used, the comorbid group had more frequently cannabis use disorder and poly nonalcoholic SUD. Regarding psychopathological dimensions, the comorbid group had higher levels of impulsivity, emotion regulation difficulties and alexithymia. Finally, regarding comorbidities, the comorbid group had a higher risk of comorbid anxiety, obsessive-compulsive, and post-traumatic stress disorders.

Conclusion: While being only exploratory, these results add evidence on the impact of the BPD comorbidity in patients with SUD and underline important dimensions that should be considered by clinicians working with this population.

While rates of opioid use disorder (OUD) continue to rise across the country, young adults with OUD are at particular risk as they have poorer treatment outcomes and lack developmentally appropriate treatment options. The introduction of mobile applications for OUD present a new avenue to improve treatment outcomes for young adults. One such app, reSET^® provides app users with weekly cognitive behavioral therapy lessons focusing on addiction with built in contingency management for completion of lessons and negative urine drug screens. This exploratory study aimed to identify the characteristics of patients who engaged with the application, reSET^®, as well as to describe potential differences in treatment outcomes between engagers and non-engagers. This observational cohort study analyzed clinical and other program data from 35 young adults between the ages of 20-28 that were involved in the care and prescribed medications for OUD in Baltimore, Maryland during the 12-week period of app prescription. Results indicated that young adults had dichotomous levels of engagement, with almost 30% engaging highly with the app, completing >90% of lessons, and approximately 70% having low engagement, completing <25% of lessons. There were no differences in mental health outcomes, but engagers were more likely to be retained in care at the end of the 12-week prescription as compared to non-engagers. Overall, results suggest that mHealth apps targeted for OUD treatment offer potential treatment benefits for young adults, especially regarding treatment retention. Future studies should investigate the treatment and mental health impacts of reSET^® and other mHealth apps within this population.

Objectives: Long-acting injectable buprenorphine (LAIB) has demonstrated a good profile for opioid use disorder (OUD) management. However, there is scarce information on LAIB in OUD patients with comorbid mental disorders (dual disorder patients).

Methods: We present a case report on OUD patients with a comorbid mental disorder who have received LAIB for at least 3 months.

Results: Two women and one man with OUD and another comorbid mental disorder were prescribed with LAIB ranging from three to twelve months. Good adherence and opioid abstinence were observed during the follow-up. Psychopathological issues related to comorbid mental disorders were stabilized. A deep discussion on LAIB in this profile of patients is conducted.

Conclusions: LAIB in OUD patients with comorbid mental disorders may be a safe and well tolerated option, similar to OUD patients without comorbid mental disorders. LAIB's impact on psychopathological issues requires further high-quality research to understand the real impact of LAIB on OUD and comorbid mental disorders.

Wernicke's encephalopathy (WE) is a dangerous and potentially fatal neurological condition associated with thiamin deficiency. The standard treatment for WE is intravenous (IV) thiamin, but limited research describes optimal dosing. We present a case of a 40-year-old male with severe alcohol use disorder (AUD) and chronic malnourishment who developed WE. Upon administration of 100 mg IV thiamin, symptoms of WE persisted, but when the dose was increased to 500 mg, altered mental status and ophthalmoplegia resolved rapidly. IV thiamin is a reliable and low-risk treatment for WE, even when administered at high doses. High-dose IV thiamin (i.e., >/100 mg) can treat neurological symptoms and cognitive dysfunction in WE and should be considered for first-line treatment. Further study of WE diagnostic and treatment guidelines is warranted to maximize recovery potential.

Background: Synthetic cannabinoids (SCs) dependence is increasingly prevalent among young individuals globally, with limited understanding of their potential detrimental effects. Therefore, we conducted this comparative study to assess impulsivity and non-suicidal self-harm behavior in patients with SCs dependence.

Subjects and method: We conducted this comparative, case-control study in the outpatient clinics of (Beni-suef University Hospital). We recruited 30 patients with SCs dependence and the 30 healthy subjects as a control group. Psychometric scales, including Addiction Severity Index (ASI), Barratt Impulsivity Scale-11 (BIS-11), Deliberate Self-harm Inventory-Short Version (DSHI), SCID I, SCID II, and drug urine screen, were applied to compare the two study arms.

Results: DSHI-s scores were significantly higher between the two study arms (3.23 ± 4.97 vs. 0.0 ± 0.0, p < 0.001, for cases and controls, respectively). Similarly, the mean ± SD score of the BIS scale was significantly higher in cases 68.13 ± 9.75 compared to the control group (45.67 ± 5.12) with a statistically significant difference (p < 0.001). Using the regression analysis, we observed a significant positive linkage between age, duration of substance use, DSHI-s, and the Barratt scale.

Conclusion: Patients with synthetic cannabis addiction exhibited more impulsivity and self-harm behaviors compared to healthy controls. The adverse effects of substance use disorder escalated, notably in individuals classified as having severe addiction based on the Addiction Severity Index. Age and length of substance use were found to be potential factors influencing the level of impulsivity and self-harm actions.

Background: Uric acid, the final product of purine metabolism, may indicate various mental disorders and may be associated with behavioral and clinical features due to its role in adenosine transmission and the antioxidant system.

Objective: In this study, it was aimed to investigate the relationship between serum uric acid, impulsivity, and suicidality in patients with opioid use disorder.

Methods: An analytical, cross-sectional study was conducted with a total of 115 participants: 62 patients diagnosed with opioid use disorder and 53 healthy controls. We performed blood tests at admission and administered the Barratt Impulsivity Scale-11, Columbia-Suicide Severity Rating Scale, Suicide Probability Scale, Structured Clinical Interview Form for DSM-5, and the Sociodemographic and Clinical Data Collection Form to the participants.

Results: Serum uric acid levels were significantly lower in the opioid use disorder group than in the healthy control group. No significant correlation was found between serum uric acid levels, suicidality, and impulsivity in the opioid use disorder group.

Conclusion: Although there is previous research that suggested a potential link between uric acid levels, impulsivity, and suicidality, we could not find a significant correlation between uric acid levels, impulsivity, and suicidality in the opioid use disorder group. However, the possible relationship between uric acid, impulsivity, and suicidality may be masked by decreasing the effect of opioid use on uric acid levels.