酒精依赖对老年颌面外科手术患者围术期谵妄的影响

目的 比较酒精依赖和非酒精依赖行颌面外科手术老年患者术后谵妄的发生率.方法 颌面外科手术患者60例,年龄60～80岁,性别男,ASA分级Ⅰ～Ⅱ级,手术时间4～6 h,符合酒精依赖条件的为酒精依赖组(AD),无酒精依赖患者组成非酒精依赖组(NAD),每组患者各30例,记录麻醉药(芬太尼、瑞芬太尼和丙泊酚)用药量;手术时间和苏醒(RE90)时间、拔管时间.术后评估患者VAS评分,以及是否出现苏醒期谵妄,并用ICU意识模糊评估法(CAM-ICU)连续一周评估两组患者是否发生谵妄(CAM-ICU),并记录术后谵妄的病例数.结果 两组患者在年龄,ASA分级,手术麻醉时间,苏醒时间,拔管时间上均无差异(P＞0.05);麻醉药用量,酒精依赖组(AD)高于非酒精依赖组(NAD),不过没有统计学意义(P＞0.05);酒精依赖组(AD)在苏醒期谵妄(10％)和术后谵妄的发生率(60％)均高于非酒精依赖组(NAD)的苏醒期谵妄发生率(3％)和术后谵妄发生率(27％)(P＜0.05).结论 酒精依赖会明显增加老年颌面外科手术患者围术期谵妄的发生率.     

Autoimmune-Mediated Psychosis: A Case of Susac Syndrome in a Drug User

Objective: Susac syndrome, a rare disorder, is thought to be mediated by autoantibodies. One of the potential targets of these autoantibodies could be an antigen in the microvessels of the brain, the retina, and the inner ear leading to central nervous system (CNS) alterations, visual disturbances, and hearing deficits. Our aim is to expand clinicians’ diagnostic options when facing psychosis due to medical conditions. Methods: A case report was conducted for this study. Results: This paper reports the case of a young male drug user who presented with psychosis, confusion and CNS vasculitis. First deemed to be drug-induced CNS vasculitis, it was finally diagnosed as Susac syndrome. Conclusions: Although an infrequent entity, Susac syndrome should remain an option in the differential diagnosis of several neurological and psychiatric presentations.     

Drinking patterns and harm of unrecorded alcohol in Russia: a qualitative interview study

Background: Consumption of unrecorded alcohol (alcohol, consumed as a beverage, but not reflected in official statistics) has been linked to heavy drinking and alcohol-related mortality in Russia, with different studies looking for possible toxic components or other explanations. This study explores self-reported drinking behaviors of people diagnosed with alcohol dependence to elicit the perspectives of consumers of unrecorded alcohol.

Methods: Semi-structured in-depth expert interviews were conducted with patients (n?=?25) of state-run addiction treatment centers of two Russian cities. Interviews were analyzed using thematic content analysis.

Results: A strict hierarchy between different types of unrecorded alcohol products, their ascribed quality, and the subjective harm caused by their consumption was found, with home-made spirits for own consumption at the top and technical fluids at the bottom. The ranking order correlated with product price, social status of associated consumers, and severity of their alcohol dependence. Binge drinking was the prevailing drinking pattern and shifts from recorded to unrecorded consumption within a single binge or a zapoi (continuous drinking for at least two days) were typical. Consumption of low-quality unrecorded alcohol was associated with stronger hang-overs, zapois, alcohol psychoses and poisonings, and other indicators of alcohol attributable harm, while no such connection was found for spirits for own consumption.

Conclusions: In the dominant explanation patterns of the consumers, the experienced alcohol-induced harm is attributed to alcohol quality, while a thorough analysis of their reported drinking behaviors cannot exclude specific drinking patterns linked to the severity of alcohol dependence as the main determinants of the described health detriments.     

Association of N-Methyl-D-Aspartate receptor 2B Subunit (GRIN2B) polymorphism with earlier age at onset of withdrawal symptoms in Indian alcohol dependent subjects

The associations of GRIN2B polymorphism (rs1806201) with alcohol withdrawal and related clinical parameters in alcohol dependent subjects were investigated. Cases were assessed using a semi-structured clinical pro forma for alcohol abuse and a questionnaire for family history of alcohol dependence and psychiatric disorders after obtaining informed consent. The study included alcohol dependent male cases (n = 220, age at onset of alcohol withdrawal symptoms = 32.4 ± 8.8 y) recruited at the Center for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India. The controls comprised of healthy unrelated males (n = 183) who were ethnically matched and selected randomly. The polymorphism rs1806201 was analyzed by polymerase chain reaction and restriction fragment length polymorphism. The presence of T allele at this locus was significantly associated with lower age at onset of alcohol withdrawal symptoms (p = .005) among the cases. Mean age at onset of alcohol withdrawal symptoms in subjects who were T carriers was 31.4 ± 8.5 y (n = 160) and non-T carriers was 35.2 ± 9.0 y (n = 60). The SNP rs1806201 in GRIN2B may play an important role in genetic susceptibility to earlier age of withdrawal in alcohol dependent patients.     

Neural Correlates of Depressive Symptoms in Smokers – A Systematic Review of Imaging Studies

This review aims to summarize neuroimaging studies in order to better understand the neural correlates of depressive symptoms in tobacco smokers. Using the keywords “depressive OR depression” AND “tobacco OR nicotine OR smok^* OR cigarette” AND “neuroimage OR magnetic resonance OR smri OR structural magnetic resonance OR fmri OR functional magnetic resonance OR pet OR positron emission tomography”, literature search was conducted in PubMed, Web of Science and PsycINFO databases. The first and the last author read the abstracts of all the studies found in the search (n = 179). The inclusion and exclusion criteria were applied and 150 articles were excluded. Then, both authors assessed the remaining 29 studies for eligibility and 16 studies were included in the present review. In the phase of active/chronic smoking, depressive symptoms are characterized as comorbidity related to an enhancement of dopamine release, and smokers have decreased Monoamine oxidase A (MAO-A). Stimuli-related functional magnetic resonance imaging (Stimuli-fMRI) studies also show that there is a positive correlation between the level of depressive symptoms and a greater response to general negative stimuli in active/chronic smokers. In the withdrawal phase, depressive symptoms are related to the withdrawal syndrome and increased MAO-A. Stimuli-fMRI studies show that there is a negative correlation between level of depressive symptoms and reactivity to negative stimuli in recent abstinent smokers. Major areas of the reward system such as the striatum and areas related to impulse control are activated to a greater extent in depressive smokers compared to non-depressed smokers.     

Decline in new psychoactive substance use disorders following legislation targeting headshops: Evidence from national addiction treatment data

Introduction and Aims. New psychoactive substances (NPS) have hedonic effects that may lead to dependence. Headshops selling NPS increased in number in Ireland from late 2009. Legislation was enacted in May and August of 2010 that caused their closure. It is unknown whether such events impact the rate of NPS use disorders. Designs and Methods. We conducted a population‐based study using the Irish national database of episodes of addiction treatment between 2009 and 2012. We examined trends in the rate of NPS‐related treatment episodes among young adults. Joinpoint trend analysis software was used to identify significant changes in trend. Results. Of the 31 284 episodes of addiction treatment commenced by adults aged 18 to 34 years, 756 (2.4%) were NPS related. In 2012, the 12‐month moving average rate had fallen 48% from its peak in 2010, from 9.0/100 000 to 4.7/100 000. Joinpoint analysis indicated that the rate of NPS related episodes increased by 218% (95% confidence interval 86 to 445, P = 0.001) every 4 months until the first third of 2010. From that point, the rate declined by 9.8% (95% confidence interval ?14.1 to ?5.4, P = 0.001) per 4‐month period. There was no significant trend change in the rate of non‐NPS related treatment episodes. Discussion and Conclusions. Over the 2 years after the enactment of prohibition‐styled legislation targeting NPS and headshops, the rate of NPS related addiction treatment episodes among young adults declined progressively and substantially. We found no coinciding trend change in the rate of episodes linked to other drug groups. [Smyth BP, Lyons S, Cullen W. Decline in new psychoactive substance use disorders following legislation targeting headshops: Evidence fromnational addiction treatment data. Drug Alcohol Rev 2017;00:000‐000]     

Outcome of alcohol dependence syndrome cases managed in armed forces

Background: Army Order for Alcohol Dependence Syndrome gives a structured and strict approach towards disposal of such cases in Indian Armed Forces. Four years have passed since the implementation of the above order. This study was conducted to assess the outcome after implementation of the said order.     

Reliability and validity of addiction severity index in drug users with methadone maintenance treatment in Guizhou province, China

Objective To evaluate the reliability and validity of the Chinese version of addiction severity index （ASI）-5th version （ASI-C-5）, in illegal drug users receiving methadone maintenance treatment （MMT） in China. Methods One hundred and eighty-six heroin addicts （144 men and 42 women） receivihg MMT at three clinics in Guizhou province, southwest China, were recmited. They were all interviewed with a questionnaire of ASI-C-5 and 35 were re-interviewed at an interval of seven days to assess its test-retest reliability. Results Cronbach＇s alpha for internal consistency of CSs varied from 0.60 to 0.81 in all domains. Test-retest reliability of composite scores （CSs） of ASI-C-5 were satisfactory （r=0.38-0.97）. Based on item analysis and expert＇s suggestions, five items were deleted and one item was modified in ASI-C-5. Criterion validity of ASI-C-5 was found acceptable, as compared to addicts＇ self-rating anxiety scale （SAS） and self-rating depression scale （SDS） （r=0.59 and 0.45） except for social support rating scale （SSRS）. Conclusions ASI-C-5 can be used for heroin addicts receiving MMT with acceptable reliability and validity.