海洛因依赖者戒断治疗中出现癫痫发作的临床研究

目的：研究海洛因依赖者戒断治疗中出现癫痫发作的情况。方法：对36例在戒断治疗中出现癫痫发作的海洛因依赖者进行临床分析总结并对症治疗。结果：海洛因依赖者戒断治疗中出现癫痫发作的多为合并多药滥用成瘾者，治疗后预后良好。结论：海洛因依赖者合并多药滥用成瘾者在戒断治疗中容易出现癫痫发作的症状。可能与这些药物导致脑功能失衡有关。     

美沙酮维持治疗对海洛因依赖者情绪状态的影响

目的:了解美沙酮维持治疗(MMT)对海洛因依赖者情绪状态的影响,为维持治疗提供指导。方法:使用抑郁自评量表(CES-D),分别对131例参加美沙酮维持治疗一年以上的海洛因依赖者及120例来我院进行自愿戒毒的海洛因依赖者(对照组)急性脱毒前、后予以问卷调查,将两组人群的CES-D总评分及各单项评分予以比较、分析。结果:64.1%的美沙酮维持治疗者肯定有抑郁症状,对照组抑郁症状检出率为64.2%,两组抑郁症状患病率差异无统计学意义(P>0.05)。美沙酮维持治疗组常见抑郁症状依次为无愉快感(57.3%)、空虚感(56.5%)、自卑感(51.9%)、绝望感(45.0%),而对照组依次为自卑感(64.2%)、绝望感(59.2%)、无愉快感(55.8%)、空虚感(52.5%);对照组脱毒前、后抑郁症状改变差异无统计学意义(P>0.05);与对照组相比(治疗前后),MMT能显著改善自卑感、绝望感等抑郁症状,差异有统计学意义(P<0.05),但对无愉快感、空虚感无改善。结论:美沙酮维持治疗对抑郁状态总体无改善作用,但一定程度上具有部分改善抑郁情绪不同症状的作用,如降低患者的自卑感和绝望感。在治疗过程中,必须高度重视美沙酮维持治疗者的情绪状态以提高MMT治疗效果。     

延迟强化条件下不同时相海洛因戒除者的行为冲动性

目的:探讨延迟强化情境中海洛因戒除者的冲动性行为模式及其与戒除时相的关系。方法:采用以假设的1000元和10000元人民币为强化物的延迟折扣任务(DDT)在8种延迟强化时间点(SOA,6h-25a)上评定了77名男性(19-38a,29.68a±s4.25a)生理脱毒后处于不同康复阶段(1-29月,11.81±s17.35月)的海洛因戒除者和35名男性(18-39a,29.94a±s5.46a)无毒品依赖行为的社会招募人员的延迟折扣率。结果:(1)双曲线模型对被试的折扣率(k)的方差变异解释率(R2)在0.90-0.93之间,具有良好的拟合度;(2)戒除组被试对1000元和10000元延迟强化的k值均显著高于对照组,U1000元=581.500,P<0.001,U10000元=232.500,P<0.001;(3)不同戒除时相被试对两种延迟强化物的k值差异均无显著性,χ12000元=0.586,df=2,P>0.10,χ120000元=1.281,df=2,P>0.10。结论:海洛因戒除者表现出对即时奖赏的超敏感性及对延迟价值的非敏感性特征,且该特征不随戒除期的延长而改善。     

海洛因依赖者情绪影响复吸分析

目的：了解海洛因依赖者的吸毒体验、负性情绪构成,探讨正、负情绪对复吸的影响。方法：采用心理学调查模式,设计《吸毒体验和负性情绪调查表》,收集海洛因依赖者的一般情况和各种情绪状况并作计数统计分析。结果：在693名海洛因依赖者中,98．27％的个体吸食海洛因获得了欣快感和多种正性感觉,呈现出明显的正性情绪效应;在戒除毒瘾后,不同的负性情绪出现率依次为：空虚无聊76．91％、无名心烦55．27％、吸戒矛盾54．40％和唯吸毒趣事32．76％;在遇到吸毒朋友时,“渴求”被唤醒率为73．01％,在心境恶化时,“渴求”被唤醒率为74．89％。结论：复吸是动物生存策略-“趋利避害”生物本能的行为体现。海洛因依赖者的高复吸率是由药物的奖赏属性与大脑奖赏的神经机制所决定。戒后至复吸的时间与负性情绪出现类型相关。     

女性海洛因成瘾者脱毒后稽延性戒断症状和焦虑情绪调查

目的··:了解海洛因成瘾者脱毒后的稽延性戒断症状和焦虑情绪 ,指导脱毒后的身心康复工作。方法··:采用稽延性戒断症状评定表及焦虑自评量表(SAS)对115例女性脱毒成功者进行测评。结果··:海洛因成瘾者脱毒成功后 ,仍普遍存在稽延性戒断症状和焦虑情绪。稽延性戒断症状主要表现为睡眠问题、烦躁、疼痛 ;焦虑情绪以睡眠障碍、静坐不能、不幸预感、多汗、呼吸困难最为严重。结论··:缓解脱毒后病人的稽延性戒断症状及控制其焦虑心理不仅可促进病人的身心康复 ,还有助于预防复吸。     

头针治疗海洛因依赖者戒断症状94例的临床研究

目的:比较头针 美沙酮、体针 美沙酮、单纯美沙酮疗法对改善海洛因依赖者脱毒期戒断症状的临床疗效,为今后头针参与戒毒治疗,降低复吸率进行积极的探索。方法:对94例海洛因依赖者用上述三种疗法治疗,随机分为三组,动态观察10天的戒断症状。使用戒断症状量表观察脱毒的疗效。结果:治疗10天后评分显示:头针组控制戒断症状的效果最为完全,体针组也有一定的效果,但不及头针组,两组比较有统计学意义(P<0.01)。两组针刺组的治疗效果均好于单纯美沙酮组(P<0.01)。在脱毒期失眠、焦虑症状的改善方面,头针组和其它两组比较表现出明显的优势(P<0.01)。在脱毒期躯体症状的改善方面,头针组和体针组无统计学差异(P>0.05)。在脱毒期焦虑症状的改善方面,体针组和美沙酮组比较无统计学意义(P>0.05)。结论:头针减轻了海洛因依赖者脱毒期戒断症状,特别是在改善患者的失眠、焦虑等精神依赖方面具有明显的优势,在目前尚无特效的戒毒疗法的情况下,针灸参与戒毒具有疗效肯定、无副作用、经济安全的特点,头针结合药物产生了一定的协同作用。     

米氮平对海洛因依赖者脱毒后期稽延性戒断症状的疗效观察

目的观察米氮平片对海洛因依赖者脱毒后期稽延性戒断症状的疗效和不良反应。方法 60例自愿戒毒者脱毒后,由患者自愿选择米氮平片口服治疗,观察其稽延性戒断症状及不良反应,同时设对照组30例,仅作对症治疗。结果在控制稽延性戒断症状方面,米氮平组与对照组相比差异有统计学意义（P〈0.01）;不良反应两组差异无统计学意义（P〉0.05）。结论在应用美沙酮替代递减疗法完成脱毒后,加用米氮平片进行后续的巩固康复治疗,能够有效地控制海洛因依赖者的稽延性戒断症状,且副反应少、安全,值得推广使用。     

海洛因依赖者自然戒断过程中内分泌激素含量变化的研究

目的··:研究海洛因依赖者自然戒断过程中内分泌激素含量的动态变化。方法··:用放免法测定28例海洛因依赖者在自然戒断的d1、d3、d10、d30血清TSH、T3 、T4 、FSH、睾酮(Tst)、醛固酮和胰岛素含量。结果··:海洛因依赖者在自然戒断的d1、d3血清TSH、T3 、胰岛素含量均低于正常组(P<0.01) ,醛固酮含量高于正常组(P<0.05或0.01) ,T4 、FSH和Tst含量与正常组无差异。自然戒断的d10,除血清T3 、T4 含量低于正常组外(P<0.01) ,其余各激素含量与正常组已无差异。自然戒断的d30,T4 、胰岛素含量低于正常组(P<0.05或0.01) ,FSH、醛固酮含量高于正常组(P<0.05) ,TSH、T3 、Tst含量与正常组无差异。结论··:海洛因依赖者在自然戒断的d10其内分泌功能已基本恢复正常 ,但一些激素即使在戒断的d30仍有异常变化 ,提示应加强稽延性戒断症状的控制 ,以利于康复     

276例男性海洛因依赖戒断者稽延期经络失衡状况调查

目的:调查分析上海地区276例男性海洛因依赖者稽延期的经络失衡状况。方法:通过对十二经井穴及八脉交会穴的皮肤穴位导电量测量来探讨男性海洛因依赖者稽延期的经络失衡状况。结果:男性海洛因依赖者稽延期十二正经经络异常主要体现在肺经、心包经、脾经、胃经、大肠经、心经、肾经、三焦经上,以肺经(占69.93%)、心包经(占62.68%)不平衡率居高,与其他经比较差异有显著性意义(P<0.05)。奇经八脉经络异常主要体现在阴维脉、阴跷脉、冲脉、任脉、阳跷脉上,以阴维(占68.48%)、阴跷(占65.58%)不平衡率居高,较之其他经脉,差异亦有显著性(P<0.05)。结论:稽延期十二经井穴及八脉交会穴的皮肤穴位导电量检测能够反映该期男性海洛因依赖者经络气血的失衡情况,稽延期该群体经络异常主要表现在与中医胃、心、胸体系相关的经脉上。     

济泰片对海洛因依赖者脱毒后期稽延性戒断症状的疗效观察

目的:观察济泰片对海洛因依赖者脱毒后期稽延性戒断症状的疗效和不良反应。方法:对30例自愿戒毒者在停用美沙酮后予以济泰片口服治疗,观察其稽延性戒断症状及不良反应;同时设对照组30例,不用戒毒中药,仅作对症治疗。结果:在控制稽延性戒断症状方面,济泰片组与对照组相比有非常显著性差异(P<0.001);不良反应两组差异无显著性(P>0.05)。结论:在应用美沙酮替代递减疗法完成脱毒后,加用济泰片进行后续的巩固康复治疗,能够有效地控制海洛因依赖者的稽延性戒断症状,且副作用少,安全,值得推广使用。     

Behavioural approach tendencies to heroin-related stimuli in abstinent heroin abusers

Rationale

Drug-related cues can elicit approach responses in drug users. However, no relevant research has ever concerned heroin abusers. In the present study, we investigated whether the abstinent heroin abusers demonstrated special behavioural tendencies to approach or avoid the drug-related stimuli compared with neutral stimuli.

Method

Twenty-two male abstinent heroin abusers (AH) and 20 healthy males (NC) were tested by a Pull/Push Task. Participants pulled (approach response) or pushed (avoidance response) a lever in response to the content of stimulus pictures (i.e. heroin-related versus neutral). The approach and avoidance scores were therefore calculated based on response times and directions to reflect their behavioural tendencies.

Results and conclusion

Relative to the NC individuals, the AH individuals demonstrated significantly heightened tendencies to approach (“pull”) the heroin-related stimuli in comparison with the neutral stimuli, while their tendencies to avoid (“push”) the heroin-related stimuli were marginally blunted, reflecting a special bias for AH individuals to behaviourally approach, and simultaneously resist to avoid, heroin-related cues.     

Neuropsychological functioning in methadone maintenance patients versus abstinent heroin abusers

Several studies have reported on neuropsychological status as an important contributing variable in drug abuse rehabilitation outcomes. However, few studies have dealt with cognitive impairment in methadone maintenance patients (MMP), despite the fact that methadone is the most frequently used opioid substitution treatment in European countries. The objective of the present study is to contrast the neuropsychological performance of MMP with that of abstinent heroin abusers (AHA). Participants were matched with respect to age, education, pre-morbid IQ, employment status and lifetime drug abuse, and they underwent a set of tests aimed at assessing visuo-spatial attention, processing speed and executive functions. Although processing speed and attention deficits have previously been the focus of studies with MMP, executive functions have not received a similar degree of attention. The purpose of comparing matched MMP and AHA is two-fold: firstly, to test the differential effects of current opioid consumption and past opioid abuse on cognitive-executive performance and secondly, to assess the potential consequences of opioid-related neuropsychological deficits. Results showed a significantly slower performance by MMP on processing speed, visuo-spatial attention, and cognitive flexibility tests (Five Digit Test (FDT) parts 1 and 3; Oral Trails (OT) parts 1, 2; Interference 2-1), and less accuracy in working memory and analogical reasoning tests extracted from the Wechsler Adult Intelligence Scale (WAIS III). Effect sizes for significant comparisons ranged from 0.67 to 1. These results seem to suggest that methadone consumption by itself induces significant cognitive impairments that could compromise drug-treatment outcomes in MMP.     

The effect of relapse on cognition in abstinent methamphetamine abusers

Data from 75 participants in a longitudinal study of methamphetamine (MA) abuse were used to differentiate the cognitive performance of those who remained abstinent, relapsed, or continued to use during treatment. Participants were divided into three groups: continuous abstinence, initial abstinence but relapse, and continuous use. Groups did not differ on age, education, gender or ethnicity. Participants in the longitudinal study completed a battery of cognitive tests within 7 days of their last use of MA, then were re-tested monthly for up to 6 months (average time for this analysis was 92 days). For episodic memory, the relapse groups performance was worse than the abstinent and significantly worse than that of the continued use group who had the best performance on all measures. Relapse to methamphetamine use may affect episodic memory differently than it affects the other cognitive functions measured.     

Mild opioid deprivation increases the degree that opioid-dependent outpatients discount delayed heroin and money

RATIONALE: A growing literature suggests that excessive temporal discounting of delayed rewards may be a contributing factor in the etiology of substance abuse problems. Little is known, however, about how drug deprivation may affect temporal discounting of delayed rewards by drug-dependent individuals. OBJECTIVE: To examine the extent to which opioid deprivation affects how opioid-dependent individuals discount small, medium and large quantities of delayed heroin and money. METHODS: Thirteen opioid-dependent individuals maintained on buprenorphine completed a hypothetical choice task in which they choose between a constant delayed reward amount and an immediate reward amount that was adjusted until they expressed indifference between both outcomes. The task was completed for three values of heroin and money rewards during eight sessions under conditions of opioid deprivation (four sessions) and satiation (four sessions). RESULTS: Across conditions, hyperbolic functions provided a good fit for the discounting data. Degree of discounting was significantly higher when subjects were opioid deprived. Consistent with previous findings, degree of discounting was higher for heroin than money and inversely related to the magnitude of the reward. CONCLUSION: Opioid deprivation increased the degree to which dependent individuals discounted delayed heroin and money. Understanding the conditions that affect how drug-dependent individuals discount delayed rewards might help us understand the myopic choices made by such individuals and help improve treatment outcomes.     

海洛因滥用者复吸情况的分析

目的:从人口学特征、药物滥用史、滥用行为特征、特别是复吸原因等多方面分析我国海洛因滥用者的复吸情况,以提高戒毒的成功率。方法:检索1995年～2008年国内医药学期刊报道的海洛因滥用者复吸案例,并进行统计、分析。结果:海洛因复吸者具有较为明显的人口学特征和药物滥用行为特征,复吸者中男性占74.43%,年龄分布在21～40岁的占74.28%,初中以下占76.24%,未婚则有53.85%,无业和个体经营者占73.89%。海洛因依赖者完全脱毒十分艰难,复吸原因复杂多样,包括社会因素、环境因素和心理因素。结论:必须充分了解我国海洛因依赖者复吸情况,加强对毒品流行的预防和控制。坚持多元视角对戒毒问题进行研究,寻求有效的预防复吸的方案,并且重视戒毒过程的每一个环节,以提高戒毒率。     

阳泉市3年海洛因非法使用情况研究

目的了解阳泉市海洛因滥用情况,并探讨了相应的措施。方法统计2003年1月-2005年12月期间由于海洛因的非法使用而被阳泉市公安局禁毒处拘留、并强制戒毒3个月~6个月的犯罪人员的案宗,内容包括海洛因非法使用者的年龄、性别、职业、文化程度。用EXCEL对数据进行统计分析并进行t检验。结果阳泉市海洛因非法使用以男性为主体,占83.3%。平均年龄(29±6)岁。20~29岁与30~39岁年龄段为其好发年龄。多为初中文化程度,达91.4%。多为无业人员,达到91.7%。复吸总人数占总样本人数的13.4%。女性复吸人员平均年龄小于总样本女性平均年龄。结论阳泉市海洛因非法使用以中青年男性、低学历、无业者为主。女性复吸低龄化。禁毒工作重在预防。     

The effects of chronic food restriction on cue-induced heroin seeking in abstinent male rats

Rationale and objectives

Previous research with an animal model of relapse has shown that acute food deprivation will reinstate extinguished drug seeking. Recent evidence with humans, however, suggests that chronic food restriction rather than acute food deprivation is related to increases in drug taking and relapse, emphasizing a need for an animal model to elucidate the neural mechanisms mediating the effects of chronic food restriction on drug seeking. Here we studied the effects of chronic food restriction during a period of abstinence on heroin seeking in rats.

Methods

Rats were trained to self-administer heroin over 10 days (0.1 mg/kg/infusion; i.v.). Rats were then removed from the operant conditioning chambers and exposed to a mild food restriction (resulting in 10–15 % decrease in body weight) or given unrestricted access to food for 14 days while abstinent. The abstinence period was followed by a drug-seeking test under extinction conditions. Subsequent experiments manipulated the length of restriction and test conditions.

Results

Rats that were food restricted throughout the abstinence period demonstrated a robust increase in cue-induced heroin seeking compared to sated rats. Re-feeding prior to testing or decreasing the length of the food restriction period prevented the augmentation of drug seeking.

Conclusions

A combination of chronic food restriction and a concurrent state of hunger appears to be necessary for an increase in cue-induced heroin seeking following abstinence. The procedure presented here may serve as a useful model to study the increased risk for relapse following dietary manipulations in abstinent subjects.     

The influence of monetary punishment on cognitive control in abstinent cocaine-users

Background

Dependent drug users show a diminished neural response to punishment, in both limbic and cortical regions, though it remains unclear how such changes influence cognitive processes critical to addiction. To assess this relationship, we examined the influence of monetary punishment on inhibitory control and adaptive post-error behavior in abstinent cocaine dependent (CD) participants.

Methods

15 abstinent CD and 15 matched control participants performed a Go/No-go response inhibition task, which administered monetary fines for failed response inhibition, during collection of fMRI data.

Results

CD participants showed reduced inhibitory control and significantly less adaptive post-error slowing in response to punishment, when compared to controls. The diminished behavioral punishment sensitivity shown by CD participants was associated with significant hypoactive error-related BOLD responses in the dorsal anterior cingulate cortex (ACC), right insula and right prefrontal regions. Specifically, CD participants’ error-related response in these regions was not modulated by the presence of punishment, whereas control participants’ response showed a significant BOLD increase during punished errors.

Conclusions

CD participants showed a blunted response to failed control (errors) that was not modulated by punishment. Consistent with previous findings of reduced sensitivity to monetary loss in cocaine users, we further demonstrate that such insensitivity is associated with an inability to increase cognitive control in the face of negative consequences, a core symptom of addiction. The pattern of deficits in the CD group may have implications for interventions that attempt to improve cognitive control in drug dependent groups via positive/negative incentives.