Carisoprodol abuse: a report from India

Carisoprodol, a centrally acting muscle relaxant, has recently been noticed to be abused. A series of 16 cases with carisoprodol abuse or dependence is described. Carisoprodol was started by the majority of patients as a substitute for opiates, although its independent distinct effects, similar to the features of hypomania, were recognized and described by most users. The drug is currently available freely over the counter and is a much cheaper substitute for the legally prohibited “harder” drugs. Unless awareness spreads and cautionary measures are taken, carisoprodol abuse might become a great menace in the near future.     

Longitudinal studies of drug abuse in a fifteen-year-old population. 5. Prognostic factors

In an attempt to identify prognostic factors, non-drug users and abusers in the Gothenburg year cohort of 1953 were compared with reference to background data. Individuals with chronic abuse differed most from the "normal" group. Prognostic factors for drug abuse were: member of a multiproblem family, child psychiatric care, contact with the Social Welfare Administration at an early age, truancy, placement in special class, premature drop-out from school, admitted high-frequency drug use in a school questionnaire, for boys early registration for crimes and for girls nervous complaints. The results indicate the necessity of earlier and more effective prevention.     

Initiation into intravenous drug abuse

At the Stockholm Police Arrest Centre, 156 intravenous drug abusers (103 men, 53 women) were interviewed during the first part of 1987. A structured questionnaire was used in order to survey the initiation process into drug abuse, focusing on the differences and similarities between men and women. Of the men, 80 (78%) had been introduced to illegal drugs by a man and only 14 (14%) by a woman. Of the women, 39 (74%) had been introduced by a man and only 11 (21%) by a woman. The majority of both the men (62%) and the women (51%) were introduced by a close friend. Most of the introductions took place in a secure environment, at the home of either the novice, a friend or the introducer.     

Longitudinal studies of drug abuse in a fifteen-year-old population. 2. Antecedents and consequences

A representative, stratified sample of ninth-graders of comprehensive school 1968 were followed retrospectively and prospectively in files from hospitals and Social Welfare Administration and in other official registers. Those who had stated high-frequency drug use in a school questionnaire, those who had attended special classes or had dropped out of school appeared to a larger extent than the average ninth-graders in social and child psychiatric registers during childhood. Over a follow-up period of 11 years they had a large over-consumption of drug-related psychiatric and social care. They were more often sick-listed and assessed to be without income than the average year cohort. The women had children before 20 years of age and the men were exempted from military service to a higher extent.     

Chronic psychosis related to benzydamine hydrochloride abuse

Benzydamine hydrochloride is a non-steroidal anti-inflammatory drug with analgesic and antipyretic effects. In those who use medicines containing this agent at high doses (500–3000 mg), some adverse effects such as hallucinosis, stimulant effects in the central nervous system, paranoia, and convulsions can be seen. The drug is vulnerable to abuse because of the stimulant effects on the central nervous system. In this paper, we present a young male patient with symptoms of psychosis due to benzydamine hydrochloride abuse. He was admitted to the psychiatry outpatient clinic with visual hallucinations, fear, and insomnia. His symptoms started after taking 10 tablets of benzydamine hydrochloride (500 mg) 6 months ago, which continued for 1–2 days and spontaneously resolved. The patient used high doses of the drug 3–4 times over a period of 3 months. Although his last drug intake was 3 months ago, his symptoms continued at the time of admission to the clinic. A neurologic examination and detailed laboratory tests of the patient revealed no evidence of a cause for psychotic symptoms. The patient was scheduled to undergo oral antipsychotic therapy. Although similar cases have been reported in the literature, this is the only case in which psychosis was still present despite discontinuation of the drug. Our aim was to contribute to the literature on the use of BH in causing chronic psychosis and to draw attention to the growing number of BH abuse cases.     

Self-reported drug abuse in male adolescents with behavioral disturbances, and follow-up for future schizophrenia.

BACKGROUND:The prevalence of illicit drug abuse in persons with schizophrenia is greater then in the general population and has been attributed to self-medication of the symptoms of the illness; however, limited data indicate that drug abuse is already prevalent before the manifestation of psychosis, consistent with the possibility that drug abuse might be associated with increased risk for schizophrenia. METHODS: The Israeli Draft Board screens the entire, unselected population of 16- to 17-year-old male adolescents for behavioral or personality disturbances. In a cohort of 270,000 male adolescents screened, 50,413 adolescents were suspected of having behavioral or personality disturbances and were questioned about drug use and abuse. These adolescents were followed for hospitalization for schizophrenia using a national, population-based psychiatric hospitalization registry; 268 of 50,413 (.5%) were hospitalized for schizophrenia over the following 5-11 years. RESULTS: The prevalence of self-reported drug abuse in adolescents later hospitalized for schizophrenia was 12.4%, compared with 5.9% prevalence of drug abuse in adolescents not later hospitalized; adjusted RR = 2.016, 95% confidence interval: 1.309-3.104. CONCLUSIONS: In this cohort of male adolescents with behavior disturbances, these results further support the hypothesis that drug abuse may be associated with increased risk for future schizophrenia.     

Psychophysiological disorders among buprenorphine patients

In this study, we examined the prevalence of 14 psychophysiological disorders among 114 opioid-dependent individuals (a sample that previously evidenced high rates of borderline personality) as well as the relationship between these disorders and borderline personality. In the aftermath of analyses, only migraine headaches (28.9%) and chronic pain (33.3%) demonstrated relatively high frequency rates in this sample. Only migraine headaches showed a significant relationship with the diagnosis of borderline personality symptoms. In conclusion, in an opioid-dependent population, the prevalence of psychophysiological disorders appears to be rather unremarkable.     

Schizophrenia and assaultive behaviour: the role of alcohol and drug abuse

To assess the role of alcohol and drug abuse among schizophrenics with assaultive behaviour, we analysed case records of 38 patients who were responsible for a total of 71 violent offences between 1972 and 1986. They were identified from a population-based cohort of 644 individuals with schizophrenia hospitalized in Stockholm County during 1971. Fourteen of the 38 offenders abused alcohol and/or drugs and another 7 were probable abusers. These figures are higher than previously reported as regards abuse among schizophrenics. Most of the offences were performed by nonhospitalized patients who had been ill for many years. The nature of most of the violent incidents resembled that of offences committed by non-psychotic individuals. Our findings give further evidence for the role of abuse and social disintegration in assaultive behaviour among persons with schizophrenia.     

Bilateral borderzone brain infarctions in association with heroin abuse

A 25-year-old drug abuser who developed an unusual pattern of cerebral ischemic lesions is presented. Cerebral magnetic resonance imaging revealed bilateral borderzone infarctions which were attributed to a heroin-associated vasculitis of the basal cerebral arteries. Under probatory corticosteroid medication the mild neurological deficits completely disappeared.     

Delirium tremens: a double-blind comparison of diazepam and barbital treatment.

The effect of diazepam and barbital in the treatment of delirium tremens and other acute conditions related to alcohol abuse was evaluated in a double-blind trial. 91 patients participated in the study, 44 in the diazepam group, 47 in the barbital group. The choice of diazepam rather than chlordiazepoxide was motivated by its major anticonvulsive properties. Barbital was given by the oral route, diazepam as intramuscular injections. Different ways of drug administration to patients with delirium tremens are discussed. It is concluded that the two different ways used in the study probably did not have a noteworthy influence on the results. All patients were excluded who had taken psychoactive drugs before admission. Nevertheless a considerable part of the patients had diazepam, but not barbital, in the blood before treatment was initiated. This may give support to the use of barbital as a "special purpose drug" in the treatment of these conditions. The patients were divided into three diagnostic categories, according to the severity of the clinical condition. No difference between the two drugs tested was found in the milder conditions, but barbital was found superior to diazepam in the treatment of fully developed delirium tremens.     

In vivo microdialysis and conditioned place preference studies in rats are consistent with abuse potential of tramadol.

The abuse potential of tramadol was investigated using both in vivo microdialysis measures of dopamine (DA) release within the nucleus accumbens (NAc) shell and the conditioned place preference (CPP) paradigm in rats. Tramadol (75 mg/kg, i.p.) induced a statistically significant increase (starting 80 min posttreatment) in DA release within the NAc shell, which was maintained for at least 120 min posttreatment. Tramadol (18.75, 37.5, and 75 mg/kg i.p.) produced a statistically significant CPP, with the effects of the two highest doses comparable to those induced by morphine (5 mg/kg, s.c.). The release of DA within the NAc shell may be responsible for the rewarding properties of tramadol and, together with the CPP results, provide evidence that tramadol may possess greater abuse potential than originally believed.     

Longitudinal studies of drug abuse in a fifteen-year-old population. 4. Chronic drug abusers

In the Gothenburg year cohort of 1953 1% of the men and 0.2% of the women were registered for chronic drug abuse through 1979. An early début and a polydrug abuse with emphasis on intravenous abuse of central stimulants but not opiates were found. Compared with matched individuals who were unregistered for drug abuse, chronic drug abusers had a large over-consumption of psychiatric and social care. Their registered criminality was higher, they were more often sick-listed and had lower incomes than the controls. The prevalence and overall impairment of chronic abusers are similar to those of schizophrenics.     

Opioid addiction and pregnancy: perinatal exposure to buprenorphine affects myelination in the developing brain

Buprenorphine is a mu-opioid receptor partial agonist and kappa-opioid receptor antagonist currently on trials for the management of pregnant opioid-dependent addicts. However, little is known about the effects of buprenorphine on brain development. Oligodendrocytes express opioid receptors in a developmentally regulated manner and thus, it is logical to hypothesize that perinatal exposure to buprenorphine could affect myelination. To investigate this possibility, pregnant rats were implanted with minipumps to deliver buprenorphine at 0.3 or 1 mg/kg/day. Analysis of their pups at different postnatal ages indicated that exposure to 0.3 mg/kg/day buprenorphine caused an accelerated and significant increase in the brain expression of all myelin basic protein (MBP) splicing isoforms. In contrast, treatment with the higher dose caused a developmental delay in MBP expression. Examination of corpus callosum at 26-days of age indicated that both buprenorphine doses cause a significant increase in the caliber of the myelinated axons. Surprisingly, these axons have a disproportionately thinner myelin sheath, suggesting alterations at the level of axon-glial interactions. Analysis of myelin associated glycoprotein (MAG) expression and glycosylation indicated that this molecule may play a crucial role in mediating these effects. Co-immunoprecipitation studies also suggested a mechanism involving a MAG-dependent activation of the Src-family tyrosine kinase Fyn. These results support the idea that opioid signaling plays an important role in regulating myelination in vivo and stress the need for further studies investigating potential effects of perinatal buprenorphine exposure on brain development.     

Pathology of toxic leucoencephalopathy in drug abuse supports hypoxic‐ischemic pathophysiology/etiology

The histopathological features of leucoencephalopathy caused by illicit drugs (such as opioids and cocaine) are well documented in acute cases but not in long‐survival cases. There are several hypotheses about the pathogenesis of this disorder, including hypoperfusion, direct drug toxicity resulting from the neurotoxic effects of the drug itself or contaminants in the illicit drug vehicle. We reviewed the post mortem findings in five males (aged 24 to 56 years, with survival intervals ranging from 7 days to 5 months) with a history of illicit drug use and concomitant fatal white matter changes. The histological characteristics of leucoencephalopathy vary with survival period. Prominent axonal injury and axonal spheroids were observed with shorter survival and spongiform changes becoming apparent with longer survival (acute and chronic incomplete infarct pattern). Necrosis was present in all cases and its appearance changed with longer survival (acute and chronic complete infarct pattern). Significant primary demyelination was not observed. These observations suggest that the primary defect in this leucoencephalopathy is hypoxic‐ischemic injury, predominantly in the white matter. Spongiform leucoencephalopathy likely represents the longer‐survival incomplete infarct pattern and is observed with polydrug abuse.     

Mental illness,physical abuse and burden of care on relatives: a study of acute psychiatric admission patients

As mental health care policies increasingly emphasize treatment and care in community settings, there has been concern over the burden that families of mentally ill people might suffer as a result. We conducted a study of the prevalence of abuse faced by relatives of patients admitted during a 6-month period to the acute psychiatric unit of a busy general hospital, who had previously been living with a relative. Patients and their relatives were assessed using semi-structured interview schedules. The experience of burden and the specific experiences of abuse since the onset of their relative's illness were recorded. In total, 32 (32%) of the 101 relatives had been struck on at least one or two occasions. Verbal abuse, threats and temper outbursts were reported by over 50% of the relatives. Principal correlates of abuse were diagnosis, concurrent drug misuse and a poor pre-morbid relationship between carer and patient.     

A genetic association study of dopamine metabolism-related genes and chronic headache with drug abuse

To assess the role of dopamine metabolism-related genes in the genetic liability to chronic headache with drug abuse (DA). We performed a genetic association study using four functional polymorphisms of the dopamine receptor 4 (DRD4), dopamine transporter (DAT), mono-amino-oxidase A (MAOA) and cathecol-O-methyl-transferase (COMT) genes in 103 patients with chronic daily headache associated with DA (CDHDA). Control samples were 117 individuals without headache or DA (controls) and 101 patients with episodic migraine without aura and without DA (MO). No differences were found at the COMT and MAOA genes among the three groups investigated. Allele 4 of DRD4 was significantly overrepresented in patients with MO compared with both controls and CDHDA. Allele 10 of the DAT gene was significantly underrepresented in patients with CDHDA when compared with the MO group. Genetic variability at the DRD4 gene is involved in the predisposition to episodic MO but not to DA, while liability to CDHDA may involve genetic variability at the DAT gene in comparison with episodic MO.     

Reversible myeloneuropathy of nitrous oxide abuse: serial electrophysiological studies

Detailed electrophysiological studies were performed in 4 patients with myeloneuropathy induced by abuse of nitrous oxide for 1 to 4 years. All presented with paresthesias, weakness, and Lhermitte's phenomena, and exhibited signs of sensorimotor polyneuropathy, ataxia, and arreflexia. Two had subnormal serum vitamin B12 levels. Baseline electrophysiologic testing revealed reduced motor unit potentials, prolonged F wave latencies, absent H reflexes, denervation potentials, and delays in motor and sensory conduction. Three had peripheral and nuchal delay after median nerve stimulation. All were reevaluated after 3 to 12 months' abstinence and treatment with vitamin B12, and all showed substantial clinical improvement. Parallel improvement in electrophysiologic findings occurred, but residual minor conduction delays, loss of H reflexes, electromyographic evidence of denervation, or abnormalities of posterior tibial SEP were noted. These findings confirm the reversibility of myeloneuropathy of nitrous oxide abuse and describe the profile of electrophysiologic recovery in subjects who abstain from further neurotoxic exposure.