Methadone Restores Local and Remote Eeg Functional Connectivity in Opioid-Dependent Patients

Currently it has been proposed that normal brain function is critically dependent upon a dynamical balance between functions of local neuronal assemblies and global integrative processes. A loss of such metastable balance in favor of either independent or hyper-ordered processing is considered as the reflection of a brain disease. It has been shown that opioid dependence can be characterized as a disease of brain metastable balance, wherein local functional connectivity (synchronicity within neuronal assemblies) increased and remote functional connectivity (synchronicity between neuronal assemblies) decreased. Since methadone may be used as a maintenance treatment for opioid-dependent patients, the aim of this research was to study how methadone would influence the temporal and metastable cortical organization through the measures of local and remote electroencephalogram (EEG) functional connectivity in six opioid-depended patients who manage to complete at least six-month methadone treatment. The present study demonstrated that average parameters of temporal and metastable organization of the cortical dynamics (indexed by local and remote EEG functional connectivity) in such opioid-dependent patients did not differ from normal values of healthy subjects. We interpret these findings as a capability of the methadone to restore a normal temporal and metastable structure of brain activity in opioid-dependent patients after many months of methadone treatment. To our knowledge, present preliminary study is the first where the influence of methadone on temporal and metastable structure of EEG activity is demonstrated.     

Use of Naltrexone to Treat Opioid Addiction in a Country in Which Methadone and Buprenorphine Are Not Available

Opioid dependence is one of the most severe drug dependencies. Naltrexone is a medication that completely blocks the subjective and other effects of opioids and, when administered to detoxified opioid addicts and taken as directed, prevents relapse and helps maintain abstinence. The major problem with naltrexone is poor compliance, particularly in countries in which there is a treatment alternative based on substitution of illicit opioids such as heroin with orally administered opioid agonists (methadone) or partial agonist/antagonists (buprenorphine). In Russia, substitution therapy is forbidden by law, and naltrexone is the only available pharmacotherapy for heroin dependence. Due to the lack of alternatives to naltrexone and stronger family control of compliance (adherence), naltrexone is more effective for relapse prevention and abstinence stabilization in Russia than in Western countries. Long-acting, sustained-release formulations (injectable and implantable) seem particularly effective compared with oral formulations. This article summarizes the results of studies conducted in Russia during the past 10 years that demonstrate these points.     

A Case of Kleptomania and Compulsive Sexual Behavior Treated with Naltrexone

Objective of this paper was to examine a possible treatment option for two disorders currently lacking agreed upon pharmacotherapeutic interventions. We report a patient fulfilling DSM-IV criteria for kleptomania with comorbid compulsive sexual behavior who failed to respond to fluoxetine, behavioral therapy, and psychotherapy, and who was therefore treated with naltrexone to reduce urges to steal and sexual urges. Treatment with high-dose naltrexone (150 mg/day) led to remission of both the patient's urges to steal and sexual urges. Discontinuation and rechallenge with the medication provides further support that improvement was due to naltrexone. Naltrexone in high doses show promise for the treatment of both kleptomania and compulsive sexual behavior.     

Mental Illness,Behavior Problems,and Social Behavior in Adults With Down Syndrome

Little is known about the behavioral characteristics of adults with Down syndrome (DS) without dementia. The main purpose of this study was to investigate the psychopathology and social behavior among adults with DS compared to adults with nonspecific intellectual disability (NSID). Thirty-four adults with DS were individually matched with 34 adults with NSID for raw scores on a task that measured nonverbal reasoning ability. Participants' caregivers completed 3 questionnaires assessing mental illness, behavior problems, and social behavior. The group with DS presented fewer difficulties associated with mental illness and behavior problems, as well as better adapted social behavior, than the group with NSID despite a similar level of nonverbal reasoning ability. Aging in the group with DS was found to be positively correlated with behavioral signs of depression and autistic symptoms. These findings highlight the specificity of the behavioral profile of adults with DS without dementia.     

Needs,Perceived Support,and Hospital Readmissions in Patients with Severe Mental Illness

People with severe mental illness have multiple and complex needs that often are not addressed. The purpose of this study was to analyse needs and support perceived and the relationship with hospital readmission. We assessed 100 patients with severe mental illness at discharge from an acute inpatient unit in terms of needs (Camberwell Assessment of Needs), clinical status (The Brief Psychiatric Rating Scale), and social functioning (Personal and Social Performance); we also followed up these patients for 1 year. The group of patients who were readmitted had more total needs than did the non-readmitted, in addition to more unmet needs, although the differences were not significant. The highest risk factor for rehospitalisation was the number of previous admissions. In addition, the help of informal carers in alleviating psychological distress was associated with the risk of readmission. The main conclusion concerns the role of the psychological support provided by informal networks in preventing readmission.     

Do Behavior Changes Herald Physical Illness in Adults with Mental Retardation?

A longitudinal study of 62 individuals with profound mental retardation was conducted to determine if direct care staff can identify behavior change prior to identifying symptoms of acute illness. Results indicate that staff were able to notice changes in sluggishness prior to the onset of illness. Self-care behavior was of borderline significance and there was no significant change in eight behavior dimensions (vocalizations, peer conflict, stereotypy, aggression, self injurious behavior, restlessness, distractibility, and depression). This finding should alert physicians and care-givers to the importance of prompt response to symptoms. Reliance on behavioral observation of direct care staff is not always sensitive enough to pick up changes in health status in less restrictive residential environments.     

Treatment Models for Treating Patients with Combined Mental Illness and Developmental Disability

The presence of co-occurring psychiatric disorders among individuals with developmental disability (DD) requires clinicians to adjust and modify standard mental health assessment and treatment planning. In particular, assessment includes input from a multi-disciplinary team and as a result, diagnosis is frequently a synthesis of data from many different points of view. Treatment planning and implementation commonly include a collection of highly specialized, individualized programs that focus on the long term management of both disorders. Crises and recurrence of mental disorders are commonplace in part due to the presence of ongoing risk and vulnerability factors for mental disorders. As a result, the need for emergency interventions, specialized respite services, hospitalization and other transition services is extensive. The quality, availability and access to these services vary considerably. Many programs are concentrated in metropolitan or university-based centers and pose hardships based on geographic distance. The availability and utilization of services is affected by political, economic, socio-cultural and psychological forces that impact both the willingness to use services and the distribution of professionals trained and qualified to manage individuals with dual diagnoses. The complex interaction between each of these factors determines the structure, function, and capacity for innovation built into current service models.     

Psychiatric and Psychosocial Correlates of Sexual Risk Behavior among Adults with Severe Mental Illness

Persons with severe mental illness (SMI) are disproportionately affected by HIV/AIDS. This study examined multivariate correlates of sexual risk among 152 adults with SMI receiving outpatient psychiatric treatment. Structured interviews assessed psychiatric, psychosocial, and behavioral risk factors. The majority was sexually active (65%), and many reported unprotected intercourse (73%), multiple partners (45%), and sex trading (21%) in the past year. Logistic regression models found that sexual behaviors were differentially associated with non-psychotic disorder, psychiatric symptoms, substance abuse, childhood sexual abuse, romantic partnership, and social support (all ps < .05). Findings underscore the need for targeted HIV prevention interventions that address psychiatric and psychosocial risk factors. Christina S. Meade is a Research Fellow at Harvard Medical School, McLean Hospital, Belmont, MA. Kathleen J. Sikkema is an Associate Professor in the Department of Epidemiology and Public Health, Yale University, New Haven, CT.     

Patients with HIV Infection and Mental Illness: A Study of Clinical Identification

We compared provider diagnosis of mental illness as noted in a chart audit to an indication of mental illness using the Revised Symptom Checklist (SCL-90R). We identified cases of correct diagnoses, over-diagnoses, and missed diagnoses of mental illness by examining mental functioning (using the SF-36). Providers over diagnosed mental illness in 23% of the cases and missed a diagnosis in 9% of the cases. The over-diagnosed group had significantly better mental functioning and the missed-diagnosis group did not have better mental functioning than those who the provider and SCL-90 agreed had mental illness. The SCL-90R had a higher correlation with mental functioning than did the providers' diagnoses, suggesting that such instruments may increase the correct detection of mental illness in the HIV population.     

Suicidal Behavior and Insight into Illness Among Patients with Schizophrenia Spectrum Disorders

The purpose of the present study was to explore the relationship between suicidal behavior and socio-demographic and clinical factors, including insight into illness, in patients with schizophrenia spectrum disorders. We evaluated 104 inpatients using the Self-Appraisal of Illness Questionnaire (SAIQ) for insight assessment, several Beck-related symptoms rating scales, and the Positive and Negative Syndrome Scale (PANSS) for psychopathology. These patients were also evaluated for suicidal behavior and risk using the critical items of the Scale for Suicide Ideation (SSI) and lifetime suicide attempts. Patients with suicidal behavior generally had greater insight into illness than those who were non-suicidal. After controlling for depressive symptoms, the association of insight into illness with current suicidal ideation remained significant, whereas the association between insight and lifetime suicide attempts was no longer significant. As predicted, the regression analyses revealed that those with greater suicide risk had significantly higher levels of depressive symptoms and hopelessness and more lifetime suicide attempts. Moreover, greater insight into illness appeared to have a close, independent connection to suicidal behavior. Our findings suggest that depression, hopelessness, and greater insight into illness are major risk factors for suicide in patients with schizophrenia. It is plausible that depression mediates the relationship between greater insight into illness and suicidal behavior. Aggressive improvement of insight without the risk of deteriorating depressive symptoms may be warranted to reduce the risk of suicide.     

Relapse Risk Factors in Heroin Addicts Treated with Naltrexone and Naltrexone-Behavioural Psychotherapy

To construct a successful treatment model for heroin addiction, it is important to define factors that contribute to relapse. In this translational ambidirectional cohort study, we evaluated 2 groups of heroin addicts that underwent the same therapeutic procedures with different outcomes (133 abstainers and 56 relapsers). The study found a new variable, “relapse marker”, defined by the synergy of the following factors: (a) non-use of tramadol before treatment (p < 0.0005), (b) absence of sense of loss of control over behaviour as a motive for treatment initiation (p = 0.048), (c) use of benzodiazepines in recovery (p < 0.0005), (d) substituting heroin addiction with gambling (p < 0.009), e) younger age (p = 0.012), and (f) explicit parental demand as a treatment motive (p = 0.040). This study reports a mathematical model that predicts relapse and inability to sustain stable abstinence as an outcome of heroin addiction treatment.     

Working Alliance in Patients with Severe Mental Illness Who Need a Crisis Intervention Plan

Working alliance has been characterized as an important predictor of positive treatment outcomes. We examined whether illness insight, psychosocial functioning, social support and locus of control were associated with working alliance as perceived by both patient and clinician. We assessed 195 outpatients with psychotic or bipolar disorders. Our findings indicated that patients rated the alliance more positively when they experienced a greater need for treatment, fewer behavioral and social problems, and more psychiatric symptoms. Clinicians rated the alliance more positively in patients who reported fewer social problems and better illness insight. Patients’ demographic characteristics, including being female and married, were also positively related to the clinician-rated alliance. Our results suggest that patients and clinicians have divergent perceptions of the alliance. Clinicians may need help developing awareness of the goals and tasks of patients with certain characteristics, i.e., singles, men, those with poor illness insight and those who report poor social functioning.     

Reconstructing a Sense of Self in Patients With Chronic Mental Illness

TOPIC. The loss and reconstruction of self in patients with a chronic mental illness.
PURPOSE. To describe the loss of self and its reconstruction.
SOURCES. The authors' own clinical work and review of the literature.
CONCLUSIONS. Nurses can help patients who have undergone a loss of self to discover a more active sense of self, take stock of the self, put the self into action, and use the enhanced self as a refuge. This process involves the fostering of hope.     

Cost Analysis of Community Based Family Support of Patients with Severe Mental Illness

Community-based family support is a new option to patients with severe mental illness in which the patient and a volunteer family meet on a regular basic. This study examined whether this support could reduce patients’ use of psychiatric services. This matched case-control study included 86 patients with severe mental illness. 40 patients were offered the intervention: community-based family support intervention. Patients’ use of psychiatric hospital services was followed from 2 years before to 2 years after the intervention using a difference-in-difference analytical approach. Although community-based family support seemed to reduce hospital admission, the reduction in cost did not compensate the cost of the programme. However, this does not rule out the potential cost effectiveness, and future studies should assess the clinical benefits and cost effectiveness of community-based family support. The present study does not provide sufficient basis for recommending the general implementation of community-based family support.