Prevalence of executive dysfunction in cocaine, heroin and alcohol users enrolled in therapeutic communities

Many studies have observed relevant executive alterations in polysubstance users but no data have been generated in terms of prevalence of these alterations. Studies of the prevalence of neuropsychological impairment can be useful in the design and implementations of interventional programs for substance abusers. The present study was conducted to estimate the prevalence of neuropsychological impairment in different components of executive functions in polysubstance users enrolled in therapeutic communities. Moreover, we estimated the effect size of the differences in the executive performance between polysubstance users and non substance users in order to know which neuropsychological tasks can be useful to detect alterations in the executive functions. Study results showed a high prevalence of executive function impairment in polysubstance users. Working memory was the component with the highest impairment proportion, followed by fluency, shifting, planning, multi-tasking and interference. Comparisons between user groups showed very similar executive impairment prevalence for all the analyzed executive components. The best discriminating task between users and controls was Arithmetic (Wechsler Adult Intelligence Scale, WAIS-III). Moreover FAS and Ruff Figural Fluency Test was discriminating for fluency, Category Test for shifting, Stroop Colour-Word Interference Test for interference, Zoo Map (Behavioural Assessment of the Dysexecutive Syndrome, BADS) for planning and Six Elements (BADS) for multi-tasking. The existence of significant prevalence of executive impairment in polysubstance users reveals the need to redirect the actuation policies in the field of drug-dependency towards the creation of treatments addressed at the executive deficits of the participants, which in turn would facilitate the individuals' compliance and final rehabilitation.     

帕金森病伴发抑郁患者认知功能调查和P300相关性研究

目的探讨帕金森病伴发抑郁患者认知功能损害及与P300相关性分析。方法对92例PD患者进行汉密尔顿抑郁量表测评,分为PD抑郁组和PD非抑郁组,采用韦氏成人智力量表分别对两组患者及正常对照组患者进行认知功能评定并同时进行P300测试。结果 PD患者韦氏成人智力量表各项得分均低于正常对照组,伴有抑郁的PD患者得分降低更为明显。与正常对照组相比PD患者P300潜伏期延长,波幅降低,伴有抑郁的PD患者潜伏期延长,波幅降低更为明显。PD伴抑郁组P300潜伏期与VIQ、PIQ、FIQ呈显著负相关,P300波幅与VIQ、PIQ、FIQ呈显著正相关。结论 PD患者存在认知功能障碍,抑郁对认知功能产生负面影响。联合P300检测及韦氏成人智力量表测试,可以更好的反映PD患者的认知功能障碍及特点,为早期干预与及时治疗提供合理依据。     

Mood and neuropsychological changes in women with midlife depression treated with escitalopram

OBJECTIVE: This study assessed mood and neuropsychological function in a population of middle-aged women with major depressive disorder treated with escitalopram. METHODS: Psychometric data measuring severity of depression were collected from 19 women and neuropsychological data were collected from 17 women aged between 45 and 65 years with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depression in a study in the Behavioral Neuroendocrinology Program at the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine. All women were treated with escitalopram in an open-label design. Mean age was 55.94 years and mean number of years of education was 16.36 years. Diagnosis of major depressive disorder was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and mood was evaluated with the 21-item Hamilton Depression Rating Scale (HAM-D) at baseline and at weekly follow-ups for 12 weeks. Cognition was assessed at baseline and 3 months after treatment using a neuropsychological test battery, which included an abbreviated measure of Full Scale Intelligence Quotient, measures of attention and processing speed, verbal and nonverbal memory, executive functioning, and verbal fluency. Self-report data were collected on current menopause status and current hormone therapy use in the postmenopausal women. Paired sample t tests were used to analyze the change in total HAM-D scores and neuropsychological variables. RESULTS: Statistically significant improvements were found in total HAM-D score, Wechsler Memory Scale III Logical Memory 1st Recall, I, and II scores, Wechsler Memory Scale III Visual Reproduction I scores, and Trail Making Test Part B scores. There was a statistically significant decrease in Controlled Oral Word Association Test FAS scores. CONCLUSIONS: Treatment of depression with escitalopram in a population of middle-aged women was shown to improve mood and cognitive efficiency in complex attention, short- and long-term recall of contextual information, short-term recall of visual information, and cognitive flexibility; however, it was shown to worsen phonemic fluency.     

酒依赖患者乙醇脱氢酶不同基因型与认知功能受损关系的研究

目的：研究酒依赖患者乙醇脱氢酶2不同基因型（ADH2＊1／ADH2＊1（野生型）、ADH2＊1／ADH2＊2（杂合型）、ADH2＊2／ADH2＊2（突变型））患者认知功能受损状况。方法：分别应用韦氏成人智力量表和韦氏记忆量表对107例酒依赖患者进行智力和记忆功能评定,对不同基因型患者认知受损的状况进行比较。结果：突变型患者智商、记忆商均显著低于野生型及杂合型。结论：突变型酒依赖患者认知功能受损更加严重。     

Effect of age, sex, drinking history and antisocial personality on neuropsychology of alcoholics

The effects of age, sex, drinking history and the presence of antisocial personality (ASP) on the Wechsler Adult Intelligence Scale (WAIS) and Halstead-Reitan Neuropsychological Test Battery subtest scores of alcoholics were examined. Subjects (172 men and 72 women) were recruited from three inpatient alcoholism treatment facilities in the Hartford area and were evaluated approximately 1 week after admission. Brain Age Quotients (BAQ) were computed for each subject. The mean BAQ score for the total sample (84.1) was slightly more than one standard deviation below the normative value. Performance on the WAIS was within normal limits for both verbal and performance IQ. Scores on the Halstead-Reitan Battery showed evidence of moderate levels of impairment. Age was found to be the most significant factor affecting neuropsychological performance. It was observed that alcoholic subjects under 40 years of age performed at the lower end of the normal range of performance; older subjects showed mild to moderately severe levels of impairment. Significant interactional effects were observed between age, amount of alcohol consumed and sex for Tactual Performance Test total time. The presence of ASP interacted with sex to affect performance on Block Design and the Category Test such that ASP men performed at higher levels and ASP women at lower levels than their non-ASP counterparts. The ASP diagnosis also interacted with alcohol consumption to affect scores on Block Design. Possible explanations of these findings are discussed.     

Cognitive deficit in middle-aged alcoholics

Two groups of male alcoholics with mean ages of 44 and 55 and two groups of matched control subjects were tested twice, one year apart. Comparisons on verbal and adaptive ability factors derived from the Wechsler Intelligence Scale and selected Halstead-Reitan neuropsychological tests found no differences on verbal abilities. Significant improvement for the younger alcoholics on retesting indicates that previous comparisons of the neuropsychological effect of aging and alcoholism may not have sufficiently taken into account the reversibility of an alcoholic deficit. For the age range studied here, it may be only older alcoholics who appear different from control subjects.     

奎硫平与氯氮平对精神分裂症患者疗效及认知功能的影响

目的探讨奎硫平与氯氮平对精神分裂症患者疗效及认知功能的影响。方法符合CCMD-3诊断标准的精神分裂症患者100例,随机分为奎硫平组（50例）,氯氮平组（50例）,疗程8周。治疗前及8周末分别进行韦氏成人智力量表（WAIS-R）、韦氏记忆量表（WMS）和威斯康星卡片分类测验（WCST）。结果治疗前患者均有认知功能损害,8周后奎硫平与氯氮平两组患者成绩均明显提高。而奎硫平组的改善明显优于氯氮平组。结论认知功能损害是精神分裂症的原发症状之一,奎硫平对其治疗优于氯氮平。     

氯胺酮滥用者认知功能障碍的临床研究

目的：探讨氯胺酮滥用者认知功能损害状况及其影响因素。方法：回顾性地分析46例住院患者的临床资料,并对韦氏记忆测验的记忆商洲Q）和韦氏成人智力测验的智商（100水平与31名正常对照组进行比较。结果：氯胺酮滥用者的MQ平均为85．4±8．4,总智商（FIQ）为8514±9．0,均显著低于对照组。滥用者MQ在临界及以下水平者为47．8％,FIQ在临界及以下水平者占43．5％。滥用者MQ异常组年龄平均21．9±3．8岁,显著小于RQ正常组。结论：氯胺酮滥用者存在明显的认知功能损害,年龄较小者的MQ易受损害。     

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.     

Antisocial personality disorder, HIV risk behavior and retention in methadone maintenance therapy

In a sample of 55 consecutive methadone maintenance admissions to our clinic, 42% were diagnosed with antisocial personality disorder (ASPD) using the National Institute of Mental Health Diagnostic Interview Schedule NIMH DIS. Individuals with ASPD exhibited greater risk for HIV infection as defined by more sexual contacts, needle use and equipment sharing. Data at 1 year follow-up were obtained on this group of patients. The objective was to compare the ASPD and non-ASPD groups with regards to demographics, drug abuse history, outcome and retention in treatment. There were no significant differences between the groups on any demographic or treatment outcome variables. Survival analysis indicated that there were no group differences in treatment retention. In conclusion, although there were no differences in treatment outcome between ASPD and non-ASPD groups it is possible that ASPD patients who drop out of treatment will be at higher risk for contracting and spreading HIV within the IV drug using population. These data also suggest that in this population the diagnosis of ASPD using primarily behavioral traits as measured in the NIMH-DIS-III, has little utility in predicting treatment outcome.     

Sociopathy, gender, and treatment outcome among outpatient substance abusers

Antisocial personality disorder (ASPD) may predict poor prognosis but gender/sociopathy relationships to prognosis remain unclear. This study investigated the effects of ASPD upon psychiatric and substance-related outcomes among 235 addiction treatment center outpatients. Prevalence rates for ASPD were similar for males (16%) and females (22%). At baseline, women and ASPD patients displayed greater substance-related and psychiatric severity. At 6-month follow-up, ASPD patients had greater severity on both measures than did patients without ASPD, but women now had equivalent psychiatric severity to men. After controlling for initial severity, ASPD was related to worse substance-related outcomes, but not to worse psychiatric outcomes.     

Neurobehavioral functioning in children exposed to narcotics in utero

The neuropsychological and behavioral status of children exposed to narcotics in utero was investigated using the Wechsler Intelligence Scale for Children-Revised, the Bender-Gestalt, the Quick Neurological Screening Test, and the Burks Behavior Rating Scales. The narcotic-exposed children scored significantly lower than control children on Performance and Full-Scale IQs and most of the performance subtests. They scored significantly in the more pathological direction on Hand Skill, Figure Recognition and Reproduction, and Behavioral Irregularities. The narcotic-exposed children were significantly lower on the neurological indicators of the Bender-Gestalt. They scored significantly in the more pathological direction on almost all of the behavioral variables. The children exposed to methadone in utero scored in the more pathological direction than those exposed to heroin so as to raise questions directed toward the societal and ethical implications of methadone treatment.     

Attention and memory in illicit amphetamine users: comparison with non-drug-using controls

The purpose of this study was to clarify the extent of neuropsychological impairment previously found among amphetamine users (McKetin and Mattick, 1997) by comparing them with a non-drug-using control group. Amphetamine users who were classified as low dependence (n=15) or high dependence (n=11) according to the severity of dependence scale (SDS) were compared to non-drug-using control subjects (n=9) on indices of the Wechsler Memory Scale-Revised (WMS-R). Dependent amphetamine users (high dependence group) performed approximately one half of a standard deviation worse than controls on the verbal memory, attention/concentration and delayed recall indices of the WMS-R but amphetamine users who were less dependent (low dependence group) showed no impairment.     

Impact of contrast sensitivity performance on visually presented neurobehavioral tests in mercury-exposed children

Presentation of neuropsychological tests on a computer screen may involve a visual challenge to the examinee. The possible need for adjustment for visual contrast sensitivity on test performance was therefore determined from data on 917 mercury-exposed children who were examined at age 7 years. Contrast sensitivity was found to be associated with performance on the computer-assisted Continuous Performance Test. However, it showed similar associations with performance on traditional pencil-and-paper tests, especially Bender Visual Motor Gestalt Test and Wechsler Intelligence Scale for Children-Revised (WISC-R) Block Designs. Contrast sensitivity was not associated with prenatal mercury exposure, and adjustment for visual function had only a negligible effect on the regression coefficients for mercury as predictor of neuropsychological deficits. The mercury-associated neurobehavioral deficits are therefore unlikely to be due to mercury-induced visual system dysfunction causing secondary deficits in cognitive domain testing. Visuospatial processing appears to be a determinant in contrast sensitivity performance, and careful consideration of whether to control for contrast sensitivity in future studies of neurotoxicant effects is therefore recommended.     

Disturbances in recent memory and behavioural changes caused by the treatment with intraventricular morphine administration (IVM) in severe cancer pain

The present study involves 20 patients with severe pain due to cancer, who were no longer in a position to receive pain relief from optimised doses of oral opioids. Thus, pain relief and satisfaction were compared with pain therapy and some aspects of the patients' neuropsychological functioning, i.e. recent memory and behavioural changes, during treatment with intraventricular administered morphine (IVM) as daily repeated doses (0·25–1 mg morphine injection) were estimated. These neuropsychological phenomena were investigated with a test-battery that examined recent memory, and included verbal/nonverbal subtests, namely the NAI-Figuren and the Wechsler Memory Scale tests, as well as a pilot test constructed by the author. The results suggested that the morphine injection caused disturbances in recent memory and provoked some behavioural changes. Low pain scores and high pain relief scores could also indicate that the treatment modality of morphine injection provided effective pain control. Nevertheless, relatively low scores were recorded in testing recent memory (numeric, verbal, visuospatial), vigilance, attention and processing. The pilot test proved to yield consistent result, in proximity to those of the Wechsler test. In conclusion, IVM administration seemed to be a simple and safe method for palliation of intractable cancer pain, but simultaneously caused significant memory and behavioural disturbances by interacting with different subtypes of receptors that belong to the opioid family. © 1998 John Wiley & Sons, Ltd.     

Relationships between neuropsychological and psychopathological dimensions in male alcoholics

A study was conducted of the relationships between psychopathology and neuropsychological deficit in chronic alcoholic patients who had received the Minnesota Multiphasic Personality Inventory (MMPI), the Halstead-Reitan Neuropsychological Test Battery, and the Wechsler Adult Intelligence Scale (WAIS). Classification of the MMPIs by code type resulted in the formation of groups of 10 subjects with normal MMPIs, 19 subjects with MMPI profiles suggestive of depression, and 10 subjects with profiles suggestive of psychosis. Analysis of covariance was performed for various Halstead-Reitan scores; the only significant findings emerged for several of the verbal subtests of the WAIS. The group with psychotic MMPIs did substantially more poorly on these measures than the other groups. It was concluded that depressed alcoholics do not show greater neuropsychological deficit than do individuals with no significant psychopathology other than alcoholism. However, alcoholics with MMPI profiles that suggest psychosis differ from the other groups studied with regard to certain verbal abilities.     

Neuroendocrine and behavioural responses to opioid receptor-antagonist during heroin detoxification: relationship with personality traits

The present study investigated clinical, cardiovascular and neuroendocrine consequences of rapid opioid detoxification (ROD) in heroin-dependent individuals, affected, or not, by comorbid antisocial personality disorder (ASPD). Thirty-two patients underwent ROD and subsequent treatment with daily naltrexone: 3 days detoxification procedures were performed utilizing clonidine, baclofen, oxazepam and ketoprofene, without anaesthesia. Withdrawal symptoms, mood changes, cardiovascular indexes (heart rate, blood pressure), norepinephrine (NE), epinephrine (EPI), adrenocorticotropic hormone (ACTH) and cortisol (CORT) were evaluated during naloxone-naltrexone administration on the second day of detoxification treatment. The patients were divided into two groups following DSM-IV criteria for ASPD. Group A comprised 14 ASPD patients and group B comprised 18 patients without ASPD. Slight and transient withdrawal symptoms and mood changes were demonstrated on the second day in the whole sample of patients, in association with a significant, but moderate, elevation of heart rate, blood pressure, NE (two-fold), EPI (five-fold), ACTH (two-fold) and CORT (two-fold) plasma levels, in response to opioid receptor-antagonist administration. When evaluated separately in ASPD (group A) and non-ASPD patients (group B), significantly higher withdrawal symptoms and mood changes, heart rate, blood pressure, NE, ACTH and cortisol levels were observed in ASPD subjects. By contrast, no differences were found in EPI responses to naloxone-naltrexone administration between group A and B patients. The significant differences demonstrated in clinical and neuroendocrine responses to opioid receptor-antagonist administration, in relation to personality traits, could be due to reduced alpha-adrenergic receptor sensitivity, which was previously reported in ASPD, with a possible impairment of clonidine action. Our study suggests that a detailed diagnostic assessment before detoxification procedure may help to predict treatment outcome.     

Determining clinically meaningful cognitive impairment following traumatic brain injury.

AIMS: To study the reliability and validity of ratings of: neuropsychological impairment with test data from traumatically brain-injured patients. METHODS: Neuropsychological test results from 66 traumatically brain-injured adults and 27 orthopaedic controls were rated for neuropsychological impairment by an experienced neuropsychologist and three undergraduate students provided with brief training in test interpretation. Ratings were based on the discrepancy between a patient's current cognitive level and their estimated premorbid cognitive level. Decision making rules were utilised in making the ratings. The raters, who were blind with respect to the patients diagnostic group membership, independently rated test results. Test results were rerated using the same method approximately two weeks later. RESULTS: The ratings of novice raters were in good to very good agreement with the ratings of an expert. All raters evidenced very good to excellent test-retest reliability. Higher rates of neuropsychological impairment were found in the traumatically brain-injured group than in the orthopaedic control group. Discriminant function analysis suggested that raters employed information from all neuropsychological measures (with the exception of current intellectual level), in making their overall ratings of neuropsychological impairment. CONCLUSION: These findings provide encouraging preliminary evidence in support of the reliability and validity of individual case-based ratings of neuropsychological impairment. The high false positive rate in the control sample may reflect the relatively low specificity of neuropsychological impairment.     

Use of the Dementia Rating Scale as a test for neuropsychological dysfunction in HIV-positive i.v. drug abusers.

Intravenous drug abusers (IVDAs) represent an increasing proportion of the HIV epidemic. Forty-three IVDA's (22 HIV-negative, 21 HIV-positive) were studied using the Mattis Dementia Rating Scale (DRS). All subjects had used intravenous heroin, but reported that they were drug-free at the time of testing. HIV-positive subjects were predominantly symptomatic and were dichotomized into AIDS and non-AIDS groups. All subjects with abnormal DRS scores were HIV-positive (57% of all HIV-positives). All HIV-negative subjects had normal DRS scores while 43% of the positive group obtained such scores. The DRS reliably identifies neuropsychological impairment, and may be a useful screening tool in this population.     

Conduct disorder, antisocial personality disorder and substance use disorders in schizophrenia and major affective disorders

OBJECTIVE: To examine the relationships between childhood conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (substance abuse or substance dependence) in psychiatric patients with severe mental illness. METHOD: Substance use-related problems on screening instruments, lifetime and recent prevalence of substance use disorders, and family history of substance use disorder were evaluated in four groups of 293 patients with mainly schizophrenia-spectrum and major affective disorders: No ASPD/CD, CD Only, Adult ASPD Only, Full ASPD. RESULTS: Full ASPD was strongly related to all measures of substance use problems and disorders, as well as fathers' history of substance use disorder. The odds ratios for Full ASPD and substance use disorders ranged between 3.96 (lifetime cannabis use disorder) to 11.35 (recent cocaine use disorder). To a lesser extent, patients with CD Only or Adult ASPD Only were also at increased risk for having substance use disorders compared to the No ASPD/CD patients. CONCLUSIONS: Childhood CD and adult ASPD represent significant risk factors for substance use disorders in patients with schizophrenia-spectrum and major affective disorders. Considering other research indicating that CD and ASPD have a higher prevalence in patients with severe mental illness, the present findings suggest that CD and ASPD could reflect a common factor that independently increases patients' vulnerability to both psychiatric and substance use disorders.