Substance misuse in patients with schizophrenia: epidemiology and management

Substance misuse in individuals with schizophrenia is very common, especially in young men, in communities where use is frequent and in people receiving inpatient treatment. Problematic use occurs at very low intake levels, so that most affected people are not physically dependent (with the exception of nicotine). People with schizophrenia and substance misuse have poorer symptomatic and functional outcomes than those with schizophrenia alone. Unless there is routine screening, substance misuse is often missed in assessments. Service systems tend to be separated, with poor inter-communication, and affected patients are often excluded from services because of their comorbidity. However, effective management of these disorders requires a fully integrated approach because of the close inter-relationship of the disorders. Use of atypical antipsychotics may be especially important in this population because of growing evidence (especially on clozapine and risperidone) that nicotine smoking, alcohol misuse and possibly some other substance misuse is reduced. Several pharmacotherapies for substance misuse can be used safely in people with schizophrenia, but the evidence base is small and guidelines for their use are necessarily derived from experience in the general population.     

Modelling human drug abuse and addiction with dedicated small animal positron emission tomography

Drug addiction is a chronically relapsing brain disorder, which causes substantial harm to the addicted individual and society as a whole. Despite considerable research we still do not understand why some people appear particularly disposed to drug abuse and addiction, nor do we understand how frequently co-morbid brain disorders such as depression and attention-deficit hyperactivity disorder (ADHD) contribute causally to the emergence of addiction-like behaviour. In recent years positron emission tomography (PET) has come of age as a translational neuroimaging technique in the study of drug addiction, ADHD and other psychopathological states in humans. PET provides unparalleled quantitative assessment of the spatial distribution of radiolabelled molecules in the brain and because it is non-invasive permits longitudinal assessment of physiological parameters such as binding potential in the same subject over extended periods of time. However, whilst there are a burgeoning number of human PET experiments in ADHD and drug addiction there is presently a paucity of PET imaging studies in animals despite enormous advances in our understanding of the neurobiology of these disorders based on sophisticated animal models. This article highlights recent examples of successful cross-species convergence of findings from PET studies in the context of drug addiction and ADHD and identifies how small animal PET can more effectively be used to model complex psychiatric disorders involving at their core impaired behavioural self-control.     

Substance Use Among Women Veterans: Epidemiology to Evidence-Based Treatment

An increasing percentage of women are U.S. Military Veterans. We review the substance misuse rates and comorbidities and the risk factors for and consequences of substance use among women Veterans. Women Veterans may have higher rates of substance misuse and comorbid psychiatric and medical disorders than male Veterans and women who are not Veterans. Studies support the AUDIT-C as a scaled marker of alcohol-related risk among female Veterans, but validated drug screening instruments are needed. We discuss evidence-based approaches in terms of treating women Veterans’ substance misuse in primary and specialty care settings, along with knowledge gaps and potential research priorities to improve care in this special population.     

After the drinking stops: completed suicide in individuals with remitted alcohol use disorders

A substantial minority of suicide victims have remitted alcohol use disorders. The authors hypothesized that psychiatric disorders are likely to be present in this group to create the necessary conditions for suicide. They compared suicide victims with active alcohol use disorders and those with remitted alcohol use disorders. Using data on a community sample of suicide victims (N=141), it was determined that 39% (N=55) had a history of alcohol misuse. These subjects were categorized by alcohol use disorder status (remitted versus active) and by age (<50, > or =50), creating four cells: younger remitted (N=8), older remitted (N=9), younger active (N=22), and older active (N=16) alcohol misusers. Results comparing proportions of DSM-III-R Axis I disorders in the four groups indicated that suicide victims with remitted alcohol use disorders were predominantly younger victims with psychotic disorders or older victims with major depression. These findings have implications for identifying those at risk for suicide even after the cessation of alcohol misuse. Case examples of suicide victims with remitted alcohol use disorders-a younger woman victim with a psychotic disorder and an older man with major depression-are presented.     

The misuse and abuse of propofol

Media attention on the misuse of propofol increased significantly when the drug was implicated in the death of pop music superstar Michael Jackson in 2010. The misuse and abuse of propofol among healthcare providers has been reported worldwide, with some misuse resulting in death. Propofol policies guiding healthcare worker re-entry into the workplace after misusing propofol have received rare attention in the research literature. The paucity of information regarding propofol-specific re-entry policies suggests that little research has addressed this problem and the lack of research and policy guidance can contribute to unsafe re-entry and even death. This paper focuses on healthcare providers because they have an easy access to propofol and therefore are vulnerable to misusing or abusing the drug. To accomplish this, the pharmacology and misuse/abuse potential of propofol and the influence of the 12-step recovery paradigm in the re-entry literature are reviewed. In conclusion, existing research and policy are drawn upon to suggest employment re-entry guidelines for healthcare workers.     

Theory, method, and power in drug and HIV-prevention research: a participant-observer's critique

Why do most substance misuse and HIV-prevention researchers not practice what they preach concerning the complementarity of quantitative and qualitative methods? Why does most of the public health literature fail to address the important intellectual and political debates that substance misuse and HIV infection confronts? Why is the entire field so timid with respect to social science theory? Most drug researchers, and virtually all the anthropologists working on the subject, publicly acknowledge the need to combine quantitative and qualitative methodologies. Surprisingly, however, there are almost no successful examples of substance misuse and HIV prevention research projects that meld quantitative methods with participant-observation approaches organically. While this methodological schism also holds true for most of the social sciences more broadly, in few other fields besides that of substance misuse research is the complementarity of quantitative and qualitative methods more urgently and obviously necessary. On the one hand this methodological dialogue has practical utility for creating better public health interventions that might relieve human suffering; and on the other hand this applied dialogue has the potential for a critical, multidisciplinary, theoretical impact on academia.     

The Misuse and Abuse of Propofol

Media attention on the misuse of propofol increased significantly when the drug was implicated in the death of pop music superstar Michael Jackson in 2010. The misuse and abuse of propofol among healthcare providers has been reported worldwide, with some misuse resulting in death. Propofol policies guiding healthcare worker re-entry into the workplace after misusing propofol have received rare attention in the research literature. The paucity of information regarding propofol-specific re-entry policies suggests that little research has addressed this problem and the lack of research and policy guidance can contribute to unsafe re-entry and even death. This paper focuses on healthcare providers because they have an easy access to propofol and therefore are vulnerable to misusing or abusing the drug. To accomplish this, the pharmacology and misuse/abuse potential of propofol and the influence of the 12-step recovery paradigm in the re-entry literature are reviewed. In conclusion, existing research and policy are drawn upon to suggest employment re-entry guidelines for healthcare workers.     

Overview of Drugs Used in Treating Drug-Induced Dependence: A Treatise Interrelating Existing Hypotheses in Order to Attain Maximal Therapeutic Benefits

Despite the fact that we do not yet completely understand the physiology of physical dependence, many treatment modalities are available. In this overview, an attempt is made to discuss available treatments and mechanisms to possibly attain a better understanding of the complex interactions that occur between systems. An attempt is also made to understand interrelations between drug misuse and mental disorders as one aspect of the treatment process—the ultimate goal being more efficacious and safer therapy.     

Theory,Method, and Power in Drug and HIV-Prevention Research: A Participant-Observer's Critique

Why do most substance misuse and HIV-prevention researchers not practice what they preach concerning the complementarity of quantitative and qualitative methods? Why does most of the public health literature fail to address the important intellectual and political debates that substance misuse and HIV infection confronts? Why is the entire field so timid with respect to social science theory? Most drug researchers, and virtually all the anthropologists working on the subject, publicly acknowledge the need to combine quantitative and qualitative methodologies. Surprisingly, however, there are almost no successful examples of substance misuse and HIV prevention research projects that meld quantitative methods with participant-observation approaches organically. While this methodological schism also holds true for most of the social sciences more broadly, in few other fields besides that of substance misuse research is the complementarity of quantitative and qualitative methods more urgently and obviously necessary. On the one hand this methodological dialogue has practical utility for creating better public health interventions that might relieve human suffering; and on the other hand this applied dialogue has the potential for a critical, multi- disciplinary, theoretical impact on academia.     

关于药品不良反应与药害事件的思考

目的:正确区分药品不良反应(ADR)及与药品相关的药害事件。方法:从"齐二药"、"欣弗"事件入手,对ADR、药品安全性、药品质量事故、错误用药事故、输液反应的内涵进行概念及性质辨析,介绍判定ADR及有效减少ADR的方法。结果与结论:药源性危害不可避免,临床实践中应准确判断并积极预防,以减少药物对患者的损害;政府相关部门应尽快建立ADR伤害救济制度。     

Alcohol and other drug use disorders among older-aged people

In Australia people aged 65 years or older currently comprise 12.1% of the population. This has been estimated to rise to 24.2% by 2051. Until recently there has been relatively little research on alcohol and other drug use disorders among these individuals but, given the ageing population, this issue is likely to become of increasing importance and prominence. Epidemiological research shows a strong age-related decline in the prevalence of alcohol and other drug use disorders with age. Possible reasons for this include: age-related declines in the use and misuse of alcohol and other drugs; increased mortality among those with a lifetime history of alcohol and other drug use disorders; historical differences in exposure to and use of alcohol and other drugs. Despite the age-related decline in the prevalence of these disorders, they do still occur among those aged 65 years or older and, given historical changes in exposure to and use of illicit drugs, it likely that the prevalence of these disorders among older-aged individuals will rise. Specific issues faced by older-aged individuals with alcohol and other drug use problems are discussed. These include: interactions with prescribed medications, under-recognition and treatment of alcohol and drug problems, unintentional injury and social isolation. Finally, a brief discussion of treatment issues is provided.