Patterns of drug use among drug misusers in Sweden. Gender differences

The goal of the article is to provide information about polydrug abuse and drug misuse patterns in Sweden among women and men. The data has been taken from a 1998 national survey of "Heavy"/severe drug misuse in Sweden, project "MAX-98" (Olsson, Adamsson-Wahren, & Byqvist, 2001). The drug misusers were reported by various government agencies, including health services, social services, police, and correctional treatment facilities on a special form. One of the significant gender differences that emerged was that a greater percent of the women in the survey used and injected amphetamines, injected opiates, and used tranquilizers/sedatives, while a greater percent of the men smoked cannabis, smoked heroin, and misused alcohol. Furthermore, the most common combinations for both genders was amphetamines + cannabis, followed by amphetamines + heroin + cannabis. Alcohol played a large role for the narcotics users. Heroin as a primary drug has grown in the age groups under 35. The trends document that the use of ecstasy as well as chemical CNS-stimulating/hallucinogenic drugs has grown, that polydrug use has increased compared with earlier surveys, and that the methods of ingestion have changed. It is therefore more precise today to speak of different types of polydrug users than about users of exclusively one drug.     

Patterns of smoking and methadone dose in drug treatment patients

Cigarette smoking prevalence is very high, and cessation rates are very low, among people in methadone treatment. This may in part be due to interactions between methadone administration and cigarette smoking. The present study explores relationships between methadone dose timing and smoking rates. Twenty methadone patients, over a period of 19 days, used electronic cigarette packs to record their smoking patterns and called a voice mailbox daily to report their methadone dose and timing. The average proportion of daily cigarettes smoked was calculated for 2-hr blocks preceding and following methadone dose administration. For all participants, peak smoking rates occurred after methadone administration. Participants smoked a greater proportion of cigarettes in their first 2-hr block after methadone dosing (M = 0.368, SD = 0.135) than during their first 2-hr block of smoking of the day (M = 0.245, SD = 0.010; S = 85.5, p < .0001). The proportion of cigarettes smoked increased by 0.02 from more than 2 hr before methadone to the 2-hr time block before methadone, by 0.04 from the 2-hr time block before methadone to the 2-hr time block after methadone, and by 0.015 from the 2-hr time block after methadone to the next 2-hr time block. From this time block (2-4 hr after methadone), smoking decreased by 0.02 in the 4-plus hr postmethadone dose. All of these changes were statistically significant. Future research should use experimental designs to better examine whether a causal relationship exists and examine the impact of other types of opioid maintenance medications on smoking patterns.     

Prolactin response to nemonapride,a new antipsychotic drug,in schizophrenic patients

The prolactin response to nemonapride, a new antipsychotic drug, was studied in 27 schizophrenic inpatients (12 males, 15 females). The daily dose of nemonapride was 18 mg/day, and the duration of treatment was 3 weeks. Plasma prolactin concentrations were measured by enzyme immunoassay. Nemonapride treatment significantly (p<0·01) increased prolactin concentrations at each week in both genders. The Δprolactin (the mean concentration during 3 weeks minus the pretreatment concentration) was significantly (p<0·01) greater in females (mean± SD, 81·6±57·8 ng/ml) than males (34·9±19·8 ng/ml). The present study thus shows that nemonapride treatment markedly increases prolactin concentrations in schizophrenic patients, with greater responses in females than males, suggesting a strong D2 receptor blockade property of the drug. © 1997 John Wiley & Sons, Ltd.     

Age standardisation of drug utilisation: comparisons of different methods using cardiovascular drug data from Sweden and Spain

In drug utilisation studies, the units of defined daily doses (DDD) and DDD/1000 inhabitants per day standardise for differences in dosage and population size, but not for age-related differences in drug utilisation. There is no consensus as to how age standardisation of DDD data should be carried out. Using cardiovascular drug utilisation data from Sweden and Spain, the current study compared the outcome of different methods of age standardisation. Both indirect methods (based on a comparison of observed and expected drug usage) and direct methods (using different weighting for the age categories) were used.The largest impact of standardisation was seen for diuretics. The crude rate for men and women combined was 26 DDD/1000 inhabitants per day in Costa de Ponent and 98 DDD/1000 inhabitants per day in Värmland. The corresponding figures when standardising the Costa de Ponent population were 26 and 58, respectively. Using the equivalent average rate (EAR) method, the rate for Värmland was 129 DDD/1000 inhabitants per day. Lesser but still important differences were found for -adrenoceptor and antihypertensives.Thus, the results of standardisation differ depending on which method is used and which drugs are evaluated. EAR is recommended for direct standardisation because of its ease of use and because it does not require the choice of a standard population.     

Methadone treatment in Spain, 1994.

The objective of this study was to describe the methadone treatment (MT) network in Spain, and to evaluate compliance with criteria known to influence the spread of human immunodeficiency virus (HIV). During the last 3 months of 1994, a mailed questionnaire was sent to the coordinators of all methadone treatment centers in Spain. A total of 224 centers completed the questionnaire (90% response rate). The total number of patients receiving MT in the studied centers was 13,402. Their mean age was 29 years, 79% were male, and approximately 60% were HIV positive. The rate of patients in MT varied by Region (mean: 6.7 patients in MT per 10,000 inhabitants). Although the global mean of reported daily dose of methadone was 60 mg, in 44% of the centers it was lower than that. Despite the high number of centers involved with MT in Spain, the coverage by regions is unequal. Studied centers revealed only a moderate adherence to procedures considered to be effective in HIV prevention. Given the magnitude of HIV infection in Spain, there is a clear need for improvement.     

Patterns of drug use and expectations in methadone patients

Expectations about future behavior have been shown to have a positive relationship with subsequent behavior. For patients in drug treatment, recovery should manifest changes in drug use and in cognitive perceptions of being able to refrain from use. The present study identified latent patterns of the longitudinal relationship between drug use expectation and illegal drug use during treatment. Latent variable mixture modeling identified three patterns of change over successive 3-month intervals during treatment: Improvers (48%), Decliners (33%), and Continuing Users (19%). The sample consisted of 497 patients in community-based outpatient methadone treatment. The utility of the latent patterns was shown through their relationship to treatment engagement, where Continuing Users had lower counseling rapport and time in treatment. These latent patterns also differed on drug use measures at follow-up. Additional analyses of expectations with measures of opioid use, cocaine use, or criminality yielded similar latent patterns. Expectations about future drug use were found to be a useful measure of cognitive change corresponding to drug use change. Its potential as a brief treatment management tool is noted.     

Fluspirilene in the treatment of non-hospitalized schizophrenic patients

A study was carried out to assess the efficacy of fluspirilene, a long-acting psychotropic agent, in the treatment of 29 non-hospitalized schizophrenic patients. Patients received an initial weekly injection of 6 mg to 10 mg fluspirlene, depending on the severity of the illness, and this was increased by 2 mg weekly as necessary to achieve control without side-effects. The mean weekly dose after stabilization was 9.2 +/- 3.4 mg (range 6 mg to 20 mg). Global assessment of patients' response to treatment showed a significant improvement in schizophrenic symptoms within 4 weeks in 20 of the 29 patients, and in 24 of 29 by the end of the 12-week trial period. Four patients were unable to be controlled in the community and were admitted to hospital. Side-effects were minimal and led to withdrawal of treatment in only 1 patient. It is suggested that fluspirilene is a useful drug in the treatment of schizophrenics without having to admit them to hospital initially.     

Fluspirilene in the treatment of non-hospitalized schizophrenic patients

Summary

A study was carried out to assess the efficacy of fluspirilene, a long-acting psychotropic agent, in the treatment of 29 non-hospitalized schizophrenic patients. Patients received an initial weekly injection of 6 mg to 10 mgfluspirilene, depending on the severity of the illness, and this was increased by 2 mg weekly as necessary to achieve control without side-effects. The mean weekly dose after stabilization was 9.2±3.4 mg (range 6 mg to 20?mg). Global assessment of patients' response to treatment showed a significant improvement in schizophrenic symptoms within 4 weeks in 20 of the 29 patients, and in 24 of 29 by the end of the 12-week trial period. Four patients were unable to be controlled in the community and were admitted to hospital. Side-effects were minimal and led to withdrawal of treatment in only 1 patient. It is suggested that fluspirilene is a useful drug in the treatment of schizophrenics without having to admit them to hospital initially.     

Patterns in the drug treatment of hypertension in Auckland, 1982-7

This paper examines the pattern of drug treatment of hypertension in Auckland in the period 1982 to 1987 using data from a representative sample of the adult population interviewed in 1982 and followed up in 1987. In 1982 the age standardised prevalence of antihypertensive treatment for people aged 40-64 years was 12.2% (95%Cl 10.4, 14.0) and in 1987 it was 10.2% (95%Cl 8.5, 11.8). Over the five year period of this study, 6% of the sample untreated in 1982 began treatment with antihypertensive medication, while 24% of those on drugs in 1982 had stopped treatment by 1987. The most common medications used in both 1982 and 1987 for hypertension were diuretics and beta blockers. Over the five year period diuretic use fell and beta blocker use remained constant. In 1982 3% of hypertensives were taking a calcium antagonist but in 1987 13% were on these drugs and a further 13% were using ACE inhibitors. This study suggests that the prevalence of drug treatment for hypertension has plateaued in New Zealand; coincidentally there is a trend towards use of more expensive drugs.     

健康教育对分裂症患者服药依从性作用

目的探讨个体化健康教育对提高分裂症患者服药依从性作用。方法将212例分裂症患者随机分对照组和研究组,对研究组患者进行了个体化健康教育,观察研究组分裂症患者服药依从性情况。结果进行个体化健康教育的分裂症患者维持服药情况明显好于对照组。结论个体化健康教育明显提高分裂症患者服药依从性。     

Pimozide in the treatment of newly admitted schizophrenic patients

Pimozide, a specific dopamine blocking agent, was compared with chlorpromazine in a 4-week double-blind study of the treatment of 40 schizophrenic patients newly admitted to hospital through the emergency room. Dosage was adjusted according to therapeutic effect and during the final week ranged from 10–70 mg/day (median 30 mg/day) for pimozide and 600–1,500 mg/day (median 900 mg/day) for chlorpromazine. Pimozide was found to exert somewhat less of an overall therapeutic effect than chlorpromazine, particularly in highly agitated patients. Women responded better to either treatment than men. A weighted mean of the doses given to male and female patients during the final week suggests that in the treatment of acutely ill patients the mg dose equivalency of pimozide in terms of chlorpromazine is approximately 1:25, considerably lower than estimates from maintenance studies. Pimozide induced significantly more parkinsonian symptoms but less autonomic side effects than chlorpromazine. It is suggested that the weaker presynaptic dopamine blocking effect of pimozide might be responsible for its reduced potency in the treatment of acute schizophrenic symptoms.Presented at the 132nd Annual Meeting of the American Psychiatric Association, Chicago, Illinois, May 12–15, 1979     

Clozapine, risperidone, olanzapine, and conventional antipsychotic drug effects on glucose, lipids, and leptin in schizophrenic patients

Some reports have indicated increased rates of diabetes and increased prevalence of glucose and lipid abnormalities during treatment with second-generation antipsychotics, with most concern raised about clozapine and olanzapine. Most of the findings have come from case reports, retrospective examination of laboratory values, and analysis of health-care claims databases. This study investigated fasting levels of glucose, lipids, and leptin in a non-randomized, cross- sectional study of 210 patients, with schizophrenic or schizoaffective disorder, treated with a single antipsychotic medication - clozapine, risperidone, olanzapine, or a conventional antipsychotic. Glucose tolerance tests (GTT), with a 75-g glucose load, were preformed in a subset of patients. In this sample most mean fasting glucose and lipid levels were within the normal range and were not significantly different across the four drug treatment groups. Patients treated with clozapine and olanzapine had higher triglyceride levels than risperidone patients. In patients receiving a GTT, risperidone-treated patients had higher glucose levels at 1 h than patients treated with olanzapine, and there were more patients on risperidone who met American Diabetes Association glucose metabolic criteria for diagnosis of diabetes. Although there were no significant differences in age or body mass index among the four drug groups, we cannot rule out some potential biasing factors we did not assess which could potentially influence our results. These include unknown physician preference in drug selection based on their beliefs about the weight-inducing or diabetes potential of different antipsychotics, differences in visceral fat, and differences in patients' antipsychotic drug history.     

Penfluridol, a peroral long-acting neuroleptic, for the maintenance treatment of schizophrenic patients who relapse.

In a multicenter collaborative study, 28 newly readmitted schizophrenic patients, stabilized for one week on short-acting neuroleptic drugs, had their medication abruptly changed to penfluridol given once a week on an outpatient basis. The average dose required for maintenance was approximately 40 mg weekly. Analysis of BPRS evaluations carried out during the 16-week trial revealed a significant linear trend toward further improvement. Social functioning, as measured by the KAS questionnaire in the outpatient period of the trial, also revealed a significant linear trend toward improvement. Significant worsening was not found with any psychometric evaluation. Side effects, when observed, were neither frequent nor severe. Three laboratory and vital sign values showed significant changes: increase in BUN concentrations, decrease in pulse rate, and increase in body weight. The changes in weight and pulse appeared to be within relatively normal ranges, and the increase in BUN concentrations did not appear to be clinically significant. During the first part of a long-term study, penfluridol received a high degree of patient acceptability and is a welcome addition to the maintenance treatment of schizophrenia.     

Antipsychotic treatment and sexual functioning in first-time neuroleptic-treated schizophrenic patients

The present study examined sexual functioning among first-time treated schizophrenia patients at the time that they initiated antipsychotic treatment, and again 3 and 6 months later. These first-time treated patients comprise a subgroup of 570 schizophrenia patients who were part of a cohort of 7,655 patients enrolled in the Intercontinental Schizophrenia Outpatient-Health Outcomes observational study (IC-SOHO). As part of a brief clinical assessment conducted at entry to the study, and after 3 and 6 months of antipsychotic medication, patients were asked to rate their sexual functioning, and the investigator was asked to rate the extent to which the patient had neuroleptic-related loss of libido and sexual dysfunction. After being treated, patients treated with olanzapine showed the lowest prevalence of neuroleptic-induced sexual difficulties. At 3 months, there were significant differences between the treatment groups on neuroleptic-related loss of libido, neuroleptic-related sexual dysfunction and change in patient-rated sexual dysfunction. At 6 months, the difference between the groups on neuroleptic-related loss of libido was statistically significant. There were no significant differences between males and females. Many recent onset patients appear to suffer from problems of sexual functioning. Olanzapine may offer an advantage in this area.