Use of Street Methadone in Italian Heroin Addicts Presenting for Opioid Agonist Treatment

ABSTRACT

It is commonly assumed that people who are addicted to certain substances would abuse any substance. This position has never been supported by validly collected and analyzed research data. In this study, the authors examine the use of street methadone by heroin addicts seeking their first agonist opioid treatment in a clinical setting. Fifty-four heroin addicts who resorted to street methadone use were compared by socio-demographic, current clinical, and disease-related variables to 251 peers who do not use street methadone. Heroin addicts who resort to street methadone use are more likely to be females and to have a higher degree of education, are less likely to engage in polyabuse (use of more than three substances), are less severely ill, have been addicted for a shorter period of time, and have been seeking treatment sooner in the course of their disease. Also, they suffer from a wider range of psychopathological distress symptoms. In Italy, resorting to street methadone does not seem to be a surrogate form of heroin addiction, but rather represents means of harm reduction, with treatment seeking occurring shortly after its initiation. This should be accounted for when deciding on take-home policies and issues of potential methadone diversion.     

Diagnostic and symptomatological features in chronic psychotic patients according to cannabis use status

The prevalence and the clinical meaning of cannabis use in patients with chronic psychosis has not been systematically explored. The authors have compared the diagnostic and symptomatological characteristics of 111 male patients affected by chronic psychosis with and without past or current use of cannabis. Sixty-six patients were still using or had used cannabis; in all cases the use preceded the onset of psychotic symptoms. Forty-three patients were cannabis-positive on urinary screening at the moment of hospitalization and 23 were currently cannabis-free but reported the use of cannabis in the past. Forty-five patients were negative on urinary screening and reported no past history of cannabis use. In evaluating the psychopathological features, the Brief Psychiatric Rating Scale (BPRS) and the Overt Aggression Rating Scale (AORS) were used. The three groups showed similar demographic data, except for age, which was lower in current cannabis users than in nonusers; no differences were found between current and past users. As regards diagnostic features, "mood cluster" was significantly better represented in cannabis users and "schizophrenic cluster" in nonusers; bipolar spectrum disorders were more frequently reported than unipolar ones. When past and current users were grouped together, only blunted affect score was significantly higher in nonusers than in users, while clastic violence showed higher scores in users. These data indicate that chronic, psychosis, whether associated with past or with current use of cannabis, is frequently associated with bipolar spectrum disorders and tends to display less blunted affect and more clastic behavior.     

Alcohol abuse in social phobic patients: is there a bipolar connection?

BACKGROUND: Epidemiological and clinical studies have reported the frequent co-occurrence of social phobia (SP) and alcohol use disorders. Patients with SP often use alcohol to cope with the social situations they fear, and to lessen anticipatory anxiety, behavioral inhibition, and phobic avoidance. We investigated whether the presence of lifetime comorbidity with alcohol abuse was associated with significant differences as regards demographic and clinical features, family history and pattern of comorbidity in a large clinical sample of SP outpatients. METHOD: The sample comprised 153 outpatients who met DSM-III-R diagnostic criteria for SP. Demographic, family history and course characteristics were investigated by a semi-structured interview. Social phobic symptoms and the severity of the illness have been assessed by the Liebowitz Social Anxiety Scale (LSAS) and the Liebowitz Social Phobic Disorders Rating Scale, Severity (LSPDRS). Patients completed the Hopkins Symptom Checklist (HSCL 90). RESULTS: Thirty-four patients (22.2%) had a past or current history of alcohol abuse for at least 1 year. There were no significant differences between these patients and those without a history of alcohol abuse, as regards demographic features and lifetime comorbidity with major depression and other anxiety disorders. Bipolar disorder type II was found almost exclusively among patients with alcohol abuse, as well as family history for bipolar disorders. LIMITATIONS: Retrospective study. CONCLUSIONS: Our data indicate a strong relationship between bipolar II disorder and alcohol abuse comorbidity in patients with SP. The socializing and disinhibiting effect that many social phobics report might be mediated by mood elation induced by alcohol. The presence of bipolar diathesis in patients presenting with social anxiety might explain their increased susceptibility to alcohol, as they might undertake alcohol abuse as an attempt to overcome social difficulties.     

Long-term therapy using GHB (sodium gamma hydroxybutyrate) for treatment-resistant chronic alcoholics

Thirty-five alcohol-dependent patients according to DSM-IV criteria who also met criteria for treatment resistance were treated with doses of gamma hydroxybutyrate (GHB) ranging between 25 and 100 mg/kg/die in an open one-year study. The results show that no patients discontinued the program during the first month of treatment. Sixty percent of these patients successfully completed the protocol; 11.4% showed complete abstinence (full responder patients); 14.3% strongly reduced their alcohol intake (partial responder patients) and 34.3% of the patients were still under treatment after one year. Forty percent of the patients were nonresponders. The retention rate under treatment of the studied sample was statistically higher than that found during the last treatment of the same subjects. No significant differences were found between full responder and partial responder patients regarding changes in clinical features, alcohol intake or social adjustment. Patients still in treatment after one year significantly differed from nonresponder patients on all the variables investigated. A six-times/daily fractionated administration of the GHB dose was the only significant predictor of the retention rate.     

Is mood-incongruent manic psychosis a distinct subtype?

Background Despite several research reports on incongruent psychotic features in mania, whether such features define a distinct disorder is unsettled. Method One hundred and fifty-five inpatients with mania according to DSM-III-R were systematically evaluated in order to collect demographic and clinical information. The symptomatological evaluation was conducted by means of the Comprehensive Psychopathological Rating Scale (CPRS) and the Scale for the Assessment of Positive Symptoms (SAPS). The presence/absence of incongruent psychotic symptoms at the index episode defined two subgroups of patients, whose familial, symptomatological, clinical and course characteristics were compared. Results Eighty-six (55.5%) patients presented mood-incongruent psychotic features (MIP+). When this group was compared with the remainder of manic patients without such features (MIP−), we found substantial similarities in most demographic, familial and clinical characteristics. Despite these fundamental similarities, 4% of MIP+ vs 0% of MIP− had family history for schizophrenia (p < 0.05). We also observed a longer duration of the current episode, a higher percentage of chronic course, more suicide attempts and hospitalisations in MIP+. Moreover, other than psychotic symptoms, MIP+ showed more frequently depressive features and hostility. They also reported higher scores in social disability, especially in family and social settings. Conclusion Although our findings suggest that incongruent psychotic features in the main do not distinguish two separate entities – and can be considered as hallmarks of overall severity of mania – in a small minority of cases such features appear linked to familial schizophrenia. The numerous overlapping clinical characteristics in MIP+ and MIP− raise questions about the general nosographic utility of this categorisation. Received: 31 May 2000 / Accepted: 18 October 2000     

Diagnostic characteristics of routine surveillance cultures of endotracheal aspirate samples in cases of late-onset ventilator-associated pneumonia due to Acinetobacter baumannii.

Of 20 consecutive episodes of ventilator-associated pneumonia due to Acinetobacter baumannii, 18 were preceded by tracheobronchial colonization with strains ofA. baumannii that had the same antibiotic susceptibility pattern. When the results of routine surveillance cultures of endotracheal aspirate samples were compared with the results of bronchoalveolar lavage fluid cultures performed for patients who developed late-onset ventilator-associated pneumonia, the sensitivity of the surveillance cultures was 90%, and the negative predictive value was 96%. The positive predictive value of surveillance cultures for identifying causative pathogens in cases of pneumonia due to A. baumannii was good.     

Effects of phototherapy on non-seasonal unipolar and bipolar depressive spectrum disorders.

In a group of 17 patients with non-SAD depressive disorders we compared the response of bipolar spectrum versus unipolar patients to treatment with light therapy. The main hypothesis was that bipolar spectrum depressed patients would preferentially respond to bright light therapy as compared to unipolar depressed patients. All patients were treated with either 400 or 2500 lux phototherapy for 2 h on seven consecutive days. All outcome measures, which included the SIGH-SAD, CGI, and the Anxiety and Depressive Factors of the SCL-90, showed significant improvement in the bipolar vs. the unipolar spectrum patients. Unexpected this occurred regardless of the intensity of the light. These changes were judged to be quite clinically significant. All patients showing response were noted to have maintained their response at a 3-month follow-up.     

Comparative Motor Pre-clinical Assessment in Parkinson’s Disease Using Supervised Machine Learning Approaches

Millions of people worldwide are affected by Parkinson’s disease (PD), which significantly worsens their quality of life. Currently, the diagnosis is based on assessment of motor symptoms, but interest toward non-motor symptoms is increasing, as well. Among them, idiopathic hyposmia (IH) is associated with an increased risk of developing PD in healthy adults. In this work, a wearable inertial device, named SensFoot V2, was used to acquire motor data from 30 healthy subjects, 30 people with IH, and 30 PD patients while performing tasks from the MDS-UPDRS III for lower limb assessment. The most significant and non-correlated extracted parameters were selected in a feature array that can identify differences between the three groups of people. A comparative classification analysis was performed by applying three supervised machine learning algorithms. The system resulted able to distinguish between healthy and patients (specificity and recall equal to 0.967), and the people with IH can be identified as a separate class within a three-group classification (accuracy equal to 0.78). Thus, the system could support the clinician in objective assessment of PD. Further, identification of IH together with changes in motor parameters could be a non-invasive two-step approach to investigate the early onset of PD.     

Episodic course in obsessive-compulsive disorder

The course of obsessive–compulsive disorder (OCD) is variable, ranging from episodic to chronic. We hypothesised that the former course is more likely to be related to bipolar mood disorders. With the use of a specially constructed OCD questionnaire, we studied 135 patients fulfilling DSM-III-R criteria for OCD with an illness duration of at least 10 years and divided by course: 27.4% were episodic and 72.6% chronic. We compared clinical and familial characteristics and comorbidity. Univariate analyses showed that episodic OCD had a significantly lower rate of checking rituals and a significantly higher rate of a positive family history for mood disorder. Multivariate stepwise discriminant analysis revealed a positive and significant relationship between episodic course, family history for mood disorders, lifetime comorbidity for panic and bipolar-II disorders, late age at onset and negative correlation with generalized anxiety disorder. These data suggest that the episodic course of OCD has important clinical correlates which are related to cyclic mood disorders. This correlation has implications for treatment and research strategies on the aetiology within a subpopulation of OCD. Received: 30 October 1997 / Accepted: 13 July 1998     

Controlled use of heroin in patients on methadone maintenance treatment

The efficacy of methadone maintenance treatment was evaluated on 93 patients after 10 years of therapy. On the basis of therapeutic compliance, patients were divided into three groups: (a) 40 Total-Agreement subjects on weekly take-home methadone; (b) 28 Partial-Agreement subjects, who regularly attended the clinic daily but presented episodic positive urinalysis; (c) 25 No- Agreement patients, who were absent from the clinic more than twice a monthand had a high rate of urinalysis positive for morphine. Statistical analysis, based on social adjustment improvement and criminality rate decrease, divided the 93 patients into 2 distinct categories. The first category, characterized by high social adjustment and low criminality score, included the Total- and Partial- agreement groups. The second, characterized by significantly lower social adjustment and higher criminality score, included all No-Agreement patients. This suggests that methadone treatment was able to dissociate heroin use from low social functioning. It was concluded that, in a condition of adequate compliance the episodic use of heroin is of no harm to patients on methadone maintenance therapy, that is, methadone maintenance treatment permits a controlled use of heroin.