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1: Rev Bras Psiquiatr. 2007 Jun;29(2):107-117.

Pathological gambling and obsessive-compulsive disorder: towards a spectrum of disorders of volition.

Department of Psychiatry, Faculty of Medicine, Universidade de São Paulo, Sao Paulo, SP, Brazil.

OBJECTIVE: Pathological gambling is proposed as a participant of an impulsive-compulsive spectrum related to obsessive-compulsive disorder\. This study aims to contrast pathological gambling and obsessive-compulsive disorder regarding course, comorbidity, and personality, hence testing the validity of the impulsive-compulsive spectrum\. METHOD: 40 pathological gambling and 40 obsessive-compulsive disorder subjects matched to 40 healthy volunteers according to gender, age, and education were assessed with the Temperament Personality Questionnaire and the Barratt Impulsiveness Scale\. Psychiatric patients were also assessed for course and comorbidity data\. RESULTS: Obsessive-compulsive disorder presented an earlier onset, but the full syndrome took longer to evolve\. Pathological gambling had higher comorbidity with substance-related disorders, and obsessive-compulsive disorder higher comorbidity with somatoform disorders\. Gamblers scored higher than controls on the sub-factors Impulsiveness, Extravagance, Disorderliness, and Fear of Uncertainty\. Obsessive-compulsive patients scored higher than controls on Fear of Uncertai-nty\. Impulsiveness, Extravagance, and Disorderliness significantly correlated with the Barratt Impulsiveness Scale total score, Fear of Uncertainty did not\. DISCUSSION: The course and comorbidity profiles of pathological gambling resemble an addiction and differ from obsessive-compulsive disorder\. Pathological gambling combines impulsive and compulsive traits\. Impulsivity and compulsivity should be regarded as orthogonal constructs, and as drives implicated in volition aspects of behavioral syndromes.

PMID: 17639253 [PubMed - as supplied by publisher]

Reconciling reinforcement learning models with behavioral extinction and renewal: Implications for addiction, relapse, and problem gambling.

Department of Neuroscience, University of Minnesota, Minneapolis, MN, US. red...@ahc.umn.edu.

Because learned associations are quickly renewed following extinction, the extinction process must include processes other than unlearning\. However, reinforcement learning models, such as the temporal difference reinforcement learning (TDRL) model, treat extinction as an unlearning of associated value and are thus unable to capture renewal\. TDRL models are based on the hypothesis that dopamine carries a reward prediction error signal; these models predict reward by driving that reward error to zero\. The authors construct a TDRL model that can accommodate extinction and renewal through two simple processes: (a) a TDRL process that learns the value of situation-action pairs and (b) a situation recognition process that categorizes the observed cues into situations\. This model has implications for dysfunctional states, including relapse after addiction and problem gambling\. ((c) 2007 APA, all rights reserved).

PMID: 17638506 [PubMed - in process]

Antipsychotic medications for cocaine dependence.

BACKGROUND: Cocaine dependence is a public health problem characterized by recidivism and a host of medical and psychosocial complications\. Cocaine dependence remains a disorder for which no pharmacological treatment of proven efficacy exists, although considerable advances in the neurobiology of this addiction could guide future medication development OBJECTIVES: To evaluate the efficacy and the acceptability of antipsychotic medications for cocaine dependence SEARCH STRATEGY: We searched the following sources: MEDLINE (1966 to October 2006), EMBASE (1980 to October 2006), CINAHL (1982 to October 2006), Cochrane Drug and Alcohol Group Specialised Register (October 2006)\. We also searched the reference lists of trials, the main electronic sources of ongoing trials (National Research Register, meta-Register of Controlled Trials; Clinical Trials.gov) and conference proceedings likely to contain trials relevant to the review.All searches included also non-English language literature\. SELECTION CRITERIA: All randomised controlled trials and controlled clinical trials with focus on the use of any antipsychotic medication for cocaine dependence DATA COLLECTION AND ANALYSIS: Two authors independently evaluated the papers, extracted data, rated methodological quality MAIN RESULTS: Seven small studies were included (293 participants): the antipsychotic drugs studied were risperidone, olanzapine and haloperidol\. No significant differences were found for any of the efficacy measures comparing any antipsychotic with placebo\. Risperidone was found to be superior to placebo in diminishing the number of dropouts, four studies, 178 participants, Relative Risk (RR) 0.77 (95% CI 0.77 to 0.98)\. Most of the included studies did not report useful results on important outcomes such as side effects, use of cocaine during treatment and craving.The results on olanzapine and haloperidol come from studies too small to give conclusive results\. AUTHORS' CONCLUSIONS: Although caution is needed when assessing results from a limited number of small clinical trials there is no current evidence, at the present , supporting the clinical use of antipsychotic medications in the treatment of cocaine dependence\. Furthermore, most of the included studies did not report useful results on important outcomes such as side effects, use of cocaine during the treatment and craving\. Aiming to answer the urgent demand of clinicians, patients, families, and the community as a whole for an adequate treatment for cocaine dependence, larger randomised investigations should be designed investigating relevant outcomes and reporting data to allow comparison of results between studies\. Moreover some efforts should be done also to investigate the efficacy of other type medications, like anticonvulsant, currently used in clinical practice.

PMID: 17636840 [PubMed - in process]

Cannabinoid type 1 receptor antagonists (rimonabant) for smoking cessation.

BACKGROUND: Rimonabant is a selective type 1 cannabinoid (CB1) receptor antagonist\. It may assist with smoking cessation by restoring the balance of the endocannabinoid system, which can be disrupted by prolonged use of nicotine\. Rimonabant also seeks to address many smokers' reluctance to persist with a quit attempt because of concerns about weight gain\. OBJECTIVES: To determine whether selective CB1 receptor antagonists increase the numbers of people stopping smoking To assess their effects on weight change in successful quitters and in those who try to quit but fail\. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Review Group specialized register for trials, using the terms 'rimonabant' and 'smoking' in the title or abstract, or as keywords\. We also searched MEDLINE, EMBASE, CINAHL and PsycINFO, using major MESH terms\. We acquired electronic or paper copies of posters of preliminary trial results presented at the American Thoracic Society Meeting in 2005, and at the Society for Research on Nicotine and Tobacco European Meeting 2006\. We also attempted to contact the authors of ongoing studies of rimonabant, and Sanofi Aventis (manufacturers of rimonabant)\. SELECTION CRITERIA: Types of studiesRandomized controlled trialsTypes of participantsAdult smokersTypes of interventionsSelective CB1 receptor antagonists, such as rimonabant.Types of outcome measuresThe primary outcome is smoking status at a minimum of six months after the start of treatment\. We preferred sustained cessation rates to point prevalence, and biochemically verified cessation to self-reported quitting\. We regarded smokers who drop out or are lost to follow up as continuing smokers\. We have noted any adverse effects of treatment.A secondary outcome is weight change associated with the cessation attempt\. DATA COLLECTION AND ANALYSIS: Two authors checked the abstracts for relevance, and attempted to acquire full trial reports\. One author extracted the data, and a second author checked them\. MAIN RESULTS: We found three trials which met our inclusion criteria, covering 1567 smokers (cessation: STRATUS-EU and STRATUS-US), and 1661 quitters (relapse prevention: STRATUS-WW)\. At one year, the pooled odds ratio (OR) for quitting with rimonabant 20 mg was 1.61 (95% confidence interval (CI) 1.12 to 2.30)\. No significant benefit was demonstrated for rimonabant at 5 mg dosage\. Adverse events included nausea and upper respiratory tract infections.In the relapse prevention trial, smokers who had quit on the 20 mg regimen were 1(1/2) times more likely to remain abstinent on either active regimen than on placebo; the OR for the 20 mg maintenance group was 1.49 (95% CI 1.09 to 2.04, and for the 5 mg maintenance group 1.51 (95% CI 1.11 to 2.07)\. There appeared to be no significant benefit of maintenance treatment for the 5 mg quitters.Weight gain was reported to be significantly lower among the 20 mg quitters than in the 5 mg or placebo quitters\. During treatment, overweight or obese smokers tended to lose weight, while normal weight smokers did not\. AUTHORS' CONCLUSIONS: From the preliminary trial reports available, rimonabant 20 mg may increase the odds of quitting approximately 1(1/2)-fold\. Adverse events include nausea and upper respiratory tract infections; the risk of serious adverse events is reported to be low\. The evidence for rimonabant in maintaining abstinence is inconclusive\. Rimonabant 20 mg may moderate weight gain in the long term.

PMID: 17636794 [PubMed - in process]

Interventions to reduce harm from continued tobacco use.

BACKGROUND: It may be reasonable to try to reduce the harm from continued smoking amongst smokers unable or unwilling to quit\. Possible approaches to reduce the exposure to toxins from smoking include reducing the amount of tobacco used, and using less toxic products\. The interventions evaluated in controlled trials have predominantly attempted to reduce the number of cigarettes smoked\. OBJECTIVES: To assess the effect of interventions intended to reduce the harm from smoking on the following: biomarkers of damage caused by tobacco, biomarkers of tobacco exposure, number of cigarettes smoked, quitting, and long-term health status\. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group Specialised Register using free text and MeSH terms for harm reduction, smoking reduction and cigarette reduction\. The initial search was in March 2006, updated in March 2007\. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials of interventions in tobacco users to reduce amount smoked, or to reduce harm from smoking by means other than cessation\. Outcomes were change in cigarette consumption, markers of cigarette exposure and any markers of damage or benefit to health, measured at least six months from the start of the intervention\. DATA COLLECTION AND ANALYSIS: We pooled trials with similar interventions and outcomes using a fixed-effect model\. Other studies were summarised narratively\. MAIN RESULTS: The 13 included trials all evaluated interventions to help smokers cut down the amount smoked\. Self-reported reduction in cigarettes per day (CPD) was validated by reduction in carbon monoxide (CO) levels\. Most trials tested nicotine replacement therapy (NRT) to assist reduction\. No eligible studies evaluated the use of potentially reduced-exposure products\. In a pooled analysis of eight trials, NRT significantly increased the odds of reducing CPD by 50% or more for people using nicotine gum or inhaler or a choice of product compared to placebo (n=3273, odds ratio [OR] 2.02, 95% confidence interval [CI] 1.55 to 2.62)\. Where average changes from baseline were compared for different measures, CO and cotinine consistently showed smaller reductions than CPD\. Whilst the effect for NRT was significant, small numbers of people in either treatment or control group successfully sustained a reduction of 50% or more\. Use of NRT also significantly increased the odds of quitting (OR 1.90, 95% CI 1.46 to 2.47)\. One trial of bupropion failed to detect an effect on reduction or cessation\. Four trials of different types of advice and instructions on reducing CPD did not provide clear evidence\. AUTHORS' CONCLUSIONS: There is insufficient evidence about long-term benefit to give firm support the use of interventions intended to help smokers reduce but not quit tobacco use\. Some people who do not wish to quit can be helped to cut down the number of cigarettes smoked and reduce their carbon monoxide levels by using nicotine gum or nicotine inhaler\. Because the long-term health benefit of a reduction in smoking rate is unclear this application of NRT is more appropriately used as a precursor to quitting.

PMID: 17636791 [PubMed - in process]

Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders.

BACKGROUND: The consumption of psychostimulants for non-medical reasons probably occurs because of their euphoriant and psychomotor-stimulating properties\. Chronic consumption of these agents results in development of stereotyped behaviour, paranoia, and possibly aggressive behaviour\. Psychosocial treatments for psychostimulant use disorder are supposed to improve compliance, and to promote abstinence\. Evidence from randomised controlled trials in this subject needs to be summarised\. OBJECTIVES: To conduct a systematic review of all RCTs on psychosocial interventions for treating psychostimulant use disorder\. SEARCH STRATEGY: Electronic searches of Cochrane Library, EMBASE, MEDLINE, and LILACS (to may 2006); reference searching; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of psychostimulants abuse/ dependence\. SELECTION CRITERIA: All randomised-controlled trials focusing on psychosocial interventions for treating psychostimulants abuse/ dependence\. DATA COLLECTION AND ANALYSIS: Three authors extracted the data independently and Relative Risks, weighted mean difference and number needed to treat were estimated, when possible\. The reviewers assumed that people who died or dropped out had no improvement (intention to treat analysis) and tested the sensitivity of the final results to this assumption\. MAIN RESULTS: Twenty-seven randomised controlled studies (3663 participants) fulfilled inclusion criteria and had data that could be used for at least one of the main comparisons\. There was a wide heterogeneity in the interventions evaluated: this did not allow to provide a summary estimate of effect and results cannot be summarised in a clear cut way\. The comparisons between different type of Behavioural Interventions showed results in favour of treatments with some form of Contingency management in respect to both reducing drop outs and lowering cocaine use.\. AUTHORS' CONCLUSIONS: Overall this review reports little significant behavioural changes with reductions in rates of drug consumption following an intervention\. Moreover, with the evidence currently available, there are no data supporting a single treatment approach that is able to comprise the multidimensional facets of addiction patterns and to significantly yield better outcomes to resolve the chronic, relapsing nature of addiction, with all its correlates and consequences.

PMID: 17636713 [PubMed - in process]

Interventions for smoking cessation in hospitalised patients.

BACKGROUND: An admission to hospital provides an opportunity to help people stop smoking\. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited\. Initiating smoking cessation services during hospitalisation may help more people to make and sustain a quit attempt\. OBJECTIVES: To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients\. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PSYCINFO in January 2007, and CINAHL in August 2006 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted\. SELECTION CRITERIA: Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission)\. The intervention had to start in the hospital but could continue after hospital discharge\. We excluded studies of patients admitted for psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow up of less than six months\. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently for each paper, with disagreements resolved by consensus\. MAIN RESULTS: Thirty-three trials met the inclusion criteria\. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (Odds Ratio (OR) 1.65, 95% confidence interval (CI) 1.44 to 1.90; 17 trials)\. No statistically significant benefit was found for less intensive counselling interventions\. The one study that tested a single brief (<=15 minutes) in-hospital intervention did not find it to be effective (OR 1.16, 95% CI 0.80 to 1.67)\. Counselling of longer duration during the hospital stay was not associated with a higher quit rate (OR 1.08, 95% CI 0.89 to 1.29, eight trials)\. Even counselling that began in the hospital but had less than one month of supportive contact after discharge did not show significant benefit (OR 1.09, 95% CI 0.91 to 1.31, six trials)\. Adding nicotine replacement therapy (NRT) did not produce a statistically significant increase in cessation over what was achieved by intensive counselling alone (OR 1.47, 95% CI 0.92 to 2.35, five studies)\. The one study that tested the effect of adding bupropion to intensive counselling had a similar nonsignificant effect (OR 1.56, 95% CI 0.79 to 3.06)\. A similar pattern of results was observed in smokers admitted to hospital because of cardiovascular disease (CVD)\. In this subgroup, intensive intervention with follow-up support increased the odds of smoking cessation (OR 1.81, 95% CI 1.54 to 2.15, 11 trials), but less intensive interventions did not\. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period\. AUTHORS' CONCLUSIONS: High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients\. These interventions are effective regardless of the patient's admitting diagnosis\. lnterventions of lower intensity or shorter duration have not been shown to be effective in this setting\. There is insufficient direct evidence to conclude that adding NRT or bupropion to intensive counselling increases cessation rates over what is achieved by counselling alone, but the evidence of benefit for NRT has strengthened in this update and the point estimates are compatible with research in other settings showing that NRT and bupropion are effective.

PMID: 17636688 [PubMed - in process]

WITHDRAWN: Interventions for pathological gambling.

BACKGROUND: With the legalization of new forms of gambling there are increasing numbers of individuals who appear to have gambling related problems and who are seeking help.The individual and societal consequences are significant\. Pathological gambling can result in the gambler jeopardizing or losing a significant relationship or job and committing criminal offences\. Pathological gamblers may develop general medical conditions associated with stress\. Increased rates have been reported for mood disorders, attention-deficit/hyperactivity disorder, substance abuse or dependence\. There is a high risk of suicide and a high correlation with antisocial, narcissistic and borderline personality disorders and alcohol addiction.With increasing public awareness of gambling related problems health funders and practitioners are asking questions about the efficacy of treatments\. Consequently quality research into gambling treatment is crucial\. OBJECTIVES: The objective of this review was to complete a systematic review and meta-analysis of all randomised controlled trials (RCTs) of psychological and pharmacological treatments for pathological gambling, from both published and unpublished scientific reports\. SEARCH STRATEGY: Published and unpublished RCTs of treatments of pathological gambling were identified by searches of electronic databases and hand searching journals likely to contain RCTs of gambling treatments\. Researchers and gambling treatment centres were contacted by letter\. Bibliographies of all identified research studies were scanned to identify other relevant references\. SELECTION CRITERIA: All RCTs of treatments for pathological gambling were eligible for inclusion\. DATA COLLECTION AND ANALYSIS: The data was entered into the Cochrane Review Manager software (REVMAN)\. The component RCTs were quality rated, with special emphasis on the concealment of treatment allocation and blinding\. Relative risk analyses were conducted for the dichotomous outcome of controlled vs\. uncontrolled gambling\. The relative risks were aggregated using both fixed and random effects models\. Tests for heterogeneity were undertaken\. Both short-term (1 month or less) and long-term (6 months or longer) outcomes were considered\. MAIN RESULTS: Only four RCTs of psychological treatments were identified\. These RCTs were heterogeneous in terms of design, interventions, outcome measurement and follow-up periods\. All had small numbers of participants\. The studies had poor methodological quality features\. The experimental interventions, behavioural or cognitive-behavioural therapy (BT/CBT), were more efficacious than the control interventions in the short-term (relative risk 0.44, 95% confidence interval (CI) 0.24-0.81)\. There was a trend for long-term treatment with BT/CBT to be more efficacious than the control treatments, but the statistical significance of this was sensitive to the statistical model used for meta-analysis\. With a fixed effect model the relative risk was 0.56 (95% CI 0.33-0.95); the relative risk with a random effects model was 0.61 (95% CI 0.25-1.47)\. AUTHORS' CONCLUSIONS: This systematic review revealed a paucity of evidence for effective treatment of pathological gambling\. As gambling is becoming more accessible in many countries and there is epidemiological evidence of increasing rates of pathological gambling, more rigorous RCTs are required.

PMID: 17636678 [PubMed - in process]

Prevalence of Interpersonal Abuse in Primary Care Patients Prescribed Opioids for Chronic Pain.

Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

BACKGROUND: Interpersonal abuse is associated with clinical problems including chronic pain disorders\. OBJECTIVES: The objective of this study is to describe 30-day and lifetime prevalence of emotional, physical, and sexual abuse found in men and women prescribed opioids for chronic pain\. DESIGN: Cross-sectional interview is the design of this study\. PARTICIPANTS: Patients, 1,009, currently prescribed opioids for chronic noncancer pain\. They were recruited from the practices of 235 Family Physicians and Internists in Wisconsin\. The most common pain diagnoses were arthritis, low back pain, headache, and fibromyalgia/myofascial pain\. MEASUREMENT: Data for this secondary analysis on rates of interpersonal abuse were based on 3 questions from the Addiction Severity Index (ASI) regarding 30-day and lifetime emotional, physical, and sexual abuse\. RESULTS: Forty-seven percent of women and 22% of men reported a history of lifetime physical abuse\. Thirty -five percent of women and 10% of men reported lifetime sexual abuse\. Binary logistic regression identified the following variables associated with lifetime physical abuse: female gender (RR 2.81, CI 2.01-3.94), age 31-50 (RR1.77, CI 1.30-2.41), Caucasian (RR1.67, CI 1.19-2.35), increased psychiatric symptoms as measured by the ASI (RR 2.14, CI 1.56-2.94), and lifetime suicide attempts (RR 3.98, CI 2.76-5.74)\. CONCLUSIONS: This study reports prevalence of abuse in both men and women prescribed opioids for chronic pain in primary care settings\. Subjects who report experiencing interpersonal abuse also report significantly higher rates of suicide attempts and score higher on the ASI psychiatric scale\. Screening patients taking opioids for chronic pain for interpersonal abuse may lead to a better understanding of contributors to their physical and mental health.

PMID: 17641933 [PubMed - as supplied by publisher]

Targeting of opioid-producing leukocytes for pain control.

Machelska H.

Klinik fur Anaesthesiologie und operative Intensivmedizin, Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany.

It is accepted that inflammatory mediators released from leukocytes contribute to the generation of pain\. However, it is less well known that immune cells also produce mediators that can effectively counteract pain\. These include anti-inflammatory cytokines and opioid peptides\. This article concentrates on recent evidence that interactions between leukocyte-derived opioid peptides and their receptors on peripheral sensory neurons can result in potent, clinically relevant inhibition of pathological pain\. Inflammation of peripheral tissues leads to increased synthesis and axonal transport of opioid receptors in dorsal root ganglion neurons\. This results in opioid receptor upregulation and enhanced G-protein coupling at peripheral sensory nerve terminals\. These events are dependent on neuronal electrical activity, production of proinflammatory cytokines and nerve growth factor within the inflamed tissue\. Together with the disruption of the perineurial barrier, all these changes lead to an enhanced peripheral analgesic efficacy of opioids\. The major source of local endogenous opioid ligands (beta-endorphin, enkephalins, endomorphins and dynorphin) are leukocytes\. These cells contain and upregulate signal-sequence encoding mRNA of the beta-endorphin precursor proopiomelanocortin and the entire enzymatic machinery necessary for its processing into the functionally active peptide\. Opioid-containing immune cells extravasate using adhesion molecules and chemokines to accumulate in inflamed tissues\. Upon stressful stimuli or in response to releasing agents such as corticotropin-releasing factor, cytokines, chemokines and catecholamines, leukocytes secrete opioids\. Depending on the cell type, this release is contingent on extracellular Ca(2+) or on inositol triphosphate receptor-triggered release of Ca(2+) from endoplasmic reticulum\. Once secreted opioid peptides activate peripheral opioid receptors and produce analgesia by inhibiting the excitability of sensory nerves and/or the release of excitatory neuropeptides\. These effects occur without central untoward side effects such as depression of breathing, clouding of consciousness or addiction\. Future aims include the selective targeting of opioid-containing leukocytes to sites of painful injury and the augmentation of opioid peptide and receptor synthesis.

PMID: 17640727 [PubMed - as supplied by publisher]

Rapid approach responses to alcohol cues in heavy drinkers.

School of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, UK.

Incentive-motivational models of addiction predict that alcohol cues should elicit approach behaviours in heavy drinkers. In this study we compared heavy and light social drinkers' response latencies when required to make approach or avoidance responses to alcohol pictures. Participants completed a stimulus-response compatibility (SRC) task, which requires participants to move a manikin towards or away from alcohol-related and matched control pictures, together with self-report measures of alcohol consumption and craving. Results demonstrated that heavy drinkers, but not light drinkers, were faster to approach than avoid alcohol pictures on the SRC task. The bias to approach alcohol pictures was also associated with alcohol craving.

PMID: 17640615 [PubMed - as supplied by publisher]

The Management of Bipolar Mania: a national survey of Baseline data from tha EMBLEM study in Italy.

ABSTRACT: BACKGROUND: Although a number of studies have assessed the management of mania in routine clinical practice, no studies have so far evaluated the short- and long-term management and outcome of patients affected by bipolar mania in different European countries\. The objective of the study is to present, in the context of a large multicenter survey (EMBLEM study), an overview of the baseline data on the acute management of a representative sample of manic bipolar patients treated in the Italian psychiatric hospital and community settings\. EMBLEM is a 2-year observational longitudinal study that evaluates across 14 European countries the patterns of the drug prescribed in patients with bipolar mania, their socio-demographic and clinical features and the outcomes of the treatment\. METHODS: The study consists of a 12-week acute phase and a =< 24-month maintenance phase\. Bipolar patients were included into the study as in- or out-patients, if they initiated or changed, according to the decision of their psychiatrist, oral antipsychotics, anticonvulsants and/or lithium for the treatment of an episode of mania\. Data concerning socio-demographic characteristics, psychiatric and medical history, severity of mania, prescribed medications, functional status and quality of life were collected at baseline and during the follow-up period\. RESULTS: In Italy, 563 patients were recruited in 56 sites: 376 were outpatients and 187 inpatients\. The mean age was 45.8 years\. The mean CGI-BP was 4.4 (+/- 0.9) for overall score and mania, 1.9 (+/- 1.2) for depression and 2.6 (+/- 1.6) for hallucinations/delusions\. The YMRS showed that 14.4% had a total score < 12, 25.1% >= 12 and < 20, and 60.5% >= 20\. At entry, 75 patients (13.7%) were treatment-naive, 186 (34.1%) were receiving a monotherapy (of which haloperidol [24.2%], valproate [16.7%] and lithium [14.5%] were the most frequently prescribed) while 285 (52.2%) a combined therapy (of which 8.0% were represented by haloperidol/lithium combinations)\. After a switch to an oral medication, 137 patients (24.8%) were prescribed a monotherapy while the rest (415, 75.2%) received a combination of drugs\. CONCLUSIONS: Data collected at baseline in the Italian cohort of the EMBLEM study represent a relevant source of information to start addressing the short and long-term therapeutic strategies for improving the clinical as well as the socio-economic outcomes of patients affected by bipolar mania\. Although it's not an epidemiological investigation and has some limitations, the results show several interesting findings as a relatively late age of onset of bipolar disorder, a low rate of past suicide attempts, a low lifetime rate of alcohol abuse and drug addiction.

PMID: 17640381 [PubMed - as supplied by publisher]

Addiction to the nicotine gum in never smokers.

Etter JF.

ABSTRACT: BACKGROUND: Addiction to nicotine gum has never been described in never smokers or in never users of tobacco\. METHODS: Internet questionnaire in 2004-2006 in a self-selected sample of 434 daily users of nicotine gum\. To assess dependence on nicotine gum, we used modified versions of the Nicotine Dependence Syndrome Scale (NDSS), the Fagerstrom Test for Nicotine Dependence and the Cigarette Dependence Scale\. RESULTS: Five never smokers used the nicotine gum daily\. They had been using the nicotine gum for longer than the 429 ever smokers (median = 6 years vs 0.8 years, p=0.004), and they had higher NDSS-gum Tolerance scores (median=0.73 vs = -1.0, p=0.03), a difference of 1.5 standard deviation units\. Two never smokers had never used smokeless tobacco, both answered "extremely true" to: "I use nicotine gums because I am addicted to them", both "fully agreed" with: "after a few hours without chewing a nicotine gum, I feel an irresistible urge to chew one" and: "I am a prisoner of nicotine gum"\. CONCLUSIONS: This is to our knowledge the first report of addiction to nicotine gum in never users of tobacco\. However, this phenomenon is rare, and although the long-term effect of nicotine gum is unknown, this product is significantly less harmful than tobacco.

PMID: 17640334 [PubMed - as supplied by publisher]

Health services for HIV/AIDS, HCV, and sexually transmitted infections in substance abuse treatment programs.

Addiction Research and Treatment Corporation, 22 Chapel St., Brooklyn, NY 11201, USA. Lbr...@ARTCNY.org

The National Drug Abuse Treatment Clinical Trials Network conducted this study to determine the availability of and factors associated with infection-related health services in substance abuse treatment settings\. In a cross-sectional descriptive design, state policies, reimbursement for providers, state level of priority, and treatment program characteristics were studied via written surveys of administrators of substance abuse treatment programs and of state health and substance abuse departments\. Data from health departments and substance abuse agencies of 48 states and from 269 substance abuse treatment programs revealed that human immunodeficiency virus/acquired immunodeficiency syndrome-related services are more frequent than hepatitis C virus or sexually transmitted infection-related services, and that nonmedical services are more frequent than medical services\. While the availability of infection-related health services is associated with medical staffing patterns, addiction pharmacotherapy services, and state priorities, reimbursement was the most significant determining factor\. These findings suggest that greater funding of these health services in substance abuse treatment settings, facilitated by supportive state policies, represents an effective response to the excess morbidity and mortality of these substance use-related infections.

PMID: 17639646 [PubMed - in process]

Prenatal exposure to cocaine alters the development of conditioned place-preference to cocaine in adult mice.

As addiction is increasingly formulated as a developmental disorder, identifying how early developmental exposures influence later responses to drugs of abuse is important to our understanding of substance abuse neurobiology\. We have previously identified behavioral changes in adult mice following gestational exposure to cocaine that differ when assessed with methods employing contingent and non-contingent drug administration\. We sought to clarify this distinction using a Pavlovian behavioral measure, conditioned place-preference\. Adult mice exposed to cocaine in utero (40 or 20 mg/kg/day), vehicle and pair-fed controls were place-conditioned to either cocaine (5 mg/kg or 20 mg/kg, i.p.) or saline injections\. The development of conditioned place-preference to cocaine was impaired in mice exposed to cocaine in utero, and was abolished by fetal malnutrition\. A context-specific place-aversion to vehicle but not cocaine injection was observed in prenatally cocaine-exposed mice\. Locomotor behavior did not differ among prenatal treatment groups\. We conclude that early developmental exposure to cocaine may diminish the subsequent rewarding effects of cocaine in adulthood measured with classical conditioning techniques, and that this is not due to changes in locomotor behavior\. Sensitivity to acute stress is also altered by prenatal cocaine exposure, consistent with earlier findings in this model.

PMID: 17644167 [PubMed - as supplied by publisher]

Interaction between buprenorphine and atazanavir or atazanavir/ritonavir.

Virginia Commonwealth University, Richmond, VA, United States.

Opioid addiction and HIV disease frequently co-occur\. Adverse drug interactions have been reported between methadone and some HIV medications, but less is known about interactions between buprenorphine, an opioid partial agonist used to treat opioid dependence, and HIV therapeutics\. This study examined drug interactions between buprenorphine and the protease inhibitors atazanavir and atazanavir/ritonavir\. Opioid-dependent, buprenorphine/naloxone-maintained, HIV-negative volunteers (n=10 per protease inhibitor) participated in two 24-h sessions to determine pharmacokinetics of (1) buprenorphine and (2) buprenorphine and atazanavir (400mg daily) or atazanavir/ritonavir (300/100mg daily) following administration for 5 days\. Objective opiate withdrawal scale scores and mini-mental state examination were determined prior to and following antiretroviral administration to examine pharmacodynamic effects\. Pharmacokinetics of atazanavir and atazanavir/ritonavir were compared in subjects and matched, healthy controls (n=10 per protease inhibitor) to determine effects of buprenorphine\. With atazanavir and atazanavir/ritonavir, respectively concentrations of buprenorphine (p<0.001, p<0.001), norbuprenorphine (p=0.026, p=0.006), buprenorphine glucuronide (p=0.002, p<0.001), and norbuprenorphine glucuronide (NS, p=0.037) increased\. Buprenorphine treatment did not significantly alter atazanavir or ritonavir concentrations\. Three buprenorphine/naloxone-maintained participants reported increased sedation with atazanavir/ritonavir\. Atazanavir or atazanavir/ritonavir may increase buprenorphine and buprenorphine metabolite concentrations and might require a decreased buprenorphine dose.

PMID: 17643869 [PubMed - as supplied by publisher]

Cutaneous changes in chronic alcoholics.

Rao GS.

Department of Skin and STDs, KMC Hospital, Mangalore, India. drup...@hotmail.com.

BACKGROUND: Alcohol consumption can have a variety of cutaneous manifestations\. Awareness of the cutaneous changes of alcohol abuse can allow early detection and intervention in an attempt to limit the adverse medical consequences\. Hence a study was planned to determine the cutaneous changes in chronic alcoholics\. AIMS: To determine the cutaneous changes in chronic alcoholics\. METHODS: All the patients attending alcohol de-addiction camps were examined for cutaneous changes\. The results were analyzed using Gausian test and compared with other reports\. RESULTS: Out of 200 alcoholics examined for cutaneous changes, 182 (91%) had cutaneous, nail, hair or oral cavity changes\. Nail changes were found in 51 (25.5%) alcoholics, koilonychia being the commonest (16%)\. Oral changes were present in 107 (53.5%) alcoholics and changes due to nutritional deficiency in 20 (10%)\. Diseases due to poor hygiene were seen in 55 (27.5%) alcoholics\. Tinea versicolor (14%) and seborrheic dermatitis (11.5%) were the commonest cutaneous changes noted\. CONCLUSION: Even though alcohol abuse has a variety of cutaneous manifestations and perhaps aggravates many diseases, there are no specific cutaneous signs of alcoholism\. Knowledge of the spectrum of cutaneous manifestations of alcohol abuse can allow its early detection and treatment in an attempt to minimize the medical consequences.

PMID: 17642570 [PubMed - in process]

Dermatitis recall during disulfiram therapy.

Consultant Dermatologist, Nashik, India. vijay...@yahoo.com.

We report an alcoholic Indian man, a known case of contact dermatitis to nickel, who presented with recurrence at the same site, without having recent contact with nickel, following disulfiram therapy for his alcohol addiction.

PMID: 17642555 [PubMed - in process]

Factors predictive of alcohol abstention after resident detoxication among alcoholics followed in an hospital outpatient center.

Federation d'Hepato-Gastroenterologie et Nutrition Clinique; Hopital l'Archet II, Nice.

OBJECTIVES: A cohort of patient hospitalized for alcohol detoxification between January 2004 and January 2005 were followed prospectively to search for factors predictive factors of sustained abstinence.PATIENTS AND METHODS: One hundred and fifteen patients (79 males, 36 females, median age 45.9+/-10.7 years), were hospitalized for alcohol detoxification\. Demographic, social, and medical data including daily alcohol intake and co-addictions were noted at inclusion and six months later\. Patients who did not attend their six-month visit were contacted by phone.RESULTS: Among the 115 included patients, six month follow-up data could be collected for 73\. Abstinence rate was 54.8%\. Factors predictive of unsuccessful cessation were homelessness (P=0.004), duration of alcohol consumption (P=0.004), smoking (P=0.02), drug substitution (P=0.04) and multiple addictions (P=0.04)\. At multivariate analysis, multiple addictions was the only independent factor predictive of unsuccessful detoxification\. Naltrexone or acamprosate treatments were not associated with a better rate of alcohol detoxification.CONCLUSION: Patient follow-up is problematic due to the large number of dropouts among alcoholics\. Early screening in search for factors predictive of unsuccessful detoxification (long duration of alcohol consumption, multiple addiction) would be helpful in elaborating appropriate pluridisciplinary management.

PMID: 17646786 [PubMed - in process]

HIV risk behavior among injection drug users in Tehran, Iran.

University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA.

Aims Iran faces parallel human immunodeficiency virus (HIV) and injection drug use epidemics; more than 62% of known HIV cases occur among injection drug users (IDU)\. We conducted a formative study of IDU in Tehran to explore risk behavior in the wake of the recent harm reduction efforts\. Participants and design Key informant interviews (n = 40), focus group discussions (nine groups of IDU, n = 66) and a review of existing published and unpublished literature were conducted\. Participants included IDU, physicians, policy makers, police, IDU advocates and their families\. IDU were diverse in gender, education, income and neighborhood of residence\. Interviews were transcribed and analyzed using grounded theory\. A typology of IDUs in Tehran, categorized according to self-defined networks as well as HIV risks, is presented\. This categorization is based on the groups identified by IDUs, compared to those identified by other key informants, and on a secondary data review\. Findings Homeless, female, young IDU and users of a more potent form of heroin were identified as having increased risks for HIV\. Participants described shortening transitions from smoked opium to injected opiates\. Whereas a majority of participants considered needle sharing less common than previously, sharing continues in locations of group injection, and in states of withdrawal or severe addiction\. System-wise barriers to harm reduction were discussed, and include the cost or stigma of purchasing needles from pharmacies, over-burdened clinics, irregular enforcement of laws protecting IDU and lack of efforts to address the sexual risks of IDU\. Conclusions This research is one of the first to describe a diversity of IDU, including women and higher socio-economic class individuals, in Tehran\. While efforts in harm reduction in Iran to date have been notable, ongoing risks point to an urgent need for targeted, culturally acceptable interventions.

PMID: 17645427 [PubMed - as supplied by publisher]

Oxcarbazepine--efficacy and tolerability during treatment of alcohol withdrawal: a double-blind, randomized, placebo-controlled multicenter pilot study.

Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.

OBJECTIVE: Alcohol withdrawal syndrome (AWS) is a serious complication of alcohol dependence and often requires intensive medical treatment\. Antiepileptic drugs (AEDs) have been shown to be as efficacious in the treatment of AWS in several controlled trials as benzodiazepines and superior to placebo in relieving alcohol withdrawal symptoms\. Oxcarbazepine (OXC), a newer anticonvulsive drug, has a favorable safety profile over carbamazepine (CBZ) and other older AEDs due to its excellent efficacy and better side-effect profile\. METHODS: The efficacy and tolerability of OXC versus placebo were investigated in 50 inpatients during a 6-day treatment of alcohol withdrawal in a 4-site, double-blind, randomized, placebo-controlled pilot study\. The amount of rescue medication of clomethiazole (CLO) capsules needed was chosen as the primary variable\. The data were collected between May 2003 and September 2004\. RESULTS: No initial differences were found regarding sociodemographic data and alcohol-related parameters, indicating successful randomization\. No differences were found in the need for rescue medication CLO, decrease of withdrawal symptoms, or craving for alcohol between the OXC and the placebo group\. Subjectively experienced side effects, normalization of vegetative parameters, craving, or improvement of psychopathological parameters were not different between the groups\. CONCLUSION: Despite the negative finding, which may be attributable to the design of the study, OXC still poses an interesting alternative to CBZ and other drugs because other studies have found it not only as efficient but also as having no addictive potential, while additionally possessing an anti-craving effect\. Therefore, well-designed investigations with larger cohorts are required to further elucidate this issue.

PMID: 17511748 [PubMed - indexed for MEDLINE]

A computational model of craving and obsession.

Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA. red...@ahc.umn.edu

If addictions and problematic behaviors arise from interactions between drugs, reward sequences, and natural learning sytems, then an explanation of clinically problematic conditions (such as the self-administration of drugs or problem gambling) requires an understanding of the neural systems that have evolved to allow an agent to make decisions\. We hypothesize a unified decision-making system consisting of three components-a situation recognition system, a flexible, planning-capable system, and an inflexible, habit-like system\. In this article, we present a model of the planning-capable system based on a planning process arising from experimentally observed look-ahead dynamics in the hippocampus enabling a forward search of possibilities and an evaluation process in the nucleus accumbens\. Based on evidence that opioid signaling can provide hedonic evalutation of an achieved outcome, we hypothesize that similar opioid-signaling processes evaluate the value of expected outcomes\. This leads to a model of craving, based on the recognition of a path to a high-value outcome, and obsession, based on a value-induced limitation of the search process\. This theory can explain why opioid antagonists reduce both hedonic responses and craving.

PMID: 17595292 [PubMed - indexed for MEDLINE]

Exposure to the Taste of Alcohol Elicits Activation of the Mesocorticolimbic Neurocircuitry.

1Department of Psychology, University of Colorado at Boulder, Boulder, CO, USA.

A growing number of imaging studies suggest that alcohol cues, mainly visual, elicit activation in mesocorticolimbic structures\. Such findings are consistent with the growing recognition that these structures play an important role in the attribution of incentive salience and the pathophysiology of addiction\. The present study investigated whether the presentation of alcohol taste cues can activate brain regions putatively involved in the acquisition and expression of incentive salience\. Using functional magnetic resonance imaging, we recorded BOLD activity while delivering alcoholic tastes to 37 heavy drinking but otherwise healthy volunteers\. The results yielded a pattern of BOLD activity in mesocorticolimbic structures (ie prefrontal cortex, striatum, ventral tegmental area/substantia nigra) relative to an appetitive control\. Further analyses suggested strong connectivity between these structures during cue-elicited urge and demonstrated significant positive correlations with a measure of alcohol use problems (ie the Alcohol Use Disorders Identification Test)\. Thus, repeated exposure to the taste alcohol in the scanner elicits activation in mesocorticolimbic structures, and this activation is related to measures of urge and severity of alcohol problems.Neuropsychopharmacology advance online publication, 25 July 2007; doi:10.1038/sj.npp.1301513.

PMID: 17653109 [PubMed - as supplied by publisher]

[Misuse of sleep and wakefulness drugs: from undesirable effects to addiction.]

[Article in French]

Bastuji H.

Federation des Unites d'Explorations et de Traitements des Troubles du Sommeil de Lyon, Inserm E 342, Universite Claude Bernard, IFNL, Unite d'Hypnologie, Hopital Neurologique, 59 boulevard Pinel F 69677 Bron.

Sleep disorders, mainly insomnia and daytime somnolence, can arise from very different causes\. For example insomnia may be related to anxiety-depression or occur in response to a stressful lifestyle or as an element of restless leg syndrome\. Subjects with hypersomnia may present episodes of sleep apnea, drug-related depression or narcolepsia\. Specific management is required for each etiology\. Misuse of sleep drugs generally results from an insufficient etiological diagnosis and a misunderstanding of their proper use\. These drugs can be used as necessary expedients but cannot replace correct management or treatment of the cause or causes of the sleep disorder\. We present here a review of the undesirable effects, particularly among the elderly population, and of the risk of addiction to the different drugs used to induce sleep in order to propose prescription guidelines.

PMID: 17652995 [PubMed - in process]

[Sleep disorders and hypnotic agents: medical, social and economical impact.]

[Article in French]

Touitou Y.

Faculte de medecine Pierre et Marie Curie, Service de biochimie medicale et biologie moleculaire, Inserm U 713, 91, boulevard de l'Hopital, F 75634 Paris Cedex 13.

Insomnia is a subjective complaint relating to approximately 30% of the adult population in France, described by the patient as a difficulty of initiating and/or maintaining sleep\. Its prevalence increases with age and sex: women are more affected than men (24% vs 14%)\. Insomnia is either occasional (20%), or chronic (10%)\. Chronic insomnia has an important impact on patients' everyday life e.g\. fatigue, perturbed diurnal waking state, impaired quality-of-life..\. which results in lower work productivity and drowsiness as well as relational difficulties, absenteeism\. About 80% of patients consult their general practitioner first\. The aim of a hypnotic agent is to obtain sleep as physiological as possible\. Benzodiazepines and benzodiazepines-like agents (zopiclone, zolpidem, zaleplon) are the most widely used hypnotics\. However, their indications must be limited to occasional insomnia with a limited duration: less than four weeks\. There is no advantage with using a combination of hypnotic agents, a practice which should be prohibited\. Adverse effects can be serious, e.g\. diurnal somnolence associated with risks of road accidents and, in the elderly, the risk of falls\. After chronic use, hypnotics can be addictive, as their effects wear off in three to four weeks\. After withdrawal, insomnia rebound is frequent\. Use of hypnotics in association with alcohol is a well-known drug-addiction behavior\. According to the French health insurance fund, 9% of the general population use hypnotics and about half of them regularly\. Insurance refunds for hypnotics and sedatives reach more than 110 million euros annually\. The efficiency of hypnotics wears off, quickly for benzodiazepines (three - four weeks), or less quickly for zopiclone and zolpidem (a few months)\. Insomnia is a major public health issue, each year 10% of the incident cases of insomnia treated by hypnotics joint the group of subjects with chronic insomnia\. This failure to treat insomnia properly can be explained, at least in part, by several insufficiencies: physicians and pharmacists training, medical profession awareness, research, public information on the rules of good sleep (public health campaigns, booklets, role of physicians and the pharmacists).

PMID: 17652991 [PubMed - in process]

Cocaine experience controls bidirectional synaptic plasticity in the nucleus accumbens.

Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota 55455, USA.

Plasticity of glutamatergic synapses is a fundamental mechanism through which experience changes neural function to impact future behavior\. In animal models of addiction, glutamatergic signaling in the nucleus accumbens (NAc) exerts powerful control over drug-seeking behavior\. However, little is known about whether, how or when experience with drugs may trigger synaptic plasticity in this key nucleus\. Using whole-cell synaptic physiology in NAc brain slices, we demonstrate that a progression of bidirectional changes in glutamatergic synaptic strength occurs after repeated in vivo exposure to cocaine\. During a protracted drug-free period, NAc neurons from cocaine-experienced mice develop a robust potentiation of AMPAR-mediated synaptic transmission\. However, a single re-exposure to cocaine during extended withdrawal becomes a potent stimulus for synaptic depression, abruptly reversing the initial potentiation\. These enduring modifications in AMPAR-mediated responses and plasticity may provide a neural substrate for disrupted processing of drug-related stimuli in drug-experienced individuals.

PMID: 17652583 [PubMed - in process]

Deprenyl treatment attenuates long-term pre- and post-synaptic changes evoked by chronic methamphetamine.

Department of Psychiatry and Behavioral Sciences, Box 3870, Duke University Medical Center, Durham, NC 27710, United States.

Deprenyl, used clinically in Parkinson's disease, has multiple pharmacological effects which make it a good candidate to treat neurotoxicity\. Thus, we investigated deprenyl's ability to attenuate methamphetamine-induced dopamine neurotoxicity\. We also examined deprenyl's effect in changing markers associated with psychostimulant sensitization\. A potential therapeutic effect on either pathological domain would be a boon in developing novel treatments for methamphetamine abuse\. Adult male Sprague-Dawley rats were split into 6 groups\. Three groups received a 7-day saline minipump with saline, 0.05 or 0.25 mg/kg SC deprenyl injections given for 10 days before, during and 5 days after the 7-day saline minipump implant\. Similarly, 3 groups received methamphetamine pumps (25 mg/kg/day) with escalating daily injections of methamphetamine (0-6 mg/kg) in addition to the minipump treatment\. These rats also received saline, 0.05 or 0.25 mg/kg deprenyl injections given before, during and the 7-day minipump treatment\. Rats were killed on day 28 of withdrawal and brain samples taken\. HPLC analysis for dopamine and 3,4-Dihydroxy-Phenylacetic Acid (DOPAC) revealed a loss of dopamine in the caudate and accumbens which was partially reversed by high dose deprenyl\. Tyrosine hydroxylase immunostaining in the midbrain was unaffected by methamphetamine, suggesting that dopamine neurotoxicity was localized to the caudate\. Western blot analysis of the caudate after methamphetamine revealed little change in Alpha-Amino-3-Hydroxy-5-Methyl-4-Isoxazole Propionic Acid (AMPA) GluR1 or N-Methyl-d-Aspartate (NMDA) NR2B subunits, or their phosphorylation state\. However, methamphetamine increased levels of GluR1 and its phosphorylation state in the prefrontal cortex (PFC), and these increases were attenuated by deprenyl\. Methamphetamine also increased levels of PFC NR2B subunit, but these increases were not attenuated by deprenyl\. We suggest that deprenyl may be effective in reducing the neurotoxic effects of methamphetamine and may also attenuate changes in prefrontal AMPA receptor function, presumably more associated with addiction rather than neurotoxicity.

PMID: 17651730 [PubMed - as supplied by publisher]

Tobacco Addiction and HIV Infection: Toward the Implementation of Cessation Programs. ANRS CO3 Aquitaine Cohort.

INSERM, U593, Universite Victor Segalen Bordeaux 2, ISPED, F-33076 Bordeaux, France., CHU Bordeaux, Service d'Information Medicale, F-33076, Bordeaux, France.

In treated HIV-infected patients, mortality is now dominated by non-AIDS-related causes in which tobacco smoking is a predominant risk factor\. The implementation of tobacco smoking cessation programs is therefore warranted to increase survival but should consider the specificities of this population to be successful\. All outpatients consulting in May to June 2004 within the ANRS CO3 Aquitaine Cohort of HIV-infected patients were asked to complete a self-administered questionnaire including questions about tobacco and other drugs consumption, the Fagerstrom Test for Nicotine Dependence (FTND), a visual scale to estimate motivation to stop smoking and the Center for Epidemiologic Studies Depression (CESD) scale\. Among 509 patients included, mean age was 44 years, 74% were men, 19% were infected through injection drug use, and 257 (51%) were regular smokers (at least one cigarette per day)\. Among them, 60% had a medium or strong nicotine dependence (FTND = 5), 40% were motivated to quit smoking and 70% had already tried at least once\. An FTND of 5 or more was more frequently reported in the 146 smokers (62%) with depressive symptoms compared to other smokers (70% versus 48%)\. Fifty-five regular smokers (23%) were codependent on cannabis and 31 (12%) to alcohol\. Overall, only 35 (14%) regular smokers were motivated, non-codependent, without depressive symptoms, and could be proposed a standard tobacco cessation program\. Depressive symptoms were highly prevalent in this representative population of HIV-infected patients\. To be successful, smoking cessation interventions should be specifically built to take into account depression and codependencies in addition to nicotine dependence and motivation.

PMID: 17651027 [PubMed - as supplied by publisher]

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