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Karabulut S. Factors Associated with Psychotic and Depressive Symptoms in Methamphetamine Users. IRANIAN JOURNAL OF PSYCHIATRY 2024; 19:1-10. [PMID: 38420276 PMCID: PMC10896751 DOI: 10.18502/ijps.v19i1.14334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/21/2022] [Accepted: 11/16/2022] [Indexed: 03/02/2024]
Abstract
Objective: Methamphetamine use has been recognized as a prominent public health issue, which is associated with psychotic and depressive symptoms. This study aimed to assess factors that show a significant relation with psychotic and depressive symptoms in adults who use methamphetamine. Method : We assessed 95 patients who had used methamphetamine within the last month and were admitted to the outpatient treatment clinic. Evaluation of all patients was carried out through face-to-face interviews, and their symptoms were evaluated using different scales. The Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms were employed to assess positive and negative symptoms of psychosis, respectively. Depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale, while illness severity was evaluated using the Clinical Global Impression- Severity Scale. Additionally, functioning status was assessed using the Functioning Assessment Short Test, and withdrawal severity was measured by employing the Amphetamine Cessation Symptom Assessment Scale. Craving severity was evaluated using the Stimulant Craving Questionnaire, anxiety severity using the Hamilton Anxiety Rating Scale, and insight status using the Schedule for Assessment of Insight Expanded. Results: Among the demographic variables, working with family was associated with lower positive symptoms scores (OR = 6.31, P < 0.05). Parole/probation related admissions were associated with lower positive and depressive symptoms scores (OR = 15.06, P = 0.03; OR = 9.87, P = 0.02). Having suicide attempts, number of suicide attempts, and amount of methamphetamine used were found to show association with higher positive (OR = 13.59, P < 0.01; OR = 2.52, P < 0.05; OR = 3.48, P < 0.05, respectively) and depressive symptoms scores (OR = 10.35, P < 0.001; OR = 2.23, P < 0.01; OR = 2.3, P < 0.05). After adjusting for all variables, clinical impression and insight scores remained significantly associated with positive symptoms scores (AOR = 6.74, P < 0.05; AOR = 2.63, P < 0.001, respectively), while anxiety, amphetamine cessation, and positive symptoms scores remained associated with depressive symptoms scores (AOR = 0.48, P < 0.001; AOR = 0.11, P = 0.003; AOR = 0.36, P = 0.02, respectively). Conclusion: This study appears to be the first to examine the associations between clinical variables and both positive symptoms and depressive symptoms in methamphetamine users. Increased attention should be paid to suicide history, anxiety level, amount of methamphetamine use and loss of insight to provide effective treatment in patients with methamphetamine use.
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Affiliation(s)
- Sercan Karabulut
- Centre of Alcohol and Substance Addiction Treatment, Ataturk State Hospital, Antalya, Turkey
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Miele C, Cabé J, Cabé N, Bertsch I, Brousse G, Pereira B, Moulin V, Barrault S. Measuring craving: A systematic review and mapping of assessment instruments. What about sexual craving? Addiction 2023; 118:2277-2314. [PMID: 37493019 DOI: 10.1111/add.16287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND AND AIMS Craving is central in the definition of addictive disorders because of its diagnostic and prognostic value. Its measurement is essential in clinical practice. Previous reviews provided a better overview of existing instruments; however, they do not consider emerging substances and behaviors such as sexual addictions. Our objectives were threefold: (1) to provide a systematic review of craving assessment instruments and their psychometric characteristics within a transdiagnostic approach, (2) to highlight and map their conceptual relationships and (3) to identify potential sexual craving assessment instruments. METHODS The review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The PubMed, Embase, PsychInfo and Cochrane/Central databases were searched for publications that met the following inclusion criterion: validation studies of craving assessment instruments, regardless of target substance or behavior. The original search identified 4561 references and included 147 articles. Each selected study was a peer-reviewed publication. RESULTS This review provides a synthesis of the psychometric properties of 36 original instruments and identified 93 variations of these instruments (e.g. translations). We were able to highlight five transdiagnostic families of instruments, each corresponding to a conceptual model. Only one instrument for assessing craving in the domain of compulsive sexual behavior, focused on pornography use, has been identified: the Pornography Craving Questionnaire. CONCLUSION This review mapped all craving assessment instruments from a transdiagnostic perspective, finding 36 original instruments and 93 variations. The evolution of instruments to measure craving mirrors the evolution of the concept of craving which has progressively integrated cognitive, conditioning and sensory dimensions, and attests to the importance of the context of assessment. Development of an instrument to measure 'sexual craving' is needed and could be based on the data from our review.
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Affiliation(s)
- Cécile Miele
- Laboratory QualiPsy, EE1901, Psychology Department, University of Tours, Tours, France
- Service d'Addictologie et de pathologies duelles, Pôle de psychiatrie, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex, France
- Laboratoire Inter-universitaire de Psychologie Personnalité, Cognition, Changement Social (LIP/PC2S) Université de Grenoble Alpes, Grenoble, France
| | - Julien Cabé
- Service d'Addictologie et de pathologies duelles, Pôle de psychiatrie, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex, France
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
| | - Nicolas Cabé
- Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
- Normandie Université, UNICAEN, INSERM, PhIND 'Physiopathology and Imaging of Neurological Disorders', Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France
| | - Ingrid Bertsch
- Laboratory QualiPsy, EE1901, Psychology Department, University of Tours, Tours, France
- Unité de Consultation Psychiatrique Post-Pénale (UC3P), CHRU de Tours, Tours, France
| | - Georges Brousse
- Service d'Addictologie et de pathologies duelles, Pôle de psychiatrie, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex, France
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Valérie Moulin
- Laboratoire Inter-universitaire de Psychologie Personnalité, Cognition, Changement Social (LIP/PC2S) Université de Grenoble Alpes, Grenoble, France
| | - Servane Barrault
- Laboratory QualiPsy, EE1901, Psychology Department, University of Tours, Tours, France
- Centre de Soins d'Accompagnement et de Prévention en Addictologie (CSAPA 37), CHRU of Tours, Tours, France
- Laboratory of Psychopathology and Health Processes, University of Paris, Boulogne-Billancourt, France
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Stauffer CS, Samson S, Hickok A, Hoffman WF, Batki SL. Intranasal Oxytocin for Stimulant Use Disorder Among Male Veterans Enrolled in an Opioid Treatment Program: A Randomized Controlled Trial. Front Psychiatry 2021; 12:804997. [PMID: 35111090 PMCID: PMC8801418 DOI: 10.3389/fpsyt.2021.804997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022] Open
Abstract
The increasing prevalence of illicit stimulant use among those in opioid treatment programs poses a significant risk to public health, stimulant users have the lowest rate of retention and poorest outcomes among those in addiction treatment, and current treatment options are limited. Oxytocin administration has shown promise in reducing addiction-related behavior and enhancing salience to social cues. We conducted a randomized, double-blind, placebo-controlled clinical trial of intranasal oxytocin administered twice daily for 6 weeks to male Veterans with stimulant use disorder who were also receiving opioid agonist therapy and counseling (n = 42). There was no significant effect of oxytocin on stimulant use, stimulant craving, or therapeutic alliance over 6 weeks. However, participants receiving oxytocin (vs. placebo) attended significantly more daily opioid agonist therapy dispensing visits. This replicated previous work suggesting that oxytocin may enhance treatment engagement among individuals with stimulant and opioid use disorders, which would address a significant barrier to effective care.
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Affiliation(s)
- Christopher S Stauffer
- Department of Mental Health, VA Portland Health Care System, Portland, OR, United States.,Social Neuroscience and Psychotherapy Lab, Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States.,Department of Psychiatry and Behavioral Sciences, San Francisco School of Medicine and San Francisco VA Health Care System, University of California, San Francisco, San Francisco, CA, United States
| | - Salem Samson
- School of Nursing, Massachusetts General Hospital (MGH) Institute of Health Professions, Boston, MA, United States
| | - Alex Hickok
- Department of Mental Health, VA Portland Health Care System, Portland, OR, United States.,Social Neuroscience and Psychotherapy Lab, Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
| | - William F Hoffman
- Department of Mental Health, VA Portland Health Care System, Portland, OR, United States.,Social Neuroscience and Psychotherapy Lab, Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
| | - Steven L Batki
- Department of Psychiatry and Behavioral Sciences, San Francisco School of Medicine and San Francisco VA Health Care System, University of California, San Francisco, San Francisco, CA, United States
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Stauffer CS, Moschetto JM, McKernan S, Meinzer N, Chiang C, Rapier R, Hsiang E, Norona J, Borsari B, Woolley JD. Oxytocin-enhanced group therapy for methamphetamine use disorder: Randomized controlled trial. J Subst Abuse Treat 2020; 116:108059. [PMID: 32741502 DOI: 10.1016/j.jsat.2020.108059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Methamphetamine (METH) use is a public health crisis that disproportionately affects men who have sex with men (MSM). There are currently no FDA-approved pharmacological interventions to treat methamphetamine use disorder (MUD). MUD is associated with social impairments and extremely high treatment attrition rates. Administration of oxytocin, a neuropeptide involved in social attachment, may be a novel approach to addressing these issues. Moreover, oxytocin administration has shown promise for reducing METH-related addictive behavior in animal models, but has not yet been investigated in clinical trials for MUD. Last, oxytocin is known to modulate stress responsivity via regulation of the autonomic nervous system, which is dysregulated in METH users. We hypothesize that oxytocin, in combination with group psychotherapy, will increase treatment engagement, reduce addiction behavior, and mitigate stress hyperreactivity. METHODS This is a randomized, double blind trial of oxytocin 40-IU (n = 24) or placebo (n = 24) administered intranasally prior to each of six weekly motivational interviewing group therapy (MIGT) sessions for MUD in MSM. PRIMARY OUTCOME (a) session attendance. SECONDARY OUTCOMES (b) group cohesion, (c) anxiety, (d) METH craving, (e) METH use, and (f) in-session cardiac physiology. RESULTS Participants receiving oxytocin had significantly higher group therapy attendance than those receiving placebo, OR 3.26, 95% CI [1.27-8.41], p = .014. There was a small effect of oxytocin on group cohension, but not anxiety or craving. METH use did not change over the six-week MIGT course in either treatment arm. Participants receiving oxytocin had lower average heart rates during MIGT sessions and higher heart rate variability. There were positive main effects of MIGT over Time regardless of study drug. CONCLUSIONS This evidence, and the lack of any serious adverse events, suggests that oxytocin may safely increase treatment attendance. One possible mechanism by which it may do so is its modulation of the autonomic nervous system. Further investigation is warranted.
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Affiliation(s)
- Christopher S Stauffer
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America; Portland Veterans Affairs Medical Center & Oregon Health and Science University, United States of America.
| | - Jenna M Moschetto
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
| | - Scott McKernan
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
| | | | - Chavy Chiang
- San Francisco Veterans Affairs Medical Center, United States of America
| | - Rachel Rapier
- San Francisco Veterans Affairs Medical Center, United States of America
| | - Elaine Hsiang
- University of California, San Francisco, United States of America
| | - Jerika Norona
- San Francisco Veterans Affairs Medical Center, United States of America
| | - Brian Borsari
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
| | - Joshua D Woolley
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
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Walker R, Northrup TF, Tillitski J, Bernstein I, Greer TL, Trivedi MH. The Stimulant Selective Severity Assessment: A replication and exploratory extension of the Cocaine Selective Severity Assessment. Subst Use Misuse 2019; 54:351-361. [PMID: 30657406 PMCID: PMC6438747 DOI: 10.1080/10826084.2018.1467453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cocaine and methamphetamine have similar withdrawal symptoms and many individuals concurrently use both substances; however, no measures concurrently assess withdrawal from multiple stimulants. OBJECTIVES This study's aim was to explore the Stimulant Selective Severity Assessment (SSSA), a modified version of the Cocaine Selective Severity Assessment (CSSA), in a sample of stimulant users to determine if it can assess withdrawal symptoms in users of one or more stimulants. METHODS Baseline data were analyzed from the STimulant Reduction Intervention using Dosed Exercise trial, a multisite randomized clinical trial that evaluated exercise versus health education on drug use outcomes in individuals with stimulant use disorders. Data were analyzed for internal consistency, construct validity, and scale dimensionality. RESULTS Internal consistency for the full sample was good (α = 0.81; N = 302), with similar alphas in Cocaine (0.81; n = 177) and Cocaine/Other Stimulant (0.82; n = 92) groups, but with much lower alpha for the group without cocaine use (Other Stimulant, i.e., primarily methamphetamine, α = 0.66; n = 32). Support for construct validity was evidenced by significant positive correlations (r = 0.17 to 0.67) with measures of stimulant craving, depressive symptoms, and pain. Four factors were revealed. Conclusions/Importance: The Stimulant Selective Severity Assessment is a new measure that can be used to assess withdrawal symptoms in users of cocaine or cocaine plus methamphetamine, but it should not be administered to users of methamphetamine only.
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Affiliation(s)
- Robrina Walker
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Thomas F Northrup
- b Department of Family and Community Medicine , The University of Texas Health Science Center at Houston, McGovern Medical School , Houston , Texas , USA
| | - John Tillitski
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Ira Bernstein
- c Department of Clinical Sciences , University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Tracy L Greer
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Madhukar H Trivedi
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , Texas , USA
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