The effects of cocaine and the amphetamines on brain and behavior: a conference report

The adolescent and substance use, an approach to office management

Adolescence is a period of transition. During this time young people explore many options in an attempt to define who they are. Substance use or abuse is an area of experimentation that creates anxiety for everyone involved and in which, as a health care provider, a physician may be asked to intervene. This article provides general principles regarding substance use, information about commonly used drugs, and recommendations on the diagnosis and management of this problem in an office setting.

Frequency of recent cocaine and alcohol use affects drug craving and associated responses to stress and drug-related cues

RATIONALE

Stress is known to increase drug craving, associated physiological arousal and risk of relapse in drug dependent individuals. However, it is unclear whether these responses are altered by recent frequency of drug use. The current study examined whether frequency of cocaine and alcohol abuse alters drug craving and associated arousal with laboratory exposure to stress and to drug related cues.

METHODS

Fifty-four recently abstinent treatment-seeking cocaine abusers who were part of a study on stress and drug craving were categorized into high- and low-frequency users on the basis of their recent cocaine use. The high use cocaine group also consumed significantly more alcohol than the low use cocaine group. Participants were exposed to a brief 5-min guided imagery procedure that involved imagining a recent personal stressful situation, a personal drug-related situation and a neutral-relaxing situation, one imagery session on separate days presented in random order. Subjective (craving and anxiety), cardiovascular (heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP)) and biochemical (adrenocorticotropic hormone (ACTH), cortisol, prolactin) measures were assessed.

RESULTS

High-frequency abusers demonstrated a significantly greater drug craving, anxiety and associated cardiovascular and hypothalamic-pituitary-adrenal (HPA) response to both stress and drug-cue exposure as compared to low-frequency abusers.

CONCLUSIONS

Increased frequency of recent cocaine and alcohol use is associated with an enhanced stress and cue-induced drug craving and arousal response that appears to be similar to the effects of cocaine, and one that may increase the vulnerability to drug-seeking behavior and relapse in drug dependent individuals.

The cocaine abusing parturient: a review of anesthetic considerations

PURPOSE

The prevalence of recreational drug abuse among young women, including in pregnancy, has increased markedly over the past two decades. Cocaine remains the drug commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anesthetic management of pregnant patients with a history of cocaine abuse.

SOURCE

A Medline search for articles highlighting drug abuse in pregnancy, with particular emphasis on cocaine abuse in pregnancy, the drug's impact on the fetus and implications for administration of obstetrical anesthesia was performed.

MAIN FINDINGS

Because the pharmacological actions of cocaine are complex, the clinical picture can be very unpredictable, the diagnosis often difficult, and management at times controversial. The diverse clinical symptomatology of cocaine intake combined with physiologic changes of pregnancy, and pathophysiology of co-existing pregnancy specific disease may lead to life-threatening complications and significantly impact the management of obstetrical anesthesia.

CONCLUSIONS

In the absence of uniform anesthetic guidelines for pregnant patients with a history of cocaine abuse the decision regarding the administration of peripartum analgesia or anesthesia should be individualized and conducted on a case-by-case basis. This article will attempt to heighten the awareness of cocaine use and abuse in pregnancy and review the perioperative anesthetic management of these high-risk parturients.

Narcolepsy and psychopathology: is there an association?

BACKGROUND

It is widely believed that patients with narcolepsy show high rates of associated psychiatric disturbance, especially schizophrenia and depression. However, surveys have produced conflicting findings and have not addressed the potential confounding effects of stimulant drug treatment.

METHOD

Forty-five patients with narcolepsy attending a sleep disorder clinic and 50 matched normal controls underwent structured psychiatric interview. Using a 'lifetime' approach, psychiatric symptoms and diagnoses were established for both groups.

RESULTS

Four of the narcolepsy patients but none of the controls had experienced psychotic symptoms. All four patients were taking amphetamines, and the symptoms resolved when the dose was lowered or treatment was changed to modafinil. The lifetime frequency of various depressive syndromes did not differ significantly between the groups.

CONCLUSIONS

Contrary to previous claims this study found little to suggest that narcolepsy is associated with schizophrenia. Nor, despite its serious social and occupational consequences, does narcolepsy appear to be associated with an increased frequency of diagnosable depressive disorders.