[Effectiveness of a psychotherapeutic intervention group program in the improvement of caregiver well-being in Alzheimer's disease patients' family caregivers: the CuiDem study]

INTRODUCTION

Caregivers of patients with Alzheimer's Disease experience physical and emotional burnout that can be treated with non-pharmacological interventions.

AIM

Assess the efficacy of a group cognitive behavioural psychotherapeutic intervention, for improving well-being perception in caregivers, compared to a support group. Also, we assessed its efficacy after a follow-up period of 1-year post-intervention.

SUBJECTS AND METHODS

A multicentre, open, quasi experimental study with control group was conducted. 221 caregivers of patients with Alzheimer's Disease, with mild to moderate-severe dementia, were non-randomly assigned to either IG-intervention group: psychotherapeutic program without active follow-up period (n = 80); IGF-intervention group: psychotherapeutic program with active follow-up period (n = 78); or CG-control group: support program with active follow-up period (n = 63). The psychotherapeutic intervention (IG and IGF) is a structured cognitive behavioural group program, of one weekly session over four months. The CG had the same duration. Caregiver's burden, mood disorders, resilience, perceived functional social support and quality of life were measured at baseline, post-intervention and after 1-year follow-up.

RESULTS

At post-intervention, statistically significant improvements were observed in the IG and IGF compared to CG in caregiver burden (p = 0,0216). After one year follow-up, significant improvements were found in IGF compared to IG in emotional state (p = 0,0271), resilience (p = 0,0018), perceived social support (p = 0,014); quality of life (p = 0,0001) and mental health (p = 0,0002); and in CG versus GI in emotional state and social support (p < 0,05).

CONCLUSIONS

These results support the efficacy of this psychotherapeutic intervention for improving well-being (burden), and the supportive follow-up period for increasing its efficacy.

5-HTTLPR polymorphism, mood disorders and MDMA use in a 3-year follow-up study

A 3-year longitudinal prospective study was conducted to compare the incidence of substance use disorders (SUD) and non-substance use disorders (NSUD) among ecstasy users and two control groups: one of cannabis users and the other of non-drug users. The 5-HTTLPR polymorphism related to NSUD was also studied. A total of 94 subjects were included: 37 ecstasy users, 23 cannabis users and 34 non-drug users. SUD and NSUD disorders were diagnosed according to the fourth edition of the Diagnostic and Statistical Manual of Mental Health Disorders criteria using the Psychiatric Research Interview for Substance and Mental Disorders. Incidence Rates (IR) are presented. The 5-HTTLPR polymorphism was analyzed. Hardy-Weinberg equilibrium was studied. The results of the study showed that the highest IR of SUD was cannabis abuse/dependence in both the ecstasy (IR: 48.6/100 person-year) and cannabis (IR: 2.5/100 person-year) groups. There were no new cases of SUD in non-drug users at follow-up. The highest IR of NSUD was primary mood disorder in both the ecstasy (IR: 4.2/100 person-year) and in the non-drug (IR: 1.3/100 person-year) groups (P < 0.282). There were no new cases of NSUD in the cannabis group at follow-up. 5-HTTLPR polymorphism was associated with lifetime of primary mood disorders in ecstasy group (P = 0.018). Ecstasy use was associated with a higher rate of cannabis abuse/dependence disorders and mood disorders than cannabis use. In the ecstasy users, 5-HTTLPR polymorphism may result in a high vulnerability to primary mood disorders.

Cognitive performance in recreational ecstasy polydrug users: a two-year follow-up study

There is important preclinical evidence of long lasting neurotoxic and selective effects of ecstasy MDMA on serotonin systems in non-human primates. In humans long-term recreational use of ecstasy has been mainly associated with learning and memory impairments. The aim of the present study was to investigate the neuropsychological profile associated with ecstasy use within recreational polydrug users, and describe the cognitive changes related to maintained or variable ecstasy use along a two years period. We administered cognitive measures of attention, executive functions, memory and learning to three groups of participants: 37 current polydrug users with regular consumption of ecstasy and cannabis, 23 current cannabis users and 34 non-users free of illicit drugs. Four cognitive assessments were conducted during two years. At baseline, ecstasy polydrug users showed significantly poorer performance than cannabis users and non-drug using controls in a measure of semantic word fluency. When ecstasy users were classified according to lifetime use of ecstasy, the more severe users (more than 100 tablets) showed additional deficits on episodic memory. After two years ecstasy users showed persistent deficits on verbal fluency, working memory and processing speed. These findings should be interpreted with caution, since the possibility of premorbid group differences cannot be entirely excluded. Our findings support that ecstasy use, or ecstasy/cannabis synergic effects, are responsible for the sub-clinical deficits observed in ecstasy polydrug users, and provides additional evidence for long-term cognitive impairment owing to ecstasy consumption in the context of polydrug use.

Combined immunomodulating properties of 3,4-methylenedioxymethamphetamine (MDMA) and cannabis in humans

AIMS

Cell-mediated immune function and the occurrence of mild infectious diseases was investigated. Participants Polydrug consumers of 3,4-methylenedioxymethamphetamine (MDMA) and cannabis (n = 37) compared to cannabis users only (n = 23) and control group (n = 34).

DESIGN

A longitudinal prospective study with three cross-sectional evaluations at time 0 and at 6 months and 1 year was performed.

FINDINGS

At baseline, a significant decrease in interleukin (IL)-2 and an increase in anti-inflammatory transforming growth factor (TGF)-beta1, together with a decrease in the number of total lymphocytes, CD4 and natural killer (NK) cells were observed in the MDMA-cannabis group, with intermediate alterations in the cannabis group. Immune alterations observed at baseline were sustained over time. No differences were found between regular and occasional MDMA users. A significantly higher rate of mild infections in regular MDMA-cannabis users compared with occasional MDMA-cannabis users and the remaining groups was observed.

CONCLUSIONS

The present data confirm that long-term alterations in immunological homeostasis may result in general health status impairment and subsequent increased susceptibility to infection and immune-related disorders.

Assessment of Chronic Exposure to MDMA in a Group of Consumers by Segmental Hair Analysis

The suitability of segmental hair analysis of MDMA to monitor past chronic exposure to the drug was investigated in a follow-up study of ecstasy consumers. The purpose, among others, was to look for an objective biomarker of the history of drug consumption. Thirteen naturally colored hair samples were used to assess possible association between hair concentration of MDMA in 1-, 5-, and 9-cm segments and self-reported use in the last 1, 6, and 12 months. Agreement between the self-reported data given by the subjects on their "ecstasy" use in the previous month and MDMA hair concentration was good (r = 0.92) in all the examined subjects, with the exception of 2 individuals who declared a high consumption of the drug (12 tablets in the last month). When comparing the subjects' declaration of tablets consumed per month within the last 6 months, concordance with the hair MDMA values decreased and no correlation seemed to exist between the mean number of tablets consumed in the last 12 months and the concentration of MDMA in hair. However, when grouping subjects with a similar level of declared drug use (independently of whether in the previous month, last 6 months and last 12 months) and comparing the data with the mean MDMA concentrations found in the corresponding hair segments, an excellent level of agreement was found in groups of subjects consuming <5 tablets of MDMA per month (r = 0.93). Although the present findings were obtained from a small group of individuals and are intended as preliminary results, we can conclude that a cutoff of 0.5 ng MDMA per mg hair seems reasonable to assess drug consumption, unless the level of consumption was once per month in the last 12 months. Doubling the monthly consumption increases hair MDMA by around 1 ng/mg hair up to a level of 4 consumed tablets a month. It does not seem possible to draw definitive conclusions from higher concentrations in hair samples.

Development and validation of a gas chromatography-mass spectrometry assay for hair analysis of amphetamine, methamphetamine and methylenedioxy derivatives

A procedure based on gas chromatography-mass spectrometry (GC-MS) is described for the determination of amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA, ecstasy), 3,4-methylenedioxyethylamphetamine (MDE or MDEA) and N-methyl-1-(3,4-methylenedioxyphenyl)-2-butanamine (MBDB) in hair. Hair samples were digested with 1 M sodium sulfide at 37 degrees C (by shaking for 3 h and was kept at room temperature overnight), and extracted with two sequential extraction procedures: liquid-liquid extraction with tert-butyl methyl ether and solid-phase extraction with Bond-Elut Certify columns. Extracted analytes were derivatised with N-methyl-bis(trifluoroacetamide), separated by a 5% phenylmethylsilicone column and determined by a mass spectrometer detector in selected ion monitoring mode. A good reproducibility (intra-assay R.S.D.=1.5-15.7%), accuracy (intra-assay error = 2.0-11.7%) and sensitivity (LOD=0.03-0.08 ng/mg hair) were attained. The method was successfully applied to the analysis of the proximal (1 cm) hair segment to assess recent self-reported use in "ecstasy" consumers. Otherwise, further studies are needed to validate methodology developed in case of amphetamine consumption.

Human pharmacology of 3,4-methylenedioxymethamphetamine ("ecstasy"): psychomotor performance and subjective effects

3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") is a recreational drug of increasing use among youth because of its apparent entactogenic properties, such as euphoria, friendliness, closeness, and empathy. However, experimental studies have shown MDMA to be neurotoxic. Data on pharmacologic actions of MDMA in humans are limited. The authors conducted a randomized, double-blind, crossover, controlled trial to assess psychomotor performance and subjective effects in eight healthy male volunteers. MDMA was given in the same range of doses used for recreational purposes (75 and 125 mg). Amphetamine (40 mg) and placebo were used as reference compounds. For the digit-symbol substitution test (DSST), MDMA-125 produced a mild decrease in responses, and amphetamine produced a mild improvement. For the Maddox wing device, MDMA-125 induced esophoria compared with the other drug conditions. MDMA-125 and MDMA-75 produced increases in feelings of euphoria and well-being, as noted by increases in scores on the Addiction Research Center Inventory (ARCI) MBG and A scales, as well as scores of "stimulated," "good effects," "liking," and "high" on the visual analog scales. Amphetamine administration induced similar effects. At the same time, MDMA-125 enhanced sedation- and dysphoria-related effects (ARCI-PCAG and LSD, "confusion," "drunken," and Profile of Mood States Confusion scale). Mild changes in some body perception-related feelings were also reported after MDMA use, but hallucinations or psychoses were not present. In summary, the short-term administration of MDMA produced marked euphoria, a slight impairment in the performance of psychomotor tasks, and mild changes in body perceptions without hallucinations. These data support the abuse liability of MDMA.

Response patterns of the Spanish version of the 49-item short form of the Addiction Research Center Inventory after the use of sedatives, stimulants, and opioids

This report examines the validity of the Spanish version of the 49-item short form of the Addiction Research Center Inventory (ARCI) for measuring subjective effects after the use of sedatives, stimulants, and opioids. Data from four clinical trials in which this questionnaire was used have been analyzed. The Spanish ARCI short form was found to be sensitive in measuring subjective effects after the administration of alcohol, triazolam, and flunitrazepam (sedatives), cocaine (stimulants), and morphine, pentazocine, and naloxone (opioids) and to distinguishing among them. The response patterns were similar to those previously reported for the same drugs with the English version of ARCI. It is concluded that Spanish version of the 49-item short form of ARCI is a valid instrument for assessing the subjective effects of psychoactive drugs in the Spanish-speaking population context.