[Early maladaptive schemes and relapse during methadone maintenance treatment among drug addicts (a cognitive approach)]

INTRODUCTION/OBJECTIVE

Dysfunction of cognitive schemas and addictive behaviors are often coexisting which can cause relapse during drug treatment. The objective of this study is to assess early maladaptive schemas (EMS) among heroin users and their relationship with relapse during methadone maintenance treatment.

SUBJECT AND METHODS

This is a cross-sectional study carried out on 166 heroin users treated with methadone at the medico-psychological center in northern Morocco during 2017. The subjects completed both the Young short version schema questionnaire (YQS) and the ASI questionnaire (Addiction Severity Index) to measure the severity of drug addiction.

RESULTS

The results showed that the most activated schemas in the totality of the subjects were fear of losing control, Emotional deficiency and failure. They were also significantly more activated in women than in men for five schemas indicating rejection and separation, and a lack of autonomy. Regarding the relapse during treatment consumption there was a positive and significant correlation with ten out of thirteen SPI, which means the more the intensity of SPI decrease the greater the tendency to relapse (r=0.509, P<0.0001). However, there was also a weak correlation between the consumption of other drugs and SPI.

CONCLUSION

The cognitive approach has highlighted the essential role of cognitive disorders in addictive behaviors that EMS may be predictors of relapse during substitution treatment, and that a concurrent therapy of schema may reduce the likelihood of relapse.

[Constipation and cancer: Current strategies]

Digestive disorders, in particular constipation, are symptoms very often reported by cancer patients as having a major impact on their quality of life. An accurate diagnosis of bowel delayed transit and defecation disorders is required to best adapt therapeutic management. Constipation associated with cancer may be related to several causes, which can be placed in three nosological categories that sometimes overlap: chronic constipation prior to cancer and having its own evolution; constipation related to the cancer condition, in particular the occlusive syndrome, and constipation induced by cancer therapies. The stricter application of diet and lifestyle measures is often necessary and sometimes sufficient. Laxative drug treatments come under various galenic forms and administration routes and must be selected according to the clinical features of constipation. Surgical management can be indicated in case of ileus or pelvic static disorders. In the case of refractory constipation induced by opioids and within the framework of palliative care to treat an advanced pathology, a peripheral morphinic antagonist can offer fast symptom relief. A way forward to improve the patients' quality of life could be to identify the contributing factors (in particular, genetic factors) to determine which patients are the more at risk and anticipate their management.