Stimulants

2020 ◽  
pp. 183-218
Author(s):  
Ryan Graddy ◽  
Darius A. Rastegar
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrhythmias ◽  
Behavioral Therapy ◽  
Contingency Management ◽  
Medical Complications ◽  
Acute Effects ◽  
Prescription Stimulants ◽  
Exchange Programs ◽  
Stimulant Use ◽  
High Doses

Stimulants are sympathomimetic substances that include cocaine, amphetamines, and cathinones. Approximately 1% of Americans have used illicit stimulants in the past month, and nearly 25,000 deaths were attributed to stimulant overdose in 2017. Acute effects include tachycardia, elevated blood pressure, and euphoria. High doses of stimulants may lead to cardiac arrhythmias, severe hypertension, agitation, myocardial infarction, aortic dissection, stroke, hyperthermia, or rhabdomyolysis. Abstinence after regular use of stimulants may lead to dysphoria, fatigue, insomnia, and agitation. People who use stimulants may present with acute effects or medical complications. Cocaine metabolites and amphetamines can be detected in urine for a few days after use. The most serious complications of acute use are cardiovascular (especially myocardial infarction and stroke) and psychiatric (agitation and delirium); the risk of hyperthermia is also increased. A number of psychosocial modalities appear to reduce stimulant use among selected individuals, including individual and group counseling, cognitive–behavioral therapy, contingency management, and community reinforcement. No medication has been consistently shown to reduce complications and use of stimulants, although prescription stimulants and topiramate show some promise for treating cocaine use disorder. Syringe exchange programs and safe consumption sites are associated with decreased stimulant use-related complications. Caffeine has mild stimulant effects and may lead to a mild dependence syndrome.

scholarly journals Pharmacotherapy treatment of stimulant use disorder

2021 ◽  
Vol 11 (6) ◽  
pp. 347-357
Author(s):  
Mei T. Liu
Keyword(s):  
Public Health ◽  
Behavioral Therapy ◽  
Contingency Management ◽  
Public Health Problem ◽  
Psychosocial Interventions ◽  
The United States ◽  
Stimulant Use ◽  
Methamphetamine Use ◽  
Methamphetamine Use Disorder ◽  
Selection Of

Abstract Stimulant use disorder (SUD) is a public health problem in the United States that is associated with increased morbidity and mortality. Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the main treatment modality for SUDs and no pharmacotherapy is currently FDA approved for this indication. Although some medications show promising data for the treatment of SUD, the evidence remains inconsistent, and the clinical application is limited due to the heterogenicity of the population and the lack of studies in patients with various comorbidities. Selection of pharmacotherapy treatment for methamphetamine intoxication, persistent methamphetamine-associated psychosis with methamphetamine use disorder, and cocaine use disorder in patients with co-occurring OUD are discussed in 3 patient cases.

Feigning Symptoms to Obtain Prescription Stimulants: A Vignette-Based Study on Its Conditions

2021 ◽  
pp. 002204262110554
Author(s):  
Floris van Veen ◽  
Sebastian Sattler ◽  
Guido Mehlkop ◽  
Fabian Hasselhorn
Keyword(s):  
Drug Use ◽  
Self Efficacy ◽  
Medical Condition ◽  
Self Control ◽  
Prescription Stimulants ◽  
Stimulant Use ◽  
Prescription Drug Use ◽  
Personal Morality ◽  
Prescription Stimulant Use ◽  
Willingness To Use

This vignette-based study examined the willingness to feign symptoms to obtain a prescription following an analysis on who might use prescription stimulants to enhance performance ( N = 3,468). It experimentally manipulated three factors: the social disapproval of prescription stimulant use for enhancement purposes, the physicians’ diagnostic efforts, and the medical condition (attention-deficit/hyperactivity disorder and narcolepsy); respondent characteristics of self-control, personal morality, and self-efficacy were also measured. Our results showed that social disapproval of prescription drug use, a personal morality that disapproves of drug use, high self-control, and high self-efficacy were negatively associated with the willingness to use. Willingness increased especially in situations of social approval when there was a stronger personal approval of drug use, or surprisingly when physicians’ diagnostic efforts were higher. The feigning willingness was lower in situations of social disapproval and when personal morality disapproved of feigning. Thus, personal and situational characteristics are relevant to understand both behaviors.

Reentrant excitation as a cause of cardiac arrhythmias

1978 ◽  
Vol 235 (1) ◽  
pp. H1-H17 ◽  
Author(s):  
A. L. Wit ◽  
P. F. Cranefield
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Experimental Evidence ◽  
Cardiac Arrhythmias ◽  
Fiber Bundles ◽  
Atrial Arrhythmias ◽  
Ventricular Muscle ◽  
Av Node ◽  
Reentrant Excitation ◽  
Longitudinal Dissociation

Mechanisms that cause reentry were defined in rings of tissue cut from jellyfish as early as 1906 by Mayer. The concepts were developed by Mines and Garrey during the next 10 years. Lewis then tried to demonstrate that reentry caused atrial flutter. Lewis, Garrey, and later Moe also proposed that atrial fibrillation was caused by reentry. Rosenblueth provided additional experimental evidence that reentry could cause atrial arrhythmias after crushing the intercaval bridge of atrial muscle. Recent studies by Allessie using microelectrodes have provided detailed evidence for reentry in atrial tissue. Mines in 1913 also proposed that reentry could occur in the AV node. Scherf then introduced the concept of functional longitudinal dissociation as a cause of return extrasystoles and this was later shown to happen in the node by Moe and his colleagues. Reentry can also occur between atria and ventricles utilizing accessory connecting pathways. Schmitt and Erlanger in 1913 were the first to do experiments which indicated that reentry can also occur in the ventricles. Subsequently it was shown that reentry can occur in Purkinje fiber bundles. Reentry in ventricular muscle may also cause some of the arrhythmias that occur after myocardial infarction.

scholarly journals Pilot Cohorts for Development of Concurrent Mobile Treatment for Alcohol and Tobacco Use Disorders

2021 ◽  
Vol 15 ◽  
pp. 117822182110305
Author(s):  
Alyssa M Medenblik ◽  
Patrick S Calhoun ◽  
Stephen A Maisto ◽  
Daniel R Kivlahan ◽  
Scott D Moore ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Behavioral Therapy ◽  
Contingency Management ◽  
Heavy Drinking ◽  
The United States ◽  
Telephone Counseling ◽  
Low Risk ◽  
Cognitive Behavioral ◽  
Total N ◽  
Polysubstance Use

Alcohol and tobacco are the 2 most frequently used drugs in the United States and represent the highest co-occurrence of polysubstance use. The objective of this study was to refine an intervention combining mobile contingency management with cognitive-behavioral telephone counseling for concurrent treatment of alcohol and tobacco use disorders. Two cohorts (n = 13 total, n = 5 women) of participants were enrolled, with 10/13 completing treatment and 7/13 completing the 6-month follow-up. At enrollment, participants were drinking a mean of 28.9 drinks per week (SD = 14.1), with a mean of 14.7 heavy drinking days in the past month (SD = 9.9), and a mean of 18.1 cigarettes per day (SD = 11.7). Treatment included a mobile application that participants used to record carbon monoxide and breath alcohol content readings to bioverify abstinence. Participants received up to 4 sessions of phone cognitive-behavioral therapy and monetary reinforcement contingent on abstinence. In cohort 1, 4/6 participants reported abstinent or low-risk drinking post-monitoring. Six weeks post quit-date, 2/6 participants were CO-bioverified abstinent from tobacco use, with 2/6 in dual remission. These results were maintained at 6-months. In cohort 2, 6/7 reported abstinent or low-risk drinking post-monitoring, 5 weeks post quit-date. At the post-monitoring visit, 5/7 were CO-bioverified abstinent from smoking, with 5/7 in dual remission. At 6-months, 3/7 reporting abstinent or low-risk drinking, 1/7 had bioverified abstinence from smoking, with 1/7 in dual remission. Observations suggest that it is possible to develop a concurrent mobile treatment for alcohol and tobacco use disorders.

scholarly journals Use of Ethylmethylhydroxypyridine in Patients Presenting with Myocardial Infarction: Antiischemic, Antidepressant, Anxiolytic Effects

2016 ◽  
pp. 67-74
Author(s):  
Maryna Dolzhenko ◽  
Olena Popovich ◽  
Oksana Shershnyova ◽  
Oleksandr Nudchenko ◽  
Kardo Faradzh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Mental State ◽  
Cardiac Arrhythmias ◽  
Average Score ◽  
Control Group ◽  
Basic Therapy ◽  
Coronary Syndrome ◽  
St Segment

The objective: to evaluate the efficiency of ethylmethylhydroxypyridine (Mexiprim, STADA Arzneimittel AG, Germany) in patients presenting with myocardial infarction at hospital and outpatient stage. Patients and methods. The study included 59 patients with coronary artery disease, acute coronary syndrome with ST1segment elevation in the first day of admission to the ICU, AH, 3-stage, 2 degrees, HF. To all patients basic therapy according to current ESH/ESC guidelines was prescribed. To 39 patients additionally intravenous infusion of 200 mg of mexiprim o.d. for 10 days, followed by 125 mg per os three times a day for next 60 days was administered. Another 20 patients presented control group and received only basic therapy. The study design included: 24-hour Holter monitoring to estimate the dynamics of changes in the ST segment, cardiac arrhythmias and heart rate variability, evaluation by the scale of Beck, Hamilton scale for the assessment of anxiety (HARS) and depression (HDRS), the common blood and urine tests, biochemical blood analysis, evaluation of therapeutic tolerability conducted before treatment and 60 days after treatment. Surveys on a scale SAN, assessment of cognitive impairment on the MMSE scale were performed on the 60th day of treatment. Efficiency criteria were: a 50% reduction of cardiac arrhythmias, a decrease in ischemia, a decrease by 50% or more from baseline average score by HARS, HDRS scales, dynamics of the mental state questionnaire and less than 9 points on a scale of depression, reducing in SAN scale score. Results. In pаtients of mexiprim group significant reduction of depression scores by 62% were observed. According to the dynamics of the mental state questionnaire patients of mexiprim group reported feeling better, that is, reduction of score by 45% . According to the Hamilton scale for the assessment of anxiety (HARS), in particular mental anxiety – decrease in the total score of 65%, somatic anxiety – by 35.5%, and a total of 50% were revealed. In the group of patients receiving additionally intravenous Mexiprim for 10 days significantly reduced the number of single and group PACs, as well as single and multiple PVCs, not only in comparison with these parameters before the treatment, but also in comparison with the control group. In patients treated with Mexiprim no evidence of residual ischaemia were noted, but in the control group statistically significant segment depression ST remained. Heart rate variability was not significantly changed in the control group, but increased in patients who received Mexiprim. Conclusion. Use of Mexiprim in patients with myocardial infarction reduces ST segment depression, amount of ventricular and supraventricular arrhythmias, improved heart rate variability, and the state of anxiety and depression.

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