scholarly journals 1107 Arousal And Sleepiness In Opioid Use Disorder Compared To Insomnia Disorder With And Without Comorbid Psychiatric Conditions

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A421-A421
Author(s):  
V B Krishnamurthy ◽  
N Hussain ◽  
K Puzino ◽  
S Yadav ◽  
S Del Tredici ◽  
...  
Keyword(s):  
Development Program ◽  
Severity Index ◽  
Opioid Use Disorder ◽  
Treatment Center ◽  
Opioid Use ◽  
Faculty Development Program ◽  
Specific Patient ◽  
Insomnia Disorder ◽  
Penn State ◽  
Psychiatric Conditions

Abstract Introduction Insomnia is frequent in opioid use disorder patients on buprenorphine (OUDB) and increases risk of relapse. There is lack of data evaluating specific differences in hyperarousal and daytime sequelae between OUDBs as compared to individuals with insomnia disorder without (ID) or with comorbid psychiatric conditions (CID). Methods We studied 112 patients with ID (47.8±16.3y, 55% female, 13% minority) and 148 with CID (44.7±15.6y, 69% female, 16% minority) evaluated at the Behavioral Sleep Medicine program of Penn State Hershey Sleep Research & Treatment Center and 71 OUDB (37.8±11.2y, 51% female, 16% minority) evaluated at the Recovery, Advocacy, Empowerment and Service program and WellSpan Internal Medicine clinics (York, PA). Subjects completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress (FIRST), Arousal Predisposition Scale (APS), Pre-sleep Arousal cognitive (PSAS-C) and somatic (PSAS-S) Scale, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and Epworth Sleepiness Scale (ESS). Excessive daytime sleepiness (EDS) was defined as an ESS score ≥ 10. MANCOVA included age, sex, race/ethnicity and depression as covariates, while logistic regression further included ISI, APS and PSAS-S. Results No differences across groups were observed in PSAS-C or DBAS scores. Subjects with CID and OUDB had significantly higher PSAS-S (15.7±0.5 and 16.4±0.7, respectively) and APS (35.6±0.6 and 36±1, respectively) scores as compared to the ID group (14.2±0.6 and 33.2±0.7, respectively). Subjects with OUDB had significantly higher ESS score (9.8±0.6) as compared to the ID or CID groups (6.2±0.5 and 6.4±0.4, respectively). The odds of EDS were 2.7 times (95%CI=1.2-6.1) higher in the OUDB group as compared to the ID group. Conclusion OUDB may present with similar phenotypic insomnia symptoms as patients with ID or CID but report more sleep-disturbing somatic symptoms and EDS. These data have important implications for tailoring behavioral and pharmacological treatments of insomnia to this specific patient population. Support Junior Faculty Development Program, Penn State College of Medicine

Neurofeedback for Opioid Dependent Patients in an Outpatient Setting: A Pilot Feasibility Study

2021 ◽  
Author(s):  
Helena A. Rempala ◽  
Justin A. Barterian
Keyword(s):  
Large Scale ◽  
The United States ◽  
Outpatient Setting ◽  
Opioid Use Disorder ◽  
High Rate ◽  
Treatment Center ◽  
Opioid Use ◽  
Treatment As Usual ◽  
Factors Affecting ◽  
Study Approach

Abstract Background: Neurofeedback (NF) has been described as “probably efficacious” when used in conjunction with other interventions for substance use disorders, including the most recent studies in population of individuals with opioid use disorder. Despite these promising outcomes, the seriousness of the opioid epidemic, and the high rate of relapse even with the most effective medication-assisted maintenance treatments NF continues to be an under-researched treatment modality. This article explores factors that affected the feasibility of adding Alpha/Theta Neurofeedback to treatment as usual for opioid dependence in an outpatient urban treatment center. The study strived to replicate previous research completed in Iran that found benefits of NF for opioid dependence.Methods: Out of approximately two dozen patients eligible for Alpha/Theta NF, about 60% (n=15) agreed to participate; however, only 2 participants completed treatment. The rates of enrollment in response to active treatment were monitored. Results: The 4 factors affecting feasibility were: 1) the time commitment required of participants, 2) ineffectiveness of standard incentives to promote participation, 3) delayed effects of training, and 4) the length and number of treatments required.Conclusion: The findings indicate a large scale study examining the use of NF for the treatment of opioid use disorder in the United States will likely be difficult to accomplish without modification to the traditional randomized control study approach and suggests challenges to the implementation of this treatment in an outpatient setting.

Pharmacotherapy for Opioid Use Disorders in Special Populations

2020 ◽  
pp. 185-202
Author(s):  
Tricia E. Wright
Keyword(s):  
At Risk ◽  
Pregnant Woman ◽  
Mental Disorder ◽  
Opioid Use Disorder ◽  
Special Populations ◽  
Opioid Use ◽  
Adverse Childhood ◽  
Psychiatric Conditions ◽  
Opioid Use Disorders ◽  
The Life Course

Three populations are most at risk for opioid use disorder: adolescents, pregnant women, and those with comorbid psychological or psychiatric disorders. Opioid use disorders present throughout the life course of an individual, often developing during adolescence. For women, these disorders commonly occur during peak childbearing years. In addition, the twin vulnerabilities of genetics and adverse childhood events often interact to impart a greater chance for co-occurring psychiatric conditions. Caring for the pregnant woman, the adolescent, or the person with a co-occurring mental disorder presents special challenges. This chapter focuses on special considerations when treating opioid use disorders in these populations.

From Research to Practice: Towards an Integrated and Comprehensive Faculty Development Program

2012 ◽  
Vol 16 (5) ◽  
Author(s):  
Lawrence C. Ragan ◽  
Paula Mae Bigatel ◽  
Shannon S. Kennan ◽  
Janet May Dillon
Keyword(s):  
Professional Development ◽  
Online Teaching ◽  
Development Program ◽  
Direct Application ◽  
State University ◽  
Online Faculty ◽  
Faculty Development Program ◽  
Research To Practice ◽  
Certificate Program ◽  
Penn State

This article describes the design and development of a professional development program based upon research on the competencies necessary for online teaching success [1] conducted at Penn State University in 2009-2010. The article highlights how the results of this research are being aligned with various professional development courses comprising the certificate program for online faculty at Penn State’s World Campus. This article describes the process of research design and implementation to the direct application for professional development.

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

2020 ◽  
pp. 104973232097123
Author(s):  
Barbara Andraka-Christou ◽  
Olivia Randall-Kosich ◽  
Rachel Totaram
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Substance Use Disorder ◽  
Professional Education ◽  
Opioid Use Disorder ◽  
Treatment Center ◽  
Opioid Use ◽  
Substance Use Disorder Treatment ◽  
History Of ◽  
Disorder Treatment

Treatment preferences of people with opioid use disorder (OUD) have been underexplored, especially among those with a history of utilizing medications for opioid use disorder (MOUD). Therefore, we sought to understand preferred characteristics of substance use disorder treatment centers among people recovering from OUD with a history of MOUD utilization. We recruited 30 individuals from eight states through snowball sampling initiated at three syringe exchange programs. Telephone interviews were audio-recorded and transcribed in 2018–2019. Inductive thematic analysis in Dedoose software occurred iteratively with recruitment. The following were “ideal” treatment center themes: a menu of treatment options, including MOUD and nonspiritual peer support groups; an integrated system with multiple care levels (e.g., outpatient, residential); a harm reduction approach, including for goal setting and success measures; adjunctive support services (e.g., housing); and employees with recovery experience and professional education. Many preferences directly related to core principles of person-centered care and harm reduction.

scholarly journals Factors Associated with Opioid Use Disorder Diagnosis and Treatment Progress

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Reanne Christina Mathai
Keyword(s):  
Social Relationships ◽  
Small Sample Size ◽  
Opioid Use Disorder ◽  
Small Sample ◽  
Treatment Center ◽  
Opioid Use ◽  
Treatment Progress ◽  
Childhood Experiences ◽  
Factors Associated ◽  
Pain Symptoms

Previous research has shown that various environmental aspects, such as a history of abuse, trauma, and pain can influence the incidence of opioid use disorder (OUD). The aims of this study were to determine risk factors associated specifically with opioid use disorder, and to identify factors that may predict treatment progress for opioid use disorder patients. Three-hundred six patients from an abstinence-based residential treatment center participated in this study. Participants completed a comprehensive battery, which included measures assessing quality of life, craving, abstinence self-efficacy, adverse childhood experiences, trauma exposure, and physical pain symptoms at treatment intake and again after 28 days of treatment. Independent t-test results showed significant differences between patients with and without opioid use disorders in social relationships, confidence abstaining from alcohol and drugs, pain intensity, and drug craving. Multiple regression analyses demonstrated that presence of an opioid use disorder predicted alcohol abstinence, social relationships, and baseline environment. Results revealed shifting attitudes towards substance use and social relationships during the opioid group’s time in treatment. Cravings and urges were identified as important focuses for future treatment of opioid use disorder. Hyperalgesia was seen as an effect of extended opioid use and its impact decreased through drug abstinence. Limitations included a small sample size, a large proportion of wealthy individuals, and age differences between the two groups. 

Rapid microinduction of sublingual buprenorphine from methadone in an outpatient setting: “A case series”

2021 ◽  
Vol 17 (7) ◽  
pp. 167-170
Author(s):  
Gurpreet Singh, MBBS ◽  
Jaya Sri Konakanchi, MBBS ◽  
Brandon Betsch ◽  
Aastha Thapa ◽  
Roopa Sethi, MD
Keyword(s):  
Medical Management ◽  
Addiction Treatment ◽  
Case Series ◽  
Outpatient Setting ◽  
Opioid Use Disorder ◽  
Treatment Center ◽  
Opioid Use ◽  
Sublingual Buprenorphine ◽  
Novel Approach ◽  
Outpatient Practice

Buprenorphine (BPN), FDA approved for opioid use disorder (OUD), requires an induction protocol for the patient in mild to moderate withdrawal. This can be problematic in outpatient practice due to complicated medical management. An emerging technique in literature uses a novel approach, called microinduction. In this method, escalating microdoses of BPN are administered, without requiring the patient to stop the opioid agonist.Our addiction treatment center used a microdosing technique to transit patients from methadone to BPN, without requiring opioid abstinence. Our case series is novel as it was outpatient microinduction from methadone to BPN in 7 days or less.

scholarly journals 0742 Hypersomnia Severity Index: Reliability and Validity in a Behavioral Sleep Medicine Clinical Sample

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A282-A282
Author(s):  
G Amatrudo ◽  
K Puzino ◽  
E Bourchetin ◽  
S L Calhoun ◽  
J Fernandez-Mendoza
Keyword(s):  
Sleep Disorders ◽  
Convergent Validity ◽  
Reliability And Validity ◽  
Severity Index ◽  
Sleep Medicine ◽  
Criterion Validity ◽  
Treatment Center ◽  
Clinical Samples ◽  
Patient Reported ◽  
Penn State

Abstract Introduction There is a need for patient-reported outcome measures of central disorders of hypersomnolence (CDH) that adequately assess both essential features and associated daytime impact. The Hypersomnia Severity Index (HSI) was designed to assess severity, distress and impairment of hypersomnolence in persons with psychiatric disorders. Little data is available regarding its psychometric properties in clinical samples with diverse sleep disorders, including CDH. Methods 158 consecutive patients (44.11±16.38 years old, 70.9% female, 19.6% minority) who were evaluated at the Behavioral Sleep Medicine (BSM) program of Penn State Hershey Sleep Research & Treatment Center completed the HSI and the Epworth Sleepiness Scale (ESS). All patients were diagnosed using ICSD-3 criteria, with 10 % receiving a diagnosis of CDH, 54% of insomnia disorder (ID) and 36% of other sleep disorders (oSD). Results The HSI showed satisfactory internal consistency (Cronbach’s α=0.79) and item-total correlations (r=0.42-0.67), except for item 1 (r=0.17). Principal component analysis provided a 2-factor structure (HSI-Symptoms and HSI-Impact) explaining 56.20% of the variance. Convergent validity with ESS was optimal (r=0.65) but greater for HSI-Symptoms (r=0.69) than HSI-Impact (r=0.39). Criterion validity showed significantly higher scores in subjects with CDH (22.63±7.57) and significantly lower scores in subjects with ID (16.96±5.96) as compared to those with oSD (18.65±6.65); however, these divergent scores were primarily driven by the HSI-Symptoms score (p<0.01) rather than the HSI-Impact score (p>0.12). Conclusion The HSI shows satisfactory indices of reliability and validity in a clinically-diverse sleep disorders sample. Its criterion validity is supported by its divergent association with insomnia vs. hypersomnia disorders. Future studies should examine cut-off score for the HSI to reliably identify CDH and test its sensitivity to treatment effects. Support Department of Psychiatry, Penn State College of Medicine

scholarly journals Impact of Current Pain Status on Low-Barrier Buprenorphine Treatment Response Among Patients with Opioid Use Disorder

Pain Medicine ◽  
2021 ◽  
Author(s):  
Kelly R Peck ◽  
Taylor A Ochalek ◽  
Joanna M Streck ◽  
Gary J Badger ◽  
Stacey C Sigmon
Keyword(s):  
Treatment Outcomes ◽  
Severity Index ◽  
Opioid Use Disorder ◽  
Addiction Severity Index ◽  
Brief Symptom Inventory ◽  
Opioid Use ◽  
Global Severity Index ◽  
Pain Status ◽  
The Impact ◽  
Buprenorphine Treatment

Abstract Objective Chronic non-cancer pain (CNCP) is prevalent among individuals with opioid use disorder (OUD). However, the impact of CNCP on buprenorphine treatment outcomes is largely unknown. In this secondary analysis, we examined treatment outcomes among individuals with and without CNCP who received a low-barrier buprenorphine maintenance regimen during waitlist delays to more comprehensive opioid treatment. Methods Participants were 28 adults with OUD who received 12 weeks of buprenorphine treatment involving bimonthly clinic visits, computerized medication dispensing, and phone-based monitoring. At intake and monthly follow-up assessments, participants completed the Brief Pain Inventory, Beck Anxiety Inventory, Beck Depression Inventory (BDI-II), Brief Symptom Inventory (BSI), Addiction Severity Index, and staff-observed urinalysis. Results Participants with CNCP (n = 10) achieved comparable rates of illicit opioid abstinence as those without CNCP (n = 18) at weeks 4 (90% vs 94%), 8 (80% vs 83%), and 12 (70% vs 67%) (P = 0.99). Study retention was also similar, with 90% and 83% of participants with and without CNCP completing the 12-week study, respectively (P = 0.99). Furthermore, individuals with CNCP demonstrated significant improvements on the BDI-II and Global Severity Index subscale of the BSI (P < 0.05). However, those with CNCP reported more severe medical problems and smaller reductions in legal problems relative to those without CNCP (P = 0.03). Conclusions Despite research suggesting that chronic pain may influence OUD treatment outcomes, participants with and without CNCP achieved similar rates of treatment retention and significant reductions in illicit opioid use and psychiatric symptomatology during low-barrier buprenorphine treatment.

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