Treatment Outcome, Cognitive Function and Psychopathology in Methamphetamine Users Compared to Other Substance Users

Abstract Background: There is an increasing demand of treatment options for methamphetamine users. The present study evaluates differences between methamphetamine users and users of other substances with respect to cognitive function and psychopathology and possible correlates of treatment outcome. Method: 110 subjects were recruited for an observational longitudinal study from a German inpatient addiction treatment center: 55 patients with methamphetamine dependence and 55 patients with dependence of other substances (OS group). Groups were examined at beginning (baseline) and end of treatment (after six months) with regard to treatment retention, craving, cognitive functioning, psychosocial resources, personality traits, and psychiatric symptoms. Results: A total drop-out rate of 40% was observed without significant differences. At baseline, Methamphetamine-group subjects had significantly lower intelligence quotient, less years of education, poorer working speed and lower working accuracy and cannabinoid and cocaine use compared to OS-group. Methamphetamine-group subjects showed a significantly lower score of conscientiousness, psychiatric symptoms than subjects from the OS-group. Both groups showed a reduction of craving and depressive symptoms and an improvement of working speed and working accuracy after treatment. Conclusions: There are differences between methamphetamine users and users of other drugs, but not with regard to the effectiveness of treatment in this inpatient setting.

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Treatment and outcomes at Takiwasi Center, a Peruvian therapeutic community: identifying patient-related indicators

Therapeutic Communities The International Journal of Therapeutic Communities ◽

10.1108/tc-07-2018-0016 ◽

2019 ◽

Vol 40 (2) ◽

pp. 93-106

Author(s):

Victoria Defelippe ◽

Anna Schlütter ◽

Annelen Meriaan ◽

Bjorn Winkens ◽

Veronika Kavenská ◽

...

Keyword(s):

Addiction Treatment ◽

Therapeutic Community ◽

Treatment Options ◽

Multivariable Analysis ◽

Significant Risk ◽

Drop Out ◽

Health Concern ◽

Content Type ◽

Addiction Therapy ◽

Treatment Centre

Purpose Substance abuse is a major public health concern, with over millions of people suffering from it worldwide. Although there is an abundance of treatment options, many of these rehabilitative trajectories are subject to “drop-out”. In addition, “drop-out” is a significant risk factor for relapse. There is an urgent demand for effective treatment, which would enable patients to reduce abuse and prevent relapse. Takiwasi is an addiction treatment centre that combines traditional Amazonian plant medicine with conventional western medicine and psychotherapy. The purpose of this paper is to explore whether socio-demographics factors, such as education level and occupation, psychiatric comorbidities and primary drug use, are associated with treatment non-completion of Ayahuasca (AYA)-assisted addiction therapy. Design/methodology/approach Data on the first treatment episode of 121 patients were collected from the patient database from the years 2012 to 2017. To determine whether there is an association between the variables of interest and treatment non-completion, a χ2 analysis and a logistic regression analysis were performed. Findings Of the 121 patients analysed, 48.2 per cent completed their treatment, whilst 51.8 per cent did not. Students compared to those who are employed showed significantly higher odds for treatment non-completion (p=0.006; OR=3.7; 95% CI=1.5–9.6). Other variables in the multivariable analysis showed no significant relationship with treatment non-completion. While several limitations restricted the study, the findings suggest that the AYA-assisted treatment in Takiwasi may benefit from additional support for patients who are students. Moreover, it is advised to conduct more long-term follow-up of patients in order to gain better insight into the outcome of treatment at an AYA-assisted treatment centre. Originality/value It appears that AYA-assisted therapy in a therapeutic community is a feasible type of treatment for addiction, for which further studies should elucidate the role of motivation in relation to socio-demographic factors and type of addiction in the risk of treatment non-completion.

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Article

Nordic Studies on Alcohol and Drugs ◽

10.1177/145507250201900202 ◽

2002 ◽

Vol 19 (2) ◽

pp. 123-137

Author(s):

Per Nielsen ◽

Steffen Røjskjær

Keyword(s):

Personality Disorder ◽

Personality Disorders ◽

Addiction Treatment ◽

Alcohol Problems ◽

Drop Out ◽

Treatment Center ◽

Millon Clinical Multiaxial Inventory ◽

Dual Disorder ◽

A Prospective Study ◽

The Impact

Per Nielsen & Steffen R⊘jskjær: Dual disorder among alcohol addicted inpatient clients This study examines the prevalence and subtypes of personality disorders among alcohol-addicted inpatients, and the impact on drop out during treatment. The study is the first phase of a prospective study of dual disorder clients (alcohol addiction and personality disorder). Subjects were 104 clients with severe alcohol problems consecutively admitted to a Danish addiction treatment center (Ring-gaarden) applying a cognitive frame of reference. Each client was tested during the first two weeks using the Millon Clinical Multiaxial Inventory (MCMI II-I). According to the psychological testing seven out of eight subjects manifested at least one personality disorder – and 65% of the clients had two or more personality disorders. Anti-social and/or passive-aggressive personality disorder was present in more than 50% of the subjects. Borderline personality disorder was found in about 30%. More than half of the subjects had elevated scores of anxiety and/or dysthymia. Cluster analysis revealed four distinct subtypes of clients: a. no/slight personality disorder, b. “avoidant/dependent”, c. “antisocial/narcissistic” and d. “borderline”. The drop-out rate was significantly higher for the “borderline” group than for the other three. The implications for treatment are discussed.

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Faculty Opinions recommendation of Cognitive function and psychiatric symptoms in early- and late-onset frontotemporal dementia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1103992.561148 ◽

2008 ◽

Author(s):

Janine Diehl-Schmid

Keyword(s):

Cognitive Function ◽

Frontotemporal Dementia ◽

Psychiatric Symptoms ◽

Late Onset

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Within-treatment changes in a novel addiction treatment program using traditional Amazonian medicine

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125320986634 ◽

2021 ◽

Vol 11 ◽

pp. 204512532098663

Author(s):

David M. O’Shaughnessy ◽

Ilana Berlowitz ◽

Robin Rodd ◽

Zoltán Sarnyai ◽

Frances Quirk

Keyword(s):

Repeated Measures ◽

Addiction Treatment ◽

Emotional Health ◽

Neuropsychological Functioning ◽

Well Being ◽

Treatment Center ◽

Therapeutic Effects ◽

Spiritual Well Being ◽

Treatment Safety ◽

Addiction Treatment Program

Aims: The therapeutic use of psychedelics is regaining scientific momentum, but similarly psychoactive ethnobotanical substances have a long history of medical (and other) uses in indigenous contexts. Here we aimed to evaluate patient outcomes in a residential addiction treatment center that employs a novel combination of Western and traditional Amazonian methods. Methods: The study was observational, with repeated measures applied throughout treatment. All tests were administered in the center, which is located in Tarapoto, Peru. Data were collected between 2014 and 2015, and the study sample consisted of 36 male inpatients who were motivated to seek treatment and who entered into treatment voluntarily. Around 58% of the sample was from South America, 28% from Europe, and the remaining 14% from North America. We primarily employed repeated measures on a psychological test battery administered throughout treatment, measuring perceived stress, craving frequency, mental illness symptoms, spiritual well-being, and physical and emotional health. Addiction severity was measured on intake, and neuropsychological performance was assessed in a subsample from intake to at least 2 months into treatment. Results: Statistically significant and clinically positive changes were found across all repeated measures. These changes appeared early in the treatment and were maintained over time. Significant improvements were also found for neuropsychological functioning. Conclusion: These results provide evidence for treatment safety in a highly novel addiction treatment setting, while also suggesting positive therapeutic effects.

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The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke

Journal of the International Neuropsychological Society ◽

10.1017/s1355617721000187 ◽

2021 ◽

pp. 1-13

Author(s):

Elisabeth Kliem ◽

Elise Gjestad ◽

Truls Ryum ◽

Alexander Olsen ◽

Bente Thommessen ◽

...

Keyword(s):

Ischemic Stroke ◽

Executive Function ◽

Depressive Symptoms ◽

Cognitive Function ◽

Psychiatric Symptoms ◽

Post Stroke ◽

Cognitive Difficulties ◽

Memory And Attention ◽

Relationship Of ◽

The Relationship

Abstract Objective: Findings on the relationship of psychiatric symptoms with performance-based and self-reported cognitive function post-stroke are inconclusive. We aimed to (1) study the relation of depression and anxiety to performance-based cognitive function and (2) explore a broader spectrum of psychiatric symptoms and their association with performance-based versus self-reported cognitive function. Method: Individuals with supratentorial ischemic stroke performed neuropsychological examination 3 months after stroke. For primary analyses, composite scores for memory and attention/executive function were calculated based on selected neuropsychological tests, and the Hospital Anxiety and Depression Scale (HADS) was used. Psychiatric symptoms and self-reported cognitive function for secondary aims were assessed using the Symptom-Checklist-90 – Revised (SCL-90-R). Results: In a sample of 86 patients [mean (M) age: 64.6 ± 9.2; Mini-Mental State Examination (MMSE), 3–7 days post-stroke: M = 28.4 ± 1.7; National Institutes of Health Stroke Scale (NIHSS) after 3 months: M = 0.7 ± 1.6] depressive symptoms (HADS) were associated with poorer memory performance after controlling for age, sex, and education (p ≤ .01). In a subsample (n = 41; Age: M = 65.7 ± 8.1; MMSE: M = 28.4 ± 1.8; NIHSS: M = 1.0 ± 1.9), symptoms of phobic anxiety (SCL-90-R) were associated with poorer performance-based memory and attention/executive function, and symptoms of anxiety (SCL-90-R) with lower attention/executive function. Higher levels of self-reported cognitive difficulties were associated with higher scores in all psychiatric domains (p ≤ .05). Conclusion: Even in relatively well-functioning stroke patients, depressive symptoms are associated with poorer memory. The results also suggest that various psychiatric symptoms are more related to self-reported rather than to performance-based cognitive function. Screening for self-reported cognitive difficulties may not only help to identify patients with cognitive impairment, but also those who need psychological treatment.

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Definition of a novel vaccination pathway in PLWHA: experience of a Southern University Hospital

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.837 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S D'Amato ◽

G F Pellicanò ◽

C Genovese ◽

F Mazzitelli ◽

G Nunnari ◽

...

Keyword(s):

Infectious Diseases ◽

Vaccination Coverage ◽

Clinical Pathway ◽

Drop Out ◽

University Hospital ◽

Treatment Center ◽

People Living With Hiv ◽

Vaccination Rates ◽

Operating Unit ◽

Hiv Aids

Abstract Background At the end of 2018 across the globe there are ∼37.9 million people with HIV/AIDS also thanks to the use of HAART which led to an increase in life expectancy. The Italy Immunization Plan 2017-19 recommend vaccines to these patients but a protocol still isn't present. Moreover, despite the availability of effective vaccines, coverage remained very low for many reasons including problems with privacy. The objectives of this study were a) the appliance of a shared clinical pathway between the “Immunization Center of Hospital Hygiene Operating Unit” and the “HIV/AIDS Disease Prevention, Diagnosis and Treatment Center of Infectious Diseases Operating Unit” b) the increase in vaccination coverage and the evaluation of side effects. Methods A prospective study was conducted from Oct 2019 to Feb 2020 at the G. Martino University Hospital of Messina. In particular, of the 138 patients followed by the Infectious Diseases OU, after evaluation of their immune status, 62% were enrolled in this study. Following the acquisition of informed consent, we collected socio-anagraphical data and we started the free administration of vaccines by providing an hoc calendar in the Immunization Center. Statistical analysis was performed with R software. Results The sample was represented by 86 patients (74% males and 26% females, 21% foreigners and 79% Italian, mean age=40±13.6 SD). We didn't observe drop out and no differences were observed for local/systemic AEs generally reported. We obtained an increase of vaccination coverage with a total of 74 doses administered for flu (+164%) and 240 for other vaccines (+172%). In particular, we immunized a total of 74% of patients for HPV (2% in 2018), 42% for HAV (28% in 2018), 37% for HBV (28% in 2018), 58% for pneumococcal (21% in 2018), 54% for meningococcal ACWY and B (0% in 2018). Conclusions The undertook clinical pathway showed the relevance of specific management of these patients and the need to increase the vaccination offer. Key messages The immunization in people living with HIV is priority to reduce the risk of infectious disease. It’s important to implement a shared clinical pathway to increase vaccination rates of these patients. The application of the protocol had an high impact in patients' adhesion to vaccination also thanks to the chance of accessing to the service in a comfortable setting and suitable to protect privacy.

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A novel preference-informed complementary trial (PICT) design for clinical trial research influenced by strong patient preferences

Trials ◽

10.1186/s13063-021-05164-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Samina Ali ◽

◽

Gareth Hopkin ◽

Naveen Poonai ◽

Lawrence Richer ◽

...

Keyword(s):

External Validity ◽

Treatment Options ◽

Internal Validity ◽

Clinical Effectiveness ◽

Drop Out ◽

Innovative Design ◽

Clinical Trial Research ◽

Research Questions ◽

Internal And External Validity ◽

Treatment Population

Abstract Background Patients and their families often have preferences for medical care that relate to wider considerations beyond the clinical effectiveness of the proposed interventions. Traditionally, these preferences have not been adequately considered in research. Research questions where patients and families have strong preferences may not be appropriate for traditional randomized controlled trials (RCTs) due to threats to internal and external validity, as there may be high levels of drop-out and non-adherence or recruitment of a sample that is not representative of the treatment population. Several preference-informed designs have been developed to address problems with traditional RCTs, but these designs have their own limitations and may not be suitable for many research questions where strong preferences and opinions are present. Methods In this paper, we propose a novel and innovative preference-informed complementary trial (PICT) design which addresses key weaknesses with both traditional RCTs and available preference-informed designs. In the PICT design, complementary trials would be operated within a single study, and patients and/or families would be given the opportunity to choose between a trial with all treatment options available and a trial with treatment options that exclude the option which is subject to strong preferences. This approach would allow those with strong preferences to take part in research and would improve external validity through recruiting more representative populations and internal validity. Here we discuss the strengths and limitations of the PICT design and considerations for analysis and present a motivating example for the design based on the use of opioids for pain management for children with musculoskeletal injuries. Conclusions PICTs provide a novel and innovative design for clinical trials with more than two arms, which can address problems with existing preference-informed trial designs and enhance the ability of researchers to reflect shared decision-making in research as well as improving the validity of trials of topics with strong preferences.

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Cognitive reserve in neuropsychiatry

Psychological Medicine ◽

10.1017/s0033291706007501 ◽

2006 ◽

Vol 36 (8) ◽

pp. 1053-1064 ◽

Cited By ~ 159

Author(s):

J. H. BARNETT ◽

C. H. SALMOND ◽

P. B. JONES ◽

B. J. SAHAKIAN

Keyword(s):

Bipolar Disorder ◽

Cognitive Function ◽

Head Injury ◽

Cognitive Reserve ◽

Protective Factor ◽

Psychiatric Symptoms ◽

Neuropsychiatric Disorders ◽

Future Studies ◽

Cognitive Failure ◽

History Of

Background. The idea that superior cognitive function acts as a protective factor against dementia and the consequences of head injury is well established. Here we suggest the hypothesis that cognitive reserve is also important in neuropsychiatric disorders including schizophrenia, bipolar disorder and depression.Method. We review the history of passive and active models of reserve, and apply the concept to neuropsychiatric disorders. Schizophrenia is used as an exemplar because the effects of premorbid IQ and cognitive function in this disorder have been extensively studied.Results. Cognitive reserve may impact on neuropsychiatric disorders in three ways: by affecting the risk for developing the disorder, in the expression of symptoms within disorders, and in patients' functional outcome. Cognitive failure below a certain threshold may alone, or in combination with common psychiatric symptoms, produce neuropsychiatric syndromes.Conclusions. Consideration of cognitive reserve may considerably improve our understanding of individual differences in the causes and consequences of neuropsychiatric disorders. For these reasons, the concept of cognitive reserve should be incorporated in future studies of neuropsychiatric disorder. It may be possible to enhance cognitive reserve through pharmacological or non-pharmacological means, such as education, neurocognitive activation or other treatment programmes.

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