DEPENDENCE OF ALEXITHYMIA INTENSITY ON COMPONENTS OF PSYCHOSOCIAL ADAPTATION IN MEN WITH PSYCHOTROPIC SUBSTANCE USE DISORDERS

Introduction. Levels of alexithymia and psychosocial adaptation can influence on the treatment and rehabilitation of patients with substance use disorders. The investigation of the state of the adaptation system is often used to examine these patients, despite its complexity and multilevel character. It is still unclear what characteristics of psychosocial adaptation may indicate increasing level of alexithymia. Therefore the aim of this study is to investigate their association for future prediction of alexithymia level in men with substance use disorders. Methods. We examined 28 men who took the treatment at the detoxication therapy stage. We studied severity of alexithymia by Russian version of the Toronto Alexithymia Scale and analyzed peculiarities of psycho-social adaptation by C.R. Rogers and R.F. Dymond methods. To analyze the dependence between variances, multiple linear regression with Akaike information criteria and stepwise variable method was used. Results. The average level of alexithymia in the subjects was 57.6 ± 14.1 scores: it points out an elevated severity of the condition. The patients have “difficulty identifying feelings” at 18.9±6.6 scores, “difficulty describing feelings” at 13.7±4.9 scores and “externally oriented thinking” at 25.04±5.4 scores. The average levels of the subscales of the psychosocial adaptation questionnaire demonstrate no difference from normal values, but integral indices were increased. After stepwise variable method we selected the minimum set of factor characteristics associated with the original variable. Two factors related to the level of alexithymia were identified: internality and emotional comfort. The analysis shows the adequacy of the linear two-factor model for predicting the level of alexithymia in men with substance use disorders that based on values of internality and emotional comfort. Conclusion. We found that increased level of internality and emotional comfort in men with substance use disorders can predict an elevating level of alexithymia.

On the Issue of Simulation Training in the Cycle of Additional Professional Education "Turnover of Narcotic and Psychotropic Drugs"

Simulation training is an interactive type of educational activity realized through immersion in the environment, by recreating a real clinical situation. At the same time, it is not possible to observe the maximum immersion in reality when training on the circulation of narcotic drug and psychotropic substance due to strict control measures on the part of the supervisory authorities in terms of the circulation of narcotic drugs and psychotropic substances. The article discusses options for resolving the issue of organizing simulation training on the circulation of narcotic and psychotropic substances for nurses.

Diagnosis of acute poisoning by addictive and psychotropic substances based on the toxidrome

Background. Poisoning by addictive and psychotropic substances is one of the main reasons for the admission of patients to emergency departments in most countries of the world. The purpose of this study was to investigate the current structure of toxic syndromes in patients with acute poisoning and to analyze existing approaches to the diagnosis of addictive and psychotropic substance poisoning based on the syndromic approach. Materials and methods. Medical data of 2987 patients treated with the diagnosis: “Acute drug poisoning” (ICD-10: T40.0-T40.3) in the Kyiv Toxicological Center were studied. Laboratory studies of addictive and psychotropic substances in the biological environment were performed using immunochromatographic analysis (rapid tests) and chromate-mass spectrometry (device Aligent 6850/5973N, column HP-5MS). Statistical analysis was performed using the program Statistica 12.6 (Windows 10/7). Results. According to the Center for Mental Health and Monitoring of Drugs and Alcohol of the Ministry of Health of Ukraine in 2018, the most common substances that result in abuse were: alcohol — 14.6 %, cannabis — 2.8 %, opioids — 2.1 %, sedative agents — 1.1 %, solvents — 0.9 %, amphetamine-type stimulants — 0.2 %, cocaine — 0.1 %, and hallucinogens — 0.1 %. The range of substances that caused severe poisoning in adults in 2016–2020 represented by: ethanol — 29.2 %, opioids — 42.3 %, cannabinoids — 8.4 %, sedative agents and hypnotics — 9.5 %, cocaine, and stimulants, inclu-ding caffeine — 7.4 %, hallucinogens — 5.5 %, solvents — 2.1 %. The following toxidromes were diagnosed: sedative in 46.3 % of patients, opioid — 37.6 %, sympathomimetic — 17.7 %, anticholinergic — 9.5 %, serotonin — 0.4 %, and syndrome of inappropriate diuretic hormone secretion (SIADH) — 0.2 %. During the study period, the number of combined poisonings increased 1.8 times (from 20.5 to 37.1 %), and among the combinations of addictive and psychotropic substances, the most common are methadone + ethanol, methadone + benzodiazepines, methadone + amphetamine, opioids + cocaine + ethanol, opioids + cannabis, as well as other combinations involving methamphetamine, hallucinogens, analgesics. Clinical diagnosis of combined poisonings is difficult, miosis may be absent in tramadol and meperidine poisoning, in cases of combined use of opioids and stimulants, or extremely severe cases, when the patient shows signs of deep post-hypoxic encephalopathy. Modern synthetic opioids (fentanyl and buprenorphine analogues) significantly outweigh the toxic effects of heroin, so there is a fairly common approach to using higher initial doses of naloxone in the treatment of such overdoses. However, approaches to the use of naloxone differ in various scientific sources. The practical experience in the Kyiv Toxicological Center proves that treatment can be started with standard doses of naloxone and quickly increased in the absence of side effects (agitation, convulsions, pulmonary edema). Given the fact that modern test systems are aimed at finding a small range of narcotic and psychotropic substances and do not determine their concentration, considerable attention should be paid to clinical diagnosis based on the definition of pathological symptoms and syndromes. Since the main target for narcotic and psychotropic substances is the nervous system, the identification of biomarkers of its dysfunction at different levels is key in the diagnosis of poisoning. Based on certain biomarkers, an understanding of the existing toxic syndrome (toxidrome) is formed. Today, opioids play a key role in morbidity and mortality from drug poisoning in Ukraine. A threatening trend in recent years is the increase in the proportion of combined poisonings by opioids and other substances, which complicates the determination of the toxidrome. It is important to note that the “fashion” for the use of combinations of narcotic drugs and psychotropic substances among drug users is constantly changing, so doctors try to regularly update information on available drugs and psychotropic substances in the region, which are popular among consumers and characteristic manifestations of poisoning. The universal approach ABCDE should be used in cases where there are no specific tests for toxic substances, and because more than a third of positive tests show the presence of two or more xenobiotics. Conclusions. Identification of toxidrome is important from the standpoint of diagnosis and treatment of acute poisoning. Many researchers note that its importance exceeds the value of rapid tests to determine the toxic substance, and the patient’s vital signs and careful examination are the best clues for choosing treatment tactics. In cases of combined poisoning with drugs or psychotropic substances, or in situations where it is not possible to conduct rapid testing of the patient’s urine for toxic substances, it is necessary to approach the use of antidotes (naloxone) with caution. It is important to remember that the object of medical intervention in any poisoning is the patient, not the toxin or the results of laboratory tests, which do not always correctly indicate the poison. Pharmacological interventions in the treatment of a patient with acute addictive or psychotropic substance poisoning should be aimed at correcting the underlying pathological syndrome (if possible), taking into account not to exacerbate its manifestations, but rather to minimize its severity and duration.

Analysis of cases of fatal poisoning by narcotic and psychotropic substances in Ukraine based on the results of the epidemic, clinical, forensic, and laboratory research (2015–2019)

Background. Today in Ukraine, acute poisoning by narcotic drugs and psychotropic substances is an extremely urgent medical and social problem, which is far out of being solved, that’s why there is a need for in-depth study of the causes of deaths from poisoning to prevent them. The purpose of this study is to analyze the cases of fatal poisonings by narcotic and psychotropic substances with the involvement of epidemic, clinical, forensic, and laboratory research methods, aimed at finding measures to improve the health care system for acute domestic poisoning. Materials and methods. There were studied the medical data of patients treated with the diagnosis: “Acute drug poisoning” (ICD-10: T40.0–T40.3) in the Kyiv Toxicological Center, the statistical data of the State Statistics Service of Ukraine, the Center for Medical Statistics of the Ministry of Health of Ukraine, the data from reports of the Bureau of Forensic Medical Examinations. The laboratory studies of narcotic and psychotropic substances in the biological environment were performed using immunochromatographic analysis and chromatography-mass spectrometry (device — Aligent 6850/5973N, column — HP-5MS). The statistical analysis was performed using the program Statistica 12.6 (Windows 10/7): the reliability of the difference in indicators in the study groups was assessed using Student’s t-test with a significance level of p < 0.05. Results. In the last 5 years, the most common narcotic and psychotropic substances are synthetic and semi-synthetic opioids, psychostimulants, smoking mixtures, sedatives, or hypnotics. At the same time, the number of poiso-nings associated with the combined use of drugs and psychotropic substances, pharmaceuticals, and ethanol is increasing. During the period 2015–2019, more than 40 groups of substances that led to acute poisoning were found in the laboratory of the Kyiv Toxicological Center. The number of positive tests increased 2.3 times during the study period. The leaders in the structure of opioid drugs are methadone, heroin, and morphine. According to the State Statistics Service of Ukraine, in 2014–2018, 1365 deaths were registered as a result of poisoning by narcotic and psychotropic substances. In 2018, a total of 399 cases of deaths related to narcotic and psychotropic substances use and poisoning were recorded in Ukraine. Of these, 64 (16.04 %) cases were related to mental and behavioral disorders due to drug and psychotropic substance abuse and 335 (98.82 %) cases were related to external causes of death related to poisoning or overdose. Among those who died in 2018, there were 90.5 % men (361 cases) and 9.5 % women (38 cases). The largest number of deaths, 340 cases (85.2 %), occurred in the age group from 25 to 44 years, 13 ca-ses — in the age group from 15 to 24 years, and 46 cases — from 45 years and older. Three hundred and fifty-five cases of death from poisoning by psychotropic substances were investigated, it was established that opioid poisoning occurred in 153 cases (codeine and morphine — 54 cases (43.1 %), methadone — 76 cases (21.4 %), opium — 15 cases (4.2 %), synthetic opioids — 8 cases (2.3 %)). One hundred and forty-four cases of death from other drug poisonings were studied, including 31 (21.5 %) cases of psychodysleptic poisoning (hallucinogens), 2 (1.4 %) cases of cocaine poisoning, and 5 (3.5 %) cases of psychostimulant poisoning. According to state statistics, the number of deaths from poisoning in 2018 compared to 2017 increased by half and much. In particular, methadone poisoning increased 2.5 times, and unidentified drug poisoning was three-fold increased. According to the intent, the deaths were distributed as follows: 268 deaths — accidental poisoning; 66 deaths — poisoning by indefinite intent; one case — self-poisoning. The opioid poisoning accounted for 28 % of all cases of the psychotropic substances revealed in biological material, 24.4 % cases were drugs containing narcotic and psychotropic substances or precursors, 15 % — of unidentified substances, the rest consisted of other psychoactive substan-ces. The age characteristics of the group of deaths resulted from narcotic and psychotropic substances revealed in the biological material, and in the group of deaths from overdose are the same (p ≤ 0.05). It means that in the samples of both groups, the age group of 25–44 years presented over 75 % of cases. In Ukraine in 2018, the frequency of deaths related to drug and psychotropic substance abuse and poisoning among the population aged 15 to 64 was 10 people per 1,000,000. Conclusions. The results of the epidemic, clinical, forensic, and laboratory studies conducted by various government agencies in the period 2014–2019, demonstrate a threatening dynamic of increasing both the number of cases of narcotic and psychotropic poisoning and their diversity, resulting in a progressive increase in lethality and mortality, mainly among the male population aged 25–44 years. The main way of the use of narcotic and psychotropic substances in Ukraine continues to be the injection of opioids (methadone, heroin, buprenorphine, etc.) and amphetamine-type stimulants. There has been an increase in the number of deaths associated with the simultaneous use of several narcotic and psychotropic substances (methadone, amphetamine, marijuana, benzodiazepines, ethanol, etc.) in various combinations.

The European Arrest Warrant in Designer Drugs Cases. With or Without Verification of Double Criminality?

The cross-border character of the designer drugs crimes forced the UE countries to cooperate in criminal prosecution. At first sight, in European Union law, there are proper instruments to enforce such cooperation. The Framework Decision on the European Arrest Warrant introduces the model of cross-border prosecution and abandons the requirement of double criminality in case of the group of the 32 crimes, listed in the Article 2 (2) of the FD EAW. The question is whether such a simple variant of EAW (without checking double criminality) may be enforced in designer drug cases. The work presents an argumentation that the normative meaning of Article 2 (2) of the FD EAW has to be established under European and international law. As long as a particular new drug is not internationally recognized as ‘psychotropic substance’ or ‘narcotic drug’, its trafficking cannot be treated as one of the 32 crimes, mentioned above.

A case-control study on psychotropic substance use and risk of Axis I psychiatric disorders in HIV-infected gay or bisexual men in Hong Kong

Background: Psychotropic substance use is common in HIV-infected gay or bisexual men (GBM). This study examined the association between Axis I psychiatric disorders and active psychotropic substance use, and identified factors affecting the prevalence of psychiatric disorders in HIV-infected GBM.Methods: This is a cross-sectional case-control study taken place in an HIV clinic and community organisations serving people living with HIV or GBM in Hong Kong. Participants were 62 HIV-infected self-identified GBM who reported psychotropic substance use in the past 1 year (cases), and 55 HIV-infected self-identified GBM without psychotropic substance use in the past 1 year and had negative toxicology tests at recruitment (controls).The Chinese-bilingual Structured Clinical Interview for DSM-IV (Axis I, Patient version) was followed to establish the psychiatric diagnoses. Socio-demographic data, level of social support, HIV-related data, and pattern of psychotropic substance use were collected. Results: Cases had lower level of social support (p=0.02), more depressive disorders (AOR 3.4, 95% CI 1.3-8.7, p=0.01) and psychotic disorders (AOR 7.2, 95% CI 1.2-41, p=0.03) but not anxiety disorders. Significant difference in the prevalence of psychiatric disorders was only evident for disorders with onset after HIV diagnosis. Methamphetamine dependence (AOR 6.63, 95% CI 1.53-228.72, p<0.01), weekly methamphetamine use for 2 years or more (AOR 18.6, 95% CI 1.26-274.69, p=0.03), using methamphetamine beyond chemsex (AOR 4.76, 95% CI 1.17-19.41, p=0.03) were significant predictors for psychiatric disorders in the cases in separate logistic regression models. Duration of HIV diagnosis was a significant independent predictor in all three models. Conclusions: Active psychotropic substance use in HIV-infected gay or bisexual men was associated with a 3-fold increase in Axis I psychiatric disorders. This increase in psychiatric disorders was predicted by the severity, duration and context of methamphetamine use and the duration of HIV diagnosis.