The moderation of the genetic risk for alcohol and drug use disorders in a Swedish national sample by the genetic aptitude for educational attainment

Background Does the genetic aptitude for educational attainment (GAEA) moderate the genetic risk for alcohol use disorder (AUD) and drug use disorder (DUD)? Methods In the native Swedish population, born 1960–1980 and followed through 2017 (n = 1 862 435), the family genetic risk score (FGRS) for AUD and DUD and GAEA were calculated from, respectively, the educational attainment and risk for AUD and DUD, of 1st through 5th degree relatives from Swedish national registers. Analyses utilized Aalen's linear hazards models. Results Risk for AUD was robustly predicted by the main effects of FGRSAUD [b = 6.32 (95% CI 6.21–6.43), z = 64.9, p < 0.001) and GAEA [b = −2.90 (2.83–2.97), z = 44.1, p < 0.001] and their interaction [b = −1.93 (1.83–2.03), z = 32.9, p < 0.001]. Results were similar for the prediction of DUD by the main effects of FGRSDUD [b = 4.65 (CI 4.56–4.74), z = 59.4, p < 0.001] and GAEA [−2.08 (2.03–2.13), z = 46.4, p < 0.001] and their interaction [b = −1.58 (1.50–1.66)), z = 30.2, p < 0.001]. The magnitude of the interactions between GAEA and FGRSAUD and FGRSDUD in the prediction of, respectively, AUD and DUD was attenuated only slightly by the addition of educational attainment to the model. Conclusions and relevance The genetic propensity to high educational attainment robustly moderates the genetic risk for both AUD and DUD such that the impact of the genetic liability to AUD and DUD on the risk of illness is substantially attenuated in those with high v. low GAEA. This effect is not appreciably mediated by the actual level of educational attainment. These naturalistic findings could form the basis of prevention efforts in high-risk youth.

Case Report: Syphilitic Hepatitis–A Rare and Underrecognized Etiology of Liver Disease With Potential for Misdiagnosis

Syphilitic hepatitis (SH) in adults is a rare condition that can be easily misdiagnosed. Clinical and histopathologic manifestations of SH can mimic other infectious and non-infectious conditions, and the diagnosis should be considered in all at-risk patients with abnormal liver function tests. We present an unusual case of SH presenting with seizures and multiple liver lesions. This case report, in line with other newly published reports, promotes awareness of SH as a rare manifestation of treponemal infection and highlights the importance of including SH in the differential diagnosis for patients at risk for sexually transmitted infections and presenting with liver enzyme abnormalities. From a hospital quality control and socioeconomic perspective, our case adds to the growing body of evidence that demonstrates an increasing incidence of patients suffering from venereal diseases and injection drug use disorders, and the burden these conditions place on the healthcare system. Recognition of the clinicopathologic features of SH is required to prevent missed diagnosis and to foster systematic crosstalk between healthcare staff and public health personnel managing this problem.

Shared genetic and environmental etiology between substance use disorders and suicidal behavior

Background Previous studies have demonstrated substantial associations between substance use disorders (SUD) and suicidal behavior. The current study empirically assesses the extent to which shared genetic and/or environmental factors contribute to associations between alcohol use disorders (AUD) or drug use disorders (DUD) and suicidal behavior, including attempts and death. Methods The authors used Swedish national registry data, including medical, pharmacy, criminal, and death registrations, for a large cohort of twins, full siblings, and half siblings (N = 1 314 990) born 1960–1980 and followed through 2017. They conducted twin-sibling modeling of suicide attempt (SA) or suicide death (SD) with AUD and DUD to estimate genetic and environmental correlations between outcomes. Analyses were stratified by sex. Results Genetic correlations between SA and SUD ranged from rA = 0.60–0.88; corresponding shared environmental correlations were rC = 0.42–0.89 but accounted for little overall variance; and unique environmental correlations were rE = 0.42–0.57. When replacing attempt with SD, genetic and shared environmental correlations with AUD and DUD were comparable (rA = 0.48–0.72, rC = 0.92–1.00), but were attenuated for unique environmental factors (rE = −0.01 to 0.31). Conclusions These findings indicate that shared genetic and unique environmental factors contribute to comorbidity of suicidal behavior and SUD, in conjunction with previously reported causal associations. Thus, each outcome should be considered an indicator of risk for the others. Opportunities for joint prevention and intervention, while limited by the polygenic nature of these outcomes, may be feasible considering moderate environmental correlations between SA and SUD.

Seminars in Addiction Psychiatry

This extensively revised new edition provides a practical guide to understanding, assessing and managing physical, psychological and social complications related to drug and alcohol use. It presents a clear review of the aetiology, epidemiology, prevention and treatment of the problematic use of and dependence on alcohol, illicit and prescribed drugs. In doing so it strikes a balance between theory, recent research and practical clinical guidance. New chapters focus on novel psychiatric substances, smoking cessation interventions, mutual aid groups and family interventions. Written by leading specialists in the field and closely following the MRCPsych curriculum, this book is an ideal resource for trainees preparing for their RCPsych membership examinations, but is also relevant to psychiatrists at all career levels. It will also appeal to other healthcare professionals, all of whom should be able to screen for alcohol and drug use disorders, deliver brief interventions, and signpost those with more severe disorders to specialist care.

Risky Alcohol Use and Comorbidity in a Swedish Adolescent Emergency Psychiatric Inpatient Population

Introduction. Underage drinking is associated with poor mental health. Early detection for risky alcohol use is recommended, although less implemented in adolescent care. The objective of this study was to investigate the prevalence of risky alcohol use and psychiatric comorbidity. Methods. Over a nine-month period, 145 eligible adolescents admitted to the child and adolescent emergency unit in Malmö, Sweden, were offered computerized screening with Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) and Drug Use Disorders Identification Test (DUDIT). Results. Ninety-six patients (73 girls and 23 boys) agreed to participate. The most common diagnoses were affective disorder (41%) and anxiety disorder (27%). Risky alcohol use was found among 33% of the girls and 22% of the boys ( p = 0.45 ) and did not differ between diagnostic categories. There was a positive correlation between AUDIT-C and DUDIT scores ( p = 0.019 ). Among adolescents with risky alcohol use, 33% of the girls and 60% of the boys also had a risky drug use. Conversely, 47% of the girls and 60% of the boys with risky drug use also had a risky alcohol use. Conclusion. In view of the poor prognosis of risky alcohol use in adolescents, alcohol and drug habits should be assessed when adolescents seek psychiatric emergency care.

Substance use patterns among university students in Egypt

Background In the past few years, there has been an expanding global interest in the problem of substance use. A variety of studies conducted within the past decade have investigated the prevalence of substance use among university students. The study aimed to detect the prevalence and associates of substance use among Egyptian students at Mansoura University. This cross-sectional, questionnaire-based, observational study was conducted during the period from February to July 2019 on 1138 university students at Mansoura University in Egypt. The university students were randomly divided into three classes (medical, practical, and theoretical). The data were assembled using questionnaires of sociodemographic, clinical attributes, and drug use disorders identification test (DUDIT). Results Lifetime substance use among students was 6.5%. Of the users, 18 (24.3%) used cannabis, 14 (18.9%) used tramadol, 10 (13.5%) used alcohol, 5 (6.8%) used benzodiazepines, and 1 (1.4%) used heroin. Only 35.1% used polysubstance, of those, 10 (13.5%), 12 (16.2%), 3 (4.1%), and 1 (1.4%) used cannabis and tramadol; cannabis and alcohol; cannabis and inhalant; and cannabis, alcohol, and tramadol respectively. There was a substantial association between substance use and male sex, age above 20 years, smoking, and living in urban areas. In the group that used substances, 50 (4.4%) suffered substance-related problems and 6 (0.5%) encountered dependency. Conclusion In total, using the mono substance is more than using poly substances in which cannabis, tramadol, and alcohol were the most often utilized substances. The highest percentage of drug-related problems was among medical students while dependence was highest among practical students. These results should be considered in future substance preventive programs.

Altered Neural Processing of Reward and Punishment in Women With Methamphetamine Use Disorder

It has been suggested that the altered function of reward and punishment is an important vulnerability factor leading to the development of drug use disorders. Previous studies have identified evidence of neurophysiological dysfunction in the reward process of individuals with substance use disorders. To date, only a few event-related potential (ERP) studies have examined the neural basis of reward and punishment processing in women with methamphetamine (MA) use disorders. The current ERP research aims to investigate the neurophysiological mechanisms of reward and punishment in women with MA use disorder using a monetary incentive delay task. Nineteen women with MA use disorder (MA group) and 20 healthy controls (HC group) were recruited in this study. The behavioral data showed that the reaction time (RT) was faster and the response accuracy (ACC) was higher for the potential reward and punishment conditions compared to neutral conditions. During the monetary incentive anticipation stage, the Cue-P3, and stimulus-preceding negativity (SPN) were larger in the MA group than in the HC group. The SPN under the potential reward condition was larger than that under the neutral condition in the MA group but not in the HC group. During the monetary incentive consummation stage, the feedback-related negativity and feedback P3 (FB-P3) following positive feedback were significantly larger than negative feedback in the potential reward condition for the HC group, but not for the MA group. However, the FB-P3 following negative feedback was significantly larger than positive feedback in the potential punishment condition for the MA group, but not the HC group. The results suggest that women with MUD have stronger expectations of generic reward and stronger response of generic harm avoidance, which could be targeted in designing interventions for women with MA use disorder.

Impact of COVID-19 on drug use disorders and provision of drug related interventions in prison

Introduction With the emergence of the COVID-19 epidemic, most European countries implemented measures to prevent the spread of infections inside prison, including: use of personal protective equipment (PPE), hygiene practices, limits to mobility, reduction of overcrowding. Their implementation affected the drug related interventions. The EMCDDA has conducted a rapid assessment to evaluate the impact of those measures on the provision of drug treatment and harm reduction services in the European prisons of 15 countries between March and June 2020. Methods The study was based on a mixed method approach that triangulated the results of an on-line survey, the outcome of a focus group with prison and drugs experts and case studies from four European countries. Results and discussion Most countries reported a reduction in the provision of drug treatment and, to a lesser extent, of harm reduction interventions inside prison during the early phase of the pandemic. The drug services tried to adapt to the new context. Innovations were introduced, including the use of telemedicine in counselling and pharmacological treatment, a better partnership between security and health staff and a more individualised approach to drug treatment. Concerns were expressed around reduction of some interventions, such as group-based interventions, services provided by external agencies, interventions in preparation for release, continuity of care and possible reduction in testing and treatment of drug related infections such as HIV, HCV and HBV due to the priority given to the COVID-19 emergence. Conclusions With the emergence of COVID-19, drug services had to address various challenges, making efforts to maintain the provision of drug-related interventions inside prison, while introducing the COVID-19 containment measures. Ensuring the equivalence and continuity of health care provision for those in prison with drug problem remains of central importance.

Serious physical assault and subsequent risk for rehospitalization in individuals with severe mental illness: a nationwide, register-based retrospective cohort study

Background Victimization is associated with worse social and clinical outcomes of individuals with severe mental illness (SMI). A relapse of SMI may be one of the clinical consequences of assaultive trauma. As far as we know, there is no published study that analyzes nationwide health registers to assess the risk of SMI rehospitalization following assault. Aim We aimed to assess whether exposure to assault is associated with an increased risk of psychiatric hospitalization in those with SMI. Methods We utilized data from the Czech nationwide registers of all-cause hospitalizations and all-cause deaths. We defined exposed individuals as those discharged from a hospitalization for SMI between 2002 and 2007, and hospitalized for serious injuries sustained in an assault in the subsequent 7 years. For each assaulted individual, we randomly selected five counterparts, matched on SMI diagnosis, age and sex, who were not assaulted in the examined time period. We used mixed effect logistic regression to assess the effect of assault on the risk of SMI rehospitalization within the following 6 months. We fitted unadjusted models and models adjusted for the number of previous SMI hospitalizations and drug use disorders. Results The sample consisted of 248 exposed and 1 240 unexposed individuals. In the unadjusted model, assaulted individuals were almost four times more likely to be rehospitalized than their non-assaulted counterparts (odds ratio (OR) = 3.96; 95% CI 2.75; 5.71). After adjusting for all covariates, the OR remained threefold higher (OR = 3.07; 95% CI 2.10; 4.49). Conclusion People with a history of SMI hospitalization were approximately three times more likely to be rehospitalized for SMI within 6 months after an assault than their non-assaulted SMI counterparts. Soon after a person with SMI is physically assaulted, there should be a psychiatric evaluation and a close follow-up.