Comorbidity of Mental Disorder in Patients with Chronic Dis-ease: A Comparative Study of Heroin Dependence Patients and Diabetes Mellitus Patients

Background: Chronic patients are at greater risk for a psychiatric problem than the normal population; yet, the increased rate of mental disorder among one chronic patient compared to another chronic patient is uncertain. We aimed to assess the rate of mental disorder among people with heroin dependence and diabetes mellitus in comparison with the healthy population. Methods: This cross-sectional study was carried out in Kuala Lumpur, Malaysia in 2017-2020. The study consisted of 648 participants including heroin dependence patients, diabetes mellitus patients, and healthy population. The GHQ-28 and SCL-90-R scales were used to assess mental disorder among the study populations. Results: The current study revealed the rate of mental disorder among heroin dependence patients, diabetes mellitus patients, and healthy population respectively at 52.1%, 49.5%, and 23.2% using SCL-90-R and GHQ-28. The rate of mental disorder in both heroin dependent (OR 95%= 3.59: 2.37-5.44) and diabetic groups (OR 95%=3.25: 2.14-4.92) were significantly more than the healthy population; however, the odds ratio of mental disorder was not significantly different between heroin dependent and diabetic groups. Furthermore, the results revealed an acceptable agreement between SCL-90-R and GHQ-28 to detect mental disorders (Kappa=0.60; P<0.001). Conclusion: People with diabetes mellitus and heroin dependence have significantly poorer mental health than healthy people in Malaysia have. Furthermore, the equivalent rate of mental disorder among such patients suggests that heroin dependence patients are not more distressed than diabetes mellitus patients are. However, further comparative studies are needed to prove these findings.

Descended Social Anxiety Disorder and Craving in Women Heroin Dependence Through Exercise Alerts Plasma Oxytocin Levels

Purpose: This study explored the association between peripheral blood oxytocin (OT) and social anxiety disorder (SAD) and cue-induced cravings in female heroin addicts. The effect of exercise on alleviation of SAD and OT levels was also explored.Methods: A total of 72 females with heroin dependence were assigned to three groups based on SAD severity. The three groups were Non-SAD control, SAD control, and SAD exercise groups. Subjects in the SAD exercise group underwent aerobic exercise and resistance training for 8 weeks (60 min/day, 5 days/week). Enzyme-linked immunosorbent assay analysis and Liebowitz Social Anxiety Scale (LSAS) scores were used to determine plasma OT concentration and SAD, respectively. Cue-induced craving was assessed using Visual Analog Scale (VAS) and Desires for Drug Questionnaire (DDQ). Mixed-effect analysis of variance and Pearson correlation analysis were used to explore the effect and correlation between different parameters.Results: OT levels in the SAD exercise group were significantly high after exercise (p &lt; 0.01). LSAS, VAS, and DDQ (“Desire and Intention” and “Negative reinforcement”) scores in the SAD exercise group were significantly lower after exercise (p &lt; 0.01). Plasma OT level was negatively correlated with LSAS score (r = −0.534, p &lt; 0.001), VAS score (r = −0.609, p &lt; 0.001), “Desire and Intention” score (r = −0.555, p &lt; 0.001), and “Negative reinforcement” score (r = −0.332, p &lt; 0.01) and positively correlated with the “control” score (r = 0.258, p &lt; 0.05). LSAS was positively correlated with VAS score (r = 0.588, p &lt; 0.001) and “Desire and Intention” score (r = 0.282, p &lt; 0.05).Conclusions: The findings of the present study indicate that plasma OT is a potential peripheral biomarker for prediction of the severity of social anxiety in female heroin withdrawal patients. Aerobic exercise combined with resistance training plus incremental load for 8 weeks can increase plasma OT levels and significantly reduce severity of SAD and cue-induced cravings in female heroin addicts.

Systematic review of Pharmacogenomics Knowledgebase evidence for pharmacogenomic links to the dopamine reward pathway for heroin dependence

Genetics play an important role in opioid use disorder (OUD); however, few specific gene variants have been identified. Therefore, there is a need to further understand the pharmacogenomics influences on the pharmacodynamics of opioids. The Pharmacogenomics Knowledgebase (PharmGKB), a database that links genetic variation and drug interaction in the body, was queried to identify polymorphisms associated with heroin dependence in the context of opioid related disorders/OUD. Eight genes with 22 variants were identified as linked to increased risk of heroin dependence, with three genes and variants linked to decreased risk, although the level of evidence was moderate to low. Therefore, continued exploration of biomarker influences on OUD, reward pathways and other contributing circuitries is necessary to understand the true impact of genetics on OUD before integration into clinical guidelines.

Opium dependence and the potential impact of changes in treatment coverage level: A dynamic modeling study

Background: The most common drug, illegally used in Iran is opium. The treatment of people with substance use disorder is one of the most important strategies in reducing its burden. The aim of this study was to investigate the effect of different increasing and decreasing opium treatment coverage on the patterns of abstinence, transition to heroin dependence and mortality, over 30 years. Methods: This study was a dynamic compartmental modeling conducted in three stages: 1) presenting a conceptual model of opium dependence treatment in Iran, 2) estimating model’s parameters value, and 3) modeling of opium dependence treatment and examining the outcomes for different treatment coverage scenarios. The input parameters of the model were extracted from the literature, and secondary data analysis, which were finalized in expert panels. Results: The number of opium dependence will increase from 1180550 to 1522063 [28.93% (95% CI: 28.6 to 29.2)] over 30 years. With a 25% decrease in coverage compared to the status quo, the number of deaths will increase by 459 cases [3.28% (95% CI: 0.91 to 5.7)] in the first year, and this trend will continue to be 2989 cases [15.63% (95% CI: 13.4 to 17.9)] in the 30th year. A 25% increase in treatment coverage causes a cumulative decrease of heroin dependence by 14451 cases [10.1% (95% CI: 9.5 to 10.8)] in the first decade. Conclusion: The modeling showed that the treatment coverage level reduction has a greater impact than the coverage level increase in the country and any amount of reduction in the coverage level, even to a small extent, may have a large negative impact in the long run.

Effect of PDYN rs2281285, rs2235749 and rs910080 gene polymorphisms on the intensity of depression symptoms and negative craving in heroin addicts

The present study was undertaken to explore whether prodynorphin (PDYN) polymorphisms have an effect on the intensity of depressive symptoms and negative craving in heroin addicts in a sample of 100 heroin addicts and 108 controls. PDYN rs2281285, rs2225749 and rs910080 polymorphisms were analyzed by PCR-RFLP. Craving and the intensity of depressive symptoms were measured by the Substance Craving Scale and the Beck Depression Inventory-II, respectively. A significant association between depression severity and PDYN rs2281285 (P=0.026) and rs2225749 (P=0.038) polymorphisms was detected. PDYN rs2225749 variation showed a trend association with increased negative craving (P=0.066). We also examined the associations between heroin dependence and PDYN rs2281285, rs2225749 and rs910080 gene polymorphisms at the gene and haplotype levels. The AAA haplotype was more frequent in heroin addicts and shown to be significantly associated with increased risk for heroin dependence (OR, 8.922; 95% CI, 1.116-71.313; P<0.05). PDYN rs2281285 and rs2225749 variations affected the intensity of depressive symptoms, and PDYN rs2225749 polymorphism may contribute to the induction of negative craving in heroin addicts. Haplotype analysis revealed for the first time that addicts with the AAA haplotype of PDYN gene may be more prone to heroin dependence.