Psychiatric Co-Morbidity and Substance Use Correlated with Medication Adherence Among People Living with HIV (PLWHIV) Attending the Virology Clinic of the University of Port Harcourt Teaching Hospital (UPTH)

HIV infection is an endemic communicable chronic disease, of enormous public health concern worldwide particularly, Sub-Saharan African. Substance use and associated psychiatric co-morbidity among the sufferers may affect medication adherence. The aim of this study, therefore, was to determine the effect of psychiatric comorbidity and substance use on medication adherence among people living with HIV at the University of Port Harcourt Teaching Hospital. A cross-sectional study was conducted among 230 Subjects Living with HIV. Sociodemographic questionnaire was used. A structured questionnaire was used to assess use of psychoactive substances. Psychiatric co-morbidity was assessed using the GHQ-12 in conjunction with the DSM 5. The Medication Adherence Rating Scale (MARS) was used to assess medication adherence. Data was analysed using the SPSS version 20. The prevalence of psychological co-morbidity among PLWHIV was 30.6%. Alcohol use disorders was the highest with 73 (31.7%), followed by cigarette smoking 38 (16.5%) while nicotine snuffing was the least with 1 (0.4%). Of the 43 (18.7%) with poor medication adherence, 31 (15.2%) had psychiatric co-morbidity, 26 (11.3%) had substance use, 25 (10.8%) had both psychiatric and substance use co-morbidity while 19 (8.2%) had none (p=0.004). Psychological co-morbidity and substance use are prevalent among PLWHIV, and may affect medication adherence.

New Perspective on Addiction: The Hypothesis of Rebound Effect

Addiction alters the levels of all happy brain hormones. My hypothesis is that addictive stimuli cause high amplitude changes in happy brain hormones with initially very high levels followed by very low levels (rebound effect). On the other hand, non-addictive stimuli such as creative work, moderate physical activity, healthy diet, healthy relationships and socialization, cause moderate amplitude changes in happy brain hormones with stable levels of dopamine, serotonin, endorphins and oxytocin without rebound effect. Therefore, all of these non-addictive stimuli might be very helpful in the treatment of addiction.

Alcohol Use Disorder among General Hospital Medical Inpatients

Objectives: We sought to examine alcohol use disorder (AUD) among general hospital medical inpatients with respect to identification, service utilization, and initiation of medication-assisted treatment. Methods: We performed a retrospective chart review for all adult inpatients over one full calendar year. Subjects were separated into two categories: patients with chart documentation of an AUD diagnosis and those without such documentation. We extracted from the electronic health record and analyzed information on demographics, service utilization, and treatment initiation of medication-assisted treatment for AUD such as naltrexone, disulfiram, or acamprosate. Results: The study revealed three main findings: 1) Less than one percent of patients discharged from the hospital in one full calendar year had an identified AUD diagnosis. 2) Patients with an AUD diagnosis had a significantly higher number of emergency department (ED) visits and longer hospital length of stay (LOS) but did not have significantly higher 30-day hospital readmissions, compared to patients with no AUD diagnosis. 3) Among patients diagnosed with AUD, only 1.8% received FDA-approved medication-assisted treatment for AUD. Conclusions: The AUD identification rate we detected was markedly lower than prevalence rates reported in the literature. Patients who were identified with AUD had higher counts of ED visits and longer LOS. Initiation rates of medication-assisted treatment for AUD were low. The study findings suggest that concerted efforts are needed to improve detection and diagnosis of AUD in order to support the delivery of effective AUD treatment including the initiation of evidence-based pharmacotherapy for AUD in the general hospital setting.

Stress Promoted Nicotine Intake in a Rat Model of Tobacco Smoking

Epidemiological documents show an association of tobacco smoking rates and perceived stress levels. This study, using an animal model of nicotine self-administration, investigated effects of stress on nicotine-taking behavior. Sprague-Dawley rats were trained to intravenously self-administer nicotine. Thirty minutes before test sessions, animals were challenged with an intraperitoneal administration of a pharmacological stressor yohimbine. In the low nicotine-taking rats, yohimbine challenge enhanced lever-press responses and thereby nicotine intake. In contrast, no such effect was observed in the high nicotine-taking rats. After yohimbine challenge, nicotine intake in those originally low nicotine-taking rats remained at the heightened level. These findings demonstrate that exposure to stress facilitates nicotine self-administration in the rats previously consuming less nicotine and makes them to become high nicotine-taking subjects. The results of this study suggest that stressful life events may be effective in increasing tobacco smoking in light to moderate smokers and therefore increase the prevalence of nicotine dependence. As such, reducing stress levels in daily life may prove to be an effective approach to the prevention of nicotine addiction.

Music Therapy in People Suffering from Korsakoff Syndrome: A Case Report

This article reports about two different cases of persons with Korsakoff syndrome (KS) who benefit greatly from music therapy while they are struggling with behavioral and emotional problems, caused by their chronic alcohol abuse which led to developing KS. Typical characteristics of persons suffering from KS are memory impairment, confabulation and problems with executive functions. Music therapy is a non-pharmacological intervention which has the potential to improve communication skills, reducing behavioral problems and thus leading to a better quality of life in KS-patients. An empathic yet directive approach has been proven beneficial when working with KS-clients. There is still little knowledge on how music therapy may contribute to improving these skills or reducing these impairments. The two case reports that follow provide greater insight into how to treat patients with KS through music therapy, specifically in patients who are residing in a long-term care facility specialized in KS.

Moral Resistance in Treatment of Post-Traumatic Stress Disorder

This case study illustrates with a detailed report the treatment of a person with post-traumatic stress disorder (PTSD). The therapist noted that the patient did not improve despite all the necessary psychological interventions taken, the patient’s request for treatment, and his commitment to the treatment. Enquiry revealed that the patient unconsciously preferred to continue suffering and feeling guilty towards his deceased so. The patient was suffering in order to preserve his loyalty to his deceased son, a phenomenon which we name moral resistance. PTSD Symptom Scale Interview (PSSI) was applied pre and post treatment and in follow-up. The Traumatic Incident Reduction (TIR) was the main therapeutic strategy, as well as Rational Emotive Behavior Therapy (REBT). The study found significant effectiveness of TIR and REBT in treatment of moral resistance according to the PSSI scale. The total score decreased from 43, which indicated a very severe level of the disorder, to 10 a week after commencement of the treatment, and to 7 after a month. Scores of 4 was kept constant in 3- and 6- months follow-up.