FDA OKs Nonprescription Defibrillators

Abstract

over 14-week period, with 2 weeks of baseline, 8 weeks of medication, and 4 weeks of follow-up. Of more than two dozen medications assessed so far, Gorelick said, the most promising include disulfiram, currently used to treat alcohol abuse, and modafinil, a nonstimulant approved for the treatment of sleepiness associated with narcolepsy, shift work sleep disorder, and obstructive sleep apnea. A phase 3 trial of disulfiram for cocaine dependence is now in progress. In addition, a recent phase 1 trial found that a “cocaine vaccine” was well tolerated and produced detectable levels of anticocaine antibodies for up to 9 months after immunization (Drugs. 2004;64: 1547-1573). PSYCHIATRIC COMORBIDITY One quarter of the US population will meet criteria for lifetime substance use disorder, said Richard N. Rosenthal, MD, professor of clinical psychiatry, Columbia University, and chair of psychiatry, St Luke’s-Roosevelt Hospital Center, New York, NY. Comorbidity is the rule, he said, not the exception. Cocaine abusers’ risk for non–substancerelated mental disorders is 11 times that of the general population (JAMA. 1990; 264:2511-2518). Cocaine abusers also are 13 times more likely than the general population to have schizophrenia. Among individuals with schizophrenia, psychostimulant abuse is two to five times higher than in the general public. Such use probably has a self-medication aspect, Rosenthal said. Stimulants may provide some relief from negative symptoms, such as anhedonia and hypochondriasis. Cocaine use also decreases dysphoria and increases sociability. On the other hand, he cautioned, stimulants may induce psychosis; some users go on to have a psychotic disorder indistinguishable from schizophrenia. For patients with psychotic illnesses, Rosenthal said, a new approach to treatment is a “sufficient services” model rather than a comprehensive approach that such patients often find overwhelming. Its core is a supportive group focused on motivational enhancement, psychoeducation, and relapse prevention. Sobriety is a goal of treatment but not a requirement.