Frequent Abuse Research Articles

Neuroleptic Dysphoria, Comorbid Drug Abuse in Schizophrenia and the Emerging Science of Subjective Tolerability—Towards a New Synthesis

One of the frequent but under-recognized side effects of antipsychotic medications is the subtle subjective changes including feelings of anxiety, distress and lack of pleasure, which are collectively labeled as neuroleptic-induced dysphoria and, ultimately, often lead to dislike and aversions to medications, with serious clinical consequences. Yet, those very patients take to frequent abuse of illicit drugs. Several surveys estimated the association of drug abuse in schizophrenia as ranging somewhere between 10–70%. One popular and frequently accepted explanation for such high association has been the self-medication hypothesis. In other words, patients take to illicit drugs as a way of dalleviating symptoms of the illness as well as medication-induced side effects, particularly neuroleptic dysphoria. Recent clinical and neuro-imaging studies have, for the first time, directly linked the genesis of neuroleptic dysphoria to the dopamine-binding ratios in the nigrostriatal complex. This recent evidence comes from the study of dopamine receptor occupancy using PET scanning as well as from dopamine depletion SPECT studies. Meanwhile, emerging evidence from research in the addiction field has implicated dopamine in the same neural circuitry in motivational and reinforcement behaviour, which is central to initiation and continuation of dependency states. As the self-medication hypothesis proved incapable of explaining all the varied pictures of dysphoria and comorbid addictions, a unifying hypothesis is put forward to argue that both vulnerability to drug addictions and medication-induced dysphoria vary on independent facets of the illness itself. The mechanism that possibly links both lies in a dysregulated dopamine signaling in the nucleus accumbens resulting from frontal/cortical and hippocampal dysfunction. Besides the neurochemical argument, clinical and epidemiological data seem also to add support to this proposition. Such proposal not only represents a major rethinking of the concept of schizophrenia and its varied domains and manifestations but has also significant clinical implications in understanding and better management of comorbid drug abuse in the context of the illness itself. The recent intensified research efforts to understand the central mechanisms related to the role of dopamine in reward, punishment and pleasurable experiences as well as motivational and reinforcement behaviour, opens a new vista in understanding how and why patients like or dislike their medications based on their subjective responses to medication-taking. It is possible that the field is on the verge of a new science, which can collectively be called: “The Science of Subjective Tolerability Disorders.”

Health of children working in small urban industrial shops

Aims: To explore associations between work status and multidimensional health indices in a sample of urban Lebanese children. Methods: A cross-sectional survey was used to compare 78 male children (aged...

The prevalence of abuse in Swedish female psychiatric users, the perpetrators and places were abuse occurred

The aims of the study were to investigate self-reported physical, sexual, emotional and economical abuse in Swedish female users of psychiatric services, who the perpetrators were and in which places abuse occurred. An anonymous self-administrated questionnaire was answered in the waiting room of the services. The drop-out rate was 21% and n=1382 women completed the questionnaire. Fifty-three per cent of the women had been abused during childhood, 63% during adulthood and 31% during past year. Seventy-four per cent of those exposed during childhood were also exposed later in life. Women subjected to abuse reported longer contact with psychiatric care. Regardless of life period, the majority reported multiple and frequent abuse. Emotional abuse was most frequent reported in both childhood and adulthood followed by physical and sexual abuse. The reported perpetrators were mainly male persons to whom the woman had an intimate relationship. Mostly the abuse occurred in the women's own home. However, other women, strangers, acquaintances and relatives were also stated as perpetrator and abusive acts also took place in other homes, outdoors or down town. The high prevalence of abuse and its multiplicity point to the necessity for the care and support system to prioritize abuse against women with psychiatric illness.

A comparative naturalistic study on opiates withdrawal

Aims The effectiveness of locally newly introduced methadone‐supported heroin withdrawal was evaluated under naturalistic conditions.Design The corresponding data of 35 patients were compared with data of 31 patients hospitalized in the same setting 3 years ago who were mostly prescribed sedatives (neuroleptics and benzodiazepines) during their heroin withdrawal.Findings No significant differences between the groups were found with regard to the irregular treatment termination, relapse frequency and clinical global impressions ratings. In one month post‐discharge period frequent abuse of heroin decreased in both groups; in the nonmethadone group, frequent abuse of cocaine and alcohol was also reduced. The sedatives‐supported heroin withdrawal group showed more distress initially followed by a rapid amelioration; in the methadone group there was less distress initially but the patients did not feel much better on day 10.Conclusions Methadone‐supported heroin withdrawal lasts longer and we failed to demonstrate its advantage over traditional (neuroleptics‐ and benzodiazepines‐supported) withdrawal except for less subjective distress at the withdrawal beginning.

Dissociation, Depression and Trauma in Psychiatric Inpatients in Puerto Rico

ABSTRACT This study investigated the frequency of self-reported childhood abuse experiences of psychiatric inpatients, and the presence of dissociative and depressive symptoms. A total of 100 Puerto Rican in-patients who were hospitalized during a two month period were included in the study. The participants' dissociative and depressive symptoms were assessed using the Dissociative Experiences Scale and a subset of its items (DES-Taxon), the Questionnaire of Experiences in Dissociation and the Beck Depression Inventory. We also used a self-report instrument to assess the frequency and severity of a variety of abusive experiences. Seventy-eight percent (78%) of the participants reported some type of abusive experiences, 38% reported extreme and frequent abuse, and 40% reported being sexually abused during childhood. The findings showed a correlation between greater frequency of the abusive experiences and higher levels of dissociative and depressive symptoms. When the variable of child sexual abuse was used, only the Dissociative Experiences Scale was able to detect differences between those patients who reported such abusive experiences and those who reported none. We conclude that the level of abusive experiences reported by psychiatric in-patients in Puerto Rico is very similar to the rate in other investigations in the international literature. The data demonstrate that the participants who report frequent and intense abuse endorse a wide variety of dissociative experiences, and, to a lesser extent, depressive symptoms. As more than 95% of our inpatients had never been screened or assessed for the possibility of a dissociative disorder, we suggest that clinicians in psychiatric units in Latin America should be more sensitive and attentive to the presence of such disorders.

Early intervention strategies in substance abuse.

Since the mid-eighties many efforts have been made to develop spezialized intervention strategies and interview techniques aiming at harm reduction and motivational enhancement in patients with substance related disorders. Firstly, the "Transtheoretical Model of Change" by Prochaska and DiClemente, which defines motivation as a dynamic process with several stage dependent intervention possibilities. Secondly, the "Motivational Interviewing" technique by Miller and Rollnick, who strongly suggest an empathic communication style deriving from humanistic psychology. It has been shown that especially persons in early stages of substance related disorders profited very well from such early interventions. Psychiatric institutions not involved in specialized addiction treatment have to face frequent comorbid substance abuse among their patients. Findings of the efficacy of early interventions in general psychiatry are encouraging. Despite there is strong evidence of efficacy of early and motivational intervention strategies in several medical fields, their implementation tends to be very difficult.

Correlates of retrospective early life experience with personality in young Japanese women.

To examine the influence of early experiences on the development of personality. We used the Temperament and Character Inventory to assess 98 young women who had first entered a company. Different early experiences were linked, albeit weakly, to test scores. Both partial correlations and multiple regression analyses indicated that Self-directedness was higher if women reported more care of parents. Partial correlation, but not multiple regression analyses, showed that Cooperativeness was greater if women reported more care of parents and less frequent abuse. Reports of early parental loss or negative or positive early life events showed no correlation with scores on any of the Temperament and Character Inventory subscales.

Intimate Partner Violence, HIV Status, and Sexual Risk Reduction

This study describes the risk of intimate partner violence for women in a low-income, urban setting and the impact of violence on condom use. Partner-specific data were used to link partner characteristics with the measures of both abuse and condom use. Using the Revised Conflict Tactics Scales (CTS2), we determined annual rates, chronicity, and types of intimate partner violence among 188 HIV-positive and 257 HIV-negative women. Of the total sample, 62% reported experiencing psychological, physical, and/or sexual abuse; 44% experienced frequent abuse (≥13 events); and 29% suffered an injury. Rates did not differ by women's HIV status. Women who experienced frequent abuse were significantly less likely to have used condoms with their intimate partner. Partner characteristics significantly associated with experiencing frequent abuse were his HIV status and substance use. Findings can help inform the development of programs and policies that promote women's health through integrated approaches to intimate partner violence and HIV prevention.

Prevalence of Opioid Abuse in Interventional Pain Medicine Practice Settings: A Randomized Clinical Evaluation

While drug therapy is one of the most commonly used modalities of treatment in managing persistent or chronic pain, controversy continues with regards to the appropriate use of controlled substances, specifically opioid analgesics, in interventional pain medicine settings. This study included 100 randomly selected patients receiving opioids in an interventional pain medicine setting. The patient's controlled substance profile was evaluated using multiple means. The patients were divided into two groups, with 76 patients in the non-abuse group and 24 patients in the abuse group after data collection. There were no significant differences noted either in demographic characteristics or psychological characteristics, except for a higher prevalence of depression in the abuse group. In conclusion, there was significant abuse of opioids in an interventional pain medicine setting, with an incidence of 24%, with frequent abuse seen in almost half of these patients. Thus, it is important for interventional pain physicians to recognize this possibility and also to recognize that there is no definite physiologic, psychologic or demographic information to suggest abuse, even though depression was more prevalent in abuse patients.

The Child Sexual Abuse Experience and the Child Sexual Abuse Medical Examination: Knowing What Correlations Exist

ABSTRACT The purpose of this study was to assess what children experience when they are sexually abused and determine if these experiences correlate with emotional distress and anogenital findings identified during medical examinations for sexual abuse. There were 269 children examined medically for sexual abuse and for whom the adult bringing the child to the medical examination reported that the child had made a statement alleging sexual abuse. Differences in what these children reportedly had stated about their sexual abuse was quantified on a questionnaire by the adults who brought the children. After the examination, children rated how distressed they felt having their bodies examined. The physician or nurse practitioner evaluating the child provided the second measure of emotional distress using the Genital Examination Distress Scale (GEDS) to rate behaviors observed during the anogenital component of the medical examination. The anogenital findings were classified as negative, inconclusive, or positive for abnormal anogenital findings consistent with sexual abuse. More frequent abuse, more perpetrators, physical injury and more severe sexual acts reportedly described by the children prior to the medical examination were variables significantly correlated with increased emotional distress. Reported threats of physical harm during the sexual abuse and a belief by mothers that sexual abuse occurred both correlated significantly with anogenital abnormalities consistent with sexual abuse. These results indicate that if children are more emotionally distressed during the medical examination and have abnormal anogenital findings consistent with sexual abuse, then they possibly have experienced more extensive and aggravated events during the sexual abuse. These results may help determine which children need more preparation for a medical assessment and which children are more likely to have sexual abuse related anogenital findings.

Women caring for women: a study at the "Viva Maria" shelter, Porto Alegre, Rio Grande do Sul, Brazil

This research was conducted in Porto Alegre, Rio Grande do Sul, with a sample of battered women selected from a government shelter called the "Casa Viva Maria". We analyzed data on 110 women staying at the shelter during the previous two years (January 1996-June 1998). The profile of the women was as follows: abused women were young (mean age 29 years), all had low socioeconomic status, 12% were illiterate, 21% were black, 80% reported frequent abuse by their partners, and 18% had returned to violent homes. The researchers visited 34 former lodgers from the shelter and invited them to participate in a series of evaluation workshops. A total of 118 persons, including mothers and children, attended three evaluation meetings. During this process, researchers encouraged participants to express opinions, perceptions, and feelings about their past experience in the shelter and their own concept of violence. Finally, a focal group was organized with the "Viva Maria" staff members. Female workers reported how their job had been helpful for their personal development and had helped change their own lives.

Democratization in Africa

Examines the state of progress of democracy in Africa at the end of the 1990s, following the third wave of democratization which the contributors argue has been characterized by retreats as well as advances. In some cases, newly established democratic orders have devolved into pseudodemocracies while, in other cases, superficial changes have been used as a cosmetic screen for continuation of often brutal regimes. The volume makes clear, however, that political liberalization is making significant headway. The first section of the book (Assessing Africa's Third Wave) offers several broad analytical surveys of democratic change and electoral processes in the 48 sub-Saharan African states. Frequent abuses are noted, but several contributors find room for guarded optimism. The second section (South Africa: An African Success?) focuses on the dramatic developments in South Africa, the most advanced democracy on the continent, but one faced with enormous challenges in the aftermath of apartheid. Essays in this section examine such issues as the role of non-governmental organizations in the new political order, the ongoing and linked problems of racial and economic division, the demographics of public opinion on democracy, and the viability of the country's new constitution. The final section of the book (African Ambiguities) considers more closely several other African states: Ghana, Kenya, Uganda, the Gambia and Nigeria, all at different crossroads in their progress towards democracy.

The Comparability of Male Violent Substance Abusers in Violence or Substance Abuse Treatment

The abuse of alcohol is strongly associated with violent behavior in general and domestic violence in particular. The present study examined the compara-bility of dual-problem (i.e., substance abuse and conjugal violence) men in substance abuse and violence treatment milieus. Thirty males in substance abuse treatment and 33 men in violence treatment were identified as being dual-problematic and were administered the Addiction Severity Index (ASI) to assess psychosocial and substance abuse status, the Conflict Tactics Scale (CTS) for the frequency and type of abusive behavior, the Symptoms Checklist-90 (SCL-90) for psychological distress, and the 16 Personality Factor (16PF) for personality attributes. When dual-problem men from each milieu were compared on these measures, men in the substance abuse-milieu reported not only significantly more severe substance abuse problems, but also more frequent partner sexual abuse. Few other differences emerged. Thus, while current referral procedures may be appropriate in identifying and directing more severe substance abuse problems to the appropriate treatment setting, violent men with difficulties comparable to those seen in violence treatment may also be found in substance abuse treatment. These findings emphasize the need for: (1) routine objective screening for family violence and substance abuse in these two treatment milieus; (2) informed and up-to-date staff in both settings who are sufficiently prepared for the therapeutic challenges such men may present, and (3) more study of how treatment for dual-problem men may be coordinated by the violence and substance abuse treatment communities to optimize their outcome.

Retrospective reports of childhood abuse and neglect among violent and property offenders

Childhood abuse and neglect may increase the risk for later antisocial and criminal behavior, especially violent behavior. The objective of this study was retrospectively to compare childhood abuse and neglect experiences in the groups of Violent and Property offenders. The sample consisted of 34 recidivist inmates with the mean age of 26.9 years. The findings showed that physical, psychological, and sexual abuse and neglect was experienced by 82%, 97%, 3% and 94% of the offenders, respectively. There were no significant differences in the prevalence of abuse or neglect between the Violent and Property offenders. Neither were the groups differentiated by any combination of the abuse and neglectċvariables. Some differences emerged in the types of physical abuse between the offender groups. The Violent offenders tended to have been subjected to more severe, frequent and versatile abuse and neglect than the Property offenders, although not significantly so. The Homicidal offenders had, however, experienced significantly more severe, frequent, and versatile physical abuse than the Property offenders. The limitations of the study lie in the small sample size and the retrospective nature of the data collection.

Maltreatment, conscience functioning and dopamine β hydroxylase in emotionally disturbed boys

Objective: Identify associations among early maltreatment, sufficiencies, and psychopathological interferences in the domains of conscience functioning and low serum dopamine beta hydroxylase activity. Method: Nineteen emotionally disturbed boys screened for maltreatment experiences were compared according to age at onset of maltreatment, enzyme activity, and their conscience functioning in the domain of moral valuation. They were also compared in conscience functions to 19 age and sex matched normal counterparts. Results: Subjects who endured maltreatment prior to 36 months had developmental delays and interferences with functioning in more conscience domains than those who were either spared such experiences or who endured maltreatment later in life. Subjects with low enzyme activity had significantly more interference with authority and peer valuation than subjects with high enzyme activity. Greater interference with valuation was associated with lower enzyme activity and more frequent abuse prior to 36 months. Conclusions: Psychosocial sequelae of early maltreatment have been identified in the domains of conscience. An association has been established between pathological interference in the domain of moral valuation and a putative neurobiologic sequelae of early maltreatment. Implications for future research in the psychobiology of maltreatment are discussed.

Mediating factors in the development of psychopathology in victims of childhood sexual abuse

The effects of sexual abuse and victim-offender characteristics have been studied extensively in relation to short- and long-term psychological consequences. However, few studies have focused on mediating factors in the development of psychological sequelae associated with sexual abuse. Three hundred seventy-nine students at Washington State University were recruited from psychology courses and administered a battery of assessments. These assessments included a modified version of Groth's Sexual Victimization questionnaire, the Minnesota Multiphasic Personality Inventory (MMPI), and the Ways of Coping Questionnaire. Results revealed that 115 subjects (30%) reported at least one level of sexual abuse before the age of 18 years. Significant differences on the main effect of abuse were found between abused and nonabused subjects on selected validity, clinical, and research scales of the MMPI. When family dysfunction was covaried, no differences were found between abused and nonabused subjects on the main effect of abuse, suggesting that family dysfunction did not account for differences between groups. In addition, a main effect of psychopathology was found between victims who reported high and those who reported lower levels of psychopathology. Differences between subjects with a history of abuse and those with no history of abuse were found on the confrontive coping, escape-avoidance, self-controlling, and distancing scales. Finally, significant differences on the main effect of abuse were found between victims who had experienced more frequent abuse and who were more familiar to the offender and victims who were less frequently abused and less familiar to the offender. Differences were found on several clinical and research scales of the MMPI and on the self-control, accepting responsibility, and escape-avoidance scales of the Ways of Coping Questionnaire. The victims who were more frequently abused and familiar with the offender had elevated scores when compared to other victims. Mediating factors, such as coping, seemed to play some role in the long-term effects of sexual abuse. Recommendations for future research in the area of other possible mediating factors and longitudinal research are suggested.

Mediating Factors in the Developrraent of Psychopathology in Victims of Childhood Sexual Abuse

The effects of sexual abuse and victim-offender characteristics have been studied extensively in relation to short- and long-term psychological consequences. However, few studies have focused on mediating factors in the development of psychological sequelae associated with sexual abuse. Three hundred seventy-nine students at Washington State University were recruited from psychology courses and administered a battery of assessments. These assessments included a modified version of Groth's Sexual Victimization questionnaire, the Minnesota Multiphasic Personality Inventory (MMPI), and the Ways of Coping Questionnaire. Results revealed that 115 subjects (30%) reported at least one level of sexual abuse before the age of 18 years. Significant differences on the main effect of abuse were found between abused and nonabused subjects on selected validity, clinical, and research scales of the MMPI. When family dysfunction was covaried, no differences were found between abused and nonabused subjects on the main effect of abuse, suggesting that family dysfunction did not account for differences between groups. In addition, a main effect of psychopathology was found between victims who reported high and those who reported lower levels of psychopathology. Differences between subjects with a history of abuse and those with no history of abuse were found on the confrontive coping, escape-avoidance, self-controlling, and distancing scales. Finally, significant differences on the main effect of abuse were found between victims who had experienced more frequent abuse and who were more familiar to the offender and victims who were less frequently abused and less familiar to the offender. Differences were found on several clinical and research scales of the MMPI and on the self-control, accepting responsibility, and escape-avoidance scales of the Ways of Coping Questionnaire. The victims who were more frequently abused and familiar with the offender had elevated scores when compared to other vietims. Mediating factors, such as coping, seemed to play some role in the long-term effects of sexual abuse. Recommendations for future research in the area of other possible mediating factors and longitudinal research are suggested.

The impact of hardiness and severity of childhood sexual abuse on adult adjustment

Abstract This study explored the relationship of hardiness, severity of abuse, frequency and duration of abuse, and the identity of the perpetrator on adjustment in a nonclinical sample of 255 women survivors. A path analysis indicated that hardiness was a significant mediating variable to adjustment. Additionally, severity was found to significantly contribute to overall adjustment Preliminary analyses showed the following: 1) longer duration and more frequent abuse resulted in higher severity scores; 2) women who showed higher levels of commitment control, and challenge were better adjusted; 3) women whose abuse was more frequent and of longer duration demonstrated more emotional trauma symptoms; and 4) father/stepfather abuse was related to poorer adjustment. Implications for treatment are explored.

Statutory regulations governing the reporting of adverse reactions

Under the Drug Law (AMG) of 1976, applicants for marketing authorisations were obliged to notify the competent authorities of any new information about the product.When the Second Amendment came into force on 17 February 1987, the regulation became tighter in so far as applicants were obliged to notify the competent authority once they get to know of any suspected adverse reaction or interaction with other agents that could be a health hazard, including frequent drug abuse or a considerable drug abuse in an individual case.

Sexual abuse in childhood and deliberate self-harm

The authors investigated the association between sexual abuse in childhood and subsequent incidents of deliberate self-harm in women. A random community sample of women (N = 252) that reported having been sexually abused as children was interviewed and compared to a similarly sized group (N = 225) that did not report abuse. The subgroup of women sexually abused as children who reported subsequent incidents of deliberate self-harm was then contrasted with abused women who did not report self-harm. There was a clear statistical association between sexual abuse in childhood and self-harm that was most marked in those subjected to more intrusive and more frequent abuse. Self-harm was also associated with major interpersonal problems in the subject's family of origin and with becoming involved in further abusive relationships as an adult. Sexual abuse in childhood is associated with later incidents of deliberate self-harm and may well be an etiologic factor in its development.