Group Of Drug Addicts Research Articles

Caratteristiche e percorsi in persone in carico al SerDP: l'uso dell'MMPI-2

This study concerns a research conducted on 329 individuals divided into three groups: 109 patients in charge of the Pathological Addiction Service (SerDP) Pianura dell'AUSL of Bologna (group of drug addicts), 110 patients followed with a psychological treatment at the AUSL of Bologna in the context of The Protection of Minors or in psychotherapy at private facilities (group of patients in treatment) and 110 students of psychology or workers (non-clinical group). There are three research questions to which the present work seeks an answer. The first is related to the possibility of identifying through the use of MMPI-2 a typical personality profile of the addict who turns to the SerDP. The second is related to the possibility of identifying among SerDP patients a typical personality profile of the alcohol user, rather than the user of cannabinoids, opioids or cocaine, through the results that emerge from the MMPI-2. The third research question aims, starting from the results emerged, to suggest which good practices can facilitate collaboration between different services such as CSM, SerDP, NPIA and SPDC in the design and maintenance of the treatment pathways of cases with comorbidities between Substance Use Disorder (DUS) and mental disorder. The results support the hypothesis that those who turn to SerDP show specific symptoms and some typical and recurrent personality characteristics of clinical relevance, detectable by the MMPI-2 test. On the basis of this evidence, the need to prepare, where they are not already foreseen, methodological paths of collaboration, joint management and treatment of comorbid patients involving the operators of the various territorial services seems central.

Lost in transition: the two structurally distinct groups of drug addicts in contemporary China

Despite of persistent anti-drug regulations and policies, China has encountered a large boom in narcotic drug addicts. Drug addicts can be found in distinct social groups, from the rich to the poor. Classic drug research theories have paid less attention to drug addiction issues in transitional China’s context. This study introduces a socio-structural transition perspective to explore the increasing and wide-spreading drug addiction problems in contemporary China. Based on in-depth interviews with drug addicts, social workers, and local policemen in Fujian, we collected 13 addict cases with detailed life experiences. Two structurally distinct groups were identified among the addicts. The impoverished descender addicts, struggling with much frustration in the disadvantaged situations, are associated with the class-based drug initiation patterns. Meanwhile, the affluent upstart addicts, gaining easy money with the traditional moral commitment left behind, are related to the consumer-based pathways to drug abuse. Moreover, these distinct addicts have commonalities in contemporary Chinese contexts. At the macro level, they fail to adapt themselves to the rapid structural transition process in both the material and spiritual ways, and thus are lost into the drug-related deviant social positions with weakening social controls and exposure to deviant peers. These findings further indicate the complex associations among deviant social consequences, social classes, and socio-structural changes in historical process.

Comparing the emerging psychological meaning of tattoos in drug-addicted and not drug-addicted adults: A look inside health risks.

Although tattoos have been historically characteristic of criminals and drug addicts therefore carrying negative associations, it is now an accepted and appreciated form of body modification. Tattoos could be considered as a projective psychological test, most people use their body as blackboard to represent the most varied meanings related to the way they perceive themselves. It is also true that tattoos can assume the role of diagnostic indicators for a possible abuse of psychoactive substances, as well as their aggregating and communicative functions within the group of drug addicts. The aim of this cross-sectional study was to explore the relation among personality traits, self-efficacy, locus of control and motivations for tattooing. The sample consisted of 150 subjects, 50 tattooed adults, 50 tattooed drug addicted adults, and 50 non-tattooed adults. Data were collected by using the Big Five Questionnaire (BFQ), the Perceived Self- efficacy Test, the Mini Locus of Control scale and a Tattoos Inventory. Results of the present study contribute to a deeper understanding of the new meaning of tattoos, they no longer represent personality traits, they rather have the function of reinforcing beliefs about how to perceive oneself, this happens especially in drug addicts in which the presence of tattoos reinforces the illusory belief of self-esteem and internal locus of control. Given the rising presence of tattoos today, this could be useful to get a better understanding of the existential unease of certain populations.

Психологический анализ реактивно-проактивного совладания наркозависимых мужчин

Difficulties in the rehabilitation and treatment of drug addicts are associated with the peculiarities of their behavior, which are a consequence of a change in their personality. The author conducted an empirical study on two groups of drug-dependent men with a combined form of drug addiction at the stage of treatment (n=30) and rehabilitation with a remission period of about a year (n=30); healthy male volunteers (n=30) acted as a control group. The study was conducted on the basis of the Regional Clinical Psychiatric Hospital, Khabarovsk Territory, Department of Medical Rehabilitation for people with drug addiction disorders in Khabarovsk. All men participating in the study had a higher education, a family, and the average age of all subjects was 32 ± 10.1 years. The study used: Kellerman-Plutchik's “Life style Index” methods (adapted by Wasserman L.I., Eryshev O.F., Klubova E.B. et al., 2005); coping test by Lazarus R. and Folkman S. (adapted by T.L. Kryukova, Kuftyak E.V., Zamishlyaeva M.S., 2005); questionnaire “Proactive coping behavior” Greenglass E., Schwarzer R. et al. (adapted by Belinskaya E.P., Vecherin A.V., Agadullina E.R., 2018). The main features of reactive-proactive coping in groups of drug addicts are defined: in the first group, coping is emotionally-oriented and cognitive-oriented in nature with a focus on social and emotional support, the protection mechanisms “denial”, “projection”, “substitution”, “intellectualization” prevail; in the second group, the intensity of avoidance strategies in combination with proactive overcoming without a focus on external support is identified, intellectual defenses are combined with strategies for reflective analysis. The main differences between the two groups of drug addicts are in the nature of the relationship between defense mechanisms and reactive-proactive coping strategies, in the variation of reactive strategies and their orientation, in the features of building proactive behavior. Understanding the features of reactive-proactive coping with drug addicts can greatly facilitate the work of a psychologist in remedial and rehabilitation activities with patients focused on life planning during remission.

OBJECTIFICATION OF MENTAL DISORDERS USING SPECIAL MAGNETIC RESONANCE IMAGING TECHNIQUES IN THE SYSTEM OF MONITORING THE MENTAL HEALTH OF SERVICEMEN

Introduction. Alcoholism and opioid addiction are the leading problems of modern narcology and together with adaptation disorders create a significant contribution to dismission from the ranks of the Armed Forces. Identifying the latent forms of mental disorders is of particular importance for making expert decisions at invoking. Special MRI techniques allow to evaluate the functional and microstructural connectivity of distant parts of the brain.Materials and methods. With the application of functional MRI and tractography, 405 patients were examined from the potential conscription pool: 76 patients with alcohol dependence syndrome, 170 with opioid dependence syndrome, and 9 with adaptation disorders. In patients suffering from adaptation disorders, opioid dependence and alcoholism, an analysis of the neural network of the passive mode of the brain was performed.Results. There was established, comparing to the control group, all the patients suffering from addiction demonstrated a weakening of the functional connections of all brain structures. Compared with the control group, the patients with drug addiction and alcoholism had microstructural deformation between the cortical and subcortical structures, especially between the amygdala and the hippocampus. The weakening of functional and microstructural links in the network of the passive mode of the brain in groups of drug addicts indicates that they have violated the processes of control, thinking and the correct decision making. In case of adaptation disorders, integral bilateral differences in terms of global and local node efficiency between groups of patients with adaptation disorder and healthy individuals showed a higher significance of the network of passive mode of the brain in the system of mutual functional connectivity of the posterior cingulate cortex and preclinical. The data obtained create the basis for the creation of biomarkers for patients suffering from mental disorders, which can be used to examine, guide and evaluate the treatment of this pathology.

Problematic Internet use in drug addicts under treatment in public rehab centers.

BACKGROUNDProblematic Internet use (PIU) or Internet addiction has been recognized to be a behavioral addiction characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding computer use and Internet access that leads to impairment or distress resembling substance abuse.AIMTo investigate the prevalence and characteristics of Internet use and abuse in a group of drug addicts from Southern Italy, by means of a specific questionnaire [“Questionario sull’Utilizzo delle Nuove Tecnologie” (QUNT)].METHODSAll subjects (183) were heavy smokers, almost 50% of them used heroin and/or opioid compounds, 30% alcohol, 10% cannabis, 8% cocaine, and 5% were polydrug users. Almost 10% of the individuals were also suffering from gambling disorder.RESULTSThe time spent online was more than 4 hours a day in the total sample, with a slight prevalence in male subjects. Cocaine and cannabis users spent more than 6 hours online, significantly more than opioid and alcohol abusers. Distribution of the QUNT factors was not different in both sexes. Cocaine users showed higher scores at the “loss of control”, “pornography addiction”, and “addiction to social networks” factors, for the stimulant effect of this substance. Moreover, 15 out of the total 17 cocaine users were pathological gamblers. Positive and statistically significant relationships were observed between some QUNT factors and body mass index.CONCLUSIONThese findings indicate that PIU is less severe in subjects taking sedative substances, such as heroin/opioids and alcohol, than in subjects taking stimulants. Alternatively, it may be used as a “stimulant” trigger in cocaine and cannabis users. Flattening effect of abuse drugs was noted on possible sex-related differences in QUNT items. We observed a sort of “protective” effect of a love relationship and/or living together with a partner, as those engaged subjects showed lower scores on different items than single subjects or those living alone. The relationship between time spent online (and related sedentary lifestyle) and body mass index would suggest that Internet use might be a contributing factor to increasing weight gain and obesity amongst adolescents and young adults worldwide. Our findings also highlighted the specific vulnerability of drug addicts who use stimulants, rather than sedative compounds, to other kinds of behavioral addictions, such as gambling disorder.

Oral and dental health of Italian drug addicted in methadone treatment

AbstractObjectivesOur group recorded the characteristic of oro‐dental health among a group of drug addicts in recovery treatment with methadone, and it evaluated the changes related to the withdrawal therapy.MethodologyA sample of 50 drug addicts in treatment with methadone was included in this study. At the beginning of the withdrawal therapy, the authors recorded the parameters involved in the most common oral diseases. Moreover, it was evaluated how, during the rehabilitation protocol, the behavioral parameters and the xerostomia that influence the oral health changed. A medical history especially referring to drug addiction features was made. An intraoral objective exam was done for each patient, at the beginning of the therapy and after 3 and 6 months.Results82% of the subjects showed a DMFT > 0. No patient showed any presences of previous restorative therapies. Lowenthal's caries, mostly localized in the cervical upper maxillary incisor, were found in 12% of the subjects. The Löe and Silness index showed marginal gingivitis in 95% of subjects, whereas 44% showed improper occlusion and/or parafunctional habits. 52% of the subjects had a normal diet, but a qualitative evaluation showed a high percentage (48%) of immoderate refined sugars use. Xerostomia, that was present in 72% of patients during the drug dependence period, showed a marked reduction in the withdrawal period.ConclusionThe group analyzed made a combined use with other drugs. They showed a high rate of caries and marginal periodontitis. The statistical analysis of the data proves how the methadone rehabilitation program is effective even on the oral health. It will show its effects over two different time related phases: after a first phase of decreased attention to oral health (0‐3 months), all index will increase in the long term (3‐6 months). The rehabilitation program contributes to an improved oral health of drug addicts.

Functional magnetic resonance imaging tomography in assessing the functional state of the brain in patients with opioid addiction

The possibilities of functional magnetic resonance imaging in the diagnosis of opioid dependence syndrome are considered. It is known that opioid addiction is one of the leading problems of modern narcology. Despite the fact that the number of researches of the neurobiological effects of opioids is increasing every year, the pathogenetic effects of dependence on this narcotic substance are still not fully understood. Functional magnetic resonance imaging rest allows one to assess the functional connectivity of the remote from each other parts of the brain and makes a great contribution to understanding the mechanisms of development of addictive disorders in general. In patients with opioid dependence, an analysis was made of the neural network of the passive mode of the brain (default mode network). This resting network is associated with the processes of control and thinking, including emotional and cognitive components, and consists of medial frontal regions, posterior cingulate sections, precuneus, lower parietal and temporal divisions. It was found that, in comparison with the control group, in all patients suffering from opioid dependence, weakened functional connections of all structures of the cerebro-spinal cord system (p0,05). In this case, changes in the medial prefrontal cortex and precuneus are more pronounced in patients who are in the state of opioid intoxication, and in the parietal-temporal regions in patients who are in a state of remission up to 1 month. The correlation of cortical structures responsible for the «behavior control» system (orbitofrontal cortex, prefrontal cortex) with subcortical structures responsible for emotions in the limbic system was also evaluated. In comparison with the control group, in patients with early remission, weakened functional connections between cortical structures and left contiguous nucleus, almond-shaped body from two sides. In patients in a state of intoxication in addition to these changes, the functional relationship between the orbital frontal cortex and the shell on the left has been weakened. The weakening of functional links in the network of the passive mode of the brain in the groups of drug addicts suggests that they have violated the processes of control, thinking and making the right decision. The resulting functional changes can form the basis for creating biomarker maps for patients suffering from opioid dependence, which can be used to guide and evaluate the treatment of this pathology.

Tempéraments affectifs des toxicomanes : étude cas-témoins

IntroductionThe study of affective temperaments is a dimensional approach to personality that would provide a better understanding of the emergence of psychopathological disorders including addictive behaviors. However, in the literature, there is a lack of studies focusing on the links between this type of disorder and affective temperaments. Our objectives were to study the distribution of the five known affective temperaments in a group of drug addicts compared to a control group, and to identify sociodemographic and clinical factors associated with emotional traits. MethodsThis was a case-control study carried out in the drug abuse prevention center “ATUPRET” of Sfax in Tunisia. It included 50 drug addicts, all male, and 50 healthy control subjects matched for age (P=0.22), marital status (P=0.28), socioeconomic level (P=0.36) and educational level (P=0.95). Sociodemographic data were collected through an interview for drug addicts hospitalized in this center while clinical data were collected from medical records. The TEMPS-A questionnaire, 110 questions validated Tunisian version, has been used to evaluate five affective temperaments. ResultsThe average age of drug addicts was 32.98 years (19–59 years) and the average age at onset of drug use was 20.36 years (12–52 years). Among drug users, the highest mean scores were observed for hyperthymic temperament (13.68±4.20), followed by cyclothymic (13.14±4.89), anxious (11.32±6.00) and depressive (11.02±3.65) ones. The lowest mean score was for irritable temperament (10.14±3.95). All of these scores, except that of cyclothymic temperament, were significantly higher than in the control group (P<0.01). The age of drug addicts was negatively correlated with cyclothymic (P=0.023) and irritable (P=0.035) temperament scores. These two temperaments were more dominant in the group of drug addicts with post-secondary education (P respectively 0.035 and 0.002). The age of onset of psychoactive substance use was negatively correlated with irritable temperament (r=−0.355, P=0.012). Cyclothymic temperament was correlated with alcohol dependence (P=0.03) and psychiatric comorbidity (P=0.01) among drug addicts. ConclusionThe present study provides support for the existence of temperamental dysregulation in drug-addicted patients. This result leads us to suggest that affective temperaments are implicated as a potential endophenotype and may represent a marker for the identification of persons vulnerable to drug use. These affective temperaments also appear to influence clinical features of drug addiction.

Traženje senzacija i anksioznost kod narkomana

The aim of the conducted research was to determine the correlation between the dimensions of the sensation seeking and anxiety. Also, it searched for significant differences in the level of expression of the dimensions of the sensation seeking and the anxiety between drug addicts and non-addicts. The sample was intentional (N=70) and it consisted of 35 drug addicts, treated for psycho active substance addiction at the Mental Health Clinic in Nis, and 35 subjects with no symptoms of addiction and without a history of substance abuse treatment, equal in age and educational attainment with a group of drug addicts. Applied instruments included Zuckerman sensation seeking scale (SSS - V), the Spielberger state-trait anxiety inventory - Form Y (STAI) and a survey designed for the research purposes. Statistically significant differences in the expression of the sensation-seeking and general anxiety dimensions between drug addicts and non-addicts were determined. Compared to the non-clinical sub-sample, drug addicts have demonstrated more prominent excitement seeking dimensions as well as boredom sensitivity and general anxiety. What was also established was the statistically significant positive and moderate correlation between the situational anxiety and the excitement and adventure seeking on the sub-sample of non-addicts. The results showed a low and negative statistically significant correlation between the disinhibition dimension and the age of both sub-samples. However, there was a statistically significant negative correlation between the situational anxiety and years of age of the drug-addict subcontract. The obtained results have partially confirmed the initial assumptions of the research and opened new questions about sensation seeking and anxiety in drug addicts, and how they are all connected. The practical implications of the conducted research are reflected in the possibility of applying the obtained results in advisory and therapeutic work with drug addicts in order to establish a better quality of life and better healing prognosis. These results could be put to use by clinical psychologists in their practice in an attempt to improve the quality of health care and provide psycho-social support to all patients treated for addiction. A good insight into the problem of research and the establishment of links between these concepts should improve existing knowledge and create a suitable foundation for the establishment of new preventive programs for addiction diseases.

Cerebral edema in drug addicts

The effect of drugs leaves permanent consequences on the brain, organic in type, followed by numerous manifestations, and it significantly affects the development of mental dysfunctions. The clinicians are often given a task to estimate a patient's personality during treatment or during experts estimate of a drug addict. The aim of this research was to determine the differences, if any, in characteristics of addicts experience and personality traits in drug addicts with or without cerebral edema. The research was conducted on a sample of 252 male drug addicts, the average age of 23.3 (SD = 4.3) years. Cerebral edema was confirmed on magnetic resonance (MR) images of the brain performed during the treatment of the addicts. The participants were tested by the psychologists using Minnesota Multiphasic Personality Inventory (MMPI-201) test, and the data were processed using canonical discriminate analysis within the SPSS program. The dependent variable in the study was cerebral edema. A block of independent variables, designed for the requirements of this study, consisted of two subgroups. The first one consisted of 12 variables describing the relevant characteristics of drug abuse. The second subgroup consisted of 8 psychopathological tendencies in the personality defined by the mentioned test. Cerebral edema was confirmed in 52 (20.63%) of the drug addicts. The differences between the groups of drug addicts with and without cerebral edema were determined in the following: the time span of taking drugs (0.301), use of alcohol parallel with drugs (0.466), and treatment for addiction (0.603). In the drug addicts with a cerebral edema, MMPI-201 confirmed the increase in the scales for hypochondria, psychopathic deviations and psychastenia, and the decrease in the scales for schizophrenia and depression. Our study confirmed a possible connection between cerebral edema and personality traits in a number of the examined drug addicts. Considering the fact that practice often requires personality estimation, regardless whether it is about treatment or expert's estimate, it is necessary to further research in this direction.

Kreativität bei Drogenkonsumierenden, Drogenabhängigen und Drogenentwöhnten

The main aim of this study was to investigate potential differences between different groups of drug addicts (patients in maintenance treatment, n = 14; patients in rehabilitation, n = 12) and Cannabis-Users (n = 13), along with a healthy control group (n = 18), with respect to verbal and figural creativity and general cognitive ability. Participants worked on different measures for the assessment of different facets of creativity, intelligence and experienced psychiatric symptoms. The results indicated that patients in maintenance and, to some extent Cannabis-Users scored higher regarding verbal creativity than patients in rehabilitation. With respect to figural creativity we observed no differences between the experimental groups. Concerning the Big Five personality traits, patients in maintenance treatment scored highest on Neuroticism while on a purely descriptive level Cannabis-Users achieved the highest scores with respect to openness to experience and extraversion.

FS09.1 Diacetylmorphine (heroin) allergy

Since heroin is delivered to a selected group of drug addicts under supervision of nurses in the Netherlands, we reported about several nurses who presented with work‐related eczema and positive patch tests to heroin. To investigate the prevalence of heroin contact allergy among all workers in this heroin delivery project, a study was started using questionnaires. Altogether 31 nurses reported work‐related complaints out of 100 who returned questionnaires. Besides reports of eczema, mainly of eyelids (probably airborne) and hands, there were mucosal and respiratory complaints. Patch tests were performed in 25 nurses with complaints; in 9 of them a heroin contact allergy could be confirmed. In 6 out of these 9 nurses this was combined with mucosal or respiratory complaints. There were also 6 nurses with mucosal or respiratory complaints without a contact allergy. Contact dermatitis from opioids, such as morphine and codeine, has been documented among opioid industry workers, nurses, doctors, pharmacists, and in patients. In conclusion heroin appears to be a potent contact allergen, causing contact dermatitis. Mucosal and respiratory complaints however, cannot be explained by this contact allergy; they might be caused by a type‐1‐allergy to heroin, or by a direct histamine liberating effect. Opioids are known histamine liberators causing urticaria, rhinitis and anaphylactoid reactions; therefore intracutaneous tests with heroin are unreliable. In an ongoing research project it will be attempted to detect specific IgE to heroin in the 12 workers with mucosal or respiratory complaints; within the next few months results will be available.

Public injection rooms, a help to heroin addicts?

The situation regarding heroin addicts in Norway is a matter of big concern and thus harm reduction measures are seen as an important supplement to help and treatment services to drug addicts. Public injection rooms are proposed to be included in the harm reduction strategy. In the article arguments in the Norwegian debate why public injecting should be established are discussed. Will public injecting rooms reduce the relatively high number of drug related deaths? Are public injecting rooms a measure in improving the bad health condition seen among the group of drug addicts? Will public injecting rooms be a way of raising the dignity of the drug addicts? Could public injecting rooms be motivated as a way of getting in touch with drug addicts? Will public injection rooms facilitate the misuse of drugs? What about public injecting rooms in the light of the UN-conventions and the penal laws? The main focus of the article is if public injecting rooms would be of any real help to the many problems seen in the group of heroin addicts.

Hepatitis C genotypes and subtypes in Saudi Arabia

Hepatitis C virus (HCV) genotypes are diverse geographically. Infectivity, pathogenicity, and sustained response to treatment may be influenced by HCV genotypes/subtypes. This study examined the relative distribution of hepatitis C genotypes and subtypes among isolates from 84 individuals with chronic active hepatitis (CAH), 39 haemodialysis patients, and 31 intravenous drug addicts, of Saudi Arabian origin. Reverse transcription-polymerase chain reaction (RT-PCR) using specific primers from the 5′-UTR was performed and amplified products were genotyped/subtyped using a commercial reverse phase hybridisation technique (Innolipa HCV 11, Innogenetics, Belgium). Seventy-four percent of the CAH patients were found to be genotype 4 (4c/4d: 33%; 4h: 14%; 4e: 7%; 4: 20%) but other subtypes such as 1b: 14%, 2b: 4%, 3a: 5%, 5a: 1%, and 6a: 1%, were also detected. A history of blood transfusion was disclosed in only 10% of the CAH group. The pattern among haemodialysis patients was as follows: genotype 4: 49% (4h: 13%; 4: 36% ); 1a: 33%, 1: 3%; 1b: 10%; and 5a: 5%. The intravenous drug addict group showed 39% subtype 1b, but other subtypes such as 9% for 1a; 3% for 2a; 36% for 4; 3% for 5a; and 9% for 3a were seen. It is concluded that genotype 4 is predominant among our HCV isolates from CAH patients but subtype 1a and 1b have emerged among our haemodialysis and intravenous drug addict cases, respectively. A significant relationship between the viral genotype and the source of infection has emerged among Saudi groups at high risk for hepatitis C virus. J. Med. Virol. 58:44–48, 1999. © 1999 Wiley-Liss, Inc.

Hepatitis C genotypes and subtypes in Saudi Arabia

Hepatitis C virus (HCV) genotypes are diverse geographically. Infectivity, pathogenicity, and sustained response to treatment may be influenced by HCV genotypes/subtypes. This study examined the relative distribution of hepatitis C genotypes and subtypes among isolates from 84 individuals with chronic active hepatitis (CAH), 39 haemodialysis patients, and 31 intravenous drug addicts, of Saudi Arabian origin. Reverse transcription-polymerase chain reaction (RT-PCR) using specific primers from the 5'-UTR was performed and amplified products were genotyped/subtyped using a commercial reverse phase hybridisation technique (Innolipa HCV 11, Innogenetics, Belgium). Seventy-four percent of the CAH patients were found to be genotype 4 (4c/4d: 33%; 4h: 14%; 4e: 7%; 4: 20%) but other subtypes such as 1b: 14%, 2b: 4%, 3a: 5%, 5a: 1%, and 6a: 1%, were also detected. A history of blood transfusion was disclosed in only 10% of the CAH group. The pattern among haemodialysis patients was as follows: genotype 4: 49% (4h: 13%; 4: 36% ); 1a: 33%, 1: 3%; 1b: 10%; and 5a: 5%. The intravenous drug addict group showed 39% subtype 1b, but other subtypes such as 9% for 1a; 3% for 2a; 36% for 4; 3% for 5a; and 9% for 3a were seen. It is concluded that genotype 4 is predominant among our HCV isolates from CAH patients but subtype 1a and 1b have emerged among our haemodialysis and intravenous drug addict cases, respectively. A significant relationship between the viral genotype and the source of infection has emerged among Saudi groups at high risk for hepatitis C virus.

Selegiline: current perspectives on issues related to neuroprotection and mortality.

Selegiline (deprenyl, Eldepryl), in doses of 10 mg per day, is a selective inhibitor of monoamine oxidase type B (MAO-B) that avoids the cheese effect associated with peripheral MAO-A inhibition. [1,2] The drug was initially developed as an antidepressant agent [3] but was not found to be effective in doses that selectively inhibit MAO-B [4] and is no longer used for this indication. Based on the capacity of selegiline to potentially increase striatal dopamine by blocking the MAO-B metabolism of dopamine, [5] Birkmayer et al. [6] tested selegiline in Parkinson's disease (PD). Both this group and a number of other investigators [7-10] reported modest anti-Parkinson benefits and a reduction in motor fluctuations when selegiline was combined with levodopa. These observations formed the basis for the approved use of deprenyl in the United States. However, interest in selegiline has largely centered on the possibility that it might provide neuroprotective benefits in PD and slow the rate of disease progression. Recently, the possibility has been raised that the addition of selegiline to levodopa therapy increases the risk of early death. [11] This article will review the status of selegiline with respect to these issues and provide a basis for determining its role in the current management of PD. ### Initial hypothesis. In the early 1980s, a group of drug addicts in northern California developed a parkinsonian syndrome following exposure to the toxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). [12] MPTP is a byproduct of the synthesis of an illegal meperidine derivative. MPTP crosses the blood-brain barrier where it is oxidized to its active metabolite 1-methyl-4-phenylpyridine (MPP+) in a reaction catalyzed by MAO-B. [13-15] MPP+ is selectively taken up by dopamine neurons and concentrated within mitochondria, where it selectively damages complex I, induces oxidative stress, and causes a parkinsonian syndrome. Inhibition of MAO-B by drugs such as selegiline …

The application of anthropological methods in general practice research.

I would like to discuss social anthropology and its relevance to qualitative research in general practice. Anthropology as a discipline was once rather generously called, in a BMJ editorial, most scientific of the humanities, and the most humane of the sciences. Unlike its sister discipline, sociology, it was developed among largely non-literate peoples at the time of Empire. Therefore, all the common sources of research data, completed questionnaires, written statements, analysis of printed material and psychometric tests were completely inapplicable. To deal with this situation, anthropologists developed a series of new research techniques. In a sense these were just the ordinary human skills of listening, observing, asking and exploring, but all elaborated in certain significant ways. The main technique was called 'ethnography', or 'participant-observation'. The anthropologist would live among a particular tribe or group of people for a lengthy period of time, usually 2 or 3 years, and would participate, as far as possible, in the tribe or group's daily lives, doing the things they did, eating the same food and taking part in the same ceremonies. The idea was not only to blend in with the local cultural landscape but also to understand it in a more holistic way by seeing the world through their eyes and experiencing it as they experienced it. In this way they could obtain what was called the 'actor's perspective'. For example, when studying a tribe in New Guinea, they would examine every aspect of its daily life, its behaviour, customs, rituals, religion, social organization, economy, diet, body image, marital patterns, relationships to the environment, symbolism, religion and myth. They also studied the complex relationships between beliefs and behaviours, between what people said they did, and what they actually did in real life. Anthropological research usually involved two stages. Firstly, ethnography was the very detailed and descriptive study of a specific group of people. In modern anthropology the 'tribes' that are studied might include a group of GPs in Durham, a clinic in London, a group of drug addicts in Piccadilly Circus, an ethnic group in Bradford, as well as tribesmen in the New Guinea

Some personality correlates in a group of drug addicts

The Eysenck Personality Questionnaire (EPQ) was administered to three groups of male, Saudi, drug addicts treated at Al-Amal Hospital, Jeddah. Each group consisted of 50 patients. The three groups were: volunteer in-patients (VIP), volunteer out-patients (VOP) and involuntary in-patients (IIP). The IIP group scored significantly higher than the VIP and VOP groups on the P scale ( P < 0.05), the N scale ( P < 0.01 and P < 0.001, respectively), and on the L scale ( P < 0.05 and P < 0.001, respectively). On the E scale the IIP scored significantly higher than the VOP ( P < 0.05). The only significant difference between the VIP and the VOP was on the N scale ( P < 0.01) in favour of the former. Addicts were also compared with the normative Saudi population and scored significantly higher than university students on the P, N and L scales ( P < 0.001) and higher than secondary students on the N and L scales ( P < 0.001). Only the E and the L scales correlated positively ( r = 0.17). The other scales showed independence.

Prevalence of HBV, HDV and HCV hepatitis markers in HIV-positive patients.

Since HIV infection could condition the natural history of parenterally transmitted viral hepatitis (HBV, HCV, HDV), with possibly differing effects in different risk groups, we decided to retrospectively examine sera from a cohort of 637 HIV seropositive patients in different stages of infection, seen from 1985 to 1992, to study the prevalence and temporal course of these infections. Virological markers of HBV, HCV and HDV were determined by ELISA and RIBA methods. The severity of HIV infection was higher in homosexuals than in drug addicts. Prevalence of antiHBc antibodies was 82% in drug addicts and 77% in homosexuals, whereas antiHCV antibodies prevalence was 72% in drug addicts and only 7% in homosexuals (p < 0.000001). When only antiHBc-positive patients were considered, there was a significant difference in antiHBs antibodies between drug addicts (DA) and homosexuals (OR for DA 0.29, 95% CI 0.08/0.83, p = 0.02), suggesting that drug addicts are less able to produce a protective response. This fact cannot be explained by the severity of HIV infection (which was higher among the homosexual group) and suggests some immunodepressive effect of drug abuse. Delta infection was only detected in the drug addict group, and the prevalence was low. Finally, we cannot confirm the interference of HCV infection with the speed of HBsAg clearance: in this study the prevalence of HBsAg was almost the same in HCV-positive and negative patients.