Substance Dependence Disorders Research Articles

Sex as predictor of employment at 5 years follow-up in First Episode Psychosis

IntroductionDespite considerable growth in the last years in treatments and research in first episode psychosis (FEP), little attention has been given to the priorities of these young people, in particular, gaining employment. For most people, work is a normal part of everyday life and can be considered one of the most important factors in promoting recovery and social inclusion. Nevertheless, these patients show low employment rates (varying from 23% to 65%) since the beginning of the psychotic symptoms and even after their contact with mental health services. But, although completing education and access to employment is a critical part for the recovery of these patients, few studies have focused on this outcome.ObjectivesTo determine the employment rate and its possible predictor factors in a FEP sample after 5 years follow – up.Methods190 FEP treated between June 2010 and July 2013 at the ETEP Program at Hospital del Mar were included. Inclusion criteria were: 1) age 18-35 years; 2) fulfillment of DSM-IV-TR criteria for brief psychotic disorder, schizophreniform disorder, schizophrenia or unspecified psychosis; 3) no previous history of severe neurological medical conditions or severe traumatic brain injury; 4) IQ level < 80, and 5) no substance abuse or dependence disorders except for cannabis and/or nicotine use. All patients underwent an assessment at baseline including sociodemographic and clinical variables (substance use, DUP, PANSS and GAF). Moreover, employment status has recorded at 5 years follow – up as dichotomyc variable (being employment defined as having either a full-/part-time job, being a student at school or university, or being involved in a study/training program). SPSS program was used for statistical analyzes.Results In our FEP sample, the employment rate was 34.2%. We observed significative differences in sex (p = 0.013), cannabis use (p = 0.022) and GAF scores (p = 0.016) between un/employed patients. Nevertheless, in the logistic regression model (ENTER METHOD) only female sex remained as predictor of higher employment rate (95% CI 1.13 to 4.85; p = 0.022) at 5 years follow – up.ConclusionsOur results suggest that females with a FEP have a better outcome in terms of employment rates, consistent with some previous studies. Some authors suggest that it could be explained by the fact that female patients used to have shorter DUP or more affective symptomatology, which has been also related to a better outcome. Nevertheless, we did not find any differences in these other variables in our sample. Employment not only provides financial independence but also structure and purpose, opportunities for socializing and developing new relationships, a sense of identity, self-worth and meaning in life. Thus, given its importance in FEP functional recovery, more studies in this field are needed to improve patients vocational achievements and determine which specific approaches would each of them need.Disclosure of InterestNone Declared

ЗАБОЛЕВАЕМОСТЬ ВИЧ-ИНФЕКЦИЕЙ И НАРКОМАНИЕЙ В РОССИИ И ОСОБЕННОСТИ ИХ КОРРЕЛЯЦИИ

Significance. The structure of drug use in the Russian Federation (injectable, non-injectable, psychoactive and others) is undergoing changes, which may affect the ratio of HIV transmission routes. These changes in the epidemic process require further research to form adequate measures to counter the spread of HIV infection in the Russian Federation. The purpose of the study was to identify specific features of correlation between HIV infection and drug addiction incidence in Russia and describe their role and influence on the HIV epidemic process in Russia at the present stage. Material and Methods. The study used data of the federal statistical observation forms on HIV incidence – Form No.61 “Information about HIV-infection” and on drug addiction – Form No.11 “Information about incidence of substance dependence disorders”. Data on narcotic drugs were retrieved from the website of the Unified interdepartmental information and statistical system provided by the Ministry of Internal Affairs of the Russian Federation. Population data were taken from the Rosstat website. The study used correlation analysis. Data processing was carried out using the SPSS Statistics ver. 26. Results. The correlation analysis shows a significant relationship between HIV incidence and detection of injecting drug users in the Russian Federation. Since 2017, the relationship between HIV incidence and users of all types of narcotic drugs has become significant as well, while the share of injecting drug users among all drug users dropped from 50% in 2011 to 18.7% in 2021. According to data for 2017 to 2021, the number of crimes related to illicit drug trafficking, as well as the amount of narcotic drugs withdrawn and the number of administrative offenses related to illicit drug trafficking are decreasing. Conclusion. Changes in the structure of drug use – a decrease in the share of the opioid group and an increase in the share of synthetic drug use leads to a change in the structure of infection among all drug users – the share of sexual transmission is increasing; while the share of the injection is decreasing. Presumably, non-injectable psychoactive substances play an increasing role among the factors predisposing to risky sexual behavior, and the risk group is not limited to injecting drug users only. For the purpose of a further epidemiological analysis it seems appropriate to divide the risk group of drug users into injecting drug users and non–injecting drug users.

Abstract B123: A descriptive study of substance use and cardiovascular issues among Nigerian men with prostate cancer

Abstract Introduction: Black males face a higher incidence of prostate cancer compared to other racial and ethnic groups. Cardiovascular disorders, including hypertension and metabolic syndrome, are more frequently observed in black men with prostate cancer, significantly impacting their quality of life, treatment outcomes, and related challenges. Socioeconomic disparities and stress also pose significant challenges for black men who engage in substance use, such as tobacco or alcohol. The purpose of this study was to explore the prevalence of cardiovascular issues and substance abuse specifically among black males diagnosed with prostate cancer. Methods: This descriptive, cross-sectional study examined associations between substance abuse, cardiovascular co-morbidities, and diagnoses of prostate cancer in men in Nigeria, Africa. It utilized data collected from the Prostate Cancer Transatlantic Consortium (CaPTC) Familial Cohort Study, an ongoing longitudinal cohort study initiated in 2018 which explores risk factors of prostate cancer among African Black men in Nigeria, Cameroon, and the United States (U.S.). Descriptive statistics generated association tables for variables captured. Results: From 708 participants who resided in Nigeria, 117 reported prostate cancer diagnoses compared to 580 who denied any cancer diagnoses. Median age of participants was 50, most were married (98.1%), Christian (65.8%), college educated (29.4%), with professional occupations (29.4%) and an average household income of 1,000,000 + Naira (24.2%). Marijuana use and alcohol consumption were identified to have statistically significant associations with prostate cancer diagnoses (p=0.003, p<0.001, respectively), while smoking (p=0.13), weight (p=0.22), and annual physicals (p=0.39) were not found to be significant predictors of prostate cancer diagnoses. Conclusion: Both marijuana and alcohol use were found to have significant associations with prostate cancer diagnoses in Nigerian men. Further research is directed to explore similar associations in Black men of other locations to confirm. This study provides a glimpse of associations of substance use and cardiovascular concerns in black males with prostate cancer. It is crucial for interventions to identify and understand the role of substance dependence and cardiovascular disorders in black males with prostate cancer to effectively address all risk factors, implementing lifestyle modifications, and providing culturally appropriate care, ultimately improving outcomes and reducing health disparities. Citation Format: Brittany M. Norris, Marvin Fullwood, Daniel Lee, Folakemi Odedina. A descriptive study of substance use and cardiovascular issues among Nigerian men with prostate cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B123.

Decoding the link between substance dependence and attention deficit hyperactivity disorder in adults: A cross-sectional study from North India.

Attention deficit hyperactivity disorder (ADHD) and Substance dependence are often thought to be linked as they are found to co-exist in many individuals. ADHD is estimated to be an essential indicator for the development of substance use disorder. Aim and Objective: To explore the relationship between different substance dependence and ADHD. This cross-sectional single-interview study was done at a tertiary care hospital in which a total of 153 Cases presenting to the Psychiatry OPD in a period of 03 months were selected serially based on inclusion and exclusion criteria. The diagnosis of substance dependence was made as per ICD-10 criteria. These subjects were then evaluated for the presence of ADHD and physical and psychological symptoms using the Adult ADHD self-rating scale and Maudsley's Addiction Profile. The majority of our study subjects were aged between 24-29 years (45%) and were predominantly males (98.7%). Most of our subjects were dependent on smack (adulterated heroin) (38.5%) followed by cannabis (27.4%) and alcohol (18.3%). When evaluated for ADHD using the ADHD self-rating scale, we found that almost one-third of the study population had ADHD (33%). Prevalence of ADHD was maximum in the subjects with cannabis dependence (47.6%) followed by tobacco/smoking (38.8%), cocaine (33%), and alcohol (21.5%). This association was statistically significant for cannabis (p = 0.035). The standard mean of both the physical as well as psychological symptoms experienced by subjects was higher in the ADHD group compared to the non-ADHD group which was statistically significant (p < 0.05). While managing patients with substance dependence we need to target both underlying ADHD and any co-morbid physical and psychological illness if present for holistic recovery of the patient.

A Systematic Review of Interventions Based on Judeo-Christian Principles for Patients with Substance Dependence.

Substance use disorders have significant consequences for patients and those around them. A qualitative systematic review was conducted to examine the effectiveness of religiosity and spirituality (R/S) interventions based on Judeo-Christian principles during the multidisciplinary treatment of patients with substance dependence disorder. Studies of patients of both sexes, at any age, of any nationality, and from any geographic location who were participating in treatment programs with religious elements explicitly tied to Christianity or Judaism were eligible for inclusion. Other religious interventions were excluded. Seven electronic databases were searched to identify eligible intervention studies published inEnglish until August 2021. Two reviewers independently screened studies and extracted data. JBI tools were used to assess risk of bias. Of 146 articles retrieved for full text reading, fivewere ultimately included in this review published from July 2008 to August 2021. The R/S interventions used in the included studies were music therapy in a religious context, reading of the Bible or Torah, reflexive readings, personal prayer and reflection, and religiously integrated cognitive behavioral psychotherapy with or without a comparison group. Despite the broad search, there were found only a small number of studies and little homogeneity in the data of patients that reported positive impacts of treatments. Well-designed controlled studies are needed to truly investigate the efficacy of Judeo-Christian religious interventions for helping people with substance use problems, so as to strengthen the evidence of the benefits of these type of approaches in the treatment of drug addicts.

Correlation between BDNF levels and folic acid levels at baseline in drug-naïve First Episode Psychosis

IntroductionSchizophrenia is a severe and common psychiatric disorder characterized by disturbed brain development. Brain-derived neurotrophic factor (BDNF) mediates differentiation and survival of neurons as well as synaptic plasticity during the brain development. Several studies have shown decreased serum levels of BDNF in chronic, first episode, and drug naïve schizophrenia patients. Folate provides the substrate for intracellular methylation reactions that are essential to normal brain development and function. Abnormal folate metabolism has been implicated in schizophrenia. For example, reduced maternal folate intake associated with an increased risk for schizophrenia. Also, low blood levels of folate have been reported in patients with schizophrenia, and are associated with clinical manifestation especially in the negative symptom domain.ObjectivesWith this study, we want to know how BDNF levels at baseline in drug-naïve FEP are associated with folic acid.MethodsFifty drug-naïve FEP treated between April 2013 and July 2017 at the ETEP Program at Hospital del Mar were included. Inclusion criteria were: 1) age 18-35 years; 2) DSM-IV-TR criteria for brief psychotic disorder, schizophreniform disorder, schizophrenia or unspecified psychosis; 3) no previous history of severe neurological medical conditions or severe traumatic brain injury; 4) presumed IQ level &gt; 80, and 5) no substance abuse or dependence disorders except for cannabis and/or nicotine use. All patients underwent an assessment at baseline including sociodemographic and clinical variables. Fasting blood samples were obtained before administering any medication at baseline and used to determine folic acid and BDNF levels.ResultsIn our drug-naïve FEP sample, folic acid levels showed a significative positive correlation with BDNF levels at baseline (r = 0.584; p = 0.003). Moreover, we did a lineal regression model that showed that the baseline variables that better predict BDNF levels were folic acid levels, and cannabis use.ConclusionsOur results are consistent with the findings from some of previous studies that also shows that lower folic acid levels are associated with lower BNDF levels at baseline in drug-naïve FEP. Folate deficiency is associated with cerebrovascular and neurological diseases, and mood disorders. The importance of folate in the nervous system was initially demonstrated in studies that established a greatly increased risk of neurodevelopmental disorders in the offspring of folate-deficient pregnant women. In the adult, epidemiological studies have linked lack of folate to neurodegenerative and neuropsychiatric diseases. However, the mechanisms by which chronic folate deficiency adversely affects CNS function are incompletely understood. Some studies in animals models have hypothesized that folate deficiency in animals could be associated with pyramidal cell loss and reduced hippocampal BDNF.Disclosure of InterestNone Declared

Association between lymphocytes, hippocampus volume and depressive symptoms in drug – naïve First Episode Psychosis

IntroductionThe role of the white blood cells, which form the peripheral immune system and are crucial in inflammatory processes, has been laid aside in the context of brain structural changes in schizophrenia.ObjectivesDetermine how blood cells are associated with some brain structures volumes in first episode psychosis (FEP) and their relationship with clinical variables at baseline and 1 year follow – up.MethodsFifty drug-naïve FEP treated between April 2013 and July 2017 at the ETEP Program at Hospital del Mar were included. Inclusion criteria were: 1) age 18-35 years; 2) fulfillment of DSM-IV-TR criteria for brief psychotic disorder, schizophreniform disorder, schizophrenia or unspecified psychosis; 3) no previous history of severe neurological medical conditions or severe traumatic brain injury; 4) presumed IQ level &gt; 80, and 5) no substance abuse or dependence disorders except for cannabis and/or nicotine use. All patients underwent an assessment at baseline and at one-year follow-up, including sociodemographic and clinical variables (substance use, DUP, PANSS, GAF and CDSS). Fasting blood samples were obtained before administering any medication at baseline. Structural T1 MRI was performed at baseline and brain volumes were quantified though FreeSurfer software. SPSS program was used for statistical analyzes.ResultsLymphocytes have a positive correlation with right and left hippocampus at baseline. Moreover, lymphocytes have a negative correlation with depressive symptoms at baseline and 1 year follow – up.ConclusionsLymphocytes may have a protective effect in some brain structures in FEP patients at baseline, especially those implicated in depressive symptoms.DisclosureNo significant relationships.

A Low-threshold Comprehensive Shared Medical Appointment Program for Perinatal Substance Use in an Underserved Population.

We describe retention in care, medication for opioid use disorder (MOUD) prescribing, and urine toxicology outcomes of a comprehensive perinatal shared medical appointment model that combined medication, group-based counseling, and recovery supports. We conducted a retrospective study of program retention between 11/1/16 and 3/31/20 in pregnant and postpartum women with substance dependence or use disorder. Disengagement reasons, MOUD prescribing, and urine toxicology were abstracted from medical records. A Cox proportional hazards model was used to evaluate risk factors for program disengagement. Approximately 87% of patients had OUD and 80% were pregnant at the initial visit (N = 140). Retention at 3 months, 6 months, 1 year, and 2 years was approximately 86%, 78%, 66%, and 48%, respectively. Over 97% of patients were prescribed MOUD and 88% of all urine toxicology results were negative for non-prescribed opioids. Patients enrolled after initiation of wraparound services (HR 0.52, 95% CI 0.28 - 0.96) and those attending more shared medical appointments (HR 0.90, 95% CI 0.87 - 0.93) had a lower hazard of disengagement after controlling for other covariates. Loss to follow-up was the most common disengagement reason. A low-threshold, comprehensive perinatal shared medical appointment program had high retention rates, increased access to evidence-based MOUD, and high rates of opioid-negative urine toxicology. Participants enrolled after wraparound services began had a lower hazard of disengagement. Future research in perinatal substance use should evaluate the most optimal and cost-effective components of comprehensive programs to inform standard of care.

Adjunct pharmacotherapy for psychotherapy

AimsA variety of pharmacotherapies have been used to assist the psychotherapy process as “adjunctive therapies.” These drugs are used in an acute, targeted fashion, such that they are explicitly delivered in the context of psychotherapy for anxiety, mood and substance-dependence disorders (SUDs). Our narrative review highlights the potential of medically-assisted psychotherapy by outlining the current state of research on few of these medications and describing the basic science that supports their use.MethodFirstly, we researched an assortment of medications that have been used off-label to enhance psychotherapy, and selected a few that have received the most empirical attention in preclinical and clinical-trial settings. Our review of clinical trials focused on three of the most common psychiatric ailments. For all studies reviewed, we identify the strengths and weaknesses of the data supporting the use of the medications for the three aforementioned disorders.ResultD-cycloserine: accelerates the process of associative emotional learning, enhancing exposure therapy in the treatment of various anxiety disorders, including obsessive-compulsive disorder and posttraumatic stress disorder. Limited studies are available on efficacy in treating SUDs.Intranasal oxytocin: accelerates memory retrieval-extinction procedures used in posttraumatic stress disorder, and promotes prosocial cognition and behaviour, facilitating a therapeutic alliance. Sufficiently powered studies and safety studies are required before strong conclusions can be made.Propranolol: interrupts the reconsolidation of memories (leading to maladaptive learned responses) involved in posttraumatic stress disorder during memory-reactivation therapy sessions, but there is little evidence that this drug can be used for depression or SUDs.Psychedelics: may effect the brain's default mode network, engendering a transformative experience that is often followed by a reduction in psychiatric symptoms. 3,4-methylenedioxymethamphetamine may additionally modulate the amygdala response in a way that allows for reprocessing of traumatic memories, and improves the therapeutic alliance. Anxiety, mood, and SUDs appear to be positively influence by traditional and non-traditional (ketamine) psychedelics.ConclusionAlthough the efficacy of the medically-assisted psychotherapies reviewed is still under investigation, we propose that these novel treatment approaches may be preferred over traditional psychopharmacological treatments due to the presence of fewer chronic side effects, as well less toxicity and abuse potential. Furthermore, these adjunctive pharmacotherapies may help to reinforce the psychotherapeutic alliance and may ultimately yield better long-term treatment outcomes. If at least some of the adjunctive pharmacotherapies outlined in this review are found to be clinically efficacious and safe, patients will benefit from having more treatment options available to them in the future.

The Continuum of Recovery from Alcohol Dependence: From Addiction Remission to Complete Mental Health

Background Few representative studies have examined optimal mental health among those with a history of alcohol dependence (AD). Objectives In a representative sample of Canadians with a history of AD, to determine prevalence of, and factors associated with 1) remission from AD, 2) the absence of Substance Dependence and Psychiatric Disorders (SDPD) in the past year, and 3) complete mental health (CMH). Method Secondary analysis of a publicly available Statistics Canada database, the 2012 Canadian Community Health Survey-Mental Health (820 adults with AD history; 19,945 without AD). Lifetime AD, past-year remission from AD, and previous 12-month absence of SDPD were determined using World Health Organisation Composite International Diagnostic Interview (WHO-CIDI) measures. Individuals are classified as being in CMH if they possessed social and psychological well-being, happiness or life satisfaction and absence of SDPD. Results Over 70% of those with a history of AD were in remission, 52% were without past-year SDPD, and 38% of respondents were in CMH. Positive outcomes were more common among married respondents, older individuals, those with higher level of social support, and those who had never had major depressive disorders or generalised anxiety disorders. Conclusion The majority of Canadians with a history of AD achieve remission and a significant proportion achieve CMH. However, targeted outreach is warranted for the most vulnerable with a history of alcohol dependence, including younger respondents and those with low levels of social support or a history of mental illness. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1922451.

N-acetylcysteine in clinical practice – properties, use and adverse effects

N-acetylcysteine is a simple chemical compound with antioxidant and mucolytic properties. Currently, it is the primary treatment for acetaminophen poisoning. Prior to the introduction of acetylcysteine, acetaminophen overdose was associated with high mortality due to acute liver failure. Owing to its antioxidant properties, acetylcysteine maintains appropriate levels of glutathione, thereby protecting the liver from damage by toxic metabolites of paracetamol. Acetylcysteine is also used for infections with excess respiratory secretions. The mechanism of action of cysteine derivatives involves cleavage of disulfide bonds between the macromolecules present in the mucus and, consequently, reduction of mucus viscosity. Clinical trials have shown that N-acetylcysteine also plays an important role in relieving cough by eliminating mucus from the airways. Owing to its antioxidant properties, it can also prevent contrast-induced nephropathy. It was shown that prophylactic doses of acetylcysteine administered the day before and at the day of contrast administration are effective in preventing contrastinduced nephropathy in patients with chronic kidney disease. The compound can also modulate pathophysiological processes involved in many mental and neurological disorders. There is also evidence supporting the efficacy of acetylcysteine in mental disorders such as autism, schizophrenia, Alzheimer’s disease, psychoactive substance dependence or bipolar disorder. However, in addition to its therapeutic activity, the drug may also induce adverse effects. Adverse effects of varying severity have been reported since the introduction of acetylcysteine into clinical use.

Psychiatric Disorders in Children of Parents With Substance Dependence Disorder

Objectives: Children of addicted parents exhibit depression, anxiety, and elevated rates of psychiatric disorders more frequently than do children from nonaddicted families. Hence, we conducted this research to illustrate the psychiatric illness of children of substance-dependent parents. Materials and Methods: The study included 50 children [25 with a parent diagnosed with substance use disorder according Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria (group A), and 25 whose parents had no psychiatric diagnosis according to general health questionnaire (group B)]. The subjects were recruited from the Heliopolis Psychiatric Hospital, which is a Ministry of Health Hospital. They were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI KID) scale. We, furthermore, assessed the relation between the Addiction Severity Index, type of substance used by group A parents, and the MINI KID scale. Results: Group A showed more significant diagnosis than group B (P=0.037) by the MINI KID scale (major depressive disorder, dysthymia, panic disorder, agoraphobia, and separation anxiety disorder) (P=0.018, 0.037, 0.042, 0.021, and 0.004, respectively). Hence, the substance abuse parent has a detrimental effect on their children’s well-being. As regards the relation between addiction severity and result of MINI KID scale in group A, only “employment” was significant (P=0.025). Surprisingly, neither the severity of substance abused nor the type of substance abused by the parent had significant relation with the diagnosed psychiatric disorders in their children. Conclusions: Our study found that the prevalence of psychiatric disorders in children increases when their parents have substance use disorder. Moreover, the variation of the severity of parent addiction does not affect the risk for having psychiatric disorders in their children.

Improving Health Equity for Women Involved in the Criminal Legal System.

Improving Health Equity for Women Involved in the Criminal Legal System.

Effective connectivity predicts cognitive empathy in cocaine addiction: a spectral dynamic causal modeling study.

Social cognition plays a crucial role in the development and treatment of cocaine dependence. However, studies investigating social cognition, such as empathy and its underlying neural basis, are lacking. To explore the neural interactions among reward and memory circuits, we applied effective connectivity analysis on resting-state fMRI data collected from cocaine-dependent subjects. The relationship between effective connectivity within these two important circuits and empathy ability - evaluated with the Interpersonal Reactivity Index (IRI) - was assessed by machine learning algorithm using multivariate regression analysis. In accordance with the neurocircuitry disruptions of cocaine addiction, the results showed that cocaine-dependent subjects relative to healthy controls had altered resting state effective connectivity between parts of the memory and reward systems. Furthermore, effective connectivity between the memory and reward system could predict the fantasy empathy (FE) subscale scores in cocaine dependence. Overall, our findings provide further evidence for the neural substrates of social cognition in cocaine-dependent patients. These new insights could be useful for the development of new treatment programs for this substance dependency disorder.

Treatment of Depression after Traumatic Brain Injury Reduces Risk of Neuropsychiatric Outcomes.

The objectives of this study were to identify characteristics associated with receipt of antidepressants for treatment of incident depression diagnosed following traumatic brain injury (TBI) and to assess the impact of receipt of treatment for depression on risk of other neuropsychiatric outcomes associated with TBI. We conducted a retrospective cohort study of individuals with TBI who were subsequently diagnosed with incident depression between 2008 and 2014 using data from the OptumLabs® Data Warehouse. We identified factors associated with receipt of antidepressants and compared risk of new diagnosis of alcohol dependence disorder, anxiety, insomnia, and substance dependence disorder between those who received antidepressants and those who did not over a maximum 2-year follow-up, controlling for duration of use and clinical and demographic characteristics. Of 9581 individuals newly diagnosed with depression following TBI, 4103 (43%) received at least one antidepressant. Moderate-severe TBI (odds ratio [OR] 1.44; 95% confidence interval [CI]: 1.39, 1.50), female sex (OR 1.21; 95% CI: 1.19, 1.24), diagnosis of Alzheimer's disease (OR 1.39; 95% CI: 1.35, 1.44), and anxiety (OR 1.35; 95% CI: 1.31, 1.38) were associated with receipt of antidepressants. Longer duration of antidepressant use was associated with decreased risk of newly diagnosed anxiety (hazard ratio [HR] 0.92; 95% CI: 0.89, 0.96), insomnia (HR 0.94; 95% CI: 0.91, 0.98), and substance dependence disorder (HR 0.92; 95% CI: 0.88, 0.97). These results provide evidence of a beneficial effect of antidepressant use on incidence of outcomes associated with poorer recovery from TBI.

Narratives about the process of recovering from addiction: the perspective of family members attending care services

Addiction treatment services usually prioritize the recovery of the user, despite the fact that problematic consumption often leads to distress among families that requires attention. The purpose of this study is to identify types of narratives constructed by relatives of people with substance dependence disorders regarding their condition and recovery process. Additionally, we seek to understand the conditions that facilitate or hinder the recovery process from the perspective of family members. Seven in-depth interviews were conducted with a narrative approach. Progressive, stable, and regressive narratives were identified, corresponding to various stages in the addiction and recovery processes. These narratives revealed different forms of distress, obstacles to treatment, and critical junctures with respect to attending care services. Families represent a valuable resource for user recovery, and therefore must be included in the treatment process.

S23. EFFICACY OF COGNITIVE-BEHAVIORAL SOCIAL SKILLS TRAINING IMPROVING SYMPTOMS AND FUNCTIONING IN PATIENTS WITH EARLY-ONSET PSYCHOSIS: A RANDOMIZED CONTROLLED TRAIL

BackgroundThe onset of a psychotic disorder before age 18 (early-onset psychosis, EOP) is a marker of greater clinical severity and poor outcome. There is a lack of studies examining the efficacy of psychological treatment in this population. The Cognitive-Behavioral Social Skills Training (CBSST) is an evidence-based psychological intervention for patients with schizophrenia. OBJECTIVE: To analyze the efficacy of the adolescent version of CBSTT (CBSST-Adolt) versus an active psychological intervention, administered during the critical period, to improve symptoms and functioning in patients with EOP.MethodsRandomized controlled trail (RCT) of the adolescent version of the CBSST-Adol compared to an active control intervention. Interventions: The CBSTT-Adol included the 3 original modules (cognitive abilities, social skills, problem-solving skills) but number of sessions was reduced. It was administered in small groups. The active control intervention (PSYCHOED-Adol) included 3 modules (psychoeducation, relapse prevention, healthy life style) with the same format and number of sessions. The language and examples were adapted for adolescents in both interventions. Inclusion criteria: schizophrenia spectrum disorder (schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified), diagnosed before 18; being in the critical period of the illness (first 5 years after the onset); being clinically stabilized (outpatients). Exclusion criteria: IQ<70; having a substance dependence disorder; having a neurological disorder. Procedure: Patients (n=30) were randomized to both branches of the study after the baseline assessment and were re-assessed after the treatment (CBSST-Adol n=16, PSYCHOED-Adol n=14). The study included a group of healthy controls (HC, n=20) matched for age and sex, who were assessed only at baseline. Pharmacological treatment was supervised by patients’ clinical psychiatrists. Instruments: PANNS, GAF, GF:Role, GF:Social, Life Skills Profile (LSP), Caregivers’ Burden Inventory (CBI). Statistical analyses: T-test was used for comparisons between patients and HC. Lineal generalized models were run for examining group differences after the treatment between CBSST-Adol and PSYCHOED-Adol, controlling for baseline scores. Intention-to-treat analyses.ResultsThere were no significant differences in sex or age, but in socioeconomic status (p<0.001), between HC and EOP subjects. Patients with EOP had lower scores in all areas of functioning (global, role, social, daily living skills, caregivers’ burden, p<0.001). There were no significant differences in any of the baseline characteristic between patients allocated in the CBSST-Adol and the PSYCHOED-Adol groups (sociodemographic variables, symptoms, functioning, pharmacological treatment, duration of the illness, p>0.05). There was a similar rate of dropouts during the trail in both branches of the study (31% and 29%, p>0.05). Improvements in clinical symptoms (PANSS total, p=0.045; PANSS positive symptoms, p=0.009) and functioning (GAF, p=0.002; GF:Social, p=0.025, CBI, p=0.020) were found at post-treatment in all sample. However, there was no a superior effect of CBSST-Adol compared to PSYCHOED-Adol in any variable. There was only a trend to a higher improving of the Communication and social contact subscale of the Life Skills Profile in the CBSST-Adol intervention (p=0.061).DiscussionThe results support the efficacy of psychological intervention improving symptoms and functioning in EOP. We find a similar positive effect after the treatment in both CBSTT-Adol and PSYCHOED-Adol interventions. Main limitations: not having a non-active control group and the sample size.

Substance Dependence Comorbidity With Mental Disorders in Egyptian Young Adults

Objectives: Substance dependence is commonly seen among Egyptian young adults. Unfortunately limited data are available about the prevalence of comorbidity of mental disorders and substance dependence in this age group. In addition, substance dependence is correlated with many psychopathologic factors such as low self-esteem, childhood abuse, and stressful life events, etc. which could aggravate the load of the disorder. Methods: A case control study that included 80 patients diagnosed with substance dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revised (DSM-IV-TR). The sample was recruited from Kasr Al-Ainy Psychiatry and Addiction Hospital. Subjects were divided into 2 groups: group 1 (cases with the diagnosis of comorbid substance dependence and other mental disorder) and group 2 (cases with the diagnosis of substance dependence only). They were examined using Addiction Severity Index (ASI) and Rosenberg Self-Esteem Scale (RES). Results: Patients in group 1 had significantly higher levels of impairment and disability in scores of ASI: drug use, social impairment, and psychiatric problems. They had higher percentage of psychopathologic factors, for example, history of childhood abuse. There was no significant difference in the presence of comorbid personality disorder, or history of stressful life events. Conclusions: Comorbidity of mental disorders with substance dependence is associated with more impairment and functional deterioration. Young adults with substance dependence have high levels of associated psychopathologic factors, such as childhood abuse, stressful life events, and deliberate self-harm.

Incidence of New Neuropsychiatric Disorder Diagnoses Following Traumatic Brain Injury.

Neuropsychiatric disturbances (NPDs) are common following traumatic brain injury (TBI) and associated with poor recovery. Prior estimates of NPD following TBI failed to account for preexisting NPDs or potential confounding. We estimated the risk of anxiety, posttraumatic stress disorder (PTSD), bipolar disorder, and alcohol and substance dependence disorder diagnoses associated with TBI using administrative claims data from a large insurer in the United States, 2008-2014. We calculated rates of new NPD diagnoses during the 12 months before and 24 months after TBI and estimated the risk of NPD following TBI using a difference-in-difference approach and adjusting for confounders. Before the TBI occurred, rates of NPD diagnoses were more than double in the TBI cohort (n = 207 354) relative to the no-TBI cohort (n = 414 708). TBI was associated with an increased risk of anxiety (rate ratio [RtR] = 1.08; 95% confidence interval [CI], 1.05-1.12) and PTSD (RtR = 1.41; 95% CI, 1.24-1.60) diagnoses. Rates of alcohol (RtR = 0.32; 95% CI, 0.30-0.34) and substance use disorder (RtR = 0.57; 95% CI, 0.55-0.59) diagnoses decreased following TBI. In this large national study, rates of NPD were much higher among individuals with TBI than those in a non-TBI cohort, even before the TBI took place. TBI was associated with an increased risk of anxiety and PTSD diagnoses. Results from this study also suggest that individuals who sustain TBI have increased contact with the healthcare system during the months prior to injury, providing a window for intervention, especially for individuals diagnosed with alcohol dependence disorder.

Comparison of artificial neural networks and logistic regression for determination of social-cognitive factors impacting drug abstinence

ABSTRACTBackground: Logistic regression model (LRM) are popular in public health studies. However, most studies have found that artificial neural networks (ANNs) have better performance than other methods especially when the relationship between the response and independent variables is complex.We aimed to compare the performance of LRM and ANNs in the determination of drug abstinence predictors.Methods: The participants of this prospective study included 317 male addicts recruited through convenience sampling in five short-term residential substance use treatment programs in Southern Khorasan, the eastern province of Iran. Eligibility criteria included being in a detoxification stage and having a primary diagnosis of substance dependency disorder based on the diagnostic criteria of the DSM-IV-TR. The performance of the models was compared using the area under the ROC (AUC).Results: LRM and ANNs method correctly classified 82.2% and 84.4% of the participants as an abstinent group, respectively. The areas under ROC curve were 90 and 91.2, the kappa statistic was 0.643 and 0.688 for LRM and ANN models, respectively.Conclusions: The results showed classification performance was not significantly different. We concluded that the selection of prediction techniques for predicting drug abstinence factors depended on our background knowledge on the data pattern.