Substance-dependent Inpatients Research Articles

Chronic repetitive transcranial magnetic stimulation (rTMS) on sleeping quality and mood status in drug dependent male inpatients during abstinence

BackgroundDrug abstinence is accompanied by aversive experiences and lasting changes in mood status and worsening sleep quality. This study investigated the potential effects of chronic repetitive transcranial magnetic stimulation (rTMS) in substance dependent inpatients during abstinence. MethodsThis was a double-blinded study with 105 males inpatients dependent on heroin or methamphetamine (average abstinence time was six months). The inpatients were randomly divided into 10 Hz intervention (n = 40), sham stimulation (n = 40) and control (waiting list, no treatment) (n = 25) groups. Five sessions of rTMS stimulation were administrated for six consecutive weeks, reaching a total of 180,000 pulses. There was no intervention for control group. Patients were assessed using the Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were assessed prior to and after six weeks of intervention. ResultsThe results showed that six weeks of rTMS treatment significantly improved the sleep quality (p < 0.001), alleviated depression (p < 0.001) and anxiety state (p < 0.001) of substance dependent inpatients in early abstinence. Furthermore, the active TMS group showed significant differences between sham and control groups. ConclusionThese findings suggested that chronic rTMS treatment have positive effects for substance dependent inpatients during abstinence. Future studies are required to understand the underlying mechanism for improving different clinical symptoms.

Smoking Cessation Program for Inpatients with Substance Use Disorder: A Quasi-Randomized Controlled Trial of Feasibility and Efficacy

Aims: The present study investigated the feasibility, acceptance and efficacy of a newly developed cognitive behavioral program for smoking cessation/reduction (‘Rethink your Smoking' program, RSP) in inpatients with substance use disorder (SUD). Method: One hundred ninety-nine inpatients with SUD were randomly assigned to either the RSP (n = 101) or a minimal intervention (MI) program (n = 98). In addition, participants were offered optional nicotine replacement therapy. Data from a group of patients with SUD without any intervention (control group, n = 78) were included in the analyses for comparison. Assessments were performed at admission, discharge and follow-up after 3 and 6 months. Results: RSP proved to be feasible and was well accepted by participants. Patients in both interventions showed lower scores for physical nicotine dependence and number of cigarettes smoked per day and higher scores for various motivational parameters at discharge and 3 months later. Both interventions were superior to no intervention, but no differences were found between the RSP and MI. Conclusion: A smoking cessation/reduction program is feasible for substance-dependent in-patients undergoing detoxification. Although the RSP appears to be effective in terms of harm reduction in in-patients with SUD, more cost- and time-efficient programs might also be suitable for this population.

The Interactive Effect of Major Depression and Nonsuicidal Self-Injury on Current Suicide Risk and Lifetime Suicide Attempts

This study examined the main and interactive effects of MDD and lifetime nonsuicidal self-injury (NSSI) on current suicide risk and past suicide attempts. We predicted that individuals with a history of NSSI and current MDD would be at greater suicide risk than those with either risk factor alone. An interaction between lifetime MDD and NSSI was hypothesized for past suicide attempts. 204 substance dependent inpatients completed self-report measures and a diagnostic interview. Patients with both a history of NSSI and current MDD, relative to all other groups, had the greatest suicide risk. No support was found for the lifetime MDD by NSSI interaction. Conclusion: Findings suggest the relevance of both NSSI and MDD in suicide risk.

Frequency of Synthetic Cannabinoid Use and Its Relationship with Socio-Demographic Characteristics and Treatment Outcomes in Alcohol-and Substance-Dependent Inpatients: A retrospective study

Objective: The recent emergence of Synthetic Cannabinoids (SCs) has become a serious public health problem. Here we aimed to analyze the frequency of SC use and its relationship with sociodemographic characteristics and treatment outcomes in alcohol-and substance-dependent inpatients retrospectively.Methods: We retrospectively analyzed medical records of 323 inpatients that were treated at the alcohol and substance dependence treatment center between January 2012 and December 2013. The data were extracted from patient records.Results: The mean age of SC users was lower than for patients without a history of SC use. The mean duration of education was shorter for SC users. Age at first drug use of SC users was lower, numbers of hospitalizations were lower and duration of substance use was shorter in SC users compared with the other substance user groups. The rate of legal issues was higher in the SC-use group. The rate of lapse and the rate of dropout was higher in patients with SC use than in other substance users (for all p< 0.05). Age, age at first substance use, duration of use (years) and criminal records were predicted as determining variables for SC use in inpatients.Conclusions: In conclusion, the socio-demographic characteristics can be included as predictive factors for SC use.

The relation of PTSD symptoms to migraine and headache-related disability among substance dependent inpatients.

Despite emerging evidence for the comorbidity of posttraumatic stress disorder (PTSD) and migraine, few studies have examined the relation of PTSD and migraine, particularly among clinical populations at-risk for both conditions (e.g., substance-dependent patients). This study examined the role of PTSD symptoms in migraine and headache-related disability within a sample of 153 substance-dependent inpatients (37.25% female, Mean age 36.46). PTSD symptoms predicted both migraine and headache-related disability above and beyond gender, depression and anxiety symptoms, the experience of a Criterion A traumatic event, and current alcohol use disorder. Findings highlight the strong association between migraine and PTSD symptoms in a unique population at risk for both conditions.

Relationship Between Alexithymia and Aggression in a Sample of Men with Substance Dependence

ABS TRACT: Relationship between alexithymia and aggression in a sample of men with substance dependence Objective: The aim of this study was to evaluate the relationship between alexithymia and aggression among men with substance dependence. In addition, we wanted to control the effect of variables such as depression and anxiety on this relationship. Methods: Participants were 200 consecutively admitted substance-dependent inpatients. Patients were assessed with the Toronto Alexithymia Scale-20, the Buss-Perry Aggression Questionnaire, the Beck Depression Inventory and the State-Trait Anxiety Inventory. Results: Of the substance-dependent inpatients, 34.0% (n=68) constituted a group suffering from alexithymia. Rates of being unemployed, being married, duration of education, and current age did not differ between the groups, whereas age at onset of regular substance use was lower in the group with alexithymia. The alexithymic group had higher scores of aggression, depression, as well as trait and state anxieties. A hierarchical linear regression analysis demonstrated that the difficulty in identifying feelings (DIF) factor of alexithymia was related with aggression, although chronic anxiety contributed to this relationship particularly in the anger and hostility dimensions of aggression. Conclusion: Trait DIF may be directly related with aggression, whereas state DIF may be a way of coping among those with chronic anxiety and may be indirectly related with cognitive and affective components of aggression. The relevance of these relationships for prevention and treatment of substance dependents deserves interest in further research.

Burden of blood transmitted infections in substance users admitted for inpatient treatment in Singapore and the associated factors

There is paucity of local data on the prevalence of blood transmitted infections (BTIs), such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) infections, among illicit drug users. This study aimed to examine the prevalence of BTIs among substance dependent inpatients and identify the factors associated with BTIs. We conducted a retrospective analysis of clinical notes of 170 inpatients with a diagnosis of substance dependence who were admitted at the National Addictions Management Service, Singapore, between 1 June 2009 and 31 May 2010. Majority of the 170 inpatients were male (88.2%) and Chinese (58.2%). The mean age of the patients was 43.1 years, and the main drug of abuse was opioids (86.5%). BTIs were found in 70 (41.2%) inpatients; the prevalence of hepatitis B, hepatitis C and HIV infections was 3.7%, 39.6% and 0%, respectively. Lifetime intravenous drug use, but not needle-sharing, was more common among inpatients who were positive for BTIs (p < 0.01). Logistic regression analysis showed that lifetime intravenous drug use (OR 4.3, 95% CI 1.7- 10.8, p < 0.01) was the only significant predictor of BTIs. A large proportion (41.2%) of the substance users seeking help was positive for at least one BTI. Lifetime intravenous drug users were found to be more than four times more likely to have a BTI. Early detection and prevention is essential to improve prognosis.

The prevalence and characteristics of attention-deficit hyperactivity disorder among a sample of Egyptian substance-dependent inpatients

Introduction Attention-deficit hyperactivity disorder (ADHD) affects not only children, but persists in up to 4.4% of the general population. Comorbidity is common among adults with ADHD, including substance abuse. To our knowledge, the relation between ADHD and substance-use disorder (SUD) has not been studied in Arab countries thoroughly. Aim of the work The aim of this study was to estimate the prevalence rate of adult ADHD among substance-use inpatients and to compare substance use in patients with and without adult ADHD with regard to the onset, the severity, and the type of substance of abuse. Participants and methods This cross-sectional comparative study was conducted at the Addiction Treatment Center at El Maamoura psychiatric hospital. One hundred and two adult male inpatients were recruited and assessed using a semistructured interview questionnaire to collect sociodemographic data, substance-use history, and medical and psychiatric history. The psychiatric interview was applied, and psychometric assessment was performed using the Arabic version of the Wender Utah Rating Scale, which examined retrospectively the symptoms of childhood ADHD, and the Arabic version of the Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist for screening for adult ADHD. Results Thirty-six (35.3%) patients were diagnosed as having adult ADHD according to DSM-IV-TR criteria. The presence of adult ADHD was associated with an earlier mean age of onset of SUD (15.58 vs. 13.22 years). It was also associated with a larger number of hospital admissions (6.83 vs. 3.39 times). Individuals with ADHD achieved a shorter mean period of abstinence (124.53 vs. 209.82 days). Conclusion This study confirmed the presence of adult ADHD among substance-use patients with a considerable prevalence rate. Also, the presence of adult ADHD was associated with a more complicated course of SUD.

Comorbidity of Migraine and Psychiatric Disorders Among Substance‐Dependent Inpatients

Limited and conflicting data exist regarding the prevalence of psychiatric disorders, particularly substance use disorders (SUDs), among migraineurs in inpatient clinical settings. As part of a larger cross-sectional study, 181 substance-dependent inpatients completed a structured psychiatric interview and measures of psychiatric symptoms and migraine. Standardized mean differences were used to quantify differences between inpatients with and without migraine across 4 domains of predictors (demographic variables, non-SUD psychiatric diagnoses, specific SUDs, and self-reported psychiatric symptoms). The predictors within each domain that best discriminated between the migraine and no-migraine groups were identified using a classification tree approach with Bonferroni corrections. These candidate predictors were subsequently entered into a multivariate logistic regression to predict migraine status, which was then replicated using bootstrapping of 500 samples. Associations between migraine status and SUD treatment dropout were also examined. Forty-four of the 181 (24.3%) participants met criteria for migraine. Migraineurs were more likely to be female (34.8% vs. 18.3%) and reported higher levels of current anxiety symptoms (mean [standard deviation]: 19.7 [11.0] vs. 11.3 [10.3]). Having a lifetime diagnosis of generalized anxiety disorder (56.8% vs. 27%, odds ratio 3.47, 95% confidence interval [CI] 1.39-10.58) or a current diagnosis of alcohol dependence (45.5% vs. 24.1%, odds ratio 3.79, 95% CI 1.63-13.62) was associated with more than a 3-fold risk of migraine. These 4 variables in combination were forced into the final multivariate model, which differentiated well between those with and without migraine (area under the receiver operating characteristic curve = 0.81; 95% CI 0.73-0.88). Migraine was not differentially associated with increased risk for SUD treatment dropout (13.6% vs. 16.1% dropout among those without migraine). A history of generalized anxiety disorder, high levels of current anxiety symptoms, and current alcohol dependence are the strongest psychiatric predictors of migraine status among substance-dependent inpatients. However, migraine status is not associated with SUD treatment dropout.

The relative and unique contributions of emotion dysregulation and impulsivity to posttraumatic stress disorder among substance dependent inpatients

BackgroundDespite elevated rates of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients, as well as the clinical relevance of this co-occurrence, few studies have examined psychological factors associated with a PTSD–SUD diagnosis. Two factors worth investigating are emotion dysregulation and impulsivity, both of which are associated with PTSD and SUDs. Therefore, this study examined associations between PTSD and facets of emotion dysregulation and impulsivity within a sample of trauma-exposed SUD inpatients. MethodsParticipants were an ethnically diverse sample of 205 SUD patients in residential substance abuse treatment. Patients were administered diagnostic interviews and completed a series of questionnaires. ResultsPatients with PTSD (n=58) reported significantly higher levels of negative urgency (i.e., the tendency to engage in impulsive behaviors when experiencing negative affect) and lower sensation seeking, as well as higher levels of emotion dysregulation and the specific dimensions of lack of emotional acceptance, difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, and lack of emotional clarity. Further, overall emotion dysregulation emerged as a significant predictor of PTSD status, accounting for unique variance in PTSD status above and beyond facets of impulsivity (as well as other relevant covariates). ConclusionsResults suggest that emotion dysregulation may contribute to the development, maintenance, and/or exacerbation of PTSD and highlight the potential clinical utility of targeting emotion dysregulation among SUD patients with PTSD.

The mediator roles of trait anxiety, hostility, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients

The aim of this study was to investigate the mediator roles of negative affect, aggression, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients. In addition, the effect of some variables that may be related with childhood trauma and dissociation among treatment-seeking substance dependents, such as substance of choice (alcohol/drug), mean of current age, and age at regular substance use was controlled. Participants were consecutively admitted 200 male substance-dependent inpatients. Patients were investigated with the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, the Barratt Impulsiveness Scale, the Buss-Perry Aggression Questionnaire, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory. Seventy-seven patients (38.5%) with pathologic dissociation were compared with 123 nondissociative patients (61.5%) classified by dissociative taxon membership. The dissociative group had lower age, age at regular substance use, duration of education, and higher rate of drug dependency rather than alcohol dependency. Beside higher scores on anxiety, depression, childhood trauma, aggression, and impulsivity, a larger proportion of dissociative group reported suicide attempts and self-mutilation than did the nondissociative group. Results of regression analyses suggest that severity of chronic anxiety, aggression (particularly hostility), and impulsivity were found to be mediators of association between childhood trauma and dissociation. Results suggest that, to reduce the risk of dissociation and related behavior such as suicide attempt and self-mutilation among substance dependents, chronic anxiety together with the feelings of hostility and impulsivity must be the targets of evaluation and treatment among those with history of childhood trauma.

Relationship of self-mutilative behaviours with severity of borderline personality, childhood trauma and impulsivity in male substance-dependent inpatients

The aim of this study was to investigate the relationship of self-mutilation (SM) with the severity of borderline personality features (BPF), childhood trauma and impulsivity in male substance-dependent inpatients. Participants were consecutively admitted comprising 200 male substance-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire (SMBQ), the Childhood Trauma Questionnaire (CTQ-28), the Barratt Impulsiveness Scale (BIS-11) and the Borderline Personality Inventory (BPI). Among 200 subjects, 62.0% (n=124) were considered as the group with SM. Mean scores of CTQ-28 total and subscales (other than emotional abuse), BIS-11 total and attentional impulsiveness subscale and BPI were higher in the SM group. In the regression model, emotional neglect, attentional impulsiveness and drug dependency were the predictors of SM, whereas in the new model in which the severity of BPF was included emotional neglect and the severity of BPF predicted SM. Among those with SMB, physical neglect and the severity of BPF predicted the number of SM episodes. Thus, to better understand SMB among substance-dependent patients, clinicians must carefully evaluate BPF and history of childhood trauma among substance-dependent inpatients. In addition, results suggest that the relationship between SMB and BPF is more prominent in drug-dependent inpatients than alcohol-dependent inpatients.

Impulsive behaviors as an emotion regulation strategy: Examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients

Recent investigations have demonstrated that posttraumatic stress disorder (PTSD) is associated with a range of impulsive behaviors (e.g., risky sexual behavior and antisocial behavior). The purpose of the present study was to extend extant research by exploring whether emotion dysregulation explains the association between PTSD and impulsive behaviors. Participants were an ethnically diverse sample of 206 substance use disorder (SUD) patients in residential substance abuse treatment. Results demonstrated an association between PTSD and impulsive behaviors, with SUD patients with PTSD reporting significantly more impulsive behaviors than SUD patients without PTSD (in general and when controlling for relevant covariates). Further, emotion dysregulation was found to fully mediate the relationship between PTSD and impulsive behaviors. Results highlight the relevance of emotion dysregulation to impulsive behaviors and suggest that treatments targeting emotion dysregulation may be useful in reducing impulsive behaviors among SUD patients with PTSD.

Relationship of alexithymia and dissociation with severity of borderline personality features in male substance-dependent inpatients

The aim of this study was to evaluate possible interactions between severity of borderline personality features (BPFs), dissociative experiences, and alexithymia among substance-dependent men while controlling for their current age, depression, and anxiety. Participants were 200 substance-dependent men consecutively admitted to a dependency treatment unit. The Borderline Personality Inventory, the Toronto Alexithymia Scale, the Dissociative Experiences Scale, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory were administered to all participants. Severity of negative affect, alexithymia, dissociative experiences, and BPF were correlated with each other. Being younger, severity of dissociative experiences, difficulty in identifying feelings, depression, and trait anxiety predicted the severity of BPF in linear regression analysis. These findings suggest that alexithymia and dissociative experiences may be a way of coping with depression and chronic anxiety, but they also seem to be related to the severity of BPF independent of the negative affect and from each other.

The validity and reliability of the Turkish version of the Buss-Perry’s Aggression Questionnaire in male substance dependent inpatients / Buss-Perry Agresyon Ölçeği Türkçe versiyonunun yatarak tedavi gören erkek alkol/madde bağımlılarında geçerliği ve güvenirliği

Objective: Buss-Perry's Aggression Questionnaire (AQ) (Buss and Perry, 1992) is a 29-item questionnaire that assesses four aggression related categories (physical aggression, verbal aggression, anger, and hostility). In the aim of this study, the reliability, validity and factorial analysis of the Turkish translation of the Buss-Perry's AQ was conducted in male substance dependent inpatients. Method: The present study was conducted with an adult sample of 200 consecutively admitted male substance dependent inpatients between May and December 2009 in Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, AMATEM (Alcohol and Drug Research, Treatment and Education Center) in Istanbul. All inpatients were evaluated with the AQ, the State-Trait Anger Expression Inventory (STAXI), the Barratt Impulsiveness Scale (BIS-11), the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI). Factor analysis was performed for AQ items. Cronbach's alpha was used to assess internal consistency that provides some indication of reliability. Test-retest method was also applied for reliability. Other instruments (STAXI and BIS-11 for aggressive, BDI and STAI for affective symptoms) were administered together with the AQ to validate the test (external or concurrent validation). Results: The Turkish version of the scale with 28-item and four factor solution was found to be compatible with the original scale in male substance dependent inpatients. The internal consistency coefficient (Cronbach's) was 0.89 for Factor 1 (Physical Aggression) scale, 0.84 for Factor 2 (Hostility) scale, 0.82 for Factor 3, 0.59 for Factor 4, and 0.93 for AQ total score. Item-subscale correlations ranged between 0.59 and 0.79. For each of the items, the corrected item-total correlation values were between 0.25 and 0.75. Test-retest correlations were 0.80 for Factor 1, 0.77 for Factor 2, 0.78 for Factor 3, 0.54 for Factor 4, and 0.84 for AQ total score. Four subscales and total score of AQ were correlated significantly with total scores and subscales of the STAXI and the BIS-11. Conclusion: Results which were obtained in this study suggests that the Turkish version of the AQ with 28-item and four factor solution could be used as a reliable and valid instrument in substance dependent inpatients. The results also suggest that the four scales of the AQ have moderate to high internal consistencies and are stable over two weeks of testing.

History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression

The aim of this study was to investigate the relationship between severity of borderline personality features and history of suicide attempt (HSA) in male substance-dependent inpatients and the effect of anger, hostility and aggression on this relationship. Further, the effect of some variables that may be related to suicide and/or borderline personality, such as age at inception of regular substance use, substance of dependence (alcohol/drug), depression, and both state and trait anxiety, were controlled. Participants were 200 consecutively admitted male substance-dependent inpatients. Patients were investigated with the Borderline Personality Inventory (BPI), the Buss–Perry Aggression Questionnaire (AQ), the Beck Depression Inventory (BDI) and the State–Trait Anxiety Inventory (STAI). Among substance-dependent inpatients, 33.0% (n=66) were identified as the group with HSA. Mean scores employment status, marital status and duration of education did not differ between groups, whereas current age and age at onset of regular substance use were lower in group with HSA. Mean scores of BPI, AQ and its subscales (anger, hostility and physical/verbal aggression), BDI and STAI were higher in the HSA group. In addition, the rates of drug dependency and borderline personality disorder were higher in this group. The severity of borderline personality symptoms was highly correlated with subscales of the AQ, depression and anxiety, whereas it was negatively correlated with age at onset of regular substance use. The severity of anger and borderline personality features predicted HSA in the logistic regression model. Results suggest that, to reduce the risk of suicide attempt among substance-dependent patients, the feeling of anger must be the target of evaluation and treatment among those with borderline personality features.

Self-mutilative behaviors in male substance-dependent inpatients and relationship with anger and aggression: mediator effect of childhood trauma

The aim of this study was to investigate the relationship of self-mutilation (SM) with anger and aggression in male substance-dependent inpatients. Also, we wanted to evaluate the mediator effect of childhood trauma on these relationships while controlling variables such as age, substance of dependence (alcohol/drug), and negative effect. Participants were consecutively admitted 200 male substance-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire, the Childhood Trauma Reports, the Buss-Perry's Aggression Questionnaire, the State-Trait Anger Expression Inventory, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Rate of being married, current age, and age onset of regular substance use were lower, whereas being unemployed and history of childhood trauma (HCT) were higher in group with SM (n = 124, or 62.0%). Higher mean scale scores were found in SM group. Predictors of SM were being younger, impaired anger control, and physical aggression in logistic regression model. Being younger and the outward expression of anger (anger-out) predicted SM in the subgroup of patients without HCT, whereas being younger, severity of anger, and the inward expression of anger (anger-in) predicted SM in the subgroup of patients with HCT. Thus, to reduce self-mutilative behavior among substance-dependent patients, clinicians must improve anger control, particularly in younger patients. Type of strategy for coping with anger, which must be worked on, may differ in different subgroup patients, that is, focusing anger toward self among those with HCT, whereas anger toward others among those without.

Exploring associations between borderline personality disorder, crack/cocaine dependence, gender, and risky sexual behavior among substance-dependent inpatients.

Engagement in self-destructive and impulsive behaviors is considered to be a cardinal symptom of borderline personality disorder (BPD), and many of the behaviors enumerated in this criterion have been the focus of extensive empirical research. However, very few studies have examined risky sexual behavior (RSB) in particular in BPD. Given evidence that BPD patients with a co-occurring substance use disorder (SUD) may be at increased risk for RSB relative to BPD patients without a SUD, the present study examined the association between BPD and past-year engagement in RSB (particularly, penetrative sex and nonuse of condoms with casual and commercial partners) within a mixed-gender sample of 94 SUD patients in residential treatment, as well as the moderating role of gender in this association. Given past findings of an association between crack/cocaine use and RSB, we also examined the moderating role of lifetime crack/cocaine dependence on the relationship between BPD and RSB. Results demonstrated a significant main effect of BPD on past-year penetrative sex with casual and commercial partners. Significant 3-way interactions between BPD status, lifetime crack/cocaine dependence, and gender were also found for past-year penetrative sex with casual and commercial partners, as well as the likelihood of not using a condom during sex with a casual partner. Post hoc analyses indicated that women with co-occurring BPD and lifetime crack/cocaine dependence were at greatest risk for RSB. Findings replicate extant findings pertaining to the association between BPD and RSB and extend research by identifying relevant factors that may moderate this association.

Childhood Abuse and Neglect as a Risk Factor for Alexithymia in Adult Male Substance Dependent Inpatients

The prevalence of childhood abuse and neglect (CAN) histories and their associations with alexithymia among male substance-dependent inpatients were studied. Participants were 159 consecutively admitted male substance dependents (115 alcohol and 44 other drugs). Substance dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. Patients were investigated with the Toronto Alexithymia Scale (TAS-20) and Childhood Abuse and Neglect Questionnaire. Among substance-dependent patients, 57.0% had at least one type of CAN and 45.3% were considered as alexithymic since they had a score greater than 60 on the TAS-20. Rate of unemployment, low educational status, emotional abuse and history of suicide attempts were higher in alexithymic substance dependent patients. Those who had histories of two or more types of childhood abuse or neglect had also higher mean score on TAS-20, particularly on the item “difficulty in identifying feelings-DIF.” Also, the number of childhood trauma types was positively correlated with TAS-20 andDIF and the “difficulty in describing feelings-DDF' items of TAS-20. History of childhood emotional abuse was the only determinant for alexithymia. Childhood emotional abuse might be a risk factor for alexithymia among inpatient substance dependents.

The Relationship Between Premature Ejaculation and Hyperthyroidism

We determine the prevalence of premature ejaculation in patients with hyperthyroidism and observed intravaginal ejaculation latency time alterations before and after hyperthyroidism treatment. Between January 2004 and June 2007, 49 patients with hyperthyroidism and no history of hyperthyroidism treatment were enrolled in the study. After obtaining a detailed sexual anamnesis an erectile function questionnaire was completed and a patient self-reported outcome measure of difficult control over ejaculation was examined. We assessed stopwatch measurements of intravaginal ejaculation latency time performed by the patient or partner. Patient anxiety status was also evaluated. Changes in the mentioned measurements induced by hyperthyroidism treatment were examined 8 weeks after the achievement of euthyroidism. In the 43 eligible patients mean +/- SD age was 48.0 +/- 8.8 years. Premature ejaculation was observed in 31 of the 43 patients (72.1%). Mean intravaginal ejaculation latency time in patients with hyperthyroidism was 72.8 +/- 83.3 seconds. Of the 43 patients 30 (69.8%) were considered to have definite premature ejaculation according to stopwatch measurements. In patients with hyperthyroidism who had definite premature ejaculation anxiety scores were determined to be higher. A positive correlation was noted between serum thyroid stimulating hormone and intravaginal ejaculation latency time in the patients. In 24 patients who completed the followup visits we noted statistically significant improvement in intravaginal ejaculation latency time after the achievement of euthyroidism. Excess thyroid hormone and premature ejaculation are clinically interrelated conditions. Hyperthyroidism should be considered a novel and reversible etiological risk factor for premature ejaculation.