P-07-01
A french study on alcohol and tobacco use in pregnant women
I. de Chazeron, D. Boussiron, D. Lemery, P.-M. Llorca. CHU Clermont Ferrand Psychiatry B, Clermont-Ferrand, France
Objective: Harmful effects of alcohol and tobacco during pregnancy recover a large panel of fetal damage sometimes identified only after school integration. The aims of this work were (i) to evaluate the prevalence of alcohol and tobacco parturient consumption using self-questionnaires, and (ii) to estimate impact of consumption on newborn weight.
Methods: Seventeen maternity hospitals located in Center of France were enquired during one month. Each delivered woman filled out AUDIT; Fagerstr0m questionnaires and alimentary habit's questions.
Results: 1050 mother-infant dyads were included. After pregnancy diagnosis, 47.4% continued alcohol use, 11.3% declared consumption 2-4 times/month, 2.5% 2 or more times/week. 0.3% AUDIT scores indicate hazardous or harmful alcohol use. 7% reported binge drinking. The prevalence of FAS (Fetal alcohol syndrome) is 1.8%o. Mothers concerned have two kinds of consumption patterns. 21.8% smoke vs 37.9% prior to pregnancy. 68.6% of cessations are during first trimester. Fagerstr0m results reveal that 7.1% have at least an high degree of dependence. At the time of evaluation, among smokers, 39.6% would like to stop and 42.5% to reduce. 67.9% wish to stop with medical support. A mean reduction in birth weight of 208g was found in infants of active smokers, without dose correlation.
Conclusion: Despite WHO's recommendations, alcohol use during pregnancy is more extensive than supposed. Observed FAS prevalence is consistent with others findings, but we identify two specific patterns of consumption. Tobacco prevalence is stable among parturients but their smoking behavior seems to be complex. Their expression for help to stop smoking suggests the need of specific prevention and commitments.
P-07-02
Codependence of drug, alcohol and tobacco abuse in adolescent risk behavior
M. Spremo, L. Ifeta, M. Burgic, S. Spremo. Psyhiatry Clinic Child atwl adolescent, Bahia Luka, Bosnia and Herzegovina
Objective: Adolescence characterize frequent psychical crisis which are result of biological development, looking for own identity, changes in family relation and many socio-cultural influences. Many of social, economic and other environmental factors make some changes in adolescent population. The main objective was finding how many adolescents had risk behavior and subsequences oftener sexual intercourse and aggressive behavior.
Methods: Research has done in Banjaluka's high schools, involved 202 adolescents age 18 (51 male, 151 female). In research used risk behavior questionnaire Q-2000 (K.B. Kelly, 2000).
Results: Out of total number of individuals in the study, 35,6% was cigarette smokers, 56,9% consumed alcohol, 20,2% consumed marijuana, and sexual intercourse 21,7% (75% used contraceptive methods). Adolescents which used alcohol oftener had sexual intercourse(27,8%) than adolescents who don't drink (13,8%), and 29,5% was aggressive in last year. Similar results was found in groups with marijuana and tobacco. Group which used marijuana 34,1% had sexual intercourse than group who don't smoke cannabis (18,6%) and they were aggressive 41,8% .Group which used tobacco had sexual intercourse 34,7% than group nonsmokers (14,6%), and aggressive behavior 30,5%.
Conclusion: Adolescents are prone to abuse of psychoactive substances in developing countries. The consequence is higher risk behavior such as violence and promiscuity. Research will be conducted to develop and formulate preventive and educational programs in schools.
P-07-03
Alcohol use and alcoholism in schizophrenia subjects - A population based study
J. Koskinen, J. Miettunen, E. Lauronen, P. Laine, H. Koponen, M. Isohanni. University of Oulu Department of Psychiatry, Oulu, Finland
Objective: To study alcohol consumption and alcoholism in schizophrenia subjects in comparison with general population.
Methods: Within the Northem Finland 1966 Birth Cohort we collected information in alcohol use using questionaires between ages 31 and 34. The diagnoses of schizophrenia and alcoholism were obtained from Finnish Hospital Discharge Register. The consumptionof 40 alcohol grams/day was regarded as heavy drinking. Our sample included 7925 non-psychotic subjects and 75 schizophrenia subjects.
Results: 4.0% (n=3) of schizophrenia subjects were heavy drinkers at the time of the interview, where as in general population the corresponding percentage was 4.1% (n=324). Higher proportion of schizophrenia subjects (n=21, 28.0%) used no alcohol compared to the group in which there were non-psychotic diagnoses (n=696, 8.8%). Lifetime alcohol abuse/dependence was diagnosed in 10 (13.3 %) schizophrenia subjects, two of them being abstainers at time of the interview.
Conclusion: The proportion of heavy drinking in schizophrenia subjects was the same than in general population. However, the amount of subjects with schizophrenia who did not drink alcohol at all was higher compared to those in general population. This is explained by factors related to local culture, religion and the structure of health care system.
P-07-04
Substance abuse in schizophrenia - A systematic review on research
J. Koskinen, J. Miettunen, E. Lauronen, H. Koponen, M. Isohanni. University of Oulu Department of Psychiatry, Oulu, Finland
Objective: Our aim was to review systematically studies concerning substance abuse in schizophrenia and to update current literature of the topic. We included studies published in 2000-2004. National and gender differences were under study as well.
Methods: Articles were collected using electronical databases (PsycINFO, PubMed, Ovid and Web of Science) and manual literature search. We included only articles written in English and published in 2000-2004. The studies reporting rates of substance abuse in schizophrenia were analysed. The search was done by using words “schizophrenia, psychos*s and psychotic” to find studies on schizophrenia and “alcoholism”, “alcohol abuse”, “alcohol dependence”, “substance abuse” and “substance dependence” and several drug names. We will study seperately rates of abuse of different substances.
Results: The database search gave 195 hits from PsyclNFO, 866 from PubMed, 1137 from Ovid and 1406 from Web of Science. Preliminary results reveal large range of rates in different substances in different samples of schizophrenia patients. In alcohol abuse the lifetime rates varied from 5 to 50 percent. There were also visible cultural differences in used substances and gender differences in rates.
Conclusion: The rates of substance abuse depend strongly on included samples, e.g. if patients were in outpatient or in inpatient care or if the sample included first admission or chronic schizophrenia patients. The national differences should be taken into account when comparing studies on substance abuse in schizophrenia studied in different countries.
P-07-05
Dietary intervention on antipsychotics induced weight gain: A six to 48 month follow up
Y. Khazaal, E. Fresard, D. f. Zullino. University of Lausanne Department of Psychiatry, Prilly-Lausanne, Switzerland
Objective: Antipsychotic (AP) induced weight gain (WG) occurs in up to 50 % of patients under administration of these drugs. Most of weight loss interventions in psychiatric outpatients were regular dietetic consultations whose long term impacts remain unknown. The objective of the present study was to explore the long term eficiency of dietary outpatient treatment.
Methods: We identified 12 outpatients treated by antipsychotic followed by a dietetician for more than six months and, then reviewed the patient's charts. All patients are followed in psychiatric outpatient unit for more than five years and undergoing an antipsychotic treatment. Each patient participated in a psycho educational group session followed by individual weekly visits for the first two months and then by monthly visits. Body mass index (BMI) was calculated for all patients. The BMI and the %BMI curves were traced using three month average figures.
Results: Continuous weight gain was observed all throughout the study period in patients who's BMI persistently increased during the first six months of treatment. However, a decrease or stability of BMI in the initial six month period is associated with significantly lower BMI final figures.
Conclusion: The present results suggest that increase in BMI within the first 6 months in patients properly following the dietetic treatments seems to predict sustained (WG). This observation may encourage either a switch of pharmacological treatment, other kinds of weight gain management programs, or the addition of another pharmacological treatment.
P-07-06
Cocaine dependence, craving, impulsivity and topiramate treatment
E. Batlle, J. Alvaros, I. Andres, J. Bastardas, T. Fernandez, J. Ferrer, L. Lozano, J. Martinez, R. Melus, J. Mir, M. Mola, J. Roig, G. Vazquez, J. Tremoleda. Hospital Mataro Psychiatry Service, Mataro (Barcelona), Spain
Objective: Numerous observations have suggested the potencial use of topkamate in impulse-control disorders and borderline personality disorder. Moreover, by its modulating properties on GABA and glutamate neurotransmitter may reduce the rewarding properties of cocaine and reduce cocaine craving. So it is reasonable evaluate the effectiveness of topiramate in the treatment of patients with cocaine abuse or dependence and related impulsivity. Evaluate the effectiveness of topiramate in cocaine craving, cocaine use and impulsive behaviour in cocaine abuse or dependence patients.
Methods: A preliminary, observational, multi-centre study was carried-out in 129 patients, with criteria for cocaine abuse or dependence, that were atended in drug abuse specialized centres and received topiramate for almost 12 weeks. Demographic ftems, cocaine craving and consumption, and impulsivity levels registered in clinic scales werw used to assess effectiveness.
Results: The results have shown a reduction in craving, dose and frequency of consumption of cocaine, and also a reduction in impulsivity levels.
Conclusion: These results suggest that topiramate could be an effective drug treatment for cocaine abuse or dependence, specially in those patients with high impulsivity levels.
P-07-07
Risperidone long-acting injectable in dual diagnosed patients
E. Batlle, L Andres, J. Bastardas, T. Fernandez, J. Ferrer, L. Lozano, J. Mattinez, R. Menus, M. Mola, G. Vazquez, J. M. Vazquez. Hospital Mataro Psychiatry Service, Mataro (Barcelona), Spain
Objective: Dual diagnosed patients show a poorer course and a lower treatment adherence. Several studies have reported the efficacy of risperidone in patients with dual pathology, particularly when a patient has concomitant substance abuse and psychotic disorders or other psychiatric conditions causing severe behavioural changes. Long-acting injectable form of risperidone could also improve treatment compflanse and adherence.To assess the value of long-acting injectable form of risperidone to improve treatment adherence, and its efficacy for reducing substance craving and consumption, and the symptoms and behaviour related with dual pathology.
Methods: A preliminary, observational, multi-center study, retrospectively evaluated data from 42 patients meeting criteria for substance abuse or dependence treated at drug dependence specialized centres and receivig treatment with risperidone longacting injectable. Demographic items, craving, substance use and clinical and adherence scales werw used to assess efficacy.
Results: There are a valuable reduction in craving, dose and frequency of use for different substances, an improvement in clinical scales and also in therapeutic adherence scale.
Conclusion: These results suggest that long-acting injectable form of risperidone could be effective in the treatment of dual diagnosed patients who have poor treatment adherence.
P-07-08
Application of risperidone in treatment and rehabilitationi programs at the heroin addicts
A. Kozlov, I. V. Dorovskih, L. Tchistyakova, D. V. Ogar. The Ministry of Public Health & Social Develop. of Russian F, Moscow, Russia
Objective: The description of psychopathological displays of a pathological inclination to drugs at heroin drug addiction in post abstinence period, and also search “safe” neurolepthics for treatment during rehabilitation.
Methods: 28 heroin drug addiction was observed in the age of from 18 till 35 years with duration of disease from 1 to 9 years. The clinical-psychopathological, catamnestical, psychological and mathematics-statistical methods were used. Risperidone was nominated daily on 4-6 mg within the first 2 months. Subsequent 2- 4 months of rehabilitation the patients received on 2-4 mg per morning. 3 patients were successfully transferred on Risperdal Consta, which is received by last 2 months on 25 mg everyone 2 weeks.
Results: After to control a sharp abstinence syndrome on the foreground acted psychopathological symptoms, which quite often was evidence of aggravation of a pathological inclination to drugs. It was affective frustration, more often as dysphoric depression, psychopath similar infringement with irritability, discontent environmental, excitation, infringements of behavior. On a background of long reception Risperidone reduction affective intensity, anger, absence of appreciable fluctuations of emotional background, dysphoric reactions, psychopath similar behavior, compulsive inclination to drugs was marked. The level of asthenia, divergence was reduced. The behavior was ordered. The expressed aggravation of a pathological inclination to drugs, subcortical symptoms was not appeared. Risperidone did not render negative influence on cognitive function.. At the patients the interest to environmental conditions and life was restored.
Conclusion: The results testify about perspective of application Risperidone (Risperdal Consta), as long antirelapse therapy in a complex with rehabilitation measures. It will promote of social - labour adaptations of the drug addicts and increase of their quality of life.
P-07-09
Prediction of efficacy of inpatient treatment in metamphetamine dependence
L. Hosak, L. Csemy, M. Preiss, E. Cermakova. Univ. Hospital Hradec Kr. Psychiatry, Prague, Czech Republic
Objectives: Dependence on metamphetamine represents a serious problem in the Czech Republic with 22 000 metamphetamine abusers. The goal of our study was to assess whether the examination of the patient's personality and complex problems brought by the substance abuse may predict a success of the inpatient treatment in a one-year follow-up.
Methods: Forty-one patients (women N = 12) at the average age of 24,0 -+ 3,9 years who have abused metamphetamine for 5,9 years on the average hospitalized in the Mental Hospital in Nechanice in 2002-2003 were the study subjects. We examined the patients using the TCI personality questionnaire and the EuropASI questionnaire during the first month of the hospitalization. We assessed the abstinence of the study subjects by mall one year after they had been discharged from the hospital.
Results: Sixteen patients (women N = 8) which is 39 % of the total study population proclaimed to have completely abstained from metarnphetamine. The abstaining patients scored significantly higher in the cooperativeness dimension of the TCI questionnaire (28,8 ± 6,7 vs 24,3 ± 6,9, p = 0,04, t-test) and the total of problems due to substance abuse according to the EuropASI questionnaire (31,1 ± 6,6 vs 25,9 ± 8,1, p = 0,04, Mann-Whitney test) as against the subjects who continued to abuse metamphetamine.
Conclusions: Our data suggest that a patient with good social skills, and a sufficient motivation to abstain may achieve good treatment results. The motivation may be based on problems, associated with the substance abuse.
P-07-10
Psychopathology among treatment-seeking cannabis users: Significance for treatment outcome
M. Arendt, L. Foldager, R. Rosenberg, G. Perto, P. Munk-Jorgensen. Aarhus University Hospital Basic Psychiatric Research, Risskov, Denmark
Objective: Previous investigations suggest that psychopathology among cannabis users is frequent. However, no studies have compared this group with the general population. It.is also unclear whether previous psychological problems influence the outcome of treatment. This study seeks to establish the relative prevalence of different psychiatric disorders and evaluate whether these problems have an impact on treatment outcome.
Methods: Between 1996 and 2002, 3114 individuals had sought treatment for cannabis dependence in a Danish treatment facility. These cases were relxieved from the Danish Substance Abuse Treatment Register. For each case, five controls from the general population, matched on age and gender, were included. Information about history of psychiatric treatment for both cases and controls was drawn from the Danish Psychiatric Central Register. It was established whether previous psychotic, affective, neurotic or personality disorders had any influence on treatment length, success, and subsequent re-admissions for substance treatment.
Results: Will be presented at the conference.
Conclusion: Will be presented at the conference.
P-07-11
Overreporting of recent cannabis use in subjects entering an inpatient detoxification unit
D. F. Zullino, S. Krenz, D. Lounici, A. Buecking, E. Frdsard, Y. Khazaal. University Lausanne Psychiatry, Prilly-Lausanne, Switzerland
Objective: In most studies underreporting of drug use has been the major problem compared to oveiTeporting. Overreporting may, conversely, occur regularly in particular settings, e.g. in subjects entering a detoxification program. The objective of the present study was to determine the proportion of patients entering a drug detoxification with regard to underreporting or overreporting of recent cannabis consumption.
Methods: Self-reports (standardized semistructured interview) of recent cannabis use of 554 consecutively patients admitted to the drug detoxification unit of the University Department of Adult Psychiatry in Lausanne were compared to the results of the urine screening at admission. Cannabis "Overreporters" were compared to "Accurate Reporters" with regard to the course of hospitalization, retention in treatment and received prn medication. Stepwise logistic regression analysis was computed.
Results: Overreporting was found in 46% of patients reporting recent cannabis consumption and underreporting in 24% of those denying having smoked cannabis during the preceding week. The retained variables of a stepwise logistic regression were: abandon of detoxification during the first week (OR 2.05) and prn medication with myorelaxant drugs (OR 2.02).
Conclusion: The retained parameters associated with overreporting of recent cannabis consumption are suggestive of patients trying to get receiving more consideration from the therapeutic team and to get more intensive pharmacological care during the detoxification period.
P-07-12
The evaluation of quantitative research on the medicinal use of cannabinoids in cancer- and AIDS-related anorexia and cachexia, Tourette's Syndrome and Multiple Sclerosia-related spasticity
S. Rysheuvels. University of Antwerp, Antwerp, Belgium
Objective: In the past 25 years research has focussed on a variety of possible medical applications of cannabinoids in clinical practice. To establish whether cannabinoids are effective and safe in the management of cancer- and AIDS-related anorexia and cachexia, Tourette's Syndrome and MS-related spasticity, we assessed the feasibility of recta-analytic research for these indications.
Methods: A systematic literature search was performed (Medfine, Cochrane Library, PsycINFO, International Association for Cannabis as Medicine Database, bibliographies) to February 2004. The methodological quality of controlled trials and pilot studies was analysed by means of the Oxford Score by Jadad et al. (1996). An assessment was made regarding the feasibility of performing a recta-analysis.
Results: With regard to cancer- and AIDS-related anorexia / cachexia 9 controlled studies were identified, 5 of which were excluded. A recta-analysis is not feasible due to lack of confirmity in the translation of abstract concepts into operational terms and presentation of results. 2 Trials have been conducted to assess the therapeutic value of cannabinoids in the management of Tourette's Syndrome. Both were not conducted independently: some patients participated in both studies. Therefore metaanalytic research is unfeasible. 4 Studies regarding MS-related spasticity were identified, 2 of which were excluded. A metaanalysis is not relevant, since only 1 large scale study of high methodological quality was conducted (Zajicek et al., 2003).
Conclusions: At present recta-analytic research on the medicinal use of cannabinoids in the management of cancer- and AIDS-related anorexia / cachexia and Tourette's Syndrome is not feasible. More large scale controlled trials are recommended.
P-07-13
Smoking initiation and schizophrenia: A replication study in a Spanish sample
J. M. Martinez Ortega, M. Gurpegui, M. C. Aguilar, F. J. Diaz, H. M. Quintana. c/o Dr. Manuel Gurpegui Dept. de Psiquiatria, Med. Fac, Granada, Spain
Objectives: To replicate a prior US study in which schizophrenia vulnerability was associated with higher risk of initiating daily smoking after 20 years of age.
Methods: The study was located at two Community Mental Health Centers of Granada (Spain). A survival analysis of onset age of daily smoking compared 290 controls with 250 consecutive DSM-IV schizophrenic patients. As in the de Leon et al.'s (2002) prior study, subjects were asked about age of onset of daily smoking (AODS) and high nicotine dependence, defined as a score ≥ 6 in the Fagerstr6m Test for Nicotine Dependence (FI'ND) (Fagerstrom et al., 1996). For a particular age, the initiation rate is defined as the hazard rate and is measured by the slope of the cumulative hazard curve at that age.
Results: After controlling for gender and education, the cumulative hazard curves for smoking initiation age of schizophrenia patients and controls were signifcantly different. After age 20, smoking initiation rates were higher in the 250 schizophrenia patients (and in 136 schizophrenia patients who started smoking at least two years before the illness onset).
Conclusions: This Spanish replication of US results suggests that vulnerability to schizophrenia may be associated with a higher risk of becoming a daily smoker. Prospective studies may be required to better establish the interaction between schizophrenia vulnerability, AODS and onset age of schizophrenia.
P-07-14
Cognitive functioninng in schizophrenics addicted and nonaddicted to illicit drugs
K. Krzysztof, I. Krupka-Matuszczyk, A. Klasik, L. Hubicki. Medical University of Silesia Psychiatry and Psychotherapy, Katowice, Poland
Objective: The number of patients with “dual diagnosis” in both psychiatric and addiction treatment systems is increasing. Among them there is a large group of subjects suffering from schizophrenia with a comorbid addiction to drugs like opiats, amphetamins, cannabis. So far there have been some studies on their cognitive functioning, which is a very important and predictive factor in schizophrenic symptomatology and outcome, however their results are still inconsistent. These differences, if confirmed, may be responsible for their often worse social and vocational functioning.
Methods: A group of 50 schizophrenic subjects underwent the examination, both men and women. 25 of them never used illicit drugs, the other 25 also matched citeria of drug addiction, mainly mixed addiction to different drugs. Each group included 22 men and 3 women. The addicted group was examined after a six-week period of detoxification and treatment in a therapeutic community, to avoid a direct influence of the used drug on the results.
Results: A battery of neuropsychiatric tests was used, which included TMT A and B, Stroop test, phonological and categorial verbal fluency tests. The psychopatological symptoms were measured with the PANSS scale.
Conclusion: No significant differences in cognitive functioning between two examined groups were found, which is constent with some of the studies found in the literature. This result may be a good predictor for this gruop in terms of their possible chances of succesful rehabilitation.
P-07-15
Nicotine dependence and psychosis onset
M. Ruiz-Veguilla, A. Fontalba Navas, M. L. Barrigón Estevez, M. Anguita Romero, L. Gomis Fletcher. Hospital Clinico San Cecilio, Granada, Spain
Objective: To determine the percentage of patients with a firstepisode psychosis who are smokers and the relationship between smoking habit and psychopatology.
Methods: In our study 27 subjects with ftrst-episode functional psychosis, according to ICD-10 criteria. Demographic data were collected. Smoking habit was measured with Fagerstr~Sm's Scale. Psychopatology was collected with PANSS
Results: 74% of the sample were males. The average of age was 25,12 years, 18% were younger than 18 (Adult age in Spain). 21 patients have been daily smokers anytime. 67% was active smokers, 94,4% of this sample was “heavy smokers”(more than 4 points in the adding of 1 and 4 item in FagerstrOm's Scale. The beginning of smoking habit was 6,5 years average before firstepisode psychosis. “Heavy Smokers” presented higher scores in Excitement PANSS Factor (p<0,01).
Conclusion: I. Smoking habit was present before than first episode psychosis. 2. “Heavy Smokers” presented higher scores in Excitement PANSS Factor than others.
Comments
No Comments have been published for this article.