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11 results

  • Chapter 4.2 - Illicit-Drug-Related Stroke

  • from 4 - Drug-Related Stroke
  • Edited by Derya Uluduz, Istanbul Üniversitesi
  • Anita Arsovska
  • Book:
    Rare Causes of Stroke
    Published online:
    06 October 2022
    Print publication:
    01 September 2022, pp 190-198

  • Summary

    Cerebrovascular disorders, contribute to the morbidity and disability associated with illicit drug use, which may be the most common predisposing condition for stroke among patients under 35 years of age. We present the case of young man with multiple illicit drug addiction and no other vascular risk factors, who presented with acute ischemic stroke and complex cardiovascular etiopathogenic mechanism. We summarize stroke mechanisms by illicit drug and stroke type and suggestion for the management of these challenging cases

  • 2 - Hitler’s Physical Health in Autumn 1941

  • Klaus H. Schmider
  • Book:
    Hitler's Fatal Miscalculation
    Published online:
    08 January 2021
    Print publication:
    28 January 2021, pp 57-69

  • Summary

    Ever since Ellen Gibbels’ research proved that Hitler was suffering from Parkinson’s Disease, historians have been asking themselves the question whether the progress of the illness is likely to have affected his judgement by 1944/45. Far more relevant is the as yet unaddressed question whether he could have known of his condition in time to influence his decision to throw down the gauntlet to the USA. This should not be seen as a far-fetched notion, since the dictator is on record as repeatedly tying the rise and fall of Germany as a great power to his life span; hence, the realisation that he was afflicted with a mortal and debilitating disease might indeed have driven him into a strategy best described as suicidal (as many historians have indeed chosen to label this decision, without one of them, however tying it to a possible diagnosis of Parkinson’s). The surviving notes taken by his personal physician Theodor Morell, together with other sources, prove conclusively that while the first symptoms of Parkinson’s may have manifested themselves before December 11th, 1941 he did not receive a diagnosis to this end before April 1945. His decisionmaking in December 1941 was as yet unaffected by his medical condition.

  • Effects of stimulant drug use on the dopaminergic system: A systematic review and meta-analysis of in vivo neuroimaging studies

  • Lisa Proebstl, Felicia Kamp, Kirsi Manz, Daniela Krause, Kristina Adorjan, Oliver Pogarell, Gabi Koller, Michael Soyka, Peter Falkai, Joseph Kambeitz
  • Journal:
    European Psychiatry / Volume 59 / June 2019
    Published online by Cambridge University Press:
    01 January 2020, pp. 15-24
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  • Background:

    Stimulant drugs can cause persistent changes in the brain. Imaging studies show that these changes are most apparent in dopamine transporter (DAT) or receptor availability within the striatum.

    Methods:

    This work focuses on influences of stimulant use on dopaminergic function assessed using nuclear-medicine imaging (PET/SPECT). Included are 39 studies on 655 cocaine, amphetamine, methamphetamine or nicotine users, as well as 690 healthy controls. Metaanalyses were conducted separately for D2/D3 receptors and dopamine transporters of the entire striatum, its subregions caudate and putamen respectively.

    Results:

    Meta-analyses results regarding nicotine did not show significant effects between smokers and nonsmokers. In cocaine users there was a significant decrease in dopamine receptor availability in all regions. The striatal DAT availability was significantly increased in cocaine users. Methamphetamine users showed a significantly decreased dopamine receptor and transporter density in all regions. Significant results also indicate a lower transporter availability in all regions. Amphetamine users showed reduced DAT availability in the striatum, as well as in the sub regions.

    Conclusion:

    This meta-analysis provides evidence that there are ongoing changes in the dopaminergic system associated with the use of stimulants. Especially the results of cocaine, methamphetamine and amphetamine use mainly showed a downregulation. In addition, this meta-analysis is the first to include nicotine. This subset of studies showed evidence for a decreased receptor and DAT availability but no significant results were found in the metaanalyses.

  • Are the effects of methylphenidate uncertain?

  • S. Cortese
  • Journal:
    Irish Journal of Psychological Medicine / Volume 35 / Issue 3 / September 2018
    Published online by Cambridge University Press:
    06 May 2018, pp. 163-167
    Print publication:
    September 2018
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  • Objectives

    A recent systematic review and meta-analysis of randomised controlled trials of methylphenidate (MPH) in children and adolescents by a Cochrane group, led by Storebø, raised concern around the level of evidence supporting the use of this medication for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. This led to several critical responses from a number of ADHD experts.

    Methods

    This paper reviews the conclusions reached from the Storebø meta-analysis by a critical analysis of methodologies used along with drawing on extant literature.

    Results

    The controversy raised by the Cochrane meta-analysis should lead to a balanced reflection on the research priorities and needs for the field.

    Conclusions

    It is hoped the controversy will ultimately lead to improve the quality of the research on the efficacy, effectiveness and tolerability of MPH for ADHD.

  • Cognitive functioning associated with stimulant use in patients with non-affective psychosis, their unaffected siblings and healthy controls

  • F. J. van der Meer, J. H. Meijer, C. J. Meijer, W. van den Brink, E. Velthorst
  • Journal:
    Psychological Medicine / Volume 44 / Issue 9 / July 2014
    Published online by Cambridge University Press:
    22 November 2013, pp. 1901-1911
  • Background

    Little is known about the effect of stimulant use (amphetamines, cocaine, ecstasy) on cognitive functioning in schizophrenia patients. The current study examined (1) whether recency and frequency of stimulant use is associated with cognitive functioning and (2) whether these associations differ between psychotic patients, their unaffected siblings and controls.

    Method

    Participants completed a comprehensive cognitive test battery. Stimulant use was assessed by urinalysis and by the Composite International Diagnostic Interview (CIDI). Using random effects regression models, the main effects of Stimulant Use and the interaction with Diagnostic Status on cognitive functioning were assessed.

    Results

    The interaction term between Stimulant Use and Diagnostic Status was not significant for any of the cognitive outcome variables, indicating similar effects of stimulant use in all three groups. Recent stimulant users showed more errors deficit in verbal learning in comparison to never users (Cohen's d = −0.60, p < 0.005). Lifetime frequent stimulant use was significantly associated with worse immediate and delayed verbal recall, working memory and acquired knowledge (Cohen's d = −0.22 to −0.29, p < 0.005). Lifetime infrequent stimulant use was not associated with significant cognitive alterations in comparison to never use.

    Conclusions

    The presence of cognitive deficits associated with lifetime stimulant use is dependent on the frequency of use, with no observed deficits in infrequent users and modest negative effects in frequent users.

  • Chapter 40 - Neuroimaging of idiopathic REM sleep behavior disorder

  • from Section 5 - Neuroimaging of sleep disorders
  • Edited by Eric Nofzinger, University of Pittsburgh, Pierre Maquet, Université de Liège, Belgium, Michael J. Thorpy
  • Book:
    Neuroimaging of Sleep and Sleep Disorders
    Published online:
    05 March 2013
    Print publication:
    07 March 2013, pp 316-332

  • Summary

    This chapter reviews the neuroimaging findings devoted to the effects of treatment in narcolepsy. These studies involved functional neuroimaging methods such as single photon emission computed tomography (SPECT), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). The majority of them focused on modafinil, with also early reports on amphetamines and methylphenidate. In narcoleptic patients single-dose treatment effects were also studied with fMRI. PET and SPECT were used to investigate brain activity changes induced by a prolonged administration of modafinil in narcoleptic patients. An 18F-fluorodeoxyglucose (18F-FDG) PET study evaluated brain glucose metabolism (CMRglu) during baseline wakefulness in eight patients and eight controls before and after two weeks of treatment with modafinil. Decreased CMRglu was observed in the brainstem, hypothalamus, thalamus, and mesiotemporal areas in narcoleptics compared to controls, both before and after treatment.

  • Chapter 17 - Use of stimulants in operational settings: issues and considerations

  • from Section 4 - Summary and Conclusions
  • Edited by Nancy J. Wesensten
  • Book:
    Sleep Deprivation, Stimulant Medications, and Cognition
    Published online:
    05 September 2012
    Print publication:
    23 August 2012, pp 237-256

  • Summary

    This chapter reviews the evidence concerning the efficacy of psychostimulants as cognitive enhancers in healthy and non-clinical individuals. Cognitive operations are the mental processes whose outcomes affect mental content in one or more areas of cognition. Cognitive functions are typically modulated by non-cognitive factors such as mood, level of energy, motor function, impulsivity, and motivation. Cognitive enhancement is an intervention that improves or augments one or more cognitive domains, such as learning, memory, or attention. Psychostimulant is a behavioral description for drugs that elevate mood, increase motor activity, increase alertness, allay sleep, and increase the brain's metabolic activity. Psychostimulants are a large class of drugs with broadly overlapping neuropharmacological properties, mechanisms of action, and therapeutic effects. The class of psychostimulants most commonly reported for use as cognitive enhancers is that of amphetamines. Amphetamines influence both dopaminergic and noradrenergic systems.

  • Chapter 6 - Ultrasound guidance for epidural anesthesia

  • Edited by Ian McConachie, University of Western Ontario
  • Book:
    Controversies in Obstetric Anesthesia and Analgesia
    Published online:
    05 December 2011
    Print publication:
    17 November 2011, pp 86-99

  • Summary

    The most commonly abused drugs include opioids, amphetamines, marijuana, ketamine and other hallucinogens, caffeine, solvents, tobacco, alcohol, and cocaine. Maternal drug abuse can have significant economic implications and also implications for being involved in criminal activities. Mothers who abuse drugs are 80% more likely to require the involvement of the anesthesiologist for analgesia and anesthesia in labor. Recognition of substance abuse is important due to the potential consequences for fetal death, premature labor and withdrawal symptoms in both the mother and baby. Venous access may be notoriously difficult and there are high prevalences of transmittable viral diseases, such as hepatitis viruses and human immunodeficiency virus (HIV), in populations who self-inject drugs of abuse. Chronic alcohol ingestion, acute intoxication, and withdrawal can all pose a challenge to the anesthesiologist. Gamma-hydroxybutyrate (GHB) has a short half life and the absence of toxic metabolites reduces its detectability.

  • 22 - Community psychiatry and service delivery models

  • from Section 4 - Psychiatry in Specific Settings
  • Edited by Robin M. Murray, King's College London, Kenneth S. Kendler, Virginia Commonwealth University, Peter McGuffin, University of Wales College of Medicine, Simon Wessely, Institute of Psychiatry, London, David J. Castle, University of Melbourne
  • Book:
    Essential Psychiatry
    Published online:
    22 August 2009
    Print publication:
    18 September 2008, pp 498-514

  • Summary

    This chapter describes the major forms of drug use and dependence in developed countries, that is, cannabis, amphetamines, cocaine and heroin. It also presents the patterns of use, problems experienced by users and interventions to assist dependent users. Cannabis is the most widely used illicit drug globally, with around 150 million users, or 3.7% of the world's population aged 15 years and older. Regular cannabis smoking impairs the functioning of the large airways and causes chronic bronchitis. After cannabis, cocaine is one of the most widely used illicit drugs in developed and developing societies. According to the World Health Organization (WHO), amphetamines and methamphetamines are the most widely abused illicit drugs after cannabis, with an estimated 35 million users worldwide. Research in the United States indicates that dependent heroin users who seek treatment or come to attention through the legal system may continue to use heroin for decades.

  • A cohort analysis of illicit psychoactive drug use in Australia 1988-98

  • Paul Williams, Ian McAllister
  • Journal:
    South Pacific Journal of Psychology / Volume 13 / 2001
    Published online by Cambridge University Press:
    05 May 2015, pp. 1-12
    Print publication:
    2001

  • Objective: To examine birth cohort trends in the prevalence, age of initiation and durability of the use of psycho-stimulant and psycho-depressant drugs in Australia between 1988 and 1998.

    Method: Nine synthetic birth cohorts were constructed from a pooled dataset of the three National Drug Strategy Household Surveys (1988, 1993, 1998). The design-effect adjusted weighted lifetime and recent prevalence, age of initiation and durability of use, of three popular psycho-stimulants (amphetamine, cocaine and ecstasy) and three popular psycho-depressants (cannabis, heroin and inhalants) were estimated. Significance tests of difference use chi-square statistics and the sociodemographic predictors of trends were tested using logistic regression techniques.

    Results: Lifetime and recent prevalence and durability of use increased and ages of initiation decreased, with each successive cohort. Psycho-stimulants were predictors for psycho-depressant use and vice versa. Being male, aged under 35 years, Australian born, employed or in fulltime education, and a tobacco smoker were significant predictors of increased risk of using both classes of drugs. Being married or having no post-secondary education qualifications were significant predictors of lower risk of using either class of drugs.

    Conclusions: Younger cohorts are more likely to use both classes of psychoactive drugs, to have commenced using the drugs earlier and to have maintained their drug habits longer, compared to older cohorts. While increased availability is an important factor in the likelihood of exposure to illicit drugs, interventions implemented since the National Drug Strategy began in 1985 do not appear to have reduced the probability that young people will initiate and maintain illicit psychoactive drug use, exposing them to associated health and legal consequences.

  • Behavioral Responses to Amphetamines in Identical Twins

  • John C. Crabbe, Lissy F. Jarvik, Edward H. Liston, Donald J. Jenden
  • Journal:
    Acta geneticae medicae et gemellologiae: twin research / Volume 32 / Issue 2 / April 1983
    Published online by Cambridge University Press:
    01 August 2014, pp. 139-149
    Print publication:
    April 1983
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  • Male, monozygotic twins (six pairs) were repeatedly tested before and after d-amphetamine, l-amphetamine, or placebo administration. Drug effects on cognitive, psychomotor, personality, mood, and pain variables were assessed. Members of a twin pair tended to respond similarly on several tests under placebo conditions, indicating genetic determination of the behavioral variables. In addition, cotwins tended to show similar responses to amphetamine as measured by one test of cognitive function, by several mood and personality variables (hostility, autonomic arousal, friendliness, feelings of tension and loss of control), and tended to have similar plasma levels of both amphetamine isomers. Although shared environmental effects cannot be ruled out, the results are consistent with genetic mediation of a variety of behavioral effects of amphetamines.