Psychopathological comorbidity in cocaine users in outpatient treatment

Cocaine addiction is a growing health problem and among its complications highlights the high prevalence of mental disorders co-occurring with abuse and dependence. This psychopathological comorbidity varies according to the time of consumption and the age of the patient. Early detection of psychopathological disorders associated with drug consumption is necessary to optimize health care and to improve the prognosis. The main aim of the present study was to estimate the prevalence and characteristics of psychopathological comorbidity in a population of subjects seeking outpatient treatment for cocaine use. We recruited 110 subjects using cocaine by nasal insufflations evaluated with the PRISM (Psychiatric Research Interview for Substance and Mental Disorders), a semi-structured diagnostic interview that differentiates primary mental disorders from those induced by the drug. This population presented 86.4% male and had a mean age of 36.5. They displayed a pathological use of cocaine of 7 years and the presence of psychopathology was associated with a higher number of DSM-IV-TR (Diagnostic and Statistical Manual of Mental DisordersIV-TR) criteria for substance dependence. The lifetime prevalence of some psychopathological comorbidity was 61.8%, highlighting mood disorders (34.5%), followed by anxiety disorders (22.7%) and psychotic disorders (15.5%). About 20% showed antisocial personality disorder and 21% borderline personality disorder. From among mood and psychotic disorders, the induced disorders were more frequent, while the primary disorders were more prevalent in anxiety.La adicción a cocaína es un problema de salud creciente y entre sus complicaciones destaca la elevada prevalencia de comorbilidad psicopatológica. La detección temprana de los trastornos psicopatológicos asociados al consumo de cocaína es necesaria para optimizar la asistencia sanitaria y mejorar el pronóstico. El objetivo principal de este estudio es estimar la prevalencia y características de la comorbilidad psicopatológica en una población de sujetos que solicitan atención por uso de cocaína en tratamiento ambulatorio. Se reclutaron 110 consumidores de cocaína por vía nasal evaluados con la entrevista diagnóstica semiestructurada PRISM (entrevista de investigación psiquiátrica para trastornos mentales y por sustancias), que diferencia los trastornos mentales primarios de los inducidos por la droga. Esta población tuvo un 86,4% de hombres y una edad media de 36,5 años. Presentó un uso patológico de cocaína medio de 7 años, y la presencia de psicopatología se asoció a un mayor número de criterios de dependencia de cocaína según el manual DSM-IVTR (manual diagnóstico y estadístico de los trastornos mentales, 4ª edición revisada). La prevalencia de comorbilidad psicopatológica encontrada a lo largo de la vida fue del 61,8%, destacando los trastornos del estado de ánimo (34,5%), seguidos de los trastornos de ansiedad (22,7%) y de los trastornos psicóticos (15,5%). Un 20% presentó trastorno de personalidad antisocial y un 21% trastorno límite de la personalidad. Entre los trastornos del estado de ánimo y psicóticos fueron más frecuentes los inducidos, mientras que en los trastornos de ansiedad los primarios fueron más prevalentes

Differences in the Rates of Drug Polyconsumption and Psychiatric Comorbidity among Patients with Cocaine Use Disorders According to the Mental Health Service.

Cocaine continues to be a worldwide public health concern in Europe. To improve prognosis and intervention, it is necessary to understand the characteristics of the patients who depend on the services where they receive care. The objective is to analyze the differences among patients who use cocaine and between ambulatory and residential resources to better adapt treatment. This is a descriptive, observational study of two populations of cocaine users in treatment: the ambulatory therapeutic community (ATC) and the therapeutic community (TC). The PRISM diagnostic interview was used for both groups. An analysis of both populations indicates a high prevalence of cocaine, heroin, cannabis, sedative, psychostimulant, and hallucinogen use disorders in the TC population compared to the ATC. In alcohol use disorder, differences between both mental health services were not observed. The degree of severity of cocaine use disorders (CUD) is greater in the TC population. The prevalence of psychiatric comorbidity is not statistically significant between the two populations, except for primary psychotic disorders, which are more prevalent in the TC population. This difference in the prevalence of psychotic disorders may be related to the high prevalence of cannabis use disorders in TC patients. Differences in the prevalence of substance use disorders, severity of CUD, and psychiatric comorbidity may limit the efficiency of mental health services involved in substance use disorder therapeutics. These results suggest the need for careful and extensive phenotyping of patients to improve intervention and prognosis in a clinical resource-dependent manner

Serotonin is the main tryptophan metabolite associated with psychiatric comorbidity in abstinent cocaine-addicted patients.

The lack of effective treatments and a high rate of relapse in cocaine addiction constitute a major health problem. The present study was conducted to examine the expression of tryptophan-derived metabolites in the context of cocaine addiction and psychiatric comorbidity, which is common in addicted subjects. Abstinent patients with cocaine use disorder (CUD) and control subjects were recruited for a cross-sectional study. Participants were assessed with a semi-structured diagnostic interview (PRISM) based on DSM-IV-TR for substance and mental disorders. Plasma concentrations of tryptophan metabolites and their association with relevant CUD-related variables and psychiatric comorbidity were explored. We observed decreased plasma kynurenic acid concentrations in the cocaine group, however no associations between CUD-related variables and tryptophan-derived metabolites were found. In contrast, 5-HT concentrations were increased in CUD-patients and the diagnosis of different psychiatric disorders in the cocaine group was related to higher plasma 5-HT concentrations compared with non-comorbid patients. Therefore, while changes in plasma kynurenic acid concentrations appear to be directly associated with lifetime CUD, changes in 5-HT concentrations are associated with psychiatric comorbidity. These results emphasize the need to find potential biomarkers for a better stratification of cocaine-addicted patients in order to develop therapeutic approaches to prevent cocaine relapse

Plasma Concentrations of BDNF and IGF-1 in Abstinent Cocaine Users with High Prevalence of Substance Use Disorders: Relationship to Psychiatric Comorbidity

Recent studies have identified biomarkers related to the severity and pathogenesis of cocaine addiction and common comorbid psychiatric disorders. Monitoring these plasma mediators may improve the stratification of cocaine users seeking treatment. Because the neurotrophic factors are involved in neural plasticity, neurogenesis and neuronal survival, we have determined plasma concentrations of brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1) and IGF-1 binding protein 3 (IGFBP-3) in a cross-sectional study with abstinent cocaine users who sought outpatient treatment for cocaine (n = 100) and age/body mass matched controls (n = 85). Participants were assessed with the diagnostic interview 'Psychiatric Research Interview for Substance and Mental Disorders'. Plasma concentrations of these peptides were not different in cocaine users and controls. They were not associated with length of abstinence, duration of cocaine use or cocaine symptom severity. The pathological use of cocaine did not influence the association of IGF-1 with age observed in healthy subjects, but the correlation between IGF-1 and IGFBP-3 was not significantly detected. Correlation analyses were performed between these peptides and other molecules sensitive to addiction: BDNF concentrations were not associated with inflammatory mediators, lipid derivatives or IGF-1 in cocaine users, but correlated with chemokines (fractalkine/CX3CL1 and SDF-1/CXCL12) and N-acyl-ethanolamines (N-palmitoyl-, N-oleoyl-, N-arachidonoyl-, N-linoleoyl- and N-dihomo-γ-linolenoyl-ethanolamine) in controls; IGF-1 concentrations only showed association with IGFBP-3 concentrations in controls; and IGFBP-3 was only correlated with N-stearoyl-ethanolamine concentrations in cocaine users. Multiple substance use disorders and life-time comorbid psychopathologies were common in abstinent cocaine users. Interestingly, plasma BDNF concentrations were exclusively found to be decreased in users diagnosed with both primary and cocaine-induced disorders for mood and anxiety disorders. In summary, BDNF, IGF-1 and IGFBP-3 were not affected by a history of pathological use of cocaine supported by the absence of associations with other molecules sensitive to cocaine addiction. However, BDNF was affected by comorbid mood disorders. Further research is necessary to elucidate the role of BDNF and IGF-1 in the transition to cocaine addiction and associated psychiatric comorbidity.The present study has been supported byInstituto de Salud Carlos III (ISC-III), Red deTrastornos Adictivos UE-FEDER 2012 (RD12/0028);Ministerio de Economía y Competitividad (PI13/02261); Plan Nacional sobre Drogas 049/2009 and049/2013; Consejería de Economía, Innovación yCiencia, Junta de Andalucía UE-FEDER (CTS-433);Consejería de Salud y Bienestar Social, Junta Andalucía (PI0228-2013 and PI0823-2012);Departament d’Innovació, Universitats i Empresa,Generalitat de Catalunya (2014-SGR-680). JS, ASand FJP hold a“Miguel Servet”research contractfrom ISC-III (CP12/03109, CP14/00173 and CP14/00212, respectively). PR-S holds a“Río Hortega”research contract from ISC-III (CM13/0115). EC-Oholds a“Sara Borrell”research contract from ISC-III(CD12/00455). The funders had no role in studydesign, data collection and analysis, decision topublish, or preparation of the manuscript

Plasma Concentrations of BDNF and IGF-1 in Abstinent Cocaine Users with High Prevalence of Substance Use Disorders: Relationship to Psychiatric Comorbidity

Recent studies have identified biomarkers related to the severity and pathogenesis of cocaine addiction and common comorbid psychiatric disorders. Monitoring these plasma mediators may improve the stratification of cocaine users seeking treatment. Because the neurotrophic factors are involved in neural plasticity, neurogenesis and neuronal survival, we have determined plasma concentrations of brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1) and IGF-1 binding protein 3 (IGFBP-3) in a cross-sectional study with abstinent cocaine users who sought outpatient treatment for cocaine (n = 100) and age/body mass matched controls (n = 85). Participants were assessed with the diagnostic interview 'Psychiatric Research Interview for Substance and Mental Disorders'. Plasma concentrations of these peptides were not different in cocaine users and controls. They were not associated with length of abstinence, duration of cocaine use or cocaine symptom severity. The pathological use of cocaine did not influence the association of IGF-1 with age observed in healthy subjects, but the correlation between IGF-1 and IGFBP-3 was not significantly detected. Correlation analyses were performed between these peptides and other molecules sensitive to addiction: BDNF concentrations were not associated with inflammatory mediators, lipid derivatives or IGF-1 in cocaine users, but correlated with chemokines (fractalkine/CX3CL1 and SDF-1/CXCL12) and N-acyl-ethanolamines (N-palmitoyl-, N-oleoyl-, N-arachidonoyl-, N-linoleoyl- and N-dihomo-γ-linolenoyl-ethanolamine) in controls; IGF-1 concentrations only showed association with IGFBP-3 concentrations in controls; and IGFBP-3 was only correlated with N-stearoyl-ethanolamine concentrations in cocaine users. Multiple substance use disorders and life-time comorbid psychopathologies were common in abstinent cocaine users. Interestingly, plasma BDNF concentrations were exclusively found to be decreased in users diagnosed with both primary and cocaine-induced disorders for mood and anxiety disorders. In summary, BDNF, IGF-1 and IGFBP-3 were not affected by a history of pathological use of cocaine supported by the absence of associations with other molecules sensitive to cocaine addiction. However, BDNF was affected by comorbid mood disorders. Further research is necessary to elucidate the role of BDNF and IGF-1 in the transition to cocaine addiction and associated psychiatric comorbidity.The present study has been supported byInstituto de Salud Carlos III (ISC-III), Red deTrastornos Adictivos UE-FEDER 2012 (RD12/0028);Ministerio de Economía y Competitividad (PI13/02261); Plan Nacional sobre Drogas 049/2009 and049/2013; Consejería de Economía, Innovación yCiencia, Junta de Andalucía UE-FEDER (CTS-433);Consejería de Salud y Bienestar Social, Junta Andalucía (PI0228-2013 and PI0823-2012);Departament d’Innovació, Universitats i Empresa,Generalitat de Catalunya (2014-SGR-680). JS, ASand FJP hold a“Miguel Servet”research contractfrom ISC-III (CP12/03109, CP14/00173 and CP14/00212, respectively). PR-S holds a“Río Hortega”research contract from ISC-III (CM13/0115). EC-Oholds a“Sara Borrell”research contract from ISC-III(CD12/00455). The funders had no role in studydesign, data collection and analysis, decision topublish, or preparation of the manuscript

Correlation analyses between plasma concentrations of BDNF, IGF-1 and IGFBP-3 and age in abstinent cocaine users (black circles) and control subjects (white circles).

<p><b>A)</b> BDNF (pg/mL); <b>B)</b> IGF-1 (ng/mL); and <b>C)</b> IGFBP-3 (μg/mL). Dots are individual values. (r) Pearson´s correlation coefficient; (rho) Spearman´s correlation coefficient; (p) p-value for statistical significance.</p

Plasma concentrations of BDNF, IGF-1 and IGFBP-3 in abstinent cocaine users grouped by diagnosis of common psychiatric disorders in substance users.

<p>Plasma concentrations of BDNF, IGF-1 and IGFBP-3 in abstinent cocaine users grouped by diagnosis of common psychiatric disorders in substance users.</p

Plasma concentrations of BDNF, IGF-1 and IGFBP-3 according to sex in abstinent cocaine users and control subjects.

<p><b>A)</b> BDNF (pg/mL); <b>B)</b> IGF-1 (ng/mL); and <b>C)</b> IGFBP-3 (μg/mL). Bars are the means and SD. Data were analyzed by two-way analyses (cocaine use [cocaine group and control group] and sex [women and men]).</p