Besteht ein Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten? Eine Diskussion konzeptioneller Aspekte am Beispiel HIV-infizierter Männer mit homosexuellem Verhalten

Zusammenfassung: Besteht ein Zusammenhang zwischen Alkoholkonsum und sexuellen Risikokontakten? Führt Alkohol zu Risikokontakten? Es lassen sich zahlreiche Studien finden, die diese Frage bejaht haben. Ebenso lassen sich Studien finden, die mit modifizierten Forschungskonzepten diese Befunde nicht bestätigen konnten. Unter Verwendung von ereignisunspezifischen und situationsspezifischen Konzepten wurden diese Fragen bei einer Stichprobe von 64 HIV-infizierten Männern mit homosexuellem Verhalten untersucht. Einen signifikanten Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten konnten wir mit dem ereignisun-spezifischen Ansatz nicht feststellen. Auch Personen, die sexuelle Kontakte unter Alkoholeinfluss eingegangen waren (situationsspezifisches Konzept), gingen nicht überdurchschnittlich häufiger Risikokontakte ein. Die Personen hingegen, die unter Alkoholkonsum riskante sexuelle Praktiken eingegangen waren, erreichen sowohl hinsichtlich des Alkoholkonsums als auch des allgemein erfassten Schutz- und Risikoverhaltens lediglich Durchschnittswerte. Erst konkrete Zusatzfragen machen es möglich, sie als Personen mit Risikoverhalten zu identifizieren. Für Untersuchungen zum sexuellen Schutz- und Risikoverhalten erscheint die Kombination sich ergänzender Forschungskonzepte zweckmässi

García, Xavier (ed.) (2015). Joan Oliver-Joaquim Molas: Diàleg epistolar il·lustrat (1959-1982). Lleida: Pagès Editors, pp. 186

<p><i>Objectives</i>: Attention-deficit/hyperactivity disorder (ADHD) has been associated with spatial working memory as well as frontostriatal core deficits. However, it is still unclear how the link between these frontostriatal deficits and working memory function in ADHD differs in children and adults. This study examined spatial working memory in adults and children with ADHD, focussing on identifying regions demonstrating age-invariant or age-dependent abnormalities. <i>Methods</i>: We used functional magnetic resonance imaging to examine a group of 26 children and 35 adults to study load manipulated spatial working memory in patients and controls. <i>Results</i>: In comparison to healthy controls, patients demonstrated reduced positive parietal and frontostriatal load effects, i.e., less increase in brain activity from low to high load, despite similar task performance. In addition, younger patients showed negative load effects, i.e., a decrease in brain activity from low to high load, in medial prefrontal regions. Load effect differences between ADHD and controls that differed between age groups were found predominantly in prefrontal regions. Age-invariant load effect differences occurred predominantly in frontostriatal regions. <i>Conclusions</i>: The age-dependent deviations support the role of prefrontal maturation and compensation in ADHD, while the age-invariant alterations observed in frontostriatal regions provide further evidence that these regions reflect a core pathophysiology in ADHD.</p

Besteht ein Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten? Eine Diskussion konzeptioneller Aspekte am Beispiel HIV-infizierter Männer mit homosexuellem Verhalten

Besteht ein Zusammenhang zwischen Alkoholkonsum und sexuellen Risikokontakten? Führt Alkohol zu Risikokontakten? Es lassen sich zahlreiche Studien finden, die diese Frage bejaht haben. Ebenso lassen sich Studien finden, die mit modifizierten Forschungskonzepten diese Befunde nicht bestätigen konnten. Unter Verwendung von ereignisunspezifischen und situationsspezifischen Konzepten wurden diese Fragen bei einer Stichprobe von 64 HIV-infizierten Männern mit homosexuellem Verhalten untersucht. Einen signifikanten Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten konnten wir mit dem ereignisun-spezifischen Ansatz nicht feststellen. Auch Personen, die sexuelle Kontakte unter Alkoholeinfluss eingegangen waren (situationsspezifisches Konzept), gingen nicht überdurchschnittlich häufiger Risikokontakte ein. Die Personen hingegen, die unter Alkoholkonsum riskante sexuelle Praktiken eingegangen waren, erreichen sowohl hinsichtlich des Alkoholkonsums als auch des allgemein erfassten Schutz- und Risikoverhaltens lediglich Durchschnittswerte. Erst konkrete Zusatzfragen machen es möglich, sie als Personen mit Risikoverhalten zu identifizieren. Für Untersuchungen zum sexuellen Schutz- und Risikoverhalten erscheint die Kombination sich ergänzender Forschungskonzepte zweckmässi

Gibt es Prädiktoren für sexuelles Risikoverhalten bei HIV-Infizierten?

The influence of four coping strategies ("rumination," "search for affiliation," "threat minimization," and "search for information"), four social network dimensions ("affectively positive," "affectively negative," "accepting confidants," and "liking confidants") and sociodemographics on the sexual risk behavior of HIV-infected persons were analyzed in sexual encounters with steady and casual partners. The analysis examines bi- and multivariately the predictors for sexual risk behavior. The study population consisted of 103 asymptomatic HIV-infected persons (80 men, 23 women, mean age 34 years, range 21-69 years) who participated in our prospective study and reported their sexual contacts during the previous 6 months. In sexual encounters with steady partners, the risk of unprotected behavior increased with the frequency of sexual contact. In these encounters, coping strategies and social network had no influence on sexual risk behavior. In sexual contacts with casual partners, the number of contacts with these partners was also of importance. The coping strategy "rumination" correlates significantly with enhanced risk behavior. In sexual contacts with casual partners, there was no correlation between sexual risk behavior and the three other coping strategies or social network. In multivariate analysis, the number of sexual contacts was the only significant predictor for sexual risk behavior with steady partners as well as casual ones. As sexual activity with HIV-infected persons is not absolutely safe, further prevention campaigns have to focus more on the motivation for safe sex, its situational aspects, and partners' responsibility

Methadone maintenance treatment and St. John's Wort - a case report.

St. John's wort, a popular over-the-counter drug for treatment of depression, might reduce concentrations of drugs such as cyclosporin and indinavir and lead to drug resistance and treatment failure. No studies as yet have examined its influence on methadone plasma levels. The trough methadone plasma levels were measured in four patients (2 males, median age: 31 years; range 19 - 40 years) in methadone maintenance treatment just before the introduction of St. John's wort (900 mg/d) and after a median period of 31-day treatment (range 14 - 47). The study was proposed to addict patients about to start an antidepressant therapy. Introduction of St. John's wort resulted in a strong reduction of (R,S)-methadone concentration-to-dose ratios in the four median patients included, with a median decrease to 47 % of the original concentration (range: 19 % - 60 % of the original concentration). Two patients reported symptoms that suggested a withdrawal syndrome. Thus, prescription of St. John's wort might decrease methadone blood levels and induce withdrawal symptoms which, if not correctly identified and handled (by changing the antidepressant or by increasing the methadone dose), might cause unnecessary discomfort to the patient, lead to resumption of illicit drug uses, or be a risk factor for discontinuation of the methadone or antidepressant treatment

Adult attention-deficit/hyperactivity disorder and its association with substance use and substance use disorders in young men.

Functional and mental health impairments that adults with attention-deficit/hyperactivity disorder (ADHD) experience may be exacerbated by regular substance use and co-morbidity with substance use disorders (SUD). This may be especially true during young adulthood, which represents a critical stage of life associated with increased substance use and associated problems. However, previous studies investigating the association between ADHD and substance use and SUD have demonstrated inconsistent results, probably due to methodological limitations (e.g., small and non-representative samples). Thus, the relationship of ADHD with substance use and related disorders remains unclear. The aim of the present study was to examine the association between ADHD and both the use of licit and illicit substances and the presence of SUD in a large, representative sample of young men. The sample included 5677 Swiss men (mean age 20 ± 1.23 years) who participated in the Cohort Study on Substance Use Risk Factors (C-SURF). ADHD was assessed using the adult ADHD Self Report Screener (ASRS). The association between ADHD and substance use and SUD was assessed for alcohol, nicotine, cannabis and other illicit drugs, while controlling for socio-demographic variables and co-morbid psychiatric disorders (i.e., major depression (MD) and anti-social personality disorder (ASPD)). Men with ADHD were more likely to report having used nicotine, cannabis and other illicit drugs at some time in their life, but not alcohol. ADHD was positively associated with early initiation of alcohol, nicotine and cannabis use, the risky use of these substances, and the presence of alcohol use disorders, and nicotine and cannabis dependence. Additionally, our analyses revealed that these patterns are also highly associated with ASPD. After adjusting for this disorder, the association between ADHD and licit and illicit substance use and the presence of SUDs was reduced, but remained significant. Our findings suggest that adult ADHD is significantly associated with a propensity to experiment with licit and illicit substances, especially at earlier ages, to exhibit risky substance use patterns, and to subsequently develop SUDs. Preventive strategies that include early intervention and addressing co-morbidity with ASPD may be crucial to reducing substance use and the development of pathological substance use patterns in young men affected by ADHD and, thus, helping to prevent further illness burden later in life

Differential diagnosis, comorbidity, and treatment of attention-deficit/hyperactivity disorder in relation to bipolar disorder or borderline personality disorder in adults

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) in adults can resemble, and often co-occurs with, bipolar disorder (BD) and borderline personality disorder (BPD). This can lead to mistaken diagnoses and ineffective treatment, resulting in potentially serious adverse consequences. All three conditions can substantially impair well-being and functioning, while BD and BPD are associated with suicidality. OBJECTIVES: To update clinicians on the overlap and differences in the symptomatology of ADHD versus BD and BPD in adults; differential diagnosis of ADHD from BD and BPD in adults; and diagnosis and treatment of adults with comorbid ADHD-BD or ADHD-BPD. METHODS: We searched four databases, referred to the new Diagnostic and Statistical Manual of Mental Disorders, 5th edition, used other relevant literature, and referred to our own clinical experience. RESULTS: ADHD coexists in ∼20% of adults with BD or BPD. BD is episodic, with periods of normal mood although not necessarily function. In patients with comorbid ADHD-BD, ADHD symptoms are apparent between BD episodes. BPD and ADHD are associated with chronic trait-like symptoms and impairments. Overlapping symptoms of BPD and ADHD include impulsivity and emotional dysregulation. Symptoms of BPD but not ADHD include frantically avoiding real/imagined abandonment, suicidal behavior, self-harm, chronic feelings of emptiness, and stress-related paranoia/severe dissociation. Consensus expert opinion recommends that BD episodes should be treated first in patients with comorbid ADHD, and these patients may need treatment in stages (e.g. mood stabilizer[s], then a stimulant/atomoxetine). Data is scarce and mixed about whether stimulants or atomoxetine exacerbate mania in comorbid ADHD-BD. BPD is primarily treated with psychotherapy. Principles of dialectical behavioral treatment for BPD may successfully treat ADHD in adults, as an adjunct to medication. No fully evidence-based pharmacotherapy exists for core BPD symptoms, although some medications may be effective for individual symptom domains, e.g. impulsivity (shared by ADHD and BPD). In our experience, treatment of ADHD should be considered when treating comorbid personality disorders. CONCLUSIONS: It is important to accurately diagnose ADHD, BD, and BPD to ensure correct targeting of treatments and improvements in patient outcomes. However, there is a shortage of data about treatment of adults with ADHD and comorbid BD or BPD