The impact of the 2008 economic crisis on substance use patterns in the countries of the European Union

Background: From 2008 on, a severe economic crisis (EC) has characterized the European Union (E.U.). However, changes in substance use behavioral patterns as a result of the economic crisis in Europe, have been poorly reflected upon, and underlying mechanisms remain to be identified; Methods: In this review we explore and systematize the available data on the effect of the 2008 economic crisis on patterns of substance use and related disorders, within the E.U. countries; Results: The results show that effects of the recession need to be differentiated. A number of studies point to reductions in population’s overall substance use. In contrast, an increase in harmful use and negative effects is found within specific subgroups within the society. Risk factors include job-loss and long-term unemployment, and pre-existing vulnerabilities. Finally, our findings point to differences between types of substances in their response on economic crisis periods; Conclusions: the effects of the 2008 economic crisis on substance use patterns within countries of the European Union are two-sided. Next to a reduction in a population’s overall substance use, a number of vulnerable subgroups experience serious negative effects. These groups are in need of specific attention and support, given that there is a real risk that they will continue to suffer negative health effects long after the economic downfall has formally been ended

Anti-amyloid antibody treatments for Alzheimer's disease

Our aim is to review the most recent evidence on novel antibody therapies for Alzheimer's disease directed against amyloid-& beta;. This is a joint statement of the European Association of Neurology and the European Psychiatric Association. After numerous unsuccessful endeavors to create a disease-modifying therapy for Alzheimer's disease, substantial and consistent evidence supporting the clinical effectiveness of monoclonal antibodies aimed at amyloid-& beta;is finally emerging. The latest trials not only achieved their primary objective of slowing the progression of the disease over several months but also demonstrated positive secondary clinical outcomes and a decrease in amyloid-& beta;levels as observed through positron emission tomography scans. Taken as a whole, these findings mark a significant breakthrough by substantiating that reducing amyloid-& beta;yields tangible clinical benefits, beyond mere changes in biomarkers. Concurrently, the regular utilization of the new generation of drugs will determine whether statistical efficacy translates into clinically meaningful improvements. This may well signify the dawning of a new era in the development of drugs for Alzheimer's disease

Addiction, Anhedonia, and Comorbid Mood Disorder. A Narrative Review

Background: Recently, anhedonia has been recognized as an important Research Domain Criterion (RDoC) by the National Institute of Mental Health. Anhedonia is proposed to play an essential role in the pathogenies of both addictive and mood disorders, and possibly their co-occurrence with a single individual. However, up to now, comprehensive information about anhedonia concerning its underlying neurobiological circuitries, the neurocognitive correlates, and their role in addiction, mood disorder, and comorbidity remains scarce.Aim: In this literature review of human studies, we bring together the current state of knowledge with respect to anhedonia in its relationship with disorders in the use of substances (DUS) and the comorbidity with mood disorders.Method: A PubMed search was conducted using the following search terms: (Anhedonia OR Reward Deficiency) AND ((Drug Dependence OR Abuse) OR Alcohol OR Nicotine OR Addiction OR Gambling OR (Internet Gaming)). Thirty-two articles were included in the review.Results: Anhedonia is associated with substance use disorders, and their severity is especially prominent in DUS with comorbid depression. Anhedonia may be both a trait and a state dimension in its relation to DUS and tends to impact DUS treatment outcome negatively

How We Lost 90% of Participants on a Bad Bet:Results from a Pilot Randomized Controlled Trial on Cognitive Bias Modification in Problem Gamblers

Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants’ motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed.</p

Validation of the AUDIT and AUDIT-C for hazardous drinking in community-dwelling older adults

Background: One of the best-known tools in screening for hazardous drinking is the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated form, the AUDIT-C. The aim of the present study is to determine the cut-offs of both instruments in identifying hazardous drinking in older adults. Method: A sample of 1577 older adults completed a questionnaire regarding alcohol behavior. Hazardous drinking was defined as drinking >10 units/week. Receiver operating characteristics (ROC) curves of AUDIT and AUDIT-C were calculated and cut-off scores were derived. Results: Respectively 27.3% and 12.3% of older men and women drank >10 units/week. For the AUDIT the best trade-off between sensitivity and specificity was using a cut-off of ≥5 for men and ≥4 for women, which yielded in men sensitivity and specificity values respectively of 80.7% and 81.3% and in women 100% and 71.7%, respectively. We found the AUDIT-C to perform well with an optimal cut-off of ≥5 for men and ≥4 for women, which generated in men sensitivity and specificity values respectively of 76.5% and 85.3% and in women 100% and 74.1%, respectively. Conclusion: The AUDIT-C is accurate and sufficient in screening for hazardous drinking in community-dwelling older adults if the cut-offs are tailored by gender

Developing the EPA guidance of pharmacological treatment of schizophrenia – results of a Delphi process

Abstract Background The development of guidelines is time-consuming and cost-intensive. The heterogeneity of clinical practice, evidence, and patients’ needs is an issue across Europe. An European core guidance for a specific psychiatric disorder may help to overcome this issue. Here, we present a progress report on the European Psychiatric Association (EPA) proof-of-concept approach to develop a European consensus guidance on the pharmacological treatment of schizophrenia. Methods All national psychiatric associations in Europe were contacted to provide their schizophrenia guidelines. Six guidelines were rated by three experts, experienced in the development of national and international guidelines, from three different countries (Italy, Hungary, and Germany), and the German schizophrenia guideline published in 2019 was found to have the highest quality. For this proof-of-concept approach, 45 recommendations on the pharmacological treatment of schizophrenia from the German guideline were evaluated in a two-step Delphi process to determine their acceptability throughout the European continent. Results 44 experts participated in the first round and 40 experts in the second round of the Delphi process. Agreement among the involved experts was reached for 75% of the presented recommendations from the German schizophrenia guidelines. 11 out of 45 recommendations (24.4%) did not reach this level of agreement. Conclusions This progress report highlights the possibility of developing a pan-European core guidance on the pharmacological treatment of schizophrenia by adapting national guidelines and reconciling their recommendations. However, several barriers in this adaptation process, such as non-agreement in recommendations with strong scientific evidence in the reconciling process, were identified and must be considered when developing the final guidance

Improving mental health care in depression: A call for action

Depressive disorders have one of the highest disability-adjusted life years (DALYs) of all medical conditions, which led the European Psychiatric Association to propose a policy paper, pinpointing their unmet health care and research needs. The first part focuses on what can be currently done to improve the care of patients with depression, and then discuss future trends for research and healthcare. Through the narration of clinical cases, the different points are illustrated. The necessary political framework is formulated, to implement such changes to fundamentally improve psychiatric care. The group of European Psychiatrist Association (EPA) experts insist on the need for (1) increased awareness of mental illness in primary care settings, (2) the development of novel (biological) markers, (3) the rapid implementation of machine learning (supporting diagnostics, prognostics, and therapeutics), (4) the generalized use of electronic devices and apps into everyday treatment, (5) the development of the new generation of treatment options, such as plasticity-promoting agents, and (6) the importance of comprehensive recovery approach. At a political level, the group also proposed four priorities, the need to (1) increase the use of open science, (2) implement reasonable data protection laws, (3) establish ethical electronic health records, and (4) enable better healthcare research and saving resources

Disadvantageous decision-making as a predictor of drop-out among cocaine-dependent individuals in long-term residential treatment

Background: The treatment of cocaine-dependent individuals (CDI) is substantially challenged by high drop-out rates, raising questions regarding contributing factors. Recently, a number of studies have highlighted the potential of greater focus on the clinical significance of neurocognitive impairments in treatment-seeking cocaine users. In the present study, we hypothesized that disadvantageous decision-making would be one such factor placing CDI at greater risk for treatment drop-out. Methods: In order to explore this hypothesis, the present study contrasted baseline performance (at treatment onset) on two validated tasks of decision-making, the Iowa Gambling Task (IGT) and the Cambridge GambleTask (CGT) in CDI who completed treatment in a residentialTherapeutic Community (TC) (N D66) and those who dropped out ofTC prematurely (N D84). Results: Compared to treatment completers, CDI who dropped out of TC prematurely did not establish a consistent and advantageous response pattern as the IGT progressed and exhibited a poorer ability to choose the most likely outcome on the CGT. There were no group differences in betting behavior. Conclusion: Our findings suggest that neurocognitive rehabilitation of disadvantageous decision-making may have clinical benefits in CDI admitted to long-term residential treatment programs

Alcohol use disorder relapse factors:an exploratory investigation of craving, alcohol dependence severity, and meaning in life

For decades predictors of alcohol use disorder (AUD) relapse have been studied, and around 40 different clinical and demographic relapse determinants have been identified. This paper aims to investigate the relationship of two of these AUD relapse factors, namely craving and meaning in life (MiL). We hypothesized that greater meaning in life would be associated with lower cravings and lower relapse rates. An AUD subsample of 81 patients within a clinical population that participated in ongoing exploratory research on religious/spiritual factors related to substance use disorders was followed up to 1 year. Craving (as measured with the Penn Alcohol Craving Scale) and meaning in life (as measured with the Meaning in Life Questionnaire- presence subscale) measures were assessed at baseline and relapse was assessed at 6- and 12-month follow up. Main effects and the interaction between craving and meaning in life in predicting alcohol relapse (with relapse defined as ‘any alcohol use’ and ≥ 3 consecutive days of drinking) were calculated/subject of analyses. We also investigated the relationship between relapse and alcohol dependence severity as measured with the Leeds Dependence Questionnaire. Baseline craving and dependence severity were related to relapse, but there were no associations between meaning in life and levels of craving or alcohol relapse. Our findings suggest a need for additional research on characterizing the Meaning in Life concept