Gender Differences in Cognitive and Personality Functioning in Patients With Substance Use Disorder

Objectives: Substance abuse is associated with impairments in cognition and many serious physical and behavioral consequences both in men and women. Gender differences, however, are not clear. The aim of this study was to examine gender differences in specific neuropsychological measures and personality variables in a sample of single and polysubstance patients.Methods: A total of 164 hospitalized patients—97 men and 67 women—underwent neuropsychological tests of verbal capacity, attention, speed of processing, perceptual reasoning, memory and learning, executive functioning, and inhibitory capacity. Personality was measured using the Minnesota Multiphasic Personality Inventory. Associations between neuropsychological measures, personality variables, and gender differences were studied using multiway analysis of covariance controlled for regular substance use in years, onset age of regular substance use, polysubstance use, and education level.Results: After adjustment, all the differences between men and women disappeared in the neuropsychological tests. Men reported higher values of somatisation and emotions of depression and anxiety than women. Men were also more suspicious and elicited more disturbed thinking than women.Conclusions: Contrary to previous studies, women are not more vulnerable to the effects of substance use compared with men. Notably, men are more vulnerable to negative emotions than women.</p

Neuropsychological performance in patients with substance use disorder with and without mood disorders

Background: Mood disorders commonly co-occur in patients with substance use disorders (SUD). This combination may increase the risk of pathological effects and impair cognitive functioning. Aim: The aim of the study was to examine the effects of mood and substance use disorders on specific neuropsychological measures. Methods: The participants comprised 164 hospitalised patients, 88 with (SUD + MD) and 76 (SUD-MD) without mood disorders, ranging in age from 19 to 65 years. Their diagnostic assessment was based on a psychiatric interview (ICD-10). Neuropsychological tests were carried out after a minimum of one month of abstinence. Results: Processing speed (p = 0.029), and perceptual reasoning (p = 0.039) were more impaired in the SUD + MD group than in the SUD-MD group. An Analysis of covariance (ANCOVA) controlled for age, education level, learning difficulties and polysubstance use revealed that the groups were most powerfully separated by the Digit Symbol test and the Block Design test. Conclusions: Patients with substance abuse and mood disorders seem to have more deficits in speed processing and perceptual reasoning than substance abuse patients without mood disorders. These processing speed difficulties and perceptual problems may impact prognosis and treatment. The Digit Symbol test and the Block Design test are a fast and sensitive ways to examine treatment effectiveness and monitor treatment progress.</p

Onset age of substance use and neuropsychological performance in hospital patients

Objective: Several studies have found neurocognitive deficits in adolescents following substance abuse. Predisposing risk factors may further impact vulnerability to neurocognitive deficits. Little is known about the cognitive performance of adult onset substance users compared to earlier onset users. This study aims to explore differencesin neuropsychological functioning between early (EOAs) and late onset substance abusers (LOAs) when the effects of confounding factors are controlled.Method: Data for this cross-sectional study was collected from hospital patients. A total of 164 patients with substance use disorder (SUD) aged 19 to 65, 76 with single-drug diagnosis and 88 with multidrug diagnosis, underwent neuropsychological tests for verbal capacity, attention, speed of processing, perceptual reasoning, memory and learning, executive functioning, and inhibitory capacity. Associations between regular onset age and neuropsychological measures were analysed using in multi-way ANCOVA, and the effect of age, multiple substance abuse, education level and learning difficulties were controlled.Results: Compared with LOAs, EOAs had weaker performance in the Digit Symbol test for mono-substance users. Meanwhile, compared with EOAs, LOAs had weaker performance in the Delayed Visual Memory test and the Raven test for mono-substance users, and the Block Design test for poly-substance users. From the confounding factors, early onset age of substance use is heightened among individuals with learning disabilities.Conclusions: Onset age of substance use is related to the deterioration of performance in neuropsychological tests. Premorbid poor learning and inhibitory capacity may be important predisposing risk factors of SUD. Conversely, high level of education may be a protective factor for cognitive performance in patients with SUD

Neuropsychological and personality correlates of substance use disorder

Previous studies show contradictory results concerning associations with age of onset of substance use, differences between genders, and comorbid substance use in patients with mood disorders on neuropsychological performance. This dissertation aims to investigate the cognitive functions, mood, and personality of hospital patients after a month of sobriety and identify psychological test methods to monitor their rehabilitation progress. The study sample consisted of patients at Järvenpää Addiction Hospital between 2005 and 2012 (N = 164). The neuropsychological tests of attention, executive function, verbal and visual reasoning, and memory were studied. The neuropsychological tests used in this study were included to the neuropsychological test battery used in clinical assessments. Personality variables were measured using the subscales of the Minnesota Multiphasic Personality Inventory (MMPI). The average age of onset of regular substance use was 14.5 (2.0) years in earlyonset abusers (EOAs) and 29.2 (9.8) years in late-onset abusers (LOAs). EOAs had greater psychomotor slowness than LOAs. LOAs had more impaired visual performance compared with EOAs. The results align with previous studies on the development of the brain and cognitive functions. Higher level of education served as a protective factor that postpones the onset of substance use to a later age. Notably, learning difficulties were more common among EOAs. After adjustment, all the differences between men and women disappeared in the neuropsychological tests. Although both men and women expressed strong negative emotions, the former were more depressed than the latter. Strong negative emotions can predispose individuals to substance use, but they can also be exacerbated by substance use. The results revealed that co-occurring diagnoses of mood disorder and substance use are associated with greater psychomotor retardation and decreased visuospatial function compared with a lone diagnosis of substance abuse disorder.Neuropsykologisten toimintojen korrelaatit päihdehäiriöissä Aiemmissa tutkimuksissa on ilmennyt ristiriitaisia tuloksia, jotka koskevat neuropsykologista suoriutumista ja päihteiden käytön alkamisiän vaikutusta, miesten ja naisten välisiä eroja, sekä samanaikaista mielialahäiriötä ja päihdehäiriötä. Tämän väitöskirjan tavoitteena oli tutkia sairaalapotilaiden kognitiivisia toimintoja ja mielialaa kuukauden raittiuden ja päihdekuntoutuksen jälkeen. Tavoitteena oli löytää kuntoutumisen seurantaan psykologisia testimenetelmiä. Tutkimuksen kohteena oli otos Järvenpään sosiaalisairaalan potilaita, jotka tulivat sairaalaan kuntoutukseen ja työkyvyn arviointiin vuosina 2005–2012 (N = 164). Neuropsykologisista toiminnoista tutkittiin tarkkaavuutta, toiminnanohjausta, kielellistä ja visuaalista päättelyä sekä muistia. Kliiniseen työhön sisältyviä neuropsykologisia testejä käytettiin myös tutkimuksessa. Lisäksi käytettiin persoonallisuustutkimusta (Minnesota Multiphasic Personality Inventory, MMPI). Varhain säännöllisen päihteiden käytön aloittaneiden aloitusikä oli 14.5 (2.0) vuotta. Varhain aloitettu päihteiden käyttö oli yhteydessä suurempaan psykomotoriseen hidastuneisuuteen verrattuna myöhemmin aloitettuun käyttöön. Myöhemmin aloitetun säännöllisen päihteiden käytön aloitusikä oli 29.2 (9.8) vuotta. Myöhemmin aloittaneilla päihteiden käyttö oli yhteydessä näönvaraisten toimintojen heikentymiseen. Korkeampi koulutustaso toimi suojaavana tekijänä ja siirsi päihteiden käytön aloitusta myöhempään ikään. Sukupuolten välisiä eroja suorituksissa ei tullut esiin neuropsykologisissa testeissä. Miehet olivat masentuneempia kuin naiset, joskin molemmat toivat esiin kielteisiä tunteita. Tutkimukset osoittivat, että jos potilaalla oli samanaikainen mielialahäiriödiagnoosi ja päihdediagnoosi, ne olivat yhteydessä erityisesti suurempaan psykomotoriseen hidastumiseen ja visuospatiaalisen toiminnan heikentymiseen verrattuna potilaisiin, joilla oli pelkkä päihdehäiriö

Long-Term Prognostication for 20?114 Women With Small and Node-Negative Breast Cancer (T1abN0)

Background: Although small, node-negative breast cancer (ie, T1abN0) constitutes 20% of all newly diagnosed breast cancers,data on prognosis and prognostic factors are limited. Methods: We conducted a population-based cohort study including20 114 Swedish women treated for T1abN0 breast cancer from 1977 onward. Patient and tumor data were collected fromSwedish breast cancer registries. Cohort subjects were followed through linkage to the Cause of Death Register. We calculatedthe cumulative incidence of breast cancer–specific and overall death and used Cox regression to estimate hazard ratios (HRs)and 95% confidence intervals (CIs). Results: During a median follow-up of 9.1 years (range ¼ 0-38), 915 women died of breastcancer and 5416 of any cause. The 10-, 20-, and 30-year cumulative incidences of breast cancer death were 3.4% (95% CI ¼3.1% to 3.7%), 7.6% (95% CI ¼ 7.1% to 8.2%), and 10.5% (95% CI ¼ 9.6% to 11.4%), respectively. The multivariable hazard ratiosand 95% confidence intervals of breast cancer death were 0.92 (95% CI ¼ 0.88 to 0.97) for each additional calendar year of diagnosis, 4.38 (95% CI ¼ 2.79 to 6.87) for grade 3 vs grade 1 tumors, 0.43 (95% CI ¼ 0.31 to 0.62) for progesterone receptor–positivevs progesterone receptor–negative disease, and 2.01 (95% CI ¼ 0.99 to 4.07) for HER2-positive vs HER2-negative disease.Women with grade 3 vs grade 1 tumors had a 56% increased risk of death from any cause (HR ¼ 1.56, 95% CI ¼ 1.30 to 1.88). Conclusions: The risk of breast cancer death in T1abN0 disease continues to increase steadily beyond 10 years afterdiagnosis, has improved over time, and varies substantially by tumor characteristics.Funding agencies: Swedish Breast Cancer Association; Swedish Society of Medicine (SLS-502451).</p