Memory function in opioid-dependent patients treated with methadone or buprenorphine along with benzodiazepine: longitudinal change in comparison to healthy individuals

<p>Abstract</p> <p>Background</p> <p>Opioid-substitution treatment (OST) for opioid dependence (OD) has proven effective in retaining patients in treatment and reducing illegal opiate abuse and crime. Consequently, the World Health Organization (WHO) has listed the opioid agonists methadone and buprenorphine as essential drugs for OD that should be available worldwide. In many areas of the world, OD is often associated with concomitant benzodiazepine (BZD) dependence and abuse, which complicates treatment. However, possible changes in the cognitive functioning of these patients are not well-known. The present study is the first to examine longitudinal stability of memory function in OST patients with BZD use, thus providing a new tool for health policy authorities in evaluating the usefulness of OST.</p> <p>Methods</p> <p>Within the first two months (T1) and between 6–9 months (T2) after OST admission, we followed the working memory, immediate verbal memory, and memory consolidation of 13 methadone- and 15 buprenorphine- or buprenorphine/naloxone-treated patients with BZD dependence or abuse disorder. The results were compared to those of fifteen normal comparison participants. All participants also completed a self-reported memory complaint questionnaire on both occasions.</p> <p>Results</p> <p>Both patient groups performed statistically significantly worse than normal comparison participants in working memory at time points T1 and T2. In immediate verbal memory, as measured by list learning at T1, patients scored lower than normal comparison participants. Both patient groups reported significantly more subjective memory problems than normal comparison participants. Patients with more memory complaints recalled fewer items at T2 from the verbal list they had learned at T1 than those patients with fewer memory complaints. The significance of the main analyses remained nearly the same when the statistical tests were performed without buprenorphine-only patients leaving 12 patients to buprenorphine/naloxone group.</p> <p>Conclusion</p> <p>Working memory may be persistently affected in OST patients with BZD use. A high number of memory complaints among OST patients with BZD use may indicate memory consolidation impairment. These findings show that recovery of memory function in OD patients treated along with BZDs takes time, and their memory complaints may have practical relevance.</p

Association between Neurocognitive Impairment and the Short Allele of 5-HTT Promoter Polymorphism in Depression: A Pilot Study.

Peer reviewe

Association between Neurocognitive Impairment and the Short Allele of 5-HTT Promoter Polymorphism in Depression: A Pilot Study.

Peer reviewe

Subjective outcomes of psychotherapeutic interventions: a naturalistic follow-up study among Finnish adolescent psychiatric outpatients

In adolescence, the prevalence of mental disorders doubles compared to childhood and the need for interventions to reduce psychological symptoms increases. Most evidence-based psychotherapeutic interventions are focused on single conditions, but in clinical practice most patients suffer from psychiatric comorbidity. However, research on effective treatment interventions for adolescents in a naturalistic setting is scarce. The aim of this three-month follow-up study was to investigate subjective outcomes of psychotherapeutic interventions in a naturalistic setting among adolescent psychiatric outpatients. The intention was to also find out if verbally performed psychotherapies were more effective than art and occupational therapies in symptom reduction. Further, to investigate whether the frequency of intervention or the severity of self-reported depressive symptoms were related to treatment effect. This study was conducted at the Helsinki University Central Hospital, Department of Adolescent Psychiatry. The study is part of an ongoing longitudinal study focusing on the effectiveness of psychotherapeutic interventions, started in February 2012. The sample comprised 58 adolescents, with a mean age of 14.2 years, referred to psychotherapy or to art and occupational therapies. The Beck Depression Inventory (BDI), the Strengths and Difficulties Questionnaire (SDQ) and the Clinical Outcomes in Routine Evaluation-Outcome-Measure (CORE-OM) were used as self-assessments both at baseline and the follow-up. The adolescents experienced symptom reduction during the first months of psychotherapeutic treatment. Symptom reduction was related to the frequency, but not to the form, of psychotherapeutic intervention. The life functioning of adolescents with severe depression improved more than those with only mild or moderate depression. In conclusion, psychotherapeutic interventions are effective in reducing the subjective symptoms of clinically referred adolescents with psychiatric disorders. Art and occupational therapies are as effective as psychotherapies in reducing symptoms. The frequency of intervention, as well as the level of depression prior to the intervention, seems to modify the outcome.In adolescence, the prevalence of mental disorders doubles compared to childhood and the need for interventions to reduce psychological symptoms increases. Most evidence-based psychotherapeutic interventions are focused on single conditions, but in clinical practice most patients suffer from psychiatric comorbidity. However, research on effective treatment interventions for adolescents in a naturalistic setting is scarce. The aim of this three-month follow-up study was to investigate subjective outcomes of psychotherapeutic interventions in a naturalistic setting among adolescent psychiatric outpatients. The intention was to also find out if verbally performed psychotherapies were more effective than art and occupational therapies in symptom reduction. Further, to investigate whether the frequency of intervention or the severity of self-reported depressive symptoms were related to treatment effect. This study was conducted at the Helsinki University Central Hospital, Department of Adolescent Psychiatry. The study is part of an ongoing longitudinal study focusing on the effectiveness of psychotherapeutic interventions, started in February 2012. The sample comprised 58 adolescents, with a mean age of 14.2 years, referred to psychotherapy or to art and occupational therapies. The Beck Depression Inventory (BDI), the Strengths and Difficulties Questionnaire (SDQ) and the Clinical Outcomes in Routine Evaluation-Outcome-Measure (CORE-OM) were used as self-assessments both at baseline and the follow-up. The adolescents experienced symptom reduction during the first months of psychotherapeutic treatment. Symptom reduction was related to the frequency, but not to the form, of psychotherapeutic intervention. The life functioning of adolescents with severe depression improved more than those with only mild or moderate depression. In conclusion, psychotherapeutic interventions are effective in reducing the subjective symptoms of clinically referred adolescents with psychiatric disorders. Art and occupational therapies are as effective as psychotherapies in reducing symptoms. The frequency of intervention, as well as the level of depression prior to the intervention, seems to modify the outcome.Peer reviewe

Cognitive function during early abstinence from opioid dependence: a comparison to age, gender, and verbal intelligence matched controls

BACKGROUND: Individuals with opioid dependence have cognitive deficits during abuse period in attention, working memory, episodic memory, and executive function. After protracted abstinence consistent cognitive deficit has been found only in executive function. However, few studies have explored cognitive function during first weeks of abstinence. The purpose of this study was to study cognitive function of individuals with opioid dependence during early abstinence. It was hypothesized that cognitive deficits are pronounced immediately after peak withdrawal symptoms have passed and then partially recover. METHODS: Fifteen patients with opioid dependence and fifteen controls matched for, age, gender, and verbal intelligence were tested with a cognitive test battery When patients performed worse than controls correlations between cognitive performance and days of withdrawal, duration of opioid abuse, duration of any substance abuse, or opioid withdrawal symptom inventory score (Short Opiate Withdrawal Scale) were analyzed. RESULTS: Early abstinent opioid dependent patients performed statistically significantly worse than controls in tests measuring complex working memory, executive function, and fluid intelligence. Their complex working memory and fluid intelligence performances correlated statistically significantly with days of withdrawal. CONCLUSION: The results indicate a rather general neurocognitive deficit in higher order cognition. It is suggested that cognitive deficit during early abstinence from opioid dependence is related to withdrawal induced neural dysregulation in the prefrontal cortex and is partly transient