Cannabis use during pregnancy and its relationship with fetal developmental outcomes and psychiatric disorders. A systematic review

This study analyze factors associated to cannabis use in pregnant women, its perceived availability, its risk perception and the relationship between prenatal exposure to cannabis and developmental and mental disorders. We present a review of the literature on cannabis use among pregnant women. The objective is to analyze factors associated to cannabis use during pregnancy and assess the potential effects of prenatal exposure to cannabis on the development of the fetus and the mental health of those exposed. Systematic review of studies on the maternal use of cannabis and the relationship between early exposure and the development of psychiatric disorders in the PubMed database until July 2018 in English and Spanish with the following keywords: Marijuana, Cannabinoids, Mental disorders, Pregnancy, Prenatal Cannabis Exposure, Risk factors. The use of cannabis among pregnant women is frequent but it has not been extensively researched. Prenatal exposure to cannabis may be associated with affective symptoms and ADHD. Mental healthcare professionals who treat women during their fertile life need to be able to explain the relationship between prenatal exposure to cannabis and the presence of developmental and mental disorders

Insomnia Symptoms in Patients With Substance Use Disorders During Detoxification and Associated Clinical Features

Background: Insomnia is highly prevalent in patients with substance use disorders (SUD), and it has been related to a worse course of addiction. Insomnia during detoxification in a hospital has not been adequately studied. This study aims to compare sociodemographic, clinical, and psychopathological characteristics of SUD patients undergoing a detoxification program, by comorbidity and insomnia symptoms. Methodology: We recruited 481 patients who received pharmacological and psychotherapeutic treatment for detoxification. They were evaluated through semi-structured interviews, standardized questionnaires, and a specific sleep log. A bivariate and multivariate analysis of the data was performed. Results: Insomnia was reported by 66.5% patients, with sleep-maintenance insomnia the most frequent issue, followed by early morning awakening and sleep-onset insomnia. Patients with alcohol use disorder and cannabis use disorder had higher prevalence of sleep-onset insomnia. Patients with cocaine and heroin use disorder had higher prevalence of sleep-maintenance insomnia. Independent factors that allowed the identification of insomnia symptoms included being female (OR: 3.43), polysubstance use (OR: 2.85), comorbid anxiety disorder (OR: 2.02), and prior admission for detoxification (OR: 1.22). Conclusions: Insomnia symptoms are very prevalent in patients admitted for detoxification. The diagnosis and therapeutic strategies for the insomnia symptoms should be improved, especially in women and in patients with greater addiction severity and with anxiety disorders

A coding system for qualitative studies of the information-seeking process in computer science research

Introduction. In this article we propose a qualitative analysis tool ?a coding system - that can support the formalisation of the information-seeking process in a specific field: research in computer science. Method. In order to elaborate the coding system, we have conducted a set of qualitative studies, more specifically a focus group and some individual interviews, and have analysed their results. Analysis. We provide a detailed description of how the qualitative studies were performed and how the subsequent analysis, refining and validation phases were carried out until we obtained the proposed coding system. Results. The coding system is presented as a list of hierarchically categorised codes that try to cover the full information-seeking process performed by researchers in computer science. In order to facilitate the understanding and later use of the codes, we also include a detailed description of each, together with real examples of use extracted from the qualitative studies. Conclusions. We present a complete list of 169 codes categorised into 13 categories that can help other researchers to analyse further qualitative results related to the information-seeking process, both at the process level and at the user level. In our case, these codes will be in the near future the seed to design a system that can adapt its functionality, visualisation and interaction based on the task at hand, the user and the context of use

Cocaine-induced Psychosis and Brain-derived Neurothrophic Factor in Patients with Cocaine Dependence : Report of Two Cases

Brain-derived neurotrophic factor (BDNF) is linked to numerous brain functions. In addition, BDNF alterations contribute to neurological, mental, and addictive disorders. Cocaine dependence has received much attention recently due to its prevalence and psychological effects. Symptoms of psychosis are one of the most serious adverse events precipitated by cocaine use. It is particularly important to identify patients at risk of developing cocaine-induced psychosis (CIP). We described two cases of patients with cocaine dependence who presented with CIP and had changes in their BDNF levels during the psychotic episode. BDNF levels were initially low in both patients, and then decreased by more than 50% in association with CIP. The relationship between BDNF and psychosis is described in the literature. These cases revealed that BDNF levels decreased during a CIP episode and, thus, it is necessary to investigate BDNF and its relationship with CIP further

Shared decision making in patients with substance use disorders : A one-year follow-up study

Patient-centered care in therapeutic processes has been associated with better clinical outcomes, however, it remains a poorly studied aspect in Substance Use Disorder (SUD). The study aimed to evaluate patient's preferences, perceived participation in treatment decisions and activation level; and how they predict retention, pharmacological adherence and substance use during one-year follow-up. Logistic regression models were used to analyze the association between independent variables, along with a wide number of sociodemographic and clinical covariates, and outcomes. Most patients prefer a shared or passive role when making decisions about their treatment, and showed concordance between their preferred and perceived roles. In the univariate models, perceiving more involvement than desired showed a higher likelihood of treatment discontinuation at 12 months, and substance use at 6 and 12 months. No significant associations were found between the remaining decisional variables or the degree of activation with the assessed outcomes. A majority of SUD patients prefer and perceive to be involved in the decision-making process about their treatment. Patients perceiving more involvement than desired might experience an excess of responsibility that could negatively influence treatment continuation and substance use. Limitations of the study preclude any definitive conclusion, and more research is needed to confirm these results

Inhaled Loxapine for Agitation in Intoxicated Patients : A Case Series

Episodes of agitation are frequent in intoxicated patients who have a substance use disorder, a psychiatric disorder or both (dual diagnosis). For managing the agitation, it is necessary to act promptly in a safe environment and addressing any underlying etiology. Inhaled loxapine improves symptoms of agitation in adults with psychiatric disorders (eg, schizophrenia) within 10 minutes of administration. Recently, some reports have documented the usefulness of loxapine in dual diagnoses patients with agitation. However, the efficacy of loxapine in intoxicated patients has not been deeply addressed. This report describes a case series of 12 patients (with addiction or dual disorder) who received inhaled loxapine for symptoms of psychomotor agitation during intoxication with different substances (eg, alcohol, cannabis, or cocaine) at 1 center in Spain. Data from 12 patients were reviewed, 5 patients were attended at the emergency room, 4 at the addiction and dual diagnosis unit, and 3 were treated during hospitalization for detoxification. All patients were under effects of substances. They had substance use disorder (including cannabis, cocaine, alcohol, hypnotics, and hallucinogens), and almost all (90%) presented 1 or more psychiatric disorders. One dose of inhaled loxapine was effective in 9 patients (75%), and in 3 patients, a second dose was required. Only mild dizziness was reported in 1 patient after the second dose. The acute agitation was effectively and quickly managed with inhaled loxapine in all intoxicated patients and enabled the appropriate clinical evaluation of the agitated state and the patient's management

Tratamiento ambulatorio grupal para dependientes de cocaína combinando terapia cognitivo conductual y entrevista motivacional

Resumen: Las intervenciones psicológicas en pacientes con dependencia de cocaína han demostrado ser eficaces, destacando el Manejo de Contingencias y la Terapia Cognitivo-Conductual [TCC], siendo la falta de adherencia la limitación más importante. La Entrevista Motivacional [EM] mejora la adherencia. El objetivo de este estudio es evaluar la retención y abstinencia con tratamiento combinado de EM y TCC grupal en pacientes cocainómanos que han alcanzado el estadio de mantenimiento según el modelo transteórico de Prochaska y DiClemente (1982). Para ello se realizó un estudio longitudinal, en dependientes de cocaína con o sin trastorno mental concomitante. Se realizó un grupo abierto de 12 sesiones con periodicidad semanal. Se incluyeron 19 pacientes (78,9% hombres, edad media 36,58 años), el 95% consumía vía intranasal y el 47% tenía otra comorbilidad psiquiátrica. La tasa de retención fue del 84%. Durante el tratamiento y el primer mes de seguimiento todos los pacientes se mantuvieron abstinentes, mientras que entre el primer y tercer mes de seguimiento tres pacientes recayeron. Los datos avalan que el tratamiento combinado de EM+TCC para dependientes de cocaína en estadio de mantenimiento mejora la adherencia y es eficaz para mantener la abstinencia. Abstract: Ambulatory group treatment for cocaine dependent patients combining cognitive behavioral therapy and motivational interviewing. Psychological interventions in cocaine dependent patients have demonstrated efficacy. Remarkable approaches are Contingency Management (CM) and Cognitive Behavioral Therapy (CBT). Lack of treatment adherence is the most important limitation. Motivational Interview (MI) has been shown to be an adherence enhancer. The objective of this study is to evaluate retention and abstinence in a combined CM and CBT group treatment in patients who have reached maintenance stage according to Prochaska and DiClemente's transtheoretical model (1982). Therefore, a longitudinal study was carried out with cocaine dependent patients with or without concomitant mental health disease. A 12-session open group was conducted weekly. Nineteen patients were included (78.9% men, mean age 36.6 years), 95% consumed intranasally and 47% had another psychiatric comorbidity. Treatment retention was 84%. During treatment and the first month of follow-up, all patients remained abstinent whereas at three months, 3 patients relapsed. These data confirm that using combined CM and CBT group therapy in cocaine dependents undergoing maintenance treatment enhances adherence and is effective to achieve abstinence

Risk factors for cocaine-induced psychosis in cocaine-dependent patients

Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases. This is the first European study on the relationship between CIP, consumption pattern variables and personality disorders. We evaluated 173 cocaine-dependent patients over 18 years; mostly males, whose average age was 33.6 years (SD=7.8). Patients attending an outpatient addictions department were enrolled in the study and subsequently systematically evaluated using SCID I and SCID II interviews for comorbid disorders, a clinical interview for psychotic symptoms and EuropASI for severity of addiction. A high proportion of cocaine dependent patients reported psychotic symptoms under the influence of cocaine (53.8%), the most frequently reported being paranoid beliefs and suspiciousness (43.9%). A logistic regression analysis was performed, finding that a model consisting of amount of cocaine consumption, presence of an antisocial personality disorder and cannabis dependence history had 66.2% sensitivity 75.8% specificity predicting the presence of CIP. In our conclusions, we discuss the relevance of evaluating CIP in all cocaine dependent-patients, and particularly in those fulfilling the clinical profile derived from our results. These findings could be useful for a clinical approach to the risks of psychotic states in cocaine-dependent patients

A Highly Polymorphic Copy Number Variant in the NSF Gene is Associated with Cocaine Dependence

Cocaine dependence is a complex psychiatric disorder involving both genetic and environmental factors. Several neurotransmitter systems mediate cocaine's effects, dependence and relapse, being the components of the neurotransmitter release machinery good candidates for the disorder. Previously, we identified a risk haplotype for cocaine dependence in the NSF gene, encoding the protein N-Ethylmaleimide-Sensitive Factor essential for synaptic vesicle turnover. Here we examined the possible contribution to cocaine dependence of a large copy number variant (CNV) that encompasses part of the NSF gene. We performed a case-control association study in a discovery sample (359 cases and 356 controls) and identified an association between cocaine dependence and the CNV (P=0.013), that was confirmed in the replication sample (508 cases and 569 controls, P=7.1e-03) and in a pooled analysis (P=1.8e-04), with an over-representation of low number of copies in cases. Subsequently, we studied the functional impact of the CNV on gene expression and found thatthe levels of two NSF transcripts were significantly increased in peripheral blood mononuclear cells (PBMC) along with the number of copies of the CNV. These results, together with a previous study from our group, support the role of NSF in the susceptibility to cocaine dependenc