Study of the sexual function of opiate and poly drug users

Research on the fields of sexuality and addiction often face ethical, methodological and other problems. Many addictive substances have been widely used for their euphoric effects and for their effect on sexuality. Almost all of them - at least in chronic use - have a negative impact on sexual function, which may also deteriorate due to other direct and indirect effects of addiction. This research focused on the sexual life and relevant issues of a group of male heroin and poly-drug users. The sexual lives of thirty men who were treated at the Addiction Services (TAE) of the Psychiatric Hospital of Thessaloniki were investigated. Interviews, questionnaires (EPQ, BDI, GRISS, STAI X2 Gr, special questionnaire) and laboratory tests (FBC, biochemical tests, testosterone, free testosterone, prolactin) were used. Descriptive statistics and data analysis were used in analysis. The assessment included the phases of admission to the detoxification unit, outpatient treatment in the "Waiting List" Group , treatment at the "Karteres" Therapeutic Community and (for 9 of them) at the Rehabilitation Service. The main observations and conclusions are: The mean age was 28,57 years. Most were unemployed on admission to the detoxification unit. There were usually close family relationships. 20 persons were living with a parent. There were also cases of family history of psychiatric illness and drugs and alcohol abuse. Often there were pending court cases (14 persons). There was a high prevalence of infection with the Hepatitis C virus (15 persons). IV use, sharing of equipment and multiple use were common. There were frequent drug- related sexual problems that were usually subsiding following discontinuation of use. On admission to the detoxification unit only 5 persons reported good or very good libido on the newly developed questionnaire. 16 persons presented erectile problems with concurrent use, and 6 without. After detoxification there were no erectile problems for three quarters of this group. 24 persons had retarded ejaculation with concurrent use. One person had premature ejaculation with concurrent use and 5 without. The frequency of sexual encounters / month presented a gradual increase from use to abstinence 16 persons were for some time prescribed naltrexone during the "Waiting List" Group phase. Naltrexone may have a positive effect on sexual function. Premorbid sexual dysfunction (e.g. premature ejaculation) may reappear following discontinuation of use. There was generally a gradual improvement in the psychometric tests from the phase of use to the phases of abstinence. Initiation of sexual activity was at a young age (age of first intercourse was 14,9 years), and there was possibly a wider repertoire of sexual activity. Lack of sexual education was pointed out. There were rather conventional points of view about several sexual issues. There was a significant number of drug dependent partners in most phases, especially during dependence. There was a low frequency of condom use and that did not significantly change from use to abstinence phases. This study demonstrates the need for appropriate management of issues related to sexual function as a part of the general therapeutic plan.Η έρευνα τόσο στον τομέα της σεξουαλικότητας, όσο και στον τομέα των εξαρτήσεων συχνά αντιμετωπίζει δεοντολογικά, μεθοδολογικά και άλλα προβλήματα. Πολλές εξαρτησιογόνες ουσίες έχουν ευρέως χρησιμοποιηθεί για τα ευφορικά τους αποτελέσματα αλλά και για την επίδραση τους στην σεξουαλικότητα. Σχεδόν όλες - σε χρόνια τουλάχιστον χρήση – έχουν αρνητική επίπτωση στην σεξουαλική λειτουργία, η οποία επίσης μπορεί να επιδεινωθεί από άλλες άμεσες και έμμεσες επιδράσεις της εξάρτησης. Η παρούσα έρευνα εστίασε στην σεξουαλική λειτουργία και σε συναφή θέματα, ομάδας ανδρών χρηστών ηρωΐνης και πολυχρηστών. Ερευνήθηκε η σεξουαλική ζωή 30 ανδρών που νοσηλεύθηκαν στις Υπηρεσίες του Τμήματος Αποκατάστασης Εξαρτημένων (ΤΑΕ) του Ψυχιατρικού Νοσοκομείου Θεσσαλονίκης. Χρησιμοποιήθηκαν συνεντεύξεις, ερωτηματολόγια ( EPQ, BDI, GRISS, STAI Χ2 Gr., νέο ερωτηματολόγιο) και εργαστηριακές εξετάσεις (γενική αίματος, βιοχημικός έλεγχος, τεστοστερόνη, ελεύθερη τεστοστερόνη, προλακτίνη). Κατά την διαδικασία της ανάλυσης χρησιμοποιήθηκαν περιγραφική στατιστική και ανάλυση των δεδομένων. Έγινε εκτίμηση για τα στάδια της εισαγωγής των χρηστών στο Τμήμα Σωματικής Αποτοξίνωσης, της παραμονής στην ομάδα «Αναμονής» (παρακολούθηση των δραστηριοτήτων της ομάδας ως εξωτερικοί ασθενείς μέχρι την εισαγωγή στην ΘΚ Καρτερών), στην Θεραπευτική Κοινότητα Καρτερών και (για 9 από αυτούς) στο στάδιο της Επανένταξης. Οι κύριες παρατηρήσεις και συμπεράσματα είναι : Ο μέσος όρος ηλικίας ήταν τα 28,57 έτη Οι περισσότεροι κατά την εισαγωγή στο ΤΣΑ ήταν άνεργοι (26 άτομα) Συνήθως υπήρχαν οικογενειακοί δεσμοί. 20 άτομα ζούσαν με τους γονείς / γονέα. Υπήρχαν επίσης περιπτώσεις οικογενειακού ιστορικού ψυχιατρικής νόσου και κατάχρησης ουσιών και αλκοόλ. Συχνά υπήρχαν δικαστικές εκκρεμότητες (14 άτομα) Εμφανίζονταν υψηλά ποσοστά μόλυνσης με το ιό της ηπατίτιδας C (15 άτομα). Συχνή ήταν η IV χρήση (27 άτομα), η κοινή χρήση (24 άτομα), και η πολλαπλή χρήση Εμφανίζονταν συχνά σεξουαλικά προβλήματα που σχετίζονταν με την χρήση και που συνήθως υποχωρούσαν με την διακοπή της. Μόνο 5 άτομα δήλωσαν στο νέο ερωτηματολόγιο καλή ή πολύ καλή σεξουαλική διάθεση, κατά την εισαγωγή τους στο ΤΣΑ. 16 άτομα εμφάνιζαν προβλήματα στύσης υπό την επήρεια ουσιών και 6 χωρίς την επήρεια., ενώ μετά την αποτοξίνωση για τα 3Α δεν υπήρχε κανένα πρόβλημα στύσης. 24 άτομα είχαν καθυστερημένη εκσπερμάτιση υπό την επήρεια ουσιών. Ένα άτομο είχε πρόωρη εκσπερμάτισηυπό την επήρεια ουσιών και 5 χωρίς την επήρεια. Ο αριθμός των σεξουαλικών επαφών / μήνα εμφάνισε σταδιακή αύξηση από την χρήση στην αποχή. 16 άτομα λάμβαναν ναλτρεξόνη για κάποιο διάστημα στην ομάδα της «Αναμονής». Η ναλτρεξόνη ίσως επιδρά θετικά στην στυτική λειτουργία. Προνοσηρή σεξουαλική δυσλειτουργία (πχ πρόωρη εκσπερμάτιση) μπορεί να επανεμφανίζεται μετά από την διακοπή της χρήσης Γενικά εμφανίσθηκε σταδιακή βελτίωση στις ψυχομετρικές δοκιμασίες από την χρήση στα στάδια της αποχής. Εμφανίσθηκε μικρή ηλικία έναρξης των σεξουαλικών επαφών (πρώτης συνουσία στα 14,9 έτη) και πιθανώς «τολμηρή» σεξουαλική δραστηριότητα. Επισημάνθηκε ελλιπής ενημέρωση για σεξουαλικά θέματα. Παρουσιάσθηκαν μάλλον συμβατικές απόψεις για σειρά σεξουαλικών θεμάτων. Υπήρχε σημαντικό ποσοστό εξαρτημένων συντρόφων στα περισσότερα στάδια. Εμφανίσθηκε χαμηλή συχνότητα χρήσης προφυλακτικού που δεν μεταβλήθηκε σημαντικά στις φάσεις χρήσης-αποχής. Η παρούσα έρευνα δείχνει την ανάγκη για κατάλληλο χειρισμό θεμάτων που σχετίζονται με την σεξουαλική λειτουργία ως τμήμα του γενικότερου θεραπευτικού σχεδιασμού

Development and validation of the Greek severe impairment battery

Most neuropsychological batteries, especially those most often used, are unsuitable for the assessment of patients with severe dementia. The Severe Impairment Battery (SIB) was developed for the evaluation of preserved cognitive functions in these patients. The aim of this study was to formulate a Greek version of the SIB and to conduct a first assessment of its use of patients with mild, moderate, or severe Alzheimer's disease (AD), compared to the Mini-Mental State Examination (MMSE). A convenience sample of 42 dementia patients according to DSM-IV-TR criteria and 23 healthy participants was selected. Patients were assessed twice using a Greek translation of the SIB and the Greek version of MMSE. Patients were divided into three severity groups based on grouped by Clinical Dementia Rating (CDR) score and the SIB and MMSE scores were compared. The validity of the SIB was confirmed by evaluating the correlation coefficients between the SIB and Greek-MMSE, grouped by CDR, which were found to be significant. Cronbach's α for the total SIB score and each subscale score showed high significance, and the item-total correlation for each subscale was also acceptable. The test-retest correlation for the total SIB score and subscale scores were significant. The total SIB score and subscale scores were examined according to CDR. The Greek SIB is reliable and valid in differentiating patients with moderate or severe dementia, whereas MMSE loses sensitivity due to a floor and ceiling effect

Non-Pharmacological Interventions for Wandering/Aberrant Motor Behaviour in Patients with Dementia

Background: Aberrant motor behaviour or wandering refers to aimless movement without a specific purpose. Wandering is common in patients with dementia and leads to early institutionalization and caregivers’ burden. Non-pharmacological interventions should be also considered as a first-line solution for the wandering because current pharmacological treatment has serious side-effects. Methods: A cross-over randomised controlled trial (RCT) with 60 participants of all stages and different types of dementia was conducted in Greece. The sample was randomly assigned in 6 different groups of 10 participants each. Every intervention lasted for 5 days, and there were 2 days as a wash-out period. There was no drop-out rate. The measurements used were the Mini Mental State Examination (MMSE), Addenbrooke’s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for Symptoms in Dementia (FRSSD), and Neuropsychiatric Inventory (NPI). The interventions that were evaluated were reminiscence therapy (RT), music therapy (MT), and physical exercise (PE). Results: NPI scores were reduced in the group receiving PE (p = 0.006). When MT (p = 0.018) follows PE, wandering symptoms are reduced further. RT should follow MT in order to reduce wandering more (p = 0.034). The same combination was effective for the caregivers’ burden as well; PE (p = 0.004), MT (p = 0.036), RT (p = 0.039). Conclusions: An effective combination that can reduce wandering symptoms in all stages and types of dementia was found: The best order was PH-MT-RT. The same combination in the same order reduced caregivers’ burden

Assess of Combinations of Non-Pharmacological Interventions for the Reduction of Irritability in Patients with Dementia and their Caregivers: A Cross-Over RCT

Introduction: Dementia is a very common disorder that affects people over 65 years old all over the world. Apart from the cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) are a crucial matter in dementia, because they affect up to 90% of the patients during the course of their illness. Irritability has been found to be a common BPSD and one of the most distressing behaviors for the caregivers. The aim of the current study was to explore the efficacy of a combination of non-pharmacological interventions to treat irritability. Methods: Sixty patients with different types and stages of dementia with irritability were participated in a cross-over RCT. Three non-pharmacological interventions were used; (a) Validation Therapy (VT)/Psycho-educational program, (b) Aromatherapy/massage and (c) Music Therapy (MT). The study assessed the three non-pharmacological interventions in order to find the most effective combination of the interventions. This study did not compare pharmacological and non-pharmacological treatments. The interventions lasted for five days. There was no drop-out rate. All patients were assessed at baseline using Mini Mental State of Examination (MMSE), Addenbrooke’s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for symptoms in dementia (FRSSD), and Neuropsychiatric Inventory (NPI) (sub questions for irritability). Only NPI used for the assessment after each intervention. The analyses used categorical variables, Wilcoxon signed-rank test, Chi-square test and z value score. Results: The most effective combination of non-pharmacological interventions was Aromatherapy/massage (p = 0.003)-VT plus Psycho-educational program (p = 0.014) plus MT (p = 0.018). The same combination was the most effective for the caregivers’ burden, too (p = 0.026). Conclusions: The above combination of non-pharmacological interventions can reduce irritability in patients with dementia and caregivers’ burden

Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia : an international multicenter study

Background The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. Methods Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 +/- 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. Results There was a 3-year later age at onset for females (P < .001) and lower rates of negative symptoms (P < .01) and higher depression/anxiety measures (P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness. Discussion Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples