Psychopathological symptoms of patients with heroin addiction entering opioid agonist or therapeutic community treatment.

The relationship between substance use disorders and psychiatric pathology is still an open question. The main aim of the present study was to verify whether the five psychopathological dimensions identified through the SCL-90 tool in a previous study carried out on patients with heroin addiction entering an outpatient opioid agonist treatment (OAT) were also observable in those entering a residential treatment community (TC). Further aims were to look at differences in the psychopathological profiles of patients entering a TC versus an OAT treatment and at the correlation between gender and the observed psychopathology.A confirmatory factor analysis was performed on the results of SCL-90 filled by 1,195 patients with heroin dependence entering TC treatment. It replicates the extraction method previously used on 1,055 OAT patients with heroin addiction by using a principal component factor analysis (PCA). The association between the kind of treatment received (TC or OAT), gender, and the psychopathological dimensions was assessed through logistic regression and general linear model (GLM) analysis.The PCA carried out on the SCL-90 results of patients entering a TC yielded a five-factor solution, confirming the same dimensions observed in patients entering an OAT: 'worthlessness and being trapped', 'somatization', 'sensitivity-psychoticism', 'panic anxiety', and 'violence-suicide'. The logistic regression analysis showed a statistically significant association between 'somatization' and 'violence-suicide' severity score and OAT. GLM analysis showed that psychopathological factorial scores for 'worthlessness-being trapped', 'somatic symptoms', and 'panic anxiety' dimensions were more severe in OAT vs TC male patients and in TC vs OAT female ones. 'Violence suicide' followed the same severity pattern for males, but did not differ in TC vs OAT females, while 'sensitivity-psychoticism' did not differ in OAT vs TC patients. The five dimensions did not differ in OAT males vs females.Our research appears to confirm the existence of a specific aggregation of psychological/psychiatric features within the category of individuals with heroin addiction. It also shows a correlation between the dominant psychopathological subgroup and the assignment to TC versus OAT. Further research is needed to clarify the differences between the five psychopathological subgroups and their determinants

Torsade de pointes caused by polypharmacy and substance abuse in a patient with human immunodeficiency virus

Drug-induced QT prolongation is a potentially dangerous adverse effect of some medication combinations. When QT prolongation progresses to torsade de pointes, life-threatening or fatal outcomes may result. A 57-year-old man with a history of human immunodeficiency syndrome on abacavir, nevirapine, tenofovir, voriconazole, and methadone presented to the emergency department with a chief complaint of new-onset seizures. The physical exam was unremarkable. The electrocardiogram demonstrated sinus bradycardia and a prolonged QTc interval of 690 ms. In the emergency department, he had several episodes of torsade de pointes (TdP) and ventricular tachycardia that resolved spontaneously. These episodes were accompanied by an alteration in mentation and generalized twitching. Magnesium and amiodarone were effective in terminating the dysrhythmia. The patient had multiple risk factors for prolonged QT syndrome including human immunodeficiency virus infection, methadone therapy, and polypharmacy leading to potential drug interactions. Physicians must be aware of multidrug interactions potentiating QT prolongation and leading to torsade de pointes

Opioid Treatment and Long QT Syndrome (LQTS): a Critical Review of the Literature

The present review aims at perusing the available literature about QT-related cardiac safety during methadone treatment. On the whole, case reports, either single or multiple, do not seem a reasonable bases to draw conclusions about the weight of any putative risk factor for QT prolongation. On the other hand, systematic studies allow making some statements about the extension and weight of QT prolongation during methadone maintenance treatment for heroin addiction. No major concern about cardiac safety of methadone itself in the average addict seems to stand. Conditions at higher risk of multiple and polydrug treatments deserve some greater surveillance. No rationale for a dose-ceiling stands in a risk/benefit perspective

Symptomatological features of patients with and without Ecstasy use during their first psychotic episode.

BACKGROUND: Ecstasy use is generally chosen by adolescents and young adults for its entactogenic properties (the production of feelings of empathy, love, and emotional closeness to others.) Despite this desired and frequently realized outcome, Ecstasy use has often resulted in the genesis of psychotic symptoms and aggressive behaviors, particularly after chronic and/or intensive use. METHODS: To explore the negative consequences of Ecstasy use and to examine the aggressive nature oftentimes seen in many Ecstasy users we employed a case-control study model. We compared, by means of validated psychometric tests, the psychopathological symptoms (BPRS), the aggressiveness (OAS) and the social adjustment (DSM-GAF) of psychotic patients with (n = 23) and without (n = 46) recent user of Ecstasy, during their first psychotic episode and hospitalization. All 23 Ecstasy users were Ecstasy users only. RESULTS: Almost all of the psychotic symptoms were of similar severity in both groups. Blunted affect was milder in users than in non-users, whereas hostility and aggressive behavior was significantly more severe in users than in non-users. CONCLUSIONS: psychosis with a high level of aggressiveness and violence constitutes an important 'side-effect' that surely runs counter to the expected entactogenic action of Ecstasy. At a patient psycho-educational level, this study suggests that the use of Ecstasy may be counterproductive with respect to user expectations

Discriminant and convergent validity of TEMPS-A[P]. Correlation with Occupational Personality Questionnaire (OPQ32) during a stressful situation.

BACKGROUND: The Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Questionnaire (TEMPS) has, in its self and rater-wise evaluation form, been designed to evaluate temperamental characteristics in clinical and non-clinical populations. METHODS: In this study we aim to extend the field of correlations of TEMPS to include the Occupational Personality Questionnaire, ipsative version (OPQ32i). These correlations, if present, could provide a partial contribute to the validation process of TEMPS, currently in progress in various countries. OPQ32 is a self-report personality questionnaire designed to give information on an individual's preferred behavior, as assessed in terms of a number of work-related characteristics. In 921 applicants, who were competing to become cadets in the Italian Navy, we assessed, during the entrance examination, the correlations between TEMPS-A[P] and OPQ32i. RESULTS: Depressive temperament implies a low level of ability to relate to others; hyperthymic temperament implies high levels of feelings and emotions, and the capability to relate to people; cyclothymic temperament appears to be distinguished by creativity and a low level of relationships with others; irritable temperament partly overlaps with cyclothymic temperament, the main difference being the higher level of energy and the lower level of empathy of irritable subjects. CONCLUSIONS: The four affective temperaments, in our sample, proved to significantly differ in the work capacity features measured by OPQ32 factors. These observed correlations between the two tests partially contributes to the ongoing validation process of TEMPS-A[P]. From a personality standpoint this study further supports the hypothesis that temperaments belong to the realm of normality rather than that of pathology, in line with their putative adaptive role