Persistent sleep problems among people in recovery from substance use disorders: a mixed methods study

Background The aims of this study are to examine the one-year trajectory of sleep problems, identify clinical correlates, and describe subjective experiences related to persistent sleep problems during recovery from substance use disorders (SUD). Methods This study builds on a sequential mixed method design. The quantitative component features data from a prospective longitudinal study of 127 poly-SUD patients in the Stavanger area in Norway, while the qualitative component describes a thematic analysis of interviews with 16 persons from this study still experiencing sleep problems after at least one year of abstinence. Results The prevalence of sleep problems at baseline for the whole cohort was 79%. Among the 59 patients who were abstinent after one year, N = 20 (33.9%) had moderate and N = 11 (18.6%) had severe sleep problems. Persistent sleep problems were associated with psychological distress and were experienced as a major challenge in the struggle to stay drug free. Establishing daily routines related to work, school, and care for children were coping strategies for participants with persistent sleep problems. Conclusions Persistent sleep problems are often overlooked in a clinical setting. Based on our findings, these issues pose a major challenge in the struggle to stay drug free. For patients with psychological distress, and lack of responsibilities that established daily routines, sleep difficulties may result in increased risk of drug use episodes that result in relapse. These results argue that screening and evidence-based methods for insomnia and sleep health-programs should be commonplace adjunct intervention for patients with SUDs.publishedVersio

Is the relapse concept in studies of substance use disorders a ‘one size fits all’ concept? A systematic review of relapse operationalisations

Issues Relapse is a theoretical construct and empirical object of inquiry. It is unclear how relapse is operationalised with regard to the various phases in substance use disorders (SUD). The aim was to investigate relapse operationalisations in SUDs studies after short- and long-term abstinence and remission, recovery and slip/lapse. Approach Systematic review using the following databases: Epistemonikos, Cochrane Central Register of Controlled Trials (CENTRAL and DARE), MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science and PsycINFO. Search returned 3426 articles, with 276 meeting the following inclusion criteria: empirical study published in English in a peer-reviewed journal; samples meet diagnostic criteria for dependence syndrome or moderate–severe drug use disorder or alcohol use disorder; reports relapse, abstinence, recovery, remission, slip or lapse. Review protocol registration: PROSPERO (CRD42020154062). Key Findings Thirty-two percent of the studies had no definition of ‘relapse’. Most relapse operationalisations were defined according to measure (26%), time (17%), use (26%) and amount and frequency (27%). Of the 16 studies with a follow-up duration of up to 2 years, one (6%) contained a definition of ‘long-term abstinence’. Of the 64 studies with a follow-up duration of more than 2 years, four (6%) contained a definition of ‘long-term abstinence’. Of those, one (2%) mentioned ‘early relapse’ and one (2%) mentioned ‘late relapse’. Implications Future research is needed to explore the possible difference between early and late relapse. Moreover, working to increase consensus on relapse operationalisations in SUD research is warranted. Conclusions We identified no consensus on relapse operationalisations nor agreement on the differentiation between early and late relapse. The clinical utility of current relapse operationalisations seems low and may compromise knowledge accumulation about relapse and implementation of research into treatment.publishedVersio

Cortical folding in Broca's area relates to obstetric complications in schizophrenia patients and healthy controls

Background The increased occurrence of obstetric complications (OCs) in patients with schizophrenia suggests that alterations in neurodevelopment may be of importance to the aetiology of the illness. Abnormal cortical folding may reflect subtle deviation from normal neurodevelopment during the foetal or neonatal period. In the present study, we hypothesized that OCs would be related to cortical folding abnormalities in schizophrenia patients corresponding to areas where patients with schizophrenia display altered cortical folding when compared with healthy controls. Method In total, 54 schizophrenia patients and 54 healthy control subjects underwent clinical examination and magnetic resonance image scanning on a 1.5 T scanner. Information on OCs was collected from original birth records. An automated algorithm was used to calculate a three-dimensional local gyrification index (lGI) at numerous points across the cortical mantle. Results In both schizophrenia patients and healthy controls, an increasing number of OCs was significantly related to lower lGI in the left pars triangularis (p<0.0005) in Broca's area. For five other anatomical cortical parcellations in the left hemisphere, a similar trend was demonstrated. No significant relationships between OCs and lGI were found in the right hemisphere and there were no significant case-control differences in lGI. Conclusions The reduced cortical folding in the left pars triangularis, associated with OCs in both patients and control subjects suggests that the cortical effect of OCs is caused by factors shared by schizophrenia patients and healthy controls rather than factors related to schizophrenia alon

Mental disorder prevalence in chronic pain patients using opioid versus non-opioid analgesics: A registry-linkage study

Background Chronic pain and mental disorders are leading causes of disability worldwide. Individuals with chronic pain are more likely to experience mental disorders compared to individuals without chronic pain, but large-scale estimates are lacking. We aimed to calculate overall prevalence of mental health diagnoses from primary and secondary care among individuals treated for chronic pain in 2019 and to compare prevalence among chronic pain patients receiving opioid versus non-opioid analgesics, according to age and gender. Methods It is a population-based cohort study. Linked data from nationwide health registers on dispensed drugs and diagnoses from primary (ICPC-2) and secondary (ICD-10) health care. Chronic pain patients were identified as all patients over 18 years of age filling at least one prescription of an analgesic reimbursed for non-malignant chronic pain in both 2018 and 2019 (N = 139,434, 69.3% women). Results Prevalence of any mental health diagnosis was 35.6% (95% confidence interval: 35.4%–35.9%) when sleep diagnoses were included and 29.0% (28.8%–29.3%) when excluded. The most prevalent diagnostic categories were sleep disorders (14% [13.8%–14.2%]), depressive and related disorders (10.1% [9.9%–10.2%]) and phobia and other anxiety disorders (5.7% [5.5%–5.8%]). Prevalence of most diagnostic categories was higher in the group using opioids compared to non-opioids. The group with the highest overall prevalence was young women (18–44 years) using opioids (50.1% [47.2%–53.0%]). Conclusions Mental health diagnoses are common in chronic pain patients receiving analgesics, particularly among young individuals and opioid users. The combination of opioid use and high psychiatric comorbidity suggests that prescribers should attend to mental health in addition to somatic pain. Significance This large-scale study with nation-wide registry data supports previous findings of high psychiatric burden in chronic pain patients. Opioid users had significantly higher prevalence of mental health diagnoses, regardless of age and gender compared to users of non-opioid analgesics. Opioid users with chronic pain therefore stand out as a particularly vulnerable group and should be followed up closely by their physician to ensure they receive sufficient care for both their mental and somatic symptoms.Mental disorder prevalence in chronic pain patients using opioid versus non-opioid analgesics: A registry-linkage studyacceptedVersionpublishedVersio

Psychometric Properties of the Drug Use Disorders Identification Test (DUDIT) in Heroin Dependent Adults and Adolescents with Drug Use Disorder

Objective:The aim of the present study was to evaluate the psychometric properties of the Drug Use Disorders Identification Test (DUDIT), developed to screen individuals for drug problems, in Turkish patients with drug use disorder

MRI Indices of Cortical Development in Young People With Psychotic Experiences: Influence of Genetic Risk and Persistence of Symptoms

Background Psychotic experiences (PEs) are considered part of an extended psychosis phenotype and are associated with an elevated risk of developing a psychotic disorder. Risk of transition increases with persistence of PEs, and this is thought to be modulated by genetic and environmental factors. However, it is unclear if persistence is associated with progressive schizophrenia-like changes in neuroanatomy. Methods We examined cortical morphometry using MRI in 247 young adults, from a population-based cohort, assessed for the presence of PEs at ages 18 and 20. We then incorporated a polygenic risk score for schizophrenia (PRS) to elucidate the effects of high genetic risk. Finally, we used atlas-based tractography data to examine the underlying white matter. Results Individuals with persisting PEs showed reductions in gyrification (local gyrification index: lGI) in the left temporal gyrus as well as atypical associations with brain volume (TBV) in the left occipital and right prefrontal gyri. No main effect was found for the PRS, but interaction effects with PEs were identified in the orbitofrontal, parietal, and temporal regions. Examination of underlying white matter did not provide strong evidence of further disturbances. Conclusions Disturbances in lGI were similar to schizophrenia but findings were mostly limited to those with persistent PEs. These could reflect subtle changes that worsen with impending psychosis or reflect an early vulnerability associated with the persistence of PEs. The lack of clear differences in underlying white matter suggests our findings reflect early disturbances in cortical expansion rather than progressive changes in brain structure