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The comorbidity between psychiatric disorders and substance use disorders is more and more common in daily clinical practice. However, only few studies have adressed this subject in north african patients.
Objectives
The main objective of our study was the estimation of the prevalence and patterns of psychiatric co-morbidities in substance users seeking care.
Methods
Our work consisted of a cross-sectional study of a sample of patients attending outpatient substance use treatment at the addiction center in Oujda, Morocco. A hetero-questionnaire was used to collect sociodemographic data and patient history, DSM-IV criteria to assess substance abuse and dependence, and the Mini-International Neuropsychiatric Interview [MINI] to assess psychiatric comorbidities.
Results
Our study involved 100 patients, with a male predominance (89% of users). The main substances used in the last 12 months were tobacco (78%), followed by cannabis (74%), alcohol (50%), and benzodiazepines (44%). Psychiatric comorbidity was identified in 71% of the users, 51% of whom had a depressive disorder, 35% an anxiety disorder and 10% a gambling disorder. The dependence on the substance that initially motivated the consultation was higher in patients with psychiatric comorbidity (p=0.033). The post-traumatic stress disorder was significantly associated with the presence of alcohol dependence (p=0.028). The presence of benzodiazepine dependence (p=0.025) and abuse of cocaine (p=0.028) and Ecstasy (p=0.000) were significantly associated with suicide risk.
Conclusions
Our study found a high prevalence of psychiatric comorbidities among substance users seeking treatment, this should prompt clinicians to pay particular attention to this issue in order to adapt and improve their management.
We present the case of a 65-year-old woman with multiple and chronic psychosomatic symptoms. Due to motor impairments she was diagnosed in 2009 with Parkinson’s Disease (PD) by the neurology department and empirical treatment with levodopa was prescribed. However, the patient increased her levodopa intake by three times the recommended dose. The patient presented many adverse effects, including psychotic symptoms, that were interrupted after the levodopa intake was ended during a two month internament in a psychiatric unit. Dopamine dysregulation syndrome (DDS) is a condition in which patients with PD increase their levodopa intake without an objective worsening of motor symptoms. Higher-than-prescribed doses are taken by patients who develop tolerance and dependence to dopaminergic agonists.
Objectives
To analyse the prevalence of DDS, its diagnosis and treatment as well as the identification of risk factors.
Methods
A case report is presented alongside a review of the relevant literature regarding DDS.
Results
The available evidence suggests that the main risk factors for DDS are a history of mood disorders and behavioural disorders, but more studies are needed. Given that DDS is considered a rare adverse effect, physicians usually overlook voluntary dose increase by patients.
Conclusions
DDS, even though uncommon, has severe adverse effects such as dependence and acute psychosis. Before prescription of dopamine agonists, individual risk factors (such as psychiatric comorbidities or history of substance abuse) should be assessed. Also, patients and families should be informed and trained in alarm signs detection. Further studies would be justified to determine DDS prevalence, early diagnosis and treatment.
The examination of the cinematic metanarrative provides many possibilities for recovery-oriented addiction consultation. The key to efficiency can be the approach of the recipient’s point of view and attitude, with which the client can interpret his own traumas and life story retrospectively.
Objectives
Our aim is to show that the recognition, the turning points, the acknowledgement and the recovery from addiction can be described as a model in the deep structure of recovery stories. Can narrative research explore more deeply the main stages of recovery andidentity shaping, with the possible use of the film’s narrative technique?
Methods
12 recovering addicts were interviewed who have been clean for at least 4 years. Interviews covered the years spent as addicts and the path to recovery using the method of deductive metanarrative analysis.
Results
Based on the results of the analysis, elements of the film narrative could be found together major psychoanalysis concepts and literary theory models in the semi-structured interviews. Emotion control dysregulation all appear in the stories. Together these can be traced to a summary narrative and a historical line. Furthermore, the addicted person as a hero, the compulsion to repeat and its spookiness, and the role of the helpers also appear in the retrospective narratives without exception.
Conclusions
The well-structured, coherent recovery stories help the recoverer to reconstruct their self, to make the behavioral change permanent, thus reducing the chances of relapse. The film narrative and toolkit provide an opportunity based on similarities with the narrator’s framework, which can strengthen the recovering identity.
Football is the world’s most-watched and played sport. Even though sports psychiatry is steadily gaining importance, the stigma on mental illness in sports, especially football, and the limited number of articles on this topic means there is a pressing need for more study in this area. This narrative review begins to fill this gap. This review summarises the work on addictive disorders in sports, with a close focus on football, as well as mentioning some initiatives that are advancing our understanding of how mental illnesses in sports can be addressed.
Objectives
This view also contributes to understanding the reasons behind mental illness and sports, and raises awareness.
Methods
This review was conducted by searching for the keywords ‘addiction’ and ‘football’ on three different database search engines, namely, PubMed, Cochrane Library, and Medline. We found 26 articles based on this literature search with these keywords from 2005 to 2020. After data extraction, we cited 10 of them considering the specificity of addiction disorders in the football industry. 16 additional articles found by backwards citation chaining are also included in this review.
Results
The articles reviewed here investigate addictive disorders within the football sector by looking at the incidence of particular addictive disorders, their underlying reasons and their consequences. This piece concludes by showing the need for more research and new initiatives regarding addictive disorders within the target group of footballers.
Conclusions
A holistic, multidisciplinary and biopsychosocial approach is essential to provide long term solutions considering different factors contributing to addictive disorders in the football sector.
Internet addiction disorder (IAD) is the compulsive and problematic use of the internet, resulting in significant functional impairment in several life domains. This happens when an individual engages in online activities disregarding daily responsibilities or other interests, and not realizing its negative consequences. Although not officially recognized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), the relationships between digital media use and mental health has been under debate and discussion amongst experts due to presenting some features of excessive use, withdrawal phenomena, tolerance, and negative repercussions typical of many substance abuse disorders.
Objectives
To present an overview of theoretical considerations on IAD and its eventual inclusion in the next version of the DSM.
Methods
Review of the most recent literature regarding internet addiction disorder. The research was carried out through the PubMed, MedLine, SpringerLink and LILACS databases, using the terms “internet addiction”, “addiction disorders” and “social media”, until December 2020.
Results
There is controversy around the diagnosis of internet addiction, including whether it is a unique clinical entity or a manifestation of other underlying psychiatric disorders, raising complex questions of causality. Since there are no standardized definition, there is lack of evidence-based recommendations to its approach.
Conclusions
Research suggests that some individuals dealing with internet addiction are at significant risk, therefore merit professional care. Further research is needed, with carefully controlled studies, emphasizing incapacity, prognosis and response to treatment, in order to consider internet addiction as a disease, and include it in DSM’s next edition.
The word motivation derives from the Latin movere, which means to move. In psychiatry, it is an isolated phenomenon found in the substrate of several pathologies, and may be part of an heterogeneous dimensional spectrum. However, there is no unique definition for it, nor a targeted approach. In addictive disorders motivation gains a fundamental role, both as a precipitant of abuse as in its withdrawal.
Objectives
To review the literature about the concept of motivation and its implications on the psychopathology, especially on addictive disorders.
Methods
Narrative review on PubMed/MEDLINE, using the keywords “motivation” AND “psychopatology” AND “addiction”. Articles in English and Portuguese were included.
Results
Three main perspectives were found addressing the concept of motivation in psychopathological terms: psychological, neurobiological and phenomenological. The first describes motivation as the energizing of behaviour in pursuit of a goal. Neurobiology says motivational drive is dependent on the concentration of extrasynaptic dopamine. In phenomenological terms, the concept stands for the web of solicitations that make a certain situation feel in a certain way for the subject. In addictive disorders, learning about what leads to reward, exaggeration in representing those values, and dominance in being guided by those representations lead to alterations on motivation mechanisms.
Conclusions
Motivation is described from different perspectives. Although it is recognized as a fundamental piece in addictive disorders, besides motivational interview model, there are no pharmacological approaches aimed to improving motivation. The recognition of motivation as a concrete psychopathological alteration, and its measure through psychopathological instruments, could optimize the patient’s approach.
Excessive alcohol consumption is an ever-topical issue regardless of social or medical problems (pandemic). In these conditions (global medical crisis),to the problem of alcohol consumption has been added a new dimension.
Objectives
The main purpose of this study is to analyze the impact of the COVID-19 pandemic on hospitalizations diagnosed with acute intoxication in the hospital. In Romania, the measures due to the pandemic were instituted starting with March 15 2020.
Methods
The study was performed retrospectively between 01.01.2020 - 30.09.2020 in the Psychiatric Hospital ‘Elisabeta Doamna’ Galati. ICD-10 criteria were used to establish the diagnosis of the disorder.
Results
In total, 458 cases were admitted during the period mentioned, of which 401 were male (87.56%), female 57 cases (12.44%). The average age of patients was 45.67 years ± 0.695, with minimum age of 19 years and maximum age of 93 years. The month with the most admissions was January with 80 (17.46%) March by 79 (17.25 %). The months with the fewest hospitalizations were April with 27 cases (5.89%) and July with 35 cases (7.64%).
Conclusions
The analysis of the data shows that as measures specific to the epidemic crisis were instituted, the number of hospitalizations decreased significantly by about 3 times.
The fundamental basis of addiction is learning which is mediated by neuroplasticity. Treatment of addiction usually begins with detoxification. The signs and symptoms of withdrawal are usually opposite to the changes produced by the acute effects of the drug, appearing as a kind of rebound. The first treatment to use cross-tolerance as a maintenance strategy was discovered in heroin addiction by Vincent Dole and colleagues in the early 1960s. Researchers have been working for decades to learn the mechanism of action of important medications such as opioids. Another approach to the treatment of opioid addiction developed in preclinical laboratories involves the use of partial opioid agonists. The next advance in the treatment of tobacco dependence was the serendipitous discovery that the antidepressant bupropion reduced craving for cigarettes and improved abstinence rates. The clinical effects are analogous to the effects of buprenorphine in opioid addicts.
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