Rapid progression of coronary artery disease in the setting of chronic cocaine abuse

Centipeda minima, a herb used medicinally to treat sinus infections in Nepal, was found to contain three antibacterial sesquiterpene lactones, identified as 6-O-methylacrylylplenolin, 6-O-isobutyroylplenolin, and 6-O-angeloylplenolin. 6-O-Methylacrylylplenolin had not been previously isolated from C. minima. All three had activity against Bacillus subtilis and Staphylococcus aureus, with 6-O-isobutyroylplenolin being the most active.     

Effects of repeated-dose isradipine on the abuse liability of cocaine.

Despite preclinical studies suggesting that isradipine may antagonize the abuse liability of cocaine, pretreatment with sustained-release isradipine did not reduce euphoric mood in cocaine-using volunteers. This double-blind, within-subject, crossover laboratory study determined whether maximal dose-loading with isradipine could antagonize effects of cocaine in 12 cocaine-dependent research volunteers administered intravenous cocaine doses (0, 0.325, and 0.65 mg/kg) on different days after 5 days of treatment with isradipine or placebo. Isradipine dose was 30 mg sustained release nightly plus 15 mg immediate release 2 hr before cocaine infusion. Cocaine produced dose-related increases in cocaine's subjective effects and a behavioral measure of reinforcement. Isradipine enhanced, rather than antagonized, subjective effects, indicating that isradipine does not antagonize cocaine's abuse liability in dependent research volunteers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nasal cocaine abuse presenting as a central facial destructive granuloma

We describe a 36-year-old patient with an aggressive, midline intranasal and naso- and oropharyngeal destructive process. For months the patient denied heavy abuse of nasal cocaine, but finally admitted it. Necrosis and atrophy of the inferior and middle nasal turbinates bilaterally, prominent naso and oropharyngeal ulcers, nasal septal as well as hard palate perforation were observed clinically. Repeated biopsies revealed focal areas of chronic inflammation and necrosis, but there was no evidence of vasculitis or granuloma formation. Since serum was slightly positive for antineutrophil cytoplasmic antibody, the initial diagnosis was Wegener's granulomatosis. In the United States there have been a few reports on a new cocaine-associated syndrome presenting as an aggressive, midline, intranasal and intrapharyngeal destructive process mimicking limited Wegener's granulomatosis and midline reticulosis. We report the first such case in Europe and offer guidelines for the diagnostic work-up of such cases.     

Mesenteric ischemia secondary to cocaine abuse: case reports and literature review

In summary, we report two cases of mesenteric ischemia following cocaine abuse in young women. In such cases it is always difficult to prove a direct causal relationship between the abuse of cocaine and mesenteric ischemia. Both our patients were relatively young (in their thirties) and did not have any history of atherosclerosis, and their urine toxicity screens were positive for the use of cocaine. Cocaine-related hospital visits are on the increase. Mesenteric ischemia should be considered in the differential diagnosis when evaluating a young patient with a history of cocaine abuse presenting with an acute abdomen.     

Emotion-focused coping as a mediator of maternal cocaine abuse and antisocial behavior.

A great deal of data implicate parental drug use as a potential risk factor for child abuse, however, theories for understanding the links between maternal drug use and antisocial behavior have yet to be examined empirically. This case-control study investigated correlates of adult antisocial behavior among 279 inner-city mothers in 3 comparison groups: drug abusers, (n = 112), depressed mothers (n = 73), and nonsubstance abusing controls (n = 94). Using hierarchical regression techniques and mediational analyses controlling for ethnicity, current depression, and family history of substance abuse, support was provided for an emotion-focused coping style as a link between addictive and antisocial behavior. These results highlight the importance of focusing on emotion regulation models in the prevention and treatment of violence in drug-abusing women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Galantamine improves sustained attention in chronic cocaine users.

Chronic cocaine users are known to have cognitive deficits that are predictive of poor treatment response. Whether these deficits improve with medications targeting specific cognitive functions has not been examined in previous studies. The goal of this study was to evaluate galantamine's efficacy on selected cognitive outcomes, including measures of sustained attention, response inhibition, and attentional bias in recently abstinent cocaine users. Galantamine, a reversible and competitive inhibitor of acetylcholinesterase, is used clinically in the treatment of Alzheimer's dementia. In a randomized, double-blind, parallel-group study, 34 participants were randomized to galantamine (8 mg/day) or placebo treatment for 10 days. Cognitive and self-report mood measures were obtained at baseline and on Days 5 and 10 after the initiation of treatment. Galantamine treatment, compared to placebo, improved the reaction time, F(2, 50) = 8.6, p .05). These results demonstrate that medications can enhance cognitive function (e.g., sustained attention) in abstinent cocaine users. The potential efficacy of galantamine as a treatment for cocaine abuse needs to be further evaluated in clinical trials. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Depressive symptoms among amphetamine and cocaine users before and after substance abuse treatment.

This study examined whether higher rates of depressive symptoms among amphetamine compared with cocaine users result from amphetamine use itself, polydrug use, or experiencing a major lifetime depressive episode and whether depressive symptoms among amphetamine users are more likely to persist 12 months after treatment. The association between amphetamine use and depressive symptoms disappears when controlling for polydrug use and lifetime major depressive episode. Polydrug use and lifetime depressive episode are significantly related to depressive symptoms in the year preceding treatment. Amphetamine use at intake does not predict depressive symptoms among individuals who are abstinent at follow-up, and amphetamine users are no more likely than cocaine users to report depression at a 12-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief coping skills treatment for cocaine abuse: substance use outcomes at three months

AIMS: Coping skills training, a promising treatment approach for alcoholics, was adapted for use with cocaine abusers and effects on outcome were investigated. DESIGN: A cocaine-specific coping skills training (CST) package was compared to an attention placebo control when both were added to a comprehensive treatment program. SETTING: The sites were two private substance abuse treatment facilities, one residential and rural, and one an urban partial hospital. PARTICIPANTS: Substance abusers in treatment with cocaine abuse or dependence were selected. INTERVENTION: The CST intervention was conducted in individual sessions. It involved functional analysis of high risk situations and coping skills training based on the functional analysis. FINDINGS: Clients who received CST had significantly fewer cocaine use days and the length of their longest binge was significantly shorter during the 3-month follow-up period compared to clients in the control condition. CST did not affect relapse rates or use of other substances. CONCLUSIONS: Results support the notion that cocaine-specific CST is a promising adjunct to treatment for cocaine abusers.     

Brief coping skills treatment for cocaine abuse: 12-month substance use outcomes.

Patients (N?=?108) in a study of cocaine-specific coping skills training (CST), which was found to reduce cocaine use during a 3-month follow-up, were followed for an additional 9 months. CST involved coping skills training in the context of high-risk situations. Control treatment used meditation-relaxation. Both were added to comprehensive private substance abuse treatment. Patients in CST who relapsed had significantly fewer cocaine use days than did the control group during the first 6 months, then both conditions did equally well. Patients in CST also drank alcohol more frequently in the last 6 months than did contrast patients but did not differ in heavy drinking days. For cocaine use outcomes, no interaction of treatment was found with gender, education, route of administration, drug use severity, sociopathy, or depression. Implications include the need to investigate different lengths and combinations of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of housing costs on polydrug abuse patterns: A comparison of heroin, cocaine, and alcohol abusers.

This study evaluated how price of housing affects hypothetical purchasing decisions. Participants (26 heroin, 28 cocaine, and 15 alcohol abusers, and 25 controls) were exposed to 4 conditions in which they "purchased" drugs, food, housing, and entertainment. Whereas income remained constant, housing prices varied across conditions. Except for 23% of heroin abusers, participants purchased housing regardless of cost, so that income increased as housing cost decreased. Demand for food was income inelastic, whereas demand for entertainment was income elastic. Each group showed income elastic demand for their drug of choice. Hypothetical choices were reliable; drug choices were correlated with urinalysis results, and willingness to forgo housing in the simulation was correlated with time spent homeless in real life. This study shows that changes in housing prices may affect choices for drug and nondrug reinforcers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurochemical and behavioral evidence supporting (+)-AJ 76 as a potential pharmacotherapy for cocaine abuse

In vivo microvoltammetry was used to detect synaptic concentrations of dopamine (DA) and serotonin (5-HT) from nucleus accumbens (NAcc) in awake, freely moving, male, Sprague Dawley laboratory rats, while their locomotor behavior was monitored, simultaneously, in an open-field paradigm; the purpose was to evaluate the pharmacology of the D3-preferring, dopamine (DA) autoreceptor antagonist, (+)-AJ 76 [cis-(+)-1S, 2R-5-methoxy-1-methyl-2-(n-propylamino)-tetralin HCL] and its potential use as a pharmacotherapy for cocaine abuse. Results showed that (1). (+)-AJ 76 significantly increased synaptic concentration of DA above baseline (p < 0.001); a small but significant decrease in synaptic concentration of 5-HT was seen (p < 0.001), although a significant increase occurred during the time course, at the 20 minute mark (p < 0.05). Analysis of the two hour data also showed that both locomotor and central locomotor activity were not affected; however, temporally related increases in both behaviors were significant at 10, 20 and 30 minutes (p < 0.05). In a second and separate study, (2). cocaine increased synaptic concentrations of DA (p < 0.001) and 5-HT (p < 0.001), and locomotor activity (p < 0.001) above baseline, but central locomotion was not affected, except for specific temporal enhancements at 10, 20, 30, 50, 60 and 90 min. (p < 0.05). In a third and separate study, (3). an (+)-AJ 76/cocaine study, (+)-AJ 76 was administered five minutes before cocaine. The results showed that synaptic DA concentration was significantly increased over baseline values (p < 0.001) but that synaptic DA was lower than cocaine-induced synaptic DA (p < 0.001). No significant difference in synaptic 5-HT occurred after (+)-AJ 76/cocaine treatment, but temporally related increases over baseline occurred from 10 to 40 min. (p < 0.05). Synaptic 5-HT concentrations after (+)-AJ 76/cocaine were not significantly different from those induced by cocaine per se. (+)-AJ 76/cocaine treatment significantly increased locomotor activity (p < 0.001); central locomotor behavior was not affected, however, time course data showed significant increases at 10, 20, 40, 50 and 80 min. (p < 0.05). The major finding from the present studies, is that +(-) AJ 76/cocaine treatment produced synaptic concentrations of DA from NAcc which were lower than those due to cocaine per se, while no differential effect on synaptic 5-HT concentration, locomotor or central locomotor behavior occurred. Therefore, these data support the hypothesis that (+)-AJ 76 may be useful for the treatment of cocaine addiction or abuse.     

Sensation seeking, substance abuse, and psychopathology in treatment-seeking and community cocaine abusers.

Sensation seeking, substance abuse severity, and psychiatric disorders were systematically assessed in a clinical and a community sample of 335 cocaine abusers. In contrast to low-sensation-seeking cocaine abusers, high-sensation seekers exhibited more severe symptoms of substance abuse, exhibited more severe psychosocial impairment, were more likely to be polysubstance abusers, and had an earlier age of onset for substance use and abuse. High-sensation seekers were more likely to report both a lifetime history and family history of antisocial personality, attention deficit disorders and conduct disorder. Sensation seeking was related to several dimensions that are important for defining subtypes of substance abusers and was consistent with other features of a Type II classification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical applications of functional MRI in neuropsychiatry

Clinical neuroimaging is due for yet another sea change as functional neuroimaging becomes increasingly powerful and available. Functional magnetic resonance imaging (fMRI) is perhaps the most promising of the emerging techniques. The following review helps us understand the physics, strengths, limitations, and promise of fMRI. The authors are all affiliated with the Brain Imaging Center at McLean Hospital and with the Departments of Neurology (Dr. Levin) and Psychiatry (Dr. Renshaw) at Harvard Medical School.     

Influence of treatment readiness on outcomes of two pharmacotherapy trials for cocaine abuse among methadone-maintained patients.

Secondary analyses were conducted on data from 2 pharmacotherapy trials for cocaine dependence in methadone-maintained patients to explore factors potentially associated with treatment readiness. One trial enrolled current cocaine users, and the other enrolled newly abstinent patients. Newly abstinent patients showed evidence of treatment readiness in that they submitted fewer cocaine-positive urine specimens during the trial and reported more aversion than craving in response to cues, greater self-efficacy in high-risk situations, greater confidence in treatment, and less depression. They identified less with an "addict" self-schema and were motivated to stop using cocaine because of perceived consequences to health and freedom and a desire for self-control. The influence of treatment readiness in pharmacotherapy trials is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reversible neurological complications in chronic alcohol abuse with hypophosphatemia

Severe hypophosphatemia is rare, usually affecting chronic alcoholics and patients under total parenteral nutrition. The most important clinical features are rhabdomyolysis and neurological deficits. The latter may take various forms and can affect the peripheral as well as the central nervous system. Symptoms of polyradiculitis with progressive paresis or cerebellar symptoms such as dysarthria, dysphagia and ataxia are frequent manifestations. Rarely, hypophosphatemia can cause confusional states, epileptic seizure or coma. The differential diagnosis includes Guillain-Barré polyradiculitis, diffuse encephalopathy, Wernicke encephalopathy and central pontine myelinolysis. We describe the neurological signs in a female chronic alcoholic who developed severe ataxia and tetraparesis after a week's course of parenteral, phosphate-free nutrition. Complete recovery occurred after adequate substitution of phosphate.