Psychiatric comorbidity in methadone maintained patients

Diagnosing comorbid psychiatric disorders in methadone maintained patients may help to identify subgroups with different outcomes and needs for treatment. In this study, 75 methadone maintenance clinic patients in treatment longer than 30 days were assessed with the Addiction Severity Index, Global Assessment Scale and Mini-Mental Status Exam, and were interviewed for DSM-III-R psychiatric diagnosis using the computerized Diagnostic Interview Schedule. Psychiatric diagnoses were prevalent in the sample with depression, phobic disorders, antisocial personality and generalized anxiety the most common. Both number of DSM-III-R diagnoses and severity of psychopathology were correlated with outcome measures such as concurrent drug abuse, family-social problems and employment status.     

A dental fears typology of oral surgery patients: Matching patients to anxiety interventions.

Two studies are described in which dental patients were administered the Dental Fear Survey (DFS) and then received 1 of 5 anxiety reduction interventions to prepare them for extraction of 3rd-molar teeth. Interventions included standard clinic treatment, oral premedications, and several relaxation-based procedures. Dependent variables were self-reported and observer-rated distress. In the 1st study (N?=?231), cluster analyses of the DFS subscales revealed that patients could be subtyped as low-fear, high-fear, or cue-anxious patients who admitted fear only in response to specific stimuli. Dental fear subtypes were distinguishable by situational cognitions reported, and fear subtype interacted with anxiety intervention to predict distress. These results were replicated in the 2nd study (N?=?150). The results are seen as supportive of a multidimensional view of dental anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of alcohol use among methadone patients

A combination of low-dose penicillin (75,000 IU/kg twice daily [b.i.d.]) vancomycin (30 mg/kg b.i.d.) and gentamicin (6 mg/kg b.i.d.) has been shown to be as effective as a combination of high-dose penicillin (500,000 IU/kg b.i.d.) and gentamicin (6 mg/kg b.i.d.) in the treatment of rabbit endocarditis caused by an Enterococcus faecium strain moderately resistant to beta-lactams and highly resistant to glycopeptides. The same regimens were evaluated against an E. faecium strain highly resistant to both penicillin (MIC, 128 micrograms/mL) and vancomycin (MIC, 512 micrograms/mL). High doses of penicillin-gentamicin and vancomycin-gentamicin had no effect in in vitro killing-curve studies or in rabbits after treatment for 5 days. High doses of penicillin-vancomycin were only bacteriostatic in killing curves and provided a small reduction in the bacterial titers of the vegetations. In contrast, high-dose penicillin-vancomycin-gentamicin was bactericidal in vitro and highly effective in treating rabbits. However, the emergence of a bacterial subpopulation resistant to the synergistic effect of penicillin and vancomycin could reduce the clinical utility of this combination.     

Changes in HIV risk behaviors among cocaine-using methadone patients

Cocaine use among methadone patients has been related to higher prevalence of HIV risk behaviors. HIV risk behaviors for cocaine-using patients in methadone treatment (N = 207) were examined for two time periods, the current month in-treatment and the month previous to treatment admission. All needle-related and sexually-related risk behaviors (except for needle hygiene) significantly and substantially declined over the average two year time interval. Several variables were associated with needle and sexual risks in multivariate regression analyses. Dropping apparent opiate use underreporters from the analyses did not alter the results. From a harm reduction perspective, high priority should be given to retaining cocaine-using patients in methadone maintenance, intensifying in-program services for those with anti-social personality, bipolar disorder or alcoholism, as well as increasing access to needle exchanges and free condoms.     

Personality disorders and treatment outcome in methadone maintenance patients

This study examined the relationship between personality disorder (PDs) and 7-month treatment outcome in 197 men admitted to methadone maintenance. Subjects reported pervasive improvement, and the amount of improvement did not significantly differ for those subjects with and without PDs. PD subjects entered treatment with more severe self-reported drug, alcohol, psychiatric, and legal problems, and despite progress, remained more problematic in those areas relative to subjects without PDs. Subjects with antisocial PD had admission and 7-month problem status similar to subjects with other PDs. The 7-month urinalysis results for opiates and cocaine showed no significant differences between subjects with and without PDs. Fewer PD subjects stayed in treatment continuously for the 7-month period. Several cluster B PDs-borderline, antisocial, and histrionic-predicted poorest overall outcomes. Methadone-maintained patients with PDs may warrant additional treatment services if they are to approach the functional level of patients without PDs.     

A typology of critical incidents in intergroup dialogue groups.

Latent semantic analysis (Landauer & Dumais, 1997) was used to derive pairwise similarity ratings based on the content of 102 critical incidents (CIs) identified by participants in four intergroup dialogues. The resulting similarity matrix was then analyzed with cluster analysis to identify the content themes of these CIs. The cluster analysis identified three superordinate clusters and nine content themes in the CIs. The three superordinate clusters were labeled: Cognitive, Affective, and Consciousness Raising change processes. The three Cognitive change processes were labeled: (1) Talking At, (2) Talking With, and (3) Facilitating the Conversation. The three Affective change processes were labeled: (1) Working Toward Acceptance, (2) Learning from Others’ Feelings and Experiences, and (3) Reflection on Felt Differences. The three Consciousness Raising change processes were labeled: (1) Having Eyes Opened, (2) Realizations about People, and (3) Personal Engagement. Similarities and differences between these change processes and change processes described in the group counseling literature are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A typology of university student living groups.

Subjected 100 university living groups measured on 10 dimensions of their social environments to cluster analysis to develop an empirically based taxonomy of university living groups. 5 distinctive clusters of living groups were identified: competition oriented, supportive achievement oriented, independence oriented, relationship oriented, and traditionally socially oriented. Clusters showed systematic differences in sex composition (i.e., male, female, and coed), size, and institutional affiliation. Some evidence that different clusters of living groups had different impacts on Ss was presented. It is concluded that an empirically derived taxonomy of the social environments of university living groups is a necessary step in understanding which types of living group programs produce optimal outcomes for various types of students. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The biological affects: A typology.

This typology of biological affects is based on developmental-interactionist theory of motivation, emotion, and cognition. Affects—subjectively experienced feelings and desires—involve interoceptive perceptual systems based on primordial molecules that characterize neurochemicals. Biological affects involve primary motivational–emotional systems (primes) associated with hierarchically organized neurochemical systems in the brain, including subcortical (reptilian) and paleocortical (limbic) brain structures. Affects fulfill individualistic (selfish) functions (arousal, approach–avoidance, agonistic) and prosocial (cooperative) functions. Selfish and cooperative functions are associated respectively with the right and left hemispheres. Biological affects constitute the physiological bases for higher level affects: social affects (e.g., pride, guilt, shame, pity, jealousy), cognitive affects (e.g., curiosity, surprise), and moral affects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study comparing severely and persistently mentally ill opiate-addicted patients in dual-diagnosis treatment with patients in methadone maintenance

Retroviral vector gene transfer strategies are currently being developed to treat a variety of hematopoietic disorders. To date, genetic modification of human pluripotent hematopoietic stem cells has been inefficient. In the present study we developed reagents and procedures for rapidly screening retroviral vector gene transfer conditions using a multiparameter fluorescence-activated cell sorting (FACS) assay. To identify transduced cells using FACS analysis, we developed a retroviral vector, termed MN, which stably expressed high levels of a truncated version of the low-affinity nerve growth factor receptor (LNGFR). In addition, procedures were developed for enriching CD34+ cells from cryopreserved umbilical cord blood. These cells were transduced with MN and evaluated using multiparameter FACS analysis for expression of CD34, CD38, and LNGFR. Stem cell maintenance was determined by measuring the CD34hi and CD34hiCD38lo/- cells remaining after ex vivo gene transfer. Gene transfer into these cells was measured by evaluating cells expressing high levels of LNGFR. Initial studies with this assay and with in vitro functional assays indicated that retroviral gene transfer following pre-incubation with a variety of cytokines in serum containing conditions resulted in 1) poor maintenance of hematopoietic stem cells and 2) gene transfer predominantly in relatively mature cells. When gene transfer in serum-free conditions was performed, some improvement was observed in the maintenance of cells retaining primitive immunophenotypes with no reduction in the gene transfer efficiency. The MN vector and multiparameter FACS analysis will be useful in efficiently screening ongoing efforts designed to improve stem cell gene transfer.     

Probable metabolic interaction between methadone and fluvoxamine in addict patients

Medical attitudes and behaviors in communicating diagnoses to patients found to have cancer were investigated in a sample of 126 practitioners in Italy. The research aimed at analyzing the medical approach to oncology patients and how they were provided information about their cancers and relevant treatments. In particular, psychosocial factors influencing the physician's decision whether or not to inform the patient of the diagnosis were examined. The results showed a significant interaction between the working environment and the practitioner's perception of cancer, which can impinge on the decision whether to provide the patient with information.     

Predicting cocaine group treatment outcome in cocaine-abusing methadone patients.

The authors examined predictors of cocaine group treatment outcome in methadone maintenance treatment (MMT) patients, including cocaine urinalysis at intake and demographic variables. Clinic policy is that patients identified as using cocaine must attend a weekly cocaine-focused, cognitive–behavioral therapy (CBT) group. Cocaine treatment is based on a behavioral (escape) contingency model whereby completers must attend group-counseling sessions and produce cocaine-negative urinalysis results. Among the 113 patients enrolled in the cocaine group, 43 (38%) were treatment completers (who attended 6 consecutive weeks of group and produced 6 consecutive weeks of cocaine-free urine tests) and 70 (62%) were treatment noncompleters. Treatment completion (i.e., cocaine abstinence) was significantly associated with baseline cocaine-free urinalysis and higher methadone dose. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of smoking and methadone dose in drug treatment patients.

Cigarette smoking prevalence is very high, and cessation rates are very low, among people in methadone treatment. This may in part be due to interactions between methadone administration and cigarette smoking. The present study explores relationships between methadone dose timing and smoking rates. Twenty methadone patients, over a period of 19 days, used electronic cigarette packs to record their smoking patterns and called a voice mailbox daily to report their methadone dose and timing. The average proportion of daily cigarettes smoked was calculated for 2-hr blocks preceding and following methadone dose administration. For all participants, peak smoking rates occurred after methadone administration. Participants smoked a greater proportion of cigarettes in their first 2-hr block after methadone dosing (M = 0.368, SD = 0.135) than during their first 2-hr block of smoking of the day (M = 0.245, SD = 0.010; S = 85.5, p     

Gut motility and transit changes in patients receiving long-term methadone maintenance

Chemical modification studies of BamHI endonuclease indicated the importance of the cysteine residue in catalysis [Nath, K. (1981) Arch. Biochem. Biophys, 212, 611-617]. Of the three cysteine residues at positions 34, 54 and 64 in the BamHI endonuclease Cys54 and Cys64 are at the DNA-protein interface. The co-crystal structure of the BamHI-DNA complex, however, does not indicate any role of cysteines either in binding or catalysis. In the context of strong biochemical evidence, Cys54 in BamHI was changed to Ala54 to investigate its role in catalysis. The mutation was carried out by PCR overlap extension, the mutant gene was cloned and characterized by sequencing. The mutant BamHI was expressed and purified to homogeneity and the kinetic parameters (K(M) and kcat) of the wild type and the C54A mutant were determined. The mutation results in up to approximately 40% enhancement of kcat and some increase in K(M). These in vitro results were also supported by in vivo SOS induction assays: the C54A mutant gene under the T7 promoter caused complete lysis in JH139 in absence of T7 RNA polymerase whereas the wild-type gene gave deep blue colonies under the same conditions. The results suggest no direct role of Cys54 in catalysis, but it can influence the catalytic activity through Val57 backbone contact seen in the co-crystal structure.     

Broad beneficial effects of cocaine abstinence reinforcement among methadone patients

Escalating reinforcement for sustained abstinence has been effective in treating cocaine abuse. Under this schedule, patients receive vouchers for cocaine-free urine samples; vouchers have monetary values that increase with the number of consecutive cocaine-free urine samples. Cocaine-abusing methadone patients were randomly assigned to receive vouchers for 12 weeks under (a) an escalating schedule (n = 20), (b) an escalating schedule with start-up bonuses (n = 20), or (c) a noncontingent schedule (n = 19). Start-up bonuses were designed to provide added reinforcement for initiating abstinence; however, they did not improve outcomes. Both contingent interventions significantly increased cocaine abstinence. In addition, the contingent interventions increased abstinence from opiates and decreased reports of cocaine craving. These results replicate the efficacy of cocaine abstinence reinforcement and show that it can have broad beneficial effects.     

Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients.

Contingency management (CM) interventions frequently utilize vouchers as reinforcers, but a prize-based system is also efficacious. This study compared these approaches. Seventy-four cocaine-dependent methadone outpatients were randomly assigned to standard treatment (ST), ST plus a maximum of $585 in contingent vouchers, or ST plus an expected average maximum of $300 in contingent prizes for 12 weeks. CM participants achieved longer durations of abstinence (LDA) than ST participants, and CM conditions did not differ significantly in outcomes or amount of reinforcement earned. Although long-term abstinence did not differ by group, LDA during treatment was the best predictor of abstinence at 9 months. Thus, reinforcement with prizes was similar to voucher CM in promoting LDA, which is associated with posttreatment benefits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal patterns of heroin and cocaine use among methadone patients

A sample of 1,038 patients newly admitted to 15 methadone clinics in New York City were studied for up to three years in treatment or until discharge. Cluster analysis identified distinct patient groups with very different heroin and cocaine usage patterns during treatment. About 80% either started in or transitioned to a low heroin use group and 50% either started in or transitioned to a low cocaine use group during treatment. One-third of patients used cocaine extensively during treatment. Other "high risk" groups, such as those not recently employed, younger, or involved with criminal justice, could benefit from special interventions very early in treatment.     

Driving fitness/driving capacity of patients treated with methadone

To answer the question whether or not therapeutic methadone doses significantly reduce traffic-related performance of drivers on medically supervised methadone programmes, 34 methadone substitution patients, all of them volunteers, were subjected to a test series: the focus of the study was a psychophysical test battery consisting of 10 individual performance tests to assess essential functions with regard to driving ability, such as concentration, attention, reaction capability, memory, perception and sensorimotor coordination. In evaluating the results of the psychophysical tests, multiple drug use and subjective methadone influence at the time of the examination were taken into consideration but current methadone blood level was neglected. The results were compared to those of a control group. The methadone group (n = 34) consisted of 25 men and 9 women aged between 18 and 38. At the time of the study, the majority of the test persons (29) were on low dosage methadone maintenance (up to 60 mg/day). In the urine samples of approximately 2/3 of the test persons, evidence was found for multiple drug use together with other psychotropic substances, the most frequent (14) being cannabis metabolites. Referring to their driving practices, a mere 4 out of 29 drivers had not committed any driving offences. A comparison of the psychophysical performance of the whole methadone group (n = 34) with a control group demonstrated that the methadone substitution patients achieved rather lower results in almost all variables. These performance deficits were particularly conspicuous in sustained attention, sensorimotor coordination and reaction capability. 12 "methadone only" participants, i.e. methadone probands without any additional consumption of psychotropic substances showed-partly considerably-better performance than the methadone group as a whole and also achieved normal results in relation to the test norm. Nevertheless, once again, results tended to be of lower level in comparison to the control group. "Methadone only" substitution patients, in particular those volunteers without a current subjective methadone influence-reached practically the same results as the corresponding control subjects, or at least average results based on test norm. However, the study revealed distinctive performance impairment (e.g. in sustained attention, reaction capability) when other psychotropic substances (including alcohol and cannabis!) were taken as well during the subjective methadone phase. The performance deficits were predominantly caused by a slowing down of reactions. Our study illustrates that, under certain conditions, long-term methadone maintenance under strict medical supervision does not have any significant unfavourable impact on the psychophysical performances in driving ability as examined in this study. Thus, these research findings support the previous Zurich experiences, according to which driving ability--and in the end also driving aptitude--of the methadone substitution patients does not depend on the methadone therapy itself, nor on the amount of the daily methadone intake. In making the final medical judgement on driving ability, the presence of a mixed drug use and the personality of the person in question are of far greater importance.     

A typology of incestuous families based on cluster analysis.

Data on abuse characteristics and family variables from 81 female adult incest survivors were subject to cluster analysis. Three clusters emerged: (1) women with the least severe abuse (as measured by type, duration, onset age, coercion, and number of perpetrators), with no severe physical family violence and the least family pathology with respect to cohesion, control, and conflict; (2) women with moderate abuse severity, more serious family problems, and families characterized by father dominance; and (3) a small group of women with severe and traumatic abuse, conflicted and controlling families, and extremely violent parents. Self-reported family variables and adjustment measures (dissociation and personality disorders) external to the cluster analysis differentiated the clusters and provided evidence of their validity. Implications for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A typology of alcohol abusers: Correlates and implications.

Used data from 725 individuals (mean age 38.1 yrs) seeking help for alcohol-related problems who had been administered the Michigan Alcoholism Screening Test; the Social Readjustment Rating Scale; the Personality Research Form; Rotter's Internal–External Locus of Control Scale; the Standard Progressive Matrices; the Vocabulary and Digit Symbol subscales of the WAIS; and measures of alcohol use, lifetime drinking history, basic personality, SES variables, and response styles to cluster analyze for types of drinkers. Analysis yielded 3 types: Type 1 Ss (early-stage problem drinkers) represented a fairly heterogeneous group, Type 2 Ss (affiliative, moderately dependent drinkers) were more socially oriented and drank on a daily basis, and Type 3 Ss (schizoid, severely dependent drinkers) were socially isolative, tended to drink in binges, and reported the most severe symptoms of alcoholism. A speculative model is proposed that consists of the 3 types superimposed on an underlying continuum of alcohol dependence; it is suggested that the model has heuristic value for stimulating further research on the etiology and differential treatment of alcohol abuse. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)