Effectiveness of Low-Dose Naltrexone in the Post-Detoxification Treatment of Opioid Dependence.

J Clin Psychopharmacol. 2007 Oct;27(5):468-474.

Related Articles, Links

Effectiveness of Low-Dose Naltrexone in the Post-Detoxification Treatment of Opioid Dependence.

Mannelli P, Patkar AA, Peindl K, Murray HW, Wu LT, Hubbard R.

*Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; †Brown University, Providence, RI.

BACKGROUND:: The clinical use of naltrexone (NTX) in the treatment of opioid dependence has been limited because of poor compliance and inconsistent outcomes. In particular, the therapeutic benefit of extended treatment with NTX after opioid detoxification is unclear. The present study evaluated whether the augmentation with low-dose NTX during the post-detoxification treatment of opioid dependence would improve outcomes. METHODS:: In an open-label naturalistic design, 435 opioid-dependent patients who had completed inpatient detoxification were offered the choice of entering 1 of the 2 outpatient treatment arms: clonidine extended treatment (CET) (clonidine + psychosocial treatment), or enhanced extended treatment (EET) (oral NTX [1-10 mg/d] + CET) for 21 days. The primary outcome measure was retention in treatment. Secondary outcomes included abstinence from opioids, dropouts, and adherence to postdischarge care. RESULTS:: One hundred sixty-two patients (37.2%) accepted EET. Subjects receiving EET stayed longer in the program (F = 64.4; P = 0.000), were less likely to drop out, used less opioids, and followed through with referral to long-term outpatient treatment in a higher number, compared with patients in the CET arm (P = 0.000 in each case). The NTX + clonidine combination was safe and well tolerated. CONCLUSIONS:: This preliminary study indicates the potential benefit of augmentation with low-dose NTX to improve outcomes after opioid detoxification for a preferred group of patients. Randomized controlled trials are necessary to further evaluate the role of low-dose NTX in the outpatient treatment of opioid dependence.

PMID: 17873678 [PubMed - as supplied by publisher]

Turning back the clock: adopting a healthy lifestyle in middle age.

Am J Med. 2007 Jul;120(7):598-603. Epub 2007 Apr 19.

Related Articles, Links

Turning back the clock: adopting a healthy lifestyle in middle age.

King DE, Mainous AG 3rd, Geesey ME.

Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. kingde@musc.edu

PURPOSE: To determine the frequency of adopting a healthy lifestyle (5 or more fruits and vegetables daily, regular exercise, BMI 18.5-29.9 kg/m2, no current smoking) in a middle-aged cohort, and determine the subsequent rates of cardiovascular disease (CVD) and mortality among those who adopt a healthy lifestyle. METHODS: We conducted a cohort study in a diverse sample of adults age 45-64 in the Atherosclerosis Risk in Communities survey. Outcomes are all-cause mortality and fatal or non-fatal cardiovascular disease. RESULTS: Of 15,708 participants, 1344 (8.5%) had 4 healthy lifestyle habits at the first visit, and 970 (8.4%) of the remainder had newly adopted a healthy lifestyle 6 years later. Men, African Americans, individuals with lower socioeconomic status, or a history of hypertension or diabetes were less likely to newly adopt a healthy lifestyle (all P <.05). During the following 4 years, total mortality and cardiovascular disease events were lower for new adopters (2.5% vs 4.2%, chi2P <.01, and 11.7% vs 16.5%, chi2P <.01 respectively) compared to individuals who did not adopt a healthy lifestyle. After adjustment, new adopters had lower all-cause mortality (OR 0.60, 95% Confidence Interval [CI], 0.39-0.92) and fewer cardiovascular disease events (OR 0.65, 95% CI, 0.39-0.92) in the next 4 years. CONCLUSIONS: People who newly adopt a healthy lifestyle in middle-age experience a prompt benefit of lower rates of cardiovascular disease and mortality. Strategies to encourage adopting healthy lifestyles should be implemented, especially among people with hypertension, diabetes, or low socioeconomic status.

Publication Types:

• Research Support, N.I.H., Extramural

PMID: 17602933 [PubMed - indexed for MEDLINE]

Depressive Symptoms Predict Mucosal Wound Healing.

Psychosom Med. 2007 Aug 31; [Epub ahead of print]

Related Articles, Links

Depressive Symptoms Predict Mucosal Wound Healing.

Bosch JA, Engeland CG, Cacioppo JT, Marucha PT.

College of Dentistry (J.A.B., C.G.E., P.T.M.), University of Illinois at Chicago, Chicago, Illinois; School of Sport and Exercise Sciences (J.A.B.), University of Birmingham, Birmingham, UK; Department of Psychology (J.T.C.), University of Chicago, Chicago, Illinois; and Institute for Behavioral Medicine Research (J.A.B., C.G.E., P.T.M.), Ohio State University, Columbus, Ohio.

Objective: There is mounting evidence that psychosocial stress can delay wound healing, but this literature almost exclusively pertains to dermal wound healing. Many surgical procedures involve damage to mucosal tissues and the time course and the role of repair processes, such as inflammation, in the healing of these tissues are markedly different from those in dermal healing. Feelings of depression and social isolation are common among surgical patients, and the present study therefore investigated if these factors predict the rate of mucosal wound healing. Methods: Undergraduate students were invited to participate in the study if they reported high or low levels of loneliness or depressive symptoms, corresponding to the upper or lower quintile of their peer group. The UCLA loneliness scale and the Beck Depression Inventory [short form] were used for this screening. A sample of 193 healthy young adults (age range 18-31 years) received a 3.5-mm circular wound on the oral hard palate, under local anesthesia. Healing was monitored by daily videographs of the wound. Results: The median healing rate was 7 days. High dysphoric participants were, however, more likely to heal slower than this median healing rate (odds ratio 3.57 (1.58-8.07); p < .001). This association remained robust after correction for a broad range of demographic and behavioral variables, including gender, age, ethnicity, and health behaviors. High dysphoric individuals also exhibited significantly larger average wound sizes from day 2 post wounding onward. Loneliness and diurnal cortisol secretion (measured over 5 days) were unrelated to healing. Conclusion: Depressive symptoms predict the rate of mucosal wound healing in healthy young adults. We discuss potential pathways that warrant further investigation.

PMID: 17766687 [PubMed - as supplied by publisher]

Association between reduced sleep and weight gain in women.

Am J Epidemiol. 2006 Nov 15;164(10):947-54. Epub 2006 Aug 16.

Related Articles, Links

Association between reduced sleep and weight gain in women.

Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB.

Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, USA. srp20@case.edu

Physiologic studies suggest that sleep restriction has metabolic effects that predispose to weight gain. The authors investigated the association between self-reported usual sleep duration and subsequent weight gain in the Nurses' Health Study. The 68,183 women who reported habitual sleep duration in 1986 were followed for 16 years. In analyses adjusted for age and body mass index, women sleeping 5 hours or less gained 1.14 kg (95% confidence interval (CI): 0.49, 1.79) more than did those sleeping 7 hours over 16 years, and women sleeping 6 hours gained 0.71 kg (95% CI: 0.41, 1.00) more. The relative risks of a 15-kg weight gain were 1.32 (95% CI: 1.19, 1.47) and 1.12 (95% CI: 1.06, 1.19) for those sleeping 5 and 6 hours, respectively. The relative risks for incident obesity (body mass index: >30 kg/m(2)) were 1.15 (95% CI: 1.04, 1.26) and 1.06 (95% CI: 1.01, 1.11). These associations remained significant after inclusion of important covariates and were not affected by adjustment for physical activity or dietary consumption. These data suggest that short sleep duration is associated with a modest increase in future weight gain and incident obesity. Further research is needed to understand the mechanisms by which sleep duration may affect weight.

Publication Types:

• Research Support, N.I.H., Extramural
• Research Support, Non-U.S. Gov't

PMID: 16914506 [PubMed - indexed for MEDLINE]

DSM Biases Evident in Clinical Training and Courtroom Testimony

An important article by Gopal and Bursztajn on the limitations of manual-driven diagnosis (and treatment). It starts:

>>The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM),1 which was most recently revised in 2000 with DSM, fourth edition, text revision (DSM-IV- TR), has been helpful in promoting inter-rater reliability or agreement among clinicians. This reliability has been achieved by moving from a causation-heavy, narrative-rich system to a causation-free, narrative- and context-empty system of diagnostic categories. However, as helpful as an increased degree of agreement among clinicians may be, this measure of the reliability of a diagnosis does not indicate if the diagnosis is valid. A challenge for those involved in the construction of the DSM, fifth edition (DSM-V) is how to retain the strength of reliability and increase diagnostic validity. When decisions need to be made quickly, heuristic processes are more likely to be used,2 reacting to the need for speed with simplifying strategies for diagnostic decision-making. However, when clinicians lack the time to check if the processes they used have led to a fundamentally misleading diagnosis,errors are more likely to go unnoticed. With insufficient time to learn about individual patients, and to observe them, there is a growing tendency to make premature cognitive commitments to diagnoses that fit the menu or bulletpoint layout of the DSM.3 Heuristic approaches are routinely employed to limit potential information overload in diagnostic decision-making.4 Unfortunately, reliance on simplifying procedures may introduce unintended biases, which are magnified by the categorical structure of the DSM.In this context, recent work on Holocaust survivors has shown that posttraumatic stress disorder (PTSD) combined with psychosis presents a diagnostic and clinical challenge.5 Throughout the course of repeated diagnostic interviews, PTSD symptoms decreased for some of these survivors; however, this does not mean that PTSD disappeared from their lives.

[The full text is here: http://www.psychiatricannalsonline.com/showPdf.asp?rID=23800]

Acute exercise reduces the effects of a 35% CO(2) challenge in patients with panic disorder.

J Affect Disord. 2007 Aug 27; [Epub ahead of print]

Related Articles, Links

Acute exercise reduces the effects of a 35% CO(2) challenge in patients with panic disorder.

Esquivel G, Díaz-Galvis J, Schruers K, Berlanga C, Lara-Muñoz C, Griez E.

Academic Anxiety Center, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.

BACKGROUND: Chronic exercise has been shown to have therapeutic effects in panic disorder (PD). The mechanism of these effects is unknown. Acute exercise reduces the effect of a panic challenge in healthy volunteers. Such an effect has not yet been demonstrated in PD patients. The present study aimed at exploring the antipanic effects of acute exercise on a 35% CO(2) panic provocation in treatment-naïve PD patients to further elucidate the mechanisms of the beneficial effects of exercise on panic. METHODS: Eighteen PD patients performed either moderate/hard exercise or very-light exercise before a 35% CO(2) challenge in a randomized, between-group design. The reactivity to CO(2) was assessed with the Visual Analogue Anxiety Scale and the DSM-IV Panic Symptom List. RESULTS: Panic reactions to CO(2) were smaller in patients that performed moderate/hard exercise in contrast to those that performed very-light exercise. Increments in both measurements and panic rates were consistently reduced by intense exercise. LIMITATIONS: Since this study focuses on the acute effects of exercise on CO(2) sensitivity in patients with PD, the results of repetitive exercise sessions on the rate of spontaneous panic attacks and overall symptoms are warranted. The small sample size and other limitations are addressed. CONCLUSIONS: Exercise reduced the panicogenic effects of a CO(2) challenge. In addition to its therapeutic potential, exercise may also be useful as a laboratory maneuver with heuristic value in experimental research into the mechanisms of antipanic treatment.

PMID: 17727960 [PubMed - as supplied by publisher]