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Currently available psychotherapies and psychotropic drugs for post-traumatic stress disorder (PTSD) are poorly effective in a substantial proportion of patients. Dopaminergic dysfunction plays a prominent role in the pathophysiology of PTSD: intrusions, avoidance symptoms, anhedonia and emotional numbing. Dopamine reuptake inhibitors can be studied as novel drugs in PTSD treatment.
Explore methylphenidate as a promising drug in PTSD treatment.
Case report presentation based on the review of clinical notes and non-systematic review of the PTSD therapeutics state-of-the-art.
A 72-year-old Portuguese male, a veteran of the Angolan War, sought medical attention four years ago after the death of his brother, which had happened three years before the consultation. The clinical picture consisted of re-experiencing the war and the loss of his brother, flash-backs, nightmares, irritability, a fear of losing control, inner dialogues with occasional intra-psychic voices, emotional numbing with the impossibility of developing loving relationships with his relatives, feelings of unreality, an episode of dissociative fugue and complaints of episodic forgetfulness and time warp. He was diagnosed with PTSD with dissociative symptoms, based on DSM 5 clinical criteria. He was initially treated with SNRIs and risperidone, with little improvement. A year ago, he suffered a flare-up, with suicidal ideation. He was prescribed methylphenidate 36 mg, with progressive improvement, persisting mild PTSD residual symptoms.
There is enough evidence of the dopamine involvement in PTSD, although research on dopaminergic drugs is scarce. Methylphenidate may be promising in the treatment of at least some individuals that haven’t responded to current psychological and medical interventions.
Patients with substance use disorders (SUD) have higher alexithymia levels and present frequently suicidal ideation (SI) and suicide (SA) [1,2]. Beside, alexithymia has been related to suicidal behaviors in several psychiatric disorders. Although, there are some studies on alexithymia and suicidality in SUD patients, to our knowledge there are no studies on this issue in Spanish population.
To compare the alexithymia levels in SUD patients with and without SI and SA in an outpatient addiction treatment center in Spain.
This is a cross-sectional study performed on 110 patients (74.3%males; mean age 43.6±14.5years old) for whom we had information from the Toronto Alexithymia Scale(TAS-20) and the presence or not of lifetime SI and SA.
Lifetime SI and SA were present in 55.5% and 35.5% of the sample respectively. The mean score of TAS-20, difficulties identifying feelings (DIF), difficulties describing feelings (DDT), and externally-oriented thinking(EOT) were 57.2±13.3, 20.0±7.0, 14.7±4.5, and 22.5±4.5 respectively.
SI and SA may be related to alexithymia levels. Hence, alexithymia should be further analyzed in SUD patients in longitudinal studies in order to analyze the bilateral association with suicidal spectrum behaviors. REFERENCES Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-5. Morie KP, et al. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3(2):239-48. Hemming L, et al. A systematic review and meta-analysis of the association between alexithymia and suicide ideation and behaviour. J Affect Disord. 2019;254:34-48.
The inhibitory effect of positional syllable frequency is a well-known phenomenon in visual word recognition: words with high-frequency syllables require extra time for deactivating the lexical syllabic neighbors. The inhibitory effect implies that a connection exists between graphemes, phonemes, the first syllable, and the phonological lexicon. However, experimental results of the first developmental stages of occurrence are scarce and inconclusive. A second- and fourth-grade sample of typical school readers participated in a lexical decision task containing high/low frequency words and high/low syllable frequency words. Our primary hypothesis was that the inhibitory effect would be found on both school grade groups. We did not predict significant differences in magnitude of effect between second- and fourth-grade participants. A general inhibitory effect was found, and separate analyses by school grade groups also indicated significant inhibitory effects. Furthermore, second- and fourth-grade children showed small sizes of the inhibitory effect, resembling the sizes found in adult normal readers. Our results suggest that Spanish readers reach a functional connection between syllables and words at an early stage. The straightforward theoretical implication is that the inhibitory effect relies heavily on the structural properties of the lexical access system that are acquired at an early age.
To analyse the consequences of broadening DSM-IV criteria for generalized anxiety disorder (GAD) on the utilization of health care resources and corresponding costs.
Multicentre, prospective and observational study conducted in outpatient psychiatric clinics selected at random and weighted by geographical density of population. Patients with GAD according to DSM-IV criteria and subjects with anxiety symptoms fulfilling broader criteria were compared. Broadening criteria was considered 1-month of excessive or non-excessive worry and only 2 associated symptoms listed on DSM-IV for GAD. Socio-demographic data, medical history and health care resources and corresponding costs were recorded during a 6-month period.
A total of 3,549 patients were systematically recruited; 12.8% excluded because not fulfilling inclusion criteria, 1,815 patients in DSM-IV criteria group (DG) and 1,264 in broad criteria group (BG). Both groups were similar on their sociodemographic characteristics at baseline. Type of treatments prescribed at psychiatric clinics during the study were similar in frequency; anti-depressives (77.0% in DG vs. 75.3% in BG, ns), benzodiazepines (71.5% vs. 67.2% respectively, ns), and anti-convulsants (72.1% vs. 67.0% respectively, ns). Health care resources utilization were statistically reduced to a similar extent in both groups as a consequences of treatments yielding to a cost-of-illness in the 6-month period of 1,196 (1,158) and 1,112 (874), respectively; p=0.304.
In a large sample of subjects, broadening of GAD criteria could lead to earlier diagnosis that would not be associated necessarily to an increase in health care resources utilization or costs to the National Health System.
Suicide is a major public health problem, one of the leading causes of death and one of the first causes of years of life lost. It is a voluntary act that can be carried out by men and women, children and adults, rich and poor, people of every race and religion.
The aim of this text is to outline the most popular suicides and briefly discuss the representation of suicide in art. Painters such as Vincent Van Gogh, Edvard Munch, Jackson Pollock, musicians as Kurt Cobain, Jim Morrison, Janis Joplin, Jimi Hendrix, the actresses Lupe Vélez, Carole Landis, Pier Angeli, Capucine, Marylin Monroe, Lucy Gordon and the actors Heath Ledger and Freddie Prinze decided the end of their lives in different ways and at different stages.
In the literary field, we find the world renowned suicides of Socrates, Seneca and Caton. Other famous and more recent suicidal writers are Ernest Hemingway, Dylan Thomas, Virginia Woolf, Yukio Mishima, Alfonsina Stormi and Cesare Pavese among others.
Suicide has been represented in several plays and operas, not only people of flesh and blood kill themselves but also fictional characters. the love-death of Liu in Turandot and Tosca in the opera of the same name Are noteworthy, both were composed by Giacomo Puccini. In Hamlet, tragedy written by William Shakespeare, is Ophelia who dies drowning at the sea.
To analyse the effect of Pregabalin (PGB) on anxiety and depression symptoms in patients with refractory-severe Generalized Anxiety Disorder (GAD) and severe concomitant depressive disorder.
Post-hoc analysis of a multicentre, prospective and observational study conducted in outpatient psychiatric clinics to ascertain the impact of broadening GAD criteria. Men and women above 18 years, with GAD (DSM-IV criteria), PGB naïve and refractory to a previous course of benzodiazepines and/or anti-depressive drugs (minimum 3 months) and severe symptoms of anxiety (HAM-A ≥ 24) and depression (MADRS ≥ 35) were included. Changes in HAM-A and MADRS were assessed after 6 months of receiving PGB as per psychiatrist's judgement.
159 patients [69.2% women, 45.9 (12.6) years] fulfilled criteria for analysis. Respectively, 92% and 90% of subjects were previously exposed to benzodiazepines and anti-depressives before adding PGB [mean dose: 223.1 (126.3) mg/day]. PGB therapy reduced both anxiety and depressive baseline symptoms by a mean of, respectively in HAM-A and MADRS scales, 57.9% (from 35.5±5.8 to 14.8±9.4; p< 0.001, effect size: 3.57) and 58.1% (from 39.4±4.3 to 16.5±10.3; p< 0.001, effect size: 5.33). As a result, the percentages of patients without symptoms of both anxiety and depression were 34.4% and 40.9%, respectively at the 6 month visit (p< 0.001 in all cases). Similarly, responder rates (≥ 50% reduction of baseline scoring) were 63.1% and 62.9%.
Despite limitations, Pregabalin therapy had a meaningful and significant effect of symptoms of anxiety and depression in patients with severe refractory GAD and concomitant severe depressive disorder.
Alcoholism is a chronic relapsing disorder characterized by compulsive drinking, alcohol seeking, loss of control over alcohol consumption, and impaired social and occupational functioning. Treatment of Alcohol Dependence (AD) comprises two steps, detoxification and relapse prevention (RP). Traditionally, long half-life benzodiazepines have been the most widely used agents for alcohol detoxification. On the other hand, disulfiram, naltrexone and acamprosate are the three drugs that have been approved for relapse prevention. In the last decades, nevertheless, there is a growing interest in the use of anticonvulsant drugs in the management of both, detoxification and relapse prevention of alcohol.
To review the different pharmacological strategies in which an anticonvulsant was used in the management of AD.
We searched in MEDLINE and in the Cochrane Database System Review, selecting all studies from 1980 until present, in which a pharmacological intervention with anticonvulsant agents was made for alcohol detoxification or RP.
The most tested anticonvulsant drugs are the classical Carbamazepine and Valproate. Both have demonstrated to be efficacious in Alcohol Withdrawal Syndrome and RP. However, the use of these agents has been limited by their hepatic and hematologic toxicity. Novel anticonvulsants such as Gabapentin, Pregabalin, Topiramate, Oxcarbazepine and Zonisamide have also been found to be effective, with the advantage of rapid onset of action, lower toxicity and fewer side effects.
Anticonvulsants are efficacious and safe agents in the management of AD. Further randomized, double-blind, placebo-controlled trials are warranted to increase the evidence of the use of these agents.
The purpose of this research was to analyse the effect of adding Pregabalin (PGB) on severe symptoms of anxiety and depression in patients with Generalized Anxiety Disorder refractory to duloxetin in daily medical practice in Spain.
This is a post-hoc analysis of a 6-month multicentre, prospective and observational study carried out in outpatient psychiatric clinics in Spain. Men and women, above 18 years, with a diagnosis of GAD according with DSM-IV-TR criteria, pregabalin naïve and refractory to a previous course of duloxetin (3 months or more) and severe symptoms of anxiety (HAM-A ≥ 24) and depression (MADRS ≥ 35) were considered eligible for analysis.
A total of twenty-five patients [76% women, mean age; 49.3 (11.8) years, 82% with a comorbid depressive disorder] fulfilled criteria for analysis, and were previously exposed to duloxetin [mean dose: 71.7 (26.7) mg/day] for an average of 6.7 (3.7) months. Adding pregabalin [mean dose: 172.8 (75.5) mg/day], during 5.2 (1.8) months, reduced both anxiety and depressive symptoms by a mean of, respectively in HAM-A and MADRS scales, 54.1% (from 36.5 ± 4.3 pts to 16.6 ± 9.1 pts; p < 0.001, effect size: 4.63) and 52.8% (from 40.4 ± 4.6 pts to 19.0 ± 11.0 pts; p < 0.001, effect size: 4.65). As a result, the percentages of patients without symptoms of either anxiety or depression were 30% and 24%, respectively.
Despite small sample, adding pregabalin had a meaningful and significant effect on severe symptoms of anxiety and depressive symptoms in patients with severe GAD and concomitant depressive disorder resistant to duloxetin.
To explore the consequences of broadening DSM-IV criteria for Generalized Anxiety Disorder (GAD) on patient's disability.
A multicentre and observational study was carried-out in outpatient psychiatric clinics in Spain between years 2007 and 2008. Naïve diagnosed patients with GAD according to DSM-IV criteria or with anxiety symptoms fulfilling broadened criteria were compared. At least 1-month of excessive or non-excessive worry along with only two of the associated symptoms listed on DSM-IV for GAD were considered as broadened GAD criteria. Socio-demographic data, medical history and functional outcome measures were recorded.
A total of 3,549 patients were systematically recruited, 12.8% excluded because not found eligible for inclusion in analysis; 1,815 in the DSM-IV group (DG) and 1,264 in the broadening criteria group (BG). Both groups were similar on their sociodemographic characteristics. Total disability score in the WHO-DAS II scale was slightly, but statistically significant, higher in DG; 41.9 (17.1) versus 38.9 (16.0) points, p < 0.05. These weak differences were observed in all of the scale domains but mainly in domains “Getting around” [34.5 (23.6) versus 29.4 (22.8), p< 0.05] and “Life activities” [55.5 (27.1) versus 52.1 (26.2), p< 0.05], since differences in the other domains, even statistically significant, were negligible.
Patients with standard DSM-IV criteria for GAD appears to show slightly, but significant, worst level of disability than subjects with broadening diagnostic GAD criteria. Life-activities and participation in society domains seems to be the functional domains most impacted by symptoms of anxiety.
to examine short and middle-term effectiveness of a group cognitive-behavioral intervention (CBT) in pathological gambling (PG) and to analyze predictors of therapy outcome.
Two hundred and ninety PG patients consecutively admitted to our Unit participated in the current study. All participants were diagnosed according to DSM-IV-criteria. Manualized outpatient group CBT [16 weekly sessions] was given. Specific assessment before and after the therapy and at 1, 3 and 6 months follow-up was conducted. Logistic regression analyses and survival analysis were applied.
outpatient group CBT was effective with abstinence rates by the end of therapy of 76.1%, and 81.5% at 6 months follow-up. The dropout rate during treatment decreased significantly after the fifth treatment session. Psychopathological distress (p = 0.040) and obsessive-compulsive symptoms were identified as factors predicting relapses and drop-outs respectively.
our findings suggest that group CBT is effective for treating PG individuals. Several psychopathological and personality traits were identified as outcome predictors.
To compare healthcare costs from the perspective of the Spanish National Healthcare System (NHS) of initiating treatment with pregabalin or SSRI/SNRI as add-on therapies in patients with generalized anxiety disorder (GAD), who are resistant to benzodiazepine-based therapy (BR).
BR patients with GAD (DSM-IV criteria) included in a prospective, multicentre, observational cohort study carried out in outpatients attending mental health centers, were selected in this post-hoc analysis. BR was defined as insufficient response with persistence of symptoms of anxiety (HAM-Anxiety scale≥ 16) after a 6-month course of BR (standard dose). Healthcare resource utilization (HRU) associated with GAD included drug treatments, medical visits, hospitalization and non-pharmacologic therapies which were collected twice (baseline and end-of-trial visits) during a 6-month period. Related costs were estimated in each visit and adjusted changes between visits compared using ANCOVA models.
A total of 128 patients received pregabalin and 126 SSRI/SNRI. Compared with SSRI/SNRI, pregabalin was associated with significantly lower adjusted mean increment use of anxiolytics; 0.55 vs. 1.12, p < 0.001, and greater reduction in medical visits; −15.12 vs.−12.99, p = 0.029. Mean adjusted healthcare costs were significantly decreased in both medication cohorts; −€;289: pregabalin (p = 0.003) and −€95 (p = 0.052) with SSRI/SNRI. Drug acquisition costs for SSRI/SNRI were lower than pregabalin, however adjusted healthcare cost reduction was numerically higher with pregabalin; −€289 versus −€194, p = 0.488.
Initiating treatment with pregabalin was associated with significant reduction in HRU and total cost for GAD compared to SSRI/SNRI in BR patients in the Spanish NHS setting.
It is well known that impulsivity and stress are risk factors for the development of addictive disorders, and more specifically alcohol dependence. Impulsivity has two dimensions: behavioural inhibition and delay of reward. The Fear- Conditioning paradigm of the Startle response (SR), which refers to the potentiation of the startle amplitude after the exposure to aversive stimulus, can be used as a stress test. The aim of this study was to explore the correlation between impulsivity laboratory tasks and the Fear-Conditioning (FC) paradigm of the SR as risk factors for the development of alcohol dependence.
The sample included 40 abstinent alcoholic men, who met DSM-IV criteria for Alcohol Dependence and had been abstinent for at least one month. Impulsivity was assessed using two laboratory tests: Stop-Signal Task (SST) and Differential Reinforcement for Low-Rate Responding (DRL6). The FC paradigm of the SR was used as a stress test. Patients were compared to 40 matched controls.
We found a positive correlation between SST tasks and the FC paradigm of the SR (p < 0,05) and a negative correlation between the DRL6 tasks and the FC paradigm of the SR (p < 0,05) in the patient's group. This significant correlation was not found in controls.
Impulsivity and stress are significantly correlated in alcohol dependent patients. This means that while healthy subjects cope with stress, alcohol dependent patients react with higher impulsivity when they are exposed to stress situations and this could lead them to drink alcohol to relieve anxiety and depressive symptoms.
Psychedelic drugs were used extensively in psychotherapy in the 1950s to lower psychological defences and facilitate emotional insight. Thousands of research participants were administered hallucinogens in the context of basic clinical research or therapeutic clinical research, resulting in hundreds of publications. Results across studies were ultimately inconclusive due to such variations in methods and a lack of modern controls and experimental rigour. The growing controversy and sensationalism resulted in increasing restrictions on access to hallucinogens throughout the 1960s (ultimately resulting in the placement of the most popular hallucinogens into Schedule I of the 1970 Controlled Substances Act in the United States).
Renewed human administration research began in the 1990s. Recent clinical studies have administered hallucinogens to evaluate their safety and efficacy in the treatment of psychiatric disorders: specifically, anxiety related to advanced-stage cancer (Grob, 2005), obsessive-compulsive disorder (Moreno, et al., 2006), heroin dependence (Krupitsky, et al., 2007), personal meaning and spiritual significance (Griffiths, et al., 2008), and a meta-analysis of randomized controlled trials of LSD for alcoholism (Krebs,et al., 2012).
Psychedelic-assisted psychotherapy utilizes the acute psychological effects of psychedelic drugs to enhance the normal mechanisms of psychotherapy. The effects of psychedelic psychotherapy are often very pronounced within several days or weeks after a treatment session, but then these effects quickly decline. This phenomenon was termed a “psychedelic afterglow”.
Fhurther research, blinded, randomized, placebo-controlled, methodology should explore the efficacy of hallucinogens.
Martinez Jambrina et al. (2010) developed the first research on the quality of assertive community treatment offered by Avilés ACT team to patients who were referred to this service with psychiatric diagnoses included in the group of severe and persistent. This research focused on the study of quality standards on internal organization, assistential activity, external coordination, accessibility and quality of care considered by the users and their families.
To analyze the quality of the interventions of the Avilés ACT team during one year (april 2011–april 2012) and compare it with results reached in 2010.
Descriptive Research - No experimental - Transversal.
ACT Team 11 members (2 psychiatrists, 6 nurses, 2 auxiliar nurses 1 social worker) and Users of ETAC: 110 users.
The results obtained are similar to our first research (2010) The ACT team of Aviles works with quality levels that can be considered optimal if referring to USA standards of quality in this intervention
SSRI/SNRI and pregabalin are recommended therapies for the treatment of GAD, particularly in case of benzodiazepines refractory (BR) patients. The aim was to compare the use of anxiolytic treatments in BR GAD patients initiating treatment with pregabalin or SSRI/SNRI as add-on therapies.
BR outpatients with GAD (DSM-IV criteria) enrolled in a prospective, multicentre, observational cohort study were included in this post-hoc analysis. BR was defined as insufficient response with persistence of symptoms of anxiety (HAM-Anxiety scale ≥ 16) after a course of a standard dose of benzodiazepines, for 6 months. The use (% of users and dose) of pregabalin, SSRI/SNRI and benzodiazepines was evaluated during the 6-month study period.
128 subjects treated with pregabalin and 126 with SSRI/SNRI were analyzed. Both cohorts presented a similar pattern of anxiolytic drugs utilization at baseline: Alprazolam (33% pregabalin and 27% SSRI/SNRI), diazepam (20% vs. 11%) and lorazepam (17% vs. 30%) were among the most used benzodiazepines. At the 6 month visit, pregabalin treated patients showed a significant decrease in the % of users of alprazolam (16% vs. 27%; p = 0.032), lorazepam (14% vs. 27%; p = 0.013) or ketazolam (0% vs. 7%; p = 0.002) compared with SSRI/SNRI. 57% of patients in pregabalin group, compared with 87% in SSRI/SNRI, were still receiving a benzodiazepine concomitantly at the 6 month visit (p < 0.001).
Compared with SSRI/SNRI, initiating therapy with pregabalin reduced the use of concomitant anxiolotic treatment in BR outpatients with GAD in routine medical practice.
To analyze the effect of adjunctive therapy with pregabalin versus usual care (UC) on healthcare costs and clinical consequences in generalized anxiety disorder (GAD) patients with partial response (PR) to previous SSRI.
Post-hoc analysis of patients enrolled in a prospective 6-month observational study. Patients with a PR [CGI score >3 and insufficient response with persistence of anxiety symptoms (HAM-A score ≥16)] to SSRI monotherapy were considered eligible for inclusion. Two groups (based on psychiatrist judgment) were analyzed 1) adding pregabalin (150-600 mg/day) to existing therapy; or 2) UC (switching to a different SSRI or adding another anxiolytic. Costs estimation used year-2009 prices for GAD related healthcare resources utilization. Measures of clinical consequences were, changes in total scores of anxiety in HAM-A (primary outcome) and GAD co-morbid depressive symptoms in MADRS (secondary outcome) scales.
Four-hundred-eighty-six newly prescribed pregabalin and 239 UC GAD patients [mean (SD) HAM-A 26.7 (6.9) and CGI 4.1 (0.5)] were analyzed. Adding pregabalin was associated with significantly higher adjusted mean changes (95% CI) vs. UC in HAM-A [-11.2 (-12.2;-10.2) vs. -14.9 (-15.6;-14.2), respectively; p< 0.001] and MADRS [-7.8 (-8.7;-6.8) vs. -11.6 (- 12.2;-10.9), respectively; p< 0.001]. Adjusted mean baseline healthcare costs were significantly reduced in both cohorts; -€487 (-652;-317) and -€531 (-648;-413), respectively (both p< 0.001), yielding to similar 6-month costs; €1543 (1375;1711) UC and €1497 (1380;1614) pregabalin, p=0.661.
In this post-hoc analysis, GAD patients with PR to SSRI experienced greater symptom improvement with adjunctive therapy with pregabalin versus UC without increasing healthcare cost.
Legal and illegal drugs can cause psychotic symptoms, in cocaine-dependent patients the prevalence of these symptoms may reach 86% (Vorspan, 2012). It is estimated that 13–32% of cocaine-dependent patients have kinaesthetic hallucinations (Siegel, 1978; Mahoney, 2008; Roncero, 2012).
To compare the prevalence of substance-induced psychotic symptoms and compare the use of welfare/social resources and social adjustment among cocaine-dependent patients (CD) and other substances dependences (OtherD).
Two hundred and six patients seeking treatment at the Addictions and Dual Diagnosis Unit of the Vall d’Hebron. Patients were assessed by ad hoc questionnaire designed to collect demographic data and psychotic symptoms associated with consumption, a record of the care/social resources used by the patient and the scale of social adaptation (SASS). A descriptive and bivariate analysis of the data was performed.
CD were 47.1% vs. 52.9% OtherD (66.1% alcohol, 17.4% cannabis, 8.3% opioid, 8.3% benzodiazepines/other drugs). Of cocaine dependent-patients, 65.6% present psychotic symptoms vs. 32.1% for the OtherD. Different exhibiting psychotic symptoms are: self-referential (69.7% vs. 30.7%), delusions of persecution (43.4% vs. 12.2%), hallucinations (49.4% vs. 14.3%), auditory hallucinations (43.5% vs. 11.4%), visual hallucinations (30.4% vs. 5.7%) and kinaesthetic hallucinations (7.2% vs. 2.9%).
Cocaine-dependent patients significantly use more health care resources in reference addiction unit (76.3% vs. 62.4%, P:.035) and infectious diseases (22.7% vs. 5.5%, P:.000) and justice-related (50.5% vs. 26 resources 0.6%; P:1.001) and less resources and mental health (25.8% vs. 43.1%; P:.013).
Regarding social adaptation, no differences were found in the SASS. Kinaesthetic hallucinations do not appear to be related to a greater use of resources and in social adaptation.
References not available.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Accident rate have a high social cost. Cocaine consumption increases the risk of traffic crashes (Monras, 2011; Fierro, 2011). However, there is not extensively studies in addicts.
Compare and analyze the history of accidents and risk behaviors while driving in cocaine dependent patients (DC) and of other substances (OtherD).
One hundred and eighty-two patients seeking treatment since January 2014 to September 2015. Sociodemographic and accident-related variables were collected, also administered the MDBQ. Descriptive analysis and bivariate analysis using Chi-square test for categorical variables and Student t test was performed for quantitative.
Of women, 30.3%, and 69.7% men, mean age 43.67 years (SD = 13). 65.6% currently driving or above. 45.2% DC vs. 54.8 DOther (35.6% alcohol, cannabis 8.3%, 5.8% opioid and 5.1% other drugs).
Comparing accident rate on the DC is a tendency to have suffered more accidents (χ2: 2.62 P=.072). Patients addicted to cocaine referred further potentially dangerous activities both under the influence of consumption (65.9% vs. 33.3%) and abstinence (41.7% vs. 12%).
As for the results of MDBQ, it has been detected that cocaine addicts show more errors and traffic violations. No differences in the lapses identified by patients of different groups.
Patients with cocaine dependence have more accidents, reduced risk perception and recognize more mistakes and traffic violations. Cocaine implies a high risk of road accidents and exposure to high-risk situations compared to the use of other substances.
References not available.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This work attempts to confirm the effect of an enriched diet with n-3 polyunsaturated fatty acids (PUFA) trying to mitigate the reproductive performances issues such as low conception rate of primiparous rabbits. A total of 127 does were fed ad libitum throughout their two first cycles with two diets with different fat sources: mixed fat in the control and salmon oil in the enriched one, with 3.19 g/100 g (n=63 does) and 28.77 g/100 g (n=64 does) of n-3 of the total fatty acid, respectively. Feed intake was similar between groups (P>0.05). Plasma progesterone concentration was higher in the enriched females than in control ones at 7 (30.9±2.18 v. 23.9±2.30 ng/ml, respectively; P=0.029) and 14 (38.7±2.18 v. 28.2±2.30 ng/ml, respectively; P=0.001) days of first gestation. Considering both cycles, reproductive parameters of mothers (fertility, duration of gestation and prolificacy) and litter parameters (weight at parturition and weaning, mortality and average daily gain (ADG) of kits during lactation) were similar in both groups. However, individual measurements of neonates of enriched group improved 5.87%, 7.10% and 18.01% (P<0.05) in terms of crown-rump length, biparietal and thoracic diameters, respectively, compared to control ones at first parturition. It is noteworthy that at the second insemination, critical point in rabbit, fertility rate of enriched group did not decline as sharply as in the control group (89.7% v. 76.6%, respectively; P=0.067), although ADG and littler weight were slightly lower at the second lactation after PUFA enrichment (P<0.05). Total PUFA and unsaturated index of milk of enriched does group were significantly elevated than in control one (33.3±0.02 v. 23.2±0.02 g/100 g and 1.20±0.00 v. 0.86±0.00, respectively; P<0.05). Finally, plasma progesterone, ovulation rate, fertility and embryo development at 3.5 days after the artificial insemination were similar between diets (P>0.05), but embryo apoptosis rate was higher in control group than in enriched one (31.1±4.56% v. 17.1±3.87%, respectively; P<0.05). In conclusion, dietary PUFA enrichment from the rearing and throughout two productive cycles improved plasma progesterone during pregnancy, fertility, milk fatty acid profile and neonates development of primiparous supporting the beneficial effect of n-3 PUFA supplementation in rabbit does.