Efficacy of cognitive-behavioral interventions in weight loss of people with body mass index of 30 or above [obesity]

Objective: Obesity is a major health problem. Nowadays approximately one-third of the world population suffer from obesity which is frequently accompanied with serious medical and emotional problems. Three main evidence-based options exist for the treatment of obese individuals: lifestyle modification, pharmacotherapy, and bariatric surgery. The purpose of this study was to determine the effectiveness of cognitive-behavioral treatment in treating of patients with obesity

Methods: Three women with body mass index of 30 kg/m2 or more were selected by purposive sampling method to take a part in an A-B single subject design with follow up. Patients responded to the multidimensional body-self relations questionnaire-appearance scales [MBSRQ-AS], Binge eating scale [BES] and Rosenberg self-esteem scale [RSES] at 3 stages of baseline [pre-treatment], treatment [2nd, 4th, 6th, 8th, 10th, and 12th sessions], and follow up. In addition, weighing of patients was carried out at beginning of each session. Data were analyzed by graphs and improvement rates$Results: Results showed that therapy was effective in weight loss, reduction of binge eating, and maintaining of weight loss. It also increased body image satisfaction but failed in self-esteem improvement

Conclusion: The cognitive-behavioral treatment was effective in treating of obese patients. This treatment outcome data are consistent with cognitive-behavioral treatment of obesity proposed by other scientists

Exploring neural correlates of different dimensions in drug craving self-reports among heroin dependents

Introduction: Drug craving could be described as a motivational state which drives drug dependents towards drug seeking and use. Different types of self-reports such as craving feeling, desire and intention, wanting and need, imagery of use, and negative affect have been attributed to this motivational state. By using subjective self-reports for different correlates of drug craving along with functional neuroimaging with cue exposure paradigm, we investigated the brain regions that could correspond to different dimensions of subjective reports for heroin craving

Methods: A total of 25 crystalline-heroin smokers underwent functional magnetic resonance imaging [fMRI], while viewing heroin-related and neutral cues presented in a block-design task. During trial intervals, subjects verbally reported their subjective feeling of cue induced craving [CIC]. After fMRI procedure, participants reported the intensity of their [need for drug use] and [drug use imagination] on a 0-100 visual analog scale [VAS]. Afterwards, they completed positive and negative affect scale [PANAS] and desire for drug questionnaire [DDQ] with 3 components of [desire and intention to drug use], [negative reinforcement,] and [loss of control]

Results: The study showed significant correlation between [subjective feeling of craving] and activation of the left and right anterior cingulate cortex, as well as right medial frontal gyrus. Furthermore, the [desire and intention to drug use] was correlated with activation of the left precentral gyrus, left superior frontal gyrus, and left middle frontal gyrus. Subjects also exhibited significant correlation between the [need for drug use] and activation of the right inferior temporal gyrus, right middle temporal gyrus, and right parahippocampal gyrus. Correlation between subjective report of [heroin use imagination] and activation of the cerebellar vermis was also observed. Another significant correlation was between the [negative affect] and activation of the left precuneus, right putamen, and right middle temporal gyrus

Discussion: This preliminary study proposes different neural correlates for various dimensions of subjective craving self-reports. It could reflect multidimensionality of cognitive functions corresponding with drug craving. These cognitive functions could represent their motivational and affective outcomes in a single item [subjective craving feeling] or in self-reports with multiple dissociable items, such as intention, need, imagination, or negative feeling. The new psychological models of drug craving for covering various dimensions of subjective craving self-reports based on their neurocognitive correspondence could potentially modify craving assessments in addiction medicine

Neuro cognitive rehabilitation for disease of addiction (NECOREDA) program: from development to trial

Despite extensive evidence for cognitive deficits associated with drug use and multiple publications supporting the efficacy of cognitive rehabilitation treatment [CRT] services for drug addictions, there are a few well-structured tools and organized programs to improve cognitive abilities in substance users. Most published studies on cognitive rehabilitation for drug dependent patients used rehabilitation tools, which have been previously designed for other types of brain injuries such as schizophrenia or traumatic brain injuries and not specifically designed for drug dependent patients. These studies also suffer from small sample size, lack of follow-up period assessments and or comprehensive treatment outcome measures. To address these limitations, we decided to develop and investigate the efficacy of a paper and pencil cognitive rehabilitation package called NECOREDA [Neurocognitive Rehabilitation for Disease of Addiction] to improve neurocognitive deficits associated with drug dependence particularly caused by stimulants [e.g. amphetamine type stimulants and cocaine] and opiates. To evaluate the feasibility of NECOREDA program, we conducted a pilot study with 10 opiate and methamphetamine dependent patients for 3 months in outpatient setting. NECOREDA was revised based on qualitative comments received from clients and treatment providers. Final version of NECOREDA is composed of brain training exercises called [Brain Gym] and psychoeducational modules called [Brain Treasures] which is implemented in 16 training sessions interleaved with 16 review and practice sessions. NECOREDA will be evaluated as an add-on intervention to methadone maintenance treatment in a randomized clinical trial among opiate dependent patients starting from August 2015. We discuss methodological features of NECOREDA development and evaluation in this article

Oral health of drug abusers: a review of health effects and care

Oral health problems, among the most prevalent comorbidities related to addiction, require more attention by both clinicians and policy-makers. Our aims were to review oral complications associated with drugs, oral health care in addiction rehabilitation, health services available, and barriers against oral health promotion among addicts. Drug abuse is associated with serious oral health problems including generalized dental caries, periodontal diseases, mucosal dysplasia, xerostomia, bruxism, tooth wear, and tooth loss. Oral health care has positive effects in recovery from drug abuse: patients' need for pain control, destigmatization, and HIV transmission. Health care systems worldwide deliver services for addicts, but most lack oral health care programs. Barriers against oral health promotion among addicts include difficulty in accessing addicts as a target population, lack of appropriate settings and of valid assessment protocols for conducting oral health studies, and poor collaboration between dental and general health care sectors serving addicts. These interfere with an accurate picture of the situation. Moreover, lack of appropriate policies to improve access to dental services, lack of comprehensive knowledge of and interest among dental professionals in treating addicts, and low demand for non-emergency dental care affect provision of effective interventions. Management of drug addiction as a multi-organ disease requires a multidisciplinary approach. Health care programs usually lack oral health care elements. Published evidence on oral complications related to addiction emphasizes that regardless of these barriers, oral health care at various levels including education, prevention, and treatment should be integrated into general care services for addicts

Attention deficits in chronic methamphetamine users as a potential target for enhancing treatment efficacy

Methamphetamine [MA] is a potent, addictive psychostimulant that has dramatic effects on the central nervous system [CNS]. The onset of methamphetamine use has been linked to heightened attention, and chronic methamphetamine use has been associated with deficits in different aspects of attention that can significantly persist into abstinence. Attention deficits in chronic methamphetamine users may be associated with severity of methamphetamine use, craving, relapse, and as a result, poor treatment outcomes. This review summarizes evidence that the continuity of attention deficits, especially during abstinence, should be considered as a potential target during methamphetamine use treatment. Implementing attention rehabilitation techniques during treatment may enhance motivation for treatment in chronic methamphetamine users, and may facilitate treatment adherence, craving control and promote relapse prevention. This issue has important clinical implications for enhancing treatment efficacy and as a result, increasing treatment outcomes

Measurement of drug craving in Persian speaking subjects; A review on current experiences and future perspectives

Drug craving is considered as one of the main cores of drug dependency and addiction. Multidimensionality of drug craving, its cultural-bounded features and its intra individual rapidly changing nature makes it difficult to be measured. Nowadays, regarding different psychometric approaches, there are various instruments available for measurement of different aspects of drug craving but mainly for Latin-based languages in North America and European countries. High prevalence and special conditions, and unique subcultures in substance abuse and addiction in many countries, like Iran, make the design of culturally validated instruments for drug craving assessment priority. Comprehensive review on drug craving measurement instruments for Persian speaking subjects have been performed by searching in databases [ELSEVIER, Science Direct and Scientific Information Database [SID]] and investigating of related documents on regional experiences. In this article seven main categories of drug craving instruments have been reviewed focusing on validated versions in Persian language including: self-reports, reinforcement "proxies", drug self administration, psycho physiological responding, neurobiological responding, cognitive processing and expressive methods. Reviewing on weak and strength points of each instrument group and national and regional experiences shows that designing and validating a new series of ecologically-validated instruments for multidimensional measurement of drug craving in different addiction subcultures should be prioritized to cover current methodological gaps in substance abuse studies in Iran.

Cognitive flexibility, attention and speed of mental processing in opioid and methamphetamine addicts in comparison with non-addicts

Introduction: Many studies have revealed that drug addicted individuals exhibit impaired performance on executive function tests but a few studies have been conducted on executive functions of drug addicts in Iran. To contribute to this understanding, the present study was designed to assess some domains related to executive functions including cognitive flexibility, attention and speed of mental processing in a sample of drug addicts in comparison with a sample of non-drug addicts. Methods: 155 male addicts between 25 to 35 years of age were selected from outpatient addiction clinics in Karaj, Iran. This group consisted of 3 subgroups of opium [n=40], hydrochloride heroin [n=63], and methamphetamine [n=52] addicts. A control group was selected matching the drug addicts in gender, age, education and scio-economic status and included 130 healthy non-drug taking males. A battery of standardized executive function tests including the Color trail making test, Stroop color word test, and Symbol digit modalities test were administered. Data analysis was conducted by performing Co-variance [MANCOVA] in SPSS.v.16.0. Results: The study findings indicated that the group of drug addicted subjects performed significantly worse compared with the controls on all executive measures. There were also significant differences among the 3 subgroups. The/GURFKORULGHheroin group had the worst performance LQcomparLVRQ with the methamphetamine and opium groups respectively. Drug addicted subjects with longer duration of drug addiction were much worse on all measures in Fomparison with drug addicted subjects with shorter duration of drug addiction. Discussion: The study results confirmed that the functions of specific brain regions underlying cognitive flexibility, attention and speed of mental processing were significantly impaired in the group of drug addicted subjects. These impairments were also significantly related to type of drug used and duration of drug addiction that may contribute to most of behavioral disturbances found in drug addicts and need specific attention for intervention and treatment programs

Measurement of cue-induced craving in human methamphetamine-dependent subjects; new methodological hopes for reliable sssessment of treatment efficacy

Methamphetamine [MA] is a highly addictive psychostimulant drug with crucial impacts on individuals on various levels. Exposure to methamphetamineassociated cues in laboratory can elicit measureable craving and autonomic reactivity in most individuals with methamphetamine dependence and the cue reactivity can model how craving would result in continued drug seeking behaviors and relapse in real environments but study on this notion is still limited. In this brief article, the authors review studies on cue-induced craving in human methamphetamine- dependent subjects in a laboratory-based approach. Craving for methamphetamine is elicited by a variety of methods in laboratory such as paraphernalia, verbal and visual cues and imaginary scripts. In this article, we review the studies applying different cues as main methods of craving incubation in laboratory settings. The brief reviewed literature provides strong evidence that craving for methamphetamine in laboratory conditions is significantly evoked by different cues. Cue-induced craving has important treatment and clinical implications for psychotherapists and clinicians when we consider the role of induced craving in evoking intense desire or urge to use methamphetamine after or during a period of successful craving prevention program. Elicited craving for methamphetamine in laboratory conditions is significantly influenced by methamphetamine-associated cues and results in rapid craving response toward methamphetamine use. This notion can be used as a main core for laboratory-based assessment of treatment efficacy for methamphetamine-dependent patients. In addition, the laboratory settings for studying craving can bridge the gap between somehow-non-reliable preclinical animal model studies and budget demanding randomized clinical trials

Human laboratory settings for assessing drug craving; implications for the evaluation of treatment efficacy

Research on assessing craving in laboratory settings often involves inducing and then measuring craving in subjects. Cue-induced craving is studied in laboratory settings using the cue reactivity paradigm, in which drug-related photos, videos, evocative scripts, olfactory cues, and paraphernalia may induce craving. Cueinduced craving evoked by drug-related stimuli could be associated with relapse and recurrence of drug addiction. In this article, the authors review different methods of assessing craving in laboratory settings and explain how human laboratory settings can bridge the gap between randomized clinical trials [RCTs] and animal models on pharmacological treatments for drug dependence. The brief reviewed literature provides strong evidence that laboratory-based studies of craving may improve our understanding of how subjective reports of drug craving are related to objective measures of drug abuse and laboratory settings provide an opportunity to measure the degree to which they co-vary during pharmacological interventions. This issue has important implications in clinical studies

The impact of hydrochloride heroin on mental flexibility, abstract reasoning, impulsivity, and attention

Introduction: Drug addiction could lead to severe impairments in executive and neurocognitive functions but study on the impact of hydrochloride heroin on executive functions has remained in infancy in Iran. The aim of this study was to examine the relationship between addiction to hydrochloride heroin and executive functioning in several cognitive domains including mental flexibility, abstract reasoning, impulsivity, and attention. Methods: A total of 60 cases of young male addicts aged 18 to 21 were recruited from outpatient addiction clinics in Karaj city and were matched with 60 non-drug using controls. A test battery including the Wisconsin Card Sorting Test [WCST], Porteus Maze Test [PMQS], Serial Seven Subtraction Test [SSST], and Color Trails Test [CTT] were administered respectively. Results: The patient group showed more problems in impulse control compared with the control group, while mental flexibility, abstract reasoning and attention were not affected. Discussion: The findings indicated that addiction to hydrochloride heroin had a negative effect on impulse control. This issue could reflect the role of impaired inhibitory control on drug-seeking behaviors and relapse. Special treatment programs must be tailored to control impulsivity among addicts to hydrochloride heroin during treatment

rey auditory verbal learning test: alternate forms equivalency and reliability for the Iranian adult population [Persian version]

Increasing demand for memory assessment in clinical settings in Iran, as well as the absence of a comprehensive and standardized task based upon the Persian culture and language, requires an appropriate culture- and language-specific version of the commonly used neuropsychological measure of verbal learning and memory, the Rey Auditory Verbal Learning Test [RAVLT]. The Persian adapted version of the original RAVLT and two other alternate word lists were generated based upon criteria previously set for developing new word lists. A total of 90 subjects [three groups of 30 persons], aged 29.7 +/- 7.10 years, volunteered to participate in our study and were tested using the original word list. The practice effect was assessed by retesting the first and second groups using the same list after 30 and 60 days, respectively. The test-retest reliability was evaluated by retesting the third group of participants twice using two new alternate word lists with an interval of 30 days. The re-administration of the same list after one or even two months led to significant practice effects. However, the use of alternate forms after a one-month delay yielded no significant difference across the forms. The first and second trials, as well as the total, immediate, and delayed recall scores showed the best reliability in retesting by the alternate list. The difference between the generated forms was minor, and it seems that the Persian version of the RAVLT is a reliable instrument for repeated neuropsychological testing as long as alternate forms are used and scores are carefully chosen

effects of chronic partial sleep deprivation on cognitive functions of medical residents

Because of on-call responsibilities, many medical residents are subjected to chronic partial sleep deprivation, a form of sleep restriction whereby individuals have chronic patterns of insufficient sleep. It is unclear whether deterioration in cognitive processing skills due to chronic partial sleep deprivation among medical residents would influence educational exposure or patient safety. Twenty-six medical residents were recruited to participate in the study. Participants wore an Actigraph over a period of 5 consecutive days and nights so their sleep pattern could be recorded. Thirteen participants worked on services that forced chronic partial sleep deprivation [<6 hours of sleep per 24h for 5 consecutive days and nights]. The other thirteen residents worked on services that permitted regular and adequate sleep patterns. Following the 5-day sleep monitoring period, the participants completed the three following cognitive tasks: [a] the Wisconsin Card Sorting Test [WCST] to assess abstract reasoning and prefrontal cortex performance; [b] the Time Perception Task [TPT] to assess time estimation and time reproduction skills; and [c] the Iowa Gambling Task [IGT] to assess decision-making ability. The results of independent samples t-tests found no significant differences between the group who was chronically sleep deprived and the group who rested adequately [all ps > .05]. These results may have emerged for several possible reasons: [a] chronic partial sleep deprivation may have a lesser impact on prefrontal cortex function than on other cognitive functions; [b] fairly modest chronic sleep restriction may be less harmful than acute and more significant sleep restriction; or [c] our research may have suffered from poor statistical power. Future research is recommended