Early cannabis use is associated with severity of Cocaine-Induced Psychosis among cocaine smokers in Martinique, French West Indies.

OBJECTIVES: Cocaine intoxication can induce transient psychotic symptoms. The principal aim of this study was to determine sociodemographic and clinical characteristics associated with cocaine-induced psychosis (CIP) and to identify clinical factors predicting CIP in crack cocaine smokers in Martinique. The second aim was to identify clinical factors associated with severity of CIP, assessed with the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP). METHODS: Fifty-three cocaine-dependent smokers (45 men and 8 women) seeking treatment for cocaine dependence were included. Patients were assessed using the Cocaine Experience Questionnaire (CEQ), an instrument for the identification of cocaine-induced paranoia, and a French version of the SAPS-CIP, for the severity of CIP. RESULTS: Thirty-five (66%) patients reported cocaine-induced paranoia on the CEQ (CIP(+) patients). The mean SAPS-CIP total score was 6.1 ± 3.7, with a significant difference between CIP(+) and CIP(-) patients (P < 0.0001). Age at first cannabis use was associated with occurrence of CIP on the CEQ, and adolescent-onset cannabis use was associated with severity of hallucinations score on the SAPS-CIP. CONCLUSIONS: Cocaine-induced psychosis is frequent in crack cocaine smokers in Martinique, and early cannabis use is associated with the occurrence and the severity of psychotic symptoms during cocaine intoxication in this population. Patients developing psychotic symptoms during cocaine use began smoking cannabis earlier during adolescence than patients without CIP. These results confirm those of previous studies, highlighting the need to better assess early cannabis use in cocaine users, because early cannabis use is associated with severity of CIP.

Psychosis in a cocaine-dependent patient with ADHD during treatment with methylphenidate.

OBJECTIVE: The objective was to report a case of experienced psychosis during the treatment with methylphenidate (MPH) in a cocaine-dependent adult treated for attention-deficit/hyperactivity disorder (ADHD) with comorbid cocaine dependence. CONCLUSION: ADHD is a frequent comorbidity in substance use disorder (SUD) patients. MPH may be effective in treating ADHD symptoms in SUD patients, thus preventing possible adverse outcomes. Cocaine-induced psychosis may be a risk factor for development of psychosis in the presence of a concurrent treatment with MPH.

[Addiction to cocaine and other stimulants]. / Addiction à la cocaïne et aux psychostimulants.

Due to many available forms (powder, pasta base, freebase and crack…) and because of multiple routes of administration (intranasal, intravenous, or smoked), cocaine has become in 30 years one of the most consumed illegal drugs worldwide, after cannabis. While the frequency of consumption decreases in North America, it continues to rise in Europe, and in some countries in South America, including Brazil, despite a growing knowledge of its specific effects, physical complications and psychiatric consequences. Elsewhere (notably in Asia and Indian Ocean), amphetamine and other stimulants (including methamphetamine), whose properties and patterns of use are very similar to those of cocaine, tend to replace it. Another amphetamine derivative, MDMA or ecstasy, is also consumed by many young people of less than 25 years, in Europe and North America, in a festive setting, with specific consequences and special procedures of care. Although there is currently no consensus for a specific medication, the most appropriate therapeutic approach seems to involve a psychosocial treatment associated with an anticraving medication, which will reduce compulsive desire to consume, in order to facilitate the psychotherapeutic and social care. However, pharmacological research remains very active, and many options are explored (GABAergic or dopaminergic agonists, amphetamine derivatives with long half-life, vaccine…), whether to treat addiction to cocaine or to methamphetamine.

Attention deficit hyperactivity disorder is associated with a more severe pattern of cocaine consumption in cocaine users from French West Indies.

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a frequent comorbidity in patients with substance use disorder. The aim of this cross-sectional study was to evaluate the consequences of ADHD comorbidity in cocaine users seeking treatment in Martinique. METHODS: During 15 months, all patients seeking treatment for cocaine dependence in a specialized center were assessed using the ADHD DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision) criteria and the French version of the Wender Utah Rating Scale. RESULTS: Forty-six (44 men and 2 women) cocaine abusers were included. Among them, 10 (21.7%) patients met DSM-IV-TR full criteria for adult ADHD. Patients with ADHD spend significantly more money (3 fold) on cocaine per week than those without ADHD, which means that they use a higher dose. All patients with ADHD used cocaine in a pipe, which allowed a greater absorption compared to smoking cocaine in a joint or snorting cocaine powder; in contrast, only 53% of the subjects without ADHD used cocaine in a pipe. CONCLUSIONS: Our study shows that cocaine users seeking treatment in Martinique with reported ADHD have a more severe pattern of cocaine consumption and the prevalence of ADHD's comorbidity in cocaine users is proximately equal to values previously found in the literature.

Prevalence of and risk factors for lifetime suicide attempts among Caribbean people in the French West Indies.

It has been suggested that Black people show lower suicidality than White people. The few conflicting studies estimating lifetime prevalence of suicide attempts in Caribbean populations were mainly carried out in the UK and the USA. Our aim was to investigate the prevalence of lifetime suicide attempts among the French Caribbean general population still living in the West Indies. As part of an international epidemiological multicenter study under the authority of the World Health Organization French Collaborating Centre, we interviewed 887 individuals selected from the general population in the Caribbean island of Martinique, using the Mini International Neuropsychiatric Interview. Among the interviewed individuals, 4.4% (N=39) reported having attempted suicide. Younger age, lifetime diagnoses of major mood disorder, panic disorder and alcohol dependence were all associated with a lifetime history of suicide attempts. Lifetime prevalence of suicide attempts among the French Caribbean general population was almost half as much as that measured in continental France.

[Cocaine and alcohol: a risky association]. / Cocaïne et alcool : des liaisons dangereuses.

Key points. Cocaine, the second most frequently consumed illicit substance after cannabis in both United States and Europe, remains the psychostimulant of choice for many, often mixed with other psychoactive substances. It is most frequently associated with alcohol, and a diagnosis of alcohol dependence may be made in 50%-90% of cocaine-dependent subjects. When treating cocaine addicts, it is important to characterize not only the modalities of cocaine use but also the modes of consumption of other substances, notably alcohol. Alcohol is often consumed to reduce the anxiety and discomfort resulting from cocaine withdrawal. Alcohol may also trigger an irresistible craving for cocaine, which can result in frequent relapses even after several months of cocaine abstinence. Brief intervention and motivational interview techniques can help to reduce alcohol use and prevent cocaine relapses in this context. In the absence of severe cocaine withdrawal symptoms, the guidelines for treating alcohol withdrawal syndrome may be applied for cocaine and alcohol codependence. Lower doses of benzodiazepine are needed for treating this alcohol-cocaine withdrawal syndrome. Cognitive behavioral therapies, alone or in combination with psychotropic medication, are accepted therapeutic approaches for alcohol-cocaine dependence. It is also accepted that over the long term the combination of psychotherapeutic treatments is usually more effective than any single approach. In the absence of a therapeutic consensus, four drugs (disulfiram, baclofen, topiramate and naltrexone) are most often recommended to promote and maintain abstinence; nevertheless, their efficacy has not been proven and their use remains experimental and off-label: they have not been approved by health authorities as treatment for addictions.

Characteristics of a French African Caribbean epidemiological psychiatric sample with a history of suicide attempt.

Research on vulnerability factors among ethnic groups, independent of primary psychiatric diagnosis, may help to identify groups at risk of suicidal behavior. French African Caribbean general psychiatric patients (N = 362) were recruited consecutively and independently of the primary psychiatric diagnosis. Demographic and clinical characteristics and lifetime history of suicide attempts were recorded. Sixty-five patients (18%) had a history of at least one suicide attempt. Presence of professional qualifications, children, poor social contacts, treatment with benzodiazepine at inclusion, and poor treatment compliance were all associated with a lifetime history of suicide attempts.

Polymorphisms TaqI A of the DRD2, BalI of the DRD3, exon III repeat of the DRD4, and 3' UTR VNTR of the DAT: association with childhood ADHD in male African-Caribbean cocaine dependents?

The conflicting results reported by genetic studies with the variants of the genes coding for the dopaminergic system in cocaine addicts could be partially explained by the difficulties to constitute homogenous sample of patients. Childhood attention-deficit/hyperactivity disorder (ADHD), and/or impulsivity are frequently associated with cocaine addiction and could participate in the heterogeneity of the samples in cocaine addicts. Accordingly, it is hypothesized that cocaine addiction would be associated with the variants of the genes coding for the dopamine system in an homogenized sample of cocaine addicts, especially in individuals with childhood ADHD comorbidity, or with a high impulsivity score. The potential association of the variants TaqI A of the DRD2, BalI of the DRD3, exon III repeat of the DRD4, and 3' UTR VNTR of the DAT was examined in African-Caribbean males, smoked-cocaine dependents. All the subjects were assessed with the Diagnostic Interview of Genetic Studies, the Barratt's impulsivity scale, and the Wender Utah rating scale for childhood ADHD. A positive association was found with the DRD2 and DRD4 polymorphisms in the subgroups of patients with childhood ADHD, or with a high impulsivity score, which represented, respectively, 53.3 and 73.0% of the patients. Conversely, no positive association was found for any of the polymorphisms studied when the group of patients was examined as a whole. Therefore, our results suggest that the clinical dimensions of childhood ADHD and of impulsivity could be taken into account to homogenize the samples of patients in cocaine association studies.

Excess of psychoses among the French West Indian population.

OBJECTIVE: To investigate and compare the prevalence of psychoses in the French West Indies (FWI) and in continental France. METHOD: As part of an international epidemiologic multicentre study under the authority of the World Health Organization French Collaborating Center (WHO-CC), we questioned 7257 individuals selected from the general population in France and in the FWI, using the Mini International Neuropsychiatric Interview. We compared data using the chi-square test. RESULTS: We found a significant discrepancy between the rate of psychoses at the continental French sites (1.8%) and the FWI sites (4.4%) (P < 0.0001). After homogenizing the rate of missing interviews, our results remained significant. CONCLUSIONS: Such a drastic increase in the rate of psychoses in the FWI population cannot be explained solely on the basis of either the classical migration hypothesis or other currently accepted hypotheses. More attention should be given to new parameters such as 1) the recent and significant abuse of crack cocaine and cannabis in the FWI, 2) the continued existence of magic practices in a significant portion of the French Afro-Caribbean population, and 3) the expression of mood disorders with overvalued ideation or psychotic symptomatology.