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1.
Subst Use Misuse ; : 1-9, 2024 Jun 22.
Article in English | MEDLINE | ID: mdl-38907593

ABSTRACT

BACKGROUND: Authors discuss the connections between novel psychoactive substance (NPS) use and psychological trauma. The transition from classical substances to NPS, a paradigm change, poses a challenge for the treatment systems. Objective: Research evidence suggests difficulties in emotion regulation and trauma-related NPS-use. Authors explore some demographic and psychopathological characteristics related to such findings and examine the connections between emotion regulation deficiency and the choice of substance. METHOD: This study uses a methodological triangulation of a biologically identified sample to confirm NPS use, a survey method to describe users' socioeconomic characteristics, and Minnesota Multiphasic Personality Inventory (MMPI-2) subscales to study dysfunctions in emotion regulation. RESULTS: Participants (77 patients) were mainly polydrug users. The transgenerational transfer of substance use was a salient feature, but material deprivation was not characteristic of the entire sample. NPS use was not connected to certain psychopathological characteristics the way classical substance use was. More than half of the respondents had elevated scores on MMPI-2 Demoralization (RCd) and Dysfunctional Negative Emotions (RC7) scales. Nearly half of them also scored high on Neuroticism/Negative Emotionality (NEGE). CONCLUSIONS: Results suggest that NPS use in the context of polydrug use is connected to psychological trauma and emotion regulation deficiency, but the MMPI-2 scales to assess emotional dysfunctions are not connected to a particular type of NPS.

2.
Minerva Surg ; 78(3): 283-292, 2023 Jun.
Article in English | MEDLINE | ID: mdl-36762602

ABSTRACT

INTRODUCTION: Metabolic surgery is a more effective manner to manage weight loss for morbidly obese patients than conservative therapy. There are many surgical and endoscopic modalities to choose which represents a real challenge for bariatric surgeons. LGCP is a restrictive procedure, the greater curvature of stomach is folded into the gastric lumen in one or two layers. Endoscopic bariatric and metabolic therapies (EBMTs) are evolving methods in metabolic interventions' inventory. There are two methods imitating LGCP (endoscopic sleeve gastroplasty and primary obesity surgery endoluminal). EVIDENCE ACQUISITION: We have conducted wide literature searches in Pubmed database in order to perform meta-analysis comparing endoscopic and surgical treatment modalities (EBMTs vs. LGCP). Safety and weight-loss outcomes were measured. EVIDENCE SYNTHESIS: A number of 3585 patients for EBMTs and 2350 cases for LGCP were enrolled to final analysis. Comparison of complications (Clavien Dindo grade 1-5) showed almost equal risk. Percent of excess of weight loss was well matched at all follow-up timepoints, however, percent of total weight loss was in favor of LGCP. Changes of BMI were compared and showed similar efficacy for both methods. CONCLUSIONS: EBMTs appeared to be superior to LGCP regarding safety but differences did not reach statistical threshold. Weight loss outcomes were favorable after each method. EBMTs imitating LGCP are promising safe and effective methods.


Subject(s)
Laparoscopy , Obesity, Morbid , Humans , Obesity, Morbid/surgery , Obesity, Morbid/etiology , Obesity, Morbid/metabolism , Gastrectomy/adverse effects , Gastrectomy/methods , Treatment Outcome , Stomach/surgery , Laparoscopy/adverse effects , Laparoscopy/methods , Weight Loss
3.
Langenbecks Arch Surg ; 407(2): 845-860, 2022 Mar.
Article in English | MEDLINE | ID: mdl-34402959

ABSTRACT

BACKGROUND: Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG. METHODS: Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena. RESULTS: Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) = - 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = - 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = - 1.914; p = 0.02; p < 0.05) in MMPI-2 data. CONCLUSION: According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance.


Subject(s)
Gastric Bypass , Laparoscopy , Obesity, Morbid , Duodenum/surgery , Female , Gastrectomy/adverse effects , Gastric Bypass/adverse effects , Humans , Laparoscopy/adverse effects , Male , Middle Aged , Obesity, Morbid/complications , Obesity, Morbid/surgery , Retrospective Studies
4.
Psychiatr Hung ; 36(2): 162-179, 2021.
Article in Hungarian | MEDLINE | ID: mdl-33870903

ABSTRACT

INTRODUCTION: Novel psychoactive substance use (NPS) has proven a challenge for the domestic addiction treatment system. In the first few years, studies focused on types of substances and prevalence. Recently social and cultu ral background, personality/identity issues and experiences of NPS users have been thematised in scientific studies. Our study is connected to the latter tradition. METHODS: Our study comprised a questionnaire on sociodemographic factors, and a mixed method content analysis of highly valenced episodes of life interviews, combining qualitative and quantitative approaches. We analysed the data obtained from 42 NPS users entering treatment. NPS use was confirmed by preceding drug tests. We used descriptive statistical methods to analyse questionnaire data, and employed paired-sample T-test to analyse the data from quanti tative content analysis. The text corpus (personal texts) of the Hungarian National Text Resources was selected as baseline to compare percentages. In our qualitative analysis, we outlined a conceptual network on high point and low point episodes of the life story. RESULTS: Extreme poverty and deprivation was not characteristic of the current sample as a whole. Our content ana - lysis supported previous results on the highly self-destructive nature of novel psychoactive substance use. Major results of the content analysis of highly valenced low point texts were experiences of entrapment, failure, victimisation and never-ending troubles. The use of function words, especially in low point texts, bore marked resemblance with "negative code" frequencies, also indicating a self-destructive attitude. Parallel, elements related to inevitability have increased significantly, while words referring to defence (generalizations and distancing) decreased. CONCLUSION: We interpret the results in terms of the arrested flight/cry of pain model. The results support and add to the conclusions of previous studies on the highly self-destructive nature of NPS-use and may introduce new aspects into treatment. The study is persuasive on the relevance of content analysis in clinical areas.


Subject(s)
Behavior, Addictive , Substance-Related Disorders , Humans , Prevalence , Psychotropic Drugs , Substance-Related Disorders/epidemiology , Surveys and Questionnaires
5.
Langenbecks Arch Surg ; 406(5): 1363-1377, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33712874

ABSTRACT

PURPOSE: Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS. METHODS: A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes. RESULTS: A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): -0.03 and confidence interval (CI): -0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01-0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: -0.03, CI: -0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74-1.59 for BMI changes). CONCLUSION: Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors' hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.


Subject(s)
Bariatric Surgery , Diabetes Mellitus, Type 2 , Gastric Bypass , Obesity, Morbid , Bariatric Surgery/adverse effects , Duodenum/surgery , Humans , Jejunum/surgery , Obesity, Morbid/surgery , Pylorus/surgery , Treatment Outcome , Weight Loss
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