Prolactin and beta-endorphin serum elevations after ECT in manic patients.

OBJECTIVE: Alterations in prolactin and beta-endorphin serum levels after ECT are well-established findings in depression. The present study focuses on electroconvulsive therapy (ECT) response patterns of the mentioned parameters in patients suffering from acute mania. METHOD: Following the first three ECTs of a treatment series in 19 patients diagnosed according to DSM-III-R criteria as suffering from mania, blood samples were drawn before, and 20, 30 and 40 minutes after ECT. Serum prolactin and beta-endorphin levels were established in order to gain information about the effects of ECT on different neurotransmitter systems. RESULTS: A significant transient increase in serum prolactin after ECT was found. Furthermore, in females but not males, delta(max)prolactin diminished over the course of treatment as prolactin baseline levels increased. beta-endorphin levels showed a stable transient increase after ECT stimulus regardless from sex or treatment. CONCLUSION: The reported findings reflect those established in depression. This suggests that they are epiphenomenal to ECT.

5-Hydroxy-indolacetic-acid (5-HIAA) serum levels in depressive patients and ECT.

In 31 drug and ECT naive melancholic patients, serum levels of the major metabolite of serotonin 5-hydroxy-indolacetic-acid (5-HIAA) were estimated in the first and third ECT of a course. Plasma samples were taken before ECT and 1, 60 and 120 min thereafter. The estimations were done by a new high performance liquid chromatography method (HPLC). After the seizure, a statistically significant decrease of 5-HIAA serum levels was observed over both ECTs. There was a significant increase in 5-HIAA serum levels from the first to the third ECT. ECT was found to influence serotonin turnover. It might be interpreted that ECT improves serotonergic responsiveness and neurotransmission. There was no significant correlation between 5-HIAA levels and gender, or age of the patients, or seizure duration. Furthermore, the severity of depression and treatment response did not correlate with certain 5-HIAA serum level patterns.

Nasal administration of naloxone is as effective as the intravenous route in opiate addicts.

Naloxone is used intravenously in opiate addiction in emergency cases, in rapid opiate detoxification, and as a diagnostic tool. This is a study comparing the efficacy of intranasal naloxone to other routes (intravenous/intramuscular) in 17 opiate-dependent patients. The nasal drug administration of naloxone was found to be as effective as the intravenous route. The nasal drug application offers a wide margin of safety for patients and medical staff, especially in emergency situations in regard to infection risks associated with vessel puncture.

[Prevalence and sociodemographic correlates of benzodiazepine utilization in an urban population]. / Prävalenz und soziodemographische Korrelate des Benzodiazepingebrauchs in einer Grossstadtbevölkerung.

In conjunction with a population survey of the prevalence of hypertension, conducted in Vienna, the consumption of benzodiazepines was investigated. In cooperation with a public opinion survey institute a quota sample of 1470 Viennese aged over 15 years was visited in their homes by 50 physicians trained in interview techniques. The quota sample comprised 0.959% of the population of 1,531,346 inhabitants and was representative in terms of age, sex, social status and area of residence. 5.3% of the probands took Benzodiazepines often, frequently or at least sometimes. Female sex and higher age correlated significantly with Benzodiazepine use, which was furthermore significantly influenced by the presence of psychopathological symptoms and the responder's subjective feeling of being under stress. Co-medication and physical illness were correlated with a higher benzodiazepine use.

[Individual dosing in methadone substitution therapy. Determination of concentration with high performance liquid chromatography in comparison to immunoassay]. / Individuelle Dosierung in der Methadon-Substitutionstherapie. Konzentrationsbestimmung mittels hochauflösender Flüssigkeitschromatographie und Immunoassay im Vergleich.

Individual Dosing in Methadone Maintenance Therapy/Plasma level determination by means of high performance liquid chromatography versus immunoassay. Measuring plasma methadone levels during maintenance therapy is a matter of discussion. Yet, there has been surprisingly little interest in integrating therapeutic drug monitoring into methadone maintenance programmes. The reasons for this are practical. To achieve optimal results during methadone maintenance therapy, a plasma level higher than 200 ng/ml is desired at all times during treatment. In the present study, a total number of 124 plasma samples were estimated twice: by means of HPLC and by means of fluorescence polarization immunoassay (Abbott TDx). The coefficient of correlation was 0.96416. We conclude that therapeutic drug monitoring should become routine in methadone treatment to achieve optimum results, especially in patients who complain of withdrawal symptoms and continue high-risk behaviour. The used immunoassay was found to be safe and inexpensive.

The use of plasma levels to optimize methadone maintenance treatment.

The question of the optimal methadone dose during maintenance therapy is controversial. For both philosophical and practical reasons, therapeutic drug monitoring has not been generally used. Some therapists prescribe low doses of methadone more for psychological than pharmacological reasons. This study examines, in 104 methadone patients, the relation between self-rating, observer-rating, urine tests, HIV-1 sero-status, daily methadone doses and plasma levels of methadone. No differences were found between HIV-1 infected and seronegative patients in these respects. The optimal methadone plasma level as judged by self- and observer-rating was more than 150 ng/ml. For oral methadone, the best results are obtained in patients receiving more than 90 mg daily. We found a significant relationship between methadone dose and plasma levels, also in patients who also used illicit drugs. We conclude that therapeutic drug monitoring should become routine in methadone treatment to achieve optimum results, especially in patients who complain of withdrawal symptoms and continue high-risk behaviour.

Midazolam shortens seizure duration following electroconvulsive therapy.

In an open, prospective clinical trial, midazolam anaesthesia was compared with thiopental (plus suxamethonium chloride as a muscle relaxant) to clinically evaluate the former as an anaesthetic and a muscle relaxant during electroconvulsive therapy (ECT). Twelve depressed patients underwent a course of ECT, receiving midazolam or thiopental anaesthesia alternatively. Significant differences were found in seizure duration between the two anaesthetics. Midazolam shortened the seizures to a duration that was not therapeutically desirable. There were no differences in stimulus parameters between the two groups. The muscle relaxant effect of midazolam failed to provide optimal paralysis. Thus, midazolam anaesthesia offers no advantage over standard anaesthetic agents for ECT.

Neuropsychological findings and psychiatric symptoms in HIV-1 infected and noninfected drug users.

Reports available on the extent and incidence of cognitive deficits in human immunodeficiency virus (HIV-1) patients are variable. To assess the influence of drug abuse and psychiatric symptoms on the extent of the cognitive deficit, we examined 42 drug-addicted HIV-1 patients and compared them with a group of seronegative drug addicts (n = 31) as well as with a group of healthy controls (n = 50), using a psychometric test battery and standardized psychiatric scales. We found no significant difference in the extent and incidence of cognitive deficits in the group of HIV-1 patients as compared with the seronegative drug addicts. Both groups, however, differed from the normal population group. Remarkable depressive symptoms were found in the HIV-1 infected patient group. We assume that long-term drug abuse contributes markedly to the cognitive deficit of HIV-1 patients, which is further influenced by depressive symptoms.

[4 years' methadone substitution therapy in Austria]. / 4 Jahre Methadon-Substitutionstherapie in Osterreich.

On September 25th 1987 methadone was legalized for therapeutic use in Austria. During the past four years altogether 1828 opiate addicts were admitted to methadone maintenance treatment. 439 females and 926 males were currently being treated in December 1991; their age ranged from 16-59 years, the daily oral d,l methadone dose levels varied between 10 mg and 250 mg per day. Only 406 doctors and 123 pharmacies participate in methadone maintenance treatment, which does not provide complete cover for the area in spite of increased finding. Moreover, the doctors' skills in this treatment have to be improved by requisite training. As Austrian experience shows, methadone treatment offers a first step towards social rehabilitation for drug addicts who have been living as criminals on the fringe of society. Socioeconomic data, as well as criminal behaviour changed dramatically for the better due to this treatment in Austria. Physicians have a clear responsibility to lead the effort on all fronts in the implementation of this treatment modality. Therapeutic drug monitoring should become routine in methadone treatment to ensure compliance and to achieve optimum results, especially in patients who complain of withdrawal symptoms and continue high-risk behaviour and to increase acceptance of substitution therapy. The Austrian treatment model for methadone maintenance treatment is a positive example for other countries who wish to introduce this treatment modality for drug addiction.

Nasal administration of naloxone for detection of opiate dependence.

In clinical trials, nasally applied naloxone was used to identify opiate dependence in humans for the first time. Withdrawal distress was recorded, and pupillary response, pulse rate and blood pressure measured. A significant increase in withdrawal distress and pupillary dilation was observed after nasal administration of 1mg (1mg/400 microliters) naloxone in all subjects who also showed opiate-positive urine samples. In control subjects, no reaction to naloxone was observed. It may be concluded that the nasal route for naloxone administration is as effective as the parenteral route. This test is sensitive enough to identify the physically-dependent opiate user and might have a role in emergency medicine and withdrawal treatment.

Drug addiction and AIDS: highlights of the 1st European Congress.

The 1st European Congress on 'Drug Addiction and AIDS' was held in Vienna, Austria, February 21-23 1991. This conference represented scientists from all areas of Europe and North America. The co-ordinators and the international scientific board offered an exciting programme with eight workshops in clinical, medical and management tracts; there were four plenary sessions with international, national and local experts, exhibits and receptions. With the impact of AIDS and the changes in Eastern Europe, we must now, more than ever before, rethink our strategies to improve effective treatment for substance abusing patients.

Tattooing and high-risk behaviour among drug addicts.

One hundred and seventy-five patients treated at the drug dependence outpatient ward of the Psychiatric University Clinic of Vienna were investigated in February 1990 using a standardized questionnaire which included questions concerning tattoo behaviour. The tattooing procedure, often carried out in prison and employing unsterile equipment, is a possible way of HIV-1 transmission. It is recommended that the fragmentary legislation in Austria be rewritten and made more effective. According to a ministerial order only medical doctors are allowed to procure a licence for tattooing as it is an invasive procedure. Therefore no licensed tattooing establishments controlled by public health offices exist. Their legal existence would guarantee a hygienic standard and reduce the danger of infection.

[Noopsychological changes and psychopathological characteristics of HIV-1 patients of various risk groups]. / Noopsychische Veränderungen und psychopathologische Auffälligkeiten bei HIV-1 Patienten unterschiedlicher Risikogruppen.

Reports on neuropsychological assessment and psychopathological symptoms in HIV-1 patients are rather different. The aim of the study was to assess frequency and extent of noopsychic changes and psychopathological symptoms in HIV-1 patients of different risk groups. Of the 77 patients being included in the study 35 patients belonged to risk group 1, 42 to risk group 2. The patient groups were compared to a control-group of healthy volunteers (n = 50) and to a control-group of HIV-negative i.v. drug-addicts (n = 31). The psychometric test battery included Raven and MWT Test, Benton Test, numerical memory Test, ARG Test. Personality variables were assessed by MMPI, Psychopathology by AMDP-System, Hamilton Depression Scale, Wellbeing Scale (von Zerssen), STAI 1 and 2 and BPRS. Patients of risk group 1 showed significantly less impairment of noopsychic performance than patients of risk group 2. Risk group 1 showed only in the Benton Test significant impairment compared to healthy volunteers while risk group 2 in most of the tests was impaired. Risk group 2 did not show impairment compared to the control-group of seronegative drug users. Depressive syndromes mainly in risk group 2 showed a significant influence on the noopsychic performance.

Comparison between observer assessment and self rating of withdrawal distress during opiate detoxification.

The Subjective Opiate Withdrawal Questionnaire (SOWQ) and the Objective Opiate Withdrawal Scale (OOWS) were administered to detect withdrawal distress during a rapid opiate detoxification. No correlations could be observed between the clinical assessments and self ratings of the 20 patients participating in this study. The observers' ratings of withdrawal reached pre-treatment levels within 3 days. In subjective rating, withdrawal distress returned to normal levels 120 h after detoxification. We conclude, that self reports are as important as observer ratings in assessing treatment efficacy. The use of both scales might prevent early relapse after detoxification.

Similar efficacy of abrupt and gradual opiate detoxification.

A study comparing abrupt and gradual opiate detoxification which identified the efficacy by means of computer-assisted pupilometry and rating of withdrawal distress is presented. This paper concentrates on the efficacies of these two detoxification modes with regard to the identical results after successful opiate detoxification treatment. The findings of the present investigation support the hypothesis that withdrawal distress returns to a normal level after rapid naloxone withdrawal treatment within 6 days. Similar results can be seen for inpatient methadone withdrawal after 3 weeks of treatment. These results indicate that by rapid detoxification therapy, the time of withdrawal can be effectively shortened. Considering the low dropout rate and the high degree of acceptance during rapid detoxification, the rapid detoxification regimen is an effective and economic alternative to gradual withdrawal treatments.

Technique for greatly shortening the transition from methadone to naltrexone maintenance of patients addicted to opiates.

Acute methadone detoxification was induced by the intravenous administration of naloxone during simultaneous intravenous sedation with midazolam, a fully reversible short-acting benzodiazepine, in seven patients addicted to opiates. Within hours the patients tolerated full doses of naltrexone. This technique enables patients to transfer easily, quickly, and safely from methadone to naltrexone maintenance.

Sharing spoons: a risk factor for HIV-1 infection in Vienna.

Sharing of needles and syringes plays a central role in HIV-1 transmission among intravenous drug users (IVDUs). There have been several suggestions to protect the injecting population from further harm, but focused mainly on the use of sterile needles and syringes as well as information about safer sexual behavior. This study examined a total of 366 IVDUs at the drug dependence out-patient ward of the Psychiatric University Clinic of Vienna. HIV-1 antibodies were found in 29.7% (58) in 1989 and in 26.9% (42) in 1990. The results show that in 1989 14% and in 1990 5% IVDUs who never shared needles or syringes or other drug paraphernalia were found to be HIV-1 positive. In spite of the high information standard among Viennese drug addicts on risk reduction, the underestimated co-factors during drug administration might be responsible for a further HIV-1 transmission. Educational interventions on this subject should address even IVDUs who do not share needles and have adjusted to 'safer sex' practices.

Combined naloxone/methadone preparations for opiate substitution therapy.

Every opportunity should be used to reduce the risk of HIV-1 infection and transmission among intravenous drug users (IVDUs). Methadone maintenance is widely accepted to keep the drug user away from risk-laden practices and to stop intravenous drug use. In order to minimize the diversion and intravenous abuse of methadone in maintenance programs, the effects of a combined naloxone/methadone preparation through oral intake and the effects of an intravenous administration were tested. In opiate addicts, the intravenous administration of this mixture caused a severe withdrawal syndrome lasting for 15 to 30 minutes. The oral administration of this combination was indistinguishable from methadone alone. It is argued that this combination therapy prevents the intravenous abuse of methadone in maintenance programs.