Pharmacological Treatment of Insomnia Symptoms in Individuals with Substance Use Disorders in Spain: A Quasi-Experimental Study.

INTRODUCTION: Pharmacological treatment of insomnia in patients with addictions has been hardly investigated and there are few researches about it in an inpatient detoxification. The aim of this study was to describe the outcomes of the pharmacological treatment of insomnia in SUD patients admitted to a detoxification unit in Spain, with a focus on the primary substance of abuse and co-occurring mental disorders. METHODS: A quasi-experimental study was conducted in 481 addicted in patients, who were admitted for substances detoxification in Vall d´Hebron University Hospital, Barcelona, Spain, from 2010 to 2015. The patients underwent systematic evaluation of axes I and II psychiatric disorders (SCID-I, SCID-II, and CAADID). Insomnia was evaluated using a night time sleep log. Substance-dependent patients, who had insomnia during hospital detoxification, received a psychotropic medication with hypnotic effect, keeping the regular clinical practice without randomization. RESULTS: At discharge, insomnia was considered to have been alleviated in 63.8% (n = 204) of patients while 36.2% (n = 116) of patients remained with insomnia disturbances. Comparing hypnotic treatments it was observed that mirtazapine and clotiapine were the treatment that corrected the insomnia more frequently. DISCUSSION: Since insomnia is not corrected in all patients, it should be further investigated in medications with hypnotic purpose. Based on the results of this work, randomized clinical trials might be proposed.

Higher severity of cocaine addiction is associated with tactile and somatic hallucinations.

BACKGROUND: The aim of this study is to describe the features of cocaine-dependent patients who have had cocaine-induced tactile/somatic hallucinations (CITSH), and to analyze the association with addiction-related variables and psychiatric comorbidity, comparing patients with CITSH, patients with cocaine psychotic symptoms (CIP) and no CITSH, and patients without any psychotic symptom. METHOD: A cross-sectional study was conducted in 767 cocaine-dependent patients in an outpatient treatment center for addictions. The following data were obtained: sociodemographic characteristics, CIP information, addiction-related variables and psychiatric comorbidity. A bivariate and multivariate analysis was performed. RESULTS: Of the whole sample, 6.6% reported CITSH at some point of their lives, 48.4% had suffered some CIP other than CITSH, and 45% had not experienced any psychotic symptom. According to multivariate analysis, risk of overdose increases by 12.1 (OR) times the probability of having had CITSH compared patients with CIP-no-CITSH. Other variables associated to patients with CITSH were: age of drug use onset, presence of episodes of overdose, prevalence of psychotic disorder induced by cocaine. In general, in all variables studied, patients with CITSH presented worse clinical features (addiction variables and psychiatric comorbidity) than patients with CIP without CITSH and non-CIP group. CONCLUSION: CITSH are usually associated with other psychotic symptoms induced by cocaine. The patients who experienced CITSH are more severe cases compared both with patients with CIP without CITSH and patients without CIP. Increased risk of overdose is an important issue in this type of patients.

Association study of 37 genes related to serotonin and dopamine neurotransmission and neurotrophic factors in cocaine dependence.

Cocaine dependence is a neuropsychiatric disorder in which both environmental and genetic factors are involved. Several processes, that include reward and neuroadaptations, mediate the transition from use to dependence. In this regard, dopamine and serotonin neurotransmission systems are clearly involved in reward and other cocaine-related effects, whereas neurotrophic factors may be responsible for neuroadaptations associated with cocaine dependence. We examined the contribution to cocaine dependence of 37 genes related to the dopaminergic and serotoninergic systems, neurotrophic factors and their receptors through a case-control association study with 319 single nucleotide polymorphisms selected according to genetic coverage criteria in 432 cocaine-dependent patients and 482 sex-matched unrelated controls. Single marker analyses provided evidence for association of the serotonin receptor HTR2A with cocaine dependence [rs6561333; nominal P-value adjusted for age = 1.9e-04, odds ratio = 1.72 (1.29-2.30)]. When patients were subdivided according to the presence or absence of psychotic symptoms, we confirmed the association between cocaine dependence and HTR2A in both subgroups of patients. Our data show additional evidence for the involvement of the serotoninergic system in the genetic susceptibility to cocaine dependence.

Manejo terapéutico y comorbilidades del paciente con dependencia a opiáceos, en programa de terapia sustitutiva: estudio PROTEUS / Therapeutic management and comorbid psychiatric disorders among opiate dependent patients in replacement therapy programs: The PROTEUS study

Objetivo. Analizar la necesidad de realizar un estudio epidemiológico de pacientes dependientes de opiáceos centrado en conocer más sus tratamientos, comorbilidades médicas y psiquiátricas. Material y métodos. Se examinó la necesidad de tener datos disponibles en nuestro medio sobre el manejo clínico de estos pacientes, el tipo de tratamiento y las posibles comorbilidades. No existen datos completos, representativos de los pacientes españoles. Por ello se seleccionó una muestra representativa a nivel nacional, a partir de la población de pacientes de pendientes de opiáceos en programas de mantenimiento con agonistas opiáceos que acudían a los centros asistenciales de drogodependencias. Resultados. El estudio final incluyó una población representativa de 624 pacientes dependientes a opiáceos en programas de mantenimiento con agonistas, procedentes de 74 centros de asistencia al dependiente de opiáceos de toda España. Conclusiones. Se conocen poco los datos sobre la comorbilidad psicopatológica y médica y los tratamientos farmacológicos en pacientes dependientes de opiáceos. Es necesario realizar un estudio epidemiológico amplio que actualice la realidad de la práctica clínica habitual del paciente dependiente de opiáceos en España (manejo terapéutico, comorbilidades, etc.) valore la gravedad de su adicción, la repercusión sobre el tipo de tratamiento, la presencia de patología dual y las repercusiones médicas (AU)

Background. The purpose of this study was to analyze the need for an epidemiological study of opiate-dependent patients aiming to improve the knowledge about their treatment and medical and psychiatric comorbidities. Matherial and methods. Data on clinical management, treatment type, and comorbidities in Spain were examined. There are no comprehensive data, representative of the Spanish patients. Therefore, a national representative sample was selected from opiate-dependent patients ongoing replacement therapy programs, attending care centers for opiate dependent patients. Results. The representative sample included 624 opiate-dependent patients ongoing opiate replacement therapy programs from 74 drug-dependent rehabilitation centers in Spain. Conclusions. Data on therapeutic management and psychiatric and medical comorbidities in opiate-dependent patients are not well known. There is a need for a comprehensive epidemiological study to update the reality of clinical practice of opioid dependent patients in Spain (therapeutic management, comorbidities, etc.) assessing the severity of their addiction, the impact on the type of treatment, the presence of dual pathology and medical implications (AU)