Association between terror attacks and suicide attempts.

Based on Durkheim's 'Control theory,' we explored the association between frequency of terror attacks in Israel and the frequency of suicide attempts admitted to the Emergency Room of a major general hospital in Tel-Aviv (1999-2004). Analysis of the six-year study period as a whole revealed no significant correlation between the variables, with the exception of one 11-month segment within it (December 2000-October 2001) that did show a statistically significant positive correlation, and in opposition to Durkeim's hypothesis. It is suggested that suicide attempts as a phenomena should be seen as a product of a multivariate model, in which the social context plays a role as well.

Does psychiatric comorbidity affect drug abuse treatment outcome? A prospective assessment of drug abuse, treatment tenure and infectious diseases in an Israeli methadone maintenance clinic.

OBJECTIVE: The influence of psychiatric comorbidity in drug addicts on therapeutic outcome is an important unresolved issue. We studied the links between patterns of psychiatric comorbidity and psychological distress with treatment outcome variables. METHOD: 151 methadone maintenance patients underwent a structured clinical interview, twice-weekly urinalysis for traces of drugs of abuse, and completed psychological distress and risk-taking questionnaires for periods of up to three years. Treatment tenure, demographics and hepatitis C status were recorded. RESULTS: High levels of lifetime (82.8%) and current (66.2%) Axis I psychiatric comorbidity were mostly anxiety and affective disorders many of which were substance induced. Patients with current psychiatric comorbidity had significantly more current substance use disorders, although they did not abuse more drugs or remain in treatment less time than patients with no current psychiatric comorbidity. Patients with a lifetime Axis 1 disorder remained in treatment longer. Severity of psychological distress was related to current substance-related diagnoses, benzodiazepine abuse, higher methadone dosage, risk-taking behavior and the presence of hepatitis C. CONCLUSIONS: Severity of psychological distress, but not comorbid psychiatric disorders, has a major negative association with treatment outcome of patients receiving methadone maintenance treatment (MMT). Surprisingly patients with comorbid mental illness seem to remain in treatment longer than those without. Therapeutic efforts should also focus on treating subjective distress and its possible influence upon drug use behavior.

Cannabis abuse is not a risk factor for treatment outcome in methadone maintenance treatment: a 1-year prospective study in an Israeli clinic.

OBJECTIVE: We addressed the following questions. What are the current and lifetime prevalence of cannabis abuse in an Israeli methadone maintenance treatment (MMT) clinic? Does cannabis abuse change over time during MMT? Is cannabis abuse related to treatment outcome measures such as retention rate and the abuse of drugs? Is the abuse of cannabis related to psychopathology, HIV/HCV risk-taking and infectious diseases? Do cannabis abusers (CAs) have a different psychosocial and demographic profile than nonabusers (NCAs)? Is cannabis abuse part of a polydrug abuse tendency or a distinct substance of abuse? METHOD: Overlapping samples of either the entire clinic population (n = 283) or all the patients who had completed 1 year of MMT treatment (n = 196 of which 20 were re-entering) underwent random and twice-weekly observed urine analysis for various drugs of abuse, responded to self-report questionnaires (SCL-90-R; HIV/HCV risk-taking behaviours; n = 164), interviews (ASI, n = 176; SCID, n = 151) and hepatitis C and HIV testing (n = 149). RESULTS: Lifetime abuse prevalence was found in 75% and current abuse at MMT intake in 25%. Abuse did not increase significantly over a 1-year period. Cannabis abusers were found to be more often polydrug abusers than NCAs. Cannabis abusers did not suffer from more psychological distress, infectious diseases, and did not engage in more HCV/HIV risk-taking behaviour, nor did they leave treatment earlier than NCAs. CONCLUSIONS: Cannabis abuse MMT patients should be treated as polydrug abusers, although no specific influences of cannabis abuse on psychological and medical conditions of MMT patients have been observed. Treatment policy should take these results into consideration.

The antinociceptive effect of amisulpride in mice is mediated through opioid mechanisms.

Antinociceptive effects of various neuroleptics in animal acute pain-models have been described, mediated trough different pathways including the opioid system. In this study, we assessed the antinociceptive effects of the atypical neuroleptic drug amisulpride, which acts as a selective blocker of dopamine D2 and D3 receptors. Furthermore, at low doses amisulpride has a selective preference for presynaptic dopamine autoreceptors, while at high doses it manifests a preferential action at post-synaptic dopamine receptors. We found amisulpride to be a potent antinociceptor agent in the mouse tail-flick assay, with an ED50 of 36.6 mg/kg. This effect was antagonized by naloxone (P<0.05), indicating an involvement of opioid mechanisms as mediators of the antinociceptive effect of amisulpride. Beta-funaltrexamine (mu1- and mu2-opioid receptor antagonist), naloxonazine (selective mu1-opioid receptor antagonist), naltrindole (selective delta-opioid receptor antagonist), Nor-binaltorphamine (kappa1-opioid receptor antagonist) reversed amisulpride antinociception at the same dose that they antagonized morphine's antinociceptive effect (all P<0.005). We found that the sensitivity of amisulpride-induced antinociception is mediated through selective involvement of all three opioid receptor subtypes. Based on previous studies with risperidone, clozapine and olanzapine we tend to attribute this global interaction with the opioid system to amisulpride's action at the dopamine D2 receptor sites.

Treatment of benzodiazepine dependence in methadone maintenance treatment patients: a comparison of two therapeutic modalities and the role of psychiatric comorbidity.

OBJECTIVE: Therapeutic approaches for benzodiazepine (BZD) dependence in patients in methadone maintenance treatment (MMT) have met with limited success. Clonazepam detoxification (CDTX) and clonazepam maintenance treatment (CMT) were compared in an open, clinical naturalistic study on such patients. METHODS: Benzodiazepine dependent patients substituted their BZD of abuse for clonazepam and were then either detoxified (CDTX) or a maintenance dose was reached and maintained (CMT). Patients were considered as failing the trial if they either abused BZDs (CDTX group) or abused BZDs over the maintenance dose (CMT group). Treatment outcome was evaluated based upon self and staff reports over 1 year after beginning treatment. Axis I and II psychiatric diagnosis was assessed and methadone dosage and history of abuse was recorded. RESULTS: In the CDTX group, 9/33 (27.3%), were BZD-free after 2 months. In the CMT group, 26/33 (78.8%) refrained from abusing additional BZDs over the maintenance dose after 2 months. The same success rate remained over the entire year. Survival analysis showed CMT to be more successful than the CDTX. Axis I psychiatric comorbidity was found to be positively related to treatment success in the CMT group while axis II antisocial personality disorder was found to be negatively related to treatment success in that group. It had no impact in the CDTX group. CONCLUSIONS: Maintenance strategy with clonazepam is a useful BZD treatment modality for BZD-dependent MMT patients with a long-term history of abuse and previous attempts at detoxification. Psychiatric comorbidity may have an important role in choosing the adequate treatment modality and influencing treatment outcome.

Benzodiazepine abuse in a methadone maintenance treatment clinic in Israel: characteristics and a pharmacotherapeutic approach.

OBJECTIVE: 1) To study the prevalence, course and correlates of benzodiazepine (BZD) abuse in an Israeli methadone maintenance treatment (MMT) clinic; and 2) to present preliminary results of an open clinical study on the treatment of BZD addiction in MMT patients using BZD maintenance. METHODS: Study 1 was carried out on 196 patients who were in MMT for at least one year. Objective information on drug use (urine testing) was recorded, and the one-year retention rate was measured. Demographic data and history of abuse were obtained, and a self-rated psychopathology and psychological distress questionnaire was administered. The second study was an open one. Twenty BZD-addicted patients were given clonazepam maintenance treatment (CMT) and were started on a daily regimen of 6 mg. followed by a gradual tapering until an individual dose was reached. This maintenance dose was the lowest level at which the patient still expressed satisfaction with the BZD dose without reporting craving or overdose. Failure was defined by three daily consecutive BZD uses above the permitted dose. RESULTS: BZD abuse was significantly reduced during the first year of MMT (from 55 to 43%, P < .000), although a number of patients started to abuse BZDs during this period. BZD abusers (BAs) were found more often to be polydrug abusers, their methadone dosage was higher than non-abusers (NBAs), they started to abuse drugs in general and heroin in particular earlier than NBA, and they had higher self-rated psychopathology and psychological distress scores. The second study showed that CMT was successful in 75% of the patients over a period of six months and that it is, therefore, a promising mode of treatment for BZD-dependent MMT patients. CONCLUSIONS: MMT patients who abuse BZDs are at an increased risk for continuing polydrug abuse. Although our results are to be taken cautiously due to the inherent limitation of a non-controlled non-randomized pilot study, ongoing maintenance with clonazepam seems to be well tolerated and a stabilizing and satisfying pharmacotherapy for BZD dependent MMT patients.