Assessment of Knowledge, Comfort, and Skills Working with Transgender Clients of Saskatchewan Family Physicians, Family Medicine Residents, and Nurse Practitioners.

People who are transgender and gender diverse (TGD) report suboptimal care from health care providers. A cross-sectional survey was codesigned with community partners to assess the knowledge, comfort, and skills of family physicians, family medicine residents, and nurse practitioners working with TGD patients in Saskatchewan. It was administered from August to October 2019. Of 188 participants, 30% and 96% were comfortable providing transition-related and non-transition-related medical care to patients who are TGD, respectively. Interest in further training in providing transition-related medical care and cultural safety was high. No significant differences between provider groups were observed. Based on our results, provincial training initiatives will be undertaken.

A model exploring the relationship between betrayal trauma and health: The roles of mental health, attachment, trust in healthcare systems, and nonadherence to treatment.

OBJECTIVE: Prior research suggests that there is a relationship between traumatic experiences and poor health. When considered through the lens of betrayal trauma (i.e., the perpetrator and the victim have a close interpersonal relationship), traumatic experiences predict greater posttraumatic difficulty and higher levels of depression. Betrayal trauma has been associated with poorer interpersonal relationships and less trust in individuals and systems that may be important for a person's wellbeing, such as health care systems. In turn, trauma survivors are less likely to adhere to medical treatment, which may ultimately affect their overall health. The current study examined the complex relationship between experiences of betrayal trauma and poor health, while accounting for demographics, mental health symptoms, trust in physicians and the medical system, attachment style, and nonadherence to medical treatment. METHOD: A demographically representative sample of 312 Canadian participants was surveyed online. Participants completed measures that assessed symptoms of mental health (PTSD, depression), trauma, attachment style, trust, and nonadherence to medical treatment. RESULTS: Hierarchical regression models were used to examine the relationship between betrayal trauma and health. Betrayal trauma significantly predicted nonadherence to treatment, while trust in physicians was explained by trauma, attachment style, and mental health symptoms. All of these factors significantly explained poor health status. CONCLUSIONS: Results suggest the importance of implementing trauma-informed care in health care systems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Memory of a drug lapse: Role of noradrenaline.

Memory processes may be involved in the transition from drug lapses to relapse. This study explored the role of noradrenaline (NA) in reacquisition of place preference, an animal model of relapse that involves the updating of memories about drugs and associated stimuli. Experiments involved 7 phases: habituation, conditioning (1 mg/kg heroin and vehicle; 4 pairings each), test of conditioning (Test I), extinction (vehicle and vehicle; 4 pairings each), test of extinction (Test II), reconditioning (1 mg/kg heroin and vehicle; 1 re-pairing each), and test of reconditioning (Test III). To target memory stabilization processes, various treatments were administered post-reconditioning: systemic clonidine (0, 10, 40, 100 µg/kg; α2 adrenergic receptor agonist); intra-locus coeruleus (LC) clonidine (0, 4.5, 18 nmol); and intra-basolateral amygdala (BLA) propranolol/prazosin (0, 34/2.4 nmol; ß and α1 adrenergic receptor antagonists, respectively). The effect of post-reconditioning systemic clonidine on BLA c-fos expression was also assessed. It was found that systemic clonidine dose-dependently blocked heroin reacquisition when given immediately or 4 h post-reconditioning, but not 8 h later or 4 h prior to Test III. Similar effects were observed following intra-LC clonidine infusions. Post-reconditioning systemic clonidine also blocked reacquisition of cocaine place preference (20 mg/kg). Finally, BLA c-fos expression was reduced by clonidine, and blockade of BLA ß and α1 receptors prevented heroin reacquisition. These findings in rats support the hypothesis that relapse involves memory stabilization processes that can be disrupted by suppression of central NA activity.

Cue-induced renewal of heroin place preference: involvement of the basolateral amygdala.

It is well established that re-exposure to a context paired with the effects of drugs of abuse can renew extinguished drug seeking behavior. A context, however, typically includes several stimuli, which may differ in their ability to control drug-oriented behaviors. Hence, the primary objective of this study was to assess whether a heroin-induced place preference could be recovered by re-exposure to a contextual stimulus that was part of the conditioning context before extinction. The second objective was to explore the role of the basolateral nucleus of the amygdala (BLA) in this conditioned effect. Male Sprague-Dawley rats were injected with 3 mg/kg heroin and confined in a compartment that was distinguished by a variety of contextual stimuli, including a ceramic floor tile. During extinction, the floor stimulus was removed, and it was reintroduced for a drug-free test of preference. A control experiment evaluated the unconditioned preference for the floor stimulus. It was found that reintroduction of the floor stimulus caused the recovery of heroin place preference. This effect was not observed in rats infused in the BLA with muscimol (0.03 nmol) and baclofen (0.3 nmol) just prior to the test. These data suggest that an extinguished heroin place preference can be renewed by a contextual tactual stimulus that was part of the conditioning context, and that this process requires an intact BLA.

The effects of acute and chronic steady state methadone on memory retrieval in rats.

RATIONALE: Although widely prescribed to treat opioid addiction, little is known about the possible side effects of methadone on memory functions. OBJECTIVES: The aim of this study is to compare the effects of acute and chronic methadone on memory retrieval in rats and to explore the selectivity of possible deficits. METHODS: Administration of acute (0, 1.25, 2.5, and 5 mg/kg SC) and chronic steady state methadone (0, 10, 30, and 55 mg/kg/day SC by osmotic mini-pump) was tested on recall of three different types of information: stimulus-reward (10-arm parallel maze), stimulus-response (8-arm radial maze), and stimulus-stimulus (Barnes maze). Acute and steady state methadone doses were also compared on tests of locomotor activity and reactivity to aversive stimuli (i.e., swimming and acoustic startle). RESULTS: In the stimulus-reward task, acute methadone impaired performance as a result of severe depression of locomotion. This motor deficit, however, was modulated by the motivational valence of environmental stimulation. In fact, acute methadone did not eliminate forced swimming behavior. In the stimulus-response and stimulus-stimulus tasks, accuracy was impaired independently of direct motor deficits, but rats were hyper-reactive to aversive stimulation and, in fact, 5 mg/kg enhanced acoustic startle. Importantly, chronic steady state methadone did not affect accuracy of memory retrieval, did not depress motor or swimming activity, and did not change startle reactivity. CONCLUSION: Only acute methadone impaired accuracy and/or performance on three tests of memory retrieval. These findings in rats suggest that memory deficits reported in methadone-maintained individuals may not be directly attributable to methadone.

Effect of yohimbine stress on reacquisition of oxycodone seeking in rats.

RATIONALE: Stress, a powerful precipitant of drug seeking during abstinence, may also accelerate the return to pathological patterns of intake after initial instances of drug reuse. OBJECTIVE: To explore the effect of stress on a learning process underlying relapse, this study assessed the effect of yohimbine on reacquisition of oxycodone seeking. METHODS: One hundred thirty-two male Sprague-Dawley rats underwent place conditioning with oxycodone (2 mg/kg, SC; ×6 days), extinction (vehicle × 6 days), and reconditioning with 0, 0.25, 2, or 5 mg/kg oxycodone (2 days). Yohimbine (0, 2.5, or 5 mg/kg, IP) was administered 30 min prior to reconditioning. RESULTS: Pretreatment with 2.5 mg/kg yohimbine increased, while 5 mg/kg yohimbine decreased, reacquisition of oxycodone-induced place preference. A follow-up study (n = 30) further indicated that the effect of yohimbine was specific to reacquisition. CONCLUSION: The observation that yohimbine can enhance reacquisition of oxycodone seeking supports the hypothesis that stress can facilitate learning processes involved in the unfolding of relapse.