Estimation of cutoff for the Severity of Dependence Scale (SDS) for opiate dependence by ROC analysis.

BACKGROUND: The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence in several types of substances. Optimal cutoff points on the SDS indicative of clinically significant dependence have been determined for a large range of substance types, however, to date no data have been reported on its performance in a population with opiate dependence. SAMPLE: A structured interview was administered to 315 opiate-dependent patients in treatment. METHOD: The diagnostic performance of the SDS was measured via Receiver Operating Characteristic (ROC) analysis according to the DSM-IV diagnosis of heroin dependence, as measured by section 12 of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). RESULTS: ROC analysis revealed the SDS to be a test of high diagnostic utility for the measurement of opiate dependence (Area Under Curve =0.8875). The cut-off point on the SDS at which there is optimal discrimination between the presence and absence of a diagnosis of heroin dependence was found to be 5 (i.e. a score of 5 or more). This score provides the best trade-off between sensitivity (83.15%) and specificity (84.51%). Similar results were found for heroin current consumption (AUC = 0.8325; cut-off = 5; sensitivity = 77.94 and specificity = 77.33). CONCLUSION: The SDS can be recommended as an effective short instrument for the discrimination of the degree of dependency and heroin consumption in the clinical area.

Ecstasy-induced psychotic disorder: six-month follow-up study.

OBJECTIVE: To describe the psychiatric symptoms manifested by persons diagnosed for the first time as having ecstasy-induced psychotic disorder and to explore the evolution of their symptoms over a 6-month period. DESIGN: Observational study with a 6-month follow-up. METHOD: The subjects studied were 32 ecstasy consumers who were treated at two drug-dependency outpatient centers for hallucinatory-delusive manifestations and who were diagnosed as having ecstasy-induced psychotic disorder according to DSM-IV criteria. For the assessment of the intensity of the syndrome and its follow-up, the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI) were used at the outset and after 1, 3 and 6 months. All subjects received treatment with olanzapine. RESULTS: The treatment program was completed by 96.9% of the patients. At the baseline assessment, a high incidence of symptoms of a severe psychiatric disorder was observed. From the first month the psychotic symptoms (BPRS) were considerably reduced with treatment, with the most severe positive symptoms remitting in the first 3 months. The three assessment indicators (BPRS, HDRS and CGI) showed a statistically significant clinical reduction over the 6 months of the assessment period. Furthermore, no relevant side effects were noted. CONCLUSIONS: In its initial manifestations, a drug-induced psychotic syndrome includes marked symptoms meeting the criteria of a severe psychotic disorder, with the presence of considerable positive and negative symptoms. Olanzapine has been shown to be very effective in these situations and its use is suggested as first-choice therapy.

Gypsies and drug addictions. Study of the adherence to treatment.

AIMS: To compare the retention in a Naltrexone Maintenance Programme (NMP) between a gipsy and a 'paya' (non-gypsy) population in the province of Alava (Basque Country, Spain). HYPOTHESIS: The exposure factor 'to be a gypsy' is no different from the factor 'to be "payo" (non-gypsy)' with regard to the response in the continuation of treatment with opiate antagonists. DESIGN AND PARTICIPANTS: Based on a retrospective follow-up study, two cohorts were considered based on the ethnic group to which one belonged. The cohort of gypsies was made up of 52 cases, for whom by means of a matching process 52 'payo' (non-gypsy) subjects were selected to form the other cohort. The matching variables were age, sex, the family support, and HIV+ status. After a period of detoxification, all the subjects participated in a NMP and the retention in this programme was evaluated. FINDINGS: The survival analysis showed a continuation probability that was higher for the non-gypsy group than for the gypsy group, even though the differences were not significant but they did show a tendency (p < 0.06). The post- hoc tests showed differences between the continuations shown by both cohorts between 4 and 8 weeks, with this not being observed at other times. A subsequent proportional risks regression analysis showed a strong influence of the previous treatments variable, the effect of which was greater in the gypsy group, with this finally causing a correction in the continuation curves that reduced the differences. CONCLUSIONS: The results are discussed with regard to the context of the gypsy ethnic group, and suggestions are made with regard to the need for establishing preventive and informative measures that manage to reach the idiosyncrasy of the gypsy culture.

A randomized trial of adding fluoxetine to a naltrexone treatment programme for heroin addicts.

AIMS: The purpose of the study was to assess whether fluoxetine would enhance retention in a naltrexone (NTX) treatment programme. DESIGN: Randomized clinical trial. SETTING: The clinical trial was conducted in two Drug Dependence Centres (DCs) of the Basque Country, Spain over a 1-year period. These DCs routinely used naltrexone as part of their treatment. PARTICIPANTS: A total of 112 heroin addicts included in a naltrexone treatment programme were randomly allocated to two groups of 56 patients each. INTERVENTION: One group received 20 mg/24 h of fluoxetine for the first 6 months, while the remaining 56 patients were used as controls. No placebo was used. MEASUREMENTS: Retention rates and hazard functions were estimated. The risk difference and relative risk were also calculated at 6 and 12 months. FINDINGS: The survival functions showed significantly higher retention rates in the fluoxetine group than among the controls. The risk difference at both 6 months (RD6 = 0.23, CI 95% = 0.06-0.42) and 12 months (RD12 = 0.21, CI 95% = 0.09-0.39) favoured the fluoxetine group, with a greater dropout risk at both times among the controls (RR6 = 1.81, CI 95% = 1.11-2.94; RR12 = 1.46, CI 95% = 1.04-2.04). CONCLUSIONS: The study showed that the combination of fluoxetine and naltrexone produced significantly greater retention than in patients given only naltrexone. Placebo-controlled trials are warranted to assess how far this reflects a specific pharmacological effect.