Factors affecting cognitive function of opiate-dependent patients.

BACKGROUND: A wide range of studies found that opiate-dependent patients suffer from cognitive impairment due to a number of different factors. However, this issue has never been examined systematically. Thus, the aim of the present study is to provide a comprehensive analysis of factors that might contribute to cognitive impairment of opiate-dependent patients and specifically differentiates between various cognitive abilities as these might be impacted differently. METHODS: Based on a comprehensive review of the literature with regard to previous findings and suggestions about which factors might affect cognitive functioning, we assessed a wide variety of variables related to substance use and opiate-dependence as well as demographic and socioeconomic variables. Cognitive functioning was assessed through a neuropsychological test-battery. RESULTS: We found that the duration of opiate dependence and maintenance treatment, as well as additional substance consumption (alcohol, amphetamines, and cocaine) are the main variables contributing to cognitive impairment in the domains of attention and executive function. Comorbid depressive symptoms negatively affected reaction times. There was no evidence for the role of demographic variables like age and education on cognitive functioning. CONCLUSIONS: Our findings suggest that it might be important in the treatment of opiate dependence to address the consumption of additional substances and to closely monitor the negative effects of maintenance treatment on cognitive functioning.

Impaired decision making in opiate addiction correlates with anxiety and self-directedness but not substance use parameters.

BACKGROUND: Despite a large number of empirical reports of impaired decision making in substance use disorders, the underlying factors contributing to such deficits remain to be elucidated. This study examined the potential influences of personality traits, affective symptoms, and pharmacological variables on decision making, as measured by the Iowa Gambling Task (IGT) in a sample of opioid-dependent patients. METHODS: A total of 46 opioid-dependent patients taking part in an opiate maintenance outpatient program and 46 healthy control subjects performed the IGT. Personality traits and affective symptoms were examined by using Zuckerman Sensation-Seeking Scale, the State-Trait Anxiety Inventory and Beck Depression Inventory. In addition, Cloninger Temperament and Character Inventory was administered in the patient group. Information on current and life-time substance use was acquired with a standardized interview. RESULTS: Opioid-dependent patients performed significantly worse on the IGT than controls. This difference disappeared after statistically controlling for trait anxiety, state anxiety, disinhibition, depressive symptoms, and lifetime alcohol consumption. Trait and state anxiety and self-directedness were significantly associated with the IGT final score. Hierarchical regression analyses suggested that self-directedness differentially moderated the relationships between the anxiety variables and IGT performance. CONCLUSIONS: The decision-making impairments observed in opioid-dependent patients are influenced by current levels of anxiety and the personality markers trait anxiety and self-directedness. Differences in decision making between opioid-dependent and healthy individuals may also be due to differences in other personality facets, affective symptoms, and alcohol consumption. Amount of opioid and other substance intake did not show any effects. These results indicate that psychological characteristics may have a higher impact on decision-making performance than drug-induced pharmacological effects.

The vicious circle of perceived stigmatization, depressiveness, anxiety, and low quality of life in substituted heroin addicts.

BACKGROUND: Perceived stigmatization of drug addicts may interact with negative mood states and thus may contribute to the maintenance of addictive behavior. METHODS: Opiate maintenance patients (n = 106) and an unselected comparison group (n = 144) rated self-report questionnaires about perceived stigmatization, quality of life (QoL), depressiveness, anxiety, self-esteem, addiction characteristics, and social support. RESULTS: 63% of opiate maintenance patients felt discriminated in contrast to 16% of the comparison group. Perceived stigmatization was rated higher by opiate maintenance patients, and all domains of QoL were rated lower, even when statistically controlling depressiveness, anxiety and social factors. Perceived stigmatization was correlated to depressiveness, anxiety, low self-esteem and low QoL, but not addiction characteristics and social support. Structural equation models revealed anxiety and the pathway depressiveness enhancing feelings of being stigmatized resulting in low self-esteem to explain 74% of variance in mental QoL, whereas anxiety and a pathway stigmatization inducing depressiveness leading to low self-esteem explained 49% of variance in physical QoL. CONCLUSIONS: A vicious circle of stigmatization, negative affective states and low QoL was confirmed. In addition to societal antistigma campaigns, antidepressive and anxiolytic therapy might have the potential to diminish feelings of being stigmatized and to improve QoL.

Buprenorphine and norbuprenorphine findings in hair during constant maintenance dosage.

It is still a matter of debate whether a positive correlation between the dose and the amount of drug in the hair exists. Drugs such as buprenorphine (BUP) used under controlled conditions present an opportunity to prove a possible relationship. Due to discrepant findings of BUP/norbuprenorphine (NBUP) ratios in hair, in vitro degradation of both analytes in diluted acid was also investigated. The levels of BUP and NBUP in proximal hair sections from 18 subjects participating in a maintenance program were determined by liquid chromatography/tandem mass spectrometry following incubation with methanol and subsequent liquid/liquid extraction. BUP and NBUP were incubated in diluted hydrochloric acid at 60°C for up to 24 h. The alleged rearrangement products were simultaneously monitored. All hair samples tested positive for BUP (lower limit of detection-0.238 ng/mg hair) and NBUP (0.043-0.961 ng/mg hair). The concentration of NBUP in hair was consistently higher than that of BUP except for a single specimen. Degradation of BUP and NBUP was dependent on time; hydrolysis of NBUP occurred faster than that of BUP. The concentration of BUP and NBUP will be underestimated if analytes are recovered by acidic procedures. NBUP should be monitored in hair samples besides BUP for the sum of both BUP and NBUP may provide an estimate of BUP exposure following long-term administration of the drug.

Neuropsychological functioning of opiate-dependent patients: a nonrandomized comparison of patients preferring either buprenorphine or methadone maintenance treatment.

OBJECTIVES: In the present study, we investigated whether buprenorphine as a partial mu-opioid receptor agonist is associated with less cognitive impairment than methadone. METHODS: Neuropsychological functioning of opioid-dependent patients, previously assigned to methadone (MMP, n = 30) or buprenorphine (BMP, n = 26) maintenance treatment according to their own preference, was compared and dose effects were investigated. RESULTS: MMP and BMP performed equally well on all measures of neuropsychological functioning including the trail making test, the continuous performance test, and a vigilance task. However, patients receiving a higher dose of methadone were impaired in a vigilance task. CONCLUSIONS: In a free-choice administration of methadone or buprenorphine, there seems to be no difference in cognitive functioning. Possible explanations are discussed.

Effect of ambulatory blood pressure measurement on sleep in patients with a major depressive episode.

BACKGROUND: To assess the effects of ambulatory blood pressure measurement (ABPM) upon sleep in mentally depressed patients with near absence of deep (stage 3 and 4) sleep. METHODS: Twelve depressed patients aged 50.5+/-13.5 (21-item Hamilton Depression Rating Scale: 23.8+/-5.1) were studied on three consecutive nights in the sleep laboratory. In a random order, blood pressure was measured with a portable device over 24 h on either day 2 or 3. Polysomnographic data were analysed according to the criteria of Rechtschaffen and Kales. RESULTS: Compared to the control night, there was a significant increase of awakenings during the ABPM night. However, total sleeping time as well as sleep efficiency remained unchanged. Percentage of nocturnal decrease in both systolic and diastolic blood pressure was unrelated to the number of arousals. CONCLUSION: In depressed patients with severe disturbances of sleep architecture, ABPM did not lead to a prolongation of time awake or decrease in sleep efficiency.

Circadian blood pressure regulation in hospitalized depressed patients and non-depressed comparison subjects.

BACKGROUND: Neuroendocrine dysregulation and disturbed sleep, frequently seen in major depression, may interfere with circadian blood pressure regulation. DESIGN AND METHODS: Using a portable device, 24 h blood pressure profiles were registered in 69 depressed in-patients and 26 hospitalized, non-depressed comparison subjects. The use of antihypertensive medication was considered to be indicative of known arterial hypertension. Mean systolic and diastolic blood pressure levels were compared between the group of depressed patients not taking antihypertensive medication and the healthy comparison subjects, both for the entire 24 h of measurement, and for the daytime and night-time periods. In a subgroup of patients, circadian blood pressure follow-up data were obtained after 5 weeks of antidepressant therapy. RESULTS: Depressed patients not receiving antihypertensive medication (n=52) had higher mean 24 h systolic blood pressure levels than non-depressed comparison subjects (125.5+/-14.7 versus 119.6+/-13.3 mmHg, P<0.05). Subgroup analysis revealed that this difference could be almost exclusively attributed to patients on hypnotic medication; this subgroup also had a high day/night blood pressure change ('dip'). In depressed patients using antihypertensive agents (n=17), circadian blood pressure levels pointed to a suboptimal control of hypertension. In the subgroup with follow-up measurements, circadian blood pressure levels had not changed after 5 weeks of antidepressant therapy. CONCLUSION: Circadian blood pressure monitoring identified a subgroup of depressed patients characterized by higher mean systolic blood pressure levels, the use of hypnotics and a high day/night blood pressure change.

Antidepressive treatment with amitriptyline and paroxetine: effects on saliva cortisol concentrations.

With regard to the course of basal human hypothalamus-pituitary-adrenal (HPA) system activity, there is a lack of data for comparing different classes of antidepressants. Ninety-four patients were included in a study comparing standardized treatment with paroxetine (PAROX) and amitriptyline (AMI) after a drug-free period of at least 6 days. Saliva for measurement of cortisol concentrations was obtained daily at 0800, 1600, and 2200 during the 6 days of drug-free washout and 35 days of active treatment. The course of HPA system activity and psychopathology, as assessed by the Hamilton Depression Scale, was compared by means of repeated-measurement analyses of variance (ANOVA-rm). Only AMI responders-not PAROX responders or nonresponders to either antidepressant-had a significant decline in saliva cortisol concentrations. In hypercortisolemically depressed patients, treatment with AMI may be preferable to PAROX in order to lower HPA system activity.

Hypercortisolemic depression is associated with increased intra-abdominal fat.

OBJECTIVE: Similar to patients with a metabolic syndrome, patients with major depression are at increased risk of developing cardiovascular disorders. Interestingly, both disorders share a specific endocrine syndrome that promotes the accumulation of visceral fat, which again is considered a marker of increased cardiovascular morbidity and mortality. METHODS: Intra-abdominal fat was measured in 22 postmenopausal depressed women and 23 age-matched healthy women by computer tomography at the level of lumbar vertebrae 1 (L1) and 4 (L4). Saliva was taken in patients and control subjects at 08:00 hours over a period of 7 drug-free days for the measurement of free cortisol. In patients only we performed an oral glucose tolerance test. RESULTS: Compared with control subjects, depressed patients with elevated free cortisol concentrations showed similar visceral fat depots at L1 (113.0 +/- 41.6 vs. 94.3 +/- 53.2 cm(2)). Hypercortisolemic depressed patients also showed greater fat depots in this area (74.5 +/- 55.5 cm(2), p =.04) than the normocortisolemic patients. However, a comparison of all patients with control subjects revealed no difference in fat accumulation at either L1 or L4. Finally, glucose concentrations during the glucose tolerance test were higher in hypercortisolemic than in normocortisolemic patients, whereas their insulin levels showed only a tendency toward being increased. CONCLUSIONS: Hypercortisolemic depressed patients suffer from resistance to insulin and increased visceral fat. The fact that hypercortisolemia reverses depression-related fat loss, particularly in the visceral area, might partially explain why major depression can be considered a risk factor for cardiovascular disorders.