Neurocognitive performance of patients undergoing intravenous versus oral opioid agonist treatment: a prospective multicenter study on three-month treatment effects.

Introduction: The first-line treatment for opioid dependence is opioid agonist treatment (OAT) with oral opioids. However, in some cases, treatment with intravenous diacetylmorphine (IV-DAM) is indicated. Research on neurocognitive impairments and treatment effects of OAT - particularly with IV-DAM - on neurocognitive functioning, is scarce.

A comprehensive model of treatment participation in chronic disease allowed prediction of opioid substitution treatment participation in Zurich, 1992-2012.

Objectives: Chronic diseases are often associated with cycling in and out of treatment. We used data of a large opioid substitution treatment case register to (1) identify associated factors and (2) integrate retention and readmission into a model of overall participation over subsequent treatment episodes of various groups.

Study Design And Setting: Data of all 9,407 patients undergoing 26,545 methadone or buprenorphine substitution treatment episodes between 1992 and 2012 in the canton of Zurich, Switzerland, were analyzed.

Ethnic- and gender-specific differences in the prevalence of HIV among patients in opioid maintenance treatment-a case register analysis.

Background: We have sought to identify ethnic- and gender-specific differences in HIV prevalence among heroin users receiving opioid maintenance treatment in the canton of Zurich, Switzerland.

Methods: We used a generalized linear model (GEE) to analyze data from the anonymized case register for all opioid maintenance treatments in the canton of Zurich. Patients who received either methadone or buprenorphine between 1991 and 2012 (n=11,422) were evaluated for gender (male vs.

QTc prolongation in methadone maintenance--the role of HCV infection.

Objectives: Several studies have reported prolonged QTc intervals in patients under methadone maintenance treatment, including development of torsade-de-pointes arrhythmia and death. It is still not clear why some patients develop critical QTc extensions while others do not.

Methods: ECG findings in a convenience sample of 210 methadone-maintained heroin-dependent patients, taking HCV-infection status and methadone dosage into account simultaneously by means of a multiple linear regression model with QTc-interval as the dependent variable.

Cognitive dysfunctions in recreational and dependent cocaine users: role of attention-deficit hyperactivity disorder, craving and early age at onset.

Background: Dependent cocaine users consistently display cognitive deficits but cognitive performance of recreational cocaine users has rarely been investigated.

Aims: To examine whether cognitive performance is impaired in relatively pure recreational and dependent cocaine users.

Method: The cognitive performance of recreational (n = 68) and dependent cocaine users (n = 30) was compared with the performance of stimulant-naive controls (n = 68) employing an extensive neuropsychological test battery.

Patient's perceptions of the cannabis-psychosis link--a systematic review.

Over the past years a growing research effort has investigated the relation between cannabis use and schizophrenia at a neurobiological, epidemiological and clinical level. A number of systematic reviews and meta analyses have summarized the available evidence in the field. Conversely the patient's perception of the link between cannabis use and psychosis has been under investigation.

High dose methylphenidate treatment in adult attention deficit hyperactivity disorder: a case report.

Introduction: Stimulant medication improves hyperactivity, inattention, and impulsivity in both pediatric and adult populations with Attention Deficit Hyperactivity Disorder (ADHD). However, data regarding the optimal dosage in adults is still limited.

Case Presentation: We report the case of a 38-year-old Caucasian patient who was diagnosed with Attention Deficit Hyperactivity Disorder when he was nine years old.

Patients on injectable diacetylmorphine maintenance have low bone mass.

Introduction And Aims: Risk factors for osteoporosis are prevalent in chronic heroin users who often start using opiates in their late teens. This study was the first to evaluate bone mineral density (BMD) in relatively young heroin-dependent patients on injectable heroin maintenance.

Design And Methods: Using cross-sectional design, BMD was assessed in a convenience sample of 19 patients (mean age ± SD = 33.

Do patients think cannabis causes schizophrenia? - A qualitative study on the causal beliefs of cannabis using patients with schizophrenia.

Background: There has been a considerable amount of debate among the research community whether cannabis use may cause schizophrenia and whether cannabis use of patients with schizophrenia is associated with earlier and more frequent relapses. Considering that studies exploring patients' view on controversial topics have contributed to our understanding of important clinical issues, it is surprising how little these views have been explored to add to our understanding of the link between cannabis and psychosis. The present study was designed to elucidate whether patients with schizophrenia who use cannabis believe that its use has caused their schizophrenia and to explore these patients other beliefs and perceptions about the effects of the drug.

Combined effects of law enforcement and substitution treatment on heroin mortality.

Introduction And Aims: To explore the combined effects of street-level law enforcement and substitution treatment programs on drug-related mortality, taking into account prevalence of heroin use and changes in injecting behaviour.

Design And Methods: Time trend analysis using annual police reports and case register data of opioid substitution treatments in Switzerland, 1975-2007.

Results: Drug-related mortality increased during times of more intense street-level law enforcement [odds ratio (OR) 1.

Effects of a single 50% extra dose of methadone on heroin craving and mood in lower- versus higher-dose methadone patients.

Some patients on steady-state methadone occasionally crave for extra opioids for different reasons (eg, cue-elicited craving, stress). This study examined the acute-on-chronic effects on heroin craving, mood, and opioid-like symptoms of a single, extra half-dose on top of the patient's prescribed daily methadone dosage. A randomized, double-blind, placebo-controlled, counterbalanced crossover design was used to test the safety of this practice and the hypotheses that extra methadone would reduce heroin craving and improve mood, with greater responses in lower-dose (20-60 mg/d) as compared with higher-dose patients (80-120 mg/d).

Agonist substitution--a treatment alternative for high-dose benzodiazepine-dependent patients?

There is vast evidence for the superiority of agonist treatments (methadone, buprenorphine) over a withdrawal approach in opioid-dependent populations. Little research, however, has been conducted on the same approach for the treatment of high-dose benzodiazepine (BZD) dependence. Even large-scale reviews and meta-analyses discussing treatment strategies for benzodiazepine-dependent patients focus solely upon approaches that aim at achieving abstinence, namely on complete BZD withdrawal.

Differences between men and women in the course of opiate dependence: is there a telescoping effect?

According to the so-called telescoping effect, there is a gender-specific course of alcohol dependence with women starting alcohol use later than men and having a faster development of harmful consequences. There are inconsistent data regarding a telescoping effect in opiate dependence. In each of six European centres, 100 opiate addicts were investigated by a structured interview (mainly the EuropASI and CIDI) at admission to various kinds of treatment (TREAT project).

Estimating incidence trends in regular heroin use in 26 regions of Switzerland using methadone treatment data.

Background: Regional incidence trends in regular heroin use are important for assessing the effectiveness of drug policies and for forecasting potential future epidemics.

Methods: To estimate incidence trends we applied both the more traditional Reporting Delay Adjustment (RDA) method as well as the new and less data demanding General Inclusion Function (GIF) method. The latter describes the probability of an individual being in substitution treatment depending on time since the onset of heroin use.

Low-threshold methadone treatment, heroin price, police activity and incidence of heroin use: the Zurich experience.

Background: There still are concerns about unwanted effects of harm-reduction measures that may lead to an increasing number of new heroin users. Furthermore, it is thought that the admission of a substantial proportion of heroin users to methadone treatments reduces the demand on the heroin market and thus results in a lower price for street heroin. And finally, the intensity of police activity in the drug field may also affect prices for street heroin.

Cannabis using schizophrenia patients treated with atypical neuroleptics: do their symptoms differ from those of cannabis abstainers?

Several studies have found that symptom patterns of cannabis-using schizophrenia patients differ from those of nonusers. However, these investigations have mostly included patients treated with typical neuroleptics (TN). Since differing symptoms could also result from a TN-cannabis combination and might not be due to cannabis use per se, this study examined schizophrenia symptoms in a group of cannabis-using outpatients treated with atypical antipsychotics.

Reasons for cannabis use: patients with schizophrenia versus matched healthy controls.

Objective: The aim of the present study was to compare self-reported reasons for cannabis use in patients with schizophrenia with those of matched healthy controls.

Methods: Thirty-six stable outpatients with schizophrenia treated with atypical antipsychotics and 36 matched controls were included. They completed a questionnaire exploring 15 common reasons for use, established in other studies.

The barriers to smoking cessation in Swiss methadone and buprenorphine-maintained patients.

Background: Smoking rates in methadone-maintained patients are almost three times higher than in the general population and remain elevated and stable. Due to the various negative health effects of smoking, nicotine dependence contributes to the high mortality in this patient group. The purpose of the current study was to investigate Swiss methadone and buprenorphine-maintained patients' willingness to stop smoking and to clarify further smoking cessation procedures.

Estimating heroin epidemics with data of patients in methadone maintenance treatment, collected during a single treatment day.

Aims: Effects of differing drug policies are difficult to evaluate, because time trends in the spread of heroin use, the most problematic illicit drug world-wide, are unknown in almost all countries. We aimed to develop a simple method to estimate these dynamics with data that can be gathered from patients in substitution treatment within a single day.

Design: We tested the assumption that being in substitution treatment on any day depends solely upon individual time since onset of regular heroin use (following a 'general inclusion function').

Repeated intravenous ketamine therapy in a patient with treatment-resistant major depression.

Background: The intravenous administration of ketamine, an N-methyl-D-aspartate receptor antagonist, results in a great improvement of depression symptoms, but it is not clear for how long. This single-case trial was conducted to explore the duration of improvement and the effects of a second administration on the clinical outcome.

Methods: In an open label trial, a 55-year-old male patient with treatment-resistant major depression and a co-occurring alcohol and benzodiazepine dependence received two intravenous infusions of 0.

Intravenous ketamine therapy in a patient with a treatment-resistant major depression.

Background: Recently, reports from North America have indicated that the intravenous infusion of ketamine hydrochloride (an N-methyl-d-aspartate receptor antagonist) results in a sudden and robust improvement of depression symptoms.

Objective: To corroborate antidepressant effectiveness of IV ketamine in a patient with a co-occurring substance use disorder for the first time in a European clinical setting.

Design: Open label trial Methods: A 55-year-old male subject with a treatment-resistant major depression and a co-occurring alcohol and benzodiazepine dependence received an intravenous infusion of 0.

Association between aggressiveness, schizotypal personality traits and cannabis use in Swiss psychology students.

Associations between aggressiveness, schizotypal traits, and self-declared cannabis consumption were explored in Swiss psychology students (n = 205). Higher hostility levels were strongly associated with more pronounced schizotypal traits, whereas frequency of cannabis use was not. Therefore, earlier reported correlations might be due to a subgroup of hostile consumers.

Utilisation of inpatient psychiatric services by people with illicit substance abuse in Switzerland.

Questions Under Study: The study aims to examine the utilisation of inpatient psychiatric services by people with substance use disorders (SUD), and to identify factors that predict inpatient service use.

Methods: Out of a sample of consecutively referred first-admitted patients from a catchment area in Switzerland, a cohort of 563 individuals with behavioural and mental disorders due to (illicit) substance use was followed over a period of 5 years by means of register data.

Results: Every fourth individual of the first-admission sample was admitted for a SUD.