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The treatment of methamphetamine use disorder (MUD) poses a significant challenge due to high rates of treatment discontinuation, substance use recurrence, and socioeconomic adversity. ‘Mummy, think of me’ (MAMADAM, an acronym from the German “Mama, denk an mich”), a treatment program specifically designed for pregnant women and young mothers with substance use disorders, has shown positive results regarding treatment efficacy and retention of child custody. This study aimed to evaluate the long-term sustainability of the MAMADAM intervention, which has not yet been examined. For this retrospective follow-up study, former patients with MUD who were pregnant and/or parenting women at the time of MAMADAM treatment were contacted by telephone. We analyzed whether self-reported abstinence after discharge from MAMADAM was associated with patient characteristics at admission to MAMADAM. Of the 114 eligible women, 39 participated in the follow-up interview, on average, 4.5 years after completing MAMADAM. Of these, 16 (41%) reported sustained abstinence from all addictive substances, excluding tobacco. At 12 and 18 months after discharge from MAMADAM, 9/39 (23%) and 11/39 (28%) women, respectively, reported at least one instance of substance use, including alcohol but excluding tobacco. Women who reported recurrences of substance use were significantly more likely to have more underage children, live apart from at least one minor, and consume methamphetamine for longer before MAMADAM than women with sustained abstinence. Cox regression, controlling for the duration of MAMADAM treatment, indicated that a longer history of methamphetamine use at admission to MAMADAM was associated with a shorter period of abstinence from all addictive substances (excluding tobacco) following discharge. The MAMADAM program is effective and sustainable in supporting long-term abstinence among pregnant and parenting women with MUD, indicating that pregnancy and parenthood can serve as turning points for promoting the necessary behavioral changes for recovery from addiction. Some women remain at elevated risk of relapse due to the vulnerabilities identified in this study. Future research should investigate whether stronger collaborations with government and community agencies can help these women maintain long-term abstinence.

The manifestations and progression of alcohol use disorder (AUD) are influenced by a number of contextual factors, with the current coronavirus pandemic being a significant example. This pandemic has profoundly impacted nearly all aspects of human life and has, therefore, strongly influenced patients suffering from AUD. In some cases, the pandemic has led to a reduction in severity, while in others, it has had the opposite effect. In our own work we have been investigating the negative impact of the pandemic on 45 patients with AUD who were undergoing outpatient treatment, including supervised use of disulfiram (Antabuse), in a close-knit program. A linear trend analysis demonstrated significant alterations in the retention rate over a 3-year period, encompassing the pre-pandemic, pandemic, and post-pandemic periods. During the pandemic the number of treatment cancellations virtually increased. Following the pandemic, a tendency towards the normalization of patient numbers was observed. Our data indicate a high level of vulnerability among patients with severe AUD and highlight a need for the development of alternative, possibly telemedical, treatment methods.

•Better memory and boundary processing during navigation in young vs. older adults.•Age × intervention interaction in medial temporal lobe activity.•L-DOPA enhanced boundary processing and spatial learning associated in older adults.•L-DOPA impaired young adults’ memory performance during spatial navigation.•Overall, L-DOPA improved location-cue processing relative to boundary processing. Aging is associated with changes in spatial navigation behavior. In addition to an overall performance decline, older adults tend to rely more on proximal location cue information than on environmental boundary information during spatial navigation compared to young adults. The fact that older adults are more susceptible to errors during spatial navigation might be partly attributed to deficient dopaminergic modulation of hippocampal and striatal functioning. Hence, elevating dopamine levels might differentially modulate spatial navigation and memory performance in young and older adults. In this work, we administered levodopa (L-DOPA) in a double-blind within-subject, placebo-controlled design and recorded functional neuroimaging while young and older adults performed a 3D spatial navigation task in which boundary geometry or the position of a location cue were systematically manipulated. An age by intervention interaction on the neural level revealed an upregulation of brain responses in older adults and a downregulation of responses in young adults within the medial temporal lobe (including hippocampus and parahippocampus) and brainstem, during memory retrieval. Behaviorally, L-DOPA had no effect on older adults’ overall memory performance; however, older adults whose spatial memory improved under L-DOPA also showed a shift towards more boundary processing under L-DOPA. In young adults, L-DOPA induced a decline in spatial memory performance in task-naïve participants. These results are consistent with the inverted-U-shaped hypothesis of dopamine signaling and cognitive function and suggest that increasing dopamine availability improves hippocampus-dependent place learning in some older adults.

Previous studies indicate a role of dopamine in spatial navigation. Although neural representations of direction are an important aspect of spatial cognition, it is not well understood whether dopamine directly affects these representations, or only impacts other aspects of spatial brain function. Moreover, both dopamine and spatial cognition decline sharply during age, raising the question which effect dopamine has on directional signals in the brain of older adults. To investigate these questions, we used a double-blind cross-over L-DOPA/Placebo intervention design in which 43 younger and 37 older adults navigated in a virtual spatial environment while undergoing functional magnetic resonance imaging (fMRI). We studied the effect of L-DOPA, a dopamine precursor, on fMRI activation patterns that encode spatial walking directions that have previously been shown to lose specificity with age. This was done in predefined regions of interest, including the early visual cortex, retrosplenial cortex, and hippocampus. Classification of brain activation patterns associated with different walking directions was improved across all regions following L-DOPA administration, suggesting that dopamine broadly enhances neural representations of direction. No evidence for differences between regions was found. In the hippocampus these results were found in both age groups, while in the retrosplenial cortex they were only observed in younger adults. Taken together, our study provides evidence for a link between dopamine and the specificity of neural responses during spatial navigation. The sense of direction is an important aspect of spatial navigation, and neural representations of direction can be found throughout a large network of space-related brain regions. But what influences how well these representations track someone’s true direction? Using a double-blind cross-over L-DOPA/Placebo intervention design, we find causal evidence that the neurotransmitter dopamine impacts the fidelity of direction selective neural representations in the human hippocampus and retrosplenial cortex. Interestingly, the effect of L-DOPA was either equally present or even smaller in older adults, despite the well-known age related decline of dopamine. These results provide novel insights into how dopamine shapes the neural representations that underlie spatial navigation.

Background Alcohol use disorder (AUD) poses severe health risks, yet many affected individuals opt out of complete abstinence. Therefore, harm reduction strategies have become more prominent in treatment guidelines for AUD. Our two case reports illustrate how disulfiram, initially intended to enforce abstinence, was repurposed to support reduced drinking. Case Presentations A 41-year-old patient with a history of severe AUD successfully reduced his alcohol consumption to a low-risk level by leveraging the effects of the disulfiram-alcohol aversive reaction. Another patient, a 63-year-old woman with long histories of AUD and major depressive disorder, experienced fewer depressive episodes and hospitalizations with disulfiram therapy despite periodically intentional discontinuation of medication. Conclusion Individualized treatment strategies are critical in optimizing outcomes for patients with AUD. Continuous disulfiram therapy, despite its limitations in directly reducing alcohol intake, might offer a new avenue for harm reduction in exceptional cases even if alcohol consumption continues. The cases suggest that maintaining therapy, aiming at reduced drinking, can enhance the therapeutic alliance and help manage comorbid conditions. Regular medical monitoring is essential for safety and efficacy, warranting further study of possible long-term consequences and psychotropic effects of elevated acetaldehyde levels related to the disulfiram-alcohol interaction.

In experimental psychology, subjects are often confronted with computer-based experimental paradigms. Creating such paradigms can require a lot of effort. PyParadigm is a newly developed Python library to ease the development of such paradigms by employing a declarative approach to build user interfaces (UIs). Paradigm specifications in this approach requires much less code and training than in alternative libraries. Although PyParadigm was initially developed for the creation of experimental paradigms, it is generally suited to build UIs that display or interact with 2D objects.

Background Alterations of mental status are characteristic of psychiatric disorders but may also result from a multitude of organic causes. Generally, physical examination and blood analysis are a part of basic psychiatric differential diagnostics, whereas more sophisticated procedures (for example, brain imaging) are applied only in cases with pathologic diagnostic findings. Our report challenges this approach by describing a case of glioblastoma multiforme presenting as postpartum depression without abnormalities in basic differential diagnostics. Case presentation A 28-year-old white woman who had been in outpatient treatment for postpartum depression was taken to the psychiatric emergency room. The psychopathological assessment, however, showed mild disorientation and severe deficits of long-term memory. Moreover, she complained of stabbing, bilateral headaches, but results of her physical examination and blood analysis were unremarkable. Magnetic resonance imaging of the brain was performed, which showed a contrast-enhanced mass lesion in the left frontal lobe. The patient underwent urgent tumor resection, and histologic results revealed an IDH -mutant glioblastoma multiforme. The patient was discharged with a substantially improved psychopathology and without neurological deficits. Conclusions This report adds to the evidence that postpartum depression may have organic causes in some cases, a fact that needs to be considered in the clinical setting. Atypical neurocognitive findings in a psychiatric interview may alone justify brain imaging, despite normal physical examination and blood analysis results.

BackgroundDespite various pharmacological and psychological treatment interventions, bipolar disorders rank among the leading causes of global disease burden. Group psychoeducation has been demonstrated an effective add-on to pharmacotherapy, but it may be difficult to implement in practice depending on the clinical setting and available human resources.MethodsMulticenter, rater-blind, randomized controlled trial to investigate the efficacy of a new intervention program consisting of an initial 6-week psychoeducation protocol plus a subsequent structured daily computer-based self-charting program (ChronoRecord) over 54 weeks in remitted patients with bipolar disorders. The control condition included non-structured group sessions followed by daily computer-based self-reports (unstructured like a diary). Both groups received treatment-as-usual.ResultsOver 2 years, 41 mood episodes occurred in the experimental group (n = 39) compared to 27 in the control group (n = 34), without reaching statistical significance. Time to recurrence did not significantly differ between the experimental and control group (25% relapsed after 112 and 273 days, respectively). There were no significant group-by-time interactions in mood symptoms, quality of life, self-efficacy expectations or perceived involvement in care.ConclusionsSix weekly psychoeducational group sessions followed by daily self-monitoring via ChronoRecord for 54 weeks may not be superior to non-structured group meetings followed by unstructured self-reporting. Other psychotherapeutic interventions may be needed to optimize the treatment of patients with bipolar disorders, especially for those at later disease stages.Trial registration Retrospectively registered at German Clinical Trials Register on May 24, 2019; DRKS00017319

Research has indicated a major role of dopamine in decision-making processes, but the underlying mechanisms remain largely unknown due to inconsistency in effects of dopaminergic drugs. To clarify the impact of dopamine on impulsive choice, we administered 150 mg L-DOPA to 87 healthy adults in a randomized, placebo-controlled, double-blind, crossover study, evaluating performance in four value-based decision-making tasks. We predicted that baseline impulsivity would moderate L-DOPA effects. In support of our hypothesis, L-DOPA had no main effect on impulsive choice, but reduced risk-seeking for gains in more-impulsive subjects. Because L-DOPA effects may be influenced by body weight, we repeated our analyses on data from half of the sample (n = 44) with lower weight, anticipating a stronger effect. In addition to the effect on risk-seeking for gains, low-weight participants also exhibited baseline-dependent effects of L-DOPA on loss aversion and delay discounting. Our results are consistent with the hypothesis of an inverted U-shaped dopamine function in which both low and high extremes of dopamine signaling are associated with high-impulsive choice. Consideration of differential baseline impulsivity and body weight may resolve previous seemingly paradoxical pharmacological results and might deepen our understanding of dopaminergic mechanisms underlying impulsivity.

ABSTRACT The consumption of alcohol affects 400 million people worldwide, where it is responsible for 7% of deaths. Treatment success rates in this field remain limited. Only 15% of those who need treatment get it. Despite treatment, alcohol intake reoccurs in up to 90% of the cases. The use of disulfiram in preventing alcohol reoccurrence is attributed to its unique mechanism of action as an aversive agent, which causes the patient to experience unpleasant physical symptoms when they consume alcohol. The objective of this study is to confirm and illustrate the efficacy of disulfiram in combination with non‐pharmacological intervention for persons with severe AUD. Clinical data from 45 patients of an outpatient treatment programme, including the application of disulfiram (2011–2023) were analysed to assess abstinence rates, craving impact, and demographic factors. Moreover, our analyses aimed to identify predictors and moderators of continuous abstinence duration. The study cohort comprised patients with severe AUD and high rates of comorbidities, the majority of which were affective disorders. During treatment, 50% of patients remained abstinent for at least 1 year. No significant differences were identified in craving, sex or comorbidities compared with those who experienced a return to substance use after treatment initiation. Disulfiram underlined its efficacy and tolerability as an adjunct to addiction‐focused treatment in a typical clinical cohort of patients severely affected by AUD. Moreover, our analyses align with previous research indicating that disulfiram appears to allow patients with AUD to resist craving episodes, therefore avoiding impulsive reoccurrences of alcohol intake. Disulfiram is experiencing a renaissance in the treatment of persons with severe alcohol use disorder due to its unique mechanism of action on the one hand and the lack of effective pharmacotherapeutic innovations on the other. Our study supports the efficacy and tolerability of disulfiram when prescribed as an adjunct to addiction‐focused treatment. Almost all of the 45 severely and mostly comorbidly affected individuals studied benefited from this therapeutic approach, with 50% remaining abstinent for at least 1 year.