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Substance use disorders (SUDs) are associated with depression and anxiety, with the latter being one of the major factors in substance-seeking and relapse. Due to dose-dependent sedative side effects there is limited efficacy of baclofen treatment for SUDs. Here we suggest the use of a novel combination of opipramol and baclofen (O/B) which is known to attenuate anxiety and depression, for the facilitation of recovery from SUDs. Since both opipramol and baclofen have a common downstream signal transduction, their individual doses could be reduced while still maintaining the benefits of the combination. We tested the O/B combination in both animals and patients. Rats treated with O/B showed significant attenuation in craving behavior and in relapse rate during withdrawal from cocaine. In a double-blind, placebo-controlled pilot study, conducted in a residential detoxification center, 14 males and 3 females, aged 28–60 years were assigned to a study ( n = 6) and a placebo ( n = 11) group (placebo group: 40 ± 10.5 years; O/B group 40 ± 10.8 years). The participants completed scales measuring depression, anxiety and craving symptoms and provided saliva samples for stress hormone examination [cortisol and dehydroepiandrosterone-sulfate (DHEA-S)]. Participants with polysubstance use disorder (PsUD) treated with O/B showed a reduction in cravings and depression and an increase in DHEA-S and in the DHEA-S/cortisol ratio. Our findings indicate a beneficial effect of O/B treatment. This study suggests a novel candidate for pharmacological treatment of patients with SUD and comorbid mood/anxiety disorders that may facilitate their rehabilitation.

Abstract The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical, dimensional model of psychological symptoms and functioning. Its goals are to augment the use and address the limitations of traditional diagnoses, such as arbitrary thresholds of severity, within-disorder heterogeneity, and low reliability. HiTOP has made inroads to addressing these problems, but its prognostic validity is uncertain. The present study sought to test the prediction of long-term outcomes in psychotic disorders was improved when the HiTOP dimensional approach was considered along with traditional (ie, DSM) diagnoses. We analyzed data from the Suffolk County Mental Health Project (N = 316), an epidemiologic study of a first-admission psychosis cohort followed for 20 years. We compared 5 diagnostic groups (schizophrenia/schizoaffective, bipolar disorder with psychosis, major depressive disorder with psychosis, substance-induced psychosis, and other psychoses) and 5 dimensions derived from the HiTOP thought disorder spectrum (reality distortion, disorganization, inexpressivity, avolition, and functional impairment). Both nosologies predicted a significant amount of variance in most outcomes. However, except for cognitive functioning, HiTOP showed consistently greater predictive power across outcomes—it explained 1.7-fold more variance than diagnoses in psychiatric and physical health outcomes, 2.1-fold more variance in community functioning, and 3.4-fold more variance in neural responses. Even when controlling for diagnosis, HiTOP dimensions incrementally predicted almost all outcomes. These findings support a shift away from the exclusive use of categorical diagnoses and toward the incorporation of HiTOP dimensions for better prognostication and linkage with neurobiology.

Background. The long-term use of methamphetamine (MAMP) can result in psychosis but it is not clear why some individuals develop psychotic symptoms, while others use MAMP regularly over long periods and remain unscathed. We set out to characterize MAMP users and to examine the relationship of pre-morbid personality, pre-morbid social function and other psychiatric disorders to MAMP psychosis. Method. Four hundred and forty-five amphetamine users were recruited from a psychiatric hospital and a detention centre in Taipei, and were assessed with the Diagnostic Interview for Genetic Studies (DIGS). Their parents were interviewed with the Premorbid Schizoid and Schizotypal Traits (PSST) and the Premorbid Social Adjustment (PSA) schedules. Pre-morbid characteristics and psychiatric co-morbidity were compared between the MAMP users with a lifetime diagnosis of MAMP psychosis and those without. Results. The MAMP users with psychosis presented a clinical picture which mimicked the positive symptoms of schizophrenia: 85% had auditory hallucinations; 71% persecutory delusions; 63% delusions of reference. Compared with their non-psychotic counterparts, these MAMP users were younger at first MAMP use, used larger amounts of MAMP, had a significantly higher mean PSST score, and higher rates of major depressive disorder, alcohol dependence and antisocial personality disorder. Conclusions. Earlier and larger use of MAMP was associated with increased risk of psychosis. Our data are also compatible with the view that pre-morbid schizoid/schizotypal personality predisposes MAMP users to develop psychosis, and that the greater the personality vulnerability, the longer the psychosis will persist.

The study aims to identify psychopathologic variables in cannabis-induced psychosis and recent-onset primary psychoses using the Symptom Checklist-90-R and the Psychiatric Research Interview for Substance and Mental Disorders. A sample of 181 subjects with psychotic symptoms and cannabis use referred to the psychiatry inpatient units of 3 university general hospitals were assessed. The final sample included 50 subjects with a diagnosis of cannabis-induced psychotic disorder (CIPD) and 104 subjects with primary psychotic disorders. Using receiver operating characteristic curves, the most efficient psychopathologic variables for classifying CIPD were interpersonal sensitivity, “depression,” phobic anxiety, and Scale to Assess Unawareness of Mental Disorders subscales. The area under the receiver operating characteristic curve of the model including depression and “misattribution” scores was 96.78% (95% confidence interval, 94.43-99.13). Depressive symptoms could be used to distinguish CIPD from other primary psychotic disorders. Clinical variables related to “neurotic” symptoms could be involved in the susceptibility to cannabis-induced psychosis.

The present study was aimed at exploring the prevalence and factor structure of methamphetamine (MA) psychotic symptoms. The data were obtained from a cross-country evaluation of substance use, health, and treatment in MA psychotic in-patients. The prevalence rates of lifetime and current psychotic symptoms were determined by using Mini-International Neurospychiatric Interview-Plus, Module M. The Manchester scale was used to assess the severity of psychotic symptoms during the week prior to assessment. All eight items of the Manchester scale were subjected to principal-component analysis, eigenvalue one test, and varimax rotation. The data of 168 patients (127 male and 41 female) included in the analyses were obtained from Australia, Japan, the Philippines and Thailand. Persecutory delusion was the most common lifetime psychotic symptom found in 130 participants (77.4%), followed by auditory hallucinations, strange or unusual beliefs, and thought reading. Auditory hallucinations were the most common current symptom found in 75 participants (44.6%), followed by strange or unusual beliefs and visual hallucinations. Current negative symptoms were also found in 36 patients (21.4%). Apart from a factor of anxiety and depression, the results yielded a two-factor model of MA psychotic symptoms, which were negative and positive/disorganized syndromes. The negative syndrome comprised poverty of speech, psychomotor retardation, and flattened/incongruous affects. The positive syndrome consisted of delusions, hallucinations, and incoherent speech. Both positive/disorganized and negative syndromes should be taken into account in assessing MA psychotic symptoms. The clinical findings do not support the shortcomings of amphetamine-induced psychosis in modelling the negative symptoms of schizophrenia.

Aim: To describe lifetime mental disorders in patients with substance use disorders (SUD) admitted for the first time to specialized treatment for psychiatric or addiction problems from a catchment area. Methods: Special efforts were made to include all eligible patients and secure completion of thorough assessments, including the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) and the Structured Clinical Interview for DSM-IV axis II personality disorders (SCID-II). The strength of this study lies in its rigorous patient recruitment and assessment methods. Results: Of 61 patients, 53 had alcohol use disorder (AUD). Of these, 28 had AUD only, and 25 had an additional drug use disorder (DUD). 89% had comorbid axis I (85%) or axis II (46%) disorders. The most prevalent axis I disorders were major depressive disorder (71%), social phobia (31%) and posttraumatic stress disorder (18%). Among those with comorbid psychiatric disorders (n = 54), 25 (41% of the sample) had disorders considered to be independent of their substance use only, 4 patients (7%) had substance-induced disorders only, and 23 patients (38%) had both independent and substance-induced disorders. Conclusion: Comorbid mental disorders were remarkably prevalent in these SUD patients who were admitted for the first time.

Background This study was performed for clinical study of suicide including risk factors in psychiatric patients admitted in psychiatric unit of Assiut University Hospital (AUH). Results We found that frequency of suicidal attempts is more in MDD (major depressive disorder), bipolar disorders followed by schizophrenia. And frequency of suicidal attempts in patients with multiple previous attempts before this one was higher in patients with mood disorders (53.8%) than psychotic and substance-induced disorders (32.3%, 13.8% respectively), with statistically significant difference in patients with MDD as well as there was significant treatment outcome on suicidal behavior. Conclusion The frequency of suicidal attempts is more in MDD (major depressive disorder), bipolar disorders followed by schizophrenia. There was significant severity of suicidal behavior in patients with psychotic disorders in comparison to patients with substance-induced disorder or mood disorders.

Background St John’s wort ( Hypericum perforatum ) has been known for centuries for its therapeutic properties and its efficacy as an antidepressant has been confirmed by a growing body of evidence. During the last two decades it has also come to prominence with a wider public, due to advertising efforts across Europe and United States of America. However, its availability without prescription, as an over-the-counter medication, raises some concern regarding its clinical management and unsupervised administration to individuals with psychopathological risks. To date, the evidence available regarding the administration of Hypericum in people with severe mental health problems is still meager and refers mainly to affective disorder spectrum or psychotic relapse in people with established diagnoses. To the best of our knowledge, this is the first report regarding the onset of psychotic features in a patient presenting with psychotic diathesis. Case presentation The case discussed in this report is a 25-year-old white man, not known to the psychiatric services, with a history of brief and self-remitting drug-induced psychosis and a positive family history of psychotic depression. He was admitted to hospital due to the onset of florid psychotic symptoms concomitant with self-administration of Hypericum perforatum . Conclusions The aim of this report is to promote further systematic research, draw the attention of clinicians to the potential risks of Hypericum precipitating psychosis, and raise awareness among health professionals to investigate and caution their patients on the haphazard use of phytotherapeutics such as Hypericum .

Female drug users report greater psychopathology and risk behaviours than male drug users, putting them at greater risk for HIV. This mixed-methods study determined psychiatric, behavioural and social risk factors for HIV among 118 female drug users (27% (32/118) were HIV seropositive) in Barcelona. DSM-IV disorders were assessed using the Spanish Psychiatric Research Interview for Substance and Mental Disorders. 30 participants were interviewed in-depth. In stepwise multiple backward logistic regression, ever injected with a used syringe, antisocial personality disorder, had an HIV seropositive sexual partner and substance-induced major depressive disorder were associated with HIV seropositivity. Qualitative findings illustrate the complex ways in which psychiatric disorders and male drug-using partners interact with these risk factors. Interventions should address all aspects of female drug users’ lives to reduce HIV.