Risk for Addiction-Related Disorders Following Mild Traumatic Brain Injury in a Large Cohort of Active-Duty U.S. Airmen.

Risk for Addiction-Related Disorders Following Mild Traumatic Brain Injury in a Large Cohort of Active-Duty U.S. Airmen.

Am J Psychiatry. 2013 Feb 22;
Miller SC, Baktash SH, Webb TS, Whitehead CR, Maynard C, Wells TS, Otte CN, Gore RK

OBJECTIVE Military personnel are at increased risk for traumatic brain injury (TBI) from combat and noncombat exposures. The sequelae of moderate to severe TBI are well described, but little is known regarding long-term performance decrements associated with mild TBI. Furthermore, while alcohol and drug use are well known to increase risk for TBI, little is known regarding the reverse pattern. The authors sought to assess possible associations between mild TBI and addiction-related disorders in active-duty U.S. military personnel. METHOD A historical prospective study was conducted using electronically recorded demographic, medical, and military data for more than a half million active-duty U.S. Air Force service members. Cases were identified by ICD-9-CM codes considered by an expert panel to be indicative of mild TBI. Outcomes included ICD-9-CM diagnoses of selected addiction-related disorders. Cox proportional hazards modeling was used to calculate hazard ratios while controlling for varying lengths of follow-up and potential confounding variables. RESULTS Airmen with mild TBI were at increased risk for certain addiction-related disorders compared with a similarly injured non-mild TBI comparison group. Hazards for alcohol dependence, nicotine dependence, and nondependent abuse of drugs or alcohol were significantly elevated, with a consistent decrease over time. CONCLUSIONS A novel finding of this study was the initial increased risk for addiction-related disorders that decreased with time, thus eroding war fighter performance in a military population. Moreover, these results suggest that mild TBI is distinguished from moderate to severe TBI in terms of timing of the risk, indicating that there is a need for screening and prevention of addiction-related disorders in mild TBI. Screening may be warranted in military troops as well as civilians at both short- and long-term milestones following mild TBI. HubMed – addiction

Setting priorities for mental health research in Brazil.

Rev Bras Psiquiatr. 2012 Dec; 34(4): 434-9
Gregório G, Tomlinson M, Gerolin J, Kieling C, Moreira HC, Razzouk D, Mari Jde J

The main aim of this study is to review the agenda for research priorities of mental health in Brazil.The first step was to gather 28 experts (22 researchers, five policy makers, and the coordinator) representing all mental health fields from different geographical areas of the country. Participants were asked to list what they considered to be the most relevant mental health research questions for the country to address in the next 10 years. Seventeen participants answered this question; after redundancies were excluded, a total of 110 responses were collected. As the second step, participants were asked to rank which questions were the 35 most significant. The final step was to score 15 items for each of the 35 selected questions to determine whether it would be a) answerable, b) effective, c) deliverable, d) equitable, and e) effective at reducing the burden of mental health. The ten highest ranked questions were then selected.There were four questions addressing primary care with respect to a) the effectiveness of interventions, b) “matrix support”, c) comparisons of different models of stepped care, and d) interventions to enhance identification and treatment of common mental disorders at the Family Health Program. The other questions were related to the evaluation of mental health services for adults and children/adolescents to clarify barriers to treatment in primary care, drug addiction, and severe mental disorders; to investigate the cost-benefit relationship of anti-psychotics; to design interventions to decrease alcohol consumption; and to apply new technologies (telemedicine) for education and supervision of non-specialists.This priority-setting research exercise highlighted a need for implementing investments at the primary-care level, particularly in the family health program; the urgent need to evaluate services; and policies to improve equity by increasing accessibility to services and testing interventions to reduce barriers for seeking mental health treatment. HubMed – addiction

Psychosocial and clinical predictors of retention in outpatient alcoholism treatment.

Rev Bras Psiquiatr. 2012 Dec; 34(4): 413-21
Corrêa Filho JM, Baltieri DA

One of the factors associated with low rates of compliance in the treatment for alcoholism seems to be the intensity of craving for alcohol. This study aimed to evaluate the associations between alcohol craving and biopsychosocial addiction model-related variables and to verify whether these variables could predict treatment retention.The sample consisted of 257 male alcoholics who were enrolled in two different pharmacological trials conducted at the Universidade de São Paulo in Brazil. Based on four factors measured at baseline – biological (age, race, and family alcoholism), psychiatric (depression symptoms), social (financial and marital status), and addiction (craving intensity, severity of alcohol dependence, smoking status, drinking history, preferential beverage, daily intake of alcohol before treatment) – direct logistic regression was performed to analyze these factors’ influence on treatment retention after controlling for medication groups and AA attendance.Increasing age, participation in Alcoholics Anonymous groups, and beer preference among drinkers were independently associated with higher treatment retention. Conversely, higher scores for depression increased dropout rates.Health services should identify the treatment practices and therapists that improve retention. Information about patients’ characteristics linked to dropouts should be studied to render treatment programs more responsive and attractive, combining pharmacological agents with more intensive and diversified psychosocial interventions. HubMed – addiction

[Examination of Young maladaptive schemes in Gamblers Anonymous group.]

Psychiatr Hung. 2012; 27(6): 435-445
Katona Z, Körmendi A

Background: Literature of gambling addiction has become widespread in last years. Many studies were written about the vulnerability factors helping the development of addiction, theoretical models, comorbid problems and therapy possibilities. Currently there is no integrated theoretical model that could explain sufficiently the development and maintanance of pathological gambling. The treatment issue is also unresolved. Cognitive psychology is a dinamically developing field of psychology and good results are achieved in gambling treatment with applying cognitive techniques. Jeffrey Young’s schema-focused therapy is a recent theoretical and therapeutic direction within cognitive psychology which emphasizes the necessity of emotional changes beside rational ones in the interest of efficiency. Purpose: The purpose of our research is to examine and analyse active maladaptive schemas among gamblers who are members of Gamblers Anonymous self-help group. Sample and methods: 23 control persons and 23 gamblers associated with support group of Gamblers Anonymous took part in our research. The severity of gambling behaviour was measured by Gamblers Anonymous Twenty Questions. For exploring maladaptive schemas we used the shorter 114-item version of the Young Schema Questionnaire (YSQ-S3). Results and conclusions: All the examined gamblers were considered as problem gamblers based on Gamblers Anonymous Twenty Questions. In the control group there where no active schemas while in the group of gamblers several schemas (Emotional deprivation, Self-sacrifice, Recognition seeking, Emotional inhibition, Unrelenting standards, Self-punitiveness, Insufficient self-control) showed activity. Active schemas show similarity in their matter with main establishments of researches about gamblers and support the role of impulsivity, narcissistic traits, self-medicalization and emotional deprivation in the development and maintanance of pathological gambling. HubMed – addiction