Abuse Victimization in Childhood or Adolescence and Risk of Food Addiction in Adult Women.
Abuse victimization in childhood or adolescence and risk of food addiction in adult women.
Obesity (Silver Spring). 2013 May 2;
Mason SM, Flint AJ, Field AE, Austin SB, Rich-Edwards JW
Objective: Child abuse appears to increase obesity risk in adulthood, but the mechanisms are unclear. This study examined the association between child abuse victimization and food addiction, a measure of stress-related overeating, in 57,321 adult participants in the Nurses’ Health Study II (NHSII). Design and Methods: The NHSII ascertained physical and sexual child abuse histories in 2001 and current food addiction in 2009. Food addiction was defined as ?3 clinically significant symptoms on a modified version of the Yale Food Addiction Scale. Confounder-adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using modified Poisson regression. Results: Over eight percent of the sample reported severe physical abuse in childhood, while 5.3% reported severe sexual abuse. Eight percent met the criteria for food addiction. Women with food addiction were 6 units of BMI heavier than women without food addiction. Severe physical and severe sexual abuse were associated with roughly 90% increases in food addiction risk (physical abuse RR=1.92; 95% CI: 1.76, 2.09; sexual abuse RR=1.87; 95% CI: 1.69, 2.05). The RR for combined severe physical abuse and sexual abuse was 2.40 (95% CI: 2.16, 2.67). Conclusions: A history of child abuse is strongly associated with food addiction in this population. HubMed – addiction
Disrupted Ventromedial Prefrontal Function, Alcohol Craving, and Subsequent Relapse Risk.
JAMA Psychiatry. 2013 May 1; 1-13
Seo D, Lacadie CM, Tuit K, Hong KI, Constable RT, Sinha R
IMPORTANCE Alcohol dependence is a chronic relapsing illness; stress, alcohol-related cues, and neutral-relaxing states significantly influence craving and relapse risk. However, neural mechanisms underlying the association between these states and alcohol craving and relapse risk remain unclear. OBJECTIVES To identify neural correlates associated with alcohol craving and relapse outcomes in 45 treatment-engaged, 4- to 8-week abstinent alcohol-dependent (AD) patients, and to compare brain responses of 30 demographically matched AD patients and 30 healthy control subjects during stress, alcohol, and neutral-relaxing cues. DESIGN Functional magnetic resonance imaging study while participants were engaging in brief individualized script-driven imagery trials of stress, alcohol cues, and neutral-relaxing scenarios, and a prospective clinical outcome design to assess alcohol relapse 90 days postdischarge from inpatient treatment in the AD group. SETTINGS Inpatient treatment setting in a community mental health center and hospital-based research unit. PATIENTS Forty-five recovering AD patients in inpatient treatment for examining relapse, and 30 healthy control subjects demographically matched to 30 AD patients (subgroup of the relapse sample) for group comparisons. INTERVENTION Twelve-step recovery-based addiction treatment for the patient group. MAIN OUTCOMES AND MEASURES Brain response, alcohol craving, and relapse outcome measures (time to relapse and relapse severity). RESULTS Increased ventromedial prefrontal cortex (vmPFC) and anterior cingulate cortex (ACC) activation during neutral-relaxing trials was correlated with high alcohol cue-induced and stress-induced craving in early recovering AD patients (x = 6, y = 43, z = -6; P < .01, whole-brain corrected). This vmPFC/ACC hyperactivity significantly predicted subsequent alcohol relapse, with a hazards ratio greater than 8 for increased relapse risk. Additionally, vmPFC/ACC hyperactivation during neutral trials and reduced activity during stress trials were each predictive of greater days of alcohol used after relapse (P < .01, whole-brain corrected). In contrast, matched control subjects showed the reverse pattern of vmPFC/ACC responses to stress, alcohol cues, and relaxed trials (F = 6.42; P < .01, whole-brain corrected). CONCLUSIONS AND RELEVANCE Findings indicate that disrupted vmPFC/ACC function plays a role in jeopardizing recovery from alcoholism and may serve as a neural marker to identify those at risk for alcohol relapse. HubMed – addiction
Brain Imaging Biomarkers to Predict Relapse in Alcohol Addiction.
JAMA Psychiatry. 2013 May 1; 1-3
Volkow ND, Baler RD
Class-wide REMS for extended-release and long-acting opioids: Potential impact on pharmacies.
J Am Pharm Assoc (2003). 2013 Jan 1; 53(1): e1-7
Matthews ML
OBJECTIVES To provide an update on the recently approved class-wide risk evaluation and mitigation strategy (REMS) for extended-release (ER) and long-acting (LA) opioids and to discuss the potential impact on pharmacy practice. DATA SOURCES In mid-2011, the Food and Drug Administration notified drug manufacturers that a single, class-wide REMS would be required for ER and LA opioids. This regulation was the result of a multiyear process that incorporated input from government, drug manufacturers, medical associations, and other stakeholders. SUMMARY The goal of the class-wide REMS for ER/LA opioids is to reduce addiction, unintentional overdose, and death resulting from inappropriate prescribing, misuse, and abuse. To accomplish these goals, this REMS focuses on physician education on safe and appropriate prescribing and patient counseling on the risks of opioids. Although voluntary, a movement to require physician education to obtain or renew Drug Enforcement Administration licensing is occurring. Pharmacists are not included in the class-wide REMS per se. Pharmacists play an important role in overall risk reduction and are critical to the success of the class-wide REMS. CONCLUSION Although the changing requirements for prescribing ER/LA opioids will not have a direct effect on pharmacist workflow, the pharmacist-patient interaction remains critical for overall risk reduction with this class of medication. HubMed – addiction