bluuebunny/crossref_metadata_2025 huggingface dataset:
Crazy? So what! Effects of a school project on students' attitudes towards people with schizophrenia
Authors: Schulze B. , Richter‐Werling M. , Matschinger H. , Angermeyer M. C.
Published: March 2003

Objective:  Aiming at promoting young people's mental health and reducing stigma towards people with schizophrenia, project weeks were carried out with secondary school students aged 14–18 years (n=90). Key to the project week is meeting a (young) person with schizophrenia.

Method:  Students' attitudes and behavioural intentions towards people with schizophrenia were assessed before and after the project. Parallelly, a control group of students were questioned (n=60). Assessment was repeated after 1 month.

Results:  Despite expected ceiling effects, the project led to a significant reduction of negative stereotypes. For social distance, a positive trend could be observed. These developments were not present with the controls. Attitude changes were still evident at the 1‐month follow‐up.

Conclusion:  Results support the hypothesis that young people's attitudes about schizophrenia are susceptible to change. Antistigma projects at school level could thus be a promising approach to improving public attitudes and to preventing stereotypes from becoming reinforced.
Wadi Suq and Iron Age period ceramics from Sharm, Fujairah (U.A.E.)
Authors: BARKER DIANE
Published: March 2003

The Wadi Suq period and Iron Age ceramics from Sharm are examined in terms of morphological, compositional and decorative features. The assemblage is typical of the second‐ and first‐millennium BC ceramics of southeastern Arabia. The more unusual Iron Age ‘imitation soft stone’ ceramics are amply represented and the Sharm assemblage considerably expands upon this corpus of ceramics which has hitherto been less than abundant in the region. Comparisons with other second‐ and first‐millennium sites suggest the tombs were largely occupied in the late Wadi Suq period, a pattern of occupation which again peaked in the Iron Age II period.
Considering depression as a consequence of activation of the inflammatory response system
Authors: Korf J. , Klein H. C. , Versijpt J. , den Boer J. A. , ter Horst G. J.
Published: March 2003

This paper summarizes the possible interrelation between peripheral and/or cerebral inflammation and depression. Often, depression is regarded as a consequence of life events, including disabling diseases. The question addressed here is whether activation of the inflammatory response system (IRS) can cause depression. Epidemiological studies suggest that depression can be precipitated by bacterial or viral infections. In depressed patients, peripheral markers of the IRS are often increased. There is some evidence that some forms of depression are caused by a viral infection of the limbic system. More consistent are the observations that depression in diseases with active cerebral inflammatory processes (e.g. multiple sclerosis, Alzheimer's disease) may concur. Direct evidence of a relation between depression and inflammation was found in post-mortem brain material of patients with a vascular depression. In both inflammatory brain diseases and in depression, a state-dependent increased hypothalamus–pituitary–adrenal axis activity is seen. Animals studies have shown that intact cerebral serotonin systems are required for the activation of the IRS following an endotoxin challenge and that long-term treatment with antidepressants may change such a response. Gender differences between the prevalence of depression and inflammatory diseases are similar, as more females are affected. We hypothesize that cerebral or peripheral activation of the IRS may contribute to the course of some antidepressant treatment-resistant depressions. Clinical trials combining antidepressants and drugs that reduce the activation of the IRS may provide evidence for such proposed depression subtypes.
Treatment of interictal psychiatric disorder in epilepsy. I. Affective and anxiety disorders
Authors: van der Feltz-Cornelis Cm
Published: March 2003

Background:

Interictal affective disorders are common in patients with epilepsy and there is a need for evidence-based treatment guidelines.

Objective:

This paper gives an overview of research concerning treatment of interictal affective disorders and interictal anxiety disorders in epilepsy.

Methods:

Literature review supplemented by clinical experience.

Results:

Interictal psychiatric disorder can be characterized as intermittent pleomorphic psychopathology. The most common manifestations are interictal dysphoric disorder (IDD) and depression. There is a lack of randomized control trials (RCTs) concerning effectiveness and side-effects of antidepressants in epilepsy patients.

Conclusion:

Treatment implications of the concept of IDD and other interictal disorders are an optimized dosage of anti-epileptics in combination with antidepressants. This coincides with recent guidelines concerning combinations of psychotropic medication, such as for depression and bipolar disorder, in general psychiatry. Systematic research involving the DSM-IV categories of generalized anxiety disorder, panic disorder and agoraphobia and depression is not yet available. Prevalence and treatment of interictal anxiety disorders and depressive disorder in epilepsy should be the subject of further research, in order to enable development of evidence-based treatment guidelines for these disorders in epilepsy patients.
Treatment of interictal psychiatric disorder in epilepsy. III. Personality disorder, aggression and mental retardation
Authors: van der Feltz-Cornelis Cm
Published: March 2003

Background:

Personality disorder, mental retardation and aggression are frequently encountered therapeutic problems in epilepsy patients.

Objective:

This paper gives an overview of symptomatology and treatment of personality disorder, interictal aggression and mental retardation in epilepsy.

Methods:

Literature review supplemented by clinical experience.

Results:

Personality changes in patients with epilepsy are often symptoms of an organic psychosyndrome. Aggression is not more frequent among epilepsy patients than in the general population, but if it does happen it is often more severe. There is a need for controlled treatment studies. A treatment strategy is suggested. In the mentally retarded, diagnostic instruments should be used to overcome diagnostic difficulties.

Conclusion:

Prevalence studies based on DSM-IV personality disorder, conducted in the community, are needed, as well as systematic research on diagnosis and treatment of personality disorder in epilepsy patients. Randomized controlled trials (RCTs) considering the effectiveness and adverse effects of antidepressants and neuroleptics in epileptic patients with mental retardation are seriously needed. In the meantime, the Expert Consensus Guideline Series on Treatment of Psychiatric and Behavioural Problems in Mental Retardation is useful. The use of neuroleptics for the treatment of aggressive or destructive behaviour in nonpsychotic mentally retarded patients remains controversial.
Assessment of borderline personality disorder: considering a diagnostic strategy
Authors: Schotte C. K. W.
Published: March 2003

Background:

Borderline personality disorder (BPD) represents a highly prevalent, severe and difficult-to-treat mental health problem.

Objective:

This paper considers methods, instruments and strategies for assessing BPD as described within the frame of the DSM-IV classification.

Conclusions:

Following the general diagnostic approach introduced by Van Praag in biological psychiatry, a two-tier diagnostic strategy for the descriptive diagnostic assessment of BPD is recommended. Axis one results in a DSM-IV Axis II categorical diagnosis, whereas axis two refers to a symptomatological, dimensional or functional approach, in which the psychological dysfunctions of the nosological syndrome are depicted. Moreover, in a clinical context a basic aim of the diagnostic evaluation is to obtain therapeutically valid information that leads to a constructive conceptual framework, to a case formulation in which therapeutic interventions are understood, selected and implemented. This framework should be based on a biopsychosocial theoretical model and its application in the clinical context involves feedback to the patient, in which the descriptive evaluation is integrated with etiological; and pathogenic elements using an idiographic approach. This therapeutically orientated diagnostic strategy is illustrated by the use of the ADP-IV (Assessment of DSM-IV personality disorders) questionnaire within a cognitive behavioral orientation.
In-patient treatment of borderline personality disorder: convergences and divergences between a psychoanalytical and a cognitive-behavioral approach
Authors: Pieters G. , Vermote R.
Published: March 2003

For more than 20 years, patients with borderline personality disorder have been treated as in-patients in the UC St-Jozef in Kortenberg, Belgium. The majority of these patients were treated in a psychoanalytical or a behavior therapy ward. During these years, the treatment programs of these wards were gradually adjusted to the challenges provided by these patients. In this paper, we will describe the process of change that both wards have experienced. We will highlight similarities and differences between the approaches that are the result of an evolution over years. In both approaches, there is a strong emphasis on training and support for staff. While the psychoanalytical ward uses a group approach, the behavior therapy ward evolves towards a more individualized treatment.
Psychiatric management of severe somatoform disorders in childhood and adolescence
Authors: Garralda M. Elena
Published: March 2003

Background:

Unexplained medical symptoms are common in children. They constitute the main feature of somatoform disorders of childhood (i.e. pain disorders, conversion disorder and chronic fatigue syndrome or neurasthenia).

Objective:

To describe assessment and treatment strategies for severe somatoform disorders of childhood.

Methods:

Review of recommendations for clinical practice and clinical trials.

Results:

A number of specific techniques have been described. Clinical accounts indicate that many children benefit and can recover. There is some empirical evidence supporting the beneficial effects of techniques such as family cognitive-behavioural therapy and relaxation technique for the less severe disorders.

Conclusions:

Existing helpful clinical guidelines require empiric validation.
Pteridines and affective disorders
Authors: Hoekstra R. , Fekkes D.
Published: March 2003

The pteridine tetrahydrobiopterin (BH4) is an essential cofactor in the biosynthesis of dopamine, (nor)epinephrine, serotonin and nitric oxide (NO). Furthermore, BH4 has a direct influence on release mechanisms of these neurotransmitters and on serotonin receptor binding activityimmunology. The synthesis of BH4 is stimulated by interferon-gamma and hence there is a close relationship with the immune systemHPA-axis. In animal experiments it was also found that the hypothalamus–pituitary–adrenal axis influences the pteridine metabolism. In clinical studies, so far, no evidence has been found for this relationshipdiseases. A congenital biopterin deficiency results in atypical phenylketonuria with severe neuropsychiatric symptoms. In several neurological diseases, such as Parkinson's disease, decreased levels of BH4 are founddepression. Since 1984 there have been reports on decreased biopterin and increased neopterin levels in urine and plasma of depressed patients. Conflicting results have also been found, however, due probably to methodological problemstherapy. Until now, oral administration of BH4 to depressed patients has been performed by two investigators, which resulted in mainly temporal clinical improvementdiscussion. Understanding of biochemical mechanisms in which pteridines are involved may contribute to our knowledge of the pathogenesis and treatment of affective disorders. This paper aims to provide an overview of the relevant literature and warrant for further research on this intriguing compound.
Psychiatric symptoms typical of patients with dementia with Lewy bodies – similarity to those of levodopa-induced psychosis
Authors: Iseki Eizo , Marui Wami , Nihashi Namiko , Kosaka Kenji
Published: March 2003

We examined psychiatric symptoms in eight cases with dementia with Lewy bodies (DLB), which included visual hallucination of persons or small animals, visual illusion, metamorphosia, leibhaftige Bewusstheit, personal or topographical misidentification, Capgras' syndrome and reduplicative paramnesia as well as depressive state and delusion of persecution. These psychiatric symptoms are identical to those of levodopa-induced psychosis, although these symptoms appeared before medication with anti-Parkinson drugs. The hypersensitivity of the dopamine receptor in the meso-limbic dopaminergic system has been presumed in levodopa-induced psychosis. We previously showed disturbance of the nigro-amygdaloid dopaminergic connections in DLB brains on pathological studies. Hypoperfusion or glucose hypometabolism in the occipital lobe has been demonstrated in DLB patients using SPECT or PET. The amygdala has reciprocal connections with the visual cortex in the occipital lobe. From these findings, it is supposed that the disturbance of the nigro-amygdaloid connections induces hypersensitivity of the dopamine receptor in the amygdala, causing psychiatric symptoms with dysfunction of the visuo-amygdaloid connections.
Stressor-induced modulation of immune function: a review of acute, chronic effects in animals
Authors: Kusnecov Alexander W. , Rossi-George Alba
Published: March 2003

The present paper reviews recent studies on the effects of stress on immune function in laboratory animals. The emphasis is on those studies where a simultaneous comparison of acute and chronic stress regimens was determined, although additional relevant studies are also reviewed. The effects of stress on basic measurements of cellular and humoral immune measures are discussed, including the growing number of studies that have reported alterations in macrophage functions. The latter are key elements in the innate immune response, and like measurements of T cell function and antibody production, are inhibited and enhanced by stressor exposure. This review does not focus on the mechanisms by which stress alters immune function, there being little to add conceptually in terms of what was reported previously (see Kusnecov AW, Rabin BS,Int Arch Allergy Immunol1994;105:107–121.). However, a question is raised in the conclusion as to how stressor effects on immune function should be interpreted, for it is clear that immunological processes in and of themselves elicit central nervous system responses that neurochemically and endocrinologically do not differ from those produced in response to psychological stressors. Therefore, at least in the short term stressor-induced immune changes may not necessarily reflect maladaptive adjustments, although, as demonstrated by some studies reviewed in this paper, they may pose a serious risk to health should stressor exposure be persistent and uncontrolled.
The acute and sensitization effects of tumor necrosis factor-α: implications for immunotherapy as well as psychiatric and neurological conditions
Authors: Hayley Shawn , Merali Zul , Anisman Hymie
Published: March 2003

In addition to their role as signaling molecules of the immune system, cytokines may participate in central neurotransmission. Variations of the central and/or peripheral levels of the proinflammatory cytokines, tumor necrosis factor-α (TNF-α) and interleukin-β (IL-1β), impact on neuroendocrine processes as well as central neurotransmitter activity. To a considerable extent, these effects are reminiscent of those elicited by psychogenic stressors. The current review describes recent findings consistent with a role for these cytokines in the neurochemical and behavioral manifestations of clinical depression, as well as the cellular death associated with cerebral ischemia. Moreover, the increasing use of cytokines in the immunotherapeutic treatment of various autoimmune diseases (e.g. rheumatoid arthritis) and cancers prompted us to consider the potential role of central processes in subserving the mood-related side-effects elicited by these treatments. Finally, a single administration of TNF-α has been shown to elicit a time-dependent sensitization effect, wherein the behavioral and neurochemical responses elicited by later cytokine treatment are greatly enhanced. Thus, particular attention was devoted to the possibility that elevated levels of TNF-α, through either exogenous (e.g. immunotherapy) or endogenous (e.g. brain damage or stressors) means may sensitize neurotransmitter or second messenger pathways important for the pathology. Given the time-dependent nature of cytokine sensitization effects, the schedule of cytokine administration during immunotherapy, or the timing of cytokine up-regulation in response to traumatic or stressful events may favor the development of sensitized central processes, which may influence clinical outcome.
A literary dessert
Authors: Hoes M. J. A. J. M.
Published: March 2003

This paper contains an expression of gratitude towards the organizers of the congress ‘Psychiatry, Food and Addiction’, and the Board members of the Interdisciplinary Society for Biological Psychiatry, of the Sections ‘Biological Psychiatry’ and ‘Psychiatry and Addiction’ of the Dutch Society of Psychiatry and the former Editorial Board of Acta Neuropsychiatry. The author has been a long-term board member of the society and cofounder of both sections and cofounder and editor-in-chief of this Journal from 1989 to 1999.
Panic disorder and depression: relationship between psychological and biochemical aspects
Authors: Timmerman L.
Published: March 2003

In a group of medication-free out-patients suffering from depression and/or panic disorder we investigated the interdependence between psychological parameters such as aggression and biochemical parameters such as serotonin and tryptophan. We compared the findings in the patient group with a reference group. In the group of patients as a whole negative correlations were observed between the concentration of serotonin in platelets and depression and with hostility and aggression against others. Serotonin in plasma and tryptophan correlated negatively with hostility. The findings support the suggested link between aggression and depression with a low functioning serotonergic system.
Interferon, tryptophan and depression
Authors: Fekkes D. , Van Gool A. R.
Published: March 2003

Depression is a frequent comorbid disorder of many inflammatory diseases and it is suggested that brain inflammatory processes have a pathogenic role in mood dysregulation. Several immunocompromised patients have been treated with cytokines and long-term treatments have resulted in a variety of neuropsychiatric side-effects. The objective of the study was to present evidence for an association between the induction of neuropsychiatric side-effects during treatment with interferon-α (IFN-α) and changes in serotonergic and immunological parameters. Moreover, the use of IFN-α-induced depression as a paradigm for research into the pathophysiology of depressive disorders in general will be discussed. This literature review focused on the relationships between tryptophan, serotonin, cytokines and depression associated with interferon treatment. Immunotherapy with IFN-α influences several immunological and serotonergic parameters, and induces in most patients neurovegetative, somatic and depressive symptoms. Literature findings indicate that the development of depressive symptoms in patients undergoing cytokine therapy are secondary to cytokine induction and could be mediated by a reduced availability of tryptophan to the brain, resulting ultimately in decreased serotonergic activity. Changes in the metabolism of tryptophan and consequently of serotonin may play a role in the pathophysiology of interferon-induced depression. Studies on interferon-induced neuropsychiatric side-effects may be a promising research paradigm and shed light on the role of immunological and serotonergic factors in the pathogenesis of depressive disorders in general. However, first the appropriate symptomatology of the interferon-induced depressive states has to be documented.
A staging approach to measuring patient‐centred subjective outcomes*
Authors: Bilsbury C. D. , Richman A.
Published: March 2003

Introduction:  In assessing clinical change, measurement is often based on psychometric scales. However, change is best revealed within the constellation of problems salient to the patient, rather than in alterations in the abstract constructs, psychometrically measured. These patients' problems often serially unfold in qualitative stages, even before the full‐blown disorder emerges. These qualitative stages constitute the natural history extending from early to late, fluctuating from mild to severe, and progressing from full‐blown disorder to recovery.

Method:  We reviewed the literature on clinimetrics and patient‐centred subjective measures, and related these findings to the use of the discretized‐analogue scaling method.

Results:  There is increasing recognition of clinimetric approaches that structure the pre‐clinical and clinical material into a scale that reflects the symptoms, consequences and complications in a manner understandable to the patient, and enabling the quantification of severity or change. This monograph provides criteria and methods for developing these building blocks that enable the assessment of severity, stage or change. We show examples of their use in quantitative clinical outcome measurement.

Conclusion:  We encourage further studies in the ideology and procedures for measuring clinical change in terms of personally subjective experiences.
The impact of antihypertensive drug groups on urinary albumin excretion in a non‐diabetic population
Authors: Monster Taco B. M. , Janssen Wilbert M. T. , De Jong Paul E. , De Jong‐van den Berg Lolkje T. W. ,   for the PREVEND Study Group
Published: March 2003

Aims  Microalbuminuria (30–300 mg 24 h−1) is recognized to be independently associated with renal and cardiovascular risk. Antihypertensives may lower microalbuminuria. We questioned whether the use of different antihypertensive drug classes in general practice influences microalbuminuria as related to blood pressure in nondiabetic subjects.

Methods  To study this, we used the data from 6836 subjects of an on‐going population based study, focused on the meaning of microalbuminuria (PREVEND). Odds ratios, adjusted for age, sex, blood pressure, cholesterol level, smoking and the use of other antihypertensive or cardiovascular drugs, were calculated to determine the association of drug groups with microalbuminuria. Influence of antihypertensives on the relation between blood pressure and (log) urinary albumin excretion was determined by comparing linear regression lines.

Results  Microalbuminuria was significantly associated with the use of dihydropyridine calcium channel blockers (odds ratio: 1.76 [1.22–2.54]), but not with other antihypertensive drug groups. The linear regression line of the relation between blood pressure and (log) urinary albumin excretion was significantly steeper (P = 0.0047) for users of calcium channel blockers, but not for other antihypertensives, compared with subjects using no antihypertensive. Users of a combination of renin‐angiotensin system inhibitors and diuretics however, had a less steep regression line (P = 0.037).

Conclusions  This study suggests a disadvantageous effect of dihydropyridine calcium channel blockers on microalbuminuria compared with other antihypertensive drug groups. Thus, if microalbuminuria is causally related to an increased risk for cardiovascular morbidity and mortality, dihydropyridines do not seem to be agents of choice to lower blood pressure. Furthermore, the combination of renin‐angiotensin system inhibition and diuretics seems to act synergistically.
Preventing cancer: dietary lifestyle or clinical intervention?
Authors: Young Graeme P , K Le Leu Richard
Published: March 2003

In Australia, colorectal, prostate and breast cancers are the most frequently occurring cancers in our society, a pattern that is quite different from that of underdeveloped countries. While diet is largely responsible for these differences, technological advances mean that the solutions can be viewed as systematic, financial, lifestyle or technological. They range from those that require self‐discipline and care for personal well‐being through to those that are seemingly a quick technological fix that will work in spite of an unhealthy lifestyle. There are three main approaches available for prevention of these cancers: dietary lifestyle, chemoprevention and screening. It has been estimated that the potential for prevention by a healthy dietary lifestyle is excellent and might reduce the burden of breast, prostate and colorectal cancer by 33−55%, 10−20% and 66−75%, respectively. This should be safe and inexpensive and have collateral benefit such as reduced cardiovascular disease and osteoporosis. But, population compliance with more plant‐based, less calorie dense foods is uncertain, the most healthy are likely to be the most compliant and evidence for effectiveness when interventional programs are undertaken is disappointing. It is not clear how dependable the dietary approach would be where inherited genetic factors determine risk for one of these cancers. Chemoprevention, the administration of natural or synthetic agents that delay, slow down or inhibit the process of tumorigenesis, are still under development and study. Hormone receptor modulators for breast and derivatives of non‐steroidal anti‐inflammatory drugs for colorectal cancers seem to have most promise and may reduce tumour incidence or death by as much as 50%. These agents are simpler to comply with than changing dietary lifestyle and they are more potent, hence they may be of particular value in high‐risk settings. But they are likely to be more costly and run the risk of adverse effects with few collateral benefits. Screening, or the testing of an individual for a disease when that individual does not have any symptoms or signs suggesting that the disease is present, aims to prevent or delay the development of the cancer. Screening impacts on mortality more so than on incidence, reducing colorectal cancer mortality in the range 15−60% and breast cancer mortality by 23−37%. Screening has the advantage of being effective in high‐risk as well as average‐risk groups and is an ‘easy’ solution for the person who elects not to follow a healthy dietary lifestyle. Nonetheless, it is expensive, demanding on resources, provides no collateral benefits and does not have the same potential to reduce incidence of disease as does the dietary approach. With these Western cancers, we are fortunate that there are options for prevention. At least choices are available and some will suite certain circumstances and personalities more than others.
Acculturation: Aboriginal and Torres Strait Islander nutrition
Authors: Shannon Cindy
Published: March 2003

The health status of Australia’s indigenous people remains the worst of any subgroup within the population, and there is little evidence of any significant improvement over the past two decades, a situation unprecedented on a world scale. Compared with non‐indigenous Australians, adult life expectancy is reduced by 15−20 years, with twice the rates of mortality from heart disease, 17 times the death rate from diabetes and 10 times the deaths from pneumonia. Despite improvements in perinatal mortality, they continue to represent a major cause of death, with infant deaths up to 2.5 times higher than the general population. The problems of educational disadvantage and unemployment are reflected in twice the rates of smoking and high obesity levels. Seven percent of indigenous families are homeless, with many more in inadequate and overcrowded housing, sometimes lacking water or sewerage. Economic disadvantage is real: 23% worry about going without food. Nutritional deficiencies in children have resulted in failure to thrive, contributing greatly to the problems of pneumonia and infectious diseases. The remoteness and isolation of many Aboriginal communities limit education and employment opportunities. It is important to consider the historical context of Aboriginal and Torres Strait Islander people, in order to gain an understanding of current health problems. The impact of past policies and practices and the ‘introduced diet’ are reflected in the poor health outcomes described above. This session will explore some of the underlying historical, cultural, structural and political factors that can be linked to the current problems.
The ‘pressures to change’ approach to working with the partners of heavy drinkers
Authors: BARBER JAMES G. , CRISP BETH R.
Published: March 2003

The ‘Pressures to Change’ approach to working with the partners of drinkers is a structured procedure for promoting change in resistant drinkers. In this study 22 women and one man were randomly allocated to two treatment conditions and one no‐treatment waiting list control condition in an experimental evaluation of the procedure. Group 1 was treated individually and Group 2 was treated as a group. Almost two‐thirds of the drinking partners of clients in treatment made a significant move towards change, compared with none of the drinkers in the waiting list control condition.
Conditioned responses to drug‐related stimuli: is context crucial“
Authors: POWELL JANE
Published: March 2003

Research into the elicitation of conditioned responses (CRs) by drug‐related stimuli in drug and alcohol addicts has produced apparently conflicting results in relation both to the form of the CR (drug‐like or drug‐opposite) and to its importance in influencing relapse rates after detoxification. Most studies looking at cue‐elicited responses directly have taken place with recently detoxified addicts in a laboratory setting. The present study examined cue‐elicited reactions in eight currently dependent opiate users (receiving prescribed physeptone) during their drug preparation rituals. Seven were seen in their own homes and one in hospital. Subjects rated their mood and physical state before getting out the drug and paraphernalia, during preparation to inject, and after injection. By contrast with the withdrawal‐like reactions, which are the most common finding in laboratory exposure studies where drugs are not subsequently accessible for use, these subjects showed a significant reduction in subjectively rated withdrawal symptoms during the pre‐injection drug preparation ritual. The results are discussed in relation to the impact of the context of exposure in influencing subjective expectancies, with perception of drug availability seen as a critical part of the conditioned stimulus complex.
Prevalence of markers for hepatitis B virus and HIV‐1 among drug injectors in London: injecting careers, positivity and risk behaviour
Authors: RHODES TIM , HUNTER GILLIAN M. , STIMSON GERRY V. , DONOGHOE MARTIN C. , NOBLE ALISON , PARRY JOHN , CHALMERS COLIN
Published: March 2003

Concerns about the risks of HIV infection among drug injectors have eclipsed concerns about the prevalence and transmission of hepatitis, and in particular hepatitis B virus infection. Findings are reported from surveys undertaken with two separate community‐recruited samples of drug injectors in London collected in 1992 (n = 505) and in 1993 (n = 507). Anonymized confirmed testing of saliva snows 51.5% of drug injectors in 1992 and 47.9% in 1993 to be antibody positive to the core antigen of hepatitis B virus (anti‐HBc). Approximately half of the drug injectors confirmed as anti‐HBc positive were unaware that they had been infected with hepatitis, Anti‐HIV‐1 prevalence was considerably lower at 7.0% in 1992 and 6.9% in 1993. Multivariate analyses showed anti‐HBc positivity to be most likely among older injectors with longer injecting careers who had a history of having shared used needles and syringes. HIV‐1 positivity was also associated with a history of having shared injecting equipment as well as with recent sharing (i.e. in the last 6 months). Unlike anti‐HBc positivity, there were no associations between HIV‐1 positivity and age or length of injecting career. Younger injectors with shorter injecting careers were more likely to report recent sharing of used injecting equipment than older injectors with longer injecting careers. We note the potential for continued transmission of HBV and HIV‐1, particularly among younger injectors. We recommend an integrated strategy to maximize the health of drug injectors, of which HIV and HBV prevention is a part. There is a need to widen the availability of HBV vaccinations for HBV negative drug injectors and their sexual partners and for clear guidelines to drug injectors about the relative efficacy of bleach to disinfect injecting equipment of HBV and HIV.
An evaluation of the history of a marijuana withdrawal syndrome in a large population
Authors: WIESBECK GERHARD A. , SCHUCKIT MARC A. , KALMIJN JELGER A. , TIPP JAYSON E. , BUCHOLZ KATHLEEN K. , SMITH TOM L.
Published: March 2003

Case reports and laboratory research indicate the existence of a cannabis withdrawal syndrome. However, the data tell us little about the prevalence and clinical characteristics of a marijuana withdrawal syndrome in people who have used the drug but who did not enter treatment for cannabis dependence. Face‐to‐face semi‐structured interviews applying standard diagnostic criteria were used in the present study to gather data from 5611 men and women, recruited between 1991 and 1995 through the Collaborative Study of the Genetics of Alcoholism (COGA). Almost 41% of the sample had no history of marijuana use (Group 1), 28% had consumed this drug less than 21 times in any single year (Group 2), and 3t% used it at least that frequently (Groups 3 and 4). Almost 16% of the more frequent marijuana users related a history of a marijuana withdrawal syndrome, and these Group 4 subjects had used the drug almost daily for an average of almost 70 months. The typical withdrawal symptoms included “nervous, tense, restlessness”, “sleep disturbance” and “appetite change”. While Group 4 subjects were more likely to have developed dependence on most types of drugs, even when alcohol and drug use patterns were statistically taken into account, marijuana use was still significantly related to a self‐report of a history of marijuana withdrawal.
Prediction of results from correspondence treatment for controlled drinking
Authors: KAVANAGH DAVID J. , SITHARTHAN THIAGARAJAN , SAYER GEOFFREY P.
Published: March 2003

Identification of people who will benefit most from brief interventions is an important research challenge in the study of addictive disorders. The current study investigated predictors of response to correspondence interventions for alcohol abuse. We examined both subject retention and alcohol intake over a 12–month period. The primary focus was on the predictive utility of self‐efficacy, stages of change and alcohol dependence. Self‐efficacy performed relatively well in the study, predicting both retention and later consumption. When predicting 12–month consumption from pretest assessments or examining subject retention over the last 6 months, self‐efficacy offered a significant contribution to multivariate analyses. However, in some other predictions a significant effect of self‐efficacy was eliminated after the entry of other variables. Stages of change significantly predicted mid‐way through treatment, but did not provide an independent prediction of overall retention or treatment response. Neither the degree of alcohol dependence nor level of alcohol problems figured in any of the predictions. Older subjects stayed longer in the study, and those with looter intake and higher pretest self‐efficacy had the lowest consumption at 12 months. Results are compared with previous research on prediction of outcomes in addictive disorders.
Alcohol consumption and suicide mortality by age among Finnish men, 1950–1991
Authors: MÄKELÄ PIA
Published: March 2003

An earlier comparative time series analysis of the connection between per capita alcohol consumption and suicide mortality reported, unexpectedly, a non‐significant effect of alcohol on the suicide rate of Finnish men. However, the suicide rate of Finnish men is heterogeneous in regard to age groups. There is also indication that the connection between alcohol and suicides is stronger in younger than in older age groups. Time series data on per capita alcohol consumption and age‐specific suicide mortality in 1950‐91 were used to scrutinize the relationship. The results indicate that the suicide rate of Finnish men in age groups 15–34 years and 35–49 years is associated with per capita alcohol consumption, while no connection could be established between the suicide rates of men aged 50–69 years and 70 + yean and either per capita alcohol consumption or a lagged consumption measure. Real income, divorce rate and unemployment rate were regarded as possible confounding variables.
Depression and smoking initiation among US Latinos
Authors: ESCOBEDO LUIS G. , KIRCH DARRELL G. , ANDA ROBERT F.
Published: March 2003

We assessed the relationship between depression and smoking initiation among people of Mexican, Puerto Rican and Cuban ancestry residing in specific geographic areas of the United States. Survey data were examined to calculate incidence of smoking initiation and prevalences and odds ratios for ever smoking by presence of depressed mood, a history of major depression or both conditions. Depressed mood, a history of major depression or both conditions were associated with smoking initiation risks during childhood, adolescence and young adulthood. These findings suggest that the relationship between depressive states and smoking initiation is established early in life. More definitive studies are needed to confirm these findings.
Cannabis: pharmacology and toxicology in animals and humans
Authors: ADAMS IRMA B. , MARTIN BILLY R.
Published: March 2003

Cannabis is one of the most widely used drugs throughout the world. The psychoactive constituent of cannabis, δ9‐tetrahydrocannabinol (δ9‐THC), produces a myriad of pharmacological effects in animals and humans. For many decades, the mechanism of action of cannabinoids, compounds which are structurally similar to δ9‐THC, was unknown. Tremendous progress has been made recently in characterizing cannabinoid receptors both centrally and peripherally and in studying the role of second messenger systems at the cellular level. Furthermore, an endogenous ligand, anandamide, for the cannabinoid receptor has been identified. Anandamide is a fatty‐acid derived compound that possesses pharmacological properties similar to δ9‐THC. The production of complex behavioral events by cannabinoids is probably mediated by specific cannabinoid receptors and interactions with other neurochemical systems. Cannabis also has great therapeutic potential and has been used for centuries for medicinal purposes. However, cannabinoid‐derived drugs on the market today lack specificity and produce many unpleasant side effects, thus limiting therapeutic usefulness. The advent of highly potent analogs and a specific antagonist may make possible the development of compounds that lack undesirable side effects. The advancements in the field of cannabinoid pharmacology should facilitate our understanding of the physiological role of endogenous cannabinoids.
On the emerging paradigm of drinking patterns and their social and health consequences
Authors: REHM JURGEN , ASHLEY MARY JANE , ROOM ROBIN , SINGLE ERIC , BONDY SUSAN , FERRENCE ROBERTA , GIESBRECHT NORMAN
Published: March 2003

Recent epidemiological and social studies have increasingly pointed to the importance of drinking patterns in explaining consequences of alcohol consumption. This paper presents recommendations for research in the area based on the presentations and discussions of the first “International Conference on Social and Health Effects of Different Drinking Patterns” held in Toronto in November 1995. In particular, the social dimension in pattern research, and the relationship between patterns of drinking and causalities as well as social harm, are stressed. The paper also argues for better theories, incorporating knowledge from related basic disciplines. In addition, we emphasize the need for improved methodologies and standardized methods for assessing drinking patterns. Finally, implications of research on drinking patterns for polity and programme development are discussed.
Alcohol‐related violence: the impact of drinking pattern and drinking context
Authors: ROSSOW INGEBORG
Published: March 2003

The impact of alcohol consumption, drinking pattern and drinking context on involvement in alcohol‐related violence was assessed in a survey of 2711 Norwegian adults. Having taken pan in a fight while influenced by alcohol and halting been injured by an intoxicated person during the past year was reported by 3% and 2.4% of the respondents, respectively. Involvement in alcohol‐related violence was most often reported among younger people, among single people, and it was positively associated with alcohol consumption, frequency of intoxication and frequency of visiting public drinking places. Both frequency of intoxication and overall alcohol consumption were positively associated with the probability of having been in a fight while intoxicated. Frequency of visits to public drinking places was significantly associated with the risk of being injured by an intoxicated person, also when own drinking pattern was controlled for. The results also indicated that the more often drinking takes place in public drinking places, the less is the impact of intoxication on the probability of getting into a fight.
Risk factors for initiation of drug use among young males in southwest China
Authors: WU ZUNYOU , ZHANG JIAPENG , DETELS ROGER , DUAN SONG , CHENG HEHE , LI ZHIRONG , DONG LELONG , HUANG SUFEN , JIA MANHONG , BI XIUQIONG
Published: March 2003

To identify risk factors for drug use among young males in southwest China a cross‐sectional survey and a non‐concurrent cohort study were conducted. Demographic, behavioral and drug‐use information was collected from young males aged 18–29 years. The non‐concurrent cohort included the period 1 January 1991 to 1 August 1994. A total of 1548 subjects were interviewed. The cumulative incidence increased between 1991 and 1993. Multivariate analysis identified the following significant risk factors for drug use: being divorced/widowed/separated, having been encouraged by friends/others to ay drugs, smoking cigarettes, belonging to the fingpo ethnic group, and having a family member who used drugs in 1991. More than 6 years of education vjas a protective factor for drug use. Drug use in the community was associated with having been encouraged by friends or others to try drugs (71%), to smoking cigarettes (50%), and to belonging to the Jingpo group (24%). The results are consistent with community based prevention approaches which should be studied carefully because of the unique cultural and epidemiological situation in China.
Prevalence, reliability and bias of adolescents' reports of smoking and quitting
Authors: STANTON WARREN R. , McCLELLAND MARGUERITE , ELWOOD CANDACE , FERRY DON , SILVA PHIL A.
Published: March 2003

A follow‐up of smoking behaviour to age 18 in a longitudinal study of a birth cohort enabled an assessment of the prevalence of smoking and quitting among adolescents approaching adulthood. There was a dramatic increase in number of daily smokers (15% at age 15 years to 31% at age 18 years), and in a climate of expected decreases in smoking, a history of never smoking to age 15 years was not as protective against future smoking as anticipated. Among 15–year‐olds who had experimented with smoking, only 11% per year stopped by age 18 years. Cessation rates for adolescent daily smokers were low (3% had not smoked in the last year at age 18 years), and previously have not been widely reported. We also examined some methodological issues related to self‐reported prevalence rates, in particular reliability, validity and sources of bias, finding confirmation of the accuracy of information from prospective longitudinal studies and supporting the conclusion that adolescents' recall for information beyond a 1‐year period is inconsistent.
Associations between drug use and behavioral repertoire in urban youths1
Authors: JOHANSON CHRIS‐ELLYN , DUFFY FARIFTEH F. , ANTHONY JAMES C.
Published: March 2003

Converging with psycho‐social research findings, animal and human laboratory studies indicate that behavioral alternatives are important determinants of drug‐taking. To investigate associations between how early adolescents spend their time, i.e. their behavioral repertoire and drug use (use of marijuana, crack/cocaine or inhalants), we analyzed data from an epidemiological sample of 1516 urban middle‐school students who had completed private interviews in spring 1993. The interview included a 36‐item questionnaire to assess how frequently the youth engaged in different activities; history of drug‐taking was assessed separately. Multiple logistic regression was used to estimate associations between drug use and each of seven behavioral domains as well as sex, age and racial‐ethnic status. Youths spending a great deal of lime working for pay and assuming other adult‐like roles were more likely to have initiated drug use (estimated odds ratio, OR = 3.49; p= 0.002). Those who spent much time in religious activities were less likely (OR = 0.2, p < 0.001). An exploratory search for interactions disclosed other associations that merit attention in future research. These results corroborate evidence on the potential etiological significance of behavioral repertoire in relation to risk of drug use.
The history of alcoholism: Brühl‐Cramer's concepts and observations
Authors: KIELHORN FRIEDRICH‐WILHELM
Published: March 2003

In 1819 the German‐Russian doctor C. von Brühl‐Cramer published one of the most important books in the history of alcoholism. He coined the term Trunksucht (which was translated as dipsomania by Hufeland), and he defined it as a physical disease. He discussed aetiology (assuming the consumption of spirits as the main occasional cause and annoyance or depressive feelings as other causes), and pathogenesis (suspecting that repetitive or noxious stimuli provoke a craving for continued intoxication). His recommendations on therapy were influenced by the contemporary ideas on treatment by the laws of chemistry and by concepts of excitability. He offered a classification in terms of continuous, remittent, intermittent, periodic and mixed forms of dipsomania. He described different sequelte, including neuropathy (in which the paresis began at the most distant parts of the limbs), dementia, suppression of the immune system and fetal alcohol syndrome (considering the typical features as proneness to diseases, mental retardation, hyperactivity, facial dysmor‐phism, incomplete growth). He examined ethnological factors based on his observations in multi‐racial Russia. Passages of his work are presented. Relations with works of his contemporaries (especially with Trotter) and influences on later concepts of alcoholism are discussed.