Bouman GGZ

e20533 Background: Comprehensive geriatric assessment (CGA) is a multidimensional method to detect frailty in elderly patients. Time saving could be accomplished by identifying those individual ite...

Psychopathology, psychosocial problems and substance use (PPS) commonly occur in pregnant women, and can have a negative impact on the course of pregnancy and the healthy development of the child. As PPS often remains undetected and untreated during pregnancy, we developed and implemented a four-step screen-and-treat protocol in routine obstetric care, with: (i) screening including triage and subsequent confirmation, (ii) indication assessment, (iii) transfer towards care and (iv) utilization of care. Adherence to the protocol and risk factors associated with dropout were examined for 236 Dutch pregnant women in a deprived urban area. Seventy-nine percent of women accepted the screening, 21% dropped out during triage, 15% during confirmation, 3% during transfer and 8% thereafter. Provided reasons for dropout were lack of time and lack of perceived benefit. In particular, smokers, multiparous women, and women of non-Western ethnicity dropout on the way towards mental and psychosocial care. For a successful implementation of the protocol in the future, with improved adherence of pregnant women to the protocol, education of women on PPS risks, motivational skills and compulsory treatment are worth investigation.

GHB is een endogene neurotransmitter, aangetoond in menselijk hersenweefsel. Het is zowel een precursor (uitgangsstof) als een metaboliet van GABA. In de afgelopen decennia is GHB in Nederland populair geworden als recreatieve en verslavende drug en het is betrokken bij circa 30% van de drugsgerelateerde incidenten (zoals ernstige intoxicaties). Het aantal GHB-afhankelijke patienten in behandeling binnen de verslavingszorg is in de laatste drie jaar verviervoudigd. Deze feiten vormen aanleiding om in dit artikel de basale informatie te schetsen over de farmacologie, de neurobiologie van de intoxicatie en de neurobiologie van GHB-afhankelijkheid. Deze kennis kan worden gebruikt om de risico’s en effecten van GHB-gebruik beter te begrijpen.

Background: The relationship between the use of alcohol and aggression is complex and represents major public health issues. Delving into the nature of this association is vital, since various underlying factors may contribute to the expression of aggression. Objective: This study examined trait aggression by assessing correlates and, subsequently, the unique contribution of alcohol craving, and dysfunctional impulsivity, by means of correlational and mediational analyses. Methods: Forty inpatient detoxified alcohol-dependent patients were recruited. These participants completed the Desire for Alcohol Questionnaire (DAQ), Dickman Impulsivity Inventory (DII), and the Aggression Questionnaire (AQ). Results: The findings indicated that aggression, dysfunctional impulsivity, and alcohol craving were all positively intercorrelated. The association between dysfunctional impulsivity and aggression was robust. The mediational analyses yielded that craving partially mediated this relationship, although not very substantial. Conclusion: It was shown that impulsivity, as a personality characteristic, is strongly associated with aggressive behaviors, whereby the impact of craving on the relationship between impulsivity and trait aggression in alcohol-dependent inpatients was weak. Scientific Significance: Since it has been posited that factors such as impulsivity and craving may contribute to the lucid association between substance use and aggression, these findings mirror previous research on stimulant users and, subsequently, substantiates that craving exerts only a minor weight on the strong impulsivity–aggression relationship.

In this multi-center, naturalistic study, the effectiveness of naltrexone maintenance combined with the Community Reinforcement Approach (CRA) was investigated in detoxified, opioid-dependent patients (N=272). Patients were recruited from methadone maintenance programs. With intention-to-treat analysis, 10 months of treatment yielded abstinence rates of 28% and 32% at 10 and 16 months after detoxification. The cumulative abstinence rate at 16 months was 24%. Quality of life, craving, general psychopathology, use of other psychoactive substances, and addiction severity of the abstinent group significantly improved when compared to the relapsed group. This abstinence-oriented approach appears to be a feasible goal, and remains an important option next to long-term methadone maintenance in the management of opioid dependence.