Persistent Depersonalization/Derealization Disorder Induced by Synthetic Cannabinoids.

Current evidence suggests that women are more sensitive to the effects of cannabinoids. The aim of this study was to investigate the relevance of sex in the association of synthetic cannabinoid (SC) use with psychosis and agitation. A retrospective chart review was conducted for patients admitted to a psychiatric unit (2014-2016) to extract information on demographic factors, use of substances, clinical symptoms, and pharmacologic treatments. Study groups were defined as SC users (anyone who reported use of SCs over the past 3 months), cannabis users (positive toxicology screen for Δ⁹-tetrahydrocannabinol [THC]), and controls (those who denied use of SCs over the past 3 months and had negative toxicology for THC). Digital charts of 983 patients were reviewed. A total of 162 subjects reported use of SCs over the past 3 months (76% male), and 292 subjects had positive toxicology screen for THC (67% male). A total of 38.9% of SC users (n = 63) had positive urine toxicology screen for THC. SC users had higher risks of psychotic presentations (adjusted odds ratio [AOR] = 3.390; 95% CI, 1.390-8.267) and agitation (AOR = 4.643; 95% CI, 1.974-10.918) compared to the controls. While women had lower rates of psychosis than men in the cannabis and control groups, the rates were markedly potentiated with SC use to high levels (79%) approximately equal to that seen in men (80%). There was also a significant interaction between SC use and sex for agitation (AOR = 0.308; 95% CI, 0.117-0.808). Female SC users were significantly more agitated than male SC users (73.7% vs 47.6%, respectively, P = .005). SC users are more likely than nonusers to be psychotic or agitated in an inpatient setting. The potentiated rates of psychosis and agitation with SC use in women suggest that they may have a greater sensitivity to these synthetic compounds.​.

BackgroundSubstance use disorders have a negative impact on quality of life and are a common public health problem. The proportion of substance users can vary, and there are considerable disparities across nations and cities. Knowing the regional characteristics of substance use and risk groups will be important for the development of strategies for the prevention of addiction. This study aimed to investigate the spectrum of substance use and collect information on the age, gender, and multiple substance use patterns of substance users by substance abuse patients admitted to our center.ResultsThe data from 11,941 drug abuse tests were reviewed, and data from 1879 people who were found to have substance use in the tests were included in the study. 87.3% of substance users were male. The substances used are listed as cannabis (n = 957), amphetamines (n = 769), synthetic cannabinoids (n = 505), opioids (n = 238), benzodiazepines (n = 208), cocaine (n = 93), and barbiturates (n = 29). The proportion of amphetamine and benzodiazepine use was higher in women, while the proportion of cannabis and synthetic cannabinoid use was higher in men (p < 0.001). It was found that 45% of substance users (n = 845) had multiple substance use. Polysubstance users were found to use cannabis, amphetamines, and synthetic cannabinoids frequently.ConclusionsThe higher male majority in drug-positive test findings may be due to women’s greater barriers to substance use treatment compared to males. Furthermore, young adults are the primary source of drug abuse admissions, frequently using cannabis, synthetic cannabinoids, and amphetamines, often combined. Improved access to substance abuse treatment, particularly for women, is crucial, and tailored treatment approaches should be implemented to address the unique challenges of polysubstance use.

In the past few years, synthetic cannabinoid products have been increasingly used by adolescents and young adults. These products are marketed as herbal or aromatic incense and potpourri, but their psychoactive properties appear to be due to the addition of synthetic cannabinoids. When smoked, they can produce significant psychoactive and physical effects similar to cannabis. Changes in cognition, behavioral disturbances, alterations in mood, and perceptual changes have been reported. An emerging body of literature indicates that use of these products is associated with anxiety and other negative mood changes not typical of cannabis intoxication. Use of synthetic cannabinoid products has been associated with new onset psychosis or exacerbation of pre-existing psychosis, although current evidence cannot establish a definitive link between synthetic cannabinoids and psychosis. Clinicians should suspect synthetic cannabinoid product use if a patient: 1) presents with signs and symptoms consistent with cannabis use, 2) has negative routine urine toxicology screens, 3) is in a situation in which his or her urine is being routinely monitored for illicit substance use, and/or 4) presents with otherwise unexplained sudden onset psychosis. To make the diagnosis, clinicians should become familiar with the effects of synthetic cannabinoid use and have a high index of suspicion.

Synthetic cannabinoid use among college students

Cognitive Function and Dissociative Disorder Status Among Veteran Subjects With Chronic Posttraumatic Stress Disorder: A Preliminary Study

This study aims to evaluate the severity of substance use disorders according to the DSM-5 criteria and to show the reliability and validity of the Turkish version of the DSM-5 Substance Use Scale that improved to learn what kind of substances are used. In this study,54 in or out-patients who met the criteria for any substance use disorder according to DSM-5 and who are receiving treatment in Psychiatry Department of Celal Bayar University Faculty of Medicine and AMATEM department of Bakırköy Prof. Dr. Mahzar Osman Mental Health and Neurology Training and Research Hospital, were included. One hundred volunteers without any mental or physical disease were also recruited as the control group. Beside the DSM-5 Level 2 substance use scale, Addiction Profile İndex was used for concurrent validity. Internal consistency coefficient and item-total correlation analysis were performed for reliability analysis. ROC Analysis was used in the validity analysis. Mean age was 26.97±10.20 years in the study group and 39% of the sample (n=60) were female. 5.6% (n=3) of the patient group were female and 94.4% (n=51) were male. In the control group, 57% (n=57) were female and 43% (n=43) were male. Of the patients diagnosed with substance use disorder (n=54), 88.7% had opiate use disorder, 5.6% had polysubstance use disorder, 5.6% had other (unknown) substance (synthetic cannabinoid) use disorder and 1.8% of patients have cannabis use disorder. The internal consistency of the substance use scale was 0.80 and itemtotal correlation coefficients were between 0,196- 0,643 (p<0.0001). Coefficient of correlation analysis with API was calculated as r=0.806 (p<0.0001). The results showed that DSM-5 Substance Use Scale is a valid and reliable questionnaire that can be used to measure the progress of different dimensions of alcohol and substance use.

Early life adversity and increased antisocial and depressive tendencies in young adults with family histories of alcohol and other substance use disorders: Findings from the Family Health Patterns project

It has been suggested that intergenerational transmission of risk for substance use disorder (SUD) manifests in the brain anatomy of substance naïve adolescents. While volume and shapes of subcortical structures (SSS) have been shown to be heritable, these structures, especially the pallidum, putamen, nucleus accumbens, and hippocampus, have also been associated with substance use disorders. However, it is not clear if those anatomical differences precede substance use or are the result of that use. Therefore, we examined if volume and SSS of adolescents with a family history (FH+) of SUD differed from adolescents without such a history (FH−). Because risk for SUD is associated with anxiety and impulsivity, we also examined correlations between these psychological characteristics and volume/SSS. Using structural MRI and FSL software, we segmented subcortical structures and obtained indices of SSS and volumes of 64 FH+ and 58 FH− adolescents. We examined group differences in volume and SSS, and the correlations between volume/SSS and trait anxiety and impulsivity. FH+ adolescents had a significant inward deformation in the shape of the right anterior hippocampus compared to FH− adolescents, while the volume of this structure did not differ between groups. Neither shape nor volume of the other subcortical structures differed between groups. In the FH+ adolescents, the left hippocampus shape was positively correlated with both trait anxiety and impulsivity, while in FH− adolescents a negative correlation pattern of SSS was seen in the hippocampus. SSS appears to capture local anatomical features that traditional volumetric analysis does not. The inward shape deformation in the right anterior hippocampus in FH+ adolescents may be related to the known increased risk for behavioral dysregulation leading to SUD in FH+ offspring. Hippocampus shape also exhibits opposite patterns of correlation with anxiety and impulsivity scores across the FH+ and FH− adolescents. These novel findings may reveal neural correlates, not captured by traditional volumetric analysis, of familial transmission of increased vulnerability to SUD.

Objective: Cannabis use disorder (CUD) is increasingly prevalent and often co-occurs with psychiatric and legal complications. While cross-sectional associations between CUD and mental illness are well-documented, longitudinal data on the clinical and forensic trajectories of affected individuals remain limited, particularly in real-world settings.Methods: This naturalistic follow-up study tracked 51 male patients diagnosed with CUD over a five-year period. Data were collected via structured telephone interviews and hospital records, assessing substance use patterns, psychiatric diagnoses, Alcohol and Substance Addiction Treatment Center (AMATEM) admissions, and legal outcomes. Psychiatric comorbidities were evaluated using medical records, and substance use severity was assessed using the Addiction Profile Index (API).Results: Over five years, 82.4% of participants continued substance use, with synthetic cannabinoids being the most frequently used substance (76.5%). More than half (64.7%) developed a psychiatric diagnosis, most commonly depression and anxiety. Synthetic cannabinoid use was significantly different in individuals with psychiatric comorbidity (p = .033). AMATEM admissions declined over time but remained higher in patients with psychiatric diagnoses (Year × Diagnosis interaction: F = 2.600, p = .037). Nearly half experienced judicial psychiatric evaluations, and 23.5% had a history of incarceration.Conclusions: CUD is associated with persistent substance use, high rates of psychiatric comorbidity, and substantial legal-system involvement. Synthetic cannabinoids appear to exacerbate psychiatric outcomes. Long-term, integrated interventions are needed to address dual-diagnosis and reduce forensic burden.

Background: Consumption of natural cannabis (NC) and synthetic cannabinoids (SCs) has been associated with psychotic disorders. We compared the prevalence of use, consumer profiles, and psychosis-inducing potential of NC and SCs in a specific high-risk population. Methods: This prospective pilot study included 332 patients (18-64 years, mean 36.83, SD 13.33). Patients' sociodemographics and medical histories as well as illicit substance use and psychiatric symptom histories were collected using a drug consumption survey that assessed the use of new psychoactive substances and the Psychotic Symptoms Interview. Results: In total, 7.2% of all patients, 10.6% of psychotic patients, and 4.5% of nonpsychotic patients reported SC consumption. Compared with SCs, NC was consumed much more frequently by its users (mean 222.73, SD 498.27). NC and SC use induced persistent psychosis. Psychotic symptoms were first experienced by patients with a history of NC or SC use during intoxication and persisted after cessation (>1 year) of drug use. Positive and negative symptoms tended to be more severe in SC and NC users, respectively. Conclusions: NC and SCs may cause different symptom clusters. These relationships should be further evaluated.

Removing the stigma of medication for opioid use disorder

Objective: This research was undertaken to evaluate factors related to program retention among participants in a community-based peer recovery program for women of childbearing age with a history of substance use disorder. Methods: In all, 184 women of childbearing age with a history of substance use disorder were enrolled in a community-based peer recovery program. Half of the participants were pregnant or postpartum. The outcome of interest was retention in the program as measured at 2 and 6 months. Participants were paired with a peer recovery coach (PRC). PRCs were women with a personal history of substance use disorder who assisted with healthcare system navigation, facilitated access to local resources, and provided advice and emotional support. All PRCs were also licensed perinatal community health workers. Independent variables included gestational status, depression, anxiety, type and frequency of substance use, childhood trauma, abuse, readiness for treatment, and attachment patterns. Results: Anxiety was found to be a key factor associated with retention. Moderate anxiety was associated with higher rates of retention compared to normal to mild anxiety. Severe anxiety was associated with lower rates of retention compared to normal to mild anxiety. Attrition was highest in the first 2 months. Conclusions: Early integration with mental health services to address severe anxiety symptoms could potentially improve retention in substance use disorder recovery programs, thereby improving outcomes. More research is needed regarding severe anxiety and care-avoidant behaviors, particularly among women of childbearing age.

The objective of the present study was to assess in detail the whole spectrum of normal and pathological dissociative experiences and dissociative disorder (DD) diagnoses in borderline personality disorder (BPD) as diagnosed with the Revised Diagnostic Interview for Borderlines. Dissociation was measured comprehensively in 21 BPD outpatients using the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised, the Multidimensional Inventory of Dissociation (MID), the Dissociative Experiences Scale pathological taxon analysis, and the Somatoform Dissociation Questionnaire. The frequencies of DDs in this BPD sample were as follows: 24% no DD, 29% mild DD (dissociative amnesia and depersonalization disorder), 24% DD Not Otherwise Specified (DDNOS), and 24% dissociative identity disorder. With regard to the dissociative experiences endorsed, almost all patients reported identity confusion, unexplained mood changes, and depersonalization. Even those BPD patients with mild DD reported derealization, depersonalization, and dissociative amnesia. BPD patients with DDNOS reported frequent depersonalization, frequent amnesia, and notable experiences of identity alteration. BPD patients with dissociative identity disorder endorsed severe dissociative symptoms in all categories. Analysis of the MID pathological dissociation items revealed that 32% of the items were endorsed at a clinically significant level of frequency by more than 50% of our BPD patients. In conclusion, the frequencies of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) DDs in these patients with BPD were surprisingly high. Likewise, the “average” BPD patient endorsed a wide variety of recurrent pathological dissociative symptoms.

On April 2, 2015, four patients were evaluated at the University of Mississippi Medical Center (UMMC) in Jackson, Mississippi, for agitated delirium after using synthetic cannabinoids. Over the next 3 days, 24 additional persons went to UMMC with illnesses suspected to be related to synthetic cannabinoid use; one patient died. UMMC notified the Mississippi State Department of Health, which issued a statewide alert via the Health Alert Network on April 5, requesting that health care providers report suspected cases of synthetic cannabinoid intoxication to the Mississippi Poison Control Center (MPCC). A suspected case was defined as the occurrence of at least two of the following symptoms: sweating, severe agitation, or psychosis in a person with known or suspected synthetic cannabinoid use. A second statewide alert was issued on April 13, instructing all Mississippi emergency departments to submit line lists of suspected patients to MPCC each day. By April 21, 16 days after the first alert was issued, MPCC had received reports of approximately 400 cases, including eight deaths possibly linked to synthetic cannabinoid use; in contrast, during April 2012–March 2015, the median number of telephone calls to MPCC regarding synthetic cannabinoid use was one per month (range = 0–11). The Mississippi State Department of Health, with the assistance of CDC, initiated an investigation to better characterize the outbreak, identify risk factors associated with severe illness, and prevent additional illnesses and deaths.

Introduction Previous work has demonstrated that follow-up rates in burn patients are concerningly low. The ability to predict which patients will follow up in the clinic could improve short and long-term patient outcomes; through providing alternative means to obtain care. This study aims to evaluate if patients are aware of their likelihood of attending follow-up appointments. Methods Following the determination by the IRB that this was an exempt project and did not require informed consent, a survey assessing patient’s confidence that they would attend follow-up, was obtained for all admitted Burn Surgery patients at the time of discharge from September 2021 to June 2022 (N=251). Chart review then determined if patients presented for follow-up within thirty days of discharge. Univariate statistical analysis was performed. For all statistically significant variables, multivariate logistic regression with backward elimination was performed. Results Of the 251 included patients, 65% (N=165) presented for follow-up. These patients were able to accurately predict if they would present to follow-up (p &amp;lt; 0.0001). Of patients who were either very or somewhat confident that they would follow up (217 patients), 151 (69.6%) did attend a follow-up. Of patients who were either very or somewhat unconfident (8 patients), 5 patients (62.5%) did not attend a follow-up. A history of substance use disorder (p=0.004), tobacco use (p=0.0004), housing insecurity (p &amp;lt; 0.0001), disposition to a location other than their prior residence (p=0.02), and MediCal or Medicare insurance (p=0.003) were associated with lack of follow up care. Factors independently associated with follow-up include confidence in presenting on survey Odds Ratio (OR)=1.36 (95% Confidence Interval (CI) 0.18-9.8), no housing insecurity OR=4.17 (95% CI 1.53-11.32), and no history of substance use disorder OR=3.09 (95% CI 1.47-6.49). Conclusions Patients can accurately predict if they will follow up after discharge, while housing insecurity and history of substance use disorder are independently associated with a lack of follow-up care. Further research on alternatives to traditional follow-up is warranted to improve patient outcomes. Applicability of Research to Practice Alternative methods of follow-up should be considered for patients who do not think they will be able to follow up in burn clinic.