Ten-year cardiovascular disease risk and related factors in lifetime marijuana use with comorbid methamphetamine-associated psychotic disorder: a QRISK®3 study.

BACKGROUND: Methamphetamine use and related direct and indirect problems are increasing all over the world. The coexistence of lifetime marijuana use (LMU) and methamphetamine use disorder (MUD) may also be accompanied by psychotic symptoms (MAP). Methamphetamine and marijuana use are known to pose risks for cardiovascular diseases (CVDs). However, ten-year CVD risk and inflammation markers of LMU-MUD (non-psychosis group) and LMU-MAP (psychosis group) subjects and the relationship of various sociodemographic and clinical variables with these markers have not yet been examined. METHODS: Thirty-two male subjects were included in non-psychosis group and 72 male subjects in psychosis group. Sociodemographic and clinical characteristics were recorded. Psychotic symptom severity of psychosis group subjects was measured. The ten-year CVD risk was calculated using QRISK®3 model. RESULTS: Age, cigarettes/pack-years, alcohol use onset age, drug use onset age, methamphetamine use onset age, duration of methamphetamine use, education and marital status of the groups were similar (p > 0.05). There was a statistical difference between the non-psychosis and psychosis groups in terms of self-mutilation history (p < 0.001), suicidal attempt history (p = 0.007), homicidal attempt history (p = 0.002), psychiatric hospitalization history (p = 0.010). Ten-year QRISK®3 score was 4.90 ± 9.30 in the psychosis group, while it was 1.60 ± 1.43 in the non-psychosis group (p = 0.004). The mean heart age of the psychosis group was 14 years higher than their chronological age, while the mean heart age of the non-psychosis group was 8 years higher. Neutrophil to lymphocyte ratio (NLR) (p = 0.003) was higher in the psychosis group. A significant correlation was detected between ten-year QRISK®3 and positive psychotic symptoms in the psychosis group (r = 0.274, p = 0.020). Regression analysis showed that self-mutilation history, NLR and relative risk obtained from QRISK®3 can be used to distinguish non-psychosis group and psychosis group subjects (sensitivity = 91.7; Nagelkerke R2 0.438; p = 0.001). CONCLUSIONS: This study is important as it demonstrates for the first time that among the subjects using marijuana and methamphetamine, those with psychotic symptoms have a higher NLR and ten-year CVD risk.

Attitudes and psychotropic preferences of primary care providers in the management of mental disorders: a web-based survey.

Background: Many variables may affect the approaches of primary care providers (PCPs) to mental disorders. This study was aimed at reaching PCPs actively practicing in Turkey through a web-based survey and determining their practices and attitudes regarding mental disorders. Methods: This was a web-based, quantitative, cross-sectional, primary care approach-based observational survey. Results: Data from 454 PCPs (213 male, 241 female; 321 general practitioners, 133 family medicine specialists) were examined. In-service training in psychiatry (p < 0.001), using classification criteria when evaluating mental disorders (p < 0.001), and experience in diagnosing mental disorders (p = 0.003) were more prevalent among family medicine specialists than general practitioners. Regardless of specialization status, PCPs reported the most difficulty diagnosing bipolar disorder (62.33%) and following-up alcohol/drug use disorder (52.20%). Significant differences in the use of psychotropic medications were observed between general practitioners and family medicine specialists. While the rate of direct referral to psychiatry without intervening in certain situations was higher among general practitioners, variety of psychotropic medication use were also more evident among them. Misinformation that antidepressants cause forgetfulness, numbness, suicide, and addiction was prevalent among all PCPs. Those who had in-service training in psychiatry had significantly more experience in using classification criteria, diagnosing and starting treatment for mental disorders, using psychotropic medications, and encountering suicide-related situations (p < 0.05). Binary logistic regression analysis demonstrated that psychiatry in-service training experience can improve the use of classification criteria, suicide detection, antidepressant choice in anxiety, and understanding the addictive nature of antidepressants (Sensitivity = 88.6%; Specificity = 98.3%; Beginning block -2 Log likelihood 628.946, overall p value < 0.001; Block one -2 Log likelihood 141.054a, Cox & Snell R 2 = 0.659, Nagelkerke R 2 = 0.878; Hosmer and Lemeshow Test p = 0.938). Conclusion: This study makes significant contributions to the literature by discussing the subject in detail and comparing general practitioners and family medicine specialists. Regardless of their specialty status, PCPs' knowledge about mental disorders needs to be improved. In-service psychiatry training is one of the tools that can be used for this purpose.

Leptin, Nesfatin-1, Orexin-A, and Total Ghrelin Levels in Drug-Naive Panic Disorder.

OBJECTIVE: This study aimed to examine the changes in serum nesfatin-1, leptin, orexin-A, and total ghrelin levels of patients diagnosed with drug-naive panic disorder (PD) before and after six weeks of the treatment and to compare the findings with the healthy subjects. METHODS: The neuropeptides were measured in venous blood samples taken from 32 patients and 32 healthy subjects. The blood samples of the patients who used paroxetine 20 mg/day plus alprazolam 0.5 mg/day were retaken again after six weeks. Measurements were performed with the Enzyme-Linked Immunosorbent Assay (ELISA) method. RESULTS: Serum nesfatin-1, leptin, orexin-A and total ghrelin levels of the patient group were found to be significantly lower than the control group (p<0.001, p<0.001, p<0.001, and p<0.001, respectively). When the serum nesfatin-1, leptin, orexin-A and total ghrelin levels of the patient group were compared before and after treatment, significant differences were found in terms of orexin-A and total ghrelin levels (p=0.046, p<0.001, respectively). However, no significant differences were found in terms of nesfatin-1and leptin levels (p=0.205, p=0.988, respectively). CONCLUSION: This study reports that PD, like other anxiety disorders, may affect serum nesfatin-1, leptin, orexin-A, and total ghrelin levels, and there may be a relationship between PD treatment and the levels of these neuropeptides. The variability of this relationship among the neuropeptides examined indicates that various factors other than treatment play a role in this process.