Emerging drugs in phase II and III clinical development for the treatment of alcohol use disorder.

INTRODUCTION: Alcohol Use Disorder (AUD) poses an ongoing significant global health burden. AUD is highly prevalent and affects not only the individuals with AUD, but also their communities and society at large. Even though pharmacotherapy is an integral part of AUD treatment, the few available substances show limited efficacy and limited clinical impact. Thus, there is a need for new innovative pharmacotherapeutic approaches. AREAS COVERED: This paper provides a comprehensive review of drugs approved for the treatment of AUD as well as those currently in phase II and III development. Data from recent clinical trials has been reviewed and supplemented by additional literature based on a systematic search of the PubMed database and clinical trials registries. Compounds discussed include disulfiram, naltrexone, nalmefene, acamprosat, baclofen, sodium oxybate, doxazosin, varenicline, zonisamide, gabapentin, apremilast, ibudilast, ivermectin, tolcapone, mifepristone, suvorexant, ketamine, psilocybin, semaglutide, oxytocin and cannabidiol. EXPERT OPINION: Even though the majority of the discussed compounds lack sufficient evidence to support their efficacy, multiple promising new treatment options are currently under investigation. Future research has to consider specific phenotypes and subgroups of AUD as well as a possible enhancement of the effects of psychotherapy through combination with pharmacotherapy. Practitioners should be encouraged to use available compounds to support existing therapeutic regimens.

Psychometric properties of the German Penn Alcohol Craving Scale.

Craving for alcohol is an important diagnostic criterion in alcohol use disorder (AUD) and an established predictor of future relapse. The 5-item Penn Alcohol Craving Scale (PACS) is one of the most widely used questionnaires to quantify craving and has been translated into different languages. It is assumed that the PACS constitutes one factor, although theoretical considerations suggest an additional second factor. We conducted stability and factor analyses (principal component and confirmatory factor analyses) of the German PACS (PACS-G) in samples of patients with AUD from the following three German study sites: Erlangen, N = 188 (mean age: 47.1 years, 43.5% female); Mannheim, N = 440 (45.5 years, 28.6% female); Hannover, N = 107 (48.1 years, 48.6% female). In our samples, the 2-factor solution of the PACS-G version is more stable than the internationally assumed 1-factor solution. The resulting two PACS-G subscores 'difficulty to resist' (items 4 and 5) and 'thoughts about alcohol' (items 1, 2, and 3) have an internal consistency (Cronbach's alpha) of 0.80 ≤ α ≤ 0.90, m = 0.86 and 0.86 ≤ α ≤ 0.91, m = 0.89 with an overlap of R2 = 62%. We found good convergent validity assessed via the Craving Automatized Scale-Alcohol and the Obsessive-Compulsive Drinking Scale, but also correlations with depression and anxiety assessed via the Beck's Depression and Anxiety Inventories. This study is the first to provide evidence for a 2-factor solution ('difficulty to resist' and 'thoughts about alcohol') underlying the PACS-G version.

Dysregulation of the autonomic nervous system in adult attention deficit hyperactivity disorder. A systematic review.

Background: Adult Attention Deficit Hyperactivity Disorder (aADHD) is characterised by inattention, hyperactivity, impulsivity, and emotional instability, all of which were linked to altered modulation of the autonomic nervous system. This and the clinical effectiveness of sympathomimetic medication raised the question if autonomic modulation is altered in aADHD patients.Methods: We systematically searched PubMed, Cochrane Library, and Web Of Science for publications investigating autonomic modulation in aADHD and controls during resting-state and/or under task conditions.Results: We reviewed 15 studies involving 846 participants (424 aADHD and 422 controls), including 4 studies on sympathetic tone at rest, 13 studies on sympathetic modulation during tasks, 3 studies on resting state parasympathetic modulation and 3 papers on task-related parasympathetic modulation. Studies comprised measurements of electrodermal activity, heart rate variability, blood pressure variability, blood volume pulse, pre-ejection period, and baroreflex sensitivity. 2 studies reported reduced sympathetic tone in aADHD; 7 papers described lower sympathetic reactivity to task demands in this cohort. One study linked aADHD to impaired vagal tone, while no indications of altered tasks-related parasympathetic reactivity in aADHD patients were reported.Conclusion: The reviewed data revealed impaired cardiovascular autonomic modulation in aADHD patients, predominantly in sympathetic modulation and during stress exposure.

Routine Screening for Peripartum Depression in the Gynecologic and Pediatric Setting - Evaluation of an Adapted EPDS Version.

PURPOSE: The aim of the study was to investigate the feasibility and acceptability of a routine screening for peripartum depression (PD) by gynecologists and pediatricians. In addition, it was investigated whether two separate Plus Questions (PQ) of the "EPDS-Plus" are valid for screening experiences of violence or a traumatic birth and whether they can be associated with symptoms of PD. METHODS: Using the EPDS-Plus the prevalence of PD was investigated in 5235 women. The convergent validity of the PQ with the Childhood Trauma Questionnaire (CTQ) and Salmon's Item List (SIL) was assessed using correlation analysis. The association between the experience of violence and/or traumatic birth experience and PD was subjected to the chi-square test. Furthermore, a qualitative analysis for acceptance and satisfaction by the practitioners was performed. RESULTS: The prevalence was 9.94%/10.18% for antepartum/postpartum depression. The convergent validity of the PQ showed strong correlation with CTQ (p<0.001) and SIL (p<0.001). For violence and PD, a significant association was found. There was no significant association for traumatic birth experience and PD. There was a high level of satisfaction and acceptance of the EPDS-Plus questionnaire. CONCLUSION: Screening for peripartum depression is feasible in regular care and can help to identify depressed as well as potentially traumatized mothers, especially in preparing trauma-sensitive birth care and treatment. Therefore, specialized peripartum "psych" treatment for all affected mothers in all regions has to be implemented.

Lower Emotion Regulation Competencies Mediate the Association between Impulsivity and Craving during Alcohol Withdrawal Treatment.

There is evidence that craving mediates the relationship between Impulsive Personality Traits (IPTs) and relapse during the treatment of an Alcohol Use Disorder (AUD). To provide tailored interventions, a deeper understanding of the relation between IPTs and craving, namely mediating processes, is important. Based on previous literature, we proposed that lower emotion regulation competencies mediate the relation between attentional as well as non-planning IPTs and craving. To investigate these interrelations, we used data from the baseline assessment (n = 320) of the SmartAssistEntz project (pre-registered in the German Clinical Trials Register [DRKS00017700]). Inpatients with a primary AUD diagnosis were interviewed using standardized self-report measures (IPTs: BIS-15, emotion regulation competencies: ERSQ, craving: OCDS-G short version) during their withdrawal treatment. Indirect effects were calculated using the SPSS macro PROCESS v3.5. Attentional as well as non-planning, but not motor, IPTs were associated with craving. Emotion regulation competencies mediated the relationship between attentional as well as non-planning IPTs and craving. Given their mediating role in the present study, it is interesting to investigate if addressing emotion regulation competencies can mitigate the negative influences of attentional and non-planning IPTs. The direct effect of attentional IPTs implicates alternate mediating processes, which should also be investigated in future research.

Association of impulsivity with quality of life and well-being after alcohol withdrawal treatment.

OBJECTIVES: Impulsivity is related to a higher risk of relapse in alcohol use disorders. However, besides drinking behavior, other recovery outcomes like physical and mental health-related quality of life are at least as important. The present study aimed to fill a research gap regarding the association of different impulsivity facets with health-related quality of life and well-being in alcohol use disorder. METHODS: Individuals with a primary alcohol use disorder diagnosis (n = 167) were interviewed with standardized self-report measures at the progressed stage of their withdrawal treatment and 6 weeks thereafter. Multiple regression models were calculated to examine the association of impulsivity, craving, and drinking patterns with health-related quality of life and well-being 6 weeks after withdrawal treatment, as well as the predictive role of impulsivity assessed during withdrawal for these two outcomes. RESULTS: Craving was associated with health-related quality of life and well-being 6 weeks after withdrawal. Likewise, non-planning and attentional impulsivity were associated with well-being 6 weeks after withdrawal. Motor impulsivity during withdrawal treatment predicted health-related quality of life 6 weeks thereafter. CONCLUSION: Impulsivity seems to be negatively related to health-related quality of life and well-being in the first weeks after alcohol withdrawal treatment, probably to a higher extent than drinking patterns, but differentiating between its facets seems to be important. These findings emphasize the importance of treatment approaches aiming at reduced impulsivity in the early recovery process.

[Weighing the benefits and harms of psychotropic and analgesic substances - A perspective of German addiction medicine experts]. / Abwägung von Nutzen und Schädlichkeit von berauschenden und schmerzlindernden Substanzen aus der Perspektive von deutschen Suchtmedizinern.

BACKGROUND: In Europe, there have been several addiction-expert rankings of harms related to the use of psychotropic substances in the last 15 years. Among them, only one expert ranking took into account the potential benefits of these drugs. Non-Opioidergic Analgesics (NOAs), such as gabapentinoids and NSAIDs, which have been increasingly the subject of abuse / misuse reports, have not been considered in such expert rankings. Likewise, there is currently no multi-substance comparison as to whether the valuation rank of the harmfulness of an illegal drug may change along with an imagined change in legal status in Germany. OBJECTIVES AND METHODS: Using a questionnaire, 101 experienced addiction physicians (first cohort) evaluated 33 psychoactive substances including analgesics with regard to their health and social harms as well as potential usefulness for the consumer and their environment / society ('others'). In addition, this cohort investigated whether the harmfulness assessment of an illegal substance changes if it would be legalized. In order to obtain the average overall harmfulness (overall risk) of a substance, the percentage contribution of each dimension to the overall harmfulness was determined in a second survey (second cohort, 36 experienced addiction medicine experts). Finally, the average benefit and overall risk ratings of each substance were related to each other. RESULTS: Prescription psychoactive substances such as analgesics, NOAs (including gabapentinoids) and opioidergic maintenance medications to treat opiate dependence were judged to have a favorable benefit-harm profile. Cannabis and ketamine were placed in the midfield of both, the harm and benefit rankings. Together with most illicit narcotic drugs, alcohol and nicotine, have been ranked among the most harmful and least useful substances, whereby alcohol was judged on average to be more harmful but also more useful than nicotine. In the event of potential legalization, the overall harm of the traditional illegal drugs methamphetamine, heroin, cocaine and cannabis was estimated to be reduced. This was mainly due to a more favorable valuation of the harm to others under these virtual conditions. CONCLUSION: Prescription substances including opioidergic and non-opioidergic analgesics as well as opioid maintenance therapy medications (methadone and buprenorphine) were assigned a favorable benefit-harm profile. Alcohol, nicotine and traditional illicit drugs (with the exception of cannabis and ketamine) were determined to have an unfavorable profile. The overall harm of traditional illicit drugs was assessed to decrease along with legalization, mainly by decreasing the harm to others in this virtual event.

Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder.

INTRODUCTION: Given the growing evidence of reduced heart rate variability in psychiatric diseases associated with emotional instability, we investigated cardiovascular autonomic modulation in patients with borderline personality disorder (BPD) during resting state, parasympathetic stimulation (metronomic breathing), and sympathetic stimulation (mental arithmetic stress test). METHODS: In 29 BPD outpatients and 30 controls, we recorded RR-intervals (RRI), blood pressure, skin conductance levels, and respiratory frequency during resting state, metronomic breathing, stress anticipation, stress exposure, and stress recovery. We calculated baroreflex sensitivity (BRS) and parameters of heart rate variability, including the root mean square of successive differences (RMSSD), an index of cardiovagal modulation. RESULTS: During resting state, BPD patients showed higher blood pressure and shorter RRI, as well as lower RMSSD and BRS than controls. Metronomic breathing increased RMSSD and BRS in BPD patients. During the stress exposure, BRS significantly decreased in controls, but not in BPD patients. Furthermore, BPD patients showed less cardioacceleration in response to stress exposure than controls. During stress recovery, we found increases in RMSSD and BRS in controls, but not in BPD patients. CONCLUSION: Our data show reduced cardiovascular autonomic modulation in BPD patients during resting state, psychophysiological relaxation, and stress exposure. The results indicate a vagal modulation deficit in this cohort. Breathing techniques, such as metronomic breathing, might be helpful to reduce stress and to increase vagal tone in BPD patients.

Association of Testosterone Levels and Steroid 5-Alpha-Reductase 2 Polymorphisms with Opioid Craving.

BACKGROUND/AIMS: Opioid dependence is a severe disease which is associated with a high risk of relapse, even in cases of successful withdrawal therapy. Studies have shown alterations of the hypothalamic-pituitary-gonadal axis in opioid-dependent patients, such as decreased testosterone serum levels in affected males. Sex hormones and the steroid 5-alpha-reductase 2 (SRD5A2) V89L polymorphism are associated with craving during alcohol withdrawal, but little is known about their impact on symptomatology of opioid dependence. METHODS: In this study, we analyzed 2 independent male cohorts of opioid-dependent patients for possible alterations in testosterone serum levels compared to non-opioid-dependent controls. In one of the cohorts, we additionally investigated associations of testosterone serum levels and 3 SRD5A2 polymorphisms with symptoms of opioid dependence, measured by the Heroin Craving Questionnaire (HCQ). RESULTS: In the patient groups, we found significantly decreased testosterone serum levels compared to the control groups. Furthermore, we found significant associations of both the testosterone serum levels and the SRD5A2 V89L polymorphism with opioid craving assessed by the HCQ. CONCLUSION: Our data show a possible role of testosterone metabolism in opioid dependence, which may be relevant for the establishment of future treatment strategies.

Shiftwork and Alcohol Consumption: A Systematic Review of the Literature.

INTRODUCTION: Shiftwork can be a risk factor for a number of different somatic and psychological health conditions, especially sleep disorders. Shiftworkers sleep less than dayworkers, and 20-40% of them suffer from difficulties initiating and maintaining sleep, which result in reduced capacity for work and social life. A common coping strategy might be the use of alcohol, which presents a health and safety hazard as it further impairs sleep quality and exacerbates sleepiness in the workplace. This review aimed to assess the extent of such possible connections. METHODS: We performed a systematic search of the scientific literature on shiftwork and alcohol consumption in PubMed, PsycInfo, and Cochrane Library. Only original studies comparing shiftworkers with non-shiftworkers were included. The recommendations of the Preferred Reporting Items of Systematic Reviews and Meta-Analyses were followed. RESULTS: Fourteen articles are included in this review. Six studies report some kind of connection between shift- or nightwork and alcohol consumption, especially as a sleep aid. Conflicting or negative results are reported by 3 studies. DISCUSSION: Shiftwork, especially working at night and in rotation shifts, is associated with binge drinking disorder in different professions. The reasons for pathological consumption of alcohol can be self-medication of sleep problems or coping with stress and psychosocial problems typical for shiftwork. Nurses aged over 50 years represent one important risk group. These results can be important for preventive programs against sleep disorders, including measures other than drinking alcohol as a sleep aid in the workplace of shiftworkers.

The Effects of the Lockdown during the COVID-19 Pandemic on Alcohol and Tobacco Consumption Behavior in Germany.

BACKGROUND: Similar to other countries, the government of Germany has implemented various restrictions of social life in March 2020 to slow the spread of COVID-19 pandemic. This results in millions of people being isolated for long periods, which may increase feelings of worry and anxiety. As the consumption of alcohol and tobacco is an often used dysfunctional strategy to cope with such feelings, these restrictions might cause an increase of consumption. Already at the beginning of the COVID-19 pandemic, the World Health Organization (WHO) warned that increased alcohol consumption during the lockdown can increase the prevalence of alcohol use disorders in the future. However, up to now little is known about the changes in alcohol-drinking behavior and tobacco smoking in the general population during the COVID-19 pandemic. METHODS: To address this theme, we investigated the changes in alcohol and tobacco consumption in the German population aged between 18 and 80 years via an online survey. RESULTS: In total, 3,245 persons participated in the survey; 35.5% of them reported an increase in drinking during the lockdown (42.9% did not change their drinking behavior, 21.3% drank less, and 0.3% started drinking). The odds of consuming more alcohol during lockdown were associated with middle age, higher subjective stress due to the COVID-19 pandemic, a lower agreement with the importance of the restrictions, and consuming alcohol more than once per week before the lockdown. Also, 45.8% of the participants increased their smoking during the lockdown. The odds of smoking more during lockdown were associated with higher subjective stress due to the COVID-19 pandemic. CONCLUSION: These findings suggest that it is important to start campaigns to inform the general population about potential long-term effects of increased alcohol and tobacco consumption and to raise the health-care professionals' awareness of this topic.

[The Pathological Buying Screener: Validation in a Clinical Sample]. / Der Pathological Buying Screener: Validierung in einer klinischen Stichprobe.

AIM: The aim of the study was to evaluate the psychometric properties of the 13-item Pathological Buying Screener (PBS, [1]) in a clinical sample. METHOD: The PBS was administered to a total sample of 413 treatment-seeking patients (buying-shopping disorder n=151, gambling disorder n=59, alcohol dependency n=60, other mental disorders [anxiety, depressive, eating, somatoform disorders] n=143). Factor structure was tested in the total sample using confirmatory factor analysis (CFA), reliability was determined by means of Cronbach's α. Group comparisons were used to determine to which degree the PBS discriminates between patients with BSD and other clinical groups. The BSD-group completed a battery of other measures to explore convergent and divergent validity. A subgroup (n=29) answered the PBS before and after psychotherapy to investigate sensitivity to change. A receiver operating characteristic (ROC) curve analysis with PBS data of patients with buying-shopping disorder and those from a previous community sample 1 was performed to define a cut-off point for buying-shopping disorder. RESULTS: The CFA showed a good model fit for both a one-factor and a two-factor structure with the subscales "loss of control/consequences" (10 items) and "excessive buying behavior" (3 items). The subscales were highly intercorrelated (r=0.92). A hierarchical regression analysis with another BSD measure as dependent variable did not indicate an own incremental validity of the subscale "excessive buying behavior". Good convergent, divergent and discriminative capacity was obtained for the PBS total score. At its recommended cut-off point of ≥29 the PBS has a sensitivity of 98% and a specificity of 94.7%. CONCLUSION: The findings indicate good psychometric properties of the PBS and suggest that the PBS total score can be used in clinical settings.

[Antipsychotics during pregnancy: a systematic review]. / Antipsychotika in der Schwangerschaft: eine systematische Übersichtsarbeit.

BACKGROUND: The benefits and risks of treatment with antipsychotics during pregnancy must be weighed up carefully and individually because antipsychotics can penetrate the placental barrier and prescription is off-label. OBJECTIVE: Evaluation of the risks and benefits of administering antipsychotics during pregnancy or for women who wish to become pregnant regarding teratogenic effects, risk of fetal death and stillbirths, perinatal complications, persisting postnatal impairments or disorders and gestational diabetes. METHODS: A systematic review of the literature is provided to aid the selection of psychotropic drugs during pregnancy and in determining whether to begin, continue or switch an antipsychotic treatment during pregnancy. RESULTS: Large, well-designed and controlled studies are missing; however, most studies suggest that the group of antipsychotics seem to be safe in terms of teratogenicity during pregnancy, at least in monotherapy. CONCLUSION: Treating mental illnesses during pregnancy requires an individual assessment of the benefits and risks. The risk of an untreated mental illness versus the benefit of a suitable treatment with antipsychotics and the potential harm to the infant must be evaluated. If certain rules are observed and a suitable antipsychotic is selected the risk to the newborn child and/or mother during pregnancy can be minimized, however, a decision about subsequent medication can only be indirectly made from the results of this study.

Predictors of attendance in outpatient group treatment for women with posttraumatic stress disorder and substance use disorder.

Objective: The present study investigated predictors of treatment attendance among 226 women with posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Participants received either an integrated intervention for PTSD and SUD ("Seeking Safety") or a relapse prevention training (RPT) as part of a multicenter randomized controlled trial. Method: Beta-binomial regression was conducted to investigate baseline sociodemographic, motivational, mental health and substance use predictors of session attendance. Treatment by predictor interactions were included to identify treatment-specific predictors. Results: Session attendance was predicted by employment status, drug use severity and abstinence status. Higher drug use severity and unemployment were associated with less session attendance. The effect of abstinence status was treatment-specific, with abstinent participants in RPT attending most sessions. Conclusions: Considering individual characteristics could enhance session attendance in outpatient treatment for women with PTSD and SUD. This might include matching treatment concepts to abstinence status, the identification of attendance barriers in unemployed women and more intensive treatment settings for those with severe drug use.

Trauma Severity in Early Childhood Correlates with Stress and Satiety Hormone Levels in a Pilot Cohort Receiving Diamorphine Maintenance Treatment.

AIMS: Childhood trauma is of importance for the manifestation of substance-related disorders and maintenance of hypothalamic-pituitary-adrenal (HPA)-axis disorders. Since stress plays a crucial role in opioid compliance and craving, we investigated the immediate effects of diacetylmorphine application on the HPA axis. In particular, adrenocorticotropic hormone (ACTH) and cortisol secretion, as well as satiety regulating proopiomelanocortin peptides α-melanocyte-stimulating hormone (MSH) and ß-endorphin (END) in a cohort of opioid-dependent patients in diamorphine maintenance treatment concerning the clinical severity of their childhood trauma. METHODS: We compared the serum levels of ACTH, cortisol, MSH, and END in 15 opioid-dependent patients. All participants received treatment with diamorphine and were observed at 5 timepoints before and after injection. We split the cohort into 2 subgroups concerning childhood trauma measured by the Childhood Trauma Questionnaire. RESULTS: Splitting in 2 subgroups for mild (5) and severe trauma (10), we found that while both groups show a significant reduction of ACTH and cortisol levels over time, slopes display different progressions over time for cortisol (F[1.6] = 9.38, p = 0.02), while remaining identical for ACTH (F[1.6] = 1.69, p = 0.24). Also, levels of both MSH and END were significantly lower in severely traumatized patients. CONCLUSIONS: For the first time, we present a detailed representation of stress- and addiction-related proteins for the first 5 h after diamorphine application, demonstrating the interrelationship between stress hormones and childhood trauma as well as its potential effects on the progression of addictions such as opioid dependence.

DNA Methylation of the Leptin Gene Promoter is Altered by Chronic Alcohol Exposure in an Animal Model for Alcohol Dependence.

Appetite-regulating peptides, such as leptin, are linked to craving and have been in the focus of alcohol dependence research for years. The objective of our study was to investigate the dynamics of leptin gene promoter methylation during alcohol withdrawal and specific treatment in a rodent (rat) model for alcohol dependence. DNA methylation was measured using direct bisulfite sequencing at 0 h, 24 h, and 6 days of alcohol withdrawal as well as after treatment with alpha-melanocyte-stimulating hormone (alpha-MSH), Beta-Endorphin, or saline. We found significantly lower methylation levels in alcohol-consuming animals compared to alcohol-naïve animals. During 6 days of alcohol deprivation, this difference in methylation vanished. Leptin methylation of the alpha-MSH-treated group and 6 days alcohol-deprived animals was significantly higher than that in saline-treated animals, possibly indicating compensatory effects of the treatment. Our results further expand on previous findings from human studies that explain leptin's role in bridging the gap between alcohol consumption and appetite regulation.

Substance Abuse-Related Self-Stigma in Women with Substance Use Disorder and Comorbid Posttraumatic Stress Disorder.

BACKGROUND: Self-stigma is a result of internalizing negative stereotypes by the affected person. Research on self-stigma in substance use disorders (SUD) is still scarce, especially regarding the role of childhood trauma and subsequent posttraumatic disorders. OBJECTIVES: The present study investigated the progressive model of self-stigma in women with SUD and posttraumatic stress disorder (PTSD), and the predictive value of PTSD severity and childhood trauma experiences on self-stigma. METHOD: In a cross-sectional study with 343 women with SUD and PTSD, we used the Self-Stigma in Alcohol Dependency Scale, the Childhood Trauma Questionnaire (CTQ), the PTSD Symptom Scale Interview (PSS-I), and to control for SUD severity and depression, the Addiction Severity Index Lite and the Beck Depression Inventory-II. Hierarchical regression analyses were conducted for each stage of self-stigma (aware-agree-apply-harm). RESULTS: The interrelated successive stages of self-stigma were largely confirmed. In the regression models, no significant effects of the PSS-I- and the CTQ-scores were observed at any stage of self-stigma. Agreeing with negative stereotypes was solely predicted by younger age, applying these stereotypes to oneself was higher in women with younger age, higher depression and SUD severity, and suffering from the application (harm) was only predicted by depression. CONCLUSIONS: The progressive model of self-stigma could be confirmed in women with SUD and PTSD, but PTSD severity and childhood trauma did not directly affect this process. Self-stigma appears to be related to depression in a stronger way than PTSD is related to women with SUD and PTSD.

Epidemiology of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background: a representative study.

BACKGROUND: Data on the prevalence of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background are scarce. There are hints that this population is at risk. The aim of the study is to investigate the epidemiology of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background in Germany while taking gender-specific differences into consideration. METHODS: A representative study with N = 10,638 students (mean age 14.91 years, SD = .73).) in the state of Lower Saxony in Germany was conducted. In the 2014-2015 school year, 672 classes were selected by randomly sampling different school types. The participation rate was 84.1%, excluding any classes for which the director refused to provide consent. A total of 49.8% were female adolescents, and 23.3% of the participants had a migration background. Target variables were assessed with items from the Ottawa Self-Injury Inventory, the Self-Harm Behavior Questionnaire and the Self-Harm Inventory, partly adapted. RESULTS: Of all students, 7.6% had a lifetime history of suicide attempts, and 36.6% answered with a rating of at least "rarely" when asked to rate the lifetime prevalence of suicidal ideation. The 12-month prevalence of direct self-injurious behavior was 17.8%. Adolescents with a migration background showed a significantly higher prevalence of all three constructs (p = .006; p < .001; p = .006). Male students with a migration background reported a significantly higher lifetime prevalence of suicide attempts (4.7% vs. 3.1%) than native males (p = .009). Female students with a migration background reported a significantly higher lifetime prevalence of suicide attempts (15.9% vs. 10.4%) and suicidal ideation ("often" 12.1% vs. 8.9%) than native female students (p < .001; p = .008). CONCLUSION: Our assessment indicates an elevated risk for suicidal behaviors in adolescents with a migration background. From research on adults, it is known that the dominant motives for suicidal behavior in migrants are associated with their migration history/situation. As suggested by Cramer and Kapusta's (Front Psychol 8:1756, 2017) theoretical model, the Social-Ecological Framework of Theory, Assessment, and Prevention, there is a need for culturally sensitive preventions that take into account the specific reasons for suicide attempts in migrants.

[Opioid maintenance treatment and Cannabis use]. / Opioidsubstitutionsbehandlung und Cannabiskonsum.

OBJECTIVES: More than 30 % of patients participating in an opioid maintenance program consume cannabis. This article describes the effects of additional cannabis use during an opioid maintenance treatment program. METHODS: Narrative literature research using online publication databases (MedLine, PubMed) RESULTS: The additional use of cannabis during an opioid maintenance treatment program may have negative side effects. CONCLUSION: Cannabis use should be discussed with the patient. It is in principle not a reason for discontinuing an opioid maintenance treatment program.

Desacylghrelin but not acylghrelin is reduced during smoking cessation.

This study focused on the acetylation status of ghrelin examining acyl- and desacylghrelin and its effect on craving during 14 days of smoking abstinence. This is the first study demonstrating changes in desacylghrelin plasma levels in smokers compared to non-smokers while there was no difference of acylated ghrelin. Future studies should specifically refer to plasma ghrelin as either desacyl- or acylghrelin since both have different effects on tobacco-seeking behavior and the underlying physiology.