Understanding the experiences of ketogenic metabolic therapy for people living with varying levels of depressive symptoms: a thematic analysis.

Background: Evidence suggests that a ketogenic diet (KD) may help to alleviate psychiatric symptoms, including depression and anxiety. Positive changes have been reported such as improvements in cognition, concentration, and sleep, a reduction in hunger, and an increase in well-being, energy, confidence, and resilience. This research aims to understand the impact of a non-calorie-restricted KD on depression and aspects of psychological well-being in those with varying degrees of depressive symptoms. Though there are a few studies directly exploring the experiences of those following a KD, this will be the first study to explore the narrative from a mental health and psychological well-being viewpoint. Method: A sample of nine participants who had followed a non-calorie restricted KD intervention of 50 g of carbohydrates or less per day for at least 12 weeks were recruited. Participants were split into 'healthy adults' group who had no to low depressive symptoms and 'depressive symptoms' group who had mild to moderate depressive symptoms. A reflexive thematic analysis was considered suitable for this study. Findings: Five core themes and 24 subthemes were created. These were, (1) Poor health prior to program; (2) Hunger and cravings-the food and mood connection; (3) Psychological well-being improvements; (4) It becomes a lifestyle; and (5) Implementation difficulties. Participants experienced mental health improvements such as increased self-esteem, confidence, motivation, and achievement. Some experienced more control in life and a greater sense of reward. Those with depressive symptoms who initially reported low self-worth and hopelessness later reported increased self-esteem and renewed meaning and purpose in life. The findings from this study reflect the previous reports that the diet implementation can be difficult initially, but soon becomes easy to follow and turns into a lifestyle. Conclusion: In the literature, there are very few qualitative studies that explore the accounts and lived experiences of those following a KD. From the participants' accounts in this study, it appears that the benefits and positive outcomes of this diet outweigh any negative side-effects experienced. This is encouraging for those who are looking for adjunctive therapies to address and improve their depressive symptoms and overall mental health.

Alcohol and drug use among bartenders: An at risk population?

INTRODUCTION: The current study explored the prevalence of hazardous alcohol and drug consumption within bartenders and the impact of working more than 40 h a week on levels of alcohol and drug use. METHODS: Three hundred and ninety bartenders (247 females), recruited via social media, took part in a cross-sectional online survey. The study recorded units of alcohol and hours worked per week among participants. The team measured hazardous drinking using the Alcohol Use Disorders Identification Test (AUDIT) and drug use by the Drug Abuse Screening Test (DAST). RESULTS: According to AUDIT scores, 39% of participants were classed as having harmful alcohol consumption and 43.6% reported moderate/severe alcohol use that might indicate alcohol dependence. According to DAST scores, 21.8% of participants were classed as intermediate risk, 6.5% as substantial risk, and 0.5% as severe risk for drug use problems. Male bartenders reported drinking significantly more units of alcohol per week and scored significantly higher on the AUDIT compared to females. Bartenders aged 26-30 and 31-40 reported drinking significantly more alcohol per week than bartenders aged 18-25. Additionally, bartenders aged 26-30 scored significantly higher on the AUDIT than ages 41-55. A high workload (more than 40 h per week) had a significant effect on units of alcohol drunk per week. CONCLUSION: This research indicates that hazardous alcohol and drug use is highly prevalent among this sample of bartenders. Working more than 40 h a week increases the amount of alcohol consumed, with males reporting higher use of alcohol and more problematic use than females. Additionally, those aged between 26 and 30 and 31 and 40 reported higher and more problematic use of alcohol compared to those in other age groups. These findings are important for public health because they describe a population that may be at risk of developing alcohol and substance use problems, and highlight the importance of adopting the brief, preventative interventions that we have suggested. Further research must help us to better understand the risk factors and causality involved in hazardous alcohol and drug use among bartenders.

Neurophysiological markers of prospective memory and working memory in typical ageing and mild cognitive impairment.

OBJECTIVE: Prospective memory (PM) -the memory of delayed intentions- is impacted by age-related cognitive decline. The current event-related potential study investigates neural mechanisms underpinning typical and atypical (Mild Cognitive Impairment, MCI) age-related decline in PM. METHODS: Young adults (YA, n = 30, age = 24.7, female n = 13), healthy older adults (OA, n = 39, age = 72.87, female n = 24) and older adults with MCI (n = 27, age = 77.54, female n = 12) performed two event-based PM tasks (perceptual, conceptual) superimposed on an ongoing working memory task. Electroencephalographic data was recorded from 128 electrodes. Groups were compared for P2 (higher order perceptual processing), N300/frontal positivity (cue detection), the parietal positivity (retrieval), reorienting negativity (RON; attention shifting). RESULTS: Participants with MCI had poorer performance (ongoing working memory task, conceptual PM), lower P2 amplitudes, and delayed RON (particularly for perceptual PM) than YA and OA. MCI had lower parietal positivity relative to YA only. YA had earlier latencies for the parietal positivity than MCI and OA, and lower amplitudes for N300 (than OA) and frontal positivity (than OA and MCI). CONCLUSIONS: Impaired attention and working memory may underpin PM deficits in MCI. SIGNIFICANCE: This is the first study to document the role of RON in PM and to investigate neurophysiological mechanisms underpinning PM in MCI.

Reasoning deficits among illicit drug users are associated with aspects of cannabis use.

Deficits in deductive reasoning have been observed among ecstasy/polydrug users. The present study seeks to investigate dose-related effects of specific drugs and whether these vary with the cognitive demands of the task. One hundred and five participants (mean age 21.33, SD 3.14; 77 females, 28 males) attempted to generate solutions for eight one-model syllogisms and one syllogism for which there was no valid conclusion. All of the one-model syllogisms generated at least one valid conclusion and six generated two valid conclusions. In these six cases, one of the conclusions was classified as common and the other as non-common. The number of valid common inferences was negatively associated with the aspects of short-term cannabis use and with measures of IQ. The outcomes observed were more than simple post-intoxication effects since cannabis use in the 10 days immediately before testing was unrelated to reasoning performance. Following adjustment for multiple comparisons, the number of non-common valid inferences was not significantly associated with any of the drug-use measures. Recent cannabis use appears to impair the processes associated with generating valid common inferences while not affecting the production of non-common inferences. It is possible, therefore, that the two types of inference may recruit different executive resources, which may differ in their susceptibility to cannabis-related effects.

Temporal and visual source memory deficits among ecstasy/polydrug users.

OBJECTIVES: We wished to investigate whether source memory judgements are adversely affected by recreational illicit drug use. METHOD: Sixty-two ecstasy/polydrug users and 75 non ecstasy users completed a source memory task, in which they tried to determine whether or not a word had been previously presented and if so, attempted to recall the format, location and temporal position in which the word had occurred. RESULTS: While not differing in terms of the number of hits and false positive responses, ecstasy/polydrug users adopted a more liberal decision criterion when judging if a word had been presented previously. With regard to source memory, users were less able to determine the format in which words had been presented (upper versus lower case). Female users did worse than female nonusers in determining which list (first or second) a word was from. Unexpectedly, the current frequency of cocaine use was negative associated with list and case source memory performance. CONCLUSIONS: Given the role that source memory plays in everyday cognition, those who use cocaine more frequently might have more difficulty in everyday tasks such as recalling the sources of crucial information or making use of contextual information as an aid to learning.

Prospective memory deficits in illicit polydrug users are associated with the average long-term typical dose of ecstasy typically consumed in a single session.

RATIONALE: Neuroimaging evidence suggests that ecstasy-related reductions in SERT densities relate more closely to the number of tablets typically consumed per session rather than estimated total lifetime use. To better understand the basis of drug related deficits in prospective memory (p.m.) we explored the association between p.m. and average long-term typical dose and long-term frequency of use. METHOD: Study 1: Sixty-five ecstasy/polydrug users and 85 nonecstasy users completed an event-based, a short-term and a long-term time-based p.m. task. Study 2: Study 1 data were merged with outcomes on the same p.m. measures from a previous study creating a combined sample of 103 ecstasy/polydrug users, 38 cannabis-only users, and 65 nonusers of illicit drugs. RESULTS: Study 1: Ecstasy/polydrug users had significant impairments on all p.m. outcomes compared with nonecstasy users. Study 2: Ecstasy/polydrug users were impaired in event-based p.m. compared with both other groups and in long-term time-based p.m. compared with nonillicit drug users. Both drug using groups did worse on the short-term time-based p.m. task compared with nonusers. Higher long-term average typical dose of ecstasy was associated with poorer performance on the event and short-term time-based p.m. tasks and accounted for unique variance in the two p.m. measures over and above the variance associated with cannabis and cocaine use. CONCLUSIONS: The typical ecstasy dose consumed in a single session is an important predictor of p.m. impairments with higher doses reflecting increasing tolerance giving rise to greater p.m. impairment.

Self-reports of executive dysfunction in current ecstasy/polydrug Users.

OBJECTIVES/BACKGROUND: Ecstasy/polydrug users have exhibited deficits in executive functioning in laboratory tests. We sought to extend these findings by investigating the extent to which ecstasy/polydrug users manifest executive deficits in everyday life. METHODS: Forty-two current ecstasy/polydrug users, 18 previous (abstinent for at least 6 months) ecstasy/polydrug users, and 50 non-users of ecstasy (including both non-users of any illicit drug and some cannabis-only users) completed the self-report Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) measure. RESULTS: Current ecstasy/polydrug users performed significantly worse than previous users and non-users on subscales measuring inhibition, self-monitoring, initiating action, working memory, planning, monitoring ongoing task performance, and organizational ability. Previous ecstasy/polydrug users did not differ significantly from non-users. In regression analyses, although the current frequency of ecstasy use accounted for statistically significant unique variance on 3 of the 9 BRIEF-A subscales, daily cigarette consumption was the main predictor in 6 of the subscales. CONCLUSIONS: Current ecstasy/polydrug users report more executive dysfunction than do previous users and non-users. This finding appears to relate to some aspect of ongoing ecstasy use and seems largely unrelated to the use of other illicit drugs. An unexpected finding was the association of current nicotine consumption with executive dysfunction.

Prospective memory functioning among ecstasy/polydrug users: evidence from the Cambridge Prospective Memory Test (CAMPROMPT).

RATIONALE: Prospective memory (PM) deficits in recreational drug users have been documented in recent years. However, the assessment of PM has largely been restricted to self-reported measures that fail to capture the distinction between event-based and time-based PM. The aim of the present study is to address this limitation. OBJECTIVES: Extending our previous research, we augmented the range laboratory measures of PM by employing the CAMPROMPT test battery to investigate the impact of illicit drug use on prospective remembering in a sample of cannabis only, ecstasy/polydrug and non-users of illicit drugs, separating event and time-based PM performance. We also administered measures of executive function and retrospective memory in order to establish whether ecstasy/polydrug deficits in PM were mediated by group differences in these processes. RESULTS: Ecstasy/polydrug users performed significantly worse on both event and time-based prospective memory tasks in comparison to both cannabis only and non-user groups. Furthermore, it was found that across the whole sample, better retrospective memory and executive functioning was associated with superior PM performance. Nevertheless, this association did not mediate the drug-related effects that were observed. Consistent with our previous study, recreational use of cocaine was linked to PM deficits. CONCLUSIONS: PM deficits have again been found among ecstasy/polydrug users, which appear to be unrelated to group differences in executive function and retrospective memory. However, the possibility that these are attributable to cocaine use cannot be excluded.

Everyday and prospective memory deficits in ecstasy/polydrug users.

The impact of ecstasy/polydrug use on real-world memory (i.e. everyday memory, cognitive failures and prospective memory [PM]) was investigated in a sample of 42 ecstasy/polydrug users and 31 non-ecstasy users. Laboratory-based PM tasks were administered along with self-reported measures of PM to test whether any ecstasy/polydrug-related impairment on the different aspects of PM was present. Self-reported measures of everyday memory and cognitive failures were also administered. Ecstasy/polydrug associated deficits were observed on both laboratory and self-reported measures of PM and everyday memory. The present study extends previous research by demonstrating that deficits in PM are real and cannot be simply attributed to self-misperceptions. The deficits observed reflect some general capacity underpinning both time- and event-based PM contexts and are not task specific. Among this group of ecstasy/polydrug users recreational use of cocaine was also prominently associated with PM deficits. Further research might explore the differential effects of individual illicit drugs on real-world memory.

Visuospatial working memory impairment in current and previous ecstasy/polydrug users.

OBJECTIVE: Previous research suggests that ecstasy users are impaired in processing visuospatial information. However, for the most part, the deficits observed appear to involve the recall and recognition of complex visual and geometric patterns. The present research sought to determine whether ecstasy use was associated with deficits in serial spatial recall and visuospatial working memory (VSWM). METHODS: Thirty-eight current ecstasy/polydrug users, 16 previous ecstasy/polydrug users and 52 non ecstasy users completed serial simple spatial recall and VSWM tasks. RESULTS: Both the current and previous users of ecstasy exhibited deficits on the VSWM task. Following controls for group differences in aspects of cannabis and cocaine use, the overall group effect fell to just below statistical significance. However, the difference contrast comparing users with nonusers continued to demonstrate a statistically significant ecstasy-related VSWM deficit. CONCLUSIONS: Ecstasy users were impaired in processing visuospatial information especially under conditions of high processing demand. The results are consistent with ecstasy-related impairment either in the short-term posterior parietal and occipital area store or the dorsolateral prefrontal cortex processes, which augment it under conditions of higher processing demands. Further research is needed to pinpoint the actual source of the ecstasy/polydrug-related VSWM deficits that have been observed here and elsewhere.

Modelling the adverse effects associated with ecstasy use.

AIMS: Ecstasy, the street name for 3,4-meththylenedioxymethamphetamine, has been associated with a range of psychiatric symptoms and impaired psychological health in both problem and recreational users. The purpose of the present paper is to determine how these impairments are related to the history of polydrug use, and the conditions under which individuals ingest ecstasy. DESIGN: Associations between the variables of interest were investigated utilizing negative binomial regression. SETTING: Liverpool and Preston in the North West of England. PARTICIPANTS: A convenience sample of 159 recreational ecstasy/polydrug users (80 males, 79 females). The sample was composed primarily of undergraduates. MEASUREMENTS: The dependent variable was the number of reported ecstasy-related adverse effects. Independent variables included quantitative aspects of ecstasy and other drug use, and the various beliefs and behaviours associated with ecstasy use. FINDINGS: The number of adverse effects was associated positively with life-time exposure to ecstasy and negatively with period of abstinence from the drug. Adverse effects were more common among those who consumed ecstasy and alcohol concurrently, but were unrelated to other aspects of polydrug use. They were unaffected by whether the user took precautions when using the drug, and only weakly related to prior beliefs concerning the effects of ecstasy. CONCLUSIONS: Greater life-time exposure to ecstasy and consuming the drug concurrently with alcohol increase the likelihood of experiencing adverse effects, including paranoia, poor general health, irritability, confusion and moodiness. Adverse effects decrease with the period of abstinence from the drug.