Effects of Mindfulness-Based Interventions on Gray Matter Volume in Patients with Opioid Dependence.

INTRODUCTION: Recently, several mindfulness-based programs showed promising clinical effects in the treatment of psychiatric disorders including substance use disorders. However, very little is known about the effects of mindfulness-based interventions (MBIs) on brain structure in such patients. METHODS: This study aimed to detect changes in gray matter volume (GMV) in opioid-dependent patients receiving MBI during their first month of treatment. Thirty patients were assigned to either 3 weeks of MBI (n = 16) or treatment as usual (TAU, n = 14) and were investigated using structural magnetic resonance imaging before and after treatment. Longitudinal pipeline of the Computational Anatomy Toolbox for SPM (CAT12) was used to detect significant treatment-related changes over time. The identified GMV changes following treatment were related to clinically relevant measures such as impulsivity, distress tolerance, and mindfulness. RESULTS: After treatment, increased mindfulness scores were found in individuals receiving MBI compared to TAU. In the MBI group, there were also significant differences with respect to distress tolerance and impulsivity. Effects on mindfulness, distress tolerance, and impulsivity were also found in the TAU group. Longitudinal within-group analysis revealed increased left anterior insula GMV in individuals receiving MBI. Anterior insula volume increase was associated with decreased impulsivity levels. In the TAU group, significant GMV changes were found in the right lingual gyrus and right entorhinal cortex. DISCUSSION/CONCLUSION: MBI can yield significant clinical effects during early abstinence from opioid dependence. MBI is particularly associated with increased insula GMV, supporting an important role of this region in the context of MBI-induced neural changes.

Mindfulness-based therapy modulates default-mode network connectivity in patients with opioid dependence.

Recently, mindfulness-based programs have shown promising clinical effects in the treatment of substance-use disorders (SUD). While several studies linked mindfulness to decreased default mode network (DMN) connectivity in meditators, only a few studies investigated its effects in patients with SUD. This study aimed to detect changes in DMN connectivity in opiate dependent patients receiving mindfulness based therapy (MBT) during their first month of treatment. Data from 32 patients that were assigned to MBT or treatment as usual (TAU) groups was investigated using resting-state functional MRI at 1.5 T before and after four weeks of treatment. Independent Component Analysis was used to investigate distinct (anterior vs. posterior) DMN subsystems. Connectivity changes after treatment were related to measures of impulsivity, distress tolerance and mindfulness. Increased mindfulness scores after treatment were found in patients receiving MBT compared to TAU. Within the anterior DMN, decreased right inferior frontal cortical connectivity was detected in patients who received MBT compared to TAU. In addition, within the MBT-group decreased right superior frontal cortex connectivity was detected after treatment. Inferior frontal cortex function was significantly associated with mindfulness measures. The data suggest that MBT can be useful during abstinence from opiates. In opiate-dependent patients distinct functional connectivity changes within the DMN are associated with MBT.

Treatment Outcomes Based on Patient's Oral Health Related Quality of Life (OHRQoL) after Receiving Conventional Clasp or Precision Attachment Removable Partial Dentures in Distal Extension Cases: A Randomized Controlled Clinical Trial / Resultado do tratamento com Prótese Parcial Removível convencional ou com encaixe de precisão, em casos de extremidade livre, baseado no índice de qualidade de vida relacionado á saúde bucal (OHROoL): ensaio clínico controlado e randomizado

Objetivos: Comparar o efeito de duas opções de tratamento (próteses parciais removíveis retidas por encaixe de precisão (PA-RPD) ou grampos (C-RPD) em casos de classe I inferiores de Kennedy em relação à qualidade de vida relacionada à saúde bucal (OHRQoL) e a força de mordida. Material e Métodos: O estudo incluiu 32 pacientes parcialmente desdentados, dos quais 16 receberam PA-RPD (OT Cap Attachment) e 16 pacientes receberam C-RPD. Todos os pacientes de ambos os grupos foram solicitados a preencher o questionário OHRQoL após 1 semana (linha de base), 3 meses, 6 meses e 12 meses após a inserção da prótese. A força de mordida foi medida usando o i-load Star Sensor uma semana, 3 meses, 6 meses e 1 ano após a inserção parcial da prótese em todos os pacientes dos dois grupos. A análise estatística compreendeu o teste U de Mann Whitney, teste de Friedman, teste de Dunn e teste do qui-quadrado. Resultados: Os resultados da OHRQoL revelaram que, no período basal, 3 meses e 6 meses, o PA-RPD apresentou um escore total médio mais baixo estatisticamente significativo do OHIP-14 do que o C-RPD. No entanto, após 12 meses, não houve diferença estatisticamente significante entre os escores totais do OHIP-14 nos dois grupos. Em relação à força de mordida, não houve diferença estatisticamente significante entre os dois grupos. Conclusão: Dentro das limitações deste estudo, concluiu-se que a OHRQoL do PARPD e do C-RPD era comparável após 12 meses. Da mesma forma, a força de mordida foi a mesma para as duas opções de tratamento.(AU)

Objective: To compare the effect of two treatment options in mandibular Kennedy class I cases regarding oral health related quality of life (OHRQoL) and the biting force, removable partial dentures retained by either precision attachment (PA-RPD) or clasps (C-RPD). Material and Methods: The study included 32 partially edentulous patients which 16 patients received PA-RPD (OT Cap Attachment) and 16 patients received C-RPD. All the patients in both groups were asked to fill the OHRQoL questionnaire after 1 week (baseline), 3 months, 6 months and 12 months after prosthesis insertion. Biting force was measured using the i-load Star Sensor one week, 3 months, 6 months and 1 year after partial denture insertion for all patients in both groups. Statistical analysis comprised Mann Whitney U test, Friedman's test, Dunn's test and Chisquare test. Results: The results of OHRQoL revealed that at the baseline, 3 months and 6 months the PA-RPD showed statistically significant lower mean total OHIP- 14 score than the C-RPD. However, after 12 Monthes , there was no statistically significant difference between total OHIP-14 scores in the two groups. Concerning the biting force there was no statistically significant difference between the two groups. Conclusion: Within the limitations of this study it was concluded that the OHRQoL of both the PA-RPD and the C-RPD was comparable after 12 months. Similarly the biting force was the same for both treatment options. (AU)

Mindfulness-based interventions modulate structural network strength in patients with opioid dependence.

Mindfulness-based interventions (MBI) are increasingly used in the treatment of patients with mental disorders, in particular in individuals presenting with affective disorders or in patients exhibiting abnormal levels of impulsive behavior. MBI have been also offered to patients with substance use disorders, where such treatment options may yield considerable clinical effects. Neural effects associated with MBI have been increasingly acknowledged, but is unknown whether MBI exert specific effects on brain structure in patients with substance use disorders. In this study, we investigated 19 inpatients with opioid dependence receiving treatment-as-usual (TAU, n = 9) or additional MBI (n = 10). Structural magnetic resonance imaging data were acquired before and after four weeks of treatment. Source-based morphometry was used to investigate modulation of structural networks after treatment. Both treatment modalities led to significant clinical improvement. Patients receiving MBI showed a significant change in distress tolerance levels. An increase in bilateral striatal/insular and prefrontal/cingulate network strength was found in patients receiving MBI compared to individuals receiving TAU. Prefrontal/cingulate cortical network strength was associated with impulsivity levels. These findings suggest that MBI can have a recognizable role in treatment of substance use disorders and that neural effects of MBI may be captured in terms of frontostriatal structural network change.

Lifetime prevalence of alcohol and substance use in Egypt: a community survey.

OBJECTIVE: The aim of this study was to determine the prevalence of substance use and addiction in Egypt and study its sociodemographic correlates. METHOD: A total of 44,000 subjects were interviewed from 8 governorates by stratified sampling. A questionnaire derived from the Addiction Severity Index (ASI) was individually administered. RESULTS: The lifetime prevalence of any substance use varies between 7.25% and 14.5%. One-month prevalence varies between 5.4% and 11.5% when adjusted to different population parameters. A total of 4832 subjects were identified as using illicit substances at least once in their life (9.6%), including 1329 experimental and social use (3.3%), 1860 regular use (4.64%), and 629 substance dependence (1.6%). The prevalence of substance use in males is 13.2% and 1.1% in females. Prevalence increases significantly in males of Bedouin origin, in seaside governorates, with lesser levels of education, and in certain occupations. The 15-19 age group showed the highest onset of substance use. Cannabis is the drug mostly misused in Egypt; alcohol is a distant second. CONCLUSIONS: The prevalence of substance use is lower than Western countries and higher compared with a 1996 survey. The true population prevalence is probably higher due to underreporting. The demographic pattern reflects availability and accessibility to drugs.