RESUMO
One of the goals of all pharmacological interventions aimed to increase the survival rate of patients with alcohol-dependent oropharyngeal cancers is to decrease alcohol use. Oxytocin is an alternative therapy for craving and alcohol management. However, the effectiveness of oxytocin on the severity of alcohol dependence has not been evaluated. In an ABABC study with a 6-month follow-up, during February 2015 to June 2016, a 67-year-old man with oropharyngeal squamous cell carcinoma with comorbidity of alcohol dependence syndrome and anhedonia was selected by Respondent-Driven sampling (RDS). The patient was treated with intranasal oxytocin in two six-week stages (B1 and B2) and received placebo only in the other two stages (A1 and A2), and the follow-up results were evaluated at stage C. The data were analyzed by Generalized Estimation Equation (GEE) and Repeated Measures Correlation (rmcorr). Primary outcomes showed that addiction severity Index (ASI) was significantly reduced in five domains of medical status, occupational status, alcohol consumption, family status, and mental status (all p's < 0.05). There was no significant effect of treatment on legal status (all p's > 0.05). Also, social (p < 0.05) and physical (p < 0.01) anhedonia syndrome decreased in the treatment stages. However, these changes did not persist until the 6-month follow-up (all p's > 0.05). Secondary outcomes showed that there was a significant direct relationship between the severity of addiction and anhedonia (rmcorr = 0.01). The findings of this study showed that the reduction of oxytocin-induced neurotoxic symptoms led to a decrease in the severity of addiction and an improvement in the anhedonia syndrome.
RESUMO
BACKGROUND: Stimulants addition and abuse can cause some functional and morphological changes in the normal function of glands and hormones. Methamphetamine as an addictive stimulant drug affects the Hypothalamic- pituitary-adrenal (HPA) axis and consequently makes some changes in the psychological state of the drug users. The present study aims to examine the relationship between plasma levels of cortisol with depression, stress and anxiety symptoms in chronic methamphetamine-dependent patients and normal individuals who have undergone the inguinal hernia surgery. METHODS: To meet the purpose of the study, 35 chronic methamphetamine-dependent patients in the active phase of drug abuse and 35 non-users (N=70) who were homogenized regarding the demographic features were purposefully selected from among the patients referred to undergo inguinal hernia surgery since March 15 to June 9, 2015. The participants were then divided into the control and experiment group. The changes in cortisol levels in plasma were measured using Radioimmunoassay (RIA) in three-time series including 0 (upon the induction of anesthesia), 12 and 24 hours after the surgery. Further, three behavioral indices of depression, anxiety and stress were measured using the Depression Anxiety Stress Scale 21 (DASS-21) and then the data were analyzed using t-test and Pearson Correlation coefficient. RESULTS: The plasma level of cortisol in the chronic methamphetamine-dependent patients (experiment group) had a significant increase in 24 hours after surgery (p<0.05). This study showed that cortisol levels in chronic methamphetamine-dependent patients were significantly higher than non-dependent patients in response to alarming events such as inguinal surgery. Changes in cortisol levels were intensified due to a confrontation with the phenomenon of pain and anxiety. In addition, depression index was higher in the chronic methamphetaminedependent patients than that in the non-dependent patients. However, there was no significant relationship between the cortisol level and depression index (p=0.001). CONCLUSION: The Hypothalamic-pituitary-adrenal (HPA) axis is considered as a key structure in the addiction to simulants, the reason which can explain the faster response of the chronic methamphetamine-dependent patients to the stressors such as surgery.