Agonist-like or antagonist-like treatment for cocaine dependence with methadone for heroin dependence: two double-blind randomized clinical trials.

Concurrent abuse of cocaine and heroin is a common problem. Methadone is effective for opioid dependence. The question arises as to whether combining agonist-like or antagonist-like medication for cocaine with methadone for opioid dependence might be efficacious. Two parallel studies were conducted. One examined sustained release d-amphetamine and the other risperidone for cocaine dependence, each in combination with methadone. In total, 240 subjects (120/study) were recruited, who were both cocaine and heroin dependent and not currently receiving medication. All provided consent. Both studies were carried out for 26 weeks, randomized, double-blind and placebo controlled. Study I compared sustained release d-amphetamine (escalating 15-30 or 30-60 mg) and placebo. Study II examined risperidone (2 or 4 mg) and placebo. All subjects underwent methadone induction and were stabilized at 1.1 mg/kg. Subjects attended clinic twice/week, provided urine samples, obtained medication take-home doses for intervening days, and completed self-report measures. Each had one behavioral therapy session/week. In Study I, reduction in cocaine use was significant for the 30/60 mg dose compared to the 15/30 mg and placebo. Opioid use was reduced in all groups with a trend toward greater reduction in the 30/60 mg d-amphetamine group. In Study II, methadone reduced illicit opioid use but cocaine use did not change in the risperidone or placebo groups. There were no adverse medication interactions in either study. The results provide support for the agonist-like (d-amphetamine) model in cocaine dependence treatment but not for antagonist-like (risperidone) treatment. They coincide with our previous reports of amphetamine or risperidone administered singly in cocaine-dependent individuals.

Prior history of physical and sexual abuse among the psychiatric inpatient population: a comparison of males and females.

Despite increasing attention given to the high prevalence and effects of abuse in the severely mentally ill, few studies have looked at its effects among males. While both male and female psychiatric patients report greater abuse history than the general population, studies have focused on females alone. The current study compared the effects of abuse history between 271 severely mentally ill males (n = 160) and females (n = 111). The mean age of participants was 33.7 years (SD = 9.73), and included 129 Caucasians, 120 African Americans, 15 Hispanic-Americans, and 7 "Other" (i.e., Asian and native American descent). Primary Axis I diagnoses included Bipolar disorder (23.2%) major depressive disorder (27.7%) schizophrenic disorder (26.6%), substance-related disorders (10.3%), and miscellaneous disorders (12.1%). Each patient completed a comprehensive assessment, including clinician ratings, self-report measures, clinical and structured interviews. Comparisons between genders revealed that females were more likely to report both physical and sexual abuse, and males were more likely to report no history of abuse. In addition, Caucasians were more likely to report abuse than were African Americans, and voluntary patients were more likely to endorse abuse history than those admitted involuntarily. Few gender differences were found in psychological symptoms among males and females. Satisfaction with the home environment was significantly lower for abused than nonabused females. This was not true for males. However, abused psychiatric patients were perceived by the physicians, nurses, and themselves as having greater emotional disturbance than were nonabused patients, regardless of gender. Clinical implications are discussed.

Is schizoaffective disorder a stable diagnostic category: a retrospective examination.

Debate continues about whether clear nosologic boundaries can be drawn between schizoaffective disorder (SA), schizophrenia (SP), and bipolar disorder (BPD). This study attempted to clarify these boundaries. A retrospective review of the records of adult psychiatric inpatients with DSM-IV diagnoses of SA (n = 96), SP (n = 245), and BPD (n = 203) was conducted. Patients were assessed at admission and discharge using standardized rating scales (completed by physicians and nurses) and self-report inventories. Differential improvement over time also was examined. Significant differences were found for gender, legal status at admission, age, LOS, episode number, and ethnicity. Overall, SA was rated by clinicians as intermediate between SP and BPD, although SA rated themselves as the most severe. SA was similar to SP on positive symptoms, intermediate on negative symptoms, and similar to BPD on mood- and distress-related symptoms. Independent of diagnosis, differences in change scores from admission to discharge were related to severity level at admission. Although several differences were found in symptom severity across domains, no syndrome was identifiable associated with the diagnosis of SA and the diagnosis was unstable over time, thereby bringing into question the validity of SA as a diagnostic entity.