Acute behavioral and physiological effects of modafinil in drug abusers.

Modafinil, a novel stimulant, is effective in the treatment of excessive daytime sleepiness associated with narcolepsy. It is biochemically and pharmacologically distinct from prototypical stimulants such as D-amphetamine, cocaine, and methylphenidate. The present experiment was designed to assess the acute behavioral effects of oral modafinil, cocaine, and placebo in participants (n=9) with recent histories of cocaine use (i.e. positive urine for cocaine or benzoylecgonine during the initial screening interview). Drug effects were assessed with a battery of self-reported drug-effect questionnaires, performance measures, and physiological indices. Cocaine, but not modafinil, produced stimulant-like self-reported drug effects (e.g. increased ratings of High and Stimulated). Modafinil and cocaine dose-dependently increased heart rate and blood pressure. The results of the present study suggest that modafinil has minimal abuse potential, but should be viewed cautiously because of the relatively small sample size. Future studies should further characterize the abuse potential of modafinil using other behavioral arrangements, such as drug discrimination or drug self-administration. A full characterization of the abuse potential of modafinil will become important as the use of this drug increases.

Characteristics of cocaine users in a private inpatient treatment setting.

Patient records were reviewed from an eighteen-month period of a private hospital adult addictive disease unit. Of 667 consecutive admissions, sixty-five (49 males, 16 females) were diagnosed with cocaine abuse or dependence; 38 percent were from rural areas. Although mean age of males and females was similar, males had a longer duration of use (8.2 years versus 5.8 years), however, females used an average of 14 grams per week versus 9.5 grams per week for males. African-American patients were over-represented among the cocaine using sample and also among the sample who chose smoking as their route of administration. A larger percentage of males had legal problems and admitted to "dealing," when compared to females. Those from rural areas were more likely to be married and less apt to have legal problems.

Developing a rural therapy with big city approaches.

Both rural communities and urban communities experience problems associated with drug use and drug dependence. However, existing treatment interventions are not tailored for rural settings. This article describes a project which will modify an existing social skills behavioral therapy for rural populations, refine the therapy, develop a manual, train and supervise therapists, and pilot test the structured behavioral outpatient rural therapy to treat rural drug users and drug dependents as Stage I Research for NIDA's Behavioral Therapies Development Program.

Caffeine and nicotine use in an addicted population.

This study was undertaken to examine differences in caffeine and nicotine use between the psychiatric population and the addicted population in a private psychiatric inpatient facility. Eighty-six patients on an adult addictive disease inpatient unit and 80 patients on an adult psychiatry unit in a private psychiatric hospital were interviewed with regard to their use of nicotine and caffeine. In addition, demographic information and primary diagnoses were obtained from the psychiatric admission assessment in the medical record as listed by the admitting psychiatrist. Although there was little difference in psychiatric patients vs. chemically dependent patients with regard to the percentage of caffeine users, the chemically dependent individuals drank more coffee, soft drinks, and tea. A much greater percentage of the chemically dependent individuals also smoked cigarettes, although not in a greater amount than the psychiatric patients who smoked. Because group assignment was not random, ordinary least squares (OLS) regression analyses were conducted to determine the independent associations of age, sex, education, and treatment population in predicting levels of caffeine and tobacco use. Even after controlling for demographic differences between the two samples, chemically dependent patients still reported higher levels of daily caffeine and tobacco use than patients on the general psychiatric unit.

The cytochrome P450 2D6 (CYP2D6) enzyme polymorphism: screening costs and influence on clinical outcomes in psychiatry.

OBJECTIVES: This study examined factors that affect cost, reliability, and the value of determining the cytochrome P450 2D6 (CYP2D6) polymorphism in clinical practice. STUDY DESIGN: The method of deoxyribonucleic acid isolation, sample preparation, oligonucleotide primers, and polymerase chain reaction procedures were scrutinized for their effect on CYP2D6 genotyping efforts. The determination of the CYP2D6 A, B, D, E, and T alleles was used to identify the deficiency in CYP2D6 expression in 161 individuals phenotyped for CYP2D6 activity with dextromethorphan. The CYP2D6 genotype was assessed in 74 outpatients who had received diagnoses of depression. Eighteen of these patients were screened because of an adverse response to a tricyclic or antidepressant known or suspected to be a CYP2D6 substrate. RESULTS: The CYP2D6 A, B, C, D, E, and T alleles could be detected in 13 hours at a cost of $84 per sample by judicious selection of conditions and procedures. The genotype provided an accurate predictor of CYP2D6 expression in all 134 subjects who expressed the enzyme and in all 27 unrelated individuals phenotyped as deficient in CYP2D6 activity. In the patient group that experienced adverse effects, 44% of all CYP2D6 gene copies contained the A, B, D, E, or T allele(s) associated with inactive CYP2D6 expression. This was more than twice the rate for the occurrence of mutant alleles in the other 56 psychiatric patients (21%) and in 80 random subjects from the general population (20%; p < 0.05). CONCLUSIONS: Screening psychiatric patients for CYP2D6 expression may distinguish metabolic-based therapeutic problems from drug sensitivity caused by other mechanisms.

Medical student suicide, 1989-1994.

OBJECTIVE: Studies examining suicide rates for medical students have yielded conflicting data. This article addresses medical student suicide from August 1989 through May 1994. METHOD: Telephone interviews were conducted with a representative from each U.S. medical school, generally the dean of student affairs. If a suicide had occurred, information regarding demographic characteristics, psychiatric or substance abuse history, means of suicide, month, and presence of a suicide note was obtained. RESULTS: Responses were obtained from 101 (80%) of the 126 U.S. medical schools. Responding schools reported 15 suicides by medical students from August 1989 through May 1994. Fourteen were by men. Six suicides were committed during the third year of medical school, and four occurred during the fourth year. Six students left notes, and nine of 13 had psychiatric histories. CONCLUSIONS: The results demonstrate a lower suicide rate than that found in previous studies and emphasize the need for standardized reporting methods.

Psychological profile of somatizing patients attending the integrative clinic.

OBJECTIVE: A clinic to evaluate and treat referred somatizing patients was established in the medicine clinic of a university medical center. METHOD: Fifty-four patients were evaluated and compared to an age- and sex-matched non-somatizing patient group. RESULTS: Somatizing patients had increased rates of psychiatric and alcohol and substance abuse histories. Somatizing patients scored high on all subscales of the SCL-90 and were most frequently found in the Anxious/Moody Cluster of the MBHI. These patients also endorsed highly beliefs in medical problems as a focus of their lives. CONCLUSIONS: These patients' psychological beliefs set the stage for conflict in the medical setting. The implications of these results are discussed in relation to liaison clinics, early identification, and treatment approaches.

TRH test, DST, and response to desipramine in primary degenerative dementia.

The relationship of primary degenerative dementia (PDD) to major depressive disorder (MDD) is important clinically and theoretically. Neuroendocrine challenge strategies in PDD have focused primarily on the hypothalamic-pituitary-adrenal axis, have had varied results, and have not been coupled with assessment of response to antidepressant therapy. We studied the Thyrotropin-Releasing Hormone (TRH) test, the Dexamethasone Suppression Test (DST), and response to desipramine in 12 patients with PDD and 10 patients with MDD. The PDD patients had a high percentage of abnormal TRH tests and DSTs. This was not associated with improvement on desipramine.

Treating psychiatric problems in medical students.

The medical school educational experience is very stressful for many students, prompting some to seek formal psychiatric care. The authors describe the Medical Student Support Services program of the University of Kentucky College of Medicine. From July 1983 to June 1985, this program served 66 patients, representing 417 visits. On the basis of retrospective chart review with the examining clinicians, the authors present DSM-III diagnoses, types of problems seen, descriptive profiles of the patients, duration of treatment, types of therapy used, and data on marital issues. They discuss the intricacies of providing psychiatric services to medical students and make recommendations for program development for such patients.