A comparative study of the efficacy of venlafaxine and naltrexone for relapse prevention in patients with opioid use disorder attributed to tramadol.

Tramadol and venlafaxine share similar pharmacological characteristics that may allow for overlapping therapeutic indications for them. The objective of this study was to compare the efficacy of venlafaxine and naltrexone in the treatment of tramadol abuse. This comparative trial included 95 patients with tramadol abuse who were detoxified for 2 weeks. Twenty-eight participants underwent the maintenance phase, while the remaining participants (n = 67) dropped out. The patients were randomized to use 50 mg/day of naltrexone or 225 mg/day of venlafaxine for 8 weeks. All participants were interviewed using SCID-I (DSM-IV-TR) criteria for diagnosing substance use and other psychiatric disorders. The proportion of relapsed patients was comparable between the naltrexone and venlafaxine groups (29.4% vs. 30.4%, P = 0.9). However, participants in the venlafaxine group stayed in treatment longer than participants in the naltrexone group, and the difference was significant (22.9 ±â€…7.89 days vs. 16.9 ±â€…3.4 days, P = 0.01). Only psychiatric comorbidity was found to be significantly associated with retention in treatment (80% vs. 22%, P = 0.005). Venlafaxine is as effective as naltrexone in preventing relapse in patients with tramadol abuse. Venlafaxine was more effective than naltrexone in treatment retention.

Assessment of compliance and relapse in patients with schizophrenia before and after the onset of COVID-19 pandemic.

OBJECTIVE: The aim of this study was to assess the frequency and correlates of relapse among patients with schizophrenia during the COVID-19 pandemic. METHODS: This retrospective study included 90 adults who met DSM-IV criteria for schizophrenia. The participants were evaluated using Positive and Negative Syndrome Scale (PANSS), Compliance Rating Scale (CRS) and World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0) before and after the onset of COVID-19 pandemic. RESULTS: The mean score of CRS was decreased after the onset of COVID-19 pandemic compared to before COVID 19 ( p < 0.001). The mean total score of PANSS scale and the mean positive subscale (P) score had increased after the onset of COVID-19 pandemic compared to before COVID 19 ( p < 0.001). Following up the news about COVID-19 regularly and decreased level of family support after the pandemic onset were associated with lower CRS scores and higher PANSS scores. In addition, the presence of infection or death with COVID-19 among family members and lower CRS scores were associated with higher scores on PANSS positive subscale. CONCLUSIONS: The relapse rate had increased among patients with schizophrenia during COVID-19 pandemic. Non-compliance with medications and lack of family support were the main correlates of relapse in schizophrenia.Key PointsPatients with schizophrenia are at high risk for relapse during Covid-19 pandemic.Non-compliance with medications, lack of family support, COVID-19-related illness or death of family members and following the news of the pandemic are correlates of relapse in patients with schizophrenia.Psychoeducation, availability of medications and mental health services and family support may help to prevent relapse in patients with schizophrenia during pandemics.Prospective studies are needed to confirm the findings of this study.

Prevalence, correlates, and consequences of attention-deficit/hyperactivity disorder in a clinical sample of adults with tramadol use in Egypt.

BACKGROUND AND OBJECTIVES: Many studies investigated the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) but none focused on the association between ADHD and nonmedical prescription opioids such as tramadol. The objective of this study was to assess the prevalence, correlates, and consequences of co-occurrence of ADHD and tramadol use among adults. METHODS: This study included 122 Egyptian adults with opioid use disorders attributed to tramadol (N = 122). Participants were recruited from the psychiatric outpatient clinic and inpatient unit of Zagazig University Hospital, Egypt. ADHD and SUDs were assessed by using the Adult ADHD Self-Report Scale (ASRS-v 1.1) and SCID-I criteria of DSM-5, respectively. All participants were screened for drugs by urinalysis. RESULTS: Forty percent of the participants used tramadol alone, whereas the remaining used it with other substances, such as alcohol (51.6%) and cannabis (48.4%). Thirty-eight cases (31%) had adult ADHD and most of them had inattentive or mixed types. Adults with tramadol use and ADHD were more likely to have a younger age of onset of tramadol use, use a higher dose of tramadol, and use it for a longer duration than those with tramadol use without ADHD. CONCLUSIONS AND DISCUSSION: ADHD in adults with tramadol use is common and is associated with early-onset, high dose, and long duration of tramadol use. SCIENTIFIC SIGNIFICANCE: This is the first study to investigate the co-occurrence of ADHD and tramadol misuse among adults.

Current attention-deficit/hyperactivity disorder and nonmedical prescription opioid use attributed to tramadol among male adolescents without conduct disorder in Egypt.

Background: Evidence for the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) is common. However, little research has investigated this relationship among adolescents using nonmedical prescription opioids, particularly tramadol.Objective: To estimate the prevalence and correlates of ADHD among adolescents with tramadol misuse and without conduct disorder (CD).Methods: This study included 122 Egyptian adolescents (100% male) with opioid use disorders attributed to tramadol. The diagnosis of SUDs, ADHD, and CD (to exclude) was based on the SCID-I criteria of the DSM-IV-TR. Drug-related problems were assessed using the Drug Use Disorders Identification Test (DUDIT). All adolescents were screened for drugs by urinalysis.Results: Thirty-eight percent of adolescents with tramadol misuse had ADHD. Adolescents with tramadol misuse and ADHD were more likely to have a younger age of onset of smoking, substance use, and tramadol misuse than adolescents without ADHD.Conclusions: ADHD is common among adolescents with tramadol misuse. There is an association between ADHD and young age of onset of tramadol misuse and drug-related problems.

Free Testosterone and Prolactin Levels and Sperm Morphology and Function Among Male Patients With Tramadol Abuse: A Case-Control Study.

BACKGROUND/PURPOSE: Tramadol abuse has become a crisis in Egypt and many other Middle Eastern countries. Tramadol abuse is associated with sexual dysfunction and male infertility, according to recent animal and human studies. The objective of this study was to compare tramadol abuse patients and healthy controls regarding free testosterone and prolactin levels and semen analysis. METHODS: Sixty patients with opiate use disorders attributed to tramadol (OUD-T) based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnostic criteria and 30 healthy controls were included in the study. Sociodemographic and clinical data and urine, blood, and semen samples were collected from patients and controls for assessment. RESULTS: Compared with controls, OUD-T patients had higher prolactin and lower free testosterone levels. Patients with OUD-T were more likely to have lower sperm count and higher abnormal motility and forms of sperms compared with controls. CONCLUSIONS: Patients with OUD-T were found to be more likely to have lower free testosterone levels and lower sperm counts and vitality, and higher prolactin levels and sperm abnormal forms compared with controls.

Opioid Use Disorders Attributed to Tramadol Among Egyptian University Students.

BACKGROUND: Tramadol use is an overwhelming problem in Egypt with tremendous medical and social consequences especially among youth. Use liability among Egyptian university students is underevaluated. This study aimed to estimate the prevalence and associated correlates of tramadol use among students from Zagazig University, Egypt. METHODS: A cross-sectional study included a total of 1135 undergraduate students, from 10 colleges in Zagazig University. Participants were randomly selected and assessed for tramadol use using The Drug Use Disorders Identification Test (DUDIT) and The Drug Use Disorders Identification Test-Extended (DUDIT-E). RESULTS: The prevalence of tramadol use was 12.3% among university students, with higher prevalence in male (20.2%) than female students (2.4%). The average age at onset of tramadol use was 17.6 ±â€Š2.1. Only 15% of the students with substance use were using tramadol alone whereas the rest (85%) were using at least 1 drug plus tramadol. One-fifth of these students started with tramadol as their first drug. Smoking, cannabis, and alcohol use predict tramadol use. About 60% of students who use tramadol had drug-related problems and 30% had dependence. Treatment readiness for tramadol use is negatively correlated with smoking and its duration. CONCLUSIONS: Tramadol use was common among university students, with higher prevalence among males. There is a considerable relationship between tramadol use, smoking, and use of other substances. Further population-based longitudinal studies need to investigate the causal relationship between tramadol use, smoking, and use of other substances.

Cognitive Impairment and Tramadol Dependence.

BACKGROUND AND OBJECTIVE: Cognitive impairment is one of the consequences of substance abuse. Tramadol abuse is a public health problem in Egypt. The objective of this study was to estimate the prevalence and correlates of cognitive impairment among tramadol-abuse patients and control subjects. METHODS: This study included 100 patients with tramadol abuse and 100 control subjects (matched for age, sex, and education) who were recruited from Zagazig University Hospital, Egypt. Patients were divided into 2 groups: patients who used tramadol only (tramadol-alone group) and patients who used tramadol and other substances (polysubstance group). The participants were interviewed using Montreal Cognitive Assessment test and had urine screening for drugs. RESULTS: Twenty-four percent of the cases used tramadol alone, whereas the remaining used tramadol and other substances, mainly cannabis (66%) and benzodiazepines (27%). Tramadol-abuse patients were about 3 times more likely to have cognitive impairment than control subjects (81% vs 28%). Tramadol-alone patients were more than 2 times more likely to have cognitive impairment than control subjects (67% vs 28%). Cognitive impairment was significantly associated with polysubstance abuse. There was no association between cognitive impairment and sociodemographic or clinical factors. CONCLUSIONS: Cognitive impairment occurs commonly among tramadol-abuse patients. Memory impairment is the most common cognitive domain to be affected. There is a significant association between cognitive impairment and polysubstance abuse.

Psychiatric Comorbidity Among Egyptian Patients With Opioid Use Disorders Attributed to Tramadol.

OBJECTIVE: Opioid use disorders attributed to tramadol (OUD-T) is a public health problem in Egypt. The objective of this study was to assess the psychiatric comorbidity among patients with opioid use disorder attributed to tramadol. METHODS: This study included 100 patients with opioid use disorders attributed to tramadol (according to DSM-IV-TR) and 100 control persons (matched for age, sex, and education), who were recruited from Zagazig University Hospital, Egypt. The participants were interviewed using Structured Clinical Interview for DSM disorders (SCID-I and SCID-II), Addiction Severity Index scale (patients), and urine screening for drugs. RESULTS: Twenty-four percent of the patients used tramadol only (pure tramadol group), whereas 76% of the patients used other substances in addition to tramadol (polysubstance group). Most (91%) of the patients had tramadol dependence. Forty-nine percent of the patients had psychiatric comorbidity, especially mood disorders (59.2%), whereas only 24% of the control persons had psychiatric comorbidity, especially anxiety disorders (83.3%). The most common personality disorders among patients were borderline (24%) and antisocial (22%), whereas in control persons, the most common personality disorders were obsessive compulsive personality disorder (8%) and the avoidant personality disorder (7%). Cluster B (76.6%) was the most common category among patients (compared with 25.8% in control persons), whereas cluster C (51.6%) was the most common category among control persons (compared with 15.6% in patients). CONCLUSIONS: Most of the patients were dependent on tramadol, and approximately 3 out of 4 used many substances. Almost half of the patients had psychiatric comorbidity, and approximately 3 out of 4 had cluster B personality disorders.

Adolescent tramadol use and abuse in Egypt.

BACKGROUND: Tramadol abuse liability is underestimated and the evidence of abuse and dependence is emerging. It has many health and social consequences especially in adolescents. Tramadol abuse has not been well studied in Egypt. The aim of this study was to estimate the prevalence and associated correlates of tramadol use and abuse among school students in Egypt. METHODS: A total of 204 students, aged 13-18 years, from six schools in Zagazig, Egypt, were screened for tramadol use using The Drug Use Disorders Identification Test and a urine screen for tramadol. RESULTS: The prevalence of tramadol use was 8.8% among school students and the average age at onset of tramadol use was 16.5 ± 1.1. Some 83% of the users were using tramadol alone while the rest (17%) were using a combination of tramadol, alcohol, and cannabis. Two-thirds of these students started with tramadol as the first drug after the onset of tobacco smoking. Over one third of tramadol users had drug-related problems and 6% had dependence. There was a significant association between tramadol use and older age, male gender, and smoking. Drug-related problems were negatively correlated with age at onset of tramadol use. CONCLUSIONS: Tramadol use was common among adolescents and over one third of tramadol users had drug-related problems. Population-based longitudinal studies are needed to investigate tramadol use and the possible role of tramadol as a gateway drug in the development of substance abuse in Egypt.

Smoking in Saudi Arabia.

This article reviewed the literature on the epidemiology, consumption, trade, control, prevention, and treatment of tobacco smoking in Saudi Arabia. The prevalence of current smoking in Saudi Arabia ranges from 2.4-52.3% (median = 17.5%). Among school students, the prevalence of current smoking ranges from 12-29.8% (median = 16.5%), among university students from 2.4-37% (median = 13.5%), and among adults from 11.6-52.3% (median = 22.6%). In elderly people, the prevalence of current smoking is 25%. The prevalence of smoking in males ranges from 13-38% (median = 26.5%), while in females it ranges from 1-16% (median = 9%). To conclude, smoking is prevalent in the Saudi population at different age groups. The prevalence of current smoking is much higher in males than in females at different ages. More research is needed in the area of prevention and treatment of smoking.

Depression and neurological disorders.

Depression is the most common psychiatric disorder in neurological disorders such as epilepsy, multiple sclerosis, stroke, and Parkinsons disease. It is associated with reduction of quality of life, functional impairment, and higher mortality. The diagnosis of depression in neurological disorders is difficult because of the overlapping symptoms. Neurological disorders are usually associated with sleep and appetite disturbances, fatigue, apathy, and lack of concentration, which is similar to those of depression. The etiology of depression with neurological disorders is unknown, but the interaction between biological, psychosocial, and neuropathological factors could be responsible for it. Few controlled trials have been carried out to investigate the efficacy of psychotherapeutic and pharmacological interventions in this population, and it seems that they are effective in improving depression, quality of life, and survival. Studies pertaining to prevention of depression in neurological disorders are promising.

Stages of progression in drug abuse involvement across generations in Jeddah, Saudi Arabia.

OBJECTIVE: To investigate the stages of progression in drug involvement among adolescents and adults in Saudi Arabia. METHODS: One hundred and one consecutive male patients (91 adults and 10 adolescents), with substance abuse or dependence according to DSM-IV criteria, admitted to Al-Amal Hospital in Jeddah, Saudi Arabia, during July and August 2002 for treatment, were included in the study. All participants answered a questionnaire, which included questions pertaining to the ages and stages of progression in drug abuse. RESULTS: Adolescents started using tobacco and drugs at a younger age than adults. The difference is statistically significant for drugs (14.6 +/- 2.6 versus 22.0 +/- 8.3, t = 2.8; p = 0.006), but not for tobacco (14.7 +/- 1.8 versus 16.4 +/- 6.5, t = -0.8; p = 0.4). Adolescents and adults were different in the first (Chi 2 (3) = 13, p = 0.001) and the second (Chi 2 (3) = 14.5; p = 0.002) stages of progression, but similar in the third stage (Chi 2 (3) = 0.1; p = 1.0). CONCLUSION: Adolescents were different from adults regarding the age of onset and sequence of progression in drug involvement. This sequence was different in Saudi Arabia from that in other cultures and this could have an implication in prevention programs.

Social anxiety disorder and depression in Saudi Arabia.

The purpose of this study was to estimate the prevalence of depression in patients with social anxiety disorder (SAD) and to assess the relationship between the severity of SAD symptoms and depression. Ninety-eight consecutive patients with generalized SAD according to DSM-IV criteria were included in a cross-sectional case-control study. Patients were referred to a psychiatric outpatient clinic in a general hospital in Saudi Arabia. The Liebowitz Social Anxiety Scale was used to estimate the severity of SAD. Fifty-eight (59%) of the patients with SAD had another current psychiatric disorder. Forty (41%) patients had current depression, and 37 (92.5%) of them had it after SAD onset. Eleven of 16 patients with severe SAD (69%) had depression whereas only 29 of 82 of SAD patients with mild or moderate subtypes (35%) had depression. Patients with severe SAD were four times more likely to have depression than the patients with mild or moderate SAD even after controlling for confounding sociodemographic and clinical factors. Depression is common among patients with SAD, particularly the severe subtype. Early recognition and treatment of SAD, especially the severe subtype, may prevent the occurrence of depression. Prospective studies are needed to investigate the risk factors that may lead to depression in SAD.

Falls and age in patients with Alzheimer's disease.

The study's objective was to estimate the prevalence of falls in community-residing patients with Alzheimer's disease (AD) and to investigate the relationship between falls and age in AD. This was a study of 326 community-residing patients with AD according to National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria. The patients and their caregivers were asked about falls, behavioral disturbances, and medication use within the last 2 weeks. The patients were also rated on standardized measures of cognitive impairment, stage of dementia, depression, daily activities, general health, and extrapyramidal symptoms. Falls occurred in 24 (7.4%) patients with AD during the last 2 weeks. Using multiple logistic regression analyses, falls were independently associated with old age (odds ratio = 1.2; p = .03; 95% confidence interval = 1.0 to 1.4) but not with other variables examined. The authors conclude that falls in community-residing patients with AD are significantly associated with old age. Population-based prospective studies are needed to investigate further the risk factors for falls in AD.

Delusions and hallucinations in Alzheimer's disease: review of the brain decade.

The authors reviewed studies published from 1990 to 2001 that address the epidemiology, phenomenology, course, etiology, assessment, and treatment of delusions and hallucinations in Alzheimer's disease. The prevalence of delusions in Alzheimer's disease patients ranged from 16% to 70% (median=36.5%) in the reviewed reports, and the prevalence of hallucinations ranged from 4% to 76% (median=23%). Delusions and hallucinations tended to persist over time, tended to recur often during the course of Alzheimer's disease, and were associated with sociodemographic and clinical correlates that differed from one study to another and with substantial consequences such as functional impairment and aggression. Psychosocial methods and both typical and atypical antipsychotics are effective in the treatment of delusions and hallucinations in Alzheimer's disease.

The relationship between delusions and depression in Alzheimer's disease.

OBJECTIVES: The aim of this investigation was to study the relationship between delusions and depression in Alzheimer's disease (AD). DESIGN: This was a cross-sectional, case control study. SETTING: Neuropsychiatry Service, the Johns Hopkins School of Medicine, USA. PARTICIPANTS: 303 community-residing patients with probable AD according to NINCDS/ADRDA criteria were included in the study. Seventy-five patients with delusions only were compared to a control group of 228 patients who had neither delusions nor hallucinations. Patients with only hallucinations or both delusions and hallucinations were excluded. MEASURES: Patients were assessed clinically for the presence of delusions using the DSM-IV glossary definitions. They were also rated on standardized measures of depression, cognitive impairment, staging of dementia, general medical health, and functional impairment. RESULTS: There was an association between delusions and depression among patients with AD. Before adjustment for other variables, the presence of depression conferred a 1.8-fold (95% confidence intervals (CI) = 1.0-3.1; p = 0.04) higher risk of delusions. After adjustment for multiple other variables, this risk increased further to 6.8-fold (95% CI = 2.1-21.6; p = 0.001). CONCLUSIONS; Delusions in AD are strongly associated with depression after statistical adjustment for all confounding variables, which might distort this association. This finding has implications for our understanding of the etio-pathogenesis and management of delusions and depression in AD.

Isolated hallucinosis in Alzheimer's disease is associated with African-American race.

OBJECTIVES: The aim of this investigation was to study the relationship between isolated hallucinosis and race in Alzheimer's disease. METHODS: This was a cross-sectional, case control study carried out at the Neuropsychiatry Service, outpatient clinic at the Johns Hopkins School of Medicine, USA. The participants were 237 community-residing patients with probable Alzheimer's disease according to NINCDS/ADRDA criteria were included in the study. 9 patients with isolated hallucinosis were compared to a control group of 228 patients who had neither delusions nor hallucinations. Patients with only delusions or both delusions and hallucinations were excluded based on prior research. Patients were assessed clinically for the presence of hallucinations using the DSM-IV glossary definitions. They were also rated on standardized measures of cognitive impairment, depression, functional impairment, and general health. RESULTS: There was a significant association between hallucinations and race in patients with Alzheimer's disease. Before adjustment for other variables, the African-American race conferred a 5.5-fold (95% CI = 1.4-21.6; p = 0.02) increased risk for isolated hallucinosis. After adjustment for multiple other variables, this risk increased further to 27.2-fold (95% CI = 1.6-457.3; p = 0.02). CONCLUSIONS: African-American patients with Alzheimer's disease are more likely to have isolated hallucinations than Caucasian patients even after statistical adjustment for multiple confounding variables, which might distort this association. This finding has implications for our understanding of the etio-pathogenesis of hallucinations in Alzheimer's disease and for meeting health service needs of African-American patients.