Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders.

BACKGROUND: The consumption of psychostimulants for non-medical reasons probably occurs because of their euphoriant and psychomotor-stimulating properties. Chronic consumption of these agents results in development of stereotyped behaviour, paranoia, and possibly aggressive behaviour. Psychosocial treatments for psychostimulant use disorder are supposed to improve compliance, and to promote abstinence. Evidence from randomised controlled trials in this subject needs to be summarised. OBJECTIVES: To conduct a systematic review of all RCTs on psychosocial interventions for treating psychostimulant use disorder. SEARCH STRATEGY: Electronic searches of Cochrane Library, EMBASE, MEDLINE, and LILACS (to may 2006); reference searching; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of psychostimulants abuse/ dependence. SELECTION CRITERIA: All randomised-controlled trials focusing on psychosocial interventions for treating psychostimulants abuse/ dependence. DATA COLLECTION AND ANALYSIS: Three authors extracted the data independently and Relative Risks, weighted mean difference and number needed to treat were estimated, when possible. The reviewers assumed that people who died or dropped out had no improvement (intention to treat analysis) and tested the sensitivity of the final results to this assumption. MAIN RESULTS: Twenty-seven randomised controlled studies (3663 participants) fulfilled inclusion criteria and had data that could be used for at least one of the main comparisons. There was a wide heterogeneity in the interventions evaluated: this did not allow to provide a summary estimate of effect and results cannot be summarised in a clear cut way. The comparisons between different type of Behavioural Interventions showed results in favour of treatments with some form of Contingency management in respect to both reducing drop outs and lowering cocaine use.. AUTHORS' CONCLUSIONS: Overall this review reports little significant behavioural changes with reductions in rates of drug consumption following an intervention. Moreover, with the evidence currently available, there are no data supporting a single treatment approach that is able to comprise the multidimensional facets of addiction patterns and to significantly yield better outcomes to resolve the chronic, relapsing nature of addiction, with all its correlates and consequences.

Risk of bleeding after endoscopic biopsy or polypectomy in patients taking aspirin or other NSAIDS.

The present study was performed to determine if the risk of bleeding after endoscopic biopsy or polypectomy was increased in patients taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Of 694 patients who underwent either upper gastrointestinal endoscopy with biopsy or colonoscopy with biopsy or polypectomy, 320 (46%) had recently consumed NSAIDs. Postprocedure bleeding was assessed by both written questionnaire and telephone follow-up. A total of 32 patients (4.6%) reported bleeding. Minor, self-limited, clinically insignificant bleeding occurred in 20/320 (6.3%) patients taking NSAIDs and 8/374 (2.1%) control patients (p = .009). Major bleeding requiring hospitalization or treatment occurred in only 4 patients (0.58%) (2 from the control group and two from the drug group), each of whom had undergone colonic polypectomy. The risk of bleeding increased with polyp size, but this did not seem to be affected by NSAID use. We conclude that the risk of significant gastrointestinal bleeding after endoscopic biopsy or poly removal is small (< 1%). Although use of NSAIDs did increase the incidence of minor self-limited bleeding, an increase in the rate of major bleeding was not observed.

Development of a structured interview scale for measuring quality of life of the severely mentally ill.

An objective, semi-structured interview questionnaire (QOLIS) was designed and tested with 201 severely mentally ill people who were living in a state hospital and in community residential facilities. Factor analysis resulted in eight factors with face validity and acceptable coefficient alphas. The factors were found to be related meaningfully to overall level of functioning, total symptom scores, self-reported life satisfaction, and an established objective measure of quality of life. Criterion validity was established and the QOLIS factors significantly differentiated people who were living in the community vs. living in a state hospital. These results suggest that the QOLIS has potential as a valid outcome measure and program evaluation tool.