Patterns of Sexualized Drug Use among Gay, Bisexual, and Other Men Who Have Sex with Men Living with HIV: Insights from a Comprehensive Study-The U-SEX-2 GESIDA 9416 Study.

BACKGROUND: Sexualized drug use (SDU) has become a public health concern in recent years. This study aimed to estimate the prevalence of SDU in gay, bisexual, and other men who have sex with men living with HIV (HIV + GBMSM) in Madrid during 2019/2020 and compare it with data from 2016/2017 in order to detect changes in patterns. METHODS: We analyzed the frequency of SDU in a sample of HIV + GBMSM attending HIV clinics, who participated in an anonymous online survey regarding sexual behavior and recreational drug use. The association between SDU, sexual risk behaviors, and STIs was evaluated. RESULTS: This study included 424 HIV + GBMSM, with a mean age of 40 (10.43) years. Overall, 94% (396) reported being sexually active. Additionally, 33% (140) had been diagnosed with an STI within the previous year. Moreover, 54% (229) had used drugs in the last year, 25% (107) engaged in SDU, and 16% (17) reported engagement in slamsex. After adjusting for confounding factors, SDU was associated with STIs, fisting, unprotected anal intercourse, and having >24 sexual partners in the last year. According to the DUDIT test scores, 80% (81) probably had problematic drug use (≥6 points), and 8% (8) probable drug dependence (≥25 points). When comparing the U-SEX-1 (2016/2017) data with the U-SEX-2 (2019/2020) data, no significant differences were found in the proportion of participants practicing SDU or slamming. CONCLUSIONS: The prevalence of SDU among HIV + GBMSM has remained high in recent years and without significant changes. The risk of problematic drug use among those who practice SDU is high. We observed a clear association between SDU, high-risk sexual behaviors, and STIs.

Understanding Attachment, Emotional Regulation, and Childhood Adversity and Their Link to Chemsex.

Background: Although evidence shows that engaging in chemsex can be associated with poor mental health, little is known about the relationship between psychological factors and this type of drug use. We aim to explore associations between engagement in chemsex and several psychological variables (adverse life events, attachment styles, emotional regulation skills, self-care patterns) in a sample of gay, bisexual, and other men who have sex with men (GBMSM) with drug-related problems. Methods: A group of GBMSM engaged in chemsex (n = 41) and a control group of GBMSM (n = 39) completed an online survey to assess drug-related problems and the abovementioned psychological variables, in which both groups were compared. All analyses were adjusted for covariates showing significant differences between groups. Results: Compared to the control group, participants engaged in chemsex showed significantly higher frequencies of an avoidant-insecure attachment style and early adverse life events, regardless of all covariates (HIV status, job situation, and place of birth). Poorer emotional regulation and self-care patterns and a higher frequency of sexual abuse were also found in participants engaged in chemsex, though we cannot rule out the influence of HIV status on this second group of variables. Conclusions: Some people with drug-related problems engaged in chemsex might have suffered early adverse events and might have an avoidant-insecure attachment style. Moreover, those who have been diagnosed with HIV might show higher emotional dysregulation and poorer self-care patterns. These variables should be routinely evaluated in this population.

La importancia de descartar patología orgánica en la psiquiatría de urgencias / The importance of ruling out organic pathology in emergency psychiatry

OBJETIVO: La clínica psiquiátrica puede ser expresión de múltiples patologías somáticas. Es necesario valorar la importancia de la historia clínica y de las pruebas complementarias pertinentes para realizar un abordaje adecuado. CASO CLÍNICO: Varón de 53 años que acude al Servicio de Urgencias con clínica abrupta consistente en fobias de impulsión, irritabilidad y agresividad verbal. La impresión diagnóstica es de trastorno adaptativo y rasgos anancásticos de personalidad. Al día siguiente acude de nuevo, con clínica confuso-delirante y hemiplejía izquierda. Se realiza TAC cerebral con el hallazgo de un infarto subagudo parietotemporal. RESULTADOS: Los «accidentes cerebrovasculares no obvios» o «infartos camaleón» se definen como ictus con principal expresión clínica psiquiátrica. Su aparición aguda es escasa y presentan un mayor error diagnóstico. CONCLUSIONES: Este caso presenta un proceso neurológico de forma atípica. Consideramos relevante la reflexión sobre la importancia de la etiología de la «descompensación psicopatológica aguda» en el servicio de urgencias

OBJECTIVE: On some occasions, diverse somatic pathologies can present relevant psychiatric clinical features. However, the etiology of the disease may not be due to psychiatric disorder, but both to organic and neurological causes. Thus, for proper diagnosis of the disease, evaluation of the importance of the clinical history, as well as supplementary tests, is required. CLINICAL CASE: A 53-years-old man is admitted to the Emergency Room, presenting abrupt psychiatric clinical features: impulsive phobias, irritability, and verbal aggression. The patient is diagnosed with adjustment disorder with obsessive personality traits. The next day, the patient returns to the Emergency Room. He is diagnosed with confused-delusional clinic and left hemiplegia, and underwent a CT scan. Sub-acute parietal-temporal stroke was found. RESULTS: The term "non-obvious cerebrovascular accident" or "stroke chameleon" has been coined to the stroke with a main clinical psychiatric expression. Literature about this type of acute onset stroke is scarce and they could present a major misdiagnosis. CONCLUSIONS: This case report highlights a neurological process with an atypical form. Great importance of the reflection of the etiology of "acute psychopathological decompensation" should be given

Drug-related and psychopathological symptoms in HIV-positive men who have sex with men who inject drugs during sex (slamsex): Data from the U-SEX GESIDA 9416 Study.

OBJECTIVES: Sexualized intravenous drug use, also known as slamsex, seems to be increasing among HIV-positive men who have sex with men (MSM). Physical and psychopathological symptoms have previously been reported in this population, although research on the subject of slamsex is scarce. The objectives of our study were to describe the psychopathological background of a sample of HIV-positive MSM who engaged in slamsex during the previous year and to compare physical, psychopathological, and drug-related symptoms between these participants and those who engaged in non-injecting sexualized drug use. DESIGN AND METHODS: Participants (HIV-positive MSM) were recruited from the U-Sex study in 22 HIV clinics in Madrid during 2016-17. All participants completed an anonymous cross-sectional online survey on sexual behavior and recreational drug use. When participants met the inclusion criteria, physicians offered them the opportunity to participate and gave them a card with a unique code and a link to access the online survey. The present analysis is based on HIV-positive MSM who had engaged in slamsex and non-injecting sexualized drug use. RESULTS: The survey sample comprised 742 participants. Of all the participants who completed the survey, 216 (29.1%) had engaged in chemsex, and of these, 34 (15.7%) had engaged in slamsex. Participants who engaged in slamsex were more likely to have current psychopathology (depression, anxiety, and drug-related disorders) than participants who engaged in non-injecting sexualized drug use. In addition, participants who engaged in slamsex more frequently reported high-risk sexual behaviors and polydrug use and were more often diagnosed with sexually transmitted infections (STIs) and hepatitis C than those who did not inject drugs. Compared with participants who did not inject drugs, participants who engaged in slamsex experienced more severe drug-related symptoms (withdrawal and dependence), symptoms of severe intoxication (loss of consciousness), and severe psychopathological symptoms during or after slamsex (eg, paranoid thoughts and suicidal behaviors). CONCLUSION: Slamsex is closely associated with current psychiatric disorders and severe drug-related and psychiatric symptoms.

Efectividad de una intervención no sedativa para prevenir las reacciones ansiosas y claustrofóbicas en la resonancia magnética / Effectiveness of a non-sedative intervention to prevent anxious and claustrophobic reactions in magnetic resonance imaging

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Sexualized Drug Use (Chemsex) Is Associated with High-Risk Sexual Behaviors and Sexually Transmitted Infections in HIV-Positive Men Who Have Sex with Men: Data from the U-SEX GESIDA 9416 Study.

The magnitude of sexualized drug use (SDU), also known as chemsex, and its association with sexually transmitted infections (STI) has not been systematically explored in HIV-positive patients. This study aimed to calculate the prevalence of SDU and associated factors in a sample of HIV-positive men who have sex with men (MSM) in Spain. We calculated the frequency of SDU in a sample of HIV-positive MSM who responded to an anonymous online survey on sexual behavior and recreational drug use. We also analyzed differences between those who responded and those who did not (data taken from the physician's registry). The association between SDU, sexual risk behaviors, and STI was evaluated using a univariate and a multivariate analysis. Data were collected and managed using Research Electronic Data Capture (REDCap). The survey was completed by 742 HIV-positive MSM, of whom 60% had had unprotected anal intercourse (UAI), 62% had been diagnosed with a STI, and 216 (29.1%) reported recent SDU (slamsex in 16% of cases). In the multivariate analysis, patients who engaged in SDU were more likely to have had high-risk sexual behaviors and a diagnosis of STI than participants who did not engage in SDU. A diagnosis of hepatitis C was independently associated with slamsex (5.2 [95% confidence interval (CI), 2.06-13.13]; p < 0.001), chemsex (2.51 [95% CI, 1.28-4.91]; p = 0.007), and UAI (1.82 [95% CI, 0.90-3.70]; p = 0.094). The magnitude of SDU or chemsex in our sample is relatively high. We found a clear association between SDU, high-risk sexual behaviors, and STI including hepatitis C.

Chemsex. An emergent phenomenon. / Chemsex. Un fenómeno emergente.

Letter to the editor.

Carta al editor.

An approach to the new psychoactive drugs phenomenon / Una aproximación al fenómeno de las nuevas drogas psicoactivas

Abstract Background. The new psychoactive drugs (NPD) are those that represent a danger to public health and are not prohibited by conventions on international narcotics. The concept also includes new contexts and new routes of consumption as well as novel ways of distribution, notably Internet. The risks associated with NPD consumption are largely unknown to users and to health care providers. Objective. To integrate the existing evidence regarding the main NPD in terms of description, epidemiology, psychopharmacology, medical complications and psychoactive effects. Method. To review relevant and updated clinical information on NPD obtained from specialized books and indexed scientific journals (PubMed/Medline, Google Scholar, Scopus), as well as official documents edited by international organizations dedicated to the epidemiologic analysis of drug abuse and Internet websites and forums managed by psychoactive substance users. Results. Aspects of clinical and pharmacological interest are described comprehensively, together with epidemiological data and risks associated to the consumption of the most relevant NPD: synthetic cannabinoids, synthetic cathinones, NBOMe series, indoleamines, piperazines, hallucinogenic mushrooms (Psilocybe SP.), synthetic opioids, plant products (khat, kratom, Salvia divinorum, ayahuasca) and dissociative anesthetics. Discussion and conclusion. The emergence of the NPD is a phenomenon on the rise with important consequences for public health. Learning about new trends in drug consumption and its potential risks should be essential for the medical professional. New research is needed in order to understand the phenomenon of the NPD and its pharmacological, clinical and legal implications.

Resumen Antecedentes. Las nuevas drogas psicoactivas (NDP) son aquellas que, aun cuando representan un peligro para la salud pública, no están prohibidas por los acuerdos internacionales sobre narcóticos. La noción incluye también nuevos contextos de usos, nuevas formas de administración y nuevas vías de distribución, entre las que destaca Internet. Los riesgos asociados al consumo de NDP son en gran medida desconocidos por los usuarios y el personal de salud. Objetivo. Integrar la información existente sobre las principales NDP en cuanto a su descripción, psicofarmacología, epidemiología, efectos psicoactivos y complicaciones médicas descritas. Método. Revisión de la información actualizada de relevancia clínica sobre las NDP obtenida de libros especializados y revistas científicas indexadas (PubMed/Medline, Google Scholar, Scopus); de documentos oficiales de organismos internacionales dedicados a la epidemiología del consumo de drogas, y de portales y foros en Internet gestionados por usuarios de sustancias psicoactivas. Resultados. Se describen de manera detallada aspectos de interés clínico y farmacológico, así como datos epidemiológicos y riesgos asociados al consumo de las NDP más relevantes: cannabinoides sintéticos, catinonas sintéticas, serie de los NBOMe, indolaminas, piperazinas, hongos alucinógenos (Psilocybe sp.), opioides sintéticos, productos vegetales (khat, kratom, Salvia divinorum, ayahuasca) y anestésicos disociativos. Discusión y conclusión. El surgimiento de las NDP es un fenómeno en auge con importantes consecuencias en la salud pública. Se hace imprescindible para el profesional médico conocer las nuevas tendencias en el consumo y los riesgos potenciales del mismo. Son necesarias también nuevas investigaciones para comprender el fenómeno de las NDP y sus implicaciones farmacológicas, clínicas y legales.

Psychopathology Related to Energy Drinks: A Psychosis Case Report.

Energy drinks (ED) are nonalcoholic beverages that have caffeine as their most common active substance. The rapid expansion of ED consumption has created concern in the scientific community as well as in the public opinion. We report a psychotic episode probably triggered by ED abuse in a young adult without previous psychotic disorders. We have reviewed the literature regarding the relationship between caffeine, energy drinks, and psychopathology. Few articles have been published about mental health effects of energy drinks and caffeine abuse. Nevertheless, this relationship has been suggested, specifically with anxiety disorders, manic episodes, suicide attempts, psychotic decompensation, and substance use disorder. ED consumption could represent a global public health problem because of the potential severe adverse effects in mental and physical health. To our knowledge, this article is probably the first case of psychosis related to ED abuse in an individual without previous psychotic disorders.

Chemsex. Un fenómeno emergente / Chemsex. An emergent phenomenon

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Mefedrona y chemsex. Análisis descriptivo de una muestra de pacientes en Madrid / Mephedrone and chemsex. A descriptive analysis of a sample of patients in Madrid

Introducción: El término chemsex hace referencia al uso intencionado de drogas psicoactivas para mantener relaciones sexuales, generalmente entre hombres que tienen sexo con hombres, en sesiones de varias horas o días y con múltiples parejas. Mefedrona es una de las sustancias más comúnmente utilizadas, generalmente en combinación con γ-hidroxibutirato, metanfetamina o inhibidores de la 5-fosfodiesterasa, entre otras. En este fenómeno destaca el uso de aplicaciones geosociales para dispositivos móviles, que facilitan tanto el contacto con otros compañeros sexuales como la adquisición de drogas. Esta práctica ha sido descrita en algunos países europeos. Objetivos: Describir las características de una muestra de pacientes con trastorno por consumo de mefedrona utilizada en el contexto de chemsex, atendidos en un centro de drogodependencias de Madrid. Método: Se recogieron datos demográficos, características del consumo, otras sustancias acompañantes, uso de aplicaciones geosociales y comorbilidad médica y psiquiátrica. Resultados: El policonsumo de sustancias se observó en un 100% de los pacientes, siendo muy frecuente la asociación con cocaína y GHB (67%). El uso de aplicaciones geosociales era mayoritario (73,3%) así como la actividad sexual en grupo (73,3 %). El 93% de los pacientes presentaba infección por VIH. Un 60% presentaba trastornos psiquiátricos, siendo los más prevalentes el trastorno adaptativo mixto y el trastorno depresivo. Conclusiones: El uso de mefedrona en el contexto del chemsex en España y su impacto a nivel sanitario es una realidad de la que aún no se tienen estimaciones precisas. Se proponen medidas destinadas a la prevención, reducción de daños y asistencia médica, entre las que se encuentran intervenciones a través de aplicaciones digitales para móviles y la formación de profesionales, así como desarrollo de estudios dirigidos a un conocimiento más exhaustivo del fenómeno

Introduction: The term chemsex refers to sex intentionally had under the influence of psychoactive drugs, usually among men who have sex with men, in sessions lasting several hours or days and with multiple sexual partners. Mephedrone is one of the most commonly used substances, usually in combination with γ-hydroxybutyrate, methamphetamine or phosphodiesterase type 5 inhibitors, among others. The use of mobile geosocial applications stand out, facilitating both contact with other sexual-partners and the acquisition of drugs. This practice has been described in some European countries. Objectives: To describe the characteristics of a sample of patients with mephedrone use disorder used in the context of chemsex, treated at a drug dependence clinic in Madrid. Method: Demographics, consumption patterns, other accompanying substances, use of geo-social applications and comorbid medical and psychiatric disease data were described. Results: Polydrug use was observed in 100% of patients, with a very frequent association of mephedrone, cocaine and GHB (67%). Most patients used geo-social applications (73.3%) and engaged on group sexual activity (73.3%). 93% of patients were HIV-positive. 60% had psychiatric disorders, the most prevalent of these being adjustment and depressive disorders. Conclusions: Mephedrone use during chemsex in Spain and its impact on health status is a reality that has not yet been accurately estimated. Measures for prevention, harm reduction and health care are proposed, such as interventions through geosocial applications, training of professionals, and the need for further research in order to gain more comprehensive knowledge of this phenomenon

Severe Psychosis, Drug Dependence, and Hepatitis C Related to Slamming Mephedrone.

Background. Synthetic cathinones (SCs), also known as "bath salts," are ß-ketone amphetamine compounds derived from cathinone, a psychoactive substance found in Catha edulis. Mephedrone is the most representative SC. Slamming is the term used for the intravenous injection of these substances in the context of chemsex parties, in order to enhance sex experiences. Using IV mephedrone may lead to diverse medical and psychiatric complications like psychosis, aggressive behavior, and suicide ideation. Case. We report the case of a 25-year-old man admitted into a psychiatric unit, presenting with psychotic symptoms after slamming mephedrone almost every weekend for the last 4 months. He presents paranoid delusions, intense anxiety, and visual and kinesthetic hallucinations. He also shows intense craving, compulsive drug use, general malaise, and weakness. After four weeks of admission and antipsychotic treatment, delusions completely disappear. The patient is reinfected with hepatitis C. Discussion. Psychiatric and medical conditions related to chemsex and slamming have been reported in several European cities, but not in Spain. Psychotic symptoms have been associated with mephedrone and other SCs' consumption, with the IV route being prone to produce more severe symptomatology and addictive conducts. In the case we report, paranoid psychosis, addiction, and medical complications are described.

Uso combinado de desvenlafaxina y terapia electro-convulsiva / No disponible

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[Vegetables as new psychoactive drugs: a narrative review]. / Vegetales como nuevas drogas psicoactivas: una revisión narrativa.

There is growing interest in plants with psychoactive effects among consumers with different levels of experience. This has generated a need for updated knowledge among medical professionals and other health workers. These plants, which may be used in shamanic healing ceremonies or rituals or just for traditional purposes, have emerged in the Western world as new psychoactive drugs; largely thanks to the ease of purchase, sale, cultivation and exchange of information that the Internet offers. This review summarizes the current knowledge about the most important psychoactive plants, either by their mention in Internet forums or harm-reduction portals or by their allusion in scientific texts.

Existe un interés creciente en los vegetales con efectos psicoactivos por parte de consumidores, con diferentes niveles de experiencia. Esto ha generado una necesidad de actualización de conocimientos del lado de los profesionales médicos y de otros responsables de la salud pública. Se trata, por lo general, de plantas de uso en ceremonias chamánicas con intención curativa, en rituales o simplemente de uso tradicional que han dado el salto al mundo occidental como nuevas drogas psicoactivas, en gran medida gracias a la facilidad de compra, venta, cultivo e intercambio de información que ofrece Internet. Recopilamos en este texto los vegetales con propiedades psicoactivas más relevantes, tanto por su frecuente mención en foros de usuarios o en portales destinados a la reducción de daños en el consumo de drogas, como por su aparición en textos científicos.

New Psychoactive Drugs.

Carta al editor.

Nuevas Drogas Psicoactivas / New Psychoactive Drugs

No disponible

Platelet monoamine oxidase activity in obsessive-compulsive disorder.

Response to SSRIs suggests the implication of the serotonergic system in obsessive-compulsive disorder (OCD). However, biological studies on serotonergic function in OCD have yielded contradictory results. Platelet monoamine oxidase (MAO) activity has been proposed as an index of cerebral serotonin activity. The aim of this study was to examine platelet MAO activity in 29 OCD patients and 29 healthy controls matched by age, sex and tobacco use. We also explored the relationship between platelet MAO activity and aggressive obsessions in OCD patients. There were no differences in platelet MAO activity between OCD patients and healthy controls. We found a significant correlation between platelet MAO activity and Y-BOCS scores in the group of patients with Y-BOCS scores >15. OCD patients with aggressive obsessions had significantly lower levels of platelet MAO activity than patients without aggressive obsessions. Our results suggest that platelet MAO activity may be a marker of OCD severity, and that low platelet MAO activity may be associated with aggressive obsessions in OCD patients.

Association between obsessive-compulsive disorder and a variable number of tandem repeats polymorphism in intron 2 of the serotonin transporter gene.

BACKGROUND: Pharmacological studies indicate a dysregulation of the serotonergic system in obsessive-compulsive disorder (OCD). A variable number tandem repeats (VNTR) polymorphism with three alleles (Stin2.9, Stin2.10, Stin2.12) has been described in intron 2 of the serotonin transporter (5-HTT) gene. This polymorphism has been associated with unipolar depression, bipolar disorder, schizophrenia, and anxiety disorders including OCD. METHODS: The association between OCD and the polymorphism is examined in 97 OCD patients, 578 psychiatric controls and 406 healthy controls, all Spanish Caucasians. RESULTS: Genotype frequencies for the polymorphism were significantly different in OCD patients, psychiatric patients and controls. There was a significant excess of 12/12 and 12/10 genotypes in OCD patients compared to psychiatric patients and controls. CONCLUSIONS: Our results indicate a possible association between the Stin2.12 allele of the VNTR polymorphism and OCD.