Neuro-behavioural correlates as predictors of drug abuse in the Jamaican population current evidence

There is growing recognition that pharmacological agents, when abused, significantly affect the central nervous system (CNS) and as a consequence neuropsychological functions. This makes it necessary to devise procedures to identify inter-alia the neurophysiological, behavioural, cognitive and emotional patterns of CNS dysfunction induced by substance abuse. The National Survey of Substance Abuse in Jamaica (1994), indicated that 2.4 percent of respondents endorsed greater than 50 percent of items on the Drug Involvement Scale (DIS). The DIS characterizes the severity of drug abuse, assessing how it dominates the persons life, inflicts behavioural disruption, thus reflecting the severity of drug dependence. Drug abusers endorsing <50 percent of DIS-items also manifested tendencies of attentional deficit hyperactivity disorder (ADHD), memory loss, severe bouts of aggression, mood-swings and other behavioural problems. Furthermore, this group of people endorsed inter-alia 37 percent of the items of domains concerned with behaviour patterns, family systems and behaviour disorders indicating a generalized psychosocial-functional-disruption. Evidence will be adduced indicating the trigger effects of drugs on certain brain mechanisms producing specific neuropsychological correlates. The data generated behavioural and social correlates associated with substance abuse. These features indicated those persons who could be regarded as vulnerable to a variety of risky behaviours, including substance abuse. This observation led to the formulation of a screening strategy to tease out drug abusers and those people likely to be vulnerable. Thus, the neuro-drug diagnostic procedure (NIDEP), a computerized device, was established to assess the population for addictions and related psychological disabilities. The NIDEP consisted of twenty-one components selected from various domains covering a complex of dysfunctional behaviours and experiences (e.g. problems of memory, cognition, emotions, conduct disorders and disturbed family situations). NIDEP was programmed to select respondents with a score of greater than 66.6 percent endorsements. In this regard, the procedure selected 6,986 people. Following the application of DIS 4,455 persons were assessed as being heavily involved with drugs. These population estimations were calculated utilizing the National Sample age range of 15-50 years. (AU)

Current findings indicate that substance abuse constitutes a major threat to health, family and social systems in Jamaica

Substance abuse is a complex and progressively expanding global problem. The insidious nature of Substance Abuse makes it a major Public Health issue of no mean order. This study is of correlational design, seeking to identify prevalence and patterns of drug use in the Jamaican population. The sample was selected to represent the national population characteristics by utilizing a multiusage stratified random sampling technique. Seventeen communities were randomly selected from a grouping stratified for this purpose. The stratification criteria are as follows: socio-economic levels; community size; community complexity; urban/rural characteristics; economic base (e.g., sugar, tourism, agriculture, fishing); and potential exposure to facilities for drug use. Based on the sample size, the sample error is estimated at +- 3.0 percent. In the national sample (2005), reported drug use during the past month (30 days) among respondents shows the most popular of all drugs used by rank are: 1. Alcohol 51 percent, 2. Pain-killers 27.9 percent, 3. Tobacco 14.6 percent. The most popular illegal drugs used are: 1. Marijuana 11.5 percent, 2. Cocaine 0.6 percent. Opiates and phencyclidine (PCP) are used in equal proportions (0.2 percent) respectively. With the exception of alcohol (51 percent), the majority of respondents reported non-use in the past month for the substances specified. For eight of the thirteen identified substances, 98 percent reported non-use. Multiple drug use is a phenomenon which exists among substance abusers. Alcohol is the drug most frequently used with other substances. Alcohol and tobacco are the most popular combinations among multiple drug users. The pattern of substances used reported by respondents shows that the majority (56.2 percent) use only one substance. The highest use of drugs is found in those parishes in the middle and western sections of the island namely: Manchester, St. Ann, Trelawny and St. Elizabeth. The use of alcohol and marijuana in all parishes with few exceptions tended to be fairly widespread. Alcohol and marijuana were the substances most popularly used across all parishes. (AU)

Ethics and law in the medical curriculum: a University of the West Indies perspective

The Faculty of Medical Sciences (FMS), University of the West Indies, recognises that ethics and law are not currently given adequate importance in the training of health professionals. FMS also recognises the rapid advancement of technology, such as transplants, artificial organs, in vitro fertilization, life-sustaining equipment and euthanasia, as well as the ever-increasing prevalence of malpractice. Thus two conferences were held to consider the implementation of ethics and law in the medical curriculum. The conferences recommended an increased input into the curriculum of ethics and law, and that this programme be taught and examined in all the medical years. The article discusses implementation strategies (AU)

Mesolimbic deficits exacerbate amphetamine treatment: clinical implications for drug abusers

Amphetamine, a common drug used by abusers, is able to produce a schizophreniform psychosis in man. The experiment reported here examined amphetamine in relation to its role in the nucleus accumbens septi (NAS) and the globus pallidus. The effects produced by apomorphine, a direct dopamine (DA) agonist, were compared with those of amphetamine, a known indirect DA agonist. The data revealed that amphetamine in NAS-lesioned animals produced very active stereotypy which intensified with time. This effect was blocked by pallidal lesioning. Apomorphine in pallidectomised rats produced persistent stereotypy, but of diminished intensity. The results are discussed in terms of the mediating roles of the NAS and globus pallidus on behavioural sequelae. (AU)

Progress in medical education in the Faculty of Medical Sciences, University of the West Indies: Implementation of problem-based learning at the St Augustine Campus

This paper reviews some of the developmental procedures regarding changes in medical education within the Faculty of Medical Sciences, University of the West Indies. Discussed are some of the constraints experienced in attempting curriculum changes in the established medical school at Mona, Jamaica, as compared with the implementation of a problem-based learning strategy curriculum at the Eric Williams Medical Complex, St Augustine, Trinidad and Tobago. At Mona, integration of disciplines, community-health and other programmes were attempted. However, it was at the Eric Williams Medical Complex, a new school, that the Faculty of Medical Sciences was able to implement a problem-based programme. (AU)

Review of the effects of Cannabis on mental and physiological functions: justification for an Intensive and Comprehensive Programme for the health of the Caribbean people

This paper draws on scientific work done in the English-speaking Caribbean in an attempt to assess the specific effects of the chronic use of Cannabis on psychological and physiological processes. Evidence is reviewed concerning the interaction of this psychotomimetic compound on cognitive functioning and the possible sequelae of altered mental states giving rise to psychopathology. The physiological work evaluates studies relating to Cannabis smoke and lung function. In addition, the work reveals some exciting findings of the impact of Cannabis on the reproductive process. The implications of these findings are discussed in view of our knowledge of the chronic use of Cannabis in Jamaica, and focuses attention on the long-term effects of this substance in the context of the abusing population (AU)

Test for autonomic function to establish the norm: a useful tool for evaluation in various clinical disorders

Little information is available regarding the responses of the Jamaican population to the Valsalva manoevre (VM), a test to investigate the integrity of the autonomic nervous system (ANS). This study is aimed at investigating the cardiac autonomic control in the Jamaican population, to explore the range of responses and to establish the norm. Such an explorative investigation provides an important tool to uncover autonomic dysfunction in psychosomatic, cardiopulmonary, metabolic and neural disorders. Fifty male and fifty female Jamaicans, who were apparently healthy and did not indulge in any drug use and smoking, are asked to perform the VM in a semirecumbent position. A tachograph (Grass model) and standard electrocardiographic leads are used for the graphic presentation of the subjects' beat-to-beat heart rate changes. The Valsalva ratio (VR) is calculated by dividing maximum tachycardia and maximum bradycardia during the VM. The mean VR for the female (2.41ñ0.18) is greater than that for the male (1.63ñ0.27) (p<0.001). Female subjects exhibit a higher basal heart rate (88+6 as against 77ñ7 in the male) and a greater magnitude of bradycardia (33 as against 4 in the male). The values for VR are above the minimum of 1.5 proposed in the literature. Relative roles of the sympathetic and parasympathetic nervous systems may differ in the male and female subjects, thus accounting for a higher VR in the female. This test is simple, safe, noninvasive and reproducible and is useful to detect the abnormal autonomic function in various conditions, including states of pregnancy and stress (AU)

Evidence to support the influence of the nucleus accumbens on drug-induced psychopathology

This study was designed to evaluate the hypothesis that the mesolimbic dopamine pathways are involved in the manifestations of psychotic symptoms. Rats were injected with amphetamine (5.0 mg/kg) and apomorphine (1.0 mg/kg) following bilateral lesions of the nucleus accumbens. The results showed high levels of stereotypy following amphetamine administrations in contrast to the low levels seen after the administration of apomorphine. These results, in conjunction with previous experiments involving the globus pallidus, were evaluated in terms of the accumbens' influence on drug-induced psychosis (AU)