The impact of substance use disorders on clinical outcomes in older-adult psychiatric inpatients.

OBJECTIVE: To examine associations among substance use disorder (SUD) and measures of length of stay (LOS) and non-psychiatric medical comorbidity (MEDCO) in older-adult inpatients with serious mental illness (SMI), hypothesizing SUD would be related to worse clinical outcomes. METHODS: A cross-sectional study analyzed medical records from 2010 to 2016 of 7258 inpatients with SMI ≥ age 50, obtained from a 274-bed psychiatric hospital. Descriptive analyses examined prevalence rates for SUD status (+/-), individual drug classes, and total number of SUDs (polysubstance use disorders). Regression models examined the influence of 2 independent variables of interest: (1) SUD status (+/-) and (2) type of SUD (ie, specific drug), controlling for demographic factors and additional (non-SUD) psychiatric disorders. Two dependent (outcome) variables were examined: LOS and MEDCO. RESULTS: The overall SUD rate was 26%; cocaine was the most common SUD (≈ 10%). SUD status and additional (non-SUD) psychiatric diagnoses were significantly associated with longer LOS (both P < 0.001). For individual SUDs, cocaine, marijuana, opiates, and alcohol were all significantly associated with LOS (all P < 0.01). SUD status, age, sex, admission status, and race were significantly associated with MEDCO (all P < 0.002). For individual SUDs, barbiturates, opiates, and alcohol were all significantly associated with MEDCO (P < 0.01). CONCLUSIONS: The prevalence of SUD in this sample underscores concerns related to treating older adults presenting providers with comorbid SUD and SMI. This combination may increase the burden and complexity of care, warranting further investigation into mechanisms and long-term consequences.

Glial fibrillary acidic protein expression after electroconvulsive shocks in rat brain.

OBJECTIVE: The aim of the present study was to assess the effect of electroconvulsive shock (ECS) in glial fibrillary acidic protein (GFAP) expression in rat brain. METHODS: Rats were given either a single (acute) or a series of eight (chronic) ECS. Brain regions were isolated and levels of glial fibrillary acidic protein (GFAP) in the brain tissue (cortex, hippocampus, and cerebellum) were assessed using an enzyme-linked immunosorbent assay (ELISA). RESULTS: We showed that GFAP expression is reduced in the hippocampus within 48 h and 7 days after acute ECS. GFAP levels are increased in the cerebellum immediately after acute and chronic ECS. No changes were observed in the cortex. CONCLUSIONS: Our findings showed a differential effect of acute and chronic ECS in the astroglial response in the brain of rats.

Refractory bipolar disorder and neuroprogression.

Immune activation and failure of physiologic compensatory mechanisms over time have been implicated in the pathophysiology of illness progression in bipolar disorder. Recent evidence suggests that such changes are important contributors to neuroprogression and may mediate the cross-sensitization of episode recurrence, trauma exposure and substance use. The present review aims to discuss the potential factors related to bipolar disorder refractoriness and neuroprogression. In addition, we will discuss the possible impacts of early therapeutic interventions as well as the alternative approaches in late stages of the disorder.