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Query: UMLS:C0011570 (depression)
172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Using cross-sectional data from an ethnically diverse sample of HIV-positive injection drug users (IDUs), we sought to identify correlates of depressive symptoms. We were particularly interested in whether perceived social support was associated with depression among HIV-positive IDUs and whether social support buffered adverse effects of other correlates. Data were collected from a sample of HIV-positive IDUs recruited from a variety of venues in the New York City and San Francisco metropolitan areas in the USA. Multiple regression analysis identified four significant correlates of depressive symptoms. Perceived social support and having a regular place for HIV medical care were significantly associated with lower levels of depressive symptoms, while history of mental health problems and non-injection polydrug use were significantly associated with higher levels of depressive symptoms. Moreover, a significant interaction effect was found between social support and non-injection polydrug use, indicating that social support buffers the association between non-injection polydrug use and depression. These results suggest that increasing social support might be a useful tool for HIV-positive IDUs in reducing depression and the adverse effect of non-injection polydrug use.
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PMID:Correlates of depressive symptoms among HIV-positive injection drug users: the role of social support. 1295 20

There is a large body of work investigating concurrent associations between polysubstance use and psychopathology, but much of this work has either pre-dated or failed to account for the complex and culturally specific patterns of contemporary drug use. In particular, attendees of dance music events report a greater drug history than their peers and engage in a unique lifestyle. To further investigate the consequences of this type of drug use, 100 subjects who regularly attended dance music events were administered a battery of self-report psychiatric symptom scales. This battery contained the Anxiety Sensitivity Index, the Beck Anxiety Inventory (BAI), the Center for Epidemiologic Studies Depression scale (CES-D), the Dissociative Experiences Scale, the Padua Inventory Revised and additional questions about substance use. Our study population included abstainers and drug users with a wide history of use. We demonstrated strong associations between use of many different drugs, suggesting that polydrug use is the norm in this type of population. We found weak, but statistically significant, correlations between use of alcohol (p < 0.05), amphetamine (p < 0.01) and ecstasy (p < 0.01) with self-reported score on the BAI. There were also positive associations between dissociative symptomatology and the use of amphetamine (p < 0.05) and cocaine (p < 0.05). Furthermore, weekly unit intake of alcohol positively correlated with score on the CES-D (p < 0.05). As polydrug use was the norm in this sample, we performed regression analysis to investigate the contribution of multiple drug use on self-report. This showed that weekly use of alcohol, and frequency of use of amyl nitrate and cigarettes were significant predictors of BAI score. However, the majority of subjects reported being unworried by these symptoms, which may represent a lack of self-awareness, or acceptance of them as the subacute effects of substance use. It remains to be determined at what point adverse effects of drug use begin to interfere with day-to-day life.
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PMID:Self-reported psychopathology in polydrug users. 1510 88

Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymethamphetamine (MDMA), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar). These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. Club drugs often are adulterated or misrepresented. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown. Persons who have adverse reactions to these club drugs are likely to consult a family physician. Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome. Severe drug reactions can occur even with a small dose and may require critical care. Club drug over-dose usually resolves with full recovery within seven hours. Education of the patient and family is essential.
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PMID:Club drugs: MDMA, gamma-hydroxybutyrate (GHB), Rohypnol, and ketamine. 1520 96

Methadone is a synthetic opioid, used both as an analgesic in severe pain relief and now mainly in the treatment of opiate dependence. Such use of the drug has increased as its advantages have become widely recognized. There are undesirable outcomes from its greater use, including a substantial market in diverted methadone and a high number of deaths where the drug has been implicated. It is important to understand how and why methadone causes death so that such fatalities can be minimized, and to disseminate such information. This paper presents an overview of the chief effects of methadone on the human body, considering its metabolism, drug interactions and tolerance. The principal mechanisms by which methadone causes death are discussed: respiratory depression, aspiration of vomit, pulmonary oedema, bronchopneumonia, cardiac problems and renal failure. Many such deaths are preventable, if drug interactions and polydrug use are avoided, its longer period of metabolism and individuals' tolerance levels are considered. It is hoped that this paper will (a) help guide health professionals in their management and treatment of patients participating in methadone treatment programmes, and (b) provide some basic information for those dealing with individuals who have consumed methadone.
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PMID:The effects of methadone and its role in fatalities. 1537 62

Drug prescription for geriatric patients is one of the most prevalent yet also one of the most difficult interventions in geriatrics. Although this article focuses solely on specific important aspects of geriatric pharmacotherapy, medication in clinical practice is only one type of geriatric intervention that needs to be embedded in a well-coordinated bundle of multidimensional interventions addressing functional and psychosocial aspects alike. Not every older patient is per se a geriatric patient, nor is each geriatric patient per se of very old age. Therefore, this article initially proposes a clinical definition of the geriatric patient before summarizing the most significant physiological age changes affecting pharmacokinetics and pharmacodynamics as well as summarizing the most prevalent risks associated with the age-correlated increase in multiple drug use in order to describe the background from which general principles of geriatric pharmacotherapy have evolved. The quality of geriatric pharmacotherapy must not only be determined by avoidance of any kind of over medication, but also by the avoidance of under medication as well as the avoidance of inappropriate drugs for elderly patients. Treatment failures do not only result from mere polypharmacy, but can also be due to under utilization of drugs as well as due to the prescription of inappropriate medications. In fact, the problem of under medication in certain age-correlated diseases (e. g. depression, dementia, pain) has rarely been addressed systematically in clinical or epidemiological studies until now. In order to improve quality and safety of geriatric pharmacotherapy, a group of experts in the field developed a set of explicit age-adjusted criteria for potentially inappropriate drugs in 1991. These criteria have been regularly updated thereafter until 2003 and focus on age-related aspects of specific drugs and dosages as well as on co-morbid states and co-medications. As long as geriatric patients are rarely included in clinical trials on drug effectiveness and drug safety, these criteria should be applied and used in clinical practice at least to identify any demand for a detailed explicit justification of a therapeutic decision not in line with the explicit criteria in order to enhance safety of drug treatment in geriatric patients.
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PMID:[Important aspects of geriatric pharmacotherapy]. 1588 71

This study examines motives for and consequences of MDMA use at different types of dance parties in the Netherlands (2001 and 2002). Participants were 490 visitors of three different types of rave parties, "club/mellow," "trance/mainstream," and "hardcore" (34% female, mean age 22.3 years, 76.5% MDMA users). Partygoers are motivated primarily by the energetic and euphoric effects they expect from MDMA. Quantity of MDMA use is associated with hardcore and trance/mainstream party style, with the motives of euphoria, sexiness, self-insight, and sociability/flirtatiousness (negative), and with gender, educational level (negative), and MDMA use by friends. Women report more (acute) negative effects--depression, confusion, loss of control, suspiciousness, edginess, nausea, dizziness--than men; and in particular, women who are motivated to cope with their problems by using MDMA are at risk. Men's polydrug use and notably their motivation to conform to friends by using MDMA are associated with negative effects.
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PMID:"Partying" hard: party style, motives for and effects of MDMA use at rave parties. 1604 29

A range of studies has indicated that users of 3.4-Methylene-dioxymethamphetamine (MDMA, 'Ecstasy') display cognitive deficits, particularly memory impairment, as compared to non-drug using controls. Yet it is difficult to determine whether these deficits are caused by MDMA or some other confounding factor, such as polydrug use. The present study was designed to establish the direct relation between MDMA and memory impairment under placebo-controlled conditions. Eighteen recreational MDMA users participated in a double blind, placebo controlled, 3-way crossover design. They were treated with placebo, MDMA 75mg and methylphenidate 20mg. Memory tests were conducted between 1.5-2h (intoxication phase) and between 25.5-26h (withdrawal phase) post dosing. Results showed that a single dose of MDMA caused impairment of immediate and delayed recall on a verbal learning task during the intoxication phase. However, there was no residual memory impairment during the withdrawal phase. Subjects reported more fatigue and less vigour, but no symptoms of depression during the withdrawal phase of MDMA treatment. Methylphenidate did not affect memory or mood at any time of testing. A single dose of MDMA produces transient memory impairment.
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PMID:Transient memory impairment after acute dose of 75mg 3.4-Methylene-dioxymethamphetamine. 1627 86

This study examines the nature, extent and consequences of prescription drug abuse among 143 ecstasy users in Miami. Participants were recruited through nightclub and college campus outreach, and through respondent referrals. Instrumentation included the Risk Behavior Assessment, Substance Abuse Module and Center for Epidemiological Studies Depression Scale. Median age was 23, 42% were female and 50% Hispanic. An arrest history was reported by 44%, and 33% reported prior drug/alcohol treatment. Prescription drug abuse was reported by 87%; alprazolam (57%), oxycodone (36%), hydrocodone (32%) and diazepam (30%) were cited most often. Prescription drug abusers were more likely to report polydrug use, drug treatment histories, risky drug use behaviors, and symptoms of depression. They also reported numerous physical, psychological and social consequences of prescription drug abuse. Additional studies among larger samples are needed to understand the processes of prescription drug access and the extent of integration in club drug using cultures.
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PMID:Prescription drug abuse among ecstasy users in Miami. 1636 53

This study examined the association between maternal cocaine use and maternal behavior and tested a conceptual model predicting maternal insensitivity during mother-infant interactions. Participants included 130 mother-infant dyads (68 cocaine-exposed and 62 non-cocaine-exposed) who were recruited after birth and assessed at 4-8 weeks of infant age. Results of model testing indicated that when the effects of prenatal cocaine use were examined in the context of polydrug use, maternal psychopathology, maternal childhood history, and infant birth weight, only postnatal cocaine use and maternal depression/anxiety were unique predictors of maternal insensitivity during mother-infant interactions.
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PMID:Conceptual model for maternal behavior among polydrug cocaine-using mothers: the role of postnatal cocaine use and maternal depression. 1653 60

The mortality and morbidity from heroin overdose have increased in the United States and internationally in the last decade. The lipid solubility allows the rapid deposition of heroin and its metabolites into the central nervous system and accounts for the "rush" experienced by users and for the toxicity. Risk factors for fatal and nonfatal heroin overdoses such as recent abstinence, decreased opiate tolerance, and polydrug use have been identified. Opiate substitution treatment such as methadone or buprenorphine is the only proven method of heroin overdose prevention. Death from a heroin overdose most commonly occurs 1 to 3 hours after injection at home in the company of other people. Numerous communities have taken advantage of this opportunity for treatment by implementing overdose prevention education to active heroin users, as well as prescribing naloxone for home use. Naloxone is a specific opiate antagonist without agonist properties or potential for abuse. It is inexpensive and nonscheduled and readily reverses the respiratory depression and sedation caused by heroin, as well as causing transient withdrawal symptoms. Program implementation considerations, legal ramifications, and research needs for prescription naloxone are discussed.
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PMID:Prescription naloxone: a novel approach to heroin overdose prevention. 1714 Nov 38


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