抗痛风药的合理应用

痛风作为一种常见的关节炎,发病率在逐年上升。不恰当的治疗可以造成慢性疼痛、肾功能不全以及关节破坏和畸形,从而影响患者的生活质量。治疗痛风的药物主要包括控制痛风急性发作期的药物和降尿酸的药物。作者结合临床经验及国内外痛风指南,对治疗痛风药物的疗效、安全性及合理用药作一综述。     

Addiction and the science of history

Aims To discuss the contributions historians have made to the addiction field, broadly construed to include licit and illicit drug use, drug policy, drug treatment and epidemiological and neuroscientific research. Methods Review of literature, highlighting specific contributions and controversies from recent research on the United States, the United Kingdom, China and world history. Findings and conclusions At the bar of addiction knowledge, historians make for excellent companions—until they turn quarrelsome. Historians' companionability arises from their ability to tell a particularly rich kind of story, one that blends structure, agency and contingency in a contextualizing narrative. Historians' occasional quarrelsomeness arises from their skepticism about the ascendant brain‐disease paradigm, the medical and pharmaceutical establishments and the drug war, especially in its US incarnation. These enterprises have put some historians in a polemical frame of mind, raising doubts about the objectivity of their work and questions about the political orientation of historical scholarship (and, more generally, of social science research) in the field.     

The Italian Association on Addiction Psychiatry (SIPDip), formerly The Italian Association on Abuse and Addictive Behaviours

The Italian Association on Addiction Psychiatry (SIPDip) is a special section of the Italian Psychiatric Association (SIP). It started, under the name of the Italian Association on Abuse and Addictive Behaviours (SICAD), in 1989 from the awareness that the addiction field had been starved of a psychiatrists' contribution since 1975. SIPDip aims to improve and implement study, clinical, research and educational topics about substance abuse and addictive behaviours. The National Board composition aims to provide an equal distribution of psychiatrists working in psychiatric and addiction facilities inside the National Health System, and private non-profit agencies. All psychiatrists and members of the Italian Psychiatric Association can become SIPDip ordinary members, while other health professionals working in psychiatric and addiction fields can become associate members. SIPDip has its National Congress every second year. In 2001 it promoted a network called the National Council of Addiction Disorders. It is recognized officially by the Drug Policy National Department and was created under the direct authority of the Prime Minister. In this, SIPDip is particularly involved in review groups relating to ethical issues, substitutive therapies and dual diagnosis. Furthermore, it organized the first Consensus Conference on Dual Diagnosis, under the sponsorship of the Italian Psychiatric Association. This was held in June 2003 to implement relevant national guidelines. The SIPDip main topics that will be addressed in the near future are: psychiatric comorbidity in substance related disorders; intervention efficacy assessment; and special populations and novel addictions. The National Board meeting on 15 December 2002 decided to submit to the General Assembly in April 2003, a motion to modify the Association's byelaws and to rename the organization 'The Italian Association of Addiction Psychiatry'.     

Stereotactic Neurosurgical Treatment of Drug Addiction

Background: Stereotactic neurosurgery is a well-developed and accepted treatment for movement disorders like Parkinson's disease. Objective: Review use of this neurosurgical intervention to treat drug addiction since the 1960s. Methods: Literature review of case and series reports. Results: Stereotactic neurosurgery has shown promising results in reducing drug addiction, but it has also caused severe side effects. Thus, surgeons have sought to refine the stereotactic lesion procedure and its target over the past 50 years. Conclusions and Significance: Recent developments in stereotactic technique and deep brain stimulation (DBS) may make stereotactic neurosurgery a viable and reversible treatment for drug addiction.     

Effect of Opium Addiction on Diabetes

Background: Type 2 diabetes is a common disorder that is recognized as a major health problem in Iran. Diabetes is a major cause of morbidity, mortality, and economic burden to the society. Some people believe that smoking opium can reduce serum glucose and lipids in diabetes mellitus. This study was designed to compare blood glucose and lipids in opium addicts with non-addicts among patients with type 2 diabetes. Methods: In this case, control study subjects were chosen from type 2 diabetic patients. Twenty-three males with type 2 diabetes and addicted to opium were selected as the case group, and 46 patients with no addiction to opioid drugs were chosen as control group. Blood Sugar (BS), glycated hemoglobin (HbA1C), lipids and microalbumin in urine were measured in two groups. Results: Our results showed that the mean FBS and 2-hour post prandial were significantly different between two groups. (P =. 04). No significant difference was observed in HbA1C, triglyceride, total cholesterol, LDL, and HDL between the two groups (P >. 05). Conclusions: Our finding showed that while opium might decrease blood glucose temporarily, it had no clear and long-lasting effects on blood glucose, as it had no significant effect on HbA1c.     

Development of the Modified Yale Food Addiction Scale Version 2.0

The Yale Food Addiction Scale (YFAS) operationalizes indicators of addictive‐like eating, originally based on the Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM‐IV‐TR) criteria for substance‐use disorders. The YFAS has multiple adaptations, including a briefer scale (mYFAS). Recently, the YFAS 2.0 was developed to reflect changes to diagnostic criteria in the DSM‐5. The current study developed a briefer version of the YFAS 2.0 (mYFAS 2.0) using the participant sample from the YFAS 2.0 validation paper (n = 536). Then, in an independent sample recruited from Mechanical Turk, 213 participants completed the mYFAS 2.0, YFAS 2.0, and measures of eating‐related constructs in order to evaluate the psychometric properties of the mYFAS 2.0, relative to the YFAS 2.0. The mYFAS 2.0 and YFAS 2.0 performed similarly on indexes of reliability, convergent validity with related constructs (e.g. weight cycling), discriminant validity with distinct measures (e.g. dietary restraint) and incremental validity evidenced by associations with frequency of binge eating beyond a measure of disinhibited eating. The mYFAS 2.0 may be an appropriate choice for studies prioritizing specificity when assessing for addictive‐like eating or when a briefer measurement of food addiction is needed. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Rational emotive occupational health coaching for quality of work-life among primary school administrators

Background:This study aimed at investigating the effect of rational emotive occupational health coaching on quality of work-life among primary school administrators.Method:This is a double blinded and randomized control design study. A total of 158 administrators were sampled, half of them were exposed to rational emotive occupational health treatment package that lasted for 12 sessions. Two self-report measures were utilized in assessing the participants using quality of work life scale. Data collected were analyzed using MANOVA statistical tool.Result:The results showed that rational emotive occupational health coaching is effective in improving perception of quality of work-life among public administrators. A follow-up result showed that rational emotive occupational health coaching had a significant effect on primary school administrators’ quality of work life.Conclusion:This study concluded rational emotive occupation health coaching is useful therapeutic strategy in improving quality of work of primary school administrators, hence, future researchers and clinical practitioners should adopt cognitive-behavioral techniques and principles in helping employers as well as employees. Based on the primary findings and limitations of this study, future studies, occupational psychotherapists should qualitatively explore the clinical relevance of rational emotive occupational health practice across cultures using different populations     

Pharmacogenetic Treatments for Drug Addiction: Cocaine,Amphetamine and Methamphetamine

Background: Pharmacogenetics uses genetic variation to predict individual differences in response to medications and holds much promise to improve treatment of addictive disorders. Objectives: To review how genetic variation affects responses to cocaine, amphetamine, and methamphetamine and how this information may guide pharmacotherapy. Methods: We performed a cross-referenced literature search on pharmacogenetics, cocaine, amphetamine, and methamphetamine. Results: We describe functional genetic variants for enzymes dopamine-beta-hydroxylase (DβH), catechol-O-methyltransferase (COMT), and dopamine transporter (DAT1), dopamine D4 receptor, and brain-derived neurotrophic factor (BDNF). A single nucleotide polymorphism (SNP; C-1021T) in the DβH gene is relevant to paranoia associated with disulfiram pharmacotherapy for cocaine addiction. Individuals with variable number tandem repeats (VNTR) of the SLC6A3 gene 3′-untranslated region polymorphism of DAT1 have altered responses to drugs. The 10/10 repeat respond poorly to methylphenidate pharmacotherapy and the 9/9 DAT1 variant show blunted euphoria and physiological response to amphetamine. COMT, D4 receptor, and BDNF polymorphisms are linked to methamphetamine abuse and psychosis. Conclusions: Disulfiram and methylphenidate pharmacotherapies for cocaine addiction are optimized by considering polymorphisms affecting DβH and DAT1 respectively. Altered subjective effects for amphetamine in DAT1 VNTR variants suggest a ‘protected’ phenotype. Scientific Significance: Pharmacogenetic-based treatments for psychostimulant addiction are critical for successful treatment.     

The diagnosis of drug dependence by primary care providers

HIV infection cannot be treated nor can its spread among those who use drugs be contained unless physicians diagnose and treat drug dependence. Recent changes in the DSM-III definitions simplify diagnosis. It is primarily by the presence and extent of the dependence syndrome that decisions are made regarding early HIV counseling and testing, medical management, referral for drug dependence treatment, and the approach to minimizing disease spread by the patient. Received from the Division of General Medicine, Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457.     

Addiction Research Centres and the Nurturing of Creativity. RAND's Drug Policy Research Center

In September 1989, amid an emotional and ideological debate regarding problematic drug use in the United States and the ‘war on drugs’, RAND's Drug Policy Research Center (DPRC) was created through private foundation funds. The purpose of this new research center was to provide objective empirical analysis on which to base sound drug policy. Twenty years later, RAND's DPRC continues its work, drawing on a broad range of analytical expertise to evaluate, compare and assess the effectiveness of a similarly broad range of drug policies. More than 60 affiliated researchers in the United States and Europe make up the Center, which attempts to provide objective empirical analyses to better inform drug policies within the United States and abroad. This paper provides a look back at the creation, evolution and growth of the Center. It then describes how the Center operates today and how it has maintained its clear identity and focus by drawing on the analytical capabilities of a talented group of researchers from a broad range of academic disciplines.     

Feasibility and Usefulness of the Peer-Run Course “Recovery Is Up to You” for People with Addiction Problems: A Qualitative Study

“Recovery Is Up to You,” a 12-week peer-run group experience for persons with major psychiatric problems, has had positive effects on important elements of recovery: empowerment, hope, and self-efficacy beliefs. Determining if such an experience would be equally efficacious for persons with addiction problems is the focus of this study. The 12-week course was experienced by eight groups of persons with addiction problems and the outcome, measured in terms of the response of participants and of the group leaders, was a favorable one as the course was found to be supportive of the recovery process, providing the participants and peer group leaders alike with new perspectives on meaningful living.     

A Realist Evaluation of a Community-Based Addiction Program for Urban Aboriginal People

The current project conducted an evaluation of a community-based addiction program in Ontario, Canada, using a realist approach. Client-targeted focus groups and staff questionnaires were conducted to develop preliminary theories regarding how, for whom, and under what circumstances the program helps or does not help clients. Individual interviews were then conducted with clients and caseworkers to refine these theories. Psychological mechanisms through which clients achieved their goals were related to client needs, trust, cultural beliefs, willingness, self-awareness, and self-efficacy. Client, staff, and setting characteristics were found to affect the development of mechanisms and outcomes.     

Becker's rational addiction theory: An empirical test with price elasticities for distilled spirits in Denmark 1911-31

AIM: To test an implication of Becker's rational addiction theory, namely that price changes will lead both to simultaneous consumption changes as well as lagged changes (and potentially also immediate changes if future changes in prices are anticipated). DESIGN: Time-series analysis, first of aggregate sales of distilled spirits and prices, controlled for gross national product (GNP), and secondly of deaths from delirium tremens. SETTING: Denmark 1911-31. Price changes were very large in the period 1916-18 due to shortages during World War I, and the Danish case can be conceived as a natural experiment. FINDINGS: No evidence for lagged price effects in the expected direction was found. On the contrary, the evidence pointed in the opposite direction. The immediate reduction in sales following rising prices are, to some degree, counteracted by an adjustment in the opposite direction the following year. The delirium tremens data confirm this pattern. CONCLUSION: Becker's theory is not confirmed. Several possible explanations are discussed. If the pattern observed in these data is representative of a more general mechanism, current price elasticity estimates may be too high, by ignoring lagged compensatory effects.     

The oratory of addiction: a 30-year perspective on alcohol and drug misuse

The annual Leonard Ball Orations illustrate changing perspectives in Australia over 30 years on medical and social effects of misuse of alcohol and other substances. The first oration, in 1968, examined causal factors in the context of 'agent', 'purveyor' and 'host' and provided themes for subsequent orators. In regard to the agent (alcohol), it was proposed that availability (and cost) determined not only overall consumption within the community, but also numbers of users at hazardous levels. This principle seemed applicable to substance misuse and addictive behaviours overall. The influence of purveyors (and advertisers) was discussed with expectedly different perspectives from the liquor industry and social and health-care providers. The role of host was examined in terms of genetic predisposition, foreshadowing current experimental applications of gene transfer and disruption technologies in mice to substance misuse and the promise of the Human Genome Project in clarifying inheritance of substance misuse. Individual successes in harm reduction were described in the context of alcohol and road trauma, smoking prevention and heroin addiction. Government intervention was introduced with the 1987 National Campaign Against Drug Abuse. The focus shifted during the 1980s from alcohol to addictive drugs, in line with community concerns. The 1996 oration on the aborted Canberra trial of supervised heroin administration illustrated the need for, and problems associated with, such studies. The prescience and achievements of the Ball orators provide optimism and direction for efforts in the future.     

Body Psychotherapy Activates Long-Term Recovery from Addiction: Anatomy of a Resentment

Older paradigms in addiction research equated abstinence with recovery. Current literature focuses on systems and relationships to support long-term recovery. This article investigates literature on long-term recovery, the gap in resentment deactivation, and utilizing body psychotherapy to boost clinical treatment of long-term recovery. A theoretical foundation is presented for the model, Anatomy of a Resentment, in which the structure of resentments is examined using cognitive and somatic techniques. The prototype is offered as a clinical tool to bridge cessation of use with long-term recovery and reignite adult development, scaffolding increased quality of life for individuals in long-term recovery from addictions.     

Direct involvement of sigma-1 receptors in the dopamine D1 receptor-mediated effects of cocaine

It is well known that cocaine blocks the dopamine transporter. This mechanism should lead to a general increase in dopaminergic neurotransmission, and yet dopamine D(1) receptors (D(1)Rs) play a more significant role in the behavioral effects of cocaine than the other dopamine receptor subtypes. Cocaine also binds to σ-1 receptors, the physiological role of which is largely unknown. In the present study, D(1)R and σ(1)R were found to heteromerize in transfected cells, where cocaine robustly potentiated D(1)R-mediated adenylyl cyclase activation, induced MAPK activation per se and counteracted MAPK activation induced by D(1)R stimulation in a dopamine transporter-independent and σ(1)R-dependent manner. Some of these effects were also demonstrated in murine striatal slices and were absent in σ(1)R KO mice, providing evidence for the existence of σ(1)R-D(1)R heteromers in the brain. Therefore, these results provide a molecular explanation for which D(1)R plays a more significant role in the behavioral effects of cocaine, through σ(1)R-D(1)R heteromerization, and provide a unique perspective toward understanding the molecular basis of cocaine addiction.