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Objective:Abuse of psychoactive drugs for therapeutic purposes is becoming more common due to their addiction potential. In many studies, quetiapine has been reported to be abused with illicit drugs. We aimed to point to the abuse and addiction potential of quetiapine by the rates of quetiapine abuse in blood samples of 4,293 cases who came to our Forensic Toxicology Laboratory by using liquid chromatography-tandem mass spectrometry method.Methods:All cases who were caught by law enforcement officers while using or trading drugs as a requirement of the judicial process initiated were drug users or dealers and then they were brought to our forensic toxicology laboratory to obtain blood and urine samples. Quantification in blood samples was performed in routine laboratory analysis. The cases were asked whether they used any prescription drugs. The therapeutic drug users were excluded in this study.Results:Quetiapine was positive in 50 of 4,293 cases (1.16%). 93.8% (n=4028) of all cases and all of the positive quetiapine were male. While quetiapine was used alone in 11 of 50 cases with quetiapine positivity, quetiapine was used simultaneously with one or more groups of illicit drugs in the remaining 39 cases.Conclusion:In this study, the most common use of cannabis and quetiapine was determined in cases with drugs of abuse. The monitoring of quetiapine is essential for preventing drug abuse especially in prone population such as illicit drug abusers and addicts. Forensic Toxicology Laboratories play an important role in taking necessary preventions related to drug abuse.

Introduction: Psychoactive drug is a worrisome and emerging global problem. This is a disturbing matter, especially in the case of medical students, as it affects not only their health and academic performance alone but their clinical efficiency as well. This study aims to determine the prevalence of psychoactive drug use among medical students in a medical college in Nepal. Methods: A descriptive cross-sectional study was conducted after receiving ethical clearance from the Institutional Review Committee (Ref: 258/19) among undergraduate medical students from December 2019 to June 2020. Convenience sampling was used to collect data. Data analysis was done in the Statistical Package for Social Sciences. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: The prevalence of psychoactive drug abuse was found to be 76 (44.2%) [CI= 43.6%–44.8%]. The study showed males 59 (59%) were more indulged in abuse than females 17 (23.6%). Alcohol 72 (41.86%) was the most commonly used, then was tobacco 24 (13.95%) followed by cannabis 17(9.88%). Only two students were sedative and opioid abusers. Pleasure 38 (31.70%) and experimentation 29 (24.20%) were the two major causes of substance abuse. Tobacco was used more frequently 14 (58.33%) used daily and found to have more financialand health-related issues in the last three months. Conclusions: Even almost half of the students were using some form of psychoactive drugs, the majority of them were occasional users. Proper counseling needs to be done to address this problem. Further study should be conducted to address the influencing factors and adverse outcomes.

Antidepressants, antiepileptics, mood stabilizers, and antipsychotics are extremely broadly used psychoactive drugs. These drug terms are universally used in the literature. However, the indications of these drugs have broadened substantially and overlap. The mismatch between drug classification and clinical uses causes a lot of confusion in communication and renders literature searches increasingly difficult. Therefore, we propose to drop the above terms altogether and replace them by simple mechanistic terms. Antidepressants are re-named as norepinephrine/serotonin (NE/5-HT) enhancers, antiepileptics comprising drugs with different mechanisms become neuronal inhibitors with pleiotropic effects (NIPEs), and antipsychotics become antagonists at multiple G protein–coupled receptors (mGPCR antagonists). Alkali metal ions, comprising lithium, are integrated into NIPEs. The terms “typical/first-generation/conventional” and “atypical/second-generation/non-conventional” antipsychotics should be dropped, because the original criterion for distinction, i.e., the presence and absence of extrapyramidal motor effects, respectively, is not valid anymore. The suggested changes in drug nomenclature have already been implemented into a recent textbook (Seifert R, Basic Knowledge of Pharmacology). The revised nomenclature ensures consistency with other fields of pharmacology and assignment of drug classes to indications without causing confusion. The authors acknowledge that the change in drug nomenclature is a cultural process that will take time and openly discuss the problems associated with the proposal. Ultimately, international learned societies will have to agree on a new nomenclature. Electronic supplementary material The online version of this article (10.1007/s00210-020-01918-x) contains supplementary material, which is available to authorized users.

OBJECTIVE: Data on the relationship between fall and psychoactive drug use among Turkish older people are limited. This study aims to investigate the prevalence of falls and the associations between psychoactive drug use and falls in community-dwelling Turkish older people. METHODS: This single center study was performed using the medical records of subjects aged over 65 years admitted to the geriatric care unit. Demographic and lifestyle factors, clinical characteristics, medications, and data on mood, cognitive status, and functional performance were obtained from the comprehensive geriatric assessment records. Based on a fall history in the last 12 months, subjects were grouped as fallers and non-fallers. Subjects treated with a psychoactive drug were identified. RESULTS: Among the total of 429 subjects, there were 184 (42.9%) fallers and 245 (57.1%) non-fallers. Of those, 33.3% were on psychoactive drug treatment. The proportion of psychoactive drug users was higher in the fallers group compared to non-fallers (45.1% vs. 24.5%, p

Determination of psychoactive substances (PAS) and/or their metabolites in surface waters is crucial for environmental risk assessment, and disclosure of their enantiomeric fractions (EF) allows discrimination between consumption, direct disposal, and synthesis pathways. The aim of this study was to develop and validate an indirect method by gas chromatography coupled to mass spectrometry (GC–MS) based on derivatization using (R)-(−)-α-methoxy-α-(trifluoromethyl) phenylacetyl chloride as chiral derivatization reagent, for enantiomeric quantification of amphetamine (AMP), methamphetamine (MAMP), 3,4-methylenedioxymethamphetamine (MDMA), norketamine, buphedrone (BPD), butylone, 3,4-dimethylmethcathinone (3,4-DMMC), 3-methylmethcathinone, and quantification of 1-benzylpiperazine and 1-(4-metoxyphenyl)-piperazine. The method allowed to evaluate the occurrence, spatial distribution, and the EF of the target chiral PAS in Portuguese surface waters and in effluents from 2 wastewater treatment plants (WWTP). For that, water samples were pre-concentrated by solid phase extraction using OASIS® MCX cartridges, derivatized and further analyzed by GC–MS. Both enantiomers of AMP, (R)-MDMA, (S)-MAMP, and the first eluted enantiomer of BPD (configuration not assigned) were found in surface waters, while effluent samples showed both enantiomers of MDMA, (S)-MAMP, (R)-AMP, and the first eluted enantiomer of BPD and 3,4-DMMC. According to our knowledge, this is the first multiresidue analytical method by CG–MS enrolling cathinones, amphetamines, and piperazines. The presence of illicit synthetic cathinones in Douro River estuary is here reported for the first time, along with other amphetamine derivatives. The potential of the method to monitor consumption of the target PAS was demonstrated.

Cannabis products (marijuana, weed, hashish) are among the most widely abused psychoactive drugs in the world, due to their euphorigenic and anxiolytic properties. Recently, hair analysis is of great interest in analytical, clinical, and forensic sciences due to its non-invasiveness, negligible risk of infection and tampering, facile storage, and a wider window of detection. Hair analysis is now widely accepted as evidence in courts around the world. Hair analysis is very feasible to complement saliva, blood tests, and urinalysis. In this review, we have focused on state of the art in hair analysis of cannabis with particular attention to hair sample preparation for cannabis analysis involving pulverization, extraction and screening techniques followed by confirmatory tests (e.g., GC–MS and LC–MS/MS). We have reviewed the literature for the past 10 years’ period with special emphasis on cannabis quantification using mass spectrometry. The pros and cons of all the published methods have also been discussed along with the prospective future of cannabis analysis.

The objective of the study : to assess the risk to develop active tuberculosis in HIV infected patients with history of substance abuse taking into account their CD4 count. Subjects and methods . A retrospective case-control study was conducted with enrollment of 171 patients: HIV Group included 85 persons, while TB/HIV Group – 86 persons. For screening for chronic alcohol/narcotic intoxication, the CAGE questionnaire was used, and tobacco dependence was detected according to the criteria of World Health Organization. CD4 counts were obtained by the retrospective analysis of medical records. The impact of the studied risk factors on the development of tuberculosis was estimated by calculating the odds ratio with the calculation of the 95% confidence interval. Results. Statistically significant association with the development of active tuberculosis was obtained for all factors studied (tobacco smoking: OR = 8.7, 95% CI 3.6-21.6, p = 0.01; chronic alcohol and narcotic intoxication: OR = 3.5, 95% CI 1.8-6.5, p = 0.001 and OR = 2.5, 95% CI 1.1-5.4, p = 0.026, respectively). In the group of patients with CD4 count above 200 cells/µL, there was a confident effect of smoking and clinically significant substance abuse on the risk to develop active tuberculosis, and the power of their effect increased: for tobacco smoking OR = 12; 95% CI 1,5-98,7, p = 0.012; for drug abuse, OR = 4.8, 95% CI 1.7-13.4, p = 0.002. The tendency of chronic alcohol intoxication providing impact on the risk to develop tuberculosis in patients with CD4 count above 200 cells/ μ l persisted, but there was no statistically significant relationship in calculating the odds ratio OR = 3.1, 95% CI 3.1–9.6, p = 0.082. The obtained data allow considering people living with HIV and possessing history of substance abuse as a group facing the high risk to develop tuberculosis in need close follow-up aimed to prevent tuberculosis.

Background: Prurigo nodularis (PN) is a chronic refractory itchy dermatosis. Although psychiatric comorbidity is known, research in cognitive impairment is lacking. We evaluated the occurrence and types of cognitive impairment in a series of inpatients with PN. Methods: This was a retrospective chart review of all the patients with PN admitted to a referral neurological institute from September 2018 to March 2021. Any neurological and psychiatric disorder, along with neuroactive drugs taken, were concomitantly assessed. Results: A total of 16 patients with PN (median age: 70 years, two males) were selected from a total of 1806 hospital admissions. Most of them had a neurodegenerative cognitive disorder, from mild cognitive impairment (8) to Alzheimer’s disease (1), followed by mixed disorder (degenerative and vascular) in six and vascular dementia in one. Comorbid psychiatric diseases (anxiety and depression) were more common than either individual condition, followed by bipolar disorder, whereas two patients did not show psychiatric manifestations. Most patients were on combined treatment with benzodiazepines and antidepressants. Conclusion: Cognitive impairment can be observed in PN. In addition to screening for psychiatric comorbidity and initiating appropriate treatment or referral, clinicians may also consider the presence of cognitive impairment in PN of both degenerative and vascular origin.

Predator‐inducible defenses constitute a widespread form of adaptive phenotypic plasticity, and such defenses have recently been suggested linked with the neuroendocrine system. The neuroendocrine system is a target of endocrine disruptors, such as psychoactive pharmaceuticals, which are common aquatic contaminants. We hypothesized that exposure to an antidepressant pollutant, fluoxetine, influences the physiological stress response in our model species, crucian carp, affecting its behavioral and morphological responses to predation threat. We examined short‐ and long‐term effects of fluoxetine and predator exposure on behavior and morphology in crucian carp. Seventeen days of exposure to a high dose of fluoxetine (100 µg/L) resulted in a shyer phenotype, regardless of the presence/absence of a pike predator, but this effect disappeared after long‐term exposure. Fluoxetine effects on morphological plasticity were context‐dependent as a low dose (1 µg/L) only influenced crucian carp body shape in pike presence. A high dose of fluoxetine strongly influenced body shape regardless of predator treatment. Our results highlight that environmental pollution by pharmaceuticals could disrupt physiological regulation of ecologically important inducible defenses., We examined short‐ and long‐term effects of fluoxetine on the anti‐predator phenotype in crucian carp. We found effects of fluoxetine on both behaviour and body shape, highlighting both proximate mechanism behind external defence regulation but also that environmental pollution by pharmaceuticals could disrupt physiological regulation of ecologically important inducible defences.

Individuals who use anabolic-androgenic steroids (AAS) may engage in concurrent psychoactive drug use recreationally and/or as an additional training aid. Aside from cannabis, individuals who use AAS most commonly report concurrent use of stimulants such as amphetamines and cocaine. In this study, we examine demographic characteristics, frequency of heavy drinking, and nightclubbing in a sample of 993 men from the Global Drug Survey 2015 who reported both AAS and psychoactive drug use before exploring the relationship between motivation for AAS use and the propensity to concurrently engage with stimulant-type substances. Results of a logistic regression analysis suggest that the propensity for concurrent use of AAS and stimulants is greater when AAS use is motivated by weight loss goals, while performance goals are associated with reduced odds of concurrent stimulant use. Identifying individuals who are at risk of polydrug use and associated harms can inform targeted harm reduction strategies.

BackgroundHuman aging is a universal and regular process characterized by uneven and steady progression, inevitably affecting to some extent all levels of biological organization. In the structure of acute exotoxicosis, patients of gerontological age range from 10.3 to 12.9%. After 60, with an increase of years, there is a growth of mortality rate from 9.8% in elderly patients to 25.5% in long-livers. A certain role in its genesis is played by the premorbid background, i.e. somatic diseases preceding and accompanying acute exotoxicosis.Aim of studyTo identify the role of concomitant diseases in the course and outcome of acute poisoning by psychoactive drugs in patients over 60. MATErIALS AnD METhODS We retrospectively analyzed hospital records of 99 patients aged 60 to 90 years who died from poisoning with psychoactive drugs at the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2013–2016, as well as their autopsy, forensic and histological research data.ResultsIn gerontological patients with acute poisoning with psychoactive drugs, the main premorbid background (100%) is atherosclerotic lesion of the heart and vessels of different degree and extent. In case of lethal outcomes, in toxicogenic stage of poisoning on primary electrocardiograms, myocardial ischemia was revealed in 76.9% of cases, heart rhythm disturbances were detected in all patients, most often in the form of supraventricular extrasystoles (38.4%) and atrial fibrillation (23.1%). In the deceased patients during the somatogenic stage of poisoning, cardiac conduction disorders (31.3%) prevailed. Concomitant chronic lesions of the bronchopulmonary system, including terminal bronchi, contributed to the development of hypostatic pneumonia and its long, migratory course. In 50% of cases, large and small droplet fatty liver disease was detected, which could have a negative effect on the course of poisoning, altering biotransformation of toxicants.ConclusionAtherosclerotic lesion of the heart and vessels, as well as chronic bronchopulmonary disease and fatty liver disease are the main premorbid background factors, which have a negative effect on the course and outcome of acute poisoning with psychoactive drugs.

BACKGROUND: People have been using psychoactive substances for a long time. Over the last few years, this practice has spread among university students, who use these substances to improve their academic performance, relieve stress and increase concentration and memory. OBJECTIVES: To estimate the use of psychoactive drugs among healthcare students at a higher education institution in the city of Passo Fundo (RS), Brazil, and to ascertain the associated demographic and lifestyle factors. DESIGN AND SETTING: Cross-sectional study in a higher education institution. METHODS: We included 287 undergraduate medicine and dentistry students in this study. They answered a self-administered questionnaire regarding sociodemographic, lifestyle and health variables. The statistical analysis used univariate and bivariate analyses with Pearson’s chi-square test (P-value < 0.05). ­Multivariate analyses were used to estimate odds ratios (OR) and their respective 95% confidence intervals. The SPSS software, version 20.0, was used. RESULTS: The prevalence of use of psychoactive substances among the students was 24.7%. Among these students, high frequencies of psychoactive drugs had been prescribed by physicians (95.8%) and for the purpose of relaxation or stress relief (73.2%). Women, medical students (compared with dental students) and participants with lower academic performance were more likely to use psychoactive drugs. After the multivariate adjustment, the “course” and “academic performance” remained associated with use of psychoactive drugs. CONCLUSION: There was high prevalence of psychoactive drug use among the students at the higher education institution investigated. Some variables (female sex, medical students and low academic performance) were associated with the outcome.

“Plants of the Gods” is a term referring to the religious meaning members of many primitive cultures worldwide attribute to plants containing hallucinogenic or mind-altering substances. The plants are customarily considered sacred and consumed in religious rituals in an attempt to reach and communicate with gods or revered ancestors. They are frequently used in healing rites. Occasionally, they are used for purely recreational purposes, this being their main use in the modern societies of both industrialized and underdeveloped nations. However, it must be noted that the hallucinogenic or psychedelic experiences, recreational, are not always euphoric. Plants of the Gods: Their Sacred, Healing, and Hallucinogenic Powers is well-written, fully illustrated with color photographs, and contains a good index. It is an effective compilation of ethnographic, historic, and neuropharmacologic information on the hallucinogenic plants of planet Earth and the psychological and sociological impact they have, particularly in primitive societies. The behavioral side effects and toxic manifestations that may be associated with transient or permanent neurological deficits or psychiatric conditions place them in the realm of neuropsychiatry, when affected individuals present to the emergency room or are referred for medical consultation.

This study reports on the prevalence and demographic correlates of substance use among individuals with mental illness in the Eastern Cape, South Africa. This cross-sectional study was conducted in the Outpatient Clinic of a large hospital in the Eastern Cape, South Africa. A pre-validated tool on alcohol and psychoactive drug use was administered to 390 individuals with mental illness. Multivariable logistic regression models were fitted to explore the demographic correlates of alcohol and psychoactive drug use. Of the total participants (N = 390), 64.4% and 33.3% reported lifetime (ever used) and past-year use of alcohol, respectively, but the prevalence of risky alcohol use was 18.5%. After adjusting for relevant covariates, only male sex, younger age, and rural residence remained significantly associated with risky alcohol use. The prevalence of ever-use and past-year use of psychoactive substances was 39.7% and 17.4%, respectively. The most common substance ever used was cannabis (37.4%). Male sex, younger age, owning a business, and being unemployed were significantly associated with higher odds of lifetime and past-year use of psychoactive substances. Findings highlight the need for dedicated infrastructure and staff training in the management of these dual diagnoses in the region.

Simple Summary The majority of dogs and cats are fearful during veterinary visits, and some individuals may show aggression as a result. We review ways to avoid negative experiences and promote positive emotions in animals visiting the veterinarian. Whenever an animal is in the practice, the veterinary team should endeavour to make the visit as pleasant as possible, by using non-threatening body language and by creating positive associations. High-value food (unless an animal needs to be fasted) or toys should be used generously throughout the visit. In the interaction with the animals, low-stress handling methods, brief pauses and adjusting the procedure based on the animal’s body language help them to feel secure. Distractions can be used to minimise perceived pain such as from injections. If a known painful area needs to be treated, pain killers are advised. For animals that are very fearful, several medication options are available that can be given prior to the veterinary visit to help them with their fears. With reward-based training, animals can learn to accept veterinary procedures. A stress-free veterinary visit benefits all involved parties—the animals, their owners, as well as the veterinary team. Abstract A high proportion of dogs and cats are fearful during veterinary visits, which in some cases may escalate into aggression. Here, we discuss factors that contribute to negative emotions in a veterinary setting and how these can be addressed. We briefly summarise the available evidence for the interventions discussed. The set-up of the waiting area (e.g., spatial dividers; elevated places for cat carriers), tailoring the examination and the treatment to the individual, considerate handling (minimal restraint when possible, avoiding leaning over or cornering animals) and offering high-value food or toys throughout the visit can promote security and, ideally, positive associations. Desensitisation and counterconditioning are highly recommended, both to prevent and address existing negative emotions. Short-term pain from injections can be minimised by using tactile and cognitive distractions and topical analgesics, which are also indicated for painful procedures such as ear cleanings. Recommendations for handling fearful animals to minimise aggressive responses are discussed. However, anxiolytics or sedation should be used whenever there is a risk of traumatising an animal or for safety reasons. Stress-reducing measures can decrease fear and stress in patients and consequently their owners, thus strengthening the relationship with the clients as well as increasing the professional satisfaction of veterinary staff.

OBJECTIVE: Investigate whether the use of psychoactive drugs would be a predictor of incidence of functional disability among seniors living in community. METHODS: It is a population-based longitudinal study, developed between January 1, 1997 and December 31, 2011, with older adults living in community. The association between the use of psychoactive drugs and the development of functional disability for instrumental (IADLs) and basic (BADLs) activities of daily living was tested using the extended Cox proportional hazards model, which considers the measure of exposure of interest throughout the follow-up period. The analyses were stratified by sex and adjusted by sociodemographic characteristics, health behavior and health conditions. RESULTS: After multivariate adjustment, the use of two or more psychoactive drugs in the female stratum was associated with disability for both IADLs (HR = 1.58; 95%CI 1.17–2.13) and BADLs (HR = 1.43; 95%CI 1.05–1.94), the use of benzodiazepines was associated with disability for IADLs (HR = 1.32; 95%CI 1.07–1.62), and the use of antidepressants was associated with disability for both IADLs (HR = 1.51; 95%CI 1.16–1.98) and BADLs (HR = 1.44; 95%CI 1.10–1.90). In the male stratum, the use of antipsychotics was associated with disability for IADLs (HR = 3.14; 95%CI 1.49–6.59). CONCLUSIONS: The study showed a prospective association between the use of psychoactive drugs and functional disability. These results indicate the need to carefully assess the prescription of psychoactive drugs for older adults and monitor their usage in order to detect damages to the health of users.

The use of behavior modifying drugs may be considered in birds with behavior problems, especially those refractory to behavior modification therapy and environmental management. To accomplish behavior change, a variety of drugs can be used, including psychoactive drugs, hormones, antihistamines, analgesics, and anticonvulsants. Because their prescription to birds is off-label, these drugs are considered appropriate only when a sound rationale can be provided for their use. This requires a (correct) behavioral diagnosis to be established. In addition, regular monitoring and follow-up are warranted to determine the efficacy of the treatment and evaluate the occurrence of potential adverse side effects.

Tina Hovgaard Lützen,1 Bodil Hammer Bech,2 Jesper Mehlsen,3 Claus Høstrup Vestergaard,1 Lene Wulff Krogsgaard,1 Jørn Olsen,4 Mogens Vestergaard,1 Oleguer Plana-Ripoll,5 Dorte Rytter2 1Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark; 2Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark; 3Coordinating Research Centre, Frederiksberg Hospital, Frederiksberg, Denmark, 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark; 5National Center for Register-based Research, Aarhus University, Aarhus V, Denmark Aim: No association between human papilloma virus (HPV) vaccination and numerous diseases has been found. Still, a large number of Danish women are reporting suspected adverse events. Other factors may play a role, and the aim of this study is to examine the association between psychiatric conditions, general practitioner (GP) attendance and indicators of psychological symptoms prior to HPV vaccination and the risk of referral to an HPV center following vaccination. Study design and setting: Register-based, matched case–control study. Cases were identified from five Danish, regional HPV centers, and health data for cases and controls were obtained from national registries. Participants: Cases were defined as women referred to an HPV center between January 1, 2015 and December 31, 2015 (n=1,496). Each case was matched with five controls on age, region and time of first vaccine registration. The total study population consisted of 8,976 women. Results: Overall, women above 18 years who had been referred to an HPV center were more likely to have used psychiatric medication (odds ratio [OR]: 1.88 [95% CI 1.48–2.40]) or to have been hospitalized because of a psychiatric disorder within 5 years prior to the first vaccine registration (OR: 2.13 [95% CI 1.59–2.86]). Specifically, referred women were more likely to have used antipsychotics, antidepressants, attention deficit hyperactivity disorder (ADHD) medication or anxiolytics, and to have been hospitalized for affective disorders or anxiety, but not to have been hospitalized for schizoid, ADHD or eating disorders. In addition, they were more likely to have had talk therapy or psychometric test performed prior to vaccination (OR: 1.72 [95% CI 0.1.35–2.18] and OR: 1.67 [95% CI 1.30–2.13], respectively). Referred women of all ages had higher use of GP before vaccination. Population attributable fraction analyses indicated that psychiatric medication, hospitalization due to a psychiatric disorder and use of talk therapy, or psychometric test “explained” 13%, 10%, 12% and 11% of the referrals, respectively. Results did not change substantially when adjusted for potential confounders. Conclusion: Women referred to HPV centers because of suspected adverse events after vaccination more often had preexisting psychiatric conditions, psychological symptoms or frequent GP attendance prior to HPV vaccination. Keywords: papillomavirus vaccines, adverse drug events, psychoactive drugs, general practice

The aim of this study was to summarise the scientific evidence on the prevalence of psychoactive substance use and on the factors associated with their intake among truck drivers. A systematic review was performed in the databases PubMed, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, and Cochrane and 36 cross-sectional studies were identified with quantitative results about the use of psychoactive substances by truck drivers. Out of these, 28 were carried out in countries with large land areas and 23 obtained their information through self-reporting. The most frequently studied substances were alcohol (n=25), amphetamines (n=17), marijuana (n=16) and cocaine (n=13). The prevalence of the use of these substances greatly varied: alcohol (0.1–91.0%); amphetamines (0.2–82.5%), marijuana (0.2–29.9%), cocaine (0.1–8.3%). The frequency of substance use was lower in studies that investigated the presence of these substances in biological samples than in those based on self-reported use. In 12 studies that evaluated factors associated with the intake of psychoactive substances, the following stood out: younger age, higher income, longer trips, alcohol consumption, driving in the night shift, travelling interstate routes, long or short sleep, fewer hours of rest, little experience of the driver, connection with small and medium sized companies, income below levels determined by labour agreements, productivity-based earnings and prior involvement in accidents. The frequency of psychoactive substance use by truck drivers seems to be high, although that greatly varies according to the type of substance and the method of collecting the information. The use of these substances was mainly associated with indicators of poor working conditions.

Objetivo: Caracterizar os comportamentos de risco face ao consumo de substâncias psicoativas numa população juvenil da cidade de Lisboa Método: Estudo observacional, descritivo, transversal. Os participantes foram 113 crianças e jovens que responderam à versão portuguesa do Questionário de Comportamento de Risco e Saúde - Youth Risk Behavior Survey. Resultados: Os participantes no que se refere à idade estavam entre os 9-13, a maioria frequentava o 5º ano de escolaridade, vivia com os pais, tinha bom aproveitamento escolar, boa relação com colegas embora ¼ referira problemas. Quando preocupados, recorrem à mãe, mas é significativa a atenção dos pares. Quanto à experimentação de substâncias psicoativas apurou-se: tabaco 9,7%, álcool 19,5%, outras substâncias 5,3%. Conclusão: No que se refere aos comportamentos de risco destaca-se principalmente a experimentação precoce de álcool. Emergiram como fatores protetores: relação familiar e relação com o espaço escola. Esta faixa etária pode constituir-se o momento ideal para a prevenção., Objective: To characterize the risk behavior of the psychoactive substances use in a youth population of Lisbon. Method: An observational, descriptive, cross-sectional study. Participants were 113 children and young people who responded to the Portuguese version of the Risk and Health Behavior questionnaire - Youth Risk Behavior Survey. Results: Participants with regard to age were between 9-13, most attending the 5th grade, living with parents, had good school performance, good relationship with colleagues while 1/4 refer problems. When concerned, recourse to the mother, but it is significant the attention of peers. As for the trial of psychoactive substances was found: 9.7% tobacco, 19.5% alcohol, other substances 5.3%. Conclusion: With regard to risk behavior stands primarily to early alcohol testing. Emerged as protective factors: family relationship and relationship with the school space. This age group may constitute the ideal time for prevention.

This is the Author’s Accepted Manuscript of the following article: I. Carpinteiro, R. Rodil, J.B. Quintana, R. Cela. Reaction of diazepam and related benzodiazepines with chlorine. Kinetics, transformation products and in-silico toxicological assessment Water Research 120 (2017) 280-289 with DOI: 10.1016/j.watres.2017.04.063 © Elsevier 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license In this work, the reaction of four benzodiazepines (diazepam, oxazepam, nordazepam and temazepam) during water chlorination was studied by means of liquid chromatography-quadrupole-time of flight-mass spectrometry (LC-QTOF-MS). For those compounds that showed a significant degradation, i.e. diazepam, oxazepam and nordazepam, parameters affecting to the reaction kinetics (pH, chlorine and bromide level) were studied in detail and transformation products were tentatively identified. The oxidation reactions followed pseudofirst-order kinetics with rate constants in the range of 1.8–42.5 M−1 s−1, 0.13–1.16 M−1 s−1 and 0.04–20.4 M−1 s−1 corresponding to half-life values in the range of 1.9–146 min, 1.8–87 h and 2.5–637 h for oxazepam, nordazepam and diazepam, respectively, depending of the levels of studied parameters. Chlorine and pH affected significantly the reaction kinetics, where an increase of the pH resulted into a decrease of the reaction rate, whereas higher chlorine dosages led to faster kinetics, as expected in this case. The transformation of the studied benzodiazepines occurs mainly at the 1,4-diazepine 7-membered-ring, resulting in ring opening to form benzophenone derivatives or the formation of a 6-membered pyrimidine ring, leading to quinazoline derivatives. The formation of these by-products was also tested in real surface water samples observing kinetics of oxazepam degradation slower in river than in creek water, while the degradation of the two other benzodiazepines occurred only in the simpler sample (creek water). Finally, the acute and chronical toxicity and mutagenicity of precursors and transformation products were estimated using quantitative structure-activity relationship (QSAR) software tools: Ecological Structure Activity Relationships (ECOSAR) and Toxicity Estimation Software Tool (TEST), finding that some transformation products could be more toxic/mutagenic than the precursor drug, but additional test would be needed to confirm this fact This study has been supported by Xunta de Galicia (EM2014-004 and GRC2013-020) and FEDER/ERDF. I.C. acknowledges her postdoctoral formation grant to Xunta de Galicia government SI

Headache patients suffering from recurrent attacks are a population at risk of overuse and abuse of analgesic medications. Associated with triptans, the first-line drugs recommended for the acute treatment, these patients usually take other medications such as opioids analgesics for the attack treatment, antidepressants and antiepileptics for prophylaxis treatment and benzodiazepines, non-benzodiazepine hypnotics and antipsychotics for the treatment of comorbidities. Regular and frequent use of triptans, like of any other symptomatic analgesic, can cause chronic headache and medication-overuse headache (MOH). In these circumstances, a detoxification treatment is necessary and therefore the monitoring and follow-up of the patients are crucial to the success of the treatment. In the present study, a LC tandem MS method has been developed for the identification of 50 psychoactive drugs in human hair, including triptans, benzodiazepines and metabolites, analgesics, antiepileptic, antidepressants and metabolites, a non-benzodiazepine hypnotic (z-drug), antipsychotics and metabolites. Hair samples were decontaminated, pulverized and incubated overnight in methanol; the extracts were then purified by a new and rapid QuEChERS procedure and analyzed by LC-MS/MS under gradient elution with positive ionization MRM mode. The procedure was fully validated in terms of selectivity, linearity, limit of detection and lower limit of quantitation, precision and accuracy, carry-over, matrix effect, recovery and dilution integrity. The validated procedure has been applied to 234 real hair samples collected from headache patients with known type and dosage of the taken drugs; the obtained data could be of interest to evaluate the xenobiotic concentrations in patients with known therapy.

A prospective study was carried out, to identify the drug related problems and to prevent or to solve the negative outcomes associated with medication of the geriatric patients that consumed psychoactive drugs, who were hospitalized. The study was carried out according to the DADER Method of Pharmacotherapy Monitoring, adapted to the Hospital's environment and the theoretical rationale of the Third Consent of Granada was assumed, for the considerations related to the drug related problems and the negative outcomes associated with medication. Thirty five patients were included whose ages ranged between the 60 and 90 years. Thirty six negative associated outcomes were identified, in 34 patients that represented 97.14% incidence. A prevalence of the negative outcomes associated with the necessity was observed, followed by those associated with the security. The inadequate drug uses was the drug related problem that prevailed in the sample. The psychoactive drugs that were related with these results were mainly the anxiolytics, meprobamate and the neuroleptics. Some 82.35% of the interventions were accepted, achieving resolution of 47.06% of the negative outcomes associated with medication.Foi realizada uma pesquisa de intervenção, prospectiva, a fim de identificar problemas relacionados aos medicamentos e evitar ou resolver resultados negativos daí decorrentes, em pacientes idosos que faziam uso de medicamentos psicotrópicos e que foram internados. O estudo foi realizado de acordo com o método DADER para o acompanhamento farmacoterapêutico e assumiram-se os pressupostos teóricos do III Consenso de Granada, as considerações relacionadas com os problemas dos fármacos e os resultados negativos associados à medicação. Foram incluídos 35 pacientes com idades entre 60 e 90 anos. Trinta e seis RM foram identificados em 34 pacientes representando incidência de 97,14% e a prevalência foi observada para os resultados negativos associados com a necessidade, seguidos por aqueles relacionados à segurança. O uso indevido de fármacos foi os problema mais frequente na amostra. Os psicofármacos mais implicados foram os ansiolíticos, meprobamato e neurolépticos. Das intervenções, 82,35% foram aceitas, alcançando 47,06% de resolução dos resultados negativos associados à medicação.

To examine the clinical spectrum of complications in pulmonary system and changes of some parameters of humoral and cell mediated immunity related to heroin overdose. The study includes 16 patients who are long-term heroin abusers with acute heroin and mixed with other psychoactive drugs intoxications with an average age of 21,5 ± 5.04 years (12 men and 4 woman). All patients were hospitalized in the Clinic of Toxicology, MHATEM “N.I.Pirogov”, Sofia. We have used clinical, clinico-laboratory, immunological, chimicotoxicological, instrumental methods. In severe intoxications with heroin and other psychoactive drugs, we observed pulmonary system complications, i.e. pneumonia, aspiration of gastric contents, noncardiogenic pulmonary edema (NCPE) and acute respiratory distress syndrome (ARDS.). Of the 16 patients in our study, 3 patients died due to complications. Some changes in the immune reactivity observed in the study were (1) statistically significant lower mean levels of IgG and (2) tendency to lower mean levels of IgA, IgM and complement components — C3 in the studied patients in comparison with the values in healthy people. The changes were more demonstrative in the group with pulmonary complications compared to the group without pulmonary complications. We observed that the CD4 lymphocytes were significantly less in the studied patients; in addition, a lower level of CD56-bearing lymphocytes (natural killer /NK/ cells) was observed in comparison to healthy controls. The results show that the mixture of acute heroin with other psychoactive drugs leads to complications in the pulmonary system and changes of some parameters of cell-mediated and humoral immunity.

Background: Falls are a major health problem among the elderly, particularly in nursing homes. Abnormalities of balance and gait, psychoactive drug use, and dementia have been shown to contribute to fall risk. Methods: We conducted a systematic review of the literature to investigate which psychoactive drugs increase fall risk and what is known about the influence of these drugs on gait in nursing home residents with dementia. We included studies with a prospective cohort design on psychoactive drug use in nursing homes with dementia residents and with falls as an outcome measure. Results: Seventeen studies were included in the review. Pooled risk estimates were not calculated because there was no homogeneity across studies. We assessed the strength of evidence for psychoactive drugs as a prognostic factor for falls by defining four levels of evidence: strong, moderate, limited or inconclusive. Strong evidence was defined as consistent findings (≥80%) in at least two high quality cohorts. We found strong evidence that the use of multiple drugs (3/3 cohorts, effect sizes 1.30–1xs0.30), antidepressants (10/12 cohorts, effect sizes 1.10–7.60), and anti-anxiety drugs (2/2 cohorts, effect sizes 1.22–1.32) is associated with increased fall risk. The evidence for the association of other psychoactive drug classes with fall risk was limited or inconclusive. Conclusions: Research on the contribution of psychoactive drugs to fall risk in nursing home residents with dementia is limited. The scarce evidence shows, however, that multiple drugs, antidepressants and anti-anxiety drugs increase fall risk in nursing home populations with residents with dementia.

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.

BACKGROUND: Statistics show an increasing proportion of alcohol and drug use in drivers in more recent times throughout the world. It has been found that among the various human factors, alcohol consumption, using drugs and subsequent driving on the roads are major risk factors. Traffic regulations in India penalises drivers who drive beyond permissible alcohol limit of 30 mg%. Consumption of psychoactive drugs such as opioid, cannabis and benzodiazepines has been reported mainly among youngsters. Hardly any data is available in Indian context particularly from North-West Zone of India. STUDY OBJECTIVE: To study the pattern of alcohol, opioid, cannabis and benzodiazepines use in injured drivers presenting to a designated trauma centre in Chandigarh zone of North-West India. MATERIALS AND METHODS: Consenting injured drivers who presented to the trauma centre in Chandigarh from September 2013 to January 2014 were included. Urine samples collected from the subjects were screened for abusive drug exposure (opioid, cannabis and benzodiazepines) and alcohol using commercial bedside urine immunoassay kits. In urine alcohol positive cases blood samples were collected and analysed for alcohol concentration using standard gas chromatography. Retrograde extrapolation method was used to assess BAC at the time of accident. RESULTS: A total of 200 injured drivers were included in this study. We found substance consumption in 54.5% of drivers and alcohol (40.5%) was the most prevalent substance consumed followed by opiates (13%), cannabis (7%) and benzodiazepines (7%). More than one substance was shown in urine of 11.5% of drivers. Among 81 alcohol positive screening cases, the quantitative analysis was successfully done for 76 cases. Except one, all cases showed BAC value more than 30 mg% which is the legal limit for driving any vehicle in India. The values of alcohol concentration in blood at the time of accident were in the range of 20 to 391 mg%. CONCLUSION: This study has shown that drivers are consuming not only alcohol but other psychoactive drugs also. Indian traffic regulatory authorities are penalising drunk drivers by doing road side breath alcohol testing with no protocols for drug screening. Appropriate measures should be adopted to screen traffic offenders for psychoactive drugs also. Language: en

Background: Psychoactive substances affect mainly central nervous system and brain function causing changes in behavior. Objectives: The purpose of this study was to determine the effects of different psychoactive substances on serum biochemical parameters. Patients and Methods: The study included 324 drug dependents, and 69 controls. The patient group was determined according to DSM-IV (The diagnostic and statistical manual of mental disorders, fourth edition) criteria. All patients and control subjects were tested for routine biochemical parameters and urine toxicology parameters for psychoactive substance use. Cases and controls with accompanying diseases like diabetes, cancer, metabolic disorders etc. are excluded from the study. Moreover, an association between urine toxicology results and changes in biochemical parameters was evaluated for statistical significance. Results: There was a statistically significant difference in the Gamma-Glutamyl Transferase (GGT), uric acid, creatinine, urea, albumin, Aspartate Aminotransferase (AST) medians between the dependent and control groups (P < 0.05). We found a statistically significant difference in sodium and albumin levels between the opium-dependent and control groups (P < 0.05). In the benzodiazepin dependent group, we found a significant difference in GGT, urea, glucose, sodium, T protein, and AST levels (P < 0.05). Moreover, a statistically significant difference was observed in triglyceride and GGT levels between the ethyl glucuronide and control groups (P < 0.05). Conclusions: In psychoactive substance dependents, serum routine biochemistry parameters can be used to predict the need for intensive monitoring and treatment programs.

The World Bank initiated a review of HIV prevention among injection drug users in Thailand, with the objective of providing technical assistance to strengthen national capacity to develop state-of-the-art injecting drug use harm reduction interventions. Thailand has received international recognition for its successful interventions to reduce the transmission of HIV among female sex workers and military recruits. It is looked upon as a role model for HIV education and awareness campaigns that include the extensive promotion and wide acceptance of condoms as an HIV prevention strategy. Thailand has the most progressive and comprehensive antiretroviral program in the region with a reported coverage of over 80 percent of eligible individuals. In 2001, it embarked on a progressive universal health care program that provides free access to a wide array of health care diagnostics and therapeutics for the people of Thailand. With these impressive achievements, it is remarkable how poorly Thailand has responded to the HIV epidemic among injection drug users (IDUs). From available data, it appears that the HIV prevalence rates among IDUs have remained high and stagnant over the last decade. Failure to provide effective interventions to reduce HIV transmission among drug users has resulted in unnecessary suffering, and for many, HIV-related death. Continued inaction threatens to undermine successful HIV prevention efforts in the country through ongoing HIV transmission among injection drug users and their sexual partners. The current focus on enforcement and punishment, along with the reliance on compulsory drug treatment centers, has done little to control drug use in Thailand. The unintended consequence of this approach has been to push drug users into precarious and dangerous environments that have directly led to risky drug using patterns and persistently high rates of HIV transmission. Adopting a harm reduction approach to deal with injection drug use could have a major impact on reducing HIV transmission as well as engaging drug users into better health care and effective drug treatment. This will require strong leadership in key government Ministries and related agencies so that the central stakeholders can roll out harm reduction programs. Thailand has the potential to greatly reduce the transmission of HIV among injection drug users and become a regional leader in harm reduction.

In the last decade, a plethora of studies utilizing pharmacological, biochemical, and genetic approaches have shown that precise translational control is required for long-lasting synaptic plasticity and the formation of long-term memory. Moreover, more recent studies indicate that alterations in translational control are a common pathophysiological feature of human neurological disorders, including developmental disorders, neuropsychiatric disorders, and neurodegenerative diseases. Finally, translational control mechanisms are susceptible to modification by psychoactive drugs. Taken together, these findings point to a central role for translational control in the regulation of synaptic function and behavior.

Uvod: Beta (β) endorfini otkriveni su u hipotalamusu i hipofizi, a u manjoj količini i u drugim organima. Cilj ove studije bio je utvrditi mogući utjecaj psi-hotropnih lijekova na β-endorfine u serumu i mozgu kod štakora kao eksperimentalnog modela. Materijal i metode: Studija je provedena na albino Wistar štakorima (200-250 g tjelesne težine) uz primjenu antidepresiva trazodona. Tehnika RIA primijenjena je za kvantificiranje β-endorfina u serumu i mozgu. Rezultati: Koncentracije serumskih β-endorfina izmjerenih 1. dana primjene trazodona bile su značajno više (72,3 ± 1,86 pg/mL; x ± SEM) od početnih koncentracija (45,83 ± 3,77 pg/mL; P = 0,001). Međutim, trazodon je doveo do značajno nižih koncentracija β-endorfina 9. dana liječenja (33,4 ± 1,91 pg/ mL) u usporedbi s koncentracijama izmjerenim 1. dana davanja lijeka (P = 0,001). Koncentracije zabilježene 28. dana (38,62 ± 1,42 pg/mL) bile su više u usporedbi s onima izmjerenim 9. dana (P = 0,439). Koncentracija β-endorfina u mozgu pokazala je značajno sniženje 1. dana davanja trazodona (431,03 ± 11,57 pg/g) u usporedbi s kontrolnim životinjama (873,5 ± 18,32 pg/g; P = 0,001). Usporedba nižih koncentracija zabilježenih 9. dana liječenja (433,65 ± 14,67 pg/g) i onih u kontrolnoj skupini životinja također je dala statistički značajne vrijednosti (P = 0,001). U skupini životinja na trazodonu 28. dana su koncentracije β-endorfina u mozgu bile značajno više 28. dana (929 ± 18,13 pg/g) od koncentracija izmjerenih 1. i 9. dana (P = 0,001 oboje) liječenja, i te su koncentracije bile više od onih zabilježenih u kontrolnoj skupini, međutim, bez statističke značajnosti (P = 0,137). Zaključak: Kronično liječenje trazodonom uzrokuje porast sinteze β-endorfina u mozgu, dok akutno davanje ovoga lijeka dovodi samo do brzog oslobađanja β-endorfina u krvotok., Introduction: Beta (β) endorphins have been detected in the hypothalamus and pituitary, and in a small amount in other organs. The aim of our study was to establish the possible influence of psychotropic drugs on serum and brain β-endorphins in rats as experimental model. Material and methods: The study was performed on albino Wistar rats (200-250 g body weight), using the antidepressant trazodone. RIA technique was employed for quantification of serum and brain β-endorphins. Results: Serum β-endorphins measured on day 1 of trazodone application were significantly higher (72.31 ± 1.86 pg/mL; x± SEM) compared to baseline values (45.83 ± 3.77 pg/mL; P = 0.001). However, trazodone produced significantly lower β-endorphin concentrations on day 9 of treatment (33.4 ±1.91 pg/mL) compared to the values measured on day 1 of trazodone administration (P = 0.001). Endorphin concentrations recorded on day 28 (38.62 ± 1.42 pg/mL) were higher compared to those measured on day 9 (P = 0.439). Data on brain β-endorphin concentration showed a significant decrease on day 1 of trazodone administration (431.03 ± 11.57 pg/g) compared to data obtained from control rat brains (873.5 ± 18.32 pg/g; P = 0.001). Statistical significance was also recorded by comparison of the lower data obtained on day 9 of treatment (433.65 ± 14.67 pg/g) and those observed in the control group (P = 0.001). In trazodone treated rats, brain β-endorphins were significantly higher on day 28 (929 ± 18.13 pg/g) compared with the levels measured on day 1 and day 9 of treatment (P = 0.001 both), showing slightly higher values than in control rats, yet without statistical significance (P = 0.137). Conclusion: Chronic trazodone treatment causes an increase in the brain β-endorphin synthesis, while acute drug administration results only in a rapid release of β-endorphins into the circulation.

OBJETIVO: Revisar as indicações e o manejo clínico das drogas psicoativas e antiepilépticas na infância e adolescência. FONTES DE DADOS: Estudo baseado em revisão de literatura. Os autores organizam, de acordo com os quadros patológicos, uma rotina para o manejo dos psicofármacos e das drogas antiepilépticas na infância e na adolescência. SÍNTESE DOS DADOS: Indicação clínica, dosagem terapêutica e efeitos colaterais dos psicofármacos e drogas antiepilépticas são descritos. O uso de psicofármacos na infância e adolescência está se tornando mais freqüente, com a disponibilidade de novos medicamentos e com o crescimento do conhecimento sobre diagnóstico de transtornos emocionais nessa faixa etária. CONCLUSÕES: O manejo dos psicofármacos e drogas antiepilépticas na faixa etária pediátrica requer amplo conhecimento da farmacocinética dos mesmos, assim como de seus efeitos colaterais deletérios. A escolha do fármaco adequado é determinante no sucesso terapêutico. OBJECTIVE: To review the guidelines for the use of psychoactive and antiepileptic drugs in childhood and adolescence. SOURCES OF DATA: Literature review. SUMMARY OF THE FINDINGS: The clinical indications, dosage and side effects of psychoactive and antiepileptic drugs are presented. The use of psychoactive drugs is increasing due to the release of new drugs and to the better understanding of emotional disorders in children and adolescents. CONCLUSIONS: The use of antiepileptic and psychoactive drugs in childhood requires extensive knowledge concerning pharmacokinetics and deleterious side effects. An adequate choice of drugs is essential to ensure a successful treatment.

The original publication is available at www.springerlink.com, Objective: To study the patterns and determinants of psychoactive drug use by Lisbon University students. Materials and methods: A cross-sectional survey was conducted, from January to April 2000, in a probabilistic sample of 1,147 students. Information about use of psychoactive drugs and co-variates was collected by a questionnaire administered by trained interviewers. Psychoactive drugs were considered to be all medicines classified in group N (nervous system) of the ATC system except the anesthetics (subgroup N01) and the analgesics (subgroup N02). Results: 91 students (7.9%) had taken psychoactive drugs during the fortnight before the interview, 39 of whom(42.8%) mentioned continuous use. The prevalence of use was significantly higher in females (9.6%), older than 25 years (13.1%), married (16%), who considered themselves to have a weak health status (21.7%), as under intense stress (15.5%). After adjustment by multivariate analysis the variables sex, self-evaluation of health status and daily stress retained a higher significant association with psychoactive drug use. A total of 132 drugs were reported as being used in that period. Tranquilizers (ATC N05B or N05C) were used by 82 students (7.2%), while 22 (1.9%) consumed psychoactive stimulants (N06B) and 19 (1.7%) antidepressants (N06A). In all of these therapeutical subgroups, females had higher consumption prevalence than males, but the difference was statistically significant only for tranquilizers (P 0.001). Anxiety, depression and insomnia were the most frequently stated health problems. More than 90% of drug consumers considered they had a compliant attitude and about 60% considered themselves well-informed about adverse effects of the drug used. The reported prevalence of self-medication for psychoactive drugs used was 12.8%. Conclusions: The prevalence of psychoactive drug use among students of Lisbon University was higher than expected, considering age group and the usual health status of this population. The administration of a questionnaire was a very useful tool to characterise the pattern of use and the consumer’s knowledge about the drugs consumed., This study is sponsored by a grant of the University of Lisbon.

INTRODUÇÃO: O estudo tem por objetivo: 1) determinar a prevalência de transtorno do pânico e de fobia social em pacientes hospitalizados devido ao transtorno do uso de substâncias psicoativas; 2) determinar o relacionamento temporal entre o início desses transtornos de ansiedade e o começo do uso de substâncias psicoativas. MÉTODO: Os diagnósticos psiquiátricos foram obtidos através de entrevista clínica semi-estruturada (SCID-I), baseada nos critérios do DSM-IV. Um questionário foi desenvolvido pelos autores, visando a estudar o relacionamento temporal entre o início do transtorno do uso de substâncias e o princípio do transtorno do pânico e da fobia social. RESULTADOS: Apenas 1 (2 %) paciente apresentou transtorno de pânico antecedendo o uso de substâncias psicoativas. A maioria dos pacientes com ataques de pânico preenchiam critérios para o diagnóstico de transtorno de ansiedade induzido pelo uso de substâncias: 11 (22.9 %) dos pacientes tiveram ataques de pânico apenas durante a intoxicação ou na síndrome de abstinência, ou seja, secundariamente ao uso de drogas. Quanto à fobia social, 16 (33.3 %) pacientes apresentavam este transtorno, sendo que, em todos, a fobia social iniciou antes de começar o uso de substâncias psicoativas. CONCLUSÕES: Os achados confirmam a elevada freqüência de fobia social em pacientes dependentes de substâncias psicoativas e reforçam a hipótese da auto-medicação nesta comorbidade, uma vez que esta fobia tende a preceder o uso de drogas. Quanto ao transtorno de pânico, na nossa amostra, este parece derivar de uma complicação do uso de substâncias psicoativas. INTRODUCTION: The objective of this study is: 1) to determine the prevalence of panic disorder and social phobia in patients hospitalized due to the use of psychoactive substances; 2) to determine the temporal relation between the beginning of these anxiety disorders and the beginning of the use of psychoactive substances. METHODS: The psychiatric diagnoses were made by means of semi-structured clinical interviews (SCID-I), based on DSM-IV criteria. A questionnaire was developed by the authors for the purpose of studying the temporal relation between the beginning of the disorder due to psychoactive substances and the beginning of panic disorder and social phobia. RESULTS: Only 1 (2 %) patient had panic disorder before using psychoactive substances. Most of the patients suffering from panic disorder fulfilled the criteria for the diagnosis of anxiety disorder induced by use of the substance: 11 (22.9 %) of them had panic attacks only while under the effect of drugs or during the withdrawal syndrome, i.e., secondarily to the use of drugs. Sixteen (33.3 %) of the patients had social phobia, and in all of them, the social phobia began before the use of psychoactive substances. CONCLUSIONS: The findings confirmed the high frequency of social phobia in psychoactive substance-dependent patients and they reinforce the self-medication hypothesis in this comorbidity, since that kind of phobia tends to precede the use of drugs. As for panic disorder, in our sample it appears to derive from a complication of the use of psychoactive substances. INTRODUCCIÓN: el estudio tiene por objetivo: 1) determinar la predominancia del trastorno de pánico y de fobia social en pacientes hospitalizados debido al trastorno del uso de sustancias psicoactivas; 2) determinar el relacionamiento temporáneo entre el inicio de esos trastornos de ansiedad y el comienzo del uso de sustancias psicoactivas. MÉTODO: los diagnósticos psiquiátricos fueron obtenidos a través de entrevista clínica semi-estructurada (SCID-I), basada en los criterios do DSM-IV. Un cuestionario fue desenvuelto por los autores, visando estudiar el relacionamiento temporáneo entre el inicio del trastorno del uso de sustancias, y el principio de trastorno de pánico y de la fobia social. RESULTADOS: apenas 1 (2.1 %) paciente presentó trastorno de pánico antes del uso de sustancias psicoactivas. La mayoría de los pacientes con ataques de pánico, cumplían criterios para el diagnóstico de trastorno de ansiedad inducido por el uso de sustancias: 11 (22.9%) de los pacientes tuvieron ataques de pánico apenas durante la intoxicación o en el síndrome de abstinencia, o sea, secundariamente al uso de drogas. Cuanto a la fobia social, 16 (33.3%) pacientes presentaban este trastorno, siendo que, en todos, la fobia social se inició antes de comenzar el uso de sustancias psicoactivas. CONCLUSIONES: lo descubierto confirma la elevada frecuencia de fobia social en pacientes dependientes de sustancias psicoactivas, y refuerza la hipótesis de la auto-medicación en esta comorbidad, una vez que esta fobia tiende a preceder el uso de drogas. Cuanto al trastorno de pánico, en nuestra muestra, este parece derivar de una complicación del uso de sustancias psicoactivas.

Current psychobiological models of drug addiction are focused on the capability of drugs to cause a pathological exploitation of the neural rewarding system. This approach has emphasized the role of hedonistic factors in the etiology of drug addiction. Comparing primitive and modern settings of intoxication, such as shamanic rituals and rave parties, it is possible to confute this assumption. The archaic way of perceiving and elaborating drug effects mainly determined their use as being for supernatural purposes and excluded recreational purposes. Only after a completely profane setting of drug use was developed, did psychoactive drugs express all their hedonistic potentialities. This development, however, has been a slow process.

Hypoactive sexual desire disorder (HSDD) is a common multifactorial condition which is characterized by a decrease in sexual desire that causes marked personal distress and/or interpersonal difficulty. The general idea that HSDD is a sexual dysfunction difficult to treat is due to the large number of potential causes and contributing factors. Indeed, a balanced approach comprising both biological and psycho-relational factors is mandatory for accurate diagnosis and tailored management in clinical practice. There are currently no approved pharmacological treatments for premenopausal women with HSDD, while transdermal testosterone is approved in Europe for postmenopausal women who experience HSDD as a result of a bilateral oophorectomy. Even though the role of sex hormones in modulating the sexual response during the entire reproductive life span of women is crucial, a better understanding of the neurobiological basis of sexual desire supports the idea that selective psychoactive agents may be proposed as nonhormonal treatments to restore the balance between excitatory and inhibitory stimuli leading to a normal sexual response cycle. We conclude that the ideal clinical approach to HSDD remains to be established in term of efficacy and safety, and further research is needed to develop specific hormonal and nonhormonal pharmacotherapies for individualized care in women.

It is well-known that humans have used medicinal plants for millennia, but as a defined field of scientific research called ethnopharmacology, it has a relatively short history. It is linked to the development of pharmacology in the 19th century (as exemplified in the work of Claude Bernard linking the explorers’ observations on traditional uses of medicines and toxins) and to fascination with psychoactive drugs in the 1960s. This fascination gave rise to what we now call ethnopharmacology, a term first used as recently as 1967. With thousands of ethnopharmacological articles published each year now, the field has expanded greatly. It nowadays covers a wide range of topics based on the anthropological, historical and other socio-cultural studies of local and traditional plants, fungi and animals; as well as the biological and clinical studies of resources used as medicines, toxins, foods, among other applications. It is one of the few fields in science truly transdisciplinary and it is a key bridge between socio-cultural and the natural/medical sciences. More importantly, ethnopharmacological research is crucial for the improvement of livelihood, health and wellbeing of humans. Keywords: Ethnopharmacology, Traditional medicine, History of science, Psychoactive drugs, Pharmacognosy, Phytopharmacy

Background Self-report is commonly used as a source of information on the use of medicine. The aim of this study was to investigate the relationship between self-reported and register-based information on the use of psychoactive medication, especially in respect to antidepressants, and reasons of non-reporting. Methods Study subjects (n = 11,031) originated from a population-based cohort of postmenopausal women born in 1932–41 from Eastern Finland who responded to a postal enquiry in 1999. Self-reported currently used prescribed medications were compared to the National prescription register data. Diuretics served as a reference for psychoactive medications. Results Only 44% out of 1,638 women reported their use of psychoactive medication when compared to the prescription register within a 4-month time window preceding their response to enquiry. Altogether, 55% out of 777 women reported their use of antidepressants and 29% out of 861 reported their use of other psychoactive medications. In comparison 83% reported their use of diuretics. After excluding the occasional use, an increase in sensitivity by approximately 10 percentage points was seen regardless of the group of psychoactive medication. High use and history of work disability pension due to psychiatric cause were associated with a much higher likelihood of reporting psychoactive medication use (for antidepressants 70% and 81%, respectively). Conclusions For research purposes, self-reported current use of psychoactive medication seems to be a sufficient indicator for regular use of antidepressants or in respect of use of any psychoactive medication, for subjects with severe psychiatric disease.