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Background: Agitation in Alzheimer's Disease (Agit‐AD) is a common and troubling neuropsychiatric syndrome which adds significantly to disability and caregiver stress. Behavioral interventions lack consistent efficacy and there are no FDA‐approved medications. Neurobiological mechanisms that contribute to Agit‐AD include brain atrophy, degradation of neurotransmission, neuroinflammation, disrupted circadian rhythms, comorbidities and frailty. Agit‐AD is a major source of disease progression, patient disability, financial burden, and caregiver stress. Dronabinol is a synthetic cannabinoid (tetrahydrocannabinol, THC). Cannabinoids may improve Agit‐AD by providing protection against neuroinflammation and excitotoxicity, regulating neurotransmitters, improving comorbidities, stabilizing circadian rhythms, and increasing cerebral blood flow. Method: THC‐AD is a three‐week placebo‐controlled, double‐blind, RCT of dronabinol (10 mg QD) in 80 patients with severe Agit‐AD. Twice daily administration maximizes daytime coverage for agitation and minimizes sundowning. Inclusionary criteria include a diagnosis of AD, severe agitation, and being 60‐95 years old, while exclusionary criteria include serious or unstable medical illness, seizure disorder, delirium, current use of lithium, and inability to swallow a pill. Primary outcomes include a change in the Pittsburgh Agitation Scale and NPI‐C Agitation/Aggression subscales. Result: We have enrolled 58 out of targeted 80 participants (Table 1: mean age 77.8 years, 65.5% female, 87.9% Caucasian, mean education 13.8 years, 45.6% family history). On average, study participants are very cognitively impaired (Table 2: mean baseline MMSE of 8.1), very agitated (mean NPI‐C Agitation 14.6, mean NPI‐C Aggression 6.3) and in reasonable overall health (Figure 1: General Medical Health Rating, 12.1% "excellent," 51.7% "good" and 34.5% "fair"). Recorded AEs have been tolerable (Figure 2). Due to the COVID‐19 pandemic, we expanded our inpatient trial to include outpatient enrollments and implemented hybrid visits with telemedicine to limit in‐person interactions. We also added a supplemental study to evaluate the effects of the pandemic on caregiver stress and burden. We are collaborating with additional clinical sites, increasing dementia bed capacity, and deploying recruitment strategies for outpatients, including referrals from providers and other research trials, social media ads, and virtual community outreach. Conclusion: Safe and effective interventions for severe agitation are greatly needed. This pilot trial will help to examine the safety and efficacy of dronabinol for Agit‐AD. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this article is to discuss the interface between judicial discipline and behavioral science in the context of substance-related disorders. Method: We review the epidemiology of psychoactive drug use and crime and discuss the courts' decisions on relevant landmark cases, particularly as they influence the practice of psychiatry. Results: (1) The phenomenology of addiction and crime is of great epidemiological import. (2) Our legal system inclines toward the view that the use of alcohol or other substances involves an element of choice and therefore would not amount to a legal insanity defense if the substance abuser commits a crime while intoxicated. (3) A state can confine an addict or alcoholic for compulsory treatment if that individual presents a danger to self or others. (4) The law has found that alcoholism and drug abuse are both 'willful misconduct' and a disabling condition; the former definition contains the end in view of punitive action. The latter is aimed toward treatment and rehabilitation. (5) The law gives the right to the employer to test a suspected employee for drug abuse. The addicted or alcoholic employee has the choice to either go for treatment or face job termination. (6) Our judicial system gives serious consideration to the welfare of a child whose parents are alcoholic or drug addicted. Conclusion: The two disciplines of psychiatry and law follow their own modes in resolving issues in alcoholism and other substance abuse. We need research and new approaches to build a bridge between the two., Alcohol and drug addiction have a unique position in die interface between law and psychiatry. They are considered as both a disabling illness and willful misconduct. The former definition is [...]

Rises in both crack cocaine use and incidence of sexually transmitted diseases have been recently reported. In this study, we investigated the relationship between crack cocaine abuse and sexual behavior in 50 psychiatric inpatients. The relationship between crack use and sexual behavior is a very complicated one, influenced by many variables such as the dose of crack used, the user's preexisting sexuality, gender, and psychiatric illness. Results indicated that while most of the subjects developed sexual disinterest and dysfunction with prolonged crack cocaine use, some of them became more sexually promiscuous and consequently contracted more sexually transmitted diseases. The implications of these findings regarding transmission of HIV among crack cocaine users are discussed., INTRODUCTION Recently there has been a dramatic rise in syphilis and other sexually transmitted diseases (STD) among heterosexuals [1]. Epidemiologists at the Centers for Disease Control (CDC) have traced a [...]

An outcome study was carried out on a series of 109 highly disadvantaged alcoholics discharged from the detoxification unit of a large municipal hospital in New York City. We examined the impact of a variety of clinical and demographic factors on retention in the initial phases of outpatient and inpatient treatment following discharge. Both high school completion and a history of at least 6 months of employment in the two years preceding admission correlated with frequency of registration for continued aftercare. Measurements of cognitive flexibility correlated with frequency of aftercare completion. An association strongly approaching significance was also found between length of hospital stay and aftercare completion. Some suggestions are made as to the assessment and aftercare planning for highly disadvantaged alcoholics., INTRODUCTION Attention is being paid to the understanding of the variables which determine outcome among the subpopulation of alcoholics who are highly disadvantaged, generally deprived, and socially disaffiliated [1]. There [...]

It is estimated that a large number of psychiatric patients also abuse drugs. An understanding of the relationship between substance abuse and a psychiatric disorder is necessary for effective treatment of these patients. It is important to know whether the addiction is the primary or secondary disorder. For example, if it is secondary, the addiction may be an attempt at self-medication for symptom relief. Treatment must take into account both the addiction and the psychiatric disorder. In the present study, 71 hospitalized schizophrenics were surveyed about their use of alcohol and drugs during the two weeks prior to hospitalization. How the use of drugs and alcohol affected their psychiatric symptoms was investigated using a 90-item, self-report scale. Of the 71 schizophrenics studied, 31 were clinically diagnosed as alcoholic, 20 had cocaine dependency, and 20 did not use any drugs. Sex was not a significant factor in this distribution, but age was; alcoholics were an average of 41.72 years old, cocaine-dependent schizophrenics were an average of 29.3 years old, and nonaddicted schizophrenics were an average of 38 years old. The age difference between alcoholic and cocaine-dependent schizophrenics was significant. Cocaine-dependent schizophrenics reported their symptoms were often made worse by the cocaine; few reported a lessening of symptoms with drug use. Alcoholic schizophrenics reported relief of their symptoms as often as not when alcohol was used. It is concluded that choice of drug was related to subjective symptom improvement or worsening during the two weeks prior to hospitalization in substance-abusing schizophrenics. This observation was independent of such factors as age, employment, residence, or severity of psychiatric symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.), INTRODUCTION Given how frequently patients with psychiatric disorders are also substance abusers ('dual diagnoses patients'), there currently is a need to understand the relationship between drugs of abuse and psychiatric [...]