Research update

CrossCurrents

Hema Zbogar

Pain medication addiction more likely among young people

Young people are more likely than older people to want to rapidly increase their dosage of opioid-based medications such as morphine, methadone and oxycodone, thus raising risk of abuse, according to research from the University of California, San Francisco. Researchers examined the medical records of 206 individuals who had been treated at a pain management centre for two years for non-cancer -related pain. Records of clients under age 50 were compared with those 60 or older. The study found that older clients, regardless of gender or type of pain, increased opioid use significantly less over two years than younger clients. The average peak dose for clients under age 50 was more than twice that of older clients - often more than half a gram per day of morphine or other drugs. Older clients also experienced long-term pain relief with opiate-based drugs, but younger clients did not. The authors indicate that younger clients may be better candidates for newer non-steroidal anti-inflammatories and poorer candidates for opioids, whereas older clients may benefit more from opioids.

Anesthesia and Analgesia, June 2005, v. 100: 1740-1745. Chante Buntin-Mushock et al., Department of Anesthesia and Perioperative Care and Department of Neurology, University of California, San Francisco.

Excessive Internet use linked with psychiatric disorders

Young people who use the Internet excessively experience more psychiatric symptoms than those who access it less often, according to researchers at Korea's Dong-A University College and Harvard Medical School in Boston, Massachusetts. Participants were 328 male and female Korean students aged 15-19. They completed four questionnaires: Internet use patterns during the previous month, the Internet Addiction Test, the Symptom Checklist-90-R and the Sixteen Personality Factor Questionnaire. Participants were separated into four groups based on average Internet use: non-users, minimal users (0.8 hours per day), moderate users (1.5 hours per day) and excessive users (2.3 hours per day). Sixteen students were classified as excessive users, logging on an average of 19 hours per week. Fifty-nine students reported no Internet use. There were significantly more males than females in the moderate and excessive groups. Excessive users experienced more hostility, obsessive-compulsiveness, paranoia, depression, irritability, impulsiveness, anxiety, phobias, somatization and psychoticism than moderate and minimal Internet users. Excessive users also appeared to have a distinctive personality profile compared with other users and non-users. The authors indicate various study limitations, including small sample size and use of questionnaires rather than interviews. They suggest that excessive Internet users "may use the Internet to counteract psychological distress rooted in their personality."

Canadian Journal of Psychiatry, June 2005, v. 50: 407-414. Chang-Kook Yang et al., Department of Psychiatry, Dong-A University College of Medicine, Busan, Korea.

Medication adherence linked to good therapeutic relationships

Good relationships with clinicians during admission to acute treatment may improve attitudes toward and adherence to anti-psychotic medication, according to UK researchers. The study examined various factors that may influence medication compliance, including psychiatric symptoms and lack of insight, as well as factors related to the therapeutic relationship, including the client's perception of the degree of coercion during admission to hospital and the attitudes of inpatient staff. The study involved 228 clients in eight inpatient acute care wards in Wales and England who were diagnosed with schizophrenia or schizoaffective disorder. It was found that good insight, lack of coercion during admission, a positive relationship with the medication prescriber, involvement in treatment decisions and medications with fewer side-effects increased medication adherence. The researchers mention limitations to the study, including the focus on the acute phase of treatment, indicating that different stages of illness and different social contexts may yield different results. They propose measures for client-centred care, including involving clients in treatment decisions, respecting clients' health beliefs and adjusting treatment to minimize negative side-effects.

Archives of General Psychiatry, June 2005, v. 62: 717-724. Jennifer C. Day et al., Pharmacy Department, Mersey Care NHS Trust, Merseyside, United Kingdom.

Antipsychotic drugs show quick effect

Antipsychotic medications begin to reduce psychosis within the first 24 hours of treatment, suggests research from the Centre for Addiction and Mental Health and University of Toronto. In this multi-centre double-blind study, 311 individuals with schizophrenia were randomly assigned to either a placebo group or a group that received the antipsychotics olanzapine or halperidol. Participantswere monitored for changes in their behaviour at baseline and two hours and 24 hours after the drugs were administered, using the Positive and Negative Syndrome Scale and the Clinical Global Impressions rating scale. Analysis of clinical data showed that change in psychosis (which included conceptual disorganization, hallucinatory behaviour and unusual thought content) appeared within 24 hours for both drugs and showed greater change than the placebo group. The authors indicate that this result is contrary to the prevailing assumption that it takes at least two weeks for antipsychotics to affect symptoms. They suggest that this finding has important clinical implications because it raises the possibility that physicians may be able to look for effects earlier, and thereby develop more efficient strategies for the medical management of psychosis.

American Journal of Psychiatry, May 2005, v. 162: 939-946. Shitij Kapur et al., Centre for Addiction and Mental Health, Toronto, Ontario.

 

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