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Biomedical subjects

N el-Guebaly

Publications and source records attributed to N el-Guebaly.

At least 19 recordsLinked to original sources
PubMed1999

Using measures of readiness to change in individuals with schizophrenia.

The literature suggests that substance abuse treatment for schizophrenia patients should consider both the patients' readiness for active treatment and matching phases of intervention with phases of the patient's acceptance of his or her dual problems. This study assessed the suitability of existing measures of "readiness to change" for use with individuals with schizophrenia. Outpatients (n = 39) with a diagnosis of schizophrenia and alcohol and/or drug dependency or abuse were given three measures to assess the stage of readiness to change. Results suggested that there was no agreement between stages defined by the interviewer and stages defined by self-report. This has implications for assessing readiness to change in terms of substance use in a population with schizophrenia.

Alcoholism↗
PubMed1999

Implications of depression on outcome from alcohol dependence: a 3-year prospective follow-up.

The prognostic implications of comorbid depression for outcome from alcohol dependence are unclear. It has been suggested that drinking may represent self-medication of depressive disorders and, alternatively, that the pharmacological properties of alcohol induce episodes of depression. In the present study, these questions were investigated by following 84 alcohol-dependent individuals seeking treatment (34% women) for 3 years in a naturalistic, prospective design. During the follow-up period, depressive and drinking outcomes were significantly related. However, there was no evidence that drinking reliably preceded depressive episodes or that depressive episodes precipitated heavy drinking. Despite their high co-occurrence, this study did not find evidence of a strong, direct causal relationship between these phenomena.

Adolescent↗
PubMed1998

Smoking cessation treatment for patients with schizophrenia.

OBJECTIVE: This study was an uncontrolled trial to assess the efficacy of a smoking cessation group program modified for individuals with schizophrenia. METHOD: Fifty outpatients with schizophrenia were divided into five groups who met separately for seven weekly sessions of a smoking cessation program. The subjects' schizophrenic and extrapyramidal symptoms were assessed before the group sessions began and after they had been completed. Assessments of smoking were made at those times and at 3-month and 6-month follow-ups. RESULTS: Forty-two percent of the subjects had stopped smoking at the end of the group sessions; 16% remained abstinent at 3 months, and 12% at 6 months. These changes were statistically significant. There was no change in the positive or negative symptoms of schizophrenia. CONCLUSIONS: The results suggest that it is possible for individuals with schizophrenia to stop smoking.

Adult↗
PubMed1998

Substance-related cravings and relapses: clinical implications.

OBJECTIVE: To review the implications of current research on clinical practice. METHOD: An examination of the literature over the last 10 years and the data from our own study group. RESULTS: A synopsis of current psychobiological and psychological conceptual underpinnings of the nature and process of cravings and relapses among substance-dependent individuals is presented. The biopsychosocial dimensions of the clinical assessment of craving components, relapse patterns, and predictors, including relevant instruments, are explored. The panoply of management strategies for cravings and relapses encompasses cue exposure treatment techniques, relapse prevention approaches, anticraving and psychotropic medication, family involvement, and twelve-step programs. CONCLUSION: A clinician's familiarity with these strategies should contribute significantly to the transformation of the sense of failure engendered by a patient's relapse into a constructive challenge and opportunity.

Combined Modality Therapy↗
PubMed1998

Nicotine and endogenous opioids: toward specific pharmacotherapy.

OBJECTIVE: To address the theoretical framework behind opioid receptor antagonism for the treatment of nicotine abuse. The current literature is reviewed with a focus on opioid-nicotine interactions in animals and humans. Furthermore, previous studies addressing the effect of opioid antagonism on smoking behaviour are reviewed critically with a focus on suggestions and implications for future trials. METHOD: Computerized data bases and reference lists of existing articles were searched for prior publications in 3 areas: 1) the association between nicotine and endogenous opioids, 2) nicotine and reward, and 3) opioid antagonism in the treatment of nicotine use. RESULTS: Nicotine affects the mesolimbic reward pathway postsynaptically via nicotinic cholinergic receptors and presynaptically via the central nervous system's (CNS) neurohumoral pathways. Thus nicotine results in the release of endogenous opioids that bind to mu receptors, which increases the release of dopamine along this pathway. Studies to date have shown mixed results on the effect of opioid antagonism on smoking behaviour. CONCLUSIONS: The role of opioid antagonism on smoking behaviour is unclear, despite the publication of 5 trials on the subject. Further trials of longer duration should be undertaken and use both longer-acting medications and those more specific to the mu receptor to further focus on the rewarding aspects of nicotine ingestion, thus addressing the craving for this drug. The development of adequate compounds has just begun, and psychiatrists can hope to have a more specific pharmacotherapy to address the cravings and short-term rewards of nicotine use.

Animals↗
PubMed1998

Psychiatric comorbidity in pathological gambling: a critical review.

OBJECTIVE: To critically review the current literature on pathological gambling as regards the significant psychiatric comorbidities associated with it. METHOD: The authors synthesized information found via electronic searches (MEDLINE) and bibliographic-directed searches in over 60 publications. RESULTS: Pathological gamblers frequently have comorbid substance use disorders. In addition, a subset appear to have comorbid antisocial personality disorder, but they represent a minority when compared with those people who have acquired their antisocial traits as a consequence of their gambling behaviour. A comorbidity with the mood disorders is probable, but methodological concerns and inconsistencies with the data prevent further delineation of this. Emerging research for other disorders possibly associated with pathological gambling is also reviewed. CONCLUSION: Pathological gambling is associated with significant psychiatric comorbidity. Recommendations for future research are described.

Antisocial Personality Disorder↗
PubMed1998

Group treatment for substance abuse in schizophrenia.

OBJECTIVES: A review of the relevant research suggests a need to develop an appropriate, effective, and replicable treatment to help individuals with schizophrenia and substance abuse problems. This pilot study describes a biweekly group specifically designed to help the individual with both schizophrenia and substance abuse. The components of the group were support, psychoeducation, and skills training. Attention was also paid to the stage of recovery. METHOD: Eighteen subjects attended the group and were assessed pregroup. Thirteen subjects completed a 1-year follow-up, and 5 subjects were assessed between 3 and 6 months. RESULTS: At the follow-up assessment, 8 subjects (44%) were abstinent. CONCLUSIONS: This type of treatment appears to be effective for reducing substance abuse in this population.

Adult↗
PubMed1998

Substance abuse and the emergency room: programmatic implications.

A literature review (1984 to 1995) was conducted to identify cost effective policy implications regarding substance use in the emergency room (ER) and trauma unit. Prevalence rates, ranging from 9% to 47%, vary according to where, when and who is tested. Other drugs, most commonly marijuana, benzodiazepines and cocaine, follow a similar pattern to alcohol. The optimal method of measuring substance use depends on the goal of the assessment and a combination of clinical, self-report and biochemical markers is recommended. Simple screening questions such as the TWEAK or AUDIT should be routinely used with all attendants and further assessment provided only when high risk factors have been identified. These include: males, younger patients, metropolitan centres, after midnight and on weekends, injury from violence, accidents including MVAs, high acuity and psychiatric morbidity. Further, this screening should be complimented by an intervention, referral and treatment resource for those in need.

Benzodiazepines↗
PubMed1997

Readiness to stop smoking in schizophrenia.

OBJECTIVE: To assess the motivation and readiness to change of individuals with schizophrenia prior to developing a smoking cessation program. METHOD: Smoking history, nicotine dependence, readiness to stop smoking, and interest in a smoking cessation group were assessed in 60 schizophrenia outpatients who smoked. RESULTS: The majority were interested in attending a smoking cessation group and appeared to be appropriately motivated. CONCLUSIONS: Smoking cessation groups for a schizophrenia population may be a worthwhile endeavour. Current measures of motivation and readiness to change may be useful to identify those who are most likely to succeed.

Adult↗
PubMed1997

Placebos in clinical trials of psychotropic medication.

This paper represents the position of the Canadian Psychiatric Association on the ethical and scientific issues related to the use of placebos in the evaluation of new psychotropic drugs. The position taken by the Association is that new psychotropic medications must be shown to be effective and must be weighed against the best current interventions. Placebo controls may be appropriate under certain circumstances, even when an established intervention is effective. These include situations in which placebo response rates are high, variable, or close to response rates for effective therapies. Placebo controls are also appropriate when established interventions carry a high risk of side effects or are effective against only certain symptoms of the disorder.

Canada↗
PubMed1997

Treatment of substance abusers: single or mixed gender programs?

Single-gender groups are advocated for women because substance abuse treatment programs tend to be male dominated both in numbers and in style. Although there is a paucity of empirical work that directly addresses this assumption, a body of literature that indirectly supports it is reviewed. Male and female substance abusers report different histories and courses for their disorders and display different needs and characteristics in treatment settings. Men and women may benefit from different treatment approaches with less structure required for women, particularly problem drinkers. Moreover, specific characteristics such as victimization, sexual orientation, sex-role conflict and degree of antisocial traits may be important mediating factors in whether single-gender groups are optimal. Social psychological research illustrates the effect of gender composition of groups for men and women. In general, mixed groups are associated with more variation in interpersonal style for men but are restrictive for women who show more variation in style in single-gender groups. These findings are suggestive of testable hypotheses concerning the effects of single and mixed gender programming. Such investigations have the potential of enhancing treatment efficacy.

Female↗
PubMed1996

Research training and productivity among faculty: the Canadian Association of Professors of Psychiatry and the Canadian Psychiatric Association Survey.

OBJECTIVE: This survey assesses the research training and productivity of academic faculty in Canadian departments of psychiatry and compares the findings with those of colleagues in the United States. METHOD: A questionnaire was adapted to suit the Canadian milieu and was distributed to a target population of 2484, including a core 522 full-time faculty. RESULTS: The response rate among full-time faculty was 65%, but only 26.5% for clinical and adjunct faculty. A small proportion (16%) of our MD and a greater proportion (57%) of our PhD respondents were included in a fairly lenient definition of researcher. Departments seek to recruit PhDs with an active involvement in research. Overall there appear to be more similarities than differences in research interests with our colleagues in the United States. The pharmaceutical industry was the most frequently mentioned source of research funding for MDs, while the availability of a mentor was perceived as the most influential factor determining the choice of a research career. CONCLUSIONS: Recommendations include adequate exposure to research during medical school and residency as well as appropriate inducements for the recruitment and retention of practising researchers.

Canada↗
PubMed1996

Physician resource variables and their impact on the future pool of research expertise among psychiatrists: the Canadian Association of Professors of Psychiatry and Canadian Psychiatric Association Survey.

OBJECTIVE: To assess the impact of the increased proportion of female psychiatrists and trainees, the rapid reduction of international medical graduates allowed in the country, and the expanding number of practitioners with subspecialization on the future pool of psychiatrist researchers in Canadian academic departments of psychiatry. METHOD: A questionnaire was adapted to suit the Canadian milieu and distributed to a target population of 2484, including a core of 522 full-time faculty. RESULTS: Female psychiatrists responding to the questionnaire reported less research involvement overall than their male counterparts. International medical graduates with both undergraduate and residency training abroad reported more research interests than other graduate categories. Respondents training in a subspecialty showed no difference in research commitment. CONCLUSIONS: Concerted efforts must be made to recruit, support, and retain female researchers. Particular attention must be paid to developing research expertise among Canadian medical graduates. The trend towards subspecialization influences only the selection of research topic.

Canada↗
PubMed1996

Research productivity among PhD faculty members and affiliates responding to the Canadian Association of Professors of Psychiatry and Canadian Psychiatric Association survey.

OBJECTIVE: This survey endeavours to assess the research productivity of PhD degree holders affiliated with Canadian academic departments of psychiatry. METHOD: A questionnaire was adapted to suit the Canadian milieu and was distributed to a target population of 2484, of whom 345 were nonmedical PhDs. RESULTS: Out of 861 respondents, 148 indicated that they held a PhD degree only--a response rate of 42.9% for that subgroup. PhD respondents engaged in significantly more research activities than MDs. Their fields of research activity differed according to amount of time spent in research activities. Few gender differences were observed. CONCLUSIONS: The recruitment of sole PhD holders is an indicator of the current research needs of departments and of the dearth of candidates for these positions among MDs.

Authorship↗