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Biomedical subjects

S M Mirin

Publications and source records attributed to S M Mirin.

At least 37 records · Page 2Linked to original sources
PubMed1989

Tricyclic antidepressants in the treatment of alcoholism and drug abuse.

Although the frequent coexistence of substance abuse and depression is widely recognized, studies assessing the efficacy of tricyclic antidepressants in patients who abuse alcohol and/or drugs have been problematic because of controversies about how to diagnose depression in this population, failure to measure plasma antidepressant levels, and inconsistent treatment outcome measures. Some studies have, however, demonstrated the effective use of specific tricyclic antidepressants in selected subgroups of substance abusers; for example, desipramine may facilitate initiation of cocaine abstinence, and doxepin may benefit certain opioid addicts. Although imipramine has shown only equivocal success in the treatment of alcoholics, preliminary studies of serotonin uptake inhibitors show some promise in this population. As research design in this field becomes more consistent, future studies may more clearly identify subgroups of chemically dependent patients who respond to specific antidepressant drugs.

Alcoholism↗
PubMed1988

Psychopathology in cocaine abusers. Changing trends.

The authors studied a group of 149 hospitalized cocaine abusers as a follow-up to previous research performed in 1980-82, which had revealed a high prevalence of affective disorder in cocaine abusers. The authors hypothesized that the changing epidemiology of cocaine abuse since that time may have been accompanied by changes in the characteristics of patients seeking treatment for dependence on the drug. The cocaine abusers were compared with 293 other drug abusers to see whether clinical changes over time were specific to individuals abusing cocaine. The authors found slightly more affective disorder in the cocaine abusers when compared with the other patients (26.8% vs. 20.1%), with a significantly higher rate of cyclothymic disorder (11.4% vs. 2.7%, p less than .001). Affective illness was significantly more prevalent in the first-degree relatives of the cocaine abusers when compared with the sex-matched relatives of the other patients (p less than .05). Diagnostic trends changed a great deal, however, between the original 1980-82 study sample and the follow-up 1982-86 sample. The rate of affective disorder decreased over time from 50.0% to 21.0% (p less than .01), and the rate of affective illness in the families also declined, from 31.0% to 11.5% in females (p less than .001) and from 14.3% to 2.2% in males (p less than .001). No such change occurred in the comparison group of opioid and central nervous system depressant abusers. The authors conclude that although a substantial number of cocaine abusers suffer from concurrent affective disorder, this form of premorbid psychopathology has become a less important risk factor for the development of chronic cocaine abuse as cocaine use has become more widespread.

Adult↗
PubMed1988

A comparison of alcoholic and nonalcoholic drug abusers.

A group of 329 hospitalized drug abusers were evaluated for a current or past diagnosis of alcoholism. The alcoholic drug-dependent patients (n = 169, 51.4%) were then compared with the nonalcoholic patients (n = 160, 48.6%) with regard to sociodemographic, clinical and family history characteristics. The alcoholics were significantly more likely to receive a DSM-III diagnosis of major depression, with melancholia; other Axis I diagnoses were equally distributed between the two groups. Antisocial personality disorder was also significantly more prevalent among the alcoholic patients. The alcoholics had somewhat longer drug histories and more vivid memories of their first drinking experiences; polydrug abuse, however, was no more common in this group. Finally, the first-degree relatives of the alcoholics had significantly more alcoholism than the first-degree relatives of the nonalcoholic patients. Implications regarding the relationship of alcoholism and other forms of substance abuse are discussed.

Adult↗
PubMed1987

Decreased single breath carbon monoxide diffusing capacity in cocaine freebase smokers.

The authors performed pulmonary function tests on 10 chronic cocaine freebase smokers. Testing occurred at least 2 weeks after stopping cocaine use. Mean single breath carbon monoxide diffusing capacity (DLCOSB) was significantly reduced (P less than 0.05) in the cocaine smokers when compared with a control group of non-smokers and non-drug users. All other parameters of lung function were normal. Since most of the cocaine smokers also smoked tobacco, the observed abnormality may have been due to an additive effect of the 2 substances. The authors conclude that smoking cocaine may damage the gas exchange surface of the lung.

Adult↗
PubMed1987

The use of the Diagnostic Interview Schedule in drug-dependent patients.

In an attempt to diagnose other psychiatric disorders in substance abusers, some clinicians and investigators have utilized the NIMH Diagnostic Interview Schedule (DIS). This study assessed the validity of the DIS in a drug-dependent population by comparing DIS diagnoses with clinical diagnoses in 124 hospitalized drug abusers. Every attempt was made to establish the validity of the clinical diagnoses; these represented a consensus of two independent psychiatrists, based on repeated clinical interviews, observation of ward behavior, and information obtained from relatives regarding patient and family history. Concordance between clinical and DIS diagnoses (represented by the kappa statistic and percent agreement) was only moderate for DSM-III Axis I disorders other than substance abuse. In addition, the DIS diagnosed alcoholism less often and antisocial personality disorder more often than the clinicians. Factors contributing to the discrepancy between clinical and DIS diagnoses in this specific population include (a) drug abuse effects, whereby distinguishing between drug effects and primary psychiatric symptoms may be difficult; and (b) the effect of the treatment process itself, whereby patients are encouraged to rethink the role drugs have played in causing some of their difficulties. Patients' reports of the chronology of their symptoms may thus change according to what they have learned in treatment. The authors conclude that the DIS, like any single diagnostic interview, may have limited utility early in the treatment of drug-dependent patients, since their recollection of their previous symptoms may change dramatically as a result of treatment efforts.

Adult↗
PubMed1986

Psychopathology in chronic cocaine abusers.

A group of 30 hospitalized cocaine abusers were studied, along with 124 hospitalized patients who were dependent upon opiates or central nervous system depressants. DSM-III diagnoses, family history data, demographic characteristics, and measures of current depressive symptomatology were compared in the two groups. Nineteen (63%) of the cocaine abusers met criteria for an Axis I diagnosis other than substance abuse; sixteen (53%) had affective disorder. These figures reflected a significantly higher prevalence rate of affective disorder among the cocaine abusers than among the opiate and depressant abusers. In addition, a significantly higher rate of affective disorder was found in the first degree relatives of the cocaine abusers when compared to the other group. Since these findings suggest that a substantial number of cocaine abusers may be suffering from other psychiatric disorders, careful diagnostic evaluation is indicated in this population.

Adult↗
PubMed1986

Affective illness in substance abusers.

The evaluation and treatment of substance abusers are complicated tasks, requiring a multifaceted approach. In addition to the patient's substance abuse problems, a substantial minority appear to be suffering from concurrent, nondrug-related psychiatric disorders. The early identification of such individuals allows for the development of specific treatment strategies that address both the substance abuse and the associated nondrug psychopathology. On the other hand, attention to nondrug psychopathology should not preclude our simultaneously addressing the patient's substance abuse problem. Thus, manic depressive patients who are also alcoholic may need a treatment program that includes alcoholism counseling. Alcoholics Anonymous, and chronic administration of disulfiram in addition to lithium carbonate and a supportive psychotherapeutic relationship. As in other areas of medicine, attention to the "whole patient" is the sine qua non of good treatment.

Central Nervous System Depressants↗
PubMed1986

Subtypes of cocaine abusers.

We have characterized five subtypes of cocaine abusers on the basis of clinical presentation, family history data, and response to specific treatment interventions. These include depressed patients who value the euphorigenic effects of the drug, patients with bipolar or cyclothymic disorder who use cocaine to augment manic or hypomanic symptoms or to alleviate depression, adults with ADD, residual type, who find that cocaine has a paradoxical effect of increasing attention span and decreasing motor restlessness, patients with narcissistic and borderline personality disorders who use cocaine for its social prestige and because it bolsters self-esteem, and patients with antisocial personality disorder who use cocaine as part of an overall pattern of antisocial behavior. Although not all cocaine abusers fit neatly into these categories, careful psychiatric evaluation and subtyping is essential in designing a specific treatment program for these patients. As the prevalence rate of cocaine abuse increases, studies that examine the efficacy of various treatment approaches for specific subtypes of cocaine abusers will be essential. It is hoped that our work will be a step in that direction.

Adult↗
PubMed1985

Treatment of chronic cocaine abuse and attention deficit disorder, residual type, with magnesium pemoline.

Research suggests that attention deficit disorder (ADD) may persist into adulthood, perhaps predisposing certain individuals to stimulant abuse. The authors describe two adults with chronic cocaine abuse and apparent residual ADD. After failing to respond to conventional treatment modalities, these patients were administered magnesium pemoline. Both displayed a sustained reduction in their cocaine use, without abusing pemoline. This finding suggests that the diagnostic assessment of cocaine abusers should include a search for a history of ADD. A carefully selected subgroup of this population may benefit from treatment with other stimulant medications.

Adult↗
PubMed1981

Hypomania and mania after withdrawal of tricyclic antidepressants.

Seven patients who had been maintained on tricyclic antidepressants developed signs of hypomania or mania shortly (two-seven days) after drug withdrawal. Three patients responded promptly to treatment with neuroleptics. One patient receiving lithium and three others who received no further drug treatment experienced more gradual resolution of symptoms. Tricyclic withdrawal is accompanied by changes in the turnover rate of individual neurotransmitters as well as by shifts in the equilibrium between various transmitter systems. These events may be accompanied by alterations in mood. Although relapse to depression is more common, hypomania or mania may also occur.

Adult↗
PubMed1981

Pulmonary dysfunction in cocaine smokers.

The authors report another complication of freebase cocaine smoking. They found a significant reduction in the carbon monoxide diffusing capacity in the lungs of two patients. This suggests that inhalation of the freebase of cocaine may damage the pulmonary gas exchange surface.

Adult↗
PubMed1980

Opiate use and sexual function.

Although opiate addicts often equate the drug experience with sexual orgasm, diminished libido and impaired sexual performance are common sequelae of chronic use. Early clinical studies suggested that opiates may interfere with sex hormone secretion. The authors carried out three sequential studies which demonstrated that heroin use in man results in acute suppression of luteinizing hormone (LH) release from the pituitary followed by a secondary drop in plasma testosterone levels. The time course of these neuroendocrine events correlates well with the tension-reducing effects of heroin and suggests that drive reduction is an important component of opiate reinforcement.

Erectile Dysfunction↗
PubMed1978

Opiates, catecholamines, behavior, and mood.

Indirect evidence has linked opioid reinforcement with changes in noradrenergic metabolism secondary to drug administration. Methodological precedents for biobehavioral correlations in depressive illness have suggested an important association between changes in mood and biogenic amine excretion patterns in the urines of patients during depression and recovery. This paper presents preliminary data on the possible relationship between changes in catecholamine excretion that were observed and the changes in behavior, mood, psychiatric status, and cardiorespiratory physiology secondary to heroin administration and methadone-assisted withdrawal. This study focuses on the urinary excretion of MHPG, since an appreciable fraction of this metabolite is probably derived from norepinephrine originating in the brain. The subjective changes in mood associated with heroin use, the decrease in respiratory rate, and the behavioral and mental status effects associated with opiate intoxication were observed only in the individuals whose MHPG excretion increased during the period of opiate administration.

Adult↗
PubMed1977

Catecholamine metabolism during heroin use.

The authors examined urinary levels of catecholamines and metabolites during a 10-day period of heroin use in 9 subjects. Catecholamine and metabolite excretion increased over baseline values on the first day of heroin use, but markedly different patterns of change emerged later. In contrast to the significant increase in normetanephrine and decrease in metanephrine excretion in all 9 subjects during heroin use, only 4 subjects showed an increase in 3-methoxy-4-hydroxyphenyl glycol (MHPG) excretion. Moreover, it appeared that the increase in MHPG excretion in this subgroup began on the day before heroin administration, which suggests the possibility of an anticipatory or conditioned response.

Catecholamines↗
PubMed1976

Behavioral and social effects of heroin self-administration and withdrawal.

Behavioral and social reactions to intravenously administered heroin were studied during a 33-day experimental addiction cycle. Three groups of four subject volunteers were allowed to self-administer heroin for a ten-day period as part of a longer study of oplate antagonists. Data relevant to sleep patterns, energy expenditure, social interaction, and other observable behaviors were collected during hourly observations. Comparison of behavioral differences before and after drug administration indicated few significant acute reactions. Reactions to long-term heroin self-administration were most pronounced in the areas of sleep behavior and social interaction. Subjects tended to sleep less, especially during the initial period of acquisition, and to withdraw more from social contact. No changes were noted in energy expenditure during waking hours. The results were interpreted in terms of physiological tolerance, central nervous system arousal, and sleep deprivation.

Adult↗
PubMed1976

A behavioral paradigm for the evaluation of narcotic antagonists.

We have developed an experimental paradigm for the behavioral evaluation of narcotic antagonists. The study specifically examined the heroin-seeking behavior of hard-core narcotic addicts on a research ward under blocked and unblocked conditions. Each patient served as his own control. A long-term follow-up program in the community, with aftercare services, was utilized to determine the relationship between behavior observed on the research ward and behavior that occurred in the community. While preliminary one-month follow-up data offered some cause for an optimistic view of narcotic antagonist treatment, behavioral data observed on the research ward raised serious doubts about the possibility of extinguishing heroin self-administration with antagonists. The behavioral data were not consistent with laboratory descriptions of extinction. Rather, the data suggested that narcotic antagonist programs should emphasize the development of contingencies for the reinforcement of narcotic antagonist self-administration to ensure an opiate-free state, instead of focusing on an extinction approach.

Adult↗