Aleksandra Dickov

Drug Addiction as Risk for Suicide Attempts.

Introduction: Suicide is closely linked to the substances use. Therefore it is very important to confirm the factors that affect the possibility of suicidal behavior. Methodology: The survey included 200 respondents; 100 heroin addicts on the substitution program that attempted suicide and 100 opiate addicts who have not attempted suicide. The evaluation included a questionnaire with socio-demographic, hereditary and addiction data, legal problems and then the Minnesota Multiphasic Personality Inventory–MMPI-2. Results: The results showed a statistically significant difference compared to the personality structure, especially pronounced in hypersensitive structures, in relation to the duration of addictive experience and duration of heroin by intravenous route, as well as in relation to the presence of psychotic disorders, drug abuse and suicidal behavior in the family. Conclusion: As risk factors among opiate addicts are indentified interfered biological and psychological factors and the effects of the substances themselves.

Non-atherosclerotic arteriopathy as the cause of ishemic stroke among young adults

The study comprised 100 ischemic stroke patients of both sexes aged 15-45 years who were treated at the Clinic of Neurology of the Clinical Center of Vojvodina in the period January 2001-September 2004. All study subjects were divided into three age groups: 15-25, 26-35 and 36-45 years. Sex, age and risk factors for cerebrovascular disease were determined in all patients. Diagnostic procedures applied in all patients included brain computed tomography and/or magnetic resonance imaging, routine laboratory tests, Doppler imaging of extra and endocranial blood vessels and coagulation tests. Contrast and/or transesophageal echocardiography, immunological blood assays, magnetic resonance angiography and/or computed tomography angiography and/or conventional angiography, thrombophilia markers, antiphospholipid antibodies and toxicological examination, etc. were performed in selected patients. Non-atherosclerotic arteriopathies were found in 8% of all study subjects, and were the most frequent cause of stroke in the age group 15-25. Carotid artery dissection was the most frequent diagnosis overall, found in 6% of all patients. Fibromuscular dysplasia and systemic vasculitis were diagnosed in one patient each. Moyamoya disease, Takayasu disease, infectious and isolated vasculitis of the CNS were not found in our patients.

The relation of stress coping strategies and self-handicapping strategies to the process of opiate addicts behavior changes

Background/Aim. During progress of addictive behavior treatment, the strategies of coping with stress are engaged, but addicts may continue self-handicapping behavior which is opposite to change of a problematic behavior. The aim of this study was to examine the stress coping strategies (CS) and self-handicapping (SH) strategies in relation to the process of addictive behavior change. Methods. In the descriptive clinical study, the sample of 200 consecutive recruited inpatient opiate addicts was explored. They underwent methadone therapy. The general information questionnaire, CSIindicator of coping strategies, SHquestionnaire for assessing self-handicapping behavior and URICAquestionnaire for the assessment of process of change were completed. The Student t-test, Pearson’s correlation coefficient and multiple regression analysis were applied. SPSS for Windows was used and the p ≤ 0.05 defined as statistically significant. Results. Among CS there were significant correlations between avoiding problems strategy and all SH strategies (p≤0.02). The social support was directly proportionate to the process of change (p=0.03, β=0.35). However, the process of change inversely correlated to internal handicaps in interpersonal relationships strategy (IHI) (p= 0.02; β= 0.54) and strategy of focusing to the problem (p=0.00, β= 0.44). Conclusion. The significant positive predictor for the process of addictive behavior change was a strategy of social support, but focusing on the problem and the strategy of internal handicaps in achievement situations were significant negative predictors. The evaluation of motivation process and stress coping strategies could be useful for the creation of improved tailored treatment of opiate addiction.

Cardiovascular effects of methadone and concomitant use of diazepam during methadone maintenance treatment induction: low concentration risk

ABSTRACT Background: The aim is to evaluate the role of diazepam concentrations in development of low-concentration-methadone-associated QTc prolongation in patients with opioid use disorder during methadone maintenance treatment (MMT) induction. Research design and methods: Individuals with addiction disorder on MMT were studied before the beginning of MMT and after one and six months of MMT. Serum concentrations of methadone, diazepam, electrolytes and ECG were analyzed. Results: Thirty patients were enrolled. The mean methadone concentration at time points was 177 ± 119 ng/ml and 343 ± 182 ng/ml, while the mean diazepam concentration was 561 ± 437 ng/ml and 1045 ± 933 ng/ml. The QTc interval before the introduction of MMT, after 1 and 6 months of MMT were 412 ± 27 ms, 425 ± 18 ms and 424 ± 15 ms, respectively, showing statistically significant increase in the length of QTc interval after 1 and 6 months of MMT. Statistically significant correlation between the concentration of methadone and QTc interval length at observed time points (R2 = 0.239, p = 0.018; R2 = 0.513, p = 0.006) was shown, and it remained so if the concentration of diazepam was included (R2 = 0.347, p = 0.026, R2 = 0.513, p = 0.009). Conclusions: The prolongation of QTc below the risk threshold in low methadone therapeutic doses has been recorded and concomitant use of diazepam could be a co-factor in such issue.

The impact of family resources and stressful events in the progression of drug addicts in the process of change

Objective: The families, when faced with difficult life events, use a specific key processes of resilience. The main objective of this study was to determine the predictor role of family resources and stressful events through which the family passes in relation to the advancement of drug users through the process of change (termination of abuse) and in relation to the quality of life of the addict. Methods: To obtain data subjects were surveyed through four questionnaires. The questionnaire with general information, FILE scale gives the index of family stress, and family vulnerability as a result of the aggregation of life events experienced by families. FIRM is the scale used for social support, WHODAS generic instrument for assessing health and disability, including mental, neurological and addiction. URICA was used for testing stages of change. The sample consisted of 200 patients who were hospitalized at the department of addiction. Results: Our study confirmed that there is a significant correlation between family resources and life events. Correlation between quality of life and life events is not statistically significant at the total score of quality of life, nor individual domains. Only in the area of quality of life relating to cognition, there is a weak negative correlation. Conclusion: Family resources and stressful life events do not affect the quality of life in the process of change but there is a significant correlation between family resources and stressful life events and families that have passed through periods of life events can strengthen their individual capacities.

Healthy in transition - Health system in Serbia - Management approach

Abstract The center of the healthcare system is all about men, throughout their lives, from conception to death, with the natural ability to take care of themselves – both when they are healthy and when they fall ill or when they need an organized and specialized help. Since a disease affects almost all men, it is one of the required priorities to think ahead. People are obliged under certain circumstances to pay for the healthcare services while they are healthy, and find its organized system available when they are ill. Healthcare for citizens of Serbia, as well as the coordinated and organized health systems, with their primary, secondary, and tertiary healthcare should be accessible to everyone under equal conditions, the principles of scientific medicine on the one hand, and business performance of health institutions, on the other. It is a human right to use an organized and efficient healthcare system, which gives them freedom from disease, and thus creates a free society.

Social functioning and support of addicts on methadone

The study aimed to determine characteristics of addicts on methadone maintenance therapy (MMT), which are related to the level of social functioning, with emphasis on the role of social support. In a prospective study, opiate addicts (n=150) who were on MMT completed the Pompidou questionnaire, the Social Adaptation Self-evaluation Scale (SASS) and the Multidimensional Scale of Perceived Social Support (MSPSS). Statistical data processing was based on testing the difference between features that best distinguish subgroups of addicts who were dissatisfied, moderately satisfied and satisfied with their social functioning. Opiate addicts up to 30 years of age had a statistically higher score on SASS scale than addicts over 30; addicts who are dissatisfied are mainly unemployed and have average or above-average family/community financial status; opiate addicts who were moderately satisfied with their social functioning were three years or longer on MMT; paradoxically, the highest mean value of score on MSPSS scale dominated among addicts who are dissatisfied with their social functioning. These results indicate that age, employment, financial status, duration of MMT are the characteristics of addicts which are related to the level of social functioning. Social support is most perceived by addicts who are dissatisfied with their social functioning.