J. Hampton Atkinson

Neurocognitive effects of methamphetamine: a critical review and meta-analysis.

This review provides a critical analysis of the central nervous system effects of acute and chronic methamphetamine (MA) use, which is linked to numerous adverse psychosocial, neuropsychiatric, and medical problems. A meta-analysis of the neuropsychological effects of MA abuse/dependence revealed broadly medium effect sizes, showing deficits in episodic memory, executive functions, information processing speed, motor skills, language, and visuoconstructional abilities. The neuropsychological deficits associated with MA abuse/dependence are interpreted with regard to their possible neural mechanisms, most notably MA-associated frontostriatal neurotoxicity. In addition, potential explanatory factors are considered, including demographics (e.g., gender), MA use characteristics (e.g., duration of abstinence), and the influence of common psychiatric (e.g., other substance-related disorders) and neuromedical (e.g., HIV infection) comorbidities. Finally, these findings are discussed with respect to their potential contribution to the clinical management of persons with MA abuse/dependence.

Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: a controlled study

&NA; This study used structured diagnostic interviews and DSM‐III criteria to assess lifetime prevalence and pre‐morbid risk of psychiatric disorder in a sample of men with long‐standing chronic back pain (CLPB) attending a primary care clinic. A control group of age and demographically matched men without history of back pain was also studied. Compared to controls, men with CLBP had significantly higher lifetime rates of major depression (32% vs. 16%), alcohol use disorder (64.9% vs. 38.8%), and a major anxiety disorder (30.9% vs. 14.3%). Almost all CLBP men ever experiencing a mood disorder reported recurrent, not single, episodes. The 6 month point prevalence of major depression, but not other disorders, was also significantly elevated for men with CLBP. In CLBP, the first episode of major depression generally (58.1%) followed pain onset. While the initial major depressive episode usually commenced within the first 2 years of established pain, late onset mood disorder was also common. By comparison in most cases (81%) onset of alcohol use disorders considerably preceded pain. When an age‐matching procedure was used to gauge relative vulnerability to psychiatric illness in patients and controls, CLBP patients had significantly higher pre‐pain rates of alcohol use disorder but not depression. After age of pain onset, CLBP subjects had over 9 times the risk of developing major depression, but had similar rates of developing alcoholism. We conclude that (1) alcohol use disorders rather than depression may increase risk of developing CLBP, and (2) risk of new onset and recurrent major depression remains high for men throughout their pain career. This suggests that psychological adaptation to long‐standing pain may be less successful than previously thought, especially with regard to recurrent mood disorder.

Methamphetamine Use Parameters Do Not Predict Neuropsychological Impairment in Currently Abstinent Dependent Adults

Methamphetamine (meth) abuse is increasingly of public health concern and has been associated with neurocognitive dysfunction. Some previous studies have been hampered by background differences between meth users and comparison subjects, as well as unknown HIV and hepatitis C (HCV) status, which can also affect brain functioning. We compared the neurocognitive functioning of 54 meth dependent (METH+) study participants who had been abstinent for an average of 129 days, to that of 46 demographically comparable control subjects (METH-) with similar level of education and reading ability. All participants were free of HIV and HCV infection. The METH+ group exhibited higher rates of neuropsychological impairment in most areas tested. Among meth users, neuropsychologically normal (n=32) and impaired (n=22) subjects did not differ with respect to self-reported age at first use, total years of use, route of consumption, or length of abstinence. Those with motor impairment had significantly greater meth use in the past year, but impairment in cognitive domains was unrelated to meth exposure. The apparent lack of correspondence between substance use parameters and cognitive impairment suggests the need for further study of individual differences in vulnerability to the neurotoxic effects of methamphetamine.

Do Patients With HIV-Associated Minor Cognitive/Motor Disorder Exhibit a “Subcortical” Memory Profile? Evidence Using the California Verbal Learning Test:

A new diagnostic category for HIV seropositive patients–Minor Cognitive/Motor Disorder (MCMD)—was recently proposed by an AIDS task force sponsored by the American Academy of Neurology. Based on past memory research with HIV+ patients who were diagnosed according to the Center for Disease Control (CDC) definition of AIDS, we predicted that HIV+ patients who met the new criteria for MCMD would exhibit a “subcortical” memory profile (i.e., they would display primarily a retrieval deficit). This hypothesis was generally supported, but with some exceptions. The HIV+ patients with MCMD were found to have a mild encoding deficit (suggestive of some cortical involvement) superimposed on a pronounced retrieval deficit (suggestive of more extensive subcortical involvement). These findings are consonant with those from a recent neuropathological study indicating an increase in cortical involvement, in addition to predominately subcortical involvement, in more advance stages of the HIV disease process.

Anemia and Red Blood Cell Indices Predict HIV-Associated Neurocognitive Impairment in the Highly Active Antiretroviral Therapy Era

BACKGROUNDnAnemia has been linked to adverse human immunodeficiency virus (HIV) outcomes, including dementia, in the era before highly active antiretroviral therapy (HAART). Milder forms of HIV-associated neurocognitive disorder (HAND) remain common in HIV-infected persons, despite HAART, but whether anemia predicts HAND in the HAART era is unknown.nnnMETHODSnWe evaluated time-dependent associations of anemia and cross-sectional associations of red blood cell indices with neurocognitive impairment in a multicenter, HAART-era HIV cohort study (N = 1261), adjusting for potential confounders, including age, nadir CD4(+) T-cell count, zidovudine use, and comorbid conditions. Subjects underwent comprehensive neuropsychiatric and neuromedical assessments.nnnRESULTSnHAND, defined according to standardized criteria, occurred in 595 subjects (47%) at entry. Mean corpuscular volume and mean corpuscular hemoglobin were positively associated with the global deficit score, a continuous measure of neurocognitive impairment (both P < .01), as well as with all HAND, milder forms of HAND, and HIV-associated dementia in multivariable analyses (all P < .05). Anemia independently predicted development of HAND during a median follow-up of 72 months (adjusted hazard ratio, 1.55; P < .01).nnnCONCLUSIONSnAnemia and red blood cell indices predict HAND in the HAART era and may contribute to risk assessment. Future studies should address whether treating anemia may help to prevent HAND or improve cognitive function in HIV-infected persons.

Typologies of positive psychotic symptoms in methamphetamine dependence

BACKGROUND AND OBJECTIVESnUnderstanding methamphetamine associated psychotic (MAP) symptom typologies could aid in identifying individuals at risk of progressing to schizophrenia and guide early intervention.nnnMETHODSnLatent class analysis (LCA) of psychotic symptoms collected from 40 (nu2009=u200940) methamphetamine dependent individuals with a history of psychotic symptoms but no history of a primary psychotic disorder.nnnRESULTSnThree typologies were identified. In one, persecutory delusions dominated (Type 1), in another persecutory delusions were accompanied by hallucinations (Type 2), and in the third a high frequency of all the assessed hallucinatory and delusional symptoms was observed (Type 3).nnnDISCUSSION AND CONCLUSIONnMAP is a heterogeneous syndrome with positive symptom typologies.nnnSCIENTIFIC SIGNIFICANCEnThis study represents the first attempt at identifying typologies of MAP and highlights the potential utility of LCA in future large-scale studies.

Predictors of psychotropic medication adherence among HIV+ individuals living with bipolar disorder.

Objective HIV infection and bipolar disorder are highly comorbid and associated with frontostriatal disruption, emotional dysregulation, and neurocognitive impairment. Psychiatric and cognitive factors have been linked to antiretroviral nonadherence; however, predictors of psychotropic adherence among HIV+ individuals with psychiatric comorbidities have not been explored. We evaluated predictors of psychotropic adherence among individuals with HIV infection and bipolar disorder. Method Psychiatric medication adherence of 50 participants with HIV infection and bipolar disorder was tracked for 30 days using Medication Event Monitoring Systems. Participants completed neurocognitive, neuromedical, and psychiatric batteries. Results Mean psychotropic adherence rate was 78%; 56% of participants achieved ≥90% adherence. Younger age and onset of depressive symptoms, more severe current depressive symptoms, number of previous psychiatric hospitalizations and suicide attempts, poorer neurocognition, and more negative attitudes and self-beliefs toward medications univariably predicted worse psychotropic adherence (p’su2009<u2009.10). A multivariable model demonstrated a combination of current depressive symptoms and more negative attitudes toward medications significantly predicting poorer adherence (R2u2009=u20090.27, pu2009<u20090.003). Secondary analyses revealed an interaction between neurocognition and mood, such that individuals with HIV infection and bipolar disorder who had greater executive dysfunction and depressive symptoms evidenced the poorest psychotropic adherence (pu2009<u20090.001). Conclusions Both psychiatric and neurocognitive factors contribute to poorer psychotropic adherence among HIV+ individuals with serious mental illness. Adherence interventions aimed at remediating these factors may be especially fruitful.

Overview: The Management of the HIV-Positive Patient with Neuropsychiatric Impairment

The assessment and management of neuropsychiatric (NP*) disturbances in the patient with acquired immunodeficiency syndrome (AIDS) must begin with an understanding of the criteria by which AIDS and other manifestations of human immunodeficiency virus (HIV) infection are diagnosed. Table 1 shows the criteria used by the Centers for Disease Control (CDC) for the classic definition of AIDS, which in large part, is a diagnosis of exclusion.1 The core features include a defect in cell mediated immunity with presence of an opportunistic disease, the most common being Pneumocystis carinii pneumonia (PCP) and/or neoplasia in the form of Kaposi’s sarcoma (KS). With discovery of the agent responsible for the immune deficiency of AIDS, HIV,2–4 the original concept of an AIDS patient being without a known cause of immune deficiency becomes irrelevant. This means that the occurrence of certain disease processes in the presence of a positive HIV antibody test are taken as diagnostic of AIDS.5 Included in this list of conditions qualifying as AIDS are two recently added conditions: severe weight loss (the “wasting syndrome”) and severe neurological illness (the so-called “AIDS dementia complex” or ADC). It must be kept in mind that none of these diseases is a direct measure of the underlying HIV infectious disease process.