Miklos F. Losonczy

Effects of Repeated Deployment to Iraq and Afghanistan on the Health of New Jersey Army National Guard Troops: Implications for Military Readiness

OBJECTIVES We assessed the effects of prior military service in Iraq or Afghanistan on the health of New Jersey Army National Guard members preparing for deployment to Iraq. METHODS We analyzed anonymous, self-administered predeployment surveys from 2543 National Guard members deployed to Iraq in 2008. We used bivariate and multivariate analyses to measure the effects of prior service in Afghanistan (Operation Enduring Freedom [OEF]) or Iraq (Operation Iraqi Freedom [OIF]) on mental and physical health. RESULTS Nearly 25% of respondents reported at least 1 previous OEF or OIF deployment. Previously deployed soldiers were more than 3 times as likely as soldiers with no previous deployments to screen positive for posttraumatic stress disorder (adjusted odds ratio [AOR]=3.69; 95% confidence interval [CI]=2.59, 5.24) and major depression (AOR=3.07; 95% CI=1.81, 5.19), more than twice as likely to report chronic pain (AOR=2.20; 95% CI=1.78, 2.72) and more than 90% more likely to score below the general population norm on physical functioning (AOR=1.94; 95% CI=1.51, 2.48). CONCLUSIONS Repeated OEF and OIF deployments may adversely affect the military readiness of New Jersey National Guard combat soldiers.

Risperidone Decreases Craving and Relapses in Individuals with Schizophrenia and Cocaine Dependence

Objective: To examine the efficacy of atypical neuroleptics for decreasing craving and drug relapses during protracted withdrawal in individuals dually diagnosed with schizophrenia and cocaine dependence. Method: We conducted a 6-week, open-label pilot study comparing risperidone with typical neuroleptics in a sample of withdrawn cocaine-dependent schizophrenia patients. Results: Preliminary results suggest that individuals treated with risperidone had significantly less cue-elicited craving and substance abuse relapses at study completion. Further, they showed a trend toward a greater reduction in negative and global symptoms of schizophrenia. Conclusion: Atypical neuroleptics may help reduce craving and relapses in this population. Future research should include more rigorous double-blind placebo-controlled studies with this class of medications.

The efficacy of olanzapine for decreasing cue-elicited craving in individuals with schizophrenia and cocaine dependence: a preliminary report

Objective: Although a growing body of research suggests that atypical neuroleptic medications are efficacious in the treatment of cocaine addiction among individuals with schizophrenia, more rigorously controlled trials are needed. To extend this research, we performed a 6-week double-blind study comparing olanzapine to haloperidol with the primary objective of reducing cue-elicited cocaine craving and the secondary aims of decreasing substance use, improving psychiatric symptoms, and determining an effect size for future studies. Methods: Thirty-one subjects with cocaine dependence and schizophrenia were randomized to olanzapine or haloperidol, underwent a cue-exposure procedure, and completed psychiatric and substance abuse ratings. Results: Individuals in the olanzapine group who completed the study had a significant reduction on the energy subscale of the Voris Cocaine Craving Scale at study completion compared with individuals in the haloperidol group. The olanzapine-treated group also had lower, but not statistically significant, PANSS General Psychopathology Subscale scores and fewer positive urine toxicology screens compared with those in the haloperidol group. Conclusion: This small, but rigorously controlled, pilot trial provides additional evidence for the use of atypical antipsychotics for the treatment of individuals with co-occurring schizophrenia and cocaine dependence. Reductions in craving were associated with medium to large effect sizes.

Cognitive disparity in schizophrenics with and without cocaine dependency.

Although cognition has been investigated in individuals with schizophrenia and in non-schizophrenic cocaine abusers, few studies have focused on cocaine-abusing schizophrenics. Previous studies have shown contradictory results despite the fact that individuals with schizophrenia and cocaine dependence have worse long-term outcomes, and that each disorder separately is associated with neuropsychological impairment. The present study intended to clarify these inconsistencies with a comprehensive neuropsychological battery. Twenty-four cocaine-dependent schizophrenics and 23 non-drug abusing schizophrenics were recruited from the VA. Participants were administered tests focusing on motor skills, processing speed, attention, concentration, and executive functioning. While individuals with schizophrenia and cocaine dependence performed worse on the Grooved Peg Board and the Stroop A, the non-drug abusing schizophrenics performed worse on Trails Part A and B. However, a MANOVA failed to show group differences in overall neuropsychological performance. These findings are similar to the existing literature and suggest that cocaine may compromise motor functioning.

Preliminary Outcomes from a Community Linkage Intervention for Individuals with Co-Occurring Substance Abuse and Serious Mental Illness

Abstract Objective: Few interventions assist individuals with a mental illness and a co-occurring substance abuse disorder in the transition from hospitalization to outpatient treatment. This change in care is often abrupt, resulting in fragmented treatment that jeopardizes recovery. This article reports on the preliminary outcomes from a new eight-week linkage intervention entitled “Time-Limited Case Management (TLC)” that integrates intensive outreach, Dual Recovery Therapy (DRT), and peer support to facilitate outpatient treatment engagement following discharge from Acute Psychiatry. Method: This eight-week naturalistic feasibility study included 59 recently hospitalized subjects with a mental illness and substance abuse disorder who were offered the new service. The individuals who agreed to receive TLC (n = 26) formed the treatment group and those who refused (n = 33) made up the comparison group. Results: The TLC service was successfully implemented into the system and improved the transition from inpatient to outpatient care. The individuals who received the TLC intervention had a higher show rate at the Day Treatment Center intake appointment, attended more days of treatment at the Day Center, had greater pharmacy refill compliance, and were less likely to be lost to follow-up at eight weeks than the comparison group. Conclusion: TLC represents a promising new approach to maintaining continuity in care following psychiatric hospitalization that may be easily implemented in other systems. We are currently in the process of developing an implementation manual and doing a large randomized controlled trial to determine whether the intervention improves substance abuse and psychiatric outcomes in addition to facilitating treatment engagement.

Electroretinogram and cue-elicited craving in withdrawn cocaine-dependent patients: a replication.

Background: We previously reported that cocaine-dependent patients with a reduced blue cone b wave electroretinogram (ERG) responses had significantly more cue-elicited craving. Methods: A new series of 21 recently withdrawn cocaine-dependent patients completed a craving questionnaire at baseline and following cue exposure; an ERG was also performed. Results: Cocainedependent patients with a blunted ERG blue cone response (<0.5 μV) showed greater increases in craving following cue exposure. When subjects were included from our preliminary study (N = 14), these differences became highly significant. Conclusions: Patients with a reduced ERG response may represent a subgroup more vulnerable to cocaine craving and future relapse.

A brief community linkage intervention for veterans with a persistent mental illness and a co-occurring substance abuse disorder

Objective: Individuals with co-occurring psychiatric and substance abuse problems often exhibit poor outpatient treatment engagement and re-hospitalization following discharge from acute psychiatric services. Although case management can improve treatment engagement and reduce attrition, these services are often delivered indefinitely, limiting the availability of treatment slots. In an effort to reduce re-hospitalization rates and improve outcomes during the transition from inpatient to outpatient treatment, we developed and evaluated Time-Limited Case Management (TLC), an eight-week integrated mental health and substance abuse augmentation intervention. Method: Sixty-five dually diagnosed veterans admitted to inpatient psychiatric treatment were included in the program evaluation, 32 who received the TLC service in addition to Treatment as Usual (TAU) that began during inpatient treatment and continued after the transition to outpatient services, and a comparison group of 33 who received only TAU without transitional support provided through the TLC augmentation service. Results: The TLC group had fewer days and episodes of hospitalization at two and six month post-study entry. Furthermore, the TLC group exhibited greater improvements on the Global Assessment of Functioning from baseline to the six-month follow-up. Conclusion: TLC appears to be an effective transitional augmentation service with benefits that persist beyond the eight weeks of the program. Future research should include a larger and more rigorously controlled trial to confirm the efficacy and unique contributions of the intervention

The Relationship Between Military Service Eras and Psychosocial Treatment Needs Among Homeless Veterans With a Co-Occurring Substance Abuse and Mental Health Disorder

This article will examine baseline assessment data from consecutive admissions to the MISSION Program, a transitional case management program for homeless veterans, to better understand the differences across military service eras that impact the psychosocial treatment needs of homeless, mentally ill, substance-abusing veterans. In all, 373 homeless veterans with a co-occurring mental illness and substance abuse disorder received the Structured Clinical Interview for DSM-IV Diagnosis, a modified Addiction Severity Index, the BASIS-32, and a comprehensive assessment battery focusing on other psychosocial treatment needs. Chi-square analysis and ANOVA were used to measure differences in mental health, substance use, physical health status, and homelessness across service eras, broken down by Vietnam era, post-Vietnam era, and Persian Gulf/Middle East era. Persian Gulf/Middle East era veterans were significantly more likely to have mental health problems than other veteran cohorts, especially problems with post-traumatic stress disorder (p ≤ .001), and reported more days of mental health problems in the last month (p = .01). Mideast veterans also became homeless at a significantly earlier age than other veterans (p ≤ .001), were more likely to report housing instability in their families of origin (p ≤ .05) and to attribute their homelessness to mental health problems (p = .01). Service providers need to be aware of the diversity of homeless veterans’ service needs by period of military service in order to develop well-targeted, effective interventions.