Sally L. Satel

Genetic association between dopamine transporter protein alleles and cocaine-induced paranoia.

Paranoia in the context of cocaine abuse is common and potentially dangerous. Several lines of evidence suggest that this phenomenon may be related to function of the dopamine transporter protein (DAT). DAT is the site of presynaptic reuptake of dopamine, an event that terminates its synaptic activity. The gene coding for dopamine transporter protein (DAT1) contains a variable number of tandem repeats (VNTR) polymorphism in the 3′ untranslated region that can be typed by the polymerase chain reaction (PCR) (Vandenbergh et al. 1992).

Effects of cocaine on hospital course in schizophrenia

The authors selected at random every fourth inpatient chart (N = 79) of patients enrolled in a schizophrenia clinic for analysis of substance use patterns and psychiatric hospitalizations. Patients were divided into three groups based on operationally defined lifetime drug use histories: a) cocaine and other substance use; b) substance use without cocaine; and c) no substance use. All available hospital records were examined for presenting symptoms and psychosocial functioning at admission, neuroleptic dosing, and hospital management. Cocaine-using schizophrenics had significantly higher hospitalization rates than other substance-using or non-using patients. No differences were found in hospital presenting symptoms among any cohort. However, the cocaine-using schizophrenic patients demonstrated significantly higher rates of suicidal ideation after cocaine use compared with their own noncocaine-associated hospitalizations or the other groups. The cocaine group also received higher neuroleptic doses by the fifth and sixth weeks of hospitalization compared with their own non-cocaine-associated hospitalizations and with the other groups. This suggests that cocaine use in schizophrenia is associated with poorer illness course and increased hospitalization, including higher rates of suicidal ideation and greater neuroleptic dose.

In defense of a regulated system of compensation for living donation.

PURPOSE OF REVIEW The organ shortage is the major problem in kidney transplantation today. Despite aggressive organ procurement efforts, the supply of donated kidneys, living and deceased, has not matched the growing demand; as a consequence, more and more qualified candidates are suffering on dialysis and then dying before being transplanted. Herein, we provide justification for a regulated system of compensation for donation. RECENT FINDINGS The main argument in favor of compensation is simple-financial incentives will increase donation, so fewer transplant candidates will suffer and die while waiting. In addition, development of a regulated system of compensation is the most effective means of crippling the core economic support for transplant tourism. Because dialysis is so much more expensive than a transplant, compensated donation could be cost-neutral to the healthcare system. Importantly, opinion polls suggest that the public would support compensation. As uncompensated kidney donation is widely accepted, persuasive arguments against compensation must explain why such a system would be morally distinguishable from uncompensated donation. SUMMARY We suggest that the potential advantages of a regulated system of compensation for donation far outweigh any potential disadvantages. It is time to advocate for a change in the law so that trials can be done.

Mental Status Changes in Children Receiving Glucocorticoids Review of the Literature

Glucocorticoid preparations are used commonly in the treatment of many diseases in children and adolescents. Although their physiologic side of effects have been described well, the psychiatric side effects of these medications have received little attention. Limited data suggest that disturbances of affect and behavior may occur in 25-50% of children receiving glucocorticoid. These steroid-induced mental changes may be underrecognized in children, and yet these changes can have considerable impact on social and psychological functioning and treatment outcome. An enhanced awareness and reporting of this phenomenon by clinicians, parents, and teachers would likely lead to better compliance with treatment, improved outcomes, and greater understanding of emotional concomitants of illness.

No association between D3 dopamine receptor (DRD3) alleles and cocaine dependence.

Cocaine is thought to act in the brain primarily by blocking dopamine re‐uptake. The dopamine D3 receptor (genetic locus DRD3) is localized to brain regions that have been implicated in the reinforcing effects of a number of substances of abuse, including cocaine. The DRD3 coding region contains a polymorphism identifiable as a polymerase chain reaction restriction fragment length polymorphism (PCR‐RFLP). This polymorphism leads to an amino acid substitution at position 9 in the extracellular N‐terminus of the D3 dopamine receptor. We examined alleles of the DRD3 gene in cocaine dependence using a genetic association strategy in samples of 62 white and 62 black cocaine‐dependent individuals. Comparisons were made with local (Connecticut) control subjects for both groups, and with a larger sample of literature controls (for the white subjects) and a contrast group of schizophrenic patients (for the black subjects). No association was found between cocaine dependence and DRD3 alleles in either group (Bonferroni corrected). There was a significant difference in allele frequency between whites and blacks. These results are consistent with no role for genetic variation of the D3 dopamine receptor in susceptibility to cocaine dependence.

Addiction and the Brain-Disease Fallacy

From Brainwashed: The Seductive Appeal of Mindless Neuroscience by Sally Satel and Scott Lilienfeld, copyright

Delivering Services to Individuals With Severe Mental Illness: SAMHSA Falls Short

In the wake of the December 2012 mass shooting at an elementary school in Newtown, Connecticut, the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce of the U.S. House of Representatives held a hearing on the Substance Abuse and Mental Health Services Administration (SAMHSA) and its role in caring for people with severe mental illness. The author was among those who testified at the hearing. In this Open Forum she raises points made in that hearing-for example, that in embracing the recovery model and certain evidence-based practices, SAMHSA has been derelict in its duty to attend to the sickest individuals, those with chronic psychosis. She calls on the agency to embrace and promote a more balanced and pragmatic agenda.

Time to Test Incentives to Increase Organ Donation

29. Delmonico FL, Arnold R, Scheper-Hughes N, Siminoff LA, Kahn J, Youngner SJ. Ethical incentives—not payment—for organ donation. N Engl J Med. 2002;346(25):2002-2005. 30. Salim A, Malinoski D, Schulman D, Desai C, Navarro S, Ley EJ. The combination of an online organ and tissue registry with a public education campaign can increase the number of organs available for transplantation. J Trauma. 2010;69(2): 451-454.