Sonia Krenz

Bupropion-induced somnambulism.

Whereas there are some case reports of bupropion‐induced vivid dreaming and nightmares, until now it has not been associated with somnambulism. A case is reported of a patient treated with bupropion as a smoking cessation medication, who developed somnambulism during nicotine withdrawal. Furthermore, the sleepwalking episodes were associated with eating behaviour. Amnesia was reported for all episodes. As, on one hand, bupropion is a noradrenergic and dopaminergic drug and nicotine withdrawal, on the other hand, is associated with alterations in monoaminergic functions, an interaction at the level of these neurotransmitters is suggested as the underlying mechanism.

French Version of the Addiction Severity Index (5th Edition): Validity and Reliability among Swiss Opiate-Dependent Patients

Objective: The aim of the study was to validate a French adaptation of the 5th version of the Addiction Severity Index (ASI) instrument in a Swiss sample of illicit drug users. Participants and Setting: The participants in the study were 54 French-speaking dependent patients, most of them with opiates as the drug of first choice. Procedure: Analyses of internal consistency (convergent and discriminant validity) and reliability, including measures of test-retest and inter-observer correlations, were conducted. Results: Besides good applicability of the test, the results on composite scores (CSs) indicate comparable results to those obtained in a sample of American opiate-dependent patients. Across the seven dimensions of the ASI, Cronbach’s α ranged from 0.42 to 0.76, test-retest correlations coefficients ranged from 0.48 to 0.98, while for CSs, inter-observer correlations ranged from 0.76 to 0.99. Conclusions: Despite several limitations, the French version of the ASI presents acceptable criteria of applicability, validity and reliability in a sample of drug-dependent patients.

Acceptance of an intended smoking ban in an alcohol dependence clinic

Alcohol treatment professionals are often reluctant to address tobacco dependence in their patients or to implement smoke-free policies in inpatient treatment programs, fearing, among others, non-adherence to alcohol treatment. The aim of the present study was to evaluate the acceptance of an intended smoking ban in a specialized hospital for alcohol withdrawal. Fifteen of 54 patients reported that they would not begin or quit alcohol treatment if smoking were banned in the clinic, but only five would not begin or quit if nicotine replacement were available. The present study indicates that a non-smoking policy would be feasible in a Swiss alcohol clinic, without jeopardizing alcohol treatment adherence.

Worsening of obsessive–compulsive symptoms under methadone tapering

There is data supporting the hypothesis that the endogenous opioid system may play a role in the pathophysiology of Obsessive Compulsive Disorder (OCD). The authors report a case of worsening of OCD during methadone tapering, which seems to confirm the role of the opioid system in the pathophysiology of OCD. The possible involvement of the cortico-limbic-basal-ganglia-thalamic circuit in the observed phenomenon is discussed.

Psychological Challenges for the Oncology Clinician Who Has to Break Bad News

Work-related stress of the oncology clinician is not only due to heavy clinical and administrative duties, but also arises when breaking bad news. However, there is important interindividual variation in stress levels during patient encounters, mainly due to the significance the situation represents for the oncologist. A reflection on his own development, his professional identity, and ways of dealing with the patient’s suffering can reduce his levels of stress and distress and prevent burnout and other psychiatric disturbances. This chapter summarizes the psychological challenges the oncology clinician is facing when he announces the diagnosis of cancer, deals with the deception of relapse, discusses the transition to palliative care, copes with progression of the disease and uncertainty, and cares for the dying who is facing the unknown. Ways of reflecting on and dealing with these situations from a psychological and communicational perspective are described and illustrated by case vignettes.

Psychometric properties of a French-language version of the stage of change readiness and treatment eagerness scale (SOCRATES)

The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) is an instrument designed to measure motivation to change behavioural and psychological problems. While the original that described a three-factor structure of the scale has been replicated by some studies, some others found rather a two-factor structure. The factor structure may vary if used in different care settings, as there tends to be considerable differences in the severity of substance abuse problems and in the perception of these problems between individuals. All previously published validation studies have used the scale to assess the motivational status with regard to alcohol consumption. The scale has, however, been used for other drugs, often in mixed samples using different drugs. No study has reported on the utility of SOCRATES for this. Notably, no study has tested whether the factor structure was maintained when using the scale addressing different drugs. The objective of the present study is to address this concern and to establish the factor-structure of a French version of the SOCRATES in different groups of patients presenting different substance-abuse problems. Methods: The study was realised in the French-speaking part of Switzerland. The SOCRATES scores of four groups of patients were included in the present analyses: 90 hospitalised multi-drug dependent patients, 11 cannabis-abusing schizophrenic patients, and 24 tobacco smokers. The terms used in addressing patients’ motivation were “drugs”, “cannabis” or “smoking”. Results: A PCA followed by a varimax rotation revealed a three-factor solution. Only one item was clearly classified as being part of another than the original factor (item 14 in Recognition instead of Taking steps). Cronbachs alpha were 0.90 for Recognition, 0.73 for Ambivalence, and 0.91 for Taking Steps. Conclusions: The factor-structure of the French language version of the SOCRATES applied to different groups of patients presenting different substance abuse problems corresponded almost exactly to that originally proposed by Miller and Tonigan (Miller WR, Tonigan JS. . Assessing drinkers’ motivations for change: The stages of change readiness and treatment eagerness scale (SOCRATES). Psychology of Addictive Behaviours 10:81–89) supporting the internal validity of the SOCRATES. The present data suggest that the type of drug can be changed without changing internal consistency and construct validity of the French version of the SOCRATES.

L'induction rapide du sevrage par des antagonistes des opiacés sous anesthésie: une alternative dans le traitement de la dépendance aux opiacés?

Die schnelle Einleitung des Entzuges mittels Opiatantagonisten unter Anasthesie ist eine kurzlich fur die Opiat-Entgiftung eingefuhrte Technik. Durch die deutliche Verkurzung der Entzugssymptomatik erhoht sich der Konfort der Patienten. Sie stellt darum eine interessante Alternative zu den konventionellen Methoden dar. Es wird auf den geschichtlichen Hintergrund und die im Zusammenhang mit der Anwendung der Technik aufgeworfenen Fragen eingegangen.

The efficiency of a carbamazepine-mianserine combination scheme in opiate detoxification

A recent comparative randomized double-blind study has suggested the utility of a carbamazepine/mianserin combination as a treatment for opiate withdrawal. The aim of the present study was to explore the feasibility and efficiency of this combination under naturalistic conditions. Five hundred and fifty mostly polysubstance abusing patients treated with a standardized scheme combining carbamazepine and mianserin were assessed with regard to deviations to the protocol, used co-medications and retention in treatment. Three hundred and sixty three patients (66.0%) received the carbamazepine/mianserin combination as specified by the standardized protocol. In 350 patients (63.7%) the whole 10 days was completed. The most frequently used p.r.n. medications were for anxiety (47.5%) and insomnia (54.5%). The treatment of opiate withdrawal with a carbamazepine/mianserin combination scheme in an inpatient setting seems to be feasible and applicable with few adaptations to most patients, and may represent an interesting treatment option for multidrug users.