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Emergency Medicine Clinics of North... Feb 2024Substance use disorders (SUDs) present a challenge in the emergency department (ED) setting. This article provides an overview of SUDs, their clinical assessment, legal... (Review)
Review
Substance use disorders (SUDs) present a challenge in the emergency department (ED) setting. This article provides an overview of SUDs, their clinical assessment, legal considerations in drug testing, diagnosis, and treatment approaches. SUDs are prevalent and coexist with mental health disorders, necessitating comprehensive evaluation and management. Clinical assessment involves screening tools, substance use history, and identification of comorbidities. Diagnosis relies on a thorough evaluation of substance abuse patterns and associated medical conditions. Treatment approaches encompass a multidisciplinary approach, incorporating counseling, medications, and social support. Effective management of SUDs in the ED requires a comprehensive understanding of these complex disorders.
Topics: Humans; Substance-Related Disorders; Comorbidity; Emergency Service, Hospital
PubMed: 37977753
DOI: 10.1016/j.emc.2023.06.023 -
Revue Medicale Suisse Jun 2024
Topics: Humans; Behavior, Addictive; Substance-Related Disorders
PubMed: 38836390
DOI: 10.53738/REVMED.2024.20.877.1099 -
The Psychiatric Clinics of North America Sep 2023Substance use disorder (SUD) is among the leading causes of premature morbidity and mortality and imposes significant health, economic, and social burdens. Gender... (Review)
Review
Substance use disorder (SUD) is among the leading causes of premature morbidity and mortality and imposes significant health, economic, and social burdens. Gender differences have been found in the development, course, and treatment of SUD, with women at increased risk for physiologic and psychosocial consequences compared with men. Reasons for these differences are multifold and include biological, genetic, environmental, and behavioral factors. This article discusses SUD among women, emphasizing clinical considerations for care. Specific topics include epidemiology, sex and gender differences, common comorbidities, screening, diagnosis, treatment, pregnancy, and sociocultural factors.
Topics: Male; Pregnancy; Humans; Female; Substance-Related Disorders; Comorbidity; Sex Factors
PubMed: 37500246
DOI: 10.1016/j.psc.2023.04.006 -
Genes Sep 2023Substance use disorders (SUD), like many neuropsychiatric conditions, are a heterogeneous group of disorders with similar symptomatology but often different...
Substance use disorders (SUD), like many neuropsychiatric conditions, are a heterogeneous group of disorders with similar symptomatology but often different pathoetiology [...].
Topics: Humans; Substance-Related Disorders; Genomics
PubMed: 37761900
DOI: 10.3390/genes14091760 -
Biomedicine & Pharmacotherapy =... Jan 2024Drug addiction is a complex disease affected by numerous genetic and environmental factors. Brain regions in reward pathway, neuronal adaptations, genetic and epigenetic... (Review)
Review
Drug addiction is a complex disease affected by numerous genetic and environmental factors. Brain regions in reward pathway, neuronal adaptations, genetic and epigenetic interactions causing transcriptional enhancement or repression of multiple genes induce different addiction phenotypes for varying duration. Addictive drug use causes epigenetic alterations and similarly epigenetic changes induced by environment can promote addiction. Epigenetic mechanisms include DNA methylation and post-translational modifications like methylation, acetylation, phosphorylation, ubiquitylation, sumoylation, dopaminylation and crotonylation of histones, and ADP-ribosylation. Non-coding RNAs also induce epigenetic changes. This review discusses these above areas and stresses the need for exploring epidrugs as a treatment alternative and adjunct, considering the limited success of current addiction treatment strategies. Epigenome editing complexes have lately been effective in eukaryotic systems. Targeted DNA cleavage techniques such as CRISPR-Cas9 system, CRISPR-dCas9 complexes, transcription activator-like effector nucleases (TALENs) and zinc-finger nucleases (ZFNs) have been exploited as targeted DNA recognition or anchoring platforms, fused with epigenetic writer or eraser proteins and delivered by transfection or transduction methods. Efficacy of epidrugs is seen in various neuropsychiatric conditions and initial results in addiction treatment involving model organisms are remarkable. Epidrugs present a promising alternative treatment for addiction.
Topics: Humans; Epigenomics; Histones; DNA Methylation; Epigenesis, Genetic; Substance-Related Disorders
PubMed: 38043446
DOI: 10.1016/j.biopha.2023.115951 -
International Review of Psychiatry... 2023
Topics: Humans; Addiction Medicine; Substance-Related Disorders; Education, Medical
PubMed: 38299648
DOI: 10.1080/09540261.2023.2285938 -
Advances in Pharmacology (San Diego,... 2024Modafinil is a central nervous system stimulant approved for the treatment of narcolepsy and sleep disorders. Due to its wide range of biochemical actions, modafinil has...
Modafinil is a central nervous system stimulant approved for the treatment of narcolepsy and sleep disorders. Due to its wide range of biochemical actions, modafinil has been explored for other potential therapeutic uses. Indeed, it has shown promise as a therapy for cognitive disfunction resulting from neurologic disorders like ADHD, and as a smart drug in non-medical settings. The mechanism(s) of actions underlying the therapeutic efficacy of this agent remains largely elusive. Modafinil is known to inhibit the dopamine transporter, thus decreasing dopamine reuptake following neuronal release, an effect shared by addictive psychostimulants. However, modafinil is unique in that only a few cases of dependence on this drug have been reported, as compared to other psychostimulants. Moreover, modafinil has been tested, with some success, as a potential therapeutic agent to combat psychostimulant and other substance use disorders. Modafinil has additional, but less understood, actions on other neurotransmitter systems (GABA, glutamate, serotonin, norepinephrine, etc.). These interactions, together with its ability to activate selected brain regions, are likely one of the keys to understand its unique pharmacology and therapeutic activity as a CNS stimulant. In this chapter, we outline the pharmacokinetics and pharmacodynamics of modafinil that suggest it has an "atypical" CNS stimulant profile. We also highlight the current approved and off label uses of modafinil, including its beneficial effects as a treatment for sleep disorders, cognitive functions, and substance use disorders.
Topics: Humans; Modafinil; Central Nervous System Stimulants; Benzhydryl Compounds; Dopamine; Substance-Related Disorders
PubMed: 38467484
DOI: 10.1016/bs.apha.2023.10.006 -
Critical Care Nursing Clinics of North... Dec 2023Substance use disorders are increasing in the growing older adult population in the U.S. and abroad. Most interventions fail to account for the unique physical and... (Review)
Review
Substance use disorders are increasing in the growing older adult population in the U.S. and abroad. Most interventions fail to account for the unique physical and psychosocial risk factors associated with substance use disorder. The older adult makes up a large portion of ICU admits and it is imperative to identify appropriate methods of prevention and treatment in this patient population. Important components of substance use disorder assessment and treatment in the older ICU patient were identified from the literature. Increased morbidity related to age-related conditions, pharmacologic concerns, withdrawals, and stigma were identified as essential items to consider when caring for the older ICU patient with substance use disorder.
Topics: Humans; Aged; Substance-Related Disorders; Risk Factors; Critical Care
PubMed: 37838419
DOI: 10.1016/j.cnc.2023.06.004 -
Genes Nov 2023Trauma in childhood and adolescence has long-term negative consequences in brain development and behavior and increases the risk for psychiatric disorders. Among them,... (Review)
Review
Trauma in childhood and adolescence has long-term negative consequences in brain development and behavior and increases the risk for psychiatric disorders. Among them, post-traumatic stress disorder (PTSD) during adolescence illustrates the connection between trauma and substance misuse, as adolescents may utilize substances to cope with PTSD. Drug misuse may in turn lead to neuroadaptations in learning processes that facilitate the consolidation of traumatic memories that perpetuate PTSD. This reflects, apart from common genetic and epigenetic modifications, overlapping neurocircuitry engagement triggered by stress and drug misuse that includes structural and functional changes in limbic brain regions and the salience, default-mode, and frontoparietal networks. Effective strategies to prevent PTSD are needed to limit the negative consequences associated with the later development of a substance use disorder (SUD). In this review, we will examine the link between PTSD and SUDs, along with the resulting effects on memory, focusing on the connection between the development of an SUD in individuals who struggled with PTSD in adolescence. Neuroimaging has emerged as a powerful tool to provide insight into the brain mechanisms underlying the connection of PTSD in adolescence and the development of SUDs.
Topics: Humans; Adolescent; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Brain; Neuroimaging; Drug Misuse
PubMed: 38136935
DOI: 10.3390/genes14122113 -
American Journal of Clinical Dermatology Mar 2024Recreational drug use is increasingly common in the dermatology patient population and is often associated with both general and specific mucocutaneous manifestations.... (Review)
Review
Recreational drug use is increasingly common in the dermatology patient population and is often associated with both general and specific mucocutaneous manifestations. Signs of substance use disorder may include changes to general appearance, skin, and mucosal findings associated with particular routes of drug administration (injection, insufflation, or inhalation) or findings specific to a particular drug. In this review article, we provide an overview of the mucocutaneous manifestations of illicit drug use including cocaine, methamphetamine, heroin, hallucinogens, marijuana, and common adulterants to facilitate the identification and improved care of these patients with the goal being to connect this patient population with appropriate resources for treatment.
Topics: Humans; Cocaine; Heroin; Methamphetamine; Recreational Drug Use; Substance-Related Disorders
PubMed: 38217568
DOI: 10.1007/s40257-023-00835-y