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Social Psychiatry and Psychiatric... Apr 2021To determine the prevalence of substance use disorders (SUDs) in patients with schizophrenia in a sample from South Africa and compare the clinical and demographic...
PURPOSE
To determine the prevalence of substance use disorders (SUDs) in patients with schizophrenia in a sample from South Africa and compare the clinical and demographic correlates in those with and without co-occurring SUDs.
METHODS
Patients with schizophrenia were interviewed using the Xhosa version SCID-I for DSM-IV. We used logistic regression to determine the predictors of SUDs.
RESULTS
In the total sample of 1420 participants, SUDs occurred in 47.8%, with the most prevalent SUD being cannabis use disorders (39.6%), followed by alcohol (20.5%), methaqualone (6.2%), methamphetamine (4.8%) and other SUDs (cocaine, ecstasy, opioids, 0.6%). Polydrug use occurred in 40%, abuse occurred in 13.5%, and 39.6% had at least one substance dependence diagnosis. Significant predictors of any SUD were younger age (41-55 vs. 21-30: OR = 0.7, 95% CI = 0.5-0.9), male sex (OR = 8.6, 95% CI = 5.1-14.6), inpatient status (OR = 1.7, 95% CI = 1.3-2.1), post-traumatic stress symptoms (OR = 4.6, 95% CI = 1.6-13.3), legal (OR = 3.4, 95% CI = 2.0-5.5) and economic problems (OR = 1.4, 95% CI = 1.0-2.0). Methamphetamine use disorders occurred significantly less often in the Eastern compared to the Western Cape provinces. Inpatient status and higher levels of prior admissions were significantly associated with cannabis and methamphetamine use disorders. Post-traumatic stress symptoms were significantly associated with alcohol use disorders. Anxiety disorders were associated with other SUDs.
CONCLUSION
SUDs occurred in almost half of the sample. It is important for clinicians to identify the presence of SUDs as their presence is associated with characteristics, such as male sex, younger age, inpatient status, more prior hospitalisations, legal and economic problems, PTSD symptoms and anxiety.
Topics: Alcoholism; Comorbidity; Humans; Male; Prevalence; Schizophrenia; South Africa; Substance-Related Disorders
PubMed: 32797244
DOI: 10.1007/s00127-020-01942-5 -
Journal of Analytical Toxicology Mar 2021Mebroqualone is an analogue of methaqualone, and there is a very little published information regarding the toxicity of this designer drug. We describe two cases with...
Mebroqualone is an analogue of methaqualone, and there is a very little published information regarding the toxicity of this designer drug. We describe two cases with non-lethal levels of mebroqualone in blood collected at autopsy. Case 1 was an accidental death that involved a house fire, and the decedent was found to have a blood mebroqualone concentration of 10,228 ng/mL. Case 2 was a completed suicide by train, and the decedent was found to have a blood concentration of 115 ng/mL. To our knowledge, this is the first report in the scientific literature to compare two postmortem blood concentrations of mebroqualone. Mebroqualone was extracted from postmortem blood using a simple liquid-liquid extraction procedure and analyzed via gas chromatography-mass spectrometry.
Topics: Autopsy; Designer Drugs; Gas Chromatography-Mass Spectrometry; Humans
PubMed: 32789477
DOI: 10.1093/jat/bkaa077 -
Molecules (Basel, Switzerland) Apr 2020Sensitive real-time detection of vapors produced by the precursors, reagents and solvents used in the illegal drugs manufacture represents a priority nowadays. Acetic...
Sensitive real-time detection of vapors produced by the precursors, reagents and solvents used in the illegal drugs manufacture represents a priority nowadays. Acetic anhydride (AA) is the key chemical used as acetylation agent in producing the illegal drugs heroin and methaqualone. This study was directed towards quick detection and quantification of AA in air, using two fast and very sensitive analytical techniques: photoionization detection (PID) and ion mobility spectrometry (IMS). Results obtained indicated that both PID and IMS can sense AA at ultra-trace levels in air, but while PID produces a non-selective response, IMS offers richer information. Ion mobility spectrometric response in the positive ion mode presented one product ion, at reduced ion mobility K of 1.89 cm V s (almost overlapped with positive reactant ion peak), while in the negative ion mode two well separated product ions, with K of 1.90 and 1.71 cm V s, were noticed. Our study showed that by using a portable, commercial IMS system (model Mini IMS, I.U.T. GmbH Berlin) AA can be easily measured at concentrations of 0.05 ppm (0.2 mg m) in negative ion mode. Best selectivity and sensitivity of the IMS response were therefore achieved in the negative operation mode.
Topics: Acetic Anhydrides; Biosensing Techniques; Illicit Drugs; Ion Mobility Spectrometry; Reproducibility of Results; Trace Elements
PubMed: 32316669
DOI: 10.3390/molecules25081852 -
Evidence-based Complementary and... 2020is a medicinal herb of Leguminosae family. It is distributed in the tropical and humid regions. The plant is traditionally used in the treatment of typhoid, diabetes,... (Review)
Review
is a medicinal herb of Leguminosae family. It is distributed in the tropical and humid regions. The plant is traditionally used in the treatment of typhoid, diabetes, malaria, asthma, ringworms, tinea infections, scabies, blotch, herpes, and eczema. The review is aimed at unveiling the ethnobotanical description and pharmacological activities of Different parts of the plant are reported in folk medicine as therapeutic substances for remediation of diverse diseases and infections. The extracts and isolated compounds displayed pronounced pharmacological activities. Display of antibacterial, antioxidant, antifungal, dermatophytic, anticancer, hepatoprotective, antilipogenic, anticonvulsant, antidiabetic, antihyperlipidemic, antimalarial, anthelmintic, and antiviral activities could be due to the array of secondary metabolites such as tannins, alkaloids, flavonoids, terpenes, anthraquinone, saponins, phenolics, cannabinoid alkaloids, 1,8-cineole, caryophyllene, limonene, -selinene, -caryophyllene, germacrene D, cinnamic acid, pyrazol-5-ol, methaqualone, isoquinoline, quinones, reducing sugars, steroids, and volatile oils present in different parts of the plant. The review divulges the ethnobotanical and pharmacological activities of the plant and also justifies the ethnomedical claims. The significant medicinal value of this plant necessitates a scientific adventure into the bioactive metabolites which constitute various extracts.
PubMed: 32148534
DOI: 10.1155/2020/2580259 -
Journal of Dual Diagnosis 2020Extrapyramidal side-effects (EPSE) are frequent in patients treated with antipsychotics and comorbid substance use disorders (SUDs). Methamphetamine has been shown to...
Extrapyramidal side-effects (EPSE) are frequent in patients treated with antipsychotics and comorbid substance use disorders (SUDs). Methamphetamine has been shown to act as a dopaminergic neurotoxin. We aimed to determine whether EPSE occur more often in patients with psychotic disorders and co-occurring methamphetamine (MA) use disorders, and we examined the relationship between MA use, antipsychotic type, dose and EPSE. This study was a secondary analysis of data from three separate primary studies. Across all studies, psychiatric and SUD diagnoses were determined using the SCID-I for DSM-IV. EPSE were determined using the Simpson-Angus Scale (SAS) for Parkinsonism, the Barnes Akathisia Rating scale (BARS), and the Abnormal Involuntary Movement Scale (AIMS) for tardive dyskinesia. Participants were classified as having any EPSE if they scored above the cutoff on any of the EPSE scales (SAS, BARS, AIMS). We analyzed data using multivariable logistic regression analysis. The sample included 102 patients with non-affective or affective psychotic disorders. Of the total sample, 65.7% were male, 54.9% had schizophrenia spectrum disorders, 20.5% bipolar type I disorder with psychotic features, 11.7% schizoaffective disorder and 12.7% had substance-induced psychosis. A diagnosis of a methamphetamine use disorder (abuse or dependence) was present in 25.5% of participants. EPSE occurred in 38.2% of patients and were significantly associated with MA use in the unadjusted and adjusted analysis, = 4.01, 95% CI [1.07, 14.98], = .039. Patients with MA dependence and MA use >3 years were significantly more likely to have EPSE. We found a significant interaction effect between MA use disorders and standardized antipsychotic dose on the occurrence of EPSE, = 1.01, 95% CI [1.00, 1.01], = .042, with MA users having a disproportionally higher likelihood of having EPSE compared to MA non-users as antipsychotic dosage increased. There were no significant associations of EPSE with comorbid alcohol, cannabis, or methaqualone use disorders. Patients with a MA use disorder were significantly more likely to have EPSE with evidence for a dose-response effect. Clinicians should carefully titrate antipsychotic dosage from lower to higher doses to avoid EPSE in patients with MA use disorders.
Topics: Adolescent; Adult; Affective Disorders, Psychotic; Aged; Amphetamine-Related Disorders; Antipsychotic Agents; Central Nervous System Stimulants; Comorbidity; Diagnosis, Dual (Psychiatry); Dyskinesia, Drug-Induced; Female; Humans; Male; Methamphetamine; Middle Aged; Psychoses, Substance-Induced; Psychotic Disorders; Schizophrenia; Young Adult
PubMed: 31984872
DOI: 10.1080/15504263.2020.1714099 -
ACS Omega May 2019A transition-metal-free synthesis of quinazolin-4-ones by CsCO-promoted SAr reaction of -fluorobenzamides with amides followed by cyclization in dimethyl sulfoxide has...
A transition-metal-free synthesis of quinazolin-4-ones by CsCO-promoted SAr reaction of -fluorobenzamides with amides followed by cyclization in dimethyl sulfoxide has been developed. The present procedure can provide efficient synthetic methods for the formation of both 2-substituted and 2,3-disubstituted quinazolin-4-one rings depending on the use of easily available starting materials and an efficient, one-pot protocol for the synthesis of the marketed drug product of methaqualone.
PubMed: 31459909
DOI: 10.1021/acsomega.9b00699 -
Organic & Biomolecular Chemistry Sep 2019Biologically important quinazolinones have been synthesized from 2-aminobenzamides and DMSO. The key feature of the reaction is the utilization of DMSO as a methine...
Biologically important quinazolinones have been synthesized from 2-aminobenzamides and DMSO. The key feature of the reaction is the utilization of DMSO as a methine source for intramolecular oxidative annulation. The CNS depressant drug methaqualone has also been synthesized by our methodology. The present method involves the synthesis of quinazolinones with a broad substrate scope and a good yield.
PubMed: 31451812
DOI: 10.1039/c9ob01629e -
Journal of Forensic and Legal Medicine Apr 2019In South Africa, violence-related injury and mortality contributes highly to the nation's burden of injury. Drug abuse, which is also reported to be rife across the...
BACKGROUND
In South Africa, violence-related injury and mortality contributes highly to the nation's burden of injury. Drug abuse, which is also reported to be rife across the county, has been associated with violence, resulting injury, and death. While post-mortem toxicological investigations are comprehensive and routine in violent fatalities internationally; this is not currently the case in South Africa.
OBJECTIVES
To conduct a post-mortem toxicological investigation on a cohort of violent fatalities in the West-Metropole of Cape Town, Western Cape.
METHODS
The study included a prospective toxicological analysis and a retrospective review of the corresponding blood alcohol results on a small cohort of victims of violent death (whether homicidal, non-overdose suicidal, or accidental) admitted to the Salt River State Mortuary in Cape Town. Biological specimens were collected from the victims following informed consent from the next-of-kin, and a targeted screening approach using liquid chromatography coupled to tandem mass spectrometry was used for the qualitative toxicology analysis. At the Forensic Chemistry National Laboratory, blood alcohol testing was conducted using a headspace gas chromatography with flame ionisation detector according to national standards. Data was analysed with regards to demographics, circumstances of death, and toxicological results.
RESULTS
Consent was obtained for 104 violent death cases, autopsied between August-October 2015, most were male victims of homicide (n = 92, 88%). Volatiles analysis for ethanol was performed on 98% of cases, with 41% testing positive (>0.01 g/100 mL). Other drugs of abuse were detected in 63 (61%) cases and more than one substance were present in 51 (49%) cases. The most commonly detected substances were combinations of methamphetamine, diphenhydramine, and methaqualone.
CONCLUSIONS
A high prevalence of drugs of abuse was identified in a cohort of victims of violent death. Objective drug trends observed were consistent with national self-reported rehabilitation centre data and research on self-reported drug user. This study was limited by the sampling strategy, including challenges associated with obtaining consent and the rapid turnover of violent fatalities. Despite this - and to the authors' knowledge - this study provided the first prospective post-mortem toxicological investigation into violent death in South Africa. Contextually, it highlights the need for routine and comprehensive toxicology in these cases to strengthen research and service provision, so as to better understand the role of drugs in violent death.
Topics: Accidents; Adolescent; Adult; Aged; Bile; Central Nervous System Depressants; Child; Chromatography, Gas; Chromatography, Liquid; Cohort Studies; Ethanol; Female; Flame Ionization; Forensic Toxicology; Homicide; Humans; Male; Middle Aged; Narcotics; Pharmaceutical Preparations; South Africa; Substance Abuse Detection; Substance-Related Disorders; Suicide; Tandem Mass Spectrometry; Vitreous Body; Young Adult
PubMed: 30844584
DOI: 10.1016/j.jflm.2019.02.005 -
BMJ Open Feb 2019Sexual and physical trauma and substance use are intersecting risks for HIV among young women. This study assesses the feasibility, acceptability and preliminary effects...
OBJECTIVES
Sexual and physical trauma and substance use are intersecting risks for HIV among young women. This study assesses the feasibility, acceptability and preliminary effects of a novel trauma-informed substance use and sexual risk reduction intervention for young South African women.
DESIGN
A single arm feasibility test and qualitative interviews of participants.
PARTICIPANTS
Sixty women, between 18 and 25 years of age, who reported trauma exposure, substance use and recent condom-less sex were recruited. Twenty participants were randomly selected for qualitative interviews.
INTERVENTION
A six-session group-based intervention.
MAIN OUTCOME MEASURES
We examined the proportion of women who provided consent, completed counselling and were retained in the study. Qualitative interviews explored intervention acceptability. Preliminary effects of the intervention on substance use, mental health (depression, psychological distress and trauma symptoms) and sexual risk outcomes (STI symptoms, number of partners and condomless sex) were explored.
RESULTS
Of the 66 eligible women, 91% were enrolled. Intervention completion rates were low; 35% attended all sessions. On average, participants attended four sessions (M=3.8, SD=1.3). A 93% follow-up rate was achieved at the 3-month endpoint. In this single group design, reductions in the proportion of participants who tested positive for methamphetamine, cannabis and methaqualone were observed at the 3-month endpoint. Symptoms of depression, psychological distress and trauma; number of STI symptoms; and number of sexual partners also decreased. Outcomes were similar for participants who completed up to four and those who completed five or more sessions. Participants thought the intervention was highly beneficial and proposed modifications to enhance acceptability.
CONCLUSIONS
This novel intervention seems acceptable and holds potential benefits for trauma-exposed women who use substances. Truncating the intervention may enhance the likelihood of its implementation. The efficacy of the intervention for improving substance use, sexual risk and mental health outcomes requires testing in a controlled design.
Topics: Adolescent; Adult; Counseling; Feasibility Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Mental Health; Patient Education as Topic; Psychological Trauma; Qualitative Research; Risk Reduction Behavior; South Africa; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Unsafe Sex; Young Adult
PubMed: 30782918
DOI: 10.1136/bmjopen-2018-024776 -
Forensic Science International Jan 2019This paper describes the performance of four Randox drug arrays, designed for whole blood, for the near-body analysis of drugs in a range of post-mortem body specimens.
BACKGROUND
This paper describes the performance of four Randox drug arrays, designed for whole blood, for the near-body analysis of drugs in a range of post-mortem body specimens.
METHODS
Liver, psoas muscle, femoral blood, vitreous humor and urine from 261 post-mortem cases were screened in the mortuary and results were obtained within the time taken to complete a post-mortem. Specimens were screened for the presence of amfetamine, barbiturates, benzodiazepines, benzoylecgonine, buprenorphine, cannabinoids, dextropropoxyphene, fentanyl, ketamine, lysergide, methadone, metamfetamine, methaqualone, 3,4-methylenedioxymetamfetamine, opioids, paracetamol, phencyclidine, salicylate, salicylic acid, zaleplon, zopiclone and zolpidem using the DOA I, DOA I+, DOA II and Custom arrays.
RESULTS
Liver and muscle specimens were obtained from each of the 261 post-mortem cases; femoral blood, vitreous humor and urine were available in 98%, 92% and 72% of the cases, respectively. As such, the equivalent of 12,978 individual drug-specific, or drug-group, immunoassay tests were undertaken. Overall >98% of the 12,978 screening tests undertaken agreed with laboratory confirmatory tests performed on femoral blood.
CONCLUSIONS
There is growing interest in the development of non-invasive procedures for determining the cause of death using MRI and CT scanning however these procedures are, in most cases, unable to determine whether death may have been associated with drug use. The Randox arrays can provide qualitative and semi-quantitative results in a mortuary environment enabling pathologists to decide whether to remove specimens from the body and submit them for laboratory analysis. Analysis can be undertaken on a range of autopsy specimens which is particularly useful when conventional specimens such as blood are unavailable.
Topics: Forensic Toxicology; Humans; Illicit Drugs; Immunoassay; Liver; Luminescence; Pharmaceutical Preparations; Psoas Muscles; Substance Abuse Detection; Substance-Related Disorders; Vitreous Body
PubMed: 30544085
DOI: 10.1016/j.forsciint.2018.11.018