• 文章类型: Journal Article
    背景:阿片类药物使用障碍(MOUD)的药物可降低矫正人群中过量服用的风险。在其他障碍中,每日剂量要求阻碍了治疗释放后的连续性。因此,延长释放丁丙诺啡(XR-BUP)可能是有益的。然而,证据有限。目标:进行系统评价,以检查XR-BUP在矫正人群中的可行性和有效性。方法:在Pubmed中进行搜索,Embase,和PsychINFO在2023年10月。纳入了十项报告XR-BUP可行性或有效性的研究,代表n=819个个体(81.6%为男性)。根据以下主要结果提取数据并进行叙述报告:1)可行性;2)有效性;3)障碍和促进者。结果:研究具有异质性。与非矫正人群相比,矫正人群尝试XR-BUP的可能性是两倍。XR-BUP是可行和安全的,没有转移注意力,用药过量,或死亡;报告了一些负面副作用。与其他MOUD相比,XR-BUP显著减少药物使用,导致相似或更高的治疗保留率,更少的再次监禁,并且成本效益高,每月/每年的总成本较低。XR-BUP的障碍,比如副作用和对针头的恐惧,以及促进者,例如降低阿片类药物复发的风险,也被确认了。结论:XR-BUP似乎是OUD矫正人群的可行且潜在有效的替代治疗选择。XR-BUP可以降低社区释放相关风险,如阿片类药物的使用和过量的风险,以及治疗保留的障碍。有必要努力扩大惩教人群对XR-BUP的获取和吸收。
    Background: Medications for opioid use disorder (MOUD) reduce risks for overdose among correctional populations. Among other barriers, daily dosing requirements hinder treatment continuity post-release. Extended-release buprenorphine (XR-BUP) may therefore be beneficial. However, limited evidence exists.Objectives: To conduct a systematic review examining the feasibility and effectiveness of XR-BUP among correctional populations.Methods: Searches were carried out in Pubmed, Embase, and PsychINFO in October 2023. Ten studies reporting on feasibility or effectiveness of XR-BUP were included, representing n = 819 total individuals (81.6% male). Data were extracted and narratively reported under the following main outcomes: 1) Feasibility; 2) Effectiveness; and 3) Barriers and Facilitators.Results: Studies were heterogeneous. Correctional populations were two times readier to try XR-BUP compared to non-correctional populations. XR-BUP was feasible and safe, with no diversion, overdoses, or deaths; several negative side effects were reported. Compared to other MOUD, XR-BUP significantly reduced drug use, resulted in similar or higher treatment retention rates, fewer re-incarcerations, and was cost-beneficial, with a lower overall monthly/yearly cost. Barriers to XR-BUP, such as side effects and a fear of needles, as well as facilitators, such as a lowered risk of opioid relapse, were also identified.Conclusion: XR-BUP appears to be a feasible and potentially effective alternative treatment option for correctional populations with OUD. XR-BUP may reduce community release-related risks, such as opioid use and overdose risk, as well as barriers to treatment retention. Efforts to expand access to and uptake of XR-BUP among correctional populations are warranted.
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  • 文章类型: Journal Article
    互联网游戏障碍(IGD)是一种新兴的公共卫生问题;有效的治疗方法仍在开发中。这篇小型评论侧重于总结来自心理学的主要科学证据,药理学,脑成像,以及新兴的IGD治疗方法。我们使用与IGD和治疗相关的关键词搜索PubMed和Scopus数据库。认知行为疗法(CBT)是IGD研究最广泛的心理治疗方法,由几个随机对照试验(RCT)支持。其他有前途的方法包括正念,预防复发,禁欲协议,和家庭治疗。安非他酮和艾司西酞普兰等药物治疗已显示出益处,尤其是当IGD与重性抑郁症等疾病并存时。然而,心理干预的证据质量中等,但药理学方法的证据质量低到中等.新兴治疗,如经颅直流电刺激(tDCS),重复经颅磁刺激(rTMS),和电针已证明在减轻IGD症状和调节大脑活动方面有效。脑成像技术,如功能磁共振成像(fMRI)已经提供了对IGD和治疗效果的潜在神经机制的见解,尽管这些研究缺乏随机对照设计。虽然多模式方法显示出希望,较大,需要精心设计的RCT来建立有效的IGD治疗。
    Internet Gaming Disorder (IGD) is an emerging public health concern; effective treatments are still under development. This mini-review focuses on summarizing the main scientific evidence from psychological, pharmacological, brain imaging, and emerging treatment approaches for IGD. We searched PubMed and Scopus databases using keywords related to IGD and treatment. Cognitive behavioral therapy (CBT) is the most extensively researched psychological treatment for IGD, supported by several randomized controlled trials (RCTs). Other promising approaches include mindfulness, relapse prevention, abstinence protocols, and family therapy. Pharmacological treatments like bupropion and escitalopram have shown benefits, especially when IGD is comorbid with conditions like major depressive disorder. However, the quality of evidence is moderate for psychological interventions but low to moderate for pharmacological approaches. Emerging treatments such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and electro-acupuncture have demonstrated efficacy in reducing IGD symptoms and modulating brain activity. Brain imaging techniques like functional magnetic resonance imaging (fMRI) have provided insights into the neural mechanisms underlying IGD and treatment effects, although these studies lack randomized controlled designs. While multimodal approaches show promise, larger, well-designed RCTs are needed to establish effective IGD treatments.
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  • 文章类型: Journal Article
    目的:物质使用在精神分裂症(SCZ)及相关疾病患者中非常普遍,然而,没有同时解决成瘾和精神病症状的广谱药物治疗。社会心理(PS)干预,在分别治疗精神病和物质依赖方面取得了有希望的结果,显示潜力,但在组合时尚未进行系统评估。
    方法:随机对照试验(RCTs)的系统评价和随机效应荟萃分析,调查PS干预措施对患有共病物质使用和精神病的个体,包括SCZ和精神分裂症谱系障碍(SSD)。我们纳入了MEDLINE发表的相关研究,PsycINFO,和谷歌学者到2023年5月。
    结果:我们纳入了35项RCT(总共5176名参与者;SSD约2840名)。干预持续时间为30分钟至3年。荟萃分析未发现对主要主要结局有统计学意义的合并PS干预效果,物质使用(18项研究;803项干预,733名对照参与者;标准化平均差,-0.05标准差[SD];95%CI,-0.16,0.07SD;I2=18%)。PS干预对其他结果的影响也没有统计学意义。证据的总体等级确定性较低。
    结论:目前,文献缺乏足够的证据支持使用PS干预措施,而不是显着改善药物使用的替代治疗方法,症状学,或SCZ和相关疾病患者的功能。然而,证据的低确定性排除了确定的结论。需要进一步的随机对照试验来确定PS治疗对双重诊断(DD)患者的疗效,单独或与药物治疗联合使用。
    OBJECTIVE: Substance use is highly prevalent among people with schizophrenia (SCZ) and related disorders, however, there is no broad-spectrum pharmacotherapy that concurrently addresses both addiction and psychotic symptoms. Psychosocial (PS) interventions, which have yielded promising results in treating psychosis and substance dependence separately, demonstrate potential but have not been systematically evaluated when combined.
    METHODS: Systematic review and random-effects meta-analyses of randomized controlled trials (RCTs) investigating PS interventions for individuals with comorbid substance use and psychotic disorders, encompassing SCZ and schizophrenia spectrum disorders (SSD). We included relevant studies published from MEDLINE, PsycINFO, and Google Scholar through May 2023.
    RESULTS: We included 35 RCTs (5176 participants total; approximately 2840 with SSD). Intervention durations ranged from 30 min to 3 years. Meta-analysis did not identify a statistically significant pooled PS intervention effect on the main primary outcome, substance use (18 studies; 803 intervention, 733 control participants; standardized mean difference, -0.05 standard deviation [SD]; 95% CI, -0.16, 0.07 SD; I2 = 18%). PS intervention effects on other outcomes were also not statistically significant. Overall GRADE certainty of evidence was low.
    CONCLUSIONS: At present, the literature lacks sufficient evidence supporting the use of PS interventions as opposed to alternative therapeutic approaches for significantly improving substance use, symptomatology, or functioning in people with SCZ and related disorders. However, firm conclusions were precluded by low certainty of evidence. Further RCTs are needed to determine the efficacy of PS treatments for people with dual-diagnoses (DD), either alone or in combination with pharmacotherapy.
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  • 文章类型: Systematic Review
    全球范围内,大约有13亿香烟消费者,表明它是早期死亡和发病的第二高危险因素。同时,心理治疗提供基于其不同模式和技术的工具,这有助于戒烟。在这种情况下,这项研究收集了科学证据,以确定可用于减少香烟消费的心理治疗方法。对对照临床研究进行了系统评价,实施PRISMA方法。使用从MESH(医学主题词)和DECS(健康科学中的描述符)提取的术语进行搜索查询。随后,搜索在Medline/PubMed的科学数据库中进行了查询,科克伦,Scopus,科学直接,ProQuest,和PsycNet,随后使用乔安娜·布里格斯研究所的检查表验证方法学质量。选定的文件显示,认知行为疗法因其在七份出版物中的使用和有效性而盛行(25%)。正念疗法的认知方法见于4份出版物(14%),动机疗法的跨理论模型发表在4篇出版物中(14%),简短的心理治疗在3出版物(10%),其余10份文件(37%)与其他文件对应。干预研究认为认知行为疗法是减少香烟消费最常用的方法;在禁欲持续时间方面,科学证据显示短期减少的有益效果。
    Globally, there are around 1.3 billion cigarette consumers, indicating it to be the second highest risk factor for early death and morbidity. Meanwhile, psychological therapy offers tools based on its different models and techniques, which can contribute to smoking cessation. In this context, this study gathers scientific evidence to identify psychological therapies that can be used to reduce cigarette consumption. A systematic review of controlled clinical studies was conducted, implementing the PRISMA methodology. Search queries were performed with terms extracted from MESH (Medical Subject Headings) and DECS (Descriptors in Health Sciences). Subsequently, the search was queried in the scientific databases of Medline/PubMed, Cochrane, Scopus, Science Direct, ProQuest, and PsycNet, with subsequent verification of methodological quality using the Joanna Briggs Institute checklists. The selected documents revealed that cognitive behavioral therapy prevails due to its use and effectiveness in seven publications (25%). The cognitive approach with mindfulness therapy is found in 4 publications (14%), the transtheoretical model with motivational therapy in 4 publications (14%), brief psychological therapy in 3 publications (10%), and the remaining 10 documents (37%) correspond with others. Intervention studies refer to cognitive behavioral therapy as the most used in reducing cigarette consumption; in terms of the duration of abstinence, scientific evidence shows beneficial effects with short-term reduction.
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  • 文章类型: Journal Article
    目的:焦虑和物质使用障碍是高度合并症,是全球疾病负担的两个主要原因。心理社会干预是并发焦虑和物质使用障碍(A-SUD)患者的重要治疗选择。迄今为止,很少有综述评估心理社会疗法对A-SUD患者的疗效.本系统综述和荟萃分析旨在综合这些文献,并评估心理社会干预在A-SUD患者中的疗效。
    方法:我们搜索了截至2023年3月在Medline发布的所有相关记录,EMBASE,PsycINFO,CINAHL和谷歌学者。两位作者提取并核对了相关数据,并评估了偏倚风险。随机效应模型用于使用Hedges计算治疗后和随访时间点的效应大小。审查的主要结果是焦虑,酒精使用,使用其他物质。我们检查了抑郁症作为次要结果的影响,因为它通常与A-SUD同时发生。
    结果:对同时发生的A-SUD的心理社会干预对焦虑有中等影响(g=0.44),酒精(对冲\'g=0.29),以及干预后的其他物质使用(g=0.38)。在具有高度异质性的干预后观察到对抑郁的巨大影响(g=0.88)。这些效果在焦虑的随访中得到了维持(对冲=0.38),其他物质(g=0.44),和抑郁(g=0.50)。人口因素的适度分析,干预特点,社区层面的因素,减少焦虑,减少酒精的使用,不重要。
    结论:当前的荟萃分析首次专门研究了心理社会干预对焦虑和并发SUD患者的影响。分析表明,治疗对焦虑的中等程度的影响是有希望的,酒精,所有其他药物的使用,和抑郁症。研究结果指出了强调和发展社会心理治疗的重要途径,同时强调了未来研究中需要解决的知识差距。
    OBJECTIVE: Anxiety and substance use disorders are highly comorbid and represent two of the leading causes of disease burden globally. Psychosocial interventions are important treatment options for people with co-occurring anxiety and substance use disorders (A-SUD). To date, few reviews have assessed the efficacy of psychosocial treatments for patients with A-SUD. This systematic review and meta-analysis aims to synthesize this literature and assess the efficacy of psychosocial interventions among patients with A-SUD.
    METHODS: We searched all relevant records published until March 2023 in Medline, EMBASE, PsycINFO, CINAHL and Google Scholar. Two authors extracted and reconciled relevant data and assessed risk of bias. Random effects models were used to calculate effect sizes using Hedges\' g for post treatment and follow-up time points. Main outcomes of the review were anxiety, alcohol use, and use of other substances. We examined effects on depression as a secondary outcome since it commonly co-occurs with A-SUD.
    RESULTS: Psychosocial interventions for co-occurring A-SUD showed moderate effects on anxiety (g = 0.44), alcohol (Hedges\' g = 0.29), and other substance use (g = 0.38) at post intervention. Large effects were observed on depression (g = 0.88) at post intervention with high heterogeneity. These effects were maintained at follow-up for anxiety (Hedges\' g = 0.38), other substances (g = 0.44), and depression (g = 0.50). Moderation analyses for demographic factors, intervention characteristics, community level factors, anxiety reduction, and alcohol use reduction, were non-significant.
    CONCLUSIONS: The current meta-analysis is the first to investigate specifically the effects of psychosocial interventions on patients with anxiety and a co-occurring SUD. The analyses indicated promising moderate-sized effects of treatment on anxiety, alcohol, all other drug use, and depression. The findings point to important avenues for psychosocial treatment emphasis and development while highlighting critical gaps in knowledge to be addressed in future research.
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  • 文章类型: Journal Article
    背景:对于经历物质使用或赌博障碍的人,基于网络的同行支持论坛是他们可以分享经验的空间,聚集在一个集体目标周围,找到相互支持。基于网络的对等支持可以帮助克服参加面对面会议的障碍,使经历成瘾的人能够在其物理位置之外寻求支持,并在需要时具有匿名的好处。了解谁参加了基于Web的同行支持的论坛(以及如何参加),以及支撑论坛的原则,还可以帮助那些有兴趣设计或实现类似平台的人。
    目的:本研究旨在回顾有关人们如何经历物质使用或赌博障碍的文献,和他们的家人,朋友,和支持者,使用和参与基于Web的同行支持的论坛。具体来说,我们提出了以下研究问题:(1)使用基于网络的同伴支持的物质使用或以赌博为中心的论坛的人的特征是什么?(2)人们如何参与基于网络的同伴支持的论坛?(3)据报道,基于网络的同伴支持的论坛的关键原则是什么?(4)基于网络的同伴支持的论坛的报告结果是什么?2021年6月对10个数据库进行了初步搜索,随后在2022年9月和2024年2月对纳入研究进行了2次引用搜索。
    结果:在14项纳入的研究中,据报道,大多数基于网络的同行支持论坛专门针对,或者主要被使用,有酒精问题的人。报告人口统计数据的9项研究的结果表明,论坛用户通常是女性,年龄在40岁到50岁之间。定量和定性地报告了对基于网络的同行支持论坛的参与情况。据报道,论坛以一系列关键原则为基础,主要是互助方法和恢复身份形成。只有3项研究报告了论坛用户的结果。
    结论:基于Web的对等支持的论坛被人们以多种方式使用,分享信息和经验,给予和接受支持。寻求基于Web的支持为传统的面对面支持选项提供了替代方法,并可能减少参与同行支持的一些障碍。
    BACKGROUND: For people experiencing substance use or gambling disorders, web-based peer-supported forums are a space where they can share their experiences, gather around a collective goal, and find mutual support. Web-based peer support can help to overcome barriers to attending face-to-face meetings by enabling people experiencing addiction to seek support beyond their physical location and with the benefit of anonymity if desired. Understanding who participates in web-based peer-supported forums (and how), and the principles underpinning forums, can also assist those interested in designing or implementing similar platforms.
    OBJECTIVE: This study aims to review the literature on how people experiencing substance use or gambling disorders, and their family, friends, and supporters, use and participate in web-based peer-supported forums. Specifically, we asked the following research questions: (1) What are the characteristics of people who use web-based peer-supported substance use or gambling-focused forums? (2) How do people participate in web-based peer-supported forums? (3) What are the key principles reportedly underpinning the web-based peer-supported forums? (4) What are the reported outcomes of web-based peer-supported forums?
    METHODS: Inclusion criteria for our scoping review were peer-reviewed primary studies reporting on web-based addiction forums for adults and available in English. A primary search of 10 databases occurred in June 2021, with 2 subsequent citation searches of included studies in September 2022 and February 2024.
    RESULTS: Of the 14 included studies, the majority of web-based peer-supported forums reported were aimed specifically for, or largely used by, people experiencing alcohol problems. Results from the 9 studies that did report demographic data suggest forum users were typically women, aged between 40 years and early 50 years. Participation in web-based peer-supported forums was reported quantitatively and qualitatively. The forums reportedly were underpinned by a range of key principles, mostly mutual help approaches and recovery identity formation. Only 3 included studies reported on outcomes for forum users.
    CONCLUSIONS: Web-based peer-supported forums are used by people experiencing addiction in a number of ways, to share information and experiences, and give and receive support. Seeking web-based support offers an alternative approach to traditional face-to-face support options, and may reduce some barriers to engaging in peer support.
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  • 文章类型: Letter
    安大略省同意和能力委员会同意治疗物质使用障碍的能力:对过去报告的决定的回顾。
    安大略省对考虑患者同意使用药物治疗的能力的法律案件的审查一般情况下,开药者必须考虑在开始治疗前是否提供了知情同意.假定患者能够同意提议的治疗,但可能无法接受任何医学治疗。虽然精神病治疗通常考虑丧失工作能力,它可能与美沙酮或Suboxone等物质使用治疗有关,也被称为“阿片类激动剂疗法”或OAT。当一个人有阿片类药物使用障碍时,OAT可以挽救生命并防止复发和过量服用。如果发现患者无法同意治疗,替代决策者将成为决策者。在这种情况下,患者有能力反对或不同意这一发现,这导致安大略省同意和能力委员会(CCB)的法庭听证会。在某些情况下,CCB发布了所谓的决策理由(RD),这解释了法庭在做出有利于医生或被发现无能力的人的决定时的推理。此信息可公开搜索。我们的方法涉及对安大略省所有可用的CCBRD进行搜索,以查找与物质使用治疗相关的搜索词,比如“美沙酮”。我们发现,在2003年6月1日(报告日期开始)和2023年6月27日之间,只有71个报告涉及物质使用搜索词,在总共10463个报告的RD中。只有一起案件涉及CCB,坚持认为美沙酮治疗无能力。这些结果表明,在很少的情况下,CCB认为在药物使用治疗方面没有能力,尽管这些病例的报告频率可能低于其他病例。
    Capacity to consent to treatment of substance use disorders at Ontario\'s Consent and Capacity Board: A review of past reported decisions.
    An Ontario review of legal cases which have considered patients\' ability to consent to substance use treatmentsPlain Language SummaryIn general, prescribers must consider whether informed consent was provided prior to starting a treatment. A patient is presumed to be capable to consent to a proposed treatment but could be incapable with respect to any medical treatment. While incapacity is often considered for psychiatric treatments, it could be relevant to substance use treatment like methadone or suboxone, which are also called “Opioid Agonist Therapies” or OAT. OAT is lifesaving and prevents relapse and overdose when a person has an opioid use disorder. If a patient is found incapable of consenting to a treatment, a Substitute Decisions Maker would become the decision maker. In such cases, the patient has the ability to contest or disagree with the finding, and this results in a tribunal hearing at the Consent and Capacity Board in Ontario (CCB). In certain circumstances, the CCB publishes what are known as its Reasons for Decision (RDs), which explain the tribunal\'s reasoning in coming to a decision in favour of the physician or the person found incapable. This information is publicly searchable. Our methods involved a search of all available CCB RDs in Ontario for search terms related to substance use treatment, such as \"methadone”. We found that between June 1, 2003 (the date on reporting of RDs began) and June 27, 2023, only 71 RDs involved substance use search terms, out of a total of 10,463 reported RDs. Only one case involved the CCB upholding a finding of incapacity with respect to methadone treatment. These results imply that there are few cases in which the CCB has considered incapacity with respect to substance use treatment, although it is possible that these cases are reported at a lower frequency than other cases.
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  • 文章类型: Journal Article
    类似于成瘾物质,赌博和游戏等成瘾行为与关键大脑区域和与学习和记忆有关的功能网络的适应失调有关。因此,这篇综述旨在了解不同的学习和记忆过程与行为成瘾的关系,并揭示其潜在的神经机制。遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目,我们系统地搜索了四个数据库——PsycINFO,PubMed,Scopus,和WebofScience使用商定的搜索字符串。研究结果表明,行为成瘾中执行功能依赖性学习过程的改变和习惯学习的增强。而工作记忆与行为成瘾之间的关系受成瘾类型的影响,工作记忆方面,任务性质。此外,长期记忆在有成瘾行为的个体中是不连贯的。始终如一,神经生理学证据表明,行为成瘾中与学习和记忆过程有关的大脑区域和网络发生了变化。总的来说,本审查认为,比如物质使用障碍,学习和记忆过程的改变可能是行为成瘾的发展和维持的基础。
    Similar to addictive substances, addictive behaviours such as gambling and gaming are associated with maladaptive modulation of key brain areas and functional networks implicated in learning and memory. Therefore, this review sought to understand how different learning and memory processes relate to behavioural addictions and to unravel their underlying neural mechanisms. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched four databases - PsycINFO, PubMed, Scopus, and Web of Science using the agreed-upon search string. Findings suggest altered executive function-dependent learning processes and enhanced habit learning in behavioural addiction. Whereas the relationship between working memory and behavioural addiction is influenced by addiction type, working memory aspect, and task nature. Additionally, long-term memory is incoherent in individuals with addictive behaviours. Consistently, neurophysiological evidence indicates alterations in brain areas and networks implicated in learning and memory processes in behavioural addictions. Overall, the present review argues that, like substance use disorders, alteration in learning and memory processes may underlie the development and maintenance of behavioural addictions.
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  • 文章类型: Journal Article
    甲基苯丙胺在美国的使用越来越多,现在促成了全国阿片类药物流行危机的“第四波”。患有甲基苯丙胺使用障碍(MUD)的人有更高的死亡风险。FDA没有批准任何药物干预措施,心理社会干预措施仅中等有效。经颅磁刺激(TMS)是一种相对新颖的FDA批准的干预措施,用于治疗重度抑郁症(MDD)和其他神经精神疾病。几项研究表明,TMS可能对治疗成瘾性疾病有用,包括泥浆。我们将回顾那些已发表的临床试验,这些临床试验显示了在背外侧前额叶皮层(DLPFC)上应用时对减少TMS渴望的潜在影响,也强调了一些影响其普遍性和适用性的局限性。我们建议使用Koob和Volkow的成瘾神经电路模型作为框架来解释TMS对MUD患者的大脑影响。我们最后将讨论新的场所,这些场所可能导致对这种复杂疾病的更个性化和更有效的治疗,包括使用神经影像学,探索大脑的不同区域,如额极皮层或显着性网络,以及生物标志物的使用。
    The use of methamphetamine in the United States is increasing, contributing now to the \"fourth wave\" in the national opioid epidemic crisis. People who suffer from methamphetamine use disorder (MUD) have a higher risk of death. No pharmacological interventions are approved by the FDA and psychosocial interventions are only moderately effective. Transcranial Magnetic Stimulation (TMS) is a relatively novel FDA-cleared intervention for the treatment of Major Depressive Disorder (MDD) and other neuropsychiatric conditions. Several lines of research suggest that TMS could be useful for the treatment of addictive disorders, including MUD. We will review those published clinical trials that show potential effects on craving reduction of TMS when applied over the dorsolateral prefrontal cortex (DLPFC) also highlighting some limitations that affect their generalizability and applicability. We propose the use of the Koob and Volkow\'s neurocircuitry model of addiction as a frame to explain the brain effects of TMS in patients with MUD. We will finally discuss new venues that could lead to a more individualized and effective treatment of this complex disorder including the use of neuroimaging, the exploration of different areas of the brain such as the frontopolar cortex or the salience network and the use of biomarkers.
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  • 文章类型: Journal Article
    背景:急性护理使用率,包括入院和再入院,对于滥用物质的人来说是很高的。住院为干预提供了宝贵的机会,但是在住院患者中通常不会解决成瘾治疗问题。成瘾咨询服务是一种新颖的干预措施,旨在改变医院的做法。目标:全面总结与住院成瘾咨询服务相关的结果(定量和定性)。方法:英语搜索:Medline,CINAHL,Embase,Cochrane系统评价数据库,PubMed,PsychInfo和GoogleScholar于2000年至2022年11月进行。包括报告与医院环境中成瘾专家咨询相关结果的研究。四位独立审稿人筛选了摘要,三位审稿人筛选了全文文章。结果:共有1,113项结果进行了标题和摘要筛选,纳入了43项研究。与成瘾专家咨询相关的结果是异质的。定量临床结果集中在药物治疗上,医疗保健利用,和门诊随访。咨询提高了药物治疗的使用率,但对医疗保健使用的影响不一致,总体随访率较低。会诊与过量用药率和90天死亡率降低相关。与医学学习者的教育成就和定性结果相关的其他结果描述了对受训者的积极影响,医疗保健提供者,以及由专业咨询服务看到的患者。获得专门的提供者改善了滥用药物的人及其医疗保健提供者在医院的体验。结论:成瘾专家咨询与几种临床指标有关,但某些结局(例如药物治疗开始)可能比其他结局(医疗保健利用)更适合干预.定性发现为定量临床结果提供了重要的背景。
    Background: Rates of acute care use, including hospital admission and readmission, are high for people who misuse substances. Hospitalization provides a valuable opportunity for intervention, but addiction treatment is often not addressed in the inpatient setting. Addiction consult services are a novel intervention intended to change hospital practices.Objectives: Comprehensively summarize outcomes (quantitative and qualitative) associated with inpatient addiction consult services.Methods: English-language searches of: Medline, CINAHL, Embase, The Cochrane Database of Systematic Reviews, PubMed, PsychInfo and Google Scholar were conducted from 2000 to November 2022. Studies reporting outcomes associated with addiction specialist consultation in the hospital setting were included. Four independent reviewers screened abstracts, and three reviewers screened full-text articles.Results: A total of 1,113 results underwent title and abstract screening and 43 studies were included. Outcomes associated with addiction specialist consultation were heterogeneous. Quantitative clinical outcomes focused on pharmacotherapy, healthcare utilization, and outpatient follow-up. Consultation improved rates of pharmacotherapy use, but had inconsistent effects on health care use, and overall follow-up rates were low. Consultation was associated with reduced overdose rates and 90-day mortality. Additional outcomes related to medical learners\' educational achievements and qualitative results described positive effects on trainees, healthcare providers, and patients seen by specialized consult services. Access to dedicated providers improved experiences in hospitals for both people who misuse substances and their healthcare providers.Conclusion: Addiction specialist consultations are related to several clinical metrics, but some outcomes (e.g. pharmacotherapy initiation) may be more amenable to intervention than others (healthcare utilization). Qualitative findings provide important context for quantitative clinical results.
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