Brink, W. van den

Intrauterine cannabis exposure leads to more aggressive behavior and attention problems in 18-month-old girls (Article)

2011-11-01T00:00:00Z

Background: The development of the fetal endocannabinoid receptor system may be vulnerable to maternal cannabis use during pregnancy and may produce long-term consequences in children. In this study, we aimed to determine the relationship between gestational cannabis use and childhood attention problems and aggressive behavior. Methods: Using a large general population birth cohort, we examined the associations between parental prenatal cannabis and tobacco use and childhood behavior problems at 18 months measured using the Child Behavior Checklist in N= 4077 children. Substance use was measured in early pregnancy. Results: Linear regression analyses demonstrated that gestational exposure to cannabis is associated with behavioral problems in early childhood but only in girls and only in the area of increased aggressive behavior (B= 2.02; 95% CI: 0.30-3.73; p= 0.02) and attention problems (B= 1.04; 95% CI: 0.46-1.62; p< 0.001). Furthermore, this study showed that long-term (but not short term) tobacco exposure was associated with behavioral problems in girls (B= 1.16; 95% CI: 0.20-2.12; p= 0.02). There was no association between cannabis use of the father and child behavior problems. Conclusions: Our results suggest that intrauterine exposure to cannabis is associated with an increased risk for aggressive behavior and attention problems as early as 18 months of age in girls, but not boys. Further research is needed to explore the association between prenatal cannabis exposure and child behavior at later ages. Our data support educating future mothers about the risk to their babies should they smoke cannabis during pregnancy.

Neurobiological substrate of smoking-related attentional bias (Article)

2011-02-01T00:00:00Z

Substance-dependent patients automatically and involuntarily allocate their attention to drug cues in the environment, a process referred to as attentional bias. Attentional bias is increased during periods of subjective craving and predictive of treatment outcome and relapse in substance dependence. Despite recent theoretical and clinical advances with regard to attentional bias, the underlying neurobiological mechanisms are largely unknown. The objective of the current study was to investigate the neural substrate of attentional bias and associated subjective craving in smokers. A group of smokers (n=20) and a group of age- and gender-matched nonsmoking controls (n=22) were recruited from the general population and participated in a single session of fMRI scanning while attentional processes were manipulated. Main outcome measures were blood oxygen level-dependent (BOLD) fMRI activation during an attentional bias paradigm and selfreported cigarette craving. Results of the current study show that the dorsal anterior cingulate cortex, the superior parietal gyrus, and the superior temporal gyrus were more strongly activated in smokers, as compared to controls, when they had to pay attention to task-relevant information (line counting) while smoking cues were present as distracters (attentional bias). Subjective craving measures during attentional bias correlated with brain activation in the insula and putamen. To our knowledge, this is the first controlled study that shows the brain regions involved in attentional bias in smokers. The current study demonstrates that brain regions contributing to top-down attentional processing are implicated in attentional bias in smokers, suggesting that smokers have to employ more attentional resources to focus on a standard cognitive task when smoking cues are present.

Treatment-disrupting behaviors during psychotherapy of patients with personality disorders: The predictive power of psychodynamic personality diagnosis (Article)

2011-01-01T00:00:00Z

Background. Behavioral dyscontrol and violations of treatment contracts are serious clinical problems during psychotherapy, especially in treating patients with personality disorders. However, little is known about predictors of these treatment-interfering phenomena. Objective. To identify psychodynamic personality characteristics that can interfere with the psychotherapy process as indicated by treatment-disrupting behaviors. Methods. Sociodemographic characteristics, descriptive psychiatric diagnoses, and psycho-dynamic characteristics were assessed in 89 inpatients with personality disorders in psychotherapeutic treatment. Psychodynamic charac teristics were assessed with the Develop mental Profile (DP). DP variables were used to predict impulsive acts, anger outbursts, para-suicidal behaviors, and contract violations. Incremental value was established. Results. In this sample, 4 out of 5 patients engaged in treatment-interfering behaviors during the first 3 months of therapy. In general, treatment-disrupting behaviors were not predicted by baseline DSM-IV Axis I or II disorders. In contrast, impulsive behaviors, anger outbursts, and contract violations were significantly predicted by psychodynamic variables, especially the DP levels Fragmentation and Egocentricity. DP variables accounted for an incremental predictive value of 23% for treatment-disrupting behaviors, over and above demographics and descriptive diagnoses. Para-suicidal gestures were not predicted by either DSM-IV diagnoses or psychodynamic variables. Conclusion. Psychodynamic personality variables significantly predicted impulsive behaviors, outbursts of anger, and treatment contract violations during psychotherapeutic treatment. The amount of explained variance and incremental value was substantial. These findings support the relevance of psychodynamic assessment in clinical practice. Copyright

Agreement between maternal cannabis use during pregnancy according to self-report and urinalysis in a population-based cohort: The generation R study (Article)

2010-12-01T00:00:00Z

Aim: To verify self-reported information on prenatal drug use in urine because reporting in pregnancy is sensitive to stigma and might lead to misclassification. Methods: Using semiquantitative immunochemical analysis, the presence of the urinary metabolite (11-nor-Δ9-tetrahydrocannabinol- 9-carboxylic acid) was compared to self-reported prenatal cannabis use. Sensitivity and specificity for self-report and urinalysis outcomes were calculated and Yule's Y was used as an agreement measure. Results: Urine samples were available for 3,997 pregnant women. Of these women, 92 reported having used cannabis during pregnancy (2.3%) and 71 had positive urine screens (1.8%). In total 35% of the 92 women with self-reported cannabis use also had a positive urine screen. Positive urines were relatively frequent in women reporting cannabis use before pregnancy only (7.6%) and in women with missing information (2.6%). Sensitivity and specificity of urinalysis compared to self-report were 0.46 and 0.98. Sensitivity and specificity of self-report compared to urinalysis were 0.36 and 0.99. Yule's Y amounted to 0.77, indicating substantial agreement between the measures. Conclusions: Our findings illustrate the difficulties in obtaining valid information on prenatal cannabis use. To improve the quality of cannabis use data, we suggest a 2-step approach starting with self-report. Copyright

Effect of early dysphoric response and cannabis use on discontinuation of olanzapine or risperidone in patients with early psychosis (Letter To Editor)

2010-11-09T00:00:00Z

A prospective study on intrauterine cannabis exposure and fetal blood flow (Article)

2010-04-01T00:00:00Z

Background: Cannabis is commonly used among pregnant women. It is unclear whether cannabis exposure causes hemodynamic modifications in the fetus, like tobacco does. Aims: This study aims to ascertain fetal blood redistribution due to intrauterine cannabis exposure. Methods: This study was embedded in the Generation R Focus Study, a population-based cohort of parents and children followed from pregnancy onwards. In late pregnancy, fetal hemodynamics was assessed with ultrasound measurements in cannabis-exposed and non-exposed fetuses. Pregnant women reported about substance use during pregnancy. A distinction was made between continued cannabis use (n=9), cannabis use only in early pregnancy (n=14), continued tobacco use (n=85), tobacco use only in early pregnancy (n=92), and no tobacco or cannabis use during pregnancy (n=85). Results: Continued cannabis use was associated with an increased pulsatility and resistance index of the uterine artery, while discontinued cannabis use was associated with a decreased pulsatility, and resistance index, as compared to controls. Additionally, continued cannabis exposure resulted in a significantly higher uterine pulsatility index and uterine resistance index compared to tobacco exposure. Continued cannabis use was found to be associated with a smaller aortic diameter, as well. No association between intrauterine cannabis exposure and the fetal cerebral vascular system was found. Conclusions: Our findings suggest that intrauterine cannabis exposure was associated with changes in hemodynamic programming of the vascular system of the fetus in late pregnancy mainly due to tobacco exposure, but intrauterine cannabis exposure did demonstrate a specific effect on the uterine blood flow.

Demographic, emotional and social determinants of cannabis use in early pregnancy: The Generation R study (Article)

2008-12-01T00:00:00Z

Aims: To ascertain demographic, emotional and social determinants of cannabis use in early pregnancy. Design: This study was embedded in the Generation R study, a multiethnic population-based cohort of parents and their children, followed from pregnancy to childhood. Setting: Rotterdam, The Netherlands. Participants: Mothers enrolled in pregnancy who answered questions about their own and their partners substance use before and during pregnancy (n = 7610). Measurements: Using self-report questionnaires, information was collected on maternal demographics, psychopathology, delinquency, childhood trauma, social stress, family functioning, and parental alcohol, tobacco and substance use. Multinomial logistic regression analysis was used, with non-using women as reference. Findings: 246 (3.2%) women used cannabis before pregnancy and 220 (2.9%) women used cannabis both before and during pregnancy. The strongest determinant for maternal cannabis use during pregnancy was cannabis use by the biological father of the child (OR = 38.56; 95%CI = 26.14-58.88). Maternal cannabis use during pregnancy was also independently associated with being single (OR = 4.25; 95%CI = 2.33-7.75) or having a partner without being married (OR = 2.75; 95%CI = 1.56-4.85), childhood trauma (OR = 1.39; 95%CI = 1.22-1.57) and delinquency (OR = 3.37; 95%CI = 1.90-5.98), but not with maternal age, ethnicity, psychopathology, family functioning and perceived stress. Being religious was protective (Islam: OR = 0.25; 95%CI = 0.09-0.65) for maternal cannabis use during pregnancy. Additionally, lower educational level determined continued cannabis use in ever-users (OR = 3.22; 95%CI = 1.54-6.74). Conclusions: Our results showed that multiple demographic, emotional and social characteristics were associated with maternal cannabis use. These characteristics should be considered when investigating offspring exposed to cannabis in utero, as they may play an important role in mother-child interaction and child development.

Obsessive-compulsive symptoms in a randomized, double-blind study with olanzapine or risperidone in young patients with early psychosis (Article)

2008-04-01T00:00:00Z

BACKGROUND: The prevalence of obsessive-compulsive symptoms (OCS) in patients with schizophrenia is relatively high. Antipsychotics have been found to influence OCS. OBJECTIVE: To determine whether induction or severity of OCS differs during treatment with olanzapine or risperidone in young patients with early psychosis. METHODS: One hundred twenty-two patients with a Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform disorder were randomized in a double-blind design to groups of 6 weeks' treatment with olanzapine (n = 59) or risperidone (n = 63), with a mean dose of 11.3 mg olanzapine and 3.0 mg risperidone at 6 weeks. Primary outcome measures were the mean baseline-to-endpoint change in total score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). RESULTS: Treatment with olanzapine was associated with greater decreases in Y-BOCS total score than treatment with risperidone in total group (N = 122: -2.2 vs -0.3, z = -2.651, P < 0.01), in patients with baseline Y-BOCS total score greater than 0 (n = 58: -5.1 vs -0.4, z = -2.717, P < 0.01), and in patients with baseline Y-BOCS total score greater than 10 (n = 29: -7.1 vs -0.6, z = -2.138, P = 0.032). CONCLUSIONS: In this randomized, 6-week, double-blind trial, we found a significant and clinically relevant difference in decrease in Y-BOCS scores favoring olanzapine compared with risperidone.

Efficacy and tolerability of naltrexone in the treatment of alcohol dependence: Oral versus injectable delivery (Article)

2007-09-01T00:00:00Z

Oral naltrexone, an opioid antagonist, reduces relapse and heavy drinking in alcohol-dependent patients. However, oral delivery is associated with poor compliance and adverse events. To enhance treatment outcome and reduce side effects, injectable extended-release naltrexone formulations have been developed. Currently, there are no studies available directly comparing oral and injectable formulations of naltrexone in alcohol-dependent patients. This paper reviews the efficacy and adverse events of oral versus injectable extended-release naltrexone. Therefore, data were extracted from two recently published reviews about oral naltrexone in the treatment of alcohol dependence. Pooled outcomes were compared with reported outcomes of recent studies on injectable extended-release naltrexone. Injectable naltrexone seems to be effective in the management of alcohol dependence. Although inconclusive, the available results indicate that the expected advantages of injectable naltrexone over oral naltrexone still have to be proven. Randomized studies with direct comparisons of oral and injectable naltrexone are urgently needed. Copyright