Blood samples and accident records of 41 female and 186 male fatally injured drivers were examined. Analyses suggested that drugs other than alcohol are causally related to fatal traffic accidents in British Columbia. Toxicologies showed: 37% alcohol only, 11% alcohol and drugs, and 9% drugs only. The most frequently found drugs were: 48% alcohol, 13% tetrahydrocannabinol or its metabolites (THC/THCCOOH), 4% cocaine, and 5% diazepam. In addition, alcohol-only impairment was missed by investigating police officers in many cases, impairment by alcohol and drugs was mistakenly identified as alcohol-only impairment, and drug-only impairment was misclassified as "driving without due care and attention".
Smoking during pregnancy is common among Inuit women from the Canadian Arctic. Yet prenatal cigarette smoke exposure (PCSE) is seen as a major risk factor for childhood behavior problems. Recent data also suggest that co-exposure to neurotoxic environmental contaminants can exacerbate the effects of PCSE on behavior. This study examined the association between PCSE and behavior at school age in a sample of Inuit children from Nunavik, Qu?bec, where co-exposure to environmental contaminants is also an important issue. Interactions with lead (Pb) and mercury (Hg), two contaminants associated with behavioral problems, were also explored.
Participants were 271 children (mean age=11.3years) involved in a prospective birth-cohort study. PCSE was assessed through maternal recall. Assessment of child behavior was obtained from the child's classroom teacher on the Teacher Report Form (TRF) and the Disruptive Behavior Disorders Rating Scale (DBD). Exposure to contaminants was assessed from umbilical cord and child blood samples. Other confounders were documented by maternal interview.
After control for contaminants and confounders, PCSE was associated with increased externalizing behaviors and attention problems on the TRF and higher prevalence of attention deficit hyperactivity disorder (ADHD) assessed on the DBD. No interactions were found with contaminants.
This study extends the existing empirical evidence linking PCSE to behavioral problems in school-aged children by reporting these effects in a population where tobacco use is normative rather than marginal. Co-exposure to Pb and Hg do not appear to exacerbate tobacco effects, suggesting that these substances act independently.
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The behavioral effects of long-term exposure to a mixture of organic solvents were investigated in a comparison of the test results of 100 car painters with those of a reference group. The test battery included tests for intelligence, memory, psychomotor performances, and personality. In addition to the comparison of the mean results, two discriminant function analyses were made. In one, only the performance test variables were used, but in the other personality variables were also included. The results indicated impairments in psychological performances, as well as personality changes in the exposed group. Impairments in visual intelligence and verbal memory and a reduction of emotional reactivity were the central features of the adverse effects of solvent exposure, but the behavioral disturbances also involved several other functions, including performance on a verbal intelligence test. The possible role of the differences in the initial intelligence levels were controlled with a separate comparison of the test results of 33 pairs of exposed and nonexposed subjects who were matched for age and for their intelligence level, measured during the military service. The discriminant function analyses were based on the results of these matched subgroups and tested in the rest of the material. According to the results the sensitivity of the psychological test methods was high, but the specificity somewhat low, with regard to solvent exposure. The concentration of various solvents included in the exposure of car painters were low, the summated exposure corresponding corresponding to 32% of the Finnish threshold limit value. The possible role of a potentiating effect of the solvent in the development of behavioral disturbances is discussed.
Alcohol is used in most cultures despite knowledge of the physical, psychological and social problems associated with its abuse. Behavioural impairment is a function of several factors, including blood alcohol concentration (BAC) and the rate of alcohol metabolism by alcohol dehydrogenase and the microsomal ethanol-oxidizing system. Their availability and activity depend upon alcohol use history, ethnicity, other drug use and gender. Adverse social consequences related to alcohol intoxication include impaired driving, acts of aggression and violence towards self and others, and various types of accidents. About 40% of all fatal traffic accidents in Canada and the US in 1986-1987 were alcohol-related. Similar statistics have been reported in the UK and Europe (e.g. Sweden). The risk of a fatal car accident increases exponentially with a driver's BAC, prompting recommendations to lower the legal BAC limit for driving and piloting aircraft. Risks of falls, drownings, and fires and burns may also be increased by alcohol intoxication. At least 22% of work-related accidents may have involved alcohol use. These data are probably conservative estimates as under-reporting of alcohol use is likely. Alcohol facilitates aggressive behaviours, but it is difficult to separate the pharmacological effect from psychosocial effects or some other common factor (e.g. low CSF levels of the serotonin metabolite 5-H1AA have been reported in alcoholics, suicide attempters, violent offenders). In addition, alcohol interacts with other drugs to increase or decrease their behavioural and therapeutic effects. An acutely high BAC inhibits the metabolism of other CNS depressants (e.g. benzodiazepines), but long-term alcohol use increases the metabolism of most drugs. A potential amethystic agent, to block or reverse alcohol's effects, has been identified in preclinical studies (Ro15-4513, an imidazobenzodiazepine). Some clinical studies indicated that naloxone, lithium, ibuprofen, zimeldine and catecholamine agonists may reduce ethanol-induced behavioural or cognitive effects but the results have not been consistently replicated. More research is needed to determine the potential clinical use of amethystic agents and other pharmacotherapies in the prevention and treatment of problem behaviours associated with alcohol abuse and intoxication.
Methylphenidate (MPH) is a prescription stimulant drug with known abuse potential; however, little is known about its patterns of misuse or the characteristics of its abusers.
A sample of 50 university students reporting MPH misuse and 50 control subjects matched for age, sex, and ethnicity completed structured face-to-face interviews about their MPH and other drug use. For each substance ever used, they provided information regarding routes of administration and other substances ever coadministered, as well as details about the most recent administration. MPH users provided additional information about their reasons for use and, in 36 cases, about how they obtained the drug.
Relative to control subjects, those who misused MPH were more likely to have used various other prescription and nonprescription stimulant drugs over their lifetime, and most MPH users reported mixing the drug with other psychoactive substances. Of the MPH sample, 70% reported recreational use of the drug, while 30% reported that MPH was used exclusively for study purposes. Relative to those using it exclusively for study, recreational users were more likely to report using MPH intranasally, as well as coadministering MPH with other substances. Most of those who reported their source of MPH obtained it from an acquaintance with a prescription.
Those who misuse MPH are more likely than their peers to misuse various other substances, and MPH misuse frequently occurs in the context of simultaneous polydrug use. Because the primary supply of inappropriately used MPH appears to be prescribed users, efforts should be directed toward preventing its diversion.
Comment In: Can J Psychiatry. 2006 Feb;51(2):126-7; author reply 12716989112
Short-term, prospective placebo-controlled simple blind randomized study of the effects of alpha-lipoic acid and mexidol on the dynamics of affective status disorders, cognitive functions, and quality of life in parallel with changes in carbohydrate metabolism and lipidemia has been conducted in diabetic patients. It is established that two-week administration of alpha-lipoic acid (600 mg once a day, i.v.) and mexidol (300 mg once a day, i.v.) reduced hyperglycemia by 13.00 with simultaneous decrease of depressive "feelings of guilt". In case of mexidol, these effects were accompanied by positive "vitality" dynamics established with SF-36 questionnaire and reflecting improvement in patients' quality of life. Additionally, course administration of alpha-lipoic acid increased attention as studied with Schulte tables. Favorable psychotropic effects of alpha-lipoic acid and mexidol were unrelated to changes in lipidemia and "lipid peroxidation - antioxidant protection" system indicators.
Although associations between antipsychotic use and neuropsychological impairment in bipolar I disorder have been observed, there is a lack of studies comparing the effects of specific agents used in this population. We compared performance between patients receiving maintenance treatment with mood stabilizer monotherapy (n=15), adjunctive risperidone (n=15) or quetiapine (n=17), and a group of demographically matched healthy controls (n=28) on tests of executive function (working memory, set shifting, and inhibition) and verbal learning. Despite having a similar clinical profile, patients being treated with risperidone showed significantly impaired working memory, set-shifting, and verbal learning (P
Chronic solvent encephalopathy (CSE) is under-reported worldwide due to difficulties in recognition and differences in national legislation. Although its occurrence in developed countries has declined, new cases continue to be detected. Our aim was to determine whether CSE can be detected in risk trades, using a stepwise screening procedure. Another aim was to evaluate if this method detects more cases than present occupational health service (OHS) practices do in Finland, a country with decreasing exposures, high OHS coverage and an annual rate of around forty cases of suspected CSE and seven cases of occupational CSE. The studied fields, based on the national occurrence of CSE, were industrial and construction painting, floor layering, the printing press industry, boat construction, reinforced plastic laminating and the metal industry. We obtained contact information from trade union registers and municipal OHS. A postal survey including the Euroquest (EQ) neurotoxic symptom questionnaire, Beck's Depression Inventory (BDI) and the Alcohol Use Disorders Identification Test-Consumption (Audit-C), and questions on exposure and medical conditions, was sent to 3,640 workers in the age range of 30-65 years in two Finnish provinces. The survey resulted in 1,730 responses (48%). This was followed by a clinical examination, with methods applicable to OHS, of subjects fulfilling the criteria: three or more EQ memory and concentration symptoms and sufficient exposure, a BDI score=18, an AUDIT-C score=8, and no evident medical condition explaining their symptoms. Of 338 respondents with memory and concentration symptoms, 129 subjects fulfilled all the criteria, of which 83 participated in clinical examinations. We found 38 CSE compatible cases. The study shows that more CSE compatible cases can be detected when the screening is directed towards the occupational fields at greatest risk. This stepwise method is more effective for finding CSE compatible cases than regular OHS activity. The number of cases was similar to the total annual occurrence, of new CSE-suspected cases, although the sample represented approximately 18% of the abundantly exposed workforce in Finland. Combining of exposure and medical differential diagnostics to neurotoxic symptom questionnaire, decreases the amount of cases needing clinical examinations. This two-step procedure can be carried out with methods suitable for OHS and other primary health care, both in industrialized and developed countries.