To approximate effects on such a short time frame, we also examined the association between change in psychiatric problems and contemporaneous change in substance use. We followed the same modeling strategy as in our primary models, but adjusted for one-year-lagged versions of all covariates . Table 6 presents the rate of contemporaneous changes in substance use frequency associated with changes in psychiatric problem T-score. In fully adjusted models, within person changes in the conduct problems T-score were associated with contemporaneous changes in marijuana frequency, alcohol frequency, and alcohol quantity. Within-person changes in the affective problems T-score were associated with contemporaneous changes in alcohol quantity. Associations of all covariates with substance use in the contemporaneous models are presented in Appendix C, Table C3. This study examined whether adolescent males tend to escalate their substance use following an increase in their psychiatric problems, and identified periods during adolescence when such associations may be particularly strong. We found that when youth experienced an increase in conduct problems, they showed an increase in the frequency of marijuana use and quantity of alcohol use in the following year. Fluctuations in conduct problems and affective problems may have an influence on alcohol use on a shorter time scale: changes in conduct problems and affective problems were concurrently associated with changes in alcohol frequency and quantity, respectively, in the same year, but not in the subsequent year. The specific effect of conduct problems on substance use is consistent with the notion that conduct disorder problems and substance use constitute elements within a broader externalizing spectrum.
Although numerous longitudinal studies have demonstrated that youth with psychiatric problems are at increased risk for using and abusing substances ,roll bench few have examined whether adolescents tend to increase their substance use following periods when they experience an increase in their psychiatric problems .By focusing on within-individual change, we were able to rule out the possibility that selection effects and stable individual differences between youth with differing levels of psychiatric problems and substance use accounted for the observed association between psychiatric problems and substance use. Further, the use of an extensive set of measures of potential time-varying covariates , allayed concerns that the associations were confounded by time-varying factors. The strength of the associations between conduct disorder problems and marijuana and alcohol use were relatively modest, suggesting that a substantial change in conduct problems would have to occur to produce a substantial within-individual change in substance use. This is consistent with prior studies that have tried to predict change over time in substance use 10,48. Substance use is shaped by multiple risk factors working together – hence, any one risk factor is likely to make a modest contribution to within individual fluctuations in substance use. This study examined the bidirectional nature of the association between psychiatric problems and substance use, and found evidence of a reverse effect of substance use on psychiatric problems. While increases in anxiety and depression did not result in increases in substance use, increases in the quantity of alcohol use did result in increases in anxiety problems. The effect of alcohol use on anxiety problems is consistent with prior studies that have found that substance use increases the risk for anxiety disorders.There are at least two possible explanations for this observed pattern. First, substance use can increase exposure to economic and social problems that increase the risk for anxiety, including crime, unemployment, loss of income, and relationship problems.Second, substance use can cause neurochemical changes which increase vulnerability to an anxiety disorder.
The effect of conduct disorder problem fluctuations on quantity of alcohol use was strongest in early adolescence, while the effect of conduct disorder changes on marijuana use was strongest in late adolescence . At the same time, the effect of quantity of alcohol use on anxiety was strongest in early and late adolescence . Two points are worth noting about this pattern. First, life transitions such as the shift from middle school to high school in early adolescence and the shift from high school to college in late adolescence may escalate existing challenges produced by fluctuations in psychiatric problems or substance use. A few studies have examined shifts in substance use during these two turning points. For example, Jackson et al. found that the prevalence of heavy drinkers more than doubled in the transition to high school and that this change was especially pronounced for youth with more problem behaviors. Studies of the transition from adolescence to young adulthood have also found that post-secondary school attendance predicted higher rates of substance use, and that the relationship between conduct problems and substance use was stronger in late adolescence than in middle adolescence,Pronounced effects of psychiatric problem and substance use fluctuations at times of transition would be consistent with an accentuation model, whereby the stress of the transition and the demands of the new context reduce contextual limitations on individual proclivities, potentially allowing for fluctuations in psychiatric problems to have a stronger effect on substance use, and vice versa. Second, the larger effect of conduct disorder on alcohol use at earlier ages and on marijuana use at later ages may reflect the developmental timing of these two substances. Drinking starts in early to mid-adolescence;hence, fluctuations in conduct problems in early adolescence may lead to involvement with alcohol use, as the drug that is most easily available in families and peer groups. In contrast, marijuana use typically starts in mid- to late adolescence, so the influence of conduct problems on marijuana use may increase as access to marijuana becomes easier in later ages.
The study findings should be taken in light of the following limitations. First, all participants in the Pittsburgh Youth Study are male; hence, we could not examine the relationship between psychopathology and substance use quantity and frequency among girls. Second, all participants were selected from Pittsburgh public schools, which potentially limits the generalizability of the findings beyond this area. Third, half of the sample was composed of high-risk boys: this limited our ability to infer to the general population, but also provided us with greater power to detect an association between fluctuations in psychiatric problems and substance use. Fourth, while we examined measures of psychiatric problems that are consistent with DSM diagnoses, these measures did not explicitly measure diagnostic criteria for DSM disorders. Grouping symptoms into “affective”, “anxiety” and “conduct” problem categories might merge stronger individual disorders with non-predictors of substance use, leading to an underestimate of the association between psychiatric problems and substance use. However, it is increasingly recognized that psychiatric problems are best conceptualized as falling on a continuum of severity rather than representing a discrete taxon. Fifth, a low base rate prevented us from examining the predictors of fluctuation in the level of use of other illicit drugs. Sixth, the prevalence of marijuana use has increased since the completion of this study. Future studies should examine the impact that within-individual changes in psychiatric problems have on substance use in the current context. Our study shows that when adolescent boys experience an increase in conduct disorder problems, they subsequently experience an increase in the quantity and frequency of substance use,drying rack cannabis while an increase in alcohol use can also subsequently result in increased anxiety problems in adolescence. Reducing fluctuations in conduct disorder problems and substance use at sensitive developmental turning points such as early and late adolescence may have lasting effects in preventing psychiatric and substance use problems by young adulthood. Synthetic cannabinoids are a class of drugs that are becoming increasingly popular throughout the United States and Europe. Also known as “K2,” “spice,” spike,” or “legal marijuana,” SC are causing intoxication requiring emergency department visits in epidemic and unparalleled numbers.Patients present with a wide array of symptoms, ranging from nausea and vomiting to confusion, agitation, short-term memory loss, cognitive impairment, psychosis, seizures, arrhythmias, strokes and even death.SC have often been associated with sympathomimetic effects such as mydriasis, hypertension and tachycardia.We present a case series of patients with SC intoxication who presented atypically with central nervous system and cardiovascular depression over a five-month period; in addition, we present an analysis of blood, urine and SC samples using mass spectrometry. Intoxication with SC products should be considered for patients with undifferentiated psychomotor depression and bradycardia in addition to the excitatory effects previously described.In early 2015 our suburban, tertiary care EDs experienced a large influx of patients presenting with lethargy and psychomotor depression, often requiring admission to the telemetry or intensive care units and rarely requiring intubation. The patients usually experienced sudden and complete resolution of symptoms after several hours in an obtunded state. Large cohorts of these patients simultaneously presented from a nearby psychiatric center that provided inpatient, outpatient and residential services.
The increased volume of intoxications exacerbated ED crowding. Patients later admitted to SC use, and some produced samples of the plant material. Questions arose regarding the potential contamination of these substances with other agents, such as clonidine or digoxin, or whether these presentations were due to newer generation SC. Blood and urine samples were collected from the patients when possible. The unknown drug samples were analyzed and compared to a reference database to identify the compounds present.We included two tertiary care EDs in our case series. In total, 141 ED visits were selected by toxicologists from the consult service database based on abnormal triage vitals, history of SC use or an obtunded mental state upon presentation. Twelve blood and 31 urine samples were collected. The 36 samples of plant material provided by patients were collected and analyzed using liquid chromatography/mass spectrometry and gas chromatography/ mass spectrometry . The samples were not correlated with specific patients. This retrospective chart review was approved by an institutional review board.Samples were extracted with organic solvent and concentrated to isolate any drugs present on the plant material. Briefly, 5 mg aliquots of an unknown plant material, or 100 μL of submitted blood/urine, were transferred to screwtop centrifuge tubes. Two mL of ethyl acetate were added and the samples were thoroughly mixed. Samples were extracted for 10 minutes on a nutating mixer at 24 revolutions per minute. The solvent was transferred to clean test tubes and the extracts were evaporated to dryness under nitrogen at 45°C. Samples were reconstituted in 50 μL methanol and 50 μL 0.1% formic acid in water and transferred to conical autosampler vials for analysis by liquid chromatography time-of-flight mass spectrometry. Similarly, samples were reconstituted in 50 μL ethyl acetate for GC/MS confirmation analysis. Biological samples underwent a 20-minute room temperature hydrolysis period prior to liquid-liquid extraction. More than one-quarter of a million women in the United States are currently living with HIV , and many women living with HIV fare poorly on the HIV Care Continuum . In 2015, only 50% of WLHIV were retained in care and 48% achieved HIV viral suppression . Despite the broad availability of effective antiretroviral medications, WLHIV also experience high rates of morbidity and mortality compared to the general population . Trauma is increasingly recognized as a near-universal experience among WLHIV and as a key contributor to HIV acquisition, morbidity, and mortality. Defined as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects” , trauma can include childhood and/or adult physical, sexual, or emotional abuse or neglect, as well as sociostructural violence such as racism, sexism, homophobia, transphobia, xenophobia, or living in a community where violence is common. People living with HIV experience disproportionately high rates of trauma , including rates of childhood sexual abuse that are more than twice the rates among the general population . Trauma exposure in PLHIV is associated with nonAIDS related deaths , and is predictive of experiencing later violence . It is also closely associated with mental health disorders including depression, PTSD, and anxiety , as well as with increased HIV-risk behavior, including substance use disorders . HIV diagnosis is itself often highly traumatic .Among PLHIV, trauma and substance use often function syndemically, as “epidemics interacting synergistically and contributing, as a result of their interaction, to excess burden of disease in a population” .