Ketamine has become increasingly popular in recent years as a club drug. New research from University College London in the
United Kingdom has found that heavy use of ketamine can harm cognitive function and psychological well-being. The study followed
150 participants over the course of one year, dividing them into five groups of 30: frequent users used ketamine more than
four times a week; infrequent users used it at least once a month; abstinent users had not used the drug for at least a month;
polydrug users used other drugs; and non-drug users did not use illicit drugs at all. Researchers found that cognitive deficits
were largely confined to frequent ketamine users, among whom increased ketamine use over the year was correlated with declines
in spatial working memory and pattern recognition memory. Former ketamine users showed no cognitive deficits, suggesting that
although impairment from ketamine may be cumulative, cognitive function can recover after people stop using the drug. Frequent
users also experienced more dissociative symptoms, and delusional symptoms increased in a dose-response relationship with
the amount of ketamine used. Both frequent and abstinent users experienced increases in depression scores over the course
of the year. The authors recommend that health education campaigns target ketamine users, who are still largely unaware of
the dangers of using the drug and its potential for dependency.
A pharmacy-based intervention can increase the likelihood that people with serious mental illness will take their medication
as required, according to a new study from the Department of Veterans Affairs in Ann Arbor, Michigan. The study involved 118
Veterans Affairs patients who had schizophrenia, schizoaffective disorder or bipolar disorder. They were all being given long-term
treatment with antipsychotic medication and had medication compliance rates under 80 per cent in the previous year. Sixty
of the patients received usual care, which included visits with a psychiatrist, non-medical mental health visits and group
visits. Another 58 per cent were assigned to a Meds-Help pharmacy-based intervention involving unit-of-use packaging of patients’
medications, a medication education session, refill reminders sent by mail and notification of clinicians when patients failed
to fill prescriptions within 7 to 10 days. Compliance rates were reassessed at 6 and 12 months. At the beginning of the study,
the average compliance rates were 54 per cent for the Meds-Help group and 55 per cent for the usual care group. At six months,
the compliance rates had increased to 91 per cent for the Meds-Help group, compared with 64 per cent for the usual care group.
At 12 months, Meds-Help patients still had 86 per cent compliance rates, while rates for the usual care group were only 62
per cent. Given that their results are comparable with those previously reported for people with diabetes and hypertension
in a similar intervention, the authors conclude that a pharmacy-based intervention can be as effective in increasing compliance
among people with serious mental illness as among people with other chronic medical conditions.
Schizophrenia Bulletin, November 21, 2009 online, doi: 10.1093/schbul/sbp121. Marcia Valenstein et al., Department of Veterans Affairs Serious Mental
Illness Treatment, Research, and Evaluation Center, Ann Arbor, Michigan.
The reasons for misuse of opioid painkillers appear to differ along gender lines, according to research from Harvard Medical
School in Boston, Massachusetts. Working with pain management centres in five U.S. states, researchers recruited 335 females
and 275 males prescribed opioid painkillers for chronic non-cancer pain. Participants were followed for five months, answering
a series of questionnaires and providing urine samples at the end of the study for toxicology assessment. The participants’
physicians also completed substance misuse behaviour checklists. At the five-month follow-up, women were more likely to self-report
misuse on a drug use questionnaire, while men were more likely to be flagged for misuse by their physicians. There were no
gender differences in actual opioid misuse as measured using urine toxicology screens and either self-report or physician
report – about one-third of both women and men were found to have misused their medication. On questionnaires examining risk
for substance misuse, women were more likely to mention risk factors such as psychiatric diagnoses and a history of physical
and sexual abuse, while men were more likely to report legal and behavioural problems and a history of alcohol or other drug
problems. The authors suggest that efforts to reduce opioid misuse should emphasize educating women about avoiding painkillers
to deal with anxiety and sleep disturbances and more closely monitoring men’s behaviour. Women may also benefit from antidepressant
medication and cognitive-behavioural therapy.
The Journal of Pain, 2009 online, doi: 10.1016/j.pain.2009.07.016. Robert N. Jamison et al., Departments of Anesthesia and Psychiatry, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.
Young men who believe that happiness declines with age are more likely to binge drink, according to research from Queen’s
University Belfast in Northern Ireland. Researchers used data from a 2007 survey of 1,036 citizens of Northern Ireland over
age 15. Participants were questioned about the frequency of binge drinking and a range of other health-related issues. Researchers
asked participants how happy they currently were and how happy they expected to be at the ages of 30 and 70. They were also
asked how happy they estimated the average person is and how happy that person would be at 30 and 70. No differences were
found between the self-reported happiness levels of young people and older people. However, young people tended to believe
that happiness declines with age. Just more than half of participants were classified as binge drinkers – 59 per cent of males
and 45 per cent of females. Young men who expected lower levels of happiness in old age were more likely to binge drink. There
was no such correlation for females. The authors suggest that young men’s underestimation of happiness later in life increases
the likelihood that cultural ideals of masculinity (toughness, strength, invulnerability, risk-taking, competitiveness and
living for the moment) will be expressed through binge drinking. The authors conclude that it may be worthwhile to remind
young men of the benefits of reducing alcohol consumption, as well as informing them about the reality that happiness is common
in old age.
Journal of Happiness Studies, November 12, 2009 online, doi: 10.1007/s10902-009-9174-1. John Garry and Maria Lohan, School of Politics, International
Studies and Philosophy, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom.
The development of a therapeutic alliance between therapist and client over the course of psychotherapy can lead to significant
improvements in the client’s level of social, occupational and psychological functioning, according to research from the Hôpital
Purpan in Toulouse, France. Using data from a previously published study, researchers studied 74 individuals who received
10 weeks of acute outpatient treatment for major depression. Thirty-nine participants were given the antidepressant clomipramine,
combined with supportive psychotherapy, and 35 received clomipramine and psychodynamic psychotherapy. Supportive therapy “focused
on empathic listening, guidance, support and alliance, while psychodynamic therapy emphasized the development of an empathic
relationship between patient and therapist who, together, investigate interpersonal difficulties in relation to past life-events.”
The researchers found that therapeutic alliance increased over time in both treatment groups. Among participants who received
supportive therapy, this increase in therapeutic alliance translated into improved social, occupational and psychological
functioning. However, the benefit from the therapeutic alliance appeared to be related more to the perception of collaboration
between client and therapist toward a common therapeutic goal, rather than to the perception of the therapist as a provider
of help. Among those who received psychodynamic therapy, there was a significant relationship between the therapeutic alliance
and improvements in functioning at two weeks, but this relationship was no longer evident after the full 10 weeks of treatment.
The authors conclude that the therapeutic alliance may not be the main active therapeutic factor in psychodynamic therapy,
but that it is more active in supportive therapy.
Psychiatry Research, December 30, 2009, v. 170 (2–3): 229–233. Lionel Cailhol et al., INSERM, Hôpital Purpan, Toulouse, France.