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Introduction: The short-acting narcotic propofol is used for sedation during electroconvulsive therapy (ECT). It remains unclear whether patients develop tolerance to propofol after repeated administration. Therefore, we studied whether propofol dosage had to be increased during a course of ECT. Methods: This retrospective study evaluated records of 39 in- and outpatients at a Swiss psychiatric hospital who underwent 10-21 ECT sessions for affective disorder over 4-28 weeks in 2011-2013. We examined the dose of propofol required to achieve deep sedation at the first and last ECT sessions. Results: 13/39 patients (33.3 %) needed a slightly higher propofol dose at the last ECT session than at the first (Group 1), 12 patients (30.8 %) needed the same dose at the first and last sessions (Group 2) and 14 patients (35.9 %) needed a lower final dose (Group 3). Conclusions: In our study patients did not appear to develop tolerance to propofol after repeated administration. Although the lack of a systematic dosing scheme in our study limits the conclusions that can be drawn, recent studies in animal models indicate that tolerance development is rather unlikely with propofol. Further studies are required to clarify the question of whether repeated use of propofol leads to tolerance. [ABSTRACT FROM AUTHOR]

Background: Opioid maintenance therapy is a well-established first-line treatment approach in opioid dependence. The effects of opioids such as buprenorphine on cognitive functioning and driving ability are a matter of debate. Objectives: A comprehensive review of studies of the eff ects of buprenorphine on traffic safety is presented. Results: A number of recent epidemiological and road surveys indicate that opioids have a moderate risk for causing accidents compared to other drugs of abuse, such as alcohol. A number of neuropsychological studies, a few of which were prospective and used a randomized control group, have used standardized test batteries to measure domains relevant for psychomotor functioning and driving ability. Single doses of buprenorphine have been shown to induce some impairment in healthy volunteers, but less than found in chronic users. Some non-randomized studies indicate somewhat better cognitive performance of patients on buprenorphine than of those on methadone but this finding has not been demonstrated in randomized controlled trials. Conclusions: Opioids as a class of drugs induce some impairment of driving ability, but less than other psychotropic agents or drugs of abuse. Personality features such as impulsivity, sensation seeking, low risk perception and antisocial behaviour, comorbid psychiatric and neurological disorders and additional substance use of opioid users are of relevance for traffic safety. Buprenorphine does not cause more cognitive impairment than methadone or may even cause less. Caution is required when initiating treatment with buprenorphine. The risk for driving ability impairment is probably less under steady state conditions. Finally, higher doses of buprenorphine are probably not associated with more impairment. [ABSTRACT FROM AUTHOR]

Introduction: Buprenorphine is well known in the treatment of opioid dependence. Despite a high safety profile and good tolerance buprenorphine has been subject to misuse and diversion. To reduce misuse the antagonist naloxone was added and the 4:1 combination of buprenorphine-naloxone was launched in Germany in March 2007. On the basis of the results from international clinical trials a non-interventional study was conducted to gather data on safety, effectiveness, retention and acceptability of buprenorphine-naloxone in the treatment of opioid dependent patients in routine care. Methods: A nationwide multicentre 12-month prospective, non-interventional, post-marketing, surveillance study was carried out with 12 assessment points in N = 384 opioid dependent patients currently in maintenance treatment from N = 69 general practitioners, clinics and outpatient clinics in Germany. Results: N = 337 data sets were eligible for analysis. The rates of patients with serious and nonserious adverse events were low with 1.2 % and 17.5 %, respectively. No deaths occurred during the observational period and only one hospitalization was documented. Concomitant drug use decreased for all illicit substances. Mental health and quality of life measured with standardized self-assessment questionnaires improved significantly. The 12-month retention rate was 57.1 %. Of the n = 181 patients still in treatment at the end of the observation period, 96.7 % continued treatment with buprenorphine-naloxone. Conclusion: The findings of the non-interventional study indicate high eff ectiveness and safety of buprenorphine-naloxone in the treatment of opioid dependence. The medication was well accepted by opioid dependent patients in long-term substitution treatment with substantial reductions of concomitant drug use and measurable improvement in quality of life. [ABSTRACT FROM AUTHOR]

Opioid maintenance treatment with oral methadone or sublingual buprenorphine is the first-line treatment in opioid dependence. Three novel long-acting buprenorphine formulations have been approved or will be available soon: for subcutaneous weekly and monthly application, the depot formulations CAM 2038 (Buvidal ® ), the monthly depot formulation RBP-6000 (Sublocade™), and a 6-month buprenorphine implant (Probuphine™). Clinical data available so far on the efficacy of these 3 medications are given, and possible clinical implications are discussed., Competing Interests: For the past 3 years, MS has worked as a consultant or has received speakers fee from Amomed, Camurus and Indivior., (Thieme. All rights reserved.)

Methamphetamine use has spread in many European countries and the United States. The current review provides a summary and critical analysis of research on cognitive deficits associated with methamphetamine, also known as "crystal meth." The literature search performed for this review led us to the hypothesis that methamphetamine use is associated with persistent changes in brain metabolism that result in various impairments, such as deficits in memory, attention, and concentration. The dopaminergic system in particular seems to be affected. Some studies indicate that cognitive impairments may improve when users become abstinent, but results of other studies are conflicting. This review discusses these findings and the consequences for the development of a specific addiction treatment for methamphetamine., Competing Interests: No conflict of interest has been declared by the author(s)., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Acamprosate decreases relapse rates in alcohol-dependent patients by approximately 10-20% within the first year after detoxification. Psychological stress is a major risk fac-tor for relapse and is associated with activation of the hypothalamic-pituitary-adrenocortical (HPA) system. In recently detoxified alcoholics, the HPA system is dysregulated with non-suppression of cortisol after dexamethasone administration. We therefore investigated whether acamprosate normalizes HPA hyperactivity in alcoholics within the first 3 weeks of abstinence, employing a combined dexamethasone/corticotropin-releasing hormone (Dex-CRH)-test., Methods: Thirty alcohol-dependent patients were tested one week after withdrawal signs had disappeared. In 15 patients, acamprosate, 1332-1998 mg/day, was administered orally and a second Dex-CRH test was performed 1 week later. In the other 15 patients, acamprosate treatment was offered only after the second test., Results: CRH-stimulated cortisol secretion was significantly increased in both the acamprosate group and the group receiving no anti-relapse medication compared to a control group of 15 healthy subjects. Acamprosate treatment had no effect on basal or CRH-stimulated ACTH or cortisol secretion., Conclusions: We conclude that 1 week of acamprosate treatment does not attenuate the HPA dysregulation ob-served during early abstinence.