Understanding opiate dependence: The influence of personality disorders during detoxification
Notice bibliographique
Résumé
Background: Dependence on opiates is a major health issue in North America. The recent increases in both prescription and illicit opiate abuse have exacted enormous tolls in terms of health care, mental illness, quality of life, unemployment, and crime, while the difficulty in treating opioid dependent patients with standard abstinence-based therapies is not well understood. Objectives: The objective of this study was to provide a novel approach to understanding the poor outcomes of opiate dependent patients. Addiction severity, medical, and psychiatric comorbidity among opiate-dependent patients was compared with a sedative-hypnotic control group. In addition, craving, mood, objective and subjective withdrawal symptoms, subjective experiences of pain, and objective measures of hyperalgesia were prospectively monitored during inpatient detoxification. Lastly treatment completion, entry into aftercare, and substance use at three and six months follow-up was examined. Methods: This study was conducted at the Addictions Unit of the McGill University Health Center in Montreal. A total of 106 patients were prospectively monitored during inpatient detoxification for opiate dependence or sedative-hypnotic dependence in terms of craving, mood, withdrawal symptoms, vital signs, subjective experiences of pain, and objective measures of hyperalgesia and allodynia. Patient psychiatric comorbidity (Axis I and Axis II disorders), chronic medical conditions (pain syndromes), and severity of substance dependence were also considered. Results: Opiate patients reported more subjective pain and hyperalgesia during inpatient detoxification. 76.7% reported chronic pain compared to 2.3% of sedative-hypnotic patients, and 39.5% of opiate-dependent patients had both chronic pain and a personality disorder. Cluster B personality disorders were particularly prevalent among both opiate (20.93%) and sedative-hypnotic(16.28%) patients. During treatment patients with cluster B personality disorders reported more negative mood symptoms (anger, anxiety, fatigue, confusion), craving and greater scores on objective measures of withdrawal. Completion rates of detoxification were high (83.5%), although at three months follow-up 51% of patients had slipped or relapsed.Conclusions: Together these findings suggest that hyperalgesic, highly sensitive opiate-dependent patients with cluster B personality disorders and chronic pain experience substantial difficulty tolerating both the physical and emotion symptoms of withdrawal. These particularly sensitive patients may benefit from the development of targeted interventions focusing on pain management and concurrent treatment of personality disorders.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».