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Biomedical subjects

John R Hughes

Publications and source records attributed to John R Hughes.

At least 19 recordsLinked to original sources
PubMed2006

Oral delta-9-tetrahydrocannabinol suppresses cannabis withdrawal symptoms.

BACKGROUND: This study assessed whether oral administration of delta-9-tetrahydrocannbinol (THC) effectively suppressed cannabis withdrawal in an outpatient environment. The primary aims were to establish the pharmacological specificity of the withdrawal syndrome and to obtain information relevant to determining the potential use of THC to assist in the treatment of cannabis dependence. METHOD: Eight adult, daily cannabis users who were not seeking treatment participated in a 40-day, within-subject ABACAD study. Participants administered daily doses of placebo, 30 mg (10 mg/tid), or 90 mg (30 mg/tid) oral THC during three, 5-day periods of abstinence from cannabis use separated by 7-9 periods of smoking cannabis as usual. RESULTS: Comparison of withdrawal symptoms across conditions indicated that (1) the lower dose of THC reduced withdrawal discomfort, and (2) the higher dose produced additional suppression in withdrawal symptoms such that symptom ratings did not differ from the smoking-as-usual conditions. Minimal adverse effects were associated with either active dose of THC. CONCLUSIONS: This demonstration of dose-responsivity replicates and extends prior findings of the pharmacological specificity of the cannabis withdrawal syndrome. The efficacy of these doses for suppressing cannabis withdrawal suggests oral THC might be used as an intervention to aid cannabis cessation attempts.

Administration, Oral↗
PubMed2006

Prevalence of DSM/ICD-defined nicotine dependence.

We conducted a qualitative review to estimate for adults (1) the lifetime and current prevalence of DSM/ICD-defined nicotine dependence and (2) the prevalence of individual DSM/ICD dependence criteria. Systematic computer searches and other methods located eleven population-based surveys of adults (>or=18 year olds) and two of young adults (18-30 year olds). In the USA and Germany, about 25% of adults had been dependent on nicotine in their lifetime, including 15% who were currently dependent. Similar or higher rates were seen in Asian men but <5% of Asian women had been dependent. About a third of ever-smokers and half of current smokers either had been or were currently dependent on nicotine and this did not consistently differ by age, country or sex. Impaired control over tobacco use was the most commonly endorsed criteria and giving up activities to use and spending lots of time with nicotine were the least commonly endorsed. Nicotine dependence is one of the most common mental disorders; however, about half of current smokers do not meet DSM/ICD dependence criterion.

Adolescent↗
PubMed2006

Errors in interpreting abstinence curves in studies of smoking cessation.

Articles on smoking cessation often present curves representing the percentage of smokers still abstinent over time. The purpose of this paper is to illustrate how common conclusions from inspecting these curves may be misleading because they are based on assumptions of which readers are not aware. For example, when active and control abstinence curves converge, this is often interpreted to indicate a diminution of treatment effect size over time. We use illustrative data to show that this interpretation is correct if one assumes a treatment has a constant additive effect; however, if one assumes treatment has a constant multiplicative effect, then converging curves can still indicate a constant treatment effect. Converging abstinence curves are also often interpreted to indicate that the rate of relapse is greater in the active than the control group. We illustrate that this interpretation is correct if one is interested in cumulative relapse rate and uses all subjects in the denominator; however, if one is interested in relapse over a discrete subperiod of time (e.g., immediately after treatment stops), and thus uses only those at risk for relapse, then converging curves can still indicate a constant relapse rate. When trials interpret abstinence curves, they should make clear whether they are assuming additive or multiplicative effects of treatment and are discussing overall or local relapse rates. They should also report both additive and multiplicative effect sizes.

Data Interpretation, Statistical↗
PubMed2006

Clinical significance of tobacco withdrawal.

To estimate the clinical significance of tobacco withdrawal, this review located six experimental studies that reported Profile of Mood States (POMS) scores after stopping smoking in untreated smokers and compared them with scores in psychiatric outpatients. The pre-cessation POMS Total Mood Disturbance scores (median = 13.6) were similar to adult norms (mean, M = 17.8) but during abstinence (M = 5 days), the scores had increased (M = 27.4) to be similar to that of psychiatric outpatient norms (M = 25.1). These results and others suggest stopping smoking causes clinically significant distress.

Affect↗
PubMed2006

Does smoking reduction increase future cessation and decrease disease risk? A qualitative review.

This review examines whether reduction in smoking among smokers not currently interested in quitting (a) undermines or promotes future smoking cessation or (b) decreases the risks of developing smoking-related diseases. Systematic computer searches and other methods located 19 studies examining reduction and subsequent cessation and 10 studies examining reduction and disease risk. Because of the heterogeneity of methods and results, a meta-analysis could not be undertaken. None of 19 studies found that reduction undermined future cessation, and 16 found that reduction was associated with greater future cessation, including the two randomized trials of reduction versus nonreduction. The 10 trials of disease risk found conflicting results, and none was an adequate test. We conclude that (a) smoking reduction increases the probability of future cessation and (b) whether smoking reduction decreases the risks of smoking-related diseases has not been adequately tested.

Attitude to Health↗
PubMed2006

The cannabis withdrawal syndrome.

PURPOSE OF REVIEW: The demand for treatment for cannabis dependence has grown dramatically. The majority of the people who enter the treatment have difficulty in achieving and maintaining abstinence from cannabis. Understanding the impact of cannabis withdrawal syndrome on quit attempts is of obvious importance. Cannabis, however, has long been considered a 'soft' drug, and many continue to question whether one can truly become dependent on cannabis. Skepticism is typically focused on whether cannabis use can result in 'physiological' dependence or withdrawal, and whether withdrawal is of clinical importance. RECENT FINDINGS: The neurobiological basis for cannabis withdrawal has been established via discovery of an endogenous cannabinoid system, identification of cannabinoid receptors, and demonstrations of precipitated withdrawal with cannabinoid receptor antagonists. Laboratory studies have established the reliability, validity, and time course of a cannabis withdrawal syndrome and have begun to explore the effect of various medications on such withdrawal. Reports from clinical samples indicate that the syndrome is common among treatment seekers. SUMMARY: A clinically important withdrawal syndrome associated with cannabis dependence has been established. Additional research must determine how cannabis withdrawal affects cessation attempts and the best way to treat its symptoms.

Animals↗
PubMed2006

A comparison of the psychometric properties of three cigarette withdrawal scales.

AIMS: To compare the psychometric properties of three cigarette withdrawal scales. DESIGN: An internet cohort study. PARTICIPANTS: Each of 4,644 current (44%), former (49%) and never smokers (7%) completed the three scales via the internet. A subsample completed the scales again after 14 days (n=1309), and indicated their smoking status after 42 days (n=1431). MEASUREMENTS: The Cigarette Withdrawal Scale (CWS), the Wisconsin Withdrawal Scale (WWS) and the Minnesota Withdrawal Form (MWF). FINDINGS: All three scales covered the main elements in the Diagnostic and Statistical Manual version IV (DSM-IV) and the International Classification of Diseases version 10 (ICD-10) definitions of tobacco withdrawal, but WWS did not cover weight gain. Factor analyses indicated that only six factors were present in WWS, instead of the expected seven factors. Cronbach's alpha coefficients (0.76-0.93) were high for all scales. Test-retest coefficients were in the range of 0.66-0.86 for CWS and WWS, but were somewhat lower for some MWF items (range 0.52-0.80). In 324 ex-smokers who had quit smoking 31 days or less before baseline, craving predicted relapse at 14-day follow-up (CWS: odds ratio=1.53 per point, P=0.003; WWS: odds ratio=1.40, P=0.04; MWF: odds ratio=1.49, P=0.002). In 34 baseline smokers who had quit smoking by 14-day retest, an increase in craving (WWS and MWF), depressed mood (MWF) and difficulty concentrating (WWS) between baseline and retest predicted relapse at 42-day follow-up. In terms of construct validity, scales performed similarly, but performance on some key tests (e.g. withdrawal will increase post-cessation) were inadequate, due perhaps to methodological limitations. CONCLUSIONS: No scale showed a decisive advantage over the others. MWF has the advantage of brevity.

Adult↗
PubMed2006

Should criteria for drug dependence differ across drugs?

AIM: To examine the pros and cons of using the same diagnostic criteria for dependence across all drugs versus using dependence criteria specific to the drug of interest. METHODS: A qualitative review of the similarities and differences in nicotine versus alcohol and opiate dependence is used as an example of the utility of using generic versus drug-specific criteria. RESULTS: Many scientists implicitly recognize that nicotine dependence is different when they do not include nicotine dependence when studying 'drug dependence'. Nicotine and alcohol/opiate dependence have many similarities (e.g. both can cause withdrawal). Among the several differences, the most important is that nicotine dependence does not cause acute behavioral impairment. Some of the generic dependence criteria do not apply to nicotine dependence (e.g. giving up activities to use the drug) and some well-validated measures of nicotine dependence (e.g. time to first cigarette) are not included in the generic criteria. CONCLUSIONS: Empirical tests of the relative utility of generic versus drug-specific criteria are needed.

Alcoholism↗
PubMed2006

Survey of U.S. Army commanders' experiences with brigade/battalion surgeons at Fort Hood, Texas.

This anonymous survey sent to every battalion and brigade commander at Fort Hood, Texas assessed the new concept of residency-trained operational physicians that had completed military unique curriculum series training. Commanders provided anonymous professional information about themselves and their assigned physicians and evaluated their physicians in 22 areas of medical and military competence using a linear scoring method from 2 (indicating poor) to 6 (indicating outstanding). Main effects and interaction effects were analyzed using multiple analysis of variance. The commanders' overall confidence in their physicians was 5.4, suggesting general satisfaction. Prior-service physicians were rated higher on several factors if the commander had combat experience. Non-prior-service physicians were rated the same on nearly all variables regardless of the commander's experience. Commanders with combat experience rated their assigned physicians significantly higher than did commanders without combat experience. Despite high ratings, several candid remarks suggest there is still room for improvement.

Adult↗
PubMed2005

The idiosyncratic aspects of the epilepsy of Fyodor Dostoevsky.

The goal of this article is to review the idiosyncratic aspects of the epilepsy of Fyodor Dostoevsky, one of the greatest writers of all time. The onset of his seizures is controversial, with some evidence pointing to his childhood and other reports that would place the onset in his teens or his twenties. His life in prison in Siberia and then in the Russian army is reviewed. His lifestyle included many factors that exacerbated his epilepsy, especially stress and sleep deprivation. His compulsion for gambling played an important role in producing great stress in his life, as he tried to reverse his poverty in the casinos. The most idiosyncratic aspect of his epilepsy was his so-called ecstatic aura. The etiology of his seizures was probably inherited as revealed by the seizures of his father and the status epilepticus and death of his young son. This great writer died from lung hemorrhages in 1891. Discussed in this review is that he did not likely have an aura of ecstasy; only a few such possible cases can be found in the world literature. For those few cases, evidence from electrical self-stimulation studies in animals and humans, investigating "pleasure centers," can be found to involve the limbic system, especially the septal nucleus. Data from the human amygdala provide evidence why almost all auras are, in fact, unpleasant and not pleasant. A review of recent data on the risks to offspring of epileptic fathers confirms that the etiology of Dostoevsky's epilepsy was probably inherited and that he probably had an idiopathic generalized epilepsy with minor involvement of the temporal lobe. A relationship is seen between his severe obsession with gambling and his epilepsy. Finally, Fyodor Dostoevsky is an excellent example of the "temporal lobe personality."

Epilepsy↗
PubMed2005

Do smokers with alcohol problems have more difficulty quitting?

This review compares nicotine dependence and the ability to stop smoking in smokers with no alcohol problems to smokers with current, past or lifetime (i.e., either current or past) alcohol problems. We searched computerized databases, meeting abstracts and made requests to listserves and grantees for comparisons of the above categories. We could not use meta-analyses and, thus, used consistency across studies to make conclusions. We located 17 articles on nicotine dependence, 12 on the ability to quit on a given attempt, 7 on lifetime quitting and 2 on quit attempts. Smokers with current and past alcohol problems were more nicotine dependent than smokers with no alcohol problems. Surprisingly, smokers with past problems were as able to quit on a given attempt as smokers with no problems. We hypothesize this may be because such smokers learned skills in resolving their alcohol problems that neutralized their increased nicotine dependence. Smokers with current or past alcohol problems appear to be less likely to quit in their lifetime. Given their equal ability to quit on a given attempt, this could be due to fewer quit attempts; however, whether this is actually so is unclear. Our results that smokers with past alcohol problems can quit as easily as those without alcohol problems suggest that smokers with past alcohol problems may respond to minimal treatments for smoking cessation.

Alcoholism↗
PubMed2005

Intentions to quit smoking change over short periods of time.

To assess the stability of intention to quit smoking, 115 US and Swedish smokers were randomized to complete Stage of Change (SOC) or ladder scales of intentions to quit at either 0, 7, 14 and 30 days or at 0 and 30 days in the absence of intervention. The four-assessment group had more progression in intention to quit than the two-assessment group. Depending on the measure, 12-17% of smokers changed their intention to quit over 7 days, 15-25% changed over 14 days and 17-34% changed over 30 days. Results were similar in Swedish and US participants and replicate the results of prior studies. We conclude intention to quit often spontaneously changes over short periods of time, especially with repeated testing.

Adult↗
PubMed2005

Did all those famous people really have epilepsy?

Many famous individuals are said to have had epilepsy, and these names often find their way into books and lectures on epilepsy. The goal of this study was to investigate in detail the histories of 43 of those people who had various kinds of attacks, but not epilepsy. They range chronologically from Pythagorus, born in 582 bc, to the actor Richard Burton, born in 1925 AD. Epilepsy was misdiagnosed in 26% who had psychogenic attacks, in 21% with attacks of anguish, nervousness, fear, agitation, or weakness; and in 12% with alcohol withdrawal seizures. In some instances no evidence of any episodic symptom could be found. One unexpected finding was that 40% of these well-known, individuals had serious, often life-threatening, physical conditions as infants or very young children. This article is an attempt to correct the record with respect to these people and also to remind us of the many reasons similar misdiagnoses are being made today.

Epilepsy↗
PubMed2005

A reappraisal of the possible seizures of Vincent van Gogh.

The tragic life of Vincent van Gogh is summarized, emphasizing his early departure from formal education, failure as a successful salesman in the art world, attempt at religious studies, difficulty with female and family relationships, return to the art world, and tendencies toward extremes of poor nutrition or near self-starvation and excessive drinking and smoking. In Paris he joined the Impressionists, but drank very heavily both absinthe and cognac. Southward he went to Arles and was joined by Paul Gauguin, with whom he had major personality problems, causing van Gogh to cut off part of his left ear. He experienced paranoid ideation and confinement in mental institutions in Arles, and then returned to Paris and onto Auvers-sur-Oise, where he committed suicide at age 37. Possible physical diagnoses include glaucoma, Meniere's disease, acute intermittent porphyria, and chronic lead poisoning, but these diagnoses seem unlikely. Possible psychiatric diagnoses include borderline personality disorder, anxiety-depressive disorder with episodes of depression and hypomania, and also paranoid schizophrenia. Van Gogh did not have spontaneous seizures and, therefore, did not have epilepsy. Before he began to drink heavily, when he was near starvation, he had "fainting fits," and after drinking, especially absinthe, a convulsant drug, he continued to have similar attacks. His episodes of unconsciousness can be well explained by chronic malnutrition and alcohol abuse, only possibly exacerbated by drinking large quantities of absinthe. Although van Gogh is an excellent example of the Geschwind syndrome, at times associated with temporal lobe epilepsy, this fact does not establish such an epilepsy. Thus, the syndrome is an orphan without the parent condition.

Adult↗
PubMed2005

Reduction in amount smoked predicts future cessation.

The goal of this article is to determine whether reducing cigarette consumption increases the likelihood of future cessation. Data from 3,385 participants who originally took part in the Community Intervention Trial for Smoking Cessation completed detailed tobacco use phone surveys in 1988, 1993, and 2001. Between 1988 and 1993, 15% of smokers reduced their daily cigarette consumption by 50% or more, and 9% of the entire baseline sample maintained this reduction in 2001. Those who reduced more than 50% were 1.7 times more likely to quit smoking by 2001 compared with those who did not reduce. Few smokers are able to reduce their consumption by 50% or more, although those who do are more likely to quit compared with those who do not.

Adult↗
PubMed2005

Ever users versus never users of a "less risky" cigarette.

The authors surveyed 173 smokers who purchased and 114 smokers who knew about but did not purchase Eclipse--a tobacco industry product that is advertised as a reduced risk cigarette. Most low-tar/nicotine cigarette users who purchased Eclipse believed Eclipse was safer than low-tar/nicotine cigarettes both for their own health (73%) and for the health of others around them (86%). Additionally, many viewed Eclipse as a step toward quitting (53%). The authors did not identify robust predictors of Eclipse use. At 6 months follow-up, Eclipse users were as likely to have tried to quit as nonusers; however, the small sample size does not rule out the possibility that Eclipse use undermines quit attempts. The authors conclude that almost all users believe Eclipse is safer than low-tar cigarettes.

Attitude↗