A lthough endocrine abnormalities are recognized in opiate users, very little is known about the range of hormones affected, their pathophysiology and their clinical relevance. Various endocrine abnormalities have been reported in these patients including, increased prolactin levels and abnormalities in sexual hormone. Path physiological mechanism postulated does explain these findings including direct action of heroin or methadone at the hypothalamic pituitary level. The aim of this study was to explore the effects of heroin and methadone maintenance treatment on the plasma prolactin levels and sexual function. Material and methods: We evaluated 20 male narcotic addicts maintained of methadone more than 3 years on oral high dose methadone 60-120 mgr/day. Patients taking neuroleptic therapy were excluded from the study because neuroleptic-included hyperprolactinemia. We also evaluated group of twenty male heroin addicts on the street heroin .The prolactin plasma levels were assayed using the chemiluminescent immunometric essay (CLIA) -high sensitive methods, The normal range of prolactin levels was 1,5-17 ng/ml(53-360 nmol/l) for men and 1,90-25,0 ng/ml for women. The sexual function was assessed using a Questionnaire: International Index of Erectile Function (IIEF) with 15 items in four levels of sexual function. The differences between two examination groups were determined by a student' s t test. The results show that street heroin addicts (55% of them have high level of prolactin) have significantly higher plasma prolactin levels (p=0,006) then the group of methadone maintenance patients (only 15% of them have high prolactin level). In our study, when we compared sexual dysfunction in examination groups in some domains, we did not find statistical significant results (sexual desire p=0,52 and overall satisfaction p=0,087). But in domains of erectile function p=0,011 and orgasm function p=0,033 we got statistical significant results.
Citizens and scientists can work together to improve the collective well-being, if citizens are inspired to help the advancement of science, and researchers motivated to listen to the voices of citizens. The benefits of such collaboration are increasingly recognized by both citizens and scientists, as reflected in the growing number of related publications and initiatives. This is especially relevant for emerging areas of research, where early involvement of citizens could help to envision, prioritize, and plan prospective studies. The Problematic Usage of the Internet (PUI) is one such area, which is fast becoming a public mental health concern. However, there remains a lack of clarity regarding the practical guidelines and ethical requirements for citizen involvement at the earliest stages of PUI. In our paper, we propose a conceptual framework and a template for initial involvement of citizens in PUI. They are derived from our community case studies, conducted in six European countries (Georgia, Greece, Malta, North Macedonia, Portugal, and Spain) and consisting of consultation with diverse groups of interested citizens (students, parents, teachers, and health professionals). Informed by our consultation exercises, we also highlight four ethical aspects for citizen involvement in the research on PUI or novel disciplines in general. They follow simple guiding principles to ensure that scientists will: enable a long-term commitment and inclusive opportunities for citizens, challenge established power hierarchies, and support collaboration, co-production and co-authorship with citizens. We believe that the proposed practical guidelines and ethical considerations, provide a valuable foundation on which to advance our understanding and generate international strategies for citizen involvement in PUI.
Special considerations are required for women with epilepsy. These include issues such as catamenial exacerbation, concerns for contraception, teratogenesis (including both anatomical and neurodevelopmental effects), and other concerns for pregnancy complications such as increased seizures or adverse obstetric outcomes. In this manuscript, several cases are presented and discussed addressing some of the important issues in the management of women with epilepsy.
Family history of schizophrenia is considered to be the strongest risk factor for schizophrenia. Evidence for disturbances in HPA activation and abnormal HPA regulatory mechanisms in schizophrenia is accumulating.In this clinical prospective study, 60 patients with schizophrenia and 40 healthy subjects, age-and sex-matched control subjects were included. Clinical evaluation of patients was performed using the Positive and Negative Symptom Scale. A questionnaire for sociodemographic and clinical data collection was used. Serum levels of cortisol, DHEA-S and their ratio were measured at baseline in all participants and after 3 and 6 weeks of the antipsychotic treatment in patients with schizophrenia.Patients with schizophrenia had a significantly higher serum cortisol and DHEA-S levels in comparison to the control group. The age of onset of the disorder did not significantly correlate with serum cortisol levels, DHEA-S and cortisol/DHEA-S ratio. Number of relapses of the disorder significantly correlated with serum DHEA-S levels, but not with serum cortisol levels and cortisol/DHEA-S ratio. Positive family history did not significantly correlate with serum levels of cortisol, DHEA-S and their ratio.Elevated serum cortisol and DHEA-S in schizophrenic patients might be associated with their role in the pathophysiology of the disorder. There was no significant difference in serum levels of cortisol, DHEA-S and their ratio according to the age of onset of the disorder and positive family history in patients with schizophrenia. Number of relapses of the disorder significantly correlated with serum DHEA-S levels.
Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Subjective sleep complaints occur in 75-84% of methadone-maintained patients, and more than 50% of methadone-maintained patients reported use of medications to improve their sleep cycle. Studies of insomnia support a female predominance.The Aim of this study was to evaluate insomnia and gender differences in insomnia among methadone-maintained patients in the Department for prevention and treatment of drug abuse and dependence, Psychiatric Hospital Skopje.This was a cross-sectional study. Two groups of methadone-maintained patients were included: 73 males and 14 females. Participants were evaluated with Bergen Insomnia Scale (BIS), and Insomnia Severity Index.The evaluation of subjects with BIS showed that 87.3% of subjects reported some sleep problems. There were significant differences between the groups related to item 3 on BIS with higher mean score for females. The total score for the Insomnia Severity Index scale showed that a larger number of females than males had moderate and severe insomnia. More females than males reported use of medications (90.5% used benzodiazepine), to help them with their sleep problems. Last month 36.8% of subjects used some substances and in 75% of cases it was alcohol, cannabis or both.This study provided evidence that sleep disturbance and use of alcohol, cannabis, and benzodiazepines was highly prevalent among methadone-maintained patients. Female patients reported a significantly worse sleep cycle than males. Use/abuse of benzodiazepines in methadone-maintained patients does not resolve the problem of insomnia.
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