Association of <i>DSM-5</i> Betel-Quid Use Disorder With Oral Potentially Malignant Disorder in 6 Betel-Quid Endemic Asian Populations

Lee, Chien-Hung; Ko, Albert Min Shan; Yang, Frances M.; Hung, Chung Chieh; Warnakulasuriya, Saman; Ibrahim, Mohamed Yousif; Zain, Rosnah Binti; Ko, Ying Chin

doi:10.1001/jamapsychiatry.2017.4307

Cited by 49 publications

(56 citation statements)

References 40 publications

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“…BQ is now the fourth most commonly consumed psychoactive substance in the world, following only alcohol, nicotine, and caffeine (5,6). A recent study with a large sample size in 6 Asian populations revealed a vast prevalence of BQ use in these counties (typically over 10%) (7). BQ use is reported to be highly associated with oral sub-mucous fibrosis and oral cancer (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…Several lines of researches have suggested that intensive BQ use shows similar symptoms of other addictive disorders. First, in the Asian Betel-quid Consortium study of 8922 participants from 6 countries, betel-quid use disorder was reported to meet DSM-V criteria for substance use disorder and had a high prevalence among users of betel-quid (7). Another study suggested that the 12-month prevalence of BQ use disorder was 18.0%, which exceeded that reported for DSM-V defined drug use disorder (3.9%) (13) and was comparable to the results of alcohol (13.9%) and nicotine (20.0%) use disorders (14,15).…”

Section: Introductionmentioning

confidence: 99%

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Dysfunction of the Prefrontal Cortex in Betel-Quid–Dependent Chewers

et al. 2020

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Betel quid is the fourth most popular psychoactive agent worldwide. Imaging studies have found altered brain structure in prefrontal cortex (PFC) in betel-quid dependent (BQD) chewers. However, the brain function in PFC associated with BQ use still remains unclear. The present study aimed to examine brain functional activity in PFC in individuals with BQD. This study recruited 48 participants with BQD and 22 normal controls (NCs). Both BQ-specific cue reactivity and Go/NoGo tasks were administered with functional magnetic resonance imaging (fMRI). Behavioral results showed a deficit in the choice reaction time task in BQD group. The fMRI results of the cue reactivity task suggested that, individuals with BQD exhibited responses in right ventromedial PFC, left posterior cingulate cortex (PCC), left lateral parietal lobe (LPL), left middle temporal gyrus and left visual cortex, when seeing BQ images compared with control images. In the Go/NoGo task, relative to NCs group, individuals with BQD showed higher activity in right dorsolateral PFC, right PCC and bilateral LPL between NoGo and Go trials. Across these two tasks, we consistently found disrupted function in PFC in individuals with BQD, which might lead to impaired craving and response inhibition in BQ addiction. Results of current study might shed light on the neural mechanisms involved in BQ use, which could be used as potential guidelines for diagnosis and treatment of BQ dependence.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dysfunction of the Prefrontal Cortex in Betel-Quid–Dependent Chewers

et al. 2020

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“…Compared to the lowest quartile of PVC burden (0%–0.002%), patients having the highest quartile of PVCs burden (0.123%–17.7%) were identified to have a higher risk of decreased LVEF, congestive heart failure, and mortality [ 39 ]. BQ is an addictive substance that can induce BQ use disorder [ 7 ]. In this investigation, BQ chewing revealed a significant effect on high level of PVC.…”

Section: Discussionmentioning

confidence: 99%

“…This substance has been habitually consumed in six Asian populations with a prevalence of 9.8–43.6% in men and 1.8–46.8% in women [ 4 ]. In large-scale psychiatry studies, chronic BQ chewers were observed to have dependence symptoms and the related symptoms meet the DSM -5 criteria for a substance use disorder [ 5 , 6 , 7 ]. Epidemiological investigations have indicated that BQ users were at a higher risk of contracting systematic diseases that occurred in the brain, heart, lungs, gastrointestinal tracts, and reproductive organs [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Betel-Quid Chewing, Heart Failure, and Premature Ventricular Contractions in Patients with Cardiopulmonary Symptoms

Huang

Chen

et al. 2020

IJERPH

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Betel-quid (BQ) is a commonly used psychoactive substance that renders a specific cardiotoxicity. The purpose of this study was to investigate the association between BQ chewing and premature ventricular contractions (PVC) in patients with cardiopulmonary symptoms, and examine the potential influences of cardiovascular and chronic diseases on such relationship. Participants were 146 patients with cardiopulmonary symptoms who participated in 24-h Holter electrocardiogram monitoring during 2012–2018 in a hospital serving residents that lived in a BQ high prevalence area. Data on substance uses and medical histories for cardiovascular and chronic diseases were collected. Baron–Kenny method was employed to evaluate possible mediation. In patients with cardiopulmonary symptoms, 36.3% were BQ users and 63.7% were nonusers. Adjusting for covariates, BQ chewing was significantly associated with heart failure and diabetes mellitus (adjusted odds ratio (aOR) = 3.4 and 2.3, respectively), but only heart failure was significantly correlated with a low and high level of PVC. Additionally controlling for the effect of heart failure, the risk of high PVC for BQ users reduced from 3.60 to 2.88; however, the risk for BQ chewers remained significant (95% CI: 1.06–7.84). Heart failure was found to explain 27.7% of the excessive effect of BQ use on high PVC. In conclusion, BQ use is directly associated with an elevated risk of high PVC in patients with cardiopulmonary symptoms. The higher risk might be elevated among patients who suffered heart failure. Given several research limitations, the findings from this study offer future opportunities for validation.

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“…In 2018, Lee et al validated BQ use disorder (BUD) among addictive BQ users using DSM-5 diagnosis of 'use disorder' in six BQ endemic Asian populations (Lee et al, 2018). For Taiwan, Mainland China, Malaysia, Indonesia, Nepal and Sri Lanka, the 12-month prevalence of DSM-5-defined BUD were determined to be 56−99% of current users (Lee et al, 2012a(Lee et al, , 2018.…”

Section: Introductionmentioning

confidence: 99%

Effect of antidepressants for cessation therapy in betel-quid use disorder: a randomised, double-blind, placebo-controlled trial

Hung

Lee

et al. 2020

Epidemiol Psychiatr Sci

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Aims More than one-half of betel-quid (BQ) chewers have betel-quid use disorder (BUD). However, no medication has been approved. We performed a randomised clinical trial to test the efficacy of taking escitalopram and moclobemide antidepressants on betel-quid chewing cessation (BQ-CC) treatment. Methods We enrolled 111 eligible male BUD patients. They were double-blinded, placebo-controlled and randomised into three treatment groups: escitalopram 10 mg/tab daily, moclobemide 150 mg/tab daily and placebo. Patients were followed-up every 2 weeks and the length of the trial was 8 weeks. The primary outcome was BQ-CC, defined as BUD patients who continuously stopped BQ use for ⩾6 weeks. The secondary outcomes were the frequency and amount of BQ intake, and two psychological rating scales. Several clinical adverse effects were measured during the 8-week treatment. Results Intention-to-treat analysis shows that after 8 weeks, two (5.4%), 13 (34.2%) and 12 (33.3%) of BUD patients continuously quit BQ chewing for ⩾6 weeks among placebo, escitalopram, moclobemide groups, respectively. The adjusted proportion ratio of BQ-CC was 6.3 (95% CI 1.5–26.1) and 6.8 (95% CI 1.6–28.0) for BUD patients who used escitalopram and moclobemide, respectively, as compared with those who used placebo. BUD patients with escitalopram and moclobemide treatments both exhibited a significantly lower frequency and amount of BQ intake at the 8th week than those with placebo. Conclusions Prescribing a fixed dose of moclobemide and escitalopram to BUD patients over 8 weeks demonstrated treatment benefits to BQ-CC. Given a relatively small sample, this study provides preliminary evidence and requires replication in larger trials.

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Association of DSM-5 Betel-Quid Use Disorder With Oral Potentially Malignant Disorder in 6 Betel-Quid Endemic Asian Populations

Cited by 49 publications

References 40 publications

Dysfunction of the Prefrontal Cortex in Betel-Quid–Dependent Chewers

Dysfunction of the Prefrontal Cortex in Betel-Quid–Dependent Chewers

Betel-Quid Chewing, Heart Failure, and Premature Ventricular Contractions in Patients with Cardiopulmonary Symptoms

Effect of antidepressants for cessation therapy in betel-quid use disorder: a randomised, double-blind, placebo-controlled trial

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