تأثير طول درمان بر علائم اضطراب و افسردگي در برنامه‌هاي مختلف درماني نگهدارنده اعتياد
محورهای موضوعی : روان شناسی
کلید واژه: كليدواژه‌ها: درمان نگهدارنده با متادون, درمان نگهدارنده با بوپرنورفين, علائم افسردگي, علائم اضطراب, طول درمان,
چکیده مقاله :
چكيده: در پژوهش حاضر، نمرة علائم اضطراب و افسردگي 44 بيمار وابسته به مواد افيوني که تحت درمان نگهدارنده با متادون (20 نفر) و بوپرنورفين (24 نفر) قرار داشتند، در سه مقطع زماني، پیش از شروع درمان، 45 روز پس از شروع درمان، و 90 روز پس از شروع درمان، مورد بررسي قرار گرفت. ابزار اندازه‌گيري، نسخة تجديدنظر شدة چک ليست علائم (SCL-90-R) بود. نتايج اين بررسي نشان داد که در هيچ¬يک از مقاطع زماني از لحاظ شدت علائم، تفاوت معناداري ميان دو گروه درماني وجود ندارد. شدت علائم اضطراب و افسردگي با گذشت زمان در هر دو گروه کاهش مي‌يابد اما اين کاهش طي 45 روز اول درمان در گروه درمان نگهدارنده با متادون، در مقايسه با بوپرنورفين، بيشتر است. با گذشت90 روز از آغاز درمان، شتاب کاهش علائم در گروه بوپرنورفين نيز بيشتر مي‌شود و در نهايت، با گذشت 90 روز از آغاز درمان، شدت علائم در دو گروه تفاوت معناداري با يکديگر ندارد. بنابراین اگرچه در کوتاه مدت متادون در کاهش نشانه‌ها مؤثرتر است، اما در درازمدت تفاوتي ميان اين دو نوع درمان وجود ندارد.
Abstract: The purpose of the present study was to determine the effects of Buprenorphine and Methadone maintenance therapy (BMT and MMT) on the symptoms of anxiety and depression. To do this, SCL-90-R question-naires were administered to 44 individuals referring to addiction clinics seeking treatment. Our results were obtained at three different stages: at the beginning, 45, and 90 days following treatment. The obtained results revealed that the symptoms of anxiety and depression in both treatment groups decreased over time. Also, there were no significant differences in the symptoms in any of the treatment periods. However, such decrease in the intensity of the symptoms was more rapid in the MMT group. Specifically, the decrease in the intensity of the symptoms of anxiety and depression occurred after 45 days in the Buprenorphine maintenance group while in the MMT group it occurred before the 45-day period. These results are discussed in the context of adherence to treatment programs and underlying biological mechanisms of MMT and BMT.
سرمد، زهره (1384). آمار استنباطي: برگزيده¬اي از روش¬هاي تک متغيري. تهران: سمت.
ميرزايي، ر. (1359). استاندارد سازي و اعتباريابي SCL-90-R در ايران. پايان¬نامه کارشناسي ارشد، دانشگاه علوم پزشکي وخدمات بهداشتي درماني تهران.
Blatchford, K. E., Diamond, K., Westbrook, R. F., & McNally, G. B. (2005). Increased vulnerability to stress following opiate exposures: Behavioral and autonomic correlates. Behavioral Neuroscience, 119, 1034-1041.
Brady, K. T., & Malcolm, M. D. (2004). Substance use disorders and co-occurring axies psychiatric disorders. In: M. Galanter & H. D. Kleber (Eds.), Textbook of Substance Abuse Treatment. Washington, DC: American Psychiatric Publishing Inc.
Brady, K. T., & Malcolm, M. D. (2004). Substance use disorders and co-occurring axies psychiatric disorders in: Galanter, M., Kleber, H. D. (Editors), Textbook of.
Darke, S., & Ross, J. (1997). Poly drug dependence and psychiatric comorbidity among heroine injectors. Drug and Alcohol Dependence, 48, 135-141.
Dean, A. J., Bell, J., Christie, M. J., & Mattick, R. P. (2004). Depressive symptoms during buprenorphine vs. methadone maintenance: findings from a randomized, controlled trial in opioid dependence. European Psychiatry, 19, 510-513.
Derogatis, L. R., Lipman, R. S., & Covi, L. (1973). SCL-90: An outpatient psychiatric rating scale, Preliminary report. Psychopharmacology Bull, 9, 13-28.
Derogatis, L., Rickels, K., & Rock, A. (1976). The SCL-90 and the MMPI: A step in the validation of a new self-report scale. British Journal of Psychiatry, 128, 280-289.
Fischer, G., Gombas, W., Eder, H., Jagsch, R., Peternell, A., & Stuhlinger, G. (1999). Buprenorphine versus methadone maintenance for the treatment of opioid dependence. Addiction, 94, 1337-1347.
Gerra, G., Leonardi, C., D'Amore, A., Strepparola, G., Fagetti, R., Assi, C., Zaimovic, A., & Lucchini, A. (2006). Buprenorphine treatment outcome in dually diagnosed heroin dependent patients: A retrospective study. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 30, 265-272.
Havard, A., Teesson, M., Darke, S., & Ross, J. (2006). Depression among heroin users: 12-month outcomes from the Australian treatment outcome study (ATOS). Journal of Substance Abuse Treatment, 30, 355-362.
Kakko, J., Wachenfeldt, J., Svanborg, K. D., Lidstrom, J., Barr, C. S., & Markus Heilig. (2007). Mood and neuroendocrine response to a chemical stressor, metyrapone, in buprenorphine-maintained heroine dependence. Biological Psychiatry, 63, 172-177.
Kosten, T., Oliveto, A., Feingold, A., Poling, J., Sevarino, K., McCancekatz, E., Stine, S., Gonzalez, G., & Gonsai, K. (2003). Desiperamine and contingency for cocaine and opiate dependence in buprenorphine maintained patients. Drug and Alcohol Dependence, 70, 315-325.
Kreek, M. J., & Hartman, N. (1982). Chronic use of opioids and antipsychotic drugs side effects, effects on endogenous opioids, and toxicity. In: Verebey, k., (Editor), Opioids in Mental Illness Theories, Clinical Observations and Treatment possibilities. New York: New York Academy of Sciences.
Lejuez, C. W, Paulson, A., Daughters, S. B., Bornovalova, M. A., & Zvolensky, M. J. (2006).The association between heroin use and anxiety sensitivity among inner-city individuals in residential drug use treatment. Behaviour Research and Therapy, 44, 667-677.
Maremmani, I., Pani, P. P., Pacini, M., & Perugi, G. (2007). Substance use and quality of life over 12 months among buprenorphine maintenance-treated heroin-addicted patients. Journal of Substance Abuse Treatment, 33, 91-98.
McGovern, M. P., Xie, h., Segal, S. R., Siembab, l., & Drake, R. E. (2006). Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers. Journal of Substance Abuse Treatment, 31, 267-275.
Nunally, J. C. (1970). Introduction to Psychological Measurement. New York: McGrew-Hill.
Nunes, E. V., Sullivan, M. A., & Levin, F. R. (2004). Treatment of depression in patients with opiate dependence. Biological Psychiatry, 56, 793-802.
Roberts, R. E., Roberts, C. R., & Xing, Y. (2007). Comorbidity of substance use disorders and other psychiatric disorders among adolescents: Evidence from an epidemiologic survey. Drug and Alcohol Dependence, 88, 4-13.
Schottenfeld, R. S. (2001). Opioids Maintenance treatment. In: M. Galanter & H. D. Kleber (Eds), Textbook of Substance Abuse Treatment (pp. 1072-1079). Washington, DC: American Psychiatric Publishing, Inc.
Simpson, D. D. (1981). Treatment of drug abuse: Follow up outcomes and length of time spent. Archive of General Psychiatry, 38, 875-880.
Swartz, J. A., & Lurigio, A. j. (2006). Screening for serious mental illness in populations with co-occurring substance use disorders: Performance of the K6 scale. Journal of Substance Abuse Treatment, 31, 287-296.
Thorberg, F. A., & Lyvers, M. (2006). Negative Mood Regulation (NMR) expectancies mood, and effect intensity among clients in substance disorders treatment facilities. Addictive Behaviors, 31, 811-820.
Weissman, M. M., Slobetz, F., Prusoff, B., Mezritz, M. & Howard, P. (1976). Clinical depression among narcotic addicts maintained on methadone in the community. American Journal of Psychiatry, 133, 1434-1438.