No abstract

The number of recognised ATS-related presentations is increasing at Albany Health Campus. A broad age range and comparatively high proportion of women were hospitalised. These patients have complex needs and many had multiple ATS-related admissions.

A 48 year old man presented to the outpatient clinic reporting memory decline interfering with his functioning. He would lose his place during tasks; forget appointments, and the names and faces of new and old acquaintances. Symptom commencement was unclear, but had been present for at least two years, first noticed when he ceased methamphetamine use.The patient began smoking amphetamine from age 16. He soon moved to injecting amphetamine and later methamphetamine on a daily basis up to 3 or 4 times a day, for 30 years before ceasing due to incarceration in prison for drug related offences. He had not used psychostimulants for over 2 years. He was also a regular smoker of cannabis. The patient had a history of head injuries from motor vehicle accidents, fights and sporting injuries.He suffered from hemochromatosis, which was well managed by regular venepuncture.On examination, the patient was alert and orientated, and was broadly able to give a coherent history, but lost his place during long anecdotes. On frontal lobe testing he performed poorly on alternating hand sequences, the 'no-go' test and proverb interpretation. There were no frontal release signs. His neurological examination was unremarkable. On further cognitive testing, he scored 75/100 on the Addenbrooke's Cognitive Examination (ACE-R), with significant impairments in memory, verbal fluency and minor impairment in attention and orientation. Other domains were unremarkable. Blood tests including iron studies, metabolic parameters, syphilis serology, HIV and hepatitis screens were negative. CT and MRI of the brain were unremarkable.Methamphetamine (MA) has been shown to be neurotoxic to both dopaminergic and serotonergic neurons in both human, but in particular animal studies. Studies have shown long term neuronal damage in abstinent MA users with significant reductions in basal ganglia and frontal white matter. [1,2] Until recently, the prevailing view was that methamphetamine use, even when the user achieved abstinence, caused a broad range of cognitive deficits, evidenced by deficits on cognitive testing and observed on neuroimaging studies.[3] However a critical review by Hart et al [4] attempted to dispel this view by examining the significance of cognitive deficits and neuroimagining changes in users, suggesting the clinical significance of these findings may be limited because the cognitive functioning had overwhelmingly fallen within the normal range when compared with normative data.Despite neuroanatomical research highlighting selective damage to the medial temporal lobe including cingulate-limbic cortex, the functional cognitive deficits experienced by abstinent chronic MA users has not been well described [3,4] suggest that although cognitive impairment in users may be statistically significant, its clinical relevance, or every day import, is rarely specified. In the case of our patient, his cognitive impairment was clinically significant, functionally impairing and of sufficient degree to merit a diagnosis of dementia in view of the pers...

With the increase in availability of gambling applications (apps) for mobile phones, it has never been easier for individuals to access gaming systems. A proportion of these users will be affected by gambling disorder (GD). Traditional therapies for GD can be geographically and financially difficult to access. Mobile health apps can be useful for other addictions and provide another avenue of treatment for GD. Our objective in this study was to review the features, models of treatment, and aims of apps marketed to assist people in addressing their gambling. We searched the three largest app stores in Australia and performed a descriptive analysis based on the Mobile App Rating Scale of the apps purporting to be of assistance in managing GD or problem gambling. The number of apps available for addressing GD in Australia was vastly outnumbered by the number of apps for gambling or gaming. Apps that met the inclusion criteria most often aimed at total cessation of gambling, but did not use a recognizable therapeutic model. A majority of apps featured a single tool, most often a sober time tracker. Few of the apps were affiliated with existing services, and those that were tended to have a broader range of features and tools. Mobile apps present another way for individuals who are struggling with GD or problem gambling to access treatment. For apps to be effective, more attention needs to be paid to their design in order for them to be both useful and noticeable in the milieu of more invitingly designed apps that promote gambling.RésuméÉtant donné le nombre grandissant d’applications de jeux de hasard pour téléphone mobile, il n’a jamais été aussi facile d’accéder à des systèmes de jeu. Un certain nombre des utilisateurs de ces appareils développeront une dépendance au jeu (DJ). Les thérapies conventionnelles en matière de DJ peuvent être difficiles d’accès en raison de la distance géographique et de leur coût. Les applications mobiles dédiées à la santé, parfois pour traiter d’autres formes de dépendance, pourraient offrir des possibilités de traitement du jeu pathologique. Nous avons analysé les caractéristiques, les modèles de traitement et les objectifs des applications qui prétendent aider les individus à dominer leur DP. Nous avons fouillé les trois principales boutiques d’applications d’Australie à la recherche de tels produits, puis les avons soumis à une analyse descriptive fondée sur un Mobile App Rating Scale [échelle d’évaluation des applications mobiles]. Le nombre d’applications destinées au contrôle de la DJ est largement inférieur à celui des produits dédiés à la pratique des jeux de hasard et des jeux vidéo. Les applications retenues visent pour la plupart l’abandon définitif du jeu, sans reposer sur un modèle thérapeutique reconnaissable. La majorité comporte un seul et unique outil, soit un dispositif de minutage du temps passé sans jouer. Quelques-unes sont jumelées à des services existants; elles tendent à offrir un éventail plus grand de caractéristiques et d’outils. Les applications mobiles offrent aux personnes aux prises avec une dépendance au jeu une autre voie d’accès au traitement. Pour améliorer leur efficacité, toutefois, il faudra accorder une plus grande attention à leur conception et faire en sorte qu’elles se démarquent nettement des applications autrement plus attrayantes qui font la promotion du jeu.

Stimulant use disorder is associated with significant global health burden. Despite evidence for sex differences in the development and maintenance of stimulant use disorder, few studies have focused on mechanisms underpinning distinct trajectories in females versus males, including the effect of the ovarian sex hormones estrogen and progesterone. This review aimed to identify and synthesise the existing preclinical and clinical literature on the effect of ovarian sex hormones on stimulant consumption in females. A systematic search of peer‐reviewed literature identified 1593 articles, screened using the following inclusion criteria: (1) adult female humans or animals, (2) using stimulant drugs, (3) ovarian sex hormones were administered exogenously OR were measured in a validated manner and (4) with stimulant consumption as an outcome measure. A total of 50 studies (3 clinical and 47 preclinical) met inclusion criteria. High‐estrogen (low progesterone) phases of the menstrual/estrus cycle were associated with increased stimulant use in preclinical studies, while there were no clinical studies examining estrogen and stimulant consumption. Consistent preclinical evidence supported progesterone use reducing stimulant consumption, which was also identified in one clinical study. The review was limited by inconsistent data reporting across studies and different protocols across preclinical laboratory paradigms. Importantly, almost all studies examined cocaine use, with impact on methamphetamine use a significant gap in the existing evidence. Given the safety and tolerability profile of progesterone, further research is urgently needed to address this gap, to explore the potential therapeutic utility of progesterone as a treatment for stimulant use disorder.