Abstract Background A number of data show the negative role of duration of untreated illness (DUI) on outcome in mood disorders, but no investigation has been carried out about the impact of this ...variable in bipolar disorder (BD) with psychotic symptoms. Clinical experience shows that many bipolar patients with psychotic symptoms receive other diagnoses and often are chronically treated with first generation antipsychotics, with the effect to reduce duration of untreated psychosis/untreated episode with psychotic symptoms (DUP), but not DUI. Purpose of the study was to define the rate of misdiagnosis and the impact of DUP/DUI on outcome of bipolar patients with psychotic symptoms. Method Clinical information (DUP, DUI, first received diagnosis) about bipolar outpatients with psychotic symptoms ( N =240) were extrapolated through a retrospective review of the clinical charts, Lombardy database and, if necessary, through clinical interviews with patients and their relatives. Outcome measures included psychiatric and substance abuse comorbidity, occupational status, Global Assessment of Functioning (GAF), number of hospitalizations and of suicidal attempts, number of depressive/manic recurrences. Patients were divided in two groups according to the DUP (1 year) and DUI (8 years) median, and the groups were compared through analyses of variance (ANOVAs) for continuous variables or χ2 tests for dichotomous ones. Multivariate analysis of variance (MANOVA) with duration of illness as covariate was then performed to eliminate the effect of this variable. Finally, binary logistic regressions were performed considering age at onset, DUI, DUP as independent variables and outcome variables as dependent ones (presence of hospitalizations/suicidal attempts, GAF scores<50, occupational status). Results Most of patients (61.5%) received a first diagnosis different from BD with the most frequent DSM-diagnosis being delusional disorder (17.9%). Patients with longer DUP were not different in outcome measures with respect to patients with shorter DUP. Patients with a DUI >8 years presented higher number of hospitalizations ( F =6.04, p =0.015), higher number of manic recurrences ( F =5.25, p =0.023), higher number of depressive recurrences ( F =7.13, p =0.008) and lower GAF scores ( F =17.74, p <0.001). Statistical significance persisted for number of hospitalizations ( p <0.001) and GAF scores ( p =0.003) after MANOVA. Finally binary logistic regression showed that a longer DUI was predictive of GAF scores<50 ( F =17.74, p <0.001). Discussion More than half of bipolar patients with psychotic symptoms receive a different diagnosis at first contact with psychiatric services. DUI (but not DUP) is a predictor of outcome in bipolar patients with psychotic symptoms. This indicates that an early diagnosis and proper treatment with a mood stabilizer (or an atypical antipsychotic with mood stabilizing effects) may improve long-term outcome of these patients. In the light of the naturalistic design of the present paper, these results have to be considered as preliminary and have to be confirmed by prospective controlled studies.
Trait mindfulness is considered a protective factor for a number of risky health behaviours, yet the relationship between mindfulness and driving behaviours remains underexplored. In the current ...study, 657 participants completed the Mindful Attention and Awareness Scale, Spielberger State Trait Anxiety Inventory, Manchester Driving Behaviour Questionnaire, Driving Behaviour Survey and Driving Cognitions Questionnaire, as well as questions concerning driving under the influence of drugs or alcohol, phone use when driving and collision history. The findings suggest that trait mindfulness is associated with decreased engagement in problematic driving behaviours including errors, lapses, willful violations of road rules, aggressive driving and phone use. Mindfulness was also associated with reduced anxious driving behaviours and reduced negative thoughts while driving. Observed effects were relatively small, though for most variables measured, safe driving was more strongly correlated with trait mindfulness than it was with age or driving experience. Overall, this study highlights important mechanisms for future examinations of mindful driving interventions.
Introduction: There is substantial debate concerning the impact of cannabis decriminalization and legalization on road safety outcomes. Methods: Seven databases were systematically searched: Embase, ...MEDLINE, and PsycINFO through Ovid as well as Web of Science Core Collection, SafetyLit, Criminal Justice Database (ProQuest), and Transport Research International Documentation (from inception to June 16, 2021). Eligible primary studies examined group-level cannabis decriminalization or legalization and a road safety outcome in any population. Results: A total of 65 reports of 64 observational studies were eligible, including 39 that applied a quasi-experimental design. Studies examined recreational cannabis legalization (n=50), medical cannabis legalization (n=22), and cannabis decriminalization (n=5). All studies except 1 used data from the U.S. or Canada. Studies found mixed impacts of legalization on attitudes, beliefs, and self-reported driving under the influence. Medical legalization, recreational legalization, and decriminalization were associated with increases in positive cannabis tests among drivers. Few studies examined impacts on alcohol or other drug use, although findings suggested a decrease in positive alcohol tests among drivers associated with medical legalization. Medical legalization was associated with reductions in fatal motor-vehicle collisions, whereas recreational legalization was conversely associated with increases in fatal collisions. Discussion: Increased cannabis positivity may reflect changes in cannabis use; however, it does not in itself indicate increased impaired driving. Subgroups impacted by medical and recreational legalization, respectively, likely explain opposing findings for fatal collisions. More research is needed concerning cannabis decriminalization; the impacts of decriminalization and legalization on nonfatal injuries, alcohol and other drugs; and the mechanisms by which legalization impacts road safety outcomes.
Nitrous oxide (N2O), colloquially known as laughing gas, is a common recreational drug of abuse. The gas is inhaled in its undiluted form from a party balloon. Its intoxicating effects are described ...as dissociative and euphoric, accompanied by ataxia, hypoxia, and attenuated consciousness. Therefore, the recreational use of N2O appears irreconcilable with operating a vehicle in road traffic. However, the Netherlands, one of the leading countries regarding prevalence of recreational N2O use, has seen a sharp increase in police reports of N2O‐related traffic incidents since 2016. Road traffic deaths associated with recreational N2O use have also been reported in the United Kingdom, as well as a recent increase in traffic incidents. Hence, driving under the influence of nitrous oxide (DUINO) is possibly an underreported threat to road traffic safety. Based on the limited information available at this time, the current review considers the prevalence of DUINO, its effects driving performance, and approaches to road‐side detection. It is concluded that DUINO is a potentially significant threat to road traffic safety. Although its prevalence is unclear, it is almost certain that DUINO is accompanied by severe driving impairment, based on its pharmacodynamics and documented cognitive and psychomotor effects in medical studies. The pharmacokinetic profile of N2O lends credibility to the notion that recent use can be demonstrated in breath, blood, and saliva. However, the analytical complexities of such measurements warrant elaborate research into N2O detection techniques.
This article is categorized under:
Toxicology > Drug‐Impaired Driving
The inside of a vehicle involved in a road traffic accident in the Netherlands (courtesy of the police of Amsterdam). The floor and seats are covered in thousands of metal canisters which contain(ed) N2O. The numerous balloons in the vehicle suggest that the metal canisters were emptied into the balloons for recreational inhalation. Although little is known about the prevalence of recreational N2O use in traffic, accident scenes like these leave little room for speculation that the phenomenon exists and poses a threat to traffic safety.
Doubly uniparental inheritance (DUI) represents a notable exception to the general rule of strict maternal inheritance (SMI) of mitochondria in metazoans. This system entails the coexistence of two ...mitochondrial lineages (F- and M-type) transmitted separately through oocytes and sperm, thence providing an unprecedented opportunity for the mitochondrial genome to evolve adaptively for male functions. In this study, we explored the impact of a sex-specific mitochondrial evolution upon gamete bioenergetics of DUI and SMI bivalve species, comparing the activity of key enzymes of glycolysis, fermentation, fatty acid metabolism, tricarboxylic acid cycle, oxidative phosphorylation and antioxidant metabolism. Our findings suggest reorganized bioenergetic pathways in DUI gametes compared to SMI gametes. This generally results in a decreased enzymatic capacity in DUI sperm with respect to DUI oocytes, a limitation especially prominent at the terminus of the electron transport system. This bioenergetic remodelling fits a reproductive strategy that does not require high energy input and could potentially link with the preservation of the paternally transmitted mitochondrial genome in DUI species. Whether this phenotype may derive from positive or relaxed selection acting on DUI sperm is still uncertain.
Objectives
To investigate how peer dynamics, specifically interpersonal conversations between a potential offender and a peer, contemporaneous with a crime opportunity, influence perceptions of ...sanction certainty and social costs.
Methods
Data are analyzed from randomized experiments and hypothetical vignettes embedded within a nationwide, online survey (n = 1,275). Vignettes were presented for three distinct crime opportunities, drunk driving, fighting, and insurance fraud.
Results
The findings suggest that respondents adjust two core decision-making perceptions—the perceived certainty of being legally sanctioned and perceived social costs such as stigma or embarrassment—in accord with the content of verbal communications from peers. There is evidence for this both between and within subjects.
Conclusions
The study underscores the importance of accounting for both physical and social features of the situational context for crime in models of offender decision making. Implications are drawn regarding the social milieu for offender decision making, and the broader criminological relevance of choice principles.
Background and Aims
The US state of South Dakota's 24/7 Sobriety Program (24/7) requires individuals charged or convicted of alcohol‐involved offenses to avoid alcohol and submit to twice‐daily or ...continuous alcohol testing. We evaluated the impact of the 24/7 program in the US state of Montana.
Methods
Using data from everyone in Montana who was convicted of their second driving under the influence (DUI) offense from 2009 to August 2013, we described program violations among 24/7 participants and then estimated the effect of 24/7 participation on the probability of DUI re‐arrest. To address potential selection issues related to individual‐level 24/7 participation, we used an instrumental variables approach that exploits county‐level variation in program adoption.
Results
Among 2768 people convicted of a second DUI in our analytical sample, 356 participated in 24/7 and were monitored for an average of 173 days (median = 112 days). Among the 332 participants monitored by breath test, 95.5% of scheduled alcohol breath tests were completed and did not lead to a program violation. After controlling for individual‐ and community‐level covariates as well as year and county fixed effects, our instrumental variable models suggested that participation in 24/7 reduced the 1‐year DUI re‐arrest probability by at least 80% (preferred model: 86% decrease; 8.9 percentage points) compared with a counterfactual group of people convicted of a second DUI over the same period but not assigned to the program.
Conclusions
South Dakota USA's 24/7 Sobriety Program appears to work in Montana as well. Certain delivery of immediate but modest sanctions for repeat driving under the influence (DUI) arrestees who violate alcohol abstinence orders appears to be able to reduce future DUI arrests.
Aim
The aim of the present study was to detect factors associated with duration of untreated illness (DUI) in bipolar disorder (BD).
Method
A total of 1575 patients were selected for the purposes of ...the study. Correlation analyses were performed to analyse the relation between DUI and quantitative variables. The length of DUI was compared between groups defined by qualitative variables through one‐way analyses of variance or Kruskal‐Wallis's tests according to the distribution of the variable. Linear multivariable regressions were used to find the most parsimonious set of variables independently associated with DUI: to this aim, qualitative variables were inserted with the numeric code of their classes by assuming a proportional effect moving from one class to another.
Results
An inverse significant correlation between length of DUI and time between visits in euthymic patients was observed (r = −.52, P < .001). DUI resulted to be longer in patients with: at least one lifetime marriage/partnership (P = .009), a first psychiatric diagnosis of major depressive disorder or substance abuse (P < .001), a depressive polarity of first episode (P < .001), no lifetime psychotic symptoms (P < .001), BD type 2 (P < .001), more lifetime depressive/hypomanic episodes (P < .001), less lifetime manic episodes (P < .001), presence of suicide attempts (P = .004), depressive episodes (P < .001), hypomanic episodes (P = .004), hospitalizations (P = .011) in the last year.
Conclusions
Different factors resulted to increase the length of DUI in a nationwide sample of bipolar patients. In addition, the DUI was found to show a negative long‐term effect in terms of more suicidal behaviour, more probability of hospitalization and depressive/hypomanic episodes.
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