PLoS One. 2015 Apr 24;10(4):e0124043. doi: 10.1371/journal.pone.0124043.

The Impact of Legal Coercion on the Therapeutic Relationship in Adult Schizophrenia Patients.

Höfer FX1, Habermeyer E1, Mokros A1, Lau S1, Gairing SK2.

Author information

• 1Department of Forensic Psychiatry, University Hospital of Psychiatry, University of Zurich, Rheinau, Switzerland.
• 2Department of General Psychiatry, University Hospital of Psychiatry, University of Basel, Basel, Switzerland.

Abstract

The quality of the therapeutic relationship between psychiatric patients and their attending physicians plays a key role in treatment success. We hypothesize that mandatory treatment is negatively associated with the quality of the therapeutic relationship. In a cross-sectional study design, data on psychopathological symptom load (as captured with the Brief Psychiatric Rating Scale) and on the quality of the therapeutic relationship (as measured with the Scale to Assess the Therapeutic Relationship) were collected from 113 adult male psychiatric patients and 35 attending physicians. Patients belonged to one of three groups: self-referred or involuntarily admitted patients from general psychiatry wards or patients from medium secure forensic psychiatric units. On average, self-referred patients rated the quality of the therapeutic relationship significantly more positive than did involuntarily admitted patients in general psychiatry wards. Forensic psychiatric patients, on average, gave an intermediate rating of the quality of the therapeutic relationship. There was no association between patients' ratings and physicians' ratings of the quality of the therapeutic relationship. Patients' ratings of the quality of the therapeutic relationship were inversely related to symptom severity in general and hostility in particular. Ratings of the quality of the therapeutic relationship are not associated with patients' legal status but rather with patients' symptoms of hostility.

Endoscopy. 2015 Apr 24. [Epub ahead of print]

Clinical outcomes in patients with a diagnosis of "indefinite for dysplasia" in Barrett's esophagus: a multicenter cohort study.

Sinh P1, Anaparthy R1, Young PE2, Gaddam S3, Thota P4, Balasubramanian G1, Singh M1, Higbee AD1, Wani S5, Gupta N6, Rastogi A1, Mathur SC7, Bansal A1,Horwhat JD8, Cash BD2, Falk GW4, Lieberman DA9, Vargo JJ4, Sampliner RE10, Sharma P1.

Author information

• 1Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
• 2Division of Gastroenterology and Hepatology, National Naval Medical Center, Bethesda, Maryland, USA.
• 3Department of Gastroenterology, Washington University in St. Louis, St Louis, Missouri, USA.
• 4Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
• 5Division of Gastroenterology, University of Colorado, Denver, Colorado, USA.
• 6Division of Gastroenterology, Loyola University, Maywood, Illinois, USA.
• 7Department of Pathology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
• 8Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
• 9Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and Oregon Health and Science University, Portland, Oregon, USA.
• 10Department of Pathology, University of Arizona Cancer Center, Tucson, Arizona, USA.

Abstract

Background and study aim: Data are limited on the natural history of patients with Barrett's esophagus with a diagnosis of "indefinite for dysplasia" (IND). The aims of this study were to: (i) determine rates of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma, and compare these with rates for low grade dysplasia (LGD); and (ii) determine the proportion of patients whose histological IND diagnosis changed on follow-up endoscopy. 

Patients and methods: Demographic, endoscopic, and histologic information of patients with diagnoses of IND and LGD and at least 12 months of follow-up were extracted from the database of a multicenter Barrett's esophagus study. Rates and times for progression to HGD and esophageal adenocarcinoma and regression to nondysplastic epithelium were calculated. Proportions of diagnoses upgraded to HGD/esophageal adenocarcinoma or downgraded to nondysplastic epithelium at first follow-up endoscopy were evaluated. 

Results: Amongst 2264 patients, 83 with a diagnosis of IND (mean age 60 years, 95 % men, 95 % white; mean follow-up 5.6 years) and 79 with diagnosis of LGD were identified. In the IND group, annual incidences of esophageal adenocarcinoma and HGD were 0.21 % and 0.64 %, respectively, representing a combined incidence of 0.8 %. Mean time to progression was 4.72 years. Within the IND group 55 % patients showed regression to nondysplastic epithelium at first follow-up endoscopy and the overall regression rate was 80 %. Corresponding rates in LGD patients were similar. 

Conclusions: Lesions diagnosed as IND and LGD show similar biological behavior and can be treated as a single category with respect to surveillance and follow-up.

"We have morphed into a nation of po-faced prudes..."

Obesity should not be a badge of pride

BYJANET STREET PORTER  

"In modern Britain we proudly celebrate free speech — except when it comes to one very touchy subject. You can't say the F-word (fatti) without kick-starting a storm of protest. God forbid I call anyone morbidly obese, chubby or just plain fat. I'll be immediately vilified on social media, in the press and online as a traitor to my sex — branded as someone who denies others the right to "celebrate" their bulk, the right to choose to eat what they like and look the way they want.

Can I whisper the horrible truth? We have morphed into a nation of po-faced prudes, and the worst offenders are usually young women claiming to be feminists. Anyone who voices a dissenting view must be dealt with."

Zombie allusions: They just keep on coming™: "...raising the qualifying age for Social Security..."

Paul Krugman's Zombie Social Security Reform Idea

"This is interesting from Paul Krugman. He describes Chris Christie’s idea of raising the qualifying age for Social Security as a “zombie idea.” Something that is, or at least should be, long dead but one that still stalks the night. This is something I find fascinating as I was originally convinced of the merits of the idea by Krugman’s sometime collaborator Brad Delong. Delong’s explanation of why we should raise the Social Security qualifying age seeming to me to be very good economics indeed."

Int J Health Policy Manag. 2015 Apr 17;4(5):265-6. doi: 10.15171/ijhpm.2015.85.

Health reform requires policy capacity.

Forest PG1, Denis JL2, Brown LD3, Helms D4.

Author information

• 1Institute for Health and Social Policy, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
• 2Ecole nationale d'administration publique, Montreal, QC, Canada.
• 3Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York City, NY, USA.
• 4Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility.

Perspect Psychol Sci. 2015 Mar;10(2):145-158.

Perceiving Political Polarization in the United States: Party Identity Strength and Attitude Extremity Exacerbate the Perceived Partisan Divide.

Westfall J1, Van Boven L2, Chambers JR3, Judd CM1.

Author information

• 1Department of Psychology and Neuroscience, University of Colorado Boulder.
• 2Department of Psychology and Neuroscience, University of Colorado Boulder vanboven@colorado.edu.
• 3Department of Psychology, Saint Louis University, St. Louis, MO.

Abstract

An important component of political polarization in the United States is the degree to which ordinary people perceive political polarization. We used over 30 years of national survey data from the American National Election Study to examine how the public perceives political polarization between the Democratic and Republican parties and between Democratic and Republican presidential candidates. People in the United States consistently overestimate polarization between the attitudes of Democrats and Republicans. People who perceive the greatest political polarization are most likely to report having been politically active, including voting, trying to sway others' political beliefs, and making campaign contributions. We present a 3-factor framework to understand ordinary people's perceptions of political polarization. We suggest that people perceive greater political polarization when they (a) estimate the attitudes of those categorized as being in the "opposing group"; (b) identify strongly as either Democrat or Republican; and (c) hold relatively extreme partisan attitudes-particularly when those partisan attitudes align with their own partisan political identity. These patterns of polarization perception occur among both Democrats and Republicans.

PLoS One. 2015 Apr 24;10(4):e0123286. doi: 10.1371/journal.pone.0123286.

"They Know, They Agree, but They Don't Do"- The Paradox of Tuberculosis Case Notification by Private Practitioners in Alappuzha District, Kerala, India.

Philip S1, Isaakidis P2, Sagili KD3, Meharunnisa A1, Mrithyunjayan S4, Kumar AM3.

Author information

• 1Government T.D. Medical College, Alappuzha, Kerala State, India.
• 2Operational Research Unit, Médecins Sans Frontières, India.
• 3International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
• 4State TB Training and Demonstration Centre, State TB Cell, Directorate of Health Services, Thiruvananthapuram, Kerala, India.

Abstract

BACKGROUND:

Despite being a recognized standard of tuberculosis (TB) care internationally, mandatory TB case notification brings forth challenges from the private sector. Only three TB cases were notified in 2013 by private practitioners compared to 2000 TB cases notified yearly from the public sector in Alappuzha district. The study objective was to explore the knowledge, opinion and barriers regarding TB Notification among private practitioners offering TB services in Alappuzha, Kerala state, India.

METHODS & FINDINGS:

This was a mixed-methods study with quantitative (survey) and qualitative components conducted between December 2013 and July 2014. The survey, using a structured questionnaire, among 169 private practitioners revealed that 88% were aware of mandatory notification. All patient-related details requested in the notification form (except government-issued identification number) were perceived to be important and easy to provide by more than 80% of practitioners. While more than 95% felt that notification should be mandatory, punitive action in case of failure to notify was considered unnecessary by almost two third. General practitioners (98%) were more likely to be aware of notification than specialists (84 %). (P<0.01). Qualitative purposive personal interviews (n=34) were carried out among private practitioners and public health providers. On thematic framework analysis of the responses, barriers to TB notification were grouped into three themes: 'private provider misconceptions about notification', 'patient confidentiality, and stigma and discrimination 'and 'lack of cohesion and coordination between public and private sector'. Private practitioners did not consider it necessary to notify TB cases treated with daily regimen.

CONCLUSION:

Communication strategies like training, timely dissemination of information of policy changes and one-to-one dialogue with private practitioners to dispel misconceptions may enhance TB notification. Trust building strategies like providing feedback about referred cases from private sector, health personnel visit or a liaison private doctor may ensure compliance to public health activities.

Cancer. 2015 Mar 30. doi: 10.1002/cncr.29364. [Epub ahead of print]

Detection of K-ras gene mutation by liquid biopsy in patients with pancreatic cancer.

Kinugasa H1, Nouso K, Miyahara K, Morimoto Y, Dohi C, Tsutsumi K, Kato H, Matsubara T, Okada H, Yamamoto K.

Author information

• 1Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.

Abstract

BACKGROUND:

Cell-free circulating tumor DNA (ctDNA) in serum has been considered to be a useful candidate for noninvasive cancer diagnosis. The current study was designed to estimate the clinical usefulness of genetic analysis for ctDNA by digital polymerase chain reaction in patients with pancreatic cancer.

METHODS:

The authors compared K-ras mutations detected in endoscopic ultrasound-guided fine-needle aspiration biopsy tissue DNA and in ctDNA from 75 patients with pancreatic cancer. K-ras mutations in the serum of 66 independent, consecutive patients with pancreatic cancer were also analyzed and the authors compared the results with survival rates.

RESULTS:

The frequencies of the mutations in tissue samples at G12V, G12D, and G12R in codon 12 were 28 of 75 samples (37.3%), 22 of 75 samples (29.3%), and 6 of 75 samples (8.0%), respectively. Conversely, the rates of the mutations in ctDNA were 26 of 75 samples (34.6%), 29 of 75 samples (38.6%), and 4 of 75 samples (5.3%), respectively. Overall, the K-ras mutation rates in tissue and ctDNA were 74.7% and 62.6%, respectively, and the concordance rate between them was 58 of 75 samples (77.3%). Survival did not appear to differ by the presence of K-ras mutations in tissue DNA, but the survival of patients with K-ras mutations in ctDNA was significantly shorter than that of patients without mutations in both a development set (P = .006) and an independent validation set (P = .002). The difference was especially evident in cases with a G12V mutation.

CONCLUSIONS:

Analysis of ctDNA is a new useful procedure for detecting mutations in patients with pancreatic cancer. This noninvasive method may have great potential as a new strategy for the diagnosis of pancreatic cancer as well as for predicting survival. Cancer 2015. © 2015 American Cancer Society.

Disagree strongly: Exercise 'not key to obesity fight'

Exercise 'not key to obesity fight'

By Nick TriggleHealth correspondent

"Physical activity has little role in tackling obesity - and instead public health messages should squarely focus on unhealthy eating, doctors say.

In an editorial in the British Journal of Sports Medicine, three international experts said it was time to "bust the myth" about exercise.

They said while activity was a key part of staving off diseases such as diabetes, heart disease and dementia, its impact on obesity was minimal."

Bioethics. 2015 Apr 23. doi: 10.1111/bioe.12160. [Epub ahead of print]

Freedom of Choice About Incidental Findings Can Frustrate Participants' True Preferences.

Viberg J, Segerdahl P, Langenskiöld S, Hansson MG.

Abstract

Ethicists, regulators and researchers have struggled with the question of whether incidental findings in genomics studies should be disclosed to participants. In the ethical debate, a general consensus is that disclosed information should benefit participants. However, there is no agreement that genetic information will benefit participants, rather it may cause problems such as anxiety. One could get past this disagreement about disclosure of incidental findings by letting participants express their preferences in the consent form. We argue that this freedom of choice is problematic. In transferring the decision to participants, it is assumed that participants will understand what they decide about and that they will express what they truly want. However, psychological findings about people's reaction to probabilities and risk have been shown to involve both cognitive and emotional challenges. People change their attitude to risk depending on what is at stake. Their mood affects judgments and choices, and they over- and underestimate probabilities depending on whether they are low or high. Moreover, different framing of the options can steer people to a specific choice. Although it seems attractive to let participants express their preferences to incidental findings in the consent form, it is uncertain if this choice enables people to express what they truly prefer. In order to better understand the participants' preferences, we argue that future empirical work needs to confront the participant with the complexity of the uncertainty and the trade-offs that are connected with the uncertain predictive value of genetic risk information.

Lung. 2015 Apr;193(2):157-71. doi: 10.1007/s00408-015-9697-7. Epub 2015 Feb 19.

Circulating tumor cells in lung cancer: detection methods and clinical applications.

Yu N1, Zhou J, Cui F, Tang X.

Author information

• 1Department of Respiratory Disease, The First Affiliated Hospital of Chongqing Medical University, #1 Youyi Rd., Yu-zhong District, Chongqing, 400016, China.

Abstract

Circulating tumor cells (CTCs) are tumor cells that have disseminated from primary and metastatic sites, and circulate in the bloodstream. Advanced immunological and molecular-based methods can be used to detect and analyze the cells with the characteristics of tumor cells, and can be detected and analyzed in the blood of cancer patients. The most commonly used methods in lung cancer combine the processes of immunomagnetic enrichment and immunocytochemical detection, morphology-based enrichment coupled with reverse transcriptase polymerase chain reaction (RT-PCR), and RT-PCR alone. CTC analysis is considered a liquid biopsy approach for early diagnosis, risk stratification, evaluation of curative efficacy, and early detection of lung cancer relapse. In this review, we discuss the present techniques for analyzing CTCs, and the restrictions of using these methods in lung cancer. We also review the clinical studies in lung cancer and discuss the underlying associations between these studies and their future applications to this disease.

Tuberc Respir Dis (Seoul). 2015 Apr;78(2):64-71. doi: 10.4046/trd.2015.78.2.64. Epub 2015 Apr 2.

Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms.

Ryu YJ1.

Author information

• 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Abstract

Pulmonary tuberculosis (TB) persists as a great public health problem in Korea. Increases in the overall age of the population and the rise of drug-resistant TB have reinforced the need for rapid diagnostic improvements and new modalities to detect TB and drug-resistant TB, as well as to improve TB control. Standard guidelines and recent advances for diagnosing pulmonary TB are summarized in this article. An early and accurate diagnosis of pulmonary TB should be established using chest X-ray, sputum microscopy, culture in both liquid and solid media, and nucleic acid amplification. Chest computed tomography, histopathological examination of biopsy samples, and new molecular diagnostic tests can be used for earlier and improved diagnoses, especially in patients with smear-negative pulmonary TB or clinically-diagnosed TB and drug-resistant TB.

Thorac Surg Clin. 2015 May;25(2):161-174. doi: 10.1016/j.thorsurg.2014.12.002. Epub 2015 Feb 15.

Lung Cancer Screening: The European Perspective.

Veronesi G1.

Author information

• 1Lung Cancer Early Detection Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: giulia.veronesi@ieo.it.

Abstract

European studies have contributed significantly to the understanding of lung cancer screening. Smoking within screening, quality of life, nodule management, minimally invasive treatments, cancer prevention programs, and risk models have been extensively investigated by European groups. Mortality data from European screening studies have not been encouraging so far, but long-term results of the NELSON study are eagerly awaited. Investigations on molecular markers of lung cancer are ongoing in Europe; preliminary results suggest they may become an important screening tool in the future.

Arch Pathol Lab Med. 2015 Apr;139(4):441-4. doi: 10.5858/arpa.2014-0335-ED.

The essential role of pathologists in health care and health policy.

Romano RC1, Allen TC, Blessing MM.

Author information

• 1From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Drs Romano and Blessing); and the Department of Pathology, University of Texas Medical Branch, Galveston, Texas (Dr Allen).

"Every township, city, county, and state is looking for better health care outcomes with lower costs, and as has been stated countless times in numerous articles and editorials, we, as pathologists, are best positioned to lead this movement."

Study: Half of food ads aimed at kids fall short of nutritional guidelines

“They are packaged for kids, they are marketed to kids, they are put on the grocery store shelf exactly at the height level for kids,” she says.

The heavy promotion of these foods makes it difficult for kids to make smart choices, and tougher for parents to ensure their children eat right.

PLoS One. 2015 Apr 8;10(4):e0124124. doi: 10.1371/journal.pone.0124124. eCollection 2015.

Impact of the CFTR-Potentiator Ivacaftor on Airway Microbiota in Cystic Fibrosis Patients Carrying A G551D Mutation.

Bernarde C1, Keravec M1, Mounier J1, Gouriou S1, Rault G2, Férec C3, Barbier G1, Héry-Arnaud G4.

Author information

• 1EA 3882-Laboratoire Universitaire de Biodiversité et Ecologie Microbienne, Université de Brest, Brest, France.
• 2Centre de Perharidy, CRCM mixte, Roscoff, France.
• 3UMR1078, Institut National de la Santé et de la Recherche Médicale, Brest, France; Laboratoire de Génétique Moléculaire, CHRU Brest, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France; Etablissement Français du Sang-Bretagne, Brest, France.
• 4EA 3882-Laboratoire Universitaire de Biodiversité et Ecologie Microbienne, Université de Brest, Brest, France; Département de Bactériologie-Virologie, Hygiène et Parasitologie-Mycologie, CHRU Brest, Brest, France.

Abstract

BACKGROUND:

Airway microbiota composition has been clearly correlated with many pulmonary diseases, and notably with cystic fibrosis (CF), an autosomal genetic disorder caused by mutation in the CF transmembrane conductance regulator (CFTR). Recently, a new molecule, ivacaftor, has been shown to re-establish the functionality of the G551D-mutated CFTR, allowing significant improvement in lung function.

OBJECTIVE AND METHODS:

The purpose of this study was to follow the evolution of the airway microbiota in CF patients treated with ivacaftor, using quantitative PCR and pyrosequencing of 16S rRNA amplicons, in order to identify quantitative and qualitative changes in bacterial communities. Three G551D children were followed up longitudinally over a mean period of more than one year covering several months before and after initiation of ivacaftor treatment.

RESULTS:

129 operational taxonomy units (OTUs), representing 64 genera, were identified. There was no significant difference in total bacterial load before and after treatment. Comparison of global community composition found no significant changes in microbiota. Two OTUs, however, showed contrasting dynamics: after initiation of ivacaftor, the relative abundance of the anaerobe Porphyromonas 1 increased (p<0.01) and that of Streptococcus 1 (S. mitis group) decreased (p<0.05), possibly in relation to the anti-Gram-positive properties of ivacaftor. The anaerobe Prevotella 2 correlated positively with the pulmonary function test FEV-1 (r=0.73, p<0.05). The study confirmed the presumed positive role of anaerobes in lung function.

CONCLUSION:

Several airway microbiota components, notably anaerobes (obligate or facultative anaerobes), could be valuable biomarkers of lung function improvement under ivacaftor, and could shed light on the pathophysiology of lung disease in CF patients.

Minerva Med. 2015 Apr 22. [Epub ahead of print]

Surgical options to early-stage lung cancer: can "the less" mean "the safe"?

Cariboni U1, Stella GM.

Author information

• 1UO Chirurgia Toracica, Istituto Clinico Humanitas, Rozzano, Milano, Italy - G.Stella@smatteo.pv.it.

Abstract

Lung cancer is the leading cause of death for solid tumors worldwide. Approximately 5-10% of patients present with an early stage tumor and can undergo radical surgery. There are different kinds of thoracotomies depending on the location of surgical entry and how much lung is removed. At the present, lobectomy is the standard procedure to remove early stage lung cancer. Two options can be performed: i) open lobectomy, through which a lobe of the lungs is removed through a long incision on the side of the chest (thoracotomy); ii) video-assisted thoracoscopic surgical (VATS) procedure which allows the lobe removal through a few small incisions in the chest with the assistance of instruments and a camera. Here we discuss and analyze the findings of a paper by Subroto and colleagues, recently published by the British Medical Journal which compares long term survival after minimally invasive lobectomy and thoracotomy lobectomy, by using a propensity matched approach. Although some methodological limitation, the study findings point out that between the two techniques there are no differences regarding the outcome, but the minor comorbidity associated to VATS. Further investigation in the form of a randomized controlled trial are thus needed to assure to ​VATS wider indications in thoracic oncology.

Calorie-laden diets: The new smoking

Sugar and Carbs, Not Physical Inactivity, Behind Surge in Obesity

Time to bust myth that anyone -- including athletes -- can outrun a bad diet

By BMJ-British Medical Journal | April 23, 2015

"Regular exercise is key to staving off serious disease, such as diabetes, heart disease, and dementia, write the authors, but our calorie laden diets now generate more ill health than physical inactivity, alcohol, and smoking combined."

"...when someone consumes fructose it enters the liver; fructose turns into fat and the fat gets sent into the bloodstream."

By AMY KRAFTCBS NEWSApril 22, 2015, 4:09 PM

High fructose corn syrup raises heart disease risk, study finds

"Stanhope told CBS News that when someone consumes fructose it enters the liver; fructose turns into fat and the fat gets sent into the bloodstream."

Nat Rev Neurosci. 2015 May;16(5):305-12. doi: 10.1038/nrn3939. Epub 2015 Apr 15.

The dopamine theory of addiction: 40 years of highs and lows.

Nutt DJ1, Lingford-Hughes A1, Erritzoe D1, Stokes PR2.

Author information

• 1Centre for Neuropsychopharmacology, Division of Brain Sciences, Burlington Danes Building, Imperial College London, London W12 0NN, UK.
• 21] Centre for Neuropsychopharmacology, Division of Brain Sciences, Burlington Danes Building, Imperial College London, London W12 0NN, UK. [2] Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK.

Abstract

For several decades, addiction has come to be viewed as a disorder of the dopamine neurotransmitter system; however, this view has not led to new treatments. In this Opinion article, we review the origins of the dopamine theory of addiction and discuss the ability of addictive drugs to elicit the release of dopamine in the human striatum. There is robust evidence that stimulants increase striatal dopamine levels and some evidence that alcohol may have such an effect, but little evidence, if any, that cannabis and opiates increase dopamine levels. Moreover, there is good evidence that striatal dopamine receptor availability and dopamine release are diminished in individuals with stimulant or alcohol dependence but not in individuals with opiate, nicotine or cannabis dependence. These observations have implications for understanding reward and treatment responses in various addictions.