Gooden James R, Petersen Vanessa, Bolt Georgia L, Curtis Ashlee, Manning Victoria, Cox Catherine A, Lubman Dan I, Arunogiri Shalini
Turning Point, Eastern Health, Richmond, VIC, Australia.
The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW, Australia.
Front Psychiatry. 2022 Feb 14;13:795400. doi: 10.3389/fpsyt.2022.795400. eCollection 2022.
In considering the cognitive harms of methamphetamine (MA) use, there is currently a limited appreciation of the profile of pre-existing, comorbid, or modifiable risk factors for cognitive impairment in individuals with MA-polydrug use who present to clinical services. This is in contrast to the well-recognized evidence in alcohol use groups. The aim of this study was to investigate the biopsychosocial and neuropsychological profiles of MA-polysubstance using individuals reporting cognitive impairment in comparison to an alcohol-using group.
A retrospective file audit was undertaken of individuals who presented for assessment to a specialist addiction neuropsychology service and reported either more than 1 year of heavy MA use as part of a polydrug use history ( = 40) or having only used alcohol ( = 27). Clinical histories including demographic, medical, mental health, substance use, and neuropsychological assessment results were extracted from medical records. Between group comparisons were conducted to explore differences in the MA-polydrug vs. the alcohol group.
Individuals in the MA-polydrug group were significantly younger, commenced substance use at an earlier age, were more likely to have an offending history, and experienced an overdose than those in the alcohol group. No differences in comorbid neurodevelopmental, psychiatric or acquired brain injury diagnoses were observed between groups. For neuropsychological functioning, significant group differences were observed in overall IQ, semantic verbal fluency, and psychomotor tracking, where individuals in the alcohol group performed significantly worse.
Neuropsychological profiles were largely equivalent between groups across cognitive domains, with minor differences in favor of the MA-polydrug group. Relative to the general population, cognitive functioning was reduced for both groups across a range of domains. High rates of comorbid mental health concerns were common across both groups, however, individuals in the MA-polydrug group presented with a higher risk of overall harm from substance use at a significantly younger age which is a unique concern for this group. These findings highlight the importance of considering the biopsychosocial factors, such as age of first use, emotional distress, indirect substance related harms including overdose and blood born virus infection that may be relevant to experiences of cognitive difficulty in MA-polydrug users.
在考虑甲基苯丙胺（MA）使用造成的认知损害时，目前对于前来临床就诊的使用多种毒品的MA使用者而言，其认知障碍的既往存在、合并存在或可改变的风险因素情况的了解有限。这与酒精使用人群中得到充分认可的证据形成对比。本研究的目的是调查报告有认知障碍的使用多种含MA物质的个体相较于酒精使用组的生物心理社会和神经心理学特征。
对前来一家专门的成瘾神经心理学服务机构进行评估并报告有超过1年作为多药使用史一部分的大量MA使用情况（n = 40）或仅使用酒精（n = 27）的个体进行回顾性档案审核。从病历中提取包括人口统计学、医学、心理健康、物质使用和神经心理学评估结果在内的临床病史。进行组间比较以探究MA多药使用组与酒精组之间的差异。
MA多药使用组的个体比酒精组的个体显著更年轻，开始使用物质的年龄更早，更有可能有犯罪史，且经历过药物过量。两组之间在合并存在的神经发育、精神或后天性脑损伤诊断方面未观察到差异。在神经心理功能方面，在总体智商、语义言语流畅性和心理运动追踪方面观察到显著的组间差异，酒精组个体的表现明显更差。
两组在认知领域的神经心理学特征在很大程度上相当，MA多药使用组有轻微优势。相对于一般人群，两组在一系列领域的认知功能均有所下降。两组中合并心理健康问题的发生率都很高，然而，MA多药使用组的个体在显著更年轻的年龄就面临物质使用带来的更高总体伤害风险，这是该组特有的问题。这些发现凸显了考虑生物心理社会因素的重要性，例如首次使用物质的年龄、情绪困扰、包括药物过量和血源性病毒感染在内的与物质相关的间接伤害，这些因素可能与MA多药使用者的认知困难经历相关。
