Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada.
BC Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Prog Neuropsychopharmacol Biol Psychiatry. 2023 Aug 30;126:110795. doi: 10.1016/j.pnpbp.2023.110795. Epub 2023 May 16.
Many individuals living in precarious housing or homelessness have multimorbid illnesses, including substance use, psychiatric, and neurological disorders. Movement disorders (MDs) associated substance use are amongst the poorly studied subtopics of drug-induced MDs. The aim of the present study was, therefore, to determine the proportion affected and severity of different signs of MDs, as well as their associations with substance use in a community-based sample of precariously housed and homeless individuals.
Participants were recruited from an impoverished urban neighborhood and were assessed for substance dependence and self-reported substance use (alcohol, cannabis, cocaine, methamphetamine, nicotine, and opioids), as well as for the severity of signs of MDs (akathisia, dyskinesia, dystonia, and parkinsonism). Adjusted regression models were used to estimate the associations of the severity of signs with the frequency of substance use over the past 4 weeks and with the baseline diagnosis of substance dependence.
The proportion of the sample with clinically relevant signs of MDs in any of the four categories was 18.6% (n = 401), and these participants demonstrated lower levels of functioning than those without signs. Of the different types of substance use, only methamphetamine (its frequency of use and dependence) was significantly associated with greater severity of overall signs of MDs. Frequency of methamphetamine use significantly interacted with age and sex, whereby older female participants exhibited the greatest overall severity with increased methamphetamine use. Of the different signs of MDs, methamphetamine use frequency was positively associated with the severity of trunk/limb dyskinesia and hypokinetic parkinsonism. Relative to no use, concurrent use of antipsychotics demonstrated lower severity of trunk/limb dyskinesia and greater severity of hypokinetic parkinsonism with methamphetamine use, and greater severity of dystonia with cocaine use.
Our study found a high proportion of MDs in a relatively young sample, and their severity was consistently associated with methamphetamine use, moderated by participant demographics and antipsychotic use. These disabling sequelae represent an important and understudied neurological condition that may affect quality of life and will require further study.
许多居住在不稳定住房或无家可归环境中的人患有多种疾病，包括物质使用、精神和神经障碍。与物质使用相关的运动障碍（MDs）是药物引起的 MDs 中研究较少的子课题之一。因此，本研究的目的是确定在一个基于社区的不稳定住房和无家可归者样本中，受 MD 不同症状影响的比例和严重程度，以及它们与物质使用的关联。
参与者从贫困的城市社区招募，并评估他们的物质依赖程度和自我报告的物质使用情况（酒精、大麻、可卡因、安非他命、尼古丁和阿片类药物），以及 MD 症状的严重程度（静坐不能、运动障碍、肌张力障碍和帕金森病）。使用调整后的回归模型来估计 MD 症状严重程度与过去 4 周内物质使用频率以及物质依赖的基线诊断之间的关联。
在任何四个类别中具有临床相关 MD 症状的样本比例为 18.6%（n=401），这些参与者的功能水平低于没有症状的参与者。在不同类型的物质使用中，只有安非他命（其使用频率和依赖）与 MD 整体症状的严重程度显著相关。安非他命使用频率与年龄和性别显著相互作用，即年龄较大的女性参与者随着安非他命使用量的增加表现出最大的总体严重程度。在 MD 的不同症状中，安非他命使用频率与躯干/肢体运动障碍和运动不能性帕金森病的严重程度呈正相关。与不使用相比，同时使用抗精神病药物会降低安非他命使用时躯干/肢体运动障碍的严重程度，并增加可卡因使用时运动不能性帕金森病的严重程度，以及使用可卡因时肌张力障碍的严重程度。
我们的研究在一个相对年轻的样本中发现了很高比例的 MDs，并且它们的严重程度与安非他命使用一致，受参与者人口统计学和抗精神病药物使用的影响。这些致残的后遗症代表了一种重要且研究不足的神经状况，可能会影响生活质量，需要进一步研究。
