Topiramate impairs cognitive function in cocaine-dependent individuals maintained on methadone

s / Drug and Alcohol Dependence 140 (2014) e169–e251 e183 Topiramate impairs cognitive function in cocaine-dependent individuals maintained on methadone Olga Rass, Annie Umbricht, G.E. Bigelow, Eric C. Strain, Miriam Mintzer Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States Aims: Topiramate is being investigated as a potential pharmacotherapy for the treatment of addictive disorders. However, its cognitive side effects raise concerns about its use, especially in cognitively impaired populations such as persons with substance use disorders. The purpose of this study was to assess the cognitive effects of topiramate in individuals dually dependent on cocaine and opioids as part of a double-blind randomized controlled trial of topiramate for the treatment of cocaine dependence. Methods: Participants were first stabilized on methadone (M=96mg) forfiveweeksand trainedonacognitivebattery tominimize practice effects, then randomized to topiramate (n=23) or placebo (n=22). Cognitive testing took place at two timepoints: at studyweek five during the placebo lead-in phase to assess baseline performance, and 10–14 weeks later to assess performance during stable dosing (150mg topiramate or placebo, b.i.d.). All participants were maintained on methadone at both testing timepoints, and testing occurred 2h after drug administration. Results: The topiramate and placebo groups did not differ on gender, level of education, premorbid intelligence, or methadone dose (ps >0.19, t-test or chi-square test as appropriate). A Group (placebo, topiramate)×Time (pre-treatment baseline, stable dosing) mixed design Analysis of Variance (ANOVA) was conducted for each cognitivemeasure. Significant interaction effects (p<0.05) revealed that topiramate slowed psychomotor and information processing speed (Trail Making Test A, Digit Symbol Substitution Test), reduced working memory accuracy (n-Back), and increased the false alarm rate in episodic memory (word recognition memory). Topiramate had no effects on visual perception, divided attention, or decision-making performance. Conclusions: Thecognitive-impairingeffectsof topiramatemay amplify pre-existing cognitive impairments in substance abusers and limit its acceptability and use as a treatment for substance use disorders. Financial support: Supported by DA021808, DA023186, T32DA07209. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.512 Differences in mood and quality of life indicators by HIV status in a group of methamphetamine-dependent individuals R. Rawson1, Joy Chudzynski1, Rachel Gonzales-Castaneda1,2, A. Ang1 1 UCLA, Los Angeles, CA, United States 2 Azuza Pacific University, Azuza, CA, United States Aims: Individuals who use MA are at increased risk for HIV transmission due to risky sexual behaviors and IV drug use. The cooccurrence of HIV among MA abusing individuals can negatively compound the course of addiction and recovery. This abstract provides information regarding the baseline mood state and quality of life of a sample of HIV positive vs. HIV negative MA abusers in residential treatment who participated in a research study examining the utility of an exercise training program on mood and posttreatment MA use. Data presented here are preliminary and part of an ongoing study. Methods:Ninety-fiveMA-dependent individualswere randomized to 3d/wk of exercise training (EX, n=48) or health education (ED, n=47) over an 8-wk study period. Roughly 65.9% (n=63) of the sample were HIV− and 34.7%, (n=32) were HIV+. Baseline mood was assessed using the BDI & BAI and quality of life was measured with the SF-36. Results: Participants with HIV were significantly more likely (p< .001) to reportmorehospitalizations in thepast year (2.3 times) compared to participants without HIV (1.3). HIV+ clients had significantlymoremental health distress compared to HIV− clients as reflected by higher depression mean symptoms on the BDI (15.9, sd =7.7 vs. 11.8, sd =7.9) and higher BAI scores (16.5, sd =14.0 vs. 11.9, sd =12.1) after controlling for demographic and drug use ASI variables. Compared to HIV− participants, those with HIV were more likely to perceive higher dysfunction in the following physical quality of life related scales: physical functioning (91.3 vs. 97.2, p< .01), role-physical (62.5 vs. 86.7, p< .002), and general health (63.1 vs. 71.2, p< .05) as well as significantly poorer mental health functioning in termsof social functioning (55.2 vs. 68.1,p< .05), role emotion (35.6 vs. 60.8, p< .05), and well-being (51 vs. 61.2, p< .05). Conclusions: Although preliminary, these data underscore the problematic influence of HIV amongMA users with regard to negative mood and quality of life indicators such as physical, social and mental health functioning. Financial support: NIDA DA027633. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.513 The association of impulsivity and distress tolerance with PTSD symptom severity: A test among trauma-exposed, cocaine-dependent adults N. Rathnayaka, S. Ahmed, C. Green, Joy Schmitz, A. Vujanovik Psychiatry and Behavioral Sciences, University of Texas, Houston, TX, United States Aims: Despite the well-established comorbidity between PTSD and cocaine dependence, few studies have focused on the role of relevant cognitive and affective factors, such as distress tolerance and impulsivity that might be targeted in treatment. This study examines the associations between PTSD symptom severity, distress tolerance, and impulsivity among trauma-exposed, cocaine dependent adults. Specifically, it is expected that lower levels of distress tolerance and higher levels of impulsivity will be associated with greater PTSD symptom severity and cocaine dependence severity. Methods: Participants (N=142) included self-reported cocaine users responding to ongoing recruitment at a large urban cocaine treatment and research center. These participants completed the Addiction Severity Index, Barratt Impulsivity Scale (BIS-11), Posttraumatic Diagnostic Scale (PDS), and Distress Tolerance Scale. Only participants who endorsed trauma exposure on the PDS were included in this analysis. Results: Among responding participants, 66.9% (n=95) had current cocaine-positive urinalysis results. Distress tolerance (F(1, 109) =13.21, p< .0004) and impulsivity (F(1, 109) =4.88, p< .0292) simultaneously demonstrate statistically reliable relations with PDS-defined PTSD total symptom severity and symptom cluster severity. Increased distress tolerance and decreased impulsivity were related to higher levels of PTSD. Data collection is ongoing.