Kenneth Dürsteler-MacFarland

Universitäre Psychiatrische Kliniken Basel | UPK · Division of Substance Use Disorders

Background: Smart phone use has become a part of people's everyday life. However, when the lack of using the smart phone to establish and maintain electronic communication is related to psychological distress, such a behavior may be considered a modern-age phobia, or nomophobia (no mobile phone phobia). The aims of the present study were to invest...

Background Mental disorders pose a high risk for the occurrence of sexual dysfunctions (SD). This study aimed to investigate prevalence of risk factors and help-seeking behavior for sexual dysfunctions in patients with opioid use disorder compared to patients seeking psychotherapeutic help.Methods Ninety-seven patients at two opioid agonist treatme...

Background: Use of benzodiazepines (BZD) in patients receiving opioid agonist treatment (OAT) is common and associated with a variety of negative health and social outcomes. This cross-sectional study investigates the impact of BZD use in OAT patients on their quality of life (QoL). Methods: A convenience sample of patients receiving oral OAT or...

Das gleichzeitige Auftreten psychischer Störungen bei Personen mit einer Suchterkrankung beziehungsweise «Doppeldiagnosen» ist eine besondere klinische Problemstellung bei der Behandlung von Suchterkrankungen (15). Da der Substanzkonsum in der Regel im Jugendalter beginnt und dort seinen Höhepunkt erreicht, geht die Behandlung dieser Patientengrupp...

Introduction: Opioid agonist treatment (OAT) is the first-line treatment for opioid use disorder (OUD). Simultaneously, opioids are essential medicines in acute pain management. The literature is scarce on acute pain management in individuals with OUD, and guidelines are controversial for patients on OAT. We aimed at analyzing rescue analgesia in...

Background: Within the spectrum of emotional competencies, callous-unemotional traits are socially discouraged, while empathy is considered a socially much more accepted emotional trait. This holds particularly true for adolescents, who are still building up their social and emotional competencies. The aims of the present study were two-fold: Firs...

Background: Heroin-assisted treatment (HAT) is a proven effective treatment option for individuals with severe opioid use disorder (OUD). In Switzerland, pharmaceutical heroin (diacetylmorphine, DAM) is available in tablet form or as injectable liquid. This creates a large barrier for individuals who require the rapid onset of effect but are eithe...

Background Heroin-assisted treatment (HAT) is effective for individuals with severe opioid use disorder (OUD) who do not respond sufficiently to other opioid agonist treatments. It is mostly offered with injectable diacetylmorphine (DAM) or DAM tablets creating a barrier for individuals who need the rapid onset of action but are either unable or un...

Citation: Mohammadi, H.; Maazinezhad, S.; Lorestani, E.; Zakiei, A.; Dürsteler, K.M.; Brühl, A.B.; Sadeghi-Bahmani, D.; Brand, S. Sleep Problems, Social Anxiety and Stuttering Severity in Adults Who Do and Adults Who Do Not Stutter.

Background and aims Alcohol Use Disorder (AUD) is characterized by a reduction in goal-directed behavior, with alcohol use taking precedence over other areas of life. These features in AUD resemble negative symptoms in schizophrenia, especially the reduction in motivation and pleasure (MAP). Given the clinical similarities of negative symptoms acro...

Hintergrund: Abhängigkeitserkrankungen bei Jugendlichen und jungen Erwachsenen besitzen einen ausgeprägten Krankheitswert und sind mit hoher Mortalität verbunden. Der derzeitige Stand der Forschung über die klinische Behandlung ist jedoch unzureichend und weist große Lücken auf. Ziel dieser Studie war es, einen Konsens zur Prävention, Behandlung un...

Amphetaminkonsumstörungen, insbesondere im Zusammenhang mit dem substituierten Amphetaminderivat Methamphetamin („Crystal Meth“), treten im deutschsprachigen Raum zunehmend häufiger auf. Dieser Beitrag soll daher eine aktuelle Übersicht zur Epidemiologie, Phänomenologie und Symptomatik sowie zur Behandlung von Amphetaminkonsumstörungen liefern. Dar...

Background Traditional heroin-assisted treatment in Switzerland consists of oral and injectable diacetylmorphine (pharmaceutical heroin) administration. To date, no suitable treatment option is available for patients who crave rapid onset (“rush”) but are either unable to inject or primarily sniff or inhale illicit heroin. We present a patient who...

Background: Physical exercise has significant benefits for mental and physical health. The Federal Office of Public Health in Switzerland defined exercise as a medium-term treatment goal in the manual of heroin-assisted treatment. Methods: Sixty-four opioid agonist treatment providers and specialized psychosocial treatment centers across the German...

Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is frag...

Background and Aims Sexual dysfunctions (SDs) show a marked impact on a person’s general wellbeing. Several risk-factors like physical and mental illnesses as well as alcohol and tobacco use have to date been identified to contribute to the occurrence of SDs. The impact of opioid-agonist treatment (OAT) on SDs remains unclear, with some studies dem...

Background Heroin-assisted treatment has proven effective in reducing criminal offenses in opioid dependent individuals. Few studies attempted to explain the observed crime reduction and the reasons why these patients keep offending and getting incarcerated have to date not been explored. Methods Patients with a history of incarcerations during th...

Adolescence and emerging adulthood are often referred to as youth. Transitional psychiatry addresses this target group, which considers patients between 15 and 25 years of age. Substance use usually begins and peaks at this stage of life. Psychiatric disorders, foremost attention-deficit/hyperactivity disorder, and affective disorders, conduct diso...

Background: While the favorable effect of adjuvant clonidine in the treatment of acute mania has been observed already about 40 years ago, this line of treatment has not been further investigated. Here, we resumed this topic, and we tested the effect of adjuvant clonidine, an antihypertensive stimulating the alpha-2 central adrenergic receptor, on...

Introduction: Opioid agonist treatment (OAT) is the first-line treatment for opioid dependence. Currently available OAT options comprise oral (methadone and morphine) and sublingual (buprenorphine) routes of administration. In Switzerland and some other countries, severely opioid-dependent individuals with insufficient response to oral or sublingu...

Background Intramuscular (IM) injection of drugs is associated with high rates of injecting-related injuries and diseases. However, little is known about the role of this route of administration in heroin-assisted treatment. The aim of this study was to determine the prevalence of IM diacetylmorphine administration and associated complications as w...

Poor sleep is associated with a higher risk of non-suicidal self-injury (NSSI) as a proxy of unfavorable emotion regulation. In the present study, we tested the hypothesis that past non-suicidal self-injury were associated with current non-suicidal self-injury and with current subjective sleep patterns. To this end, a larger sample of young adults...

Background Iboga and its primary alkaloids, ibogaine and noribogaine, have been of interest to researchers and practitioners, mainly due to their putative efficacy in treating substance use disorders (SUDs). For many SUDs, still no effective pharmacotherapies exist. Distinct psychoactive and somatic effects of the iboga alkaloids set them apart fro...

Heroin-assisted treatment comprises the use of diacetylmorphine (pharmaceutical heroin) for individuals with severe opioid use disorder. In Switzerland, take-home doses in heroin-assisted treatment are more strictly regulated as compared to conventional opioid agonist treatment. In light of the COVID-19 pandemic, the Swiss Federal Council provision...

Background: For men, early ejaculation is a serious health concern. Here, we tested the influence of modafinil (Profinil®) on early ejaculation. To this end, we performed a double-blind randomized clinical trial among men with early ejaculation. Methods: A total of 46 men with early ejaculation (mean age: 37.35 years) and in stable marital relatio...

Background: Physical inactivity has become a global somatic and mental health issue. To counterbalance, promoting regular physical activity appears plausible, above all among adults, where physical inactivity is particularly high. However, some, but sparse, research also indicates that excessive exercising might be associated with unfavorable ment...

Objective: Individuals with major depressive disorder (MDD) report more issues in social interaction compared to the general population. Moreover, dimensions of dissociation are considered dysfunctional strategies to cope with adverse life events. In this regard, current symptoms of MDD could be associated with traumatic events that occurred in ch...

ZUSAMMENFASSUNG Dank verbesserter Behandlungsmöglichkeiten opioidabhängiger Menschen ist ein Anstieg der Zahl älterer Patienten in Opioid-Agonistentherapie (OAT) zu verzeichnen. Insgesamt verbesserte sich die Lebenserwartung dieser Patienten in den letzten Jahren deutlich und das Durchschnittsalter der Patienten in OAT nahm zu. Bei den über 50-jähr...

Background: Among male sexual dysfunctions, erectile dysfunction and early ejaculation have the highest prevalence rates. Here, we tested the influence of lisdexamfetamine dimesylate (Vyas®) on early ejaculation. To this end, we performed a double-blind randomized clinical trial among males with early ejaculation. Methods: A total of 46 males wi...

Seit 2015 gibt es an den Universitären Psychiatrischen Kliniken mit der Ambulanz für Suchttherapie (AfS) eine interdisziplinäre Anlaufstelle seitens der Erwachsenen sowie der Kinder und Jugendpsychiatrie für Jugendliche und junge Erwachsene. Der Schwerpunkt liegt auf der sorgfältigen diagnostischen Abklärung und integriert psychiatrisch-psychologis...

Hospital staff members reported increased stress-related workload, when caring for inpatients with COVID-19 (“frontline hospital staff members”). Here, we tested, if depression, anxiety, and stress were associated with poor sleep and lower general health, and if social support mediated these associations. Further, we compared current insomnia score...

Abstract Background: Excessive gaming has become a psychological health issue for both gamers and their social environments. This observation holds true for Western but also non-western countries such as Iran. The aim of the present study was to translate and validate a Persian version of the Game Addiction Scale 21 (GAS 21) using a sample of adole...

Aim: Bipolar disorder is a multifactorial disorder being linked with dysregulation of several genes. Among the recently acknowledged factors in the pathophysiology of bipolar disorder are non-coding RNAs (ncRNAs). Methods: We searched PubMed and Google Scholar databases to find studies that assessed the expression profile of miRNAs, lncRNAs and...

Background and objective: Inflammation and cell-mediated immunity can have significant roles in different stages of carcinogenesis. The present meta-analysis aimed to evaluate the association between the polymorphisms of IL-8 (-251T/A) and IL-6 (-174G/C) and the risk of oral cancer (OC). Methods: PubMed/MEDLINE, Web of Science, Cochrane Library,...

Background: High sensitivity C-reactive protein (hs-CRP) and CRP are inflammatory biomarkers associated with several inflammatory diseases. In both pediatric and adult individuals with Obstructive Sleep Apnea (OSA) higher hs-CRP and CRP were observed, compared to controls. With the present systematic review, meta-analysis and meta-regression we exp...

Insomnia is a common problem in the general population. To treat insomnia, medication therapies and insomnia-related cognitive-behavioral interventions are often applied. The aim of the present study was to investigate the influence of acceptance and commitment therapy (ACT) on sleep quality, dysfunctional sleep beliefs and attitudes, experiential...

Attention-deficit and hyperactivity disorder (ADHD) is a widespread neurodevelopmental disorder in children and adolescents, persisting into adulthood in a majority of them. ADHD and substance use disorders (SUDs) commonly co-occur in the clinical adult population. The higher-than-normal prevalence rates of SUDs in people with ADHD indicate increas...

Background: Poor sleep is a major complaint of people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and undergoing methadone maintenance therapy (MMT). We tested the impact of three different sleep-improving interventions (trazodone; sleep hygiene training; sleep hygiene training + trazodone) on sleep, psych...

Die Adoleszenz stellt in vielerlei Hinsicht eine entscheidende Lebensphase dar. Sie ist geprägt von jugendlichen Autonomiebestrebungen, Explorationsverhalten und Peer-Orientierung. Gleichzeitig weist das adoleszente Gehirn eine hohe Empfindlichkeit gegenüber Neurotoxizität und ausgeprägte neuropsychologische Effekte auf (Newton et al. 2013; Spear,...

Background/aims: Opioid dependence is a severe disease which is associated with a high risk of relapse, even in cases of successful withdrawal therapy. Studies have shown alterations of the hypothalamic-pituitary-gonadal axis in opioid-dependent patients, such as decreased testosterone serum levels in affected males. Sex hormones and the steroid 5...

Use of illicit opioids, most commonly heroin, has a wide ranging impact on individuals and society. It may lead to dependence, which is best conceptualised using a “chronic disease” model: effective treatments are available, but illness is often characterised by relapses, remissions, and risk of premature death. Across Europe, four trends are notew...

We present the case of a 35-year-old woman in heroin-assisted treatment (HAT) expressing the wish for the transition to oral opioid agonist treatment. After failed attempts to change to oral diacetylmorphine and slow-release oral morphine, respectively, she was induced on overlapping buprenorphine (BUP) treatment with the Bernese method. Gradual do...

Background: Alternative cannabis regulation models are discussed and implemented worldwide. A baseline scenario under the assumption of no policy or market changes may prove useful to forecast cannabis use and treatment demand and evaluate changes in legislation. Methods: Based on data of the Continuous Rolling Survey of Addictive Behaviours and...

Sexual Dysfunction in Primary Health Care Abstract. In primary health care, sexual dysfunctions are usually only insufficiently recorded. At the same time, these disorders are relatively common and often remain untreated. This study investigated sexual dysfunction and how it is influenced by lifestyle in patients in a general practitioner's practic...

Background and aims Opioid agonist treatment (OAT) is currently the most effective treatment for people with opioid dependence. In most countries, however, access to the whole range of effective medications is restricted. This study aims to model the distribution of different OAT medications within a naturalistic and relatively unrestricted treatme...

Dank verbesserter Behandlungsmöglichkeiten opioidabhängiger Menschen ist eine Zunahme älterer Patienten in opioidgestützter Behandlung (OGB) zu verzeichnen. Aufgrund erfolgreicher Umsetzung der OGB verbesserte sich die Lebenserwartung dieser Patienten in den letzten Jahren deutlich und das Durchschnittsalter der Patienten in OGB nahm zu. Bei den ü...

Background: Individuals in treatment for substance dependence suffer more frequently from a variety of psychiatric and physical comorbidities in comparison with the general population. In the past, it has been shown that exercise can be beneficial as an adjunct therapy in the treatment of these diverse comorbidities; however, in substance dependenc...

Background Patients with substance use disorders grow older thanks to effective treatments. Together with a high prevalence of comorbidities, psychological problems, and low social support, these patients are at high risk for medication non-adherence. Established treatment facilities face challenges to accommodate these complex patients within thei...

Objective: Substance use treatment is often performed inside locked wards. We investigate the effects of adopting a policy of open-door treatment for a substance use treatment and dual diagnosis ward. Methods: This is a prospective open-label study investigating 3-month study periods before opening (P1), immediately after (P2), and 1 year after...

Background: Dependence on high-dose benzodiazepines (BZDs) is well known and discontinuation attempts are generally unsuccessful. A well established protocol for high-dose BZD withdrawal management is lacking. We present the case of withdrawal from high-dose lorazepam (>20 mg daily) in an unemployed 35-year-old male outpatient through agonist subs...

Background: Life expectancy of older drug users has increased, primarily thanks to opioid agonist treatment (OAT). Nursing homes are often not adapted to accommodate patients with substance use disorders. Although care and adherence to polypharmacy in older opioid users need considerable resources e.g., daily visits to an outpatient clinic, outpati...

Background: Although the beneficial effects of opioid substitution for the reduction of heroin use are well established, its effect on other substance use is unclear. We aimed to evaluate short-term and long-term changes in substance use in opioid-dependent patients on opioid substitution therapy. We focused on frequent use of heroin, cocaine, ben...

Background and Objectives The number of older patients with opioid-substitution therapy (OST) and polypharmacy is rising globally. Alternative supply models to assist these patients with their medication management and optimize medication adherence are required. Higher adherence is associated with reduced overall healthcare costs and reduced hospit...

Opioid dependence often is a chronic relapsing disorder. The evidence for medication-assisted treatment (MAT) being the treatment of first choice is unequivocal. Yet, health systems, professionals and patients often fail to offer or, respectively, to enter long-term and low-threshold MAT and instead treat opioid dependence as a semi-acute disorder....

Background: Although the potential of exercise as an adjunct treatment for substance dependence is persuasive in theory, few controlled trials have assessed its effectiveness. Existing research has also largely focused on individuals aiming towards, or having already achieved, abstinence. This study employed a randomized design in a pilot trial to...

Background and aims: Dual diagnosis commonly occurs among patients with an opioid use disorder. Treatment is ideally performed in an integrated fashion. We present a case which illustrates the complex and challenging psychiatric and medical therapy of such patients in the light of the literature. Case description: We report on a 56-year old pati...

Background: Buprenorphine is a partial µ-opioid receptor agonist used for maintenance treatment of opioid dependence. Because of the partial agonism and high receptor affinity, it may precipitate withdrawal symptoms during induction in persons on full µ-opioid receptor agonists. Therefore, current guidelines and drug labels recommend leaving a suf...

Background: There is controversy about which outcome parameters should be employed to assess substance use treatment. Subjective measures of medication-assisted treatment (MAT) of opioid dependence are increasingly important. However, while patients' perspectives have been examined, the caregivers' views remain largely unknown. Here, we explore ho...

Methylphenidate (MPH) is commonly prescribed for attention deficit hyperactivity disorder (ADHD). Recreational nonmedical use has been described and also occurs in patients on opioid maintenance treatment (OMT). MPH has been proposed for use as replacement therapy in cocaine dependence, although evidence for efficacy is inconclusive. We conducted a...

In den letzten Jahren wurden verschiedene psychotherapeutische Verfahren zur Behandlung von Suchterkrankungen entwickelt, deren Wirksamkeit in zahlreichen Studien belegt werden konnte. Dieser Artikel gibt einen Überblick ünder die am besten untersuchten Interventionen und deren jeweilige Anwendungsgebiete und beleuchtet mögliche zukünftige Entwickl...

Personen in Opioidsubstitution werden zunehmend älter. Damit verbunden kommt es im Rahmen der Substitutionsbehandlung zu einer Zunahme chronischer Erkrankungen und vielfältiger altersbedingter Einschränkungen, die das Versorgungssystem vor ganz neue Herausforderungen stellen. Die Bedürfnisse älterer Personen in Substitution unterscheiden sich erheb...

Introduction: Substance use disorders and polypharmacy often coincide with multiple risk factors for medication non-adherence. The increase of both age and associated comorbidities in these patients demand innovative solutions to optimize medication management compatible with opioid substitution therapy. We developed a novel medication supply model...

Cocaine use continues to be a public health problem, yet there is no proven effective pharmacotherapy for cocaine dependence. A promising approach to treating cocaine dependence may be agonist-replacement therapy, which is already used effectively in the treatment of opioid and tobacco dependence. The replacement approach for cocaine dependence pos...

Chronic diseases are often associated with cycling in and out of treatment. We used data of a large opioid substitution treatment case register to (1) identify associated factors and (2) integrate retention and readmission into a model of overall participation over subsequent treatment episodes of various groups. Data of all 9,407 patients undergoi...

Addictive disorders are chronic relapsing conditions marked by compulsive and often uncontrolled use of psychotropic substances or stimuli. In this review, we present and discuss the current specific psychosocial interventions for addictive disorders and their effectiveness. In particular cognitive behavioral therapy, motivational interviewing, rel...

Introduction: Electronic dispensers for polypharmacy aim to assist patients with their medication management and to improve medication adherence. Opioid dependent patients with substitution therapy often exhibit multiple risk factors for non-adherence. The increase of both the age and associated comorbidities in this population demand for innovativ...

Das Injizieren psychotroper Substanzen in die Leistenvene ist mit einem hohen Risiko von Komplikationen verbunden, wird jedoch ver- gleichsweise häufig von Menschen angewandt, die das rasche Anfluten einer Substanz suchen. Der Umgang mit diesem Phänomen in der heroingestützten Behandlung (HegeBe) ist uneinheitlich und konfrontiert die Behandelnden...

Suchterkrankungen sind chronisch rezidivierende Erkrankungen mit zwanghaftem und häufig unkontrolliertem Konsum psychotroper Substanzen oder Reize. In der Übersicht werden die aktuellen suchtspezifischen psychotherapeutischen Interventionen und ihre Wirksamkeit zusammengestellt und diskutiert. Als wirksam gelten neben der Kognitiv-Behavioralen Ther...

Abstract BACKGROUND: Concomitant cocaine use is a major problem in clinical practice in methadone maintenance treatment (MMT) and may interfere with successful treatment. Data from European methadone populations is sparse. This register-based study sought to explore the association between prescribed methadone dose and concomitant cocaine and heroi...

Background Electronic dispensers for polypharmacy are used in home care to assist patients with their medication management and to improve adherence. Opioid dependent patients with substitution therapy often exhibit multiple risk factors for non-adherence. The increase of both the age and associated comorbidities in this population demand for innov...