DALLAS -- Sept. 11, 2002 -- The lasting effects of Sept. 11 on everyday citizens caused Dr. Vicki Nejtek, assistant professor of psychiatry at UT Southwestern Medical Center at Dallas, to wonder how terrorism's aftermath impacts her vulnerable research population -- patients suffering from dual diagnosis.

Dual-diagnosis psychiatric patients suffer from both mental illness and drug abuse or dependence, Nejtek explained. The UT Southwestern researcher is studying bipolar disorder coupled with stimulant abuse.

"Bipolar disorder, which has alternating cycles of depression and mania and/or extreme irritability, may well be associated with the highest rates of substance abuse of any psychiatric illness," she said.

Nejtek, head of dual-diagnosis research, said bipolar patients have a rate of substance abuse that is as high as 60 percent; cocaine abuse is reportedly as high as 30 percent. Bipolar patients who are also substance abusers require increased hospitalization and have poorer psychiatric recovery and treatment response than patients who have bipolar disorder alone, she said.

Dr. Saundra Gilfillan, associate professor of psychiatry and medical director of emergency psychiatry services at Parkland Memorial Hospital, said cases of dual-diagnosis patients coming into the emergency room with severe anxiety have reached new levels since the events of Sept. 11.

"This last year we have seen more dual-diagnosis patients coming into the psych ER than ever before," she said. "Also, we have seen more teen-agers with either psychiatric or behavior-related problems, besides drug and alcohol use, than ever before."

Nejtek is overseeing two research projects involving dual-diagnosis psychiatric patients. The Stanley Medical Research Institute recently awarded $833,500 to study medications in bipolar patients who also abuse or are addicted to stimulants such as cocaine, amphetamines and ecstasy. A second study, partially funded by the Department of Psychiatry at UT Southwestern, will examine stress-induced drug use to determine whether major stress triggers drug cravings and initiates relapse or increased drug use.

The Stanley study will look at the effectiveness of two medications -- atypical antipsychotic agents quetiapine and risperidone, which have not been tested on dual-diagnosis patients in double-blind studies.

"The primary aim of the Stanley study is to compare psychiatric, drug-craving, and cognitive decision-making processes between the two patient groups," Nejtek said. "I will also look at the amount of time individuals in the two drug groups continue to improve on their medications and participate in the research and treatment programs."

Nejtek said conventional neuroleptics rather than atypical antipsychotics, are commonly prescribed to treat dual-diagnosis patients; however, previous clinical research indicates that neuroleptics actually increase depressive symptoms as well as cause a significant increase in stimulant cravings. She also said preclinical study results have shown that giving neuroleptics to rats increases cocaine self-administration while giving atypical antipsychotics decreases cocaine self-administration.

"Since bipolar patients often self-medicate to alleviate stress-induced anxiety and manic and depressive symptoms with illicit drugs, antipsychotic medications that may reduce anxiety and depression, while stabilizing manic episodes, may also help reduce drug cravings and usage," Nejtek said.

The second study will examine stress-induced drug use to predict whether high levels of the stress-associated natural hormone cortisol may be related to drug relapse or to frequency of drug use. "This information is vital in our understanding of how stimulant abuse in some bipolar patients may escalate to stimulant dependence," Nejtek said.

Volunteers for the second study who do not suffer from bipolar disorder and are not drug-dependent will come from an earlier stress research study conducted by Nejtek. The study was the first to identify two distinct patterns of cortisol release corresponding to events of high and low emotional impact. The adult study showed a strong correlation between the amount of emotionally impacted stress, individual cognition and cortisol salivary levels when subjects watched videos of differing emotional impact.

For further information about participation in any of Nejtek's studies, call 214-645-8127 or 214-648-5555.

---UT Southwestern Medical Center at Dallas