This narrative review examines the pathophysiology, clinical presentation, and emergency management of cocaine and amphetamine toxicity in the context of the increasing burden of stimulant-related medical emergencies. Recent epidemiologic trends demonstrate substantial increases in stimulant use, polysubstance exposure, and stimulant-related emergency department visits and overdose deaths. Contemporary clinical guidance emphasizes early recognition of the hyperadrenergic syndrome, prompt benzodiazepine-based sedation, aggressive management of hyperthermia and cardiovascular complications, and integrated medical and psychiatric care. Emerging evidence has also refined the management of cocaine-associated cardiovascular toxicity, including evolving perspectives regarding β-blocker use. Stimulant toxicity represents a complex medical emergency requiring rapid stabilization, aggressive management of agitation and hyperthermia, and continuous monitoring for life-threatening complications. Early recognition and integrated medical and psychiatric care are essential for reducing morbidity and mortality.
This review synthesises qualitative evidence on care experiences within alcohol and other drug (AOD) treatment services in Australia, with a focus on factors influencing engagement, retention, and recovery across diverse populations and service settings. Across 25 qualitative studies, five interconnected themes were identified: relational practice, peer support and mixed staffing models, stigma and privacy, integrated and holistic care, and continuity and safety of treatment environments. Participants described the importance of respectful and consistent relationships with staff, the credibility of peer workers with lived experience, and the impact of stigma on disclosure and engagement. Holistic care, including housing and social supports, was described as closely connected to recovery, while gaps in aftercare and fragmented systems were highlighted as ongoing challenges. The synthesis indicates that AOD treatment experiences are shaped by the interaction of relational, structural, and cultural factors. Care was described as most effective when it extended beyond clinical intervention to include trust, cultural responsiveness, continuity, and practical support. Findings suggest that improving engagement and recovery may require integrated service models, strengthened peer workforce support, and attention to stigma reduction and continuity of care. These insights may inform the design of more responsive, person-centred AOD services aligned with the needs of diverse populations.
The purpose of this review was to summarize and evaluate advancements within the prevalence, etiology, assessment, and treatment of compulsive sexual behavior disorder within sexual minority individuals. Our understanding of the prevalence of compulsive sexual behavior (CSB) and compulsive sexual behavior disorder (CSBD) in sexual minority individuals is limited, with preliminary evidence suggesting sexual minority individuals may endorse CSBD at similar rates to the general population. Recently, the field has moved towards conceptualizing the development and maintenance of CSBD in sexual minority individuals within minority stress theory. Research, assessment, and treatment of CSBD are likely complicated by sexual minority individuals’ experiences of minority stress. While the field has made advances to improve assessment and treatment practices (e.g., through the creation of guidelines), researchers have yet to test the reliability and validity of these advancements within sexual minority individuals. While our theoretical understanding of the etiology, assessment, and treatment of CSBD in sexual minority individuals has improved, greater empirical support is required.
Treatment-resistant depression (TRD), major depressive disorder (MDD) characterized by inadequate response to a series of antidepressant treatments, is a major clinical challenge. Implanted vagus nerve stimulation (VNS), surgical placement of a pulse generator with an electrical lead attached to the cervical vagus nerve, provides intermittent electrical stimulation 24/7. VNS for TRD was approved by the US FDA in 2005. This review summarizes the evidence for durability of the antidepressant effects of VNS and examines potential mechanisms that may explain this durability. Since the approval of VNS for TRD, numerous studies have demonstrated sustained durability of antidepressant responses up to 2 years. Most recently, the large, multicenter RECOVER VNS trial demonstrated very strong sustained durability ( 80
Chemsex, defined as the intentional use of psychoactive substances in sexual contexts, has become an important public health concern among gay, bisexual, and other men who have sex with men (GBMSM). This systematic review aimed to synthesize the available evidence on interventions designed to reduce chemsex practices and improve psychological well-being in this population. A systematic search identified 15 eligible studies published between 2017 and 2024. Interventions included psychological approaches (cognitive behavioral therapy, acceptance and commitment therapy, behavioral activation, mindfulness, and motivational interviewing), psychosocial interventions (harm reduction, contingency management, peer support, and digital interventions), and psychobiological approaches combining pharmacological treatment with counseling. Overall, psychological and psychosocial interventions showed favorable trends in reducing chemsex-related behaviors, stimulant use, and sexual risk behaviors, while also improving self-efficacy, mental health, and well-being. Pharmacological interventions demonstrated mixed findings, with some evidence supporting the efficacy of mirtazapine but limited benefits observed for extended-release naltrexone. Current evidence suggests that interventions addressing chemsex may contribute to reductions in chemsex-related behaviors and improvements in psychological well-being among GBMSM, particularly when psychological and psychosocial components are integrated. However, confidence in the findings is limited by methodological heterogeneity, small sample sizes, risk of bias, and short follow-up periods. Future research should prioritize standardized outcomes, longer-term evaluations, and integrated models of care.
