Analyses of use of tranquilizers and sleeping pills across five surveys of the same population (1985-1991): the relationship with gender, age and use of other substances

Associations between sleep medication use and alcohol consumption over 36 years in Finnish twins

BACKGROUND

Sleep medication use is an indicator of underlying sleep problems that might be induced by various factors such as alcohol use. However, the longitudinal relationship between drinking and sleep problems remains poorly understood. We investigated associations between sleep medication and alcohol use throughout adulthood, and examined the role of familial and potential confounding factors contributing to these associations.

METHODS

We used information of zygosity and self-report questionnaire data over a follow-up period of 36 years from the Older Finnish Twin Cohort (N=13,851).

RESULTS

Logistic regression analyses suggested consistent associations between sleep medication use and heavy/binge drinking at all four time points (OR range =1.36-3.18, P <0.05), implying that increased drinking is associated with increased sleep medication use over time. Cross-lagged path analyses suggested that moderate/heavy and binge drinking predict sleep medication use at most time points (OR range = 1.15-1.94, P <0.05), whilst sleep medication use predicts subsequent abstaining from alcohol (OR range =2.26-2.47, P <0.05). Within-pair analyses implied that familial factors play a role, and quantitative genetic modelling estimated genetic factors to explain approximately 80% of the lifetime association of sleep medication use with moderate/heavy and binge drinking.

CONCLUSIONS

Drinking is associated with sleep medication use throughout adulthood. Further, our results suggest that drinking is likely to predict sleep medication use, thereby potentially constituting a risk factor for sleep problems, and that genetic factors contribute to the association. These findings are important in terms of better understanding the development of sleep and alcohol use disorders.

Association Between Sleep Medications and Falls and Fall-related Worries in Community-Dwelling Older Adults in the United States

Background Falls are the leading cause of unintentional fatal and nonfatal injuries in seniors. Sleep medications are associated with adverse events risk in older adults. The objective of this study is to quantify the relationship between different levels of sleep medication use with falls and fall-related worries in United States adults aged 65 years and older using a nationally representative sample. Methods Using the 2011 National Health and Aging Trends Study, survey-weighted multiple logistic regression was used to determine the association between participants who reported sleep medication use and the outcomes: falls in the last month, falls in the last year, multiple falls in the last year, fall-related worries, and limitation of activities due to fall-related worries. Results In adjusted analyses, older adults who used sleep medications every night compared to non-users of sleep medications were at increased odds of falls in the last year with an odds ratio (OR) of 1.51 (95% confidence limit [CL] 1.27, 1.78) and of multiple falls with an OR = 1.67 (95% CL 1.35, 2.06). For those who used sleep medications less than every night compared to non-users, there were no statistically significant increased odds of fall outcomes. Older adults who used sleep medication most nights (5–6 nights per week) and every night compared to non-users had increased odds of having fall-related worries with an OR = 1.61 (95% CL 1.06, 2.45) and an OR = 1.32 (95% CL 1.11, 1.58), respectively. Conclusion Older adults who use sleep medication every night are at greater odds of experiencing falls and having fall-related worries. Increased involvement by pharmacists in the community setting and pharmacist-led comprehensive medication reviews are efforts that may reduce sleep medication use and result in fewer falls in older adults.

Polydrug use by European adolescents in the context of other problem behaviours

Aim

Previous studies of the association between polydrug use and other risk behaviours have generally been limited to specific substances and a small number of behaviours. The aim of this study is to obtain better insight into polydrug use (comprising legal and illegal substances: tobacco, alcohol, tranquillisers/sedatives, cannabis, and other illegal drugs) and its association with co-occurring problem behaviours drawn from various broad domains (sexual, aggressive, delinquent, school achievement, relationships) among European adolescents.

Methods

Data were obtained from 101,401 16-year-old students from 35 European countries participating in the 2011 ESPAD survey. Associations between polydrug use and other problem behaviours were examined by multinomial and binary logistic regression analyses.

Results

Tranquillisers/sedatives appeared among the commonest combinations in the polydrug use pattern, especially for females. A strong trend was found between levels of involvement with polydrug use and other problem behaviours for both genders. The highest associations with polydrug use were for problems with the police, risky sexual behaviour and skipping school. Gender differences showed higher prevalences among boys than girls of problem behaviours of aggressive, antisocial type, while girls prevailed over boys in relationship problems.

Conclusion

An incremental relationship exists between the level of involvement with polydrug use and the co-occurrence of problem behaviours. Preventative interventions should consider the misuse of tranquillisers/sedatives within the context of polydrug use by adolescents and expand their target groups towards multiple problem behaviours.

Few middle-aged women with severe mental symptoms use psychotropic drugs: The Women's Health in Lund Area (WHILA) Study

Aims: In a population of middle-aged women a survey was carried out to ascertain the prevalence of mental symptoms and psychotropic drug use, and further to investigate whether severe mental symptoms are associated with social situation, alcohol consumption, smoking, and physical health. Methods: All women (n=10,766) aged 50—59 years and living in the Lund area were invited to the WHILA study, a health survey including laboratory examinations and a self-administered questionnaire; 6,917 (64.2%) participated. This study is based on the questionnaire only. Results: During the past three months 25.4% (n=1,709) had been troubled by none or 1 mental symptom (labelled ``absent/slight''), 52.8% (n=3,555) by 2—6 mental symptoms (``moderate'') and 21.8% (n=1,471) by 7—10 mental symptoms (``severe''). Among women with severe mental symptoms 15.4% regularly used psychotropic drugs, mainly antidepressants. A multiple logistic regression analysis showed that women with severe mental symptoms had higher odds for living alone (OR 1.7; CI 1.3—2.2) or as single parents (OR 2.1; CI 1.2—3.6), being university-educated (OR 1.5; CI 1.1—2.0), being on long-term sick-leave (OR 8.8; CI 3.0—25.5), using hormone replacement therapy (OR 1.3; CI 1.1—1.6), and having severe physical symptoms (136.8; CI 89.2—209.7) compared with women with absent/slight mental symptoms. Conclusion: Mental symptoms were common among the participating women. The presence of severe mental symptoms was strongly associated with severe physical symptoms. Few women with severe mental symptoms used psychotropic drugs. Middle-aged women with severe mental symptoms need to be identified and provided with appropriate psychopharmacological, hormonal, and/or psychosocial treatment.

Predictors of New Onset Sleep Medication and Treatment Utilization Among Older Adults in the United States

BACKGROUND

Sleep disturbances are common among older adults resulting in frequent sleep medication utilization, though these drugs are associated with a number of risks. We examine rates and predictors of new prescription sleep medications and sleep treatments, as well as sleep treatments without a doctor's recommendation.

METHODS

Participants were 8,417 adults aged 50 and older from two waves of the nationally representative Health and Retirement Study (HRS) who were not using a sleep medication or treatment at baseline (2006). Logistic regression analyses are run with sociodemographic, health, and mental health factors as predictors of three outcomes: new prescription medication use, sleep treatment use, and sleep treatment out of a doctor's recommendation in 2010.

RESULTS

New sleep medication prescriptions were started by 7.68%, 12.62% started using a new sleep treatment, and 31.93% were using the treatment outside of their doctor's recommendation. Common predictors included greater severity of insomnia, worsening insomnia, older age, and use of psychiatric medications. New prescription medication use was also associated with poorer mental and physical health, whereas new sleep treatment was associated with being White, higher educated, and drinking less alcohol.

CONCLUSIONS

Starting a new prescription sleep medication may reflect poorer health and higher health care utilization, whereas beginning a sleep treatment may reflect an individual's awareness of treatments and determination to treat their problem. Clinicians should be aware of predictors of new sleep medication and treatment users and discuss various forms of treatment or behavioral changes to help patients best manage sleep disturbance.

Roles of "Wanting" and "Liking" in Motivating Behavior: Gambling, Food, and Drug Addictions

The motivation to seek out and consume rewards has evolutionarily been driven by the urge to fulfill physiological needs. However in a modern society dominated more by plenty than scarcity, we tend to think of motivation as fueled by the search for pleasure. Here, we argue that two separate but interconnected subcortical and unconscious processes direct motivation: "wanting" and "liking." These two psychological and neuronal processes and their related brain structures typically work together, but can become dissociated, particularly in cases of addiction. In drug addiction, for example, repeated consumption of addictive drugs sensitizes the mesolimbic dopamine system, the primary component of the "wanting" system, resulting in excessive "wanting" for drugs and their cues. This sensitizing process is long-lasting and occurs independently of the "liking" system, which typically remains unchanged or may develop a blunted pleasure response to the drug. The result is excessive drug-taking despite minimal pleasure and intense cue-triggered craving that may promote relapse long after detoxification. Here, we describe the roles of "liking" and "wanting" in general motivation and review recent evidence for a dissociation of "liking" and "wanting" in drug addiction, known as the incentive sensitization theory (Robinson and Berridge 1993). We also make the case that sensitization of the "wanting" system and the resulting dissociation of "liking" and "wanting" occurs in both gambling disorder and food addiction.

Heavy drinking and use of sedative or anxiolytic drugs among aging men: an 11-year follow-up of the FinDrink study

BACKGROUND

Most studies on heavy drinking and sedative/anxiolytic drug use have been cross-sectional, and evidence for a possible temporal association is lacking.

OBJECTIVE

To prospectively investigate whether heavy drinking predicts initiation, continuation, or discontinuation of sedative/anxiolytic drugs at 4 and 11 years and, conversely, whether sedative/anxiolytic drug use predicts heavy drinking.

METHOD

This was a longitudinal population-based study conducted in Kuopio, Finland. An age-stratified random sample of 1516 men aged 42, 48, 54, and 60 years received a structured clinical examination at baseline (August 1986-December 1989). Follow-up clinical examinations were conducted at 4 (n = 1038) and 11 (n = 854) years. Multinomial logistic regression was used to compute odds ratios and 95% confidence intervals for the association between sedative/anxiolytic drug use and initiation, continuation, and discontinuation of heavy drinking (≥ 14 drinks/wk). The reverse association between heavy drinking and sedative/anxiolytic drug use was also investigated. Regression models were adjusted for age, working status, smoking, and depressive symptoms.

RESULTS

At baseline 12.9% (134/1038) of participants were heavy drinkers and 4.0% (41/1030) used sedative/anxiolytic drugs. In multivariate analyses, baseline heavy drinking predicted initiation of sedative/anxiolytic drug use at 4 years (OR 2.96; 95% CI 1.23 to 7.15). Conversely, baseline sedative/anxiolytic drug use predicted continuation of heavy drinking at 11 years in unadjusted analysis (OR 3.30; 95% CI 1.19 to 8.44). However, the association was not statistically significant in adjusted analyses (OR 2.69; 95% CI 0.86 to 8.44).

CONCLUSIONS

The main finding of this study was the association between heavy drinking and subsequent initiation of sedative/anxiolytic drugs that was not fully explained by baseline depressive symptoms. This may inform strategies to optimize the use of sedative/anxiolytic drugs, and assist in the early identification of patients at risk of heavy drinking. Clinicians should consider a patient's alcohol consumption prior to prescribing or dispensing sedative/anxiolytic drugs. Clinicians should also monitor patients prescribed sedative/anxiolytic drugs for subsequent heavy drinking.

Pattern of psychotropic drug use among older adults having a depression or an anxiety disorder: results from the longitudinal ESA study

OBJECTIVE

To document the use of psychotropic drugs in Quebec older adult population with a depressive or anxiety disorder.

METHOD

Data from the Enquête sur la Santé des Aînés (ESA) study conducted between 2005 and 2008 using a representative sample (n = 1869) of community-dwelling adults aged 65 years and older were used to examine the use of psychotropic drugs in the Quebec older adult population.

RESULTS

Our results indicate that only 46.9% of the older adults with a diagnosis of depression or anxiety during the 24-month period studied according to the Régie de l'assurance maladie du Quebec (RAMQ) register used antidepressants (AD) for 400 days (12.9 months) on average during this period. Also, 59% of the RAMQ's mental health disorder patients used a mean daily dose of 5 mg of a diazepam equivalent for 338 days (10.9 months) on average during the same period. However, 10.0% of the older adults without any symptoms (ESA) at T1 and at T2 and any RAMQ depression and anxiety diagnosis between T0 and T2 were AD users during the 24-month period studied. They represent 26.2% of the AD users and consumed them for 494 days (15.9 months) on average during the 24-month period studied. Finally, the number of days of AD and benzodiazepine use was not associated with partial or total remission.

CONCLUSIONS

This result questions the population effectiveness of these drugs in this population.

Perceptions of young women using SSRI antidepressants — a reclassification of stigma

Objective

To contribute to an understanding of young women's perspective on using selective serotonin re-uptake inhibitors (SSRIs).

Method

Eight in-depth interviews and four re-interviews were conducted with young women (aged 21–34) using SSRIs. Informants were recruited through pharmacies in Copenhagen, Denmark. Pharmacy personnel identified potential participants based on dispensed prescriptions and gave them a contact letter with information about the study.

Key findings

When suffering from emotional problems, the women saw themselves as dysfunctional in their daily lives. They felt that they deviated from what is considered “normal” in society and thus felt stigmatised. When the women contacted their physicians they were prescribed SSRIs. After starting the medication, the women felt that they could once again function in everyday life and they felt relieved. However, the women also associated taking SSRIs with Stigmatisation due to the reputation of the medicines as “happiness pills” and the association with mental instability. The women concealed their emotional problems and medication from most people in their social networks. This was the result of the women's own anticipation of being stigmatised and their fear of negative reactions from others if they revealed the truth.

Conclusion

The young women using SSRIs felt stigmatised, initially due to their emotional problems. After the women were diagnosed, the stigma was reclassified and then became associated with taking SSRIs. The women coped primarily by trying to pass for normal. Our findings show that the SSRI users attach psychological and social meanings to their use of the drugs. Pharmacy professionals need to be aware of such meanings if they are to enhance their role in patient care.

Heart rate stress response dampening: the impact of alcohol, family history, and gender on at risk children and siblings

OBJECTIVE

In the following study we tested the stress response dampening (SRD) model which postulates that stress responses are more likely to be attenuated by alcohol in individuals at risk for alcohol dependence than in persons without that risk. In a laboratory experiment we examined a) if SRD effects exist for both sons and healthy daughters of alcohol dependent fathers, and b) if SRD effects exist for siblings of alcohol dependent males.

METHODS

We recruited 104 subjects at risk and 51 matched control subjects. In a laboratory experiment, study subjects received alcohol in one of two laboratory sessions and a stress paradigm served to elicit heart rate stress responses.

RESULTS

Heart rate stress responses were attenuated by alcohol in female family history positive (FHP) and female family history negative (FHN) subjects, however not in males. A multiple regression analysis revealed "Heart Rate Stress Response in the Non-Alcohol Condition" and "Blood Alcohol Level" as significant predictors of SRD.

CONCLUSIONS

According to our findings, females carry a distinct risk for developing alcohol dependence, regardless of their family history and regardless of their degree of familial relationship. This is an important issue for devising models concerning the development and maintenance of alcohol dependence in females. The study extends the current research literature, which mainly focuses on male subjects at risk, by including female subjects at risk, as well as siblings at risk of both genders.

Pattern of benzodiazepine use in psychiatric outpatients in Pakistan: a cross-sectional survey

Background

Benzodiazepines (BDZ) are the largest-selling drug group in the world. The potential of dependence with BDZ has been known for almost three decades now. In countries like Pakistan where laws against unlicensed sale of BDZ are not implemented vigorously the risk of misuse of and dependence on these drugs is even higher. Previous studies have shown that BDZ prevalence among patients/visitors to general outpatient clinics in Pakistan may be as high as 30%. However, no research has been carried out on the prevalence of BDZ use in psychiatric patients in Pakistan.

Methods

We carried out a cross-sectional survey over 3 months in psychiatry outpatient clinics of two tertiary care hospitals in Karachi and Lahore. Besides basic socio-demographic data the participants were asked if they were taking a BDZ at present and if yes, the frequency, route and dosage of the drug, who had initiated the drug and why it had been prescribed. We used chi-square test and t-test to find out which socio-demographic or clinical factors were associated with an increased risk of BDZ use. We used Logistic Regression to find out which variable(s) best predicted the increased likelihood of BDZ use.

Results

Out of a total of 419 participants 187 (45%) of the participants had been currently using at least one BDZ. Seventy-three percent of the users had been using the drug for 4 weeks or longer and 87% were taking it every day. In 90% of cases the BDZ had been initiated by a doctor, who was a psychiatrist in 70% of the cases. Female gender, increasing age, living in Lahore, and having seen a psychiatrist before, were associated with an increased likelihood of using BDZ.

Conclusion

The study shows how high BDZ use is in psychiatric outpatients in Pakistan. Most of the users were taking it for a duration and with a frequency which puts them at risk of becoming dependent on BDZ. In most of the cases it had been initiated by a doctor. Both patients and doctors need to be made aware of the risk of dependence associated with the use of BDZ.

Medication use and gender in Massachusetts: results of a household survey

In this study, we investigate the extent to which women and men differ in patterns of medication use, based on quantitative and qualitative data from a household survey in Western Massachusetts. Using a broad definition of medications, 96% of the sample reported taking one or more medications in the month preceding the survey (86% if vitamins, supplements, and alternative medications are excluded). Twenty-one percent of respondents reported taking five or more medications, and women were significantly more likely to report taking five or more medications in the month preceding the survey. For both sexes, analgesics and vitamins were the most commonly used medications, but women were more likely to report having taken hormones, supplements, and antihistamines. The likelihood of medicating reported health conditions did not differ by sex, but the frequency of reporting health conditions was higher among women, and the difference was significant for body aches and psychosomatic conditions. Analyses of qualitative data indicate that female networks of relatives and friends are an important source of advice on medications for both men and women. Responses to open-ended questions suggest that women's discourse about the effect of medications differs from men's in terms of the range and detail of descriptions of symptoms and side effects.

Prevalence of dependence on prescription drugs and associated mental disorders in a representative sample of general hospital patients

OBJECTIVES

The aim of this study was to determine the prevalence of dependence on prescription drugs (DPD) and associated comorbid disorders in consecutive general hospital inpatients.

METHODS

The sample consisted of 952 volunteer patients (age range, 18 to 64 years) in a German general hospital. The screening instrument was a self-administered questionnaire. A personal interview containing the Structured Clinical Interview for DSM-IV (SCID, Axis I) was used to evaluate positive screening results and to diagnose comorbid disorders.

RESULTS

The current prevalence of DPD was 4.7% [95% confidence interval (CI), 3.40-6.18; n=45). The current prevalence of single sedative dependence was 1.4% (95% CI, 0.62-2.14); of single hypnotic dependence, 1.2% (95% CI, 0.47-1.87); and of painkillers, 1.3% (95% CI, 0.54-2.01). In addition, dependence on sedatives and hypnotics was found in 0.1% of screened patients, painkillers and sedatives in 0.2%, painkillers and hypnotics in 0.4% and all three substances in 0.2%. Women were slightly overrepresented. The average age was 50.3 years. Psychiatric Axis I comorbidities were diagnosed in 66.7% of all cases, mostly anxiety disorders, followed by comorbid substance use and affective disorders.

CONCLUSION

The results indicate that the prevalence of DPD in general hospitals is frequent and should therefore become an important subject for health care providers. The general hospital might serve as an appropriate setting to provide early interventions for this group of patients.

Chronic Insomnia in Kidney Transplant Recipients

BACKGROUND

Recent studies confirmed that sleep disorders have a significant impact on various aspects of health in patients at different stages of chronic kidney disease. At the same time, there is an almost complete lack of information on the prevalence and correlates of insomnia in kidney transplant recipients.

METHODS

In a cross-sectional study, the Athens Insomnia Scale was used to assess the prevalence of insomnia in a large sample of kidney transplant recipients compared with wait-listed dialysis patients and also a matched group obtained from a nationally representative sample of the Hungarian population.

RESULTS

The prevalence of insomnia was 15% in wait-listed patients, whereas it was only 8% in transplant recipients (P < 0.001), which, in turn, was not different from the prevalence of this sleep problem in the sample of the general population (8%). Prevalences of insomnia in the transplant group were 5%, 7%, and 14% for the groups with glomerular filtration rates (GFRs) greater than 60 mL/min (> 1.00 mL/s), 30 to 60 mL/min (0.50 to 1.00 mL/s), and less than 30 mL/min (< 0.5 mL/s), respectively (P < 0.01). However, estimated GFR was no longer associated significantly with insomnia in the transplant population after statistical adjustment for several covariates. In a multivariate model, insomnia was significantly and independently associated with treatment modality (transplantation versus wait listing), as well as the presence of depression, restless legs syndrome, and high risk for obstructive sleep apnea syndrome, and with self-reported comorbidity.

CONCLUSION

The prevalence of insomnia was substantially less in the transplant group than in wait-listed dialysis patients and similar to that observed in the general population. Because this condition potentially is treatable, attention should be directed to the appropriate diagnosis and management of insomnia in the kidney transplant recipient population.

Hypnotic consumption in the Portuguese population: data from the National Health Survey 1998-1999

OBJECTIVE

To assess the prevalence and factors related to hypnotic intake in Portugal.

METHODS

Data from the National Health Survey conducted in 1998-1999 in a representative sample of 39 640 subjects aged > 18 years. Subjects were asked if they took hypnotics, for how long and also for how many days they had taken them the previous 2 weeks.

RESULTS

Overall, 13% of subjects reported taking hypnotics, and this frequency was higher for women (19%) than for men (7.4%, p < 0.001) and increased from 1.5% among age group [18-25[ to 26.2% among subjects aged > 75 years (p < 0.001). In both genders, the Lisbon region had the higher prevalence (15.4%) and Algarve the lowest (10%, p < 0.001); also ex-smokers the highest (15.4%), and current smokers the lowest prevalence (6.8%, p < 0.001). Women took hypnotics continuously during the previous 2 weeks more frequently than men (75 vs. 70%, p < 0.001), and the main reason for intake also differed between genders (p < 0.001). Finally, 69% of the subjects reported taking hypnotics for more than 3 years, and this prevalence was higher in women (71.6%) than in men (62.0%, p < 0.001). Multivariate analysis showed hypnotic intake to be positively related with age and inversely related with a sedentary lifestyle in both genders, and positively related with smoking and negatively related with obesity in men.

CONCLUSION

A significant percentage of the Portuguese population takes hypnotics in an almost continuous manner, and the intake is related to gender, age, obesity, and physical activity status.

Uso não-médico de medicamentos psicoativos entre escolares do ensino fundamental e médio no Sul do Brasil

O objetivo do presente estudo é investigar a prevalência de uso não-médico de medicamentos entre escolares da rede de ensino público e privado de Passo Fundo, Rio Grande do Sul, Brasil, e sua distribuição em relação a fatores sócio-demográficos. Por meio de um delineamento transversal, foi aplicado um questionário de autopreenchimento a 5.057 estudantes a partir da quinta série do ensino fundamental até o terceiro ano do ensino médio. O questionário continha perguntas sobre o uso, sem receita médica, de anfetamínicos, ansiolíticos, barbitúricos, anticolinérgicos, opiáceos, orexígenos e anabolizantes. Da amostra, 7,7% consumiram ansiolíticos alguma vez na vida, 6,4% consumiram anfetamínicos, 2,2%, anabolizantes, e 1,1%, barbitúricos. Estudantes do sexo feminino apresentaram maior consumo de ansiolíticos e anfetamínicos, enquanto que o consumo de anabolizantes foi maior no sexo masculino. O padrão de consumo de medicamentos psicoativos é semelhante ao observado em adultos, sugerindo a necessidade de inclusão de crianças e adolescentes nas campanhas educativas para prevenção do uso indevido de medicamentos.

Prescription drug abuse in Canada and the diversion of prescription drugs into the illicit drug market

Prescription drug abuse has received considerable attention in media reports in recent years. The purpose of this article is to describe the Canadian situation and context with regards to prescription drug abuse and the diversion of psychotropic prescription drugs into the illicit drug market, with a focus on the need for more data and interventions. Canada ranks within the top 10% of countries in the use of benzodiazepines, opioid prescriptions and stimulants. There are many ways that prescription drugs are diverted into the illicit market and varied reasons for use and abuse. Prescription drug abuse is further related to a number of negative consequences, including overdose. While seniors and women have been the primary focus for research in Canada on prescription drug abuse, adolescents and young adults have received less attention. Systematic epidemiological data specifically on prescription drug abuse in the Canada context are lacking and are needed in order to more clearly understand the reasons for the phenomenon and to develop and implement appropriate interventions.

Use of tranquilizers and sleeping pills among cancer patients is associated with a poorer quality of life

PURPOSE

To evaluate the association between sleeping pill/tranquilizer (SP/T) use and quality of life (QOL) among cancer patients.

PATIENTS AND METHODS

Oncology patients (n = 909) in three Israeli hospitals were interviewed in clinics, day centers and in-patient departments regarding SP/T use in the previous week. Crude and adjusted QOL scores, measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30), were compared in users vs. non-users.

RESULTS

Sleeping pill/tranquilizer use was self-reported by 234 (25.7%) participants, but rarely documented in medical charts. Factors associated with SP/T use were female gender (adjusted Odds ratio, OR: 1.79; 95% Confidence interval, CI: 1.22-2.62, age (OR: 4.6; 95% CI: 1.66-12.53 for age 70+), place of birth (OR: 1.97; 95% CI: 1.19-3.26 for Eastern Europe compared with Israel), concomitant use of painkillers (OR: 2.88; 95% CI: 1.97-4.20) and presence of cardiovascular disease (OR: 2.41; 95% CI: 1.48-3.91). Controlling these factors as well as disease status, users had a poorer QOL on all functional scales (p < 0.001) as well as global QOL. Furthermore, users reported increased severity of symptoms, especially fatigue, insomnia, pain, dyspnea and constipation (p < 0.01), compared to non-users.

CONCLUSIONS

Use of SP/T, reported by one fourth of cancer patients, was associated with substantially poorer QOL and increased severity of symptoms. Causal inference is not possible given the cross-sectional design. Periodic inquiry regarding use of these medications in the Oncology Clinic is recommended since it may identify patients with poor QOL and unmet needs.

Utilisation des anxiolytiques, sédatifs et hypnotiques chez les personnes âgées vivant dans la communauté : construction d’un cadre conceptuel

La consommation non appropriée d’anxiolytiques, de sédatifs et d’hypnotiques (ASH) chez les personnes âgées est un problème de santé publique important. Près de 35 % de la population âgée vivant à domicile consomment ces médicaments, en moyenne 206 jours par an. Selon les données québécoises, les personnes âgées de plus de 65 ans consomment cinq fois plus d’ASH que les individus âgés entre 18 et 64 ans. L’utilisation des ASH ne serait pas uniquement déterminée par la présence de symptômes, mais aussi par les caractéristiques psychosociales des sujets. En outre, plusieurs chercheurs ont suggéré que l’entourage et le système de soins étaient des facteurs environnementaux pouvant faciliter ou inhiber la consommation de ces médicaments chez les personnes âgées. Un cadre conceptuel est proposé pour aider à spécifier adéquatement les diverses hypothèses explicatives de ce comportement social de santé et, par conséquent, pour aider à mieux cibler les interventions visant à le modifier.

Factors associated with psychotropic drug use among community-dwelling older persons: A review of empirical studies

BACKGROUND: In the many descriptive studies on prescribed psychotropic drug use by community-dwelling older persons, several sociodemographic and other factors associated with drug use receive inconsistent support. METHOD: Empirical reports with data on at least benzodiazepine or antidepressant drug use in samples of older persons published between 1990 and 2001 (n = 32) were identified from major databases and analyzed to determine which factors are most frequently associated with psychotropic drug use in multivariate analyses. Methodological aspects were also examined. RESULTS: Most reports used probability samples of users and non-users and employed cross-sectional designs. Among variables considered in 5 or more reports, race, proximity to health centers, medical consultations, sleep complaints, and health perception were virtually always associated to drug use. Gender, mental health, and physical health status were associated in about two-thirds of reports. Associations with age, marital status, medication coverage, socioeconomic status, and social support were usually not observed. CONCLUSIONS: The large variety of methods to operationalize drug use, mental health status, and social support probably affected the magnitude of observed relationships. Employing longitudinal designs and distinguishing short-term from long-term use, focusing on samples of drug users exclusively, defining drug use and drug classes more uniformly, and utilizing measures of psychological well-being rather than only of distress, might clarify the nature of observed associations and the direction of causality. Few studies tested specific hypotheses. Most studies focused on individual characteristics of respondents, neglecting the potential contribution of health care professionals to the phenomenon of psychotropic drug use among seniors.

Prescription psychotropic medication use among the U.S. adult population: results from the third National Health and Nutrition Examination Survey, 1988-1994

OBJECTIVE

We estimated prescription psychotropic medication use among US adults.

METHODS

We examined household interview data from the third National Health and Nutrition Examination Survey (1988-1994) for persons 17 years and older (n=20,050).

STUDY DESIGN AND SETTING

An estimated 10 million adults (5.5%) reported psychotropic medication use during a 1-month period. The use of anxiolytics, sedatives, and hypnotics (ASH) was most common (3.2%), followed by antidepressants (2.3%), antipsychotics (0.7%), and antimanics (0.1%). Psychotropic medication use was more prevalent among women than men (P<.001), non-Hispanic whites than non-Hispanic blacks (P<.001) and Mexican Americans (P<.001), and older rather than younger age groups (P<.001). Psychotropic medication use was also most common among those below the federal poverty level, those with no high school education, and among insured persons. Only 1% of adults used two or more psychotropic medications monthly.

CONCLUSION

Many adults use psychotropic medications on a monthly basis. ASH users comprised the largest proportion of psychotropic medication users. Patterns of use varied by several socio-demographic factors.

Leading ordinary lives: a qualitative study of younger women's perceived functions of antidepressants

BACKGROUND

While the overall consumption of psychotropic medicines such as tranquillisers and hypnotics has declined, the consumption of the newer antidepressants--selective serotonin reuptake inhibitors (SSRIs) has increased drastically since their introduction. In order to understand the mechanisms underlying the use, it is important to gain insight into the users' perceptions about their medicine and use.

OBJECTIVE

To analyse younger women's perceived functions of SSRIs in their everyday lives.

METHODS

12 in-depth interviews and 6 re-interviews were conducted with a community-based sample of 21- to 34-year-old women taking SSRIs. The women were recruited through Danish pharmacies.

RESULTS

Prior to taking SSRIs the women struggled with their emotional problems, often in great frustration and distress. While taking SSRIs the women experienced that the medicine functioned both at a psychological and a social level. They believed that the medicine gave them resources to behave actively in a way that was not previously possible. They felt that the medicine use enabled them to concentrate on daily life activities other than dealing solely with their emotional problems. The women found that the medicine gave them back a sense of 'normality'.

CONCLUSION

The main finding in this paper is that the perceived functions of SSRIs were related to social meanings and goals in everyday life.

[5 year trajectories for dependence to psychotropics in a cohort of consumers]

The terms regular, excessive or intermittent consumption do not characterize type of consumption, the profile of the drug user, or the threshold of drug dependence.

OBJECTIVE

To characterize trajectories of consumption over a 5-year period and identify sociodemographic and medical characteristics, and modes of consumption associated with the types of trajectories.

METHODS

286 drug users from the cohort SUVIMAX agreed to take part in our study. SUVIMAX is a controlled randomized primary prevention trial using nutritional doses of a combination of anti-oxidant vitamins and minerals to reduce cardiovascular diseases and cancers. The data came from the questionnaire that examined each psychotropic drug taken between 1994 and 1998, rates of consumption and the beliefs associated with the drug users' modes of consumption and their dependence profiles.

RESULTS

A continuous trajectory is defined as uninterrupted consumption during the 5-year follow-up, and an occasional trajectory as an interruption of consumption for at least 1 month. Only 30% of the drug users with a continuous trajectory considered they could do without psychotropic agents.

CONCLUSION

The consumption of psychotropic drugs is not in itself harmful, but the duration and regularity of drug intake registered over a 5-year period indicate the drug dependence profile. The trajectory is a relevant and operational tool for better adapting therapeutic follow-up.

Factors associated with the consumption of psychotropic drugs in a cohort of men and women aged 50 and over

OBJECTIVES

The use of psychotropic drugs has increased continuously over recent years in industrialized countries. In Europe, France has the highest consumption of such drugs. The aim of this study was to identify the sociodemographic and medical factors associated with the use of psychotropic agents.

METHODS

Data, collected as part of the SUVIMAX (SUpplementation en VItamines et sels Mineraux AntioXydants) prevention trial, from a self- administered questionnaire involving 7299 subjects aged 45-60 years, were subjected to logistic regression analysis.

RESULTS

A total of 467 subjects used psychotropic drugs (8.4% of the women, 4.6% of the men). Use of psychotropic drugs increased in subjects of both sexes with past history of depression, perception of poor health and use of other drug treatments. Widowhood in men [odds ratio (OR) = 3.4; 95% CI = 1.6-7.3] and divorce in women (OR = 2; 95% CI = 1.2-3.2) were also associated with an increased use of psychotropic drugs. Interaction was demonstrated between educational level and occupational satisfaction in men (OR = 2.9; 95% CI = 1.5-5.8) and between perception of health status and use of other types of medication in women (OR = 6.5; 95% CI = 4.6-9.5).

CONCLUSION

The results of our study are consistent with those of others in demonstrating that specific socio-occupational factors in men and specific medical factors in women influence extent of use of psychotropic drugs.

Treatment of generalized anxiety disorder in older adults

Older adults with generalized anxiety disorder (GAD; N = 75; M age = 67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry-provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only I significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention.

Substance use disorders: sex differences and psychiatric comorbidities

OBJECTIVE

This article reviews sex differences in psychiatric comorbidity among individuals with substance use disorders and, in particular, the clinical significance of these differences for treatment outcome among women.

METHOD

We undertook a computerized search of major health care databases. To enhance the search, we drew prior relevant articles from the reference list.

RESULTS

Women with alcohol and other drug use disorders present higher rates of psychiatric comorbidity, particularly mood and anxiety disorders, than do men. Moreover, the comorbid diagnosis, particularly of depression, is more often primary in women, while in men the comorbidity is more often secondary to the substance abuse diagnosis. In addition, there is evidence that psychiatric comorbidity is associated with distinct, sex-specific outcomes for substance use treatment.

CONCLUSIONS

Sex differences in the clinical presentation of substance-dependent individuals with psychiatric comorbidity present specific treatment challenges and opportunities.

Drug prescribing patterns in Parkinson's disease: a pharmacoepidemiological survey in a cohort of ambulatory patients

PURPOSE

Drug treatment of idiopathic Parkinson's disease (IPD) is a difficult task, and comorbidity and comedication add to its complexity. Since in IPD there is little information about drug use, this study investigated drug prescribing and indications in IPD patients.

METHODS

From June 1997 to April 1998, a cross-sectional survey of IPD outpatients was performed and demographic and clinical data and information about drug treatments was collected and analysed.

RESULTS

In the 130 IPD patients included in the study, anti-Parkinson drug (APD) prescriptions increased with disease duration and severity. Levodopa was most frequently used, followed by dopamine agonists and anticholinergic agents. Levodopa with other APDs was given to older patients with later IPD onset. Prescriptions of drugs for other indications (non-APDs) were given to 80.8% of the patients and their number increased with patient age. Non-APD prescriptions concerned mainly the circulatory system, mental disorders, the musculoskeletal system and the digestive system. Prescriptions for indications corresponding to secondary symptoms that often complicate IPD increased with patient age and also with IPD duration.

CONCLUSION

In IPD patients, disease duration and severity and patient age seem to be major determinants of drug use. Indications for drug prescription suggest that main comorbidity includes neuropsychiatric, circulatory, musculoskeletal and digestive disorders. Analysis of prescribing patterns in IPD can provide a readily accessible indirect indicator of patient health status for both health services and epidemiologic research purposes.

Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population

OBJECTIVES

Only a few prospective surveys have been performed to investigate the relationship between sleep complaints and coronary artery disease (CAD) mortality. This study was conducted to determine whether sleep complaints in a middle-aged population predicted total mortality and CAD mortality.

DESIGN

A population-based prospective study. Setting. The County of Dalarna, Sweden.

SUBJECTS AND METHODS

In 1983, a random sample of 1870 subjects aged 45-65 years responded to a postal questionnaire (response rate 70.2%) including questions about sleep complaints and various diseases. Mortality data for the period 1983-95 were collected, and Cox proportional hazard analyses were used to examine the mortality risks.

RESULTS

At 12-year follow-up 165 males (18.2%) and 101 females (10.5%) had died. After adjustment for a wide range of important putative risk factors, difficulties initiating sleep (DIS) were related to CAD death in males [relative risk (RR), 3.1; 95% confidence interval (CI), 1.5-6.3; P < 0.01], but not in females. Short or long sleep duration did not influence risk of CAD mortality or total mortality for either gender. Depression in males increased the risk of death attributed to CAD (RR, 3.0; 95% CI, 1.1-8.4; P < 0.05) and total mortality (RR, 2.2; 95% CI, 1.1-4.5; P < 0.05).

CONCLUSION

These results provide evidence that there is an association between difficulties falling asleep and CAD mortality in males.

Correlates of psychotropic drug use in the elderly compared to adults aged 18-64: results from the Quebec Health Survey

This study documents correlates of psychotropic drug use among older adults and compares the results observed in this group to those observed in individuals aged 18-64. A multivariate logistic regression analysis using data from the Quebec Health Survey (1992-1993) was employed to study predisposing and facilitating factors of this behavior. Results showed that 22% of the elderly reported having used anxiolytics, sedatives or hypnotics during the two days preceding the survey, compared to 4.9% of the respondents aged 18-64. Combining both samples, perceived health status, physical functional status, and health services utilization for psychological distress symptoms were the main health factors associated with psychotropic drug use. A significant difference was observed between the two age groups with regard to the association between the respondents' health status and the use of anxiolytics, sedatives or hypnotics. When the effect of other explanatory factors was controlled, older adults in poor health used anxiolytics, sedatives or hypnotics 2.21 times more than individuals aged 18-64 with a similar health condition, whereas older adults in good health used these drugs 7.49 times more than healthy individuals aged 18-64. Furthermore, after controlling for the effect of the respondents' physical and psychological health status, our results showed that more women than men used psychotropic drugs (OR = 1.57; 99% CI = 1.26-1.94). Low-income respondents were also more likely to report using these medications (OR = 1.53; 99% CI = 1.22-1.90). These results were interpreted as supporting the socio-cultural hypothesis of psychotropic drug use, which suggests that the prescribing and utilization of psychotropic drugs is influenced not only by symptoms but also by the social characteristics of individuals. It is suggested that future research may contribute to a better understanding of psychotropic drug utilization in the older adult community-dwelling population by examining consumers' attitudes and health care providers' social values concerning the appropriateness of this behavior.

Self-report of memory and affective dysfunction in association with medication use in a sample of individuals with chronic sleep disturbance

Benzodiazepines produce memory disturbance after acute administration. It is not clear whether chronic use of benzodiazepines is hazardous to memory processes. Epidemiological data indicate that a large proportion (10-30 per cent) of individuals with sleep dysfunction take hypnotic aids for a year or longer. The purpose of the present study was to evaluate self-reported memory dysfunction in a sample of individuals who considered their sleep disturbance sufficiently severe to seek investigation in sleep clinics. It was hypothesized that individuals taking benzodiazepines for sleep would report greater perceived everyday memory failures than individuals taking other sleep aids or no medication. Questionnaires were given to 368 individuals referred into the study by investigators in six sleep disorders clinics. All respondents completed a lengthy (700-item) questionnaire, which included scales assessing memory difficulties, affective status and sleep disturbance. Respondents also reported any medication use for sleep problems and duration of use of the current drug. Information on medication use was reported by 289 participants. Fifty-six per cent of respondents reported using some form of psychoactive medication (antidepressants, benzodiazepines, Zopiclone). Twenty-two per cent reported using no medication. Analysis of covariance showed that these medications had no detectable effect on subjective memory difficulties during chronic use, F(4,226)=1.34, p=0.25. Copyright 2000 John Wiley & Sons, Ltd.

The relationship between alcohol problems and use of tranquilizing drugs: longitudinal patterns among American women

A previous community study of older adults (Graham et al., 1996) indicated a relationship between alcohol problems and use of tranquilizing drugs despite no relationship between alcohol consumption and tranquilizer use. The present paper explores this issue further using longitudinal data from a representative sample of American women. The results replicated previous findings of a significant relationship between alcohol problems and tranquilizer use that was unrelated to alcohol consumption. Analyses of longitudinal patterns indicated that alcohol problems in 1981 predicted subsequent use of tranquilizing drugs and that this relationship may be moderated by anxiety, with the relationship being strongest for respondents who reported few or no problems with anxiety. The results indicated no support for the relationship being due to: a pharmacological interaction of alcohol with tranquilizing drugs; use of tranquilizing drugs precipitating alcohol problems; or depression, anxiety, poor health or childhood sexual abuse being common causes of both alcohol problems and tranquilizer use. The link between alcohol problems and use of tranquilizing drugs needs to be investigated further to increase understanding of addictive behaviors.