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Okazaki Y, Yoshida S, Kashima S, Ishii S, Koike S, Matsumoto M. Impact of the 2018 Japan Floods on benzodiazepine use: a longitudinal analysis based on the National Database of Health Insurance Claims. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2411-2421. [PMID: 35474395 DOI: 10.1007/s00127-022-02289-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Natural disaster has an impact on mental health. The 2018 Japan Floods, which took place in July 2018 were one of the largest water disasters in Japan's recorded history. We aimed to evaluate the change in the number of benzodiazepine prescriptions by physicians before and after the disaster. METHODS A retrospective cohort study based on the National Database of Health Insurance Claims was conducted in the flood-stricken areas between July 2017 and June 2019. The subjects were divided between victims and non-victims according to certification by local governments. Members of both groups were then categorized into three groups based on their pre-flood use of benzodiazepines: non-user, occasional user, and continuous user. Difference-in-differences (DID) analysis with a logistic regression model was conducted to estimate the effect of the disaster among victims by comparing the occurrence of benzodiazepine prescriptions before and after the disaster. RESULTS Of 5,000,129 people enrolled, 31,235 were victims. Among all participants, the mean prescription rate for benzodiazepines in victims before the disaster (11.3%) increased to 11.8% after the disaster, while that in non-victims (8.3%) decreased to 7.9%. The DID analysis revealed that benzodiazepine prescription among victims significantly increased immediately after the disaster (adjusted ratio of odds ratios (ROR) 1.07: 95% confidence interval 1.05-1.11), and the effect of the disaster persisted even 1 year after the disaster (adjusted ROR 1.2: 95% confidence interval 1.16-1.24). CONCLUSION The flood increased the number of benzodiazepines prescriptions among victims, and the effect persisted for at least 1 year.
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Affiliation(s)
- Yuji Okazaki
- Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.
- Department of Community-Based Medical Systems, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Shuhei Yoshida
- Department of Community-Based Medical Systems, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Saori Kashima
- Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8529, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Tochigi, 329-0498, Japan
| | - Masatoshi Matsumoto
- Department of Community-Based Medical Systems, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Yamamoto M, Inada K, Enomoto M, Habukawa M, Hirose T, Inoue Y, Ishigooka J, Kamei Y, Kitajima T, Miyamoto M, Shinno H, Nishimura K, Ozone M, Takeshima M, Suzuki M, Yamashita H, Mishima K. Current state of hypnotic use disorders: Results of a survey using the Japanese version of Benzodiazepine Dependence Self-Report Questionnaire. Neuropsychopharmacol Rep 2020; 41:14-25. [PMID: 33259705 PMCID: PMC8182966 DOI: 10.1002/npr2.12149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 12/02/2022] Open
Abstract
Aims Benzodiazepine receptor agonists (BZ‐RAs) are frequently prescribed to treat insomnia; however, their long‐term use is not recommended. To introduce an appropriate pharmaco‐therapy, the current state and background factors of BZ‐RAs' dependence must be elucidated. In this study, we developed a Japanese version of the Benzodiazepine Dependence Self‐Report Questionnaire (Bendep‐SRQ‐J) and conducted a study of BZ‐RAs' use disorder. Methods The Bendep‐SRQ‐J was created with permission from the original developer. Subjects were inpatients and outpatients receiving BZ‐RAs between 2012 and 2013. Clinical data collected were Bendep‐SRQ‐J scores, sleep disorders for which BZ‐RAs were prescribed, physical comorbidities, psychotropic drugs, and lifestyle factors. Logistic analysis was performed to extract factors associated with severe symptoms. Results Of the 707 patients prescribed BZ‐RAs, 324 had voluntarily tapered or discontinued their drugs. Logistic analysis showed that the total number of drugs administered in the last 6 months correlated with both worsening of symptoms or conditions. This was more notable among younger patients, and the proportion of patients with severe symptoms or conditions increased with the increasing number of drugs. Conclusion Using the Bendep‐SRQ‐J, we elucidated the current state of BZ‐RA dependence. Nearly half of the patients were non‐compliant. The proportion of patients with severe symptoms or disease conditions increased with the increase in the number of drugs administered. These findings highlight the need for clinicians to be aware of the likelihood of benzodiazepine dependence, especially in young patients and patients prescribed multiple hypnotics. Using the Bendep‐SRQ‐J, we elucidated the current state of BZ‐RA dependence. Nearly half of the patients were non‐compliant.![]()
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Affiliation(s)
- Mai Yamamoto
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Minori Enomoto
- Department of Sleep-wake disorders, NIMH, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Medical Technology, School of Health Science, Tokyo University of Technology, Tokyo, Japan
| | - Mitsunari Habukawa
- Department of Neuropsychiatry, School of Medicine, Kurume University, Kurume, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University School of Medicine, Tokyo, Japan
| | | | - Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Yuichi Kamei
- Center for Sleep Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tsuyoshi Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Shimotsuga-gun, Japan
| | | | - Hideto Shinno
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Motohiro Ozone
- Department of Medical Technology, School of Health Science, Tokyo University of Technology, Tokyo, Japan.,Department of Psychiatry, Jikei University, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Mayumi Suzuki
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Hidehisa Yamashita
- Department of Psychiatry and Neurosciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Mishima
- Department of Sleep-wake disorders, NIMH, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
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Enomoto M, Kitamura S, Tachimori H, Takeshima M, Mishima K. Long-term use of hypnotics: Analysis of trends and risk factors. Gen Hosp Psychiatry 2020; 62:49-55. [PMID: 31786448 DOI: 10.1016/j.genhosppsych.2019.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients with chronic insomnia are prone to long-term use of hypnotics. Reported risk factors include aging, female sex, and comorbid psychiatric disorders. However, most previous studies have been cross-sectional cohort studies. METHOD We conducted a retrospective cohort study using medical service payment data for 330,000 people to determine the duration of prescription of hypnotics and the risk factors for long-term use. We followed up 3981 patients (2382 M, 1599 F, age 40.3 ± 12.4 years) who were prescribed hypnotics for the first time between April 2005 and March 2008. RESULTS Of these 3981 patients, 59.6% were prescribed hypnotics for only 1 month, 11.3% were prescribed hypnotics for 2 consecutive months, and 10.1% of patients continued receiving prescriptions for the entire 12-month observation period. In multiple logistic time-dependent Cox analyses, use of antidepressants, mean dose of hypnotics, and advanced age were significantly associated with long-term use of hypnotics (p < 0.01). In an analysis of the association between long-term use of hypnotics and prescribed dosage, high monthly dose, advanced age, and department of first visit were significantly associated with long-term use (p < 0.01). CONCLUSION These clinical indicators may be effective for early identification of patients with insomnia who are at high risk of developing physical dependence on hypnotics.
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Affiliation(s)
- Minori Enomoto
- Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan; Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Shingo Kitamura
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Hisateru Tachimori
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan.
| | - Kazuo Mishima
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; International Institute for Integrative Sleep Medicine, Tsukuba, Japan.
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Hata T, Kanazawa T, Hamada T, Nishihara M, Bush AI, Yoneda H, Nakajima M, Katsumata T. What can predict and prevent the long-term use of benzodiazepines? J Psychiatr Res 2018; 97:94-100. [PMID: 29223863 DOI: 10.1016/j.jpsychires.2017.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/14/2017] [Accepted: 11/22/2017] [Indexed: 11/18/2022]
Abstract
Although benzodiazepines (BZDs) are commonly prescribed for insomnia or anxiety, long-term use of BZDs causes serious adverse effects such as daytime drowsiness and cognitive decline. In the current study, we evaluated the predictors and preventers of long-term usage of BZDs from a retrospective survey by utilizing the 12-year prescription record of a university hospital. From the prescription data of 92,005 people, users of BZDs (n = 3,470, male = 39.2%, mean age = 60 ± 17.5) were analyzed. During this period, both the number of prescriptions (2722 in 2004 to 1019 in 2016) and the number of BZDs (1.73 in 2004 to 1.36 in 2016) gradually decreased, although more than half of the patients continued to take BZDs for over three years. High risk factors for long-term use of BZDs include elderly patients (>65 years old), high dosage (>5 mg diazepam per day), psychiatrist-prescribers, and users with polytherapy. Discontinuation is significantly found in users of hypnotic BZDs and alternative psychotropic medical drugs (including antipsychotics, serotonergic drugs, or newer types of sleep medicine). Future studies should focus on elucidating interventions that are more effective against long-term usage of BZDs.
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Affiliation(s)
- Takeo Hata
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan; Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa 920-1192, Japan.
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan; Department of Psychiatry, The University of Melbourne, VIC 3010, Australia; Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, 30 Royal Parade, Parkville, VIC 3052, Australia
| | - Takeshi Hamada
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Masami Nishihara
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Ashley Ian Bush
- Department of Psychiatry, The University of Melbourne, VIC 3010, Australia; Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, 30 Royal Parade, Parkville, VIC 3052, Australia
| | - Hiroshi Yoneda
- Department of Neuropsychiatry, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Miki Nakajima
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa 920-1192, Japan
| | - Takahiro Katsumata
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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Takeshima N, Ogawa Y, Hayasaka Y, Furukawa TA. Continuation and discontinuation of benzodiazepine prescriptions: A cohort study based on a large claims database in Japan. Psychiatry Res 2016; 237:201-7. [PMID: 26805564 DOI: 10.1016/j.psychres.2016.01.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 10/15/2015] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
Although benzodiazepines (BZDs) are often prescribed to treat a wide range of psychiatric and neurological conditions, they are also associated with various harms and risks including dependence. However the frequency of its continued use in the real world has not been well studied, especially at longer follow-ups. The aim of this study was to clarify the frequency of long-term BZD use among new BZD users over longer follow-ups and to identify its predictors. We conducted a cohort study to examine how frequently new BZD users became chronic users, based on a large claims database in Japan from January 2005 to June 2014. We used Cox proportional hazards models to identify potential predictors. A total 84,412 patients with new BZD prescriptions were included in our cohort. Among them, 35.8% continued to use BZD for three months, 15.2% for one year and 4.9% for eight years without ever attaining three months of no BZD prescription. The confirmed predictors for long-term BZD use were older age, psychiatrist-prescriber, regular use, high dose of BZD, and concomitant prescription of psychotropic drugs. When we consider BZD use, we have to keep in mind these figures and avoid these predictors as much as possible.
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Affiliation(s)
- Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yusuke Ogawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yu Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
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Neutel CI, Skurtveit S, Berg C. What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population. Sleep Med 2012; 13:893-7. [DOI: 10.1016/j.sleep.2011.12.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 11/30/2011] [Accepted: 12/09/2011] [Indexed: 11/28/2022]
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Sarwer DB, Cash TF, Magee L, Williams EF, Thompson JK, Roehrig M, Tantleff-Dunn S, Agliata AK, Wilfley DE, Amidon AD, Anderson DA, Romanofski M. Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image. Plast Reconstr Surg 2005; 115:931-8. [PMID: 15731697 DOI: 10.1097/01.prs.0000153204.37065.d3] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This large, multisite study investigated female college students' experiences with and attitudes about cosmetic surgery. The study also assessed the relationship between several aspects of body image, including appearance satisfaction and investment and symptoms of body dysmorphic disorder, and interest in cosmetic surgery. Thirty (5 percent) of the 559 women surveyed reported that they had undergone cosmetic surgery. Two thirds of respondents reported knowing someone who had received cosmetic surgery, and approximately one third indicated that a family member had undergone surgery. Overall, participants held relatively favorable attitudes about surgery. Regression analysis suggested that a greater psychological investment in physical appearance and greater internalization of mass media images of beauty predicted more favorable attitudes toward cosmetic surgery. Fourteen women (2.5 percent) screened positive for body dysmorphic disorder based on the nature and severity of their self-reported body-image concerns. Results of this study provide new information on young women's experiences and attitudes about cosmetic surgery and how these attitudes relate to body image.
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Affiliation(s)
- David B Sarwer
- University of Pennsylvania School of Medicine, Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, Pa 19104, USA.
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Abstract
Recommendations for benzodiazepine (BZD) use suggest durations of no more than a few weeks, but studies report use for months, years, or even decades. This article examines the who (who are long-term users), why (why do they use BZD), what (what are patterns of long-term use) and how (how do they compare to all BZD users). The study population is from the National Population Health Survey in Canada which interviewed respondents four times at two-year intervals, asking about specific drugs use as well as demographic, lifestyle and health-related questions. Long-term BZD use was defined as BZD use for two successive cycles. Four percent of the Canadian population used BZD at any one time, half of whom also reported use in the previous cycle. Benzodiazepine users were more likely to be female, elderly, smokers, to prefer speaking a language other than English, to have insurance coverage for medication, and to have completed high school education. Almost none of these determinants predicted long-term use. Persons reporting BZD use in 2000 had an odds ratio (OR) of 38.6 for also using BZD in 1998, were more likely to use antidepressants (OR=8.5) and suffer from conditions such as poor health, stress, and pain. Most of these determinants had no association with long-term use or if they did at a considerably lower OR. Of the 395 BZD users in 2000, almost 48.4% also used BZD in the previous cycle and 17% in all three previous cycles. Benzodiazepine use in any previous cycle made BZD use in 2000 more likely, with use determined by how recent and the frequency of reported use, culminating in a very high OR of 83.3 for use in all three previous cycles. Continued use for any of the individual BZD tended to be largely for the same BZD. We conclude that: (1) the overriding determinant for BZD use was that of previous use; and (2) long-term use was not determined by the same factors as overall use, which is significant in developing approaches to dealing with long-term BZD use.
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Affiliation(s)
- C Ineke Neutel
- Treatment and Outcomes Monitoring Section, Centre for Chronic Diseases Prevention and Control, Public Health Agency of Canada, 120 Colonnade Road, Ottawa, Ontario, Canada.
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Ozaki S, Kikuchi S, Wada K. Characteristics of patients with hypnotic-related psychiatric disorders in the nationwide mental hospital survey. Psychiatry Clin Neurosci 2001; 55:205-7. [PMID: 11422843 DOI: 10.1046/j.1440-1819.2001.00827.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We investigated the characteristics of patients with hypnotic-related psychiatric disorders. Subjects were 90 patients reported in the nationwide Mental Hospital Survey in 1998, who were divided into three groups according to their history of substances use. Group A (patients without history of any illicit substance use) was estimated to be the most common and core group with iatrogenic characteristics. Hypnotic use in Group B (patients with history of any illicit substance use) was recognized as one of behavioral disorders in the psychosocial context. Patients in Group C (patients with multiple-substance use and without history of any illicit substance use) showed the most serious disorders in the context of addiction. More specified treatment programs would be required considering patients' characteristics.
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Affiliation(s)
- S Ozaki
- Division of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology, Ichikawa-shi, Japan.
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