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Cardona-Acosta AM, Meisser N, Vardeleon NI, Steiner H, Bolaños-Guzmán CA. Mother's little helper turned a foe: Alprazolam use, misuse, and abuse. Prog Neuropsychopharmacol Biol Psychiatry 2024; 136:111137. [PMID: 39260815 DOI: 10.1016/j.pnpbp.2024.111137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/27/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024]
Abstract
Benzodiazepines are effective in managing anxiety and related disorders when used properly (short-term). Their inappropriate use, however, carries significant risks, involving amnesia, rebound insomnia, rebound anxiety, depression, dependence, abuse, addiction, and an intense and exceedingly prolonged withdrawal, among other complications. Benzodiazepines also amplify the effects of opioids and, consequently, have been implicated in approximately 30 % of opioid overdose deaths. Despite their unfavorable profile, sharp increases in medical and non-medical use of benzodiazepines have been steadily reported worldwide. Alprazolam (Xanax®), a potent, short-acting benzodiazepine, is among the most prescribed and abused anxiolytics in the United States. This medication is commonly co-abused with opioids, increasing the likelihood for oversedation, overdose, and death. Notwithstanding these risks, it is surprising that research investigating how benzodiazepines, such as alprazolam, interact with opioids is severely lacking in clinical and preclinical settings. This review therefore aims to present our current knowledge of benzodiazepine use and misuse, with an emphasis on alprazolam when data is available, and particularly in populations at higher risk for developing substance use disorders. Additionally, the potential mechanism(s) surrounding tolerance, dependence and abuse liability are discussed. Despite their popularity, our understanding of how benzodiazepines and opioids interact is less than adequate. Therefore, it is now more important than ever to understand the short- and long-term consequences of benzodiazepine/alprazolam use.
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Affiliation(s)
- Astrid M Cardona-Acosta
- Department of Psychological and Brain Sciences, and Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
| | - Noelle Meisser
- Department of Psychological and Brain Sciences, and Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
| | - Nathan I Vardeleon
- Department of Psychological and Brain Sciences, and Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
| | - Heinz Steiner
- Stanson Toshok Center for Brain Function and Repair, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; Discipline of Cellular and Molecular Pharmacology, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
| | - Carlos A Bolaños-Guzmán
- Department of Psychological and Brain Sciences, and Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA.
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Rolland B, Karila L, Franchitto N, Barrault C, Naassila M. Should the French approval of baclofen for alcohol dependence be extended to abstinence maintenance? L'ENCEPHALE 2024:S0013-7006(24)00138-6. [PMID: 39244501 DOI: 10.1016/j.encep.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/04/2024] [Accepted: 05/17/2024] [Indexed: 09/09/2024]
Abstract
Ever since 2018 France has been the only country to approve the gamma aminobutyric acid type B (GABA-B) receptor agonist baclofen for alcohol dependence. This authorization follows a ten-year period of intensive off-label use during which baclofen was used in doses of up to 300 and even 400mg per day to support the gradual reduction of alcohol consumption in patients suffering from alcohol dependence. However, in international clinical trials, baclofen has mainly been studied to support the maintenance of abstinence. The French use of baclofen was therefore somewhat atypical as it paved the way for drug-supported approaches to reducing alcohol consumption, even before nalmefene was marketed. In line with this specific use of baclofen, approval was granted only for alcohol reduction support. However, a recent Cochrane systematic review and meta-analysis by Agabio et al. found significant efficacy only for abstinence maintenance, while no significant effect was found on alcohol reduction outcomes and no dose-response relationship was identified in the analyses. The safety of baclofen was judged to be good. Based on these substantial new results, the Société française d'alcoologie (SFA) now considers that baclofen should also be approved for the maintenance of abstinence. The extension of approval should not lead to the removal of the initial indication or the possibility of using high doses, as some patients have found this therapeutic regimen particularly useful for them. France, which has been a open skies national laboratory on the use of baclofen in alcohol dependence for over ten years, should let this original therapeutic option available to patients. However, it should update the regulatory framework defining the main conditions of access to treatment for patients based on the latest and highest scientific evidence.
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Affiliation(s)
- Benjamin Rolland
- Service universitaire d'addictologie de Lyon (SUAL), hospices civils de Lyon, CH Le Vinatier, 95, boulevard Pinel, 69500 Lyon, France; UPSYR2, CRNL, U1028, CNRS, UMR5292, Inserm, UCBL1, Lyon, France.
| | - Laurent Karila
- Centre d'enseignement, de recherche et de traitement des addictions, hôpital universitaire Paul-Brousse (AP-HP), 94800 Villejuif, France; UR PSYCOMADD, université Paris Saclay, 94270 Le-Kremlin-Bicêtre, France
| | - Nicolas Franchitto
- Service universitaire d'addictologie, CHU de Purpan, Toulouse, France; EQUITY Research Team, CERPOP, UMR 1295, University Toulouse III, Paul Sabatier, Toulouse, France
| | | | - Mickael Naassila
- Unité Inserm UMRS 1247, université de Picardie Jules-Verne, Amiens, France
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Minozzi S, Ambrosi L, Saulle R, Uhm SS, Terplan M, Sinclair JM, Agabio R. Psychosocial and medication interventions to stop or reduce alcohol consumption during pregnancy. Cochrane Database Syst Rev 2024; 4:CD015042. [PMID: 38682758 PMCID: PMC11057221 DOI: 10.1002/14651858.cd015042.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Despite the known harms, alcohol consumption is common in pregnancy. Rates vary between countries, and are estimated to be 10% globally, with up to 25% in Europe. OBJECTIVES To assess the efficacy of psychosocial interventions and medications to reduce or stop alcohol consumption during pregnancy. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO, from inception to 8 January 2024. We also searched for ongoing and unpublished studies via ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). All searches included non-English language literature. We handsearched references of topic-related systematic reviews and included studies. SELECTION CRITERIA We included randomised controlled trials that compared medications or psychosocial interventions, or both, to placebo, no intervention, usual care, or other medications or psychosocial interventions used to reduce or stop alcohol use during pregnancy. Our primary outcomes of interest were abstinence from alcohol, reduction in alcohol consumption, retention in treatment, and women with any adverse event. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS We included eight studies (1369 participants) in which pregnant women received an intervention to stop or reduce alcohol use during pregnancy. In one study, almost half of participants had a current diagnosis of alcohol use disorder (AUD); in another study, 40% of participants had a lifetime diagnosis of AUD. Six studies took place in the USA, one in Spain, and one in the Netherlands. All included studies evaluated the efficacy of psychosocial interventions; we did not find any study that evaluated the efficacy of medications for the treatment of AUD during pregnancy. Psychosocial interventions were mainly brief interventions ranging from a single session of 10 to 60 minutes to five sessions of 10 minutes each. Pregnant women received the psychosocial intervention approximately at the end of the first trimester of pregnancy, and the outcome of alcohol use was reassessed 8 to 24 weeks after the psychosocial intervention. Women in the control group received treatment as usual (TAU) or similar treatments such as comprehensive assessment of alcohol use and advice to stop drinking during pregnancy. Globally, we found that, compared to TAU, psychosocial interventions may increase the rate of continuously abstinent participants (risk ratio (RR) 1.34, 95% confidence interval (CI) 1.14 to 1.57; I2 =0%; 3 studies; 378 women; low certainty evidence). Psychosocial interventions may have little to no effect on the number of drinks per day, but the evidence is very uncertain (mean difference -0.42, 95% CI -1.13 to 0.28; I2 = 86%; 2 studies; 157 women; very low certainty evidence). Psychosocial interventions probably have little to no effect on the number of women who completed treatment (RR 0.98, 95% CI 0.94 to 1.02; I2 = 0%; 7 studies; 1283 women; moderate certainty evidence). None of the included studies assessed adverse events of treatments. We downgraded the certainty of the evidence due to risk of bias and imprecision of the estimates. AUTHORS' CONCLUSIONS Brief psychosocial interventions may increase the rate of continuous abstinence among pregnant women who report alcohol use during pregnancy. Further studies should be conducted to investigate the efficacy and safety of psychosocial interventions and other treatments (e.g. medications) for women with AUD. These studies should provide detailed information on alcohol use before and during pregnancy using consistent measures such as the number of drinks per drinking day. When heterogeneous populations are recruited, more detailed information on alcohol use during pregnancy should be provided to allow future systematic reviews to be conducted. Other important information that would enhance the usefulness of these studies would be the presence of other comorbid conditions such as anxiety, mood disorders, and the use of other psychoactive substances.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Ludovico Ambrosi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Seilin S Uhm
- School of Medicine, University of Southampton, Southampton, UK
| | - Mishka Terplan
- Friends Research Institute, Baltimore, USA
- Family and Community Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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Peyron E, Franck N, Labaume L, Rolland B. [The psychosocial rehabilitation in addiction medicine]. L'ENCEPHALE 2024; 50:91-98. [PMID: 37718195 DOI: 10.1016/j.encep.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES Addictive behaviors constitute complex behaviors that are usually related to social habits, such as substance use, gambling or gaming activities, or sexual or physical activity. They progressively overrun and stifle the routine habits of the concerned individuals, for example within their occupational or family spheres of life, as well as in their hobbies or in their main physiological functions, such as sleep or eating cycles. The rehabilitation approach of care integrates the objective of restoring the altered habits and functional rhythms, to optimize the clinical outcomes and improve quality of life of the concerned persons. METHODS Using a focused and narrative literature review, we aimed to explain what psychosocial rehabilitation consists in, and why this approach is particularly relevant for the addiction care, although to date it has remained insufficiently developed in the routine practice of many facilities. RESULTS The "rehab" approach, is first based on a structured and comprehensive assessment of the clinical and functional aspects of the patient, which secondarily allows to frame an individualized project of care that is closely built together with the patient. This project of care can integrate classical pharmacotherapeutic and psychotherapeutic tools, but it also emphasizes wider approaches for restoring some basic social and physiological functions of the concerned person, such as sleep, eating, social functioning, physical activity, or spiritual needs. Priorities among these different dimensions have to be defined by the concerned person. CONCLUSIONS The "rehab" approach is particularly relevant in addiction medicine. It represents a more global conception of care that conceives the recovery of social and physiological functioning as a core treatment objective for the concerned persons. The consequences for care organization are that many additional professionals should be integrated into the treatment schemes for addiction, including peer counselors, occupational therapists, physical activity coaches, or dieticians.
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Affiliation(s)
- Eric Peyron
- Service universitaire d'addictologie de Lyon (SUAL), hospices civils de Lyon, CH Le Vinatier, 95, boulevard Pinel, 69500 Lyon, France
| | - Nicolas Franck
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, pôle centre rive gauche, hôpital Le Vinatier, UMR 5229, CNRS & Claude-Bernard university Lyon 1, université de Lyon, Lyon, France
| | | | - Benjamin Rolland
- Service universitaire d'addictologie de Lyon (SUAL), hospices civils de Lyon, CH Le Vinatier, 95, boulevard Pinel, 69500 Lyon, France; PSYR2, CRNL, U1028, CNRS, UMR5292, Inserm, UCBL1, Lyon, France.
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5
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Crystal R, Ellison M, Purdon C, Skolnick P. Pharmacokinetic Properties of an FDA-approved Intranasal Nalmefene Formulation for the Treatment of Opioid Overdose. Clin Pharmacol Drug Dev 2024; 13:58-69. [PMID: 37496452 PMCID: PMC10818017 DOI: 10.1002/cpdd.1312] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023]
Abstract
Nalmefene is a high-affinity, long-duration opioid antagonist that was approved in 1995 as an injection for the treatment of opiate overdose, but subsequently withdrawn (2008) for reasons other than safety or effectiveness. The dramatic rise in opioid overdose deaths over the past 7-8 years catalyzed the development of an intranasal (IN) formulation of nalmefene for the emergency treatment of opioid overdose. The studies described here compare the pharmacokinetic properties and safety profiles of an IN formulation containing nalmefene (2.7 mg in 0.1 mL) to an approved 1 mg intramuscular (IM) dose. IN nalmefene produced maximum plasma concentrations that were significantly higher than observed following the IM dose (12.2 and 1.77 ng/mL, respectively). The time to reach maximum plasma concentrations was also faster following IN administration (0.25 and 0.33 hours, respectively) with significant differences in plasma concentrations manifested as early as 2.5 minutes after administration (NCT04759768). The plasma half-life of nalmefene was similar following IM and IN administration (10.6-11.4 hours). Furthermore, dose-normalized nalmefene exposure was similar for both 1 spray in each nostril and 2 sprays in the same nostril compared to a single spray in each nostril (NCT05219669). There were no sex differences in the pharmacokinetic properties of either IN or IM nalmefene. In an era when almost 90% of opioid overdose deaths have been linked to high-potency synthetic opioids, the ability to rapidly deliver high concentrations of nalmefene could represent an important tool for reducing both morbidity and mortality.
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Crosnier Leconte G, Clergue-Duval V, Bloch V, Barre T, Amami J, Bellivier F, Questel F, Vorspan F, Icick R. Prevalence of benzodiazepine use disorder during hospitalization for alcohol detoxification. Fundam Clin Pharmacol 2023. [PMID: 36878490 DOI: 10.1111/fcp.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 01/07/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
Benzodiazepines (BZDs) are the first-line treatment of alcohol withdrawal. Comorbidity between benzodiazepine use disorder (BUD) and alcohol use disorders (AUD) is common. However, the risk factors are poorly characterized due to the paucity of available BUD screening tools. The present study aimed to rectify this by conducting an observational screening investigation for BUD in patients hospitalized for alcohol detoxification in a specialized unit. During a face-to-face interview, a short BUD screening tool, Echelle Cognitive d'Attachement aux benzodiazépines (ECAB), was administered to record recent patterns of BZD use, thereby allowing categorization of AUD patients as follows: non-BZD users, BZD users without BUD, and BUD (ECAB ≥6). Clinical and sociodemographic risk factors were identified and recorded during clinical assessment and were analyzed using nonparametric bivariate tests and multinomial regression for association with BUD, with p < 0.05 for significance. Of the 150 AUD patients, 23 (15%) had comorbid BUD. Several variables were associated with ECAB score, with their independence being verified using multinomial regression, with lower risk of BUD versus BZD use, when the initial prescriber was an addiction specialist compared with a psychiatrist or a general practitioner [odds ratio (OR) = 0.12, 95% confidence interval (CI) = 0.14-0.75]. A higher risk of BZD use versus no use was evident when comorbid psychiatric disorders were present (OR = 9.2, 95%CI = 1.3-65). Our findings raise clinicians' awareness that in patients hospitalized for alcohol detoxification, BUD is highly prevalent but not specifically related to psychiatric disorders. BUD can be effectively screened by utilization of the ECAB.
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Affiliation(s)
- Gilles Crosnier Leconte
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Virgile Clergue-Duval
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Vanessa Bloch
- Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France.,Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord, DMU Pharmacie Hospitalière, DMU Biologie-Génétique-PUI, Paris, France
| | - Thomas Barre
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France
| | - Jihed Amami
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France
| | - Frank Bellivier
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Frank Questel
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Florence Vorspan
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Romain Icick
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
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7
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Strayer RJ, Friedman BW, Haroz R, Ketcham E, Klein L, LaPietra AM, Motov S, Repanshek Z, Taylor S, Weiner SG, Nelson LS. Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine. J Emerg Med 2023; 64:517-540. [PMID: 36997435 DOI: 10.1016/j.jemermed.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/06/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Reuben J Strayer
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
| | - Benjamin W Friedman
- Department of Emergency Medicine, Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Haroz
- Cooper Medical School of Rowan University, Cooper University Healthcare, Camden, New Jersey
| | - Eric Ketcham
- Department of Emergency Medicine, Department of Behavioral Health, Addiction Medicine, Presbyterian Healthcare System, Santa Fe & Española, New Mexico
| | - Lauren Klein
- Department of Emergency Medicine, Good Samaritan Hospital, West Islip, New York
| | - Alexis M LaPietra
- Department of Emergency Medicine, Saint Joseph's Regional Medical Center, Paterson, New Jersey
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Zachary Repanshek
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Scott Taylor
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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8
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Quintrell E, Wyrwoll C, Rosenow T, Larcombe A, Kelty E. The effects of acamprosate on maternal and neonatal outcomes in a mouse model of alcohol use disorders. Physiol Behav 2023; 259:114037. [PMID: 36427542 DOI: 10.1016/j.physbeh.2022.114037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite the teratogenic effects of alcohol, little is known about the safety of pharmacotherapies such as acamprosate for the treatment of alcohol use disorders in pregnancy. The aims of this study were to investigate, in a mouse model, the effects of maternally administered acamprosate on maternal and neonatal health, offspring neurodevelopment and behaviour, as well as examine whether acamprosate reduces the neurological harm associated with alcohol consumption in pregnancy. METHODS Dams were randomly allocated to one of four treatment groups: (i) control (water), (ii) acamprosate (1.6 g/L), (iii) alcohol (5% v/v) or (iv) acamprosate and alcohol (1.6 g/L; 5% v/v ethanol) and exposed from 2-weeks pre-pregnancy until postpartum day 7. Gestational outcomes including litter size and sex ratio were assessed, in addition to early-life markers of neurodevelopment. At 8 weeks of age, motor coordination, anxiety, locomotion, and memory of the adult offspring were also examined. RESULTS Exposure to acamprosate did not affect maternal and birth outcomes (mating success, gestational weight gain, litter size, sex ratio), neonatal outcomes (head and body length, postnatal weight) or neurodevelopmental markers (righting reflex and negative geotaxis). Acamprosate exposure did not affect offspring motor control, locomotion or anxiety, however the effects on short-term memory remain uncertain. Prenatal alcohol exposed offspring exhibited various alterations, such as lower postnatal weight, smaller head (p = 0.04) and body lengths (p = 0.046) at postnatal day 70 (males only), increased negative geotaxis speed (p = 0.03), an increased time spent in the inner zone of the open field (p = 0.02). Acamprosate mitigated the effects of alcohol for negative geotaxis at postnatal day 7 (p = 0.01) and female offspring weight at postnatal day 70 (p = 0.03). CONCLUSIONS Overall, we show that prenatal acamprosate exposure was not associated with poor maternal or neonatal health outcomes or impaired neurodevelopment and behaviour. However, acamprosate's effects on short-term memory remain uncertain. We present preliminary evidence to suggest acamprosate displayed some neuroprotective effects against damage caused by in utero alcohol exposure.
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Affiliation(s)
- Ebony Quintrell
- School of Population and Global Health, University of Western Australia, Nedlands, Western Australia Australia; Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Caitlin Wyrwoll
- Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Human Sciences, University of Western Australia, Nedlands, Western Australia, Australia
| | - Tim Rosenow
- The Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Alexander Larcombe
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia; Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Erin Kelty
- School of Population and Global Health, University of Western Australia, Nedlands, Western Australia Australia.
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Fluyau D, Kailasam VK, Pierre CG. A Bayesian meta-analysis of topiramate's effectiveness for individuals with alcohol use disorder. J Psychopharmacol 2023; 37:155-163. [PMID: 36648091 DOI: 10.1177/02698811221149643] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Topiramate (TPM) has the potential to become one of the most prominent treatment options for alcohol use disorder (AUD). We investigated the efficacy of TPM for AUD treatment, considering new randomized controlled trials carried out since the publication of four prior investigations. METHODS We searched six major databases, comparing TPM to placebo for AUD treatment. We performed a Bayesian meta-analysis. We conducted a meta-regression, analyzing the effect of age, TPM dosage, duration of treatment, gender, and attrition rate on the outcomes measured. The protocol is registered with PROSPERO: CRD42021286266. RESULTS TPM reduced heavy drinking days (d = 0.401, Bayes factor (BF) = 23.088) and weeks (d = 0.461, BF = 3.784), lowered alcohol craving (d = 0.477, BF = 107.749), prolonged abstinence throughout the duration of trials (d = 0.505, BF = 54.998), and decreased the amount of gamma-glutamyl transferase in the blood (d = 0.345, BF = 39.048). The analysis pointed out that TPM could reduce anxiety (d = 0.517, BF = 5.993). TPM's efficacy in relieving alcohol withdrawal, minimizing relapse, and decreasing depressive symptoms was inconclusive. There was evidence of a meta-regression effect of attrition rate on heavy drinking days and craving and length of treatment on abstinence. CONCLUSION TPM has the potential to become a key pharmacological agent in the treatment of AUD.
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Affiliation(s)
- Dimy Fluyau
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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10
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Angerville B, Ritz L, Pitel AL, Beaunieux H, Houchi H, Martinetti MP, Naassila M, Dervaux A. Early Improvement of Neuropsychological Impairments During Detoxification in Patients with Alcohol Use Disorder. Alcohol Alcohol 2023; 58:46-53. [PMID: 36221321 DOI: 10.1093/alcalc/agac048] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/19/2022] [Accepted: 09/02/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS To assess recovery of alcohol-related neuropsychological deficits in a group of patients with pure severe alcohol use disorder (AUD) during a detoxification program using the Brief Evaluation of Alcohol-Related Neuropsychological Impairment (BEARNI) test. METHODS Thirty-two patients with severe AUD using DSM-IV criteria (24 men, mean age = 45.5 ± 6.8 years old) were assessed using the BEARNI 8 ± 2 days after alcohol cessation (T1) and then were reassessed within 18 ± 2 days after alcohol cessation (T2). The primary study endpoint was the number of patients initially impaired at T1 who recovered cognitive functions at T2 assessment. RESULTS At T1, 59% (n = 19) patients with pure severe AUD had at least one impaired cognitive function assessed by the BEARNI. At T2, 63% of the patients with AUD with deficits at T1 had normal BEARNI cognitive scores (χ2 = 7.7, P = 0.005); specifically, the percentages of participants with normal subtest scores were 63% on memory (χ2 = 12.4, P = 0.0004), 100% on verbal fluency (χ2 = 16; P = <0.0001), 60% on alphabetical span (χ2 = 12.8; P = 0.0003) and 67% on visuospatial (χ2 = 15, P = 0.0001). CONCLUSIONS The cognitive impairments of two-thirds of patients with pure AUD included in the present study recovered within 18 days of abstinence, earlier than reported in previous studies.
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Affiliation(s)
- Bernard Angerville
- Service de Psychiatrie et Addictologie de liaison, CHU Sud, 80054 Amiens Cedex, France.,Université de Picardie Jules Verne. Groupe de Recherche sur l'Alcool & les Pharmacodépendances (GRAP) INSERM U1247, 80054 Amiens, France
| | - Ludivine Ritz
- Université de Caen Normandie, Laboratoire de Psychologie Caen Normandie (LPCN; EA 7452), 14000 Caen, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | - Hélène Beaunieux
- Université de Caen Normandie, Laboratoire de Psychologie Caen Normandie (LPCN; EA 7452), 14000 Caen, France
| | - Hakim Houchi
- Université de Picardie Jules Verne. Groupe de Recherche sur l'Alcool & les Pharmacodépendances (GRAP) INSERM U1247, 80054 Amiens, France
| | - Margaret P Martinetti
- Université de Picardie Jules Verne. Groupe de Recherche sur l'Alcool & les Pharmacodépendances (GRAP) INSERM U1247, 80054 Amiens, France.,The College of New Jersey, Department of Psychology, Ewing, NJ 08618, USA
| | - Mickaël Naassila
- Université de Picardie Jules Verne. Groupe de Recherche sur l'Alcool & les Pharmacodépendances (GRAP) INSERM U1247, 80054 Amiens, France
| | - Alain Dervaux
- Service de Psychiatrie et Addictologie de liaison, CHU Sud, 80054 Amiens Cedex, France.,Université de Picardie Jules Verne. Groupe de Recherche sur l'Alcool & les Pharmacodépendances (GRAP) INSERM U1247, 80054 Amiens, France
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11
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Seshadri A, Appelbaum R, Carmichael SP, Farrell MS, Filiberto DM, Jawa R, Kodadek L, Mandell S, Miles MVP, Paul J, Robinson B, Michetti CP. Prevention of alcohol withdrawal syndrome in the surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document. Trauma Surg Acute Care Open 2022; 7:e001010. [PMCID: PMC9680182 DOI: 10.1136/tsaco-2022-001010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
Alcohol withdrawal syndrome is a common and challenging clinical entity present in trauma and surgical intensive care unit (ICU) patients. The screening tools, assessment strategies, and pharmacological methods for preventing alcohol withdrawal have significantly changed during the past 20 years. This Clinical Consensus Document created by the American Association for the Surgery of Trauma Critical Care Committee reviews the best practices for screening, monitoring, and prophylactic treatment of alcohol withdrawal in the surgical ICU.
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Affiliation(s)
- Anupamaa Seshadri
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rachel Appelbaum
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samuel P Carmichael
- Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | - Dina M Filiberto
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Randeep Jawa
- Department of Surgery, Stony Brook University, Stony Brook, New York, USA
| | - Lisa Kodadek
- Surgery, Yale University School of Medicine, New Haven, Connecticut, USA,Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Samuel Mandell
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - M Victoria P Miles
- College of Medicine Chattanooga, The University of Tennessee Health Science Center, Chattanooga, Tennessee, USA
| | - Jasmeet Paul
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Bryce Robinson
- Department of Surgery, Harborview Medical Center, Seattle, Washington, USA
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12
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Clergue-Duval V, Coulbault L, Questel F, Cabé N, Laniepce A, Delage C, Boudehent C, Bloch V, Segobin S, Naassila M, Pitel AL, Vorspan F. Alcohol Withdrawal Is an Oxidative Stress Challenge for the Brain: Does It Pave the Way toward Severe Alcohol-Related Cognitive Impairment? Antioxidants (Basel) 2022; 11:2078. [PMID: 36290801 PMCID: PMC9598168 DOI: 10.3390/antiox11102078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/22/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022] Open
Abstract
Alcohol use is a leading cause of mortality, brain morbidity, neurological complications and minor to major neurocognitive disorders. Alcohol-related neurocognitive disorders are consecutive to the direct effect of chronic and excessive alcohol use, but not only. Indeed, patients with severe alcohol use disorders (AUD) associated with pharmacological dependence suffer from repetitive events of alcohol withdrawal (AW). If those AW are not managed by adequate medical and pharmacological treatment, they may evolve into severe AW, or be complicated by epileptic seizure or delirium tremens (DT). In addition, we suggest that AW favors the occurrence of Wernicke's encephalopathy (WE) in patients with known or unknown thiamine depletion. We reviewed the literature on oxidative stress as a core mechanism in brain suffering linked with those conditions: AW, epileptic seizure, DT and WE. Thus, we propose perspectives to further develop research projects aiming at better identifying oxidative stress brain damage related to AW, assessing the effect of repetitive episodes of AW, and their long-term cognitive consequences. This research field should develop neuroprotective strategies during AW itself or during the periwithdrawal period. This could contribute to the prevention of severe alcohol-related brain damage and cognitive impairments.
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Affiliation(s)
- Virgile Clergue-Duval
- Département de Psychiatrie et de Médecine Addictologique, Site Lariboisière Fernand-Widal, GHU APHP Nord–Université Paris Cité, APHP, F-75010 Paris, France
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, F-75006 Paris, France
- FHU Network of Research in Substance Use Disorders (NOR-SUD), F-75006 Paris, France
- Resalcog (Réseau Pour la Prise en Charge Des Troubles Cognitifs Liés à L’alcool), F-75017 Paris, France
| | - Laurent Coulbault
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, F-14074 Caen, France
- FHU Améliorer le Pronostic Des Troubles Addictifs et Mentaux Par Une Médecine Personnalisée (A2M2P), F-14074 Caen, France
| | - Frank Questel
- Département de Psychiatrie et de Médecine Addictologique, Site Lariboisière Fernand-Widal, GHU APHP Nord–Université Paris Cité, APHP, F-75010 Paris, France
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, F-75006 Paris, France
- FHU Network of Research in Substance Use Disorders (NOR-SUD), F-75006 Paris, France
- Resalcog (Réseau Pour la Prise en Charge Des Troubles Cognitifs Liés à L’alcool), F-75017 Paris, France
| | - Nicolas Cabé
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, F-14074 Caen, France
- FHU Améliorer le Pronostic Des Troubles Addictifs et Mentaux Par Une Médecine Personnalisée (A2M2P), F-14074 Caen, France
- Service d’Addictologie, Centre Hospitalier Universitaire de Caen, F-14000 Caen, France
| | - Alice Laniepce
- Normandie Univ, UNIROUEN, CRFDP (EA 7475), Rouen F-76000, France
| | - Clément Delage
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, F-75006 Paris, France
- Service de Pharmacie, Site Lariboisière Fernand-Widal, GHU APHP Nord–Université Paris Cité, APHP, F-75010 Paris, France
- UFR de Pharmacie, Université Paris Cité, F-75006 Paris, France
| | - Céline Boudehent
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, F-14074 Caen, France
| | - Vanessa Bloch
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, F-75006 Paris, France
- FHU Network of Research in Substance Use Disorders (NOR-SUD), F-75006 Paris, France
- Service de Pharmacie, Site Lariboisière Fernand-Widal, GHU APHP Nord–Université Paris Cité, APHP, F-75010 Paris, France
- UFR de Pharmacie, Université Paris Cité, F-75006 Paris, France
| | - Shailendra Segobin
- FHU Améliorer le Pronostic Des Troubles Addictifs et Mentaux Par Une Médecine Personnalisée (A2M2P), F-14074 Caen, France
- Normandie Univ, UNICAEN, PSL Université Paris Cité, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, F-14074 Caen, France
| | - Mickael Naassila
- FHU Améliorer le Pronostic Des Troubles Addictifs et Mentaux Par Une Médecine Personnalisée (A2M2P), F-14074 Caen, France
- Inserm UMRS-1247 Groupe de Recherche Sur L’alcool et Les Pharmacodépendances, Université de Picardie Jules Verne, F-80000 Amiens, France
- UFR de Pharmacie, Université de Picardie Jules Verne, F-80000 Amiens, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, F-14074 Caen, France
- FHU Améliorer le Pronostic Des Troubles Addictifs et Mentaux Par Une Médecine Personnalisée (A2M2P), F-14074 Caen, France
- Normandie Univ, UNICAEN, PSL Université Paris Cité, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, F-14074 Caen, France
| | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Site Lariboisière Fernand-Widal, GHU APHP Nord–Université Paris Cité, APHP, F-75010 Paris, France
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, F-75006 Paris, France
- FHU Network of Research in Substance Use Disorders (NOR-SUD), F-75006 Paris, France
- UFR de Médecine, Université Paris Cité, F-75006 Paris, France
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13
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Bertin C, Bezin J, Chenaf C, Delorme J, Kerckhove N, Pariente A, Tournier M, Authier N. Oral Morphine as an Alternative Substitution Treatment for Opioid Use Disorder, a Rare but Non-risk-free Use. Front Psychiatry 2022; 13:893590. [PMID: 35845444 PMCID: PMC9282723 DOI: 10.3389/fpsyt.2022.893590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background National health monitoring agencies have reported the alternative use of morphine sulfate painkiller for maintenance treatment of opioid use disorder (OUD), associated with a potential increase in overdose risk. Objectives This study sought to assess the prevalence of regular and occasional legally prescribed morphine use in patients treated for OUD and compare their characteristics to those of patients receiving conventional opioid maintenance treatment (OMT), buprenorphine or methadone. Then, we assessed the factors associated with opioid overdose risk. Methods Data were extracted from the French national healthcare system database, covering the entire population in 2015. Diagnosis associated with hospital discharge and long-term disease codes were extracted to select the population and identify outcomes and covariates. OUD non-chronic pain patients were divided into regular (≤35 days between dispensing and ≥3 months of continuous treatment duration) morphine users, and occasional users. Their sociodemographic and health characteristics were compared to OMT controls. A multivariate logistic regression model was performed to determine factors associated with opioid overdose. Results In patients treated for OUD, 2,237 (2.2%) morphine users (1,288 regular and 949 occasional), 64,578 (63.7%) buprenorphine and 34,638 (34.1%) methadone controls were included. The prevalence of regular morphine use among patients treated for OUD regularly receiving an opioid was 1.3%. Compared to users who receive morphine regularly, occasional users had an increased risk of overdose [OR = 2.2 (1.5-3.3)], while the risk was reduced in the buprenorphine group [OR = 0.5 (0.4-0.7)] and not significantly different for methadone [OR = 1.0 (0.7-1.4)]. Other overdose risk factors were low-income, comorbidity, i.e., psychiatric conditions, alcohol use disorder or complications related to intravenous drug use, and coprescription with benzodiazepines or pregabalin. These factors were more frequent in morphine groups. Conclusions Patients that were prescribed oral morphine represented a small minority of the treated for OUD. The poorer health condition affected by numerous comorbidities and higher risk of opioid overdose in patients treated with oral morphine compared with OMT controls points toward the need to better supervise the practices of these patients, to strengthen multidisciplinary care and risk reduction measures.
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Affiliation(s)
- Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Julien Bezin
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
- Service de Pharmacologie médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
| | - Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
| | - Nicolas Kerckhove
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Antoine Pariente
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
- Service de Pharmacologie médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Marie Tournier
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
- Hospital Charles Perrens, Bordeaux, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
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Athayde LA, de Aguiar SLF, Miranda MCG, Brito RVJ, de Faria AMC, Nobre SAM, Andrade MC. Lactococcus lactis Administration Modulates IgE and IL-4 Production and Promotes Enterobacteria Growth in the Gut from Ethanol-Intake Mice. Protein Pept Lett 2021; 28:1164-1179. [PMID: 34315363 DOI: 10.2174/0929866528666210727102019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is well known that alcohol can trigger inflammatory effects in the gastrointestinal tract (GIT) interfering with mucosal homeostasis. OBJECTIVE This study evaluated the effectiveness of Lactococcus lactis treatment in controlling the increase in molecular biomarkers related to allergic inflammation, and the effect on the diversity and abundance of the Enterobacteriaceae family in the GIT after high-dose acute administration of ethanol. METHODS Mice received ethanol or saline solution by gavage for four consecutive days, and 24 h after the last administration the animals were given L. lactis or M17 broth orally ad libitum for two consecutive days. The animals were subsequently sacrificed and dissected. RESULTS L. lactis treatment was able to restore basal levels of secretory immunoglobulin A in the gastric mucosa, serum total immunoglobulin E, interleukin (IL)-4 production in gastric and intestinal tissues, and IL-10 levels in gastric tissue. L. lactis treatment encouraged the diversification of the Enterobacteriaceae population, particularly the commensal species, in the GIT. CONCLUSION This research opens a field of studies regarding the modulatory effect of L. lactis on immunological and microbial changes induced after alcohol intake.
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15
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Graves L, Carson G, Poole N, Patel T, Bigalky J, Green CR, Cook JL. Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:1158-1173.e1. [PMID: 32900457 DOI: 10.1016/j.jogc.2020.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To establish national standards of care for screening and counselling pregnant women and women of child-bearing age about alcohol consumption and possible alcohol use disorder based on current best evidence. INTENDED USERS Health care providers who care for pregnant women and women of child-bearing age. TARGET POPULATION Pregnant women and women of child-bearing age and their families. EVIDENCE Medline, EMBASE, and CENTRAL databases were searched for "alcohol use and pregnancy." The results were filtered for a publication date between 2010 and September 2018. The search terms were developed using Medical Subject Headings terms and keywords, including pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring, and brief intervention. Evidence was included from clinical trials, observational studies, reviews, systematic reviews and meta-analyses, guidelines, and conference consensus. VALIDATION METHODS The content and recommendations in this guideline were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework. BENEFITS, HARMS, COSTS Implementation of the recommendations in these guidelines using validated screening tools and brief intervention approaches may increase obstetrical care provider recognition of alcohol consumption and problematic alcohol use among women of child-bearing age and those who are pregnant. It is anticipated that health care providers will become confident and competent in managing and supporting these women so they can achieve optimal health and pregnancy outcomes. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Aubin HJ, Dureau-Pournin C, Falissard B, Paille F, Rigaud A, Micon S, Pénichon M, Andersohn F, Truchi C, Blin P. Use of Nalmefene in Routine Practice: Results from a French Prospective Cohort Study and a National Database Analysis. Alcohol Alcohol 2021; 56:545-555. [PMID: 33969378 PMCID: PMC8406069 DOI: 10.1093/alcalc/agab029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/22/2021] [Accepted: 03/20/2021] [Indexed: 11/13/2022] Open
Abstract
Aims Two complementary studies were used to assess the real-life use of nalmefene in alcohol-dependent patients and its impact on alcohol use health status. Methods USE-PACT was a prospective cohort study designed to evaluate the real-life effectiveness of nalmefene in the management of alcohol dependence, as assessed by total alcohol consumption (TAC) and number of heavy drinking days (HDD) at 1 year. USE-AM was a cohort study using data from the French nationwide claims database and was used to evaluate the external validity of the population in the prospective study. Results Overall, 256 of 700 new nalmefene users enrolled in the USE-PACT study had valid data at 1 year. After 1 year, patients treated with nalmefene showed a mean ± SD reduction from baseline in TAC (−41.5 ± 57.4 g/day) and number of HDD (−10.7 ± 11.7 days/4 weeks). Patients took a mean ± SD of 20.0 ± 12.0 tablets/4 weeks (median of 1 tablet/day) for the first 3 months and then reduced the dose. The proportion of patients who no longer took nalmefene gradually increased from 5% at 1 month to 52% at 1 year. The USE-AM study identified 486 patients with a first reimbursement for nalmefene in 2016; baseline characteristics confirmed external validity of the USE-PACT study. Overall, 46.3% of initial USE-AM prescriptions were made by GPs; most (91.8%) patients stopped treatment during follow-up. However, 15.2% of patients resumed treatment after stopping. Conclusions In this analysis of French routine practice, patients with alcohol dependence treated with nalmefene showed reduced alcohol consumption, and nalmefene was generally well tolerated.
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Affiliation(s)
- Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, AP-HP. Université Paris Saclay, 12, avenue Paul-Vaillant-Couturier, 94804 Villejuif, France
| | - Caroline Dureau-Pournin
- Université de Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Rue Eugène Jacquet, Bordeaux 33000, France
| | - Bruno Falissard
- CESP/INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Hôpital Paul Brousse Bat 15/16, 16 av PV Couturier - 94807 Villejuif, France
| | - François Paille
- Université de Lorraine, 34 Cours Léopold, 54000 Nancy, France
| | - Alain Rigaud
- Ancien chef du pôle d'Addictologie de l'EPSM Marne, Psychiatre des hôpitaux honoraire, 28 bis, rue de Courcelles 51100 Reims, France
| | - Sophie Micon
- Université de Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Rue Eugène Jacquet, Bordeaux 33000, France
| | - Marine Pénichon
- Université de Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Rue Eugène Jacquet, Bordeaux 33000, France
| | - Frank Andersohn
- Frank Andersohn Consulting and Research Services, Mandelstrasse 16, 10409 Berlin, Germany
| | - Christine Truchi
- Lundbeck SAS, 102 Terrasse Boieldieu 92085 Paris La Défense, France
| | - Patrick Blin
- Université de Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Rue Eugène Jacquet, Bordeaux 33000, France
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Kelty E, Terplan M, Greenland M, Preen D. Pharmacotherapies for the Treatment of Alcohol Use Disorders During Pregnancy: Time to Reconsider? Drugs 2021; 81:739-748. [PMID: 33830479 DOI: 10.1007/s40265-021-01509-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
It is generally recommended that medications only be used in pregnancy where the potential harms to both the mother and foetus are outweighed by the potential benefits. Despite the known harms associated with alcohol consumption during pregnancy, the use of medication for the treatment of pregnant women with an alcohol use disorder (AUD) appears to be rare. This is likely due to the lack of available data regarding the safety of these medications in pregnancy. We reviewed the literature and weighed up the harms associated with alcohol use and AUD during pregnancy with the potential benefits of medications for AUD in pregnancy, including acamprosate, naltrexone and disulfiram. There is little published evidence to support the safety of medications for AUD in pregnancy. However, from the research available it is likely that only disulfiram has the potential to cause serious foetal harm. While further research is required, acamprosate and naltrexone do not appear to be associated with substantial risks of congenital malformations or other serious consequences. Given the potential risks associated with alcohol consumption during pregnancy, the use of acamprosate and naltrexone should be considered for the treatment of pregnant women with AUD based on the current evidence base, although more research is warranted.
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Affiliation(s)
- Erin Kelty
- School of Population and Global Health, The University of Western Australia, Stirling Highway, Crawley, WA, 6009, Australia.
| | - Mishka Terplan
- University of California, San Francisco, San Francisco, California, USA
| | - Melanie Greenland
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - David Preen
- School of Population and Global Health, The University of Western Australia, Stirling Highway, Crawley, WA, 6009, Australia
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18
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Lopez E, Jeanne G, Lefort LH, Autissier C, Picot MC, Peyrière H, Donnadieu-Rigole H. Characterization of benzodiazepine misuse and comorbidities in patients with alcohol use disorder. Fundam Clin Pharmacol 2021; 35:1133-1140. [PMID: 33797099 DOI: 10.1111/fcp.12678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Due to the frequent presence of anxious symptoms and sleep disorders, benzodiazepines (BZD) are often prescribed to patients with alcohol use disorder (AUD). OBJECTIVES To assess BZD misuse and psychiatric comorbidities in patients with AUD. METHODS This prospective, monocentric study included all adult patients with AUD hospitalized in a French addiction unit for alcohol withdrawal from November 2017 to May 2018. RESULTS Among the 153 patients included, 75 (49%) were using BZD at the time of their hospitalization. Duration of alcohol addiction was longer in BZD users: (33 ± 27 years vs. 29 ± 11 years; P = 0.001). BZD misuse was noted in 27 patients consuming benzodiazepines (36% of BZD users and 18% of all included patients), mainly increase in the dose (on average, 3 ± 4 times the prescribed dose). The most frequently misused benzodiazepines were diazepam (43.2%), alprazolam (18.9%), and lormetazepam (13.5%). The frequency of patients with lifetime use of cocaine or heroin was higher among BZD misusers than among non-misusers (84.6% vs. 42.2%; <0.01 and 53.9% vs. 27.1%; P = 0.04). The frequency of patients consuming cocaine in the last month was higher in BZD misusers than in others: 16% versus 6%, P = 0.002. In multivariate analysis, age (OR=1.65 for 5 years, 95% CI = 1.19-2.27; P = 0.023), psychiatric comorbidities (at least one comorbidity: OR=6.03, 95% CI = 1.40-25.83; P = 0.015) and lifetime cocaine consumption (OR=4.37, 95% CI = 1.21-15.86; P = 0.025) were independently associated with BZD misuse. CONCLUSION BZD prescription for long periods might result in tolerance and dose increase. Educational therapy, prescribers' awareness, and development of therapeutic alternatives are essential to limit BZD misuse.
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Affiliation(s)
- Elodie Lopez
- Département d'Addictologie et complications somatiques des addictions, CHU Montpellier, Montpellier, France
| | - Guillaume Jeanne
- Département d'Addictologie et complications somatiques des addictions, CHU Montpellier, Montpellier, France
| | - Laure-Hélène Lefort
- Département d'Addictologie et complications somatiques des addictions, CHU Montpellier, Montpellier, France
| | - Cécile Autissier
- Département de l'Information Médicale, CHU Montpellier, Montpellier, France
| | | | - Hélène Peyrière
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Montpellier, France.,INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier, France
| | - Hélène Donnadieu-Rigole
- Département d'Addictologie et complications somatiques des addictions, CHU Montpellier, Montpellier, France.,INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier, France
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Pharmacotherapy of substance use disorders in the neuroscience-based nomenclature (NbN). Therapie 2021; 76:127-136. [DOI: 10.1016/j.therap.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
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Abstract
OBJECTIVES Relapse rates in subjects with an alcohol use disorder who have undergone alcohol detoxification are high, and risk factors vary according to the studied population and the context in which withdrawal occurred. Subjects being treated in psychiatric settings require increased monitoring at the moment of detoxification and during follow-up. It is thus important to identify specific risk factors for relapse in such patients. The objective of this study was to determine factors associated with maintenance of abstinence 2 months after alcohol withdrawal (M2) and to characterize factors associated with later relapses 6 months after withdrawal (M6) among those who were abstainers at M2. METHODS We conducted an ancillary study of a specific psychiatric cohort of subjects with an alcohol use disorder who were followed after withdrawal, by analyzing clinical and biological data collected at M2 and M6. RESULTS The specific factors predictive of future relapse were age, intensity of craving, number of standard glasses consumed, psychiatric comorbidity (depression), and employment and family/marital status. Substance use (other than the use of tobacco) decreased the likelihood of abstinence at M2, whereas a depressive state at the time of alcohol withdrawal increased the likelihood of abstinence at M2. Consumption of other substances and a greater intensity of craving at the time of alcohol withdrawal decreased the likelihood of abstinence at M6. CONCLUSIONS The results of this study highlight the importance of identifying craving, multiple substance use, and psychiatric comorbidities (depression) during comprehensive interviews in follow-up after alcohol withdrawal. In caring for patients after alcohol detoxification, priority should be given to factors that have been shown to enhance the beneficial effects of abstinence, such as mood enhancement.
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Oroei M, Rahimi M, Talab Evini P, Yousefi Y. Clinical profile of patients with baclofen poisoning in an academic medical center. JOURNAL OF REPORTS IN PHARMACEUTICAL SCIENCES 2021. [DOI: 10.4103/jrptps.jrptps_15_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sarkar M, Brady CW, Fleckenstein J, Forde KA, Khungar V, Molleston JP, Afshar Y, Terrault NA. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73:318-365. [PMID: 32946672 DOI: 10.1002/hep.31559] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Monika Sarkar
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Jean P Molleston
- Indiana University and Riley Hospital for Children, Indianapolis, IN
| | - Yalda Afshar
- University of California, Los Angeles, Los Angeles, CA
| | - Norah A Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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Bertin C, Delorme J, Riquelme M, Peyrière H, Brousse G, Eschalier A, Ardid D, Chenaf C, Authier N. Risk assessment of using off-label morphine sulfate in a population-based retrospective cohort of opioid-dependent patients. Br J Clin Pharmacol 2020; 86:2338-2348. [PMID: 31389036 PMCID: PMC7688539 DOI: 10.1111/bcp.14082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 05/02/2019] [Accepted: 07/19/2019] [Indexed: 01/09/2023] Open
Abstract
AIMS Several addictovigilance studies have described the off-label use of morphine sulfate (MS) for nonchronic pain in opioid use disorder (OUD) patients as an alternative to conventional opioid substitution treatments (OSTs). This study primarily sought to compare the incidence of unintentional opioid-related overdose in the year following the prescription initiation in off-label MS users, compared to OST-maintained patients. METHODS Sequential cohorts of OUD patients who were regularly dispensed MS, buprenorphine, or methadone, between 1 April 2012 and 31 December 2014, were retrospectively identified using the French nationwide healthcare data system. The incidence of overdoses, deaths, doctor shopping, and complications of a viral, bacterial or thrombotic nature, was compared using the Cox regression method. RESULTS Overall, 1075, 20 834 and 9778 OUD patients without chronic-pain were included in the MS, buprenorphine, and methadone cohorts, respectively. Overdose incidence was 3.8 (P < .01 [95% confidence interval (CI): 2.1-6.8]) and 2.0 (P = .02 [95%CI: 1.1-3.6]) higher in the MS cohort vs buprenorphine and methadone, respectively. Death incidence was 9.1 (P < .01 [95%CI: 3.2-25.9]) and 3.9 (P < .01 [95%CI: 1.4-10.7]) higher in the MS cohort vs buprenorphine and methadone, respectively. The incidences of other associated risks were significantly higher in the MS group vs OSTs, except for hepatitis C viral infection and thrombotic complications. CONCLUSION This first French comprehensive nationwide study reveals increasing overdose, death, bacterial infection, abuse and diversion risks when off-label MS is initiated as alternative to OST. These results question the relevance of prescribing MS as a safe opioid maintenance treatment, considering its health risk profile.
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Affiliation(s)
- Célian Bertin
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
| | - Jessica Delorme
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
| | - Marie Riquelme
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
| | - Hélène Peyrière
- CHU Montpellier, Laboratoire de Pharmacie Clinique, Département de Pharmacologie Médicale et Toxicologie, Centre AddictovigilanceUniversité de MontpellierMontpellierFrance
| | - Georges Brousse
- CIRCEA, Service de Psychiatrie‐addictologieUniversité Clermont AuvergneClermont‐FerrandFrance
| | - Alain Eschalier
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
- Faculté de MédecineInstitut AnalgesiaClermont‐FerrandFrance
| | - Denis Ardid
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
- Faculté de MédecineInstitut AnalgesiaClermont‐FerrandFrance
| | - Chouki Chenaf
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
| | - Nicolas Authier
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
- Faculté de MédecineInstitut AnalgesiaClermont‐FerrandFrance
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Kikuchi M, Matsutani N, Ishihara R, Sugihara M, Mizuno Y, Chiba C, Ohta T, Yamada E, Oguro S, Sato Y, Bessho H, Horie Y. Inter-professional and inter-departmental alcoholism rehabilitation program. Clin Mol Hepatol 2020; 26:626-632. [PMID: 33053935 PMCID: PMC7641577 DOI: 10.3350/cmh.2020.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/07/2020] [Accepted: 08/15/2020] [Indexed: 11/05/2022] Open
Abstract
A 3-month alcoholism rehabilitation program at psychiatric hospitals is common in Japan for patients with alcohol use disorder (AUD). However, many AUD patients are often hospitalized for the treatment of digestive disorders due to alcohol-related liver diseases and pancreatitis. In this sense, AUD patients need to be better supported by professionals and departments in general hospitals. Here we analyzed the problems in alcohol-related medical care in Japan and examined the measures to be taken at general hospitals.
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Affiliation(s)
- Masahiro Kikuchi
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Naomi Matsutani
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Ryota Ishihara
- Department of Psychiatry, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masako Sugihara
- Department of Psychiatry, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yuuki Mizuno
- Department of Medical Welfare, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Chiyo Chiba
- Department of Psychiatry, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takahiro Ohta
- Department of Pharmacy, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Eri Yamada
- Department of Nutrition, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Sota Oguro
- Department of Radiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yasuko Sato
- Department of Nursing, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hiroki Bessho
- Department of Dentistry, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoshinori Horie
- Department of Gastroenterology, Shonan Keiiku Hospital, Kanagawa, Japan
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Graves DL, Carson DG, Poole N, Patel DT, Bigalky J, Green CR, Cook JL. Directive clinique n o 405 : Dépistage et conseils en matière de consommation d'alcool pendant la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1174-1192.e1. [PMID: 32900458 DOI: 10.1016/j.jogc.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIF Établir des normes pancanadiennes fondées sur les meilleures données probantes actuelles sur le dépistage et les conseils en matière de consommation d'alcool et de troubles de consommation d'alcool chez les femmes enceintes ou en âge de procréer. PROFESSIONNELS CONCERNéS: Les fournisseurs de soins qui prodiguent des soins aux femmes enceintes et aux femmes en âge procréer. POPULATION CIBLE Les femmes enceintes, les femmes en âge de procréer et leurs familles. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, Embase et CENTRAL avec le thème « alcohol use and pregnancy ». Les résultats ont été filtrés de façon à obtenir des publications parues entre 2010 et septembre 2018. Les termes de recherche ont été mis au point à partir des termes du thésaurus de référence biomédicale MeSH et de mots clés, dont les suivants : pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring et brief intervention. Les données probantes retenues proviennent d'essais cliniques, d'études observationnelles, de revues de la littérature, d'analyses systématiques et méta-analyses, de lignes directrices et de conférences de consensus. MéTHODES DE VALIDATION: Les auteurs ont rédigé et accepté le contenu et les recommandations de la présente directive. Le conseil d'administration de la Société des obstétriciens et gynécologues du Canada a approuvé la version définitive aux fins de publication. La qualité des données probantes a été évaluée au moyen des critères de l'approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation) (consulter les tableaux A1 et A2 de l'annexe en ligne). BéNéFICES, RISQUES, COûTS: La mise en œuvre des recommandations de la présente directive à l'aide d'outils de dépistage validés et de stratégies d'intervention brève peut améliorer la capacité des fournisseurs de soins obstétricaux à reconnaître la consommation d'alcool et la consommation problématique d'alcool chez les femmes enceintes ou en âge de procréer. Il est attendu des fournisseurs de soins de santé qu'ils deviennent confiants et compétents en matière de prise en charge et de soutien de ces femmes afin qu'elles puissent avoir la meilleure santé possible et une issue de grossesse optimale. DÉCLARATIONS SOMMAIRES (CLASSEMENT GRADE ENTRE PARENTHèSES): RECOMMANDATIONS (CLASSEMENT GRADE ENTRE PARENTHèSES).
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Holla B, Biswal J, Ramesh V, Shivakumar V, Bharath RD, Benegal V, Venkatasubramanian G, Chand PK, Murthy P. Effect of prefrontal tDCS on resting brain fMRI graph measures in Alcohol Use Disorders: A randomized, double-blind, sham-controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2020; 102:109950. [PMID: 32339664 DOI: 10.1016/j.pnpbp.2020.109950] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Transcranial Direct Current Stimulation (tDCS) is a promising new adjuvant approach in the treatment of Alcohol Use Disorders (AUDs) that has the potential to ameliorate the aberrations secondary to chronic alcohol use. In this study, using a randomized, double-blind, sham-controlled, parallel-arm design, we examined the effects of prefrontal tDCS on resting-state functional magnetic resonance imaging (rsfMRI) and its correlates with impulsivity and time to first lapse in subjects with AUDs. METHODS Patients with AUD as per DSM-5 criteria were randomly allocated to receive a five-day course of either verum-tDCS (n = 12) or sham-tDCS (n = 12). Of them, 21 patients (verum/sham = 11/10) participated in both baseline and post-intervention 10-min rsfMRI sessions. Outside the scanner, subjects also performed the Stop-Signal Task at two time-points (baseline and post-intervention), which provided a measure of changes in impulsivity following tDCS. After completion of the post-intervention scan, all subjects were discharged and were followed-up for 90 days post-discharge or until lapse to first alcohol use. RESULTS Graph theoretical analysis of rsfMRI data revealed that verum-tDCS (but not sham) resulted in a significant increase in the global efficiency of brain networks with a concurrent significant reduction in global clustering; network-based statistical analysis identified a significant increase in the functional connectivity of a specific sub-network involving prefrontal regions. Furthermore, increased global efficiency of brain networks following verum tDCS predicted a significantly reduced likelihood of relapse. In addition, a reduction in the global clustering had a significant positive correlation with a reduction in the measure of impulsivity. CONCLUSIONS The present study adds further support to the increasing evidence base for the clinical utility of tDCS in AUDs. Importantly, we observed improvement in both whole-brain network efficiency as well as inter-regional connectivity within a specific local prefrontal sub-network that is relevant to the neurobiology of AUDs. Replication and extension of these promising leads from the present study can facilitate clinical translation of tDCS, given its advantages (i.e. safety, cost-effectiveness, administration ease with potential for remotely-supervised / home-based application) for treating patients with AUDs.
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Affiliation(s)
- Bharath Holla
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Jitendriya Biswal
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Vinutha Ramesh
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Venkataram Shivakumar
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Rose Dawn Bharath
- Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Vivek Benegal
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Prabhat Kumar Chand
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Pratima Murthy
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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Tien J, Lewis GD, Liu J. Prenatal risk factors for internalizing and externalizing problems in childhood. World J Pediatr 2020; 16:341-355. [PMID: 31617077 PMCID: PMC7923386 DOI: 10.1007/s12519-019-00319-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A growing body of research has documented the effects of prenatal risk factors on a wide spectrum of adverse offspring health outcomes. Childhood behavior problems, such as externalizing and internalizing problems, are no exception. This comprehensive literature review aims to summarize and synthesize current research about commonly experienced prenatal risk factors associated with internalizing and externalizing problems, with a focus on their impact during childhood and adolescence. Potential mechanisms as well as implications are also outlined. DATA SOURCES The EBSCO, Web of Science, PubMed, Google Scholar, and Scopus databases were searched for studies examining the association between prenatal risk factors and offspring internalizing/externalizing problems, using keywords "prenatal" or "perinatal" or "birth complications" in combination with "internalizing" or "externalizing". Relevant articles, including experimental research, systematic reviews, meta-analyses, cross-sectional and longitudinal cohort studies, and theoretical literature, were reviewed and synthesized to form the basis of this integrative review. RESULTS Prenatal risk factors that have been widely investigated with regards to offspring internalizing and externalizing problems encompass health-related risk factors, including maternal overweight/obesity, substance use/abuse, environmental toxicant exposure, maternal infection/inflammation, as well as psychosocial risk factors, including intimate partner violence, and anxiety/depression. Collectively, both epidemiological and experimental studies support the adverse associations between these prenatal factors and increased risk of emotional/behavioral problem development during childhood and beyond. Potential mechanisms of action underlying these associations include hormonal and immune system alterations. Implications include prenatal education, screening, and intervention strategies. CONCLUSIONS Prenatal risk factors are associated with a constellation of offspring internalizing and externalizing problems. Identifying these risk factors and understanding potential mechanisms will help to develop effective, evidence-based prevention, and intervention strategies.
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Affiliation(s)
- Joyce Tien
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Gary D Lewis
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jianghong Liu
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Hines S, Carey TA, Hirvonen T, Martin K, Cibich M. Effectiveness and appropriateness of culturally adapted approaches to treating alcohol use disorders in Indigenous people: a mixed methods systematic review protocol. JBI Evid Synth 2020; 18:1100-1107. [PMID: 32813364 DOI: 10.11124/jbisrir-d-19-00040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of this review is to investigate the effectiveness and appropriateness of culturally adapted approaches for treating alcohol use disorders in Indigenous peoples in Canada, New Zealand, Australia, and the USA. INTRODUCTION Poor and disadvantaged people, particularly those who are Indigenous, suffer more health effects due to alcohol misuse and are therefore subject to more law enforcement actions. Analyses have identified strategies for improving health services for Indigenous people; chief among these is culturally safe care specifically tailored to the context. Alcohol addiction is a chronic relapsing condition that usually requires ongoing treatment, so it is vital that treatment therapies are appropriate, meaningful, and effective. Many evidence-based therapies for substance abuse have not been specifically designed for or tested in Indigenous and First Nations communities. This absence of cultural considerations may be a contributor to the failure of these programs to engage with clients and successfully influence their behavior. INCLUSION CRITERIA This review will consider qualitative and quantitative studies of any methodology, published in any language after 1998. Studies including adult and/or adolescent participants in inpatient or outpatient alcohol treatment programs described as being adapted to meet cultural needs will be considered. METHODS This review will use the convergent segregated approach to mixed methods reviews. A range of databases will be searched, including MEDLINE, CINAHL, Embase, and PsycINFO. Two reviewers will critically appraise and extract data from studies meeting the inclusion criteria. Qualitative research findings will, where possible, be pooled using JBI SUMARI with the meta-aggregation approach, and quantitative studies will, where possible, be pooled in statistical meta-analysis using JBI SUMARI. The JBI convergent segregated approach to mixed methods reviews will be followed.
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Affiliation(s)
- Sonia Hines
- The Centre for Remote Health: A JBI Affiliated Group
- Flinders Northern Territory, Alice Springs, Australia
| | | | - Tanja Hirvonen
- The Centre for Remote Health: A JBI Affiliated Group
- Flinders Northern Territory, Alice Springs, Australia
| | - Kathleen Martin
- The Centre for Remote Health: A JBI Affiliated Group
- Flinders Northern Territory, Alice Springs, Australia
| | - Mikaela Cibich
- The Centre for Remote Health: A JBI Affiliated Group
- Flinders Northern Territory, Alice Springs, Australia
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Rolland B, Dricot L, Creupelandt C, Maurage P, De Timary P. Respective influence of current alcohol consumption and duration of heavy drinking on brain morphological alterations in alcohol use disorder. Addict Biol 2020; 25:e12751. [PMID: 30963660 DOI: 10.1111/adb.12751] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 01/29/2023]
Abstract
Numerous studies have explored the morphological differences of the brain between subjects with alcohol use disorder (AUD) and control subjects, but very few have investigated the impact of the duration of alcohol use disorder (DAD) and current level of alcohol consumption (CAC) within AUD subjects using magnetic resonance imaging (MRI). We compared the morphological MRI of 44 controls and 66 AUD subjects, recruited at the end of a detoxification program. Additional analyses within the AUD group determined which specific alterations were respectively associated with DAD and CAC using: (1) Bonferroni-corrected multivariable linear regressions to explore the DAD/CAC impact on brain volumes and (2) a general linear model (GLM module of FreeSurfer's Qdec) and Monte Carlo simulation to correct for multiple comparisons (P < 0.05) to explore the DAD/CAC impact on cortical thickness and volumes. Analyses were adjusted for age and tobacco use. CAC and DAD were significantly correlated (ρ = 0.25, P < 0.0001), and sensitivity analyses were conducted with and without both CAC and DAD included in the same model. While the AUD-control comparisons globally reproduced preexisting findings, within-AUD analyses found that CAC was inversely correlated with cortical thickness and gray matter volume in a bilateral dorsal band of the temporal lobe, including the fusiform and parahippocampal gyri. For DAD, only a left and more ventral temporal band that partially overlapped the CAC-associated area was found in cortical thickness analyses. No significant volumetric result was reached after a Bonferroni correction. CAC and, to a lesser extent, DAD were thus associated with specific, though partially overlapping, temporal surface-based signatures.
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Affiliation(s)
- Benjamin Rolland
- Centre de Recherche en Neurosciences de LyonUniversity Lyon, UCBL, INSERM U1028, CNRS UMR5292 Bron France
- CH Le Vinatier, Service Universitaire d'Addictologie de Lyon (SUAL), Bron France
- Institute of NeuroscienceUniversité Catholique de Louvain Louvain‐la‐Neuve Belgium
| | - Laurence Dricot
- Institute of NeuroscienceUniversité Catholique de Louvain Louvain‐la‐Neuve Belgium
- Department of Adult Psychiatry, Cliniques Universitaires Saint‐Luc Brussels Belgium
| | - Coralie Creupelandt
- Institute of NeuroscienceUniversité Catholique de Louvain Louvain‐la‐Neuve Belgium
- Department of Adult Psychiatry, Cliniques Universitaires Saint‐Luc Brussels Belgium
- Laboratory for Experimental Psychopathology (LEP), Psychological Science Research InstituteUniversité Catholique de Louvain Louvain‐la‐Neuve Belgium
| | - Pierre Maurage
- Institute of NeuroscienceUniversité Catholique de Louvain Louvain‐la‐Neuve Belgium
- Laboratory for Experimental Psychopathology (LEP), Psychological Science Research InstituteUniversité Catholique de Louvain Louvain‐la‐Neuve Belgium
| | - Philippe De Timary
- Institute of NeuroscienceUniversité Catholique de Louvain Louvain‐la‐Neuve Belgium
- Department of Adult Psychiatry, Cliniques Universitaires Saint‐Luc Brussels Belgium
- Laboratory for Experimental Psychopathology (LEP), Psychological Science Research InstituteUniversité Catholique de Louvain Louvain‐la‐Neuve Belgium
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Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet 2019; 394:781-792. [PMID: 31478502 DOI: 10.1016/s0140-6736(19)31775-1] [Citation(s) in RCA: 338] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/30/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
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Affiliation(s)
- Andre F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia.
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Abstract
Taking opioids is often accompanied by the development of dependence. Unfortunately, treatment of opioid dependence is difficult, particularly because of codependence - for example, on alcohol or other drugs of abuse. In the presented study, we analyzed the potential influence of disulfiram, a drug used to aid the management of alcoholism, on opioid abstinence syndrome, which occurs as a result of opioid withdrawal. Opioid dependence in mice was induced by subcutaneous administration of either morphine or methadone at a dose of 48 mg/kg for 10 consecutive days. To trigger a withdrawal syndrome, the opioid receptor antagonist, naloxone, was administered at a dose of 1 mg/kg (subcutaneous), and the severity of withdrawal signs was assessed individually. Interruption of chronic treatment with morphine or methadone by naloxone has led to the occurrence of opioid abstinence signs such as jumping, paw tremor, wet-dog shakes, diarrhea, teeth chattering, ptosis, and piloerection. Importantly, pretreatment with disulfiram (25, 50, and 100 mg/kg) reduced the intensity of withdrawal signs induced by naloxone in morphine or methadone-treated mice. These findings show the effectiveness of disulfiram in reducing opioid abstinence signs.
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De Ternay J, Naassila M, Nourredine M, Louvet A, Bailly F, Sescousse G, Maurage P, Cottencin O, Carrieri PM, Rolland B. Therapeutic Prospects of Cannabidiol for Alcohol Use Disorder and Alcohol-Related Damages on the Liver and the Brain. Front Pharmacol 2019; 10:627. [PMID: 31214036 PMCID: PMC6554654 DOI: 10.3389/fphar.2019.00627] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Cannabidiol (CBD) is a natural component of cannabis that possesses a widespread and complex immunomodulatory, antioxidant, anxiolytic, and antiepileptic properties. Much experimental data suggest that CBD could be used for various purposes in alcohol use disorder (AUD) and alcohol-related damage on the brain and the liver. Aim: To provide a rationale for using CBD to treat human subjects with AUD, based on the findings of experimental studies. Methods: Narrative review of studies pertaining to the assessment of CBD efficiency on drinking reduction, or on the improvement of any aspect of alcohol-related toxicity in AUD. Results: Experimental studies find that CBD reduces the overall level of alcohol drinking in animal models of AUD by reducing ethanol intake, motivation for ethanol, relapse, anxiety, and impulsivity. Moreover, CBD reduces alcohol-related steatosis and fibrosis in the liver by reducing lipid accumulation, stimulating autophagy, modulating inflammation, reducing oxidative stress, and by inducing death of activated hepatic stellate cells. Finally, CBD reduces alcohol-related brain damage, preventing neuronal loss by its antioxidant and immunomodulatory properties. Conclusions: CBD could directly reduce alcohol drinking in subjects with AUD. Any other applications warrant human trials in this population. By reducing alcohol-related steatosis processes in the liver, and alcohol-related brain damage, CBD could improve both hepatic and neurocognitive outcomes in subjects with AUD, regardless of the individual's drinking trajectory. This might pave the way for testing new harm reduction approaches in AUD, in order to protect the organs of subjects with an ongoing AUD.
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Affiliation(s)
- Julia De Ternay
- Service Universitaire d’Addictologie de Lyon (SUAL), Bron, France
| | - Mickaël Naassila
- Université de Picardie Jules Verne, Centre Universitaire de Recherche en Santé, INSERM UMR 1247, Groupe de Recherche sur l’Alcool & les Pharmacodépendances, Amiens, France
| | | | - Alexandre Louvet
- Service des maladies de l’appareil digestif, CHU Lille, Universitéde Lille and INSERM U995, Lille, France
| | - François Bailly
- Service d’Addictologie et d’Hépatologie, GHN, HCL, Lyon, France
| | - Guillaume Sescousse
- Université de Lyon, UCBL, Centre de Recherche en Neurosciences de Lyon (CRNL), Inserm U1028, CNRS UMR5292, PSYR2, Bron, France
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology (LEP), Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Olivier Cottencin
- CHU de Lille, Université Lille, service d’addictologie, CNRS, UMR 9193, SCALab, équipe psyCHIC, Lille, France
| | - Patrizia Maria Carrieri
- INSERM, UMR_S 912, Sciences Economiques & Sociales de la Santé et Traitement de l’Information Médicale (SESSTIM), Marseille, France
| | - Benjamin Rolland
- Service Universitaire d’Addictologie de Lyon (SUAL), Bron, France
- Université de Lyon, UCBL, Centre de Recherche en Neurosciences de Lyon (CRNL), Inserm U1028, CNRS UMR5292, PSYR2, Bron, France
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Effect of intranasal oxytocin on alcohol withdrawal syndrome: A randomized placebo-controlled double-blind clinical trial. Drug Alcohol Depend 2019; 197:95-101. [PMID: 30784955 DOI: 10.1016/j.drugalcdep.2019.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND In a pilot study, intranasal oxytocin was demonstrated to reduce the benzodiazepine dose needed to relieve withdrawal symptoms during alcohol detoxification. The aim of the present study was to compare the effect of oxytocin and placebo during a three-day period of alcohol detoxification at an addiction treatment center in Norway. METHODS Randomized, double-blind, placebo-controlled trial with 40 patients fulfilling criteria for ICD-10 diagnosis of alcohol dependence (F10.2), admitted for alcohol detoxification and withdrawal treatment. The benzodiazepine oxazepam was given as symptom-triggered treatment based on the scores of the Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) scale. Participants were randomized to receive either intranasal oxytocin (24 IU twice daily) or placebo. PRIMARY OUTCOME Oxazepam dose required to complete a three-day course of detoxification. SECONDARY OUTCOMES Scores of the CIWA-Ar, the 10-item Hopkins Symptom Check List (HSCL-10), and self-reported total number of hours of sleep. RESULTS The mean total oxazepam dose (± standard deviation) was 56.8 ± 72.8 mg in the oxytocin group and 79.0 ± 122.9 in the placebo group (p = 0.490; difference -22.3 mg; 95% confidence interval (CI) -86.9 to +42.4 mg). The findings were inconclusive as to whether a difference in the CIWA-Ar score (5.94 ± 3.86 vs. 6.48 ± 3.92; p = 0.665) or in any of the other secondary outcomes was present. No serious adverse events were reported. CONCLUSION Compared to placebo, intranasal oxytocin did not significantly reduce the oxazepam dose needed to complete a 3-day course of alcohol detoxification and withdrawal treatment.
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Airagnes G, Ducoutumany G, Laffy-Beaufils B, Le Faou AL, Limosin F. Alcohol withdrawal syndrome management: Is there anything new? Rev Med Interne 2019; 40:373-379. [PMID: 30853380 DOI: 10.1016/j.revmed.2019.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/20/2019] [Accepted: 02/06/2019] [Indexed: 01/19/2023]
Abstract
Patients with alcohol use disorder experience frequently alcohol withdrawal syndrome (AWS), which is a potentially life-threatening condition mainly caused by glutamate overactivity. The aim of therapeutic alcohol withdrawal is the entry into a process of complete and lasting abstinence. Therefore preparing withdrawal is crucial to optimize compliance and efficacy of aftercare. Indeed, performing repeated withdrawal per se without any project of subsequent abstinence may be deleterious, at least because of repeated exposure to glutamate neurotoxicity. Managing AWS mainly consists in anticipating severe withdrawal, decreasing the risk of complications, making this experience as comfortable as possible, preventing from long-term benzodiazepine use, and enhancing motivation to aftercare and long-term abstinence. In particular, there are specific guidelines to choose which benzodiazepine administration approach to adopt (i.e. symptom-triggered, fixed schedule or loading dosage) and which other drugs to deliver (e.g. thiamine, folate, magnesium). Specific precautions should be taken in the elderly.
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Affiliation(s)
- G Airagnes
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; UMS 011, Population-based Epidemiological Cohorts, Inserm, 94800 Villejuif, France.
| | - G Ducoutumany
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - B Laffy-Beaufils
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - A-L Le Faou
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; UMR-S 1123, Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, 75010 Paris, France
| | - F Limosin
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; U 894, Centre Psychiatrie et Neurosciences, Inserm, 75014 Paris, France
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Michel L, Conq E, Combs E, Cholet J, Bodenez P, Le Reste JY, Landreat MG. Alcohol use by people in their seventies is not an exception: a preliminary prospective study. Br J Community Nurs 2019; 24:128-133. [PMID: 30817203 DOI: 10.12968/bjcn.2019.24.3.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The ageing population is rapidly increasing worldwide, and the alcohol-related disease burden in most Western countries is on the rise. However, very few studies assess alcohol use in older people. Here, a self-reported questionnaire was administered to all individuals aged 70 years or more who visited a social centre for older people in western France. The average age of the 98 subjects included in the survey was 79 years (range, 70-97 years; SD=6), and 57.1% (n=56) reported weekly alcohol consumption. An average consumption of over two standard units each day during weekends was reported by 53% subjects (n=52), and the same on each weekday was reported by 34% (n=33). Thus, a significant proportion of subjects aged 70 years or over consumed more alcohol than is recommended in current guidelines. The participants also reported that they rarely discussed alcohol consumption with their general practitioners. Alcohol use should be assessed regularly. District nurses and members of the primary care team should recommend strategies to help older people reduce their alcohol consumption.
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Affiliation(s)
- Lenaig Michel
- Specialised Nurse, Addictive Disorders Unit, University Hospital of Brest, Brest, France
| | - Estelle Conq
- EA Soins primaires, Santé publique, Registre des cancers de Bretagne Occidentale (SPURBO), Family Practice Department, Université Bretagne Occidentale, Brest, France
| | | | - Jennyfer Cholet
- Addictive Disorders Unit, University Hospital of Nantes, Nantes, France
| | - Pierre Bodenez
- EA SPURBO, Université Bretagne Occidentale, Brest, France
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Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Rondon M, Riecher-Rössler A, Soyka M, Yonkers K, Yonkers K. WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry 2019; 20:17-50. [PMID: 30632868 DOI: 10.1080/15622975.2018.1510185] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication. RESULTS AND DISCUSSION There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.
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Affiliation(s)
- Florence Thibaut
- a University Hospital Cochin , Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry and Neurosciences , Paris , France
| | - Abdeslam Chagraoui
- b Neuronal and Neuroendocrine Differentiation and Communication Laboratory , Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Normandie Univ , UNIROUEN, INSERM, U1239, CHU Rouen , Rouen , France ; Department of Medical Biochemistry , Rouen University Hospital , Rouen , France
| | - Leslie Buckley
- c Addiction Services , University Health Network, University of Toronto , Toronto , Canada
| | - Florence Gressier
- d Department of Psychiatry , INSERM UMR1178 CESP, Univ. Paris-Sud , Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre , Le Kremlin Bicêtre , France
| | - Javier Labad
- e Department of Mental Health , Parc Tauli Hospital Universitari, I3PT ; Department of Psychiatry and Legal Medicine , Universitat Autonoma de Barcelona, CIBERSAM, Sabadell , Barcelona , Spain
| | - Sandrine Lamy
- f Department of Addictology , Ramsay- General de Santé, SSR Petit Colmoulins , Harfleur , France
| | - Marc N Potenza
- g Neuroscience and Child Study , Yale University School of Medicine , New Haven , CT , USA
| | - Marta Rondon
- h Instituto Nacional Materno Perinatal , Lima , Peru
| | - Anita Riecher-Rössler
- i Center for Gender Research and Early Detection , University of Basel Psychiatric Hospital , Basel , Switzerland
| | - Michael Soyka
- j University of Munich , Munich, and Medicalpark Chiemseeblick, Bernau , Germany
| | - Kim Yonkers
- k Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences , Yale University , New Haven , CT , USA
| | - Kim Yonkers
- Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
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Caputo F, Agabio R, Vignoli T, Patussi V, Fanucchi T, Cimarosti P, Meneguzzi C, Greco G, Rossin R, Parisi M, Mioni D, Arico' S, Palmieri VO, Zavan V, Allosio P, Balbinot P, Amendola MF, Macciò L, Renzetti D, Scafato E, Testino G. Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol. Intern Emerg Med 2019; 14:143-160. [PMID: 30187438 DOI: 10.1007/s11739-018-1933-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023]
Abstract
The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3-5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few physicians are adequately trained in identifying and treating AWS. The Italian Society on Alcohol has, therefore, implemented a task force of specialists to draw up recommendations for the treatment of AWS with the following main results: (1) while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated; (2) out-patient treatment is appropriate in patients with mild or moderate AWS, while patients with severe AWS need to be treated as in-patients; (3) benzodiazepines, BDZs are the "gold standard" for the treatment of AWS and DTs; (4) alpha-2-agonists, beta-blockers, and neuroleptics may be used in association when BDZs do not completely resolve specific persisting symptoms of AWS; (5) in the case of a refractory form of DTs, the use of anaesthetic drugs (propofol and phenobarbital) in an intensive care unit is appropriate; (6) alternatively to BDZs, sodium oxybate, clomethiazole, and tiapride approved in some European Countries for the treatment of AWS may be employed for the treatment of moderate AWS; (7) anti-convulsants are not sufficient to suppress AWS, and they may be used only in association with BDZs for the treatment of refractory forms of convulsions in the course of AWS.
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Affiliation(s)
- Fabio Caputo
- Unit of Internal Medicine, Department of Internal Medicine, SS Annunziata Hospital, Via Vicini 2, 44042, Cento, Ferrara, Italy.
- "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Roberta Agabio
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Teo Vignoli
- Unit of Addiction Treatment, Lugo, Ravenna, Italy
| | | | | | | | | | | | | | | | - Davide Mioni
- Nursing Home Parco dei Tigli, Teolo, Padova, Italy
| | - Sarino Arico'
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Vincenzo Ostilio Palmieri
- "Murri" Clinic of Internal Medicine, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | | | | | | | | | | | - Doda Renzetti
- Department of Internal Medicine, Mater Dei Hospital, Bari, Italy
| | - Emanuele Scafato
- National Observatory on Alcohol, National Institute of Health, Rome, Italy
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Palma-Álvarez RF, Rodríguez-Cintas L, Abad AC, Sorribes M, Ros-Cucurull E, Robles-Martínez M, Grau-López L, Aguilar L, Roncero C. Mood Disorders and Severity of Addiction in Alcohol-Dependent Patients Could Be Mediated by Sex Differences. Front Psychiatry 2019; 10:343. [PMID: 31214056 PMCID: PMC6554686 DOI: 10.3389/fpsyt.2019.00343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 05/01/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Alcohol dependence is highly prevalent in the general population; some differences in alcohol use and dependence between women and men have been described, including outcomes and ranging from biological to social variables. This study aims to compare the severity of alcohol dependence with clinical and psychopathological characteristics between sexes. Methods: A cross-sectional descriptive study was conducted in alcohol-dependent outpatients; the recruitment period was 7 years. The assessment of these patients was carried out by obtaining sociodemographic characteristics and using the Semi-structured Clinical Interview for Axis I and II (SCID-I and SCID-II), European version of the Addiction Severity Index (EuropASI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) scales. Variables were compared and analyzed. Results: The sample was composed of 178 patients (74.2% males and 25.8% females) with a mean age of 46.52 ± 9.86. No sociodemographic differences were found between men and women. Females had a higher rate of suicide attempts and depression symptoms at the treatment onset. When results of EuropASI were compared, females had worse psychological and employment results than males. According to consumption variables, males had an earlier onset of alcohol use, had more regular alcohol use, and develop alcohol dependence earlier than females. Conclusions: According to results, there are sex-dependent differences (severity and other variables such as mood or suicide) in alcohol dependence. Thus, this may implicate the need of future specific research and treatment programs based on the specific necessities of each sex.
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Affiliation(s)
- Raul F Palma-Álvarez
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònomade Barcelona, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònomade Barcelona, Barcelona, Spain
| | - Alfonso C Abad
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
| | - Marta Sorribes
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
| | - Elena Ros-Cucurull
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònomade Barcelona, Barcelona, Spain
| | | | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònomade Barcelona, Barcelona, Spain
| | - Lourdes Aguilar
- Psychiatry Service, Salamanca University Health Care Complex, Institute of Biomedicine, University of Salamanca, Salamanca, Spain
| | - Carlos Roncero
- Psychiatry Service, Salamanca University Health Care Complex, Institute of Biomedicine, University of Salamanca, Salamanca, Spain
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Gaur N, Gautam M, Singh S, Raju VV, Sarkar S. Clinical Practice Guidelines on Assessment and Management of Substance Abuse Disorder in Children and Adolescents. Indian J Psychiatry 2019; 61:333-349. [PMID: 30745707 PMCID: PMC6345135 DOI: 10.4103/psychiatry.indianjpsychiatry_581_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Navendu Gaur
- Director and Consultant Psychiatrist, Gaur Mental-Health Clinic, Ajmer, Rajasthan, India
| | - Manaswi Gautam
- Director and Consultant Psychiatrist, Gautam Hospital & Research Centre, Jaipur, Rajasthan, India
| | - Shubhmohan Singh
- Additional Professor, Department of Psychiatry, PGIMER, Chandigarh, India
| | - V Venkatesh Raju
- Senior Resident DM, Child and Adolescent Psychiatry, PGIMER, Chandigarh, India
| | - Siddharth Sarkar
- Assistant Professor, Department of Psychiatry and NDDTC, AIIMS, New Delhi, India
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Lux-Battistelli C, Battistelli D. Alcohol Withdrawal: Possible Risk of Latent Scurvy Appearing as Tiredness: A STROBE-Compliant Study. J Clin Med Res 2018; 11:26-34. [PMID: 30627275 PMCID: PMC6306134 DOI: 10.14740/jocmr3643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/20/2018] [Indexed: 11/29/2022] Open
Abstract
Background Little is known about the prevalence of vitamin C deficiency in the population of individuals who are withdrawing from alcohol, and about possible consequences of latent scurvy. The aim of this study was to evaluate the prevalence of vitamin C deficiency in patients who were withdrawing from alcohol, its correlation with latent scurvy (mainly tiredness and weakness) and the change in the latter symptoms at 3 months after oral vitamin C supplementation. Methods A total of 47 patients (33 males, 14 females) who volunteered to undertake alcohol detoxification were included prospectively between January 2014 and November 2016. Determination of vitamin C blood levels was performed, and selected clinical signs of latent scurvy were recorded in a structured questionnaire. The decrease of tiredness after vitamin C supplementation was also studied 3 months after the inclusion of patients who had no other explanation for their weakness. Results About 57.44% of the patients were affected by vitamin C deficiency (< 11.4 mol/L). Less than one-third (29.70%) had a normal plasma vitamin C level. There was a clear correlation between decreased vitamin C levels and the presence of tiredness (P = 0.003) and no correlation between gum inflammation or purpura (P = 0.97 and 0.44 respectively). After 3 months of alcohol withdrawal and vitamin C supplementation, 89% of the patients reported a decrease of tiredness. Conclusions Vitamin C deficiency is prevalent in patients undertaking alcohol detoxification. Patients with this vitamin deficiency status often suffer from tiredness, which may be symptoms of latent scurvy. Even if tiredness is a highly nonspecific symptom, presence of fatigue should draw attention and the vitamin C level should be determined. Our preliminary data suggest that vitamin C supplementation, may decrease fatigue and improve patient’s quality of life. This last evolution needs to be confirmed by a double-blind randomized study.
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Affiliation(s)
| | - Daniel Battistelli
- Nouvelle Clinique des Trois Frontieres, 8, rue Saint Damien 68300 Saint-Louis, France.,Fondation du Diaconat, 12 rue d'Alsace, 68100 Mulhouse, France
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Jamshidi N, Morley KC, Cairns R, Dawson A, Haber PS. A Review of Baclofen Overdoses in Australia: Calls to a Poisons Information Centre and a Case Series. Alcohol Alcohol 2018; 54:73-78. [DOI: 10.1093/alcalc/agy082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 10/29/2018] [Indexed: 01/02/2023] Open
Affiliation(s)
- Nazila Jamshidi
- Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia
| | - Kirsten C Morley
- School of Medicine, NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, NSW, Australia
| | - Rose Cairns
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, Australia
| | - Andrew Dawson
- Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, Australia
- Central Clinical School, Royal Prince Alfred Hospital, University of Sydney, Sydney
| | - Paul S Haber
- Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia
- School of Medicine, NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, NSW, Australia
- Central Clinical School, Royal Prince Alfred Hospital, University of Sydney, Sydney
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Costa M, Yaya I, Mora M, Marcellin F, Villotitch A, Berenger C, Tanti M, Cutarella C, Polomeni P, Maradan G, Roux P, Rolland B, Carrieri PM. Barriers and levers in screening and care for alcohol use disorders among French general practitioners: results from a computer-assisted telephone interview-based survey. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1514989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marie Costa
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Issifou Yaya
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Mora
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Fabienne Marcellin
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Antoine Villotitch
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Cyril Berenger
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marc Tanti
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
| | | | | | - Gwenaelle Maradan
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Perrine Roux
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Benjamin Rolland
- Service Universitaire d’Addictologie, Bron, France
- Centre de Recherche en Neurosciences de Lyon, Institut national de la santé et de la recherche médical U1028, Centre national de la recherche scientifique UMR5292, Univ Lyon, Université Claude Bernard Lyon 1, France
| | - Patrizia Maria Carrieri
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
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Hamant C, Deneuve S, Albaret MA, Zrounba P, Breton P, Céruse P, Gleizal A, Alix T, Bettega G, Chauvin F, Saintigny P, Régnier Denois V. [Smoking and alcohol cessation programs in patients with head and neck cancer]. Bull Cancer 2018; 105:1012-1019. [PMID: 30201374 DOI: 10.1016/j.bulcan.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 06/19/2018] [Accepted: 07/02/2018] [Indexed: 11/16/2022]
Abstract
Most head and neck cancers are associated with smoking and alcohol exposure. Smoking and alcohol cessation (ASC) is associated with improved quality of life, cancer therapy efficacy, decreased treatment-related and cardiovascular risks, and is expected to decrease the risk of second primary tumor. It is therefore a high priority in the plan of care. However, results of current ASC programs are disappointing and understanding the reasons of this is critical. We started a qualitative study in 6 academic centers including 3 university hospitals, one regional hospital and one comprehensive cancer center. We first interviewed surgeons and care givers involved in the management of head and neck cancers. Poor communication between stakeholders, absence of alignment of care goals between patients, surgeons and other caregivers, and low level of understanding by patients of the benefits of ASC were felt to represent frequent obstacles to successful outcome. More work is ongoing within the context of our IHNPACT umbrella protocol to identify hurdles associated with successful ASC.
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Affiliation(s)
- Chloé Hamant
- Institut de cancérologie Lucien-Neuwirth, HYGEE center, Inserm 1408, 42270 Saint-Priest-en-Jarez, France
| | - Sophie Deneuve
- Centre Léon-Bérard, department of surgical oncology, 69008 Lyon, France
| | | | - Philippe Zrounba
- Centre Léon-Bérard, department of surgical oncology, 69008 Lyon, France
| | - Pierre Breton
- Hospice civil de Lyon, Lyon Sud hospital, department of maxillo-facial surgery and plastic surgery, 69310 Pierre-Bénite, France
| | - Philippe Céruse
- University hospital Lyon, university Claude-Bernard Lyon 1, otolaryngology, head and neck surgery department, Lyon, France
| | - Arnaud Gleizal
- Groupement hospitalier Lyon Nord, maxillo-facial surgery unit, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - Thomas Alix
- University hospital of Saint-Etienne, department of maxillo-facial and plastic surgery, 42100 Saint-Etienne, France
| | - Georges Bettega
- Institut Albert-Bonniot, Inserm U1209, 38000 Grenoble, France; Centre hospitalier d'Annecy-Genevois, service de chirurgie maxillo-faciale, 1, avenue de l'hôpital, 74370 Epagny Metz-Tessy, France
| | - Franck Chauvin
- Institut de cancérologie Lucien-Neuwirth, HYGEE center, Inserm 1408, 42270 Saint-Priest-en-Jarez, France
| | - Pierre Saintigny
- Centre Léon-Bérard, department of translational research and innovation, 69008 Lyon, France; Centre Léon-Bérard, department of medical oncology, 69008 Lyon, France.
| | - Véronique Régnier Denois
- Institut de cancérologie Lucien-Neuwirth, HYGEE center, Inserm 1408, 42270 Saint-Priest-en-Jarez, France.
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45
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L’addictologie de liaison : outils et spécificités. Encephale 2018; 44:354-362. [DOI: 10.1016/j.encep.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
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46
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González-Marín MC, Lebourgeois S, Jeanblanc J, Diouf M, Naassila M. Evaluation of alcohol use disorders pharmacotherapies in a new preclinical model of binge drinking. Neuropharmacology 2018; 140:14-24. [DOI: 10.1016/j.neuropharm.2018.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 12/26/2022]
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Simon N, Moirand R, Dematteis M, Bordet R, Deplanque D, Rolland B. Full-Profile Pharmacokinetic Study of High Dose Baclofen in Subjects With Alcohol Use Disorder. Front Psychiatry 2018; 9:385. [PMID: 30190685 PMCID: PMC6115517 DOI: 10.3389/fpsyt.2018.00385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/31/2018] [Indexed: 12/20/2022] Open
Abstract
Baclofen a gamma amino-butyric acid type B (GABA-B) receptor agonist, which has raised some interest for the treatment of alcohol use disorder (AUD), occasionally at dose up to 300 mg/d. We conducted the first full-profile pharmacokinetic study on baclofen in AUD subjects, up to the oral daily dose of 300 mg. Sixty subjects treated for AUD with marketed baclofen were enrolled in a prospective phase-1 study. Participants were divided into four dose groups (1: <60 mg/d; 2: 60-120 mg/d; 3: >120 mg/d-180 mg/d; and 4: >180 mg/d), and they underwent a full-profile pharmacokinetic analysis of baclofen, using a nonlinear mixed effects modeling. The influence of different clinical and biological covariates was assessed in an upward modeling. Fifty-seven participants completed the study (522 observed concentrations collected). Racemic baclofen showed a linear pharmacokinetic profile, corresponding to a one-compartment model, with no influencing clinical or biological factor. The pharmacokinetic parameters of baclofen were (bootstrap 95% confidence intervals): absorption constant (Ka) 1.64 1/h (1.34-2), clearance (Cl/F) 11.6 L/h (10.8-12.3) and volume of distribution (Vd/F) 72.8 L (66.5-80.4) leading to a half-life of 4.4 h. The interindividual variability (IIV) was 44% (19-65), 21% (16-27), and 22% (11-36) for Ka, Cl/F, and Vd/F, respectively. The residual variability was 24% (21-26). No serious adverse event was reported. Registration: EudraCT #2013-003412-46.
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Affiliation(s)
- Nicolas Simon
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, Service de Pharmacologie Clinique, CAP-TV, Marseille, France
| | - Romain Moirand
- Univ Rennes, INSERM, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), CIC 1414, Unité d'Addictologie, Rennes, France
| | - Maurice Dematteis
- UFR de Médecine, Université Grenoble Alpes, Grenoble, France
- Service d'Addictologie, CHU Grenoble Alpes, Grenoble, France
| | - Régis Bordet
- Inserm U1171, Université de Lille, Lille, France
| | - Dominique Deplanque
- Inserm U1171, Université de Lille, Lille, France
- Inserm CIC1403, CHU Lille, Université de Lille, Lille, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le VInatier, Bron, France
- Université de Lyon, Inserm U1028, CNRS UMR5292, UCBL, CRNL, Bron, France
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Louw KA. Substance use in pregnancy: The medical challenge. Obstet Med 2018; 11:54-66. [PMID: 29997687 PMCID: PMC6038015 DOI: 10.1177/1753495x17750299] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023] Open
Abstract
Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.
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Affiliation(s)
- Kerry-Ann Louw
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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49
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Costa M, Rolland B, Carrieri P. The need for patient-tailored dosing of baclofen in future clinical trials ☆. Eur Neuropsychopharmacol 2018; 28:656-657. [PMID: 29551439 DOI: 10.1016/j.euroneuro.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Marie Costa
- INSERM -UMR1252 - ORS PACA, Aix-Marseille Université, Marseille, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie, CH Le Vinatier, Bron, France; CRNL, Inserm U1028 / CNRS UMR5292, Univ Lyon1, Lyon, France
| | - Patrizia Carrieri
- INSERM -UMR1252 - ORS PACA, Aix-Marseille Université, Marseille, France
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Franchitto N, Rolland B, Pelissier F, Simon N. How to Manage Self-Poisoning With Baclofen in Alcohol Use Disorder? Current Updates. Front Psychiatry 2018; 9:417. [PMID: 30233433 PMCID: PMC6132193 DOI: 10.3389/fpsyt.2018.00417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/14/2018] [Indexed: 12/20/2022] Open
Abstract
Specialists in addiction medicine continue to debate whether baclofen is still indicated to treat alcohol use disorders in view of conflicting results as to its efficacy. This review summarizes current knowledge on self-poisoning with baclofen focusing of alcohol-use disorder in order to provide an overview of the reliable scientific knowledge on management of such an intoxication. Moreover, as alcohol-dependent patients experience many psychiatric co-morbidities, the risk in suicide attempt using baclofen seems real. Numerous studies have suggested that patients given daily-doses of baclofen higher than 80 mg/day are more likely to attempt suicides than others. Following an ingestion of a large amount of baclofen, central nervous system depression is usually observed. Seizures require the patient to be admitted in intensive care unit and should be treated like other toxicological seizures. Cardiac complications include prolonged QTc interval, degree heart block, premature atrial contractions, and supraventricular tachycardia, hypotension and bradycardia. In cases of intoxication, the elimination half-life of baclofen may last between 12 and 36 h post-overdose and renal failure is known to delay its clearance. Rarely measured in clinical practice, the toxic level of baclofen blood level ranges from 1.1 to 3.5 mg/l, and coma or fatal intoxication are observed from 6 to 9.6 mg/l. Baclofen withdrawal has been observed but making the diagnosis of withdrawal in case of suspected self-poisoning is difficult as baclofen intoxication and baclofen withdrawal share many clinical signs. Admission to hospital to manage of suicide attempt with baclofen is mandatory and should not be limited to baclofen alone. It needs to include other aspects of the overall care of patients with alcohol disorders (psychological and psychosocial interventions, management of comorbid mental conditions and physical complications).
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Affiliation(s)
- Nicolas Franchitto
- Department of Addiction Medicine, Toulouse-Purpan University Hospital, Toulouse, France.,Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France.,UMR 1027, Paul Sabatier University, Toulouse, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le Vinatier, Bron, France.,Univ Lyon, Inserm U1028, CNRS UMR5292, UCBL, CRNL, Lyon, France
| | - Fanny Pelissier
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Nicolas Simon
- APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, Service de Pharmacologie Clinique, CAP-TV, Aix Marseille Univ, Marseille, France
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