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The Characteristics of Benzodiazepine Prescribing in the Republic of Srpska, Bosnia and Herzegovina. Medicina (B Aires) 2022; 58:medicina58080980. [PMID: 35893095 PMCID: PMC9332377 DOI: 10.3390/medicina58080980] [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: 04/16/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Benzodiazepines (BZDs) are among the most prescribed psychotropic drugs and significant number of patients use these drugs for longer periods than recommended. The objective of this study was to determine the factors associated with prescribing of BZDs at the primary healthcare level. Materials and Methods: A retrospective analysis of family physicians’ prescriptions from the databases of family medicine teams of the Republic of Srpska was performed. The number of BZDs users, as well as the total number of prescriptions, were determined. Thereafter, it was determined which specific BZD had been prescribed, in which dose, for how long, as well as the specific social and demographic characteristics of patients to whom the drugs were prescribed. Results: The results showed that 38.47% of patients used the BZDs for a period longer than six months. The most frequent BZDs prescribed were the intermediate-acting BZDs, primarily bromazepam (58.69%). Two thirds of patients were women. The average age of the patients was 60, 60.46% of patients were single, and 69.68% lived in urban areas. The longer uses of BZDs were recorded in women, the elderly, single people and those who lived in urban areas, while higher doses of BZDs were prescribed to men, as well as younger and married people. The highest positive correlation was found between the dose and length of use of BZD. Conclusions: A significant percentage of patients used BZDs for a time period longer than recommended. Caution is necessary when prescribing BZDs to women, the elderly, patients that live in urban areas and patients who are single. When prescribing BZDs, family physicians should be aware of their potential interactions and addictive potentials.
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Martins UCDM, Ramalho-de-Oliveira D, Nascimento MMGD, Nascimento YA, Oliveira GCBD, Cid AS, Lima MG. Potentially inappropriate medication use in a comprehensive therapy management service: clinical outcomes and interventions. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Prevalência e fatores associados ao uso de benzodiazepínicos em idosos atendidos em um ambulatório especializado em Porto Alegre, Brasil. PAJAR - PAN AMERICAN JOURNAL OF AGING RESEARCH 2021. [DOI: 10.15448/2357-9641.2021.1.40298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivos: verificar a prevalência de uso de BZDs na população idosa atendida em um ambulatório de psiquiatria geriátrica de um hospital universitário em Porto Alegre, Brasil.Métodos: estudo transversal realizado no ambulatório de psiquiatria geriátrica. A coleta de dados ocorreu durante a primeira consulta dos indivíduos com idade igual ou superior a 60 anos. Os dados avaliados compreendem questões sociodemográficas, clínicas, de saúde e uso de medicamentos. Para análise estatística foi utilizado o programa SPSS (do inglês, Statistical Package for the Social Sciences).Resultados: um total de 295 idosos foram incluídos no estudo. A média de idade foi de 72,1±8,3 anos, sendo na maioria mulheres (76,6%), com escolaridade de 5 a 8 e 9 a 12 anos de estudo (ambos com a mesma frequência, 28,9%), casados (45,0%), residindo com familiar (34,4%), aposentados (79,8%). A prevalência de utilização de BZD foi de 33,6% (n=99). A queixa principal de ansiedade e o diagnóstico de transtornos ansiosos foram associadas ao uso de BZDs.Conclusões: a prevalência do uso de BZDs foi alta e associada à queixa principal de ansiedade e aos diagnósticos de transtornos ansiosos e depressivos, mesmo esses sendo considerados medicamentos potencialmente inapropriados e com alto risco de complicações. O tratamento da população geriátrica, muitas vezes, é colocado em segundo plano, não recebendo devidamente os cuidados direcionados às demandas específicas que esses indivíduos necessitam. O conhecimento epidemiológico da população idosa expõe características e auxilia na elaboração de plano terapêutico diferenciado.
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Simal-Aguado J, Campos-Navarro MP, Valdivia-Muñoz F, Galindo-Tovar A, García-Carmona JA. Evaluation of Risk Factors Associated to Prescription of Benzodiazepines and its Patterns in a Cohort of Patients from Mental Health: A Real World Study in Spain. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:81-93. [PMID: 33897065 PMCID: PMC8063129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE we aimed 1) to evaluate the risk factors associated to the benzodiazepines intake; 2) to assess the impact about the use of long acting injectables antipsychotics (LAIs); 3) to assess the risk in severe and affective disorders and 4) to identify the prescription patterns of use in mental health in a cohort of patients from Spain. METHODS 735 outpatients from Mental Health were included. Demographic and clinical data were collected. In order to compare the use of benzodiazepines we calculated the daily dose equivalents (mg/day) to diazepam as standard. RESULTS The most commonly prescribed benzodiazepine was clonazepam (33%) and the mean daily dose of diazepam equivalents was 24.9 mg. It was higher in affective disorders (40.35 ± 3.36) and lower in patients using LAIs antipsychotics (17.50 ± 1.39; p = 0.001). Multivariate analysis showed that to be women (OR = 1.559, 95% CI = 1.059-2.295, p = 0.024), the use of drugs (OR = 1.671, 95% CI = 1.127-2.477, p = 0.011) and suffering any affective disorder (OR = 1.542, 95% CI = 1.355-1.826, p = 0.040) increased the risk of benzodiazepine intake. In contrast, the use of LAIs antipsychotics significantly reduced it versus oral antipsychotics (OR = 5.226, 95% CI = 3.185-8.575, p = 0.001). CONCLUSIONS benzodiazepines are widely prescribed, mainly clonazepam followed by lorazepam and diazepam. Most of patients used at least one benzodiazepine and the mean daily intake was 25 mg diazepam equivalents. Therefore, benzodiazepines are extensively prescribed and used at higher doses than desirable. These, findings could be useful for clinicians and their practice.
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Affiliation(s)
- Jorge Simal-Aguado
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
| | - María-Pilar Campos-Navarro
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
| | - Francisco Valdivia-Muñoz
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
| | - Alejandro Galindo-Tovar
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
| | - Juan Antonio García-Carmona
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
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Lorazepam induces acinar cells apoptosis of rat parotid glands. Saudi Dent J 2020; 32:276-282. [PMID: 32874067 PMCID: PMC7452012 DOI: 10.1016/j.sdentj.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 11/20/2022] Open
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Oliveira ALML, Nascimento MMGD, Castro-Costa É, Firmo JOA, Lima-Costa MF, Loyola Filho AID. Increased use of benzodiazepines among older adults: Bambuí Project. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200029. [PMID: 32401915 DOI: 10.1590/1980-549720200029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults. OBJECTIVE To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years. METHODS The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance. RESULTS The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62). CONCLUSION This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.
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Affiliation(s)
| | | | - Érico Castro-Costa
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Josélia Oliveira Araújo Firmo
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Maria Fernanda Lima-Costa
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Antônio Ignácio de Loyola Filho
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
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Gnjidic D, Ong HMM, Leung C, Jansen J, Reeve E. The impact of in hospital patient-education intervention on older people's attitudes and intention to have their benzodiazepines deprescribed: a feasibility study. Ther Adv Drug Saf 2019; 10:2042098618816562. [PMID: 30728943 PMCID: PMC6351969 DOI: 10.1177/2042098618816562] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Long-term benzodiazepine use in the older population is common and is associated with significant harm. The provision of a patient-educational booklet during hospitalization may encourage patients to discuss review and possible deprescribing of benzodiazepine therapy with their health professionals. The aim of this study was to assess the feasibility and effect of a patient empowerment intervention in hospital inpatients on patient initiation of a discussion about deprescribing benzodiazepines versus usual care. Methods A feasibility interventional study using a patient-empowerment education intervention was conducted at a Sydney teaching hospital. Patients aged ⩾ 65 years, prescribed a benzodiazepine, and able to provide consent were invited to participate in the study. Participants were randomly allocated to intervention or control group (1:1). Intervention participants received the patient-empowerment booklet and control received usual care. All participants received 1-month follow-up phone interviews to assess medication and attitudinal changes. Results A total of 42 participants were recruited (20 intervention and 22 control). The average age was 71.5 (interquartile range: 69.0-80.3) and 54.8% were females. There was no difference in baseline characteristics between intervention and control groups (p > 0.05). At baseline, 65.0% of participants (53.0% intervention, 86.0% control) were not concerned about the potential benzodiazepine side effects. Twenty-nine participants (15 intervention and 14 control) completed 1-month follow up; 22 participants (11 intervention and 11 control) were discharged on the benzodiazepine. Among these, 13 (59.1%) had ceased benzodiazepine at 1-month follow up [46.2% (n = 6) intervention; 53.8% (n = 7) control]. In the intervention group, 33.3% (n = 5) of participants had initiated a discussion with their doctor or pharmacist about stopping the benzodiazepine compared with 35.7% (n = 5) in the control group. Conclusion Cessation of benzodiazepines 1 month following discharge was common. Future larger studies are required to confirm the effectiveness of providing a patient-empowerment booklet on reducing benzodiazepine use and other potentially inappropriate medications.
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Affiliation(s)
| | | | | | - Jesse Jansen
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Emily Reeve
- Faculty of Medicine and Health, University of Sydney, NSW, Australia Geriatric Medicine Research, Dalhousie University and Nova Scotia Health Authority, NS, Canada College of Pharmacy, Dalhousie University, NS, Canada
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Maksimović Ž, Stajić M, Lončar-Stojiljković D. Analysis of the Benzodiazepine prescribing patterns in the primary healthcare of the Republic of Srpska. SCRIPTA MEDICA 2019. [DOI: 10.5937/scriptamed50-22426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Kim YH, Kim HB, Kim DH, Kim JY, Shin HY. Use of hypnotics and the risk of or mortality from heart disease: a meta-analysis of observational studies. Korean J Intern Med 2018; 33:727-736. [PMID: 28844123 PMCID: PMC6030407 DOI: 10.3904/kjim.2016.282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/12/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND/AIMS Some observational epidemiologic studies have reported conflicting results on the relationship between hypnotics use and the risk of developing and/or dying from heart disease. We investigated these associations using a meta-analysis of available literatures. METHODS We searched the databases PubMed and EMBASE, along with the bibliographies of relevant articles to find additional publications in February 2016. RESULTS Of 495 articles satisfying our initial criteria, two case-control studies and six cohort studies met our inclusion criteria and were included in the final analyses. Compared with never having used any kind of hypnotics, the odds ratio for overall use was 0.84 for risk of or mortality from heart disease (95% confidence interval, 0.79 to 0.89) in a random-effects meta-analysis of all eight studies. With respect to the geographical region, use of hypnotics was associated with a decreased risk or mortality of heart disease in Asia but not in Western countries. Among various types of sleep medications, zolpidem showed a decreased risk (-29%) of developing or dying from heart disease, but benzodiazepines were related with an increased risk (80%) of or mortality from heart disease. CONCLUSIONS The current meta-analysis of observational epidemiological studies suggested an evidence of association between hypnotics use and a decreased risk of heart disease.
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Affiliation(s)
- Young-Hyo Kim
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Hong-Bae Kim
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
- Department of Family Medicine, Yonsei University Graduate School of Medicine, Seoul, Korea
- Correspondence to Hong-Bae Kim, M.D. Department of Family Medicine, Myongji Hospital, 55 Hwasu-ro 14beon-gil, Deokyang-gu, Goyang 10475, Korea Tel: +82-31-810-5420 Fax: +82-31-969-0500 E-mail:
| | - Do-Hyoung Kim
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Ja-Young Kim
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Hyun-Young Shin
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
- Department of Family Medicine, Yonsei University Graduate School of Medicine, Seoul, Korea
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Laurito LD, Loureiro CP, Dias RV, Vigne P, de Menezes GB, Freire RC, Stangier U, Fontenelle LF. Predictors of benzodiazepine use in a transdiagnostic sample of panic disorder, social anxiety disorder, and obsessive-compulsive disorder patients. Psychiatry Res 2018; 262:237-245. [PMID: 29475102 DOI: 10.1016/j.psychres.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/13/2018] [Accepted: 02/02/2018] [Indexed: 01/04/2023]
Abstract
We investigated the rates of current and past benzodiazepine (BZD) use in a sample of 102 subjects attending specialized anxiety disorder clinics, including panic disorder (PD; N = 36), social anxiety disorder (SAD; N = 28) and obsessive-compulsive disorder (OCD; N = 38) patients. Almost 56% of the entire sample was using BZDs at the moment of the assessment, and 74.5% described having used them at some point during their lifetimes. The duration of psychiatric treatment and a lifetime history of PD, but not any other "transdiagnostic" measure of severity (such as the Panic and Agoraphobia Scale, the Social Phobia Inventory, the Dimensional Obsessive-Compulsive Scale, the Anxiety Sensitivity Index-36, and the Beck Inventories) were independent risk factors for current prescription of BZDs. Patients who continued to use BZDs differed from patients who stopped them by being older (both currently and when firstly seen in the clinic), by having a later age at onset of their most significant anxiety disorder, by being more agoraphobic/avoidant, and by believing to be less capable of stopping their BZDs for the fear of not being able to sleep.
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Affiliation(s)
- Luana D Laurito
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Carla P Loureiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafaela V Dias
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Paula Vigne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Gabriela B de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia.
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A prevalence study of potentially inappropriate medications use in hospitalized Pakistani elderly. Aging Clin Exp Res 2018; 30:53-60. [PMID: 28258500 DOI: 10.1007/s40520-017-0742-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inappropriate prescribing in elderly patients is a widespread health problem. It is associated with increased drug-related problems and health expenditure. AIMS To determine the prevalence and types of potentially inappropriate medications (PIM) prescribed to elderly patients with polypharmacy and the factors associated with their use in these patients. METHODS A cross-sectional study conducted among 228 elderly hospitalized patients with polypharmacy. Elderly patients were defined as patients ≥65 years of age, and polypharmacy was defined as taking ≥5 drugs. Based on previously published criteria (Beers and STOPP), a list of 32 PIM was developed using a Delphi technique, which was used as a tool to detect the prevalence of PIM. Age, gender, comorbidity, patients' functional status, and complete medication history were recorded to evaluate as variables related to PIM. The association between PIM used and independent variables was also assessed. RESULTS The prevalence of PIM used among the hospitalized elderly patients was 64%. PIM use according to STOPP criteria was identified in 44% of patients, whereas Beers-listed PIM were identified in 50% of patients. The most frequently observed PIM were the combination of nonsteroidal anti-inflammatory drugs (NSAIDs) with antihypertensives and long-term NSAIDs, which account for more than 90 and 75% of the total observed PIM, respectively. Patients with age ≥85 years were more likely to be prescribed PIM. High comorbidity was found to be an independent predictor of PIM use. Polypharmacy with ≥10 drugs prescribed to patients predicted the presence of PIM. DISCUSSION The study showed a high prevalence of PIM use among hospitalized elderly patients. The consensus-validated list of PIM was a useful tool for screening inappropriate prescribing in this particular patient population. CONCLUSION Our findings support the need for measures to improve the quality of drug treatment in the elderly Pakistani population, especially among dependent patients with polypharmacy.
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Reeve E, Ong M, Wu A, Jansen J, Petrovic M, Gnjidic D. A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people. Eur J Clin Pharmacol 2017; 73:927-935. [DOI: 10.1007/s00228-017-2257-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 04/18/2017] [Indexed: 01/10/2023]
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Abi-Ackel MM, Lima-Costa MF, Castro-Costa É, Loyola Filho AID. Uso de psicofármacos entre idosos residentes em comunidade: prevalência e fatores associados. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 20:57-69. [DOI: 10.1590/1980-5497201700010005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 05/31/2016] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Objetivo: Investigar a prevalência e os fatores associados ao uso de psicofármacos entre idosos. Métodos: O estudo, realizado em 2003, baseou-se no Inquérito de Saúde da Região Metropolitana de Belo Horizonte (RMBH). Participaram do estudo 1.635 idosos (60 anos ou mais) residentes nos municípios da RMBH, selecionados por meio de amostra probabilística complexa. Modelos de regressão logística foram utilizados para identificar os fatores associados ao uso de psicofármacos, considerando o nível de significância de 5,0%. Resultados: A prevalência de uso de psicofármacos foi de 13,4%, sendo 8,3% para uso de benzodiazepínicos e 5,0% para antidepressivos. Os fatores independentemente associados ao uso de psicofármacos foram sexo feminino (OR = 2,20; IC95% 1,49 - 3,27), relato de diagnóstico médico para depressão (OR = 6,42; IC95% 4,31 - 9,55), ter realizado 5 ou mais consultas médicas nos últimos 12 meses (OR = 2,15; IC95% 1,32 - 3,53) e afiliação a plano de privado saúde (OR = 2,69; IC95% 1,86 - 3,88). Conclusão: A prevalência observada foi semelhante ao verificado entre idosos brasileiros e o padrão de associações detectado foi consistente com o observado em populações idosas de países de maior renda, sendo o relato de diagnóstico médico para depressão o fator mais fortemente associado ao uso de psicofármacos.
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Harnod T, Wang YC, Lin CL, Tseng CH. Association between use of short-acting benzodiazepines and migraine occurrence: a nationwide population-based case-control study. Curr Med Res Opin 2017; 33:511-517. [PMID: 27893291 DOI: 10.1080/03007995.2016.1266313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the association between using benzodiazepines (BZDs) with short- or long-acting durations and migraine occurrence. METHODS The migraine group comprised 9616 subjects older than 20 years and newly diagnosed with migraine between 2005 and 2011, and the comparison group comprised 38,464 subjects without migraine. The BZDs used in the subjects were dichotomously defined as short-acting (half-life ≤24 h) and long-acting substances. A logistic regression model was used to calculate the odds ratio (OR) of migraine associated with BZD exposure and other diseases. RESULTS The adjusted OR of migraine associated with BZD exposure was 1.73 (95% confidence interval [CI] = 1.63-1.84). Either exposure to a short-acting BZD alone or using it combining with a long-acting BZD had significant higher risks of migraine (adjusted OR = 1.69, 95% CI = 1.59-1.80; adjusted OR = 2.06, 95% CI = 1.91-2.24, respectively), whereas only long-acting BZD use was not associated with an increase of migraine. Meanwhile, sleep disorders, anxiety, and stroke were strongly associated with migraine (adjusted OR = 2.00, 1.91, and 1.57, respectively). CONCLUSIONS We observed a significant increase of migraine occurrence in subjects using short-acting BZDs, either alone or in combination with long-acting ones.
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Affiliation(s)
- Tomor Harnod
- a Department of Neurosurgery , Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation , Hualien , Taiwan
- b College of Medicine , Tzu Chi University , Hualien , Taiwan
| | - Yu-Chiao Wang
- c Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan
- d College of Medicine , China Medical University , Taichung , Taiwan
| | - Cheng-Li Lin
- c Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan
- d College of Medicine , China Medical University , Taichung , Taiwan
| | - Chun-Hung Tseng
- e Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine , China Medical University , Taichung , Taiwan
- f Department of Neurology , China Medical University Hospital , Taichung , Taiwan
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do Nascimento MMG, Mambrini JVDM, Lima-Costa MF, Firmo JOA, Peixoto SWV, de Loyola Filho AI. Potentially inappropriate medications: predictor for mortality in a cohort of community-dwelling older adults. Eur J Clin Pharmacol 2017; 73:615-621. [DOI: 10.1007/s00228-017-2202-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
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Kim HB, Myung SK, Park YC, Park B. Use of benzodiazepine and risk of cancer: A meta-analysis of observational studies. Int J Cancer 2016; 140:513-525. [PMID: 27667780 DOI: 10.1002/ijc.30443] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/21/2016] [Indexed: 12/15/2022]
Abstract
Several observational epidemiological studies have reported inconsistent results on the association between the use of benzodiazepine and the risk of cancer. We investigated the association by using a meta-analysis. We searched PubMed, EMBASE, and the bibliographies of relevant articles to locate additional publications in January 2016. Three evaluators independently reviewed and selected eligible studies based on predetermined selection criteria. Of 796 articles meeting our initial criteria, a total of 22 observational epidemiological studies with 18 case-control studies and 4 cohort studies were included in the final analysis. Benzodiazepine use was significantly associated with an increased risk of cancer (odds ratio [OR] or relative risk [RR] 1.19; 95% confidence interval 1.16-1.21) in a random-effects meta-analysis of all studies. Subgroup meta-analyses by various factors such as study design, type of case-control study, study region, and methodological quality of study showed consistent findings. Also, a significant dose-response relationship was observed between the use of benzodiazepine and the risk of cancer (p for trend <0.01). The current meta-analysis of observational epidemiological studies suggests that benzodiazepine use is associated with an increased risk of cancer.
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Affiliation(s)
- Hong-Bae Kim
- Department of Family Medicine, MyongJi Hospital, 14-55 Hwasu-ro, Deokyang-gu, Goyang, Gyeonggi-do, 10475, Republic of Korea.,Department of Family Medicine, School of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Republic of Korea
| | - Seung-Kwon Myung
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.,Molecular Epidemiology Branch, Division of Cancer Epidemiology and Prevention, Research Institute, National Cancer Center, Goyang, Republic of Korea.,Department of Family Medicine and Center for Cancer Prevention and Detection, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Yon Chul Park
- Department of Family Medicine, School of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Republic of Korea.,Department of Family Medicine, Wonju Severance Christian Hospital, 20 Ilsan-ro, Wonju, Gangwon-do, 220-701, Republic of Korea
| | - Byoungjin Park
- Department of Family Medicine, School of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Republic of Korea.,Department of Family Medicine, Yongin Severance Hospital, 225 Gumhak-ro, Cheoin-gu, Yongin, Gyeonggi-do, 17046, Republic of Korea
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Benzodiazepine use associated with co-morbid post-traumatic stress syndrome and depression in older adults seeking services in general medical settings. Int Psychogeriatr 2016; 28:913-20. [PMID: 26804712 DOI: 10.1017/s1041610216000016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Benzodiazepines (BZD) should be limited in older adults. This study aimed to determine the association between BZD use and the presence of a probable post-traumatic stress syndrome (PTSS) and whether this association is dependent on gender and co-morbid physical and mental conditions. METHODS Data were retained from the Étude sur la Santé des Aînés (ESA) - Services study (2011-2013) and included 1,453 older adults (≥65 years) who completed a face to face at-home interview, who were covered under Quebec's public drug insurance plan, and had given permission to access their Régie de l'Assurance Maladie du Québec (RAMQ) medical and pharmaceutical services data. The presence of a PTSS was measured using the Impact of Event Scale-Revised (IES-R). The use of BZD and antidepressants in the year prior to interview was ascertained from data reported in the RAMQ drug registry. The presence of depression and an anxiety disorder was assessed with the ESA-Questionnaire which was based on DSM-5 criteria. The interaction between PTSS and gender, depression, anxiety, and multi-morbidity was also assessed. RESULTS The prevalence of PTSS and BZD use reached 4.5% and 31.2%. Participants with PTSS were 1.9 (95% CI = 1.1-3.2) times more likely to use BZD. The presence of depression had a negative impact on the association between BZD use and PTSS (p = 0.04). CONCLUSION The use of BZD in older adults with PTSS is still prevalent today. Differences in benzodiazepine prescribing practices for more complex co-morbid psychiatric cases needs to be further studied.
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Harnod T, Wang YC, Kao CH. Association Between Benzodiazepine Use and Epilepsy Occurrence: A Nationwide Population-Based Case-Control Study. Medicine (Baltimore) 2015; 94:e1571. [PMID: 26376408 PMCID: PMC4635822 DOI: 10.1097/md.0000000000001571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We conducted a retrospective case-control study to evaluate the association between the risk of benzodiazepine (BZD) use and epilepsy occurrence by using data from the Taiwan National Health Insurance Research Database. We recruited 1065 participants who ages 20 years or older and newly diagnosed with epilepsy (International Classification of Diseases, Ninth Revision, Clinical Modification 345) between 2004 and 2011 and assigned them to the epilepsy group. We subsequently frequency-matched them with participants in a control group (n = 4260) according to sex, age, and index year at a 1:4 ratio. A logistic regression model was employed to calculate the odds ratio (OR) for association of epilepsy with BZD exposure. Multivariate logistic regression was conducted to estimate the dose-response relationship between BZD levels and epilepsy risk. The adjusted OR (aOR) for the association of epilepsy with BZD exposure was 2.02 (95% confidence interval [CI] = 1.68-2.42). The aOR for an average BZD dose increased to 1.26 for the participants on <0.01 defined daily dose (DDD), and increased to 4.32 for those on ≥1.50 DDD. On average, when the DDD of BZD exposure increased by 100 units, the epilepsy risk increase by 1.03-fold (95% CI = 1.01-1.04, P = 0.003). The annual BZD exposure day ranges were significantly associated with epilepsy (2-7 days: aOR = 1.67; 8-35 days: aOR = 3.16; and ≥35 days: aOR = 5.60). Whenever the annual BZD exposure increased by 30 days, the risk of epilepsy notably increased by 1.03-fold (95% CI = 1.01-1.04, P < 0.001). In addition, users who quit BZD for more than 6 months still exhibited a higher risk of epilepsy than did the non-BZD users. A considerable increase in epilepsy occurrence was observed in ones with BZD use, particularly in those with prolonged use, multiple exposure, and high-dose consumption.
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Affiliation(s)
- Tomor Harnod
- From the Department of Neurosurgery, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (TH); College of Medicine, Tzu Chi University, Hualien, Taiwan (TH); Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (Y-CW); College of Medicine, China Medical University, Taichung, Taiwan (Y-CW); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Cunha CDDA, Souza MCCD, Cattanio GAA, Iahnn SR, Lima RDC. Benzodiazepine use and associated factors in elderly in the city of Dourados, MS, Brazil. JORNAL BRASILEIRO DE PSIQUIATRIA 2015. [DOI: 10.1590/0047-2085000000080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective The use of benzodiazepines (BZD) and associated factors in the elderly of Dourados, MS, Brazil was investigated. Methods This is a cross-sectional population-based study using a multistage sampling design. Participants were 1,022 individuals aged ≥ 60 years. Measurements socioeconomic status, schooling, demographic aspects, marital status, physical activity, hospitalizations, self-rated health, use of alcohol beverages and smoking were assessed by standard questionnaire. The drugs used were obtained by checking the prescription or package and classified according to the Anatomical Therapeutic Chemical Index. Chi-square test, Chi-square for linear tendency, Fisher's exact test and Poisson regression were used to assess association between variables. Results The prevalence of use of BZD was 6.5% (CI95%: 5.1-8.2%). The oldest group (PR: 1.60 for 70-79 years and PR: 1.79 for ≥ 80 years), non-use of alcohol (PR: 4.14) and use of antidepressants (PR: 8.73) were the statistically associated characteristics. Conclusions The prevalence of use of BZD in the study population was low, similar to findings of more recent Brazilian studies and lower than those obtained in international studies. The prevalence of use of BZD increased with aging and use of antidepressants.
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Social differences associated with the use of psychotropic drugs among men and women aged 65 to 74 years living in the community: the International Mobility in Aging Study (IMIAS). BMC Geriatr 2015; 15:85. [PMID: 26188649 PMCID: PMC4506764 DOI: 10.1186/s12877-015-0083-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/06/2015] [Indexed: 12/03/2022] Open
Abstract
Background Elderly persons make greater use of psychotropic drugs, but there are few international studies on social differences in the use of these medications. The aim of this study is to examine social differences in the use of psychotropic drugs among persons aged 65–74 years in the International Mobility in Aging Study (IMIAS). Methods The sample consisted of 1,995 participants in the IMIAS 2012 baseline study in Saint-Hyacinthe (Canada), Kingston (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). During home visits, all medication taken by the participants in the previous 15 days was recorded. We then used the Anatomical Therapeutic Chemical classification system to code psychotropic drugs as anxiolytics, sedatives, hypnotics (ASH); antidepressants (ADP); or analgesics, antiepileptics, or antiparkinsonians (AEP). Prevalence ratios for psychotropic drug use according to sex, education, income, and occupation were estimated by fitting a Poisson regression and controlling for demographic and health covariates. Results Psychotropic drug use was higher among Canadian participants than among those living outside Canada. Prevalence of AEP drug use was higher for women than men in the Canadian and Latin American sites. In Tirana, antidepressant drugs were rarely used. Socioeconomic differences varied among sites. In the Canadian cities, low socioeconomic standing was associated with higher frequency of psychotropic drug use. In the Latin American cities, elderly people with high education and income levels showed a higher level of antidepressant drug use, while people with manual occupations had a higher use of AEP drugs. In Tirana, ASH drug use was higher among those with low income. Conclusion An inverse association was observed between socioeconomic standing and psychotropic drug use in Canada, while the opposite was true in Latin America. Albania was notable for an absence of antidepressant use and greater use of ASH drugs among low-income groups.
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Alvarenga JM, Loyola Filho AID, Giacomin KC, Uchoa E, Firmo JOA. Uso de benzodiazepínicos entre idosos: o alívio de "jogar água no fogo", não pensar e dormir. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Compreender a percepção e os significados que os idosos atribuem a suas experiências relacionadas ao uso prolongado de benzodiazepínicos. MÉTODOS: Trabalho de abordagem qualitativa, de cunho antropológico, realizado junto a idosos participantes do Projeto Bambuí, estudo de base populacional sobre as condições de saúde da população idosa, realizado na cidade de Bambuí-MG. Foram realizadas entrevistas semiestruturadas com 22 idosos, sem comprometimento cognitivo e residentes na cidade de Bambuí-MG, que relataram uso de medicação benzodiazepínica. RESULTADOS: No grupo pesquisado, o uso de benzodiazepínicos foi compatível com a definição de "padrão de uso crônico", variando de seis meses a 40 anos, sendo o medicamento mais utilizado o Clonazepam. A coleta e análise dos dados foram guiadas pelo modelo de signos, significados e ações. Emergiram como categorias: a utilização de um remédio "muito bom"; o remédio bom que "parece que vicia"; a (des)obediência à prescrição médica; e o alívio. CONCLUSÃO: Os idosos entrevistados justificam o uso crônico de benzodiazepínicos como um paliativo para lidar com dificuldades existenciais decorrentes de situações culturais, sociais e familiares, as quais precisam ser abordadas nos serviços de saúde.
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Affiliation(s)
| | | | | | - Elizabeth Uchoa
- Fundação Oswaldo Cruz, Brasil; Fundação Oswaldo Cruz, Brasil
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Ivanets NN, Kinkulkina MA, Avdeeva TI, Tikhonova YG. Remote consequences of the long-term uncontrollable consumption of anxiolytics and hypnotics in elderly: a problem of drug dependence. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:47-59. [DOI: 10.17116/jnevro20151157147-59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ivanets NN, Kinkulkina MA, Avdeeva TI, Sysoeva VP. [Remote consequences of the long-term uncontrolled use of anxiolytic and hypnotic drugs by elderly patients: cognitive disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:50-64. [PMID: 26978494 DOI: 10.17116/jnevro201511511250-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Frequents cases (10-30% of the elderly population) of regular long-term use of anxiolytic and hypnotic drugs, in particular, benzodiazepines, without control of the physician is an urgent problem of medicine worldwide. Severe and irreversible cognitive impairment is a frequent and severe consequence of this use. Authors studied cognitive impairment in these cases. MATERIAL AND METHODS Patients were enrolled in the study from a psychiatric hospital. The study included 56 women, aged over 50 years, admitted to the hospital with the diagnosis of a mental disorder. Before admission, the patients regularly used benzodiazepines without a prescription for more than 2 months. Later on, anxiolytics were withdrawn during 1-5 days. The patients were studied during 4 weeks in the hospital. To assess the severity and dynamics of their condition, authors used MADRS, HAM-A, MMSE. RESULTS AND CONCLUSION Severe cognitive impairment, achieving the level of dementia, was found in 57.2% of the patients, mild or moderate of cognitive impairment was in 32.1% and only 10.7% had normal level of cognitive functioning. After 4 weeks of benzodiazepine withdrawal, the percentage of patients with dementia reduced to 21.4%, the severity of cognitive impairment was estimated as mild or moderate. A number of patients without cognitive impairment increased to 37.5%. The old age of patients was a significant negative predictor of the dynamics. An impact of the high anxiolytic dose was shown on trend level. The duration of a mental disorder and duration of uncontrollable consumption of anxiolytics and hypnotics did not exert an effect on the development and reversibility of cognitive impairment. A combination of anxiolytics with alcohol increased the risk of dementia and did not reverse the cognitive pathology.
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Affiliation(s)
- N N Ivanets
- Kafedra psihiatrii i narkologii GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva, Nauchno-issledovatel'skij otdel 'Psihicheskogo zdorov'ja' Nauchno-issledovatel'skogo tsentra GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva
| | - M A Kinkulkina
- Kafedra psihiatrii i narkologii GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva, Nauchno-issledovatel'skij otdel 'Psihicheskogo zdorov'ja' Nauchno-issledovatel'skogo tsentra GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva
| | - T I Avdeeva
- Kafedra psihiatrii i narkologii GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva, Nauchno-issledovatel'skij otdel 'Psihicheskogo zdorov'ja' Nauchno-issledovatel'skogo tsentra GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva
| | - V P Sysoeva
- Kafedra psihiatrii i narkologii GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva, Nauchno-issledovatel'skij otdel 'Psihicheskogo zdorov'ja' Nauchno-issledovatel'skogo tsentra GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva
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Alvarenga JM, Giacomin KC, de Loyola AI, Uchoa E, Firmo JOA. Chronic use of benzodiazepines among older adults. Rev Saude Publica 2014; 48:866-72. [PMID: 26039388 PMCID: PMC4285823 DOI: 10.1590/s0034-8910.2014048004986] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 05/26/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the perception of and motivation for the chronic use of benzodiazepine among older adults. METHODS A qualitative study was conducted on 22 older adults living in Bambuí, MG, Southeastern Brazil, who were taking benzodiazepines and had the clinical and cognitive ability to respond to interview questions. The collected data were analyzed on the basis of the "signs, meanings, and actions" model. RESULTS The main reasons pointed out for the use of benzodiazepines were "nervousness", "sleep problems", and "worry" due to family and financial problems, everyday problems, and existential difficulties. None of the interviewees said that they used benzodiazepines in a dose higher than that recommended or had been warned by health professionals about any risks of their continuous use. Different strategies were used to obtain the prescription for the medication, and any physician would prescribe it, indicating that a bond was established with the drug and not with the health professional or healthcare service. Obtaining and consuming the medication turned into a crucial issue because benzodiazepine assumes the status of an essential food, which leads users to not think but sleep. It causes a feeling of relief from their problems such as awareness of human finitude and fragility, existential difficulties, and family problems. CONCLUSIONS Benzodiazepine assumes the characteristics of polyvalence among older adults, which extrapolate specific clinical indications, and of essentiality to deal with life's problems in old age. Although it relieves the "nerves", the chronic use of benzodiazepines buffers suffering and prevents older adults from going through the suffering. This shows important difficulties in the organization and planning of strategies that are necessary for minimizing the chronic use in this population.
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Affiliation(s)
- Jussara Mendonça Alvarenga
- Programa de Pós-Graduação em Ciências da Saúde. Centro de Pesquisas René Rachou. Fundação Oswaldo Cruz. Belo Horizonte, MG, Brasil
| | - Karla Cristina Giacomin
- Secretaria Municipal de Saúde de Belo Horizonte. Gerência de Assistência. Belo Horizonte, MG, Brasil
- Núcleo de Estudos em Saúde Pública e Envelhecimento. Centro de Pesquisas René Rachou. Fundação Oswaldo Cruz
| | - Antônio Ignácio de Loyola
- Núcleo de Estudos em Saúde Pública e Envelhecimento. Centro de Pesquisas René Rachou. Fundação Oswaldo Cruz
- Departamento de Enfermagem Aplicada. Escola de Enfermagem. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Elizabeth Uchoa
- Núcleo de Estudos em Saúde Pública e Envelhecimento. Centro de Pesquisas René Rachou. Fundação Oswaldo Cruz
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Huang WS, Muo CH, Chang SN, Chang YJ, Tsai CH, Kao CH. Benzodiazepine use and risk of stroke: a retrospective population-based cohort study. Psychiatry Clin Neurosci 2014; 68:255-62. [PMID: 24829937 DOI: 10.1111/pcn.12117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to investigate the possible association between benzodiazepine (BZD) use and risk of incident stroke by utilizing data from 2000 to 2003 from the National Health Insurance system of Taiwan. METHODS Study subjects consisted of 38,671 patients with new BZD use and 38,663 people without BZD use who were frequency-matched for age, sex and baseline comorbidity with BZD users. All subjects had no history of stroke. Each study patient's case was followed until a new diagnosis of stroke was made or until the patient was censored by loss to follow up, death, or termination of insurance. The study lasted until the end of 2009. A Cox proportional hazards regression model was used to estimate the incidences and hazard ratios (HR) of stroke. RESULTS The HR of hemorrhagic stroke was significantly lower in the BZD group when compared with the non-BZD group. For patients aged 20-39 years, the HR of ischemic stroke was significantly higher in the BZD group when compared with the non-BZD group. Compared to the non-BZD group, patients with a lower annual dosage (<1 g) or duration (<30 days) of BZD use had a lower risk of stroke in the elder group (P < 0.0001) and patients with a higher annual dosage (≥ 4 g) or duration (≥ 95 days) of BZD use had a higher risk of stroke in all age groups (P < 0.0001). CONCLUSIONS Our findings may suggest neuroprotection under lower-dosage BZD use and neurotoxicity under higher-dosage BZD use.
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Affiliation(s)
- Wei-Shih Huang
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
| | | | | | - Yen-Jung Chang
- Management Office for Health Data; Taichung Taiwan
- Department of Health Promotion and Health Education; National Taiwan Normal University; Taipei Taiwan
| | - Chon-Haw Tsai
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
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Harnod T, Lin CL, Sung FC, Kao CH. An association between benzodiazepine use and occurrence of benign brain tumors. J Neurol Sci 2014; 336:8-12. [DOI: 10.1016/j.jns.2013.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/06/2013] [Accepted: 11/08/2013] [Indexed: 01/08/2023]
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Patients' and physicians' characteristics associated with the purchase of benzodiazepines by older primary care patients in Israel. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 40:117-23. [PMID: 22015399 DOI: 10.1007/s10488-011-0381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This study evaluated patients' and physicians' characteristics associated with the purchase of benzodiazepines by older primary care patients in Israel. The analytic sample consists of those 6,421 patients age 65 and older. We used multi-level analysis with whether or not benzodiazepines were purchased at least once between June 2005 and 2007 as an outcome. We also evaluated patients' and physicians' characteristics associated with the purchase of benzodiazepines for 6 months or longer. Almost half the sample (41.5%) purchased benzodiazepines at least once during the study period and more than half (54.5%) of those purchasing benzodiazepines had a continued purchase for 6 months or longer. Physicians' characteristics explained only a small portion of the variance associated with purchasing, whereas patients' demographic and clinical characteristics were associated with purchasing. Any intervention to improve the use of benzodiazepines should be directed at both patients and physicians.
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Leibing A, Collin J. The multiple anxieties of getting older: tranquilizers and the ambivalence of effect. Med Anthropol 2013; 32:399-416. [PMID: 23944243 DOI: 10.1080/01459740.2013.774394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Most studies on benzodiazepines emphasize overconsumption and warn of addiction, especially by older adults. This article is about the avoidance of benzodiazepine medications by 'aging' women living in a Brazilian village. This case study helps to support our central concern: to call attention to the ambiguities that exist in discussing these medications, and to stress the importance of a multilayered understanding of effect. We argue that benzodiazepines, like other psychopharmaka, induce bodily sensations that, at least in part, correspond to and are shaped by the situated self-image of individuals in distress.
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Affiliation(s)
- Annette Leibing
- Faculté des Sciences Infirmières, Université de Montréal, Montreal, Quebec, Canada.
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Noia AS, Secoli SR, Duarte YADO, Lebrão ML, Lieber NSR. Fatores associados ao uso de psicotrópicos por idosos residentes no Município de São Paulo. Rev Esc Enferm USP 2012; 46 Spec No:38-43. [DOI: 10.1590/s0080-62342012000700006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/18/2012] [Indexed: 11/22/2022] Open
Abstract
Os objetivos do estudo foram identificar a prevalência e os fatores associados ao uso de psicotrópicos entre os idosos do Município de São Paulo. Trata-se de um estudo transversal, de base populacional, cujos dados foram obtidos do Estudo Saúde, Bem-estar e Envelhecimento. A amostra foi constituída de 1.115 idosos de 65 anos ou mais, os quais foram entrevistados por meio de instrumento padronizado. Na análise dos dados utilizou-se regressão logística univariada e múltipla stepwise forward e nível de significância de 5%. A prevalência de uso de psicotrópicos foi 12,2% e os fatores associados foram sexo feminino (OR=3,04 IC95%=1,76-5,23) e polifarmácia (OR=4,91 IC95%=2,74-8,79). O uso de psicotrópicos por idosos deve ter sua avaliação risco-benefício muito bem estabelecida. Mulheres idosas, especialmente as submetidas à polifarmácia merecem atenção diferenciada, no ajuste posológico e tempo de tratamento, visando à minimização dos desfechos adversos a que estão sujeitas.
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Telles Filho PCP, Chagas ARD, Pinheiro MLP, Lima AMDJ, Durão AMS. Utilização de benzodiazepínicos por idosos de umaestratégia de saúde da família: implicações para enfermagem. ESCOLA ANNA NERY 2011. [DOI: 10.1590/s1414-81452011000300020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os benzodiazepínicos são medicamentos que podem causar riscos aos idosos. Este estudo teve como objetivo verificar e analisar a prevalência da utilização de benzodiazepínicos por idosos cadastrados em uma Estratégia Saúde da Família de Diamantina - Minas Gerais. Trata-se de estudo descritivo, realizado com 27 idosos, de maio a julho de 2010, por meio de questionário semiestruturado. Utilizou-se a análise descritiva junto aos dados. Como resultados, destacaram-se a faixa etária de 71 a 75 anos (25,92%), gênero feminino (88,88%) e, em relação à escolaridade, o primeiro grau incompleto (66,66%). Os medicamentos mais usados foram: Diazepam (37,03%), Clonazepam (25,92%), Bromazepam (18,51%) e Alprazolam (11,11%). 88,90% dos entrevistados possuíam receita e 11,10% não a possuíam. Dentre os idosos que possuíam receita, 33,33% não a seguiam. Faz-se presente a necessidade de reorganizar o processo de trabalho na instituição investigada, de forma que se propicie uma adequação das prescrições e um seguimento mais eficaz destas.
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Iqbal SP, Ahmer S, Farooq S, Parpio Y, Tharani A, Khan RAM, Zaman M. Benzodiazepine use among adults residing in the urban settlements of Karachi, Pakistan: a cross sectional study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2011; 6:19. [PMID: 21801457 PMCID: PMC3162550 DOI: 10.1186/1747-597x-6-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 08/01/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are hardly any studies carried out in Pakistan on the usage of benzodiazepines at the level of community. This research was aimed to determine the frequency of benzodiazepine use, along with its associations with socio-demographic and clinical characteristics among community dwelling adults, residing in two urban settlements of Karachi, Pakistan. METHODS We performed a cross sectional study from August 2008 to December 2009, in 2 areas of Karachi, namely Garden and Sultanabad. We followed the systematic sampling strategy to randomly select the households, with an adult of either sex and of age 18 years or more. Data collection was carried out through interview, using a pre-tested questionnaire, with items on socio-demographic position, medical history and benzodiazepine use. Student's t-test and χ2 test was employed to determine the associations between socio-demographic and clinical characteristics, and their relationship with benzodiazepine use was determined using applied logistic regression. RESULTS The overall percentage of benzodiazepine consumption was estimated to be 14%. There were significantly more benzodiazepine users in the peri-urban Sultanabad community to the urban community of Garden (p-value = 0.001). The mean age (± SD) for users was 51.3 (± 15.6) years compared to 37.1 (± 14.4) years among non-users. Bromazepam was the most widely used benzodiazepine (29%); followed by diazepam, with a median duration on primary use being 144 weeks (IQR = 48-240). The adjusted logistic regression model revealed that increasing age, location, female sex, unemployment and psychiatric consultation were associated with increased likelihood of benzodiazepine use. CONCLUSION We believe the unregulated over-the-counter sales of benzodiazepines and social conditions might be playing a role in this high consumption of benzodiazepines in the community.
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Affiliation(s)
- Saleem P Iqbal
- Department of Pediatrics & Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan.
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Firmino KF, Abreu MHNGD, Perini E, Magalhães SMS. Fatores associados ao uso de benzodiazepínicos no serviço municipal de saúde da cidade de Coronel Fabriciano, Minas Gerais, Brasil. CAD SAUDE PUBLICA 2011; 27:1223-32. [DOI: 10.1590/s0102-311x2011000600019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 04/26/2011] [Indexed: 11/21/2022] Open
Abstract
O uso inadequado de benzodiazepínicos é observado em diversos países. Este estudo transversal avaliou os fatores associados à prescrição de benzodiazepínicos para os usuários do Serviço Municipal de Saúde de Coronel Fabriciano, Minas Gerais, Brasil. A coleta de dados foi feita a partir da notificação das receitas (n = 1.866), entre setembro e outubro de 2006. Análises bivariada e multivariada, utilizando regressão de Poisson, foram executadas. O uso prolongado de benzodiazepínicos foi associado independentemente com o tipo de benzodiazepínico prescrito e cadastro em programas de saúde. O uso concomitante de outros psicofármacos foi associado independentemente com a idade e cadastro nos programas de saúde. O tipo de benzodiazepínico utilizado (Diazepam ou Clonazepam) esteve independentemente associado com a idade e sexo dos pacientes, bem como, com a participação em programas de saúde. Os fatores associados à prescrição de benzodiazepínicos evidenciam a amplitude do problema e devem ser considerados no planejamento de intervenções para a racionalização da utilização desses medicamentos no município, particularmente na organização dos programas de saúde.
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Bossé C, Préville M, Vasiliadis HM, Béland SG, Lapierre S. Suicidal Ideation, Death Thoughts, and Use of Benzodiazepines in the Elderly Population. ACTA ACUST UNITED AC 2011. [DOI: 10.7870/cjcmh-2011-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Cindy Bossé
- Université de Sherbrooke, and Charles LeMoyne Research Centre
| | - Michel Préville
- Université de Sherbrooke, and Charles LeMoyne Research Centre
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Rikala M, Korhonen MJ, Sulkava R, Hartikainen S. Psychotropic drug use in community-dwelling elderly people—characteristics of persistent and incident users. Eur J Clin Pharmacol 2011; 67:731-9. [DOI: 10.1007/s00228-011-0996-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/10/2011] [Indexed: 11/29/2022]
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Spanemberg L, Nogueira EL, da Silva CTB, Dargél AA, Menezes FS, Cataldo Neto A. High prevalence and prescription of benzodiazepines for elderly: data from psychiatric consultation to patients from an emergency room of a general hospital. Gen Hosp Psychiatry 2011; 33:45-50. [PMID: 21353127 DOI: 10.1016/j.genhosppsych.2010.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 12/08/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study is to compare the use and prescription of psychotropic drugs, with emphasis on benzodiazepines, in elderly and non-elderly patients who are assisted at the emergency room by a psychiatric consultation of a university teaching hospital. METHOD This is a cross-sectional study. We analyzed all records of psychiatric consultation in an emergency room of a general hospital from March 2009 until March 2010. Sociodemographic and clinical variables were compared between the group of elderly and non-elderly in two cutoff points (≥60 and ≥65 years), with emphasis on the use and prescription of benzodiazepines. RESULTS Five hundred seventy-five records were found with 71 elderly and 504 nonelderly for the first cutoff point and 51 elderly and 524 nonelderly in the second. Differences between groups were found in all sociodemographic variables (gender, marital status, education, current occupational status). Elderly patients treated at emergency rooms used more psychotropic drugs, particularly antidepressants and benzodiazepines, than non-elderly. About 25% of the patients received benzodiazepine treatment in the emergency setting, and there was no statistical difference between age groups. CONCLUSION There is a wide prevalence of benzodiazepine use among elderly patients in a psychiatric emergency service. Despite the recommendations for its judicious use, benzodiazepines were the most commonly used drug by psychiatrists on duty, regardless of patient's age. These results call for caution in prescribing these drugs and require alternatives to the treatment of psychiatric disorders in the elderly.
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Affiliation(s)
- Lucas Spanemberg
- Departament of Psychiatry, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
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Alvarenga JM, Loyola Filho AID, Firmo JOA, Lima-Costa MF, Uchoa E. A population based study on health conditions associated with the use of benzodiazepines among older adults (The Bambuí Health and Aging Study). CAD SAUDE PUBLICA 2009; 25:605-12. [PMID: 19300849 DOI: 10.1590/s0102-311x2009000300015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 04/16/2008] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to assess the health conditions and use of health services among elderly users of benzodiazepines. The study was carried out in the city of Bambuí in Minas Gerais State, Brazil. Of 1,742 inhabitants aged over 60, 1,419 participated in the study. Information about benzodiazepine and the use of other medications was obtained by means of interviews and checking medication packaging. After adjustments for confounding variables, benzodiazepine remained significantly associated with poorer self reported health (prevalence ratio = 1.94 and 2.04 for reasonable and bad/very bad health, respectively), common mental disorders (1.33), myocardial infarction (1.42), number of doctor visits in the previous 12 months (1.90 and 2.24 for 2-3 and 4+ visits, respectively) and concomitant use of other medications (1.84 and 1.83 for 2-4 and 5+ medications). The results showed that the factors associated with the use of benzodiazepine were similar to those observed in the elderly in higher income countries. The concomitant use of benzodiazepines and two or more medications was highly prevalent (59.5%), characterizing a situation of risk, which deserves attention as a public health problem.
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Affiliation(s)
- Jussara Mendonça Alvarenga
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Cunha M, Machado S, Miana LC, Machado D, Bastos VH, Velasques B, Cagy M, Basile LF, Piedade R, Ribeiro P. Effects of a cognitive modulator in the theta and alpha asymmetry during a typewriting task: a sensorimotor integration perspective. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:214-8. [DOI: 10.1590/s0004-282x2009000200008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 03/03/2009] [Indexed: 11/21/2022]
Abstract
This study aimed to elucidate cortical mechanisms and to identify the areas where occur such mechanisms due to interaction between bromazepam and motor learning. The sample was composed of 45 healthy subjects randomly distributed in 3 groups: placebo (n=15), bromazepam 3 mg (n=15) or bromazepam 6 mg (n=15). To perform the experimental task, subjects sat comfortably at a distance of approximately 20 cm from the typewriter. The typewriter keyboard was covered with a wooden box to avoid visual information about the hands' position. The typewriting task was performed concomitantly with EEG recording. ANOVA two-way results indicated a decreased asymmetry in sensorimotor areas in the experimental groups. Our interpretation is that moderate doses of bromazepam may improve performance on tasks with predictable elements to promote stability of psychomotor functions, but may also impair performance on tasks executed in unpredictable environments.
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Affiliation(s)
- Marlo Cunha
- Federal University of Rio de Janeiro, Brazil; Brazilian Institute of Neural Bioscience, Brazil
| | - Sergio Machado
- Federal University of Rio de Janeiro, Brazil; Brazilian Institute of Neural Bioscience, Brazil
| | | | | | - Victor Hugo Bastos
- Federal University of Rio de Janeiro, Brazil; Bennett METHODist School, Brazil; Brazilian Institute of Neural Bioscience, Brazil
| | - Bruna Velasques
- Federal University of Rio de Janeiro, Brazil; Brazilian Institute of Neural Bioscience, Brazil
| | | | - Luis F. Basile
- University of São Paulo, Brazil; Brazilian Institute of Neural Bioscience, Brazil
| | | | - Pedro Ribeiro
- Federal University of Rio de Janeiro, Brazil; UFRJ, Brazil; Brazilian Institute of Neural Bioscience, Brazil
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Cunha M, Portela C, Bastos VH, Machado D, Machado S, Velasques B, Budde H, Cagy M, Basile L, Piedade R, Ribeiro P. Responsiveness of sensorimotor cortex during pharmacological intervention with bromazepam. Neurosci Lett 2008; 448:33-6. [DOI: 10.1016/j.neulet.2008.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 09/19/2008] [Accepted: 10/07/2008] [Indexed: 11/30/2022]
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