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Singh NM, Daniel K, Balasanova AA. Impact of hospital-administered extended-release naltrexone on readmission rates for patients with alcohol use disorder. Intern Med J 2024. [PMID: 38984396 DOI: 10.1111/imj.16467] [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: 02/19/2024] [Accepted: 06/10/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND AND AIMS Alcohol use disorder (AUD) is a persistent public health concern, contributing significantly to mortality and morbidity. This study aims to evaluate the impact of in-hospital extended-release naltrexone (XR-NTX) administration on alcohol-related outcomes. METHODS This retrospective cohort study, conducted at an academic medical centre, included 141 adult patients with AUD who received XR-NTX between December 2020 and June 2021. Primary and secondary outcomes were assessed 90 days before and after XR-NTX administration to identify number of alcohol-related hospitalisations, emergency department (ED) visits and average length of hospital stay. Subgroup analyses assessed outcomes in high hospital utilisers and marginally housed or unhoused populations. RESULTS There was a significant decrease in ED visits and length of hospital stay post XR-NTX and no significant difference in the number of rehospitalisations. Subgroup analysis showed significant reduction in hospital readmissions and ED visits among high hospital utilisers. Our sample was a predominantly middle-aged, male and white patient population. CONCLUSIONS In-hospital initiation of XR-NTX for AUD was associated with a significant decrease in ED visits and length of hospital stay. While no significant impact on the number of hospitalisations was observed overall, there was a substantial reduction in hospital readmissions and ED visits among high utilisers. Our findings suggest the potential benefits of in-hospital XR-NTX, emphasising the need for further research to establish causal relationships, assess cost-effectiveness and explore effectiveness across diverse patient populations. Effective in-hospital interventions, such as XR-NTX, hold promise for improving patient outcomes and reducing the healthcare burden associated with AUD.
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Affiliation(s)
- Nathaniel M Singh
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kristin Daniel
- Division of Pharmaceutical and Nutrition Care, Nebraska Medicine, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Alёna A Balasanova
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Rosenstand NJ, Nielsen AS, Skøt L, Anhøj S, Nielsen DG, Højlund M, Mellentin AI. Pharmacological Treatment of Alcohol use Disorder in Patients with Psychotic Disorders: A Systematic Review. Curr Neuropharmacol 2024; 22:1129-1143. [PMID: 36582063 DOI: 10.2174/1570159x21666221229160300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with psychotic disorders (PD) often have comorbid alcohol use disorder (AUD), which is typically treated pharmacologically. Up till now, no systematic review has examined the effectiveness and safety of AUD treatment in PD patients. OBJECTIVES This study aimed to systematically review the literature on (1) the effects of pharmacological treatments for AUD on drinking outcomes, (2) the side effects of the drugs, and (3) the effects of polypharmacy in patients with comorbid AUD and PD. METHODS Bibliographic searches were conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO. At least two reviewers extracted the data, assessed the risk of bias, and performed the qualitative synthesis of the collected evidence. RESULTS Twelve eligible studies were identified, half being randomized controlled trials (RCTs). Three studies examined disulfiram, nine naltrexone, two acamprosate, and one nalmefene by comparing the effects of treatment to placebo, baseline, or pharmacological agents. Disulfiram and naltrexone were shown to reduce alcohol intake. Regarding acamprosate, the findings were mixed. Nalmefene decreased alcohol intake. All pharmacological agents appeared safe to use as AUD monotherapy, but cardiac events were reported when combining naltrexone and disulfiram. Nine studies had a high risk of bias, and three had some other concerns. CONCLUSION The studies provide tentative support for the use of naltrexone and disulfiram in this population, although combinations of pharmacological AUD treatments and other polypharmacy remain unexplored. The studies had high adherence rates that are hardly replicable in real-world settings. Thus, the findings should be confirmed in larger high quality efficacy and effectiveness RCTs with longer follow-ups.
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Affiliation(s)
- Niels Jørgen Rosenstand
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Psychiatry, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, Odense, Denmark
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Simon Anhøj
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Psychiatry, Region of Southern Denmark, Svendborg, Denmark
| | - Dorthe Grüner Nielsen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Drug Treatment Center Odense, Odense C, Denmark
| | - Mikkel Højlund
- Drug Treatment Center Odense, Odense C, Denmark
- Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark
| | - Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Department of Psychiatry, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
- Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense, Denmark
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Bodnar RJ. Endogenous opiates and behavior: 2021. Peptides 2023; 164:171004. [PMID: 36990387 DOI: 10.1016/j.peptides.2023.171004] [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: 02/26/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
This paper is the forty-fourth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2021 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonizts and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY 11367, USA.
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Martelli C, Artiges E, Miranda R, Romeo B, Petillion A, Aubin HJ, Amirouche A, Chanraud S, Benyamina A, Martinot JL. Caudate gray matter volumes and risk of relapse in Type A alcohol-dependent patients: A 7-year MRI follow-up study. Front Psychiatry 2023; 14:1067326. [PMID: 36873223 PMCID: PMC9975333 DOI: 10.3389/fpsyt.2023.1067326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Whether alteration in regional brain volumes can be detected in Type A alcoholics both at baseline and after a long follow-up remains to be confirmed. Therefore, we examined volume alterations at baseline, and longitudinal changes in a small follow-up subsample. METHODS In total of 26 patients and 24 healthy controls were assessed at baseline using magnetic resonance imaging and voxel-based morphometry, among which 17 patients and 6 controls were re-evaluated 7 years later. At baseline, regional cerebral volumes of patients were compared to controls. At follow-up, three groups were compared: abstainers (n = 11, more than 2 years of abstinence), relapsers (n = 6, <2 years of abstinence), and controls (n = 6). RESULTS The cross-sectional analyses detected, at both times, higher caudate nuclei volumes bilaterally in relapsers compared to abstainers. In abstainers, the longitudinal analysis indicated recovery of normal gray matter volumes in the middle and inferior frontal gyrus, and in the middle cingulate, while white matter volumes recovery was detected in the corpus callosum and in anterior and superior white matter specific regions. CONCLUSIONS Overall, the present investigation revealed larger caudate nuclei in the relapser AUD patient group both at baseline and at follow-up in the cross-sectional analyses. This finding suggest that a higher caudate volume could be a candidate risk factor of relapse. In patients with specific type A alcohol-dependence, we showed that long-term recovery in fronto-striato-limbic GM and WM volumes occurs during long-term abstinence. These results support the crucial role of frontal circuitry in AUD.
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Affiliation(s)
- Catherine Martelli
- Institut National de la Santé et de la Recherche Médicale (INSERM) Research Unit 1299 "Trajectoires développementales en psychiatrie", École Normale Supérieure Paris-Saclay, Université Paris-Saclay, Centre National de la Recherche Scientifique (CNRS) 9010, Centre Borelli, Gif-sur-Yvette, France.,Department of Psychiatry and Addictology, Assistance Publique - Hôpitaux de Paris, Paul-Brousse Hospital, Villejuif, France.,Psychiatry-Comorbidities-Addictions Research Unit (PSYCOMADD), Paris-Saclay University, Gif-sur-Yvette, France
| | - Eric Artiges
- Institut National de la Santé et de la Recherche Médicale (INSERM) Research Unit 1299 "Trajectoires développementales en psychiatrie", École Normale Supérieure Paris-Saclay, Université Paris-Saclay, Centre National de la Recherche Scientifique (CNRS) 9010, Centre Borelli, Gif-sur-Yvette, France.,Department of Psychiatry, Établissement Public de Santé (EPS) Barthélemy Durand, Etampes, France
| | - Rubén Miranda
- Institut National de la Santé et de la Recherche Médicale (INSERM) Research Unit 1299 "Trajectoires développementales en psychiatrie", École Normale Supérieure Paris-Saclay, Université Paris-Saclay, Centre National de la Recherche Scientifique (CNRS) 9010, Centre Borelli, Gif-sur-Yvette, France.,Department of Psychiatry and Addictology, Assistance Publique - Hôpitaux de Paris, Paul-Brousse Hospital, Villejuif, France.,Psychiatry-Comorbidities-Addictions Research Unit (PSYCOMADD), Paris-Saclay University, Gif-sur-Yvette, France
| | - Bruno Romeo
- Department of Psychiatry and Addictology, Assistance Publique - Hôpitaux de Paris, Paul-Brousse Hospital, Villejuif, France.,Psychiatry-Comorbidities-Addictions Research Unit (PSYCOMADD), Paris-Saclay University, Gif-sur-Yvette, France
| | - Amélie Petillion
- Department of Psychiatry and Addictology, Assistance Publique - Hôpitaux de Paris, Paul-Brousse Hospital, Villejuif, France.,Psychiatry-Comorbidities-Addictions Research Unit (PSYCOMADD), Paris-Saclay University, Gif-sur-Yvette, France
| | - Henri-Jean Aubin
- Department of Psychiatry and Addictology, Assistance Publique - Hôpitaux de Paris, Paul-Brousse Hospital, Villejuif, France.,Institut National de la Santé et de la Recherche Médicale Research Unit 1018, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Paris, France
| | - Ammar Amirouche
- Department of Psychiatry and Addictology, Assistance Publique - Hôpitaux de Paris, Paul-Brousse Hospital, Villejuif, France.,Psychiatry-Comorbidities-Addictions Research Unit (PSYCOMADD), Paris-Saclay University, Gif-sur-Yvette, France
| | - Sandra Chanraud
- Paris Sciences & Lettres (PSL) Research University-École Pratique des Hautes Études (EPHE), Paris, France.,Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) 5287, University of Bordeaux, Bordeaux, France
| | - Amine Benyamina
- Department of Psychiatry and Addictology, Assistance Publique - Hôpitaux de Paris, Paul-Brousse Hospital, Villejuif, France.,Psychiatry-Comorbidities-Addictions Research Unit (PSYCOMADD), Paris-Saclay University, Gif-sur-Yvette, France
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale (INSERM) Research Unit 1299 "Trajectoires développementales en psychiatrie", École Normale Supérieure Paris-Saclay, Université Paris-Saclay, Centre National de la Recherche Scientifique (CNRS) 9010, Centre Borelli, Gif-sur-Yvette, France
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Alcohol-Induced Oxidative Stress and the Role of Antioxidants in Alcohol Use Disorder: A Systematic Review. Antioxidants (Basel) 2022; 11:antiox11071374. [PMID: 35883865 PMCID: PMC9311529 DOI: 10.3390/antiox11071374] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 12/12/2022] Open
Abstract
Alcohol use disorder (AUD) is a highly prevalent, comorbid, and disabling disorder. The underlying mechanism of ethanol neurotoxicity and the involvement of oxidative stress is still not fully elucidated. However, ethanol metabolism has been associated with increased oxidative stress through alcohol dehydrogenase, the microsomal ethanol oxidation system, and catalase metabolic pathways. We searched the PubMed and genome-wide association studies (GWAS) catalog databases to review the literature systematically and summarized the findings focusing on AUD and alcohol abstinence in relation to oxidative stress. In addition, we reviewed the ClinicalTrials.gov resource of the US National Library of Medicine to identify all ongoing and completed clinical trials that include therapeutic interventions based on antioxidants. The retrieved clinical and preclinical studies show that oxidative stress impacts AUD through genetics, alcohol metabolism, inflammation, and neurodegeneration.
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