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Salomoni M, Missanelli A, Crescioli G, Lanzi C, Totti A, Losso L, Gitto S, Bonaiuti R, Vannacci A, Lombardi N, Mannaioni G. Real-world analysis on the use of gamma-hydroxybutyric acid for alcohol withdrawal syndrome in hospitalized patients with diagnosis of cirrhosis. Intern Emerg Med 2024:10.1007/s11739-024-03761-x. [PMID: 39249626 DOI: 10.1007/s11739-024-03761-x] [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: 02/15/2024] [Accepted: 08/28/2024] [Indexed: 09/10/2024]
Abstract
The present real-world analysis aimed to evaluate and describe the use of gamma-hydroxybutyric acid (GHB) for alcohol withdrawal syndrome (AWS) in hospitalized patients with diagnosis of liver cirrhosis. An 11-year observational retrospective study on patients affected by liver cirrhosis and alcohol use disorder (AUD) was performed using data from the Medical Toxicology Unit of Careggi University Hospital in Florence (Italy). A multivariate logistic regression was performed to estimate the probability of having a CIWA-Ar Max 3-4 during hospitalization, an AWS length > 36 h, a hospitalization > 9 days, and the probability of developing drowsiness. A total of 166 AUD patients were included, of these 77 received GHB (70.13% within the first day of hospitalization) and 89 were treated without GHB. The majority were ≥ 40 years of age (87.35%) and males (80.12%). GHB patients were more likely to have a CIWA-Ar Max 3-4 during hospitalization (OR 3.76 [CI 95% 1.02-13.85]), and a longer hospitalization (OR 3.08 [95% CI 1.23-7.71]). Early GHB administration decreased the probability of CIWA-Ar Max worsening (OR 0.06 [95% CI 0.01-0.49]). GHB dose ≥ 100 mg/kg was not associated with the occurrence of drowsiness. Patients exposed to other sedative agents were more likely to experience drowsiness (OR 7.22 [95% CI 1.46-35.61]). The present real-world analysis underlines that GHB could be a valuable and safe option for the management of AWS in AUD patients affected by liver cirrhosis, also when administered early and even at higher than recommended dosages.
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Affiliation(s)
- Monica Salomoni
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Andrea Missanelli
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy.
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.
| | - Cecilia Lanzi
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Arianna Totti
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Lorenzo Losso
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Guido Mannaioni
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
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Xiao T, Chen Y, Boisvert A, Cole M, Kimbrough A. Chronic Intermittent Ethanol Vapor Exposure Paired with Two-Bottle Choice to Model Alcohol Use Disorder. J Vis Exp 2023:10.3791/65320. [PMID: 37427930 PMCID: PMC11164185 DOI: 10.3791/65320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Alcohol use disorder (AUD) is a chronic alcohol-related disorder that typically presents as uncontrolled drinking and preoccupation with alcohol. A key component of AUD research is using translationally relevant preclinical models. Over the past several decades, a variety of animal models have been used to study AUD. One prominent model of AUD is the chronic intermittent ethanol vapor exposure (CIE) model, which is a well-established approach for inducing alcohol dependence in rodents through repeated cycles of ethanol exposure via inhalation. To model AUD in mice, the CIE exposure is paired with a voluntary two-bottle choice (2BC) of alcohol drinking and water to measure the escalation of alcohol drinking. The 2BC/CIE procedure involves alternating weeks of 2BC drinking and CIE, which repeat until the escalation of alcohol drinking is achieved. In the present study, we outline the procedures for performing 2BC/CIE, including the daily use of the CIE vapor chamber, and provide an example of escalated alcohol drinking in C57BL/6J mice using this approach.
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Affiliation(s)
- Tiange Xiao
- Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University
| | - Yueyi Chen
- Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University
| | - Alyssa Boisvert
- Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University
| | | | - Adam Kimbrough
- Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University; Purdue Institute for Integrative Neuroscience; Weldon School of Biomedical Engineering, Purdue University; Purdue Institute of Inflammation, Immunology, and Infectious Disease;
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Motta-Ochoa R, Incio-Serra N, Brulotte A, Flores-Aranda J. Motives for alcohol use, risky drinking patterns and harm reduction practices among people who experience homelessness and alcohol dependence in Montreal. Harm Reduct J 2023; 20:22. [PMID: 36829166 PMCID: PMC9955533 DOI: 10.1186/s12954-023-00757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND People experiencing homelessness are disproportionately affected by harms related to alcohol use. Indeed, their alcohol dependence is associated with numerous physical and mental health problems along with strikingly high rates of alcohol-related mortality. Recent research has extensively examined alcohol use patterns among people experiencing homelessness in an effort to develop interventions and treatments for this problem. However, only a few studies have incorporated the perspectives of the individuals under study about their drinking or examined the ways in which they manage the associated harms. To bridge this gap, we conducted a qualitative study exploring the relation between the drinking motives, risky drinking patterns and harm reduction practices of a group of people (n = 34) experiencing homelessness in Montreal, Canada. METHODS The qualitative methods we used consisted of semi-structured interviews (n = 12) and focus groups (n = 2, with a total of 22 participants). The content of the collected data was then analyzed. RESULTS Participants identified their various motives for alcohol use (coping with painful memories, dealing with harsh living conditions, socializing/seeking a sense of belonging, enjoying themselves/having fun); their risky drinking patterns (binge drinking, mixing alcohol with drugs, non-beverage alcohol drinking, failing to keep sufficient alcohol on hand to prevent acute withdrawal, drinking in public settings); their harm reduction practices (planning how much to drink, keeping a supply of alcohol to prevent acute withdrawal, hiding to drink, concealing alcohol, drinking alone, drinking/hanging out with others, drinking non-beverage alcohol, and taking benzodiazepines, cocaine or other stimulant drugs); and the rationales underpinning their alcohol use and harm reduction practices. CONCLUSION Associating the drinking motives of a group of study participants with their risky drinking patterns and harm reduction practices shed light on their rationales for alcohol use, yielding insights that could be used to better tailor policies and interventions to their needs.
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Affiliation(s)
- Rossio Motta-Ochoa
- grid.38678.320000 0001 2181 0211École de travail social, Université du Québec à Montréal, 455 René-Lévesque Blvd. Est Local W-4020, Montreal, QC H2L 4Y2 Canada ,grid.14848.310000 0001 2292 3357École de travail social, Université de Montréal, Pavillon Lionel-Groulx, 3150 Jean-Brillant Street (C-7075), Montreal, QC H3T 1J7 Canada ,Canada Research Chair in Sexually and Gender Diverse Individuals (SGD) and Their Psychoactive Substance Use Trajectories (TRADIS Chair), Montreal, Canada
| | - Natalia Incio-Serra
- grid.14709.3b0000 0004 1936 8649Faculty of Education, McGill University, 3700 McTavish Street, Montreal, QC H3A 1Y2 Canada
| | - Alexandre Brulotte
- grid.38678.320000 0001 2181 0211École de travail social, Université du Québec à Montréal, 455 René-Lévesque Blvd. Est Local W-4020, Montreal, QC H2L 4Y2 Canada ,Canada Research Chair in Sexually and Gender Diverse Individuals (SGD) and Their Psychoactive Substance Use Trajectories (TRADIS Chair), Montreal, Canada
| | - Jorge Flores-Aranda
- École de travail social, Université du Québec à Montréal, 455 René-Lévesque Blvd. Est Local W-4020, Montreal, QC, H2L 4Y2, Canada. .,Canada Research Chair in Sexually and Gender Diverse Individuals (SGD) and Their Psychoactive Substance Use Trajectories (TRADIS Chair), Montreal, Canada.
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Chand PK, Panda U, Mahadevan J, Murthy P. Management of Alcohol Withdrawal Syndrome in Patients with Alcoholic Liver Disease. J Clin Exp Hepatol 2022; 12:1527-1534. [PMID: 36340306 PMCID: PMC9630022 DOI: 10.1016/j.jceh.2022.03.003] [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: 01/11/2022] [Accepted: 03/13/2022] [Indexed: 12/12/2022] Open
Abstract
Alcohol withdrawal syndrome (AWS) is a common condition that is seen in treatment-seeking patients with Alcohol use disorder (AUD) and alcoholic liver disease (ALD). AWS, which typically starts within 4-6 h of the last alcohol use, can range from mild symptoms such as insomnia, tremors, and autonomic hyperactivity to more severe symptoms such as seizures and delirium tremens. Clinical Institute Withdrawal Assessment Scale-Alcohol Revised (CIWA-Ar) is the most commonly used scale to assess AWS in clinical practice. The presence of moderate withdrawal as indicated by a score of more than 8 is an indication for pharmacotherapy. Lorazepam and oxazepam are preferred agents for the management of AWS in the setting of ALD. In severe ALD, benzodiazepines should be used cautiously with monitoring due to the risk of excessive sedation or precipitating hepatic encephalopathy.
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Key Words
- ALD, alcoholic liver disease
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- AUD, alcohol use disorder
- AUDIT – C, Alcohol Use Disorder Identification Test – Consumption
- AUDIT, Alcohol Use Disorder Identification Test
- AWS, alcohol withdrawal syndrome
- CIWA – Ar, Clinical Institute Withdrawal Assessment for Alcohol Revised
- CNS, central nervous system
- EtG, ethyl glucuronide
- EtS, ethyl sulphate
- GABA, gamma-aminobutyric acid
- GGT, gamma glutamyl transferase
- HE, hepatic encephalopathy
- MCV, mean corpuscular volume
- NMDA, N-methyl-d-aspartate
- alcohol
- alcoholic liver disease
- assessment
- treatment
- withdrawal
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Affiliation(s)
- Prabhat Kumar Chand
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Udit Panda
- Kalinga Institute of Medical Sciences, Bhubaneshwar, India
| | - Jayant Mahadevan
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bangalore, India
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5
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Maguire D, Burns A, Talwar D, Catchpole A, Stefanowicz F, Ross DP, Galloway P, Ireland A, Robson G, Adamson M, Orr L, Kerr JL, Roussis X, Colgan E, Forrest E, Young D, McMillan DC. Randomised trial of intravenous thiamine and/or magnesium sulphate administration on erythrocyte transketolase activity, lactate concentrations and alcohol withdrawal scores. Sci Rep 2022; 12:6941. [PMID: 35484175 PMCID: PMC9051209 DOI: 10.1038/s41598-022-10970-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/08/2022] [Indexed: 02/06/2023] Open
Abstract
Alcohol withdrawal syndrome (AWS) occurs in 2% of patients admitted to U.K. hospitals. Routine treatment includes thiamine and benzodiazepines. Laboratory studies indicate that thiamine requires magnesium for optimal activity, however this has not translated into clinical practice. Patients experiencing AWS were randomized to three groups: (group 1) thiamine, (group 2) thiamine plus MgSO4 or (group 3) MgSO4. Pre- and 2-h post-treatment blood samples were taken. AWS severity was recorded using the Glasgow Modified Alcohol Withdrawal Score (GMAWS). The primary outcome measure was 15% change in erythrocyte transketolase activity (ETKA) in group 3. Secondary outcome measures were change in plasma lactate concentrations and time to GMAWS = 0. 127 patients were recruited, 115 patients were included in the intention-to-treat analysis. Pre-treatment, the majority of patients had normal or high erythrocyte thiamine diphosphate (TDP) concentrations (≥ 275–675/> 675 ng/gHb respectively) (99%), low serum magnesium concentrations (< 0.75 mmol/L) (59%), and high plasma lactate concentrations (> 2 mmol/L) (67%). Basal ETKA did not change significantly in groups 1, 2 or 3. Magnesium deficient patients (< 0.75 mmol/L) demonstrated less correlation between pre-treatment basal ETKA and TDP concentrations than normomagnesemic patients (R2 = 0.053 and R2 = 0.236). Median plasma lactate concentrations normalized (≤ 2.0 mmol/L) across all three groups (p < 0.001 for all groups), but not among magnesium deficient patients in group 1 (n = 22). The median time to achieve GMAWS = 0 for groups 1, 2 and 3 was 10, 5.5 and 6 h respectively (p < 0.001).
No significant difference was found between groups for the primary endpoint of change in ETKA. Co-administration of thiamine and magnesium resulted in more consistent normalization of plasma lactate concentrations and reduced duration to achieve initial resolution of AWS symptoms. ClinicalTrials.gov: NCT03466528.
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Affiliation(s)
- Donogh Maguire
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK. .,Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Alana Burns
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Govan, G51 4TF, UK
| | - Dinesh Talwar
- The Scottish Trace Element and Micronutrient Diagnostic Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Anthony Catchpole
- The Scottish Trace Element and Micronutrient Diagnostic Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Fiona Stefanowicz
- The Scottish Trace Element and Micronutrient Diagnostic Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, UK
| | - David P Ross
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Peter Galloway
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Govan, G51 4TF, UK
| | - Alastair Ireland
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Gordon Robson
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Michael Adamson
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Lesley Orr
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Joanna-Lee Kerr
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Xenofon Roussis
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Eoghan Colgan
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Ewan Forrest
- Department of Gastroenterology and Hepatology, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Richmond Street, Glasgow, G1 1XH, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
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6
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Seo Y, Lee HJ, Ha EJ, Ha TS. 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit. Acute Crit Care 2022; 37:1-25. [PMID: 35279975 PMCID: PMC8918705 DOI: 10.4266/acc.2022.00094] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/22/2022] [Indexed: 01/12/2023] Open
Abstract
We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.
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7
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Papanna B, Lazzari C, Kulkarni K, Perumal S, Nusair A. Pregabalin abuse and dependence during insomnia and protocol for short-term withdrawal management with diazepam: examples from case reports. Sleep Sci 2022; 14:193-197. [PMID: 35082992 PMCID: PMC8764940 DOI: 10.5935/1984-0063.20200129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/19/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Pregabalin (PGN) is an anxiolytic, analgesic, antiepileptic, and hypnotic medication. There are concerns about its abuse in the community for managing chronic insomnia and other risks when assumed in overdose or combination with other abuse substances. PGN is classified as a controlled medication. While its discontinuation is accompanied by rebound insomnia and other neurological symptoms, cross-tapering PGN with short-term diazepam (DZ) during inpatient admissions has shown promising results in dealing with PGN withdrawal symptoms accompanied by rebound insomnia. Material and Methods: We report three cases that began abusing their prescribed PGN. During hospital admission, our teams used a protocol for cross-tapering PGN with DZ to reduce withdrawal symptoms. Other sedative medications are suspended while alcohol is not allowed if patients are on leave from the hospital. Standardized scales for assessment were clinical global impression scale-severity (CGI-S), generalized anxiety disorder scale (GAD-7), and insomnia severity index (ISI). Results: The cross-tapering PGN with DZ showed similar clinical outcomes with reduced withdrawal symptoms and rebound insomnia during two weeks of cross-tapering. Eventually, DZ, too, is stopped in the hospital to avoid another dependence syndrome. Conclusion: As emerging in the current study, PGN has strong addictive effects in people who have insomnia and is mostly abused for its hypnotic or sleep-inducing properties when other medications have failed. As applied in the current study, DZ can manage PGN withdrawal symptoms with rebound insomnia while cross-tapering. DZ is then discontinued.
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Affiliation(s)
- Basavaraja Papanna
- Essex Partnership University NHS Foundation Trust, Psychiatry - Colchester - Essex - United Kingdom
| | - Carlo Lazzari
- South-West Yorkshire NHS Trust, Psychiatric Intensive Care Unit - Wakefield - South Yorkshire - United Kingdom
| | - Kapil Kulkarni
- Essex Partnership University NHS Foundation Trust, Psychiatry - Colchester - Essex - United Kingdom
| | - Sivasankar Perumal
- Essex Partnership University NHS Foundation Trust, Psychiatry - Colchester - Essex - United Kingdom
| | - Abdul Nusair
- South-West Yorkshire NHS Trust, Psychiatric Intensive Care Unit - Wakefield - South Yorkshire - United Kingdom
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8
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Skryabin VY, Zastrozhin M, Torrado M, Grishina E, Ryzhikova K, Shipitsyn V, Galaktionova T, Sorokin A, Bryun E, Sychev D. Effects of CYP2C19*17 Genetic Polymorphisms on the Steady-State Concentration of Diazepam in Patients With Alcohol Withdrawal Syndrome. Hosp Pharm 2021; 56:592-596. [PMID: 34720165 DOI: 10.1177/0018578720931756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Diazepam is one of the most widely prescribed tranquilizers for the therapy of alcohol withdrawal syndrome (AWS), which includes the symptoms of anxiety, fear, and emotional tension. However, diazepam therapy often turns out to be ineffective, and some patients experience dose-dependent adverse drug reactions, reducing the efficacy of therapy. Aim: The purpose of our study was to investigate the effects of CYP2C19*17 genetic polymorphisms on the steady-state concentration of diazepam in patients with AWS. Materials and Methods: The study was conducted on 50 Russian male patients suffering from the AWS. For the therapy of psychomotor agitation, anxiety, fear, and emotional tension, patients received diazepam in injections at a dosage of 30.0 mg/day for 5 days. Genotyping was performed by real-time polymerase chain reaction. The efficacy and safety assessment was performed using psychometric scales and scales for assessing the severity of adverse drug reactions. Therapeutic drug monitoring (TDM) was performed using the high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS) method. Results: Based on the results of the study, we revealed the differences in the efficacy of therapy in patients with different CYP2C19 -806C>T genotypes: (*1/*1) -12.0 [-15.0; -8.0], (*1/*17+*17/*17) -7.0 [-14.0; -5.0], P < .001, as well as the results of TDM: (CC) 250.70 [213.34; 308.53] ng/mL (*1/*17+*17/*17) 89.12 [53.26; 178.07] ng/mL, P < .001. Conclusion: Thus, our study enrolling 50 patients with AWS, showed the effects of CYP2C19*17 genetic polymorphisms on the efficacy and safety rates of diazepam. Furthermore, we revealed the statistically significant difference in the levels of plasma steady-state concentrations of diazepam in patients carrying different genotypes.
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Affiliation(s)
| | - Mikhail Zastrozhin
- Moscow Department of Healthcare, Moscow, Russia.,Ministry of Health of the Russian Federation, Moscow, Russia
| | | | - Elena Grishina
- Ministry of Health of the Russian Federation, Moscow, Russia
| | | | | | | | | | - Evgeny Bryun
- Moscow Department of Healthcare, Moscow, Russia.,Ministry of Health of the Russian Federation, Moscow, Russia
| | - Dmitry Sychev
- Ministry of Health of the Russian Federation, Moscow, Russia
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9
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Carrarini C, Russo M, Dono F, Barbone F, Rispoli MG, Ferri L, Di Pietro M, Digiovanni A, Ajdinaj P, Speranza R, Granzotto A, Frazzini V, Thomas A, Pilotto A, Padovani A, Onofrj M, Sensi SL, Bonanni L. Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions. Front Neurol 2021; 12:644317. [PMID: 33935943 PMCID: PMC8085397 DOI: 10.3389/fneur.2021.644317] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/12/2021] [Indexed: 01/11/2023] Open
Abstract
Agitation is a behavioral syndrome characterized by increased, often undirected, motor activity, restlessness, aggressiveness, and emotional distress. According to several observations, agitation prevalence ranges from 30 to 50% in Alzheimer's disease, 30% in dementia with Lewy bodies, 40% in frontotemporal dementia, and 40% in vascular dementia (VaD). With an overall prevalence of about 30%, agitation is the third most common neuropsychiatric symptoms (NPS) in dementia, after apathy and depression, and it is even more frequent (80%) in residents of nursing homes. The pathophysiological mechanism underlying agitation is represented by a frontal lobe dysfunction, mostly involving the anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC), respectively, meaningful in selecting the salient stimuli and subsequent decision-making and behavioral reactions. Furthermore, increased sensitivity to noradrenergic signaling has been observed, possibly due to a frontal lobe up-regulation of adrenergic receptors, as a reaction to the depletion of noradrenergic neurons within the locus coeruleus (LC). Indeed, LC neurons mainly project toward the OFC and ACC. These observations may explain the abnormal reactivity to weak stimuli and the global arousal found in many patients who have dementia. Furthermore, agitation can be precipitated by several factors, e.g., the sunset or low lighted environments as in the sundown syndrome, hospitalization, the admission to nursing residencies, or changes in pharmacological regimens. In recent days, the global pandemic has increased agitation incidence among dementia patients and generated higher distress levels in patients and caregivers. Hence, given the increasing presence of this condition and its related burden on society and the health system, the present point of view aims at providing an extensive guide to facilitate the identification, prevention, and management of acute and chronic agitation in dementia patients.
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Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Filomena Barbone
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marianna G Rispoli
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Anna Digiovanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Paola Ajdinaj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Rino Speranza
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Alberto Granzotto
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Mind Impairments and Neurological Disorders-iMIND, University of California, Irvine, Irvine, CA, United States
| | - Valerio Frazzini
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institut du Cerveau et de la Moelle épinière, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié Salpêtrière Hospital, Paris, France.,AP-HP, GH Pitie-Salpêtrière-Charles Foix, Epilepsy Unit and Neurophysiology Department, Paris, France
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Parkinson's Disease Rehabilitation Centre, FERB ONLUS-S. Isidoro Hospital, Trescore Balneario, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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10
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Barkley-Levenson AM, Lee A, Palmer AA. Genetic and Pharmacological Manipulations of Glyoxalase 1 Mediate Ethanol Withdrawal Seizure Susceptibility in Mice. Brain Sci 2021; 11:127. [PMID: 33478138 PMCID: PMC7835754 DOI: 10.3390/brainsci11010127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/03/2022] Open
Abstract
Central nervous system (CNS) hyperexcitability is a clinically significant feature of acute ethanol withdrawal. There is evidence for a genetic contribution to withdrawal severity, but specific genetic risk factors have not been identified. The gene glyoxalase 1 (Glo1) has been previously implicated in ethanol consumption in mice, and GLO1 inhibition can attenuate drinking in mice and rats. Here, we investigated whether genetic and pharmacological manipulations of GLO1 activity can also mediate ethanol withdrawal seizure severity in mice. Mice from two transgenic lines overexpressing Glo1 on different genetic backgrounds (C57BL/6J (B6) and FVB/NJ (FVB)) were tested for handling-induced convulsions (HICs) as a measure of acute ethanol withdrawal. Following an injection of 4 g/kg alcohol, both B6 and FVB mice overexpressing Glo1 showed increases in HICs compared to wild-type littermates, though only the FVB line showed a statistically significant difference. We also administered daily ethanol injections (2 g/kg + 9 mg/kg 4-methylpyrazole) to wild-type B6 mice for 10 days and tested them for HICs on the 10th day following treatment with either a vehicle or a GLO1 inhibitor (S-bromobenzylglutathione cyclopentyl diester (pBBG)). Treatment with pBBG reduced HICs, although this effect was only statistically significant following two 10-day cycles of ethanol exposure and withdrawal. These results provide converging genetic and pharmacological evidence that GLO1 can mediate ethanol withdrawal seizure susceptibility.
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Affiliation(s)
- Amanda M. Barkley-Levenson
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; (A.L.); (A.A.P.)
| | - Amy Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; (A.L.); (A.A.P.)
| | - Abraham A. Palmer
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; (A.L.); (A.A.P.)
- Institute for Genomic Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
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11
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Wang G, Weber-Fahr W, Frischknecht U, Hermann D, Kiefer F, Ende G, Sack M. Cortical Glutamate and GABA Changes During Early Abstinence in Alcohol Dependence and Their Associations With Benzodiazepine Medication. Front Psychiatry 2021; 12:656468. [PMID: 34290627 PMCID: PMC8287125 DOI: 10.3389/fpsyt.2021.656468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
In this report, we present cross-sectional and longitudinal findings from single-voxel MEGA-PRESS MRS of GABA as well as Glu, and Glu + glutamine (Glx) concentrations in the ACC of treatment-seeking alcohol-dependent patients (ADPs) during detoxification (first 2 weeks of abstinence). The focus of this study was to examine whether the amount of benzodiazepine administered to treat withdrawal symptoms was associated with longitudinal changes in Glu, Glx, and GABA. The tNAA levels served as an internal quality reference; in agreement with the vast majority of previous reports, these levels were initially decreased and normalized during the course of abstinence in ADPs. Our results on Glu and Glx support hyperglutamatergic functioning during alcohol withdrawal, by showing higher ACC Glu and Glx levels on the first day of detoxification in ADPs. Withdrawal severity is reflected in cumulative benzodiazepine requirements throughout the withdrawal period. The importance of withdrawal severity for the study of GABA and Glu changes in early abstinence is emphasized by the benzodiazepine-dependent Glu, Glx, and GABA changes observed during the course of abstinence.
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Affiliation(s)
- Guoying Wang
- Department of Neuroimaging, Central Institute of Mental Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Wolfgang Weber-Fahr
- Department of Neuroimaging, Central Institute of Mental Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Ulrich Frischknecht
- Department of Addiction Medicine and Addictive Behavior, Central Institute of Mental Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany.,German Institute of Addiction and Prevention Research, Catholic University of Applied Sciences, Cologne, Germany
| | - Derik Hermann
- Department of Addiction Medicine and Addictive Behavior, Central Institute of Mental Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany.,Therapieverbund Ludwigsmühle, Landau in der Pfalz, Germany
| | - Falk Kiefer
- Department of Addiction Medicine and Addictive Behavior, Central Institute of Mental Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Markus Sack
- Department of Neuroimaging, Central Institute of Mental Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
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12
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Moore TA. Ambulatory detoxification in alcohol use disorder and opioid use disorder. Ment Health Clin 2020; 10:307-316. [PMID: 33224688 PMCID: PMC7653729 DOI: 10.9740/mhc.2020.11.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ambulatory detoxification in alcohol use disorder and opioid use disorder is an important component in the management of patients experiencing withdrawal symptoms from alcohol or opioids. The goal of withdrawal management is ultimately to provide each patient with comfort and safety. Having the knowledge of the possible signs and symptoms of intoxication and withdrawal assists providers to institute the most appropriate treatment protocol and setting for the patient. Pharmacists play a vital role in choosing appropriate therapeutic management options for common or complex clinical situations involving ambulatory detoxification from alcohol and opioids. Ambulatory detoxification serves as an appealing option to many patients and helps save the limited inpatient resources that many institutions have for those patients with more severe withdrawal presentations.
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13
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Volney GS, Scatena R. Continuous Intravenous Flumazenil Infusion Used in Iatrogenic Chlordiazepoxide Overdose in the Setting of Alcoholic Withdrawal Syndrome Management. Cureus 2020; 12:e10648. [PMID: 33133818 PMCID: PMC7586353 DOI: 10.7759/cureus.10648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chlordiazepoxide is a benzodiazepine that is widely used in the treatment of alcohol withdrawal syndrome (AWS). Flumazenil is a competitive antagonist at the benzodiazepine receptor site and is the drug of choice for the treatment of benzodiazepine overdose. Reversal of benzodiazepine overdose is usually achieved by the use of a flumazenil bolus; however, the continuous infusion has been used when concomitant medical conditions may lead to delayed metabolism of the benzodiazepine involved. We present a patient with AWS, with inadvertent chlordiazepoxide overdose treated effectively with a prolonged flumazenil infusion.
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Affiliation(s)
| | - Robyn Scatena
- Pulmonary and Critical Care, Norwalk Hospital, Norwalk, USA
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14
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Ferreira ADS, Sodré MLG, Cristina Ferreira MCF, Marinho SF, Fernandes MA, Rodrigues MDS, Belfort IKP, Monteiro SCM. Perfil farmacoterapêutico em um Centro de Atenção Psicossocial Álcool e Drogas (CAPS-ad) do Nordeste brasileiro. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i3.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivo: Verificar o perfil farmacoterapêutico de usuários de um Centro de Atenção Psicossocial Álcool e Drogas de Drogas (CAPS-ad) de uma capital do nordeste brasileiro. Métodos: Estudo exploratório, descritivo, retrospectivo com abordagem quantitativa, realizado em usuários de drogas maiores de 18 anos, sem distinção de sexo e etnia. Os dados (medicamentos, diagnóstico clínico, uso de drogas ilícitas, entre outros) foram coletados dos prontuários do serviço. A análise foi realizada por meio de estatística descritiva (frequências absoluta e relativa, média e desvio padrão). Resultados: Foram analisados 60 prontuários de pacientes em acompanhamento no CAPS-ad, sendo 83,3% do sexo masculino, com predomínio de pacientes com faixa etária entre 30 a 39 anos (35%), ensino fundamental incompleto (40%) e diagnóstico CID-10 F19 (transtornos mentais e comportamentais devidos ao uso de múltiplas drogas e ao uso de outras substâncias psicoativas; 45%). A classe medicamentosa mais prescrita foi a dos benzodiazepínicos (23,8%), sendo preponderante o uso do princípio ativo clonazepam (15,4%), seguida dos antidepressivos (16,1%), com a amitriptilina (4,9%) sendo o mais prescrito quando comparado com outros da mesma classe. Conclusão: O estudo permitiu ressaltar a importância do papel do farmacêutico junto à equipe de saúde visando promover o uso racional dos medicamentos bem como o controle das reações adversas e êxito na terapia medicamentosa.
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15
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El Azab IH, Elkanzi NA. An Efficient Synthetic Approach Towards Benzo[ b]pyrano[2,3- e][1,4]diazepines, and Their Cytotoxic Activity. Molecules 2020; 25:molecules25092051. [PMID: 32354014 PMCID: PMC7248725 DOI: 10.3390/molecules25092051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 02/07/2023] Open
Abstract
In search of unprecedented tri and/or tetrapod pharmacophoric conjugates, a series of 32 new 4-ethyl-1H-benzo[b][1,4]diazepin-2(3H)-ones were synthesized and properly elucidated using MS, IR, NMR, and elemental analysis. In vitro investigation of 11 compounds of this series, using a panel of two human tumor cell lines namely; human breast adenocarcinoma (MCF-7), and human colorectal carcinoma (HCT-116), revealed promising cytotoxic activities. Among all synthesized compounds, analogue 9 displayed maximum cytotoxicity with IC50 values of 16.19 ± 1.35 and 17.16 ± 1.54 μM against HCT-116 and MCF-7, respectively, compared to standard drug doxorubicin.
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Affiliation(s)
- Islam H. El Azab
- Chemistry Department, Faculty of Science, Taif University, Al-Haweiah, P.O. Box 888, Taif 21974, Saudi Arabia
- On leave from Chemistry Department, Faculty of Science, Aswan University, Aswan, P.O. Box, Aswan 81528, Egypt;
- Correspondence: or ; Tel.: +966-543-350-861
| | - Nadia A.A. Elkanzi
- On leave from Chemistry Department, Faculty of Science, Aswan University, Aswan, P.O. Box, Aswan 81528, Egypt;
- Chemistry Department, College of Science, Jouf University, P.O. Box 2014, Sakaka, Saudi Arabia
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16
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Abstract
Age and body mass index are associated with increased risks of overactive bladder, whereas employment status is associated with a decreased risk of overactive bladder. Objective The purpose of this study was to investigate the risk factors of overactive bladder (OAB). Methods The PubMed, Embase, and Cochrane Library databases were retrieved through May 2016. Odds ratios (OR) or standard mean differences (SMDs) with 95% confidence intervals (CIs) were used to evaluate the associations between risk factors and OAB. Heterogeneity among studies was examined using χ2 test based on the Q and I2 tests. Results A total of 28 articles were analyzed in our study. The results suggested that age and body mass index were significantly higher in OAB patients than in non-OAB controls (SMDs [95% CIs], 0.30 [0.19–0.41] and 0.39 [0.24–0.53]). A significant negative association was found between employment status and OAB (OR [95% CIs], 0.64 [0.46–0.90]). However, sex, educational level, parity, vaginal delivery, race, menopause, marital status, smoking, and alcohol consumption were not significantly different in OAB and non-OAB control patients (ORs [95% CIs], 0.95 [0.59–1.55], 1.04 [0.82, 1.33], 0.98 [0.56–1.70], 1.66 [0.90–3.07], 0.98 [0.75–1.28], 1.84 [0.23–14.70], 0.97 [0.78–1.19], 0.91 [0.77–1.08], and 0.88 [0.71–1.09], respectively). In addition, the number of parities and vaginal deliveries in OAB patients also showed no significant differences compared with non-OAB control patients (SMDs [95% CI], 0.05 [−0.27 to 0.38] and −0.16 [0.40 to 0.09]). Conclusions This meta-analysis suggests that age and body mass index are associated with increased risks of OAB, whereas employment status is associated with a decreased risk of OAB. Further prospective studies with large sample sizes are needed to confirm this conclusion.
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17
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Knox J, Hasin DS, Larson FRR, Kranzler HR. Prevention, screening, and treatment for heavy drinking and alcohol use disorder. Lancet Psychiatry 2019; 6:1054-1067. [PMID: 31630982 PMCID: PMC6883141 DOI: 10.1016/s2215-0366(19)30213-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
Abstract
Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.
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Affiliation(s)
- Justin Knox
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | | | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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18
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Andaluz A, DeMoss D, Claassen C, Blair S, Hsu J, Bakre S, Khan M, Atem F, Rush AJ. Fixed-dose gabapentin augmentation in the treatment of alcohol withdrawal syndrome: a retrospective, open-label study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 46:49-57. [PMID: 31490712 DOI: 10.1080/00952990.2019.1634085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Lorazepam use in the treatment of alcohol withdrawal syndrome (AWS) is not without risk.Objective: This study compares AWS outcomes using a standard, symptom-triggered lorazepam dosing protocol (control group) and symptom-triggered lorazepam dosing augmented with a gabapentin loading dose and taper (GABA group).Methods: Consecutive, non-randomized adults (n = 982; 64.0% male) undergoing treatment for AWS were included in this retrospective, open-label study. Symptom-triggered lorazepam dosing was informed by scores on the Clinical Institute Withdrawal Assessment-Alcohol, revised (CIWA-Ar). Gabapentin augmentation utilized an initial loading dose (900 mg) and a three-day taper. Outcomes included average symptom severity per treatment hour and average lorazepam dose per treatment hour. Average time in the protocol by group, stratified by highest CIWA-Ar score, was examined as a secondary outcome. A priori group differences were controlled statistically.Results: GABA patients were older and exhibited somewhat more severe withdrawal symptoms than controls. After controlling for confounders, gabapentin augmentation did not significantly lower average lorazepam dosing per treatment hour or withdrawal symptom severity per treatment hour. Compared to controls, overall withdrawal symptoms diminished somewhat more rapidly for GABA patients experiencing low or moderate-level withdrawal symptoms; however, severe withdrawal symptoms remitted more slowly in the GABA group. Results should be interpreted in light of the uncontrolled nature of group assignment and other confounders.Conclusions: Compared to symptom-triggered lorazepam dosing alone, gabapentin augmentation did not produce better outcomes during treatment of acute AWS. These results do not support the use of scheduled gabapentin as an augmentation to benzodiazepines during inpatient treatment of AWS.
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Affiliation(s)
- Alex Andaluz
- Psychiatry Residency Training Program, Dept. of Psychiatry, John Peter Smith Hospital, Fort Worth, USA
| | - Dustin DeMoss
- Psychiatry Residency Training Program, Dept. of Psychiatry, John Peter Smith Hospital, Fort Worth, USA
| | - Cynthia Claassen
- Research & Education, Behavioral Health Service, John Peter Smith Hospital, Fort Worth, USA
| | - Somer Blair
- Office of Clinical Research, John Peter Smith Hospital, Fort Worth, USA
| | - Jennifer Hsu
- Texas College of Osteopathic Medicine, UNT Health Science Center, Fort Worth, USA
| | - Sulaimon Bakre
- Dept. of Public Health, University of North Texas Health Science Center, Fort Worth, USA
| | - Mehreen Khan
- Research Division, Behavioral Health Service, John Peter Smith Hospital, Fort Worth, USA
| | - Folefac Atem
- Department of Biostatistics & Data Science, University of Texas Health Science Center School of Public Health-Houston, Houston, USA
| | - A John Rush
- Adj Prof, Duke Med Sch; Adj Prof, Texas Tech, CEO Curbstone Consultant, Durham, USA
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19
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Batlle E, Lizano E, Viñas M, Dolors Pujol M. 1,4-Benzodiazepines and New Derivatives: Description, Analysis, and Organic Synthesis. Med Chem 2019. [DOI: 10.5772/intechopen.79879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Tracy MF, Chlan L, Savik K, Skaar DJ, Weinert C. A Novel Research Method for Determining Sedative Exposure in Critically Ill Patients. Nurs Res 2019; 68:73-79. [PMID: 30540694 DOI: 10.1097/nnr.0000000000000322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although potent sedative and opioid drugs are some of the most commonly used medications to manage pain, anxiety, and discomfort in critically ill patients, conducting clinical trials where sedative and opioid medications are outcome variables within a longitudinal research design can be a methodological challenge. OBJECTIVES The purpose of this article is to provide in detail a conceptual discussion of the concept and analysis of sedative exposure: A novel research analysis method for aggregating sedative and opioid medication doses from disparate drug classes commonly administered to critically ill patients and used by our team in several clinical research studies. METHODS Comparing the dose of each sedative and opioid administered to an individual patient (within a defined time interval) to all other patients in a research study receiving the same medications allows for ranking of dosages for each medication by quartiles. Rank values for all sedatives and opioids received can be summed to a single value resulting in a Sedation Intensity Score. In addition, a simple count of how many hours at least one dose of a sedative or opioid medication has been administered can determine sedation frequency. RESULTS This method can allow for comparison of sedative exposure with medications from disparate drug classes and for analysis of estimates of change in medication use over time. DISCUSSION This novel research analysis method can overcome the challenges and limitations of determining changes in sedative and opioid medication regimens in cohort and clinical trial study designs.
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Affiliation(s)
- Mary Fran Tracy
- Mary Fran Tracy, PhD, RN, APRN, CNS, FAAN, is Associate Professor, University of Minnesota School of Nursing, and Nurse Scientist, University of Minnesota Medical Center, Minneapolis. Linda Chlan, PhD, RN, ATSF, FAAN, is Associate Dean for Nursing Research and Professor of Nursing, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. Kay Savik, MS, is Senior Statistician, University of Minnesota School of Nursing, Minneapolis. Debra J. Skaar, PharmD, FCCM, is Associate Professor of Experimental & Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis. Craig Weinert, MD, MPH, is Professor of Medicine, Pulmonary, Allergy, Critical Care, and Sleep Medicine Division, University of Minnesota Medical School, Minneapolis
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Vadiei N, Smith TL, Walton AE, Kjome KL. Impact of Gabapentin Adjunct use with Benzodiazepines for the Treatment of Alcohol Withdrawal in a Psychiatric Hospital. PSYCHOPHARMACOLOGY BULLETIN 2019; 49:17-27. [PMID: 30858636 PMCID: PMC6386428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Benzodiazepines are currently the gold standard for treatment of alcohol withdrawal. Gabapentin has growing evidence to support its use in the treatment of alcohol use disorder, however there is limited evidence regarding its role in the treatment of alcohol withdrawal. The purpose of this study was to determine if adjunctive gabapentin reduces the need for benzodiazepine (BZD) administration during alcohol withdrawal. METHODS This was a retrospective single-center cohort study. Patients were included if they were 18-89 years old, had an underlying alcohol use disorder, and were initiated on the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) protocol with or without scheduled gabapentin. They were excluded if they had a BZD use disorder, were on concomitant anti-epileptics, as-needed gabapentin, or BZDs outside the CIWA-Ar protocol. RESULTS A total of 129 patients met inclusion criteria (n = 63 gabapentin group and 66 non-gabapentin group). There was a significant difference in as-needed BZD requirements, with the gabapentin group requiring a higher number of as-needed BZDs in the initial 72 hours of treatment (gabapentin 6 [IQR 0.5-10] non-gabapentin 2 [IQR 0-4]; p = 0.01) and overall (gabapentin 6 [IQR 0.5-10] vs. non-gabapentin 2 [IQR 0-5.5]; p = 0.01). The gabapentin group also had higher maximum CIWA-Ar scores in the initial 72 hours of treatment, and higher anxiety item scores in the initial 48 hours. CONCLUSION Gabapentin was not shown to reduce as-needed BZD requirements in patients with a diagnosis of alcohol use disorder admitted for alcohol withdrawal.
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Affiliation(s)
- Nina Vadiei
- Vadiei, Pharm.D., BCPP, Assistant Professor, The University of Arizona, College of Pharmacy Practice and Science, Tucson, AZ. Smith, Pharm.D., BCPP, Associate Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX. Walton, MD., Assistant Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX. Kjome, MD., Assistant Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX
| | - Tawny L Smith
- Vadiei, Pharm.D., BCPP, Assistant Professor, The University of Arizona, College of Pharmacy Practice and Science, Tucson, AZ. Smith, Pharm.D., BCPP, Associate Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX. Walton, MD., Assistant Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX. Kjome, MD., Assistant Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX
| | - Amy E Walton
- Vadiei, Pharm.D., BCPP, Assistant Professor, The University of Arizona, College of Pharmacy Practice and Science, Tucson, AZ. Smith, Pharm.D., BCPP, Associate Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX. Walton, MD., Assistant Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX. Kjome, MD., Assistant Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX
| | - Kimberly L Kjome
- Vadiei, Pharm.D., BCPP, Assistant Professor, The University of Arizona, College of Pharmacy Practice and Science, Tucson, AZ. Smith, Pharm.D., BCPP, Associate Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX. Walton, MD., Assistant Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX. Kjome, MD., Assistant Professor, Department of Psychiatry, Dell Medical School at The University of Texas at Austin, TX
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22
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Béracochéa D, Mons N, David V. Targeting the Glucocorticoid Receptors During Alcohol Withdrawal to Reduce Protracted Neurocognitive Disorders. Front Psychiatry 2019; 10:580. [PMID: 31620025 PMCID: PMC6759466 DOI: 10.3389/fpsyt.2019.00580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/23/2019] [Indexed: 11/13/2022] Open
Abstract
Persistent regional glucocorticoid (GC) dysregulation in alcohol-withdrawn subjects emerges as a key factor responsible for protracted molecular and neural alterations associated with long-term cognitive dysfunction. Regional brain concentrations of corticosterone vary independently from plasma concentrations in alcohol-withdrawn subjects, which may account for the treatment of alcohol withdrawal-induced persistent pathology. Thus, from a pharmacological point of view, a main issue remains to determine the relative efficacy of compounds targeting the GC receptors to attenuate or suppress the long-lasting persistence of brain regional GC dysfunctions in abstinent alcoholics, as well as persistent changes of neural plasticity. Data from animal research show that acting directly on GC receptors during the withdrawal period, via selective antagonists, can significantly counteract the development and persistence of cognitive and neural plasticity disorders during protracted abstinence. A critical remaining issue is to better assess the relative long-term efficacy of GC antagonists and other compounds targeting the corticotropic axis activity such as gamma-aminobutyric acid A (GABAA) and GABAB agonists. Indeed, benzodiazepines (acting indirectly on GABAA receptors) and baclofen (agonist of the GABAB receptor) are the compounds most widely used to reduce alcohol dependence. Clinical and preclinical data suggest that baclofen exerts an effective and more powerful counteracting action on such persistent cognitive and endocrine dysfunctions as compared to diazepam, even though its potential negative effects on memory processes, particularly at high doses, should be better taken into account.
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Affiliation(s)
- Daniel Béracochéa
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France.,CNRS UMR 5287, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France
| | - Nicole Mons
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France.,CNRS UMR 5287, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France
| | - Vincent David
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France.,CNRS UMR 5287, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France
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23
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Thompson C, McLeod SL, Perelman V, Lee S, Carver S, Dear T, Borgundvaag B. Evaluation of a Web-based Educational Program to Teach the Identification and Management of Alcohol Withdrawal in the Emergency Department. AEM EDUCATION AND TRAINING 2019; 3:50-57. [PMID: 30680347 PMCID: PMC6339544 DOI: 10.1002/aet2.10202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom-driven approach, where patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised [CIWA-Ar]) and treated according to severity. Accurate administration of the CIWA-Ar requires experience, yet there is no training program to teach this competency. The objective of this study was to develop and evaluate a curriculum to teach clinicians how to accurately assess and treat AWS. METHODS This was a three-phase education program consisting of a series of e-learning modules containing core competency material, an in-person seminar to orient learners to high-fidelity simulation, and a summative evaluation in an objective structured clinical examination setting using a standardized patient. To determine the impact of the AWS curriculum, we recorded how often the CIWA-Ar was appropriately applied in the emergency department (ED) before and after training. A CIWA-Ar protocol breach was defined as inappropriate administration of benzodiazepines (CIWA-Ar < 10) and failure to administer benzodiazepines when required (CIWA-Ar ≥ 10). ED length of stay, amount of benzodiazepines administered in the ED, discharge prescriptions, and unit doses (take-away bottle of four tablets) of benzodiazepine given were recorded. RESULTS Seventy-four ED nurses completed the curriculum over an 8-week period. In the 5 months prior to the educational program delivery, we identified 144 of 565 (25.5%) CIWA-Ar protocol breaches, compared to 64 of 547 (11.7%) in the 5 months after training (∆13.8%, 95% confidence interval [CI] = 9.3%-18.3%). Program completion resulted in a reduction in the median total dose of diazepam administered in the ED (40 mg vs. 30 mg, ∆10 mg, 95% CI = 0-20 mg) and no change was detected in ED length of stay and benzodiazepines prescribed. CONCLUSIONS Completion of this curriculum resulted in better compliance with the CIWA-Ar protocol by those who administer the CIWA-Ar; however, changes in inappropriate benzodiazepine prescribing practice will require future interdisciplinary initiatives.
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Affiliation(s)
- Cameron Thompson
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Shelley L. McLeod
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Emergency MedicineDepartment of Family & Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Vsevolod Perelman
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Emergency MedicineDepartment of Family & Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Shirley Lee
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Emergency MedicineDepartment of Family & Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Sally Carver
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Taylor Dear
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Emergency MedicineDepartment of Family & Community MedicineUniversity of TorontoTorontoOntarioCanada
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24
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Madruga CS, Paim TL, Palhares HN, Miguel AC, Massaro LTS, Caetano R, Laranjeira RR. Prevalence of and pathways to benzodiazepine use in Brazil: the role of depression, sleep, and sedentary lifestyle. ACTA ACUST UNITED AC 2018; 41:44-50. [PMID: 30328968 PMCID: PMC6781701 DOI: 10.1590/1516-4446-2018-0088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/12/2018] [Indexed: 12/21/2022]
Abstract
Objective: This study aimed to determine the prevalence of benzodiazepine (BZD) use in Brazil and to investigate the direct and indirect effects of alcohol consumption, sedentary lifestyle (SL), depressive symptoms (DS), and sleep dissatisfaction (SD) on BZD use. Methods: The Second Brazilian Alcohol and Drugs Survey (II BNADS) used stratified cluster probabilistic sampling to select 4,607 individuals aged 14 years and older from the Brazilian household population. Results: The lifetime and 12-month prevalence of BZD use was 9.8 and 6.1%, respectively. Older participants (age 40 and older) and women had higher rates. Alcohol use disorder, DS, and SD were significantly more prevalent in BZD users. The parallel multiple mediator model showed a positive direct effect of alcohol consumption on BZD use, with significant positive indirect effects of SL, SD, and DS as simultaneous mediators leading to higher BZD intake. Other statistically significant indirect pathways were DS alone, SD alone, and all of the above except SL. Conclusion: The prevalence of BZD use in Brazil is high compared to that of other countries. Knowledge of the main risk factors and pathways to consumption can guide prevention initiatives and underlie the development of better tailored and effective treatment strategies.
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Affiliation(s)
- Clarice S Madruga
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Thales L Paim
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Hamer N Palhares
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Andre C Miguel
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Luciana T S Massaro
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | | | - Ronaldo R Laranjeira
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
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25
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Jung ME, Mallet RT. Intermittent hypoxia training: Powerful, non-invasive cerebroprotection against ethanol withdrawal excitotoxicity. Respir Physiol Neurobiol 2018; 256:67-78. [PMID: 28811138 PMCID: PMC5825251 DOI: 10.1016/j.resp.2017.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/24/2017] [Accepted: 08/08/2017] [Indexed: 12/12/2022]
Abstract
Ethanol intoxication and withdrawal exact a devastating toll on the central nervous system. Abrupt ethanol withdrawal provokes massive release of the excitatory neurotransmitter glutamate, which over-activates its postsynaptic receptors, causing intense Ca2+ loading, p38 mitogen activated protein kinase activation and oxidative stress, culminating in ATP depletion, mitochondrial injury, amyloid β deposition and neuronal death. Collectively, these mechanisms produce neurocognitive and sensorimotor dysfunction that discourages continued abstinence. Although the brain is heavily dependent on blood-borne O2 to sustain its aerobic ATP production, brief, cyclic episodes of moderate hypoxia and reoxygenation, when judiciously applied over the course of days or weeks, evoke adaptations that protect the brain from ethanol withdrawal-induced glutamate excitotoxicity, mitochondrial damage, oxidative stress and amyloid β accumulation. This review summarizes evidence from ongoing preclinical research that demonstrates intermittent hypoxia training to be a potentially powerful yet non-invasive intervention capable of affording robust, sustained neuroprotection during ethanol withdrawal.
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Affiliation(s)
- Marianna E Jung
- Center for Neuroscience Discovery, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107-2699, USA.
| | - Robert T Mallet
- Institute for Cardiovascular and Metabolic Diseases, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107-2699, USA.
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26
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Hanlon CA, Dowdle LT, Henderson JS. Modulating Neural Circuits with Transcranial Magnetic Stimulation: Implications for Addiction Treatment Development. Pharmacol Rev 2018; 70:661-683. [PMID: 29945899 PMCID: PMC6020107 DOI: 10.1124/pr.116.013649] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although the last 50 years of clinical and preclinical research have demonstrated that addiction is a brain disease, we still have no neural circuit-based treatments for substance dependence or cue reactivity at large. Now, for the first time, it appears that a noninvasive brain stimulation technique known as transcranial magnetic stimulation (TMS), which is Food and Drug Administration approved to treat depression, may be the first tool available to fill this critical void in addiction treatment development. The goals of this review are to 1) introduce TMS as a tool to induce causal change in behavior, cortical excitability, and frontal-striatal activity; 2) describe repetitive TMS (rTMS) as an interventional tool; 3) provide an overview of the studies that have evaluated rTMS as a therapeutic tool for alcohol and drug use disorders; and 4) outline a conceptual framework for target selection when designing future rTMS clinical trials in substance use disorders. The manuscript concludes with some suggestions for methodological innovation, specifically with regard to combining rTMS with pharmacotherapy as well as cognitive behavioral training paradigms. We have attempted to create a comprehensive manuscript that provides the reader with a basic set of knowledge and an introduction to the primary experimental questions that will likely drive the field of TMS treatment development forward for the next several years.
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Affiliation(s)
- Colleen A Hanlon
- Departments of Psychiatry (C.A.H., L.T.D., J.S.H.) and Neurosciences (C.A.H., L.T.D.), Medical University of South Carolina, Charleston, South Carolina; and Ralph Johnson VA Medical Center, Charleston, South Carolina (C.A.H.)
| | - Logan T Dowdle
- Departments of Psychiatry (C.A.H., L.T.D., J.S.H.) and Neurosciences (C.A.H., L.T.D.), Medical University of South Carolina, Charleston, South Carolina; and Ralph Johnson VA Medical Center, Charleston, South Carolina (C.A.H.)
| | - J Scott Henderson
- Departments of Psychiatry (C.A.H., L.T.D., J.S.H.) and Neurosciences (C.A.H., L.T.D.), Medical University of South Carolina, Charleston, South Carolina; and Ralph Johnson VA Medical Center, Charleston, South Carolina (C.A.H.)
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27
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Phenobarbital monotherapy for alcohol withdrawal syndrome in the non-intensive care unit setting: a review. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0523-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huitron-Resendiz S, Nadav T, Krause S, Cates-Gatto C, Polis I, Roberts AJ. Effects of Withdrawal from Chronic Intermittent Ethanol Exposure on Sleep Characteristics of Female and Male Mice. Alcohol Clin Exp Res 2018; 42:540-550. [PMID: 29265376 DOI: 10.1111/acer.13584] [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: 08/07/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep disruptions are an important consequence of alcohol use disorders. There is a dearth of preclinical studies examining sex differences in sleep patterns associated with ethanol (EtOH) dependence despite documented sex differences in alcohol-related behaviors and withdrawal symptoms. The purpose of this study was to investigate the effects of chronic intermittent EtOH on sleep characteristics in female and male mice. METHODS Female and male C57BL6/J mice had access to EtOH/water 2-bottle choice (2BC) 2 h/d for 3 weeks followed by exposure to EtOH vapor (vapor-2BC) or air for 5 cycles of 4 days. An additional group never experienced EtOH (naïve). Mice were implanted with electroencephalographic (EEG) electrodes, and vigilance states were recorded across 24 hours on the fourth day of withdrawal. The amounts of wakefulness, slow-wave sleep (SWS), and rapid eye movement sleep were calculated, and spectral analysis was performed by fast Fourier transformation. RESULTS Overall, vapor-2BC mice showed a decrease in the amount of SWS 4 days into withdrawal as well as a decrease in the power density of slow waves, indicating disruptions in both the amount and quality of sleep in EtOH-dependent mice. This was associated with a decrease in duration and an increase in number of SWS episodes in males and an increase in latency to sleep in females. CONCLUSIONS Our results revealed overall deficits in sleep regulation in EtOH-dependent mice of both sexes. Female mice appeared to be more affected with regard to the triggering of sleep, while male mice appeared more sensitive to disruptions in the maintenance of sleep.
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Affiliation(s)
| | - Tali Nadav
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California
| | - Stephanie Krause
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California
| | - Chelsea Cates-Gatto
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California
| | - Ilham Polis
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California
| | - Amanda J Roberts
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California
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Gil F, de Andrade AG, Castaldelli-Maia JM. Discussing prevalence, impacts, and treatment of substance use disorders in athletes. Int Rev Psychiatry 2016; 28:572-578. [PMID: 27534440 DOI: 10.1080/09540261.2016.1212821] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The consumption of alcohol, tobacco, and other drugs has become a concern in high-performance athletes. Professional athletes are more exposed to drugs than the general population. Although some drugs are unquestionably detrimental to performance, several studies have nevertheless shown evidence of increased consumption of these substances within this sub-population. This review aimed to elucidate alcohol, tobacco, cocaine, cannabis, and opioid use among high-performance athletes, discussing the prevalence of substance use, its impacts, and alternatives to treatment in this special population. Unfortunately, no clinical trials for the treatment of substance use disorders were carried out with this specific sub-population. Therefore, the strategies adopted for the general population should be adapted to high-performance athletes. Psychological, psychosocial, psychoeducational, cognitive-behavioural, motivational interviewing approaches can be implemented. As regards pharmacological treatment, medications used in the treatment of alcohol and tobacco dependence, such as naltrexone, disulfiram, acamprosate, varenicline, bupropion, and nicotine replacement treatment can be used without problems. However, some medications used in cocaine and opioid dependence treatment, such as moldafinil and methadone, are prohibited by doping enforcement agencies. Professionals involved with athletes should be aware of the signs and symptoms of the acute effects of substances so as to enable an early identification of substance abuse problems, especially during training periods.
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Affiliation(s)
- Felipe Gil
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , SP , Brazil
| | - Arthur Guerra de Andrade
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , SP , Brazil.,b Department of Psychiatry , Medical School, University of São Paulo , São Paulo , SP , Brazil.,c ABC Center for Mental Health Studies , Santo André , SP , Brazil
| | - João Maurício Castaldelli-Maia
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , SP , Brazil.,b Department of Psychiatry , Medical School, University of São Paulo , São Paulo , SP , Brazil.,c ABC Center for Mental Health Studies , Santo André , SP , Brazil
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Kleczkowska P, Smaga I, Filip M, Bujalska-Zadrozny M. Are Alcohol Anti-relapsing and Alcohol Withdrawal Drugs Useful in Cannabinoid Users? Neurotox Res 2016; 30:698-714. [PMID: 27484692 DOI: 10.1007/s12640-016-9655-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 11/27/2022]
Abstract
Cannabinoids are still classified as illegal psychoactive drugs despite their broad and increasingly acknowledged therapeutic potential. These substances are most famous for their wide recreational use, particularly among young adults to either alter the state of consciousness, intensify pleasure induced by other psychoactive substances or as an alternative to the previously abused drugs. It is important to emphasize that cannabinoids are often taken together with a variety of medications intended for the treatment of alcohol use disorder (AUD) or alcohol withdrawal syndrome (AWS). These medications include disulfiram, acamprosate, and naltrexone. In this paper, we summarize recent advances in the knowledge of possible beneficial effects and interactions between cannabinoids and drugs commonly used for treatment of AUD and AWS either comorbid or existing as a separate disorder.
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Affiliation(s)
- Patrycja Kleczkowska
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology, Medical University of Warsaw, 1B Banacha Str, 02-097, Warsaw, Poland.
| | - Irena Smaga
- Faculty of Pharmacy, Medical College, Jagiellonian University, Medyczna 9, 30-688, Kraków, Poland
| | - Małgorzata Filip
- Laboratory of Drug Addiction Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343, Kraków, Poland
| | - Magdalena Bujalska-Zadrozny
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology, Medical University of Warsaw, 1B Banacha Str, 02-097, Warsaw, Poland
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