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Abstract
OBJECTIVES Older adults commonly take benzodiazepines (BZDs) that may have long-term adverse cognitive effects. We investigated whether BZD use was related to developing mild cognitive impairment (MCI) or dementia in cognitively normal older adults in the community. SETTING/PARTICIPANTS A population-based cohort (n = 1959) of adults aged 65 and over, recruited from communities of low socioeconomic status. MEASUREMENTS BZD use, Clinical Dementia Rating (CDR), anxiety symptoms, depression symptoms, sleep difficulties, and APOE genotype. DESIGN We examined time from study entry to MCI (CDR = 0.5) and time from study entry to dementia (CDR ≥ 1) in participants who were cognitively normal at baseline (CDR = 0). We used survival analysis (Cox model), adjusted for age, sex, education, sleep, anxiety, and depression. For all the models, we included an interaction term between BZD use and APOE*4. RESULTS Taking BZDs was significantly associated with higher risk of developing MCI, but not of developing dementia. The effect was not affected by APOE genotype. CONCLUSIONS In a population-based sample of cognitively normal older adults, BZD use is associated with developing MCI, but not dementia. BZD use may be a potentially modifiable risk factor for MCI.
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Affiliation(s)
- Esther G Teverovsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Xinhui Ran
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chung-Chou H Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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Villalobos-Madriz JA, Serrano-Arias B, Arguedas-Chacón S, Zavaleta-Monestel E, Rodríguez-Miranda R, Chaverri-Fernández JM, Covarrubias-Gómez A. Prescribing Trends in Psychotropic Medications Among Outpatients of a Latin American Healthcare Setting: A Five-Year Retrospective Study. Cureus 2023; 15:e37832. [PMID: 37213996 PMCID: PMC10198243 DOI: 10.7759/cureus.37832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Mental health problems affect millions worldwide, and the prescription of psychotropic drugs is increasing globally. The World Health Organization (WHO) has emphasized the need for proper monitoring of psychotropic drug prescriptions. This study aims to characterize and find trends in the prescription of psychotropics in a Latin American General Hospital. Methods The study analyzed the dispensation of psychotropic prescriptions to outpatients at three pharmacies in the central headquarters of Hospital Clínica Bíblica in San José, Costa Rica, from 2017 to 2021. Psychotropic drugs were classified by the Anatomical Therapeutic Chemical (ATC) code, and the amount of each medication dispensed was standardized using the defined daily dose per 10,000 population per day metric. Patients' ages were categorized into four groups: under 18 years, 18 to 39 years, 40 to 64 years, and 65 years and above. The prescriptions were categorized according to medical specialty. Regression analyses were performed to determine the significance of trends observed in the data Results A total of 5793 psychotropic prescriptions were recorded. The average age of the patients was 58 years. The total consumption of psychotropics decreased by 33.94% from 2017 to 2021, with the most significant decline until 2020. However, there was an increase in consumption in 2021. Clonazepam was the most consumed medication, followed by bromazepam and alprazolam, which was the sole drug to exhibit an escalation in usage between 2017 and 2021. Regression analysis showed that only alprazolam and zopiclone had statistically significant trends. The highest number of prescriptions was dispensed to patients aged between 40 and 64 years, followed by those aged over 65 years. Anxiolytics were also the most commonly prescribed group of drugs. General medicine (20.22%), psychiatry (19.95%), and internal medicine (12.73%) were the primary specialties that prescribed psychotropic; 38.6% of prescriptions were associated with the 10th decile of patients, and 44.9% of prescriptions were issued by the 10th decile of physicians. Conclusion The consumption of psychotropic drugs decreased from 2017 to 2020 but increased in 2021, with alprazolam being the only drug that showed an increase in consumption throughout the entire period. General practitioners and psychiatrists were found to be the specialties that most commonly prescribe these medications. The study found significant trends only for the consumption of alprazolam and zopiclone and for prescription patterns among psychiatrists and internal medicine physicians.
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Affiliation(s)
| | | | | | | | | | - José M Chaverri-Fernández
- Department of Pharmacology, Toxicology, and Pharmacodependency, Universidad de Costa Rica, San José, CRI
| | - Alfredo Covarrubias-Gómez
- Department of Pain and Palliative Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubirán, México City, MEX
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Alvarenga-Brant R, Costa FO, Mattos-Pereira G, Esteves-Lima RP, Belém FV, Lai H, Ge L, Gomez RS, Martins CC. Treatments for Burning Mouth Syndrome: A Network Meta-analysis. J Dent Res 2023; 102:135-145. [PMID: 36214096 DOI: 10.1177/00220345221130025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The aim of this systematic review and network meta-analysis (NMA) of randomized controlled trials was to evaluate the effectiveness of treatments for pain relief of burning mouth syndrome (BMS). Five databases and gray literature were searched. Independent reviewers selected studies, extracted data, and assessed the risk of bias. The primary outcome was pain relief or burning sensation, and the secondary outcomes were side effects, quality of life, salivary flow, and TNF-α and interleukin 6 levels. Four comparable interventions were grouped into different network geometries to ensure the transitivity assumption for pain: photobiomodulation therapy, alpha-lipoic acid, phytotherapics, and anxiolytics/antidepressants. Mean difference (MD) and 95% CI were calculated for continuous outcomes. The minimal important difference to consider a therapy beneficial against placebo was an MD of at least -1 for relief of pain. To interpret the results, the GRADE approach for NMA was used with a minimally contextualized framework and the magnitude of the effect. Forty-four trials were included (24 in the NMA). The anxiolytic (clonazepam) probably reduces the pain of BMS when compared with placebo (MD, -1.88; 95% CI, -2.61 to -1.16; moderate certainty). Photobiomodulation therapy (MD, -1.90; 95% CI, -3.58 to -0.21) and pregabalin (MD, -2.40; 95% CI, -3.49 to -1.32) achieved the minimal important difference of a beneficial effect with low or very low certainty. Among all tested treatments, only clonazepam is likely to reduce the pain of BMS when compared with placebo. The majority of the other treatments had low and very low certainty, mainly due to imprecision, indirectness, and intransitivity. More randomized controlled trials comparing treatments against placebo are encouraged to confirm the evidence and test possible alternative treatments (PROSPERO CRD42021255039).
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Affiliation(s)
- R Alvarenga-Brant
- Department of Clinical Dentistry, Pathology and Oral Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - F O Costa
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - G Mattos-Pereira
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - R P Esteves-Lima
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - F V Belém
- Department of Pediatric Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - H Lai
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - L Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - R S Gomez
- Department of Clinical Dentistry, Pathology and Oral Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - C C Martins
- Department of Pediatric Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Bosman L, Wauters L, Vanuytsel T. Neuromodulating agents in functional dyspepsia: a comprehensive review. Acta Gastroenterol Belg 2023; 86:49-57. [PMID: 36842175 DOI: 10.51821/86.1.10998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Background and study aims Functional dyspepsia is a common chronic condition with upper abdominal symptoms in the absence of an organic cause. The first line treatment consists of protonpomp inhibition or Helicobacter pylori eradication. However, this approach often does not provide enough symptom relief. Neuromodulating agents are commonly used in clinical practice but only tricyclic antidepressant (TCAs) are mentioned in European and American and Canadian guidelines. Methods We performed a comprehensive review of the literature in Pubmed for full-text randomized controlled trials in English with adult participants (>18 years) who met the Rome II, III or IV criteria or were diagnosed by a physician with a negative upper endoscopy and that compared a neuromodulating agent with placebo. Results The search strategy identified 386 articles of which 14 articles met the eligibility criteria. TCAs like amitriptyline and imipramine have been shown to be effective in the treatment of functional dyspepsia whereas other neuromodulating agents like tetracyclic antidepressants, levosulpiride and anxiolytics might be beneficial but conclusive evidence is lacking. serotonin and noradrenaline reuptake inhibitors (SNRI) and selective serotonin reuptake inhibitors (SSRI) have not shown benefit in patients with functional dyspepsia. Conclusion Selected neuromodulators have an established efficacy in functional dyspepsia. The best supporting evidence is available for TCAs with a potential role for tetracyclic antidepressants, levosulpiride and anxiolytics.
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Webber R, Patzkowski MS, Costantino RC, Velosky AG, Lee V, Cyr KL, Harris LM, Scott-Richardson M, Highland KB. Procedural Benzodiazepine and Post-Vasectomy Opioid and Nonopioid Prescribing Variation in a Large Health Care System. Urol Pract 2022; 9:431-440. [PMID: 37145714 DOI: 10.1097/upj.0000000000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Our goal was to describe variation in procedural benzodiazepine and post-vasectomy nonopioid pain and opioid prescription dispense events, and multilevel factors associated with the probability of an opioid refill. METHODS Patients (40,584) undergoing vasectomies in the U.S. Military Health System between January 2016-January 2020 were included in this observational retrospective study. The main outcome was the probability of being dispensed an opioid prescription refill within 30 days post-vasectomy. Bivariate analyses examined the relationships between patient- and care-level characteristics, prescription dispense and 30-day opioid prescription refill. A generalized additive mixed-effects model and sensitivity analyses examined factors associated with opioid refill. RESULTS There was wide variation in procedural benzodiazepine (32%) and post-vasectomy nonopioid (71%) and opioid (73%) prescription dispense patterns across facilities. Only 5% of the patients dispensed opioids received a refill. Probability of an opioid refill was associated with race (White), younger age, opioid dispense history, documented mental health or pain condition, lack of post-vasectomy nonopioid pain medication dispense events and higher dispensed post-vasectomy opioid prescription dose; albeit the effect of dose did not replicate in sensitivity analyses. CONCLUSIONS Despite the wide variation in vasectomy-related pharmacological pathways across a large health care system, most patients do not require an opioid refill. Significant variation in prescribing practices indicated racial inequities. Given the low rates of opioid prescription refill, combined with the wide variation in opioid prescription dispense events and American Urological Association recommendations for conservative opioid prescribing after vasectomy, intervention to address excessive opioid prescribing is warranted.
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Affiliation(s)
- Robert Webber
- School of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Michael S Patzkowski
- Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, Texas
- Department of Anesthesiology, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland
| | - Ryan C Costantino
- Program Executive Office, Enterprise Intelligence and Data Solutions (EIDS) Program Office, San Antonio, Texas
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland
| | - Alexander G Velosky
- Department of Anesthesiology, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Vivian Lee
- Walter Reed National Military Medical Center, Graduate Medical Education, Bethesda, Maryland
| | - Kyle L Cyr
- Walter Reed National Military Medical Center, Department of Anesthesia, Bethesda, Maryland
| | - Lisa M Harris
- Department of Family Medicine, Uniformed Services University, Bethesda, Maryland
| | - Maya Scott-Richardson
- Department of Anesthesiology, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Krista B Highland
- Department of Anesthesiology, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
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Cáceres-Matos R, Gil-García E, López-Millán JM, Martínez-Navas Á, Peña I, Cabrera-León A. Profiles of adult people in a Spanish sample with chronic pain: Cluster analysis. J Adv Nurs 2022; 78:2837-2848. [PMID: 35285540 PMCID: PMC9540400 DOI: 10.1111/jan.15201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
AIM To establish groups of people with chronic non-cancer pain according to the impairment caused by pain and to identify factors associated with the group with a higher level of impairment. BACKGROUND Knowing the profiles of people who suffer from chronic non-cancer pain could make it possible to direct their treatment and to detect associated risks. DESIGN A cross-sectional study. METHODS A sample of 395 people with chronic non-cancer pain was collected in Pain Units and Primary Healthcare Centres in southern Spain (January to March 2020). A cluster analysis was performed to divide the population into groups and a binary logistic regression model was established to determine factors associated with the group with a higher level of impairment. RESULTS Two groups were identified: lower level of impairment due to pain, characterized by being 45-65 years old, not medicated with opioids or anxiolytics, employed and with a mild level of impact on daily life; and higher level of impairment characterized by being older than 65 years old, medicated with opioids and anxiolytics, retired or on medical leave and with a severe impact on daily life. In addition, among women, being widowed, single or a smoker are risk factors for belonging to the group with a higher level of impairment; being smokers or consuming alcohol three or less times a week would be risk factors in men. CONCLUSIONS Age, chronic non-cancer pain impact on daily life, work situation and the consumption of opioid drugs and/or anxiolytics are factors that appear to influence the level of impairment due to chronic pain. IMPACT These findings could help detect impairment due to pain in its early stages, determining the specific needs of each person.
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Affiliation(s)
- Rocío Cáceres-Matos
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Eugenia Gil-García
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | | | | | - Isaac Peña
- Pain Department of the Virgen del Rocío University Hospital, Seville, Spain
| | - Andrés Cabrera-León
- Andalusian School of Public Health, Granada, Spain.,Biomedical Research Networking Centre on Public Health and Epidemiology (CIBERESP, Spanish Acronym), Madrid, Spain
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Urtasun MA, Noble M, Cañás M, Bustin J, Regueiro AJ, Triskier F, Gaido Stulle EJ. [Use of benzodiazepines and related drugs in social security for older adults in Argentina]. Medicina (B Aires) 2022; 82:389-397. [PMID: 35639060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
The clinical use of benzodiazepines (BZD) and related drugs is a controversial issue, especially prolonged prescription in older adults, which is contrary to general recommendations. Our objective was to describe the use of BZD and the hypnotics called Z drugs (zolpidem, zopiclone and eszopiclone) in elderly beneficiaries of the National Institute of Social Services for Retirees and Pensioners (INSSJP-PAMI) of Argentina. An observational, descriptive, cross-sectional drug use study was conducted based on the Institute's drug dispensing database. Beneficiaries of both sexes aged 65 years and over were included. The prevalence of use in 2018 and the defined daily doses (DDD) per 1000 inhabitants / day (DHD) were calculated for each drug. A total of 3 864 949 beneficiaries were included (77.6% of the Argentine population of that age, 61.2% women), with 184 000 nonagenarians and more than 5000 centenarians; 30.3% of whom received at least one dispensation of BZD or "Z drugs" during 2018, with a higher prevalence of use in women (35.6%) than in men (22.0%) and with a progressive increase until 85-89 years, with a subsequent decrease. The most prescribed BZDs were alprazolam (41.6%) and clonazepam (41.1%), followed by lorazepam (9.9%). The dispense drugs reached 252.7 DHD, representing an average of 0.8 DDD per user and per day, a value that decreased with age. The prevalence of use found is among the highest at international level, justifying the implementation of clinical and public health interventions to improve this situation.
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Affiliation(s)
- Martín A Urtasun
- área Farmacología, Fundación FEMEBA, Buenos Aires, Argentina. E-mail:
- Instituto de Ciencias de la Salud, Universidad Nacional Arturo Jauretche (UNAJ), Buenos Aires, Argentina
| | - María Noble
- Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP), Buenos Aires, Argentina
| | - Martín Cañás
- área Farmacología, Fundación FEMEBA, Buenos Aires, Argentina
- Instituto de Ciencias de la Salud, Universidad Nacional Arturo Jauretche (UNAJ), Buenos Aires, Argentina
| | - Julián Bustin
- Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP), Buenos Aires, Argentina
- Instituto de Neurociencia Cognitiva y Traslacional (INCYT), Buenos Aires, Argentina
| | - Alejandro J Regueiro
- Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP), Buenos Aires, Argentina
| | - Fabián Triskier
- Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP), Buenos Aires, Argentina
- Instituto de Neurología Cognitiva (INECO), Buenos Aires, Argentina
| | - Eduardo J Gaido Stulle
- Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP), Buenos Aires, Argentina
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Pelgrim CE, van den Heuvel JM, Folkerts G, Garssen J, Maitland-van der Zee AH, Kraneveld AD. Higher prescription of antidepressants and/or anxiolytics among chronic obstructive pulmonary disease patients. Ther Adv Respir Dis 2021; 15:1753466620961696. [PMID: 33752539 PMCID: PMC8093612 DOI: 10.1177/1753466620961696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by
psychiatric problems, such as depression and anxiety, affecting both
treatment outcomes and mortality. Evidence for the number of COPD patients
using medication for these disorders is sparse. In this study, chronic
antidepressant (ATD) and anxiolytic (ANX) drug use – to identify depression
and anxiety – among COPD patients was compared with subjects with or without
other chronic diseases. Methods: The NControl database containing prescription data of 800 pharmacies
including 7 million individuals in The Netherlands was used. Patients of age
55+ years who received frequent prescriptions – at least two/year in 5 out
of 6 years – for COPD medication, dermatological drugs, disease-modifying
antirheumatic drugs (DMARDs), statins and oral glucose-lowering medication
were analyzed for concomitant chronic use of ATDs and ANXs between 1 January
2013 and 1 January 2019. All other subjects aged 55+ years were included as
a control group (control group 1). This group was further stratified into a
group of subjects that received frequent prescriptions of any kind (control
group 2). Results: 15.2% of the patients that receive COPD treatment
(n = 96,319), 15.3% of subjects that are treated for
dermatological problems (n = 62,865), 13.2% of subjects
that receive DMARDs (n = 7900), 11.6% of statins users
(n = 422,376) and 11.4% of oral glucose-lowering
medication users (n = 165,975) are also chronically treated
for depression or anxiety, compared with 2.6% (control group 1;
n = 3,290,608) and 11.4% (control group 2;
n = 757,947). In general, female and 75+ years aged
subjects showed a higher risk for using ATDs and ANXs chronically. In the
COPD and the dermatological patient group the risk was the highest compared
with the other patient groups. Conclusions: The rates of chronic ATD and ANX use and the risk of having depression and/or
anxiety are especially high in COPD patients, indicating that psychiatric
problems are more common in COPD than in most other chronic diseases. In
general, age and gender strongly influence the risk of chronically using
ATDs and ANXs. The reviews of this paper are available via the supplemental
material section.
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Affiliation(s)
- Charlotte E Pelgrim
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Jan Maurik van den Heuvel
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands Danone Nutricia Research, Utrecht, The Netherlands
| | - Anke H Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, 3508 TC, The Netherlands
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Khan A, Akram M, Thiruvengadam M, Daniyal M, Zakki SA, Munir N, Zainab R, Heydari M, Mosavat SH, Rebezov M, Shariati MA. Anti-anxiety properties of selected medicinal plants. Curr Pharm Biotechnol 2021; 23:1041-1060. [PMID: 33480339 DOI: 10.2174/1389201022666210122125131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/21/2020] [Accepted: 12/27/2020] [Indexed: 11/22/2022]
Abstract
Exploration of new drugs targeting anxiety treatment is a major concern worldwide. Medicinal plants are being used as a potential source of novel drugs for anxiety disorders. The objective of this review is to provide information about the healing outcomes of anxiety treatment with natural products. Valeriana officinalis, Citrus aurantium, Commelina benghalensis, Achyranthes aspera, Mimosa pudica, Achillea millefolium, Nymphaea alba, Leonurus cardiac, Camellia sinensis, Turnera aphrodisiaca, Crataegus oxyacantha and Piper methysticum showed promising effects on anxiety in animal models. In clinical studies, passion flower, kava, valerian, St John's wort, and ashwagandha showed the most positive results. More studies are needed for the exploration of the anti-anxiety of medicinal plants. In drugs derived from natural sources have explored many components that are playing an essential role in curing anxiety disorders and associated complications.
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Affiliation(s)
- Asmatullah Khan
- Department of Eastern Medicine, University of Poonch, Rawalakot, Azad Jammu and Kashmir. Pakistan
| | - Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad. Pakistan
| | | | - Muhammad Daniyal
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Drug Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha. China
| | - Shahbaz Ahmad Zakki
- Department of Public Health, Faculty of Medicine, Graduate School of Medicine & Pharmaceutical Sciences, University of Toyama, Sugitani, Toyama 9300194. Japan
| | - Naveed Munir
- Department of Biochemistry, Government College University Faisalabad. Pakistan
| | - Rida Zainab
- Department of Eastern Medicine, Government College University Faisalabad. Pakistan
| | - Mojtaba Heydari
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz. Iran
| | - Seyed Hamdollah Mosavat
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz. Iran
| | - Maksim Rebezov
- V.M.Gorbatov Federal Research Center for Food System of Russian Academy of Science, Moscow. Russian Federation
| | - Mohammad Ali Shariati
- K.G.Razumovsky Moscow State University of technologies and management (the First Cossack University), Moscow109004. Russian Federation
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Gulbransen G, Xu W, Arroll B. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand. BJGP Open 2020; 4:bjgpopen20X101010. [PMID: 32019776 DOI: 10.3399/bjgpopen20X101010] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/24/2019] [Indexed: 12/05/2022] Open
Abstract
Background Cannabidiol (CBD) is the non-euphoriant component of cannabis. In 2017, the New Zealand Misuse of Drugs Regulations (1977) were amended, allowing doctors to prescribe CBD. Therapeutic benefit and tolerability of CBD remains unclear. Aim To review the changes in self-reported quality of life measurements, drug tolerability, and dose-dependent relationships in patients prescribed CBD oil for various conditions at a single institution. Design & setting An audit including all patients (n = 400) presenting to Cannabis Care, New Zealand, between 7 December 2017 and 7 December 2018 seeking CBD prescriptions Method Indications for CBD use were recorded at baseline. Outcomes included EuroQol quality of life measures at baseline and after 3 weeks of use, patient-reported satisfaction, incidence of side effects, and patient-titrated dosage levels of CBD. Results Four hundred patients were assessed for CBD and 397 received a prescription. Follow-up was completed on 253 patients (63.3%). Patients reported a mean increase of 13.6 points (P<0.001) on the EQ-VAS scale describing overall quality of health. Patients with non-cancer pain and mental-health symptoms achieved improvements to patient-reported pain and depression and anxiety symptoms (P<0.05). There were no major adverse effects. Positive side effects included improved sleep and appetite. No associations were found between CBD dose and patient-reported benefit. Conclusion There may be analgesic and anxiolytic benefits of CBD in patients with non-cancer chronic pain and mental health conditions such as anxiety. CBD is well tolerated, making it safe to trial for non-cancer chronic pain, mental health, neurological, and cancer symptoms.
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Souissi MA, Bellakhal S, Gharbi E, Abdelkefi I, Douggui MH. A Stiff Person Syndrome Misdiagnosed as a Psychiatric Illness: A Case Report. Curr Rheumatol Rev 2019; 16:343-345. [PMID: 31738138 DOI: 10.2174/1573397115666191116101240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/24/2019] [Accepted: 10/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stiff Person Syndrome (SPS) is a rare autoimmune neurological disorder which is often misdiagnosed. We report here a case of SPS with a long diagnosis delay. CASE A 36-year-old man presented with an 11-year history of progressive stiffness and painful spasms of his both legs, with recent worsening of his condition over the last year resulting in a considerable difficulty of standing up and walking. As the patient developed phobic symptoms, he was considered as having a psychiatric illness and treated with antianxiety and antidepressant drugs. As no real improvement was observed, the patient was referred to internal medicine. Neurological examination showed paraspinal, abdominal and lower limbs muscle contraction with lumbar rigidity. These symptoms were associated to adrenergic symptoms: profuse sweating, tachycardia and high bloodpressure. Initial routine investigations revealed high blood glucose level. Polygraphic electromyographic (EMG) evaluation from paraspinal and leg muscles showed continuous motor unit activity in agonist and antagonist muscle. Electroencephalography and brain magnetic resonance imaging were normal. Immunologic tests according to radio immune assay technique revealed high level of serum anti-glutamic acid decarboxylase (anti-GAD65) antibodies. Diagnosis of autoimmune SPS was retained based on clinical, electrophysiological, and immunological findings. Pregabalin at the dose of 150 mg, three times a day was prescribed with satisfying response. CONCLUSION SPS is supported by an autoimmune pathogenesis and anti-GAD antibodies seems to be very helpful when SPS is clinically suspected. Treatment of SPS is a challenge, given the scarcity of the syndrome and the absence of established recommendations.
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Affiliation(s)
- Mohamed-Anis Souissi
- Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
| | - Syrine Bellakhal
- Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
| | - Emna Gharbi
- Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
| | - Istabrak Abdelkefi
- Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
| | - Mohamed-Hedi Douggui
- Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
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Hanna AH, Ramsingh D, Sullivan-Lewis W, Cano S, Leiter P, Wallace D, Andrews G, Austin B, Applegate RL. A comparison of midazolam and zolpidem as oral premedication in children, a prospective randomized double-blinded clinical trial. Paediatr Anaesth 2018; 28:1109-1115. [PMID: 30328648 DOI: 10.1111/pan.13501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anxiety associated with pediatric surgery can be stressful. Midazolam is a well-accepted anxiolytic in this setting. However, there are cases in which this medication is not effective. Zolpidem is a short-acting nonbenzodiazepine hypnotic drug that is administered orally and has quick onset of action (~15 minutes), and 2-3 hour duration. AIMS Based on the theory that impaired perception following oral zolpidem administration would suppress the development of anxiety, we sought to compare zolpidem to midazolam for pediatric preoperative anxiety. METHODS This prospective randomized double-blinded clinical trial was designed to compare the effectiveness of oral midazolam and zolpidem for anxiety premedication. Eighty ASA class I-II pediatric patients between 2 and 9 years old, surgery >2 hours, and at least 23 hours postoperative admission were included in the study. Randomization was done with 0.5 mg/kg midazolam or 0.25 mg/kg zolpidem administered orally. The primary outcome measure was between group difference in patient anxiety at the time of separation using the Modified Yale Preoperative Anxiety Scale. Secondary outcomes included emergence delirium and mask acceptance at induction. RESULTS There was no significant difference in Modified Yale Preoperative Anxiety Scale scores at separation between midazolam (median/interquartile range = 26.7/23.3-36.6) and zolpidem (median/interquartile range = 30.0/23.3-56.6) groups, difference 0.01 (95% CI -3E-5 , 3E-2 ; P = 0.07). Mask acceptance score was significantly better in the midazolam group. There was no significant difference in emergence delirium scores between groups. CONCLUSION This study demonstrates that zolpidem, as dosed, was similar to midazolam with regard to anxiety scoring, and inferior with regard to mask acceptance scores.
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Affiliation(s)
- Amgad H Hanna
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Davinder Ramsingh
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Whitney Sullivan-Lewis
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Sarah Cano
- Department of Anesthesiology, University of Rochester Medical Center, Rochester, New York
| | - Patrick Leiter
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Desiree Wallace
- Department of Pharmacy, Loma Linda University Medical Center, Loma Linda, California
| | - Gerald Andrews
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Briahnna Austin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Richard L Applegate
- Department of Anesthesiology and Pain Medicine, University of California Davis, Sacramento, California
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Kyriakides R, Jones P, Geraghty R, Skolarikos A, Liatsikos E, Traxer O, Pietropaolo A, Somani BK. Effect of Music on Outpatient Urological Procedures: A Systematic Review and Meta-Analysis from the European Association of Urology Section of Uro-Technology. J Urol 2017; 199:1319-1327. [PMID: 29225059 DOI: 10.1016/j.juro.2017.11.117] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Music is a practical, inexpensive and harmless analgesic and anxiolytic. An increasing number of original studies have been performed to investigate its potential application in urology. Our aim was to identify the effect of music on outpatient based urological procedures. MATERIALS AND METHODS We systematically reviewed the effect of using music during all reported outpatient urology procedures, including transrectal ultrasound guided prostate biopsy, shock wave lithotripsy, urodynamic studies, percutaneous nephrostomy tube placement and cystoscopy. Data were included on all randomized trials from 1980 to 2017 and no language restrictions were applied. RESULTS Included in analysis were 16 randomized studies in which 972 of 1,950 patients (49.8%) were exposed to music during an outpatient procedure. The procedures included transrectal ultrasound guided prostate biopsy in 4 studies in a total of 286 patients, shock wave lithotripsy in 6 studies in a total of 1,023, cystoscopy in 3 studies in a total of 331, urodynamics in 2 studies in a total of 210 and percutaneous nephrostomy in 1 study in a total of 100. All studies incorporated a visual analog score to measure pain. Anxiety was measured by STAI (State-Trait Anxiety Inventory) in 13 studies and by a visual analog scale in 2. While 14 of the 16 studies showed a reduction in self-reported pain, a reduction in anxiety was seen in 14. When using music, overall procedural satisfaction was better in 9 studies and patient willingness to repeat the procedure was also higher in 7. Our meta-analysis revealed a significant reduction in visual analog scale and STAI findings across all studies (p <0.001). CONCLUSIONS Our systematic review demonstrated a beneficial effect of music on urological outpatient procedures. Music seemed to decrease anxiety and pain. It might serve as a useful adjunct to increase procedural satisfaction and patient willingness to undergo the procedure again.
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Affiliation(s)
- Rena Kyriakides
- University of Southampton, University Hospital Southampton National Health Service Trust, Southampton, United Kingdom
| | - Patrick Jones
- University of Southampton, University Hospital Southampton National Health Service Trust, Southampton, United Kingdom
| | - Robert Geraghty
- University of Southampton, University Hospital Southampton National Health Service Trust, Southampton, United Kingdom
| | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens and 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece
| | | | - Olivier Traxer
- Tenon Hospital, Pierre and Marie Curie University and Group Recherche Clinique Lithiase No. 20, Paris, France
| | - Amelia Pietropaolo
- University of Southampton, University Hospital Southampton National Health Service Trust, Southampton, United Kingdom
| | - Bhaskar K Somani
- University of Southampton, University Hospital Southampton National Health Service Trust, Southampton, United Kingdom.
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Barzegari H, Zohrevandi B, Masoumi K, Forouzan A, Darian AA, Khosravi S. Comparison of Oral Midazolam and Promethazine with Oral Midazolam alone for Sedating Children during Computed Tomography. Emerg (Tehran) 2015; 3:109-13. [PMID: 26495395 PMCID: PMC4608335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Both midazolam and promethazine are recommended to be used as sedatives in many studies but each have some side effects that limits their use. Combination therapy as an alternative method, may decreases these limitations. Therefore, this study aimed to compare midazolam with midazolam-promethazine regarding induction, maintenance, and recovery characteristics following pediatric procedural sedation and analgesia. METHODS Children under 7 years old who needed sedation for being CT scanned were included in this double-blind randomized clinical trial. The patients were randomly divided into 2 groups: one only received midazolam (0.5 mg/kg), while the other group received a combination of midazolam (0.5 mg/kg) and promethazine (1.25 mg/kg). University of Michigan Sedation Scale (UMSS) was used to assess sedation induction. In addition to demographic data, the child's vital signs were evaluated before prescribing the drugs and after inducing sedation (reaching UMSS level 2). The primary outcomes in the present study were onset of action after administration and duration of the drugs' effect. RESULTS 107 patients were included in the study. Mean onset of action was 55.4±20.3 minutes for midazolam and 32.5±11.1 minutes for midazolam-promethazine combination (p<0.001). But duration of effect was not different between the 2 groups (p=0.36). 8 (7.5%) patients were unresponsive to the medication, all 8 of which were in the midazolam treated group (p=0.006). Also in 18 (16.8%) cases a rescue dose was prescribed, 14 (25.9%) were in the midazolam group and 4 (7.5%) were in the midazolam-promethazine group (p=0.02). Comparing systolic (p=0.20) and diastolic (p=0.34) blood pressure, heart rate (p=0.16), respiratory rate (p=0.17) and arterial oxygen saturation level (p=0.91) showed no significant difference between the 2 groups after intervention. CONCLUSION Based on the findings of this study, it seems that using a combination of midazolam and promethazine not only speeds up the sedation induction, but also decreases unresponsiveness to the treatment and the need for a rescue dose.
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Affiliation(s)
| | | | | | - Arash Forouzan
- Corresponding Author: Arash Forouzan; Department of Emergency Medicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University of Medical Sciences, Azadegan Avenue, Ahvaz, Khuzestan Province, Iran. Postal Code: 6193673166; Tel/Fax: +986112229166;
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Crump C, Sundquist K, Sundquist J, Winkleby MA. Neighborhood deprivation and psychiatric medication prescription: a Swedish national multilevel study. Ann Epidemiol 2011; 21:231-7. [PMID: 21376269 PMCID: PMC3541429 DOI: 10.1016/j.annepidem.2011.01.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Revised: 12/21/2010] [Accepted: 12/21/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Previous studies of neighborhood deprivation and mental disorders have yielded mixed results, possibly because they were based on different substrata of the population. We conducted a national multilevel study to determine whether neighborhood deprivation is independently associated with psychiatric medication prescription in a national population. METHODS Nationwide outpatient and inpatient psychiatric medication data were analyzed for all Swedish adults (N = 6,998,075) after 2.5 years of follow-up. Multilevel logistic regression was used to estimate the association between neighborhood deprivation (index of education, income, unemployment, and welfare assistance) and prescription of psychiatric medications (antipsychotics, antidepressants, anxiolytics, or hypnotics/sedatives), after adjusting for broadly measured individual-level sociodemographic characteristics. RESULTS For each psychiatric medication class, a monotonic trend of increasing prescription was observed by increasing level of neighborhood deprivation. The strongest associations were found for antipsychotics and anxiolytics, with adjusted odds ratios of 1.40 (95% confidence interval [CI], 1.36-1.44) and 1.24 (95% CI, 1.22-1.27), respectively, comparing the highest- to the lowest-deprivation neighborhood quintiles. CONCLUSIONS These findings suggest that neighborhood deprivation is associated with psychiatric medication prescription independent of individual-level sociodemographic characteristics. Further research is needed to elucidate the mechanisms by which neighborhood deprivation may affect mental health and to identify the most susceptible groups in the population.
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Affiliation(s)
- Casey Crump
- Stanford Family Medicine, Stanford University, Palo Alto, California 94304-5765, USA.
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Chouinard G. The search for new off-label indications for antidepressant, antianxiety, antipsychotic and anticonvulsant drugs. J Psychiatry Neurosci 2006; 31:168-76. [PMID: 16699602 PMCID: PMC1449873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Most drugs are prescribed for several illnesses, but it took several years for psychotropic drugs to have multiple clinical indications. Our search for serotonergic drugs in affective illnesses and related disorders led to new off-label indications for fluoxetine, sertraline, tryptophan, clonazepam, alprazolam, tomoxetine, buproprion, duloxetine, risperidone and gabapentin. Various clinical trial designs were used for these proof-of-concept studies. Novel therapeutic uses of benzodiazepines, such as in panic disorder and mania, were found with the introduction of 2 high-potency benzodiazepines, clonazepam and alprazolam, which were thought to have serotonergic properties. Our initial clinical trials of fluoxetine and sertraline led to their approved indications in the treatment of obsessive-compulsive disorder, and our trials of gabapentin led to new indications in anxiety disorders (generalized anxiety, panic attack and social phobia) and sleep disorders (insomnia).
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Affiliation(s)
- Guy Chouinard
- Clinical Psychopharmacology Unit, Allan Memorial Institute, McGill University Health Centre, McGill University, Montréal, Que, Canada.
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