Avoiding withdrawal symptoms following antipsychotic discontinuation is an important factor when planning a safe therapy. We performed a systematic review and meta-analysis concerning occurrence of ...withdrawal symptoms after discontinuation of antipsychotics.
We searched the databases CENTRAL, Pubmed, and EMBASE with no restriction to the beginning of the searched time period and until October 1, 2019 (PROSPERO registration no. CRD42019119148).
Of the 18,043 screened studies, controlled and cohort trials that assessed withdrawal symptoms after discontinuation of oral antipsychotics were included in the random-effects model. Studies that did not implement placebo substitution were excluded from analyses. The primary outcome was the proportion of individuals with withdrawal symptoms after antipsychotic discontinuation. We compared a control group with continued antipsychotic treatment in the assessment of odds ratio and number needed to harm (NNH).
We followed guidelines by the Cochrane Collaboration, PRISMA, and MOOSE.
Five studies with a total of 261 individuals were included. The primary outcome, proportion of individuals with withdrawal symptoms after antipsychotic discontinuation, was 0.53 (95% CI, 0.37-0.70;
= 82.98%,
< 0.01). An odds ratio of 7.97 (95% CI, 2.39-26.58;
= 82.7%,
= 0.003) and NNH of 3 was calculated for the occurrence of withdrawal symptoms after antipsychotic discontinuation.
Withdrawal symptoms appear to occur frequently after abrupt discontinuation of an oral antipsychotic. The lack of randomized controlled trials with low risk of bias on antipsychotic withdrawal symptoms highlights the need for further research.
•Kratom was often used to self-treat opioid withdrawal or as an opioid substitute.•Polydrug use that included kratom and at least one other substance was common.•Kratom was perceived as lifesaving, ...but also potentially addictive.•Kratom dependence and withdrawal symptoms were described in detail.•Most used kratom for pragmatic health reasons, rather than to achieve euphoria.
Mitragyna speciosa, referred to as “kratom”, is increasingly used in the United States for self-treating pain, psychiatric, and substance use disorder symptoms. It is used by some to attenuate opioid withdrawal and as a longer-term drug substitute. Most self-report data have come from online surveys, small in-person surveys, and case reports. These may not be representative of the broader kratom-using population.
Analyze user-generated social media posts to determine if independent, descriptive accounts are generally consistent with prior U.S. kratom survey findings and gain a more nuanced understanding of kratom use patterns.
Reddit posts mentioning kratom from 42 subreddits between June 2019–July 2020 were coded by two independent raters.
Relevant posts (number of comments, upvotes, and downvotes) from 1274 posts comprised the final sample (n = 280). Of the 1521 codes applied, 1273 (83.69%) were concordant. Desirable kratom effects were described among a majority, but so too were adverse effects. Reports of kratom as acute self-treatment for opioid withdrawal were more prominent compared to longer-term opioid substitution. Quantitative analysis found higher kratom doses associated (p < .001) with greater odds of reported kratom addiction (OR = 3.56) or withdrawal (OR = 5.88), with slightly lower odds of desirable effects (OR = 0.53, p = .014). Despite perceived therapeutic benefits, kratom was characterized by some in terms of addiction that, in some cases, appeared dose-dependent. Polydrug use was also prominently discussed.
Results validated many prior survey findings while illustrating complexities of kratom use that are not being fully captured and require continued investigation.
Currently, there is no confirmed drug intervention in the treatment of methamphetamine (MA) dependence. In the present study, we tested the possible influence of venlafaxine in individuals with MA ...dependence.
A total of 52 male patients (mean age: 33.93 years) diagnosed with MA dependence referred to Farabi Hospital in Kermanshah, Iran, was randomly assigned either to enlafaxine or a placebo condition. At the baseline, as well as 4 to 8 weeks later, patients completed questionnaires on depression, withdrawal symptoms, and cravings.
The mean scores of withdrawal symptoms (hyperarousal, anxiety, reversed vegetative), depression, and cravings (desire & intention, negative reinforcement, and control) during the study and in both groups had a descending trend. Unlike the effect of the studied groups, the effect of time on the repeated measure model was significant. The mean of inverse symptoms, desire, and control from the fourth week to the end of the study did not have a statistically significant difference.
The results showed that venlafaxine can be effective in reducing depression, withdrawal symptoms, and cravings in people who are dependent on MA, though these results were observed in parallel in the placebo group, and as such warrants further study.
•Kratom (Mitragyna speciosa) is a psychoactive plant that is receiving increased international attention.•Kratom use carries important mental health risks and benefits that require study.•Kratom has ...harm reduction potential for substance users who want to quit opioids.•Kratom enhances mood and relieves anxiety for some people.•Kratom’s withdrawal syndrome and dependence potential is (often) mild vs. opioids.
Kratom (Mitragyna speciosa) is a psychoactive plant native to Southeastern Asia that is receiving increased international attention as a potential therapeutic agent. While much of the limited scientific research on kratom is focused on its analgesic potential, kratom use also has important risks and benefits in the domain of mental health.
We conducted a comprehensive systematic review of all studies on kratom use and mental health published between January 1960 and July 2017.
Findings indicate kratom’s potential as a harm reduction tool, most notably as a substitute for opioids among people who are addicted. Kratom also enhances mood and relieves anxiety among many users. For many, kratom’s negative mental health effects – primarily withdrawal symptoms – appear to be mild relative to those of opioids. For some users, however, withdrawal is highly uncomfortable and maintaining abstinence becomes difficult.
Results inform clinicians working in the mental health and substance use fields, policy-makers, and researchers about the mental health effects of this plant.
Care for neonatal abstinence syndrome (NAS), a postnatal drug withdrawal syndrome, remains variable. We designed and implemented a multicenter quality improvement collaborative for infants with NAS. ...Our objective was to determine if the collaborative was effective in standardizing hospital policies and improving patient outcomes.
From 2012 to 2014, data were collected through serial cross-sectional audits of participating centers. Hospitals assessed institutional policies and patient-level data for infants with NAS requiring pharmacotherapy, including length of pharmacologic treatment and length of hospital stay (LOS). Models were fit, clustered according to hospital, to evaluate changes in patient outcomes over time.
Among 199 participating centers, the mean number of NAS-focused guidelines increased from 3.7 to 5.1 of a possible 6 (P < .001), with improvements noted in all measured domains. Among infants cared for at participating centers, decreases occurred in median (interquartile range) length of pharmacologic treatment, from 16 days (10 to 27 days) to 15 days (10 to 24 days; P = .02), and LOS from 21 days (14 to 33 days) to 19 days (15 to 28 days; P = .002). In addition, there was a statistically significant decrease in the proportion of infants discharged on medication for NAS, from 39.7% to 26.5% (P = .02). After adjusting for potential confounders, standardized NAS scoring process was associated with shorter LOS (-3.3 days,95% confidence interval, -4.9 to -1.4).
Involvement in a multicenter, multistate quality improvement collaborative focused on infants requiring pharmacologic treatment for NAS was associated with increases in standardizing hospital patient care policies and decreases in health care utilization.
To improve Neonatal Abstinence Syndrome (NAS) inpatient outcomes through a comprehensive quality improvement (QI) program.
Inclusion criteria were opioid-exposed infants ≥36 weeks. QI methodology ...including stakeholder interviews and plan-do-study-act (PDSA) cycles were utilized. We compared pre- and post-intervention NAS outcomes after a QI initiative that included: A non-pharmacologic care bundle, function-based assessments consisting of symptom prioritization and then the "Eat, Sleep, Console" (ESC) Tool; and a switch to methadone for pharmacologic treatment.
Pharmacologic treatment decreased from 87.1 to 40.0%; adjunctive agent use from 33.6 to 2.4%; hospitalization length from a mean 17.4 to 11.3 days, and opioid treatment days from 16.2 to 12.7 (p < 0.001 for all). Total hospital charges decreased from $31,825 to $20,668 per infant. Parental presence increased from 55.6 to 75.8% (p < 0.0001). No adverse events were noted.
A comprehensive QI program focused on non-pharmacologic care, function-based assessments, and methadone resulted in significant sustained improvements in NAS outcomes. These findings have important implications for establishing potentially better practices for opioid-exposed newborns.
•20.8% of the sample reported lifetime kratom use and 10.2% reported past-year use.•Among this group of polysubstance users, kratom-users reported more extensive use.•68.9% of kratom-users reported ...using kratom to reduce opioid/heroin dependence.•64.1% of kratom-users reported using kratom as a substitute for opioids/heroin.•Kratom was one of the least preferred substances among the sample.
Kratom use in the West has increased recently, yet the prevalence and motives for use among individuals with a history of substance use disorder (SUD) have not been fully examined. Kratom has been documented as a means of treating chronic pain, mitigating drug dependence, and easing withdrawal symptoms, yet it is unclear if substance users are utilizing kratom as a self-medication. Abuse liability, side effects, and overall appeal of kratom remain uncertain.
In April 2017, an anonymous survey regarding kratom use and motivations was completed by clients enrolled in a 12-Step-oriented residential program. 500 respondents with a self-reported history of SUD completed the survey.
20.8% of respondents endorsed lifetime kratom use and 10.2% reported past-12-month use. Kratom-users were younger (=32.1 vs. 35.9, p<0.001) and were more versatile substance users. A majority (68.9%) of kratom-users reported having used the drug as a means of reducing or abstaining from non-prescription opioids (NPO) and/or heroin, and 64.1% reported using kratom as a substitute for NPO/heroin. 18.4% of kratom-users reported using the drug due to a disability or chronic pain. One-third of kratom-users stated that kratom was a helpful substance and that they would try it again. However, kratom was not preferred and was indicated as having less appeal than NPO, heroin, amphetamines, and Suboxone.
Among substance users, kratom use may be initiated for a variety of reasons, including as a novel form of harm-reduction or drug substitution, particularly in the context of dependence and withdrawal from other substances.
Cel pracy W pracy opisano związek między nasileniem objawów uzależnienia od ćwiczeń, strategiami behawioralnymi w sytuacji ograniczonych możliwości trenowania a stanem zdrowia psychicznego osób ...ćwiczących. Metoda W badaniu wzięło udział 391 uczestników, 286 kobiety (73,1%) i 105 mężczyzn (26,9%), w wieku od 18 do 68 lat. Badani po 17-19 dniach barier w rutynowych treningach spowodowanych największymi ograniczeniami COVID-19 w Polsce jednorazowo wypełniali ankietę online. Respondenci wypełniali polskie wersje Exercise Dependence Scale, Oceny Zdrowia Psychicznego (GHQ-28) oraz kwestionariusze umożliwiające zebranie danych demograficznych, klinicznych i dotyczących zachowań związanych z ćwiczeniami. Wyniki Zmienne związane z uzależnieniem od ćwiczeń i niektóre odnoszące się do zmian behawioralnych są predyktorami zdrowia psychicznego, zwłaszcza w zakresie lęku, bezsenności i objawów somatycznych. Wszystkie wprowadzone zmienne odpowiadały za 27,4% do 43,7% zróżnicowania stanu zdrowia psychicznego badanych, w zależności od podskal GHQ. Łamanie reguł restrykcji przez trening na świeżym powietrzu chroniło przed objawami zaburzeń psychicznych, zwłaszcza w odniesieniu do objawów somatycznych (Beta=-0,23, p<0,001). Indywidualna ocena stresogenności sytuacji była predyktorem wyników we wszystkich podskalach GHQ, najsilniejszym dla objawów lęku i bezsenności (Beta=0,37, p<0,001). Wnioski Osoby z cechami uzależnienia od ćwiczeń są narażone na pogorszenie samopoczucia podczas przymusowej abstynencji. Ponadto subiektywny poziom indukcji stresu w danej sytuacji jest ważną determinantą warunkującą dobrostan psychiczny, zwłaszcza nasilenie objawów depresyjnych. Osoby, które ignorują ograniczenia i oceniają stres jako niski, doświadczają niższych kosztów psychologicznych.
Objectives The paper describes the relationship between the symptoms of exercise addiction, behavioral strategies in situations of limited workout possibilities and mental health state in exercising individuals. Methods The study included 391 participants, 286 women (73.1%) and 105 men (26.9%), aged 18 to 68 years. The respondents were surveyed online after 17–19 days of barriers to routine training due to greatest COVID-19 restrictions in Poland. Subjects completed the Exercise Dependence Scale, General Health Questionnaire – 28 (GHQ-28) and questionnaires enabling the collection of demographic and clinical data as well as data related to exercise behaviors. Results The variables related to exercise addiction and some related to behavioral changes are predictors of mental health, especially in terms of anxiety, insomnia and somatic symptoms. All the introduced variables accounted for 27.4% to 43.7% of the variation in the mental health status of the subjects, depending on GHQ subscales. Breaking the restriction rules by outdoor training protected against symptoms of psychological disorders, especially in relation to somatic symptoms (Beta = –0.23; p< 0.001). Individual assessment of stress induction in a given situation was a predictor of results in all GHQ subscales, which was the strongest for symptoms of anxiety and insomnia (Beta = 0.37; p< 0.001). Conclusions Individuals with features of exercise addiction are at risk of deterioration of their well-being during forced abstinence. In addition, the subjective level of stress induction in a given situation is an important determinant that conditions psychological well-being, especially the aggravation of depressive symptoms. People who ignore restrictions and have low levels of stress, experience lower psychological costs.
Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor - withdrawal ...catastrophizing - a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms.
We define a novel concept - withdrawal catastrophizing - and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS).
Prospective observational study (
= 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach's α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal.
WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity - Greater withdrawal catastrophizing was associated with next-day SOWS (r
(99) = 0.237,
= .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (r
(119) = 0.357,
< .001); withdrawal-motivated OUD treatment avoidance (r
(119) = 0.421,
< .001), history of leaving the hospital against medical advice (r
(119) = 0.373,
< .001) and buprenorphine-precipitated withdrawal (r
(119) = 0.369,
< .001).
This study provides first evidence of
as a clinically important phenomenon with implications for the future study and treatment of OUD.
Despite the widespread use of glucocorticoids in inflammatory and autoimmune disorders, there is uncertainty about the safe cessation of long-term systemic treatment, as data from prospective trials ...are largely missing. Due to potential disease relapse or glucocorticoid-induced hypocortisolism, the drug is often tapered to sub-physiological doses rather than stopped when the underlying disease is clinically stable, increasing the cumulative drug exposure. Conversely, the duration of exposure to glucocorticoids should be minimized to lower the risk of side effects. We designed a multicenter, randomized, triple-blinded, placebo-controlled trial to test the clinical noninferiority of abrupt glucocorticoid stop compared to tapering after greater than or equal to28 treatment days with greater than or equal to420 mg cumulative and greater than or equal to7.5 mg mean daily prednisone-equivalent dose. 573 adult patients treated systemically for various disorders will be included after their underlying disease has been stabilized. Prednisone in tapering doses or matching placebo is administered over 4 weeks. A 250 mg ACTH-test, the result of which will be revealed a posteriori, is performed at study inclusion; all patients are instructed on glucocorticoid stress cover dosing. Follow-up is for 6 months. The composite primary outcome measure is time to hospitalization, death, initiation of unplanned systemic glucocorticoid therapy, or adrenal crisis. Secondary outcomes include the individual components of the primary outcome, cumulative glucocorticoid doses, signs and symptoms of hypocortisolism, and the performance of the ACTH test in predicting the clinical outcome. Cox proportional hazard, linear, and logistic regression models will be used for statistical analysis. This trial aims to demonstrate the clinical noninferiority and safety of abrupt treatment cessation after greater than or equal to28 days of systemic glucocorticoid therapy in patients with stabilized underlying disease.
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