Several independent meta-analytic reviews suggest a relationship between vitamin D (VTD) deficiency and depressive symptoms. Theoretically, behavioural withdrawal (staying home, discontinuing outdoor ...activities etc.) is likely to exacerbate VTD deficiency. This pilot study assessed the efficacy of a modified form of behavioral therapy designed to simultaneously target VTD deficiency and depressive symptoms. College women (
N
= 114), all citizens of the United Arab Emirates, were screened for depressive symptoms and VTD deficiency. Those participants who were severely VTD deficient and experiencing clinically significant depressive symptoms, were randomly allocated to either a 12-week program of behavioral activation, emphasizing safe-sun exposure (
N
= 10), or a waiting list control group (
N
= 10). At time 2 the sun exposure and behavioral activation (SEBA) group showed a significant increases in 25-hydroxyvitamin D and were, on average, no longer VTD deficient, whereas the control group deteriorated in terms of VTD. Similarly positive results were observed for depressive symptoms. Sun exposure and behavioral activation (SEBA) may be an effective approach to improving VTD status and alleviating depressive symptoms.
Neonatal abstinence syndrome (NAS) refers to a constellation of signs occurring in newborn infants who were exposed to opioids or opiates
. These manifestations include poor feeding, gastrointestinal ...disorders, abnormal sleep patterns, and neurological signs such as jitteriness, tremors, and seizures (1, 2). Myoclonus, jitteriness, and tremors often may be interpreted as seizures and therefore treated as epileptic seizures.
To determine whether seizure like activity observed in infants with NAS correlate with electroencephalogram (EEG) findings.
We reviewed the standard EEG or video electroencephalogram (VEEG) of infants with NAS who were admitted because of seizure-like clinical activity. The exclusion criteria were major neurological anomalies, hypoxic ischemic encephalopathy, metabolic disorders, or with clinical diagnosis other than NAS.
Forty neonates met study criteria; 28 had standard EEG recordings and 18 had VEEG. Mean gestational age was 38.5 weeks. The onset of seizure-like clinical activity was as early as day 1 and as late as day 16 of life. The clinical seizure-like activity described at the referring hospital were jerking, rhythmic movement of the extremities, or tremors. Only three (7.5%) neonates had epileptic seizures. There were increased sharp transients in frontal, central, temporal, and or occipital regions. VEEG showed disturbed non-rapid eye movement (REM) sleep with frequent arousal, jittery movements, or sleep myoclonus.
Clinical seizure-like activity correlates poorly with epileptic seizures in infants with NAS. In neonates with NAS, a VEEG would be useful to determine if the clinical seizure-like activity is of epileptic origin or not, prior to initiation of anti-seizure medications.
Purpose: While the individual and social costs of alcoholism or alcohol use disorder are well established, few are aware that medical problems can arise during detoxification, some of which can be ...life-threatening. This study determines if sustained treatment for Alcohol Withdrawal Syndrome (AWS) might be based on the strategic choices and expectations of patients and health care providers alike, as well as the risk mitigation options available to them. Design/approach: AWS was modeled as a Stag Hunt to explain both risk and decision-making in medical treatments for detoxification, since it can deduce a set of equilibrium strategies available to both patient and provider. Modeling was based on a review of juried literature gathered from search engines with the use medical subject heading terms. Main findings: While there is little evidence that decision-making is shared between patient and physician in AWS treatments, the outcomes of their interactions depend on utility-maximizing choices each makes in anticipation of the other. Payoff-dominant and risk-dominant treatment outcomes are equally likely and equally cost-efficient, as conditioned by the presence (or absence) of mutual trust and assurance in reciprocal transactions. Conclusion/value: Simulation games, such as the Stag Hunt, offer a viable framework to understand patient and provider incentives and health-affecting behaviors during treatments for addiction cessation. If both anticipate indefinitely interacting in the absence of any predetermined or foreseeable final visit, they can maximize future payoffs from mutual cooperation and accountability, which fosters health promotion. However, this study suggests that the effect of cooperation is distinct from the effect of time in AWS and other addiction-cessation programs. Keywords: health-affecting behaviors, healthcare provider, patient compliance, payoff, relapse, simulation game, treatment disruption/discontinuation
Introduction and Aims
Prescribed psychotropic medications contribute to overdose mortality among people with alcohol and other drug (AOD) disorders. We report on prescribed psychotropic medication ...use among AOD treatment service attendees, focusing on sedative drugs.
Design and Methods
Prospective multi‐site naturalistic outcome study in residential and outpatient AOD treatment facilities in Victoria and Western Australia. A convenience sample of 480 people (57% male; mean age 36.1) entering treatment were surveyed, of whom 313 (65%) were followed up by telephone interview after a median of 377 days. Participants’ prescribed psychotropic medication use was ascertained by self‐report at baseline and follow‐up.
Results
At baseline, 41% of participants reported prescribed sedative medication (benzodiazepine, zopiclone or zolpidem) use within the past month, including prescriptions to treat withdrawal symptoms. At follow‐up, the cohort reported a reduced rate of past month prescribed sedative use (23%; P < 0.001) and this rate did not significantly differ between those who continued to use their primary drug of concern and those who were abstinent at follow‐up (P = 0.08). Among those with opioids as their primary drug of concern, one‐third were still being prescribed a sedative at follow‐up (P > 0.99 for change from baseline). At baseline, 40% of participants were prescribed an antidepressant and 13% an antipsychotic medication, which remained similar at follow‐up (45% and 13%, respectively).
Discussion and Conclusions
The high level of prescribed sedative drug use reported by people receiving AOD treatment is a serious public health concern given the increasing incidence of drug overdose deaths in Australia.
Research reports show increased prevalence of habitual khat chewing among various parts of the community in Ethiopia. Some users experience problems controlling their use; withdrawal symptoms may be ...adding to difficulties with reducing or ceasing use. We aimed to describe the nature and the time course of any withdrawal syndrome in relation to the cessation of khat use over the first 2 weeks of a quit attempt. Fifty-nine participants between the ages of 18 and 35 and who have already chewed ≥1 bundle of khat in their life with a chewing frequency of ≥3 days per week were recruited from Adama Science and Technology University campus. Participants were predominantly male (n = 45, 75%) and had the mean age of 24.8 years (range = 20-32; SD = 2.8). Participants used smart phones to monitor withdrawal symptoms and cravings. The total assessments were divided in to 3 prequit and 14 postquit days. The development of withdrawal symptoms was evident, and all withdrawal symptoms followed similar overall patterns, with salient elevations after the quit day and curvatures around the first week of postquit period. Depression, craving, nervousness, tiredness, restlessness, poor motivation, irritability, and negative affect substantially increased and reached peak on the first week around Day 7 and remained higher compared with the level at baseline indicating the persistence and severity of these symptoms over time. In addition, craving, irritability, and restlessness had significantly reverted to their baseline level during the second week of the postquit duration. We have demonstrated low rates of success during unaided quite attempts from khat and that the withdrawal syndrome is not trivial. Interventions are necessary to support individuals during the period of increased symptoms of dysphoria and to reduce the risk of relapse.
...patients with opioid withdrawal symptoms benefit from its agonistic properties in the form of diminished cravings; however, its ceiling effect prevents the consequences of respiratory depression ...and euphoria present with full μ-receptor agonists such as methadone.1 These characteristics contribute to buprenorphine's excellent safety and efficacy profiles, protecting patients with OUD from overdose and death. ...we respectfully disagree with the notion that “medication alone is not sufficient treatment for OUD.” 11 In addition to the difficulties accessing treatment for OUD—including buprenorphine or buprenorphine-naloxone—that our colleagues in Chicago describe and we have seen in Maine as well, emerging literature points to other pandemic-related challenges.12,13 First, evidence suggests that people with OUD may be at higher risk for experiencing COVID-19 infection due to a higher prevalence of pre-existing conditions, smoking, opioid-related immunosuppression, and the presence of structural lung disease.14-17 In addition, those with OUD are more likely to reside in congregate living situations such as group recovery housing, shelters, and correctional facilities where they may be unable to maintain social distancing.14,15 People with OUD also make up a disproportionate share of the United States unsheltered and unstably housed population, placing them at further risk for exposure to COVID-19.16,18 Although social distancing is an important public health measure, there is potential for the isolation associated with COVID-19 to cause harm for those with OUD.19 There is a strong association between social isolation, mood, and substance use disorders.20 Isolation can act as a trigger for some, exacerbating existing patterns of substance use or contributing to a return to use for those who are in recovery.19 In addition, many supportive and harm-reducing services for people with OUD are unavailable as a result of the current pandemic, including support groups, treatment programs, daily medication dispensing clinics, and needle exchanges.
Aim
Phenobarbital, a long‐acting barbiturate, presents an alternative to conventional benzodiazepine treatment for alcohol withdrawal syndrome (AWS). Currently, existing research offers only modest ...guidance on the safety and effectiveness of phenobarbital in managing AWS in hospital settings. The study objective was to assess if a phenobarbital protocol for the treatment of AWS reduces respiratory complications when compared to a more traditionally used benzodiazepine protocol.
Methods
A retrospective cohort study analyzing adults who received either phenobarbital or benzodiazepine‐based treatment for AWS over a 4‐year period, 2015–2019, in a community teaching hospital in a large academic medical system.
Results
A total of 147 patient encounters were included (76 phenobarbital and 71 benzodiazepine). Phenobarbital was associated with a significantly decreased risk of respiratory complications, defined by the occurrence of intubation (15/76 phenobarbital 20% vs. 36/71 benzodiazepine 51%) and decreased incidence of the requirement of six or greater liters of oxygen when compared with benzodiazepines (10/76 13% vs. 28/71 39%). There was a significantly higher incidence of pneumonia in benzodiazepine patients (15/76 20% vs. 33/71 47%). Mode Richmond Agitation Sedation Scale (RASS) scores were more frequently at goal (0 to −1) between 9 and 48 h after the loading dose of study medication for phenobarbital patients. Median hospital and ICU length of stay were significantly shorter for phenobarbital patients when compared with benzodiazepine patients (5 vs. 10 days and 2 vs. 4 days, respectively).
Conclusion
Parenteral phenobarbital loading doses with an oral phenobarbital tapered protocol for AWS resulted in decreased risk of respiratory complications when compared to standard treatment with benzodiazepines.
Phenobarbital, a long‐acting barbiturate, presents as an alternative to conventional benzodiazepine treatment for alcohol withdrawal syndrome (AWS). This is a retrospective cohort study analyzing adults who received either phenobarbital or benzodiazepine‐based treatment for AWS over a 4‐year period, 2015 to 2019, in a community teaching hospital in a large academic medical system. Parenteral phenobarbital loading doses with an oral phenobarbital tapered protocol for AWS resulted in decreased risk of respiratory complications when compared to standard treatment with benzodiazepines.
OBJECTIVES: This study has been performed to evaluate the use of CNS stimulants among the undergraduate students of medical or non-medical field. METHODS: A semi-structured questionnaire was prepared ...for survey based cross-sectional study. A sample of 440 students of 4th and final year was selected conveniently from four institutes, two medical colleges and two universities of Southern Punjab, Pakistan RESULTS: The response rate of 100% was achieved, all the participants responded well. It was evaluated that medical students (n=178, 80.9%) have more knowledge about CNS stimulants then non-medical students(n=102, 46.4%). So there is significant difference in knowledge about prescription CNS stimulants but insignificant difference is present in several features like withdrawal symptoms associated with the use of the Prescription CNS stimulant in medical and nonmedical students. This study revealed that (n=25, 11.4%) and (n=33,15%) of the medical and non-medical students respectively stated to be the diagnosed ADHD patients. Total 77.7% and 70.5% medical and non-medical students respectively use non-prescription CNS stimulants (Nicotine, Caffeine, Cocaine, Energy drinks, alcoholic beverages and shisha smoking) for various purposes i.e. to improve attention, mend up the confidence and to lose weight. Medical students (n=75, 34.1%) stated to suffer with fatigue as withdrawal symptom more than non-medical students (n=41, 18.6%) while sleep disturbance issue was most commonly endure by the non-medical students. The Illicit use by oral route of administration for prescription CNS Stimulants more among medical students than non-medical students; whereas least adopted route of administration is snorting and intranasal among both these groups of students CONCLUSIONS: It is concluded that there is significant difference between medical and non-medical students with respect to knowledge about the appropriate use and risk association, problem encounter in concentrating things and current status of the user and the reason behind their use is less awareness, increased educational burden and lack of parental guidance.
OBJECTIVES: This study was conducted to characterize real-world usage of buprenorphine/naloxone sublingual tablets (BUP/NLX) in France. METHODS: This retrospective observational study was conducted ...using the French IMS Health Cegedim Longitudinal Patient Database (LPD). LPD records were searched for patients with opioid dependence in general practice settings who received a prescription for BUP/NLX, buprenorphine, or methadone between 2-January-2012 and 31-December-2014. Outcomes included: (1) characteristics of patients started on BUP/NLX; (2) switches from BUP/NLX to low-dose buprenorphine (0.4 mg) or methadone; and (3) AEs of general and specific concern in France. RESULTS: 10,152 patients received a prescription during the inclusion period: buprenorphine, n=7,987 (78.7%); methadone, n=2,120 (20.9%); BUP/NLX, n=495 (4.9%). Prescription cohorts were not mutually exclusive. Mean age in the BUP/NLX cohort was 37.9 years, with 73.2% of patients between 30-49 years; 81.6% were male. The most common comorbidities (> 10%) were pain (34.1%), depression (20.8%), and hepatitis C (10.9%). Most patients (96.4%) had a history of mental disorders due to psychoactive substance use or drug dependence. BUP/NLX was first prescribed for a drug addiction diagnosis in 73.4% of patients, documented either as "addiction unspecified" (35.4%) or "opioids addiction" (38.0%); opioid withdrawal treatment accounted for 13.5% of first prescriptions. Mean daily dose for BUP/NLX was 9.2 mg (individual dose range, 1-32 mg). Mean treatment durations for BUP/NLX, buprenorphine (any dose), and methadone were 52.0,107.7, and 93.1 days, respectively. Only 9 (1.8%) patients switched from BUP/NLX to buprenorphine 0.4 mg during the study period; 4 (0.8%) switched to methadone. Common AEs (>1% in any cohort) were as follows (for BUP/NLX, buprenorphine, and methadone, respectively): abscess (1.4%, 2.6%, 4.3%); depression (2.8%, 2.8%, 4.6%); drug withdrawal syndrome (1.6%, 1.8%, 2.4%). CONCLUSIONS: Few patients were switched from BUP/NLX to low-dose buprenorphine or methadone, and no safety concerns were detected for BUP/NLX compared to buprenorphine and methadone.
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•We explored using ondansetron to prevent physical dependence to chronic morphine use.•After a month of morphine therapy with or without ondansetron, withdrawal was induced.•Objective ...and subjective withdrawal scores suggest no disparity between treatment groups.•Ondansetron does not prevent dependence in regular users of morphine for pain management.
In this study, we investigated the co-administration of ondansetron with morphine, and whether it could prevent the development of physical dependence in patients taking opioids for the treatment of chronic pain.
A total of 48 chronic back pain patients (N = 48) participated in this double-blinded, placebo-controlled, randomized study. Patients were titrated onto sustained-release oral morphine and randomized to take 8 mg ondansetron or placebo three times daily concurrently with morphine during the 30-day titration. Following titration, patients underwent Naloxone induced opioid withdrawal. Opioid withdrawal signs and symptoms were then assessed by a blinded research assistant (objective opioid withdrawal score: OOWS) and by the research participant (subjective opioid withdrawal score: SOWS).
We observed clinically significant signs of naloxone-precipitated opioid withdrawal in all participants (ΔOOWS = 4.3 ± 2.4, p < 0.0001; ΔSOWS = 14.1 ± 11.7, p < 0.0001), however no significant differences in withdrawal scores were detected between treatment groups.
We hypothesized that ondansetron would prevent the development of physical dependence in human subjects when co-administered with opioids, but found no difference in naloxone-precipitated opioid withdrawal scores between ondansetron and placebo treatment groups. These results suggest that further studies are needed to determine if 5HT3 receptor antagonists are useful in preventing opioid physical dependence.
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