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benzodiazepines discontinuation

Quentin Boucherie, Gaëtan Gentile, Coralie Chalançon, Vincent Sciortino, Olivier Blin, Joëlle Micallef, Sylvie Bonin-Guillaume
The aim of this study was to assess the prevalence of long-term antipsychotic (AP) use in community-dwelling patients with dementia considering hospitalization periods as AP exposure or not. A retrospective study was carried out from 2009 to 2012 on a PACA-Alzheimer cohort (which included 31 963 patients in 2009 and 36 442 in 2012 from 5 million inhabitants). Three groups of patients were identified according to the longest exposure to APs without interruption: nonusers, short-term users (≤3 successive months without discontinuation), and long-term users...
October 12, 2016: International Clinical Psychopharmacology
Zeyad T Sahli, Jae Jo, Shaker A Mousa, Frank I Tarazi
Restless legs syndrome (RLS) is a common neurological movement disorder, characterized by restless and unpleasant sensations in the deep inside of legs. The symptoms of RLS are less noticeable during daytime, but more prevalent at night. Therefore, the disorder can induce low quality of life, insomnia, and impairment of daytime activity. RLS in end-stage renal disease (ESRD) patients is especially problematic due to premature discontinuation of dialysis and increased mortality. The prevalence of RLS among dialysis patients is much higher compared to the prevalence of the same disorder in patients with normal renal functions...
October 5, 2016: CNS Spectrums
Eric J Hawkins, Carol A Malte, Hildi J Hagedorn, Douglas Berger, Anissa Frank, Aline Lott, Carol E Achtmeyer, Anthony J Mariano, Andrew J Saxon
BACKGROUND:  Due to the involvement of opioids and benzodiazepines in rising pharmaceutical overdoses, a reduction in coprescribing of these medications is a national priority, particularly among patients with substance use disorders and other high-risk conditions. However, little is known about primary care (PC) and mental health (MH) prescribers' perspectives on these medications and efforts being implemented to reduce coprescribing. DESIGN:  An anonymous survey...
August 24, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Guillaume Airagnes, Antoine Pelissolo, Mélanie Lavallée, Martine Flament, Frédéric Limosin
Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly...
October 2016: Current Psychiatry Reports
Jessica L Norman, Sarah L Anderson
Insomnia, a highly prevalent disorder, can be detrimental to patients' overall health and worsen existing comorbidities. Patients may have acute episodes of insomnia related to a traumatic event, but more commonly insomnia occurs chronically. While proper sleep hygiene and behavioral therapy play important roles in the nonpharmacologic management of short-term and chronic insomnia, medications may also be required. Historically, insomnia has been treated with agents such as benzodiazepines, nonbenzodiazepine receptor agonists, and melatonin agonists...
2016: Nature and Science of Sleep
Chi-Shun Wu, Show-Hwa Tong, Cheung-Ter Ong, Sheng-Feng Sung
PURPOSE: Serotonin syndrome is a potentially life-threatening complication of serotonergic agents. Although mirtazapine is a relatively safe antidepressant and has a comparatively low incidence of side effects, it still could induce serotonin syndrome. CASE REPORT: We described a 34-year-old man with schizophrenic disorder who presented with acute consciousness disturbance, extremely high fever, rigidity, and spontaneous clonus in lower limbs. Two days before entry, oral mirtazapine was added to his regular medication of olanzapine...
December 2015: Acta Neurologica Taiwanica
Yoko Komada, Yoshikazu Takaesu, Kentaro Matsui, Masaki Nakamura, Shingo Nishida, Meri Kanno, Akira Usui, Yuichi Inoue
PURPOSE: The aim of this study was to ascertain the clinical characteristics of drug-induced sleep-related eating disorder (SRED). PATIENTS AND METHODS: We retrospectively reviewed the medical records of 30 patients with primary SRED (without any comorbid sleep disorders and who were not taking any possible causative medications), and ten patients with drug-induced SRED (occurrence of SRED episodes after starting nightly medication of sedative drugs, which completely resolved after dose reduction or discontinuation of the sedatives)...
2016: Neuropsychiatric Disease and Treatment
Anna Lembke, Keith Humphreys, Jordan Newmark
Evidence supports the use of opioids for treating acute pain. However, the evidence is limited for the use of chronic opioid therapy for chronic pain. Furthermore, the risks of chronic therapy are significant and may outweigh any potential benefits. When considering chronic opioid therapy, physicians should weigh the risks against any possible benefits throughout the therapy, including assessing for the risks of opioid misuse, opioid use disorder, and overdose. When initiating opioid therapy, physicians should consider buprenorphine for patients at risk of opioid misuse, opioid use disorder, and overdose...
June 15, 2016: American Family Physician
Marine Thorel, Camille Fummi, Valérie Gras, Kamel Masmoudi
Twenty-two cases related to benzodiazepine (BZD) withdrawal syndrome were identified and reported to Amiens's regional pharmacovigilance center between January 1st, 1995 and March 25th, 2014, all with a favourable outcome after reintroduction of a BZD. Despite being a very classical well-known side effect, physicians may underestimate this risk. Our series also confirms that the patient is misinformed about the consequences of an abrupt BZD discontinuation especially when the BZD has been consumed for many years...
June 2016: Thérapie
J Madigand, P Lebain, G Callery, S Dollfus
INTRODUCTION: Catatonia is a psychomotor syndrome which can include motor, mental, behavioral and vegetative symptoms. Exclusively associated with schizophrenia until the 1970s, catatonia still remains an under-diagnosed syndrome with significant morbidity and mortality. LITERATURE FINDINGS: As a result of its different forms and developments, catatonic syndrome can be associated with many organic and psychiatric etiologies and confused with a variety of diagnoses...
August 2016: L'Encéphale
Muna Beg, Sara Fisher, Dana Siu, Sudhir Rajan, Lawrence Troxell, Vincent X Liu
CONTEXT: Studies suggest that dexmedetomidine-an intravenous central-acting α2-adrenergic agonist that effectively reduces anxiety among critically ill patients-is being used in patients with severe alcohol withdrawal. However, evidence supporting its use is limited, and it is not approved for this indication. OBJECTIVE: To assess the effect of dexmedetomidine on severe alcohol withdrawal symptoms and to compare its use with benzodiazepines alone. DESIGN: A retrospective, cohort study of 77 patients admitted to the adult medical intensive care unit with severe alcohol withdrawal between January 1, 2009, and October 31, 2013...
2016: Permanente Journal
Marie Bulathsinghala, Kimberly Keefer, Andry Van de Louw
Propylene glycol (PG) is used as a solvent in numerous medications, including trimethoprim/sulfamethoxazole (TMP/SMX) and lorazepam, and is metabolized in the liver to lactic acid. Cases of lactic acidosis related to PG toxicity have been described and always involved large doses of benzodiazepines and PG. We present the first case of severe lactic acidosis after a 3-day course of TMP/SMX alone, involving allegedly safe amounts of PG.A 31-year-old female with neurofibromatosis and pilocytic astrocytoma, receiving temozolomide and steroids, was admitted to the intensive care unit for pneumonia and acute respiratory failure requiring intubation...
April 2016: Medicine (Baltimore)
Lone Baandrup, Birte Yding Glenthøj, Poul Jørgen Jennum
Benzodiazepines are frequently long-term prescribed for the treatment of patients with severe mental illness. This prescribing practice is problematic because of well-described side effects including risk of dependence. We examined the efficacy of prolonged-release melatonin on objective and subjective sleep quality during benzodiazepine discontinuation and whether sleep variables were associated with benzodiazepine withdrawal. Eligible patients included adults with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder and long-term use of benzodiazepines in combination with antipsychotics...
June 30, 2016: Psychiatry Research
Jennifer L Bornkamp, Sheilah Robertson, Natalie M Isaza, Kelly Harrison, Brian A DiGangi, Luisito Pablo
OBJECTIVE: To assess the effect of anesthetic induction with a benzodiazepine plus ketamine or propofol on hypothermia in dogs undergoing ovariohysterectomy without heat support. ANIMALS: 23 adult sexually intact female dogs undergoing ovariohysterectomy. PROCEDURES: Baseline rectal temperature, heart rate, and respiratory rate were recorded prior to premedication with buprenorphine (0.02 mg/kg, IM) and acepromazine (0.05 mg/kg, IM). Anesthesia was induced with midazolam or diazepam (0...
April 2016: American Journal of Veterinary Research
Teija Kasteenpohja, Mauri Marttunen, Terhi Aalto-Setälä, Jonna Perälä, Samuli I Saarni, Jaana Suvisaari
BACKGROUND: Anxiety disorders are common in early adulthood, but general population studies concerning the treatment adequacy of anxiety disorders taking into account appropriate pharmacological and psychological treatment are scarce. The aims of this study were to examine treatments received for anxiety disorders in a Finnish general population sample of young adults, and to define factors associated with receiving minimally adequate treatment and with dropping out from treatment. METHODS: A questionnaire containing several mental health screens was sent to a nationally representative two-stage cluster sample of 1894 Finns aged 19 to 34 years...
2016: BMC Psychiatry
Deborah Dowell, Tamara M Haegerich, Roger Chou
IMPORTANCE: Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose. OBJECTIVE: To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. PROCESS: The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs...
April 19, 2016: JAMA: the Journal of the American Medical Association
John J Mariani, Robert J Malcolm, Agnieszka K Mamczur, Jean C Choi, Ronald Brady, Edward Nunes, Frances R Levin
BACKGROUND: Benzodiazepine use disorders are a common clinical problem among methadone maintenance treatment patients and have adverse effects on clinical outcomes. OBJECTIVES: To evaluate gabapentin for the outpatient treatment of benzodiazepine abuse or dependence in methadone maintenance patients. METHODS: Participants (n = 19) using benzodiazepines at least 4 days per week were enrolled into an 8-week randomized double-blind placebo-controlled outpatient pilot trial...
May 2016: American Journal of Drug and Alcohol Abuse
Mark A Oldham, Paul H Desan
BACKGROUND: Withdrawal from alcohol and sedative-hypnotics can be complicated by seizures, hallucinations, or delirium. Withdrawal catatonia is another, less commonly discussed complication that clinicians should appreciate. METHODS: We present a case of alcohol withdrawal catatonia and a case of benzodiazepine withdrawal catatonia and offer a systematic review of previous cases of alcohol or sedative-hypnotic withdrawal catatonia. We outline clinical features that suggest a potential link between withdrawal catatonia and withdrawal delirium...
May 2016: Psychosomatics
Ivana Kacirova, Milan Grundmann, Petr Silhan, Hana Brozmanova
Clonazepam is long-acting benzodiazepine agonist used in short-acting benzodiazepine withdrawal; however, recent observations suggest the existence of its abuse. We demonstrate a 40-year-old man with a 20-year history of psychiatric care with recently benzodiazepine dependence (daily intake of ∼60 mg of clonazepam and 10 mg of alprazolam). High serum levels of both drugs were analyzed 3 weeks before admission to hospitalization (clonazepam 543.9 ng/mL, alprazolam 110 ng/mL) and at the time of admission (clonazepam 286...
March 2016: Medicine (Baltimore)
Paulo Sérgio Lucas da Silva, Maria Eunice Reis, Thais Suelotto Machado Fonseca, Marcelo Cunio Machado Fonseca
BACKGROUND AND AIMS: Although iatrogenic withdrawal syndrome (IWS) has been recognized in patients exposed to opioids and benzodiazepines, very few studies have used a validated tool for diagnosis and assessment of IWS in critically ill children. We sought to determine IWS rate, risk factors, and outcomes of IWS patients. METHODS: Prospective observational study conducted in a pediatric intensive care unit. A total of 137 patients (31 with IWS and 106 with no IWS) received a continuous infusion of fentanyl and midazolam for 3 or more days...
March 2016: Journal of Addiction Medicine
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