Lorazepam, Tiapride and Pregabalin in Alcohol Withdrawal: A Multicenter, Randomised, Comparison Trial

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
G. Martinotti ◽  
M. Di Nicola ◽  
D. Tedeschi ◽  
A. Frustaci ◽  
R. De Filippis ◽  
...  
Keyword(s):  
Alcohol Withdrawal ◽  
Psychiatric Symptoms ◽  
Italian Version ◽  
Psychiatric Symptomatology ◽  
Secondary Endpoints ◽  
Symptom Check List ◽  
Comparison Trial ◽  
Dsm Iv ◽  
Single Blind ◽  
Alcohol Dependent

Introduction:In this multicenter, randomised, single-blind, parellel group, comparison trial we aimed to investigate the efficacy of lorazepam, tiapride and pregabalin in alcohol withdrawal. Craving and psychiatric symptoms improvements were the secondary endpoints.Methods:One-hundred-nine alcohol dependent subjects (DSM-IV) were detoxified and subsequently randomised into three groups, respectively receiving 200-400 mg of tiapride (TIA; mean dosage 300 mg), 2-5 mg of lorazepam (LOR; mean dosage 3 mg) and 150-450 mg of pregabalin (PRE; mean dosage 280 mg). Withdrawal symptomatology was determined by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), whereas the level of craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VAS) and the Italian -version of the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptomatology was evaluated by the Symptom Check List 90 Revised (SCL-90 R).Results:All the three medications have shown efficacy on reducing alcohol drinking indices, craving scores and withdrawal symptomatology. The reduction observed in the PRE group was significantly higher than those in the LOR and TIA groups. In terms of safety and tolerability, all the compounds were generally well-tolerated. Only one patient has reported an epileptic episode during the treatment with tiapride.Discussion:Results from this study globally place the three medications at the same range of efficacy, with the PRE group reporting an higher reduction of withdrawal symptoms. Another point in favour of the employment of pregabalin was represented by a better outcome in those patients reporting a comorbid psychiatric disorder.

Oxcarbazepine vs. Topiramate in Alcohol Dependence

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
G. Martinotti ◽  
M. Di Nicola ◽  
D. Tedeschi ◽  
O. De Vita ◽  
L. Guerriero ◽  
...  
Keyword(s):  
Alcohol Dependence ◽  
Psychiatric Symptoms ◽  
Italian Version ◽  
Clinical Criteria ◽  
Alcohol Relapse ◽  
Pilot Clinical Study ◽  
Symptom Check List ◽  
Dsm Iv ◽  
Group Trial ◽  
Alcohol Dependent

Introduction:Aim of this randomised, parallel, placebo-controlled group trial was to compare oxcarbazepina and topiramate with placebo on alcohol drinking indices. Craving and psychiatric simptomatology have also been investigated.Methods:This randomised, parallel, placebo-controlled psychopharmacology trial studied 60 patients, consecutively recruited, meeting clinical criteria for Alcohol Dependence (DSM-IV). After detoxification, subjects were assigned to flexible doses of oxcarbazepine (n=20), or topiramate (n=20) or placebo (n=20). Withdrawal symptomatology was determined by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) and the level of craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VAS) and the Italian -version of the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptoms were evaluated with the Symptom Check List 90 Revised (SCL-90 R).Results:Non-benzodiazepine anticonvulsants have been shown to be efficacious treatments for the prevention of alcohol relapse although the FDA has yet approved none of these agents. During the congress the main results of this study will be presented.Conclusions:To our knowledge, this is the first randomised, parallel, placebo-controlled group study to evaluate the efficacy of oxcarbazepine and topiramate compared in alcohol dependent patients. The data of this pilot clinical study suggest and investigate a possible role for the anticonvulsants agents in the treatment of alcohol dependent patients.

Pregabalin, tiapride and lorazepam in alcohol withdrawal syndrome: a multi-centre, randomized, single-blind comparison trial

Addiction ◽  
2010 ◽  
Vol 105 (2) ◽  
pp. 288-299 ◽  
Author(s):  
Giovanni Martinotti ◽  
Marco di Nicola ◽  
Alessandra Frustaci ◽  
Roberto Romanelli ◽  
Daniela Tedeschi ◽  
...  
Keyword(s):  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Comparison Trial ◽  
Blind Comparison ◽  
Single Blind

Relationship between insomnia and tobacco smoking in alcohol-dependent patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S398-S398
Author(s):  
A. Wnorowska ◽  
A. Jakubczyk ◽  
A. Klimkiewicz ◽  
A. Mach ◽  
K. Brower ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Tobacco Smoking ◽  
Sleep Problems ◽  
Psychiatric Symptoms ◽  
Tobacco Dependence ◽  
Multivariate Regression Analysis ◽  
Brief Symptom Inventory ◽  
Study Group ◽  
The Relationship ◽  
Alcohol Dependent

IntroductionInsomnia and tobacco use are frequent and important problems in alcohol-dependent patients. However, the relationship between sleep problems and cigarette smoking was not thoroughly investigated in this population.AimThe purpose of the study was to investigate the relationship between tobacco smoking and severity of insomnia in alcohol-dependent patients in treatment. We also aimed at assessing other predictors of insomnia in this population.MethodsThe study group comprised 384 alcohol-dependent patients. Standardized tools were used to assess: tobacco dependence (Fagerström Test for Nicotine Dependence [FTND]), sleep problems (Athens Insomnia Scale [AIS]), severity of alcohol dependence (Michigan Alcohol Screening Test [MAST]) and drinking quantities before entering treatment (Timeline Follow Back [TFLB]). Other comorbid psychiatric symptoms were assessed using Brief Symptom Inventory (BSI) and Barratt's Impulsiveness Scale (BIS-11).ResultsThe study group included 79.1% of current smokers, 62% of participants reported insomnia (AIS). The mean FTND score was 6.05 ± 2.18. The multivariate regression analysis revealed that the severity of tobacco dependence was significantly associated with the severity of insomnia (FTND, beta = 0.140, P = 0.013). Other factors associated with insomnia that remained significant in multivariate model were severity of psychopathological symptoms (BSI, beta = 0.422, P < 0.0005) and intensity of drinking (TLFB, beta = 0.123, P = 0.034).ConclusionTobacco use may predict severity of insomnia in alcohol-dependent patients. This finding may have important clinical implications and influence strategies applied in treatment of alcohol use disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Psychiatric Symptomatology in Medical Students in Lebanon: What about us?

2021 ◽  
Author(s):  
Alfred Chabbouh ◽  
Carmen Al Haddad ◽  
Grace El Bejjani ◽  
Vanessa Daou ◽  
Michele Chahoud
Keyword(s):  
Mental Health ◽  
Medical Students ◽  
Psychiatric Symptoms ◽  
Healthcare Providers ◽  
Private University ◽  
Additional Stress ◽  
Psychiatric Symptomatology ◽  
Dsm 5 ◽  
Being Bullied ◽  
Level 1

Medical students are an at-risk population to develop mental health disorders, especially students in Lebanon who are facing constant additional stress due to the volatile situation in the country. The present study used the APA’s DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure – Adult to screen for psychiatric symptoms in 12 different domains. Out of the sample of 364 students from all universities in Lebanon, only 5.2% had already a psychiatric diagnosis. Of the non-diagnosed subpopulation, a massive percentage of 92.75% screened positive and subsequently, were in need of further mental health evaluation. Roughly half of the participants described the existence of barriers for them to seek mental health services, finances and stigma being major reasons. Predictors of a more severe screen were being from a private university and previously being bullied. The situation in medical schools in Lebanon is profoundly alarming. Shouldn’t the health of future healthcare providers be a priority?

scholarly journals Cortical Glutamate and GABA Changes During Early Abstinence in Alcohol Dependence and Their Associations With Benzodiazepine Medication

2021 ◽  
Vol 12 ◽  
Author(s):  
Guoying Wang ◽  
Wolfgang Weber-Fahr ◽  
Ulrich Frischknecht ◽  
Derik Hermann ◽  
Falk Kiefer ◽  
...  
Keyword(s):  
Alcohol Dependence ◽  
Alcohol Withdrawal ◽  
Withdrawal Symptoms ◽  
Internal Quality ◽  
Treatment Seeking ◽  
Withdrawal Period ◽  
Cross Sectional ◽  
Longitudinal Changes ◽  
Single Voxel ◽  
Alcohol Dependent

In this report, we present cross-sectional and longitudinal findings from single-voxel MEGA-PRESS MRS of GABA as well as Glu, and Glu + glutamine (Glx) concentrations in the ACC of treatment-seeking alcohol-dependent patients (ADPs) during detoxification (first 2 weeks of abstinence). The focus of this study was to examine whether the amount of benzodiazepine administered to treat withdrawal symptoms was associated with longitudinal changes in Glu, Glx, and GABA. The tNAA levels served as an internal quality reference; in agreement with the vast majority of previous reports, these levels were initially decreased and normalized during the course of abstinence in ADPs. Our results on Glu and Glx support hyperglutamatergic functioning during alcohol withdrawal, by showing higher ACC Glu and Glx levels on the first day of detoxification in ADPs. Withdrawal severity is reflected in cumulative benzodiazepine requirements throughout the withdrawal period. The importance of withdrawal severity for the study of GABA and Glu changes in early abstinence is emphasized by the benzodiazepine-dependent Glu, Glx, and GABA changes observed during the course of abstinence.

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

2021 ◽  
Author(s):  
Alexander Thompson ◽  
Andrea Weber
Keyword(s):  
Alcohol Withdrawal ◽  
Psychiatric Hospitalization ◽  
Psychiatric Symptoms ◽  
Signs And Symptoms ◽  
Opioid Withdrawal ◽  
Sustained Remission ◽  
Opioid Agonist ◽  
Dsm 5 ◽  
Cannabis Withdrawal ◽  
Withdrawal Syndromes

Withdrawal syndromes are clusters of signs and symptoms that occur with cessation or decrease in use of a substance. All substance withdrawal syndromes are classified and diagnosed based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). All withdrawal syndromes range in their ability to cause significant medical and/or psychiatric consequences. Alcohol withdrawal remains a medically serious syndrome that can occur within hours to days of decreased use and result in hallucinations, delirium, seizures, and death. Despite increasing research into the type, frequency, dose, and route of administration, benzodiazepines remain the first-line treatment in preventing alcohol withdrawal complications. Although typically not medically severe, opioid withdrawal is often associated with relapse even after successful detoxification. Opioid-agonist therapy, including methadone and buprenorphine, remains the treatment of choice for both opioid withdrawal and relapse prevention. Stimulant withdrawal from cocaine or amphetamines can cause significant psychiatric symptoms within minutes to hours of cessation and may require psychiatric hospitalization for suicidal ideation or attempts. There are no current medications approved by the Food and Drug Administration (FDA) for treatment of stimulant withdrawal. Cannabis withdrawal, although not medically dangerous, has recently been adopted as a discrete syndrome in the DSM-5. Its severity correlates significantly with the amount of cannabis used, functional impairment, and ability to achieve sustained remission. There are no current medications approved by the FDA for treatment of cannabis withdrawal. This review contains 6 figures, 13 tables, and 101 references. Key words: alcohol, amphetamine, benzodiazepines, buprenorphine, cannabis, clonidine, cocaine, dexmedetomidine, methadone, opioid, phenobarbital, stimulant, withdrawal 

scholarly journals Abnormalities of confidence in psychiatry: an overview and future perspectives

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Monja Hoven ◽  
Maël Lebreton ◽  
Jan B. Engelmann ◽  
Damiaan Denys ◽  
Judy Luigjes ◽  
...  
Keyword(s):  
Decision Making ◽  
General Population ◽  
Psychiatric Disorders ◽  
Symptom Severity ◽  
Positive Relationship ◽  
Psychiatric Symptoms ◽  
Current Knowledge ◽  
Future Perspectives ◽  
Psychiatric Symptomatology ◽  
Underlying Processes

Abstract Our behavior is constantly accompanied by a sense of confidence and its’ precision is critical for adequate adaptation and survival. Importantly, abnormal confidence judgments that do not reflect reality may play a crucial role in pathological decision-making typically seen in psychiatric disorders. In this review, we propose abnormalities of confidence as a new model of interpreting psychiatric symptoms. We hypothesize a dysfunction of confidence at the root of psychiatric symptoms either expressed subclinically in the general population or clinically in the patient population. Our review reveals a robust association between confidence abnormalities and psychiatric symptomatology. Confidence abnormalities are present in subclinical/prodromal phases of psychiatric disorders, show a positive relationship with symptom severity, and appear to normalize after recovery. In the reviewed literature, the strongest evidence was found for a decline in confidence in (sub)clinical OCD, and for a decrease in confidence discrimination in (sub)clinical schizophrenia. We found suggestive evidence for increased/decreased confidence in addiction and depression/anxiety, respectively. Confidence abnormalities may help to understand underlying psychopathological substrates across disorders, and should thus be considered transdiagnostically. This review provides clear evidence for confidence abnormalities in different psychiatric disorders, identifies current knowledge gaps and supplies suggestions for future avenues. As such, it may guide future translational research into the underlying processes governing these abnormalities, as well as future interventions to restore them.

scholarly journals Medical mimics: Differential diagnostic considerations for psychiatric symptoms

2016 ◽  
Vol 6 (6) ◽  
pp. 289-296 ◽  
Author(s):  
Jerry McKee ◽  
Nancy Brahm
Keyword(s):  
Psychiatric Symptoms ◽  
Age Of Onset ◽  
Medical Condition ◽  
Clinical Situation ◽  
Symptom Presentation ◽  
Psychiatric Symptomatology ◽  
Statistical Manual ◽  
Diagnostic Categories ◽  
Diagnostic And Statistical Manual ◽  
Underlying Medical Condition

Abstract Patients with underlying medical disease can present to the health care system with psychiatric symptoms predominating. Identification of an underlying medical condition masquerading as a psychiatric disorder can be challenging for clinicians, especially in patients with an existing psychiatric condition. The term medical mimic or secondary psychosis has been used to describe this clinical situation. Diagnostic categories from The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, that may encompass medical mimics include substance-induced disorders, which includes medications, and unspecified mental disorder due to another medical condition in situations where the clinician may lack needed information for a complete diagnosis. At this time, there is no single diagnostic test or procedure available to differentiate primary versus secondary psychosis on the basis of psychopathology presentation alone. When considering a diagnosis, clinicians should evaluate for the presence of atypical features uncharacteristic of the psychiatric symptoms observed; this may include changes in functionality and/or age of onset and symptom presentation severity. The purpose of this work is to provide a structured clinical framework for evaluation for medical mimics, identify groups considered to be at highest risk for medical mimics, and present common syndromic features suggestive of a medical mimic. Selected case scenarios are used to illustrate key concepts for evaluating and assessing a patient presenting with acute psychiatric symptomatology to improve judgment in ruling out potential medical causality.

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