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Australian Family Physician Nov 2004Benzodiazepine dependency can occur as a result of treatment for anxiety disorders or sleep disturbance. While benzodiazepine withdrawal can be challenging, cessation of... (Review)
Review
BACKGROUND
Benzodiazepine dependency can occur as a result of treatment for anxiety disorders or sleep disturbance. While benzodiazepine withdrawal can be challenging, cessation of use can be even more difficult if there are other comorbidities such as oestrogen deficiency with vasomotor symptoms and anxiety disorders.
OBJECTIVE
This article provides practical information for general practitioners in the management of patients with benzodiazepine dependence.
DISCUSSION
Some patients may have common medical presentations and coexisting drug dependence. It is often difficult to separate these two issues. In the case of benzodiazepine dependence, gradual withdrawal over time and nonpharmacological treatment of the symptoms of withdrawal such as anxiety or insomnia is effective. Better outcomes are achieved where the GP discusses and plans strategies well in advance with the patient. Treatment often involves multiple interventions from various health professionals. General practitioners are ideally placed to coordinate such treatment.
Topics: Anti-Anxiety Agents; Anxiety Disorders; Benzodiazepines; Clinical Protocols; Drug Tolerance; Family Practice; Female; Humans; Middle Aged; Oxazepam; Relaxation Therapy; Sleep Initiation and Maintenance Disorders; Substance Withdrawal Syndrome; Substance-Related Disorders
PubMed: 15584332
DOI: No ID Found -
Psychiatry and Clinical Neurosciences Feb 1998Double-blind, placebo-controlled trials of pharmacotherapy for personality disorders (PD) were reviewed, and the indications concluded were as follows: (1) Severe cases... (Review)
Review
Double-blind, placebo-controlled trials of pharmacotherapy for personality disorders (PD) were reviewed, and the indications concluded were as follows: (1) Severe cases of both Borderline Personality Disorder (BDP) and Schizotypal Personality Disorder (SPD) respond to low dose antipsychotic drugs resulting in improvement of a broad spectrum of symptoms. They also respond to monoamine oxidase inhibitor (MAOI). Amitriptyline causes a paradoxical effect. (2) Borderline personality disorder with behavioral dyscontrol responds to carbamazepine which reduces actual episodes of dyscontrol, to an antipsychotic drug and to MAOI. Alprazolam is associated with an increase in suicidality and dyscontrol. Borderline personal disorder or Histrionic Personality Disorder with a tendency to suicide, responds to a depot antipsychotic drug. Personality disorders with aggressive behavior respond to lithium. Moderately severe PD with explosive behavior respond to oxazepam, but at a dose where the side effect is sedation. (3) Borderline personality disorder and SPD with psychotic symptoms respond to an antipsychotic drug which improves psychotic symptoms as well as neurotic symptoms. Emotionally Unstable Character Disorder with a disturbance of mood swings, responds to lithium. Adolescent PD respond to an antipsychotic drug. (4) Comorbid atypical depression of histrionic personality and BPD respond to MAOI or imipramine. Comorbid neurotic disorder of PD responds to dothiepin. Comorbid social phobia of avoidant and dependent PD responds to MAOI.
Topics: Antipsychotic Agents; Clinical Trials as Topic; Double-Blind Method; Humans; Personality Disorders; Psychotropic Drugs
PubMed: 9682928
DOI: 10.1111/j.1440-1819.1998.tb00967.x -
Environmental Pollution (Barking, Essex... Jun 2021A recent surge in the use and abuse of diverse prescribed psychotic and illicit drugs necessitates the surveillance of drug residues in source water and the associated...
A recent surge in the use and abuse of diverse prescribed psychotic and illicit drugs necessitates the surveillance of drug residues in source water and the associated ecological impacts of chronic exposure to the aquatic organism. Thirty-six psychotic and illicit drug residues were determined in discharged wastewater from two centralized municipal wastewater treatment facilities and two wastewater receiving creeks for seven consecutive days in Kentucky. Zebrafish (Danio rerio) larvae were exposed to the environmental relevant mixtures of all drug residues, all illicit drugs, and all prescribed psychotic drugs. The extracted RNA from fish homogenates was sequenced, and differentially expressed sequences were analyzed for known or predicted nervous system expression, and screened annotated protein-coding genes to the true environmental cocktail mixture. Illicit stimulant (cocaine and one metabolite), opioids (methadone, methadone metabolite, and oxycodone), hallucinogen (MDA), benzodiazepine (oxazepam and temazepam), carbamazepine, and all target selective serotonin reuptake inhibitors including sertraline, fluoxetine, venlafaxine, and citalopram were quantified in 100% of collected samples from both creeks. The high dose cocktail mixture exposure group revealed the largest group of differentially expressed genes: 100 upregulated and 77 downregulated (p ≤ 0.05; q ≤ 0.05). The top 20 differentially expressed sequences in each exposure group comprise 82 unique transcripts corresponding to 74% annotated genes, 7% non-coding sequences, and 19% uncharacterized sequences. Among 61 differentially expressed sequences that corresponded to annotated protein-coding genes, 23 (38%) genes or their homologs are known to be expressed in the nervous system of fish or other organisms. Several of the differentially expressed sequences are associated primarily with the immune system, including several major histocompatibility complex class I and interferon-induced proteins. Interleukin-1 beta (downregulated in this study) abnormalities are considered a risk factor for psychosis. This is the first study to assess the contributions of multiple classes of psychotic and illicit drugs in combination with developmental gene expression.
Topics: Animals; Fluoxetine; Larva; Selective Serotonin Reuptake Inhibitors; Water Pollutants, Chemical; Zebrafish
PubMed: 33689951
DOI: 10.1016/j.envpol.2021.116777 -
Tidsskrift For Den Norske Laegeforening... Jun 2020Benzodiazepines are also used as intoxicants. This can be dangerous, particularly in multi-substance abuse. We describe cases of acute poisoning related to substance...
BACKGROUND
Benzodiazepines are also used as intoxicants. This can be dangerous, particularly in multi-substance abuse. We describe cases of acute poisoning related to substance abuse of benzodiazepines in patients at the main A&E clinic in Oslo.
MATERIAL AND METHOD
We included all patients treated for substance abuse poisoning with benzodiazepines and/or z-hypnotics at the Oslo Accident and Emergency Outpatient Clinic from 1 October 2013 to 30 September 2015. The patients were found through a retrospective review of the A&E clinic's registers. Data were taken from patient records. Diagnosis of the toxic agent was based on the attending doctor's recorded clinical evaluation.
RESULTS
Of 1 037 cases, 787 (76 %) were men. The median age was 36 (interquartile range 28-46, range 14-78). Clonazepam (Rivotril) was the most frequently occurring drug, with 575 cases (55 %), followed by diazepam (Stesolid, Valium, Vival) 158 (15 %), alprazolam (Xanor) 125 (12 %) and oxazepam (Sobril) 94 (9 %). Zopiclone (Imovane, Zopitin) and zolpidem (Stilnoct) occurred rarely, in 25 (2 %) and 11 (1 %) cases, respectively. Benzodiazepines were combined with other intoxicants in 936 (90 %) cases, most frequently heroin 484 (47 %), ethanol 321 (31 %) and amphetamine 199 (19 %).
INTERPRETATION
In substance abuse poisoning, benzodiazepines were very often combined with other intoxicants, most frequently opioids, ethanol and/or amphetamine.
Topics: Adult; Analgesics, Opioid; Benzodiazepines; Female; Humans; Hypnotics and Sedatives; Male; Poisoning; Retrospective Studies; Substance-Related Disorders
PubMed: 32602327
DOI: 10.4045/tidsskr.20.0035 -
Tidsskrift For Den Norske Laegeforening... Dec 2014
Topics: Alcoholism; Anti-Anxiety Agents; Humans; Life Style; Oxazepam; Physician-Patient Relations
PubMed: 25492343
DOI: 10.4045/tidsskr.14.1288 -
Toxics Dec 2022Stimulants belonging to the amphetamine group nowadays pose an undeniable worldwide threat to the life and health of users. Intoxications of domestic animals also occur,...
Stimulants belonging to the amphetamine group nowadays pose an undeniable worldwide threat to the life and health of users. Intoxications of domestic animals also occur, which can either be accidental or related to intentional human action. This study presents the first ever reported case of a simultaneous amphetamine and methamphetamine intoxication of a cat, along with the results of toxicological studies. Blood, urine, vitreous humor and liver were collected during the cat's autopsy and analyzed by UHPLC─QqQ─MS/MS. The sample preparation technique was based on one-step precipitation of proteins with cold acetonitrile. The determined amphetamine concentrations in the collected biological materials were 93.4 ng/mL in blood, 496.6 ng/mL in urine, 589.2 ng/mL in the vitreous humor and 291.2 ng/g in liver, respectively. Methamphetamine concentrations were 45.5 ng/mL in blood, 263.1 ng/mL in urine, 351.2 ng/mL in vitreous humor, and 97.7 ng/g in liver. Other substances were also found in the biological material, i.e., diazepam, oxazepam and nordiazepam. Cases of intentional or accidental poisoning of pets with psychoactive substances are a serious problem, carrying the risk to the health and life of the animal. Therefore, it is important to increase awareness of the high risk of poisoning of domestic animals, as well as to learn about the incompletely understood mechanisms of pharmacokinetics of various drugs in animals, including cats.
PubMed: 36548582
DOI: 10.3390/toxics10120749 -
International Journal of Environmental... 2022'Voodoo' is a new substance of abuse that recently spread among youth in Egypt. It has numerous potentially dangerous effects on humans. However, to date the composition...
BACKGROUND
'Voodoo' is a new substance of abuse that recently spread among youth in Egypt. It has numerous potentially dangerous effects on humans. However, to date the composition of the main constituents of this compound is unknown.
PURPOSE
We sought to identify the active components of this unknown substance"voodoo".
METHODS
Three samples were collected and analysed by high-performance liquid chromatography with photodiode array detector (HPLC-PAD), gas chromatography/mass spectrometry (GC/MS), and ultra-performance liquid chromatography/mass spectrometry (UPLC-MS/MS) using targeted multiple reaction monitoring (MRM).
RESULTS
HPLC-PAD analysis showed that samples 1 and 2 had some common major peaks, the same retention time, and similar spectra, whereas sample 3 showed different peaks. GC/MS analysis revealed the presence of various putatively identified bioactive compounds, including quinazolines, morphinan alkaloid, cannabinoids, penitrem A, and the well-known synthetic cannabinoid FUB-AMB (methyl(2S)-2-{[1-[(4-fluorophenyl)methyl]indazole-3-carbonyl]amino}-3 methylbutanoate). UPLC-MS/MS analysis revealed the presence of common compounds such as tetrahydrocannabinol (THC), amphetamine, 3,4-methylenedioxyamphetamine, tramadol, and oxazepam.
CONCLUSION
We concluded that Voodoo is a mixture of substances of abuse at varying concentrations.
PubMed: 35002018
DOI: 10.1080/03067319.2020.1715384 -
Cancer Causes & Control : CCC Dec 2009To screen commonly used prescription drugs for possible carcinogenic effects. (Review)
Review
OBJECTIVE
To screen commonly used prescription drugs for possible carcinogenic effects.
METHODS
In a large health care program we identified 105 commonly used drugs, not previously screened. Recipients were followed for up to 12½ years for incident cancer. Nested case-control analyses of 55 cancer sites and all combined included up to ten matched controls per case, with lag of at least 2 years between drug dispensing and cancer. Positive associations entailed a relative risk of 1.50, with p ≤ 0.01 and higher risk for three or more, than for one prescription. Evaluation included further analyses, searches of the literature, and clinical judgment.
RESULTS
There were 101 associations of interest for 61 drugs. Sixty-six associations were judged to have involved substantial confounding. We found evidence that of the remaining 35, the following associations may not be due to chance: sulindac with gallbladder cancer and leukemia, hyoscyamine with nonHodgkin lymphoma, nortriptyline with esophageal and hepatic cancer, oxazepam with lung cancer, both fluoxetine and paroxetine with testicular cancer, hydrochlorothiazide with renal and lip cancer, and nifedipine with lip cancer.
CONCLUSIONS
These preliminary findings suggest that further studies are indicated regarding sulindac, hyoscyamine, nortriptyline, oxazepam, fluoxetine, paroxetine, hydrochlorothiazide, and nifedipine.
Topics: Carcinogenicity Tests; Carcinogens; Case-Control Studies; Confounding Factors, Epidemiologic; Drug Evaluation, Preclinical; Drug-Related Side Effects and Adverse Reactions; Female; Follow-Up Studies; Gonadal Steroid Hormones; HIV Infections; Humans; Neoplasms; Pharmaceutical Preparations
PubMed: 19582585
DOI: 10.1007/s10552-009-9375-2 -
Biosensors Oct 2022Despite all the psychological advantages of alprazolam, its long list of toxic properties and interactions has caused concern and highlighted the need for a reliable...
Despite all the psychological advantages of alprazolam, its long list of toxic properties and interactions has caused concern and highlighted the need for a reliable sensing method. In this study, we developed a simple, highly sensitive electrochemical nanobiosensor to determine the desirable dose of alprazolam, averting the undesirable consequences of overdose. Gold nanourchins (AuNUs) and iron-nickel reduced graphene oxide (Fe-Ni@rGO) were immobilized on a glassy carbon electrode, which was treated beforehand. The electrode surface was characterized using cyclic voltammetry, Fourier transform infrared spectroscopy, scanning electron microscopy/energy-dispersive X-ray spectroscopy, and differential pulse voltammetry. The fabricated sensor showed two linear ranges (4 to 500 µg L and 1 to 50 mg L), low limit of detection (1 µg L), high sensitivity, good repeatability, and good recovery. Increased -OH and carboxyl (-COOH) groups on the electrode surface, resulting in improved the adsorption of alprazolam and thus lower limit of detection. This nanobiosensor could detect alprazolam powder dissolved in diluted blood serum; we also studied other benzodiazepine drugs (clonazepam, oxazepam, and diazepam) with this nanobiosensor, and results were sensible, with a significant difference.
Topics: Alprazolam; Graphite; Nanocomposites; Gold; Electrodes; Electrochemical Techniques
PubMed: 36354454
DOI: 10.3390/bios12110945 -
Psychopharmacology Apr 2018Screening of drug-induced performance impairment is needed to provide meaningful information for users and prescribers regarding the impact of drugs on driving. The main... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Screening of drug-induced performance impairment is needed to provide meaningful information for users and prescribers regarding the impact of drugs on driving. The main objective was to assess the effects of oxazepam 10 mg (OXA10), oxazepam 30 mg (OXA30), and diazepam 10 mg (DIA10) on standard deviation of lateral position (SDLP) in a highway driving test in actual traffic and to determine the ability of eight neurocognitive tests to detect comparable effects.
METHODS
Twenty-three healthy volunteers participated in a four-way double-blind, placebo-controlled, crossover study. The highway driving test was conducted between 4 and 5 h after drug intake. A range of neurocognitive tests was conducted before and after driving, 2 and 6 h post-treatment, respectively.
RESULTS
Mean SDLP increased by 1.83, 3.03, and 7.57 cm after OXA10, DIA10, and OXA30, respectively. At 2 h post-treatment, all neurocognitive tests, except the useful field of view, showed performance impairment in all active treatments. Effect sizes (ES) were moderate for OXA10, large ES for DIA10, and largest ES for OXA30. Modest correlations were found between changes in SDLP and performance in the attention network test (ANT), the divided attention test (DAT), and the psychomotor vigilance test (PVT).
CONCLUSION
OXA10 caused minor, DIA10 moderate, and OXA30 severe driving impairment. No neurocognitive test was both dose dependently sensitive and able to be associated with driving impairment. No neurocognitive test can replace the on-the-road highway driving test.
Topics: Adult; Attention; Automobile Driving; Cognition; Cross-Over Studies; Diazepam; Double-Blind Method; Female; Healthy Volunteers; Humans; Hypnotics and Sedatives; Male; Mental Status and Dementia Tests; Middle Aged; Oxazepam; Psychomotor Performance; Young Adult
PubMed: 29500585
DOI: 10.1007/s00213-018-4844-5