Intensity Of Withdrawal Symptoms Research Articles

Effect of psychic sleep on controlling withdrawal symptoms, balance and gait among alcohol dependent patients of selected hospital of Bhubaneswar and Cuttack

Background: In worldwide alcoholism is the major issues for affecting individual’s life and for socioeconomic development. Various treatment modalities have been developed for alcoholism, yoga nidra is one of them. yoga Nidra is an easy tool and very cost effective to practice for manage these symptoms. A wide range of gastrointestinal, cardiovascular, autonomic, neurological and psychological symptoms are all a part of the acute alcohol withdrawal syndrome. Objectives 1.To assess the level of alcohol dependents with demographic variables. 2. To assess the effect of psychic sleep on controlling withdrawal symptoms, balance and gait among alcohol dependent patients. 3. To find out the association between withdrawal symptoms, balance and gait among alcohol dependent patients with selected sociodemographic variables. Methods: A Quasi-Experimental research approach with purposive sampling technique was used at IMS & SUM Hospital, Bhubaneswar and SCB, Cuttack among 72 alcohol dependent patients. Psychic sleep module of 10 sessions were given to the experimental group for 10 days following the pretest. Posttest were conducted after 10 days of psychic sleep practice. Results: The results showed a substantial difference between the levels of the pretest and posttest withdrawal symptoms, balance and gait after giving psychic sleep as evidenced by Mann- Whitney U value at p= 0.000 which is extremely significant. There was a strong significant association between intensity of withdrawal symptoms and educational status and type of family and in level of balance and gait with duration of consumption of alcohol (by using SPSS Version20 software). The psychic sleep was an effective to reducing withdrawal symptoms, balance and gait. What is already Known . The severity of the alcohol dependence syndrome was observed in psychiatric co-morbidities as mood disorders which is the most common diagnosis. . In general alcohol usage is more common among college students. . The research shows that yoga nidra was effective among college students in reducing anxiety and depression. What this paper adds . The findings of the psychic sleep study show that Yoga nidra intervention was successful in lowering withdrawal symptoms in patients who were alcohol dependent. . Those patients who are consuming alcohol and are admitted to a DE addiction center can retain balance and gait with the help of psychic sleep. . Further study can be conducted with other substance abuse cases and with larger sample.

Comparison of withdrawal symptom intensity between hypnosis and nicotine-replacement-therapies: A pilot study

ABSTRACT Smoking cessation is a global public health issue. Nicotine dependence is a dynamic process that is not limited to physical dependence. Hypnosis can be helpful in the global management of smoking cessation. We explored this effect by comparing the effects of hypnosis and nicotine-replacement therapies (NRT) on tobacco withdrawal. Thirty participants were included in this comparative-randomized pilot study in parallel controlled groups after ethical validation. Participants were recruited by a general practitioner and had standardized consultations with addiction and hypnosis specialists and adapted treatment. The evolution of withdrawal symptoms was compared using the Cigarette Withdrawal Scale-21 for one month after smoking cessation in an adult tobacco-addict population wishing to stop smoking and receiving either NRT or hypnosis, both supported by motivational interviews. Craving intensity (French version of the Tobacco Craving Questionnaire), nicotine dependence (Fagerström), tobacco consumption, anxiety (Hamilton scale), and depression (Montgomery-Asberg scale) were also evaluated. Hypnosis appeared to have an influence on reducing the number of smoked cigarettes, whereas NRT appeared to influence markers of both physical and psychic dependence. A complementarity of hypnosis and NRT may be a viable therapeutic alternative to reduce the intensity of withdrawal symptoms after voluntary smoking cessation. A study on a larger population with a longer follow-up is needed to assess the advantages of each method to quit smoking.

Delayed crises following benzodiazepine withdrawal: deficient adaptive mechanisms or simple pharmacokinetics? Detoxification assisted by serum-benzodiazepine elimination tracking

ObjectiveRapid relapses after successful withdrawal occur even in apparently motivated benzodiazepine (BZD)-dependent patients. Regardless of known personality or biological (re-adaptation) issues, the aim of this open-label, single-arm, seminaturalistic study was to search for any detoxification errors contributing to failures.MethodsThe data came from 350 inpatients. Based on serum-BZD evolution criteria, the procedure was divided into four stages: substitution, accumulation, elimination and post-elimination observation. After switching the patients to a long-acting substitute (diazepam), to prevent data falsification due to unwanted overaccumulation, the doses were expeditiously reduced under laboratory feedback until accumulation stopped. With the start of effective elimination, the tapering rate slowed and was individually adjusted to the patient’s current clinical state. The tracking of both serum-BZD concentration and the corresponding intensity of withdrawal symptoms was continued throughout the entire elimination phase, also following successful drug withdrawal. Detoxification was concluded only after the patient's post-elimination stabilization.ResultsRegardless of various initial serum-BZD concentration levels and the customized dose-reduction rate, and despite the novel lab-driven actions preventing initial overaccumulation, elimination was systematically proven to be protracted and varied within the 2- to 95-day range after the final dose. Within this period, withdrawal syndrome culminated several times, with varying combinations of symptoms. The last crisis occurrence (typically 2–3 weeks after withdrawal) correlated with the final serum-BZD elimination. The factors that prolonged elimination and delayed the final crisis were patient age, duration of addiction, adjunct valproate medication and elimination stage start parameters growing with former overaccumulation.ConclusionsThe low-concentration detoxification stage is critical for patients’ confrontations with recurring withdrawal symptoms. Underestimated elimination time following drug withdrawal and premature conclusions of detoxification expose patients to unassisted withdrawal crises. Concentration tracking defines proper limits for medical assistance, preventing early relapses.

Metabolic diversity as a reason for unsuccessful detoxification from benzodiazepines: the rationale for serum BZD concentration monitoring.

Many harms secondary to benzodiazepine (BZD) dependence force users towards detoxification treatment. However, even strongly motivated patients tolerate the process badly or experience early relapse. The detoxification procedure has not yet been standardized. The objective of this paper is to examine the hypothesis that faulty detoxification routines may have caused some failures. The detoxification approaches found in the literature were compared stage by stage. The review was used to identify possible common, across-the-board systematic errors. The presented literature review confirms that the widespread divergence in the BZD metabolism rate is effectively neglected during detoxification routines. Without laboratory measurements, these differences, additionally interfered with by auxiliary drugs, undermine not only the scheduled but even the symptom-driven procedures. An initial substitution with a long-acting BZD, although recommended, may lead to over-accumulation. This excess, varying between patients and incompatible with the current tapering stage, may lead to repeated overestimation of the patient's adjustments to reduced doses. Consequently, the patient's good clinical presentation at withdrawal, resulting in a conclusion of detoxification, may actually reflect a persistently high serum BZD concentration. The low-concentration stage, if shifted past the end of treatment, exposes patients to unexpected, unassisted withdrawal crises. With laboratory feedback, these crises, unlike the symptoms related to deficient re-adaptation mechanisms, could be prevented. Moreover, by minimizing the high-concentration phase, time can be saved for properly assisted low-concentration challenges. A customized detoxification procedure driven not only by the intensity of withdrawal symptoms but also by serum BZD monitoring may prevent some failures. As the standard regimen, it would make detoxification from BZDs more reliable and effective.

Substance use disorders: Baclofen as a promising drug

IntroductionBaclofen, a drug currently used in the treatment of spasticity, has been reported to be useful in reducing the intensity of withdrawal symptoms of substance use disorders of alcohol or other psychotropic drugs.ObjectivesWith our clinical case we aim to demonstrate that baclofen reduces severe withdrawal symptoms and also helps to achieve and maintain abstinence in severe cases, in agreement with the current literature.Aims/methodsWe present a clinical case of a 68 year-old patient with alcohol use disorder since his childhood, with familiar antecedents, multiples relapses and associated organic pathology such as alcoholic polyneuropathy and Wernicke syndrome. We used to high doses of baclofen to reduce the craving and withdrawal symptoms. Additionally, we searched in PubMed for more case reports and for a systematic review of the efficacy and tolerability of baclofen.ResultsWe were able to demonstrate that high doses of baclofen can be useful in resistant cases of substance use disorders like alcoholism. For our case study, we obtained positive results with a large remission, in comparison with the previous detoxications, with doses up to 150 mg/day.ConclusionsWe conclude that baclofen is an interesting alternative for resistant cases, with a good outcome and tolerability, in complicated patients, with important organic repercussions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Detoxification Methods of Benzodiazepines Mono-Dependence: Application and Comparison

B are among the most common drugs of abuse in Egypt. The severe suffering during withdrawal of benzodiazepines following long term use magnifies the need to develop treatment strategies for discontinuing these medications. The study aimed to evaluate different detoxification procedures that have been followed to manage benzodiazepines dependence and to assess their efficiency in controlling withdrawal symptoms and relapse rates. This study had been conducted in the center of Psychiatry, Neurology and Neurosurgery, Faculty of Medicine, Tanta University, Egypt. It lasted for 45 days and was divided into three phases; pretreatment phase (7 days), detoxification phase (8 days) and follow-up phase (30 days). Three different methods of detoxification of benzodiazepines dependence were applied during the detoxification phase and included Slow flumazenil infusion (1 mg/500ml saline twice daily) as the main line of treatment with low doses of oxazepam given orally during the first three nights of detoxification phase; using oxazepam gradual tapering and abrupt discontinuation of benzodiazepines with symptomatic treatment. Withdrawal symptoms were assessed by psychometric scales BWSQ, HAM-A, HAM-D scores and craving was assessed by VAS scores emerged in the three studied groups during the detoxification phase. The study revealed that flumazenil infusion with low doses of oxazepam was associated with the least intensity of withdrawal symptoms and craving. Also, relapse rates were decreased in patients treated with flumazenil than those treated by oxazepam tapering or abrupt discontinuation with symptomatic treatment. It can be concluded that slow flumazenil infusion with low doses of oxazepam appeared to be more effective in controlling withdrawal symptoms reducing craving and relapse rate after benzodiazepine discontinuation than oxazepam tapering or abrupt discontinuation with symptomatic treatment.

P-112 - Association between insight and intensity of withdrawal symptoms among cannabis dependant outpatients

Withdrawal syndrome occurs in 50% of cannabis dependant patients. In our clinical practice, we observed that few patients recognize and attribute abstinence symptoms to cannabis cessation. Insight or awareness of cannabis dependence remains poorly studied. We propose to study the relationship between insight and cannabis withdrawal syndrome. Our hypothesis is that patients showing a higher score on a cannabis withdrawal scale would have a higher score on an insight scale. We recruited 35 cannabis dependent outpatients between October 2008 and April 2009 in an addiction clinic. Insight of cannabis dependance was assessed with the insight Q8 scale ranging [0–8]. We designed a cannabis withdrawal scale by checking DSM V withdrawal symptoms, and each symptom was retrospectively scored by an analogue scale (from 0 to 5). Correlation between insight and withdrawal scores was calculated using Spearman's ρ. Sex ratio was 2.5. Mean age was 35.9 ± 1.4 years. Most patients (85.7%) reported at least one withdrawal symptom. Sleep disturbances (95.8%) and craving (75.8%) were the most frequent. Mean score of insight was of 4.2 ± 0.4 points. The intensity of withdrawal syndrome and insight score were positively correlated (ρ = 0.594, p < 0.001). Our results show an association between experiencing more withdrawal symptoms and insight or awareness of cannabis dependence. These results could be used in the treatment of cannabis dependent patients.

Influence of the 393T&gt;C Polymorphism of the GNAS1 Gene on the Intensity of Opiate Withdrawal

There are high interindividual differences regarding the intensity of withdrawal symptoms. in opiate addicts. This study was carried out in order to test whether the intensity of withdrawal is influenced by the 393T>C polymorphism of the GNASI gene. Only patients addicted exclusively to opiates were included. Thirty-three out of 39 patients undergoing inpatient detoxification treatment achieved a drug-free state. During the most intense period of withdrawal (stop of methadone and following days) TT homozygotes (n=4) had a significantly higher pulse rate (primary outcome criterion) than C-allele carriers (n=29). This study and a previous study about GNB3 825C> T underline the possible role of G-protein polymorphisms in the interindividual variability of opiate withdrawal.

Anhedonia and Substance Dependence: Clinical Correlates and Treatment Options

Anhedonia is a condition in which the capacity of experiencing pleasure is totally or partially lost, and it refers to both a state symptom in various psychiatric disorders and a personality trait. It has a putative neural substrate, originating in the dopaminergic mesolimbic and mesocortical reward circuit. Anhedonia frequently occurs in mood disorders, as a negative symptom in schizophrenia, and in substance use disorders. In particular, we focus our attention on the relationships occurring between anhedonia and substance use disorders, as highlighted by many studies. Several authors suggested that anhedonia is an important factor involved in relapse as well as in the transition from recreational use to excessive drug intake. In particular, anhedonia has been found to be a frequent feature in alcoholics and addicted patients during acute and chronic withdrawal as well as in cocaine, stimulant, and cannabis abusers. Furthermore, in subjects with a substance dependence disorder, there is a significant correlation between anhedonia, craving, intensity of withdrawal symptoms, and psychosocial and personality characteristics. Therefore treating anhedonia in detoxified alcohol-dependent subjects could be critical in terms of relapse prevention strategies, given its strong relationship with craving.

Prolonged benzodiazepine elimination in addicted patients as a reason of early post-detoxification relapses

Materials and methods Presented data come from 200 cases. Detoxification followed through 4 stages: long-acting benzodiazepine substitution, dose reduction, elimination, post-withdrawal observation. Clinical state (CIWA-B, [1]) and the benzodiazepine serum level (standard immunoenzymatic assay) were monitored. Patient’s dose reduction rate was adjusted according to current intensity of withdrawal symptoms. Continued clinical state monitoring followed the final dose until total serum benzodiazepines elimination.

Transferring Methadone‐Stabilized Pregnant Patients to Buprenorphine Using an Immediate Release Morphine Transition: An Open‐Label Exploratory Study

A transition from methadone to buprenorphine without intervening withdrawal symptoms is critical for advancing the treatment of opioid-dependent patients. Four pregnant inpatients were transferred from methadone (65-85 mg) to five days of immediate release morphine (IRM) and then to buprenorphine (12-28 mg). Withdrawal scores decreased during the five days of IRM and subsequently increased over the first three days on buprenorphine. The transitional use of IRM appears safe for both mother and fetus. Withdrawal symptoms appeared during buprenorphine induction; however, these data suggest that the intensity of withdrawal symptoms may be lessened by the dose and frequency of buprenorphine administration.

Is premature termination of opiate detoxification due to intensive withdrawal or craving?

Opiate addicts terminate inpatient detoxification prematurely in about 50% of treatment episodes. Premature termination of treatment is often considered to be motivated by intensive withdrawal symptoms. Therefore, the relation between discontinuing treatment and the intensity of withdrawal symptoms and heroin craving is investigated. 130 opiate addicts consecutively admitted to a detoxification ward daily assessed the intensity of withdrawal symptoms on the Short Opiate Withdrawal Scale (SOWS) as well as the intensity of heroin craving on a visual analogue scale. Withdrawal symptoms were treated by stepwise reduction of methadone and symptom-oriented medication. 66 patients (50.8%) terminated treatment prematurely. However, during the days preceding treatment termination, these patients did not differ from regularly detoxified patients assessed on corresponding days with respect to craving, and reported even less intensity of withdrawal symptoms. In conclusion, neither the intensity of withdrawal symptoms nor the intensity of heroin craving constitutes the primary reason for premature termination of detoxification.

Rapid discontinuation of hypnotics in terminal cancer patients: A prospective study

To determine the proportion of patients receiving hypnotics upon admission to a palliative care unit, the frequency and intensity of withdrawal symptoms after rapid hypnotic discontinuation, and the effect of discontinuation on insomnia and cognitive failure. 120 consecutive admitted patients. Rapid hypnotic discontinuation (1-4 days) was attempted. Insomnia (visual analogue 0 = best, 100 = worst for insomnia, restedness during the morning and difficulty falling asleep), cognition (Mini-Mental State Questionnaire), and withdrawal signs were monitored. Upon admission, 92/120 patients (77%) had been receiving hypnotics for a mean of 11 (standard deviation = 8) weeks. 4/92 patients (4%) refused hypnotic discontinuation. Acute mild withdrawal was observed in 2/88 patients (2%). The intensity of insomnia was not significantly different, while cognition significantly improved after hypnotic discontinuation. A large proportion of terminal cancer patients receives hypnotic drugs chronically. These drugs are probably not useful for the treatment of their insomnia, and rapid discontinuation can be safely achieved in most patients.

Methadone levels and neonatal withdrawal

The purpose of this study was to observe the effects of methadone exposure in utero, with special reference to maternal and neonatal methadone concentrations and neonatal withdrawal. Two groups of mother-infant pairs were studied. In the first group, serum methadone concentrations were determined in infants at 1, 6 and 24 h after delivery. In the second group, blood was obtained at 24, 48, 72 and 96 h after birth. There was no correlation between neonatal serum levels and the intensity of withdrawal symptoms. There was no relationship between maternal methadone dose at delivery or maternal serum levels and neonatal methadone levels. The results of this study may be complicated by the prenatal exposure of the neonates to other drugs of abuse apart from methadone.