Intensity Of Withdrawal Syndrome Research Articles

Acupuncture for protracted amphetamine abstinence syndrome: study protocol for a systematic review and meta-analysis

IntroductionAmphetamine-type stimulants (ATSs) are presenting a great challenge to global public health along with its worldwide abuse in recent years. Protracted amphetamine abstinence syndrome (PAAS) is one of the primary...

Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2)

IntroductionThere are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. MethodsAn observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24 h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneously assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). ResultsA total of 261 critically ill paediatric patients with median age of 1.61 years (IQR = 0.35-6.55) were included. An overall discomfort score of 10.79 ± 3.7 was observed during morning compared to 10.31 ± 3.3 during the night. When comparing analgosedation and non-analgosedation groups, statistical differences were found in both shifts (χ2: 45.48; P = .001). At the same time, an association was observed (P < .001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. ConclusionsAs there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.

Grado de disconfort del paciente crítico pediátrico y correlación con variables sociodemográficas y clínicas, analgosedación y síndrome de abstinencia. Estudio multicéntrico COSAIP (Fase 2)

IntroductionThere are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. MethodsAn observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneous assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). ResultsA total of 261 critically ill paediatric patients with median age of 1.61 years (IQR=0.35-6.55) were included. An overall discomfort score of 10.79±3.7 was observed during morning compared to 10.31±3.3 observed during the night. When comparing analgosedation and non-analgosedation groups, statistically differences were found in both shifts (χ2: 45.48; P=.001). At the same time, an association was observed (P<.001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. ConclusionsAs there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.

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.

Passive immunization against nicotine attenuates somatic nicotine withdrawal syndrome in the rat

Nicotine immunization is under consideration as an intervention for smoking cessation. Therefore, it was of interest to evaluate the effects of nicotine antibodies on the withdrawal syndrome following termination of chronic nicotine administration. Experiment 1 determined whether passive immunization following continuous nicotine infusion would alter the intensity of nicotine withdrawal syndrome in the rat. Fourteen rats were rendered nicotine dependent by 7 days of subcutaneous nicotine bitartrate infusion. On the final day, seven rats received 150 mg intraperitoneal (i.p.) of immune gamma globulin (IgG) raised against 3'-aminomethylnicotine-recombinant Pseudomonas aeruginosa exoprotein A (NicVAX, Nabi Biopharmaceuticals, Rockville, MD) and seven rats received normal IgG. Rats were observed under blind conditions for somatically expressed nicotine abstinence signs immediately prior to drug termination and at 12, 24, and 36 hr afterward. In Experiment 2, similarly treated rats were observed at 6- and 72-hr postwithdrawal, to test the possibility that immunization altered the time course rather than the intensity of withdrawal syndrome. Experiment 3 tested whether immunized rats were still nicotine dependent. Without pump removal, each rat was challenged by 1/mg/kg mecamylamine HCl and observed for precipitated withdrawal syndrome. In Experiment 1, there was no premature withdrawal syndrome during nicotine infusion. After termination, the immunized group had significantly fewer withdrawal signs than controls. Experiment 2 showed that immunization did not simply alter the timing of the nicotine abstinence syndrome since immunization did not increase signs before or after the usual withdrawal timeframe. In Experiment 3, rats immunized on the final day of infusion were still nicotine dependent since they exhibited a vigorous mecamylamine-precipitated withdrawal syndrome. Nicotine antibodies did not precipitate a withdrawal syndrome, and they markedly reduced the severity of spontaneous nicotine withdrawal. The present data suggests that this may be most readily explained by their reported delay of nicotine clearance.

Estudio descriptivo de las desintoxicaciones de alcohol en un Servicio de Medicina Interna

Alcohol dependence is a chronic disease whose treatment begins with detoxification, followed by rehabilitation. We present a descriptive and retrospective study of 147 patients admitted to our unit during the period 2003-2005. Median age was 46.07 years, with 77.6% men and 22.4% women. Admission diagnosis was alcohol withdrawal syndrome in 31 patients (21.1%) and programmed alcohol detoxification in 116 patients (78.9%). On the CIWA-Ar scale: mild withdrawal, 100 patients (68.5%), moderate, 35 patients (24%), severe, 11 patients (7.5%). Mild group showed a statistically significantly lower proportion of hepatopathy, by comparison with the moderate and severe groups. Statistically significant differences were found between the mild and severe groups on comparing mean age, duration of stay, quantity of alcohol and parameters of chronic consumption (ferritine, fe, VCM, UBE, AST, bilirubin and Mg) for AST and bilirubin. There were 11 seizures: 4 patients from the programmed group, with mild withdrawal on the CIWA-Ar scale, and 7 patients with moderate-severe withdrawal. No relationship was found between patients intensity of withdrawal syndrome, age or sex. There was higher intensity on the CIWA-Ar score (moderate and severe) among patients who had already begun withdrawal syndrome, compared to those admitted on a planned detoxification programme. The CIWA-Ar is a useful tool for assessing withdrawal symptoms and risks of complication and for planning treatment. Clinical practice must provide patients with access to health resources for the appropriate treatment of their addiction, with standardized assistance during their stay in hospital.

Gender Differences in Diazepam Withdrawal Syndrome in Mice

The present work was designed to study the influence of testosterone and oestrogens on the benzodiazepine withdrawal syndrome in mice. Several withdrawal signs were induced by 15 mg/kg intraperitoneally of flumazenil in diazepam-treated mice. The most noticeable were jerks, usually accompanied by tail lifts, and seizures. The intensity of the diazepam withdrawal syndrome was significantly lower in male than in female mice, especially in relation to the incidence of seizures. Castrated male mice showed a significant increase in the intensity of withdrawal syndrome. In addition, diazepam produced a significant increase of body weight in males but not in females. The principal finding of the present work is that the incidence of seizures produced by the administration of flumazenil was significantly lower in male than in female diazepam-treated mice. This fact suggests that the mechanism of action of benzodiazepines is modulated by the action of sexual hormones, and that testosterone plays a relevant role.