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Cloos JM, Lim Cow CYS, Bocquet V. Benzodiazepine high-doses: The need for an accurate definition. Int J Methods Psychiatr Res 2021; 30:e1888. [PMID: 34331787 PMCID: PMC8633930 DOI: 10.1002/mpr.1888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES A clear definition of what we understand of high-dose misuse or of a 'markedly increased dose' (as stated by the DSM-5) is important and past definitions may be inadequate. The aim of this review is to describe the different definitions used and to test these definitions for their accuracy. METHODS A narrative PubMed literature review was conducted based on articles published between 1 January 1990 and 31 December 2020 describing benzodiazepines (in MeSH Terms or MeSH Major Topic) and high-dose (or high-dosage). Specific definitions were applied to a population sample to show how definitions affect high-dose benzodiazepine prevalence. RESULTS Multiples of an equivalent-diazepam dose or of the World Health Organization 'defined daily dosage' were used more frequently than the overstep of the recommended maximum therapeutic dosage as a cut-off point. CONCLUSION High-dose use is rare but the prevalence in the general population varies among studies, mainly due to different definitions, making both clinical and epidemiological comparisons between studies difficult. Defining a high-dose user as a person who takes at least a higher dose than the maximum usual therapeutic dose over a defined period of time therefore appears to be clinically more consistent.
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Affiliation(s)
- Jean-Marc Cloos
- Department of Psychiatry, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | | | - Valéry Bocquet
- Department of Public Health, Competence Centre in Methodology and Statistics, Luxembourg Institute of Health, Luxembourg.,Unité de Soutien Méthodologique, CHU La Réunion, Saint-Denis, France
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Holzbach R, Hunold P, Konert F. [Evaluation of the Lippstädter Benzo-Check as a Screening Tool for Side Effects of Long-term Use of Benzodiazepines and Z-drugs]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:547-551. [PMID: 34388828 DOI: 10.1055/a-1510-8425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The Lippstädter Benzo-Check is intended to motivate those affected by unwanted effects of Benzodiazepines and Z-drugs. This study serves as the first check whether the Lippstädter Benzo-Check adequately recorded the symptoms of longterm-use before the withdrawal and, on the other hand, a depressive control group without taking the corresponding drugs unremarkable values achieved. METHODS 101 inpatient withdrawal patients with dependency on Benzodiazepines or Z-drugs and 154 day clinic patients without benzodiazepines or Z-drugs completed the Lippstädter Benzo-Check at the beginning of treatment. The total score and a subscore "dependency" were compared between the two groups. RESULTS The total score of the Lippstädter Benzo-check in the two collectives differ highly significantly, nevertheless around half oft he depressed patients are in the lowest of three warning areas - "the symptoms you have specified probably come from the long-term use oft he medication".The items "sleep disorder", "stealth", "loss of effectiveness", "fixation on medication" and "extension oft he indication" can be combined into a subscore ("dependency score"). This achieves a high selectivity for a cut-off value of<5 points, since 100% of the day clinic patients and only 10% of the withdrawal patients are below it. CONCLUSIONS The results of this first study using the Lippstädter Benzo-Check as a screening tool for undesirable consequences on benzodiazepines or Z-drugs are encouraging, despite methodological limitations and the need for further investigations.
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Affiliation(s)
- Rüdiger Holzbach
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Klinikum Hochsauerland, Arnsberg.,Zentrum für Interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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Buth S, Holzbach R, Martens MS, Neumann-Runde E, Meiners O, Verthein U. Problematic Medication With Benzodiazepines, "Z-drugs", and Opioid Analgesics. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:607-614. [PMID: 32048590 DOI: 10.3238/arztebl.2019.0607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 05/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND An estimated 1.4 to 2.6 million people in German suffer from drug dependence. Most of them are long-term users of benzodiazepines (BZD), Z drugs (ZD), or opioid analgesics (OA). METHODS This analysis is based on prescription data from patients of the national statutory health insurance system in the German federal states of Schleswig-Holstein, Hamburg, Bremen, and Lower Saxony. Drug-taking trends, duration, dosage, and long-term use of BZD, ZD, and OA in the years 2006 to 2015 are analyzed; prevalences are estimated for the years 2006 to 2016. RESULTS In 2006, 7.7% of patients received at least one prescription for a BZD, ZD, or OA; in 2016, 7.0% did. Over the period of analysis, a marked drop was seen in prescriptions of BZD and a slight fall in prescriptions of ZD (2006: BZD 3.5%, ZS 1.1%; 2016: BZD 2.0%, ZS 0.8%), but there was also an increase in prescriptions of OA, from 4.2% to 4.9%. The number of defined daily doses (DDD) prescribed per year fell for both BZD and ZD. For OA, the number of DDD prescribed per year rose from 2006 to 2009 and decreased by a small amount in subsequent years. The proportions of BZD and ZD patients who had long-term prescriptions fell over time, while the corresponding percentage of OA patients rose. CONCLUSION Nearly one-fifth of all prescriptions for BZD were long-term prescriptions for an entire year, in violation of the relevant guidelines. The rising prevalence of OA use was in the expected range in view of the aging population, but the number of prescriptions rose among younger patients as well. This trend toward more common treatment with opioid analgesics should be critically examined.
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Affiliation(s)
- Sven Buth
- Center for Interdisciplinary Addiction Research at the University of Hamburg (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Psychiatry, Psychotherapy, and Psychosomatics, Hochsauerland Hospital Group, Arnsberg; North German Pharmacy Data Center/Pharmacy Billing Center (NARZ/AVN)
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Fleiner T, Gersie M, Ghosh S, Mellone S, Zijlstra W, Haussermann P. Prominent physical inactivity in acute dementia care: Psychopathology seems to be more important than the dose of sedative medication. Int J Geriatr Psychiatry 2019; 34:308-314. [PMID: 30403307 PMCID: PMC6587796 DOI: 10.1002/gps.5021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/18/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION To objectively quantify patients' physical activity and analyze the relationships between physical activity levels, psychopathology, and sedative medication in acute hospital dementia care. MATERIALS AND METHODS In this cross-sectional study, we assessed the patients' physical activity based on data collection by hybrid motion sensors attached on their lower back. Daily doses of antipsychotics have been converted to olanzapine-equivalents and daily benzodiazepine medication is reported as diazepam-equivalents. We assessed patients' neuropsychiatric symptoms with the Neuropsychiatric Inventory and the Cohen-Mansfield Agitation Inventory. RESULTS We analyzed motion sensor data from 64 patients (MMSE M = 18.6). On average, patients were lying for 11.5 hours, sitting/standing sedentary for 10.3 hours, sitting/standing active for 1.0 hours, and walking for 1.2 hours per day. The analysis revealed no correlations between patients' physical activity and antipsychotic or benzodiazepine medication. More severe neuropsychiatric symptoms were associated with a decrease in the patients' physical activity (r = .32, P = .01). In particular, patients with apathy symptoms were less physically active than patients without apathy symptoms. DISCUSSION The results reveal that most of the patients in acute dementia care had very low levels of physical activity. Their physical inactivity may be due to the severity of their neuropsychiatric symptoms, especially apathy. Antipsychotic and benzodiazepine medication appeared to have less impact on patients' physical activity. Dementia care should pay more attention to prevent physical inactivity in patients.
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Affiliation(s)
- Tim Fleiner
- Institute of Movement and Sport GerontologyGerman Sport University CologneCologneGermany,Department of Geriatric Psychiatry and PsychotherapyLVR‐Hospital CologneCologneGermany
| | - Marleen Gersie
- Department of Geriatric Psychiatry and PsychotherapyLVR‐Hospital CologneCologneGermany
| | - Sayantan Ghosh
- Institute of Movement and Sport GerontologyGerman Sport University CologneCologneGermany,Faculty of Mathematics and TechnologyUniversity of Applied Sciences Koblenz RheinAhrCampusKoblenzGermany
| | - Sabato Mellone
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”University of BolognaBolognaItaly
| | - Wiebren Zijlstra
- Institute of Movement and Sport GerontologyGerman Sport University CologneCologneGermany
| | - Peter Haussermann
- Department of Geriatric Psychiatry and PsychotherapyLVR‐Hospital CologneCologneGermany
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Fleiner T, Dauth H, Gersie M, Zijlstra W, Haussermann P. Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT. ALZHEIMERS RESEARCH & THERAPY 2017; 9:68. [PMID: 28851451 PMCID: PMC5576378 DOI: 10.1186/s13195-017-0289-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/17/2017] [Indexed: 12/14/2022]
Abstract
Background The primary objective of this trial is to investigate the effects of a short-term exercise program on neuropsychiatric signs and symptoms in acute hospital dementia care. Methods Within a hospital-based randomized controlled trial, the intervention group conducted a 2-week exercise program with four 20-min exercise sessions on 3 days per week. The control group conducted a social stimulation program. Effects on neuropsychiatric signs and symptoms were measured via the Alzheimer’s Disease Cooperative Study-Clinical Global Impression of Change, the Neuropsychiatric Inventory, and the Cohen-Mansfield Agitation Inventory. The antipsychotic and sedative dosage was quantified by olanzapine and diazepam equivalents. Results Eighty-five patients were randomized via minimization to an intervention group (IG) and a control group (CG). Seventy patients (82%) (mean age 80 years, 33 females, mean Mini Mental State Examination score 18.3 points) completed the trial. As compared to the CG (n = 35), the IG (n = 35) showed significantly reduced neuropsychiatric signs and symptoms. Especially, agitated behavior and lability improved. There were no between-group differences concerning antipsychotic and benzodiazepine medication. Conclusions This exercise program is easily applicable in hospital dementia care and significantly reduces neuropsychiatric signs and symptoms in patients suffering from predominantly moderate stages of dementia. Trial registration German Clinical Trial Register DRKS00006740. Registered 28 October 2014.
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Affiliation(s)
- Tim Fleiner
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933, Köln, Germany. .,LVR-Hospital Cologne, Department of Geriatric Psychiatry & Psychotherapy, Academic Teaching Hospital of the University of Cologne, Wilhelm-Griesinger-Straße 23, 51109, Köln, Germany.
| | - Hannah Dauth
- LVR-Hospital Cologne, Department of Geriatric Psychiatry & Psychotherapy, Academic Teaching Hospital of the University of Cologne, Wilhelm-Griesinger-Straße 23, 51109, Köln, Germany
| | - Marleen Gersie
- LVR-Hospital Cologne, Department of Geriatric Psychiatry & Psychotherapy, Academic Teaching Hospital of the University of Cologne, Wilhelm-Griesinger-Straße 23, 51109, Köln, Germany
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933, Köln, Germany
| | - Peter Haussermann
- LVR-Hospital Cologne, Department of Geriatric Psychiatry & Psychotherapy, Academic Teaching Hospital of the University of Cologne, Wilhelm-Griesinger-Straße 23, 51109, Köln, Germany
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Janhsen K, Roser P, Hoffmann K. The problems of long-term treatment with benzodiazepines and related substances. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:1-7. [PMID: 25613443 DOI: 10.3238/arztebl.2015.0001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Benzodiazepine abuse and dependence have been recognized and widely discussed for more than 40 years. With more than 230 million daily doses prescribed in Germany per year, the burden of reimbursement on the statutory health insurance carriers is high, albeit with a slight decline from year to year. At present, about 50% of all prescriptions in Germany are issued privately, even for patients who have statutory health insurance. METHODS We selectively review the literature on the epidemiology and treatment of benzodiazepine dependence and abuse in Germany. RESULTS Estimates of the number of benzodiazepine-dependent persons in Germany range from 128 000 to 1.6 million. Most estimates take no account of the large number of private prescriptions (i.e., those that are not reimbursed by the statutory health insurance scheme), while many exclude prescriptions for elderly persons, for whom these drugs are frequently prescribed. For the outpatient treatment of benzodiazepine withdrawal, it is recommended that the drug should first be switched to an equivalent dose of another benzodiazepine with an intermediate or long-acting effect; the dose should then, in general, be reduced weekly. In case of consumption of a high dose (≥ 20 mg diazepam equivalent), hospitalization and the additional administration of carbamazepine or valproic acid are recommended. Flumazenil treatment can improve with - drawal symptoms and leads to higher abstinence rates. Antidepressants should be given only if the patient is depressed. The dependence potential of nonbenzodiazepine drugs such as zolpidem and zopiclon must also be borne in mind. CONCLUSION Benzodiazepines are generally highly effective when first given, but they should generally be given only for strict indications and for a limited time. If these drugs still need to be given beyond the short term, timely referral to a specialist is indicated, and possibly also contact with the addiction aid system.
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Affiliation(s)
- Katrin Janhsen
- LWL-Klinik Bochum, Department of Psychiatry, Psychotherapy, Psychosomatic and Preventive Medicine, Ruhr University Bochum, Faculty of Health (Department of Medicine), Witten/Herdecke University
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Fleiner T, Zijlstra W, Dauth H, Haussermann P. Evaluation of a hospital-based day-structuring exercise programme on exacerbated behavioural and psychological symptoms in dementia--the exercise carrousel: study protocol for a randomised controlled trial. Trials 2015; 16:228. [PMID: 26006738 PMCID: PMC4465726 DOI: 10.1186/s13063-015-0758-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 05/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conceptual reviews and observational studies describe a link between physical inactivity and behavioural disturbances in people with dementia. Consequently, treatment of these symptoms requires physical activation and pharmacological or physical immobilization should be avoided. The few trials that have been conducted in inpatient dementia care to investigate the effects of exercise on behavioural and psychological symptoms revealed inconsistent results. Due to a lack of evidence, there is a paucity of recommendations for physical activation in this stage of care. Therefore, this trial seeks to investigate the effects of a day-structuring exercise programme on behavioural and psychological symptoms as well as on circadian rhythms of patients with dementia, hospitalized because of their behavioural and psychological disturbances. METHODS/DESIGN A single-centre randomised controlled trial will be conducted in three special dementia care units of an old age psychiatry hospital. Enrolled patients will receive either a 2-week exercise programme, or a 2-week social stimulation programme in addition to usual care. Due to the provision of four day-structuring exercise-sessions in the course of an intervention day, the exercise programme for the study group is called exercise-carrousel. Baseline and post-intervention assessment for the primary outcome variable - the overall effects on behavioural and psychological symptoms--will be measured by the Alzheimer's disease Cooperative Study-Clinical Global Impression of Change. The following objectives are set up as secondary outcomes: dimensions of the behavioural and psychological symptoms of dementia (BPSD) and caregiver burden, routine and on-demand psychotropic medication, patients' motor behaviour, diurnal cortisol-levels from saliva probes and brain-derived neurotrophic factor-levels from blood serum. DISCUSSION In order to be regarded as an important treatment option for behavioural and psychological symptoms, physical activation in inpatient hospital dementia care requires more evidence and appropriate recommendations. Respecting hospital routines and the intra-daily variability of the patients' motivation and behavioural disturbances in the provision of exercise sessions could lead to higher exercise adherence and better effects on patients' behavioural and psychological symptoms than former trials have presented. The concealment of allocation throughout the trial and the rating of individual exercise exertion present the key challenges and main limitations of this trial. TRIAL REGISTRATION DRKS00006740 (German Clinical Trial Register, date of registration: 28 October 2014).
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Affiliation(s)
- Tim Fleiner
- Institute of Movement and Sport Gerontology, German Sport University, Cologne, 50993, Germany. .,Department of Old Age Psychiatry, LVR-Klinik Köln, Köln, 51109, Germany.
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University, Cologne, 50993, Germany.
| | - Hannah Dauth
- Department of Old Age Psychiatry, LVR-Klinik Köln, Köln, 51109, Germany.
| | - Peter Haussermann
- Department of Old Age Psychiatry, LVR-Klinik Köln, Köln, 51109, Germany.
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Bleckwenn M, Rüdisser V, Mücke M. [Treatment of a silent addiction- current treatment recommendations to drug dependence]. MMW Fortschr Med 2015; 157:41-44. [PMID: 26012456 DOI: 10.1007/s15006-015-2971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Markus Bleckwenn
- Institut für Hausarztmedizin, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, D-53127, Bonn, Deutschland,
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Matos EGD, Kraus L, Pabst A, Piontek D. Problembewusstsein und Inanspruchnahme von Hilfe bei substanzbezogenen Problemen. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2013. [DOI: 10.1024/0939-5911.a000278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ziel: Es wurden 12-Monats-Prävalenzen geschätzt bezüglich a) der Wahrnehmung substanzbezogener Probleme, b) der Inanspruchnahme verschiedener Hilfsangebote und c) der Inanspruchnahme professioneller Hilfe. Faktoren, die mit der Inanspruchnahme von Hilfe assoziiert sind, wurden analysiert. Methodik: Die Auswertung basiert auf Daten des Epidemiologischen Suchtsurveys (ESA) 2012 (n = 9084; 18 – 64 Jahre; Ausschöpfungsrate 53.6 %). Missbrauch und Abhängigkeit nach DSM-IV wurden anhand des M-CIDI erfasst. Prädiktoren der Hilfesuche wurden regressionsanalytisch getestet. Ergebnisse: Zwischen 6 % (Alkohol) und 19 % (illegale Drogen) der Konsumenten berichteten substanzbezogene Probleme. Von diesen nahmen 14 % (Alkohol), 33 % (Illegale Drogen) bzw. 59 % (Medikamente) Hilfe in Anspruch. Mit Ausnahme des Einkommens bei Alkoholkonsumenten waren soziodemografische Variablen nicht mit der Inanspruchnahme von Hilfe assoziiert. Schlussfolgerungen: Die Studie zeigt eine Unterversorgung von Personen mit substanzbezogenen Problemen. Das Hilfesuchverhalten scheint hauptsächlich durch die Schwere der substanzbezogenen Störung beeinflusst zu sein.
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Affiliation(s)
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm
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Braun SI, Bischof G, Rumpf HJ. Development and validation of the Decisional Balance Scale for problematic Prescription Drug use (DBS-PD)-20. Addict Behav 2012; 37:444-8. [PMID: 22209654 DOI: 10.1016/j.addbeh.2011.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 10/08/2011] [Accepted: 12/06/2011] [Indexed: 10/14/2022]
Abstract
The purpose of this study was to develop a Decisional Balance Scale (DBS) for Prescription Drugs (PD), the DBS-PD-20, to examine its factorial structure and test its reliability and external validity by comparison across Stages of Change. A sample of 126 general hospital inpatients with either regular use of PD (more than 60 days within the last three months) or abuse of or dependence on PD was recruited in a northern German city. Exploratory principal components analysis revealed a two-factor structure, the Pros and Cons of PD intake, as expected. While the DBS-PD-20 showed good reliability (Cronbach's alpha=0.91 for the Pros and=0.89 for the Cons), external validity could be proven for the Cons (significant increase from precontemplation to contemplation/action), whereas the Pros showed an insignificant increase. Although further validation is needed, the DBS-PD-20 may be helpful for interventions and research.
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Affiliation(s)
- Sabine I Braun
- University of Lübeck, Department of Psychiatry and Psychotherapy, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
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