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Hung CC, Ko YC, Chung CM. Association between Single Nucleotide Polymorphisms in Monoamine Oxidase and the Severity of Addiction to Betel Quid. Curr Issues Mol Biol 2024; 46:1010-1019. [PMID: 38392182 PMCID: PMC10887354 DOI: 10.3390/cimb46020064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Betel quid (BQ) is the fourth most popular psychoactive substance in the world, and BQ use disorder (BUD) is prevalent in Asian countries. Although the mechanisms underlying BUD remain unclear, studies have reported influences from monoamine oxidase inhibitor. We enrolled 50 patients with BUD and assessed their BQ consumption habits, emotional conditions, and the clinical severity of addiction-assessed using the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition] (DSM-5) criteria, Substance Use Severity Rating Scale, and Yale-Brown Obsessive Compulsive Disorder Rating Scale for BQ. Patients were categorized into the severe group when showing six or more symptoms defined by DSM-5. A genome-wide association study was conducted for single nucleotide polymorphisms in BRCA1, COL9A1, NOTCH1, HSPA13, FAT1, and MAOA by using patients' blood samples. More severe BUD symptoms were associated with younger age of using BQ and poor oral hygiene and with severe craving for and more anxiety toward BQ use. The MAOA rs5953210 polymorphism was significantly associated with severe BUD (odds ratio, 6.43; 95% confidence interval, 5.12-7.74; p < 0.01) and might contribute to BQ-associated cancer risk. Further studies are required to investigate the addictive properties of BQ and the development of novel diagnostic tools and pharmacotherapeutic alternatives to BUD treatment.
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Affiliation(s)
- Chung-Chieh Hung
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Ying-Chin Ko
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 106216, Taiwan
| | - Chia-Min Chung
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
- Department of Psychiatry and Center for Addiction and Mental Health, China Medical University Hospital, Taichung 404327, Taiwan
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Lowton K, Chiba G. Assessing the clinical utility of the severity dependence scale for benzodiazepine use disorder. S Afr J Psychiatr 2021; 27:1571. [PMID: 34394974 PMCID: PMC8335755 DOI: 10.4102/sajpsychiatry.v27i0.1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/14/2021] [Indexed: 11/01/2022] Open
Abstract
Background Benzodiazepines are often used as a part of mental health pharmacological management; however, often when prescribed for extended periods, they increase the risk of benzodiazepine use disorder (BUD). Clinical interviews are at the centre of diagnosing this disorder. However, in addition to clinical assessment a simple, validated questionnaire conducted by any healthcare professional may aid in screening for BUD and referral for further management. Aim To compare the accuracy of the severity dependence scale (SDS) as a screening tool for BUD against the standard clinical interviews using the Diagnostic and Statistical Manual of Mental Disorders, edition 5, (DSM 5) checklist amongst benzodiazepine users with primary psychiatric disorders. Setting Outpatient psychiatric clinic in South Rand Hospital, Johannesburg, South Africa. Methods A cross-sectional study was conducted, once informed consent was attained, looking at demographic and clinical profiles of benzodiazepine users. Clinical interviews were conducted in 81 patients who completed the SDS. In comparing the results of the SDS and clinical interview outcomes, chi-square tests were used to determine an association between categorical variables. A receiver-operating characteristic (ROC) curve was generated in determining the cut-off score in the SDS with the highest sensitivity and specificity. Results This study indicated that a cutoff score of greater than or equal to six of the SDS showed 86% sensitivity and 90.3% specificity compared to a diagnosis of BUD made with clinical interview. The only categorical variables of marginal significance (p~0.06) in comparison to a BUD diagnosis were with benzodiazepine type (oxazepam) and longer duration of use (greater than 24 months). Conclusion This study identified the SDS as a useful screening tool for BUD with a high sensitivity and specificity compared to interview outcomes. Statistically, correlates were identified between duration and type of benzodiazepine prescribed and BUD suggesting emphasis on these factors when prescribing benzodiazepines.
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Affiliation(s)
- Karishma Lowton
- Department of Psychiatry, Faculty of Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaveeta Chiba
- Department of Psychiatry, Faculty of Health, University of the Witwatersrand, Johannesburg, South Africa
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Bystritsky A, Spivak NM, Dang BH, Becerra SA, Distler MG, Jordan SE, Kuhn TP. Brain circuitry underlying the ABC model of anxiety. J Psychiatr Res 2021; 138:3-14. [PMID: 33798786 DOI: 10.1016/j.jpsychires.2021.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 12/13/2022]
Abstract
Anxiety Disorders are prevalent and often chronic, recurrent conditions that reduce quality of life. The first-line treatments, such as serotonin reuptake inhibitors and cognitive behavioral therapy, leave a significant proportion of patients symptomatic. As psychiatry moves toward targeted circuit-based treatments, there is a need for a theory that unites the phenomenology of anxiety with its underlying neural circuits. The Alarm, Belief, Coping (ABC) theory of anxiety describes how the neural circuits associated with anxiety interact with each other and domains of the anxiety symptoms, both temporally and spatially. The latest advancements in neuroimaging techniques offer the ability to assess these circuits in vivo. Using Neurosynth, a large open-access meta-analytic imaging database, the association between terms related to specific neural circuits was explored within the ABC theory framework. Alarm-related terms were associated with the amygdala, anterior cingulum, insula, and bed nucleus of stria terminalis. Belief-related terms were associated with medial prefrontal cortex, precuneus, bilateral temporal poles, and hippocampus. Coping-related terms were associated with the ventrolateral and dorsolateral prefrontal cortices, basal ganglia, and anterior cingulate. Neural connections underlying the functional neuroanatomy of the ABC model were observed. Additionally, there was considerable interaction and overlap between circuits associated with the symptom domains. Further neuroimaging research is needed to explore the dynamic interaction between the functional domains of the ABC theory. This will pave the way for probing the neuroanatomical underpinnings of anxiety disorders and provide an evidence-based foundation for the development of targeted treatments, such as neuromodulation.
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Affiliation(s)
- Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; BrainSonix Corporation, Sherman Oaks, CA, USA.
| | - Norman M Spivak
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; Department of Neurosurgery, UCLA, Los Angeles, CA, USA; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Bianca H Dang
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Sergio A Becerra
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Margaret G Distler
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Sheldon E Jordan
- Neurology Management Associates - Los Angeles, Santa Monica, CA, USA
| | - Taylor P Kuhn
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Hung CC, Lee CH, Ko AMS, Lane HY, Lee CP, Ko YC. Effect of antidepressants for cessation therapy in betel-quid use disorder: a randomised, double-blind, placebo-controlled trial. Epidemiol Psychiatr Sci 2020; 29:e125. [PMID: 32370818 PMCID: PMC7216045 DOI: 10.1017/s2045796020000384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIMS More than one-half of betel-quid (BQ) chewers have betel-quid use disorder (BUD). However, no medication has been approved. We performed a randomised clinical trial to test the efficacy of taking escitalopram and moclobemide antidepressants on betel-quid chewing cessation (BQ-CC) treatment. METHODS We enrolled 111 eligible male BUD patients. They were double-blinded, placebo-controlled and randomised into three treatment groups: escitalopram 10 mg/tab daily, moclobemide 150 mg/tab daily and placebo. Patients were followed-up every 2 weeks and the length of the trial was 8 weeks. The primary outcome was BQ-CC, defined as BUD patients who continuously stopped BQ use for ⩾6 weeks. The secondary outcomes were the frequency and amount of BQ intake, and two psychological rating scales. Several clinical adverse effects were measured during the 8-week treatment. RESULTS Intention-to-treat analysis shows that after 8 weeks, two (5.4%), 13 (34.2%) and 12 (33.3%) of BUD patients continuously quit BQ chewing for ⩾6 weeks among placebo, escitalopram, moclobemide groups, respectively. The adjusted proportion ratio of BQ-CC was 6.3 (95% CI 1.5-26.1) and 6.8 (95% CI 1.6-28.0) for BUD patients who used escitalopram and moclobemide, respectively, as compared with those who used placebo. BUD patients with escitalopram and moclobemide treatments both exhibited a significantly lower frequency and amount of BQ intake at the 8th week than those with placebo. CONCLUSIONS Prescribing a fixed dose of moclobemide and escitalopram to BUD patients over 8 weeks demonstrated treatment benefits to BQ-CC. Given a relatively small sample, this study provides preliminary evidence and requires replication in larger trials.
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Affiliation(s)
- Chung-Chieh Hung
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Hung Lee
- Department of Public Health and Research Center for Environment Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Albert Min-Shan Ko
- Key Laboratory of Vertebrate Evolution and Human Origins of Chinese Academy of Sciences, Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China
| | - Hsien-Yuan Lane
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Chi-Pin Lee
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ying-Chin Ko
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Duresso SW, Matthews AJ, Ferguson SG, Bruno R. Using the Severity of Dependence Scale to screen for DSM-5 khat use disorder. Hum Psychopharmacol 2018. [PMID: 29527722 DOI: 10.1002/hup.2653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to determine the efficacy of the Severity of Dependence Scale (SDS) as a screening tool for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-defined khat use disorder. METHODS Cross-sectional, purposive sample of past-year khat consumers aged 16 and above were recruited from khat markets and cafes from university and general community in Adama, Ethiopia. Participants self-completed a survey comprising current substance use disorder. RESULTS The SDS formed a unifactorial structure, consistent with the dependence construct. Almost three quarters (73%) of the sample were identified as experiencing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition khat use disorder. The SDS demonstrated excellent discrimination (area under the curve = 0.92) and an optimal cut-off as a score of 3 or greater, with sensitivity of 81% and specificity of 96%. This classification validly identified a group with more frequent and higher dose khat use than participants that did not screen positive. CONCLUSION Although khat is a mild stimulant, there is clear evidence that some consumers are both concerned with their use and experience problems associated with their use. Consistent with its application for other drugs, the SDS is a brief and simple screening tool that appears to validly identify individuals experiencing a khat use disorder syndrome and experiencing high rates of adverse consequences in association with use.
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Affiliation(s)
- Samson W Duresso
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | | | | | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Fernández-Calderón F, Vidal-Giné C, López-Guerrero J, Lozano-Rojas ÓM. Reliability, convergent and structural validity and cut-off score of the Severity of Dependence Scale for recreational ketamine users. Addict Behav 2016; 60:1-7. [PMID: 27082261 DOI: 10.1016/j.addbeh.2016.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 01/27/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS There is a lack of instruments for measuring ketamine substance use disorders. The aims were (i) to estimate the reliability and provide evidence of validity of the Severity of Dependence Scale (SDS) in a sample of recreational users, and (ii) propose a cut-off point to determine the presence of dependence. METHODS We conducted a web-based cross-sectional survey with recreational users who accessed webs related to recreational drug use and harm reduction. 264 recreational ketamine users who had taken it in the past month participated in the study. The Spanish version of the SDS was used. Information on ketamine use-related problems and ketamine use patterns was also collected. RESULTS The reliability estimation calculated by the Cronbach's alpha coefficient was 0.776. SDS showed evidence of convergent validity based on relationships with other variables. Two comparisons were made in this study to analyze the Receiver Operating Characteristic Curve. For frequency of use in the last month the area under curve (AUC) was 0.835 (CI=0.775-0.895) with optimal discrimination at an SDS score of 3. For having been in treatment for decreasing or quitting ketamine use the AUC was 0.902 (CI=0.840-0.963) and the cut-off point was 4. Confirmatory factor analysis showed a one-dimensional structure when Items 3 and 4 were correlated. CONCLUSIONS This study has provided evidence of reliability and validity of the ketamine version of the SDS for recreational users. Considering that ketamine use is linked to young people and its strong potential for causing serious impairment, a cut-off of 3 is proposed as indicative of dependence.
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Murakoshi A, Takaesu Y, Komada Y, Ishikawa J, Inoue Y. Prevalence and associated factors of hypnotics dependence among Japanese outpatients with psychiatric disorders. Psychiatry Res 2015; 230:958-63. [PMID: 26614012 DOI: 10.1016/j.psychres.2015.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 08/05/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
This study aimed to investigate the prevalence of the dependence for benzodiazepine or their agonist (BZDs) hypnotics, as well as factors associated with this dependence among Japanese psychiatric outpatients. One thousand and forty-three patients in the psychiatric outpatient clinic of Tokyo Medical University Hospital receiving treatment with BZDs hypnotics were analyzed. The subjects answered questionnaires including demographic variables, subjective sleep difficulty assessed by the Pittsburg Sleep Quality Index (PSQI), duration of hypnotics medication, dose of diazepam equivalent BZDs hypnotics, the presence or absence of subjective side effects due to BZDs hypnotics (dizziness, fatigue, daytime sleepiness, amnesia, and headache), and dependency assessed by the Dependency 2-A (D 2-A) score. Subjects with a D 2-A score ≥10 were considered as having BZDs hypnotics dependence, and the variables associated with the presence of dependence were examined using logistic regression analyses. Eighty-two out of the 1043 subjects (7.9%) were determined to have BZDs hypnotics dependence. Compared with the non-dependence group, the dependence group had a significantly higher proportion of positive respondents for all the side effects. Multiple logistic regression analyses showed that the dependence was significantly associated with younger age, higher total PSQI score, and higher daily dose of BZDs hypnotics. Younger age, higher total PSQI score, and higher dose may be associated with BZDs hypnotics dependence. The finding that patients with BZDs hypnotics dependence frequently suffered from subjective side effects and had greater sleep difficulty encourages the establishment of alternative treatments for patients with insomnia symptoms refractory to BZDs hypnotics treatment.
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Affiliation(s)
- Akiko Murakoshi
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yoshikazu Takaesu
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yoko Komada
- Department of Somnology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, 1-24-10 Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan
| | - Jun Ishikawa
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yuichi Inoue
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; Department of Somnology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, 1-24-10 Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan.
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Yen CF, Ko CH, Chang YP, Yu CY, Huang MF, Yeh YC, Lin JJ, Chen CS. Dependence, misuse, and beliefs regarding use of hypnotics by elderly psychiatric patients taking zolpidem, estazolam, or flunitrazepam. Asia Pac Psychiatry 2015; 7:298-305. [PMID: 25296384 DOI: 10.1111/appy.12147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To examine the prevalence rates and correlates of dependence on, misuse of, and beliefs regarding use of hypnotics in elderly psychiatric patients with long-term use of zolpidem, estazolam, or flunitrazepam. METHODS A total of 139 psychiatric outpatients 65 or more years of age who used zolpidem, estazolam, or flunitrazepam for at least 3 months were studied. The levels of hypnotic dependence and beliefs regarding hypnotic use (necessity and concern) were assessed. Three patterns of hypnotic misuse in the past 1 month were also explored. The correlates of high dependence, misuse, and unfavorable attitude and high concern toward hypnotic use were examined using logistic regression analyses. RESULTS A total of 28.8%, 7.9%, 12.2%, and 22.3% of participants reported high dependence on, misuse of, unfavorable attitude toward, and high concern toward hypnotic use, respectively. Males were more likely to report unfavorable attitude toward hypnotic use than females. Elders with significant depression were more likely to report high concern toward hypnotic use than those without significant depression. Elders with high concern toward hypnotic use were more likely to report high dependence on hypnotics than those with low concern. Elders with significant depression and taking zolpidem were more likely to misuse hypnotics than those without significant depression and taking estazolam or flunitrazepam, respectively. DISCUSSION Clinicians should monitor the possibility of dependence on and misuse of hypnotics among elderly psychiatric patients who had the correlates identified in this study.
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Affiliation(s)
- Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, Buffalo, NY, USA
| | - Cheng-Ying Yu
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Mei-Feng Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jin-Jia Lin
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Psychiatry, Chi-Mei Hospital, Liuying Campus, Tainan, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Guerlais M, Grall-Bronnec M, Feuillet F, Gérardin M, Jolliet P, Victorri-Vigneau C. Dependence on prescription benzodiazepines and Z-drugs among young to middle-aged patients in France. Subst Use Misuse 2015; 50:320-7. [PMID: 25474727 DOI: 10.3109/10826084.2014.980952] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Benzodiazepines (BZD) and nonbenzodiazepines hypnotics (z-drugs) are recognized as one of the most widely prescribed medications in the world. OBJECTIVES The purpose of the study was to assess the BZD and z-drugs dependence in young to middle-aged outpatients who were taking BZD/z-drugs on a chronic basis, and to characterize their profile. METHODS This is a forward-looking cross-sectional epidemiological study. Data were collected through a semi-structured interview within a network of partner pharmacies from the Nantes area, in France. All data were obtained exclusively through patients' declarations. 212 patients (19-64 years old) were included: they were considered dependent when they answered positively to at least three items of the DSM IV. A multivariate logistic regression and a principal component analysis (PCA) were carried out to determine their profile. RESULTS Almost half of the patients met criteria for BZD/z-drugs dependence. The risk to develop BZD/z-drugs dependence is significantly associated with psychiatric history and with the quantity of BZD/z-drugs that is taken. A two factor concept of dependence could be identified according to the PCA: one axis with items of "tolerance" and "long term administration or higher doses", and a second axis with "concerned by treatment" and "somatic consequences". Conclusions/Importance: Among this BZD/z-drug dependent population, the two axes identified in the PCA represent two profiles of dependence: being in positive conditioning or suffering from negative consequences. Clinicians need to know them: these two clinical profiles may have an influence in terms of decision-making, especially to manage discontinuation.
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Affiliation(s)
- Marylène Guerlais
- 1CHU de Nantes, Clinical Pharmacology department, Institut de Biologie, 9 quai Moncousu, Nantes, France
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Yen CF, Yen CN, Ko CH, Hwang TJ, Chen CS, Chen TT, Su PW, Chen ST, Lin JJ. Correlates of dependence and beliefs about the use of hypnotics among zolpidem and zopiclone users. Subst Use Misuse 2015; 50:350-7. [PMID: 25458710 DOI: 10.3109/10826084.2014.980955] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Zolpidem and zopiclone are the two most commonly prescribed Z-drugs approved to treat insomnia. OBJECTIVES To examine the demographic and clinical correlates of dependence and beliefs about hypnotic use among long-term zolpidem and zopiclone users in psychiatric treatment for insomnia. METHODS A total of 392 psychiatric outpatients who received zolpidem or zopiclone treatment for at least 3 months for insomnia were studied. Participants' severity of hypnotic dependence and beliefs about the use of hypnotics to treat sleep problems were assessed. The correlation of dependence and beliefs about zolpidem and zopiclone treatment with demographic characteristics, hypnotic-using behaviors, co-use of addictive substances, and depressive symptoms were analyzed using multiple regression analysis models. RESULTS Zolpidem users reported more severe dependence and a lower level of necessity regarding the use of hypnotics than zopiclone users did. High equivalent doses of hypnotics and long duration of use were significantly associated with severe dependence and a low level of necessity. Severe depressive symptoms were signiciantly associated with severe dependence, a low level of necessity, and a low level of concern. Educational level was also associated with the levels of concern and necessity. Conclusions/Importance: There were differences in the level of dependence and belief about hypnotic use between zolpidem and zopiclone users. The correlates of dependence and belief identified in this study can serve as the basis for prevention and intervention programs.
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Affiliation(s)
- Cheng-Fang Yen
- 1Department of Psychiatry, Kaohsiung Medical University Hospital, and School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
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11
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Nakajima M, Dokam A, Alsameai A, AlSoofi M, Khalil N, al'Absi M. Severity of khat dependence among adult khat chewers: the moderating influence of gender and age. JOURNAL OF ETHNOPHARMACOLOGY 2014; 155:1467-1472. [PMID: 25064835 PMCID: PMC4167481 DOI: 10.1016/j.jep.2014.07.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The escalating use of khat (Catha edulis) in East Africa and Arabia is a major concern for public health. Yet little is known about the impact of khat on behavior. There has been no study in the region to assess the extent to which dependence syndrome is associated with khat use in this population. AIM OF THE STUDY To examine psychometric properties of the Severity of Dependence Scale-Khat (SDS-khat), gender differences in patterns of khat use and dependence, and the extent to which age moderated the link between gender and khat dependence. MATERIALS AND METHODS Two-hundred and seventy khat chewers recruited in two Yemeni cities completed face-to-face interviews asking about demographics and patterns of khat use. Validity of SDS-khat was examined by the principle component analysis and reliability of the scale was tested by Cronbach׳s alpha. A series of chi-square tests and analysis of variances (ANOVAs) were conducted to examine gender differences in khat use variables. RESULTS The results indicated that the mean age of khat chewers was 30.52 years (95% CI: 29.34, 31.70) and 52% of them were males. The SDS-khat was found to have two factors with moderate reliability. This pattern was consistent when the analysis was conducted in the entire sample and in each gender. Male khat chewers reported more symptoms related to khat dependence than female chewers. A significant gender by age interaction in SDS-khat levels (p=0.013) revealed a positive association between age and khat dependence in women only. CONCLUSION These results provide initial support for the use of SDS-khat in the assessment of khat dependence in Yemen. Gender differences in khat use patterns and dependence observed in this study call the need for more studies carefully examining the role of gender in khat research.
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Affiliation(s)
- Motohiro Nakajima
- University of Minnesota Medical School, 1035 University Drive, Duluth, Minnesota 55812, USA.
| | | | | | | | | | - Mustafa al'Absi
- University of Minnesota Medical School, 1035 University Drive, Duluth, Minnesota 55812, USA.
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Chen TT, Ko CH, Chen ST, Yen CN, Su PW, Hwang TJ, Lin JJ, Yen CF. Severity of alprazolam dependence and associated features among long-term alprazolam users from psychiatric outpatient clinics in Taiwan. J Formos Med Assoc 2014; 114:1097-104. [PMID: 24840273 DOI: 10.1016/j.jfma.2014.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 03/28/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/PURPOSE The aim of this study was to examine the correlations between the severity of alprazolam dependence and socio-demographic characteristics, the characteristics of alprazolam use, psychiatric comorbidity, and beliefs toward alprazolam use among long-term alprazolam users in Taiwan. METHODS A total of 148 long-term alprazolam users participated in this study. The Chinese version of the Severity of Dependence Scale was used to assess participants' severity of alprazolam dependence in the preceding month. Their socio-demographic characteristics, family function characteristics, dosage of prescribed alprazolam, duration of alprazolam use, alcohol use pattern, pain reliever and cigarette use pattern, severity of depressive symptoms, psychiatric diagnosis, and belief toward alprazolam use were investigated. RESULTS The results of multiple regression analysis indicated that a longer duration of alprazolam use, severe depressive symptoms, a high level of belief in the necessity of alprazolam treatment, and a high level of concern about the potential adverse consequences of alprazolam use were significantly associated with more severe alprazolam dependence. CONCLUSION Doctors should closely monitor the severity of alprazolam dependence among long-term users, especially patients' levels of depression, beliefs in the necessity of alprazolam treatment, and their concerns over the adverse consequences of continued treatment with alprazolam.
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Affiliation(s)
- Tzu-Ting Chen
- Department of Psychiatry, Yun-Lin Branch, National Taiwan University Hospital, Yunlin, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, and Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shao-Tsu Chen
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan; Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chia-Nan Yen
- Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Executive Yuan, Tainan, Taiwan
| | - Po-Wen Su
- Department of Psychiatry, Chu-Tung Branch, National Taiwan University Hospital, Hsinchu, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan.
| | - Jin-Jia Lin
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan; Department of Psychiatry, Chi-Mei Hospital, Liuying Campus, Tainan, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, and Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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