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Alidema F, Isjanovski V, Hasani-Alidema A, Halilaj-Vishi B, Alilaj-Beqiraj M. Pharmacotherapy of Mental Illness in the Mental Health Centers in Kosovo During 2021. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background- Treatment of mental illness with pharmacotherapy is strictly monitored in clinical centers dedicated to this purpose. While in most of developed countries this practice is well established, in Kosovo, in absence of such system, there is the need for further and continues investigation in this context with the aim to better monitor the therapy.
Aim of the study - This work aims to analyze and investigate the treatment of the patients with mental illness in the Mental Health Centers in Kosovo.
Methods - The methodology of this research work is based on the specific guidelines published by the WHO. Handbook of the World Health Organization (WHO). All patients’ data were obtained from protocol books of the treated patients. For each city, 30 patients which were selected according to the theory of probability, were analyzed. A total of 209 patients were enrolled in the study. Regarding the pharmacotherapeutic characteristics we have analyzed the way of treatment of mental illnesses according to the groups of drugs and centers. The diseases were categorized according to the International Classification of Diseases - Revision 10.
Results - Drugs were mainly administered through mouth, per os (PO) (82.4%). According to the clinics there was no significant change as per administration route of the drugs (ChiTest = 28, p > 0.11) (Tab.3). Almost, 2/3 of the prescribed drugs were non-essential (66.1%). Considering the class of the therapeutic drugs, over half of them were antipsychotic (53.2%), whereas in a percentage of 17.2% and 13.8% were anticholinergic and anxiolytic/hypnotic drugs, accordingly. These classes of drugs were 84.2% of the overall used drugs. Taken together, In the Mental Health Centers in Kosovo, drugs are mainly administered orally, with only 17.6% of the cases treated parenterally. The majority of the drugs used are the non-essential drugs, with antipsychotics being the most prescribed ones.
Conclusions - Furthermore, the study highlights the use of the third-line therapy as a first choice, and the use of effective drugs with low safety profile such as: Clozapine 84.62% (from SDA group). Moreover, ineffective drugs are used in 1.92% of patients and non-compliance of treatment with drug indications was found in 5.77% of cases.
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Baptista JDS, Leite TH, Ferreira VKDL, Magalhães LDSPD, Cruz MS, Mathias ACR. Relationship between levels of mindfulness and substance use pattern. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
ABSTRACT Objective Evaluate the association between levels of mindfulness and sociodemographic characteristics and pattern of drug use of individuals seeking treatment in a University Service Specialized in Substance Use Disorders. Methods This is a cross-sectional study with 164 individuals over 18 years of age seeking treatment for the use of psychoactive substances in the June 2018-December 2019 period, using a questionnaire for sociodemographic data, the Mindful Attention Awareness Scale (MAAS) self-reporting instrument, and the Alcohol, Smoking, and Substance Involvement Screening Test. Results An association was found between low levels of mindfulness mainly with the individual risk of being a medium/high-risk user of sedative-hypnotic drugs (p = 0.020). A borderline association was also found between MAAS and the risk of the individual being a medium/high risk of alcohol (p = 0.053) and with a more severe pattern of substance use (p = 0.065). Conclusion Individuals seeking treatment for substance use presented impairments in the attentional aspect of mindfulness and levels of mindfulness seem to protect against behaviors related to substance use, especially against the use of high/moderate risk of sedative-hypnotics.
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Krawczyk N, da Mota JC, Coutinho C, Bertoni N, de Vasconcellos MTL, Silva PLN, De Boni RB, Cerdá M, Bastos FI. Polysubstance use in a Brazilian national sample: Correlates of co-use of alcohol and prescription drugs. Subst Abus 2021; 43:520-526. [PMID: 34283709 DOI: 10.1080/08897077.2021.1949666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Responses to problem substance use have largely focused on illicit drugs, but reports on rising prescription drug misuse worldwide raise questions about their combined use with alcohol and potential consequences. The current study assessed prevalence of alcohol in conjunction with nonmedical opioid and benzodiazepine use across a nationally representative sample of adults in Brazil. Methods: Cross-sectional data on prevalence were estimated from the 2015 Brazilian Household Survey on Substance Use. We estimated past month nonmedical use of benzodiazepines and alcohol and past month nonmedical use of opioids and alcohol among adults who reported any past-year alcohol use. Zero-inflated Poisson models assessed independent correlates of alcohol and nonmedical opioid use, and alcohol and nonmedical benzodiazepine use. Results: Among adults who reported past year alcohol use, 0.4% (N = 257,051) reported past month alcohol and non-medical benzodiazepine use, and 0.5% (N = 337,333) reported past month alcohol and non-medical opioid use. Factors independently associated with co-use of alcohol and benzodiazepines included having depression (adjusted prevalence ratio (aPR):4.61 (95%CI 1.76-12.08)), anxiety (aPR:4.21 (95%CI 1.59-11.16)) and tobacco use (aPR: 5.48 (95%CI 2.26-13.27)). Factors associated with past-month alcohol and opioid use included having experienced physical or a threat of violence (aPR: 4.59 (95%CI 1.89-11.14)), and tobacco use (aPR:2.81(95%CI:1.29-6.12)). Conclusions: Co-use of prescription drugs with alcohol remains relatively rare among Brazilians, but findings point to a unique profile of persons at risk. Results of this study are important in light of changing dynamics and international markets of prescription drugs and the need for more research on use of these substances on a global scale.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jurema C da Mota
- Institute of Scientific and Technological Communication and Information in Health (ICICT), FIOCRUZ, Rio de Janeiro, Brazil
| | - Carolina Coutinho
- São Paulo School of Business Administration, Getúlio Vargas Foundation, Sao Paulo, Brazil
| | - Neilane Bertoni
- Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | | | | | - Raquel B De Boni
- Institute of Scientific and Technological Communication and Information in Health (ICICT), FIOCRUZ, Rio de Janeiro, Brazil
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Francisco Inácio Bastos
- Institute of Scientific and Technological Communication and Information in Health (ICICT), FIOCRUZ, Rio de Janeiro, Brazil
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Fegadolli C, Varela NMD, Carlini ELDA. [Use and abuse of benzodiazepines in primary healthcare: professional practices in Brazil and Cuba]. CAD SAUDE PUBLICA 2019; 35:e00097718. [PMID: 31291423 DOI: 10.1590/0102-311x00097718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 02/06/2019] [Indexed: 11/21/2022] Open
Abstract
The current study aimed to grasp the healthcare aspects present at the basis of the indiscriminate use of benzodiazepines. Based on a partnership between a Brazilian university and a Cuban university, the study aimed to understand the practices related to the use of these drugs in primary care and the meanings healthcare workers assign to them. The research was part of a multiple case study in the cities of São Paulo and Diadema (Brasil), and Santiago de Cuba (Cuba). The fieldwork data collection strategy was based on individual interviews and focus groups. Data were analyzed thematically and yielded five themes: (i) no man's land: lack of management of benzodiazepine use by primary care workers; (ii) inadequate indications: the benzodiazepine prescribed for unjustifiable situations; (iii) salvation and perdition: the medicine as attenuating the difficulty of acting in mental health by primary care professionals; (iv) limited empowerment to work in mental health; and (v) fragmented care: dissociation of the psychosocial care network. Limited grasp of mental health issues by primary care workers, fragmented care, work overload with what are considered other priorities, deficiencies in the availability of therapeutic resources, and limited investment in specific training contribute to the inadequate use of benzodiazepines. Independently of the health contexts, the challenges are similar for the health systems and can only be confronted if they become a priority for the organizations' management and the health workers as a whole.
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Prevalence of late-life depression and its correlates in a community-dwelling low-educated population aged 75+ years: The Pietà study. J Affect Disord 2019; 242:173-179. [PMID: 30189354 DOI: 10.1016/j.jad.2018.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/03/2018] [Accepted: 08/07/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The number of individuals with advanced age is growing worldwide, especially in developing countries. Depression is the most common mental disorder in the elderly. The aim of this study was to evaluate the prevalence rates and the correlates of late-life depression (LLD) and clinically significant depressive symptoms (CSDS) in a population aged 75+ years. METHODS We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil, and used the MINI to diagnose LLD according to DSM-IV criteria and the GDS-15 to identify CSDS. Quality of life was assessed by the WHOQOL-OLD scale. RESULTS Overall, 639 individuals (64% female, with a mean age of 81.1 ± 5.2 and 2.6 ± 2.8 years of schooling) were evaluated; 70 (11.1%) were diagnosed with LLD and 146 (25.6%) with CSDS. Depressed subjects (both with LLD and CSDS) had poorer measures of quality of life. Logistic regression analyses showed that LLD was independently associated to a history of falls/fracture, a diagnosis of cognitive impairment-no dementia, the number of regular drugs used, lack of reading habit and, inversely, to systolic blood pressure. LIMITATIONS The use of MINI which has not been validated in the elderly. No information was available on the number of previous depressive episodes or on the age of first episode. CONCLUSION Both dimensional and categorical diagnoses of depression were prevalent among community-dwelling oldest-old individuals. Different clinical and personal variables were associated with depression, which negatively influenced the quality of life of the affected individuals.
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Transnational trends in prescription drug misuse among women: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 63:56-73. [DOI: 10.1016/j.drugpo.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 09/14/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
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Laurito LD, Loureiro CP, Dias RV, Vigne P, de Menezes GB, Freire RC, Stangier U, Fontenelle LF. Predictors of benzodiazepine use in a transdiagnostic sample of panic disorder, social anxiety disorder, and obsessive-compulsive disorder patients. Psychiatry Res 2018; 262:237-245. [PMID: 29475102 DOI: 10.1016/j.psychres.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/13/2018] [Accepted: 02/02/2018] [Indexed: 01/04/2023]
Abstract
We investigated the rates of current and past benzodiazepine (BZD) use in a sample of 102 subjects attending specialized anxiety disorder clinics, including panic disorder (PD; N = 36), social anxiety disorder (SAD; N = 28) and obsessive-compulsive disorder (OCD; N = 38) patients. Almost 56% of the entire sample was using BZDs at the moment of the assessment, and 74.5% described having used them at some point during their lifetimes. The duration of psychiatric treatment and a lifetime history of PD, but not any other "transdiagnostic" measure of severity (such as the Panic and Agoraphobia Scale, the Social Phobia Inventory, the Dimensional Obsessive-Compulsive Scale, the Anxiety Sensitivity Index-36, and the Beck Inventories) were independent risk factors for current prescription of BZDs. Patients who continued to use BZDs differed from patients who stopped them by being older (both currently and when firstly seen in the clinic), by having a later age at onset of their most significant anxiety disorder, by being more agoraphobic/avoidant, and by believing to be less capable of stopping their BZDs for the fear of not being able to sleep.
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Affiliation(s)
- Luana D Laurito
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Carla P Loureiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafaela V Dias
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Paula Vigne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Gabriela B de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia.
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Brakoulias V, Starcevic V, Belloch A, Dell'Osso L, Ferrão YA, Fontenelle LF, Lochner C, Marazziti D, Martin A, Matsunaga H, Miguel EC, Reddy YCJ, do Rosário MC, Shavitt RG, Sundar AS, Stein DJ, Viswasam K. International prescribing practices in obsessive-compulsive disorder (OCD). Hum Psychopharmacol 2016; 31:319-24. [PMID: 27271200 DOI: 10.1002/hup.2541] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/21/2016] [Accepted: 05/03/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To assess rates of psychotropic medication use in patients with obsessive-compulsive disorder (OCD) in seven different countries on five continents and to compare these with international treatment guidelines. METHODS Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their patients with OCD and on their incidence of psychotropic use. Consistency of summary statistics across countries was evaluated. RESULTS The data came from Brazil (n = 955), Italy (n = 750), South Africa (n = 555), Japan (n = 382), Australia (n = 213), India (n = 202) and Spain (n = 82). The majority (77.9%; n = 2445) of the total sample of 3139 participants received a psychotropic medication. Consistent with international guidelines, selective serotonin reuptake inhibitors (SSRIs) were most commonly used (73.5%, n = 1796), but their use ranged from 59% in Australia to 96% in Japan. Clomipramine use varied from 5% in Japan and South Africa to 26% in India and Italy. Atypical antipsychotic use ranged from 12% in South Africa to 50% in Japan. CONCLUSIONS Pharmacotherapy for OCD varied significantly across sites. Prospective studies are required to determine the cultural, pharmacoeconomic and pharmacogenomic factors that may play a role in the variation in prescribing practices internationally and whether these variations influence treatment outcomes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Vlasios Brakoulias
- Department of Psychiatry, The University of Sydney and Nepean Hospital, Sydney Medical School-Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
| | - Vladan Starcevic
- Department of Psychiatry, The University of Sydney and Nepean Hospital, Sydney Medical School-Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders, I'TOC, Faculty of Psychology, Universidad de Valencia, Spain
| | - Liliana Dell'Osso
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Italy
| | - Ygor A Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Leonardo F Fontenelle
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, Brazil.,D'Or Institute for Research and Education; Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - Christine Lochner
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Italy
| | - Andrew Martin
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Euripedes C Miguel
- Department and Institute of Psychiatry, University of São Paulo School of Medicine, Brazil
| | - Y C Janardhan Reddy
- Department of Psychiatry National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Maria C do Rosário
- Child and Adolescent Psychiatry Unit (UPIA) at the Department of Psychiatry, Federal University of São Paulo, Brazil
| | - Roseli G Shavitt
- Department and Institute of Psychiatry, University of São Paulo School of Medicine, Brazil
| | - Arumugham Shyam Sundar
- Department of Psychiatry National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Dan Joseph Stein
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Kirupamani Viswasam
- Department of Psychiatry, The University of Sydney and Nepean Hospital, Sydney Medical School-Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
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Ramadan WH, El Khoury GM, Deeb ME, Sheikh-Taha M. Prescription patterns of benzodiazepines in the Lebanese adult population: a cross-sectional study. Neuropsychiatr Dis Treat 2016; 12:2299-305. [PMID: 27660452 PMCID: PMC5019479 DOI: 10.2147/ndt.s113078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study assessed the profile of benzodiazepine (BDZ) users in Lebanon. Adult patients visiting the pharmacies with prescriptions of BDZs were included in the study. Seven hundred and eighty-six current BDZ users were included, of whom 54.2% were females. Twenty-three percent reported being alcohol consumers and were mostly males. The two most commonly used BDZs were alprazolam (34.6%) and bromazepam (33.6%). The indication for use was mainly anxiety (44.4%), insomnia (22.5%), and depression (15.9%). The prescribing physicians were primarily psychiatrists (43.2%), followed by general practitioners (29.7%). Forty percent had been taking the drug for more than a year. Among those using BDZs for at least 1 month, 35.5% increased the dose with time. Thirty-three percent reported having experienced side effects. Eighteen patients (2.3%) reported taking more than one BDZ concomitantly, while 18.3% were taking drugs that should not be prescribed along with BDZs. In conclusion, the use of BDZs is highest among females, especially for the treatment of anxiety. Moreover, continuous use of the drugs for more than a year as well as significant potential drug interactions was identified.
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Affiliation(s)
| | | | - Mary E Deeb
- School of Medicine, Lebanese American University, Byblos, Lebanon
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Abstract
This study aimed to determine the frequency of benzodiazepine (BDZ) use in a large sample of patients with obsessive-compulsive disorder (OCD) and ascertain the type of BDZ used and the correlates and predictors of BDZ use in OCD. The sample consisted of 955 patients with OCD from a comprehensive, cross-sectional, multicentre study conducted by the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders between 2003 and 2009. The rate of BDZ use over time in this OCD sample was 38.4%. Of individuals taking BDZs, 96.7% used them in combination with other medications, usually serotonin reuptake inhibitors. The most commonly used BDZ was clonazepam. Current age, current level of anxiety and number of additional medications for OCD taken over time significantly predicted BDZ use. This is the first study to comprehensively examine BDZ use in OCD patients, demonstrating that it is relatively common, despite recommendations from treatment guidelines. Use of BDZs in combination with several other medications over time and in patients with marked anxiety suggests that OCD patients taking BDZs may be more complex and more difficult to manage. This calls for further research and clarification of the role of BDZs in the treatment of OCD.
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Azevedo ÂJPD, Araújo AAD, Ferreira MÂF. Consumo de ansiolíticos benzodiazepínicos: uma correlação entre dados do SNGPC e indicadores sociodemográficos nas capitais brasileiras. CIENCIA & SAUDE COLETIVA 2016; 21:83-90. [DOI: 10.1590/1413-81232015211.15532014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 05/17/2015] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo do artigo é conhecer a distribuição e a frequência de consumo de ansiolíticos benzodiazepínicos, bem como avaliar a correlação entre consumo e características demográficas, epidemiológicas, econômicas e sociais. Estudo ecológico tendo como unidade amostral as 27 capitais brasileiras. A coleta de dados foi executada através do banco da Anvisa, para a dispensação do Alprazolam, Bromazepam, Clonazepam, Diazepam e Lorazepam, de 2010 a 2012, do Censo Demográfico 2010 (IBGE), Datasus e da pesquisa Demografia Médica. A análise estatística descritiva e a de regressão linear múltipla foram realizadas para análise dos dados. A região Norte possui as capitais com menores médias de consumo desses medicamentos e o Sudeste as mais elevadas. O consumo médio para a população de todas as capitais foi de 3,60 DHD. O Alprazolam é o mais dispensado pelas farmácias e drogarias particulares, com média de 2,00 DHD para as capitais. A análise de regressão linear múltipla demonstrou que 76% da variância do consumo foi explicada pela variação da densidade demográfica (β = 0,310 p = 0,045) e percentual de médicos (β = 0,507 p = 0,016). O consumo de ansiolíticos de meia vida curta vem crescendo ao longo dos anos, principalmente nas capitais de maior densidade demográfica e concentração de médicos.
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Tol WA, Barbui C, Bisson J, Cohen J, Hijazi Z, Jones L, de Jong JTVM, Magrini N, Omigbodun O, Seedat S, Silove D, Souza R, Sumathipala A, Vijayakumar L, Weissbecker I, Zatzick D, van Ommeren M. World Health organization guidelines for management of acute stress, PTSD, and bereavement: key challenges on the road ahead. PLoS Med 2014; 11:e1001769. [PMID: 25514024 PMCID: PMC4267806 DOI: 10.1371/journal.pmed.1001769] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Wietse Tol and colleagues discuss some of the key challenges for implementation of new WHO guidelines for stress-related mental health disorders in low- and middle-income countries. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Wietse A. Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health, University of Verona, Verona, Italy
| | - Jonathan Bisson
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Judith Cohen
- Department of Psychiatry, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Zeinab Hijazi
- International Medical Corps, Santa Monica, California, and Washington, D.C., United States of America
| | - Lynne Jones
- FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Joop T. V. M. de Jong
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicola Magrini
- WHO Collaborating Centre for Evidence-based Research Synthesis and Guideline Development, Bologna, Italy
| | - Olayinka Omigbodun
- Department of Psychiatry, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
| | - Derrick Silove
- School of Psychiatry and Ingham Institute, University of New South Wales, Sydney, Australia
| | - Renato Souza
- Institute of Psychiatry, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Athula Sumathipala
- Research Institute for Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, United Kingdom & Institute for Research and Development, Colombo, Sri Lanka
| | | | - Inka Weissbecker
- International Medical Corps, Santa Monica, California, and Washington, D.C., United States of America
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, United States of America
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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The Brazilian Drug Policy Situation: The Public Health Approach Based on Research Undertaken in a Developing Country. Public Health Rev 2013. [DOI: 10.1007/bf03391706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Brunoni AR, Nunes MA, Figueiredo R, Barreto SM, da Fonseca MDJM, Lotufo PA, Benseñor IM. Patterns of benzodiazepine and antidepressant use among middle-aged adults. the Brazilian longitudinal study of adult health (ELSA-Brasil). J Affect Disord 2013; 151:71-7. [PMID: 23769607 DOI: 10.1016/j.jad.2013.05.054] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/17/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antidepressant and benzodiazepine medicines are widely prescribed in high-income countries. Our aim was to investigate and describe clinical and demographic characteristics of their use in a large cohort from a middle-income country. METHODS Participants (n=15,105) from the Brazilian Health Longitudinal Study (ELSA-Brasil), a civil servant cohort from six different sites in Brazil were asked about antidepressant and benzodiazepine use. The Clinical Interview Schedule-Revised was used for psychiatric assessment. Sociodemographic and clinical data were also collected. RESULTS Current use of antidepressant and benzodiazepine medicines was respectively reported by 6.87% and 3.88% of participants. These numbers were higher in major depression-MDD (16.5% and 13.9%), generalized anxiety disorder-GAD (14% and 9.5%) and any mental disorder (11.7% and 7.8%). The use of antidepressant and benzodiazepine was directly associated with clinical comorbidities and psychiatry diagnosis. In addition, older age was associated with benzodiazepine use and more years of schooling, with antidepressant use. Finally, the use of these medicines was strongly associated (odds ratio=8.48, p<0.001). LIMITATIONS Our cohort does not include younger adults (18-34 years), although it includes older (65-75 years) participants. DISCUSSION Antidepressant and benzodiazepine use in Brazil is lower than in high-income countries. We found that factors such as age and education level were associated with the use of these medicines, whereas MDD and GAD were poor predictors of psychopharmacotherapy use, suggesting misuse/overuse of psychopharmacotherapy among individuals without psychiatric illness and underuse among those with psychiatric conditions in Brazil.
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Affiliation(s)
- Andre R Brunoni
- Hospital Universitário, Universidade de São Paulo, São Paulo, Brasil.
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15
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Leibing A, Collin J. The multiple anxieties of getting older: tranquilizers and the ambivalence of effect. Med Anthropol 2013; 32:399-416. [PMID: 23944243 DOI: 10.1080/01459740.2013.774394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Most studies on benzodiazepines emphasize overconsumption and warn of addiction, especially by older adults. This article is about the avoidance of benzodiazepine medications by 'aging' women living in a Brazilian village. This case study helps to support our central concern: to call attention to the ambiguities that exist in discussing these medications, and to stress the importance of a multilayered understanding of effect. We argue that benzodiazepines, like other psychopharmaka, induce bodily sensations that, at least in part, correspond to and are shaped by the situated self-image of individuals in distress.
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Affiliation(s)
- Annette Leibing
- Faculté des Sciences Infirmières, Université de Montréal, Montreal, Quebec, Canada.
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Opaleye ES, Noto AR, Sanchez ZM, Amato TC, Locatelli DP, Gossop M, Ferri CP. Nonprescribed use of tranquilizers or sedatives by adolescents: a Brazilian national survey. BMC Public Health 2013; 13:499. [PMID: 23705991 PMCID: PMC3664606 DOI: 10.1186/1471-2458-13-499] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/16/2013] [Indexed: 11/10/2022] Open
Abstract
Background Although the nonprescribed use of tranquilizers or sedatives by adolescents is a cause for concern in many countries, there is a shortage of data from low and middle income countries (LAMIC). The present study aims to estimate the prevalence of nonprescribed use of tranquilizers/sedatives by adolescents in Brazil, and to assess how socioeconomic and demographic circumstances, as well as indicators of access to these substances are associated with their use and with risk perception. Methods A cross-sectional study was conducted using a multi-stage probability sample of 18131 high school students from public and private schools from all 27 Brazilian state capitals. A self-reporting questionnaire was used to obtain information on social and economic circumstances, nonprescribed use of tranquilizers or sedatives and risk perception of their use. Results Lifetime nonprescribed use of tranquilizers or sedatives was reported by 5% of respondents, more commonly among females (OR: 2.19, 95% CI: 1.75-2.75) and those attending private schools (OR: 1.47, 95% CI: 1.17-1.84). The use of tranquilizers/sedatives by relatives or friends was associated with nonprescribed use by the participant (OR: 4.26, 95% CI: 3.46-5.23) and a majority of lifetime users obtained these substances from a family environment (82%). Previous medical prescription was independently associated with nonprescribed use (OR: 6.61, 95% CI: 4.87-8.98) and with low risk perception (OR: 2.42, 95% CI: 1.12-5.24). Conclusions A substantial proportion of Brazilian adolescents use nonprescribed tranquilizers/sedatives. Easy access to these substances seems to play an important role in this use and should be tackled by preventive and treatment interventions.
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Affiliation(s)
- Emerita S Opaleye
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Botucatu, 862- 1° andar, São Paulo CEP 04023-062, Brasil
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Souza ARLD, Opaleye ES, Noto AR. Contextos e padrões do uso indevido de benzodiazepínicos entre mulheres. CIENCIA & SAUDE COLETIVA 2013; 18:1131-40. [DOI: 10.1590/s1413-81232013000400026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 03/20/2012] [Indexed: 11/22/2022] Open
Abstract
O uso indevido de benzodiazepínicos, especialmente entre mulheres, tem despertado preocupação na área de saúde pública. Este estudo objetivou compreender qualitativamente crenças e valores associados ao consumo indevido dessa substância por mulheres. Foram entrevistadas trinta e três mulheres (18-60 anos) com histórico de uso indevido de benzodiazepínicos no último ano, selecionadas intencionalmente e por critérios. Os discursos foram transcritos e submetidos à análise de conteúdo com auxílio do software NVivo. A maioria das entrevistadas referiu tempo de uso bem superior ao recomendado (mediana: 7 anos) e compra com receita médica. Os motivos de uso mais citados foram diminuição da ansiedade, problemas de insônia e fuga dos problemas. Apesar de reconhecerem a possibilidade de dependência, esta não motivou a interrupção do uso. O acompanhamento médico não pareceu, necessariamente, estimular a percepção de risco dos benzodiazepínicos, sendo um fator que favoreceu a manutenção do uso prolongado.
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Souza TT, Silva WB, Onofre ASC, Quintans JDSS, Onofre FBDM, Quintans-Júnior LJ. Evaluation of adherence to treatment by patients seen in a psychosocial care center in northeastern Brazil. BRAZ J PHARM SCI 2011. [DOI: 10.1590/s1984-82502011000400016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the treatment of mental disorders, nonadherence to medication, the main cause of psychiatric morbidity, is observed in about 50% of the cases and is responsible for numerous losses. This study evaluated adherence to drug treatment by patients seen in a Psychosocial Care Center (CAPS) in northeastern Brazil. Adherence to treatment was evaluated using the Haynes-Sackett and Morisky-Green-Levine tests. All patients registered in the CAPS were included in the study (n= 101). Only 11.88% of the patients adhered to drug treatment. The main reasons not to use medication were: oblivion (68.83%), feeling unwell after taking the medication (54.22%), not having money to buy the medication (43.83%), not finding the medication in the public health service (39.94%) and fear of harm that might be caused by the drug (28.90%). Furthermore, 85.1% of the patients did not know their diseases, 88.1% did not know their treatment, 86.4% did not feel good when they took their medication, and 88.1% took their medication incorrectly. The results revealed that the lack of information about diseases and drugs used, the nuisance posed by drug therapy and the low access to medications reduce adherence to treatment and, consequently, treatment effectiveness.
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Iqbal SP, Ahmer S, Farooq S, Parpio Y, Tharani A, Khan RAM, Zaman M. Benzodiazepine use among adults residing in the urban settlements of Karachi, Pakistan: a cross sectional study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2011; 6:19. [PMID: 21801457 PMCID: PMC3162550 DOI: 10.1186/1747-597x-6-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 08/01/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are hardly any studies carried out in Pakistan on the usage of benzodiazepines at the level of community. This research was aimed to determine the frequency of benzodiazepine use, along with its associations with socio-demographic and clinical characteristics among community dwelling adults, residing in two urban settlements of Karachi, Pakistan. METHODS We performed a cross sectional study from August 2008 to December 2009, in 2 areas of Karachi, namely Garden and Sultanabad. We followed the systematic sampling strategy to randomly select the households, with an adult of either sex and of age 18 years or more. Data collection was carried out through interview, using a pre-tested questionnaire, with items on socio-demographic position, medical history and benzodiazepine use. Student's t-test and χ2 test was employed to determine the associations between socio-demographic and clinical characteristics, and their relationship with benzodiazepine use was determined using applied logistic regression. RESULTS The overall percentage of benzodiazepine consumption was estimated to be 14%. There were significantly more benzodiazepine users in the peri-urban Sultanabad community to the urban community of Garden (p-value = 0.001). The mean age (± SD) for users was 51.3 (± 15.6) years compared to 37.1 (± 14.4) years among non-users. Bromazepam was the most widely used benzodiazepine (29%); followed by diazepam, with a median duration on primary use being 144 weeks (IQR = 48-240). The adjusted logistic regression model revealed that increasing age, location, female sex, unemployment and psychiatric consultation were associated with increased likelihood of benzodiazepine use. CONCLUSION We believe the unregulated over-the-counter sales of benzodiazepines and social conditions might be playing a role in this high consumption of benzodiazepines in the community.
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Affiliation(s)
- Saleem P Iqbal
- Department of Pediatrics & Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan.
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Nordon DG, Akamine K, Novo NF, Hübner CVK. Características do uso de benzodiazepínicos por mulheres que buscavam tratamento na atenção primária. ACTA ACUST UNITED AC 2009. [DOI: 10.1590/s0101-81082009000300004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUÇÃO: Benzodiazepínicos são medicamentos psicotrópicos de prescrição restrita utilizados para crises agudas de ansiedade, insônia e convulsões. Sua utilização é muitas vezes inadequada. O objetivo deste trabalho é identificar o perfil da usuária de benzodiazepínicos na atenção primária e as características de sua utilização. MÉTODO: Foram entrevistadas todas as pacientes maiores de 18 anos em espera para atendimento em uma unidade básica de saúde de Sorocaba (SP) em 2008. RESULTADOS: Foi encontrada utilização de benzodiazepínicos por 13,14% das frequentadoras da unidade básica de saúde, sendo maior em mulheres de 50 a 69 anos, em relacionamento estável e analfabetas. O uso encontrado foi principalmente por insônia (48,14%), de medicamentos de longa meia-vida, crônico (mais de 6 meses, 89,14%), com prescrição inicial principalmente pelo clínico geral (47,82%), com alta taxa de tentativas de interrupção (91,3%) infrutíferas (69,05%). DISCUSSÃO: A utilização é 3,3 vezes maior do que a descrita na literatura para mulheres de perfil semelhante, com prescrições em geral inadequadas, independentemente do prescritor inicial (especialista ou não). CONCLUSÃO: O uso é crônico em mulheres mais idosas, de menor escolaridade, de relacionamento estável, por motivos corretos, porém de tempo de tratamento inadequado.
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Raoof M, Nawaz H, Nusrat R, Pabaney AH, Randhawa AR, Rehman R, Rizvi NB, Naqvi H. Awareness and use of Benzodiazepines in healthy volunteers and ambulatory patients visiting a tertiary care hospital: a cross sectional survey. PLoS One 2008; 3:e1804. [PMID: 18350143 PMCID: PMC2265543 DOI: 10.1371/journal.pone.0001804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Accepted: 02/14/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Indiscriminate prescription of Benzodiazepines in Pakistan and subsequent availability over-the-counter without prescription is a major public health problem, requiring systematic inquiry through research. Additionally, there is limited data on the awareness and use of Benzodiazepines from developing countries making it impossible to devise meaningful health policies. METHODOLOGY/PRINCIPAL FINDINGS This was an Observational, Cross-Sectional study. conducted at Aga Khan University. A total of 475 (58.5% males, 41.5% females) people visiting a tertiary care hospital were interviewed by means of a structured questionnaire. The results showed that majority of population was aware of one or more Benzodiazepines (80.4%) and 30.4% had used them at some point in life. 42.4% of the users had been using it for more than a year. Commonest reason for use was sleep disturbance. Frequency of usage was higher for females, married individuals, educated (>Grade12), high socioeconomic status and housewives. More (59%) were prescribed than not and of them most by GP (58.5%). Only 36.5% of them were particularly told about the long-term addiction potential by the use of these drugs. CONCLUSION Easy availability, access to re-fills without prescription and self prescription compounded with the lack of understanding of abuse potential of benzodiazepines constitutes a significant problem demanding serious consideration from health policy makers.
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Affiliation(s)
- Mustafa Raoof
- Aga Khan University, Medical College, Karachi, Pakistan.
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Carvalho AF, Cavalcante JL, Castelo MS, Lima MCO. Augmentation strategies for treatment-resistant depression: a literature review. J Clin Pharm Ther 2007; 32:415-28. [PMID: 17875106 DOI: 10.1111/j.1365-2710.2007.00846.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The large majority of depressed patients fail to remit on the first antidepressant prescribed. These patients with residual symptoms have higher relapse rates and poorer outcomes than those who remit. Treatment-resistant depression (TRD) is a therapeutic challenge for the clinician. Augmentation pharmacotherapy refers to the addition of drugs that are not standard antidepressants in order to enhance the effect of a classical antidepressant drug. The aim of this paper was to review the available evidence on the various augmenting agents that have been tested for efficacy in TRD. METHODS Electronic databases and relevant textbooks were searched and the information retrieved was integrated in this review. RESULTS Although augmentation strategies have been tested with various pharmacological agents, there are few controlled studies published. Lithium, triiodothyronine (T3), buspirone and pindolol have been most widely studied. Other agents include dopaminergic agents, atypical antipsychotics, psychostimulants, benzodiazepines/hypnotics, hormones and anticonvulsants. CONCLUSION The augmentation therapy with the best evidence was the lithium-antidepressant combination, especially in patients not responding to tricyclic agents. However, good results have also been reported with augmentation strategies involving T3 and buspirone.
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Affiliation(s)
- A F Carvalho
- Department of Medicine, Psychiatry Outpatient Clinics, Federal University of Ceará, Fortaleza, CE, Brazil.
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Srisurapanont M, Garner P, Critchley J, Wongpakaran N. Benzodiazepine prescribing behaviour and attitudes: a survey among general practitioners practicing in northern Thailand. BMC FAMILY PRACTICE 2005; 6:27. [PMID: 15975145 PMCID: PMC1182364 DOI: 10.1186/1471-2296-6-27] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 06/23/2005] [Indexed: 11/13/2022]
Abstract
BACKGROUND Over-prescribing of benzodiazepines appears common in many countries, a better understanding of prescribing practices and attitudes may help develop strategies to reduce prescribing. This study aimed to evaluate benzodiazepine prescribing behaviour and attitudes in general practitioners practising in Chiang Mai and Lampoon, Thailand. METHODS Questionnaire survey of general practitioners in community hospitals, to estimate: i) use of benzodiazepines for anxiety/insomnia, panic disorder, depression, essential hypertension, and uncomplicated low back pain and ii) views on the optimal duration of benzodiazepine use. RESULTS Fifty-five of 100 general practitioners returned the completed questionnaires. They reported use of benzodiazepines for anxiety/insomnia (n = 51, 93%), panic disorder (n = 43, 78%), depression (n = 26, 43%), essential hypertension (n = 15, 27 %) and uncomplicated low back pain (n = 10, 18%). Twenty-eight general practitioners would prescribe benzodiazepines for non-psychiatric conditions, 17 for use as muscle relaxants. Seventy-five per cent, 62% and 29% of the general practitioners agreed or totally agreed with the use of benzodiazepines for insomnia, anxiety and depression, respectively. Practitioners agreed that prescribing should be less than one week (80%); or from 1 week to 1 month (47%); or 1 to 4 months (16%); or 4 to 6 months (5%) or more than 6 months (2%). Twenty-five general practitioners (45%) accepted that they used benzodiazepines excessively in the past year. CONCLUSION A considerable proportion of general practitioners in Chiang Mai and Lampoon, Thailand inappropriately use benzodiazepines for physical illnesses, especially essential hypertension and uncomplicated low back pain. However, almost half of them thought that they overused benzodiazepines. General practitioner's lack of time, knowledge and skills should be taken into account in improving prescribing behaviour and attitudes.
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Affiliation(s)
- Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Amphur Muang, Chiang Mai, 50200 Thailand
| | - Paul Garner
- International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA UK
| | - Julia Critchley
- International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA UK
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Amphur Muang, Chiang Mai, 50200 Thailand
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