Actigraphy assessment of motor activity and sleep in patients with alcohol withdrawal syndrome and the effects of intranasal oxytocin.

BACKGROUND AND AIMS: The alcohol withdrawal syndrome increases autonomic activation and stress in patients during detoxification, leading to alterations in motor activity and sleep irregularities. Intranasal oxytocin has been proposed as a possible treatment of acute alcohol withdrawal. The aim of the present study was to explore whether actigraphy could be used as a tool to register symptoms during alcohol detoxification, whether oxytocin affected actigraphy variables related to motor activity and sleep compared to placebo during detoxification, and whether actigraphy-recorded motor function during detoxification was different from that in healthy controls. METHODS: This study was a part of a randomized, double blind, placebo-controlled trial in which 40 patients with alcohol use disorder admitted for acute detoxification were included. Of these, 20 received insufflations with intranasal oxytocin and 20 received placebo. Outcomes were actigraphy-recorded motor activity during 5-hour sequences following the insufflations and a full 24-hour period, as well as actigraphy-recorded sleep. Results were related to clinical variables of alcohol intake and withdrawal, including self-reported sleep. Finally, the actigraphy results were compared to those in a group of 34 healthy individuals. RESULTS: There were no significant differences between the oxytocin group and the placebo group for any of actigraphy variables registered. Neither were there any correlations between actigraphy-recorded motor function and clinical symptoms of alcohol withdrawal, but there was a significant association between self-reported and actigraphy-recorded sleep. Compared to healthy controls, motor activity during alcohol withdrawal was lower in the evenings and showed increased variability. CONCLUSION: Intranasal oxytocin did not affect actigraphy-recorded motor activity nor sleep in patients with acute alcohol withdrawal. There were no findings indicating that actigraphy can be used to evaluate the degree of withdrawal symptoms during detoxification. However, patients undergoing acute alcohol withdrawal had a motor activity pattern different from than in healthy controls.

Clusters of personality traits and psychological symptoms associated with later benzodiazepine prescriptions in the general population: The HUNT Cohort Study.

OBJECTIVE: The aim of this population-based study was to identify factors associated with later benzodiazepine prescriptions, including clusters of personality traits, self-esteem characteristics, sleep difficulties, depression and anxiety symptoms. METHODS: A 13year historical cohort study (n=58,967) was carried out and baseline measures of self-reported depression and anxiety symptoms, sleep difficulties, self-esteem and personality traits were obtained from the second wave of the Nord-Trøndelag Health Study (HUNT 2, 1995-1997), Norway. Data on benzodiazepine prescriptions were collected from the Norwegian Prescription Database (NorPD, 2004-2008) for each case in the cohort. RESULTS AND CONCLUSIONS: We found that a combined high extraversion and high neuroticism personality score at baseline was associated with increased benzodiazepine prescription rates. Further, sleep difficulties, low self-esteem and high depression and anxiety scores were also linked to later prescriptions of benzodiazepines, in particular chronic and high dose benzodiazepine prescriptions patterns. The findings are discussed in relation to prescription practice and policy.

Identifying co-occurring substance use disorders in community mental health centres. Tailored approaches are needed.

BACKGROUND: Increasing evidence shows that substance use disorders (SUD) and psychiatric illness co-occur, and that this co-morbidity renders treatment more difficult and results in greater use of health services. Thus, clinical routines to identify SUD amongst patients in mental healthcare should have high priority in order to provide optimal treatment. AIM: In this study, we examine whether common and well-known substance use measures are appropriate in detecting SUD in Community Mental Health Centres (CMHCs). MATERIAL AND METHODS: The present study used a subset of data from an evaluation of the National Plan for Mental Health. Clinicians at eight CMHCs registered socio-demographic and treatment information about their patients during a 4-week period in 2007. This included diagnostic measures, the Alcohol and Drug Use Scales and the substance use item of the Health of the Nation Outcome Scales. Prevalence rates from the different substance use measures and the observed agreement between them were calculated. The prevalence rates were compared with other estimates of substance use prevalence. RESULTS: All the different measures gave low prevalence rates of SUD, and the inter-measure agreement was poor. A combination of the measures gave prevalence rates closer to what is expected from previous epidemiological studies. CONCLUSION: The CMHCs participating in this study lack sufficient diagnostic routines and specific instruments to identify SUD. Clinical research that relies on methods used in this study will need combined approaches to provide reliable findings. Both clinical practice and research would benefit from valid, reliable screening methods and diagnostic procedures.