ABSTRACT
OBJECTIVE: To evaluate the efficacy and tolerability of baclofen vs. placebo for long-term treatment of alcohol use disorder. METHOD: Systematic review and meta-analysis following methods of the Cochrane Collaboration Handbook (PROSPERO registration: CRD42017073663). Primary outcome was the random-effects summary estimate of all standardized mean differences (SMDs), as calculated from the primary outcomes of each study. RESULTS: Fourteen double-blind RCTs (1522 patients) were included. Heterogeneity was substantial for most analyses (I2 about 75%). Baclofen showed a small, but not statistically significant superiority over placebo: SMD = 0.22 ([95% CI: -0.03; 0.47], P = 0.09). This result was supported by a leave-one-out-analysis, and Orwin's fail-safe N, by predefined secondary analyses (on abstinence rates and amount of drinking), and by a post hoc-analysis of high-dose studies (>80 mg/day). An analysis of low risk of bias studies (SMD = 0.10 [-0.20; 0.41], P = 0.51, I2 = 43.3%) found no effect. Exclusion of four studies focusing on patients with comorbidity yielded a small positive effect. Drop-out rates were similar. CONCLUSION: Our results question baclofen's utility in the long-term treatment of alcohol use disorder at both normal and high doses. While the confidence intervals indicate that marginally harmful or moderately beneficial effects of baclofen remain a possibility, the most likely effect size is slightly above placebo effects.
Subject(s)
Alcohol Drinking/adverse effects , Alcoholism/drug therapy , Baclofen/therapeutic use , Alcohol Drinking/psychology , Alcoholism/psychology , Baclofen/administration & dosage , Double-Blind Method , Female , GABA-B Receptor Agonists/therapeutic use , Humans , Male , Outcome Assessment, Health Care , Placebos/administration & dosage , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: Suicide is one of the four most common causes of death in adolescence worldwide. Although it is well known that suicidal people often have insufficient communication strategies, the importance of family communication for adolescent suicidality has not yet been sufficiently explored. OBJECTIVE: The aim of this study was to provide a systematic review of family communication as a risk factor for adolescent suicidal tendencies and to develop treatment recommendations. METHODS: In this study a systematic literature search was conducted in PubMed, Embase, CENTRAL and PsychINFO. The methodological quality of the studies was evaluated and a summary prepared. RESULT: A total of 195 studies were extracted and screened for their suitability. Of these studies, 7 which examined a total of 13,107 adolescents aged 11-22 years were included in this review and critically evaluated. Of the studies evaluated six found a correlative relationship between dysfunctional parent-child communication and adolescent suicidality. Communication with the mother appears to be more essential. CONCLUSION: The results of this literature search indicate that functional communication with parents seems to be protective for suicidal adolescents. From this, recommendations can be derived for preventive measures in families with adolescents who are otherwise at increased risk of suicide. Longitudinal study designs are needed to conclusively answer the research question.