Correlates of benzodiazepine dependence in patients with depression followed up in a psychiatric outpatient unit in Tunisia.

Benzodiazepines may be prescribed to manage anxiety and insomnia in patients with depression. However, as noticed during our daily practice, a considerable proportion of patients treated for depression and receiving benzodiazepines developed a dependence to these medicines. Our aims were to estimate the proportion of patients with depression who develop a benzodiazepine dependence and to identify its correlates. We conducted a comparative study in Razi Hospital's outpatient psychiatry unit (Tunisia). We included patients aged 18 to 65 years who were diagnosed with depression during the first three quarters of 2014. Included patients were prescribed benzodiazepines. Follow-up period was of 2 years. A multivariate analysis was performed to identify dependence-associated factors. We included 54 patients, and 52% developed a benzodiazepine dependence during the follow-up period. Two associated factors were identified: a daily mean benzodiazepine dose of more than 9.5 milligrams of diazepam equivalents prior to taper off (p = .001) and a benzodiazepine taper-off initiated after the fifth week of benzodiazepine intake onset (p = .007). The proportion of patients who developed a benzodiazepine dependence was high. Low doses and time-limited benzodiazepine prescription should be taken into consideration when managing patients with depression in order to prevent dependence.

Correlates of offense recidivism in patients with schizophrenia.

INTRODUCTION: Schizophrenia increases the risk of offending. Recidivism rates are significant. Literature doesn't provide recidivism risk factors specific to patients with schizophrenia independently of the offenses' types. OBJECTIVE: Identifying recidivism risk factors in schizophrenia patients independently of the offenses' types. METHODS: We conducted a case-control study. All included patients were admitted, at least once, to the forensic psychiatry unit in Razi Hospital between January 1st, 1985 and December 31st, 2014 after a decision of irresponsibility by reason of insanity. All those who reoffended during this period were considered as cases. Univariate and multivariate analyses were performed to identify recidivism risk factors. RESULTS: We included 25 cases and 38 controls. Eight recidivism risk factors were identified. Living in poor urban neighborhoods (P = 0.023; OR = 4.86), having been unemployed (P = 0.042; OR = 2.18) and not having lived with the family (P = 0.039; OR = 1.36) after discharge were considered as risk factors. The same applied to alcohol (P = 0.026; OR = 4.89) and cannabis use disorders (P = 0.018; OR = 6.01). A hospitalization shorter than 6 months multiplied the risk by 1.79 (P = 0.046). A combination of conventional antipsychotics (P = 0.023; OR = 4.81) and a poor adherence to treatment (P = 0.001; OR = 10.42) were considered as recidivism risk factors too. CONCLUSIONS: All eight recidivism risk factors are dynamic. This makes recidivism prevention conceivable. Measures involving the patient, the health care system, patients' families, society and the government should be undertaken.

The impact of OPRM1's genetic polymorphisms on methadone maintenance treatment in opioid addicts: a systematic review.

AIM: Methadone is a long-acting opioid receptor agonist. It is prescribed to patients with opioid-related use disorders. The OPRM1 gene encodes for methadone's main receptor. It appears that polymorphisms in OPRM1 may affect the efficacy of methadone maintenance treatment (MMT). OBJECTIVE: Our purpose was to identify all relevant published papers dealing with the impact ofOPRM1's SNPs  on MMT's efficacy and to summarize results in order to evaluate the relevance of conducting pretherapeutic genotyping in opioid addicts prior to the onset of MMT. METHODS: MEDLINE, PsychINFO and Scopus databases were systematically searched up to 1 January  2018 with no year restrictions using the following keyword combination (MMT) AND (mu or OPRM or mu opioid receptors or SNP or polymorphism or gene). Endpoint of the included studies had to be the impact of OPRM1 gene polymorphisms on the efficacy of MMT and/or methadone required doses during MMT. All abstracts were reviewed to assess papers' relevance. Studies conducted on animals and duplicate papers were excluded. RESULTS: Our literature search identified 438 articles. Eight of them were included in our systematic review. The total number of included participants was equal to 2170, of whom 1718 underwent MMT. One study reported results of a randomized controlled trial. Three were designed as case-control studies and four as cross-sectional studies. rs1799971 (A118G) was the most studied allele. Results were divergent. Other SNPs might affect MMT's efficacy, however they were scarcely studied. CONCLUSION: Genotyping patients with opioid-related use disorders is a promising way to reach a better outcome in patients willing to be on MMT. Focusing on OPRM1 solely should be balanced since polymorphisms in other genes implicated in methadone pharmacodynamics and/or pharmacokinetics may conjunctly affect the efficacy of MMT. Recommendations cannot be enunciated for the moment.

Postictal Delirium and Violent Behavior in Patients with Post-Neurosurgical Epilepsy.

BACKGROUND: Neurosurgical brain interventions may result in lesions that can cause epilepsy. Diagnosis may be delayed in some situations. Meanwhile, violent behavior can occur during postictal delirium states. Although benign behavioral manifestations are well documented in literature, violent offenses in post-neurosurgical epilepsy have been rarely reported. Here we describe 2 such cases, focusing on management and emphasizing the need for prevention. CASE DESCRIPTION: Both patients were suffering from post-neurosurgical epilepsy and offended during postictal delirium states. The first patient had generalized epilepsy and committed an attempted rape. The second patient had temporal lobe epilepsy and committed an attempted homicide. Both patients were well managed using anticonvulsant medication after the offenses. CONCLUSIONS: Early diagnosis and regular follow-up are measures to take into consideration to prevent violent behavior in patients with post-neurosurgical epilepsy.