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1.
Psychol Health ; 37(7): 903-916, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-33979239

RESUMO

OBJECTIVE: To measure the association between knowledge, attitudes and practices of personal misuse of tranquilizers among parents of schoolchildren in Beirut (Lebanon). DESIGN: We carried out a cross-sectional study in 1396 adults recruited from parents of students of eleven public and private schools, from primary schools to high schools, using a Knowledge, Attitude and Practices (KAP) questionnaire of personal use of tranquilizers. MAIN OUTCOME MEASURES: We assessed five patterns of tranquilizers' misuse: unprescribed use, shortened treatment, stored leftovers, doubled forgotten doses or taken when remembered, changed dose without medical recommendation, and a sixth composite outcome: 'any misuse'. RESULTS: Sixty-three (62.2%) of 91 parents who used tranquilizers reported at least one misuse pattern. Higher odds of 'any misuse' were observed among parents who reported taking tranquilizers to sleep better, to enjoy themselves with their families or to work better [2.35 ≤ adjusted interquartile odds ratio (aIqOR) ≤ 1.99]. Storing tranquilizers for future need was strongly associated with misuse [aIqOR: 5.00 (95% CI: 3.30, 7.59)]. Greater awareness about hazards of tranquilizers and the importance of therapeutic compliance was associated with lower odds of specific misuse patterns (0.50 ≤ aIqOR ≤ 0.72). CONCLUSIONS: Poor knowledge and medically disapproved attitudes increase the likelihood of practices of tranquilizer misuse.


Assuntos
Tranquilizantes , Adulto , Criança , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Líbano , Pais , Inquéritos e Questionários
2.
J Addict Med ; 16(1): e23-e29, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33758113

RESUMO

BACKGROUND: Adolescents' consumption of tranquilizers, sedatives, and sleeping pills (TSSp) has increased during the last few decades, and TSSp are currently among the substances with the lowest age-of-onset. We characterized current-use patterns of TSSp consumers by age when first taken. METHODS: This study used individualized secondary data retrieved from the 2016 Spanish State Survey on Drug Use in Secondary Education (16-18-year-olds), and included all subjects who reported having taken TSSp at any point, but excluded those who had started during the previous year (n = 1502). Logistic regression models were used to obtain adjusted odds ratios (aOR) for associations between early TSSp consumption (<14 years) and current TSSp use patterns, adjusted for sociodemographic factors. RESULTS: About 17.9% of respondents had taken TSSp (average age-of-onset = 13.7) and 45% of these without a prescription. TSSp consumption at <14 years was higher for males and nonrepeaters. Having begun to use TSSp < 14 years was associated with both higher probability of consumption in the last month (aOR = 1.41; 95%CI:1.12-1.77) and daily/almost daily consumption in the last month (aOR = 1.56; 95CI%:1.16-2.08). CONCLUSIONS: The results of this study show there is a high proportion of 16 to 18 TSSp student consumers - both prescribed and nonprescribed; it also establishes that early onset-of-use is associated with higher levels of intensive use later on.


Assuntos
Medicamentos Indutores do Sono , Transtornos Relacionados ao Uso de Substâncias , Tranquilizantes , Adolescente , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Medicamentos Indutores do Sono/uso terapêutico , Estudantes , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Tranquilizantes/uso terapêutico
3.
J Addict Med ; 16(4): 470-474, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34775440

RESUMO

OBJECTIVES: This study aims to investigate racial-ethnic differences in reasons for misuse of prescription medications among a nationally representative sample of US adults. METHODS: We analyzed data from the 2015-2019 National Surveys on Drug Use and Health. The study population includes US adults (18-49 years old) who reported misuse of 3 types of prescription drugs (stimulants [n = 6139], sedatives and tranquilizers [n = 5643], and pain relievers [n = 8780]) for 3 reasons: medical-only (eg, to help with pain), recreational-only (eg, to get high), or combined medical and recreational reasons. Multinomial logistic regressions assessed the association between reasons of misuse of prescription medications and self-identified race-ethnicity. RESULTS: Misuse of the 4 types of prescription medications was primarily motivated by medical reasons (63%-80%). Compared to non-Hispanic Whites, non-Hispanic Blacks (nHB), and Hispanics (H) were less likely to report misuse of pain relievers for combined (nHB: adjusted relative risk ratio [aRRR] = 0.6, 95% confidence interval [CI]: 0.4, 0.7; H; aRRR = 0.7, 95% CI: 0.5, 0.9) or recreational reasons (nHB: aRRR = 0.8, 95% CI: 0.6, 1.0; H; aRRR = 0.7, 95% CI: 0.6, 0.9) rather than medical-only reasons. The odds of misuse of sedatives and tranquilizers for recreational-only reasons as opposed to medical-only reasons were higher among nHB (aRRR = 1.9, 95% CI: 1.3, 2.7) and H (aRRR = 1.9, 95% CI: 1.4, 2.4) than among non-Hispanic Whites. CONCLUSIONS: The increased misuse of prescription pain relievers for medical reasons among racial-ethnic minority groups demonstrates a continued need to investigate underlying structural factors driving these behaviors. The higher odds of sedative and tranquilizer misuse for recreational purposes among racial-ethnic minority groups warrant further investigation.


Assuntos
Uso Indevido de Medicamentos sob Prescrição , Medicamentos sob Prescrição , Tranquilizantes , Adolescente , Adulto , Etnicidade , Humanos , Hipnóticos e Sedativos , Pessoa de Meia-Idade , Grupos Minoritários , Dor/tratamento farmacológico , Prescrições , Estados Unidos/epidemiologia , Adulto Jovem
4.
Subst Use Misuse ; 57(2): 316-327, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34903123

RESUMO

BACKGROUND: Prescription drug misuse (PDM) is a significant public health problem associated with mental health symptoms. OBJECTIVES: This project investigates the connections between PDM motivations and mental health to inform intervention efforts. METHODS: Using nationally representative adult data from the 2016-2018 National Survey on Drug Use and Health (N = 128,205; 53% female) this project investigated which motivations for misuse are related to past-year mental health problems including any mental illness, serious mental illness, major depressive episode, and suicidal thoughts. Complex samples logistic regression models of the main motivation of PDM for each mental health problem were conducted separately for each prescription drug class (i.e., opioids, tranquilizers, sedatives, and stimulants) while controlling for demographic characteristics. RESULTS: Adults that reported PDM were more likely than those with no PDM to endorse past year mental health problems. Compared to those that reported PDM of other medications, those misusing prescription opioids and tranquilizers to help with emotions and misusing sedatives to "relax or relieve tension" were more likely to have all categories of mental health problems. Those that misused prescription stimulants to "help study" had lower odds of all mental health problems. CONCLUSIONS: While there were differences based on prescription drug class, a range of motivations increased adults' likelihood to have mental health problems and common themes were found across drug classes. While causality is still undetermined, prevention and intervention efforts that are multifaceted and individualized, while broadly providing adults with other ways to cope with negative emotions are likely to help reduce PDM.


Assuntos
Estimulantes do Sistema Nervoso Central , Transtorno Depressivo Maior , Uso Indevido de Medicamentos sob Prescrição , Medicamentos sob Prescrição , Transtornos Relacionados ao Uso de Substâncias , Tranquilizantes , Adulto , Analgésicos Opioides/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Saúde Mental , Motivação , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
5.
J Clin Psychopharmacol ; 42(1): 43-50, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34928560

RESUMO

BACKGROUND: Valproic acid (VPA) is frequently used with clozapine (CLZ) as mood stabilizer and/or seizure prophylaxis. Valproic acid is known to reduce N-desmethylclozapine (N-DMC) but not CLZ levels. This leads to the hypothesis that VPA induces the CLZ metabolism via non-N-desmethylation pathways. Therefore, we aimed to investigate the effect of concurrent VPA use on the serum concentrations of a spectrum of CLZ metabolites in patients, adjusting for smoking. METHODS: In total, 288 patients with an overall number of 737 serum concentration measurements of CLZ and metabolites concurrently using VPA (cases, n = 22) or no interacting drugs (controls, n = 266) were included from a routine therapeutic drug monitoring service. Linear mixed model analyses were performed to compare the dose-adjusted concentrations (C/D) of CLZ, N-DMC, CLZ 5N/N+-glucuronides, and metabolite-to-parent ratios in cases versus controls. RESULTS: After adjusting for covariates, the N-DMC (-40%, P < 0.001) and N+-glucuronide C/Ds (-78%, P < 0.001) were reduced in cases versus controls, while the CLZ C/D was unchanged (P > 0.7). In contrast, the 5N-glucuronide C/D (+250%, P < 0.001) and 5N-glucuronide-to-CLZ ratios (+120%, P = 0.01) were increased in cases versus controls. CONCLUSIONS: Our findings show that complex changes in CLZ metabolism underly the pharmacokinetic interaction with VPA. The lower levels of N-DMC seem to be caused by VPA-mediated induction of CLZ 5N-glucuronide formation, subsequently leading to reduced substrate availability for N-desmethylation. Whether the changes in CLZ metabolism caused by VPA affects the clinical outcome warrants further investigation.


Assuntos
Clozapina/sangue , Esquizofrenia/sangue , Esquizofrenia/tratamento farmacológico , Tranquilizantes/sangue , Ácido Valproico/sangue , Adulto , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Hum Psychopharmacol ; 36(6): e2803, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34237180

RESUMO

OBJECTIVE: To examine prevalence of past-month prescription drug misuse (PDM) and alcohol co-ingestion and its correlates in adults age 50 or older. METHODS: Data were from the 2015-2018 US National Survey on Drug Use and Health (n = 35,190). PDM-alcohol co-ingestion was defined as prescription opioid, tranquilizer/sedative, or stimulant misuse while "drinking alcohol or within a couple of hours of drinking." Co-ingestion prevalence was estimated, and logistic and negative binomial regressions examined the sociodemographic, physical health, mental health, substance use, and substance use disorder (SUD) correlates of co-ingestion. RESULTS: Over 344,000 adults aged 50 years or older (0.3%) engaged in past-month PDM-alcohol co-ingestion, or 27.4% of those with past-month PDM. Past-month co-ingestion was linked to greater past-month alcohol use frequency and elevated adjusted odds ratios (aORs) for all examined substance use outcomes (e.g., non-PDM SUD aOR = 21.8; 49.7% prevalence rate). The aOR for suicidal ideation was 506% higher in those with co-ingestion than those without past-year PDM. CONCLUSIONS: US adults aged 50 years or older with past-month PDM-alcohol co-ingestion are at high risk for SUD and concerning mental health symptoms. Screening for mental health and substance use treatment is warranted among aging adults with signs of PDM, especially involving co-ingestion.


Assuntos
Uso Indevido de Medicamentos sob Prescrição , Medicamentos sob Prescrição , Transtornos Relacionados ao Uso de Substâncias , Tranquilizantes , Adulto , Ingestão de Alimentos , Humanos , Pessoa de Meia-Idade , Uso Indevido de Medicamentos sob Prescrição/psicologia , Prevalência , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Estados Unidos/epidemiologia
7.
Int J Geriatr Psychiatry ; 36(12): 1867-1877, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34318511

RESUMO

OBJECTIVE: Substance use rates have increased in adults 50 years and older, and substance use in this population is associated with significant consequences. Given that little is known about their underlying substance use patterns, the objective was to identify latent classes of adults 50 years and older by past-year substance use, past-month substance use, and past-year substance use disorder (SUD) diagnosis. METHODS: The National Survey on Drug Use and Health is an annual nationwide cross-sectional U.S. survey. Participants were 35,229 civilian, non-institutionalized U.S. residents, 50 years and older. Past-year and past-month alcohol, tobacco, marijuana, heroin, cocaine, methamphetamine use, and opioid, stimulant, and tranquilizer/sedative prescription drug misuse (PDM) were captured, as was past-year DSM-IV SUD from these substances. Correlates included mental health, physical health, and healthcare utilization variables. RESULTS: Latent class analysis indicated four past-year or past-month substance use subgroups (Alcohol-Only, Alcohol-Tobacco-Marijuana, Cocaine-Polydrug, PDM-Polydrug), with SUD prevalence rising from 3.2% to 17.3%, 68.8%, and 78.5% by past-year subgroup; similarly, rates of past-year suicidal ideation increased from 2.1%, to 4.8%, 12.0%, and 20.4% by past-year subgroup. For SUD, there were three subgroups (Low Nicotine Dependence [ND], High Alcohol Use Disorder, Multiple SUDs). Over 90% of adults were in a low-risk subgroup (i.e., Alcohol-Only and Low ND), but members of Cocaine-Polydrug, PDM-Polydrug, or Multiple SUDs latent classes had high rates of mental and physical health concerns. CONCLUSIONS: Most adults 50 and older have lower risk profiles, but those engaged in PDM or cocaine use are heavily substance-involved and need screening and likely multi-disciplinary intervention.


Assuntos
Uso Indevido de Medicamentos sob Prescrição , Transtornos Relacionados ao Uso de Substâncias , Tranquilizantes , Analgésicos Opioides/uso terapêutico , Estudos Transversais , Humanos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
8.
Sci Rep ; 11(1): 13660, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34211003

RESUMO

Ganoderma lucidum is a medicinal mushroom used in traditional Chinese medicine with putative tranquilizing effects. However, the component of G. lucidum that promotes sleep has not been clearly identified. Here, the effect and mechanism of the acidic part of the alcohol extract of G. lucidum mycelia (GLAA) on sleep were studied in mice. Administration of 25, 50 and 100 mg/kg GLAA for 28 days promoted sleep in pentobarbital-treated mice by shortening sleep latency and prolonging sleeping time. GLAA administration increased the levels of the sleep-promoting neurotransmitter 5-hydroxytryptamine and the Tph2, Iptr3 and Gng13 transcripts in the sleep-regulating serotonergic synapse pathway in the hypothalamus during this process. Moreover, GLAA administration reduced lipopolysaccharide and raised peptidoglycan levels in serum. GLAA-enriched gut bacteria and metabolites, including Bifidobacterium, Bifidobacterium animalis, indole-3-carboxylic acid and acetylphosphate were negatively correlated with sleep latency and positively correlated with sleeping time and the hypothalamus 5-hydroxytryptamine concentration. Both the GLAA sleep promotion effect and the altered faecal metabolites correlated with sleep behaviours disappeared after gut microbiota depletion with antibiotics. Our results showed that GLAA promotes sleep through a gut microbiota-dependent and serotonin-associated pathway in mice.


Assuntos
Produtos Biológicos/farmacologia , Microbioma Gastrointestinal/efeitos dos fármacos , Reishi , Serotonina/metabolismo , Sono/efeitos dos fármacos , Tranquilizantes/farmacologia , Animais , Produtos Biológicos/química , Produtos Biológicos/isolamento & purificação , Ritmo Circadiano/efeitos dos fármacos , Masculino , Camundongos , Reishi/química , Transdução de Sinais/efeitos dos fármacos , Tranquilizantes/química , Tranquilizantes/isolamento & purificação
9.
Drug Alcohol Depend ; 225: 108793, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34087748

RESUMO

BACKGROUND: Tranquilizer misuse represents a growing international public health problem with heavy social and economic consequences. We aimed to identify the psychosocial determinants of this misuse practice, focusing on modifiable factors including knowledge and attitudes towards these medications. METHODS: A prospective cohort study involving 847 adults accompanying children in primary care clinics was carried out in Spain. A validated Knowledge, Attitudes and Practices (KAP) questionnaire on tranquilizer use was self-administered at baseline, and then participants were followed-up bimonthly. A misuse event was defined as unprescribed intake of tranquilizers, storing/sharing leftovers of tranquilizers, and/or not adhering to the prescribed treatment period, timing or dosage. Poisson regression models were applied to estimate adjusted Incidence Rate Ratios (IRRs) of misuse and their 95 % Confidence Intervals (CIs). FINDINGS: Individuals' personal attitudes towards tranquilizers and treating physicians are strongly associated with the misuse of these drugs. These attitudes include: individuals' acceptance of taking tranquilizers to improve sleeping [IRR: 5.10 (95 %CI: 2.74-9.48)], to work better [IRR: 2.04 (95 %CI: 1.05-3.99)], or for recreational purposes [IRR: 1.85 (95 %CI: 1.04-3.32)]; willingness to prolong the course of tranquilizer treatment without medical consultation [IRR: 2.45 (95 %CI: 1.46-4.13)]; agreeing on storing tranquilizers for possible future need [IRR: 5.07 (95 %CI: 2.73-9.40)]; and untrusting the physician's decision about tranquilizer prescription [IRR: 1.92 (95 %CI: 1.12-3.30)]. The level of knowledge is marginally associated with tranquilizer misuse. CONCLUSIONS: There is a strong association between individuals' attitudes towards tranquilizers and the misuse practices of these drugs. Educational interventional studies could help reduce the incidence of tranquilizer misuse.


Assuntos
Uso Indevido de Medicamentos sob Prescrição , Tranquilizantes , Adulto , Atitude , Criança , Estudos de Coortes , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Prospectivos , Espanha/epidemiologia
10.
Cell Rep Med ; 2(5): 100281, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34095883

RESUMO

Anxiety and stress-related conditions represent a significant health burden in modern society. Unfortunately, most anxiolytic drugs are prone to side effects, limiting their long-term usage. Here, we employ a bioinformatics screen to identify drugs for repurposing as anxiolytics. Comparison of drug-induced gene-expression profiles with the hippocampal transcriptome of an importin α5 mutant mouse model with reduced anxiety identifies the hypocholesterolemic agent ß-sitosterol as a promising candidate. ß-sitosterol activity is validated by both intraperitoneal and oral application in mice, revealing it as the only clear anxiolytic from five closely related phytosterols. ß-sitosterol injection reduces the effects of restraint stress, contextual fear memory, and c-Fos activation in the prefrontal cortex and dentate gyrus. Moreover, synergistic anxiolysis is observed when combining sub-efficacious doses of ß-sitosterol with the SSRI fluoxetine. These preclinical findings support further development of ß-sitosterol, either as a standalone anxiolytic or in combination with low-dose SSRIs.


Assuntos
Ansiolíticos/farmacologia , Transtornos de Ansiedade/tratamento farmacológico , Ansiedade/tratamento farmacológico , Sitosteroides/farmacologia , Animais , Medo/efeitos dos fármacos , Fluoxetina/farmacologia , Camundongos Endogâmicos C57BL , Atividade Motora/efeitos dos fármacos , Preparações Farmacêuticas/metabolismo , Córtex Pré-Frontal/efeitos dos fármacos , Proteínas Proto-Oncogênicas c-fos/farmacologia , Tranquilizantes/farmacologia
11.
J Clin Psychopharmacol ; 41(4): 465-469, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34121063

RESUMO

PURPOSE/BACKGROUND: Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur among US military veterans. Oxytocin may have therapeutic value in treating both conditions. The potential for oxytocin to augment affective features common to PTSD and AUD, such as anger, is relevant to inform emerging treatments. METHODS/PROCEDURES: We examined the influence of intranasally administered oxytocin on connections between alcohol craving and stress-induced anger in a sample of 73 veterans (91.3% men) with co-occurring PTSD and AUD. Participants self-administered oxytocin (40 IU) or placebo (saline) 45 minutes before completing the Trier Social Stress Task (TSST). Self-reports of alcohol craving and anger were assessed pre- and post-TSST using a modified visual analog scale. Multiple regression analysis, including main effects for group, baseline craving, and their interaction, was used to predict post-TSST anger. FINDINGS/RESULTS: A marginally significant interaction was observed, suggesting a positive association between baseline craving and anger for those in the oxytocin group (B = 0.65, P = 0.01). Among those reporting low craving, participants in the oxytocin group reported significantly lower post-TSST anger than those in the placebo group. IMPLICATIONS/CONCLUSIONS: The current study is among the first to examine relevant psychosocial moderators that may influence the effects of oxytocin among veterans with comorbid PTSD and AUD. Although oxytocin attenuated ratings of anger after a stress task among those with low baseline craving, findings suggest that oxytocin may not be as effective at reducing anger, a highly salient factor in PTSD, for individuals experiencing high levels of craving. Findings are consistent with the social salience hypothesis and suggest that individual differences in alcohol craving should be considered when evaluating oxytocin as a potential treatment for individuals with comorbid PTSD and AUD.


Assuntos
Sintomas Afetivos , Alcoolismo , Ira/efeitos dos fármacos , Fissura , Ocitocina/administração & dosagem , Transtornos de Estresse Pós-Traumáticos , Veteranos/psicologia , Administração Intranasal , Sintomas Afetivos/tratamento farmacológico , Sintomas Afetivos/etiologia , Alcoolismo/complicações , Alcoolismo/diagnóstico , Alcoolismo/tratamento farmacológico , Alcoolismo/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Militar/estatística & dados numéricos , Técnicas Psicológicas , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/psicologia , Tranquilizantes/administração & dosagem , Resultado do Tratamento
12.
J Clin Psychiatry ; 82(1)2021 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-33999540

RESUMO

Major depressive disorder (MDD) and bipolar depression (BD) can often be difficult to treat. N-acetylcysteine (NAC) is a nutraceutical product that has been trialed in a large number of neuropsychiatric and medical disorders, with mixed results. Many randomized controlled trials (RCTs) have studied NAC augmentation as an intervention in MDD and BD. These RCTs were pooled in 2 recent meta-analyses. One meta-analysis with 7 RCTs (pooled N = 728) conducted in patients with MDD or BD found that NAC was not superior to placebo in the attenuation of depression ratings in either main or sensitivity analyses. The other meta-analysis with 6 RCTs (pooled N = 248) conducted in patients with BD found a small, imprecise effect size for NAC (standardized mean difference, 0.45; 95% confidence interval, 0.06-0.84). The advantage for NAC in this meta-analysis would almost certainly have been lost had the authors excluded from analysis 2 RCTs, both of which had problematic characteristics and findings and both of which also obtained a large and statistically significant advantage for NAC. At present, therefore, evidence does not encourage the use of NAC as an augmentation treatment for patients with MDD or BD. It remains to be seen whether NAC augmentation benefits depressed subpopulations, such as those with higher levels of inflammatory biomarkers at baseline.


Assuntos
Acetilcisteína/farmacologia , Transtorno Bipolar/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde , Antidepressivos/farmacologia , Sinergismo Farmacológico , Quimioterapia Combinada , Humanos , Metanálise como Assunto , Tranquilizantes/farmacologia
13.
Forensic Sci Int ; 324: 110825, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34000617

RESUMO

We report a case in which a tapentadol acute intoxication was suspected as the cause of death of a 39-year-old man: approximately two days after death, cardiac and femoral blood, as well as urine, bile, gastric content and chest hair, were collected during the autopsy. Tapentadol was detected before and after hydrolysis in femoral (530 ng/mL unconjugated and 1570 ng/mL conjugated) and cardiac (680 ng/mL unconjugated and 3440 ng/mL conjugated) blood, and additionally in bile (3200 ng/mL), urine (9300 ng/mL), chest hair (2850 pg/mg) and gastric content. LC-QTOF screening analysis confirmed the presence of five different tapentadol metabolites (tapentadol-O-glucuronide, tapentadol-O-sulfate, N-desmethyltapentadol, N-desmethyltapentadol-glucuronide and N-desmethyltapentadol-O-sulfate), in urine, bile, cardiac and femoral blood. Positivity of body hairs allowed us to conclude that the man had used tapentadol in the last weeks/months. Autopsy and toxicological results (also positive for clotiapine, diazepam and chlordesmethyldiazepam) suggested that tapentadol could have caused, even at low concentrations, a severe respiratory depression, which contributed to the death of the subject. This is one of the few cases in literature where tapentadol was detected in blood, together with its metabolites, and the only one in which the parent drug was identified in hairs.


Assuntos
Analgésicos Opioides/envenenamento , Tapentadol/envenenamento , Adulto , Analgésicos Opioides/análise , Benzodiazepinas/análise , Bile/química , Cromatografia Líquida , Diazepam/análise , Dibenzotiazepinas/análise , Cromatografia Gasosa-Espectrometria de Massas , Conteúdo Gastrointestinal/química , Cabelo/química , Humanos , Masculino , Nordazepam/análogos & derivados , Nordazepam/análise , Prisioneiros , Tapentadol/análise , Tranquilizantes/análise , Ácido Valproico/análise
14.
Rev. habanera cienc. méd ; 20(2): e2957, mar.-abr. 2021. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1251793

RESUMO

Introducción: Existen plantas que se usan desde tiempos ancestrales con efecto alucinógeno y alteraciones al sistema nervioso central, debido a la presencia principalmente de mezcalina son usadas para cumplir objetivos tradicionales asociados a la adivinación, curandería, divinidad y otros. Objetivos: Determinar el efecto del extracto acuoso de Trichocereus pachanoi a dosis de 10 por ciento, 20 por ciento y 30 por ciento sobre el comportamiento exploratorio de carácter depresivo en Rattus rattus var. albinus. Material y métodos: El presente estudio experimental es de carácter exploratorio aplicado, constructivo y prospectivo, se formaron 4 grupos de 10 ratas cada uno a las que se les administró extracto acuoso de Trichocereus pachanoi en dosis creciente, luego fueron sometidas a natación forzada con entrenamiento previo de 15 minutos. Resultados: El grupo que no recibió tratamiento alguno posee la más baja respuesta en gasto de tiempo para el escalamiento, comparado con los grupos B, C y D que presentan 13,5 min. 17,17 min. y 24,37 min. respectivamente. También en la evaluación de la movilidad, el grupo A posee en valor más bajo, comparado con los grupos B, C y D que presentan 13,42 min. 17,62 min. y 23,12 min., respectivamente. Conclusiones: El tratamiento en ratas con extracto acuoso de Trichocereus pachanoi a concentraciones de 10 por ciento, 20 por ciento y 30 por ciento ha sido eficaz en producir un efecto tranquilizante en el comportamiento exploratorio de carácter depresivo en el sujeto(AU)


Introduction: Since ancient times, some mescaline containing plants that have hallucinogen effects and cause alterations in the central nervous system have been used to fulfill traditional objectives associated with divination, healing, spirituality and others. Objective: To determine the effect of the aqueous extract of Trichocereus pachanoi at doses of 10 %, 20 % and 30 % solution on depression-like exploratory behavior in Rattus rattus var. albinus. Material and Methods: The present experimental study, which is exploratory, constructive and prospective in nature, was conducted in 4 groups of 10 rats. The rats were administered increasing doses of aqueous extract of Trichocereus pachanoi; then, they underwent forced swimming with a previous 15-minute training. Results: The group that did not receive any treatment had the lowest response to the duration of time spent at scaling compared to groups B, C and D that spent 13.5 min., 17.17 min., and 24.37 min., respectively. Also, in the evaluation of mobility, group A showed the lowest value compared to groups B, C and D that recorded 13.42 min., 17.62 min., and 23.12 min., respectively. Conclusions: The treatment with aqueous extract of Trichocereus pachanoi at concentrations of 10 percent, 20 percent and 30 percent applied to rats has been effective in producing a tranquilizer effect on the depression-like exploratory behavior in rats(AU)


Assuntos
Ratos , Tranquilizantes , Sistema Nervoso Central , Comportamento Exploratório , Alucinógenos , Mescalina , Estudos de Intervenção
15.
Pharmacol Biochem Behav ; 204: 173169, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33684453

RESUMO

BACKGROUND: This paper examines the epidemiology of extra-medical use of prescription medications for sleep among a nationally representative sample of U.S. adults. METHODS: We analyzed data from the 2015-2018 National Surveys on Drug Use and Health. The sample includes 3410 U.S. adults who reported extra-medical use of prescription medications for sleep. Multinomial logistic regression models identified correlates of type of drug used [i.e., sedatives and/or tranquilizers-only (ST-only), prescription pain relievers-only (PPR-only), or sedatives, tranquilizers, and prescription pain relievers (ST + PPR)], and logistic regression models identified correlates of reasons for extra-medical use (i.e., sleep-only vs. sleep and recreational). RESULTS: About 60% (95%CI = 58.9, 63.5) of the sample reported extra-medical use of ST-only, followed by PPR-only (29.9%, 95%CI = 27.5, 32.5), and ST + PPR (8.9%, 95%CI = 7.7, 10.4). Recreational use was reported by 28.4% (95% CI = 26.5, 30.4) of the sample. The odds of extra-medical use of PPR-only (aRRR = 3.1, 95%CI = 2.1, 4.5) and ST + PPR (aRRR = 1.9, 95%CI = 1.2, 3.1) as opposed to ST-only, were greater among Non-Hispanic Blacks than Non-Hispanic Whites. Compared to non-alcohol users, those with a past-12 months diagnosis of alcohol use disorder were more likely to use ST + PPR rather than ST-only (aIRR = 2.0, 95%CI = 1.1, 3.7). Non-Hispanic Blacks (aOR = 0.6, 95%CI = 0.4, 08) and individuals living in rural areas (aOR = 0.5, 95%CI = 0.3, 09) were less likely to report extra-medical use of prescription medications for recreational reasons than Non-Hispanic Whites and those residing in large metropolitan areas, respectively. CONCLUSIONS: Extra-medical use of PPR-only and ST + PPR as an aid to sleep, is prevalent among Non-Hispanic Blacks, young adults, and those residing in rural areas. Most individuals reported that extra-medical use of prescription medications was primarily motivated by sleep reasons, rather than by sleep and recreational reasons. Potential interventions include access to sleep treatments, education on the effectiveness and risk associated with extra-medical use and co-use of prescription medications for sleep, and research on sleep-related disparities.


Assuntos
Analgésicos/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Transtornos do Sono-Vigília/tratamento farmacológico , Tranquilizantes/uso terapêutico , Adolescente , Adulto , Alcoolismo/epidemiologia , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Uso Recreativo de Drogas/estatística & dados numéricos , Sono , Medicamentos Indutores do Sono/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
16.
Nurs Health Sci ; 23(2): 325-336, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33605053

RESUMO

With an imperative to reduce or eliminate the use of coercive practices in mental health care it is important to understand the experience of service users and staff. This review aimed to synthesize qualitative studies, published between 1996 and 2020, reporting on mental health service users' and staff's experiences of chemical restraint. The databases PsycINFO, CINAHL, MEDLINE, Embase, Emcare, Web of Science, and Scopus were searched. Three analytic themes were identified from 17 included articles, synthesizing the experiences of service users and staff. These were "Unjustified versusjustified," "Violence versus necessity," and "Reflecting back: Positives and negatives." Service users viewed chemical restraint as an unjustified response to "behaviors of concern" and experienced it as a violent act with negative outcomes, although some saw it as necessary in retrospect and preferred it to other forms of coercion. Staff generally viewed it as a justified response to "behaviors of concern" and experienced it as appropriate within the constraints of staff numbers and limited alternatives. These findings identify nuances not apparent in the literature, which has generally conflated all forms of coercive practices.


Assuntos
Coerção , Serviços de Saúde Mental/estatística & dados numéricos , Tranquilizantes/uso terapêutico , Violência/prevenção & controle , Controle Comportamental/métodos , Humanos , Saúde Mental , Restrição Física
17.
Neuropsychopharmacol Rep ; 41(1): 117-121, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33506653

RESUMO

AIM: This study aimed to investigate body composition in Japanese patients with psychiatric disorders. METHODS: A cross-sectional study was conducted to assess the body composition in Japanese patients with psychiatric disorders and healthy controls. InBody470 was used to measure the body composition of the participants. For the primary analysis, measures of body composition between patients and healthy controls were compared. Moreover, the following patient subgroups were also compared with the healthy controls: (a) patients with psychotic disorders only, (b) patients with mood disorders only, (c) patients receiving antipsychotics, (d) patients receiving conventional mood stabilizers, (e) patients receiving antidepressants only but not any antipsychotics and/or mood stabilizers, and (f) patients receiving hypnotics/anxiolytics. RESULTS: This study included 205 individuals (105 patients and 100 healthy controls). It was found that patients had a significantly higher body mass index, waist-hip ratio, body fat mass, and percent body fat compared with the healthy controls. Moreover, significant differences were noted in the waist-hip ratio, body fat mass, and percent body fat between all patient subgroups other than patients receiving conventional mood stabilizers subgroup and healthy controls. CONCLUSION: This is the first cross-sectional study to examine body composition in Japanese patients with psychiatric disorders. No difference in the skeletal muscle volume was noted although patients had higher body fat than healthy controls. A longitudinal and large cohort study in the future, controlling for medication and diagnosis, will need to determine why body fat is increased in Japanese patients with psychiatric disorders.


Assuntos
Antidepressivos/uso terapêutico , Composição Corporal/fisiologia , Índice de Massa Corporal , Hipnóticos e Sedativos/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Tranquilizantes/uso terapêutico , Relação Cintura-Quadril , Adulto , Distribuição da Gordura Corporal , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológico , Adulto Jovem
19.
J Addict Med ; 15(3): 191-200, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32909984

RESUMO

OBJECTIVES: Roughly 6.5 million US residents engaged in prescription tranquilizer/sedative (eg, benzodiazepines, Z-drugs) misuse in 2018, but tranquilizer/sedative misuse motives are understudied, with a need for nationally representative data and examinations of motives by age group. Our aims were to establish tranquilizer/sedative misuse motives and correlates of motives by age cohort, and whether motive-age cohort interactions existed by correlate. METHODS: Data were from the 2015 to 2018 US National Survey on Drug Use and Health, with 223,520 total respondents (51.5% female); 6580 noted past-year prescription tranquilizer/sedative misuse motives (2.4% overall, 50.3% female). Correlates included substance use (eg, opioid misuse), mental (eg, suicidal ideation) and physical health variables (e.g., inpatient hospitalization). Design-based, weighted cross-tabulations and logistic regression analyses were used, including analyses of age cohort-motive interactions for each correlate. RESULTS: Prescription tranquilizer/sedative misuse motives varied by age group, with the highest rates of self-treatment only motives (ie, sleep and/or relax) in those 65 and older (82.7%), and the highest rates of any recreational motives in adolescents (12-17 years; 67.5%). Any tranquilizer/sedative misuse was associated with elevated odds of substance use, mental health, and physical health correlates, but recreational misuse was associated with the highest odds. Age-based interactions suggested stronger relationships between tranquilizer/sedative misuse and mental health in adults 50 and older. CONCLUSIONS: Any tranquilizer/sedative misuse signals a need for substance use and mental health screening, with intervention needs most acute in those with any recreational motives. Older adult tranquilizer/sedative misuse may be more driven by undertreated insomnia and anxiety/psychopathology than in younger groups.


Assuntos
Uso Indevido de Medicamentos sob Prescrição , Transtornos Relacionados ao Uso de Substâncias , Tranquilizantes , Adolescente , Idoso , Analgésicos Opioides/uso terapêutico , Criança , Feminino , Humanos , Hipnóticos e Sedativos , Masculino , Motivação , Prescrições , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Estados Unidos
20.
J Addict Dis ; 39(1): 54-65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32921294

RESUMO

Background and Objectives: Prior research has identified that sources of prescription drugs for misuse vary based on educational attainment, which is important as certain sources are associated with adverse outcomes. The current research addressed limitations of the extant literature by creating distinct categories of push factors for high school dropout (e.g., negative school performance/experiences), pull factors for high school dropout (e.g., starting a family or getting a job), and high school graduates who did not attend college.Methods: Using data from the 2009-2014 National Survey on Drug Use and Health, prevalence of sources were estimated and design-based multivariable logistic regression investigated the association between sources and educational attainment. Additionally, multivariable logistic regression assessed the associations between sources and adverse outcomes (i.e., substance use, substance use disorders, and mental health) separately for each educational category.Results: College respondents were more likely to report "physician" and free from "friend/relative" and less likely to report "purchased" as sources. For most educational categories, "purchasing" prescription drugs was associated with adverse outcomes. Additionally, "theft/fake" prescription emerged as a source associated with adverse outcomes for college respondents, while "friend/relative" was associated with adverse outcomes for high school graduates that did not go on to college.Conclusions: This research has important clinical implications as it identified young adults with a college education as being less likely to obtain prescription drugs from sources known to be associated with adverse outcomes. It also highlighted how associations between sources and adverse outcomes vary based on educational attainment.


Assuntos
Analgésicos Opioides , Escolaridade , Uso Indevido de Medicamentos sob Prescrição , Evasão Escolar/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias , Tranquilizantes , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Feminino , Amigos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Médicos/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Tranquilizantes/administração & dosagem , Tranquilizantes/efeitos adversos , Estados Unidos , Universidades , Adulto Jovem
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