The Withdrawal of Habituating Substances

1993 ◽  
Vol 11 (2) ◽  
pp. 76-79 ◽  
Author(s):  
Paul Marcus
Keyword(s):  
Hong Kong ◽  
Withdrawal Symptoms ◽  
Opiate Addiction ◽  
Controlled Trials ◽  
Success Rates ◽  
Endogenous Opioid ◽  
Locus Caeruleus ◽  
Anxiety Control ◽  
Site Of Action ◽  
Fear And Anxiety

The use of acupuncture to combat opiate addiction dates from 1972, when it was serendipitiously discovered to reduce the withdrawal symptoms of opium smokers during neurosurgery under acupuncture anaesthesia at the Kwong Wah Hospital in Hong Kong. Since then acupuncture has become popular in the treatment of a variety of addictions ranging from tobacco to benzodiazapines and over 20 controlled trials have been reported, although the success rates have varied considerably. Suggested modes of action have included sympathetic inhibition, parasympathetic inhibition and endogenous opioid release. A possible site of action is the medullary locus caeruleus which affects fear and anxiety control.

Electro Acupuncture Combined Methadone for Withdrawal Symptoms of Opioid Addiction: A Protocol for Systematic Review and Meta Analysis

2021 ◽  
Author(s):  
Tianyao Zhang ◽  
Xiaoyan He ◽  
Lijuan Wu ◽  
Xianrong Feng ◽  
Yu Yang ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Randomized Controlled Trials ◽  
Depression Scale ◽  
Opioid Addiction ◽  
Withdrawal Symptoms ◽  
Opiate Withdrawal ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Hamilton Depression Scale ◽  
Randomized Controlled

Opioid addiction is a chronic brain disorder characterized by a series of withdrawalsymptoms in behavioral, psychological, and neurobiological manifestations.Withdrawal symptoms are the main causeof relapse after periods of abstinence; thus,the treatment is focused on abstinence symptoms. Due to most of all types of opioidagonist drugs carry a potential for addiction and exacerbation of withdrawalsymptoms, nondrug methods have great potentials i n clinical applications.Electro acupuncture (EA), as a novel nonpharmacological approach, combined withmethadone has a long term positive efficacy on treating addict ion . Therefore, we designed a protocol to evaluate the adjuvant effect of EA for treating withdrawalsymptoms of opioid addiction addiction.MethodTo review reports of relevant clinical trials, we will searchEnglish language databases(EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials) andChinese databases (Chinese Biomedical Lit eratures, China National KnowledgeInfrastructure, Wanfang, and VIP). We will collect documents from the earliestpossible date up t to May 2020. We will also search online trial registries such as ClinicalTrials.gov (ClinicalTrials.gov/), the European Medicine Agency(www.ema.europa.eu/ema/), and WHO International Clinical Trials Registry Platform(www.who.int/ictrp). We will select randomized controlled trials RCT forwithdrawal from opioid addiction involving EA methadone and methadone alonetreatment. W e will use psychological assessment scales to evaluate treatment majoroutcomes which include numerous components such as OWS, VAS, HAMD, HAMA;then u rinalysis and m ethadone dosage also will be measure as the additional outcomes.Finally, RevMan5 software will be used for literature quality evaluation and dataana lysis.Result: To evaluate the efficacy of EA in combination therapy by observing the outcomes of corresponding scale, urinalysis and decreasing methadone.Conclusion: This protocol will be used to evaluate the efficacy and safety of EA in combination with methadone in treatment of opioid addiction withdrawal symptomsAbbreviationsOpioid dependence, OWS=Opiate Withdrawal Scale, VAS=Craving Visual Analog Scale, PWSS=Post-withdrawal symptoms Scale, HAMD=Hamilton Depression Scale, HAMA=Hamilton Anxiety Scale, RCTs =Randomized Controlled Trials, EA=Electrical Acupuncture, PRISMA=Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

scholarly journals Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Justin Jek-Kahn Koh ◽  
Madeline Malczewska ◽  
Mary M. Doyle ◽  
Jessica Moe
Keyword(s):  
Emergency Department ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Observational Studies ◽  
Alcohol Withdrawal Syndrome ◽  
Withdrawal Symptoms ◽  
Rapid Review ◽  
Controlled Trials ◽  
Seizure Recurrence ◽  
Outpatient Settings

Abstract Background Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19 pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome in the ED. Methods We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED. Results We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED. Conclusions Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings should be evaluated in the ED setting before routine use.

scholarly journals Systematic Review on the Efficacy of Interventions for Fear of Childbirth, Anxiety and Fear in Pregnant Women

2021 ◽  
Author(s):  
Carmen Birner ◽  
Gerlind Grosse
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Quality Assessment ◽  
Pregnant Women ◽  
Controlled Trials ◽  
Fear Of Childbirth ◽  
Pregnancy And Childbirth ◽  
Randomized Controlled ◽  
Quantitative Studies ◽  
Fear And Anxiety

Abstract Background: Fears and anxieties during pregnancy and childbirth are a frequent phenomenon and can have negative consequences on wellbeing, psychological health and birth outcomes. Therefore, it is important to focus on the interventions to reduce those fears and anxieties during pregnancy and childbirth. A systematic review was conducted to examine the current literature on psychological interventions to reduce anxieties and fears during pregnancy and childbirth. Scopus and PubMed were searched from 2015 up until December 2020 for relevant studies. Included were pregnant women, with no restriction on age ranges or parity. Entered in the review were quantitative studies, including randomized controlled trials (RCTs), non-randomized controlled trials as well as treatment evaluations. After reviewing titles, abstracts and studies, 72 studies were included in this review as they met the inclusion criteria. Standard methodological procedures for systematic reviews were used. The quality assessment of included articles was done by using the Quality Assessment Tool for Quantitative Studies (EPHPP). Results: The main results of this review concern the fear and anxiety reducing effects of psychoeducation, relaxation techniques, guided imagery, supportive care through a midwife, group discussion, “lifestyle based education”, writing therapy, cognitive behavioral therapy groups and stress intervention, individual structured psychotherapy, communication skills training, counseling approaches (except distraction techniques), a motivational interviewing psychotherapy, emotional freedom techniques, breathing awareness and different hypnotherapeutic techniques on different fears and anxieties during pregnancy and childbirth. For mindfulness-based interventions mixed results are found. The effect of an acceptance and commitment therapy, biofeedback interventions, a mind body intervention, mental health training courses, the group intervention Nyytti® as well as cognitive analytic therapy is unclear, due to weak ratings. Antenatal class attendance reduced delivery fear significantly only in first time mothers. An internet-based problem-solving treatment did not reduce anxiety during pregnancy. Conclusion: A broad range of interventions show positive effects on fear of childbirth and fear and anxiety in pregnancy. Further research should address other acknowledged psychotherapeutic practices, like psycho-dynamic as well as systemic interventions, as they are underrepresented within this review. Furthermore , there is a need for manualized therapeutic interventions, with regards to a combination of effective intervention components.

Psychopharmacological Treatments for Substance Use Disorders

2007 ◽  
pp. 145-178 ◽  
Author(s):  
Charles P. O’Brien ◽  
James McKay
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Methadone Maintenance ◽  
Abstinence Rate ◽  
Opiate Addiction ◽  
Blood Levels ◽  
Controlled Trials ◽  
Pharmacological Agents ◽  
Improve Compliance ◽  
Reduced Drinking

The treatment of substance abuse with pharmacological agents is well established, although most experts agree that, to be successful, medication interventions must be combined with psychosocial therapies. A large number of Type 1 and Type 2 controlled trials have shown that the use of nicotine replacement therapy to induce and maintain smoking cessations significantly increases the abstinence rate. Bupropion, which is also an antidepressant, has been found in controlled trials to significantly increase the smoking abstinence rate measured at intervals up to 12 months after beginning of treatment. Trials with novel agents such as the cannabinoid receptor antagonist rimonabant and varenicline, a nicotine receptor partial agonist, have been reported at meetings but have not yet appeared in print. The treatment of alcoholism can now be enhanced by three totally different types of medications: disulfiram, which works when compliance is assured; naltrexone, which reduces alcohol reward via the endogenous opioid system and results in decreased alcohol craving and reduced drinking in most randomized clinical trials; and acamprosate, which reduces post-alcohol excitability and has been effective in European trials but less so in U.S. trials. A depot version of the opiate antagonist naltrexone was approved by the FDA in 2006. It gives therapeutic blood levels for at least 30 days and should greatly improve compliance, thus making naltrexone more useful for the treatment of both opiate addiction and alcoholism. Methadone maintenance treatment for heroin dependence has consistently shown efficacy, and the treatment options have been increased by the availability of the partial opiate agonist buprenorphine. Buprenorphine is unique in that it can be used for the treatment of opiate addiction by qualified physicians in their offices rather than requiring enrollment in a highly regulated methadone treatment program. There are as yet no FDA-approved medications for the treatment of stimulant addiction, which includes cocaine and methamphetamine. There are recent double-blind, placebo-controlled clinical trials of several medications that have been found effective against cocaine addiction and are currently in multisite trials to confirm efficacy.

scholarly journals Malignant pleural effusions and the role of talc poudrage and talc slurry: a systematic review and meta-analysis

F1000Research ◽  
2015 ◽  
Vol 3 ◽  
pp. 254 ◽  
Author(s):  
Srinivas Mummadi ◽  
Anusha Kumbam ◽  
Peter Y. Hahn
Keyword(s):  
Journal Club ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Success Rates ◽  
Respiratory Complications ◽  
Talc Pleurodesis ◽  
Advanced Malignancy ◽  
Significant Difference ◽  
Talc Poudrage ◽  
Q Statistic

Background:Malignant Pleural Effusion (MPE) is common with advanced malignancy. Palliative care with minimal adverse events is the cornerstone of management. Although talc pleurodesis plays an important role in treatment, the best modality of talc application remains controversial.  Objective:To compare rates of successful pleurodesis, rates of respiratory and non-respiratory complications between thoracoscopic talc insufflation/poudrage (TTI) and talc slurry (TS). Data sources and study selection:MEDLINE (PubMed, OVID),  EBM Reviews (Cochrane database of Systematic Reviews, ACP Journal Club, DARE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database), EMBASE and Scopus. Randomized controlled trials published between 01/01/1980 - 10/1/2014 and comparing the two strategies were selected. Results:Twenty-eight potential studies were identified of which 24 studies were further excluded, leaving four studies. No statistically significant difference in the probability of successful pleurodesis was observed between TS and TTI groups (RR 1.06; 95 % CI 0.99-1.14; Q statistic, 4.84). There was a higher risk of post procedural respiratory complications in the TTI group compared to the TS group (RR 1.91, 95% CI= 1.24-2.93, Q statistic 3.15). No statistically significant difference in the incidence of non-respiratory complications between the TTI group and the TS group was observed (RR 0.88, 95% CI= 0.72-1.07, Q statistic 4.61).Conclusions:There is no difference in success rates of pleurodesis based on patient centered outcomes between talc poudrage and talc slurry treatments.  Respiratory complications are more common with talc poudrage via thoracoscopy.

Management of pain and anxiety

2018 ◽  
Author(s):  
M.T. Hosey ◽  
G.J. Roberts
Keyword(s):  
Dental Treatment ◽  
Dental Anxiety ◽  
Strong Relationship ◽  
Older Children ◽  
Behaviour Management ◽  
General Anxiety ◽  
Anxiety Control ◽  
Operative Care ◽  
Fear And Anxiety ◽  
Good Behaviour

Pain and anxiety are natural physiological and psychological responses. Pain is a direct response to an adverse stimulus that has occurred; anxiety is the unpleasant feeling, the worry that something unpleasant might occur. Pain and anxiety are often intertwined, especially in the dental setting. The best way to manage child dental anxiety is to avoid its occurrence in the first place through prevention of dental disease, good behaviour management, pain-free operative care, and treatment planning that is tailored to the needs and developmental stage of each individual child. These issues are detailed in the previous chapters. This chapter specifically focuses on pharmacological pain and anxiety control and explores the roles of conscious sedation and general anaesthesia (GA) as adjuncts to behaviour management. A child’s perception of pain is subjective and varies widely, particularly with age. Infants up to about 2 years of age are believed to be unable to distinguish between pressure and pain. Older children begin to have some understanding of ‘hurt’ and begin to distinguish it from pressure or ‘a heavy push’. It is not always possible to identify which children are amenable to explanation and will respond by being cooperative when challenged with local anaesthesia (LA) and dental treatment in the form of drilling or extractions. Children over 10 years of age are much more likely to be able to think abstractly and participate more actively in the decision to use LA, sedation, or GA. As children enter their teenage years they are rapidly becoming more and more like adults and are able to determine more directly, sometimes emphatically, whether or not a particular method of pain control will be used. The response is further determined by the child’s coping ability influenced by family values, level of general anxiety and intelligence. There is a strong relationship between the perception of pain experienced and the degree of anxiety perceived by the patient. Painful procedures cause fear and anxiety; fear and anxiety intensify pain. This circle of cause and effect is central to the management of all patients. Good behaviour management reduces anxiety, which in turn reduces the perceived intensity of pain, which further reduces the experience of anxiety.

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