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Biomedical subjects

D Ladewig

Publications and source records attributed to D Ladewig.

At least 19 recordsLinked to original sources
PubMed1998

Comparison of buprenorphine and methadone in the treatment of opioid dependence. Swiss multicentre study.

A three-centre, randomised, double-blind study was designed to compare the efficacy and safety of buprenorphine and methadone. This was the first European study to compare these agents and was based on a previous trial performed in the US. Opioid-dependent subjects were randomised to receive either sublingual buprenorphine or oral methadone daily. Both objective and subjective measures of efficacy were monitored weekly, and safety parameters were regularly monitored over the entire six-week study. Urinalysis showed that the two treatments were similar with a slight increase in opioid-negative urines noted in both groups. The retention rate in the buprenorphine group was lower than in the methadone group, although it has been suggested that the buprenorphine dose may have been too low for some patients. None of the side effects noted were considered serious and all were attributable to chronic opioid dependence. Experience of two years substitution treatment in Fribourg suggests that initial induction onto buprenorphine allows for patients to be subgrouped before being given the most appropriate maintenance agent. Further investigation is required into the different dose-related effects of buprenorphine seen in particular subsets of addicts.

Adult↗
PubMed1997

High prevalence and coinfection rate of hepatitis G and C infections in intravenous drug addicts.

BACKGROUND/AIMS: The hepatitis G virus is a newly discovered RNA virus which is possibly transmitted parenterally. Hepatitis G virus is associated with acute or chronic hepatitis and may lead to cirrhosis and liver cancer, characteristics shared by the hepatitis C virus. Hepatitis C virus is prevalent in drug users, but the frequency and role of hepatitis G virus is not yet well established. METHODS: One hundred and seventeen heavy i.v. drug users were enrolled in a prospective, controlled, randomized study for i.v. administration of heroin and/or methadone. Hepatitis G virus was detected using a hot start polymerase chain reaction followed by an ELISA polymerase chain reaction assay. Hepatitis C virus genotyping was done using the Inno-Lipa strip assay. RESULTS: Hepatitis G virus infection was detected in 35% (41/117) of the study population and hepatitis C virus infection in 95.7% (112/117). Ninety-seven percent of hepatitis G virus positive patients were coinfected with hepatitis C virus, of whom 75% were infected with hepatitis C virus genotype 3a. This genotype was prevalent in 48.3% of patients infected with hepatitis C virus alone. The presence or absence of hepatitis G virus infection had no influence on chronic hepatitis. Twenty-two percent of patients who started injecting heroin before 1980 and 40% of those who started after 1980 were hepatitis G virus positive. Overall, 16 patients were infected with human immunodeficiency virus, six were coinfected with hepatitis G virus and hepatitis C virus, and 10 only with hepatitis C virus. CONCLUSIONS: Hepatitis G virus infection is highly prevalent in i.v. drug users, but less frequent than hepatitis C virus infection. The fact that all but two patients were coinfected with hepatitis C virus, 75% with one genotype, supports a common route of transmission for both viruses. The course of hepatitis C virus infection is not altered by hepatitis G virus infection.

Enzyme-Linked Immunosorbent Assay↗
PubMed1997

[Drug dependence--diagnostic and therapeutic aspects].

In Switzerland, dependence on these drugs reflects primarily the relationship between patient and doctor, due to the strict regulations. Drugs involved are in most cases benzodiazepines and other sedatives, less frequently stimulants including weight-control products and drugs containing opioids. Patients' characteristics and motivations include 1.) attempt for specific psychotropic effects, 2.) habituation developed during long-term treatment, 3.) overconsumption of drugs without seeking specific psychotropic effects. Clinical syndromes and therapeutic and preventive strategies are described.

Anti-Anxiety Agents↗
PubMed1996

[Initial results with withdrawal treatments of male and female participants in the diversified Janus opiate prescription project in Basel].

Since the beginning of the 'Janus' opiate project in Basel in which severely opiate-dependent persons are treated intravenously with heroin, morphine or methadone 11 from 160 participants (to november 1995) were treated in the withdrawal and intervention unit at the psychiatry clinic of the university of Basel. 7 patients sought a total, 4 a partial withdrawal. Whereas the 4 patients wanting withdrawal from consumption of drugs in addition to study drugs all reached their goal 4 of the 7 persons aiming at total withdrawal interrupted treatment prematurely. The 3 patients who were successful are-as far as the authors know-still off opiates. Substitution of intravenous opiates provided by 'Janus' with oral methadone and slow tapering off of the latter over days to weeks occurred mostly without problems. Participants of the 'Janus' project thus desired a withdrawal oriented treatment with equal frequency and had not less success than persons substituted with oral methadone in achieving this goal.

Adult↗
PubMed1995

[Sleep disorders in chronic pain and generalized tendomyopathy].

Patients with a chronic pain syndrome often suffer from sleep disturbance. As both symptoms are frequent in the fibromyalgia syndrome, these patients in particular have been examined in this regard. No clear polysomnographic evaluation of the subjectively experienced sleep disturbance in these patients has been done so far. Therefore, we recorded the sleep EEG of 13 patients with a fibromyalgia syndrome in order to objectively characterize their sleep. Furthermore, we were interested in the relationship between the sleep alterations and pain intensity. In a subsequent placebo-controlled study based on pathophysiological considerations, we attempted to beneficially influence the sleep disturbance and the pain syndrome with the 5-HT2-receptor antagonist ketanserine, as this system has been proved to play a major role in the regulation of both sleep and pain. The results of our studies in patients with fibromyalgia show that the alteration of sleep is mainly characterized by a disturbance of sleep continuity associated with the experience of pain intensity. The application of 5-HT-receptor-antagonists may be a new strategy for the common treatment of sleep disturbance and the pain syndrome which needs to be evaluated in further studies. Duration of the patients' illness seems to be a predictive value in relation to intensity of the symptoms and the therapeutic outcome.

Adult↗
PubMed1995

[Sleep and addiction].

Sleep disorders and depressive symptoms are concomitant features in patients with addictive disorders. In this study, patients with addiction (alcohol and opioid, resp.) and with major depression (DSM-III-R) were examined with a sleep EEG and compared to age-matched controls. An age-dependent decrease of total sleep time and slow-wave sleep (SWS) was demonstrated. Sober patients with alcohol dependency showed a decrease of SWS, whereas patients with opioid dependency substituted with methadone showed a disorder of REM sleep (REM suppression). Depressive patients revealed a disturbance of sleep continuity and REM sleep (increased REM sleep). The neurobiological differentiation by sleep EEG is of interest for research and clinical practice.

Adolescent↗
PubMed1994

[Withdrawal treatment of drug dependent patients with the aim of achieving abstinence].

The treatment of patients who are dependent on drugs is undergoing a conceptual change, and in this connection more attention is being paid to a qualified withdrawal and weaning. More than 200 withdrawals are being performed annually in the U2 section of the Department of Psychiatry of the University of Basel. The authors report on the composition of the patient groups, their withdrawal symptoms and the therapy offered. In respect of the continually too frequent discontinuations of therapy attention is drawn to the need for a really efficient pharmacotherapy.

Adolescent↗
PubMed1994

[Substitution as a possibility for the treatment of opiate dependent patients].

The treatment of patients who are dependent on opiates has definitely been including drug substitution besides withdrawal and weaning in the Swiss urban community ("Kanton") of Basel City since 1980. After a significant increase of treatments in 1987 in connection with the spread of HIV infections, more than 800 patients were presently receiving substitution treatment according to a descentralised schedule. The type of long-term treatment is illustrated by sociodemographic and treatment data of 500 substituted individuals who are mostly being looked after always by the same persons entrusted with caring for them. This represents a flexible, economically feasible and highly individual type of care and treatment that can help to reduce illegal drug consumption and hence the undesirable events associated with it in an urban district such as Basel city.

Adult↗
PubMed1993

[Evaluation of a drug withdrawal unit].

New concepts of addiction treatment pay greater attention to the organization of qualitative withdrawal. On the ward U2 of the PUK, over 200 drug withdrawals are carried out each year. We report the demographic characteristics of our patient sample, quantify their withdrawal symptoms and describe the range of therapeutic techniques applied. We emphasize the necessity for an efficacious pharmacotherapy to minimize the drop-out rate.

Adolescent↗
PubMed1993

[Substitute drug treatments with methadone].

Methadone maintenance treatment for patients with opiate addiction, started in the Canton of Basel in 1980, today includes more than 600 patients, with a marked increase since 1987 due to a change in inclusion criteria following the spreading of HIV infections. Data from 500 patients, gathered in 1991/92 on sociodemographic and treatment characteristics, emphasize the long-term aspect of the methadone maintenance treatment and the necessity of an intensive psychosocial treatment.

Adult↗
PubMed1993

[The Basel dependence study].

In a survey of 177 patients of several outpatient departments and private practices in the area of Basel there were 23% with a dependence syndrome according to the diagnostic guidelines of ICD-10. Sedatives and hypnotics were the mostly mentioned psychotropic substances in this group. In a second survey six to twelve months later 80% of the initial study group were reassessed, focusing on referrals of the patients with a dependence syndrome to institutions specialized for the treatment of addiction. In most cases these patients were still treated at the previous institution; there were only a few referrals. Improvements concerning the increase of the referral rate to competent specialized institutions for patients with addiction seems possible by implementation of a decentralized consultation liaison service for outpatient departments, hospitals and also private practitioners in a mobile form.

Adaptation, Psychological↗
PubMed1993

[EMG abnormalities in REM sleep of addicted patients].

EMG abnormalities such as short muscle twitches and marked increase of muscle tone can be identified during REM sleep. We compared the polysomnographic parameters of ten alcoholic patients who were sober and medication-free for at least four weeks, five methadone-substituted politoxicomanic patients (MSP) and ten healthy control patients. The alcoholics and the MSP showed significantly more twitches than the control patients, and the MSP had significantly more tonus increase than the alcoholics and the controlled. The polysomnographic measures differed significantly between the groups in sleep architecture. The alcoholics had significantly less slow-wave sleep (SWS) and more REM sleep, the MSP had a longer REM latency and more of stage 2. Dividing all subjects along the median of the two EMG abnormalities, the group which showed a high number of twitches had significantly less SWS with a compensatory increase of stage 2. The two EMG measures, which were scored additionally, may provide a useful additional information in the differentiation of sleep disturbances in alcoholic and methadone-substituted patients. The interaction between the occurrence of these EMG abnormalities and the other polysomnographic measures in our study needs further clarification.

Adolescent↗
PubMed1993

[Beta-carbolines (harman/norharman) are increased in heroin dependent patients].

Endogenous substances resulting from interactions between alcohol and possibly opioid metabolites and neurotransmitters (dopamine, indolamines) are mediators of the pathochemical process towards dependence. Beta-carbolines are increased in alcoholics and--according to our own results--in heroin-addicts. Still unclear is the impact of other psychopathological disturbances like states of anxiety or depression; unclear is also, if it has to be interpreted as state, trait or residual marker of the dependence syndrome.

Adult↗
PubMed1993

[Acamprosate--a stabilizing factor in long-term withdrawal of alcoholic patients].

In a one-year double-blind-treatment study with acamprosat (six months with and six months without substance) the efficiency of this new medicament could be proved. The number of relapses in the treatment group was significantly lower during the first 30 days with a trend to further 150 days. The substance caused very few side effects.

Acamprosate↗