[Therapeutic strategies with drugs].
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Humans↗
Biomedical subjects
D Ladewig
Publications and source records attributed to D Ladewig.
[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↗
[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↗
[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↗
[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↗
[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↗
[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↗
[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↗
[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↗
[The importance of work and unemployment for the long-term outcome and rehabilitation of drug dependent patients].
Physicians generally have to deal with therapy and less with rehabilitation of diseases. Employment and the necessary capacity and skills are to be focused on therapeutically in every second drug addict or alcoholic. The continuation of work is an important aim of secondary and tertiary prevention. Some general psychosocial aspects concerning this topic are discussed.
Combined Modality Therapy↗
[Drugs and violence].
The physician is confronted with victims of drug-related violence in emergency situations, especially in excitations (cocaine) or alcohol-induced intoxications. Moreover, the topic of drug-related violence should not only engage criminologists, specialists in legal and forensic medicine, but also every doctor because of the implications concerning interactions of drugs and society in which the medical profession ist deeply involved.
Cocaine↗
[Future prospects in treatment of drug dependent patients].
During the last 25 years, an important evolution in therapeutic-rehabilitative strategies for drug addicts was observed. Many inputs came from social pedagogics. Great demands are again put on the medical profession in relation to AIDS and substitution programs. In the future the engagement of the medical profession will be required more again, particularly the psychosocial competence of doctors as well as the medical-biological research.
Acquired Immunodeficiency Syndrome↗
Epidemiology of benzodiazepine dependence.
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Anti-Anxiety Agents↗
Urine analysis for benzodiazepines among opiate consumers.
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Anti-Anxiety Agents↗
Opiate maintenance and abstinence--attitudes, treatment modalities and outcome.
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Attitude of Health Personnel↗
Drug dependence in patients in psychiatric hospitals in Switzerland. A survey conducted in nine psychiatric hospitals from 1983-1986.
The present article forms part of an investigation which has been carried on continuously under the auspices of the Conference of Swiss Sanitary Directors with the aim of providing evidence on the frequency of drug dependence in inpatients of psychiatric hospitals. The investigation is an important source of information concerning trends in drug dependence patterns. In this study, it was possible to observe a change in preference with regard to the use of analgetic compounds over the past years. The decreasing use of barbiturates was found to have been replaced by an increased intake of benzodiazepines. Dependence on heroin has increasingly been observed in recent years. On the whole, multiple drug dependence combined with alcoholism are at present the most frequently observed forms of dependence.
Alcoholism↗
Mental and behavioural disorders due to psychoactive substance use (section F1): results of the ICD-10 field trial.
The ICD-10 field trial of section F1 (mental and behavioural disorders due to psychoactive substance use) shows comparatively high acceptance of the new classification in German-speaking countries. Goodness of fit and subjective confidence of the main diagnosis are above average. Analysis of interrater reliability with regard to main diagnostic categories reveal certain problems. The reliability values are flow average within the ICD-10 field study. Possible causes for low interrater reliability are inadequate differentiation from section F0 (organic disorders) and uncertainties in the differential assessment of psychopathological symptoms between F1 and F2, as also between F1 and F4. Interrater reliability could be improved by introducing "psychoactive substance use" as a separate axis in a forthcoming multiaxial scheme for ICD-10.
Behavior↗
[Drug-dependent patients in general practice].
Contrary to the popular opinion of many physicians, addicts are primarily seeking help in the practice. The treatment of addicts in the practice requires an early diagnose. The competence of treatment needs a sensible part, concerning the knowledge about the potential of dependence and the following symptoms, the withdrawal medication and the relapse situations, and an emotional part, concerning personal attitude towards personal vulnerability to face relapses. It is desirable to develop liaison services between physicians in practice and the specialists to improve the efficiency of treatment.
Alcoholism↗