Biomedical subjects
Publications and source records attributed to D Ladewig.
Naltrexon is an longterm opioid antagonist, which can be used in the psychosocial rehabilitation process of former dependents on opiates. It was established that there were less opiates used during the treatment with Naltrexon. The exclusive delivery of Naltrexon cannot protect from relapse and has to be completed with psychotherapeutic measures.
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Anxiety and sleep disturbances are frequent symptoms in medical practice. They still constitute the main indications for prescription patterns. The evaluation of risks and benefits deals with many methodological problems concerning terminology of dependence and pharmaco-epidemiology finally findings in the literature are reviewed under the aspects of diminishing the risk of dependence.
In the city of Basle with a catchment area of 300,000 inhabitants a significant number of physicians were asked for observations concerning benzodiazepine abuse by their patients. In 1985, 31 patients abusing benzodiazepine only were observed, which represents an incidence of 1:10,000 or 0.01%. In addition, concrete information on 88 patients with multiple abuse was obtained. Demographic data, diagnosis and main reason of abuse, data on most frequently abused drugs, consequences of abuse, as well as measures against the abused are described in relation to the two main groups of abusers.
A sample of opiate addicts from the Basle area followed over six years (1979-1985) was in 1985 investigated concerning psychopathological features. Using the Derogatis scale significant differences between opiate abstinence and opiate dependence could be demonstrated. People still using opiates described themselves as being more obsessive, insecure, depressed, aggressive and anxious than people who had become abstinent from opiates. Patients in methadone maintenance were located in between. There were in addition significant differences between people living outside an institution and people being treated in therapeutic or penal institutions, but no differences between people from each kind of institution.
Drug addicts of the Basle area have been analysed during 6 years in connexion with the National Research Programme 'social integration' and also a following project. The results are contradictory to the pessimism which exists against changes of development of drug addicts.
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According to pharmacological data as well as to clinical experience a potential of benzodiazepines for producing dependence is not a matter of doubt. However, when compared to the dependence liability of barbiturates the corresponding effect of benzodiazepines is low. In evaluating the dependence potential of benzediazepines account must be taken of the rareness of psychotropic effects of these substances and of the absence of usual mechanisms of tolerance, as well as the epidemiology of psychosomatic syndromes and their treatment outcome. The paper summarizes different types of clinical approaches to evaluating the abuse and dependence liability. In relation to the high incidence of prescriptions for benzodiazepines, the incidence of dependence syndromes is low, but with a wide range of degrees and patterns of such syndromes. Mostly autonomic and psychic symptoms, occasionally grand mal seizures and sensory disturbances and very rarely psychotic symptoms have been described. While the time course differs there is, in comparison to barbiturates, a shift in onset and duration of symptoms.
In a first study we developed a test (BDA) for measuring the degree of dependence on alcohol, medicaments and drugs in alcoholics as well as drug addicts. The present study analysed this test according to the principles of construct validity. The aim was to create a test with those items that optimally fulfil some of the following criteria. This was achieved with 22 out of the original 59 items of the test. The shortened test contains those items that optimally differentiate both externally (the addicted population from the rest of the sample: depressives, neurotics and normals) and internally (the degree of dependence). The score obtained with 22 items was more efficacious in differentiating the addicts from the rest of the sample than the total score of 59 items. 86% of the 22 items are sufficiently sensitive to measure changes during hospitalisation in a psychiatric clinic. However only 33% of the 22 items can effectively discriminate between alcohol-, medicaments- und drug-dependence. Intercorrelation and factor analyses with other variables that were also measured indicate that a large part of the variance arises from unspecific "general psychopathology" and only a small part is specific for drug-dependence. The test is sufficiently reliable (rtt = .89), unifactoral, and with clear mean test-item correlation (rit = .54), to justify further investigation. We recommend this 22 items test for scientific research into dependence, in spite of the questions that still remain open. The English version of the 22 items is given in the appendix.
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UNLABELLED: Methadon is a synthetic morphin used as a substitution therapy for heroin addicts. 21 patients were selected according the usual swiss indications and observed over 1 year. TREATMENT: daily methadon, weekly psychotherapy and unexpected urine controls. PROBLEMS: side effects, lack of medical care and control and the fact that it is a long term treatment for years, troublesome and often merely palliative.
Drug dependence has been defined in 1964 as 'a state arriving from repeated administration of a drug on a periodic or continuous basis'. Its characteristics would vary with the agent involved, but partly with individual and social characteristics, too. Multiple interactions between various distal and/or immediate psychosocial antecedents with aversive and/or reinforcing consequences of drug use lead to a state of neuroadaptation. This term needs further explanation in the light of research regarding biological aspects (e.g. peptides, neurotransmitters, tetrahydroisoquinolines) as well as psychosocial theories (e.g. social learning, systems theory). In the field of rehabilitation one is struck by the relatively high rate of prosocial behavioral change looking on different samples surveyed. It seems that change takes place virtually irrespective of the type of treatment. Nevertheless diversification of rehabilitative procedures and study of comparative virtues of different strategies should be promoted.
A nation-wide survey on the abuse of benzodiazepines in Switzerland showed an average morbidity (incidence) of 0.0006 per year for isolated abuse of benzodiazepines. The exposure risk was, independently of the benzodiazepine compound used. 0.00002 per prescription. The afflicted population differed demographically in no way from the population of "normal" benzodiazepine consumers, legitimate therapeutic use of a benzodiazepine being the only visible risk factor for development of an abuse. The motivation for abuse, too, was in about 90% of the case self-medication of anxiety and/or insomnia and related symptomatology. Main source of the drug was new prescriptions by the treating physician. The majority of patients were medically in a good state of health and socially well adjusted; 52 out of 180 patients, however, showed negative consequences. Withdrawal syndromes were reported in about one quarter of the detected cases, but detection was mostly due to the increased frequency of prescriptions of confession of the patient. Because of the low frequency of severe negative consequences and the mostly unobtrusive behaviour of the patients, differing in many ways from the accustomed picture of an "abuser of (illicit) drugs", the physician's attitude towards abuse of benzodiazepines was in many cases ambivalent, resulting in a tacit acquiescence and continued prescription. From the data presented it is concluded that the most appropriate measure against abuse of benzodiazepines would be, rather than international control, education of medical professionals and the public, according to internationally accepted medical knowledge and to national law and prescription regulations.
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1. The patient population consisting of fifteen patients was divided into three groups, namely: diazepam group, phenobarbital group and placebo group. After three weeks the medicated groups were switched to placebo for a week and the placebo group was given phenobarbital. 2. The parameters to be assessed once a week comprised frequency-analyzed EEG recordings, performance in two attention tests and subjectively estimated mood modalities. 3. The EEG analysis suggested that EEG patterns: a) were drug-dependent, with a differential distribution for each drug of the four frequency bands analyzed; b) showed no change during the three-week treatment period; c) changed on cessation of medication or on switch from placebo to active medication; d) were task-dependent and changed in a systematic way with the level of activation (stress, vigilance or relaxation). 4. The results would allow a better understanding of the clinical course, the choice of therapeutic measures and of the underlying mechanisms of action.