SUN's abdominal acupuncture for depression after methamphetamine withdrawal: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical effect of SUN 's abdominal acupuncture and conventional acupuncture in the treatment of depression after methamphetamine withdrawal.@*METHODS@#A total of 80 female patients with depression after methamphetamine withdrawal were randomly divided into an observation group (40 cases, 1 case dropped off) and a control group (40 cases, 2 cases dropped off). The control group was treated with conventional acupuncture at Baihui (GV 20), Yintang (GV 29), Taichong (LR 3), Shenmen (HT 7), Neiguan (PC 6), Danzhong (GV 17), and the observation group was treated with SUN 's abdominal acupuncture at area 1 of the abdomen and area 8 of the abdomen. Both groups were treated once a day, 30 min each time, 6 days as a course of treatment, 1 day rest between treatment courses, a total of 4 courses of treatment. The scores of withdrawal symptoms, Hamilton depression scale (HAMD), Pittsburgh sleep quality index (PSQI) scale and serum serotonin (5-HT) level were compared between the two groups before and after treatment.@*RESULTS@#After treatment, the scores of withdrawal symptoms, HAMD and the various scores and total score of PSQI scale in the two groups were all lower than before treatment (P<0.01), and the scores of withdrawal symptoms, HAMD and the sleep quality, time to fall asleep, sleep time scores and total score of PSQI in the observation group were lower than the control group (P<0.05, P<0.01). After treatment, the serum 5-HT level of the two groups was increased (P<0.01), and that in the observation group was higher than the control group (P<0.05).@*CONCLUSION@#SUN 's abdominal acupuncture can improve withdrawal symptom, depression and sleep quality, increase serum 5-HT content in treatment of depression after methamphetamine withdrawal, and has better effect than conventional acupuncture.

Opioid tapering and weaning protocols in pediatric critical care units: a systematic review

SUMMARY OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly. METHODS: A systematic review was made from data of four different databases. Forty-nine articles of observational and experimental studies were selected based on the inclusion criteria (critical pediatric patients in acute use of opioids) and exclusion criteria (previous chronic use of opioids, other medications). The data regarding specific themes were separated in sections: initial dose of methadone, use of protocols in clinical practice, abstinence scales and adjuvant drugs. RESULTS: The articles showed a great heterogeneity of ways to calculate the initial dose of methadone. The pediatric intensive care units of the study had different weaning protocols, with a lower incidence of abstinence when a pre-defined sequence of tapering was used. The Withdrawal Assessment Tool - 1 was the most used scale for tapering the opioids, with good sensitivity and specificity for signs and symptoms. CONCLUSION: There is still little evidence of other medications that can help prevent the abstinence syndrome of opioids. This study tries to promote a better practice during opioid weaning.

RESUMO OBJETIVO: A síndrome de abstinência de opioides é comum no ambiente de terapia intensiva pediátrica porque a sedação é frequentemente necessária durante o tratamento das crianças. Não existe uma diretriz específica sobre o manejo desse paciente e, ultimamente, a metadona tem sido uma droga importante para a prevenção dos sintomas de abstinência durante o desmame dos opioides. Este estudo reúne as pesquisas disponíveis para estabelecer a dose inicial de metadona, taxa de redução e ferramentas para reconhecer essa síndrome e agir prontamente. MÉTODOS: Uma revisão sistemática foi feita a partir de dados de quatro diferentes bases de dados. Quarenta e nove artigos, de estudos observacionais e experimentais, foram selecionados com base nos critérios de inclusão (pacientes críticos pediátricos em uso de opioides agudamente) e critérios de exclusão (uso crônico prévio de opioides, outros medicamentos). Os dados referentes a temas específicos foram separados em seções: dose inicial de metadona, uso de protocolos na prática clínica, escalas de abstinência e drogas adjuvantes. RESULTADOS: Os artigos mostraram uma grande heterogeneidade de formas de calcular a dose inicial de metadona. As unidades de terapia intensiva pediátrica do estudo apresentaram diferentes protocolos de desmame, com menor incidência de abstinência quando foi utilizada uma sequência predefinida de redução gradual. A Ferramenta de Avaliação de Retirada - 1 foi a escala mais utilizada durante a redução dos opioides, com boa sensibilidade e especificidade para sinais e sintomas. CONCLUSÃO: Ainda há poucas evidências de outros medicamentos que possam ajudar a prevenir a síndrome de abstinência dos opioides. Este estudo tenta promover uma prática melhor durante o desmame dos opioides.

¿Cómo afrontar un paciente con dependencia a benzodiacepinas en atención primaria? Estrategias para la deshabituación / How to face a patient with benzodiazepine dependence in primary health care? Strategies for withdrawal

Las benzodiacepinas son fármacos ampliamente utilizados en atención primaria de salud. Su uso prolongado se ha convertido en un problema relevante dadas las consecuencias médicas que ocasionan, especialmente en adultos mayores. Entre otras, estas son: dependencia, deterioro cognitivo y riesgo de caídas. Además, los médicos que trabajan en atención primaria cuentan con pocas herramientas para ayudar al paciente en su deshabituación. Se realizó una búsqueda y revisión de la mejor evidencia disponible sobre estrategias prácticas para el médico no especialista en adicciones, para evitar la dependencia al momento de la prescripción inicial y en el paciente con uso prolongado y probablemente dependiente. Se encontraron 10 revisiones sistemáticas relevantes que mostraron evidencia a favor del uso de estrategias multifacéticas en la prescripción, disminución progresiva, cartas y consejería estandarizadas, farmacoterapia y psicoterapia cognitiva conductual. Una estrategia sencilla, eficaz y duradera para prescribir benzodiacepinas es informar al paciente de la necesidad de reducir su consumo, dándole por escrito la pauta de retirada, señalando sus posibles efectos y su solución. Debido a la evidencia disponible, se propone un modelo integrado y escalonado para el manejo del paciente usuario de benzodiacepinas, desde su prescripción hasta su descontinuación.

Benzodiazepines are widely used in primary health care, and their prolonged use is an important problem given the medical consequences particularly in older adults, such as dependence, cognitive impairment, and risk of falls, among others. Primary care doctors generally have few tools to help with managing withdrawal from benzodiazepines. We conducted a review of the best available evidence on practical strategies to avoid dependence at the time of the initial prescription, and to help the patient with prolonged and probably dependent use. We found ten relevant systematic reviews showing evidence in favor of the use of multifaceted prescription strategies, gradual dose reduction, standardized letters, standardized counseling, pharmacotherapy and cognitive behavioral psychotherapy. For benzodiazepine withdrawal, a simple strategy that can be effective and long-lasting is to inform patients of the need to reduce consumption, giving them in writing the withdrawal guideline, indicating the possible effects of withdrawal and its solution. Given the available evidence, an integrated and step-by-step model is proposed for the management of the benzodiazepine user, from prescription to withdrawal.

Avances en la comprensión de las adicciones: niveles, modelos, farmacoterapia / Progress in the understanding of addictins: Levels, models, pharmacotherapy

La comprensión de los mecanismos subyacentes en las diversas adicciones avanza continuamente. Las diferentes líneas de investigación, ya sea tanto en el plano molecular, o de los circuitos y áreas involucradas, como así también de los abordajes psicosociales, profundizan su búsqueda con el objetivo de mejorar la eficacia de los tratamientos. Un interesante artículo de Koob y colaboradores (2009), que lleva por subtítulo El abordaje de la piedra de Rosetta, revisa detalladamente los distintos niveles en juego en esta compleja problemática. El objetivo del mencionado artículo es aportar elementos en el sentido de favorecer el desarrollo de fármacos adecuados para el tratamiento de estas condiciones patológicas, que incluyen tanto el uso de drogas ilícitas, como del alcohol y el tabaco. Las actuales farmacoterapias utilizadas para el tratamiento de la adicción pueden ser empleadas para validar y mejorar los modelos de laboratorios en animales y humanos, para así identificar nuevos candidatos viables para tratamientos. Esta aproximación tiene la capacidad de promover la investigación traslacional y puede proveer un marco heurístico para desarrollar farmacoterapias eficientes y efectivas para la adicción

The comprehension of the mechanisms underlying the different addictions is in constant progess. The different lines of research, both in the molecular field or the circuits and areas involved, as well as in psychosocial approaches emphasize their investigations with the purpose of enhancing the efficacy of the treatments. An interesting article by Koob et al (2009), which is subtitled "The Rosetta Stone Approach", provides a detailed review of the different levels involved in this complex issue. The purpose of the mentioned article is to provide elements that promote the development of pharmacological drugs suitable for the treatment of these pathological conditions, which include both the use of illegal drugs, as well as acohol and tobacco. The current pharmacological therapies used for the treatment of addiction can be used to validate and improve labortory models in animals and humans, in order to identify new potential candidates for treatments. This approach is able to promote a translational research and can offer a heuristic framework to develop efficient and effective pharmacotherapies for addiction

Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica / Management of patients with substance use illnesses in psychiatric emergency department

OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28 por cento das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50 por cento dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência", "álcool", "cocaína", "cannabis", "opioides", "inalantes" e "manejo", tendo o inglês como idioma. RESULTADOS E CONCLUSÃO: O cuidado de pessoas com transtornos por uso de substâncias deve conter: avaliação completa (médica geral e psiquiátrica), tratamento dos quadros diagnosticados (abstinência, intoxicação e quadros clínicos que caracterizem uma emergência), sensibilização do paciente para realizar tratamento, se for necessário, e elaboração de encaminhamento.

OBJECTIVE: Substance use disorders are prevalent in emergency departments in medical and psychiatric services, reaching rates of 28 percent of cases in medical emergency departments. However, professionals in the emergency department identify less than 50 percent of cases of alcohol-related problems. This article aims to provide evidence-based interventions for the specific treatment to patients who meet diagnostic criteria for substance use disorders and who present to emergency rooms during intoxication or abstinence. METHOD: A literature review was performed on Medline database, using the descriptors "acute intoxication", "withdrawal", "alcohol", "cocaine", "cannabis", "opioid", "inhalant", "management", using English as the language. RESULTS: AND CONCLUSION: The care of persons with substance use disorders should include: comprehensive assessment (medical and psychiatric), treatment of diagnosed disorders (withdrawal, intoxication and clinical features that characterize an emergency), awareness of the patient to carry out treatment if necessary and referral.

effects of aqueous extracts of Melissa Officinalis on withdrawal syndrome in rats

Melissa officinalis [MO] grows in the different parts of Iran abundantly. In previous studies, the extract of MO has been reported to have antinociceptive and anticonvulsive effects in rats. This study was designed to evaluate the effect of different doses of the aqueous decoction extracts of MO on withdrawal syndrome in rats. 40 male albino rats [25-30 gr] were selected for this study. Morphine was used to produce drug dependency by Marshall method [injection of 10 doses of drug in four days]. 30 min before injection of naloxone [2 mg/kg], different doses of the extract [5, 10, 25 mg/kg] were injected intraperitoneally and saline [l0ml/kg IP] was injected into the rats of control group. Assessment of classic withdrawal syndrome was based on the number of jumps and the weight of the fecal material for every rat. The results of this study indicated that injection of doses of 10, 25 mg/kg of the extract led to a significant decrease in the number of Jumps [p=0.005] and also in the weight of feces of the rats [p=0.01]. We conclude the aqueous extract of MO can have an important role in the reduction of the severity of withdrawal syndrome in rats

[Effects of Matricaria Chamomilla extract on morphine withdrawal syndrome in mice]

Matricaria chamomilla [MC] contains flavonoids, which exert benzodiazepine-like activity and so it may be helpful in morphine withdrawal syndrome [MWS] treatment. To determine the effects of MC extract on morphine withdrawal syndrome signs in adult male mice. This was an experimental study carried out in two steps at the department of physiology, Qazvin School of medicine [Iran], in 2005. Step 1: 3 adult male mice [n=6] were originally divided into 2 groups marked as saline [control] and morphine [case] groups. The morphine group were injected by increasing doses of morphine [10, 20, 40 mg/kg, s.c], 3 times daily, for a total duration of 4 days and were further divided into 4 subgroups as morphine group and 3 MC extract groups receiving one dose of MC extract [10, 20 or 30 mg/kg I.P] at day 4, 30 min before naloxone injection. At the end of training day [4[th] days] all groups were injected by naloxone [5mg/kg I.P] and MWS was studied for 30 minutes. Step 2: another 30 adult male mice [n=6] were injected by saline, morphine and MC extracts as above except for morphine and naloxane which were injected as one single dose [50 mg/kg]. Naloxone was injected 3hr after the last injection of morphine and the frequencies of withdrawal behaviors [jumping, climbing] were assessed later. The results of the present study showed that the acute and chronic administration of MC at doses used in our experiment significantly abolished the morphine withdrawal syndrome signs [jumping, climbing, writhing, weight loss] compared with morphine group. Our data suggest that the MC can attenuate the expression of withdrawal behaviors in male mice

Getting clean and harm reduction: adversarial or complementary issues for injection drug users

Muitas intervencões para prevenir a infeccão pelo HIV entre usuários de drogas injetáveis adotam a técnica de reducão de danos como referencial teórico. Entretanto, os próprios usuários tendem a preferir modelos baseados na abstinência, defendidos pelos Narcóticos Anônimos, além de outras abordagens adotadas amplamente para o tratamento da dependência química. O artigo descreve uma avaliacão etnográfica da dicotomia ideológica entre reducão de danos e o modelo terapêutico baseado na abstinência (getting clean) durante a fase piloto de uma intervencão para a prevencão de HIV na Cidade de Baltimore, Maryland, Estados Unidos. O artigo descreve como o conflito foi identificado e que mudancas foram introduzidas na intervencão para ajudar a resolver as idéias dicotômicas dos participantes em relacão às questões de dependência química.

Is hypnotherapy effective in relapse rates of drug dependence and reducing withdrawal symptoms?

This study was performed to assess the effect of hypnotherapy on withdrawal symptoms and the relapse rates of substance use. In a clinical trial, 22 subjects at the detoxification stage who were eligible for the study were randomly assigned to the case and control groups. Each group similarly took part in the cognitive therapy sessions. Additionally, the case group took five sessions of hypnotherapy. After six months of follow-up, relapse rates of the two groups were compared. Also, in the case group, the effect of autohypnosis on symptoms of withdrawal was evaluated. By the end of the study, there were 40% and 73% relapse in the case and control groups, respectively. Subjective reports on positive effects of autohypnosis were 88% on insomnia, 80% on restlessness, 60% on pain, and 33% on autonomic symptoms. According to the findings of this study, autohypnosis has no significant effect on the relapse rates in opium users, but the effect was clinically prominent

Tratamento farmacológico da síndrome de dependencia ao álcool / Pharmacological treatment of alcohol dependence syndrome

O autor realiza revisäo bibliográfica sobre vários aspectos do tratamento farmacológico da síndrome de dependencia ao álcool, discorrendo também sobre alguns aspectos de saúde pública e diagnóstico. Enfatiza a utilizaçäo de psicofarmacoterapia específica, como o acamprosato, uma droga recente ainda näo utilizada no Brasil, mas com importante experiência na Europa e Estados Unidos.(au)

Tabaquismo: repercusión y métodos de control / Smoking: repercution and control method

El tabaquismo es un hábito muy arraigado en nuestra sociedad, un trascendente problema de salud pública al constituirse en la principal causa prevenible de muerte prematura, morbilidad y gastos innecesarios en salud. El tabaco es responsable del 20 por ciento de la mortalidad general y se encuentra directamente involucrado en numerosas entidades, tales como cáncer pulmonar y laríngeo entre otros, patología vascular periférica, coronaria y cerebral; es el principal factor etiológico de la enfermedad pulmonar obstructiva crónica y se asocia a morbilidad perinatal entre otras. Su control es difícil y de todas las personas que anualmente intentan abandonar, sólo unos pocos lo logran debido al poder adictivo de la nicotina y los intensos síntomas sufridos en el período de abstinencia a causa del síndrome de privación. En el control del hábito tabáquico es crucial el consejo médico, asociado al apoyo psicológico y técnicas conductuales y en situaciones específicas, un apoyo especializado ya sea con psicofármacos del tipo Bupropión o con terapia de sustitución nicotínica tipo parche

Sindrome de abstinencia alcohólica / Alcoholic withdrawal syndrome

El Sindrome de abstinencia alcohólica es una de las mayores complicaciones vinculadas al alcoholismo. En esta revisión hacemos referencia a su fisiopatología, las diferentes presentaciones clínicas, desde las más leves en las que predominan las manifestaciones de hiperactividad adrenérgica a las formas más severas: la convulsión y el delirium tremens. Se describen los trastornos electrolíticos más frecuentemente encontrados. Hacemos hincapié en el manejo de estos pacientes, las medidas no farmacológicas y las farmacológicas, basándonos en el uso de la escala de CIWA-Ar para cuantificar la severidad del cuadro clínico y la oportunidad de tratamiento farmacológico

Tratamento ambulatorial da síndrome de abstinência do álcool / Outpatient treatment of the alcohol abstinence syndrome

O objetivo deste trabalho é demonstrar a viabilidade do tratamento ambulatorial da abstinência alcoólica (TAAA) realizado por enfermeira especialista. Neste sentido, 114 pacientes abstinentes, em grau leve ou moderado, foram avaliados através de história clínica, exame físico de enfermagem e escala CIWAA (Clinical Institute Withdrawal Assesment for Alcohol). O programa de desintoxicaçäo promoveu avaliaçöes diárias por um período de sete dias, recebendo assim orientaçöes relativas a abstinência alcoólica, cuidados gerais e, quando necessário, foi utilizada terapêutica medicamentosa (BZD), como auxiliar no abrandamento dos sinais e/ou sintomas de abstinência. A maioria dos pacientes era do sexo masculino, com idade média em torno de 39 anos, 75 por cento dos pacientes atendidos apresentavam abstinência leve. A insônia, a agitaçäo psicomotora e o tremor de extremidades foram os sinais e sintomas que prevaleceram no decorrer do tratamento. Apenas 20,2 por cento dos pacientes foram encaminhados a avaliaçäo específica com clínico, por apresentarem alguma queixa ou alteraçäo clínica significativa. Sendo assim, a hipertensäo arterial (30,4 por cento) e a síndrome dispéptica (26,1 por cento) mostraram-se presentes durante a investigaçäo clínica. Ao término do período de desintoxicaçäo proposto, a taxa de aderência permaneceu em torno de 73 por cento. Visando um melhor acompanhamento, os pacientes foram encaminhados a terapia individual ou em grupo, conforme a necessidade de cada um. O tratamento ambulatorial realizado por enfermeira, muito mais que oferecer uma forma alternativa de abordagem terapêutica, amplia o campo de atuaçäo do especialista em saúde mental, oferecendo a baixo custo social e assistencial, uma proposta de tratamento individualizado, objetivo, seguro e eficaz da síndrome de abstinência alcoólica.

Sedación y analgesia en el paciente neurocrítico / Sedation and analgesy in neurocritical patient

El dolor y la agitación son los síntomas más frecuentes que presentan los pacientes internados en una unidad de cuidados intensivos. En el paciente neurocrítico tienen un perfil especial, pues por la afección neurológica de base, no se traducen en la misma forma que en otros pacientes y el tratamiento de los mismos debe ser eficaz pero sin interferir en la evaluación clínica de los mismos. Ambos tienen efectos adversos y efectos beneficiosos y su tratamiento debe contemplar esta situación. El tratamiento de la agitación exige como primer paso terapéutico definir la causa de la misma, y si Ústa es detectable, corregirla. Se insiste en la importancia que tiene el delirio por deprivación delalcohol, drogas o ambas en el paciente neurocrítico, sobre todo en los traumatismos craneocerebrales. Se definen las indicaciones para administrar sedantes en estos pacientes. Se describen los fármacos usualmente utilizados con dicho propósito, señalando vías de administración, dosis, y efectos colaterales. Se resumen los principios básicos para el manejo del paciente excitado que estáß intubado o no. Se señala la alta prevalencia del dolor en los pacientes neurológicos, la forma de detectarlo y la oportunidad de tratarlo. Se hace referencia a los analgésicos habitualmente utilizados para la analgesia del paciente neurocrítico, su forma de administración y sus efectos adversos

Tolerância e dependência a benzodiazepínicos: a respeito de um caso / Tolerance and dependence to the benzodiazepines: apropos of a case

E estudado um caso de abso e dependência a benzodiazepinicos com tolerância a alguns (psicomotor, sedativo), mas näo a todos (amnéstico) os efeitos dessas drogas (tolerância diferencial) e síndrome de abstinência com acentuaçäo de traços paranóides de personalidade

Empleo de placebos en el tratamiento de síndrome de abstinencia en farmacodependientes a heroina / Use of placebo in the tratament of abstinence syndrome in heroin pharmacodependency

Trabajo surgido en el curso del tratamiento de un grupo de farmacodependientes a heroina, durante la fase de desintoxicación en la penitenciaria del Estado de Baja California, México de marzo de 1976 a septiembre de 1977. A 13 Pacientes se les suministró dextropropoxifeno 500 mg/día, clorbenzodiacepina 60 mg/día y clorfenoticina 100 mg/día; al día siguiente hubo quejas de seis pacientes de no efectividad, se les aplicó agua destilada como paceblo suministrando 2 ml. por via intramuscular dos veces por día además de los medicamentos ya señalados, disminuyendo estos últimos hasta el decimoquinto día en que se suspendió el tratamiento. Los resultados satisfactorios. Se repitió el experimento con 11 pacientes más y el resultado volvió a ser favorable al 100%. A través de esta breve experiencia se cree demostrar que la ansiedad es la rectora y al mismo tiempo el termómetro de la sintomatología del síndrome de abstinencia