ABSTRACT
Long-term use of benzodiazepines (BZDs) is known to induce tolerance and dependence, and increase the risk of falls-related injuries in older adults. We present a study carried out in a French nursing home that concerns the implementation of a BZD withdrawal program reassessed at one year. BZD deprescription was achieved by gradual cessation of doses. A secondary benefit of this program was assessed by comparing the number of falls among residents before and after withdrawal. The number of falls was recorded over a six-month period prior to the onset of withdrawal (T1) and then over a six-month period after reassessment at one year (T2). At the beginning, 31 (28.7%) of the patients were under BZD. Total deprescription was obtained for 11 patients. The number of falls per patient over the T1 period was not different between the two groups (future non-withdrawn and withdrawn patients in BZD): 2.1 ± 1.3 and 2.3 ± 0.6 falls per resident, respectively. Conversely, the number of falls per patient was significantly decreased in the population completely withdrawn in BZD between the T1 and T2 periods (2.3 ± 0.6 vs. 0.5 ± 0.2 falls, p = 0.01). The results show that BZD deprescription, through a gradual reduction of doses, is possible to achieve.
Subject(s)
Buprenorphine, Naloxone Drug Combination/adverse effects , Buprenorphine/therapeutic use , Drug Substitution/adverse effects , Edema/chemically induced , Narcotic Antagonists/therapeutic use , Adult , Buprenorphine, Naloxone Drug Combination/administration & dosage , Hand , Humans , Male , Opiate Substitution Treatment/methodsABSTRACT
A number of non medication-based methods of nursing care for geriatric patients have been developed over recent decades to treat non cognitive symptoms associated with dementia. Among these, Snoezelen rooms for multisensory behavioural therapy and animal-assisted therapy emerge as innovative strategies which could potentially complement other more frequently developed methods such as physical activity.
Subject(s)
Animal Assisted Therapy , Dementia/therapy , Sensory Art Therapies , Aged , Animals , HumansABSTRACT
Bupropion is an antidepressant drug also used as a smoking cessation aid, which inhibits norepinephrine and dopamine re-uptake. Given its pharmacological properties, it has been associated with reports on psychosis and acute delirious episodes. Case We report the case of a patient with schizoaffective disorder who developed two psychotic episodes respectively after a four and a two-day administration of sustained-release (SR) bupropion at a dose of 150 mg/day. To our knowledge, this is the first reported case of involuntary rechallenge with bupropion SR during a smoking cessation program. Conclusion There is a serious risk of incorrectly identifying bupropion as only a therapy for nicotine withdrawal without taking the precaution of exploring possible psychiatric co-morbidity with addiction. Our case illustrates the problem.
