Nocturnal wandering caused by restless legs and short-acting benzodiazepines.

A patient with incapacitating restless-leg syndrome had suffered from repetitive confusional states exclusively after use of short-acting benzodiazepines. Complete removal of symptoms was achieved using levodopa. An association between many reported adverse reactions to triazolam and the common syndrome of restless legs or nocturnal myoclonus is suggested.     

Psychotropic drug use in a representative community sample: the Upper Bavarian study

A sample of 1979 community residents aged 15 years and above was assessed in a major survey of health status and consumption of psychotropic medication. Interviews were conducted in the subjects' home by a psychiatrically trained physician, who actually inspected the subjects' medical supplies. Of all subjects 6.9% (4.3% of the males and 9.0% of the females) had used a drug containing a benzodiazepine at least once in the 4 weeks preceding the interview. In the same period 3.6% had taken a medication containing a barbiturate, 2.2% a medicine containing an opioid (mainly codeine), 1.8% had taken a neuroleptic drug, 1.5% an antidepressant, 0.8% a carbamine-acid derivative and 0.1% lithium. High use of psychotropic medication was associated with higher age, female sex, higher psychiatric morbidity, higher somatic morbidity, reduced work capacity and higher neuroticism but not with social class and not with the personality factor extra- or introversion.     

A survey of sudden death associated with the use of antipsychotic or antidepressant drugs: 49 cases in Finland.

Phenothiazines have repeatedly been found to be associated with cases of sudden death, but the issue of causality has remained controversial. A survey of medicolegal autopsies performed in Finland over a 3-year period revealed that sudden unexpected deaths of 31 women (mean age 44 years, range 25-69) and 18 men (mean age 40 years, range 26-62) were associated with either the use of antipsychotic or antidepressant drugs. Therapeutic use of phenothiazines was documented in all but 3 of these 49 cases and thioridazine was involved in over half of them. Thus, whereas thioridazine was the only antipsychotic drug associated with 15 cases, only 5 cases were associated with any of the other antipsychotic or antidepressant drugs. The differences between the subgroups of psychotropic drugs remained clear after adjustment according to the respective data on drug use in the population. Although there are several uncontrolled confounding factors, the overrepresentation of phenothiazines, especially thioridazine, among psychiatric patients who died suddenly is striking and, taken together with their well-established arrhythmogenic effects, warrants further attention.     

Perceived Social Support, Coping Strategies and Alcohol Use among Rural Adolescents/USA Sample

Purpose Rural adolescents are under-researched in substance use studies. The purpose of this study was to determine whether perceived social support and coping strategies predict rural adolescents’ alcohol use. Materials and Methods Ordinal logistic regression was used to examine the relationship among alcohol use levels, coping strategies, and perceived social support. A total of 376 females and 248 males (average age 16 years) recruited from four rural high schools. Results Perceived family social support was a strong protective factor against alcohol use (OR=1.05, p _Wald=0.002) while avoidance coping strategy was a strong risk factor of alcohol use (OR=1.022, p _Wald=0.008). Female and male rural adolescents were significantly different in alcohol use level (χ ²=15.77, df=2/623, p=<0.001). Conclusion Avoidance coping strategies and perception of social support from family are strong predictors of alcohol level among rural adolescents.     

Clinical outcome and brain MRI four years after carbon monoxide intoxication

Brain damage from carbon monoxide intoxication has not been extensively studied with magnetic resonance imaging. We report the clinical outcome and brain magnetic resonance imaging in three individuals simultaneously exposed to toxic levels of carbon monoxide four years previously. Lesions are seen in multiple locations and do not correlate well with the clinical condition.     

Prospective relations between alexithymia,substance use and depression: findings from a National Birth Cohort

Abstract

Purpose: This study examined a developmental model that links affect-regulation difficulties in childhood with three dimensions of alexithymia in adolescence (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking) and substance use and depression in adulthood, while accounting for cumulative contextual risk in childhood, and testing potential gender moderation.

Methods: Multiple group path analyses were conducted using data from the Northern Finland Birth Cohort 1986 (N?=?6963). Analyses used data collected during prenatal/birth, childhood, adolescence, and young adulthood periods.

Results: Our examination of early precursors for alexithymia indicated that the associations of affect-regulation problems in childhood with alexithymia were stronger for girls, potentially putting girls with affect-regulation difficulties in childhood at higher risk for developing alexithymia in adolescence. The associations of cumulative contextual risk in childhood with alexithymia, substance use disorder, and depression diagnosis in adulthood were significant for both girls and boys. Our findings in regard to substance use and depression disorders revealed that alexithymia in adolescence predicted depression diagnosis in adulthood, particularly due to a contribution from the alexithymia domain of ‘difficulties identifying feelings.’ However, none of the alexithymia domains was directly associated with substance use disorder in adulthood.

Conclusions: Our study contributes to research that links alexithymia with difficulties in affect regulation and cumulative contextual risk in childhood, yielding findings that may be relevant for preventive interventions.     

In vitro characterization of agonist, antagonist, inverse agonist and agonist/antagonist benzodiazepines

1. The efficacy of coupling between the benzodiazepine receptor and chloride channel as well as the coupling to the GABA receptor is differentially affected by different benzodiazepine ligands.

2. In general, the order of efficacy with regard to allosteric effects of benzodiazepine ligands on the chloride channel ([³⁵S]TBPS) and GABA receptor ([³H]muscimol), is: agonist > agonist/antagonist > partial agonist > antagonist; with inverse agonists acting in a manner opposite to the classical benzodiazepine agonists.

3. The chloride ionophore is allosterically modulated both by benzodiazepine and GABA receptors.     

PK 8165 and PK 9084, two quinoline derivatives with anxiolytic properties, antagonize the anticonvulsant effects of diazepam

PK 8165 and PK 9084 are two quinoline derivatives reported to interact with the benzodiazepine receptor and possess selective anxiolytic properties in vivo. In the present study we demonstrate that these two compounds antagonize the anticonvulsant effects of diazepam. In addition, in vitro binding studies indicate that both PK 8165 and PK 9084 interact competitively with [³H]flunitrazepam for brain benzodiazepine receptors. Based upon these findings, we propose the hypothesis that PK 8165 and PK 9084 act as partial agonists at the benzodiazepine receptor.     

Drug use and psychiatric symptoms in adolescence

Drug use and psychiatric symptoms were independently assessed in a random sample of 177 adolescents from a junior high school population. Pupils who used cigarettes, alcohol, cannabis, solutions (sniffing), and tranquilizers, all had higher frequencies of psychiatric symptoms than non-users. The use of alcohol was shown the lowest connection with psychiatric symptoms, especially among the males. Smoking was more frequent among the females, and the connection with psychiatric symptoms was stronger than in the males. The importance of both a clinical and a public health approach to drug use in this age group is stressed.     

Memory dysfunction in panic disorder: an investigation of the role of chronic benzodiazepine use

Background: Studies of the neurocognitive effects of long‐term benzodiazepine use have been confounded by the presence of neurocognitive deficits characterizing the clinical conditions for which these medications are taken. Similarly, studies of the neurocognitive effects of anxiety disorders have been confounded by the inclusion of chronically benzodiazepine‐medicated patients. This study was designed to tease apart the potentially confounding effects of long‐term benzodiazepine use and panic disorder (PD) on memory and visuoconstructive abilities. Methods: Twenty chronically benzodiazepine‐medicated and 20 benzodiazepine‐free patients with PD with agoraphobia were compared with a group of 20 normal control participants, group‐matched for age, education, and gender on a battery of neuropsychological tests assessing short‐term, episodic long‐term, and semantic memory, as well as visuoconstructive abilities. Results: Results indicated that benzodiazepine‐free panic patients were relatively impaired in nonverbal short‐term and nonverbal episodic long‐term memory and visuoconstructive abilities, whereas verbal short‐term and verbal episodic memory and semantic memory were preserved. Only limited evidence was found for more pronounced impairments in chronically benzodiazepine‐medicated PD patients. Conclusions: This study provides evidence that patients with PD are characterized by relative impairments in nonverbal memory and visuoconstructive abilities, independent of benzodiazepine use. Nonetheless, we found evidence that chronic treatment with benzodiazepines is associated with intensification of select relative impairments in this realm. Documentation of these deficits raises questions about the broader etiology of neurocognitive impairment in PD as well as its impact on daily functioning. Depression and Anxiety, 2011. © 2011 Wiley Periodicals, Inc.     

Therapeutic effects of fengabine, a new GABAergic agent, in depressed outpatients: a double-blind study versus clomipramine

The results of a double-blind clinical trial of fengabine vs clomipramine in depressed outpatients are reported. Fengabine, a new GABAergic agent, seems to be as effective as the reference drug, with a faster onset of action and a more marked effect on cognitive disturbances and retardation. The new drug is free of any significant anticholinergic or cardiovascular effect, and it is not sedative.     

Pharmacological studies on stress-induced renin and prolactin secretion: Effects of benzodiazepines, Naloxone, propranolol and diisopropyl fluorophosphate

Stress-induced renin and prolactin secretion was investigated using a conditioned emotional response paradigm. Three minutes after placement in a chamber the rats received an electric shock to their feet via the grid floor, then were immediately returned to their home cage. This procedure was repeated for 3 consecutive days. On the fourth day, instead of receiving an electric shock, they were removed after 3 min and sacrificed by decapitation. Control rats were treated identically with the exception that shock was not administered at any time. There was a significant increase in plasma renin activity and prolactin level in the stressed rats. The administration of the antianxiety drugs chlordiazepoxide (10 mg/kg i.p.) or midazolam (0.125-2 mg/kg i.p.) blocked the stress-induced increase in prolactin levels but not the stress-induced rise in plasma renin activity. Administration of the beta-blocker propranolol (1 mg/kg i.p.) inhibited, but did not completely block, stress-induced rise in plasma-renin activity and had no effect on stress-induced prolactin secretion. The opiate antagonist naloxone (0.1-10 mg/kg i.p.) and the acetylcholinesterase inhibitor diisopropyl fluorophosphate (0.5 mg/kg i.p.) did not block stress-induced renin or prolactin secretion. It is concluded that stress-induced prolactin secretion is regulated by a benzodiazepine-mediated mechanism and that stress-induced renin but not prolactin secretion is mediated in part via beta-receptors.     

Reasons for using substances in adolescents with and without psychosis

Aim: To increase our understanding of substance use among adolescents with psychosis by comparing their reasons for use with those of typically developing adolescents. Methods: Participants were 35 outpatient adolescents, recently admitted for a first episode of psychosis to an early psychosis programme, and 35 typically developing adolescents. Measures used included the Personal Experience Screening Questionnaire and Reasons for Use Scale. Results: Adolescents with psychosis used significantly more substances than adolescents without psychosis (P < 0.01). Reasons for use in the two groups were similar. Conclusions: Although adolescents with psychosis report using substances for the same reasons as other adolescents, they may also use to self‐medicate secondary morbidity associated with psychosis. These results have a number of implications for prevention and treatment.     

The Relationship Between Mindfulness,Depressive Symptoms,and Non-Suicidal Self-Injury Amongst Adolescents

Mindfulness is often part of treatment for non-suicidal self-injury (NSSI); however, there has been limited research examining the role of mindfulness in NSSI. Thus, the current study sought to investigate the relationship among mindfulness, depressive symptoms, and NSSI (past year) in adolescents (N = 764; 56.8% female, M age = 14.42, SD = 0.64) with consideration of gender. Adolescents with recent NSSI (n = 74; 83.8% female, M age = 14.36, SD = 0.56) and a matched for age and gender no-NSSI group completed measures of mindfulness and depression. Findings revealed that mindfulness and depressive symptoms were negatively correlated, although significantly less so for the NSSI group. Second, the NSSI group reported greater depressive symptoms and less mindfulness. Finally, mindfulness was found to partially mediate the effect of depressive symptoms on NSSI. The present study is the first to provide empirical support for the protective role of mindfulness in NSSI.     

Self-Harm in Adolescents: A Self-Report Survey in Schools from Lisbon,Portugal

The study aims to determine the prevalence of self-harm (SH) and related psychosocial factors in a large sample of Portuguese adolescents. A total of 1,713 pupils, aged 12 to 20 years, completed an anonymous questionnaire in a school setting. In all, 7.3% reported at least 1 episode of SH: rates were 3 times higher for females than males. Almost half reported repeated SH, most commonly self-cutting. Anxiety, depression, and substance abuse were linked to SH, and particularly repeated SH. Anxiety, trouble with the police, and exposure to SH or suicide of others, were independently associated with SH in both genders. These findings indicate that SH is a public health concern in Portugal as in other European countries.