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- ItemAcesso aberto (Open Access)The brain decade in debate: II. Panic or anxiety? From animal models to a neurobiological basis(Associação Brasileira de Divulgação Científica, 2001-02-01) Andreatini, R.; Blanchard, C.; Blanchard, R.; Brandão, M.l.; Carobrez, A.p.; Griebel, G.; Guimarães, F.s.; Handley, S.l.; Jenck, F.; Leite, Jose Roberto [UNIFESP]; Rodgers, J.; Schenberg, L.c.; Da Cunha, C.; Graeff, F.g.; Universidade Federal do Paraná Departamento de Farmacologia Laboratório de Fisiologia e Farmacologia do Sistema Nervoso Central; University of Hawaii Department of Neurobiology; University of Hawaii Department of Psychology; Universidade de São Paulo (USP); Universidade Federal de Santa Catarina Departamento de Farmacologia; Central Nervous System Research Department Sanofi Synthelabo; Aston University Institute of Pharmaceutical Sciences; Hoffmann-La Roche Ltd.; Universidade Federal de São Paulo (UNIFESP); University of Leeds Department of Psychology Ethopharmacology Laboratory; Universidade Federal do Espírito Santo Centro de Biomedicina Departamento de Ciências FisiológicasThis article is a transcription of an electronic symposium sponsored by the Brazilian Society of Neuroscience and Behavior (SBNeC). Invited researchers from the European Union, North America and Brazil discussed two issues on anxiety, namely whether panic is a very intense anxiety or something else, and what aspects of clinical anxiety are reproduced by animal models. Concerning the first issue, most participants agreed that generalized anxiety and panic disorder are different on the basis of clinical manifestations, drug response and animal models. Also, underlying brain structures, neurotransmitter modulation and hormonal changes seem to involve important differences. It is also common knowledge that existing animal models generate different types of fear/anxiety. A challenge for future research is to establish a good correlation between animal models and nosological classification.
- ItemSomente MetadadadosCan valerian improve the sleep of insomniacs after benzodiazepine withdrawal?(Elsevier B.V., 2002-04-01) Poyares, Dalva R. [UNIFESP]; Guilleminault, C.; Ohayon, M. M.; Tufik, Sergio [UNIFESP]; Stanford Univ; Universidade Federal de São Paulo (UNIFESP)Purpose: the authors studied the sleep of patients with insomnia who complained of poor sleep despite chronic use of benzodiazepines (BZDs). the sample consisted of 19 patients (mean age 43.3 +/- 10.6 years) with primary insomnia (DSM-IV), who had taken BZDs nightly, for 7.1 +/- 5.4 years. the control group was composed of 18 healthy individuals (mean age 37:E 8 years). Sleep electroencephalogram (EEG) of the patients was analyzed with period amplitude analysis (PAA) and associated algorithms, during chronic BZD use (Night 1), and after 15 days of a valerian placebo trial (initiated after washout of BZD, Night 2). Sleep of control subjects was monitored in parallel. Results: Valerian subjects reported significantly better subjective sleep quality than placebo ones, after BZD withdrawal, despite the presence of a few side effects. However, some of the differences found in sleep structure between Night I and Night 2 in both the valerian and placebo groups may be due to the sleep recovery process after BZD washout. Example of this are: the decrease in Sleep Stage 2 and in sigma count; the increase in slow-wave sleep (SWS), and delta count, which were found to be altered by BZD ingestion. There was a significant decrease in wake time after sleep onset (WASO) in valerian subjects when compared to placebo subjects; results were similar to normal controls. Nonetheless, valerian-treated patients also presented longer sleep latency and increased alpha count in SWS than control subjects. Conclusions: the decrease in WASO associated with the mild anxiolytic effect of valerian appeared to be the major contributor to subjective sleep quality improvement found after 2-week of treatment in insomniacs who had withdrawn from BDZs. Despite subjective improvement, sleep data showed that valerian did not produce faster sleep onset; the increase in alpha count compared with normal controls may point to residual hyperarousabilty, which is known to play a role in insomnia. Nonetheless, we lack data on the extent to which a sedative drug can improve alpha sleep EEG. Thus, the authors suggest that valerian had a positive effect on withdrawal from BDZ use. (C) 2001 Elsevier Science Inc. All rights reserved.
- ItemSomente MetadadadosClinical profile of menopausal insomniac women referred to sleep laboratory(Taylor & Francis As, 2009-01-01) Hachul, Helena [UNIFESP]; Brandao, Leticia de C. [UNIFESP]; Bittencourt, Lia R. A. [UNIFESP]; D'Almeida, Vania [UNIFESP]; Andersen, Monica L. [UNIFESP]; Baracat, Edmund C. [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective. the primary purpose of this study was to assess the overall clinical profile of menopausal women complaining of insomnia who were referred to a sleep laboratory. Methods. A total of 206 menopausal women who had complaints related to insomnia were interviewed. Each participant completed a questionnaire in order to obtain data on general health, menopausal status, medications, and sleep patterns. Results. the mean age of the participants was 55.9 years. Clinical profiles revealed that the most prevalent health problems were systemic arterial hypertension (33.9%) and osteoporosis (19%), though there was no association between insomnia and incidence of chronic disease. Our data demonstrate an overall prevalence of insomnia of 4-5 times a week in 62% of the women, with 68.9% complaining of hot flashes. However, there was no association between hot flashes and frequency of insomnia across the menopausal transition period. Only 7% of women had already undergone polysomnography. Less than 5% of the participants were undergoing treatment for menopause, while 8% were taking benzodiazepines for sleep problems. Conclusions. This study provides evidence that insomnia in postmenopausal women was not associated with incidence of chronic disease. in addition, the majority of the participants were not undergoing treatment for menopause or for sleep disturbance.
- ItemAcesso aberto (Open Access)Clonazepam, um campeão de vendas no Brasil. Por quê?(Universidade Federal de São Paulo (UNIFESP), 2016-06-01) Cruz, Nelma Lourenco de Matos [UNIFESP]; Carlini, Elisaldo Luiz de Araujo [UNIFESP]; http://lattes.cnpq.br/5948335656347039; http://lattes.cnpq.br/8459051263596166; Universidade Federal de São Paulo (UNIFESP)Clonazepam, a benzodiazepine, is the leading seller in Brazil and the most consumed version of Ordinance 344/98. It is used in the treatment of central nervous system disorders including epilepsy, anxiety, social phobia, insomnia, affective bipolar disorders, panic disorders and akathisia. Clonazepam has high therapeutic efficacy, low toxicity and can lead to dependence after six to eight weeks of use – withdrawal symptoms may occur if there is abrupt discontinuation of use, even in therapeutic doses. This study aims to analyse the various reasons for high sales and consumption of the drug in Brazil. Methodology: the high consumption of clonazepam is a phenomenon of unknown causes and effects; therefore, qualitative research was employed. The focus groups of nineteen patients, five doctors and four pharmacists was formed within two research sites: Funilândia (Minas Gerais) and São Paulo (São Paulo). Interviews were conducted with semi-structured scripts and content analysis with the help of NVivo software. Results – Patients: After use of Clonazepam, patients declared feeling symptoms of sleepiness, relaxation, comfort and security. The range of dosage patients self-administer can be dependent on the emotional state of the users, who do not report taking high doses of clonazepam. The period of use of the drug among patients was up to fifteen years. Information is exchanged between users, and many of them are friends or relatives. Many of them reported being able to get a prescription for clonazepam without receiving medical consultation. Many patients also tried to stop the use of the drug, but were not able to. All of them reported never having received guidance from pharmacists, and only a few received instruction from doctors. Doctors: The main stated reason for prescribing the drug to patients was “renewing a previous prescription from another doctor”. They also declared that were aware of the dosage flexibility, but that the patients do not abusive it. Doctors trust the drug and find it safe, believing that patients use Clonazepam in order to treat ‘problems’. Pharmacists: Pharmacists do not feel co-responsible for the prescription of Clonazepam. They believe that the control of sales of the drug is inefficient and easy to get around – there have been sales of the drug without the correct prescription produced. One of the pharmacists in the study declared that they sell the drug without prescription, something that was witnessed during during the interview. Pharmaceutical laboratories - were not forthcoming in their interest to be a part of the research, and they refused the invitation to participate. Conclusions: The abuse and misuse of Clonazepam is a public health problem. The results of the research indicate failure in the use, the prescription, and the control of sales of Clonazepam. It is necessary to restructure systems that monitor the production, prescription and sales of the drug. Refresher training for health professionals should be encouraged in order to promote rational and sensible use of medicines, especially in the case of psychotropic medicine. Finally, there should be further promotion of actions aimed at users of Clonazepam seeking to educate them about the benefits and risks of using such drugs, self-medication and appropriate use of medicines.
- ItemSomente MetadadadosA double-dissociation of behavioural and event-related potential effects of two benzodiazepines with similar potencies(Sage Publications Ltd, 2000-09-01) Pompeia, S.; Bueno, OFA; Lucchesi, L. M.; Manzano, G. M.; Galduroz, JCF; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This study was designed to explore the role of benzodiazepine affinity to benzodiazepine binding site on acute psychomotor, subjective and memory effects, as well as auditory Event Related Potential (ERP) latencies, in healthy volunteers. Two benzodiazepines with similar affinity to benzodiazepine binding sites, or potency, were compared: the atypical compound lorazepam (2.0 mg), which has been reported to impair priming, and a standard benzodiazepine, flunitrazepam (0.6 mg, 0.8 mg, 1.0 mg). The study followed a placebo-controlled, double-blind, parallel-group design. Sixty subjects completed a test battery before treatment and at theoretical peak plasma concentration of drugs. Lorazepam and 1.0 mg of flunitrazepam led to comparable alterations on psychomotor, subjective and auditory episodic memory measures. A double-dissociation was found for lorazepam and the equipotent dose of flunitrazepam (1.0 mg): lorazepam was more deleterious than flunitrazepam in time taken to identify fragmented shapes. Lorazepam also impaired direct and indirect stem-completion in comparison to placebo, but this effect was abolished when time to identify shapes was used as a covariate. By contrast, 1.0 mg of flunitrazepam prolonged auditory ERP latencies to a greater extent than lorazepam. High affinity to the benzodiazepine binding sites does not seem to explain the consistent lorazepam-induced impairment of indirect stem-completion. Differences in impairment profile between the benzodiazepines employed may relate to the modality (visual or not) of the tasks used.
- ItemSomente MetadadadosEffects of a benzodiazepine on free recall of semantically related words(Wiley-Blackwell, 2006-07-01) Lemos Nogueira, Ana Maria; Pompeia, Sabine; Galduroz, Jose Carlos F.; Bueno, Orlando F. A.; Universidade Federal de São Paulo (UNIFESP)Although it is widely known that benzodiazepines impair episodic memory, few studies have investigated their effects upon specific processes involved in free recall. This study evaluated the acute effects of flunitrazcpam (1.0 mg; 1.3 mg) and placebo in healthy volunteers on immediate and delayed free recall of word lists considering serial positions as well as semantic relations between words inserted in the middle of the lists (e.g. milk-cheese-butter). Flunitrazepam promoted a global amnestic effect, impairing recall in all serial positions except the last words (recency effect). Primacy and recency effects were preserved as indexed, respectively, by larger recall of the first and last words in relation to adjacent items. Facilitation in recall of semantically related words was not impaired by the drug when compared to recall in adjacent positions, in spite of a dose-dependent diminution of the number of words recalled also in mid-list positions. Flunitrazepam -induced deficits were interpreted as impairment in the formation of new associations between items, or groups of items in the case of related words, and context. Copyright (c) 2006 John Wiley & Sons, Ltd.
- ItemSomente MetadadadosEffects of lorazepam on visual perceptual abilities(Wiley-Blackwell, 2008-04-01) Pompeia, S. [UNIFESP]; Pradella-Hallinan, M. [UNIFESP]; Manzano, G. M. [UNIFESP]; Bueno, O. F. A. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective To evaluate the effects of an acute dose of the benzodiazepine (BZ) lorazepam in young healthy volunteers on five distinguishable visual perception abilities determined by previous factor-analytic studies.Methods This was a double-blind, cross-over design study of acute oral doses of lorazepam (2 mg) and placebo in young healthy volunteers. We focused on a set of paper-and-pencil tests of visual perceptual abilities that load on five correlated but distinguishable factors (Spatial Visualization, Spatial Relations, Perceptual Speed, Closure Speed, and Closure Flexibility). Some other tests (DSST, immediate and delayed recall of prose; measures of subjective mood alterations) were used to control for the classic BZ-induced effects.Results Lorazepam impaired performance in the DSST and delayed recall of prose, increased subjective sedation and impaired tasks of all abilities except Spatial Visualization and Closure Speed. Only impairment in Perceptual Speed (Identical Pictures task) and delayed recall of prose were not explained by sedation.Conclusion Acute administration of lorazepam, in a dose that impaired episodic memory, selectively affected different visual perceptual abilities before and after controlling for sedation. Central executive demands and sedation did not account for results, so impairment in the Identical Pictures task may be attributed to lorazeparn's visual processing alterations. Copyright (c) 2008 John Wiley & Sons, Ltd.
- ItemSomente MetadadadosFlunitrazepam-induced changes in neurophysiological, behavioural, and subjective measures used to assess sedation(Elsevier B.V., 2003-05-01) Lucchesi, Lígia M. [UNIFESP]; Pompeia, Sabine [UNIFESP]; Manzano, Gilberto M. [UNIFESP]; Kohn, A. F.; Galduroz, José CF [UNIFESP]; Bueno, Orlando FA [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Introduction: Certain features of event-related potentials (ERPs), electroencephalographic (EEG), and behavioural measures vary with differing states of alertness and/or sedation. Purpose: This study was conducted to investigate changes in several measures usually viewed as reflecting states of sedation/sleepiness associated with the use of a range of doses of the hypnotic benzodiazepine (BZD) flunitrazepam (FNZ). Methods: This was a double blind, independent group design study of the effects of acute oral doses of FNZ in young healthy volunteers. Forty-eight subjects were randomly allocated to one of four groups-FNZ (0.6, 0.8, and 1.0 mg) and placebo (PLAC)-and tested prior to treatment and then in a posttreatment session close to the theoretical peak plasma concentration. ERP latencies and amplitudes were measured at midfrontal (Fz), midcentral (Cz), and midparietal (Pz) using a standard auditory oddball paradigm. EEG changes were assessed at Pz. Behavioural measures included the digit-symbol substitution test (DSST), a cancellation task (CT), and subjective ratings of alertness and attentiveness by the subjects (SUB) and the experimenter (EXP). Results: FNZ led to psychomotor impairments and decreased alertness and attention; these effects were consistent with previous findings. A progressive, dose-related increase in P3 latency occurred in Fz, Cz, and Pz, and there was an increase in N1 (Fz, Cz) and N2 (Fz). N2-P3 amplitude decreased in Fz. EEG power bands beta 1 increased for the two highest doses, but no significant differences were noted in theta, delta, and alpha bands. P3 latencies, experimenter-rated levels of alertness, and DSST scores differentiated all three doses of FNZ from PLAC. Conclusion: the most sensitive measures used were P3 latencies of the ERPs (which varied with FNZ dose), DSST, and the experimenter-rated levels of alertness. However, we found no evidence for the assumption that one single phenomenon was reflected in all measures and different mechanisms were probably involved. Further experiments will be needed for more in-depth probing of the finer mechanisms underlying sedation/sleepiness and how they affect behavioural and eletrophysiological measures of the central nervous system (CNS) function. (C) 2003 Elsevier Science Inc. All rights reserved.
- ItemSomente MetadadadosHeightened aggression after chronic flunitrazepam in male rats: potential links to cortical and caudate-putamen-binding sites(Springer, 2008-04-01) Almeida, Rosa Maria M. de; Benini, Quelin; Betat, Juliana S.; Hipolide, Debora C. [UNIFESP]; Miczek, Klaus A.; Svensson, Anders I.; Univ Vale Rio dos Sinos; Universidade Federal de São Paulo (UNIFESP); Tufts Univ; Univ GothenburgRationale Higher doses of benzodiazepines induce sedation. However, in low to moderate doses, benzodiazepines can increase aggressive behavior both after acute and chronic administration. the determinants for increasing aggression after chronic intake of flunitrazepam, a so-called date rape drug, in violence-prone individuals are incompletely understood.Objectives the aim of this study is to assess the effects of acute and chronic treatment with flunitrazepam on male aggression in resident rats. We also examined possible changes in binding to benzodiazepine receptors throughout the brain of rats that display aggressive behavior after repeated flunitrazepam treatment using quantitative receptor autoradiography.Materials and methods the behaviors of the male Wistar resident rats (n=35) toward a male intruder were recorded for 10 min twice a week. the salient aggressive and non-aggressive elements in the resident rat's behavior were analyzed. Initially, the dose-dependent effects of flunitrazepam (0.01, 0.03, 0.1, 0.18, and 0.3 mg/kg) or vehicle were determined in all rats; subsequently, 0.3 mg/kg per day flunitrazepam was administered for 42 days (n=15), and a parallel group was treated with vehicle (n=20). After the chronic treatment, the flunitrazepam (0, 0.01, 0.03, 0.1, 0.18, and 0.3 mg/kg) effects were again assessed.Results the most significant finding is the escalation of aggression after chronic treatment with flunitrazepam. A previously sedative 0.3 mg/kg dose of flunitrazepam engendered very high levels of attack bites, sideways threats, and aggressive postures (total aggression) after 6 weeks of daily administration. Individual differences emerged, and these were associated with decreased binding to benzodiazepine receptors, mainly in the limbic structures such as the cingulate cortex (cingulate areas 1 and 2) and caudate-putamen (posterior part) of aggressive animals, suggesting that these areas are pivotal in the control of emotional and aggressive behavior.Conclusions Chronic flunitrazepam produces changes in receptor binding in discrete areas of the cingulate cortex and caudate-putamen that are proposed to be part of the mechanisms for increased expression of aggressive behavior.
- ItemSomente MetadadadosInternational prescribing practices in obsessive-compulsive disorder (OCD)(Wiley-Blackwell, 2016) Brakoulias, Vlasios; Starcevic, Vladan; Belloch, Amparo; Dell'Osso, Liliana; Ferrao, Ygor A.; Fontenelle, Leonardo F.; Lochner, Christine; Marazziti, Donatella; Martin, Andrew; Matsunaga, Hisato; Miguel, Euripedes C.; Reddy, Y. C. Janardhan; do Rosario, Maria C. [UNIFESP]; Shavitt, Roseli G.; Sundar, Arumugham Shyam; Stein, Dan Joseph; Viswasam, KirupamaniObjectivesTo assess rates of psychotropic medication use in patients with obsessive-compulsive disorder (OCD) in seven different countries on five continents and to compare these with international treatment guidelines. MethodsResearchers in the field of OCD were invited to contribute summary statistics on the characteristics of their patients with OCD and on their incidence of psychotropic use. Consistency of summary statistics across countries was evaluated. ResultsThe data came from Brazil (n=955), Italy (n=750), South Africa (n=555), Japan (n=382), Australia (n=213), India (n=202) and Spain (n=82). The majority (77.9%
- ItemSomente MetadadadosLorazepam induces an atypical dissociation of visual and auditory event-related potentials(Sage Publications Ltd, 2003-03-01) Pompeia, S.; Manzano, G. M.; Galduroz, JCF; Tufik, S.; Bueno, OFA; Universidade Federal de São Paulo (UNIFESP)Lorazepam has been reported to atypically disrupt visual processing compared to other benzodiazepines (BZs), but it is not known to what extent this effect extends to impairment in other modalities. Our objective was to compare the effects of lorazepam with those of flunitrazepam, a BZ with standard effects, on visual and auditory event-related potentials (ERPs) using the same paradigm. the study followed a placebo-controlled, double-blind, parallel group-design and involved single oral doses of lorazepam (2.0 mg), flunitrazepam (1.2 mg) and placebo. Thirty-six young, healthy subjects completed a test battery before and after treatment including classic behavioural tests, visual and auditory ERPs. Both drugs led to comparable alterations on behavioural tests and double-dissociations were found, indicating that the doses used were equipotent: lorazepam was more deleterious than flunitrazepam and placebo in fragmented shape identification, while simple reaction times were prolonged for flunitrazepam in comparison to lorazepam and placebo. Effects on P3 latencies were also distinct: alterations in both modalities for flunitrazepam were equivalent and greater than placebo's. in contrast, lorazepam at the frontal and central electrode sites led to greater changes in visual than in auditory latency, and also to longer visual latencies than flunitrazepam and placebo, but lorazepam's auditory latency effects were only different to placebo's at the parietal electrode site. Peripheral visual changes were not responsible for these effects. Differences in the impairment profile between equipotent doses of lorazepam and flunitrazepam suggests that lorazepam induces atypical central visual processing changes.
- ItemSomente MetadadadosStem-completion tasks (indirect, direct inclusion and exclusion) are differently affected by equipotent doses of lorazepam and flunitrazepam(Wiley-Blackwell, 2003-10-01) Pompeia, S.; Bueno, OFA; Galduroz, JCF; Tufik, S.; Universidade Federal de São Paulo (UNIFESP)This study was designed to explore the effects on performance in stem-completion tasks of two benzodiazepines (BZ) in equipotent doses: lorazepam, a drug that atypically disrupts perceptual priming, and flunitrazepam, a compound with standard BZ effects. the study followed a placebo-controlled, double-blind, parallel-group design. Thirty-six young and healthy subjects carried out three completion tasks at theoretical peak-plasma concentrations of drugs: (a) indirect tasks, in which the subjects were instructed to complete stems with the first word that came to mind; (b) direct inclusion tasks/cued recall, in which the participants had to try to use words seen at study as completions; and (c) direct exclusion tasks, in which words seen at study were to be avoided. the PDP was applied to the results in the inclusion and exclusion tasks, to obtain indices of explicit/controlled (C) and implicit/automatic (A) memory. the C index was lowered by both BZs and A was equivalent in all treatments, confirming the general amnestic action of BZs. However, lorazepam led to decreases in completions in the indirect and inclusion tasks, while flunitrazepam impaired performance in the exclusion task. the qualitative differences between the drugs in their effects on performance suggest that these BZs may lead to differences in response bias. Copyright (C) 2003 John Wiley Sons, Ltd.
- ItemSomente MetadadadosStress-induced c-Fos expression is differentially modulated by dexamethasone, diazepam and imipramine(Nature Publishing Group, 2005-07-01) Medeiros, Magda Alves de; Reis, Luis Carlos; Mello, Luiz Eugênio Araujo de Moraes [UNIFESP]; UFRRJ; Universidade Federal de São Paulo (UNIFESP)Immobilization stress upregulates c-Fos expression in several CNS areas. Repeated stress or the use of drugs can modulate stress-induced c-Fos expression. Here, we investigated in 40 different areas of the rat brain the effects of dexamethasone (SDX, a synthetic glucocorticoid), diazepam (SBDZ, a benzodiazepine), and imipramine (IMI, an antidepressant) on the c-Fos expression induced by restraint stress. Wistar rats were divided into four groups and submitted to 20 days of daily injection of saline (three first groups) or imipramine, 15 mg/kg, i.p. On day 21, animals were submitted to injections of saline (somatosensory, SS), SDX (1 mg/kg, i.p.), SBDZ (5 mg/kg, i.p.), or IMI (15 mg/kg, i.p.) before being submitted to restraint. Immediately after stress, the animals were perfused and their brains processed with immunohistochemistry for c-Fos (Ab-5 Oncogene Science). Dexamethasone reduced stress- induced c-Fos expression in SS cortex, hippocampus, paraventricular nucleus of the hypothalamus (PVH), and locus coeruleus (LC), whereas diazepam reduced c-Fos staining in the SS cortex, hippocampus, bed nucleus of stria terminalis, septal area, and hypothalamus (preoptic area and supramammillary nucleus). Chronic administration of imipramine decreased staining in the hippocampus, PVH, and LC, while increasing it in the nucleus raphe pallidus. We conclude that dexamethasone, diazepam and imipramine differentially modulate stress-induced Fos expression. the present study provides an important comparative background that may help in the further understanding of the effects of these compounds and on the brain activation as well as on the behavioral, neuroendocrine, and autonomic responses to stress.
- ItemSomente MetadadadosUse of benzodiazepines in obsessive-compulsive disorder(Lippincott Williams & Wilkins, 2016) Starcevic, Vladan; Berle, David; do Rosario, Maria Conceicao [UNIFESP]; Brakoulias, Vlasios; Ferrao, Ygor A.; Viswasam, Kirupamani; Shavitt, Roseli; Miguel, Euripedes; Fontenelle, Leonardo F.This study aimed to determine the frequency of benzodiazepine (BDZ) use in a large sample of patients with obsessive-compulsive disorder (OCD) and ascertain the type of BDZ used and the correlates and predictors of BDZ use in OCD. The sample consisted of 955 patients with OCD from a comprehensive, cross-sectional, multicentre study conducted by the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders between 2003 and 2009. The rate of BDZ use over time in this OCD sample was 38.4%. Of individuals taking BDZs, 96.7% used them in combination with other medications, usually serotonin reuptake inhibitors. The most commonly used BDZ was clonazepam. Current age, current level of anxiety and number of additional medications for OCD taken over time significantly predicted BDZ use. This is the first study to comprehensively examine BDZ use in OCD patients, demonstrating that it is relatively common, despite recommendations from treatment guidelines. Use of BDZs in combination with several other medications over time and in patients with marked anxiety suggests that OCD patients taking BDZs may be more complex and more difficult to manage. This calls for further research and clarification of the role of BDZs in the treatment of OCD.
- ItemSomente MetadadadosUse of benzodiazepines in obsessive-compulsive disorder(Lippincott Williams & Wilkins, 2016) Starcevic, Vladan; Berle, David; do Rosario, Maria Conceicao [UNIFESP]; Brakoulias, Vlasios; Ferrao, Ygor A.; Viswasam, Kirupamani; Shavitt, Roseli; Miguel, Euripedes; Fontenelle, Leonardo F.This study aimed to determine the frequency of benzodiazepine (BDZ) use in a large sample of patients with obsessive-compulsive disorder (OCD) and ascertain the type of BDZ used and the correlates and predictors of BDZ use in OCD. The sample consisted of 955 patients with OCD from a comprehensive, cross-sectional, multicentre study conducted by the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders between 2003 and 2009. The rate of BDZ use over time in this OCD sample was 38.4%. Of individuals taking BDZs, 96.7% used them in combination with other medications, usually serotonin reuptake inhibitors. The most commonly used BDZ was clonazepam. Current age, current level of anxiety and number of additional medications for OCD taken over time significantly predicted BDZ use. This is the first study to comprehensively examine BDZ use in OCD patients, demonstrating that it is relatively common, despite recommendations from treatment guidelines. Use of BDZs in combination with several other medications over time and in patients with marked anxiety suggests that OCD patients taking BDZs may be more complex and more difficult to manage. This calls for further research and clarification of the role of BDZs in the treatment of OCD.
- ItemSomente MetadadadosZolpidem and memory: a study using the process-dissociation procedure(Springer, 2004-07-01) Pompeia, S.; Lucchesi, L. M.; Bueno, OFA; Manzano, G. M.; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Rationale. There is a dearth of studies which have employed sophisticated paradigms to investigate the effects of zolpidem on memory. Objectives. To explore anterograde cognitive deficits induced by acute oral doses of zolpidem by means of the process-dissociation procedure (PDP). Methods. the present study followed a placebo-controlled, double-blind, parallel-group design. Young, healthy females were randomly allocated to one of three treatments with 12 subjects each: placebo, 5 mg and 10 mg zolpidem. Two word-stem completion tasks were carried out close to theoretical peak-plasma concentration: a) direct inclusion task with cued recall, in which participants had to try to use words seen at study to complete stems; and b) direct exclusion task, in which words seen at study were to be avoided as completions. the PDP was applied to the results in these tasks to yield indices of explicit/controlled (C) and implicit/automatic (A) memory. Classical psychometric tests were also carried out. Results. Zolpidem 10 mg led to cognitive effects similar to benzodiazepines (except for the atypical lorazepam), including impairment of exclusion, but not inclusion-task performance. Results of the application of the PDP were inconclusive but concurred with the pattern established in previously published work on benzodiazepine effects, i.e. that zolpidem (10 mg) impaired C. Conclusions. Zolpidem leads to cognitive effects similar to most benzodiazepines. Although the application of PDP in drug studies may be counterproductive in view of methodological difficulties that are discussed, the pattern of effects on the stem-completion tasks involved in this paradigm is potentially useful in the investigation of cognitive effects of psychoactive drugs.