"These evidence-based guidance recommendations were derived from current scientific evidence (by means of a systematic literature search – detailed below) in addition to expert experience and consensus. This position statement was developed by the EPA in accordance with the available international guidelines on tobacco withdrawal     . This statement aims to summarise the current knowledge about tobacco dependence and withdrawal in patients with mental illness and to give recommendations for the core components of diagnostics and treatment in this patient group. "
[Show abstract][Hide abstract] ABSTRACT: Tobacco dependence is the most common substance use disorder in adults with mental illness. The prevalence rates for tobacco dependence are two to four times higher in these patients than in the general population. Smoking has a strong, negative influence on the life expectancy and quality of life of mental health patients, and remains the leading preventable cause of death in this group. Despite these statistics, in some countries smokers with mental illness are disadvantaged in receiving intervention and support for their tobacco dependence, which is often overlooked or even tolerated. This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well-being of patients suffering from mental illness.
European Psychiatry 01/2014; 29(2). DOI:10.1016/j.eurpsy.2013.11.002 · 3.44 Impact Factor
"To this end, sP rats were exposed to the " alcohol deprivation effect " (ADE) paradigm, a validated animal model of relapse episodes occurring in human alcoholics. Relapse to heavy alcohol drinking, together with loss of control over alcohol, represent the core features of alcohol addiction in humans (see Morse and Flavin, 1992; Kleber et al., 2007). ADE is defined as the temporary increase in alcohol drinking occurring after a period of alcohol abstinence (see Spanagel, 2005; Martin-Fardon and Weiss, 2013). "
[Show abstract][Hide abstract] ABSTRACT: γ-Hydroxybutyric acid (GHB) reduces (a) alcohol intake and alcohol motivational properties in alcohol-preferring rats and (b) alcohol drinking and craving for alcohol in human alcoholics. The present study was designed to extend to relapse-like drinking the capacity of GHB to suppress different alcohol-related behaviors in alcohol-preferring rats. The "alcohol deprivation effect," defined as the temporary increase in alcohol intake occurring in laboratory animals after a period of alcohol deprivation, was used as model of alcohol relapse. Acute administration of non-sedative doses of GHB (0, 100, 200, and 300 mg/kg, i.p.) resulted in the complete suppression of the extra-amount of alcohol consumed by Sardinian alcohol-preferring rats during the first hour of re-access to alcohol after a 14-day period of deprivation. These data demonstrate that GHB suppressed relapse-like drinking in a rat model of excessive alcohol consumption.
Frontiers in Psychiatry 11/2012; 3:95. DOI:10.3389/fpsyt.2012.00095
"Treatment settings for opioid-related disorders include inpatient units and outpatient clinics and offi ces, opioid agonist substitution programmes, selfhelp groups and therapeutic communities (Kleber et al. 2007). The choice of treatment setting depends on the patient ' s preferences and treatment needs. "
[Show abstract][Hide abstract] ABSTRACT: To develop evidence-based practice guidelines for the pharmacological treatment of opioid abuse and dependence.
An international task force of the World Federation of Societies of Biological Psychiatry (WFSBP) developed these practice guidelines after a systematic review of the available evidence pertaining to the treatment of opioid dependence. On the basis of the evidence, the Task Force reached a consensus on practice recommendations, which are intended to be clinically and scientifically meaningful for physicians who treat adults with opioid dependence. The data used to develop these guidelines were extracted primarily from national treatment guidelines for opioid use disorders, as well as from meta-analyses, reviews, and publications of randomized clinical trials on the efficacy of pharmacological and other biological treatments for these disorders. Publications were identified by searching the MEDLINE database and the Cochrane Library. The literature was evaluated with respect to the strength of evidence for efficacy, which was categorized into one of six levels (A-F).
There is an excellent evidence base supporting the efficacy of methadone and buprenorphine or the combination of buprenorphine and naloxone for the treatment of opioid withdrawal, with clonidine and lofexidine as secondary or adjunctive medications. Opioid maintenance with methadone and buprenorphine is the best-studied and most effective treatment for opioid dependence, with heroin and naltrexone as second-line medications.
There is enough high quality data to formulate evidence-based guidelines for the treatment of opioid abuse and dependence. This task force report provides evidence for the efficacy of a number of medications to treat opioid abuse and dependence, particularly the opioid agonists methadone or buprenorphine. These medications have great relevance for clinical practice.
The World Journal of Biological Psychiatry 04/2011; 12(3):160-87. DOI:10.3109/15622975.2011.561872 · 4.18 Impact Factor
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