Randomized Clinical Trial of Supervised Tapering and Cognitive Behavior Therapy to Facilitate Benzodiazepine Discontinuation in Older Adults With Chronic Insomnia

Morin, Charles M.; Bastien, Célyne; Guay, Bernard; Radouco-Thomas, Monelly; Leblanc, Jacynthe; Vallières, Annie

doi:10.1176/appi.ajp.161.2.332

Cited by 260 publications

(196 citation statements)

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“…Although there is clear evidence of the risks associated with long-term use of hypnotic/anxiolytic drugs, stopping these treatments may also expose patients to rebound anxiety, withdrawal syndrome, and the social consequences of untreated anxiety disorders. [52][53][54] Thus, efforts to reduce the risks associated with long-term use of psychotropics should be balanced with the risks associated with psychotropic withdrawal.…”

Section: Implications For Future Research and Clinical Practicementioning

confidence: 99%

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Lasserre

Younès

Blanchon³

et al. 2010

Br J Gen Pract

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The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. AimTo analyse discrepancies between GPs' opinions and practice when prescribing psychotropic drugs to older patients. SettingPostal surveys sent to GPs all over mainland France. Design of studyCross-sectional postal study. MethodA questionnaire collected data on characteristics of GPs' practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day. ResultsA total of 350 participating GPs saw 2498 patients aged ≥65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients' refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). ConclusionA mismatch exists between GPs' intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged ≥65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.

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Section: Implications For Future Research and Clinical Practicementioning

confidence: 99%

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Lasserre

Younès

Blanchon³

et al. 2010

Br J Gen Pract

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“…However, there are limitations to the generalizability of these trials, including restrictive entry criteria, usually focusing on a specific anxiety disorder or insomnia with current mood disorders as exclusion criteria. [14][15][16][17] In addition, there is low accrual in these trials, with sometimes hundreds of potential participants contacted to yield a small sample, both eligible and accepting of the intervention. Substantial attrition further reduces final samples, limiting the scope, and perhaps, biasing the results.…”

Section: Introductionmentioning

confidence: 99%

Older Patient Perspectives on Long-Term Anxiolytic Benzodiazepine Use and Discontinuation: A Qualitative Study

et al. 2007

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OBJECTIVE:The objective of the study is to understand patient factors contributing to the chronicity of benzodiazepine use by older adults as a first step in the development of acceptable intervention strategies for taper/discontinuation or prevention of chronic use. DESIGN:The design of the study consists of qualitative semi-structured patient interviews. SETTING AND PARTICIPANTS:The participants were 50 anxiolytic benzodiazepine users, 61-95 years of age, recruited through referrals from primary care physicians who practiced in the general Philadelphia, Pennsylvania area.RESULTS: Many older chronic users have come to rely and psychologically depend on benzodiazepines for their unique soothing properties, attributing to these medications characteristics that extend beyond an ordinary medication, i.e., affording control over daily stress, bringing tranquility, and even prolonging life. Most of the patients denied or minimized side effects and expressed resistance to taper or discontinuation, ranging from subtle reluctance to outright refusal and fear of being left suffering without these medications. CONCLUSIONS:The reluctance of older chronic benzodiazepine users to taper or discontinue use highlights the importance of prevention and early intervention strategies to avoid the development of chronic use. Suggestions for curbing chronic use are presented.

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“…Age can be a strong predictor of the long-term consumption of benzodiazepines (28), however, this was not observed in this study, although a tendency can be seen in this sense. All other factors analyzed, sex, marital status, and education level (29,30,31,32,33) are indicated as risk factors for benzodiazepine consumption, but not for prolonged use. These results of this study are in agreement with the generality of other studies found, except the education level, which does not present significant differences.…”

Section: Discussionmentioning

confidence: 93%

“…A idade será um forte preditor do consumo de longo termo de benzodiazepinas (28) o que de facto não acontece neste estudo, ainda que se possa descortinar uma tendên-cia nesse sentido. Todos os outros fatores analisados, sexo, estado civil e escolaridade (29,30,31,32,33) são indicados como fatores de risco para o consumo de benzodiazepinas, ainda que não para tempos de utilização prolongados. Os resultados obtidos neste estudo vão no mesmo sentido, exceto ao nível da escolaridade, que neste caso não apresenta grandes diferenças.…”

Section: Discussionunclassified

The benzodiazepines use and psychological intervention in a Porto health center

Regalado

Rocha

Duarte

et al. 2017

BBR

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161 Biomedical and Biopharmaceutical Research J o r n a l d e I n v e s t i g a ç ã o B i o m é d i c a e B i o f a r m a c ê u t i c a The benzodiazepines use and psychological intervention in a Porto health center AbstractThe misuse of benzodiazepines is a well know public health problem. For this reason, it is more and more relevant to monitor misuse and try to implement solutions. We aim to understand the use of benzodiazepines in a health center population in the city of Porto, as well the connections with present, past and future psychological intervention. We have built a questionnaire to assess usage of both benzodiazepines and psychological services. Our sample population included individuals older than 18 years who picked up our questionnaire in health center waiting rooms. A total of 352 participants, 258 females and 92 males, answered the questionnaire.Results points to an excessive use of benzodiazepines, especially in older persons, divorced or widowed, and females. We found a significant association between the current interest in receiving psychological intervention and the use of benzodiazepines. In the same way, the participants who have received psychological intervention use benzodiazepines less in comparison to the participants who are still receiving psychological intervention. In conclusion, there is an abuse of benzodiazepines in this health center, and few access to psychological intervention that may have good results reducing benzodiazepines abuse. Keywords: psychological intervention; benzodiazepines; primary health careResumo O uso inadequado de benzodiazepinas é um problema de saúde pública bem conhecido e, por isso, é particularmente relevante a sua monitorização e a implementação de soluções adequadas. Pretendemos conhecer a realidade dos utentes de um Centro de Saúde na Cidade do Porto relativamente ao consumo de benzodiazepinas, bem como a sua relação com o acompanhamento psicológico passado, atual ou futuro por parte dos mesmos. Foi construído um inquérito por questionário. Foi aplicado a indivíduos com mais de 18 anos nas salas de espera do Centro de Saúde. Responderam ao questionário 352 participantes, dos quais 258 mulheres e 92 homens. Os resultados obtidos apontam para um consumo excessivo de benzodiazepinas com predominância nas pessoas com mais idade, divorciadas ou viúvas, e do sexo feminino. Verificou-se uma associação significativa entre o interesse atual em ter acompanhamento psicológico e o consumo de benzodiazepinas. Os utentes que beneficiaram de acompanhamento psicológico consomem menos benzodiazepinas, quando comparados com os que ainda estão em acompanhamento. Em conclusão, pode salientar-se que existe um consumo desproporcionado de benzodiazepinas nos cuidados de saúde primários, havendo um acesso reduzido à intervenção psicológica que pode apresentar bons resultados ao nível da redução da utilização destes fármacos.Palavras-chave: acompanhamento psicológico; benzodiazepinas; cuidados de saúde primários

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Randomized Clinical Trial of Supervised Tapering and Cognitive Behavior Therapy to Facilitate Benzodiazepine Discontinuation in Older Adults With Chronic Insomnia

Cited by 260 publications

References 0 publications

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Older Patient Perspectives on Long-Term Anxiolytic Benzodiazepine Use and Discontinuation: A Qualitative Study

The benzodiazepines use and psychological intervention in a Porto health center

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