Showing papers by "Michael Soyka published in 2017"
TL;DR: Long-term use of benzodiazepines can lead to dependence and symptoms of withdrawal include anxiety, irritability, confusion, seizures, and sleep disorders.
Abstract: Long-term use of benzodiazepines can lead to dependence. Symptoms of withdrawal include anxiety, irritability, confusion, seizures, and sleep disorders. Withdrawal management relies on the use of a single agent (diazepam) and gradual dose reduction.
212 citations
University of Grenoble1, University of Bordeaux2, University of Manchester3, Central and North West London NHS Foundation Trust4, University of Helsinki5, University of Paris-Sud6, University of Oviedo7, University of Pisa8, Autonomous University of Barcelona9, Ludwig Maximilian University of Munich10
TL;DR: This work provides consensus recommendation on pharmacotherapy in OUD to assist clinicians with practical decision making in this field and helps to reduce risks of illicit opioid use, overdose mortality, infection with HIV or HCV, improving health, psychological and social outcomes.
Abstract: Introduction: Management of patients with opioid use disorder (OUD) commonly includes opioid agonist therapy (OAT) as a part of an integrated treatment plan. These interventions are associated with proven benefits to the individual and society.Areas covered: The use of methadone and buprenorphine within an integrated treatment plan in the management of patients with OUD: this work provides consensus recommendation on pharmacotherapy in OUD to assist clinicians with practical decision making in this field.Expert opinion: Pharmacotherapy is recommended as part of an integrated OUD treatment approach with psychosocial interventions, with the goal of reducing risks of illicit opioid use, overdose mortality, infection with HIV or HCV, improving health, psychological and social outcomes. Access to OAT should be prioritised in the treatment of OUD. Treatment choices in OUD pharmacotherapy should be based on the needs of the individual and characteristics of medications. Recommendations for choices of OAT...
89 citations
TL;DR: This paper discusses approved AUD medications, including the opioid antagonists naltrexone and nalmefene, the putative glutamate receptor antagonist acamprosate and the aldehyde dehydrogenase inhibitor disulfiram, and off-label medications of interest, including topiramate, gabapentin, ondansetron, varenicline, baclofen, sodium oxybate and antidepressants.
Abstract: Introduction: Only a few medications are available for the treatment of alcohol use disorders (AUDs).Areas covered: This paper discusses approved AUD medications, including the opioid antag...
75 citations
TL;DR: These practice guidelines for the biological treatment of alcohol use disorders are an update of the first edition published in 2008 and provide a clinically and scientifically relevant, evidence-based update of earlier recommendations.
Abstract: These practice guidelines for the biological treatment of alcohol use disorders are an update of the first edition, published in 2008, which was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). For this 2016 revision, we performed a systematic review (MEDLINE/PUBMED database, Cochrane Library) of all available publications pertaining to the biological treatment of alcoholism and extracted data from national guidelines. The Task Force evaluated the identified literature with respect to the strength of evidence for the efficacy of each medication and subsequently categorised it into six levels of evidence (A-F) and five levels of recommendation (1-5). Thus, the current guidelines provide a clinically and scientifically relevant, evidence-based update of our earlier recommendations. These guidelines are intended for use by clinicians and practitioners who evaluate and treat people with alcohol use disorders and are primarily concerned with the biological treatment of adults with such disorders.
54 citations
TL;DR: The study provides further evidence for the efficacy and safety of maintenance treatment with opioid agonists and changes in concomitant drug use and somatic and mental health.
Abstract: Background: In many countries, the opioid agonists, buprenorphine and methadone, are licensed for maintenance treatment of opioid dependence. Many short-term stud
44 citations
Virginia Commonwealth University1, Royal Brisbane and Women's Hospital2, Washington University in St. Louis3, Heidelberg University4, University Hospital Regensburg5, Ludwig Maximilian University of Munich6, Max Planck Society7, German Center for Neurodegenerative Diseases8, University of Bonn9, Boston University10, Texas Biomedical Research Institute11, Yale University12, University of Pennsylvania13, Veterans Health Administration14, Johns Hopkins University15, University of Southern California16
TL;DR: Despite nonreplication of COL6A3, KLF12, and RYR3 signals, orthologs of these genes influence behavioral response to EtOH in MOs, suggesting potential involvement in human EtOH response and AD liability.
Abstract: BackgroundAlcohol dependence (AD) shows evidence for genetic liability, but genes influencing risk remain largely unidentified. MethodsWe conducted a genomewide association study in 706 related AD cases and 1,748 unscreened population controls from Ireland. We sought replication in 15,496 samples of European descent. We used model organisms (MOs) to assess the role of orthologous genes in ethanol (EtOH)-response behaviors. We tested 1 primate-specific gene for expression differences in case/control postmortem brain tissue. ResultsWe detected significant association in COL6A3 and suggestive association in 2 previously implicated loci, KLF12 and RYR3. None of these signals are significant in replication. A suggestive signal in the long noncoding RNA LOC339975 is significant in case:control meta-analysis, but not in a population sample. Knockdown of a COL6A3 ortholog in Caenorhabditis elegans reduced EtOH sensitivity. Col6a3 expression correlated with handling-induced convulsions in mice. Loss of function of the KLF12 ortholog in C.elegans impaired development of acute functional tolerance (AFT). Klf12 expression correlated with locomotor activation following EtOH injection in mice. Loss of function of the RYR3 ortholog reduced EtOH sensitivity in C.elegans and rapid tolerance in Drosophila. The ryanodine receptor antagonist dantrolene reduced motivation to self-administer EtOH in rats. Expression of LOC339975 does not differ between cases and controls but is reduced in carriers of the associated rs11726136 allele in nucleus accumbens (NAc). ConclusionsWe detect association between AD and COL6A3, KLF12, RYR3, and LOC339975. Despite nonreplication of COL6A3, KLF12, and RYR3 signals, orthologs of these genes influence behavioral response to EtOH in MOs, suggesting potential involvement in human EtOH response and AD liability. The associated LOC339975 allele may influence gene expression in human NAc. Although the functions of long noncoding RNAs are poorly understood, there is mounting evidence implicating these genes in multiple brain functions and disorders.
41 citations
TL;DR: BUP differs significantly from MET in its pharmacology, side effects, and safety issues, but the risk of respiratory depression is lower than with MET, so decisions regarding the use of BUP or MET in opioid-dependent people are supported.
Abstract: Opioid maintenance treatment is the first-line approach in opioid dependence. Both the full opioid agonist methadone (MET) and the partial agonist buprenorphine (BUP) are licensed for the treatment of opioid dependence. BUP differs significantly from MET in its pharmacology, side effects, and safety issues. For example, the risk of respiratory depression is lower than with MET. The risk of diversion and injection of BUP have been reduced by also making it available as a tablet containing the opioid antagonist naloxone. This review summarizes the clinical effects of BUP and examines possible factors that can support decisions regarding the use of BUP or MET in opioid-dependent people.
18 citations
TL;DR: The efficacy of two inpatient treatment models for methamphetamine dependence are currently studied in a study funded by the German Ministry of health and possible implications are discussed.
Abstract: Following a short overview on the epidemiology and clinical correlates of amphetamine abuse and dependence, with special emphasis on metamphetamine ("crystal"), current treatment concepts and recent results of therapy research are discussed. The efficacy of two inpatient treatment models for methamphetamine dependence are currently studied in a study funded by the German Ministry of health. The study concept is given and possible implications are discussed.
13 citations
Heidelberg University1, University Hospital of Basel2, German Cancer Research Center3, University of Bonn4, University of Bern5, University of Regensburg6, University of Düsseldorf7, University of Mainz8, University of Duisburg-Essen9, Max Planck Society10, University of Cologne11, Dresden University of Technology12, Martin Luther University of Halle-Wittenberg13
TL;DR: The present study investigated the genetic contribution to alcohol dependence (AD) using genome-wide association data from three German samples, finding no association with ADH1B was found in the combined ACP + ALC sample, demonstrating the importance of large samples in which the phenotype is well assessed.
Abstract: The present study investigated the genetic contribution to alcohol dependence (AD) using genome-wide association data from three German samples. These comprised patients with: (i) AD; (ii) chronic alcoholic pancreatitis (ACP); and (iii) alcohol-related liver cirrhosis (ALC). Single marker, gene-based, and pathway analyses were conducted. A significant association was detected for the ADH1B locus in a gene-based approach (puncorrected = 1.2 × 10−6; pcorrected = 0.020). This was driven by the AD subsample. No association with ADH1B was found in the combined ACP + ALC sample. On first inspection, this seems surprising, since ADH1B is a robustly replicated risk gene for AD and may therefore be expected to be associated also with subgroups of AD patients. The negative finding in the ACP + ALC sample, however, may reflect genetic stratification as well as random fluctuation of allele frequencies in the cases and controls, demonstrating the importance of large samples in which the phenotype is well assessed.
10 citations
TL;DR: There is evidence that indicates that the German translation of the revised Trauma Symptom Inventory (TSI-2) is a reliable and valid instrument for the assessment of complex posttraumatic stress symptoms.
Abstract: The study aimed to validate the German version of the revised Trauma Symptom Inventory (TSI-2) by John Briere. TSI-2 assesses complex posttraumatic stress symptoms. In order to validate it, further instruments were applied, namely the Adverse Childhood Experience Scale, the CIDI list, the revised Impact of Event-Scale, the interview for complex posttraumatic stress disorder, the revised symptom checklist 90, the dissociative experiences scale, the inventory for interpersonal problems, and the self-efficacy questionnaire. The participants were N=100 traumatized psychiatric in-patients of a psychiatric hospital localized in the German-speaking part of Switzerland. The sample consisted of N=42 women. The study design was longitudinal with 2 assessments. The second assessment took place 4 weeks after the first, in order to investigate retest reliability. Here, N=17 patients participated, of whom N=8 were women. Regarding the results, on average, 3.5 aversive or traumatic experiences during childhood were reported, and 2,1 during adulthood. The diagnosis of (classical) PTSD was estimated at 33%. The results indicate that TSI-2 is both reliable and valid with respect to different criteria: Most scales and subscales of the TSI-2 showed acceptable to very good internal consistencies (α from 0.73 to 0.95) as well as good discriminatory power, and an acceptable retest reliability. Results also indicate good divergent and convergent construct validity as well as good criterion validity. It was not possible to replicate the 4-factor-model presented by the original author of the TSI-2. Instead, in line with the study that validated the German translation of the first version of the TSI-1, a 2-factor-model was found. There were gender differences regarding the TSI-2 scales with higher posttraumatic stress symptoms in women. In conclusion, there is evidence that indicates that the German translation of the TSI-2 is a reliable and valid instrument for the assessment of complex posttraumatic stress symptoms.
7 citations
TL;DR: To date there is no established pharmacotherapy for relapse prevention and the CANDIS protocol is the best established German intervention among abstinence-oriented therapies.
Abstract: Use and misuse of cannabis and marihuana are frequent. About 5% of the adult population are current users but only 1.2% are dependent. The medical use of cannabis is controversial but there is some evidence for improvement of chronic pain and spasticity. The somatic toxicity of cannabis is well proven but limited and psychiatric disorders induced by cannabis are of more relevance, e.g. cognitive disorders, amotivational syndrome, psychoses and delusional disorders as well as physical and psychological dependence. The withdrawal symptoms are usually mild and do not require pharmacological interventions. To date there is no established pharmacotherapy for relapse prevention. Psychosocial interventions include psychoeducation, behavioral therapy and motivational enhancement. The CANDIS protocol is the best established German intervention among abstinence-oriented therapies.
TL;DR: Missbrauch und Abhangigkeit of MethA werden bei Frauen von psychischen als auch sozialen Faktoren determiniert, um die Pravention, Beratung and Therapie zu verbessern.
Abstract: Gegenstand Methamphetamin (MethA) wird im Verhaltnis zu anderen illegalen Drogen tendenziell haufiger von Frauen als Mannern konsumiert. Unter Annahme des bio-psycho-sozialen Atiologie-Modells beruht die Abhangigkeit auf biologischen, psychischen und sozialen Faktoren, in denen sich Frauen und Manner unterscheiden. Systematische genderdifferenzierte Erkenntnisse, die einen wichtigen Einfluss auf therapeutische Masnahmen haben, fehlen allerdings noch. Methode Die Ubersicht basiert auf einer Datenbank-Recherche (PUBMED) zu biologischen, psychischen, sozialen sowie therapeutischen Aspekten bei von MethA abhangigen Frauen. Ergebnisse MethA-induzierte kognitive Storungen scheinen bei Frauen starker ausgepragt zu sein als bei Mannern. Ihr Lebensstil ist oft von aktiver und passiver (sexualisierter) Gewalt gepragt. Sie zeigen ein erhohtes sexuelles Risikoverhalten; v. a. durch ungeschutzten Verkehr mit mehreren Partnern. Psychiatrische Komorbiditaten scheinen quantitativ ausgepragter zu sein und betreffen v. a. Angststorungen und depressive Syndrome. Schlussfolgerung und Klinische Relevanz Missbrauch und Abhangigkeit von MethA werden bei Frauen von psychischen als auch sozialen Faktoren determiniert. Es bedarf aber weiterer gendersensibler Forschungen, um die Pravention, Beratung und Therapie zu verbessern.
TL;DR: Evaluation of cognitive functioning in formerly opioid-dependent adults after at least 1 year of abstinence found many cognitive functions were comparable between long-term abstainers and healthy controls, and few relevant differences.
Abstract: This study is an evaluation of cognitive functioning in formerly opioid-dependent adults after at least 1 year of abstinence. Participants (45 formerly opioid-dependent patients, referred to as abstainers, and 45 matched healthy controls) completed a structured screening and subsequent cognitive test battery covering intelligence, learning and memory, attention, and executive functions. Many cognitive functions were comparable between long-term abstainers and healthy controls, and we found few relevant differences. Long-term abstainers seem to have subtle deficits in recognition performance. Based on our and earlier findings, opioid maintenance treatment may be seen as relatively safe with respect to cognitive dysfunction and cognitive functioning is of great relevance for the rehabilitation and daily functioning of substance-dependent people.
TL;DR: Diese Studie untersuchte die Eignung der „Health of the Nation Outcome Scales“ (HoNOS) zur Erfassung des Verlauf and Schweregrad depressiver Symptomatik nur teilweise erfassen, sollten sie nur kombiniert mit anderen depressionsspezifischen Messinstrumenten angewendet werden.
Abstract: Ziel Diese Studie untersuchte die Eignung der „Health of the Nation Outcome Scales“ (HoNOS) zur Erfassung des Verlaufs depressiver Symptomatik und des Schweregrads der Depression im stationaren Setting. Methode Die Stichprobe umfasste 132 depressive Patienten (F32: n=102; F33: n=30). Die HoNOS wurden mittels bivariaten Korrelationen mit der selbstbeurteilten (BDI) und fremdbeurteilten Depressivitat (HAMD) verglichen. Die pradiktive Validitat wurde mit linearen Regressionsanalysen untersucht. Ergebnisse Die HoNOS differenzierten zwischen Patienten mit einer mittelgradigen versus schweren Depression (p 0,008). Die HoNOS sagten die Depressivitat bei Austritt nicht voraus (β=0,03, p>0,05). Schlussfolgerung Da die HoNOS den Verlauf und Schweregrad depressiver Symptomatik nur teilweise erfassen, sollten sie nur kombiniert mit anderen depressionsspezifischen Messinstrumenten angewendet werden.
TL;DR: Examination of the relationship between cumulative childhood traumatic events and adult sexual disturbances and the role of interpersonal sensitivity found it to be strong predictors of sexual disturbances, with interpersonal sensitivity partially mediating this relationship.
Abstract: Previous research has shown that cumulative childhood traumatic events are stronger predictors of sexual disturbances than childhood sexual abuse. Additional factors are likely to influence this relationship. Whereas socio-interpersonal factors such as interpersonal sensitivity have repeatedly been shown to be salutogenic in the aftermath of traumatic events, the specific underlying mechanisms are little understood. The aim of the present study was to examine the relationship between cumulative childhood traumatic events and adult sexual disturbances (i.e., the avoidance of sexual contacts, disruptive sexual behavior, poor sexual boundaries, decreased regulation of sexual impulses) and to investigate the role of interpersonal sensitivity as a potential mediator. The sample comprised 100 adult psychiatric in-patients. As expected, cumulative childhood traumatic events were found to be strong predictors of sexual disturbances, with interpersonal sensitivity partially mediating this relationship.
TL;DR: Eine Ubersicht uber die Wirkungen and die Verbreitung of (Psycho-)Stimulanzien zur Verbesserung kognitiver Funktionen bei Gesunden unter besonderer Berucksichtigung suchtmedizinischer Aspekte zu geben.
Abstract: Zusammenfassung. Zielsetzung: Ziel des Artikels ist es, dem Leser eine Ubersicht uber die Wirkungen und die Verbreitung von (Psycho-)Stimulanzien zur Verbesserung kognitiver Funktionen bei Gesunden (pharmakologisches kognitives Neuroenhancement [PCE]) unter besonderer Berucksichtigung suchtmedizinischer Aspekte zu geben. Methodik: Systematische Literaturrecherche via PubMed nach Psychostimulanzien („stimulants“), die zur geistigen Leistungssteigerung („cognitive enhancement“) eingesetzt werden, und Literaturrecherche in aktuellen Buchern aus dem Bereich Sucht. Ergebnisse: Nach heutigem Kenntnisstand spielt die Gruppe der (Psycho-)Stimulanzien die zentrale Rolle beim Phanomen des PCE. Hierzu zahlen sowohl die frei verkauflichen Methylxanthine wie Koffein aber auch illegale bzw. verschreibungspflichtige Amphetamine und deren Derivate wie Methylphenidat, die zum PCE missbraucht werden. Gleichermasen werden die verschreibungspflichtigen Substanzen dieser Gruppe aber auch gemas ihrer Indikation psychopharmakot...