Purpose. The use of benzodiazepines remains a source of controversy. Some prescribers believe that they are beneficial and espouse their use; others regard their risk:benefit ratio as too adverse for any but occasional use. This review considers these viewpoints based on the appropriate literature. Survey. The recent English-language literature relating to this topic was surveyed. The publications proved too heterogeneous for a formal meta-analysis, so a descriptive review is provided. Overview. Surveys of benzodiazepine use provide data mainly from the UK, Europe and North America. Prescribing patterns varied widely but long-term usage is common and sometimes the norm. Conclusions. Long-term prescription of benzodiazepines still takes place despite general warnings from the medical and other professions and drug regulatory bodies that long-term use is unjustified both from the lack of a systemic database establishing such efficacy and a large literature documenting the risks of long-term usage, such as dependence. The young and the old are particularly at risk. Continued monitoring is essential, but the regulatory authorities may need to take a more active role in curbing such undesirable practice.

Usage of benzodiazepines: A review

........................................................................................................................................ iii! Lay Summary............................................................................................................................... iv! Preface.............................................................................................................................................v! Table of

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Overlapping criminal offences and gendered violence : what is overlap and when is it part of the problem of overcriminalisation?

AIM Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. METHODS We included 429 BZD users and 2423 non-users from the Netherlands Study of Depression and Anxiety (NESDA) in order to investigate sociodemographic, psychological and physical determinants of BZD use and inappropriate use by logistic and linear regression analyses. RESULTS BZDs were used by a considerable proportion of the 2852 NESDA participants (15.0%). BZD use was independently associated with older age, singleness, unemployment, treatment in secondary care, higher medical consumption (more severe) anxiety, depression (OR [95% CI] = 1.95 [1.29, 2.93]), comorbidity, insomnia, SSRI (OR [95% CI] = 2.05 [1.55, 2.70]), TCA and other antidepressant (OR [95% CI] = 2.44 [1.64, 3.62]) use. Overall, BZD use was rarely in accordance with all guidelines, mainly because most users (82.5%) exceeded the recommended duration of safe use. Inappropriate use was independently associated with older age (beta = 0.130) and chronic illnesses (beta = 0.120). Higher scores on agreeableness were associated with less inappropriate use. CONCLUSIONS Mentally or physically vulnerable subjects were most likely to use BZDs. The most vulnerable (i.e. the old and physically ill) BZD users were at highest risk of inappropriate BZD use. Without further evidence of the effectiveness of BZDs in long-term use, caution in initiating BZD prescriptions is recommended, particularly when patients are chronically ill and old, as those are most likely to display inappropriate use.

https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2125.2010.03818.x

Correlates of (inappropriate) benzodiazepine use : the Netherlands Study of Depression and Anxiety (NESDA)

Background The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. Aim To analyse discrepancies between GPs9 opinions and practice when prescribing psychotropic drugs to older patients. Setting Postal surveys sent to GPs all over mainland France. Design of study Cross-sectional postal study. Method A questionnaire collected data on characteristics of GPs9 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. Results A 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 patients9 refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). Conclusion A mismatch exists between GPs9 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.

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

Many women who access mental health services have been subjected to violent acts, including childhood sexual abuse and adult sexual assault, often at the hands of family members and partners. The vulnerability of these women can be further complicated when health professionals lack sensitivity to the issues involved; and the treatment received by the women is insensitive, leading to experiences of re-traumatisation. This article considers the principles of trauma-informed care and practice, as represented in the literature; and explains how mental health nurses can lead the way in multidisciplinary environments to ensure that women who have experienced violence receive the most appropriate health care, and are thereby supported to attain the best possible outcome.

Trauma-informed Care and the Research Literature: How Can the Mental Health Nurse Take the Lead to Support Women Who Have Survived Sexual Assault?

Posttraumatic stress disorder, depression, and hopelessness in women who are victims of sexual violence

CONTEXT AND OBJECTIVE: Chronic use of benzodiazepines is frequent in general practice. The aim of this study was to describe the usage pattern and profile of chronic users of diazepam who had been consuming this drug for a minimum of thirty-six months continuously. DESIGN AND SETTING: This was a descriptive study (survey and clinical assessment) at five primary healthcare centers in Campinas, Brazil. METHODS: Psychotropic drug control books revealed 48 eligible patients. Among these, 41 were assessed by means of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), the Hospital Anxiety and Depression scale (HAD) and a questionnaire on usage pattern. RESULTS: Most patients were women (85.4%). The patients' mean age was 57.6 years, and they were from the social strata C (39%), D (54%) and E (7%). The mean length of diazepam consumption was 10 years. The patients presented a lack of prescription compliance and had made frustrated attempts to stop using the drug. 55.5% said their doctor had never given any guidance on the effects of the drug. According to SCAN, 25 patients (61%) suffered from depressive disorders; only 12 cases of benzodiazepine dependence were detected by this instrument. CONCLUSION: There is a need to improve the detection and treatment of mental disorders, as well as to prevent inappropriate prescription and use of benzodiazepines. Diazepam dependence has distinctive characteristics that make it undetected by SCAN.

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Chronic use of diazepam in primary healthcare centers: user profile and usage pattern

CONTEXT AND OBJECTIVE: The prevalence of psychiatric conditions in clinical settings is high, particularly in emergency services. This is a challenge for healthcare professionals and an essential element in the functioning of the mental health network. The objective here was to describe the sociodemographic and clinical profile and the practices among patients treated psychiatrically in the Emergency Unit. DESIGN AND SETTING: Descriptive and quantitative study, conducted at Hospital das Clinicas (HC), Universidade Estadual de Campinas (Unicamp). METHODS: Sociodemographic data, reasons for attendance, diagnostic hypotheses and practices were analyzed. RESULTS: Psychiatric staff attended 1,835 cases over the study period, corresponding to 1465 patients. The patients were predominantly women (53.7%) and white (79.6%); their mean age was 37 years and 41.3% lived with their parents. The commonest reasons for attendance were depressive symptoms (28.1%), agitation (23.6%) and problems with psychoactive substances (19.5%). The commonest diagnoses were psychoactive substance-related disorders (23%) and depressive disorders (18.5%). 31.6% of the patients were referred to healthcare centers and 29.2% to specialized outpatient clinics, while 8.2% were hospitalized. CONCLUSIONS: This study emphasizes that it is important for professionals working in emergency service to have information about the patients' profile and the main reasons that lead them to seek psychiatric care, and to establish a diagnosis that will allow proper management at the emergency service and case referral.

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Profile of patients attended as psychiatric emergencies at a university general hospital.

Increased popliteal circumferential wall tension induced by orthostatic body posture is associated with local atherosclerotic plaques.

This prospective, descriptive and quantitative study detected patients with psychoactive substance use disorders treated at the Referenced Psychiatric Emergency Unit from May 2010 to May 2011. These patients were invited to attend the Intervention Group (IG) – a psychiatric medical assessment occurred in up to seven days after the emergency visit whose purpose was to increase motivation and facilitate access to treatment in the health care network in the region - and conducted follow-up evaluating reduction in psychoactive substances consumption and treatmentseeking after 30 and 90 days by comparing patients that attended in IG with those who did not, the Control Group (CG). The interventionGroup had a greater reduction in psychoactive substance use, after 30 days (p<0.0001) and 90 days (p<0.0001), more patients sought treatment after 30 days (p<0.0001) and 90 days (p=0.0026) and there was lower hospitalization rates within 30 days (p<0.0001) and 90 days (p=0.0005). Individuals with addiction to crack were 1.66 times more likely to not reduce consumption in 90 days. The Intervention Group proved itself an effective tool in reducing psychoactive substance abuse and promoting treatment-seeking after 30 and 90 days.

Renata Cruz Soares Azevedo

Papers

Posttraumatic stress disorder, depression, and hopelessness in women who are victims of sexual violence

Chronic use of diazepam in primary healthcare centers: user profile and usage pattern

Profile of patients attended as psychiatric emergencies at a university general hospital.

Increased popliteal circumferential wall tension induced by orthostatic body posture is associated with local atherosclerotic plaques.

Intervention for Patients with Psychoactive Substance Use Disorders, Starting from Psychiatric Emergency Care: Follow-Up Study after 30 and 90 Days