Branimir Radmanovic

Prescribing practices in Southeastern Europe – focus on benzodiazepine prescription at discharge from nine university psychiatric hospitals

There is much concern about the widespread long-term use of benzodiazepines. Our manuscript addressed its use in the region of Southeastern Europe, which seems extensive, but insufficiently explored. At nine university psychiatric hospitals (Croatia, Macedonia and Serbia), we retrospectively analyzed discharge summary documents to find the prevalence of discharge benzodiazepine prescriptions and the prescribed benzodiazepine doses. This study included 1047 adult subjects and showed that 81.9% of them had benzodiazepines prescribed in the discharge summary document, with high mean daily dose of around 5mg lorazepam equivalents. Factors associated with the prescriptions were exclusively clinical factors (diagnosis of schizophrenia spectrum disorders, more lifetime hospitalizations, psychiatric comorbidity, co-prescription of antidepressant or mood stabilizer, shorter duration of the hospitalization), while socio-demographic factors were not found to influence benzodiazepine discharge prescriptions. Similarly, factors which influenced the prescription of higher daily benzodiazepine dose were more lifetime psychiatric hospitalizations and co-prescription of antidepressant or mood stabilizer, as well as the diagnosis of mental/behavioral disorders due to substance use and co-prescribed antipsychotic. Our data are emphasizing an urgent need for guidelines and improved education of both health care professionals and patients, in order to prevent long term benzodiazepine (mis)use and related side-effects.

PSYCHOLOGICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS AND DEVELOPMENT OF PHYSICAL EXERCISE DEPENDENCE

Introduction: Excessive physical exercise combined with certain psychic and sociodemographic factors can lead to dependence. Objective: To examine which factors lead to the emergence of exercise dependence. Methods: Sample consisted of 103 men (mean age 27.3 years, SD 6.127) who performed exercises at gyms at least three times a week in the last year or more in Novi Pazar, Sjenica, Raska and Tutin, Serbia. Participants completed questionnaires and took appropriate tests. Results: Our results showed that there is no association between exercise dependence and financial status, number of siblings, level of education, family stability, health, and medication use among the interviewees. However, it was found that the degree of exercise dependence is associated with marital status and problems with the law. Regression analysis showed that body dysmorphia, body mass index and aggressiveness are better predictors of exercise dependence. Conclusion: People whose self-perception is dismorphic have lower self-esteem, and exercise in gyms to improve their physical appearance. If we consider other characteristics, such as unfavorable BMI, problems with the lаw and being single, it is hardly surprising these individuals cross the line between healthy exercise and exercise dependence. An important finding is that aggressiveness and exercise dependence are related to problems with the law due to aggression, and body dysmorphia. Level of Evidence; Diagnostic studies Investigating a diagnostic test.

Quality of Life in Primary Insomnia: Three-week Treatment With Zolpidem Vs. Lorazepam

Abstract Insomnia is a condition of inadequate quality or quantity of sleep that has extremely adverse effects on daytime activities. Th e aim of this study was to compare the quality of life in patients with primary insomnia before and after a 3-week treatment with lorazepam (n=20) and zolpidem (n=21) and to compare the potential differences in dysfunctional beliefs and attitudes regarding patients’ sleep between the two groups. Th e diagnosis of primary insomnia was established using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, and patients had to complete a specially designed sleep log every day; on scheduled visits, we also administered a Visual Analogue Scale for quality of life and a self-evaluation questionnaire about Dysfunctional Beliefs and Attitudes related to Sleep at the beginning and end of this study. In summary, the examinees in our study had significantly decreased parameters of quality of life, quite lower than expected based on previous findings in this area. However, by the end of the study, quality of life significantly improved with treatment: it improved by approximately 2/3 in the Lorazepam group and more than twice in the Zolpidem group, with a significant difference in favour of Zolpidem (p=0.047). Th is finding is most likely a consequence of its better safety profile and in part its better efficiency in terms of influence on certain domains of sleep itself, as previously discussed. Further specialized studies in this area with larger samples and a more detailed methodology are clearly warranted.

P.8.b.006 Side effects of zolpidem and temazepam in treating primary insomnia

There were no abnormalities in cardiovascular status. Baseline laboratory results again included a normal platelet count, normal liver enzymes and liver function tests. Hypomania was also excluded. After agomelatine discontinuation, symptoms improved. Adverse effect was determined by clinical pharmacist with the Naranjo probability scale and was probably associated with agomelatine use (6 points) and possibly associated with duloxetine hydrochloride use (4 points). After discussing the benefits and risks with the patient, a clinical pharmacist advised discontinuation of agomelatine and switching to trazodone 50mg daily at bedtime. The physician accepted our recommendations and the symptoms completely disappeared in three days after agomelatine discontinuation. Discussion: No case of agomelatine-induced sweating has been described. The interactions with agomelatine are reported to be mediated by cytochrome CYP1A2 enzymes. CYP1A2 and CYP2D6 have a major role in the metabolism of duloxetine hydrochloride and duloxetine hydrochloride increases the exposure of drugs that metabolized with CYP2D6, but not CYP1A2 [1]. Consequently any pharmacokinetics drug interaction between agomelatine and duloxetine hydrochloride had not occurred in this patient. An adverse effect was not induced by duloxetine hydrochloride itself, but pharmacodynamic drug–drug interaction between duloxetine hydrochloride and agomelatine could occur, which led to small additive adrenergic overstimulation. Such case has not yet been described in literature, however an adverse effect associated with drug–drug interaction can occur, as this report clearly demonstrates. No case of agomelatine-induced sweating has been described. Pharmacodynamic drug–drug interaction between agomelatine and duloxetine hydrochloride could occur, which led to small additive adrenergic overstimulation. Daily dose of duloxetine hydrochloride was not changed in switching time. This case serves to illustrate how clinical pharmacy can help ensure a satisfactory clinical outcome and prevent a potentially life threatening adverse drug reaction, similar to other case reports of timely recognition of adverse drug reactions from other psychotropic medications by clinical pharmacy that were followed by close collaboration between clinical pharmacy and psychiatry for successful management of the clinical disorder in question [2,3]. Conclusion: The benefit of this antidepressant combination needs to be carefully balanced with the risks associated with its use. Antidepressant combination treatment is common in some clinical practice settings, there is limited evidence to support this practice. Trazodone in small doses could be used in treating patients with agomelatine associated excessive sweating.