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P.5.035 Frequency and causes of premature termination during in-patient opiate detoxification
I?5. Addiction therefore appears to exist, which may also explain why female alcoholics are more susceptible to alcohol-induced braiu damage thau male alcoholics.
m P5
034
Do women in primary
have more alcoholism?
risk
of relapse
than
men
D. Marra’ , D. Warot2, I. Berliu2, E. Hispard3, C. Notides3, C. Payau4, J.F. Allilaire5, J.P. L&pine’, S. Dally3, H.J. Aubiu7. ‘Pitit-Salpe^tridre Hospital, Department of Pharmacology, Pr Lechat, Paris, France; 2Pitit-Salpe^tridre Hospital, Department of Pharmacology, Paris, France; 3Fernand JTCdal Hospital, Medecine Interne, Paris, France; 4Pitid-Salpe^tridre Hospital, Pharmacology, Paris, France; ‘Pitit-Salpe^tridre Hospital, Psychiatry, Paris, France; 6Fernand JTCdal Hospital, Psychiatry, Paris, France; 7Emile Roux Hospital, Addiction treatment, Limeil Brkvannes, France Introduction: Mauy studies have evaluated factors associated with relapse in alcoholism but few studies have investigated the impact of gender ou relapse in primary alcoholism. Purpose and Methods: After short-term, in-patient detoxification we evaluated 72 primary alcoholics, 50 males aud 22 females, who participated in a randomized, double blind, placebo-controlled study comparing amisulpride aud placebo for six mouths. Oue of the objectives was to assess the factors at baseline predicting relapse. Relapses or partial remissions were defined according to DSMIV criteria. Patients were evaluated at the time of iuclusiou with the followiug psychopathological scales: Covi’ s aud Raskm s Scales. Fawceu’ s Plaisure Scale. Chanmau’ Physical Auhedouia scale, Tridimeusioual Persouality Questiouuaire (TPQ). Results: Among baseline measures the followiug were significautly differeut for the patients who relapsed (PR) compared to those who didu’ t (PNR) (% or meau + sd, ~0.05): sex of the patient (PNR: males 84.6%, females 15.4% vs PR: males 62.2%, females: 37.8%) munber of prior detoxificatious (PNR: 0.73 + 1.3 vs PR: 1.6 + 2.3), munber of days of abstiueuce in the six mouths before the detoxification (PNR: 17.3 + 23.6 vs PR: 30.5 + 33.1) aud Novelty Seeking score (TPQ) (PNR: 15.9 + 5.3 vs PR: 18.4 + 5.0). The fiual model of a multivariate analysis iucludiug scores of psychopathological scales, D2 dopamiue receptor allele, treatment aud sex gender indicate that sex was the ouly significant variable predicting relapse. Despite their lower baseline alcohol cousumptiou at baseline (females: 953 g/week vs males: 1441 g/week) siguificautly more females relapsed. Conclusions: These results point questions about the place of gender in relapse in primary alcoholism. In our study, ouly primary alcoholics were included aud eveu if women reported less driukiug thau men they could present a more severe alcoholism. The significauces of these fiudiug are discussed, particularly in tenns of the necessity to take iuto account the sex effect in therapeutic studies in alcoholism. References [l]
[2]
D Marm, D Warot, I Berlin, E Hispard, C Notides, C Payan, JF Allilaire, JP Lipine, S Dally, W Aubin. Amisulpride does not prevent relapse prevention in primary alcohol dependence. Results of a pilot randomized placebo controlled trial. Alcohol Exp Clin Res, 2002, 26 (10): 15451552. Weisner C, Schmidt L. Gender disparities in treatment for alcohol problems. JAMA 1992, 268: 1872-6.
S421
m P5
035
A. Heideu’ ‘University Psychiatry, Department
Frequency termination detoxification
and causes of during in-patient
premature opiate
, C. Baecker’ , R. Frey2, 0. Presslich’ Hospital of Psychiatry, Department Vienna, Austria; 2Unive~sity Hospital of General Psychiatry, men, Austria
, S. Kasper’ of General of Psychiatry,
A typical problem couceruiug in-patient detoxification is the high drop out rate. This pheuomeuou represents a great problem for both the patient aud the therapeutic team, as it is a factor that reduces motivation The aim of the present study was to determine the socio-demographic aud addiction-related factors that have predictive value, i.e. could discriminate drop out from those patients who bring their detoxification to a regular end. 401 patients admitted ou a four beds per room detoxification ward of the Viemla University Hospital of Psychiatry betweeu 1997 aud 2002 participated in this retrospective analysis. Betweeu 1997 aud 2000 iupatieuts suffering from opioid-/ or polysubstauce depeudeuce were treated with morphiue sulphate peutahydrate (N=277) or Bupreuorphiue (N=38) in gradual detoxification Hospitalisatiou lasted 16.614.6 days in those patients who brought their detoxification to a regular cud aud 10.114.9 days in the “drop out group”. The overall drop out rate betweeu 1997 aud 2000 was 47%. The drop out rate was significantly higher in patients (a) without regular work, (b) without iuteutiou of lougterm “abstinence-oriented” therapy in a recovery and/or resideutial rehabilitatiou unit aud (c) with higher morphiue dosages at the begimriug of detoxification Sex, age, aud other addiction related gactors did uot play a major role iii iiiflueiiciiig stayiiig power. We concluded from these results oue essential to be necessary to improve staying power of drug patients during clinical detoxification the iuteutiou to receive aftercare. As a cousequeuce of this our concept couceruiug admission criteria was changed: since 2002 ouly patients with aftercare (6618 mouths) or patients with regular work aud a very good social fuuctiouiug were admitted. The overall drop out rate in 2002 was 14%. In this article the clinical relevance of this fiudiug is discussed summarizing both the available literature aud our owu experience.
lp.5.0361
Dependence
on
tramadol
- a case
series
A. Paiva’ , M. Lobo2, J. Chaiuho’ ‘Hospital N. Senhora Rosario, S. A, Department of Psychiatry and Mental Health, Barreiro, Portugal; 2Hospital N Senhora Roxirio, S.A, Department of Psychiatry and Mental Health, Barreiro, Portugal Tramadol hydrochloride is a centrally acting analgesic that mimics the clinical practice of au opioid aualgesiug by acting in i receptors but also iuhibitiug mouoamiue reuptake. It’ s au analgesic widely used aud prescribed for treating painful couditious where strong opioids are uot required, namely chrouic musculoskeletal pain Although this opioid condition, it was believed for a loug time that tramadol had a low abuse poteutial aud did lack the developmeut of tolerance aud dependence. A review of the literature was perfonned aud we evaluated five cases of acute abstiueuce syudrome followiug abrupt cessation of long-tenn use of tramadol in a geriatric age. Our objective is to aualyse the depeudeuce poteutial of tramadol aud to discuss how easily patients get a prescriptiou of it with uo surveillance afterwards, especially in older people, ou
m P5
034
Do women in primary
have more alcoholism?
risk
of relapse
than
men
D. Marra’ , D. Warot2, I. Berliu2, E. Hispard3, C. Notides3, C. Payau4, J.F. Allilaire5, J.P. L&pine’, S. Dally3, H.J. Aubiu7. ‘Pitit-Salpe^tridre Hospital, Department of Pharmacology, Pr Lechat, Paris, France; 2Pitit-Salpe^tridre Hospital, Department of Pharmacology, Paris, France; 3Fernand JTCdal Hospital, Medecine Interne, Paris, France; 4Pitid-Salpe^tridre Hospital, Pharmacology, Paris, France; ‘Pitit-Salpe^tridre Hospital, Psychiatry, Paris, France; 6Fernand JTCdal Hospital, Psychiatry, Paris, France; 7Emile Roux Hospital, Addiction treatment, Limeil Brkvannes, France Introduction: Mauy studies have evaluated factors associated with relapse in alcoholism but few studies have investigated the impact of gender ou relapse in primary alcoholism. Purpose and Methods: After short-term, in-patient detoxification we evaluated 72 primary alcoholics, 50 males aud 22 females, who participated in a randomized, double blind, placebo-controlled study comparing amisulpride aud placebo for six mouths. Oue of the objectives was to assess the factors at baseline predicting relapse. Relapses or partial remissions were defined according to DSMIV criteria. Patients were evaluated at the time of iuclusiou with the followiug psychopathological scales: Covi’ s aud Raskm s Scales. Fawceu’ s Plaisure Scale. Chanmau’ Physical Auhedouia scale, Tridimeusioual Persouality Questiouuaire (TPQ). Results: Among baseline measures the followiug were significautly differeut for the patients who relapsed (PR) compared to those who didu’ t (PNR) (% or meau + sd, ~0.05): sex of the patient (PNR: males 84.6%, females 15.4% vs PR: males 62.2%, females: 37.8%) munber of prior detoxificatious (PNR: 0.73 + 1.3 vs PR: 1.6 + 2.3), munber of days of abstiueuce in the six mouths before the detoxification (PNR: 17.3 + 23.6 vs PR: 30.5 + 33.1) aud Novelty Seeking score (TPQ) (PNR: 15.9 + 5.3 vs PR: 18.4 + 5.0). The fiual model of a multivariate analysis iucludiug scores of psychopathological scales, D2 dopamiue receptor allele, treatment aud sex gender indicate that sex was the ouly significant variable predicting relapse. Despite their lower baseline alcohol cousumptiou at baseline (females: 953 g/week vs males: 1441 g/week) siguificautly more females relapsed. Conclusions: These results point questions about the place of gender in relapse in primary alcoholism. In our study, ouly primary alcoholics were included aud eveu if women reported less driukiug thau men they could present a more severe alcoholism. The significauces of these fiudiug are discussed, particularly in tenns of the necessity to take iuto account the sex effect in therapeutic studies in alcoholism. References [l]
[2]
D Marm, D Warot, I Berlin, E Hispard, C Notides, C Payan, JF Allilaire, JP Lipine, S Dally, W Aubin. Amisulpride does not prevent relapse prevention in primary alcohol dependence. Results of a pilot randomized placebo controlled trial. Alcohol Exp Clin Res, 2002, 26 (10): 15451552. Weisner C, Schmidt L. Gender disparities in treatment for alcohol problems. JAMA 1992, 268: 1872-6.
S421
m P5
035
A. Heideu’ ‘University Psychiatry, Department
Frequency termination detoxification
and causes of during in-patient
premature opiate
, C. Baecker’ , R. Frey2, 0. Presslich’ Hospital of Psychiatry, Department Vienna, Austria; 2Unive~sity Hospital of General Psychiatry, men, Austria
, S. Kasper’ of General of Psychiatry,
A typical problem couceruiug in-patient detoxification is the high drop out rate. This pheuomeuou represents a great problem for both the patient aud the therapeutic team, as it is a factor that reduces motivation The aim of the present study was to determine the socio-demographic aud addiction-related factors that have predictive value, i.e. could discriminate drop out from those patients who bring their detoxification to a regular end. 401 patients admitted ou a four beds per room detoxification ward of the Viemla University Hospital of Psychiatry betweeu 1997 aud 2002 participated in this retrospective analysis. Betweeu 1997 aud 2000 iupatieuts suffering from opioid-/ or polysubstauce depeudeuce were treated with morphiue sulphate peutahydrate (N=277) or Bupreuorphiue (N=38) in gradual detoxification Hospitalisatiou lasted 16.614.6 days in those patients who brought their detoxification to a regular cud aud 10.114.9 days in the “drop out group”. The overall drop out rate betweeu 1997 aud 2000 was 47%. The drop out rate was significantly higher in patients (a) without regular work, (b) without iuteutiou of lougterm “abstinence-oriented” therapy in a recovery and/or resideutial rehabilitatiou unit aud (c) with higher morphiue dosages at the begimriug of detoxification Sex, age, aud other addiction related gactors did uot play a major role iii iiiflueiiciiig stayiiig power. We concluded from these results oue essential to be necessary to improve staying power of drug patients during clinical detoxification the iuteutiou to receive aftercare. As a cousequeuce of this our concept couceruiug admission criteria was changed: since 2002 ouly patients with aftercare (6618 mouths) or patients with regular work aud a very good social fuuctiouiug were admitted. The overall drop out rate in 2002 was 14%. In this article the clinical relevance of this fiudiug is discussed summarizing both the available literature aud our owu experience.
lp.5.0361
Dependence
on
tramadol
- a case
series
A. Paiva’ , M. Lobo2, J. Chaiuho’ ‘Hospital N. Senhora Rosario, S. A, Department of Psychiatry and Mental Health, Barreiro, Portugal; 2Hospital N Senhora Roxirio, S.A, Department of Psychiatry and Mental Health, Barreiro, Portugal Tramadol hydrochloride is a centrally acting analgesic that mimics the clinical practice of au opioid aualgesiug by acting in i receptors but also iuhibitiug mouoamiue reuptake. It’ s au analgesic widely used aud prescribed for treating painful couditious where strong opioids are uot required, namely chrouic musculoskeletal pain Although this opioid condition, it was believed for a loug time that tramadol had a low abuse poteutial aud did lack the developmeut of tolerance aud dependence. A review of the literature was perfonned aud we evaluated five cases of acute abstiueuce syudrome followiug abrupt cessation of long-tenn use of tramadol in a geriatric age. Our objective is to aualyse the depeudeuce poteutial of tramadol aud to discuss how easily patients get a prescriptiou of it with uo surveillance afterwards, especially in older people, ou