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Un colpo al cerchio ed un colpo alla botte: il ruolo del flumazenil in una disintossicazione da abuso severo iatrogeno di GHB e tollerenza alle BZD
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Lormetazepam Addiction
No full textThis chapter focuses on lormetazepam addiction. Lormetazepam is a BDZ mainly used as sedative-hypnotic, has some specific pharmacological properties that differentiate it from other BDZs. In Italy, lormetazepam is the most commonly used BDZ, followed by lorazepam and alprazolam. However, it is very difficult to determine the use deriving from abuse, dependence, and addiction from consumption data only. Furthermore, these data do not take into consideration under-the-counter use. Despite guidelines recommending to limit the use of BDZs, lormetazepam included, to a few weeks, their consumption is often chronic and many people take these drugs for many years. Patients often take these drugs for a long period, because they are generally well tolerated and safe. Lormetazepam abuse, dependence, and addiction may appear after prolonged treatment. A drug-induced alteration in the GABA inhibitory regulation of DA neurons has been implicated for the neural basis of BDZ addiction. Some authors proposed that BDZs increase DA level through disinhibition. This disinhibition is dependent on the BDZ binding site on alpha1-containing GABAA receptors in the VTA. To our knowledge, there is limited evidence of specific addictive properties of lormetazepam in the scientific literature. In our experience, lormetazepam addiction is an increasingly common occurrence in Italy and its abuse concerns almost exclusively the drop formulation (84% of abusers). Some special features (such as the presence of 95% alcohol in the dropformulation) seem to facilitate its abuse. l Reports of lormetazepam abuse/dependence/addiction sent to the Italian pharmacovigilance system account for about 50% of the total BDZ abuse/dependence/addiction reports.The lack of data about lormetazepam addiction in the literature is probably because drop solution exists only in Italy and Spain. Research shows that combining medications for addiction treatment (e.g., flumazenil) with behavioral therapy is the best way to ensure success for most patients
Il ruolo formativo di un centro per il trattamento del tabismo. Le opportunità da non tralasciare
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La formazione sulle dipendenze patologiche: possono i SerD avere una funzione didattica vicariante nei confronti dell'Università? Alcune opportunità da non tralasciare.
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High-dose lormetazepam dependence: strange case of Dr. Jekyll and Mr. Hyde
No full textHigh-dose benzodiazepine (BZD) abuse is emerging as a substance use disorder (SUD). The aim of the study is to explore the impact of high-dose lormetazepam (LMZ) abuse and the characteristics of patients affected by this SUD in a tertiary referral addiction unit. We have retrospectively evaluated 1112 patients admitted to the Addiction Medicine Unit, Verona University Hospital, Italy for detoxification from high-dose BZD dependence. LMZ was the most common BZD, with an increasing prevalence from January 2003 to June 2018. Socio-demographic (more women; higher age and education) and clinical features (higher daily diazepam dosage equivalent, BZD abuse duration, age of first BZD intake; BZD prescribed more frequently for sleep disorders; less frequent history of other SUDs, previous/active alcohol, previous opioids abuse; more frequent overall major psychiatric diseases and major depression; less-frequent bipolar disorders and other psychoses, personality disorders, and more than one psychiatric disease) of LMZ vs. other BZD abusers significantly differed. 96.7% LMZ abusers took oral solution, while two-thirds of other BZD abusers took tablets. Oral solution, BZD abuse duration and prescription of BZD for sleep disorders increased, while history of other SUDs, previous/active alcohol and active cannabinoids SUD reduced the risk of high-dose LMZ vs. other BZDs abuse. The large prevalence of high-dose LMZ abusers in Italy may be strongly related to the availability and characteristics of oral formulation that may transform the innocuous Dr. Jekyll tablets into an evil Mr. Hyde. Restriction to the market of LMZ oral formulation might reduce the risk of high-dose abuse
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Benzodiazepine misuse and heroin addiction: data from a cohort of 40 overdose deaths
No full textThe mortality rate of heroin users (HUs) is far higher than that of the general population of the same age and sex. Overdose still represents a significant cause of death among HUs, especially if users are injecting drugs. Deaths attributed to overdose represented in literature are typically older, heroin-dependent males not in drug treatment at the time of death. The presence of other drugs, primarily alcohol and benzodiazepines (BZD), has been described as commontl detected at autopsy. Subjects who have previously developed opiod dependence abuse BDZs more frequently and at larger doses compared to BDZ mono-abusers. Drug users and alcoholics often use high doses of BDZ to soften withdrawal symptoms of the primary drug. To better describe this phenomenon we assessed alcohol and BDZ prevalence and typing in 40 overdose death, observed by an Italian forensic Medicine Department. the biological samples analyzed for this study were central blood and urine. All tests were performed using an ultra-sensitive liquid chromatography coupled with mass spectrometry in "tandem Mass Spectrometers". The demographic data of the cohort did not seem to differ from the Italian data on overdose presented by government agencies. The male / female ratio was 9:1 with a mean age slightly lower than the national one, 36 versus 37 years. Even in thi case, heroin overdose was markedly preponderant over cocaine. Low percentages of methadone in dead Hus have been found, yet another confirmation of the crucial role of this drug in counteracting the opioid overdose. Cocaine is confirmed as primary cause of death in 15% of the cohort. The BZDs were the substances most present in this sample. 62.5% of HUs were positive to one or more BZD. paradoxically, the BZDs were much more represented in this sample compared to antidepressants, mood stabilizers and antipsychotics. Opioid users should be educated about risks associated with poly-drug intake. Administration of BDZ in HUs may increase the risk of accidental fatal overdose. Prescribers should carefully consider pharmacological intervention alternative to BDZ when managing and treating opiate addiction. Last but not least, no presence of presription analgesic opioid was found in this sample. The pain killers epidemic seems not to have yet reached this part of Italy
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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