Leal Gabriel, Studart Igor, Figueiredo Caio Petrus Monteiro, di Santi Talita, Suen Paulo, Brasiliano Silvia, Hochgraf Patricia B, Bacchi Pedro Starzynski
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Instituto de Psiquiatria, São Paulo, Brazil.
Front Psychiatry. 2024 Dec 18;15:1456148. doi: 10.3389/fpsyt.2024.1456148. eCollection 2024.
This study presents a case series of five women with zolpidem dependence treated at the Drug Dependent Women Treatment Center (PROMUD), one of the first women-specific substance use disorder outpatient services in Latin America.
This was an retrospective review of medical records of patients with a diagnosis of zolpidem dependence at the Institute of Psychiatry of Clinics Hospital of University of São Paulo between December 2021 and December 2023. Description of the cases followed the Case Report Statement, Checklist and Guidelines (CARE). The weekly zolpidem intake, comprising prescribed amounts and relapse episodes, was totaled to compute a mean daily dose. This was graphically illustrated to bring clinical insights.
The patients, aged 25-45 years, displayed escalating oral zolpidem doses (range: 60-900 mg/day), with adverse effects such as memory and social impairment, falls, seizures. Commonalities among cases included initiating zolpidem use for primary insomnia and withdrawal symptoms, including rebound insomnia, social impairment, and craving. History of physical and psychological abuse were reported. Comorbid psychiatric conditions, particularly eating disorders (n=3), recurrent depression (n=1), borderline personality disorder traits (n=1), and attention deficit hyperactivity disorder (n=1), were identified. Although zolpidem abuse often correlates with the concurrent abuse of other substances, none of the reported cases in this study exhibited other substance use disorders. Concurrent use of sedatives, especially benzodiazepines and levomepromazine, was observed (n=2).
The surge in zolpidem prescriptions, driven by its perceived safety and low abuse potential compared to benzodiazepines, may lead to a global health issue of dependence. The medical community faces the challenge of managing this without standardized treatment protocols. Our case series underscores the effectiveness of the PROMUD program, which employs a multidisciplinary, women-specific approach with tailored group therapies and weekly psychiatric appointments to address and prevent relapse.
本研究呈现了在药物依赖女性治疗中心(PROMUD)接受治疗的5例唑吡坦依赖女性的病例系列,该中心是拉丁美洲首批专门针对女性的物质使用障碍门诊服务机构之一。
这是一项对2021年12月至2023年12月期间在圣保罗大学临床医院精神病学研究所被诊断为唑吡坦依赖的患者病历的回顾性研究。病例描述遵循病例报告声明、清单和指南(CARE)。计算每周唑吡坦摄入量,包括处方量和复发次数,以得出平均每日剂量。通过图表展示以获得临床见解。
患者年龄在25 - 45岁之间,口服唑吡坦剂量不断增加(范围:60 - 900毫克/天),出现了如记忆和社交障碍、跌倒、癫痫发作等不良反应。病例的共同特征包括因原发性失眠开始使用唑吡坦以及出现戒断症状,如反弹性失眠、社交障碍和渴望。报告了身体和心理虐待史。识别出共病的精神疾病,特别是饮食失调(n = 3)、复发性抑郁症(n = 1)、边缘型人格障碍特质(n = 1)和注意力缺陷多动障碍(n = 1)。尽管唑吡坦滥用通常与其他物质的同时滥用相关,但本研究报告的病例均未表现出其他物质使用障碍。观察到同时使用镇静剂,尤其是苯二氮䓬类药物和左美丙嗪(n = 2)。
与苯二氮䓬类药物相比,唑吡坦因其被认为的安全性和低滥用潜力导致其处方量激增,这可能会引发全球范围内的依赖健康问题。医学界面临着在没有标准化治疗方案的情况下管理这一问题的挑战。我们的病例系列强调了PROMUD项目的有效性,该项目采用多学科、针对女性的方法,提供量身定制的团体治疗和每周一次的精神科预约,以解决和预防复发。