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Biomedical subjects

R L DuPont

Publications and source records attributed to R L DuPont.

At least 19 recordsLinked to original sources
PubMed1992

Depressant substances in adolescent medicine.

The benzodiazepines have replaced widespread use of barbiturates and other sedatives. They are effective, safe medicines used to treat a variety of disorders associated with excessive CNS excitability. Although many physicians avoid prescribing benzodiazepines to adolescents, there is little evidence to support this practice. Unless an adolescent has a history of substance abuse/dependence and suicidal ideation, the benzodiazepines are safe. Benzodiazepine toxicity rarely occurs unless another CNS depressant, especially alcohol, is used concurrently.

Abnormalities, Drug-Induced↗
PubMed1992

Discontinuation of alprazolam after long-term treatment of panic-related disorders.

Discontinuation of alprazolam after long-term treatment of 142 patients with panic-related disorders was examined in five study sites using a telephone interview. The majority (67%) of patients interviewed discontinued alprazolam for a period of at least 3 days after a gradual dosage reduction schedule over a 4-week period at the end of the long-term treatment study. A marked difference among the study sites in percentages of patients discontinuing therapy with alprazolam suggests that physician intervention played an important role in determining the ability of patients successfully to discontinue use of alprazolam: 90% and 95% of patients ceased therapy at two sites whereas only 21%, 38%, and 66% of patients discontinued therapy at the other three sites. The mean daily dosage for patients who continued using alprazolam decreased from 5.1 mg/day at the end of the long-term segment to 2.7 mg/day at the time of the poststudy interview. This decline indicates a lack of tolerance to the therapeutic effectiveness of alprazolam over an extended period of time.

Adult↗
PubMed1990

A practical approach to benzodiazepine discontinuation.

Non-medical use of benzodiazepines is rare among patients with anxiety disorders. Numerous studies have found that non-medical use, or abuse, of benzodiazepines occurs usually among patients with histories of alcohol and drug abuse--those who use those drugs to get "high". This article distinguishes between medical and non-medical use of benzodiazepines in clinical practice, and offers practical approaches to discontinuation of benzodiazepine treatment for both medical and non-medical users of those medicines. The major barrier to clear thinking about the abuse of benzodiazepines is the confusion of "addiction" and "withdrawal". Addiction means high, unstable dosing outside medical and social boundaries for "recreational" purposes, loss of control over use, and continued use despite clear evidence of harm. Alcoholism and heroin addiction are typical examples of addiction (Kalant, 1989). In contrast, withdrawal is a pharmacological consequence of discontinuation of a substance on which a person has become dependent. Many drug-addicted people have only minor withdrawal symptoms when they stop drug use. Many medical patients, with no evidence of addiction, have withdrawal symptoms when they stop treatment, especially when they stop abruptly (e.g. surgical patients using narcotic analgesics and epileptics using benzodiazepines or barbiturates in their treatment). Addiction to benzodiazepines, in the sense of loss of control over use and continued despite harm, is virtually limited to people with pre-existing drug or alcohol abuse, while withdrawal symptoms after prolonged daily use are common among medical users of benzodiazepines. The serious nature of both drug abuse and anxiety disorders is not emphasized sufficiently during medical school or in the professional literature. The distress and disability from which both groups of patients and their families suffer is profound. Fortunately, both drug abuse and anxiety patients receive tremendous benefit from successful treatments, both pharmacological and nonpharmacological (DuPont, 1986a; DuPont, 1984). This article discusses the use of benzodiazepines in two distinct populations--drug abusers and patients with anxiety disorders--and helps clinicians distinguish between the use of benzodiazepines in the two groups. The central distinction made in this article is reflected in the common use of the words "drugs" and "medicines". The former term often denotes non-medical substance use, while the latter term refers to traditional pharmacotherapy.

Anti-Anxiety Agents↗
PubMed1990

A physician's guide to discontinuing benzodiazepine therapy.

Practicing physicians need to have practical techniques to help patients who want to stop using benzodiazepines. I have developed three approaches that usually work. The first, and most widely applicable, is gradually reducing the dose without adding any other medicine. Failing this, use one of the following two approaches, occasionally combining them: switch to a longer-acting, cross-tolerant medication (usually clonazepam or phenobarbital) or use medications to suppress the withdrawal symptoms, usually carbamazepine, propranolol, or clonidine. If this fails, use inpatient detoxification. Chemically dependent patients, including those abusing alcohol and taking higher than recommended doses of sedative-hypnotics, require special care during discontinuation. Aftercare is important for all long-term benzodiazepine users if they are to remain drug-free and live relatively comfortable lives.

Ambulatory Care↗
PubMed1990

Thinking about stopping treatment for panic disorder.

The lifelong nature of panic disorder and the development of effective new treatments have focused attention on long-term use of antipanic medications, particularly benzodiazepines and their possibly addictive nature. Benzodiazepines are generally safe and effective. An understanding of the distinction between chemical dependence and physical dependence places problems involved in the use and discontinuation of benzodiazepines into perspective. Patients with a dual diagnosis of panic disorder and chemical dependence are at risk of addiction. Others may develop physical dependence but are able to discontinue benzodiazepine treatment when panic symptoms subside. The approach to benzodiazepine use and discontinuation should be different for patients with chemical dependence as opposed to patients with physical dependence. A four-step approach to discontinuation that is applicable to both groups is offered.

Anxiety Disorders↗
PubMed1988

Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment.

Following promising preliminary evidence, the benzodiazepine-derivative alprazolam was studied in a large, placebo-controlled, eight-week, flexible-dose trial in patients with agoraphobia with panic attacks and panic disorder. Of 526 patients, 481 completed three weeks of treatment; however, significantly more placebo (102/234) than alprazolam (21/247) recipients subsequently dropped out of the trial, primarily citing ineffectiveness (of placebo) as the reason. Alprazolam was found to be effective and well tolerated. There were significant alprazolam-placebo differences in improvement for (1) spontaneous and situational panic attacks, (2) phobic fears, (3) avoidance behavior, (4) anxiety, and (5) secondary disability, all significant by the end of week 1. At the primary comparison point (week 4), 82% of the patients receiving alprazolam were rated moderately improved or better vs 43% of the placebo group. At that point, 50% of the alprazolam recipients vs 28% of placebo recipients were free of panic attacks.

Adolescent↗
PubMed1988

Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. II. Patient acceptance, side effects, and safety.

In a multicenter placebo-controlled study, the safety, side effects, and patient acceptance of alprazolam for the treatment of panic disorder and agoraphobia were examined. A total of 525 patients meeting DSM-III criteria for agoraphobia with panic attacks or panic disorder were randomly assigned to receive alprazolam or placebo, which they took for eight weeks. The mean daily dose at the end of the study was 5.7 mg of alprazolam or 7.5 capsules of placebo daily. Potentially serious reactions to alprazolam occurred in ten of 263 subjects who received the drug. These included acute intoxication (three), hepatitis (two), mania (two), amnesia (one), aggressive behavior (one), and depression (one). Treatment-related side effects that were worse in patients taking alprazolam than in those taking placebo included sedation, fatigue, ataxia, slurred speech, and amnesia. Sedation was the most frequent but tended to subside with dose reduction or continued administration of the drug. Patient acceptance of alprazolam, as measured by the rate of completion for study participants, was high. Eighty-four percent of patients receiving active drug completed the study compared with 50% receiving placebo.

Adult↗
PubMed1988

Secondary depression in panic disorder and agoraphobia. I. Frequency, severity, and response to treatment.

Depressive symptomatology in 481 subjects with panic disorder and phobic avoidance was studied as part of an investigation of the efficacy of alprazolam in panic disorder. Subjects who had a major depressive episode (MDE) before the onset of their panic disorder were not included in the trial. With this exclusion criterion, 31% of subjects had a secondary MDE occurring after the onset of the panic disorder. The occurrence of secondary MDE was related to the length of time subjects were ill with panic disorder. Compared with the subjects without depression, those subjects with current MDE had higher scores on measures of anxiety and depression but not on the number of panic attacks per week. The presence of depression and the degree of phobic avoidance contributed independently to measures of the severity of the panic illness. Alprazolam was effective in reducing panic and depressive symptomatology in both depressed and nondepressed subjects with panic disorder. The presence of an MDE was not predictive of the outcome of treatment for the panic and phobic symptoms. Subjects with or without depression responded similarly to alprazolam.

Adult↗
PubMed1987

Prevention of adolescent chemical dependency.

Chemical dependency is part of a significant pattern of serious health problems resulting from the breakdown of social control over impulsive, pleasure-driven adolescent behavior. The drug epidemic in North America, after two decades of relentless increases, shows encouraging signs that stopping it may be possible. Chemical dependency prevention became a serious concern in the 1970s in response to the rising drug epidemic. Initial efforts focused on drug-specific education in the mass media and in the schools. After discouraging and even counterproductive results, nonspecific or generic prevention efforts were tried in both areas. These efforts, too, did not prevent drug use or drug problems. More recently, using cigarette smoking prevention initiatives in schools as a model, hopeful results have been achieved. These efforts combine education about immediate negative effects of drug use with training in skills to resist peer pressure to use drugs. These efforts also build youth peer rejection of drug use. Promising a wider community effort to prevent chemical dependency are several macro prevention programs. These include efforts to decrease tolerance for drug use and to identify drug users in four specific areas: families, schools, highways, and the workplace. Chemical dependency can be prevented by a variety of interventions, including one-to-one encounters, school-based skills training, and society-wide initiatives to reject drug use. The teenage years are a time of unique vulnerability to initiation of drug and alcohol use. The clear goal of prevention is to help young people to survive these years without using drugs, including the gateway drugs: alcohol, tobacco, marijuana, and cocaine. The pediatrician can play a vital role in successful prevention activities with patients, with their families, in communities, and in the nation as a whole.

Adolescent↗
PubMed1983

Phobias in children.

Although fears are so common in children as to be "normal," phobias associated with prolonged avoidance of ordinary situations are distinctly uncommon, even among children in psychiatric treatment. Three treatment approaches are described, including traditional dynamically oriented psychotherapy and the use of antidepressant medication, with major emphasis given to the new supported-exposure technique widely practiced in contemporary phobia programs.

Child↗