دانلود رایگان ترجمه مقاله حمام درمانی همراه با یک برنامه آموزش روانشناختی برای ترک بنزودیازپین (نشریه هینداوی 2016)

معالجه با شستشو به همراه برنامه آموزش روانی جهت خودداری از بنزودیازپین: مطالعه عملی

Balneotherapy Together with a Psychoeducation Program for Benzodiazepine Withdrawal: A Feasibility Study

Benzodiazepines should be prescribed on a short-term basis, but a significant proportion of patients (%) use them for more than 6 months, constituting a serious public health issue. Indeed, few strategies are effective in helping patients to discontinue long-term benzodiazepine treatments. The aim of this study was to assess the feasibility and the impact of a program including cognitive behavioural therapy, psychoeducation, and balneotherapy in a spa resort to facilitate long-term discontinuation of benzodiazepines. We conducted a prospective multicentre cohort study. Patients with long-term benzodiazepine use were recruited with the aim of anxiolytic withdrawal by means of a psychoeducational program and daily balneotherapy during 3 weeks. The primary efficacy outcome measure was benzodiazepine use 6 months after the program, compared to use at baseline. A total of 70 subjects were enrolled. At 6 months, overall benzodiazepine intake had decreased by 75.3%, with 41.4% of patients completely stopping benzodiazepine use. The results also suggest a significantly greater improvement in anxiety and depression symptoms among patients who discontinued benzodiazepines compared to patients who only reduced their use. Our findings suggest that balneotherapy in association with a psychoeducative program is efficient in subjects with benzodiazepine addiction.

1 Introduction

Among psychotropic drugs, benzodiazepines are one of the most widely prescribed. Given their sedative, anxiolytic, muscle relaxant, anticonvulsive, and hypnotic properties, benzodiazepines are widely used in the short-term management of anxiety, insomnia, alcohol withdrawal, seizures, or agitation. Their long-term use is not recommended for several reasons including misuse with tolerance, dependence, decreased alertness, and the potential risk of domestic or traffic accidents. Furthermore, long-term use has been associated with cognitive impairment especially in elderly patients, with recent studies highlighting a possible link with dementia and particularly Alzheimer’s disease [1].

Prevalence rates of long-term benzodiazepine use vary widely in older studies [2] with differing eligibility criteria. A study of the literature estimated the prevalence to be between 2.2 and 17.6% [3]. Results of the ESEMeD/MHEDEA 2000 epidemiological study showed that in France 21% of a sample of the general population (? = 580) had taken at least one psychotropic drug during the current year, an anxiolytic or hypnotic drug for 19% of subjects, often on a long-term basis (3 to 6 months: 6.7%; >6 months: 23%) [4, 5].

Reducing the consumption of benzodiazepines and promoting their proper use is a major public health issue. Thus seeking new strategies to help patients discontinue long-term benzodiazepine use is essential. Indeed while many strategies have been tried the rates of effective discontinuation remain low [6].

Balneotherapy (BT) with mineral water and other types of somatic care in the environment of a spa resort can be used for the treatment of affective disorders, anxiety disorders, and withdrawal syndromes.

Recently, BT has been shown to be effective in the treatment of generalized anxiety disorder (GAD) [7, 8]. A prospective, randomized, multicentric, controlled clinical trial demonstrated the significant superiority of BT over paroxetine treatment in terms of efficacy and tolerance. Furthermore, a pilot study has suggested that balneotherapy improves the psychological symptoms of occupational burnout [9].

Few studies have attempted to explain the pathophysiological mechanisms underlying the effectiveness of balneotherapy. However, a decrease in salivary cortisol levels, a stress marker that is modified by psychotropic drugs, was reported after spa bathing [10] and the affinity of the serotonin transporter, altered in depression, appears to be increased between 30 min and 1 week after balneotherapy in ozonized water [11]. Warm footbaths have been shown to induce relaxation with a concomitant decrease in sympathetic tone and serum cortisol levels as well as an elevation in salivary secretory IgA titers [12]. A local effect through nociceptive skin receptors and central effects on endorphins and immune factors have been suggested by Lange et al. [13]. Moreover, balneotherapy by fibromyalgia patients stimulated the hypothalamic axis, corticotropic releasing factor, and adrenocorticotropic hormone in correlation with pain decrease and improvements in depression and quality of life [14]. Another hypothesis is that balneotherapy could stimulate ?MSH cutaneous cells which could activate the corticotropic system [15]. Lastly, gate control theory explains why heat and the hydrostatic pressure of water on the body surface can decrease the sensation of pain [16].

Psychoeducation is a psychosocial intervention centred on cognitive and behavioral therapy.

The aim of this approach is to teach patients to understand their illness and its treatment, to manage everyday symptoms, and to improve coping strategies.

A large number of studies have shown this strategy to be effective in major depressive disorders (in particular relapse/recurrence prevention) [17, 18], bipolar disorders [19, 20], and schizophrenia [21] as well as for addiction [22] and anxiety disorder [23, 24].

The present study was performed in anxious outpatients with long-term (more than 6 months) benzodiazepine use. The aim was to study the interest of a psychoeducation program together with balneotherapy in a spa resort for benzodiazepine withdrawal and the feasibility of such a program. We expected a significant decrease in benzodiazepine intake following the program.