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Hamilton LK, Lapham GT, Day A, Black-Watson M, Bishop D, Parsons D, Budimir CA, Baulckim L, Lee AK, Addis M, Bradley KA. Improving alcohol-related care in small-medium primary care practices: An evaluation of an adaptation of the SPARC trial intervention for small-medium sized practices. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2025; 173:209697. [PMID: 40228792 DOI: 10.1016/j.josat.2025.209697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 03/18/2025] [Accepted: 04/07/2025] [Indexed: 04/16/2025]
Abstract
INTRODUCTION The Sustained Patient-centered Alcohol-Related Care (SPARC) trial demonstrated that 6 months of practice facilitation, decision support in electronic health records (EHRs) and performance feedback, increased identification and treatment of unhealthy alcohol use (UAU) in primary care (PC). The Michigan SPARC (MI-SPARC) study tested an adaptation of SPARC for small-medium PC practices. METHODS PC practices were recruited for and participated in alcohol-related quality improvement (2/2020-2/2023). Outcomes collected for quality improvement were used for this evaluation, with data collected manually ("manual practices") or electronically ("electronic practices"). The prevalence of EHR-documented brief intervention (BI) and AUD medication treatment (primary outcomes), and alcohol screening and AUD diagnosis (secondary outcomes) were measured at baseline and 6-months. Secondary data from formative evaluation and practice surveys were analyzed using PRISM domains: external environment, recipients, implementation infrastructure, and intervention. RESULTS 25 practices enrolled; 14 completed data collection. Neither primary outcome was consistently monitored or collected by practices. Mean prevalence of documented screening increased from 20 % to 55 % (manual practices) and from 3 % to 20 % (electronic practices). The mean prevalences of documented AUD diagnosis at baseline and follow-up, were 1.4 % and 3.8 % (manual) and 0.1 % and 0.05 % (electronic). At follow-up, 12 practices reported screening with validated questionnaires, and 13 and 8 offering BI and AUD medications respectively. Barriers identified were low resources, small PC teams, low EHR functionality, intervention complexity, stigma, and COVID-19. CONCLUSION Despite adaptions for smaller PC practices and improvements in screening, MI-SPARC did not increase documented BI or AUD medication treatment, largely reflecting mismatch between intervention complexity and implementation infrastructure in PC practices.
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Affiliation(s)
- Leah K Hamilton
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA.
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA; Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, 98 South Los Robles Ave., Pasadena, CA 91101, USA.
| | - Anya Day
- Altarum Institute, 26200 Town Center Drive, Suite 350, Novi, MI 48375, USA.
| | | | - Dawn Bishop
- Altarum Institute, 26200 Town Center Drive, Suite 350, Novi, MI 48375, USA.
| | - Darla Parsons
- Altarum Institute, 26200 Town Center Drive, Suite 350, Novi, MI 48375, USA.
| | - Cheryl A Budimir
- Altarum Institute, 26200 Town Center Drive, Suite 350, Novi, MI 48375, USA.
| | - La'Tia Baulckim
- Altarum Institute, 26200 Town Center Drive, Suite 350, Novi, MI 48375, USA
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA.
| | - Megan Addis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA.
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA; Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, 98 South Los Robles Ave., Pasadena, CA 91101, USA; Department of Health Systems and Population Health, University of Washington Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA; Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.
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Lachmann M, Forrester S. Mental Health of Older Adults in the Emergency Department. Emerg Med Clin North Am 2025; 43:303-315. [PMID: 40210348 DOI: 10.1016/j.emc.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2025]
Abstract
Older adults with acute mental health concerns represent a large and growing population presenting to emergency departments (EDs). An organized approach to seniors experiencing a mental health crisis, grounded in a life course perspective, is essential. A structured approach to suicide risk assessment is a key part of ED practice. Mania, psychosis, anxiety, trauma, substance use, and the neuropsychiatric complications of Parkinson's disease are described in this article.
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Affiliation(s)
- Mark Lachmann
- Geriatric Psychiatry, University of Toronto, Toronto, Ontario, Canada; Medical Affairs, Sinai Health, Toronto, Ontario, Canada; Mount Sinai Hospital, 19-316 Medical Affairs Office, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
| | - Savannah Forrester
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada; Medical Lead for Acute Care, Seniors Health, Island Health, Victoria, British Columbia, Canada; Emergency Medicine Department, Victoria General Hospital, 1 Hospital Way, Victoria, British Columbia, V8Z 6R5, Canada
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Hayes S, Mach K, Briggs J, Hartwell M. Emergency department wait times in concordance with blood alcohol content and subsequent alcohol use disorder. J Osteopath Med 2025:jom-2024-0168. [PMID: 40270462 DOI: 10.1515/jom-2024-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 03/24/2025] [Indexed: 04/25/2025]
Abstract
CONTEXT In the United States, nearly 80 % of the adult population reported lifetime alcohol use, with 50 % of those reporting alcohol consumption within the past 30 days in 2019. The expense of excess alcohol intake was estimated to have an annual associated healthcare cost of $28 billion, and there was greater than $221 billion in additional costs due to the detrimental effects of excess alcohol intake on productivity and societal setbacks over the last year. Alcohol use disorder (AUD) provides a major barrier for patients seeking medical treatment, because AUD is consistently regarded as one of the most stigmatized disorders globally. Provider-based discrimination toward patients with AUD may lead to providing a lower quality of care. OBJECTIVES Our objective was to assess whether patients with a history of AUD and/or positive blood alcohol content (BAC+) affect emergency department (ED) wait times. We hypothesized that patients presenting to the ED with AUD+/BAC+ would have longer wait times. Secondarily, we investigated the impacts of sociodemographics within these analyses. METHODS We conducted a cross-sectional analysis of the 2019-2021 National Hospital Ambulatory Medical Care Survey (NHAMCS). Individuals' primary diagnosis had to be of musculoskeletal origin based on ICD-10 codes starting with 'S' for skeletal or bodily injuries or 'M' for diagnoses related to musculoskeletal or connective tissue conditions. Wait time was quantified from time of entry into the triage system to the time patients were seen by the first provider. We included data points with or without a recorded history of alcohol misuse or dependence (AUD+/-) in their chart and those with a positive or negative blood alcohol content (BAC+/-). RESULTS ED wait times among individuals presenting with musculoskeletal injuries with a current history of AUD presenting with BAC- at the time of triage were not significantly different from those without a history of AUD. Individuals who were BAC+ at the time of triage had shorter wait times regardless of AUD history - and only AUD-/BAC+ had shorter wait times. Our binary regression and adjusted models showed that individuals who were AUD-/BAC+ had a significantly shorter wait time (minimum -18.43, standard error [SE]=1.92, t=-9.59, p<0.001; SE=2.97; t=-5.62, p<0.001) compared to individuals who were AUD-/BAC- respectively. Those who were AUD+/BAC+ also had shorter wait times compared to AUD-/BAC- (min=-11.11, SE=4.05; t=-2.75, p=0.006). CONCLUSIONS Overall, our study showed no significant difference in ED wait times between individuals with and without a history of AUD - indicating that AUD history does not delay being seen. Shorter wait times for those entering the ED BAC+ may be due to their immediate need for treatment due to toxicity or alcohol withdrawal syndrome, having more severe injuries, or harm prevention.
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Affiliation(s)
- Sean Hayes
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Kaylee Mach
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Jennifer Briggs
- Department of Emergency Medicine, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Micah Hartwell
- Department of Psychiatry and Behavioral Sciences, 33264 Oklahoma State University Center for Health Sciences , Tulsa, OK, USA
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Salomoni M, Missanelli A, Crescioli G, Lanzi C, Totti A, Losso L, Gitto S, Bonaiuti R, Vannacci A, Lombardi N, Mannaioni G. Real-world analysis on the use of gamma-hydroxybutyric acid for alcohol withdrawal syndrome in hospitalized patients with diagnosis of cirrhosis. Intern Emerg Med 2025; 20:119-129. [PMID: 39249626 PMCID: PMC11794374 DOI: 10.1007/s11739-024-03761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 08/28/2024] [Indexed: 09/10/2024]
Abstract
The present real-world analysis aimed to evaluate and describe the use of gamma-hydroxybutyric acid (GHB) for alcohol withdrawal syndrome (AWS) in hospitalized patients with diagnosis of liver cirrhosis. An 11-year observational retrospective study on patients affected by liver cirrhosis and alcohol use disorder (AUD) was performed using data from the Medical Toxicology Unit of Careggi University Hospital in Florence (Italy). A multivariate logistic regression was performed to estimate the probability of having a CIWA-Ar Max 3-4 during hospitalization, an AWS length > 36 h, a hospitalization > 9 days, and the probability of developing drowsiness. A total of 166 AUD patients were included, of these 77 received GHB (70.13% within the first day of hospitalization) and 89 were treated without GHB. The majority were ≥ 40 years of age (87.35%) and males (80.12%). GHB patients were more likely to have a CIWA-Ar Max 3-4 during hospitalization (OR 3.76 [CI 95% 1.02-13.85]), and a longer hospitalization (OR 3.08 [95% CI 1.23-7.71]). Early GHB administration decreased the probability of CIWA-Ar Max worsening (OR 0.06 [95% CI 0.01-0.49]). GHB dose ≥ 100 mg/kg was not associated with the occurrence of drowsiness. Patients exposed to other sedative agents were more likely to experience drowsiness (OR 7.22 [95% CI 1.46-35.61]). The present real-world analysis underlines that GHB could be a valuable and safe option for the management of AWS in AUD patients affected by liver cirrhosis, also when administered early and even at higher than recommended dosages.
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Affiliation(s)
- Monica Salomoni
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Andrea Missanelli
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy.
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.
| | - Cecilia Lanzi
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Arianna Totti
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Lorenzo Losso
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Guido Mannaioni
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
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Zhao Y, Arora J, Tao Y, Miller DB, Adams AT, Choudhury T. Translation Effectiveness of Offset Heart Rate Biofeedback as a Mindless Intervention for Alcohol Craving Among Risky Drinkers: Controlled Experiment. JMIR Form Res 2024; 8:e54438. [PMID: 39740221 PMCID: PMC11733521 DOI: 10.2196/54438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 08/26/2024] [Accepted: 09/23/2024] [Indexed: 01/02/2025] Open
Abstract
BACKGROUND Digital and wearable intervention systems promise to improve how people manage their behavioral health conditions by making interventions available when the user can best benefit from them. However, existing interventions are obtrusive because they require attention and motivation to engage in, limiting the effectiveness of such systems in demanding contexts, such as when the user experiences alcohol craving. Mindless interventions, developed by the human-computer interaction community, offer an opportunity to intervene unobtrusively. Offset heart rate biofeedback is an iconic type of mindless intervention powered by entrainment and can mitigate the physiological and psychological response to stressors. OBJECTIVE This work aimed to characterize the translational effectiveness of offset heart rate biofeedback on cue-elicit alcohol craving among risky drinkers. METHODS We conducted an out-of-lab, between-group, controlled experiment with 26 participants who performed harmful or hazardous drinking. The control group served as negative control and received no intervention, while the experimental group received offset heart rate biofeedback during alcohol exposure and recovery. We elicited alcohol cravings through a series of alcohol cues, including performing mental imagery, viewing alcohol images, and sniffing alcohol. We measured the physiological response to alcohol (ie, heart rate variability), self-reported craving, and self-reported anxiety. We constructed linear mixed-effects models to understand the effect of intervention during alcohol exposure and alcohol recovery after exposure. Following the linear mixed effect model, we conducted pair-wise comparisons for measures between the control and experimental groups. RESULTS We found that offset heart rate biofeedback significantly reduced the increase in heart rate variability (P=.01 and P=.052) and self-reported craving (P=.04 and P=.02) in response to alcohol cues. Participants' anxiety was not affected by either the alcohol cues or the offset heart rate biofeedback. CONCLUSIONS Offset heart rate biofeedback has the potential to immediately and unobtrusively mitigate cue-elicit alcohol craving among risky drinkers. The results of this study opened new opportunities for digital and wearable interventions to mitigate alcohol craving, either as wellness apps for risky drinkers or as digital prescriptions and integration with sensing systems for people with alcohol dependency.
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Affiliation(s)
- Yiran Zhao
- Department of Information Science, Cornell University, New York, NY, United States
| | - Jatin Arora
- Department of Information Science, Cornell University, New York, NY, United States
| | - Yujie Tao
- Department of Computer Science, Stanford University, Stanford, CA, United States
| | - Dave B Miller
- Department of Mechanical Engineering, Tufts University, Medford, MA, United States
| | - Alexander T Adams
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Tanzeem Choudhury
- Department of Information Science, Cornell University, New York, NY, United States
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Choi HY, Balter DR, Haque LY. Epidemiology and Health Care Burden of Alcohol Use Disorder. Clin Liver Dis 2024; 28:577-588. [PMID: 39362708 PMCID: PMC11772009 DOI: 10.1016/j.cld.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
Alcohol use disorder (AUD) is a chronic medical condition that affects over 29.5 million people and accounts for $249 billion in social and health care costs annually. Prevalence is higher among young adults, males, sexual and gender minorities, American Indians and Alaska Natives, and the uninsured. Despite its high prevalence and societal impact, AUD is often overlooked in health care settings. This has resulted in insufficient implementation of AUD screening as well as low levels of treatment uptake. Addressing these challenges requires recognition of the current epidemiology of AUD and role of social determinants of health.
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Affiliation(s)
- Hye Young Choi
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | | | - Lamia Y Haque
- Department of Internal Medicine - Section of Digestive Diseases, Yale Program in Addiction Medicine, Yale School of Medicine, 40 Temple Street, Suite 1A, New Haven, CT 06510, USA.
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Ferreira LO, Padilha da Silveira E, Paz CA, Otake Hamoy MK, Barbosa GB, Santos MF, Conceição RM, Amaral ALG, Resende KD, Favacho Lopes DC, Hamoy M. Decreasing brain activity caused by acute administration of ketamine and alcohol - A randomized, controlled, observer-blinded experimental study. Front Pharmacol 2024; 15:1456009. [PMID: 39478968 PMCID: PMC11521905 DOI: 10.3389/fphar.2024.1456009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 09/30/2024] [Indexed: 11/02/2024] Open
Abstract
Introduction Substance abuse is a major public health problem. In recent years, ketamine, which is a parenteral anesthetic, has been consumed increasingly as an illicit drug together with alcohol, although little is known of how this association alters brain activity. The present study investigated the influence of progressive doses of ketamine, associated with alcohol, on electrophysiological activity. Methods For this, 72 late-adolescent (8-10-week-old) male Wistar rats received either ketamine only, at low (10 mg/kg), intermediate (20 mg/kg) or high (30 mg/kg) doses via intraperitoneal injection, or alcohol (2 mL/100 g) via oral gavage followed by ketamine (at low, intermediate, and high doses). Electroencephalograms (EEG) and electromyographic recordings were obtained 5 min after the final application of the drug. Results When administered alone, ketamine resulted in an increase in delta, theta, beta, and gamma brainwaves, with a more pronounced effect being detected at the highest dose (30 mg/kg) in the case of the delta, beta, and gamma waves. The amplitude of the alpha brainwaves was reduced at all doses of ketamine, but less intensively at the highest dose. When administered alone, alcohol reduced all the brainwaves, with the reduction in the alpha waves being exacerbated by ketamine at all doses, and that of the theta and beta waves being boosted at the lowest dose. The intermediate dose of ketamine (20 mg/kg) reverted the alcohol-induced reduction in the theta and gamma waves, whereas the high dose increased delta, theta, beta, and gamma bandpower. Discussion Overall, then, while ketamine enhances the depressant effects of alcohol on the alpha brainwave at all doses, a low dose intensified this effect on the theta and beta 175 waves, whereas a high dose produces neuronal hyperexcitability in the theta and 176 gamma bandpower.
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Affiliation(s)
- Luan Oliveira Ferreira
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
- Department of Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Esther Padilha da Silveira
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Clarissa A. Paz
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Maria K. Otake Hamoy
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Gabriela B. Barbosa
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Murilo F. Santos
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Raína M. Conceição
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Anthony Lucas G. Amaral
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Karina Dias Resende
- Department of Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Dielly Catrina Favacho Lopes
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Moisés Hamoy
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
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Berro LF, Rowlett JK, Platt DM. GABAergic compounds for the treatment of alcohol use disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 178:383-399. [PMID: 39523061 DOI: 10.1016/bs.irn.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Decades of research have implicated the gamma-aminobutyric acid (GABA)ergic system as one of the main mediators of the behavioral effects of alcohol. Of importance, the addiction-related effects of alcohol also have been shown to be mediated in part by GABAergic systems, raising the possibility that pharmacotherapies targeting GABAergic receptors may be promising candidates for the treatment of alcohol use disorder (AUD). Alcohol modulates the activity of GABAA and GABAB receptors, and studies show that compounds targeting some of those receptors may decrease the addiction-related behavioral effects of alcohol. Specifically, drugs that share similar pharmacological properties with alcohol, such as positive allosteric modulators (PAMs) of GABAA and GABAB receptors, have been proposed as substitution therapies for AUD. Available evidence also suggests that negative allosteric modulators (NAMs) of GABAergic receptors may be potential therapeutics for AUD, although this effect is selective for specific receptor subtypes. Therefore, this Chapter reviews the available evidence on the use of GABAergic compounds for the treatment of AUD. Several GABAA and GABAB ligands show promising results, with a particularly positive therapeutic profile demonstrated for α5GABAA receptor NAMs, α4/6δGABAA receptor modulators (both positive and negative, including neurosteroids), and GABAB receptor PAMs. As newer and better GABAergic compounds become available, future research should focus on understanding how these ligands can modulate different clinical symptoms of AUD, with potential new areas of research encompassing alcohol withdrawal syndrome and AUD-related insomnia.
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Affiliation(s)
- Laís F Berro
- Department of Psychiatry and Human Behavior, Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States.
| | - James K Rowlett
- Department of Psychiatry and Human Behavior, Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Donna M Platt
- Department of Psychiatry and Human Behavior, Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
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Zhao S, Widman L, Hagström H, Shang Y. Disentangling the contributions of alcohol use disorder and alcohol-related liver disease towards dementia: A population-based cohort study. Addiction 2024; 119:706-716. [PMID: 38044804 DOI: 10.1111/add.16395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023]
Abstract
AIMS The aim of the study was to disentangle the contributions of alcohol and alcohol-related liver disease (ALD) towards dementia by independently measuring the association between alcohol use disorder (AUD) alone and ALD with dementia. DESIGN This was a nation-wide cohort study. SETTING The study was conducted in Sweden from 1987 to 2020. PARTICIPANTS DELIVER (DEcoding the epidemiology of LIVER disease in Sweden) cohort, containing administrative codes on patients with chronic liver disease from the National Patient Register and other registers between 1987 and 2020. MEASUREMENTS International Classification of Disease 9th (ICD-9) and 10th (ICD-10) version codes were used to define the presence of AUD, ALD and dementia. The associations of AUD alone and ALD with incident dementia were estimated using Cox regression models adjusting for potential confounders. Cumulative incidences were also calculated accounting for competing risks of death. FINDINGS A total of 128 884 individuals with AUD alone, 17 754 with ALD and 2 479 049 controls were identified. During a median follow-up of 8.9 years, 13 395 (10.4%), 2187 (12.3%) and 138 925 (5.6%) dementia cases were identified in these groups, respectively. Dementia rates were increased in AUD alone [adjusted hazard ratio (aHR) = 4.6, 95% confidence interval (CI) = 4.5-4.6] and in ALD (aHR = 8.6, 95% CI = 8.3-9.0) compared with controls. AUD alone was also associated with increased rates of vascular dementia (aHR = 2.3, 95% CI = 2.2-2.5) and Alzheimer's disease (aHR = 1.4, 95% CI = 1.3-1.4), while ALD was only associated with vascular dementia (aHR = 2.7, 95% CI = 2.3-3.2). The median age at dementia diagnosis was 67 years [interquartile range (IQR) = 56-76] in AUD alone and 63 years (IQR = 56-71) in ALD compared with 85 years (IQR = 79-89) in controls. CONCLUSION In Sweden, patients with alcohol use disorder (AUD) appear to have increased rates of dementia and diagnosis at a younger age, compared with patients without AUD. Concurrent alcohol-related liver disease appears to increase the diagnosis rate and lower the median age further.
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Affiliation(s)
- Sixian Zhao
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Widman
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Unit of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ying Shang
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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Silva-Cardoso GK, N'Gouemo P. Influence of Inherited Seizure Susceptibility on Intermittent Voluntary Alcohol Consumption and Alcohol Withdrawal Seizures in Genetically Epilepsy-Prone Rats (GEPR-3s). Brain Sci 2024; 14:188. [PMID: 38391762 PMCID: PMC10886844 DOI: 10.3390/brainsci14020188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The link between epilepsy and alcohol consumption is complex, with conflicting reports. To enhance our understanding of this link, we conducted a study to determine how inherited seizure susceptibility affects voluntary alcohol consumption and influences alcohol withdrawal seizures in male and female genetically epilepsy-prone rats (GEPR-3s) compared to Sprague Dawley (SD) rats. METHODS In the first experiment, animals were given access to two bottles simultaneously, one containing water and the other 7.5%, 15%, or 30% (v/v) alcohol three times a week for each dose after acclimation to drinking water. In a second experiment, animals were tested for acoustically evoked alcohol seizures 24 h after the last session of voluntary alcohol consumption. RESULTS Analysis revealed that GEPR-3s (males and females) had lower alcohol intake and preference than SD rats, particularly at lower alcohol concentrations. However, female GEPR-3s consumed more alcohol and had a higher alcohol preference than males. Furthermore, withdrawal from voluntary alcohol consumption facilitated the onset and duration of seizures in GEPR-3s. CONCLUSIONS Our study suggests that genetic seizure susceptibility in GEPR-3s is negatively associated with alcohol consumption. However, withdrawal from low to moderate amounts of alcohol intake can promote epileptogenesis in the epileptic GEPR-3s.
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Affiliation(s)
- Gleice Kelli Silva-Cardoso
- Department of Physiology and Biophysics, Howard University College of Medicine, Washington, DC 20059, USA
| | - Prosper N'Gouemo
- Department of Physiology and Biophysics, Howard University College of Medicine, Washington, DC 20059, USA
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Liu Y, Liu Y, Cheng J, Pang LJ, Zhang XL. Correlation analysis of mental health conditions and personality of patients with alcohol addiction. World J Psychiatry 2023; 13:893-902. [DOI: 10.5498/wjp.v13.i11.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Alcohol addiction, or alcohol dependence, refers to a psychological state of strong craving for alcohol caused by drinking when both the drinking times and alcohol consumption reach a certain level. Alcohol addiction can cause irreversible damage, leading to mental illness or mental disorders, negative changes in their original personality, and a tendency to safety incidents such as committing suicide or violent attacks on others. Significant attention needs to be given to the mental health of alcohol addicts, which could reflect their abnormal personality traits. However, only a few papers on this issue have been reported in China.
AIM To investigate the correlation between mental health and personality in patients with alcohol addiction.
METHODS In this single-center observational study, we selected 80 patients with alcohol addiction as the research subjects, according to the criteria of the K10 scale to evaluate the mental health of patients with alcohol addiction, and divided these patients into four groups based on the evaluation results: Good, average, relatively poor and bad. And then analyzed the correlation between mental health conditions and personality characteristics from these four groups of patients.
RESULTS The average score of the K10 scale (Kessler 10 Simple Psychological Status Assessment Scale) in 80 patients with alcohol addiction was 25.45 points, the median score was 25 points, the highest score was 50 points, and the lowest score was 11 points. Pearson's analysis showed that the K10 score was positively correlated with the scores of these two subscales, such as the P-subscale and the N-subscale (P < 0.05). In contrast, the K10 score had no significant correlation with the scores from the E-subscale and the L-subscale (P > 0.05).
CONCLUSION The mental health conditions of patients with alcohol addiction are positively correlated with their personality characteristics.
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Affiliation(s)
- Yu Liu
- Department of Material Dependence, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Yang Liu
- Department of Material Dependence, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Jun Cheng
- Department of Material Dependence, Hefei Fourth People’s Hospital, Hefei 230022, Anhui Province, China
| | - Liang-Jun Pang
- Department of Material Dependence, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Xu-Lai Zhang
- Department of Geriatric Psychology, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Ware OD, Labos B, Hudgins D, Irvin NA, Buresh ME, Bergeria CL, Sweeney MM. Prior Periods of Abstinence Among Adults With an Alcohol Use
Disorder: A Qualitative Template Analysis. SUBSTANCE ABUSE: RESEARCH AND TREATMENT 2023; 17:11782218231162468. [PMID: 36968973 PMCID: PMC10034338 DOI: 10.1177/11782218231162468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
Abstaining from substance use is a goal of many people with alcohol use disorder
(AUD). Understanding patient perspectives of a period of abstinence may assist
persons with AUD in achieving this goal. We accessed the electronic health
records of adults with AUD entering an emergency department in Baltimore,
Maryland, who received a brief peer support intervention for substance use. Data
contained open-ended text entered by staff after a patient indicated ever having
a sustained period of substance abstinence. Using qualitative template analysis
methodology, we identified codes and themes from these open-ended responses from
N = 153 adults with AUD. The sample was primarily male (n = 109, 71.2%) and
White (n = 98, 64.1%) with an average age of 43.8 years (SD = 11.2). Themes
identified included the abstinence length, abstinence reason, relapse, triggers,
time of relapse, and treatment. The most common code for abstinence length was
“between 1 and 5 years” (n = 55, 35.9%). Other abstinence length codes included
“less than 1 year” and “more than 5 years.” Relapse triggers included “family
(non-death),” “death of a loved one,” “social,” “economic,” and
“treatment-related” reasons. Findings from this study could be used to inform
strategies for peer support interventions to assist patients with substance
abstinence.
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Affiliation(s)
- Orrin D. Ware
- School of Social Work, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Orrin D. Ware, School of Social Work,
University of North Carolina at Chapel Hill, 325 Pittsboro Street, Chapel Hill,
NC 27599, USA.
| | - Breanna Labos
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral
Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Daniella Hudgins
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral
Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Nathan A. Irvin
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan E. Buresh
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Medicine, Division of
Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
- Department of Epidemiology, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cecilia L. Bergeria
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral
Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Mary M. Sweeney
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral
Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
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13
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Strayer RJ, Friedman BW, Haroz R, Ketcham E, Klein L, LaPietra AM, Motov S, Repanshek Z, Taylor S, Weiner SG, Nelson LS. Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine. J Emerg Med 2023; 64:517-540. [PMID: 36997435 DOI: 10.1016/j.jemermed.2023.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/06/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Reuben J Strayer
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
| | - Benjamin W Friedman
- Department of Emergency Medicine, Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Haroz
- Cooper Medical School of Rowan University, Cooper University Healthcare, Camden, New Jersey
| | - Eric Ketcham
- Department of Emergency Medicine, Department of Behavioral Health, Addiction Medicine, Presbyterian Healthcare System, Santa Fe & Española, New Mexico
| | - Lauren Klein
- Department of Emergency Medicine, Good Samaritan Hospital, West Islip, New York
| | - Alexis M LaPietra
- Department of Emergency Medicine, Saint Joseph's Regional Medical Center, Paterson, New Jersey
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Zachary Repanshek
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Scott Taylor
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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14
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Zhao L, Huang S, Jing F, Yu TT, Wei Z, Chen X. Pneumonia risk prediction in patients with acute alcohol withdrawal syndrome through evaluation of sarcopenia index as a prognostic factor. BMC Geriatr 2023; 23:84. [PMID: 36755225 PMCID: PMC9906960 DOI: 10.1186/s12877-023-03792-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE This study aimed to explore the relationship between the sarcopenia index (SI) and the risk of pneumonia in hospitalized patients with acute alcohol withdrawal syndrome (AWS). STUDY DESIGN We have performed a retrospective study of individuals with AWS from a teaching hospital in western China. Patients' data were retrieved from the medicinal record databases. Patients' primary (upon admission) blood serum creatinine (Cr) and cystatin C (CysC) levels were incorporated into the records. Participants were separated into low and high SI cohorts based on the three-quarter digit of SI (SI = serum Cr/serum CysC ratio × 100). The association between SI and the risk of pneumonia in hospitalized patients with AWS was assessed by logistic regression analysis. RESULT Three hundred and twelve patients with acute AWS were included in this retrospective analysis. Among hospitalized patients with acute AWS, the incidence of pneumonia was 13.78%. The average median age of acute AWS patients with pneumonia was 55.28 (10.65) years, and the mean age of acute AWS individuals without pneumonia was 51.23 (10.08) years. In the univariate analysis, the high SI group (SI > 87.91) had a lower incidence of pneumonia than the low SI group (SI ≤ 87.91) (high SI vs. low SI, 6.41% vs. 16.24%, p = 0.029). Further logistic regression analysis showed that the high SI group demonstrated a poorer risk of pneumonia (OR = 0.353, 95%CI: 0.134-0.932, p = 0.036). After adjusting for possible confounders, the risk of pneumonia remained low in the high SI group (OR = 0.358, 95%CI: 0.132-0.968, p = 0.043). CONCLUSION Our results showed that SI was linked with the risk of pneumonia in hospitalized individuals with acute AWS. We further suggest that it could be a pneumonia risk factor, especially in medical centers where sarcopenia diagnosis is unavailable.
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Affiliation(s)
- Lingdan Zhao
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, Sichuan Province China ,grid.410578.f0000 0001 1114 4286School of Nursing, Southwest Medical University, Luzhou, Sichuan China
| | - Sha Huang
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, Sichuan Province China
| | - Fu Jing
- grid.410578.f0000 0001 1114 4286School of Nursing, Southwest Medical University, Luzhou, Sichuan China
| | - Ting-ting Yu
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, Sichuan Province China
| | - Zeng Wei
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, Sichuan Province China
| | - Xiaoyan Chen
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, Sichuan Province, China.
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15
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Fischler PV, Soyka M, Seifritz E, Mutschler J. Off-label and investigational drugs in the treatment of alcohol use disorder: A critical review. Front Pharmacol 2022; 13:927703. [PMID: 36263121 PMCID: PMC9574013 DOI: 10.3389/fphar.2022.927703] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Compounds known to be successful in the treatment of alcohol use disorder include the aversive agent, Disulfiram, the glutamatergic NMDA receptor antagonist, Acamprosate, and the opioid receptor antagonists, Naltrexone and Nalmefene. Although all four are effective in maintaining abstinence or reduction of alcohol consumption, only a small percentage of patients receive pharmacological treatment. In addition, many other medications have been investigated for their therapeutic potential in the treatment of alcohol use disorder. In this review we summarize and compare Baclofen, Gabapentin, Topiramate, Ondansetron, Varenicline, Aripiprazole, Quetiapine, Clozapine, Antidepressants, Lithium, Neuropeptide Y, Neuropeptide S, Corticotropin-releasing factor antagonists, Oxytocin, PF-05190457, Memantine, Ifenprodil, Samidorphan, Ondelopran, ABT-436, SSR149415, Mifepristone, Ibudilast, Citicoline, Rimonabant, Surinabant, AM4113 and Gamma-hydroxybutyrate While some have shown promising results in the treatment of alcohol use disorder, others have disappointed and should be excluded from further investigation. Here we discuss the most promising results and highlight medications that deserve further preclinical or clinical study. Effective, patient-tailored treatment will require greater understanding provided by many more preclinical and clinical studies.
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Affiliation(s)
- Pascal Valentin Fischler
- Department for Gynecology and Obstetrics, Women’s Clinic Lucerne, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- *Correspondence: Pascal Valentin Fischler,
| | - Michael Soyka
- Psychiatric Hospital University of Munich, Munich, Germany
| | - Erich Seifritz
- Director of the Clinic for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Clinic Zürich, Zürich, Switzerland
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16
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Owens JM. Recognition of Unhealthy Alcohol Use in Older Adults. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Kobayashi NHC, Farias SV, Luz DA, Machado-Ferraro KM, da Conceição BC, da Silveira CCM, Fernandes LMP, Cartágenes SDC, Ferreira VMM, Fontes-Júnior EA, Maia CDSF. Ketamine plus Alcohol: What We Know and What We Can Expect about This. Int J Mol Sci 2022; 23:ijms23147800. [PMID: 35887148 PMCID: PMC9323326 DOI: 10.3390/ijms23147800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 01/02/2023] Open
Abstract
Drug abuse has become a public health concern. The misuse of ketamine, a psychedelic substance, has increased worldwide. In addition, the co-abuse with alcohol is frequently identified among misusers. Considering that ketamine and alcohol share several pharmacological targets, we hypothesize that the consumption of both psychoactive substances may synergically intensify the toxicological consequences, both under the effect of drugs available in body systems and during withdrawal. The aim of this review is to examine the toxicological mechanisms related to ketamine plus ethanol co-abuse, as well the consequences on cardiorespiratory, digestive, urinary, and central nervous systems. Furthermore, we provide a comprehensive discussion about the probable sites of shared molecular mechanisms that may elicit additional hazardous effects. Finally, we highlight the gaps of knowledge in this area, which deserves further research.
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Affiliation(s)
- Natalia Harumi Correa Kobayashi
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
| | - Sarah Viana Farias
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
| | - Diandra Araújo Luz
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
| | - Kissila Márvia Machado-Ferraro
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
| | - Brenda Costa da Conceição
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
| | - Cinthia Cristina Menezes da Silveira
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
| | - Luanna Melo Pereira Fernandes
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
| | - Sabrina de Carvalho Cartágenes
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
| | - Vânia Maria Moraes Ferreira
- Laboratory of Psychobiology, Psychology Institute, University of Brasília, Campus Universitário Darcy Ribeiro—Asa Norte, Brasília 70910900, DF, Brazil;
| | - Enéas Andrade Fontes-Júnior
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
| | - Cristiane do Socorro Ferraz Maia
- Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Institute of Health Science, Federal University of Pará, Belém 66075110, PA, Brazil; (N.H.C.K.); (S.V.F.); (D.A.L.); (K.M.M.-F.); (B.C.d.C.); (C.C.M.d.S.); (L.M.P.F.); (S.d.C.C.); (E.A.F.-J.)
- Correspondence: ; Tel.: +55-91-3201-7201
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