Journal Digest

Drug Education Prompts Elderly to Reduce Benzodiazepine Use

Discontinuing use of benzodiazepines by the elderly is made easier when patients are educated about the medication’s potential harm, according to a study published last month in JAMA Internal Medicine.

Researchers from the departments of pharmacy and geriatrics at the University of Montreal conducted a study to determine whether educating older patients on the health risks of benzodiazepines would serve as an effective method to discourage the use of such drugs. The study included 303 long-term users of benzodiazepines aged 65 to 95. The participants were randomly selected to receive a booklet describing adverse health risks of benzodiazepines, along with instructions on how to safely reduce use of the medication and information on alternative strategies for treating insomnia and anxiety. They were compared with a cohort that received no such information.

At the six month follow-up, the results showed that 62 percent of the patients who received booklets initiated a conversation with their physician or pharmacist about benzodiazepine cessation, while 27 percent discontinued their use. Patients who were not educated on the potential harms of benzodiazepines had a discontinuation rate of 5 percent.

The authors said, “In an era of multimorbidity, polypharmacy, and costly therapeutic competition, direct-to-consumer education is emerging as a promising strategy to stem potential overtreatment and reduce the risk of drug harms.” They concluded that “the value of the patient as a catalyst for driving decisions to optimize health care utilization should not be underestimated.”

Mobile App Aids in Recovery From Alcohol Abuse

A study in JAMA Psychiatry suggests that smartphones could be effective in providing continued intervention for individuals recovering from alcohol use disorder (AUD).

Researchers in the departments of Industrial Engineering and Preventive Medicine at the University of Wisconsin-Madison randomized 349 patients who were recently released from a residential program for AUD to receive typical treatments, such as monthly therapy sessions, or typical treatments plus a smartphone with the Addiction-Comprehensive Health Enhancement Support System (A-CHESS) application. The application consisted of audio-guided relaxation techniques and alerts if patients neared a high-risk location for drinking, such as a bar they once frequented.

After one year of follow-up, the smartphone intervention group reported approximately 1.5 fewer risky drinking days—days in which a male patient exceeded four standard drinks and a female patient exceeded three standard drinks in a two-hour period—than those who did not a receive the smartphone intervention. In addition, 52 percent of individuals in the smartphone cohort reported abstinence from drinking in the 30 days prior to the one-year follow-up, compared with 40 percent in the non-smartphone cohort.

John Luo, M.D., a senior informaticist and professor of clinical psychiatry at the University of California at Los Angeles, who was not involved in the study, told Psychiatric News that the study’s “smartphone [app] works similarly to apps that help patients lose weight by having them record their caloric intake—since the process of entering values and seeing results helps shape behavior.” Luo explained that the main innovation in the current study is the GPS tracking device, which serves as a “panic button” when patients are near high-risk locations for drinking. Luo concluded that though no one app is a perfect fit for all, “any application that increases the likelihood for patients to maintain abstinence is a start in the right direction.”

Alternative Therapy May Help Prevent Onset of Major Depression in Elderly

Scientists from the University of Pittsburgh Medical Center report in Psychiatric Services in Advance that problem-solving therapy for primary care (PST-PC)—an intervention delivered by nonmental health professionals to help patients improve coping skills and confidence—may be beneficial for older adults who are at risk for major depression.

Charles Reynolds III, M.D., a professor of geriatric psychiatry, and colleagues evaluated the efficacy of PST-PC in preventing episodes of major depression and reducing depressive symptoms in elderly adults. The study included approximately 250 individuals with subsyndromal depressive symptoms who received 15 months of PST-PC, a technique that has been shown to reduce stress, or dietary coaching, which had been shown to reduce depression risk in an elderly population in a previous study by Reynolds. The two cohorts were compared with each other in addition to being compared with age-matched cohorts from previously published studies of those who received neither therapy for subsyndromal depressive symptoms.

After two years, the analysis showed PST-PC to be as effective as dietary coaching in preventing episodes of major depression in this at-risk cohort. Incident rates for major depression in both cohorts were approximately 9 percent, compared with published rates of 20 percent to 25 percent in those who received neither treatment. The researchers also observed a significant reduction in depressive symptoms in both the PST-PC and dietary-coaching groups.

“Avoiding episodes of major depression can help people stay happy and engaged in their communities,” said Reynolds. “This project tells us that interventions in which people actively engage in managing their own life problems. . .tend to have a positive effect on well-being and a protective effect against the onset of depression.”

Aerobic Activity in Young Adulthood May Preserve Midlife Cognitive Function

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Young adults who participate in cardio fitness activities such as running may be doing more than helping to preserve their heart function—they may be helping to preserve their memory and thinking skills as well.

Researchers at the University of Minnesota conducted a study with nearly 3,000 healthy individuals in their mid-20s to assess the relationship between aerobic exercise and cognitive function. The participants were subjected to one year of treadmill tests at study initiation and another series of treadmill tests, in addition to cognitive tests, 20 to 25 years later. During the treadmill tests, participants were evaluated on their ability to endure increasing speeds and inclines without shortness of breath.

Results showed that participants lasted an average of 10 minutes on treadmills during young adulthood, compared with an average of 7.1 minutes at middle age. Every additional minute completed on the treadmill during young adulthood was significantly associated with more words and numbers being recalled on tests evaluating memory and psychomotor speed at ages 45 to 55—even after adjusting for factors such as smoking, diabetes, and cholesterol level.

Dilip Jeste, M.D., director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego, and a professor of psychiatry and neurosciences, told Psychiatric News that “though the findings need to be replicated in prospective longitudinal research, . . . the findings suggest that activities such as running can potentially reduce cognitive impairment in later life. Following these adults into old age may help determine if neurocognitive disorders such as dementia are less common in the individuals who engaged in vigorous exercise at younger age.” Jeste, who is a past president of APA, urged clinicians to encourage physical activity, especially aerobic exercise, in all of their patients—young and old—according to the patient’s personal physical capacity. “It can help not only their muscles and heart, but possibly also their brains in later life.”