<p>Benzodiazepines are drugs used to treat insomnia and anxiety. This group of drugs should be prescribed with the duty of care to the elderly because of it´s negative effects. Life expectancy is increasing because of the progress of drug development. Aging brings physical and psychological changes leading to changes in pharmacokinetic and pharmacodynamic features. Drug treatment is becoming increasingly widespread and contributes to the increasing number of interactions and complications for the elderly. The aim of the study was to illuminate the consequences of long-term use of benzodiazepines in the elderly. The study was conducted as a literature review based on 14 scientific articles that were analyzed. The result showed that the theme benzodiazepine use among the elderly could be divided into three categories; consequences out of long-term use, benzodiazepine users experiences and the nursing perspective. The category of impact out of long-term use of benzodiazepines revealed three sub-categories: physical consequences, psychological consequences and social consequences. Information and education to the elderly patients is important to make the elderly aware of the negative effects that may arise out of a long-term use of benzodiazepines. It is essential that nurses already in their basic education acquire more knowledge about benzodiazepine use among elderly in order to address these problems in the nursing care.</p>

Benzodiazepines are drugs used to treat insomnia and anxiety. This group of drugs should be prescribed with the duty of care to the elderly because of it´s negative effects. Life expectancy is increasing because of the progress of drug development. Aging brings physical and psychological changes leading to changes in pharmacokinetic and pharmacodynamic features. Drug treatment is becoming increasingly widespread and contributes to the increasing number of interactions and complications for the elderly. The aim of the study was to illuminate the consequences of long-term use of benzodiazepines in the elderly. The study was conducted as a literature review based on 14 scientific articles that were analyzed. The result showed that the theme benzodiazepine use among the elderly could be divided into three categories; consequences out of long-term use, benzodiazepine users experiences and the nursing perspective. The category of impact out of long-term use of benzodiazepines revealed three sub-categories: physical consequences, psychological consequences and social consequences. Information and education to the elderly patients is important to make the elderly aware of the negative effects that may arise out of a long-term use of benzodiazepines. It is essential that nurses already in their basic education acquire more knowledge about benzodiazepine use among elderly in order to address these problems in the nursing care.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19890号 / 医博第4139号 / 新制||医||1016(附属図書館) / 32967 / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 福原 俊一, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

This chapter addresses the following questions: Can the brain-computer interface (BCI) design be implemented in a form suitable for long-term independent use? Who are the people who need the BCI system, and can they use it? Can their home environments support their use of the BCI, and do they actually use it? Does the BCI improve their lives? It considers the steps involved in answering each of these questions and the potential problems that must be overcome. Since the present peer-reviewed literature lacks any formal multisubject studies that address these questions, the discussion relies heavily on personal experience to date, which is primarily with a noninvasive EEG P300-based BCI system. The chapter's overall intent is to provide information and insight that would apply to any effort to take any BCI system out of the lab and validate its effectiveness in the everyday lives of people with disabilities.

京都大学 / 0048 / 新制・論文博士 / 博士(農学) / 乙第13183号 / 論農博第2862号 / 新制||農||1061(附属図書館) / 学位論文||H30||N5105(農学部図書室) / (主査)教授 村上 章, 教授 藤原 正幸, 教授 渦岡 良介 / 学位規則第4条第2項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13632号 / 論医博第2323号 / 新制||医||1074(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 辻川 明孝, 教授 滝田 順子, 教授 森田 智視 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Benzodiazepines have been widely prescribed since the 1960s for the management of adverse symptoms related to anxiety, depression, and sleep problems. They were regarded as an efficacious medication when compared with their predecessor, barbiturates. Within 10 years of their introduction, concerns began to be raised regarding their potential to produce dependence and withdrawal symptoms when ceased, including symptoms not present prior to their being prescribed. Subsequent research focussed on establishing effective strategies to ameliorate the adverse symptoms experienced even when the daily intake was slowly reduced. The aim of the work undertaken for this doctorate was to establish whether there was a role for cognitive behaviour therapy (CBT) in benzodiazepine cessation. The initial step in conducting the research for this doctorate was to obtain a detailed understanding of the current state of research on benzodiazepine cessation. Study 1 therefore focussed on establishing the effectiveness of treatment approaches used to assist individuals to cease benzodiazepine use. A Meta-analysis of treatment strategies undertaken in general practice and outpatient settings established that brief intervention resulted in superior cessation rates at post-treatment than routine care. Gradual dose reduction plus CBT was slightly superior to gradual dose reduction alone. However, substitutive pharmacotherapies in combination with gradual dose reduction did not result in a superior outcome to gradual dose reduction alone, and substitutive pharmacotherapy plus abrupt benzodiazepine cessation was less effective than gradual dose reduction. While, providing CBT in conjunction with gradual dose reduction offered a superior outcome than gradual dose reduction alone, current evidence does not identify the CBT strategies that contributed to the superior outcome. The next step in the development of the CBT intervention involved obtaining a deep appreciation of the issues relating to cessation from the perspective of General Practitioners (GPs) and Benzodiazepine Users (BzUs). Accordingly, Study 2 administered semi-structured interviews about benzodiazepine use and its cessation to 28 GPs and 23 BzUs. Responses were analysed using the Consensual Qualitative Research approach, as it enabled comparisons to be made between the views of the two groups of interviewees. The study identified commonality between GPs and BzUs on reasons for commencing use, the role of dependence in continued use, and the importance of lifestyle change in its cessation. BzUs felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before prescribing benzodiazepines. Few GPs had assisted a patient to cease use reportedly due to the required time and the expectation of a poor outcome. There was a perception that patients wanted a pharmacological solution to their problems. A critical gap in assessment instruments that are needed for a comprehensive assessment of the outcomes from a treatment trial was identified. In particular, there was no measure of benzodiazepine expectancy or self-efficacy concerning maintenance of benzodiazepine dose reduction. Therefore, Study 3 adapted existing expectancy and self-efficacy measures form other substance domains to verify their applicability to benzodiazepines. Current BzUs (n = 155) were invited to complete two questionnaires either online or via hard copy. Principal component analysis (PCA) of a newly developed Benzodiazepine Expectancy Questionnaire (BEQ) resulted an 18-item, 2-factor scale, while a Benzodiazepine Refusal Self Efficacy Questionnaire (BRSEQ) formed a 16-item, 4-factor scale, Confirmatory factor analysis (CFA) in a second sample (n = 139) confirmed these internal structures, reducing the BEQ to 12 items and the BRSEQ to 14 items respectively. The qualitative study suggested that many GPs would be reluctant to engage in psychological support for benzodiazepine cessation and it was evident that specialist services would be unable to provide substantial support especially in rural and remote areas. Accordingly, it was decided to develop a treatment that was remotely delivered. The initial pilot used a correspondence-based approach, delivered via the postal service. Study 4 comprised a small pilot comparing GP managed gradual dose reduction, plus CBT via mail (M-CBT), which was either delivered immediately (IM-CBT) or after 3 months (DM-CBT). Despite substantial efforts over a 2 year period to recruit GPs and BzUs, only 6 received the allocated intervention. It was decided to trial the intervention as an internet-delivered program to enhance its accessibility to BzUs. Access to the program was promoted through the project website and links from high profile support websites. Study 5 was an uncontrolled trial of internet-based CBT (I-CBT). Access was provided to all newsletters, although, participants were given a suggested sequence for access. Despite placement on the internet and cross-listing on several key websites, the study still only recruited 35 participants (3 of which received the program by mail). Of the 32 undertaking the program via the internet, 21 completed the 3-month assessments and 14 the 6-month assessments. Eight participants reduced their weekly benzodiazepine intake by at least 50%, by 3 months, with five ceasing use at 6 months. A significant increase in self-efficacy, and a decrease in depressive symptoms and dependence were seen. Providing CBT either via mail or the internet assisted some participants to reduce or cease long-term benzodiazepine use. Recruitment to both M-CBT and I-CBT was limited, despite substantial attempts to market the intervention. The studies undertaken for this doctorate make a unique contribution to improving treatment outcomes for people wishing to cease long-term benzodiazepine use. They also provide direction for more extensive studies to definitively establish the nature of effective treatment. The current evidence clearly supports the importance of gradual dose reduction and the role of CBT in further improving treatment outcomes. However, engagement of both BzUs and GPs remains challenging. Remote delivery of CBT via mail or the internet may assist with improving access to CBT, but it does not solve the problem of GP and BzU engagement. An effective system-wide program to address long-term benzodiazepine use will require that incentives for GP involvement (a disincentive for long-term prescription) are in place.