Harmen Beurmanjer

92 Chapter 7 Chapter 4 COGNITIVE IMPAIRMENT IN PATIENTS WITH GUD While research on cognitive impairment in patients with GUD is limited, several studies show that GHB use and in particular GHB induced coma’s are associated with memory problems. Our study used the Montreal cognitive assessment (MoCA) to screen for cognitive impairments in patients with GUD before and after detoxification. The study showed a substantial number of patients with GUD screened positive for cognitive impairment before detoxification. Cognitive functioning improved after detoxification with still about one third screening positive for impairment. The cognitive domain showing the strongest impairment was memory. Cognitive impairment before detoxification, particularly on the subscale memory, was associated with relapse. Part 2: P harmacological treatment interventions for patients with GHB use disorder Chapter 5 GHB DETOXIFICATION Two pharmacological treatment regimens are commonly used to counteract withdrawal symptoms during GHB detoxification: tapering with benzodiazepines (BZDs) and tapering with pharmaceutical GHB. Our study aimed to compare both tapering methods and determine whether one should be preferred over the other. The results showed that GHB tapering was associated with a milder withdrawal syndrome and fewer adverse events (including delirium) during detoxification, compared with BZD treatment. Chapter 6 RELAPSE MANAGEMENT FOR PATIENTS WITH GUD There is no GUD specific relapse management available in current practice. Several studies however have suggested that the GABA-B agonist baclofen could help supress craving and anxiety in patients with GUD(Kamal, Schellekens, et al., 2015; Lingford-Hughes et al., 2016). In our open label study, we prescribed baclofen up to 60 mg to patients with GUD after detoxification. The results showed that patients receiving baclofen per protocol after detoxification had reduced relapse rates compared with patients receiving treatment as usual, supported by a similar trend towards beneficial effects of baclofen in the intention to treat analysis. Limited side effects were reported.