Prolonged Use Of Benzodiazepines Research Articles

Fatores associados ao uso de benzodiazepínicos no serviço municipal de saúde da cidade de Coronel Fabriciano, Minas Gerais, Brasil

Numerous countries have witnessed increasing misuse of benzodiazepines. This cross-sectional study assessed the factors associated with prescription of benzodiazepines for users of the Municipal Health Service in Colonel Fabriciano, Minas Gerais State, Brazil. Data were collected from official records on drug prescription (n = 1,866) from September to October 2006. Bivariate and multivariate analyses using Poisson regression were performed. Prolonged benzodiazepine use was independently associated with benzodiazepine type and patient participation in health programs. Concomitant use of other psychoactive drugs was independently associated with age and participation in health programs. Type of benzodiazepine (clonazepam or diazepam) was independently associated with age and gender, as well as with participation in health programs. Factors associated with benzodiazepine prescription show the problem's extent and should be considered in planning interventions to rationalize the use of these drugs in Brazil, particularly through health program planning.

Ten-year trends in benzodiazepine use in the Dutch population

BackgroundIn the past decades knowledge on adequate treatment of affective disorders and awareness of the negative consequences of long-term benzodiazepine use increased. Therefore, a decrease in benzodiazepine use is expected, particularly in prolonged use. The aim of this study was to assess time trends in benzodiazepine use.Methods and materialData from the Longitudinal Aging Study Amsterdam (LASA) were used to investigate trends in benzodiazepine use between 1992 and 2002 in two population-based samples aged 55–64 years. Differences between the two samples with respect to benzodiazepine use and to sociodemographic, physical health and mental health characteristics were described and tested with chi-square tests and logistic regression analyses.ResultsBenzodiazepine use remained stable over 10 years, with 7.8% in LASA-1 (n = 874) and 7.9% in LASA-2 (n = 919) (p = 0.90) with a persisting preponderance in women and in people with low education, low income, chronic physical diseases, functional limitations, cognitive impairment, depression, anxiety complaints, sleep problems and when using antidepressants. Long-term use remained high with 70% in 1992 and 80% in 2002 of total benzodiazepine use.ConclusionIn the Dutch population aged 55–64, overall benzodiazepine use remained stable from 1992 to 2002, with a high proportion of long-term users, despite the effort to reduce benzodiazepine use and the renewal of the guidelines. More effort should be made to decrease prolonged benzodiazepine use in this middle-aged group, because of the increasing risks with ageing.

Factores de riesgo de la osteoporosis en mujeres atendidas en Atención Primaria y en consultas hospitalarias. Estudio OPINHO-PC

IntroductionOsteoporosis (OP) is a disease with high prevalence and high economic and social cost. This study has aimed to describe risk factors (RF) among women with osteoporosis (OP) treated in primary care (PC) and hospitals (HO). Material and methodsCross-sectional, epidemiological and multicenter study, including 194 PC and 186 HO women with OP. ResultsPatients in both groups had equivalent age (age±SD 67.6±9.8 PC and 67.6±10 years HO), and OP severity (-3.0±0.8 PC vs -3.1±0.8 HO). Some specific risk factors for falls such as prolonged use of benzodiazepines and heart rate higher than 80 pulses per minute were more frequent in the hospital setting (24.2% PC vs 15.6% HO, p=0.0354) and (12.9% PC vs 3.2% HO, p=0.0006), respectively. In contrast, intrinsically bone-related RFs for osteoporotic fracture were generally more prevalent in HO: surgical menopause (20.7% vs. 12.8%, p=0.047), previous vertebral fractures (20.6% PC vs 34.9% HO, p=0.0018), and prolonged use of steroids (7.7% PC vs 15.6% HO, p=0.0167). Sedentary lifestyle and tobacco consumption (cigarettes/day), however, were more prevalent in PC than in HO (48.5% PC vs 31.7% HO, p=0.0009 and 16.9±4.6 PC vs 11.4±9.7 HO, p=0.0344, respectively). ConclusionsRisk factors associated with the risk of falling (not bone-related factors) are more prevalent in OP patients, whilst factors associated with bone quality and density (bone-related factors) are more prevalent in HO patients.

P03-230 No NREM phase 3-4 (deep sleep) among benzodiazepine abuse patients in methadone maintenance treatment (MMT)

Aims:As benzodiazepines (BDZ) abuse is highly prevalent among former heroin addicts, current MMTpatients, and poor sleep is highly prevalent complaint, we studied objective sleep patterns by polysomnography (PSG) and it relation with BDZ abuse.Methods:Urine results for BDZ (and opiates, cocaine, cannabis, amphetamines) which are routinely monitored, were taken at the month before PSG night. Pittsburgh Sleep Quality Index (PSQI), a self report questionnaire, questionnaire for pain (chronic pain defined if patient had current pain that lasted for ≥6month, of moderate or worse intensity), and DSM-IV-TR lifetime psychiatric diagnosis were studied.Results:Of 67 patients, 44(64.7%) were positive to BDZ. Patients included 86% males, 64.2% with any DSM-IV-TR axis I psychiatric diagnosis, 47% with chronic pain, with no differences between BDZ groups. PSQI scores and objective sleep efficiency were similar between yes and no BDZ groups (12.4±4.1 vs. 11.1±4.5, p=0.3, and 78±17.4% vs. 74±19.5%, p=0.4), but architecture differed notably. Specifically, 23(53.5%) of BDZ group had no non-REM deep sleep (phases 3+4) at all as compared with 4(16.7%) of the no-BDZ patients. REM phase was shorter among BDZ group (10.5±8.9 vs. 15.4±7.3, F=5.4, p=0.02). No other differences were found, and the absence of phase 3-4 was not related to methadone dose, treatment duration, or history of opiate abuse.Conclusions:Chronic / prolonged use of BDZ (which at times are prescribed for sleep), may disturb sleep, as shown to absolutely delete all restorative sleep phase. BDZ discontinuation is of important, but further studies are needed to establish the best way.

Prescription of benzodiazepines in general practice in the context of a man-made disaster: a longitudinal study

Mental health problems associated with benzodiazepine treatment are often highly prevalent in the aftermath of disasters. Nevertheless, not much is known about benzodiazepine use after disasters. Considering the negative effects associated with prolonged use and the adverse effects of benzodiazepines on recovery of patients with acute stress, the aim of the present study was to explore benzodiazepine use in the context of the Enschede fireworks disaster of 13 May 2000. A longitudinal study using electronic medical records of general practitioners. Subjects were patients aged 16 years and older, registered at one of the practices between 1999 and 2003 (1541 victims and 5370 references). Pre- and post-disaster data were available on benzodiazepine prescriptions, healthcare utilization and sociodemographic characteristics. Benzodiazepine use was defined using different criteria (e.g. any use, daily use, chronic use). Data were analysed using multivariate multilevel logistic regression analyses. Compared with patients from a reference group, disaster victims were at increased risk of becoming an incident benzodiazepine user after the disaster. Benzodiazepine use also had a different time course among victims compared with references. However, daily or prolonged use of benzodiazepines was not often observed and did not show dramatic deviations among disaster victims compared with references. There is no convincing evidence that general practitioners systematically deviated from clinical guidelines for benzodiazepines, which generally advocate their short time application.

Reducing Polypharmacy Through the Introduction of a Treatment Algorithm: Use of a Treatment Algorithm on the Impact on Polypharmacy

Polypharmacy is very common in the psychiatric setting despite the lack of evidence to justify its use. The objective of this study was to review the prescription patterns in a tertiary mental health institute in Asia and evaluate the impact of a treatment algorithm for patients with first-episode psychosis (FEP) on the use of polypharmacy. A treatment algorithm was implemented for patients accepted into an Early Psychosis Intervention Programme (EPIP) and the prescription patterns of these patients were compared with a comparator group (pre-EPIP) before the use of the algorithm. The prescribing pattern was established at 2 points: at baseline after the diagnosis was made, and 3 months later. There were 68 subjects in the comparator group and 483 EPIP patients; the latter were on the average younger. None in the comparator group was diagnosed to have an affective psychosis. There was a significant reduction in the rate of antipsychotic polypharmacy, prolonged use of benzodiazepines and anticholinergic medication in EPIP patients. This group also had an increase in the use of second-generation antipsychotics and received lower doses of antipsychotics. The implementation of a treatment algorithm coupled with audit has changed the trend towards polypharmacy among patients with FEP.

Uso indevido de benzodiazepínicos: um estudo com informantes-chave no município de São Paulo

Este estudo teve por objetivo compreender a prática de prescrição, dispensação e uso prolongado de benzodiazepínicos, a partir da visão de profissionais de saúde e de usuários crônicos dessas substâncias. A amostra foi composta por técnica de bola de neve, totalizando19 informantes-chave. As entrevistas semi-estruturadas foram gravadas e transcritas para análise. A maioria dos entrevistados relatou ser freqüente a obtenção de prescrição de benzodiazepínicos por solicitações junto aos médicos, sem necessidade de consulta formal. Os usuários relataram histórico de uso prolongado (entre 2 e 8 anos) com finalidades outras que não apenas a terapêutica. Enfatizaram também a facilidade em adquirir a medicação e a falta de orientação médica sobre os cuidados necessários durante o tratamento. O estudo sugere que a ocorrência de uso indevido envolve não apenas o sistema de controle da dispensação, mas uma série de outros fatores, entre os quais as atitudes dos profissionais de saúde.

Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse

Discontinuation of benzodiazepine (BZD) treatment for insomnia can be a difficult task. Cognitive-behavior therapy (CBT) for insomnia, combined with a supervised medication taper, can facilitate withdrawal but there is limited evidence on long-term outcome after discontinuation. The objective of this study was to examine medication-free survival time and predictors of relapse (i.e., resumed BZD hypnotics) over a 2-year period in 47 older adults (mean age 62.1 years) with persistent insomnia and prolonged BZD use (average duration of 18.9 years), who had successfully discontinued BZD following CBT for insomnia, a supervised medication taper program, or a combined approach. The Kaplan–Meier product-limit method was used to estimate survival time, defined as time between end-of-treatment and relapse or end of follow-up. By the end of the 24-month follow-up, 42.6% of the samples had resumed BZD use. Participants in the Combined (33.3%) and Taper (30.8%) groups relapsed significantly less than their counterparts from the CBT group (69.2%). Survival rates at 3 months were 61.5% (CBT), 100% (Taper), and 80.9% (Combined). At 12 months, they were 38.5%, 83.3%, and 70.8%, respectively; and, at 24 months, they were 28.9%, 64.8% and 64.9%, respectively. Mean survival time was significantly longer for both the Taper (18.6 months, SE=2.1) and Combined groups (12.6 months, SE=1.4), relative to the CBT group (8.5 months, SE=1.8). Significant predictors of relapse included treatment condition, end of treatment insomnia severity, and psychological distress. In conclusion, there is a substantial relapse rate following BZD discontinuation among prolonged users. CBT booster sessions might enhance compliance with CBT and prove useful in preventing relapse.

Initial 3-month usage characteristics predict long-term use of benzodiazepines: an 8-year follow-up.

The aim of the study was to identify initial usage predictors for prolonged benzodiazepine use. An 8-year pharmacy data-based study (1983-1992) was carried out on a retrospective cohort of 425 initial benzodiazepine users. The setting was the only pharmacy in a community of 13,500 people. Among the 425 initial users, 36% had a single initial exposure year, 50% had two to seven exposure years, and 14% had benzodiazepine use during all 8 years of follow-up. Prolonged use over more years was associated with an initial high number of prescriptions, elderly patients and initial use of hypnotics. Two patterns of irregular prolonged use were investigated: increase in use was associated with a shorter length of the first usage period and switching to another benodiazepine during the first 90 days; relapses of use were associated with a shorter length of first usage period and initial use of an anxiolytic. Gender and initial dosage were not associated with prolonged use at all. During the first 90 days after initiation of benzodiazepine use, a number of determinants of prolonged benzodiazepine use were visible. The prescribers of these drugs and the pharmacists should advise rational use not only at the start but also at the moment of the first repeat prescription in order to prevent needless prolonged use and dependence.

The impact of attitudes and beliefs on length of benzodiazepine use: a study among inexperienced and experienced benzodiazepine users

Prolonged benzodiazepine use is a widespread phenomenon in medical practice. In the present article, we argue that psychological models may contribute to our understanding of benzodiazepine use. This study examined variables derived from the theory of planned behaviour and the health belief model in relation to the length of benzodiazepine use. Data were collected from a sample of all benzodiazepine users with a request for this medicine in the only pharmacy in a Dutch community ( N=467). Determinants of the length of benzodiazepine use were analysed separately for inexperienced and experienced users using structural equation modelling (SEM) analyses. For both groups, results showed that the intention to use benzodiazepines was a predictor of length of use. Attitudes towards benzodiazepine use had an indirect influence on length of use, through intentions. Furthermore, a positive attitude toward using benzodiazepines was related to the perceived norm of the prescriber. Experienced users were more inclined to consume benzodiazepines when they had less control over drug taking. In this group, the belief that benzodiazepine use leads to dependence was associated with less control over drug taking and a high intention to use the drug. In addition, older experienced users reported a higher intention to use the drug. For inexperienced users, the perceived attitude of the prescriber towards use of the medicine was a strong determinant. Finally, results of SEM-analyses showed that the model accounted for far more variance in behaviour for experienced users (67%), than for inexperienced users (18%).

Effets des benzodiazépines sur la performance cognitive et psychomotrice des personnes âgées souffrant d'insomnie

ABSTRACTThis study investigates the effects of chronic use of benzodiazepines (BZ) as hypnotics on the neuropsychological performance of older adults with insomnia. Twenty-one older persons who had used BZ on a chronic basis (average duration = 21.7 years) for their sleep difficulties were enrolled in a medication withdrawal program. A neuropsychological evaluation was conducted before and after the taper program. A control group composed of older adults not using BZs and without sleep complaints were also evaluated for comparative purpose. The results showed that prolonged use of BZ produces mild and selective impairments of cognitive and psychomotor performance. However, BZ users subjectively evaluated their own performance much more negatively than good sleepers. The results are discussed in terms of a possible amplification of performance deficits among insomnia patients and also as a tolerance to adverse effects that develops with prolonged utilization of BZ.

Differential acute psychomotor and cognitive effects of diazepam on long-term benzodiazepine users

The aim of this study is to determine whether long-term use (5-20 years) of therapeutic doses of diazepam (5-20 mg/day) in anxious patients (n = 28) is associated with tolerance to its psychomotor and cognitive effects. Patients were tested at baseline, before and after a 10 mg oral dose of diazepam during chronic use, and at 3 weeks and 10 months after benzodiazepine (BZ) discontinuation. The effects of a single i.v. dose of flumazenil (1 mg administered 5 days before baseline) on reversing tolerance were also assessed. No acute effect of diazepam was observed on the psychomotor performance of patients both under BZ treatment and after short- and long-term discontinuation, suggesting persistence of tolerance. In contrast, acute effects of diazepam were observed in memory measures at all times. Given subjects' very prolonged BZ use, it is possible to predict that tolerance to the memory effects never fully develops. Flumazenil administration did not reverse tolerance. This suggests that neuroadaptative mechanisms, other than benzodiazepine receptor set-point shift, occur after long-term use.

Pharmacologic considerations in the treatment of substance abuse.

Drug and alcohol abuse continue to be commonly encountered problems in most patient populations. To deal effectively with these problems, the primary care physician must have a thorough knowledge of the pharmacology of commonly abused drugs and the adjunctive agents used in treatment. Management of alcoholism may involve a range of medical interventions, including the treatment of alcohol intoxication, the use of benzodiazepines for alcohol withdrawal, and possibly the short-term administration of disulfiram to maintain sobriety. Successful management of cocaine or amphetamine abuse requires an understanding of the powerful reinforcing properties of these drugs and the unique problems that arise in the recovery period. Barbiturate intoxication and withdrawal are potentially life-threatening events requiring skilled in-patient treatment. Prolonged use of benzodiazepines can lead to drug dependence; successful withdrawal involves gradual dosage reduction. Acute intoxication from marijuana or hallucinogenic drugs may occasionally result in adverse reactions requiring medical intervention, but significant withdrawal reactions are rare. Management of opioid overdose, whether illicit or iatrogenic, requires the prompt and skillful use of opioid overdose, whether illicit or iatrogenic, requires the prompt and skillful use of opioid antagonists. Promising new pharmacologic approaches are now being successfully applied to the management of opioid dependence. An acceptance of nicotine as the addictive component of tobacco smoke has led to the development of nicotine gum as substitution therapy for cigarette smoking. Successful pharmacologic management of overdose or withdrawal is often the prerequisite for effective long-term treatment and recovery.

Problems and Pitfalls in the Use of Benzodiazepines in the Elderly

Benzodiazepines are frequently prescribed for elderly patients living in the community and for those in hospitals and institutions. Their use is more prevalent in women. Prolonged use of benzodiazepines is particularly likely in old age for the treatment not only of insomnia and anxiety, but also of a wide range of nonspecific symptoms. Long term users are likely to have multiple concomitant physical and psychological health problems. The distinction between benzodiazepine anxiolytics and hypnotics is difficult and somewhat arbitrary, since the differences between the compounds are less than their similarities, especially in respect of adverse reactions. Despite their wide therapeutic range, elderly patients are particularly prone to adverse reactions to benzodiazepines. The incidence of unwanted effects, predominantly manifestations of central nervous system depression, has been found to be significantly increased in hospitalised elderly patients, particularly in the frail elderly. Studies on unwanted effects during long term use are scarce, but there is some evidence of tolerance to side effects. However, benzodiazepines have been found to be frequently implicated in drug-associated hospital admissions. There is suggestive evidence that benzodiazepines, especially compounds with long half-lives, may contribute to the falls which are a major health problem in old age. The incidence of benzodiazepine dependence in elderly patients is unknown. The features of benzodiazepine withdrawal in the elderly may differ from those seen in young patients; withdrawal symptoms include confusion and disorientation which often does not precipitate milder reactions such as anxiety, insomnia and perceptual changes. Problems due to both adverse reactions and to benzodiazepine withdrawal may easily be overlooked in multimorbid elderly patients, particularly in those suffering from disorders of the central nervous system. There are numerous studies on benzodiazepine pharmacokinetics indicating that alterations, especially in distribution and elimination of certain compounds, occur in old age. Benzodiazepines with oxidative metabolic pathways and longer half-lives are likely to accumulate with regular administration. However, changes in pharmacodynamics may be more important to explain altered responses to benzodiazepines in the elderly. Although information on pharmacodynamics is still limited, there is convincing evidence of increased pharmacodynamic response in the elderly which may be further accentuated by disease factors. Since the variability of pharmacological response increases with age and is not always predictable, there is good reason at least to start therapy at lower doses and to titrate dosages individually. This may also be appropriate for the newer benzodiazepines, irrespective of advantageous pharmacokinetics.(ABSTRACT TRUNCATED AT 400 WORDS)

Benzodiazepine use in a rural general practice population.

This study investigates the prevalence and pattern of benzodiazepine use in an isolated Australian rural general practice setting. Some clinical features of psychological dependence were also examined. Data were obtained from 771 patients attending each of two general practices over a five-day period. The results indicated that 11.3% of the sample had used a benzodiazepine in the preceding four weeks and that 82% of these had been regular users for over six months. Prevalence increased with age and 36.5% of patients over the age of 70 were using benzodiazepines. Features suggesting some degree of psychological dependence were found in over 50% of users. The findings illustrate the extensive and prolonged use of benzodiazepines and raise questions about overuse and dependence, particularly in the elderly.

Cognitive impairment in long-term benzodiazepine users.

In view of the very extensive and often prolonged use of benzodiazepines in therapeutic practice, this study was designed to investigate whether or not cognitive ability is impaired in long-term benzodiazepine users, and to determine the nature and extent of any deficit. Fifty patients currently taking benzodiazepines for at least one year, thirty-four who had stopped taking benzodiazepines, and a matched control group of subjects who had never taken benzodiazepines or who had taken benzodiazepines in the past for less than one year were administered a battery of neuropsychological tests designed to measure a wide range of cognitive functions. It was found that patients taking high doses of benzodiazepines for long periods of time perform poorly on tasks involving visual-spatial ability and sustained attention. This is consistent with deficits in posterior cortical cognitive function.

Outpatient Benzodiazepine Withdrawal and the Occupational Therapist

Prolonged use of benzodiazepines (minor tranquillizers) can cause physical and psychological dependence and intoxication. There are often severe withdrawal symptoms when the drugs are reduced or stopped, forming a problem which is becoming increasingly recognized. This article describes the work being carried out in a community setting by two senior occupational therapists who have started outpatient benzodiazepine withdrawal groups. It outlines the problem, the difficulties experienced during withdrawal, the selection of group members, and the organization of the groups and their content. The article concludes with two brief case studies.

A variety of adverse effects occur with prolonged benzodiazepine use

A variety of adverse effects occur with prolonged benzodiazepine use