Benzodiazepines: Risks and Benefits. A Reconsideration

Baldwin, David S.; Aitchison, Katherine; Bateson, Alan N.; Curran, H. Valerie; Davies, Simon; Leonard, Brian E.; Nutt, David; Stephens, David; Wilson, Sue

doi:10.1176/appi.focus.12.2.229

Cited by 58 publications

(100 citation statements)

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“…Further, it can impair driving and working performance and cause accidents. 24 Poor sleep was associated with an irregularity of hours of sleep and lying down for long periods without sleep. Other studies have shown a relation between sleep hygiene and sleep quality.…”

Section: Discussionmentioning

confidence: 99%

Sleep Quality Among Psychiatry Residents

et al. 2016

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Objective: Medical residency programs are traditionally known for long working hours, which can be associated with a poor quality of sleep and daytime sleepiness. However, few studies have focused on this theme. Our objective was to investigate sleep quality, daytime sleepiness, and their relation with anxiety, social phobia, and depressive symptoms. Methods:This cross-sectional observational study involved 59 psychiatry residents. The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were used to measure the quality of sleep and excessive daytime sleepiness ([EDS] and ESS > 10), respectively.Results: Among the 59 psychiatry residents, 59.3% had poor sleep quality (PSQI > 5) and 28.8% had EDS. Poor sleep quality was associated with higher EDS (P ¼ 0.03) and the year of residency program (P ¼ 0.03). Only 20% of residents with poor sleep had consulted at least once for sleep problems; 54.2% had used medications for sleep; and 16.9% were using medications at the time of interview. Only 30% obtained medication during medical consultations. Poor sleep was associated with irregular sleep hours (P ¼ 0.001) and long periods lying down without sleep (P ¼ 0.03). Poor sleep quality was also associated with high scores of anxiety symptoms (P < 0.001) and social phobia symptoms (P ¼ 0.02).Conclusion: Psychiatry residents frequently have poor sleep quality and EDS. Considering that sleep disorders can affect quality of life, predispose to metabolic syndrome, and be associated with worse performance at work, attention to this clinical problem is needed. Abré géObjectif : Les programmes de résidence en médecine sont reconnus traditionnellement pour leurs longues heures de travail, qui peuvent être associées à une mauvaise qualité du sommeil et à une somnolence diurne. Toutefois, peu d'études se sont penchées sur ce thème. L'objectif de cette étude était d'investiguer la qualité du sommeil, la somnolence diurne, et leur relation à l'anxiété, à la phobie sociale, et aux symptô mes dépressifs.Mé thodes : Cette étude transversale par observation comptait 59 résidents en psychiatrie. Le Pittsburgh Sleep Quality Index (PSQI) et l'Epworth Sleepiness Scale (ESS) ont servi à mesurer la qualité du sommeil et la somnolence diurne excessive ([SDE] et ESS > 10), respectivement. Ré sultats : Parmi les 59 résidents en psychiatrie, 59,3% avaient une mauvaise qualité du sommeil (MQS > 5) et 28,8% avaient une SDE. La mauvaise qualité du sommeil était associée à une SDE plus élevée (P ¼ 0,03) et au programme de l'année de résidence (P ¼ 0,03). Parmi les résidents qui dormaient mal, seulement 20% avaient consulté au moins une fois pour des problèmes de sommeil; 54,2% avaient utilisé des médicaments pour dormir; et 16,9% en utilisaient présentement. Seulement 30% ont obtenu des médicaments durant des consultations médicales. Le mauvais sommeil était associé à des heures de

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Section: Discussionmentioning

confidence: 99%

Sleep Quality Among Psychiatry Residents

et al. 2016

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“…Nevertheless, Stowell et al 23 did not detect significant difference in alcohol use among BZD users or non-users. Not drinking alcohol beverages is possibly due to medical contraindications 14,16 . This recommendation is very important due to the risk of severe respiratory depression, a consequence of the depressant effect synergism, which may result in serious and fatal poisoning.…”

Section: Discussionmentioning

confidence: 99%

“…The use of these substances has been associated, in the elderly, to increased number of falls [7][8][9] , decreased cognitive functioning 10 , dementia 11 pneumonia 12 , weight gain and adverse effects on glycidic and lipid metabolisms 13 . Despite the risks inherent to using these substances, they bring important benefits for the elderly including: reduced anxiety, decreased fear, greater social participation, sleep induction and maintenance, muscle relaxing effects and treatment and prevention of epileptic seizures 14 . Few studies have assessed the prevalence of benzodiazepines use in elderly.…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine use and associated factors in elderly in the city of Dourados, MS, Brazil

Cunha

Souza

Cattanio

et al. 2015

J. bras. psiquiatr.

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Objective: The use of benzodiazepines (BZD) and associated factors in the elderly of Dourados, MS, Brazil was investigated. Methods: This is a cross-sectional population-based study using a multistage sampling design. Participants were 1,022 individuals aged ≥ 60 years. Measurements: socioeconomic status, schooling, demographic aspects, marital status, physical activity, hospitalizations, self-rated health, use of alcohol beverages and smoking were assessed by standard questionnaire. The drugs used were obtained by checking the prescription or package and classified according to the Anatomical Therapeutic Chemical Index. Chi-square test, Chi-square for linear tendency, Fisher's exact test and Poisson regression were used to assess association between variables. Results: The prevalence of use of BZD was 6.5% (CI95%: 5.1-8.2%). The oldest group (PR: 1.60 for 70-79 years and PR: 1.79 for ≥ 80 years), non-use of alcohol (PR: 4.14) and use of antidepressants (PR: 8.73) were the statistically associated characteristics. Conclusions: The prevalence of use of BZD in the study population was low, similar to findings of more recent Brazilian studies and lower than those obtained in international studies. The prevalence of use of BZD increased with aging and use of antidepressants. REsUMOObjetivo: Foi investigado o uso de benzodiazepínicos (BZD) e fatores associados em idosos no município de Dourados, MS. Métodos: Delineamento transversal, de base populacional com amostra de conglomerados estratificada e em múltiplos estágios. Os participantes totalizaram 1.022 indivíduos com idade > 60 anos. Foi utilizado questionário padronizado com as variáveis nível econômico, escolaridade, demográficas, situação conjugal, exercícios físicos, internações hospitalares, autopercepção de saúde, uso de bebida alcoólica e fumo. Os medicamentos utilizados foram obtidos por meio da verificação da receita médica ou embalagem e classificados segundo o Anatomical Therapeutic Chemical Index. Para avaliar a associação entre as variáveis foram utilizados os testes do qui-quadrado, de tendência linear, exato de Fisher e regressão de Poisson. Resultados: A prevalência do uso de BZD foi de 6,5% (IC95%: 5,1-8,2%). A maior idade (RP: 1,60 para 70-79 anos e RP: 1,79 para > 80

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“…'If there is no history of drug dependence, and positive indicative "lifestyle" factors are present, a conscious decision to continue benzodiazepine treatment may be more reasonable than the alternatives, provided the patient periodically attempts to slowly reduce the dosage at regular intervals and tries to stop altogether when or if possible' (Baldwin 2013). However, the group explicitly states that longerterm prescribing is appropriate only for those with no history of drug dependence. In relation to anxiety disorders it states:…”

Section: Long-term Benzodiazepine Prescription In Anxiety Disorders Amentioning

confidence: 99%

“…'There are clinical circumstances in which longerterm prescription of benzodiazepines might be considered desirable because the alternatives are probably worse than the continued use […] In rare instances longer-term prescriptions […] may be seen as a form of harm reduction in patients who would otherwise consume illicit benzodiazepines' (Baldwin 2013). There is little evidence that long-term benzo diazepines assist abstinence in alcohol dependence.…”

Section: Long-term Benzodiazepine Prescription In Anxiety Disorders Amentioning

confidence: 99%

Drug and alcohol addiction: new challenges

Luty

2014

Adv. psychiatr. treat

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SummaryThere have been many developments in addiction psychiatry over the past decade. Some of these are political, such as preference for recovery-/ abstinence-based programmes. Prohibition is becoming increasingly unrealistic, especially considering the effective legalisation of recreational cannabis in Uruguay and two US states. Legal highs and diversion of prescribed drugs (such as methadone, gabapentinoids, methylphenidate and benzodiazepines) are now a major problem. Furthermore, diversion of opioid drugs that are prescribed for pain is reaching epidemic proportions, causing a significant change in the nature of patients being referred to addiction services.Learning Objectives•Be aware of political issues regarding abstinence-based treatment and prohibition.•Be aware of risks and increased prevalence of diversion of drugs of misuse, especially opioid pain killers, gabapentinoids and benzodiazepines.•Update knowledge of problems with methadone such as cardiac arrhythmias and diversion.

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Benzodiazepines: Risks and Benefits. A Reconsideration

Cited by 58 publications

References 0 publications

Sleep Quality Among Psychiatry Residents

Sleep Quality Among Psychiatry Residents

Benzodiazepine use and associated factors in elderly in the city of Dourados, MS, Brazil

Drug and alcohol addiction: new challenges

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