Benzodiazepine (BZD), its abuse and management

Benzodiazepine dependance

1. Benzodiazepine (BZD) DEPENDENCE DR. SARANYA . S

2. CASE Mr. X, 44 year old married male, couldn’t complete 10th, currently doing manual labor for daily earning came with complaints of restlessness, palpitations, reduced sleep, increased fear and nervousness following cessation of prolonged use of higher doses of tablet ATIVAN(lorazepam) and alcohol. H/O use of alcohol from 1999 following the death of his father to relieve the anxious symptoms, mainly toddy, on occasions only. DAILY use of alcohol for last 4 years; following the suicidal death of his nephew. Use of T.ATIVAN for last 2 years, initially 1 month according to the prescription obtained from psychiatrist for his anxiety symptoms and sleep disturbances. Later increased frequency and amount of intake of ATIVAN obtained illicitly from manipulated prescriptions for 1 and half year; 15-20 tablets/day!!!!!!!!! Last day of use of alcohol and Ativan – 31/12/23. (acc. to patient).

3. Course in hospital. Day 1- patient was very anxious, never allowed his bystanders to leave him in fear of death due to palpitations. Day 2 – at night, patient had 2 episodes of seizures each lasting for 1-2 mins. Day 3 – morning, during prerounds, patient had an another episode of seizure lasted for 2 mins and followed by post ictal confusion and extreme fear.

4. BZD…

5. BENZODIAZEPINES : mechanism of action. Primarily effect on GABA(A) receptor complex ; to specific BZD binding site other than GABA binding site  increase in frequency of opening of chloride channels and GABA mediated chloride current  HYPERPOLARIZATION  CNS depression.

6. After long term BZD use, GABA stimulation of GABA(A) receptors results in less chloride influx than was caused before BZD use. --------------(tolerance and dependance)?

7. WHY benzodiazepine dependence? Due to the euphoriant and calming effect And > 1/3 of patient with BZD therapeutic dose for> 6 months will develop dependance.

8. Ideally, bzd are prescribed for about 2-3 weeks. If >time required longer acting bzd are used IATROGENIC Low daily dose, prescribed over years. NON IATROGENIC High doses intermittently, illicitly obtained.

9. Bzd withdrawal Onset within 2-3 days of abstinence for a short acting BZD and 3-8 days for a long acting BZD. Resolves within 2-6 hours after BZD administration Disturbance in mood and cognition. Sleep disturbance. Physical symptoms. Perceptual abnormalities.

10. LONG TERM EFFECTS OF BZD..? Dose and duration α development of Alzheimer’s. Slow down heart rate  heart failure  hypoxia and tissue death. liver failure

11. references 1.The Maudsley prescribing guidelines(14) 2.KAPLAN &SADOCK’S Concise textbook of clinical psychiatry(4) 3.IPS on substance use disorders. 4.Pharmacology, TARA V SHANBHAG. 5.PubMed.Cognitive outcomes of long term BZD,PMID: 31604674,NILVAD STUDY GROUP.

12. THANK YOU