Misplaced Pages

#487512

81-585: BDZ may refer to: Benzodiazepines , a class of drugs Bulgarian State Railways ( Balgarski Darzhavni Zheleznitsi in Bulgarian) BDZ (album) , a 2018 album by Twice "BDZ" (song) , a song from the album bdz, the ISO 639-3 code of the Badeshi language Topics referred to by the same term [REDACTED] This disambiguation page lists articles associated with

162-428: A medical emergency that can usually be dealt with effectively by administering fast-acting benzodiazepines, which are potent anticonvulsants . In a hospital environment, intravenous clonazepam , lorazepam , and diazepam are first-line choices. In the community, intravenous administration is not practical and so rectal diazepam or buccal midazolam are used, with a preference for midazolam as its administration

243-528: A premedication for medical or dental procedures. Benzodiazepines are categorized as short, intermediate, or long-acting. Short- and intermediate-acting benzodiazepines are preferred for the treatment of insomnia; longer-acting benzodiazepines are recommended for the treatment of anxiety. Benzodiazepines are generally viewed as safe and effective for short-term use of two to four weeks, although cognitive impairment and paradoxical effects such as aggression or behavioral disinhibition can occur. According to

324-401: A class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders , insomnia , and seizures . The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955, and was made available in 1960 by Hoffmann–La Roche , which followed with

405-1006: A common side effect. Depression and disinhibition may emerge. Hypotension and suppressed breathing ( hypoventilation ) may be encountered with intravenous use. Less common side effects include nausea and changes in appetite, blurred vision, confusion, euphoria , depersonalization and nightmares. Cases of liver toxicity have been described but are very rare. The long-term effects of benzodiazepine use can include cognitive impairment as well as affective and behavioural problems. Feelings of turmoil, difficulty in thinking constructively, loss of sex-drive, agoraphobia and social phobia, increasing anxiety and depression, loss of interest in leisure pursuits and interests, and an inability to experience or express feelings can also occur. Not everyone, however, experiences problems with long-term use. Additionally, an altered perception of self, environment and relationships may occur. A study published in 2020 found that long-term use of prescription benzodiazepines

486-411: A distinct problem for them and necessitating the need for more effective long-term treatment (e.g., psychotherapy, serotonergic antidepressants). Discontinuation of benzodiazepines or abrupt reduction of the dose, even after a relatively short course of treatment (two to four weeks), may result in two groups of symptoms, rebound and withdrawal . Rebound symptoms are the return of the symptoms for which

567-527: A first-line long-term treatment of insomnia. However, the UK National Institute for Health and Clinical Excellence did not find any convincing evidence in favor of Z-drugs. NICE review pointed out that short-acting Z-drugs were inappropriately compared in clinical trials with long-acting benzodiazepines. There have been no trials comparing short-acting Z-drugs with appropriate doses of short-acting benzodiazepines. Based on this, NICE recommended choosing

648-590: A first-line therapy for panic disorder; benzodiazepine use has been found to interfere with therapeutic gains from these therapies. Benzodiazepines are usually administered orally; however, very occasionally lorazepam or diazepam may be given intravenously for the treatment of panic attacks . Benzodiazepines have robust efficacy in the short-term management of generalized anxiety disorder (GAD), but were not shown effective in producing long-term improvement overall. According to National Institute for Health and Clinical Excellence (NICE), benzodiazepines can be used in

729-538: A lack of long-term effectiveness. As for insomnia, they may also be used on an irregular/"as-needed" basis, such as in cases where said anxiety is at its worst. Compared to other pharmacological treatments, benzodiazepines are twice as likely to lead to a relapse of the underlying condition upon discontinuation. Psychological therapies and other pharmacological therapies are recommended for the long-term treatment of generalized anxiety disorder. Antidepressants have higher remission rates and are, in general, safe and effective in

810-450: A large population-based cohort study included 579,710 66-year-old adults who were followed for a total of 3,870,293 person-years (average 6.68 ± 1.33 years per person), subjective cognitive decline was significantly associated with an increased risk of subsequent dementia . In addition to a series of cognitive tests, general practitioner physicians often also rely on clinical judgement for diagnosing cognitive impairment. Clinical judgement

891-811: A long half-life and long-acting active metabolites , can be used as an alternative. Nonbenzodiazepines are contraindicated during benzodiazepine withdrawal as they are cross tolerant with benzodiazepines and can induce dependence. Alcohol is also cross tolerant with benzodiazepines and more toxic and thus caution is needed to avoid replacing one dependence with another. During withdrawal, fluoroquinolone -based antibiotics are best avoided if possible; they displace benzodiazepines from their binding site and reduce GABA function and, thus, may aggravate withdrawal symptoms. Antipsychotics are not recommended for benzodiazepine withdrawal (or other CNS depressant withdrawal states) especially clozapine , olanzapine or low potency phenothiazines , e.g., chlorpromazine as they lower

SECTION 10

#1732901573488

972-399: A pathology in the brain. Examples include Alzheimer's disease, Parkinson's disease, HIV/AIDS -induced dementia, dementia with Lewy bodies , and Huntington’s disease . Short-term cognitive impairment can be caused by pharmaceutical drugs such as sedatives . Screening for cognitive impairment in those over the age of 65 without symptoms is of unclear benefit versus harm as of 2020. In

1053-572: A prolonged treatment with benzodiazepines as the add-on to an antidepressant may be justified. A 2015 review found a larger effect with medications than talk therapy. Medications with benefit include serotonin-noradrenaline reuptake inhibitors , benzodiazepines, and selective serotonin reuptake inhibitors . Benzodiazepines are sometimes used in the treatment of acute anxiety , since they result in rapid and marked relief of symptoms in most individuals; however, they are not recommended beyond 2–4 weeks of use due to risks of tolerance and dependence and

1134-412: A result of abrupt or over-rapid withdrawal. Abrupt withdrawal can be dangerous and lead to excitotoxicity , causing damage and even death to nerve cells as a result of excessive levels of the excitatory neurotransmitter glutamate . Increased glutamatergic activity is thought to be part of a compensatory mechanism to chronic GABAergic inhibition from benzodiazepines. Therefore, a gradual reduction regimen

1215-419: A variety of indications such as alcohol dependence , seizures , anxiety disorders , panic , agitation , and insomnia. Most are administered orally; however, they can also be given intravenously , intramuscularly , or rectally . In general, benzodiazepines are well tolerated and are safe and effective drugs in the short term for a wide range of conditions. Tolerance can develop to their effects and there

1296-462: A withdrawal period typified by rebound insomnia and a prolonged period of anxiety and agitation. The list of benzodiazepines approved for the treatment of insomnia is fairly similar among most countries, but which benzodiazepines are officially designated as first-line hypnotics prescribed for the treatment of insomnia varies between countries. Longer-acting benzodiazepines such as nitrazepam and diazepam have residual effects that may persist into

1377-428: A worsening of the very symptoms the medications are meant to treat. Potential explanations include exacerbating cognitive problems that are already common in anxiety disorders, causing or worsening depression and suicidality, disrupting sleep architecture by inhibiting deep stage sleep, withdrawal symptoms or rebound symptoms in between doses mimicking or exacerbating underlying anxiety or sleep disorders, inhibiting

1458-495: A year or more may be needed to withdraw. Withdrawal is best managed by transferring the physically dependent patient to an equivalent dose of diazepam because it has the longest half-life of all of the benzodiazepines, is metabolised into long-acting active metabolites and is available in low-potency tablets, which can be quartered for smaller doses. A further benefit is that it is available in liquid form, which allows for even smaller reductions. Chlordiazepoxide , which also has

1539-650: Is a risk of life-threatening interactions with these drugs. In the United States, the Food and Drug Administration has categorized benzodiazepines into either category D or X meaning potential for harm in the unborn has been demonstrated. Exposure to benzodiazepines during pregnancy has been associated with a slightly increased (from 0.06 to 0.07%) risk of cleft palate in newborns, a controversial conclusion as some studies find no association between benzodiazepines and cleft palate. Their use by expectant mothers shortly before

1620-481: Is also a risk of dependence , and upon discontinuation a withdrawal syndrome may occur. These factors, combined with other possible secondary effects after prolonged use such as psychomotor, cognitive, or memory impairments, limit their long-term applicability. The effects of long-term use or misuse include the tendency to cause or worsen cognitive deficits , depression, and anxiety. The College of Physicians and Surgeons of British Columbia recommends discontinuing

1701-416: Is associated with an increase in all-cause mortality among those age 65 or younger, but not those older than 65. The study also found that all-cause mortality was increased further in cases in which benzodiazepines are co-prescribed with opioids, relative to cases in which benzodiazepines are prescribed without opioids, but again only in those age 65 or younger. Compared to other sedative-hypnotics, visits to

SECTION 20

#1732901573488

1782-493: Is associated with increased dementia risk, even after controlling for protopathic bias . Cognitive impairment There are different approaches to assessing or diagnosing a cognitive impairment including neuropsychological testing using various different tests that consider the different domains of cognition. Examples of shorter assessment clinical tools include the Mini Mental State Examination (MMSE) and

1863-683: Is associated with increased risk of cognitive impairment and dementia, and reduction in prescribing levels is likely to reduce dementia risk. The association of a history of benzodiazepine use and cognitive decline is unclear, with some studies reporting a lower risk of cognitive decline in former users, some finding no association and some indicating an increased risk of cognitive decline. Benzodiazepines are sometimes prescribed to treat behavioral symptoms of dementia. However, like antidepressants , they have little evidence of effectiveness, although antipsychotics have shown some benefit. Cognitive impairing effects of benzodiazepines that occur frequently in

1944-472: Is controversial because of concerns about decreasing effectiveness , physical dependence , benzodiazepine withdrawal syndrome , and an increased risk of dementia and cancer . The elderly are at an increased risk of both short- and long-term adverse effects , and as a result, all benzodiazepines are listed in the Beers List of inappropriate medications for older adults. There is controversy concerning

2025-538: Is critical. However, this advantage is offset by the possibility of developing benzodiazepine dependence . APA does not recommend benzodiazepines for persons with depressive symptoms or a recent history of substance use disorder . APA guidelines state that, in general, pharmacotherapy of panic disorder should be continued for at least a year, and that clinical experience supports continuing benzodiazepine treatment to prevent recurrence. Although major concerns about benzodiazepine tolerance and withdrawal have been raised, there

2106-409: Is easier and more socially acceptable. When benzodiazepines were first introduced, they were enthusiastically adopted for treating all forms of epilepsy . However, drowsiness and tolerance become problems with continued use and none are now considered first-line choices for long-term epilepsy therapy. Clobazam is widely used by specialist epilepsy clinics worldwide and clonazepam is popular in

2187-462: Is ideal when paired with additional tests to that permit the medical professional to confirm the diagnosis or confirm the absence of a diagnosis. Clinical judgement in these cases may also help inform the choice in additional tests. Deciding on an appropriate treatment for people with cognitive decline takes clinical judgement based on the diagnosis (the specific cognitive problem), the person's symptoms, other patient factors including expectations and

2268-854: Is limited to a narrow window within 90 minutes after each dose". A major disadvantage of benzodiazepines is that tolerance to therapeutic effects develops relatively quickly while many adverse effects persist. Tolerance develops to hypnotic and myorelaxant effects within days to weeks, and to anticonvulsant and anxiolytic effects within weeks to months. Therefore, benzodiazepines are unlikely to be effective long-term treatments for sleep and anxiety. While BZD therapeutic effects disappear with tolerance, depression and impulsivity with high suicidal risk commonly persist. Several studies have confirmed that long-term benzodiazepines are not significantly different from placebo for sleep or anxiety. This may explain why patients commonly increase doses over time and many eventually take more than one type of benzodiazepine after

2349-472: Is no evidence for significant dose escalation in patients using benzodiazepines long-term. For many such patients, stable doses of benzodiazepines retain their efficacy over several years. Guidelines issued by the UK-based National Institute for Health and Clinical Excellence (NICE), carried out a systematic review using different methodology and came to a different conclusion. They questioned

2430-424: Is recommended. Symptoms may also occur during a gradual dosage reduction, but are typically less severe and may persist as part of a protracted withdrawal syndrome for months after cessation of benzodiazepines. Approximately 10% of patients experience a notable protracted withdrawal syndrome, which can persist for many months or in some cases a year or longer. Protracted symptoms tend to resemble those seen during

2511-412: Is required when benzodiazepines are used in people with personality disorders or intellectual disability because of frequent paradoxical reactions . In major depression , they may precipitate suicidal tendencies and are sometimes used for suicidal overdoses. Individuals with a history of excessive alcohol use or non-medical use of opioids or barbiturates should avoid benzodiazepines, as there

BDZ - Misplaced Pages Continue

2592-588: Is the most effective in preventing and controlling acute seizures. Benzodiazepines are often prescribed for a wide range of conditions: Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, alcohol or drug-dependent individuals and individuals with comorbid psychiatric disorders . Because of their muscle relaxant action, benzodiazepines may cause respiratory depression in susceptible individuals. For that reason, they are contraindicated in people with myasthenia gravis , sleep apnea , bronchitis , and COPD . Caution

2673-484: The GABA A receptor , resulting in sedative , hypnotic ( sleep-inducing ), anxiolytic (anti-anxiety), anticonvulsant , and muscle relaxant properties. High doses of many shorter-acting benzodiazepines may also cause anterograde amnesia and dissociation . These properties make benzodiazepines useful in treating anxiety , panic disorder , insomnia , agitation , seizures , muscle spasms , alcohol withdrawal and as

2754-510: The Government of Victoria 's (Australia) Department of Health , long-term use can cause "impaired thinking or memory loss, anxiety and depression, irritability, paranoia, aggression, etc." A minority of people have paradoxical reactions after taking benzodiazepines such as worsened agitation or panic. Benzodiazepines are associated with an increased risk of suicide due to aggression, impulsivity, and negative withdrawal effects. Long-term use

2835-1125: The Montreal Cognitive Assessment (MoCA). There are many different syndromes and pathologies that cause cognitive impairment including dementia , mild neurocognitive disorder , and Alzheimer's disease . Cognitive impairments may be caused by many different factors including environmental factors or injuries to the brain (e.g. traumatic brain injury ), neurological illnesses, or mental disorders . While more common in elderly people, not all people who are elderly have cognitive impairments. Some known causes of cognitive impairments that are more common in younger people are: chromosomal abnormalities or genetic syndromes , exposure to teratogens while in utero (e.g., prenatal exposure to drugs), undernourishment , poisonings , autism , and child abuse . Stroke , dementia, depression , schizophrenia , substance abuse , brain tumours , malnutrition , brain injuries , hormonal disorders, and other chronic disorders may result in cognitive impairment with aging . Cognitive impairment may also be caused by

2916-586: The barbiturates , and death rarely results when a benzodiazepine is the only drug taken. Combined with other central nervous system (CNS) depressants such as alcohol and opioids , the potential for toxicity and fatal overdose increases significantly. Benzodiazepines are commonly used recreationally and also often taken in combination with other addictive substances, and are controlled in most countries. Benzodiazepines possess psycholeptic , sedative , hypnotic , anxiolytic , anticonvulsant, muscle relaxant , and amnesic actions, which are useful in

2997-462: The first-line treatment options with the anticonvulsant drug pregabalin indicated as a second- or third-line treatment and suitable for long-term use. NICE stated that long-term use of benzodiazepines for panic disorder with or without agoraphobia is an unlicensed indication, does not have long-term efficacy, and is, therefore, not recommended by clinical guidelines. Psychological therapies such as cognitive behavioural therapy are recommended as

3078-532: The Netherlands, Belgium and France. Clobazam was approved for use in the United States in 2011. In the UK, both clobazam and clonazepam are second-line choices for treating many forms of epilepsy. Clobazam also has a useful role for very short-term seizure prophylaxis and in catamenial epilepsy . Discontinuation after long-term use in epilepsy requires additional caution because of the risks of rebound seizures. Therefore,

3159-523: The accuracy of studies that were not placebo-controlled. And, based on the findings of placebo-controlled studies , they do not recommend use of benzodiazepines beyond two to four weeks, as tolerance and physical dependence develop rapidly, with withdrawal symptoms including rebound anxiety occurring after six weeks or more of use. Nevertheless, benzodiazepines are still prescribed for long-term treatment of anxiety disorders , although specific antidepressants and psychological therapies are recommended as

3240-507: The amnesic effects does not occur. However, controversy exists as to tolerance to the anxiolytic effects with some evidence that benzodiazepines retain efficacy and opposing evidence from a systematic review of the literature that tolerance frequently occurs and some evidence that anxiety may worsen with long-term use. The question of tolerance to the amnesic effects of benzodiazepines is, likewise, unclear. Some evidence suggests that partial tolerance does develop, and that, "memory impairment

3321-638: The benefits of psychotherapy by inhibiting memory consolidation and reducing fear extinction, and reducing coping with trauma/stress and increasing vulnerability to future stress. The latter two explanations may be why benzodiazepines are ineffective and/or potentially harmful in PTSD and phobias . Anxiety, insomnia and irritability may be temporarily exacerbated during withdrawal, but psychiatric symptoms after discontinuation are usually less than even while taking benzodiazepines. Functioning significantly improves within 1 year of discontinuation. The main problem of

BDZ - Misplaced Pages Continue

3402-476: The benzodiazepine medication itself. The benzodiazepines with a longer half-life make detoxification more tolerable, and dangerous (and potentially lethal) alcohol withdrawal effects are less likely to occur. On the other hand, short-acting benzodiazepines may lead to breakthrough seizures , and are, therefore, not recommended for detoxification in an outpatient setting. Oxazepam and lorazepam are often used in patients at risk of drug accumulation, in particular,

3483-449: The best choice of pharmacotherapy for many patients with panic disorder, but benzodiazepines are also often used, and some studies suggest that these medications are still used with greater frequency than the SSRIs. One advantage of benzodiazepines is that they alleviate the anxiety symptoms much faster than antidepressants, and therefore may be preferred in patients for whom rapid symptom control

3564-446: The chronic use of benzodiazepines is the development of tolerance and dependence . Tolerance manifests itself as diminished pharmacological effect and develops relatively quickly to the sedative, hypnotic, anticonvulsant, and muscle relaxant actions of benzodiazepines. Tolerance to anti-anxiety effects develops more slowly with little evidence of continued effectiveness beyond four to six months of continued use. In general, tolerance to

3645-589: The delivery may result in a floppy infant syndrome . Newborns with this condition tend to have hypotonia , hypothermia , lethargy , and breathing and feeding difficulties. Cases of neonatal withdrawal syndrome have been described in infants chronically exposed to benzodiazepines in utero . This syndrome may be hard to recognize, as it starts several days after delivery, for example, as late as 21 days for chlordiazepoxide. The symptoms include tremors , hypertonia , hyperreflexia , hyperactivity , and vomiting and may last for up to three to six months. Tapering down

3726-431: The development of diazepam (Valium) three years later, in 1963. By 1977, benzodiazepines were the most prescribed medications globally; the introduction of selective serotonin reuptake inhibitors (SSRIs), among other factors, decreased rates of prescription, but they remain frequently used worldwide. Benzodiazepines are depressants that enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at

3807-430: The dose during pregnancy may lessen its severity. If used in pregnancy, those benzodiazepines with a better and longer safety record, such as diazepam or chlordiazepoxide , are recommended over potentially more harmful benzodiazepines, such as temazepam or triazolam . Using the lowest effective dose for the shortest period of time minimizes the risks to the unborn child. The benefits of benzodiazepines are least and

3888-406: The dose is slowly tapered over a period of up to six months or longer. Chlordiazepoxide is the most commonly used benzodiazepine for alcohol detoxification , but diazepam may be used as an alternative. Both are used in the detoxification of individuals who are motivated to stop drinking, and are prescribed for a short period of time to reduce the risks of developing tolerance and dependence to

3969-425: The effects of long-term administration. One view is that many of the short-term effects continue into the long-term and may even worsen, and are not resolved after stopping benzodiazepine usage. Another view maintains that cognitive deficits in chronic benzodiazepine users occur only for a short period after the dose, or that the anxiety disorder is the cause of these deficits. While the definitive studies are lacking,

4050-440: The elderly and those with cirrhosis , because they are metabolized differently from other benzodiazepines, through conjugation . Benzodiazepines are the preferred choice in the management of alcohol withdrawal syndrome , in particular, for the prevention and treatment of the dangerous complication of seizures and in subduing severe delirium . Lorazepam is the only benzodiazepine with predictable intramuscular absorption and it

4131-459: The elderly can also worsen dementia. The most common side-effects of benzodiazepines are related to their sedating and muscle-relaxing action. They include drowsiness , dizziness, and decreased alertness and concentration. Lack of coordination may result in falls and injuries particularly in the elderly. Another result is impairment of driving skills and increased likelihood of road traffic accidents. Decreased libido and erection problems are

SECTION 50

#1732901573488

4212-468: The elderly can resemble dementia , depression, or anxiety syndromes , and progressively worsens over time. Adverse effects on cognition can be mistaken for the effects of old age. The benefits of withdrawal include improved cognition, alertness, mobility, reduced risk of incontinence, and a reduced risk of falls and fractures. The success of gradual-tapering benzodiazepines is as great in the elderly as in younger people. Benzodiazepines should be prescribed to

4293-535: The elderly only with caution and only for a short period at low doses. Short to intermediate-acting benzodiazepines are preferred in the elderly such as oxazepam and temazepam . The high potency benzodiazepines alprazolam and triazolam and long-acting benzodiazepines are not recommended in the elderly due to increased adverse effects. Nonbenzodiazepines such as zaleplon and zolpidem and low doses of sedating antidepressants are sometimes used as alternatives to benzodiazepines. Long-term use of benzodiazepines

4374-417: The first couple of months of withdrawal but usually are of a sub-acute level of severity. Such symptoms do gradually lessen over time, eventually disappearing altogether. Benzodiazepines have a reputation with patients and doctors for causing a severe and traumatic withdrawal; however, this is in large part due to the withdrawal process being poorly managed. Over-rapid withdrawal from benzodiazepines increases

4455-448: The first loses effectiveness. Additionally, because tolerance to benzodiazepine sedating effects develops more quickly than does tolerance to brainstem depressant effects, those taking more benzodiazepines to achieve desired effects may experience sudden respiratory depression, hypotension or death. Most patients with anxiety disorders and PTSD have symptoms that persist for at least several months, making tolerance to therapeutic effects

4536-454: The former view received support from a 2004 meta-analysis of 13 small studies. This meta-analysis found that long-term use of benzodiazepines was associated with moderate to large adverse effects on all areas of cognition, with visuospatial memory being the most commonly detected impairment. Some of the other impairments reported were decreased IQ, visiomotor coordination, information processing, verbal learning and concentration. The authors of

4617-517: The hospital involving benzodiazepines had a 66% greater odds of a serious adverse health outcome. This included hospitalization, patient transfer, or death, and visits involving a combination of benzodiazepines and non-benzodiapine receptor agonists had almost four-times increased odds of a serious health outcome. In September 2020, the US Food and Drug Administration (FDA) required the boxed warning be updated for all benzodiazepine medicines to describe

4698-478: The hypnotic based on cost and the patient's preference. Older adults should not use benzodiazepines to treat insomnia unless other treatments have failed. When benzodiazepines are used, patients, their caretakers, and their physician should discuss the increased risk of harms, including evidence that shows twice the incidence of traffic collisions among driving patients, and falls and hip fracture for older patients. Prolonged convulsive epileptic seizures are

4779-428: The immediate management of GAD, if necessary. However, they should not usually be given for longer than 2–4 weeks. The only medications NICE recommends for the longer term management of GAD are antidepressants. Likewise, Canadian Psychiatric Association (CPA) recommends benzodiazepines alprazolam , bromazepam , lorazepam , and diazepam only as a second-line choice, if the treatment with two different antidepressants

4860-524: The initial treatment for panic disorder is strongly supported by numerous controlled trials. APA states that there is insufficient evidence to recommend any of the established panic disorder treatments over another. The choice of treatment between benzodiazepines, SSRIs, serotonin–norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants , and psychotherapy should be based on the patient's history, preference, and other individual characteristics. Selective serotonin reuptake inhibitors are likely to be

4941-427: The lowest effective dose. They improve sleep-related problems by shortening the time spent in bed before falling asleep, prolonging the sleep time, and, in general, reducing wakefulness. However, they worsen sleep quality by increasing light sleep and decreasing deep sleep. Other drawbacks of hypnotics, including benzodiazepines, are possible tolerance to their effects, rebound insomnia , and reduced slow-wave sleep and

SECTION 60

#1732901573488

5022-493: The matter has been researched further. One possible reason for this conclusion is the rare need for a person to perform at their maximum. There is a difference between typical functioning, that is – the normal level of functioning for daily life, and maximal functioning, that is – what cognitive tests observe as our maximum level of functioning. As the maximum cognitive ability that we are able to achieve decreases, it may not actually affect our daily lives, which only require

5103-584: The meta-analysis and a later reviewer noted that the applicability of this meta-analysis is limited because the subjects were taken mostly from withdrawal clinics; the coexisting drug, alcohol use, and psychiatric disorders were not defined; and several of the included studies conducted the cognitive measurements during the withdrawal period. Paradoxical reactions , such as increased seizures in epileptics, aggression , violence, impulsivity , irritability and suicidal behavior sometimes occur. These reactions have been explained as consequences of disinhibition and

5184-447: The most important risk factor for disinhibition; learning disabilities and neurological disorders are also significant risks. Most reports of disinhibition involve high doses of high-potency benzodiazepines. Paradoxical effects may also appear after chronic use of benzodiazepines. While benzodiazepines may have short-term benefits for anxiety, sleep and agitation in some patients, long-term (i.e., greater than 2–4 weeks) use can result in

5265-471: The new non benzodiazepine hypnotics (Z-drugs) are better than the short-acting benzodiazepines. The efficacy of these two groups of medications is similar. According to the US Agency for Healthcare Research and Quality , indirect comparison indicates that side-effects from benzodiazepines may be about twice as frequent as from nonbenzodiazepines. Some experts suggest using nonbenzodiazepines preferentially as

5346-414: The next day and are, in general, not recommended. Since the release of nonbenzodiazepines , also known as z-drugs, in 1992 in response to safety concerns, individuals with insomnia and other sleep disorders have increasingly been prescribed nonbenzodiazepines (2.3% in 1993 to 13.7% of Americans in 2010), less often prescribed benzodiazepines (23.5% in 1993 to 10.8% in 2010). It is not clear as to whether

5427-411: The normal level. Some studies have indicated that childhood hunger might have a protective effect on cognitive decline. One possible explanation is that the onset of age-related changes in the body can be delayed by calorie restriction . Another possible explanation is the selective survival effect, as the study participants who had a childhood with hunger tend to be the healthiest of their era. When

5508-574: The patient was treated but worse than before. Withdrawal symptoms are the new symptoms that occur when the benzodiazepine is stopped. They are the main sign of physical dependence . The most frequent symptoms of withdrawal from benzodiazepines are insomnia, gastric problems, tremors , agitation, fearfulness, and muscle spasms . The less frequent effects are irritability, sweating, depersonalization , derealization , hypersensitivity to stimuli, depression, suicidal behavior, psychosis , seizures , and delirium tremens . Severe symptoms usually occur as

5589-471: The person's own ideas, and previous approaches to helping the person. Although one would expect cognitive decline to have major effects on job performance , it seems that there is little to no correlation of health with job performance. With the exception of cognitive-dependent jobs such as air-traffic controller, professional athlete, or other elite jobs, age does not seem to impact one's job performance. This obviously conflicts with cognitive tests given, so

5670-656: The result of suppression of withdrawal effects. Beyond the well established link between benzodiazepines and psychomotor impairment resulting in motor vehicle accidents and falls leading to fracture; research in the 2000s and 2010s has raised the association between benzodiazepines (and Z-drugs ) and other, as of yet unproven, adverse effects including dementia, cancer, infections, pancreatitis and respiratory disease exacerbations. A number of studies have drawn an association between long-term benzodiazepine use and neuro-degenerative disease, particularly Alzheimer's disease. It has been determined that long-term use of benzodiazepines

5751-573: The risks are greatest in the elderly. They are listed as a potentially inappropriate medication for older adults by the American Geriatrics Society . The elderly are at an increased risk of dependence and are more sensitive to the adverse effects such as memory problems, daytime sedation, impaired motor coordination, and increased risk of motor vehicle accidents and falls, and an increased risk of hip fractures . The long-term effects of benzodiazepines and benzodiazepine dependence in

5832-437: The risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all the medicines in the class. The short-term use of benzodiazepines adversely affects multiple areas of cognition, the most notable one being that it interferes with the formation and consolidation of memories of new material and may induce complete anterograde amnesia . However, researchers hold contrary opinions regarding

5913-432: The safety of benzodiazepines in pregnancy. While they are not major teratogens , uncertainty remains as to whether they cause cleft palate in a small number of babies and whether neurobehavioural effects occur as a result of prenatal exposure; they are known to cause withdrawal symptoms in the newborn . In an overdose, benzodiazepines can cause dangerous deep unconsciousness , but are less toxic than their predecessors,

5994-411: The seizure threshold and can worsen withdrawal effects; if used extreme caution is required. Withdrawal from long term benzodiazepines is beneficial for most individuals. Withdrawal of benzodiazepines from long-term users, in general, leads to improved physical and mental health particularly in the elderly; although some long term users report continued benefit from taking benzodiazepines, this may be

6075-544: The severity of the withdrawal syndrome and increases the failure rate. A slow and gradual withdrawal customised to the individual and, if indicated, psychological support is the most effective way of managing the withdrawal. Opinion as to the time needed to complete withdrawal ranges from four weeks to several years. A goal of less than six months has been suggested, but due to factors such as dosage and type of benzodiazepine, reasons for prescription, lifestyle, personality, environmental stresses , and amount of available support,

6156-429: The short and long term. Benzodiazepines can be useful for short-term treatment of insomnia . Their use beyond 2 to 4 weeks is not recommended due to the risk of dependence. The Committee on Safety of Medicines report recommended that where long-term use of benzodiazepines for insomnia is indicated then treatment should be intermittent wherever possible. It is preferred that benzodiazepines be taken intermittently and at

6237-408: The subsequent loss of control over socially unacceptable behavior. Paradoxical reactions are rare in the general population, with an incidence rate below 1% and similar to placebo. However, they occur with greater frequency in recreational abusers, individuals with borderline personality disorder , children, and patients on high-dosage regimes. In these groups, impulse control problems are perhaps

6318-518: The title BDZ . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=BDZ&oldid=1030884098 " Category : Disambiguation pages Hidden categories: Short description is different from Wikidata All article disambiguation pages All disambiguation pages Benzodiazepine Benzodiazepines ( BZD , BDZ , BZs ), colloquially known as " benzos ", are

6399-635: The treatment of anxiety associated with panic disorder . However, there is disagreement among expert bodies regarding the long-term use of benzodiazepines for panic disorder. The views range from those holding benzodiazepines are not effective long-term and should be reserved for treatment-resistant cases to those holding they are as effective in the long term as selective serotonin reuptake inhibitors (SSRIs). American Psychiatric Association (APA) guidelines, published in January 2009, note that, in general, benzodiazepines are well tolerated, and their use for

6480-421: The usage of benzodiazepines in those on opioids and those who have used them long term. Benzodiazepines can have serious adverse health outcomes, and these findings support clinical and regulatory efforts to reduce usage, especially in combination with non-benzodiazepine receptor agonists. Because of their effectiveness, tolerability, and rapid onset of anxiolytic action, benzodiazepines are frequently used for

6561-401: Was unsuccessful. Although they are second-line agents, benzodiazepines can be used for a limited time to relieve severe anxiety and agitation. CPA guidelines note that after 4–6 weeks the effect of benzodiazepines may decrease to the level of placebo, and that benzodiazepines are less effective than antidepressants in alleviating ruminative worry , the core symptom of GAD. However, in some cases,

#487512