Benzodiazepines (BZO) are frequently used as anxiolytics
and hypnotics in daily clinical treatment. Surgeons as well as
psychiatrists observe that long term usage of BZO disturbs
activity of daily life (ADL) and causes unexpectedly critical side
effects. Clinicians are likely to prescribe BZO more frequently for
patients with chronic pain, motor deficits caused by unknown Pathophysiology, or some neuropsychiatric illnesses such as depression
and schizophrenia, than for patients without these health problems.
However, it has been shown that long term administration of BZO
do not improve clinical course of schizophrenia. Etizolam is a
preferable BZO among Japanese orthopedist, for its muscle relaxant
effect to stiffness of shoulder, cervical spondylosis and cervical disc
herniation, and its hypnotic effect, as well as for its anxiolytic effect.
Whereas side effects, muscle weakness, daytime sleepiness, loss
of attention, unstable gait, gait disturbance, cognitive impairment,
and dependence may reduce patients’ ADL.
Psychiatrists working in general hospitals with emergency
centers encounter severe cases related to BZO side effects. BZO
side effects are enhanced in elderlies and patients with epilepsy,
especially in cases with BZO poly pharmacy. The author sometimes
experiences cases with suicidal attempt, who suffered from chronic
pain, motor disturbance (ex. gait disturbance), muscle weakness,
and in elderly cases, cognitive impairment, to whom long term BZO
poly pharmacy had been continued. Most of the cases also showed
depressed state. Considering the side effects of BZO, the author used
to reduce BZO, and to try to discontinue them. In most cases, motor
disturbance, muscle weakness, and cognitive impairment recovered
after BZO washout. Pain control and treatment of depression by
using antidepressants or of dementia by anti-dementia agents
made rehabilitation easier, and made it possible to improve ADL,
leading to shorten the duration if admission.
In a case of forced double suicide attempt of mother and
son, the mother (60’s) who had 2 anti-epileptic agents from her
childhood and 3 BZO for more than 10 years, had orthopedic pain
of lower extremities.This increased her psychosocial problems. After the psychiatric liaison consultation
from the emergency center in our hospital, BZO was discontinued
and replaced to low dosage of risperidone. The mother patient’s
muscle weakness, gait disturbance, cognitive impairment and
depression were greatly improved within 3 weeks, and her suicidal
idea disappeared. Clinicians’ efforts in BZO discontinuation and/
or BZO consumption decrease may promote prevention of suicide
incidence.
ISSN: 2574 -1241
