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2.1
Benzodiazepine Withdrawal

Images

WIKIDATA, Public Domain
WIKIDATA, CC BY-SA 4.0
WIKIDATA, CC BY-SA 4.0

Presentation

The deceased presented to the hospital with hypertension, elevated temperature, worsening bizarre behavior, and movement irregularities. [ncbi.nlm.nih.gov]

The molecular effects of long-term benzodiazepine exposure are reviewed and a model is presented that draws on results from a number of research groups working in this area. [doi.org]

Entire Body System

  • Nightmare

    During withdrawal, all patients had severe reactions including anxiety, sleep disturbance, rage reactions, hyperalertness, increased nightmares, and intrusive thoughts; and 6 of the 8 patients had homicidal ideation. [ncbi.nlm.nih.gov]

    Seizures - Loss of interest in people and things - Pupils of eyes become minute - Iris in eyes changes colour - Agoraphobia - Feeling of vulnerability - Feeling of extreme cold - Extremely nervous and jumpy - Muscle wastage - Impotence - Unable to walk - Nightmares [benzo.org.uk]

    Dilara Seyidova Khoshknabi, Sleep Problems and Nightmares, Palliative Medicine, 10.1016/B978-0-323-05674-8.50180-8, (965-972), (2009) ., Depressants, Drug and Alcohol Abuse, 10.1007/0-387-25733-0_2, (41-67), (2006). MELINDA J. BARKER, KENNETH M. [doi.org]

  • Weight Loss

    […] of interest in sex loss of appetite nausea (feeling sick) nightmares panic attacks restlessness sore eyes sore tongue and metallic taste tinnitus (ringing in the ears) tingling in the hands and feet unsteady legs vomiting (being sick) weight loss. [mind.org.uk]

    Associated with the gradual reduction of medication was the emergence of severe symptoms of anxiety as well as sensory intolerance, perceptual disturbances and weight loss. [karger.com]

    Symptoms can be considered under three main headings: Anxiety and related symptoms anxiety, panic attacks, hyperventilation, tremor sleep disturbance, muscle spasms, anorexia, weight loss visual disturbance, sweating altered mood. [sahealth.sa.gov.au]

  • Antipsychotic Agent

    Abstract Antipsychotic agents which are considered to depressive to the central nervous system (CNS) but free of dependence liability were used in combination with barbiturates or tranquilizers to study the physical dependence liability in the so-enhanced [dx.doi.org]

    Some antipsychotic agents may be riskier than others during withdrawal, especially clozapine, olanzapine or low potency phenothiazines (e.g., chlorpromazine), as they lower the seizure threshold and can worsen withdrawal effects; if used, extreme caution [en.wikipedia.org]

Gastrointestinal

  • Nausea

    […] blood pressure and anxiety scores), only the experimental group showed considerable changes in physiological measures, participant ratings (e.g., increased ratings of dizziness, blurred vision, heart pounding, feelings of unreality, pins and needles, nausea [ncbi.nlm.nih.gov]

Cardiovascular

  • Palpitations

    […] is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations [ncbi.nlm.nih.gov]

    She says: "I have physical symptoms which are the palpitations, hot and cold sweats, shaking, trembling to the psychological symptoms which is I think that I am going to lose it, I think I am going crazy." [news.bbc.co.uk]

    They may include: Insomnia Sweating Headache Irritability Anxiety Panic attacks Tremors Difficulty concentrating Nausea Heart palpitations Muscle stiffness and pain Seizures, full-blown psychosis, and medical emergency resulting in death are worst-case [dualdiagnosis.org]

    Withdrawal symptoms may include: abdominal cramps agoraphobia (fear of crowded places) increased anxiety physical symptoms of anxiety (muscle tension, tight chest, palpitations, fast heartbeat, sweating, trembling or shaking) blurred vision depression [mind.org.uk]

    The most common benzodiazepine withdrawal symptoms can include: Anxiety and panic attacks Tremors Concentration and memory problems Heart palpitations Pain and stiffness Headaches/migraines Nausea and vomiting Sweating Irritability and restlessness In [columbusrecoverycenter.com]

Musculoskeletal

  • Fracture

    That decision was made primarily because common side-effects of benzodiazepines—confusion and clouded thinking—often have disastrous consequences, including falls, fractures, and auto accidents. [health.harvard.edu]

    Falls may occur, resulting in broken bones, especially hip fractures. [msdmanuals.com]

    Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995; 332 767-773 128 Lichtenstein M J, Griffin M R, Cornell J E. et al. Risk factors for hip fractures occurring in the hospital. [dx.doi.org]

Skin

  • Sweating

    Withdrawal symptoms may include: abdominal cramps agoraphobia (fear of crowded places) increased anxiety physical symptoms of anxiety (muscle tension, tight chest, palpitations, fast heartbeat, sweating, trembling or shaking) blurred vision depression [mind.org.uk]

    Objective assessment of sweating, restlessness (pacing), and tremor are also documented. A tally of points based on responses and observation can be used to determine treatment. [essentialsofcorrectionalnursing.com]

    Abstract Physiological dependence on benzodiazepines is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration [ncbi.nlm.nih.gov]

    Withdrawal symptoms of benzodiazepine use include: Restlessness Insomnia Severe stomach upset Vomiting Goose bumps Muscle and bone pain Involuntary movements Agitation Anxiety Sweating Cramping Seizures Psychosis Pupil dilation Mood disturbance Intense [castlecraig.co.uk]

Psychiatrical

  • Euphoria

    They are also popular for self-medicating or abuse purposes; providing peace and euphoria for troubled individuals. They are rarely abused alone and often combined with alcohol or opiates. [essentialsofcorrectionalnursing.com]

    Benzodiazepines produce sensations of euphoria, sedation, calmness, and general sedation. Although they are often prescribed for various disorders, most abusers do not have a prescription for them. [treatment4addiction.com]

    — New York Times, "Watching ‘Euphoria,’ Two Young Recovering Addicts Saw Themselves," 24 June 2019 Sometimes doctors will also prescribe medications known as benzodiazepines like diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin) to reduce [merriam-webster.com]

    Lethargy Loss of appetite Nausea Slurred speech Stuttering Tremors Vertigo Vision changes Vomiting When taking high doses of benzodiazepines, such as with abuse, you can also experience mood swings, hostile or irregular behavior, slowed reactions, and euphoria [drugrehab.org]

    They are often abused for their relaxing and calming qualities which at high doses can cause a feeling of euphoria. [addictionresource.com]

  • Depersonalization

    […] and anxiety extremely problematic, especially if the individual has never struggled with these disorders before, but the psychotic symptoms, hallucinations, and depersonalization can all create extremely risky or aggressive behavior that could cause [addictions.com]

    Signs of benzodiazepine addiction usually include irregular sleep schedule, depersonalization, and irritability. Benzodiazepine Withdrawal Treatment Possibly the biggest hurdle for a benzo addict to overcome is the detox. [treatment4addiction.com]

    […] withdrawal syndrome associates the resurgence of the pre-existing anxiety symptoms and new symptoms as sensory disturbances (metallic taste, hyperosmia, cutaneous exacerbated sensitivity, photophobia...) nausea, headache, motor disturbance in some rare cases depersonalization [ncbi.nlm.nih.gov]

    We experience: fear terror debilitating panic Derealization and depersonalization are common withdrawal symptoms, as well. [prescription-drug.addictionblog.org]

    2015 an endoscopic ultrasound showed I had damage and was diagnosed with chronic pancreatitis ), bad bloat and gas (aka benzo belly), ear fullness/popping, weird stools, constipation alternating with loose yellow stools, food sensitivities, brain fog, depersonalization [hormonesmatter.com]

Neurologic

  • Insomnia

    Insomnia and depression are frequently encountered in patients during withdrawal from substances. [ncbi.nlm.nih.gov]

    Mid Withdrawal: Progressing to include tremor, fever, diaphoresis, insomnia, anorexia, and diarrhea. [essentialsofcorrectionalnursing.com]

    MEDICATIONS FOR THE TREATMENT OF INSOMNIA Sedatives and Hypnotics Insomnia is an extremely common complaint. [pubmedcentral.nih.gov]

  • Agitation

    Frequently, midazolam is also used as an injection or infusion for the treatment of agitation in ventilator-dependent patients. [ncbi.nlm.nih.gov]

  • Headache

    Withdrawal can include pain, agitation, restlessness, shakiness, anxiety, headaches, cramps, dizziness, nausea, vomiting, trouble sleeping, and diarrhea, among many others. [fairview.org]

    Over the past year she developed headaches, dizziness and muscle cramps if she missed her regular diazepam and she had increased her dose to 5mg four times a day. [benzo.org.uk]

    Symptoms may include sleep disturbances, increased anxiety, irritability, headache, muscle pain and stiffness. Acute symptoms may resolve after a few months; however, in some cases symptoms may persist for years. [patientslikeme.com]

    […] treatment but in an exacerbated from; the withdrawal syndrome associates the resurgence of the pre-existing anxiety symptoms and new symptoms as sensory disturbances (metallic taste, hyperosmia, cutaneous exacerbated sensitivity, photophobia...) nausea, headache [ncbi.nlm.nih.gov]

  • Irritability

    The CIWA-B is a 22-item instrument that monitors type and severity of benzodiazepine withdrawal symptoms such as irritability, fatigue, appetite, and sleeplessness. [essentialsofcorrectionalnursing.com]

    Common symptoms of benzodiazepine withdrawal include: Irritability Anxiety Insomnia Depression. [treatment4addiction.com]

    Symptoms in these patients are mostly agitation, irritability, anxiety, insomnia, tachycardia, hypertension, and sweating. [doi.org]

    Symptoms may include sleep disturbances, increased anxiety, irritability, headache, muscle pain and stiffness. Acute symptoms may resolve after a few months; however, in some cases symptoms may persist for years. [patientslikeme.com]

    This can result in a prolonged protracted withdrawal syndrome characterized by irritability, paresthesias, cognitive impairment, insomnia, and dysphoria, increased sensitivity to sound and light and even psychosis. [benzo.org.uk]

  • Sleep Disturbance

    The abstinence syndrome is partially characterized by anxiety, dysphoria, sleep disturbances and other unspecific symptoms. [ncbi.nlm.nih.gov]

Workup

[…] antidepressants Chest radiograph, if respiratory compromise is present Pregnancy test, in women of childbearing age In cases of intentional overdose, measure the following: Serum electrolytes Glucose BUN Creatinine clearance Ethanol level Acetaminophen level See Workup [emedicine.medscape.com]

Treatment

Long-term outcomes for a cognitive-behavioral treatment group and a treatment-as-usual group were measured. RESULTS: BZ discontinuation treatment outcomes were maintained in both treatment groups. No between-group differences were found. [ncbi.nlm.nih.gov]

Prognosis

Anticonvulsants and antidepressants seem to reduce the intensity of benzodiazepine withdrawal and to enhance long term prognosis of dependence. [ncbi.nlm.nih.gov]

Etiology

The possible biochemical and neuropsychological mechanisms involved in the etiology and maintenance of this condition are reviewed. [ncbi.nlm.nih.gov]

The possible biochemical and neuropsychological mechanisms involved in the etiology and maintenance of this condition are reviewed. Related Topics Loading Related Articles [doi.org]

Epidemiology

MEASUREMENTS: Urine BDZ; self-reported Pittsburgh Sleep Quality Index (PSQI) and the Center for Epidemiologic Studies Depression (CES-D) questionnaires administered at baseline, and at 6, 7 and 13 weeks. [ncbi.nlm.nih.gov]

Because such effects are often not recognized by clinicians, accurate epidemiologic data on their incidence are not available. [doi.org]

Pathophysiology

The following update gives recent research results on the withdrawal pathophysiology and practical information in order to treat or prevent benzodiazepine withdrawal syndrome. [ncbi.nlm.nih.gov]

Pharmacotherapy: A Pathophysiologic Approach, 9th edition. Chapter 53: Anxiety Disorders I; Generalized Anxiety, Panic, and Social Anxiety Disorders. Access Pharmacy [online]. DiPiro et al. Pharmacotherapy: A Pathophysiologic Approach, 9th edition. [rxlist.com]

This pharmacology lecture covers topics such as pathophysiology of anxiety and insomnia, role of GABA in the central nervous system, structure and function of GABA-A receptor, limbic system, mechanism of action and side effects of benzodiazepines, barbiturates [youtube.com]

Pathophysiology Although the precise pathophysiological mechanisms of NMS are unproven, antipsychotic-induced dopamine blockade likely plays a pivotal triggering role in the condition ( Figure 1 ) (21). [doi.org]

Prevention

Flumazenil, given 24h prior to the measurements, prevented both the sensitivity changes and benzodiazepine tolerance in vivo. The anxiety and decreases in seizure threshold during withdrawal were also prevented. [ncbi.nlm.nih.gov]

Google Scholar [3] Cavazzutti G.B. : Prevention of febrile convulsions with dipropylacetate (Depakine). Epilepsia 16: 647–648, 1975. PubMed Google Scholar [4] Chu N-S. : Carbamazepine: Prevention of alcohol withdrawal seizures. [dx.doi.org]

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