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Benzodiazepine Withdrawal


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]
Malingering
  • The motor phenomena may persist long after the more common signs of withdrawal have resolved and, if unrecognized, can lead to such misdiagnoses as drug seeking, conversion, hysteria, or malingering.[ncbi.nlm.nih.gov]
Burning Feet
  • Burning feet persisted for a further year, gradually decreasing in intensity and now almost disappeared. No abnormal signs; good peripheral pulses. Medication; promethazine 50mg nocte since 1988. Case 2: Female, aged 67.[benzo.org.uk]
Nausea
  • ., increased ratings of dizziness, blurred vision, heart pounding, feelings of unreality, pins and needles, nausea, sweatiness, noises louder than usual, jitteriness, things moving, sensitivity to touch), and observer ratings in response to flumazenil[ncbi.nlm.nih.gov]
Shoulder Pain
  • Also, over the past four years she had been taking diazepam and oxazepam in therapeutic doses for chronic shoulder pain. About six months before admission she was started on lorazepam 2.5mg four times a day.[benzo.org.uk]
Nits on the Hair
  • Formication is also common during benzodiazepine withdrawal, and many patients temporarily complain of a feeling of insects crawling on the skin or of lice or nits in the hair.[benzo.org.uk]
Hysteria
  • […] imbalance, a group of such patients suffering prolonged withdrawal symptoms (PWS) was compared on a range of psychophysiological measures with matched groups of anxious and conversion hysteria patients and normal controls.[ncbi.nlm.nih.gov]
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]
  • We experience: fear terror debilitating panic Derealization and depersonalization are common withdrawal symptoms, as well.[prescription-drug.addictionblog.org]
  • […] 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]
  • 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]
Paranoid Ideation
  • He had a borderline personality disorder, and 5 days before admission he was prescribed risperidone 2 mg/day for the treatment of paranoid ideation and persecutory feelings related to professional stress.[doi.org]
Anhedonia
  • Benzodiazepine withdrawal facilitates the subsequent onset of escape failures and anhedonia: influence of different antidepressant drugs . Brain Research, Vol. 819, Issue. 1-2, p. 40. CrossRef Google Scholar Ashton, Heather 1995.[doi.org]
Insomnia
  • Insomnia and depression are frequently encountered in patients during withdrawal from substances.[ncbi.nlm.nih.gov]
  • Rebound insomnia may be so intense during these nights that the patient may be unwilling to risk another sleepless night and so returns to taking the benzodiazepine. Rebound insomnia is less common with long-acting benzodiazepines.[encyclopedia.com]
  • In contrast, rebound insomnia occurs with greater frequency and severity with the short-acting agents. Benzodiazepine therapy should be stopped as early as possible, with tapering after moderate dose and/or prolonged use therapy.[doi.org]
Agitation
  • Frequently, midazolam is also used as an injection or infusion for the treatment of agitation in ventilator-dependent patients.[ncbi.nlm.nih.gov]
  • Abstract The use of benzodiazepine medication is associated with a variety of acute and well-recognized withdrawal syndromes including anxiety, agitation, insomnia, and confusion. Catatonia has not previously been described.[doi.org]
Headache
  • 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]
  • Withdrawal can include pain, agitation, restlessness, shakiness, anxiety, headaches, cramps, dizziness, nausea, vomiting, trouble sleeping, and diarrhea, among many others.[fairview.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]
  • […] 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, headache[ncbi.nlm.nih.gov]
  • True withdrawal symptoms include headache, anxiety, insomnia, restlessness, depression, irritability, nausea, loss of appetite, indigestion, and unsteadiness.[encyclopedia.com]
Irritability
  • Common symptoms of benzodiazepine withdrawal include: Irritability Anxiety Insomnia Depression.[treatment4addiction.com]
  • 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]
  • 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]
  • These withdrawal symptoms can last up to 10 days or so and may include: sleep disturbance and irritability increased tension and rebound anxiety or panic attacks hand tremors sweating difficulty concentrating nausea and vomiting/dry-retching, which can[promises.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]
Sleep Disturbance
  • The abstinence syndrome is partially characterized by anxiety, dysphoria, sleep disturbances and other unspecific symptoms.[ncbi.nlm.nih.gov]
  • 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]

Workup

Epileptiform Activity
  • While an increase in seizure frequency occurred during withdrawal and prior to the onset of behavioral changes, electroencephalograms did not show epileptiform activity during the delirium.[ncbi.nlm.nih.gov]

Treatment

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]
Sex distribution
Age distribution

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]
  • 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).[dx.doi.org]
  • 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]

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