1988 - Resumption Of Benzodiazepine Use After Withdrawal In Hospital - A Follow-up Study

2l (1988)353-3s4 Phama@psychiat. @CeorgThiemeVerlagStullgdn. NewYork

in Hospilal UseAtterWithdrawal ot Benzodiazepine Resumption A Follow-upStudy. S. Priebe,O. Liesenleld,B. Miiller-Oedinghausen FreeUnive.sity ol Be i (Wes0 Gemay oepariment ot Psychiairy,

in any case.Basic charac1eristi(x,such 3s sex, age,and psvchia' tric diagnosis according ro ICD'9 classification of de patients Despite th€ ongoing controvelsy about fte benefit-risk-ratio ol had beeninterviewedd;d whosephysiciansor who themselves benzodiazepines in psychiat.ic t.eatmenl (3, 5), they are still 47 patients who could of lhe dilT€r lrom those nol sig ficantly widely used (4,6).In ou. hospital we iollow the generalpoiicv no1be tnced. Twenty five patients(29%) had siarted|o Lake lhat there is hardly any indication for long-tem beuodiazepi_ beuodiazepinesagainand 62 patients(71%)had not Table I ne treatment. Thus, Plients who take benzodiuepines and get sunnadzes age and sex of the lwo grouPs Additionallv, it admilted !o ou. hospital are regularly wilhdrawn This studv sho*s in how nany palienti ofeach Sroupa critical rcviewof was intended to investigate how many patienis would slan to th€ padenfs history taken during inpatienttreatmenthad re lake benzodiazepines agaio afte. discharge and how f3r charac vealed critena for benzodirzepine dbuse or dependenceaccorleristics of rhe patienls could predict that resunption of bending to the DSM-III cldssificationThe analysisof wHo-cri1e ria yielalsthe samepattem. fhe tenden,) rhar tumdlepdrient.re'ume b
T.bre 1 aqe. se! and presenceoi benzoddep ne abuseor dep€ndenceaccord ng to osM L n resumersand non{esumefs

Age (yeafs)

Resuhption olbenzodiaepne

Noresunplon of ben2oddeprne p

lN:25)

(N - 62)

Mean 48.2

SD 142

45.1

'

Theseiindi4s arepln of thedodo.de thesnof O L

Table 2 P.mary psychialrc d agnosesaccordinglo ICD 9 c 4sili_ canon in resumersand noniesumers

( N: 2 5 )

(N - 62)

16 (6.1%)

36 (58%)

i5.8

(remarehare) 19(76%)/6 (24%) 37 (60%)/25 (40%)n.s

9136%)

2216\) 4( 6%)

encetullilled

10(,10%)

1 7( 2 7 % )

154

Phamacopsychial.2l (1988)

S.Priebe. O. Liesenfeld, B. MiilleFoerlinghausen

Table 3 Duraiionoi conlinlous benzodiszeptne lse precedng ad, misson i. resume.sand non resuhers

Duration or Fesomptronoi Noresumplion ot ben2odi@ep- benzodiazepine benzodidepine (N: 19)

(N - 33)

15(74%) 15(74%) 14168%) 3 (16%) 1(5%)

1 9( 5 8 % ) 14142%) 10(30?i) 5 (15%)

p

<005

3(s%)

Sinc€there was no coni.adictionbet$'eenstateme.txof patientsand thei. physjcians,a relevanttendency1o concealthe acnral use of beDodiaz epines among those patierts cannot be .uppo'ed.Th^ would be in ac{"dJnce s irh our previouserpe .iences (7). Our findings Fesent little evid€nc€thal usual clini€l dala sould Jllou an) prediclronwhelherpdrienlsresume raking benzod;ep;nes after discharge.lt seemssu.prisjng iha! criteriafor abuseor dependencedo not sigrificantlycoFelate $th rhe resumption of benzodiazepine us€. One explanation may be thal the problemofactual benzodimpine dependence is not refleded by thesecri.eria adequately.As far asthe variables we looked al are concemedthe bestpredicrionis achieved when ihe patientis simply askedfor how long he bad conlinu' ously |aken benzodiazepines akeady. A period of 6 months may be regardedas a cntical threshold. We are asare of severalshon'comings of the study. In panicula., furtherand moredetailedinfomation aboutpatientssymptoms and drug-takjngbehaviourand about additionaltrealmentswithinthe follow upperjod arestilllackjng.

The only signific.xntdiffererce was found in the du.ation of b€nzodiazepin€ usep.ior to admission.fifty-lwo ofthe 87 pa, tienlr had madeclearslatements abouthowlongtheyhadcont; nuouslttakenbeEodiazepines prior to admission.Thesestatements were categorized into 5 different groups : Benzodidzepine use tbr al leastone month. threemonths,six months.over morethanoneyear,and finallyor€rmorethanfive years.Table 3 comparesthoseslalemenbofthetwogroups. Thereis a sijgh!tendencythal resumeBhad takenbenzodiaze- 1 pines for mor€ lhan one month more ofter than non-resumers. H o q e ! e ' . L h ec l e a r e , dr i l T e r e n cb€e r r e e nr h e r s o B r o u p i i . found in statements aboxt a continuousbenzodiazepine useof 2 morethanthreeor six monthspriorro admission.63%ofthe resumen slaledthat thetr had uken benzodidzeDines for more than 6 rnonths,wbiie only 30% ofthe non resumers did so.Fre- 3 quencyofcontinuousbenzodiazep;ne useover morethan on€ year or mor€ than five years does nol differ b€rweeoresumers 5 The loaer l;mit of deteclionofthe enzymeimmunoassayh too high for assessnrent of the intakeofregular dosesof b.omzepam or lorazepam,two of the mostwidely usedbenzodiazepi nesin thrscountry(l). The.efor€,it can be assumedthal more palienbhad actuallylakenbenzodiazepines thanwecould diagnoseand includein the follow,upstudy.However,wc assur,€ tha!thisshouldrot aflectlhe presentfindings.

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Ahms,S.,lV T.Kanza||,,4. r?mbi. errErgeb.isse einesMedi kamentoScrcening slationiraufgenonnener Palienleneiner psychiairischft UnileBirersuinik. NeFena., 57 (1986)53253? Gold,M. 5., C A. Dackisr Rolcof laboralon i. the elaluationot suspecied drucabuse. Joumalof Clini€l Aychiat!_47(1986)l?23 la.let, M., H. PetuBsan:Lon8iem elTectsof b€Dodiuepines. Neurcphana@ios/ 22 (1983)527 533 .t deus. D.: Abuse of bemodioepine in wesrem European' socier\ - Incidene rnd prerdlence.mori.e . otuB eqdFrron. Phamaopsrchiat'l' 16(1983) i03 106 Markr, .r.rBenzodieepines- lor g@d or for e\il Nelropsychc b i o l o e yl 0 ( 1 9 8 3 I) l 5 - 1 2 6 PetuBsm, H., M b.lq: Betuodizepine depend€nce. Bdtish ioumal of Addiction76 (1981)133 145 Pnebe S. O. Li?,?nlctd I Mnllc. OenirEhdu,en. Doe. t rcJine sdeeningfor benddidzepinesbelp to diasnosedep.ndene in psychiat.icinpalienrs?(in prepardtion)

Dipl.-Psfch. Dr. ned. S. hiebe, Abteilung lir Sozidltslchiatie, freie Uniqst.it D-lIM9 Bulin 19lWext),Gemah!

Eerlin, Platanenalke 19