Rothschild A J, Shindul-Rothschild J A, Viguera A, Murray M, Brewster S
Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655, USA.
J Clin Psychopharmacol. 2000 Feb;20(1):7-11. doi: 10.1097/00004714-200002000-00003.
Several case reports have suggested that treatment with the benzodiazepine alprazolam can result in behavioral disinhibition. To address this question, the authors reviewed the medical records (blinded to all pharmacologic treatments the patients received) of 323 psychiatric inpatients treated with alprazolam (108 patients), clonazepam (111 patients), or no benzodiazepine (104 patients) between January 1989 and June 1990. During benzodiazepine treatment, there were no significant differences among the three groups on the following measures: (1) acts of self-injury (alprazolam, 1.9%; clonazepam, 1.8%; no benzodiazepine, 2.9%); (2) assaults on staff or other patients (alprazolam, 0%; clonazepam, 0.9%; no benzodiazepine, 1.0%); (3) need for seclusion or restraints (alprazolam, 3.7%; clonazepam, 6.3%; no benzodiazepine, 4.8%); (4) increased need for observation by hospital staff (alprazolam, 8.3%; clonazepam, 7.2%; no benzodiazepine, 6.7%); and (5) decrease in patient privileges (alprazolam, 11.1%; clonazepam, 12.6%; no benzodiazepine, 11.5%). The results indicate that in an inpatient psychiatric population, the frequency of behavioral disturbances with alprazolam, clonazepam, or no benzodiazepine does not differ. This suggests that alprazolam does not possess unique disinhibitory activity. Second, these data suggest that disinhibition may not be an important clinical problem associated with benzodiazepine use. The design of the study does not allow one to establish a relationship between the prescription of the benzodiazepine and worsening behaviors, and the findings need to be interpreted conservatively because it was a retrospective review of a heterogeneous population. However, it is noteworthy that the incidence of adverse events was low even in this high-risk population, and because the patients were in the hospital and under constant observation, the objective assessment of so-called paradoxical reactions was undertaken in a controlled setting.
几例病例报告表明，使用苯二氮䓬类药物阿普唑仑进行治疗可能会导致行为脱抑制。为解决这一问题，作者回顾了1989年1月至1990年6月期间接受阿普唑仑治疗的323名精神科住院患者（108例）、氯硝西泮治疗的患者（111例）或未使用苯二氮䓬类药物的患者（104例）的病历（对患者接受的所有药物治疗情况均不知情）。在苯二氮䓬类药物治疗期间，三组患者在以下指标上无显著差异：（1）自我伤害行为（阿普唑仑组为1.9%；氯硝西泮组为1.8%；未使用苯二氮䓬类药物组为2.9%）；（2）对工作人员或其他患者的攻击行为（阿普唑仑组为0%；氯硝西泮组为0.9%；未使用苯二氮䓬类药物组为1.0%）；（3）需要隔离或约束的情况（阿普唑仑组为3.7%；氯硝西泮组为6.3%；未使用苯二氮䓬类药物组为4.8%）；（4）医院工作人员增加观察的必要性（阿普唑仑组为8.3%；氯硝西泮组为7.2%；未使用苯二氮䓬类药物组为6.7%）；以及（5）患者特权减少（阿普唑仑组为11.1%；氯硝西泮组为12.6%；未使用苯二氮䓬类药物组为11.5%）。结果表明，在精神科住院患者中，使用阿普唑仑、氯硝西泮或不使用苯二氮䓬类药物时行为障碍的发生率并无差异。这表明阿普唑仑不具有独特的脱抑制活性。其次，这些数据表明脱抑制可能不是与使用苯二氮䓬类药物相关的重要临床问题。该研究设计无法确定苯二氮䓬类药物的处方与行为恶化之间的关系，且由于这是对异质性人群的回顾性研究，研究结果需要谨慎解读。然而，值得注意的是，即使在这个高风险人群中不良事件的发生率也很低，并且由于患者住院且处于持续观察之下，所谓的矛盾反应是在可控环境中进行客观评估的。
