Voshaar Richard C Oude, Couvée Jaap E, van Balkom Anton J L M, Mulder Paul G H, Zitman Frans G
Department of Psychiatry, Radboud University Nijmegen Medical Center, The Netherlands.
Br J Psychiatry. 2006 Sep;189:213-20. doi: 10.1192/bjp.189.3.213.
The prevalence of benzodiazepine consumption in European countries remains at 2-3% of the general population despite the well-documented disadvantages of long-term use.
To review systematically the success rates of different benzodiazepine discontinuation strategies.
Meta-analysis of comparable intervention studies.
Twenty-nine articles met inclusion criteria. Two groups of interventions were identified; minimal intervention (e.g. giving simple advice in the form of a letter or meeting to a large group of people; n=3), and systematic discontinuation (defined as treatment programmes led by a physician or psychologist; n=26). Both were found to be significantly more effective than treatment as usual: minimal interventions (pooled OR=2.8, 95% CI 1.6-5.1); systematic discontinuation alone (one study, OR=6.1, 95% CI 2.0-18.6). Augmentation of systematic discontinuation with imipramine (two studies, OR=3.1, 95% CI 1.1-9.4) or group cognitive-behavioural therapy for patients with insomnia (two studies, OR=5.5, 95% CI 2.3-14.2) was superior to systematic discontinuation alone.
Evidence was found for the efficacy of stepped care (minimal intervention followed by systematic discontinuation alone) in discontinuing long-term benzodiazepine use.
尽管长期使用苯二氮䓬类药物存在诸多已被充分证明的弊端，但欧洲国家使用该药物的人口比例仍维持在总人口的2%至3%。
系统回顾不同苯二氮䓬类药物停药策略的成功率。
对可比干预研究进行荟萃分析。
29篇文章符合纳入标准。确定了两组干预措施；最小干预（例如以信件形式或与一大群人会面给予简单建议；n = 3）和系统停药（定义为由医生或心理学家主导的治疗方案；n = 26）。两者均被发现比常规治疗显著更有效：最小干预（合并OR = 2.8，95% CI 1.6 - 5.1）；仅系统停药（一项研究，OR = 6.1，95% CI 2.0 - 18.6）。用丙咪嗪增强系统停药（两项研究，OR = 3.1，95% CI 1.1 - 9.4）或对失眠患者进行团体认知行为疗法（两项研究，OR = 5.5，95% CI 2.3 - 14.2）优于仅系统停药。
有证据表明逐步护理（先进行最小干预，然后仅进行系统停药）在停用长期苯二氮䓬类药物方面有效。
