van der Bijl P, Roelofse J A
Faculty of Dentistry, University of Stellenbosch, Tygerberg, South Africa.
J Oral Maxillofac Surg. 1991 May;49(5):519-23. doi: 10.1016/0278-2391(91)90180-t.
This article reviews some of the important aspects of benzodiazepine-induced disinhibitory reactions. Although reactions of this type are relatively rare, they may sometimes manifest themselves in aggressive behavior accompanied by suicidal or homicidal tendencies. It appears that these reactions occur more commonly in younger patients, although the elderly (above 65 years) may also be at risk. Many mechanisms have been postulated, but none truly explain how these reactions arise. The concept that central cholinergic mechanisms may play a role, however, remains attractive and stems primarily from physostigmine's ability to successfully reverse this type of reaction. The potential role of the benzodiazepine antagonists, eg, flumazenil, in reversing disinhibitory reactions is also discussed. Apart from patients who previously exhibited poor impulse control, there are no reliable indicators for recognizing potential candidates for this type of reaction. To minimize the occurrence of disinhibitory reactions, some guidelines, which include the avoidance of certain drug combinations, the use of low doses of benzodiazepines, slow incremental intravenous administration, and good rapport with patients, are presented.
本文综述了苯二氮䓬类药物引起的去抑制反应的一些重要方面。虽然这类反应相对罕见，但有时可能表现为伴有自杀或杀人倾向的攻击行为。这些反应似乎在年轻患者中更常见，不过老年人（65岁以上）也可能有风险。人们提出了许多机制，但没有一个能真正解释这些反应是如何产生的。然而，中枢胆碱能机制可能起作用这一概念仍然很有吸引力，主要源于毒扁豆碱成功逆转这类反应的能力。还讨论了苯二氮䓬类拮抗剂（如氟马西尼）在逆转去抑制反应中的潜在作用。除了先前表现出冲动控制能力差的患者外，没有可靠的指标来识别这类反应的潜在候选者。为了尽量减少去抑制反应的发生，提出了一些指导原则，包括避免某些药物组合、使用低剂量苯二氮䓬类药物、缓慢递增静脉给药以及与患者建立良好关系。
