Vikander Britt, Koechling Ulrike M, Borg Stefan, Tönne Ulla, Hiltunen Arto J
Karolinska Institute, Department of Clinical Neuroscience, Division of Alcohol and Drug Dependence, Stockholm.
Nord J Psychiatry. 2010 Aug;64(4):273-82. doi: 10.3109/08039481003624173.
Benzodiazepines (BZD) are the most widely used sedative-hypnotics, and evidence is rapidly accumulating suggesting potential BZD dependence, association of chronic use with adverse effects and a definite abstinence syndrome produced by withdrawal.
The present investigation followed prospectively long-term BZD users over 1 year following graded BZD withdrawal in terms of clinical and withdrawal symptoms.
Clinical symptoms were measured by the Comprehensive Psychopathological Rating Scale (CPRS) and by the Newcastle Anxiety and Depression Diagnostic Index (NADDI) in a sample of BZD users over a 50-week period following graded BZD withdrawal.
The results showed that the frequency and severity of clinical symptomatology measured by both scales significantly decreased over time. A detailed analysis of possible patterns of symptoms on both scales revealed four patterns: 1) a gradual decrease over the 50-week time period; 2) an increase in the severity of symptoms at the onset of tapering and a decrease in severity post-tapering; 3) an increase in the severity of symptoms 4 weeks after the cessation of BZD tapering; and 4) no change over the 50-week time period. Rate of BZD withdrawal was associated with CPRS ratings of global illness at admission and at end of treatment, but was not associated with duration or dosage of BZDs, type of BZD, prescriptive and/or non-prescriptive drug use prior to admission, marital status, sex or age.
The results of the present study provide a detailed picture of the pattern of symptoms, their time course and multidimensional determinants of the BZD withdrawal symptoms.
苯二氮䓬类药物（BZD）是使用最广泛的镇静催眠药，越来越多的证据表明存在潜在的BZD依赖、长期使用与不良反应的关联以及戒断时产生的明确戒断综合征。
本研究对长期使用BZD的患者在按梯度逐渐停用BZD后的1年多时间里进行前瞻性随访，观察临床及戒断症状。
在一组BZD使用者中，于按梯度逐渐停用BZD后的50周内，采用综合精神病理学评定量表（CPRS）和纽卡斯尔焦虑抑郁诊断指数（NADDI）测量临床症状。
结果显示，两种量表所测量的临床症状学的频率和严重程度均随时间显著下降。对两种量表上可能的症状模式进行详细分析，发现了四种模式：1）在50周时间段内逐渐下降；2）在逐渐减量开始时症状严重程度增加，逐渐减量后严重程度下降；3）BZD逐渐减量停止后4周症状严重程度增加；4）在50周时间段内无变化。BZD的撤药率与入院时及治疗结束时CPRS评定的总体病情有关，但与BZD的使用时长或剂量、BZD类型、入院前的处方和/或非处方药物使用情况、婚姻状况、性别或年龄无关。
本研究结果详细描绘了症状模式、其时间进程以及BZD戒断症状的多维度决定因素。
