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弥合精神病临床实践中苯二氮䓬类药物教育与合理使用之间的差距。

Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice.

作者信息

Dell'Osso Bernardo, Albert Umberto, Atti Anna Rita, Carmassi Claudia, Carrà Giuseppe, Cosci Fiammetta, Del Vecchio Valeria, Di Nicola Marco, Ferrari Silvia, Goracci Arianna, Iasevoli Felice, Luciano Mario, Martinotti Giovanni, Nanni Maria Giulia, Nivoli Alessandra, Pinna Federica, Poloni Nicola, Pompili Maurizio, Sampogna Gaia, Tarricone Ilaria, Tosato Sarah, Volpe Umberto, Fiorillo Andrea

机构信息

Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy ; Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA.

Rita Levi Montalcini Department of Neuroscience, University of Turin, Torino, Italy.

出版信息

Neuropsychiatr Dis Treat. 2015 Jul 30;11:1885-909. doi: 10.2147/NDT.S83130. eCollection 2015.

Abstract

More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review.

摘要

苯二氮䓬类药物(BDZs)被发现半个多世纪后,仍然是最大且处方量最广泛的精神类化合物群体之一,不仅在临床精神病学领域如此,在整个医学领域亦是如此。然而,在过去二十年里,制药行业、临床医生和研究人员越来越关注抗抑郁药和抗精神病药的研发,对BDZs的兴趣有所降低,尽管它们在临床上被广泛使用。因此,许多精神科住院医师、医学生、护士和其他心理健康专业人员可能在这些药物方面接受的学术教学和培训不足,并错误地认为BDZs代表了临床精神药理学中过时的篇章。然而,该领域最近的进展,包括有关流行病学、成瘾风险和药物相互作用的研究结果,以及《精神疾病诊断与统计手册》第五版的推出及相关诊断变化,强烈促使人们对BDZs在临床实践中的使用进行更新评估。在最近一次旨在以批判性方式探讨该主题的专题活动中,一群年轻的意大利精神科医生试图突出当前教学途径中可能存在的缺陷,确定当前BDZs在临床实践中使用的主要临床利弊,并提供其在特定临床领域和患者群体中使用情况的最新概述。本次综述将呈现并讨论主要结果。

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