De Carlo Vera, Grancini Benedetta, Vismara Matteo, Benatti Beatrice, Arici Chiara, Cremaschi Laura, Cirnigliaro Giovanna, Degoni Luca, Oldani Lucio, Palazzo Carlotta, Glick Ira D, Viganò Caterina, Dell'Osso Bernardo
Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.
Department of Mental Health, Fondazione IRCCS Cà Granda Policlinico, Milan, Italy.
Hum Psychopharmacol. 2019 May;34(3):e2695. doi: 10.1002/hup.2695. Epub 2019 May 1.
In patients with affective disorders, benzodiazepines (BZDs) are frequently administered at the onset, sometimes inappropriately. We sought to identify clinical variables associated with first BZD prescription in a large sample of patients with affective disorders.
Four hundred sixty patients with mood or anxiety disorders attending different psychiatric services were assessed comparing those who received BZD as first treatment (BZD w/) and those who did not (BZD w/o).
More than one third (35.7%) of the total sample had received BZDs as first prescription. In relation to mood disorders, BZD w/ subjects more frequently (a) had not a psychiatrist as first therapist, (b) had anxious symptoms at onset, (c) had adjustment disorder as first diagnosis, (d) were treated as outpatients. In relation to specific diagnoses, (a) personal decision of treatment for major depressive disorder, (b) outpatient status for bipolar disorder and (c) longer duration of untreated illness for adjustment disorder were more frequently associated with first BZD prescription. For anxiety disorders, the presence of stressful life events and the diagnoses of panic disorder or specific phobias were more frequently observed in BZD w/ patients.
Patients with affective disorders frequently received BZDs as first prescription with significant differences between and within mood and anxiety disorders.
在情感障碍患者中，苯二氮䓬类药物（BZDs）常在疾病发作时频繁使用，有时并不恰当。我们试图在大量情感障碍患者样本中确定与首次开具BZD处方相关的临床变量。
对460名就诊于不同精神科的心境或焦虑障碍患者进行评估，比较接受BZD作为首次治疗的患者（BZD组）和未接受BZD治疗的患者（非BZD组）。
超过三分之一（35.7%）的总样本接受过BZDs作为首次处方。对于心境障碍，BZD组患者更频繁地（a）首次治疗医生不是精神科医生，（b）发病时有焦虑症状，（c）首次诊断为适应障碍，（d）接受门诊治疗。对于特定诊断，（a）重度抑郁症的个人治疗决定，（b）双相情感障碍的门诊状态，以及（c）适应障碍未经治疗的病程较长，更常与首次BZD处方相关。对于焦虑障碍，BZD组患者更频繁地出现应激性生活事件以及惊恐障碍或特定恐惧症的诊断。
情感障碍患者经常接受BZDs作为首次处方，在心境障碍和焦虑障碍之间以及内部存在显著差异。
