Nakajima Aiichiro, Kanie Ayako, Ito Masaya, Hirabayashi Naotsugu, Imamura Fumi, Takebayashi Yoshitake, Horikoshi Masaru
National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.
Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan.
Neuropsychiatr Dis Treat. 2020 Sep 18;16:2135-2142. doi: 10.2147/NDT.S263537. eCollection 2020.
Benzodiazepines (BZDs) are prescribed to treat psychiatric diseases. However, many guidelines recommend limiting the use of BZDs because of side effects and lack of evidence regarding long-term efficacy. Moreover, reducing BZDs' use is difficult because of dependency and the severity of withdrawal symptoms. The efficacy of cognitive behavioral therapy (CBT) for mood and anxiety disorders has been demonstrated. However, there is scant evidence that CBT has effectively reduced BZDs use, especially in Japan, where the BZDs prescription rate is high. Therefore, we sought to examine the impact of CBT on reducing BZDs use in a Japanese psychiatric setting.
Participants were outpatients with mood and anxiety disorders who were prescribed BZD anxiolytics. We retrospectively reviewed changes in BZD anxiolytics prescription dosages during CBT (66 patients; mean number of CBT sessions, 14.6) from our hospital record between April 2015 and September 2017. We checked prescriptions at four time points: at first interview for judging adaptation of CBT (baseline), at the first CBT session, at the last CBT session, and 3 months after the last CBT session.
A total of 13 of 66 patients discontinued BZD anxiolytics during CBT, and 21 of 66 reduced their prescribed dosage by 50%. The association between discontinuation and dose-reduction and assessment period was modeled simultaneously using Bayesian hierarchical hurdle model. Results from the modeling showed a significant discontinuation at post-CBT and at 3 months post-CBT session compared to baseline (estimated median odds ratio [OR] post-CBT = 9.79 [95% CI: 4.65-20.45]; OR at 3 months post-CBT = 11.53 [95% CI: 6.06-22.33]). Moreover, a significant dose reduction was observed post-intervention (estimated median relative risk = 0.845 [95% CI: 0.729-0.982]), with a median reduction of 1.7 mg (diazepam conversion) in BZD use.
Our results suggest that CBT possibly aids in reducing and discontinuing BZD anxiolytics use for Japanese patients.
苯二氮䓬类药物（BZDs）被用于治疗精神疾病。然而，许多指南建议限制使用BZDs，因为其存在副作用且缺乏长期疗效的证据。此外，由于药物依赖和戒断症状的严重性，减少BZDs的使用存在困难。认知行为疗法（CBT）对情绪和焦虑障碍的疗效已得到证实。然而，几乎没有证据表明CBT能有效减少BZDs的使用，尤其是在日本，该国BZDs的处方率很高。因此，我们试图研究CBT对日本精神科环境中减少BZDs使用的影响。
参与者为患有情绪和焦虑障碍且正在服用BZD类抗焦虑药的门诊患者。我们回顾性分析了2015年4月至2017年9月我院记录中CBT治疗期间（66例患者；CBT平均疗程数为14.6）BZD类抗焦虑药处方剂量的变化。我们在四个时间点检查处方：首次访谈以判断CBT的适应性（基线）、首次CBT疗程、最后一次CBT疗程以及最后一次CBT疗程后3个月。
66例患者中有13例在CBT治疗期间停用了BZD类抗焦虑药，66例中有21例将其处方剂量减少了50%。使用贝叶斯分层障碍模型同时对停药和剂量减少与评估期之间的关联进行建模。建模结果显示，与基线相比，CBT后及CBT疗程后3个月有显著的停药情况（估计中位数优势比[OR]，CBT后 = 9.79 [95% CI：4.65–20.45]；CBT后3个月 = 11.53 [95% CI：6.06–22.33]）。此外，干预后观察到显著的剂量减少（估计中位数相对风险 = 0.845 [95% CI：0.729–0.982]），BZD使用量中位数减少了1.7毫克（地西泮换算）。
我们的结果表明，CBT可能有助于减少日本患者使用BZD类抗焦虑药并使其停药。
