Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences.
Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences.
Int Clin Psychopharmacol. 2024 May 1;39(3):206-210. doi: 10.1097/YIC.0000000000000486. Epub 2023 Aug 9.
This study reports a rare case of high-dose midazolam abuse and Munchausen Syndrome. A 48-year-old female physician was referred by a psychiatrist to the Toxicology Department of Imam Reza Hospital for abstaining from 300 mg/day of parenteral midazolam. She had mimicked the symptoms of Crohn's disease; therefore, she had undergone 15 colonoscopies and 40 times MRI or CT scan, all of which were normal. Six months earlier, she had switched oral methadone to 30 mg/day of intravenous midazolam. She also had several skin lesions on injection sites that she considered pyoderma gangrenosum. When the total daily dose of intravenous midazolam was switched to oral bioequivalence of clonazepam, she could not tolerate withdrawal (Clinical Institute Withdrawal Assessment Scale-Benzodiazepines = 68). Therefore, she received midazolam again as a continuous intravenous infusion. Within 7 days, the whole dose was replaced by the bioequivalence oral dose of clonazepam. She was also treated with carbamazepine and cognitive behavior therapy. Afterward, she was transferred to the psychiatric ward for further psychiatric treatment. Dependency on a high dose of midazolam could be treated by tapering off the long-acting benzodiazepine.
本研究报告了一例罕见的大剂量咪达唑仑滥用和孟乔森综合征病例。一名 48 岁女性医生因每天静脉注射 300 毫克咪达唑仑而被一位精神科医生转诊至伊玛目礼萨医院毒理学部门。她模仿了克罗恩病的症状；因此，她接受了 15 次结肠镜检查和 40 次 MRI 或 CT 扫描，结果均正常。六个月前，她将口服美沙酮改为每天静脉注射 30 毫克咪达唑仑。她在注射部位也有几个皮肤损伤，她认为是坏疽性脓皮病。当静脉注射咪达唑仑的总日剂量转换为口服等效的氯硝西泮时，她无法耐受戒断（临床研究所戒断评估量表-苯二氮䓬类=68）。因此，她再次接受咪达唑仑作为连续静脉输注。在 7 天内，整个剂量被氯硝西泮的生物等效口服剂量取代。她还接受了卡马西平和认知行为治疗。之后，她被转到精神科病房进行进一步的精神治疗。依赖大剂量咪达唑仑可以通过逐渐减少长效苯二氮䓬类药物的剂量来治疗。
