Ginestet D
Encephale. 1983;9(4 Suppl 2):97B-101B.
In both general practice and psychiatry, the indication for benzodiazepines recognized by the French Technical Commissions--"all forms of anxiety"--remains very broad, and absolute contraindications are limited to severe respiratory insufficiency and, for certain drugs, myasthenia. Responsibility for deciding at what moment it becomes necessary to prescribe benzodiazepines therapy lies with the individual doctor--he is sole judge in his relationship with the patient: reactional anxiety, anxiety or distress accompanying somatic disease, insomnia. Benzodiazepines should not be prescribed to children, unless there are exceptional reasons for doing so. In psychiatry, higher doses are authorized for neurotic or psychotic anxiety, which are considered to be more serious forms. It is more or less accepted practice to prescribe benzodiazepines in combination therapy of various kinds with other psychotropic drugs. There are certain indications for which benzodiazepines in monotherapy are wrongly used, such as depressive states, and others where their use is contested, schizophrenic states, for example. Pharmacokinetic data are now beginning to provide a guide to dosage scheduling and to the choice of drug for the different indications. Maximum duration of benzodiazepine therapy should not exceed 4 months in certain cases. Risk of withdrawal syndrome appears to be slight for usual therapeutic doses. Finally, benzodiazepines are not the first choice of the drug addicts.
在普通科和精神科，法国技术委员会认可的苯二氮䓬类药物适应症——“所有形式的焦虑”——仍然非常宽泛，绝对禁忌症仅限于严重呼吸功能不全，以及某些药物的重症肌无力。决定何时有必要开具苯二氮䓬类药物治疗的责任在于个体医生——他是其与患者关系中的唯一判断者：反应性焦虑、躯体疾病伴发的焦虑或痛苦、失眠。除非有特殊原因，否则不应给儿童开具苯二氮䓬类药物。在精神科，对于被认为更严重形式的神经症性或精神病性焦虑，允许使用更高剂量。在各类联合治疗中，将苯二氮䓬类药物与其他精神药物联合使用在某种程度上是被认可的做法。在某些适应症中，苯二氮䓬类药物单药治疗存在误用情况，如抑郁状态，而在其他一些情况下其使用存在争议，例如精神分裂症状态。药代动力学数据现在开始为不同适应症的剂量安排和药物选择提供指导。在某些情况下，苯二氮䓬类药物治疗的最长持续时间不应超过4个月。对于常规治疗剂量，出现戒断综合征的风险似乎较小。最后，苯二氮䓬类药物不是吸毒者的首选药物。
