Received: July 17, 2017; Published: July 20, 2017
Corresponding author:Keiko Ikemoto, Department of Psychiatry, Iwaki Kyoritsu General Hospital, Iwaki 973-8555, Japan
Benzodiazepines (BZO) are frequently used as anxiolytics and hypnotics in daily clinical treatment. However it should be noticed that long term usage of BZO may disturb activity of daily life (ADL) and cause unexpectedly critical side effects. To patients with chronic pain, or some neuropsychiatric illnesses such as schizophrenia, clinicians are likely to prescribe BZO more frequently than to patients without these health problems. Nevertheless, it has been shown that there is no evidence that BZO improve clinical course of schizophrenia. Etizolam is a preferable BZO among Japanese orthopedists, for its muscle relaxant effect to stiffness of shoulder, cervical spondylosis and cervical disc herniation, and its hypnotic effect, as well as for its anxiolytic effect. Whereas side effects, muscle weakness, daytime sleepiness, loss of attention, unstable gait, gait disturbance, cognitive impairment, and dependence may reduce patients’ ADL.
Psychiatrists working in general hospitals with emergency centers encounter severe cases related to BZO side effects. BZO side effects are enhanced in elderlies and patients Who take anti convulsants, especially in cases with BZO poly pharmacy. The author sometimes experiences cases with suicidal attempt, who suffered from chronic pain, gait disturbance, muscle weakness, and in elderly cases, cognitive impairment, to whom long time BZO poly pharmacy had continued. Most of the cases also showed depressed state. Considering the side effects of BZO, the author used to reduce BZO, and to try to discontinue them. In most cases, gait disturbance, muscle weakness, and cognitive impairment recovered after BZO washout. Pain control and treatment of depression by using antidepressants or dementia by anti-dementia agents made rehabilitation easier, and made it possible to discharge earlier.
In a case of forced double suicide attempt of mother and son, the mother (60’s) who had 2 anti-epileptic agents from her childhood and 3 BZO for more than 10 years, had orthopedic pain of lower extremities.This increased her family and financial problems.Then,BZO was discontinued and replaced to low dosage of risperidone, and the mother’s muscle weakness, gait disturbance, cognitive impairment and depression was greatly improved, and mother’s suicidal idea disappeared. BZO discontinuation and/or BZO consumption decrease may prevent suicide incidence.