Paradoxical reaction to benzodiazepines in elderly – Case series

Reddy, M S; Achary, Umesh; Harbishettar, Vijaykumar; Sivakumar, Palanimuthu T.; Varghese, Mathew

doi:10.1016/j.ajp.2018.04.037

Cited by 13 publications

(5 citation statements)

References 22 publications

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“…paradoxical reactions; Tae et al, 2014). These reactions are typically observed in polydrug users (Gillet et al, 2001), but also in the elderly (Reddy et al, 2018); and in individuals with pre-existing brain damage (Anderson and Bokor, 2012). This behavioural disinhibition may increase the risk of auto or heteroaggression and acting out (Gillet et al, 2001;Saxon et al, 2010;Wallace and Taylor, 2009).…”

Section: Benzodiazepinesmentioning

confidence: 99%

Substance-Use Disorders and Violence

Schifano

Zangani

Chiappini

et al. 2019

Comprehensive Approach to Psychiatry

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Substance use seems to be associated with increased prevalence levels of violent behaviour in both general population and psychiatric patients, with 'dual diagnosis' clients showing high rates of risky and criminal behaviour and worse therapy compliance. Cases of drug-related aggressiveness mostly involve a number of molecules, e.g. ethanol, stimulants, cannabinoids, opiates, benzodiazepines, synthetic cannabinoids and synthetic cathinones. Consumers of the virtually few hundreds, and up to a few thousands substances currently available may present to the emergency departments without providing information about the substances(s) ingested and it is likely that standard drug tests will show negative results. An appropriate treatment/management plan to cope with the related acute behavioural and psychopathological disturbances is here discussed. Because of the complex behavioural and medical toxicity issues associated with drug intake, raising awareness and education of health care professionals on drugs' health harms, interventions, harm reduction techniques, and referral pathways are here deemed of particular relevance.

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Section: Benzodiazepinesmentioning

confidence: 99%

Substance-Use Disorders and Violence

Schifano

Zangani

Chiappini

et al. 2019

Comprehensive Approach to Psychiatry

View full text Add to dashboard Cite

show abstract

“…This is especially true for venlafaxine (MDMA-like perceptual disturbances); bupropion (excessive mood lifting and pendular drug alterations) [64]; pregabalin (perceptual disturbances/dissociative effects); and quetiapine (intense psychomotor function retardation effects). Further, the therapeutic-dosage BDZ intake may be associated with paradoxical effects only in selected subgroups, e.g., patients with personality disorder [65] or the elderly [66]. Conversely, the high-dose, highly potent BDZs/novel BDZs are often ingested to achieve proper stimulant/aggressive -as opposed to sedative -effects [65,67] Increasing levels of access to the web over the past 15 years or so may have contributed to the current scenario of prescribed-drug misuse and abuse, with social networks having played a role in the aggressive marketing/ distribution of prescription drugs from rogue websites [25].…”

Section: Discussionmentioning

confidence: 99%

Coming Off Prescribed Psychotropic Medications: Insights from Their Use as Recreational Drugs

Schifano

2020

Psychother Psychosom

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“…Benzodiazepines can produce a paradoxical agitated state in older adults with delirium, and they should be avoided except under specifi c circumstances, including alcohol withdrawal, active prolonged seizure activity, or when following a benzodiazepine taper schedule. 36 Th ey should not be used for insomnia unless the patient has been using them as a home medication for this purpose, and even then, they should be used with extreme caution in older adults.…”

Section: Nonpharmacologic Interventionsmentioning

confidence: 99%