Posted by Squiggles on October 24, 2002, at 8:41:31
In reply to Re: RATIONAL USE OF BENZODIAZAPINES » Squiggles, posted by Alan on October 23, 2002, at 22:12:32
Alan,
Once statistics are out, and the further
understanding of the effect of benzos on
the GABA system is accomplished, the
"interpretation" of those devilish details
should not exceed the capacity of an
intelligent physician.I continue from 3.4, where I made a remark
that if benzos must be used for agitated
depression or anxiety or mania along with
an anti-psychotic, then THIS is a good thing.
And it is a pleasure to see the vigilence
against tardive dyskinesia and neuroleptic malignant
syndrome if the antipsychotics are mixed with
antidepressants.Something I missed on 3.3.6 about the lipophilic
tendency of the benzos. I am quite surprised to
see this here because in the Benzo group, some
people claimed that benzos tended to stay in the
fat cells and therefore could delay the withdrawal
process or introduce erratic w/d symptoms. Others,
said this was just pseudo-science. It is no longer
1996 so perhaps some current research has settled
this question.
4. INDICATIONSThis means for what these drugs are given (mainly
anxiety and insomnia). Anxiety is defined pretty
extensively. However, the causes and duration of
anxiety is not mentioned, which I think would certainly
influence the understanding of why benzos must commonly
be administered for longer than a year.It is interesting that there are different headings
for Phobias and Panic Attacks; though different
in name, if a doctor were to look at the physical
manifestations (such tachycardia, sweating, dry mouth,
trembling, infact all the autonomic overactivity
symptoms) they would see that there is little
difference. This might reduce the number of
prescriptions that have escalated since 1996, making
the benzos among the top 5 drugs prescribed.Again--differential diagnosis. Autonomic overactivity
may also be caused by thyroid toxicity and other
physical disorders; and as the medical psychiatry
model knows so very well--the body influences the
mind.Mania is very briefly discussed. I think it
is inadequate. "In manic episodes benzodiazepines
may be used adjunctively with mood stabilizers."
Does this mean that we wait for the manic episode?
Do we give the benzo to those described as manic depressives.
And, this is a point which disturbs me greatly--
is mania a possible side effect of unrecognized
benzo withdrawal, for which more benzos are prescribed?Again--differential diagnosis-- ask the patient
if he or she has been taking benzos, and if she or
he has stopped suddenly or forgotten to take them
for some weeks or decided on his own he no longer
needs them.4.1.4 Benzo and alcohol withdrawal
I did not know that chlormethiazole could be used
for withdrawal; i thought phenobarbitol was.
Anyway, the statement that benzos are of great
value in the management of the withdrwal state
ensuing abstinence from alcohol or benzos or hypnotics,
begs the question in the case of benzos. Why,
would one want to get off benzos if they are
prescribed for these disorders so effectively?
Does the patient say, I no longer have a phobia,
or insomnia, or mania? And if that is the case,
how will the doctor distinguish between the
"underlying disease" having been cured by benzos,
and the assumption that time alone has cured it.
What medical criteria are there for these
diagnostic problems?4.1.5 Personality Disorders
I think this is a good assessment, and
takes into account very important aspect
of the patient's health such as physical
problems, drugs taken, and personal toleration
of these drugs. The voluntary aspect may
be something to consider too, and again where
panic is mentioned, a physical examination
should be stressed.4.1.2 Psychoses
I'm going to break here before continuing with
Psychoses.Squiggles
poster:Squiggles
thread:124171
URL: http://www.dr-bob.org/babble/20021019/msgs/124991.html