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Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort Study
- C.-F. Sun, Y. Lin, A. S. Pola, A. S. Kablinger, R. L. Trestman
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S324
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Introduction
While the role of benzodiazepines (BZDs) has been well established for anxiety and related disorders, there are significant concerns about BZD dependence, withdrawal, and tolerance. There is a lot of ambiguity regarding the potential long-term effects of BZDs on mental health. However, the risk of developing subsequent other substance use disorders is in question.
ObjectivesIn this electronic medical record (EMR) based retrospective cohort study, the study cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) prescribed with at least one BZD; the control cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) with no BZD prescription during the five-year timeframe examined. We excluded patients with pre-existing substance use disorders (ICD-10-CM: F10-F19), et al.
MethodsWe collected data from TriNetX Research database, a real-time international EMR network, from September 2017 to September 2022. Patients in the two cohorts were matched by gender, age, race, ethnicity, and common medical conditions at a 1:1 ratio by propensity scoring and then underwent Kaplan–Meier analysis and association analysis.
ResultsA total of 626,754 patients were identified and matched for analysis. Patients in the study cohort were more likely to be female (67.6% vs. 66.7%, p < 0.001), non-Hispanic (65.8% vs. 62.5%, p < 0.001) and white (72.8% vs. 69.1%, p < 0.001). Kaplan–Meier analysis showed the survival probability at the end of the time window was 94.1% for the control cohort and 89.5% for the study cohort (Hazard ratio, 2.20; 95% CI, 2.16-2.25; P < 0.001) in all type of substance use disorders. (Table 1)
Table 1. Hazard ratio of substance use disorders difference in BZD cohort versus the control cohort. BZD Cohort n (risk%) Control Cohort n (risk%) Hazard Ratio (95% Cl) P value Substance Use Disorders* 26,569 (4.2) 11,976 (1.9) 2.20 (2.16- 2.25) <0.001 Sedative/hypnotic/anxiolytic related disorders 656 (0.1) 152 (0.0) 4.26 (3.57- 5.09) <0.001 Alcohol Related Disorder 5,749 (0.9) 2,064 (0.3) 2.74 (2.61-2.88) <0.001 Opioid Related Disorder 2,807 (0.4) 815 (0.1) 3.38 (3.13-3.66) <0.001 Stimulant Related Disorder 1,658 (0.3) 551 (0.1) 2.94 (2.67- 3.24) <0.001 Cannabis Related Disorder 3,376 (0.5) 970 (0.2) 3.41 (3.17- 3.66) <0.001 * Substance use disorders was defined as Mental and behavioral disorders due to psychoactive substance use (ICD-10-CM: F10-F19).
ConclusionsPatients with an anxiety disorder who were prescribed BZDs are at higher risk of not only BZD dependence but all types of substance use disorders than a matched cohort not prescribed BZDs. Given this notable association, clinicians should be cautious while prescribing BZDs and inform the patient about the risks associated with their utilization.
Disclosure of InterestNone Declared
Donepezil-induced psychosis: a cautionary report of a rare adverse reaction
- K. R. Hutchings, B. K. Hutchings, B. Ratnakaran, A. S. Kablinger
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S357-S358
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Introduction
Donepezil is an acetylcholinesterase inhibitor approved by the Food and Drug Administration for the treatment of dementia in Alzheimer’s disease. While it is not curative for Alzheimer’s disease, donepezil has been shown to improve symptoms and slow disease progression; however, cases of rare psychiatric adverse effects, including hallucinations, mania, and increased confusion, have been reported. This report presents a case of donepezil-induced psychosis, which quickly resolved following cessation of the offending medication.
ObjectivesTo illustrate a unique case of donepezil-induced psychosis
MethodsThe patient is an 81-year-old male with a history of late-onset Alzheimer’s disease, mild depression, hypertension, hyperlipidemia, gastroesophageal reflux disease, and myocardial infarction. The patient was prescribed oral donepezil 10mg twice daily to manage his late-onset Alzheimer’s disease. Subsequently, he began developing persecutory delusions, increased agitation toward his family, and auditory hallucinations. His symptoms were worse at night after taking the donepezil, and he regularly requested to have a firearm for self-defense in the late hours of the night. His symptoms progressed for several weeks before his family brought him into the geriatric psychiatry clinic to address his psychosis. The family recognized that these new symptoms started shortly after the patient began taking donepezil and had already started decreasing the dose to half of what was originally prescribed.
ResultsThis patient experienced symptom remission from psychosis immediately upon discontinuation of donepezil. The patient and his family reported significant improvement with no continuation of hallucinations or paranoia. There was also reported improvement in mood and irritability, and the patient appeared significantly better upon follow-up with geriatric psychiatry. Due to this immediate improvement, the suspected causative factor in the precipitation of psychosis in this patient is the anticholinesterase activity of the donepezil. Although the prescribing information of donepezil details inadequate data proving an association between donepezil and psychotic symptoms, two other published case reports (Yorston GA et al. J Psychopharmacol 2000;14:303-4, Pozzi FE et al. Case Rep Neurol 2022; 14:359-365), along with this one, provide evidence of a causal relationship between the two. The patient was switched to memantine therapy and has remained free of psychotic symptoms thus far.
ConclusionsThis case demonstrates the caution required among clinicians when prescribing donepezil for the treatment of Alzheimer’s disease. There needs to be a more focused risk evaluation of potential psychiatric adverse effects in patients treated with donepezil.
Disclosure of InterestNone Declared