Benzodiazepines
- PDF / 175,019 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 64 Downloads / 193 Views
S
Mirror symptoms presenting as various toxicities due to drug dependence: 2 case reports In a report, two patients were described, of whom, a 56-year-old woman developed irritability, insomnia, headaches, back pain, tremor, palpitations, hypertension, cardiovascular crises and grand mal seizure following dependence with lorazepam, diazepam, estazolam and clonazepam for anxiety disorder, and a 34-year-old man developed increasing dyspnoea, paroxysmal anxiety, panic attacks, sleep disturbances, tinnitus and arterial hypertension following dependence with alprazolam for stress [routes and duration of treatments to reaction onsets not stated; not all dosages and outcomes stated]. Case 1: A 56-year-old woman, who had a 30-year history of anxiety disorder, had been treated with clomipramine initially with a good improvement. Hence, she stopped visiting the clinic, and discontinued treatment over the time. During stressful circumstances, she experienced anxiety recurrence due to which clomipramine was re-initiated along with lorazepam. She found no effect on clomipramine, and continued only lorazepam thereafter. She again stopped visiting the clinic, and received prescription form her general physician. Her anxiety recurred after a temporary improvement, hence, the doctor kept increasing lorazepam dose. She also developed insomnia and irritability. Clomipramine re-initiation was attempted but her symptoms remained same. Further, paroxetine, venlafaxine and citalopram were tried. Venlafaxine was stopped secondary to elevated BP. She had relief on lorazepam therapy. Estazolam, diazepam and clonazepam were used because of the growing drug tolerance. She started experiencing back pain, tremor and headaches that became chronic over the time. She also developed uncontrollable hypertension and palpitations. Her hypertension was treated with four unspecified antihypertensive drugs with a poor effect. Her condition progressed systematically despite increased benzodiazepine dose. She had been hospitalised multiple times for cardiovascular crises in the recent years. Subsequently, she was admitted to the detoxification ward for drug-resistant arterial hypertension and drug-resistant anxiety disorder. She experienced first grand mal seizure prior to the admission, indicating drug dependence. A systematic improvement of the somatic symptoms like tremor and pain was noted at an advanced stage of the detoxification during which benzodiazepine serum level was monitored. Her antihypertensive therapy was reduced to a single drug. Venlafaxine was used to manage her anxiety, which she tolerated well after adapting to benzodiazepine absence. Case 2: A 34-year-old man was recommended alprazolam by a friend for stress after a family argument 10 years prior. He had a satisfactory short-term effect. However, in similar circumstances later his mood became more depressive. Hence, he presented to a psychiatrist for alprazolam prescription. He was diagnosed with depressive adjustment disorder, and was prescribed citalopram, mianserin and perazine.
Data Loading...
