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Benzodiazepines in Geriatric Psychiatry

What Doctors Report and What Patients Actually Use

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Abstract

Objective

Exact information on drug use is important information at admittance to hospital departments. The aim of this study was to validate the information given in the referral regarding benzodiazepine use by analysis of serum samples.

Methods

A total of 241 patients were included at admittance to a geriatric psychiatry department. Information on use of benzodiazepines according to the referral was recorded, and serum samples were analysed for benzodiazepine drugs. The number of patients with incorrect information in the referral was calculated for each benzodiazepine.

Results

Information on benzodiazepine use was included in 60 % of patient referrals. However, serum analyses revealed the use of different or additional benzodiazepines compared with the referral information in 24 % of the patients. In 10 % of the patients, a benzodiazepine was detected despite no information on benzodiazepine use at all in the referral. For diazepam, 70 % of users were identified by serum analyses only, while this number was lower for the other benzodiazepines.

Conclusions

This study shows that benzodiazepine use is widespread in geriatric psychiatry, but that information about the use of these drugs is very often incorrect. This may have significant clinical consequences if symptoms caused by use or abrupt cessation of benzodiazepines are misinterpreted.

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References

  1. Barat I, Andreasen F, Damsgaard EM. Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol. 2001;51(6):615–22.

    Article  PubMed  CAS  Google Scholar 

  2. Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15(2):122–6.

    Article  PubMed  CAS  Google Scholar 

  3. Rognstad S, Straand J. Do general practitioners know what medication community nurses give their shared patients? [in Norwegian]. Tidsskr Nor Laegeforen. 2004;124(6):810–2.

    PubMed  Google Scholar 

  4. Wafford KA. GABAA receptor subtypes: any clues to the mechanism of benzodiazepine dependence? Curr Opin Pharmacol. 2005;5(1):47–52.

    Article  PubMed  CAS  Google Scholar 

  5. Ingum J, Pettersen G, Sager G, Morland J. Relationship between unbound plasma concentrations and various psychomotor and subjective effects after intakes of diazepam and flunitrazepam. Int Clin Psychopharmacol. 1994;9(2):115–21.

    Article  PubMed  CAS  Google Scholar 

  6. Golombok S, Moodley P, Lader M. Cognitive impairment in long-term benzodiazepine users. Psychol Med. 1988;18(2):365–74.

    Article  PubMed  CAS  Google Scholar 

  7. Barker MJ, Greenwood KM, Jackson M, Crowe SF. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs. 2004;18(1):37–48.

    Article  PubMed  CAS  Google Scholar 

  8. Sylvestre MP, Abrahamowicz M, Capek R, Tamblyn R. Assessing the cumulative effects of exposure to selected benzodiazepines on the risk of fall-related injuries in the elderly. Int Psychogeriatr. 2012;24(4):577–86.

    Article  Google Scholar 

  9. Wolf B, Griffiths RR. Physical dependence on benzodiazepines: differences within the class. Drug Alcohol Depend. 1991;29(2):153–6.

    Article  PubMed  CAS  Google Scholar 

  10. Hiemke C, Baumann P, Bergemann N, Conca A, Dietmaier O, Egberts K, et al. AGNP consensus guidelines for therapeutic drug monitoring in psychiatry: update 2011. Pharmacopsychiatry. 2011;44(6):195–235.

    Article  Google Scholar 

  11. Rognstad S, Brekke M, Fetveit A, Spigset O, Wyller TB, Straand J. The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients: a modified Delphi study. Scand J Prim Health Care. 2009;27(3):153–9.

    Article  PubMed  Google Scholar 

  12. Gilchrist WJ, Lee YC, Tam HC, Macdonald JB, Williams BO. Prospective study of drug reporting by general practitioners for an elderly population referred to a geriatric service. Br Med J (Clin Res Ed). 1987;294(6567):289–90.

    Article  CAS  Google Scholar 

  13. Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41(2):67–76.

    Article  PubMed  CAS  Google Scholar 

  14. Schulz M, Schmoldt A. Therapeutic and toxic blood concentrations of more than 800 drugs and other xenobiotics. Pharmazie. 2003;58(7):447–74.

    PubMed  CAS  Google Scholar 

  15. Ineke NC, Skurtveit S, Berg C. Polypharmacy of potentially addictive medication in the older persons: quantifying usage. Pharmacoepidemiol Drug Saf. 2012;121(2):199–206.

    Article  Google Scholar 

  16. Rockett IR, Putnam SL, Jia H, Smith GS. Declared and undeclared substance use among emergency department patients: a population-based study. Addiction. 2006;101(5):706–12.

    Article  PubMed  Google Scholar 

  17. Elliott L, Glenday J, Freeman L, Ajeda D, Johnston B, Christie M, et al. Reducing diazepam prescribing for illicit drug users: a randomised control study. Drug Alcohol Rev. 2005;24(1):25–31.

    Article  PubMed  Google Scholar 

  18. Hayward P, Wardle J, Higgitt A, Gray J. Changes in ‘withdrawal symptoms’ following discontinuation of low-dose diazepam. Psychopharmacology (Berl). 1996;125(4):392–7.

    Article  CAS  Google Scholar 

  19. Kleykamp BA, Griffiths RR, Mintzer MZ. Dose effects of triazolam and alcohol on cognitive performance in healthy volunteers. Exp Clin Psychopharmacol. 2010;18(1):1–16.

    Article  PubMed  CAS  Google Scholar 

  20. Roache JD, Griffiths RR. Comparison of triazolam and pentobarbital: performance impairment, subjective effects and abuse liability. J Pharmacol Exp Ther. 1985;234(1):120–33.

    PubMed  CAS  Google Scholar 

  21. Mintzer MZ, Griffiths RR. An abuse liability comparison of flunitrazepam and triazolam in sedative drug abusers. Behav Pharmacol. 2005;16(7):579–84.

    Article  PubMed  CAS  Google Scholar 

  22. Barker MJ, Greenwood KM, Jackson M, Crowe SF. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol. 2004;19(3):437–54.

    Article  PubMed  Google Scholar 

  23. Drummer OH, Gerostamoulos J, Batziris H, Chu M, Caplehorn J, Robertson MD, et al. The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes. Accid Anal Prev. 2004;36(2):239–48.

    Article  PubMed  Google Scholar 

  24. Longo MC, Hunter CE, Lokan RJ, White JM, White MA. The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability: part II. The relationship between drug prevalence and drug concentration, and driver culpability. Accid Anal Prev. 2000;32(5):623–32.

    Article  PubMed  CAS  Google Scholar 

  25. Finkle WD, Der JS, Greenland S, Adams JL, Ridgeway G, Blaschke T, et al. Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults. J Am Geriatr Soc. 2011;59(10):1883–90.

    Article  PubMed  Google Scholar 

  26. Landi F, Cesari M, Russo A, Onder G, Sgadari A, Bernabei R. Benzodiazepines and the risk of urinary incontinence in frail older persons living in the community. Clin Pharmacol Ther. 2002;72(6):729–34.

    Article  PubMed  CAS  Google Scholar 

  27. Titler MG, Shever LL, Kanak MF, Picone DM, Qin R. Factors associated with falls during hospitalization in an older adult population. Res Theory Nurs Pract. 2011;25(2):127–48.

    Article  PubMed  Google Scholar 

  28. Griffiths RR, Johnson MW. Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds. J Clin Psychiatry. 2005;66(Suppl. 9):31–41.

    PubMed  CAS  Google Scholar 

  29. Fontaine R, Chouinard G, Annable L. Rebound anxiety in anxious patients after abrupt withdrawal of benzodiazepine treatment. Am J Psychiatry. 1984;141(7):848–52.

    PubMed  CAS  Google Scholar 

  30. Jorgensen VR. Benzodiazepine reduction in general practice: are the elderly neglected? J Affect Disord. 2012;136(3):1216–21.

    Article  PubMed  Google Scholar 

  31. Neutel CI, Skurtveit S, Berg C. What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population. Sleep Med. 2012;13(7):893–7.

    Article  PubMed  Google Scholar 

  32. Glintborg B, Poulsen HE, Dalhoff KP. The use of nationwide on-line prescription records improves the drug history in hospitalized patients. Br J Clin Pharmacol. 2008;65(2):265–9.

    Article  PubMed  Google Scholar 

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Acknowledgments

There are no conflicts of interest for any of the authors. No funding was received for this study.

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Authors and Affiliations

  1. Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway

    Gudrun Høiseth, Kari Midtbø Kristiansen & Bernhard Lorentzen

  2. Center for Psychopharmacology, Diakonhjemmet Hospital, Forskningsveien 7, Pb 85 Vinderen, 0319, Oslo, Norway

    Gudrun Høiseth & Helge Refsum

  3. The Norwegian Medicines Agency, Oslo, Norway

    Kristin Kvande

  4. Department of Research & Development in Psychiatry, Akershus University Hospital and University of Oslo, Oslo, Norway

    Lars Tanum

Authors
  1. Gudrun Høiseth
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  2. Kari Midtbø Kristiansen
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  3. Kristin Kvande
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  4. Lars Tanum
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  5. Bernhard Lorentzen
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  6. Helge Refsum
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Correspondence to Gudrun Høiseth.

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Høiseth, G., Kristiansen, K.M., Kvande, K. et al. Benzodiazepines in Geriatric Psychiatry. Drugs Aging 30, 113–118 (2013). https://doi.org/10.1007/s40266-012-0045-9

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  • DOI: https://doi.org/10.1007/s40266-012-0045-9

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