Ms. X is an attractive 21 year old final semester engineering student, an active member of her college literary and drama club presented with a 10 day history of excessive cheerfulness, over talkativeness, spending sprees, endless partying, insomnia, and suspicions of being teased and harmed.
She has no past history of medical/ mental illness/ no substance use.
Family history revealed an episodic illness in mother stabilized on lithium.
Cognitive effects of long-term benzodiazepine use: a meta-analysis
Moderate-to-large weighted effect sizes were found for all cognitive domains suggesting that long-term benzodiazepine users were significantly impaired, compared with controls, in all of the areas that were assessed. However, this study has several limitations, one being that it includes a relatively small number of studies.
Neuroimaging studies have found transient changes in the brain after benzodiazepine administration but no brain abnormalities in patients treated long term with benzodiazepines.
Such findings suggest that patients should be advised of potential cognitive effects when treated long term with benzodiazepines, although they should also be informed that the impact of such effects may be insignificant in the daily functioning of most patients.
Stewart SA (2005) J Clin Psychiatry, 66 Suppl 2: 9-13
In 1990, the APA task force on BZD’s concluded that BZD are not drugs of abuse though it is common among people actively abusing alcohol, opiates, sedative hypnotics.
Selzman C (1991) Am. J Psychiatry, 148:151-52
In early 1980’s studies indicated that long term administration of BZD at therapeutic doses produce physical dependence. So in 1990’s it was recommended that these agents should (esp. short t 1/2 ) be tapered gradually when discontinuing them
Rosenbaum JR (2005) J. Clin. Psychiatry, 66 Suppl 2: 4-8
By 1999 International group of experts recommended the use of BZD for anxiety disorders even for long periods
BDZ1 (Omega - 1) -preferentially labelled by triazolopyridazines, imidazolopyridine and pyrazoloqinolines. Also, beta carbolines.
BDZ1 rich areas - lamina IV of cerebral cortex, cingulate cortex , globus pallidus, nucleus basalis, substantia nigra pars reticulata, molecular layer of the cerebellum, Amygdaloid nucleus , periaqueductal gray matter, ventral pallidum and inferior colliculus.
Implicated in sleep wakefulness mechanism
BZD-2 receptors (Omega-2) - caudate putamen, olfactory bulb, cerebral cortex, hippocampus and dentategyrus Related to cognitive, memory and psychomotor function. BZD-3(Omega-3) are not directly associated with GABA receptors or with chloride channels . They may regulate the synthesis of neuroactive steroids. BENZODIAZEPINE RECEPTOR