versión impresa ISSN 0185-3325
FRESAN, Ana; MINAYA, Omar; CORTES-LOPEZ, Jorge Luis y UGALDE, Oscar. Demographic and clinical features related to benzodiazepine dependence in psychiatric patients. Salud Ment [online]. 2011, vol.34, n.2, pp. 103-109. ISSN 0185-3325.
Introduction Inappropriate use and dependence to prescription drugs has been considered as a growing health problem in recent years. It has been recognized that benzodiazepines (BZD) are one of the most commonly prescribed drugs due to their rapid therapeutic effect, high efficacy and favorable side effect profile when compared to other psychotropic medications. Despite the desirable therapeutic actions of BZD, mainly for the treatment of anxiety disorders, concerns about the dependence producing or addictive nature of these drugs have been expressed for decades. BZD dependence, unlike dependence to other substances, is a condition generally circumscribed to a therapeutic framework. It is well known that BZD use generally starts legitimately by a medical prescription for the treatment of anxiety symptoms or insomnia. Persons with psychiatric disorders are at a greater health risk for BZD dependence than other groups as BZD are highly used for the treatment of several psychiatric symptoms. BZD dependence in these patients may have a negative clinical impact in the medical treatment of the primary psychiatric disorder and may also affect patients' quality of life as the BZD dependence is added as a comorbid diagnosis that also requires clinical management. In this way, the need for clinical useful information for the prevention or early detection of BZD dependence emerges. Although inconsistent associations have been encountered in the scientific literature, some sociodemographic variables, such as gender and level of education, as well as the characteristics of BZD use, have been identified as potential risk factors for the development of BZD dependence. This information is of easy access for the mental health professional during the initial or subsequent clinical interview with patients, and if significant findings are obtained in Mexican psychiatric patients, these variables may become useful clinical tools for a closer follow-up of those patients with high risk of presenting BZD dependence. Objective To determine sociodemographic variables and characteristics of BZD use that may be risk factors for the development of BZD dependence in a sample of psychiatric patients from Mexico City. Method Subjects. Subjects were consecutively recruited at the outpatient services of the Instituto Nacional de Psiquiatría Ramón de la Fuente (INPRF) in Mexico City. All patients with BZD consumptions were included indistinctly of their psychiatric diagnosis of attendance in the institution. All patients gave their written informed consent after receiving a comprehensive explanation of the nature of the study. The Ethics Review Board of the INPRF approved the study. Assessment procedure Psychiatric diagnoses were made with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and BZD dependence was determined with an adapted version of the substance dependence section of the SCID-I designed to assess BZD use exclusively. Sociodemographic features and characteristics of BZD use were registered in a previously designed format and information was obtained by a personal interview with each patient and main caregiver. The Benzodiazepine Dependence Questionnaire in its Mexican version (BDEPQ-MX) is a self-administered questionnaire used to assess the subjective experience with BZD in the last month in three main areas: perceived dependence, BZD pleasant effects and perceived need of BZD consumption. Results The sample comprised 150 psychiatric patients. A total of 70.0% (n=105) were women and 30.0% (n = 45) were men. Their mean age was 45.9±14.1 with a mean educational level of 11.6±3.9 years. Diagnoses of the sample were mainly anxiety disorders (n = 76, 50.7%) and affective disorders (38.0%). According to the SCID-I, a total of 73 (48.7%) patients met the diagnostic criteria for BZD dependence. Sixty seven percent of the men included in the study reported BZD dependence in contrast to 41.0% of the women. Also, patients with BZD dependence exhibited a higher level of education and a longer time consumption of BZD. A longer duration of BZD consumptions was the main indicator for BZD dependence conferring a risk 10.4 higher for its development. Male gender and psychiatric diagnoses different to anxiety and affective disorders were also significant predictors for BZD dependence. Discussion Numerous potential risk factors relating to BZD dependence have been found and our results support the influence of sociodemographic features and characteristics of BZD consumption for dependence development in a Mexican sample of psychiatric patients. In general, it has been described that men are more prone to substance abuse and dependence and our results showed this same pattern. Nevertheless, this result must be replicated in future studies as for BZD dependence men and women may exhibit similar patterns of consumption and dependence. High rates of BZD prescription, coupled with an elevated risk of substance dependence in diagnoses different to anxiety disorders, highlight the need for a careful review of the costs-benefits of BZD use for the treatment of anxiety emergent symptoms, as other additional medications with lower dependence effect can be used to minimize the potential risk of BZD dependence in these patients. One of the biggest controversies surrounding BZD use has been its long-term use, which has been reported and replicated in our studies as the main indicator for BZD dependence development. Treatment with BZD may be useful for short-term periods of time, and specific goals and objectives of their therapeutic benefits must be established since the initial treatment plans for each patient. The clinical relevance of the present study relies in standing out the high prevalence of BZD dependence found in patients treated with BZD and had not been treated for this comorbid condition. It is important to promote in the mental health professional attendance team strategies for the prevention and early detection of BZD dependence in psychiatric patients.
Palabras llave : Dependence; benzodiazepines; predictors; gender; long-term use of benzodiazepines.