Disinhibitory reactions to benzodiazepines: A review

This article reviews some of the important aspects of benzodiazepineinduced disinhibitory reactions. Although reactions of this type are relatively rare, they may sometimes manifest themselves in aggressive behavior accompanied by suicidal or homicidal tendencies. It appears that these reactions occ...

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Bibliographic Details
Published inJournal of oral and maxillofacial surgery Vol. 49; no. 5; pp. 519 - 523
Main Authors Van Der Bijl, P., Roelofse, J.A.
Format Journal Article
LanguageEnglish
Published New York, NY Elsevier Inc 01.05.1991
Elsevier
Subjects
Aggression - drug effects
Animals
Benzodiazepines - adverse effects
Benzodiazepines - antagonists & inhibitors
Benzodiazepines - pharmacology
Biological and medical sciences
Flumazenil - pharmacology
Humans
Hypnotics. Sedatives
Medical sciences
Neuropharmacology
Pharmacology. Drug treatments
Psychology. Psychoanalysis. Psychiatry
Psychopharmacology
Human
Secondary effect
Benzodiazepine derivatives
Dentistry
Stomatology
Surgery
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Summary:This article reviews some of the important aspects of benzodiazepineinduced disinhibitory reactions. Although reactions of this type are relatively rare, they may sometimes manifest themselves in aggressive behavior accompanied by suicidal or homicidal tendencies. It appears that these reactions occur more commonly in younger patients, although the elderly (above 65 years) may also be at risk. Many mechanisms have been postulated, but none truly explain how these reactions arise. The concept that central cholinergic mechanisms may play a role, however, remains attractive and stems primarily from physostigmine's ability to successfully reverse this type of reaction. The potential role of the benzodiazepine antagonists, eg, flumazenil, in reversing disinhibitory reactions is also discussed. Apart from patients who previously exhibited poor impulse control, there are no reliable indicators for recognizing potential candidates for this type of reaction. To minimize the occurrence of disinhibitory reactions, some guidelines, which include the avoidance of certain drug combinations, the use of low doses of benzodiazepines, slow incremental intravenous administration, and good rapport with patients, are presented.
ISSN:0278-2391
1531-5053
DOI:10.1016/0278-2391(91)90180-T