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苯二氮䓬類藥物戒斷症候群

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苯二氮䓬類藥物戒斷症候群又稱苯二氮卓戒斷綜合症（英語：Benzodiazepine withdrawal syndrome），通常縮寫為苯並戒斷（benzo withdrawal）或BZD戒斷（BZD withdrawal） ，是指服用苯二氮䓬類藥物（可能因醫療原因或娛樂性原因用藥）並產生生理依賴性後，減少用量或停藥時產生的藥物戒斷徵狀。覓藥行為或按處方服藥均可能導致生理依賴性與藥物成癮（或二者之一）以及因此產生的戒斷徵狀。某些徵狀可能持續數年。苯二氮䓬類藥物戒斷症候群的顯著特徵徵狀包括：睡眠障礙、易怒、緊張焦慮、恐慌發作、手顫、發抖、出汗、難以集中精神、意識混亂和認知障礙、記憶減退、噁心乾嘔、體重下降、心悸、頭痛、肌肉疼痛僵硬、知覺變化、幻覺、癲癇發作、思覺失調[1]以及自殺[2][3]。此外，這些徵狀可能時好時壞，每日或每周的嚴重程度不一，而不是持續穩定好轉。[4]

苯二氮䓬類藥物戒斷症候群
類型戒斷狀態[*]、苯二氮䓬類藥物依賴性
分類和外部資源
醫學專科精神病學
ICD-10F13.3（持續用藥後）
[編輯此條目的維基數據]

苯二氮䓬類戒斷徵狀可能很嚴重，徵狀複雜且常常長期持續。[5][6]長期使用苯二氮䓬類（即每日用藥，持續至少三個月）[7]可能有更高的藥物依賴風險[8]，亦可能造成用量增加、藥效降低、增加事故和摔倒的概率（尤其是老年人），[9]還可能與認知、[10]神經系統和智力損傷有關[11]。因此不宜長期使用苯二氮䓬類藥物。[8]將苯二氮䓬類藥物作為短效安眠藥使用，在入睡時可能有效，但可能因戒斷反應而導致後半段睡眠質量不佳。[12]儘管如此，對於長期服用苯二氮䓬類藥物者，不應違背其意願強迫停藥。[5]

苯二氮䓬類戒斷可能有重症反應，甚至產生癲癇發作等危及生命的徵狀，[13]尤其是突然戒斷或減量過快的大劑量或長期用藥者。[5]然而逐步減量或相對用量較少的短期用藥者亦可能出現重症戒斷反應，[14]在動物模型中甚至曾有單次大劑量用藥後戒斷出現重症反應。[15][16]少數人會出現遷延性戒斷徵狀（英語：post-acute-withdrawal syndrome），徵狀可能在戒斷後數月甚至數年內持續，維持在亞急性狀態。緩慢而逐步的減少藥物用量能使遷延性戒斷徵狀的出現概率儘可能降低。[17]

長期使用苯二氮䓬類藥物會導致神經適應，降低藥物效果，造成耐受和依賴。[18]即使是持續服用治療劑量期間，長期使用苯二氮䓬類藥物亦可能引起類似戒斷反應的徵狀，尤其是在服藥間隔期。[19]停藥或減少用量後，用藥者即會出現藥物戒斷徵狀，直至其生理適應恢復。[20]這些反跳徵狀（英語：Rebound effect）可能與最初服藥前的病症相同，亦可能是戒斷症候群的一部分。[21]在重症病例中，戒斷反應可能會惡化，或與嚴重的精神疾病相似，如狂躁、精神分裂症，尤其在大劑量用藥者中還會出現癲癇重積狀態。[22]若不能正確診斷出戒斷症候群，可能會誤診為服藥前的疾病復發而需要繼續用藥，導致戒斷失敗、重新開始用藥，而重新用藥往往比之前的劑量更大。[22]

提高戒斷成功率的方法包括：提升對戒斷反應的意識，針對用藥者的戒斷反應嚴重程度而制定個人化的逐步戒斷方法，以及增加其他替代方法輔助，如使用藥者安心、參加苯二氮䓬類藥物戒斷互助小組。這些方法都能有效提高戒斷的成功率。[23][24]

徵狀和體徵

編輯
 
地西泮，其2毫克與5毫克片劑常用於治療苯二氮䓬類戒斷反應[25]
 
氯二氮平（英語：Chlordiazepoxide），其5毫克膠囊劑有時可作為地西泮的替代藥物，用於治療苯二氮䓬類戒斷反應。氯二氮平與地西泮都有較長的消除半衰期和長效活性代謝產物

苯二氮䓬類、巴比妥類等鎮靜安眠藥物或酒精成癮者在停用後會產生嚴重的戒斷反應徵狀。《臨床成人精神醫學手冊》顯示這些戒斷徵狀比鴉片類藥物的戒斷徵狀更嚴重、危害更大。[26]使用者在停藥時一般甚少獲得相關建議和支持。[27]一些戒斷徵狀與用藥治療之前的病症相同，[21]可能徵狀嚴重或長期持續。半衰期較長的苯二氮䓬類藥物可能在停用長達三周之後才會出現戒斷反應，而半衰期較短的藥物則較早出現戒斷反應，一般在停用24-48小時後即會出現。[28]不同劑量用藥者的戒斷徵狀種類可能沒有重大差異，但大劑量用藥者的徵狀嚴重程度往往更高。[29]

在用藥量減少時，服藥者可能會首次出現戒斷反應，包括失眠、焦慮、痛苦、體重下降、暈眩、夜汗、肌肉抽搐、恐慌發作、抑鬱、失實症、偏執等。這些徵狀更常見於短效苯二氮䓬類停藥時，例如三唑侖等藥物。[22][30]日間徵狀可能在夜間用藥給藥數日至數周后出現，[31][32]亦可能出現於佐匹克隆等Z藥物使用者。[33]即使是間歇服用苯二氮䓬類，[34]亦可能在戒斷後出現失眠徵狀反彈，可能比服藥前更加嚴重。[35][36]

逐步或突然減少藥量可能出現下列徵狀：

迅速停藥可能會引發更嚴重的徵狀：

參考來源

編輯
  1. ^ 1.0 1.1 1.2 1.3 1.4 Petursson, H. The benzodiazepine withdrawal syndrome. Addiction. 1994, 89 (11): 1455–9. PMID 7841856. doi:10.1111/j.1360-0443.1994.tb03743.x. 
  2. ^ 2.0 2.1 2.2 Colvin, Rod. Overcoming Prescription Drug Addiction: A Guide to Coping and Understanding 3. United States of America: Addicus Books. 26 August 2008: 74–76. ISBN 978-1-886039-88-9. I have treated ten thousand patients for alcohol and drug problems and have detoxed approximately 1,500 patients for benzodiazepines – the detox for the benzodiazepines is one of the hardest detoxes we do. It can take an extremely long time, about half the length of time they have been addicted – the ongoing relentless withdrawals can be so incapacitating it can cause total destruction to one’s life – marriages break up, businesses are lost, bankruptcy, hospitalization, and of course suicide is probably the most single serious side effect. 
  3. ^ 3.0 3.1 3.2 Dodds TJ. Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature. Primary Care Companion for CNS Disorders. 2017, 19 (2). PMID 28257172. doi:10.4088/PCC.16r02037. 
  4. ^ C. Heather Ashton DM. Chapter III: Benzodiazepine withdrawal symptoms, acute & protracted. Institute of Neuroscience, Newcastle University. [29 April 2013]. （原始內容存檔於2019-04-04）. Benzodiazepines : How they work and how to withdraw 
  5. ^ 5.0 5.1 5.2 5.3 Professor Heather Ashton. Benzodiazepines: How They Work and How to Withdraw. 2002 [2018-04-02]. （原始內容存檔於2012-10-18）. 
  6. ^ O'Connor, RD. Benzodiazepine dependence--a treatment perspective and an advocacy for control. NIDA research monograph. 1993, 131: 266–9. PMID 8105385. 
  7. ^ Voshaar, R. C. O.; Couvée, JE; Van Balkom, AJ; Mulder, PG; Zitman, FG. Strategies for discontinuing long-term benzodiazepine use: Meta-analysis. British Journal of Psychiatry. 2006, 189 (3): 213–20. PMID 16946355. doi:10.1192/bjp.189.3.213. 
  8. ^ 8.0 8.1 Nutt, David. Benzodiazepine dependence in the clinic: Reason for anxiety?. Trends in Pharmacological Sciences. 1986, 7: 457–60. doi:10.1016/0165-6147(86)90420-7. 
  9. ^ De Gier, N.; Gorgels, W.; Lucassen, P.; Oude Voshaar, R.; Mulder, J.; Zitman, F. Discontinuation of long-term benzodiazepine use: 10-year follow-up. Family Practice. 2010, 28 (3): 253–9. PMID 21193495. doi:10.1093/fampra/cmq113. 
  10. ^ Authier, Nicolas; Boucher, Alexandra; Lamaison, Dominique; Llorca, Pierre-Michel; Descotes, Jacques; Eschalier, Alain. Second Meeting of the French CEIP (Centres d'Évaluation et d'Information sur la Pharmacodépendance). Part II: Benzodiazepine Withdrawal. Thérapie. 2009, 64 (6): 365–70. PMID 20025839. doi:10.2515/therapie/2009051. 
  11. ^ Heberlein, A.; Bleich, S.; Kornhuber, J.; Hillemacher, T. Benzodiazepin-Abhängigkeit: Ursachen und Behandlungsmöglichkeiten [Benzodiazepine Dependence: Causalities and Treatment Options]. Fortschritte der Neurologie · Psychiatrie. 2008, 77 (1): 7–15. PMID 19101875. doi:10.1055/s-0028-1100831 （德語）. 
  12. ^ Lee-chiong, Teofilo. Sleep Medicine: Essentials and Review. Oxford University Press, USA. 24 April 2008: 468. ISBN 0-19-530659-7. 
  13. ^ Evans, Katie; Sullivan, Michael J. Withdrawal and Medical Issues. Dual Diagnosis: Counseling the Mentally Ill Substance Abuser 2nd. Guilford Press. 2001: 52–3 [2018-04-02]. ISBN 978-1-57230-446-8. （原始內容存檔於2018-05-03）. 
  14. ^ Lader, M. Long-term anxiolytic therapy: The issue of drug withdrawal. The Journal of Clinical Psychiatry. 1987,. 48 Suppl: 12–6. PMID 2891684. 
  15. ^ Boisse, NR; Periana, RM; Guarino, JJ; Kruger, HS; Samoriski, GM. Pharmacologic characterization of acute chlordiazepoxide dependence in the rat. Journal of Pharmacology and Experimental Therapeutics. 1986, 239 (3): 775–83. PMID 3098961. 
  16. ^ Boisse, NR; Periana, RM; Guarino, JJ; Kruger, HS. Acute chlordiazepoxide dependence in the rat: Comparisons to chronic. NIDA research monograph. 1986, 67: 197–201. PMID 3092067. 
  17. ^ 17.0 17.1 Professor Heather Ashton. Protracted Withdrawal Symptoms From Benzodiazepines. Comprehensive Handbook of Drug & Alcohol Addiction. 2004 [2018-04-02]. （原始內容存檔於2020-09-28）.  引用錯誤：帶有name屬性「pwsfb」的<ref>標籤用不同內容定義了多次
  18. ^ Allison, C; Pratt, J.A. Neuroadaptive processes in GABAergic and glutamatergic systems in benzodiazepine dependence. Pharmacology & Therapeutics. 2003, 98 (2): 171–95. PMID 12725868. doi:10.1016/S0163-7258(03)00029-9. 
  19. ^ Herman, JB; Brotman, AW; Rosenbaum, JF. Rebound anxiety in panic disorder patients treated with shorter-acting benzodiazepines. The Journal of Clinical Psychiatry. 1987,. 48 Suppl: 22–8. PMID 2889722. 
  20. ^ Allgulander, C; Bandelow, B; Hollander, E; Montgomery, SA; Nutt, DJ; Okasha, A; Pollack, MH; Stein, DJ; Swinson, RP; World Council Of, Anxiety. WCA recommendations for the long-term treatment of generalized anxiety disorder. CNS Spectrums. 2003, 8 (8 Suppl 1): 53–61. PMID 14767398. 
  21. ^ 21.0 21.1 Salzman, Carl. Benzodiazepine treatment of panic and agoraphobic symptoms: Use, dependence, toxicity, abuse. Journal of Psychiatric Research. 1993, 27: 97–110. PMID 7908335. doi:10.1016/0022-3956(93)90021-S. 
  22. ^ 22.0 22.1 22.2 22.3 Gabbard, Glen O. Gabbard's Treatments of Psychiatric Disorders, Fourth Edition (Treatments of Psychiatric Disorders). American Psychiatric Publishing. 15 May 2007: 209–211. ISBN 1-58562-216-8. 
  23. ^ Onyett, SR. The benzodiazepine withdrawal syndrome and its management. The Journal of the Royal College of General Practitioners. 1989, 39 (321): 160–3. PMC 1711840  . PMID 2576073. 
  24. ^ 24.0 24.1 24.2 Ashton, Heather. Protracted withdrawal syndromes from benzodiazepines. Journal of Substance Abuse Treatment. 1991, 8 (1–2): 19–28. PMID 1675688. doi:10.1016/0740-5472(91)90023-4. 
  25. ^ 25.0 25.1 25.2 25.3 Soyka M. Treatment of Benzodiazepine Dependence. The New England Journal of Medicine. 2017, 376 (12): 1147–1157. PMID 28328330. doi:10.1056/NEJMra1611832. 
  26. ^ Lindsay, S. J. E. The Handbook of Clinical Adult Psychology. Psychology Press. 1994: 363 [2018-04-05]. ISBN 9780415072168. （原始內容存檔於2019-09-05）. 
  27. ^ Authier, N.; Balayssac, D.; Sautereau, M.; Zangarelli, A.; Courty, P.; Somogyi, A.A.; Vennat, B.; Llorca, P.-M.; Eschalier, A. Benzodiazepine dependence: Focus on withdrawal syndrome. Annales pharmaceutiques françaises. 2009, 67 (6): 408–13. PMID 19900604. doi:10.1016/j.pharma.2009.07.001. 
  28. ^ Committee on Safety of Medicines. Hypnotics and anxiolytics. British National Formulary. 2007 [17 September 2007].  
  29. ^ Murphy, S. M.; Tyrer, P. A double-blind comparison of the effects of gradual withdrawal of lorazepam, diazepam and bromazepam in benzodiazepine dependence. British Journal of Psychiatry. 1991, 158 (4): 511–6. PMID 1675901. doi:10.1192/bjp.158.4.511. 
  30. ^ Adam, Kirstine; Oswald, I. Can a Rapidly-eliminated Hypnotic Cause Daytime Anxiety?. Pharmacopsychiatry. 2008, 22 (3): 115–9. PMID 2748714. doi:10.1055/s-2007-1014592. 
  31. ^ Scharf, Martin B; Kales, Judith A; Bixler, EO; Jacoby, JA; Schweitzer, PK. Lorazepam—Efficacy, side effects, and rebound phenomena. Clinical Pharmacology & Therapeutics. 1982, 31 (2): 175–9. PMID 6120058. doi:10.1038/clpt.1982.27. 
  32. ^ Walsh, James K; Schweitzer, Paula K; Parwatikar, Sadashiv. Effects of lorazepam and its withdrawal on sleep, performance, and subjective state. Clinical Pharmacology & Therapeutics. 1983, 34 (4): 496–500. PMID 6617072. doi:10.1038/clpt.1983.203. 
  33. ^ Fontaine, Réjean; Beaudry, Paul; Le Morvan, Patrick LE; Beauclair, Linda; Chouinard, GUY. Zopiclone and Triazolam in Insomnia Associated with Generalized Anxiety Disorder. International Clinical Psychopharmacology. 1990, 5 (3): 173–83. PMID 2230061. doi:10.1097/00004850-199007000-00002. 
  34. ^ Kales, Anthony; Manfredi, Rocco L; Vgontzas, Alexandras N; Bixler, Edward O; Vela-Bueno, Antonio; Fee, Eric C. Rebound insomnia after only brief and intermittent use of rapidly eliminated benzodiazepines. Clinical Pharmacology & Therapeutics. 1991, 49 (4): 468–76. PMID 2015735. doi:10.1038/clpt.1991.55. 
  35. ^ Kales, Anthony; Bixler, Edward O.; Soldatos, Constantin R.; Jacoby, Judith A.; Kales, Joyce D. Lorazepam: Effects on Sleep and Withdrawal Phenomena. Pharmacology. 1986, 32 (3): 121–30. PMID 3960963. doi:10.1159/000138160. 
  36. ^ Bonnet, M H; Arand, D L. The use of lorazepam TID for chronic insomnia. International Clinical Psychopharmacology. 1999, 14 (2): 81–9. PMID 10220122. doi:10.1097/00004850-199903000-00004. 
  37. ^ 37.00 37.01 37.02 37.03 37.04 37.05 37.06 37.07 37.08 37.09 37.10 37.11 37.12 37.13 37.14 37.15 Saxon, L.; Hjemdahl, P.; Hiltunen, A. J.; Borg, S. Effects of flumazenil in the treatment of benzodiazepine withdrawal - a double-blind pilot study. Psychopharmacology. 1997, 131 (2): 153–60. PMID 9201803. doi:10.1007/s002130050278. 
  38. ^ Terao, T; Yoshimura, R; Terao, M; Abe, K. Depersonalization following nitrazepam withdrawal. Biological Psychiatry. 1992, 31 (2): 212–3. PMID 1737083. doi:10.1016/0006-3223(92)90209-I. 
  39. ^ Lader, Malcolm. Anxiety or depression during withdrawal of hypnotic treatments. Journal of Psychosomatic Research. 1994, 38: 113–23; discussion 118–23. PMID 7799243. doi:10.1016/0022-3999(94)90142-2. 
  40. ^ 40.0 40.1 40.2 40.3 Mintzer, M. Z.; Stoller, K. B.; Griffiths, R. R. A controlled study of flumazenil-precipitated withdrawal in chronic low-dose benzodiazepine users. Psychopharmacology. 1999, 147 (2): 200–9. PMID 10591888. doi:10.1007/s002130051161. 
  41. ^ Mendelson, WB; Weingartner, H; Greenblatt, DJ; Garnett, D; Gillin, JC. A clinical study of flurazepam. Sleep. 1982, 5 (4): 350–60. PMID 6761826. 
  42. ^ Schöpf, J. Withdrawal Phenomena after Long-term Administration of Benzodiazepines a Review of Recent Investigations. Pharmacopsychiatry. 2008, 16 (1): 1–8. PMID 6131447. doi:10.1055/s-2007-1017439. 
  43. ^ Mintzer, Miriam Z.; Griffiths, Roland R. Flumazenil-precipitated withdrawal in healthy volunteers following repeated diazepam exposure. Psychopharmacology. 2004, 178 (2–3): 259–67. PMID 15452683. doi:10.1007/s00213-004-2009-1. 
  44. ^ Biswas, AK; Feldman, BL; Davis, DH; Zintz, EA. Myocardial ischemia as a result of severe benzodiazepine and opioid withdrawal. Clinical Toxicology. 2005, 43 (3): 207–9. PMID 15902797. doi:10.1081/clt-200053099. 
  45. ^ 45.0 45.1 45.2 45.3 45.4 Bismuth, C; Le Bellec, M; Dally, S; Lagier, G. Benzodiazepine physical dependence. 6 cases (author's transl). La Nouvelle presse medicale. 1980, 9 (28): 1941–5. PMID 6106922. 
  46. ^ 46.0 46.1 Loeb, P; Adnet, P; Boittiaux, P; Forget, AP; Mille, FX. Sevrage en benzodiazépines révélé par un syndrome douloureux abdominal pseudochirurgical [Benzodiazepine withdrawal masquerading as surgical abdominal syndrome]. Annales Françaises d'Anesthésie et de Réanimation. 1997, 16 (5): 521–2. doi:10.1016/S0750-7658(97)83345-X （法語）. 
  47. ^ BENZODIAZEPINE WITHDRAWAL SYMPTOMS, ACUTE AND PROTRACTED. Benzo.org.uk. [2018-04-05]. （原始內容存檔於2019-04-04）. 
  48. ^ 48.0 48.1 48.2 48.3 48.4 Pelissolo, A; Bisserbe, JC. Dependence on benzodiazepines. Clinical and biological aspects. L'Encéphale. 1994, 20 (2): 147–57. PMID 7914165. 
  49. ^ Pecknold, J.C. Discontinuation reactions to alprazolam in panic disorder. Journal of Psychiatric Research. 1993, 27: 155–170. doi:10.1016/0022-3956(93)90025-W. 
  50. ^ Kliniska Färdigheter: Informationsutbytet Mellan Patient Och Läkare, LINDGREN, STEFAN, ISBN 91-44-37271-X (Swedish)[頁碼請求]
  51. ^ Drummond, Lynne M.; Matthews, Helen P. SINGLE CASE STUDY Obsessive-Compulsive Disorder Occurring as a Complication in Benzodiazepine Withdrawal. Journal of Nervous and Mental Disease. 1988, 176 (11): 688–91. PMID 3183654. doi:10.1097/00005053-198811000-00008. 
  52. ^ Matthews, HP; Drummond, LM. Obsessive-compulsive disorder--a complication of benzodiazepine withdrawal. British Journal of Psychiatry. 1987, 150: 272. PMID 3651695. doi:10.1192/s0007125000122810. 
  53. ^ Shader, RI; Greenblatt, DJ. The use of benzodiazepines in clinical practice. British Journal of Clinical Pharmacology. 1981,. 11 Suppl 1 (Suppl 1): 5S–9S. PMC 1401641  . PMID 6133535. doi:10.1111/j.1365-2125.1981.tb01832.x. 
  54. ^ Pagel, J. F.; Parnes, Bennett L. Medications for the Treatment of Sleep Disorders. Primary Care Companion to the Journal of Clinical Psychiatry. 2001, 3 (3): 118–125. PMC 181172  . PMID 15014609. doi:10.4088/PCC.v03n0303. 
  55. ^ Van Engelen, BG; Gimbrere, JS; Booy, LH. Benzodiazepine withdrawal reaction in two children following discontinuation of sedation with midazolam. Annals of Pharmacotherapy. 1993, 27 (5): 579–81. PMID 8347907. doi:10.1177/106002809302700509. 
  56. ^ Beeley, L. Benzodiazepines and tinnitus. BMJ. 1991, 302 (6790): 1465. doi:10.1136/bmj.302.6790.1465. 
  57. ^ Mellor, CS; Jain, VK. Diazepam withdrawal syndrome: Its prolonged and changing nature. Canadian Medical Association Journal. 1982, 127 (11): 1093–6. PMC 1862031  . PMID 7139456. 
  58. ^ Olajide, Dele; Lader, Malcolm. Depression following withdrawal from long-term benzodiazepine use: A report of four cases. Psychological Medicine. 2009, 14 (4): 937–40. PMID 6152745. doi:10.1017/S0033291700019899. 
  59. ^ Rosebush, Patricia I.; Mazurek, Michael F. Catatonia After Benzodiazepine Withdrawal. Journal of Clinical Psychopharmacology. 1996, 16 (4): 315–9. PMID 8835707. doi:10.1097/00004714-199608000-00007. 
  60. ^ Deuschle, M.F.; Lederbogen, F. Benzodiazepine Withdrawal - Induced Catatonia. Pharmacopsychiatry. 2001, 34 (1): 41–2. PMID 11229621. doi:10.1055/s-2001-15188. 
  61. ^ Kanemoto, Kousuke; Miyamoto, Toshio; Abe, Ryuji. Ictal catatonia as a manifestation of de novo absence status epilepticus following benzodiazepine withdrawal. Seizure. 1999, 8 (6): 364–6. PMID 10512781. doi:10.1053/seiz.1999.0309. 
  62. ^ Metten, Pamela; Crabbe, John C. Genetic Determinants of Severity of Acute Withdrawal from Diazepam in Mice. Pharmacology Biochemistry and Behavior. 1999, 63 (3): 473–9. PMID 10418790. doi:10.1016/S0091-3057(99)00017-9. 
  63. ^ Haque, W; Watson, DJ; Bryant, SG. Death following suspected alprazolam withdrawal seizures: A case report. Texas Medicine. Vol. 86 no. 1. 1990: 44–7. PMID 2300914. 
  64. ^ De Bard, ML. Diazepam withdrawal syndrome: A case with psychosis, seizure, and coma. American Journal of Psychiatry. 1979, 136 (1): 104–5. PMID 103443. doi:10.1176/ajp.136.1.104. 
  65. ^ Provini, F.; Cortelli, P.; Montagna, P.; Gambetti, P.; Lugaresi, E. Fatal insomnia and agrypnia excitata: Sleep and the limbic system. Revue Neurologique. 2008, 164 (8–9): 692–700. PMID 18805303. doi:10.1016/j.neurol.2007.11.003. 
  66. ^ 66.0 66.1 Berezak, A.; Weber, M.; Hansmann, J.; Tulasne, P.A.; Laporte, B.; Ould Ouali, A. Dépendance physique aux benzodiazépines dans un contexte traumatologique [Benzodiazepine physical dependence in traumatology]. Annales Françaises d'Anesthésie et de Réanimation. 1984, 3 (5): 383–4. doi:10.1016/S0750-7658(84)80078-7 （法語）. 
  67. ^ Turkington, Douglas; Gill, Paul. Mania induced by lorazepam withdrawal: A report of two cases. Journal of Affective Disorders. 1989, 17 (1): 93–5. PMID 2525581. doi:10.1016/0165-0327(89)90028-1. 
  68. ^ Lapierre, YD; Labelle, A. Manic-like reaction induced by lorazepam withdrawal. The Canadian Journal of Psychiatry. 1987, 32 (8): 697–8. PMID 3690487. doi:10.1177/070674378703200812. 
  69. ^ Kawajiri, M; Ohyagi, Y; Furuya, H; Araki, T; Inoue, N; Esaki, S; Yamada, T; Kira, J. A patient with Parkinson's disease complicated by hypothyroidism who developed malignant syndrome after discontinuation of etizolam. Rinsho Shinkeigaku. 2002, 42 (2): 136–9. PMID 12424963. 
  70. ^ Strawn, Jeffrey; Keck Jr, PE; Caroff, SN. Neuroleptic Malignant Syndrome. American Journal of Psychiatry. 2007, 164 (6): 870–6. PMID 17541044. doi:10.1176/ajp.2007.164.6.870. 
  71. ^ Khan, A; Joyce, P; Jones, AV. Benzodiazepine withdrawal syndromes. The New Zealand medical journal. 1980, 92 (665): 94–6 [2018-04-05]. PMID 6107888. （原始內容存檔於2019-12-02）. 
  72. ^ Peh, LH; Mahendran, R. Psychiatric complications of Erimin abuse. Singapore medical journal. 1989, 30 (1): 72–3. PMID 2595393. 
  73. ^ Fruensgaard, K. Withdrawal Psychosis: A Study of 30 Consecutive Cases. Acta Psychiatrica Scandinavica. 1976, 53 (2): 105–18. PMID 3091. doi:10.1111/j.1600-0447.1976.tb00065.x. 
  74. ^ Einarson, A; Selby, P; Koren, G. Abrupt discontinuation of psychotropic drugs during pregnancy: Fear of teratogenic risk and impact of counselling. Journal of Psychiatry & Neuroscience. 2001, 26 (1): 44–8. PMC 1408034  . PMID 11212593. 
  75. ^ Citrome, Leslie; Volavka, Jan. Violent Patients in the Emergency Setting. Psychiatric Clinics of North America. 1999, 22 (4): 789–801. PMID 10623971. doi:10.1016/S0193-953X(05)70126-X. 
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