Lorazepam disorders

Benzodiazepines, ie, the hiU BZR agonists, are prescribed for anxiety, insomnia, sedation, myorelaxation, and as anticonvulsants (97). Those benzodiazepines most commonly prescribed for the treatment of anxiety disorders are lorazepam (19), alprazolam (20), diazepam (21), bromazepam (22), chlorazepate (23), and oxazepam (24). These dmgs together represent about 70% of total... 

Medical use of benzodiazepines has been declining. Prescribing trends show an overall decline in the number of all benzodiazepine prescriptions written, with a market shift to increased prescribing of short elimination half-life agents (lorazepam, alprazolam), compared with long-elimination half-life agents (diazepam, chlordiazepoxide) (Ciraulo et al. 2004). In 2001, alprazolam was the most widely prescribed benzodiazepine (Ciraulo et al. 2004), and it also was the most widely prescribed psychiatric medication in that year for mood and anxiety disorders (Stahl 2002). 

Table 32.1 describes 30 persons who have been observed to use one of four available therapeutic compounds for the treatment of one of three possible disorders. The four compounds in this measurement table are the benzodiazepine tranquillizers Clonazepam (C), Diazepam (D), Lorazepam (L) and Triazolam (T). The three disorders are anxiety (A), epilepsy (E) and sleep disturbance (S). In this example, both measurements (compounds and disorders) are defined on nominal scales. Measurements can also be defined on ordinal scales, or on interval and ratio scales in which case they need to be subdivided in discrete and non-overlapping categories. 

The two plots can be superimposed into a biplot as shown in Fig. 32.7. Such a biplot reveals the correspondences between the rows and columns of the contingency table. The compound Triazolam is specific for the treatment of sleep disturbances. Anxiety is treated preferentially by both Lorazepam and Diazepam. The latter is also used for treating epilepsy. Clonazepam is specifically used with epilepsy. Note that distances between compounds and disorders are not to be considered. This would be a serious error of interpretation. A positive correspondence between a compound and a disorder is evidenced by relatively large distances from the origin and a common orientation (e.g. sleep disturbance and Triazolam). A negative correspondence is manifest in the case of relatively large distances from the origin and opposite orientations (e.g. sleep disturbance and Diazepam). 

Delle Chiaie, R., Pancheri, P., Casacchia, M., Stratta, P., Kotzalidis, G.D. and Zibellini, M. (1995) Assessment of the efficacy of buspirone in patients affected by generalized anxiety disorder, shifting to buspirone from prior treatment with lorazepam a placebo-controlled, doubleblind study. Journal of Clinical Psychopharmacology, 15,... 

Lorazepam Ativan Oral, IV, IM Intermediate 1-10 Anxiety disorders, alcohol withdrawal, insomnia... 

Benzodiazepines. Benzodiazepines have not been well studied in patients with Clnster B personality disorders however, they do appear to be used on a relatively common basis. There are two scenarios in which benzodiazepines have been used to treat BPD. First, they have been used on an as-needed basis in the inpatient setting to manage severe agitation and aggression. Lorazepam (Ativan) is often preferred because it can be administered either orally or by injection. Usually, 0.5-2mg of lorazepam can help to cahn an agitated patient with BPD. This can then be repeated as needed every 2-A hours, though care should be taken not to overly sedate the patient. 

All benzodiazepines are indicated in obsessive compulsive disorders. Diazepam and lorazepam are effective in status epilepticus, whereas chlordiazepoxide is indicated in alcohol withdrawal. 

Anxiety For the management of anxiety disorders or for the short-term relief of the symptoms of anxiety (anxiety associated with depression is also responsive) (alprazolam immediate-release and intensol, clorazepate, chlordiazepoxide, diazepam, lorazepam, oxazepam) for the management of anxiety, tension, agitation, and irritability in older patients (oxazepam). 

Ceulemans DLS, Floppenbrouwers MLJA, Gelders YG, et al The influence of ritanserin, a serotonergic antagonist, in anxiety disorders a double-blind placebo-controlled study versus lorazepam. Pharmacopsychiatry 8 303-305, 1985... 

Fieve RR, Platman SR, Plutchik RR The use of lithium in affective disorders, I acute endogenous depression. Am J Psychiatry 125 79-83, 1968 Fieve RR, Kumbaraci T, Dunner DL Lithium prophylaxis of depression in bipolar I, bipolar II, and unipolar patients. Am J Psychiatry 133 925-930, 1976 File SE Rapid development of tolerance to the sedative effects of lorazepam and triazolam in rats. Psychopharmacology 73 240-245, 1981... 

Benzodiazepines are highly effective anxiolytics and sedatives. They also have muscle relaxant, amnestic, and anticonvulsant properties. Benzodiazepines effectively treat both acute and chronic generalized anxiety and panic disorder. The high-potency benzodiazepines alprazolam and clonazepam have received more attention as antipanic agents, but double-blind studies also have confirmed the efficacy of diazepam and lorazepam in the treatment of panic disorder. Although only a few benzodiazepines are specifically approved by the... 

Catatonia. Catatonia is a syndrome that can present as a symptom of several disorders. A large number of case reports have found that BZDs are effective in the treatment of catatonia. Specifically, lorazepam, clonazepam, and diazepam have been reported to induce temporary remission of catatonic symptoms (352, 353, 354,... 

BZDs may exacerbate depression and possibly increase suicide risk. Case reports and clinical trials also indicate that BZD treatment of generalized anxiety and panic may result in emergence of depression (215, 216, 217, 218, 219, 220, 221, 222, 223, 224, 225 and 226). In some of these reports, depression is ill-defined, but in others, it met DSM-III criteria for a major depressive disorder, requiring treatment with an antidepressant ( 225, 226). Depression has been reported with a variety of BZDs (alprazolam, bromazepam, clonazepam, diazepam, lorazepam), but there is no evidence that one is more likely than another to cause or aggravate depressive illness. 

Most physicians felt these symptoms were a reflection of the patient s anxiety disorder and not a manifestation of dependence. Their opinions were reinforced when resumption of lorazepam therapy resulted in symptom amelioration, suggesting recontrol of the patient s anxiety disorder. Rarely were these patients considered dependent, mainly because they had not escalated lorazepam dosage, or manifested any signs or symptoms of drug-seeking behavior. They appeared to be typical medical users of prescribed medication. 

Charney DS, Woods SW, Goodman WK, et al. The efficacy of lorazepam in panic disorders. Presented at the Annual Meeting of the American Psychiatric Association, Chicago, May 1987. 

Schweizer E, Fox I, Case WG, Rickels K. Alprazolam versus lorazepam in the treatment of panic disorder. Presented at the Annual NCDEU Meeting, Key Biscayne, Florida, May 1987. 

Antipsychotic drugs are also indicated for schizoaffective disorders, which share characteristics of both schizophrenia and affective disorders. No fundamental difference between these two diagnoses has been reliably demonstrated. They are part of a continuum with bipolar psychotic disorder. The psychotic aspects of the illness require treatment with antipsychotic drugs, which may be used with other drugs such as antidepressants, lithium, or valproic acid. The manic phase in bipolar affective disorder often requires treatment with antipsychotic agents, although lithium or valproic acid supplemented with high-potency benzodiazepines (eg, lorazepam or clonazepam) may suffice in milder cases. Recent controlled trials support the efficacy of monotherapy with atypical antipsychotics in the acute phase (up to 4 weeks) of mania, and olanzapine and quetiapine has been approved for this indication. 

High-potency benzodiazepines (alprazolam, clonazepam) generally are more effective in panic disorder than low-potency benzodiazepines (diazepam, lorazepam, etc.). Although less research has been done on the low-potency benzodiazepines, it is generally accepted that they frequently result in sedation prior to adequately relieving panic attacks. The reader is referred to the discussion of benzodiazepines in Chapter 8 for a detailed overview of mechanism of action. A critique of the issues of benzodiazepine dependence and appropriate use is given in Chapter 13-... 

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