Study Examines Benzodiazepines with Antipsychotics for Aggression

Benzodiazepines are the most widely prescribed drugs in the world, used mainly as anxiolytics and hypnotics. The drug class as a whole is used in many different indications, from schizophrenia to epilepsy. A study in 2008 showed that approximately 5.2% of US adults aged 18 to 80 years used benzodiazepines.

Study results published in International Clinical Psychopharmacology suggest that adding benzodiazepines to antipsychotic medications was previously considered an effective therapy modification, but recent studies indicate otherwise. The authors aimed to clarify if the addition of benzodiazepines reduces the amount of aggression seen in acutely psychotic patients.

These investigators gathered data from 400 patient charts between 2012 to 2014, and analyzed the first 2 weeks of hospitalization. Two groups were defined: those who were only prescribed antipsychotics, and those who were prescribed antipsychotics and benzodiazepines. They compared levels of aggression between the 2 groups to see what effect—if any—benzodiazepines had on aggressive behavior.

The authors’ main conclusion was that the 2 groups presented with no differences in measures of violence, and adding benzodiazepines to address aggression was inappropriate. One of the reasons that benzodiazepines have come under fire in the last few years is their propensity to cause addiction, cognitive decline, and falls. In this study, the research found no increase in falls or referrals to the emergency room in either group.

The groups had similar antipsychotic medication doses, indicating a similar level of severity of illness. Additionally, levels of suicidal thinking or self-harm were not significantly different between the groups.

The researchers note that the study was small and lacked an evolution of aggression at admission, Including an early evaluation that could increase the finding’s validity.

The authors concluded that using benzodiazepines with antipsychotics in patients with aggressive behavior does not affect the level of aggression any more than atypical antipsychotics alone. Other analyses referenced in the report support this conclusion. Perhaps this finding and others being published could reduce benzodiazepine use in psychiatric care.

Reference

Baranchik S, Stryjer R, Weizman A, Shelef A. Add-on benzodiazepines for psychosis-induced aggression. Int Clin Psychopharmacol. 2019;34(3):119-123.