Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
8.7 Major clinical issues with personality disorders and benzodiazepine use
Table of contents
- Acknowledgments
- Abbreviations
- Preface
- Introduction
- Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
1. Levels of evidence- 2. Management of people with comorbidity of mental disorders and substance use
- 3. The common drug groups
- 4. Tobacco
- 5. Depression and substance use
- 6. Anxiety disorders and substance use
- 7. Psychosis (schizophrenia and bipolar disorder) and substance use
8. Personality disorders and substance use- 8.1 Personality disorders
- 8.2 Comorbidity with personality disorders
- 8.3 Major clinical issues with personality disorders and cannabis/ hallucinogen use
- 8.4 Major clinical issues with personality disorders and alcohol use
- 8.5 Major clinical issues with personality disorders and opioid use
- 8.6 Major clinical issues with personality disorders and stimulant (including methamphetamine) use
- 8.7 Major clinical issues with personality disorders and benzodiazepine use
- 8.8 Major clinical issues with personality disorders and inhalant/ solvent use
- 9. Eating disorders and substance use
- 10. Somatoform disorders and substance use
- 11. Gambling and substance use
- 12. Brain injury, mental disorders and substance use
- 13. Bibliography
- 14. Appendices
- Benzodiazepines have been associated with reduced impulse control, disinhibition and increased levels of violence, particularly in people with Cluster B type personality disorders.
- There is an increased risk of sedation and overdose with the combination of benzodiazepines and sedative antidepressants.
- Benzodiazepines can increase the sedative effects of carbamazepine, lithium and sodium valproate.
8.7.1 Effects of benzodiazepines on personality disorders
- Benzodiazepines are thought to have a negative effect on many of the problematic behaviours associated with these disorders.
- Benzodiazepines have been associated with reduced impulse control, disinhibition and increased levels of violence, particularly in people with Cluster B type personality disorders.
8.7.2 Interactions between benzodiazepines and therapeutic agents for personality disorders
- Benzodiazepines can increase the sedative effects of carbamazepine, lithium and sodium valproatex.
- There is an increased risk of sedation and overdose with the combination of benzodiazepines and sedative antidepressants such as tricyclics and mirtazepinex.
- Benzodiazepines and antidepressants are both metabolised by CYP 450 enzymes which may result in the inhibition or induction of either drug group. Therefore, individuals should be monitored closely to ensure they are experiencing the appropriate therapeutic effectx.
- Fluvoxamine will inhibit the metabolism of alprazolam, midazolam, triazolam and diazepam causing increased sedation and potential toxicityx.
- Citalopram and sertraline are the least likely SSRIs to have cytochrome mediated drug interactionsx.
8.7.3 Management approaches to comorbid personality disorders and benzodiazepine use
- If benzodiazepine dependence has developed, then graduated withdrawal through slow reduction of dosage should be commenced****(194-196), possibly after transferring the patient onto a long acting benzodiazepine.
- If benzodiazepine use is indicated or to occur, then:
- This should be subject to a contract with the patient.
- Authorities should be advised, including registration with the relevant local government health authority.
- The seeking of additional benzodiazepines from other prescribers should be monitored (e.g. using the Authority to release personal PBS claims information to a third party form).
- A more direct liaison approach between clinicians who are dealing with individuals with suspected comorbid personality disorders and benzodiazepine use may help to minimise unnecessary prescribing.
- Daily or weekly dispensing of benzodiazepines should be considered and may also assist with controlling use.
- If large quantities of benzodiazepines (e.g. 40mg diazepam daily equivalent) are being consumed, then inpatient withdrawal to lower levels should be considered to avoid seizures(194).
