Benzodiazepines and antidepressants have been shown to change responses to unfairness; however, the effects of their combined use on unfairness evaluation are unknown. This study examines the effects of concomitant benzodiazepines and antidepressants long-term use on the evaluation of fair and unfair offers. To analyze behavioral changes on responses to unfairness, we compared the performance of medicated participants and healthy controls in the Ultimatum Game, both in the proposer and in the respondent role. The results showed that long-term (...) psychotropic users had the worse economic strategy by accepting less offers than control subjects. However, in the proposer role, the unfair offers made by participants were similar between groups. The present results suggest that long-term use of psychotropic medication, specifically the combination of benzodiazepines and antidepressants, may increase the sensitivity to unfairness, resulting in higher rejection rates in conditions where this strategy is the most disadvantageous. (shrink)

Lorazepam has been repeatedly shown to induce memory impairments. The effects of this benzodiazepine on the processes involved in the strategic regulation of memory accuracy have not as yet been explored. An experimental procedure that delineates the role of monitoring and control processes was used. Fifteen lorazepam and 15 placebo subjects were examined using a semantic memory task that combined both a forced- and a free-report option and a no-incentive and an incentive condition. Memory accuracy was lower in the lorazepam (...) than in the placebo group. Lorazepam impaired control sensitivity (the extent to which volunteering of answers is affected by the confidence judgments). While the absolute aspect of monitoring was impaired (calibration scores), both the discriminative aspect (the ability to distinguish between correct and incorrect answers) and the response criterion setting (the confidence threshold set for volunteering a report) were spared. The pharmacological dissociation between monitoring effectiveness and control sensitivity indicates that these two components involve distinct processes. (shrink)

Lorazepam has been repeatedly shown to induce memory impairments. The effects of this benzodiazepine on the processes involved in the strategic regulation of memory accuracy have not as yet been explored. An experimental procedure that delineates the role of monitoring and control processes was used. Fifteen lorazepam and 15 placebo subjects were examined using a semantic memory task that combined both a forced- and a free-report option and a no-incentive and an incentive condition. Memory accuracy was lower in the lorazepam (...) than in the placebo group. Lorazepam impaired control sensitivity . While the absolute aspect of monitoring was impaired , both the discriminative aspect and the response criterion setting were spared. The pharmacological dissociation between monitoring effectiveness and control sensitivity indicates that these two components involve distinct processes. (shrink)

The benzodiazepines can produce a wide variety of abnormal mental responses and hazardous behavioral abnormalities, including rebound anxiety and insomnia, mania and other forms of psychosis, paranoia, violence, antisocial acts, depression, and suicide. These drugs can impair cognition, especially memory, and can result in confusion. They can induce dependence and addiction. Severe withdrawal syndromes with psychosis, seizures, and death can develop. The short-acting benzodiazepines, alprazolam and triazolam , are especially prone to cause psychological and behavioral abnormalities. The sources (...) of data to support these observations and conclusions are discussed in regard to the scientific method. These adverse drug effects can wreck havoc in the lives of individuals and their families. (shrink)

Background: Benzodiazepines have been widely used in clinical practice for over four decades and continue to be one of the most consumed and highly prescribed class of drugs available in the treatment of anxiety, depression, and insomnia. The literature indicates that Benzodiazepine users at a significantly increased risk of Motor Vehicle accidents compared to non-users but the impact on injuries at workplace is not well-defined. We aimed to investigate whether use of benzodiazepine is associated with increased risk of occupational (...) injuries.Methods: PubMed, Embase, and Scopus databases were searched. A meta-analysis was performed to calculate odds ratio and 95% confidence interval among case controls, cross-sectional studies, either questionnaire or laboratory exams based.Results: A total of 13 studies met inclusion criteria, involving 324,168 OI from seven different countries, with an estimated occurrence of benzodiazepine positivity of 2.71%. A total of 14 estimates were retrieved. Of them, 10 were based on laboratory analyses, three on institutional databases, while one study was based on questionnaires. Regarding the occupational groups, three estimates focused on commercial drivers, that exhibited a reduced risk ratio for benzodiazepine positivity compared to other occupational groups. Eventually, no increased risk for benzodiazepine positivity was identified, either from case control studies, or cross sectional studies, when only laboratory based estimates were taken in account.Conclusions: Even though benzodiazepines have the potential to increase injury rates among casual and chronic users, available evidence are insufficient to sustain this hypothesis, particularly when focusing on laboratory-based studies. (shrink)

Stiff Person Syndrome is a rare autoimmune disorder associated with antibodies against glutamic acid decarboxylase, the key enzyme in γ -aminobutyric acid synthesis. In order to investigate the role of cerebral benzodiazepinereceptor binding in SPS, we performed [ 11 C]flumazenil positron emission tomography in a female patient with SPS compared to nine healthy controls. FMZ is a radioligand to the postsynaptic central benzodiazepine receptor which is co-localized with the GABA-A receptor. In the SPS patient, we found a global reduction of (...) cortical FMZ binding. In addition, distinct local clusters of reduced radiotracer binding were observed. These data provide first in vivo evidence for a reduced postsynaptic GABA-A receptor availability which may reflect the loss of GABAergic neuronal inhibition in SPS. (shrink)

Animal research suggests that central serotonergic neurons are involved in behavioral suppression, particularly anxiety-related inhibition. The hypothesis linking decreased serotonin transmission to reduced anxiety as the mechanism in the anxiolytic activity of benzodiazepines conflicts with most clinical observations. Serotonin antagonists show no marked capacity to alleviate anxiety. On the other hand, clinical signs of reduced serotonergic transmission (low 5-HIAA levels in the cerebrospinal fluid) are frequently associated with aggressiveness, suicide attempts, and increased anxiety. The target article attempts to reconcile (...) such human and animal findings by investigating whether anxiety reduction or increased impulsivity is more Likely to account for animal behavioral changes associated with decreased serotonergic transmission. The effects of manipulating central serotonin in experimental anxiety paradigms in animals (punishment, extinction, novelty) are reviewed and compared with the effects of antianxiety drugs. Anxiety seems neither necessary nor sufficient to induce control by serotonergic neurons on behavior. Further evidence suggests that behavioral effects of anxiolytics thought to be mediated by decreases in anxiety are not caused by the ability of these drugs to reduce serotonin transmission. Blockade of serotonin transmission, especially at the level of the substantia nigra, results in a shift of behavior toward facilitation of responding. This behavioral shift is particularly marked when there is competition between acting and restraining response tendencies and when obstacles prevent the immediate attainment of an anticipated reward. It is proposed that serotonergic neurons are involved not only in behavioral arousal but also in enabling the organism to arrange or tolerate delay before acting. Decreases in serotonin transmission seem to be associated with the increased performance of behaviors that are usually suppressed, though not necessarily because of the alleviation of anxiety, which might contribute to the suppression. (shrink)

A model of the neuropsychology of anxiety is proposed. The model is based in the first instance upon an analysis of the behavioural effects of the antianxiety drugs in animals. From such psychopharmacologi-cal experiments the concept of a “behavioural inhibition system” has been developed. This system responds to novel stimuli or to those associated with punishment or nonreward by inhibiting ongoing behaviour and increasing arousal and attention to the environment. It is activity in the BIS that constitutes anxiety and that (...) is reduced by antianxiety drugs. The effects of the antianxiety drugs in the brain also suggest hypotheses concerning the neural substrate of anxiety. Although the benzodiazepines and barbiturates facilitate the effects of γ-aminobutyrate, this is insufficient to explain their highly specific behavioural effects. Because of similarities between the behavioural effects of certain lesions and those of the antianxiety drugs, it is proposed that these drugs reduce anxiety by impairing the functioning of a widespread neural system including the septo-hippocampal system, the Papez circuit, the prefrontal cortex, and ascending monoaminergic and cholinergic pathways which innervate these forebrain structures. Analysis of the functions of this system suggests that it acts as a comparator: it compares predicted to actual sensory events and activates the outputs of the BIS when there is a mismatch or when the predicted event is aversive. Suggestions are made as to the functions of particular pathways within this overall brain system. The resulting theory is applied to the symptoms and treatment of anxiety in man, its relations to depression, and the personality of individuals who are susceptible to anxiety or depression. (shrink)

The history of benzodiazepine supply, as negotiated in the GDR following its commercial success in western markets in 1960, demonstrates how patients in East Germany (GDR) influenced drug policies by assuming the role of consumers. This article traces general political discussions on psycho-pharmaceuticals as essential components of a healthcare system that faced grave financial constraints, then focuses on the “Wunschverordnung” concept, that is, a prescription that was filled on request. This concept was ideologically employed to portray the rising demand for (...) tranquilizer drugs as inadequate. The ways in which citizens of the GDR influenced state decisions—import and production alike—on tranquilizer supply through petitions is investigated. The article concludes by discussing the scope and function of the activist role of patients as consumers in a socialist state. (shrink)

The history of benzodiazepine supply, as negotiated in the GDR following its commercial success in western markets in 1960, demonstrates how patients in East Germany (GDR) influenced drug policies by assuming the role of consumers. This article traces general political discussions on psycho-pharmaceuticals as essential components of a healthcare system that faced grave financial constraints, then focuses on the “Wunschverordnung” concept, that is, a prescription that was filled on request. This concept was ideologically employed to portray the rising demand for (...) tranquilizer drugs as inadequate. The ways in which citizens of the GDR influenced state decisions—import and production alike—on tranquilizer supply through petitions is investigated. The article concludes by discussing the scope and function of the activist role of patients as consumers in a socialist state. (shrink)

Concepts and experimental results taken frombehavioral pharmacology, functional brain imaging,brain physiology, and behavioral neuroscience, wereused to develop the hypothesis that behavioraltolerance can, in part, be attributed to cellulartolerance. It is argued that task specific activationof circumscribed neuronal populations gives rise tocorresponding increases in regional cerebral bloodflow such that neurons related to task performance areexposed to higher effective doses of blood-borne drugthan neuronal groups not highly activated by thebehavioral task. Through this cerebral hemodynamicregulatory mechanism cellular tolerance phenomena canat least partially account (...) for behavioral tolerance(i.e., tolerance conferred through drugged practice). (shrink)

Source preference in which equally distributed risks may be valued differently has been receiving increasing attention. Using subjects recruited in Berkeley, Fox and Tversky demonstrate a familiarity bias in source preference—betting on a less than even-chance event based on San Francisco temperature is valued more than betting on a better than even-chance event based on Istanbul temperature. Neophobia is associated with the amygdala which is GABA-rich and is known to be modulated by benzodiazepines as anxiolytic agents that enhance the (...) activity of the GABAA receptor in processing anxiety and fear. This leads to our hypothesis that familiarity bias in decision making may be explained by polymorphic variations in this receptor mediated by anxiety regulation in the amygdala. In two companion studies involving Beijing-based subjects, we examine 10 single nucleotide polymorphisms of GABRB2 and find 7 SNPs each showing negative association between familiarity bias—preference for betting on parity of Beijing temperature over Tokyo temperature—and having at least one minor allele. In an imaging genetics study of a subsample of subjects based on the SNP with the most balanced allelic distribution, we find that subjects’ familiarity bias in terms of risk aversion towards bets on the parity of the temperature of 20 Chinese cities is negatively associated with their post-scanning familiarity ratings of the cities only for those with no minor allele in this SNP. Moreover, familiarity bias is positively associated with activation in the right amygdala along with the brain’s attention networks. Overall, our findings help discriminate between ambiguity aversion and familiarity bias in source preference and supports our gene–brain–behavior hypothesis of GABAergic modulation of amygdala activation in response to familiarity towards the source of uncertainty. (shrink)

BackgroundSelf-prescribing and prescribing to personal contacts is explicitly discouraged by General Medical Council guidelines.AimsThis study examines how widespread the practice of self-prescribing and prescribing to personal contacts is.MethodsA 16-item questionnaire was distributed via an online forum comprising 4445 young medical doctors, which asked respondents about previous prescribing to themselves, their families, friends and colleagues, including the class of medication prescribed. Demographic details were collected including medical grade and specialty.ResultsA total of 729 responses were obtained, the majority of which were from (...) young non-consultant hospital doctors from a range of specialties. Two-thirds of respondents had self-prescribed, over 70% had prescribed to family, and nearly 60% had prescribed to a friend or colleague. Older doctors were more likely to self-prescribe. Interns being less likely to self-prescribe was not unexpected, while general practitioners and paediatricians were more likely to self-prescribe. GPs, paediatricians and hospital medicine specialties were more likely to prescribe to family and surgeons were more likely to prescribe to friends. Some 3% to 7% who had self-prescribed had prescribed an opiate, benzodiazepine or psychotropic medication. Male doctors, anaesthetists and surgeons were more likely to self-prescribe opioids, while those in hospital medicine were more likely to self-prescribe psychotropic medications.ConclusionPrescribing outside the traditional doctor-patient relationship is widespread despite clear professional guidance advising against it. (shrink)

Objective: To review the principles and practice of the use of conscious sedation for IVF.Design: The pertinent literature was reviewed and recommendations are provided.Result(s): Conscious sedation appears to be the most commonly used method of pain relief for transvaginal retrieval of oocytes. Conscious sedation does not require the presence of an anesthesiologist and can be done in freestanding clinics. Agents commonly used include opioids in combination with benzodiazepines. This combination minimizes pain, decreases anxiety, and provides sedation and some amnesia (...) Adjuvants such as promethazine and hydroxyzine can also be used but often are not needed. Conscious sedation is well tolerated by patients and does not require highly specialized equipment. However, there are specific safeguards that should be followed. Only a few toxicity studies have been performed, but they are reassuring because they have not found significant effects on fertilization or cleavage.Conclusion(s): Conscious sedation appears to be a safe and cost-effective method of providing analgesia and anesthesia for transvaginal retrieval of oocytes. (shrink)

The aim of this article is to examine some of the consequences of the recent advances in neurobiology in terms of the ability of drugs to manipulate the mind. Most laymen are totally ignorant of the general mechanism underlying the brain-mind relationship and therefore of the action of mind-altering drugs. Professor Grahame-Smith considers that one of the intrinsic evils of man's neurobiological make up is that a prime motive of the brain seems to be to bring comfort, security and pleasure (...) for itself. Therefore it is not surprising that drugs - notably the barbiturates and more recently the benzodiazepines (tranquilizers) - have been prescribed to give to the brain that peace of mind that it seeks. However, it can be argued that such drugs cannot replace anxiety with peace of mind or unhappiness or depression with happiness. The action of such drugs upon the molecules of the brain is negative - a placebo effect. (shrink)

We can think about the use of controlled substances in the treatment of anxiety disorders in two simple but diametrically opposed ways. First, we can say that anxiety disorders are trivial and require only acts of willpower, or, if anxiety disorders do require treatment, they are better treated without the use of benzodiazepines. When BZs are used to treat anxiety, they pose grave risks of addiction to the patients to whom these medicines are prescribed; they relieve patients’ symptoms, but (...) are the equivalent of a pharmacological “roach motel,” a haven into which many unsuspecting patients enter, but from which few emerge without becoming addicted. Patients must then face terrible struggles to free themselves of dependence on BZs, and this compounds the problem for which they sought treatment. Furthermore, the large number of prescriptions for BZs are a threat to the public health because these drugs are widely abused by alcoholics and drug addicts. (shrink)

We can think about the use of controlled substances in the treatment of anxiety disorders in two simple but diametrically opposed ways. First, we can say that anxiety disorders are trivial and require only acts of willpower, or, if anxiety disorders do require treatment, they are better treated without the use of benzodiazepines. When BZs are used to treat anxiety, they pose grave risks of addiction to the patients to whom these medicines are prescribed; they relieve patients’ symptoms, but (...) are the equivalent of a pharmacological “roach motel,” a haven into which many unsuspecting patients enter, but from which few emerge without becoming addicted. Patients must then face terrible struggles to free themselves of dependence on BZs, and this compounds the problem for which they sought treatment. Furthermore, the large number of prescriptions for BZs are a threat to the public health because these drugs are widely abused by alcoholics and drug addicts. (shrink)

TOT states may be viewed as a temporary and reversible microamnesia. We investigated the effects of lorazepam on TOT states in response to general knowledge questions. The lorazepam participants produced more commission errors and more TOTs following commission errors than the placebo participants . The resolution of the TOTs was unimpaired by the drug. Neither feeling-of-knowing accuracy nor recognition were affected by lorazepam. The higher level of incorrect recalls produced by lorazepam participants may be due to the fact that they (...) were more frequently temporarily unable to access a known item. For some of these items, the awareness of the retrieval failure resulted in a commission TOT . The resolution of the TOT conflict is discussed in the light of the anxiolytic and anticonflict effects of lorazepam. The data are discussed in terms of contemporary theories of TOTs and the effects that benzodiazepines have on semantic memory. (shrink)

We experience anxiety because things may not turn out as we wish. Perhaps the problem is not located in the unfolding of events, but rather in the nature of the wishing. In this paper, I will argue that the Roman Stoics correctly analyzed the necessary conditions surrounding the arising of anxiety, and offered an effective prescription for the treatment and prevention of this disordered emotional state—a prescription that does not involve benzodiazepines such as Valium or Xanax, but one that (...) holds out the promise of a more stable and enduring anxiolytic effect. Ultimately, anxiety can afflict only those whose desires are not rationally governed. There is little that anyone can do about the vicissitudes of the external world and the unraveling of events therein, but there is a great deal thata rational agent can do to manage the objects and direction of desire and aversion. Though not dispensed in tablet or capsule form, Stoic anxiolytics remain available without prescription and exhibit an extraordinarily benign side effect profile. They rarely cause weight gain, sexual dysfunction, or uncontrollable movements of the limbs. Physiological dependence is relatively rare—and not especially pernicious. Instead, Stoicism offers rationally grounded, proven psychological techniques for the gradual development of consistent self-mastery and emotional detachment from those facets of the human condition that tend to cause the most pervasive and unsettling forms of fear, anxiety, and avoidable disquiet. (shrink)