G
Gene-Badia J, Blay-Pueyo C, Soler-Vila M.
Risk-Factors in the Use of Benzodiazepines.
Family Practice 1988; 5: 283-288.

"... general practitioners, who are the principal prescribers of drugs, are causing over-medication in the population. " [p. 283]

" It is also important to note that in our sample, a great number of patients suffering from depression were taking benzodiazepines. A possible interpretation for this is that the physician detecting the existence of a psychopathological disorder is either unable to categorise it or to use
a psychopharmacological agent other than benzodiazepine. ( - - - ) This fact, together with an unjustified fear of non-benzodiazepine psychopharmacological agents, explains why the anxiolytics are prescribed to patients who could otherwise benefit from specific treatment with
antidepressants. This therapeutic pitfall tends to mask the symptoms and contributes to a chronic evolution of the depression which is later aggravated by the addictive effects of benzodiazepines.
" [p. 287]

[Key words; dependence, depression, long-term effects]

Gilbert D, Chetley A.
New Trends in Drug Promotion.
Consumer Policy Review 1996; 6: 162-167.

As the National Health Service (NHS) moves towards evidence-based medicine and more rational prescribing, drug companies are seeking new ways to promote their products. They target the NHS by sponsoring conferences, publications and continuing education. Of equal
concern is the promotion to consumers through patient groups, the Internet and other forms of patient information. This is defended as promoting consumers choice. but by redefining illness and "selling" the disease, they create new markets for themselves. A thorough review of self-regulation
is required. [ABSTRACT p. 162]

[Key words; drug manufactures]

Gillberg C.
"Floppy Infant Syndrome" and Maternal Diazepam.
Lancet 1977; ii: 244.

" In the neonatal care ward of this hospital high concentrations of diazepam and desmethyldiazepam have been found in the sera of children with abnormal neonatal behaviour and whose mothers had taken diazepam towards the end of pregnancy. Diazepam has been indicted responsible, at
least in part, for the children's symptoms (hypotonia, sucking difficulties, hypothermia, and attacks of cyanosis). "

[Key words; Valium, diazepam, infants]

Giri AK, Banerjee S.
Genetic Toxicology of Four Commonly Used Benzodiazepines: A Review.
Mutation Research 1996; 340: 93-108.

"The wide human exposure to this group of drugs throughout the world
is of great concern for human health."

Golombok S, Moodley P, Lader M.
Cognitive Impairment in Long-Term Benzodiazepine Users.
Psychological Medicine 1988; 18: 365-374.

" The finding that patients taking high doses of benzodiazepines for long periods of time perform poorly on tasks involving visual-spatial ability and sustained attention, implies that these patients are not functioning well in everyday life. Furthermore, the lack of relationship between benzodiazepine intake and the cognitive Failures Questionnaire, a subjective measure of
impairment, suggests that they are not aware of their reduced ability. This is in line with clinical evidence that patients who withdraw from their medication often report improved concentration and increased sensory appreciation, and that only after withdrawal do they realise that they have
been functioning below par. " [p. 373]

" The cognitive effects of long-term administration of benzodiazepines may not only be debilitating but may also be dangerous. Although benzodiazepines have not been directly implicated in road traffic accidents, Hindmarch (1986) estimated that up to 10% of drivers involved in car accidents had been taking psychoactive drugs, and that psychoactive drugs are responsible for the loss of 200 000 lives word-wide on the roads each year. " [p. 373]

" It appears... that not only are long-term benzodiazepine users at risk of dependence, but that cognitive impairment also represents a very real hazard. " [p. 373]

[Key words; cognitive impairment, psychomotor impairment, long-term effects, accidents]

Grad R.
Addiction to Benzodiazepines - How Common ?
Archives of Family Medicine 1996; 5: 384.

" Although earlier literature may have suggested that benzodiazepines are relatively safe drugs (as compared with the barbiturates), there is now a body of observational research suggesting that safety is an important problem for subgroups such as elderly patients. For example, an
association between benzodiazepines and adverse events such as falls, hip fracture, cognitive impairment, and motor vehicle crash has been demonstrated in elderly patients. " [p. 384]

[Key words; addiction, dependence, cognitive impairment, fractures, accidents, the elderly]

Grant I, Adams KM, Carlin AS, Rennick PM, Judd LL, Schooff K, Reed R. Organic Impairment in Polydrug Users: Risk Factors.
American Journal of Psychiatry 1978; 135: 178-184.

In a national collaborative study to assess the neuropsychological status of 151 polydrug users, the Halstead-Reitan Neuropsychological Battery showed deficits in 37% two to three weeks after they entered treatment and in 34% at three month follow-up. Comparative rates for a group
of psychiatric patients were 26% and 27%, and for nonpatients, 8% and 4%. Extensive and intensive use of CNS depressants and opiates correlated positively with neuropsychological deficit. Older, less educated subjects with adverse medical or developmental histories were more likely to show polydrug-related organic impairment. Although t here is some evidence that such impairment is reversible, the condition appears to be of at least intermediate duration and may be long lasting. [SUMMARY p. 178]

" If our findings are confirmed by others, several implications might be considered. First, sedatives and opiates might produce more long-term toxicity than has previously been suspected. If this is so, we need to rethink practices that have led to exceedingly widespread use of sedatives and
minor tranquillisers." [p. 183]

[Key words; cognitive impairment, long-term effects]

Greenberg R.
Dream Interruption Insomnia.
Journal of Nervous and Mental Disease 1967; 144: 18-21.

A form of insomnia, developing in response to nightmares and characterized by interruptional dreams, is described. This type of insomnia leads to further psychopathological symptoms. Treatment with Librium or Valium at bed time leads to initial improvement in sleep and in psychic
state, but over a period of time both these drugs suppress the amount of Stage 1-REM sleep. [SUMMARY p. 21]

[Key words; Librium, Valium, chlordiazepoxide, diazepam, insomnia, nightmares]

Gross HS.
Use of Benzodiazepines in Anxiety Disorders.
New England Journal of Medicine 1993; 20: 1501.

"Some patients with generalized anxiety who are treated with a short-acting benzodiazepine such as alprazolam report a paradoxical and harmful effect. Patients with generalized anxiety are continuously anxious. The short-acting benzodiazepines provide relief that begins to diminish before the next dose is due. Patients are thus conditioned to expect increasing anxiety three or
four times each day. This iatrogenic cycle of relief and anxiety is sometimes associated with an acceleration of generalized anxiety, greater dependence on a short-acting benzodiazepine, and concern about the competence of the physician. Therapy with a longer acting benzodiazepine will avert this paradoxical effect."

[Key words; anxiety, tolerance]

Guilleminault C.
Benzodiazepines, Breathing, and Sleep.
American Journal of Medicine 1990; 88 suppl 3A: 3-25.

The benzodiazepines are sedative hypnotic drugs, i.e., central nervous system depressant drugs, that may adversely affect the control of ventilation during sleep. Prescription of these drugs may worsen sleep-related breathing disorders especially in patients with chronic obstructive pulmonary disease or cardiac failure. The most frequent uses of sedative hypnotics are the polymorbid elderly with a secondary complaint of insomnia. Although the benzodiazepines may reduce sleep fragmentation, their long-term use may also cause health problems, such as complete obstructive sleep apnea in heavy snorers of short repetitive central sleep apnea in patients with recent myocardial infarctation. Since drugs of this class vary in their effects, it is crucial to note the action of a given benzodiazepine on the control of vital functions during sleep. [ABSTRACT p. 3]

[Key words; long-term effects]

Gundlach R, Engelhard DM, Hankoff L, Paley H, Rudorfer L, Bird E.
A Double-Blind Outpatient Study of Diazepam (Valium) and Placebo.
Psychopharmacologia (Berlin) 1966; 9: 81-92.

" During the course of treatment, nine patients developed suicidal thoughts or impulses; seven from the diazepam and two from the placebo group. Three had to be dropped from the protocol
- because of the suicidal threat - all from the diazepam treatment group. " (---)

" In addition, diazepam seemed to have adverse effects on a number of psychotic patients. Out of 33 schizophrenic and 4 involutional patients who started the protocol on diazepam, 12 developed suicidal and/or paranoid thoughts or tendencies. This suggests that diazepam would be
contraindicated in a psychotic population." [p. 91]

[Key word; Valium, diazepam, depression, suicide, paranoia, paradoxical effects]

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