苯二氮䓬类药物停药综合征

苯二氮䓬类药物停药综合征又称苯二氮卓戒断综合征（英语：Benzodiazepine withdrawal syndrome），通常缩写为苯并戒断（benzo withdrawal）或BZD戒断（BZD withdrawal） ，是指服用苯二氮䓬类药物（可能因医疗原因或娱乐性原因用药）并产生生理依赖性后，减少用量或停药时产生的药物戒断症状。觅药行为或按处方服药均可能导致生理依赖性与药物成瘾（或二者之一）以及因此产生的戒断症状。某些症状可能持续数年。苯二氮䓬类药物停药综合征的显著特征症状包括：睡眠障碍、易怒、紧张焦虑、恐慌发作、手颤、发抖、出汗、难以集中精神、意识混乱和认知障碍、记忆减退、恶心干呕、体重下降、心悸、头痛、肌肉疼痛僵硬、知觉变化、幻觉、癫痫发作、思觉失调^[1]以及自杀^[2][3]。此外，这些症状可能时好时坏，每日或每周的严重程度不一，而不是持续稳定好转。^[4]

维基百科中的医学内容仅供参考，并不能视作专业意见。如需获取医疗帮助或意见，请咨询专业人士。详见医学声明。

苯二氮䓬类药物停药综合征
类型	戒断状态[*]、苯二氮䓬类药物依赖性
分类和外部资源
医学专科	精神病学
ICD-10	F13.3（持续用药后）

苯二氮䓬类戒断症状可能很严重，症状复杂且常常长期持续。^[5][6]长期使用苯二氮䓬类（即每日用药，持续至少三个月）^[7]可能有更高的药物依赖风险^[8]，亦可能造成用量增加、药效降低、增加事故和摔倒的概率（尤其是老年人），^[9]还可能与认知、^[10]神经系统和智力损伤有关^[11]。因此不宜长期使用苯二氮䓬类药物。^[8]将苯二氮䓬类药物作为短效安眠药使用，在入睡时可能有效，但可能因戒断反应而导致后半段睡眠质量不佳。^[12]尽管如此，对于长期服用苯二氮䓬类药物者，不应违背其意愿强迫停药。^[5]

苯二氮䓬类戒断可能有重症反应，甚至产生癫痫发作等危及生命的症状，^[13]尤其是突然戒断或减量过快的大剂量或长期用药者。^[5]然而逐步减量或相对用量较少的短期用药者亦可能出现重症戒断反应，^[14]在动物模型中甚至曾有单次大剂量用药后戒断出现重症反应。^[15][16]少数人会出现迁延性戒断症状（英语：post-acute-withdrawal syndrome），症状可能在戒断后数月甚至数年内持续，维持在亚急性状态。缓慢而逐步的减少药物用量能使迁延性戒断症状的出现概率尽可能降低。^[17]

长期使用苯二氮䓬类药物会导致神经适应，降低药物效果，造成耐受和依赖。^[18]即使是持续服用治疗剂量期间，长期使用苯二氮䓬类药物亦可能引起类似戒断反应的症状，尤其是在服药间隔期。^[19]停药或减少用量后，用药者即会出现药物戒断症状，直至其生理适应恢复。^[20]这些反跳症状（英语：Rebound effect）可能与最初服药前的病症相同，亦可能是停药综合征的一部分。^[21]在重症病例中，戒断反应可能会恶化，或与严重的精神疾病相似，如狂躁、精神分裂症，尤其在大剂量用药者中还会出现癫痫重积状态。^[22]若不能正确诊断出停药综合征，可能会误诊为服药前的疾病复发而需要继续用药，导致戒断失败、重新开始用药，而重新用药往往比之前的剂量更大。^[22]

提高戒断成功率的方法包括：提升对戒断反应的意识，针对用药者的戒断反应严重程度而制定个人化的逐步戒断方法，以及增加其他替代方法辅助，如使用药者安心、参加苯二氮䓬类药物戒断互助小组。这些方法都能有效提高戒断的成功率。^[23][24]

症状和体征

地西泮，其2毫克与5毫克片剂常用于治疗苯二氮䓬类戒断反应^[25]

氯二氮平（英语：Chlordiazepoxide），其5毫克胶囊剂有时可作为地西泮的替代药物，用于治疗苯二氮䓬类戒断反应。氯二氮平与地西泮都有较长的消除半衰期和长效活性代谢产物

苯二氮䓬类、巴比妥类等镇静安眠药物或酒精成瘾者在停用后会产生严重的戒断反应症状。《临床成人精神医学手册》显示这些戒断症状比鸦片类药物的戒断症状更严重、危害更大。^[26]使用者在停药时一般甚少获得相关建议和支持。^[27]一些戒断症状与用药治疗之前的病症相同，^[21]可能症状严重或长期持续。半衰期较长的苯二氮䓬类药物可能在停用长达三周之后才会出现戒断反应，而半衰期较短的药物则较早出现戒断反应，一般在停用24-48小时后即会出现。^[28]不同剂量用药者的戒断症状种类可能没有重大差异，但大剂量用药者的症状严重程度往往更高。^[29]

在用药量减少时，服药者可能会首次出现戒断反应，包括失眠、焦虑、痛苦、体重下降、晕眩、夜汗、肌肉抽搐、恐慌发作、抑郁、失实症、偏执等。这些症状更常见于短效苯二氮䓬类停药时，例如三唑仑等药物。^[22][30]日间症状可能在夜间用药给药数日至数周后出现，^[31][32]亦可能出现于佐匹克隆等Z药物使用者。^[33]即使是间歇服用苯二氮䓬类，^[34]亦可能在戒断后出现失眠症状反弹，可能比服药前更加严重。^[35][36]

逐步或突然减少药量可能出现下列症状：

• 静坐不能
• 激动、焦虑，^[25]可能有惊恐及恐慌发作^[1][37]
• 视力模糊^[37]
• 胸痛^[37]
• 人格解体^[38]
• 抑郁（可能严重），^[39]甚至有自杀念头^[2][3]
• 失实症^[40]
• 瞳孔放大^[22]
• 头晕^[37]
• 口干^[37]
• 烦躁^[41][42]
• 血压升高，^[43]或高血压^[44]
• 疲劳、虚弱^[37]
• 胃肠功能紊乱（包括恶心、腹泻、呕吐等）^{[45][46][46][47]}
• 听觉障碍^[37]
• 头痛^[1]
• 潮热、发冷^[37]
• 嗅觉过敏（英语：Hyperosmia）^[48]
• 入睡前幻觉（英语：Hypnagogia）^[17]
• 疑病症^[37]
• 触觉敏感度增强^[40]
• 排尿频率增加^[37]
• 失眠^[45]
• 记忆力和专注力受损^[1][37]
• 食欲不振、体重下降^[49]
• 轻微至中度失语症^[48]
• 情绪波动^[37]
• 肌肉痉挛、抽筋、不适或肌束震颤（英语：fasciculation）^[50]
• 梦魇^[45]
• 强迫症^[51][52]
• 感觉异常^{[37][40][48][5][53]}
• 偏执^[48]
• 出汗^[1]
• 畏光^[48]
• 姿位性低血压^[45]
• 快速动眼期睡眠反弹（英语：REM sleep rebound）^[54]
• 不宁腿综合征^[24]
• 关节僵硬^[37]
• 味觉和嗅觉障碍^[37]
• 心跳过速^[55]
• 耳鸣^[56]
• 颤抖^[57][58]
• 视觉障碍^[40]

迅速停药可能会引发更严重的症状：

• 紧张性抑郁障碍，可能致死^[59][60][61]
• 意识错乱（英语：Confusion）^[25]
• 癫痫发作，^[25]可能致死^[62][63]
• 昏迷^[64]（罕见）
• 震颤性谵妄^[65][66][66]
• 高热^[45]
• 狂躁^[67][68]
• 抗精神药物恶性综合征（英语：Neuroleptic malignant syndrome）类似表现^[69][70]（罕见）
• 器质性脑病综合征（英语：Organic brain syndrome）^[71]
• 创伤后压力综合征^[24]
• 思觉失调^[72][73]
• 自杀意念（英语：Suicidal ideation）^[74]或自杀^[2][3]
• 暴力、攻击行为^[37][75]

参考来源

1. Petursson, H. The benzodiazepine withdrawal syndrome. Addiction. 1994, 89 (11): 1455–9. PMID 7841856. doi:10.1111/j.1360-0443.1994.tb03743.x.
2. Colvin, Rod. Overcoming Prescription Drug Addiction: A Guide to Coping and Understanding 3. United States of America: Addicus Books. 26 August 2008: 74–76. ISBN 978-1-886039-88-9. I have treated ten thousand patients for alcohol and drug problems and have detoxed approximately 1,500 patients for benzodiazepines – the detox for the benzodiazepines is one of the hardest detoxes we do. It can take an extremely long time, about half the length of time they have been addicted – the ongoing relentless withdrawals can be so incapacitating it can cause total destruction to one’s life – marriages break up, businesses are lost, bankruptcy, hospitalization, and of course suicide is probably the most single serious side effect.
3. Dodds TJ. Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature. Primary Care Companion for CNS Disorders. 2017, 19 (2). PMID 28257172. doi:10.4088/PCC.16r02037.
4. C. Heather Ashton DM. Chapter III: Benzodiazepine withdrawal symptoms, acute & protracted. Institute of Neuroscience, Newcastle University. [29 April 2013]. （原始内容存档于2019-04-04）. Benzodiazepines : How they work and how to withdraw
5. Professor Heather Ashton. Benzodiazepines: How They Work and How to Withdraw. 2002 [2018-04-02]. （原始内容存档于2012-10-18）.
6. O'Connor, RD. Benzodiazepine dependence--a treatment perspective and an advocacy for control. NIDA research monograph. 1993, 131: 266–9. PMID 8105385.
7. Voshaar, R. C. O.; Couvée, JE; Van Balkom, AJ; Mulder, PG; Zitman, FG. Strategies for discontinuing long-term benzodiazepine use: Meta-analysis. British Journal of Psychiatry. 2006, 189 (3): 213–20. PMID 16946355. doi:10.1192/bjp.189.3.213.
8. Nutt, David. Benzodiazepine dependence in the clinic: Reason for anxiety?. Trends in Pharmacological Sciences. 1986, 7: 457–60. doi:10.1016/0165-6147(86)90420-7.
9. De Gier, N.; Gorgels, W.; Lucassen, P.; Oude Voshaar, R.; Mulder, J.; Zitman, F. Discontinuation of long-term benzodiazepine use: 10-year follow-up. Family Practice. 2010, 28 (3): 253–9. PMID 21193495. doi:10.1093/fampra/cmq113.
10. Authier, Nicolas; Boucher, Alexandra; Lamaison, Dominique; Llorca, Pierre-Michel; Descotes, Jacques; Eschalier, Alain. Second Meeting of the French CEIP (Centres d'Évaluation et d'Information sur la Pharmacodépendance). Part II: Benzodiazepine Withdrawal. Thérapie. 2009, 64 (6): 365–70. PMID 20025839. doi:10.2515/therapie/2009051.
11. Heberlein, A.; Bleich, S.; Kornhuber, J.; Hillemacher, T. Benzodiazepin-Abhängigkeit: Ursachen und Behandlungsmöglichkeiten [Benzodiazepine Dependence: Causalities and Treatment Options]. Fortschritte der Neurologie · Psychiatrie. 2008, 77 (1): 7–15. PMID 19101875. doi:10.1055/s-0028-1100831 （德语）.
12. Lee-chiong, Teofilo. Sleep Medicine: Essentials and Review. Oxford University Press, USA. 24 April 2008: 468. ISBN 0-19-530659-7.
13. Evans, Katie; Sullivan, Michael J. Withdrawal and Medical Issues. Dual Diagnosis: Counseling the Mentally Ill Substance Abuser 2nd. Guilford Press. 2001: 52–3 [2018-04-02]. ISBN 978-1-57230-446-8. （原始内容存档于2018-05-03）.
14. Lader, M. Long-term anxiolytic therapy: The issue of drug withdrawal. The Journal of Clinical Psychiatry. 1987,. 48 Suppl: 12–6. PMID 2891684.
15. Boisse, NR; Periana, RM; Guarino, JJ; Kruger, HS; Samoriski, GM. Pharmacologic characterization of acute chlordiazepoxide dependence in the rat. Journal of Pharmacology and Experimental Therapeutics. 1986, 239 (3): 775–83. PMID 3098961.
16. Boisse, NR; Periana, RM; Guarino, JJ; Kruger, HS. Acute chlordiazepoxide dependence in the rat: Comparisons to chronic. NIDA research monograph. 1986, 67: 197–201. PMID 3092067.
17. Professor Heather Ashton. Protracted Withdrawal Symptoms From Benzodiazepines. Comprehensive Handbook of Drug & Alcohol Addiction. 2004 [2018-04-02]. （原始内容存档于2020-09-28）. 引用错误：带有name属性“pwsfb”的<ref>标签用不同内容定义了多次
18. Allison, C; Pratt, J.A. Neuroadaptive processes in GABAergic and glutamatergic systems in benzodiazepine dependence. Pharmacology & Therapeutics. 2003, 98 (2): 171–95. PMID 12725868. doi:10.1016/S0163-7258(03)00029-9.
19. Herman, JB; Brotman, AW; Rosenbaum, JF. Rebound anxiety in panic disorder patients treated with shorter-acting benzodiazepines. The Journal of Clinical Psychiatry. 1987,. 48 Suppl: 22–8. PMID 2889722.
20. Allgulander, C; Bandelow, B; Hollander, E; Montgomery, SA; Nutt, DJ; Okasha, A; Pollack, MH; Stein, DJ; Swinson, RP; World Council Of, Anxiety. WCA recommendations for the long-term treatment of generalized anxiety disorder. CNS Spectrums. 2003, 8 (8 Suppl 1): 53–61. PMID 14767398.
21. Salzman, Carl. Benzodiazepine treatment of panic and agoraphobic symptoms: Use, dependence, toxicity, abuse. Journal of Psychiatric Research. 1993, 27: 97–110. PMID 7908335. doi:10.1016/0022-3956(93)90021-S.
22. Gabbard, Glen O. Gabbard's Treatments of Psychiatric Disorders, Fourth Edition (Treatments of Psychiatric Disorders). American Psychiatric Publishing. 15 May 2007: 209–211. ISBN 1-58562-216-8.
23. Onyett, SR. The benzodiazepine withdrawal syndrome and its management. The Journal of the Royal College of General Practitioners. 1989, 39 (321): 160–3. PMC 1711840 . PMID 2576073.
24. Ashton, Heather. Protracted withdrawal syndromes from benzodiazepines. Journal of Substance Abuse Treatment. 1991, 8 (1–2): 19–28. PMID 1675688. doi:10.1016/0740-5472(91)90023-4.
25. Soyka M. Treatment of Benzodiazepine Dependence. The New England Journal of Medicine. 2017, 376 (12): 1147–1157. PMID 28328330. doi:10.1056/NEJMra1611832.
26. Lindsay, S. J. E. The Handbook of Clinical Adult Psychology. Psychology Press. 1994: 363 [2018-04-05]. ISBN 9780415072168. （原始内容存档于2019-09-05）.
27. Authier, N.; Balayssac, D.; Sautereau, M.; Zangarelli, A.; Courty, P.; Somogyi, A.A.; Vennat, B.; Llorca, P.-M.; Eschalier, A. Benzodiazepine dependence: Focus on withdrawal syndrome. Annales pharmaceutiques françaises. 2009, 67 (6): 408–13. PMID 19900604. doi:10.1016/j.pharma.2009.07.001.
28. Committee on Safety of Medicines. Hypnotics and anxiolytics. British National Formulary. 2007 [17 September 2007].
29. Murphy, S. M.; Tyrer, P. A double-blind comparison of the effects of gradual withdrawal of lorazepam, diazepam and bromazepam in benzodiazepine dependence. British Journal of Psychiatry. 1991, 158 (4): 511–6. PMID 1675901. doi:10.1192/bjp.158.4.511.
30. Adam, Kirstine; Oswald, I. Can a Rapidly-eliminated Hypnotic Cause Daytime Anxiety?. Pharmacopsychiatry. 2008, 22 (3): 115–9. PMID 2748714. doi:10.1055/s-2007-1014592.
31. Scharf, Martin B; Kales, Judith A; Bixler, EO; Jacoby, JA; Schweitzer, PK. Lorazepam—Efficacy, side effects, and rebound phenomena. Clinical Pharmacology & Therapeutics. 1982, 31 (2): 175–9. PMID 6120058. doi:10.1038/clpt.1982.27.
32. Walsh, James K; Schweitzer, Paula K; Parwatikar, Sadashiv. Effects of lorazepam and its withdrawal on sleep, performance, and subjective state. Clinical Pharmacology & Therapeutics. 1983, 34 (4): 496–500. PMID 6617072. doi:10.1038/clpt.1983.203.
33. Fontaine, Réjean; Beaudry, Paul; Le Morvan, Patrick LE; Beauclair, Linda; Chouinard, GUY. Zopiclone and Triazolam in Insomnia Associated with Generalized Anxiety Disorder. International Clinical Psychopharmacology. 1990, 5 (3): 173–83. PMID 2230061. doi:10.1097/00004850-199007000-00002.
34. Kales, Anthony; Manfredi, Rocco L; Vgontzas, Alexandras N; Bixler, Edward O; Vela-Bueno, Antonio; Fee, Eric C. Rebound insomnia after only brief and intermittent use of rapidly eliminated benzodiazepines. Clinical Pharmacology & Therapeutics. 1991, 49 (4): 468–76. PMID 2015735. doi:10.1038/clpt.1991.55.
35. Kales, Anthony; Bixler, Edward O.; Soldatos, Constantin R.; Jacoby, Judith A.; Kales, Joyce D. Lorazepam: Effects on Sleep and Withdrawal Phenomena. Pharmacology. 1986, 32 (3): 121–30. PMID 3960963. doi:10.1159/000138160.
36. Bonnet, M H; Arand, D L. The use of lorazepam TID for chronic insomnia. International Clinical Psychopharmacology. 1999, 14 (2): 81–9. PMID 10220122. doi:10.1097/00004850-199903000-00004.
37. Saxon, L.; Hjemdahl, P.; Hiltunen, A. J.; Borg, S. Effects of flumazenil in the treatment of benzodiazepine withdrawal - a double-blind pilot study. Psychopharmacology. 1997, 131 (2): 153–60. PMID 9201803. doi:10.1007/s002130050278.
38. Terao, T; Yoshimura, R; Terao, M; Abe, K. Depersonalization following nitrazepam withdrawal. Biological Psychiatry. 1992, 31 (2): 212–3. PMID 1737083. doi:10.1016/0006-3223(92)90209-I.
39. Lader, Malcolm. Anxiety or depression during withdrawal of hypnotic treatments. Journal of Psychosomatic Research. 1994, 38: 113–23; discussion 118–23. PMID 7799243. doi:10.1016/0022-3999(94)90142-2.
40. Mintzer, M. Z.; Stoller, K. B.; Griffiths, R. R. A controlled study of flumazenil-precipitated withdrawal in chronic low-dose benzodiazepine users. Psychopharmacology. 1999, 147 (2): 200–9. PMID 10591888. doi:10.1007/s002130051161.
41. Mendelson, WB; Weingartner, H; Greenblatt, DJ; Garnett, D; Gillin, JC. A clinical study of flurazepam. Sleep. 1982, 5 (4): 350–60. PMID 6761826.
42. Schöpf, J. Withdrawal Phenomena after Long-term Administration of Benzodiazepines a Review of Recent Investigations. Pharmacopsychiatry. 2008, 16 (1): 1–8. PMID 6131447. doi:10.1055/s-2007-1017439.
43. Mintzer, Miriam Z.; Griffiths, Roland R. Flumazenil-precipitated withdrawal in healthy volunteers following repeated diazepam exposure. Psychopharmacology. 2004, 178 (2–3): 259–67. PMID 15452683. doi:10.1007/s00213-004-2009-1.
44. Biswas, AK; Feldman, BL; Davis, DH; Zintz, EA. Myocardial ischemia as a result of severe benzodiazepine and opioid withdrawal. Clinical Toxicology. 2005, 43 (3): 207–9. PMID 15902797. doi:10.1081/clt-200053099.
45. Bismuth, C; Le Bellec, M; Dally, S; Lagier, G. Benzodiazepine physical dependence. 6 cases (author's transl). La Nouvelle presse medicale. 1980, 9 (28): 1941–5. PMID 6106922.
46. Loeb, P; Adnet, P; Boittiaux, P; Forget, AP; Mille, FX. Sevrage en benzodiazépines révélé par un syndrome douloureux abdominal pseudochirurgical [Benzodiazepine withdrawal masquerading as surgical abdominal syndrome]. Annales Françaises d'Anesthésie et de Réanimation. 1997, 16 (5): 521–2. doi:10.1016/S0750-7658(97)83345-X （法语）.
47. BENZODIAZEPINE WITHDRAWAL SYMPTOMS, ACUTE AND PROTRACTED. Benzo.org.uk. [2018-04-05]. （原始内容存档于2019-04-04）.
48. Pelissolo, A; Bisserbe, JC. Dependence on benzodiazepines. Clinical and biological aspects. L'Encéphale. 1994, 20 (2): 147–57. PMID 7914165.
49. Pecknold, J.C. Discontinuation reactions to alprazolam in panic disorder. Journal of Psychiatric Research. 1993, 27: 155–170. doi:10.1016/0022-3956(93)90025-W.
50. Kliniska Färdigheter: Informationsutbytet Mellan Patient Och Läkare, LINDGREN, STEFAN, ISBN 91-44-37271-X (Swedish)^{[页码请求]}
51. Drummond, Lynne M.; Matthews, Helen P. SINGLE CASE STUDY Obsessive-Compulsive Disorder Occurring as a Complication in Benzodiazepine Withdrawal. Journal of Nervous and Mental Disease. 1988, 176 (11): 688–91. PMID 3183654. doi:10.1097/00005053-198811000-00008.
52. Matthews, HP; Drummond, LM. Obsessive-compulsive disorder--a complication of benzodiazepine withdrawal. British Journal of Psychiatry. 1987, 150: 272. PMID 3651695. doi:10.1192/s0007125000122810.
53. Shader, RI; Greenblatt, DJ. The use of benzodiazepines in clinical practice. British Journal of Clinical Pharmacology. 1981,. 11 Suppl 1 (Suppl 1): 5S–9S. PMC 1401641 . PMID 6133535. doi:10.1111/j.1365-2125.1981.tb01832.x.
54. Pagel, J. F.; Parnes, Bennett L. Medications for the Treatment of Sleep Disorders. Primary Care Companion to the Journal of Clinical Psychiatry. 2001, 3 (3): 118–125. PMC 181172 . PMID 15014609. doi:10.4088/PCC.v03n0303.
55. Van Engelen, BG; Gimbrere, JS; Booy, LH. Benzodiazepine withdrawal reaction in two children following discontinuation of sedation with midazolam. Annals of Pharmacotherapy. 1993, 27 (5): 579–81. PMID 8347907. doi:10.1177/106002809302700509.
56. Beeley, L. Benzodiazepines and tinnitus. BMJ. 1991, 302 (6790): 1465. doi:10.1136/bmj.302.6790.1465.
57. Mellor, CS; Jain, VK. Diazepam withdrawal syndrome: Its prolonged and changing nature. Canadian Medical Association Journal. 1982, 127 (11): 1093–6. PMC 1862031 . PMID 7139456.
58. Olajide, Dele; Lader, Malcolm. Depression following withdrawal from long-term benzodiazepine use: A report of four cases. Psychological Medicine. 2009, 14 (4): 937–40. PMID 6152745. doi:10.1017/S0033291700019899.
59. Rosebush, Patricia I.; Mazurek, Michael F. Catatonia After Benzodiazepine Withdrawal. Journal of Clinical Psychopharmacology. 1996, 16 (4): 315–9. PMID 8835707. doi:10.1097/00004714-199608000-00007.
60. Deuschle, M.F.; Lederbogen, F. Benzodiazepine Withdrawal - Induced Catatonia. Pharmacopsychiatry. 2001, 34 (1): 41–2. PMID 11229621. doi:10.1055/s-2001-15188.
61. Kanemoto, Kousuke; Miyamoto, Toshio; Abe, Ryuji. Ictal catatonia as a manifestation of de novo absence status epilepticus following benzodiazepine withdrawal. Seizure. 1999, 8 (6): 364–6. PMID 10512781. doi:10.1053/seiz.1999.0309.
62. Metten, Pamela; Crabbe, John C. Genetic Determinants of Severity of Acute Withdrawal from Diazepam in Mice. Pharmacology Biochemistry and Behavior. 1999, 63 (3): 473–9. PMID 10418790. doi:10.1016/S0091-3057(99)00017-9.
63. Haque, W; Watson, DJ; Bryant, SG. Death following suspected alprazolam withdrawal seizures: A case report. Texas Medicine. Vol. 86 no. 1. 1990: 44–7. PMID 2300914.
64. De Bard, ML. Diazepam withdrawal syndrome: A case with psychosis, seizure, and coma. American Journal of Psychiatry. 1979, 136 (1): 104–5. PMID 103443. doi:10.1176/ajp.136.1.104.
65. Provini, F.; Cortelli, P.; Montagna, P.; Gambetti, P.; Lugaresi, E. Fatal insomnia and agrypnia excitata: Sleep and the limbic system. Revue Neurologique. 2008, 164 (8–9): 692–700. PMID 18805303. doi:10.1016/j.neurol.2007.11.003.
66. Berezak, A.; Weber, M.; Hansmann, J.; Tulasne, P.A.; Laporte, B.; Ould Ouali, A. Dépendance physique aux benzodiazépines dans un contexte traumatologique [Benzodiazepine physical dependence in traumatology]. Annales Françaises d'Anesthésie et de Réanimation. 1984, 3 (5): 383–4. doi:10.1016/S0750-7658(84)80078-7 （法语）.
67. Turkington, Douglas; Gill, Paul. Mania induced by lorazepam withdrawal: A report of two cases. Journal of Affective Disorders. 1989, 17 (1): 93–5. PMID 2525581. doi:10.1016/0165-0327(89)90028-1.
68. Lapierre, YD; Labelle, A. Manic-like reaction induced by lorazepam withdrawal. The Canadian Journal of Psychiatry. 1987, 32 (8): 697–8. PMID 3690487. doi:10.1177/070674378703200812.
69. Kawajiri, M; Ohyagi, Y; Furuya, H; Araki, T; Inoue, N; Esaki, S; Yamada, T; Kira, J. A patient with Parkinson's disease complicated by hypothyroidism who developed malignant syndrome after discontinuation of etizolam. Rinsho Shinkeigaku. 2002, 42 (2): 136–9. PMID 12424963.
70. Strawn, Jeffrey; Keck Jr, PE; Caroff, SN. Neuroleptic Malignant Syndrome. American Journal of Psychiatry. 2007, 164 (6): 870–6. PMID 17541044. doi:10.1176/ajp.2007.164.6.870.
71. Khan, A; Joyce, P; Jones, AV. Benzodiazepine withdrawal syndromes. The New Zealand medical journal. 1980, 92 (665): 94–6 [2018-04-05]. PMID 6107888. （原始内容存档于2019-12-02）.
72. Peh, LH; Mahendran, R. Psychiatric complications of Erimin abuse. Singapore medical journal. 1989, 30 (1): 72–3. PMID 2595393.
73. Fruensgaard, K. Withdrawal Psychosis: A Study of 30 Consecutive Cases. Acta Psychiatrica Scandinavica. 1976, 53 (2): 105–18. PMID 3091. doi:10.1111/j.1600-0447.1976.tb00065.x.
74. Einarson, A; Selby, P; Koren, G. Abrupt discontinuation of psychotropic drugs during pregnancy: Fear of teratogenic risk and impact of counselling. Journal of Psychiatry & Neuroscience. 2001, 26 (1): 44–8. PMC 1408034 . PMID 11212593.
75. Citrome, Leslie; Volavka, Jan. Violent Patients in the Emergency Setting. Psychiatric Clinics of North America. 1999, 22 (4): 789–801. PMID 10623971. doi:10.1016/S0193-953X(05)70126-X.