Lorazepam 남용 6례

6 Cases of Lorazepam Abuse

With brief review of literatures on abuse of benzodiazepines, the author reported 6 cases of lorazepam abuse and discussed their characteristic clinical features. Of 6 cases, 5 were females and the daily dosages of lorazepam were 20 to 150mg and durations of abuse were 6 months to 7 years. Their premorbid personality was characterized by dependence, introversion, social isolation and sensitivity. They had begun to abuse the drug mainly due to anxiety, insomnia and neurotic somatic symptoms soon after object loss such as death of significant persons. Accordingly, it seemed that abuse resulted from defense against object loss and from oral gratifica-tion. As combined substances, alcohol, analgesics, diuretics and psychostimulants were reported in some of the patients. All the patients said that they had to take the drug and had to increase the dosage to relieve anxiety, insomnia, and neurotic somatic symptoms, but some of the patients expected or experienced some euphoric effect from lorazepam. Though the dosage was very heavy and the duration of abuse was so extended, no significant physical side effects or complications were found in any of them except drowsiness and weakness that could be found with therapeutic dose. Tolerance seemed to develop in relatively short time and the main reason seemed to be strong oral craving, culminating to psychological dependence rather than physical dependence. On withdrawal, severe anxiety, insomnia and somatic symptoms as headache and agitation have developed in all patients, which were considered as rebound phenomena. In addition, rigidity and tremor around mouth and extremities, paresthesia, perspiration, impulsive destructive behavior, depression, and psychosis-like menifestations which could be considered as true withdrawal symptoms have developed in some patients who had taken larger dcses of about lOOmg a day. Most of them have been treated in hospital with medically supportive treatment, complete discontinuation of lorazepam and medication of tricyclic antidepressants and phenothiazines against possible withdrawal symptoms. The treatment result was successful on a short term but in long term perspective, prognosis may be less favourable. The clinical feature of not to be so different from benzodiazdpine abuses. lorazepam abuse seems general feature of other benzodiazdpine abuses.