Amnestic effects of triazolam and other hypnotics

Le traitement cognitivo-comportemental de l’insomnie et son utilisation lors de l’arrêt des hypnotiques

L’insomnie constitue un problème de santé très répandu menant souvent à l’utilisation d’hypnotiques. Parmi les agents pharmacologiques disponibles pour traiter l’insomnie, les benzodiazépines (BZD) sont les plus prescrites. Bien qu’efficaces pour améliorer le sommeil à court terme, les BZD présentent certains effets indésirables, entraînent des risques de tolérance et de dépendance, et augmentent le risque d’accidents de la route, de chutes et de fractures chez les personnes âgées. Le traitement cognitivo-comportemental (TCC) de l’insomnie, qui met l’accent sur les facteurs psychologiques et comportementaux jouant un rôle dans le maintien des difficultés de sommeil, est efficace pour améliorer le sommeil des personnes aux prises avec un trouble d’insomnie primaire. Il peut représenter une alternative à la pharmacothérapie ou encore être un complément thérapeutique facilitant lors de l’arrêt des hypnotiques. Le TCC de l’insomnie peut inclure différentes composantes, telles que le contrôle par le stimulus, la restriction du sommeil, la relaxation, la restructuration cognitive et l’hygiène du sommeil. Chez les personnes dépendantes aux BZD ou autres hypnotiques, un sevrage supervisé, basé sur l’atteinte d’objectifs successifs, s’ajoute généralement au TCC de l’insomnie.

Benzodiazepine-induced persisting amnestic disorder: are older adults at risk?

Currently there are approximately 31.5 million Americans 65 years and older. This number is expected to reach 39.3 million by 2010. This group represents 12% of the population, however, they use 25% to 40% of the prescription medications, averaging 4.5 medications daily; 75% of them use over-the-counter medications as well. This population has also experienced an increase in the prescription of central nervous system (CNS) medications. Benzodiazepines are the most widely prescribed class of CNS antianxiety/sedative medication. This article examines the use of benzodiazepines in relation to physiological, pharmacokintic, and pharmacodynamic changes of the older adult. The amnestic properties of these drugs in relation to the already decreasing cognitive function of the older adult are explored in relationship to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for substance-induced persisting amnestic disorder.

Triazolam impairs delayed recall but not acquisition of various everyday memory tasks in humans

A double-blind test battery was administered to 24 human subjects (8 control, 16 drug) to assess the effects of 0.125 mg triazolam (oral) on memory encoding and retention across delay intervals ranging from seconds to 1 week after presentation. Although the drug reduced immediate psychomotor performance, it did not impair recall of previously learned information, nor did it significantly impair encoding of new information. The drug enhanced immediate recall of the location and identity of playing cards, without affecting 4-h delayed recall. The drug treatment impaired correct recall of object names after a delay of 20 min. At 4 h delay, the drug impaired olfactory recognition and free-recall of object names. At both 1 day and 1 week delay, the drug impaired recall of biographical information and correct identification of picture-photographer pair associations. The drug also impaired the daily improvement of the drug group as compared with the control group in a geometric puzzle solving task. The time course of these memory impairments compares well with the known effects of triazolam on long-term potentiation (LTP), a candidate biological mechanism underlying telencephalic memory formation and expression.