Comparison of the frequency of behavioral disinhibition on alprazolam, clonazepam, or no benzodiazepine in hospitalized psychiatric patients

Several case reports have suggested that treatment with the benzodiazepine alprazolam can result in behavioral disinhibition. To address this question , the authors reviewed the medical records (blinded to all pharmacologic tr eatments the patients received) of 323 psychiatric inpatients treated with alprazolam (108 patients), clonazepam (111 patients), or no benzodiazepine (104 patients) between January 1989 and June 1990, During benzodiazepine tr eatment, there were no significant differences among the three groups on th e following measures: (I) acts of self-injury (alprazolam, 1.9%; clonazepam , 1.8%; no benzodiazepine, 2.9%); (2) assaults on staff or other patients ( alprazolam, 0%; clonazepam, 0.9%; no benzodiazepine, 1.0%); (3) need for se clusion or restraints (alprazolam, 3.7%; clonazepam, 6.3%; no benzodiazepin e, 4.8%); (4) increased need for observation by hospital staff (alprazolam, 8.3%; clonazepam, 7.2%; no benzodiazepine, 6.7%); and (5) decrease in pati ent privileges (alprazolam, 11.1%; clonazepam, 12.6%; no benzodiazepine, 11 .5%), The results indicate that in an inpatient psychiatric population, the frequency of behavioral disturbances with alprazolam, clonazepam, or no be nzodiazepine does not differ. This suggests that alprazolam does not posses s unique disinhibitory activity. Second, these data suggest that disinhibit ion may not be an important clinical problem associated with benzodiazepine use. The design of the study does not allow one to establish a relationshi p between the prescription of the benzodiazepine and worsening behaviors, a nd the findings need to be interpreted conservatively because it was a retr ospective review of a heterogeneous population. However, it is noteworthy t hat the incidence of adverse events was low even in this high-risk populati on, and because the patients were in the hospital and under constant observ ation, the objective assessment of so-called paradoxical reactions was unde rtaken in a controlled setting.