Paradoxical reactions to benzodiazepines in the elderly

The prevalence of paradoxical reactions to benzodiazepines is estimated of about 1% in the general population. The semiology can be very rich, diverse and misleading. Advanced age as well as cognitive disorders are classically described in the literature as risk factors for developing paradoxical reactions. However, the review of the literature has only identified a limited number of articles focusing on the elderly and only one article for patients with neurocognitive disorders. One may wonder about this paradox and whether these are unpublished clinical observations, or whether the elderly population is really at risk, especially patients with neurocognitive disorders. Semiology can be confused with underlying neurocognitive disorders. So, paradoxical reactions are ultimately only rarely or not evoked leading to a very high risk of iatrogeny. It is therefore important to be aware of these paradoxical effects in order to be able to evoke them quickly. The most striking semiological element would be the suddenness of onset of self-aggressive or hetero-aggressive behaviors.

Automated summary

The prevalence of paradoxical reactions to benzodiazepines is estimated at about 1% in the general population. Although advanced age and cognitive disorders are known risk factors, there is a lack of literature focusing on the elderly and patients with neurocognitive disorders. It is crucial to be aware of these paradoxical effects and be able to recognize and address them quickly, especially due to the potential high risk of iatrogeny.