Sedative, Hypnotic, or Anxiolytic (Benzodiazepine) Intoxication

• The prevalence is not well known.^[2]
  • The prevalence of non-medical sedative, hypnotic, or anxiolytic use in the general population may be similar to the prevalence of sedative, hypnotic, or anxiolytic intoxication.

• Similar to alcohol intoxication, the risks include operation of vehicles that could result in car accidents.
• During the acute phase of intoxication, individuals may be unaware of their surroundings and at risk for injury.
• Some individuals may mix different sedative, hypnotic, or anxiolytic agents with alcohol, which can markedly increase the effects of these agents, and increase the risk for overdose and respiratory depression.

Recent use of a sedative, hypnotic, or anxiolytic.

Clinically significant maladaptive behavioural or psychological changes (e.g. - inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, sedative, hypnotic, or anxiolytic use.

At least 1 of the following signs or symptoms developing during, or shortly after, sedative, hypnotic, or anxiolytic use:

1. Slurred speech
2. Incoordination
3. Unsteady gait
4. Nystagmus
5. Impairment in cognition (e.g. - attention, memory)
6. Stupor or coma

The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

• Like with other depressants (e.g. - alcohol) individuals with this intoxication can have slurred speech, incoordination (e.g. - impaired driving abilities), unsteady gait, nystagmus, cognitive impairment (e.g. - attentional or memory problems), and stupor or coma.^[3]
• Memory impairment is the most prominent feature of a sedative, hypnotic, or anxiolytic intoxication
  • Individuals may have an anterograde amnesia that resembles a “alcohol-induced blackout.”^[4]

• Alcohol use disorders
  • Since the clinical presentations may be identical, distinguishing sedative, hypnotic, or anxiolytic intoxication from alcohol use requires evidence for recent ingestion of a sedative, hypnotic, or anxiolytic medications (either by self-report, informant report, or toxicological investigations). Many individuals may misuse both, so multiple diagnoses are possible.
• Alcohol intoxication
  • Alcohol intoxication may be distinguished from sedative, hypnotic, or anxiolytic intoxication by the smell of alcohol on the breath. Otherwise, the features of the two disorders may be similar.
• Other sedative-, hypnotic-, or anxiolytic-induced disorders
  • Sedative, hypnotic, or anxiolytic intoxication is distinguished from the other sedative-, hypnotic-, or anxiolytic- induced disorders (e.g. - sedative-, hypnotic-, or anxiolytic-induced anxiety disorder, with onset during withdrawal) because the symptoms in the induced disorder predominate in the clinical presentation and are severe enough to warrant separate clinical attention.
• Neurocognitive disorders
  • In cognitive impairment, traumatic brain injury, and/or delirium, the use of sedatives, hypnotics, or anxiolytics can be intoxicating at very low doses. The differential diagnosis in these complex settings is based on the predominant syndrome. An additional diagnosis of sedative, hypnotic, or anxiolytic intoxication may be appropriate even if the substance has been ingested at a low dosage in the setting of these conditions.

• Urine drug screens may be helpful to identity a sedative, hypnotic, or anxiolytic intoxication.
• However, the diagnosis can be made clinically based on history without any specific investigations.

• Signs of intoxication include slurred speech, poor motor coordination, nystagmus, and cognitive impairment.

• In the absence of severe cardiorespiratory compromise (in which case acute and critical care may be needed), intoxication can be managed conservatively.
• Flumazenil (a benzodiazepine receptor antagonist) can used in acute overdose or severe toxicity, but it is rarely used as it can precipitate seizures.