Patient emergency assessment following deliberate self-poisoning with benzodiazepines: Can cognitive markers predict recall of the psychiatric interview? A pilot study

Memory impairment following intentional self-poisoning with benzodiazepines: Should we pay more attention to attention?

STUDY HYPOTHESIS

In cases where patients attempt suicide through intentional self-poisoning, they often ingest drugs such as benzodiazepines that alter the central nervous system and memory. This is problematic, given that experts recommend the recovery of a patient's cognitive capacity before any psychiatric assessment is conducted. A previous pilot study by our group showed that cognitive tests focusing on attention are the most valuable when it comes to determining whether sufficient cognitive recovery has occurred to ensure that patients will remember the assessment after intentional self-poisoning with benzodiazepines. The main aim of our study was to determine cognitive predictors of the recall of the psychiatric assessment after a suicide attempt. The second aim was to determine the threshold for episodic memory.

METHODS

We recruited 97 patients admitted for intentional self-poisoning. At the time of the psychiatric assessments, we quantified plasma benzodiazepine levels and performed a cognitive assessment. We then used a linear regression model to identify the associations in a control and a benzodiazepine group between cognitive functions and episodic memory scores obtained 24 hours after psychiatric assessment.

RESULTS

Our model accounted for 28% and 37%, respectively, of the variance in memory in the control and benzodiazepine groups. The most significant correlations were found for the Wechsler Adult Intelligence Scale coding test in both groups. In the control group, tests such as visual and verbal memory were also associated with recall.

CONCLUSIONS

Benzodiazepines particularly affect memory by impairing what is remembered of attentional tests. These are, however, the most suitable cognitive tests for predicting recall of the memory assessment.

The effect of short-term use of benzodiazepines on cognitive function of major depressive disorder patients being treated with antidepressants

BACKGROUND

This study aimed to evaluate the effect of short-term use of benzodiazepines (BZDs) on cognitive function of major depressive disorder (MDD) patients being treated with antidepressants (ADs).

METHODS

This was a part of a multi-center, multi-stage and prospective study of "Objective Diagnostic Indicators and Individualized Drug Intervention of Major Depressive Disorder (OIMDD)". Three hundred and fifty-three patients treated with the selective serotonin reuptake inhibitors (SSRIs) alone (Group 1) and 49 patients treated with SSRIs combined with short-term use of BZDs (Group 2) during the acute treatment period were included in the analysis. Cognitive function and depressive and anxiety symptoms were assessed at baseline, weekend 8 and 48. A cognitive test battery included 5 domains: information processing speed assessed by the Animal Verbal Fluency Scale (AVFS), Digit Symbol Coding Test (DSCT) and Color Trial Test (CTT), verbal learning assessed by the Hopkins Verbal Learning Test-Revised (HVLT-R), visual learning assessed by the Brief Visual Memory Test-Revised (BVMT-R), executive function assessed by the Stroop Color Word Test (SCWT), and attention or vigilance assessed by the Continuous Performance Test (CPT).

RESULTS

Significant differences were found in education level (χ² = 5.442, p = 0.020), the severity of depressive (t = -1.982, p = 0.048) and anxiety symptoms (t = -2.629, p = 0.009) between Group 1 and 2 at baseline. There were no significant differences between G1 and G2 in cognitive functions at baseline. After Multiple correction, DSCT was better in patients treated with BZDs combined with ADs than in patients with ADs alone at weekend 8 without controlling education level, depressive and anxiety symptoms at baseline (F = -2.747, p = 0.042). After controlling these factors at baseline, the DSCT was still slightly high in patients treated with ADs combined with BZDs than in patients with ADs alone at weekend 8 (OR = 1.052, 95%CI:1.000-1.105). The repeated measurement analysis of variance showed that the DSCT could be improved by the treatment of BZDs combined with ADs at 1-year follow-up compared to baseline (F = 7.569, p = 0.006).

CONCLUSIONS

The findings suggest that short-term use of BZDs does not impair cognitive function of MDD patients; conversely, it could improve the information processing speed after acute treatment and at 1 year follow up.