Paradoxical reactions to benzodiazepines.

Paradoxal reactions to benzodiazepines may be presented in different ways. In some persons, primarily older persons and children, especilally with coexisting somatic disorders, paradoxal reactions may be manifested as logoroic speech, unapropriate social behaviour, and psychomotor agitation. Although benzodiazepines lower levels of agression, few studies described that in some persons levels of agression get higher with use of benzodiazepines. From our clinical practice we will present the patient who deveoped changed 'uninhibited' behavour after use of alprazolam perorally. Patient K.M. in age of 41 years, married, with one child, works as a clark at office. He denied psychiatric disoreders in his relatives, and also he denied any somatic disorders. Patient came to the psychiatrist after he had troubles at his job, he was acused of something he didn't do. He desided to ask help after few weeks of troubles in functioning, he couldn't sleep, he was anxious, emotionally instable, he couldn't controll crying, his thougts were peocupaied with problems at job, his communication with his family was disturbed. His wife told him to seek for help. He was diagnsed as Acute reaction to stress, and prescribed alprazolam in small dose od 2x0,25 mg per day. After two weeks he came to controll and described the same symptoms, so his therapy was corrected to alprazolam 3x0,5mg per day. After ten days he came with his wife to controll exam. He was different person as his wife described him. He was angry all the time, he was verbally agressive to family members as well as to their friends. He described that he couldn't keep his mouth quiet, everything that bothered him he yelled about it. He went to his job and was verbally agressive and abusive to his working collleagues. Patient described very high levels of agitation, he couldn't be still at one place. Before his wife described him as very quiet and nice person, he never raised his voice, and always found peacefull solutions to every problem. We told him to stop taking the medication, and he came to controll exam after one week. Two days after the last medication his agression dissapeared, he was ashamed of his behaviour. But he told that lot's of things he sad last few weeks he wanted to say for many years before, but he was too anxious and affraid to do so. Therefore, in this case report it is unclear what really happened, was that desinhibition or not?