Journal of the Academy of Consultation-Liaison Psychiatry · 2026
Clinical Characteristics and Treatment of Benzodiazepine Withdrawal Delirium in Adults: An Illustrative Case and Systematic Review of Published Cases.
Клинический случайСтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Al-Soleiti Majd, Park Jin Hong, Kummerlowe Megan N, Kinzelman-Vesely Elissa, Gerberi Dana J, Philbrick Kemuel L, Fipps David C
Аннотация
BACKGROUND: Benzodiazepines (BZDs) are widely prescribed in diverse populations and BZD withdrawal can cause delirium, especially for individuals with chronic use patterns.
OBJECTIVE: This paper identifies an illustrative case of benzodiazepine-withdrawal delirium and reviews the literature regarding the complex clinical presentation and subsequent management strategies.
METHODS: We present a case in which withdrawal from long-term use of lorazepam before a medical admission contributed to complex delirium and how this was managed. This is followed by a literature search of English language articles that was carried out from inception through September 2025. Data were abstracted regarding benzodiazepine-withdrawal delirium. Search terms included "benzodiazepine," all types of BZD, "withdrawal," and "delirium." Case reports/series were included. Data extracted included demographics, BZD exposure, psychiatric and medical comorbidities, delirium characteristics, withdrawal context, diagnostic findings, assessment scales, treatments, and outcomes.
RESULTS: A total of 1997 articles were reviewed, with 35 articles undergoing full-text extraction, and 19 articles eventually included. Case reports/series published between 1977 and 2025 described 24 benzodiazepine-withdrawal delirium cases (including our illustrative case), with ages 27 to 84 y (mean 55.8) and male predominance (63%). Alprazolam, lorazepam, and clonazepam were the most common antecedent BZD, with a median lorazepam milligram equivalent dose of 8.3 mg daily. Previous exposure duration to BZD ranged from 6 wk to 50 y. Delirium onset occurred 12 h to 13 d after dose changes, most often due to tapering or abrupt discontinuation by inpatient health care teams. BZD reinitiation was the primary treatment, using either the original agent or a substitute, leading to complete symptom resolution in 22 cases; standardized delirium scales were not used in any of the cases. All cases involved disorientation and cognitive dysfunction, frequently accompanied by agitation, hallucinations, and persecutory delusions and were typically hyperactive in nature. Common comorbidities included major depressive disorder, BZD use disorder, hypertension, and hypothyroidism.
CONCLUSIONS: BZD can contribute to delirium in the setting of acute discontinuation without prior taper. It is important to review and reconcile BZD schedules of newly admitted patients to minimize the risk of iatrogenic-withdrawal delirium in inpatient settings.
OBJECTIVE: This paper identifies an illustrative case of benzodiazepine-withdrawal delirium and reviews the literature regarding the complex clinical presentation and subsequent management strategies.
METHODS: We present a case in which withdrawal from long-term use of lorazepam before a medical admission contributed to complex delirium and how this was managed. This is followed by a literature search of English language articles that was carried out from inception through September 2025. Data were abstracted regarding benzodiazepine-withdrawal delirium. Search terms included "benzodiazepine," all types of BZD, "withdrawal," and "delirium." Case reports/series were included. Data extracted included demographics, BZD exposure, psychiatric and medical comorbidities, delirium characteristics, withdrawal context, diagnostic findings, assessment scales, treatments, and outcomes.
RESULTS: A total of 1997 articles were reviewed, with 35 articles undergoing full-text extraction, and 19 articles eventually included. Case reports/series published between 1977 and 2025 described 24 benzodiazepine-withdrawal delirium cases (including our illustrative case), with ages 27 to 84 y (mean 55.8) and male predominance (63%). Alprazolam, lorazepam, and clonazepam were the most common antecedent BZD, with a median lorazepam milligram equivalent dose of 8.3 mg daily. Previous exposure duration to BZD ranged from 6 wk to 50 y. Delirium onset occurred 12 h to 13 d after dose changes, most often due to tapering or abrupt discontinuation by inpatient health care teams. BZD reinitiation was the primary treatment, using either the original agent or a substitute, leading to complete symptom resolution in 22 cases; standardized delirium scales were not used in any of the cases. All cases involved disorientation and cognitive dysfunction, frequently accompanied by agitation, hallucinations, and persecutory delusions and were typically hyperactive in nature. Common comorbidities included major depressive disorder, BZD use disorder, hypertension, and hypothyroidism.
CONCLUSIONS: BZD can contribute to delirium in the setting of acute discontinuation without prior taper. It is important to review and reconcile BZD schedules of newly admitted patients to minimize the risk of iatrogenic-withdrawal delirium in inpatient settings.