Early Morning Insomnia, Daytime Anxiety, and Organic Mental Disorder Associated with Triazolam
Early Morning Insomnia, Daytime Anxiety, and Organic Mental Disorder Associated with Triazolam Tjiauw-Ling Tan, MD, Edward 0. Bixler, PhD, Anthony Kales, MD, Roger J. Cadieux, MD, and Amy L. Goodman, MD Hershey, Pennsylvania A psychiatric syndrome characterized by agita Sleep Disorders Clinic. He began taking triazolam tion, paranoid ideation, depersonalization, and de at bedtime in a 0.5-mg dose eight months before pression, as well as paresthesias and hyperacusis, his referral. Although the drug was effective ini has been attributed to administration of triazolam tially, tolerance developed, causing the patient to (Halcion).1 The occurrence of these reactions led gradually increase the dosage until eventually he to the removal of the drug from the market in the was taking a total of 1.5 mg nightly. Netherlands. Isolated behavioral side effects that The physical examination revealed no contribu include amnesia2-4 and hallucinations5 have also tory conditions. However, assessment of the pa been reported with administration of triazolam. tient’s mental status revealed that he was extreme Rebound insomnia6 and early morning insom ly guarded and suspicious and preoccupied with nia,7 both associated with increases in daytime his sleeplessness to the degree that this hypochon anxiety,7,8 are withdrawal syndromes known driacal concern had a delusional quality. He also to occur with rapidly eliminated benzodiazepine described two episodes indicating memory impair hypnotics such as triazolam. Rebound insomnia ment; both incidents occurred in the late afternoon consists of a marked increase in wakefulness and involved preparing to eat certain foods, which above baseline levels following drug withdrawal.
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