Sedatif, Hipnotik ve Anksiyolitik Kullanımıyla İlişkili Bozukluklar
Özet
Sedatif, hipnotik ve anksiyolitik ilaçlar, GABA-A reseptörleri üzerinden etki gösteren ve benzodiazepinler, barbitüratlar ve Z grubu ilaçlar olarak sınıflandırılan maddelerdir. Tarisel süreçte ilk olarak bromidler, ardından sedatif, hipnotik, antikonvülzan ve kas gevşetici etkileri nedeniyle barbitüratlar kullanılmış; ancak solunum depresyonu ve bağımlılık riskinin azlığı sebebiyle daha sonra benzodiazepinler tercih edilmiştir. Barbitüratlar yüksek dozlarda ciddi hayati risk taşırken, benzodiazepinler de yaygın kullanımlarına rağmen kısa sürede bağımlılık ve fiziksel tolerans geliştirme riski taşımaktadır. DSM-5'e göre, 12 aylık bir dönemde işlevsellikte düşüşe yol açan kriterlerden en az ikisinin varlığı kullanım bozukluğu tanısı için gereklidir. İntoksikasyon vakalarında solunum desteği hayati önem taşırken, benzodiazepin ve Z grubu ilaç zehirlenmelerinde flumazenil kullanılır. Tedavi süreçlerinde yavaş doz azaltımı ve bilişsel davranışçı terapiler gibi psikolojik müdahaleler uygulanmakta, ancak ileri yaş ve komorbid maddelerin varlığı prognozu olumsuz etkilemektedir. Bağımlılık potansiyeli en yüksek olandan en düşüğe doğru barbitüratlar, benzodiazepinler ve Z grubu ilaçlar sıralanmaktadır. Dolayısıyla, özellikle yaşlılar ve ek madde kullanımı olan riskli gruplarda endikasyon dışı veya uzun süreli kullanımdan kaçınılmalıdır.
Sedative, hypnotic, and anxiolytic drugs are substances that act through GABA-A receptors and are classified as benzodiazepines, barbiturates, and Z-group drugs. Historically, bromides were used first, followed by barbiturates for their sedative, hypnotic, anticonvulsant, and muscle relaxant effects; however, benzodiazepines were later preferred due to their lower risk of respiratory depression and dependence. While barbiturates carry a severe vital risk at high doses, benzodiazepines also pose a risk of developing dependence and physical tolerance within a short period despite their widespread use. According to DSM-5, the presence of at least two criteria leading to a decline in functioning over a 10-month period is required for the diagnosis of a use disorder. In cases of intoxication, respiratory support is of vital importance, while flumazenil is utilized in benzodiazepine and Z-group drug poisonings. Treatment processes involve gradual dose reduction and psychological interventions such as cognitive behavioral therapies, but advanced age and the presence of comorbid substances negatively affect the prognosis. Barbiturates, benzodiazepines, and Z-group drugs are ranked from highest to lowest potential for dependence. Therefore, off-label or long-term use should be avoided, particularly in risky groups such as the elderly and those with additional substance use.
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