停用苯二氮平後之睡眠剝奪引起短暫精神病疾患或譫妄－－兩例報告及文獻回顧

Sleep Deprivation Induced Brief Psychotic Disorder or Delirium after Cessation of Benzodiazepines － Two Case Reports and a Review of the Literature

睡眠剝奪(sleep deprivation)是現代社會常見的問題。常見引起睡眠剝奪的原因如精神疾患、物質濫用、身體疾患、藥物副作用、工作因素等。已有許多研究證實睡眠剝奪對生理與心理健康的影響。本文報告兩罕見案例，分別為停用苯二氮平(benzodiazepine)後之睡眠剝奪引起短暫精神病疾患(brief psychotic disorder)與譫妄(delirium)。案例一74歲男性，連續服用高劑量flunitrazepam 4mg三個月，停藥後出現急性完全睡眠剝奪，且於停藥後第14天出現被害妄想，第20天出現身體妄想、幻聽等症狀。案例二49歲女性，連續服用flunitrazepam 2mg約四年，停藥後亦出現急性完全睡眠剝奪，且於停藥後第三天出現譫妄。案例一、二皆因服用高劑量flunitrazepam，停藥後造成睡眠剝奪，引發後續精神疾患，且兩案例之精神症狀皆於睡眠改善後消失，因此推論其精神症狀可能由睡眠剝奪引起。本文藉由案例分析與文獻回顧，探討睡眠剝奪可能引發之生理與心理疾患。此外，簡介苯二氮平類藥物之正確使用原則，與失眠之非藥物治療。本文之目的在於期望改善國人睡眠相關疾患，與減少苯二氮平類藥物濫用問題。

Sleep deprivation is a serious problem in modern society. Common causes of sleep deprivation include mental and physical illness, substance misuse, adverse effects of medications, and job stress. Many studies confirm that sleep deprivation results in a deterioration of mental and physical health. We report two rare cases in which sleep-deprivation after cessation of benzodiazepines induced a brief psychotic disorder in one and delirium in the other. The first patient, a 74-year-old male, had suffered from acute total sleep deprivation after he stopped taking a high dose of flunitrazepam at 4mg daily for three months. He then developed persecutory delusions on day 14 and somatic delusions and auditory hallucinations on day 20. The second patient, a 49-year-old female, also suffered from acute total sleep deprivation after she stopped taking flunitrazepam 2mg daily for four years. Delirium was observed on day three. The two patients had stopped a high dose of flunitrazepam abruptly and then experienced sleep deprivation. After that, they both suffered from transient mental illness. Based on the case analyses and literature review, we discussed what physical and mental illnesses might be induced by sleep deprivation. We also discussed the treatment principles for benzodiazepines and suggested non-pharmaceutical therapies for insomnia.