« on: November 01, 2019, 08:58:41 pm »
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Hi Everyone,

I have witnessed a lot of frustration from members who are baffled that their doctors have not heard of Protracted Withdrawal associated with benzodiazepines.  This may be due in part from a mixed bag of terms used in conjunction with the condition.  The term officially recognized by the National Library of Medicine (NLM) and the National Institutes of health is ‘Organic Brain Syndrome (OBS).’  Here I will present the following:

I Clinical evidence that benzodiazepines cause OBS

II Long lasting Benzo induced OBS is recognized by the National Library of Medicine (NLM)/National Institutes of Health (NIH)

III Meta-analysis supporting the existence of possible long-term mental deficits incurred from long-term benzo usage

IV A proposal to replace the term OBS with a diagnosis of Chronic Brain Impairment (CBI) to better reflect the condition of mental impairment induced by long-term administration of psychiatric medication

V A list of prerequisites to qualify for Social Security Disability benefits under ‘Organic Mental Disorders’ for those who are too sick to work (you will need to discuss this with your doctor)

First off we need to establish the existence of OBS in conjuction with benzo withdrawal.  Here are excerpts from a medical paper describing 8 cases of withdrawal from benzodiazepines where OBS was observed occurring after benzo discontinuation.  The condition was confirmed as being benzo induced as reinstatement of the drug resulted in disappearance of the OBS symptoms:

Benzodiazepine Withdrawal Syndromes.
Khan A, Joyce P, Jones AV.
N Z Med J. 1980 Aug 13;92(665):94-6. PMID: 6107888

“We report eight cases of benzodiazepine withdrawal syndromes seen in a general psychiatric hospital. These consisted of acute organic brain syndrome, grand mal convulsions and abstinence syndromes. All of the cases were using benzodiazepines in prescribed therapeutic doses. These problems appear to be more common than are generally acknowledged…
In all cases of acute organic brain syndrome a benzodiazepine was substituted resulting in marked improvement in mental status and thus confirming the diagnosis.

Next, the NLM/NIH website Medline Plus lists withdrawal from sedative hypnotics as a cause of OBS states that the length of time of the condition may be long-term in nature (Note: benzos are sedative hypnotics):

Organic Brain Syndrome
Updated by: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
Medline Plus 2/24/2014

Listed below are disorders associated with OBS.
Drug and alcohol-related conditions
•   Alcohol withdrawal state
•   Intoxication from drug or alcohol use
•   Wernicke-Korsakoff syndrome (a long-term effect of excessive alcohol consumption or malnutrition)
•   Withdrawal from drugs (especially sedative-hypnotics and corticosteroids)

Outlook (Prognosis)
Some disorders are short-term and treatable, but many are long-term or get worse over time.”

A Meta-analysis showed that after 6 months of abstinence, long-term benzodiazepine users mental deficits persisted, supporting a OBS diagnosis:

Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis.
Barker MJ, Greenwood KM, Jackson M, Crowe SF.
Arch Clin Neuropsychol. 2004 Apr;19(3):437-54. PMID:15033227

”Results of the meta-analyses indicated that long-term benzodiazepine users do show recovery of function in many areas after withdrawal. However, there remains a significant impairment in most areas of cognition in comparison to controls or normative data. The findings of this study highlight the problems associated with long-term benzodiazepine therapy and suggest that previous benzodiazepine users would be likely to experience the benefit of improved cognitive functioning after withdrawal. However, the reviewed data did not support full restitution of function, at least in the first 6 months following cessation and suggest that there may be some permanent deficits or deficits that take longer than 6 months to completely recover.

Dr. Peter Breggin has proposed a new term , Chronic Brain Impairment (CBI) for this condition, pointing out that the term OBS has become obsolete in some clinics:

Psychiatric drug-induced Chronic Brain Impairment (CBI): implications for long-term treatment with psychiatric medication.
Breggin PR.
Int J Risk Saf Med. 2011;23(4):193-200. doi: 10.3233/JRS-2011-0542. Review. PMID: 22156084

“Drawing on the scientific literature and clinical experience, the author describes the syndrome of Chronic Brain Impairment (CBI) which can be caused by any trauma to the brain including Traumatic Brain Injury (TBI), electroconvulsive therapy (ECT), and long-term exposure to psychiatric medications. Knowledge of the syndrome should enable clinicians to more easily identify long-term adverse effects caused by psychiatric drugs while enabling researchers to approach the problem with a more comprehensive understanding of the common elements of brain injury as they are manifested after long-term exposure to psychiatric medications…

Studies of all classes of psychiatric drugs have yielded similar findings of mental dysfunction and atrophy of the brain in humans after long term exposure, as well as atrophy of the brain, abnormal proliferations of cells and persistent biochemical changes in animals [5]; for the benzodiazepines [15, 16], for lithium see [17] for antidepressants see [18–22]…

The syndrome of Chronic Brain Impairment (CBI)
The clinical effect of chronic exposure to psychoactive substances, including psychiatric drugs, produces effects very similar to those of close-head injury due to traumatic brain injury (TBI) [23] or the Postconcussive Syndrome [24]. Generalized or global harm to the brain from any cause produces very similar mental effects. The brain and its associated mental processes respond in a very similar fashion to injuries from causes as diverse as electroshock treatment [25] closed head injury from repeated sports-induced concussions or TBI in wartime, chronic abuse of alcohol and street drugs, long-term exposure to psychiatric polydrug treatment, and long-term exposure to particular classes of psychiatric drugs including stimulants, benzodiazepines, lithium and antipsychotic drugs…

Based on these observations I have proposed the syndrome and diagnosis of Chronic Brain Impairment (CBI).2 The specific cause of the CBI is added as a prefix, as in Alprazolam CBI, Antipsychotic Drug CBI, or Poly Psychiatric Drug CBI.3 Other examples are ECT CBI, Polydrug Abuse CBI, and Concussive CBI.

The concept of CBI also resembles the concept of organic brain syndrome (OBS). However, OBS is no longer used in the diagnostic system or in clinical practice [26]. When used in the past [27], it was not defined as a specific syndrome or a specific diagnosis with defined criteria…It did not have the nuance and broad spectrum of effects associated with CBI.

Most patients begin to recover from CBI early in the withdrawal process. Many patients, especially children and teenagers, will experience complete recovery. Others may recover over a period of years. Even when recovery is incomplete, or psychiatric relapses occur off the medication, most patients remain grateful for their improved CBI, and wish to remain on reduced medication or none at all.”

Lastly I have included information for you to review to see if you may qualify for Social Security Disability if you are unable to work due to your withdrawal.  The first step would be to present this information to your doctor to get the correct diagnosis of OBS and then take it to Social Security when you apply for benefits.  I do not know whether they will approve you or not but if you meet all of the requirements listed below I should think you would have a good chance.

Disability Evaluation Under Social Security
12.00 Mental Disorders – Adult

12.02 Organic mental disorders: Psychological or behavioral abnormalities associated with a dysfunction of the brain. History and physical examination or laboratory tests demonstrate the presence of a specific organic factor judged to be etiologically related to the abnormal mental state and loss of previously acquired functional abilities.
The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied.

A. Demonstration of a loss of specific cognitive abilities or affective changes and the medically documented persistence of at least one of the following:
1. Disorientation to time and place; or
2. Memory impairment, either short-term (inability to learn new information), intermediate, or long-term (inability to remember information that was known sometime in the past); or
3. Perceptual or thinking disturbances (e.g., hallucinations, delusions); or
4. Change in personality; or
5. Disturbance in mood; or
6. Emotional lability (e.g., explosive temper outbursts, sudden crying, etc.) and impairment in impulse control; or
7. Loss of measured intellectual ability of at least 15 I.Q. points from premorbid levels or overall impairment index clearly within the severely impaired range on neuropsychological testing, e.g., the Luria-Nebraska, Halstead-Reitan, etc;


B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration;


C. Medically documented history of a chronic organic mental disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following:
1. Repeated episodes of decompensation, each of extended duration; or
2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or
3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.

I hope you find this information helpful and wish you all the best in your recovery.

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