Iatrogenic benzodiazepine withdrawal delirium in hospitalized older patients

OBJECTIVE: The purpose of this review was to identify cases of benzodiazepine withdrawal delirium in a population of older hospitalized patients and to determine whether the withdrawal was caused by iatrogenic factors. DESIGN: Retrospective chart review of selected cases from a referred sample. A Bayesian Adverse Reactions Diagnosis Instrument (BARDI) was applied to cases of benzodiazepine withdrawal delirium to quantify the probability that drug withdrawal was the causative mechanism. SETTING: A university-affiliated health sciences center. PATIENTS: A review of the psychiatric consultation liaison service database for a consecutive 4-month period yielded 21 cases of delirium in a referred sample of 119 patients more than 65 years of age. Four cases of benzodiazepine withdrawal were identified within the group of patients with delirium, and retrospective chart review identified potential iatrogenic causes for withdrawal in three patients. RESULTS: The posterior possibilities calculated by the BARDI for the three cases of delirium were 0.98, 0.95, and 0.75, indicating a high probability that the delirium was caused by benzodiazepine withdrawal. CONCLUSIONS: Benzodiazepine withdrawal delirium in older hospitalized patients may be associated with iatrogenic factors.