title: High-Dose Benzodiazepine Users' Perceptions and Experiences of Anterograde Amnesia.
abstract: Associations between criminal activity and the use of psychotropic substances are well established. Flunitrazepam, specifically, has been suspected of triggering, per se, violent criminal behavior and severe memory disturbances in the form of anterograde amnesia. However, data from investigations of this relationship are scarce and have been primarily derived from forensic institutions, where there may be a reporting bias. This study was a qualitative exploration of high-dose benzodiazepine users' experiences of anterograde amnesia symptoms and their beliefs about their behavior during the phases of memory impairment in a nonforensic setting. Users subjectively reported experiencing symptoms of anterograde amnesia, especially after combining short-acting benzodiazepines with alcohol, but only rarely when using slow-onset, long-acting compounds. They perceived their experiences as unpleasurable, unpredictable, and embarrassing. Their awareness developed with time, triggered by descriptions of disinhibited and erratic behavior by others. Users described being victimized during phases of anterograde amnesia in addition to engaging in violent and criminal activities themselves. Although unable to recall, many participants believed that they had been able to make rational decisions while intoxicated with flunitrazepam, disregarding notions of diminished insight. In light of the varying terminology used for the phases of memory disturbance and these findings, we suggest that forensic experts additionally explore evaluees' beliefs about amnestic periods and their self-perceptions about their behaviors during these episodes, when evaluating high-dose benzodiazepine-dependent patients.
authors.affiliation: Dr. Liebrenz is Head of the Research Division, Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland. Mr. Schneider is Resident Physician, Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland. Dr. Buadze is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Ms. Gehring is a Psychologist and Head of the Residential Rehabilitation Treatment Program, Ulmenhof, Sozialtherapie, Ottenbach, Switzerland. Dr. Dube is Attending Physician, County of Santa Barbara, Department of Behavioral Wellness, Santa Barbara, California. Dr. Caflisch is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Dr. Liebrenz was financially supported by the Prof. Dr. Max Cloëtta Foundation, Zurich, Switzerland and the Uniscientia Foundation, Vaduz, Principality of Liechtenstein. contact@fpd.unibe.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Liebrenz
authors.affiliation: Dr. Liebrenz is Head of the Research Division, Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland. Mr. Schneider is Resident Physician, Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland. Dr. Buadze is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Ms. Gehring is a Psychologist and Head of the Residential Rehabilitation Treatment Program, Ulmenhof, Sozialtherapie, Ottenbach, Switzerland. Dr. Dube is Attending Physician, County of Santa Barbara, Department of Behavioral Wellness, Santa Barbara, California. Dr. Caflisch is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Dr. Liebrenz was financially supported by the Prof. Dr. Max Cloëtta Foundation, Zurich, Switzerland and the Uniscientia Foundation, Vaduz, Principality of Liechtenstein.
authors.forename: Marcel
authors.initials: M
authors.lastname: Schneider
authors.affiliation: Dr. Liebrenz is Head of the Research Division, Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland. Mr. Schneider is Resident Physician, Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland. Dr. Buadze is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Ms. Gehring is a Psychologist and Head of the Residential Rehabilitation Treatment Program, Ulmenhof, Sozialtherapie, Ottenbach, Switzerland. Dr. Dube is Attending Physician, County of Santa Barbara, Department of Behavioral Wellness, Santa Barbara, California. Dr. Caflisch is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Dr. Liebrenz was financially supported by the Prof. Dr. Max Cloëtta Foundation, Zurich, Switzerland and the Uniscientia Foundation, Vaduz, Principality of Liechtenstein.
authors.forename: Anna
authors.initials: A
authors.lastname: Buadze
authors.affiliation: Dr. Liebrenz is Head of the Research Division, Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland. Mr. Schneider is Resident Physician, Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland. Dr. Buadze is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Ms. Gehring is a Psychologist and Head of the Residential Rehabilitation Treatment Program, Ulmenhof, Sozialtherapie, Ottenbach, Switzerland. Dr. Dube is Attending Physician, County of Santa Barbara, Department of Behavioral Wellness, Santa Barbara, California. Dr. Caflisch is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Dr. Liebrenz was financially supported by the Prof. Dr. Max Cloëtta Foundation, Zurich, Switzerland and the Uniscientia Foundation, Vaduz, Principality of Liechtenstein.
authors.forename: Marie-Therese
authors.initials: MT
authors.lastname: Gehring
authors.affiliation: Dr. Liebrenz is Head of the Research Division, Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland. Mr. Schneider is Resident Physician, Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland. Dr. Buadze is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Ms. Gehring is a Psychologist and Head of the Residential Rehabilitation Treatment Program, Ulmenhof, Sozialtherapie, Ottenbach, Switzerland. Dr. Dube is Attending Physician, County of Santa Barbara, Department of Behavioral Wellness, Santa Barbara, California. Dr. Caflisch is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Dr. Liebrenz was financially supported by the Prof. Dr. Max Cloëtta Foundation, Zurich, Switzerland and the Uniscientia Foundation, Vaduz, Principality of Liechtenstein.
authors.forename: Anish
authors.initials: A
authors.lastname: Dube
authors.affiliation: Dr. Liebrenz is Head of the Research Division, Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland. Mr. Schneider is Resident Physician, Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland. Dr. Buadze is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Ms. Gehring is a Psychologist and Head of the Residential Rehabilitation Treatment Program, Ulmenhof, Sozialtherapie, Ottenbach, Switzerland. Dr. Dube is Attending Physician, County of Santa Barbara, Department of Behavioral Wellness, Santa Barbara, California. Dr. Caflisch is Attending Physician, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Dr. Liebrenz was financially supported by the Prof. Dr. Max Cloëtta Foundation, Zurich, Switzerland and the Uniscientia Foundation, Vaduz, Principality of Liechtenstein.
authors.forename: Carlo
authors.initials: C
authors.lastname: Caflisch
mesh_terms: D000328:Adult; D000368:Aged; D020324:Amnesia, Anterograde / Q000188:drug therapy*; D001569:Benzodiazepines / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research; D055815:Young Adult
chemical_list: D001569:Benzodiazepines