322 Clinical psychopharmacotherapy Journal of Psychopathology 2014;20:322-340 Summary Objectives To evaluate the knowledge of specialists on the pharmacological properties and clinical use of benzodiazepines (BDZs) in anxiety. Methods A 16-item online questionnaire, produced using the Delphi method, was submitted to a panel of 300 psychiatrists and neu- rologists. Results The specialists showed poor knowledge regarding the pharma- cokinetic and pharmacodynamic principles of BDZs, but good knowledge on the mechanisms of interactions of these drugs and their co-administration in polytherapy. Patients receiving prolonged treatment with BDZs can develop “psychological at- tachment” to the drug. The phase of tapering down the dose of BDZ that is easiest for patients is the initial, intermediate or final phase, but not an undetermined phase. The optimal withdrawal strategy should take 2-4, 4-6 or 8-12 weeks. All patients are at risk of using BDZs poorly, and the doctor must “educate” the patient on correct administration of BDZs. It is prudent to advise patients to not use BDZs during pregnancy and lactation. The ideal pharmacokinetic profile of a BDZ in elderly subjects is one with a short half-life either without active metabolites or with one or more active metabolites, or an intermediate half-life with no active metabolites. Lorazepam has the best risk/benefit ratio for “acute” use in psychomotor agitation in cases of dementia. Treat- ment with BDZs should be withdrawn gradually when the symp- toms requiring treatment disappear, with the awareness that it can be re-introduced if needed. The specialists indicated an even shorter treatment time than the those reported in the prescribing information for BDZs data sheets. Conclusions This shows that the use of BDZs is empirical and based only poorly on clinical and pharmacological knowledge about these compounds. Key words Anxiety • Benzodiazepines • Delphi method Anxiety and benzodiazepines. A Delphi method-based survey of knowledge on their pharmacology and clinical use Ansia e benzodiazepine. Il metodo Delphi basato sulle conoscenze della loro farmacologia e del loro uso clinico C. Vampini, 1 L. Gallelli 2 1  2° Servizio di Psichiatria, Ospedale Civile Maggiore e Dipartimento per la Salute Mentale, Verona; 2  Department of Health Science, School of Medicine, University of Catanzaro Correspondence Claudio Vampini, 2° Servizio di Psichiatria, Ospedale Civile Maggiore, piazzale Stefani 1, 37126 Verona, Italy • Tel. +39 045 8122715 • Fax +39 045 8123299 • E-mail: claudio.vampini@gmail.com Introduction Benzodiazepines (BDZs) are the most commonly-pre- scribed class of drugs worldwide due to their anxio- lytic, hypnotic, sedative, muscle relaxant and anticon- vulsant effects  1 2 . BDZs act by potentiating the gamma-aminobutyric acid (GABA) pathway through binding to the GABA-A receptor, increasing permeability to chloride ions  3 . Once bound to the receptor, BDZs act as positive allosteric modifiers, altering the spatial conformation of the protein complex and increasing the receptor’s affinity for GABA  4 and the frequency of channel opening. In this way, BDZs have an inhibitory effect on the central nervous system at the level of the limbic system, the reticular formation of the brain stem and the cerebral cortex  5 . The pharmacokinetic properties of BDZs, and in particu- lar their absorption and metabolism, influence their clini- cal applicability, since they determine the speed of onset and duration of pharmacological effects  6 . In addition to the chemical characteristics of these drugs, another im- portant factor that influences their absorption is the route of administration  7 . The oral route of administration is most commonly used in the treatment of anxiety, since BDZs administered orally are almost completely absorbed in the gastrointestinal tract, although there are differences in terms of speed of onset. Other factors can also influence the rate of ab- sorption when the drugs are administered orally, and, for example, concomitant administration of anticholinergic drugs can slow gastric emptying. A valid alternative to oral