Benzodiazepines II: Waking up on Sedatives: Providing Optimal Care when Inheriting Benzodiazepine Prescriptions in Transfer Patients

This review discusses risks, benefits, and alternatives in patients already taking benzodiazepines when care transfers to a new clinician. Prescribers have the decision—sometimes mutually agreed-upon and sometimes unilateral—to continue, discontinue, or change treatment. This decision should be made based on evidence-based indications (conditions and timeframes), comorbidities, potential drug-drug interactions, and evidence of adverse effects, misuse, abuse, dependence, or diversion. We discuss management tools involved in continuation (e.g., monitoring symptoms, laboratory testing, prescribing contracts, state prescription databases, stages of change) and discontinuation (e.g., tapering, psychotherapeutic interventions, education, handouts, reassurance, medications to assist with discontinuation, and alternative treatments)

Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives

Benzodiazepines are some of the most commonly prescribed medications in the world. These sedative-hypnotics can provide rapid relief for symptoms like anxiety and insomnia, but are also linked to a variety of adverse effects (whether used long-term, short-term, or as needed). Many patients take benzodiazepines long-term without ever receiving evidence-based first-line treatments (e.g., psychotherapy, relaxation techniques, sleep hygiene education, serotonergic agents). This review discusses the risks and benefits of, and alternatives to benzodiazepines. We discuss evidence-based indications and contraindications, and the theoretical biopsychosocial bases for effectiveness, ineffectiveness and harm. Potential adverse effects and drug-drug interactions are summarized. Finally, both fast-acting/acute and delayed-action/chronic alternative treatments for anxiety and/or insomnia are discussed. Response to treatment—whether benzodiazepines, other pharmacological agents, or psychotherapy—should be determined based on functional recovery and not merely sedation

Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives

Benzodiazepines are some of the most commonly prescribed medications in the world. These sedative-hypnotics can provide rapid relief for symptoms like anxiety and insomnia, but are also linked to a variety of adverse effects (whether used long-term, short-term, or as needed). Many patients take benzodiazepines long-term without ever receiving evidence-based first-line treatments (e.g., psychotherapy, relaxation techniques, sleep hygiene education, serotonergic agents). This review discusses the risks and benefits of, and alternatives to benzodiazepines. We discuss evidence-based indications and contraindications, and the theoretical biopsychosocial bases for effectiveness, ineffectiveness and harm. Potential adverse effects and drug-drug interactions are summarized. Finally, both fast-acting/acute and delayed-action/chronic alternative treatments for anxiety and/or insomnia are discussed. Response to treatment—whether benzodiazepines, other pharmacological agents, or psychotherapy—should be determined based on functional recovery and not merely sedation

Benzodiazepines II: Waking Up on Sedatives: Providing Optimal Care When Inheriting Benzodiazepine Prescriptions in Transfer Patients

This review discusses risks, benefits, and alternatives in patients already taking benzodiazepines when care transfers to a new clinician. Prescribers have the decision—sometimes mutually agreed-upon and sometimes unilateral—to continue, discontinue, or change treatment. This decision should be made based on evidence-based indications (conditions and timeframes), comorbidities, potential drug-drug interactions, and evidence of adverse effects, misuse, abuse, dependence, or diversion. We discuss management tools involved in continuation (e.g., monitoring symptoms, laboratory testing, prescribing contracts, state prescription databases, stages of change) and discontinuation (e.g., tapering, psychotherapeutic interventions, education, handouts, reassurance, medications to assist with discontinuation, and alternative treatments)

A 20‐year follow‐up survey of police officers’ experience with Tarasoff warnings: How law enforcement reacts to clinicians’ duty to protect

Since the Tarasoff case of 1976, mental health professionals are recognized to have a “duty to protect” third‐party targets from violence‐threatening patients, but little is known about what happens after clinicians warn law enforcement. In 2000, Huber et al. published a study that surveyed Michigan police about “Tarasoff warnings.” We conducted a 20‐year follow‐up study, inviting all Michigan police and sheriff departments to participate. There were no significant differences between studies about knowledge of Tarasoff‐related policies, which was low in both surveys. We found significant decreases in the number of officers who had ever intervened due to warning calls. Of the survey respondents, 83% supported documenting warning calls. For those who received warnings, 96% followed up with at least one intervention. In both studies, notifying other officers was the most common action taken. 56% said they would take action to remove a firearm. We identified opportunities for training law enforcement.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/174795/1/bsl2564.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/174795/2/bsl2564_am.pd

Benzodiazepine Therapy: The Good, The Bad, and The Ugly

Benzodiazepines are some of the most commonly prescribed medications worldwide. When used appropriately for the right condition, patient, dose, and duration, these drugs can provide rapid relief of the symptoms of anxiety and insomnia for some patients, but they are also linked to a variety of adverse effects (whether used long-term, short-term, or as needed). Many patients are prescribed, and take, benzodiazepines long-term without ever receiving evidence-based first-line treatments such as psychotherapy, relaxation techniques, sleep hygiene education, or serotonergic agents. This chapter discusses the risks and benefits of, and alternatives to, benzodiazepines. The evidence-based indications and contraindications are discussed, as are putative biopsychosocial bases for effectiveness, ineffectiveness, and harm. The known potential adverse effects and drug-drug interactions are summarized. Finally, alternative fast-acting/acute and chronic treatments for anxiety and/or insomnia are discussed. Response to treatment—whether benzodiazepines, other pharmacological agents, or psychotherapy—must be assessed

Benzodiazepine Therapy: The Good, The Bad, and The Ugly

Benzodiazepines are some of the most commonly prescribed medications worldwide. When used appropriately for the right condition, patient, dose, and duration, these drugs can provide rapid relief of the symptoms of anxiety and insomnia for some patients, but they are also linked to a variety of adverse effects (whether used long-term, short-term, or as needed). Many patients are prescribed, and take, benzodiazepines long-term without ever receiving evidence-based first-line treatments such as psychotherapy, relaxation techniques, sleep hygiene education, or serotonergic agents. This chapter discusses the risks and benefits of, and alternatives to, benzodiazepines. The evidence-based indications and contraindications are discussed, as are putative biopsychosocial bases for effectiveness, ineffectiveness, and harm. The known potential adverse effects and drug-drug interactions are summarized. Finally, alternative fast-acting/acute and chronic treatments for anxiety and/or insomnia are discussed. Response to treatment—whether benzodiazepines, other pharmacological agents, or psychotherapy—must be assessed

PTSD Symptom Severities, Interpersonal Traumas, and Benzodiazepines Are Associated with Substance-Related Problems in Trauma Patients

Background: Trauma is commonly associated with substance-related problems, yet associations between specific substances and specific posttraumatic stress disorder symptoms (PTSSs) are understudied. We hypothesized that substance-related problems are associated with PTSS severities, interpersonal traumas, and benzodiazepine prescriptions. Methods: Using a cross-sectional survey methodology in a consecutive sample of adult outpatients with trauma histories (n = 472), we used logistic regression to examine substance-related problems in general (primary, confirmatory analysis), as well as alcohol, tobacco, and illicit drug problems specifically (secondary, exploratory analyses) in relation to demographics, trauma type, PTSSs, and benzodiazepine prescriptions. Results: After adjusting for multiple testing, several factors were significantly associated with substance-related problems, particularly benzodiazepines (AOR = 2.78; 1.99 for alcohol, 2.42 for tobacco, 8.02 for illicit drugs), DSM-5 PTSD diagnosis (AOR = 1.92; 2.38 for alcohol, 2.00 for tobacco, 2.14 for illicit drugs), most PTSSs (especially negative beliefs, recklessness, and avoidance), and interpersonal traumas (e.g., assaults and child abuse). Conclusion: In this clinical sample, there were consistent and strong associations between several trauma-related variables and substance-related problems, consistent with our hypotheses. We discuss possible explanations and implications of these findings, which we hope will stimulate further research, and improve screening and treatment