Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-25T15:28:28.829Z Has data issue: false hasContentIssue false
  • English
  • Français

Patient-controlled benzodiazepine dose reduction in a community mental health service

Published online by Cambridge University Press:  13 June 2014

Bangaru Raju  and
David Meagher
David Meagher
Affiliation:
Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Ireland
Get access Rights & Permissions [Opens in a new window]

Abstact

Objectives: We report a patient-controlled benzodiazepine discontinuation programme in a generic multidisciplinary community mental health service.

Method: A prescribing audit identified suboptimal benzodiazepine use which stimulated a discontinuation programme [prescribing policy, psychoeducation, anxiety management] to encourage benzodiazepine cessation. Benzodiazepine status was re-assessed at 12 and 24 month follow-ups.

Results: 158 patients were receiving benzodiazepines at study onset. At 12 month follow-up, 68 of these were still receiving benodiazepines. This was due to discontinuation (n = 32), dose reduction (n = 26) and service dropout (n = 71). Benzodiazepine status at follow-up was predicted by attendance at anxiety management sessions (p = 0.01) and shorter duration of benzodiazepine use (p = 0.005). Patients attending anxiety management sessions were 2.5 times more likely to reduce use. Discontinuation followed four patterns: (a) rapid and complete discontinuation (n = 19); (b) total discontinuation in a gradual manner (n = 13); (c) partial dose reduction without total discontinuation (n = 18) and (d) almost total discontinuation with continued low-dose use (n = 8). The patients that achieved total discontinuation were younger (p = 0.01) and in receipt of benzodiazepine agents for a shorter duration (p = 0.009). At 24 month follow-up only three patients had relapsed into benzodiazepine use and a further 13 had achieved total discontinuation.

Conclusions: Many chronic benzodiazepine users can achieve lasting discontinuation with patient-controlled dose tapering. Patient refusal and service dropout are common during discontinuation programmes. Anxiety management is a valuable adjunct to discontinuation.

Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 22 , Issue 2 , June 2005 , pp. 42 - 45
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Taylor, D, McConnell, D, McConnell, H, Kerwin, R. The South London and Maudsley Trust 2001 Prescribing Guidelines: 6th ed. London: Martin Dunitz, 2001.Google Scholar
2. Royal Pharmaceutical Society of Great Britain. London: Bri National Formulary, 2002.Google Scholar
3.Department of Health and Children. Report of the benzodiazepine committee. Dublin: Government Publications, 2002.Google Scholar
4.Wang, PS, Bohn, RL, Glynn, RJ, Mogun, H, Avorn, J. Hazardous benzodiazepine regimens in the elderly: effects of half-life, dosage and duation on risk of hip racture. Am J Psychiatry 2001; 158:892–8.CrossRefGoogle Scholar
5.American Psychiatric Association. Benzodiazepine dependence, toxicity and abuse: a task force report. Washington DC: APA, 1990.Google Scholar
6.Oude Voshaar, RC, Gorgels, WJ, Mol, AJ, Couvee, JE, van Balkom, AJ, Zitman, FG. Treatment methods for discontinuation of long-term benzodiazepine use. Ned Tijdschr Geneeskd 2001; 145: 1347–50Google ScholarPubMed
7.Ashton, CH, Rawlins, MD, Tyrer, SP (1990). A double-blind placebo-controlled study of buspirone in diazepam withdrawal in chronic benzodiazepine users. Br J Psychiatry 1990; 157:232–8.CrossRefGoogle ScholarPubMed
8.Spiegel, DA, Bruce, TJ. Benzodiazepines and exposure-based cognitive therapies for panic disorder: conclusions from combined treatment trials. Am J Psychiatry 1997; 154: 773–81.Google ScholarPubMed
9.Otto, MW, Pollack, MH, Sachs, GS, Reiter, SR, Meltzer-Brody, S, Rosenbaum, JF. Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioural therapy for patients with panic disorder. Am J Psychiatry 1993; 150:1485–90.Google ScholarPubMed
10.Oude-Voshaar, RC, Gorgels, WJMJ, Mol, AJJ, Van Bolkom, AJLM, et al.Tapering off long-term benzodiazepine use with or without group cognitive-behavioural therapy: three-condition, randomised controlled trial. Br J Psychiatry 2003; 182: 498–504.CrossRefGoogle Scholar
11.Fraser, D, Peterkin, GSD, Gamsu, CV, Baldwin, PJ. Benzodiazepine withdrawal: a pilot comparison of three models. Br J Clinical Psychology 1990; 29: 231–3.CrossRefGoogle Scholar
12.Tyrer, P, Ferguson, B, Hallstrom, C, Michie, M, Tyrer, S, Cooper, S, Caplan, R, Barczak, P. A controlled trial of dothiepin and placebo in treating benzodiazepine withdrawal symptoms. Br J Psychiatry 1996; 168: 457–61.CrossRefGoogle ScholarPubMed
13.Zitman, FG, Couvee, JE. Chronic benzodiazepine use in general practice patients with depression: an evaluation of controlled treatment and taper-off. Br J Psychiatry 2001; 178:317–24.CrossRefGoogle ScholarPubMed
14.Linden, M, Bar, T, Geiselmann, B. Patient treatment insistence and medication craving in long-term low-dosage benzodiazepine prescriptions. Psychological Med 1998; 28: 721–9.CrossRefGoogle ScholarPubMed
15.Meagher, D, Moran, M. Sub-optimal prescribing in an adult community mental health service: prevalence and determinants. Psychiatric Bulletin 2003; 27: 266–71.CrossRefGoogle Scholar
16.World Health Organization. The ICD-10 classification of mental and behavioural disorders. Geneva: WHO, 1993.Google Scholar
17.Bazire, S. Psychotropic Drug directory. The professionals pocket handbook and aide memoire. Bath: Bath Press, 2001.Google Scholar
18.Gutierrez-Lobos, K, Frohlich, S, Quiner, S, Haring, C, Barnas, CPrescription patterns and quality of information provided for consumers of benzodiazepines. Acta Med Austriaoa 2001; 28: 56–9.Google ScholarPubMed
19.Van Haaren, AM, Lapane, KL, Hughes, CM. Effect of triplicate prescription policy on benzodiazepine administration in nursing home residents. Pharmacothereapy 2001; 21: 1159–66.CrossRefGoogle ScholarPubMed
20.Griffith, DN, Robinson, M. Prescribing practice and policy for hypnotics: a model of pharmacy audit. Age Ageing 1996; 25: 490–2.CrossRefGoogle Scholar
21.Murphy, SM, Tyrer, P. A double-blind comparison of the effects of gradual withdrawal of lorazepam, diazepam and bromazepam in benzodiazepine dependence. Br J Psychiatry 1991; 158:511–6.CrossRefGoogle ScholarPubMed
22.Cormack, MA, Sweeney, KG, Hughes-Jones, H, Foot, GA. Evaluation of an easy, cost effective strategy for cutting benzodiazepine use in general practice. Br J Gen Practice 1994;44:5–8.Google ScholarPubMed
23.Rickels, K, Schweizer, E, Case, WG, et al.Long-term therapeutic use of benzodiazepines I: effects of abrupt discontinuation. Arch Gen Psychiatry 1990; 47: 899–907.CrossRefGoogle ScholarPubMed
24.Schweizer, E, Rickels, K, Case, WG, Greenblatt, DJ. Carbamazepine treatment in patients discontinuing long-term benzodiazepine therapy. Arch Gen Psychiatry 1991; 48: 448–52.CrossRefGoogle ScholarPubMed
25.Rickels, K, Schweizer, E, Garcia Espana, F, Case, G, DeMartinis, N, Greenblatt, D. Trazadone and valproate in patients discontinuing long-term benzodiazepine therapy: effects on withdrawal symptoms and taper outcome. Psychopharmac 1999; 141:1;1–5.CrossRefGoogle Scholar
26.Spiegel, DA, Bruce, TJ, Gregg, SF, Nuzzarello, A. Does cognitive therapy assist slow-taper alprazolam discontinuation in panic disorder? Am J Psychiatry 1994; 151: 876–81.Google ScholarPubMed
27.Vorma, H, Naukkarinen, H, Sarna, S, Kuoppasalmi, K (2003). Long-term outcome after benzodiazepine withdrawal treatment in subjects with complicated dependence. Drug Alcohol Depend 2003; 70(3); 309–14.CrossRefGoogle ScholarPubMed
28.Golombok, S, Higgitt, A, Fonagy, P, Dodds, S, Saper, J, Lader, M. A follow-up study of patients treated for benzodiazepine dependence. Br J Med Psychol 1987; 60: 141–9.CrossRefGoogle ScholarPubMed
29.Zitman, FG, Couvee, JE. 1991Google Scholar
30.Williams, DDR, McBride, A. Benzodiazepines: time for reassessment. Br J Psychiatry 173:361–3.CrossRefGoogle Scholar