Patient-controlled benzodiazepine dose reduction in a community mental health service
| Autor: | David Meagher, Bangaru Raju |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Pediatrics
medicine.medical_specialty Benzodiazepine business.industry medicine.drug_class medicine.medical_treatment Attendance Mental health Discontinuation Drug user Psychiatry and Mental health History and Philosophy of Science Psychoeducation Medicine Anxiety Dose reduction medicine.symptom business Psychiatry Applied Psychology |
| Zdroj: | Irish journal of psychological medicine. 22(2) |
| ISSN: | 2051-6967 |
| Popis: | AbstactObjectives: 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. |
| Databáze: | OpenAIRE |
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