Psychiatric Disorders (Depression, Anxiety, Sleep)
Benzodiazepines are commonly prescribed medications for several indications, including anxiety and sleep disorders. Let’s discuss their use in our health care systems and the impact on our patients.
Things to consider might include (just getting you thinking):
• Safety: How could the side effect profile affect your patients?
• Efficacy: Are benzodiazepines efficacious for anxiety and sleep?
• Use: How can we ensure safe use of these medications?
Consider the following cases:
KT is a 24 year old female completing her studies. While home for spring break, she presents to her primary care physician because she has been worried about her academic, professional, and personal future since class restarted in late August. She is constantly worried about passing all of her exams and that she is going to be the only one of her friends that graduates school without a ring on her finger.
• Assuming KT meets the diagnostic criteria for GAD, in addition to a structured program of counseling (CBT), what pharmacotherapeutic plan would you design [Medication(s) selection and rationale, titration plan if necessary, monitoring / follow up and patient education regarding the medications you have chosen]?
WD is a 49-year-old male who suffered a myocardial infarction one week ago. Upon discharge, it was noted that Walt appeared depressed. At a follow-up visit with his physician a week later, WD met criteria for a diagnosis of major depressive disorder. His past medical history includes: treatment refractory hypertension, diabetes mellitus (type II), and severe uncontrolled narrow angle glaucoma
• Assuming WD meets the diagnostic criteria for MDD, in addition to a structured program of counseling (CBT), what pharmacotherapeutic plan would you design [Medication(s) selection and rationale, titration plan if necessary, monitoring / follow up and patient education regarding the medications you have chosen]?
• Six months later him mood is better and he is doing well on fluoxetine 40mg daily. He now complains of ED. Based on the The Princeton III Consensus Recommendations for Cardiovascular Risk Assessment and the Management of Erectile Dysfunction, he is low risk. How, if at all, would you modify his treatment plan?
JM is a 42 year old female who was referred for management of insomnia. She reports that she is unable to sleep at all during the week (difficulty going to sleep and staying asleep) and sleeps all day on Sunday. She currently takes temazepam (Restoril) 30 mg HS (recently increased from 15mg). She also experiences depression due to an abusive relationship with her boyfriend as well as her current lack of employment. She reports poor sleep hygiene (reads and watches TV in bed), drinks 6-8 cups of coffee throughout the day and does not pay attention to how late she eats or exercises.
• What non-pharmacological and pharmacological therapies would you recommend for JM?
Please complete the assignment with a minimum of 250 words, scholarly written, APA 7th edition formatted with a minimum of 2 references (one of which may include a Pharmacology textbook, and the other must be a peer-reviewed article no more than 5 years old.