Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey.

BACKGROUND: Acute benzodiazepine withdrawal has been described, but literature regarding the benzodiazepine-induced neurological injury that may result in enduring symptoms and life consequences is scant. OBJECTIVE: We conducted an internet survey of current and former benzodiazepine users and asked about their symptoms and adverse life events attributed to benzodiazepine use. METHODS: This is a secondary analysis of the largest survey ever conducted with 1,207 benzodiazepine users from benzodiazepine support groups and health/wellness sites who completed the survey. Respondents included those still taking benzodiazepines (n = 136), tapering (n = 294), or fully discontinued (n = 763). RESULTS: The survey asked about 23 specific symptoms and more than half of the respondents who experienced low energy, distractedness, memory loss, nervousness, anxiety, and other symptoms stated that these symptoms lasted a year or longer. These symptoms were often reported as de novo and distinct from the symptoms for which the benzodiazepines were originally prescribed. A subset of respondents stated that symptoms persisted even after benzodiazepines had been discontinued for a year or more. Adverse life consequences were reported by many respondents as well. LIMITATIONS: This was a self-selected internet survey with no control group. No independent psychiatric diagnoses could be made in participants. CONCLUSIONS: Many prolonged symptoms subsequent to benzodiazepine use and discontinuation (benzodiazepine-induced neurological dysfunction) have been shown in a large survey of benzodiazepine users. Benzodiazepine-induced neurological dysfunction (BIND) has been proposed as a term to describe symptoms and associated adverse life consequences that may emerge during benzodiazepine use, tapering, and continue after benzodiazepine discontinuation. Not all people who take benzodiazepines will develop BIND and risk factors for BIND remain to be elucidated. Further pathogenic and clinical study of BIND is needed.

Psychiatrists' Cognitive and Affective Biases and the Practice of Psychopharmacology: Why Do Psychiatrists Differ From One Another in How They View and Prescribe Certain Medication Classes?

ABSTRACT: Cognitive and affective biases impact clinical decision-making in general medicine. This article explores how such biases might specifically affect psychiatrists' attitudes and prescribing patterns regarding two medication classes (stimulants and benzodiazepines) and addresses related issues. To supplement personal observations, selective PubMed narrative literature searches were conducted using relevant title/abstract terms, followed by snowballing for additional pertinent titles. Acknowledging that there are many more types of biases, we describe and use clinical vignettes to illustrate 17 cognitive and affective biases that might influence clinicians' psychopharmacological practices. Factors possibly underlying these biases include temperamental differences and both preprofessional and professional socialization. Mitigating strategies can reduce the potentially detrimental impacts that biases may impose on clinical care. How extensively these biases appear, how they differ among psychiatrists and across classes of medication, and how they might be most effectively addressed to minimize harms deserve further systematic study.

Thirty-Minute Psychiatric Management Visits in Academic Medical Centers: Framing and Exploring Distinct Clinical-Educational Social Processes.

ABSTRACT: To address high clinical demand and manage workflow, some university-based practice settings are tending to replace traditional hour-long outpatient appointments with 30-minute psychiatric management visits, which must comply with multiple regulatory requirements for documentation and billing. This care model can significantly shape the culture of psychiatric treatment and education. Based on the limited published literature on this topic and pooled experiences of faculty, residents, and administrators, this article offers observations and raises questions concerning 1) clinical, educational and administrative benefits, limitations, and challenges for conducting 30-minute psychiatric visits in training contexts; 2) how administrative impositions affecting resident and faculty time and attention impact clinical encounters; 3) how various teaching settings manage regulatory requirements differently; and 4) considerations for education needs and opportunities, research gaps, and policy implications. Quality of care and education could be improved by judicious overhaul of administrative requirements to minimize burdens offering little clinical or educational value.

Addiction psychiatry and addiction medicine - Strange bedfellows or separated at birth?

Substance use disorders (SUDs) are major causes of morbidity and mortality in the United States. SUDs commonly co-occur with other psychiatric and physical illness and often require management by an addiction specialist to comprehensively address patients' complex needs. The American Board of Medical Specialties (ABMS) offers two pathways leading to addiction subspecialty board certification: addiction psychiatry (American Board of Psychiatry and Neurology) and addiction medicine (American Board of Preventive Medicine). We explore the history of the distinct but overlapping practices of addiction medicine and addiction psychiatry and describe the unique contributions of each field. Specifically, we review skill sets, specialty training, and career outcomes for physicians specializing in the assessment and management of SUDs. We conclude by highlighting collaboration between the two specialties and offer a shared vision for the future of addiction specialty care.

Using Extended Release Buprenorphine Injection to Discontinue Sublingual Buprenorphine: A Case Series.

Buprenorphine is highly effective for the treatment of opioid use disorder and is increasingly being used in the treatment of chronic pain. For various reasons, patients on buprenorphine may request discontinuation of this medication. Tapering off buprenorphine can be challenging due to intolerable withdrawal symptoms, including nausea, malaise, anxiety, and dysphoria. A single dose of extended-release buprenorphine may facilitate discontinuation of buprenorphine by mitigating prolonged, debilitating opioid withdrawal symptoms. We report on three cases of successful transition from low dose sublingual buprenorphine to a single injection of 100 mg extended-release buprenorphine to opioid cessation in patients who had previously been unable to taper fully off buprenorphine. This novel use of extended-release buprenorphine provides a viable alternative to fully transition patients off buprenorphine when they are medically and emotionally ready.