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Chapter 24. Benzodiazepines

David V. Sheehan, M.D., M.B.A.; B. Ashok Raj, M.D.
DOI: 10.1176/appi.books.9781585623860.417936

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Excerpt

In spite of adverse publicity and a problematic public image, the most widely prescribed psychiatric medication in the United States over the past several years is not an antidepressant, an atypical antipsychotic, or a mood stabilizer but the benzodiazepine alprazolam, with 31 million prescriptions issued in 2001 (see Stahl 2002).

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FIGURE 24–1. Chemical structures of diazepam and alprazolam.
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TABLE 24–1. Pharmacokinetics of benzodiazepines
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TABLE 24–2. DSM-IV-TR criteria for substance dependence

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Sample questions:
1.
You wish to prescribe a benzodiazepine to an elderly patient for treatment of an anxiety disorder. You realize that selecting a benzodiazepine that is conjugated rather than metabolized by oxidation would be desirable. Which of the following benzodiazepines is metabolized by conjugation?
2.
A 40-year-old woman who is referred to you for evaluation reports that she has been having trouble sleeping because she is going through a divorce. Although her primary care physician prescribed a benzodiazepine to help her sleep, she now is experiencing episodes of amnesia and memory impairment. She forgets the name of the benzodiazepine, but on the basis of her description of symptoms, you conclude that the most likely agent is
3.
A 46-year-old man who is referred to you for evaluation of depression also reports early morning awakening and rebound anxiety. You decide to prescribe a selective serotonin reuptake inhibitor (SSRI) for his depression, but believing that he would benefit from improved sleep, you also prescribe a benzodiazepine for several weeks. Which of the following benzodiazepines would be most effective in treating this patient’s early morning awakening?
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