Im anxious and would like valium What to Cover in a 10min Consultation

1
Im anxious and would like valiumWhat to
Cover in a 10min Consultation

• Aled Davies

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• Case study
• 30yr old male
• Recently moved to area from Bristol
• No fixed abode
• Previous psych hx
• Drug abuse in the past tried everything
• Started citalopram for low mood, now come back as
  meds not working, wants something stronger

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• Explore reasons for wanting it
• Anxiety/depression
• Insomnia
• Help comedown from amphetamines, ecstasy, cocaine
  or crack cocaine.
• Withdrawal of alcohol
• Counteract non-euphoric effect of methadone
• Have they taken it before?
• Help with voices

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• Drug Cocktails
• Benzodiazepines use in opioid users is prevalant
  and a major problem
• Opioid users largest group needing help with this
  problem.
• Opioid problem needs stabilizing initially with
  substitute
• Used to enhance a primary drug, counter
  withdrawal symptoms of other drugs or for own
  intoxicating effects.

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• Street Value
• Easily available illegally are we contributing
  to this?
• 10mg Diazepam sells for 50p to 1

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• Risk taking behaviour
• Drug users show higher rates of risk taking
  behaviour
• Chance to screen for HIV/HCV and engage in risk
  management.

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• Where and when to use diazepam - NICE
• Anxiety
• Panic Disorders not recommended
• Generalized anxiety not to be used beyond 2-4
  wks
• Depression
• Short term use of benzodiazepines in mod to
  severe depression with agitation
• Insomnia
• Recommended newer anxiolytics e.g. Zopiclone and
  zolpidem for short periods of time.

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• Available options
• CBT
• Medications SSRIs
• Self help
• Sleep hygeine

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• What if prescribing diazepam is reasonable
• Give short course can prescribe for instalment
  dispensing on FP10(MDA)
• Start low
• Urine tests x2 to establish benzo use
• Set clear goals and time frame
• If using other types of benzodiazepams try and
  get onto one preparation

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• What the pt should be clear about
• Addictive
• Potentially more difficult to come off than
  opioids
• Paradoxical aggression
• Withdrawal symptoms in chronic daily users
• Some evidence of cognitive damage with high doses
  over long period
• Emotional suppression and reduce coping ability.
• Unsafe injecting

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• Reducing-dose prescribing
• For future consultations
• Regime for doing this
• Needs to be properly monitored - ?within scope of
  GP.