Benzodiazepine

Dependence
Myra Cabus

Patient Background
54 y/o Caucasian female with a medical hx of chronic PTSD,
chronic panic disorder, chronic anxiety, adjustment disorder
Attempted suicide by ingesting unknown amounts of alcohol,
Celexa, Valium, Xanax
Pt was found and taken into an acute care ER ICU
Transferred to another hospital locked psychiatric unit on an
MH-4 w/suicide precautions
Pts sister plans to take pt back to California after DC for
support; willing to support pts OP treatments, support groups,
etc.

Strengths
Pt graduated from nursing school and
subsequently got married (~ age 20)

Limitations
Child Abuse / sex slave from infancy
to 15 years old

Has a daughter and sister for support. Activated from Reserves in 2006:
They visit her daily.
Commander abused pt and others,
commander was court martialled out
of military for abuse
Steady income from job as Case
Manager, R.N. for military

Pt suffers from PTSD r/t abuse in

2006; has been on benzos since 2006

Pt separated from husband 3-4 weeks

before admission; Pt living in car so
husband can move things from home
Pt was recently activated from
Reserves status

Pt has been seeing a new therapist

On day of suicide attempt, therapist
explains that she does not treat
active duty military

DSM IV: Sedative, Hypnotic, or

Anxiolytic Dependence

Axis I
Benzodiazepine Dependence

Stats
There is a higher prevalence of benzodiazepine dependence/abuse in
males, though the gap is closing
The risk is heightened when pain killers are prescribed with
benzodiazepines
It is stated that benzodiazepines, and other addictive meds, are
overprescribed: In Hawaii, 19.3% of people are prescribed
benzodiazepines
Hawaii ranks LAST in the nation (including the District of Columbia) for
prescription benzodiazepines
Still, there is need for public awareness on the dependence of
benzodiazepine dependence and long-term use
As the rates of prescribed anti-depressant meds are decreasing, the rates
of prescribed benzos are increasing

Priority Assessment
1. Safety
a)

b)

Risk for suicide AEB hx of suicide attempt and current

suicidal ideation + pt states, I wish no one waked me
up on day 1 of admission. On day 2 of admission pt is
still pre-occupied with failed suicide attempt and death.
Use nonjudgmental and empathic listening,
encouragement, tolerance of expressions of pain (and
stress), flexible responses to pt needs

Priority Assessment
2. Ineffective Individual Coping
a)

b)

Impairment of adaptive behaviors and problem-solving

abilities in meeting lifes demands and roles AEB pt has a
benzodiazepine dependency from 2006 and a recent
suicide attempt of prescription meds and alcohol
Provide opportunities to express concerns, fears,
expectations; Encourage pt to identify own strengths and
abilities

Priority Assessment
3. Denial
a)

b)

Pt does not perceive personal relevance of symptoms or

danger AEB pt does not admit impact of condition on life
pattern and reports on day of admission that suicide
attempt is directly related to psychiatrist unable to
treat active duty military
Discuss current life situation and impact of substance
abuse

Priority Assessment
4. Altered Family Process
a)

b)

Disturbed family dynamics and altered role function AEB

marital problems and pt is dependent on daughter for
emotional support
Explore roles of family members, circumstances
involving drug use, strengths, areas for growth.

References
American Psychiatric Association. Diagnostic Statistical
Manual of Mental Disorders Fourth Edition (DSM-IV).
American Psychiatric Association, Washington D.C., 1994.
Centers for Disease Control and Prevention. Prescription
Painkiller Overdoses. (2013, July 3). Retrieved October 1,
2014, from
http://www.cdc.gov/vitalsigns/PrescriptionPainkillerOverdos
es/
Fortinash, K.M., Holoday-Worret, P.A. (2012). Psychiatric
Mental Health Nursing. (5th ed.). St. Louis: Mosby.
Paulozzi, L., Mack, K., & Hockenberry, J. (2014). Vital signs:
variation among States in prescribing of opioid pain relievers
and benzodiazepines - United States, 2012. MMWR: Morbidity
& Mortality Weekly Report, 63(26), 563-568.

Pencil Symbolization
(in-class activity)
Wooden pencils symbolize people who have adequate
support to endure life stressors
Mechanical pencils symbolize people who are on
benzodiazepines and can endure life stressors

Lead without mechanical pencils symbolize people who

have depended on benzodiazepines for years: shows
what life can be like without benzodiazepines
Shows degree of strength in support for each category
of people