Neobook — clinical reference

Medication treatment of comorbid psychiatric conditions

GENERAL AND SUPPORTIVE MEASURES

Psycho-education about dependence including withdrawal and tolerance within a close therapeutic relationship will assist with compliance. Encourage the patient and caregivers not to seek medication from other doctors and negotiate each reduction with the patient and caregivers. Withdrawal from benzodiazepines takes time. The patient will require regular monitoring and motivation.

MEDICATION TREATMENT

Replace short-acting benzodiazepines with an equivalent long-acting benzodiazepine (diazepam) dose. Patients may present with medicines that are unavailable in the public sector.

Approximate equivalent doses to diazepam 5 mg are:

lorazepam 1 mg
alprazolam 0.5 mg
bromazepam 1.5 mg
flunitrazepam 0.5 mg
nitrazepam 5 mg
oxazepam 15 mg
temazepam 10 mg
zopiclone 7.5 mg
zolpidem 10 mg

Decrease the dose of diazepam every 2 weeks by 2.5 mg. If symptoms reappear, increase the dose a little and reduce more slowly.

MEDICATION TREATMENT OF CO-MORBID PSYCHIATRIC CONDITIONS

Treat according to the primary psychiatric condition, as per treatment guidelines. Refer to: sedation of acutely disturbed child or adolescent; mood disorders and psychosis.
Beware of adverse interactions between illicit drugs and psychotropic medication, i.e. drug levels of both illicit drugs and psychotropic medications are altered.

REFERRAL

All for psychotherapeutic interventions or drug rehabilitation.
Outpatient treatment: refer to SANCA (South African National Council on Alcoholism and Drug Dependence).

Tel: 011 892 3829 or Toll free: 0861 472 622

In-patient treatment: refer for in-patient drug rehabilitation.
Patients with severe and persistent behavioural disturbance, psychotic or manic symptoms to an in-patient child and adolescent psychiatric facility, for ongoing containment and management of psychiatric symptoms.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 14: Child & Adolescent Psychiatry, 14.13 Substance Use Disorder, 14.13.3 Substance Withdrawal, 14.13.3.5 Benzodiazepine Withdrawal

Drugs mentioned