Rosh Psychiatry Board Practice Exam

In a patient with anxiety who discontinued alprazolam, what is the best course of action for treating withdrawal symptoms?

1. Admit the patient for intravenous therapy

2. Switch to a long-acting benzodiazepine and taper gradually

3. Initiate cognitive behavioral therapy immediately

4. Prescribe a non-benzodiazepine anxiolytic

The correct answer is: Switch to a long-acting benzodiazepine and taper gradually

Switching to a long-acting benzodiazepine and tapering gradually is the most effective method for managing withdrawal symptoms in a patient who has discontinued alprazolam. Alprazolam is a short-acting benzodiazepine, and when a patient stops using it, they can experience withdrawal symptoms due to the sudden change in drugs. Long-acting benzodiazepines, such as diazepam or clonazepam, have a more gradual elimination half-life, allowing for a smoother reduction in benzodiazepine levels in the body. By transitioning to a long-acting formulation, the patient can experience more stable blood levels, which can reduce the intensity of withdrawal symptoms. The gradual tapering process allows the nervous system to readjust to the absence of the medication without provoking significant withdrawal effects. This approach is particularly important because abrupt cessation of benzodiazepines can lead to severe symptoms such as anxiety, insomnia, agitation, and, in severe cases, seizures. Therefore, a managed tapering schedule is critical for maintaining safety and comfort while reducing the risk of withdrawal complications. While other options, such as initiating cognitive behavioral therapy or prescribing non-benzodiazepine anxiolytics, can be useful components of an overall treatment plan