Rosh Psychiatry Board Practice Exam

A woman in the emergency department reports anxiety and confusion after misusing benzodiazepines. What is the most appropriate therapy?

1. Diazepam

2. Flumazenil

3. Propranolol

4. Valproate

The correct answer is: Diazepam

In cases of benzodiazepine misuse, particularly when a patient presents with anxiety and confusion, the most appropriate therapy is to provide supportive care and manage symptoms. Diazepam, a benzodiazepine itself, can be used to reduce anxiety and agitation if the patient is experiencing withdrawal symptoms or heightened anxiety due to misuse. Administering another benzodiazepine like diazepam can help stabilize the patient by addressing the symptoms directly. Flumazenil, a benzodiazepine antagonist, is not a first-line treatment in benzodiazepine overdose or misuse cases due to its risk of precipitating withdrawal seizures, especially in patients who have developed physical dependence on benzodiazepines. While propranolol may help with physical symptoms of anxiety, it does not address the underlying issues related to benzodiazepine misuse and is not indicated in acute treatment scenarios. Valproate is an anticonvulsant and mood stabilizer, which would generally not be the first choice in managing benzodiazepine-related anxiety or confusion. In summary, the use of diazepam effectively manages the patient's acute anxiety and confusion stemming from benzodiazepine misuse, making it the most appropriate therapy in this context.