Diazepam Counseling Notes

History Taking

• Patient Details:

  • 45-year-old woman.
  • Taking diazepam for 6 months.
  • Started due to anxiety related to her son's leukemia diagnosis.
  • Son is now in remission after chemotherapy.
  • Patient describes her mood as okay.
  • Considering stopping medication.

• Key History Points:

  • Medication started after son's diagnosis.
  • Patient was anxious but is now feeling better.
  • Worried about addiction and side effects.
  • Good support at home (supportive partner, son is feeling better).
  • Past history of anxiety as a teenager (seeing a psychologist, not on medication).
  • Expresses fear about stopping the medication: "I'm scared to stop the medication."

Initial Questions for the Patient

• How can I address you?
• Thanks for coming in today. How can I help you?
• Confidentiality statement: What we discuss today is private and confidential unless there is a risk of harm to you or anyone else.

Questions to Assess the Patient's Situation

• Since when do you take this medication?
• Do you have regular follow ups with your GP and specialist?
• Do you have to increase the dose of the medication to get the same effect?
• Have you ever gone without this medication? What happened?
• Did you have any symptoms?
• On a scale of 1 to 10, how motivated are you to stop taking this medication?
• How has your mood been?
• How is your sleep?
• How is your appetite?
• Do you have any intentions of harming yourself or anyone else?
• How is the home situation?
• Do you work? Do you study?
• Are you still enjoying the things you used to enjoy?
• Do you use any drugs? Alcohol? Any regular medication?
• Do you have any other preference?
• Do you have any changes in your sexual history?

Explanation of Diazepam

• Diazepam can cause dependence. The body gets used to the medication, and a higher dose may be needed for the same effect over time.
• Abruptly stopping can cause withdrawal effects including anxiety, sleep problems, headaches, seizures.

Cessation Plan (Tapering Off)

• Gradually decrease the medication dose over 4-8 weeks.
• Decrease the dose by 15-20% every 1-2 weeks.
• Towards the end, decrease by 10% every week and incorporate medication-free days.
• Small scripts will be provided to supervise medication use.

Safety and Monitoring

• Urgent Symptoms: If severe withdrawal symptoms occur (severe headache, dizziness, vomiting, faint, seizure), call an ambulance or go to the hospital immediately.

Additional Support and Interventions

• Referral to a psychologist for Cognitive Behavioral Therapy (CBT) for anxiety and medication use problems.
• Encourage relaxation techniques (yoga, meditation, mindfulness).
• If anxiety returns, consider other medications like SSRIs.
• Lifestyle modifications: exercise, healthy diet, reduce coffee, alcohol, and smoking.
• Offer a family meeting to address questions from family members or the partner. Other questions or concerns from the family can be discussed with a family meeting.