Different Attitudes of Patients and Psychiatrists Toward Benzodiazepine Treatment

Figures & data

Figure 1 Responses of patients and their referring psychiatrists regarding the difficulty of reducing the dose of BDZs.

Notes: The box shaded with vertical lines shows a type A discrepancy (patients perceive a reduction in the dose of BDZs to be more difficult than their referring psychiatrists do). The box shaded with horizontal lines shows a type B discrepancy (patients perceive a reduction in the dose of BDZs to be less difficult than their referring psychiatrists do).

Table 1 Clinical and Demographic Characteristics. Values are the Mean and Standard Deviation (SD) or Number (%)

Characteristics	All (N=155)
Age (years), mean (SD)	48.2 (15.9)
Female sex, n (%)	101 (65.2%)
Occasional (not daily) use of BDZs, n (%)	8 (5.2%)
Previous BDZ cessation attempts indicated by psychiatrist, n (%)	16 (9.3%)
Duration of illness (years), mean (SD)	11.7 (7.6)
Duration of BDZ use (years), mean (SD)	11 (7.1)
CGI-S, mean (SD)	3.2 (1.2)
Smoking, n (%)
Not at all	108 (69.7%)
Sometimes	2 (1.3%)
Everyday	45 (29.0%)
Alcohol consumption, n (%)
Not at all	100 (64.5%)
Sometimes	45 (29.0%)
Everyday	10 (6.5%)
Driving cars, n (%)
Not at all	69 (44.5%)
Sometimes	29 (18.7%)
Everyday	57 (36.8%)
Adherence, n (%)
Taking BDZs as prescription	135 (87.1%)
Forgetting to take BDZs sometimes	7 (4.5%)
Adjust BDZs by myself	13 (8.4%)
Diagnosis, n (%)
Schizophrenia spectrum	44 (27.7%)
Bipolar disorder	13 (8.4%)
Major depressive disorder	40 (25.8%)
Anxiety disorders	43 (27.7%)
Autism spectrum disorder	6 (3.9%)
Others	9 (5.8%)
Total DZP equivalent dose (mg), mean (SD)	14.3 (11.9)
DZP equivalent dose of BDZs except for z-drugs (mg), mean (SD)	13.4 (11.8)
Short half-life BDZs except for z-drugs (mg), mean (SD)	3.4 (4.8)
Intermediate half-life BDZs except for z-drugs (mg), mean (SD)	7.6 (8.0)
Long half-life BDZs except for z-drugs (mg), mean (SD)	2.4 (6.9)
DZP equivalent dose of z-drugs (mg), mean (SD)	0.8 (2.0)

Abbreviations: BDZ, benzodiazepine; CGI-S, Clinical Global Impressions-Severity of Illness scale; DZP, diazepam.

Table 2 Patitent’s Attitudes Toward BDZs

Do you believe …	Agree
Q1 … that dose reduction of BDZs is difficult?	65.8% (102/155)
Q2 … that anxiolytics have efficacy for anxiety?	88.4% (137/155)
Q3 … that hypnotics have efficacy for insomnia?	87.1% (135/155)
Q4 … that anxiolytics have efficacy for pain?	35.5% (55/168)
Q5 … that anxiolytics have efficacy for depressive mood?	84.5% (131/155)
Q6 … that anxiolytics are necessary even with psychotherapy?	81.9% (127/168)
Q7 … that psychotherapy takes long time?	67.7% (105/155)
Q8 for patients … that psychotherapy is unsuitable for yourself?	37.4% (58/155)
Q8 for psychiatrists … that psychotherapy is unsuitable for this patient?
Q9 for patients … that the continued administration of BDZs should continue as long as you desire?	89.0% (138/155)
Q9 for psychiatrists … that the continued administration of BDZs is justified because of the patient’s desire?
Q10 for patients … that the continued administration of BDZs is justified as long as social functions (job/housekeeping/study) are maintained?	81.9% (127/155)
Q10 for psychiatrists … that the continued administration of BDZs is justified because the patient’s social functions are maintained?
Q11 for patients … that the continued administration of BDZs is justified as long as adverse effects are not observed?	84.5% (131/155)
Q11 for psychiatrists … that the continued administration of BDZs is justified because adverse effect have not been observed?
Q12 for patients … that the continued administration of BDZs is justified for 1 month?	55.5% (86/155)
Q12 for psychiatrists … that the continued administration of BDZs is justified for 1 month for this patient?
Q13 … that information about addiction is important?	80.0% (124/155)
Q14 … that BDZs increase falls?	19.4% (30/155)
Q15 … that BDZs lead to daytime drowsiness?	53.5% (83/155)
Q16 … that rapport breaks down without the administration of BDZs?	34.8% (54/155)
Q17 … that the dose of BDZs has increased since the initial administration?	25.8% (40/155)
Q18 for patients Do you not want to take BDZs on principle?	37.4% (58/155)
Q18 for psychiatrists Do you not want to prescribe BDZs to this patient on principle?

Abbreviation: BDZs, benzodiazepines.

Table 3 Psychiatrist’s Attitudes Toward BDZs

Do you believe …	Agree	Not Applicable
Q1 … that dose reduction of BDZs is difficult?	78.1% (121/155)	0% (0/155)
Q2 … that anxiolytics have efficacy for anxiety?	69.7% (108/155)	14.2% (22/155)
Q3 … that hypnotics have efficacy for insomnia?	75.5% (117/155)	14.2% (22/155)
Q4 … that anxiolytics have efficacy for pain?	12.9% (20/155)	38.1% (59/155)
Q5 … that anxiolytics have efficacy for depressive mood?	51.6% (80/155)	18.1% (28/155)
Q6 … that anxiolytics are necessary even with psychotherapy?	52.3% (81/155)	14.8% (23/155)
Q7 … that psychotherapy takes long time?	93.5% (145/155)	2.6% (4/155)
Q8 for patients … that psychotherapy is unsuitable for yourself?	67.1% (104/155)	0% (0/155)
Q8 for psychiatrists … that psychotherapy is unsuitable for this patient?
Q9 for patients … that the continued administration of BDZs should continue as long as you desire?	72.9% (113/155)	0.6% (1/155)
Q9 for psychiatrists … that the continued administration of BDZs is justified because of the patient’s desire?
Q10 for patients … that the continued administration of BDZs is justified as long as social functions (job/housekeeping/study) are maintained?	74.8% (116/155)	0.6% (1/155)
Q10 for psychiatrists … that the continued administration of BDZs is justified because the patient’s social functions are maintained?
Q11 for patients … that the continued administration of BDZs is justified as long as adverse effects are not observed?	75.5% (117/155)	0% (0/155)
Q11 for psychiatrists … that the continued administration of BDZs is justified because adverse effect have not been observed?
Q12 for patients … that the continued administration of BDZs is justified for 1 month?	39.4% (61/155)	7.1% (11/155)
Q12 for psychiatrists … that the continued administration of BDZs is justified for 1 month for this patient?
Q13 … that information about addiction is important?	98.1% (152/155)	0% (0/155)
Q14 … that BDZs increase falls?	5.2% (8/155)	1.3% (2/155)
Q15 … that BDZs lead to daytime drowsiness?	18.1% (28/155)	0.6% (1/155)
Q16 … that rapport breaks down without the administration of BDZs?	41.3% (64/155)	0% (0/155)
Q17 … that the dose of BDZs has increased since the initial administration?	35.5% (55/155)	1.9% (3/155)
Q18 for patients Do you not want to take BDZs on principle?	65.8% (102/155)	0% (0/155)
Q18 for psychiatrists Do you not want to prescribe BDZs to this patient on principle?

Abbreviation: BDZs, benzodiazepines.

Table 4 Perception of Difficulty in Reducing BDZ Dose Among Patients and Psychiatrists Divided by Age and Gender

	Number and %
Age (Years)	≤39	40–54	≥55	Total
Patients
Male sex	8 (47.1%)	18 (72.0%)	7 (58.3%)	33 (61.1%)
Female sex	29 (76.3%)	15 (68.2%)	25 (61.0%)	69 (68.3%)
Psychiatrists
Male sex	14 (82.4%)	22 (88.0%)	10 (83.3%)	46 (85.2%)
Female sex	24 (63.2%)	16 (72.7%)	35 (85.4%)	75 (74.3%)

Table 5 Factors Associated with Difficulties with Reducing the Dose of BDZs According to Patients and Psychiatrists

	B	Standard Error	Wald Value	P-value	Odds	Ratio
Patients
DZP equivalent dose of short half-life BDZs except for z-drugs	0.117	0.050	5.382	0.020	1.124	(1.018–1.241)
Q6 for patients	2.020	0.546	13.680	<0.001	7.538	(2.585–21.987)
Q16 for patients	1.254	0.465	7.278	0.007	3.504	(1.409–8.715)
Q17 for patients	1.497	0.546	7.516	0.006	4.469	(1.532–13.031)
Psychiatrists
Duration of BDZs use	0.160	0.056	8.351	0.004	1.174	(1.053–1.309)
Driving cars
Not at all (ref.)
Sometimes	−0.678	0.866	0.614	0.433	0.507	(0.093–2.769)
Everyday	−2.475	0.863	8.234	0.004	0.084	(0.016–0.456)
Habitual alcohol intake	2.227	0.809	7.579	0.006	9.271	(1.899–45.252)
Q2 for psychiatrists	2.263	1.189	3.624	0.057	9.611	(0.935–98.754)
Q5 for psychiatrists	−3.378	1.113	9.211	0.002	0.034	(0.004–0.302)
Q9 for psychiatrists	2.101	0.719	8.543	0.003	8.178	(1.998–33.466)
Q16 for psychiatrists	3.460	1.225	7.972	0.005	31.818	(2.881–351.406)
Q17 for psychiatrists	2.028	0.895	5.142	0.023	7.603	(1.317–43.892)
Q18 for psychiatrists	1.512	0.679	4.965	0.026	4.537	(1.200–17.158)

Abbreviations: BDZs, benzodiazepines; DZP, diazepam.

Table 6 Factors Associated with Patient-Psychiatrist Disagreement Regarding the Difficulties Involved in Reducing the Dose of BDZs

	B	Standard Error	Wald Value	P-value	Odds	Ratio
Type A discrepancy
Female sex	2.220	0.832	7.113	0.008	9.205	(1.801–47.038)
Q9 for psychiatrists	−1.837	0.630	8.498	0.004	0.159	(0.046–0.548)
Q12 for psychiatrists	1.520	0.635	5.724	0.017	4.572	(1.316–15.880)
Q16 for psychiatrists	−2.616	1.063	6.055	0.014	0.073	(0.009–0.587)
Type B discrepancy
Q6 for patients	−2.390	0.564	17.971	<0.001	0.092	(0.030–0.277)
Q17 for patients	−2.433	0.747	10.595	0.001	0.088	(0.020–0.380)
Q9 for psychiatrists	1.290	0.611	4.461	0.035	3.634	(1.097–12.037)

Notes: Type A discrepancy: patients perceive more difficulties involved in reducing the dose of BDZs than their referring psychiatrists. Type B discrepancy: referring psychiatrists perceive more difficulties involved in reducing the dose of BDZs than patients.

Abbreviation: BDZs, benzodiazepines.