What medication can be prescribed to calm a patient experiencing anxiety and distress after the death of her two-week-old grandchild, presenting with symptoms of emotional upset and tremors?

From the Guidelines

I strongly recommend offering the patient immediate support through a combination of medication and counseling to manage her acute grief reaction and anxiety symptoms. For acute anxiety relief, prescribe lorazepam (Ativan) 0.5-1mg orally every 6-8 hours as needed for severe anxiety, with a limited supply of 10-15 tablets, as suggested by the management of anxiety and depression in adult survivors of cancer guideline update 1. This benzodiazepine works quickly to reduce anxiety symptoms by enhancing the effect of GABA, an inhibitory neurotransmitter in the brain. Additionally, schedule an urgent in-person appointment within 24-48 hours to properly assess the patient's mental state and provide appropriate grief counseling. The patient is experiencing acute grief reaction following the traumatic loss of her grandchild, and her physical symptoms (shaking, difficulty communicating) indicate significant distress that requires prompt intervention. While medication can help manage immediate symptoms, it's essential to develop a comprehensive treatment plan that addresses both the acute crisis and provides ongoing support through this difficult time. Inform the patient that short-term medication use is appropriate in this situation but should be accompanied by proper psychological support, and consider interventions with short-term duration, monitoring regularly for adherence, side effects, and adverse events 1. Some studies suggest alternative medications such as haloperidol for delirium or agitation 1, but in this case, lorazepam is a more suitable option for acute anxiety relief. Key considerations for the patient's treatment plan include:

• Close monitoring of medication side effects and adherence
• Regular follow-up appointments to assess the patient's mental state and adjust the treatment plan as needed
• Provision of ongoing psychological support and grief counseling to address the underlying causes of the patient's distress.

From the FDA Drug Label

For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given twice daily or three times daily. The patient is experiencing anxiety due to a recent traumatic event, and lorazepam may be prescribed to help calm her down. The recommended initial dose for anxiety is 2 mg/day to 3 mg/day, given twice daily or three times daily 2. However, it's essential to consider the patient's overall health and medical history before prescribing any medication.

• The patient's difficulty in understanding and shaking may be symptoms of severe anxiety or grief.
• Lorazepam should be used with caution, as it can cause drowsiness, dizziness, and weakness 2.
• It's crucial to monitor the patient's response to the medication and adjust the dosage as needed to avoid adverse effects.
• The patient should be advised not to operate heavy machinery or engage in activities that require alertness until the effects of the medication are known.

From the Research

Patient's Condition

The patient is experiencing intense emotional distress due to the recent loss of her two-week-old grandchild. She is reporting feelings of anxiety and is having difficulty communicating over the phone.

Treatment Options

• Benzodiazepines may be considered as a treatment option for acute stress reactions and anxiety disorders, as stated in the study 3.
• The study 4 suggests that short-term use of benzodiazepines is justified in patients with severe symptomatic distress and/or impairment of ability to cope.
• However, long-term use of benzodiazepines is only justified in patients with chronic severe anxiety, and the risk of dependence should be carefully considered, as noted in the studies 3, 4, and 5.
• Combination treatment with benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) may be effective for comorbid anxiety and depression, as discussed in the study 6.

Considerations

• The patient's age and medical history are not provided, but it is essential to consider these factors when prescribing benzodiazepines, as they can have adverse effects in certain populations, such as the elderly, as mentioned in the study 5.
• The study 7 provides guidance on the use of benzodiazepines in anxiety disorders, including their pharmacology, efficacy, and potential risks.
• It is crucial to assess the patient's symptoms and develop a treatment plan that addresses her specific needs, as noted in the studies 3 and 4.