What is the recommended psychiatric management for a patient with generalized anxiety disorder, unspecified dementia with behavioral disturbance, and metabolic encephalopathy, currently taking Buspirone HCl (Buspar) 15 MG, who is irritable and desires discharge?

From the Guidelines

The patient's current buspirone regimen (15mg) should be continued for anxiety management, and a comprehensive discharge planning approach should be implemented to address the patient's desire to go home, taking into account their dementia with behavioral disturbance, anxiety disorder, and metabolic encephalopathy. Given the patient's complex medical conditions, a multidisciplinary approach involving neurology, psychiatry, and social work would be beneficial to ensure a smooth transition to home. The patient's irritability and resistance likely stem from anxiety exacerbated by cognitive impairment and the unfamiliar healthcare environment. Behavioral interventions, including reorientation techniques, consistent daily routines, and clear communication strategies, should be implemented to reduce anxiety and agitation.

Before discharge, a home safety evaluation should be conducted to assess the patient's ability to function independently, with consideration for home health services or caregiver support 1. The patient's metabolic encephalopathy should be addressed by identifying and treating underlying causes. Regular follow-up psychiatric appointments should be scheduled post-discharge to monitor medication efficacy and behavioral symptoms, with potential medication adjustments if anxiety or behavioral disturbances worsen. It is also essential to ensure access to social/mental health services and conduct medication reconciliation and patient counseling by an inpatient pharmacist before discharge, as recommended in the 2020 guidelines for discharge planning 1.

Key considerations in the patient's management include:

• Continuing the current buspirone regimen for anxiety management
• Implementing behavioral interventions to reduce anxiety and agitation
• Conducting a home safety evaluation to assess the patient's ability to function independently
• Addressing the patient's metabolic encephalopathy by identifying and treating underlying causes
• Scheduling regular follow-up psychiatric appointments to monitor medication efficacy and behavioral symptoms
• Ensuring access to social/mental health services and conducting medication reconciliation and patient counseling before discharge 1.

From the FDA Drug Label

INDICATIONS AND USAGE Buspirone hydrochloride tablets are indicated for the management of anxiety disorder or the short-term relief of the symptoms of anxiety. The efficacy of buspirone hydrochloride tablets has been demonstrated in controlled clinical trials of outpatients whose diagnosis roughly corresponds to Generalized Anxiety Disorder (GAD). Many of the patients enrolled in these studies also had coexisting depressive symptoms and buspirone hydrochloride tablets relieved anxiety in the presence of these coexisting depressive symptoms

The recommended psychiatric management for a patient with generalized anxiety disorder, unspecified dementia with behavioral disturbance, and metabolic encephalopathy, currently taking Buspirone HCl (Buspar) 15 MG, who is irritable and desires discharge, cannot be directly determined from the provided drug label, as it does not explicitly address the management of patients with these specific comorbidities.

• The label indicates buspirone is used for the management of anxiety disorder, but does not provide guidance on managing anxiety in the context of unspecified dementia with behavioral disturbance and metabolic encephalopathy.
• The patient's irritability and desire for discharge are not directly addressed in the label. 2

From the Research

Psychiatric Management

The patient's condition involves generalized anxiety disorder, unspecified dementia with behavioral disturbance, and metabolic encephalopathy, and is currently taking Buspirone HCl (Buspar) 15 MG. The recommended psychiatric management for this patient is unclear based on the provided studies.

Buspirone Therapy

• Buspirone is an anxiolytic drug that is a partial agonist for the serotonin 5-HT(1A) receptors and has low affinity as an antagonist for the dopamine D(2) autoreceptors, with some evidence of a weak affinity to 5-HT(2) receptors 3.
• The drug has been proposed to inhibit the synthesis and release of serotonin, leading to inhibition of the firing rate of 5-HT-containing neurons in the dorsal raphe 4.
• Buspirone is indicated in the treatment of generalized anxiety disorders and has efficacy comparable to benzodiazepines 4.
• Long-term buspirone therapy for up to one year has been associated with no new or unexpected side effects and no evidence of a withdrawal syndrome or unusual events when therapy was abruptly discontinued 5.

Considerations for Coexisting Conditions

• Buspirone may be useful in various other neurological and psychiatric disorders, such as attenuating side effects of Parkinson's disease therapy, ataxia, depression, social phobia, and behavior disturbances following brain injury, and those accompanying Alzheimer's disease, dementia, and attention deficit disorder 3.
• Patients with generalized anxiety disorder and coexisting depressive symptoms have been found to exhibit significant improvement with buspirone compared to placebo treatment 6.

Irritability and Desire for Discharge

• The patient's irritability and desire for discharge should be addressed through a comprehensive treatment plan that takes into account their multiple conditions and current medication regimen.
• However, there is no direct evidence from the provided studies to support a specific recommendation for managing the patient's irritability and desire for discharge.