Assessment - Disorders of Sedative–Hypnotics

Assessment

Drug Use History

The patient’s drug use history is usually the first source of in-formation that is used in assessing sedative–hypnotic abuse or dependence. If the sedative–hypnotics were being used for treat-ment of insomnia or anxiety, the history is often best obtained as part of the history of the primary disorder and its response to treatment. A detailed history of use of all sedative– hypnotics, including alcohol, should be elicited from the patient. When framed in terms of the presenting disorder, patients are generally more candid about their drug use and their relationship with past treating physicians.

For many reasons, patients may minimize or exaggerate their drug use and not accurately report the behavioral conse-quences of their use. High doses of benzodiazepines or therapeu-tic doses of benzodiazepines in combination with alcohol may disrupt memory. Patients are likely to attribute impairment of function to the underlying disorder rather than to the medication use. Observations of patients’ behavior by family members can be a source of valuable information. Whenever possible, the pa-tient’s history should be supplemented by medical and pharmacy records to help piece together as accurate a picture of drug use as possible. Pharmacy records may be helpful in establishing and verifying patient’s drug use history, and urine testing can be use-ful in verifying recent drug use history.

Patients who are obtaining some or all of their medication from street sources may not know what they have been taking, as deception in the street-drug marketplace is common. For ex-ample, tablets sold as methaqualone have been found to contain phenobarbital or diazepam.

Physical Findings

Sustained horizontal nystagmus is a reliable indicator of sedative–hypnoticintoxication.Onsetoftremor,abnormalsweating and blood pressure or pulse increase may be produced by seda-tive–hypnotic withdrawal.