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35th AM (2025) - Poster Session
Risk, Relief, and Relapse An Algorithmic Approach ...
Risk, Relief, and Relapse An Algorithmic Approach to Acute Anxiety in Patients with Substance Use Disorders
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Pdf Summary
This project by Dr. Samuel Qian addresses the management of acute anxiety in hospitalized patients with co-occurring post-traumatic stress disorder (PTSD) and substance use disorders (SUD), a population at high risk for treatment complications and relapse. Acute anxiety, while often not urgent medically, can interfere with care, prolong hospital stays, and increase relapse likelihood. The work presents an evidence-based, risk-stratified algorithm for guiding treatment choices specifically tailored to this dual-diagnosis group.<br /><br />The algorithm emphasizes safer, lower-risk pharmacological options such as selective serotonin reuptake inhibitors (SSRIs), clonidine, hydroxyzine, and gabapentin as first-line treatments. Benzodiazepines, historically linked with misuse especially among patients with generalized anxiety disorder (GAD) and SUD, are recommended only for short-term, carefully monitored use when necessary and deemed safe. This approach aims to balance immediate symptom relief with longer-term stability and relapse prevention. Additionally, the algorithm incorporates structured behavioral therapies like Seeking Safety and CALM ARC to improve outcomes.<br /><br />A clinical case is presented involving a 32-year-old man with GAD, PTSD, and past benzodiazepine and alcohol misuse, who experienced panic episodes after a traumatic injury. He was successfully managed with escitalopram, clonidine, and a short lorazepam taper, followed by psychiatric follow-up and discontinuation of lorazepam, illustrating the algorithm’s practical application.<br /><br />The project integrates a comprehensive literature review covering guidelines and randomized controlled trials from 2006 to 2024, including risk assessment tools like the Progress Assessment tool, to tailor treatment based on relapse risk. In conclusion, the algorithm supports individualized, safe, and effective management of acute anxiety in patients with SUD/PTSD, promoting safer prescribing practices and structured psychosocial interventions. Future research is needed to evaluate its impact on clinical care quality and relapse rates.
Keywords
acute anxiety management
PTSD and substance use disorders
risk-stratified treatment algorithm
selective serotonin reuptake inhibitors
clonidine
gabapentin
benzodiazepine misuse
Seeking Safety therapy
CALM ARC intervention
relapse prevention
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