Psych CASC / OSCE · Psychopharmacology — anxiolytics and hypnotics
Negotiating short-term hypnotic use and a deprescribing plan (CASC)
CASC-style station: explain GABA-A risks in older adults, refuse automatic Z-drug swap as a safety solution, offer CBT-I/sleep strategies and optional modest melatonin, and co-design a gradual taper with falls safety-netting.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 71-year-old retired teacher has taken temazepam 20 mg nocte for 4 years after bereavement insomnia. She fell twice last month. Her daughter (in the room) found online that 'Z-drugs are safer' and asks to switch to zolpidem forever. The patient fears she will 'never sleep again' without tablets and becomes tearful when deprescribing is mentioned.
Station instructions (candidate)
You have 7 minutes. Explain why long-term temazepam is no longer the safest plan after falls, address the Z-drug myth, and negotiate a gradual deprescribing plan with sleep supports. Include the daughter without talking over the patient. Avoid scaremongering and avoid false safety guarantees.[1][2][4]
References8ShowHide
- [1]Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits BMJ, 2005.PMID 16284208
- [2]By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults J Am Geriatr Soc, 2023.PMID 37139824
- [3]Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial JAMA Intern Med, 2014.PMID 24733354
- [4]Pottie K, Thompson W, Davies S, et al. Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline Can Fam Physician, 2018.PMID 29760253
- [5]Soyka M Treatment of Benzodiazepine Dependence N Engl J Med, 2017.PMID 28328330
- [6]Ferracioli-Oda E, Qawasmi A, Bloch MH Meta-analysis: melatonin for the treatment of primary sleep disorders PLoS One, 2013.PMID 23691095
- [7]Gunja N The clinical and forensic toxicology of Z-drugs J Med Toxicol, 2013.PMID 23404347
- [8]Wilson S, Anderson K, Baldwin D, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update J Psychopharmacol, 2019.PMID 31271339