Archive for June, 2010

Benzodiazepines are a class of medication used to treat anxiety and insomnia.  These medications have been around since the late 1950s and their role in treatment has changed over the years.  Initially benzodiazepines were a staple treatment for people suffering from “nervous conditions” (now called anxiety disorders).  Over the past 20 years, these medications have given ground to Serotonin Specific Reuptake Inhibitors (SSRIs) in the treatment of anxiety.  Despite this, they remain effective tools in treating anxiety due to their rapid and predictable clinical effect and good tolerability.

After prolonged use or use of high doses, a person’s brain develops a tolerance to benzodiazepines.  This tolerance is not just for the specific medication, but for the entire class of medications.  If a person were to miss several doses of the medication in succession or were to dramatically decrease their dose quickly, that person might experience benzodiazepine withdrawal.  This is a syndrome characterized by an increase in anxiety, irritability, nausea, insomnia, and head and body aches among other symptoms.  In most cases, this is a miserable period of days or weeks that will gradually abate.  However, in some cases this can lead to a life-threatening situation requiring hospitalization.

Generally, the treatment of benzodiazepine withdrawal involves replacement of the missing medication and then gradual tapering of the medication.  People taking a benzodiazepine should consult with their medication prescriber before deciding to reduce or stop one of these medications.

A person’s recovery from facial cosmetic surgery has several unique aspects that are relevant to psychiatry.  In this article I will talk about some of the unique challenges to recovery and discuss some of the ways that these issues can be addressed.

Expectations for a surgical procedure determine how the outcome of that surgery is interpreted by a patient.  Full recovery from a facial cosmetic surgery can take weeks to months.  Pain levels can exceed what was expected.  When the pace of recovery, pain levels or the surgical outcome are not what a patient had anticipated, a sense of frustration is common.

Every surgical procedure contains an element of unpredictability and because of this, anxiety is often seen during recovery.  Facial cosmetic surgery procedures are no different.  Two common postoperative variables are the time it takes for swelling to reduce and the time for bruising to resolve.  Swelling and bruising are inherent to any surgical procedure.  In an abdominal procedure, these can be masked with clothes.  With a facial procedure it is difficult to disguise swelling or bruising.  This can raise self-consciousness and make social interactions uncomfortable.

Up to 55% of patients undergoing facial cosmetic surgery develop some degree of anxiety or depression in the postoperative period.  Many of these patients will experience a gradual reduction in these symptoms over time without the intervention of a psychiatrist.  A smaller percentage of patients will continue to struggle with anxiety and unmet expectations, and in some cases these concerns may escalate.  For these patients, reassurance from the surgical team does not provide any relief.  In these cases, treatment by a psychiatrist can be helpful in reducing anxiety and coming to terms with the surgical outcome.  Treatment can consist of medication, psychotherapy or both. Specific recommendations are based on current and past symptoms and patient preference.