Benzodiazepines are highly beneficial for managing anxiety and agitation in psychiatric inpatient settings, but we must be cautious about prescribing them to patients with substance use disorders (SUDs). Here we review strategies to reduce the risk of benzodiazepine misuse and discuss alternative medication options, including second-generation antipsychotics, antidepressants, gabapentin, and pregabalin.

Dr. Ponce Martinez highlights the need to identify and manage alcohol withdrawal in psychiatric settings, underscoring the use of the CIWA-Ar scale for monitoring symptom progression. While benzodiazepines remain the primary treatment, she reviews alternative treatment strategies and tells us which patients are so high risk that they must be transferred to a medical unit for care.

Substance-induced psychosis (SIP) presents diagnostic challenges in distinguishing it from primary psychotic disorders, with substance timing, symptom type, and duration being key differentiators. Effective treatment combines antipsychotic medications and substance cessation strategies. Dr. Athanasiou reviews key points in the management of SIP.