Physician Withdrawal Checklist (PWC-20)

Abstract Anxiety disorders are the most common mental illnesses in the United States. Despite having a number of medication options readily available, benzodiazepines (BZs) and antidepressants have achieved remission rates of only 35% after 8 weeks of acute treatment. In the development of new anxiolytics, particularly those that affect the γ-aminobutyric acid system, it is essential to assess the new compound's potential to cause discontinuation symptoms after stopping the medication as part of both short- and long-term treatment. This report describes the development of the 20-item Penn Physician Withdrawal Checklist (PWC), a smaller version of the original 35-item PWC, and examines its validity, internal consistency, test-retest and interrater reliability, and factor structure. The PWC scores, assessed at the peak of withdrawal severity, were selected from 143 of our patients for an orthogonal factor analysis. Our results suggest that the Penn Physician Withdrawal Checklist is a simple and accurate method to assess anxiolytic discontinuation symptoms.

[1]  K. Rickels,et al.  Remission of generalized anxiety disorder: a review of the paroxetine clinical trials database. , 2006, The Journal of clinical psychiatry.

[2]  M. Pollack,et al.  The selective GABA reuptake inhibitor tiagabine for the treatment of generalized anxiety disorder: results of a placebo-controlled study. , 2005, The Journal of clinical psychiatry.

[3]  M. Keller,et al.  Are benzodiazepines still the medication of choice for patients with panic disorder with or without agoraphobia? , 2003, The American journal of psychiatry.

[4]  J. Davidson,et al.  Pregabalin in generalized anxiety disorder: a placebo-controlled trial. , 2003, The American journal of psychiatry.

[5]  J. Lépine,et al.  The epidemiology of anxiety disorders: prevalence and societal costs. , 2002, The Journal of clinical psychiatry.

[6]  S. Stahl Don't ask, don't tell, but benzodiazepines are still the leading treatments for anxiety disorder. , 2002, The Journal of clinical psychiatry.

[7]  M. Höfler,et al.  Generalized anxiety and depression in primary care: prevalence, recognition, and management. , 2002, The Journal of clinical psychiatry.

[8]  C. Allgulander,et al.  Venlafaxine Extended Release (ER) in the Treatment of Generalised Anxiety Disorder , 2001, British Journal of Psychiatry.

[9]  R. Kessler,et al.  One‐year prevalence of subthreshold and threshold DSM‐IV generalized anxiety disorder in a nationally representative sample , 2001, Depression and anxiety.

[10]  D. Greenblatt,et al.  Imipramine and buspirone in treatment of patients with generalized anxiety disorder who are discontinuing long-term benzodiazepine therapy. , 2000, The American journal of psychiatry.

[11]  D. Greenblatt,et al.  Trazodone and valproate in patients discontinuing long-term benzodiazepine therapy: effects on withdrawal symptoms and taper outcome , 1999, Psychopharmacology.

[12]  M. Fava,et al.  Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial , 1998, Biological Psychiatry.

[13]  K. Rickels,et al.  Gepirone and diazepam in generalized anxiety disorder: a placebo-controlled trial. , 1997, Journal of clinical psychopharmacology.

[14]  K. Rickels,et al.  Placebo‐controlled comparison of the clinical effects of rapid discontinuation of ipsapirone and lorazepam after 8 weeks of treatment for generalized anxiety disorder , 1995, International clinical psychopharmacology.

[15]  K. Rickels,et al.  A double-blind trial of oral progesterone, alprazolam, and placebo in treatment of severe premenstrual syndrome. , 1995, JAMA.

[16]  K. Rickels,et al.  Maintenance drug treatment for panic disorder. II. Short- and long-term outcome after drug taper. , 1993, Archives of general psychiatry.

[17]  D. Greenblatt,et al.  Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation. , 1990, Archives of general psychiatry.

[18]  D. Greenblatt,et al.  Long-term therapeutic use of benzodiazepines. II. Effects of gradual taper. , 1990, Archives of general psychiatry.

[19]  K. Rickels,et al.  Long-term treatment of anxiety and risk of withdrawal. Prospective comparison of clorazepate and buspirone. , 1988, Archives of general psychiatry.

[20]  R. Fontaine,et al.  Differential efficacy of unilateral and bilateral ECT. , 1984, The American journal of psychiatry.

[21]  G. Chouinard,et al.  Rebound anxiety in anxious patients after abrupt withdrawal of benzodiazepine treatment. , 1984, The American journal of psychiatry.

[22]  K. Rickels,et al.  Long-term diazepam therapy and clinical outcome. , 1983, JAMA.

[23]  H. Pétursson,et al.  Withdrawal from long-term benzodiazepine treatment. , 1981, British medical journal.

[24]  J. Schöpf [Unusual withdrawal symptoms after long-term administration of benzodiazepines (author's transl)]. , 1981, Der Nervenarzt.

[25]  D. Greenblatt,et al.  Withdrawal reaction from long-term, low-dosage administration of diazepam. A double-blind, placebo-controlled case study. , 1980, Archives of general psychiatry.

[26]  H. Halbach,et al.  Drug dependence: its significance and characteristics. , 1966, Psychopharmacology bulletin.