Virtual Conference
Neuroscience conference 2022

Karishma Lowton


Title: Assessing the clinical utility of the severity dependence scale for benzodiazepine use disorder


Background: Benzodiazepines are often used as a part of mental health pharmacological management, however, often when prescribed for extended periods increase the risk of Benzodiazepine Use Disorder (BUD).  Clinical interviews are at the centre of diagnosing this disorder. However in addition to clinical assessment a simple, validated questionnaire conducted by any health care professional may aid in screening for BUD and referral for further management.
Aim: To compare the accuracy of the Severity Dependence Scale (SDS) as a screening tool for BUD against the standard clinical interviews using the DSM V checklist among benzodiazepine users with primary psychiatric disorders.
Setting: Outpatient psychiatric clinic in South Rand Hospital, Johannesburg, South Africa.
Methods: Once informed consent was attained, a cross sectional study was conducted, looking at demographic and clinical profiles of benzodiazepine users. Clinical interviews were conducted in eighty-one patients who completed the SDS. In comparing the results of the SDS and clinical interview outcomes, chi-square tests were used to determine an association between categorical variables. A receiver operating characteristic (ROC) curve was generated in determining the cut off score in the SDS with the highest sensitivity and specificity. For the estimation of sensitivity and specificity at 85% with 10% precision and a 95% confidence interval, given an anticipated prevalence of the BUD diagnosis of approximately 60%, a sample size of 80 was required based on sensitivity and 126 for specificity.  
Results: This study indicated that a cut off score of greater than/equal to six of the SDS showed 86% sensitivity and 90.3% specificity when compared to a diagnosis of BUD made with clinical interview. The only categorical variables of marginal significance (p~0.06) in comparison to a BUD diagnosis were with benzodiazepine type (oxazepam) and longer duration of use (greater than 24 months). 
Conclusion:  This study identified the SDS as a useful screening tool for BUD with a high sensitivity and specificity compared to interview outcomes. Statistically correlates were identified between duration and type of benzodiazepine prescribed and BUD suggesting emphasis on these factors when prescribing benzodiazepines.


My name is Dr Karishma Lowton, a neuropsychiatrist currently working at Charlotte Maxeke Johannesburg Academic Hospital. I attained my undergraduate training at the University of Witwatersrand in 2006, and my postgraduate and sub speciality certifications through the Colleges of Medicine, South Africa (CMSA) in 2017 and 2021, respectively. 

Neuropsychiatry is a fairly new, but ever evolving sub speciality in South Africa. In recent times, my aim has been, together with my colleagues, centered on creating a subspecialty program at the University of Witwatersrand. The success of this has culminated in my involvement in training a second fellow. Additionally, I have been invited as a convenor and examiner in the postgraduate and sub-specialty examinations for the CMSA.  

I am a senior lecturer at the University of Witwatersrand and currently involved in the registrar training program with one-on-one neuropsychiatry supervision to improve the knowledge and skill of upcoming clinicians. 

Research has been a focal point for me aiming to enhance the due acknowledgment of work emitting from our country. Since graduating, I have published 3 articles, am in the process of submitting a chapter for book publication on an international basis and I am supervising 5 Masters students with neuropsychiatry based research. 

The value of attending and presenting at this congress will afford me the opportunity to attain new insights in the field, network with other like minded specialists from all parts of the world and represent South Africa on an incredible platform.