¹Pusan National University School of Medicine, Psychiatry, Yangsan, Korea, Republic of, ²Pusan National University Hospital, Psychiatry, Busan, Korea, Republic of, ³Yonsei University Wonju College of Medicine, Psychiatry, Wonju, Korea, Republic of, ⁴CHA Ilsan Medical Center, CHA University, Psychiatry, Ilsan, Korea, Republic of, ⁵Sanggye Paik Hospital, Inje University College of Medicine, Psychiatry, Seoul, Korea, Republic of, ⁶College of Medicine, Soonchunhyang University Cheonan Hospital, Psychiatry, Cheonan, Korea, Republic of, ⁷Health Screening and Promotion Center, Asan Medical Center, Division of Psychiatry, Seoul, Korea, Republic of, ⁸CHA Bundan Medical Center, CHA University, Psychiatry, Seongnam, Korea, Republic of, ⁹St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Psychiatry, Seoul, Korea, Republic of, ¹⁰Suh Hosuk Yonsei Psychiatry Clinic for Healthy Mind, Psychiatry, Seoul, Korea, Republic of, ¹¹Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Psychiatry, Seoul, Korea, Republic of

Background: Panic disorder (PD) and generalized anxiety disorder (GAD) present with distinct anxiety profiles, which may lead clinicians to adopt different pharmacological strategies. Benzodiazepines (BDZs) are sometimes prescribed on a pro re nata (PRN) basis to provide rapid relief of acute or situational anxiety, despite guideline recommendations favoring short-term, scheduled use. Although PRN prescribing is common in clinical practice, particularly for patients who prefer as-needed symptom control, evidence regarding its effectiveness, risks, and appropriate indications remains limited. Prior studies have reported inconsistent findings regarding PRN BDZ use, and concerns persist about the potential for tolerance, dependence, and long-term misuse. Given the paucity of systematic research, examining real-world prescribing behaviors among clinicians with extensive experience treating anxiety disorders may offer meaningful insights. This study aimed to investigate the current status of BDZ PRN prescribing in PD and GAD and to identify clinician- and treatment-related factors associated with its use.

Aims & Objectives: This study aimed to explore patterns of BDZ PRN prescribing in PD and GAD among experienced Korean psychiatrists, compare PRN prescribing rates between the two disorders, and identify clinical and demographic factors associated with such prescribing practices.

Method: A cross-sectional web-based survey was administered to lifetime members of the Korean Anxiety Disorders Association. A total of 105 respondents completed the PD survey and 99 completed the GAD survey. Survey items assessed the proportion of patients receiving PRN prescriptions, BDZ prescribing rates, typical duration of BDZ use, number of BDZs concurrently used, and demographic characteristics including age, hospital type, and years of specialist experience. Descriptive statistics summarized prescribing patterns. Differences between PD and GAD were examined using chi-square tests. Associations between PRN prescribing and clinician- or treatment-related variables were analyzed using Spearman’s rank correlation coefficients.

Results: BDZ prescribing rates differed significantly between PD and GAD. The most common proportion of PD patients receiving PRN BDZ prescriptions was 41–60%, whereas in GAD the most frequent response was 0–20%, indicating overall lower PRN use in GAD. PRN prescribing rates differed significantly between disorders. In PD, PRN prescribing showed significant negative correlations with clinician age and years of specialist experience, suggesting declining reliance on PRN strategies with accumulated clinical expertise. In contrast, PRN use in GAD was positively correlated with overall BDZ prescribing rates and average BDZ duration. In both disorders, PRN prescribing was positively correlated with the number of BDZs used and BDZ polypharmacy rates.

Discussion & Conclusions: Findings indicate that BDZ PRN prescribing patterns vary between PD and GAD and are influenced by clinician experience and BDZ treatment characteristics. PRN prescribing appears to be used more often in PD, where acute or episodic symptom exacerbations may justify as-needed strategies. Meanwhile, greater clinical experience is associated with reduced PRN use, highlighting a more conservative and selective application among seasoned psychiatrists. These results underscore the need for individualized, disorder-specific guidance for BDZ PRN prescribing, balanced consideration of risks such as tolerance and dependence, and further systematic research to inform evidence-based practice.