Management Of Anxiety Disorders Research Articles

Anxiety Disorders in Older Adults

Late life anxiety disorders are the most prevalent psychiatric conditions among older adults and they often present at a sub-threshold level. Specific phobias (SP) are particularly frequent and fear of falling is increasingly being recognized as a class of phobias typically seen in older adults. Generalized anxiety disorder (GAD), although recognized as a chronic disorder with early onset, has been found to have an onset late in life as well. Social phobia (SoP) has been found to not necessarily have a chronic course in this population. Post-traumatic stress disorder (PTSD) manifests in older adults often as an exacerbation of symptoms from a trauma earlier in life. Cognitive behavior therapy (CBT) augmented with learning and memory aids, and a combination of CBT and medication, has had good outcomes in the management of anxiety disorders in older adults.

The Wounded Self: New Approach to Understanding and Treating Anxiety Disorders

This article synthesizes the concept of “wounded self” in the understanding and psychological treatment of anxiety disorders. The focal point of this concept is the notion of self-wounds or early unresolved emotional injuries. According to this conceptualization, anxiety represents an unconscious fear of unbearable insult to the wounded self, which is protected by maladaptive conscious strategies such as avoidance, cognitive distortions, or emotional constriction. This perspective provides a theoretical basis for blending elements of psychodynamic, behavioral, cognitive, and experiential therapies in the psychological management of anxiety disorders. As cognitive hypnotherapy embodies all of these therapeutic elements, its application to anxiety disorders is described in this article. Various hypnotherapeutic techniques for symptomatic relief and for eliciting and healing the wounded self are discussed and exemplified by a case. This case illustrates that symptom-focused treatment is necessary, but not sufficient. A more durable treatment requires resolution of underlying conflicts that drive the anxiety.

Efficacy of Alternative Treatment for Anxiety Disorders: A Review

Management of anxiety disorders is a matter of utmost attention and poses challenges for the selection of adequate line of treatment to ensure the provision of the most appropriate management of symptoms of anxiety disorders. Hence, the present article attempts to unfold the possibilities of having effective complementary treatments viz. nutritional therapy as well as psychotherapy for the management of the anxiety disorders. Psychodynamic psychotherapy and CBT are helpful in the management of symptoms of anxiety disorders and nutritional supplementation has a role in reducing anxiety symptoms, although both complementary management require more research investigations, to establish whether the result outcomes will be better if employed in combination with psychopharmacological treatment or not.

Bioequivalence of Alprazolam Sublingual Tablet Formulation and Alprazolam Immediate Release Tablet in Healthy Volunteers

Alprazolam immediate release (IR) tablets are currently approved for the management of anxiety disorder or the short-term relief of symptoms of anxiety. A sublingual (SL) formulation of alprazolam, which disintegrates in the mouth without the need for additional fluids, has been developed. The aim of this study was to determine if the alprazolam SL 1 mg tablet was bioequivalent to the alprazolam IR 1 mg tablet in healthy volunteers. In this randomized, open label, two-way crossover, single dose study, subjects were randomized to receive a single alprazolam 1 mg IR tablet during one dosing period and a single 1 mg SL tablet during the other dosing period. The primary pharmacokinetic endpoints were area under the plasma concentration-time profile from time zero to the time of the last quantifiable concentration AUC (0-t) and maximum plasma concentration (C max ). Adverse events (AEs) were monitored throughout the study. Bioequivalence was concluded if the 90% confidence intervals (CI) for the ratio of adjusted geometric means for both AUC (0-t) and C max were wholly within 80%-125%. Participants were mostly male (27/28 [96.4%]) and had a mean (standard deviation) age of 35.9 (8.2) years. For the alprazolam 1 mg SL tablet relative to the alprazolam 1 mg IR tablet, the ratio of adjusted geometric means (90% CI) for AUC (0-t) and C max were 95.43% (91.74%, 99.27%) and 88.27% (83.68%, 93.11%), respectively. The incidence of AEs was similar during both treatment periods: 24 participants reported 39 AEs during the alprazolam 1 mg IR treatment period, and 23 participants reported 38 AEs during the alprazolam 1 mg SL treatment period. Bioequivalence was demonstrated between the alprazolam IR and SL 1 mg tablets, suggesting that the clinical performance of the SL tablet will be similar to that of the IR tablet.

A CLINICAL STUDY TO COMPARE THE ROLE OF JALADHARA AND SANKHAPUSPI RASAYAN IN THE MANAGEMENT OF CHITTODVEGA (ANXIETY DISORDERS)

C h ittodvega is a Manasa Vikara described by Charak . It has been considered as a perfect word for highlighting the status of anxiety, which is pro duced due to vitiation of Raja and Tama. In addition Prana, Udana, Vyana Vayu; Sadhaka Pitta; and Tarpaka Kapha are also prov ocated factors in it. On the basis of these considerations it can be postulated that C h ittodvega is a minor mental disorder. In mo dern parlances also, the neurotic disorders which include anxiety disorders are considered as minor mental disorder in comparison to major mental condition like schizophrenia etc. Beneficial action of Shirodhara in the management of anxiety disorder has be en reported. Acharya Charaka has advised to use Medhya Rasayana drugs for the mental disorders, especially for the promotion of Medha . Sankhapuspi ( Convolvulus pluricaulis ) has been considered best amongst the Medhya Rasayana drugs. Here in this study t he total 36 patients of C h ittodvega (Anxiety disorders) were randomly divided into two groups: 1) Group - J : The patients of this group were subjected to Jaladhara for 30 minutes daily in the morning between 8:30 to 11:00 AM for 6 w eeks with a gap of 1 week aft er completion of three weeks course of Jaladhara. 2) Group - SR : The Patients of this group were administered 3 gms powder s of Sankhapuspi Rasayana three times a day orally with water for 6 weeks. It can be concluded that Jaladhara gave better relief in pani c attack and phobic disorder while Sankhapuspi Rasayana is more useful in generalized anxiety disorder. Results of the study are encouraging and these two therapies i.e. Jaladhara and Sankhapuspi Rasayana may become first line treatment of C h ittodvega ( Anx iety disorders).

Benzodiazepines for anxiety disorders: maximising the benefits and minimising the risks

SummaryBenzodiazepines still play an important role in the management of anxiety disorders but dependence is associated with their therapeutic use. The key to effective and safe long-term use of benzodiazepines is: the careful selection of patients who might benefit from them; administration in clinical situations in which they are more likely to be beneficial; use of lower doses and in conjunction with an antidepressant, if possible; monitoring and managing their side-effects; and minimising the risk of withdrawal symptoms and relapse, mainly through tapering the dose and/or combining with effective psychological interventions.

Yoga in the management of anxiety disorders

Holistic approaches are gaining increasing popularity in the management of psychiatric disorders. Yoga is among the oldest sciences with a holistic approach and hence, has been studied extensively in psychiatry. Many uncertainties and methodological problems and both theoretical as well as practical issues, surround research pertaining to yoga in health and disease. Various studies have emphasized the benefits of incorporating yoga practice in the management of anxiety disorders. The effect of this technique needs to be further explored and more scientific studies should focus on the usage, long term effects and physiological basis of yoga practice. The present review covers the role of yoga in the management of anxiety disorders and future research needs that are warranted. DOI: http://dx.doi.org/10.4038/sljpsyc.v3i1.4452 SL J Psychiatry 2012; 3 (1):3-9

Factors associated with anxiety disorders among HIV-positive attendees of an HIV clinic in Lagos, Nigeria

Anxiety disorders (ADs) occurring in people living with HIV/AIDS (PLWHA) are often poorly identified in spite of the untold consequences that may result if not diagnosed and treated promptly. This study aimed to describe factors associated with ADs among PLWHA. Three hundred participants were administered sociodemographic/clinical profile questionnaires, and diagnoses of ADs were made using Schedule for Clinical Assessment in Neuropsychiatry (SCAN) based on International Classification of Diseases, 10th edition (ICD-10) criteria. In this study, 65 (21.7%) participants were diagnosed with ADs. A lack of family support, unemployment, younger mean age and being unmarried (P < 0.05) were factors associated with ADs in PLWHA; however, lack of family support (odds ratio [OR] = 0.458, 95% confidence interval [CI] = 0.254-0.827, P = 0.010), being unmarried (OR = 1.930, 95% CI = 1.046-3.560, P = 0.035) and unemployment (OR = 0.495, 95% CI = 0.264-0.926, P = 0.028) were the only factors that remained significant following logistic regression analysis. Prompt identification with active management of ADs and their associated factors among PLWHA are advocated. Further research on the risk factors for ADs is also warranted.

Family Factors in the Development and Management of Anxiety Disorders

Family variables are thought to play a key role in a wide variety of psychopathology according to many theories. Yet, specific models of the development of anxiety disorders place little emphasis on general family factors despite clear evidence that anxiety runs in families. The current review examines evidence for the involvement of a number of family-related variables in the development of anxiety disorders as well as the importance of families in their management. Evidence across most areas is shown to be weak and inconsistent, with the one exception being an extensive literature on the role of parenting in the development of anxiety. There is also currently little evidence that family factors have a strong role to play in the treatment of anxiety, aside from research demonstrating the value of parents and partners as non-critical supports in therapy. The promises and hints in the literature, combined with the currently inconsistent methods, suggest that considerably more research is needed to determine whether specific family factors may yet be shown to play a key role in the development and management of anxiety disorders.

Management of Anxiety Disorders in the Pediatric Primary Care Setting

Management of Anxiety Disorders in the Pediatric Primary Care Setting

Brain Substratum Of Pathogenic Neurotic Belief In Panic Disorder: A Single Case Study

Abstract The aim of the study was to demonstrate how recent research achievements in the neuroscience of emotions can influence practical management of anxiety disorders. Using the data obtained from analysis of psychophysiological mechanisms in one case of panic disorder, the type of threat, key threat stimuli, and the structure of the pathogenic neurotic belief were ascertained and, on this basis, an individually tailored therapeutic procedure was designed. Its application resulted in almost complete dissipation of the neurotic belief, which represented the key p athogenic mechanism in the case studied. The study called attention especially to the importance of detailed diagnostics of memory mechanisms underlying the formation of neurotic belief in the psychotherapy of anxiety disorders.

Improving the detection and management of anxiety disorders in primary care

There has been considerable emphasis on encouraging GPs to improve their skills in the diagnosis and management of depression, yet anxiety disorders have been relatively neglected. Anxiety symptoms are more common than those of depression in the community, and may be accompanied by significant morbidity. The 2007 UK Adult Psychiatric Morbidity Survey reported a 9% prevalence of mixed anxiety and depression in their doorstep community survey, while generalised anxiety disorder (GAD) affected 4.4% of the population, other anxiety disorders 3.6%, and only 2.3% reported depressive disorders.1 Despite this, there has been much less research to assess outcomes in anxiety than depressive disorders, and most of the research comes from the US or Europe. Studies suggests that anxiety disorders are often more chronic than other common mental disorders, presumably because anxiety is often left untreated and it is frequently comorbid with depressive disorders or chronic physical health problems.2,3 Such comorbidity is associated with poor quality of life, substance misuse, disability, and high health and social costs.4 GP rates of diagnosis and treatment of anxiety disorders are much lower than expected, given their prevalence.5 This may be due to both patient and practitioner factors. Patients may have symptoms of anxiety, worry, tension, irritability, or tiredness, which they are unsure about presenting to their GP; whereas GPs may dismiss such symptoms or attribute them to general malaise or a potentially physical condition requiring investigation, and not specifically consider or ask about anxiety symptoms. In addition, many people present with the …

Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in The Netherlands study of depression and anxiety (NESDA)

BackgroundAppropriate management of anxiety disorders in primary care requires clinical assessment and monitoring of the severity of the anxiety. This study focuses on the Beck Anxiety Inventory (BAI) as a severity indicator for anxiety in primary care patients with different anxiety disorders (social phobia, panic disorder with or without agoraphobia, agoraphobia or generalized anxiety disorder), depressive disorders or no disorder (controls).MethodsParticipants were 1601 primary care patients participating in the Netherlands Study of Depression and Anxiety (NESDA). Regression analyses were used to compare the mean BAI scores of the different diagnostic groups and to correct for age and gender.ResultsPatients with any anxiety disorder had a significantly higher mean score than the controls. A significantly higher score was found for patients with panic disorder and agoraphobia compared to patients with agoraphobia only or social phobia only. BAI scores in patients with an anxiety disorder with a co-morbid anxiety disorder and in patients with an anxiety disorder with a co-morbid depressive disorder were significantly higher than BAI scores in patients with an anxiety disorder alone or patients with a depressive disorder alone. Depressed and anxious patients did not differ significantly in their mean scores.ConclusionsThe results suggest that the BAI may be used as a severity indicator of anxiety in primary care patients with different anxiety disorders. However, because the instrument seems to reflect the severity of depression as well, it is not a suitable instrument to discriminate between anxiety and depression in a primary care population.

Imaging escape and avoidance behavior in zebrafish larvae

This review provides an overview of the assays that are used for measuring escape and avoidance behavior in zebrafish, with a specific focus on zebrafish larvae during the first week of development. Zebrafish larvae display a startle response when exposed to tactile, acoustic, or visual stimuli and will avoid dark areas, moving objects, conspecifics, and open spaces. Emotional states such as fear and anxiety might be induced when larvae are exposed to stimuli that they would normally escape from or avoid. Although these emotional states probably differ between species and change during development, much can be learned about human fear and anxiety using zebrafish as a model system. The molecular mechanisms of fear and anxiety are highly conserved in vertebrates and are present during early zebrafish development. Larvae during the first week of development display elevated cortisol levels in response to stress and are sensitive to the same anxiolytics that are used for the management of anxiety in humans. Zebrafish larvae are well suited for high-throughput analyses of behavior, and automated systems have been developed for imaging and analyzing the behavior of zebrafish larvae in multiwell plates. These high-throughput analyses will not only provide a wealth of information on the genes and environmental factors that influence escape and avoidance behaviors and the emotional states that might accompany them but will also facilitate the discovery of novel pharmaceuticals that could be used in the management of anxiety disorders in humans.

Recognizing and managing anxiety disorders in primary health care in Turkey

BackgroundAnxiety disorders are common and are frequently not diagnosed accurately in primary care. Our aim was to determine the knowledge gaps of general practitioners (GPs) in the diagnosis and treatment of anxiety disorders by using vignettes.MethodsA cross-sectional survey was completed with 255 primary care physicians (response rate 59.4%) in Manisa, a city in western Turkey. From the postal questionnaire, information on working experience, postgraduate education in psychiatry, the interests of the physicians in psychiatry were obtained. The physicians' diagnosis and treatment preferences for generalized anxiety disorder (GAD), social phobia (SP), and obsessive compulsive disorder (OCD) were determined through clinical vignettes prepared for data collection.ResultsTwo hundred and twenty-seven (89.0%) out of 255 GPs included the diagnosis of obsessive compulsive disorder in their differential diagnosis; however, the rates for social phobia and generalized anxiety disorder were 69.4% (n = 177) and 22.3% (n = 57), respectively. GPs with a post-graduate education on psychiatry diagnosed vignettes more accurately for OCD (p = 0.04). For all three cases, GPs mostly preferred a combination therapy including psychotherapy and psycho-pharmacotherapy. The referral rate to a psychiatrist was between 23.1 and 30.6%. The percentages of the prescription of selective serotonin reuptake inhibitors (SSRI) in accurate diagnosis were 59.3 for social phobia, 33.3 for GAD, and 55.5 for OCD.ConclusionsThere is a gap of knowledge in GPs, which leads to poor recognition and management of anxiety disorders in primary care. Effective interventions including post-graduate education and updated guidelines on anxiety disorders should be planned and implemented with their assessments by vignettes.

P03-93 Anxiety disorders in the elderly: Sub-diagnosis and sub-treatment

Background:Although anxiety disorders prevalence and incidence decline in later life, anxiety is a major health problem for the elderly. Epidemiology, neurobiology, and treatment of anxiety disorders are poorly studied in the geriatric population. Nevertheless, anxiety has a high impact on functional status and health-related quality of life.Aim:To underline the significant impact of anxiety in the elderly. to discuss the sub-diagnosis and sub-treatment of late-life anxiety and subclinical symptoms.Methods:Literature Review. MEDLINE and PubMed databases searches for peer-reviewed studies, published between 1998 and 2008, using combinations of the Medline Subject Heading terms anxiety, anxiety disorders and old age.Results:There are few studies in the literature addressing this topic. Late-life anxiety has a high prevalence and is associated with increased morbidity, mortality, functional impairment, poorer quality of life and significant societal costs. Clinical studies show that most cases of anxiety disorders in late life are undetected and under-treated. Intervention research in late-life anxiety disorders is lacking.Conclusions:It is extremely important and urgent a more efficacious assessment and management of anxiety disorders in the elderly. It is also fundamental an increased attention to subtreshold anxiety, which will allow an earlier intervention and prevention of new cases of anxiety disorders. Well designed interventions will be capable of reducing the burden, morbidity and incidence of late-life anxiety.

Implementing clinical guidelines for bipolar disorder

To critically review the evidence concerning the implementation of clinical guidelines for bipolar disorder. A Medline search was made of the literature on the implementation of guidelines in bipolar disorder and mental health. The implementation of non-pharmacological treatments from the 2006 NICE Guideline for Bipolar Disorder was then used as a case example. May's model of normalization of complex interventions was then applied to the NICE guideline recommendations for bipolar disorder. The effective local implementation of guidelines requires a detailed understanding of local barriers to their implementation. Some recommendations in the NICE Guideline on advanced directives and management of anxiety disorder in bipolar disorder appear to follow the existing trends in practice and are more likely to be implemented. Interventions concerning the psychological management of bipolar depression and maintenance psychological treatments are going to be the most difficult to implement because of shortages of skilled staff, the absence of specific training and supervision, the requirements for staff to adopt practices that are quite different from what they are used to, and some uncertainty about whether these interventions are effective in the most severe patients. Without a detailed local understanding of the barriers to implementation and the resources and will to overcome them, there is likely to be a considerable local variation in the implementation of guidelines for bipolar disorder. Recommendations that require little change to working practices and resources are most likely to be implemented.

Valproate (depakine-chrono) in the acute treatment of outpatients with generalized anxiety disorder without psychiatric comorbidity: Randomized, double-blind placebo-controlled study

Objective Anxiety disorders are highly prevalent in population of European countries. However, the effect of Valproate (depakine-chrono) on generalized anxiety disorder (GAD) has not been studied in a double-blind placebo-controlled design. Method Eighty patients (all men) were washout from the all medications. Each patient was randomized to receive either depakine-chrono (40 patients) for 6 weeks or matched placebo (40 patients) in a double-blind manner. Eligible participants, in addition to meeting the DSM-IV criteria for GAD and having a minimum score of 25 and more on the Hamilton Anxiety Scale, were required to be between 18 and 65 years. Response was defined as a 50% reduction in the Hamilton anxiety scale score. Response and side effects with depakine-chrono and placebo were compared by using analysis of variance (ANOVA) and chi-square tests. Six patients did not return for at least one subsequent assessment, leaving 74 patients (36 taking depakine-chrono and 38 taking placebo) in the valuables study group. Results Twenty six of the 36 depakine-chrono-treated participants responded by 6 weeks, versus six of the 38 placebo-treated participants ( p < 0.001). The most common and problematic side effect in the depakine-chrono group was dizziness and nausea. Conclusions The authors believe this to be the first double-blind placebo-controlled randomization study to test the efficacy of a depakine-chrono in the management of anxiety disorders. They need to be replicated in a larger study group.

Akathisia in schizophrenia patients treated with aripiprazole, haloperidol, or olanzapine - analysis of three double-blind, long-term trials

Anxiety disorders are highly prevalent in population of European countries. However, the effect of Valproate (depakine-chrono) on generalized anxiety disorder (GAD) has not been studied in a double-blind placebo-controlled design.Eighty patients (all men) were washout from the all medications. Each patient was randomized to receive either depakine-chrono (40 patients) for 6 weeks or matched placebo (40 patients) in a double-blind manner. Eligible participants, in addition to meeting the DSM-IV criteria for GAD and having a minimum score of 25 and more on the Hamilton Anxiety Scale, were required to be between 18 and 65 years. Response was defined as a 50% reduction in the Hamilton anxiety scale score. Response and side effects with depakine-chrono and placebo were compared by using analysis of variance (ANOVA) and chi-square tests. Six patients did not return for at least one subsequent assessment, leaving 74 patients (36 taking depakine-chrono and 38 taking placebo) in the valuables study group.Twenty six of the 36 depakine-chrono-treated participants responded by 6 weeks, versus six of the 38 placebo-treated participants (p < 0.001). The most common and problematic side effect in the depakine-chrono group was dizziness and nausea.The authors believe this to be the first double-blind placebo-controlled randomization study to test the efficacy of a depakine-chrono in the management of anxiety disorders. They need to be replicated in a larger study group.

Integrating Psychological and Biological Approaches to Anxiety Disorders

This review attempts to integrate information and methods from CBT, family therapy and pharmacotherapy orientations, in the treatment of six adult anxiety disorders, and separation anxiety in pediatrie populations. Anxiety disorders have been under-recognized and undertreated, in part because practitioners of different orientations have too often worked in isolation from one another. Both CBT and pharmacotherapy are evidence-supported treatments. However, the effectiveness of CBT can be enhanced if it is provided within a family therapy context. Similarly, medications can be an important treatment partner in the management of anxiety disorders.