Management Of Anxiety Disorders Research Articles

Identification of Anxiolytic Potential of Niranthin: In-vivo and Computational Investigations

Anxiety is an unpleasant state, which can critically decrease the quality of life is often accompanied by nervous behaviour and rumination. Niranthin is a lignan isolated from various Phyllanthus sources. The literature survey on niranthin highlights wide ranges of the therapeutic potentials. In a present study, based on our previous investigations, we evaluated pure, isolated and characterized niranthin as an anxiolytic agent. The niranthin [6-[(2R,3R)-3-[(3,4-dimethoxyphenyl)methyl]-4-methoxy-2-(methoxymethyl)butyl]-4-methoxy-1,3-benzodioxole] was purchased from commercial source and further subjected for assessment of its anxiolytic potentials using popular animal models including Elevated plus-maze model/test (EPM) and Light & Dark Exploration test (L&D). GABA-A receptor mediation was evaluated by pretreating the mice with the GABA-A receptor antagonist Flumazenil before the EPM task. Molecular docking simulation studies (pdb id: 4COF) carried out by Vlife QSAR software showed that niranthin (docking score: − 62.1714 kcal/mol) have shown comparatively best docking score compared to the standard drug Diazepam (docking score: − 63.1568 kcal/mol). To conclude, Niranthin has probable potential in the management of anxiety disorder. Our in-silico and in-vivo analysis (indirectly) indicated the plausible role of GABA mediation for anxiolytic activity. Although, these studies are preliminary, future in depth experimental explorations will be required to use Niranthin as anti-anxiety drug in near future.Graphic

Management of anxiety disorders in children with attention-deficit hyperactivity disorder: a narrative review.

Anxiety disorders are common comorbidities of attention deficit/hyperactivity disorder (ADHD) and conversely, ADHD is prevalent among anxious youths. A variety of treatments, both psychopharmacological and nonpsychopharmacological, are used to manage combined ADHD/anxiety disorder. This article aims to review the literature on the treatment of ADHD with comorbid anxiety disorders, and make evidence-based recommendations for clinical practice. In most cases, when ADHD is the primary condition, stimulants are the first-line of treatment, frequently resulting not only in improvement in ADHD symptoms but also alleviating the symptoms of the comorbid anxiety disorder. Stimulant treatment is relatively safe and well-tolerated in ADHD with comorbid anxiety disorder. When the stimulant administration does not attenuate the severity of the comorbid anxiety disorder, a treatment that targets specifically the anxiety disorder should be added. This recommendation, however, might be challenged by the impressive efficacy of atomoxetine for both the ADHD and anxiety disorder symptoms. Adjunctive cognitive-behavior therapy for anxiety disorder symptoms is strongly recommended and is considered superior to medication alone. Other options include adding pharmacological treatment for the anxiety symptoms. In moderate and severe cases of comorbid Ads, selective serotonin reuptake inhibitors can be added to the stimulants, with the required caution.

An Overview of Anxiety Disorders and Depression in Children with Epilepsy: A Literature Review

AbstractComorbid psychiatric disorders in children with epilepsy have long been a subject of medical literature. Many studies conducted by pediatric neurologists, neurosurgeons, psychiatrists, and psychologists have revealed that psychiatric disorders, including anxiety disorders and depression, are frequently seen in children and adolescents with epilepsy. Due to various etiologies behind epilepsy, causes, manifestation, and treatment of anxiety and depression all have unique aspects. We think there are multiple reasons behind anxiety disorders and depression in children with epilepsy, varying from the physiological nature of the epilepsy itself to the environmental factors such as family, parenting, and social status. In this article, we aim to review the causes, risk factors, and management of anxiety disorders and depression in children with epilepsy.

Effects of N-acetylcysteine amide on anxiety and stress behavior in zebrafish.

Anxiety disorders are highly prevalent and a leading cause of disability worldwide. Their etiology is related to stress, an adaptive response of the organism to restore homeostasis, in which oxidative stress and glutamatergic hyperactivity are involved. N-Acetylcysteine (NAC) is a multitarget approved drug proved to be beneficial in the treatment of various mental disorders. Nevertheless, NAC has low membrane permeability and poor bioavailability and its limited delivery to the brain may explain inconsistencies in the literature. N-Acetylcysteine amide (AD4) is a synthetic derivative of NAC in which the carboxyl group was modified to an amide. The amidation of AD4 improved lipophilicity and blood-brain barrier permeability and enhanced its antioxidant properties. The purpose of this study was to investigate the effects of AD4 on behavioral and biochemical parameters in zebrafish anxiety models. Neither AD4 nor NAC induced effects on locomotion and anxiety-related parameters in the novel tank test. However, in the light/dark test, AD4 (0.001 mg/L) increased the time spent in the lit side in a concentration 100 times lower than NAC (0.1 mg/L). In the acute restraint stress protocol, NAC and AD4 (0.001 mg/L) showed anxiolytic properties without meaningful effects on oxidative status. The study suggests that AD4 has anxiolytic effects in zebrafish with higher potency than the parent compound. Additional studies are warranted to characterize the anxiolytic profile of AD4 and its potential in the management of anxiety disorders.

The Relationship Between Epilepsy and Anxiety Disorders.

The current review aims at providing an overview of relevant aspects of anxiety symptoms and anxiety disorders (AD) in adults patients with epilepsy (PWE). Firstly, the appropriate diagnosis of type of anxiety symptoms and AD in PWE will be presented. Anxiety symptoms are often peri-ictal and classified in relation to their temporal occurrence to seizures. Anxiety symptoms are of three types: preictal (preceding a seizure), ictal (presenting as part of the seizure symptoms and signs), and postictal (occurring within 72h of a seizure). AD are diagnosed in the interictal period and occur independently of seizures. Four specific AD in PWE can be objectified: anticipatory anxiety of epileptic seizures (AAS), seizure phobia, epileptic social phobia, and epileptic panic disorder. Secondly, the bidirectional pathophysiological relationship between anxiety and epilepsy will be described. Anxiety is a trigger for seizures in some patients, and the notion of stress and arousal is essential to understand the relationship between anxiety and seizure. Moreover, seizures arising from the limbic network especially involving amygdala, which may express fear-related semiology, provide insight into the pathophysiology of AD comorbidities. Thirdly, the methods of screening for AD and anxiety symptoms will be detailed. Fourthly, the pharmacological and psychobehavioral management of anxiety symptoms and AD in PWE will be presented. Arousal-based approaches for preictal and ictal symptoms and anxiety-based approaches for postictal and interictal symptoms will be presented. Despite lack of evidence-based approaches, it is recognized that management of epilepsy is not only about controlling seizures, but also depends heavily on detecting, correctly diagnosing, and appropriately managing anxiety symptoms and AD comorbidities, in order to maximize quality of life. Improving self-control and self-efficacy is of fundamental importance in the management of PWE. Further rigorously designed studies focusing on anxiety symptoms and AD are essential to improve the overall care of PWE.

Pharmacology and prescribing in anxiety

This article in the series of ‘bite-sized’ pharmacology will look at the pharmacological actions of drugs used in the management of anxiety disorders. It will outline the categories of anxiety disorder and pharmacological interventions required in these disorders with reference to guidelines and formulary. The common therapeutic interventions in patients with general anxiety disorder, panic disorder, social phobia, post-traumatic stress disorder and obsessive compulsive disorder will be illustrated. Furthermore, the main types of drug used and their pharmacodynamic actions will be explored. The management will be considered within the guidance and evidence base. Exercises will be provided to help you apply this knowledge to your prescribing practice.

The effects of citalopram and low-dose risperidone on memory and anxiety in rats subjected to chronic immobilization stress

OBJECTIVES: Many clinical reports describe the beneficial effects of low-dose atypical antipsychotic added to the antidepressants in the management of anxiety disorders. The aim of this study was t...

Diagnosis and Management of Anxiety Disorders.

This article provides a synopsis of the current understanding of the pathophysiology of anxiety disorders, the biological and environmental risk factors that contribute to their development and maintenance, a review of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria, and a practical approach to the treatment of anxiety disorders in adults. Despite the ubiquity of anxiety, the evidence is that most individuals with an anxiety disorder are not identified and do not receive guideline-level care. In part, this may be because of the manifold clinical presentations of anxiety disorders and clinicians' lack of confidence in accurately diagnosing and treating these conditions, especially in nonpsychiatric settings. Anxiety disorders represent the complex interplay between biological, psychological, temperamental, and environmental factors. Converging lines of evidence point to dysfunction in regulating activity in the "threat circuit" in the brain as a putative common pathophysiology underlying anxiety disorders. Evidence-based treatments for anxiety disorders, such as cognitive-behavioral therapy and antidepressant medications, have been shown to regulate activity in this circuit, which consists of reciprocal connections between the dorsomedial prefrontal cortex, insula, and amygdala. Anxiety disorders are the most common class of emotional disorders and a leading cause of disability worldwide. A variety of effective treatment strategies are available, which may exert their therapeutic benefits from top-down or bottom-up modulation of the dysfunctional brain activity associated with anxiety disorders.

Poster Number: EI 33 - Management of Anxiety Disorders in Parkinson's Disease: A Case Series and Challenges in Treatment

Poster Number: EI 33 - Management of Anxiety Disorders in Parkinson's Disease: A Case Series and Challenges in Treatment

Clinical Management of Anxiety Disorders

Anxiety disorders are characterized by excessive fear and anxiety accompanied by associated behavioral disturbances that cause significant impairment in social and occupational functioning. Anxiety is a complex mood state that involves physiologic, cognitive, and behavioral components. This review describes the five anxiety disorders most commonly diagnosed in adults: social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and specific phobia. Diagnostic criteria for these disorders are presented along with empirically supported psychological and pharmacologic treatment approaches. Decades of evidence have indicated that for anxiety disorders of mild to moderate severity, cognitive-behavioral therapy (CBT) should be first-line treatment. CBT interventions for anxiety, including psychoeducation, cognitive restructuring, exposure, applied relaxation/breathing retraining, and skills training, are presented with descriptions of how they may be adapted to particular diagnoses, along with data for their efficacy. Data suggest that selective serotonin and norepinephrine reuptake inhibitors are pharmacologic treatments of choice for anxiety and may be used in combination with CBT for moderate to severe symptoms. d-Cycloserine is an emerging treatment that may enhance outcomes in anxiety disorders by optimizing exposure therapy through the facilitation of fear extinction. This review contains 7 figures, 12 tables, and 105 references. Key words: agoraphobia, anxiety, generalized anxiety disorder, panic disorder, phobias, social anxiety disorder

Clinical Management of Anxiety Disorders

Anxiety disorders are characterized by excessive fear and anxiety accompanied by associated behavioral disturbances that cause significant impairment in social and occupational functioning. Anxiety is a complex mood state that involves physiologic, cognitive, and behavioral components. This review describes the five anxiety disorders most commonly diagnosed in adults: social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and specific phobia. Diagnostic criteria for these disorders are presented along with empirically supported psychological and pharmacologic treatment approaches. Decades of evidence have indicated that for anxiety disorders of mild to moderate severity, cognitive-behavioral therapy (CBT) should be first-line treatment. CBT interventions for anxiety, including psychoeducation, cognitive restructuring, exposure, applied relaxation/breathing retraining, and skills training, are presented with descriptions of how they may be adapted to particular diagnoses, along with data for their efficacy. Data suggest that selective serotonin and norepinephrine reuptake inhibitors are pharmacologic treatments of choice for anxiety and may be used in combination with CBT for moderate to severe symptoms. d-Cycloserine is an emerging treatment that may enhance outcomes in anxiety disorders by optimizing exposure therapy through the facilitation of fear extinction. This review contains 7 figures, 12 tables, and 105 references. Key words: agoraphobia, anxiety, generalized anxiety disorder, panic disorder, phobias, social anxiety disorder

Lavender oil supplementation for the management of anxiety disorder

Lavender oil supplementation for the management of anxiety disorder

Clinical Management of Anxiety Disorders

Anxiety disorders are characterized by excessive fear and anxiety accompanied by associated behavioral disturbances that cause significant impairment in social and occupational functioning. Anxiety is a complex mood state that involves physiologic, cognitive, and behavioral components. This review describes the five anxiety disorders most commonly diagnosed in adults: social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and specific phobia. Diagnostic criteria for these disorders are presented along with empirically supported psychological and pharmacologic treatment approaches. Decades of evidence have indicated that for anxiety disorders of mild to moderate severity, cognitive-behavioral therapy (CBT) should be first-line treatment. CBT interventions for anxiety, including psychoeducation, cognitive restructuring, exposure, applied relaxation/breathing retraining, and skills training, are presented with descriptions of how they may be adapted to particular diagnoses, along with data for their efficacy. Data suggest that selective serotonin and norepinephrine reuptake inhibitors are pharmacologic treatments of choice for anxiety and may be used in combination with CBT for moderate to severe symptoms. d-Cycloserine is an emerging treatment that may enhance outcomes in anxiety disorders by optimizing exposure therapy through the facilitation of fear extinction. This review contains 7 figures, 12 tables, and 105 references. Key words: agoraphobia, anxiety, generalized anxiety disorder, panic disorder, phobias, social anxiety disorder

Role of integrated yoga therapy in the management of a 49-year-old patient with trait anxiety

A 49 year old male participant with sedentary life style, diagnosed with Anxiety disorder (Neurosis) [Trait anxiety] and other anxiety related problems since 2013. He undergone with Integrated approach of Yoga Therapy (IAYT) for 2 weeks at Holistic Health home-Arogyadhama (known as Prashanti kutiram,Jigani) in Bengaluru between October and November 2016. The results showed that reduction in train anxiety or anxiety symptoms. There was significant reduction of STAI-X11 scores after two week of IAYT intervention. The percentage change of trait anxiety was 75 % after Integrated Yoga Therapy. His anxiety symptoms minimized and blood pressure, respiratory rate, pulse rate came to normal condition at the time of discharge. There was improvement in feeling of wellness and overall functional health. This case report suggests that yogic lifestyle and IAYT intervention is beneficial in the management of Anxiety disorder.

Evaluation of antianxiety activity of ethanolic extract of leaves of Ocimum sanctum (tulsi) in albino mice

Background: Anxiety is a normal emotional behavior, however, becomes pathological precipitating cardiovascular and psychiatric disorders when it is severe. Many allopathic drugs are available to treat anxiety disorders, among which benzodiazepines are most commonly used which possess various systemic side effects. Aims and Objectives: In our study, we have attempted to evaluate new compound Ocimum sanctum (OS) in the hope of identifying the anxiolytics with fewer side effects as many plant products have been claimed to be free from side effects and less toxic than synthetic drugs. Materials and Methods: The anxiolytic activity of ethanolic extract of OS is evaluated with two validated modes, elevated plus maze and light and dark exploration test. A total of 60 animals (n = 60) were used. They were divided into five groups of six animals each for both models. The effects of the test drug OS at three different doses 1.75, 4.25, and 8.5 mg/kg were compared with the standard anxiolytic diazepam at 1 mg/kg dose and control group using 1% gum acacia at 10 ml/kg dose 1 h after administration of the drug. Results: The behavioral changes in both paradigms are suggestive of decreased anxiety, decreased aversion to light and increased exploratory behavior of the animal which is comparable changes produced by the standard drug diazepam concluding that OS has anxiolytic activity. Conclusion: OS has potential clinical application in the management of anxiety disorders. Further investigation of the mechanism/mechanisms of action of the plant extract, as well as the active substance/substances responsible for its biological actions, is necessary.

Isolation, characterization and quantification of an anxiolytic constituent - mahanimbine, from Murraya koenigii Linn. Spreng Leaves

Ethnopharmacological relevanceLeaves of M. koenigii Linn. Spreng (Rutaceae) have been used as traditional medicine for anxiety disorders. Aim of the study was to isolate antianxiety principle(s) from the leaves of M. koenigii using bioactivity guided approach. Material and methodsHydroalcoholic extract of M. koenigii leaves was prepared using soxhlet apparatus, and the same was evaluated for antianxiety activity at 250, 500 and 750mg/kg, po, using Elevated plus-maze (EPM). The extract was further partitioned successively with pet ether, chloroform, ethyl acetate and 1-butanol. All the fractions were evaluated for antianxiety activity. The bioactive ethyl acetate fraction was column chromatographed to get 5 fractions (F1-F5). All the fractions were evaluated for antianxiety activity using EPM. A pure compound, separated out from F2, was characterized using standard spectroscopic techniques, and its anxiolytic activity was evaluated using EPM. Antianxiety activity of isolated compound was further evaluated using Actophotometer and m-CPP induced anxiety model. TLC-densitometric method was developed to quantify mahanimbine in the plant. ResultsThe present study resulted in the isolation of mahanimbine, which exhibits potent antianxiety activity at 3mg/kg, and the activity was statistically comparable to that of diazepam (2mg/kg). The developed TLC-densitometric method is specific, linear, precise, accurate, repeatable and robust. ConclusionsThis study validates the ethnopharmacological use of M. koenigii leaves in the management of anxiety disorders. Mahanimbine is responsible for the antianxiety effect of M. koenigii leaves.

<i>Manasamitra vataka</i> and <i>Shirodhara</i> Treatments Preserve Slow Wave Sleep and Promote Sleep Continuity in Patients with Generalized Anxiety Disorder and Co-Morbid Generalized Social Phobia

This study demonstrates the clinical efficacy of Manasamitra Vataka and Shirodhara (Ayurvedic treatments) over clonazepam in preserving slow wave sleep and promoting sleep quality in patients of generalized anxiety disorder (GAD) with co-morbid generalized social phobia. Whole night polysomnography was carried out to assess the sleep architecture and spindle- delta dynamics. The study highlights the sleep promoting and preserving nature of Manasamitra Vataka and Shirodhara in GAD patients with co-morbid generalized social phobia. Ayurvedic treatments were helpful in improving the subjective quality of sleep and preserve sleep organization. Further studies are needed to confirm the potential of Ayurvedic interventions as a treatment of choice in the management of anxiety disorders.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a psychotherapeutic approach that addresses unhelpful cognitions and behaviours that result in distress. It has been shown to be effective in the management of anxiety disorders, depression, eating disorders, chronic pain syndromes and personality disorders. Although there is a clear need for CBT services, access to them remains limited. GPs cannot be expected to fill this gap, but specific CBT techniques can help in the management of common conditions. In this paper, we will discuss several CBT techniques that a clinician can apply in 10-minute consultations with a case study to espouse how the techniques can be implemented in clinical practice.

Cognitive Hypnotherapy for Accessing and Healing Emotional Injuries for Anxiety Disorders

Although anxiety disorders on the surface may appear simple, they often represent complex problems that are compounded by underlying factors. For these reasons, treatment of anxiety disorders should be individualized. This article describes cognitive hypnotherapy, an individual comprehensive treatment protocol that integrates cognitive, behavioral, mindfulness, psychodynamic, and hypnotic strategies in the management of anxiety disorders. The treatment approach is based on the self-wounds model of anxiety disorders, which provides the rationale for integrating diverse strategies in the psychotherapy for anxiety disorders. Due to its evidence-based and integrated nature, the psychotherapy described here provides accuracy, efficacy, and sophistication in the formulation and treatment of anxiety disorders. This model can be easily adapted to the understanding and treatment of other emotional disorders.

Psychiatric aspects of pediatric epilepsy: Focus on anxiety disorder

Psychiatric co-morbidities are commonly seen with pediatric epilepsy, which can be in the form of cognitive deficits like - inattention and intellectual disability, motor disturbances like - hyperactivity, emotional disturbances like - depression and anxiety disorders and behavioral problems like - impulsivity, aggression and even psychotic behavior. Anxiety disorders like - Obsessive compulsive disorder, posttraumatic stress disorder, social phobia, separation anxiety disorder, agoraphobia and panic attacks are commonly seen with pediatric epilepsy. Presence of co-morbid anxiety disorder in pediatric epilepsy is responsible for scholastic decline, peer maladjustment and poor quality of life. Management of anxiety disorders in children with epilepsy is always a challenge. Until, there is no general consensus regarding management of anxiety disorders in pediatric epilepsy. Despite its enormous impact on an individual's life, this area has not been addressed adequately through clinical research. This review focuses on psychiatric aspects of pediatric epilepsy with specific emphasis on anxiety disorders.