Pharmacological Treatment Of Anxiety Research Articles

A systematic review on pharmacological treatment of anxiety in older adults

A systematic review on pharmacological treatment of anxiety in older adults

Understanding and preventing nonadherence and treatment dropout in adolescents and young adults with anxiety and depressive disorders.

Dropout from psychological or pharmacological treatment for anxiety and depressive disorders is common. It is especially problematic in adolescents and young adults because of the adverse consequences for their development. Reasons for treatment dropout can be divided into therapy-process related factors, attitudinal aspects, and practical issues. Adjusting treatment to patient preferences and shared decision making, improving the therapeutic alliance, and interventions such as (family) psychoeducation, motivational interviewing, and help with practical issues are promising strategies to optimize engagement and adherence.

Buspirone for the Treatment of Generalized Anxiety Disorder in Down Syndrome: 3 Cases.

Reports on the pharmacologic treatment of anxiety, including generalized anxiety disorder (GAD), in individuals with Down syndrome (DS) are lacking. We present the case histories of 1 adolescent and 2 young adults with DS and the treatment course of comorbid GAD with buspirone. Treatment with buspirone was safe and well-tolerated and resulted in sustained improvement in symptoms of anxiety for a minimum of 2 years in all 3 cases. Buspirone's generally benign adverse effect profile makes it well suited for treating anxiety in individuals with DS in light of their common medical comorbidities.

An update on the pharmacological treatment of anxiety and related disorders

The anxiety disorders, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are common and debilitating, often coexist with medical and psychiatric conditions, and usually require long-term treatment. Effective anxiolytic drugs include the selective serotonin reuptake inhibitors (SSRIs) and the serotonin and noradrenaline reuptake inhibitors (SNRIs), which are the preferred agents in primary care. Patients who fail to respond adequately to these may benefit from second-line tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs). Alternative antidepressants include agomelatine and mirtazapine. Benzodiazepines, the anti-epileptic agent, pregabalin, and atypical antipsychotics are generally reserved for specialist use. The 5-HT1A agonist, buspirone, and the antihistamine, hydroxyzine, may also be useful, although the evidence for their efficacy covers a very narrow spectrum. This review describes the pharmacology of these anxiolytics and provides updated evidence for their use in the anxiety and related disorders.

Quality of life in patients with inflammatory bowel disease: importance of clinical, demographic and psychosocial factors.

Inflammatory bowel disease causes physical and psychosocial consequences that can affect the health related quality of life. To analyze the relationship between clinical and sociodemographic factors and quality of life in inflammatory bowel disease patients. Ninety two patients with Crohn's disease and 58 with ulcerative colitis, filled in the inflammatory bowel disease questionnaire (IBDQ-32) and a questionnaire to collect sociodemographic and clinical data. The association between categorical variables and IBDQ-32 scores was determined using Student t test. Factors statistically significant in the univariate analysis were included in a multivariate regression model. IBDQ-32 scores were significantly lower in female patients (P<0.001), patients with an individual perception of a lower co-workers support (P<0.001) and career fulfillment (P<0.001), patients requiring psychological support (P = 0.010) and pharmacological treatment for anxiety or depression (P = 0.002). A multivariate regression analysis identified as predictors of impaired HRQOL the female gender (P<0.001) and the perception of a lower co-workers support (P = 0.025) and career fulfillment (P = 0.001). The decrease in HRQQL was significantly related with female gender and personal perception of disease impact in success and social relations. These factors deserve a special attention, so timely measures can be implemented to improve the quality of life of patients.

Treatment of Anxiety Disorders and Comorbid Alcohol Abuse with Buspirone in a Patient with Antidepressant-Induced Platelet Dysfunction: A Case Report

The risk of abnormal bleeding with serotonin reuptake inhibitors has been known, but there is insufficient evidence base to guide pharmacological treatment of anxiety in patients with underlying haematological conditions. The following case report is about a 50-year-old female with generalized anxiety disorder, social phobia, obsessive compulsive disorder, and alcohol abuse where pharmacological treatment of anxiety symptoms has been difficult as it would lead to bruising due to the patient's underlying qualitative platelet dysfunction. Treatment with venlafaxine, citalopram, escitalopram, and clomipramine resulted in improvement and anxiety symptoms, as well as reduction in alcohol use, but pharmacological treatment has to be discontinued because of bruising and hematomas. In view of an active substance use disorder, benzodiazepines were avoided as a treatment option. The patient's anxiety symptoms and comorbid alcohol abuse responded well to pharmacological treatment with buspirone which gradually titrated up to a dose of 30 mg BID. Patient was followed for around a six-month period while she was on buspirone before being discharged to family doctor's care. Buspirone is unlikely to have a significant effect on platelet serotonin transponder and could be an effective alternative for pharmacological treatment of anxiety in patients with a bleeding diathesis.

Using the conditioned fear stress (CFS) animal model to understand the neurobiological mechanisms and pharmacological treatment of anxiety.

SummaryThe mechanisms underlying the etiology and pathophysiology of anxiety disorders — the most prevalent class of mental disorders — remain unclear. Over the last 30 years investigators have used the animal model of conditioned fear stress (CFS) to investigate the brain structures and neurotransmitter systems involved in aversive emotional learning and memory. Recent studies have focused on the neuronal circuitry and cellular mechanisms of fearful emotional experiences. This review describes the CFS paradigm, discusses the neural circuit and neurotransmission underlying CFS, and explains the mechanism of action of pharmacological treatments of CFS. The focus of the review is on the molecular mechanisms of fear extinction, a phenomenon directly implicated in the clinical treatment of anxiety. Based on our assessment of previous work we will conclude by considering potential molecular targets for treating symptoms of anxiety and fear.

An 11-Year-Old Boy with Tantrums and Head Banging

CME Educational Objectives 1. Distinguish presentations of anxiety from core autism spectrum disorder (ASD) symptoms. 2. Become familiar with developmental differences between anxiety and anxiety in ASD. 3. Know when either, or both, psychosocial and pharmacologic treatment of anxiety in ASD is appropriate. The patient is an 11-year-old white male with a history of Asperger’s disorder who presents with a history of anger and tantrums that occur about twice per week in reaction to frustrations and requests made of him. The tantrums consist of balling his fists, gesturing to hit, banging his head, grunting, screaming, and crying. He struggles with transitions from preferred activities and is upset if his expectations are not met. The parents report he also has tantrums over any mistakes he makes in his schoolwork.

O medicamento, a ansiedade e a depressão.

To ascertain the opinion about anxiety, depression and the medicines to treat them by gender, labour activity and age. validated questionnaire; patients attending a Central Portugal Health Centre; doctors and nurses that proposed the questionnaire to all attending patients. Cross sectional observational study, by anonymous and secret self-fulfilment, in a convenience sample drawn from a population composed by all those attending the Health Centre between the 22nd June and the 3rd July (both inclusive) 2009. Descriptive and inferential statistics were performed by means of a SPSS 11.0 statistical package. Age groups were defined as: < 36 years, 36-55 years, =56 years and professional activity groups as non-actives (students, retired and unemployed) and actives (housewives, and workers in primary, secondary and tertiary sectors). A n = 281 sample was studied age distribution of < 36 years = 47,7%, 36-55 years = 36,7% and = 56 years = 15,6%, mostly active (69,4% actives) and predominantly female (71,6% women). Age distribution is normal (Kolmogorov-Smirnov Z = 1,644 2 tailed p = 0,009). As results of agreement vs disagreement, showing the significant differences, 'In general medicines for anxiety and for depression are capable of making me feel well' (71,4% vs 15,2%, p = 0,035 by age group), 'In general medicines can relieve the unpleasant sensations caused by day by day stress of actual society' (67,7% vs 22,6%, ns), 'If necessary medicines can relieve my anxiety or depression problems' (52,0% vs 34,1%, p = 0,000 by gender) and 'Anxiety and depression problems are displays of body illnesses' (42,8% vs 33,2%, ns). There is a majority of disagreement for 'In general medicines can, by themselves cure depression or anxiety' (72,5% vs 20,7%, p = 0,013 by sex), 'In general medicines for anxiety or depression can help change the way one sees the problems' (49,4% vs 43,4%, p = 0,041 by age group, p = 0,004 by sex, p = 0,002 by group of professional activity), 'I can feel good just by taking medicines' (71,4% vs 19,8%, p =0,008 by sex, p = 0,006 by professional activity group) and 'Medicines can bring more joy to my life' (58,5% vs 23,9%, p = 0,008 by sex, p = 0,006 by professional activity group). Anxiety problems and depression problems are demonstrations of body diseases, 42,8% vs 33,2%, ns). The pharmacological treatment for anxiety or depression must be individualised by sex, gender, age and activity of patients. In general medicines are judged capable of curing anxiety and depression problems but in the particular own case their activity is considered. Anxiety problems and depression problems are considered as manifestations of the body's disease.

Psychotherapies for comorbid anxiety in bipolar spectrum disorders

Comorbid anxiety disorders are highly prevalent in bipolar disorder and have been shown to have serious negative impacts on the course of illness. The pharmacological treatment of anxiety can interact with the bipolar disorder and has not been proven effective. As such, many have recommended the psychological treatment of anxiety. This paper reviews the literature on psychological treatments for anxiety comorbid to bipolar disorder. The Medline, PsychInfo and Web of Science databases were thoroughly examined for relevant treatment studies. Despite frequent recommendations in the literature, surprisingly few have studied the psychological treatment of comorbid anxiety in bipolar disorders. Nevertheless, preliminary results suggest that comorbid anxiety disorders can be effectively treated in a bipolar clientele using cognitive-behavioral therapy, mindfulness-based cognitive-behavioral therapy or relaxation training. In contrast, interpersonal, family therapy and psychoeducation alone would not seem to be beneficial treatment alternatives for anxiety. Cognitive-behavioral therapy appears to reduce the symptoms of obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, post-traumatic stress disorder and general symptoms of anxiety among patients with bipolar disorder. However, the long-term maintenance of anxiety treatment effects may be somewhat reduced and adaptations may be called for to augment and sustain benefits. There is an urgent need for randomized controlled trials of different forms of psychotherapy for anxiety disorders comorbid to bipolar disorder. Until such trials are available, the most promising approach would appear to be the sequential or modular CBT-based treatment of the anxiety disorder.

Mood and Anxiety Disorders in Women

Back to table of contents Previous article Next article Book ReviewFull AccessMood and Anxiety Disorders in WomenKathleen P. Whitley M.D.Kathleen P. Whitley M.D.Search for more papers by this authorPublished Online:1 Sep 2007https://doi.org/10.1176/ps.2007.58.9.1234AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Physicians and medical researchers have long known that certain psychiatric disorders are diagnosed with greater frequency among women than among men. Major depression, dysthymia, seasonal affective disorder, panic disorder, social phobia, and generalized anxiety disorders are diagnosed for women at rates that range from 1.6 to six times those for men. An increasing amount of research has been published over the past 20 years focusing on gender differences in the etiology, symptom patterns, and effective treatment of these disorders.David Castle of the University of Melbourne, Jayashri Kulkarni of Monash University, and Kathryn Abel of the University of Manchester have brought together experts from Australia, the United Kingdom, Canada, and the United States to write a series of thorough yet concise reviews on the subject of mood and anxiety disorders among women. Each chapter of their valuable book focuses on one aspect of the general topic, from the initial emergence of the "gender gap" in mood disorders during adolescence to the clinical aspects of anxiety and depression during women's senior years.The writing is clear and succinct, and the discussions are broad based and well supported with references to recent research. Developmental, social, cultural, biological, and psychological factors are all considered. Some of the specific areas addressed include hormonal influences on depression during childbearing years and during menopause, domestic violence and its impact on mental health, posttraumatic stress disorder, and special issues for women with bipolar disease. The chapter on pharmacological treatment of anxiety and depression during pregnancy and lactation provides extremely helpful recommendations on a clinical management challenge that constantly confronts physicians. However, I find it difficult to praise one chapter over another because every one was filled with useful data for researchers, clinicians, educators, and health care administrators.Mood and Anxiety Disorders in Women is an excellent overview of selected mental disorders that disproportionately affect women. Clinicians in both inpatient and outpatient mental health practice will find it a valuable guide to understanding these disorders and to current treatment practices. Although written primarily from the perspective of psychiatry, clinicians working in family practice, adolescent medicine, gynecology, and public health will also find it useful in treating the women under their care. Training programs will also want to purchase this book as a reference for psychiatric residents and trainees who have few other texts that provide such a complete review of important diagnostic and treatment issues in women's mental health. Dr. Whitley is director of clinical and professional services, Worcester State Hospital, and assistant professor at University of Massachusetts Medical School, Worcester. FiguresReferencesCited byDetailsCited ByNone Volume 58Issue 9 September, 2007Pages 1234-1234PSYCHIATRIC SERVICES September 2007 Volume 58 Number 9 Metrics PDF download History Published online 1 September 2007 Published in print 1 September 2007

Anti-Anxiety Medications

ABSTRACT Social workers in mental health settings frequently participate in the treatment of clients with incapacitating anxiety. Medication is often included among the interventions for these clients. Social workers, who specialize in psychosocial interventions, also have key roles in the assessment and monitoring of medication effects. The purpose of this article is to provide social workers with an overview of the pharmacological treatment of anxiety so that they can carry out their range of interventions more effectively. Included is information about types of medication and their dosages, positive and adverse effects, interactions of medication with other interventions, and special concerns with children and adolescents.

New developments in the pharmacological treatment of anxiety

Partly as a consequence of the growing public concern regarding dependence and possible abuse of benzodiazepine anxiolytics over the past 10 years, a number of approaches to the development of novel, non-dependence-producing anxiolytics have occurred. Knowledge of the complexity of benzodiazepine receptors has resulted in the development of a number of partial agonists (for example, bretazenil) that show anxiolytic activity without causing excessive sedation or memory disturbance that characterizes some of the full agonist benzodiazepines such as diazepam. It is also apparent that a slight modification of the benzodiazepine structure can produce anxiolytics that have fewer adverse side-effects than the typical 1,4-benzodiazepines such as diazepam. For example, clobazam combines the anxiolytic and anticonvulsant properties of conventional benzodiazepines without causing sedation, and has a low dependence potential. Etizolam is another unique molecule that appears to combine the anxiolytic properties of conventional benzodiazepines with noradrenaline reuptake inhibition. The triazolobenzodiazepine alprazolam, like etizolam, also modulates noradrenergic and serotonergic function which could account for its efficacy not only as a potent anxiolytic but also as an anti-panic agent. Suriclone is an example of another structurally modified benzodiazepine that lacks the sedative properties of the conventional benzodiazepines, but appears to be an effective anxiolytic that lacks dependence-producing properties, while etazolate appears to owe its anxiolytic action to an ability to enhance chloride ion conductance at the GABA-benzodiazepine receptor complex. Non-benzodiazepine anxiolytics have also been developed that appear to act by modulating the serotonergic, histaminergic and non-aminergic systems. The anxiolytic effects of drugs acting as partial agonists at 5HT1A receptors, thereby reducing the functional activity of serotonin in limbic regions of the brain, may be characterized by buspirone, gepirone, ipsapirone and tandispirone. In addition, 5HT2A antagonists such as ketanserin and 5HT3 antagonists, exemplified by ondansetron, have also been shown to have anxiolytic properties, although their efficacy and cost appears to limit their clinical development. Recently attention has also been redirected towards drugs with a central antihistaminic action. For example, hydroxyzine has been shown to be a non-dependence producing anxiolytic with therapeutic efficacy in the treatment of GAD. Of the novel approaches that are currently under consideration, cholecystokinin antagonists, such as devazepride, have shown activity in the treatment of panic disorder, while the adenosine receptor agonist indosine has been shown to exert weak anxiolytic activity possibly by an indirect modulatory effect on the benzodiazepine receptor. Irrespective of the direct mechanisms of action of this diverse group of anxiolytics, it is apparent that all therapeutically effective agents ultimately enhance inhibitory neurotransmission in the brain. The main advantages of the non-benzodiazepines lies not in their efficacy, but their reduced ability to cause sedation, potentiate the effects of alcohol and cause dependence. Copyright © 1999 John Wiley & Sons, Ltd.

New developments in the pharmacological treatment of anxiety

New developments in the pharmacological treatment of anxiety

Pharmacological treatment of anxiety in the medically ill patient.

Treatment guidelines which are available are intended for treatment of medically healthy patients. There is little information in the literature regarding the treatment of patients who are medically ill. Anxiety and anxiety disorders are frequently encountered in patients with serious medical disorders. These medically ill patients may have substantial changes in pharmacokinetic factors as a result of their current illness or treatment. Also, treatment considerations related to their accompanying medical treatment(s) are sometimes required. These various factors may result in a different initial choice of agents, alterations in the dosage of a given agent, or even preclude the use of some standard agents. In this chapter, we first present a review of the current psychopharmacologic treatment of anxiety disorders. In the second section, we review the potential pharmacokinetic consequences of serious hepatic renal, pulmonary and cardiac disease relevant to the pharmacological treatment of anxiety.

The pharmacologic treatment of anxiety and depression in African Americans. Considerations for the general practitioner.

A growing pool of recent research points to the importance of ethnicity in psychopharmacologic management of depression and anxiety disorders, with sometimes profound implications for efficacy and safety. Such research has provided provocative findings that illustrate important interethnic pharmacogenetic, pharmacokinetic, and pharmacodynamic differences, especially for African Americans. We did a systematic literature review of psychopharmacologic treatment considerations among African Americans with anxiety and mood disturbance seen by primary care physicians, who provide most psychopharmacologic treatment. The findings commonly point to a greater percentage of "poor metabolizers" among African Americans compared with Euro-Americans. General treatment considerations include greater attention to adverse effects and better clinical response and poorer compliance for a given dose, potential need for lower starting doses and slower increases, use of plasma drug levels if available, determination of past responses to a similar drug, and integration of pharmacogenetic information into an overall socioculturally and ethnically sensitive approach to assessment and treatment.

Future Prospects for the Pharmacological Treatment of Anxiety

Recent advances have been made in understanding the neurobiology of fear and anxiety, and elucidating the nature of the neurotransmitters involved in these processes. These findings are, at last, improving the prospect of alternatives to the benzodiazepines in the treatment of anxiety disorders.

Efficacy of pharmacological treatment of anxiety in HIV-positive asymptomatic men

Efficacy of pharmacological treatment of anxiety in HIV-positive asymptomatic men

Possible reasons for the negative attitude to benzodiazepines as antianxiety drugs

The generally restrictive and negative attitude to the prescription and use of benzodiazepines, mediated by authorities, semi-public bodies and mass media, has no scientific justification. On the contrary, all data available indicate that the present prescription of benzodiazepines corresponds to a real need based on the etiology, prevalence and course of the anxiety disorders. These data are relatively new and not very well known, and this could be one possible explanation of the general negativism to the pharmacological treatment of anxiety. Another possible explanation is the belief that benzodiazepine therapy involves an increased risk of side effects, abuse and other hazards.