Chapter 35

1. Chapter 35 Management of Anxiety Disorders

2. Anxiety • An uncomfortable state with psychologic and physical components • Characterized by fear, apprehension, dread, and uneasiness • Among the most common psychiatric illnesses

3. Types of Anxiety Disorders • Generalized anxiety disorder • Panic disorder • Obsessive-compulsive disorder (OCD) • Social anxiety disorder (social phobia) • Post-traumatic stress disorder (PTSD)

4. Generalized Anxiety Disorder • Characteristics • Uncontrollable worrying that lasts 6 months or longer • Not situational anxiety • Treatment • Nondrug approaches • Supportive therapy • Cognitive behavioral therapy • Biofeedback • Relaxation training

5. Generalized Anxiety Disorder • Drug therapy • Benzodiazepines • Buspirone (BuSpar) • Non-CNS depressant • Does not cause sedation • Has no abuse potential • Does not intensify the effects of CNS depressants • Anxiolytic effects develop slowly • Pharmacokinetics • Well absorbed following oral administration

6. Generalized Anxiety Disorder • Buspirone (BuSpar) (cont’d) • Adverse effects • Dizziness • Nausea • Headache • Nervousness • Lightheadedness • Excitement

7. Generalized Anxiety Disorder • Buspirone (BuSpar) (cont’d) • Drug and food interactions • Erythromycin and ketoconazole • Grapefruit juice • Tolerance, dependence, and abuse • No withdrawal symptoms have been observed • Preparations, dosage, and administration

8. Generalized Anxiety Disorder • Antidepressants • Venlafaxine (Effexor XR) • Paroxetine (Paxil) • Short- and long-term • Escitalopram (Lexapro)

9. Panic Disorder • Characteristics • Palpitations, pounding heart, racing heartbeat • Chest pain or discomfort • Sensation of shortness of breath • Feeling of choking • Dizziness, lightheadedness • Nausea or abdominal discomfort • Derealization or depersonalization • Fear of losing control • Fear of dying • Tingling or numbness in the hands • Flushes or chills

10. Panic Disorder • Treatment • Cognitive behavioral therapy (CBT) • Drug therapy • Antidepressants • Selective serotonin reuptake inhibitors • Tricyclic antidepressants • Monoamine oxidase inhibitors • Benzodiazepines • First-line drugs for panic disorder

11. Obsessive-Compulsive Disorder • Characteristics • Potentially disabling condition • Persistent obsessions and compulsions • Treatment • Behavioral therapy • Drug therapy • Selective serotonin reuptake inhibitors (SSRIs)

12. Obsessive-Compulsive Disorder • SSRIs • First-line drugs for OCD • Citalopram • Escitalopram • Fluoxetine • Fluvoxamine • Paroxetine • Sertraline • Clomipramine (Anafranil) • Less tolerated • Second-line drug

13. Social Anxiety Disorder(Social Phobia) • Characteristics • Intense, irrational fear that one might be scrutinized by others • Generalized • Nongeneralized • Very debilitating • One of the most common psychiatric disorders • Treatment • Psychotherapy • Drug therapy

14. Post-Traumatic Stress Disorder • Characteristics • Develops following a traumatic event • Re-experiencing the event • Avoiding reminders of the event • Persistent state of hyperarousal • Treatment • Psychotherapy with drugs • Psychotherapy alone