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Chapter 35

Chapter 35. Management of Anxiety Disorders. Anxiety. An uncomfortable state with psychologic and physical components Characterized by fear, apprehension, dread, and uneasiness Among the most common psychiatric illnesses. Types of Anxiety Disorders. Generalized anxiety disorder

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Chapter 35

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  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

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